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 Health, 1.4miscellaneous provisions, health licensing fees, health care, and continuing 1.5care; redesigning service delivery; making changes to chemical and mental 1.6health; modifying fee schedules; modifying program eligibility requirements; 1.7authorizing rulemaking; imposing criminal penalties; requiring reports; 1.8appropriating money for the Departments of Health and Human Services and 1.9other health-related boards and councils; making forecast adjustments;amending 1.10Minnesota Statutes 2010, sections 3.98, by adding a subdivision; 62D.08, 1.11subdivision 7; 62E.08, subdivision 1; 62E.14, by adding a subdivision; 62J.04, 1.12subdivisions 3, 9; 62J.17, subdivision 4a; 62J.495, by adding a subdivision; 1.1362J.497, by adding a subdivision; 62J.692; 62Q.32; 62U.04, subdivisions 3, 9; 1.1462U.06, subdivision 2; 119B.011, subdivision 13; 119B.035, subdivisions 1, 1.154; 119B.09, subdivision 10, by adding subdivisions; 119B.13, subdivisions 1, 1.161a, 7; 144.05, by adding a subdivision; 144.1499; 144.1501, subdivisions 1, 1.174; 144.98, subdivisions 2a, 7, by adding subdivisions; 144A.071, by adding a 1.18subdivision; 144A.102; 144A.61, by adding a subdivision; 144E.123; 145.928, 1.19subdivision 2; 145.986, by adding subdivisions; 145A.17, subdivision 3; 148.07, 1.20subdivision 1; 148.108, by adding a subdivision; 148.191, subdivision 2; 1.21148.212, subdivision 1; 148.231; 148B.17; 148B.33, subdivision 2; 148B.52; 1.22150A.091, subdivisions 2, 3, 4, 5, 8, by adding a subdivision; 151.07; 151.101; 1.23151.102, by adding a subdivision; 151.12; 151.13, subdivision 1; 151.19; 151.25; 1.24151.47, subdivision 1; 151.48; 152.027, by adding a subdivision; 152.12, 1.25subdivision 3; 157.15, by adding a subdivision; 157.20, by adding a subdivision; 1.26169A.20, subdivisions 1, 1a, 1b, 1c; 245.50; 245A.14, subdivision 4; 246B.10; 1.27252.025, subdivision 7; 252.27, subdivision 2a; 253B.212; 254B.03, subdivisions 1.281, 4; 254B.04, subdivision 1, by adding a subdivision; 254B.06, subdivision 1.292; 256.01, subdivisions 2b, 14b, 24, 29, by adding subdivisions; 256.045, 1.30subdivision 4a; 256.9657, subdivision 1; 256.969, subdivision 2b, by adding a 1.31subdivision; 256B.04, subdivisions 14a, 18; 256B.05, by adding a subdivision; 1.32256B.055, subdivision 15; 256B.056, subdivisions 3, 4, by adding a subdivision; 1.33256B.057, subdivision 9; 256B.06, subdivision 4; 256B.0625, subdivisions 1.348e, 13e, 13h, 17, 17a, 18, 31a, 41, by adding subdivisions; 256B.0631, 1.35subdivisions 1, 2, 3; 256B.0644; 256B.0657; 256B.0659, subdivisions 11, 1.3628; 256B.0751, subdivisions 1, 2, 3, 4, by adding subdivisions; 256B.0753, 1.37by adding a subdivision; 256B.0754, by adding a subdivision; 256B.0755, 1.38subdivision 4, by adding subdivisions; 256B.0756; 256B.0911, subdivisions 1a, 1.393a, 4a, 6; 256B.0913, subdivision 4; 256B.0915, subdivisions 3a, 3b, 3e, 3h, 5, 2.110; 256B.0916, subdivision 6a; 256B.092, subdivisions 1a, 1b, 1e, 1g, 3, 8; 2.2256B.0945, subdivision 4; 256B.14, by adding a subdivision; 256B.19, by adding 2.3a subdivision; 256B.37, subdivision 5; 256B.431, subdivision 2r, by adding 2.4a subdivision; 256B.434, subdivision 4; 256B.437, subdivision 6; 256B.441, 2.5by adding a subdivision; 256B.48, subdivision 1; 256B.49, subdivisions 12, 2.613, 14, 15; 256B.5012, by adding subdivisions; 256B.69, subdivisions 3a, 4, 2.75a, 5c, 6, by adding subdivisions; 256B.692, subdivisions 2, 5, 7, by adding 2.8a subdivision; 256B.694; 256B.76, subdivision 4; 256D.03, subdivision 3; 2.9256D.031, subdivisions 6, 7, 10; 256D.05, subdivision 1; 256D.06, subdivisions 2.101, 1b, 2; 256D.09, subdivision 6; 256D.44, subdivision 5; 256D.46, subdivision 2.111; 256D.49, subdivision 3; 256G.02, subdivision 6; 256I.03, by adding a 2.12subdivision; 256I.04, subdivision 2b; 256I.05, subdivisions 1a, 1e, by adding a 2.13subdivision; 256J.20, subdivision 3; 256J.38, subdivision 1; 256J.49, subdivision 2.1413; 256J.53, subdivision 2; 256L.01, subdivision 4a; 256L.02, subdivision 3; 2.15256L.03, subdivisions 3, 5; 256L.04, subdivisions 1, 7; 256L.05, subdivisions 2.162, 3a, 5, by adding a subdivision; 256L.07, subdivision 1; 256L.09, subdivision 2.174; 256L.11, subdivision 7; 256L.12, subdivision 9; 256L.15, subdivision 1a; 2.18260C.157, subdivision 3; 260D.01; 297F.10, subdivision 1; 326B.175; 393.07, 2.19subdivisions 10, 10a; 402A.10, subdivisions 4, 5; 402A.15; 402A.18; 402A.20; 2.20518A.51; Laws 2008, chapter 363, article 18, section 3, subdivision 5; Laws 2.212009, chapter 79, article 8, sections 4, as amended; 51, as amended; article 13, 2.22section 3, subdivision 8, as amended; Laws 2010, First Special Session chapter 1, 2.23article 15, section 3, subdivision 6; article 25, section 3, subdivision 6; proposing 2.24coding for new law in Minnesota Statutes, chapters 1; 62E; 62J; 62Q; 62U; 137; 2.25144; 145; 148; 151; 256; 256B; 256L; 326B; 402A; repealing Minnesota Statutes 2.262010, sections 62J.07, subdivisions 1, 2, 3; 62J.17, subdivisions 1, 3, 5a, 6a, 8; 2.2762J.321, subdivision 5a; 62J.381; 62J.41, subdivisions 1, 2; 144.1464; 145A.14, 2.28subdivisions 1, 2; 256.979, subdivisions 5, 6, 7, 10; 256.9791; 256.9862, 2.29subdivision 2; 256B.055, subdivision 15; 256B.057, subdivision 2c; 256D.46, 2.30subdivisions 2, 3; 256L.07, subdivision 7; 402A.30; 402A.45; Laws 2008, 2.31chapter 358, article 3, sections 8; 9; Laws 2009, chapter 79, article 3, section 2.3218, as amended; article 5, sections 55, as amended; 56; 57; 60; 61; 62; 63; 64; 2.3365; 66; 68; 69; 79; Minnesota Rules, parts 3400.0130, subpart 8; 4651.0100, 2.34subparts 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 14, 15, 16, 16a, 18, 19, 20, 20a, 21, 2.3522, 23; 4651.0110, subparts 2, 2a, 3, 4, 5; 4651.0120; 4651.0130; 4651.0140; 2.364651.0150; 9500.1243, subpart 3; 9500.1261, subparts 3, items D, E, 4, 5.2.37BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:2.38ARTICLE 12.39CHILDREN AND FAMILY SERVICES2.40    Section 1. Minnesota Statutes 2010, section 119B.011, subdivision 13, is amended to 2.41read:2.42    Subd. 13. Family. "Family" means parents, stepparents, guardians and their spouses, 2.43or other eligible relative caregivers and their spouses, and their blood related dependent 2.44children and adoptive siblings under the age of 18 years living in the same home including 2.45children temporarily absent from the household in settings such as schools, foster care, and 2.46residential treatment facilities or parents, stepparents, guardians and their spouses, or other 2.47relative caregivers and their spouses temporarily absent from the household in settings 2.48such as schools, military service, or rehabilitation programs. An adult family member who 3.1is not in an authorized activity under this chapter may be temporarily absent for up to 60 3.2days. When a minor parent or parents and his, her, or their child or children are living with 3.3other relatives, and the minor parent or parents apply for a child care subsidy, "family" 3.4means only the minor parent or parents and their child or children. An adult age 18 or 3.5older who meets this definition of family and is a full-time high school or postsecondary 3.6student may be considered a dependent member of the family unit if 50 percent or more of 3.7the adult's support is provided by the parents, stepparents, guardians, and their spouses or 3.8eligible relative caregivers and their spouses residing in the same household.3.9EFFECTIVE DATE.This section is effective April 16, 2012.3.10    Sec. 2. Minnesota Statutes 2010, section 119B.035, subdivision 1, is amended to read:3.11    Subdivision 1. Establishment. A family in which a parent provides care for the 3.12family's infant child may receive a subsidy in lieu of assistance if the family is eligible for 3.13or is receiving assistance under the basic sliding fee program. An eligible family must 3.14meet the eligibility factors under section 
         119B.09, except as provided in subdivision 4, 3.15and the requirements of this section. Subject to federal match and maintenance of effort 3.16requirements for the child care and development fund, and up to available appropriations, 3.17the commissioner shall provide assistance under the at-home infant child care program and 3.18for administrative costs associated with the program. The commissioner shall set aside 3.19two percent of the basic sliding fee child care appropriation under section 119B.03, for 3.20purposes of this section. At the end of a fiscal year, the commissioner may carry forward 3.21any unspent funds under this section to the next fiscal year within the same biennium for 3.22assistance under the basic sliding fee program.3.23    Sec. 3. Minnesota Statutes 2010, section 119B.035, subdivision 4, is amended to read:3.24    Subd. 4. Assistance. (a) A family is limited to a lifetime total of 12 months of 3.25assistance under subdivision 2. The maximum rate of assistance is equal to 90 64 percent 3.26of the rate established under section 
         119B.13 for care of infants in licensed family child 3.27care in the applicant's county of residence.3.28(b) A participating family must report income and other family changes as specified 3.29in the county's plan under section 
         119B.08, subdivision 3.3.30(c) Persons who are admitted to the at-home infant child care program retain their 3.31position in any basic sliding fee program. Persons leaving the at-home infant child care 3.32program reenter the basic sliding fee program at the position they would have occupied.3.33(d) Assistance under this section does not establish an employer-employee 3.34relationship 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. The card must include the 8.18following statement: "It is unlawful to use this card to purchase tobacco products or 8.19alcoholic beverages." This card must be issued within 30 calendar days of an eligibility 8.20determination. During the initial 30 calendar days of eligibility, a recipient may have 8.21cash benefits issued on an EBT card without a name printed on the card. This card may 8.22be the same card on which food support benefits are issued and does not need to meet 8.23the requirements of this section.8.24    Subd. 2.EBT card use restricted to Minnesota vendors.EBT cardholders 8.25receiving cash benefits under the general assistance and Minnesota supplemental aid 8.26programs under chapter 256D or programs under chapter 256J are prohibited from using 8.27their EBT cards at vendors located outside of Minnesota. This subdivision does not apply 8.28to food support benefits.8.29    Subd. 3.Prohibited purchases.EBT debit cardholders in programs listed under 8.30subdivision 1 are prohibited from using the EBT debit card to purchase tobacco products 8.31and alcoholic beverages, as defined in section 340A.101, subdivision 2. It is unlawful for 8.32an EBT cardholder to purchase or attempt to purchase tobacco products or alcoholic 8.33beverages with the cardholder's EBT card. Violation of this subdivision is a petty 8.34misdemeanor.9.1    Sec. 11. Minnesota Statutes 2010, section 256D.05, subdivision 1, is amended to read:9.2    Subdivision 1. Eligibility. (a) Each assistance unit with income and resources 9.3less than the standard of assistance established by the commissioner and with a member 9.4who is a resident of the state shall be eligible for and entitled to general assistance if 9.5the assistance unit is:9.6(1) a person who is suffering from a professionally certified permanent or temporary 9.7illness, injury, or incapacity which is expected to continue for more than 30 90 days and 9.8which prevents the person from obtaining or retaining employment;9.9(2) a person whose presence in the home on a substantially continuous basis is 9.10required because of the professionally certified illness, injury, incapacity, or the age of 9.11another member of the household;9.12(3) (2) a person who has been placed in, and is residing in, a licensed or certified 9.13facility for purposes of physical or mental health or rehabilitation, or in an approved 9.14chemical dependency domiciliary facility, if the placement is based on illness or incapacity 9.15and is according to a plan developed or approved by the county agency through its 9.16director or designated representative;9.17(4) (3) a person who resides in a shelter facility described in subdivision 3;9.18(5) (4) a person not described in clause (1) or (3) (2) who is diagnosed by a licensed 9.19physician, psychological practitioner, or other qualified professional, as developmentally 9.20disabled or mentally ill, and that condition prevents the person from obtaining or retaining 9.21employment;9.22(6) a person who has an application pending for, or is appealing termination of 9.23benefits from, the Social Security disability program or the program of supplemental 9.24security income for the aged, blind, and disabled, provided the person has a professionally 9.25certified permanent or temporary illness, injury, or incapacity which is expected to 9.26continue for more than 30 days and which prevents the person from obtaining or retaining 9.27employment;9.28(7) a person who is unable to obtain or retain employment because advanced age 9.29significantly affects the person's ability to seek or engage in substantial work;9.30(8) (5) a person who has been assessed by a vocational specialist and, in consultation 9.31with the county agency, has been determined to be unemployable for purposes of this 9.32clause; a person is considered employable if there exist positions of employment in the 9.33local labor market, regardless of the current availability of openings for those positions, 9.34that the person is capable of performing. The person's eligibility under this category must 9.35be reassessed at least annually. The county agency must provide notice to the person not 9.36later than 30 days before annual eligibility under this item ends, informing the person of the 10.1date annual eligibility will end and the need for vocational assessment if the person wishes 10.2to continue eligibility under this clause. For purposes of establishing eligibility under this 10.3clause, it is the applicant's or recipient's duty to obtain any needed vocational assessment;10.4(9) (6) a person who is determined by the county agency, according to permanent 10.5rules adopted by the commissioner, to be learning disabled have a condition that qualifies 10.6under Minnesota's special education rules as a specific learning disability, provided that if10.7a rehabilitation plan for the person is developed or approved by the county agency, and10.8the person is following the plan;10.9(10) a child under the age of 18 who is not living with a parent, stepparent, or legal 10.10custodian, and only if: the child is legally emancipated or living with an adult with the 10.11consent of an agency acting as a legal custodian; the child is at least 16 years of age 10.12and the general assistance grant is approved by the director of the county agency or a 10.13designated representative as a component of a social services case plan for the child; or the 10.14child is living with an adult with the consent of the child's legal custodian and the county 10.15agency. For purposes of this clause, "legally emancipated" means a person under the age 10.16of 18 years who: (i) has been married; (ii) is on active duty in the uniformed services of 10.17the United States; (iii) has been emancipated by a court of competent jurisdiction; or (iv) 10.18is otherwise considered emancipated under Minnesota law, and for whom county social 10.19services has not determined that a social services case plan is necessary, for reasons other 10.20than the child has failed or refuses to cooperate with the county agency in developing 10.21the plan;10.22(11) (7) a person who is eligible for displaced homemaker services, programs, or 10.23assistance under section 
         116L.96, but only if that person is enrolled as a full-time student;10.24(12) a person who lives more than four hours round-trip traveling time from any 10.25potential suitable employment;10.26(13) (8) a person who is involved with protective or court-ordered services that 10.27prevent the applicant or recipient from working at least four hours per day; or10.28(14) a person over age 18 whose primary language is not English and who is 10.29attending high school at least half time; or10.30(15) (9) a person whose alcohol and drug addiction is a material factor that 10.31contributes to the person's disability; applicants who assert this clause as a basis for 10.32eligibility must be assessed by the county agency to determine if they are amenable 10.33to treatment; if the applicant is determined to be not amenable to treatment, but is 10.34otherwise eligible for benefits, then general assistance must be paid in vendor form, for 10.35the individual's shelter costs up to the limit of the grant amount, with the residual, if 10.36any, paid according to section 
         256D.09, subdivision 2a; if the applicant is determined 11.1to be amenable to treatment, then in order to receive benefits, the applicant must be in 11.2a treatment program or on a waiting list and the benefits must be paid in vendor form, 11.3for the individual's shelter costs, up to the limit of the grant amount, with the residual, if 11.4any, paid according to section 
         256D.09, subdivision 2a.11.5(b) As a condition of eligibility under paragraph (a), clauses (1), (3) (2), (5) (4), 11.6(8) (5), and (9) (6), the recipient must complete an interim assistance agreement and 11.7must apply for other maintenance benefits as specified in section 
         256D.06, subdivision 11.85
         , and must comply with efforts to determine the recipient's eligibility for those other 11.9maintenance benefits.11.10(c) As a condition of eligibility under this section, the recipient must complete 11.11at least 20 hours per month of volunteer or paid work. The county of residence shall 11.12determine what may be included as volunteer work. Recipients must provide monthly 11.13proof of volunteer work on the forms established by the county. A person who is unable 11.14to obtain or retain 20 hours per month of volunteer or paid work due to a professionally 11.15certified illness, injury, disability, or incapacity must not be made ineligible for general 11.16assistance under this section.11.17(c) (d) The burden of providing documentation for a county agency to use to verify 11.18eligibility for general assistance or for exemption from the food stamp employment 11.19and training program is upon the applicant or recipient. The county agency shall use 11.20documents already in its possession to verify eligibility, and shall help the applicant or 11.21recipient obtain other existing verification necessary to determine eligibility which the 11.22applicant or recipient does not have and is unable to obtain.11.23    Sec. 12. Minnesota Statutes 2010, section 256D.06, subdivision 1, is amended to read:11.24    Subdivision 1. Eligibility; amount of assistance. General assistance shall be 11.25granted in an amount that when added to the nonexempt income actually available to the 11.26assistance unit, the total amount equals the applicable standard of assistance for general 11.27assistance. In determining eligibility for and the amount of assistance for an individual or 11.28married couple, the county agency shall disregard the first $50 $150 of earned income 11.29per month.11.30    Sec. 13. Minnesota Statutes 2010, section 256D.06, subdivision 1b, is amended to read:11.31    Subd. 1b. Earned income savings account. In addition to the $50 $150 disregard 11.32required under subdivision 1, the county agency shall disregard an additional earned 11.33income up to a maximum of $150 $500 per month for: (1) persons residing in facilities 11.34licensed under Minnesota Rules, parts 9520.0500 to 9520.0690 and 9530.2500 to 12.19530.4000, and for whom discharge and work are part of a treatment plan; and (2) 12.2persons living in supervised apartments with services funded under Minnesota Rules, 12.3parts 9535.0100 to 9535.1600, and for whom discharge and work are part of a treatment 12.4plan; and (3) persons residing in group residential housing, as that term is defined in 12.5section 
         256I.03, subdivision 3, for whom the county agency has approved a discharge plan 12.6which includes work. The additional amount disregarded must be placed in a separate 12.7savings account by the eligible individual, to be used upon discharge from the residential 12.8facility into the community. For individuals residing in a chemical dependency program 12.9licensed under Minnesota Rules, part 9530.4100, subpart 22, item D, withdrawals from 12.10the savings account require the signature of the individual and for those individuals with 12.11an authorized representative payee, the signature of the payee. A maximum of $1,00012.12$2,000, including interest, of the money in the savings account must be excluded from 12.13the resource limits established by section 
         256D.08, subdivision 1, clause (1). Amounts in 12.14that account in excess of $1,000 $2,000 must be applied to the resident's cost of care. If 12.15excluded money is removed from the savings account by the eligible individual at any 12.16time before the individual is discharged from the facility into the community, the money is 12.17income to the individual in the month of receipt and a resource in subsequent months. If 12.18an eligible individual moves from a community facility to an inpatient hospital setting, 12.19the separate savings account is an excluded asset for up to 18 months. During that time, 12.20amounts that accumulate in excess of the $1,000 $2,000 savings limit must be applied to 12.21the patient's cost of care. If the patient continues to be hospitalized at the conclusion of the 12.2218-month period, the entire account must be applied to the patient's cost of care.12.23    Sec. 14. Minnesota Statutes 2010, section 256D.06, subdivision 2, is amended to read:12.24    Subd. 2. Emergency need.(a) Notwithstanding the provisions of subdivision 1, a 12.25grant of emergency general assistance shall, to the extent funds are available, be made to 12.26an eligible single adult, married couple, or family for an emergency need, as defined in 12.27rules promulgated by the commissioner, where the recipient requests temporary assistance 12.28not exceeding 30 days if an emergency situation appears to exist and the individual or 12.29family is ineligible for MFIP or DWP or is not a participant of MFIP or DWP under 12.30written criteria adopted by the county agency. If an applicant or recipient relates facts 12.31to the county agency which may be sufficient to constitute an emergency situation, the 12.32county agency shall, to the extent funds are available, advise the person of the procedure 12.33for applying for assistance according to this subdivision. 12.34    (b) The applicant must be ineligible for assistance under chapter 256J, must have 12.35annual net income no greater than 200 percent of the federal poverty guidelines for the 13.1previous calendar year, and may receive an emergency general assistance grant is available 13.2to a recipient not more than once in any 12-month period. 13.3    (c) Funding for an emergency general assistance program is limited to the 13.4appropriation. Each fiscal year, the commissioner shall allocate to counties the money 13.5appropriated for emergency general assistance grants based on each county agency's 13.6average share of state's emergency general expenditures for the immediate past three fiscal 13.7years as determined by the commissioner, and may reallocate any unspent amounts to 13.8other counties. No county shall be allocated less than $1,000 for a fiscal year.13.9    (d) Any emergency general assistance expenditures by a county above the amount of 13.10the commissioner's allocation to the county must be made from county funds.13.11    Sec. 15. Minnesota Statutes 2010, section 256D.44, subdivision 5, is amended to read:13.12    Subd. 5. Special needs. In addition to the state standards of assistance established in 13.13subdivisions 1 to 4, payments are allowed for the following special needs of recipients of 13.14Minnesota supplemental aid who are not residents of a nursing home, a regional treatment 13.15center, or a group residential housing facility.13.16    (a) The county agency shall pay a monthly allowance for medically prescribed 13.17diets if the cost of those additional dietary needs cannot be met through some other 13.18maintenance benefit. The need for special diets or dietary items must be prescribed by 13.19a licensed physician. Costs for special diets shall be determined as percentages of the 13.20allotment for a one-person household under the thrifty food plan as defined by the United 13.21States Department of Agriculture. The types of diets and the percentages of the thrifty 13.22food plan that are covered are as follows:13.23    (1) high protein diet, at least 80 grams daily, 25 percent of thrifty food plan;13.24    (2) controlled protein diet, 40 to 60 grams and requires special products, 100 percent 13.25of thrifty food plan;13.26    (3) controlled protein diet, less than 40 grams and requires special products, 125 13.27percent of thrifty food plan;13.28    (4) low cholesterol diet, 25 percent of thrifty food plan;13.29    (5) high residue diet, 20 percent of thrifty food plan;13.30    (6) pregnancy and lactation diet, 35 percent of thrifty food plan;13.31    (7) gluten-free diet, 25 percent of thrifty food plan;13.32    (8) lactose-free diet, 25 percent of thrifty food plan;13.33    (9) antidumping diet, 15 percent of thrifty food plan;13.34    (10) hypoglycemic diet, 15 percent of thrifty food plan; or13.35    (11) ketogenic diet, 25 percent of thrifty food plan.14.1    (b) Payment for nonrecurring special needs must be allowed for necessary home 14.2repairs or necessary repairs or replacement of household furniture and appliances using 14.3the payment standard of the AFDC program in effect on July 16, 1996, for these expenses, 14.4as long as other funding sources are not available.14.5    (c) A fee for guardian or conservator service is allowed at a reasonable rate 14.6negotiated by the county or approved by the court. This rate shall not exceed five percent 14.7of the assistance unit's gross monthly income up to a maximum of $100 per month. If the 14.8guardian or conservator is a member of the county agency staff, no fee is allowed.14.9    (d) The county agency shall continue to pay a monthly allowance of $68 for 14.10restaurant meals for a person who was receiving a restaurant meal allowance on June 1, 14.111990, and who eats two or more meals in a restaurant daily. The allowance must continue 14.12until the person has not received Minnesota supplemental aid for one full calendar month 14.13or until the person's living arrangement changes and the person no longer meets the criteria 14.14for the restaurant meal allowance, whichever occurs first.14.15    (e) A fee of ten percent of the recipient's gross income or $25, whichever is less, 14.16is allowed for representative payee services provided by an agency that meets the 14.17requirements under SSI regulations to charge a fee for representative payee services. This 14.18special need is available to all recipients of Minnesota supplemental aid regardless of 14.19their living arrangement.14.20    (f)(1) Notwithstanding the language in this subdivision, an amount equal to the 14.21maximum allotment authorized by the federal Food Stamp Program for a single individual 14.22which is in effect on the first day of July of each year will be added to the standards of 14.23assistance established in subdivisions 1 to 4 for adults under the age of 65 who qualify 14.24as shelter needy and are: (i) relocating from an institution, or an adult mental health 14.25residential treatment program under section 
         256B.0622; (ii) eligible for the self-directed 14.26supports option as defined under section 
         256B.0657, subdivision 2; or (iii) home and 14.27community-based waiver recipients living in their own home or rented or leased apartment 14.28which is not owned, operated, or controlled by a provider of service not related by blood 14.29or marriage, unless allowed under paragraph (g).14.30    (2) Notwithstanding subdivision 3, paragraph (c), an individual eligible for the 14.31shelter needy benefit under this paragraph is considered a household of one. An eligible 14.32individual who receives this benefit prior to age 65 may continue to receive the benefit 14.33after the age of 65.14.34    (3) "Shelter needy" means that the assistance unit incurs monthly shelter costs that 14.35exceed 40 percent of the assistance unit's gross income before the application of this 14.36special needs standard. "Gross income" for the purposes of this section is the applicant's or 15.1recipient's income as defined in section 
         256D.35, subdivision 10, or the standard specified 15.2in subdivision 3, paragraph (a) or (b), whichever is greater. A recipient of a federal or 15.3state housing subsidy, that limits shelter costs to a percentage of gross income, shall not be 15.4considered shelter needy for purposes of this paragraph.15.5(g) Notwithstanding this subdivision, to access housing and services as provided 15.6in paragraph (f), the recipient may choose housing that may be owned, operated, or 15.7controlled by the recipient's service provider. In a multifamily building of more than four 15.8or more units, the maximum number of apartments at one address that may be used by 15.9recipients of this program shall be 50 percent of the units in a building. This paragraph 15.10expires on June 30, 2012 2014.15.11    Sec. 16. Minnesota Statutes 2010, section 256D.46, subdivision 1, is amended to read:15.12    Subdivision 1. Eligibility.A county agency must grant emergency Minnesota 15.13supplemental aid, to the extent funds are available, if the recipient is without adequate 15.14resources to resolve an emergency that, if unresolved, will threaten the health or safety of 15.15the recipient. For the purposes of this section, the term "recipient" includes persons for 15.16whom a group residential housing benefit is being paid under sections 256I.01 to 256I.06.15.17Applicants for or recipients of SSI or Minnesota supplemental aid who have emergency 15.18need may apply for emergency general assistance under section 256D.06, subdivision 2.15.19    Sec. 17. Minnesota Statutes 2010, section 256I.03, is amended by adding a subdivision 15.20to read:15.21    Subd. 8.Supplementary services."Supplementary services" means services 15.22provided to residents of group residential housing providers in addition to room and 15.23board including, but not limited to, oversight and up to 24-hour supervision, medication 15.24reminders, assistance with transportation, arranging for meetings and appointments, and 15.25arranging for medical and social services.15.26    Sec. 18. Minnesota Statutes 2010, section 256I.04, subdivision 2b, is amended to read:15.27    Subd. 2b. Group residential housing agreements.(a) Agreements between county 15.28agencies and providers of group residential housing must be in writing and must specify 15.29the name and address under which the establishment subject to the agreement does 15.30business and under which the establishment, or service provider, if different from the 15.31group residential housing establishment, is licensed by the Department of Health or the 15.32Department of Human Services; the specific license or registration from the Department 15.33of Health or the Department of Human Services held by the provider and the number 16.1of beds subject to that license; the address of the location or locations at which group 16.2residential housing is provided under this agreement; the per diem and monthly rates that 16.3are to be paid from group residential housing funds for each eligible resident at each 16.4location; the number of beds at each location which are subject to the group residential 16.5housing agreement; whether the license holder is a not-for-profit corporation under section 16.6501(c)(3) of the Internal Revenue Code; and a statement that the agreement is subject to 16.7the provisions of sections 
         256I.01 to 
         256I.06 and subject to any changes to those sections. 16.8Group residential housing agreements may be terminated with or without cause by either 16.9the county or the provider with two calendar months prior notice.16.10(b) Beginning July 1, 2011, counties must not enter into agreements with providers 16.11of group residential housing that are licensed as board and lodging with special services 16.12and that do not include a residency requirement of at least 20 hours per month of volunteer 16.13or paid work. A person who is unable to obtain or retain 20 hours per month of volunteer 16.14or paid work due to a professionally certified illness, injury, disability, or incapacity must 16.15not be made ineligible for group residential housing under this section.16.16    Sec. 19. Minnesota Statutes 2010, section 256I.05, subdivision 1a, is amended to read:16.17    Subd. 1a. Supplementary service rates. (a) Subject to the provisions of section 16.18256I.04, subdivision 3
         , the county agency may negotiate a payment not to exceed $426.37 16.19for other services necessary to provide room and board provided by the group residence 16.20if the residence is licensed by or registered by the Department of Health, or licensed by 16.21the Department of Human Services to provide services in addition to room and board, 16.22and if the provider of services is not also concurrently receiving funding for services for 16.23a recipient under a home and community-based waiver under title XIX of the Social 16.24Security Act; or funding from the medical assistance program under section 
         256B.0659, 16.25for personal care services for residents in the setting; or residing in a setting which 16.26receives funding under Minnesota Rules, parts 9535.2000 to 9535.3000. If funding is 16.27available for other necessary services through a home and community-based waiver, or 16.28personal care services under section 
         256B.0659, then the GRH rate is limited to the rate 16.29set in subdivision 1. Unless otherwise provided in law, in no case may the supplementary 16.30service rate exceed $426.37. The registration and licensure requirement does not apply to 16.31establishments which are exempt from state licensure because they are located on Indian 16.32reservations and for which the tribe has prescribed health and safety requirements. Service 16.33payments under this section may be prohibited under rules to prevent the supplanting of 16.34federal funds with state funds. The commissioner shall pursue the feasibility of obtaining 16.35the approval of the Secretary of Health and Human Services to provide home and 17.1community-based waiver services under title XIX of the Social Security Act for residents 17.2who are not eligible for an existing home and community-based waiver due to a primary 17.3diagnosis of mental illness or chemical dependency and shall apply for a waiver if it is 17.4determined to be cost-effective.17.5(b) The commissioner is authorized to make cost-neutral transfers from the GRH 17.6fund for beds under this section to other funding programs administered by the department 17.7after consultation with the county or counties in which the affected beds are located. 17.8The commissioner may also make cost-neutral transfers from the GRH fund to county 17.9human service agencies for beds permanently removed from the GRH census under a plan 17.10submitted by the county agency and approved by the commissioner. The commissioner 17.11shall report the amount of any transfers under this provision annually to the legislature.17.12(c) The provisions of paragraph (b) do not apply to a facility that has its 17.13reimbursement rate established under section 
         256B.431, subdivision 4, paragraph (c).17.14    (d) Beginning July 1, 2011, counties must not negotiate supplementary service rates 17.15with providers of group residential housing that are licensed as board and lodging with 17.16special services and that do not enforce a policy of sobriety on their premises.17.17    Sec. 20. Minnesota Statutes 2010, section 256I.05, subdivision 1e, is amended to read:17.18    Subd. 1e. Supplementary rate for certain facilities.(a) Notwithstanding the 17.19provisions of subdivisions 1a and 1c, beginning July 1, 2005, a county agency shall 17.20negotiate a supplementary rate in addition to the rate specified in subdivision 1, not to 17.21exceed $700 per month, including any legislatively authorized inflationary adjustments, 17.22for a group residential housing provider that:17.23(1) is located in Hennepin County and has had a group residential housing contract 17.24with the county since June 1996;17.25(2) operates in three separate locations a 75-bed facility, a 50-bed facility, and a 17.2626-bed facility; and17.27(3) serves a chemically dependent clientele, providing 24 hours per day supervision 17.28and limiting a resident's maximum length of stay to 13 months out of a consecutive 17.2924-month period.17.30(b) Notwithstanding the provisions of subdivisions 1a and 1c, beginning July 1, 17.312011, a county agency shall negotiate a supplementary rate in addition to the rate specified 17.32in subdivision 1, not to exceed $700 per month, including any legislatively authorized 17.33inflationary adjustments, for the group residential provider described under paragraph 17.34(a), not to exceed an additional 175 beds.18.1    Sec. 21. Minnesota Statutes 2010, section 256I.05, is amended by adding a subdivision 18.2to read:18.3    Subd. 1o.Supplemental rate adjustment.Notwithstanding any other provision to 18.4the contrary, board and lodging with services providers that receive a supplemental service 18.5rate in excess of the supplemental service rate established under subdivision 1, shall be 18.6reduced no more than $10.42 per bed per month.18.7    Sec. 22. Minnesota Statutes 2010, section 256J.20, subdivision 3, is amended to read:18.8    Subd. 3. Other property limitations. To be eligible for MFIP, the equity value of 18.9all nonexcluded real and personal property of the assistance unit must not exceed $2,000 18.10for applicants and $5,000 for ongoing participants. The value of assets in clauses (1) to 18.11(19) must be excluded when determining the equity value of real and personal property:18.12    (1) a licensed vehicle up to a loan value of less than or equal to $15,000 $10,000. If 18.13the assistance unit owns more than one licensed vehicle, the county agency shall determine 18.14the loan value of all additional vehicles and exclude the combined loan value of less than 18.15or equal to $7,500. The county agency shall apply any excess loan value as if it were 18.16equity value to the asset limit described in this section, excluding: (i) the value of one 18.17vehicle per physically disabled person when the vehicle is needed to transport the disabled 18.18unit member; this exclusion does not apply to mentally disabled people; (ii) the value of 18.19special equipment for a disabled member of the assistance unit; and (iii) any vehicle used 18.20for long-distance travel, other than daily commuting, for the employment of a unit member.18.21    To establish the loan value of vehicles, a county agency must use the N.A.D.A. 18.22Official Used Car Guide, Midwest Edition, for newer model cars. When a vehicle is not 18.23listed in the guidebook, or when the applicant or participant disputes the loan value listed 18.24in the guidebook as unreasonable given the condition of the particular vehicle, the county 18.25agency may require the applicant or participant document the loan value by securing a 18.26written statement from a motor vehicle dealer licensed under section 
         168.27, stating 18.27the amount that the dealer would pay to purchase the vehicle. The county agency shall 18.28reimburse the applicant or participant for the cost of a written statement that documents 18.29a lower loan value;18.30    (2) the value of life insurance policies for members of the assistance unit;18.31    (3) one burial plot per member of an assistance unit;18.32    (4) the value of personal property needed to produce earned income, including 18.33tools, implements, farm animals, inventory, business loans, business checking and 18.34savings accounts used at least annually and used exclusively for the operation of a 19.1self-employment business, and any motor vehicles if at least 50 percent of the vehicle's use 19.2is to produce income and if the vehicles are essential for the self-employment business;19.3    (5) the value of personal property not otherwise specified which is commonly 19.4used by household members in day-to-day living such as clothing, necessary household 19.5furniture, equipment, and other basic maintenance items essential for daily living;19.6    (6) the value of real and personal property owned by a recipient of Supplemental 19.7Security Income or Minnesota supplemental aid;19.8    (7) the value of corrective payments, but only for the month in which the payment 19.9is received and for the following month;19.10    (8) a mobile home or other vehicle used by an applicant or participant as the 19.11applicant's or participant's home;19.12    (9) money in a separate escrow account that is needed to pay real estate taxes or 19.13insurance and that is used for this purpose;19.14    (10) money held in escrow to cover employee FICA, employee tax withholding, 19.15sales tax withholding, employee worker compensation, business insurance, property rental, 19.16property taxes, and other costs that are paid at least annually, but less often than monthly;19.17    (11) monthly assistance payments for the current month's or short-term emergency 19.18needs under section 
         256J.626, subdivision 2;19.19    (12) the value of school loans, grants, or scholarships for the period they are 19.20intended to cover;19.21    (13) payments listed in section 
         256J.21, subdivision 2, clause (9), which are held 19.22in escrow for a period not to exceed three months to replace or repair personal or real 19.23property;19.24    (14) income received in a budget month through the end of the payment month;19.25    (15) savings from earned income of a minor child or a minor parent that are set aside 19.26in a separate account designated specifically for future education or employment costs;19.27    (16) the federal earned income credit, Minnesota working family credit, state and 19.28federal income tax refunds, state homeowners and renters credits under chapter 290A, 19.29property tax rebates and other federal or state tax rebates in the month received and the 19.30following month;19.31    (17) payments excluded under federal law as long as those payments are held in a 19.32separate account from any nonexcluded funds;19.33    (18) the assets of children ineligible to receive MFIP benefits because foster care or 19.34adoption assistance payments are made on their behalf; and19.35    (19) the assets of persons whose income is excluded under section 
         256J.21, 19.36subdivision 2
         , clause (43).20.1    Sec. 23. Minnesota Statutes 2010, section 256J.49, subdivision 13, is amended to read:20.2    Subd. 13.  Work activity.(a) "Work activity" means any activity in a participant's 20.3approved employment plan that leads to employment. For purposes of the MFIP program, 20.4this includes activities that meet the definition of work activity under the participation 20.5requirements of TANF. Work activity includes: 20.6    (1) unsubsidized employment, including work study and paid apprenticeships or 20.7internships; 20.8    (2) subsidized private sector or public sector employment, including grant diversion 20.9as specified in section 
         256J.69, on-the-job training as specified in section 
         256J.66, paid 20.10work experience, and supported work when a wage subsidy is provided; 20.11    (3) unpaid work experience, including community service, volunteer work, 20.12the community work experience program as specified in section 
         256J.67, unpaid 20.13apprenticeships or internships, and supported work when a wage subsidy is not provided. 20.14Unpaid work experience is only an option if the participant has been unable to obtain or 20.15maintain paid employment in the competitive labor market, and no paid work experience 20.16programs are available to the participant. Prior to placing a participant in unpaid work, 20.17the county must inform the participant that the participant will be notified if a paid work 20.18experience or supported work position becomes available. Unless a participant consents in 20.19writing to participate in unpaid work experience, the participant's employment plan may 20.20only include unpaid work experience if including the unpaid work experience in the plan 20.21will meet the following criteria: 20.22    (i) the unpaid work experience will provide the participant specific skills or 20.23experience that cannot be obtained through other work activity options where the 20.24participant resides or is willing to reside; and 20.25    (ii) the skills or experience gained through the unpaid work experience will result 20.26in higher wages for the participant than the participant could earn without the unpaid 20.27work experience; 20.28    (4) job search including job readiness assistance, job clubs, job placement, 20.29job-related counseling, and job retention services; 20.30    (5) job readiness education, including English as a second language (ESL) or 20.31functional work literacy classes as limited by the provisions of section 
         256J.531, 20.32subdivision 2
         , general educational development (GED) course work, high school 20.33completion, and adult basic education as limited by the provisions of section 
         256J.531, 20.34subdivision 1
         ; 21.1    (6) job skills training directly related to employment, including education and 21.2training that can reasonably be expected to lead to employment, as limited by the 21.3provisions of section 
         256J.53; 21.4    (7) providing child care services to a participant who is working in a community 21.5service program; 21.6    (8) activities included in the employment plan that is developed under section 21.7256J.521, subdivision 3
         ; and 21.8    (9) preemployment activities including chemical and mental health assessments, 21.9treatment, and services; learning disabilities services; child protective services; family 21.10stabilization services; or other programs designed to enhance employability. 21.11(b) "Work activity" does not include activities done for political purposes as defined 21.12in section 211B.01, subdivision 6.21.13    Sec. 24. Minnesota Statutes 2010, section 256J.53, subdivision 2, is amended to read:21.14    Subd. 2. Approval of postsecondary education or training. (a) In order for a 21.15postsecondary education or training program to be an approved activity in an employment 21.16plan, the plan must include additional work activities if the education and training 21.17activities do not meet the minimum hours required to meet the federal work participation 21.18rate under Code of Federal Regulations, title 45, sections 261.31 and 261.35 participant 21.19must be working in unsubsidized employment at least 20 hours per week.21.20    (b) Participants seeking approval of a postsecondary education or training plan 21.21must provide documentation that:21.22    (1) the employment goal can only be met with the additional education or training;21.23    (2) there are suitable employment opportunities that require the specific education or 21.24training in the area in which the participant resides or is willing to reside;21.25    (3) the education or training will result in significantly higher wages for the 21.26participant than the participant could earn without the education or training;21.27    (4) the participant can meet the requirements for admission into the program; and21.28    (5) there is a reasonable expectation that the participant will complete the training 21.29program based on such factors as the participant's MFIP assessment, previous education, 21.30training, and work history; current motivation; and changes in previous circumstances.21.31(c) The hourly unsubsidized employment requirement does not apply for intensive 21.32education or training programs lasting 12 weeks or less when full-time attendance is 21.33required.21.34    Sec. 25. Minnesota Statutes 2010, section 260C.157, subdivision 3, is amended to read:22.1    Subd. 3. Juvenile treatment screening team. (a) The responsible social services 22.2agency shall establish a juvenile treatment screening team to conduct screenings and 22.3prepare case plans under this subdivision section 245.487, subdivision 3, and chapters 22.4260C and 260D. Screenings shall be conducted within 15 days of a request for a screening. 22.5The team, which may be the team constituted under section 
         245.4885 or 
         256B.092 or 22.6Minnesota Rules, parts 9530.6600 to 9530.6655, shall consist of social workers, juvenile 22.7justice professionals, and persons with expertise in the treatment of juveniles who are 22.8emotionally disabled, chemically dependent, or have a developmental disability. The team 22.9shall involve parents or guardians in the screening process as appropriate, and the child's 22.10parent, guardian, or permanent legal custodian under section 260C.201, subdivision 11. 22.11The team may be the same team as defined in section 
         260B.157, subdivision 3.22.12(b) The social services agency shall determine whether a child brought to its 22.13attention for the purposes described in this section is an Indian child, as defined in section 22.14260C.007, subdivision 21
         , and shall determine the identity of the Indian child's tribe, as 22.15defined in section 
         260.755, subdivision 9. When a child to be evaluated is an Indian child, 22.16the team provided in paragraph (a) shall include a designated representative of the Indian 22.17child's tribe, unless the child's tribal authority declines to appoint a representative. The 22.18Indian child's tribe may delegate its authority to represent the child to any other federally 22.19recognized Indian tribe, as defined in section 
         260.755, subdivision 12.22.20(c) If the court, prior to, or as part of, a final disposition, proposes to place a child:22.21(1) for the primary purpose of treatment for an emotional disturbance, a 22.22developmental disability, or chemical dependency in a residential treatment facility out 22.23of state or in one which is within the state and licensed by the commissioner of human 22.24services under chapter 245A; or22.25(2) in any out-of-home setting potentially exceeding 30 days in duration, including a 22.26postdispositional placement in a facility licensed by the commissioner of corrections or 22.27human services, the court shall ascertain whether the child is an Indian child and shall 22.28notify the county welfare agency and, if the child is an Indian child, shall notify the Indian 22.29child's tribe. The county's juvenile treatment screening team must either: (i) screen and 22.30evaluate the child and file its recommendations with the court within 14 days of receipt 22.31of the notice; or (ii) elect not to screen a given case and notify the court of that decision 22.32within three working days.22.33(d) If the screening team has elected to screen and evaluate the child, The child 22.34may not be placed for the primary purpose of treatment for an emotional disturbance, a 22.35developmental disability, or chemical dependency, in a residential treatment facility out of 23.1state nor in a residential treatment facility within the state that is licensed under chapter 23.2245A, unless one of the following conditions applies:23.3(1) a treatment professional certifies that an emergency requires the placement 23.4of the child in a facility within the state;23.5(2) the screening team has evaluated the child and recommended that a residential 23.6placement is necessary to meet the child's treatment needs and the safety needs of the 23.7community, that it is a cost-effective means of meeting the treatment needs, and that it 23.8will be of therapeutic value to the child; or23.9(3) the court, having reviewed a screening team recommendation against placement, 23.10determines to the contrary that a residential placement is necessary. The court shall state 23.11the reasons for its determination in writing, on the record, and shall respond specifically 23.12to the findings and recommendation of the screening team in explaining why the 23.13recommendation was rejected. The attorney representing the child and the prosecuting 23.14attorney shall be afforded an opportunity to be heard on the matter.23.15(e) When the county's juvenile treatment screening team has elected to screen and 23.16evaluate a child determined to be an Indian child, the team shall provide notice to the 23.17tribe or tribes that accept jurisdiction for the Indian child or that recognize the child as a 23.18member of the tribe or as a person eligible for membership in the tribe, and permit the 23.19tribe's representative to participate in the screening team.23.20(f) When the Indian child's tribe or tribal health care services provider or Indian 23.21Health Services provider proposes to place a child for the primary purpose of treatment 23.22for an emotional disturbance, a developmental disability, or co-occurring emotional 23.23disturbance and chemical dependency, the Indian child's tribe or the tribe delegated by 23.24the child's tribe shall submit necessary documentation to the county juvenile treatment 23.25screening team, which must invite the Indian child's tribe to designate a representative to 23.26the screening team.23.27    Sec. 26. Minnesota Statutes 2010, section 260D.01, is amended to read:23.28260D.01 CHILD IN VOLUNTARY FOSTER CARE FOR TREATMENT.23.29    (a) Sections 
         260D.01 to 
         260D.10, may be cited as the "child in voluntary foster care 23.30for treatment" provisions of the Juvenile Court Act.23.31    (b) The juvenile court has original and exclusive jurisdiction over a child in 23.32voluntary foster care for treatment upon the filing of a report or petition required under 23.33this chapter. All obligations of the agency to a child and family in foster care contained in 23.34chapter 260C not inconsistent with this chapter are also obligations of the agency with 23.35regard to a child in foster care for treatment under this chapter.24.1    (c) This chapter shall be construed consistently with the mission of the children's 24.2mental health service system as set out in section 
         245.487, subdivision 3, and the duties 24.3of an agency under section 
         256B.092, 260C.157, and Minnesota Rules, parts 9525.0004 24.4to 9525.0016, to meet the needs of a child with a developmental disability or related 24.5condition. This chapter:24.6    (1) establishes voluntary foster care through a voluntary foster care agreement as the 24.7means for an agency and a parent to provide needed treatment when the child must be in 24.8foster care to receive necessary treatment for an emotional disturbance or developmental 24.9disability or related condition;24.10    (2) establishes court review requirements for a child in voluntary foster care for 24.11treatment due to emotional disturbance or developmental disability or a related condition;24.12    (3) establishes the ongoing responsibility of the parent as legal custodian to visit the 24.13child, to plan together with the agency for the child's treatment needs, to be available and 24.14accessible to the agency to make treatment decisions, and to obtain necessary medical, 24.15dental, and other care for the child; and24.16    (4) applies to voluntary foster care when the child's parent and the agency agree that 24.17the child's treatment needs require foster care either:24.18    (i) due to a level of care determination by the agency's screening team informed by 24.19the diagnostic and functional assessment under section 
         245.4885; or24.20    (ii) due to a determination regarding the level of services needed by the responsible 24.21social services' screening team under section 
         256B.092, and Minnesota Rules, parts 24.229525.0004 to 9525.0016.24.23    (d) This chapter does not apply when there is a current determination under section 24.24626.556
          that the child requires child protective services or when the child is in foster care 24.25for any reason other than treatment for the child's emotional disturbance or developmental 24.26disability or related condition. When there is a determination under section 
         626.556 that 24.27the child requires child protective services based on an assessment that there are safety 24.28and risk issues for the child that have not been mitigated through the parent's engagement 24.29in services or otherwise, or when the child is in foster care for any reason other than 24.30the child's emotional disturbance or developmental disability or related condition, the 24.31provisions of chapter 260C apply.24.32    (e) The paramount consideration in all proceedings concerning a child in voluntary 24.33foster care for treatment is the safety, health, and the best interests of the child. The 24.34purpose of this chapter is:24.35    (1) to ensure a child with a disability is provided the services necessary to treat or 24.36ameliorate the symptoms of the child's disability;25.1    (2) to preserve and strengthen the child's family ties whenever possible and in the 25.2child's best interests, approving the child's placement away from the child's parents only 25.3when the child's need for care or treatment requires it and the child cannot be maintained 25.4in the home of the parent; and25.5    (3) to ensure the child's parent retains legal custody of the child and associated 25.6decision-making authority unless the child's parent willfully fails or is unable to make 25.7decisions that meet the child's safety, health, and best interests. The court may not find 25.8that the parent willfully fails or is unable to make decisions that meet the child's needs 25.9solely because the parent disagrees with the agency's choice of foster care facility, unless 25.10the agency files a petition under chapter 260C, and establishes by clear and convincing 25.11evidence that the child is in need of protection or services.25.12    (f) The legal parent-child relationship shall be supported under this chapter by 25.13maintaining the parent's legal authority and responsibility for ongoing planning for the 25.14child and by the agency's assisting the parent, where necessary, to exercise the parent's 25.15ongoing right and obligation to visit or to have reasonable contact with the child. Ongoing 25.16planning means:25.17    (1) actively participating in the planning and provision of educational services, 25.18medical, and dental care for the child;25.19    (2) actively planning and participating with the agency and the foster care facility 25.20for the child's treatment needs; and25.21    (3) planning to meet the child's need for safety, stability, and permanency, and the 25.22child's need to stay connected to the child's family and community.25.23    (g) The provisions of section 
         260.012 to ensure placement prevention, family 25.24reunification, and all active and reasonable effort requirements of that section apply. This 25.25chapter shall be construed consistently with the requirements of the Indian Child Welfare 25.26Act of 1978, United States Code, title 25, section 1901, et al., and the provisions of the 25.27Minnesota Indian Family Preservation Act, sections 
         260.751 to 
         260.835.25.28    Sec. 27. Minnesota Statutes 2010, section 393.07, subdivision 10a, is amended to read:25.29    Subd. 10a. Expedited issuance of food stamps. The commissioner of human 25.30services shall continually monitor the expedited issuance of food stamp benefits to ensure 25.31that each county complies with federal regulations and that households eligible for 25.32expedited issuance of food stamps are identified, processed, and certified within the time 25.33frames prescribed in federal regulations.26.1County food stamp offices shall screen and issue food stamps to applicants on the 26.2day of application. Applicants who meet the federal criteria for expedited issuance and 26.3have an immediate need for food assistance shall receive within two working dayseither:26.4(1) a manual Authorization to Participate (ATP) card; or26.5(2) the immediate issuance of food stamp coupons benefits.26.6The local food stamp agency shall conspicuously post in each food stamp office a 26.7notice of the availability of and the procedure for applying for expedited issuance and 26.8verbally advise each applicant of the availability of the expedited process.26.9    Sec. 28. Minnesota Statutes 2010, section 518A.51, is amended to read:26.10518A.51 FEES FOR IV-D SERVICES.26.11    (a) When a recipient of IV-D services is no longer receiving assistance under the 26.12state's title IV-A, IV-E foster care, medical assistance, or MinnesotaCare programs, the 26.13public authority responsible for child support enforcement must notify the recipient, 26.14within five working days of the notification of ineligibility, that IV-D services will be 26.15continued unless the public authority is notified to the contrary by the recipient. The 26.16notice must include the implications of continuing to receive IV-D services, including the 26.17available services and fees, cost recovery fees, and distribution policies relating to fees.26.18    (b) An application fee of $25 shall be paid by the person who applies for child 26.19support and maintenance collection services, except persons who are receiving public 26.20assistance as defined in section 
         256.741 and the diversionary work program under section 26.21256J.95
         , persons who transfer from public assistance to nonpublic assistance status, and 26.22minor parents and parents enrolled in a public secondary school, area learning center, or 26.23alternative learning program approved by the commissioner of education.26.24    (c) In the case of an individual who has never received assistance under a state 26.25program funded under Title IV-A of the Social Security Act and for whom the public 26.26authority has collected at least $500 of support, the public authority must impose an 26.27annual federal collections fee of $25 for each case in which services are furnished. This 26.28fee must be retained by the public authority from support collected on behalf of the 26.29individual, but not from the first $500 collected.26.30    (d) When the public authority provides full IV-D services to an obligee who has 26.31applied for those services, upon written notice to the obligee, the public authority must 26.32charge a cost recovery fee of one percent of the amount collected. This fee must be 26.33deducted from the amount of the child support and maintenance collected and not assigned 26.34under section 
         256.741 before disbursement to the obligee. This fee does not apply to an 26.35obligee who:27.1    (1) is currently receiving assistance under the state's title IV-A, IV-E foster care, 27.2medical assistance, or MinnesotaCare programs; or27.3    (2) has received assistance under the state's title IV-A or IV-E foster care programs, 27.4until the person has not received this assistance for 24 consecutive months.27.5     (e) When the public authority provides full IV-D services to an obligor who has 27.6applied for such services, upon written notice to the obligor, the public authority must 27.7charge a cost recovery fee of one percent of the monthly court-ordered child support and 27.8maintenance obligation. The fee may be collected through income withholding, as well 27.9as by any other enforcement remedy available to the public authority responsible for 27.10child support enforcement.27.11     (f) Fees assessed by state and federal tax agencies for collection of overdue support 27.12owed to or on behalf of a person not receiving public assistance must be imposed on the 27.13person for whom these services are provided. The public authority upon written notice to 27.14the obligee shall assess a fee of $25 to the person not receiving public assistance for each 27.15successful federal tax interception. The fee must be withheld prior to the release of the 27.16funds received from each interception and deposited in the general fund.27.17     (g) Federal collections fees collected under paragraph (c) and cost recovery 27.18fees collected under paragraphs (d) and (e), retained by the commissioner of human 27.19services, shall be considered child support program income according to Code of Federal 27.20Regulations, title 45, section 304.50, and shall be deposited in the special revenue fund 27.21account established under paragraph (i). The commissioner of human services must elect 27.22to recover costs based on either actual or standardized costs.27.23     (h) The limitations of this section on the assessment of fees shall not apply to 27.24the extent inconsistent with the requirements of federal law for receiving funds for the 27.25programs under Title IV-A and Title IV-D of the Social Security Act, United States Code, 27.26title 42, sections 601 to 613 and United States Code, title 42, sections 651 to 662.27.27     (i) The commissioner of human services is authorized to establish a special revenue 27.28fund account to receive the federal collections fees collected under paragraph (c) and cost 27.29recovery fees collected under paragraphs (d) and (e). A portion of the nonfederal share of 27.30these fees may be retained for expenditures necessary to administer the fees and must be 27.31transferred to the child support system special revenue account. The remaining nonfederal 27.32share of the federal collections fees and cost recovery fees must be retained by the 27.33commissioner and dedicated to the child support general fund county performance-based 27.34grant account authorized under sections 256.979 and 256.9791. The commissioner shall 27.35distribute the remaining nonfederal share of these fees to the counties quarterly using the 27.36methodology specified in section 256.979, subdivision 11. The funds received by the 28.1counties must be reinvested in the child support enforcement program, and the counties 28.2shall not reduce the funding of their child support programs by the amount of funding 28.3distributed.28.4    Sec. 29. GRANT PROGRAM TO PROMOTE HEALTHY COMMUNITY 28.5INITIATIVES.28.6    (a) The commissioner of human services must contract with the Search Institute to 28.7help local communities develop, expand, and maintain the tools, training, and resources 28.8needed to foster positive community development and effectively engage people in their 28.9community. The Search Institute must: (1) provide training in community mobilization, 28.10youth development, and assets getting to outcomes; (2) provide ongoing technical 28.11assistance to communities receiving grants under this section; (3) use best practices to 28.12promote community development; (4) share best program practices with other interested 28.13communities; (5) create electronic and other opportunities for communities to share 28.14experiences in and resources for promoting healthy community development; and (6) 28.15provide an annual report of the strong communities project.28.16    (b) Specifically, the Search Institute must use a competitive grant process to select 28.17four interested communities throughout Minnesota to undertake strong community 28.18mobilization initiatives to support communities wishing to catalyze multiple sectors to 28.19create or strengthen a community collaboration to address issues of poverty in their 28.20communities. The Search Institute must provide the selected communities with the 28.21tools, training, and resources they need for successfully implementing initiatives focused 28.22on strengthening the community. The Search Institute also must use a competitive 28.23grant process to provide four strong community innovation grants to encourage current 28.24community initiatives to bring new innovation approaches to their work to reduce poverty. 28.25Finally, the Search Institute must work to strengthen networking and information sharing 28.26activities among all healthy community initiatives throughout Minnesota, including 28.27sharing best program practices and providing personal and electronic opportunities for 28.28peer learning and ongoing program support.28.29(c) In order to receive a grant under paragraph (b), a community must show 28.30involvement of at least three sectors of their community and the active leadership of both 28.31youth and adults. Sectors may include, but are not limited to, local government, schools, 28.32community action agencies, faith communities, businesses, higher education institutions, 28.33and the medical community. In addition, communities must agree to: (1) attend training 28.34on community mobilization processes and strength-based approaches; (2) apply the assets 28.35getting to outcomes process in their initiative; (3) meet at least two times during the 29.1grant period to share successes and challenges with other grantees; (4) participate on an 29.2electronic listserv to share information throughout the period on their work; and (5) all 29.3communication requirements and reporting processes.29.4    (d) The commissioner of human services must evaluate the effectiveness of this 29.5program and must recommend to the committees of the legislature with jurisdiction over 29.6health and human services reform and finance by February 15, 2013, whether or not 29.7to make the program available statewide. The Search Institute annually must report to 29.8the commissioner of human services on the services it provided and the grant money 29.9it expended under this section.29.10EFFECTIVE DATE.This section is effective the day following final enactment.29.11    Sec. 30. CIRCLES OF SUPPORT GRANTS.29.12The commissioner of human services must provide grants to community action 29.13agencies to help local communities develop, expand, and maintain the tools, training, and 29.14resources needed to foster social assets to assist people out of poverty through circles of 29.15support. The circles of support model must provide a framework for a community to build 29.16relationships across class and race lines so that people can work together to advocate for 29.17change in their communities and move individuals toward self-sufficiency.29.18Specifically, circles of support initiatives must focus on increasing social capital, 29.19income, educational attainment, and individual accountability, while reducing debt, 29.20service dependency, and addressing systemic disparities that hold poverty in place. The 29.21effort must support the development of local guiding coalitions as the link between the 29.22community and circles of support for resource development and funding leverage.29.23EFFECTIVE DATE.This section is effective July 1, 2011.29.24    Sec. 31. HOMELESS SHELTERS; SCHOOL DISTRICTS.29.25School districts may coordinate with local units of government and homeless 29.26services providers to use empty school buildings as homeless shelters.29.27    Sec. 32. REQUIREMENT FOR LIQUOR STORES, TOBACCO STORES, 29.28GAMBLING ESTABLISHMENTS, AND TATTOO PARLORS.29.29Liquor stores, tobacco stores, gambling establishments, and tattoo parlors must 29.30negotiate with their third-party processors to block EBT card cash transactions at their 29.31places of business and withdrawals of cash at automatic teller machines located in their 29.32places of business.30.1    Sec. 33. MINNESOTA EBT BUSINESS TASK FORCE.30.2    Subdivision 1.Members.The Minnesota EBT Business Task Force includes seven 30.3members, appointed as follows:30.4(1) two members of the Minnesota house of representatives, one appointed by the 30.5speaker of the house and one appointed by the minority leader;30.6(2) two members of the Minnesota senate, one appointed by the senate majority 30.7leader and one appointed by the senate minority leader;30.8(3) the commissioner of human services, or designee;30.9(4) an appointee of the Minnesota Grocers Association; and30.10(5) a credit card processor, appointed by the commissioner of human services.30.11    Subd. 2.Duties.The Minnesota EBT Business Task Force shall create a workable 30.12strategy to eliminate the purchase of tobacco and alcoholic beverages by recipients of the 30.13general assistance program and Minnesota supplemental aid program under Minnesota 30.14Statutes, chapter 256D, and programs under Minnesota Statutes, chapter 256J, using EBT 30.15cards. The task force will consider cost to the state, feasibility of execution at retail, and 30.16ease of use and privacy for EBT cardholders.30.17    Subd. 3.Report.The task force will report back to the legislative committees with 30.18jurisdiction over health and human services policy and finance by April 1, 2012, with 30.19recommendations related to the task force duties under subdivision 2.30.20    Subd. 4.Expiration.The task force expires on June 30, 2012.30.21    Sec. 34. STREAMLINING CHILDREN AND COMMUNITY SERVICES ACT 30.22REPORTING REQUIREMENTS.30.23    The commissioner of human services and county human services representatives, in 30.24consultation with other interested parties, shall develop a streamlined alternative to current 30.25reporting requirements related to the Children and Community Services Act service plan. 30.26The commissioner shall submit recommendations and draft legislation to the chairs and 30.27ranking minority members of the committees having jurisdiction over human services no 30.28later than November 15, 2012.30.29    Sec. 35.  REPEALER.30.30(a) Minnesota Statutes 2010, sections 256.979, subdivisions 5, 6, 7, and 10; 30.31256.9791; 256.9862, subdivision 2; and 256D.46, subdivisions 2 and 3, are repealed.30.32(b) Minnesota Rules, parts 3400.0130, subpart 8; and 9500.1261, subparts 3, items D 30.33and E, 4, and 5, are repealed effective September 3, 2012.31.1ARTICLE 231.2DEPARTMENT OF HEALTH31.3    Section 1. Minnesota Statutes 2010, section 62D.08, subdivision 7, is amended to read:31.4    Subd. 7. Consistent administrative expenses and investment income reporting.31.5(a) Every health maintenance organization must directly allocate administrative expenses 31.6to specific lines of business or products when such information is available. The definition 31.7of administrative expenses must be consistent with that of the National Association of 31.8Insurance Commissioners (NAIC) as provided in the most current NAIC blank. Remaining 31.9expenses that cannot be directly allocated must be allocated based on other methods, as 31.10recommended by the Advisory Group on Administrative Expenses. Health maintenance 31.11organizations must submit this information, including administrative expenses for dental 31.12services, using the reporting template provided by the commissioner of health.31.13(b) Every health maintenance organization must allocate investment income based 31.14on cumulative net income over time by business line or product and must submit this 31.15information, including investment income for dental services, using the reporting template 31.16provided by the commissioner of health.31.17    Sec. 2. Minnesota Statutes 2010, section 62J.04, subdivision 3, is amended to read:31.18    Subd. 3. Cost containment duties. The commissioner shall:31.19(1) establish statewide and regional cost containment goals for total health care 31.20spending under this section and collect data as described in sections 
         62J.38to 62J.41 and 31.2162J.40 to monitor statewide achievement of the cost containment goals; 31.22(2) divide the state into no fewer than four regions, with one of those regions being 31.23the Minneapolis/St. Paul metropolitan statistical area but excluding Chisago, Isanti, 31.24Wright, and Sherburne Counties, for purposes of fostering the development of regional 31.25health planning and coordination of health care delivery among regional health care 31.26systems and working to achieve the cost containment goals;31.27(3) monitor the quality of health care throughout the state and take action as 31.28necessary to ensure an appropriate level of quality;31.29(4) issue recommendations regarding uniform billing forms, uniform electronic 31.30billing procedures and data interchanges, patient identification cards, and other uniform 31.31claims and administrative procedures for health care providers and private and public 31.32sector payers. In developing the recommendations, the commissioner shall review the 31.33work of the work group on electronic data interchange (WEDI) and the American National 31.34Standards Institute (ANSI) at the national level, and the work being done at the state and 32.1local level. The commissioner may adopt rules requiring the use of the Uniform Bill 32.282/92 form, the National Council of Prescription Drug Providers (NCPDP) 3.2 electronic 32.3version, the Centers for Medicare and Medicaid Services 1500 form, or other standardized 32.4forms or procedures;32.5(5) undertake health planning responsibilities;32.6(6) authorize, fund, or promote research and experimentation on new technologies 32.7and health care procedures;32.8(7) within the limits of appropriations for these purposes, administer or contract for 32.9statewide consumer education and wellness programs that will improve the health of 32.10Minnesotans and increase individual responsibility relating to personal health and the 32.11delivery of health care services, undertake prevention programs including initiatives to 32.12improve birth outcomes, expand childhood immunization efforts, and provide start-up 32.13grants for worksite wellness programs;32.14(8) undertake other activities to monitor and oversee the delivery of health care 32.15services in Minnesota with the goal of improving affordability, quality, and accessibility of 32.16health care for all Minnesotans; and32.17(9) make the cost containment goal data available to the public in a 32.18consumer-oriented manner.32.19EFFECTIVE DATE.This section is effective July 1, 2011.32.20    Sec. 3. Minnesota Statutes 2010, section 62J.17, subdivision 4a, is amended to read:32.21    Subd. 4a. Expenditure reporting. Each hospital, outpatient surgical center, 32.22diagnostic imaging center, and physician clinic shall report annually to the commissioner 32.23on all major spending commitments, in the form and manner specified by the 32.24commissioner. The report shall include the following information:32.25    (a) a description of major spending commitments made during the previous year, 32.26including the total dollar amount of major spending commitments and purpose of the 32.27expenditures;32.28    (b) the cost of land acquisition, construction of new facilities, and renovation of 32.29existing facilities;32.30    (c) the cost of purchased or leased medical equipment, by type of equipment;32.31    (d) expenditures by type for specialty care and new specialized services;32.32    (e) information on the amount and types of added capacity for diagnostic imaging 32.33services, outpatient surgical services, and new specialized services; and32.34    (f) information on investments in electronic medical records systems.33.1For hospitals and outpatient surgical centers, this information shall be included in reports 33.2to the commissioner that are required under section 
         144.698. For diagnostic imaging 33.3centers, this information shall be included in reports to the commissioner that are required 33.4under section 
         144.565. For physician clinics, this information shall be included in reports 33.5to the commissioner that are required under section 62J.41. For all other health care 33.6providers that are subject to this reporting requirement, reports must be submitted to the 33.7commissioner by March 1 each year for the preceding calendar year.33.8EFFECTIVE DATE.This section is effective July 1, 2011.33.9    Sec. 4. Minnesota Statutes 2010, section 62J.495, is amended by adding a subdivision 33.10to read:33.11    Subd. 7.Exemption.Any clinical practice with a total annual net revenue of less 33.12than $500,000, and that has not received a state or federal grant for implementation 33.13of electronic health records, is exempt from the requirements of subdivision 1. This 33.14subdivision expires December 31, 2020.33.15    Sec. 5. Minnesota Statutes 2010, section 62J.497, is amended by adding a subdivision 33.16to read:33.17    Subd. 6.Additional standards for electronic prescribing.By January 1, 2012, 33.18the commissioner of health, in consultation with the Minnesota e-Health Advisory 33.19Committee, must develop a method for incorporation of the following transactions into the 33.20requirements and standards for electronic prescribing provided in subdivisions 2 and 3:33.21(1) submission of requests for a formulary exception based on information required 33.22on the form developed according to subdivision 4; and33.23(2) submission of prior authorization requests based on information required on the 33.24form developed according to subdivision 5.33.25    Sec. 6. Minnesota Statutes 2010, section 62J.692, is amended to read:33.2662J.692 MEDICAL EDUCATION.33.27    Subdivision 1. Definitions. For purposes of this section, the following definitions 33.28apply:33.29    (a) "Accredited clinical training" means the clinical training provided by a 33.30medical education program that is accredited through an organization recognized by the 33.31Department of Education, the Centers for Medicare and Medicaid Services, or another 33.32national body who reviews the accrediting organizations for multiple disciplines and 34.1whose standards for recognizing accrediting organizations are reviewed and approved by 34.2the commissioner of health in consultation with the Medical Education and Research 34.3Advisory Committee.34.4    (b) "Commissioner" means the commissioner of health.34.5    (c) "Clinical medical education program" means the accredited clinical training of 34.6physicians (medical students and residents), doctor of pharmacy practitioners, doctors 34.7of chiropractic, dentists, advanced practice nurses (clinical nurse specialists, certified 34.8registered nurse anesthetists, nurse practitioners, and certified nurse midwives), and 34.9physician assistants.34.10    (d) "Sponsoring institution" means a hospital, school, or consortium located in 34.11Minnesota that sponsors and maintains primary organizational and financial responsibility 34.12for a clinical medical education program in Minnesota and which is accountable to the 34.13accrediting body.34.14    (e) "Teaching institution" means a hospital, medical center, clinic, or other 34.15organization that conducts a clinical medical education program in Minnesota.34.16    (f) "Trainee" means a student or resident involved in a clinical medical education 34.17program.34.18    (g) "Eligible trainee FTE's" means the number of trainees, as measured by full-time 34.19equivalent counts, that are at training sites located in Minnesota with currently active 34.20medical assistance enrollment status and a National Provider Identification (NPI) number 34.21where training occurs in either an inpatient or ambulatory patient care setting and where 34.22the training is funded, in part, by patient care revenues. Training that occurs in nursing 34.23facility settings is not eligible for funding under this section.34.24    Subd. 3. Application process. (a) A clinical medical education program conducted 34.25in Minnesota by a teaching institution to train physicians, doctor of pharmacy practitioners, 34.26dentists, advanced dental therapists, chiropractors, or physician assistants is eligible for 34.27funds under subdivision 4 or 11, as appropriate, if the program:34.28(1) is funded, in part, by patient care revenues;34.29(2) occurs in patient care settings that face increased financial pressure as a result of 34.30competition with nonteaching patient care entities training activities; and34.31(3) emphasizes primary care or specialties that are in undersupply in Minnesota in 34.32rural areas or for racial, ethnic, or cultural populations in the state experiencing health 34.33disparities.34.34A clinical medical education program that trains pediatricians is requested to include 34.35in its program curriculum training in case management and medication management for 34.36children suffering from mental illness to be eligible for funds under subdivision 4.35.1(b) A clinical medical education program for advanced practice nursing, registered 35.2nurses, or licensed practical nurses is eligible for funds under subdivision 4 or 11, as 35.3appropriate, if the program meets the eligibility requirements in paragraph (a), clauses 35.4(1) to (3), and is sponsored by the University of Minnesota Academic Health Center, 35.5the Mayo Foundation, or institutions that are part of the Minnesota State Colleges and 35.6Universities system or members of the Minnesota Private College Council.35.7(c) Applications must be submitted to the commissioner by a sponsoring institution 35.8on behalf of an eligible clinical medical education program and must be received by 35.9October 31 of each year for distribution in the following year. An application for funds 35.10must contain the following information:35.11(1) the official name and address of the sponsoring institution and the official 35.12name and site address of the clinical medical education programs on whose behalf the 35.13sponsoring institution is applying;35.14(2) the name, title, and business address of those persons responsible for 35.15administering the funds;35.16(3) for each clinical medical education program for which funds are being sought; 35.17the type and specialty orientation of trainees in the program; the name, site address, and 35.18medical assistance provider number or National Provider Identification number (NPI) of 35.19each training site used in the program; the total number of trainees at each training site; 35.20and the total number of eligible trainee FTEs at each site; and35.21(4) other supporting information the commissioner deems necessary to determine 35.22program eligibility based on the criteria in paragraphs (a) and (b) and to ensure the 35.23equitable appropriate distribution of funds.35.24(d) An application must include the information specified in clauses (1) to (3) for 35.25each clinical medical education program on an annual basis for three consecutive years. 35.26After that time, an application must include the information specified in clauses (1) to (3) 35.27when requested, at the discretion of the commissioner:35.28(1) audited clinical training costs per trainee for each clinical medical education 35.29program when available or estimates of clinical training costs based on audited financial 35.30data;35.31(2) a description of current sources of funding for clinical medical education costs, 35.32including a description and dollar amount of all state and federal financial support, 35.33including Medicare direct and indirect payments; and35.34(3) other revenue received for the purposes of clinical training.35.35(e) An applicant that does not provide information requested by the commissioner 35.36shall not be eligible for funds for the current funding cycle.36.1    Subd. 4. Distribution of funds. (a) Following the distribution described under 36.2paragraph (b), the commissioner shall annually distribute the available medical education 36.3funds to all qualifying applicants based on a distribution formula that reflects a summation 36.4of two factors:36.5    (1) a public program volume factor, which is determined by the total volume of 36.6public program revenue received by each training site as a percentage of all public 36.7program revenue received by all training sites in the fund pool; and.36.8    (2) a supplemental public program volume factor, which is determined by providing 36.9a supplemental payment of 20 percent of each training site's grant to training sites whose 36.10public program revenue accounted for at least 0.98 percent of the total public program 36.11revenue received by all eligible training sites. Grants to training sites whose public 36.12program revenue accounted for less than 0.98 percent of the total public program revenue 36.13received by all eligible training sites shall be reduced by an amount equal to the total 36.14value of the supplemental payment.36.15    Public program revenue for the distribution formula includes revenue from medical 36.16assistance, prepaid medical assistance, general assistance medical care, and prepaid 36.17general assistance medical care. Training sites that receive no public program revenue 36.18are ineligible for funds available under this subdivision. For purposes of determining 36.19training-site level grants to be distributed under paragraph (a), total statewide average 36.20costs per trainee for medical residents is based on audited clinical training costs per trainee 36.21in primary care clinical medical education programs for medical residents. Total statewide 36.22average costs per trainee for dental residents is based on audited clinical training costs 36.23per trainee in clinical medical education programs for dental students. Total statewide 36.24average costs per trainee for pharmacy residents is based on audited clinical training costs 36.25per trainee in clinical medical education programs for pharmacy students. Training sites 36.26whose training-site level grant is less than $1,000, based on the formula described in this 36.27paragraph, are ineligible for funds available under this subdivision.36.28    (b) $5,350,000 $4,900,000 of the available medical education funds in fiscal year 36.292012 and $3,044,000 beginning in fiscal year 2013 shall be distributed to fund training 36.30designed to address health disparities as follows:36.31    (1) $1,475,000 $500,000 in fiscal year 2012 and $200,000 beginning in fiscal year 36.322013 to the University of Minnesota Medical Center-Fairview the White Earth Band of 36.33Ojibwe Indians according to section 145.9271;36.34    (2) $2,075,000 $600,000 in fiscal year 2012 and $200,000 beginning in fiscal 36.35year 2013 to the University of Minnesota School of Dentistry University of Minnesota 36.36according to section 137.395; and37.1(3) $500,000 in fiscal year 2012 and $200,000 beginning in fiscal year 2013 shall 37.2be distributed to the community health centers development grants program according 37.3to section 145.987;37.4(4) $500,000 in fiscal year 2012 and $200,000 beginning in fiscal year 2013 shall be 37.5distributed to the community mental health centers grant program according to section 37.6145.9272;37.7(5) $1,000,000 in fiscal year 2012 and $444,000 beginning in fiscal year 2013 shall 37.8be distributed to the health careers opportunities grant program according to section 37.9144.1499; and37.10    (3) (6) $1,800,000 to the Academic Health Center. $150,000 of the funds distributed 37.11to the Academic Health Center under this paragraph shall be used for a program to assist 37.12internationally trained physicians who are legal residents and who commit to serving 37.13underserved Minnesota communities in a health professional shortage area to successfully 37.14compete for family medicine residency programs at the University of Minnesota.37.15    (c) Funds distributed shall not be used to displace current funding appropriations 37.16from federal or state sources.37.17    (d) Funds shall be distributed to the sponsoring institutions indicating the amount 37.18to be distributed to each of the sponsor's clinical medical education programs based on 37.19the criteria in this subdivision and in accordance with the commissioner's approval letter. 37.20Each clinical medical education program must distribute funds allocated under paragraph 37.21(a) to the training sites as specified in the commissioner's approval letter. Sponsoring 37.22institutions, which are accredited through an organization recognized by the Department 37.23of Education or the Centers for Medicare and Medicaid Services, may contract directly 37.24with training sites to provide clinical training. To ensure the quality of clinical training, 37.25those accredited sponsoring institutions must:37.26    (1) develop contracts specifying the terms, expectations, and outcomes of the clinical 37.27training conducted at sites; and37.28    (2) take necessary action if the contract requirements are not met. Action may 37.29include the withholding of payments under this section or the removal of students from 37.30the site.37.31    (e) Any funds not distributed in accordance with the commissioner's approval letter 37.32must be returned to the medical education and research fund within 30 days of receiving 37.33notice from the commissioner. The commissioner shall distribute returned funds to the 37.34appropriate training sites in accordance with the commissioner's approval letter.38.1    (f) A maximum of $150,000 of the funds dedicated to the commissioner under 38.2section 
         297F.10, subdivision 1, clause (2), may be used by the commissioner for 38.3administrative expenses associated with implementing this section.38.4    Subd. 5. Report. (a) Sponsoring institutions receiving funds under this section 38.5must sign and submit a medical education grant verification report (GVR) to verify that 38.6the correct grant amount was forwarded to each eligible training site. If the sponsoring 38.7institution fails to submit the GVR by the stated deadline, or to request and meet 38.8the deadline for an extension, the sponsoring institution is required to return the full 38.9amount of funds received to the commissioner within 30 days of receiving notice from 38.10the commissioner. The commissioner shall distribute returned funds to the appropriate 38.11training sites in accordance with the commissioner's approval letter.38.12    (b) The reports must provide verification of the distribution of the funds and must 38.13include:38.14    (1) the total number of eligible trainee FTEs in each clinical medical education 38.15program;38.16    (2) the name of each funded program and, for each program, the dollar amount 38.17distributed to each training site;38.18    (3) documentation of any discrepancies between the initial grant distribution notice 38.19included in the commissioner's approval letter and the actual distribution;38.20    (4) a statement by the sponsoring institution stating that the completed grant 38.21verification report is valid and accurate; and38.22    (5) other information the commissioner, with advice from the advisory committee, 38.23deems appropriate to evaluate the effectiveness of the use of funds for medical education.38.24    (c) By February 15 of each year, the commissioner, with advice from the 38.25advisory committee, shall provide an annual summary report to the legislature on the 38.26implementation of this section.38.27    Subd. 6. Other available funds. The commissioner is authorized to distribute, in 38.28accordance with subdivision 4, funds made available through:38.29(1) voluntary contributions by employers or other entities;38.30(2) allocations for the commissioner of human services to support medical education 38.31and research; and38.32(3) other sources as identified and deemed appropriate by the legislature for 38.33inclusion in the fund.38.34    Subd. 7. Transfers from the commissioner of human services. Of the amount 38.35transferred according to section 
         256B.69, subdivision 5c, paragraph (a), clauses (1) to (4), 38.36$21,714,000 shall be distributed as follows:39.1(1) $2,157,000 shall be distributed by the commissioner to the University of 39.2Minnesota Board of Regents for the purposes described in sections 
         137.38 to 
         137.40;39.3(2) $1,035,360 shall be distributed by the commissioner to the Hennepin County 39.4Medical Center for clinical medical education;39.5(3) $17,400,000 shall be distributed by the commissioner to the University of 39.6Minnesota Board of Regents for purposes of medical education;39.7(4) $1,121,640 $1,021,640 shall be distributed by the commissioner to clinical 39.8medical education dental innovation grants in accordance with subdivision 7a; and39.9(5) $100,000 shall be distributed to the health careers opportunities grant program 39.10according to section 144.1499; and39.11(6) the remainder of the amount transferred according to section 
         256B.69, 39.12subdivision 5c, clauses (1) to (4), shall be distributed by the commissioner annually to 39.13clinical medical education programs that meet the qualifications of subdivision 3 based on 39.14the formula in subdivision 4, paragraph (a), or subdivision 11, as appropriate.39.15    Subd. 7a. Clinical medical education innovations grants. (a) The commissioner 39.16shall award grants to teaching institutions and clinical training sites for projects that39.17provide training to  increase dental access for underserved populations and promote 39.18innovative clinical training of dental professionals and for racial, ethnic, or cultural 39.19populations in the state experiencing health disparities. In awarding the grants, the 39.20commissioner, in consultation with the commissioner of human services, shall consider 39.21the following:39.22(1) potential to successfully increase access to an underserved population;39.23(2) the long-term viability of the project to improve access beyond the period 39.24of initial funding;39.25(3) evidence of collaboration between the applicant and local communities; and39.26(4) the efficiency in the use of the funding; and39.27(5) (3) the priority level of the project in relation to state clinical education, access, 39.28and health disparity workforce goals.39.29(b) The commissioner shall periodically evaluate the priorities in awarding the 39.30innovations grants in order to ensure that the priorities meet the changing workforce 39.31needs of the state.39.32    Subd. 8. Federal financial participation.  The commissioner of human services 39.33shall seek to maximize federal financial participation in payments for medical education 39.34and research costs.40.1    The commissioner shall use physician clinic rates where possible to maximize 40.2federal financial participation. Any additional funds that become available must be 40.3distributed under subdivision 4, paragraph (a), or 11, as appropriate.40.4    Subd. 9. Review of eligible providers. The commissioner and the Medical 40.5Education and Research Costs Advisory Committee may review provider groups included 40.6in the definition of a clinical medical education program to assure that the distribution of 40.7the funds continue to be consistent with the purpose of this section. The results of any 40.8such reviews must be reported to the Legislative Commission on Health Care Access.40.9    Subd. 11.Distribution of funds.(a) Upon receiving federal approval, the 40.10commissioner shall annually distribute the available medical education funds to all 40.11qualifying applicants based on the following distribution formula, which supersedes the 40.12formula described in subdivision 4, paragraphs (a) and (b):40.13(1) funds received pursuant to section 297F.10 shall be distributed to eligible clinical 40.14training sites using a public program volume factor, which is determined by the total 40.15volume of public program revenue received by each eligible training site as a percentage 40.16of all public program revenue received by all eligible training sites in the fund pool. Only 40.17clinical training that occurs in a hospital that reports financial, utilization, and services 40.18data to the commissioner of health, pursuant to sections 144.564 and 144.695 to 144.703 40.19and Minnesota Rules, chapter 4650, is eligible for funding under this clause; and40.20(2) funds transferred according to section 256B.69, subdivision 5c, paragraph (a), 40.21clauses (1) to (4), shall be distributed to eligible training sites based on the total number of 40.22eligible trainee FTEs and the total statewide average costs per FTE, by type of trainee, in 40.23each clinical medical education program. The number of eligible trainee FTEs for funds 40.24distributed under this clause is determined using the following steps:40.25(i) each FTE trainee from an advanced practice nursing, physician assistant, family 40.26medicine, internal medicine, general pediatrics, or psychiatry program is weighted at 1.25. 40.27Each FTE trainee from any other eligible training program is weighted at 1.0;40.28(ii) each FTE trainee at a clinical training site located in an isolated rural area 40.29according to the four category classification of the Rural Urban Commuting Area (RUCA) 40.30system developed for the United States Health Resources and Services Administration 40.31shall be weighted at the weight in item (i) multiplied by 1.5; each FTE trainee at a clinical 40.32training site located in a small rural area according to the RUCA system shall be weighted 40.33at the weight in item (i) multiplied by 1.25; each FTE trainee at a clinical training site 40.34located in a large rural area according to the RUCA system shall be weighted at the weight 40.35in item (i) multiplied by 1.1; and each FTE trainee at a clinical training site located in an 41.1urban area according to the RUCA system shall be weighted at the weight in item (i) 41.2multiplied by 1.0;41.3(iii) each FTE trainee at a clinical training site that is a hospital eligible for funding 41.4under clause (1) shall be weighted at the weight in item (ii) multiplied by 0.85; and each 41.5FTE trainee at a clinical training site that is an ambulatory, nursing home, or other eligible 41.6nonhospital setting shall be weighted at the weight in item (ii) multiplied by 1.15; and41.7(iv) grants to hospitals under this item are limited to a percentage share of the total 41.8pool of funds available under this item that is no more than 1.5 times the percentage of the 41.9hospital's total revenue that comes from public programs. Grants to hospitals in excess of 41.10this amount will be redistributed to other sites eligible for funding under this item. Each 41.11eligible clinical training site's grant under this item will be calculated by multiplying the 41.12training site's adjusted FTE count upon completion of items (i) to (iv) by the statewide 41.13average cost per trainee for each provider type to determine an adjusted clinical training 41.14cost for each site. The grant to each eligible clinical training site under this item shall 41.15equal that site's share of total adjusted clinical training costs for all eligible training sites 41.16receiving funding under this item. Any clinical training site with fewer than 0.1 FTE 41.17eligible trainees from all programs upon completion of items (i) to (iv) and any clinical 41.18training site that would receive less than a cumulative $1,000 under clauses (1) and (2) 41.19will be eliminated from the distribution.41.20(b) Public program revenue for the distribution formula includes revenue for the 41.21relevant MERC reporting period from medical assistance, prepaid medical assistance, 41.22general assistance medical care, MinnesotaCare, and prepaid general assistance medical 41.23care, as reported to the Department of Health pursuant to sections 144.562, 144.564, 41.24and 144.695 to 144.703 and Minnesota Rules, chapter 4650, by December 31 of the 41.25year in which the MERC application is submitted. Training sites that receive no public 41.26program revenue are ineligible for funds available under this subdivision. For purposes 41.27of determining training-site level grants to be distributed under paragraph (a), clause 41.28(2), total statewide average costs per trainee for medical residents is based on audited 41.29clinical training costs per trainee in primary care clinical medical education programs for 41.30medical residents. Total statewide average costs per trainee for dental residents is based 41.31on audited clinical training costs per trainee in clinical medical education programs for 41.32dental students. Total statewide average costs per trainee for pharmacy residents is based 41.33on audited clinical training costs per trainee in clinical medical education programs for 41.34pharmacy students.42.1    Sec. 7. [62U.15] ALZHEIMER'S DISEASE; PREVALENCE AND SCREENING 42.2MEASURES.42.3    Subdivision 1.Data from providers.(a) By July 1, 2012, the commissioner 42.4shall review currently available quality measures and make recommendations for future 42.5measurement aimed at improving assessment and care related to Alzheimer's disease and 42.6other dementia diagnoses, including improved rates and results of cognitive screening, 42.7rates of Alzheimer's and other dementia diagnoses, and prescribed care and treatment 42.8plans.42.9(b) The commissioner may contract with a private entity to complete the 42.10requirements in this subdivision. If the commissioner contracts with a private entity 42.11already under contract through section 62U.02, then the commissioner may use a sole 42.12source contract and is exempt from competitive procurement processes.42.13    Subd. 2.Learning collaborative.By July 1, 2012, the commissioner shall 42.14develop a health care home learning collaborative curriculum that includes screening and 42.15education on best practices regarding identification and management of Alzheimer's and 42.16other dementia patients under section 256B.0751, subdivision 5, for providers, clinics, 42.17care coordinators, clinic administrators, patient partners and families, and community 42.18resources including public health.42.19    Subd. 3.Comparison data.The commissioner, with the commissioner of human 42.20services, the Minnesota Board on Aging, and other appropriate state offices, shall jointly 42.21review existing and forthcoming literature in order to estimate differences in the outcomes 42.22and costs of current practices for caring for those with Alzheimer's disease and other 42.23dementias, compared to the outcomes and costs resulting from:42.24(1) earlier identification of Alzheimer's and other dementias;42.25(2) improved support of family caregivers; and42.26(3) improved collaboration between medical care management and community-based 42.27supports.42.28    Subd. 4.Reporting.By January 15, 2013, the commissioner must report to the 42.29legislature on progress toward establishment and collection of quality measures required 42.30under this section.42.31    Sec. 8. [137.395] EDUCATION AND TRAINING FOR HEALTH DISPARITY 42.32POPULATIONS.42.33    Subdivision 1.Condition.If the Board of Regents accepts the amount transferred 42.34under section 62J.692, subdivision 4, paragraph (b), clause (2), then it must be used for the 42.35purposes provided in this section.43.1    Subd. 2.Purpose.The Board of Regents, through the Academic Health Center, 43.2is required to implement a scholarship program in order to increase the number of 43.3graduates of the Academic Health Center programs who are from racial, ethnic, or cultural 43.4populations in the state that experience health disparities.43.5    Subd. 3.Scholarships.The Board of Regents is required to provide full 43.6scholarships to Academic Health Center programs for students who are from racial, ethnic, 43.7or cultural populations that experience health disparities. One-third of the scholarship 43.8funding available under this program must go to students at the University of Minnesota, 43.9Medical School, Duluth.43.10    Sec. 9. Minnesota Statutes 2010, section 144.05, is amended by adding a subdivision 43.11to read:43.12    Subd. 6.Elimination of certain provider reporting requirements; sunset of new 43.13requirements.(a) Notwithstanding any other law, rule, or provision to the contrary, 43.14effective July 1, 2012, the commissioner shall cease collecting from health care providers 43.15and purchasers all reports and data related to health care costs, quality, utilization, access, 43.16patient encounters, and disease surveillance and public health, and related to provider 43.17licensure, monitoring, finances, and regulation, unless the reports or data are necessary for 43.18federal compliance. For purposes of this subdivision, the term "health care providers and 43.19purchasers" has the meaning provided in section 62J.03, subdivision 8, except that it also 43.20includes nursing homes, health plan companies as defined in section 62Q.01, subdivision 43.214, and managed care and county-based purchasing plans delivering services under sections 43.22256B.69 and 256B.692.43.23(b) The commissioner shall present to the 2012 legislature draft legislation to repeal, 43.24effective July 1, 2012, the provider reporting requirements identified under paragraph (a) 43.25that are not necessary for federal compliance.43.26(c) The commissioner may establish new provider reporting requirements to take 43.27effect on or after July 1, 2012. These new reporting requirements must sunset five years 43.28from their effective date, unless they are renewed by the commissioner. All new provider 43.29reporting requirements and requests for their renewal shall not take effect unless they 43.30are enacted in state law.43.31    Sec. 10. Minnesota Statutes 2010, section 144.1499, is amended to read:43.32144.1499 PROMOTION OF HEALTH CARE AND LONG-TERM CARE 43.33CAREERS HEALTH CAREERS OPPORTUNITIES GRANT PROGRAM.44.1    Subdivision. 1.Program. The commissioner of health, in consultation with 44.2an organization representing health care employers, long-term care employers, and 44.3educational institutions, may make grants to qualifying consortia as defined in section 44.4116L.11, subdivision 4, for intergenerational programs to encourage middle and high 44.5school students to work and volunteer in health care and long-term care settings. 44.6To qualify for a grant under this section, a consortium shall:health care employers, 44.7educational institutions, and related organizations for eligible activities intended to 44.8increase the number of people from racial, ethnic, or cultural populations that experience 44.9health disparities who are entering health careers in Minnesota.44.10(1) develop a health and long-term care careers curriculum that provides career 44.11exploration and training in national skill standards for health care and long-term care and 44.12that is consistent with Minnesota graduation standards and other related requirements;44.13(2) offer programs for high school students that provide training in health and 44.14long-term care careers with credits that articulate into postsecondary programs; and44.15(3) provide technical support to the participating health care and long-term care 44.16employer to enable the use of the employer's facilities and programs for kindergarten to 44.17grade 12 health and long-term care careers education.44.18    Subd. 2.Eligible activities.Eligible activities must focus on students from racial, 44.19ethnic, or cultural populations experiencing health disparities. Eligible activities include 44.20the following:44.21(1) health careers exploration activities for students from racial, ethnic, or cultural 44.22populations experiencing health disparities;44.23(2) elementary, secondary, and postsecondary education activities to improve the 44.24academic readiness to enter health professions education programs for students from 44.25racial, ethnic, or cultural populations experiencing health disparities;44.26(3) health careers mentoring for students from racial, ethnic, or cultural populations 44.27experiencing health disparities, including support for faculty involved in mentoring these 44.28students enrolled in or interested in entering health professions education programs;44.29(4) secondary and postsecondary summer health care internships that provide 44.30students from racial, ethnic, or cultural populations experiencing health disparities with 44.31formal exposure to a health care profession in an employment setting;44.32(5) health careers preparation, guidance, and support for students from racial, ethnic, 44.33or cultural populations experiencing health disparities who are interested in entering health 44.34professions education programs;44.35(6) health careers preparation, guidance, and support for students from racial, 44.36ethnic, or cultural populations experiencing health disparities who are enrolled in health 45.1professions education programs and other activities to improve retention of these students 45.2in health professions education programs; or45.3(7) other activities the commissioner has reason to believe will prepare, attract, and 45.4educate for health careers students from racial, ethnic, or cultural populations experiencing 45.5health disparities.45.6    Subd. 3.Applications.Applicants seeking a grant must apply to the commissioner. 45.7Applications must include the following:45.8(1) a description of the need, challenges, or barriers that the proposed project will 45.9address;45.10(2) a detailed description of the project and how it proposes to address the challenges 45.11or barriers;45.12(3) a budget detailing all sources of funds for the project and how project funds 45.13will be used;45.14(4) baseline data showing the current percentage of program applicants and current 45.15students who are from racial, ethnic, or cultural populations experiencing health disparities;45.16(5) a description of achievable objectives that demonstrate how the project will 45.17contribute to increasing the number of students from racial, ethnic, or cultural populations 45.18experiencing health disparities who are entering health professions in Minnesota;45.19(6) a timeline for completion of the project;45.20(7) roles and capabilities of responsible individuals and organizations, including 45.21partner organizations;45.22(8) a plan to evaluate project outcomes; and 45.23(9) other information the commissioner believes necessary to evaluate the 45.24application.45.25    Subd. 4.Consideration of applications.The commissioner must review each 45.26application to determine whether or not the application is complete and whether 45.27the applicant and the project are eligible for a grant. In evaluating applications, the 45.28commissioner must evaluate each application based on the following:45.29(1) the extent to which the applicant has demonstrated that its project is likely 45.30to contribute to increasing the number of American Indians and underrepresented 45.31populations of color entering health professions in Minnesota;45.32(2) the application's clarity and thoroughness in describing the challenges and 45.33barriers it is addressing;45.34(3) the extent to which the applicant appears likely to coordinate  project efforts 45.35with other organizations;45.36(4) the reasonableness of the project budget; and46.1(5) the organizational capacity of the applicant and its partners.46.2The commissioner may also take into account other relevant factors. During 46.3application review the commissioner may request additional information about a proposed 46.4project, including information on project cost. Failure to provide the information requested 46.5disqualifies an applicant.46.6    Subd. 5.Program oversight.The commissioner shall determine the amount of a 46.7grant to be given to an eligible applicant based on the relative strength of each eligible 46.8application and the funds available to the commissioner. The commissioner may collect 46.9from grantees any information necessary to evaluate the program.46.10    Sec. 11. Minnesota Statutes 2010, section 144.1501, subdivision 1, is amended to read:46.11    Subdivision 1. Definitions. (a) For purposes of this section, the following definitions 46.12apply.46.13(b) "Dentist" means an individual who is licensed to practice dentistry.46.14(c) "Designated rural area" means:46.15(1) an area in Minnesota outside the counties of Anoka, Carver, Dakota, Hennepin, 46.16Ramsey, Scott, and Washington, excluding the cities of Duluth, Mankato, Moorhead, 46.17Rochester, and St. Cloud; or46.18(2) a municipal corporation, as defined under section 471.634, that is physically 46.19located, in whole or in part, in an area defined as a designated rural area under clause (1).46.20an area defined as a small rural area or isolated rural area according to the four category 46.21classifications of the Rural Urban Commuting Area system developed for the United 46.22States Health Resources and Services Administration.46.23(d) "Emergency circumstances" means those conditions that make it impossible for 46.24the participant to fulfill the service commitment, including death, total and permanent 46.25disability, or temporary disability lasting more than two years.46.26(e) "Medical resident" means an individual participating in a medical residency in 46.27family practice, internal medicine, obstetrics and gynecology, pediatrics, or psychiatry.46.28(f) "Midlevel practitioner" means a nurse practitioner, nurse-midwife, nurse 46.29anesthetist, advanced clinical nurse specialist, or physician assistant.46.30(g) "Nurse" means an individual who has completed training and received all 46.31licensing or certification necessary to perform duties as a licensed practical nurse or 46.32registered nurse.46.33(h) "Nurse-midwife" means a registered nurse who has graduated from a program of 46.34study designed to prepare registered nurses for advanced practice as nurse-midwives.47.1(i) "Nurse practitioner" means a registered nurse who has graduated from a program 47.2of study designed to prepare registered nurses for advanced practice as nurse practitioners.47.3(j) "Pharmacist" means an individual with a valid license issued under chapter 151.47.4(k) "Physician" means an individual who is licensed to practice medicine in the areas 47.5of family practice, internal medicine, obstetrics and gynecology, pediatrics, or psychiatry.47.6(l) "Physician assistant" means a person licensed under chapter 147A.47.7(m) "Qualified educational loan" means a government, commercial, or foundation 47.8loan for actual costs paid for tuition, reasonable education expenses, and reasonable living 47.9expenses related to the graduate or undergraduate education of a health care professional.47.10(n) "Underserved urban community" means a Minnesota urban area or population 47.11included in the list of designated primary medical care health professional shortage areas 47.12(HPSAs), medically underserved areas (MUAs), or medically underserved populations 47.13(MUPs) maintained and updated by the United States Department of Health and Human 47.14Services.47.15    Sec. 12. Minnesota Statutes 2010, section 144.1501, subdivision 4, is amended to read:47.16    Subd. 4. Loan forgiveness. The commissioner of health may select applicants 47.17each year for participation in the loan forgiveness program, within the limits of available 47.18funding. The commissioner shall distribute available funds for loan forgiveness 47.19proportionally among the eligible professions according to the vacancy rate for each 47.20profession in the required geographic area, facility type, teaching area, patient group, 47.21or specialty type specified in subdivision 2. The commissioner shall allocate funds for 47.22physician loan forgiveness so that 75 percent of the funds available are used for rural 47.23physician loan forgiveness and 25 percent of the funds available are used for underserved 47.24urban communities and pediatric psychiatry loan forgiveness. If the commissioner does 47.25not receive enough qualified applicants each year to use the entire allocation of funds for 47.26any eligible profession, the remaining funds may be allocated proportionally among the 47.27other eligible professions according to the vacancy rate for each profession in the required 47.28geographic area, patient group, or facility type specified in subdivision 2. Applicants are 47.29responsible for securing their own qualified educational loans. The commissioner shall 47.30select participants based on their suitability for practice serving the required geographic 47.31area or facility type specified in subdivision 2, as indicated by experience or training. 47.32The commissioner shall give preference to applicants from racial, ethnic, or cultural 47.33populations experiencing health disparities who are closest to completing their training47.34and who agree to serve in settings in Minnesota that provide health care services to at least 47.3550 percent American Indian or other populations of color, such as a federally recognized 48.1Native American reservation. For each year that a participant meets the service obligation 48.2required under subdivision 3, up to a maximum of four years, the commissioner shall make 48.3annual disbursements directly to the participant equivalent to 15 percent of the average 48.4educational debt for indebted graduates in their profession in the year closest to the 48.5applicant's selection for which information is available, not to exceed the balance of the 48.6participant's qualifying educational loans. Before receiving loan repayment disbursements 48.7and as requested, the participant must complete and return to the commissioner an affidavit 48.8of practice form provided by the commissioner verifying that the participant is practicing 48.9as required under subdivisions 2 and 3. The participant must provide the commissioner 48.10with verification that the full amount of loan repayment disbursement received by the 48.11participant has been applied toward the designated loans. After each disbursement, 48.12verification must be received by the commissioner and approved before the next loan 48.13repayment disbursement is made. Participants who move their practice remain eligible for 48.14loan repayment as long as they practice as required under subdivision 2.48.15    Sec. 13. [144.1503] HEALTH PROFESSIONS OPPORTUNITIES 48.16SCHOLARSHIP PROGRAM.48.17    Subdivision 1.Definitions.For purposes of this section, the following definitions 48.18apply: 48.19(a) "Certified clinical nurse specialist" means an individual licensed in Minnesota as 48.20a registered nurse and certified by a national nurse certification organization acceptable to 48.21the Minnesota Board of Nursing to practice as a clinical nurse specialist.48.22(b) "Certified nurse midwife" means an individual licensed in Minnesota as a 48.23registered nurse and certified by a national nurse certification organization acceptable to 48.24the Minnesota Board of Nursing to practice as a nurse midwife.48.25(c) "Certified nurse practitioner" means an individual licensed in Minnesota as a 48.26registered nurse and certified by a national nurse certification organization acceptable to 48.27the Minnesota Board of Nursing to practice as a nurse practitioner.48.28(d) "Chiropractor" means an individual licensed and regulated under sections 148.02 48.29to 148.108.48.30(e) "Dental therapist" means an individual licensed in the state and includes 48.31advanced dental therapists certified under section 150A.106.48.32(f) "Dentist" means an individual licensed in Minnesota as a dentist under chapter 48.33150A.48.34(g) "Eligible scholarship placement site" means a nonprofit, private, or public 48.35entity located in Minnesota that provides at least 50 percent of its health care services to 49.1American Indian or other populations of color, such as federally recognized American 49.2Indian reservations.49.3(h) "Emergency circumstances" means those conditions that make it impossible for 49.4the participant to fulfill the contractual requirements, including death, total and permanent 49.5disability, or temporary disability lasting more than two years.49.6(i) "Participant" means an individual receiving a scholarship under this program.49.7(j) "Physician assistant" means a person licensed in Minnesota under chapter 147A.49.8(k) "Primary care physician" means an individual licensed in Minnesota as a 49.9physician and board-certified in family practice, internal medicine, obstetrics and 49.10gynecology, pediatrics, geriatrics, emergency medicine, hospital medicine, or psychiatry.49.11(l) "Registered nurse" means an individual licensed by the Minnesota Board of 49.12Nursing to practice professional nursing.49.13    Subd. 2.Establishment and purpose.The commissioner shall establish a health 49.14professions opportunities scholarship program. The purpose of the program is to increase 49.15the number of students from racial, ethnic, or cultural populations experiencing health 49.16disparities who enter health professions.49.17    Subd. 3.Eligible students.To be eligible to apply to the commissioner for the 49.18scholarship program, an applicant must be:49.19(1) accepted for full-time study in a program of study that will result in licensure as 49.20a primary care physician, certified nurse practitioner, certified nurse midwife, certified 49.21clinical nurse specialist, chiropractor, physician assistant, registered nurse, dentist, or 49.22dental therapist;49.23(2) a Minnesota resident; and49.24(3) an individual from a racial, ethnic, or cultural population experiencing health 49.25disparities in the state.49.26    Subd. 4.Scholarship.The commissioner may award a scholarship for the cost of 49.27full tuition, fees, and living expenses up to $40,000 per year to eligible students. The 49.28commissioner will subtract the amount of other scholarship, grant, and gift awards to the 49.29participant from the award made by this program. Scholarship awards will be limited to 49.30the number of years for full-time enrollment in the applicant's program of study but will 49.31not include any years completed prior to applying. The commissioner shall determine the 49.32number of new scholarship awards made per fiscal year based on availability of state 49.33funding. Scholarship awards will be paid by the commissioner directly to the participant's 49.34educational institution after full-time enrollment is verified. Appropriations made to the 49.35scholarship program do not cancel and are available until expended.50.1    Subd. 5.Obligated service.A participant shall agree in contract to fulfill a 50.2three-year service obligation at an eligible scholar placement site upon completion of 50.3training, including residency, and obtaining Minnesota licensure. Participants must 50.4provide at least 32 hours of direct patient care per week for at least 45 weeks per year. 50.5Obligated service must start by March 31 of the year following completion of required 50.6training.50.7    Subd. 6.Affidavit of service required.Before starting a service obligation and 50.8annually thereafter, participants shall submit to the commissioner an affidavit of practice 50.9signed by a representative of their eligible scholar placement site verifying employment 50.10status and the number of weekly hours of direct patient care provided by the participant. 50.11Participants must also provide written notice to the commissioner within 30 days of:50.12(1) a change in name or address;50.13(2) a decision not to fulfill a service obligation; or50.14(3) cessation of obligated practice.50.15    Subd. 7.Penalty for nonfulfillment.If a participant does not complete the 50.16educational program, successfully obtain licensure, or fulfill the required minimum 50.17commitment of service according to subdivision 6, the commissioner of health shall collect 50.18from the participant the total amount awarded to the participant under the scholarship 50.19program plus interest at a rate established according to section 270C.40. Funds collected 50.20for nonfulfillment shall be credited to the health professions opportunities scholarship 50.21program. The commissioner shall allow waivers of all or part of the money owed the 50.22commissioner as a result of a nonfulfillment penalty due to emergency circumstances.50.23    Sec. 14. [144.586] PATIENT SAFETY SURVEY.50.24Hospitals licensed under section 144.55 must submit necessary information to the 50.25Leapfrog Group patient safety survey on an annual basis in order to publicly report patient 50.26safety information and track the progress of each hospital to improve quality, safety, 50.27and efficiency of care delivery.50.28    Sec. 15. Minnesota Statutes 2010, section 144.98, subdivision 2a, is amended to read:50.29    Subd. 2a. Standards.Notwithstanding the exemptions in subdivisions 8 and 9, the 50.30commissioner shall accredit laboratories according to the most current environmental 50.31laboratory accreditation standards under subdivision 1 and as accepted by the accreditation 50.32bodies recognized by the National Environmental Laboratory Accreditation Program 50.33(NELAP) of the NELAC Institute.51.1    Sec. 16. Minnesota Statutes 2010, section 144.98, subdivision 7, is amended to read:51.2    Subd. 7. Initial accreditation and annual accreditation renewal. (a) The 51.3commissioner shall issue or renew accreditation after receipt of the completed application 51.4and documentation required in this section, provided the laboratory maintains compliance 51.5with the standards specified in subdivision 2a, notwithstanding any exemptions under 51.6subdivisions 8 and 9, and attests to the compliance on the application form.51.7(b) The commissioner shall prorate the fees in subdivision 3 for laboratories 51.8applying for accreditation after December 31. The fees are prorated on a quarterly basis 51.9beginning with the quarter in which the commissioner receives the completed application 51.10from the laboratory.51.11(c) Applications for renewal of accreditation must be received by November 1 and 51.12no earlier than October 1 of each year. The commissioner shall send annual renewal 51.13notices to laboratories 90 days before expiration. Failure to receive a renewal notice does 51.14not exempt laboratories from meeting the annual November 1 renewal date.51.15(d) The commissioner shall issue all accreditations for the calendar year for which 51.16the application is made, and the accreditation shall expire on December 31 of that year.51.17(e) The accreditation of any laboratory that fails to submit a renewal application 51.18and fees to the commissioner expires automatically on December 31 without notice or 51.19further proceeding. Any person who operates a laboratory as accredited after expiration of 51.20accreditation or without having submitted an application and paid the fees is in violation 51.21of the provisions of this section and is subject to enforcement action under sections 51.22144.989
          to 
         144.993, the Health Enforcement Consolidation Act. A laboratory with expired 51.23accreditation may reapply under subdivision 6.51.24    Sec. 17. Minnesota Statutes 2010, section 144.98, is amended by adding a subdivision 51.25to read:51.26    Subd. 8.Exemption from national standards for quality control and personnel 51.27requirements.Effective January 1, 2012, a laboratory that analyzes samples for 51.28compliance with a permit issued under section 115.03, subdivision 5, may request 51.29exemption from the personnel requirements and specific quality control provisions for 51.30microbiology and chemistry stated in the national standards as incorporated by reference 51.31in subdivision 2a. The commissioner shall grant the exemption if the laboratory:51.32(1) complies with the methodology and quality control requirements, where 51.33available, in the most recent, approved edition of the Standard Methods for the 51.34Examination of Water and Wastewater as published by the Water Environment Federation; 51.35and52.1(2) supplies the name of the person meeting the requirements in section 115.73, or 52.2the personnel requirements in the national standard pursuant to subdivision 2a.52.3A laboratory applying for this exemption shall not apply for simultaneous 52.4accreditation under the national standard.52.5    Sec. 18. Minnesota Statutes 2010, section 144.98, is amended by adding a subdivision 52.6to read:52.7    Subd. 9.Exemption from national standards for proficiency testing frequency.52.8(a) Effective January 1, 2012, a laboratory applying for or requesting accreditation under 52.9the exemption in subdivision 8 must obtain an acceptable proficiency test result for each 52.10of the laboratory's accredited or requested fields of testing. The laboratory must analyze 52.11proficiency samples selected from one of two annual proficiency testing studies scheduled 52.12by the commissioner.52.13(b) If a laboratory fails to successfully complete the first scheduled proficiency 52.14study, the laboratory shall:52.15(1) obtain and analyze a supplemental test sample within 15 days of receiving the 52.16test report for the initial failed attempt; and52.17(2) participate in the second annual study as scheduled by the commissioner.52.18(c) If a laboratory does not submit results or fails two consecutive proficiency 52.19samples, the commissioner will revoke the laboratory's accreditation for the affected 52.20fields of testing.52.21(d) The commissioner may require a laboratory to analyze additional proficiency 52.22testing samples beyond what is required in this subdivision if information available to 52.23the commissioner indicates that the laboratory's analysis for the field of testing does not 52.24meet the requirements for accreditation.52.25(e) The commissioner may collect from laboratories accredited under the exemption 52.26in subdivision 8 any additional costs required to administer this subdivision and 52.27subdivision 8.52.28    Sec. 19. Minnesota Statutes 2010, section 144A.102, is amended to read:52.29144A.102 WAIVER FROM FEDERAL RULES AND REGULATIONS; 52.30PENALTIES.52.31(a) By January 2000, the commissioner of health shall work with providers to 52.32examine state and federal rules and regulations governing the provision of care in licensed 52.33nursing facilities and apply for federal waivers and identify necessary changes in state 52.34law to:53.1(1) allow the use of civil money penalties imposed upon nursing facilities to abate 53.2any deficiencies identified in a nursing facility's plan of correction; and53.3(2) stop the accrual of any fine imposed by the Health Department when a follow-up 53.4inspection survey is not conducted by the department within the regulatory deadline.53.5(b) By January 2012, the commissioner of health shall work with providers and 53.6the ombudsman for long-term care to examine state and federal rules and regulations 53.7governing the provision of care in licensed nursing facilities and apply for federal waivers 53.8and identify necessary changes in state law to:53.9(1) eliminate the requirement for written plans of correction from nursing homes for 53.10federal deficiencies issued at a scope and severity that is not widespread, harmful, or in 53.11immediate jeopardy; and53.12(2) issue the federal survey form electronically to nursing homes.53.13The commissioner shall issue a report to the legislative chairs of the committees 53.14with jurisdiction over health and human services by January 31, 2012, on the status of 53.15implementation of this paragraph.53.16    Sec. 20. Minnesota Statutes 2010, section 144A.61, is amended by adding a 53.17subdivision to read:53.18    Subd. 9.Electronic transmission.The commissioner of health must accept 53.19electronic transmission of applications and supporting documentation for interstate 53.20endorsement for the nursing assistant registry.53.21    Sec. 21. Minnesota Statutes 2010, section 144E.123, is amended to read:53.22144E.123 PREHOSPITAL CARE DATA.53.23    Subdivision 1. Collection and maintenance. Until July 1, 2014, a licensee shall53.24may collect and provide prehospital care data to the board in a manner prescribed by the 53.25board. At a minimum, the data must include items identified by the board that are part of 53.26the National Uniform Emergency Medical Services Data Set. A licensee shall maintain 53.27prehospital care data for every response.53.28    Subd. 2. Copy to receiving hospital. If a patient is transported to a hospital, a copy 53.29of the ambulance report delineating prehospital medical care given shall be provided 53.30to the receiving hospital.53.31    Subd. 3. Review. Prehospital care data may be reviewed by the board or its 53.32designees. The data shall be classified as private data on individuals under chapter 13, the 53.33Minnesota Government Data Practices Act.54.1    Subd. 4.Penalty.Failure to report all information required by the board under this 54.2section shall constitute grounds for license revocation.54.3    Subd. 5.Working group.By October 1, 2011, the board must convene a working 54.4group composed of six members, three of which must be appointed by the board and three 54.5of which must be appointed by the Minnesota Ambulance Association, to redesign the 54.6board's policies related to collection of data from licenses. The issues to be considered 54.7include, but are not limited to, the following: user-friendly reporting requirements; data 54.8sets; improved accuracy of reported information; appropriate use of information gathered 54.9through the reporting system; and methods for minimizing the financial impact of data 54.10reporting on licenses, particularly for rural volunteer services. The working group must 54.11report its findings and recommendations to the board no later than January 1, 2014.54.12EFFECTIVE DATE.This section is effective the day following final enactment.54.13    Sec. 22. [145.9271] WHITE EARTH BAND URBAN CLINIC.54.14    Subdivision 1.Condition.If the White Earth Band of Ojibwe Indians accepts the 54.15amount transferred under section 62J.692, subdivision 4, paragraph (b), clause (1), then it 54.16must use the funds for purposes of this section.54.17    Subd. 2.Establish urban clinic.The White Earth Band of Ojibwe Indians shall 54.18establish and operate one or more health care clinics in the Minneapolis area or greater 54.19Minnesota to serve members of the White Earth Tribe and may use funds received under 54.20section 62J.692, subdivision 4, paragraph (b), clause (1), for application to qualify as a 54.21federally qualified health center.54.22    Subd. 3.Grant agreements.Before receiving the funds to be transferred under 54.23section 62J.692, subdivision 4, paragraph (b), clause (1), the White Earth Band of Ojibwe 54.24Indians is requested to submit to the commissioner of health a work plan and budget that 54.25describes its annual plan for the funds. The commissioner will incorporate the work 54.26plan and budget into a grant agreement between the commissioner and the White Earth 54.27Band of Ojibwe Indians. Before each successive disbursement, the White Earth Band of 54.28Ojibwe Indians is requested to submit a narrative progress report and an expenditure 54.29report to the commissioner.54.30    Sec. 23. [145.9272] COMMUNITY MENTAL HEALTH CENTER GRANTS.54.31    Subdivision 1.Definitions.For purposes of this section, "community mental 54.32health center" means an entity that is eligible for payment under section 256B.0625, 54.33subdivision 5.55.1    Subd. 2.Allocation of subsidies.The commissioner of health shall distribute, from 55.2money appropriated for this purpose, grants to community mental health centers operating 55.3in the state on July 1 of the year 2011 and each subsequent year for community mental 55.4health center services to low-income consumers and patients with mental illness. The 55.5amount of each grant shall be in proportion to each community mental health center's 55.6revenues received from state health care programs in the most recent calendar year for 55.7which data is available.55.8    Sec. 24. Minnesota Statutes 2010, section 145.928, subdivision 2, is amended to read:55.9    Subd. 2. State-community partnerships; plan. The commissioner, in partnership 55.10with culturally based community organizations; the Indian Affairs Council under section 55.113.922
         ; the Council on Affairs of Chicano/Latino People under section 
         3.9223; the Council 55.12on Black Minnesotans under section 
         3.9225; the Council on Asian-Pacific Minnesotans 55.13under section 
         3.9226; the Alliance for Racial and Cultural Health Equity; community 55.14health boards as defined in section 
         145A.02; and tribal governments, shall develop and 55.15implement a comprehensive, coordinated plan to reduce health disparities in the health 55.16disparity priority areas identified in subdivision 1. 55.17    Sec. 25. [145.929] PROFESSIONALS FROM POPULATIONS WITH HEALTH 55.18DISPARITIES.55.19The commissioner of health shall survey the diversity of the work force for 55.20health-related professions and compare proportions in the allied health professions 55.21among populations experiencing health disparities, including cultural, racial, ethnic, 55.22and geographic factors, compared to the population of the state. Based on this survey, 55.23the commissioner shall determine on an annual basis the ratio of training and residency 55.24positions needed versus those available based on funding capacity.55.25    Sec. 26. Minnesota Statutes 2010, section 145.986, is amended by adding a subdivision 55.26to read:55.27    Subd. 7.Consultation and engagement of consumers and communities with 55.28poorer health and outcomes.Communities who receive state and federal health 55.29grants must demonstrate to the commissioner that the applicant or grantee consulted 55.30with and engaged local consumers, community organizations, and leaders representing 55.31the subgroups of the community that experience the greatest health disparities in the 55.32development of the local plan and that the plan incorporates components and activities 55.33that reflect the needs and preferences of these communities.  The plan must also include 56.1a process for ongoing consultation and engagement of these consumers, community 56.2organizations, and leaders in the implementation of the plan and activities funded by 56.3state grants.56.4    Sec. 27. Minnesota Statutes 2010, section 145.986, is amended by adding a subdivision 56.5to read:56.6    Subd. 8.Coordination with payment reform demonstration projects.A 56.7community who received a health improvement plan grant under this section and 56.8a payment reform demonstration project authorized under section 256B.0755 shall 56.9coordinate activities to improve the health of the communities and patients served by both 56.10the health improvement plan and the demonstration project provider.56.11    Sec. 28. [145.987] COMMUNITY HEALTH CENTERS DEVELOPMENT 56.12GRANTS FOR UNDERSERVED COMMUNITIES.56.13(a) The commissioner of health shall award grants from money appropriated for this 56.14purpose to expand community health centers, as defined in section 145.9269, subdivision 56.151, in the state through the establishment of new community health centers or sites in 56.16areas defined as small rural areas or isolated rural areas according to the four category 56.17classification of the Rural Urban Commuting Area system developed for the United States 56.18Health Resources and Services Administration or serving underserved patient populations 56.19who experience the greatest disparities in health outcomes.56.20(b) Grant funds may be used to pay for:56.21(1) costs for an organization to develop and submit a proposal to the federal 56.22government for the designation of a new community health center or site;56.23(2) costs of engaging underserved communities, health care providers, local 56.24government agencies, or businesses in a process of developing a plan for a new center or 56.25site to serve people in that community; and56.26(3) costs of planning, designing, remodeling, constructing, or purchasing equipment 56.27for a new center or site.56.28Funds may not be used for operating costs.56.29(d) A proposal must demonstrate that racial and ethnic communities to be served by 56.30the community health center were consulted with and participated in the development of 56.31the proposal.56.32(e) The commissioner shall award grants on a competitive basis based on the 56.33following criteria: 56.34(1) the unmet need in the underserved community;57.1(2) the degree of disparities in health outcomes in the underserved community; and57.2(3) the extent to which people from the underserved community participated in 57.3the development of the proposal.57.4    Sec. 29. Minnesota Statutes 2010, section 145A.17, subdivision 3, is amended to read:57.5    Subd. 3. Requirements for programs; process. (a) Community health boards 57.6and tribal governments that receive funding under this section must submit a plan to 57.7the commissioner describing a multidisciplinary approach to targeted home visiting for 57.8families. The plan must be submitted on forms provided by the commissioner. At a 57.9minimum, the plan must include the following:57.10    (1) a description of outreach strategies to families prenatally or at birth;57.11    (2) provisions for the seamless delivery of health, safety, and early learning services;57.12    (3) methods to promote continuity of services when families move within the state;57.13    (4) a description of the community demographics;57.14    (5) a plan for meeting outcome measures; and57.15    (6) a proposed work plan that includes:57.16    (i) coordination to ensure nonduplication of services for children and families;57.17    (ii) a description of the strategies to ensure that children and families at greatest risk 57.18receive appropriate services; and57.19    (iii) collaboration with multidisciplinary partners including public health, 57.20ECFE, Head Start, community health workers, social workers, community home 57.21visiting programs, school districts, and other relevant partners. Letters of intent from 57.22multidisciplinary partners must be submitted with the plan.57.23    (b) Each program that receives funds must accomplish the following program 57.24requirements:57.25    (1) use a community-based strategy to provide preventive and early intervention 57.26home visiting services;57.27    (2) offer a home visit by a trained home visitor. If a home visit is accepted, the first 57.28home visit must occur prenatally or as soon after birth as possible and must include a 57.29public health nursing assessment by a public health nurse;57.30    (3) offer, at a minimum, information on infant care, child growth and development, 57.31positive parenting, preventing diseases, preventing exposure to environmental hazards, 57.32and support services available in the community;57.33    (4) provide information on and referrals to health care services, if needed, including 57.34information on and assistance in applying for health care coverage for which the child or 58.1family may be eligible; and provide information on preventive services, developmental 58.2assessments, and the availability of public assistance programs as appropriate;58.3    (5) provide youth development programs when appropriate;58.4    (6) recruit home visitors who will represent, to the extent possible, the races, 58.5cultures, and languages spoken by families that may be served;58.6    (7) train and supervise home visitors in accordance with the requirements established 58.7under subdivision 4;58.8    (8) maximize resources and minimize duplication by coordinating or contracting 58.9with local social and human services organizations, education organizations, and other 58.10appropriate governmental entities and community-based organizations and agencies;58.11    (9) utilize appropriate racial and ethnic approaches to providing home visiting 58.12services; and58.13    (10) connect eligible families, as needed, to additional resources available in the 58.14community, including, but not limited to, early care and education programs, health or 58.15mental health services, family literacy programs, employment agencies, social services, 58.16and child care resources and referral agencies.58.17    (c) When available, programs that receive funds under this section must offer or 58.18provide the family with a referral to center-based or group meetings that meet at least 58.19once per month for those families identified with additional needs. The meetings must 58.20focus on further enhancing the information, activities, and skill-building addressed during 58.21home visitation; offering opportunities for parents to meet with and support each other; 58.22and offering infants and toddlers a safe, nurturing, and stimulating environment for 58.23socialization and supervised play with qualified teachers.58.24    (d) Funds available under this section shall not be used for medical services. The 58.25commissioner shall establish an administrative cost limit for recipients of funds. The 58.26outcome measures established under subdivision 6 must be specified to recipients of 58.27funds at the time the funds are distributed.58.28    (e) Data collected on individuals served by the home visiting programs must remain 58.29confidential and must not be disclosed by providers of home visiting services without a 58.30specific informed written consent that identifies disclosures to be made. Upon request, 58.31agencies providing home visiting services must provide recipients with information on 58.32disclosures, including the names of entities and individuals receiving the information and 58.33the general purpose of the disclosure. Prospective and current recipients of home visiting 58.34services must be told and informed in writing that written consent for disclosure of data is 58.35not required for access to home visiting services.59.1(f) Upon initial contact with a family, programs that receive funding under this 59.2section must request permission from the family to share with other family service 59.3providers information about services the family is receiving and unmet needs of the family 59.4in order to select a lead agency for the family and coordinate available resources. For 59.5purposes of this paragraph, the term "family service providers" includes local public 59.6health, social services, school districts, Head Start programs, health care providers, and 59.7other public agencies.59.8    Sec. 30. Minnesota Statutes 2010, section 152.027, is amended by adding a subdivision 59.9to read:59.10    Subd. 6.Sale or possession of synthetic cannabinoids.(a) A person who 59.11unlawfully  sells any amount of a synthetic cannabinoid is guilty of a gross misdemeanor.59.12(b) A person who unlawfully possesses any amount of a synthetic cannabinoid is 59.13guilty of a misdemeanor.59.14(c) For purposes of this subdivision, "synthetic cannabinoid" includes, unless 59.15specifically excepted or unless listed in another schedule, any natural or synthetic material, 59.16compound, mixture, or preparation that contains any quantity of a substance that is a 59.17cannabinoid receptor agonist, including, but not limited to, the following substances and 59.18their analogs, including homologues; isomers, whether optical, positional, or geometric; 59.19esters; ethers; salts; and salts of isomers, esters, and ethers, whenever the existence of the 59.20isomers, esters, ethers, or salts is possible within the specific chemical designation:59.211-pentyl-2-methyl-3-(1-naphthoyl)indole (JWH-007), 59.22(2-Methyl-1-propyl-1H-indol-3-yl)-1-naphthalenylmethanone (JWH-015), 59.231-Pentyl-3-(1-naphthoyl)indole (JWH-018), 1-hexyl-3-(naphthalen-1-oyl)indole 59.24(JWH-019), 1-Butyl-3-(1-naphthoyl)indole (JWH-073), 59.254-methoxynaphthalen-1-yl-(1-pentylindol-3-yl)methanone (JWH-081), 59.264-methoxynaphthalen-1-yl-(1-pentyl-2-methylindol-3-yl)methanone 59.27(JWH-098), (1-(2-morpholin-4-ylethyl)indol-3-yl)-naphthalen-1-ylmethanone 59.28(JWH-200), 7-methoxynaphthalen-1-yl-(1-pentylindol-3-yl)methanone 59.29(JWH-164), 2-(2-chlorophenyl)-1-(1-pentylindol-3-yl)ethanone (JWH-203), 59.304-ethylnaphthalen-1-yl-(1-pentylindol-3-yl)methanone (JWH-210), 59.312-(2-methoxyphenyl)-1-(1-pentylindol-3-yl)ethanone (JWH-250), 59.321-pentyl-3-(4-chloro-1-naphthoyl)indole (JWH-398), (6aR,10aR)- 59.339-(Hydroxymethyl)-6,6-dimethyl-3-(2-methyloctan-2-yl)-6a,7,10,10a- 59.34tetrahydrobenzo[c]chromen-1-ol (HU-210), (dexanabinol, (6aS,10aS)-9- 59.35(hydroxymethyl)-6,6-dimethyl-3-(2-methyloctan-2-yl)-6a,7,10,10a- 60.1tetrahydrobenzo[c]chromen-1-ol) (HU-211), (R)-(+)-[2,3-Dihydro-5-methyl-3- 60.2(4-morpholinylmethyl)pyrrolo[1,2,3-de)-1,4-benzoxazin-6-yl]-1-napthalenylmethanone 60.3(WIN-55/212-2), 2-[(1R,3S)-3-hydroxycyclohexyl]- 5-(2-methyloctan-2-yl)phenol 60.4(CP47,497), dimethylheptylpyran.60.5EFFECTIVE DATE.This section is effective August 1, 2011, and applies to crimes 60.6committed on or after that date.60.7    Sec. 31. Minnesota Statutes 2010, section 157.15, is amended by adding a subdivision 60.8to read:60.9    Subd. 7a.Limited food establishment."Limited food establishment" means a food 60.10and beverage service establishment that primarily provides beverages that consist of 60.11combining dry mixes and water or ice for immediate service to the consumer. Limited 60.12food establishments must use equipment and utensils that are nontoxic, durable, and retain 60.13their characteristic qualities under normal use conditions and may request a variance for 60.14plumbing requirements from the commissioner.60.15    Sec. 32. Minnesota Statutes 2010, section 157.20, is amended by adding a subdivision 60.16to read:60.17    Subd. 5.Waivers during inspection.Notwithstanding any provision of this 60.18chapter or Minnesota Rules, chapter 4626, any plumbing or other facility requirement, 60.19including sewage access charge and related local fees, may be waived by the inspector if 60.20the inspector deems a waiver appropriate and reasonable and determines that no significant 60.21adverse effects on public health, safety, or the environment would result from such waiver.60.22    Sec. 33. Minnesota Statutes 2010, section 169A.20, subdivision 1, is amended to read:60.23    Subdivision 1. Driving while impaired crime; motor vehicle. It is a crime for 60.24any person to drive, operate, or be in physical control of any motor vehicle, as defined 60.25in section 
         169A.03, subdivision 15, except for motorboats in operation and off-road 60.26recreational vehicles, within this state or on any boundary water of this state when:60.27(1) the person is under the influence of alcohol;60.28(2) the person is under the influence of a controlled substance or a substance listed in 60.29section 152.027, subdivision 6;60.30(3) the person is knowingly under the influence of a hazardous substance that 60.31affects the nervous system, brain, or muscles of the person so as to substantially impair 60.32the person's ability to drive or operate the motor vehicle;61.1(4) the person is under the influence of a combination of any two or more of the 61.2elements named in clauses (1) to (3);61.3(5) the person's alcohol concentration at the time, or as measured within two hours 61.4of the time, of driving, operating, or being in physical control of the motor vehicle is 61.50.08 or more;61.6(6) the vehicle is a commercial motor vehicle and the person's alcohol concentration 61.7at the time, or as measured within two hours of the time, of driving, operating, or being in 61.8physical control of the commercial motor vehicle is 0.04 or more; or61.9(7) the person's body contains any amount of a controlled substance listed in 61.10Schedule I or II, or its metabolite, other than marijuana or tetrahydrocannabinols.61.11EFFECTIVE DATE.This section is effective August 1, 2011, and applies to crimes 61.12committed on or after that date.61.13    Sec. 34. Minnesota Statutes 2010, section 169A.20, subdivision 1a, is amended to read:61.14    Subd. 1a. Driving while impaired crime; motorboat in operation. It is a crime 61.15for any person to operate or be in physical control of a motorboat in operation on any 61.16waters or boundary water of this state when:61.17(1) the person is under the influence of alcohol;61.18(2) the person is under the influence of a controlled substance or a substance listed in 61.19section 152.027, subdivision 6;61.20(3) the person is knowingly under the influence of a hazardous substance that affects 61.21the nervous system, brain, or muscles of the person so as to substantially impair the 61.22person's ability to drive or operate the motorboat;61.23(4) the person is under the influence of a combination of any two or more of the 61.24elements named in clauses (1) to (3);61.25(5) the person's alcohol concentration at the time, or as measured within two hours 61.26of the time, of driving, operating, or being in physical control of the motorboat is 0.08 or 61.27more; or61.28(6) the person's body contains any amount of a controlled substance listed in 61.29Schedule I or II, or its metabolite, other than marijuana or tetrahydrocannabinols.61.30EFFECTIVE DATE.This section is effective August 1, 2011, and applies to crimes 61.31committed on or after that date.61.32    Sec. 35. Minnesota Statutes 2010, section 169A.20, subdivision 1b, is amended to read:62.1    Subd. 1b. Driving while impaired crime; snowmobile and all-terrain vehicle. It 62.2is a crime for any person to operate or be in physical control of a snowmobile as defined in 62.3section 
         84.81, subdivision 3, or all-terrain vehicle as defined in section 
         84.92, subdivision 62.48, anywhere in this state or on the ice of any boundary water of this state when:62.5(1) the person is under the influence of alcohol;62.6(2) the person is under the influence of a controlled substance or a substance listed in 62.7section 152.027, subdivision 6;62.8(3) the person is knowingly under the influence of a hazardous substance that affects 62.9the nervous system, brain, or muscles of the person so as to substantially impair the 62.10person's ability to drive or operate the snowmobile or all-terrain vehicle;62.11(4) the person is under the influence of a combination of any two or more of the 62.12elements named in clauses (1) to (3);62.13(5) the person's alcohol concentration at the time, or as measured within two hours 62.14of the time, of driving, operating, or being in physical control of the snowmobile or 62.15all-terrain vehicle is 0.08 or more; or62.16(6) the person's body contains any amount of a controlled substance listed in 62.17Schedule I or II, or its metabolite, other than marijuana or tetrahydrocannabinols.62.18EFFECTIVE DATE.This section is effective August 1, 2011, and applies to crimes 62.19committed on or after that date.62.20    Sec. 36. Minnesota Statutes 2010, section 169A.20, subdivision 1c, is amended to read:62.21    Subd. 1c. Driving while impaired crime; off-highway motorcycle and off-road 62.22vehicle. It is a crime for any person to operate or be in physical control of any off-highway 62.23motorcycle as defined in section 
         84.787, subdivision 7, or any off-road vehicle as defined 62.24in section 
         84.797, subdivision 7, anywhere in this state or on the ice of any boundary 62.25water of this state when:62.26(1) the person is under the influence of alcohol;62.27(2) the person is under the influence of a controlled substance or a substance listed in 62.28section 152.027, subdivision 6;62.29(3) the person is knowingly under the influence of a hazardous substance that affects 62.30the nervous system, brain, or muscles of the person so as to substantially impair the 62.31person's ability to drive or operate the off-highway motorcycle or off-road vehicle;62.32(4) the person is under the influence of a combination of any two or more of the 62.33elements named in clauses (1) to (3);63.1(5) the person's alcohol concentration at the time, or as measured within two hours of 63.2the time, of driving, operating, or being in physical control of the off-highway motorcycle 63.3or off-road vehicle is 0.08 or more; or63.4(6) the person's body contains any amount of a controlled substance listed in 63.5Schedule I or II, or its metabolite, other than marijuana or tetrahydrocannabinols.63.6EFFECTIVE DATE.This section is effective August 1, 2011, and applies to crimes 63.7committed on or after that date.63.8    Sec. 37. Minnesota Statutes 2010, section 297F.10, subdivision 1, is amended to read:63.9    Subdivision 1. Tax and use tax on cigarettes. Revenue received from cigarette 63.10taxes, as well as related penalties, interest, license fees, and miscellaneous sources of 63.11revenue shall be deposited by the commissioner in the state treasury and credited as 63.12follows:63.13(1) $22,220,000 for fiscal year 2006 and $22,250,000 for fiscal year 2007 and each 63.14year thereafter must be credited to the Academic Health Center special revenue fund 63.15hereby created and is annually appropriated to the Board of Regents at the University of 63.16Minnesota for Academic Health Center funding at the University of Minnesota; and63.17(2) $8,553,000 for fiscal year 2006 and, $8,550,000 for fiscal year 2007 and, 63.18$8,337,000 for fiscal year 2012, and $6,781,000 each year thereafter must be credited to 63.19the medical education and research costs account hereby created in the special revenue 63.20fund and is annually appropriated to the commissioner of health for distribution under 63.21section 
         62J.692, subdivision 4 or 11, as appropriate; and63.22(3) the balance of the revenues derived from taxes, penalties, and interest (under 63.23this chapter) and from license fees and miscellaneous sources of revenue shall be credited 63.24to the general fund.63.25    Sec. 38. TRANSFER OF HEALTH QUALITY DATA COLLECTION.63.26    Subdivision 1.Transfer.The duties and activities of the commissioner of 63.27health conducted pursuant to Minnesota Statutes, chapter 62U, are transferred to the 63.28commissioner of human services.63.29    Subd. 2.Effect of transfer.Minnesota Statutes, section 15.039 applies to the 63.30transfer required in subdivision 1.63.31    Subd. 3.Effective date.The transfer required in subdivision 1 is effective July 1, 63.322011.63.33    Subd. 4.Suspended data collection.Data collection under Minnesota Statutes, 63.34section 62U.04, subdivision 4, is suspended, effective July 1, 2011.64.1    Subd. 5.Commissioner of human services.(a) During the 2012 legislative session, 64.2the commissioner of human services, in consultation with the revisor of statutes, shall 64.3submit to the legislature a bill making all statutory changes required by the reorganization 64.4required under subdivision 1.64.5(b) By July 1, 2013, the commissioner must make recommendations to the legislature 64.6for collection of encounter data for state health care programs, including SEGIP, through a 64.7mechanism that allows a third-party contractor to capture data as it is transmitted through 64.8existing claims processing mechanisms.64.9    Sec. 39. PATIENT AND COMMUNITY ENGAGEMENT IN PAYMENT 64.10REFORM AND HEALTH CARE PROGRAM REFORMS.64.11    Subdivision 1.Implementation of data system improvements.The commissioners 64.12of health and human services shall implement the recommendations regarding data on 64.13health disparities that were contained in the report prepared under Laws 2010, First 64.14Special Session chapter 1, article 19, section 23, in consultation with an advisory work 64.15group representing racial and ethnic groups and representatives of government and private 64.16sector health care organizations. Among other activities, the commissioners shall:64.17(1) continue engagement with diverse communities on collection of and access to 64.18racial and ethnic data from state agencies, health care providers, and health plans;64.19(2) develop a plan to make data more accessible to communities;64.20(3) develop consistent data elements across programs when feasible; and64.21(4) develop consistent policies on data sampling.64.22    Subd. 2.Patient and community engagement.The commissioner of health, in 64.23cooperation with the commissioners of human services and commerce, shall consult with 64.24an advisory committee representing racial and ethnic groups regarding the implementation 64.25of subdivision 1 and major agency activities related to state and federal health care reform, 64.26payment reform demonstration projects, state health care program reforms, improvements 64.27in quality and patient satisfaction measures, and major changes in state public health 64.28priorities and strategies.  At the request of the advisory committee established under Laws 64.292010, First Special Session chapter 1, article 19, section 23, the commissioner shall 64.30designate a private sector organization of multiple racial and ethnic groups to serve as the 64.31advisory committee under this subdivision.64.32    Sec. 40. EVALUATION OF HEALTH AND HUMAN SERVICES REGULATORY 64.33RESPONSIBILITIES.65.1(a) The commissioner of health, in consultation with the commissioner of human 65.2services, shall evaluate and recommend options for reorganizing health and human 65.3services regulatory responsibilities in both agencies to provide better efficiency and 65.4operational cost savings while maintaining the protection of the health, safety, and welfare 65.5of the public. Regulatory responsibilities that are to be evaluated are those found in 65.6Minnesota Statutes, chapters 62D, 62N, 62R, 62T, 144A, 144D, 144G, 146A, 146B, 65.7149A, 153A, 245A, 245B, and 245C, and sections 62Q.19, 144.058, 144.0722, 144.50, 65.8144.651, 148.511, 148.6401, 148.995, 256B.692, 626.556, and 626.557.65.9(b) The evaluation and recommendations shall be submitted in a report to the 65.10legislative committees with jurisdiction over health and human services no later than 65.11February 15, 2012, and shall include, at a minimum, the following:65.12(1) whether the regulatory responsibilities of each agency should be combined into 65.13a separate agency;65.14(2) whether the regulatory responsibilities of each agency should be merged into 65.15an existing agency;65.16(3) what cost savings would result by merging the activities regardless of where 65.17they are located;65.18(4) what additional costs would result if the activities were merged;65.19(5) whether there are additional regulatory responsibilities in both agencies that 65.20should be considered in any reorganization; and65.21(6) for each option recommended, projected cost and a timetable and identification 65.22of the necessary steps and requirements for a successful transition period.65.23    Sec. 41. TRANSFER OF THE HEALTH ECONOMICS PROGRAM.65.24    Subdivision 1.Transfer.The duties and activities of the health economics program 65.25at the Minnesota Department of Health conducted pursuant to Minnesota Statutes, chapter 65.2662J, are transferred to the commissioner of commerce.65.27    Subd. 2.Effect of transfer.Minnesota Statutes, section 15.039, applies to the 65.28transfer required in subdivision 1.65.29    Subd. 3.Commissioner of commerce.During the 2012 legislative session, the 65.30commissioner of commerce, in consultation with the revisor of statutes, shall submit to 65.31the legislature a bill making all statutory changes required by the reorganization required 65.32under subdivision 1.65.33    Subd. 4.Effective date.The transfer required in subdivision 1 is effective July 1, 65.342011.66.1    Sec. 42. STUDY OF FOR-PROFIT HEALTH MAINTENANCE 66.2ORGANIZATIONS.66.3The commissioner of health shall contract with an entity with expertise in health 66.4economics and health care delivery and quality to study the efficiency, costs, service 66.5quality, and enrollee satisfaction of for-profit health maintenance organizations, relative to 66.6not-for-profit health maintenance organizations operating in Minnesota and other states. 66.7The study findings must address whether the state of Minnesota could: (1) reduce medical 66.8assistance and MinnesotaCare costs and costs of providing coverage to state employees; 66.9and (2) maintain or improve the quality of care provided to state health care program 66.10enrollees and state employees if for-profit health maintenance organizations were allowed 66.11to operate in the state. The commissioner shall require the entity under contract to report 66.12study findings to the commissioner and the legislature by January 15, 2012.66.13    Sec. 43. MINNESOTA TASK FORCE ON PREMATURITY.66.14    Subdivision 1.Establishment.The Minnesota Task Force on Prematurity is 66.15established to evaluate and make recommendations on methods for reducing prematurity 66.16and improving premature infant health care in the state.66.17    Subd. 2.Membership; meetings; staff.(a) The task force shall be composed of at 66.18least the following members, who serve at the pleasure of their appointing authority:66.19(1) 15 representatives of the Minnesota Prematurity Coalition including, but not 66.20limited to, health care providers who treat pregnant women or neonates, organizations 66.21focused on preterm births, early childhood education and development professionals, and 66.22families affected by prematurity;66.23(2) one representative appointed by the commissioner of human services;66.24(3) two representatives appointed by the commissioner of health;66.25(4) one representative appointed by the commissioner of education; 66.26(5) two members of the house of representatives, one appointed by the speaker of 66.27the house and one appointed by the minority leader; and66.28(6) two members of the senate, appointed according to the rules of the senate.66.29(b) Members of the task force serve without compensation or payment of expenses.66.30(c) The commissioner of health must convene the first meeting of the Minnesota 66.31Task Force on Prematurity by July 31, 2011. The task force must continue to meet at 66.32least quarterly. Staffing and technical assistance shall be provided by the Minnesota 66.33Perinatal Coalition.67.1    Subd. 3.Duties.The task force must report the current state of prematurity in 67.2Minnesota and develop recommendations on strategies for reducing prematurity and 67.3improving premature infant health care in the state by considering the following:67.4(1) standards of care for premature infants born less than 37 weeks gestational age, 67.5including recommendations to improve hospital discharge and follow-up care procedures;67.6(2) coordination of information among appropriate professional and advocacy 67.7organizations on measures to improve health care for infants born prematurely;67.8(3) identification and centralization of available resources to improve access and 67.9awareness for caregivers of premature infants;67.10(4) development and dissemination of evidence-based practices through networking 67.11and educational opportunities; 67.12(5) a review of relevant evidence-based research regarding the causes and effects of 67.13premature births in Minnesota;67.14(6) a review of relevant evidence-based research regarding premature infant health 67.15care, including methods for improving quality of and access to care for premature infants; 67.16and67.17(7) identification of gaps in public reporting measures and possible effects of these 67.18measures on prematurity rates.67.19    Subd. 4.Report; expiration.(a) By November 30, 2011, the task force must submit 67.20a report on the current state of prematurity in Minnesota to the chairs of the legislative 67.21policy committees on health and human services.67.22(b) By January 15, 2013, the task force must report its final recommendations, 67.23including any draft legislation necessary for implementation, to the chairs of the legislative 67.24policy committees on health and human services.67.25(c) This task force expires on January 31, 2013, or upon submission of the final 67.26report required in paragraph (b), whichever is earlier.67.27    Sec. 44. NURSING HOME REGULATORY EFFICIENCY.67.28The commissioner of health shall work with stakeholders to review, develop, 67.29implement, and recommend legislative changes in the nursing home licensure process that 67.30address efficiency, eliminate duplication, and ensure positive resident clinical outcomes. 67.31The commissioner shall ensure that the changes are cost-neutral.67.32    Sec. 45.  REPEALER.67.33(a) Minnesota Statutes 2010, sections 62J.17, subdivisions 1, 3, 5a, 6a, and 8; 67.3462J.321, subdivision 5a; 62J.381; 62J.41, subdivisions 1 and 2; and 144.1464, are repealed.68.1(b) Minnesota Statutes 2010, section 145A.14, subdivisions 1 and 2, are repealed 68.2effective January 1, 2012.68.3(c) Minnesota Rules, parts 4651.0100, subparts 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 68.414, 15, 16, 16a, 18, 19, 20, 20a, 21, 22, and 23; 4651.0110, subparts 2, 2a, 3, 4, and 5; 68.54651.0120; 4651.0130; 4651.0140; and 4651.0150, are repealed effective July 1, 2011.68.6ARTICLE 368.7MISCELLANEOUS68.8    Section 1. Minnesota Statutes 2010, section 3.98, is amended by adding a subdivision 68.9to read:68.10    Subd. 5.Health note.The commissioner of health, in consultation with other state 68.11agencies, shall develop a report and recommendations for the legislature for a process 68.12through which a health impact review of proposed legislation may be requested by a 68.13legislative committee chair and ranking minority members of the house of representatives 68.14and senate committees with jurisdiction over health and human services finance and policy 68.15issues and added to fiscal notes to estimate the impact of the proposed legislation on 68.16costs of health care for public employees, state health care programs, private employers, 68.17local governments, or Minnesota individuals and families, including costs related to the 68.18impact of the legislation on private insurance premiums and the health status of the state 68.19or a community. The commissioner may consult with local and private public health 68.20organizations and other persons or organizations in the development of the report and 68.21recommendations. The report and recommendations shall be provided to the legislature by 68.22January 15, 2012.68.23    Sec. 2. Minnesota Statutes 2010, section 245A.14, subdivision 4, is amended to read:68.24    Subd. 4. Special family day care homes. Nonresidential child care programs 68.25serving 14 or fewer children that are conducted at a location other than the license holder's 68.26own residence shall be licensed under this section and the rules governing family day 68.27care or group family day care if:68.28(a) the license holder is the primary provider of care and the nonresidential child 68.29care program is conducted in a dwelling that is located on a residential lot;68.30(b) the license holder is an employer who may or may not be the primary provider 68.31of care, and the purpose for the child care program is to provide child care services to 68.32children of the license holder's employees;68.33(c) the license holder is a church or religious organization;69.1(d) the license holder is a community collaborative child care provider. For 69.2purposes of this subdivision, a community collaborative child care provider is a provider 69.3participating in a cooperative agreement with a community action agency as defined in 69.4section 256E.31; or69.5(e) the license holder is a not-for-profit agency that provides child care in a dwelling 69.6located on a residential lot and the license holder maintains two or more contracts with 69.7community employers or other community organizations to provide child care services. 69.8The county licensing agency may grant a capacity variance to a license holder licensed 69.9under this paragraph to exceed the licensed capacity of 14 children by no more than five 69.10children during transition periods related to the work schedules of parents, if the license 69.11holder meets the following requirements:69.12(1) the program does not exceed a capacity of 14 children more than a cumulative 69.13total of four hours per day;69.14(2) the program meets a one to seven staff-to-child ratio during the variance period;69.15(3) all employees receive at least an extra four hours of training per year than 69.16required in the rules governing family child care each year;69.17(4) the facility has square footage required per child under Minnesota Rules, part 69.189502.0425;69.19(5) the program is in compliance with local zoning regulations;69.20(6) the program is in compliance with the applicable fire code as follows:69.21(i) if the program serves more than five children older than 2-1/2 years of age, 69.22but no more than five children 2-1/2 years of age or less, the applicable fire code is 69.23educational occupancy, as provided in Group E Occupancy under the Minnesota State 69.24Fire Code 2003, Section 202; or69.25(ii) if the program serves more than five children 2-1/2 years of age or less, the 69.26applicable fire code is Group I-4 Occupancies, as provided in the Minnesota State Fire 69.27Code 2003, Section 202; and69.28(7) any age and capacity limitations required by the fire code inspection and square 69.29footage determinations shall be printed on the license.; or69.30(f) the license holder is the primary provider of care and has located the licensed 69.31child care program in a commercial space, if the license holder meets the following 69.32requirements:69.33(1) the program is in compliance with local zoning regulations;69.34(2) the program is in compliance with the applicable fire code as follows:69.35(i) if the program serves more than five children older than 2-1/2 years of age, 69.36but no more than five children 2-1/2 years of age or less, the applicable fire code is 70.1educational occupancy, as provided in Group E Occupancy under the Minnesota State 70.2Fire Code 2003, Section 202; or70.3(ii) if the program serves more than five children 2-1/2 years of age or less, the 70.4applicable fire code is Group I-4 Occupancies, as provided under the Minnesota State Fire 70.5Code 2003, Section 202;70.6(3) any age and capacity limitations required by the fire code inspection and square 70.7footage determinations are printed on the license; and70.8(4) the license holder prominently displays the license issued by the commissioner 70.9which contains the statement "This special family child care provider is not licensed as a 70.10child care center."70.11    Sec. 3. Minnesota Statutes 2010, section 256.01, is amended by adding a subdivision 70.12to read:70.13    Subd. 33.Combined application form; referral of veterans.The commissioner 70.14shall modify the combined application form to add a question asking applicants: "Are 70.15you a United States military veteran?" The commissioner shall ensure that all applicants 70.16who identify themselves as veterans are referred to a county veterans service officer for 70.17assistance in applying to the United States Department of Veterans Affairs for any benefits 70.18for which they may be eligible.70.19    Sec. 4. Minnesota Statutes 2010, section 256B.04, subdivision 14a, is amended to read:70.20    Subd. 14a. Level of need determination. Nonemergency medical transportation 70.21level of need determinations must be performed by a physician, a registered nurse working 70.22under direct supervision of a physician, a physician's assistant, a nurse practitioner, a 70.23licensed practical nurse, or a discharge planner.70.24 Nonemergency medical transportation level of need determinations must not be 70.25performed more than annually on any individual, unless the individual's circumstances 70.26have sufficiently changed so as to require a new level of need determination. No entity 70.27shall charge, and the commissioner shall pay, no more than $25 for performing a level of 70.28need determination regarding any person receiving nonemergency medical transportation, 70.29including special transportation.70.30Special transportation services to eligible persons who need a stretcher-accessible 70.31vehicle from a hospital are exempt from a level of need determination if the special 70.32transportation services have been ordered by the eligible person's physician, registered 70.33nurse working under direct supervision of a physician, physician's assistant, nurse 70.34practitioner, licensed practical nurse, or discharge planner pursuant to Medicare guidelines.71.1 Individuals transported to or residing in licensed nursing facilities are exempt from a 71.2level of need determination and are eligible for special transportation services until the 71.3individual no longer resides in a licensed nursing facility. If a person authorized by this 71.4subdivision to perform a level of need determination determines that an individual requires 71.5stretcher transportation, the individual is presumed to maintain that level of need until 71.6otherwise determined by a person authorized to perform a level of need determination, or 71.7for six months, whichever is sooner.71.8    Sec. 5. Minnesota Statutes 2010, section 256B.0625, subdivision 17, is amended to 71.9read:71.10    Subd. 17. Transportation costs. (a) Medical assistance covers medical 71.11transportation costs incurred solely for obtaining emergency medical care or transportation 71.12costs incurred by eligible persons in obtaining emergency or nonemergency medical 71.13care when paid directly to an ambulance company, common carrier, or other recognized 71.14providers of transportation services. Medical transportation must be provided by:71.15(1) an ambulance, as defined in section 
         144E.001, subdivision 2;71.16(2) special transportation; or71.17(3) common carrier including, but not limited to, bus, taxicab, other commercial 71.18carrier, or private automobile.71.19(b) Medical assistance covers special transportation, as defined in Minnesota Rules, 71.20part 9505.0315, subpart 1, item F, if the recipient has a physical or mental impairment that 71.21would prohibit the recipient from safely accessing and using a bus, taxi, other commercial 71.22transportation, or private automobile.71.23The commissioner may use an order by the recipient's attending physician to certify that 71.24the recipient requires special transportation services. Special transportation providers 71.25shall perform driver-assisted services for eligible individuals. Driver-assisted service 71.26includes passenger pickup at and return to the individual's residence or place of business, 71.27assistance with admittance of the individual to the medical facility, and assistance in 71.28passenger securement or in securing of wheelchairs or stretchers in the vehicle. Special 71.29transportation providers must obtain written documentation from the health care service 71.30provider who is serving the recipient being transported, identifying the time that the 71.31recipient arrived. Special transportation providers may not bill for separate base rates for 71.32the continuation of a trip beyond the original destination. Special transportation providers 71.33must take recipients to the nearest appropriate health care provider, using the most direct 71.34route as determined by a commercially available mileage software program approved by 72.1the commissioner. The minimum medical assistance reimbursement rates for special 72.2transportation services are:72.3(1) (i) $17 for the base rate and $1.35 per mile for special transportation services to 72.4eligible persons who need a wheelchair-accessible van;72.5(ii) $11.50 for the base rate and $1.30 per mile for special transportation services to 72.6eligible persons who do not need a wheelchair-accessible van; and72.7(iii) $60 for the base rate and $2.40 per mile, and an attendant rate of $9 per trip, for 72.8special transportation services to eligible persons who need a stretcher-accessible vehicle;72.9(2) the base rates for special transportation services in areas defined under RUCA 72.10to be super rural shall be equal to the reimbursement rate established in clause (1) plus 72.1111.3 percent; and72.12(3) for special transportation services in areas defined under RUCA to be rural 72.13or super rural areas:72.14(i) for a trip equal to 17 miles or less, mileage reimbursement shall be equal to 125 72.15percent of the respective mileage rate in clause (1); and72.16(ii) for a trip between 18 and 50 miles, mileage reimbursement shall be equal to 72.17112.5 percent of the respective mileage rate in clause (1).72.18(c) For purposes of reimbursement rates for special transportation services under 72.19paragraph (b), the zip code of the recipient's place of residence shall determine whether 72.20the urban, rural, or super rural reimbursement rate applies.72.21(d) For purposes of this subdivision, "rural urban commuting area" or "RUCA" 72.22means a census-tract based classification system under which a geographical area is 72.23determined to be urban, rural, or super rural.72.24    Sec. 6. Minnesota Statutes 2010, section 256B.14, is amended by adding a subdivision 72.25to read:72.26    Subd. 3a.Spousal contribution.(a) For purposes of this subdivision, the following 72.27terms have the meanings given:72.28(1) "commissioner" means the commissioner of human services;72.29(2) "community spouse" means the spouse, who lives in the community, of an 72.30individual receiving long-term care services in a long-term care facility or home care 72.31services pursuant to the Medicaid waiver for elderly services under section 256B.0915 72.32or the alternative care program under section 256B.0913. A community spouse does not 72.33include a spouse living in the community who receives a monthly income allowance 72.34under section 256B.058, subdivision 2, or who receives home care services or home 73.1and community-based services under section 256B.0915, 256B.092, or 256B.49, or the 73.2alternative care program under section 256B.0913;73.3(3) "cost of care" means the actual fee-for-service costs or capitated payments for 73.4the long-term care spouse;73.5(4) "department" means the Department of Human Services;73.6(5) "disabled child" means a blind or permanently and totally disabled son or 73.7daughter of any age as defined in the Supplemental Security Income program or the state 73.8medical review team;73.9(6) "income" means earned and unearned income, attributable to the community 73.10spouse, used to calculate the adjusted gross income on the prior year's income tax return. 73.11Evidence of income includes, but is not limited to, W-2 and 1099 forms; and73.12(7) "long-term care spouse" means the spouse who is receiving long-term care 73.13services in a long-term care facility or home care services pursuant to the Medicaid 73.14waiver for elderly services under section 256B.0915 or the alternative care program under 73.15section 256B.0913.73.16(b) The community spouse of a long-term care spouse who receives medical 73.17assistance or alternative care services has an obligation to contribute to the cost of care. 73.18The community spouse must pay a monthly fee on a sliding fee scale based on the 73.19community spouse's income. If a minor or disabled child resides with and receives care 73.20from the community spouse, then no fee shall be assessed.73.21(c) For a community spouse with an income equal to or greater than 250 percent of 73.22the federal poverty guidelines for a family of two and less than 545 percent of the federal 73.23poverty guidelines for a family of two, the spousal contribution shall be determined using 73.24a sliding fee scale established by the commissioner that begins at 7.5 percent of the 73.25community spouse's income and increases to 15 percent for those with an income of up to 73.26545 percent of the federal poverty guidelines for a family of two.73.27(d) For a community spouse with an income equal to or greater than 545 percent of 73.28the federal poverty guidelines for a family of two and less than 750 percent of the federal 73.29poverty guidelines for a family of two, the spousal contribution shall be determined using 73.30a sliding fee scale established by the commissioner that begins at 15 percent of the 73.31community spouse's income and increases to 25 percent for those with an income of up to 73.32750 percent of the federal poverty guidelines for a family of two.73.33(e) For a community spouse with an income equal to or greater than 750 percent of 73.34the federal poverty guidelines for a family of two and less than 975 percent of the federal 73.35poverty guidelines for a family of two, the spousal contribution shall be determined using 73.36a sliding fee scale established by the commissioner that begins at 25 percent of the 74.1community spouse's income and increases to 33 percent for those with an income of up to 74.2975 percent of the federal poverty guidelines for a family of two.74.3(f) For a community spouse with an income equal to or greater than 975 percent of 74.4the federal poverty guidelines for a family of two, the spousal contribution shall be 33 74.5percent of the community spouse's income.74.6(g) The spousal contribution shall be explained in writing at the time eligibility 74.7for medical assistance or alternative care is being determined. In addition to explaining 74.8the formula used to determine the fee, the county or tribal agency shall provide written 74.9information describing how to request a variance for undue hardship, how a contribution 74.10may be reviewed or redetermined, the right to appeal a contribution determination, and 74.11that the consequences for not complying with a request to provide information shall be 74.12an assessment against the community spouse for the full cost of care for the long-term 74.13care spouse.74.14(h) The contribution shall be assessed for each month the long-term care spouse 74.15has a community spouse and is eligible for medical assistance payment of long-term 74.16care services or alternative care.74.17(i) The spousal contribution shall be reviewed at least once every 12 months and 74.18when there is a loss or gain in income in excess of ten percent. Thirty days prior to a 74.19review or redetermination, written notice must be provided to the community spouse 74.20and must contain the amount the spouse is required to contribute, notice of the right to 74.21redetermination and appeal, and the telephone number of the division at the agency that is 74.22responsible for redetermination and review. If, after review, the contribution amount is to 74.23be adjusted, the county or tribal agency shall mail a written notice to the community spouse 74.2430 days in advance of the effective date of the change in the amount of the contribution.74.25(1) The spouse shall notify the county or tribal agency within 30 days of a gain or 74.26loss in income in excess of ten percent and provide the agency supporting documentation 74.27to verify the need for redetermination of the fee.74.28(2) When a spouse requests a review or redetermination of the contribution amount, 74.29a request for information shall be sent to the spouse within ten calendar days after the 74.30county or tribal agency receives the request for review.74.31(3) No action shall be taken on a review or redetermination until the required 74.32information is received by the county or tribal agency.74.33(4) The review of the spousal contribution shall be completed within ten days after 74.34the county or tribal agency receives completed information that verifies a loss or gain in 74.35income in excess of ten percent.75.1(5) An increase in the contribution amount is effective in the month in which the 75.2increase in spousal income occurs.75.3(6) A decrease in the contribution amount is effective in the month the spouse 75.4verifies the reduction in income, retroactive to no longer than six months.75.5(j) In no case shall the spousal contribution exceed the amount of medical assistance 75.6expended or the cost of alternative care services for the care of the long-term care spouse. 75.7Annually, upon redetermination, or at termination of eligibility, the total amount of 75.8medical assistance paid or costs of alternative care for the care of the long-term care spouse 75.9and the total amount of the spousal contribution shall be compared. If the total amount 75.10of the spousal contribution exceeds the total amount of medical assistance expended or 75.11cost of alternative care, then the agency shall reimburse the community spouse the excess 75.12amount if the long-term care spouse is no longer receiving services, or apply the excess 75.13amount to the spousal contribution due until the excess amount is exhausted.75.14(k) A community spouse may request a variance by submitting a written request 75.15and supporting documentation that payment of the calculated contribution would cause 75.16an undue hardship. An undue hardship is defined as the inability to pay the calculated 75.17contribution due to medical expenses incurred by the community spouse. Documentation 75.18must include proof of medical expenses incurred by the community spouse since the last 75.19annual redetermination of the contribution amount that are not reimbursable by any public 75.20or private source, and are a type, regardless of amount, that would be allowable as a 75.21federal tax deduction under the Internal Revenue Code.75.22(1) A spouse who requests a variance from a notice of an increase in the amount 75.23of spousal contribution shall continue to make monthly payments at the lower amount 75.24pending determination of the variance request. A spouse who requests a variance from 75.25the initial determination shall not be required to make a payment pending determination 75.26of the variance request. Payments made pending outcome of the variance request that 75.27result in overpayment must be returned to the spouse, if the community spouse is no 75.28longer receiving services, or applied to the spousal contribution in the current year. If the 75.29variance is denied, the spouse shall pay the additional amount due from the effective date 75.30of the increase or the total amount due from the effective date of the original notice of 75.31determination of the spousal contribution.75.32(2) A spouse who is granted a variance shall sign a written agreement in which the 75.33spouse agrees to report to the county or tribal agency any changes in circumstances that 75.34gave rise to the undue hardship variance.75.35(3) When the county or tribal agency receives a request for a variance, written notice 75.36of a grant or denial of the variance shall be mailed to the spouse within 30 calendar days 76.1after the county or tribal agency receives the financial information required in this clause. 76.2The granting of a variance will necessitate a written agreement between the spouse and the 76.3county or tribal agency with regard to the specific terms of the variance. The variance 76.4will not become effective until the written agreement is signed by the spouse. If the 76.5county or tribal agency denies in whole or in part the request for a variance, the denial 76.6notice shall set forth in writing the reasons for the denial that address the specific hardship 76.7and right to appeal.76.8(4) If a variance is granted, the term of the variance shall not exceed 12 months 76.9unless otherwise determined by the county or tribal agency.76.10(5) Undue hardship does not include action taken by a spouse which divested or 76.11diverted income in order to avoid being assessed a spousal contribution.76.12(l) A spouse aggrieved by an action under this subdivision has the right to appeal 76.13under subdivision 4. If the spouse appeals on or before the effective date of an increase 76.14in the spousal fee, the spouse shall continue to make payments to the county or tribal 76.15agency in the lower amount while the appeal is pending. A spouse appealing an initial 76.16determination of a spousal contribution shall not be required to make monthly payments 76.17pending an appeal decision. Payments made that result in an overpayment shall be 76.18reimbursed to the spouse if the long-term care spouse is no longer receiving services, or 76.19applied to the spousal contribution remaining in the current year. If the commissioner's 76.20determination is affirmed, the community spouse shall pay within 90 calendar days of the 76.21order the total amount due from the effective date of the original notice of determination 76.22of the spousal contribution. The commissioner's order is binding on the spouse and the 76.23agency and shall be implemented subject to section 256.045, subdivision 7. No additional 76.24notice is required to enforce the commissioner's order.76.25(m) If the county or tribal agency finds that notice of the payment obligation was 76.26given to the community spouse and the spouse was determined to be able to pay, but that 76.27the spouse failed or refused to pay, a cause of action exists against the community spouse 76.28for that portion of medical assistance payment of long-term care services or alternative 76.29care services granted after notice was given to the community spouse. The action may be 76.30brought by the county or tribal agency in the county where assistance was granted for the 76.31assistance together with the costs of disbursements incurred due to the action. In addition 76.32to granting the county or tribal agency a money judgment, the court may, upon a motion or 76.33order to show cause, order continuing contributions by a community spouse found able to 76.34repay the county or tribal agency. The order shall be effective only for the period of time 76.35during which a contribution shall be assessed.77.1    (n) Counties and tribes are entitled to one-half of the nonfederal share of 77.2contributions made under this section for long-term care spouses on medical assistance 77.3that are directly attributed to county or tribal efforts. Counties and tribes are entitled to 77.425 percent of the contributions made under this section for long-term care spouses on 77.5alternative care directly attributed to county or tribal efforts.77.6    Sec. 7. Minnesota Statutes 2010, section 326B.175, is amended to read:77.7326B.175 ELEVATORS, ENTRANCES SEALED.77.8    Except as provided in section 326B.188, it shall be the duty of the department and 77.9the licensing authority of any municipality which adopts any such ordinance whenever 77.10it finds any such elevator under its jurisdiction in use in violation of any provision of 77.11sections 
         326B.163 to 
         326B.178 to seal the entrances of such elevator and attach a notice 77.12forbidding the use of such elevator until the provisions thereof are complied with.77.13    Sec. 8. [326B.188] COMPLIANCE WITH ELEVATOR CODE CHANGES.77.14(a) This section applies to code requirements for existing elevators and related 77.15devices under Minnesota Rules, chapter 1307, where the deadline set by law for meeting 77.16the code requirements is January 29, 2012, or later.77.17(b) If the department or municipality conducting elevator inspections within its 77.18jurisdiction notifies the owner of an existing elevator or related device of the code 77.19requirements before the effective date of this section, the owner may submit a compliance 77.20plan by December 30, 2011. If the department or municipality does not notify the owner 77.21of an existing elevator or related device of the code requirements before the effective 77.22date of this section, the department or municipality shall notify the owner of the code 77.23requirements and permit the owner to submit a compliance plan by December 30, 2011, or 77.24within 60 days after the date of notification, whichever is later.77.25(c) Any compliance plan submitted under this section must result in compliance with 77.26the code requirements by the later of January 29, 2012, or three years after submission of 77.27the compliance plan. Elevators and related devices that are not in compliance with the 77.28code requirements by the later of January 29, 2012, or three years after the submission of 77.29the compliance plan may be taken out of service as provided in section 326B.175.77.30    Sec. 9. DEVELOPMENTAL DISABILITY WAIVERED SERVICES.77.31    Subdivision 1.Purpose.All individuals in the state of Minnesota who are eligible 77.32for developmental disability waivered services are entitled to receive adequate services, 78.1within the limits of available funding, to ensure their basic needs for housing, food, health, 78.2and safety are met.78.3    Subd. 2.Instructions to commissioner.(a) No later than November 1, 2011, 78.4the commissioner of human services shall convene a workgroup to define the essential 78.5services required to adequately meet the needs of individuals who receive developmental 78.6disability waivered services. The commissioner shall identify the essential services in 78.7each of the following tiers:78.8(1) tier 1, services and costs associated with safety, food, housing, and health care;78.9(2) tier 2, services and costs associated with enhancements toward self-sufficiency; 78.10and78.11(3) tier 3, services and costs associated with quality of life improvements.78.12(b) The commissioner, or designee, and a representative designated by the counties 78.13shall cochair the workgroup. The workgroup shall consider Tier 1 services to be the most 78.14important and of highest priority for available funds, and may choose to implement a policy 78.15that all waiver-eligible individuals receive Tier 1 services within the limits of available 78.16funding before services from Tier 2 or 3 are offered to waiver-eligible individuals.78.17    Sec. 10. ANALYSIS OF PROGRAMS AND THEIR EFFECT ON MARRIAGES; 78.18REPORT.78.19(a) The commissioner of human services shall conduct an analysis of how current 78.20human services programs affect the motivation and capacity of individuals to form and 78.21sustain marriages in which to raise children. Programs to be examined in this marriage 78.22impact analysis may include, but are not limited to, medical assistance, MinnesotaCare, 78.23Minnesota family investment program, child protection, child support enforcement, and 78.24child welfare services.78.25(b) Before January 1, 2012, the commissioner shall submit a report to the legislature 78.26describing the results of this analysis and outline proposals to improve the ability of 78.27human services programs to help people who are interested in marriage to form and 78.28sustain marriages in which to raise children. The commissioner shall ensure that experts 78.29on marriage are consulted on the process of conducting the analysis and writing the report.78.30    Sec. 11. LEGISLATIVE APPROVAL FOR FEDERAL FUNDS.78.31In addition to the requirements of Minnesota Statutes, section 3.3005, the 78.32commissioners of human services and health shall not expend any funding received 78.33through federal grants or subsequent renewal of federal grants without the approval of 79.1three of the four chairs and ranking minority members of the legislative committees with 79.2jurisdiction over health and human services finance.79.3    Sec. 12. NONEMERGENCY MEDICAL TRANSPORTATION SINGLE 79.4ADMINISTRATIVE STRUCTURE PROPOSAL.79.5(a) The commissioner of human services shall develop a proposal to create a single 79.6administrative structure for providing nonemergency medical transportation services to 79.7fee-for-service medical assistance recipients. This proposal must consolidate access and 79.8special transportation into one administrative structure with the goal of standardizing 79.9eligibility determination processes, scheduling arrangements, billing procedures, data 79.10collection, and oversight mechanisms in order to enhance coordination, improve 79.11accountability, and lessen confusion.79.12(b) In developing the proposal, the commissioner shall:79.13(1) examine the current responsibilities performed by the counties and the 79.14Department of Human Services and consider the shift in costs if these responsibilities are 79.15changed;79.16(2) identify key performance measures to assess the cost effectiveness of 79.17nonemergency medical transportation statewide, including a process to collect, audit, 79.18and report data;79.19(3) develop a statewide complaint system for medical assistance recipients using 79.20special transportation;79.21(4) establish a standardized billing process;79.22(5) establish a process that provides public input from interested parties before 79.23special transportation eligibility policies are implemented or significantly changed;79.24(6) establish specific eligibility criteria that include the frequency of eligibility 79.25assessments and the length of time a recipient remains eligible for special transportation;79.26(7) develop a reimbursement method to compensate volunteers for no-load miles 79.27when transporting recipients to or from health-related appointments; and79.28(8) establish specific eligibility criteria to maximize the use of public transportation 79.29by recipients who are without a physical, mental, or other impairment that would prohibit 79.30safely accessing and using public transportation.79.31(c) In developing the proposal, the commissioner shall consult with the 79.32nonemergency medical transportation advisory council established under paragraph (d).79.33(d) The commissioner shall establish the nonemergency medical transportation 79.34advisory council to assist the commissioner in developing a single administrative structure 80.1for providing nonemergency medical transportation services. The council shall be 80.2comprised of: 80.3(1) one representative each from the departments of human services and 80.4transportation; 80.5(2) one representative each from the following organizations: the Minnesota State 80.6Council on Disability, the Minnesota Consortium for Citizens with Disabilities, ARC of 80.7Minnesota, the Association of Minnesota Counties, the R-80 Medical Transportation 80.8Coalition, the Minnesota Para Transit Association, Legal Aid, the Minnesota Ambulance 80.9Association, the National Alliance on Mental Illness, the Minnesota Transportation 80.10Providers Alliance, and the Minnesota Inter-County Association; and 80.11(3) four members from the house of representatives, two from the majority party 80.12and two from the minority party, appointed by the speaker, and four members from the 80.13senate, two from the majority party and two from the minority party, appointed by the 80.14Subcommittee on Committees of the Committee on Rules and Administration.80.15The council is governed by Minnesota Statutes, section 15.509, except that members 80.16shall not receive per diems. The commissioner of human services shall fund all costs 80.17related to the council from existing resources.80.18(e) The commissioner shall submit the proposal and draft legislation necessary for 80.19implementation to the chairs and ranking minority members of the senate and house of 80.20representatives committees or divisions with jurisdiction over health care policy and 80.21finance by January 15, 2012.80.22    Sec. 13. RECOVERY FROM BROKER.80.23(a) If deemed appropriate after a review by the Attorney General's office, the 80.24commissioner of human services, in cooperation with the commissioner of management 80.25and budget, shall recover from any broker of nonemergency medical transportation 80.26services all administrative amounts paid in excess of the original agreed upon amount as 80.27stated in any contract or compensation agreement that provided for the total compensation 80.28for administrative services in each state fiscal year to not exceed a specific agreed amount 80.29for fiscal years 2005, 2006, 2007, 2008, 2009, and 2010.80.30(b) Recoveries under this section shall be based on the findings of the Office of 80.31Legislative Auditor's report on medical nonemergency transportation released in February 80.322011.81.1ARTICLE 481.2HEALTH LICENSING FEES81.3    Section 1. Minnesota Statutes 2010, section 148.07, subdivision 1, is amended to read:81.4    Subdivision 1. Renewal fees. All persons practicing chiropractic within this state, 81.5or licensed so to do, shall pay, on or before the date of expiration of their licenses, to the 81.6Board of Chiropractic Examiners a renewal fee set by the board in accordance with section 81.716A.1283, with a penalty set by the board for each month or portion thereof for which a 81.8license fee is in arrears and upon payment of the renewal and upon compliance with all the 81.9rules of the board, shall be entitled to renewal of their license.81.10    Sec. 2. Minnesota Statutes 2010, section 148.108, is amended by adding a subdivision 81.11to read:81.12    Subd. 4.Animal chiropractic.(a) Animal chiropractic registration fee is $125.81.13(b) Animal chiropractic registration renewal fee is $75.81.14(c) Animal chiropractic inactive renewal fee is $25.81.15    Sec. 3. Minnesota Statutes 2010, section 148.191, subdivision 2, is amended to read:81.16    Subd. 2. Powers. (a) The board is authorized to adopt and, from time to time, revise 81.17rules not inconsistent with the law, as may be necessary to enable it to carry into effect the 81.18provisions of sections 
         148.171 to 
         148.285. The board shall prescribe by rule curricula 81.19and standards for schools and courses preparing persons for licensure under sections 81.20148.171
          to 
         148.285. It shall conduct or provide for surveys of such schools and courses 81.21at such times as it may deem necessary. It shall approve such schools and courses as 81.22meet the requirements of sections 
         148.171 to 
         148.285 and board rules. It shall examine, 81.23license, and renew the license of duly qualified applicants. It shall hold examinations 81.24at least once in each year at such time and place as it may determine. It shall by rule 81.25adopt, evaluate, and periodically revise, as necessary, requirements for licensure and for 81.26registration and renewal of registration as defined in section 
         148.231. It shall maintain a 81.27record of all persons licensed by the board to practice professional or practical nursing and 81.28all registered nurses who hold Minnesota licensure and registration and are certified as 81.29advanced practice registered nurses. It shall cause the prosecution of all persons violating 81.30sections 
         148.171 to 
         148.285 and have power to incur such necessary expense therefor. 81.31It shall register public health nurses who meet educational and other requirements 81.32established by the board by rule, including payment of a fee. Prior to the adoption of rules, 81.33the board shall use the same procedures used by the Department of Health to certify public 82.1health nurses. It shall have power to issue subpoenas, and to compel the attendance of 82.2witnesses and the production of all necessary documents and other evidentiary material. 82.3Any board member may administer oaths to witnesses, or take their affirmation. It shall 82.4keep a record of all its proceedings. 82.5(b) The board shall have access to hospital, nursing home, and other medical records 82.6of a patient cared for by a nurse under review. If the board does not have a written consent 82.7from a patient permitting access to the patient's records, the nurse or facility shall delete 82.8any data in the record that identifies the patient before providing it to the board. The board 82.9shall have access to such other records as reasonably requested by the board to assist the 82.10board in its investigation. Nothing herein may be construed to allow access to any records 82.11protected by section 
         145.64. The board shall maintain any records obtained pursuant to 82.12this paragraph as investigative data under chapter 13. 82.13(c) The board may accept and expend grants or gifts of money or in-kind services 82.14from a person, a public or private entity, or any other source for purposes consistent with 82.15the board's role and within the scope of its statutory authority.82.16(d) The board may accept registration fees for meetings and conferences conducted 82.17for the purposes of board activities that are within the scope of its authority.82.18    Sec. 4. Minnesota Statutes 2010, section 148.212, subdivision 1, is amended to read:82.19    Subdivision 1. Issuance. Upon receipt of the applicable licensure or reregistration 82.20fee and permit fee, and in accordance with rules of the board, the board may issue 82.21a nonrenewable temporary permit to practice professional or practical nursing to an 82.22applicant for licensure or reregistration who is not the subject of a pending investigation 82.23or disciplinary action, nor disqualified for any other reason, under the following 82.24circumstances:82.25(a) The applicant for licensure by examination under section 148.211, subdivision 82.261, has graduated from an approved nursing program within the 60 days preceding board 82.27receipt of an affidavit of graduation or transcript and has been authorized by the board to 82.28write the licensure examination for the first time in the United States. The permit holder 82.29must practice professional or practical nursing under the direct supervision of a registered 82.30nurse. The permit is valid from the date of issue until the date the board takes action on 82.31the application or for 60 days whichever occurs first. 82.32(b) The applicant for licensure by endorsement under section 
         148.211, subdivision 2, 82.33is currently licensed to practice professional or practical nursing in another state, territory, 82.34or Canadian province. The permit is valid from submission of a proper request until the 82.35date of board action on the application or for 60 days, whichever comes first. 83.1(c) (b) The applicant for licensure by endorsement under section 
         148.211, 83.2subdivision 2
         , or for reregistration under section 
         148.231, subdivision 5, is currently 83.3registered in a formal, structured refresher course or its equivalent for nurses that includes 83.4clinical practice. 83.5(d) The applicant for licensure by examination under section 148.211, subdivision 83.61, who graduated from a nursing program in a country other than the United States or 83.7Canada has completed all requirements for licensure except registering for and taking the 83.8nurse licensure examination for the first time in the United States. The permit holder must 83.9practice professional nursing under the direct supervision of a registered nurse. The permit 83.10is valid from the date of issue until the date the board takes action on the application or for 83.1160 days, whichever occurs first. 83.12    Sec. 5. Minnesota Statutes 2010, section 148.231, is amended to read:83.13148.231 REGISTRATION; FAILURE TO REGISTER; REREGISTRATION; 83.14VERIFICATION.83.15    Subdivision 1. Registration. Every person licensed to practice professional or 83.16practical nursing must maintain with the board a current registration for practice as a 83.17registered nurse or licensed practical nurse which must be renewed at regular intervals 83.18established by the board by rule. No certificate of registration shall be issued by the board 83.19to a nurse until the nurse has submitted satisfactory evidence of compliance with the 83.20procedures and minimum requirements established by the board.83.21The fee for periodic registration for practice as a nurse shall be determined by the 83.22board by rule law. A penalty fee shall be added for any application received after the 83.23required date as specified by the board by rule. Upon receipt of the application and the 83.24required fees, the board shall verify the application and the evidence of completion of 83.25continuing education requirements in effect, and thereupon issue to the nurse a certificate 83.26of registration for the next renewal period.83.27    Subd. 4. Failure to register. Any person licensed under the provisions of sections 83.28148.171
          to 
         148.285 who fails to register within the required period shall not be entitled to 83.29practice nursing in this state as a registered nurse or licensed practical nurse. 83.30    Subd. 5. Reregistration. A person whose registration has lapsed desiring to 83.31resume practice shall make application for reregistration, submit satisfactory evidence of 83.32compliance with the procedures and requirements established by the board, and pay the 83.33registration reregistration fee for the current period to the board. A penalty fee shall be 83.34required from a person who practiced nursing without current registration. Thereupon, the84.1registration certificate shall be issued to the person who shall immediately be placed on 84.2the practicing list as a registered nurse or licensed practical nurse.84.3    Subd. 6. Verification. A person licensed under the provisions of sections 
         148.171 to 84.4148.285
          who requests the board to verify a Minnesota license to another state, territory, 84.5or country or to an agency, facility, school, or institution shall pay a fee to the board84.6for each verification. 84.7    Sec. 6. [148.242] FEES.84.8The fees specified in section 148.243 are nonrefundable and must be deposited in 84.9the state government special revenue fund.84.10    Sec. 7. [148.243] FEE AMOUNTS.84.11    Subdivision 1.Licensure by examination.The fee for licensure by examination is 84.12$105.84.13    Subd. 2.Reexamination fee.The reexamination fee is $60.84.14    Subd. 3.Licensure by endorsement.The fee for licensure by endorsement is $105.84.15    Subd. 4.Registration renewal.The fee for registration renewal is $85.84.16    Subd. 5.Reregistration.The fee for reregistration is $105.84.17    Subd. 6.Replacement license.The fee for a replacement license is $20.84.18    Subd. 7.Public health nurse certification.The fee for public health nurse 84.19certification is $30.84.20    Subd. 8.Drug Enforcement Administration verification for Advanced Practice 84.21Registered Nurse (APRN).The Drug Enforcement Administration verification for 84.22APRN is $50.84.23    Subd. 9.Licensure verification other than through Nursys.The fee for 84.24verification of licensure status other than through Nursys verification is $20.84.25    Subd. 10.Verification of examination scores.The fee for verification of 84.26examination scores is $20.84.27    Subd. 11.Microfilmed licensure application materials.The fee for a copy of 84.28microfilmed licensure application materials is $20.84.29    Subd. 12.Nursing business registration; initial application.The fee for the initial 84.30application for nursing business registration is $100.84.31    Subd. 13.Nursing business registration; annual application.The fee for the 84.32annual application for nursing business registration is $25.84.33    Subd. 14.Practicing without current registration.The fee for practicing without 84.34current registration is two times the amount of the current registration renewal fee for any 85.1part of the first calendar month, plus the current registration renewal fee for any part of 85.2any subsequent month up to 24 months.85.3    Subd. 15.Practicing without current APRN certification.The fee for practicing 85.4without current APRN certification is $200 for the first month or any part thereof, plus 85.5$100 for each subsequent month or part thereof.85.6    Subd. 16.Dishonored check fee.The service fee for a dishonored check is as 85.7provided in section 604.113.85.8    Subd. 17.Border state registry fee.The initial application fee for border state 85.9registration is $50. Any subsequent notice of employment change to remain or be 85.10reinstated on the registry is $50.85.11    Sec. 8. Minnesota Statutes 2010, section 148B.17, is amended to read:85.12148B.17 FEES.85.13    Subdivision. 1.Fees; Board of Marriage and Family Therapy.Each board shall 85.14by rule establish The board's fees, including late fees, for licenses and renewals are 85.15established so that the total fees collected by the board will as closely as possible equal 85.16anticipated expenditures during the fiscal biennium, as provided in section 
         16A.1285. 85.17Fees must be credited to accounts the board's account in the state government special 85.18revenue fund. 85.19    Subd. 2.Licensure and application fees.Nonrefundable licensure and application 85.20fees charged by the board are as follows:85.21(1) application fee for national examination is $220;85.22(2) application fee for Licensed Marriage and Family Therapist (LMFT) state 85.23examination is $110;85.24(3) initial LMFT license fee is prorated, but cannot exceed $125;85.25(4) annual renewal fee for LMFT license is $125;85.26(5) late fee for initial Licensed Associate Marriage and Family Therapist LAMFT 85.27license renewal is $50;85.28(6) application fee for LMFT licensure by reciprocity is $340;85.29(7) fee for initial Licensed Associate Marriage and Family Therapist (LAMFT) 85.30license is $75;85.31(8) annual renewal fee for LAMFT license is $75;85.32(9) late fee for LAMFT renewal is $50;85.33(10) fee for reinstatement of license is $150; and 85.34(11) fee for emeritus status is $125.85.35    Subd. 3.Other fees.Other fees charged by the board are as follows:86.1(1) sponsor application fee for approval of a continuing education course is $60;86.2(2) fee for license verification by mail is $10;86.3(3) duplicate license fee is $25;86.4(4) duplicate renewal card fee is $10;86.5(5) fee for licensee mailing list is $60;86.6(6) fee for a rule book is $10; and86.7(7) fees as authorized by section 148B.175, subdivision 6, clause (7).86.8    Sec. 9. Minnesota Statutes 2010, section 148B.33, subdivision 2, is amended to read:86.9    Subd. 2. Fee. Each applicant shall pay a nonrefundable application fee set by 86.10the board under section 148B.17.86.11    Sec. 10. Minnesota Statutes 2010, section 148B.52, is amended to read:86.12148B.52 DUTIES OF THE BOARD.86.13(a) The Board of Behavioral Health and Therapy shall:86.14(1) establish by rule appropriate techniques, including examinations and other 86.15methods, for determining whether applicants and licensees are qualified under sections 86.16148B.50
          to 
         148B.593; 86.17(2) establish by rule standards for professional conduct, including adoption of a 86.18Code of Professional Ethics and requirements for continuing education and supervision;86.19(3) issue licenses to individuals qualified under sections 
         148B.50 to 
         148B.593; 86.20(4) establish by rule standards for initial education including coursework for 86.21licensure and content of professional education;86.22(5) establish, maintain, and publish annually a register of current licensees and 86.23approved supervisors;86.24(6) establish initial and renewal application and examination fees sufficient to cover 86.25operating expenses of the board and its agents in accordance with section 16A.1283;86.26(7) educate the public about the existence and content of the laws and rules for 86.27licensed professional counselors to enable consumers to file complaints against licensees 86.28who may have violated the rules; and86.29(8) periodically evaluate its rules in order to refine the standards for licensing 86.30professional counselors and to improve the methods used to enforce the board's standards.86.31(b) The board may appoint a professional discipline committee for each occupational 86.32licensure regulated by the board, and may appoint a board member as chair. The 86.33professional discipline committee shall consist of five members representative of the 87.1licensed occupation and shall provide recommendations to the board with regard to rule 87.2techniques, standards, procedures, and related issues specific to the licensed occupation.87.3    Sec. 11. Minnesota Statutes 2010, section 150A.091, subdivision 2, is amended to read:87.4    Subd. 2. Application fees. Each applicant shall submit with a license, advanced 87.5dental therapist certificate, or permit application a nonrefundable fee in the following 87.6amounts in order to administratively process an application:87.7(1) dentist, $140;87.8(2) full faculty dentist, $140;87.9(2) (3) limited faculty dentist, $140;87.10(3) (4) resident dentist or dental provider, $55;87.11(5) advanced dental therapist, $100;87.12(4) (6) dental therapist, $100;87.13(5) (7) dental hygienist, $55;87.14(6) (8) licensed dental assistant, $55; and87.15(7) (9) dental assistant with a permit as described in Minnesota Rules, part 87.163100.8500, subpart 3, $15.87.17    Sec. 12. Minnesota Statutes 2010, section 150A.091, subdivision 3, is amended to read:87.18    Subd. 3. Initial license or permit fees. Along with the application fee, each of the 87.19following applicants shall submit a separate prorated initial license or permit fee. The 87.20prorated initial fee shall be established by the board based on the number of months of the 87.21applicant's initial term as described in Minnesota Rules, part 3100.1700, subpart 1a, not to 87.22exceed the following monthly fee amounts:87.23(1) dentist or full faculty dentist, $14 times the number of months of the initial term;87.24(2) dental therapist, $10 times the number of months of the initial term;87.25(3) dental hygienist, $5 times the number of months of the initial term;87.26(4) licensed dental assistant, $3 times the number of months of the initial term; and87.27(5) dental assistant with a permit as described in Minnesota Rules, part 3100.8500, 87.28subpart 3, $1 times the number of months of the initial term.87.29    Sec. 13. Minnesota Statutes 2010, section 150A.091, subdivision 4, is amended to read:87.30    Subd. 4. Annual license fees. Each limited faculty or resident dentist shall submit 87.31with an annual license renewal application a fee established by the board not to exceed 87.32the following amounts:87.33(1) limited faculty dentist, $168; and88.1(2) resident dentist or dental provider, $59.88.2    Sec. 14. Minnesota Statutes 2010, section 150A.091, subdivision 5, is amended to read:88.3    Subd. 5. Biennial license or permit fees. Each of the following applicants shall 88.4submit with a biennial license or permit renewal application a fee as established by the 88.5board, not to exceed the following amounts:88.6(1) dentist or full faculty dentist, $336;88.7(2) dental therapist, $180;88.8(3) dental hygienist, $118;88.9(4) licensed dental assistant, $80; and88.10(5) dental assistant with a permit as described in Minnesota Rules, part 3100.8500, 88.11subpart 3, $24.88.12    Sec. 15. Minnesota Statutes 2010, section 150A.091, subdivision 8, is amended to read:88.13    Subd. 8. Duplicate license or certificate fee. Each applicant shall submit, with 88.14a request for issuance of a duplicate of the original license, or of an annual or biennial 88.15renewal certificate for a license or permit, a fee in the following amounts:88.16(1) original dentist, full faculty dentist, dental therapist, dental hygiene, or dental 88.17assistant license, $35; and88.18(2) annual or biennial renewal certificates, $10.88.19    Sec. 16. Minnesota Statutes 2010, section 150A.091, is amended by adding a 88.20subdivision to read:88.21    Subd. 16.Failure of professional development portfolio audit.A licensee shall 88.22submit a fee as established by the board not to exceed the amount of $250 after failing 88.23two consecutive professional development portfolio audits and, thereafter, for each failed 88.24professional development portfolio audit under Minnesota Rules, part 3100.5300.88.25    Sec. 17. [151.065] FEE AMOUNTS.88.26    Subdivision 1.Application fees.Application fees for licensure and registration 88.27are as follows:88.28(1) pharmacist licensed by examination, $130;88.29(2) pharmacist licensed by reciprocity, $225;88.30(3) pharmacy intern, $30;88.31(4) pharmacy technician, $30;88.32(5) pharmacy, $190;89.1(6) drug wholesaler, legend drugs only, $200;89.2(7) drug wholesaler, legend and nonlegend drugs, $200;89.3(8) drug wholesaler, nonlegend drugs, veterinary legend drugs, or both, $175;89.4(9) drug wholesaler, medical gases, $150;89.5(10) drug wholesaler, also licensed as a pharmacy in Minnesota, $125;89.6(11) drug manufacturer, legend drugs only, $200;89.7(12) drug manufacturer, legend and nonlegend drugs, $200;89.8(13) drug manufacturer, nonlegend or veterinary legend drugs, $175;89.9(14) drug manufacturer, medical gases, $150;89.10(15) drug manufacturer, also licensed as a pharmacy in Minnesota, $125;89.11(16) medical gas distributor, $75;89.12(17) controlled substance researcher, $50; and89.13(18) pharmacy professional corporation, $100.89.14    Subd. 2.Original license fee.The pharmacist original licensure fee, $130.89.15    Subd. 3.Annual renewal fees.Annual licensure and registration renewal fees 89.16are as follows:89.17(1) pharmacist, $130;89.18(2) pharmacy technician, $30;89.19(3) pharmacy, $190;89.20(4) drug wholesaler, legend drugs only, $200;89.21(5) drug wholesaler, legend and nonlegend drugs, $200;89.22(6) drug wholesaler, nonlegend drugs, veterinary legend drugs, or both, $175;89.23(7) drug wholesaler, medical gases, $150;89.24(8) drug wholesaler, also licensed as a pharmacy in Minnesota, $125;89.25(9) drug manufacturer, legend drugs only, $200;89.26(10) drug manufacturer, legend and nonlegend drugs, $200;89.27(11) drug manufacturer, nonlegend, veterinary legend drugs, or both, $175;89.28(12) drug manufacturer, medical gases, $150;89.29(13) drug manufacturer, also licensed as a pharmacy in Minnesota, $125;89.30(14) medical gas distributor, $75;89.31(15) controlled substance researcher, $50; and89.32(16) pharmacy professional corporation, $45.89.33    Subd. 4.Miscellaneous fees.Fees for issuance of affidavits and duplicate licenses 89.34and certificates are as follows:89.35(1) intern affidavit, $15;89.36(2) duplicate small license, $15; and90.1(3) duplicate large certificate, $25.90.2    Subd. 5.Late fees.All annual renewal fees are subject to a 50 percent late fee if 90.3the renewal fee and application are not received by the board prior to the date specified 90.4by the board.90.5    Subd. 6.Reinstatement fees.(a) A pharmacist who has allowed the pharmacist's 90.6license to lapse may reinstate the license with board approval and upon payment of any 90.7fees and late fees in arrears, up to a maximum of $1,000.90.8(b) A pharmacy technician who has allowed the technician's registration to lapse 90.9may reinstate the registration with board approval and upon payment of any fees and late 90.10fees in arrears, up to a maximum of $90.90.11(c) An owner of a pharmacy, a drug wholesaler, a drug manufacturer, or a medical 90.12gas distributor who has allowed the license of the establishment to lapse may reinstate the 90.13license with board approval and upon payment of any fees and late fees in arrears.90.14(d) A controlled substance researcher who has allowed the researcher's registration 90.15to lapse may reinstate the registration with board approval and upon payment of any fees 90.16and late fees in arrears.90.17(e) A pharmacist owner of a professional corporation who has allowed the 90.18corporation's registration to lapse may reinstate the registration with board approval and 90.19upon payment of any fees and late fees in arrears.90.20    Sec. 18. Minnesota Statutes 2010, section 151.07, is amended to read:90.21151.07 MEETINGS; EXAMINATION FEE.90.22The board shall meet at times as may be necessary and as it may determine to 90.23examine applicants for licensure and to transact its other business, giving reasonable 90.24notice of all examinations by mail to known applicants therefor. The secretary shall record 90.25the names of all persons licensed by the board, together with the grounds upon which 90.26the right of each to licensure was claimed. The fee for examination shall be in such the 90.27 amount as the board may determine specified in section 151.065, which fee may in the 90.28discretion of the board be returned to applicants not taking the examination.90.29    Sec. 19. Minnesota Statutes 2010, section 151.101, is amended to read:90.30151.101 INTERNSHIP.90.31Upon payment of the fee specified in section 151.065, the board may license register90.32as an intern any natural persons who have satisfied the board that they are of good moral 90.33character, not physically or mentally unfit, and who have successfully completed the 90.34educational requirements for intern licensure registration prescribed by the board. The 91.1board shall prescribe standards and requirements for interns, pharmacist-preceptors, and 91.2internship training but may not require more than one year of such training.91.3The board in its discretion may accept internship experience obtained in another 91.4state provided the internship requirements in such other state are in the opinion of the 91.5board equivalent to those herein provided.91.6    Sec. 20. Minnesota Statutes 2010, section 151.102, is amended by adding a subdivision 91.7to read:91.8    Subd. 3.Registration fee.The board shall not register an individual as a pharmacy 91.9technician unless all applicable fees specified in section 151.065 have been paid.91.10    Sec. 21. Minnesota Statutes 2010, section 151.12, is amended to read:91.11151.12 RECIPROCITY; LICENSURE.91.12The board may in its discretion grant licensure without examination to any 91.13pharmacist licensed by the Board of Pharmacy or a similar board of another state which 91.14accords similar recognition to licensees of this state; provided, the requirements for 91.15licensure in such other state are in the opinion of the board equivalent to those herein 91.16provided. The fee for licensure shall be in such the amount as the board may determine by 91.17rule specified in section 151.065.91.18    Sec. 22. Minnesota Statutes 2010, section 151.13, subdivision 1, is amended to read:91.19    Subdivision 1. Renewal fee. Every person licensed by the board as a pharmacist 91.20shall pay to the board a the annual renewal fee to be fixed by it specified in section 91.21151.065. The board may promulgate by rule a charge to be assessed for the delinquent 91.22payment of a fee. the late fee specified in section 151.065 if the renewal fee and 91.23application are not received by the board prior to the date specified by the board. It shall 91.24be unlawful for any person licensed as a pharmacist who refuses or fails to pay such any 91.25applicable  renewal or late fee to practice pharmacy in this state. Every certificate and 91.26license shall expire at the time therein prescribed.91.27    Sec. 23. Minnesota Statutes 2010, section 151.19, is amended to read:91.28151.19 REGISTRATION; FEES.91.29    Subdivision 1. Pharmacy registration. The board shall require and provide for the 91.30annual registration of every pharmacy now or hereafter doing business within this state. 91.31Upon the payment of a any applicable  fee to be set by the board specified in section 91.32151.065, the board shall issue a registration certificate in such form as it may prescribe to 92.1such persons as may be qualified by law to conduct a pharmacy. Such certificate shall be 92.2displayed in a conspicuous place in the pharmacy for which it is issued and expire on the 92.330th day of June following the date of issue. It shall be unlawful for any person to conduct 92.4a pharmacy unless such certificate has been issued to the person by the board.92.5    Subd. 2. Nonresident pharmacies. The board shall require and provide for an 92.6annual nonresident special pharmacy registration for all pharmacies located outside of this 92.7state that regularly dispense medications for Minnesota residents and mail, ship, or deliver 92.8prescription medications into this state. Nonresident special pharmacy registration shall 92.9be granted by the board upon payment of any applicable fee specified in section 151.065 92.10and the disclosure and certification by a pharmacy:92.11    (1) that it is licensed in the state in which the dispensing facility is located and from 92.12which the drugs are dispensed;92.13    (2) the location, names, and titles of all principal corporate officers and all 92.14pharmacists who are dispensing drugs to residents of this state;92.15    (3) that it complies with all lawful directions and requests for information from 92.16the Board of Pharmacy of all states in which it is licensed or registered, except that it 92.17shall respond directly to all communications from the board concerning emergency 92.18circumstances arising from the dispensing of drugs to residents of this state;92.19    (4) that it maintains its records of drugs dispensed to residents of this state so that the 92.20records are readily retrievable from the records of other drugs dispensed;92.21    (5) that it cooperates with the board in providing information to the Board of 92.22Pharmacy of the state in which it is licensed concerning matters related to the dispensing 92.23of drugs to residents of this state;92.24    (6) that during its regular hours of operation, but not less than six days per week, for 92.25a minimum of 40 hours per week, a toll-free telephone service is provided to facilitate 92.26communication between patients in this state and a pharmacist at the pharmacy who has 92.27access to the patients' records; the toll-free number must be disclosed on the label affixed 92.28to each container of drugs dispensed to residents of this state; and92.29    (7) that, upon request of a resident of a long-term care facility located within the 92.30state of Minnesota, the resident's authorized representative, or a contract pharmacy or 92.31licensed health care facility acting on behalf of the resident, the pharmacy will dispense 92.32medications prescribed for the resident in unit-dose packaging or, alternatively, comply 92.33with the provisions of section 
         151.415, subdivision 5.92.34    Subd. 3. Sale of federally restricted medical gases. The board shall require and 92.35provide for the annual registration of every person or establishment not licensed as a 92.36pharmacy or a practitioner engaged in the retail sale or distribution of federally restricted 93.1medical gases. Upon the payment of a any applicable  fee to be set by the board specified 93.2in section 151.065, the board shall issue a registration certificate in such form as it may 93.3prescribe to those persons or places that may be qualified to sell or distribute federally 93.4restricted medical gases. The certificate shall be displayed in a conspicuous place in the 93.5business for which it is issued and expire on the date set by the board. It is unlawful for 93.6a person to sell or distribute federally restricted medical gases unless a certificate has 93.7been issued to that person by the board.93.8    Sec. 24. Minnesota Statutes 2010, section 151.25, is amended to read:93.9151.25 REGISTRATION OF MANUFACTURERS; FEE; PROHIBITIONS.93.10The board shall require and provide for the annual registration of every person 93.11engaged in manufacturing drugs, medicines, chemicals, or poisons for medicinal purposes, 93.12now or hereafter doing business with accounts in this state. Upon a payment of a any 93.13applicable fee as set by the board specified in section 151.065, the board shall issue a 93.14registration certificate in such form as it may prescribe to such manufacturer. Such 93.15registration certificate shall be displayed in a conspicuous place in such manufacturer's 93.16or wholesaler's place of business for which it is issued and expire on the date set by the 93.17board. It shall be unlawful for any person to manufacture drugs, medicines, chemicals, 93.18or poisons for medicinal purposes unless such a certificate has been issued to the person 93.19by the board. It shall be unlawful for any person engaged in the manufacture of drugs, 93.20medicines, chemicals, or poisons for medicinal purposes, or the person's agent, to sell 93.21legend drugs to other than a pharmacy, except as provided in this chapter.93.22    Sec. 25. Minnesota Statutes 2010, section 151.47, subdivision 1, is amended to read:93.23    Subdivision 1. Requirements. All wholesale drug distributors are subject to the 93.24requirements in paragraphs (a) to (f).93.25(a) No person or distribution outlet shall act as a wholesale drug distributor without 93.26first obtaining a license from the board and paying the required any applicable  fee93.27specified in section 151.065.93.28(b) No license shall be issued or renewed for a wholesale drug distributor to operate 93.29unless the applicant agrees to operate in a manner prescribed by federal and state law and 93.30according to the rules adopted by the board.93.31(c) The board may require a separate license for each facility directly or indirectly 93.32owned or operated by the same business entity within the state, or for a parent entity 93.33with divisions, subsidiaries, or affiliate companies within the state, when operations 94.1are conducted at more than one location and joint ownership and control exists among 94.2all the entities.94.3(d) As a condition for receiving and retaining a wholesale drug distributor license 94.4issued under sections 
         151.42 to 
         151.51, an applicant shall satisfy the board that it has 94.5and will continuously maintain: 94.6(1) adequate storage conditions and facilities;94.7(2) minimum liability and other insurance as may be required under any applicable 94.8federal or state law;94.9(3) a viable security system that includes an after hours central alarm, or comparable 94.10entry detection capability; restricted access to the premises; comprehensive employment 94.11applicant screening; and safeguards against all forms of employee theft;94.12(4) a system of records describing all wholesale drug distributor activities set forth 94.13in section 
         151.44 for at least the most recent two-year period, which shall be reasonably 94.14accessible as defined by board regulations in any inspection authorized by the board; 94.15(5) principals and persons, including officers, directors, primary shareholders, 94.16and key management executives, who must at all times demonstrate and maintain their 94.17capability of conducting business in conformity with sound financial practices as well 94.18as state and federal law;94.19(6) complete, updated information, to be provided to the board as a condition for 94.20obtaining and retaining a license, about each wholesale drug distributor to be licensed, 94.21including all pertinent corporate licensee information, if applicable, or other ownership, 94.22principal, key personnel, and facilities information found to be necessary by the board;94.23(7) written policies and procedures that assure reasonable wholesale drug distributor 94.24preparation for, protection against, and handling of any facility security or operation 94.25problems, including, but not limited to, those caused by natural disaster or government 94.26emergency, inventory inaccuracies or product shipping and receiving, outdated product 94.27or other unauthorized product control, appropriate disposition of returned goods, and 94.28product recalls;94.29(8) sufficient inspection procedures for all incoming and outgoing product 94.30shipments; and94.31(9) operations in compliance with all federal requirements applicable to wholesale 94.32drug distribution.94.33(e) An agent or employee of any licensed wholesale drug distributor need not seek 94.34licensure under this section.94.35(f) A wholesale drug distributor shall file with the board an annual report, in a 94.36form and on the date prescribed by the board, identifying all payments, honoraria, 95.1reimbursement or other compensation authorized under section 
         151.461, clauses (3) to 95.2(5), paid to practitioners in Minnesota during the preceding calendar year. The report 95.3shall identify the nature and value of any payments totaling $100 or more, to a particular 95.4practitioner during the year, and shall identify the practitioner. Reports filed under this 95.5provision are public data. 95.6    Sec. 26. Minnesota Statutes 2010, section 151.48, is amended to read:95.7151.48 OUT-OF-STATE WHOLESALE DRUG DISTRIBUTOR LICENSING.95.8(a) It is unlawful for an out-of-state wholesale drug distributor to conduct business 95.9in the state without first obtaining a license from the board and paying the required any 95.10applicable fee specified in section 151.065.95.11(b) Application for an out-of-state wholesale drug distributor license under this 95.12section shall be made on a form furnished by the board.95.13(c) No person acting as principal or agent for any out-of-state wholesale drug 95.14distributor may sell or distribute drugs in the state unless the distributor has obtained 95.15a license.95.16(d) The board may adopt regulations that permit out-of-state wholesale drug 95.17distributors to obtain a license on the basis of reciprocity to the extent that an out-of-state 95.18wholesale drug distributor:95.19(1) possesses a valid license granted by another state under legal standards 95.20comparable to those that must be met by a wholesale drug distributor of this state as 95.21prerequisites for obtaining a license under the laws of this state; and95.22(2) can show that the other state would extend reciprocal treatment under its own 95.23laws to a wholesale drug distributor of this state.95.24    Sec. 27. Minnesota Statutes 2010, section 152.12, subdivision 3, is amended to read:95.25    Subd. 3. Research project use of controlled substances. Any qualified person 95.26may use controlled substances in the course of a bona fide research project but cannot 95.27administer or dispense such drugs to human beings unless such drugs are prescribed, 95.28dispensed and administered by a person lawfully authorized to do so. Every person 95.29who engages in research involving the use of such substances shall apply annually for 95.30registration by the state Board of Pharmacy and shall pay any applicable fee specified in 95.31section 151.065, provided that such registration shall not be required if the person is 95.32covered by and has complied with federal laws covering such research projects.96.1ARTICLE 596.2HEALTH CARE96.3    Section 1. [1.06] FREEDOM OF CHOICE IN HEALTH CARE ACT.96.4    Subdivision 1.Citation.This section shall be known as and may be cited as the 96.5"Freedom of Choice in Health Care Act."96.6    Subd. 2.Definitions.(a) For purposes of this section, the following terms have 96.7the meanings given them.96.8(b) "Health care service" means any service, treatment, or provision of a product for 96.9the care of a physical or mental disease, illness, injury, defect, or condition, or to otherwise 96.10maintain or improve physical or mental health, subject to all laws and rules regulating 96.11health service providers and products within the state of Minnesota.96.12(c) "Mode of securing" means to purchase directly or on credit or by trade, or to 96.13contract for third-party payment by insurance or other legal means as authorized by the 96.14state of Minnesota, or to apply for or accept employer-sponsored or government-sponsored 96.15health care benefits under such conditions as may legally be required as a condition of 96.16such benefits, or any combination of the same.96.17(d) "Penalty" means any civil or criminal fine, tax, salary or wage withholding, 96.18surcharge, fee, or any other imposed consequence established by law or rule of a 96.19government or its subdivision or agency that is used to punish or discourage the exercise 96.20of rights protected under this section.96.21    Subd. 3.Statement of public policy.(a) The power to require or regulate a person's 96.22choice in the mode of securing health care services, or to impose a penalty related to that 96.23choice, is not found in the Constitution of the United States of America, and is therefore a 96.24power reserved to the people pursuant to the Ninth Amendment, and to the several states 96.25pursuant to the Tenth Amendment. The state of Minnesota hereby exercises its sovereign 96.26power to declare the public policy of the state of Minnesota regarding the right of all 96.27persons residing in the state in choosing the mode of securing health care services.96.28(b) It is hereby declared that the public policy of the state of Minnesota, consistent 96.29with our constitutionally recognized and inalienable rights of liberty, is that every person 96.30within the state of Minnesota is and shall be free to choose or decline to choose any mode 96.31of securing health care services without penalty or threat of penalty.96.32(c) The policy stated under this section shall not be applied to impair any right of 96.33contract related to the provision of health care services to any person or group.96.34    Subd. 4.Enforcement.Upon penalty of suspension or revocation of any applicable 96.35license, no public official, employee, officer of the court, or agent of the state of 97.1Minnesota, or any branch or political subdivision thereof, shall act to impose, collect, 97.2enforce, or effectuate any penalty in the state of Minnesota that violates the public policy 97.3set forth in this section.97.4    Sec. 2. Minnesota Statutes 2010, section 62E.08, subdivision 1, is amended to read:97.5    Subdivision 1. Establishment. The association shall establish the following 97.6maximum premiums to be charged for membership in the comprehensive health insurance 97.7plan:97.8(a) the premium for the number one qualified plan shall range from a minimum of 97.9101 percent to a maximum of 125 percent of the weighted average of rates charged by 97.10those insurers and health maintenance organizations with individuals enrolled in:97.11(1) $1,000 annual deductible individual plans of insurance in force in Minnesota;97.12(2) individual health maintenance organization contracts of coverage with a $1,000 97.13annual deductible which are in force in Minnesota; and97.14(3) other plans of coverage similar to plans offered by the association based on 97.15generally accepted actuarial principles;97.16(b) the premium for the number two qualified plan shall range from a minimum of 97.17101 percent to a maximum of 125 percent of the weighted average of rates charged by 97.18those insurers and health maintenance organizations with individuals enrolled in:97.19(1) $500 annual deductible individual plans of insurance in force in Minnesota;97.20(2) individual health maintenance organization contracts of coverage with a $500 97.21annual deductible which are in force in Minnesota; and97.22(3) other plans of coverage similar to plans offered by the association based on 97.23generally accepted actuarial principles;97.24(c) the premiums for the plans with a $2,000, $5,000, or $10,000 annual deductible 97.25shall range from a minimum of 101 percent to a maximum of 125 percent of the weighted 97.26average of rates charged by those insurers and health maintenance organizations with 97.27individuals enrolled in:97.28(1) $2,000, $5,000, or $10,000 annual deductible individual plans, respectively, in 97.29force in Minnesota; and97.30(2) individual health maintenance organization contracts of coverage with a $2,000, 97.31$5,000, or $10,000 annual deductible, respectively, which are in force in Minnesota; or97.32(3) other plans of coverage similar to plans offered by the association based on 97.33generally accepted actuarial principles;97.34(d) the premium for each type of Medicare supplement plan required to be offered 97.35by the association pursuant to section 
         62E.12 shall range from a minimum of 101 percent 98.1to a maximum of 125 percent of the weighted average of rates charged by those insurers 98.2and health maintenance organizations with individuals enrolled in: 98.3(1) Medicare supplement plans in force in Minnesota;98.4(2) health maintenance organization Medicare supplement contracts of coverage 98.5which are in force in Minnesota; and98.6(3) other plans of coverage similar to plans offered by the association based on 98.7generally accepted actuarial principles; and98.8(e) the charge for health maintenance organization coverage shall be based on 98.9generally accepted actuarial principles.; and98.10(f) the premium for a high-deductible, basic plan offered under section 62E.121 shall 98.11range from a minimum of 101 percent to a maximum of 125 percent of the weighted 98.12average of rates charged by those insurers and health maintenance organizations offering 98.13comparable plans outside of the Minnesota Comprehensive Health Association.98.14The list of insurers and health maintenance organizations whose rates are used to 98.15establish the premium for coverage offered by the association pursuant to paragraphs (a) 98.16to (d) and (f) shall be established by the commissioner on the basis of information which 98.17shall be provided to the association by all insurers and health maintenance organizations 98.18annually at the commissioner's request. This information shall include the number of 98.19individuals covered by each type of plan or contract specified in paragraphs (a) to (d) and 98.20(f) that is sold, issued, and renewed by the insurers and health maintenance organizations, 98.21including those plans or contracts available only on a renewal basis. The information shall 98.22also include the rates charged for each type of plan or contract.98.23In establishing premiums pursuant to this section, the association shall utilize 98.24generally accepted actuarial principles, provided that the association shall not discriminate 98.25in charging premiums based upon sex. In order to compute a weighted average for each 98.26type of plan or contract specified under paragraphs (a) to (d) and (f), the association 98.27shall, using the information collected pursuant to this subdivision, list insurers and health 98.28maintenance organizations in rank order of the total number of individuals covered by 98.29each insurer or health maintenance organization. The association shall then compute 98.30a weighted average of the rates charged for coverage by all the insurers and health 98.31maintenance organizations by:98.32(1) multiplying the numbers of individuals covered by each insurer or health 98.33maintenance organization by the rates charged for coverage;98.34(2) separately summing both the number of individuals covered by all the insurers 98.35and health maintenance organizations and all the products computed under clause (1); and99.1(3) dividing the total of the products computed under clause (1) by the total number 99.2of individuals covered.99.3The association may elect to use a sample of information from the insurers and 99.4health maintenance organizations for purposes of computing a weighted average. In no 99.5case, however, may a sample used by the association to compute a weighted average 99.6include information from fewer than the two insurers or health maintenance organizations 99.7highest in rank order.99.8    Sec. 3. [62E.121] HIGH-DEDUCTIBLE, BASIC PLAN.99.9    Subdivision 1.Required offering.The Minnesota Comprehensive Health 99.10Association shall offer a high-deductible, basic plan that meets the requirements specified 99.11in this section. The high-deductible, basic plan is a one-person plan. Any dependents 99.12must be covered separately.99.13    Subd. 2.Annual deductible; out-of-pocket maximum.(a) The plan shall provide 99.14the following in-network annual deductible options: $3,000, $6,000, $9,000, and $12,000. 99.15The in-network annual out-of-pocket maximum for each annual deductible option shall be 99.16$1,000 greater than the amount of the annual deductible.99.17(b) The deductible is subject to an annual increase based on the change in the 99.18Consumer Price Index (CPI).99.19    Subd. 3.Office visits for nonpreventive care.The following co-payments shall 99.20apply for each of the first three office visits per calendar year for nonpreventive care:99.21(1) $30 per visit for the $3,000 annual deductible option;99.22(2) $40 per visit for the $6,000 annual deductible option;99.23(3) $50 per visit for the $9,000 annual deductible option; and99.24(4) $60 per visit for the $12,000 annual deductible option.99.25For the fourth and subsequent visits during the calendar year, 80 percent coverage is 99.26provided under all deductible options, after the deductible is met.99.27    Subd. 4.Preventive care.One hundred percent coverage is provided for preventive 99.28care, and no co-payment, coinsurance, or deductible requirements apply.99.29    Subd. 5.Prescription drugs.A $10 co-payment applies to preferred generic drugs. 99.30Preferred brand-name drugs require an enrollee payment of 100 percent of the health 99.31plan's discounted rate.99.32    Subd. 6.Convenience care center visits.A $20 co-payment applies for the first 99.33three convenience care center visits during a calendar year. For the fourth and subsequent 99.34visits during a calendar year, 80 percent coverage is provided after the deductible is met.100.1    Subd. 7.Urgent care center visits.A $100 co-payment applies for the first urgent 100.2care center visit during a calendar year. For the second and subsequent visits during a 100.3calendar year, 80 percent coverage is provided after the deductible is met.100.4    Subd. 8.Emergency room visits.A $200 co-payment applies for the first 100.5emergency room visit during a calendar year. For the second and subsequent visits during 100.6a calendar year, 80 percent coverage is provided after the deductible is met.100.7    Subd. 9.Lab and x-ray; hospital services; ambulance; surgery.Lab and x-ray 100.8services, hospital services, ambulance services, and surgery are covered at 80 percent 100.9after the deductible is met.100.10    Subd. 10.Eyewear.The health plan pays up to $50 per calendar year for eyewear.100.11    Subd. 11.Maternity.Maternity, labor and delivery, and postpartum care are not 100.12covered. One hundred percent coverage is provided for prenatal care and no deductible 100.13applies.100.14    Subd. 12.Other eligible health care services.Other eligible health care services 100.15are covered at 80 percent after the deductible is met.100.16    Subd. 13.Option to remove mental health and substance abuse coverage.100.17Enrollees have the option of removing mental health and substance abuse coverage in 100.18exchange for a reduced premium.100.19    Subd. 14.Option to upgrade prescription drug coverage.Enrollees have 100.20the option to upgrade prescription drug coverage to include coverage for preferred 100.21brand-name drugs with a $50 co-payment and coverage for nonpreferred drugs with a 100.22$100 co-payment in exchange for an increased premium.100.23    Subd. 15.Out-of-network services.(a) The out-of-network annual deductible is 100.24double the in-network annual deductible.100.25(b) There is no out-of-pocket maximum for out-of-network services.100.26(c) Benefits for out-of-network services are covered at 60 percent after the deductible 100.27is met.100.28(d) The lifetime maximum benefit for out-of-network services is $1,000,000.100.29    Subd. 16.Services not covered.Services not covered include: custodial care 100.30or rest care; most dental services; cosmetic services; refractive eye surgery; infertility 100.31services; and services that are investigational, not medically necessary, or received while 100.32on military duty.100.33    Sec. 4. Minnesota Statutes 2010, section 62E.14, is amended by adding a subdivision 100.34to read:101.1    Subd. 4f.Waiver of preexisting conditions for persons covered by healthy 101.2Minnesota contribution program.A person may enroll in the comprehensive plan with 101.3a waiver of the preexisting condition limitation in subdivision 3 if the person is eligible for 101.4the healthy Minnesota contribution program, and has been denied coverage as described 101.5under section 256L.031, subdivision 6.101.6    Sec. 5. Minnesota Statutes 2010, section 62J.04, subdivision 9, is amended to read:101.7    Subd. 9. Growth limits; federal programs. The commissioners of health and 101.8human services shall establish a rate methodology for Medicare and Medicaid risk-based 101.9contracting with health plan companies that is consistent with statewide growth limits. 101.10The methodology shall be presented for review by the Minnesota Health Care Commission 101.11and the Legislative Commission on Health Care Access prior to the submission of a 101.12waiver request to the Centers for Medicare and Medicaid Services and subsequent 101.13implementation of the methodology.101.14    Sec. 6. Minnesota Statutes 2010, section 62J.692, subdivision 9, is amended to read:101.15    Subd. 9. Review of eligible providers. The commissioner and the Medical 101.16Education and Research Costs Advisory Committee may review provider groups included 101.17in the definition of a clinical medical education program to assure that the distribution of 101.18the funds continue to be consistent with the purpose of this section. The results of any 101.19such reviews must be reported to the Legislative Commission on Health Care Access101.20chairs and ranking minority members of the legislative committees with jurisdiction over 101.21health care policy and finance.101.22    Sec. 7. [62J.824] BILLING FOR PROCEDURES TO CORRECT MEDICAL 101.23ERRORS PROHIBITED.101.24A health care provider shall not bill a patient, and shall not be reimbursed, for 101.25any operation, treatment, or other care that is provided to reverse, correct, or otherwise 101.26minimize the affects of an adverse health care event, as described in section 144.7065, 101.27subdivisions 2 to 7, for which that health care provider is responsible.101.28    Sec. 8. Minnesota Statutes 2010, section 62Q.32, is amended to read:101.2962Q.32 LOCAL OMBUDSPERSON.101.30County board or community health service agencies may establish an office of 101.31ombudsperson to provide a system of consumer advocacy for persons receiving health 102.1care services through a health plan company. The ombudsperson's functions may include, 102.2but are not limited to:102.3(a) mediation or advocacy on behalf of a person accessing the complaint and appeal 102.4procedures to ensure that necessary medical services are provided by the health plan 102.5company; and102.6(b) investigation of the quality of services provided to a person and determine the 102.7extent to which quality assurance mechanisms are needed or any other system change 102.8may be needed. The commissioner of health shall make recommendations for funding 102.9these functions including the amount of funding needed and a plan for distribution. The 102.10commissioner shall submit these recommendations to the Legislative Commission on 102.11Health Care Access by January 15, 1996.102.12    Sec. 9. [62Q.46] PAYMENT TO OUT-OF-NETWORK PROVIDERS.102.13    A health plan company may limit payments to out-of-network providers to the usual 102.14and customary payment rate that applies to similarly situated providers participating in the 102.15health plan company's provider network.102.16    Sec. 10. Minnesota Statutes 2010, section 62U.04, subdivision 3, is amended to read:102.17    Subd. 3. Provider peer grouping. (a) The commissioner shall develop a peer 102.18grouping system for providers based on a combined measure that incorporates both 102.19provider risk-adjusted cost of care and quality of care, and for specific conditions as 102.20determined by the commissioner. In developing this system, the commissioner shall 102.21consult and coordinate with health care providers, health plan companies, state agencies, 102.22and organizations that work to improve health care quality in Minnesota. For purposes of 102.23the final establishment of the peer grouping system, the commissioner shall not contract 102.24with any private entity, organization, or consortium of entities that has or will have a direct 102.25financial interest in the outcome of the system.102.26    (b) By no later than October 15, 2010, the commissioner shall disseminate 102.27information to providers on their total cost of care, total resource use, total quality of care, 102.28and the total care results of the grouping developed under this subdivision in comparison 102.29to an appropriate peer group. Any analyses or reports that identify providers may only be 102.30published after the provider has been provided the opportunity by the commissioner to 102.31review the underlying data and submit comments. Providers may be given any data for 102.32which they are the subject of the data. The provider shall have 30 days to review the data 102.33for accuracy and initiate an appeal as specified in paragraph (d).103.1    (c) By no later than January 1, 2011, the commissioner shall disseminate information 103.2to providers on their condition-specific cost of care, condition-specific resource use, 103.3condition-specific quality of care, and the condition-specific results of the grouping 103.4developed under this subdivision in comparison to an appropriate peer group. Any 103.5analyses or reports that identify providers may only be published after the provider has 103.6been provided the opportunity by the commissioner to review the underlying data and 103.7submit comments. Providers may be given any data for which they are the subject of the 103.8data. The provider shall have 30 days to review the data for accuracy and initiate an 103.9appeal as specified in paragraph (d).103.10(d) The commissioner shall establish an appeals process to resolve disputes from 103.11providers regarding the accuracy of the data used to develop analyses or reports. When 103.12a provider appeals the accuracy of the data used to calculate the peer grouping system 103.13results, the provider shall:103.14(1) clearly indicate the reason they believe the data used to calculate the peer group 103.15system results are not accurate;103.16(2) provide evidence and documentation to support the reason that data was not 103.17accurate; and103.18(3) cooperate with the commissioner, including allowing the commissioner access to 103.19data necessary and relevant to resolving the dispute.103.20If a provider does not meet the requirements of this paragraph, a provider's appeal shall be 103.21considered withdrawn. The commissioner shall not publish results for a specific provider 103.22under paragraph (e) or (f) while that provider has an unresolved appeal.103.23    (e) Beginning January 1, 2011, the commissioner shall, no less than annually, 103.24publish information on providers' total cost, total resource use, total quality, and the results 103.25of the total care portion of the peer grouping process. The results that are published must 103.26be on a risk-adjusted basis.103.27(f) Beginning March 30, 2011, the commissioner shall no less than annually publish 103.28information on providers' condition-specific cost, condition-specific resource use, and 103.29condition-specific quality, and the results of the condition-specific portion of the peer 103.30grouping process. The results that are published must be on a risk-adjusted basis.103.31(g) Prior to disseminating data to providers under paragraph (b) or (c) or publishing 103.32information under paragraph (e) or (f), the commissioner shall ensure the scientific 103.33validity and reliability of the results according to the standards described in paragraph (h). 103.34If additional time is needed to establish the scientific validity and reliability of the results, 103.35the commissioner may delay the dissemination of data to providers under paragraph (b) 103.36or (c), or the publication of information under paragraph (e) or (f). If the delay is more 104.1than 60 days, the commissioner shall report in writing to the Legislative Commission on 104.2Health Care Access chairs and ranking minority members of the legislative committees 104.3with jurisdiction over health care policy and finance the following information:104.4(1) the reason for the delay;104.5(2) the actions being taken to resolve the delay and establish the scientific validity 104.6and reliability of the results; and104.7(3) the new dates by which the results shall be disseminated.104.8If there is a delay under this paragraph, the commissioner must disseminate the 104.9information to providers under paragraph (b) or (c) at least 90 days before publishing 104.10results under paragraph (e) or (f).104.11(h) The commissioner's assurance of valid and reliable clinic and hospital peer 104.12grouping performance results shall include, at a minimum, the following:104.13(1) use of the best available evidence, research, and methodologies; and104.14(2) establishment of an explicit minimum reliability threshold developed in 104.15collaboration with the subjects of the data and the users of the data, at a level not below 104.16nationally accepted standards where such standards exist.104.17In achieving these thresholds, the commissioner shall not aggregate clinics that are not 104.18part of the same system or practice group. The commissioner shall consult with and solicit 104.19feedback from representatives of physician clinics and hospitals during the peer grouping 104.20data analysis process to obtain input on the methodological options prior to final analysis 104.21and on the design, development, and testing of provider reports.104.22    Sec. 11. Minnesota Statutes 2010, section 62U.04, subdivision 9, is amended to read:104.23    Subd. 9. Uses of information. (a) By no later than 12 months after the commissioner 104.24publishes the information in subdivision 3, paragraph (e): For product renewals or for 104.25new products that are offered, after 12 months have elapsed from publication by the 104.26commissioner of the information in subdivision 3, paragraph (e):104.27    (1) the commissioner of management and budget shall use the information and 104.28methods developed under subdivision 3 to strengthen incentives for members of the state 104.29employee group insurance program to use high-quality, low-cost providers;104.30    (2) all political subdivisions, as defined in section 
         13.02, subdivision 11, that offer 104.31health benefits to their employees must offer plans that differentiate providers on their 104.32cost and quality performance and create incentives for members to use better-performing 104.33providers;105.1    (3) all health plan companies shall use the information and methods developed 105.2under subdivision 3 to develop products that encourage consumers to use high-quality, 105.3low-cost providers; and105.4    (4) health plan companies that issue health plans in the individual market or the 105.5small employer market must offer at least one health plan that uses the information 105.6developed under subdivision 3 to establish financial incentives for consumers to choose 105.7higher-quality, lower-cost providers through enrollee cost-sharing or selective provider 105.8networks.105.9    (b) By January 1, 2011, the commissioner of health shall report to the governor 105.10and the legislature on recommendations to encourage health plan companies to promote 105.11widespread adoption of products that encourage the use of high-quality, low-cost providers. 105.12The commissioner's recommendations may include tax incentives, public reporting of 105.13health plan performance, regulatory incentives or changes, and other strategies.105.14    Sec. 12. Minnesota Statutes 2010, section 62U.06, subdivision 2, is amended to read:105.15    Subd. 2. Legislative oversight. Beginning January 15, 2009, the commissioner 105.16of health shall submit to the Legislative Commission on Health Care Access chairs and 105.17ranking minority members of the legislative committees with jurisdiction over health care 105.18policy and finance periodic progress reports on the implementation of this chapter and 105.19sections 
         256B.0751 to 
         256B.0754.105.20    Sec. 13. Minnesota Statutes 2010, section 256.01, subdivision 2b, is amended to read:105.21    Subd. 2b. Performance payments.The commissioner shall develop and implement 105.22a pay-for-performance system to provide performance payments to eligible medical 105.23groups and clinics that demonstrate optimum care in serving individuals with chronic 105.24diseases who are enrolled in health care programs administered by the commissioner under 105.25chapters 256B, 256D, and 256L. The commissioner may receive any federal matching 105.26money that is made available through the medical assistance program for managed care 105.27oversight contracted through vendors, including consumer surveys, studies, and external 105.28quality reviews as required by the federal Balanced Budget Act of 1997, Code of Federal 105.29Regulations, title 42, part 438-managed care, subpart E-external quality review. Any 105.30federal money received for managed care oversight is appropriated to the commissioner 105.31for this purpose. The commissioner may expend the federal money received in either 105.32year of the biennium.106.1    Sec. 14. Minnesota Statutes 2010, section 256.01, is amended by adding a subdivision 106.2to read:106.3    Subd. 33.Contingency contract fees.When the commissioner enters into 106.4a contingency-based contract for the purpose of recovering medical assistance or 106.5MinnesotaCare funds, the commissioner may retain that portion of the recovered funds 106.6equal to the amount of the contingency fee.106.7    Sec. 15. Minnesota Statutes 2010, section 256.01, is amended by adding a subdivision 106.8to read:106.9    Subd. 34.Elimination of certain provider reporting requirements; sunset of 106.10new requirements.(a) Notwithstanding any other law, rule, or provision to the contrary, 106.11effective July 1, 2012, the commissioner shall cease collecting from health care providers 106.12and purchasers all reports and data related to health care costs, quality, utilization, access, 106.13patient encounters, and disease surveillance and public health, and related to provider 106.14licensure, monitoring, finances, and regulation, unless the reports or data are necessary for 106.15federal compliance. For purposes of this subdivision, the term "health care providers and 106.16purchasers" has the meaning provided in section 62J.03, subdivision 8, except that it also 106.17includes nursing homes, health plan companies as defined in section 62Q.01, subdivision 106.184, and managed care and county-based purchasing plans delivering services under sections 106.19256B.69 and 256B.692.106.20(b) The commissioner shall present to the 2012 legislature draft legislation to repeal, 106.21effective July 1, 2012, the provider reporting requirements identified under paragraph (a) 106.22that are not necessary for federal compliance.106.23(c) The commissioner may establish new provider reporting requirements to take 106.24effect on or after July 1, 2012. These new reporting requirements must sunset five years 106.25from their effective date, unless they are renewed by the commissioner. All new provider 106.26reporting requirements and requests for their renewal shall not take effect unless they 106.27are enacted in state law.106.28    Sec. 16. Minnesota Statutes 2010, section 256.969, subdivision 2b, is amended to read:106.29    Subd. 2b. Operating payment rates. In determining operating payment rates for 106.30admissions occurring on or after the rate year beginning January 1, 1991, and every two 106.31years after, or more frequently as determined by the commissioner, the commissioner 106.32shall obtain operating data from an updated base year and establish operating payment 106.33rates per admission for each hospital based on the cost-finding methods and allowable 106.34costs of the Medicare program in effect during the base year. Rates under the general 107.1assistance medical care, medical assistance, and MinnesotaCare programs shall not be 107.2rebased to more current data on January 1, 1997, January 1, 2005, for the first 24 months 107.3of the rebased period beginning January 1, 2009. For the first 24 months of the rebased 107.4period beginning January 1, 2011, rates shall not be rebased, except that a Minnesota 107.5long-term hospital shall be rebased effective January 1, 2011, based on its most recent 107.6Medicare cost report ending on or before September 1, 2008, with the provisions under 107.7subdivisions 9 and 23, based on the rates in effect on December 31, 2010. For subsequent 107.8rate setting periods in which the base years are updated, a Minnesota long-term hospital's 107.9base year shall remain within the same period as other hospitals. Effective January 1, 107.102013, rates shall be rebased at full value Rates must not be rebased to more current data 107.11for the first six months of the rebased period beginning January 1, 2013. The base year 107.12operating payment rate per admission is standardized by the case mix index and adjusted 107.13by the hospital cost index, relative values, and disproportionate population adjustment. 107.14The cost and charge data used to establish operating rates shall only reflect inpatient 107.15services covered by medical assistance and shall not include property cost information 107.16and costs recognized in outlier payments.107.17    Sec. 17. Minnesota Statutes 2010, section 256.969, is amended by adding a subdivision 107.18to read:107.19    Subd. 31.Initiatives to reduce incidence of low birth-weight.The commissioner 107.20shall require hospitals located in the seven-county metropolitan area, as a condition of 107.21contract, to implement strategies to reduce the incidence of low birth-weight in geographic 107.22areas identified by the commissioner as having a higher than average incidence of low 107.23birth-weight, with special emphasis on areas within a one-mile radius of the hospital. 107.24These strategies may focus on smoking prevention and cessation, ensuring that pregnant 107.25women get adequate nutrition, and addressing demographic, social, and environmental 107.26risk factors. The strategies must coordinate health care with social services and the 107.27local public health system, and offer patient education through appropriate means. 107.28The commissioner shall require hospitals to submit proposed initiatives for approval 107.29to the commissioner by January 1, 2012, and the commissioner shall require hospitals 107.30to implement approved initiatives by July 1, 2012. The commissioner shall evaluate 107.31the strategies adopted to reduce low birth-weight, and shall require hospitals to submit 107.32outcome and other data necessary for the evaluation.107.33    Sec. 18. Minnesota Statutes 2010, section 256B.04, subdivision 18, is amended to read:108.1    Subd. 18. Applications for medical assistance.(a) The state agency may 108.2take applications for medical assistance and conduct eligibility determinations for 108.3MinnesotaCare enrollees.108.4    (b) The commissioner of human services shall modify the Minnesota health care 108.5programs application form to add a question asking applicants: "Are you a United States 108.6military veteran?"108.7    Sec. 19. Minnesota Statutes 2010, section 256B.05, is amended by adding a 108.8subdivision to read:108.9    Subd. 5.Technical assistance.The commissioner shall provide technical assistance 108.10to county agencies in processing complex medical assistance applications, including but 108.11not limited to applications for long-term care services. The commissioner shall provide 108.12this technical assistance using existing financial resources.108.13    Sec. 20. Minnesota Statutes 2010, section 256B.055, subdivision 15, is amended to 108.14read:108.15    Subd. 15. Adults without children.(a) Medical assistance may be paid for a 108.16person who is:108.17(1) at least age 21 and under age 65;108.18(2) not pregnant;108.19(3) not entitled to Medicare Part A or enrolled in Medicare Part B under Title XVIII 108.20of the Social Security Act;108.21(4) not an adult in a family with children as defined in section 
         256L.01, subdivision 108.223a; and108.23(5) not described in another subdivision of this section.108.24(b) If the federal government eliminates the federal Medicaid match or reduces the 108.25federal Medicaid matching rate beyond any adjustment required as part of the annual 108.26recalculation of the state's overall Medicaid matching rate for persons eligible under this 108.27subdivision, the commissioner shall eliminate coverage for persons enrolled under this 108.28subdivision and suspend new enrollment under this subdivision effective on the date 108.29of the elimination or reduction.108.30EFFECTIVE DATE.The amendments to this section are effective the day 108.31following final enactment and expire January 1, 2014.108.32    Sec. 21. Minnesota Statutes 2010, section 256B.056, subdivision 3, is amended to read:109.1    Subd. 3. Asset limitations for individuals and families.(a) To be eligible for 109.2medical assistance, a person must not individually own more than $3,000 in assets, or if a 109.3member of a household with two family members, husband and wife, or parent and child, 109.4the household must not own more than $6,000 in assets, plus $200 for each additional 109.5legal dependent. In addition to these maximum amounts, an eligible individual or family 109.6may accrue interest on these amounts, but they must be reduced to the maximum at the 109.7time of an eligibility redetermination. The accumulation of the clothing and personal 109.8needs allowance according to section 
         256B.35 must also be reduced to the maximum at 109.9the time of the eligibility redetermination. The value of assets that are not considered in 109.10determining eligibility for medical assistance is the value of those assets excluded under 109.11the supplemental security income program for aged, blind, and disabled persons, with 109.12the following exceptions:109.13    (1) household goods and personal effects are not considered;109.14    (2) capital and operating assets of a trade or business that the local agency determines 109.15are necessary to the person's ability to earn an income are not considered;109.16    (3) motor vehicles are excluded to the same extent excluded by the supplemental 109.17security income program;109.18    (4) assets designated as burial expenses are excluded to the same extent excluded by 109.19the supplemental security income program. Burial expenses funded by annuity contracts 109.20or life insurance policies must irrevocably designate the individual's estate as contingent 109.21beneficiary to the extent proceeds are not used for payment of selected burial expenses; and109.22    (5) effective upon federal approval, for a person who no longer qualifies as an 109.23employed person with a disability due to loss of earnings, assets allowed while eligible 109.24for medical assistance under section 
         256B.057, subdivision 9, are not considered for 12 109.25months, beginning with the first month of ineligibility as an employed person with a 109.26disability, to the extent that the person's total assets remain within the allowed limits of 109.27section 
         256B.057, subdivision 9, paragraph (c).109.28    (b) No asset limit shall apply to persons eligible under section 256B.055, subdivision 109.2915.109.30EFFECTIVE DATE.This section is effective January 1, 2012.109.31    Sec. 22. Minnesota Statutes 2010, section 256B.056, subdivision 4, is amended to read:109.32    Subd. 4. Income. (a) To be eligible for medical assistance, a person eligible under 109.33section 
         256B.055, subdivisions 7, 7a, and 12, may have income up to 100 percent of 109.34the federal poverty guidelines. Effective January 1, 2000, and each successive January, 110.1recipients of supplemental security income may have an income up to the supplemental 110.2security income standard in effect on that date.110.3    (b) To be eligible for medical assistance, families and children may have an income 110.4up to 133-1/3 percent of the AFDC income standard in effect under the July 16, 1996, 110.5AFDC state plan. Effective July 1, 2000, the base AFDC standard in effect on July 16, 110.61996, shall be increased by three percent.110.7    (c) Effective July 1, 2002, to be eligible for medical assistance, families and children 110.8may have an income up to 100 percent of the federal poverty guidelines for the family size.110.9    (d) To be eligible for medical assistance under section 256B.055, subdivision 15, a 110.10person may have an income up to 75 percent of federal poverty guidelines for the family 110.11size.110.12    (e) (d) In computing income to determine eligibility of persons under paragraphs 110.13(a) to (d) (c) who are not residents of long-term care facilities, the commissioner shall 110.14disregard increases in income as required by Public Law Numbers 94-566, section 503; 110.1599-272; and 99-509. Veterans aid and attendance benefits and Veterans Administration 110.16unusual medical expense payments are considered income to the recipient.110.17EFFECTIVE DATE.This section is effective January 1, 2012.110.18    Sec. 23. Minnesota Statutes 2010, section 256B.06, subdivision 4, is amended to read:110.19    Subd. 4. Citizenship requirements. (a) Eligibility for medical assistance is limited 110.20to citizens of the United States, qualified noncitizens as defined in this subdivision, and 110.21other persons residing lawfully in the United States. Citizens or nationals of the United 110.22States must cooperate in obtaining satisfactory documentary evidence of citizenship or 110.23nationality according to the requirements of the federal Deficit Reduction Act of 2005, 110.24Public Law 109-171.110.25(b) "Qualified noncitizen" means a person who meets one of the following 110.26immigration criteria:110.27(1) admitted for lawful permanent residence according to United States Code, title 8;110.28(2) admitted to the United States as a refugee according to United States Code, 110.29title 8, section 1157;110.30(3) granted asylum according to United States Code, title 8, section 1158;110.31(4) granted withholding of deportation according to United States Code, title 8, 110.32section 1253(h);110.33(5) paroled for a period of at least one year according to United States Code, title 8, 110.34section 1182(d)(5);111.1(6) granted conditional entrant status according to United States Code, title 8, 111.2section 1153(a)(7);111.3(7) determined to be a battered noncitizen by the United States Attorney General 111.4according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, 111.5title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;111.6(8) is a child of a noncitizen determined to be a battered noncitizen by the United 111.7States Attorney General according to the Illegal Immigration Reform and Immigrant 111.8Responsibility Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill, 111.9Public Law 104-200; or111.10(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public 111.11Law 96-422, the Refugee Education Assistance Act of 1980.111.12(c) All qualified noncitizens who were residing in the United States before August 111.1322, 1996, who otherwise meet the eligibility requirements of this chapter, are eligible for 111.14medical assistance with federal financial participation.111.15(d) All qualified noncitizens who entered the United States on or after August 22, 111.161996, and who otherwise meet the eligibility requirements of this chapter, are eligible for 111.17medical assistance with federal financial participation through November 30, 1996.111.18Beginning December 1, 1996, qualified noncitizens who entered the United States 111.19on or after August 22, 1996, and who otherwise meet the eligibility requirements of this 111.20chapter are eligible for medical assistance with federal participation for five years if they 111.21meet one of the following criteria:111.22(i) refugees admitted to the United States according to United States Code, title 8, 111.23section 1157;111.24(ii) persons granted asylum according to United States Code, title 8, section 1158;111.25(iii) persons granted withholding of deportation according to United States Code, 111.26title 8, section 1253(h);111.27(iv) veterans of the United States armed forces with an honorable discharge for 111.28a reason other than noncitizen status, their spouses and unmarried minor dependent 111.29children; or111.30(v) persons on active duty in the United States armed forces, other than for training, 111.31their spouses and unmarried minor dependent children.111.32Beginning December 1, 1996, qualified noncitizens who do not meet one of the 111.33criteria in items (i) to (v) are eligible for medical assistance without federal financial 111.34participation as described in paragraph (j).111.35Notwithstanding paragraph (j), beginning July 1, 2010, children and pregnant 111.36women who are noncitizens described in paragraph (b) or (e), are eligible for medical 112.1assistance with federal financial participation as provided by the federal Children's Health 112.2Insurance Program Reauthorization Act of 2009, Public Law 111-3.112.3(e) Noncitizens who are not qualified noncitizens as defined in paragraph (b), who 112.4are lawfully present in the United States, as defined in Code of Federal Regulations, title 112.58, section 
         103.12, and who otherwise meet the eligibility requirements of this chapter, are 112.6eligible for medical assistance under clauses (1) to (3). These individuals must cooperate 112.7with the United States Citizenship and Immigration Services to pursue any applicable 112.8immigration status, including citizenship, that would qualify them for medical assistance 112.9with federal financial participation.112.10(1) Persons who were medical assistance recipients on August 22, 1996, are eligible 112.11for medical assistance with federal financial participation through December 31, 1996.112.12(2) Beginning January 1, 1997, persons described in clause (1) are eligible for 112.13medical assistance without federal financial participation as described in paragraph (j).112.14(3) Beginning December 1, 1996, persons residing in the United States prior to 112.15August 22, 1996, who were not receiving medical assistance and persons who arrived on 112.16or after August 22, 1996, are eligible for medical assistance without federal financial 112.17participation as described in paragraph (j).112.18(f) Nonimmigrants who otherwise meet the eligibility requirements of this chapter 112.19are eligible for the benefits as provided in paragraphs (g) to (i). For purposes of this 112.20subdivision, a "nonimmigrant" is a person in one of the classes listed in United States 112.21Code, title 8, section 1101(a)(15).112.22(g) Payment shall also be made for care and services that are furnished to noncitizens, 112.23regardless of immigration status, who otherwise meet the eligibility requirements of 112.24this chapter, if such care and services are necessary for the treatment of an emergency 112.25medical condition, except for organ transplants and related care and services and routine 112.26prenatal care.112.27(h) For purposes of this subdivision, the term "emergency medical condition" means 112.28a medical condition that meets the requirements of United States Code, title 42, section 112.291396b(v).112.30(i)(1) Notwithstanding paragraph (h), services that are necessary for the treatment of 112.31an emergency medical condition are limited to the following:112.32(i) services delivered in an emergency room that are directly related to the treatment 112.33of an emergency medical condition;112.34(ii) services delivered in an inpatient hospital setting following admission from an 112.35emergency room or clinic for an acute emergency condition; and113.1(iii) follow-up services that are directly related to the original service provided to 113.2treat the emergency medical condition and that are covered by the global payment made 113.3to the provider.113.4    (2) Services for the treatment of emergency medical conditions do not include:113.5(i) services delivered in an emergency room or inpatient setting to treat a 113.6nonemergency condition;113.7(ii) organ and stem cell transplants and related care;113.8(iii) services for routine prenatal care;113.9(iv) continuing care, including long-term care, nursing facility services, home health 113.10care, adult day care, day training, or supportive living services;113.11(v) elective surgery;113.12(vi) outpatient prescription drugs, unless the drugs are administered or dispensed as 113.13part of an emergency room visit;113.14(vii) preventative health care and family planning services;113.15(viii) dialysis;113.16(ix) chemotherapy or therapeutic radiation services;113.17(x) rehabilitation services;113.18(xi) physical, occupational, or speech therapy;113.19(xii) transportation services;113.20(xiii) case management;113.21(xiv) prosthetics, orthotics, durable medical equipment, or medical supplies;113.22(xv) dental services;113.23(xvi) hospice care;113.24(xvii) audiology services and hearing aids;113.25(xviii) podiatry services;113.26(xix) chiropractic services;113.27(xx) immunizations;113.28(xxi) vision services and eyeglasses;113.29(xxii) waiver services;113.30(xxiii) individualized education programs; or113.31(xxiv) chemical dependency treatment.113.32(i) (j) Beginning July 1, 2009, pregnant noncitizens who are undocumented, 113.33nonimmigrants, or lawfully present as designated in paragraph (e) and who are not 113.34covered by a group health plan or health insurance coverage according to Code of 113.35Federal Regulations, title 42, section 457.310, and who otherwise meet the eligibility 113.36requirements of this chapter, are eligible for medical assistance through the period of 114.1pregnancy, including labor and delivery, and 60 days postpartum, to the extent federal 114.2funds are available under title XXI of the Social Security Act, and the state children's 114.3health insurance program.114.4(j) (k) Qualified noncitizens as described in paragraph (d), and all other noncitizens 114.5lawfully residing in the United States as described in paragraph (e), who are ineligible 114.6for medical assistance with federal financial participation and who otherwise meet the 114.7eligibility requirements of chapter 256B and of this paragraph, are eligible for medical 114.8assistance without federal financial participation. Qualified noncitizens as described 114.9in paragraph (d) are only eligible for medical assistance without federal financial 114.10participation for five years from their date of entry into the United States.114.11(k) (l) Beginning October 1, 2003, persons who are receiving care and rehabilitation 114.12services from a nonprofit center established to serve victims of torture and are otherwise 114.13ineligible for medical assistance under this chapter are eligible for medical assistance 114.14without federal financial participation. These individuals are eligible only for the period 114.15during which they are receiving services from the center. Individuals eligible under this 114.16paragraph shall not be required to participate in prepaid medical assistance.114.17    Sec. 24. Minnesota Statutes 2010, section 256B.0625, is amended by adding a 114.18subdivision to read:114.19    Subd. 1b.Care coordination services provided through pediatric hospitals.114.20(a) Medical assistance covers care coordination services provided by certain pediatric 114.21hospitals to children with high-cost medical conditions and children at risk of recurrent 114.22hospitalization for acute or chronic illnesses. There must be Level I and Level II pediatric 114.23care coordination services.114.24(b) Level I pediatric care coordination services are provided by advanced practice 114.25nurses employed by or under contract with pediatric hospitals that have a neonatal 114.26intensive care unit and are either recipients of payments to support the training of residents 114.27from an approved graduate medical residency program under United States Code, title 114.2842, section 256e, or the major pediatric teaching hospital affiliate of the University of 114.29Minnesota Medical School, and that meet the criteria in this subdivision.114.30(c) The services in paragraph (b) must be available through in-home video telehealth 114.31management and other methods, and must be designed to improve patient outcomes 114.32and reduce unnecessary hospital and emergency room utilization. The services must 114.33streamline communication, reduce redundancy, and eliminate unnecessary documentation 114.34through the use of a Web-accessible, uniform document that contains critical patient care 114.35management information, and which is accessible to all providers with patient consent. 115.1The commissioner shall develop the uniform document and associated Web site and shall 115.2implement procedures to assess patient outcomes and evaluate the effectiveness of the 115.3care coordination services provided under this subdivision.115.4(d) Medical assistance also covers, as durable medical equipment, computers, 115.5webcams, and other technology necessary to allow in-home video telehealth management.115.6(e) For purposes of paragraph (b), a child has a high-cost medical condition if 115.7inpatient hospital expenses for that child related to complex or chronic illnesses or 115.8conditions for the most recent calendar year exceeded $100,000, or if the expenses for that 115.9child are projected to exceed $100,000 for the current calendar year. For purposes of this 115.10subdivision, a child is at risk of recurrent hospitalization if the child was hospitalized three 115.11or more times for acute or chronic illness in the most recent calendar year.115.12(f) For purposes of paragraph (b), "care coordination" means collaboration between 115.13the advanced practice nurse and primary care physicians and specialists to manage 115.14care and reduce hospitalizations, patient case management, development of medical 115.15management plans for chronic illnesses and recurrent acute illnesses, oversight and 115.16coordination of all aspects of care in partnership with families, organization of medical 115.17information into a summary of critical information, coordination and appropriate 115.18sequencing of tests and multiple appointments, information and assistance with accessing 115.19resources, and telephone triage for acute illnesses or problems.115.20(g) The commissioner shall adjust managed care and county-based purchasing plan 115.21capitation rates to reflect savings from the coverage of this service.115.22(h) Level II pediatric care coordination services are provided by registered nurses 115.23employed by or under contract with a pediatric hospital that has been designated as 115.24an essential community provider under section 62Q.19, subdivision 1, clause (4), and 115.25has been a recipient of payments to support the training of residents from an approved 115.26graduate medical residency program pursuant to United States Code, title 42, section 115.27256e, and that meets the following criteria: 115.28(1) the services must be provided through telehealth management and other methods, 115.29be available on a regular schedule seven days per week, and be designed to provide 115.30collaboration in patient care as provided by the patient's family, primary care providers, 115.31and the hospital and specialized physicians;115.32(2) for purposes of this paragraph, a child has a high-cost medical condition if the 115.33child has a serious chronic physical disability caused by a congenital anomaly, birth 115.34injury or traumatic injury, complications which can be expected to cause further injury, 115.35hospitalization, or death, but that can be effectively addressed through ongoing family 116.1and primary care supported by communication of ongoing care information and care 116.2coordination; and 116.3(3) for purposes of this paragraph, "care coordination" means the ready availability 116.4of telehealth management services to support collaboration through a registered nurse 116.5between a child's family, the primary care professional that is available to care for the 116.6child, and appropriate professionals to address urgent questions about and minimize the 116.7consequences of medical complications, develop medical management plans for complex 116.8conditions, and avoid serious health consequences and hospitalizations to treat such 116.9complications.116.10EFFECTIVE DATE.This section is effective January 1, 2012.116.11    Sec. 25. Minnesota Statutes 2010, section 256B.0625, is amended by adding a 116.12subdivision to read:116.13    Subd. 3q.Evidence-based childbirth program.(a) The commissioner shall 116.14implement a program to reduce the number of elective inductions of labor prior to 39 116.15weeks' gestation. In this subdivision, the term "elective induction of labor" means the 116.16use of artificial means to stimulate labor in a woman without the presence of a medical 116.17condition affecting the woman or the child that makes the onset of labor a medical 116.18necessity. The program must promote the implementation of policies within hospitals 116.19providing services to recipients of medical assistance or MinnesotaCare that prohibit the 116.20use of elective inductions prior to 39 weeks' gestation, and adherence to such policies by 116.21the attending providers.116.22(b) For all births covered by medical assistance or MinnesotaCare on or after 116.23January 1, 2012, a payment for professional services associated with the delivery of a 116.24child in a hospital must not be made unless the provider has submitted information about 116.25the nature of the labor and delivery including any induction of labor that was performed 116.26in conjunction with that specific birth. The information must be on a form prescribed by 116.27the commissioner.116.28(c) The requirements in paragraph (b) must not apply to deliveries performed 116.29at a hospital that has policies and processes in place that have been approved by the 116.30commissioner which prohibit elective inductions prior to 39 weeks' gestation. A process 116.31for review of hospital induction policies must be established by the commissioner and 116.32review of policies must occur at the discretion of the commissioner. The commissioner's 116.33decision to approve or rescind approval must include verification and review of items 116.34including, but not limited to:116.35(1) policies that prohibit use of elective inductions for gestation less than 39 weeks;117.1(2) policies that encourage providers to document and communicate with patients a 117.2final expected date of delivery by 20 weeks' gestation that includes data from ultrasound 117.3measurements as applicable;117.4(3) policies that encourage patient education regarding elective inductions, and 117.5requires documentation of the processes used to educate patients;117.6(4) ongoing quality improvement review as determined by the commissioner; and117.7(5) any data that has been collected by the commissioner.117.8(d) All hospitals must report annually to the commissioner induction information 117.9for all births that were covered by medical assistance or MinnesotaCare in a format and 117.10manner to be established by the commissioner.117.11(e) The commissioner at any time may choose not to implement or may discontinue 117.12any or all aspects of the program if the commissioner is able to determine that hospitals 117.13representing at least 90 percent of births covered by medical assistance or MinnesotaCare 117.14have approved policies in place.117.15EFFECTIVE DATE.This section is effective January 1, 2012.117.16    Sec. 26. Minnesota Statutes 2010, section 256B.0625, subdivision 8e, is amended to 117.17read:117.18    Subd. 8e. Chiropractic services. Payment for chiropractic services is limited to 117.19one annual evaluation and 12 24 visits per year unless prior authorization of a greater 117.20number of visits is obtained.117.21    Sec. 27. Minnesota Statutes 2010, section 256B.0625, is amended by adding a 117.22subdivision to read:117.23    Subd. 8f.Acupuncture services.Medical assistance covers acupuncture, as defined 117.24in section 147B.01, subdivision 3, only when provided by a licensed acupuncturist or by 117.25another Minnesota licensed practitioner for whom acupuncture is within the practitioner's 117.26scope of practice and who has specific acupuncture training or credentialing.117.27    Sec. 28. Minnesota Statutes 2010, section 256B.0625, subdivision 13e, is amended to 117.28read:117.29    Subd. 13e. Payment rates. (a) The basis for determining the amount of payment 117.30shall be the lower of the actual acquisition costs of the drugs plus a fixed dispensing fee; 117.31the maximum allowable cost set by the federal government or by the commissioner plus 117.32the fixed dispensing fee; or the usual and customary price charged to the public. The 117.33amount of payment basis must be reduced to reflect all discount amounts applied to the 118.1charge by any provider/insurer agreement or contract for submitted charges to medical 118.2assistance programs. The net submitted charge may not be greater than the patient liability 118.3for the service. The pharmacy dispensing fee shall be $3.65, except that the dispensing fee 118.4for intravenous solutions which must be compounded by the pharmacist shall be $8 per 118.5bag, $14 per bag for cancer chemotherapy products, and $30 per bag for total parenteral 118.6nutritional products dispensed in one liter quantities, or $44 per bag for total parenteral 118.7nutritional products dispensed in quantities greater than one liter. Actual acquisition cost 118.8includes quantity and other special discounts except time and cash discounts. Effective 118.9July 1, 2009, The actual acquisition cost of a drug shall be estimated by the commissioner,118.10at average wholesale price minus 15 percent. The actual acquisition cost of antihemophilic 118.11factor drugs shall be estimated at the average wholesale price minus 30 percent. wholesale 118.12acquisition cost plus four percent for independently owned pharmacies located in a 118.13designated rural area within Minnesota, and at wholesale acquisition cost plus two percent 118.14for all other pharmacies. A pharmacy is "independently owned" if it is one of four or 118.15fewer pharmacies under the same ownership nationally. A "designated rural area" means 118.16an area defined as a small rural area or isolated rural area according to the four-category 118.17classification of the Rural Urban Commuting Area system developed for the United States 118.18Health Resources and Services Administration. Wholesale acquisition cost is defined as 118.19the manufacturer's list price for a drug or biological to wholesalers or direct purchasers 118.20in the United States, not including prompt pay or other discounts, rebates, or reductions 118.21in price, for the most recent month for which information is available, as reported in 118.22wholesale price guides or other publications of drug or biological pricing data. The 118.23maximum allowable cost of a multisource drug may be set by the commissioner and it 118.24shall be comparable to, but no higher than, the maximum amount paid by other third-party 118.25payors in this state who have maximum allowable cost programs. Establishment of the 118.26amount of payment for drugs shall not be subject to the requirements of the Administrative 118.27Procedure Act.118.28    (b) An additional dispensing fee of $.30 may be added to the dispensing fee paid 118.29to pharmacists for legend drug prescriptions dispensed to residents of long-term care 118.30facilities when a unit dose blister card system, approved by the department, is used. Under 118.31this type of dispensing system, the pharmacist must dispense a 30-day supply of drug. 118.32The National Drug Code (NDC) from the drug container used to fill the blister card must 118.33be identified on the claim to the department. The unit dose blister card containing the 118.34drug must meet the packaging standards set forth in Minnesota Rules, part 6800.2700, 118.35that govern the return of unused drugs to the pharmacy for reuse. The pharmacy provider 118.36will be required to credit the department for the actual acquisition cost of all unused 119.1drugs that are eligible for reuse. Over-the-counter medications must be dispensed in the 119.2manufacturer's unopened package. The commissioner may permit the drug clozapine to be 119.3dispensed in a quantity that is less than a 30-day supply.119.4    (c) Whenever a maximum allowable cost has been set for a multisource drug, 119.5payment shall be on the basis of the maximum allowable cost established by the 119.6commissioner unless prior authorization for the brand name product has been granted 119.7according to the criteria established by the Drug Formulary Committee as required by 119.8subdivision 13f, paragraph (a), and the prescriber has indicated "dispense as written" on 119.9the prescription in a manner consistent with section 
         151.21, subdivision 2.119.10    (d) The basis for determining the amount of payment for drugs administered in an 119.11outpatient setting shall be the lower of the usual and customary cost submitted by the 119.12provider or the amount established for Medicare by the106 percent of the average sales 119.13price as determined by the United States Department of Health and Human Services 119.14pursuant to title XVIII, section 1847a of the federal Social Security Act. If average sales 119.15price is unavailable, the amount of payment must be lower of the usual and customary cost 119.16submitted by the provider or the wholesale acquisition cost.119.17    (e) The commissioner may negotiate lower reimbursement rates for specialty 119.18pharmacy products than the rates specified in paragraph (a). The commissioner may 119.19require individuals enrolled in the health care programs administered by the department 119.20to obtain specialty pharmacy products from providers with whom the commissioner has 119.21negotiated lower reimbursement rates. Specialty pharmacy products are defined as those 119.22used by a small number of recipients or recipients with complex and chronic diseases 119.23that require expensive and challenging drug regimens. Examples of these conditions 119.24include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis 119.25C, growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms 119.26of cancer. Specialty pharmaceutical products include injectable and infusion therapies, 119.27biotechnology drugs, antihemophilic factor products, high-cost therapies, and therapies 119.28that require complex care. The commissioner shall consult with the formulary committee 119.29to develop a list of specialty pharmacy products subject to this paragraph. In consulting 119.30with the formulary committee in developing this list, the commissioner shall take into 119.31consideration the population served by specialty pharmacy products, the current delivery 119.32system and standard of care in the state, and access to care issues. The commissioner shall 119.33have the discretion to adjust the reimbursement rate to prevent access to care issues.119.34(f) Home infusion therapy services provided by home infusion therapy pharmacies 119.35must be paid at rates according to subdivision 8d.120.1EFFECTIVE DATE.This section is effective July 1, 2011, or upon federal 120.2approval, whichever is later.120.3    Sec. 29. Minnesota Statutes 2010, section 256B.0625, subdivision 13h, is amended to 120.4read:120.5    Subd. 13h. Medication therapy management services. (a) Medical assistance 120.6and general assistance medical care cover medication therapy management services for 120.7a recipient taking four three or more prescriptions to treat or prevent two one or more 120.8chronic medical conditions, or; a recipient with a drug therapy problem that is identified120.9by the commissioner or identified by a pharmacist and approved by the commissioner; or 120.10prior authorized by the commissioner that has resulted or is likely to result in significant 120.11nondrug program costs. The commissioner may cover medical therapy management 120.12services under MinnesotaCare if the commissioner determines this is cost-effective. For 120.13purposes of this subdivision, "medication therapy management" means the provision 120.14of the following pharmaceutical care services by a licensed pharmacist to optimize the 120.15therapeutic outcomes of the patient's medications:120.16    (1) performing or obtaining necessary assessments of the patient's health status;120.17    (2) formulating a medication treatment plan;120.18    (3) monitoring and evaluating the patient's response to therapy, including safety 120.19and effectiveness;120.20    (4) performing a comprehensive medication review to identify, resolve, and prevent 120.21medication-related problems, including adverse drug events;120.22    (5) documenting the care delivered and communicating essential information to 120.23the patient's other primary care providers;120.24    (6) providing verbal education and training designed to enhance patient 120.25understanding and appropriate use of the patient's medications;120.26    (7) providing information, support services, and resources designed to enhance 120.27patient adherence with the patient's therapeutic regimens; and120.28    (8) coordinating and integrating medication therapy management services within the 120.29broader health care management services being provided to the patient.120.30Nothing in this subdivision shall be construed to expand or modify the scope of practice of 120.31the pharmacist as defined in section 
         151.01, subdivision 27.120.32    (b) To be eligible for reimbursement for services under this subdivision, a pharmacist 120.33must meet the following requirements:120.34    (1) have a valid license issued under chapter 151;121.1    (2) have graduated from an accredited college of pharmacy on or after May 1996, or 121.2completed a structured and comprehensive education program approved by the Board of 121.3Pharmacy and the American Council of Pharmaceutical Education for the provision and 121.4documentation of pharmaceutical care management services that has both clinical and 121.5didactic elements;121.6    (3) be practicing in an ambulatory care setting as part of a multidisciplinary team or 121.7have developed a structured patient care process that is offered in a private or semiprivate 121.8patient care area that is separate from the commercial business that also occurs in the 121.9setting, or in home settings, excluding including long-term care and settings, group homes, 121.10if the service is ordered by the provider-directed care coordination team and facilities 121.11providing assisted living services; and121.12    (4) make use of an electronic patient record system that meets state standards.121.13    (c) For purposes of reimbursement for medication therapy management services, 121.14the commissioner may enroll individual pharmacists as medical assistance and general 121.15assistance medical care providers. The commissioner may also establish contact 121.16requirements between the pharmacist and recipient, including limiting the number of 121.17reimbursable consultations per recipient.121.18(d) If there are no pharmacists who meet the requirements of paragraph (b) practicing 121.19within a reasonable geographic distance of the patient, a pharmacist who meets the 121.20requirements may provide the services via two-way interactive video. Reimbursement 121.21shall be at the same rates and under the same conditions that would otherwise apply to 121.22the services provided. To qualify for reimbursement under this paragraph, the pharmacist 121.23providing the services must meet the requirements of paragraph (b), and must be located 121.24within an ambulatory care setting approved by the commissioner. The patient must also 121.25be located within an ambulatory care setting approved by the commissioner. Services 121.26provided under this paragraph may not be transmitted into the patient's residence.121.27(e) The commissioner shall establish a pilot project for an intensive medication 121.28therapy management program for patients identified by the commissioner with multiple 121.29chronic conditions and a high number of medications who are at high risk of preventable 121.30hospitalizations, emergency room use, medication complications, and suboptimal 121.31treatment outcomes due to medication-related problems. For purposes of the pilot 121.32project, medication therapy management services may be provided in a patient's home 121.33or community setting, in addition to other authorized settings. The commissioner may 121.34waive existing payment policies and establish special payment rates for the pilot project. 121.35The pilot project must be designed to produce a net savings to the state compared to the 122.1estimated costs that would otherwise be incurred for similar patients without the program. 122.2The pilot project must begin by January 1, 2010, and end June 30, 2012.122.3EFFECTIVE DATE.This section is effective July 1, 2011.122.4    Sec. 30. Minnesota Statutes 2010, section 256B.0625, subdivision 17, is amended to 122.5read:122.6    Subd. 17. Transportation costs. (a) Medical assistance covers medical 122.7transportation costs incurred solely for obtaining emergency medical care or transportation 122.8costs incurred by eligible persons in obtaining emergency or nonemergency medical 122.9care when paid directly to an ambulance company, common carrier, or other recognized 122.10providers of transportation services. Medical transportation must be provided by:122.11(1) an ambulance, as defined in section 
         144E.001, subdivision 2;122.12(2) special transportation; or122.13(3) common carrier including, but not limited to, bus, taxicab, other commercial 122.14carrier, or private automobile.122.15(b) Medical assistance covers special transportation, as defined in Minnesota Rules, 122.16part 9505.0315, subpart 1, item F, if the recipient has a physical or mental impairment that 122.17would prohibit the recipient from safely accessing and using a bus, taxi, other commercial 122.18transportation, or private automobile.122.19The commissioner may use an order by the recipient's attending physician to certify that 122.20the recipient requires special transportation services. Special transportation providers shall 122.21perform driver-assisted services for eligible individuals. Driver-assisted service includes 122.22passenger pickup at and return to the individual's residence or place of business, assistance 122.23with admittance of the individual to the medical facility, and assistance in passenger 122.24securement or in securing of wheelchairs or stretchers in the vehicle. Special transportation 122.25providers must obtain written documentation from the health care service provider who 122.26is serving the recipient being transported, identifying the time that the recipient arrived. 122.27Special transportation providers may not bill for separate base rates for the continuation of 122.28a trip beyond the original destination. Special transportation providers must take recipients 122.29to the nearest appropriate health care provider, using the most direct route. The minimum 122.30medical assistance reimbursement rates for special transportation services are:122.31(1) (i) $17 for the base rate and $1.35 per mile for special transportation services to 122.32eligible persons who need a wheelchair-accessible van;122.33(ii) $11.50 for the base rate and $1.30 per mile for special transportation services to 122.34eligible persons who do not need a wheelchair-accessible van; and123.1(iii) $60 for the base rate and $2.40 per mile, and an attendant rate of $9 per trip, for 123.2special transportation services to eligible persons who need a stretcher-accessible vehicle;123.3(2) the base rates for special transportation services in areas defined under RUCA 123.4to be super rural shall be equal to the reimbursement rate established in clause (1) plus 123.511.3 percent; and123.6(3) for special transportation services in areas defined under RUCA to be rural 123.7or super rural areas:123.8(i) for a trip equal to 17 miles or less, mileage reimbursement shall be equal to 125 123.9percent of the respective mileage rate in clause (1); and123.10(ii) for a trip between 18 and 50 miles, mileage reimbursement shall be equal to 123.11112.5 percent of the respective mileage rate in clause (1).123.12(c) For purposes of reimbursement rates for special transportation services under 123.13paragraph (b), the zip code of the recipient's place of residence shall determine whether 123.14the urban, rural, or super rural reimbursement rate applies.123.15(d) For purposes of this subdivision, "rural urban commuting area" or "RUCA" 123.16means a census-tract based classification system under which a geographical area is 123.17determined to be urban, rural, or super rural.123.18(e) Effective for services provided on or after July 1, 2011, nonemergency 123.19transportation rates, including special transportation, taxi, and other commercial carriers, 123.20are reduced 4.5 percent. Payments made to managed care plans and county-based 123.21purchasing plans must be reduced for services provided on or after January 1, 2012, 123.22to reflect this reduction.123.23    Sec. 31. Minnesota Statutes 2010, section 256B.0625, subdivision 17a, is amended to 123.24read:123.25    Subd. 17a. Payment for ambulance services.(a) Medical assistance covers 123.26ambulance services. Providers shall bill ambulance services according to Medicare 123.27criteria. Nonemergency ambulance services shall not be paid as emergencies. Effective 123.28for services rendered on or after July 1, 2001, medical assistance payments for ambulance 123.29services shall be paid at the Medicare reimbursement rate or at the medical assistance 123.30payment rate in effect on July 1, 2000, whichever is greater.123.31(b) Effective for services provided on or after July 1, 2011, ambulance services 123.32payment rates are reduced 4.5 percent. Payments made to managed care plans and 123.33county-based purchasing plans must be reduced for services provided on or after January 123.341, 2012, to reflect this reduction.124.1    Sec. 32. Minnesota Statutes 2010, section 256B.0625, subdivision 18, is amended to 124.2read:124.3    Subd. 18. Bus or taxicab transportation. To the extent authorized by rule of the 124.4state agency, medical assistance covers costs of the most appropriate and cost-effective 124.5form of transportation incurred by any ambulatory eligible person for obtaining 124.6nonemergency medical care.124.7    Sec. 33. Minnesota Statutes 2010, section 256B.0625, is amended by adding a 124.8subdivision to read:124.9    Subd. 25b.Authorization with third-party liability.(a) Except as otherwise 124.10allowed under this subdivision or required under federal or state regulations, the 124.11commissioner must not consider a request for authorization of a service when the recipient 124.12has coverage from a third-party payer unless the provider requesting authorization has 124.13made a good faith effort to receive payment or authorization from the third-party payer. 124.14A good faith effort is established by supplying with the authorization request to the 124.15commissioner the following:124.16(1) a determination of payment for the service from the third-party payer, a 124.17determination of authorization for the service from the third-party payer, or a verification 124.18of noncoverage of the service by the third-party payer; and124.19(2) the information or records required by the department to document the reason for 124.20the determination or to validate noncoverage from the third-party payer.124.21(b) A provider requesting authorization for services covered by Medicare is not 124.22required to bill Medicare before requesting authorization from the commissioner if the 124.23provider has reason to believe that a service covered by Medicare is not eligible for 124.24payment. The provider must document that, because of recent claim experiences with 124.25Medicare or because of written communication from Medicare, coverage is not available 124.26for the service.124.27(c) Authorization is not required if a third-party payer has made payment that is 124.28equal to or greater than 60 percent of the maximum payment amount for the service 124.29allowed under medical assistance.124.30    Sec. 34. Minnesota Statutes 2010, section 256B.0625, subdivision 31a, is amended to 124.31read:124.32    Subd. 31a. Augmentative and alternative communication systems. (a) Medical 124.33assistance covers augmentative and alternative communication systems consisting of 124.34electronic or nonelectronic devices and the related components necessary to enable a 125.1person with severe expressive communication limitations to produce or transmit messages 125.2or symbols in a manner that compensates for that disability.125.3(b) Until the volume of systems purchased increases to allow a discount price, the 125.4commissioner shall reimburse augmentative and alternative communication manufacturers 125.5and vendors at the manufacturer's suggested retail price for augmentative and alternative 125.6communication systems and related components. The commissioner shall separately 125.7reimburse providers for purchasing and integrating individual communication systems 125.8which are unavailable as a package from an augmentative and alternative communication 125.9vendor. Augmentative and alternative communication systems must be paid the lower 125.10of the: 125.11(1) submitted charge; or125.12(2)(i) manufacturer's suggested retail price minus 20 percent for providers that are 125.13manufacturers of augmentative and alternative communication systems; or125.14(ii) manufacturer's invoice charge plus 20 percent for providers that are not 125.15manufacturers of augmentative and alternative communication systems.125.16(c) Reimbursement rates established by this purchasing program are not subject to 125.17Minnesota Rules, part 9505.0445, item S or T.125.18    Sec. 35. Minnesota Statutes 2010, section 256B.0625, is amended by adding a 125.19subdivision to read:125.20    Subd. 55.Payment for multiple services provided on same day.The 125.21commissioner shall not prohibit payment, including any supplemental payments, for 125.22mental health services or dental services provided to a patient by a clinic or health care 125.23professional solely because the mental health services or dental services were provided on 125.24the same day as other covered health care services furnished by the same provider.125.25    Sec. 36. Minnesota Statutes 2010, section 256B.0625, is amended by adding a 125.26subdivision to read:125.27    Subd. 56.Medical care coordination.(a) Medical assistance covers in-reach 125.28community-based care coordination that is performed in a hospital emergency department 125.29as an eligible procedure under a state health care program or private insurance for a 125.30frequent user.125.31(b) Reimbursement must be made in 15-minute increments under current Medicaid 125.32mental health social work reimbursement methodology and allowed for up to 60 days 125.33posthospital discharge based upon the specific identified emergency department visit or 125.34inpatient admitting event. A frequent user who is participating in care coordination within 126.1a health care home framework is ineligible for reimbursement under this subdivision. 126.2Eligible in-reach care coordinators must hold a minimum of a bachelor's degree in social 126.3work, public health, corrections, or related field. The commissioner shall submit any 126.4necessary application for waivers to the Centers for Medicare and Medicaid Services to 126.5implement this subdivision.126.6(c) A frequent user is defined as an individual who:126.7(1) has frequented the hospital emergency department for services three or more 126.8times in the previous six consecutive months;126.9(2) would benefit from the provision of in-reach community-based services; and126.10(3) has two or more of the following risk factors:126.11(i) on one or more occasions within the last 24 months, the individual was diagnosed 126.12with a chronic or life-threatening condition that requires management of symptoms, 126.13medications, health care, or changes in lifestyle or risk-related behaviors that may 126.14include, but are not limited to, HIV/AIDS, hepatitis, diabetes, heart disease, hypertension, 126.15emphysema, asthma, or cancer;126.16(ii) on one or more occasions within the last 24 months, the individual was diagnosed 126.17or, in the judgment of an emergency department physician, would likely be diagnosed, 126.18if provided a mental assessment, with an Axis I or II mental disorder identified in the 126.19Diagnostic and Statistical Manual of Mental Disorders;126.20(iii) on one or more occasions within the last 24 months, the individual was 126.21diagnosed or, in the judgment of an emergency department physician, would likely be 126.22diagnosed, if provided an assessment, with a substance use problem that interferes with 126.23the individual's health or appropriate utilization of health services; or126.24(iv) the individual is currently experiencing homelessness. "Homelessness" means 126.25lacking a fixed, regular, or adequate nighttime residence or a primary nighttime residence 126.26that is a supervised publicly or privately operated shelter designed to provide temporary 126.27living accommodations or a public or private place not designed for, or ordinarily used 126.28as, regular sleeping accommodations for human beings.126.29(d) Any hospital choosing to participate in medical care coordination under this 126.30subdivision must, upon request by the commissioner of human services, make available 126.31program utilization data. Frequent users who are enrolled in a program must track:126.32(1) the total number of program participants in the frequent user program for a 126.33defined period of time established by the commissioner;126.34(2) the total number of program participants and what form of health care coverage 126.35they had at the time of enrollment and the number of beneficiaries who did not remain 126.36enrolled in the program for at least two months;127.1(3) the frequency of emergency department visits during the 12 months prior to 127.2enrollment in the program and associated costs to the hospital;127.3(4) the frequency of emergency department visits during the 12 months after 127.4program enrollment and the associated costs to the hospital;127.5(5) the total number of inpatient admissions during the 12 months immediately 127.6preceding enrollment and the associated costs to the hospital;127.7(6) the total number of inpatient admissions during the 12 months after enrollment in 127.8the program and the associated costs to the hospital;127.9(7) the total number of inpatient days during the 12 months immediately preceding 127.10enrollment and the associated costs to the hospital; and127.11(8) the total number of inpatient days during the 12 months after program enrollment 127.12and the associated costs to the hospital.127.13(e) For the purposes of this subdivision, "in-reach community-based care 127.14coordination" means the practice of a community-based worker with training, knowledge, 127.15skills, and ability to access a continuum of services, including housing, transportation, 127.16chemical and mental health treatment, employment, and peer support services, by working 127.17with an organization's staff to transition an individual back into the individual's living 127.18environment. In-reach community-based care coordination includes working with the 127.19individual during their discharge and for up to a defined amount of time in the individual's 127.20living environment, reducing the individual's need for readmittance.127.21    Sec. 37. Minnesota Statutes 2010, section 256B.0625, is amended by adding a 127.22subdivision to read:127.23    Subd. 57.Payment for Part B Medicare crossover claims.Effective for services 127.24provided on or after January 1, 2012, medical assistance payment for an enrollee's cost 127.25sharing associated with Medicare Part B is limited to an amount up to the medical 127.26assistance total allowed, when the medical assistance rate exceeds the amount paid by 127.27Medicare.127.28EFFECTIVE DATE.This section is effective January 1, 2012.127.29    Sec. 38. Minnesota Statutes 2010, section 256B.0625, is amended by adding a 127.30subdivision to read:127.31    Subd. 58.Early and periodic screening, diagnosis, and treatment services.127.32Medical assistance covers early and periodic screening, diagnosis, and treatment services 127.33(EPSDT). The payment amount for a complete EPSDT screening shall not exceed the rate 127.34established per Minnesota Rules, part 9505.0445, item M, effective October 1, 2010.128.1    Sec. 39. Minnesota Statutes 2010, section 256B.0625, is amended by adding a 128.2subdivision to read:128.3    Subd. 59.Services provided by advanced dental therapists and dental 128.4therapists.Medical assistance covers services provided by advanced dental therapists 128.5and dental therapists when provided within the scope of practice identified in sections 128.6150A.105 and 150A.106.128.7    Sec. 40. Minnesota Statutes 2010, section 256B.0625, is amended by adding a 128.8subdivision to read:128.9    Subd. 60.Payment for noncovered services.(a) Except when specifically 128.10prohibited by the commissioner or federal law, a provider may seek payment from the 128.11recipient for services not eligible for payment under the medical assistance program when 128.12the provider, prior to delivering the service, reviews and considers all other available 128.13covered alternatives with the recipient and obtains a signed acknowledgment from the 128.14recipient of the potential of the recipient's liability. The signed acknowledgment must be 128.15in a form approved by the commissioner.128.16    (b) Conditions under which a provider must not request payment from the recipient 128.17include, but are not limited to:128.18    (1) a service that requires prior authorization, unless authorization has been denied 128.19as not medically necessary and all other therapeutic alternatives have been reviewed;128.20    (2) a service for which payment has been denied for reasons relating to billing 128.21requirements;128.22    (3) standard shipping or delivery and setup of medical equipment or medical 128.23supplies;128.24    (4) services that are included in the recipient's long-term care per diem;128.25    (5) the recipient is enrolled in the restricted recipient program and the provider is 128.26one of a provider type designated for the recipient's health care services; and128.27    (6) the noncovered service is a prescriptive drug identified by the commissioner as 128.28having the potential for abuse and overuse, except where payment by the recipient is 128.29specifically approved by the commissioner on the date of service based upon compelling 128.30evidence supplied by the prescribing provider that establishes medical necessity for that 128.31particular drug.128.32    (c) The payment requested from recipients for noncovered services under this 128.33subdivision must not exceed the provider's usual and customary charge for the actual 128.34service received by the recipient. A recipient must not be billed for the difference between 129.1what medical assistance paid for the service or would pay for a less costly alternative 129.2service.129.3    Sec. 41. Minnesota Statutes 2010, section 256B.0631, subdivision 1, is amended to 129.4read:129.5    Subdivision 1. Co-payments Cost-sharing. (a) Except as provided in subdivision 129.62, the medical assistance benefit plan shall include the following co-payments cost-sharing129.7for all recipients, effective for services provided on or after October 1, 2003, and before 129.8January 1, 2009 July 1, 2011:129.9    (1) $3 per nonpreventive visit, except as provided in paragraph (c). For purposes 129.10of this subdivision, a visit means an episode of service which is required because of 129.11a recipient's symptoms, diagnosis, or established illness, and which is delivered in an 129.12ambulatory setting by a physician or physician ancillary, chiropractor, podiatrist, nurse 129.13midwife, advanced practice nurse, audiologist, optician, or optometrist;129.14    (2) $3 for eyeglasses;129.15    (3) $6 $3.50 for nonemergency visits to a hospital-based emergency room, except 129.16that this co-payment shall be increased to $20 upon federal approval; and129.17    (4) $3 per brand-name drug prescription and $1 per generic drug prescription, 129.18subject to a $12 per month maximum for prescription drug co-payments. No co-payments 129.19shall apply to antipsychotic drugs when used for the treatment of mental illness.;129.20(5) a family deductible equal to the maximum amount allowed under Code of 129.21Federal Regulations, title 42, part 447.54; and129.22    (b) Except as provided in subdivision 2, the medical assistance benefit plan shall 129.23include the following co-payments for all recipients, effective for services provided on 129.24or after January 1, 2009:129.25    (1) $3.50 for nonemergency visits to a hospital-based emergency room;129.26    (2) $3 per brand-name drug prescription and $1 per generic drug prescription, 129.27subject to a $7 per month maximum for prescription drug co-payments. No co-payments 129.28shall apply to antipsychotic drugs when used for the treatment of mental illness; and129.29    (3) (6) for individuals identified by the commissioner with income at or below 100 129.30percent of the federal poverty guidelines, total monthly co-payments cost-sharing must 129.31not exceed five percent of family income. For purposes of this paragraph, family income 129.32is the total earned and unearned income of the individual and the individual's spouse, if 129.33the spouse is enrolled in medical assistance and also subject to the five percent limit on 129.34co-payments cost-sharing.130.1    (c) (b) Recipients of medical assistance are responsible for all co-payments  and 130.2deductibles in this subdivision.130.3(c) Effective January 1, 2012, or upon federal approval, whichever is later, the 130.4following co-payments for nonpreventive visits shall apply to providers included in 130.5provider peer grouping:130.6(1) $3 for visits to providers whose average, risk-adjusted, total annual cost of 130.7care per medical assistance enrollee is at the 60th percentile or lower for providers of 130.8the same type;130.9(2) $6 for visits to providers whose average, risk-adjusted, total annual cost of care 130.10per medical assistance enrollee is greater than the 60th percentile but does not exceed the 130.1180th percentile for providers of the same type; and130.12(3) $10 for visits to providers whose average, risk-adjusted, total annual cost of 130.13care per medical assistance enrollee is greater than the 80th percentile for providers of 130.14the same type.130.15Each managed care and county-based purchasing plan shall calculate the average, 130.16risk-adjusted, total annual cost of care for providers under this paragraph using a 130.17methodology approved by the commissioner. The commissioner shall develop a 130.18methodology for calculating the average, risk-adjusted, total annual cost of care for 130.19fee-for-service providers.130.20(d) The commissioner shall seek any federal waivers and approvals necessary to 130.21increase the co-payment for nonemergency visits to a hospital-based emergency room 130.22under paragraph (a), clause (3), and to implement paragraph (c).130.23    Sec. 42. Minnesota Statutes 2010, section 256B.0631, subdivision 2, is amended to 130.24read:130.25    Subd. 2. Exceptions. Co-payments and deductibles shall be subject to the following 130.26exceptions:130.27(1) children under the age of 21;130.28(2) pregnant women for services that relate to the pregnancy or any other medical 130.29condition that may complicate the pregnancy;130.30(3) recipients expected to reside for at least 30 days in a hospital, nursing home, or 130.31intermediate care facility for the developmentally disabled;130.32(4) recipients receiving hospice care;130.33(5) 100 percent federally funded services provided by an Indian health service;130.34(6) emergency services;130.35(7) family planning services;131.1(8) services that are paid by Medicare, resulting in the medical assistance program 131.2paying for the coinsurance and deductible; and131.3(9) co-payments that exceed one per day per provider for nonpreventive visits, 131.4eyeglasses, and nonemergency visits to a hospital-based emergency room.131.5    Sec. 43. Minnesota Statutes 2010, section 256B.0631, subdivision 3, is amended to 131.6read:131.7    Subd. 3. Collection. (a) The medical assistance reimbursement to the provider shall 131.8be reduced by the amount of the co-payment or deductible, except that reimbursements 131.9shall not be reduced:131.10    (1) once a recipient has reached the $12 per month maximum or the $7 per month 131.11maximum effective January 1, 2009, for prescription drug co-payments; or131.12    (2) for a recipient identified by the commissioner under 100 percent of the federal 131.13poverty guidelines who has met their monthly five percent co-payment cost-sharing limit.131.14    (b) The provider collects the co-payment or deductible from the recipient. Providers 131.15may not deny services to recipients who are unable to pay the co-payment or deductible.131.16    (c) Medical assistance reimbursement to fee-for-service providers and payments to 131.17managed care plans shall not be increased as a result of the removal of co-payments or 131.18deductibles effective on or after January 1, 2009.131.19    Sec. 44. Minnesota Statutes 2010, section 256B.0644, is amended to read:131.20256B.0644 REIMBURSEMENT UNDER OTHER STATE HEALTH CARE 131.21PROGRAMS.131.22    (a) A vendor of medical care, as defined in section 
         256B.02, subdivision 7, and a 131.23health maintenance organization, as defined in chapter 62D, must participate as a provider 131.24or contractor in the medical assistance program, general assistance medical care program, 131.25and MinnesotaCare as a condition of participating as a provider in health insurance plans 131.26and programs or contractor for state employees established under section 
         43A.18, the 131.27public employees insurance program under section 
         43A.316, for health insurance plans 131.28offered to local statutory or home rule charter city, county, and school district employees, 131.29the workers' compensation system under section 
         176.135, and insurance plans provided 131.30through the Minnesota Comprehensive Health Association under sections 
         62E.01 to 131.3162E.19
         . The limitations on insurance plans offered to local government employees shall 131.32not be applicable in geographic areas where provider participation is limited by managed 131.33care contracts with the Department of Human Services.132.1    (b) For providers other than health maintenance organizations, participation in the 132.2medical assistance program means that:132.3     (1) the provider accepts new medical assistance, general assistance medical care, 132.4and MinnesotaCare patients;132.5    (2) for providers other than dental service providers, at least 20 percent of the 132.6provider's patients are covered by medical assistance, general assistance medical care, 132.7and MinnesotaCare as their primary source of coverage; or132.8    (3) for dental service providers, at least ten percent of the provider's patients are 132.9covered by medical assistance, general assistance medical care, and MinnesotaCare as 132.10their primary source of coverage, or the provider accepts new medical assistance and 132.11MinnesotaCare patients who are children with special health care needs. For purposes 132.12of this section, "children with special health care needs" means children up to age 18 132.13who: (i) require health and related services beyond that required by children generally; 132.14and (ii) have or are at risk for a chronic physical, developmental, behavioral, or emotional 132.15condition, including: bleeding and coagulation disorders; immunodeficiency disorders; 132.16cancer; endocrinopathy; developmental disabilities; epilepsy, cerebral palsy, and other 132.17neurological diseases; visual impairment or deafness; Down syndrome and other genetic 132.18disorders; autism; fetal alcohol syndrome; and other conditions designated by the 132.19commissioner after consultation with representatives of pediatric dental providers and 132.20consumers.132.21    (c) Patients seen on a volunteer basis by the provider at a location other than 132.22the provider's usual place of practice may be considered in meeting the participation 132.23requirement in this section. The commissioner shall establish participation requirements 132.24for health maintenance organizations. The commissioner shall provide lists of participating 132.25medical assistance providers on a quarterly basis to the commissioner of management and 132.26budget, the commissioner of labor and industry, and the commissioner of commerce. Each 132.27of the commissioners shall develop and implement procedures to exclude as participating 132.28providers in the program or programs under their jurisdiction those providers who do 132.29not participate in the medical assistance program. The commissioner of management 132.30and budget shall implement this section through contracts with participating health and 132.31dental carriers.132.32    (d) For purposes of paragraphs (a) and (b), participation in the general assistance 132.33medical care program applies only to pharmacy providers.132.34    (e) A provider described in section 256B.76, subdivision 5, may limit the eligibility 132.35of new medical assistance, general assistance medical care, and MinnesotaCare patients 132.36for specific categories of rehabilitative services, if medical assistance, general assistance 133.1medical care, and MinnesotaCare patients served by the provider in the aggregate exceed 133.230 percent of the provider's overall patient population.133.3    Sec. 45. Minnesota Statutes 2010, section 256B.0751, subdivision 1, is amended to 133.4read:133.5    Subdivision 1. Definitions. (a) For purposes of sections 
         256B.0751 to 
         256B.0753, 133.6the following definitions apply.133.7    (b) "Commissioner" means the commissioner of human services.133.8    (c) "Commissioners" means the commissioner of humans services and the 133.9commissioner of health, acting jointly.133.10    (d) "Health plan company" has the meaning provided in section 
         62Q.01, subdivision 133.114.133.12    (e) "Personal clinician" means a physician licensed under chapter 147, a physician 133.13assistant licensed and practicing under chapter 147A, ora mental health professional 133.14licensed under section 245.462, subdivision 18, clauses (1) to (6); or 245.4871, subdivision 133.1527, clauses (1) to (6), or an advanced practice nurse licensed and registered to practice 133.16under chapter 148.133.17    (f) "State health care program" means the medical assistance, MinnesotaCare, and 133.18general assistance medical care programs.133.19    Sec. 46. Minnesota Statutes 2010, section 256B.0751, subdivision 2, is amended to 133.20read:133.21    Subd. 2. Development and implementation of standards. (a) By July 1, 2009, 133.22the commissioners of health and human services shall develop and implement standards 133.23of certification for health care homes for state health care programs. In developing these 133.24standards, the commissioners shall consider existing standards developed by national 133.25independent accrediting and medical home organizations. The standards developed by the 133.26commissioners must meet the following criteria:133.27    (1) emphasize, enhance, and encourage the use of primary care, and include the use 133.28of primary care physicians, advanced practice nurses, andmental health professionals, 133.29and physician assistants as personal clinicians but permitting multidisciplinary teams of 133.30other health professionals;133.31    (2) focus on delivering high-quality, efficient, and effective health care services133.32and providing, arranging, or coordinating related social and public health services and 133.33other services that directly affect an individual's health, access to services, quality and 133.34outcomes, and patient satisfaction;134.1    (3) encourage patient-centered care and services, including active participation by 134.2the patient and family or a legal guardian, or a health care agent as defined in chapter 134.3145C, as appropriate in decision making and care plan development, and providing care 134.4that is appropriate to the patient's race, ethnicity, and language;134.5    (4) provide patients with a consistent, ongoing contact with a personal clinician or 134.6team of clinical professionals to ensure continuous and appropriate care for the patient's 134.7condition;134.8    (5) ensure that health care homes develop and maintain appropriate comprehensive 134.9care and wellness plans for their patients with complex or chronic conditions, including an 134.10assessment of health risks and, chronic conditions, and socioeconomic factors affecting 134.11health and treatment;134.12    (6) enable and encourage utilization of a range of qualified health care professionals134.13and other professionals or services related to the health and treatment of the patient, 134.14including dedicated care coordinators, in a manner that enables providers to practice to 134.15the fullest extent of their license;134.16    (7) focus initially on patients who have or are at risk of developing chronic health 134.17conditions;134.18    (8) incorporate measures of quality, resource use, cost of care, and patient 134.19experience, with appropriate adjustments for socioeconomic factors;134.20    (9) ensure the use of health information technology and systematic follow-up, 134.21including the use of patient registries; and134.22    (10) encourage the use of scientifically based health care, patient decision-making 134.23aids that provide patients with information about treatment and service options and their 134.24associated benefits, risks, costs, and comparative outcomes, and other clinical decision 134.25support tools.134.26    (b) In developing these standards, the commissioners shall consult with national 134.27and local organizations working on health care home models, physicians, relevant 134.28state agencies, health plan companies, hospitals, other providers, patients, and patient 134.29advocates. The commissioners may satisfy this requirement by continuing the provider 134.30directed care coordination advisory committee.134.31    (c) For the purposes of developing and implementing these standards, the 134.32commissioners may use the expedited rulemaking process under section 
         14.389.134.33    Sec. 47. Minnesota Statutes 2010, section 256B.0751, subdivision 3, is amended to 134.34read:135.1    Subd. 3. Requirements for clinicians certified as health care homes. (a) A 135.2personal clinician or, a primary care clinic, or community mental health center eligible for 135.3payment under section 256B.0625, subdivision 5, may be certified as a health care home. 135.4If a primary care clinic or mental health center is certified, all of the primary care clinic's 135.5or mental health center's clinicians who may provide care to persons enrolled with the 135.6health care home must meet the criteria of a health care home. In order to be certified as 135.7a health care home, a clinician or, clinic, or community mental health center must meet 135.8the standards set by the commissioners in accordance with this section. Certification as 135.9a health care home is voluntary. In order to maintain their status as health care homes, 135.10clinicians or clinics must renew their certification annually.135.11    (b) Clinicians or, clinics, or mental health centers certified as health care homes must 135.12offer their health care home services to all their patients with complex or chronic health 135.13conditions who are interested in participation.135.14    (c) Health care homes must participate in the health care home collaborative 135.15established under subdivision 5.135.16    Sec. 48. Minnesota Statutes 2010, section 256B.0751, subdivision 4, is amended to 135.17read:135.18    Subd. 4. Alternative models and waivers of requirements.(a) Nothing in this 135.19section shall preclude the continued development of existing medical or health care 135.20home projects currently operating or under development by the commissioner of human 135.21services or preclude the commissioner from establishing alternative models and payment 135.22mechanisms for persons who are enrolled in integrated Medicare and Medicaid programs 135.23under section 
         256B.69, subdivisions 23 and 28, are enrolled in managed care long-term 135.24care programs under section 
         256B.69, subdivision 6b, are dually eligible for Medicare and 135.25medical assistance, are in the waiting period for Medicare, or who have other primary 135.26coverage.135.27(b) The commissioner of health shall modify the health care homes application 135.28for certification to add an item allowing an applicant to indicate status as a federally 135.29qualified health center or a federally qualified health center look-alike, as defined in 135.30section 145.9269, subdivision 1. Effective July 1, 2012, the commissioner shall certify as 135.31a health care home each applicant that indicates this status on a completed application for 135.32certification, without requiring the applicant to meet the standards in Minnesota Rules, 135.33part 4764.0040. In order to retain certification, a federally qualified health center or 135.34federally qualified health center look-alike certified under this paragraph must seek annual 136.1recertification by submitting a letter of intent stating its desire to be recertified but is not 136.2required to meet the standards for recertification in Minnesota Rules, part 4764.0040.136.3(c) The commissioner of health shall waive health care home certification 136.4requirements if an applicant demonstrates that compliance with a certification requirement 136.5will create a major financial hardship or is not feasible, and the applicant establishes an 136.6alternative way to accomplish the objectives of the certification requirement.136.7    Sec. 49. Minnesota Statutes 2010, section 256B.0751, is amended by adding a 136.8subdivision to read:136.9    Subd. 8.Coordination with local services.The health care home and the county 136.10shall coordinate care and services provided to patients enrolled with a health care home 136.11who have complex medical or socioeconomic needs or a disability, and who need and are 136.12eligible for additional local services administered by counties, including but not limited 136.13to waivered services, mental health services, social services, public health services, 136.14transportation, and  housing.  The coordination of care and services must be as provided in 136.15the plan established by the patient and health care home.136.16    Sec. 50. Minnesota Statutes 2010, section 256B.0751, is amended by adding a 136.17subdivision to read:136.18    Subd. 9.Patient choice of health care home.Notwithstanding section 256B.69, 136.19subdivisions 4 and 23, and subject to any necessary federal approval, the commissioner 136.20may require a patient enrolled in a state health care program through a managed care 136.21plan, county-based purchasing plan, fee-for-service, or demonstration project under 136.22section 256B.0755 to select a health care home and agree to receive primary care and 136.23care coordination services through the health care home as a condition of enrollment in 136.24the state health care program.  The patient must be allowed to choose from among all 136.25available qualified health care providers, including an essential community provider as 136.26defined in section  62Q.19,  if the provider is certified as a health care home and agrees to 136.27accept the terms, conditions, and payment rates for participation in the managed care plan, 136.28county-based purchasing plan, fee-for-service program, or demonstration project, except 136.29that reimbursement to federally qualified health centers and federally qualified health 136.30center look-alikes as defined in section 145.9269 must comply with federal law. 136.31    Sec. 51. Minnesota Statutes 2010, section 256B.0751, is amended by adding a 136.32subdivision to read:137.1    Subd. 10.Engagement of patients and communities in health care home.The 137.2commissioner of health shall require health care homes to demonstrate that their health 137.3care home patients, and the racial and ethnic communities of current or potential patients, 137.4participate in evaluating the health care home and recommending improvements and 137.5changes to the health care home's methods and procedures in order to improve health, 137.6quality, and patient satisfaction for patients from those communities. The commissioner 137.7shall consult with racial and ethnic communities to determine whether the requirements of 137.8this section and rules adopted under it are barriers to effective health care home methods 137.9and procedures for serving patients of racial and ethnic communities.137.10    Sec. 52. Minnesota Statutes 2010, section 256B.0753, is amended by adding a 137.11subdivision to read:137.12    Subd. 4.Waiver recipients.A health care home shall receive the highest care 137.13coordination payment established under section 256B.0753 for providing services to an 137.14enrollee receiving home and community-based waiver services.137.15    Sec. 53. Minnesota Statutes 2010, section 256B.0754, is amended by adding a 137.16subdivision to read:137.17    Subd. 3.Primary care provider tiering.(a) The commissioner shall establish 137.18a tiering system for all providers participating in Minnesota health care programs. 137.19The tiering system must differentiate providers on the basis of their ability to provide 137.20cost-effective, quality care and must incorporate the provider peer grouping measures 137.21established under section 62U.04. The tier assignments must be established annually based 137.22on the most recent peer grouping measures available. Differentiation of tier assignments 137.23must be statistically valid. The commissioner may set specific quality standards for 137.24providers designated as high-performing providers under this subdivision.137.25(b) The commissioner may adjust the rates paid to providers within each tier group 137.26established under paragraph (a) on an annual basis. Adjustments to rates shall not include 137.27the rate paid for care coordination services to certified health care homes under section 137.28256B.0753. Providers designated high-performing providers under paragraph (c) are not 137.29eligible for rate increases unless the provider also meets the cost and quality criteria 137.30associated with that tier level.137.31(c) Health care homes certified under section 256B.0751, rural health clinics, and 137.32federally qualified health care clinics are designated as high-performing providers under 137.33this subdivision.138.1(d) Providers reimbursed on a cost basis are subject to rate adjustments under this 138.2section.138.3(e) The commissioner may phase in the tiering system by service type. 138.4EFFECTIVE DATE.This section is effective one year from the public release of 138.5provider peer grouping measures under Minnesota Statutes, section 62U.04, or upon 138.6federal approval, whichever is later.138.7    Sec. 54. Minnesota Statutes 2010, section 256B.0755, subdivision 4, is amended to 138.8read:138.9    Subd. 4. Payment system. (a) In developing a payment system for health care 138.10delivery systems, the commissioner shall establish a total cost of care benchmark or a 138.11risk/gain sharing payment model to be paid for services provided to the recipients enrolled 138.12in a health care delivery system.138.13(b) The payment system may include incentive payments to health care delivery 138.14systems that meet or exceed annual quality and performance targets realized through 138.15the coordination of care.138.16(c) An amount equal to the savings realized to the general fund as a result of the 138.17demonstration project shall be transferred each fiscal year to the health care access fund.138.18(d) The total cost of care benchmark for demonstration projects must be no 138.19greater than the capitation rate that would have been paid to a managed care plan for a 138.20substantially similar enrollee population based on the per-member per-month rate in 138.21effect on December 31, 2010.  The commissioner shall  adjust benchmark payment rates 138.22for demonstration projects as necessary to reflect the higher level of service and cost 138.23necessary to serve a patient population with a higher incidence of socioeconomic barriers 138.24and complexity, and shall make corresponding reductions in payment rates for projects 138.25with a lower concentration of patients with socioeconomic barriers and complexity.138.26    Sec. 55. Minnesota Statutes 2010, section 256B.0755, is amended by adding a 138.27subdivision to read:138.28    Subd. 8.Coordination with local services.The health care home and the county 138.29shall coordinate care and services provided to patients enrolled in a demonstration project 138.30who have complex medical or socioeconomic needs or a disability, and who need and are 138.31eligible for additional local services administered by counties, including but not limited 138.32to waivered services, mental health services, social services, public health services, 138.33transportation, or housing.  The coordination of care and services must be as provided in 138.34the plan established by the patient and primary care provider or health care home.139.1    Sec. 56. Minnesota Statutes 2010, section 256B.0755, is amended by adding a 139.2subdivision to read:139.3    Subd. 9.Rural demonstration projects.For demonstration projects serving 139.4rural areas, the commissioner shall consult with rural hospitals, primary care providers, 139.5county boards, health plans, and other key stakeholders primarily domiciled in the 139.6service area regarding the development and approval of alternative rural health care 139.7delivery demonstration projects under this section. In addition to organizations eligible 139.8to establish a demonstration project under subdivision 1, a rural demonstration project 139.9may be established by a county public health or social services agency or a county-based 139.10purchasing plan. In a rural area where multiple, competing provider-based demonstration 139.11projects are not possible, the commissioner shall not approve more than one demonstration 139.12project to serve the primary geographic area and shall follow the applicable procedures 139.13and requirements in section 256B.692 regarding participation of county boards in 139.14reviewing and approving demonstration project proposals.139.15    Sec. 57. Minnesota Statutes 2010, section 256B.0755, is amended by adding a 139.16subdivision to read:139.17    Subd. 10.Patient choice of qualified provider.The commissioner shall implement 139.18and approve demonstration projects in a manner that allows a patient to choose a primary 139.19care provider and health care home from among all available qualified options.  The 139.20commissioner may require the patient to remain with the chosen provider, health care 139.21home, or demonstration project organization for a period of time determined by the 139.22commissioner.  The commissioner shall implement the demonstration projects in a manner 139.23that ensures that a patient has the option of receiving services, including health care home 139.24services, through a provider designated as an essential community provider under section 139.2562Q.19. Demonstration projects and essential community providers must comply with 139.26section 62Q.19, subdivisions 3 to 7, for purposes of participation of providers in the 139.27demonstration project, except that reimbursement to federally qualified health centers 139.28and federally qualified health center look-alikes as defined in section 145.9269 must be 139.29in compliance with federal law.139.30    Sec. 58. Minnesota Statutes 2010, section 256B.0755, is amended by adding a 139.31subdivision to read:139.32    Subd. 11.Patient and community engagement.As a condition of approval of 139.33a demonstration project, the commissioner shall require the applicant to demonstrate 139.34that consumers and communities to be served under the project were consulted with and 140.1engaged in the process of developing the project proposal.  The proposal must identify the 140.2needs and preferences of consumers and communities that were identified through this 140.3process of consultation and engagement.  The consumers and communities consulted with 140.4and engaged in the development of the proposal must generally reflect the demographics, 140.5race, and ethnicity of those likely to be served under the demonstration project, with a 140.6special focus on those who experience the greatest health disparities.  The commissioner 140.7shall require that demonstration project providers continue to consult with and engage 140.8consumers and communities during implementation and operation of the demonstration 140.9project.140.10    Sec. 59. Minnesota Statutes 2010, section 256B.0755, is amended by adding a 140.11subdivision to read:140.12    Subd. 12.Care coordination system.The commissioner of human services, in 140.13consultation with the commissioner of health, shall convene an advisory committee of 140.14small, independent, rural, and safety net primary care clinics, community hospitals, 140.15mental health centers, dental clinics, and other providers to advise the commissioner 140.16on the establishment of a system that will allow providers participating in payment 140.17reform demonstration projects established under this section and section 256B.0756 to 140.18effectively coordinate and deliver care to patients.  In consultation with the advisory 140.19committee, the commissioner shall develop a plan for the care coordination system, issue a 140.20request for proposals, and contract with a vendor or vendors to establish and maintain the 140.21technology for the care coordination system.  Using appropriations made for this purpose, 140.22the commissioner shall fund the planning, development, and establishment of the system. 140.23Ongoing costs must be covered by payments made by the providers who use the system.140.24    Sec. 60. Minnesota Statutes 2010, section 256B.0755, is amended by adding a 140.25subdivision to read:140.26    Subd. 13.Approval and implementation.Beginning January 1, 2012, the 140.27commissioner of human services shall approve payment reform projects authorized under 140.28this section for medical assistance and MinnesotaCare. The commissioner may approve 140.29projects for persons enrolled in fee-for-service programs and may require managed care 140.30plans and county-based purchasing plans to contract with a demonstration project provider 140.31on the same terms, conditions, and payment arrangements as are established by the 140.32commissioner for fee-for-service programs.141.1    Sec. 61. Minnesota Statutes 2010, section 256B.0756, is amended to read:141.2256B.0756 HENNEPIN AND RAMSEY COUNTIES PILOT PROGRAM.141.3(a) The commissioner, upon federal approval of a new waiver request or amendment 141.4of an existing demonstration, may establish a pilot program in Hennepin County or 141.5Ramsey County, or both, to test alternative and innovative integrated health care delivery 141.6networks.141.7(b) Individuals eligible for the pilot program shall be individuals who are eligible for 141.8medical assistance under section 
         256B.055, subdivision 15, and who reside in Hennepin 141.9County or Ramsey County.141.10(c) Individuals enrolled in the pilot program shall be enrolled in an integrated 141.11health care delivery network in their county of residence. The integrated health care 141.12delivery network in Hennepin County shall be a network, such as an accountable care 141.13organization or a community-based collaborative care network, created by or including 141.14Hennepin County Medical Center. The integrated health care delivery network in Ramsey 141.15County shall be a network, such as an accountable care organization or community-based 141.16collaborative care network, created by or including Regions Hospital.141.17(d) The commissioner shall cap pilot program enrollment at 7,000 enrollees for 141.18Hennepin County and 3,500 enrollees for Ramsey County.141.19(e) In developing a payment system for the pilot programs, the commissioner shall 141.20establish a total cost of care for the recipients enrolled in the pilot programs that equals 141.21the cost of care that would otherwise be spent for these enrollees in the prepaid medical 141.22assistance program.141.23(f) Counties may transfer funds necessary to support the nonfederal share of 141.24payments for integrated health care delivery networks in their county. Such transfers per 141.25county shall not exceed 15 percent of the expected expenses for county enrollees.141.26(g) The commissioner shall apply to the federal government for, or as appropriate, 141.27cooperate with counties, providers, or other entities that are applying for any applicable 141.28grant or demonstration under the Patient Protection and Affordable Health Care Act, Public 141.29Law 111-148, or the Health Care and Education Reconciliation Act of 2010, Public Law 141.30111-152, that would further the purposes of or assist in the creation of an integrated health 141.31care delivery network for the purposes of this subdivision, including, but not limited to, a 141.32global payment demonstration or the community-based collaborative care network grants.141.33(h) A demonstration project established under this section must meet the 141.34requirements of section 256B.0755, subdivisions 8, 9, 10, and 11.141.35    Sec. 62. [256B.0758] PREGNANCY CARE HOMES.142.1    Subdivision 1.Definitions.(a) For purposes of this section, the following definitions 142.2apply.142.3(b) "Pregnancy care home" means a health care home certified by the commissioner 142.4of health under section 256B.0751 that provides pregnancy care services in a way that 142.5is patient-centered, outcome-driven, comprehensive, and coordinated, and meets the 142.6standards specified and developed under subdivision 3.142.7(c) "Pregnancy care services" means prenatal care, consultative perinatal services, 142.8intrapartum and postpartum care, and well-baby care for the first week.142.9(d) "State health care program" means the medical assistance and MinnesotaCare 142.10programs.142.11    Subd. 2.Development and implementation of standards.(a) The commissioners 142.12of human services and health shall develop and implement standards of certification 142.13of pregnancy care homes for state health care programs. In developing standards, the 142.14commissioners shall consult with representatives of the American College of Nurse 142.15Midwives, the American Congress of OB/GYN, the American Academy of Family 142.16Practice, the American Academy of Pediatrics, and relevant local consumer groups.142.17    Subd. 3.Criteria for development of standards.(a) A pregnancy care home must 142.18meet the general health care home standards developed by the commissioners under 142.19section 256B.0751, subdivision 2, paragraph (a), clauses (1) to (4), (6), and (8) to (10), and 142.20must also meet specific standards for pregnancy care homes. The specific standards for 142.21pregnancy care homes developed by the commissioners must meet the criteria specified 142.22in this subdivision.142.23(b) A pregnancy care home must provide pregnancy care services. Nonpregnancy 142.24complications, such as preexisting illness, shall be covered by medical assistance outside 142.25of the pregnancy care home. During a pregnancy episode, the pregnancy care home must 142.26coordinate necessary nonpregnancy health care services with the mother's primary care 142.27provider or another appropriate provider.142.28(c) Each pregnancy care home must have adequate malpractice insurance that meets 142.29the standards specified by the commissioners.142.30(d) A pregnancy care home may provide pregnancy services through any health care 142.31professional licensed to provide the service in Minnesota, including but not limited to 142.32licensed traditional midwives, certified nurse midwives, family practitioners, obstetricians, 142.33perinatologists, neonatologists, and other advanced practice registered nurses. 142.34(e) Pregnancy care within a pregnancy care home may be provided at any Minnesota 142.35facility licensed to provide pregnancy care and birth, including but not limited to 142.36freestanding birth centers, integrated birth centers, and hospitals. Each pregnancy care 143.1home must offer the option of midwife-directed pregnancy care services in a licensed 143.2integrated or freestanding birth center.143.3(f) A pregnancy care home must have a governing board comprised of at least 143.4eight members. One-half of the governing board members must be providers licensed to 143.5attend births.143.6(g) Each pregnancy care home must have a formal consultative relationship with at 143.7least one level III perinatal center to provide care for mothers and babies who develop 143.8pregnancy complications.143.9(h) Each pregnancy care home must comply with state and federal requirements for 143.10the use of interoperable electronic medical records.143.11(i) Each pregnancy care home must submit annual reports to the commissioners of 143.12human services and health that document:143.13(1) all relevant pregnancy care outcomes and patient satisfaction measures; and143.14(2) the financial status of the pregnancy care home.143.15All reports are public data under section 13.02.143.16(j) Each pregnancy care home must offer culturally competent  care coordination 143.17services in a manner that is consistent with health care home requirements.143.18(k) For the purposes of developing and implementing the standards in this 143.19subdivision, the commissioners may use the expedited rulemaking process under section 143.2014.389.143.21    Subd. 4.Certification process.Providers seeking certification as a pregnancy care 143.22home must apply to the commissioner of health. Providers certified by the commissioner 143.23of health may provide pregnancy care services through pregnancy care homes beginning 143.24July 1, 2012. Certification as a pregnancy care home is voluntary, except that beginning 143.25July 1, 2014, all nonemergency pregnancy care services covered under state health care 143.26programs must be provided through providers certified as pregnancy care homes.143.27    Subd. 5.Payments to pregnancy care homes.(a) The commissioner of human 143.28services, in coordination with the commissioner of health, shall develop a payment system 143.29that provides a single per-person payment to pregnancy care homes to cover all pregnancy 143.30care services provided to each mother and infant enrolled in a state health care program. 143.31Pregnancy care homes receiving payments under this subdivision remain eligible for care 143.32coordination payments under section 256B.0753.143.33(b) Payment amounts for pregnancy care homes shall be uniform statewide and 143.34determined annually by the commissioner, based initially upon a specified percentage 143.35of the calculated average cost of care for mothers and infants under state health care 143.36programs for the three most recent fiscal years for which cost information is available. 144.1Beginning July 1, 2014, statewide payment amounts for pregnancy care homes shall be 144.2determined annually by the commissioner by adjusting the current payment amount by 144.3a measure of medical inflation selected by the commissioner that best represents the 144.4change in the cost of pregnancy-related services provided to patients covered by private 144.5sector health coverage.144.6(c) Pregnancy care home payments must initially be made for pregnancy care 144.7services provided to pregnant women who are not high risk, beginning July 1, 2012. 144.8Beginning January 1, 2013, the commissioner shall phase in higher payments for high-risk 144.9pregnancy categories so that beginning July 1, 2014, pregnancy care services for all 144.10low-risk and high-risk pregnancies are reimbursed under this subdivision.144.11    Sec. 63. [256B.0759] CARE COORDINATION FOR ENROLLEES.144.12    Subdivision 1.Qualified enrollee.For purposes of this section, a "qualified 144.13enrollee" means: (1) a medical assistance enrollee eligible under this chapter; or (2) a 144.14MinnesotaCare enrollee eligible under chapter 256L.144.15    Subd. 2.Selection of primary care provider.The commissioner shall require 144.16qualified enrollees who do not have a designated medical condition to select a primary 144.17care provider and agree to receive primary care services from that provider as a condition 144.18of medical assistance or MinnesotaCare enrollment.144.19    Subd. 3.Selection of health care home; care coordination.(a) The commissioner 144.20shall require qualified enrollees who have a medical condition designated by the 144.21commissioner to select a health care home certified under section 256B.0751 and agree 144.22to receive primary care and care coordination services through that health care home as 144.23a condition of medical assistance or MinnesotaCare enrollment. For purposes of this 144.24subdivision, the commissioner shall designate medical conditions with a high likelihood 144.25of inappropriate inpatient hospital admissions for which care coordination and prior 144.26authorization of admissions are expected to improve the quality of care and lead to costs 144.27savings for state health care programs.144.28(b) The commissioner shall include on Minnesota health care program enrollment 144.29cards a designation as to whether an enrollee meets the criteria in paragraph (a). In order 144.30to receive medical assistance or MinnesotaCare payment for nonemergency inpatient 144.31hospital admissions for enrollees meeting the criteria in paragraph (a), a hospital must 144.32receive prior authorization from the enrollee's health care home.144.33EFFECTIVE DATE.This section is effective January 1, 2012, for MinnesotaCare 144.34enrollees not eligible for a federal match, and is effective January 1, 2012, or upon federal 145.1approval, whichever is later, for medical assistance enrollees and for MinnesotaCare 145.2enrollees eligible for a federal match.145.3    Sec. 64. [256B.0760] ELECTIVE SURGERY.145.4    Subdivision 1.Payment prohibition.The commissioner, in consultation with 145.5health care providers, health care homes certified under section 256B.0751, managed 145.6care plans providing services under section 256B.69, and county-based purchasing plans 145.7providing services under section  256B.692, shall identify elective or nonemergency 145.8surgical procedures for which less invasive and less costly alternative treatment methods 145.9are available, and shall prohibit payment for these elective or nonemergency surgical 145.10procedures if the alternative treatment methods have not first been evaluated for use 145.11and, if appropriate, provided to the enrollee.145.12    Subd. 2.Implementation.The commissioner shall implement the payment 145.13prohibitions in paragraph (a) for fee-for-service medical assistance providers by January 145.141, 2012, and shall require managed care and county-based purchasing plans to implement 145.15the payment prohibitions in paragraph (a) for providers employed or under contract for 145.16services provided to medical assistance and MinnesotaCare enrollees beginning January 145.171, 2012.145.18    Subd. 3.Reduction in capitation rates.The commissioner shall reduce medical 145.19assistance and MinnesotaCare capitation rates to managed care and county-based 145.20purchasing plans beginning January 1, 2012, to reflect cost-savings to plans resulting from 145.21implementation of the payment prohibitions required by this subdivision.145.22    Sec. 65. Minnesota Statutes 2010, section 256B.37, subdivision 5, is amended to read:145.23    Subd. 5. Private benefits to be used first. Private accident and health care 145.24coverage, including Medicare for medical services and coverage provided through the 145.25United States Department of Veterans Affairs, is primary coverage and must be exhausted 145.26before medical assistance or alternative care services are paid for medical services 145.27including home health care, personal care assistance services, hospice, supplies and 145.28equipment, or services covered under a Centers for Medicare and Medicaid Services 145.29waiver. When a person who is otherwise eligible for medical assistance has private 145.30accident or health care coverage, including Medicare or a prepaid health plan or coverage 145.31provided through the United States Department of Veterans Affairs, the private health care 145.32benefits available to the person must be used first and to the fullest extent.145.33    Sec. 66. Minnesota Statutes 2010, section 256B.69, subdivision 3a, is amended to read:146.1    Subd. 3a. County authority. (a) The commissioner, when implementing or 146.2administering the medical assistance prepayment program within a county, must include 146.3the county board in the process of development, approval, and issuance of the request for 146.4proposals to provide services to eligible individuals within the proposed county, including 146.5proposals for demonstration projects established under section 256B.0755. County boards 146.6must be given reasonable opportunity to make recommendations regarding assist in146.7the development, issuance, review of responses, and changes needed in the request for 146.8proposals. The commissioner must provide county boards the opportunity to review 146.9each proposal based on the identification of community needs under chapters 145A and 146.10256E and county advocacy activities. If a county board finds that a proposal does not 146.11address certain community needs, the county board and commissioner shall continue 146.12efforts for improving the proposal and network prior to the approval of the contract. 146.13The county board shall make recommendations determinations regarding the approval 146.14of local networks and their operations to ensure adequate local availability and access to 146.15covered services. The provider or health plan must respond directly to county advocates 146.16and the state prepaid medical assistance ombudsperson regarding service delivery and 146.17must be accountable to the state regarding contracts with medical assistance funds. The 146.18county board may recommend shall decide a maximum number of participating health 146.19plans including county-based purchasing plans after considering the size of the enrolling 146.20population; ensuring adequate access and capacity; considering the client and county 146.21administrative complexity; and considering the need to promote the viability of locally 146.22developed health plans, managed care plans, or demonstration projects established under 146.23section 256B.0755. The county board or a single entity representing a group of county 146.24boards and the commissioner shall mutually select one or more qualified health plans or 146.25county-based purchasing plans for participation at the time of initial implementation of the 146.26prepaid medical assistance program or a demonstration project established under section 146.27256B.0755 in that county or group of counties and at the time of contract renewal. The 146.28commissioner shall also seek input for contract requirements from the county or single 146.29entity representing a group of county boards at each contract renewal and incorporate 146.30those recommendations into the contract negotiation process.146.31    (b) At the option of the county board, the board may develop contract requirements 146.32related to the achievement of local public health goals and health care delivery and access 146.33goals to meet the health needs of medical assistance enrollees. These requirements must 146.34be reasonably related to the performance of health plan managed care or delivery system 146.35demonstration project functions and within the scope of the medical assistance benefit 146.36set. If the county board and the commissioner mutually agree to such requirements, the 147.1department The commissioner shall include such requirements in all health plan contracts 147.2governing the prepaid medical assistance program in that county at initial implementation 147.3of the program or demonstration project in that county and at the time of contract renewal. 147.4The county board may participate in the enforcement of the contract provisions related to 147.5local public health goals.147.6    (c) For counties in which a prepaid medical assistance program has not been 147.7established, the commissioner shall not implement that program if a county board submits 147.8an acceptable and timely preliminary and final proposal under section 
         256B.692, until 147.9county-based purchasing is no longer operational in that county. For counties in which 147.10a prepaid medical assistance program is in existence on or after September 1, 1997, the 147.11commissioner must terminate contracts with health plans according to section 
         256B.692, 147.12subdivision 5
         , if the county board submits and the commissioner accepts a preliminary and 147.13final proposal according to that subdivision. The commissioner is not required to terminate 147.14contracts that begin on or after September 1, 1997, according to section 
         256B.692 until 147.15two years have elapsed from the date of initial enrollment.147.16    (d) In the event that a county board or a single entity representing a group of county 147.17boards and the commissioner cannot reach agreement regarding: (i) the selection of 147.18participating health plans or demonstration projects under section 256B.0755 in that 147.19county; (ii) contract requirements; or (iii) implementation and enforcement of county 147.20requirements including provisions regarding local public health goals, the commissioner 147.21shall resolve all disputes after taking into account by approving the recommendations of 147.22a three-person mediation panel. The panel shall be composed of one designee of the 147.23president of the association of Minnesota counties, one designee of the commissioner of 147.24human services, and one person selected jointly by the designee of the commissioner of 147.25human services and the designee of the Association of Minnesota Counties. Within a 147.26reasonable period of time before the hearing, the panelists must be provided all documents 147.27and information relevant to the mediation. The parties to the mediation must be given 147.2830 days' notice of a hearing before the mediation panel.147.29    (e) If a county which elects to implement county-based purchasing ceases to 147.30implement county-based purchasing, it is prohibited from assuming the responsibility of 147.31county-based purchasing for a period of five years from the date it discontinues purchasing.147.32    (f) The commissioner shall not require that contractual disputes between 147.33county-based purchasing entities and the commissioner be mediated by a panel that 147.34includes a representative of the Minnesota Council of Health Plans.148.1    (g) At the request of a county-purchasing entity, the commissioner shall adopt a 148.2contract reprocurement or renewal schedule under which all counties included in the 148.3entity's service area are reprocured or renewed at the same time.148.4    (h) The commissioner shall provide a written report under section 
         3.195 to the chairs 148.5of the legislative committees having jurisdiction over human services in the senate and the 148.6house of representatives describing in detail the activities undertaken by the commissioner 148.7to ensure full compliance with this section. The report must also provide an explanation 148.8for any decisions of the commissioner not to accept the recommendations of a county or 148.9group of counties required to be consulted under this section. The report must be provided 148.10at least 30 days prior to the effective date of a new or renewed prepaid or managed care 148.11contract in a county.148.12(i) This section also applies to other Minnesota health care programs administered 148.13by the commissioner, including but not limited to the MinnesotaCare program.148.14    Sec. 67. Minnesota Statutes 2010, section 256B.69, subdivision 4, is amended to read:148.15    Subd. 4. Limitation of choice. (a) The commissioner shall develop criteria to 148.16determine when limitation of choice may be implemented in the experimental counties. 148.17The criteria shall ensure that all eligible individuals in the county have continuing access 148.18to the full range of medical assistance services as specified in subdivision 6.148.19    (b) The commissioner shall exempt the following persons from participation in the 148.20project, in addition to those who do not meet the criteria for limitation of choice:148.21    (1) persons eligible for medical assistance according to section 
         256B.055, 148.22subdivision 1
         ;148.23    (2) persons eligible for medical assistance due to blindness or disability as 148.24determined by the Social Security Administration or the state medical review team, unless:148.25    (i) they are 65 years of age or older; or148.26    (ii) they reside in Itasca County or they reside in a county in which the commissioner 148.27conducts a pilot project under a waiver granted pursuant to section 1115 of the Social 148.28Security Act;148.29    (3) recipients who currently have private coverage through a health maintenance 148.30organization;148.31    (4) recipients who are eligible for medical assistance by spending down excess 148.32income for medical expenses other than the nursing facility per diem expense;148.33    (5) recipients who receive benefits under the Refugee Assistance Program, 148.34established under United States Code, title 8, section 1522(e);149.1    (6) children who are both determined to be severely emotionally disturbed and 149.2receiving case management services according to section 
         256B.0625, subdivision 20, 149.3except children who are eligible for and who decline enrollment in an approved preferred 149.4integrated network under section 
         245.4682;149.5    (7) adults who are both determined to be seriously and persistently mentally ill and 149.6received case management services according to section 
         256B.0625, subdivision 20;149.7    (8) persons eligible for medical assistance according to section 
         256B.057, 149.8subdivision 10
         ; and149.9    (9) persons with access to cost-effective employer-sponsored private health 149.10insurance or persons enrolled in a non-Medicare individual health plan determined to be 149.11cost-effective according to section 
         256B.0625, subdivision 15.149.12Children under age 21 who are in foster placement may enroll in the project on an elective 149.13basis. Individuals excluded under clauses (1), (6), and (7) may choose to enroll on an 149.14elective basis. The commissioner may enroll recipients in the prepaid medical assistance 149.15program for seniors who are (1) age 65 and over, and (2) eligible for medical assistance by 149.16spending down excess income.149.17    (c) The commissioner may allow persons with a one-month spenddown who are 149.18otherwise eligible to enroll to voluntarily enroll or remain enrolled, if they elect to prepay 149.19their monthly spenddown to the state.149.20    (d) The commissioner may require those individuals to enroll in the prepaid medical 149.21assistance program who otherwise would have been excluded under paragraph (b), clauses 149.22(1), (3), and (8), and under Minnesota Rules, part 9500.1452, subpart 2, items H, K, and L.149.23    (e) Before limitation of choice is implemented, eligible individuals shall be notified 149.24and after notification, shall be allowed to choose only among demonstration providers. 149.25The commissioner may assign an individual with private coverage through a health 149.26maintenance organization, to the same health maintenance organization for medical 149.27assistance coverage, if the health maintenance organization is under contract for medical 149.28assistance in the individual's county of residence. After initially choosing a provider, 149.29the recipient is allowed to change that choice only at specified times as allowed by the 149.30commissioner. If a demonstration provider ends participation in the project for any reason, 149.31a recipient enrolled with that provider must select a new provider but may change providers 149.32without cause once more within the first 60 days after enrollment with the second provider.149.33    (f) An infant born to a woman who is eligible for and receiving medical assistance 149.34and who is enrolled in the prepaid medical assistance program shall be retroactively 149.35enrolled to the month of birth in the same managed care plan as the mother once the 150.1child is enrolled in medical assistance unless the child is determined to be excluded from 150.2enrollment in a prepaid plan under this section.150.3(g) For an eligible individual under the age of 65, in the absence of a specific 150.4managed care plan choice by the individual, the commissioner shall assign the individual to 150.5the county-based purchasing plan, if any, in the county of the individual's residence. For an 150.6eligible individual over the age of 65, the commissioner shall make the default assignment 150.7on the county-based purchasing plan entering into a contract with the commissioner to 150.8serve this population and receiving federal approval as a special needs plan.150.9    Sec. 68. Minnesota Statutes 2010, section 256B.69, subdivision 5a, is amended to read:150.10    Subd. 5a. Managed care contracts. (a) Managed care contracts under this section 150.11and section 
         256L.12 shall be entered into or renewed on a calendar year basis beginning 150.12January 1, 1996. Managed care contracts which were in effect on June 30, 1995, and set to 150.13renew on July 1, 1995, shall be renewed for the period July 1, 1995 through December 150.1431, 1995 at the same terms that were in effect on June 30, 1995. The commissioner may 150.15issue separate contracts with requirements specific to services to medical assistance 150.16recipients age 65 and older.150.17    (b) A prepaid health plan providing covered health services for eligible persons 150.18pursuant to chapters 256B and 256L is responsible for complying with the terms of its 150.19contract with the commissioner. Requirements applicable to managed care programs 150.20under chapters 256B and 256L established after the effective date of a contract with the 150.21commissioner take effect when the contract is next issued or renewed.150.22    (c) Effective for services rendered on or after January 1, 2003, the commissioner 150.23shall withhold five percent of managed care plan payments under this section and 150.24county-based purchasing plan payments under section 
         256B.692 for the prepaid medical 150.25assistance program pending completion of performance targets. Each performance target 150.26must be quantifiable, objective, measurable, and reasonably attainable, except in the case 150.27of a performance target based on a federal or state law or rule. Criteria for assessment 150.28of each performance target must be outlined in writing prior to the contract effective 150.29date. The managed care plan must demonstrate, to the commissioner's satisfaction, 150.30that the data submitted regarding attainment of the performance target is accurate. The 150.31commissioner shall periodically change the administrative measures used as performance 150.32targets in order to improve plan performance across a broader range of administrative 150.33services. The performance targets must include measurement of plan efforts to contain 150.34spending on health care services and administrative activities. The commissioner may 150.35adopt plan-specific performance targets that take into account factors affecting only one 151.1plan, including characteristics of the plan's enrollee population. The withheld funds 151.2must be returned no sooner than July of the following year if performance targets in the 151.3contract are achieved. The commissioner may exclude special demonstration projects 151.4under subdivision 23.151.5    (d) Effective for services rendered on or after January 1, 2009, through December 151.631, 2009, the commissioner shall withhold three percent of managed care plan payments 151.7under this section and county-based purchasing plan payments under section 
         256B.692 151.8for the prepaid medical assistance program. The withheld funds must be returned no 151.9sooner than July 1 and no later than July 31 of the following year. The commissioner may 151.10exclude special demonstration projects under subdivision 23.151.11(e) Effective for services provided on or after January 1, 2010, the commissioner 151.12shall require that managed care plans use the assessment and authorization processes, 151.13forms, timelines, standards, documentation, and data reporting requirements, protocols, 151.14billing processes, and policies consistent with medical assistance fee-for-service or the 151.15Department of Human Services contract requirements consistent with medical assistance 151.16fee-for-service or the Department of Human Services contract requirements for all 151.17personal care assistance services under section 
         256B.0659.151.18(f) Effective for services rendered on or after January 1, 2010, through December 151.1931, 2010, the commissioner shall withhold 4.5 percent of managed care plan payments 151.20under this section and county-based purchasing plan payments under section 
         256B.692 151.21for the prepaid medical assistance program. The withheld funds must be returned no 151.22sooner than July 1 and no later than July 31 of the following year. The commissioner may 151.23exclude special demonstration projects under subdivision 23.151.24(g) Effective for services rendered on or after January 1, 2011, the commissioner 151.25shall include as part of the performance targets described in paragraph (c) a reduction in 151.26the health plan's emergency room utilization rate for state health care program enrollees 151.27by a measurable rate of five percent from the plan's utilization rate for state health care 151.28program enrollees for the previous calendar year.151.29The withheld funds must be returned no sooner than July 1 and no later than July 31 151.30of the following calendar year if the managed care plan demonstrates to the satisfaction of 151.31the commissioner that a reduction in the utilization rate was achieved.151.32The withhold described in this paragraph shall continue for each consecutive 151.33contract period until the plan's emergency room utilization rate for state health care 151.34program enrollees is reduced by 25 percent of the plan's emergency room utilization 151.35rate for state health care program enrollees for calendar year 2009. Hospitals shall 151.36cooperate with the health plans in meeting this performance target and shall accept 152.1payment withholds that may be returned to the hospitals if the performance target is 152.2achieved. The commissioner shall structure the withhold so that the commissioner returns 152.3a portion of the withheld funds in amounts commensurate with achieved reductions in 152.4utilization less than the targeted amount. The withhold in this paragraph does not apply to 152.5county-based purchasing plans.152.6(h) Effective for services rendered on or after January 1, 2012, the commissioner 152.7shall include as part of the performance targets described in paragraph (c) a reduction in 152.8the plan's hospitalization rates or subsequent hospitalizations within 30 days of a previous 152.9hospitalization of a patient regardless of the reason for the hospitalization for state health 152.10care program enrollees by a measurable rate of five percent from the plan's utilization rate 152.11for state health care program enrollees for the previous calendar year.152.12The withheld funds must be returned no sooner than July 1 and no later than July 31 152.13of the following calendar year if the managed care plan or county-based purchasing plan 152.14demonstrates to the satisfaction of the commissioner that a reduction in the hospitalization 152.15rate was achieved.152.16The withhold described in this paragraph must continue for each consecutive 152.17contract period until the plan's subsequent hospitalization rate for state health care 152.18program enrollees is reduced by 25 percent of the plan's subsequent hospitalization rate 152.19for state health care program enrollees for calendar year 2010. Hospitals shall cooperate 152.20with the plans in meeting this performance target and shall accept payment withholds that 152.21must be returned to the hospitals if the performance target is achieved. The commissioner 152.22shall structure the withhold so that the commissioner returns a portion of the withheld 152.23funds in amounts commensurate with achieved reductions in utilization less than the 152.24targeted amount.152.25(h) (i) Effective for services rendered on or after January 1, 2011, through December 152.2631, 2011, the commissioner shall withhold 4.5 percent of managed care plan payments 152.27under this section and county-based purchasing plan payments under section 
         256B.692 152.28for the prepaid medical assistance program. The withheld funds must be returned no 152.29sooner than July 1 and no later than July 31 of the following year. The commissioner may 152.30exclude special demonstration projects under subdivision 23.152.31(i) (j) Effective for services rendered on or after January 1, 2012, through December 152.3231, 2012, the commissioner shall withhold 4.5 percent of managed care plan payments 152.33under this section and county-based purchasing plan payments under section 
         256B.692 152.34for the prepaid medical assistance program. The withheld funds must be returned no 152.35sooner than July 1 and no later than July 31 of the following year. The commissioner may 152.36exclude special demonstration projects under subdivision 23.153.1(j) (k) Effective for services rendered on or after January 1, 2013, through December 153.231, 2013, the commissioner shall withhold 4.5 percent of managed care plan payments 153.3under this section and county-based purchasing plan payments under section 
         256B.692 153.4for the prepaid medical assistance program. The withheld funds must be returned no 153.5sooner than July 1 and no later than July 31 of the following year. The commissioner may 153.6exclude special demonstration projects under subdivision 23.153.7(k) (l) Effective for services rendered on or after January 1, 2014, the commissioner 153.8shall withhold three percent of managed care plan payments under this section and 153.9county-based purchasing plan payments under section 
         256B.692 for the prepaid medical 153.10assistance program. The withheld funds must be returned no sooner than July 1 and 153.11no later than July 31 of the following year. The commissioner may exclude special 153.12demonstration projects under subdivision 23.153.13(l) (m) A managed care plan or a county-based purchasing plan under section 153.14256B.692 
         may include as admitted assets under section 
         62D.044 any amount withheld 153.15under this section that is reasonably expected to be returned.153.16(m) (n) Contracts between the commissioner and a prepaid health plan are exempt 153.17from the set-aside and preference provisions of section 
         16C.16, subdivisions 6, paragraph 153.18(a), and 7.153.19(n) (o) The return of the withhold under paragraphs (d), (f), and (h) to (k) is not 153.20subject to the requirements of paragraph (c).153.21    Sec. 69. Minnesota Statutes 2010, section 256B.69, subdivision 5c, is amended to read:153.22    Subd. 5c. Medical education and research fund. (a) The commissioner of human 153.23services shall transfer each year to the medical education and research fund established 153.24under section 
         62J.692, the following:153.25(1) an amount equal to the reduction in the prepaid medical assistance payments as 153.26specified in this clause. Until January 1, 2002, the county medical assistance capitation 153.27base rate prior to plan specific adjustments and after the regional rate adjustments under 153.28subdivision 5b is reduced 6.3 percent for Hennepin County, two percent for the remaining 153.29metropolitan counties, and no reduction for nonmetropolitan Minnesota counties; and after 153.30January 1, 2002, the county medical assistance capitation base rate prior to plan specific 153.31adjustments is reduced 6.3 percent for Hennepin County, two percent for the remaining 153.32metropolitan counties, and 1.6 percent for nonmetropolitan Minnesota counties. Nursing 153.33facility and elderly waiver payments and demonstration project payments operating 153.34under subdivision 23 are excluded from this reduction. The amount calculated under 154.1this clause shall not be adjusted for periods already paid due to subsequent changes to 154.2the capitation payments;154.3(2) beginning July 1, 2003, $4,314,000 from the capitation rates paid under this 154.4section;154.5(3) beginning July 1, 2002, an additional $12,700,000 from the capitation rates 154.6paid under this section; and154.7(4) beginning July 1, 2003, an additional $4,700,000 from the capitation rates paid 154.8under this section.154.9(b) This subdivision shall be effective upon approval of a federal waiver which 154.10allows federal financial participation in the medical education and research fund. Effective 154.11July 1, 2009, and thereafter, the transfers required by paragraph (a), clauses (1) to (4), 154.12shall not exceed the total amount transferred for fiscal year 2009. Any excess shall first 154.13reduce the amounts otherwise required to be transferred under paragraph (a), clauses 154.14(2) to (4). Any excess following this reduction shall proportionally reduce the transfers 154.15under paragraph (a), clause (1).154.16(c) Beginning July 1, 2009, of the amounts in paragraph (a), the commissioner shall 154.17transfer $21,714,000 each fiscal year to the medical education and research fund. The 154.18balance of the transfers under paragraph (a) shall be transferred to the medical education 154.19and research fund no earlier than July 1 of the following fiscal year.154.20(d) Beginning in fiscal year 2012, the commissioner shall reduce the amount 154.21transferred to the medical education research fund under paragraph (a), by $4,500,000 154.22each fiscal year. This reduction must be applied to the amount available for general 154.23distribution under section 62J.692, subdivision 7, clause (5).154.24    Sec. 70. Minnesota Statutes 2010, section 256B.69, subdivision 6, is amended to read:154.25    Subd. 6. Service delivery. (a) Each demonstration provider shall be responsible for 154.26the health care coordination for eligible individuals. Demonstration providers:154.27    (1) shall authorize and arrange for the provision of all needed health services 154.28including but not limited to the full range of services listed in sections 
         256B.02, 154.29subdivision 8
         , and 
         256B.0625 in order to ensure appropriate health care is delivered to 154.30enrollees. Notwithstanding section 
         256B.0621, demonstration providers that provide 154.31nursing home and community-based services under this section shall provide relocation 154.32service coordination to enrolled persons age 65 and over;154.33    (2) shall accept the prospective, per capita payment from the commissioner in return 154.34for the provision of comprehensive and coordinated health care services for eligible 154.35individuals enrolled in the program;155.1    (3) may contract with other health care and social service practitioners to provide 155.2services to enrollees; and155.3    (4) shall institute recipient grievance procedures according to the method established 155.4by the project, utilizing applicable requirements of chapter 62D. Disputes not resolved 155.5through this process shall be appealable to the commissioner as provided in subdivision 11.155.6    (b) Demonstration providers must comply with the standards for claims settlement 155.7under section 
         72A.201, subdivisions 4, 5, 7, and 8, when contracting with other health 155.8care and social service practitioners to provide services to enrollees. A demonstration 155.9provider must pay a clean claim, as defined in Code of Federal Regulations, title 42, 155.10section 447.45(b), within 30 business days of the date of acceptance of the claim.155.11(c) A demonstration provider must accept into its medical assistance and 155.12MinnesotaCare provider networks any health care or social service provider that agrees 155.13to accept payment, quality assurance, and other contract terms that the demonstration 155.14provider applies to other similarly situated providers in its provider network.155.15EFFECTIVE DATE.This section is effective January 1, 2012, and applies to 155.16provider contracts that take effect on or after that date.155.17    Sec. 71. Minnesota Statutes 2010, section 256B.69, is amended by adding a 155.18subdivision to read:155.19    Subd. 30.Provider payment rates.(a) Each managed care and county-based plan 155.20shall, by October 1, 2011, array all providers within each provider type, employed by or 155.21under contract with the plan, by their average total annual cost of care for serving medical 155.22assistance and MinnesotaCare enrollees for the most recent reporting year for which data 155.23is available, risk-adjusted for enrollee demographics and health status.155.24(b) Beginning January 1, 2012, and each contract year thereafter, each managed 155.25care and county-based purchasing plan shall implement a progressive payment withhold 155.26methodology for each provider type, under which the withhold for a provider increases 155.27proportionally as the provider's risk-adjusted total annual cost increases, relative to other 155.28providers of the same type. For purposes of this paragraph, the risk-adjusted total annual 155.29cost of care is the dollar amount calculated under paragraph (a).155.30(c) At the end of each contract year, each plan shall array all providers within each 155.31provider type by their average total annual cost of care for serving medical assistance and 155.32MinnesotaCare enrollees for that contract year, risk-adjusted for enrollee demographics 155.33and health status. For each provider whose risk-adjusted total annual cost of care is at or 155.34below a benchmark percentile established by the plan, the plan shall return the full amount 155.35of any withhold. For each provider whose risk-adjusted total annual cost of care is above 156.1the benchmark percentile, the plan shall return only the portion of the withhold sufficient 156.2to bring the provider's payment rate to the average for providers within the provider type 156.3whose risk-adjusted total annual cost of care is at the benchmark percentile. Each plan shall 156.4establish the benchmark percentile at a level that allows the plan to adjust expenditures for 156.5provider payments to reflect the reduction in capitation rates under paragraph (f).156.6(d) Each managed care and county-based purchasing plan must establish an appeals 156.7process to allow providers to appeal determinations of risk-adjusted total annual cost of 156.8care. Each plan's appeals process must be approved by the commissioner.156.9(e) The commissioner shall require each plan to submit to the commissioner, in 156.10the form and manner specified by the commissioner, all provider payment data and 156.11information on the withhold methodology that the commissioner determines is necessary 156.12to verify compliance with this subdivision.156.13(f) The commissioner, for the contract year beginning January 1, 2012, shall reduce 156.14plan capitation rates by 12 percent from the rates that would otherwise apply, absent 156.15application of this subdivision. The reduced rate shall be the historical base rate for 156.16negotiating capitation rates for future contract years. The commissioner may recommend 156.17additional reductions in capitation rates for future contract years to the legislature, if the 156.18commissioner determines this is necessary to ensure that health care providers under 156.19contract with managed care and county-based purchasing plans practice in an efficient 156.20manner. Effective for services rendered on or after January 1, 2012, managed care plans 156.21and county-based purchasing plans contracted with the state to administer the health 156.22care programs provided under sections 256B.69, 256B.692, and 256L.12, may reduce 156.23payments made to providers employed or under contract with the plan.156.24(g) The commissioner of human services, in consultation with the commissioner of 156.25health, shall develop and provide to managed care and county-based purchasing plans, by 156.26September 1, 2011, standard criteria and definitions necessary for consistent calculation 156.27of the total annual risk-adjusted cost of care across plans. The commissioner may use 156.28encounter data to implement this subdivision, and may provide encounter data or analyses 156.29to plans.156.30(h) For purposes of this subdivision, "provider" means a vendor of medical care 156.31as defined in section 256B.02, subdivision 7, for which sufficient encounter data on 156.32utilization and costs is available to implement this subdivision.156.33(i) A managed care or county-based purchasing plan must use the methodology 156.34described in paragraphs (a) to (e), unless the plan develops an alternative model consistent 156.35with the purpose of this subdivision.156.36EFFECTIVE DATE.This section is effective the day following final enactment.157.1    Sec. 72. Minnesota Statutes 2010, section 256B.69, is amended by adding a 157.2subdivision to read:157.3    Subd. 31.Initiatives to reduce incidence of low birth weight.The commissioner 157.4shall require managed care and county-based purchasing plans as a condition of contract 157.5to implement strategies to reduce the incidence of low birth weight in geographic areas 157.6identified by the commissioner as having a higher than average incidence of low birth 157.7weight, with special emphasis on areas within a one-mile radius of hospitals within their 157.8provider networks. These strategies may focus on smoking prevention and cessation, 157.9ensuring that pregnant women get adequate nutrition, and addressing demographic, 157.10social, and environmental risk factors. The strategies must coordinate health care with 157.11social services and the local public health system, and offer patient education through 157.12appropriate means. The commissioner shall require plans to submit proposed initiatives 157.13for approval to the commissioner by January 1, 2012, and the commissioner shall require 157.14plans to implement approved initiatives by July 1, 2012. The commissioner shall evaluate 157.15the strategies adopted to reduce low birth weight and shall require plans to submit outcome 157.16and other data necessary for the evaluation.157.17    Sec. 73. Minnesota Statutes 2010, section 256B.69, is amended by adding a 157.18subdivision to read:157.19    Subd. 32.Health education.The commissioner shall require managed care and 157.20county-based purchasing plans, as a condition of contract, to provide health education, 157.21wellness training, and information about the availability and benefits of preventive 157.22services to all medical assistance and MinnesotaCare enrollees, beginning January 1, 157.232012. Plan initiatives developed or implemented to comply with this requirement must be 157.24approved by the commissioner.157.25    Sec. 74. Minnesota Statutes 2010, section 256B.692, subdivision 2, is amended to read:157.26    Subd. 2. Duties of commissioner of health. (a) Notwithstanding chapters 62D and 157.2762N, a county that elects to purchase medical assistance in return for a fixed sum without 157.28regard to the frequency or extent of services furnished to any particular enrollee is not 157.29required to obtain a certificate of authority under chapter 62D or 62N. The county board 157.30of commissioners is the governing body of a county-based purchasing program. In a 157.31multicounty arrangement, the governing body is a joint powers board established under 157.32section 
         471.59.157.33    (b) A county that elects to purchase medical assistance services under this section 157.34must satisfy the commissioner of health that the requirements for assurance of consumer 158.1protection, provider protection, and, effective January 1, 2010, fiscal solvency of chapter 158.262D, applicable to health maintenance organizations will be met according to the 158.3following schedule:158.4    (1) for a county-based purchasing plan approved on or before June 30, 2008, the 158.5plan must have in reserve:158.6    (i) at least 50 percent of the minimum amount required under chapter 62D as 158.7of January 1, 2010;158.8    (ii) at least 75 percent of the minimum amount required under chapter 62D as of 158.9January 1, 2011;158.10    (iii) at least 87.5 percent of the minimum amount required under chapter 62D as 158.11of January 1, 2012; and158.12    (iv) at least 100 percent of the minimum amount required under chapter 62D as 158.13of January 1, 2013; and158.14    (2) for a county-based purchasing plan first approved after June 30, 2008, the plan 158.15must have in reserve:158.16    (i) at least 50 percent of the minimum amount required under chapter 62D at the 158.17time the plan begins enrolling enrollees;158.18    (ii) at least 75 percent of the minimum amount required under chapter 62D after 158.19the first full calendar year;158.20    (iii) at least 87.5 percent of the minimum amount required under chapter 62D after 158.21the second full calendar year; and158.22    (iv) at least 100 percent of the minimum amount required under chapter 62D after 158.23the third full calendar year.158.24    (c) Until a plan is required to have reserves equaling at least 100 percent of the 158.25minimum amount required under chapter 62D, the plan may demonstrate its ability 158.26to cover any losses by satisfying the requirements of chapter 62N. Notwithstanding 158.27this paragraph and paragraph (b), a county-based purchasing plan may satisfy its fiscal 158.28solvency requirements by obtaining written financial guarantees from participating 158.29counties in amounts equivalent to the minimum amounts that would otherwise apply.158.30A county-based purchasing plan must also assure the commissioner of health that the 158.31requirements of sections 
         62J.041; 
         62J.48; 
         62J.71 to 
         62J.73; 
         62M.01 to 
         62M.16; all 158.32applicable provisions of chapter 62Q, including sections 
         62Q.075; 
         62Q.1055; 
         62Q.106; 158.3362Q.12
         ; 
         62Q.135; 
         62Q.14; 
         62Q.145; 
         62Q.19; 
         62Q.23, paragraph (c); 
         62Q.43; 
         62Q.47; 158.3462Q.50
         ; 
         62Q.52 to 
         62Q.56; 
         62Q.58; 
         62Q.68 to 
         62Q.72; and 
         72A.201 will be met.159.1    (d) All enforcement and rulemaking powers available under chapters 62D, 62J, 62M, 159.262N, and 62Q are hereby granted to the commissioner of health with respect to counties 159.3that purchase medical assistance services under this section.159.4    (e) The commissioner, in consultation with county government, shall develop 159.5administrative and financial reporting requirements for county-based purchasing programs 159.6relating to sections 
         62D.041, 
         62D.042, 
         62D.045, 
         62D.08, 
         62N.28, 
         62N.29, and 
         62N.31, 159.7and other sections as necessary, that are specific to county administrative, accounting, and 159.8reporting systems and consistent with other statutory requirements of counties.159.9    (f) The commissioner shall collect from a county-based purchasing plan under 159.10this section the following fees:159.11    (1) fees attributable to the costs of audits and other examinations of plan financial 159.12operations. These fees are subject to the provisions of Minnesota Rules, part 4685.2800, 159.13subpart 1, item F;159.14    (2) an annual fee of $21,500, to be paid by June 15 of each calendar year, beginning 159.15in calendar year 2009; and159.16    (3) for fiscal year 2009 only, a per-enrollee fee of 14.6 cents, based on the number of 159.17enrollees as of December 31, 2008.159.18All fees collected under this paragraph shall be deposited in the state government special 159.19revenue fund.159.20    Sec. 75. Minnesota Statutes 2010, section 256B.692, subdivision 5, is amended to read:159.21    Subd. 5. County proposals. (a) On or before September 1, 1997, a county board 159.22that wishes to purchase or provide health care under this section must submit a preliminary 159.23proposal that substantially demonstrates the county's ability to meet all the requirements 159.24of this section in response to criteria for proposals issued by the department on or before 159.25July 1, 1997. Counties submitting preliminary proposals must establish a local planning 159.26process that involves input from medical assistance recipients, recipient advocates, 159.27providers and representatives of local school districts, labor, and tribal government to 159.28advise on the development of a final proposal and its implementation.159.29(b) The county board must submit a final proposal on or before July 1, 1998, that 159.30demonstrates the ability to meet all the requirements of this section, including beginning 159.31enrollment on January 1, 1999, unless a delay has been granted under section 
         256B.69, 159.32subdivision 3a
         , paragraph (g). 159.33(c) After January 1, 1999, for a county in which the prepaid medical assistance 159.34program is in existence, the county board must submit a preliminary proposal at least 15 159.35months prior to termination of health plan contracts in that county and a final proposal160.1that meets the requirements of this section six months prior to the health plan contract 160.2termination date in order to begin enrollment after the termination. Nothing in this section 160.3shall impede or delay implementation or continuation of the prepaid medical assistance 160.4program in counties for which the board does not submit a proposal, or submits a proposal 160.5that is not in compliance with this section.160.6(d) The commissioner is not required to terminate contracts for the prepaid medical 160.7assistance program that begin on or after September 1, 1997, in a county for which a 160.8county board has submitted a proposal under this paragraph, until two years have elapsed 160.9from the date of initial enrollment in the prepaid medical assistance program.160.10    Sec. 76. Minnesota Statutes 2010, section 256B.692, subdivision 7, is amended to read:160.11    Subd. 7. Dispute resolution. In the event the commissioner rejects a proposal 160.12under subdivision 6, the county board may request the recommendation decision of a 160.13three-person mediation panel. The commissioner shall resolve all disputes after taking 160.14into account by following the recommendations decision of the mediation panel. The 160.15panel shall be composed of one designee of the president of the Association of Minnesota 160.16Counties, one designee of the commissioner of human services, and one person selected 160.17jointly by the designee of the commissioner of human services and the designee of 160.18the Association of Minnesota Counties. Within a reasonable period of time before the 160.19hearing, the panelists must be provided all documents and information relevant to the 160.20mediation. The parties to the mediation must be given 30 days' notice of a hearing before 160.21the mediation panel.160.22    Sec. 77. Minnesota Statutes 2010, section 256B.692, is amended by adding a 160.23subdivision to read:160.24    Subd. 11.Patient choice of qualified provider.Effective January 1, 2012, a county 160.25board operating a county-based purchasing plan must ensure that each enrollee has the 160.26option of choosing a primary care provider or a health care home from all qualified 160.27providers who agree to accept the terms, conditions, and payment rates offered by the 160.28plan to similarly situated providers. Notwithstanding this requirement, reimbursement 160.29to federally qualified health centers and federally qualified health center look-alikes as 160.30defined in section 145.9269 must be in compliance with federal law.160.31    Sec. 78. Minnesota Statutes 2010, section 256B.694, is amended to read:160.32256B.694 SOLE-SOURCE OR SINGLE-PLAN MANAGED CARE 160.33CONTRACT.161.1    (a) Notwithstanding section 
         256B.692, subdivision 6, clause (1), paragraph (c), 161.2the commissioner of human services shall approve a county-based purchasing health 161.3plan proposal, submitted on behalf of Cass, Crow Wing, Morrison, Todd, and Wadena 161.4Counties, that requires county-based purchasing on a single-plan basis contract if the 161.5implementation of the single-plan purchasing proposal does not limit an enrollee's 161.6provider choice or access to services and all other requirements applicable to health plan 161.7purchasing are satisfied. The commissioner shall continue to use single-health plan, 161.8county-based purchasing arrangements for medical assistance and general assistance 161.9medical care programs and products for the counties that were in single-health plan, 161.10county-based purchasing arrangements on March 1, 2008. This paragraph does not require 161.11the commissioner to terminate an existing contract with a noncounty-based purchasing 161.12plan that had enrollment in a medical assistance program or product in these counties on 161.13March 1, 2008. This paragraph expires on December 31, 2010, or the effective date 161.14of a new contract for medical assistance and general assistance medical care managed 161.15care programs entered into at the conclusion of the commissioner's next scheduled 161.16reprocurement process for the county-based purchasing entities covered by this paragraph, 161.17whichever is later.161.18    (b) At the request of a county or group of counties, the commissioner shall consider, 161.19and may approve, contracting on a single-health plan basis with other county-based 161.20purchasing plans, or with other qualified health plans that have coordination arrangements 161.21with counties, to serve persons with a disability who voluntarily enroll, enrolled in 161.22Minnesota health care programs in order to promote better coordination or integration 161.23of health care services, social services and other community-based services, provided 161.24that all requirements applicable to health plan purchasing, including those in section 161.25256B.69, subdivision 23
         , are satisfied. Nothing in this paragraph supersedes or modifies 161.26the requirements in paragraph (a).161.27    Sec. 79. Minnesota Statutes 2010, section 256B.76, subdivision 4, is amended to read:161.28    Subd. 4. Critical access dental providers.  (a) Effective for dental services 161.29rendered on or after January 1, 2002, the commissioner shall increase reimbursements 161.30to dentists and dental clinics deemed by the commissioner to be critical access dental 161.31providers. For dental services rendered on or after July 1, 2007, the commissioner shall 161.32increase reimbursement by 30 percent above the reimbursement rate that would otherwise 161.33be paid to the critical access dental provider. The commissioner shall pay the managed 161.34care plans and county-based purchasing plans in amounts sufficient to reflect increased 161.35reimbursements to critical access dental providers as approved by the commissioner.162.1(b) The commissioner shall designate the following dentists and dental clinics as 162.2critical access dental providers:162.3    (1) nonprofit community clinics that:162.4(i) have nonprofit status in accordance with chapter 317A;162.5(ii) have tax exempt status in accordance with the Internal Revenue Code, section 162.6501(c)(3);162.7(iii) are established to provide oral health services to patients who are low income, 162.8uninsured, have special needs, and are underserved;162.9(iv) have professional staff familiar with the cultural background of the clinic's 162.10patients;162.11(v) charge for services on a sliding fee scale designed to provide assistance to 162.12low-income patients based on current poverty income guidelines and family size;162.13(vi) do not restrict access or services because of a patient's financial limitations 162.14or public assistance status; and162.15(vii) have free care available as needed;162.16    (2) federally qualified health centers, rural health clinics, and public health clinics;162.17    (3) county owned and operated hospital-based dental clinics;162.18(4) a dental clinic or dental group owned and operated by a nonprofit corporation in 162.19accordance with chapter 317A with more than 10,000 patient encounters per year with 162.20patients who are uninsured or covered by medical assistance, general assistance medical 162.21care, or MinnesotaCare; and162.22(5) a dental clinic associated with an oral health or dental education program owned 162.23and operated by the University of Minnesota or an institution within the Minnesota State 162.24Colleges and Universities system.162.25     (c) The commissioner may designate a dentist or dental clinic as a critical access 162.26dental provider if the dentist or dental clinic is willing to provide care to patients covered 162.27by medical assistance, general assistance medical care, or MinnesotaCare at a level which 162.28significantly increases access to dental care in the service area.162.29(d) Notwithstanding paragraph (a), critical access payments must not be made for 162.30dental services provided from April 1, 2010, through June 30, 2010.162.31(e) Notwithstanding section 256B.04, subdivision 2, the commissioner of human 162.32services shall not adopt rules governing this section or section 256L.11, subdivision 7.162.33EFFECTIVE DATE.This section is effective July 1, 2011.162.34    Sec. 80. [256B.7671] PATIENT-CENTERED DECISION-MAKING.163.1(a) For purposes of this section, "patient-centered decision-making process" means a 163.2process that involves directed interaction with the patient to assist the patient in arriving at 163.3an informed objective health care decision regarding the surgical procedure that is both 163.4informed and consistent with the patient's preference and values. The interaction may be 163.5conducted by a health care provider or through the electronic use of decision aids. If 163.6decision aids are used in the process, the aids must meet the criteria established by the 163.7International Patients Decision Aids Standards Collaboration or the Cochrane Decision 163.8Aid Registry.163.9(b) Effective January 1, 2012, the commissioner of human services shall require 163.10active participation in a patient-centered decision-making process before authorization is 163.11approved or payment reimbursement is provided for any of the following:163.12(1) a surgical procedure for abnormal uterine bleeding, benign prostate enlargement, 163.13chronic back pain, early stage of breast and prostate cancers, gastroesophageal reflux 163.14disease, hemorrhoids, spinal stenosis, temporomandibular joint dysfunction, ulcerative 163.15colitis, urinary incontinence, uterine fibroids, or varicose veins; and163.16(2) bypass surgery for coronary disease, angioplasty for stable coronary artery 163.17disease, or total hip replacement. 163.18(c) A list of the procedures in paragraph (b) shall be published in the State Register 163.19by October 1, 2011. The list shall be reviewed no less than every two years by the 163.20commissioner, in consultation with the commissioner of health. The commissioner 163.21shall hold a public forum and receive public comment prior to any changes to the list in 163.22paragraph (b). Any changes made shall be published in the State Register.163.23(d) Prior to receiving authorization or reimbursement for the procedures identified 163.24under this section, a health care provider must certify that the patient has participated in a 163.25patient-centered decision-making process. The format for this certification and the process 163.26for coordination between providers shall be developed by the Health Services Policy 163.27Committee under section 256B.0625, subdivision 3c.163.28(e) This section does not apply if any of the procedures identified in this section are 163.29performed under an emergency situation.163.30    Sec. 81. [256B.771] COMPLEMENTARY AND ALTERNATIVE MEDICINE 163.31DEMONSTRATION PROJECT.163.32    Subdivision 1.Establishment and implementation.The commissioner of 163.33human services, in consultation with the commissioner of health, shall contract 163.34with a Minnesota-based academic and research institution specializing in providing 163.35complementary and alternative medicine education and clinical services to establish and 164.1implement a five-year demonstration project in conjunction with federally qualified health 164.2centers and federally qualified health center look-alikes as defined in section 145.9269, to 164.3improve the quality and cost-effectiveness of care provided under medical assistance to 164.4enrollees with neck and back problems.  The demonstration project must maximize the use 164.5of complementary and alternative medicine-oriented primary care providers, including but 164.6not limited to physicians and chiropractors.  The demonstration project must be designed 164.7to significantly improve physical and mental health for enrollees who present with 164.8neck and back problems while decreasing medical treatment costs. The commissioner, 164.9in consultation with the commissioner of health, shall deliver services through the 164.10demonstration project beginning July 1, 2011, or upon federal approval, whichever is later.164.11    Subd. 2.RFP and project criteria.The commissioner, in consultation with the 164.12commissioner of health, shall develop and issue a request for proposal (RFP) for the 164.13demonstration project. The RFP must require the academic and research institution 164.14selected to demonstrate a proven track record over at least five years of conducting 164.15high-quality, federally funded clinical research. The institution and the federally qualified 164.16health centers and federally qualified health center look-alikes shall also:164.17(1) provide patient education, provider education, and enrollment training 164.18components on health and lifestyle issues in order to promote enrollee responsibility for 164.19health care decisions, enhance productivity, prepare enrollees to reenter the workforce, 164.20and reduce future health care expenditures;164.21(2) use high-quality and cost-effective integrated disease management that includes 164.22the best practices of traditional and complementary and alternative medicine;164.23(3) incorporate holistic medical care, appropriate nutrition, exercise, medications, 164.24and conflict resolution techniques;164.25(4) include a provider education component that makes use of professional 164.26organizations representing chiropractors, nurses, and other primary care providers 164.27and provides appropriate educational materials and activities in order to improve the 164.28integration of traditional medical care with licensed chiropractic services and other 164.29alternative health care services and achieve program enrollment objectives; and164.30(5) provide to the commissioner the information and data necessary for the 164.31commissioner to prepare the annual reports required under subdivision 6.164.32    Subd. 3.Enrollment.Enrollees from the program shall be selected by the 164.33commissioner from current enrollees in the prepaid medical assistance program who 164.34have, or are determined to be at significant risk of developing, neck and back problems. 164.35Participation in the demonstration project shall be voluntary.  The commissioner shall 164.36seek to enroll, over the term of the demonstration project, ten percent of current and 165.1future medical assistance enrollees who have, or are determined to be at significant risk 165.2of developing, neck and back problems.165.3    Subd. 4.Federal approval.The commissioner shall seek any federal waivers and 165.4approvals necessary to implement the demonstration project.165.5    Subd. 5.Project costs.The commissioner shall require the academic and research 165.6institution selected, federally qualified health centers, and federally qualified health center 165.7look-alikes to fund all net costs of the demonstration project.165.8    Subd. 6.Annual reports.The commissioner, in consultation with the commissioner 165.9of health, beginning December 15, 2011, and each December 15 thereafter through 165.10December 15, 2015, shall report annually to the legislature on the functional and mental 165.11improvements of the populations served by the demonstration project, patient satisfaction, 165.12and the cost-effectiveness of the program. The reports must also include data on hospital 165.13admissions, days in hospital, rates of outpatient surgery and other services, and drug 165.14utilization. The report, due December 15, 2015, must include recommendations on 165.15whether the demonstration project should be continued and expanded.165.16    Sec. 82. [256B.841] WAIVER APPLICATION AND PROCESS.165.17    Subdivision 1.Intent.It is the intent of the legislature that medical assistance be:165.18(1) a sustainable, cost-effective, person-centered, and opportunity-driven program 165.19utilizing competitive and value-based purchasing to maximize available service options; 165.20and165.21(2) a results-oriented system of coordinated care that focuses on independence 165.22and choice, promotes accountability and transparency, encourages and rewards healthy 165.23outcomes and responsible choices, and promotes efficiency.165.24    Subd. 2.Waiver application.(a) By September 1, 2011, the commissioner of 165.25human services shall apply for a waiver and any necessary state plan amendments from 165.26the secretary of the United States Department of Health and Human Services, including, 165.27but not limited to, a waiver of the appropriate sections of title XIX of the federal Social 165.28Security Act, United States Code, title 42, section 1396 et seq., or other provisions of 165.29federal law that provide program flexibility and under which Minnesota will operate all 165.30facets of the state's medical assistance program.165.31(b) The commissioner of human services shall provide the legislative committees 165.32with jurisdiction over health and human services finance and policy with the waiver 165.33application and financial and other related materials, at least ten days prior to submitting 165.34the application and materials to the federal Centers for Medicare and Medicaid Services.166.1(c) If the state's waiver application is approved, the commissioner of human services 166.2shall:166.3(1) notify the chairs of the legislative committees with jurisdiction over health and 166.4human services finance and policy and allow the legislative committees with jurisdiction 166.5over health and human services finance and policy to review the terms of the waiver; and166.6(2) not implement the waiver until ten legislative days have passed following 166.7notification of the chairs.166.8    Subd. 3.Rulemaking; legislative proposals.Upon acceptance of the terms of the 166.9waiver, the commissioner of human services shall:166.10(1) adopt rules to implement the waiver; and166.11(2) propose any legislative changes necessary to implement the terms of the waiver.166.12    Subd. 4.Joint commission on waiver implementation.(a) After acceptance 166.13of the terms of the waiver, the governor shall establish a joint commission on waiver 166.14implementation. The commission shall consist of eight members; four of whom shall 166.15be members of the senate, not more than three from the same political party, to be 166.16appointed by the Subcommittee on Committees of the senate Committee on Rules and 166.17Administration, and four of whom shall be members of the house of representatives, not 166.18more than three from the same political party, to be appointed by the speaker of the house.166.19(b) The commission shall:166.20(1) oversee implementation of the waiver;166.21(2) confer as necessary with state agency commissioners;166.22(3) make recommendations on services covered under the medical assistance 166.23program;166.24(4) monitor and make recommendations on quality and access to care under the 166.25global waiver; and166.26(5) make recommendations for the efficient and cost-effective administration of the 166.27medical assistance program under the terms of the waiver.166.28    Sec. 83. [256B.842] PRINCIPLES AND GOALS FOR MEDICAL ASSISTANCE 166.29REFORM.166.30    Subdivision 1.Goals for reform. In developing the waiver application and 166.31implementing the waiver, the commissioner of human services shall ensure that the 166.32reformed medical assistance program is a person-centered, financially sustainable, and 166.33cost-effective program.166.34    Subd. 2.Reformed medical assistance criteria.The reformed medical assistance 166.35program established through the waiver must:167.1(1) empower consumers to make informed and cost-effective choices about their 167.2health and offer consumers rewards for healthy decisions;167.3(2) ensure adequate access to needed services;167.4(3) enable consumers to receive individualized health care that is outcome-oriented 167.5and focused on prevention, disease management, recovery, and maintaining independence;167.6(4) promote competition between health care providers to ensure best value 167.7purchasing, leverage resources, and to create opportunities for improving service quality 167.8and performance;167.9(5) redesign purchasing and payment methods and encourage and reward 167.10high-quality and cost-effective care by incorporating and expanding upon current payment 167.11reform and quality of care initiatives, including but not limited to those initiatives 167.12authorized under chapter 62U; and167.13(6) continually improve technology to take advantage of recent innovations and 167.14advances that help decision makers, consumers, and providers make informed and 167.15cost-effective decisions regarding health care.167.16    Subd. 3.Annual report.The commissioner of human services shall annually 167.17submit a report to the governor and the legislature, beginning December 1, 2012, and each 167.18December 1 thereafter, describing the status of the administration and implementation 167.19of the waiver.167.20    Sec. 84. [256B.843] WAIVER APPLICATION REQUIREMENTS.167.21    Subdivision 1.Requirements for waiver request.The commissioner shall seek 167.22federal approval to:167.23(1) enter into a five-year agreement with the United States Department of Health and 167.24Human Services and Centers for Medicaid and Medicare Services (CMS) under section 167.251115a to waive provisions of title XIX of the federal Social Security Act, United States 167.26Code, title 42, section 1396 et seq., requiring:167.27(i) statewideness to allow for the provision of different services in different areas or 167.28regions of the state;167.29(ii) comparability of services to allow for the provision of different services to 167.30members of the same or different coverage groups;167.31(iii) no prohibitions restricting the amount, duration, and scope of services included 167.32in the medical assistance state plan;167.33(iv) no prohibitions limiting freedom of choice of providers; and167.34(v) retroactive payment for medical assistance, at the state's discretion;168.1(2) waive the applicable provisions of title XIX of the federal Social Security Act, 168.2United States Code, title 42, section 1396 et seq., in order to:168.3(i) expand cost sharing requirements above the five percent of income threshold for 168.4beneficiaries in certain populations;168.5(ii) establish health savings or power accounts that encourage and reward 168.6beneficiaries who reach certain prevention and wellness targets; and168.7(iii) implement a tiered set of parameters to use as the basis for determining 168.8long-term service care and setting needs;168.9(3) modify income and resource rules in a manner consistent with the goals of the 168.10reformed program;168.11(4) provide enrollees with a choice of appropriate private sector health coverage 168.12options, with full federal financial participation;168.13(5) treat payments made toward the cost of care as a monthly premium for 168.14beneficiaries receiving home and community-based services when applicable;168.15(6) provide health coverage and services to individuals over the age of 65 that are 168.16limited in scope and are available only in the home and community-based setting;168.17(7) consolidate all home and community-based services currently provided under 168.18title XIX of the federal Social Security Act, United States Code, title 42, section 1915(c), 168.19into a single program of home and community-based services that include options for 168.20consumer direction and shared living;168.21(8) expand disease management, care coordination, and wellness programs for all 168.22medical assistance recipients; and168.23(9) empower and encourage able-bodied medical assistance recipients to work, 168.24whenever possible.168.25    Subd. 2.Agency coordination.The commissioner shall establish an intraagency 168.26assessment and coordination unit to ensure that decision making and program planning for 168.27recipients who may need long-term care, residential placement, and community support 168.28services are coordinated. The assessment and coordination unit shall determine level of 168.29care, develop service plans and a service budget, make referrals to appropriate settings, 168.30provide education and choice counseling to consumers and providers, track utilization, 168.31and monitor outcomes. 168.32    Sec. 85. Minnesota Statutes 2010, section 256D.03, subdivision 3, is amended to read:168.33    Subd. 3. General assistance medical care; eligibility. (a) Beginning April 1, 168.342010 January 1, 2012, the general assistance medical care program shall be administered 168.35according to section 
         256D.031, unless otherwise stated, except for outpatient prescription 169.1drug coverage, which shall continue to be administered under this section and funded 169.2under section 256D.031, subdivision 9, beginning June 1, 2010.169.3    (b) Outpatient prescription drug coverage under general assistance medical care is 169.4limited to prescription drugs that:169.5    (1) are covered under the medical assistance program as described in section 169.6256B.0625, subdivisions 13
          and 13d; and169.7    (2) are provided by manufacturers that have fully executed general assistance 169.8medical care rebate agreements with the commissioner and comply with the agreements. 169.9Outpatient prescription drug coverage under general assistance medical care must conform 169.10to coverage under the medical assistance program according to section 
         256B.0625, 169.11subdivisions 13
          to 13h.169.12    (c) Outpatient prescription drug coverage does not include drugs administered in a 169.13clinic or other outpatient setting.169.14    (d) For the period beginning April 1, 2010, to May 31, 2010, general assistance 169.15medical care covers the services listed in subdivision 4.169.16EFFECTIVE DATE.This section is effective January 1, 2012.169.17    Sec. 86. Minnesota Statutes 2010, section 256D.031, subdivision 6, is amended to read:169.18    Subd. 6. Coordinated care delivery systems. (a) Effective June 1, 2010 January 169.191, 2012, the commissioner shall contract with hospitals or groups of hospitals, or 169.20county-based purchasing plans, that qualify under paragraph (b) and agree to deliver 169.21services according to this subdivision. Contracting hospitals or plans shall develop 169.22and implement a coordinated care delivery system to provide health care services to 169.23individuals who are eligible for general assistance medical care under this section and who 169.24either choose to receive services through the coordinated care delivery system or who are 169.25enrolled by the commissioner under paragraph (c). The health care services provided by 169.26the system must include: (1) the services described in subdivision 4 with the exception 169.27of outpatient prescription drug coverage but shall include drugs administered in a clinic 169.28or other outpatient setting; or (2) a set of comprehensive and medically necessary health 169.29services that the recipients might reasonably require to be maintained in good health and 169.30that has been approved by the commissioner, including at a minimum, but not limited 169.31to, emergency care, medical transportation services, inpatient hospital and physician 169.32care, outpatient health services, preventive health services, mental health services, 169.33and prescription drugs administered in a clinic or other outpatient setting. Outpatient 169.34prescription drug coverage is covered on a fee-for-service basis in accordance with section 169.35256D.03, subdivision 3, and funded under subdivision 9. A hospital or plan establishing a 170.1coordinated care delivery system under this subdivision must ensure that the requirements 170.2of this subdivision are met.170.3    (b) A hospital or group of hospitals, or a county-based purchasing plan established 170.4under section 256B.692, may contract with the commissioner to develop and implement a 170.5coordinated care delivery system as follows: if the hospital or group of hospitals or plan 170.6agrees to satisfy the requirements of this subdivision.170.7    (1) effective June 1, 2010, a hospital qualifies under this subdivision if: (i) during 170.8calendar year 2008, it received fee-for-service payments for services to general assistance 170.9medical care recipients (A) equal to or greater than $1,500,000, or (B) equal to or greater 170.10than 1.3 percent of net patient revenue; or (ii) a contract with the hospital is necessary to 170.11provide geographic access or to ensure that at least 80 percent of enrollees have access to 170.12a coordinated care delivery system; and170.13    (2) effective December 1, 2010, a Minnesota hospital not qualified under clause 170.14(1) may contract with the commissioner under this subdivision if it agrees to satisfy the 170.15requirements of this subdivision.170.16Participation by hospitals or plans shall become effective quarterly on June 1, September 170.171, December 1, or March 1 January 1, April 1, July 1, or October 1. Hospital or plan 170.18participation is effective for a period of 12 months and may be renewed for successive 170.1912-month periods.170.20    (c) Applicants and recipients may enroll in any available coordinated care delivery 170.21system statewide. If more than one coordinated care delivery system is available, the 170.22applicant or recipient shall be allowed to choose among the systems. The commissioner 170.23may assign an applicant or recipient to a coordinated care delivery system if no choice 170.24is made by the applicant or recipient. The commissioner shall consider a recipient's zip 170.25code, city of residence, county of residence, or distance from a participating coordinated 170.26care delivery system when determining default assignment. An applicant or recipient may 170.27decline enrollment in a coordinated care delivery system but services are only available 170.28through a coordinated care delivery system. Upon enrollment into a coordinated care 170.29delivery system, the recipient must agree to receive all nonemergency services through the 170.30coordinated care delivery system. Enrollment in a coordinated care delivery system is 170.31for six months and may be renewed for additional six-month periods, except that initial 170.32enrollment is for six months or until the end of a recipient's period of general assistance 170.33medical care eligibility, whichever occurs first. A recipient who continues to meet the 170.34eligibility requirements of this section is not eligible to enroll in MinnesotaCare during 170.35a period of enrollment in a coordinated care delivery system. From June 1, 2010, to 170.36February 28, 2011, applicants and recipients not enrolled in a coordinated care delivery 171.1system may seek services from a hospital eligible for reimbursement under the temporary 171.2uncompensated care pool established under subdivision 8. After February 28, 2011, 171.3services are available only through a coordinated care delivery system.171.4    (d) The hospital or plan may contract and coordinate with providers and clinics 171.5for the delivery of services and shall contract with essential community providers as 171.6defined under section 
         62Q.19, subdivision 1, paragraph (a), clauses (1) and (2), to the 171.7extent practicable. When contracting with providers and clinics, the hospital or plan 171.8shall give preference to providers and clinics certified as health care homes under section 171.9256B.0751. The hospital or plan must contract with federally qualified health centers or 171.10federally qualified health center look-alikes, as defined in section 145.9269, subdivision 1, 171.11and essential community providers as defined in section 62Q.19, that agree to accept the 171.12terms, conditions, and payment rates offered by the hospital or plan to similarly situated 171.13providers, except that reimbursement to federally qualified health centers and federally 171.14qualified health center look-alikes must comply with federal law. If a provider or clinic or 171.15health center contracts with a hospital or plan to provide services through the coordinated 171.16care delivery system, the provider may not refuse to provide services to any recipient 171.17enrolled in the system, and payment for services shall be negotiated with the hospital or 171.18plan and paid by the hospital or plan from the system's allocation under subdivision 7.171.19    (e) A coordinated care delivery system must:171.20    (1) provide the covered services required under paragraph (a) to recipients enrolled 171.21in the coordinated care delivery system, and comply with the requirements of subdivision 171.224, paragraphs (b) to (g);171.23    (2) establish a process to monitor enrollment and ensure the quality of care provided;171.24    (3) in cooperation with counties, coordinate the delivery of health care services with 171.25existing homeless prevention, supportive housing, and rent subsidy programs and funding 171.26administered by the Minnesota Housing Finance Agency under chapter 462A; and171.27    (4) adopt innovative and cost-effective methods of care delivery and coordination, 171.28which may include the use of allied health professionals, telemedicine, patient educators, 171.29care coordinators, and community health workers.171.30    (f) The hospital or plan may require a recipient to designate a primary care provider 171.31or a primary care clinic. The hospital or plan may limit the delivery of services to a 171.32network of providers who have contracted with the hospital or plan to deliver services in 171.33accordance with this subdivision, and require a recipient to seek services only within this 171.34network. The hospital or plan may also require a referral to a provider before the service 171.35is eligible for payment. A coordinated care delivery system is not required to provide 171.36payment to a provider who is not employed by or under contract with the system for 172.1services provided to a recipient enrolled in the system, except in cases of an emergency. 172.2For purposes of this section, emergency services are defined in accordance with Code of 172.3Federal Regulations, title 42, section 438.114 (a).172.4    (g) A recipient enrolled in a coordinated care delivery system has the right to appeal 172.5to the commissioner according to section 
         256.045.172.6    (h) The state shall not be liable for the payment of any cost or obligation incurred 172.7by the coordinated care delivery system.172.8    (i) The hospital or plan must provide the commissioner with data necessary for 172.9assessing enrollment, quality of care, cost, and utilization of services. Each hospital or 172.10plan must provide, on a quarterly basis on a form prescribed by the commissioner for each 172.11recipient served by the coordinated care delivery system, the services provided, the cost of 172.12services provided, and the actual payment amount for the services provided and any other 172.13information the commissioner deems necessary to claim federal Medicaid match. The 172.14commissioner must provide this data to the legislature on a quarterly basis.172.15    (j) Effective June 1, 2010, The provisions of section 
         256.9695, subdivision 2, 172.16paragraph (b), do not apply to general assistance medical care provided under this section.172.17    (k) Notwithstanding any other provision in this section to the contrary, for 172.18participation beginning September 1, 2010, the commissioner shall offer the same contract 172.19terms related toshall negotiate an enrollment threshold formula and financial liability 172.20protections to with a hospital or group of hospitals or plan qualified under this subdivision 172.21to develop and implement a coordinated care delivery system as those contained in the 172.22coordinated care delivery system contracts effective June 1, 2010.172.23    (l) If sections 256B.055, subdivision 15, and 256B.056, subdivisions 3 and 4, are 172.24implemented effective July 1, 2010, this subdivision must not be implemented.172.25EFFECTIVE DATE.This section is effective January 1, 2012.172.26    Sec. 87. Minnesota Statutes 2010, section 256D.031, subdivision 7, is amended to read:172.27    Subd. 7. Payments; rate setting for the hospital coordinated care delivery 172.28system. (a) Effective for general assistance medical care services, with the exception 172.29of outpatient prescription drug coverage, provided on or after June 1, 2010, through a 172.30coordinated care delivery system, the commissioner shall allocate the annual appropriation 172.31for the coordinated care delivery system to hospitals or plans participating under 172.32subdivision 6 in quarterly payments, beginning on the first scheduled warrant on or after 172.33June 1, 2010 March 1, 2012. The payment shall be allocated among all hospitals or plans 172.34qualified to participate on the allocation date as follows: based upon the enrollment 172.35thresholds negotiated with the commissioner.173.1    (1) each hospital or group of hospitals shall be allocated an initial amount based on 173.2the hospital's or group of hospitals' pro rata share of calendar year 2008 payments for 173.3general assistance medical care services to all participating hospitals;173.4    (2) the initial allocations to Hennepin County Medical Center; Regions Hospital; 173.5Saint Mary's Medical Center; and the University of Minnesota Medical Center, Fairview, 173.6shall be increased to 110 percent of the value determined in clause (1);173.7    (3) the initial allocation to hospitals not listed in clause (2) shall be reduced a pro rata 173.8amount in order to keep the allocations within the limit of available appropriations; and173.9    (4) the amounts determined under clauses (1) to (3) shall be allocated to participating 173.10hospitals.173.11The commissioner may prospectively reallocate payments to participating hospitals or 173.12plans on a biannual basis to ensure that final allocations reflect actual coordinated care 173.13delivery system enrollment. The 2008 base year shall be updated by one calendar year 173.14each June 1, beginning June 1, 2011.173.15    (b) Beginning June 1, 2010, and every quarter beginning in June thereafter, the 173.16commissioner shall make one-third of the quarterly payment in June and the remaining 173.17two-thirds of the quarterly payment in July to each participating hospital or group of 173.18hospitals.173.19    (c) (b) In order to be reimbursed under this section, nonhospital providers of health 173.20care services shall contract with one or more hospitals or plans described in paragraph (a) 173.21to provide services to general assistance medical care recipients through the coordinated 173.22care delivery system established by the hospital or plan. The hospital or plan shall 173.23reimburse bills submitted by nonhospital providers participating under this paragraph at a 173.24rate negotiated between the hospital or plan and the nonhospital provider.173.25    (d) (c) The commissioner shall apply for federal matching funds under section 173.26256B.199
         , paragraphs (a) to (d), for expenditures under this subdivision.173.27    (e) (d) Outpatient prescription drug coverage is provided in accordance with section 173.28256D.03, subdivision 3
         , and paid on a fee-for-service basis under subdivision 9.173.29EFFECTIVE DATE.This section is effective January 1, 2012.173.30    Sec. 88. Minnesota Statutes 2010, section 256D.031, subdivision 10, is amended to 173.31read:173.32    Subd. 10. Assistance for veterans. Hospitals and plans participating in the 173.33coordinated care delivery system under subdivision 6 shall consult with counties, county 174.1veterans service officers, and the Veterans Administration to identify other programs for 174.2which general assistance medical care recipients enrolled in their system are qualified.174.3    Sec. 89. Minnesota Statutes 2010, section 256L.01, subdivision 4a, is amended to read:174.4    Subd. 4a. Gross individual or gross family income. (a) "Gross individual or gross 174.5family income" for nonfarm self-employed means income calculated for the 12-month174.6six-month period of eligibility using as a baseline the adjusted gross income reported 174.7on the applicant's federal income tax form for the previous year and adding back in 174.8depreciation, and carryover net operating loss amounts that apply to the business in which 174.9the family is currently engaged.174.10(b) "Gross individual or gross family income" for farm self-employed means 174.11income calculated for the 12-month six-month period of eligibility using as the baseline 174.12the adjusted gross income reported on the applicant's federal income tax form for the 174.13previous year.174.14(c) "Gross individual or gross family income" means the total income for all family 174.15members, calculated for the 12-month six-month period of eligibility.174.16    Sec. 90. Minnesota Statutes 2010, section 256L.02, subdivision 3, is amended to read:174.17    Subd. 3. Financial management. (a) The commissioner shall manage spending for 174.18the MinnesotaCare program in a manner that maintains a minimum reserve. As part of 174.19each state revenue and expenditure forecast, the commissioner must make an assessment 174.20of the expected expenditures for the covered services for the remainder of the current 174.21biennium and for the following biennium. The estimated expenditure, including the 174.22reserve, shall be compared to an estimate of the revenues that will be available in the health 174.23care access fund. Based on this comparison, and after consulting with the chairs of the 174.24house of representatives Ways and Means Committee and the senate Finance Committee, 174.25and the Legislative Commission on Health Care Access, the commissioner shall, as 174.26necessary, make the adjustments specified in paragraph (b) to ensure that expenditures 174.27remain within the limits of available revenues for the remainder of the current biennium 174.28and for the following biennium. The commissioner shall not hire additional staff using 174.29appropriations from the health care access fund until the commissioner of management 174.30and budget makes a determination that the adjustments implemented under paragraph (b) 174.31are sufficient to allow MinnesotaCare expenditures to remain within the limits of available 174.32revenues for the remainder of the current biennium and for the following biennium.174.33(b) The adjustments the commissioner shall use must be implemented in this order: 174.34first, stop enrollment of single adults and households without children; second, upon 45 175.1days' notice, stop coverage of single adults and households without children already 175.2enrolled in the MinnesotaCare program; third, upon 90 days' notice, decrease the premium 175.3subsidy amounts by ten percent for children in families with gross annual income above 175.4200 percent of the federal poverty guidelines; fourth, upon 90 days' notice, decrease the 175.5premium subsidy amounts by ten percent for children in families with gross annual income 175.6at or below 200 percent; and fifth, require applicants to be uninsured for at least six months 175.7prior to eligibility in the MinnesotaCare program. If these measures are insufficient to 175.8limit the expenditures to the estimated amount of revenue, the commissioner shall further 175.9limit enrollment or decrease premium subsidies.175.10EFFECTIVE DATE.This section is effective January 1, 2012, or upon federal 175.11approval, whichever is later, and expires June 30, 2013. The commissioner shall notify 175.12the revisor of statutes when federal approval is obtained and publish a notice in the State 175.13Register.175.14    Sec. 91. Minnesota Statutes 2010, section 256L.02, subdivision 3, is amended to read:175.15    Subd. 3. Financial management. (a) The commissioner shall manage spending for 175.16the MinnesotaCare program in a manner that maintains a minimum reserve. As part of 175.17each state revenue and expenditure forecast, the commissioner must make an assessment 175.18of the expected expenditures for the covered services for the remainder of the current 175.19biennium and for the following biennium. The estimated expenditure, including the 175.20reserve, shall be compared to an estimate of the revenues that will be available in the health 175.21care access fund. Based on this comparison, and after consulting with the chairs of the 175.22house of representatives Ways and Means Committee and the senate Finance Committee, 175.23and the Legislative Commission on Health Care Access, the commissioner shall, as 175.24necessary, make the adjustments specified in paragraph (b) to ensure that expenditures 175.25remain within the limits of available revenues for the remainder of the current biennium 175.26and for the following biennium. The commissioner shall not hire additional staff using 175.27appropriations from the health care access fund until the commissioner of management 175.28and budget makes a determination that the adjustments implemented under paragraph (b) 175.29are sufficient to allow MinnesotaCare expenditures to remain within the limits of available 175.30revenues for the remainder of the current biennium and for the following biennium.175.31(b) The adjustments the commissioner shall use must be implemented in this order: 175.32first, stop enrollment of single adults and households without children; second, upon 45 175.33days' notice, stop coverage of single adults and households without children already 175.34enrolled in the MinnesotaCare program; third, upon 90 days' notice, decrease the premium 175.35subsidy amounts by ten percent for families with gross annual income above 200 percent 176.1of the federal poverty guidelines; fourth, upon 90 days' notice, decrease the premium 176.2subsidy amounts by ten percent for families with gross annual income at or below 200 176.3percent; and fifth, require applicants to be uninsured for at least six months prior to 176.4eligibility in the MinnesotaCare program. If these measures are insufficient to limit the 176.5expenditures to the estimated amount of revenue, the commissioner shall further limit 176.6enrollment or decrease premium subsidies.176.7    Sec. 92. Minnesota Statutes 2010, section 256L.03, subdivision 3, is amended to read:176.8    Subd. 3. Inpatient hospital services. (a) Covered health services shall include 176.9inpatient hospital services, including inpatient hospital mental health services and inpatient 176.10hospital and residential chemical dependency treatment, subject to those limitations 176.11necessary to coordinate the provision of these services with eligibility under the medical 176.12assistance spenddown. The inpatient hospital benefit for adult enrollees who qualify under 176.13section 
         256L.04, subdivision 7, or who qualify under section 256L.04, subdivisions 1 and 176.142, with family gross income that exceeds 200 percent of the federal poverty guidelines or 176.15215 percent of the federal poverty guidelines on or after July 1, 2009, and who are not 176.16pregnant, is subject to an annual limit of $10,000.176.17    (b) Admissions for inpatient hospital services paid for under section 
         256L.11, 176.18subdivision 3
         , must be certified as medically necessary in accordance with Minnesota 176.19Rules, parts 9505.0500 to 9505.0540, except as provided in clauses (1) and (2):176.20    (1) all admissions must be certified, except those authorized under rules established 176.21under section 
         254A.03, subdivision 3, or approved under Medicare; and176.22    (2) payment under section 
         256L.11, subdivision 3, shall be reduced by five percent 176.23for admissions for which certification is requested more than 30 days after the day of 176.24admission. The hospital may not seek payment from the enrollee for the amount of the 176.25payment reduction under this clause.176.26EFFECTIVE DATE.This section is effective January 1, 2012, or upon federal 176.27approval, whichever is later, and expires June 30, 2013. The commissioner shall notify 176.28the revisor of statutes when federal approval is obtained and publish a notice in the State 176.29Register.176.30    Sec. 93. Minnesota Statutes 2010, section 256L.03, subdivision 5, is amended to read:176.31    Subd. 5. Co-payments and coinsurance Cost-sharing. (a) Except as provided in 176.32paragraphs (b) and, (c), and (h), the MinnesotaCare benefit plan shall include the following 176.33co-payments and coinsurance cost-sharing requirements for all enrollees:177.1    (1) ten percent of the paid charges for inpatient hospital services for adult enrollees, 177.2subject to an annual inpatient out-of-pocket maximum of $1,000 per individual;177.3    (2) $3 per prescription for adult enrollees;177.4    (3) $25 for eyeglasses for adult enrollees;177.5    (4) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an 177.6episode of service which is required because of a recipient's symptoms, diagnosis, or 177.7established illness, and which is delivered in an ambulatory setting by a physician or 177.8physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse, 177.9audiologist, optician, or optometrist; and177.10    (5) $6 for nonemergency visits to a hospital-based emergency room for services 177.11provided through December 31, 2010, and $3.50 effective January 1, 2011; and177.12(6) a family deductible equal to the maximum amount allowed under Code of 177.13Federal Regulations, title 42, part 447.54.177.14    (b) Paragraph (a), clause (1), does and paragraph (e) do not apply to parents and 177.15relative caretakers of children under the age of 21.177.16    (c) Paragraph (a) does not apply to pregnant women and children under the age of 21.177.17    (d) Paragraph (a), clause (4), does not apply to mental health services.177.18    (e) Adult enrollees with family gross income that exceeds 200 percent of the federal 177.19poverty guidelines or 215 percent of the federal poverty guidelines on or after July 1, 2009, 177.20and who are not pregnant shall be financially responsible for the coinsurance amount, if 177.21applicable, and amounts which exceed the $10,000 inpatient hospital benefit limit.177.22    (f) When a MinnesotaCare enrollee becomes a member of a prepaid health plan, 177.23or changes from one prepaid health plan to another during a calendar year, any charges 177.24submitted towards the $10,000 annual inpatient benefit limit, and any out-of-pocket 177.25expenses incurred by the enrollee for inpatient services, that were submitted or incurred 177.26prior to enrollment, or prior to the change in health plans, shall be disregarded.177.27(g) MinnesotaCare reimbursements to fee-for-service providers and payments to 177.28managed care plans or county-based purchasing plans shall not be increased as a result of 177.29the reduction of the co-payments in paragraph (a), clause (5), effective January 1, 2011.177.30(h) Effective January 1, 2012, the following co-payments for nonpreventive visits 177.31shall apply to enrollees who are adults without children eligible under section 256L.04, 177.32subdivision 7:177.33(1) $3 for visits to providers whose average, risk-adjusted, total annual cost of care 177.34per MinnesotaCare enrollee is at the 60th percentile or lower for providers of the same 177.35type;178.1(2) $6 for visits to providers whose average, risk-adjusted, total annual cost of care 178.2per MinnesotaCare enrollee is greater than the 60th percentile but does not exceed the 178.380th percentile for providers of the same type; and178.4(3) $10 for visits to providers whose average, risk-adjusted, total annual cost of 178.5care per MinnesotaCare enrollee is greater than the 80th percentile for providers of the 178.6same type.178.7Each managed care and county-based purchasing plan shall calculate the average, 178.8risk-adjusted, total annual cost of care for providers under this paragraph using a 178.9methodology that has been approved by the commissioner.178.10EFFECTIVE DATE.The amendments to paragraph (e) are effective January 1, 178.112012, or upon federal approval, whichever is later, and expires June 30, 2013. The 178.12commissioner shall notify the revisor of statutes when federal approval is obtained and 178.13publish a notice in the State Register.178.14    Sec. 94. [256L.031] HEALTHY MINNESOTA CONTRIBUTION PROGRAM.178.15    Subdivision 1.Defined contributions to enrollees.(a) Beginning January 1, 2012, 178.16the commissioner shall provide each MinnesotaCare enrollee eligible under section 178.17256L.04, subdivision 7, with gross family income equal to or greater than 133 percent 178.18of the federal poverty guidelines, with a monthly defined contribution to purchase health 178.19coverage under a health plan as defined in section 62A.011, subdivision 3. Beginning 178.20January 1, 2012, or upon federal approval, whichever is later, the commissioner shall 178.21provide each MinnesotaCare enrollee eligible under section 256L.04, subdivision 1, with 178.22gross family income equal to or greater than 133 percent of the federal poverty guidelines, 178.23with a monthly defined contribution to purchase health coverage under a health plan as 178.24defined in section 62A.011, subdivision 3, offered by a health plan company as defined 178.25in section 62Q.01, subdivision 4.178.26(b) Enrollees eligible under paragraph (a) shall not be charged premiums under 178.27section 256L.15 and are exempt from the managed care enrollment requirement of section 178.28256L.12.178.29(c) Sections 256L.03; 256L.05, subdivision 3; and 256L.11 do not apply to 178.30enrollees eligible under paragraph (a). Covered services, cost-sharing, disenrollment 178.31for nonpayment of premium, enrollee appeal rights and complaint procedures, and the 178.32effective date of coverage for enrollees eligible under paragraph (a) shall be as provided 178.33under the terms of the health plan purchased by the enrollee.179.1(d) Unless otherwise provided in this section, all MinnesotaCare requirements 179.2related to eligibility, income and asset methodology, income reporting, and program 179.3administration continue to apply to enrollees obtaining coverage under this section.179.4    Subd. 2.Use of defined contribution.An enrollee may use up to the monthly 179.5defined contribution to pay premiums for coverage under a health plan as defined in 179.6section 62A.011, subdivision 3.179.7    Subd. 3.Determination of defined contribution amount.(a) The commissioner 179.8shall determine the defined contribution sliding scale using the base contribution specified 179.9in paragraph (b) for the specified age ranges. The commissioner shall use a sliding scale 179.10for defined contributions that provides:179.11(1) persons with household incomes equal to 133 percent of the federal poverty 179.12guidelines with a defined contribution of 150 percent of the base contribution;179.13(2) persons with household incomes equal to 175 percent of the federal poverty 179.14guidelines with a defined contribution of 100 percent of the base contribution;179.15(3) persons with household incomes equal to or greater than 250 percent of 179.16the federal poverty guidelines with a defined contribution of 80 percent of the base 179.17contribution; and179.18(4) persons with household incomes in evenly spaced increments between the 179.19percentages of the federal poverty guideline specified in clauses (1) to (3) with a base 179.20contribution that is a percentage interpolated from the defined contribution percentages 179.21specified in clauses (1) to (3).

179.22AgeMonthly Per-Person Base Contribution179.23Under 21$122.79179.2421-29122.79179.2530-31129.19179.2632-33132.38179.2734-35134.31179.2836-37136.06179.2938-39141.02179.3040-41151.25179.3142-43159.89179.3244-45175.08179.3346-47191.71179.3448-49213.13179.3550-51239.51179.3652-53266.69179.3754-55293.88179.3856-57323.77180.158-59341.20180.260+357.19

180.3(b) The commissioner shall multiply the defined contribution amounts developed 180.4under paragraph (a) by 1.20 for enrollees who are denied coverage under an individual 180.5health plan by a health plan company and who purchase coverage through the Minnesota 180.6Comprehensive Health Association.180.7(c) Notwithstanding paragraphs (a) and (b), the monthly defined contribution shall 180.8not exceed 90 percent of the monthly premium for the health plan purchased by the 180.9enrollee. If the enrollee purchases coverage under a health plan that does not include 180.10mental health services and chemical dependency treatment services, the monthly defined 180.11contribution amount determined under this subdivision shall be reduced by five percent.180.12    Subd. 4.Administration by commissioner.The commissioner shall administer the 180.13defined contributions. The commissioner shall:180.14    (1) calculate and process defined contributions for enrollees; and180.15    (2) pay the defined contribution amount to health plan companies or the Minnesota 180.16Comprehensive Health Association, as applicable, for enrollee health plan coverage.180.17    Subd. 5.Assistance to enrollees.The commissioner of human services, in 180.18consultation with the commissioner of commerce, shall develop an efficient and 180.19cost-effective method of referring eligible applicants to professional insurance agent 180.20associations.180.21    Subd. 6.Minnesota Comprehensive Health Association (MCHA).Beginning 180.22January 1, 2012, MinnesotaCare enrollees who are denied coverage under an individual 180.23health plan by a health plan company are eligible for coverage through a health plan 180.24offered by the MCHA and may enroll in MCHA according to section 62E.14. Any 180.25difference between the revenue and covered losses to the MCHA related to implementation 180.26of this section shall be paid to the MCHA from the health care access fund.180.27    Subd. 7.Federal approval.The commissioner shall seek all federal waivers 180.28and approvals necessary to implement coverage under this section for MinnesotaCare 180.29enrollees eligible under section 256L.04, subdivision 1, with gross family incomes equal 180.30to or greater than 133 percent of the federal poverty guidelines, while continuing to 180.31receive federal matching funds.180.32    Sec. 95. Minnesota Statutes 2010, section 256L.04, subdivision 1, is amended to read:180.33    Subdivision 1. Families with children. (a) Families with Children with family 180.34income equal to or less than 275 percent of the federal poverty guidelines for the 180.35applicable family size and adults in families with children with family income equal to or 181.1less than 200 percent of the federal poverty guidelines for the applicable family size, shall 181.2be eligible for MinnesotaCare according to this section. All other provisions of sections 181.3256L.01
          to 
         256L.18, including the insurance-related barriers to enrollment under section 181.4256L.07
         , shall apply unless otherwise specified.181.5    (b) Parents who enroll in the MinnesotaCare program must also enroll their children, 181.6if the children are eligible. Children may be enrolled separately without enrollment by 181.7parents. However, if one parent in the household enrolls, both parents must enroll, unless 181.8other insurance is available. If one child from a family is enrolled, all children must 181.9be enrolled, unless other insurance is available. If one spouse in a household enrolls, 181.10the other spouse in the household must also enroll, unless other insurance is available. 181.11Families cannot choose to enroll only certain uninsured members.181.12    (c) Beginning October 1, 2003, the dependent sibling definition no longer applies 181.13to the MinnesotaCare program. These persons are no longer counted in the parental 181.14household and may apply as a separate household.181.15    (d) Beginning July 1, 2010, or upon federal approval, whichever is later, parents are 181.16not eligible for MinnesotaCare if their gross income exceeds $57,500.181.17    (e) Children formerly enrolled in medical assistance and automatically deemed 181.18eligible for MinnesotaCare according to section 256B.057, subdivision 2c, are exempt 181.19from the requirements of this section until renewal.181.20(f) [Reserved.]181.21EFFECTIVE DATE.This section is effective January 1, 2012, or upon federal 181.22approval, whichever is later, and expires June 30, 2013, except that the amendment 181.23striking paragraph (e) is effective retroactively from October 1, 2008, does not expire, 181.24and federal approval is no longer necessary. The commissioner shall notify the revisor of 181.25statutes when federal approval is obtained and publish a notice in the State Register.181.26    Sec. 96. Minnesota Statutes 2010, section 256L.04, subdivision 7, is amended to read:181.27    Subd. 7. Single adults and households with no children. (a) The definition of 181.28eligible persons, through December 31, 2011, includes all individuals and households with 181.29no children who have gross family incomes that are equal to or less than 200 percent 181.30of the federal poverty guidelines.181.31    (b) Effective July 1, 2009 January 1, 2012, the definition of eligible persons includes 181.32all individuals and households with no children who have gross family incomes that are 181.33greater than 75 percent of the federal poverty guidelines and equal to or less than 250 200181.34percent of the federal poverty guidelines. Effective July 1, 2013, the maximum income 181.35limit under this paragraph is increased to 250 percent of the federal poverty guidelines.182.1EFFECTIVE DATE.This section is effective January 1, 2012.182.2    Sec. 97. Minnesota Statutes 2010, section 256L.05, subdivision 2, is amended to read:182.3    Subd. 2. Commissioner's duties.(a) The commissioner or county agency shall 182.4use electronic verification as the primary method of income verification. If there is a 182.5discrepancy between reported income and electronically verified income, an individual 182.6may be required to submit additional verification. In addition, the commissioner shall 182.7perform random audits to verify reported income and eligibility. The commissioner 182.8may execute data sharing arrangements with the Department of Revenue and any other 182.9governmental agency in order to perform income verification related to eligibility and 182.10premium payment under the MinnesotaCare program.182.11(b) In determining eligibility for MinnesotaCare, the commissioner shall require 182.12applicants and enrollees seeking renewal of eligibility to verify both earned and unearned 182.13income. The commissioner shall also require applicants and enrollees to submit the 182.14names of their employers and a contact name with a phone number for each employer 182.15for purposes of verifying whether the applicant or enrollee, and any dependents, are 182.16eligible for employer-subsidized coverage. Data collected is nonpublic data as defined 182.17in section 13.02, subdivision 9.182.18    Sec. 98. Minnesota Statutes 2010, section 256L.05, subdivision 3a, is amended to read:182.19    Subd. 3a. Renewal of eligibility. (a) Beginning July 1, 2007 2011, an enrollee's 182.20eligibility must be renewed every 12 six months. The 12-month period begins in the 182.21month after the month the application is approved.182.22    (b) The first six-month period of eligibility begins the month the application is 182.23received by the commissioner. The effective date of coverage within the first six-month 182.24period of eligibility is as provided in subdivision 3. Each new period of eligibility must 182.25take into account any changes in circumstances that impact eligibility and premium 182.26amount. An enrollee must provide all the information needed to redetermine eligibility 182.27by the first day of the month that ends the eligibility period. If there is no change in 182.28circumstances, the enrollee may renew eligibility at designated locations that include 182.29community clinics and health care providers' offices. The designated sites shall forward 182.30the renewal forms to the commissioner. The commissioner may establish criteria and 182.31timelines for sites to forward applications to the commissioner or county agencies. The 182.32premium for the new period of eligibility must be received as provided in section 
         256L.06182.33in order for eligibility to continue.183.1    (c) An enrollee who fails to submit renewal forms and related documentation 183.2necessary for verification of continued eligibility in a timely manner shall remain eligible 183.3for one additional month beyond the end of the current eligibility period before being 183.4disenrolled. The enrollee remains responsible for MinnesotaCare premiums for the 183.5additional month.183.6    Sec. 99. Minnesota Statutes 2010, section 256L.05, subdivision 5, is amended to read:183.7    Subd. 5. Availability of private insurance. The commissioner, in consultation with 183.8the commissioners of health and commerce, shall provide information regarding the 183.9availability of private health insurance coverage and the possibility of disenrollment 183.10under section 
         256L.07, subdivision 1, paragraphs (b) and (c), to all: (1) families enrolled 183.11in the MinnesotaCare program whose gross family income is equal to or more than 225 183.12percent of the federal poverty guidelines; and (2) single adults and households without 183.13children enrolled in the MinnesotaCare program whose gross family income is equal to 183.14or more than 165 percent of the federal poverty guidelines. This information must be 183.15provided upon initial enrollment and annually thereafter. The commissioner shall also 183.16include information regarding the availability of private health insurance coverage in the 183.17notice of ineligibility provided to persons subject to disenrollment under section 
         256L.07, 183.18subdivision 1
         , paragraphs (b) and (c).183.19EFFECTIVE DATE.This section is effective January 1, 2012, and expires June 183.2030, 2013.183.21    Sec. 100. Minnesota Statutes 2010, section 256L.05, is amended by adding a 183.22subdivision to read:183.23    Subd. 6.Referral of veterans.The commissioner shall ensure that all applicants 183.24for MinnesotaCare with incomes less than 133 percent of the federal poverty guidelines 183.25who identify themselves as veterans are referred to a county veterans service officer for 183.26assistance in applying to the United States Department of Veterans Affairs for any veterans 183.27benefits for which they may be eligible.183.28    Sec. 101. Minnesota Statutes 2010, section 256L.07, subdivision 1, is amended to read:183.29    Subdivision 1. General requirements. (a) Children enrolled in the original 183.30children's health plan as of September 30, 1992, children who enrolled in the 183.31MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549, 183.32article 4, section 17, and children who have family gross incomes that are equal to or 183.33less than 150 percent of the federal poverty guidelines are eligible without meeting 184.1the requirements of subdivision 2 and the four-month requirement in subdivision 3, as 184.2long as they maintain continuous coverage in the MinnesotaCare program or medical 184.3assistance. Children who apply for MinnesotaCare on or after the implementation date 184.4of the employer-subsidized health coverage program as described in Laws 1998, chapter 184.5407, article 5, section 45, who have family gross incomes that are equal to or less than 150 184.6percent of the federal poverty guidelines, must meet the requirements of subdivision 2 to 184.7be eligible for MinnesotaCare.184.8    (b) Families enrolled in MinnesotaCare under section 
         256L.04, subdivision 1, whose 184.9income increases above 275 percent of the federal poverty guidelines, are no longer 184.10eligible for the program and shall be disenrolled by the commissioner. Beginning January 184.111, 2008,184.12(c) Individuals enrolled in MinnesotaCare under section 
         256L.04, subdivision 7, 184.13whose income increases above 200 percent of the federal poverty guidelines or 250 184.14percent of the federal poverty guidelines on or after July 1, 2009, the limits described 184.15in section 256L.04, subdivision 7, are no longer eligible for the program and shall be 184.16disenrolled by the commissioner.184.17(d) For persons disenrolled under this subdivision, MinnesotaCare coverage 184.18terminates the last day of the calendar month following the month in which the 184.19commissioner determines that the income of a family or individual exceeds program 184.20income limits.184.21    (b) (e) Notwithstanding paragraph (a), children may remain enrolled in 184.22MinnesotaCare if ten percent of their gross individual or gross family income as defined 184.23in section 
         256L.01, subdivision 4, is less than the annual premium for a six-month 184.24policy with a $500 deductible available through the Minnesota Comprehensive Health 184.25Association. Children who are no longer eligible for MinnesotaCare under this clause shall 184.26be given a 12-month notice period from the date that ineligibility is determined before 184.27disenrollment. The premium for children remaining eligible under this clause shall be the 184.28maximum premium determined under section 
         256L.15, subdivision 2, paragraph (b).184.29    (c) (f) Notwithstanding paragraphs (a) and (b) (e), parents are not eligible for 184.30MinnesotaCare if gross household income exceeds $57,500 for the 12-month $25,000 for 184.31the six-month period of eligibility.184.32EFFECTIVE DATE.This section is effective January 1, 2012, and expires June 184.3330, 2013, except the amendments to the new paragraphs (e) and (f) are effective July 1, 184.342011, and do not expire.184.35    Sec. 102. Minnesota Statutes 2010, section 256L.07, subdivision 1, is amended to read:185.1    Subdivision 1. General requirements. (a) Children enrolled in the original 185.2children's health plan as of September 30, 1992, children who enrolled in the 185.3MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549, 185.4article 4, section 17, and children who have family gross incomes that are equal to or 185.5less than 150 percent of the federal poverty guidelines are eligible without meeting 185.6the requirements of subdivision 2 and the four-month requirement in subdivision 3, as 185.7long as they maintain continuous coverage in the MinnesotaCare program or medical 185.8assistance. Children who apply for MinnesotaCare on or after the implementation date 185.9of the employer-subsidized health coverage program as described in Laws 1998, chapter 185.10407, article 5, section 45, who have family gross incomes that are equal to or less than 150 185.11percent of the federal poverty guidelines, must meet the requirements of subdivision 2 to 185.12be eligible for MinnesotaCare.185.13    (b) Families enrolled in MinnesotaCare under section 
         256L.04, subdivision 1, whose 185.14income increases above 275 percent of the federal poverty guidelines the limits described 185.15in section 256L.04, subdivision 1, are no longer eligible for the program and shall be 185.16disenrolled by the commissioner.185.17(c) Beginning January 1, 2008, individuals enrolled in MinnesotaCare under section 185.18256L.04, subdivision 7
         , whose income increases above 200 percent of the federal poverty 185.19guidelines or 250 percent of the federal poverty guidelines on or after July 1, 2009, are no 185.20longer eligible for the program and shall be disenrolled by the commissioner.185.21(d) For persons disenrolled under this subdivision, MinnesotaCare coverage 185.22terminates the last day of the calendar month following the month in which the 185.23commissioner determines that the income of a family or individual exceeds program 185.24income limits.185.25    (b) (e) Notwithstanding paragraph (a), children may remain enrolled in 185.26MinnesotaCare if ten percent of their gross individual or gross family income as defined in 185.27section 
         256L.01, subdivision 4, is less than the annual premium for a policy with a $500 185.28deductible available through the Minnesota Comprehensive Health Association. Children 185.29who are no longer eligible for MinnesotaCare under this clause shall be given a 12-month 185.30notice period from the date that ineligibility is determined before disenrollment. The 185.31premium for children remaining eligible under this clause shall be the maximum premium 185.32determined under section 
         256L.15, subdivision 2, paragraph (b).185.33    (c) (f) Notwithstanding paragraphs (a) and (b) (e), parents are not eligible for 185.34MinnesotaCare if gross household income exceeds $57,500 for the 12-month period 185.35of eligibility.186.1EFFECTIVE DATE.The amendment in paragraph (b) is effective January 1, 2012, 186.2or upon federal approval whichever is later, and expires June 30, 2013. The commissioner 186.3shall notify the revisor of statutes when federal approval is obtained and publish a notice 186.4in the State Register.186.5    Sec. 103. Minnesota Statutes 2010, section 256L.09, subdivision 4, is amended to read:186.6    Subd. 4. Eligibility as Minnesota resident. (a) For purposes of this section, a 186.7permanent Minnesota resident is a person who has demonstrated, through persuasive and 186.8objective evidence, that the person is domiciled in the state and intends to live in the 186.9state permanently.186.10    (b) To be eligible as a permanent resident, an applicant must demonstrate the 186.11requisite intent to live in the state permanently by:186.12    (1) showing that the applicant maintains a residence at a verified address other than a 186.13place of public accommodation, unless the place of public accommodation is the person's 186.14primary or only residence, through the use of evidence of residence described in section 186.15256D.02, subdivision 12a
         , paragraph (b), clause (2) (1);186.16    (2) demonstrating that the applicant has been continuously domiciled in the state for 186.17no less than 180 days immediately before the application; and186.18    (3) signing an affidavit declaring that (A) the applicant currently resides in the state 186.19and intends to reside in the state permanently; and (B) the applicant did not come to the 186.20state for the primary purpose of obtaining medical coverage or treatment.186.21    (c) A person who is temporarily absent from the state does not lose eligibility for 186.22MinnesotaCare. "Temporarily absent from the state" means the person is out of the state 186.23for a temporary purpose and intends to return when the purpose of the absence has been 186.24accomplished. A person is not temporarily absent from the state if another state has 186.25determined that the person is a resident for any purpose. If temporarily absent from the 186.26state, the person must follow the requirements of the health plan in which the person is 186.27enrolled to receive services.186.28    Sec. 104. Minnesota Statutes 2010, section 256L.11, subdivision 7, is amended to read:186.29    Subd. 7. Critical access dental providers. Effective for dental services provided to 186.30MinnesotaCare enrollees on or after January 1, 2007, July 1, 2011, the commissioner shall 186.31increase payment rates to dentists and dental clinics deemed by the commissioner to be 186.32critical access providers under section 
         256B.76, subdivision 4, by 50 30 percent above 186.33the payment rate that would otherwise be paid to the provider. The commissioner shall 186.34pay the prepaid health plans under contract with the commissioner amounts sufficient to 187.1reflect this rate increase. The prepaid health plan must pass this rate increase to providers 187.2who have been identified by the commissioner as critical access dental providers under 187.3section 
         256B.76, subdivision 4.187.4    Sec. 105. Minnesota Statutes 2010, section 256L.12, subdivision 9, is amended to read:187.5    Subd. 9. Rate setting; performance withholds. (a) Rates will be prospective, 187.6per capita, where possible. The commissioner may allow health plans to arrange for 187.7inpatient hospital services on a risk or nonrisk basis. The commissioner shall consult with 187.8an independent actuary to determine appropriate rates.187.9    (b) For services rendered on or after January 1, 2004, the commissioner shall 187.10withhold five percent of managed care plan payments and county-based purchasing 187.11plan payments under this section pending completion of performance targets. Each 187.12performance target must be quantifiable, objective, measurable, and reasonably attainable, 187.13except in the case of a performance target based on a federal or state law or rule. Criteria 187.14for assessment of each performance target must be outlined in writing prior to the 187.15contract effective date. The managed care plan must demonstrate, to the commissioner's 187.16satisfaction, that the data submitted regarding attainment of the performance target is 187.17accurate. The commissioner shall periodically change the administrative measures used 187.18as performance targets in order to improve plan performance across a broader range of 187.19administrative services. The performance targets must include measurement of plan 187.20efforts to contain spending on health care services and administrative activities. The 187.21commissioner may adopt plan-specific performance targets that take into account factors 187.22affecting only one plan, such as characteristics of the plan's enrollee population. The 187.23withheld funds must be returned no sooner than July 1 and no later than July 31 of the 187.24following calendar year if performance targets in the contract are achieved.187.25(c) For services rendered on or after January 1, 2011, the commissioner shall 187.26withhold an additional three percent of managed care plan or county-based purchasing 187.27plan payments under this section. The withheld funds must be returned no sooner than 187.28July 1 and no later than July 31 of the following calendar year. The return of the withhold 187.29under this paragraph is not subject to the requirements of paragraph (b).187.30(d) Effective for services rendered on or after January 1, 2011, the commissioner 187.31shall include as part of the performance targets described in paragraph (b) a reduction in 187.32the plan's emergency room utilization rate for state health care program enrollees by a 187.33measurable rate of five percent from the plan's utilization rate for the previous calendar 187.34year.188.1The withheld funds must be returned no sooner than July 1 and no later than July 31 188.2of the following calendar year if the managed care plan demonstrates to the satisfaction of 188.3the commissioner that a reduction in the utilization rate was achieved.188.4The withhold described in this paragraph shall continue for each consecutive 188.5contract period until the plan's emergency room utilization rate for state health care 188.6program enrollees is reduced by 25 percent of the plan's emergency room utilization rate 188.7for state health care program enrollees for calendar year 2009. Hospitals shall cooperate 188.8with the health plans in meeting this performance target and shall accept payment 188.9withholds that may be returned to the hospitals if the performance target is achieved. The 188.10commissioner shall structure the withhold so that the commissioner returns a portion of 188.11the withheld funds in amounts commensurate with achieved reductions in utilization less 188.12than the targeted amount. The withhold described in this paragraph does not apply to 188.13county-based purchasing plans.188.14(e) Effective for services provided on or after January 1, 2012, the commissioner 188.15shall include as part of the performance targets described in paragraph (b) a reduction in 188.16the plan's hospitalization rate for a subsequent hospitalization within 30 days of a previous 188.17hospitalization of a patient regardless of the reason for the hospitalization for state health 188.18care program enrollees by a measurable rate of five percent from the plan's hospitalization 188.19rate for the previous calendar year.188.20The withheld funds must be returned no sooner than July 1 and no later than July 31 188.21of the following calendar year if the managed care plan or county-based purchasing plan 188.22demonstrates to the satisfaction of the commissioner that a reduction in the hospitalization 188.23rate was achieved.188.24The withhold described in this paragraph must continue for each consecutive 188.25contract period until the plan's subsequent hospitalization rate for state health care 188.26program enrollees is reduced by 25 percent of the plan's subsequent hospitalization rate 188.27for state health care program enrollees for calendar year 2010. Hospitals shall cooperate 188.28with the plans in meeting this performance target and shall accept payment withholds that 188.29must be returned to the hospitals if the performance target is achieved. The commissioner 188.30shall structure the withhold so that the commissioner returns a portion of the withheld 188.31funds in amounts commensurate with achieved reductions in utilizations less than the 188.32targeted amount. The withhold described in this paragraph does not apply to county-based 188.33purchasing plans.188.34(e) (f) A managed care plan or a county-based purchasing plan under section 188.35256B.692 
         may include as admitted assets under section 
         62D.044 any amount withheld 188.36under this section that is reasonably expected to be returned.189.1    Sec. 106. Minnesota Statutes 2010, section 256L.15, subdivision 1a, is amended to 189.2read:189.3    Subd. 1a. Payment options. The commissioner may offer the following payment 189.4options to an enrollee:189.5(1) payment by check;189.6(2) payment by credit card;189.7(3) payment by recurring automatic checking withdrawal;189.8(4) payment by onetime electronic transfer of funds;189.9(5) payment by wage withholding with the consent of the employer and the 189.10employee; or189.11(6) payment by using state tax refund payments.189.12The commissioner shall include information about the payment options on each 189.13premium notice. At application or reapplication, a MinnesotaCare applicant or enrollee 189.14may authorize the commissioner to use the Revenue Recapture Act in chapter 270A to 189.15collect funds from the applicant's or enrollee's refund for the purposes of meeting all or 189.16part of the applicant's or enrollee's MinnesotaCare premium obligation. The applicant or 189.17enrollee may authorize the commissioner to apply for the state working family tax credit 189.18on behalf of the applicant or enrollee. The setoff due under this subdivision shall not be 189.19subject to the $10 fee under section 
         270A.07, subdivision 1.189.20    Sec. 107. Laws 2008, chapter 363, article 18, section 3, subdivision 5, is amended to 189.21read:

189.22Subd. 5.Basic Health Care Grants

189.23(a) MinnesotaCare Grants

189.24Health Care Access-0-(770,000)

189.25Incentive Program and Outreach Grants.189.26Of the appropriation for the Minnesota health 189.27care outreach program in Laws 2007, chapter 189.28147, article 19, section 3, subdivision 7, 189.29paragraph (b):189.30(1) $400,000 in fiscal year 2009 from the 189.31general fund and $200,000 in fiscal year 2009 189.32from the health care access fund are for the 189.33incentive program under Minnesota Statutes, 189.34section 
         256.962, subdivision 5. For the 190.1biennium beginning July 1, 2009, base level 190.2funding for this activity shall be $360,000 190.3from the general fund and $160,000 from the 190.4health care access fund; and190.5(2) $100,000 in fiscal year 2009 from the 190.6general fund and $50,000 in fiscal year 2009 190.7from the health care access fund are for the 190.8outreach grants under Minnesota Statutes, 190.9section 
         256.962, subdivision 2. For the 190.10biennium beginning July 1, 2009, base level 190.11funding for this activity shall be $90,000 190.12from the general fund and $40,000 from the 190.13health care access fund.

190.14190.15(b) MA Basic Health Care Grants - Families and Children-0-(17,280,000)

190.16Third-Party Liability. (a) During 190.17fiscal year 2009, the commissioner shall 190.18employ a contractor paid on a percentage 190.19basis to improve third-party collections. 190.20Improvement initiatives may include, but not 190.21be limited to, efforts to improve postpayment 190.22collection from nonresponsive claims and 190.23efforts to uncover third-party payers the 190.24commissioner has been unable to identify.190.25(b) In fiscal year 2009, the first $1,098,000 190.26of recoveries, after contract payments and 190.27federal repayments, is appropriated to 190.28the commissioner for technology-related 190.29expenses.190.30Administrative Costs. (a) For contracts 190.31effective on or after January 1, 2009, 190.32the commissioner shall limit aggregate 190.33administrative costs paid to managed care 190.34plans under Minnesota Statutes, section 190.35256B.69
         , and to county-based purchasing 191.1plans under Minnesota Statutes, section 191.2256B.692
         , to an overall average of 6.6 6.1191.3percent of total contract payments under 191.4Minnesota Statutes, sections 
         256B.69 and 191.5256B.692
         , for each calendar year. For 191.6purposes of this paragraph, administrative 191.7costs do not include premium taxes paid 191.8under Minnesota Statutes, section 
         297I.05, 191.9subdivision 5
         , and provider surcharges paid 191.10under Minnesota Statutes, section 
         256.9657, 191.11subdivision 3
         .191.12(b) Notwithstanding any law to the contrary, 191.13the commissioner may reduce or eliminate 191.14administrative requirements to meet the 191.15administrative target under paragraph (a). 191.16(c) Notwithstanding any contrary provision 191.17of this article, this rider shall not expire.191.18Hospital Payment Delay. Notwithstanding 191.19Laws 2005, First Special Session chapter 4, 191.20article 9, section 2, subdivision 6, payments 191.21from the Medicaid Management Information 191.22System that would otherwise have been made 191.23for inpatient hospital services for medical 191.24assistance enrollees are delayed as follows: 191.25(1) for fiscal year 2008, June payments must 191.26be included in the first payments in fiscal 191.27year 2009; and (2) for fiscal year 2009, 191.28June payments must be included in the first 191.29payment of fiscal year 2010. The provisions 191.30of Minnesota Statutes, section 
         16A.124, 191.31do not apply to these delayed payments. 191.32Notwithstanding any contrary provision in 191.33this article, this paragraph expires on June 191.3430, 2010.

191.35191.36(c) MA Basic Health Care Grants - Elderly and Disabled(14,028,000)(9,368,000)

192.1Minnesota Disability Health Options Rate 192.2Setting Methodology. The commissioner 192.3shall develop and implement a methodology 192.4for risk adjusting payments for community 192.5alternatives for disabled individuals (CADI) 192.6and traumatic brain injury (TBI) home 192.7and community-based waiver services 192.8delivered under the Minnesota disability 192.9health options program (MnDHO) effective 192.10January 1, 2009. The commissioner shall 192.11take into account the weighting system used 192.12to determine county waiver allocations in 192.13developing the new payment methodology. 192.14Growth in the number of enrollees receiving 192.15CADI or TBI waiver payments through 192.16MnDHO is limited to an increase of 200 192.17enrollees in each calendar year from January 192.182009 through December 2011. If those limits 192.19are reached, additional members may be 192.20enrolled in MnDHO for basic care services 192.21only as defined under Minnesota Statutes, 192.22section 
         256B.69, subdivision 28, and the 192.23commissioner may establish a waiting list for 192.24future access of MnDHO members to those 192.25waiver services.192.26MA Basic Elderly and Disabled 192.27Adjustments. For the fiscal year ending June 192.2830, 2009, the commissioner may adjust the 192.29rates for each service affected by rate changes 192.30under this section in such a manner across 192.31the fiscal year to achieve the necessary cost 192.32savings and minimize disruption to service 192.33providers, notwithstanding the requirements 192.34of Laws 2007, chapter 147, article 7, section 192.3571.

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

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

193.2MinnesotaCare Outreach Grants Special 193.3Revenue Account. The balance in the 193.4MinnesotaCare outreach grants special 193.5revenue account on July 1, 2009, estimated 193.6to be $900,000, must be transferred to the 193.7general fund.193.8Grants Reduction. Effective July 1, 2008, 193.9base level funding for nonforecast, general 193.10fund health care grants issued under this 193.11paragraph shall be reduced by 1.8 percent at 193.12the allotment level.193.13    Sec. 108. Laws 2010, First Special Session chapter 1, article 25, section 3, subdivision 193.146, is amended to read:

193.15Subd. 6.Health Care Grants

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

193.17This appropriation is from the health care 193.18access fund.193.19Health Care Access Fund Transfer to 193.20General Fund. The commissioner of 193.21management and budget shall transfer the 193.22following amounts in the following years 193.23from the health care access fund to the 193.24general fund: $998,000 $0 in fiscal year 193.252010; $176,704,000 $59,901,000 in fiscal 193.26year 2011; $141,041,000 in fiscal year 2012; 193.27and $286,150,000 in fiscal year 2013. If at 193.28any time the governor issues an executive 193.29order not to participate in early medical 193.30assistance expansion, no funds shall be 193.31transferred from the health care access 193.32fund to the general fund until early medical 193.33assistance expansion takes effect. This 194.1paragraph is effective the day following final 194.2enactment.194.3MinnesotaCare Ratable Reduction.194.4Effective for services rendered on or after 194.5July 1, 2010, to December 31, 2013, 194.6MinnesotaCare payments to managed care 194.7plans under Minnesota Statutes, section 194.8256L.12
         , for single adults and households 194.9without children whose income is greater 194.10than 75 percent of federal poverty guidelines 194.11shall be reduced by 15 percent. Effective 194.12for services provided from July 1, 2010, to 194.13June 30, 2011, this reduction shall apply to 194.14all services. Effective for services provided 194.15from July 1, 2011, to December 31, 2013, this 194.16reduction shall apply to all services except 194.17inpatient hospital services. Notwithstanding 194.18any contrary provision of this article, this 194.19paragraph shall expire on December 31, 194.202013.

194.21194.22(b) Medical Assistance Basic Health Care Grants - Families and Children-0-295,512,000

194.23Critical Access Dental. Of the general 194.24fund appropriation, $731,000 in fiscal year 194.252011 is to the commissioner for critical 194.26access dental provider reimbursement 194.27payments under Minnesota Statutes, section 194.28256B.76
          subdivision 4. This is a onetime 194.29appropriation.194.30Nonadministrative Rate Reduction. For 194.31services rendered on or after July 1, 2010, 194.32to December 31, 2013, the commissioner 194.33shall reduce contract rates paid to managed 194.34care plans under Minnesota Statutes, 194.35sections 
         256B.69 and 
         256L.12, and to 194.36county-based purchasing plans under 195.1Minnesota Statutes, section 
         256B.692, by 195.2three percent of the contract rate attributable 195.3to nonadministrative services in effect on 195.4June 30, 2010. Notwithstanding any contrary 195.5provision in this article, this rider expires on 195.6December 31, 2013.

195.7195.8(c) Medical Assistance Basic Health Care Grants - Elderly and Disabled-0-(30,265,000)

195.9195.10(d) General Assistance Medical Care Grants-0-(75,389,000)(59,583,000)

195.11The reduction to general assistance medical 195.12care grants is contingent upon the effective 195.13date in Laws 2010, First Special Session 195.14chapter 1, article 16, section 48. The 195.15reduction shall be reestimated based upon 195.16the actual effective date of the law. The 195.17commissioner of management and budget 195.18shall make adjustments in fiscal year 195.192011 to general assistance medical care 195.20appropriations to conform to the total 195.21expected expenditure reductions specified in 195.22this section.

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

195.24Cobra Carryforward. Unexpended funds 195.25appropriated in fiscal year 2010 for COBRA 195.26grants under Laws 2009, chapter 79, article 195.275, section 78, do not cancel and are available 195.28to the commissioner for fiscal year 2011 195.29COBRA grant expenditures. Up to $111,000 195.30of the fiscal year 2011 appropriation for 195.31COBRA grants provided in Laws 2009, 195.32chapter 79, article 13, section 3, subdivision 195.336, may be used by the commissioner for costs 195.34related to administration of the COBRA 195.35grants.196.1    Sec. 109. COMMISSIONER'S ACTIONS; REPEAL OF EARLY MEDICAL 196.2ASSISTANCE EXPANSION.196.3    Effective January 1, 2012, the commissioner of human services shall suspend 196.4implementation and administration of Minnesota Statutes 2010, sections 256B.055, 196.5subdivision 15; 256B.056, subdivision 3, paragraph (b); and 256B.056, subdivision 4, 196.6paragraph (d). The commissioner shall refer persons enrolled under these provisions, and 196.7applicants for coverage under these provisions, to the general assistance medical care 196.8program established under Minnesota Statutes, section 256D.031.196.9    Sec. 110. GENERAL ASSISTANCE MEDICAL CARE PROGRAM; 196.10PROVISIONS REVIVED.196.11    Notwithstanding their contingent repeal in Laws 2010, First Special Session chapter 196.121, article 16, section 47, the following statutes are revived and have the force of law 196.13effective January 1, 2012:196.14    (1) Minnesota Statutes 2010, section 256D.03, subdivisions 3, 3a, 6, 7, and 8;196.15    (2) Minnesota Statutes 2010, section 256D.031, subdivisions 1, 2, 3, 4, 6, 7, and 196.1610; and196.17    (3) Laws 2010, chapter 200, article 1, section 18.196.18    Sec. 111. PLAN TO COORDINATE CARE FOR CHILDREN WITH 196.19HIGH-COST MENTAL HEALTH CONDITIONS.196.20The commissioner of human services shall develop and submit to the legislature 196.21by December 15, 2011, a plan to provide care coordination to medical assistance and 196.22MinnesotaCare enrollees who are children with high-cost mental health conditions. For 196.23purposes of this section, a child has a "high-cost mental health condition" if mental health 196.24and medical expenses over the past year totalled $100,000 or more. For purposes of this 196.25section, "care coordination" means collaboration between an advanced practice nurse and 196.26primary care physicians and specialists to manage care; development of mental health 196.27management plans for recurrent mental health issues; oversight and coordination of all 196.28aspects of care in partnership with families; organization of medical, treatment, and 196.29therapy information into a summary of critical information; coordination and appropriate 196.30sequencing of evaluations and multiple appointments; information and assistance with 196.31accessing resources; and telephone triage for behavior or other problems.196.32    Sec. 112. DATA ON CLAIMS AND UTILIZATION.197.1The commissioner of human services, in consultation with the Health and Human 197.2Services Reform Committee, shall develop and provide to the legislature by December 15, 197.32011, a methodology and any draft legislation necessary to allow for the release, upon 197.4request, of summary data as defined in Minnesota Statutes, section 13.02, subdivision 19, 197.5on claims and utilization for medical assistance, general assistance medical care, and 197.6MinnesotaCare enrollees at no charge to the University of Minnesota Medical School, the 197.7Mayo Medical School, Northwestern Health Sciences University, the Institute for Clinical 197.8Systems Improvement, and other research institutions to conduct analyses of health care 197.9outcomes and treatment effectiveness, provided the research institutions do not release 197.10private or nonpublic data or data for which dissemination is prohibited by law.197.11    Sec. 113. REDUCTION OF STATE-MANDATED ADMINISTRATIVE 197.12REPORTS.197.13(a) The commissioner of management and budget shall convene a report reduction 197.14working group of persons designated by the commissioners of health, human services, and 197.15commerce to eliminate redundant, unnecessary, obsolete, and low-priority state-mandated 197.16administrative reports required of health plans and county-based purchasing plans 197.17that serve persons enrolled in Minnesota health care programs. The commissioner of 197.18management and budget and the report reduction working group shall develop a plan to 197.19oversee the report reduction activities of the individual state agencies and coordinate the 197.20activities of multiple state agencies to consolidate reports or eliminate redundant reports 197.21required by more than one state agency on the same or a similar topic.197.22(b) The commissioners of health, human services, and commerce shall reduce, 197.23eliminate, or consolidate state-mandated reports according to the plan developed by the 197.24commissioner of management and budget through the report reduction working group. 197.25In addition to other report reduction actions the commissioners or the working group 197.26may undertake, the commissioners shall:197.27(1) collect encounter data, including provider payment data if collected, in a 197.28consolidated report provided to a single state agency, with the data collected by that state 197.29agency to be shared with other state agencies who need the data;197.30(2) collect only one provider network report annually through a single state agency, 197.31with the data collected by that state agency to be shared with other state agencies who 197.32need the data;197.33(3) collect only one standard financial report through a single state agency, with 197.34the data collected by that state agency to be shared with other state agencies who need 197.35the data.  Data collected must be of a nature and in a format to allow comparison of the 198.1cost-effectiveness of fee-for-service payment systems and prepaid programs administered 198.2by health plans and county-based purchasing plans;198.3(4) consolidate and simplify reports and documentation requirements relating to 198.4member communications and marketing materials, and establish a single review process 198.5for all programs, products, and agencies in order to ensure uniform and consistent 198.6regulation of  health plan contracts;198.7(5) consolidate state regulation and oversight of health plans and county-based 198.8purchasing plans so that activities of multiple agencies are administered through an 198.9efficient and uniform multiagency process of oversight and audits, with consistent 198.10standards, measures, and definitions for state oversight of quality, utilization management, 198.11care management, delegation accountability, access to care, appeals and grievances, and 198.12financial management;198.13(6) establish uniform requirements and procedures for denial, termination, or 198.14reduction of services and member appeals and grievances, and align state requirements 198.15and procedures with federal requirements and procedures; and198.16(7) reform the state's performance improvement projects, requirements, and 198.17procedures to be more flexible and efficient, and to place greater focus on measuring 198.18improvement of outcomes and less on mandating detailed or prescriptive requirements for 198.19specific performance improvement projects or activities.198.20(d) New reporting requirements or ad hoc report requests shall be established by a 198.21state agency only:198.22(1) if required by a federal agency;198.23(2) if needed for a state regulatory audit or corrective action plan; or198.24(3) after the completion of a review and analysis, and the development of 198.25recommendations by the commissioner of management and budget, in consultation 198.26with the report reduction working group, regarding the necessity, importance, and 198.27administrative cost of the new report, and after completing a review to determine 198.28whether the information sought can be obtained through another available state or federal 198.29report. The results of the review, analysis, and recommendations of the commissioner of 198.30management and budget must be provided to health plans and county-based purchasing 198.31plans for review and comment at least 60 days before a new report or requirement is 198.32established.198.33(e) To the extent possible, all state agencies shall use the procedures, reports, 198.34and audits of the Centers for Medicare and Medicaid Services instead of requiring an 198.35additional state-mandated report on the same or a similar topic.199.1(f) By January 15, 2012, the commissioner of management and budget shall provide 199.2a report on the activities and results of the report reduction project to the legislature. 199.3The report must include:199.4(1) a timetable for report reduction actions already taken or planned by the 199.5commissioners or the report reduction working group;199.6(2) the specific reports that have been or will be eliminated or consolidated;199.7(3) the amount of money that will be saved through reductions in administrative 199.8costs of health plans and county-based purchasing plans as a result of the report reduction 199.9project; and199.10(4) proposed legislation for changes to laws or rules that are needed to allow state 199.11agencies to further reduce, consolidate, or eliminate reports when the changes cannot 199.12be made administratively.199.13    Sec. 114. COMPETITIVE BIDDING PILOT.199.14For managed care contracts effective January 1, 2012, the commissioner of 199.15human services is required to establish a competitive price bidding pilot for nonelderly, 199.16nondisabled adults and children in medical assistance and MinnesotaCare in the 199.17seven-county metropolitan area. The pilot must allow a minimum of two managed care 199.18organizations to serve the metropolitan area. The pilot shall expire after two full calendar 199.19years on December 31, 2013. The commissioner of human service shall conduct an 199.20evaluation of the pilot to determine the cost-effectiveness and impacts to provider access at 199.21the end of the two-year period. The commissioner must consult with other states that have 199.22experience implementing competitive bidding in their medical assistance population and 199.23incorporate best practices from those states in designing this pilot. The commissioner, prior 199.24to implementation, must also consult with stakeholders on the design and implementation 199.25of the pilot, including providers, plans, advocacy groups, and other interested parties.199.26    Sec. 115. REQUEST FOR PROPOSAL; PROVIDER BILLING PATTERNS.199.27(a) The commissioner of human services shall issue a request for proposal, using 199.28existing resources, to identify abnormal provider billing patterns in order to prevent and 199.29identify improper medical assistance payments.199.30(b) The request for proposal must include the following requirements for the 199.31contractor:199.32(1) identification and reporting of improper claims, outlier claims, and improper 199.33payments, both prior to and subsequent to reimbursement; 200.1(2) utilization of fraud detection methods that maximize contemporary predictive 200.2analytic tools, including but not limited to identity analytics, link analysis, and matching 200.3capabilities; 200.4(3) utilization of data analytics that improve fraud detection through the identification 200.5of outlier reimbursement; 200.6(4) reduction in state expenditures by reducing or eliminating payouts of improper 200.7medical assistance claims; and 200.8(5) demonstrated success with other states and state agencies using the specified 200.9proposed solution, deployment, and implementation.  200.10(c) The commissioner shall enter into a contract for the services in this section by 200.11October 1, 2011. The contract must incorporate a performance-based vendor financing 200.12mechanism under which the vendor shares in the risk of the project's success.200.13    Sec. 116. HEALTH SERVICES POLICY COMMITTEE STUDIES.200.14(a) The commissioner of human services, through the health services policy 200.15committee established under Minnesota Statutes, section 256B.0625, subdivision 3c, shall 200.16identify and review medical assistance services provided by health care professionals who 200.17are not trained to provide the services in a high-quality manner. The commissioner shall 200.18develop a process to limit payment for medical assistance services to providers who are 200.19not appropriately trained to provide the service, and shall present recommendations and 200.20draft legislation by January 15, 2012, to the legislature.200.21(b) The commissioner of human services, through the health services policy 200.22committee established under Minnesota Statutes, section 256B.0625, subdivision 3c, shall 200.23study the effectiveness of new strategies for wound care treatment for medical assistance 200.24and MinnesotaCare enrollees with diabetes, including but not limited to the use of new 200.25wound care technologies, assessment tools, and reporting programs. The commissioner 200.26shall present recommendations by December 15, 2011, to the legislature on whether these 200.27new strategies for wound care treatment should be covered under medical assistance 200.28and MinnesotaCare.200.29    Sec. 117. SPECIALIZED MAINTENANCE THERAPY.200.30The commissioner of human services shall evaluate whether providing medical 200.31assistance coverage for specialized maintenance therapy for enrollees with serious and 200.32persistent mental illness who are at risk of hospitalization will improve the quality of 200.33care and lower medical assistance spending by reducing rates of hospitalization. The 200.34commissioner shall present findings and recommendations to the chairs and ranking 201.1minority members of the legislative committees with jurisdiction over health and human 201.2services finance and policy by December 15, 2011.201.3    Sec. 118. COVERAGE FOR LOWER-INCOME MINNESOTACARE 201.4ENROLLEES.201.5The commissioner of human services shall develop and present to the legislature, 201.6by December 15, 2011, a plan to redesign service delivery for MinnesotaCare enrollees 201.7eligible under Minnesota Statutes, section 256L.04, subdivisions 1 and 7, with incomes 201.8less than 133 percent of the federal poverty guidelines. The plan must be designed to 201.9improve continuity and quality of care, reduce unnecessary emergency room visits, and 201.10reduce average per-enrollee costs. In developing the plan, the commissioner shall consider 201.11innovative methods of service delivery, including but not limited to increasing the use 201.12and choice of private sector health plan coverage and encouraging the use of community 201.13health clinics, as defined in the federal Community Health Care Act of 1964, as health 201.14care homes.201.15    Sec. 119. DIRECTION TO COMMISSIONER; FEDERAL WAIVERS.201.16(a) The commissioner of human services shall apply to the Centers for Medicare 201.17and Medicaid Services (CMS) for federal waivers to cover:201.18(1) families with children eligible under Minnesota Statutes, section 256L.04, 201.19subdivision 1; and201.20(2) adults eligible under Minnesota Statutes, section 256L.04, subdivision 1, 201.21under the MinnesotaCare healthy Minnesota contribution program established under 201.22Minnesota Statutes, section 256L.031, by July 1, 2011. The commissioner shall report to 201.23the legislative committees with jurisdiction over health and human services policy and 201.24finance whether or not the federal waiver application was accepted within ten working 201.25days of receipt of the decision.201.26(b) The commissioner of human services shall apply to the CMS for a section 201.271115(a) demonstration waiver, and any other necessary federal waivers and amendments, 201.28including, but not limited to, a waiver of the appropriate sections of title XIX, United 201.29States Code, title 42, section 1396a, and a waiver of any applicable federal maintenance of 201.30effort provisions that would provide Minnesota with medical assistance program flexibility 201.31in exchange for federal budget certainty. The commissioner shall seek federal approval to 201.32enter into an agreement with CMS under which Minnesota would:202.1(1) accept an aggregate annual allotment for the medical assistance program, trended 202.2forward at an agreed upon rate, with protections to cover medical inflation and projected 202.3caseload growth; and202.4(2) receive federal waivers of Medicaid requirements related to: statewideness and 202.5comparability of services; the amount, duration, and scope of services; freedom of choice; 202.6cost-sharing; and other areas of program administration specified by the commissioner.202.7EFFECTIVE DATE.This section is effective the day following final enactment.202.8    Sec. 120. TRANSPARENCY AND QUALITY REPORTING FOR PUBLIC 202.9HEALTH CARE PROGRAMS.202.10When negotiating with external vendors to provide managed care services, the 202.11commissioner of human services shall require use of an advanced request for information 202.12tool. This tool must provide the department with an evidence-based assessment that 202.13focuses on the cost control, quality, and information transparency of the health care 202.14vendor. The assessment may include evidence-based performance measures that have 202.15been shown to influence better health, better health care, and more cost-effective use of 202.16resources including, but not limited to, areas that determine each plan's capabilities and 202.17performance with respect to:202.18(1) consumer engagement, support, and incentives;202.19(2) processes and outcomes for closing gaps in care according to clinical guideline 202.20expectations;202.21(3) provider management, including outcome and population-based reimbursement, 202.22transparent measurement of provider performance, and support of physician practice 202.23structures that lead to better care; and202.24(4) measures of clinical outcomes and waste approved by the National Quality 202.25Forum.202.26    Sec. 121. RISK CORRIDORS.202.27(a) Effective for services rendered on or after January 1, 2012, the commissioner 202.28shall establish risk corridors for state public programs that are actuarially sound for each 202.29managed care plan and each county-based purchasing plan. The risk corridors will be 202.30calculated annually based on the calendar year's net underwriting gain or loss. If the 202.31managed care plan or county-based purchasing plan has achieved a net underwriting gain 202.32of greater than three percent of revenue, 80 percent of any excess must be repaid to the 202.33commissioner by July 31 of the year following calculation of the risk corridor year, and 202.3420 percent must be invested by the plan directly into programs for improving quality of 203.1care or access to care for state public health care program enrollees. If the managed 203.2care plan or county-based purchasing plan has incurred a net underwriting loss greater 203.3than three percent of total revenue, 50 percent of any excess must be repaid to the plan 203.4by the commissioner by July 31 of the year following calculation of the risk corridor 203.5year. Determination of total revenues and net underwriting gain or loss must be based 203.6on the Minnesota Supplement Report #1 which is filed on April 1 of the year following 203.7calculation of the risk corridor and adjusted for the actual withhold calculation under 203.8sections 256B.69, subdivision 5a, and 256L.12, subdivision 9. The report must be filed 203.9with and publicly disclosed by the Department of Health.203.10(b) For purposes of this section, "state public programs" means those prepaid 203.11medical assistance and MinnesotaCare programs for which a managed care plan or 203.12county-based purchasing plan contracts with the commissioner to provide coverage under 203.13sections 256B.69, 256B.692, and 256L.12. The risk corridors shall not apply to plans for 203.14persons who are enrolled in integrated Medicare and medical assistance programs under 203.15section 256B.69, subdivisions 23 and 28.203.16(c) This section expires January 1, 2014.203.17    Sec. 122.  REPEALER.203.18(a) Minnesota Statutes 2010, section 62J.07, subdivisions 1, 2, and 3, (Legislative 203.19Commission on Health Care Access) are repealed.203.20(b) Laws 2009, chapter 79, article 5, section 64, (256L.07, subdivision 2) is repealed 203.21retroactively from July 1, 2009, and federal approval is no longer necessary.203.22(c) Laws 2009, chapter 79, article 5, section 65,  (256L.07, subdivision 3) is repealed 203.23retroactively from July 1, 2009, and federal approval is no longer necessary.203.24(d) Laws 2009, chapter 79, article 5, section 68,  (256L.15, subdivision 2, exemption 203.25of low-income children from MinnesotaCare premiums and insurance barriers) is 203.26repealed retroactively from July 1, 2009, and federal approval is no longer necessary.203.27(e) Minnesota Statutes 2010, section 256L.07, subdivision 7, exempting eligibility 203.28for children formally under medical assistance, is repealed retroactively from October 203.291, 2008, and federal approval is no longer necessary.203.30(f) The amendment in Laws 2009, chapter 79, article 5, section 55, as amended by 203.31Laws 2009, chapter 173, article 1, section 36, (256L.04, subdivision 1, children deemed 203.32eligible are exempt from eligibility requirements) is repealed retroactively from January 203.331, 2009, and federal approval is no longer necessary.204.1(g) Laws 2009, chapter 79, article 5, section 56,  (256L.04, subdivision 1b, 204.2exemption from income limit for children) is repealed retroactively from July 1, 2009, 204.3and federal approval is no longer necessary.204.4(h) Laws 2009, chapter 79, article 5, section 60, (256L.05, subdivision 1c, open 204.5enrollment and streamlined application) is repealed retroactively from July 1, 2009, 204.6and federal approval is no longer necessary.204.7(i) Laws 2009, chapter 79, article 5, section 66, (256L.07, subdivision 8, automatic 204.8eligibility certain children) is repealed retroactively from July 1, 2009, and federal 204.9approval is no longer necessary.204.10(j) The amendment in Laws 2009, chapter 79, article 5, section 57, (256L.04, 204.11subdivision 7a, ineligibility for adults with certain income) is repealed retroactively 204.12from July 1, 2009, and federal approval is no longer necessary.204.13(k) The amendment in Laws 2009, chapter 79, article 5, section 61,  (256L.05, 204.14subdivision 3, children eligibility following termination from foster care) is repealed 204.15retroactively from July 1, 2009, and federal approval is no longer necessary.204.16(l) The amendment in Laws 2009, chapter 79, article 5, section 62,  (256L.05, 204.17subdivision 3a, exemption from cancellation for nonrenewal for children) is repealed 204.18retroactively from July 1, 2009, and federal approval is no longer necessary.204.19(m) The amendment in Laws 2009, chapter 79, article 5, section 63,  (256L.07, 204.20subdivision 1, children whose gross family income is greater than 275 percent FPG 204.21may remain enrolled) is repealed retroactively from July 1, 2009, and federal approval is 204.22no longer necessary.204.23(n) The amendment in Laws 2009, chapter 79, article 5, section 64,  (256L.07, 204.24subdivision 2, exempts children from requirement not to have employer-subsidized 204.25coverage) is repealed retroactively from July 1, 2009, and federal approval is no longer 204.26necessary.204.27(o) The amendment in Laws 2009, chapter 79, article 5, section 65,  (256L.07, 204.28subdivision 3, requires children with family gross income over 200 percent of FPG 204.29to have had no health coverage for four months prior to application) is repealed 204.30retroactively from July 1, 2009, and federal approval is no longer necessary.204.31(p) The amendment in Laws 2009, chapter 79, article 5, section 68,  (256L.15, 204.32subdivision 2, children in families with income less than 200 percent FPG pay no 204.33premium) is repealed retroactively from July 1, 2009, and federal approval is no longer 204.34necessary.204.35(q) The amendment in Laws 2009, chapter 79, article 5, section 69,  (256L.15, 204.36subdivision 3, exempts children with family income below 200 percent FPG from 205.1sliding fee scale) is repealed retroactively from July 1, 2009, and federal approval is 205.2no longer necessary.205.3(r) Laws 2009, chapter 79, article 5, section 79,  (uncoded federal approval) is 205.4repealed the day following final enactment.205.5(s) Minnesota Statutes 2010, section 256B.057, subdivision 2c, (extended medical 205.6assistance for certain children) is repealed.205.7(t) The amendments in Laws 2008, chapter 358, article 3, sections 8; and 9, (renewal 205.8rolling month and premium grace month) are repealed.205.9    Sec. 123.  REPEALER; EARLY MEDICAL ASSISTANCE EXPANSION.205.10Minnesota Statutes 2010, section 256B.055, subdivision 15, is repealed January 205.111, 2012.205.12ARTICLE 6205.13CONTINUING CARE205.14    Section 1. Minnesota Statutes 2010, section 144A.071, is amended by adding a 205.15subdivision to read:205.16    Subd. 4d.Consolidation of nursing facilities.(a) The commissioner of health, 205.17in consultation with the commissioner of human services, may approve a request for 205.18consolidation of nursing facilities which includes the closure of one or more facilities 205.19and the upgrading of the physical plant of the remaining nursing facility or facilities, 205.20the costs of which exceed the threshold project limit under subdivision 2, clause (a). 205.21The commissioners shall consider the criteria in this section, section 144A.073, and 205.22section 256B.437, in approving or rejecting a consolidation proposal. In the event the 205.23commissioners approve the request, the commissioner of human services shall calculate a 205.24property rate adjustment according to clauses (1) to (3):205.25(1) the closure of  beds shall not be eligible for a planned closure rate adjustment 205.26under section 256B.437, subdivision 6;205.27(2) the construction project permitted in this clause shall not be eligible for a 205.28threshold project rate adjustment under section 256B.434, subdivision 4f, or a moratorium 205.29exception adjustment under section 144A.073; and205.30(3)  the property payment rate for a remaining facility or facilities shall be increased 205.31by an amount equal to 65 percent of the projected net cost savings to the state calculated in 205.32paragraph (b), divided by the state's medical assistance percentage of medical assistance 205.33dollars, and then divided by estimated medical assistance resident days, as determined in 205.34paragraph (c), of the remaining nursing facility or facilities in the request in this paragraph.206.1(b) For purposes of calculating the net cost savings to the state, the commissioner 206.2shall consider clauses (1) to (7):206.3(1) the annual savings from estimated medical assistance payments from the net 206.4number of beds closed taking into consideration only beds that are in active service on the 206.5date of the request and that have been in active service for at least three years;206.6(2) the estimated annual cost of increased case load of individuals receiving services 206.7under the elderly waiver;206.8(3) the estimated annual cost of elderly waiver recipients receiving support under 206.9group residential housing;206.10(4) the estimated annual cost of increased case load of individuals receiving services 206.11under the alternative care program;206.12(5) the annual loss of license surcharge payments on closed beds;206.13(6) the savings from not paying planned closure rate adjustments that the facilities 206.14would otherwise be eligible for under section 256B.437; and206.15(7) the savings from not paying property payment rate adjustments from submission 206.16of renovation costs that would otherwise be eligible as threshold projects under section 206.17256B.434, subdivision 4f.206.18(c) For purposes of the calculation in paragraph (a), clause (3), the estimated medical 206.19assistance resident days of the remaining facility or facilities shall be computed assuming 206.2095 percent occupancy multiplied by the historical percentage of medical assistance 206.21resident days of the remaining facility or facilities, as reported on the facility's or facilities' 206.22most recent nursing facility statistical and cost report filed before the plan of closure 206.23is submitted, multiplied by 365.206.24(d) For purposes of net cost of savings to the state in paragraph (b), the average 206.25occupancy percentages will be those reported on the facility's or facilities' most recent 206.26nursing facility statistical and cost report filed before the plan of closure is submitted, and 206.27the average payment rates shall be calculated based on the approved payment rates in 206.28effect at the time the consolidation request  is submitted.206.29(e) To qualify for the property payment rate adjustment under this provision, the 206.30closing facilities shall:206.31(1) submit an application for closure according to section 256B.437, subdivision 206.323; and206.33(2) follow the resident relocation provisions of section 144A.161.206.34(f) The county or counties in which a facility or facilities are closed under this 206.35subdivision shall not be eligible for designation as a hardship area under section 144A.071, 206.36subdivision 3, for five years from the date of the approval of the proposed consolidation. 207.1The applicant shall notify the county of this limitation and the county shall acknowledge 207.2this in a letter of support.207.3    Sec. 2. Minnesota Statutes 2010, section 252.27, subdivision 2a, is amended to read:207.4    Subd. 2a. Contribution amount. (a) The natural or adoptive parents of a minor 207.5child, including a child determined eligible for medical assistance without consideration of 207.6parental income, must contribute to the cost of services used by making monthly payments 207.7on a sliding scale based on income, unless the child is married or has been married, 207.8parental rights have been terminated, or the child's adoption is subsidized according to 207.9section 
         259.67 or through title IV-E of the Social Security Act. The parental contribution 207.10is a partial or full payment for medical services provided for diagnostic, therapeutic, 207.11curing, treating, mitigating, rehabilitation, maintenance, and personal care services as 207.12defined in United States Code, title 26, section 213, needed by the child with a chronic 207.13illness or disability.207.14    (b) For households with adjusted gross income equal to or greater than 100 percent 207.15of federal poverty guidelines, the parental contribution shall be computed by applying the 207.16following schedule of rates to the adjusted gross income of the natural or adoptive parents:207.17    (1) if the adjusted gross income is equal to or greater than 100 percent of federal 207.18poverty guidelines and less than 175 percent of federal poverty guidelines, the parental 207.19contribution is $4 per month;207.20    (2) if the adjusted gross income is equal to or greater than 175 percent of federal 207.21poverty guidelines and less than or equal to 545 525 percent of federal poverty guidelines, 207.22the parental contribution shall be determined using a sliding fee scale established by the 207.23commissioner of human services which begins at one percent of adjusted gross income at 207.24175 percent of federal poverty guidelines and increases to 7.5 eight percent of adjusted 207.25gross income for those with adjusted gross income up to 545 525 percent of federal 207.26poverty guidelines;207.27    (3) if the adjusted gross income is greater than 545 525 percent of federal 207.28poverty guidelines and less than 675 percent of federal poverty guidelines, the parental 207.29contribution shall be 7.5 9.5 percent of adjusted gross income;207.30    (4) if the adjusted gross income is equal to or greater than 675 percent of federal 207.31poverty guidelines and less than 975 900 percent of federal poverty guidelines, the parental 207.32contribution shall be determined using a sliding fee scale established by the commissioner 207.33of human services which begins at 7.5 9.5 percent of adjusted gross income at 675 percent 207.34of federal poverty guidelines and increases to ten 12 percent of adjusted gross income for 207.35those with adjusted gross income up to 975 900 percent of federal poverty guidelines; and208.1    (5) if the adjusted gross income is equal to or greater than 975 900 percent of 208.2federal poverty guidelines, the parental contribution shall be 12.5 13.5 percent of adjusted 208.3gross income.208.4    If the child lives with the parent, the annual adjusted gross income is reduced by 208.5$2,400 prior to calculating the parental contribution. If the child resides in an institution 208.6specified in section 
         256B.35, the parent is responsible for the personal needs allowance 208.7specified under that section in addition to the parental contribution determined under this 208.8section. The parental contribution is reduced by any amount required to be paid directly to 208.9the child pursuant to a court order, but only if actually paid.208.10    (c) The household size to be used in determining the amount of contribution under 208.11paragraph (b) includes natural and adoptive parents and their dependents, including the 208.12child receiving services. Adjustments in the contribution amount due to annual changes 208.13in the federal poverty guidelines shall be implemented on the first day of July following 208.14publication of the changes.208.15    (d) For purposes of paragraph (b), "income" means the adjusted gross income of the 208.16natural or adoptive parents determined according to the previous year's federal tax form, 208.17except, effective retroactive to July 1, 2003, taxable capital gains to the extent the funds 208.18have been used to purchase a home shall not be counted as income.208.19    (e) The contribution shall be explained in writing to the parents at the time eligibility 208.20for services is being determined. The contribution shall be made on a monthly basis 208.21effective with the first month in which the child receives services. Annually upon 208.22redetermination or at termination of eligibility, if the contribution exceeded the cost of 208.23services provided, the local agency or the state shall reimburse that excess amount to 208.24the parents, either by direct reimbursement if the parent is no longer required to pay a 208.25contribution, or by a reduction in or waiver of parental fees until the excess amount is 208.26exhausted. All reimbursements must include a notice that the amount reimbursed may be 208.27taxable income if the parent paid for the parent's fees through an employer's health care 208.28flexible spending account under the Internal Revenue Code, section 125, and that the 208.29parent is responsible for paying the taxes owed on the amount reimbursed.208.30    (f) The monthly contribution amount must be reviewed at least every 12 months; 208.31when there is a change in household size; and when there is a loss of or gain in income 208.32from one month to another in excess of ten percent. The local agency shall mail a written 208.33notice 30 days in advance of the effective date of a change in the contribution amount. 208.34A decrease in the contribution amount is effective in the month that the parent verifies a 208.35reduction in income or change in household size.209.1    (g) Parents of a minor child who do not live with each other shall each pay the 209.2contribution required under paragraph (a). An amount equal to the annual court-ordered 209.3child support payment actually paid on behalf of the child receiving services shall be 209.4deducted from the adjusted gross income of the parent making the payment prior to 209.5calculating the parental contribution under paragraph (b).209.6    (h) The contribution under paragraph (b) shall be increased by an additional five 209.7percent if the local agency determines that insurance coverage is available but not 209.8obtained for the child. For purposes of this section, "available" means the insurance is a 209.9benefit of employment for a family member at an annual cost of no more than five percent 209.10of the family's annual income. For purposes of this section, "insurance" means health 209.11and accident insurance coverage, enrollment in a nonprofit health service plan, health 209.12maintenance organization, self-insured plan, or preferred provider organization.209.13    Parents who have more than one child receiving services shall not be required 209.14to pay more than the amount for the child with the highest expenditures. There shall 209.15be no resource contribution from the parents. The parent shall not be required to pay 209.16a contribution in excess of the cost of the services provided to the child, not counting 209.17payments made to school districts for education-related services. Notice of an increase in 209.18fee payment must be given at least 30 days before the increased fee is due.209.19    (i) The contribution under paragraph (b) shall be reduced by $300 per fiscal year if, 209.20in the 12 months prior to July 1:209.21    (1) the parent applied for insurance for the child;209.22    (2) the insurer denied insurance;209.23    (3) the parents submitted a complaint or appeal, in writing to the insurer, submitted 209.24a complaint or appeal, in writing, to the commissioner of health or the commissioner of 209.25commerce, or litigated the complaint or appeal; and209.26    (4) as a result of the dispute, the insurer reversed its decision and granted insurance.209.27    For purposes of this section, "insurance" has the meaning given in paragraph (h).209.28    A parent who has requested a reduction in the contribution amount under this 209.29paragraph shall submit proof in the form and manner prescribed by the commissioner or 209.30county agency, including, but not limited to, the insurer's denial of insurance, the written 209.31letter or complaint of the parents, court documents, and the written response of the insurer 209.32approving insurance. The determinations of the commissioner or county agency under this 209.33paragraph are not rules subject to chapter 14.209.34(j) Notwithstanding paragraph (b), for the period from July 1, 2010, to June 30, 209.352013, the parental contribution shall be computed by applying the following contribution 209.36schedule to the adjusted gross income of the natural or adoptive parents:210.1(1) if the adjusted gross income is equal to or greater than 100 percent of federal 210.2poverty guidelines and less than 175 percent of federal poverty guidelines, the parental 210.3contribution is $4 per month;210.4(2) if the adjusted gross income is equal to or greater than 175 percent of federal 210.5poverty guidelines and less than or equal to 525 percent of federal poverty guidelines, 210.6the parental contribution shall be determined using a sliding fee scale established by the 210.7commissioner of human services which begins at one percent of adjusted gross income 210.8at 175 percent of federal poverty guidelines and increases to eight percent of adjusted 210.9gross income for those with adjusted gross income up to 525 percent of federal poverty 210.10guidelines;210.11(3) if the adjusted gross income is greater than 525 percent of federal poverty 210.12guidelines and less than 675 percent of federal poverty guidelines, the parental contribution 210.13shall be 9.5 percent of adjusted gross income;210.14(4) if the adjusted gross income is equal to or greater than 675 percent of federal 210.15poverty guidelines and less than 900 percent of federal poverty guidelines, the parental 210.16contribution shall be determined using a sliding fee scale established by the commissioner 210.17of human services which begins at 9.5 percent of adjusted gross income at 675 percent of 210.18federal poverty guidelines and increases to 12 percent of adjusted gross income for those 210.19with adjusted gross income up to 900 percent of federal poverty guidelines; and210.20(5) if the adjusted gross income is equal to or greater than 900 percent of federal 210.21poverty guidelines, the parental contribution shall be 13.5 percent of adjusted gross 210.22income. If the child lives with the parent, the annual adjusted gross income is reduced by 210.23$2,400 prior to calculating the parental contribution. If the child resides in an institution 210.24specified in section 256B.35, the parent is responsible for the personal needs allowance 210.25specified under that section in addition to the parental contribution determined under this 210.26section. The parental contribution is reduced by any amount required to be paid directly to 210.27the child pursuant to a court order, but only if actually paid.210.28    Sec. 3. Minnesota Statutes 2010, section 256.01, subdivision 24, is amended to read:210.29    Subd. 24. Disability Linkage Line. The commissioner shall establish the Disability 210.30Linkage Line, ato serve as Minnesota's neutral access point for statewide consumer210.31disability information, referral, and assistance system for people with disabilities and 210.32chronic illnesses that. The Disability Linkage Line shall:210.33(1) deliver information and assistance based on national and state standards;210.34    (1) provides (2) provide information about state and federal eligibility requirements, 210.35benefits, and service options;211.1(3) provide benefits and options counseling;211.2    (2) makes (4) make referrals to appropriate support entities;211.3    (3) delivers information and assistance based on national and state standards;211.4    (4) assists (5) educate people to on their options so they can make well-informed 211.5decisions choices; and211.6    (5) supports (6) help support the timely resolution of service access and benefit 211.7issues.;211.8(7) inform people of their long-term community services and supports;211.9(8) provide necessary resources and supports that can lead to employment and 211.10increased economic stability of people with disabilities; and211.11(9) serve as the technical assistance and help center for the Web-based tool, 211.12Minnesota's Disability Benefits 101.org.211.13EFFECTIVE DATE.This section is effective July 1, 2011.211.14    Sec. 4. Minnesota Statutes 2010, section 256.01, subdivision 29, is amended to read:211.15    Subd. 29. State medical review team. (a) To ensure the timely processing of 211.16determinations of disability by the commissioner's state medical review team under 211.17sections 
         256B.055, subdivision 7, paragraph (b), 
         256B.057, subdivision 9, paragraph 211.18(j), and 
         256B.055, subdivision 12, the commissioner shall review all medical evidence 211.19submitted by county agencies with a referral and seek additional information from 211.20providers, applicants, and enrollees to support the determination of disability where 211.21necessary. Disability shall be determined according to the rules of title XVI and title 211.22XIX of the Social Security Act and pertinent rules and policies of the Social Security 211.23Administration.211.24    (b) Prior to a denial or withdrawal of a requested determination of disability due 211.25to insufficient evidence, the commissioner shall (1) ensure that the missing evidence is 211.26necessary and appropriate to a determination of disability, and (2) assist applicants and 211.27enrollees to obtain the evidence, including, but not limited to, medical examinations 211.28and electronic medical records.211.29(c) The commissioner shall provide the chairs of the legislative committees with 211.30jurisdiction over health and human services finance and budget the following information 211.31on the activities of the state medical review team by February 1 of each year:211.32(1) the number of applications to the state medical review team that were denied, 211.33approved, or withdrawn;211.34(2) the average length of time from receipt of the application to a decision;212.1(3) the number of appeals, appeal results, and the length of time taken from the date 212.2the person involved requested an appeal for a written decision to be made on each appeal;212.3(4) for applicants, their age, health coverage at the time of application, hospitalization 212.4history within three months of application, and whether an application for Social Security 212.5or Supplemental Security Income benefits is pending; and212.6(5) specific information on the medical certification, licensure, or other credentials 212.7of the person or persons performing the medical review determinations and length of 212.8time in that position.212.9(d) Any appeal made under section 
         256.045, subdivision 3, of a disability 212.10determination made by the state medical review team must be decided according to the 212.11timelines under section 
         256.0451, subdivision 22, paragraph (a). If a written decision is 212.12not issued within the timelines under section 
         256.0451, subdivision 22, paragraph (a), the 212.13appeal must be immediately reviewed by the chief appeals referee.212.14EFFECTIVE DATE.This section is effective July 1, 2011.212.15    Sec. 5. Minnesota Statutes 2010, section 256.045, subdivision 4a, is amended to read:212.16    Subd. 4a. Case management appeals.(a) Any recipient of case management 212.17services pursuant to section 256B.0625 or256B.092, personal care assistance services 212.18under section 256B.0625, or other services who contests the county agency's action, 212.19reduction, suspension, denial, or termination of services,  or failure to act in the provision 212.20of those services, other than a failure to act with reasonable promptness or a suspension, 212.21reduction, denial, or termination of services, must submit a written request for a 212.22conciliation conference with the recipient's case worker and the county social service 212.23director or designee to the county agency prior to filing an appeal under this section. 212.24    (b) For purposes of this subdivision, a county agency's actions include actions by 212.25the department with respect to these services. The request must be filed no later than 30 212.26days from the date of a notice of action on personal care assistance services or ten days 212.27from the date of a notice of agency action on case management or other services. The 212.28county agency or the state may implement the action, reduction, suspension, denial, or 212.29termination of services described in the notice of action unless the recipient includes a 212.30request for continuation of services. The recipient may request a 30-day continuation of 212.31personal care assistance services or ten-day continuation for case management or other 212.32services. The county agency may hold the conference by telephone or by electronic media 212.33unless the recipient requests the conference take place in person in their written request for 212.34conference. The county agency shall have discretion to continue the conference. 213.1    (c) The county agency shall inform the commissioner of the receipt of a request 213.2when it is submitted and shall schedule a conciliation conference to be held in person, by 213.3telephone, or by electronic media within ten days of the receipt of the recipient's written 213.4request. The county agency shall notify the recipient, the commissioner, and all interested 213.5persons of the time, date, and location of the conciliation conference. The commissioner 213.6may assist the county by providing mediation services or by identifying other resources 213.7that may assist in the mediation between the parties. Within 30 15 days after the conference 213.8has been held, the county agency shall conduct the conciliation conference and inform the 213.9recipient in writing of the action the county agency is going to take and when that action 213.10will be taken and notify the recipient of the right to a hearing under this subdivision. 213.11    The conciliation conference shall be conducted in a manner consistent with the 213.12commissioner's instructions. (d) If the county fails to conduct the conciliation conference 213.13and issue its report within 30 days, or, at any time up to 90 days after the conciliation 213.14conference is held as provided in paragraph (b) and the recipient disputes the county 213.15agency's notice of its intended action, or if a recipient is otherwise entitled to a fair hearing 213.16under subdivision 3a, a recipient may submit to the commissioner a written request for a 213.17fair hearing before a state human services referee to determine whether case management 213.18services have been provided in accordance with applicable laws and rules or whether the 213.19county agency has assured that the services identified in the recipient's individual service 213.20plan have been delivered in accordance with the laws and rules governing the provision of 213.21those services under this section. 213.22    (e) Hearings involving claims the county agency failed to comply with the 213.23requirement to schedule and hold a conference or to notify the recipient of its intended 213.24action according to this subdivision shall be limited in scope to those issues only, and the 213.25human services judge may recommend an order to the commissioner remanding the case 213.26to the county agency with directions to schedule and hold the conference and to notify 213.27the recipient of its intended action. The state human services referee shall recommend an 213.28order to the commissioner, who shall, in accordance with the procedure in subdivision 5, 213.29issue a final order within 60 days of the receipt of the request for a hearing involving case 213.30management services only, unless the commissioner refuses to accept the recommended 213.31order, in which event a final order shall issue within 90 days of the receipt of that request. 213.32The order may direct the county agency to take those actions necessary to comply with 213.33applicable laws or rules. The commissioner may issue a temporary order prohibiting the 213.34demission of a recipient of case management services under section 256B.092, from 213.35a residential or day habilitation program licensed under chapter 245A, while a county 213.36agency review process or an appeal brought by a recipient under this subdivision is 214.1pending, or for the period of time necessary for the county agency to implement the 214.2commissioner's order. The commissioner shall not issue a final order staying the demission 214.3of a recipient of case management services from a residential or day habilitation program 214.4licensed under chapter 245A.214.5    (f) Any recipient of case management services under section 256B.0625 or 214.6256B.092, or personal care assistance services under section 256B.0625, must be informed 214.7in writing at the time of application and at the time of any change in services that they 214.8must submit a written request to the county agency for a conference with the case manager 214.9and the county social service director before they can file an appeal under this section, 214.10of their right to continue receiving services pending the outcome of the conference 214.11and notice from the county agency, and that their time for requesting a hearing under 214.12subdivision 3a and requesting continuation of services begins to run when they receive the 214.13postconference notice of the county's intended actions. For purposes of this paragraph, 214.14recipients are presumed to have received notice of the agency's intended actions three 214.15business days after the date of the notice. Recipients have the burden of overcoming this 214.16presumption by a preponderance of the evidence.214.17EFFECTIVE DATE.This section is effective for all notices of action dated on 214.18or after January 1, 2012.214.19    Sec. 6. Minnesota Statutes 2010, section 256.9657, subdivision 1, is amended to read:214.20    Subdivision 1. Nursing home license surcharge. (a) Effective July 1, 1993, 214.21each non-state-operated nursing home licensed under chapter 144A shall pay to the 214.22commissioner an annual surcharge according to the schedule in subdivision 4. The 214.23surcharge shall be calculated as $620 per licensed bed. If the number of licensed beds 214.24is reduced, the surcharge shall be based on the number of remaining licensed beds the 214.25second month following the receipt of timely notice by the commissioner of human 214.26services that beds have been delicensed. The nursing home must notify the commissioner 214.27of health in writing when beds are delicensed. The commissioner of health must notify 214.28the commissioner of human services within ten working days after receiving written 214.29notification. If the notification is received by the commissioner of human services by 214.30the 15th of the month, the invoice for the second following month must be reduced 214.31to recognize the delicensing of beds. Beds on layaway status continue to be subject to 214.32the surcharge. The commissioner of human services must acknowledge a medical care 214.33surcharge appeal within 30 days of receipt of the written appeal from the provider.214.34(b) Effective July 1, 1994, the surcharge in paragraph (a) shall be increased to $625.215.1(c) Effective August 15, 2002, the surcharge under paragraph (b) shall be increased 215.2to $990.215.3(d) Effective July 15, 2003, the surcharge under paragraph (c) shall be increased 215.4to $2,815.215.5(e) Effective July 15, 2013, the surcharge under paragraph (d) shall apply only to 215.6occupied, licensed nursing home beds that are not in layaway under section 144A.071, 215.7subdivision 4b. Beginning January 1, 2013, nursing facilities may, on a quarterly basis, 215.8report data on occupancy as a percent of capacity days, on a form and in a manner 215.9prescribed by the commissioner. This data must be provided by the end of the month 215.10following the calendar quarter. The commissioner shall use this data to adjust the 215.11surcharge amount due for the calendar quarter following submission of the data. This 215.12adjustment shall be allowed only for a nursing facility that provides complete and timely 215.13data allowed in this paragraph. The commissioner shall apply a monthly surcharge 215.14computed as the occupancy percentage as reported in this paragraph times the number of 215.15licensed nursing home beds times $2,815 divided by 12.215.16(f) The commissioner may reduce, and may subsequently restore, the surcharge 215.17under paragraph (d) based on the commissioner's determination of a permissible surcharge.215.18(f) (g) Between April 1, 2002, and August 15, 2004, a facility governed by this 215.19subdivision may elect to assume full participation in the medical assistance program 215.20by agreeing to comply with all of the requirements of the medical assistance program, 215.21including the rate equalization law in section 
         256B.48, subdivision 1, paragraph (a), and 215.22all other requirements established in law or rule, and to begin intake of new medical 215.23assistance recipients. Rates will be determined under Minnesota Rules, parts 9549.0010 215.24to 9549.0080. Notwithstanding section 
         256B.431, subdivision 27, paragraph (i), rate 215.25calculations will be subject to limits as prescribed in rule and law. Other than the 215.26adjustments in sections 
         256B.431, subdivisions 30 and 32; 
         256B.437, subdivision 3, 215.27paragraph (b), Minnesota Rules, part 9549.0057, and any other applicable legislation 215.28enacted prior to the finalization of rates, facilities assuming full participation in medical 215.29assistance under this paragraph are not eligible for any rate adjustments until the July 1 215.30following their settle-up period.215.31    Sec. 7. Minnesota Statutes 2010, section 256B.056, subdivision 3, is amended to read:215.32    Subd. 3. Asset limitations for individuals and families. (a) To be eligible for 215.33medical assistance, a person must not individually own more than $3,000 in assets, or if a 215.34member of a household with two family members, husband and wife, or parent and child, 215.35the household must not own more than $6,000 in assets, plus $200 for each additional 216.1legal dependent. In addition to these maximum amounts, an eligible individual or family 216.2may accrue interest on these amounts, but they must be reduced to the maximum at the 216.3time of an eligibility redetermination. The accumulation of the clothing and personal 216.4needs allowance according to section 
         256B.35 must also be reduced to the maximum at 216.5the time of the eligibility redetermination. The value of assets that are not considered in 216.6determining eligibility for medical assistance is the value of those assets excluded under 216.7the supplemental security income program for aged, blind, and disabled persons, with 216.8the following exceptions:216.9(1) household goods and personal effects are not considered;216.10(2) capital and operating assets of a trade or business that the local agency determines 216.11are necessary to the person's ability to earn an income are not considered;216.12(3) motor vehicles are excluded to the same extent excluded by the supplemental 216.13security income program;216.14(4) assets designated as burial expenses are excluded to the same extent excluded by 216.15the supplemental security income program. Burial expenses funded by annuity contracts 216.16or life insurance policies must irrevocably designate the individual's estate as contingent 216.17beneficiary to the extent proceeds are not used for payment of selected burial expenses; and216.18(5) effective upon federal approval, for a person who no longer qualifies as an 216.19employed person with a disability due to loss of earnings, assets allowed while eligible 216.20for medical assistance under section 
         256B.057, subdivision 9, are not considered for 12 216.21months, beginning with the first month of ineligibility as an employed person with a 216.22disability, to the extent that the person's total assets remain within the allowed limits of 216.23section 
         256B.057, subdivision 9, paragraph (c) (d).216.24(b) No asset limit shall apply to persons eligible under section 
         256B.055, subdivision 216.2515.216.26EFFECTIVE DATE.This section is effective January 1, 2014.216.27    Sec. 8. Minnesota Statutes 2010, section 256B.056, is amended by adding a 216.28subdivision to read:216.29    Subd. 5d.Spenddown adjustments.When income is projected for a six-month 216.30budget period, retroactive adjustments to income determined to be available to a person 216.31under section 256B.0575 must be made at the end of each six-month budget period 216.32based on changes occurring during the budget period. For changes occurring outside the 216.33six-month budget period, such retroactive adjustments are limited to the six full calendar 216.34months before the month the change is reported or discovered.217.1    Sec. 9. Minnesota Statutes 2010, section 256B.057, subdivision 9, is amended to read:217.2    Subd. 9. Employed persons with disabilities. (a) Medical assistance may be paid 217.3for a person who is employed and who:217.4(1) but for excess earnings or assets, meets the definition of disabled under the 217.5Supplemental Security Income program;217.6(2) is at least 16 but less than 65 years of age;217.7(3) meets the asset limits in paragraph (c) (d); and217.8(4) pays a premium and other obligations under paragraph (e).217.9    (b) For purposes of eligibility, there is a $65 earned income disregard. To be eligible 217.10for medical assistance under this subdivision, a person must have more than $65 of earned 217.11income. Earned income must have Medicare, Social Security, and applicable state and 217.12federal taxes withheld. The person must document earned income tax withholding. Any 217.13spousal income or assets shall be disregarded for purposes of eligibility and premium 217.14determinations.217.15(b) (c) After the month of enrollment, a person enrolled in medical assistance under 217.16this subdivision who:217.17(1) is temporarily unable to work and without receipt of earned income due to a 217.18medical condition, as verified by a physician, may retain eligibility for up to four calendar 217.19months; or217.20(2) effective January 1, 2004, loses employment for reasons not attributable to the 217.21enrollee, and is without receipt of earned income may retain eligibility for up to four 217.22consecutive months after the month of job loss. To receive a four-month extension, 217.23enrollees must verify the medical condition or provide notification of job loss. All other 217.24eligibility requirements must be met and the enrollee must pay all calculated premium 217.25costs for continued eligibility.217.26(c) (d) For purposes of determining eligibility under this subdivision, a person's 217.27assets must not exceed $20,000, excluding:217.28(1) all assets excluded under section 
         256B.056;217.29(2) retirement accounts, including individual accounts, 401(k) plans, 403(b) plans, 217.30Keogh plans, and pension plans; and217.31(3) medical expense accounts set up through the person's employer.; and217.32(4) spousal assets, including spouse's share of jointly held assets.217.33(d)(1) Effective January 1, 2004, for purposes of eligibility, there will be a $65 217.34earned income disregard. To be eligible, a person applying for medical assistance under 217.35this subdivision must have earned income above the disregard level.218.1(2) Effective January 1, 2004, to be considered earned income, Medicare, Social 218.2Security, and applicable state and federal income taxes must be withheld. To be eligible, 218.3a person must document earned income tax withholding.218.4(e)(1) A person whose earned and unearned income is equal to or greater than 100 218.5percent of federal poverty guidelines for the applicable family size must pay a premium 218.6to be eligible for medical assistance under this subdivision. (e) All enrollees must pay a 218.7premium to be eligible for medical assistance under this subdivision, except as provided 218.8under section 256.01, subdivision 18b.218.9(1) An enrollee must pay the greater of a $65 premium or the premium shall be218.10calculated based on the person's gross earned and unearned income and the applicable 218.11family size using a sliding fee scale established by the commissioner, which begins at 218.12one percent of income at 100 percent of the federal poverty guidelines and increases 218.13to 7.5 percent of income for those with incomes at or above 300 percent of the federal 218.14poverty guidelines. 218.15(2) Annual adjustments in the premium schedule based upon changes in the federal 218.16poverty guidelines shall be effective for premiums due in July of each year.218.17(2) Effective January 1, 2004, all enrollees must pay a premium to be eligible for 218.18medical assistance under this subdivision. An enrollee shall pay the greater of a $35 218.19premium or the premium calculated in clause (1).218.20(3) Effective November 1, 2003, All enrollees who receive unearned income must 218.21pay one-half of one five percent of unearned income in addition to the premium amount, 218.22except as provided under section 256.01, subdivision 18b.218.23(4) Effective November 1, 2003, for enrollees whose income does not exceed 200 218.24percent of the federal poverty guidelines and who are also enrolled in Medicare, the 218.25commissioner must reimburse the enrollee for Medicare Part B premiums under section 218.26256B.0625, subdivision 15, paragraph (a).218.27(5) (4) Increases in benefits under title II of the Social Security Act shall not be 218.28counted as income for purposes of this subdivision until July 1 of each year.218.29(f) A person's eligibility and premium shall be determined by the local county 218.30agency. Premiums must be paid to the commissioner. All premiums are dedicated to 218.31the commissioner.218.32(g) Any required premium shall be determined at application and redetermined at 218.33the enrollee's six-month income review or when a change in income or household size is 218.34reported. Enrollees must report any change in income or household size within ten days 218.35of when the change occurs. A decreased premium resulting from a reported change in 218.36income or household size shall be effective the first day of the next available billing month 219.1after the change is reported. Except for changes occurring from annual cost-of-living 219.2increases, a change resulting in an increased premium shall not affect the premium amount 219.3until the next six-month review.219.4(h) Premium payment is due upon notification from the commissioner of the 219.5premium amount required. Premiums may be paid in installments at the discretion of 219.6the commissioner.219.7(i) Nonpayment of the premium shall result in denial or termination of medical 219.8assistance unless the person demonstrates good cause for nonpayment. Good cause exists 219.9if the requirements specified in Minnesota Rules, part 9506.0040, subpart 7, items B to 219.10D, are met. Except when an installment agreement is accepted by the commissioner, 219.11all persons disenrolled for nonpayment of a premium must pay any past due premiums 219.12as well as current premiums due prior to being reenrolled. Nonpayment shall include 219.13payment with a returned, refused, or dishonored instrument. The commissioner may 219.14require a guaranteed form of payment as the only means to replace a returned, refused, 219.15or dishonored instrument.219.16(j) The commissioner shall notify enrollees annually beginning at least 24 months 219.17before the person's 65th birthday of the medical assistance eligibility rules affecting 219.18income, assets, and treatment of a spouse's income and assets that will be applied upon 219.19reaching age 65.219.20(k) For enrollees whose income does not exceed 200 percent of the federal poverty 219.21guidelines and who are also enrolled in Medicare, the commissioner shall reimburse 219.22the enrollee for Medicare part B premiums under section 256B.0625, subdivision 15, 219.23paragraph (a).219.24EFFECTIVE DATE.This section is effective January 1, 2014, for adults age 21 or 219.25older, and October 1, 2019, for children age 16 to before the child's 21st birthday.219.26    Sec. 10. Minnesota Statutes 2010, section 256B.0657, is amended to read:219.27256B.0657 SELF-DIRECTED SUPPORTS OPTION OPTIONS.219.28    Subdivision 1. Definition.(a) "Lead agency" has the meaning given in section 219.29256B.0911, subdivision 1a, paragraph (d).219.30(b) "Legal representative" means a legal guardian of a child or an adult, or parent of 219.31a minor child.219.32(c) "Individual representative" means an individual who has been authorized, in 219.33a written statement by the person or the person's legal representative, to speak on the 219.34person's behalf and help the person understand and make informed choices in matters 220.1related to identification of needs and choice of services and supports and assist the person 220.2to implement an approved support plan and has no financial interest in the provision of any 220.3services included in the individual's plan unless related by blood, adoption, or marriage.220.4(d) "Self-directed supports option options" means personal assistance, supports, 220.5items, and related services purchased under an approved budget plan and budget by a 220.6recipient.220.7    Subd. 2. Eligibility. (a) The self-directed supports option is available to a person 220.8who:220.9    (1) is a recipient of medical assistance as determined under sections 
         256B.055, 220.10256B.056
         , and 
         256B.057, subdivision 9;220.11    (2) is eligible for personal care assistance services under section 
         256B.0659, or 220.12for a home and community-based services waiver program under section 256B.0915, 220.13256B.092, or 256B.49, or alternative care under section 256B.0913;220.14    (3) lives in the person's own apartment or home, which is not owned, operated, or 220.15controlled by a provider of services not except for services provided by those related by 220.16blood or, adoption, marriage, or family foster care consistent with the requirements of 220.17section 256B.0651, subdivision 1, paragraph (e);220.18    (4) has the ability to hire, fire, supervise, establish staff compensation for, and 220.19manage the individuals providing services, and to choose and obtain items, related 220.20services, and supports as described in the participant's plan. If the recipient is not able 220.21to carry out these functions but has a legal guardian, individual representative,  or parent 220.22to carry them out, the guardian, individual representative,  or parent may fulfill these 220.23functions on behalf of the recipient; and220.24    (5) has not been excluded or disenrolled by the commissioner.220.25    (b) The commissioner may disenroll or, exclude, or require other measures such as 220.26training, increased assistance, reporting, or oversight for recipients, including guardians 220.27and,  parents, and individual representatives under the following circumstances:220.28    (1) recipients who have been restricted by the Primary Care Utilization Review 220.29Committee Minnesota restricted recipient program may be excluded for a specified time 220.30period;220.31    (2) recipients who exit the self-directed supports option during the recipient's 220.32service plan year shall not access the self-directed supports option for the remainder of 220.33that service plan year; and220.34    (3) when the department determines that the recipient cannot manage recipient 220.35responsibilities under the program.221.1(c) For vendors or other self-directed service providers, the commissioner may 221.2take any action authorized under surveillance and integrity review in Minnesota Rules, 221.3parts 9505.2160 to 9505.2245.221.4    Subd. 3. Eligibility for other services. Selection of the self-directed supports 221.5option by a recipient shall not restrict access to other medically necessary care and 221.6services furnished under the state plan medical assistance benefit, including home care 221.7targeted case management, except that a person receiving choosing lead agency managed221.8home and community-based waiver services, agency-provided personal care assistance 221.9services, a family support grant, or a consumer support grant is not eligible for funding 221.10under the self-directed supports option.221.11    Subd. 4. Assessment requirements. (a) The self-directed supports option 221.12assessment must meet the following requirements:221.13    (1) it shall be conducted by the county public health nurse or a certified public health 221.14nurse under contract with the county consistent with the requirements of personal care 221.15assistance services under section 256B.0659, subdivision 3a; home and community-based 221.16waiver services programs under section 256B.0915, 256B.092, or 256B.49; and the 221.17alternative care program under section 256B.0913, until section 256B.0911, subdivision 221.183a, has been implemented;221.19    (2) it shall be conducted face-to-face in the recipient's home initially, and at least 221.20annually thereafter; when there is a significant change in the recipient's condition; and 221.21when there is a change in the person's need for personal care assistance services under the 221.22programs listed in subdivision 2, paragraph (a), clause (2). A recipient who is residing in a 221.23facility may be assessed for the self-directed support option for the purpose of returning 221.24to the community using this option; and221.25    (3) it shall be completed using the format established by the commissioner.221.26    (b) The results of the personal care assistance assessment and recommendations shall 221.27be communicated to the commissioner and the recipient by the county public health nurse 221.28or certified public health nurse under contract with the county as required under section 221.29256B.0659, subdivision 3a. The person's annual and monthly average authorization for 221.30the self-directed budget amount shall be provided within 40 days after the personal care 221.31assessment or reassessment, or within ten days after a request not related to an assessment.221.32(c) The lead agency responsible for administration of home and community-based 221.33waiver services under section 256B.0915, 256B.092, or 256B.49, and alternative care 221.34under section 256B.0913, shall provide annual and monthly average authorization for the 221.35self-directed services budget amounts for all eligible persons within 40 days after an 222.1initial assessment or annual review and within ten days if requested at a time unrelated to 222.2the assessment or annual review.222.3    Subd. 5. Self-directed supports option plan requirements. (a) The plan and 222.4provider for the self-directed supports option must meet the following requirements:222.5    (1) the plan must be completed using a person-centered process that:222.6    (i) builds upon the recipient's capacity to engage in activities that promote 222.7community life;222.8    (ii) respects the recipient's preferences, choices, and abilities;222.9    (iii) involves families, friends, and professionals in the planning or delivery of 222.10services or supports as desired or required by the recipient; and222.11    (iv) addresses the need for personal care assistance and other services and supports222.12identified in the recipient's self-directed supports option assessment;222.13    (2) the plan shall be developed by the recipient, legal representative, or by the 222.14guardian of an adult recipient or by a parent or guardian of a minor child,individual 222.15representative, and may be assisted by a provider who meets the requirements established 222.16for using a person-centered planning process and shall be reviewed at least annually upon 222.17reassessment or when there is a significant change in the recipient's condition; and222.18    (3) the plan must include the total budget amount available divided into monthly 222.19amounts that cover the number of months of personal care assistance services or home 222.20and community-based waiver or alternative care authorization included in the budget. 222.21A recipient may reserve funds monthly for the purchase of items that meet the standards 222.22in subdivision 6, paragraph (a), clause (2), and are reflected in the support plan. The 222.23amount used each month may vary, but additional funds shall not be provided above the 222.24annual personal care assistance services authorized amount unless a change in condition 222.25is documented.222.26    (b) The commissioner or the commissioner's designee shall:222.27    (1) ensure that outreach activities and information materials on self-directed options 222.28are developed and provided across the state to persons who use or are seeking community 222.29support services;222.30    (1) (2) establish the format and criteria for the plan as well as the requirements for 222.31providers who assist with plan development;222.32    (2) (3) review the assessment and plan and, within 30 days after receiving the 222.33assessment and plan, make a decision on approval of the plan;222.34    (3) (4) notify the recipient, parent, or guardian legal representative, or individual 222.35representative of approval or denial of the plan and provide notice of the right to appeal 222.36under section 
         256.045; and223.1    (4) (5) provide a copy of the plan to the fiscal support entity selected by the recipient223.2from among at least three certified entities.223.3    (c) The commissioner shall:223.4    (1) establish provider enrollment requirements for provision of fiscal support entity 223.5services and person-centered support plan services, including benefits counseling to 223.6support employment; and223.7    (2) collect a fee to cover the costs of certifying providers for the services described 223.8in this subdivision.223.9    Subd. 6. Services covered. (a) Services covered under the self-directed supports 223.10option include:223.11    (1) personal care assistance services under section 
         256B.0659, and services under 223.12the home and community-based waivers, except those provided in licensed or registered 223.13residential settings unless the services are provided in a family foster care setting which 223.14meets the requirements of section 256B.0651, subdivision 1, paragraph (e); and223.15    (2) items, related services, and supports, including assistive technology, that increase 223.16independence or substitute for human assistance to the extent expenditures would 223.17otherwise be used for human assistance.223.18    (b) Items, supports, and related services purchased under this option shall not be 223.19considered home care services for the purposes of section 
         144A.43.223.20    Subd. 7. Noncovered services. Services or supports that are not eligible for 223.21payment under the self-directed supports option include:223.22    (1) services, goods, or supports that do not benefit the recipient;223.23    (2) any fees incurred by the recipient, such as Minnesota health care program fees 223.24and co-pays, legal fees, or costs related to advocate agencies;223.25    (3) insurance, except for insurance costs related to employee coverage or fiscal 223.26support entity payments;223.27    (4) room and board and personal items that are not related to the disability, except 223.28that medically prescribed specialized diet items may be covered if they reduce the need for 223.29human assistance;223.30    (5) home modifications that add square footage, except those modifications that 223.31configure a bathroom to accommodate a wheelchair;223.32    (6) home modifications for a residence other than the primary residence of the 223.33recipient, or in the event of a minor with parents not living together, the primary residences 223.34of the parents;224.1    (7) expenses for travel, lodging, or meals related to training the recipient, the 224.2parent or guardian of an adult recipient, or the parent or guardian of a minor child legal 224.3representative, or paid or unpaid caregivers that exceed $500 in a 12-month period;224.4    (8) experimental treatment;224.5    (9) any service or item to the extent the service or item is covered by other medical 224.6assistance state plan services, including prescription and over-the-counter medications, 224.7compounds, and solutions and related fees, including premiums and co-payments;224.8    (10) membership dues or costs, except when the service is necessary and appropriate 224.9to treat a physical condition or to improve or maintain the recipient's physical condition. 224.10The condition must be identified in the recipient's plan of care and monitored by a 224.11Minnesota health care program enrolled physician;224.12    (11) vacation expenses other than the cost of direct services;224.13    (12) vehicle maintenance or modifications not related to the disability;224.14    (13) tickets and related costs to attend sporting or other recreational events; and224.15    (14) costs related to Internet access, except when necessary for operation of assistive 224.16technology, to increase independence, or to substitute for human assistance.224.17    Subd. 8. Self-directed budget requirements.(a) The budget for the provision of 224.18the self-directed service option shall be established for persons eligible for personal care 224.19assistance services under section 256B.0659 based on:224.20    (1) assessed personal care assistance units, not to exceed the maximum number of 224.21personal care assistance units available, as determined by section 
         256B.0659; and224.22    (2) the personal care assistance unit rate:224.23    (i) with a reduction to the unit rate to pay for a program administrator as defined in 224.24subdivision 10; and224.25    (ii) an additional adjustment to the unit rate as needed to ensure cost neutrality for 224.26the state.224.27(b) The budget for persons eligible for programs listed in subdivision 2, paragraph 224.28(a), clause (2), is based on the approved budget methodologies for each program.224.29    Subd. 9. Quality assurance and risk management. (a) The commissioner 224.30shall establish quality assurance and risk management measures for use in developing 224.31and implementing self-directed plans and budgets that (1) recognize the roles and 224.32responsibilities involved in obtaining services in a self-directed manner, and (2) assure 224.33the appropriateness of such plans and budgets based upon a recipient's resources and 224.34capabilities. These measures must include (i) background studies, and (ii) backup and 224.35emergency plans, including disaster planning, and (iii) for persons using home and 225.1community-based waiver services, monitoring by the lead agency on quality assurance 225.2measures and recipient health, safety, and welfare.225.3    (b) The commissioner shall provide ongoing technical assistance and resource 225.4and educational materials for families and recipients selecting the self-directed option, 225.5including information on the quality assurance efforts.225.6    (c) Performance assessments measures, such as of a recipient's  functioning, 225.7satisfaction with the services and supports, and ongoing monitoring of health and 225.8well-being shall be identified in consultation with the stakeholder group.225.9    Subd. 10. Fiscal support entity. (a) Each recipient or legal representative shall 225.10choose a fiscal support entity provider certified by the commissioner to make payments 225.11for services, items, supports, and administrative costs related to managing a self-directed 225.12service plan authorized for payment in the approved plan and budget. Recipients The 225.13recipient or legal representative  shall also choose the payroll, agency with choice, or the 225.14fiscal conduit model of financial and service management.225.15    (b) The fiscal support entity:225.16    (1) may not limit or restrict the recipient's choice of service or support providers, 225.17including use of the payroll, agency with choice, or fiscal conduit model of financial 225.18and service management;225.19    (2) must have a written agreement with the recipient, individual representative,  or 225.20the recipient's legal representative that identifies the duties and responsibilities to be 225.21performed and the specific related charges;225.22    (3) must provide the recipient and the home care targeted case manager, legal 225.23representative, and individual representative with a monthly written summary of the 225.24self-directed supports option services that were billed, including charges from the fiscal 225.25support entity;225.26    (4) must be knowledgeable of and comply with Internal Revenue Service 225.27requirements necessary to process employer and employee deductions, provide appropriate 225.28and timely submission of employer tax liabilities, and maintain documentation to support 225.29medical assistance claims;225.30    (5) must have current and adequate liability insurance and bonding and sufficient 225.31cash flow and have on staff or under contract a certified public accountant or an individual 225.32with a baccalaureate degree in accounting; and225.33    (6) must maintain records to track all self-directed supports option services 225.34expenditures, including time records of persons paid to provide supports and receipts for 225.35any goods purchased. The records must be maintained for a minimum of five years from 225.36the claim date and be available for audit or review upon request. Claims submitted by 226.1the fiscal support entity must correspond with services, amounts, and time periods as 226.2authorized in the recipient's self-directed supports option plan.226.3    (c) The commissioner shall have authority to:226.4    (1) set or negotiate rates with fiscal support entities;226.5    (2) limit the number of fiscal support entities;226.6    (3) identify a process to certify and recertify fiscal support entities and assure fiscal 226.7support entities are available to recipients throughout the state; and226.8    (4) establish a uniform format and protocol to be used by eligible fiscal support 226.9entities.226.10    Subd. 11. Stakeholder consultation. The commissioner shall consult with 226.11a statewide consumer-directed self-directed  services stakeholder group, including 226.12representatives of all types of consumer-directed self-directed  service users, advocacy 226.13organizations, counties, and consumer-directed self-directed  service providers. The 226.14commissioner shall seek recommendations from this stakeholder group in developing, 226.15monitoring, evaluating, and modifying:226.16    (1) the self-directed plan format;226.17    (2) requirements and guidelines for the person-centered plan assessment and 226.18planning process;226.19    (3) implementation of the option and the quality assurance and risk management 226.20techniques; and226.21    (4) standards and requirements, including rates for the personal support plan 226.22development provider and the fiscal support entity; policies; training; and implementation; 226.23and226.24(5) the self-directed supports options available through the home and 226.25community-based waivers under section 256B.0916 and the personal care assistance 226.26program under section 256B.0659, including recommendations on possible ways to 226.27increase participation, improve flexibility, and provide incentives for recipients to 226.28participate in a life transition and crisis funding pool with others to save and contribute 226.29part of their authorized budgets, which can be carried over year to year and used according 226.30to priority standards under section 256B.092, subdivision 12, paragraph (a), clauses (1), 226.31(3), (4), (5), and (6).226.32The stakeholder group shall provide recommendations on the repeal of the personal 226.33care assistance choice option, transition issues, and whether the consumer support grant 226.34program under section 
         256.476 should be modified. The stakeholder group shall meet 226.35at least three times each year to provide advice on policy, implementation, and other 226.36aspects of consumer and self-directed services.227.1    Subd. 12. Enrollment and evaluation. Enrollment in the self-directed supports 227.2option is available to current personal care assistance recipients upon annual personal 227.3care assistance reassessment, with a maximum enrollment of 1,000 2,000 people in the 227.4first fiscal year of implementation and an additional 1,000 3,000 people in the second 227.5fiscal year. The commissioner shall evaluate the self-directed supports option during the 227.6first two years of implementation and make any necessary changes prior to the option 227.7becoming available statewide.227.8EFFECTIVE DATE.This section is effective July 1, 2012.227.9    Sec. 11. Minnesota Statutes 2010, section 256B.0659, subdivision 11, is amended to 227.10read:227.11    Subd. 11. Personal care assistant; requirements. (a) A personal care assistant 227.12must meet the following requirements:227.13    (1) be at least 18 years of age with the exception of persons who are 16 or 17 years 227.14of age with these additional requirements:227.15    (i) supervision by a qualified professional every 60 days; and227.16    (ii) employment by only one personal care assistance provider agency responsible 227.17for compliance with current labor laws;227.18    (2) be employed by a personal care assistance provider agency;227.19    (3) enroll with the department as a personal care assistant after clearing a background 227.20study. Except as provided in subdivision 11a, before a personal care assistant provides 227.21services, the personal care assistance provider agency must initiate a background study on 227.22the personal care assistant under chapter 245C, and the personal care assistance provider 227.23agency must have received a notice from the commissioner that the personal care assistant 227.24is:227.25    (i) not disqualified under section 
         245C.14; or227.26    (ii) is disqualified, but the personal care assistant has received a set aside of the 227.27disqualification under section 
         245C.22;227.28    (4) be able to effectively communicate with the recipient and personal care 227.29assistance provider agency;227.30    (5) be able to provide covered personal care assistance services according to the 227.31recipient's personal care assistance care plan, respond appropriately to recipient needs, 227.32and report changes in the recipient's condition to the supervising qualified professional 227.33or physician;227.34    (6) not be a consumer of personal care assistance services;228.1    (7) maintain daily written records including, but not limited to, time sheets under 228.2subdivision 12;228.3    (8) effective January 1, 2010, complete standardized training as determined 228.4by the commissioner before completing enrollment. The training must be available 228.5in languages other than English and to those who need accommodations due to 228.6disabilities. Personal care assistant training must include successful completion of the 228.7following training components: basic first aid, vulnerable adult, child maltreatment, 228.8OSHA universal precautions, basic roles and responsibilities of personal care assistants 228.9including information about assistance with lifting and transfers for recipients, emergency 228.10preparedness, orientation to positive behavioral practices, fraud issues, and completion of 228.11time sheets. Upon completion of the training components, the personal care assistant must 228.12demonstrate the competency to provide assistance to recipients;228.13    (9) complete training and orientation on the needs of the recipient within the first 228.14seven days after the services begin; and228.15    (10) be limited to providing and being paid for up to 275 hours per month, except 228.16that this limit shall be 275 hours per month for the period July 1, 2009, through June 30, 228.172011, of personal care assistance services regardless of the number of recipients being 228.18served or the number of personal care assistance provider agencies enrolled with. The 228.19number of hours worked per day shall not be disallowed by the department unless in 228.20violation of the law.228.21    (b) A legal guardian may be a personal care assistant if the guardian is not being paid 228.22for the guardian services and meets the criteria for personal care assistants in paragraph (a).228.23    (c) Effective January 1, 2010, persons who do not qualify as a personal care assistant 228.24include parents and stepparents of minors, spouses, paid legal guardians, family foster 228.25care providers, except as otherwise allowed in section 
         256B.0625, subdivision 19a, or 228.26staff of a residential setting. When the personal care assistant is a relative of the recipient, 228.27the commissioner shall pay 80 percent of the provider rate. For purposes of this section, 228.28relative means the parent or adoptive parent of an adult child, a sibling aged 16 years or 228.29older, an adult child, a grandparent, or a grandchild. 228.30    Sec. 12. Minnesota Statutes 2010, section 256B.0659, subdivision 28, is amended to 228.31read:228.32    Subd. 28. Personal care assistance provider agency; required documentation.228.33(a) Required documentation must be completed and kept in the personal care assistance 228.34provider agency file or the recipient's home residence. The required documentation 228.35consists of:229.1(1) employee files, including:229.2(i) applications for employment;229.3(ii) background study requests and results;229.4(iii) orientation records about the agency policies;229.5(iv) trainings completed with demonstration of competence;229.6(v) supervisory visits;229.7(vi) evaluations of employment; and229.8(vii) signature on fraud statement;229.9(2) recipient files, including:229.10(i) demographics;229.11(ii) emergency contact information and emergency backup plan;229.12(iii) personal care assistance service plan;229.13(iv) personal care assistance care plan;229.14(v) month-to-month service use plan;229.15(vi) all communication records;229.16(vii) start of service information, including the written agreement with recipient; and229.17(viii) date the home care bill of rights was given to the recipient;229.18(3) agency policy manual, including:229.19(i) policies for employment and termination;229.20(ii) grievance policies with resolution of consumer grievances;229.21(iii) staff and consumer safety;229.22(iv) staff misconduct; and229.23(v) staff hiring, service delivery, staff and consumer safety, staff misconduct, and 229.24resolution of consumer grievances;229.25(4) time sheets for each personal care assistant along with completed activity sheets 229.26for each recipient served; and229.27(5) agency marketing and advertising materials and documentation of marketing 229.28activities and costs; and229.29(6) for each personal care assistant, whether or not the personal care assistant is 229.30providing care to a relative as defined in subdivision 11.229.31(b) The commissioner may assess a fine of up to $500 on provider agencies that do 229.32not consistently comply with the requirements of this subdivision.229.33    Sec. 13. Minnesota Statutes 2010, section 256B.0911, subdivision 1a, is amended to 229.34read:229.35    Subd. 1a. Definitions. For purposes of this section, the following definitions apply:230.1    (a) "Long-term care consultation services" means:230.2    (1) assistance in identifying services needed to maintain an individual in the most 230.3inclusive environment;230.4    (2) providing recommendations on cost-effective community services that are 230.5available to the individual;230.6    (3) development of an individual's person-centered community support plan;230.7    (4) providing information regarding eligibility for Minnesota health care programs;230.8    (5) face-to-face long-term care consultation assessments, which may be completed 230.9in a hospital, nursing facility, intermediate care facility for persons with developmental 230.10disabilities (ICF/DDs), regional treatment centers, or the person's current or planned 230.11residence;230.12    (6) federally mandated screening to determine the need for an institutional level of 230.13care under subdivision 4a;230.14    (7) determination of home and community-based waiver service eligibility 230.15including level of care determination for individuals who need an institutional level of 230.16care as defined under section 
         144.0724, subdivision 11, or 
         256B.092, service eligibility 230.17including state plan home care services identified in sections 
         256B.0625, subdivisions 230.186
         , 7, and 19, paragraphs (a) and (c), and 
         256B.0657, based on assessment and support 230.19plan development with appropriate referrals, including the option for consumer-directed 230.20communityself-directed supports;230.21    (8) providing recommendations for nursing facility placement when there are no 230.22cost-effective community services available; and230.23    (9) assistance to transition people back to community settings after facility 230.24admission; and230.25(10) providing notice to the individual or legal representative of the annual and 230.26monthly average authorized amount for traditional agency services and self-directed 230.27services under section 256B.0657 for which the recipient is found eligible.230.28    (b) "Long-term care options counseling" means the services provided by the linkage 230.29lines as mandated by sections 
         256.01 and 
         256.975, subdivision 7, and also includes 230.30telephone assistance and follow up once a long-term care consultation assessment has 230.31been completed.230.32    (c) "Minnesota health care programs" means the medical assistance program under 230.33chapter 256B and the alternative care program under section 
         256B.0913.230.34    (d) "Lead agencies" means counties or a collaboration of counties, tribes, and health 230.35plans administering long-term care consultation assessment and support planning services.230.36EFFECTIVE DATE.This section is effective January 1, 2012.231.1    Sec. 14. Minnesota Statutes 2010, section 256B.0911, subdivision 3a, is amended to 231.2read:231.3    Subd. 3a. Assessment and support planning. (a) Persons requesting assessment, 231.4services planning, or other assistance intended to support community-based living, 231.5including persons who need assessment in order to determine waiver or alternative 231.6care program eligibility, must be visited by a long-term care consultation team within 231.715 calendar 20 calendar days after the date on which an assessment was requested or 231.8recommended. After January 1, 2011, these requirements also apply to personal care 231.9assistance services, private duty nursing, and home health agency services, on timelines 231.10established in subdivision 5. Face-to-face assessments must be conducted according 231.11to paragraphs (b) to (i).231.12    (b) The county may utilize a team of either the social worker or public health nurse, 231.13or both. After January 1, 2011, lead agencies shall use certified assessors to conduct the 231.14assessment in a face-to-face interview. The consultation team members must confer 231.15regarding the most appropriate care for each individual screened or assessed.231.16    (c) The assessment must be comprehensive and include a person-centered 231.17assessment of the health, psychological, functional, environmental, and social needs of 231.18referred individuals and provide information necessary to develop a support plan that 231.19meets the consumers needs, using an assessment form provided by the commissioner.231.20    (d) The assessment must be conducted in a face-to-face interview with the person 231.21being assessed and the person's legal representative, as required by legally executed 231.22documents, and other individuals as requested by the person, who can provide information 231.23on the needs, strengths, and preferences of the person necessary to develop a support plan 231.24that ensures the person's health and safety, but who is not a provider of service or has any 231.25financial interest in the provision of services.231.26    (e) The person, or the person's legal representative, must be provided with 231.27written recommendations for community-based services, including consumer-directed231.28self-directed  options, or institutional care that include documentation that the most 231.29cost-effective alternatives available were offered to the individual. For purposes of 231.30this requirement, "cost-effective alternatives" means community services and living 231.31arrangements that cost the same as or less than institutional care. For persons determined 231.32eligible for services defined under subdivision 1a, paragraph (a), clauses (7) to (9), the 231.33community support plan must also include the estimated annual and monthly average 231.34authorized budget amount for those services.231.35    (f) If the person chooses to use community-based services, the person or the person's 231.36legal representative must be provided with a written community support plan, regardless 232.1of whether the individual is eligible for Minnesota health care programs. The written 232.2community support plan must include:232.3    (1) a summary of assessed needs as defined in paragraphs (c) and (d);232.4    (2) the individual's options and choices to meet identified needs, including all 232.5available options for case management services and providers;232.6    (3) identification of health and safety risks and how those risks will be addressed, 232.7including personal risk management strategies;232.8    (4) referral information; and 232.9    (5) informal caregiver supports, if applicable.232.10    For persons determined eligible for services defined under subdivision 1a, paragraph 232.11(a), clauses (7) to (10), the community support plan must also include:232.12    (6) identification of individual goals;232.13    (7) identification of short-term and long-term service outcomes. Short-term service 232.14outcomes are defined as achievable within six months; 232.15    (8) a recommended schedule for case management visits. When achievement of 232.16short-term service outcomes may affect the amount of service required, the schedule must 232.17be at least every six months and must reflect evaluation and progress toward identified 232.18short-term service outcomes; and232.19    (9) the estimated annual and monthly budget amount for services.232.20    In addition, for persons determined eligible for state plan home care under 232.21subdivision 1a, paragraph (a), clause (8), the person or person's representative must also 232.22receive a copy of the home care service plan developed by a certified assessor.232.23A person may request assistance in identifying community supports without 232.24participating in a complete assessment. Upon a request for assistance identifying 232.25community support, the person must be transferred or referred to the services available 232.26under sections 
         256.975, subdivision 7, and 
         256.01, subdivision 24, for telephone 232.27assistance and follow up.232.28    (g) The person has the right to make the final decision between institutional 232.29placement and community placement after the recommendations have been provided, 232.30except as provided in subdivision 4a, paragraph (c).232.31    (h) The team must give the person receiving assessment or support planning, or 232.32the person's legal representative, materials, and forms supplied by the commissioner 232.33containing the following information:232.34    (1) the need for and purpose of preadmission screening if the person selects nursing 232.35facility placement;233.1    (2) the role of the long-term care consultation assessment and support planning in 233.2waiver and alternative care program eligibility determination;233.3    (3) information about Minnesota health care programs;233.4    (4) the person's freedom to accept or reject the recommendations of the team;233.5    (5) the person's right to confidentiality under the Minnesota Government Data 233.6Practices Act, chapter 13;233.7    (6) the long-term care consultant's decision regarding the person's need for 233.8institutional level of care as determined under criteria established in section 
         144.0724, 233.9subdivision 11
         , or 
         256B.092; and233.10(7) the person's right to appeal the decision regarding the need for nursing facility 233.11level of care or the county's final decisions regarding public programs eligibility according 233.12to section 
         256.045, subdivision 3.233.13    (i) Face-to-face assessment completed as part of eligibility determination for 233.14the alternative care, elderly waiver, community alternatives for disabled individuals, 233.15community alternative care, and traumatic brain injury waiver programs under sections 233.16256B.0915
         , 
         256B.0917, and 
         256B.49 is valid to establish service eligibility for no more 233.17than 60 calendar days after the date of assessment. The effective eligibility start date 233.18for these programs can never be prior to the date of assessment. If an assessment was 233.19completed more than 60 days before the effective waiver or alternative care program 233.20eligibility start date, assessment and support plan information must be updated in a233.21face-to-face visit and documented in the department's Medicaid Management Information 233.22System (MMIS). The updated assessment may be completed by face-to-face visit, written 233.23communication, or telephone as determined by the commissioner to establish statewide 233.24consistency. The effective date of program eligibility in this case cannot be prior to the 233.25date the updated assessment is completed.233.26EFFECTIVE DATE.This section is effective January 1, 2012.233.27    Sec. 15. Minnesota Statutes 2010, section 256B.0911, subdivision 4a, is amended to 233.28read:233.29    Subd. 4a. Preadmission screening activities related to nursing facility 233.30admissions. (a) All applicants to Medicaid certified nursing facilities, including certified 233.31boarding care facilities, must be screened prior to admission regardless of income, assets, 233.32or funding sources for nursing facility care, except as described in subdivision 4b. The 233.33purpose of the screening is to determine the need for nursing facility level of care as 233.34described in paragraph (d) and to complete activities required under federal law related to 233.35mental illness and developmental disability as outlined in paragraph (b).234.1(b) A person who has a diagnosis or possible diagnosis of mental illness or 234.2developmental disability must receive a preadmission screening before admission 234.3regardless of the exemptions outlined in subdivision 4b, paragraph (b), to identify the need 234.4for further evaluation and specialized services, unless the admission prior to screening is 234.5authorized by the local mental health authority or the local developmental disabilities case 234.6manager, or unless authorized by the county agency according to Public Law 101-508.234.7The following criteria apply to the preadmission screening:234.8(1) the county must use forms and criteria developed by the commissioner to identify 234.9persons who require referral for further evaluation and determination of the need for 234.10specialized services; and234.11(2) the evaluation and determination of the need for specialized services must be 234.12done by:234.13(i) a qualified independent mental health professional, for persons with a primary or 234.14secondary diagnosis of a serious mental illness; or234.15(ii) a qualified developmental disability professional, for persons with a primary or 234.16secondary diagnosis of developmental disability. For purposes of this requirement, a 234.17qualified developmental disability professional must meet the standards for a qualified 234.18developmental disability professional under Code of Federal Regulations, title 42, section 234.19483.430.234.20(c) The local county mental health authority or the state developmental disability 234.21authority under Public Law Numbers 100-203 and 101-508 may prohibit admission to a 234.22nursing facility if the individual does not meet the nursing facility level of care criteria or 234.23needs specialized services as defined in Public Law Numbers 100-203 and 101-508. For 234.24purposes of this section, "specialized services" for a person with developmental disability 234.25means active treatment as that term is defined under Code of Federal Regulations, title 234.2642, section 483.440 (a)(1).234.27(d) The determination of the need for nursing facility level of care must be made 234.28according to criteria established developed by the commissioner, and in section 
         144.0724, 234.29subdivision 11, and256B.092, using forms developed by the commissioner. Effective no 234.30sooner than on or after January 1, 2014, for individuals age 21 and older, and on or after 234.31October 1, 2019, for individuals under age 21, the determination of need for nursing 234.32facility level of care shall be based on criteria in section 144.0724, subdivision 11. In 234.33assessing a person's needs, consultation team members shall have a physician available for 234.34consultation and shall consider the assessment of the individual's attending physician, if 234.35any. The individual's physician must be included if the physician chooses to participate. 234.36Other personnel may be included on the team as deemed appropriate by the county.235.1    Sec. 16. Minnesota Statutes 2010, section 256B.0911, subdivision 6, is amended to 235.2read:235.3    Subd. 6. Payment for long-term care consultation services. (a) Seventy-five 235.4percent of the total payment for each county must be paid monthly by certified nursing 235.5facilities in the county. The monthly amount to be paid by each nursing facility for each 235.6fiscal year must be determined by dividing the county's annual allocation for long-term 235.7care consultation services by 12 to determine the monthly payment and allocating the 235.8monthly payment to each nursing facility based on the number of licensed beds in the 235.9nursing facility. Payments to counties in which there is no certified nursing facility must be 235.10made by increasing the payment rate of the two facilities located nearest to the county seat.235.11    (b) The commissioner shall include the total annual payment determined under 235.12paragraph (a) for each nursing facility reimbursed under section 
         256B.431 or 
         256B.434 235.13according to section 
         256B.431, subdivision 2b, paragraph (g).235.14    (c) In the event of the layaway, delicensure and decertification, or removal from 235.15layaway of 25 percent or more of the beds in a facility, the commissioner may adjust 235.16the per diem payment amount in paragraph (b) and may adjust the monthly payment 235.17amount in paragraph (a). The effective date of an adjustment made under this paragraph 235.18shall be on or after the first day of the month following the effective date of the layaway, 235.19delicensure and decertification, or removal from layaway.235.20    (d) Payments for long-term care consultation services are available to the county 235.21or counties to cover staff salaries and expenses to provide the services described in 235.22subdivision 1a. The county shall employ, or contract with other agencies to employ, within 235.23the limits of available funding, sufficient personnel to provide long-term care consultation 235.24services while meeting the state's long-term care outcomes and objectives as defined in 235.25section 
         256B.0917, subdivision 1. The county shall be accountable for meeting local 235.26objectives as approved by the commissioner in the biennial home and community-based 235.27services quality assurance plan on a form provided by the commissioner.235.28    (e) Notwithstanding section 
         256B.0641, overpayments attributable to payment of the 235.29screening costs under the medical assistance program may not be recovered from a facility.235.30    (f) The commissioner of human services shall amend the Minnesota medical 235.31assistance plan to include reimbursement for the local consultation teams.235.32    (g) The county may bill, as case management services, assessments, support 235.33planning, and follow-along provided to persons determined to be eligible for case 235.34management under Minnesota health care programs. No individual or family member 235.35shall be charged for an initial assessment or initial support plan development provided 235.36under subdivision 3a or 3b. Counties may set a fee schedule for initial assessments and 236.1support plan development for individuals who are not financially eligible for medical 236.2assistance or MinnesotaCare. The maximum fee must not be greater than the actual cost 236.3of the initial assessment and support plan development.236.4(h) The commissioner shall develop an alternative payment methodology for 236.5long-term care consultation services that includes the funding available under this 236.6subdivision, and sections 
         256B.092 and 
         256B.0659. In developing the new payment 236.7methodology, the commissioner shall consider the maximization of federal funding for 236.8this activity.236.9    Sec. 17. Minnesota Statutes 2010, section 256B.0913, subdivision 4, is amended to 236.10read:236.11    Subd. 4. Eligibility for funding for services for nonmedical assistance recipients.236.12    (a) Funding for services under the alternative care program is available to persons who 236.13meet the following criteria:236.14    (1) the person has been determined by a community assessment under section 236.15256B.0911
          to be a person who would require the level of care provided in a nursing 236.16facility, as determined under section 256B.0911, subdivision 4a, paragraph (d), but for 236.17the provision of services under the alternative care program. Effective January 1, 2011, 236.18this determination must be made according to the criteria established in section 144.0724, 236.19subdivision 11;236.20    (2) the person is age 65 or older;236.21    (3) the person would be eligible for medical assistance within 135 days of admission 236.22to a nursing facility;236.23    (4) the person is not ineligible for the payment of long-term care services by the 236.24medical assistance program due to an asset transfer penalty under section 
         256B.0595 or 236.25equity interest in the home exceeding $500,000 as stated in section 
         256B.056;236.26    (5) the person needs long-term care services that are not funded through other 236.27state or federal funding, or other health insurance or other third-party insurance such as 236.28long-term care insurance;236.29    (6) except for individuals described in clause (7), the monthly cost of the alternative 236.30care services funded by the program for this person does not exceed 75 percent of the 236.31monthly limit described under section 
         256B.0915, subdivision 3a. This monthly limit 236.32does not prohibit the alternative care client from payment for additional services, but in no 236.33case may the cost of additional services purchased under this section exceed the difference 236.34between the client's monthly service limit defined under section 
         256B.0915, subdivision 236.353
         , and the alternative care program monthly service limit defined in this paragraph. If 237.1care-related supplies and equipment or environmental modifications and adaptations are or 237.2will be purchased for an alternative care services recipient, the costs may be prorated on a 237.3monthly basis for up to 12 consecutive months beginning with the month of purchase. 237.4If the monthly cost of a recipient's other alternative care services exceeds the monthly 237.5limit established in this paragraph, the annual cost of the alternative care services shall be 237.6determined. In this event, the annual cost of alternative care services shall not exceed 12 237.7times the monthly limit described in this paragraph;237.8    (7) for individuals assigned a case mix classification A as described under section 237.9256B.0915, subdivision 3a
         , paragraph (a), with (i) no dependencies in activities of daily 237.10living, or (ii) only one dependency up to two dependencies in bathing, dressing, grooming, 237.11or walking, or (iii) a dependency score of less than three if eating is the only dependency237.12and eating when the dependency score in eating is three or greater as determined by 237.13an assessment performed under section 
         256B.0911, the monthly cost of alternative 237.14care services funded by the program cannot exceed $600 $593 per month for all new 237.15participants enrolled in the program on or after July 1, 2009 2011. This monthly limit 237.16shall be applied to all other participants who meet this criteria at reassessment. This 237.17monthly limit shall be increased annually as described in section 
         256B.0915, subdivision 237.183a
         , paragraph (a). This monthly limit does not prohibit the alternative care client from 237.19payment for additional services, but in no case may the cost of additional services 237.20purchased exceed the difference between the client's monthly service limit defined in this 237.21clause and the limit described in clause (6) for case mix classification A; and237.22(8) the person is making timely payments of the assessed monthly fee.237.23A person is ineligible if payment of the fee is over 60 days past due, unless the person 237.24agrees to:237.25    (i) the appointment of a representative payee;237.26    (ii) automatic payment from a financial account;237.27    (iii) the establishment of greater family involvement in the financial management of 237.28payments; or237.29    (iv) another method acceptable to the lead agency to ensure prompt fee payments.237.30    The lead agency may extend the client's eligibility as necessary while making 237.31arrangements to facilitate payment of past-due amounts and future premium payments. 237.32Following disenrollment due to nonpayment of a monthly fee, eligibility shall not be 237.33reinstated for a period of 30 days.237.34    (b) Alternative care funding under this subdivision is not available for a person 237.35who is a medical assistance recipient or who would be eligible for medical assistance 237.36without a spenddown or waiver obligation. A person whose initial application for medical 238.1assistance and the elderly waiver program is being processed may be served under the 238.2alternative care program for a period up to 60 days. If the individual is found to be eligible 238.3for medical assistance, medical assistance must be billed for services payable under the 238.4federally approved elderly waiver plan and delivered from the date the individual was 238.5found eligible for the federally approved elderly waiver plan. Notwithstanding this 238.6provision, alternative care funds may not be used to pay for any service the cost of which: 238.7(i) is payable by medical assistance; (ii) is used by a recipient to meet a waiver obligation; 238.8or (iii) is used to pay a medical assistance income spenddown for a person who is eligible 238.9to participate in the federally approved elderly waiver program under the special income 238.10standard provision.238.11    (c) Alternative care funding is not available for a person who resides in a licensed 238.12nursing home, certified boarding care home, hospital, or intermediate care facility, except 238.13for case management services which are provided in support of the discharge planning 238.14process for a nursing home resident or certified boarding care home resident to assist with 238.15a relocation process to a community-based setting.238.16    (d) Alternative care funding is not available for a person whose income is greater 238.17than the maintenance needs allowance under section 
         256B.0915, subdivision 1d, but equal 238.18to or less than 120 percent of the federal poverty guideline effective July 1 in the fiscal 238.19year for which alternative care eligibility is determined, who would be eligible for the 238.20elderly waiver with a waiver obligation.238.21    Sec. 18. Minnesota Statutes 2010, section 256B.0915, subdivision 3a, is amended to 238.22read:238.23    Subd. 3a. Elderly waiver cost limits. (a) The monthly limit for the cost of 238.24waivered services to an individual elderly waiver client except for individuals described 238.25in paragraph (b) shall be the weighted average monthly nursing facility rate of the case 238.26mix resident class to which the elderly waiver client would be assigned under Minnesota 238.27Rules, parts 9549.0050 to 9549.0059, less the recipient's maintenance needs allowance 238.28as described in subdivision 1d, paragraph (a), until the first day of the state fiscal year in 238.29which the resident assessment system as described in section 
         256B.438 for nursing home 238.30rate determination is implemented. Effective on the first day of the state fiscal year in 238.31which the resident assessment system as described in section 
         256B.438 for nursing home 238.32rate determination is implemented and the first day of each subsequent state fiscal year, the 238.33monthly limit for the cost of waivered services to an individual elderly waiver client shall 238.34be the rate of the case mix resident class to which the waiver client would be assigned 238.35under Minnesota Rules, parts 9549.0050 to 9549.0059, in effect on the last day of the 239.1previous state fiscal year, adjusted by the greater of any legislatively adopted home and 239.2community-based services percentage rate increase or the average statewide percentage 239.3increase in nursing facility payment rates adjustment.239.4    (b) The monthly limit for the cost of waivered services to an individual elderly 239.5waiver client assigned to a case mix classification A under paragraph (a) with:239.6(1) no dependencies in activities of daily living,; or239.7(2) only one dependency up to two dependencies in bathing, dressing, grooming, or239.8walking, or (3) a dependency score of less than three if eating is the only dependency,239.9and eating when the dependency score in eating is three or greater as determined by an 239.10assessment performed under section 256B.0911239.11 shall be the lower of the case mix classification amount for case mix A as determined 239.12under paragraph (a) or the case mix classification amount for case mix A$1,750 per 239.13month effective on October July 1, 2008 2011, per month for all new participants enrolled 239.14in the program on or after July 1, 2009 2011. This monthly limit shall be applied to all 239.15other participants who meet this criteria at reassessment. This monthly limit shall be 239.16increased annually as described in paragraph (a).239.17(c) If extended medical supplies and equipment or environmental modifications are 239.18or will be purchased for an elderly waiver client, the costs may be prorated for up to 239.1912 consecutive months beginning with the month of purchase. If the monthly cost of a 239.20recipient's waivered services exceeds the monthly limit established in paragraph (a) or 239.21(b), the annual cost of all waivered services shall be determined. In this event, the annual 239.22cost of all waivered services shall not exceed 12 times the monthly limit of waivered 239.23services as described in paragraph (a) or (b).239.24    Sec. 19. Minnesota Statutes 2010, section 256B.0915, subdivision 3b, is amended to 239.25read:239.26    Subd. 3b. Cost limits for elderly waiver applicants who reside in a nursing 239.27facility. (a) For a person who is a nursing facility resident at the time of requesting a 239.28determination of eligibility for elderly waivered services, a monthly conversion budget 239.29limit for the cost of elderly waivered services may be requested. The monthly conversion 239.30budget limit for the cost of elderly waiver services shall be the resident class assigned 239.31under Minnesota Rules, parts 9549.0050 to 9549.0059, for that resident in the nursing 239.32facility where the resident currently resides until July 1 of the state fiscal year in which 239.33the resident assessment system as described in section 
         256B.438 for nursing home rate 239.34determination is implemented. Effective on July 1 of the state fiscal year in which the 239.35resident assessment system as described in section 
         256B.438 for nursing home rate 240.1determination is implemented, the monthly conversion budget limit for the cost of elderly 240.2waiver services shall be based on the per diem nursing facility rate as determined by the 240.3resident assessment system as described in section 
         256B.438 for that resident residents240.4in the nursing facility where the resident elderly waiver applicant currently resides 240.5multiplied. The monthly conversion budget limit shall be calculated by multiplying the 240.6per diem by 365 and,  divided by 12, less and reduced by  the recipient's maintenance needs 240.7allowance as described in subdivision 1d. The initially approved monthly conversion rate 240.8may budget limit shall be adjusted by the greater of any subsequent legislatively adopted 240.9home and community-based services percentage rate increase or the average statewide 240.10percentage increase in nursing facility payment rates annually as described in subdivision 240.113a, paragraph (a). The limit under this subdivision only applies to persons discharged from 240.12a nursing facility after a minimum 30-day stay and found eligible for waivered services 240.13on or after July 1, 1997. For conversions from the nursing home to the elderly waiver 240.14with consumer directed community support services, the conversion rate limit is equal to 240.15the nursing facility rate per diem used to calculate the monthly conversion budget limit 240.16must be reduced by a percentage equal to the percentage difference between the consumer 240.17directed services budget limit that would be assigned according to the federally approved 240.18waiver plan and the corresponding community case mix cap, but not to exceed 50 percent.240.19    (b) The following costs must be included in determining the total monthly costs 240.20for the waiver client:240.21    (1) cost of all waivered services, including extended medical specialized supplies 240.22and equipment and environmental modifications and accessibility adaptations; and240.23    (2) cost of skilled nursing, home health aide, and personal care services reimbursable 240.24by medical assistance.240.25    Sec. 20. Minnesota Statutes 2010, section 256B.0915, subdivision 3e, is amended to 240.26read:240.27    Subd. 3e. Customized living service rate. (a) Payment for customized living 240.28services shall be a monthly rate authorized by the lead agency within the parameters 240.29established by the commissioner. The payment agreement must delineate the amount of 240.30each component service included in the recipient's customized living service plan. The 240.31lead agency shall ensure that there is a documented need within the parameters established 240.32by the commissioner for all component customized living services authorized.240.33(b) The payment rate must be based on the amount of component services to be 240.34provided utilizing component rates established by the commissioner. Counties and tribes 241.1shall use tools issued by the commissioner to develop and document customized living 241.2service plans and rates.241.3(c) Component service rates must not exceed payment rates for comparable elderly 241.4waiver or medical assistance services and must reflect economies of scale. Customized 241.5living services must not include rent or raw food costs.241.6    (d) With the exception of individuals described in subdivision 3a, paragraph (b), the 241.7individualized monthly authorized payment for the customized living service plan shall 241.8not exceed 50 percent of the greater of either the statewide or any of the geographic 241.9groups' weighted average monthly nursing facility rate of the case mix resident class 241.10to which the elderly waiver eligible client would be assigned under Minnesota Rules, 241.11parts 9549.0050 to 9549.0059, less the maintenance needs allowance as described 241.12in subdivision 1d, paragraph (a), until the July 1 of the state fiscal year in which the 241.13resident assessment system as described in section 
         256B.438 for nursing home rate 241.14determination is implemented. Effective on July 1 of the state fiscal year in which 241.15the resident assessment system as described in section 
         256B.438 for nursing home 241.16rate determination is implemented and July 1 of each subsequent state fiscal year, the 241.17individualized monthly authorized payment for the services described in this clause shall 241.18not exceed the limit which was in effect on June 30 of the previous state fiscal year 241.19updated annually based on legislatively adopted changes to all service rate maximums for 241.20home and community-based service providers.241.21(e) Effective July 1, 2011, the individualized monthly payment for the customized 241.22living service plan for individuals described in subdivision 3a, paragraph (b), must be the 241.23monthly authorized payment limit for customized living for individuals classified as case 241.24mix A, reduced by 25 percent. This rate limit must be applied to all new participants 241.25enrolled in the program on or after July 1, 2011, who meet the criteria described in 241.26subdivision 3a, paragraph (b). This monthly limit also applies to all other participants who 241.27meet the criteria described in subdivision 3a, paragraph (b), at reassessment.241.28    (e) (f) Customized living services are delivered by a provider licensed by the 241.29Department of Health as a class A or class F home care provider and provided in a 241.30building that is registered as a housing with services establishment under chapter 144D.241.31Licensed home care providers are subject to section 256B.0651, subdivision 14.241.32(g) A provider may not bill or otherwise charge an elderly waiver participant or their 241.33family for additional units of any allowable component service beyond those available 241.34under the service rate limits described in paragraph (d), nor for additional units of any 241.35allowable component service beyond those approved in the service plan by the lead agency.242.1    Sec. 21. Minnesota Statutes 2010, section 256B.0915, subdivision 3h, is amended to 242.2read:242.3    Subd. 3h. Service rate limits; 24-hour customized living services. (a) The 242.4payment rate for 24-hour customized living services is a monthly rate authorized by the 242.5lead agency within the parameters established by the commissioner of human services. 242.6The payment agreement must delineate the amount of each component service included in 242.7each recipient's customized living service plan. The lead agency shall ensure that there is a 242.8documented need within the parameters established by the commissioner for all component 242.9customized living services authorized. The lead agency shall not authorize 24-hour 242.10customized living services unless there is a documented need for 24-hour supervision.242.11(b) For purposes of this section, "24-hour supervision" means that the recipient 242.12requires assistance due to needs related to one or more of the following:242.13    (1) intermittent assistance with toileting, positioning, or transferring;242.14    (2) cognitive or behavioral issues;242.15    (3) a medical condition that requires clinical monitoring; or242.16    (4) for all new participants enrolled in the program on or after January July 1, 2011, 242.17and all other participants at their first reassessment after January July 1, 2011, dependency 242.18in at least two three of the following activities of daily living as determined by assessment 242.19under section 
         256B.0911: bathing; dressing; grooming; walking; or eating when the 242.20dependency score in eating is three or greater; and needs medication management and at 242.21least 50 hours of service per month. The lead agency shall ensure that the frequency and 242.22mode of supervision of the recipient and the qualifications of staff providing supervision 242.23are described and meet the needs of the recipient.242.24(c) The payment rate for 24-hour customized living services must be based on the 242.25amount of component services to be provided utilizing component rates established by the 242.26commissioner. Counties and tribes will use tools issued by the commissioner to develop 242.27and document customized living plans and authorize rates.242.28(d) Component service rates must not exceed payment rates for comparable elderly 242.29waiver or medical assistance services and must reflect economies of scale.242.30(e) The individually authorized 24-hour customized living payments, in combination 242.31with the payment for other elderly waiver services, including case management, must not 242.32exceed the recipient's community budget cap specified in subdivision 3a. Customized 242.33living services must not include rent or raw food costs.242.34(f) The individually authorized 24-hour customized living payment rates shall not 242.35exceed the 95 percentile of statewide monthly authorizations for 24-hour customized 242.36living services in effect and in the Medicaid management information systems on March 243.131, 2009, for each case mix resident class under Minnesota Rules, parts 9549.0050 243.2to 9549.0059, to which elderly waiver service clients are assigned. When there are 243.3fewer than 50 authorizations in effect in the case mix resident class, the commissioner 243.4shall multiply the calculated service payment rate maximum for the A classification by 243.5the standard weight for that classification under Minnesota Rules, parts 9549.0050 to 243.69549.0059, to determine the applicable payment rate maximum. Service payment rate 243.7maximums shall be updated annually based on legislatively adopted changes to all service 243.8rates for home and community-based service providers.243.9    (g) Notwithstanding the requirements of paragraphs (d) and (f), the commissioner 243.10may establish alternative payment rate systems for 24-hour customized living services in 243.11housing with services establishments which are freestanding buildings with a capacity of 243.1216 or fewer, by applying a single hourly rate for covered component services provided 243.13in either:243.14    (1) licensed corporate adult foster homes; or243.15    (2) specialized dementia care units which meet the requirements of section 
         144D.065 243.16and in which:243.17    (i) each resident is offered the option of having their own apartment; or243.18    (ii) the units are licensed as board and lodge establishments with maximum capacity 243.19of eight residents, and which meet the requirements of Minnesota Rules, part 9555.6205, 243.20subparts 1, 2, 3, and 4, item A.243.21(h) A provider may not bill or otherwise charge an elderly waiver participant or their 243.22family for additional units of any allowable component service beyond those available 243.23under the service rate limits described in paragraph (e), nor for additional units of any 243.24allowable component service beyond those approved in the service plan by the lead agency.243.25    Sec. 22. Minnesota Statutes 2010, section 256B.0915, subdivision 5, is amended to 243.26read:243.27    Subd. 5. Assessments and reassessments for waiver clients. (a) Each client 243.28shall receive an initial assessment of strengths, informal supports, and need for services 243.29in accordance with section 
         256B.0911, subdivisions 3, 3a, and 3b. A reassessment of a 243.30client served under the elderly waiver must be conducted at least every 12 months and 243.31at other times when the case manager determines that there has been significant change 243.32in the client's functioning. This may include instances where the client is discharged 243.33from the hospital. There must be a determination that the client requires nursing facility 243.34level of care as defined in section 
         144.0724, subdivision 11 256B.0911, subdivision 4a, 244.1paragraph (d), at initial and subsequent assessments to initiate and maintain participation 244.2in the waiver program.244.3(b) Regardless of other assessments identified in section 
         144.0724, subdivision 244.44, as appropriate to determine nursing facility level of care for purposes of medical 244.5assistance payment for nursing facility services, only face-to-face assessments conducted 244.6according to section 
         256B.0911, subdivisions 3a and 3b, that result in a nursing facility 244.7level of care determination will be accepted for purposes of initial and ongoing access to 244.8waiver service payment.244.9    Sec. 23. Minnesota Statutes 2010, section 256B.0915, subdivision 10, is amended to 244.10read:244.11    Subd. 10. Waiver payment rates; managed care organizations. The 244.12commissioner shall adjust the elderly waiver capitation payment rates for managed care 244.13organizations paid under section 
         256B.69, subdivisions 6a and 23, to reflect the maximum 244.14service rate limits for customized living services and 24-hour customized living services 244.15under subdivisions 3e and 3h for the contract period beginning October 1, 2009. Medical 244.16assistance rates paid to customized living providers by managed care organizations under 244.17this section shall not exceed the maximum service rate limits and component rates as 244.18determined by the commissioner under subdivisions 3e and 3h.244.19    Sec. 24. Minnesota Statutes 2010, section 256B.0916, subdivision 6a, is amended to 244.20read:244.21    Subd. 6a. Statewide availability of consumer-directed community self-directed 244.22 support services. (a) The commissioner shall submit to the federal Health Care Financing 244.23Administration by August 1, 2001, an amendment to the home and community-based 244.24waiver for persons with developmental disabilities under section 256B.092 and by April 1, 244.252005, for waivers under sections 256B.0915 and 256B.49,  to make consumer-directed 244.26community self-directed support services available in every county of the state by January 244.271, 2002.244.28(b) Until the waiver amendment for self-directed community supports under 244.29section 51 is effective, if a county declines to meet the requirements for provision of 244.30consumer-directed communityself-directed supports, the commissioner shall contract 244.31with another county, a group of counties, or a private agency to plan for and administer 244.32consumer-directed community self-directed  supports in that county.244.33(c) The state of Minnesota, county agencies, tribal governments, or administrative 244.34entities under contract to participate in the implementation and administration of the home 245.1and community-based waiver for persons with developmental disabilities, shall not be 245.2liable for damages, injuries, or liabilities sustained through the purchase of support by the 245.3individual, the individual's family, legal representative, or the authorized representative 245.4with funds received through the consumer-directed community self-directed support 245.5service under this section. Liabilities include but are not limited to: workers' compensation 245.6liability, the Federal Insurance Contributions Act (FICA), or the Federal Unemployment 245.7Tax Act (FUTA).245.8EFFECTIVE DATE.This section is effective July 1, 2011.245.9    Sec. 25. Minnesota Statutes 2010, section 256B.092, subdivision 1a, is amended to 245.10read:245.11    Subd. 1a. Case management administration and services. (a) The administrative 245.12functions of case management provided to or arranged for a person include:245.13(1) review of eligibility for services;245.14(2) screening;245.15(3) intake;245.16(4) diagnosis;245.17(5) the review and authorization of services based upon an individualized service 245.18plan; and245.19(6) responding to requests for conciliation conferences and appeals according 245.20to section 256.045 made by the person, the person's legal guardian or conservator, or 245.21the parent if the person is a minor. Case management services must be provided by a 245.22public or private agency that is enrolled as a medical assistance provider determined by 245.23the commissioner to meet all of the requirements in the approved federal waiver plans. 245.24Case management services cannot be provided to a recipient by a private agency that has 245.25any financial interest in the provisions of any other services included in the recipient's 245.26coordinated service and support plan.245.27(b) Case management service activities provided to or arranged for a person include245.28services must be provided to each recipient of home and community-based waiver 245.29services and available to those eligible for case management under sections 256B.0621 245.30and 256B.0924, subdivision 4, who choose this service. Case management services for an 245.31eligible person include:245.32(1) development of the individualcoordinated service and support plan;245.33(2) informing the individual or the individual's legal guardian or conservator, or 245.34parent if the person is a minor, of service options;245.35(3) consulting with relevant medical experts or service providers;246.1(4) assisting the person in the identification of potential providers;246.2(5) assisting the person to access services;246.3(6) coordination of services, including coordinating with the person's health care 246.4home or health coordinator, if coordination of long-term care or community supports and 246.5health care is not provided by another service provider;246.6(7) evaluation and monitoring of the services identified in the plan including at least 246.7one face-to-face visit with each person annually by the case manager; and246.8(8) annual reviews of service plans and services provided providing the lead agency 246.9with recommendations for service authorization based upon the individual's needs 246.10identified in the support plan within ten working days after receiving the community 246.11support plan from the certified assessor under section 256B.0911.246.12(c) Case management administration and service activities that are provided to the 246.13person with a developmental disability shall be provided directly by county agencies or 246.14under contract a public or private agency that is enrolled as a medical assistance provider 246.15determined by the commissioner to meet all of the requirements in section 256B.0621, 246.16subdivision 5, paragraphs (a) and (b), clauses (1) to (5), and has no financial interest in the 246.17provision of any other services to the person choosing case management service.246.18(d) Case managers are responsible for the administrative duties and service 246.19provisions listed in paragraphs (a) and (b). Case managers shall collaborate with 246.20consumers, families, legal representatives, and relevant medical experts and service 246.21providers in the development and annual review of the individualized service and 246.22habilitation plans.246.23(e) The Department of Human Services shall offer ongoing education in case 246.24management to case managers. Case managers shall receive no less than ten hours of case 246.25management education and disability-related training each year.246.26(f) Persons eligible for home and community-based waiver services may choose a 246.27case management service provider from among the public or private vendors enrolled 246.28according to paragraph (d).246.29(g) For persons eligible for case management under section 256B.0924, and 246.30Minnesota Rules, parts 9525.0004 to 9525.0036, the county or lead agency shall designate 246.31the case management service provider.246.32EFFECTIVE DATE.This section is effective January 1, 2013, except subdivision 246.331a, paragraph (b), clause (6), is effective July 1, 2011.246.34    Sec. 26. Minnesota Statutes 2010, section 256B.092, subdivision 1b, is amended to 246.35read:247.1    Subd. 1b. Individual Coordinated service and support plan.The individualEach 247.2recipient of case management services and any legal representative shall be provided a 247.3written copy of the coordinated service  and support plan must, which:247.4(1) includeis developed within ten working days after the case management service 247.5receives the community support plan from the certified assessor under section 256B.0911;247.6(2) includes the results of the assessment information on the person's need for 247.7service, including identification of service needs that will be or that are met by the person's 247.8relatives, friends, and others, as well as community services used by the general public;247.9(3) reasonably assures the health, safety, and welfare of the recipient;247.10(2) identify(4) identifies the person's preferences for services as stated by the person, 247.11the person's legal guardian or conservator, or the parent if the person is a minor;247.12(5) provides for an informed choice, as defined in section 256B.77, subdivision 2, 247.13paragraph (o), of service and support providers;247.14(3) identify(6) identifies long- and short-range goals for the person;247.15(4) identify (7) identifies specific services and the amount and frequency of the 247.16services to be provided to the person based on assessed needs, preferences, and available 247.17resources. The individual service plan shall also specify other services the person needs 247.18that are not available, and other services the person needs that are not available. The 247.19individual coordinated service and support plan shall also specify service outcomes and 247.20the provider's responsibility to monitor the achievement of the service outcomes;247.21(5) identify (8) identifies the need for an individual programindividual's provider 247.22plan to be developed by the provider according to the respective state and federal licensing 247.23and certification standards, and additional assessments to be completed or arranged by the 247.24provider after service initiation;247.25(6) identify (9) identifies provider responsibilities to implement and make 247.26recommendations for modification to the individualcoordinated service and support plan;247.27(7) include(10) includes notice of the right to have assessments completed and 247.28service plans developed within specified time periods, the right to appeal action or 247.29inaction, and the right to request a conciliation conference or a hearing an appeal under 247.30section 
         256.045;247.31(8) be (11) is agreed upon and signed by the person, the person's legal guardian 247.32or conservator, or the parent if the person is a minor, and the authorized county 247.33representative; and247.34(9) be (12) is reviewed by a health professional if the person has overriding medical 247.35needs that impact the delivery of services.248.1Service planning formats developed for interagency planning such as transition, 248.2vocational, and individual family service plans may be substituted for service planning 248.3formats developed by county agencies.248.4EFFECTIVE DATE.This section is effective January 1, 2013.248.5    Sec. 27. Minnesota Statutes 2010, section 256B.092, subdivision 1e, is amended to 248.6read:248.7    Subd. 1e. Case management service monitoring, coordination, and evaluation, 248.8and monitoring of services duties. (a) If the individualcoordinated service and support 248.9plan identifies the need for individual programprovider plans for authorized services, 248.10the case managermanagement service provider shall assure that individual programthe 248.11individual provider plans are developed by the providers according to clauses (2) to (5). 248.12The providers shall assure that the individual programprovider plans:248.13(1) are developed according to the respective state and federal licensing and 248.14certification requirements;248.15(2) are designed to achieve the goals of the individual service plan;248.16(3) are consistent with other aspects of the individualcoordinated service and 248.17support plan;248.18(4) assure the health and safety of the person; and248.19(5) are developed with consistent and coordinated approaches to services and service 248.20outcomes among the various service providers.248.21(b) The case managermanagement service provider shall monitor the provision of 248.22services:248.23(1) to assure that the individual service plan is being followed according to 248.24paragraph (a);248.25(2) to identify any changes or modifications that might be needed in the individual 248.26service plan, including changes resulting from recommendations of current service 248.27providers;248.28(3) to determine if the person's legal rights are protected, and if not, notify the 248.29person's legal guardian or conservator, or the parent if the person is a minor, protection 248.30services, or licensing agencies as appropriate; and248.31(4) to determine if the person, the person's legal guardian or conservator, or the 248.32parent if the person is a minor, is satisfied with the services provided.248.33(c) If the provider fails to develop or carry out the individual program provider plan 248.34according to paragraph (a), the case manager shall notify the person's legal guardian or 248.35conservator, or the parent if the person is a minor, the provider, the respective licensing 249.1and certification agencies, and the county board where the services are being provided. In 249.2addition, the case manager shall identify other steps needed to assure the person receives 249.3the services identified in the individualcoordinated service and support plan.249.4EFFECTIVE DATE.This section is effective January 1, 2012.249.5    Sec. 28. Minnesota Statutes 2010, section 256B.092, subdivision 1g, is amended to 249.6read:249.7    Subd. 1g. Conditions not requiring development of individuala coordinated 249.8service and support plan. Unless otherwise required by federal law, the county agency is 249.9not required to complete an individual a coordinated service and support plan as defined in 249.10subdivision 1b for:249.11(1) persons whose families are requesting respite care for their family member who 249.12resides with them, or whose families are requesting a family support grant and are not 249.13requesting purchase or arrangement of habilitative services; and249.14(2) persons with developmental disabilities, living independently without authorized 249.15services or receiving funding for services at a rehabilitation facility as defined in section 249.16268A.01, subdivision 6
         , and not in need of or requesting additional services.249.17EFFECTIVE DATE.This section is effective January 1, 2012.249.18    Sec. 29. Minnesota Statutes 2010, section 256B.092, subdivision 3, is amended to read:249.19    Subd. 3. Authorization and termination of services.County agency case 249.20managers Lead agencies, under rules of the commissioner, shall authorize and terminate 249.21services of community and regional treatment center providers according to individual249.22coordinated  service and support plans. Services provided to persons with developmental 249.23disabilities may only be authorized and terminated by case managers according to (1) 249.24rules of the commissioner and (2) the individualcoordinated service and support plan as 249.25defined in subdivision 1b. Medical assistance services not needed shall not be authorized 249.26by county agencies or funded by the commissioner. When purchasing or arranging for 249.27unlicensed respite care services for persons with overriding health needs, the county 249.28agency shall seek the advice of a health care professional in assessing provider staff 249.29training needs and skills necessary to meet the medical needs of the person.249.30EFFECTIVE DATE.This section is effective January 1, 2012.249.31    Sec. 30. Minnesota Statutes 2010, section 256B.092, subdivision 8, is amended to read:250.1    Subd. 8. Screening teamAdditional certified assessor duties. The screening team250.2certified assessor shall:250.3(1) review diagnostic data;250.4(2) review health, social, and developmental assessment data using a uniform 250.5screeningcomprehensive assessment tool specified by the commissioner;250.6(3) identify the level of services appropriate to maintain the person in the most 250.7normal and least restrictive setting that is consistent with the person's treatment needs;250.8(4) identify other noninstitutional public assistance or social service that may prevent 250.9or delay long-term residential placement;250.10(5) assess whether a person is in need of long-term residential care;250.11(6) make recommendations regarding placementservices and payment for: (i) social 250.12service or public assistance support, or both, to maintain a person in the person's own home 250.13or other place of residence; (ii) training and habilitation service, vocational rehabilitation, 250.14and employment training activities; (iii) community residential placement services; (iv) 250.15regional treatment center placement; or (v) (iv)  a home and community-based service 250.16alternative to community residential placement or regional treatment center placement;250.17(7) evaluate the availability, location, and quality of the services listed in clause 250.18(6), including the impact of placement alternativesservices and supports options on the 250.19person's ability to maintain or improve existing patterns of contact and involvement with 250.20parents and other family members;250.21(8) identify the cost implications of recommendations in clause (6) and provide 250.22written notice of the annual and monthly average authorized amount to be spent for 250.23services for the recipient;250.24(9) make recommendations to a court as may be needed to assist the court in making 250.25decisions regarding commitment of persons with developmental disabilities; and250.26(10) inform the person and the person's legal guardian or conservator, or the parent if 250.27the person is a minor, that appeal may be made to the commissioner pursuant to section 250.28256.045
         .250.29EFFECTIVE DATE.This section is effective January 1, 2012.250.30    Sec. 31. [256B.0961] STATE QUALITY ASSURANCE, QUALITY 250.31IMPROVEMENT, AND LICENSING SYSTEM.250.32    Subdivision 1.Scope.(a) In order to improve the quality of services provided to 250.33Minnesotans with disabilities and to meet the requirements of the federally approved 250.34home and community-based waivers under section 1915c of the Social Security Act, a 250.35State Quality Assurance, Quality Improvement, and Licensing System for Minnesotans 251.1receiving disability services is enacted. This system is a partnership between the 251.2Department of Human Services and the State Quality Council established under 251.3subdivision 3.251.4    (b) This system is a result of the recommendations from the Department of Human 251.5Services' licensing and alternative quality assurance study mandated under Laws 2005, 251.6First Special Session chapter 4, article 7, section 57, and presented to the legislature 251.7in February 2007.251.8    (c) The disability services eligible under this section include:251.9    (1) the home and community-based services waiver programs for persons with 251.10developmental disabilities under section 256B.092, subdivision 4, or section 256B.49, 251.11including traumatic brain injuries and services for those who qualify for nursing facility 251.12level of care or hospital facility level of care;251.13    (2) home care services under section 256B.0651;251.14    (3) family support grants under section 252.32;251.15    (4) consumer support grants under section 256.476;251.16    (5) semi-independent living services under section 252.275; and251.17    (6) services provided through an intermediate care facility for the developmentally 251.18disabled.251.19    (d) For purposes of this section, the following definitions apply:251.20    (1) "commissioner" means the commissioner of human services;251.21    (2) "council" means the State Quality Council under subdivision 3;251.22    (3) "Quality Assurance Commission" means the commission under section 251.23256B.0951; and251.24    (4) "system" means the State Quality Assurance, Quality Improvement and 251.25Licensing System under this section.251.26    Subd. 2.Duties of the commissioner of human services.(a) The commissioner of 251.27human services shall establish the State Quality Council under subdivision 3.251.28    (b) The commissioner shall initially delegate authority to perform licensing 251.29functions and activities according to section 245A.16 to a host county in Region 10. The 251.30commissioner must not license or reimburse a participating facility, program, or service 251.31located in Region 10 if the commissioner has received notification from the host county 251.32that the facility, program, or service has failed to qualify for licensure.251.33    (c) The commissioner may conduct random licensing inspections based on outcomes 251.34adopted under section 256B.0951, subdivision 3, at facilities or programs, and of services 251.35eligible under this section. The role of the random inspections is to verify that the system 252.1protects the safety and well-being of persons served and maintains the availability of 252.2high-quality services for persons with disabilities.252.3    (d) The commissioner shall ensure that the federal home and community-based 252.4waiver requirements are met and that incidents that may have jeopardized safety and health 252.5or violated services-related assurances, civil and human rights, and other protections 252.6designed to prevent abuse, neglect, and exploitation, are reviewed, investigated, and 252.7acted upon in a timely manner.252.8    (e) The commissioner shall seek a federal waiver by July 1, 2012 to allow 252.9intermediate care facilities for persons with developmental disabilities to participate in 252.10this system.252.11    Subd. 3.State Quality Council.(a) There is hereby created a State Quality 252.12Council which must define regional quality councils, and carry out a community-based, 252.13person-directed quality review component, and a comprehensive system for effective 252.14incident reporting, investigation, analysis, and follow-up.252.15    (b) By August 1, 2011, the commissioner of human services shall appoint the 252.16members of the initial State Quality Council. Members shall include representatives 252.17from the following groups:252.18    (1) disability service recipients and their family members; 252.19    (2) during the first two years of the State Quality Council, there must be at least three 252.20members from the Region 10 stakeholders. As regional quality councils are formed under 252.21subdivision 4, each regional quality council shall appoint one member;252.22    (3) disability service providers;252.23    (4) disability advocacy groups; and252.24    (5) county human services agencies and staff from the Departments of Human 252.25Services and Health, and Ombudsman for Mental Health and Developmental Disabilities.252.26    (c) Members of the council who do not receive a salary or wages from an employer 252.27for time spent on council duties may receive a per diem payment when performing council 252.28duties and functions.252.29    (d) The State Quality Council shall:252.30    (1) assist the Departments of Human Services and Health in fulfilling federally 252.31mandated obligations by monitoring disability service quality and quality assurance and 252.32improvement practices in Minnesota; and252.33    (2) establish state quality improvement priorities with methods for achieving results 252.34and provide an annual report to the legislative committees with jurisdiction over policy 252.35and funding of disability services on the outcomes, improvement priorities, and activities 252.36undertaken by the commission during the previous state fiscal year.253.1    (e) The State Quality Council, in partnership with the commissioner, shall:253.2    (1) approve and direct implementation of the community-based, person-directed 253.3system established in this section;253.4    (2) recommend an appropriate method of funding this system, and determine the 253.5feasibility of the use of Medicaid, licensing fees, as well as other possible funding options;253.6    (3) approve measurable outcomes in the areas of health and safety, consumer 253.7evaluation, education and training, providers, and systems;253.8    (4) establish variable licensure periods not to exceed three years based on outcomes 253.9achieved; and253.10    (5) in cooperation with the Quality Assurance Commission, design a transition plan 253.11for licensed providers from Region 10 into the alternative licensing system by July 1, 2013.253.12    (f) The State Quality Council shall notify the commissioner of human services that a 253.13facility, program, or service has been reviewed by quality assurance team members under 253.14subdivision 4, paragraph (b), clause (13), and qualifies for a license.253.15    (g) The State Quality Council, in partnership with the commissioner, shall establish 253.16an ongoing review process for the system. The review shall take into account the 253.17comprehensive nature of the system which is designed to evaluate the broad spectrum of 253.18licensed and unlicensed entities that provide services to persons with disabilities. The 253.19review shall address efficiencies and effectiveness of the system.253.20    (h) The State Quality Council may recommend to the commissioner certain 253.21variances from the standards governing licensure of programs for persons with disabilities 253.22in order to improve the quality of services so long as the recommended variances do 253.23not adversely affect the health or safety of persons being served or compromise the 253.24qualifications of staff to provide services.253.25    (i) The safety standards, rights, or procedural protections referenced under 253.26subdivision 2, paragraph (c), shall not be varied. The State Quality Council may make 253.27recommendations to the commissioner or to the legislature in the report required under 253.28paragraph (c) regarding alternatives or modifications to the safety standards, rights, or 253.29procedural protections referenced under subdivision 2, paragraph (c).253.30    (j) The State Quality Council may hire staff to perform the duties assigned in this 253.31subdivision.253.32    Subd. 4.Regional quality councils.(a) The commissioner shall establish, as 253.33selected by the State Quality Council, regional quality councils of key stakeholders, 253.34including regional representatives of:253.35    (1) disability service recipients and their family members;253.36    (2) disability service providers;254.1    (3) disability advocacy groups; and254.2    (4) county human services agencies and staff from the Departments of Human 254.3Services, and Health, and Ombudsman for Mental Health and Developmental Disabilities.254.4    (b) Each regional quality council shall:254.5    (1) direct and monitor the community-based, person-directed quality assurance 254.6system in this section;254.7    (2) approve a training program for quality assurance team members under clause 254.8(13);254.9    (3) review summary reports from quality assurance team reviews and make 254.10recommendations to the State Quality Council regarding program licensure;254.11    (4) make recommendations to the State Quality Council regarding the system;254.12    (5) resolve complaints between the quality assurance teams, counties, providers, 254.13persons receiving services, their families, and legal representatives;254.14    (6) analyze and review quality outcomes and critical incident data reporting 254.15incidents of life safety concerns immediately to the Department of Human Services 254.16licensing division;254.17    (7) provide information and training programs for persons with disabilities and their 254.18families and legal representatives on service options and quality expectations;254.19    (8) disseminate information and resources developed to other regional quality 254.20councils;254.21    (9) respond to state-level priorities;254.22    (10) establish regional priorities for quality improvement;254.23    (11) submit an annual report to the State Quality Council on the status, outcomes, 254.24improvement priorities, and activities in the region;254.25    (12) choose a representative to participate on the State Quality Council and assume 254.26other responsibilities consistent with the priorities of the State Quality Council; and254.27    (13) recruit, train, and assign duties to members of quality assurance teams, taking 254.28into account the size of the service provider, the number of services to be reviewed, 254.29the skills necessary for the team members to complete the process, and ensure that no 254.30team member has a financial, personal, or family relationship with the facility, program, 254.31or service being reviewed or with anyone served at the facility, program, or service. 254.32Quality assurance teams must be comprised of county staff, persons receiving services 254.33or the person's families, legal representatives, members of advocacy organizations, 254.34providers, and other involved community members. Team members must complete 254.35the training program approved by the regional quality council and must demonstrate 255.1performance-based competency. Team members may be paid a per diem and reimbursed 255.2for expenses related to their participation in the quality assurance process.255.3    (c) The commissioner shall monitor the safety standards, rights, and procedural 255.4protections for the monitoring of psychotropic medications and those identified under 255.5sections 245.825; 245.91 to 245.97; 245A.09, subdivision 2, paragraph (c), clauses (2) 255.6and (5); 245A.12; 245A.13; 252.41, subdivision 9; 256B.092, subdivision 1b, clause 255.7(7); 626.556; and 626.557.255.8    (d) The regional quality councils may hire staff to perform the duties assigned in 255.9this subdivision.255.10    (e) The regional quality councils may charge fees for their services.255.11    (f) The quality assurance process undertaken by a regional quality council consists of 255.12an evaluation by a quality assurance team of the facility, program, or service. The process 255.13must include an evaluation of a random sample of persons served. The sample must be 255.14representative of each service provided. The sample size must be at least five percent but 255.15not less than two persons served. All persons must be given the opportunity to be included 255.16in the quality assurance process in addition to those chosen for the random sample.255.17    (g) A facility, program, or service may contest a licensing decision of the regional 255.18quality council as permitted under chapter 245A.255.19    Subd. 5.Annual survey of service recipients.The commissioner, in consultation 255.20with the State Quality Council, shall conduct an annual independent statewide survey 255.21of service recipients, randomly selected, to determine the effectiveness and quality 255.22of disability services. The survey must be consistent with the system performance 255.23expectations of the Centers for Medicare and Medicaid Services (CMS) Quality 255.24Framework. The survey must analyze whether desired outcomes for persons with different 255.25demographic, diagnostic, health, and functional needs, who are receiving different types 255.26of services in different settings and with different costs, have been achieved. Annual 255.27statewide and regional reports of the results must be published and used to assist regions, 255.28counties, and providers to plan and measure the impact of quality improvement activities.255.29    Subd. 6.Mandated reporters.Members of the State Quality Council under 255.30subdivision 3, the regional quality councils under subdivision 4, and quality assurance 255.31team members under subdivision 4, paragraph (b), clause (13), are mandated reporters as 255.32defined in sections 626.556, subdivision 3, and 626.5572, subdivision 16.255.33EFFECTIVE DATE.(a) Subdivisions 1 to 6 are effective July 1, 2011.255.34    (b) The jurisdictions of the regional quality councils in subdivision 4 must be 255.35defined, with implementation dates, by July 1, 2012. During the biennium beginning July 256.11, 2011, the Quality Assurance Commission shall continue to implement the alternative 256.2licensing system under this section.256.3    Sec. 32. Minnesota Statutes 2010, section 256B.19, is amended by adding a 256.4subdivision to read:256.5    Subd. 2d.Obligation of local agency to process medical assistance applications 256.6within established timelines.(a) Except as provided in paragraph (b), when an individual 256.7submits an application for medical assistance and the applicant's eligibility is based on 256.8disability or on being age 65 or older, the county must determine the applicant's eligibility 256.9and mail a notice of its decision to the applicant within:256.10(1) 60 days from the date of the application for an individual whose eligibility 256.11is based on disability; or256.12(2) 45 days from the date of the application for an individual whose eligibility is 256.13based on being age 65 or older.256.14(b) The county must determine eligibility and mail a notice of its decision within the 256.15time frames stated in paragraph (a), except in the following circumstances: 256.16(1) the county cannot make a determination because, despite reasonable efforts by 256.17the county to communicate what is required, the applicant or an examining physician 256.18delays or fails to take a required action; or 256.19(2) there is an administrative or other emergency beyond the county's control.  For 256.20purposes of this clause, a staffing shortage does not constitute an emergency beyond 256.21the county's control.256.22For the events in either clause (1) or (2), the county must document in the applicant's 256.23case record the reason for delaying beyond the established time frames. 256.24(c) The county must not use the time frames established in paragraph (a) as a waiting 256.25period before determining eligibility or as a reason for denying eligibility because it has 256.26not determined eligibility within the established time frames.256.27(d) Effective July 1, 2011, unless one of the exceptions listed under paragraph (b) 256.28applies, if a county fails to comply with paragraph (a) and the applicant ultimately is 256.29determined to be eligible for medical assistance, the county is responsible for the entire 256.30cost of medical assistance services provided to the applicant by a nursing facility and not 256.31paid for by federal funds, from and including the first date of eligibility through the date 256.32on which the county mails written notice of its decision on the application. The applicable 256.33facility will bill and receive payment directly from the commissioner in customary 256.34fashion, and the commissioner shall deduct any obligation incurred under this paragraph 256.35from the amount due to the local agency under subdivision 1. 257.1(e) This subdivision supersedes subdivision 1, clause (2), if both apply to an 257.2applicant.257.3    Sec. 33. Minnesota Statutes 2010, section 256B.431, subdivision 2r, is amended to 257.4read:257.5    Subd. 2r. Payment restrictions on leave days.(a) Effective July 1, 1993, the 257.6commissioner shall limit payment for leave days in a nursing facility to 79 percent of that 257.7nursing facility's total payment rate for the involved resident. 257.8(b) For services rendered on or after July 1, 2003, for facilities reimbursed under this 257.9section or section 
         256B.434, the commissioner shall limit payment for leave days in a 257.10nursing facility to 60 percent of that nursing facility's total payment rate for the involved 257.11resident.257.12(c) For services rendered on or after July 1, 2011, for facilities reimbursed under 257.13this chapter, the commissioner shall limit payment for leave days in a nursing facility 257.14to 30 percent of that nursing facility's total payment rate for the involved resident, and 257.15shall allow this payment only when the occupancy of the nursing facility, inclusive of 257.16bed hold days, is equal to or greater than 96 percent, notwithstanding Minnesota Rules, 257.17part 9505.0415.257.18    Sec. 34. Minnesota Statutes 2010, section 256B.431, is amended by adding a 257.19subdivision to read:257.20    Subd. 44.Property rate increase for a facility in Bloomington effective 257.21November 1, 2010.Notwithstanding any other law to the contrary, money available for 257.22moratorium projects under section 144A.073, subdivision 11, shall be used, effective 257.23November 1, 2010, to fund an approved moratorium exception project for a nursing 257.24facility in Bloomington licensed for 137 beds as of November 1, 2010, up to a total 257.25property rate adjustment of $19.33.257.26    Sec. 35. Minnesota Statutes 2010, section 256B.434, subdivision 4, is amended to read:257.27    Subd. 4. Alternate rates for nursing facilities. (a) For nursing facilities which 257.28have their payment rates determined under this section rather than section 
         256B.431, the 257.29commissioner shall establish a rate under this subdivision. The nursing facility must enter 257.30into a written contract with the commissioner.257.31    (b) A nursing facility's case mix payment rate for the first rate year of a facility's 257.32contract under this section is the payment rate the facility would have received under 257.33section 
         256B.431.258.1    (c) A nursing facility's case mix payment rates for the second and subsequent years 258.2of a facility's contract under this section are the previous rate year's contract payment 258.3rates plus an inflation adjustment and, for facilities reimbursed under this section or 258.4section 
         256B.431, an adjustment to include the cost of any increase in Health Department 258.5licensing fees for the facility taking effect on or after July 1, 2001. The index for the 258.6inflation adjustment must be based on the change in the Consumer Price Index-All Items 258.7(United States City average) (CPI-U) forecasted by the commissioner of management and 258.8budget's national economic consultant, as forecasted in the fourth quarter of the calendar 258.9year preceding the rate year. The inflation adjustment must be based on the 12-month 258.10period from the midpoint of the previous rate year to the midpoint of the rate year for 258.11which the rate is being determined. For the rate years beginning on July 1, 1999, July 1, 258.122000, July 1, 2001, July 1, 2002, July 1, 2003, July 1, 2004, July 1, 2005, July 1, 2006, 258.13July 1, 2007, July 1, 2008, October 1, 2009, and October 1, 2010, October 1, 2011, and 258.14October 1, 2012. this paragraph shall apply only to the property-related payment rate, 258.15except that adjustments to include the cost of any increase in Health Department licensing 258.16fees taking effect on or after July 1, 2001, shall be provided. For the rate years beginning 258.17on October 1, 2011, and October 1, 2012, the rate adjustment under this paragraph shall 258.18be suspended. Beginning in 2005, adjustment to the property payment rate under this 258.19section and section 
         256B.431 shall be effective on October 1. In determining the amount 258.20of the property-related payment rate adjustment under this paragraph, the commissioner 258.21shall determine the proportion of the facility's rates that are property-related based on the 258.22facility's most recent cost report.258.23    (d) The commissioner shall develop additional incentive-based payments of up to 258.24five percent above a facility's operating payment rate for achieving outcomes specified 258.25in a contract. The commissioner may solicit contract amendments and implement those 258.26which, on a competitive basis, best meet the state's policy objectives. The commissioner 258.27shall limit the amount of any incentive payment and the number of contract amendments 258.28under this paragraph to operate the incentive payments within funds appropriated for this 258.29purpose. The contract amendments may specify various levels of payment for various 258.30levels of performance. Incentive payments to facilities under this paragraph may be in the 258.31form of time-limited rate adjustments or onetime supplemental payments. In establishing 258.32the specified outcomes and related criteria, the commissioner shall consider the following 258.33state policy objectives:258.34    (1) successful diversion or discharge of residents to the residents' prior home or other 258.35community-based alternatives;258.36    (2) adoption of new technology to improve quality or efficiency;259.1    (3) improved quality as measured in the Nursing Home Report Card;259.2    (4) reduced acute care costs; and259.3    (5) any additional outcomes proposed by a nursing facility that the commissioner 259.4finds desirable.259.5    (e) Notwithstanding the threshold in section 
         256B.431, subdivision 16, facilities that 259.6take action to come into compliance with existing or pending requirements of the life 259.7safety code provisions or federal regulations governing sprinkler systems must receive 259.8reimbursement for the costs associated with compliance if all of the following conditions 259.9are met:259.10    (1) the expenses associated with compliance occurred on or after January 1, 2005, 259.11and before December 31, 2008;259.12    (2) the costs were not otherwise reimbursed under subdivision 4f or section 259.13144A.071
          or 
         144A.073; and259.14    (3) the total allowable costs reported under this paragraph are less than the minimum 259.15threshold established under section 
         256B.431, subdivision 15, paragraph (e), and 259.16subdivision 16.259.17The commissioner shall use money appropriated for this purpose to provide to qualifying 259.18nursing facilities a rate adjustment beginning October 1, 2007, and ending September 30, 259.192008. Nursing facilities that have spent money or anticipate the need to spend money 259.20to satisfy the most recent life safety code requirements by (1) installing a sprinkler 259.21system or (2) replacing all or portions of an existing sprinkler system may submit to the 259.22commissioner by June 30, 2007, on a form provided by the commissioner the actual 259.23costs of a completed project or the estimated costs, based on a project bid, of a planned 259.24project. The commissioner shall calculate a rate adjustment equal to the allowable 259.25costs of the project divided by the resident days reported for the report year ending 259.26September 30, 2006. If the costs from all projects exceed the appropriation for this 259.27purpose, the commissioner shall allocate the money appropriated on a pro rata basis 259.28to the qualifying facilities by reducing the rate adjustment determined for each facility 259.29by an equal percentage. Facilities that used estimated costs when requesting the rate 259.30adjustment shall report to the commissioner by January 31, 2009, on the use of this 259.31money on a form provided by the commissioner. If the nursing facility fails to provide 259.32the report, the commissioner shall recoup the money paid to the facility for this purpose. 259.33If the facility reports expenditures allowable under this subdivision that are less than 259.34the amount received in the facility's annualized rate adjustment, the commissioner shall 259.35recoup the difference.260.1    Sec. 36. Minnesota Statutes 2010, section 256B.437, subdivision 6, is amended to read:260.2    Subd. 6. Planned closure rate adjustment. (a) The commissioner of human 260.3services shall calculate the amount of the planned closure rate adjustment available under 260.4subdivision 3, paragraph (b), for up to 5,140 beds according to clauses (1) to (4):260.5(1) the amount available is the net reduction of nursing facility beds multiplied 260.6by $2,080;260.7(2) the total number of beds in the nursing facility or facilities receiving the planned 260.8closure rate adjustment must be identified;260.9(3) capacity days are determined by multiplying the number determined under 260.10clause (2) by 365; and260.11(4) the planned closure rate adjustment is the amount available in clause (1), divided 260.12by capacity days determined under clause (3).260.13(b) A planned closure rate adjustment under this section is effective on the first day 260.14of the month following completion of closure of the facility designated for closure in the 260.15application and becomes part of the nursing facility's total operating payment rate.260.16(c) Applicants may use the planned closure rate adjustment to allow for a property 260.17payment for a new nursing facility or an addition to an existing nursing facility or as an 260.18operating payment rate adjustment. Applications approved under this subdivision are 260.19exempt from other requirements for moratorium exceptions under section 
         144A.073, 260.20subdivisions 2 and 3.260.21(d) Upon the request of a closing facility, the commissioner must allow the facility a 260.22closure rate adjustment as provided under section 
         144A.161, subdivision 10.260.23(e) A facility that has received a planned closure rate adjustment may reassign it 260.24to another facility that is under the same ownership at any time within three years of its 260.25effective date. The amount of the adjustment shall be computed according to paragraph (a).260.26(f) If the per bed dollar amount specified in paragraph (a), clause (1), is increased, 260.27the commissioner shall recalculate planned closure rate adjustments for facilities that 260.28delicense beds under this section on or after July 1, 2001, to reflect the increase in the per 260.29bed dollar amount. The recalculated planned closure rate adjustment shall be effective 260.30from the date the per bed dollar amount is increased.260.31(g) For planned closures approved after June 30, 2009, the commissioner of human 260.32services shall calculate the amount of the planned closure rate adjustment available under 260.33subdivision 3, paragraph (b), according to paragraph (a), clauses (1) to (4).260.34(h) Beginning July 16, 2011, the commissioner shall no longer approve planned 260.35closure rate adjustments under this subdivision.261.1    Sec. 37. Minnesota Statutes 2010, section 256B.441, is amended by adding a 261.2subdivision to read:261.3    Subd. 60.Rate increase for low-rate facilities.(a) Effective October 1, 2011, 261.4the commissioner shall adjust the operating payment rates of a nursing facility whose 261.5operating payment rate on September 30, 2011, is greater than the 95th percentile of all 261.6nursing facilities operating payment rates. The commissioner shall:261.7(1) array all operating payment rates in effect on September 30, 2011, at a case-mix 261.8weight equal to 1.00 (DDF) from lowest to highest;261.9(2) remove from the array any nursing facility determined by the commissioner to 261.10be providing specialized care, determined in accordance with criteria in subdivision 51a, 261.11paragraph (b), and any facilities receiving a rate increase under paragraph (c), clause (1);261.12(3) determine the 95th percentile of the array in clause (1);261.13(4) compute a reduction amount not to exceed three percent, if a facility's amount 261.14in clause (1) is greater than the amount computed in clause (3) by subtracting a facility's 261.15DDF rate in clause (1) from the amount computed in clause (3);261.16(5) compute the portion of each facility's DDF operating payment rate that is the 261.17direct care per diem based on the rates in effect on September 30, 2011; and261.18(6) determine the change for all other case-mix levels, by multiplying the amount in 261.19clause (4) by the percentage in clause (5) and by the corresponding case-mix weight for 261.20each care level. Add to this product the non-direct care per diem portion of the amount 261.21in clause (4).261.22(b) The total amount to be saved by the rate reductions will be computed. The 261.23commissioner shall:261.24(1) for each facility receiving a rate change in paragraph (a), multiply each case-mix 261.25level's rate change in paragraph (a), clause (6), by the corresponding case-mix resident 261.26days from the most recent cost report that has been desk audited; and261.27(2) sum all the products computed in clause (1).261.28(c) The amount of total payment reductions computed in paragraph (b) shall be 261.29distributed to the facilities with the lowest DDF operating payment rates determined in 261.30paragraph (a), clause (1). The commissioner shall:261.31(1) for nursing facilities located no more than one-quarter mile from a peer group 261.32with higher limits under either subdivision 50 or 51, give an operating rate adjustment. 261.33The operating payment rates of a lower-limit peer group facility must be adjusted to be 261.34equal to those of the nearest facility in a higher-limit peer group if that facility's RUG rate 261.35with a weight of 1.00 is higher than the lower-limit peer group facility. Peer groups are 262.1those defined in subdivision 30. The nearest facility must be determined by the most 262.2direct driving route;262.3(2) start with the facility or facilities with the lowest DDF operating payment rate 262.4and compute the amount of a rate adjustment needed to make the DDF rate equal to the 262.5DDF of the facility directly below it in the array;262.6(3) compute the rate increases for the other case-mix levels using the amount 262.7computed in clause (2), and the process stated in paragraph (a), clauses (5) and (6);262.8(4) compute the total amount the lowest facilities will receive using the process 262.9described in paragraph (b);262.10(5) compute the running total to be spent at all facilities receiving an increase under 262.11this paragraph by summing each facility's amount computed in clause (4); and 262.12(6) repeat the process in clauses (2) to (5) as long as the amount in clause (5) does 262.13not exceed the amount in paragraph (b), clause (2). In no case shall the DDF operating 262.14payment rate increase determined in clauses (2) to (6) exceed two percent.262.15    Sec. 38. Minnesota Statutes 2010, section 256B.48, subdivision 1, is amended to read:262.16    Subdivision 1. Prohibited practices. A nursing facility is not eligible to receive 262.17medical assistance payments unless it refrains from all of the following:262.18(a) Charging private paying residents rates for similar services which exceed those 262.19which are approved by the state agency for medical assistance recipients as determined by 262.20the prospective desk audit rate, except under the following circumstances:262.21(1) the nursing facility may:262.22(1)(i) charge private paying residents a higher rate for a private room,; and 262.23(2)(ii) charge for special services which are not included in the daily rate if medical 262.24assistance residents are charged separately at the same rate for the same services in 262.25addition to the daily rate paid by the commissioner.;262.26(2) effective July 1, 2011, through September 30, 2012, nursing facilities may charge 262.27private paying residents rates up to two percent higher than the allowable payment rate 262.28determined by the commissioner for the RUGS group currently assigned to the resident;262.29(3) effective October 1, 2012, through September 30, 2013, nursing facilities 262.30may charge private paying residents rates up to four percent higher than the allowable 262.31payment rate determined by the commissioner for the RUGS group currently assigned 262.32to the resident;262.33(4) effective October 1, 2013, through September 30, 2014, nursing facilities may 262.34charge private paying residents rates up to six percent higher than the allowable payment 263.1rate determined by the commissioner for the RUGS group currently assigned to the 263.2resident;263.3(5) effective October 1, 2014, nursing facilities may charge private paying 263.4residents up to eight percent higher than the allowable payment rate determined by the 263.5commissioner for the RUGS group currently assigned to the resident; and263.6(6) the higher private pay charges allowed in this paragraph shall be limited to actual 263.7costs per resident day, as determined by the commissioner, based on data provided in the 263.8statistical and cost report in section 256B.441.263.9Nothing in this section precludes a nursing facility from charging a rate allowable 263.10under the facility's single room election option under Minnesota Rules, part 9549.0060, 263.11subpart 11. Services covered by the payment rate must be the same regardless of payment 263.12source. Special services, if offered, must be available to all residents in all areas of the 263.13nursing facility and charged separately at the same rate. Residents are free to select 263.14or decline special services. Special services must not include services which must be 263.15provided by the nursing facility in order to comply with licensure or certification standards 263.16and that if not provided would result in a deficiency or violation by the nursing facility. 263.17Services beyond those required to comply with licensure or certification standards must 263.18not be charged separately as a special service if they were included in the payment rate for 263.19the previous reporting year. A nursing facility that charges a private paying resident a rate 263.20in violation of this clause is subject to an action by the state of Minnesota or any of its 263.21subdivisions or agencies for civil damages. A private paying resident or the resident's legal 263.22representative has a cause of action for civil damages against a nursing facility that charges 263.23the resident rates in violation of this clause. The damages awarded shall include three 263.24times the payments that result from the violation, together with costs and disbursements, 263.25including reasonable attorneys' fees or their equivalent. A private paying resident or the 263.26resident's legal representative, the state, subdivision or agency, or a nursing facility may 263.27request a hearing to determine the allowed rate or rates at issue in the cause of action. 263.28Within 15 calendar days after receiving a request for such a hearing, the commissioner 263.29shall request assignment of an administrative law judge under sections 
         14.48 to 
         14.56 to 263.30conduct the hearing as soon as possible or according to agreement by the parties. The 263.31administrative law judge shall issue a report within 15 calendar days following the close 263.32of the hearing. The prohibition set forth in this clause shall not apply to facilities licensed 263.33as boarding care facilities which are not certified as skilled or intermediate care facilities 263.34level I or II for reimbursement through medical assistance. 263.35(b)(1) Charging, soliciting, accepting, or receiving from an applicant for admission 263.36to the facility, or from anyone acting in behalf of the applicant, as a condition of 264.1admission, expediting the admission, or as a requirement for the individual's continued 264.2stay, any fee, deposit, gift, money, donation, or other consideration not otherwise required 264.3as payment under the state plan. For residents on medical assistance, medical assistance 264.4payment according to the state plan must be accepted as payment in full for continued 264.5stay, except where otherwise provided for under statute;264.6(2) requiring an individual, or anyone acting in behalf of the individual, to loan 264.7any money to the nursing facility;264.8(3) requiring an individual, or anyone acting in behalf of the individual, to promise 264.9to leave all or part of the individual's estate to the facility; or264.10(4) requiring a third-party guarantee of payment to the facility as a condition of 264.11admission, expedited admission, or continued stay in the facility.264.12Nothing in this paragraph would prohibit discharge for nonpayment of services in 264.13accordance with state and federal regulations.264.14(c) Requiring any resident of the nursing facility to utilize a vendor of health care 264.15services chosen by the nursing facility. A nursing facility may require a resident to use 264.16pharmacies that utilize unit dose packing systems approved by the Minnesota Board of 264.17Pharmacy, and may require a resident to use pharmacies that are able to meet the federal 264.18regulations for safe and timely administration of medications such as systems with specific 264.19number of doses, prompt delivery of medications, or access to medications on a 24-hour 264.20basis. Notwithstanding the provisions of this paragraph, nursing facilities shall not restrict 264.21a resident's choice of pharmacy because the pharmacy utilizes a specific system of unit 264.22dose drug packing.264.23(d) Providing differential treatment on the basis of status with regard to public 264.24assistance.264.25(e) Discriminating in admissions, services offered, or room assignment on the 264.26basis of status with regard to public assistance or refusal to purchase special services. 264.27Discrimination in admissions discrimination, services offered, or room assignment shall 264.28include, but is not limited to:264.29(1) basing admissions decisions upon assurance by the applicant to the nursing 264.30facility, or the applicant's guardian or conservator, that the applicant is neither eligible for 264.31nor will seekinformation or assurances regarding current or future eligibility for public 264.32assistance for payment of nursing facility care costs; and264.33(2) engaging in preferential selection from waiting lists based on an applicant's 264.34ability to pay privately or an applicant's refusal to pay for a special service.264.35The collection and use by a nursing facility of financial information of any applicant 264.36pursuant to a preadmission screening program established by law shall not raise an 265.1inference that the nursing facility is utilizing that information for any purpose prohibited 265.2by this paragraph.265.3(f) Requiring any vendor of medical care as defined by section 
         256B.02, subdivision 265.47
         , who is reimbursed by medical assistance under a separate fee schedule, to pay any 265.5amount based on utilization or service levels or any portion of the vendor's fee to the 265.6nursing facility except as payment for renting or leasing space or equipment or purchasing 265.7support services from the nursing facility as limited by section 
         256B.433. All agreements 265.8must be disclosed to the commissioner upon request of the commissioner. Nursing 265.9facilities and vendors of ancillary services that are found to be in violation of this provision 265.10shall each be subject to an action by the state of Minnesota or any of its subdivisions or 265.11agencies for treble civil damages on the portion of the fee in excess of that allowed by 265.12this provision and section 
         256B.433. Damages awarded must include three times the 265.13excess payments together with costs and disbursements including reasonable attorney's 265.14fees or their equivalent. 265.15(g) Refusing, for more than 24 hours, to accept a resident returning to the same 265.16bed or a bed certified for the same level of care, in accordance with a physician's order 265.17authorizing transfer, after receiving inpatient hospital services.265.18(h) For a period not to exceed 180 days, the commissioner may continue to make 265.19medical assistance payments to a nursing facility or boarding care home which is in 265.20violation of this section if extreme hardship to the residents would result. In these cases 265.21the commissioner shall issue an order requiring the nursing facility to correct the violation. 265.22The nursing facility shall have 20 days from its receipt of the order to correct the violation. 265.23If the violation is not corrected within the 20-day period the commissioner may reduce 265.24the payment rate to the nursing facility by up to 20 percent. The amount of the payment 265.25rate reduction shall be related to the severity of the violation and shall remain in effect 265.26until the violation is corrected. The nursing facility or boarding care home may appeal the 265.27commissioner's action pursuant to the provisions of chapter 14 pertaining to contested 265.28cases. An appeal shall be considered timely if written notice of appeal is received by the 265.29commissioner within 20 days of notice of the commissioner's proposed action.265.30In the event that the commissioner determines that a nursing facility is not eligible 265.31for reimbursement for a resident who is eligible for medical assistance, the commissioner 265.32may authorize the nursing facility to receive reimbursement on a temporary basis until the 265.33resident can be relocated to a participating nursing facility.265.34Certified beds in facilities which do not allow medical assistance intake on July 1, 265.351984, or after shall be deemed to be decertified for purposes of section 
         144A.071 only. 266.1    Sec. 39. Minnesota Statutes 2010, section 256B.49, subdivision 12, is amended to read:266.2    Subd. 12. Informed choice. Persons who are determined likely to require the 266.3level of care provided in a nursing facility as determined under sections 144.0724, 266.4subdivision 11, and section256B.0911, or a hospital shall be informed of the home and 266.5community-based support alternatives to the provision of inpatient hospital services or 266.6nursing facility services. Each person must be given the choice of either institutional or 266.7home and community-based services using the provisions described in section 
         256B.77, 266.8subdivision 2
         , paragraph (p).266.9    Sec. 40. Minnesota Statutes 2010, section 256B.49, subdivision 13, is amended to read:266.10    Subd. 13. Case management.(a) Each recipient of a home and community-based 266.11waiver under this section shall be provided case management services according to 266.12section 256B.092, subdivisions 1a, 1b, and 1e, by qualified vendors as described in the 266.13federally approved waiver application. The case management service activities provided 266.14will include:266.15    (1) assessing the needs of the individual within 20 working days of a recipient's 266.16request;266.17    (2) developing the written individual service plan within ten working days after the 266.18assessment is completed;266.19    (3) informing the recipient or the recipient's legal guardian or conservator of service 266.20options;266.21    (4) assisting the recipient in the identification of potential service providers;266.22    (5) assisting the recipient to access services;266.23    (6) coordinating, evaluating, and monitoring of the services identified in the service 266.24plan;266.25    (7) completing the annual reviews of the service plan; and266.26    (8) informing the recipient or legal representative of the right to have assessments 266.27completed and service plans developed within specified time periods, and to appeal county 266.28action or inaction under section 256.045, subdivision 3, including the determination of 266.29nursing facility level of care.266.30    (b) The case manager may delegate certain aspects of the case management service 266.31activities to another individual provided there is oversight by the case manager. The case 266.32manager may not delegate those aspects which require professional judgment including 266.33assessments, reassessments, and care plan development.266.34EFFECTIVE DATE.This section is effective January 1, 2012.267.1    Sec. 41. Minnesota Statutes 2010, section 256B.49, subdivision 14, is amended to read:267.2    Subd. 14. Assessment and reassessment. (a) Assessments of each recipient's 267.3strengths, informal support systems, and need for services shall be completed within 20 267.4working days of the recipient's request as provided in section 256B.0911. Reassessment 267.5of each recipient's strengths, support systems, and need for services shall be conducted 267.6at least every 12 months and at other times when there has been a significant change in 267.7the recipient's functioning.267.8(b) There must be a determination that the client requires a hospital level of care or a 267.9nursing facility level of care as defined in section 
         144.0724, subdivision 11 256B.0911, 267.10subdivision 4a, paragraph (d), at initial and subsequent assessments to initiate and 267.11maintain participation in the waiver program.267.12(c) Regardless of other assessments identified in section 
         144.0724, subdivision 4, as 267.13appropriate to determine nursing facility level of care for purposes of medical assistance 267.14payment for nursing facility services, only face-to-face assessments conducted according 267.15to section 
         256B.0911, subdivisions 3a, 3b, and 4d, that result in a hospital level of care 267.16determination or a nursing facility level of care determination must be accepted for 267.17purposes of initial and ongoing access to waiver services payment.267.18(d) Persons with developmental disabilities who apply for services under the nursing 267.19facility level waiver programs shall be screened for the appropriate level of care according 267.20to section 
         256B.092.267.21(e) Recipients who are found eligible for home and community-based services under 267.22this section before their 65th birthday may remain eligible for these services after their 267.2365th birthday if they continue to meet all other eligibility factors.267.24(f) The commissioner shall develop criteria to identify individuals whose level of 267.25functioning is reasonably expected to improve and reassess these individuals every six 267.26months. Individuals who meet these criteria must have a comprehensive transitional 267.27service plan developed under subdivision 15, paragraphs (b) and (c). Counties, case 267.28managers, and service providers are responsible for conducting these reassessments and 267.29shall complete the reassessments out of existing funds.267.30EFFECTIVE DATE.This section is effective January 1, 2012, except for paragraph 267.31(f), which is effective July 1, 2013.267.32    Sec. 42. Minnesota Statutes 2010, section 256B.49, subdivision 15, is amended to read:267.33    Subd. 15. Individualized Coordinated service and support plan; comprehensive 267.34transitional service plan; maintenance service plan. (a) Each recipient of home and 267.35community-based waivered services shall be provided a copy of the written coordinated268.1service and support plan which: that complies with the requirements of section 256B.092, 268.2subdivisions 1b and 1e.268.3(1) is developed and signed by the recipient within ten working days of the 268.4completion of the assessment;268.5(2) meets the assessed needs of the recipient;268.6(3) reasonably ensures the health and safety of the recipient;268.7(4) promotes independence;268.8(5) allows for services to be provided in the most integrated settings; and268.9(6) provides for an informed choice, as defined in section 256B.77, subdivision 2, 268.10paragraph (p), of service and support providers.268.11(b) In developing the comprehensive transitional service plan, the individual 268.12receiving services, the case manager, and the guardian, if applicable, will identify 268.13the transitional service plan fundamental service outcome and anticipated timeline to 268.14achieve this outcome. Within the first 20 days following a recipient's request for an 268.15assessment or reassessment, the transitional service planning team must be identified. A 268.16team leader must be identified who will be responsible for assigning responsibility and 268.17communicating with team members to ensure implementation of the transition plan and 268.18ongoing assessment and communication process. The team leader should be an individual, 268.19such as the case manager or guardian, who has the opportunity to follow the individual to 268.20the next level of service.268.21Within ten days following an assessment, a comprehensive transitional service plan 268.22must be developed incorporating elements of a comprehensive functional assessment and 268.23including short-term measurable outcomes and timelines for achievement of and reporting 268.24on these outcomes. Functional milestones must also be identified and reported according 268.25to the timelines agreed upon by the transitional service planning team. In addition, the 268.26comprehensive transitional service plan must identify additional supports that may assist 268.27in the achievement of the fundamental service outcome such as the development of greater 268.28natural community support, increased collaboration among agencies, and technological 268.29supports.268.30The timelines for reporting on functional milestones will prompt a reassessment of 268.31services provided, the units of services, rates, and appropriate service providers. It is 268.32the responsibility of the transitional service planning team leader to review functional 268.33milestone reporting to determine if the milestones are consistent with observable skills 268.34and that milestone achievement prompts any needed changes to the comprehensive 268.35transitional service plan.269.1For those whose fundamental transitional service outcome involves the need to 269.2procure housing, a plan for the individual to seek the resources necessary to secure 269.3the least restrictive housing possible should be incorporated into the plan, including 269.4employment and public supports such as housing access and shelter needy funding.269.5(c) Counties and other agencies responsible for funding community placement and 269.6ongoing community supportive services are responsible for the implementation of the 269.7comprehensive transitional service plans. Oversight responsibilities include both ensuring 269.8effective transitional service delivery and efficient utilization of funding resources.269.9(d) Following one year of transitional services, the transitional services planning 269.10team will make a determination as to whether or not the individual receiving services 269.11requires the current level of continuous and consistent support in order to maintain the 269.12individual's current level of functioning. Individuals who move from a transitional to a 269.13maintenance service plan must be reassessed to determine if the individual would benefit 269.14from a transitional service plan on at least an annual basis. This assessment should 269.15consider any changes to technological or natural community supports.269.16(b) (e) When a county is evaluating denials, reductions, or terminations of home 269.17and community-based services under section 
         256B.49 for an individual, the case manager 269.18shall offer to meet with the individual or the individual's guardian in order to discuss the 269.19prioritization of service needs within the individualized service plan, comprehensive 269.20transitional service plan, or maintenance service plan. The reduction in the authorized 269.21services for an individual due to changes in funding for waivered services may not exceed 269.22the amount needed to ensure medically necessary services to meet the individual's health, 269.23safety, and welfare.269.24EFFECTIVE DATE.This section is effective January 1, 2012, except for 269.25paragraphs (b), (c), and (d), which are effective July 1, 2013.269.26    Sec. 43. Minnesota Statutes 2010, section 256B.5012, is amended by adding a 269.27subdivision to read:269.28    Subd. 9.ICF/MR rate increase.Effective July 1, 2011, the commissioner shall 269.29increase the daily rate to $138.23 at an intermediate care facility for the developmentally 269.30disabled located in Clearwater County and classified as a class A facility with 15 beds.269.31EFFECTIVE DATE.This section is effective July 1, 2011.269.32    Sec. 44. Minnesota Statutes 2010, section 256B.5012, is amended by adding a 269.33subdivision to read:270.1    Subd. 10.ICF/MR rate adjustment.For each facility reimbursed under this 270.2section, except for a facility located in Clearwater County and classified as a class A 270.3facility with 15 beds, the commissioner shall decrease operating payment rates equal to ... 270.4percent of the operating payment rates in effect on June 30, 2011. For each facility, the 270.5commissioner shall apply the rate reduction, based on occupied beds, using the percentage 270.6specified in this subdivision multiplied by the total payment rate, including the variable rate 270.7but excluding the property-related payment rate, in effect on the preceding date. The total 270.8rate reduction shall include the adjustment provided in section 256B.501, subdivision 12.270.9    Sec. 45. Minnesota Statutes 2010, section 256G.02, subdivision 6, is amended to read:270.10    Subd. 6. Excluded time. "Excluded time" means:270.11(a) any period an applicant spends in a hospital, sanitarium, nursing home, shelter 270.12other than an emergency shelter, halfway house, foster home, semi-independent living 270.13domicile or services program, residential facility offering care, board and lodging facility 270.14or other institution for the hospitalization or care of human beings, as defined in section 270.15144.50
         , 
         144A.01, or 
         245A.02, subdivision 14; maternity home, battered women's shelter, 270.16or correctional facility; or any facility based on an emergency hold under sections 270.17253B.05, subdivisions 1 and 2
         , and 
         253B.07, subdivision 6;270.18(b) any period an applicant spends on a placement basis in a training and habilitation 270.19program, including a rehabilitation facility or work or employment program as defined 270.20in section 
         268A.01; or receiving personal care assistance services pursuant to section 270.21256B.0659; semi-independent living services provided under section 
         252.275, and 270.22Minnesota Rules, parts 9525.0500 to 9525.0660; day training and habilitation programs 270.23and assisted living services; and270.24(c) any placement for a person with an indeterminate commitment, including 270.25independent living.270.26EFFECTIVE DATE.This section is effective July 1, 2011.270.27    Sec. 46. Laws 2009, chapter 79, article 8, section 4, the effective date, as amended by 270.28Laws 2010, First Special Session chapter 1, article 24, section 12, is amended to read:270.29EFFECTIVE DATE.The This section is effective July 1, 2011 on or after January 270.301, 2014, for individuals age 21 and older, and on or after October 1, 2019, for individuals 270.31under age 21.271.1    Sec. 47. Laws 2009, chapter 79, article 8, section 51, the effective date, as amended by 271.2Laws 2010, First Special Session chapter 1, article 17, section 14, is amended to read:271.3EFFECTIVE DATE.This section is effective July 1, 2011 January 1, 2014.271.4    Sec. 48. Laws 2009, chapter 79, article 13, section 3, subdivision 8, as amended by 271.5Laws 2009, chapter 173, article 2, section 1, subdivision 8, and Laws 2010, First Special 271.6Session chapter 1, article 15, section 5, and article 25, section 16, is amended to read:

271.7Subd. 8.Continuing Care Grants

271.8The amounts that may be spent from the 271.9appropriation for each purpose are as follows:

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

271.11Base Adjustment. The general fund base is 271.12increased by $5,751,000 in fiscal year 2012 271.13and $6,705,000 in fiscal year 2013.271.14Information and Assistance 271.15Reimbursement. Federal administrative 271.16reimbursement obtained from information 271.17and assistance services provided by the 271.18Senior LinkAge or Disability Linkage lines 271.19to people who are identified as eligible for 271.20medical assistance shall be appropriated to 271.21the commissioner for this activity.271.22Community Service Development Grant 271.23Reduction. Funding for community service 271.24development grants must be reduced by 271.25$260,000 for fiscal year 2010; $284,000 in 271.26fiscal year 2011; $43,000 in fiscal year 2012; 271.27and $43,000 in fiscal year 2013. Base level 271.28funding shall be restored in fiscal year 2014.271.29Community Service Development Grant 271.30Community Initiative. Funding for 271.31community service development grants shall 271.32be used to offset the cost of aging support 272.1grants. Base level funding shall be restored 272.2in fiscal year 2014.272.3Senior Nutrition Use of Federal Funds.272.4For fiscal year 2010, general fund grants 272.5for home-delivered meals and congregate 272.6dining shall be reduced by $500,000. The 272.7commissioner must replace these general 272.8fund reductions with equal amounts from 272.9federal funding for senior nutrition from the 272.10American Recovery and Reinvestment Act 272.11of 2009.

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

272.13Base Adjustment. The general fund base is 272.14decreased by $3,598,000 in fiscal year 2012 272.15and $3,470,000 in fiscal year 2013.272.16Alternative Care Transfer. Any money 272.17allocated to the alternative care program that 272.18is not spent for the purposes indicated does 272.19not cancel but must be transferred to the 272.20medical assistance account.

272.21272.22(c) Medical Assistance Grants; Long-Term Care Facilities.367,444,000419,749,000

272.23272.24(d) Medical Assistance Long-Term Care Waivers and Home Care Grants853,567,0001,039,517,000

272.25Manage Growth in TBI and CADI 272.26Waivers. During the fiscal years beginning 272.27on July 1, 2009, and July 1, 2010, the 272.28commissioner shall allocate money for home 272.29and community-based waiver programs 272.30under Minnesota Statutes, section 
         256B.49, 272.31to ensure a reduction in state spending that is 272.32equivalent to limiting the caseload growth of 272.33the TBI waiver to 12.5 allocations per month 272.34each year of the biennium and the CADI 272.35waiver to 95 allocations per month each year 273.1of the biennium. Limits do not apply: (1) 273.2when there is an approved plan for nursing 273.3facility bed closures for individuals under 273.4age 65 who require relocation due to the 273.5bed closure; (2) to fiscal year 2009 waiver 273.6allocations delayed due to unallotment; or (3) 273.7to transfers authorized by the commissioner 273.8from the personal care assistance program 273.9of individuals having a home care rating 273.10of "CS," "MT," or "HL." Priorities for the 273.11allocation of funds must be for individuals 273.12anticipated to be discharged from institutional 273.13settings or who are at imminent risk of a 273.14placement in an institutional setting.273.15Manage Growth in DD Waiver. The 273.16commissioner shall manage the growth in 273.17the DD waiver by limiting the allocations 273.18included in the February 2009 forecast to 15 273.19additional diversion allocations each month 273.20for the calendar years that begin on January 273.211, 2010, and January 1, 2011. Additional 273.22allocations must be made available for 273.23transfers authorized by the commissioner 273.24from the personal care program of individuals 273.25having a home care rating of "CS," "MT," 273.26or "HL."273.27Adjustment to Lead Agency Waiver 273.28Allocations. Prior to the availability of the 273.29alternative license defined in Minnesota 273.30Statutes, section 
         245A.11, subdivision 8, 273.31the commissioner shall reduce lead agency 273.32waiver allocations for the purposes of 273.33implementing a moratorium on corporate 273.34foster care.274.1Alternatives to Personal Care Assistance 274.2Services. Base level funding of $3,237,000 274.3in fiscal year 2012 and $4,856,000 in 274.4fiscal year 2013 is to implement alternative 274.5services to personal care assistance services 274.6for persons with mental health and other 274.7behavioral challenges who can benefit 274.8from other services that more appropriately 274.9meet their needs and assist them in living 274.10independently in the community. These 274.11services may include, but not be limited to, a 274.121915(i) state plan option.

274.13(e) Mental Health Grants

274.14Appropriations by Fund274.15General77,739,00077,739,000274.16Health Care Access750,000750,000274.17Lottery Prize1,508,0001,508,000

274.18Funding Usage. Up to 75 percent of a fiscal 274.19year's appropriation for adult mental health 274.20grants may be used to fund allocations in that 274.21portion of the fiscal year ending December 274.2231.

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

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

274.25Payments for Substance Abuse Treatment.274.26For placements beginning during fiscal years 274.272010 and 2011, county-negotiated rates and 274.28provider claims to the consolidated chemical 274.29dependency fund must not exceed the lesser 274.30of:274.31(1) rates charged for these services on 274.32January 1, 2009; or275.1(2) 160 percent of the average rate on January 275.21, 2009, for each group of vendors with 275.3similar attributes.275.4Rates for fiscal years 2010 and 2011 must 275.5not exceed 160 percent of the average rate on 275.6January 1, 2009, for each group of vendors 275.7with similar attributes.275.8Effective July 1, 2010, rates that were above 275.9the average rate on January 1, 2009, are 275.10reduced by five percent from the rates in 275.11effect on June 1, 2010. Rates below the 275.12average rate on January 1, 2009, are reduced 275.13by 1.8 percent from the rates in effect on 275.14June 1, 2010. Services provided under 275.15this section by state-operated services are 275.16exempt from the rate reduction. For services 275.17provided in fiscal years 2012 and 2013, the 275.18statewide aggregate payment under the new 275.19rate methodology to be developed under 275.20Minnesota Statutes, section 
         254B.12, must 275.21not exceed the projected aggregate payment 275.22under the rates in effect for fiscal year 2011 275.23excluding the rate reduction for rates that 275.24were below the average on January 1, 2009, 275.25plus a state share increase of $3,787,000 for 275.26fiscal year 2012 and $5,023,000 for fiscal 275.27year 2013. Notwithstanding any provision 275.28to the contrary in this article, this provision 275.29expires on June 30, 2013.275.30Chemical Dependency Special Revenue 275.31Account. For fiscal year 2010, $750,000 275.32must be transferred from the consolidated 275.33chemical dependency treatment fund 275.34administrative account and deposited into the 275.35general fund.276.1County CD Share of MA Costs for 276.2ARRA Compliance. Notwithstanding the 276.3provisions of Minnesota Statutes, chapter 276.4254B, for chemical dependency services 276.5provided during the period October 1, 2008, 276.6to December 31, 2010, and reimbursed by 276.7medical assistance at the enhanced federal 276.8matching rate provided under the American 276.9Recovery and Reinvestment Act of 2009, the 276.10county share is 30 percent of the nonfederal 276.11share. This provision is effective the day 276.12following final enactment.

276.13276.14(h) Chemical Dependency Nonentitlement Grants1,729,0001,729,000

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

276.16Base Adjustment. The general fund base is 276.17increased by $2,639,000 in fiscal year 2012 276.18and increased by $3,854,000 in fiscal year 276.192013.276.20Technology Grants. $650,000 in fiscal 276.21year 2010 and $1,000,000 in fiscal year 276.222011 are for technology grants, case 276.23consultation, evaluation, and consumer 276.24information grants related to developing and 276.25supporting alternatives to shift-staff foster 276.26care residential service models.276.27Other Continuing Care Grants; HIV 276.28Grants. Money appropriated for the HIV 276.29drug and insurance grant program in fiscal 276.30year 2010 may be used in either year of the 276.31biennium.276.32Quality Assurance Commission. Effective 276.33July 1, 2009, state funding for the quality 276.34assurance commission under Minnesota 276.35Statutes, section 
         256B.0951, is canceled.277.1    Sec. 49. DIRECTIONS TO COMMISSIONER.277.2    Subdivision 1.Co-payments for home and community-based services.Upon 277.3federal approval, the commissioner of human services shall develop and implement a 277.4co-payment schedule for individuals receiving home and community-based services under 277.5Minnesota Statutes, chapter 256B.277.6    Subd. 2.Federal waiver amendment.The commissioner shall seek an amendment 277.7to the 1915c home and community-based waivers under Minnesota Statutes, sections 277.8256B.092 and 256B.49, to allow properly licensed residential programs under Minnesota 277.9Statutes, section 245A.02, subdivision 14, to provide residential services to up to eight 277.10individuals with physical or developmental disabilities, chronic illnesses, or traumatic 277.11brain injuries. A facility licensed for five to eight people must be an existing residential 277.12building, such as a duplex, that is owned by the same company and meets all other 277.13licensing requirements.277.14    Subd. 3.Recommendations for personal care assistance service changes.The 277.15commissioner shall consult with stakeholder groups, including counties, advocates, 277.16persons receiving personal care assistance services, and personal care assistance providers, 277.17and make recommendations to the legislature by February 1, 2014, on changes that could 277.18be made to the program to improve oversight, program efficiency, and cost-effectiveness.277.19    Subd. 4.Nursing facility pay-for-performance reimbursement system.277.20The commissioner of human services shall report to the legislative committees with 277.21jurisdiction over nursing facility policy and finance with recommendations for developing 277.22and implementing a pay-for-performance reimbursement system with a quality add-on by 277.23January 15, 2012.277.24    Subd. 5.ICF/MR transition plan.The commissioner of human services shall 277.25work with stakeholders to develop and implement a plan by June 30, 2013, to transition 277.26individuals currently residing in intermediate care facilities for persons with developmental 277.27disabilities into the least restrictive community settings possible. The plan must include a 277.28requirement for a cooperative planning process between the counties and providers for 277.29the downsizing or closure of intermediate care facilities for persons with developmental 277.30disabilities, with funding from the bed closures converting to home and community-based 277.31waiver funding to fund services for those leaving the intermediate care facilities for 277.32persons with developmental disabilities based on a plan approved by the commissioner. In 277.33order to facilitate this process, the commissioner shall provide information to facilities and 277.34counties about the number of people in facilities who have requested to move to home and 277.35community-based services. Individuals residing in intermediate care facilities for persons 277.36with developmental disabilities who choose to remain there or whose health or safety 278.1would be put at risk in a less restrictive setting may continue to reside in intermediate care 278.2facilities for persons with developmental disabilities.278.3    Subd. 6.Representative payee.The commissioner of human services shall make 278.4recommendations to the legislative committees with jurisdiction over health and human 278.5services policy and finance by January 15, 2012, on ways to better manage funds for 278.6persons who rely on a representative payee.278.7    Subd. 7.Autism treatment.The commissioner of human services shall review 278.8autism treatment benefits under the TEFRA option and make recommendations to the 278.9legislative committees with jurisdiction over health and human services policy and finance 278.10by January 1, 2012, to extend the same autism treatment benefits to MA managed care and 278.11county-based purchasing.278.12    Sec. 50. STATE PLAN AMENDMENT TO IMPLEMENT SELF-DIRECTED 278.13PERSONAL SUPPORTS.278.14By July 15, 2011, the commissioner shall submit a state plan amendment to 278.15implement Minnesota Statutes, section 256B.0657, as soon as possible upon federal 278.16approval.278.17    Sec. 51. AMENDMENT FOR SELF-DIRECTED COMMUNITY SUPPORTS.278.18By September 1, 2011, the commissioner shall submit an amendment to the home 278.19and community-based waiver programs consistent with implementing the self-directed 278.20option under Minnesota Statutes, section 256B.0657, through statewide enrolled providers 278.21contracted to provide outreach information, training, and fiscal support entity services to 278.22all eligible recipients choosing this option and with shared care in some types of services. 278.23The waiver amendment shall be consistent with changes in case management services 278.24under Minnesota Statutes, section 256B.092.278.25    Sec. 52. ESTABLISHMENT OF RATES FOR SHARED HOME AND 278.26COMMUNITY-BASED WAIVER SERVICES.278.27By January 1, 2012, the commissioner shall establish rates to begin paying for 278.28in-home services and personal supports under all of the home and community-based 278.29waiver services programs consistent with the standards in Minnesota Statutes, section 278.30256B.4912, subdivision 2.278.31    Sec. 53. ESTABLISHMENT OF RATE FOR CASE MANAGEMENT 278.32SERVICES.279.1By July 1, 2012, the commissioner shall establish the rate to be paid for case 279.2management services under Minnesota Statutes, sections 256B.0621, subdivision 2, clause 279.3(4), 256B.092, and 256B.49, consistent with the standards in Minnesota Statutes, section 279.4256B.4912, subdivision 2.279.5    Sec. 54. RECOMMENDATIONS FOR FURTHER CASE MANAGEMENT 279.6REDESIGN.279.7By February 1, 2012, the commissioner of human services shall develop a legislative 279.8report with specific recommendations and language for proposed legislation to be effective 279.9July 1, 2012, for the following:279.10(1) definitions of service and consolidation of standards and rates to the extent 279.11appropriate for all types of medical assistance case management services, including 279.12targeted case management under Minnesota Statutes, sections 256B.0621; 256B.0625, 279.13subdivision 20; and 256B.0924; mental health case management services for children 279.14and adults, all types of home and community-based waiver case management, and case 279.15management under Minnesota Rules, parts 9525.0004 to 9525.0036. This work shall be 279.16completed in collaboration with efforts under Minnesota Statutes, section 256B.4912;279.17(2) recommendations on county of financial responsibility requirements and quality 279.18assurance measures for case management; 279.19(3) identification of county administrative functions that may remain entwined in 279.20case management service delivery models; and279.21(4) implementation of a methodology to fully fund county case management 279.22administrative functions. 279.23    Sec. 55. MY LIFE, MY CHOICES TASK FORCE.279.24    Subdivision 1.Establishment.The My Life, My Choices Task Force is established 279.25to create a system of supports and services for people with disabilities governed by the 279.26following principles:279.27(1) freedom to act as a consumer of services in the marketplace;279.28(2) freedom to choose to take as much risk as any other citizen;279.29(3) more choices in levels of service that may vary throughout life;279.30(4) opportunity to work with a trusted partner and fiscal support entity to manage a 279.31personal budget and to be accountable for reporting spending and personal outcomes;279.32(5) opportunity to live with minimal constraints instead of minimal freedoms; and279.33(6) ability to consolidate funding streams into an individualized budget.280.1    Subd. 2.Membership.The My Life, My Choices Task Force shall consist of the 280.2lieutenant governor; the commissioner of human services, or designee; a representative of 280.3the Minnesota Chamber of Commerce; and the following to be appointed by the governor: 280.4one administrative law judge, one labor representative, two family members of people 280.5with disabilities, and one individual with disabilities. In addition, the following shall be 280.6appointed jointly by the speaker of the house and the senate Subcommittee on Committees 280.7of the Committee on Rules and Administration, a representative of a disability advocacy 280.8organization; a representative of a disability legal services advocacy organization; 280.9representatives of two nonprofit organizations, one of which serves all 87 counties; and 280.10a representative of a philanthropic organization. Appointed nongovernmental members 280.11of the task force shall serve as staff for the task force and take on the responsibilities of 280.12coordinating meetings, reporting on committee recommendations, and providing other 280.13staff support as needed to meet the responsibilities of the task force as described in 280.14subdivision 3. Legislative appointment of nongovernmental members of the task force 280.15shall be conditioned upon agreement from the appointees to provide staff assistance to 280.16execute the work of the task force. The chairs and ranking minority members of the 280.17legislative committees with jurisdiction over health and human services policy and finance 280.18shall serve as ex officio members.280.19    Subd. 3.Duties.The task force shall make recommendations, including proposed 280.20legislation, and report to the legislative committees with jurisdiction over health and 280.21human services policy and finance by November 15, 2011, on creating a system of 280.22supports and services for people with disabilities by July 1, 2012, as governed by the 280.23principles under subdivision 1. In making recommendations and proposed legislation, the 280.24council shall work in conjunction with the Consumer-Directed Community Supports Task 280.25Force and shall include self-directed planning, individual budgeting, choice of trusted 280.26partner, self-directed purchasing of services and supports, reporting of outcomes, ability 280.27to share in any savings, and any additional rules or laws that may need to be waived. 280.28Recommendations from the task force shall be fully implemented by July 1, 2013.280.29    Subd. 4.Expense reimbursement.The members of the task force shall not be 280.30reimbursed for expenses related to the duties of the task force. The task force shall be 280.31independently staffed and coordinated by nongovernmental appointees who serve on the 280.32task force, and no state funding shall be appropriated for expenses related to the task 280.33force under this section.280.34    Subd. 5.Expiration.The task force expires on July 1, 2013.280.35EFFECTIVE DATE.This section is effective the day following final enactment.281.1ARTICLE 7281.2REDESIGNING SERVICE DELIVERY281.3    Section 1. Minnesota Statutes 2010, section 119B.09, is amended by adding a 281.4subdivision to read:281.5    Subd. 4b.Electronic verification.County agencies are authorized to use all 281.6automated databases containing information regarding recipients' or applicants' income 281.7in order to determine eligibility for the child care assistance under this chapter. The 281.8information is sufficient to determine eligibility.281.9    Sec. 2. Minnesota Statutes 2010, section 256.01, subdivision 14b, is amended to read:281.10    Subd. 14b. American Indian child welfare projects. (a) The commissioner of 281.11human services may authorize projects to test tribal delivery of child welfare services to 281.12American Indian children and their parents and custodians living on the reservation. 281.13The commissioner has authority to solicit and determine which tribes may participate 281.14in a project. Grants may be issued to Minnesota Indian tribes to support the projects. 281.15The commissioner may waive existing state rules as needed to accomplish the projects. 281.16Notwithstanding section 
         626.556, the commissioner may authorize projects to use 281.17alternative methods of investigating and assessing reports of child maltreatment, provided 281.18that the projects comply with the provisions of section 
         626.556 dealing with the rights 281.19of individuals who are subjects of reports or investigations, including notice and appeal 281.20rights and data practices requirements. The commissioner may seek any federal approvals 281.21necessary to carry out the projects as well as seek and use any funds available to the 281.22commissioner, including use of federal funds, foundation funds, existing grant funds, 281.23and other funds. The commissioner is authorized to advance state funds as necessary to 281.24operate the projects. Federal reimbursement applicable to the projects is appropriated 281.25to the commissioner for the purposes of the projects. The projects must be required to 281.26address responsibility for safety, permanency, and well-being of children.281.27(b) For the purposes of this section, "American Indian child" means a person under 281.2818 years of age who is a tribal member or eligible for membership in one of the tribes 281.29chosen for a project under this subdivision and who is residing on the reservation of 281.30that tribe.281.31(c) In order to qualify for an American Indian child welfare project, a tribe must:281.32(1) be one of the existing tribes with reservation land in Minnesota;281.33(2) have a tribal court with jurisdiction over child custody proceedings;282.1(3) have a substantial number of children for whom determinations of maltreatment 282.2have occurred;282.3(4) have capacity to respond to reports of abuse and neglect under section 
         626.556;282.4(5) provide a wide range of services to families in need of child welfare services; and282.5(6) have a tribal-state title IV-E agreement in effect.282.6(d) Grants awarded under this section may be used for the nonfederal costs of 282.7providing child welfare services to American Indian children on the tribe's reservation, 282.8including costs associated with:282.9(1) assessment and prevention of child abuse and neglect;282.10(2) family preservation;282.11(3) facilitative, supportive, and reunification services;282.12(4) out-of-home placement for children removed from the home for child protective 282.13purposes; and282.14(5) other activities and services approved by the commissioner that further the goals 282.15of providing safety, permanency, and well-being of American Indian children.282.16(e) When a tribe has initiated a project and has been approved by the commissioner 282.17to assume child welfare responsibilities for American Indian children of that tribe under 282.18this section, the affected county social service agency is relieved of responsibility for 282.19responding to reports of abuse and neglect under section 
         626.556 for those children 282.20during the time within which the tribal project is in effect and funded. The commissioner 282.21shall work with tribes and affected counties to develop procedures for data collection, 282.22evaluation, and clarification of ongoing role and financial responsibilities of the county 282.23and tribe for child welfare services prior to initiation of the project. Children who have not 282.24been identified by the tribe as participating in the project shall remain the responsibility 282.25of the county. Nothing in this section shall alter responsibilities of the county for law 282.26enforcement or court services.282.27(f) Participating tribes may conduct children's mental health screenings under section 282.28245.4874, subdivision 1
         , paragraph (a), clause (14), for children who are eligible for the 282.29initiative and living on the reservation and who meet one of the following criteria:282.30(1) the child must be receiving child protective services;282.31(2) the child must be in foster care; or282.32(3) the child's parents must have had parental rights suspended or terminated.282.33Tribes may access reimbursement from available state funds for conducting the screenings. 282.34Nothing in this section shall alter responsibilities of the county for providing services 282.35under section 
         245.487.283.1(g) Participating tribes may establish a local child mortality review panel. In 283.2establishing a local child mortality review panel, the tribe agrees to conduct local child 283.3mortality reviews for child deaths or near-fatalities occurring on the reservation under 283.4subdivision 12
         . Tribes with established child mortality review panels shall have access 283.5to nonpublic data and shall protect nonpublic data under 
         subdivision 12, paragraphs (c) 283.6to (e). The tribe shall provide written notice to the commissioner and affected counties 283.7when a local child mortality review panel has been established and shall provide data upon 283.8request of the commissioner for purposes of sharing nonpublic data with members of the 283.9state child mortality review panel in connection to an individual case.283.10(h) The commissioner shall collect information on outcomes relating to child safety, 283.11permanency, and well-being of American Indian children who are served in the projects. 283.12Participating tribes must provide information to the state in a format and completeness 283.13deemed acceptable by the state to meet state and federal reporting requirements.283.14    (i) In consultation with the White Earth Band, the commissioner shall develop 283.15and submit to the chairs and ranking minority members of the legislative committees 283.16with jurisdiction over health and human services a plan to transfer legal responsibility 283.17for providing child protective services to White Earth Band member children residing in 283.18Hennepin County to the White Earth Band. The plan shall include a financing proposal, 283.19definitions of key terms, statutory amendments required, and other provisions required to 283.20implement the plan. The commissioner shall submit the plan by January 15, 2012.283.21    Sec. 3. Minnesota Statutes 2010, section 256.01, is amended by adding a subdivision 283.22to read:283.23    Subd. 14c.American Indian child welfare, social, and human services project; 283.24White Earth Band of Ojibwe.(a) The commissioner of human services shall enter into a 283.25contractual agreement as authorized under subdivision 2, paragraph (a), clause (7), with 283.26the White Earth Band of Ojibwe Indians for the tribe to provide all human services and 283.27public assistance programs that are under the supervision of the commissioner to tribal 283.28members who reside on the reservation. Grants may be issued to the White Earth Band 283.29of Ojibwe Indians to support the project. The commissioner may waive existing rules to 283.30support this project. The commissioner shall seek any federal approvals necessary to carry 283.31out the project as well as seek and use any funds available to the commissioner, including 283.32use of federal funds, foundation funds, existing grant funds, and other funds. The 283.33commissioner is authorized to advance state funds as necessary to operate the projects. 283.34Federal reimbursement applicable to the projects is appropriated to the commissioner for 283.35purposes of the project.284.1(b) The commissioner shall redirect all funds provided to Mahnomen County for 284.2these services, including administrative expenses, to the White Earth Band of Ojibwe 284.3Indians.284.4(c) The commissioner, in consultation with the tribe, is authorized to determine: (1) 284.5which programs not currently provided by the White Earth Band of Ojibwe Indians will be 284.6transferred to the tribe; and (2) the process by which the new programs will be transferred. 284.7In the case of a dispute, a two-thirds vote of the tribal council to transfer a program to 284.8the tribe must overrule the decision of the commissioner.284.9(d) When the commissioner approves transfer of programs and the tribe assumes 284.10responsibility under this section, Mahnomen County is relieved of responsibility for 284.11providing program services to tribal members who live on the reservation while the tribal 284.12project is in effect and funded. The commissioner shall seek and use any funds available, 284.13including federal funds, foundation funds, existing grant funds, and other state funds as 284.14available. 284.15(e) The tribe shall comply with all reporting and record keeping requirements under 284.16state and federal laws and rules.284.17    Sec. 4. [256.0145] COMPUTER SYSTEM SIMPLIFICATION.284.18    Subdivision 1.Reprogram MAXIS.The commissioner of human services, as part 284.19of the enterprise architecture project, shall reprogram the MAXIS computer system to 284.20automatically apply child support payments entered into the PRISM computer system to 284.21a MAXIS case file.284.22    Subd. 2.Program the social service information system.The commissioner of 284.23human services shall require all prepaid health plans to accept a billing format identical to 284.24the MMIS billing format for payment to county agencies for mental health targeted case 284.25management claims, elderly waiver claims, and other claim categories as added to the 284.26benefit set. The commissioner shall make any necessary changes to the SSIS system to 284.27bill prepaid health plans for those claims.284.28    Sec. 5. [256.0147] COUNTY ELECTRONIC VERIFICATION TO DETERMINE 284.29ELIGIBILITY.284.30County agencies are authorized to use all automated databases containing 284.31information regarding recipients' or applicants' income in order to determine eligibility 284.32for child support enforcement, general assistance, Minnesota supplemental aid, and 284.33programs, services, and supports under chapter 256J. The information is sufficient to 284.34determine eligibility. State and county caseworkers shall not be cited in error, as part of 285.1any audit and quality review, for an incorrect eligibility determination based on current but 285.2inaccurate information received through a state-approved electronic data source. If there 285.3is a potential error, the reviewer must forward a corrective action notice to the caseworker 285.4for proper and immediate correction. If the state or county caseworker has data available 285.5through client reporting, or other means, that are more accurate than state-approved 285.6electronic data, the caseworker should use the more accurate information in making the 285.7eligibility determination.285.8    Sec. 6. Minnesota Statutes 2010, section 256B.69, is amended by adding a subdivision 285.9to read:285.10    Subd. 30.Provision of required materials in alternative formats.(a) For the 285.11purposes of this subdivision, "alternative format" means a medium other than paper and 285.12"prepaid health plan" means managed care plans and county-based purchasing plans.285.13(b) A prepaid health plan may provide in an alternative format a provider directory 285.14and certificate of coverage, or materials otherwise required to be available in writing 285.15under Code of Federal Regulations, title 42, section 438.10, or under the commissioner's 285.16contract with the prepaid health plan, if the following conditions are met:285.17(1) the prepaid health plan, local agency, or commissioner, as applicable, informs the 285.18enrollee that:285.19(i) provision in an alternative format is available and the enrollee affirmatively 285.20requests of the prepaid health plan that the provider directory, certificate of coverage, 285.21or materials otherwise required under Code of Federal Regulations, title 42, section 285.22438.10, or under the commissioner's contract with the prepaid health plan be provided in 285.23an alternative format; and285.24(ii) a record of the enrollee request is retained by the prepaid health plan in the 285.25form of written direction from the enrollee or a documented telephone call followed by a 285.26confirmation letter to the enrollee from the prepaid health plan that explains that the 285.27enrollee may change the request at any time;285.28(2) the materials are sent to a secured mailbox and are made available at a 285.29password-protected secured Web site or on a data storage device if the materials contain 285.30enrollee data that is individually identifiable;285.31(3) the enrollee is provided a customer service number on the enrollee's membership 285.32card that may be called to request a paper version of the materials provided in an 285.33alternative format; and285.34(4) the materials provided in an alternative format meet all other requirements of 285.35the commissioner regarding content, size of typeface, and any required time frames for 286.1distribution. "Required time frames for distribution" must permit sufficient time for 286.2prepaid health plans to distribute materials in alternative formats upon receipt of enrollees' 286.3requests for the materials.286.4(c) A prepaid health plan may provide in an alternative format its primary care 286.5network list to the commissioner and to local agencies within its service area. The 286.6commissioner or local agency, as applicable, shall inform a potential enrollee of the 286.7availability of a prepaid health plan's primary care network list in an alternative format. If 286.8the potential enrollee requests an alternative format of the prepaid health plan's primary 286.9care network list, a record of that request shall be retained by the commissioner or local 286.10agency. The potential enrollee is permitted to withdraw the request at any time.286.11The prepaid health plan shall submit sufficient paper versions of the primary 286.12care network list to the commissioner and to local agencies within its service area to 286.13accommodate potential enrollee requests for paper versions of the primary care network 286.14list.286.15(d) A prepaid health plan may provide in an alternative format materials otherwise 286.16required to be available in writing under Code of Federal Regulations, title 42, section 286.17438.10, or under the commissioner's contract with the prepaid health plan, if the conditions 286.18of paragraphs (b), (c), and (e), are met for persons who are:286.19(1) enrolled in integrated Medicare and Medicaid programs under subdivisions 286.2023 and 28;286.21(2) enrolled in managed care long-term care programs under subdivision 6b;286.22(3) dually eligible for Medicare and medical assistance; or286.23(4) in the waiting period for Medicare.286.24(e) The commissioner shall seek any federal Medicaid waivers within 90 days after 286.25the effective date of this subdivision that are necessary to provide alternative formats of 286.26required material to enrollees of prepaid health plans as authorized under this subdivision.286.27(f) The commissioner shall consult with managed care plans, county-based 286.28purchasing plans, counties, and other interested parties to determine how materials 286.29required to be made available to enrollees under Code of Federal Regulations, title 42, 286.30section 438.10, or under the commissioner's contract with a prepaid health plan may 286.31be provided in an alternative format on the basis that the enrollee has not opted in to 286.32receive the alternative format. The commissioner shall consult with managed care 286.33plans, county-based purchasing plans, counties, and other interested parties to develop 286.34recommendations relating to the conditions that must be met for an opt-out process 286.35to be granted.287.1    Sec. 7. Minnesota Statutes 2010, section 256D.09, subdivision 6, is amended to read:287.2    Subd. 6. Recovery of overpayments. (a) If an amount of general assistance or 287.3family general assistance is paid to a recipient in excess of the payment due, it shall be 287.4recoverable by the county agency. The agency shall give written notice to the recipient of 287.5its intention to recover the overpayment.287.6(b) Except as provided for interim assistance in section 256D.06, subdivision 287.75, when an overpayment occurs, the county agency shall recover the overpayment 287.8from a current recipient by reducing the amount of aid payable to the assistance unit of 287.9which the recipient is a member, for one or more monthly assistance payments, until 287.10the overpayment is repaid. All county agencies in the state shall reduce the assistance 287.11payment by three percent of the assistance unit's standard of need in nonfraud cases and 287.12ten percent where fraud has occurred, or the amount of the monthly payment, whichever is 287.13less, for all overpayments.287.14(c) In cases when there is both an overpayment and underpayment, the county 287.15agency shall offset one against the other in correcting the payment.287.16(d) Overpayments may also be voluntarily repaid, in part or in full, by the individual, 287.17in addition to the aid reductions provided in this subdivision, to include further voluntary 287.18reductions in the grant level agreed to in writing by the individual, until the total amount 287.19of the overpayment is repaid.287.20(e) The county agency shall make reasonable efforts to recover overpayments to 287.21persons no longer on assistance under standards adopted in rule by the commissioner 287.22of human services. The county agency need not attempt to recover overpayments of 287.23less than $35 paid to an individual no longer on assistance if the individual does not 287.24receive assistance again within three years, unless the individual has been convicted of 287.25violating section 
         256.98.287.26(f) Establishment of an overpayment is limited to 12 months prior to the month of 287.27discovery due to agency error and six years prior to the month of discovery due to client 287.28error or an intentional program violation determined under section 256.046.287.29    Sec. 8. Minnesota Statutes 2010, section 256D.49, subdivision 3, is amended to read:287.30    Subd. 3. Overpayment of monthly grants and recovery of ATM errors.(a) When 287.31the county agency determines that an overpayment of the recipient's monthly payment 287.32of Minnesota supplemental aid has occurred, it shall issue a notice of overpayment 287.33to the recipient. If the person is no longer receiving Minnesota supplemental aid, the 287.34county agency may request voluntary repayment or pursue civil recovery. If the person is 287.35receiving Minnesota supplemental aid, the county agency shall recover the overpayment 288.1by withholding an amount equal to three percent of the standard of assistance for the 288.2recipient or the total amount of the monthly grant, whichever is less. 288.3(b) Establishment of an overpayment is limited to 12 months from the date of 288.4discovery due to agency error and six years prior to the month of discovery due to client 288.5error or an intentional program violation determined under section 256.046.288.6(c) For recipients receiving benefits via electronic benefit transfer, if the overpayment 288.7is a result of an automated teller machine (ATM) dispensing funds in error to the recipient, 288.8the agency may recover the ATM error by immediately withdrawing funds from the 288.9recipient's electronic benefit transfer account, up to the amount of the error. 288.10(d) Residents of nursing homes, regional treatment centers, andlicensed residential 288.11facilities with negotiated rates shall not have overpayments recovered from their personal 288.12needs allowance.288.13    Sec. 9. Minnesota Statutes 2010, section 256J.38, subdivision 1, is amended to read:288.14    Subdivision 1. Scope of overpayment.(a) When a participant or former participant 288.15receives an overpayment due to agency, client, or ATM error, or due to assistance received 288.16while an appeal is pending and the participant or former participant is determined 288.17ineligible for assistance or for less assistance than was received, the county agency must 288.18recoup or recover the overpayment using the following methods:288.19(1) reconstruct each affected budget month and corresponding payment month;288.20(2) use the policies and procedures that were in effect for the payment month; and288.21(3) do not allow employment disregards in section 
         256J.21, subdivision 3 or 4, in the 288.22calculation of the overpayment when the unit has not reported within two calendar months 288.23following the end of the month in which the income was received. 288.24(b) Establishment of an overpayment is limited to 12 months prior to the month of 288.25discovery due to agency error and six years prior to the month of discovery due to client 288.26error or an intentional program violation determined under section 256.046.288.27    Sec. 10. Minnesota Statutes 2010, section 393.07, subdivision 10, is amended to read:288.28    Subd. 10. Food stamp program; Maternal and Child Nutrition Act. (a) The local 288.29social services agency shall establish and administer the food stamp program according 288.30to rules of the commissioner of human services, the supervision of the commissioner as 288.31specified in section 
         256.01, and all federal laws and regulations. The commissioner of 288.32human services shall monitor food stamp program delivery on an ongoing basis to ensure 288.33that each county complies with federal laws and regulations. Program requirements to be 288.34monitored include, but are not limited to, number of applications, number of approvals, 289.1number of cases pending, length of time required to process each application and deliver 289.2benefits, number of applicants eligible for expedited issuance, length of time required 289.3to process and deliver expedited issuance, number of terminations and reasons for 289.4terminations, client profiles by age, household composition and income level and sources, 289.5and the use of phone certification and home visits. The commissioner shall determine the 289.6county-by-county and statewide participation rate.289.7(b) On July 1 of each year, the commissioner of human services shall determine a 289.8statewide and county-by-county food stamp program participation rate. The commissioner 289.9may designate a different agency to administer the food stamp program in a county if the 289.10agency administering the program fails to increase the food stamp program participation 289.11rate among families or eligible individuals, or comply with all federal laws and regulations 289.12governing the food stamp program. The commissioner shall review agency performance 289.13annually to determine compliance with this paragraph.289.14(c) A person who commits any of the following acts has violated section 
         256.98 or 289.15609.821
         , or both, and is subject to both the criminal and civil penalties provided under 289.16those sections:289.17(1) obtains or attempts to obtain, or aids or abets any person to obtain by means of a 289.18willful statement or misrepresentation, or intentional concealment of a material fact, food 289.19stamps or vouchers issued according to sections 
         145.891 to 
         145.897 to which the person 289.20is not entitled or in an amount greater than that to which that person is entitled or which 289.21specify nutritional supplements to which that person is not entitled; or289.22(2) presents or causes to be presented, coupons or vouchers issued according to 289.23sections 
         145.891 to 
         145.897 for payment or redemption knowing them to have been 289.24received, transferred or used in a manner contrary to existing state or federal law; or289.25(3) willfully uses, possesses, or transfers food stamp coupons, authorization to 289.26purchase cards or vouchers issued according to sections 
         145.891 to 
         145.897 in any manner 289.27contrary to existing state or federal law, rules, or regulations; or289.28(4) buys or sells food stamp coupons, authorization to purchase cards, other 289.29assistance transaction devices, vouchers issued according to sections 
         145.891 to 
         145.897, 289.30or any food obtained through the redemption of vouchers issued according to sections 289.31145.891
          to 
         145.897 for cash or consideration other than eligible food.289.32(d) A peace officer or welfare fraud investigator may confiscate food stamps, 289.33authorization to purchase cards, or other assistance transaction devices found in the 289.34possession of any person who is neither a recipient of the food stamp program nor 289.35otherwise authorized to possess and use such materials. Confiscated property shall be 289.36disposed of as the commissioner may direct and consistent with state and federal food 290.1stamp law. The confiscated property must be retained for a period of not less than 30 days 290.2to allow any affected person to appeal the confiscation under section 
         256.045.290.3(e) Food stamp overpayment claims which are due in whole or in part to client error 290.4shall be established by the county agency for a period of six years from the date of any 290.5resultant overpayment Establishment of an overpayment is limited to 12 months prior to 290.6the month of discovery due to agency error and six years prior to the month of discovery 290.7due to client error or an intentional program violation determined under section 256.046.290.8(f) With regard to the federal tax revenue offset program only, recovery incentives 290.9authorized by the federal food and consumer service shall be retained at the rate of 50 290.10percent by the state agency and 50 percent by the certifying county agency.290.11(g) A peace officer, welfare fraud investigator, federal law enforcement official, 290.12or the commissioner of health may confiscate vouchers found in the possession of any 290.13person who is neither issued vouchers under sections 
         145.891 to 
         145.897, nor otherwise 290.14authorized to possess and use such vouchers. Confiscated property shall be disposed of 290.15as the commissioner of health may direct and consistent with state and federal law. The 290.16confiscated property must be retained for a period of not less than 30 days.290.17(h) The commissioner of human services may seek a waiver from the United States 290.18Department of Agriculture to allow the state to specify foods that may and may not be 290.19purchased in Minnesota with benefits funded by the federal Food Stamp Program. The 290.20commissioner shall consult with the members of the house of representatives and senate 290.21policy committees having jurisdiction over food support issues in developing the waiver. 290.22The commissioner, in consultation with the commissioners of health and education, shall 290.23develop a broad public health policy related to improved nutrition and health status. The 290.24commissioner must seek legislative approval prior to implementing the waiver.290.25    Sec. 11. Minnesota Statutes 2010, section 402A.10, subdivision 4, is amended to read:290.26    Subd. 4. Essential human services or essential services. "Essential human 290.27services" or "essential services" means assistance and services to recipients or potential 290.28recipients of public welfare and other services delivered by counties or tribes that are 290.29mandated in federal and state law that are to be available in all counties of the state.290.30    Sec. 12. Minnesota Statutes 2010, section 402A.10, subdivision 5, is amended to read:290.31    Subd. 5. Service delivery authority. "Service delivery authority" means a single 290.32county, or group consortium of counties operating by execution of a joint powers 290.33agreement under section 
         471.59 or other contractual agreement, that has voluntarily 290.34chosen by resolution of the county board of commissioners to participate in the redesign 291.1under this chapter or has been assigned by the commissioner pursuant to section 402A.18. 291.2A service delivery authority includes an Indian tribe or group of tribes that have voluntarily 291.3chosen by resolution of tribal government to participate in redesign under this chapter.291.4    Sec. 13. Minnesota Statutes 2010, section 402A.15, is amended to read:291.5402A.15 STEERING COMMITTEE ON PERFORMANCE AND OUTCOME 291.6REFORMS.291.7    Subdivision 1. Duties. (a) The Steering Committee on Performance and Outcome 291.8Reforms shall develop a uniform process to establish and review performance and outcome 291.9standards for all essential human services based on the current level of resources available, 291.10and to shall develop appropriate reporting measures and a uniform accountability process 291.11for responding to a county's or human service delivery authority's failure to make adequate 291.12progress on achieving performance measures. The accountability process shall focus on 291.13the performance measures rather than inflexible implementation requirements.291.14(b) The steering committee shall:291.15(1) by November 1, 2009, establish an agreed-upon list of essential services;291.16(2) by February 15, 2010, develop and recommend to the legislature a uniform, 291.17graduated process, in addition to the remedies identified in section 
         402A.18, for responding 291.18to a county's failure to make adequate progress on achieving performance measures; and291.19(3) by December 15, 2012, for each essential service, make recommendations 291.20to the legislature regarding (1) (i) performance measures and goals based on those 291.21measures for each essential service, (2) and (ii) a system for reporting on the performance 291.22measures and goals, and (3) appropriate resources, including funding, needed to achieve 291.23those performance measures and goals. The resource recommendations shall take into 291.24consideration program demand and the unique differences of local areas in geography and 291.25the populations served. Priority shall be given to services with the greatest variation in 291.26availability and greatest administrative demands. By January 15 of each year starting 291.27January 15, 2011, the steering committee shall report its recommendations to the governor 291.28and legislative committees with jurisdiction over health and human services. As part of its 291.29report, the steering committee shall, as appropriate, recommend statutory provisions, rules 291.30and requirements, and reports that should be repealed or eliminated.291.31(c) As far as possible, the performance measures, reporting system, and funding 291.32shall be consistent across program areas. The development of performance measures shall 291.33consider the manner in which data will be collected and performance will be reported. 291.34The steering committee shall consider state and local administrative costs related to 291.35collecting data and reporting outcomes when developing performance measures. The 292.1steering committee shall correlate the performance measures and goals to available levels 292.2of resources, including state and local funding. The steering committee shall also identify 292.3and incorporate federal performance measures in its recommendations for those program 292.4areas where federal funding is contingent on meeting federal performance standards. The 292.5steering committee shall take into consideration that the goal of implementing changes 292.6to program monitoring and reporting the progress toward achieving outcomes is to 292.7significantly minimize the cost of administrative requirements and to allow funds freed 292.8by reduced administrative expenditures to be used to provide additional services, allow 292.9flexibility in service design and management, and focus energies on achieving program 292.10and client outcomes.292.11(d) In making its recommendations, the steering committee shall consider input from 292.12the council established in section 
         402A.20. The steering committee shall review the 292.13measurable goals established in a memorandum of understanding entered into under 292.14section 402A.30, subdivision 2, paragraph (b), and consider whether they may be applied 292.15as statewide performance outcomes.292.16(e) The steering committee shall form work groups that include persons who provide 292.17or receive essential services and representatives of organizations who advocate on behalf 292.18of those persons.292.19(f) By December 15, 2009, the steering committee shall establish a three-year 292.20schedule for completion of its work. The schedule shall be published on the Department of 292.21Human Services Web site and reported to the legislative committees with jurisdiction over 292.22health and human services. In addition, the commissioner shall post quarterly updates on 292.23the progress of the steering committee on the Department of Human Services Web site.292.24    Subd. 2. Composition. (a) The steering committee shall include:292.25(1) the commissioner of human services, or designee, and two additional 292.26representatives of the department;292.27(2) two county commissioners, representative of rural and urban counties, selected 292.28by the Association of Minnesota Counties;292.29(3) two county directors of human services, representative of rural and urban 292.30counties, selected by the Minnesota Association of County Social Service Administrators; 292.31and292.32(4) three clients or client advocates representing different populations receiving 292.33services from the Department of Human Services, who are appointed by the commissioner.292.34(b) The commissioner, or designee, and a county commissioner shall serve as 292.35cochairs of the committee. The committee shall be convened within 60 days of May 292.3615, 2009.293.1(c) State agency staff shall serve as informational resources and staff to the steering 293.2committee. Statewide county associations may assemble county program data as required.293.3(d) To promote information sharing and coordination between the steering committee 293.4and council, one of the county representatives from paragraph (a), clause (2), and one of the 293.5county representatives from paragraph (a), clause (3), must also serve as a representative 293.6on the council under section 402A.20, subdivision 1, paragraph (b), clause (5) or (6).293.7    Sec. 14. Minnesota Statutes 2010, section 402A.18, is amended to read:293.8402A.18 COMMISSIONER POWER TO REMEDY FAILURE TO MEET 293.9PERFORMANCE OUTCOMES.293.10    Subdivision 1. Underperforming county; specific service. If the commissioner 293.11determines that a county or service delivery authority is deficient in achieving minimum 293.12performance outcomes for a specific essential service, the commissioner may impose the 293.13following remedies and adjust state and federal program allocations accordingly:293.14(1) voluntary incorporation of the administration and operation of the specific 293.15essential service with an existing service delivery authority or another county. A 293.16service delivery authority or county incorporating an underperforming county shall 293.17not be financially liable for the costs associated with remedying performance outcome 293.18deficiencies;293.19(2) mandatory incorporation of the administration and operation of the specific 293.20essential service with an existing service delivery authority or another county. A 293.21service delivery authority or county incorporating an underperforming county shall 293.22not be financially liable for the costs associated with remedying performance outcome 293.23deficiencies; or 293.24(3) transfer of authority for program administration and operation of the specific 293.25essential service to the commissioner.293.26    Subd. 2. Underperforming county; more than one-half of service services. If 293.27the commissioner determines that a county or service delivery authority is deficient in 293.28achieving minimum performance outcomes for more than one-half of the defined essential 293.29service services, the commissioner may impose the following remedies:293.30(1) voluntary incorporation of the administration and operation of the specific293.31essential service services with an existing service delivery authority or another county. 293.32A service delivery authority or county incorporating an underperforming county shall 293.33not be financially liable for the costs associated with remedying performance outcome 293.34deficiencies;294.1(2) mandatory incorporation of the administration and operation of the specific294.2essential service services with an existing service delivery authority or another county. 294.3A service delivery authority or county incorporating an underperforming county shall 294.4not be financially liable for the costs associated with remedying performance outcome 294.5deficiencies; or 294.6(3) transfer of authority for program administration and operation of the specific294.7essential service services to the commissioner.294.8    Subd. 2a.Financial responsibility of underperforming county.A county subject 294.9to remedies under subdivision 1 or 2 shall provide to the entity assuming administration of 294.10the essential service or essential services the amount of nonfederal and nonstate funding 294.11needed to remedy performance outcome deficiencies.294.12    Subd. 3. Conditions prior to imposing remedies. Before the commissioner may 294.13impose the remedies authorized under this section, the following conditions must be met:294.14(1) the county or service delivery authority determined by the commissioner 294.15to be deficient in achieving minimum performance outcomes has the opportunity, in 294.16coordination with the council, to develop a program outcome improvement plan. The 294.17program outcome improvement plan must be developed no later than six months from the 294.18date of the deficiency determination; and294.19(2) the council has conducted an assessment of the program outcome improvement 294.20plan to determine if the county or service delivery authority has made satisfactory 294.21progress toward performance outcomes and has made a recommendation about remedies 294.22to the commissioner. The review assessment and recommendation must be made to the 294.23commissioner within 12 months from the date of the deficiency determination.294.24    Sec. 15. Minnesota Statutes 2010, section 402A.20, is amended to read:294.25402A.20 COUNCIL.294.26    Subdivision 1. Council. (a) The State-County Results, Accountability, and Service 294.27Delivery Redesign Council is established. Appointed council members must be appointed 294.28by their respective agencies, associations, or governmental units by November 1, 2009. 294.29The council shall be cochaired by the commissioner of human services, or designee, and a 294.30county representative from paragraph (b), clause (4) or (5), appointed by the Association 294.31of Minnesota Counties. Recommendations of the council must be approved by a majority 294.32of the voting council members. The provisions of section 
         15.059 do not apply to this 294.33council, and this council does not expire.294.34(b) The council must consist of the following members:295.1(1) two legislators appointed by the speaker of the house, one from the minority 295.2and one from the majority;295.3(2) two legislators appointed by the Senate Rules Committee, one from the majority 295.4and one from the minority;295.5(3) the commissioner of human services, or designee, and three employees from 295.6the department;295.7(4) two county commissioners appointed by the Association of Minnesota Counties;295.8(5) two county representatives appointed by the Minnesota Association of County 295.9Social Service Administrators; 295.10(6) one representative appointed by AFSCME as a nonvoting member; and295.11(7) one representative appointed by the Teamsters as a nonvoting member.295.12(c) Administrative support to the council may be provided by the Association of 295.13Minnesota Counties and affiliates.295.14(d) Member agencies and associations are responsible for initial and subsequent 295.15appointments to the council.295.16    Subd. 2. Council duties. The council shall:295.17(1) provide review of the service delivery redesign process, including proposed 295.18memoranda of understanding to establish a service delivery authority to conduct and 295.19administer experimental projects to test new methods and procedures of delivering 295.20services;295.21(2) certify, in accordance with section 402A.30, subdivision 4, the formation of 295.22a service delivery authority, including the memorandum of understanding in section 295.23402A.30, subdivision 2, paragraph (b);295.24(3) ensure the consistency of the memorandum of understanding entered into 295.25under section 402A.30, subdivision 2, paragraph (b), with the performance standards 295.26recommended by the steering committee and enacted by the legislature;295.27(4) (2) ensure the consistency of the memorandum of understanding, to the extent 295.28appropriate, or with other memorandum of understanding entered into by other service 295.29delivery authorities; 295.30(3) review and make recommendations on applications from a service delivery 295.31authority for waivers of statutory or rule program requirements that are needed for 295.32flexibility to determine the most cost-effective means of achieving specified measurable 295.33goals in a redesign of human services delivery;295.34(5) (4) establish a process to take public input on the service delivery framework 295.35specified in the memorandum of understanding in section 402A.30, subdivision 2, 296.1paragraph (b) scope of essential services over which a service delivery authority has 296.2jurisdiction;296.3(6) (5) form work groups as necessary to carry out the duties of the council under the 296.4redesign;296.5(7) (6) serve as a forum for resolving conflicts among participating counties and 296.6tribes or between participating counties or tribes and the commissioner of human services, 296.7provided nothing in this section is intended to create a formal binding legal process;296.8(8) (7) engage in the program improvement process established in section 
         402A.18, 296.9subdivision 3; and296.10(9) (8) identify and recommend incentives for counties and tribes to participate in 296.11human services service delivery authorities.296.12    Subd. 3.Program evaluation.By December 15, 2014, the council shall request 296.13consideration by the legislative auditor for a reevaluation under section 3.971, subdivision 296.147, of those aspects of the program evaluation of human services administration reported 296.15in January 2007 affected by this chapter.296.16    Sec. 16. [402A.35] DESIGNATION OF SERVICE DELIVERY AUTHORITY.296.17    Subdivision 1.Requirements for establishing a service delivery authority.296.18(a) A county, tribe, or consortium of counties is eligible to establish a service delivery 296.19authority if:296.20(1) the county, tribe, or consortium of counties is:296.21(i) a single county with a population of 55,000 or more;296.22(ii) a consortium of counties with a total combined population of 55,000 or more;296.23(iii) a consortium of four or more counties in reasonable geographic proximity 296.24without regard to population; or296.25(iv) one or more tribes with a total combined population of 25,000 or more.296.26The council may recommend that the commissioner of human services exempt a 296.27single county, tribe, or consortium of counties from the minimum population standard if 296.28the county, tribe, or consortium of counties can demonstrate that it can otherwise meet 296.29the requirements of this chapter.296.30(b) A service delivery authority shall:296.31(1) comply with current state and federal law, including any existing federal or state 296.32performance measures and performance measures under section 402A.15 when they are 296.33enacted into law, except where waivers are approved by the commissioner. Nothing 296.34in this subdivision requires the establishment of performance measures under section 297.1402A.15 prior to a service delivery authority participating in the service delivery redesign 297.2under this chapter;297.3(2) define the scope of essential services over which the service delivery authority 297.4has jurisdiction;297.5(3) designate a single administrative structure to oversee the delivery of those 297.6services included in a proposal for a redesigned service or services and identify a single 297.7administrative agent for purposes of contact and communication with the department;297.8(4) identify the waivers from statutory or rule program requirements that are needed 297.9to ensure greater local control and flexibility to determine the most cost-effective means of 297.10achieving specified measurable goals that the participating service delivery authority is 297.11expected to achieve;297.12(5) set forth a reasonable level of targeted reductions in overhead and administrative 297.13costs for each service delivery authority participating in the service delivery redesign; and297.14(6) set forth the terms under which a county, tribe, or consortium of counties may 297.15withdraw from participation.297.16(c) Once a county, tribe, or consortium of counties establishes a service delivery 297.17authority, no county, tribe, or consortium of counties that is a member of the service 297.18delivery authority may participate as a member of any other service delivery authority. 297.19The service delivery authority may allow an additional county, a tribe, or a consortium of 297.20counties to join the service delivery authority subject to the approval of the council and 297.21the commissioner.297.22(d) Nothing in this chapter precludes local governments from using sections 465.81 297.23and 465.82 to establish procedures for local governments to merge, with the consent 297.24of the voters. Nothing in this chapter limits the authority of a county board or tribal 297.25council to enter into contractual agreements for services not covered by the provisions 297.26of a memorandum of understanding establishing a service delivery authority with other 297.27agencies or with other units of government.297.28    Subd. 2.Relief from statutory requirements.(a) Unless otherwise identified in 297.29the memorandum of understanding, any county, tribe, or consortium of counties forming a 297.30service delivery authority is exempt from the provisions of sections 245.465; 245.4835; 297.31245.4874; 245.492, subdivision 2; 245.4932; 256F.13; 256J.626, subdivision 2, paragraph 297.32(b); and 256M.30.297.33(b) This subdivision does not preclude any county, tribe, or consortium of counties 297.34forming a service delivery authority from requesting additional waivers from statutory and 297.35rule requirements to ensure greater local control and flexibility.297.36    Subd. 3.Duties.The service delivery authority shall:298.1(1) within the scope of essential services set forth in the memorandum of 298.2understanding establishing the authority, carry out the responsibilities required of local 298.3agencies under chapter 393 and human services boards under chapter 402;298.4(2) manage the public resources devoted to human services and other public services 298.5delivered or purchased by the counties or tribes that are subsidized or regulated by the 298.6Department of Human Services under chapters 245 to 261;298.7(3) employ staff to assist in carrying out its duties;298.8(4) develop and maintain a continuity of operations plan to ensure the continued 298.9operation or resumption of essential human services functions in the event of any business 298.10interruption according to local, state, and federal emergency planning requirements;298.11(5) receive and expend funds received for the redesign process under the 298.12memorandum of understanding;298.13(6) plan and deliver services directly or through contract with other governmental, 298.14tribal, or nongovernmental providers;298.15(7) rent, purchase, sell, and otherwise dispose of real and personal property as 298.16necessary to carry out the redesign; and298.17(8) carry out any other service designated as a responsibility of a county.298.18    Subd. 4.Process for establishing a service delivery authority.(a) The county, 298.19tribe, or consortium of counties meeting the requirements of section 402A.30 and 298.20proposing to establish a service delivery authority shall present to the council:298.21(1) in conjunction with the commissioner, a proposed memorandum of understanding 298.22meeting the requirements of subdivision 1, paragraph (b), and outlining:298.23(i) the details of the proposal;298.24(ii) the state, tribal, and local resources, which may include, but are not limited to, 298.25funding, administrative and technology support, and other requirements necessary for 298.26the service delivery authority; and298.27(iii) the relief available to the service delivery authority if the resource commitments 298.28identified in item (ii) are not met; and298.29(2) a board resolution from the board of commissioners of each participating county 298.30stating the county's intent to participate, or in the case of a tribe, a resolution from tribal 298.31government, stating the tribe's intent to participate.298.32(b) After the council has considered and recommended approval of a proposed 298.33memorandum of understanding, the commissioner may finalize and execute the 298.34memorandum of understanding.298.35    Subd. 5.Commissioner authority to seek waivers.The commissioner may use the 298.36authority under section 256.01, subdivision 2, paragraph (l), to grant waivers identified as 299.1part of a proposed service delivery authority under subdivision 1, paragraph (b), clause 299.2(4), except that waivers granted under this section must be approved by the council under 299.3section 402A.20 rather than the Legislative Advisory Committee.299.4    Sec. 17. ALIGNMENT OF VERIFICATION AND REDETERMINATION 299.5POLICIES.299.6The commissioner of human services shall develop recommendations to align 299.7eligibility verification procedures for all health care, economic assistance, food support, 299.8child support enforcement, and child care programs. The commissioner shall report back 299.9to the chairs of the legislative committees with jurisdiction over these issues by January 299.1015, 2012, with recommendations and draft legislation to implement the alignment of 299.11eligibility verifications.299.12    Sec. 18. ALTERNATIVE STRATEGIES FOR CERTAIN 299.13REDETERMINATIONS.299.14The commissioner of human services shall develop and implement by January 15, 299.152012, a simplified process to redetermine eligibility for recipient populations in the medical 299.16assistance, Minnesota supplemental aid, food support, and group residential housing 299.17programs who are eligible based upon disability, age, or chronic medical conditions, and 299.18who are expected to experience minimal change in income or assets from month to month. 299.19The commissioner shall apply for any federal waivers needed to implement this section.299.20    Sec. 19. SIMPLIFICATION OF ELIGIBILITY AND ENROLLMENT 299.21PROCESS.299.22    Subdivision 1.Request for proposal.(a) The commissioner of human services 299.23shall issue a request for proposals for a contract to create an implementation plan for 299.24an integrated service delivery framework including, at a minimum, all service delivery 299.25components specified in paragraph (f). The implementation plan shall include proposed 299.26implementation phasing with implementation timelines, estimated costs and savings 299.27associated with each implementation phase, tasks related to obtaining federal financial 299.28participation, and a draft of the first implementation request for proposals that will be 299.29issued. The first implementation request for proposals shall be for implementation of a 299.30phased-in integrated online eligibility and application portal for health care programs, 299.31food support, cash assistance, and child care. The implementation request for proposals 299.32may incorporate a performance-based vendor financing option in which the vendor shares 299.33the risk of the project's success. The health care portal must be developed in phases with 300.1the capacity to integrate food support, cash assistance, and child care programs as funds 300.2are available. The request for proposals must require that the system recommended and 300.3implemented by the contractor:300.4    (1) streamline eligibility determinations and case processing to support statewide 300.5eligibility processing. Responses to the request for proposals must specify components of 300.6the service delivery framework the proposal addresses and the expected administrative 300.7savings;300.8    (2) enable interested persons to determine eligibility for each program, and to apply 300.9for programs online in a manner that the applicant will be asked only those questions 300.10relevant to the programs for which the person is applying;300.11    (3) leverage technology that has been operational in other state environments with 300.12similar requirements; and300.13    (4) include Web-based application, worker application processing support, and the 300.14opportunity for expansion. Responses to the request for proposals must indicate how 300.15future expansion can include remaining service delivery components as specified in 300.16paragraph (f).300.17    (b) The commissioner shall issue a final report, including the implementation 300.18plan and first implementation request for proposals, to the chairs and ranking minority 300.19members of the legislative committees with jurisdiction over health and human services 300.20no later than April 30, 2012.300.21    (c) The commissioner shall partner with counties, a service delivery authority 300.22established under Minnesota Statutes, chapter 402A, the Office of Enterprise Technology, 300.23other state agencies, and service partners to develop an integrated service delivery 300.24framework which will simplify and streamline human services eligibility and enrollment 300.25processes. The primary objectives for the simplification effort include significantly 300.26improved eligibility processing productivity resulting in reduced time for eligibility 300.27determination and enrollment, increased customer service for applicants and recipients of 300.28services, increased program integrity, and greater administrative flexibility.300.29    (d) The commissioner shall develop a service-oriented business architecture 300.30for a fully automated medical, cash support, food support, and child care eligibility 300.31and enrollment process that aligns with, and supports, the business processes. The 300.32commissioner shall use the eligibility and enrollment business architecture to create an 300.33integrated and collaborative service delivery framework for evolving or maintaining 300.34existing information technology and acquiring new information technology. The agency's 300.35plan and program for creating the business architecture and integrated service delivery 300.36framework shall include counties, service delivery authorities, collaborative partners, 301.1the Office of Enterprise Technology, and end-users in the delivery of human services. 301.2An Enterprise Architecture Board shall govern these efforts and shall be chaired by the 301.3commissioner.301.4    (e) The commissioner will ensure agency compliance with the prompt, efficient, and 301.5effective implementation of these governance provisions and specific service delivery 301.6components. The commissioner, along with a county representative appointed by the 301.7Association of Minnesota Counties, shall report specific implementation progress to the 301.8legislature every six months beginning January 15, 2012.301.9    (f) The commissioner shall work with the Minnesota Association of County Social 301.10Service Administrators and the Office of Enterprise Technology to develop collaborative 301.11task forces, as necessary, to support implementation of these service delivery components. 301.12The commissioner must develop and include, as part of the integrated eligibility and 301.13enrollment service delivery framework, the following:301.14    (1) screening tools for applicants to determine potential eligibility as part of an 301.15online application process;301.16    (2) the capacity to use databases to electronically verify application and renewal 301.17data as required by law;301.18    (3) online accounts accessible by applicants, enrollees, and third parties acting on 301.19behalf of applicants and enrollees. At a minimum, online accounts must contain date of 301.20application, application data, status of eligibility determination, premium and spenddown 301.21amounts and due dates, recertification dates, required verifications, and supplemental 301.22information. These accounts must be a component of a self-service Web site that includes 301.23the capacity for online application and renewal;301.24    (4) recertification forms prepopulated with name, case number, eligibility data, 301.25and a bar code for use statewide;301.26    (5) an Interactive Voice Response system, available statewide, that provides case 301.27information for applicants, enrollees, and authorized third parties;301.28    (6) a statewide electronic document management system that provides seamless 301.29electronic transfer of all documents required for eligibility and enrollment processes. All 301.30entities processing eligibility and enrollment within the state shall use the electronic 301.31document management system to accept and transfer any eligibility and enrollment 301.32documents. Processing entities include the state, counties, service delivery authorities 301.33established under Minnesota Statutes, chapter 402A, and authorized third parties. 301.34The electronic document management system must interface with existing document 301.35management systems and automated eligibility systems. Agency produced documents will 301.36contain bar codes that must be used by all eligibility processing entities; and302.1    (7) a centralized customer contact center that applicants, enrollees, and authorized 302.2third parties can use statewide to receive program information, application assistance, and 302.3case information; to report changes; to make cost-sharing payments; and conduct other 302.4eligibility and enrollment transactions.302.5    (g) All provisions in paragraph (f) must be fully integrated as part of any automated 302.6eligibility systems. The commissioner must seek federal financial participation to fund 302.7system development.302.8    Subd. 2.Appropriation.$200,000 is appropriated to the commissioner from the 302.9general fund for implementation of this section.302.10EFFECTIVE DATE.This section is effective the day following final enactment.302.11    Sec. 20.  REPEALER.302.12(a) Minnesota Statutes 2010, sections 402A.30; and 402A.45, are repealed.302.13(b) Minnesota Rules, part 9500.1243, subpart 3, is repealed.302.14ARTICLE 8302.15CHEMICAL AND MENTAL HEALTH302.16    Section 1. Minnesota Statutes 2010, section 245.50, is amended to read:302.17245.50 INTERSTATE CONTRACTS, MENTAL HEALTH, CHEMICAL 302.18HEALTH, DETOXIFICATION SERVICES.302.19    Subdivision 1. Definitions. For purposes of this section, the following terms have 302.20the meanings given them.302.21    (a) "Bordering state" means Iowa, North Dakota, South Dakota, or Wisconsin.302.22    (b) "Receiving agency" means a public or private hospital, mental health center, 302.23chemical health treatment facility, detoxification facility, or other person or organization 302.24which provides mental health or, chemical health, or detoxification services under this 302.25section to individuals from a state other than the state in which the agency is located.302.26    (c) "Receiving state" means the state in which a receiving agency is located.302.27    (d) "Sending agency" means a state or county agency which sends an individual to a 302.28bordering state for treatment or detoxification under this section.302.29    (e) "Sending state" means the state in which the sending agency is located.302.30    Subd. 2. Purpose and authority. (a) The purpose of this section is to enable 302.31appropriate treatment or detoxification services to be provided to individuals, across state 302.32lines from the individual's state of residence, in qualified facilities that are closer to the 302.33homes of individuals than are facilities available in the individual's home state.303.1    (b) Unless prohibited by another law and subject to the exceptions listed in 303.2subdivision 3, a county board or the commissioner of human services may contract 303.3with an agency or facility in a bordering state for mental health or, chemical health, or 303.4detoxification services for residents of Minnesota, and a Minnesota mental health or,303.5chemical health, or detoxification agency or facility may contract to provide services to 303.6residents of bordering states. Except as provided in subdivision 5, a person who receives 303.7services in another state under this section is subject to the laws of the state in which 303.8services are provided. A person who will receive services in another state under this 303.9section must be informed of the consequences of receiving services in another state, 303.10including the implications of the differences in state laws, to the extent the individual will 303.11be subject to the laws of the receiving state.303.12    Subd. 3. Exceptions. A contract may not be entered into under this section for 303.13services to persons who:303.14    (1) are serving a sentence after conviction of a criminal offense;303.15    (2) are on probation or parole;303.16    (3) are the subject of a presentence investigation; or303.17    (4) have been committed involuntarily in Minnesota under chapter 253B for 303.18treatment of mental illness or chemical dependency, except as provided under subdivision 303.195.303.20    Subd. 4. Contracts. Contracts entered into under this section must, at a minimum:303.21    (1) describe the services to be provided;303.22    (2) establish responsibility for the costs of services;303.23    (3) establish responsibility for the costs of transporting individuals receiving 303.24services under this section;303.25    (4) specify the duration of the contract;303.26    (5) specify the means of terminating the contract;303.27    (6) specify the terms and conditions for refusal to admit or retain an individual; and303.28    (7) identify the goals to be accomplished by the placement of an individual under 303.29this section.303.30    Subd. 5. Special contracts; bordering states. (a) An individual who is detained, 303.31committed, or placed on an involuntary basis under chapter 253B may be confined or 303.32treated in a bordering state pursuant to a contract under this section. An individual 303.33who is detained, committed, or placed on an involuntary basis under the civil law of a 303.34bordering state may be confined or treated in Minnesota pursuant to a contract under 303.35this section. A peace or health officer who is acting under the authority of the sending 303.36state may transport an individual to a receiving agency that provides services pursuant to 304.1a contract under this section and may transport the individual back to the sending state 304.2under the laws of the sending state. Court orders valid under the law of the sending state 304.3are granted recognition and reciprocity in the receiving state for individuals covered by 304.4a contract under this section to the extent that the court orders relate to confinement for 304.5treatment or care of mental illness or, chemical dependency, or detoxification. Such 304.6treatment or care may address other conditions that may be co-occurring with the mental 304.7illness or chemical dependency. These court orders are not subject to legal challenge in 304.8the courts of the receiving state. Individuals who are detained, committed, or placed under 304.9the law of a sending state and who are transferred to a receiving state under this section 304.10continue to be in the legal custody of the authority responsible for them under the law 304.11of the sending state. Except in emergencies, those individuals may not be transferred, 304.12removed, or furloughed from a receiving agency without the specific approval of the 304.13authority responsible for them under the law of the sending state.304.14    (b) While in the receiving state pursuant to a contract under this section, an 304.15individual shall be subject to the sending state's laws and rules relating to length of 304.16confinement, reexaminations, and extensions of confinement. No individual may be sent 304.17to another state pursuant to a contract under this section until the receiving state has 304.18enacted a law recognizing the validity and applicability of this section.304.19    (c) If an individual receiving services pursuant to a contract under this section leaves 304.20the receiving agency without permission and the individual is subject to involuntary 304.21confinement under the law of the sending state, the receiving agency shall use all 304.22reasonable means to return the individual to the receiving agency. The receiving agency 304.23shall immediately report the absence to the sending agency. The receiving state has the 304.24primary responsibility for, and the authority to direct, the return of these individuals 304.25within its borders and is liable for the cost of the action to the extent that it would be 304.26liable for costs of its own resident.304.27    (d) Responsibility for payment for the cost of care remains with the sending agency.304.28    (e) This subdivision also applies to county contracts under subdivision 2 which 304.29include emergency care and treatment provided to a county resident in a bordering state.304.30    (f) If a Minnesota resident is admitted to a facility in a bordering state under this 304.31chapter, a physician, licensed psychologist who has a doctoral degree in psychology, or 304.32an advance practice registered nurse certified in mental health, who is licensed in the 304.33bordering state, may act as an examiner under sections 
         253B.07, 
         253B.08, 
         253B.092, 304.34253B.12
         , and 
         253B.17 subject to the same requirements and limitations in section 304.35253B.02, subdivision 7
         . Such examiner may initiate an emergency hold under section 304.36253B.05
          on a Minnesota resident who is in a hospital that is under contract with a 305.1Minnesota governmental entity under this section provided the resident, in the opinion of 305.2the examiner, meets the criteria in section 
         253B.05.305.3    (g) This section shall apply to detoxification services that are unrelated to treatment 305.4whether the services are provided on a voluntary or involuntary basis.305.5    Sec. 2. Minnesota Statutes 2010, section 246B.10, is amended to read:305.6246B.10 LIABILITY OF COUNTY; REIMBURSEMENT.305.7    The civilly committed sex offender's county shall pay to the state a portion of the 305.8cost of care provided in the Minnesota sex offender program to a civilly committed sex 305.9offender who has legally settled in that county. A county's payment must be made from 305.10the county's own sources of revenue and payments must equal ten 25 percent of the cost of 305.11care, as determined by the commissioner, for each day or portion of a day, that the civilly 305.12committed sex offender spends at the facility. If payments received by the state under this 305.13chapter exceed 90 75 percent of the cost of care, the county is responsible for paying the 305.14state the remaining amount. The county is not entitled to reimbursement from the civilly 305.15committed sex offender, the civilly committed sex offender's estate, or from the civilly 305.16committed sex offender's relatives, except as provided in section 
         246B.07.305.17EFFECTIVE DATE.This section is effective for all individuals who are civilly 305.18committed to the Minnesota sex offender program on or after August 1, 2011.305.19    Sec. 3. Minnesota Statutes 2010, section 252.025, subdivision 7, is amended to read:305.20    Subd. 7. Minnesota extended treatment options. The commissioner shall develop 305.21by July 1, 1997, the Minnesota extended treatment options to serve Minnesotans who 305.22have developmental disabilities and exhibit severe behaviors which present a risk to 305.23public safety. This program is statewide and must provide specialized residential services 305.24in Cambridge and an array of community-based services with sufficient levels of care 305.25and a sufficient number of specialists to ensure that individuals referred to the program 305.26receive the appropriate care. The individuals working in the community-based services 305.27under this section are state employees supervised by the commissioner of human services. 305.28No midcontract layoffs shall occur as a result of restructuring under this section, but 305.29layoffs may occur as a normal consequence of a low census or closure of the facility 305.30due to decreased census.306.1    Sec. 4. Minnesota Statutes 2010, section 253B.212, is amended to read:306.2253B.212 COMMITMENT; RED LAKE BAND OF CHIPPEWA INDIANS; 306.3WHITE EARTH BAND OF OJIBWE.306.4    Subdivision 1. Cost of care; commitment by tribal court order; Red Lake 306.5Band of Chippewa Indians. The commissioner of human services may contract with 306.6and receive payment from the Indian Health Service of the United States Department of 306.7Health and Human Services for the care and treatment of those members of the Red 306.8Lake Band of Chippewa Indians who have been committed by tribal court order to the 306.9Indian Health Service for care and treatment of mental illness, developmental disability, or 306.10chemical dependency. The contract shall provide that the Indian Health Service may not 306.11transfer any person for admission to a regional center unless the commitment procedure 306.12utilized by the tribal court provided due process protections similar to those afforded 306.13by sections 
         253B.05 to 
         253B.10.306.14    Subd. 1a.Cost of care; commitment by tribal court order; White Earth Band of 306.15Ojibwe Indians.The commissioner of human services may contract with and receive 306.16payment from the Indian Health Service of the United States Department of Health and 306.17Human Services for the care and treatment of those members of the White Earth Band 306.18of Ojibwe Indians who have been committed by tribal court order to the Indian Health 306.19Service for care and treatment of mental illness, developmental disability, or chemical 306.20dependency. The tribe may also contract directly with the commissioner for treatment 306.21of those members of the White Earth Band who have been committed by tribal court 306.22order to the White Earth Department of Health for care and treatment of mental illness, 306.23developmental disability, or chemical dependency. The contract shall provide that the 306.24Indian Health Service and the White Earth Band shall not transfer any person for admission 306.25to a regional center unless the commitment procedure utilized by the tribal court provided 306.26due process protections similar to those afforded by sections 253B.05 to 253B.10.306.27    Subd. 2. Effect given to tribal commitment order. When, under an agreement 306.28entered into pursuant to subdivision 1 subdivisions 1 or 1a, the Indian Health Service 306.29applies to a regional center for admission of a person committed to the jurisdiction of the 306.30health service by the tribal court as a person who is mentally ill, developmentally disabled, 306.31or chemically dependent, the commissioner may treat the patient with the consent of 306.32the Indian Health Service.306.33A person admitted to a regional center pursuant to this section has all the rights 306.34accorded by section 
         253B.03. In addition, treatment reports, prepared in accordance with 306.35the requirements of section 
         253B.12, subdivision 1, shall be filed with the Indian Health 306.36Service within 60 days of commencement of the patient's stay at the facility. A subsequent 307.1treatment report shall be filed with the Indian Health Service within six months of the 307.2patient's admission to the facility or prior to discharge, whichever comes first. Provisional 307.3discharge or transfer of the patient may be authorized by the head of the treatment facility 307.4only with the consent of the Indian Health Service. Discharge from the facility to the 307.5Indian Health Service may be authorized by the head of the treatment facility after notice 307.6to and consultation with the Indian Health Service.307.7    Sec. 5. Minnesota Statutes 2010, section 254B.03, subdivision 1, is amended to read:307.8    Subdivision 1. Local agency duties. (a) Every local agency shall provide chemical 307.9dependency services to persons residing within its jurisdiction who meet criteria 307.10established by the commissioner for placement in a chemical dependency residential 307.11or nonresidential treatment service subject to the limitations on residential chemical 307.12dependency treatment in section 254B.04, subdivision 1. Chemical dependency money 307.13must be administered by the local agencies according to law and rules adopted by the 307.14commissioner under sections 
         14.001 to 
         14.69.307.15    (b) In order to contain costs, the commissioner of human services shall select eligible 307.16vendors of chemical dependency services who can provide economical and appropriate 307.17treatment. Unless the local agency is a social services department directly administered by 307.18a county or human services board, the local agency shall not be an eligible vendor under 307.19section 
         254B.05. The commissioner may approve proposals from county boards to provide 307.20services in an economical manner or to control utilization, with safeguards to ensure that 307.21necessary services are provided. If a county implements a demonstration or experimental 307.22medical services funding plan, the commissioner shall transfer the money as appropriate.307.23    (c) A culturally specific vendor that provides assessments under a variance under 307.24Minnesota Rules, part 9530.6610, shall be allowed to provide assessment services to 307.25persons not covered by the variance.307.26    Sec. 6. Minnesota Statutes 2010, section 254B.03, subdivision 4, is amended to read:307.27    Subd. 4. Division of costs. Except for services provided by a county under 307.28section 
         254B.09, subdivision 1, or services provided under section 
         256B.69 or 
         256D.03, 307.29subdivision 4
         , paragraph (b), the county shall, out of local money, pay the state for 307.3016.14 22.95 percent of the cost of chemical dependency services, including those services 307.31provided to persons eligible for medical assistance under chapter 256B and general 307.32assistance medical care under chapter 256D. Counties may use the indigent hospitalization 307.33levy for treatment and hospital payments made under this section. 16.14 22.95 percent 307.34of any state collections from private or third-party pay, less 15 percent for the cost of 308.1payment and collections, must be distributed to the county that paid for a portion of the 308.2treatment under this section.308.3EFFECTIVE DATE.This section is effective for claims processed beginning 308.4July 1, 2011.308.5    Sec. 7. Minnesota Statutes 2010, section 254B.04, subdivision 1, is amended to read:308.6    Subdivision 1. Eligibility. (a) Persons eligible for benefits under Code of Federal 308.7Regulations, title 25, part 20, persons eligible for medical assistance benefits under 308.8sections 
         256B.055, 
         256B.056, and 
         256B.057, subdivisions 1, 2, 5, and 6, or who meet 308.9the income standards of section 
         256B.056, subdivision 4, and persons eligible for general 308.10assistance medical care under section 
         256D.03, subdivision 3, are entitled to chemical 308.11dependency fund services subject to the following limitations: (1) no more than three 308.12residential chemical dependency treatment episodes for the same person in a four-year 308.13period of time unless the person meets the criteria established by the commissioner of 308.14human services; and (2) no more than four residential chemical dependency treatment 308.15episodes in a lifetime unless the person meets the criteria established by the commissioner 308.16of human services. State money appropriated for this paragraph must be placed in a 308.17separate account established for this purpose. 308.18Persons with dependent children who are determined to be in need of chemical 308.19dependency treatment pursuant to an assessment under section 
         626.556, subdivision 10, or 308.20a case plan under section 
         260C.201, subdivision 6, or 
         260C.212, shall be assisted by the 308.21local agency to access needed treatment services. Treatment services must be appropriate 308.22for the individual or family, which may include long-term care treatment or treatment in a 308.23facility that allows the dependent children to stay in the treatment facility. The county 308.24shall pay for out-of-home placement costs, if applicable. 308.25(b) A person not entitled to services under paragraph (a), but with family income 308.26that is less than 215 percent of the federal poverty guidelines for the applicable family 308.27size, shall be eligible to receive chemical dependency fund services within the limit 308.28of funds appropriated for this group for the fiscal year. If notified by the state agency 308.29of limited funds, a county must give preferential treatment to persons with dependent 308.30children who are in need of chemical dependency treatment pursuant to an assessment 308.31under section 
         626.556, subdivision 10, or a case plan under section 
         260C.201, subdivision 308.326
         , or 
         260C.212. A county may spend money from its own sources to serve persons under 308.33this paragraph. State money appropriated for this paragraph must be placed in a separate 308.34account established for this purpose. 309.1(c) Persons whose income is between 215 percent and 412 percent of the federal 309.2poverty guidelines for the applicable family size shall be eligible for chemical dependency 309.3services on a sliding fee basis, within the limit of funds appropriated for this group for the 309.4fiscal year. Persons eligible under this paragraph must contribute to the cost of services 309.5according to the sliding fee scale established under subdivision 3. A county may spend 309.6money from its own sources to provide services to persons under this paragraph. State 309.7money appropriated for this paragraph must be placed in a separate account established 309.8for this purpose.309.9EFFECTIVE DATE.This section is effective for all chemical dependency 309.10residential treatment beginning on or after July 1, 2011.309.11    Sec. 8. Minnesota Statutes 2010, section 254B.04, is amended by adding a subdivision 309.12to read:309.13    Subd. 2a.Eligibility for treatment in residential settings.Notwithstanding 309.14provisions of Minnesota Rules, part 9530.6622, subparts 5 and 6, related to an assessor's 309.15discretion in making placements to residential treatment settings, a person eligible for 309.16services under this section must score at level 4 on assessment dimensions related to 309.17relapse, continued use, and recovery environment in order to be assigned to services with 309.18a room and board component reimbursed under this section.309.19    Sec. 9. Minnesota Statutes 2010, section 254B.06, subdivision 2, is amended to read:309.20    Subd. 2. Allocation of collections. The commissioner shall allocate all federal 309.21financial participation collections to a special revenue account. The commissioner shall 309.22allocate 83.86 77.05 percent of patient payments and third-party payments to the special 309.23revenue account and 16.14 22.95 percent to the county financially responsible for the 309.24patient.309.25EFFECTIVE DATE.This section is effective for claims processed beginning 309.26July 1, 2011.309.27    Sec. 10. Minnesota Statutes 2010, section 256B.0625, subdivision 41, is amended to 309.28read:309.29    Subd. 41. Residential services for children with severe emotional disturbance.309.30Medical assistance covers rehabilitative services in accordance with section 
         256B.0945309.31that are provided by a county or an American Indian tribe through a residential facility, 310.1for children who have been diagnosed with severe emotional disturbance and have been 310.2determined to require the level of care provided in a residential facility.310.3EFFECTIVE DATE.This section is effective October 1, 2011.310.4    Sec. 11. Minnesota Statutes 2010, section 256B.0945, subdivision 4, is amended to 310.5read:310.6    Subd. 4. Payment rates. (a) Notwithstanding sections 
         256B.19 and 
         256B.041, 310.7payments to counties for residential services provided by a residential facility shall only 310.8be made of federal earnings for services provided under this section, and the nonfederal 310.9share of costs for services provided under this section shall be paid by the county from 310.10sources other than federal funds or funds used to match other federal funds. Payment to 310.11counties for services provided according to this section shall be a proportion of the per 310.12day contract rate that relates to rehabilitative mental health services and shall not include 310.13payment for costs or services that are billed to the IV-E program as room and board.310.14    (b) Per diem rates paid to providers under this section by prepaid plans shall be 310.15the proportion of the per-day contract rate that relates to rehabilitative mental health 310.16services and shall not include payment for group foster care costs or services that are 310.17billed to the county of financial responsibility. Services provided in facilities located in 310.18bordering states are eligible for reimbursement on a fee-for-service basis only as described 310.19in paragraph (a) and are not covered under prepaid health plans.310.20    (c) Payment for mental health rehabilitative services provided under this section by 310.21or under contract with an American Indian tribe or tribal organization or by agencies 310.22operated by or under contract with an American Indian tribe or tribal organization must 310.23be made according to section 256B.0625, subdivision 34, or other relevant federally 310.24approved rate-setting methodology.310.25(d) The commissioner shall set aside a portion not to exceed five percent of the 310.26federal funds earned for county expenditures under this section to cover the state costs of 310.27administering this section. Any unexpended funds from the set-aside shall be distributed 310.28to the counties in proportion to their earnings under this section.310.29EFFECTIVE DATE.This section is effective October 1, 2011.310.30    Sec. 12. COMMUNITY MENTAL HEALTH SERVICES; USE OF 310.31BEHAVIORAL HEALTH HOSPITALS.310.32The commissioner shall issue a written report to the chairs and ranking minority 310.33members of the house and senate committees with jurisdiction of health and human 311.1services by December 31, 2011, on how the community behavioral health hospital 311.2facilities will be fully utilized to meet the mental health needs of regions in which the 311.3hospitals are located. The commissioner must consult with the regional planning work 311.4groups for adult mental health and must include the recommendations of the work groups 311.5in the legislative report. The report must address future use of community behavioral 311.6health hospitals that are not certified as Medicaid eligible by CMS or have a less than 65 311.7percent licensed bed occupancy rate, and using the facilities for another purpose that will 311.8meet the mental health needs of residents of the region. The regional planning work 311.9groups shall work with the commissioner to prioritize the needs of their regions. These 311.10priorities, by region, must be included in the commissioner's report to the legislature.311.11    Sec. 13. INTEGRATED DUAL DIAGNOSIS TREATMENT.311.12(a) The commissioner shall require individuals who perform chemical dependency 311.13assessments or mental health assessments to use approved screening tools in order to 311.14identify whether an individual who is the subject of the assessment has a co-occurring 311.15mental health or chemical dependency disorder. Screening for co-occurring disorders must 311.16begin no later than December 31, 2011.311.17(b) No later than October 1, 2011, the commissioner shall develop and implement a 311.18certification process for integrated dual diagnosis treatment providers.311.19(c) No later than December 31, 2011, the commissioner shall develop and implement 311.20a referral system so that individuals who, at screening, are identified with co-occurring 311.21disorders are referred to certified integrated dual diagnosis treatment providers.311.22(d) The commissioner shall apply for any federal waivers necessary to secure, to the 311.23extent allowed by law, federal financial participation for the provision of integrated dual 311.24diagnosis treatment to persons with co-occurring disorders.311.25    Sec. 14. STATE-OPERATED SERVICES FACILITIES.311.26    (a) The commissioner shall close the Willmar Community Behavioral Health 311.27Hospital no later than October 1, 2011.311.28    (b) The commissioner shall present a plan to the legislative committees with 311.29jurisdiction over health and human services finance no later than January 1, 2012, on 311.30how the department will:311.31    (1) accommodate the mental health needs of clients impacted by the closure or 311.32redesign of any state-operated services facilities; and311.33    (2) accommodate the state employees adversely affected by the closure or redesign 311.34of any state-operated services facilities.312.1    Sec. 15. REGIONAL TREATMENT CENTERS; EMPLOYEES; REPORT.312.2(a) No layoffs shall occur as a result of restructuring services at the Anoka-Metro 312.3Regional Treatment Center.312.4(b) The commissioner shall issue a report to the legislative committees with 312.5jurisdiction over health and human services finance no later than December 31, 2011, 312.6which provides the number of employees in management positions at the Anoka-Metro 312.7Regional Treatment Center and the Minnesota Security Hospital at St. Peter and the ratio 312.8of management to direct-care staff for each facility.312.9    Sec. 16. COMMISSIONER'S CRITERIA FOR RESIDENTIAL TREATMENT.312.10The commissioner shall develop specific criteria to approve treatment for individuals 312.11who require residential chemical dependency treatment in excess of the maximum allowed 312.12in section 254B.04, subdivision 1, due to co-occurring disorders, including disorders 312.13related to cognition, traumatic brain injury, or documented disability. Criteria shall be 312.14developed for use no later than October 1, 2011.312.15    Sec. 17. MINNESOTA STATE-OPERATED COMMUNITY SERVICES.312.16    The commissioner shall evaluate the effectiveness of overnight supervision 312.17provided at the Minnesota state-operated community services residential programs. The 312.18commissioner shall determine whether safety is compromised when only one overnight 312.19staff person is scheduled to work, and shall document the incidents in which the staff 312.20person called for assistance or reported behavior that threatened the safety of clients or the 312.21staff person. The commissioner shall report findings to the legislative committees with 312.22jurisdiction over health and human services no later than January 15, 2012.312.23    Sec. 18.  REPEALER.312.24Laws 2009, chapter 79, article 3, section 18, as amended by Laws 2010, First Special 312.25Session chapter 1, article 19, section 19, is repealed.312.26ARTICLE 9312.27HEALTH AND HUMAN SERVICES APPROPRIATIONS

312.28Section 1.  SUMMARY OF APPROPRIATIONS.

312.29The amounts shown in this section summarize direct appropriations, by fund, made 312.30in this article.

312.3120122013Total312.32General$5,646,994,000$5,159,920,000$10,806,914,000313.1313.2State Government Special Revenue63,198,00063,154,000126,352,000313.3Health Care Access400,917,000409,880,000810,797,000313.4Federal TANF274,091,000282,814,000556,905,000313.5Lottery Prize Fund1,665,0001,665,0003,330,000313.6Total$6,386,865,000$5,917,433,000$12,304,298,000

313.7Sec. 2. HUMAN SERVICES APPROPRIATIONS.

313.8The sums shown in the columns marked "Appropriations" are appropriated to the 313.9agencies and for the purposes specified in this article. The appropriations are from the 313.10general fund, or another named fund, and are available for the fiscal years indicated 313.11for each purpose. The figures "2012" and "2013" used in this article mean that the 313.12appropriations listed under them are available for the fiscal year ending June 30, 2012, or 313.13June 30, 2013, respectively. "The first year" is fiscal year 2012. "The second year" is fiscal 313.14year 2013. "The biennium" is fiscal years 2012 and 2013.

313.15APPROPRIATIONS313.16Available for the Year313.17Ending June 30313.1820122013

313.19313.20Sec. 3. COMMISSIONER OF HUMAN SERVICES

313.21Subdivision 1.Total Appropriation$6,215,925,000$5,756,045,000

313.22Appropriations by Fund313.2320122013313.24General5,564,174,0005,081,996,000313.25313.26State Government Special Revenue565,000565,000313.27Health Care Access387,143,000400,718,000313.28Federal TANF262,378,000271,101,000313.29Lottery Prize Fund1,665,0001,665,000

313.30Receipts for Systems Projects. 313.31Appropriations and federal receipts for 313.32information systems projects for MAXIS, 313.33PRISM, MMIS, and SSIS must be deposited 313.34in the state systems account authorized in 313.35Minnesota Statutes, section 256.014. Money 313.36appropriated for computer projects approved 313.37by the Minnesota Office of Enterprise 314.1Technology, funded by the legislature, 314.2and approved by the commissioner of 314.3Minnesota Management and Budget, may 314.4be transferred from one project to another 314.5and from development to operations as the 314.6commissioner of human services considers 314.7necessary. Any unexpended balance in 314.8the appropriation for these projects does 314.9not cancel but is available for ongoing 314.10development and operations.314.11Nonfederal Share Transfers. The 314.12nonfederal share of activities for which 314.13federal administrative reimbursement is 314.14appropriated to the commissioner may be 314.15transferred to the special revenue fund.314.16TANF Maintenance of Effort.314.17(a) In order to meet the basic maintenance 314.18of effort (MOE) requirements of the TANF 314.19block grant specified under Code of Federal 314.20Regulations, title 45, section 263.1, the 314.21commissioner may only report nonfederal 314.22money expended for allowable activities 314.23listed in the following clauses as TANF/MOE 314.24expenditures:314.25(1) MFIP cash, diversionary work program, 314.26and food assistance benefits under Minnesota 314.27Statutes, chapter 256J;314.28(2) the child care assistance programs 314.29under Minnesota Statutes, sections 119B.03 314.30and 119B.05, and county child care 314.31administrative costs under Minnesota 314.32Statutes, section 119B.15;314.33(3) state and county MFIP administrative 314.34costs under Minnesota Statutes, chapters 314.35256J and 256K;315.1(4) state, county, and tribal MFIP 315.2employment services under Minnesota 315.3Statutes, chapters 256J and 256K;315.4(5) expenditures made on behalf of 315.5noncitizen MFIP recipients who qualify 315.6for the medical assistance without federal 315.7financial participation program under 315.8Minnesota Statutes, section 256B.06, 315.9subdivision 4, paragraphs (d), (e), and (j);315.10(6) qualifying working family credit 315.11expenditures under Minnesota Statutes, 315.12section 290.0671; and315.13(7) qualifying Minnesota education credit 315.14expenditures under Minnesota Statutes, 315.15section 290.0674.315.16(b) The commissioner shall ensure that 315.17sufficient qualified nonfederal expenditures 315.18are made each year to meet the state's 315.19TANF/MOE requirements. For the activities 315.20listed in paragraph (a), clauses (2) to 315.21(7), the commissioner may only report 315.22expenditures that are excluded from the 315.23definition of assistance under Code of 315.24Federal Regulations, title 45, section 260.31.315.25(c) For fiscal years beginning with state fiscal 315.26year 2003, the commissioner shall assure 315.27that the maintenance of effort used by the 315.28commissioner of management and budget 315.29for the February and November forecasts 315.30required under Minnesota Statutes, section 315.3116A.103, contains expenditures under 315.32paragraph (a), clause (1), equal to at least 16 315.33percent of the total required under Code of 315.34Federal Regulations, title 45, section 263.1.316.1(d) Minnesota Statutes, section 256.011, 316.2subdivision 3, which requires that federal 316.3grants or aids secured or obtained under that 316.4subdivision be used to reduce any direct 316.5appropriations provided by law, do not apply 316.6if the grants or aids are federal TANF funds.316.7(e) Notwithstanding any contrary provision 316.8in this article, paragraph (a), clauses (1) to 316.9(7), and paragraphs (b) to (d), expire June 316.1030, 2015.316.11Working Family Credit Expenditures 316.12as TANF/MOE. The commissioner may 316.13claim as TANF maintenance of effort up to 316.14$6,707,000 per year of working family credit 316.15expenditures for fiscal years 2012 and 2013.316.16Working Family Credit Expenditures 316.17to be Claimed for TANF/MOE. The 316.18commissioner may count the following 316.19amounts of working family credit 316.20expenditures as TANF/MOE:316.21(1) fiscal year 2012, $12,037,000;316.22(2) fiscal year 2013, $29,942,000;316.23(3) fiscal year 2014, $23,235,000; and316.24(4) fiscal year 2015, $23,198,000.316.25Notwithstanding any contrary provision in 316.26this article, this rider expires June 30, 2015.316.27TANF Transfer to Federal Child Care 316.28and Development Fund. (a) The following 316.29TANF fund amounts are appropriated 316.30to the commissioner for purposes of 316.31MFIP/Transition Year Child Care Assistance 316.32under Minnesota Statutes, section 119B.05:316.33(1) fiscal year 2012, $11,020,000;317.1(2) fiscal year 2013, $35,020,000;317.2(3) fiscal year 2014, $14,020,000; and317.3(4) fiscal year 2015, $14,020,000.317.4(b) The commissioner shall authorize the 317.5transfer of sufficient TANF funds to the 317.6federal child care and development fund to 317.7meet this appropriation and shall ensure that 317.8all transferred funds are expended according 317.9to federal child care and development fund 317.10regulations.317.11Food Stamps Employment and Training 317.12Funds. (a) Notwithstanding Minnesota 317.13Statutes, sections 256D.051, subdivisions 1a, 317.146b, and 6c, and 256J.626, federal food stamps 317.15employment and training funds received 317.16as reimbursement for child care assistance 317.17program expenditures must be deposited in 317.18the general fund. The amount of funds must 317.19be limited to $500,000 per year in fiscal 317.20years 2012 through 2015, contingent upon 317.21approval by the federal Food and Nutrition 317.22Service.317.23(b) Consistent with the receipt of these 317.24federal funds, the commissioner may 317.25adjust the level of working family credit 317.26expenditures claimed as TANF maintenance 317.27of effort. Notwithstanding any contrary 317.28provision in this article, this rider expires 317.29June 30, 2015.317.30ARRA Food Support Benefit Increases. 317.31The funds provided for food support benefit 317.32increases under the Supplemental Nutrition 317.33Assistance Program provisions of the 317.34American Recovery and Reinvestment Act 318.1(ARRA) of 2009 must be used for benefit 318.2increases beginning July 1, 2009.318.3Supplemental Security Interim Assistance 318.4Reimbursement Funds. $2,800,000 of 318.5uncommitted revenue available to the 318.6commissioner of human services for SSI 318.7advocacy and outreach services must be 318.8transferred to and deposited into the general 318.9fund by June 30, 2012.

318.10Subd. 2.Central Office Operations

318.11The amounts that may be spent from this 318.12appropriation for each purpose are as follows:

318.13(a) Operations

318.14Appropriations by Fund318.15General81,458,00080,335,000318.16Health Care Access11,742,00011,508,000318.17318.18State Government Special Revenue440,000440,000318.19Federal TANF222,000222,000

318.20DHS Receipt Center Accounting. The 318.21commissioner is authorized to transfer 318.22appropriations to, and account for DHS 318.23receipt center operations in, the special 318.24revenue fund.318.25Base Adjustment. The general fund base 318.26for fiscal year 2014 shall be increased by 318.27$79,000. This adjustment is onetime.

318.28(b) Children and Families

318.29Appropriations by Fund318.30General9,615,0009,417,000318.31Federal TANF2,160,0002,160,000

318.32Financial Institution Data Match and 318.33Payment of Fees. The commissioner is 318.34authorized to allocate up to $310,000 each 318.35year in fiscal years 2012 and 2013 from the 319.1PRISM special revenue account to make 319.2payments to financial institutions in exchange 319.3for performing data matches between account 319.4information held by financial institutions 319.5and the public authority's database of child 319.6support obligors as authorized by Minnesota 319.7Statutes, section 13B.06, subdivision 7.

319.8(c) Health Care

319.9Appropriations by Fund319.10General16,284,00016,030,000319.11Health Care Access22,574,00026,555,000

319.12Minnesota Senior Health Options 319.13Reimbursement. Federal administrative 319.14reimbursement resulting from the Minnesota 319.15senior health options project is appropriated 319.16to the commissioner for this activity.319.17Utilization Review. Federal administrative 319.18reimbursement resulting from prior 319.19authorization and inpatient admission 319.20certification by a professional review 319.21organization shall be dedicated to the 319.22commissioner for these purposes. A portion 319.23of these funds must be used for activities to 319.24decrease unnecessary pharmaceutical costs 319.25in medical assistance.319.26Base Adjustment. The general fund base 319.27shall be decreased by $2,000 in fiscal year 319.282014 and $114,000 in 2015.319.29The health care access fund base is decreased 319.30by $16,000 in fiscal year 2014 and $142,000 319.31in 2015.

319.32(d) Continuing Care

320.1Appropriations by Fund320.2General18,110,00018,011,000320.3320.4State Government Special Revenue125,000125,000

320.5Region 10 Administrative Expenses.320.6$100,000 is appropriated each fiscal 320.7year, beginning in fiscal year 2012, for 320.8the administration of the State Quality 320.9Improvement and Licensing System under 320.10Minnesota Statutes, section 256B.0961.320.11Base Adjustment. The general fund base is 320.12decreased by $259,000 in each of fiscal years 320.132014 and 2015.

320.14(e) Chemical and Mental Health

320.15Appropriations by Fund320.16General4,194,0004,194,000320.17Lottery Prize157,000157,000

320.18Subd. 3.Forecasted Programs

320.19The amounts that may be spent from this 320.20appropriation for each purpose are as follows:

320.21(a) MFIP/DWP Grants

320.22Appropriations by Fund320.23General84,256,00091,212,000320.24Federal TANF84,425,00075,417,000

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

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

320.27General Assistance Standard. The 320.28commissioner shall set the monthly standard 320.29of assistance for general assistance units 320.30consisting of an adult recipient who is 320.31childless and unmarried or living apart 320.32from parents or a legal guardian at $203. 320.33The commissioner may reduce this amount 321.1according to Laws 1997, chapter 85, article 321.23, section 54.321.3Emergency General Assistance. The 321.4amount appropriated for emergency general 321.5assistance funds is limited to no more 321.6than $7,889,812 in fiscal year 2012 and 321.7$7,889,812 in fiscal year 2013. Funds 321.8to counties shall be allocated by the 321.9commissioner using the allocation method 321.10specified in Minnesota Statutes, section 321.11256D.06.

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

321.13Emergency Minnesota Supplemental 321.14Aid Funds. The amount appropriated for 321.15emergency Minnesota supplemental aid 321.16funds is limited to no more than $1,100,000 321.17in fiscal year 2012 and $1,100,000 in fiscal 321.18year 2013. Funds to counties shall be 321.19allocated by the commissioner using the 321.20allocation method specified in Minnesota 321.21Statutes, section 256D.46.

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

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

321.24This appropriation is from the health care 321.25access fund.

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

321.27Coordinated Care Delivery System. This 321.28appropriation is to fund coordinated care 321.29delivery systems under Minnesota Statutes, 321.30section 256D.031, subdivision 6.321.31Payments for Cost Settlements. The 321.32commissioner is authorized to use amounts 321.33repaid to the general assistance medical care 321.34program under Minnesota Statutes 2009 322.1Supplement, section 256D.03, subdivision 322.23, to pay cost settlements for claims for 322.3services provided prior to June 1, 2010. 322.4Notwithstanding any contrary provision in 322.5this article, this provision does not expire.322.6Base Adjustment. The general fund base is 322.7reduced by $120,000,000 in fiscal year 2014 322.8and by $280,000,000 in fiscal year 2015.

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

322.10Managed Care Incentive Payments. The 322.11commissioner shall not make managed care 322.12incentive payments for expanding preventive 322.13services during fiscal years beginning July 1, 322.142011 and July 1, 2012.322.15Reduction of Rates for Congregate 322.16Living for Individuals with Lower Needs. 322.17Beginning October 1, 2011, lead agencies 322.18must reduce rates in effect on January 1, 322.192011, by ten percent for individuals with 322.20lower needs living in foster care settings 322.21where the license holder does not share the 322.22residence with recipients on the CADI, DD, 322.23and TBI waivers and customized living 322.24settings for CADI and TBI. Lead agencies 322.25must adjust contracts within 60 days of the 322.26effective date.322.27Reduction of Lead Agency Waiver 322.28Allocations to Implement Rate Reductions 322.29for Congregate Living for Individuals 322.30with Lower Needs. Beginning October 1, 322.312011, the commissioner shall reduce lead 322.32agency waiver allocations to implement the 322.33reduction of rates for individuals with lower 322.34needs living in foster care settings where the 322.35license holder does not share the residence 323.1with recipients on the CADI, DD, and TBI 323.2waivers and customized living settings for 323.3CADI and TBI.323.4Reduce customized living and 24-hour 323.5customized living component rates.323.6Effective July 1, 2011, the commissioner 323.7shall reduce elderly waiver customized living 323.8and 24-hour customized living component 323.9service spending by ten percent through 323.10reductions in component rates and service 323.11rate limits. The commissioner shall adjust 323.12the elderly waiver capitation payment 323.13rates for managed care organizations paid 323.14under Minnesota Statutes, section 256B.69, 323.15subdivisions 6a and 23, to reflect reductions 323.16in component spending for customized living 323.17services and 24-hour customized living 323.18services under Minnesota Statutes, section 323.19256B.0915, subdivisions 3e and 3h, for the 323.20contract period beginning January 1, 2012. 323.21To implement the reduction specified in 323.22this provision, capitation rates paid by the 323.23commissioner to managed care organizations 323.24under Minnesota Statutes, section 256B.69, 323.25shall reflect a 20 percent reduction for the 323.26specified services for the period January 1, 323.272012, to June 30, 2012, and a ten percent 323.28reduction for those services on or after July 323.291, 2012.323.30Limit Growth in the Developmental 323.31Disability Waiver. For the biennium 323.32beginning July 1, 2011, the commissioner 323.33shall limit the developmental disability 323.34waiver to the number of recipients served 323.35in March 2010. To achieve this level, the 323.36commissioner shall not refill waiver openings 324.1until the number of waiver recipients 324.2reaches the March 2010 level. Once the 324.3March 2010 enrollment level is reached, the 324.4commissioner shall refill vacated openings to 324.5maintain the March 2010 enrollment level. 324.6To the extent possible, waiver allocations 324.7shall be available to individuals who meet 324.8the priorities for accessing waiver services 324.9described in Minnesota Statutes, section 324.10256B.092, subdivision 12. The limits do not 324.11include conversions from intermediate care 324.12facilities for persons with developmental 324.13disabilities. When implementing the waiver 324.14enrollment limits under this provision, it 324.15is an absolute defense to an appeal under 324.16Minnesota Statutes, section 256.045, if 324.17the commissioner or lead agency proves 324.18that it followed the established written 324.19procedures and criteria and determined that 324.20home and community-based services could 324.21not be provided to the person within the 324.22appropriations or lead agency's allocation of 324.23home and community-based services money.324.24Limit Growth in the Community 324.25Alternatives for Disabled Individuals 324.26Waiver. For the biennium beginning 324.27July 1, 2011, the commissioner shall limit 324.28the community alternatives for disabled 324.29individuals waiver to the number of 324.30recipients served in March 2010. To achieve 324.31this level, the commissioner shall not 324.32refill waiver openings until the number of 324.33waiver recipients reaches the March 2010 324.34level. Once the March 2010 enrollment 324.35level is reached, the commissioner shall 324.36refill vacated openings to maintain the 325.1March 2010 enrollment level. To the 325.2extent possible, waiver allocations shall 325.3be available to individuals who meet the 325.4priorities for accessing waiver services 325.5described in Minnesota Statutes, section 325.6256B.49, subdivision 11a. The limits include 325.7conversions and diversions, unless the 325.8commissioner has approved a plan to convert 325.9funding due to the closure or downsizing 325.10of a residential facility or nursing facility 325.11to serve directly affected individuals on 325.12the community alternatives for disabled 325.13individuals waiver. When implementing 325.14the waiver enrollment limits under this 325.15provision, it is an absolute defense to an 325.16appeal under Minnesota Statutes, section 325.17256.045, if the commissioner or lead agency 325.18proves that it followed the established written 325.19procedures and criteria and determined that 325.20home and community-based services could 325.21not be provided to the person within the 325.22appropriations or lead agency's allocation of 325.23home and community-based services money. 325.24Limit Growth in the Waiver for 325.25Individuals with Traumatic Brain Injury.325.26For the biennium beginning July 1, 2011, 325.27the commissioner shall limit the traumatic 325.28brain injury waiver to the number of 325.29recipients served in March 2010. To achieve 325.30this level, the commissioner shall not 325.31refill waiver openings until the number of 325.32waiver recipients reaches the March 2010 325.33level. Once the March 2010 enrollment 325.34level is reached, the commissioner shall 325.35refill vacated openings to maintain the 325.36March 2010 enrollment level. To the 326.1extent possible, waiver allocations shall 326.2be available to individuals who meet the 326.3priorities for accessing waiver services 326.4described in Minnesota Statutes, section 326.5256B.49, subdivision 11a. The limits include 326.6conversions and diversions, unless the 326.7commissioner has approved a plan to convert 326.8funding due to the closure or downsizing of a 326.9residential facility or nursing facility to serve 326.10directly affected individuals on the traumatic 326.11brain injury waiver. When implementing 326.12the waiver enrollment limits under this 326.13provision, it is an absolute defense to an 326.14appeal under Minnesota Statutes, section 326.15256.045, if the commissioner or lead agency 326.16proves that it followed the established written 326.17procedures and criteria and determined that 326.18home and community-based services could 326.19not be provided to the person within the 326.20appropriations or lead agency's allocation of 326.21home and community-based services money.326.22Management of Fee-for-Service Spending. 326.23Total state and federal funding for the 326.24biennium beginning on July 1, 2011, for 326.25fee-for-service medical assistance basic care 326.26for the elderly and persons with disabilities 326.27is limited to $2,536,949,000. Total state and 326.28federal funding for the biennium beginning 326.29July 1, 2011, for fee-for-service medical 326.30assistance basic care for adults without 326.31children is limited to $526,251,000.326.32(1) Total state and federal funding for 326.33fee-for-service medical assistance basic care 326.34for the elderly and persons with disabilities is 326.35limited to $950,183,000 for fiscal year 2012 326.36and $1,115,961,000 for fiscal year 2013.327.1(2) The commissioner shall contract with 327.2a vendor to manage spending within these 327.3limits, beginning January 1, 2012. The 327.4vendor selected may:327.5(i) manage and coordinate the care provided 327.6by high-cost providers;327.7(ii) implement payment reform initiatives to 327.8encourage efficient and cost-effective service 327.9provision;327.10(iii) identify and deny payment for 327.11unnecessary services; and327.12(iv) implement other initiatives proven to 327.13improve the efficiency of fee-for-service care 327.14delivery.327.15The contract with the vendor must be 327.16on a contingency basis, under which the 327.17vendor retains six percent of any savings 327.18obtained from management of fee-for-service 327.19spending.327.20(3) The commissioner, by October 1, 327.212012, shall evaluate the extent to which 327.22initiatives implemented by the vendor will 327.23be successful in managing spending within 327.24the specified limits. If the commissioner 327.25determines that the vendor will not be 327.26successful in managing spending within 327.27the specified limits, the commissioner shall 327.28reduce medical assistance provider payments 327.29by an amount sufficient to comply with 327.30the spending limits. In implementing rate 327.31reductions, the commissioner shall exempt 327.32payments to nursing facilities and providers 327.33of home and community-based waiver 327.34services. No provider payment reduction 328.1shall affect services provided to the elderly 328.2or persons with disabilities.328.3Contingent Rate Reductions. If 328.4the commissioner determines that 328.5implementation of the global waiver under 328.6Minnesota Statutes, sections 256B.841, 328.7256B.842, and 256B.843, will not achieve a 328.8state general fund savings of $300,000,000 328.9for the biennium beginning July 1, 2011, the 328.10commissioner shall calculate an estimate 328.11of the shortfall in savings, and, for the 328.12fiscal year beginning July 1, 2012, shall 328.13reduce medical assistance provider payment 328.14rates, including but not limited to rates to 328.15individual health care providers and provider 328.16agencies, hospitals, other residential settings, 328.17and capitation rates provided to managed 328.18care and county-based purchasing plans, by 328.19the amount necessary to recoup the shortfall 328.20in savings over that fiscal year. No provider 328.21payment reduction shall affect services 328.22provided to the elderly or persons with 328.23disabilities.

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

328.25Alternative Care Transfer. Any money 328.26allocated to the alternative care program that 328.27is not spent for the purposes indicated does 328.28not cancel but shall be transferred to the 328.29medical assistance account.

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

328.31Subd. 4.Grant Programs

328.32The amounts that may be spent from this 328.33appropriation for each purpose are as follows:

328.34(a) Support Services Grants

329.1Appropriations by Fund329.2General8,715,0008,715,000329.3Federal TANF96,525,00090,611,000

329.4MFIP Consolidated Fund Grants. The 329.5TANF fund base is reduced by $14,000,000 329.6each year beginning in fiscal year 2012.329.7Subsidized Employment Funding Through 329.8ARRA. The commissioner is authorized to 329.9apply for TANF emergency fund grants for 329.10subsidized employment activities. Growth 329.11in expenditures for subsidized employment 329.12within the supported work program and the 329.13MFIP consolidated fund over the amount 329.14expended in the calendar year quarters in 329.15the TANF emergency fund base year shall 329.16be used to leverage the TANF emergency 329.17fund grants for subsidized employment and 329.18to fund supported work. The commissioner 329.19shall develop procedures to maximize 329.20reimbursement of these expenditures over the 329.21TANF emergency fund base year quarters, 329.22and may contract directly with employers 329.23and providers to maximize these TANF 329.24emergency fund grants.329.25Healthy Communities. $150,000 in fiscal 329.26year 2012 and $150,000 in fiscal year 2013 329.27are appropriated from the general fund to 329.28the commissioner of human services for 329.29contracting with the Search Institute to 329.30promote healthy community initiatives. 329.31The commissioner may expend up to five 329.32percent of the appropriation to provide for 329.33the program evaluation.329.34Circles of Support. $200,000 in fiscal year 329.352012 and $200,000 in fiscal year 2013 are 330.1appropriated from the general fund to the 330.2commissioner of human services for the 330.3purpose of providing grants to community 330.4action agencies for circles of support 330.5initiatives.330.6Northern Connections. $100,000 is 330.7appropriated in fiscal year 2012 and 330.8$100,000 is appropriated in fiscal year 2013 330.9from the general fund to the commissioner 330.10of human services for a grant to expand 330.11Northern Connections workforce program 330.12that provides one-stop supportive services 330.13to individuals as they transition into the 330.14workforce to up to two interested counties in 330.15rural Minnesota.

330.16330.17(b) Basic Sliding Fee Child Care Assistance Grants38,131,00041,035,000

330.18Base Adjustment. The general fund base is 330.19decreased by $1,131,000 in fiscal year 2014 330.20and $1,126,000 in fiscal year 2015.330.21Child Care and Development Fund 330.22Unexpended Balance. In addition to 330.23the amount provided in this section, the 330.24commissioner shall expend $5,000,000 330.25in fiscal year 2012 from the federal child 330.26care and development fund unexpended 330.27balance for basic sliding fee child care under 330.28Minnesota Statutes, section 119B.03. The 330.29commissioner shall ensure that all child 330.30care and development funds are expended 330.31according to the federal child care and 330.32development fund regulations.

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

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

331.1Federal Child Support Demonstration 331.2Grants. Federal administrative 331.3reimbursement resulting from the federal 331.4child support grant expenditures authorized 331.5under section 1115a of the Social Security 331.6Act is appropriated to the commissioner for 331.7this activity.

331.8(e) Children's Services Grants

331.9Appropriations by Fund331.10General46,788,00046,788,000331.11Federal TANF140,000140,000

331.12Adoption Assistance and Relative Custody 331.13Assistance Payments. $1,661,000 each 331.14year is for continuation of current payments 331.15for adoption assistance and relative custody 331.16assistance.331.17Adoption Assistance and Relative Custody 331.18Assistance Transfer.  The commissioner 331.19may transfer unencumbered appropriation 331.20balances for adoption assistance and relative 331.21custody assistance between fiscal years and 331.22between programs.331.23Privatized Adoption Grants. Federal 331.24reimbursement for privatized adoption grant 331.25and foster care recruitment grant expenditures 331.26is appropriated to the commissioner for 331.27adoption grants and foster care and adoption 331.28administrative purposes.331.29Adoption Assistance Incentive Grants.331.30Federal funds available during fiscal year 331.312012 and fiscal year 2013 for adoption 331.32incentive grants are appropriated to the 331.33commissioner for these purposes.

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

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

332.2Long-term homeless services. $700,000 332.3is appropriated from the federal TANF 332.4fund for the biennium beginning July 332.51, 2011, to the commissioner of human 332.6services for long-term homeless services 332.7for low-income homeless families under 332.8Minnesota Statutes, section 256K.26. This 332.9is a onetime appropriation and is not added 332.10to the base.332.11Base Adjustment. The general fund base 332.12is increased by $491,000 in fiscal year 2014 332.13only.

332.14(h) Health Care Grants

332.15Appropriations by Fund332.16General195,000-0-332.17Health Care Access900,000900,000

332.18Surplus Appropriation Canceled. Of the 332.19appropriation in Laws 2009, chapter 79, 332.20article 13, section 3, subdivision 6, paragraph 332.21(e), for the COBRA premium state subsidy 332.22program, $11,750,000 must be canceled in 332.23fiscal year 2011. This provision is effective 332.24the day following final enactment.332.25Grant Cancellation. Effective for the 332.26biennium beginning July 1, 2011, the 332.27following appropriations are canceled: (1) a 332.28general fund appropriation of $205,000 for 332.29the U Special Kids program; (2) a general 332.30fund appropriation of $90,000 for medical 332.31assistance outreach grants; and (3) a health 332.32care access fund appropriation of $40,000 for 332.33MinnesotaCare outreach grants.333.1State Subsidy Program for Community 333.2Mental Health Centers. $100,000 is 333.3appropriated from the general fund to 333.4the commissioner of human services for 333.5the biennium beginning July 1, 2011, to 333.6provide onetime grants to establish new 333.7community mental health centers that are 333.8eligible for payment under Minnesota 333.9Statutes, section 256B.0625, subdivision 5. 333.10In awarding grants, the commissioner shall 333.11give preference to areas of the state that 333.12lack access to mental health services or are 333.13underserved.

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

333.15Aging Grants Reduction. Effective July 333.161, 2011, funding for grants made under 333.17Minnesota Statutes, sections 256.9754 and 333.18256B.0917, subdivision 13, is reduced by 333.19$3,600,000 for each year of the biennium. 333.20These reductions are onetime and do 333.21not affect base funding for the 2014-2015 333.22biennium. Grants made during the 2012-2013 333.23biennium under Minnesota Statutes, section 333.24256B.9754, must not be used for new 333.25construction or building renovation.333.26Essential Community Support Grant 333.27Delay. Essential community supports 333.28grants under Minnesota Statutes, section 333.29256B.0917, subdivision 14, is reduced 333.30by $6,410,000 in fiscal year 2012 and 333.31$7,279,000 in fiscal year 2013. Base level 333.32funding for fiscal year 2014 is reduced by 333.33$5,919,000. These reductions are onetime 333.34and do not affect base level funding for fiscal 333.35year 2015.

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

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

334.3Money Follows the Person Rebalancing 334.4Demonstration Project. Notwithstanding 334.5the provisions of Minnesota Statutes, section 334.6256.011, subdivision 3, estimated general 334.7fund savings resulting from the operation of 334.8the Money Follows the Person federal grant 334.9fund must be retained within the medical 334.10assistance general fund appropriation for the 334.11payment of federally required rebalancing 334.12expenditures. If a rebalancing expenditure 334.13is not eligible for medical assistance, the 334.14corresponding portion of estimated savings 334.15must be transferred to and paid from a special 334.16revenue account established for this purpose. 334.17Money in the account does not cancel and 334.18is appropriated to the commissioner for the 334.19purposes of the demonstration project.334.20Region 10. Any unspent allocation for 334.21Region 10 Quality Assurance from the 334.22biennium beginning on July 1, 2009, may be 334.23carried over into the biennium beginning on 334.24July 1, 2011.334.25Local Planning Grants for Creating 334.26Alternatives to Congregate Living for 334.27Individuals with Lower Needs. The 334.28commissioner shall make available a total 334.29of $250,000 per year in local planning 334.30grants, beginning July 1, 2011, to assist 334.31lead agencies and provider organizations in 334.32developing alternatives to congregate living 334.33within the available level of resources for the 334.34home and community-based services waivers 334.35for persons with disabilities.

335.1(l) Adult Mental Health Grants

335.2Appropriations by Fund335.3General77,539,00077,539,000335.4Lottery Prize Fund1,508,0001,508,000

335.5Funding Usage. Up to 75 percent of a fiscal 335.6year's appropriation for adult mental health 335.7grants may be used to fund allocations in that 335.8portion of the fiscal year ending December 335.931.335.10Base Adjustment. The lottery prize fund 335.11base for this program shall be increased by 335.12$78,000 in each of fiscal years 2014 and 335.132015.

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

335.15Funding Usage. Up to 75 percent of a fiscal 335.16year's appropriation for children's mental 335.17health grants may be used to fund allocations 335.18in that portion of the fiscal year ending 335.19December 31.

335.20335.21(n) Chemical Dependency Nonentitlement Grants1,336,0001,336,000

335.22Subd. 5.State-Operated Services

335.23Transfer Authority Related to 335.24State-Operated Services. Money 335.25appropriated for state-operated services 335.26may be transferred between fiscal years 335.27of the biennium with the approval of the 335.28commissioner of management and budget.

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

335.30State-Operated Services.  To achieve these 335.31savings, the commissioner shall close the 335.32Willmar Community Behavioral Health 335.33Hospital no later than October 1, 2011, and 335.34shall close the inpatient child and adolescent 336.1behavioral health service program in 336.2Willmar, the subacute mental health facility 336.3in Wadena, and the community behavioral 336.4health hospitals in Alexandria, Annandale, 336.5Baxter, Bemidji, Fergus Falls, and Rochester 336.6no later than October 1, 2012.336.7Base Adjustment. The general fund base is 336.8reduced by $8,443,000 in fiscal year 2014 336.9and $11,543,000 in fiscal year 2015.

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

336.11Subd. 6.Sex Offender Program70,416,00067,570,000

336.12Transfer Authority Related to Minnesota 336.13Sex Offender Program. Money 336.14appropriated for the Minnesota sex offender 336.15program may be transferred between fiscal 336.16years of the biennium with the approval 336.17of the commissioner of management and 336.18budget.336.19Minnesota Sex Offender Program 336.20Reduction.  The fiscal year 2011 general 336.21fund appropriation for Minnesota sex 336.22offender services under Laws 2009, chapter 336.2379, article 13, section 3, subdivision 10, 336.24paragraph (b), is reduced by $3,000,000.

336.25Subd. 7.Technical Activities78,206,000102,551,000

336.26This appropriation is from the federal TANF 336.27fund.

336.28Sec. 4. COMMISSIONER OF HEALTH

336.29Subdivision 1.Total Appropriation$147,939,000$136,632,000

336.30Appropriations by Fund336.3120122013336.32General77,634,00072,738,000336.33336.34State Government Special Revenue45,268,00045,325,000337.1Health Care Access13,774,0009,162,000337.2Federal TANF11,713,00011,713,000

337.3The amounts that may be spent for each 337.4purpose are specified in the following 337.5subdivisions.

337.6337.7Subd. 2.Community and Family Health Promotion

337.8Appropriations by Fund337.9General50,430,00045,690,000337.10337.11State Government Special Revenue1,033,0001,033,000337.12Health Care Access2,918,0002,459,000337.13Federal TANF11,713,00011,713,000

337.14TANF Appropriations. (1) $1,156,000 of 337.15the TANF funds is appropriated each year to 337.16the commissioner for family planning grants 337.17under Minnesota Statutes, section 145.925.337.18(2) $3,579,000 of the TANF funds is 337.19appropriated each year to the commissioner 337.20for home visiting and nutritional services 337.21listed under Minnesota Statutes, section 337.22145.882, subdivision 7, clauses (6) and (7). 337.23Funds must be distributed to community 337.24health boards according to Minnesota 337.25Statutes, section 145A.131, subdivision 1.337.26(3) $2,000,000 of the TANF funds is 337.27appropriated each year to the commissioner 337.28for decreasing racial and ethnic disparities 337.29in infant mortality rates under Minnesota 337.30Statutes, section 145.928, subdivision 7.337.31(4) $4,978,000 of the TANF funds is 337.32appropriated each year to the commissioner 337.33for the family home visiting grant program 337.34according to Minnesota Statutes, section 337.35145A.17. $4,000,000 of the funding must 337.36be distributed to community health boards 338.1according to Minnesota Statutes, section 338.2145A.131, subdivision 1. $978,000 of 338.3the funding must be distributed to tribal 338.4governments based on Minnesota Statutes, 338.5section 145A.14, subdivision 2a.338.6(5) The commissioner may use up to 6.23 338.7percent of the funds appropriated each fiscal 338.8year to conduct the ongoing evaluations 338.9required under Minnesota Statutes, section 338.10145A.17, subdivision 7, and training and 338.11technical assistance as required under 338.12Minnesota Statutes, section 145A.17, 338.13subdivisions 4 and 5.338.14TANF Carryforward. Any unexpended 338.15balance of the TANF appropriation in the 338.16first year of the biennium does not cancel but 338.17is available for the second year.

338.18Subd. 3.Policy Quality and Compliance

338.19Appropriations by Fund338.20General10,434,00010,230,000338.21338.22State Government Special Revenue14,026,00014,083,000338.23Health Care Access10,856,0006,703,000

338.24MERC Fund Transfers. The commissioner 338.25of management and budget shall transfer 338.26$9,800,000 from the MERC fund to the 338.27general fund by October 1, 2011.338.28Comprehensive Advanced Life Support.338.29Of the general fund appropriation, $31,000 338.30each year is added to the base of the 338.31comprehensive advanced life support 338.32(CALS) program under Minnesota Statutes, 338.33section 144.6062.338.34Unused Federal Match Funds. Of the 338.35funds appropriated in Laws 2009, chapter 339.179, article 13, section 4, subdivision 3, for 339.2state matching funds for the federal Health 339.3Information Technology for Economic and 339.4Clinical Health Act, $2,800,000 is transferred 339.5to the health care access fund by October 1, 339.62011.339.7Health Careers Opportunities Grants. 339.8$447,000 each year is appropriated to the 339.9commissioner of health from the health 339.10care access fund for the health careers 339.11opportunities grant program under Minnesota 339.12Statutes, section 144.1499.339.13Health Professions Opportunities 339.14Scholarship Program. $63,000 each year is 339.15appropriated to the commissioner of health 339.16from the health care access fund for the 339.17health professions opportunities scholarship 339.18program under Minnesota Statutes, section 339.19144.1503. $138,000 in fiscal year 2012 and 339.20$276,000 each year thereafter is appropriated 339.21to the commissioner of health from the 339.22general fund for the health professions 339.23opportunities scholarship program under 339.24Minnesota Statutes, section 144.1503.339.25Base Level Adjustment. The state 339.26government special revenue fund base shall 339.27be reduced by $141,000 in fiscal years 2014 339.28and 2015. The health care access base shall 339.29be increased by $600,000 in fiscal year 2014.

339.30Subd. 4.Health Protection

339.31Appropriations by Fund339.32General9,370,0009,370,000339.33339.34State Government Special Revenue30,209,00030,209,000

339.35Subd. 5.Administrative Support Services7,400,0007,448,000

340.1Sec. 5. COUNCIL ON DISABILITY$524,000$524,000

340.2340.3340.4Sec. 6. OMBUDSMAN FOR MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES$1,655,000$1,655,000

340.5Funds appropriated for fiscal year 2011 are 340.6available until expended.

340.7Sec. 7. OMBUDSPERSON FOR FAMILIES$265,000$265,000

340.8Sec. 8. HEALTH-RELATED BOARDS

340.9Subdivision 1.Total Appropriation$17,365,000$17,264,000

340.10This appropriation is from the state 340.11government special revenue fund. The 340.12amounts that may be spent for each  purpose 340.13are specified in the following  subdivisions.

340.14Subd. 2.Board of Chiropractic Examiners469,000469,000

340.15Subd. 3.Board of Dentistry1,959,0001,914,000

340.16Health Professional Services Program.340.17$834,000 in fiscal year 2012 and $804,000 in 340.18fiscal year 2013 from the state government 340.19special revenue fund are for the health 340.20professional services program.

340.21340.22Subd. 4.Board of Dietetic and Nutrition Practice110,000110,000

340.23340.24Subd. 5.Board of Marriage and Family Therapy192,000167,000

340.25Rulemaking. Of this appropriation, $25,000 340.26in fiscal year 2012 is for rulemaking. This is 340.27a onetime appropriation.

340.28Subd. 6.Board of Medical Practice3,866,0003,866,000

340.29Subd. 7.Board of Nursing3,545,0003,545,000

340.30340.31Subd. 8.Board of Nursing Home Administrators2,153,0002,145,000

341.1Rulemaking. Of this appropriation, $44,000 341.2in fiscal year 2012 is for rulemaking. This is 341.3a onetime appropriation.341.4Electronic Licensing System Adaptors.341.5Of this appropriation, $761,000 in fiscal 341.6year 2013 from the state government special 341.7revenue fund is to the administrative services 341.8unit to cover the costs to connect to the 341.9e-licensing system. Minnesota Statutes, 341.10section 16E.22. Base level funding  for this 341.11activity in fiscal year 2014 shall be  $100,000. 341.12Base level funding for this activity in fiscal 341.13year 2015 shall be $50,000.341.14Development and Implementation of a 341.15Disciplinary, Regulatory, Licensing and 341.16Information Management System. Of this 341.17appropriation, $800,000 in fiscal  year 2012 341.18and $300,000 in fiscal year 2013 are  for the 341.19development of a shared system.   Base level 341.20funding for this activity in fiscal year  2014 341.21shall be $50,000.341.22Administrative Services Unit - Operating 341.23Costs. Of this appropriation, $526,000 341.24in fiscal year 2012 and $526,000 in 341.25fiscal year 2013 are for operating costs 341.26of the administrative services unit. The 341.27administrative services unit may receive 341.28and expend reimbursements for services 341.29performed by other agencies.341.30Administrative Services Unit - Retirement 341.31Costs. Of this appropriation in fiscal year 341.322012, $225,000 is for onetime retirement 341.33costs in the health-related boards. This 341.34funding may be transferred to the health 341.35boards incurring those costs for their 342.1payment. These funds are available either 342.2year of the biennium.342.3Administrative Services Unit - Volunteer 342.4Health Care Provider Program. Of this 342.5appropriation, $150,000 in fiscal year 2012 342.6and $150,000 in fiscal year 2013 are to pay 342.7for medical professional liability coverage 342.8required under Minnesota Statutes, section 342.9214.40.342.10Administrative Services Unit - Contested 342.11Cases and Other Legal Proceedings.342.12Of  this appropriation, $200,000 in fiscal 342.13year  2012 and $200,000 in fiscal year 342.142013  are for costs of contested case 342.15hearings  and other unanticipated costs of 342.16legal  proceedings involving health-related 342.17boards funded under this section. Upon 342.18certification of a health-related board to the 342.19administrative services unit that the costs 342.20will be incurred and that there is insufficient 342.21money available to pay for the costs out of 342.22money currently available to that board, the 342.23administrative services unit is authorized 342.24to transfer money from this appropriation 342.25to the board for payment of those costs 342.26with the approval of the commissioner of 342.27finance. This appropriation does not cancel. 342.28Any unencumbered and unspent balances 342.29remain available for these expenditures in 342.30subsequent fiscal years.

342.31Subd. 9.Board of Optometry106,000106,000

342.32Subd. 10.Board of Pharmacy1,977,0001,980,000

342.33Prescription Electronic Reporting. Of 342.34this appropriation, $356,000 in fiscal year 342.352012 and $356,000 in fiscal year 2013 from 343.1the state government special revenue fund 343.2are to the board to operate the prescription 343.3electronic reporting system in Minnesota 343.4Statutes, section 152.126. Base level funding 343.5for this activity in fiscal year 2014 shall be 343.6$356,000.

343.7Subd. 11.Board of Physical Therapy389,000345,000

343.8Rulemaking. Of this appropriation, $44,000 343.9in fiscal year 2012 is for rulemaking. This is 343.10a onetime appropriation.

343.11Subd. 12.Board of Podiatry75,00075,000

343.12Subd. 13.Board of Psychology846,000846,000

343.13Subd. 14.Board of Social Work1,036,0001,053,000

343.14Subd. 15.Board of Veterinary Medicine228,000229,000

343.15343.16Subd. 16.Board of Behavioral Health and Therapy414,000414,000

343.17343.18Sec. 9. EMERGENCY MEDICAL SERVICES BOARD$2,742,000$2,742,000

343.19Of the appropriation, $700,000 in fiscal year 343.202012 and $700,000 in fiscal year 2013 are 343.21for the Cooper/Sams volunteer ambulance 343.22program under Minnesota Statutes, section 343.23144E.40.343.24    Sec. 10. Minnesota Statutes 2010, section 256.01, is amended by adding a subdivision 343.25to read:343.26    Subd. 33.Federal administrative reimbursement dedicated.Federal 343.27administrative reimbursement resulting from the following activities is appropriated to the 343.28commissioner for the designated purposes:343.29(1) reimbursement for the Minnesota senior health options project; and343.30(2) reimbursement related to prior authorization and inpatient admission certification 343.31by a professional review organization. A portion of these funds must be used for activities 343.32to decrease unnecessary pharmaceutical costs in medical assistance.344.1    Sec. 11. Laws 2010, First Special Session chapter 1, article 15, section 3, subdivision 344.26, is amended to read:

344.3Subd. 6.Continuing Care Grants

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

344.5Community Service/Service Development 344.6Grants Reduction. Effective retroactively 344.7from July 1, 2009, funding for grants made 344.8under Minnesota Statutes, sections 
         256.9754344.9and 
         256B.0917, subdivision 13, is reduced 344.10by $5,807,000 for each year of the biennium. 344.11Grants made during the biennium under 344.12Minnesota Statutes, section 
         256.9754, shall 344.13not be used for new construction or building 344.14renovation.344.15Aging Grants Delay. Aging grants must be 344.16reduced by $917,000 in fiscal year 2011 and 344.17increased by $917,000 in fiscal year 2012. 344.18These adjustments are onetime and must not 344.19be applied to the base. This provision expires 344.20June 30, 2012.

344.21344.22(b) Medical Assistance Long-Term Care Facilities Grants(3,827,000)(2,745,000)

344.23ICF/MR Variable Rates Suspension.344.24Effective retroactively from July 1, 2009, 344.25to June 30, 2010, no new variable rates 344.26shall be authorized for intermediate care 344.27facilities for persons with developmental 344.28disabilities under Minnesota Statutes, section 344.29256B.5013, subdivision 1
         .344.30ICF/MR Occupancy Rate Adjustment 344.31Suspension. Effective retroactively from 344.32July 1, 2009, to June 30, 2011, approval 344.33of new applications for occupancy rate 344.34adjustments for unoccupied short-term 345.1beds under Minnesota Statutes, section 345.2256B.5013, subdivision 7
         , is suspended.

345.3345.4(c) Medical Assistance Long-Term Care Waivers and Home Care Grants(2,318,000)(5,807,000)

345.5Developmental Disability Waiver Acuity 345.6Factor. Effective retroactively from January 345.71, 2010, the January 1, 2010, one percent 345.8growth factor in the developmental disability 345.9waiver allocations under Minnesota Statutes, 345.10section 
         256B.092, subdivisions 4 and 5, 345.11that is attributable to changes in acuity,345.12is suspended to June 30, 2011 eliminated. 345.13Effective January 1, 2012, the one percent 345.14growth factor in the developmental 345.15disability waiver allocations is eliminated. 345.16Notwithstanding any law to the contrary, this 345.17provision does not expire.

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

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

345.20345.21(f) Chemical Dependency Nonentitlement Grants(393,000)(393,000)

345.22345.23(g) Other Continuing Care Grants-0-(2,500,000)(1,414,000)

345.24Other Continuing Care Grants Delay.345.25Other continuing care grants must be reduced 345.26by $1,414,000 in fiscal year 2011 and 345.27increased by $1,414,000 in fiscal year 2012. 345.28These adjustments are onetime and must not 345.29be applied to the base. This provision expires 345.30June 30, 2012.

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

345.32Deaf and Hard-of-Hearing Grants Delay.345.33Effective retroactively from July 1, 2010, 345.34deaf and hard-of-hearing grants must be 345.35reduced by $169,000 in fiscal year 2011 and 346.1increased by $169,000 in fiscal year 2012. 346.2These adjustments are onetime and must not 346.3be applied to the base. This provision expires 346.4June 30, 2012.346.5    Sec. 12. TRANSFERS.346.6    Subdivision 1.Grants.The commissioner of human services, with the approval 346.7of the commissioner of management and budget, and after notification of the chairs of 346.8the senate health and human services budget and policy committee and the house of 346.9representatives health and human services finance committee, may transfer unencumbered 346.10appropriation balances for the biennium ending June 30, 2013, within fiscal years among 346.11the MFIP; general assistance; general assistance medical care under Minnesota Statutes 346.122009 Supplement, section 256D.03, subdivision 3; medical assistance; MFIP child care 346.13assistance under Minnesota Statutes, section 119B.05; Minnesota supplemental aid; 346.14and group residential housing programs, and the entitlement portion of the chemical 346.15dependency consolidated treatment fund, and between fiscal years of the biennium.346.16    Subd. 2.Administration.Positions, salary money, and nonsalary administrative 346.17money may be transferred within the Departments of Health and Human Services as the 346.18commissioners consider necessary, with the advance approval of the commissioner of 346.19management and budget. The commissioner shall inform the chairs of the senate health 346.20and human services budget and policy committee and the house of representatives health 346.21and human services finance committee quarterly about transfers made under this provision.346.22    Sec. 13. INDIRECT COSTS NOT TO FUND PROGRAMS.346.23The commissioners of health and human services shall not use indirect cost 346.24allocations to pay for the operational costs of any program for which they are responsible.346.25    Sec. 14. EXPIRATION OF UNCODIFIED LANGUAGE.346.26All uncodified language contained in this article expires on June 30, 2013, unless a 346.27different expiration date is explicit.346.28    Sec. 15. EFFECTIVE DATE.346.29The provisions in this article are effective July 1, 2011, unless a different effective 346.30date is specified.347.1ARTICLE 10347.2HUMAN SERVICES FORECAST ADJUSTMENTS

347.3347.4Section 1. DEPARTMENT OF HUMAN SERVICES FORECAST ADJUSTMENT APPROPRIATIONS.

347.5The sums shown are added to, or if shown in parentheses, are subtracted from the 347.6appropriations in Laws 2009, chapter 79, article 13, as amended by Laws 2009, chapter 347.7173, article 2; Laws 2010, First Special Session chapter 1, articles 15, 23, and 25; and 347.8Laws 2010, Second Special Session chapter 1, article 3, to the commissioner of human 347.9services and for the purposes specified in this article. The appropriations are from the 347.10general fund or another named fund and are available for the fiscal year indicated for 347.11each purpose. The figure "2011" used in this article means that the appropriation or 347.12appropriations listed are available for the fiscal year ending June 30, 2011.

347.13347.14Sec. 2. COMMISSIONER OF HUMAN SERVICES

347.15Subdivision 1.Total Appropriation$(235,463,000)

347.16Appropriations by Fund347.172011347.18General(381,869,000)347.19Health Care Access169,514,000347.20Federal TANF(23,108,000)

347.21The amounts that may be spent for each 347.22purpose are specified in the following 347.23subdivisions.

347.24Subd. 2.Revenue and Pass-through732,000

347.25This appropriation is from the federal TANF 347.26fund.

347.27347.28Subd. 3.Children and Economic Assistance Grants

347.29Appropriations by Fund347.30General(7,098,000)347.31Federal TANF(23,840,000)

347.32(a) MFIP/DWP Grants

347.33Appropriations by Fund347.34General18,715,000347.35Federal TANF(23,840,000)

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

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

348.3(d) Minnesota Supplemental Aid Grants793,000

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

348.5Subd. 4.Basic Health Care Grants

348.6Appropriations by Fund348.7General(335,050,000)348.8Health Care Access169,514,000

348.9(a) MinnesotaCare Grants169,514,000

348.10This appropriation is from the health care 348.11access fund.

348.12348.13(b) Medical Assistance Basic Health Care - Families and Children(49,368,000)

348.14348.15(c) Medical Assistance Basic Health Care - Elderly and Disabled(43,258,000)

348.16348.17(d) Medical Assistance Basic Health Care - Adults without Children(242,424,000)

348.18Subd. 5.Continuing Care Grants(39,721,000)

348.19348.20(a) Medical Assistance Long-Term Care Facilities(14,627,000)

348.21348.22(b) Medical Assistance Long-Term Care Waivers(44,718,000)

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

348.24    Sec. 3. Laws 2010, First Special Session chapter 1, article 25, section 3, subdivision 6, 348.25is amended to read:

348.26Subd. 6.Health Care Grants

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

348.28This appropriation is from the health care 348.29access fund.348.30Health Care Access Fund Transfer to 348.31General Fund. The commissioner of 349.1management and budget shall transfer the 349.2following amounts in the following years 349.3from the health care access fund to the 349.4general fund: $998,000 $0 in fiscal year 349.52010; $176,704,000 $59,901,000 in fiscal 349.6year 2011; $141,041,000 in fiscal year 2012; 349.7and $286,150,000 in fiscal year 2013. If at 349.8any time the governor issues an executive 349.9order not to participate in early medical 349.10assistance expansion, no funds shall be 349.11transferred from the health care access 349.12fund to the general fund until early medical 349.13assistance expansion takes effect. This 349.14paragraph is effective the day following final 349.15enactment.349.16MinnesotaCare Ratable Reduction.349.17Effective for services rendered on or after 349.18July 1, 2010, to December 31, 2013, 349.19MinnesotaCare payments to managed care 349.20plans under Minnesota Statutes, section 349.21256L.12
         , for single adults and households 349.22without children whose income is greater 349.23than 75 percent of federal poverty guidelines 349.24shall be reduced by 15 percent. Effective 349.25for services provided from July 1, 2010, to 349.26June 30, 2011, this reduction shall apply to 349.27all services. Effective for services provided 349.28from July 1, 2011, to December 31, 2013, this 349.29reduction shall apply to all services except 349.30inpatient hospital services. Notwithstanding 349.31any contrary provision of this article, this 349.32paragraph shall expire on December 31, 349.332013.

349.34349.35(b) Medical Assistance Basic Health Care Grants - Families and Children-0-295,512,000

350.1Critical Access Dental. Of the general 350.2fund appropriation, $731,000 in fiscal year 350.32011 is to the commissioner for critical 350.4access dental provider reimbursement 350.5payments under Minnesota Statutes, section 350.6256B.76
          subdivision 4. This is a onetime 350.7appropriation.350.8Nonadministrative Rate Reduction. For 350.9services rendered on or after July 1, 2010, 350.10to December 31, 2013, the commissioner 350.11shall reduce contract rates paid to managed 350.12care plans under Minnesota Statutes, 350.13sections 
         256B.69 and 
         256L.12, and to 350.14county-based purchasing plans under 350.15Minnesota Statutes, section 
         256B.692, by 350.16three percent of the contract rate attributable 350.17to nonadministrative services in effect on 350.18June 30, 2010. Notwithstanding any contrary 350.19provision in this article, this rider expires on 350.20December 31, 2013.

350.21350.22(c) Medical Assistance Basic Health Care Grants - Elderly and Disabled-0-(30,265,000)

350.23350.24(d) General Assistance Medical Care Grants-0-(75,389,000)(59,583,000)

350.25The reduction to general assistance medical 350.26care grants is contingent upon the effective 350.27date in Laws 2010, First Special Session 350.28chapter 1, article 16, section 48. The 350.29reduction shall be reestimated based upon 350.30the actual effective date of the law. The 350.31commissioner of management and budget 350.32shall make adjustments in fiscal year 350.332011 to general assistance medical care 350.34appropriations to conform to the total 350.35expected expenditure reductions specified in 350.36this section.

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

351.2Cobra Carryforward. Unexpended funds 351.3appropriated in fiscal year 2010 for COBRA 351.4grants under Laws 2009, chapter 79, article 351.55, section 78, do not cancel and are available 351.6to the commissioner for fiscal year 2011 351.7COBRA grant expenditures. Up to $111,000 351.8of the fiscal year 2011 appropriation for 351.9COBRA grants provided in Laws 2009, 351.10chapter 79, article 13, section 3, subdivision 351.116, may be used by the commissioner for costs 351.12related to administration of the COBRA 351.13grants.351.14    Sec. 4. EFFECTIVE DATE.351.15This article is effective the day following final enactment.