1.1 	A bill for an act
1.2 	relating to state government; making changes to health and human services 
1.3 	policy provisions; modifying provisions related to continuing care, the telephone 
1.4 	equipment program, chemical and mental health, and health care; reforming 
1.5 	comprehensive assessment and case management services; making technical 
1.6 	changes; requiring reports;amending Minnesota Statutes 2010, sections 
1.7 	144A.071, subdivision 5a; 237.50; 237.51; 237.52; 237.53; 237.54; 237.55; 
1.8 	237.56; 245.461, by adding a subdivision; 245.462, subdivision 20; 245.487, 
1.9 	by adding a subdivision; 245.4871, subdivision 15; 245.4932, subdivision 1; 
1.10 	245A.11, subdivisions 2a, 8; 246.53, by adding a subdivision; 252.32, subdivision 
1.11 	1a; 252A.21, subdivision 2; 256.476, subdivision 11; 256.9657, subdivision 1; 
1.12 	256B.04, subdivision 14; 256B.056, subdivision 3c; 256B.0595, subdivision 2; 
1.13 	256B.0625, subdivisions 13, 13d, 19c, 42; 256B.0659, subdivisions 1, 2, 3, 3a, 4, 
1.14 	9, 13, 14, 19, 21, 30; 256B.0911, subdivisions 1, 2b, 2c, 3, 3b, 4c, 6; 256B.0913, 
1.15 	subdivisions 7, 8; 256B.0915, subdivisions 1a, 1b, 3c, 6; 256B.0916, subdivision 
1.16 	7; 256B.092, subdivisions 1, 1a, 1b, 1e, 1g, 2, 3, 5, 7, 8, 8a, 9, 11; 256B.096, 
1.17 	subdivision 5; 256B.15, subdivisions 1c, 1f; 256B.19, subdivision 1c; 256B.441, 
1.18 	subdivisions 13, 31, 53; 256B.49, subdivisions 13, 21; 256B.69, subdivision 
1.19 	5; 256F.13, subdivision 1; 256G.02, subdivision 6; 256L.05, subdivision 3; 
1.20 	514.982, subdivision 1; Minnesota Statutes 2011 Supplement, sections 125A.21, 
1.21 	subdivision 7; 144A.071, subdivisions 3, 4a; 245A.03, subdivision 7; 254B.04, 
1.22 	subdivision 2a; 256B.056, subdivision 3; 256B.057, subdivision 9; 256B.0625, 
1.23 	subdivisions 13e, 13h, 14, 56; 256B.0631, subdivisions 1, 2; 256B.0659, 
1.24 	subdivision 11; 256B.0911, subdivisions 1a, 3a, 4a; 256B.0915, subdivision 
1.25 	10; 256B.49, subdivisions 14, 15; 256B.69, subdivisions 5a, 28; 256L.12, 
1.26 	subdivision 9; 256L.15, subdivision 1; 626.557, subdivision 9; Laws 2009, 
1.27 	chapter 79, article 8, section 81, as amended; proposing coding for new law in 
1.28 	Minnesota Statutes, chapter 252; repealing Minnesota Statutes 2010, sections 
1.29 	256.01, subdivision 18b; 256B.431, subdivisions 2c, 2g, 2i, 2j, 2k, 2l, 2o, 3c, 
1.30 	11, 14, 17b, 17f, 19, 20, 25, 27, 29; 256B.434, subdivisions 4a, 4b, 4c, 4d, 4e, 
1.31 	4g, 4h, 7, 8; 256B.435; 256B.436; Minnesota Statutes 2011 Supplement, section 
1.32 	256B.431, subdivision 26; Minnesota Rules, part 9555.7700.
1.33 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

2.1 	ARTICLE 1
2.2 	CONTINUING CARE

2.3 	Section 1. Minnesota Statutes 2011 Supplement, section 144A.071, subdivision 3, 
2.4 	is amended to read:
2.5 		Subd. 3.Exceptions authorizing increase in beds; hardship areas. (a) The 
2.6 	commissioner of health, in coordination with the commissioner of human services, may 
2.7 	approve the addition of new licensed and Medicare and Medicaid certified nursing home 
2.8 	beds, using the criteria and process set forth in this subdivision.
2.9 	(b) The commissioner, in cooperation with the commissioner of human services, 
2.10 	shall consider the following criteria when determining that an area of the state is a 
2.11 	hardship area with regard to access to nursing facility services:
2.12 	(1) a low number of beds per thousand in a specified area using as a standard the 
2.13 	beds per thousand people age 65 and older, in five year age groups, using data from the 
2.14 	most recent census and population projections, weighted by each group's most recent 
2.15 	nursing home utilization, of the county at the 20th percentile, as determined by the 
2.16 	commissioner of human services;
2.17 	(2) a high level of out-migration for nursing facility services associated with a 
2.18 	described area from the county or counties of residence to other Minnesota counties, as 
2.19 	determined by the commissioner of human services, using as a standard an amount greater 
2.20 	than the out-migration of the county ranked at the 50th percentile;
2.21 	(3) an adequate level of availability of noninstitutional long-term care services 
2.22 	measured as public spending for home and community-based long-term care services per 
2.23 	individual age 65 and older, in five year age groups, using data from the most recent 
2.24 	census and population projections, weighted by each group's most recent nursing home 
2.25 	utilization, as determined by the commissioner of human services using as a standard an 
2.26 	amount greater than the 50th percentile of counties;
2.27 	(4) there must be a declaration of hardship resulting from insufficient access to 
2.28 	nursing home beds by local county agencies and area agencies on aging; and
2.29 	(5) other factors that may demonstrate the need to add new nursing facility beds.
2.30 	(c) On August 15 of odd-numbered years, the commissioner, in cooperation with 
2.31 	the commissioner of human services, may publish in the State Register a request for 
2.32 	information in which interested parties, using the data provided under section 144A.351, 
2.33 	along with any other relevant data, demonstrate that a specified area is a hardship area 
2.34 	with regard to access to nursing facility services. For a response to be considered, the 
2.35 	commissioner must receive it by November 15. The commissioner shall make responses 
3.1 	to the request for information available to the public and shall allow 30 days for comment. 
3.2 	The commissioner shall review responses and comments and determine if any areas of 
3.3 	the state are to be declared hardship areas.
3.4 	(d) For each designated hardship area determined in paragraph (c), the commissioner 
3.5 	shall publish a request for proposals in accordance with section 144A.073 and Minnesota 
3.6 	Rules, parts 4655.1070 to 4655.1098. The request for proposals must be published in the 
3.7 	State Register by March 15 following receipt of responses to the request for information. 
3.8 	The request for proposals must specify the number of new beds which may be added 
3.9 	in the designated hardship area, which must not exceed the number which, if added to 
3.10 	the existing number of beds in the area, including beds in layaway status, would have 
3.11 	prevented it from being determined to be a hardship area under paragraph (b), clause 
3.12 	(1). Beginning July 1, 2011, the number of new beds approved must not exceed 200 
3.13 	beds statewide per biennium. After June 30, 2019, the number of new beds that may be 
3.14 	approved in a biennium must not exceed 300 statewide. For a proposal to be considered, 
3.15 	the commissioner must receive it within six months of the publication of the request for 
3.16 	proposals. The commissioner shall review responses to the request for proposals and 
3.17 	shall approve or disapprove each proposal by the following July 15, in accordance with 
3.18 	section 144A.073 and Minnesota Rules, parts 4655.1070 to 4655.1098. The commissioner 
3.19 	shall base approvals or disapprovals on a comparison and ranking of proposals using 
3.20 	only the criteria in subdivision 4a. Approval of a proposal expires after 18 months 
3.21 	unless the facility has added the new beds using existing space, subject to approval 
3.22 	by the commissioner, or has commenced construction as defined in section 144A.071, 
3.23 	subdivision 1a, paragraph (d). OperatingIf, after the approved beds have been added, 
3.24 	fewer than 50 percent of the beds in a facility are newly licensed, the operating payment 
3.25 	rates previously in effect shall remain. If, after the approved beds have been added, 50 
3.26 	percent or more of the beds in a facility are newly licensed, operating payment rates shall 
3.27 	be determined according to Minnesota Rules, part 9549.0057, using the limits under 
3.28 	section 256B.441. External fixed payment rates must be determined according to section 
3.29 	256B.441, subdivision 53. Property payment rates for facilities with beds added under this 
3.30 	subdivision must be determined in the same manner as rate determinations resulting from 
3.31 	projects approved and completed under section 144A.073.
3.32 	(e) The commissioner may:
3.33 	(1) certify or license new beds in a new facility that is to be operated by the 
3.34 	commissioner of veterans affairs or when the costs of constructing and operating the new 
3.35 	beds are to be reimbursed by the commissioner of veterans affairs or the United States 
3.36 	Veterans Administration; and
4.1 	(2) license or certify beds in a facility that has been involuntarily delicensed or 
4.2 	decertified for participation in the medical assistance program, provided that an application 
4.3 	for relicensure or recertification is submitted to the commissioner by an organization that 
4.4 	is not a related organization as defined in section 256B.441, subdivision 34, to the prior 
4.5 	licensee within 120 days after delicensure or decertification.

4.6 	Sec. 2. Minnesota Statutes 2011 Supplement, section 144A.071, subdivision 4a, 
4.7 	is amended to read:
4.8 		Subd. 4a.Exceptions for replacement beds.  It is in the best interest of the state 
4.9 	to ensure that nursing homes and boarding care homes continue to meet the physical 
4.10 	plant licensing and certification requirements by permitting certain construction projects. 
4.11 	Facilities should be maintained in condition to satisfy the physical and emotional needs 
4.12 	of residents while allowing the state to maintain control over nursing home expenditure 
4.13 	growth.
4.14 	The commissioner of health in coordination with the commissioner of human 
4.15 	services, may approve the renovation, replacement, upgrading, or relocation of a nursing 
4.16 	home or boarding care home, under the following conditions:
4.17 	(a) to license or certify beds in a new facility constructed to replace a facility or to 
4.18 	make repairs in an existing facility that was destroyed or damaged after June 30, 1987, by 
4.19 	fire, lightning, or other hazard provided:
4.20 	(i) destruction was not caused by the intentional act of or at the direction of a 
4.21 	controlling person of the facility;
4.22 	(ii) at the time the facility was destroyed or damaged the controlling persons of the 
4.23 	facility maintained insurance coverage for the type of hazard that occurred in an amount 
4.24 	that a reasonable person would conclude was adequate;
4.25 	(iii) the net proceeds from an insurance settlement for the damages caused by the 
4.26 	hazard are applied to the cost of the new facility or repairs;
4.27 	(iv) the number of licensed and certified beds in the new facility does not exceed the 
4.28 	number of licensed and certified beds in the destroyed facility; and
4.29 	(v) the commissioner determines that the replacement beds are needed to prevent an 
4.30 	inadequate supply of beds.
4.31 	Project construction costs incurred for repairs authorized under this clause shall not be 
4.32 	considered in the dollar threshold amount defined in subdivision 2;
4.33 	(b) to license or certify beds that are moved from one location to another within a 
4.34 	nursing home facility, provided the total costs of remodeling performed in conjunction 
4.35 	with the relocation of beds does not exceed $1,000,000;
5.1 	(c) to license or certify beds in a project recommended for approval under section 
5.2 	144A.073;
5.3 	(d) to license or certify beds that are moved from an existing state nursing home to 
5.4 	a different state facility, provided there is no net increase in the number of state nursing 
5.5 	home beds;
5.6 	(e) to certify and license as nursing home beds boarding care beds in a certified 
5.7 	boarding care facility if the beds meet the standards for nursing home licensure, or in a 
5.8 	facility that was granted an exception to the moratorium under section 144A.073, and if 
5.9 	the cost of any remodeling of the facility does not exceed $1,000,000. If boarding care 
5.10 	beds are licensed as nursing home beds, the number of boarding care beds in the facility 
5.11 	must not increase beyond the number remaining at the time of the upgrade in licensure. 
5.12 	The provisions contained in section 144A.073 regarding the upgrading of the facilities 
5.13 	do not apply to facilities that satisfy these requirements;
5.14 	(f) to license and certify up to 40 beds transferred from an existing facility owned and 
5.15 	operated by the Amherst H. Wilder Foundation in the city of St. Paul to a new unit at the 
5.16 	same location as the existing facility that will serve persons with Alzheimer's disease and 
5.17 	other related disorders. The transfer of beds may occur gradually or in stages, provided 
5.18 	the total number of beds transferred does not exceed 40. At the time of licensure and 
5.19 	certification of a bed or beds in the new unit, the commissioner of health shall delicense 
5.20 	and decertify the same number of beds in the existing facility. As a condition of receiving 
5.21 	a license or certification under this clause, the facility must make a written commitment 
5.22 	to the commissioner of human services that it will not seek to receive an increase in its 
5.23 	property-related payment rate as a result of the transfers allowed under this paragraph;
5.24 	(g) to license and certify nursing home beds to replace currently licensed and certified 
5.25 	boarding care beds which may be located either in a remodeled or renovated boarding care 
5.26 	or nursing home facility or in a remodeled, renovated, newly constructed, or replacement 
5.27 	nursing home facility within the identifiable complex of health care facilities in which the 
5.28 	currently licensed boarding care beds are presently located, provided that the number of 
5.29 	boarding care beds in the facility or complex are decreased by the number to be licensed 
5.30 	as nursing home beds and further provided that, if the total costs of new construction, 
5.31 	replacement, remodeling, or renovation exceed ten percent of the appraised value of 
5.32 	the facility or $200,000, whichever is less, the facility makes a written commitment to 
5.33 	the commissioner of human services that it will not seek to receive an increase in its 
5.34 	property-related payment rate by reason of the new construction, replacement, remodeling, 
5.35 	or renovation. The provisions contained in section 144A.073 regarding the upgrading of 
5.36 	facilities do not apply to facilities that satisfy these requirements;
6.1 	(h) to license as a nursing home and certify as a nursing facility a facility that is 
6.2 	licensed as a boarding care facility but not certified under the medical assistance program, 
6.3 	but only if the commissioner of human services certifies to the commissioner of health that 
6.4 	licensing the facility as a nursing home and certifying the facility as a nursing facility will 
6.5 	result in a net annual savings to the state general fund of $200,000 or more;
6.6 	(i) to certify, after September 30, 1992, and prior to July 1, 1993, existing nursing 
6.7 	home beds in a facility that was licensed and in operation prior to January 1, 1992;
6.8 	(j) to license and certify new nursing home beds to replace beds in a facility acquired 
6.9 	by the Minneapolis Community Development Agency as part of redevelopment activities 
6.10 	in a city of the first class, provided the new facility is located within three miles of the site 
6.11 	of the old facility. Operating and property costs for the new facility must be determined 
6.12 	and allowed under section 256B.431 or 256B.434;
6.13 	(k) to license and certify up to 20 new nursing home beds in a community-operated 
6.14 	hospital and attached convalescent and nursing care facility with 40 beds on April 21, 
6.15 	1991, that suspended operation of the hospital in April 1986. The commissioner of human 
6.16 	services shall provide the facility with the same per diem property-related payment rate 
6.17 	for each additional licensed and certified bed as it will receive for its existing 40 beds;
6.18 	(l) to license or certify beds in renovation, replacement, or upgrading projects as 
6.19 	defined in section 144A.073, subdivision 1, so long as the cumulative total costs of the 
6.20 	facility's remodeling projects do not exceed $1,000,000;
6.21 	(m) to license and certify beds that are moved from one location to another for the 
6.22 	purposes of converting up to five four-bed wards to single or double occupancy rooms 
6.23 	in a nursing home that, as of January 1, 1993, was county-owned and had a licensed 
6.24 	capacity of 115 beds;
6.25 	(n) to allow a facility that on April 16, 1993, was a 106-bed licensed and certified 
6.26 	nursing facility located in Minneapolis to layaway all of its licensed and certified nursing 
6.27 	home beds. These beds may be relicensed and recertified in a newly constructed teaching 
6.28 	nursing home facility affiliated with a teaching hospital upon approval by the legislature. 
6.29 	The proposal must be developed in consultation with the interagency committee on 
6.30 	long-term care planning. The beds on layaway status shall have the same status as 
6.31 	voluntarily delicensed and decertified beds, except that beds on layaway status remain 
6.32 	subject to the surcharge in section 256.9657. This layaway provision expires July 1, 1998;
6.33 	(o) to allow a project which will be completed in conjunction with an approved 
6.34 	moratorium exception project for a nursing home in southern Cass County and which is 
6.35 	directly related to that portion of the facility that must be repaired, renovated, or replaced, 
7.1 	to correct an emergency plumbing problem for which a state correction order has been 
7.2 	issued and which must be corrected by August 31, 1993;
7.3 	(p) to allow a facility that on April 16, 1993, was a 368-bed licensed and certified 
7.4 	nursing facility located in Minneapolis to layaway, upon 30 days prior written notice to 
7.5 	the commissioner, up to 30 of the facility's licensed and certified beds by converting 
7.6 	three-bed wards to single or double occupancy. Beds on layaway status shall have the 
7.7 	same status as voluntarily delicensed and decertified beds except that beds on layaway 
7.8 	status remain subject to the surcharge in section 256.9657, remain subject to the license 
7.9 	application and renewal fees under section 144A.07 and shall be subject to a $100 per bed 
7.10 	reactivation fee. In addition, at any time within three years of the effective date of the 
7.11 	layaway, the beds on layaway status may be:
7.12 	(1) relicensed and recertified upon relocation and reactivation of some or all of 
7.13 	the beds to an existing licensed and certified facility or facilities located in Pine River, 
7.14 	Brainerd, or International Falls; provided that the total project construction costs related to 
7.15 	the relocation of beds from layaway status for any facility receiving relocated beds may 
7.16 	not exceed the dollar threshold provided in subdivision 2 unless the construction project 
7.17 	has been approved through the moratorium exception process under section 144A.073;
7.18 	(2) relicensed and recertified, upon reactivation of some or all of the beds within the 
7.19 	facility which placed the beds in layaway status, if the commissioner has determined a 
7.20 	need for the reactivation of the beds on layaway status.
7.21 	The property-related payment rate of a facility placing beds on layaway status 
7.22 	must be adjusted by the incremental change in its rental per diem after recalculating the 
7.23 	rental per diem as provided in section 256B.431, subdivision 3a, paragraph (c). The 
7.24 	property-related payment rate for a facility relicensing and recertifying beds from layaway 
7.25 	status must be adjusted by the incremental change in its rental per diem after recalculating 
7.26 	its rental per diem using the number of beds after the relicensing to establish the facility's 
7.27 	capacity day divisor, which shall be effective the first day of the month following the 
7.28 	month in which the relicensing and recertification became effective. Any beds remaining 
7.29 	on layaway status more than three years after the date the layaway status became effective 
7.30 	must be removed from layaway status and immediately delicensed and decertified;
7.31 	(q) to license and certify beds in a renovation and remodeling project to convert 12 
7.32 	four-bed wards into 24 two-bed rooms, expand space, and add improvements in a nursing 
7.33 	home that, as of January 1, 1994, met the following conditions: the nursing home was 
7.34 	located in Ramsey County; had a licensed capacity of 154 beds; and had been ranked 
7.35 	among the top 15 applicants by the 1993 moratorium exceptions advisory review panel. 
8.1 	The total project construction cost estimate for this project must not exceed the cost 
8.2 	estimate submitted in connection with the 1993 moratorium exception process;
8.3 	(r) to license and certify up to 117 beds that are relocated from a licensed and 
8.4 	certified 138-bed nursing facility located in St. Paul to a hospital with 130 licensed 
8.5 	hospital beds located in South St. Paul, provided that the nursing facility and hospital are 
8.6 	owned by the same or a related organization and that prior to the date the relocation is 
8.7 	completed the hospital ceases operation of its inpatient hospital services at that hospital. 
8.8 	After relocation, the nursing facility's status under section 256B.431, subdivision 2j, shall 
8.9 	be the same as it was prior to relocation. The nursing facility's property-related payment 
8.10 	rate resulting from the project authorized in this paragraph shall become effective no 
8.11 	earlier than April 1, 1996. For purposes of calculating the incremental change in the 
8.12 	facility's rental per diem resulting from this project, the allowable appraised value of 
8.13 	the nursing facility portion of the existing health care facility physical plant prior to the 
8.14 	renovation and relocation may not exceed $2,490,000;
8.15 	(s) to license and certify two beds in a facility to replace beds that were voluntarily 
8.16 	delicensed and decertified on June 28, 1991;
8.17 	(t) to allow 16 licensed and certified beds located on July 1, 1994, in a 142-bed 
8.18 	nursing home and 21-bed boarding care home facility in Minneapolis, notwithstanding 
8.19 	the licensure and certification after July 1, 1995, of the Minneapolis facility as a 147-bed 
8.20 	nursing home facility after completion of a construction project approved in 1993 under 
8.21 	section 144A.073, to be laid away upon 30 days' prior written notice to the commissioner. 
8.22 	Beds on layaway status shall have the same status as voluntarily delicensed or decertified 
8.23 	beds except that they shall remain subject to the surcharge in section 256.9657. The 
8.24 	16 beds on layaway status may be relicensed as nursing home beds and recertified at 
8.25 	any time within five years of the effective date of the layaway upon relocation of some 
8.26 	or all of the beds to a licensed and certified facility located in Watertown, provided that 
8.27 	the total project construction costs related to the relocation of beds from layaway status 
8.28 	for the Watertown facility may not exceed the dollar threshold provided in subdivision 
8.29 	2 unless the construction project has been approved through the moratorium exception 
8.30 	process under section 144A.073.
8.31 	The property-related payment rate of the facility placing beds on layaway status 
8.32 	must be adjusted by the incremental change in its rental per diem after recalculating the 
8.33 	rental per diem as provided in section 256B.431, subdivision 3a, paragraph (c). The 
8.34 	property-related payment rate for the facility relicensing and recertifying beds from 
8.35 	layaway status must be adjusted by the incremental change in its rental per diem after 
8.36 	recalculating its rental per diem using the number of beds after the relicensing to establish 
9.1 	the facility's capacity day divisor, which shall be effective the first day of the month 
9.2 	following the month in which the relicensing and recertification became effective. Any 
9.3 	beds remaining on layaway status more than five years after the date the layaway status 
9.4 	became effective must be removed from layaway status and immediately delicensed 
9.5 	and decertified;
9.6 	(u) to license and certify beds that are moved within an existing area of a facility or 
9.7 	to a newly constructed addition which is built for the purpose of eliminating three- and 
9.8 	four-bed rooms and adding space for dining, lounge areas, bathing rooms, and ancillary 
9.9 	service areas in a nursing home that, as of January 1, 1995, was located in Fridley and had 
9.10 	a licensed capacity of 129 beds;
9.11 	(v) to relocate 36 beds in Crow Wing County and four beds from Hennepin County 
9.12 	to a 160-bed facility in Crow Wing County, provided all the affected beds are under 
9.13 	common ownership;
9.14 	(w) to license and certify a total replacement project of up to 49 beds located in 
9.15 	Norman County that are relocated from a nursing home destroyed by flood and whose 
9.16 	residents were relocated to other nursing homes. The operating cost payment rates for 
9.17 	the new nursing facility shall be determined based on the interim and settle-up payment 
9.18 	provisions of Minnesota Rules, part 9549.0057, and the reimbursement provisions of 
9.19 	section 256B.431, except that subdivision 26, paragraphs (a) and (b), shall not apply until 
9.20 	the second rate year after the settle-up cost report is filed. Property-related reimbursement 
9.21 	rates shall be determined under section 256B.431, taking into account any federal or state 
9.22 	flood-related loans or grants provided to the facility;
9.23 	(x) to license and certify a total replacement project of up to 129 beds located 
9.24 	in Polk County that are relocated from a nursing home destroyed by flood and whose 
9.25 	residents were relocated to other nursing homes. The operating cost payment rates for 
9.26 	the new nursing facility shall be determined based on the interim and settle-up payment 
9.27 	provisions of Minnesota Rules, part 9549.0057, and the reimbursement provisions of 
9.28 	section 256B.431, except that subdivision 26, paragraphs (a) and (b), shall not apply until 
9.29 	the second rate year after the settle-up cost report is filed. Property-related reimbursement 
9.30 	rates shall be determined under section 256B.431, taking into account any federal or state 
9.31 	flood-related loans or grants provided to the facility;
9.32 	(y) to license and certify beds in a renovation and remodeling project to convert 13 
9.33 	three-bed wards into 13 two-bed rooms and 13 single-bed rooms, expand space, and 
9.34 	add improvements in a nursing home that, as of January 1, 1994, met the following 
9.35 	conditions: the nursing home was located in Ramsey County, was not owned by a hospital 
9.36 	corporation, had a licensed capacity of 64 beds, and had been ranked among the top 15 
10.1 	applicants by the 1993 moratorium exceptions advisory review panel. The total project 
10.2 	construction cost estimate for this project must not exceed the cost estimate submitted in 
10.3 	connection with the 1993 moratorium exception process;
10.4 	(z) to license and certify up to 150 nursing home beds to replace an existing 285 
10.5 	bed nursing facility located in St. Paul. The replacement project shall include both the 
10.6 	renovation of existing buildings and the construction of new facilities at the existing 
10.7 	site. The reduction in the licensed capacity of the existing facility shall occur during the 
10.8 	construction project as beds are taken out of service due to the construction process. Prior 
10.9 	to the start of the construction process, the facility shall provide written information to the 
10.10 	commissioner of health describing the process for bed reduction, plans for the relocation 
10.11 	of residents, and the estimated construction schedule. The relocation of residents shall be 
10.12 	in accordance with the provisions of law and rule;
10.13 	(aa) to allow the commissioner of human services to license an additional 36 beds 
10.14 	to provide residential services for the physically disabled under Minnesota Rules, parts 
10.15 	9570.2000 to 9570.3400, in a 198-bed nursing home located in Red Wing, provided that 
10.16 	the total number of licensed and certified beds at the facility does not increase;
10.17 	(bb) to license and certify a new facility in St. Louis County with 44 beds 
10.18 	constructed to replace an existing facility in St. Louis County with 31 beds, which has 
10.19 	resident rooms on two separate floors and an antiquated elevator that creates safety 
10.20 	concerns for residents and prevents nonambulatory residents from residing on the second 
10.21 	floor. The project shall include the elimination of three- and four-bed rooms;
10.22 	(cc) to license and certify four beds in a 16-bed certified boarding care home in 
10.23 	Minneapolis to replace beds that were voluntarily delicensed and decertified on or 
10.24 	before March 31, 1992. The licensure and certification is conditional upon the facility 
10.25 	periodically assessing and adjusting its resident mix and other factors which may 
10.26 	contribute to a potential institution for mental disease declaration. The commissioner of 
10.27 	human services shall retain the authority to audit the facility at any time and shall require 
10.28 	the facility to comply with any requirements necessary to prevent an institution for mental 
10.29 	disease declaration, including delicensure and decertification of beds, if necessary;
10.30 	(dd) to license and certify 72 beds in an existing facility in Mille Lacs County with 
10.31 	80 beds as part of a renovation project. The renovation must include construction of 
10.32 	an addition to accommodate ten residents with beginning and midstage dementia in a 
10.33 	self-contained living unit; creation of three resident households where dining, activities, 
10.34 	and support spaces are located near resident living quarters; designation of four beds 
10.35 	for rehabilitation in a self-contained area; designation of 30 private rooms; and other 
10.36 	improvements;
11.1 	(ee) to license and certify beds in a facility that has undergone replacement or 
11.2 	remodeling as part of a planned closure under section 256B.437;
11.3 	(ff) to license and certify a total replacement project of up to 124 beds located 
11.4 	in Wilkin County that are in need of relocation from a nursing home significantly 
11.5 	damaged by flood. The operating cost payment rates for the new nursing facility shall 
11.6 	be determined based on the interim and settle-up payment provisions of Minnesota 
11.7 	Rules, part 9549.0057, and the reimbursement provisions of section 256B.431, except 
11.8 	that section 256B.431, subdivision 26, paragraphs (a) and (b), shall not apply until the 
11.9 	second rate year after the settle-up cost report is filed. Property-related reimbursement 
11.10 	rates shall be determined under section 256B.431, taking into account any federal or state 
11.11 	flood-related loans or grants provided to the facility;
11.12 	(gg) to allow the commissioner of human services to license an additional nine beds 
11.13 	to provide residential services for the physically disabled under Minnesota Rules, parts 
11.14 	9570.2000 to 9570.3400, in a 240-bed nursing home located in Duluth, provided that the 
11.15 	total number of licensed and certified beds at the facility does not increase;
11.16 	(hh) to license and certify up to 120 new nursing facility beds to replace beds in a 
11.17 	facility in Anoka County, which was licensed for 98 beds as of July 1, 2000, provided the 
11.18 	new facility is located within four miles of the existing facility and is in Anoka County. 
11.19 	Operating and property rates shall be determined and allowed under section 256B.431
11.20 	and Minnesota Rules, parts 9549.0010 to 9549.0080, or section 256B.434 or 256B.435. 
11.21 	The provisions of section 256B.431, subdivision 26, paragraphs (a) and (b), do not apply 
11.22 	until the second rate year following settle-up 256B.441; or
11.23 	(ii) to transfer up to 98 beds of a 129-licensed bed facility located in Anoka County 
11.24 	that, as of March 25, 2001, is in the active process of closing, to a 122-licensed bed 
11.25 	nonprofit nursing facility located in the city of Columbia Heights or its affiliate. The 
11.26 	transfer is effective when the receiving facility notifies the commissioner in writing of the 
11.27 	number of beds accepted. The commissioner shall place all transferred beds on layaway 
11.28 	status held in the name of the receiving facility. The layaway adjustment provisions of 
11.29 	section 256B.431, subdivision 30, do not apply to this layaway. The receiving facility 
11.30 	may only remove the beds from layaway for recertification and relicensure at the receiving 
11.31 	facility's current site, or at a newly constructed facility located in Anoka County. The 
11.32 	receiving facility must receive statutory authorization before removing these beds from 
11.33 	layaway status, or may remove these beds from layaway status if removal from layaway 
11.34 	status is part of a moratorium exception project approved by the commissioner under 
11.35 	section 144A.073.

12.1 	Sec. 3. Minnesota Statutes 2011 Supplement, section 245A.03, subdivision 7, is 
12.2 	amended to read:
12.3 		Subd. 7.Licensing moratorium. (a) The commissioner shall not issue an 
12.4 	initial license for child foster care licensed under Minnesota Rules, parts 2960.3000 to 
12.5 	2960.3340, or adult foster care licensed under Minnesota Rules, parts 9555.5105 to 
12.6 	9555.6265, under this chapter for a physical location that will not be the primary residence 
12.7 	of the license holder for the entire period of licensure. If a license is issued during this 
12.8 	moratorium, and the license holder changes the license holder's primary residence away 
12.9 	from the physical location of the foster care license, the commissioner shall revoke the 
12.10 	license according to section 245A.07. Exceptions to the moratorium include:
12.11 	(1) foster care settings that are required to be registered under chapter 144D;
12.12 	(2) foster care licenses replacing foster care licenses in existence on May 15, 2009, 
12.13 	and determined to be needed by the commissioner under paragraph (b);
12.14 	(3) new foster care licenses determined to be needed by the commissioner under 
12.15 	paragraph (b) for the closure of a nursing facility, ICF/MR, or regional treatment center, or 
12.16 	restructuring of state-operated services that limits the capacity of state-operated facilities;
12.17 	(4) new foster care licenses determined to be needed by the commissioner under 
12.18 	paragraph (b) for persons requiring hospital level care; or
12.19 	(5) new foster care licenses determined to be needed by the commissioner for the 
12.20 	transition of people from personal care assistance to the home and community-based 
12.21 	services.
12.22 	(b) The commissioner shall determine the need for newly licensed foster care homes 
12.23 	as defined under this subdivision. As part of the determination, the commissioner shall 
12.24 	consider the availability of foster care capacity in the area in which the licensee seeks to 
12.25 	operate, and the recommendation of the local county board. The determination by the 
12.26 	commissioner must be final. A determination of need is not required for a change in 
12.27 	ownership at the same address.
12.28 	(c) Residential settings that would otherwise be subject to the moratorium established 
12.29 	in paragraph (a), that are in the process of receiving an adult or child foster care license as 
12.30 	of July 1, 2009, shall be allowed to continue to complete the process of receiving an adult 
12.31 	or child foster care license. For this paragraph, all of the following conditions must be met 
12.32 	to be considered in the process of receiving an adult or child foster care license:
12.33 	(1) participants have made decisions to move into the residential setting, including 
12.34 	documentation in each participant's care plan;
12.35 	(2) the provider has purchased housing or has made a financial investment in the 
12.36 	property;
13.1 	(3) the lead agency has approved the plans, including costs for the residential setting 
13.2 	for each individual;
13.3 	(4) the completion of the licensing process, including all necessary inspections, is 
13.4 	the only remaining component prior to being able to provide services; and
13.5 	(5) the needs of the individuals cannot be met within the existing capacity in that 
13.6 	county.
13.7 	To qualify for the process under this paragraph, the lead agency must submit 
13.8 	documentation to the commissioner by August 1, 2009, that all of the above criteria are 
13.9 	met.
13.10 	(d) (c) The commissioner shall study the effects of the license moratorium under this 
13.11 	subdivision and shall report back to the legislature by January 15, 2011. This study shall 
13.12 	include, but is not limited to the following:
13.13 	(1) the overall capacity and utilization of foster care beds where the physical location 
13.14 	is not the primary residence of the license holder prior to and after implementation 
13.15 	of the moratorium;
13.16 	(2) the overall capacity and utilization of foster care beds where the physical 
13.17 	location is the primary residence of the license holder prior to and after implementation 
13.18 	of the moratorium; and
13.19 	(3) the number of licensed and occupied ICF/MR beds prior to and after 
13.20 	implementation of the moratorium.
13.21 	(e) (d) When a foster care recipient moves out of a foster home that is not the 
13.22 	primary residence of the license holder according to section 256B.49, subdivision 15, 
13.23 	paragraph (f), the county shall immediately inform the Department of Human Services 
13.24 	Licensing Division, and the department shall immediately decrease the licensed capacity 
13.25 	for the home. A decreased licensed capacity according to this paragraph is not subject to 
13.26 	appeal under this chapter.
13.27 	(e) At the time of application and reapplication for licensure, the applicant and the 
13.28 	license holder that are subject to the moratorium or an exclusion established in paragraph 
13.29 	(a) are required to inform the commissioner whether the physical location where the foster 
13.30 	care will be provided is or will be the primary residence of the license holder for the entire 
13.31 	period of licensure. If the primary residence of the applicant or license holder changes, the 
13.32 	applicant or license holder must notify the commissioner immediately. The commissioner 
13.33 	shall print on the foster care license certificate whether or not the physical location is the 
13.34 	primary residence of the license holder.
13.35 	(f) License holders of foster care homes identified under paragraph (e) that are not 
13.36 	the primary residence of the license holder and that also provide services in the foster care 
14.1 	home that are covered by a federally approved home and community-based services 
14.2 	waiver, as authorized under section 256B.0915, 256B.092, or 256B.49 must inform the 
14.3 	human services licensing division that the license holder provides or intends to provide 
14.4 	these waiver-funded services. These license holders must be considered registered under 
14.5 	section 256B.092, subdivision 11, paragraph (c), and this registration status must be 
14.6 	identified on their license certificates.

14.7 	Sec. 4. Minnesota Statutes 2010, section 245A.11, subdivision 2a, is amended to read:
14.8 		Subd. 2a.Adult foster care license capacity. (a) The commissioner shall issue 
14.9 	adult foster care licenses with a maximum licensed capacity of four beds, including 
14.10 	nonstaff roomers and boarders, except that the commissioner may issue a license with a 
14.11 	capacity of five beds, including roomers and boarders, according to paragraphs (b) to (f).
14.12 	(b) An adult foster care license holder may have a maximum license capacity of five 
14.13 	if all persons in care are age 55 or over and do not have a serious and persistent mental 
14.14 	illness or a developmental disability.
14.15 	(c) The commissioner may grant variances to paragraph (b) to allow a foster care 
14.16 	provider with a licensed capacity of five persons to admit an individual under the age of 55 
14.17 	if the variance complies with section 245A.04, subdivision 9, and approval of the variance 
14.18 	is recommended by the county in which the licensed foster care provider is located.
14.19 	(d) The commissioner may grant variances to paragraph (b) to allow the use of a fifth 
14.20 	bed for emergency crisis services for a person with serious and persistent mental illness 
14.21 	or a developmental disability, regardless of age, if the variance complies with section 
14.22 	245A.04, subdivision 9, and approval of the variance is recommended by the county in 
14.23 	which the licensed foster care provider is located.
14.24 	(e) If the 2009 legislature adopts a rate reduction that impacts providers of adult 
14.25 	foster care services, the commissioner may issue an adult foster care license with a 
14.26 	capacity of five adults if the fifth bed does not increase the overall statewide capacity of 
14.27 	licensed adult foster care beds in homes that are not the primary residence of the license 
14.28 	holder, over the licensed capacity in such homes on July 1, 2009, as identified in a plan 
14.29 	submitted to the commissioner by the county, when the capacity is recommended by 
14.30 	the county licensing agency of the county in which the facility is located and if the 
14.31 	recommendation verifies that:
14.32 	(1) the facility meets the physical environment requirements in the adult foster 
14.33 	care licensing rule;
14.34 	(2) the five-bed living arrangement is specified for each resident in the resident's:
14.35 	(i) individualized plan of care;
15.1 	(ii) individual service plan under section 256B.092, subdivision 1b, if required; or
15.2 	(iii) individual resident placement agreement under Minnesota Rules, part 
15.3 	9555.5105, subpart 19, if required;
15.4 	(3) the license holder obtains written and signed informed consent from each 
15.5 	resident or resident's legal representative documenting the resident's informed choice to 
15.6 	living in the home and that the resident's refusal to consent would not have resulted in 
15.7 	service termination; and
15.8 	(4) the facility was licensed for adult foster care before March 1, 2009.
15.9 	(f) The commissioner shall not issue a new adult foster care license under paragraph 
15.10 	(e) after June 30, 2011 2014. The commissioner shall allow a facility with an adult foster 
15.11 	care license issued under paragraph (e) before June 30, 2011 2014, to continue with a 
15.12 	capacity of five adults if the license holder continues to comply with the requirements in 
15.13 	paragraph (e).

15.14 	Sec. 5. Minnesota Statutes 2010, section 245A.11, subdivision 8, is amended to read:
15.15 		Subd. 8.Community residential setting license. (a) The commissioner shall 
15.16 	establish provider standards for residential support services that integrate service standards 
15.17 	and the residential setting under one license. The commissioner shall propose statutory 
15.18 	language and an implementation plan for licensing requirements for residential support 
15.19 	services to the legislature by January 15, 2011 2012, as a component of the quality outcome 
15.20 	standards recommendations required by Laws 2010, chapter 352, article 1, section 24.
15.21 	(b) Providers licensed under chapter 245B, and providing, contracting, or arranging 
15.22 	for services in settings licensed as adult foster care under Minnesota Rules, parts 
15.23 	9555.5105 to 9555.6265, or child foster care under Minnesota Rules, parts 2960.3000 to 
15.24 	2960.3340; and meeting the provisions of section 256B.092, subdivision 11, paragraph 
15.25 	(b), must be required to obtain a community residential setting license.

15.26 	Sec. 6. Minnesota Statutes 2010, section 252.32, subdivision 1a, is amended to read:
15.27 		Subd. 1a.Support grants. (a) Provision of support grants must be limited to 
15.28 	families who require support and whose dependents are under the age of 21 and who 
15.29 	have been certified disabled under section 256B.055, subdivision 12, paragraphs (a), 
15.30 	(b), (c), (d), and (e). Families who are receiving: home and community-based waivered 
15.31 	services for persons with developmental disabilities authorized under section 256B.092 or 
15.32 	256B.49; personal care assistance under section 256B.0652; or a consumer support grant 
15.33 	under section 256.476 are not eligible for support grants.
16.1 	Families whose annual adjusted gross income is $60,000 or more are not eligible for 
16.2 	support grants except in cases where extreme hardship is demonstrated. Beginning in state 
16.3 	fiscal year 1994, the commissioner shall adjust the income ceiling annually to reflect the 
16.4 	projected change in the average value in the United States Department of Labor Bureau of 
16.5 	Labor Statistics Consumer Price Index (all urban) for that year.
16.6 	(b) Support grants may be made available as monthly subsidy grants and lump-sum 
16.7 	grants.
16.8 	(c) Support grants may be issued in the form of cash, voucher, and direct county 
16.9 	payment to a vendor.
16.10 	(d) Applications for the support grant shall be made by the legal guardian to the 
16.11 	county social service agency. The application shall specify the needs of the families, the 
16.12 	form of the grant requested by the families, and the items and services to be reimbursed.

16.13 	Sec. 7. [252.34] REPORT BY COMMISSIONER OF HUMAN SERVICES.
16.14 	Beginning January 1, 2013, the commissioner of human services shall provide a 
16.15 	biennial report to the chairs of the legislative committees with jurisdiction over health and 
16.16 	human services policy and funding. The report must provide a summary of overarching 
16.17 	goals and priorities for persons with disabilities, including the status of how each of the 
16.18 	following programs administered by the commissioner is supporting the overarching 
16.19 	goals and priorities:
16.20 	(1) home and community-based services waivers for persons with disabilities under 
16.21 	sections 256B.092 and 256B.49;
16.22 	(2) home care services under section 256B.0652; and
16.23 	(3) other relevant programs and services as determined by the commissioner.

16.24 	Sec. 8. Minnesota Statutes 2010, section 252A.21, subdivision 2, is amended to read:
16.25 		Subd. 2.Rules. The commissioner shall adopt rules to implement this chapter. 
16.26 	The rules must include standards for performance of guardianship or conservatorship 
16.27 	duties including, but not limited to: twice a year visits with the ward; quarterly reviews 
16.28 	of records from day, residential, and support services; a requirement that the duties of 
16.29 	guardianship or conservatorship and case management not be performed by the same 
16.30 	person; specific standards for action on "do not resuscitate" orders, sterilization requests, 
16.31 	and the use of psychotropic medication and aversive procedures.

16.32 	Sec. 9. Minnesota Statutes 2010, section 256.476, subdivision 11, is amended to read:
17.1 		Subd. 11.Consumer support grant program after July 1, 2001.  Effective 
17.2 	July 1, 2001, the commissioner shall allocate consumer support grant resources to 
17.3 	serve additional individuals based on a review of Medicaid authorization and payment 
17.4 	information of persons eligible for a consumer support grant from the most recent fiscal 
17.5 	year. The commissioner shall use the following methodology to calculate maximum 
17.6 	allowable monthly consumer support grant levels:
17.7 	(1) For individuals whose program of origination is medical assistance home care 
17.8 	under sections 256B.0651 and 256B.0653 to 256B.0656, the maximum allowable monthly 
17.9 	grant levels are calculated by:
17.10 	(i) determining 50 percent of the averagethe service authorization for each 
17.11 	individual based on the individual's home care rating assessment;
17.12 	(ii) calculating the overall ratio of actual payments to service authorizations by 
17.13 	program;
17.14 	(iii) applying the overall ratio to the average50 percent of the service authorization 
17.15 	level of each home care rating; and
17.16 	(iv) adjusting the result for any authorized rate increaseschanges provided by the 
17.17 	legislature; and.
17.18 	(v) adjusting the result for the average monthly utilization per recipient.
17.19 	(2) The commissioner may review and evaluateshall ensure the methodology to 
17.20 	reflect changes inis consistent with the home care programs.

17.21 	Sec. 10. Minnesota Statutes 2010, section 256.9657, subdivision 1, is amended to read:
17.22 		Subdivision 1.Nursing home license surcharge. (a) Effective July 1, 1993, 
17.23 	each non-state-operated nursing home licensed under chapter 144A shall pay to the 
17.24 	commissioner an annual surcharge according to the schedule in subdivision 4. The 
17.25 	surcharge shall be calculated as $620 per licensed bed. If the number of licensed beds 
17.26 	is reduced, the surcharge shall be based on the number of remaining licensed beds the 
17.27 	second month following the receipt of timely notice by the commissioner of human 
17.28 	services that beds have been delicensed. The nursing home must notify the commissioner 
17.29 	of health in writing when beds are delicensed. The commissioner of health must notify 
17.30 	the commissioner of human services within ten working days after receiving written 
17.31 	notification. If the notification is received by the commissioner of human services by 
17.32 	the 15th of the month, the invoice for the second following month must be reduced 
17.33 	to recognize the delicensing of beds. Beds on layaway status continue to be subject to 
17.34 	the surcharge. The commissioner of human services must acknowledge a medical care 
17.35 	surcharge appeal within 30 days of receipt of the written appeal from the provider.
18.1 	(b) Effective July 1, 1994, the surcharge in paragraph (a) shall be increased to $625.
18.2 	(c) Effective August 15, 2002, the surcharge under paragraph (b) shall be increased 
18.3 	to $990.
18.4 	(d) Effective July 15, 2003, the surcharge under paragraph (c) shall be increased 
18.5 	to $2,815.
18.6 	(e) The commissioner may reduce, and may subsequently restore, the surcharge 
18.7 	under paragraph (d) based on the commissioner's determination of a permissible surcharge.
18.8 	(f) Between April 1, 2002, and August 15, 2004, a facility governed by this 
18.9 	subdivision may elect to assume full participation in the medical assistance program 
18.10 	by agreeing to comply with all of the requirements of the medical assistance program, 
18.11 	including the rate equalization law in section 256B.48, subdivision 1, paragraph (a), and 
18.12 	all other requirements established in law or rule, and to begin intake of new medical 
18.13 	assistance recipients. Rates will be determined under Minnesota Rules, parts 9549.0010 
18.14 	to 9549.0080. Notwithstanding section 256B.431, subdivision 27, paragraph (i), Rate 
18.15 	calculations will be subject to limits as prescribed in rule and law. Other than the 
18.16 	adjustments in sections 256B.431, subdivisions 30 and 32; 256B.437, subdivision 3, 
18.17 	paragraph (b), Minnesota Rules, part 9549.0057, and any other applicable legislation 
18.18 	enacted prior to the finalization of rates, facilities assuming full participation in medical 
18.19 	assistance under this paragraph are not eligible for any rate adjustments until the July 1 
18.20 	following their settle-up period.

18.21 	Sec. 11. Minnesota Statutes 2010, section 256B.0625, subdivision 19c, is amended to 
18.22 	read:
18.23 		Subd. 19c.Personal care. Medical assistance covers personal care assistance 
18.24 	services provided by an individual who is qualified to provide the services according to 
18.25 	subdivision 19a and sections 256B.0651 to 256B.0656, provided in accordance with a 
18.26 	plan, and supervised by a qualified professional.
18.27 	"Qualified professional" means a mental health professional as defined in section 
18.28 	245.462, subdivision 18, clauses (1) to (6), or 245.4871, subdivision 27, clauses (1) to (6); 
18.29 	or a registered nurse as defined in sections 148.171 to 148.285, a licensed social worker 
18.30 	as defined in sections 148D.010 and 148D.055, or a qualified developmental disabilities 
18.31 	specialist under section 245B.07, subdivision 4. The qualified professional shall perform 
18.32 	the duties required in section 256B.0659.

18.33 	Sec. 12. Minnesota Statutes 2010, section 256B.0659, subdivision 1, is amended to 
18.34 	read:
19.1 		Subdivision 1.Definitions. (a) For the purposes of this section, the terms defined in 
19.2 	paragraphs (b) to (r) have the meanings given unless otherwise provided in text.
19.3 	(b) "Activities of daily living" means grooming, dressing, bathing, transferring, 
19.4 	mobility, positioning, eating, and toileting.
19.5 	(c) "Behavior," effective January 1, 2010, means a category to determine the home 
19.6 	care rating and is based on the criteria found in this section. "Level I behavior" means 
19.7 	physical aggression towards self, others, or destruction of property that requires the 
19.8 	immediate response of another person.
19.9 	(d) "Complex health-related needs," effective January 1, 2010, means a category to 
19.10 	determine the home care rating and is based on the criteria found in this section.
19.11 	(e) "Critical activities of daily living," effective January 1, 2010, means transferring, 
19.12 	mobility, eating, and toileting.
19.13 	(f) "Dependency in activities of daily living" means a person requires assistance to 
19.14 	begin and complete one or more of the activities of daily living.
19.15 	(g) "Extended personal care assistance service" means personal care assistance 
19.16 	services included in a service plan under one of the home and community-based services 
19.17 	waivers authorized under sections 256B.0915, 256B.092, subdivision 5, and 256B.49, 
19.18 	which exceed the amount, duration, and frequency of the state plan personal care 
19.19 	assistance services for participants who:
19.20 	(1) need assistance provided periodically during a week, but less than daily will not 
19.21 	be able to remain in their homes without the assistance, and other replacement services 
19.22 	are more expensive or are not available when personal care assistance services are to 
19.23 	be terminated reduced; or
19.24 	(2) need additional personal care assistance services beyond the amount authorized 
19.25 	by the state plan personal care assistance assessment in order to ensure that their safety, 
19.26 	health, and welfare are provided for in their homes.
19.27 	(h) "Health-related procedures and tasks" means procedures and tasks that can 
19.28 	be delegated or assigned by a licensed health care professional under state law to be 
19.29 	performed by a personal care assistant.
19.30 	(i) "Instrumental activities of daily living" means activities to include meal planning 
19.31 	and preparation; basic assistance with paying bills; shopping for food, clothing, and other 
19.32 	essential items; performing household tasks integral to the personal care assistance 
19.33 	services; communication by telephone and other media; and traveling, including to 
19.34 	medical appointments and to participate in the community.
19.35 	(j) "Managing employee" has the same definition as Code of Federal Regulations, 
19.36 	title 42, section 455.
20.1 	(k) "Qualified professional" means a professional providing supervision of personal 
20.2 	care assistance services and staff as defined in section 256B.0625, subdivision 19c.
20.3 	(l) "Personal care assistance provider agency" means a medical assistance enrolled 
20.4 	provider that provides or assists with providing personal care assistance services and 
20.5 	includes a personal care assistance provider organization, personal care assistance choice 
20.6 	agency, class A licensed nursing agency, and Medicare-certified home health agency.
20.7 	(m) "Personal care assistant" or "PCA" means an individual employed by a personal 
20.8 	care assistance agency who provides personal care assistance services.
20.9 	(n) "Personal care assistance care plan" means a written description of personal 
20.10 	care assistance services developed by the personal care assistance provider according 
20.11 	to the service plan.
20.12 	(o) "Responsible party" means an individual who is capable of providing the support 
20.13 	necessary to assist the recipient to live in the community.
20.14 	(p) "Self-administered medication" means medication taken orally, by injection or 
20.15 	insertion, or applied topically without the need for assistance.
20.16 	(q) "Service plan" means a written summary of the assessment and description of the 
20.17 	services needed by the recipient.
20.18 	(r) "Wages and benefits" means wages and salaries, the employer's share of FICA 
20.19 	taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation, 
20.20 	mileage reimbursement, health and dental insurance, life insurance, disability insurance, 
20.21 	long-term care insurance, uniform allowance, and contributions to employee retirement 
20.22 	accounts.

20.23 	Sec. 13. Minnesota Statutes 2010, section 256B.0659, subdivision 3, is amended to 
20.24 	read:
20.25 		Subd. 3.Noncovered personal care assistance services. (a) Personal care 
20.26 	assistance services are not eligible for medical assistance payment under this section 
20.27 	when provided:
20.28 	(1) by the recipient's spouse, parent of a recipient under the age of 18, paid legal 
20.29 	guardian, licensed foster provider, except as allowed under section 256B.0652, subdivision 
20.30 	10, or responsible party;
20.31 	(2) in lieu of other staffing options order to meet staffing or license requirements in a 
20.32 	residential or child care setting;
20.33 	(3) solely as a child care or babysitting service; or
20.34 	(4) without authorization by the commissioner or the commissioner's designee.
21.1 	(b) The following personal care services are not eligible for medical assistance 
21.2 	payment under this section when provided in residential settings:
21.3 	(1) effective January 1, 2010, when the provider of home care services who is not 
21.4 	related by blood, marriage, or adoption owns or otherwise controls the living arrangement, 
21.5 	including licensed or unlicensed services; or
21.6 	(2) when personal care assistance services are the responsibility of a residential or 
21.7 	program license holder under the terms of a service agreement and administrative rules.
21.8 	(c) Other specific tasks not covered under paragraph (a) or (b) that are not eligible 
21.9 	for medical assistance reimbursement for personal care assistance services under this 
21.10 	section include:
21.11 	(1) sterile procedures;
21.12 	(2) injections of fluids and medications into veins, muscles, or skin;
21.13 	(3) home maintenance or chore services;
21.14 	(4) homemaker services not an integral part of assessed personal care assistance 
21.15 	services needed by a recipient;
21.16 	(5) application of restraints or implementation of procedures under section 245.825;
21.17 	(6) instrumental activities of daily living for children under the age of 18, except 
21.18 	when immediate attention is needed for health or hygiene reasons integral to the personal 
21.19 	care services and the need is listed in the service plan by the assessor; and
21.20 	(7) assessments for personal care assistance services by personal care assistance 
21.21 	provider agencies or by independently enrolled registered nurses.

21.22 	Sec. 14. Minnesota Statutes 2010, section 256B.0659, subdivision 9, is amended to 
21.23 	read:
21.24 		Subd. 9.Responsible party; generally. (a) "Responsible party" means an 
21.25 	individual who is capable of providing the support necessary to assist the recipient to live 
21.26 	in the community.
21.27 	(b) A responsible party must be 18 years of age, actively participate in planning and 
21.28 	directing of personal care assistance services, and attend all assessments for the recipient.
21.29 	(c) A responsible party must not be the:
21.30 	(1) personal care assistant;
21.31 	(2) qualified professional;
21.32 	(3) home care provider agency owner or staff manager; or
21.33 	(4) home care provider agency staff unless staff who are not listed in clauses (1) to 
21.34 	(3) are related to the recipient by blood, marriage, or adoption; or
21.35 	(3) (5) county staff acting as part of employment.
22.1 	(d) A licensed family foster parent who lives with the recipient may be the 
22.2 	responsible party as long as the family foster parent meets the other responsible party 
22.3 	requirements.
22.4 	(e) A responsible party is required when:
22.5 	(1) the person is a minor according to section 524.5-102, subdivision 10;
22.6 	(2) the person is an incapacitated adult according to section 524.5-102, subdivision 
22.7 	6, resulting in a court-appointed guardian; or
22.8 	(3) the assessment according to subdivision 3a determines that the recipient is in 
22.9 	need of a responsible party to direct the recipient's care.
22.10 	(f) There may be two persons designated as the responsible party for reasons such 
22.11 	as divided households and court-ordered custodies. Each person named as responsible 
22.12 	party must meet the program criteria and responsibilities.
22.13 	(g) The recipient or the recipient's legal representative shall appoint a responsible 
22.14 	party if necessary to direct and supervise the care provided to the recipient. The 
22.15 	responsible party must be identified at the time of assessment and listed on the recipient's 
22.16 	service agreement and personal care assistance care plan.

22.17 	Sec. 15. Minnesota Statutes 2011 Supplement, section 256B.0659, subdivision 11, 
22.18 	is amended to read:
22.19 		Subd. 11.Personal care assistant; requirements. (a) A personal care assistant 
22.20 	must meet the following requirements:
22.21 	(1) be at least 18 years of age with the exception of persons who are 16 or 17 years 
22.22 	of age with these additional requirements:
22.23 	(i) supervision by a qualified professional every 60 days; and
22.24 	(ii) employment by only one personal care assistance provider agency responsible 
22.25 	for compliance with current labor laws;
22.26 	(2) be employed by a personal care assistance provider agency;
22.27 	(3) enroll with the department as a personal care assistant after clearing a background 
22.28 	study. Except as provided in subdivision 11a, before a personal care assistant provides 
22.29 	services, the personal care assistance provider agency must initiate a background study on 
22.30 	the personal care assistant under chapter 245C, and the personal care assistance provider 
22.31 	agency must have received a notice from the commissioner that the personal care assistant 
22.32 	is:
22.33 	(i) not disqualified under section 245C.14; or
22.34 	(ii) is disqualified, but the personal care assistant has received a set aside of the 
22.35 	disqualification under section 245C.22;
23.1 	(4) be able to effectively communicate with the recipient and personal care 
23.2 	assistance provider agency;
23.3 	(5) be able to provide covered personal care assistance services according to the 
23.4 	recipient's personal care assistance care plan, respond appropriately to recipient needs, 
23.5 	and report changes in the recipient's condition to the supervising qualified professional 
23.6 	or physician;
23.7 	(6) not be a consumer of personal care assistance services;
23.8 	(7) maintain daily written records including, but not limited to, time sheets under 
23.9 	subdivision 12;
23.10 	(8) effective January 1, 2010, complete standardized training as determined 
23.11 	by the commissioner before completing enrollment. The training must be available 
23.12 	in languages other than English and to those who need accommodations due to 
23.13 	disabilities. Personal care assistant training must include successful completion of the 
23.14 	following training components: basic first aid, vulnerable adult, child maltreatment, 
23.15 	OSHA universal precautions, basic roles and responsibilities of personal care assistants 
23.16 	including information about assistance with lifting and transfers for recipients, emergency 
23.17 	preparedness, orientation to positive behavioral practices, fraud issues, and completion of 
23.18 	time sheets. Upon completion of the training components, the personal care assistant must 
23.19 	demonstrate the competency to provide assistance to recipients;
23.20 	(9) complete training and orientation on the needs of the recipient within the first 
23.21 	seven days after the services begin; and
23.22 	(10) be limited to providing and being paid for up to 275 hours per month, except 
23.23 	that this limit shall be 275 hours per month for the period July 1, 2009, through June 30, 
23.24 	2011, of personal care assistance services regardless of the number of recipients being 
23.25 	served or the number of personal care assistance provider agencies enrolled with. The 
23.26 	number of hours worked per day shall not be disallowed by the department unless in 
23.27 	violation of the law.
23.28 	(b) A legal guardian may be a personal care assistant if the guardian is not being paid 
23.29 	for the guardian services and meets the criteria for personal care assistants in paragraph (a).
23.30 	(c) Persons who do not qualify as a personal care assistant include parents and,
23.31 	stepparents, and legal guardians of minors,; spouses,; paid legal guardians, of adults;
23.32 	family foster care providers, except as otherwise allowed in section 256B.0625, 
23.33 	subdivision 19a, or; and staff of a residential setting. When the personal care assistant is a 
23.34 	relative of the recipient, the commissioner shall pay 80 percent of the provider rate. For 
23.35 	purposes of this section, relative means the parent or adoptive parent of an adult child, a 
23.36 	sibling aged 16 years or older, an adult child, a grandparent, or a grandchild.

24.1 	Sec. 16. Minnesota Statutes 2010, section 256B.0659, subdivision 13, is amended to 
24.2 	read:
24.3 		Subd. 13.Qualified professional; qualifications. (a) The qualified professional 
24.4 	must work for a personal care assistance provider agency and meet the definition under 
24.5 	section 256B.0625, subdivision 19c. Before a qualified professional provides services, the 
24.6 	personal care assistance provider agency must initiate a background study on the qualified 
24.7 	professional under chapter 245C, and the personal care assistance provider agency must 
24.8 	have received a notice from the commissioner that the qualified professional:
24.9 	(1) is not disqualified under section 245C.14; or
24.10 	(2) is disqualified, but the qualified professional has received a set aside of the 
24.11 	disqualification under section 245C.22.
24.12 	(b) The qualified professional shall perform the duties of training, supervision, and 
24.13 	evaluation of the personal care assistance staff and evaluation of the effectiveness of 
24.14 	personal care assistance services. The qualified professional shall:
24.15 	(1) develop and monitor with the recipient a personal care assistance care plan based 
24.16 	on the service plan and individualized needs of the recipient;
24.17 	(2) develop and monitor with the recipient a monthly plan for the use of personal 
24.18 	care assistance services;
24.19 	(3) review documentation of personal care assistance services provided;
24.20 	(4) provide training and ensure competency for the personal care assistant in the 
24.21 	individual needs of the recipient; and
24.22 	(5) document all training, communication, evaluations, and needed actions to 
24.23 	improve performance of the personal care assistants.
24.24 	(c) Effective July 1, 2010 2011, the qualified professional shall complete the provider 
24.25 	training with basic information about the personal care assistance program approved by 
24.26 	the commissioner. Newly hired qualified professionals must complete the training within 
24.27 	six months of the date hired by a personal care assistance provider agency. Qualified 
24.28 	professionals who have completed the required training as a worker from a personal care 
24.29 	assistance provider agency do not need to repeat the required training if they are hired 
24.30 	by another agency, if they have completed the training within the last three years. The 
24.31 	required training shall must be available in languages other than English and to those who 
24.32 	need accommodations due to disabilities,with meaningful access according to title VI of 
24.33 	the Civil Rights Act and federal regulations adopted under that law or any guidance from 
24.34 	the United States Health and Human Services Department. The required training must 
24.35 	be available online, or by electronic remote connection, and. The required training must
24.36 	provide for competency testing to demonstrate an understanding of the content without 
25.1 	attending in-person training. A qualified professional is allowed to be employed and is not 
25.2 	subject to the training requirement until the training is offered online or through remote 
25.3 	electronic connection. A qualified professional employed by a personal care assistance 
25.4 	provider agency certified for participation in Medicare as a home health agency is exempt 
25.5 	from the training required in this subdivision. When available, the qualified professional 
25.6 	working for a Medicare-certified home health agency must successfully complete the 
25.7 	competency test. The commissioner shall ensure there is a mechanism in place to verify 
25.8 	the identity of persons completing the competency testing electronically.

25.9 	EFFECTIVE DATE. This section is effective retroactively from July 1, 2011.

25.10 	Sec. 17. Minnesota Statutes 2010, section 256B.0659, subdivision 14, is amended to 
25.11 	read:
25.12 		Subd. 14.Qualified professional; duties. (a) Effective January 1, 2010, all personal 
25.13 	care assistants must be supervised by a qualified professional.
25.14 	(b) Through direct training, observation, return demonstrations, and consultation 
25.15 	with the staff and the recipient, the qualified professional must ensure and document 
25.16 	that the personal care assistant is:
25.17 	(1) capable of providing the required personal care assistance services;
25.18 	(2) knowledgeable about the plan of personal care assistance services before services 
25.19 	are performed; and
25.20 	(3) able to identify conditions that should be immediately brought to the attention of 
25.21 	the qualified professional.
25.22 	(c) The qualified professional shall evaluate the personal care assistant within the 
25.23 	first 14 days of starting to provide regularly scheduled services for a recipient, or sooner as 
25.24 	determined by the qualified professional, except for the personal care assistance choice 
25.25 	option under subdivision 19, paragraph (a), clause (4). For the initial evaluation, the 
25.26 	qualified professional shall evaluate the personal care assistance services for a recipient 
25.27 	through direct observation of a personal care assistant's work. The qualified professional 
25.28 	may conduct additional training and evaluation visits, based upon the needs of the 
25.29 	recipient and the personal care assistant's ability to meet those needs. Subsequent visits to 
25.30 	evaluate the personal care assistance services provided to a recipient do not require direct 
25.31 	observation of each personal care assistant's work and shall occur:
25.32 	(1) at least every 90 days thereafter for the first year of a recipient's services;
25.33 	(2) every 120 days after the first year of a recipient's service or whenever needed for 
25.34 	response to a recipient's request for increased supervision of the personal care assistance 
25.35 	staff; and
26.1 	(3) after the first 180 days of a recipient's service, supervisory visits may alternate 
26.2 	between unscheduled phone or Internet technology and in-person visits, unless the 
26.3 	in-person visits are needed according to the care plan.
26.4 	(d) Communication with the recipient is a part of the evaluation process of the 
26.5 	personal care assistance staff.
26.6 	(e) At each supervisory visit, the qualified professional shall evaluate personal care 
26.7 	assistance services including the following information:
26.8 	(1) satisfaction level of the recipient with personal care assistance services;
26.9 	(2) review of the month-to-month plan for use of personal care assistance services;
26.10 	(3) review of documentation of personal care assistance services provided;
26.11 	(4) whether the personal care assistance services are meeting the goals of the service 
26.12 	as stated in the personal care assistance care plan and service plan;
26.13 	(5) a written record of the results of the evaluation and actions taken to correct any 
26.14 	deficiencies in the work of a personal care assistant; and
26.15 	(6) revision of the personal care assistance care plan as necessary in consultation 
26.16 	with the recipient or responsible party, to meet the needs of the recipient.
26.17 	(f) The qualified professional shall complete the required documentation in the 
26.18 	agency recipient and employee files and the recipient's home, including the following 
26.19 	documentation:
26.20 	(1) the personal care assistance care plan based on the service plan and individualized 
26.21 	needs of the recipient;
26.22 	(2) a month-to-month plan for use of personal care assistance services;
26.23 	(3) changes in need of the recipient requiring a change to the level of service and the 
26.24 	personal care assistance care plan;
26.25 	(4) evaluation results of supervision visits and identified issues with personal care 
26.26 	assistance staff with actions taken;
26.27 	(5) all communication with the recipient and personal care assistance staff; and
26.28 	(6) hands-on training or individualized training for the care of the recipient.
26.29 	(g) The documentation in paragraph (f) must be done on agency forms templates.
26.30 	(h) The services that are not eligible for payment as qualified professional services 
26.31 	include:
26.32 	(1) direct professional nursing tasks that could be assessed and authorized as skilled 
26.33 	nursing tasks;
26.34 	(2) supervision of personal care assistance completed by telephone;
26.35 	(3) (2) agency administrative activities;
27.1 	(4) (3) training other than the individualized training required to provide care for a 
27.2 	recipient; and
27.3 	(5) (4) any other activity that is not described in this section.

27.4 	Sec. 18. Minnesota Statutes 2010, section 256B.0659, subdivision 19, is amended to 
27.5 	read:
27.6 		Subd. 19.Personal care assistance choice option; qualifications; duties. (a) 
27.7 	Under personal care assistance choice, the recipient or responsible party shall:
27.8 	(1) recruit, hire, schedule, and terminate personal care assistants according to the 
27.9 	terms of the written agreement required under subdivision 20, paragraph (a);
27.10 	(2) develop a personal care assistance care plan based on the assessed needs 
27.11 	and addressing the health and safety of the recipient with the assistance of a qualified 
27.12 	professional as needed;
27.13 	(3) orient and train the personal care assistant with assistance as needed from the 
27.14 	qualified professional;
27.15 	(4) effective January 1, 2010, supervise and evaluate the personal care assistant with 
27.16 	the qualified professional, who is required to visit the recipient at least every 180 days;
27.17 	(5) monitor and verify in writing and report to the personal care assistance choice 
27.18 	agency the number of hours worked by the personal care assistant and the qualified 
27.19 	professional;
27.20 	(6) engage in an annual face-to-face reassessment to determine continuing eligibility 
27.21 	and service authorization; and
27.22 	(7) use the same personal care assistance choice provider agency if shared personal 
27.23 	assistance care is being used.
27.24 	(b) The personal care assistance choice provider agency shall:
27.25 	(1) meet all personal care assistance provider agency standards;
27.26 	(2) enter into a written agreement with the recipient, responsible party, and personal 
27.27 	care assistants;
27.28 	(3) not be related as a parent, child, sibling, or spouse to the recipient, qualified 
27.29 	professional, or the personal care assistant; and
27.30 	(4) ensure arm's-length transactions without undue influence or coercion with the 
27.31 	recipient and personal care assistant.
27.32 	(c) The duties of the personal care assistance choice provider agency are to:
27.33 	(1) be the employer of the personal care assistant and the qualified professional for 
27.34 	employment law and related regulations including, but not limited to, purchasing and 
27.35 	maintaining workers' compensation, unemployment insurance, surety and fidelity bonds, 
28.1 	and liability insurance, and submit any or all necessary documentation including, but not 
28.2 	limited to, workers' compensation and unemployment insurance;
28.3 	(2) bill the medical assistance program for personal care assistance services and 
28.4 	qualified professional services;
28.5 	(3) request and complete background studies that comply with the requirements for 
28.6 	personal care assistants and qualified professionals;
28.7 	(4) pay the personal care assistant and qualified professional based on actual hours 
28.8 	of services provided;
28.9 	(5) withhold and pay all applicable federal and state taxes;
28.10 	(6) verify and keep records of hours worked by the personal care assistant and 
28.11 	qualified professional;
28.12 	(7) make the arrangements and pay taxes and other benefits, if any, and comply with 
28.13 	any legal requirements for a Minnesota employer;
28.14 	(8) enroll in the medical assistance program as a personal care assistance choice 
28.15 	agency; and
28.16 	(9) enter into a written agreement as specified in subdivision 20 before services 
28.17 	are provided.

28.18 	Sec. 19. Minnesota Statutes 2010, section 256B.0659, subdivision 21, is amended to 
28.19 	read:
28.20 		Subd. 21.Requirements for initial enrollment of personal care assistance 
28.21 	provider agencies. (a) All personal care assistance provider agencies must provide, at the 
28.22 	time of enrollment as a personal care assistance provider agency in a format determined 
28.23 	by the commissioner, information and documentation that includes, but is not limited to, 
28.24 	the following:
28.25 	(1) the personal care assistance provider agency's current contact information 
28.26 	including address, telephone number, and e-mail address;
28.27 	(2) proof of surety bond coverage in the amount of $50,000 or ten percent of the 
28.28 	provider's payments from Medicaid in the previous year, whichever is less;
28.29 	(3) proof of fidelity bond coverage in the amount of $20,000;
28.30 	(4) proof of workers' compensation insurance coverage;
28.31 	(5) proof of liability insurance;
28.32 	(6) a description of the personal care assistance provider agency's organization 
28.33 	identifying the names of all owners, managing employees, staff, board of directors, and 
28.34 	the affiliations of the directors, owners, or staff to other service providers;
29.1 	(7) a copy of the personal care assistance provider agency's written policies and 
29.2 	procedures including: hiring of employees; training requirements; service delivery; 
29.3 	and employee and consumer safety including process for notification and resolution 
29.4 	of consumer grievances, identification and prevention of communicable diseases, and 
29.5 	employee misconduct;
29.6 	(8) copies of all other forms the personal care assistance provider agency uses in 
29.7 	the course of daily business including, but not limited to:
29.8 	(i) a copy of the personal care assistance provider agency's time sheet if the time 
29.9 	sheet varies from the standard time sheet for personal care assistance services approved 
29.10 	by the commissioner, and a letter requesting approval of the personal care assistance 
29.11 	provider agency's nonstandard time sheet;
29.12 	(ii) the personal care assistance provider agency's template for the personal care 
29.13 	assistance care plan; and
29.14 	(iii) the personal care assistance provider agency's template for the written 
29.15 	agreement in subdivision 20 for recipients using the personal care assistance choice 
29.16 	option, if applicable;
29.17 	(9) a list of all training and classes that the personal care assistance provider agency 
29.18 	requires of its staff providing personal care assistance services;
29.19 	(10) documentation that the personal care assistance provider agency and staff have 
29.20 	successfully completed all the training required by this section;
29.21 	(11) documentation of the agency's marketing practices;
29.22 	(12) disclosure of ownership, leasing, or management of all residential properties 
29.23 	that is used or could be used for providing home care services;
29.24 	(13) documentation that the agency will use the following percentages of revenue 
29.25 	generated from the medical assistance rate paid for personal care assistance services 
29.26 	for employee personal care assistant wages and benefits: 72.5 percent of revenue in the 
29.27 	personal care assistance choice option and 72.5 percent of revenue from other personal 
29.28 	care assistance providers; and
29.29 	(14) effective May 15, 2010, documentation that the agency does not burden 
29.30 	recipients' free exercise of their right to choose service providers by requiring personal 
29.31 	care assistants to sign an agreement not to work with any particular personal care 
29.32 	assistance recipient or for another personal care assistance provider agency after leaving 
29.33 	the agency and that the agency is not taking action on any such agreements or requirements 
29.34 	regardless of the date signed.
29.35 	(b) Personal care assistance provider agencies shall provide the information specified 
29.36 	in paragraph (a) to the commissioner at the time the personal care assistance provider 
30.1 	agency enrolls as a vendor or upon request from the commissioner. The commissioner 
30.2 	shall collect the information specified in paragraph (a) from all personal care assistance 
30.3 	providers beginning July 1, 2009.
30.4 	(c) All personal care assistance provider agencies shall require all employees in 
30.5 	management and supervisory positions and owners of the agency who are active in the 
30.6 	day-to-day management and operations of the agency to complete mandatory training 
30.7 	as determined by the commissioner before enrollment of the agency as a provider. 
30.8 	Employees in management and supervisory positions and owners who are active in 
30.9 	the day-to-day operations of an agency who have completed the required training as 
30.10 	an employee with a personal care assistance provider agency do not need to repeat 
30.11 	the required training if they are hired by another agency, if they have completed the 
30.12 	training within the past three years. By September 1, 2010, the required training must be 
30.13 	available in languages other than English and to those who need accommodations due 
30.14 	to disabilities,with meaningful access according to title VI of the Civil Rights Act and 
30.15 	federal regulations adopted under that law or any guidance from the United States Health 
30.16 	and Human Services Department. The required training must be available online, or by 
30.17 	electronic remote connection, and. The required training must provide for competency 
30.18 	testing. Personal care assistance provider agency billing staff shall complete training about 
30.19 	personal care assistance program financial management. This training is effective July 1, 
30.20 	2009. Any personal care assistance provider agency enrolled before that date shall, if it 
30.21 	has not already, complete the provider training within 18 months of July 1, 2009. Any new 
30.22 	owners or employees in management and supervisory positions involved in the day-to-day 
30.23 	operations are required to complete mandatory training as a requisite of working for the 
30.24 	agency. Personal care assistance provider agencies certified for participation in Medicare 
30.25 	as home health agencies are exempt from the training required in this subdivision. When 
30.26 	available, Medicare-certified home health agency owners, supervisors, or managers must 
30.27 	successfully complete the competency test.

30.28 	Sec. 20. Minnesota Statutes 2010, section 256B.0659, subdivision 30, is amended to 
30.29 	read:
30.30 		Subd. 30.Notice of service changes to recipients. The commissioner must provide:
30.31 	(1) by October 31, 2009, information to recipients likely to be affected that (i) 
30.32 	describes the changes to the personal care assistance program that may result in the 
30.33 	loss of access to personal care assistance services, and (ii) includes resources to obtain 
30.34 	further information; and
31.1 	(2) notice of changes in medical assistance personal care assistance services to each 
31.2 	affected recipient at least 30 days before the effective date of the change.
31.3 	The notice shall include how to get further information on the changes, how to get help to 
31.4 	obtain other services, a list of community resources, and appeal rights. Notwithstanding 
31.5 	section 256.045, a recipient may request continued services pending appeal within the 
31.6 	time period allowed to request an appeal; and
31.7 	(3) (2) a service agreement authorizing personal care assistance hours of service at 
31.8 	the previously authorized level, throughout the appeal process period, when a recipient 
31.9 	requests services pending an appeal.

31.10 	EFFECTIVE DATE. This section is effective July 1, 2012.

31.11 	Sec. 21. Minnesota Statutes 2010, section 256B.0916, subdivision 7, is amended to 
31.12 	read:
31.13 		Subd. 7.Annual report by commissioner. (a) Beginning November 1, 2001, and 
31.14 	each November 1 thereafter, the commissioner shall issue an annual report on county and 
31.15 	state use of available resources for the home and community-based waiver for persons with 
31.16 	developmental disabilities. For each county or county partnership, the report shall include:
31.17 	(1) the amount of funds allocated but not used;
31.18 	(2) the county specific allowed reserve amount approved and used;
31.19 	(3) the number, ages, and living situations of individuals screened and waiting for 
31.20 	services;
31.21 	(4) the urgency of need for services to begin within one, two, or more than two 
31.22 	years for each individual;
31.23 	(5) the services needed;
31.24 	(6) the number of additional persons served by approval of increased capacity within 
31.25 	existing allocations;
31.26 	(7) results of action by the commissioner to streamline administrative requirements 
31.27 	and improve county resource management; and
31.28 	(8) additional action that would decrease the number of those eligible and waiting 
31.29 	for waivered services.
31.30 	The commissioner shall specify intended outcomes for the program and the degree to 
31.31 	which these specified outcomes are attained.
31.32 	(b) This subdivision expires January 1, 2013.

32.1 	Sec. 22. Minnesota Statutes 2010, section 256B.092, subdivision 11, is amended to 
32.2 	read:
32.3 		Subd. 11.Residential support services. (a) Upon federal approval, there is 
32.4 	established a new service called residential support that is available on the community 
32.5 	alternative care, community alternatives for disabled individuals, developmental 
32.6 	disabilities, and traumatic brain injury waivers. Existing waiver service descriptions 
32.7 	must be modified to the extent necessary to ensure there is no duplication between 
32.8 	other services. Residential support services must be provided by vendors licensed as a 
32.9 	community residential setting as defined in section 245A.11, subdivision 8.
32.10 	(b) Residential support services must meet the following criteria:
32.11 	(1) providers of residential support services must own or control the residential site;
32.12 	(2) the residential site must not be the primary residence of the license holder;
32.13 	(3) the residential site must have a designated program supervisor responsible for 
32.14 	program oversight, development, and implementation of policies and procedures;
32.15 	(4) the provider of residential support services must provide supervision, training, 
32.16 	and assistance as described in the person's community support plan; and
32.17 	(5) the provider of residential support services must meet the requirements of 
32.18 	licensure and additional requirements of the person's community support plan.
32.19 	(c) Providers of residential support services that meet the definition in paragraph 
32.20 	(a) must be registered using a process determined by the commissioner beginning July 
32.21 	1, 2009. Providers licensed to provide child foster care under Minnesota Rules, parts 
32.22 	2960.3000 to 2960.3340, or adult foster care licensed under Minnesota Rules, parts 
32.23 	9555.5105 to 9555.6265, and that meet the requirements in section 245A.03, subdivision 
32.24 	7, paragraph (e), are considered registered under this section.

32.25 	Sec. 23. Minnesota Statutes 2010, section 256B.096, subdivision 5, is amended to read:
32.26 		Subd. 5.Biennial report. (a) The commissioner shall provide a biennial report to 
32.27 	the chairs of the legislative committees with jurisdiction over health and human services 
32.28 	policy and funding beginning January 15, 2009, on the development and activities of the 
32.29 	quality management, assurance, and improvement system designed to meet the federal 
32.30 	requirements under the home and community-based services waiver programs for persons 
32.31 	with disabilities. By January 15, 2008, the commissioner shall provide a preliminary 
32.32 	report on priorities for meeting the federal requirements, progress on development and 
32.33 	field testing of the annual survey, appropriations necessary to implement an annual survey 
32.34 	of service recipients once field testing is completed, recommendations for improvements 
33.1 	in the incident reporting system, and a plan for incorporating quality assurance efforts 
33.2 	under section 256B.095 and other regional efforts into the statewide system.
33.3 	(b) This subdivision expires January 1, 2013.

33.4 	Sec. 24. Minnesota Statutes 2010, section 256B.441, subdivision 13, is amended to 
33.5 	read:
33.6 		Subd. 13.External fixed costs. "External fixed costs" means costs related to the 
33.7 	nursing home surcharge under section 256.9657, subdivision 1; licensure fees under 
33.8 	section 144.122; long-term care consultation fees under section 256B.0911, subdivision 6; 
33.9 	family advisory council fee under section 144A.33; scholarships under section 256B.431, 
33.10 	subdivision 36; planned closure rate adjustments under section 256B.436 or256B.437; or 
33.11 	single bed room incentives under section 256B.431, subdivision 42; property taxes and 
33.12 	property insurance; and PERA.

33.13 	Sec. 25. Minnesota Statutes 2010, section 256B.441, subdivision 31, is amended to 
33.14 	read:
33.15 		Subd. 31.Prior system operating cost payment rate. "Prior system operating 
33.16 	cost payment rate" means the operating cost payment rate in effect on September 30, 
33.17 	2008, under Minnesota Rules and Minnesota Statutes, not including planned closure rate 
33.18 	adjustments under section 256B.436 or256B.437, or single bed room incentives under 
33.19 	section 256B.431, subdivision 42.

33.20 	Sec. 26. Minnesota Statutes 2010, section 256B.441, subdivision 53, is amended to 
33.21 	read:
33.22 		Subd. 53.Calculation of payment rate for external fixed costs. The commissioner 
33.23 	shall calculate a payment rate for external fixed costs.
33.24 	(a) For a facility licensed as a nursing home, the portion related to section 256.9657
33.25 	shall be equal to $8.86. For a facility licensed as both a nursing home and a boarding care 
33.26 	home, the portion related to section 256.9657 shall be equal to $8.86 multiplied by the 
33.27 	result of its number of nursing home beds divided by its total number of licensed beds.
33.28 	(b) The portion related to the licensure fee under section 144.122, paragraph (d), 
33.29 	shall be the amount of the fee divided by actual resident days.
33.30 	(c) The portion related to scholarships shall be determined under section 256B.431, 
33.31 	subdivision 36.
33.32 	(d) The portion related to long-term care consultation shall be determined according 
33.33 	to section 256B.0911, subdivision 6.
34.1 	(e) The portion related to development and education of resident and family advisory 
34.2 	councils under section 144A.33 shall be $5 divided by 365.
34.3 	(f) The portion related to planned closure rate adjustments shall be as determined 
34.4 	under sections 256B.436 and section256B.437, subdivision 6, and Minnesota Statutes 
34.5 	2010, section 256B.436. Planned closure rate adjustments that take effect before October 
34.6 	1, 2014, shall no longer be included in the payment rate for external fixed costs beginning 
34.7 	October 1, 2016. Planned closure rate adjustments that take effect on or after October 1, 
34.8 	2014, shall no longer be included in the payment rate for external fixed costs beginning on 
34.9 	October 1 of the first year not less than two years after their effective date.
34.10 	(g) The portions related to property insurance, real estate taxes, special assessments, 
34.11 	and payments made in lieu of real estate taxes directly identified or allocated to the nursing 
34.12 	facility shall be the actual amounts divided by actual resident days.
34.13 	(h) The portion related to the Public Employees Retirement Association shall be 
34.14 	actual costs divided by resident days.
34.15 	(i) The single bed room incentives shall be as determined under section 256B.431, 
34.16 	subdivision 42. Single bed room incentives that take effect before October 1, 2014, shall 
34.17 	no longer be included in the payment rate for external fixed costs beginning October 1, 
34.18 	2016. Single bed room incentives that take effect on or after October 1, 2014, shall no 
34.19 	longer be included in the payment rate for external fixed costs beginning on October 1 of 
34.20 	the first year not less than two years after their effective date.
34.21 	(j) The payment rate for external fixed costs shall be the sum of the amounts in 
34.22 	paragraphs (a) to (i).

34.23 	Sec. 27. Minnesota Statutes 2010, section 256B.49, subdivision 21, is amended to read:
34.24 		Subd. 21.Report. (a) The commissioner shall expand on the annual report required 
34.25 	under section 256B.0916, subdivision 7, to include information on the county of residence 
34.26 	and financial responsibility, age, and major diagnoses for persons eligible for the home 
34.27 	and community-based waivers authorized under subdivision 11 who are:
34.28 	(1) receiving those services;
34.29 	(2) screened and waiting for waiver services; and
34.30 	(3) residing in nursing facilities and are under age 65.
34.31 	(b) This subdivision expires January 1, 2013.

34.32 	Sec. 28. Minnesota Statutes 2011 Supplement, section 626.557, subdivision 9, is 
34.33 	amended to read:
35.1 		Subd. 9.Common entry point designation. (a) Each county board shall designate 
35.2 	a common entry point for reports of suspected maltreatment. Two or more county boards 
35.3 	may jointly designate a single common entry point. The common entry point is the unit 
35.4 	responsible for receiving the report of suspected maltreatment under this section.
35.5 	(b) The common entry point must be available 24 hours per day to take calls from 
35.6 	reporters of suspected maltreatment. The common entry point shall use a standard intake 
35.7 	form that includes:
35.8 	(1) the time and date of the report;
35.9 	(2) the name, address, and telephone number of the person reporting;
35.10 	(3) the time, date, and location of the incident;
35.11 	(4) the names of the persons involved, including but not limited to, perpetrators, 
35.12 	alleged victims, and witnesses;
35.13 	(5) whether there was a risk of imminent danger to the alleged victim;
35.14 	(6) a description of the suspected maltreatment;
35.15 	(7) the disability, if any, of the alleged victim;
35.16 	(8) the relationship of the alleged perpetrator to the alleged victim;
35.17 	(9) whether a facility was involved and, if so, which agency licenses the facility;
35.18 	(10) any action taken by the common entry point;
35.19 	(11) whether law enforcement has been notified;
35.20 	(12) whether the reporter wishes to receive notification of the initial and final 
35.21 	reports; and
35.22 	(13) if the report is from a facility with an internal reporting procedure, the name, 
35.23 	mailing address, and telephone number of the person who initiated the report internally.
35.24 	(c) The common entry point is not required to complete each item on the form prior 
35.25 	to dispatching the report to the appropriate lead investigative agency.
35.26 	(d) The common entry point shall immediately report to a law enforcement agency 
35.27 	any incident in which there is reason to believe a crime has been committed.
35.28 	(e) If a report is initially made to a law enforcement agency or a lead investigative 
35.29 	agency, those agencies shall take the report on the appropriate common entry point intake 
35.30 	forms and immediately forward a copy to the common entry point.
35.31 	(f) The common entry point staff must receive training on how to screen and 
35.32 	dispatch reports efficiently and in accordance with this section.
35.33 	(g) When a centralized database is available, the common entry point has access to 
35.34 	the centralized database and must log the reports into the database. The commissioner of 
35.35 	human services shall maintain a centralized database for the collection of common entry 
36.1 	point data, lead investigative agency data including maltreatment report disposition, and 
36.2 	appeals data.

36.3 	Sec. 29. Laws 2009, chapter 79, article 8, section 81, as amended by Laws 2010, 
36.4 	chapter 352, article 1, section 24, is amended to read:
36.5 	Sec. 81. ESTABLISHING A SINGLE SET OF STANDARDS.
 36.6 	(a) The commissioner of human services shall consult with disability service 
36.7 	providers, advocates, counties, and consumer families to develop a single set of standards, 
36.8 	to be referred to as "quality outcome standards," governing services for people with 
36.9 	disabilities receiving services under the home and community-based waiver services 
36.10 	program, with the exception of customized living services because the service license 
36.11 	is under the jurisdiction of the Department of Health, to replace all or portions of 
36.12 	existing laws and rules including, but not limited to, data practices, licensure of facilities 
36.13 	and providers, background studies, reporting of maltreatment of minors, reporting of 
36.14 	maltreatment of vulnerable adults, and the psychotropic medication checklist. The 
36.15 	standards must:
36.16 	(1) enable optimum consumer choice;
36.17 	(2) be consumer driven;
36.18 	(3) link services to individual needs and life goals;
36.19 	(4) be based on quality assurance and individual outcomes; 
36.20 	(5) utilize the people closest to the recipient, who may include family, friends, and 
36.21 	health and service providers, in conjunction with the recipient's risk management plan to 
36.22 	assist the recipient or the recipient's guardian in making decisions that meet the recipient's 
36.23 	needs in a cost-effective manner and assure the recipient's health and safety;
36.24 	(6) utilize person-centered planning; and
36.25 	(7) maximize federal financial participation.
36.26 	(b) The commissioner may consult with existing stakeholder groups convened under 
36.27 	the commissioner's authority, including the home and community-based expert services 
36.28 	panel established by the commissioner in 2008, to meet all or some of the requirements 
36.29 	of this section.
36.30 	(c) The commissioner shall provide the reports and plans required by this section to 
36.31 	the legislative committees and budget divisions with jurisdiction over health and human 
36.32 	services policy and finance by January 15, 2012.

36.33 	Sec. 30. DISABILITY HOME AND COMMUNITY-BASED WAIVER 
36.34 	REQUEST.
 37.1 	By December 1, 2012, the commissioner shall request all federal approvals and 
37.2 	waiver amendments to the disability home and community-based waivers to allow properly 
37.3 	licensed adult foster care homes to provide residential services for up to five individuals.

37.4 	EFFECTIVE DATE. This section is effective July 1, 2012.

37.5 	Sec. 31. HOURLY NURSING DETERMINATION MATRIX.
 37.6 	A service provider applying for medical assistance payments for private duty nursing 
37.7 	services under Minnesota Statutes, section 256B.0654, must complete and submit to the 
37.8 	commissioner of human services an hourly nursing determination matrix for each recipient 
37.9 	of private duty nursing services. The commissioner of human services will collect and 
37.10 	analyze data from the hourly nursing determination matrix.

37.11 	Sec. 32.  REPEALER.
 37.12 	(a) Minnesota Statutes 2010, sections 256B.431, subdivisions 2c, 2g, 2i, 2j, 2k, 2l, 
37.13 	2o, 3c, 11, 14, 17b, 17f, 19, 20, 25, 27, and 29; 256B.434, subdivisions 4a, 4b, 4c, 4d, 4e, 
37.14 	4g, 4h, 7, and 8; 256B.435; and 256B.436, are repealed.
37.15 	(b) Minnesota Statutes 2011 Supplement, section 256B.431, subdivision 26, is 
37.16 	repealed.
37.17 	(c) Minnesota Rules, part 9555.7700, is repealed.

37.18 	ARTICLE 2
37.19 	TELEPHONE EQUIPMENT PROGRAM

37.20 	Section 1. Minnesota Statutes 2010, section 237.50, is amended to read:
37.21 	237.50 DEFINITIONS.
37.22 		Subdivision 1.Scope. The terms used in sections 237.50 to 237.56 have the 
37.23 	meanings given them in this section.
37.24 		Subd. 3.Communication impaired disability. "Communication impaired
37.25 	disability" means certified as deaf, severely hearing impaired, hard-of-hearing having 
37.26 	a hearing loss, speech impaired, deaf and blind disability, or mobility impaired if the 
37.27 	mobility impairment significantly impedes the ability physical disability that makes it 
37.28 	difficult or impossible to use standard customer premises telecommunications services 
37.29 	and equipment.
37.30 		Subd. 4.Communication device. "Communication device" means a device that 
37.31 	when connected to a telephone enables a communication-impaired person to communicate 
37.32 	with another person utilizing the telephone system. A "communication device" includes a 
38.1 	ring signaler, an amplification device, a telephone device for the deaf, a Brailling device 
38.2 	for use with a telephone, and any other device the Department of Human Services deems 
38.3 	necessary.
38.4 		Subd. 4a.Deaf. "Deaf" means a hearing impairment loss of such severity that the 
38.5 	individual must depend primarily upon visual communication such as writing, lip reading, 
38.6 	manual communication sign language, and gestures.
38.7 		Subd. 4b.Deafblind. "Deafblind" means any combination of vision and hearing 
38.8 	loss which interferes with acquiring information from the environment to the extent that 
38.9 	compensatory strategies and skills are necessary to access that or other information.
38.10 		Subd. 5.Exchange. "Exchange" means a unit area established and described by the 
38.11 	tariff of a telephone company for the administration of telephone service in a specified 
38.12 	geographical area, usually embracing a city, town, or village and its environs, and served 
38.13 	by one or more central offices, together with associated facilities used in providing 
38.14 	service within that area.
38.15 		Subd. 6.Fund. "Fund" means the telecommunications access Minnesota fund 
38.16 	established in section 237.52.
38.17 		Subd. 6a.Hard-of-hearing. "Hard-of-hearing" means a hearing impairment loss
38.18 	resulting in a functional loss limitation, but not to the extent that the individual must 
38.19 	depend primarily upon visual communication.
38.20 		Subd. 7.Interexchange service. "Interexchange service" means telephone service 
38.21 	between points in two or more exchanges.
38.22 		Subd. 8.Inter-LATA interexchange service. "Inter-LATA interexchange service" 
38.23 	means interexchange service originating and terminating in different LATAs.
38.24 		Subd. 9.Local access and transport area. "Local access and transport area 
38.25 	(LATA)" means a geographical area designated by the Modification of Final Judgment 
38.26 	in U.S. v. Western Electric Co., Inc., 552 F. Supp. 131 (D.D.C. 1982), including 
38.27 	modifications in effect on the effective date of sections 237.51 to 237.54.
38.28 		Subd. 10.Local exchange service. "Local exchange service" means telephone 
38.29 	service between points within an exchange.
38.30 		Subd. 10a.Telecommunications device. "Telecommunications device" means 
38.31 	a device that (1) allows a person with a communication disability to have access to 
38.32 	telecommunications services as defined in subdivision 13, and (2) is specifically 
38.33 	selected by the Department of Human Services for its capacity to allow persons with 
38.34 	communication disabilities to use telecommunications services in a manner that is 
38.35 	functionally equivalent to the ability of an individual who does not have a communication 
38.36 	disability. A telecommunications device may include a ring signaler, an amplified 
39.1 	telephone, a hands-free telephone, a text telephone, a captioned telephone, a wireless 
39.2 	device, a device that produces Braille output for use with a telephone, and any other 
39.3 	device the Department of Human Services deems appropriate.
39.4 		Subd. 11.Telecommunication Telecommunications Relay service Services.
 39.5 	"Telecommunication Telecommunications Relay service Services" or "TRS" means 
39.6 	a central statewide service through which a communication-impaired person, 
39.7 	using a communication device, may send and receive messages to and from a 
39.8 	non-communication-impaired person whose telephone is not equipped with a 
39.9 	communication device and through which a non-communication-impaired person 
39.10 	may, by using voice communication, send and receive messages to and from a 
39.11 	communication-impaired person the telecommunications transmission services required 
39.12 	under Federal Communications Commission (FCC) regulations at Code of Federal 
39.13 	Regulations, title 47, sections 64.604 to 64.606. TRS allows an individual who has 
39.14 	a communication disability to use telecommunications services in a manner that is 
39.15 	functionally equivalent to the ability of an individual who does not have a communication 
39.16 	disability.
39.17 		Subd. 12.Telecommunications. "Telecommunications" means the transmission, 
39.18 	between or among points specified by the user, of information of the user's choosing, 
39.19 	without change in the form or content of the information as sent and received.
39.20 		Subd. 13.Telecommunications services. "Telecommunications services" means 
39.21 	the offering of telecommunications for fee directly to the public, or to such classes of users 
39.22 	as to be effectively available to the public, regardless of the facilities used.

39.23 	Sec. 2. Minnesota Statutes 2010, section 237.51, is amended to read:
39.24 	237.51 TELECOMMUNICATIONS ACCESS MINNESOTA PROGRAM 
39.25 	ADMINISTRATION.
39.26 		Subdivision 1.Creation. The commissioner of commerce shall:
39.27 	(1) administer through interagency agreement with the commissioner of human 
39.28 	services a program to distribute communication telecommunications devices to eligible 
39.29 	communication-impaired persons who have communication disabilities; and
39.30 	(2) contract with a one or more  qualified vendor vendors  that serves 
39.31 	communication-impaired serve persons who have communication disabilities to create 
39.32 	and maintain a telecommunication provide telecommunications relay service services.
39.33 	For purposes of sections 237.51 to 237.56, the Department of Commerce and any 
39.34 	organization with which it contracts pursuant to this section or section 237.54, subdivision 
40.1 	2, are not telephone companies or telecommunications carriers as defined in section 
40.2 	237.01.
40.3 		Subd. 5.Commissioner of commerce duties. In addition to any duties specified 
40.4 	elsewhere in sections 237.51 to 237.56, the commissioner of commerce shall:
40.5 	(1) prepare the reports required by section 237.55;
40.6 	(2) administer the fund created in section 237.52; and
40.7 	(3) adopt rules under chapter 14 to implement the provisions of sections 237.50
40.8 	to 237.56.
40.9 		Subd. 5a.Department Commissioner of human services duties. (a) In addition to 
40.10 	any duties specified elsewhere in sections 237.51 to 237.56, the commissioner of human 
40.11 	services shall:
40.12 	(1) define economic hardship, special needs, and household criteria so as to 
40.13 	determine the priority of eligible applicants for initial distribution of devices and to 
40.14 	determine circumstances necessitating provision of more than one communication
40.15 	telecommunications device per household;
40.16 	(2) establish a method to verify eligibility requirements;
40.17 	(3) establish specifications for communication telecommunications devices to be 
40.18 	purchased provided under section 237.53, subdivision 3; and
40.19 	(4) inform the public and specifically the community of communication-impaired
40.20 	persons who have communication disabilities of the program.; and
40.21 	(5) provide devices based on the assessed need of eligible applicants.
40.22 	(b) The commissioner may establish an advisory board to advise the department 
40.23 	in carrying out the duties specified in this section and to advise the commissioner of 
40.24 	commerce in carrying out duties under section 237.54. If so established, the advisory 
40.25 	board must include, at a minimum, the following communication-impaired persons:
40.26 	(1) at least one member who is deaf;
40.27 	(2) at least one member who is has a speech impaired disability;
40.28 	(3) at least one member who is mobility impaired has a physical disability that 
40.29 	makes it difficult or impossible for the person to access telecommunications services; and
40.30 	(4) at least one member who is hard-of-hearing.
40.31 	The membership terms, compensation, and removal of members and the filling of 
40.32 	membership vacancies are governed by section 15.059. Advisory board meetings shall be 
40.33 	held at the discretion of the commissioner.

40.34 	Sec. 3. Minnesota Statutes 2010, section 237.52, is amended to read:
40.35 	237.52 TELECOMMUNICATIONS ACCESS MINNESOTA FUND.
41.1 		Subdivision 1.Fund established. A telecommunications access Minnesota fund is 
41.2 	established as an account in the state treasury. Earnings, such as interest, dividends, and 
41.3 	any other earnings arising from fund assets, must be credited to the fund.
41.4 		Subd. 2.Assessment. (a) The commissioner of commerce, the commissioner 
41.5 	of employment and economic development, and the commissioner of human services 
41.6 	shall annually recommend to the Public Utilities Commission (PUC) an adequate and 
41.7 	appropriate surcharge and budget to implement sections 237.50 to 237.56, 248.062, 
41.8 	and 256C.30, respectively. The maximum annual budget for section 248.062 must not 
41.9 	exceed $100,000 and for section 256C.30 must not exceed $300,000. The Public Utilities 
41.10 	Commission shall review the budgets for reasonableness and may modify the budget 
41.11 	to the extent it is unreasonable. The commission shall annually determine the funding 
41.12 	mechanism to be used within 60 days of receipt of the recommendation of the departments 
41.13 	and shall order the imposition of surcharges effective on the earliest practicable date. The 
41.14 	commission shall establish a monthly charge no greater than 20 cents for each customer 
41.15 	access line, including trunk equivalents as designated by the commission pursuant to 
41.16 	section 403.11, subdivision 1.
41.17 	(b) If the fund balance falls below a level capable of fully supporting all programs 
41.18 	eligible under subdivision 5 and sections 248.062 and 256C.30, expenditures under 
41.19 	sections 248.062 and 256C.30 shall be reduced on a pro rata basis and expenditures under 
41.20 	sections 237.53 and 237.54 shall be fully funded. Expenditures under sections 248.062
41.21 	and 256C.30 shall resume at fully funded levels when the commissioner of commerce 
41.22 	determines there is a sufficient fund balance to fully fund those expenditures.
41.23 		Subd. 3.Collection. Every telephone company or communications carrier that 
41.24 	provides service provider of services capable of originating a telecommunications relay
41.25 	TRS call, including cellular communications and other nonwire access services, in this 
41.26 	state shall collect the charges established by the commission under subdivision 2 and 
41.27 	transfer amounts collected to the commissioner of public safety in the same manner as 
41.28 	provided in section 403.11, subdivision 1, paragraph (d). The commissioner of public 
41.29 	safety must deposit the receipts in the fund established in subdivision 1.
41.30 		Subd. 4.Appropriation. Money in the fund is appropriated to the commissioner of 
41.31 	commerce to implement sections 237.51 to 237.56, to the commissioner of employment 
41.32 	and economic development to implement section 248.062, and to the commissioner of 
41.33 	human services to implement section 256C.30.
41.34 		Subd. 5.Expenditures. (a) Money in the fund may only be used for:
42.1 	(1) expenses of the Department of Commerce, including personnel cost, public 
42.2 	relations, advisory board members' expenses, preparation of reports, and other reasonable 
42.3 	expenses not to exceed ten percent of total program expenditures;
42.4 	(2) reimbursing the commissioner of human services for purchases made or services 
42.5 	provided pursuant to section 237.53;
42.6 	(3) reimbursing telephone companies for purchases made or services provided 
42.7 	under section 237.53, subdivision 5; and
42.8 	(4) contracting for establishment and operation of the telecommunication relay 
42.9 	service the provision of TRS required by section 237.54.
42.10 	(b) All costs directly associated with the establishment of the program, the purchase 
42.11 	and distribution of communication telecommunications devices, and the establishment 
42.12 	and operation of the telecommunication relay service provision of TRS are either 
42.13 	reimbursable or directly payable from the fund after authorization by the commissioner 
42.14 	of commerce. The commissioner of commerce shall contract with the message relay 
42.15 	service operator one or more TRS providers to indemnify the local exchange carriers of 
42.16 	the relay telecommunications service providers for any fines imposed by the Federal 
42.17 	Communications Commission related to the failure of the relay service to comply with 
42.18 	federal service standards. Notwithstanding section 16A.41, the commissioner may 
42.19 	advance money to the contractor of the telecommunication relay service TRS providers if 
42.20 	the contractor establishesproviders establish to the commissioner's satisfaction that the 
42.21 	advance payment is necessary for the operation provision of the service. The advance 
42.22 	payment may be used only for working capital reserve for the operation of the service. 
42.23 	The advance payment must be offset or repaid by the end of the contract fiscal year 
42.24 	together with interest accrued from the date of payment.

42.25 	Sec. 4. Minnesota Statutes 2010, section 237.53, is amended to read:
42.26 	237.53 COMMUNICATION TELECOMMUNICATIONS DEVICE.
42.27 		Subdivision 1.Application. A person applying for a communication
42.28 	telecommunications device under this section must apply to the program administrator on 
42.29 	a form prescribed by the Department of Human Services.
42.30 		Subd. 2.Eligibility. To be eligible to obtain a communication telecommunications
42.31 	device under this section, a person must be:
42.32 	(1) be able to benefit from and use the equipment for its intended purpose;
42.33 	(2) have a communication impaired disability;
42.34 	(3) be a resident of the state;
43.1 	(4) be a resident in a household that has a median income at or below the applicable 
43.2 	median household income in the state, except a deaf and blind person who is deafblind
43.3 	applying for a telebraille unit Braille device may reside in a household that has a median 
43.4 	income no more than 150 percent of the applicable median household income in the 
43.5 	state; and
43.6 	(5) be a resident in a household that has telephone telecommunications service 
43.7 	or that has made application for service and has been assigned a telephone number; or 
43.8 	a resident in a residential care facility, such as a nursing home or group home where 
43.9 	telephone telecommunications service is not included as part of overall service provision.
43.10 		Subd. 3.Distribution. The commissioner of human services shall purchase and 
43.11 	distribute a sufficient number of communication telecommunications devices so that each 
43.12 	eligible household receives an appropriate device devices as determined under section 
43.13 	237.51, subdivision 5a. The commissioner of human services shall distribute the devices 
43.14 	to eligible households in each service area free of charge as determined under section 
43.15 	237.51, subdivision 5a.
43.16 		Subd. 4.Training; maintenance. The commissioner of human services shall 
43.17 	maintain the communication telecommunications devices until the warranty period 
43.18 	expires, and provide training, without charge, to first-time users of the devices.
43.19 		Subd. 5.Wiring installation. If a communication-impaired person is not served by 
43.20 	telephone service and is subject to economic hardship as determined by the Department 
43.21 	of Human Services, the telephone company providing local service shall at the direction 
43.22 	of the administrator of the program install necessary outside wiring without charge to 
43.23 	the household.
43.24 		Subd. 6.Ownership. All communication Telecommunications devices purchased 
43.25 	pursuant to subdivision 3 will become are the property of the state of Minnesota. Policies 
43.26 	and procedures for the return of devices from individuals who withdraw from the program 
43.27 	or whose eligibility status changes shall be determined by the commissioner of human 
43.28 	services.
43.29 		Subd. 7.Standards. The communication telecommunications devices distributed 
43.30 	under this section must comply with the electronic industries association alliance standards 
43.31 	and be approved by the Federal Communications Commission. The commissioner of 
43.32 	human services must provide each eligible person a choice of several models of devices, 
43.33 	the retail value of which may not exceed $600 for a communication device for the deaf
43.34 	text telephone, and a retail value of $7,000 for a telebraille Braille device, or an amount 
43.35 	authorized by the Department of Human Services for a telephone device for the deaf with 
44.1 	auxiliary equipment all other telecommunications devices and auxiliary equipment it 
44.2 	deems cost-effective and appropriate to distribute according to sections 237.51 to 237.56.

44.3 	Sec. 5. Minnesota Statutes 2010, section 237.54, is amended to read:
44.4 	237.54 TELECOMMUNICATION TELECOMMUNICATIONS RELAY 
44.5 	SERVICE SERVICES (TRS).
44.6 		Subd. 2.Operation. (a) The commissioner of commerce shall contract with 
44.7 	a one or more  qualified vendor vendors for the operation and maintenance of the 
44.8 	telecommunication relay system provision of Telecommunications Relay Services (TRS).
44.9 	(b) The telecommunication relay service provider TRS providers shall operate the 
44.10 	relay service within the state of Minnesota. The operator of the system TRS providers
44.11 	shall keep all messages confidential, shall train personnel in the unique needs of 
44.12 	communication-impaired people, and shall inform communication-impaired persons 
44.13 	and the public of the availability and use of the system. Except in the case of a speech- 
44.14 	or mobility-impaired person, the operator shall not relay a message unless it originates 
44.15 	or terminates through a communication device for the deaf or a Brailling device for use 
44.16 	with a telephone comply with all current and subsequent FCC regulations at Code of 
44.17 	Federal Regulations, title 47, sections 64.601 to 64.606, and shall inform persons who 
44.18 	have communication disabilities and the public of the availability and use of TRS.

44.19 	Sec. 6. Minnesota Statutes 2010, section 237.55, is amended to read:
44.20 	237.55 ANNUAL REPORT ON COMMUNICATION
44.21 	TELECOMMUNICATIONS ACCESS.
44.22 	The commissioner of commerce must prepare a report for presentation to the Public 
44.23 	Utilities Commission by January 31 of each year. Each report must review the accessibility 
44.24 	of the telephone system to communication-impaired persons, review the ability of 
44.25 	non-communication-impaired persons to communicate with communication-impaired 
44.26 	persons via the telephone system telecommunications services to persons who have 
44.27 	communication disabilities, describe services provided, account for money received and 
44.28 	disbursed annually annual revenues and expenditures for each aspect of the program fund
44.29 	to date, and include predicted program future operation.

44.30 	Sec. 7. Minnesota Statutes 2010, section 237.56, is amended to read:
44.31 	237.56 ADEQUATE SERVICE ENFORCEMENT.
45.1 	The services required to be provided under sections 237.50 to 237.55 may be 
45.2 	enforced under section 237.081 upon a complaint of at least two communication-impaired
45.3 	persons within the service area of any one telephone company telecommunications 
45.4 	service provider, provided that if only one person within the service area of a company 
45.5 	is receiving service under sections 237.50 to 237.55, the commission Public Utilities 
45.6 	Commission may proceed upon a complaint from that person.

45.7 	ARTICLE 3
45.8 	COMPREHENSIVE ASSESSMENT AND CASE MANAGEMENT REFORM

45.9 	Section 1. Minnesota Statutes 2011 Supplement, section 256B.0625, subdivision 56, 
45.10 	is amended to read:
45.11 		Subd. 56.Medical service coordination. (a) Medical assistance covers in-reach 
45.12 	community-based service coordination that is performed in through a hospital emergency 
45.13 	department as an eligible procedure under a state healthcare program or private insurance
45.14 	for a frequent user. A frequent user is defined as an individual who has frequented the 
45.15 	hospital emergency department for services three or more times in the previous four 
45.16 	consecutive months. In-reach community-based service coordination includes navigating 
45.17 	services to address a client's mental health, chemical health, social, economic, and housing 
45.18 	needs, or any other activity targeted at reducing the incidence of emergency room and 
45.19 	other nonmedically necessary health care utilization.
45.20 	(b) Reimbursement must be made in 15-minute increments under current Medicaid 
45.21 	mental health social work reimbursement methodology and allowed for up to 60 days 
45.22 	posthospital discharge based upon the specific identified emergency department visit or 
45.23 	inpatient admitting event. A frequent user who is participating in care coordination within 
45.24 	a health care home framework is ineligible for reimbursement under this subdivision.
45.25 	In-reach community-based service coordination shall seek to connect frequent users with 
45.26 	existing covered services available to them, including, but not limited to, targeted case 
45.27 	management, waiver case management, or care coordination in a health care home.
45.28 	Eligible in-reach service coordinators must hold a minimum of a bachelor's degree in 
45.29 	social work, public health, corrections, or a related field. The commissioner shall submit 
45.30 	any necessary application for waivers to the Centers for Medicare and Medicaid Services 
45.31 	to implement this subdivision.
45.32 	(c) For the purposes of this subdivision, "in-reach community-based service 
45.33 	coordination" means the practice of a community-based worker with training, knowledge, 
45.34 	skills, and ability to access a continuum of services, including housing, transportation, 
45.35 	chemical and mental health treatment, employment, and peer support services, by working 
46.1 	with an organization's staff to transition an individual back into the individual's living 
46.2 	environment. In-reach community-based service coordination includes working with the 
46.3 	individual during their discharge and for up to a defined amount of time in the individual's 
46.4 	living environment, reducing the individual's need for readmittance.

46.5 	Sec. 2. Minnesota Statutes 2010, section 256B.0659, subdivision 1, is amended to read:
46.6 		Subdivision 1.Definitions. (a) For the purposes of this section, the terms defined in 
46.7 	paragraphs (b) to (r) have the meanings given unless otherwise provided in text.
46.8 	(b) "Activities of daily living" means grooming, dressing, bathing, transferring, 
46.9 	mobility, positioning, eating, and toileting.
46.10 	(c) "Behavior," effective January 1, 2010, means a category to determine the home 
46.11 	care rating and is based on the criteria found in this section. "Level I behavior" means 
46.12 	physical aggression towards self, others, or destruction of property that requires the 
46.13 	immediate response of another person.
46.14 	(d) "Complex health-related needs," effective January 1, 2010, means a category to 
46.15 	determine the home care rating and is based on the criteria found in this section.
46.16 	(e) "Critical activities of daily living," effective January 1, 2010, means transferring, 
46.17 	mobility, eating, and toileting.
46.18 	(f) "Dependency in activities of daily living" means a person requires assistance to 
46.19 	begin and complete one or more of the activities of daily living.
46.20 	(g) "Extended personal care assistance service" means personal care assistance 
46.21 	services included in a service plan under one of the home and community-based services 
46.22 	waivers authorized under sections 256B.0915, 256B.092, subdivision 5, and 256B.49, 
46.23 	which exceed the amount, duration, and frequency of the state plan personal care 
46.24 	assistance services for participants who:
46.25 	(1) need assistance provided periodically during a week, but less than daily will not 
46.26 	be able to remain in their homes without the assistance, and other replacement services 
46.27 	are more expensive or are not available when personal care assistance services are to be 
46.28 	terminated; or
46.29 	(2) need additional personal care assistance services beyond the amount authorized 
46.30 	by the state plan personal care assistance assessment in order to ensure that their safety, 
46.31 	health, and welfare are provided for in their homes.
46.32 	(h) "Health-related procedures and tasks" means procedures and tasks that can 
46.33 	be delegated or assigned by a licensed health care professional under state law to be 
46.34 	performed by a personal care assistant.
47.1 	(i) "Instrumental activities of daily living" means activities to include meal planning 
47.2 	and preparation; basic assistance with paying bills; shopping for food, clothing, and other 
47.3 	essential items; performing household tasks integral to the personal care assistance 
47.4 	services; communication by telephone and other media; and traveling, including to 
47.5 	medical appointments and to participate in the community.
47.6 	(j) "Managing employee" has the same definition as Code of Federal Regulations, 
47.7 	title 42, section 455.
47.8 	(k) "Qualified professional" means a professional providing supervision of personal 
47.9 	care assistance services and staff as defined in section 256B.0625, subdivision 19c.
47.10 	(l) "Personal care assistance provider agency" means a medical assistance enrolled 
47.11 	provider that provides or assists with providing personal care assistance services and 
47.12 	includes a personal care assistance provider organization, personal care assistance choice 
47.13 	agency, class A licensed nursing agency, and Medicare-certified home health agency.
47.14 	(m) "Personal care assistant" or "PCA" means an individual employed by a personal 
47.15 	care assistance agency who provides personal care assistance services.
47.16 	(n) "Personal care assistance care plan" means a written description of personal 
47.17 	care assistance services developed by the personal care assistance provider according 
47.18 	to the service plan.
47.19 	(o) "Responsible party" means an individual who is capable of providing the support 
47.20 	necessary to assist the recipient to live in the community.
47.21 	(p) "Self-administered medication" means medication taken orally, by injection, 
47.22 	nebulizer, or insertion, or applied topically without the need for assistance.
47.23 	(q) "Service plan" means a written summary of the assessment and description of the 
47.24 	services needed by the recipient.
47.25 	(r) "Wages and benefits" means wages and salaries, the employer's share of FICA 
47.26 	taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation, 
47.27 	mileage reimbursement, health and dental insurance, life insurance, disability insurance, 
47.28 	long-term care insurance, uniform allowance, and contributions to employee retirement 
47.29 	accounts.

47.30 	Sec. 3. Minnesota Statutes 2010, section 256B.0659, subdivision 2, is amended to read:
47.31 		Subd. 2.Personal care assistance services; covered services. (a) The personal 
47.32 	care assistance services eligible for payment include services and supports furnished 
47.33 	to an individual, as needed, to assist in:
47.34 	(1) activities of daily living;
47.35 	(2) health-related procedures and tasks;
48.1 	(3) observation and redirection of behaviors; and
48.2 	(4) instrumental activities of daily living.
48.3 	(b) Activities of daily living include the following covered services:
48.4 	(1) dressing, including assistance with choosing, application, and changing of 
48.5 	clothing and application of special appliances, wraps, or clothing;
48.6 	(2) grooming, including assistance with basic hair care, oral care, shaving, applying 
48.7 	cosmetics and deodorant, and care of eyeglasses and hearing aids. Nail care is included, 
48.8 	except for recipients who are diabetic or have poor circulation;
48.9 	(3) bathing, including assistance with basic personal hygiene and skin care;
48.10 	(4) eating, including assistance with hand washing and application of orthotics 
48.11 	required for eating, transfers, and feeding;
48.12 	(5) transfers, including assistance with transferring the recipient from one seating or 
48.13 	reclining area to another;
48.14 	(6) mobility, including assistance with ambulation, including use of a wheelchair. 
48.15 	Mobility does not include providing transportation for a recipient;
48.16 	(7) positioning, including assistance with positioning or turning a recipient for 
48.17 	necessary care and comfort; and
48.18 	(8) toileting, including assistance with helping recipient with bowel or bladder 
48.19 	elimination and care including transfers, mobility, positioning, feminine hygiene, use of 
48.20 	toileting equipment or supplies, cleansing the perineal area, inspection of the skin, and 
48.21 	adjusting clothing.
48.22 	(c) Health-related procedures and tasks include the following covered services:
48.23 	(1) range of motion and passive exercise to maintain a recipient's strength and 
48.24 	muscle functioning;
48.25 	(2) assistance with self-administered medication as defined by this section, including 
48.26 	reminders to take medication, bringing medication to the recipient, and assistance with 
48.27 	opening medication under the direction of the recipient or responsible party, including 
48.28 	medications given through a nebulizer;
48.29 	(3) interventions for seizure disorders, including monitoring and observation; and
48.30 	(4) other activities considered within the scope of the personal care service and 
48.31 	meeting the definition of health-related procedures and tasks under this section.
48.32 	(d) A personal care assistant may provide health-related procedures and tasks 
48.33 	associated with the complex health-related needs of a recipient if the procedures and 
48.34 	tasks meet the definition of health-related procedures and tasks under this section and the 
48.35 	personal care assistant is trained by a qualified professional and demonstrates competency 
48.36 	to safely complete the procedures and tasks. Delegation of health-related procedures and 
49.1 	tasks and all training must be documented in the personal care assistance care plan and the 
49.2 	recipient's and personal care assistant's files. A personal care assistant must not determine 
49.3 	the medication dose or time for medication.
49.4 	(e) Effective January 1, 2010, for a personal care assistant to provide the 
49.5 	health-related procedures and tasks of tracheostomy suctioning and services to recipients 
49.6 	on ventilator support there must be:
49.7 	(1) delegation and training by a registered nurse, certified or licensed respiratory 
49.8 	therapist, or a physician;
49.9 	(2) utilization of clean rather than sterile procedure;
49.10 	(3) specialized training about the health-related procedures and tasks and equipment, 
49.11 	including ventilator operation and maintenance;
49.12 	(4) individualized training regarding the needs of the recipient; and
49.13 	(5) supervision by a qualified professional who is a registered nurse.
49.14 	(f) Effective January 1, 2010, a personal care assistant may observe and redirect the 
49.15 	recipient for episodes where there is a need for redirection due to behaviors. Training of 
49.16 	the personal care assistant must occur based on the needs of the recipient, the personal 
49.17 	care assistance care plan, and any other support services provided.
49.18 	(g) Instrumental activities of daily living under subdivision 1, paragraph (i).

49.19 	Sec. 4. Minnesota Statutes 2010, section 256B.0659, subdivision 3a, is amended to 
49.20 	read:
49.21 		Subd. 3a.Assessment; defined. (a) "Assessment" means a review and evaluation 
49.22 	of a recipient's need for home personal care assistance services conducted in person. 
49.23 	Assessments for personal care assistance services shall be conducted by the county public 
49.24 	health nurse or a certified public health nurse under contract with the county except when a 
49.25 	long-term care consultation assessment is being conducted for the purposes of determining 
49.26 	a person's eligibility for home and community-based waiver services including personal 
49.27 	care assistance services according to section 256B.0911. An in-person assessment 
49.28 	must include: documentation of health status, determination of need, evaluation of 
49.29 	service effectiveness, identification of appropriate services, service plan development 
49.30 	or modification, coordination of services, referrals and follow-up to appropriate payers 
49.31 	and community resources, completion of required reports, recommendation of service 
49.32 	authorization, and consumer education. Once the need for personal care assistance 
49.33 	services is determined under this section or sections 256B.0651, 256B.0653, 256B.0654, 
49.34 	and 256B.0656, the county public health nurse or certified public health nurse under 
49.35 	contract with the county is responsible for communicating this recommendation to the 
50.1 	commissioner and the recipient. An in-person assessment must occur at least annually or 
50.2 	when there is a significant change in the recipient's condition or when there is a change 
50.3 	in the need for personal care assistance services. A service update may substitute for 
50.4 	the annual face-to-face assessment when there is not a significant change in recipient 
50.5 	condition or a change in the need for personal care assistance service. A service update 
50.6 	may be completed by telephone, used when there is no need for an increase in personal 
50.7 	care assistance services, and used for two consecutive assessments if followed by a 
50.8 	face-to-face assessment. A service update must be completed on a form approved by the 
50.9 	commissioner. A service update or review for temporary increase includes a review of 
50.10 	initial baseline data, evaluation of service effectiveness, redetermination of service need, 
50.11 	modification of service plan and appropriate referrals, update of initial forms, obtaining 
50.12 	service authorization, and on going consumer education. Assessments or reassessments 
50.13 	must be completed on forms provided by the commissioner within 30 days of a request for 
50.14 	home care services by a recipient or responsible party or personal care provider agency.
50.15 	(b) This subdivision expires when notification is given by the commissioner as 
50.16 	described in section 256B.0911, subdivision 3a.

50.17 	Sec. 5. Minnesota Statutes 2010, section 256B.0659, subdivision 4, is amended to read:
50.18 		Subd. 4.Assessment for personal care assistance services; limitations. (a) An 
50.19 	assessment as defined in subdivision 3a must be completed for personal care assistance 
50.20 	services.
50.21 	(b) The following limitations apply to the assessment:
50.22 	(1) a person must be assessed as dependent in an activity of daily living based on the 
50.23 	person's daily need or need on the days during the week the activity is completed for:
50.24 	(i) cuing and constant supervision to complete the task; or
50.25 	(ii) hands-on assistance to complete the task; and
50.26 	(2) a child may not be found to be dependent in an activity of daily living if because 
50.27 	of the child's age an adult would either perform the activity for the child or assist the child 
50.28 	with the activity. Assistance needed is the assistance appropriate for a typical child of 
50.29 	the same age.
50.30 	(c) Assessment for complex health-related needs must meet the criteria in this 
50.31 	paragraph. During the assessment process, A recipient qualifies as having complex 
50.32 	health-related needs if the recipient has one or more of the interventions that are ordered 
50.33 	by a physician, specified in a personal care assistance care plan or community support 
50.34 	plan developed under section 256B.0911, and found in the following:
50.35 	(1) tube feedings requiring:
51.1 	(i) a gastrojejunostomy tube; or
51.2 	(ii) continuous tube feeding lasting longer than 12 hours per day;
51.3 	(2) wounds described as:
51.4 	(i) stage III or stage IV;
51.5 	(ii) multiple wounds;
51.6 	(iii) requiring sterile or clean dressing changes or a wound vac; or
51.7 	(iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require 
51.8 	specialized care;
51.9 	(3) parenteral therapy described as:
51.10 	(i) IV therapy more than two times per week lasting longer than four hours for 
51.11 	each treatment; or
51.12 	(ii) total parenteral nutrition (TPN) daily;
51.13 	(4) respiratory interventions, including:
51.14 	(i) oxygen required more than eight hours per day;
51.15 	(ii) respiratory vest more than one time per day;
51.16 	(iii) bronchial drainage treatments more than two times per day;
51.17 	(iv) sterile or clean suctioning more than six times per day;
51.18 	(v) dependence on another to apply respiratory ventilation augmentation devices 
51.19 	such as BiPAP and CPAP; and
51.20 	(vi) ventilator dependence under section 256B.0652;
51.21 	(5) insertion and maintenance of catheter, including:
51.22 	(i) sterile catheter changes more than one time per month;
51.23 	(ii) clean intermittent catheterization, and including self-catheterization more than 
51.24 	six times per day; or
51.25 	(iii) bladder irrigations;
51.26 	(6) bowel program more than two times per week requiring more than 30 minutes to 
51.27 	perform each time;
51.28 	(7) neurological intervention, including:
51.29 	(i) seizures more than two times per week and requiring significant physical 
51.30 	assistance to maintain safety; or
51.31 	(ii) swallowing disorders diagnosed by a physician and requiring specialized 
51.32 	assistance from another on a daily basis; and
51.33 	(8) other congenital or acquired diseases creating a need for significantly increased 
51.34 	direct hands-on assistance and interventions in six to eight activities of daily living.
52.1 	(d) An assessment of behaviors must meet the criteria in this paragraph. A recipient 
52.2 	qualifies as having a need for assistance due to behaviors if the recipient's behavior requires 
52.3 	assistance at least four times per week and shows one or more of the following behaviors:
52.4 	(1) physical aggression towards self or others, or destruction of property that requires 
52.5 	the immediate response of another person;
52.6 	(2) increased vulnerability due to cognitive deficits or socially inappropriate 
52.7 	behavior; or
52.8 	(3) increased need for assistance for recipients who are verbally aggressive and or 
52.9 	 resistive to care so that the time needed to perform activities of daily living is increased.

52.10 	Sec. 6. Minnesota Statutes 2010, section 256B.0911, subdivision 1, is amended to read:
52.11 		Subdivision 1.Purpose and goal. (a) The purpose of long-term care consultation 
52.12 	services is to assist persons with long-term or chronic care needs in making long-term care 
52.13 	decisions and selecting support and service options that meet their needs and reflect their 
52.14 	preferences. The availability of, and access to, information and other types of assistance, 
52.15 	including assessment and support planning, is also intended to prevent or delay certified 
52.16 	nursing facility institutional placements and to provide access to transition assistance 
52.17 	after admission. Further, the goal of these services is to contain costs associated with 
52.18 	unnecessary certified nursing facility institutional admissions. Long-term consultation 
52.19 	services must be available to any person regardless of public program eligibility. The 
52.20 	commissioner of human services shall seek to maximize use of available federal and state 
52.21 	funds and establish the broadest program possible within the funding available.
52.22 	(b) These services must be coordinated with long-term care options counseling 
52.23 	provided under section 256.975, subdivision 7, and section 256.01, subdivision 24, for 
52.24 	telephone assistance and follow up and to offer a variety of cost-effective alternatives 
52.25 	to persons with disabilities and elderly persons. The county or tribal lead agency or 
52.26 	managed care plan providing long-term care consultation services shall encourage the use 
52.27 	of volunteers from families, religious organizations, social clubs, and similar civic and 
52.28 	service organizations to provide community-based services.

52.29 	Sec. 7. Minnesota Statutes 2011 Supplement, section 256B.0911, subdivision 1a, 
52.30 	is amended to read:
52.31 		Subd. 1a.Definitions. For purposes of this section, the following definitions apply:
52.32 	(a) Until additional requirements apply under paragraph (b), "long-term care 
52.33 	consultation services" means:
53.1 	(1) intake for and access to assistance in identifying services needed to maintain an 
53.2 	individual in the most inclusive environment;
53.3 	(2) providing recommendations on for and referrals to cost-effective community 
53.4 	services that are available to the individual;
53.5 	(3) development of an individual's person-centered community support plan;
53.6 	(4) providing information regarding eligibility for Minnesota health care programs;
53.7 	(5) face-to-face long-term care consultation assessments, which may be completed 
53.8 	in a hospital, nursing facility, intermediate care facility for persons with developmental 
53.9 	disabilities (ICF/DDs), regional treatment centers, or the person's current or planned 
53.10 	residence;
53.11 	(6) federally mandated preadmission screening to determine the need for an 
53.12 	institutional level of care under subdivision 4a activities described under subdivisions 
53.13 	4a and 4b;
53.14 	(7) determination of home and community-based waiver and other service eligibility 
53.15 	as required under sections 256B.0913, 256B.0915, and 256B.49, including level of 
53.16 	care determination for individuals who need an institutional level of care as determined 
53.17 	under section 256B.0911, subdivision 4a, paragraph (d), or 256B.092, service eligibility 
53.18 	including state plan home care services identified in sections 256B.0625, subdivisions 6, 
53.19 	7, and 19, paragraphs (a) and (c), and 256B.0657, based on assessment and community 
53.20 	support plan development with, appropriate referrals to obtain necessary diagnostic 
53.21 	information, and including the option an eligibility determination for consumer-directed 
53.22 	community supports;
53.23 	(8) providing recommendations for nursing facilityinstitutional placement when 
53.24 	there are no cost-effective community services available; and
53.25 	(9) providing access to assistance to transition people back to community settings 
53.26 	after facilityinstitutional admission.; and
53.27 	(10) providing information about competitive employment, with or without supports, 
53.28 	for school-age youth and working-age adults and referrals to the Disability Linkage 
53.29 	Line and Disability Benefits 101 to ensure that an informed choice about competitive 
53.30 	employment can be made. For the purposes of this subdivision, "competitive employment" 
53.31 	means work in the competitive labor market that is performed on a full-time or part-time 
53.32 	basis in an integrated setting, and for which an individual is compensated at or above the 
53.33 	minimum wage, but not less than the customary wage and level of benefits paid by the 
53.34 	employer for the same or similar work performed by individuals without disabilities.
53.35 	(b) Upon statewide implementation of lead agency requirements in subdivisions 2b, 
53.36 	2c, and 3a, "long-term care consultation services" also means:
54.1 	(1) service eligibility determination for state plan home care services identified in:
54.2 	(i) section 256B.0625, subdivisions 7, 19a, and 19c;
54.3 	(ii) section 256B.0657; or
54.4 	(iii) consumer support grants under section 256.476;
54.5 	(2) notwithstanding provisions in Minnesota Rules, parts 9525.0004 to 9525.0024, 
54.6 	determination of eligibility for case management services available under sections 
54.7 	256B.0621, subdivision 2, paragraph (4), and 256B.0924 and Minnesota Rules, part 
54.8 	9525.0016;
54.9 	(3) determination of institutional level of care, home and community-based service 
54.10 	waiver, and other service eligibility as required under section 256B.092, determination 
54.11 	of eligibility for family support grants under section 252.32, semi-independent living 
54.12 	services under section 252.275, and day training and habilitation services under section 
54.13 	256B.092; and
54.14 	(4) obtaining necessary diagnostic information to determine eligibility under clauses 
54.15 	(2) and (3).
54.16 	(b) (c) "Long-term care options counseling" means the services provided by the 
54.17 	linkage lines as mandated by sections 256.01 and 256.975, subdivision 7, and also 
54.18 	includes telephone assistance and follow up once a long-term care consultation assessment 
54.19 	has been completed.
54.20 	(c) (d) "Minnesota health care programs" means the medical assistance program 
54.21 	under chapter 256B and the alternative care program under section 256B.0913.
54.22 	(d) (e) "Lead agencies" means counties administering or a collaboration of counties,
54.23 	tribes, and health plans administering under contract with the commissioner to administer
54.24 	long-term care consultation assessment and support planning services.

54.25 	Sec. 8. Minnesota Statutes 2010, section 256B.0911, subdivision 2b, is amended to 
54.26 	read:
54.27 		Subd. 2b.Certified assessors. (a) Beginning January 1, 2011, Each lead agency 
54.28 	shall use certified assessors who have completed training and the certification processes 
54.29 	determined by the commissioner in subdivision 2c. Certified assessors shall demonstrate 
54.30 	best practices in assessment and support planning including person-centered planning 
54.31 	principals and have a common set of skills that must ensure consistency and equitable 
54.32 	access to services statewide. Assessors must be part of a multidisciplinary team of 
54.33 	professionals that includes public health nurses, social workers, and other professionals 
54.34 	as defined in paragraph (b). For persons with complex health care needs, a public health 
54.35 	nurse or registered nurse from a multidisciplinary team must be consulted. A lead agency 
55.1 	may choose, according to departmental policies, to contract with a qualified, certified 
55.2 	assessor to conduct assessments and reassessments on behalf of the lead agency.
55.3 	(b) Certified assessors are persons with a minimum of a bachelor's degree in social 
55.4 	work, nursing with a public health nursing certificate, or other closely related field with at 
55.5 	least one year of home and community-based experience, or a two-year registered nursing 
55.6 	degreenurse without public health certification with at least three two years of home and 
55.7 	community-based experience that have has received training and certification specific to 
55.8 	assessment and consultation for long-term care services in the state.

55.9 	Sec. 9. Minnesota Statutes 2010, section 256B.0911, subdivision 2c, is amended to 
55.10 	read:
55.11 		Subd. 2c.Assessor training and certification. The commissioner shall develop 
55.12 	and implement a curriculum and an assessor certification process to begin no later than 
55.13 	January 1, 2010. All existing lead agency staff designated to provide the services defined 
55.14 	in subdivision 1a must be certified by December 30, 2010. within timelines specified by 
55.15 	the commissioner, but no sooner than six months after statewide availability of the training 
55.16 	and certification process. The commissioner must establish the timelines for training and 
55.17 	certification in a manner that allows lead agencies to most efficiently adopt the automated 
55.18 	process established in subdivision 5. Each lead agency is required to ensure that they have 
55.19 	sufficient numbers of certified assessors to provide long-term consultation assessment and 
55.20 	support planning within the timelines and parameters of the service by January 1, 2011. 
55.21 	Certified assessors are required to be recertified every three years.

55.22 	Sec. 10. Minnesota Statutes 2010, section 256B.0911, subdivision 3, is amended to 
55.23 	read:
55.24 		Subd. 3.Long-term care consultation team. (a) Until January 1, 2011, A long-term 
55.25 	care consultation team shall be established by the county board of commissioners. Each 
55.26 	local consultation team shall consist of at least one social worker and at least one public 
55.27 	health nurse from their respective county agencies. The board may designate public 
55.28 	health or social services as the lead agency for long-term care consultation services. If a 
55.29 	county does not have a public health nurse available, it may request approval from the 
55.30 	commissioner to assign a county registered nurse with at least one year experience in 
55.31 	home care to participate on the team. Two or more counties may collaborate to establish 
55.32 	a joint local consultation team or teams.
55.33 	(b) Certified assessors must be part of a multidisciplinary long-term care consultation 
55.34 	team of professionals that includes public health nurses, social workers, and other 
56.1 	professionals as defined in subdivision 2b, paragraph (b). The team is responsible for 
56.2 	providing long-term care consultation services to all persons located in the county who 
56.3 	request the services, regardless of eligibility for Minnesota health care programs.
56.4 	(c) The commissioner shall allow arrangements and make recommendations that 
56.5 	encourage counties and tribes to collaborate to establish joint local long-term care 
56.6 	consultation teams to ensure that long-term care consultations are done within the 
56.7 	timelines and parameters of the service. This includes integrated service models as 
56.8 	required in subdivision 1, paragraph (b).
56.9 	(d) Tribes and health plans under contract with the commissioner must provide 
56.10 	long-term care consultation services as specified in the contract.
56.11 	(e) The lead agency must provide the commissioner with an administrative contact 
56.12 	for communication purposes.

56.13 	Sec. 11. Minnesota Statutes 2011 Supplement, section 256B.0911, subdivision 3a, 
56.14 	is amended to read:
56.15 		Subd. 3a.Assessment and support planning. (a) Persons requesting assessment, 
56.16 	services planning, or other assistance intended to support community-based living, 
56.17 	including persons who need assessment in order to determine waiver or alternative care 
56.18 	program eligibility, must be visited by a long-term care consultation team within 15 20
56.19 	calendar days after the date on which an assessment was requested or recommended. 
56.20 	After January 1, 2011, these requirements also apply toUpon statewide implementation 
56.21 	of subdivisions 2b, 2c, and 5, this requirement also applies to an assessment of a person 
56.22 	requesting personal care assistance services,and private duty nursing, and home health 
56.23 	agency services, on timelines established in subdivision 5. The commissioner shall provide 
56.24 	at least a 90-day notice to lead agencies prior to the effective date of this requirement. 
56.25 	Face-to-face assessments must be conducted according to paragraphs (b) to (i).
56.26 	(b) The county lead agency may utilize a team of either the social worker or public 
56.27 	health nurse, or both. After January 1, 2011 Upon implementation of subdivisions 2b, 2c, 
56.28 	and 5, lead agencies shall use certified assessors to conduct the assessment in a face-to-face 
56.29 	interview assessment. The consultation team members must confer regarding the most 
56.30 	appropriate care for each individual screened or assessed. For a person with complex 
56.31 	health care needs, a public health or registered nurse from the team must be consulted.
56.32 	(c) The assessment must be comprehensive and include a person-centered assessment 
56.33 	of the health, psychological, functional, environmental, and social needs of referred 
56.34 	individuals and provide information necessary to develop a community support plan that 
56.35 	meets the consumers needs, using an assessment form provided by the commissioner.
57.1 	(d) The assessment must be conducted in a face-to-face interview with the person 
57.2 	being assessed and the person's legal representative, as required by legally executed 
57.3 	documents, and other individuals as requested by the person, who can provide information 
57.4 	on the needs, strengths, and preferences of the person necessary to develop a community 
57.5 	support plan that ensures the person's health and safety, but who is not a provider of 
57.6 	service or has any financial interest in the provision of services.
57.7 	(e) The person, or the person's legal representative, must be provided with written 
57.8 	recommendations for community-based services, including consumer-directed options, 
57.9 	or institutional care that include documentation that the most cost-effective alternatives 
57.10 	available were offered to the individual, and alternatives to residential settings, including, 
57.11 	but not limited to, foster care settings that are not the primary residence of the license 
57.12 	holder. For purposes of this requirement, "cost-effective alternatives" means community 
57.13 	services and living arrangements that cost the same as or less than institutional care.
57.14 	(f) (e) If the person chooses to use community-based services, the person or the 
57.15 	person's legal representative must be provided with a written community support plan
57.16 	within 40 calendar days of the assessment visit, regardless of whether the individual 
57.17 	is eligible for Minnesota health care programs. The written community support plan 
57.18 	must include:
57.19 	(1) a summary of assessed needs as defined in paragraphs (c) and (d);
57.20 	(2) the individual's options and choices to meet identified needs, including all 
57.21 	available options for case management services and providers;
57.22 	(3) identification of health and safety risks and how those risks will be addressed, 
57.23 	including personal risk management strategies;
57.24 	(4) referral information; and
57.25 	(5) informal caregiver supports, if applicable.
57.26 	For a person determined eligible for state plan home care under subdivision 1a, 
57.27 	paragraph (b), clause (1), the person or person's representative must also receive a copy of 
57.28 	the home care service plan developed by the certified assessor.
57.29 	(f) A person may request assistance in identifying community supports without 
57.30 	participating in a complete assessment. Upon a request for assistance identifying 
57.31 	community support, the person must be transferred or referred to the long-term care 
57.32 	options counseling services available under sections 256.975, subdivision 7, and 256.01, 
57.33 	subdivision 24, for telephone assistance and follow up.
57.34 	(g) The person has the right to make the final decision between institutional 
57.35 	placement and community placement after the recommendations have been provided, 
57.36 	except as provided in subdivision 4a, paragraph (c).
58.1 	(h) The team lead agency must give the person receiving assessment or support 
58.2 	planning, or the person's legal representative, materials, and forms supplied by the 
58.3 	commissioner containing the following information:
58.4 	(1) written recommendations for community-based services and consumer-directed 
58.5 	options;
58.6 	(2) documentation that the most cost-effective alternatives available were offered to 
58.7 	the individual. For purposes of this clause, "cost-effective" means community services and 
58.8 	living arrangements that cost the same as or less than institutional care. For an individual 
58.9 	found to meet eligibility criteria for home and community-based service programs under 
58.10 	section 256B.0915 or 256B.49, "cost effectiveness" has the meaning found in the federally 
58.11 	approved waiver plan for each program;
58.12 	(3) the need for and purpose of preadmission screening if the person selects nursing 
58.13 	facility placement;
58.14 	(2) (4) the role of the long-term care consultation assessment and support planning 
58.15 	in waiver and alternative care program eligibility determination for waiver and alternative 
58.16 	care programs, and state plan home care, case management, and other services as defined 
58.17 	in subdivision 1a, paragraphs (a), clause (7), and (b);
58.18 	(3)(5) information about Minnesota health care programs;
58.19 	(4)(6) the person's freedom to accept or reject the recommendations of the team;
58.20 	(5)(7) the person's right to confidentiality under the Minnesota Government Data 
58.21 	Practices Act, chapter 13;
58.22 	(6)(8) the long-term care consultant's certified assessor's decision regarding the 
58.23 	person's need for institutional level of care as determined under criteria established in 
58.24 	section 144.0724, subdivision 11, or 256B.092 256B.0911, subdivision 4a, paragraph (d), 
58.25 	and the certified assessor's decision regarding eligibility for all services and programs as 
58.26 	defined in subdivision 1a, paragraphs (a), clause (7), and (b); and
58.27 	(7)(9) the person's right to appeal the certified assessor's decision regarding 
58.28 	eligibility for all services and programs as defined in subdivision 1a, paragraphs (a), 
58.29 	clause (7), and (b), and incorporating the decision regarding the need for nursing facility
58.30 	institutional  level of care or the county's lead agency's final decisions regarding public 
58.31 	programs eligibility according to section 256.045, subdivision 3.
58.32 	(i) Face-to-face assessment completed as part of eligibility determination for 
58.33 	the alternative care, elderly waiver, community alternatives for disabled individuals, 
58.34 	community alternative care, and traumatic brain injury waiver programs under sections 
58.35 	256B.0913, 256B.0915, 256B.0917, and 256B.49 is valid to establish service eligibility 
58.36 	for no more than 60 calendar days after the date of assessment.
59.1 	(j) The effective eligibility start date for these programs in paragraph (i) can never 
59.2 	be prior to the date of assessment. If an assessment was completed more than 60 days 
59.3 	before the effective waiver or alternative care program eligibility start date, assessment 
59.4 	and support plan information must be updated in a face-to-face visit and documented in 
59.5 	the department's Medicaid Management Information System (MMIS). Notwithstanding 
59.6 	retroactive medical assistance coverage of state plan services, the effective date of 
59.7 	program eligibility in this case for programs included in paragraph (i) cannot be prior to 
59.8 	the date the most recent updated assessment is completed.

59.9 	Sec. 12. Minnesota Statutes 2010, section 256B.0911, subdivision 3b, is amended to 
59.10 	read:
59.11 		Subd. 3b.Transition assistance. (a) A long-term care consultation team Lead 
59.12 	agency certified assessors shall provide assistance to persons residing in a nursing 
59.13 	facility, hospital, regional treatment center, or intermediate care facility for persons with 
59.14 	developmental disabilities who request or are referred for assistance. Transition assistance 
59.15 	must include assessment, community support plan development, referrals to long-term 
59.16 	care options counseling under section 256B.975 256.975, subdivision 10 7, for community 
59.17 	support plan implementation and to Minnesota health care programs, including home and 
59.18 	community-based waiver services and consumer-directed options through the waivers, 
59.19 	and referrals to programs that provide assistance with housing. Transition assistance 
59.20 	must also include information about the Centers for Independent Living and the Senior 
59.21 	LinkAge Line, Disability Linkage Line, and about other organizations that can provide 
59.22 	assistance with relocation efforts, and information about contacting these organizations to 
59.23 	obtain their assistance and support.
59.24 	(b) The county lead agency shall develop transition processes with institutional 
59.25 	social workers and discharge planners to ensure that:
59.26 	(1) referrals for in-person assessments are taken from long-term care options 
59.27 	counselors as provided for in section 256.975, subdivision 7, paragraph (b), clause (11);
59.28 	(2) persons admitted to facilitiesassessed in institutions receive information about 
59.29 	transition assistance that is available;
59.30 	(2) (3) the assessment is completed for persons within ten working 20 calendar days 
59.31 	of the date of request or recommendation for assessment; and
59.32 	(3) (4) there is a plan for transition and follow-up for the individual's return to the 
59.33 	community. The plan must require, including notification of other local agencies when a 
59.34 	person who may require assistance is screened by one county for admission to a facility
59.35 	from agencies located in another county.; and
60.1 	(5) relocation targeted case management as defined in section 256B.0621, 
60.2 	subdivision 2, clause (4), is authorized for an eligible medical assistance recipient.
60.3 	(c) If a person who is eligible for a Minnesota health care program is admitted to a 
60.4 	nursing facility, the nursing facility must include a consultation team member or the case 
60.5 	manager in the discharge planning process.

60.6 	Sec. 13. Minnesota Statutes 2011 Supplement, section 256B.0911, subdivision 4a, 
60.7 	is amended to read:
60.8 		Subd. 4a.Preadmission screening activities related to nursing facility 
60.9 	admissions. (a) All applicants to Medicaid certified nursing facilities, including certified 
60.10 	boarding care facilities, must be screened prior to admission regardless of income, assets, 
60.11 	or funding sources for nursing facility care, except as described in subdivision 4b. The 
60.12 	purpose of the screening is to determine the need for nursing facility level of care as 
60.13 	described in paragraph (d) and to complete activities required under federal law related to 
60.14 	mental illness and developmental disability as outlined in paragraph (b).
60.15 	(b) A person who has a diagnosis or possible diagnosis of mental illness or 
60.16 	developmental disability must receive a preadmission screening before admission 
60.17 	regardless of the exemptions outlined in subdivision 4b, paragraph (b), to identify the need 
60.18 	for further evaluation and specialized services, unless the admission prior to screening is 
60.19 	authorized by the local mental health authority or the local developmental disabilities case 
60.20 	manager, or unless authorized by the county agency according to Public Law 101-508.
60.21 	The following criteria apply to the preadmission screening:
60.22 	(1) the county lead agency must use forms and criteria developed by the 
60.23 	commissioner to identify persons who require referral for further evaluation and 
60.24 	determination of the need for specialized services; and
60.25 	(2) the evaluation and determination of the need for specialized services must be 
60.26 	done by:
60.27 	(i) a qualified independent mental health professional, for persons with a primary or 
60.28 	secondary diagnosis of a serious mental illness; or
60.29 	(ii) a qualified developmental disability professional, for persons with a primary or 
60.30 	secondary diagnosis of developmental disability. For purposes of this requirement, a 
60.31 	qualified developmental disability professional must meet the standards for a qualified 
60.32 	developmental disability professional under Code of Federal Regulations, title 42, section 
60.33 	483.430.
60.34 	(c) The local county mental health authority or the state developmental disability 
60.35 	authority under Public Law Numbers 100-203 and 101-508 may prohibit admission to a 
61.1 	nursing facility if the individual does not meet the nursing facility level of care criteria or 
61.2 	needs specialized services as defined in Public Law Numbers 100-203 and 101-508. For 
61.3 	purposes of this section, "specialized services" for a person with developmental disability 
61.4 	means active treatment as that term is defined under Code of Federal Regulations, title 
61.5 	42, section 483.440 (a)(1).
61.6 	(d) The determination of the need for nursing facility level of care must be made 
61.7 	according to criteria developed by the commissioner, and in section 256B.092, using 
61.8 	forms developed by the commissioner. Effective no sooner than on or after July 1, 2012, 
61.9 	for individuals age 21 and older, and on or after October 1, 2019, for individuals under 
61.10 	age 21, the determination of need for nursing facility level of care shall be based on 
61.11 	criteria in section 144.0724, subdivision 11. In assessing a person's needs, consultation 
61.12 	team members shall have a physician available for consultation and shall consider the 
61.13 	assessment of the individual's attending physician, if any. The individual's physician must 
61.14 	be included if the physician chooses to participate. Other personnel may be included on 
61.15 	the team as deemed appropriate by the county lead agency.

61.16 	Sec. 14. Minnesota Statutes 2010, section 256B.0911, subdivision 4c, is amended to 
61.17 	read:
61.18 		Subd. 4c.Screening requirements. (a) A person may be screened for nursing 
61.19 	facility admission by telephone or in a face-to-face screening interview. Consultation team 
61.20 	members Certified assessors shall identify each individual's needs using the following 
61.21 	categories:
61.22 	(1) the person needs no face-to-face screening interview to determine the need 
61.23 	for nursing facility level of care based on information obtained from other health care 
61.24 	professionals;
61.25 	(2) the person needs an immediate face-to-face screening interview to determine the 
61.26 	need for nursing facility level of care and complete activities required under subdivision 
61.27 	4a; or
61.28 	(3) the person may be exempt from screening requirements as outlined in subdivision 
61.29 	4b, but will need transitional assistance after admission or in-person follow-along after 
61.30 	a return home.
61.31 	(b) Persons admitted on a nonemergency basis to a Medicaid-certified nursing 
61.32 	facility must be screened prior to admission.
61.33 	(c) The county lead agency screening or intake activity must include processes to 
61.34 	identify persons who may require transition assistance as described in subdivision 3b.

62.1 	Sec. 15. Minnesota Statutes 2010, section 256B.0911, subdivision 6, is amended to 
62.2 	read:
62.3 		Subd. 6.Payment for long-term care consultation services. (a) The total payment 
62.4 	for each county must be paid monthly by certified nursing facilities in the county. The 
62.5 	monthly amount to be paid by each nursing facility for each fiscal year must be determined 
62.6 	by dividing the county's annual allocation for long-term care consultation services by 12 
62.7 	to determine the monthly payment and allocating the monthly payment to each nursing 
62.8 	facility based on the number of licensed beds in the nursing facility. Payments to counties 
62.9 	in which there is no certified nursing facility must be made by increasing the payment 
62.10 	rate of the two facilities located nearest to the county seat.
62.11 	(b) The commissioner shall include the total annual payment determined under 
62.12 	paragraph (a) for each nursing facility reimbursed under section 256B.431or,256B.434
62.13 	according to section 256B.431, subdivision 2b, paragraph (g), or 256B.441.
62.14 	(c) In the event of the layaway, delicensure and decertification, or removal from 
62.15 	layaway of 25 percent or more of the beds in a facility, the commissioner may adjust 
62.16 	the per diem payment amount in paragraph (b) and may adjust the monthly payment 
62.17 	amount in paragraph (a). The effective date of an adjustment made under this paragraph 
62.18 	shall be on or after the first day of the month following the effective date of the layaway, 
62.19 	delicensure and decertification, or removal from layaway.
62.20 	(d) Payments for long-term care consultation services are available to the county 
62.21 	or counties to cover staff salaries and expenses to provide the services described in 
62.22 	subdivision 1a. The county shall employ, or contract with other agencies to employ, within 
62.23 	the limits of available funding, sufficient personnel to provide long-term care consultation 
62.24 	services while meeting the state's long-term care outcomes and objectives as defined in 
62.25 	section 256B.0917, subdivision 1. The county shall be accountable for meeting local 
62.26 	objectives as approved by the commissioner in the biennial home and community-based 
62.27 	services quality assurance plan on a form provided by the commissioner.
62.28 	(e) Notwithstanding section 256B.0641, overpayments attributable to payment of the 
62.29 	screening costs under the medical assistance program may not be recovered from a facility.
62.30 	(f) The commissioner of human services shall amend the Minnesota medical 
62.31 	assistance plan to include reimbursement for the local consultation teams.
62.32 	(g) Until the alternative payment methodology in paragraph (h) is implemented, 
62.33 	the county may bill, as case management services, assessments, support planning, and 
62.34 	follow-along provided to persons determined to be eligible for case management under 
62.35 	Minnesota health care programs. No individual or family member shall be charged for an 
62.36 	initial assessment or initial support plan development provided under subdivision 3a or 3b.
63.1 	(h) The commissioner shall develop an alternative payment methodology for 
63.2 	long-term care consultation services that includes the funding available under this 
63.3 	subdivision, and sections 256B.092 and 256B.0659. In developing the new payment 
63.4 	methodology, the commissioner shall consider the maximization of other funding sources, 
63.5 	including federal funding, for this all long-term care consultation and preadmission 
63.6 	screening activity.

63.7 	Sec. 16. Minnesota Statutes 2010, section 256B.0913, subdivision 7, is amended to 
63.8 	read:
63.9 		Subd. 7.Case management. (a) The provision of case management under the 
63.10 	alternative care program is governed by requirements in section 256B.0915, subdivisions 
63.11 	1a and 1b.
63.12 	(b) The case manager must not approve alternative care funding for a client in any 
63.13 	setting in which the case manager cannot reasonably ensure the client's health and safety.
63.14 	(c) The case manager is responsible for the cost-effectiveness of the alternative care 
63.15 	individual care coordinated service and support plan and must not approve any care plan 
63.16 	in which the cost of services funded by alternative care and client contributions exceeds 
63.17 	the limit specified in section 256B.0915, subdivision 33a, paragraph (b).
63.18 	(d) Case manager responsibilities include those in section 256B.0915, subdivision 
63.19 	1a, paragraph (g).

63.20 	Sec. 17. Minnesota Statutes 2010, section 256B.0913, subdivision 8, is amended to 
63.21 	read:
63.22 		Subd. 8.Requirements for individual care coordinated service and support
63.23 	plan. (a) The case manager shall implement the coordinated service and support plan of 
63.24 	care for each alternative care client and ensure that a client's service needs and eligibility 
63.25 	are reassessed at least every 12 months. The coordinated service and support plan must 
63.26 	meet the requirements in section 256B.0915, subdivision 6. The plan shall include any 
63.27 	services prescribed by the individual's attending physician as necessary to allow the 
63.28 	individual to remain in a community setting. In developing the individual's care plan, the 
63.29 	case manager should include the use of volunteers from families and neighbors, religious 
63.30 	organizations, social clubs, and civic and service organizations to support the formal home 
63.31 	care services. The lead agency shall be held harmless for damages or injuries sustained 
63.32 	through the use of volunteers under this subdivision including workers' compensation 
63.33 	liability. The case manager shall provide documentation in each individual's plan of care
63.34 	and, if requested, to the commissioner that the most cost-effective alternatives available 
64.1 	have been offered to the individual and that the individual was free to choose among 
64.2 	available qualified providers, both public and private, including qualified case management 
64.3 	or service coordination providers other than those employed by any county; however, the 
64.4 	county or tribe maintains responsibility for prior authorizing services in accordance with 
64.5 	statutory and administrative requirements. The case manager must give the individual a 
64.6 	ten-day written notice of any denial, termination, or reduction of alternative care services.
64.7 	(b) The county of service or tribe must provide access to and arrange for case 
64.8 	management services, including assuring implementation of the coordinated service 
64.9 	and support plan. "County of service" has the meaning given it in Minnesota Rules, 
64.10 	part 9505.0015, subpart 11. The county of service must notify the county of financial 
64.11 	responsibility of the approved care plan and the amount of encumbered funds.

64.12 	Sec. 18. Minnesota Statutes 2010, section 256B.0915, subdivision 1a, is amended to 
64.13 	read:
64.14 		Subd. 1a.Elderly waiver case management services. (a) Elderly Except 
64.15 	as provided to individuals under prepaid medical assistance programs as described 
64.16 	in paragraph (h), case management services under the home and community-based 
64.17 	services waiver for elderly individuals are available from providers meeting qualification 
64.18 	requirements and the standards specified in subdivision 1b. Eligible recipients may choose 
64.19 	any qualified provider of elderly case management services.
64.20 	(b) Case management services assist individuals who receive waiver services in 
64.21 	gaining access to needed waiver and other state plan services, and assist individuals in 
64.22 	appeals under section 256.045, as well as needed medical, social, educational, and other 
64.23 	services regardless of the funding source for the services to which access is gained. Case 
64.24 	managers shall collaborate with consumers, families, legal representatives, and relevant 
64.25 	medical experts and service providers in the development and periodic review of the 
64.26 	coordinated service and support plan.
64.27 	(c) A case aide shall provide assistance to the case manager in carrying out 
64.28 	administrative activities of the case management function. The case aide may not assume 
64.29 	responsibilities that require professional judgment including assessments, reassessments, 
64.30 	and care plan development. The case manager is responsible for providing oversight of 
64.31 	the case aide.
64.32 	(d) Case managers shall be responsible for ongoing monitoring of the provision 
64.33 	of services included in the individual's plan of care. Case managers shall initiate and 
64.34 	oversee the process of assessment and reassessment of the individual's care coordinated 
65.1 	service and support plan and review the plan of care at intervals specified in the federally 
65.2 	approved waiver plan.
65.3 	(e) The county of service or tribe must provide access to and arrange for case 
65.4 	management services. County of service has the meaning given it in Minnesota Rules, 
65.5 	part 9505.0015, subpart 11.
65.6 	(f) Except as described in paragraph (h), case management services must be provided 
65.7 	by a public or private agency that is enrolled as a medical assistance provider determined 
65.8 	by the commissioner to meet all of the requirements in subdivision 1b. Case management 
65.9 	services must not be provided to a recipient by a private agency that has a financial interest 
65.10 	in the provision of any other services included in the recipient's coordinated service and 
65.11 	support plan. For purposes of this section, "private agency" means any agency that is not 
65.12 	identified as a lead agency under section 256B.0911, subdivision 1a, paragraph (e).
65.13 	(g) Case management service activities provided to or arranged for a person include:
65.14 	(1) development of the coordinated service and support plan under subdivision 6;
65.15 	(2) informing the individual or the individual's legal guardian or conservator of 
65.16 	service options, and options for case management services and providers;
65.17 	(3) consulting with relevant medical experts or service providers;
65.18 	(4) assisting the person in the identification of potential providers;
65.19 	(5) assisting the person to access services;
65.20 	(6) coordination of services; and
65.21 	(7) evaluation and monitoring of the services identified in the plan, which must 
65.22 	incorporate at least one annual face-to-face visit by the case manager with each person.
65.23 	(h) Notwithstanding any requirements in this section, for individuals enrolled in 
65.24 	prepaid medical assistance programs under section 256B.69, subdivisions 6b and 23, the 
65.25 	health plan shall provide or arrange to provide elderly waiver case management services in 
65.26 	paragraph (g), in accordance with contract requirements established by the commissioner.

65.27 	Sec. 19. Minnesota Statutes 2010, section 256B.0915, subdivision 1b, is amended to 
65.28 	read:
65.29 		Subd. 1b.Provider qualifications and standards. (a) The commissioner must 
65.30 	enroll qualified providers of elderly case management services under the home and 
65.31 	community-based waiver for the elderly under section 1915(c) of the Social Security 
65.32 	Act. The enrollment process shall ensure the provider's ability to meet the qualification 
65.33 	requirements and standards in this subdivision and other federal and state requirements 
65.34 	of this service. An elderly A case management provider is an enrolled medical 
66.1 	assistance provider who is determined by the commissioner to have all of the following 
66.2 	characteristics:
66.3 	(1) the demonstrated capacity and experience to provide the components of 
66.4 	case management to coordinate and link community resources needed by the eligible 
66.5 	population;
66.6 	(2) administrative capacity and experience in serving the target population for 
66.7 	whom it will provide services and in ensuring quality of services under state and federal 
66.8 	requirements;
66.9 	(3) a financial management system that provides accurate documentation of services 
66.10 	and costs under state and federal requirements;
66.11 	(4) the capacity to document and maintain individual case records under state and 
66.12 	federal requirements; and
66.13 	(5) the lead agency may allow a case manager employed by the lead agency to 
66.14 	delegate certain aspects of the case management activity to another individual employed 
66.15 	by the lead agency provided there is oversight of the individual by the case manager. 
66.16 	The case manager may not delegate those aspects which require professional judgment 
66.17 	including assessments, reassessments, and care coordinated service and support plan 
66.18 	development. Lead agencies include counties, health plans, and federally recognized 
66.19 	tribes who authorize services under this section.
66.20 	(b) A health plan shall provide or arrange to provide elderly waiver case 
66.21 	management services in subdivision 1a, paragraph (g), as part of an integrated delivery 
66.22 	system in accordance with contract requirements established by the commissioner related 
66.23 	to provider standards and qualifications.

66.24 	Sec. 20. Minnesota Statutes 2010, section 256B.0915, subdivision 3c, is amended to 
66.25 	read:
66.26 		Subd. 3c.Service approval and contracting provisions. (a) Medical assistance 
66.27 	funding for skilled nursing services, private duty nursing, home health aide, and personal 
66.28 	care services for waiver recipients must be approved by the case manager and included in 
66.29 	the individual care coordinated service and support plan.
66.30 	(b) A lead agency is not required to contract with a provider of supplies and 
66.31 	equipment if the monthly cost of the supplies and equipment is less than $250.

66.32 	Sec. 21. Minnesota Statutes 2010, section 256B.0915, subdivision 6, is amended to 
66.33 	read:
67.1 		Subd. 6.Implementation of care coordinated service and support plan. (a) Each 
67.2 	elderly waiver client shall be provided a copy of a written care coordinated service and 
67.3 	support plan that meets the requirements outlined in section 256B.0913, subdivision 8. 
67.4 	The care plan must be implemented by the county of service when it is different than the 
67.5 	county of financial responsibility. The county of service administering waivered services 
67.6 	must notify the county of financial responsibility of the approved care plan. which:
67.7 	(1) is developed and signed by the recipient within ten working days after the case 
67.8 	manager receives the assessment information and written community support plan as 
67.9 	described in section 256B.0911, subdivision 3a, from the certified assessor;
67.10 	(2) includes the person's need for service and identification of service needs that will 
67.11 	be or that are met by the person's relatives, friends, and others, as well as community 
67.12 	services used by the general public;
67.13 	(3) reasonably ensures the health and safety of the recipient;
67.14 	(4) identifies the person's preferences for services as stated by the person or the 
67.15 	person's legal guardian or conservator;
67.16 	(5) reflects the person's informed choice between institutional and community-based 
67.17 	services, as well as choice of services, supports, and providers, including available case 
67.18 	manager providers;
67.19 	(6) identifies long and short-range goals for the person;
67.20 	(7) identifies specific services and the amount, frequency, duration, and cost of the 
67.21 	services to be provided to the person based on assessed needs, preferences, and available 
67.22 	resources;
67.23 	(8) includes information about the right to appeal decisions under section 256.045; 
67.24 	and
67.25 	(9) includes the authorized annual and monthly amounts for the services.
67.26 	(b) In developing the coordinated service and support plan, the case manager should 
67.27 	also include the use of volunteers, religious organizations, social clubs, and civic and 
67.28 	service organizations to support the individual in the community. The lead agency must be 
67.29 	held harmless for damages or injuries sustained through the use of volunteers and agencies 
67.30 	under this paragraph, including workers' compensation liability.

67.31 	Sec. 22. Minnesota Statutes 2011 Supplement, section 256B.0915, subdivision 10, 
67.32 	is amended to read:
67.33 		Subd. 10.Waiver payment rates; managed care organizations. The 
67.34 	commissioner shall adjust the elderly waiver capitation payment rates for managed 
67.35 	care organizations paid under section 256B.69, subdivisions 6a 6b and 23, to reflect the 
68.1 	maximum service rate limits for customized living services and 24-hour customized 
68.2 	living services under subdivisions 3e and 3h. Medical assistance rates paid to customized 
68.3 	living providers by managed care organizations under this section shall not exceed the 
68.4 	maximum service rate limits and component rates as determined by the commissioner 
68.5 	under subdivisions 3e and 3h.

68.6 	Sec. 23. Minnesota Statutes 2010, section 256B.092, subdivision 1, is amended to read:
68.7 		Subdivision 1.County of financial responsibility; duties. Before any services 
68.8 	shall be rendered to persons with developmental disabilities who are in need of social 
68.9 	service and medical assistance, the county of financial responsibility shall conduct or 
68.10 	arrange for a diagnostic evaluation in order to determine whether the person has or may 
68.11 	have a developmental disability or has or may have a related condition. If the county 
68.12 	of financial responsibility determines that the person has a developmental disability, 
68.13 	the county shall inform the person of case management services available under this 
68.14 	section. Except as provided in subdivision 1g or 4b, if a person is diagnosed as having a 
68.15 	developmental disability, the county of financial responsibility shall conduct or arrange for 
68.16 	a needs assessment by a certified assessor, and develop or arrange for an individual service
68.17 	a community support plan according to section 256B.0911, provide or arrange for ongoing 
68.18 	case management services at the level identified in the individual service plan, provide 
68.19 	or arrange for case management administration, and authorize services identified in the 
68.20 	person's individual service coordinated service and support plan developed according to 
68.21 	subdivision 1b. Diagnostic information, obtained by other providers or agencies, may be 
68.22 	used by the county agency in determining eligibility for case management. Nothing in this 
68.23 	section shall be construed as requiring: (1) assessment in areas agreed to as unnecessary 
68.24 	by the case manager a certified assessor and the person, or the person's legal guardian or 
68.25 	conservator, or the parent if the person is a minor, or (2) assessments in areas where there 
68.26 	has been a functional assessment completed in the previous 12 months for which the 
68.27 	case manager certified assessor and the person or person's guardian or conservator, or the 
68.28 	parent if the person is a minor, agree that further assessment is not necessary. For persons 
68.29 	under state guardianship, the case manager certified assessor shall seek authorization from 
68.30 	the public guardianship office for waiving any assessment requirements. Assessments 
68.31 	related to health, safety, and protection of the person for the purpose of identifying service 
68.32 	type, amount, and frequency or assessments required to authorize services may not be 
68.33 	waived. To the extent possible, for wards of the commissioner the county shall consider 
68.34 	the opinions of the parent of the person with a developmental disability when developing 
69.1 	the person's individual service community support plan and coordinated service and 
69.2 	support plan.

69.3 	Sec. 24. Minnesota Statutes 2010, section 256B.092, subdivision 1a, is amended to 
69.4 	read:
69.5 		Subd. 1a.Case management administration and services. (a) The administrative 
69.6 	functions of case management provided to or arranged for a person include: Each recipient 
69.7 	of a home and community-based waiver shall be provided case management services by 
69.8 	qualified vendors as described in the federally approved waiver application.
69.9 	(1) review of eligibility for services;
69.10 	(2) screening;
69.11 	(3) intake;
69.12 	(4) diagnosis;
69.13 	(5) the review and authorization of services based upon an individualized service 
69.14 	plan; and
69.15 	(6) responding to requests for conciliation conferences and appeals according to 
69.16 	section 256.045 made by the person, the person's legal guardian or conservator, or the 
69.17 	parent if the person is a minor.
69.18 	(b) Case management service activities provided to or arranged for a person include:
69.19 	(1) development of the individual service coordinated service and support plan
69.20 	under subdivision 1b;
69.21 	(2) informing the individual or the individual's legal guardian or conservator, or 
69.22 	parent if the person is a minor, of service options;
69.23 	(3) consulting with relevant medical experts or service providers;
69.24 	(4) assisting the person in the identification of potential providers;
69.25 	(5) assisting the person to access services and assisting in appeals under section 
69.26 	256.045;
69.27 	(6) coordination of services, if coordination is not provided by another service 
69.28 	provider;
69.29 	(7) evaluation and monitoring of the services identified in the coordinated service 
69.30 	and support plan, which must incorporate at least one annual face-to-face visit by the case 
69.31 	manager with each person; and
69.32 	(8) annual reviews of service plans and services provided reviewing coordinated 
69.33 	service and support plans and providing the lead agency with recommendations for service 
69.34 	authorization based upon the individual's needs identified in the coordinated service and 
69.35 	support plan.
70.1 	(c) Case management administration and service activities that are provided to the 
70.2 	person with a developmental disability shall be provided directly by county agencies or 
70.3 	under contract. Case management services must be provided by a public or private agency 
70.4 	that is enrolled as a medical assistance provider determined by the commissioner to meet 
70.5 	all of the requirements in the approved federal waiver plans. Case management services 
70.6 	must not be provided to a recipient by a private agency that has a financial interest in the 
70.7 	provision of any other services included in the recipient's coordinated service and support 
70.8 	plan. For purposes of this section, "private agency" means any agency that is not identified 
70.9 	as a lead agency under section 256B.0911, subdivision 1a, paragraph (e).
70.10 	(d) Case managers are responsible for the administrative duties and service 
70.11 	provisions listed in paragraphs (a) and (b). Case managers shall collaborate with 
70.12 	consumers, families, legal representatives, and relevant medical experts and service 
70.13 	providers in the development and annual review of the individualized service coordinated 
70.14 	service and support plan and habilitation plans plan.
70.15 	(e) The Department of Human Services shall offer ongoing education in case 
70.16 	management to case managers. Case managers shall receive no less than ten hours of case 
70.17 	management education and disability-related training each year.

70.18 	Sec. 25. Minnesota Statutes 2010, section 256B.092, subdivision 1b, is amended to 
70.19 	read:
70.20 		Subd. 1b.Individual Coordinated service and support plan. The individual 
70.21 	service plan must (a) Each recipient of home and community-based waivered services 
70.22 	shall be provided a copy of the written coordinated service and support plan which:
70.23 	(1) is developed and signed by the recipient within ten working days after the case 
70.24 	manager receives the assessment information and written community support plan as 
70.25 	described in section 256B.0911, subdivision 3a, from the certified assessor;
70.26 	(1) include the results of the assessment information on(2) includes the person's 
70.27 	need for service, including identification of service needs that will be or that are met 
70.28 	by the person's relatives, friends, and others, as well as community services used by 
70.29 	the general public;
70.30 	(3) reasonably ensures the health and safety of the recipient;
70.31 	(2) identify (4) identifies the person's preferences for services as stated by the 
70.32 	person, the person's legal guardian or conservator, or the parent if the person is a minor, 
70.33 	including the person's choices made on self-directed options and on services and supports 
70.34 	to achieve employment goals;
71.1 	(5) provides for an informed choice, as defined in section 256B.77, subdivision 2, 
71.2 	paragraph (o), of service and support providers, and identifies all available options for 
71.3 	case management services and providers;
71.4 	(3) identify (6) identifies long- and short-range goals for the person;
71.5 	(4) identify (7) identifies specific services and the amount and frequency of the 
71.6 	services to be provided to the person based on assessed needs, preferences, and available 
71.7 	resources. The individual service coordinated service and support plan shall also specify 
71.8 	other services the person needs that are not available;
71.9 	(5) identify (8) identifies the need for an individual program plan to be developed 
71.10 	by the provider according to the respective state and federal licensing and certification 
71.11 	standards, and additional assessments to be completed or arranged by the provider after 
71.12 	service initiation;
71.13 	(6) identify (9) identifies provider responsibilities to implement and make 
71.14 	recommendations for modification to the individual service coordinated service and 
71.15 	support plan;
71.16 	(7) include (10) includes notice of the right to request a conciliation conference or a 
71.17 	hearing under section 256.045;
71.18 	(8) be (11) is agreed upon and signed by the person, the person's legal guardian 
71.19 	or conservator, or the parent if the person is a minor, and the authorized county 
71.20 	representative; and
71.21 	(9) be (12) is reviewed by a health professional if the person has overriding medical 
71.22 	needs that impact the delivery of services.; and
71.23 	(13) includes the authorized annual and monthly amounts for the services.
71.24 	Service planning formats developed for interagency planning such as transition, 
71.25 	vocational, and individual family service plans may be substituted for service planning 
71.26 	formats developed by county agencies.
71.27 	(b) In developing the coordinated service and support plan, the case manager is 
71.28 	encouraged to include the use of volunteers, religious organizations, social clubs, and civic 
71.29 	and service organizations to support the individual in the community. The lead agency 
71.30 	must be held harmless for damages or injuries sustained through the use of volunteers and 
71.31 	agencies under this paragraph, including workers' compensation liability.

71.32 	Sec. 26. Minnesota Statutes 2010, section 256B.092, subdivision 1e, is amended to 
71.33 	read:
71.34 		Subd. 1e.Coordination, evaluation, and monitoring of services. (a) If the 
71.35 	individual service coordinated service and support plan identifies the need for individual 
72.1 	program plans for authorized services, the case manager shall assure that individual 
72.2 	program plans are developed by the providers according to clauses (2) to (5). The 
72.3 	providers shall assure that the individual program plans:
72.4 	(1) are developed according to the respective state and federal licensing and 
72.5 	certification requirements;
72.6 	(2) are designed to achieve the goals of the individual service coordinated service 
72.7 	and support plan;
72.8 	(3) are consistent with other aspects of the individual service coordinated service 
72.9 	and support plan;
72.10 	(4) assure the health and safety of the person; and
72.11 	(5) are developed with consistent and coordinated approaches to services among the 
72.12 	various service providers.
72.13 	(b) The case manager shall monitor the provision of services:
72.14 	(1) to assure that the individual service coordinated service and support plan is 
72.15 	being followed according to paragraph (a);
72.16 	(2) to identify any changes or modifications that might be needed in the individual 
72.17 	service coordinated service and support plan, including changes resulting from 
72.18 	recommendations of current service providers;
72.19 	(3) to determine if the person's legal rights are protected, and if not, notify the 
72.20 	person's legal guardian or conservator, or the parent if the person is a minor, protection 
72.21 	services, or licensing agencies as appropriate; and
72.22 	(4) to determine if the person, the person's legal guardian or conservator, or the 
72.23 	parent if the person is a minor, is satisfied with the services provided.
72.24 	(c) If the provider fails to develop or carry out the individual program plan according 
72.25 	to paragraph (a), the case manager shall notify the person's legal guardian or conservator, 
72.26 	or the parent if the person is a minor, the provider, the respective licensing and certification 
72.27 	agencies, and the county board where the services are being provided. In addition, the 
72.28 	case manager shall identify other steps needed to assure the person receives the services 
72.29 	identified in the individual service coordinated service and support plan.

72.30 	Sec. 27. Minnesota Statutes 2010, section 256B.092, subdivision 1g, is amended to 
72.31 	read:
72.32 		Subd. 1g.Conditions not requiring development of individual service
72.33 	coordinated service and support plan. Unless otherwise required by federal law, the 
72.34 	county agency is not required to complete an individual service a coordinated service and 
72.35 	support plan as defined in subdivision 1b for:
73.1 	(1) persons whose families are requesting respite care for their family member who 
73.2 	resides with them, or whose families are requesting a family support grant and are not 
73.3 	requesting purchase or arrangement of habilitative services; and
73.4 	(2) persons with developmental disabilities, living independently without authorized 
73.5 	services or receiving funding for services at a rehabilitation facility as defined in section 
73.6 	268A.01, subdivision 6, and not in need of or requesting additional services.

73.7 	Sec. 28. Minnesota Statutes 2010, section 256B.092, subdivision 2, is amended to read:
73.8 		Subd. 2.Medical assistance. To assure quality case management to those persons 
73.9 	who are eligible for medical assistance, the commissioner shall, upon request:
73.10 	(1) provide consultation on the case management process;
73.11 	(2) assist county agencies in the screening and annual reviews of clients review 
73.12 	process to assure that appropriate levels of service are provided to persons;
73.13 	(3) provide consultation on service planning and development of services with 
73.14 	appropriate options;
73.15 	(4) provide training and technical assistance to county case managers; and
73.16 	(5) authorize payment for medical assistance services according to this chapter 
73.17 	and rules implementing it.

73.18 	Sec. 29. Minnesota Statutes 2010, section 256B.092, subdivision 3, is amended to read:
73.19 		Subd. 3.Authorization and termination of services. County agency case 
73.20 	managers, under rules of the commissioner, shall authorize and terminate services of 
73.21 	community and regional treatment center providers according to individual service
73.22 	support plans. Services provided to persons with developmental disabilities may only be 
73.23 	authorized and terminated by case managers or certified assessors according to (1) rules of 
73.24 	the commissioner and (2) the individual service coordinated service and support plan as 
73.25 	defined in subdivision 1b. Medical assistance services not needed shall not be authorized 
73.26 	by county agencies or funded by the commissioner. When purchasing or arranging for 
73.27 	unlicensed respite care services for persons with overriding health needs, the county 
73.28 	agency shall seek the advice of a health care professional in assessing provider staff 
73.29 	training needs and skills necessary to meet the medical needs of the person.

73.30 	Sec. 30. Minnesota Statutes 2010, section 256B.092, subdivision 5, is amended to read:
73.31 		Subd. 5.Federal waivers. (a) The commissioner shall apply for any federal 
73.32 	waivers necessary to secure, to the extent allowed by law, federal financial participation 
73.33 	under United States Code, title 42, sections 1396 et seq., as amended, for the provision 
74.1 	of services to persons who, in the absence of the services, would need the level of care 
74.2 	provided in a regional treatment center or a community intermediate care facility for 
74.3 	persons with developmental disabilities. The commissioner may seek amendments to the 
74.4 	waivers or apply for additional waivers under United States Code, title 42, sections 1396 
74.5 	et seq., as amended, to contain costs. The commissioner shall ensure that payment for 
74.6 	the cost of providing home and community-based alternative services under the federal 
74.7 	waiver plan shall not exceed the cost of intermediate care services including day training 
74.8 	and habilitation services that would have been provided without the waivered services.
74.9 	The commissioner shall seek an amendment to the 1915c home and 
74.10 	community-based waiver to allow properly licensed adult foster care homes to provide 
74.11 	residential services to up to five individuals with developmental disabilities. If the 
74.12 	amendment to the waiver is approved, adult foster care providers that can accommodate 
74.13 	five individuals shall increase their capacity to five beds, provided the providers continue 
74.14 	to meet all applicable licensing requirements.
74.15 	(b) The commissioner, in administering home and community-based waivers for 
74.16 	persons with developmental disabilities, shall ensure that day services for eligible persons 
74.17 	are not provided by the person's residential service provider, unless the person or the 
74.18 	person's legal representative is offered a choice of providers and agrees in writing to 
74.19 	provision of day services by the residential service provider. The individual service
74.20 	coordinated service and support plan for individuals who choose to have their residential 
74.21 	service provider provide their day services must describe how health, safety, protection, 
74.22 	and habilitation needs will be met, including how frequent and regular contact with 
74.23 	persons other than the residential service provider will occur. The individualized service
74.24 	coordinated service and support plan must address the provision of services during the 
74.25 	day outside the residence on weekdays.
74.26 	(c) When a county lead agency is evaluating denials, reductions, or terminations 
74.27 	of home and community-based services under section 256B.0916 for an individual, the 
74.28 	case manager lead agency shall offer to meet with the individual or the individual's 
74.29 	guardian in order to discuss the prioritization of service needs within the individualized 
74.30 	service coordinated service and support plan. The reduction in the authorized services 
74.31 	for an individual due to changes in funding for waivered services may not exceed the 
74.32 	amount needed to ensure medically necessary services to meet the individual's health, 
74.33 	safety, and welfare.

74.34 	Sec. 31. Minnesota Statutes 2010, section 256B.092, subdivision 7, is amended to read:
75.1 		Subd. 7.Screening teams Assessments. (a) Assessments and reassessments shall 
75.2 	be conducted by certified assessors according to section 256B.0911, and must incorporate 
75.3 	appropriate referrals to determine eligibility for case management under subdivision 1a.
75.4 	(b) For persons with developmental disabilities, screening teams shall be established 
75.5 	which a certified assessor shall evaluate the need for the an institutional level of care.
75.6 	provided by residential-based habilitation services, residential services, training and 
75.7 	habilitation services, and nursing facility services. The evaluation assessment shall 
75.8 	address whether home and community-based services are appropriate for persons who 
75.9 	are at risk of placement in an intermediate care facility for persons with developmental 
75.10 	disabilities, or for whom there is reasonable indication that they might require this level of 
75.11 	care. The screening team certified assessor shall make an evaluation of need within 60 
75.12 	working days of a request for service by a person with a developmental disability, and
75.13 	within five working days of an emergency admission of a person to an intermediate care 
75.14 	facility for persons with developmental disabilities. The screening team shall consist of 
75.15 	the case manager for persons with developmental disabilities, the person, the person's 
75.16 	legal guardian or conservator, or the parent if the person is a minor, and a qualified 
75.17 	developmental disability professional, as defined in the Code of Federal Regulations, 
75.18 	title 42, section 483.430, as amended through June 3, 1988. The case manager may also 
75.19 	act as the qualified developmental disability professional if the case manager meets 
75.20 	the federal definition. County social service agencies may contract with a public or 
75.21 	private agency or individual who is not a service provider for the person for the public 
75.22 	guardianship representation required by the screening or individual service planning 
75.23 	process. The contract shall be limited to public guardianship representation for the 
75.24 	screening and individual service planning activities. The contract shall require compliance 
75.25 	with the commissioner's instructions and may be for paid or voluntary services. For 
75.26 	persons determined to have overriding health care needs and are seeking admission to a 
75.27 	nursing facility or an ICF/MR, or seeking access to home and community-based waivered 
75.28 	services, a registered nurse must be designated as either the case manager or the qualified 
75.29 	developmental disability professional. For persons under the jurisdiction of a correctional 
75.30 	agency, the case manager must consult with the corrections administrator regarding 
75.31 	additional health, safety, and supervision needs. The case manager, with the concurrence 
75.32 	of the person, the person's legal guardian or conservator, or the parent if the person is a 
75.33 	minor, may invite other individuals to attend meetings of the screening team. No member 
75.34 	of the screening team shall have any direct or indirect service provider interest in the case. 
75.35 	Nothing in this section shall be construed as requiring the screening team meeting to be 
75.36 	separate from the service planning meeting.

76.1 	Sec. 32. Minnesota Statutes 2010, section 256B.092, subdivision 8, is amended to read:
76.2 		Subd. 8.Screening team Additional certified assessor duties. In addition to the 
76.3 	responsibilities of certified assessors described in section 256B.0911, for persons with 
76.4 	developmental disabilities, the screening team certified assessor shall:
76.5 	(1) review diagnostic data;
76.6 	(2) review health, social, and developmental assessment data using a uniform 
76.7 	screening tool specified by the commissioner;
76.8 	(3) identify the level of services appropriate to maintain the person in the most 
76.9 	normal and least restrictive setting that is consistent with the person's treatment needs;
76.10 	(4) (1) identify other noninstitutional public assistance or social service that may 
76.11 	prevent or delay long-term residential placement;
76.12 	(5) (2) assess whether a person is in need of long-term residential care;
76.13 	(6) (3) make recommendations regarding placement and payment for:
76.14 	(i) social service or public assistance support, or both, to maintain a person in the 
76.15 	person's own home or other place of residence;
76.16 	(ii) training and habilitation service, vocational rehabilitation, and employment 
76.17 	training activities;
76.18 	(iii) community residential service placement;
76.19 	(iv) regional treatment center placement; or
76.20 	(v) a home and community-based service alternative to community residential 
76.21 	placement service or regional treatment center placement including self-directed service 
76.22 	options;
76.23 	(7) (4) evaluate the availability, location, and quality of the services listed in clause 
76.24 	(6) (3), including the impact of placement alternatives on the person's ability to maintain 
76.25 	or improve existing patterns of contact and involvement with parents and other family 
76.26 	members;
76.27 	(8) (5) identify the cost implications of recommendations in clause (6) (3); and
76.28 	(9) (6) make recommendations to a court as may be needed to assist the court in 
76.29 	making decisions regarding commitment of persons with developmental disabilities; and.
76.30 	(10) inform the person and the person's legal guardian or conservator, or the parent if 
76.31 	the person is a minor, that appeal may be made to the commissioner pursuant to section 
76.32 	256.045.

76.33 	Sec. 33. Minnesota Statutes 2010, section 256B.092, subdivision 8a, is amended to 
76.34 	read:
77.1 		Subd. 8a.County concurrence notification. (a) If the county of financial 
77.2 	responsibility wishes to place a person in another county for services, the county of 
77.3 	financial responsibility shall seek concurrence from notify the proposed county of service 
77.4 	and the placement shall be made cooperatively between the two counties. Arrangements 
77.5 	shall be made between the two counties for ongoing social service, including annual 
77.6 	reviews of the person's individual service coordinated service and support plan. The county 
77.7 	where services are provided may not make changes in the person's service coordinated 
77.8 	service and support plan without approval by the county of financial responsibility.
77.9 	(b) When a person has been screened and authorized for services in an intermediate 
77.10 	care facility for persons with developmental disabilities or for home and community-based 
77.11 	services for persons with developmental disabilities, the case manager shall assist that 
77.12 	person in identifying a service provider who is able to meet the needs of the person 
77.13 	according to the person's individual service plan. If the identified service is to be provided 
77.14 	in a county other than the county of financial responsibility, the county of financial 
77.15 	responsibility shall request concurrence of the county where the person is requesting to 
77.16 	receive the identified services. The county of service may refuse to concur shall notify 
77.17 	the county of financial responsibility if:
77.18 	(1) it can demonstrate that the provider is unable to provide the services identified in 
77.19 	the person's individual service plan as services that are needed and are to be provided; or
77.20 	(2), in the case of an intermediate care facility for persons with developmental 
77.21 	disabilities, there has been no authorization for admission by the admission review team 
77.22 	as required in section 256B.0926.
77.23 	(c) The county of service shall notify the county of financial responsibility of 
77.24 	concurrence or refusal to concur any concerns about the chosen provider's capacity to 
77.25 	meet the needs of the person seeking to move to residential services in another county no 
77.26 	later than 20 working days following receipt of the written request notification. Unless 
77.27 	other mutually acceptable arrangements are made by the involved county agencies, the 
77.28 	county of financial responsibility is responsible for costs of social services and the costs 
77.29 	associated with the development and maintenance of the placement. The county of 
77.30 	service may request that the county of financial responsibility purchase case management 
77.31 	services from the county of service or from a contracted provider of case management 
77.32 	when the county of financial responsibility is not providing case management as defined 
77.33 	in this section and rules adopted under this section, unless other mutually acceptable 
77.34 	arrangements are made by the involved county agencies. Standards for payment limits 
77.35 	under this section may be established by the commissioner. Financial disputes between 
78.1 	counties shall be resolved as provided in section 256G.09. This subdivision also applies to 
78.2 	home and community-based waiver services provided under section 256B.49.

78.3 	Sec. 34. Minnesota Statutes 2010, section 256B.092, subdivision 9, is amended to read:
78.4 		Subd. 9.Reimbursement. Payment for services shall not be provided to a 
78.5 	service provider for any person placed in an intermediate care facility for persons with 
78.6 	developmental disabilities prior to the person being screened by the screening team
78.7 	receiving an assessment by a certified assessor. The commissioner shall not deny 
78.8 	reimbursement for: (1) a person admitted to an intermediate care facility for persons 
78.9 	with developmental disabilities who is assessed to need long-term supportive services, 
78.10 	if long-term supportive services other than intermediate care are not available in that 
78.11 	community; (2) any person admitted to an intermediate care facility for persons with 
78.12 	developmental disabilities under emergency circumstances; (3) any eligible person placed 
78.13 	in the intermediate care facility for persons with developmental disabilities pending an 
78.14 	appeal of the screening team's certified assessor's decision; or (4) any medical assistance 
78.15 	recipient when, after full discussion of all appropriate alternatives including those that 
78.16 	are expected to be less costly than intermediate care for persons with developmental 
78.17 	disabilities, the person or the person's legal guardian or conservator, or the parent if the 
78.18 	person is a minor, insists on intermediate care placement. The screening team certified 
78.19 	assessor shall provide documentation that the most cost-effective alternatives available 
78.20 	were offered to this individual or the individual's legal guardian or conservator.

78.21 	Sec. 35. Minnesota Statutes 2010, section 256B.092, subdivision 11, is amended to 
78.22 	read:
78.23 		Subd. 11.Residential support services. (a) Upon federal approval, there is 
78.24 	established a new service called residential support that is available on the community 
78.25 	alternative care, community alternatives for disabled individuals, developmental 
78.26 	disabilities, and traumatic brain injury waivers. Existing waiver service descriptions 
78.27 	must be modified to the extent necessary to ensure there is no duplication between 
78.28 	other services. Residential support services must be provided by vendors licensed as a 
78.29 	community residential setting as defined in section 245A.11, subdivision 8.
78.30 	(b) Residential support services must meet the following criteria:
78.31 	(1) providers of residential support services must own or control the residential site;
78.32 	(2) the residential site must not be the primary residence of the license holder;
78.33 	(3) the residential site must have a designated program supervisor responsible for 
78.34 	program oversight, development, and implementation of policies and procedures;
79.1 	(4) the provider of residential support services must provide supervision, training, 
79.2 	and assistance as described in the person's community coordinated service and support 
79.3 	plan; and
79.4 	(5) the provider of residential support services must meet the requirements of 
79.5 	licensure and additional requirements of the person's community coordinated service and
79.6 	support plan.
79.7 	(c) Providers of residential support services that meet the definition in paragraph 
79.8 	(a) must be registered using a process determined by the commissioner beginning July 
79.9 	1, 2009.

79.10 	Sec. 36. Minnesota Statutes 2010, section 256B.15, subdivision 1c, is amended to read:
79.11 		Subd. 1c.Notice of potential claim. (a) A state agency with a claim or potential 
79.12 	claim under this section may file a notice of potential claim under this subdivision anytime 
79.13 	before or within one year after a medical assistance recipient dies. The claimant shall be 
79.14 	the state agency. A notice filed prior to the recipient's death shall not take effect and shall 
79.15 	not be effective as notice until the recipient dies. A notice filed after a recipient dies 
79.16 	shall be effective from the time of filing.
79.17 	(b) The notice of claim shall be filed or recorded in the real estate records in the 
79.18 	office of the county recorder or registrar of titles for each county in which any part of 
79.19 	the property is located. The recorder shall accept the notice for recording or filing. The 
79.20 	registrar of titles shall accept the notice for filing if the recipient has a recorded interest in 
79.21 	the property. The registrar of titles shall not carry forward to a new certificate of title any 
79.22 	notice filed more than one year from the date of the recipient's death.
79.23 	(c) The notice must be dated, state the name of the claimant, the medical assistance 
79.24 	recipient's name and last four digits of the Social Security number if filed before their 
79.25 	death and their date of death if filed after they die, the name and date of death of any 
79.26 	predeceased spouse of the medical assistance recipient for whom a claim may exist, a 
79.27 	statement that the claimant may have a claim arising under this section, generally identify 
79.28 	the recipient's interest in the property, contain a legal description for the property and 
79.29 	whether it is abstract or registered property, a statement of when the notice becomes 
79.30 	effective and the effect of the notice, be signed by an authorized representative of the state 
79.31 	agency, and may include such other contents as the state agency may deem appropriate.

79.32 	Sec. 37. Minnesota Statutes 2010, section 256B.15, subdivision 1f, is amended to read:
79.33 		Subd. 1f.Agency lien. (a) The notice shall constitute a lien in favor of the 
79.34 	Department of Human Services against the recipient's interests in the real estate it 
80.1 	describes for a period of 20 years from the date of filing or the date of the recipient's death, 
80.2 	whichever is later. Notwithstanding any law or rule to the contrary, a recipient's life estate 
80.3 	and joint tenancy interests shall not end upon the recipient's death but shall continue 
80.4 	according to subdivisions 1h, 1i, and 1j. The amount of the lien shall be equal to the total 
80.5 	amount of the claims that could be presented in the recipient's estate under this section.
80.6 	(b) If no estate has been opened for the deceased recipient, any holder of an interest 
80.7 	in the property may apply to the lienholder for a statement of the amount of the lien or 
80.8 	for a full or partial release of the lien. The application shall include the applicant's name, 
80.9 	current mailing address, current home and work telephone numbers, and a description of 
80.10 	their interest in the property, a legal description of the recipient's interest in the property, 
80.11 	and the deceased recipient's name, date of birth, and last four digits of the Social Security 
80.12 	number. The lienholder shall send the applicant by certified mail, return receipt requested, 
80.13 	a written statement showing the amount of the lien, whether the lienholder is willing to 
80.14 	release the lien and under what conditions, and inform them of the right to a hearing under 
80.15 	section 256.045. The lienholder shall have the discretion to compromise and settle the lien 
80.16 	upon any terms and conditions the lienholder deems appropriate.
80.17 	(c) Any holder of an interest in property subject to the lien has a right to request 
80.18 	a hearing under section 256.045 to determine the validity, extent, or amount of the lien. 
80.19 	The request must be in writing, and must include the names, current addresses, and home 
80.20 	and business telephone numbers for all other parties holding an interest in the property. A 
80.21 	request for a hearing by any holder of an interest in the property shall be deemed to be a 
80.22 	request for a hearing by all parties owning interests in the property. Notice of the hearing 
80.23 	shall be given to the lienholder, the party filing the appeal, and all of the other holders of 
80.24 	interests in the property at the addresses listed in the appeal by certified mail, return receipt 
80.25 	requested, or by ordinary mail. Any owner of an interest in the property to whom notice of 
80.26 	the hearing is mailed shall be deemed to have waived any and all claims or defenses in 
80.27 	respect to the lien unless they appear and assert any claims or defenses at the hearing.
80.28 	(d) If the claim the lien secures could be filed under subdivision 1h, the lienholder 
80.29 	may collect, compromise, settle, or release the lien upon any terms and conditions it deems 
80.30 	appropriate. If the claim the lien secures could be filed under subdivision 1i or 1j, the lien 
80.31 	may be adjusted or enforced to the same extent had it been filed under subdivisions 1i 
80.32 	and 1j, and the provisions of subdivisions 1i, clause (f), and 1j, clause (d), shall apply to 
80.33 	voluntary payment, settlement, or satisfaction of the lien.
80.34 	(e) If no probate proceedings have been commenced for the recipient as of the date 
80.35 	the lien holder executes a release of the lien on a recipient's life estate or joint tenancy 
80.36 	interest, created for purposes of this section, the release shall terminate the life estate or 
81.1 	joint tenancy interest created under this section as of the date it is recorded or filed to the 
81.2 	extent of the release. If the claimant executes a release for purposes of extinguishing a 
81.3 	life estate or a joint tenancy interest created under this section to remove a cloud on title 
81.4 	to real property, the release shall have the effect of extinguishing any life estate or joint 
81.5 	tenancy interests in the property it describes which may have been continued by reason 
81.6 	of this section retroactive to the date of death of the deceased life tenant or joint tenant 
81.7 	except as provided for in section 514.981, subdivision 6.
81.8 	(f) If the deceased recipient's estate is probated, a claim shall be filed under this 
81.9 	section. The amount of the lien shall be limited to the amount of the claim as finally 
81.10 	allowed. If the claim the lien secures is filed under subdivision 1h, the lien may be released 
81.11 	in full after any allowance of the claim becomes final or according to any agreement to 
81.12 	settle and satisfy the claim. The release shall release the lien but shall not extinguish 
81.13 	or terminate the interest being released. If the claim the lien secures is filed under 
81.14 	subdivision 1i or 1j, the lien shall be released after the lien under subdivision 1i or 1j is 
81.15 	filed or recorded, or settled according to any agreement to settle and satisfy the claim. The 
81.16 	release shall not extinguish or terminate the interest being released. If the claim is finally 
81.17 	disallowed in full, the claimant shall release the claimant's lien at the claimant's expense.

81.18 	Sec. 38. Minnesota Statutes 2010, section 256B.49, subdivision 13, is amended to read:
81.19 		Subd. 13.Case management. (a) Each recipient of a home and community-based 
81.20 	waiver shall be provided case management services by qualified vendors as described 
81.21 	in the federally approved waiver application. The case management service activities 
81.22 	provided will must include:
81.23 	(1) assessing the needs of the individual within 20 working days of a recipient's 
81.24 	request;
81.25 	(2) developing (1) finalizing the written individual service coordinated service and 
81.26 	support plan within ten working days after the assessment is completed case manager 
81.27 	receives the plan from the certified assessor;
81.28 	(3) (2) informing the recipient or the recipient's legal guardian or conservator 
81.29 	of service options;
81.30 	(4) (3) assisting the recipient in the identification of potential service providers and 
81.31 	available options for case management service and providers;
81.32 	(5) (4) assisting the recipient to access services and assisting with appeals under 
81.33 	section 256.045; and
81.34 	(6) (5) coordinating, evaluating, and monitoring of the services identified in the 
81.35 	service plan;.
82.1 	(7) completing the annual reviews of the service plan; and
82.2 	(8) informing the recipient or legal representative of the right to have assessments 
82.3 	completed and service plans developed within specified time periods, and to appeal county 
82.4 	action or inaction under section 256.045, subdivision 3, including the determination of 
82.5 	nursing facility level of care.
82.6 	(b) The case manager may delegate certain aspects of the case management service 
82.7 	activities to another individual provided there is oversight by the case manager. The case 
82.8 	manager may not delegate those aspects which require professional judgment including 
82.9 	assessments, reassessments, and care plan development.:
82.10 	(1) finalizing the coordinated service and support plan;
82.11 	(2) ongoing assessment and monitoring of the person's needs and adequacy of the 
82.12 	approved coordinated service and support plan; and
82.13 	(3) adjustments to the coordinated service and support plan.
82.14 	(c) Case management services must be provided by a public or private agency that is 
82.15 	enrolled as a medical assistance provider determined by the commissioner to meet all of 
82.16 	the requirements in the approved federal waiver plans. Case management services must 
82.17 	not be provided to a recipient by a private agency that has any financial interest in the 
82.18 	provision of any other services included in the recipient's coordinated service and support 
82.19 	plan. For purposes of this section, "private agency" means any agency that is not identified 
82.20 	as a lead agency under section 256B.0911, subdivision 1a, paragraph (e).

82.21 	Sec. 39. Minnesota Statutes 2011 Supplement, section 256B.49, subdivision 14, 
82.22 	is amended to read:
82.23 		Subd. 14.Assessment and reassessment. (a) Assessments of each recipient's 
82.24 	strengths, informal support systems, and need for services shall be completed within 20 
82.25 	working days of the recipient's request as provided in section 256B.0911. Reassessment 
82.26 	of each recipient's strengths, support systems, and need for services shall be conducted 
82.27 	at least every 12 months and at other times when there has been a significant change in 
82.28 	the recipient's functioning and reassessments shall be conducted by certified assessors 
82.29 	according to section 256B.0911, subdivision 2b.
82.30 	(b) There must be a determination that the client requires a hospital level of care or a 
82.31 	nursing facility level of care as defined in section 256B.0911, subdivision 4a, paragraph 
82.32 	(d), at initial and subsequent assessments to initiate and maintain participation in the 
82.33 	waiver program.
82.34 	(c) Regardless of other assessments identified in section 144.0724, subdivision 4, as 
82.35 	appropriate to determine nursing facility level of care for purposes of medical assistance 
83.1 	payment for nursing facility services, only face-to-face assessments conducted according 
83.2 	to section 256B.0911, subdivisions 3a, 3b, and 4d, that result in a hospital level of care 
83.3 	determination or a nursing facility level of care determination must be accepted for 
83.4 	purposes of initial and ongoing access to waiver services payment.
83.5 	(d) Persons with developmental disabilities who apply for services under the nursing 
83.6 	facility level waiver programs shall be screened for the appropriate level of care according 
83.7 	to section 256B.092.
83.8 	(e) (d) Recipients who are found eligible for home and community-based services 
83.9 	under this section before their 65th birthday may remain eligible for these services after 
83.10 	their 65th birthday if they continue to meet all other eligibility factors.
83.11 	(f) (e) The commissioner shall develop criteria to identify recipients whose level of 
83.12 	functioning is reasonably expected to improve and reassess these recipients to establish 
83.13 	a baseline assessment. Recipients who meet these criteria must have a comprehensive 
83.14 	transitional service plan developed under subdivision 15, paragraphs (b) and (c), and be 
83.15 	reassessed every six months until there has been no significant change in the recipient's 
83.16 	functioning for at least 12 months. After there has been no significant change in the 
83.17 	recipient's functioning for at least 12 months, reassessments of the recipient's strengths, 
83.18 	informal support systems, and need for services shall be conducted at least every 12 
83.19 	months and at other times when there has been a significant change in the recipient's 
83.20 	functioning. Counties, case managers, and service providers are responsible for 
83.21 	conducting these reassessments and shall complete the reassessments out of existing funds.

83.22 	Sec. 40. Minnesota Statutes 2011 Supplement, section 256B.49, subdivision 15, 
83.23 	is amended to read:
83.24 		Subd. 15.Individualized service Coordinated service and support plan; 
83.25 	comprehensive transitional service plan; maintenance service plan. (a) Each recipient 
83.26 	of home and community-based waivered services shall be provided a copy of the written 
83.27 	coordinated service and support plan which: meets the requirements in section 256B.092, 
83.28 	subdivision 1b.
83.29 	(1) is developed and signed by the recipient within ten working days of the 
83.30 	completion of the assessment;
83.31 	(2) meets the assessed needs of the recipient;
83.32 	(3) reasonably ensures the health and safety of the recipient;
83.33 	(4) promotes independence;
83.34 	(5) allows for services to be provided in the most integrated settings; and
84.1 	(6) provides for an informed choice, as defined in section 256B.77, subdivision 2, 
84.2 	paragraph (p), of service and support providers.
84.3 	(b) In developing the comprehensive transitional service plan, the individual 
84.4 	receiving services, the case manager, and the guardian, if applicable, will identify 
84.5 	the transitional service plan fundamental service outcome and anticipated timeline to 
84.6 	achieve this outcome. Within the first 20 days following a recipient's request for an 
84.7 	assessment or reassessment, the transitional service planning team must be identified. A 
84.8 	team leader must be identified who will be responsible for assigning responsibility and 
84.9 	communicating with team members to ensure implementation of the transition plan and 
84.10 	ongoing assessment and communication process. The team leader should be an individual, 
84.11 	such as the case manager or guardian, who has the opportunity to follow the recipient to 
84.12 	the next level of service.
84.13 	Within ten days following an assessment, a comprehensive transitional service plan 
84.14 	must be developed incorporating elements of a comprehensive functional assessment and 
84.15 	including short-term measurable outcomes and timelines for achievement of and reporting 
84.16 	on these outcomes. Functional milestones must also be identified and reported according 
84.17 	to the timelines agreed upon by the transitional service planning team. In addition, the 
84.18 	comprehensive transitional service plan must identify additional supports that may assist 
84.19 	in the achievement of the fundamental service outcome such as the development of greater 
84.20 	natural community support, increased collaboration among agencies, and technological 
84.21 	supports.
84.22 	The timelines for reporting on functional milestones will prompt a reassessment of 
84.23 	services provided, the units of services, rates, and appropriate service providers. It is 
84.24 	the responsibility of the transitional service planning team leader to review functional 
84.25 	milestone reporting to determine if the milestones are consistent with observable skills 
84.26 	and that milestone achievement prompts any needed changes to the comprehensive 
84.27 	transitional service plan.
84.28 	For those whose fundamental transitional service outcome involves the need to 
84.29 	procure housing, a plan for the recipient to seek the resources necessary to secure the least 
84.30 	restrictive housing possible should be incorporated into the plan, including employment 
84.31 	and public supports such as housing access and shelter needy funding.
84.32 	(c) Counties and other agencies responsible for funding community placement and 
84.33 	ongoing community supportive services are responsible for the implementation of the 
84.34 	comprehensive transitional service plans. Oversight responsibilities include both ensuring 
84.35 	effective transitional service delivery and efficient utilization of funding resources.
85.1 	(d) Following one year of transitional services, the transitional services planning 
85.2 	team will make a determination as to whether or not the individual receiving services 
85.3 	requires the current level of continuous and consistent support in order to maintain the 
85.4 	recipient's current level of functioning. Recipients who are determined to have not had 
85.5 	a significant change in functioning for 12 months must move from a transitional to a 
85.6 	maintenance service plan. Recipients on a maintenance service plan must be reassessed 
85.7 	to determine if the recipient would benefit from a transitional service plan at least every 
85.8 	12 months and at other times when there has been a significant change in the recipient's 
85.9 	functioning. This assessment should consider any changes to technological or natural 
85.10 	community supports.
85.11 	(e) When a county is evaluating denials, reductions, or terminations of home and 
85.12 	community-based services under section 256B.49 for an individual, the case manager 
85.13 	shall offer to meet with the individual or the individual's guardian in order to discuss the 
85.14 	prioritization of service needs within the individualized coordinated service and support 
85.15 	plan, comprehensive transitional service plan, or maintenance service plan. The reduction 
85.16 	in the authorized services for an individual due to changes in funding for waivered 
85.17 	services may not exceed the amount needed to ensure medically necessary services to 
85.18 	meet the individual's health, safety, and welfare.
85.19 	(f) At the time of reassessment, local agency case managers shall assess each 
85.20 	recipient of community alternatives for disabled individuals or traumatic brain injury 
85.21 	waivered services currently residing in a licensed adult foster home that is not the primary 
85.22 	residence of the license holder, or in which the license holder is not the primary caregiver, 
85.23 	to determine if that recipient could appropriately be served in a community-living setting. 
85.24 	If appropriate for the recipient, the case manager shall offer the recipient, through a 
85.25 	person-centered planning process, the option to receive alternative housing and service 
85.26 	options. In the event that the recipient chooses to transfer from the adult foster home, 
85.27 	the vacated bed shall not be filled with another recipient of waiver services and group 
85.28 	residential housing, unless provided under section 245A.03, subdivision 7, paragraph (a), 
85.29 	clauses (3) and (4), and the licensed capacity shall be reduced accordingly. If the adult 
85.30 	foster home becomes no longer viable due to these transfers, the county agency, with the 
85.31 	assistance of the department, shall facilitate a consolidation of settings or closure. This 
85.32 	reassessment process shall be completed by June 30, 2012.

85.33 	Sec. 41. Minnesota Statutes 2010, section 256G.02, subdivision 6, is amended to read:
85.34 		Subd. 6.Excluded time. "Excluded time" means:
86.1 	(a) (1) any period an applicant spends in a hospital, sanitarium, nursing home, 
86.2 	shelter other than an emergency shelter, halfway house, foster home, semi-independent 
86.3 	living domicile or services program, residential facility offering care, board and lodging 
86.4 	facility or other institution for the hospitalization or care of human beings, as defined in 
86.5 	section 144.50, 144A.01, or 245A.02, subdivision 14; maternity home, battered women's 
86.6 	shelter, or correctional facility; or any facility based on an emergency hold under sections 
86.7 	253B.05, subdivisions 1 and 2, and 253B.07, subdivision 6;
86.8 	(b) (2) any period an applicant spends on a placement basis in a training and 
86.9 	habilitation program, including: a rehabilitation facility or work or employment program 
86.10 	as defined in section 268A.01; or receiving personal care assistance services pursuant to 
86.11 	section 256B.0659; semi-independent living services provided under section 252.275, and 
86.12 	Minnesota Rules, parts 9525.0500 to 9525.0660; or day training and habilitation programs 
86.13 	and assisted living services; and
86.14 	(c) (3) any placement for a person with an indeterminate commitment, including 
86.15 	independent living.

86.16 	Sec. 42. RECOMMENDATIONS FOR FURTHER CASE MANAGEMENT 
86.17 	REDESIGN AND STUDY OF COUNTY AND TRIBAL ADMINISTRATIVE 
86.18 	FUNCTIONS.
 86.19 	(a) By February 1, 2013, the commissioner of human services shall develop a 
86.20 	legislative report with specific recommendations and language for proposed legislation 
86.21 	for the following:
86.22 	(1) definitions of service and consolidation of standards and rates to the extent 
86.23 	appropriate for all types of medical assistance case management service services, including 
86.24 	targeted case management under Minnesota Statutes, sections 256B.0621, 256B.0924, and 
86.25 	256B.094, and all types of home and community-based waiver case management and case 
86.26 	management under Minnesota Rules, parts 9525.0004 to 9525.0036. This work must be 
86.27 	completed in collaboration with efforts under Minnesota Statutes, section 256B.4912;
86.28 	(2) recommendations on county of financial responsibility requirements and quality 
86.29 	assurance measures for case management; and
86.30 	(3) identification of county administrative functions that may remain entwined in 
86.31 	case management service delivery models.
86.32 	(b) The commissioner of human services shall evaluate county and tribal 
86.33 	administrative functions, processes, and reimbursement methodologies for the purposes 
86.34 	of administration of home and community-based services, and compliance and 
86.35 	oversight functions.  The commissioner shall work with county, tribal, and stakeholder 
87.1 	representatives in the evaluation process and develop a plan for the delegation of 
87.2 	commissioner duties to county and tribal entities after the elimination of county contracts 
87.3 	under Minnesota Statutes, section 256B.4912, for waiver service provision and the 
87.4 	creation of quality outcome standards under Laws 2009, chapter 79, article 8, section 
87.5 	81, and residential support services under Minnesota Statutes, sections 256B.092, 
87.6 	subdivision 11, and 245A.11, subdivision 8.  The commissioner shall present findings 
87.7 	and recommendations to the chairs and ranking minority members of the legislative 
87.8 	committees with jurisdiction over health and human services finance and policy by 
87.9 	February 1, 2013, with any specific recommendations and language for proposed 
87.10 	legislation to be effective July 1, 2013.

87.11 	ARTICLE 4
87.12 	CHEMICAL AND MENTAL HEALTH

87.13 	Section 1. Minnesota Statutes 2010, section 245.461, is amended by adding a 
87.14 	subdivision to read:
87.15 		Subd. 6.Diagnostic codes list. By July 1, 2013, the commissioner of human 
87.16 	services shall develop a list of diagnostic codes to define the range of child and adult 
87.17 	mental illnesses for the statewide mental health system. The commissioner may use the 
87.18 	International Classification of Diseases (ICD); the American Psychiatric Association's 
87.19 	Diagnostic and Statistical Manual (DSM); or a combination of both to develop the list. 
87.20 	The commissioner shall establish an advisory committee, comprising mental health 
87.21 	professional associations, counties, tribes, managed care organizations, state agencies, 
87.22 	and consumer organizations that shall advise the commissioner regarding development of 
87.23 	the diagnostic codes list. The commissioner shall annually notify providers of changes 
87.24 	to the list.

87.25 	Sec. 2. Minnesota Statutes 2010, section 245.462, subdivision 20, is amended to read:
87.26 		Subd. 20.Mental illness. (a) "Mental illness" means an organic disorder of the 
87.27 	brain or a clinically significant disorder of thought, mood, perception, orientation, 
87.28 	memory, or behavior that is listed in the clinical manual of the International Classification 
87.29 	of Diseases (ICD-9-CM), current edition, code range 290.0 to 302.99 or 306.0 to 316.0 
87.30 	or the corresponding code in the American Psychiatric Association's Diagnostic and 
87.31 	Statistical Manual of Mental Disorders (DSM-MD), current edition, Axes I, II, or III
87.32 	detailed in a diagnostic codes list published by the commissioner, and that seriously limits 
87.33 	a person's capacity to function in primary aspects of daily living such as personal relations, 
87.34 	living arrangements, work, and recreation.
88.1 	(b) An "adult with acute mental illness" means an adult who has a mental illness that 
88.2 	is serious enough to require prompt intervention.
88.3 	(c) For purposes of case management and community support services, a "person 
88.4 	with serious and persistent mental illness" means an adult who has a mental illness and 
88.5 	meets at least one of the following criteria:
88.6 	(1) the adult has undergone two or more episodes of inpatient care for a mental 
88.7 	illness within the preceding 24 months;
88.8 	(2) the adult has experienced a continuous psychiatric hospitalization or residential 
88.9 	treatment exceeding six months' duration within the preceding 12 months;
88.10 	(3) the adult has been treated by a crisis team two or more times within the preceding 
88.11 	24 months;
88.12 	(4) the adult:
88.13 	(i) has a diagnosis of schizophrenia, bipolar disorder, major depression, or borderline 
88.14 	personality disorder;
88.15 	(ii) indicates a significant impairment in functioning; and
88.16 	(iii) has a written opinion from a mental health professional, in the last three years, 
88.17 	stating that the adult is reasonably likely to have future episodes requiring inpatient or 
88.18 	residential treatment, of a frequency described in clause (1) or (2), unless ongoing case 
88.19 	management or community support services are provided;
88.20 	(5) the adult has, in the last three years, been committed by a court as a person 
88.21 	who is mentally ill under chapter 253B, or the adult's commitment has been stayed or 
88.22 	continued; or
88.23 	(6) the adult (i) was eligible under clauses (1) to (5), but the specified time period 
88.24 	has expired or the adult was eligible as a child under section 245.4871, subdivision 6; and 
88.25 	(ii) has a written opinion from a mental health professional, in the last three years, stating 
88.26 	that the adult is reasonably likely to have future episodes requiring inpatient or residential 
88.27 	treatment, of a frequency described in clause (1) or (2), unless ongoing case management 
88.28 	or community support services are provided.

88.29 	Sec. 3. Minnesota Statutes 2010, section 245.487, is amended by adding a subdivision 
88.30 	to read:
88.31 		Subd. 7.Diagnostic codes list. By July 1, 2013, the commissioner of human 
88.32 	services shall develop a list of diagnostic codes to define the range of child and adult 
88.33 	mental illnesses for the statewide mental health system. The commissioner may use the 
88.34 	International Classification of Diseases (ICD); the American Psychiatric Association's 
88.35 	Diagnostic and Statistical Manual (DSM); or a combination of both to develop the list. 
89.1 	The commissioner shall establish a time-limited advisory committee, comprising mental 
89.2 	health professional associations, counties, tribes, managed care organizations, state 
89.3 	agencies, and consumer organizations that shall advise the commissioner regarding 
89.4 	development of the diagnostic codes list. The commissioner shall annually notify 
89.5 	providers of changes to the list.

89.6 	Sec. 4. Minnesota Statutes 2010, section 245.4871, subdivision 15, is amended to read:
89.7 		Subd. 15.Emotional disturbance. "Emotional disturbance" means an organic 
89.8 	disorder of the brain or a clinically significant disorder of thought, mood, perception, 
89.9 	orientation, memory, or behavior that:
89.10 	(1) is listed in the clinical manual of the International Classification of Diseases 
89.11 	(ICD-9-CM), current edition, code range 290.0 to 302.99 or 306.0 to 316.0 or the 
89.12 	corresponding code in the American Psychiatric Association's Diagnostic and Statistical 
89.13 	Manual of Mental Disorders (DSM-MD), current edition, Axes I, II, or III detailed in a 
89.14 	diagnostic codes list published by the commissioner; and
89.15 	(2) seriously limits a child's capacity to function in primary aspects of daily living 
89.16 	such as personal relations, living arrangements, work, school, and recreation.
89.17 	"Emotional disturbance" is a generic term and is intended to reflect all categories 
89.18 	of disorder described in DSM-MD, current edition the clinical code list published by the 
89.19 	commissioner as "usually first evident in childhood or adolescence."

89.20 	Sec. 5. Minnesota Statutes 2010, section 245.4932, subdivision 1, is amended to read:
89.21 		Subdivision 1.Collaborative responsibilities. The children's mental health 
89.22 	collaborative shall have the following authority and responsibilities regarding federal 
89.23 	revenue enhancement:
89.24 	(1) the collaborative must establish an integrated fund;
89.25 	(2) the collaborative shall designate a lead county or other qualified entity as the 
89.26 	fiscal agency for reporting, claiming, and receiving payments;
89.27 	(3) the collaborative or lead county may enter into subcontracts with other counties, 
89.28 	school districts, special education cooperatives, municipalities, and other public and 
89.29 	nonprofit entities for purposes of identifying and claiming eligible expenditures to enhance 
89.30 	federal reimbursement;
89.31 	(4) the collaborative shall use any enhanced revenue attributable to the activities of 
89.32 	the collaborative, including administrative and service revenue, solely to provide mental 
89.33 	health services or to expand the operational target population. The lead county or other 
89.34 	qualified entity may not use enhanced federal revenue for any other purpose;
90.1 	(5) the members of the collaborative must continue the base level of expenditures, 
90.2 	as defined in section 245.492, subdivision 2, for services for children with emotional or 
90.3 	behavioral disturbances and their families from any state, county, federal, or other public 
90.4 	or private funding source which, in the absence of the new federal reimbursement earned 
90.5 	under sections 245.491 to 245.495, would have been available for those services. The 
90.6 	base year for purposes of this subdivision shall be the accounting period closest to state 
90.7 	fiscal year 1993;
90.8 	(6) (5) the collaborative or lead county must develop and maintain an accounting and 
90.9 	financial management system adequate to support all claims for federal reimbursement, 
90.10 	including a clear audit trail and any provisions specified in the contract with the 
90.11 	commissioner of human services;
90.12 	(7) (6) the collaborative or its members may elect to pay the nonfederal share of the 
90.13 	medical assistance costs for services designated by the collaborative; and
90.14 	(8) (7) the lead county or other qualified entity may not use federal funds or local 
90.15 	funds designated as matching for other federal funds to provide the nonfederal share of 
90.16 	medical assistance.

90.17 	Sec. 6. Minnesota Statutes 2010, section 246.53, is amended by adding a subdivision 
90.18 	to read:
90.19 		Subd. 4.Exception from statute of limitations. Any statute of limitations that 
90.20 	limits the commissioner in recovering the cost of care obligation incurred by a client or 
90.21 	former client shall not apply to any claim against an estate made under this section to 
90.22 	recover the cost of care.

90.23 	Sec. 7. Minnesota Statutes 2011 Supplement, section 254B.04, subdivision 2a, is 
90.24 	amended to read:
90.25 		Subd. 2a.Eligibility for treatment in residential settings. Notwithstanding 
90.26 	provisions of Minnesota Rules, part 9530.6622, subparts 5 and 6, related to an assessor's 
90.27 	discretion in making placements to residential treatment settings, a person eligible for 
90.28 	services under this section must score at level 4 on assessment dimensions related to 
90.29 	relapse, continued use, andor recovery environment in order to be assigned to services 
90.30 	with a room and board component reimbursed under this section.

90.31 	Sec. 8. Minnesota Statutes 2010, section 256B.0625, subdivision 42, is amended to 
90.32 	read:
91.1 		Subd. 42.Mental health professional. Notwithstanding Minnesota Rules, part 
91.2 	9505.0175, subpart 28, the definition of a mental health professional shall include a person 
91.3 	who is qualified as specified in section 245.462, subdivision 18, clauses (5) and(1) to (6); 
91.4 	or 245.4871, subdivision 27, clauses (5) and(1) to (6), for the purpose of this section and 
91.5 	Minnesota Rules, parts 9505.0170 to 9505.0475.

91.6 	Sec. 9. Minnesota Statutes 2010, section 256F.13, subdivision 1, is amended to read:
91.7 		Subdivision 1.Federal revenue enhancement. (a) The commissioner of human 
91.8 	services may enter into an agreement with one or more family services collaboratives 
91.9 	to enhance federal reimbursement under title IV-E of the Social Security Act and 
91.10 	federal administrative reimbursement under title XIX of the Social Security Act. The 
91.11 	commissioner may contract with the Department of Education for purposes of transferring 
91.12 	the federal reimbursement to the commissioner of education to be distributed to the 
91.13 	collaboratives according to clause (2). The commissioner shall have the following 
91.14 	authority and responsibilities regarding family services collaboratives:
91.15 	(1) the commissioner shall submit amendments to state plans and seek waivers as 
91.16 	necessary to implement the provisions of this section;
91.17 	(2) the commissioner shall pay the federal reimbursement earned under this 
91.18 	subdivision to each collaborative based on their earnings. Payments to collaboratives for 
91.19 	expenditures under this subdivision will only be made of federal earnings from services 
91.20 	provided by the collaborative;
91.21 	(3) the commissioner shall review expenditures of family services collaboratives 
91.22 	using reports specified in the agreement with the collaborative to ensure that the base level 
91.23 	of expenditures is continued and new federal reimbursement is used to expand education, 
91.24 	social, health, or health-related services to young children and their families;
91.25 	(4) the commissioner may reduce, suspend, or eliminate a family services 
91.26 	collaborative's obligations to continue the base level of expenditures or expansion of 
91.27 	services if the commissioner determines that one or more of the following conditions 
91.28 	apply:
91.29 	(i) imposition of levy limits that significantly reduce available funds for social, 
91.30 	health, or health-related services to families and children;
91.31 	(ii) reduction in the net tax capacity of the taxable property eligible to be taxed by 
91.32 	the lead county or subcontractor that significantly reduces available funds for education, 
91.33 	social, health, or health-related services to families and children;
91.34 	(iii) reduction in the number of children under age 19 in the county, collaborative 
91.35 	service delivery area, subcontractor's district, or catchment area when compared to the 
92.1 	number in the base year using the most recent data provided by the State Demographer's 
92.2 	Office; or
92.3 	(iv) termination of the federal revenue earned under the family services collaborative 
92.4 	agreement;
92.5 	(5)(4) the commissioner shall not use the federal reimbursement earned under this 
92.6 	subdivision in determining the allocation or distribution of other funds to counties or 
92.7 	collaboratives;
92.8 	(6) (5) the commissioner may suspend, reduce, or terminate the federal 
92.9 	reimbursement to a provider that does not meet the reporting or other requirements 
92.10 	of this subdivision;
92.11 	(7) (6) the commissioner shall recover from the family services collaborative any 
92.12 	federal fiscal disallowances or sanctions for audit exceptions directly attributable to the 
92.13 	family services collaborative's actions in the integrated fund, or the proportional share if 
92.14 	federal fiscal disallowances or sanctions are based on a statewide random sample; and
92.15 	(8) (7) the commissioner shall establish criteria for the family services collaborative 
92.16 	for the accounting and financial management system that will support claims for federal 
92.17 	reimbursement.
92.18 	(b) The family services collaborative shall have the following authority and 
92.19 	responsibilities regarding federal revenue enhancement:
92.20 	(1) the family services collaborative shall be the party with which the commissioner 
92.21 	contracts. A lead county shall be designated as the fiscal agency for reporting, claiming, 
92.22 	and receiving payments;
92.23 	(2) the family services collaboratives may enter into subcontracts with other 
92.24 	counties, school districts, special education cooperatives, municipalities, and other public 
92.25 	and nonprofit entities for purposes of identifying and claiming eligible expenditures to 
92.26 	enhance federal reimbursement, or to expand education, social, health, or health-related 
92.27 	services to families and children;
92.28 	(3) the family services collaborative must use all new federal reimbursement 
92.29 	resulting from federal revenue enhancement to expand expenditures for education, social, 
92.30 	health, or health-related services to families and children beyond the base level, except 
92.31 	as provided in paragraph (a), clause (4);
92.32 	(4) the family services collaborative must ensure that expenditures submitted for 
92.33 	federal reimbursement are not made from federal funds or funds used to match other 
92.34 	federal funds. Notwithstanding section 256B.19, subdivision 1, for the purposes of family 
92.35 	services collaborative expenditures under agreement with the department, the nonfederal 
93.1 	share of costs shall be provided by the family services collaborative from sources other 
93.2 	than federal funds or funds used to match other federal funds;
93.3 	(5) the family services collaborative must develop and maintain an accounting and 
93.4 	financial management system adequate to support all claims for federal reimbursement, 
93.5 	including a clear audit trail and any provisions specified in the agreement; and
93.6 	(6) the family services collaborative shall submit an annual report to the 
93.7 	commissioner as specified in the agreement.

93.8 	Sec. 10. TERMINOLOGY AUDIT.
 93.9 	The commissioner of human services shall collaborate with individuals with 
93.10 	disabilities, families, advocates, and other governmental agencies to solicit feedback and 
93.11 	identify inappropriate and insensitive terminology relating to individuals with disabilities, 
93.12 	conduct a comprehensive audit of the placement of this terminology in Minnesota Statutes 
93.13 	and Minnesota Rules, and make recommendations for changes to the 2013 legislature 
93.14 	on the repeal and replacement of this terminology with more appropriate and sensitive 
93.15 	terminology.

93.16 	ARTICLE 5
93.17 	HEALTH CARE

93.18 	Section 1. Minnesota Statutes 2011 Supplement, section 125A.21, subdivision 7, 
93.19 	is amended to read:
93.20 		Subd. 7.District disclosure of information. A school district may disclose 
93.21 	information contained in a student's individualized education program, consistent with 
93.22 	section 13.32, subdivision 3, paragraph (a), and Code of Federal Regulations, title 34, 
93.23 	parts 99 and 300; including records of the student's diagnosis and treatment, to a health 
93.24 	plan company only with the signed and dated consent of the student's parent, or other 
93.25 	legally authorized individual, including consent that the parent or legal representative gave 
93.26 	as part of the application process for MinnesotaCare or medical assistance under section 
93.27 	256B.08, subdivision 1. The school district shall disclose only that information necessary 
93.28 	for the health plan company to decide matters of coverage and payment. A health plan 
93.29 	company may use the information only for making decisions regarding coverage and 
93.30 	payment, and for any other use permitted by law.

93.31 	Sec. 2. Minnesota Statutes 2010, section 256B.04, subdivision 14, is amended to read:
93.32 		Subd. 14.Competitive bidding. (a) When determined to be effective, economical, 
93.33 	and feasible, the commissioner may utilize volume purchase through competitive bidding 
94.1 	and negotiation under the provisions of chapter 16C, to provide items under the medical 
94.2 	assistance program including but not limited to the following:
94.3 	(1) eyeglasses;
94.4 	(2) oxygen. The commissioner shall provide for oxygen needed in an emergency 
94.5 	situation on a short-term basis, until the vendor can obtain the necessary supply from 
94.6 	the contract dealer;
94.7 	(3) hearing aids and supplies; and
94.8 	(4) durable medical equipment, including but not limited to:
94.9 	(i) hospital beds;
94.10 	(ii) commodes;
94.11 	(iii) glide-about chairs;
94.12 	(iv) patient lift apparatus;
94.13 	(v) wheelchairs and accessories;
94.14 	(vi) oxygen administration equipment;
94.15 	(vii) respiratory therapy equipment;
94.16 	(viii) electronic diagnostic, therapeutic and life-support systems;
94.17 	(5) nonemergency medical transportation level of need determinations, disbursement 
94.18 	of public transportation passes and tokens, and volunteer and recipient mileage and 
94.19 	parking reimbursements; and
94.20 	(6) drugs.
94.21 	(b) Rate changes and recipient cost-sharing under this chapter and chapters 256D and 
94.22 	256L do not affect contract payments under this subdivision unless specifically identified.
94.23 	(c) The commissioner may not utilize volume purchase through competitive bidding 
94.24 	and negotiation for special transportation services under the provisions of chapter 16C.

94.25 	Sec. 3. Minnesota Statutes 2011 Supplement, section 256B.056, subdivision 3, is 
94.26 	amended to read:
94.27 		Subd. 3.Asset limitations for individuals and families. (a) To be eligible for 
94.28 	medical assistance, a person must not individually own more than $3,000 in assets, or if a 
94.29 	member of a household with two family members, husband and wife, or parent and child, 
94.30 	the household must not own more than $6,000 in assets, plus $200 for each additional 
94.31 	legal dependent. In addition to these maximum amounts, an eligible individual or family 
94.32 	may accrue interest on these amounts, but they must be reduced to the maximum at the 
94.33 	time of an eligibility redetermination. The accumulation of the clothing and personal 
94.34 	needs allowance according to section 256B.35 must also be reduced to the maximum at 
94.35 	the time of the eligibility redetermination. The value of assets that are not considered in 
95.1 	determining eligibility for medical assistance is the value of those assets excluded under 
95.2 	the supplemental security income program for aged, blind, and disabled persons, with 
95.3 	the following exceptions:
95.4 	(1) household goods and personal effects are not considered;
95.5 	(2) capital and operating assets of a trade or business that the local agency determines 
95.6 	are necessary to the person's ability to earn an income are not considered;
95.7 	(3) motor vehicles are excluded to the same extent excluded by the supplemental 
95.8 	security income program;
95.9 	(4) assets designated as burial expenses are excluded to the same extent excluded by 
95.10 	the supplemental security income program. Burial expenses funded by annuity contracts 
95.11 	or life insurance policies must irrevocably designate the individual's estate as contingent 
95.12 	beneficiary to the extent proceeds are not used for payment of selected burial expenses; and
95.13 	(5) for a person who no longer qualifies as an employed person with a disability due 
95.14 	to loss of earnings, assets allowed while eligible for medical assistance under section 
95.15 	256B.057, subdivision 9, are not considered for 12 months, beginning with the first month 
95.16 	of ineligibility as an employed person with a disability, to the extent that the person's total 
95.17 	assets remain within the allowed limits of section 256B.057, subdivision 9, paragraph 
95.18 	(d).; and
95.19 	(6) effective July 1, 2009, certain assets owned by American Indians are excluded as 
95.20 	required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public 
95.21 	Law 111-5. For purposes of this clause, an American Indian is any person who meets the 
95.22 	definition of Indian according to Code of Federal Regulations, title 42, section 447.50.
95.23 	(b) No asset limit shall apply to persons eligible under section 256B.055, subdivision 
95.24 	15.

95.25 	EFFECTIVE DATE. This section is effective retroactively from July 1, 2009.

95.26 	Sec. 4. Minnesota Statutes 2010, section 256B.056, subdivision 3c, is amended to read:
95.27 		Subd. 3c.Asset limitations for families and children. A household of two or more 
95.28 	persons must not own more than $20,000 in total net assets, and a household of one 
95.29 	person must not own more than $10,000 in total net assets. In addition to these maximum 
95.30 	amounts, an eligible individual or family may accrue interest on these amounts, but they 
95.31 	must be reduced to the maximum at the time of an eligibility redetermination. The value of 
95.32 	assets that are not considered in determining eligibility for medical assistance for families 
95.33 	and children is the value of those assets excluded under the AFDC state plan as of July 16, 
95.34 	1996, as required by the Personal Responsibility and Work Opportunity Reconciliation 
95.35 	Act of 1996 (PRWORA), Public Law 104-193, with the following exceptions:
96.1 	(1) household goods and personal effects are not considered;
96.2 	(2) capital and operating assets of a trade or business up to $200,000 are not 
96.3 	considered, except that a bank account that contains personal income or assets, or is used to 
96.4 	pay personal expenses, is not considered a capital or operating asset of a trade or business;
96.5 	(3) one motor vehicle is excluded for each person of legal driving age who is 
96.6 	employed or seeking employment;
96.7 	(4) assets designated as burial expenses are excluded to the same extent they are 
96.8 	excluded by the Supplemental Security Income program;
96.9 	(5) court-ordered settlements up to $10,000 are not considered;
96.10 	(6) individual retirement accounts and funds are not considered; and
96.11 	(7) assets owned by children are not considered.; and
96.12 	(8) effective July 1, 2009, certain assets owned by American Indians are excluded, as 
96.13 	required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public 
96.14 	Law 111-5. For purposes of this clause, an American Indian is any person who meets the 
96.15 	definition of Indian according to Code of Federal Regulations, title 42, section 447.50.
96.16 	The assets specified in clause (2) must be disclosed to the local agency at the time of 
96.17 	application and at the time of an eligibility redetermination, and must be verified upon 
96.18 	request of the local agency.

96.19 	EFFECTIVE DATE. This section is effective retroactively from July 1, 2009.

96.20 	Sec. 5. Minnesota Statutes 2011 Supplement, section 256B.057, subdivision 9, is 
96.21 	amended to read:
96.22 		Subd. 9.Employed persons with disabilities. (a) Medical assistance may be paid 
96.23 	for a person who is employed and who:
96.24 	(1) but for excess earnings or assets, meets the definition of disabled under the 
96.25 	Supplemental Security Income program;
96.26 	(2) is at least 16 but less than 65 years of age;
96.27 	(3) meets the asset limits in paragraph (d); and
96.28 	(4) pays a premium and other obligations under paragraph (e).
96.29 	(b) For purposes of eligibility, there is a $65 earned income disregard. To be eligible 
96.30 	for medical assistance under this subdivision, a person must have more than $65 of earned 
96.31 	income. Earned income must have Medicare, Social Security, and applicable state and 
96.32 	federal taxes withheld. The person must document earned income tax withholding. Any 
96.33 	spousal income or assets shall be disregarded for purposes of eligibility and premium 
96.34 	determinations.
97.1 	(c) After the month of enrollment, a person enrolled in medical assistance under 
97.2 	this subdivision who:
97.3 	(1) is temporarily unable to work and without receipt of earned income due to a 
97.4 	medical condition, as verified by a physician; or
97.5 	(2) loses employment for reasons not attributable to the enrollee, and is without 
97.6 	receipt of earned income may retain eligibility for up to four consecutive months after the 
97.7 	month of job loss. To receive a four-month extension, enrollees must verify the medical 
97.8 	condition or provide notification of job loss. All other eligibility requirements must be met 
97.9 	and the enrollee must pay all calculated premium costs for continued eligibility.
97.10 	(d) For purposes of determining eligibility under this subdivision, a person's assets 
97.11 	must not exceed $20,000, excluding:
97.12 	(1) all assets excluded under section 256B.056;
97.13 	(2) retirement accounts, including individual accounts, 401(k) plans, 403(b) plans, 
97.14 	Keogh plans, and pension plans;
97.15 	(3) medical expense accounts set up through the person's employer; and
97.16 	(4) spousal assets, including spouse's share of jointly held assets.
97.17 	(e) All enrollees must pay a premium to be eligible for medical assistance under this 
97.18 	subdivision, except as provided under section 256.01, subdivision 18b clause (5).
97.19 	(1) An enrollee must pay the greater of a $65 premium or the premium calculated 
97.20 	based on the person's gross earned and unearned income and the applicable family size 
97.21 	using a sliding fee scale established by the commissioner, which begins at one percent of 
97.22 	income at 100 percent of the federal poverty guidelines and increases to 7.5 percent of 
97.23 	income for those with incomes at or above 300 percent of the federal poverty guidelines.
97.24 	(2) Annual adjustments in the premium schedule based upon changes in the federal 
97.25 	poverty guidelines shall be effective for premiums due in July of each year.
97.26 	(3) All enrollees who receive unearned income must pay five percent of unearned 
97.27 	income in addition to the premium amount, except as provided under section 256.01, 
97.28 	subdivision 18b clause (5).
97.29 	(4) Increases in benefits under title II of the Social Security Act shall not be counted 
97.30 	as income for purposes of this subdivision until July 1 of each year.
97.31 	(5) Effective July 1, 2009, American Indians are exempt from paying premiums as 
97.32 	required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public 
97.33 	Law 111-5. For purposes of this clause, an American Indian is any person who meets the 
97.34 	definition of Indian according to Code of Federal Regulations, title 42, section 447.50.
98.1 	(f) A person's eligibility and premium shall be determined by the local county 
98.2 	agency. Premiums must be paid to the commissioner. All premiums are dedicated to 
98.3 	the commissioner.
98.4 	(g) Any required premium shall be determined at application and redetermined at 
98.5 	the enrollee's six-month income review or when a change in income or household size is 
98.6 	reported. Enrollees must report any change in income or household size within ten days 
98.7 	of when the change occurs. A decreased premium resulting from a reported change in 
98.8 	income or household size shall be effective the first day of the next available billing month 
98.9 	after the change is reported. Except for changes occurring from annual cost-of-living 
98.10 	increases, a change resulting in an increased premium shall not affect the premium amount 
98.11 	until the next six-month review.
98.12 	(h) Premium payment is due upon notification from the commissioner of the 
98.13 	premium amount required. Premiums may be paid in installments at the discretion of 
98.14 	the commissioner.
98.15 	(i) Nonpayment of the premium shall result in denial or termination of medical 
98.16 	assistance unless the person demonstrates good cause for nonpayment. Good cause exists 
98.17 	if the requirements specified in Minnesota Rules, part 9506.0040, subpart 7, items B to 
98.18 	D, are met. Except when an installment agreement is accepted by the commissioner, 
98.19 	all persons disenrolled for nonpayment of a premium must pay any past due premiums 
98.20 	as well as current premiums due prior to being reenrolled. Nonpayment shall include 
98.21 	payment with a returned, refused, or dishonored instrument. The commissioner may 
98.22 	require a guaranteed form of payment as the only means to replace a returned, refused, 
98.23 	or dishonored instrument.
98.24 	(j) The commissioner shall notify enrollees annually beginning at least 24 months 
98.25 	before the person's 65th birthday of the medical assistance eligibility rules affecting 
98.26 	income, assets, and treatment of a spouse's income and assets that will be applied upon 
98.27 	reaching age 65.
98.28 	(k) For enrollees whose income does not exceed 200 percent of the federal poverty 
98.29 	guidelines and who are also enrolled in Medicare, the commissioner shall reimburse 
98.30 	the enrollee for Medicare part B premiums under section 256B.0625, subdivision 15, 
98.31 	paragraph (a).

98.32 	EFFECTIVE DATE. This section is effective retroactively from July 1, 2009.

98.33 	Sec. 6. Minnesota Statutes 2010, section 256B.0595, subdivision 2, is amended to read:
98.34 		Subd. 2.Period of ineligibility for long-term care services. (a) For any 
98.35 	uncompensated transfer occurring on or before August 10, 1993, the number of months 
99.1 	of ineligibility for long-term care services shall be the lesser of 30 months, or the 
99.2 	uncompensated transfer amount divided by the average medical assistance rate for nursing 
99.3 	facility services in the state in effect on the date of application. The amount used to 
99.4 	calculate the average medical assistance payment rate shall be adjusted each July 1 to 
99.5 	reflect payment rates for the previous calendar year. The period of ineligibility begins 
99.6 	with the month in which the assets were transferred. If the transfer was not reported to 
99.7 	the local agency at the time of application, and the applicant received long-term care 
99.8 	services during what would have been the period of ineligibility if the transfer had been 
99.9 	reported, a cause of action exists against the transferee for the cost of long-term care 
99.10 	services provided during the period of ineligibility, or for the uncompensated amount of 
99.11 	the transfer, whichever is less. The uncompensated transfer amount is the fair market 
99.12 	value of the asset at the time it was given away, sold, or disposed of, less the amount of 
99.13 	compensation received.
99.14 	(b) For uncompensated transfers made after August 10, 1993, the number of months 
99.15 	of ineligibility for long-term care services shall be the total uncompensated value of the 
99.16 	resources transferred divided by the average medical assistance rate for nursing facility 
99.17 	services in the state in effect on the date of application. The amount used to calculate 
99.18 	the average medical assistance payment rate shall be adjusted each July 1 to reflect 
99.19 	payment rates for the previous calendar year. The period of ineligibility begins with the 
99.20 	first day of the month after the month in which the assets were transferred except that 
99.21 	if one or more uncompensated transfers are made during a period of ineligibility, the 
99.22 	total assets transferred during the ineligibility period shall be combined and a penalty 
99.23 	period calculated to begin on the first day of the month after the month in which the first 
99.24 	uncompensated transfer was made. If the transfer was reported to the local agency after 
99.25 	the date that advance notice of a period of ineligibility that affects the next month could 
99.26 	be provided to the recipient and the recipient received medical assistance services or the 
99.27 	transfer was not reported to the local agency, and the applicant or recipient received 
99.28 	medical assistance services during what would have been the period of ineligibility if 
99.29 	the transfer had been reported, a cause of action exists against the transferee for that 
99.30 	portion of long-term care services provided during the period of ineligibility, or for the 
99.31 	uncompensated amount of the transfer, whichever is less. The uncompensated transfer 
99.32 	amount is the fair market value of the asset at the time it was given away, sold, or disposed 
99.33 	of, less the amount of compensation received. Effective for transfers made on or after 
99.34 	March 1, 1996, involving persons who apply for medical assistance on or after April 13, 
99.35 	1996, no cause of action exists for a transfer unless:
100.1 	(1) the transferee knew or should have known that the transfer was being made by a 
100.2 	person who was a resident of a long-term care facility or was receiving that level of care in 
100.3 	the community at the time of the transfer;
100.4 	(2) the transferee knew or should have known that the transfer was being made to 
100.5 	assist the person to qualify for or retain medical assistance eligibility; or
100.6 	(3) the transferee actively solicited the transfer with intent to assist the person to 
100.7 	qualify for or retain eligibility for medical assistance.
100.8 	(c) For uncompensated transfers made on or after February 8, 2006, the period 
100.9 	of ineligibility:
100.10 	(1) for uncompensated transfers by or on behalf of individuals receiving medical 
100.11 	assistance payment of long-term care services, begins the first day of the month following 
100.12 	advance notice of the period of ineligibility, but no later than the first day of the month 
100.13 	that follows three full calendar months from the date of the report or discovery of the 
100.14 	transfer; or
100.15 	(2) for uncompensated transfers by individuals requesting medical assistance 
100.16 	payment of long-term care services, begins the date on which the individual is eligible 
100.17 	for medical assistance under the Medicaid state plan and would otherwise be receiving 
100.18 	long-term care services based on an approved application for such care but for the period 
100.19 	of ineligibility resulting from the uncompensated transfer; and
100.20 	(3) cannot begin during any other period of ineligibility.
100.21 	(d) If a calculation of a period of ineligibility results in a partial month, payments for 
100.22 	long-term care services shall be reduced in an amount equal to the fraction.
100.23 	(e) In the case of multiple fractional transfers of assets in more than one month for 
100.24 	less than fair market value on or after February 8, 2006, the period of ineligibility is 
100.25 	calculated by treating the total, cumulative, uncompensated value of all assets transferred 
100.26 	during all months on or after February 8, 2006, as one transfer.
100.27 	(f) A period of ineligibility established under paragraph (c) may be eliminated if 
100.28 	all of the assets transferred for less than fair market value used to calculate the period of 
100.29 	ineligibility, or cash equal to the value of the assets at the time of the transfer, are returned 
100.30 	within 12 months after the date the period of ineligibility began. A period of ineligibility 
100.31 	must not be adjusted if less than the full amount of the transferred assets or the full cash 
100.32 	value of the transferred assets are returned.

100.33 	Sec. 7. Minnesota Statutes 2010, section 256B.0625, subdivision 13, is amended to 
100.34 	read:
101.1 		Subd. 13.Drugs. (a) Medical assistance covers drugs, except for fertility drugs 
101.2 	when specifically used to enhance fertility, if prescribed by a licensed practitioner and 
101.3 	dispensed by a licensed pharmacist, by a physician enrolled in the medical assistance 
101.4 	program as a dispensing physician, or by a physician, physician assistant, or a nurse 
101.5 	practitioner employed by or under contract with a community health board as defined in 
101.6 	section 145A.02, subdivision 5, for the purposes of communicable disease control.
101.7 	(b) The dispensed quantity of a prescription drug must not exceed a 34-day supply, 
101.8 	unless authorized by the commissioner.
101.9 	(c) For the purpose of this subdivision and subdivision 13d, an "active 
101.10 	pharmaceutical ingredient" is defined as a substance that is represented for use in a drug 
101.11 	and when used in the manufacturing, processing, or packaging of a drug, becomes an 
101.12 	active ingredient of the drug product. An "excipient" is defined as an inert substance 
101.13 	used as a diluent or vehicle for a drug. The commissioner shall establish a list of active 
101.14 	pharmaceutical ingredients and excipients which are included in the medical assistance 
101.15 	formulary. Medical assistance covers selected active pharmaceutical ingredients and 
101.16 	excipients used in compounded prescriptions when the compounded combination is 
101.17 	specifically approved by the commissioner or when a commercially available product:
101.18 	(1) is not a therapeutic option for the patient;
101.19 	(2) does not exist in the same combination of active ingredients in the same strengths 
101.20 	as the compounded prescription; and
101.21 	(3) cannot be used in place of the active pharmaceutical ingredient in the 
101.22 	compounded prescription.
101.23 	(c) (d) Medical assistance covers the following over-the-counter drugs when 
101.24 	prescribed by a licensed practitioner or by a licensed pharmacist who meets standards 
101.25 	established by the commissioner, in consultation with the board of pharmacy: antacids, 
101.26 	acetaminophen, family planning products, aspirin, insulin, products for the treatment of 
101.27 	lice, vitamins for adults with documented vitamin deficiencies, vitamins for children 
101.28 	under the age of seven and pregnant or nursing women, and any other over-the-counter 
101.29 	drug identified by the commissioner, in consultation with the formulary committee, as 
101.30 	necessary, appropriate, and cost-effective for the treatment of certain specified chronic 
101.31 	diseases, conditions, or disorders, and this determination shall not be subject to the 
101.32 	requirements of chapter 14. A pharmacist may prescribe over-the-counter medications as 
101.33 	provided under this paragraph for purposes of receiving reimbursement under Medicaid. 
101.34 	When prescribing over-the-counter drugs under this paragraph, licensed pharmacists must 
101.35 	consult with the recipient to determine necessity, provide drug counseling, review drug 
101.36 	therapy for potential adverse interactions, and make referrals as needed to other health care 
102.1 	professionals. Over-the-counter medications must be dispensed in a quantity that is the 
102.2 	lower of: (1) the number of dosage units contained in the manufacturer's original package; 
102.3 	and (2) the number of dosage units required to complete the patient's course of therapy.
102.4 	(d) (e) Effective January 1, 2006, medical assistance shall not cover drugs that 
102.5 	are coverable under Medicare Part D as defined in the Medicare Prescription Drug, 
102.6 	Improvement, and Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), 
102.7 	for individuals eligible for drug coverage as defined in the Medicare Prescription 
102.8 	Drug, Improvement, and Modernization Act of 2003, Public Law 108-173, section 
102.9 	1860D-1(a)(3)(A). For these individuals, medical assistance may cover drugs from the 
102.10 	drug classes listed in United States Code, title 42, section 1396r-8(d)(2), subject to this 
102.11 	subdivision and subdivisions 13a to 13g, except that drugs listed in United States Code, 
102.12 	title 42, section 1396r-8(d)(2)(E), shall not be covered.

102.13 	Sec. 8. Minnesota Statutes 2010, section 256B.0625, subdivision 13d, is amended to 
102.14 	read:
102.15 		Subd. 13d.Drug formulary. (a) The commissioner shall establish a drug 
102.16 	formulary. Its establishment and publication shall not be subject to the requirements of the 
102.17 	Administrative Procedure Act, but the Formulary Committee shall review and comment 
102.18 	on the formulary contents.
102.19 	(b) The formulary shall not include:
102.20 	(1) drugs, active pharmaceutical ingredients, or products for which there is no 
102.21 	federal funding;
102.22 	(2) over-the-counter drugs, except as provided in subdivision 13;
102.23 	(3) drugs or active pharmaceutical ingredients used for weight loss, except that 
102.24 	medically necessary lipase inhibitors may be covered for a recipient with type II diabetes;
102.25 	(4) drugs or active pharmaceutical ingredients when used for the treatment of 
102.26 	impotence or erectile dysfunction;
102.27 	(5) drugs or active pharmaceutical ingredients for which medical value has not 
102.28 	been established; and
102.29 	(6) drugs from manufacturers who have not signed a rebate agreement with the 
102.30 	Department of Health and Human Services pursuant to section 1927 of title XIX of the 
102.31 	Social Security Act.
102.32 	(c) If a single-source drug used by at least two percent of the fee-for-service 
102.33 	medical assistance recipients is removed from the formulary due to the failure of the 
102.34 	manufacturer to sign a rebate agreement with the Department of Health and Human 
102.35 	Services, the commissioner shall notify prescribing practitioners within 30 days of 
103.1 	receiving notification from the Centers for Medicare and Medicaid Services (CMS) that a 
103.2 	rebate agreement was not signed.

103.3 	Sec. 9. Minnesota Statutes 2011 Supplement, section 256B.0625, subdivision 13e, 
103.4 	is amended to read:
103.5 		Subd. 13e.Payment rates. (a) The basis for determining the amount of payment 
103.6 	shall be the lower of the actual acquisition costs of the drugs or the maximum allowable 
103.7 	cost by the commissioner plus the fixed dispensing fee; or the usual and customary price 
103.8 	charged to the public. The amount of payment basis must be reduced to reflect all discount 
103.9 	amounts applied to the charge by any provider/insurer agreement or contract for submitted 
103.10 	charges to medical assistance programs. The net submitted charge may not be greater 
103.11 	than the patient liability for the service. The pharmacy dispensing fee shall be $3.65, 
103.12 	except that the dispensing fee for intravenous solutions which must be compounded by the 
103.13 	pharmacist shall be $8 per bag, $14 per bag for cancer chemotherapy products, and $30 
103.14 	per bag for total parenteral nutritional products dispensed in one liter quantities, or $44 per 
103.15 	bag for total parenteral nutritional products dispensed in quantities greater than one liter. 
103.16 	Actual acquisition cost includes quantity and other special discounts except time and cash 
103.17 	discounts. The actual acquisition cost of a drug shall be estimated by the commissioner at 
103.18 	wholesale acquisition cost plus four percent for independently owned pharmacies located 
103.19 	in a designated rural area within Minnesota, and at wholesale acquisition cost plus two 
103.20 	percent for all other pharmacies. A pharmacy is "independently owned" if it is one 
103.21 	of four or fewer pharmacies under the same ownership nationally. A "designated rural 
103.22 	area" means an area defined as a small rural area or isolated rural area according to the 
103.23 	four-category classification of the Rural Urban Commuting Area system developed for the 
103.24 	United States Health Resources and Services Administration. Wholesale acquisition cost 
103.25 	is defined as the manufacturer's list price for a drug or biological to wholesalers or direct 
103.26 	purchasers in the United States, not including prompt pay or other discounts, rebates, or 
103.27 	reductions in price, for the most recent month for which information is available, as 
103.28 	reported in wholesale price guides or other publications of drug or biological pricing data. 
103.29 	The maximum allowable cost of a multisource drug may be set by the commissioner and it 
103.30 	shall be comparable to, but no higher than, the maximum amount paid by other third-party 
103.31 	payors in this state who have maximum allowable cost programs. Establishment of the 
103.32 	amount of payment for drugs shall not be subject to the requirements of the Administrative 
103.33 	Procedure Act.
103.34 	(b) An additional dispensing fee of $.30 may be added to the dispensing fee paid 
103.35 	to pharmacists for legend drug prescriptions dispensed to residents of long-term care 
104.1 	facilities when a unit dose blister card system, approved by the department, is used. Under 
104.2 	this type of dispensing system, the pharmacist must dispense a 30-day supply of drug. 
104.3 	The National Drug Code (NDC) from the drug container used to fill the blister card must 
104.4 	be identified on the claim to the department. The unit dose blister card containing the 
104.5 	drug must meet the packaging standards set forth in Minnesota Rules, part 6800.2700, 
104.6 	that govern the return of unused drugs to the pharmacy for reuse. The pharmacy provider 
104.7 	will be required to credit the department for the actual acquisition cost of all unused 
104.8 	drugs that are eligible for reuse. Over-the-counter medications must be dispensed in the 
104.9 	manufacturer's unopened package. The commissioner may permit the drug clozapine to be 
104.10 	dispensed in a quantity that is less than a 30-day supply.
104.11 	(c) Whenever a maximum allowable cost has been set for a multisource drug, 
104.12 	payment shall be the lower of the usual and customary price charged to the public or the 
104.13 	maximum allowable cost established by the commissioner unless prior authorization 
104.14 	for the brand name product has been granted according to the criteria established by 
104.15 	the Drug Formulary Committee as required by subdivision 13f, paragraph (a), and the 
104.16 	prescriber has indicated "dispense as written" on the prescription in a manner consistent 
104.17 	with section 151.21, subdivision 2.
104.18 	(d) The basis for determining the amount of payment for drugs administered in an 
104.19 	outpatient setting shall be the lower of the usual and customary cost submitted by the 
104.20 	provider or 106 percent of the average sales price as determined by the United States 
104.21 	Department of Health and Human Services pursuant to title XVIII, section 1847a of the 
104.22 	federal Social Security Act. If average sales price is unavailable, the amount of payment 
104.23 	must be lower of the usual and customary cost submitted by the provider or the wholesale 
104.24 	acquisition cost.
104.25 	(e) The commissioner may negotiate lower reimbursement rates for specialty 
104.26 	pharmacy products than the rates specified in paragraph (a). The commissioner may 
104.27 	require individuals enrolled in the health care programs administered by the department 
104.28 	to obtain specialty pharmacy products from providers with whom the commissioner has 
104.29 	negotiated lower reimbursement rates. Specialty pharmacy products are defined as those 
104.30 	used by a small number of recipients or recipients with complex and chronic diseases 
104.31 	that require expensive and challenging drug regimens. Examples of these conditions 
104.32 	include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis 
104.33 	C, growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms 
104.34 	of cancer. Specialty pharmaceutical products include injectable and infusion therapies, 
104.35 	biotechnology drugs, antihemophilic factor products, high-cost therapies, and therapies 
104.36 	that require complex care. The commissioner shall consult with the formulary committee 
105.1 	to develop a list of specialty pharmacy products subject to this paragraph. In consulting 
105.2 	with the formulary committee in developing this list, the commissioner shall take into 
105.3 	consideration the population served by specialty pharmacy products, the current delivery 
105.4 	system and standard of care in the state, and access to care issues. The commissioner shall 
105.5 	have the discretion to adjust the reimbursement rate to prevent access to care issues.
105.6 	(f) Home infusion therapy services provided by home infusion therapy pharmacies 
105.7 	must be paid at rates according to subdivision 8d.

105.8 	Sec. 10. Minnesota Statutes 2011 Supplement, section 256B.0625, subdivision 13h, 
105.9 	is amended to read:
105.10 		Subd. 13h.Medication therapy management services. (a) Medical assistance 
105.11 	and general assistance medical care cover medication therapy management services for 
105.12 	a recipient taking three or more prescriptions to treat or prevent one or more chronic 
105.13 	medical conditions; a recipient with a drug therapy problem that is identified by the 
105.14 	commissioner or identified by a pharmacist and approved by the commissioner; or prior 
105.15 	authorized by the commissioner that has resulted or is likely to result in significant 
105.16 	nondrug program costs. The commissioner may cover medical therapy management 
105.17 	services under MinnesotaCare if the commissioner determines this is cost-effective. For 
105.18 	purposes of this subdivision, "medication therapy management" means the provision 
105.19 	of the following pharmaceutical care services by a licensed pharmacist to optimize the 
105.20 	therapeutic outcomes of the patient's medications:
105.21 	(1) performing or obtaining necessary assessments of the patient's health status;
105.22 	(2) formulating a medication treatment plan;
105.23 	(3) monitoring and evaluating the patient's response to therapy, including safety 
105.24 	and effectiveness;
105.25 	(4) performing a comprehensive medication review to identify, resolve, and prevent 
105.26 	medication-related problems, including adverse drug events;
105.27 	(5) documenting the care delivered and communicating essential information to 
105.28 	the patient's other primary care providers;
105.29 	(6) providing verbal education and training designed to enhance patient 
105.30 	understanding and appropriate use of the patient's medications;
105.31 	(7) providing information, support services, and resources designed to enhance 
105.32 	patient adherence with the patient's therapeutic regimens; and
105.33 	(8) coordinating and integrating medication therapy management services within the 
105.34 	broader health care management services being provided to the patient.
106.1 	Nothing in this subdivision shall be construed to expand or modify the scope of practice of 
106.2 	the pharmacist as defined in section 151.01, subdivision 27.
106.3 	(b) To be eligible for reimbursement for services under this subdivision, a pharmacist 
106.4 	must meet the following requirements:
106.5 	(1) have a valid license issued under chapter 151 by the Board of Pharmacy of the 
106.6 	state in which the medication therapy management service is being performed;
106.7 	(2) have graduated from an accredited college of pharmacy on or after May 1996, or 
106.8 	completed a structured and comprehensive education program approved by the Board of 
106.9 	Pharmacy and the American Council of Pharmaceutical Education for the provision and 
106.10 	documentation of pharmaceutical care management services that has both clinical and 
106.11 	didactic elements;
106.12 	(3) be practicing in an ambulatory care setting as part of a multidisciplinary team or 
106.13 	have developed a structured patient care process that is offered in a private or semiprivate 
106.14 	patient care area that is separate from the commercial business that also occurs in the 
106.15 	setting, or in home settings, including long-term care settings, group homes, and facilities 
106.16 	providing assisted living services, but excluding skilled nursing facilities; and
106.17 	(4) make use of an electronic patient record system that meets state standards.
106.18 	(c) For purposes of reimbursement for medication therapy management services, 
106.19 	the commissioner may enroll individual pharmacists as medical assistance and general 
106.20 	assistance medical care providers. The commissioner may also establish contact 
106.21 	requirements between the pharmacist and recipient, including limiting the number of 
106.22 	reimbursable consultations per recipient.
106.23 	(d) If there are no pharmacists who meet the requirements of paragraph (b) practicing 
106.24 	within a reasonable geographic distance of the patient, a pharmacist who meets the 
106.25 	requirements may provide the services via two-way interactive video. Reimbursement 
106.26 	shall be at the same rates and under the same conditions that would otherwise apply to 
106.27 	the services provided. To qualify for reimbursement under this paragraph, the pharmacist 
106.28 	providing the services must meet the requirements of paragraph (b), and must be located 
106.29 	within an ambulatory care setting approved by the commissioner. The patient must also 
106.30 	be located within an ambulatory care setting approved by the commissioner. Services 
106.31 	provided under this paragraph may not be transmitted into the patient's residence.
106.32 	(e) The commissioner shall establish a pilot project for an intensive medication 
106.33 	therapy management program for patients identified by the commissioner with multiple 
106.34 	chronic conditions and a high number of medications who are at high risk of preventable 
106.35 	hospitalizations, emergency room use, medication complications, and suboptimal 
106.36 	treatment outcomes due to medication-related problems. For purposes of the pilot 
107.1 	project, medication therapy management services may be provided in a patient's home 
107.2 	or community setting, in addition to other authorized settings. The commissioner may 
107.3 	waive existing payment policies and establish special payment rates for the pilot project. 
107.4 	The pilot project must be designed to produce a net savings to the state compared to the 
107.5 	estimated costs that would otherwise be incurred for similar patients without the program. 
107.6 	The pilot project must begin by January 1, 2010, and end June 30, 2012.

107.7 	Sec. 11. Minnesota Statutes 2011 Supplement, section 256B.0625, subdivision 14, 
107.8 	is amended to read:
107.9 		Subd. 14.Diagnostic, screening, and preventive services. (a) Medical assistance 
107.10 	covers diagnostic, screening, and preventive services.
107.11 	(b) "Preventive services" include services related to pregnancy, including:
107.12 	(1) services for those conditions which may complicate a pregnancy and which may 
107.13 	be available to a pregnant woman determined to be at risk of poor pregnancy outcome;
107.14 	(2) prenatal HIV risk assessment, education, counseling, and testing; and
107.15 	(3) alcohol abuse assessment, education, and counseling on the effects of alcohol 
107.16 	usage while pregnant. Preventive services available to a woman at risk of poor pregnancy 
107.17 	outcome may differ in an amount, duration, or scope from those available to other 
107.18 	individuals eligible for medical assistance.
107.19 	(c) "Screening services" include, but are not limited to, blood lead tests.
107.20 	(d) The commissioner shall encourage, at the time of the child and teen checkup or 
107.21 	at an episodic care visit, the primary care health care provider to perform primary caries 
107.22 	preventive services. Primary caries preventive services include, at a minimum:
107.23 	(1) a general visual examination of the child's mouth without using probes or other 
107.24 	dental equipment or taking radiographs;
107.25 	(2) a risk assessment using the factors established by the American Academies 
107.26 	of Pediatrics and Pediatric Dentistry; and
107.27 	(3) the application of a fluoride varnish beginning at age one to those children 
107.28 	assessed by the provider as being high risk in accordance with best practices as defined by 
107.29 	the Department of Human Services. The provider must obtain parental or legal guardian 
107.30 	consent before a fluoride treatment varnish is applied to a minor child's teeth.
107.31 	At each checkup, if primary caries preventive services are provided, the provider must 
107.32 	provide to the child's parent or legal guardian: information on caries etiology and 
107.33 	prevention; and information on the importance of finding a dental home for their child 
107.34 	by the age of one. The provider must also advise the parent or legal guardian to contact 
107.35 	the child's managed care plan or the Department of Human Services in order to secure a 
108.1 	dental appointment with a dentist. The provider must indicate in the child's medical record 
108.2 	that the parent or legal guardian was provided with this information and document any 
108.3 	primary caries prevention services provided to the child.

108.4 	Sec. 12. Minnesota Statutes 2011 Supplement, section 256B.0631, subdivision 1, 
108.5 	is amended to read:
108.6 		Subdivision 1.Cost-sharing. (a) Except as provided in subdivision 2, the medical 
108.7 	assistance benefit plan shall include the following cost-sharing for all recipients, effective 
108.8 	for services provided on or after September 1, 2011:
108.9 	(1) $3 per nonpreventive visit, except as provided in paragraph (b). For purposes 
108.10 	of this subdivision, a visit means an episode of service which is required because of 
108.11 	a recipient's symptoms, diagnosis, or established illness, and which is delivered in an 
108.12 	ambulatory setting by a physician or physician ancillary, chiropractor, podiatrist, nurse 
108.13 	midwife, advanced practice nurse, audiologist, optician, or optometrist;
108.14 	(2) $3 for eyeglasses;
108.15 	(3) (2) $3.50 for nonemergency visits to a hospital-based emergency room, except 
108.16 	that this co-payment shall be increased to $20 upon federal approval;
108.17 	(4) (3) $3 per brand-name drug prescription and $1 per generic drug prescription, 
108.18 	subject to a $12 per month maximum for prescription drug co-payments. No co-payments 
108.19 	shall apply to antipsychotic drugs when used for the treatment of mental illness;
108.20 	(5) (4) effective January 1, 2012, a family deductible equal to the maximum amount 
108.21 	allowed under Code of Federal Regulations, title 42, part 447.54; and
108.22 	(6) (5) for individuals identified by the commissioner with income at or below 100 
108.23 	percent of the federal poverty guidelines, total monthly cost-sharing must not exceed five 
108.24 	percent of family income. For purposes of this paragraph, family income is the total 
108.25 	earned and unearned income of the individual and the individual's spouse, if the spouse is 
108.26 	enrolled in medical assistance and also subject to the five percent limit on cost-sharing.
108.27 	(b) Recipients of medical assistance are responsible for all co-payments and 
108.28 	deductibles in this subdivision.

108.29 	Sec. 13. Minnesota Statutes 2011 Supplement, section 256B.0631, subdivision 2, 
108.30 	is amended to read:
108.31 		Subd. 2.Exceptions. Co-payments and deductibles shall be subject to the following 
108.32 	exceptions:
108.33 	(1) children under the age of 21;
109.1 	(2) pregnant women for services that relate to the pregnancy or any other medical 
109.2 	condition that may complicate the pregnancy;
109.3 	(3) recipients expected to reside for at least 30 days in a hospital, nursing home, or 
109.4 	intermediate care facility for the developmentally disabled;
109.5 	(4) recipients receiving hospice care;
109.6 	(5) 100 percent federally funded services provided by an Indian health service;
109.7 	(6) emergency services;
109.8 	(7) family planning services;
109.9 	(8) services that are paid by Medicare, resulting in the medical assistance program 
109.10 	paying for the coinsurance and deductible; and
109.11 	(9) co-payments that exceed one per day per provider for nonpreventive visits, 
109.12 	eyeglasses, and nonemergency visits to a hospital-based emergency room.; and
109.13 	(10) services, fee-for-service payments subject to volume purchase through 
109.14 	competitive bidding.

109.15 	Sec. 14. Minnesota Statutes 2010, section 256B.19, subdivision 1c, is amended to read:
109.16 		Subd. 1c.Additional portion of nonfederal share. (a) Hennepin County shall 
109.17 	be responsible for a monthly transfer payment of $1,500,000, due before noon on the 
109.18 	15th of each month and the University of Minnesota shall be responsible for a monthly 
109.19 	transfer payment of $500,000 due before noon on the 15th of each month, beginning July 
109.20 	15, 1995. These sums shall be part of the designated governmental unit's portion of the 
109.21 	nonfederal share of medical assistance costs.
109.22 	(b) Beginning July 1, 2001, Hennepin County's payment under paragraph (a) shall 
109.23 	be $2,066,000 each month.
109.24 	(c) Beginning July 1, 2001, the commissioner shall increase annual capitation 
109.25 	payments to the metropolitan health plan a demonstration provider serving eligible 
109.26 	individuals in Hennepin County under section 256B.69 for the prepaid medical assistance 
109.27 	program by approximately $6,800,000 to recognize higher than average medical education 
109.28 	costs.
109.29 	(d) Effective August 1, 2005, Hennepin County's payment under paragraphs (a) 
109.30 	and (b) shall be reduced to $566,000, and the University of Minnesota's payment under 
109.31 	paragraph (a) shall be reduced to zero. Effective October 1, 2008, to December 31, 2010, 
109.32 	Hennepin County's payment under paragraphs (a) and (b) shall be $434,688. Effective 
109.33 	January 1, 2011, Hennepin County's payment under paragraphs (a) and (b) shall be 
109.34 	$566,000.
110.1 	(e) Notwithstanding paragraph (d), upon federal enactment of an extension to June 
110.2 	30, 2011, of the enhanced federal medical assistance percentage (FMAP) originally 
110.3 	provided under Public Law 111-5, for the six-month period from January 1, 2011, to June 
110.4 	30, 2011, Hennepin County's payment under paragraphs (a) and (b) shall be $434,688.

110.5 	Sec. 15. Minnesota Statutes 2010, section 256B.69, subdivision 5, is amended to read:
110.6 		Subd. 5.Prospective per capita payment. The commissioner shall establish the 
110.7 	method and amount of payments for services. The commissioner shall annually contract 
110.8 	with demonstration providers to provide services consistent with these established 
110.9 	methods and amounts for payment.
110.10 	If allowed by the commissioner, a demonstration provider may contract with 
110.11 	an insurer, health care provider, nonprofit health service plan corporation, or the 
110.12 	commissioner, to provide insurance or similar protection against the cost of care provided 
110.13 	by the demonstration provider or to provide coverage against the risks incurred by 
110.14 	demonstration providers under this section. The recipients enrolled with a demonstration 
110.15 	provider are a permissible group under group insurance laws and chapter 62C, the 
110.16 	Nonprofit Health Service Plan Corporations Act. Under this type of contract, the insurer 
110.17 	or corporation may make benefit payments to a demonstration provider for services 
110.18 	rendered or to be rendered to a recipient. Any insurer or nonprofit health service plan 
110.19 	corporation licensed to do business in this state is authorized to provide this insurance or 
110.20 	similar protection.
110.21 	Payments to providers participating in the project are exempt from the requirements 
110.22 	of sections 256.966 and 256B.03, subdivision 2. The commissioner shall complete 
110.23 	development of capitation rates for payments before delivery of services under this section 
110.24 	is begun. For payments made during calendar year 1990 and later years, the commissioner 
110.25 	shall contract with an independent actuary to establish prepayment rates.
110.26 	By January 15, 1996, the commissioner shall report to the legislature on the 
110.27 	methodology used to allocate to participating counties available administrative 
110.28 	reimbursement for advocacy and enrollment costs. The report shall reflect the 
110.29 	commissioner's judgment as to the adequacy of the funds made available and of the 
110.30 	methodology for equitable distribution of the funds. The commissioner must involve 
110.31 	participating counties in the development of the report.
110.32 	Beginning July 1, 2004, the commissioner may include payments for elderly waiver 
110.33 	services and 180 days of nursing home care in capitation payments for the prepaid medical 
110.34 	assistance program for recipients age 65 and older. Payments for elderly waiver services 
111.1 	shall be made no earlier than the month following the month in which services were 
111.2 	received.

111.3 	Sec. 16. Minnesota Statutes 2011 Supplement, section 256B.69, subdivision 5a, 
111.4 	is amended to read:
111.5 		Subd. 5a.Managed care contracts. (a) Managed care contracts under this section 
111.6 	and section 256L.12 shall be entered into or renewed on a calendar year basis beginning 
111.7 	January 1, 1996. Managed care contracts which were in effect on June 30, 1995, and set to 
111.8 	renew on July 1, 1995, shall be renewed for the period July 1, 1995 through December 
111.9 	31, 1995 at the same terms that were in effect on June 30, 1995. The commissioner may 
111.10 	issue separate contracts with requirements specific to services to medical assistance 
111.11 	recipients age 65 and older.
111.12 	(b) A prepaid health plan providing covered health services for eligible persons 
111.13 	pursuant to chapters 256B and 256L is responsible for complying with the terms of its 
111.14 	contract with the commissioner. Requirements applicable to managed care programs 
111.15 	under chapters 256B and 256L established after the effective date of a contract with the 
111.16 	commissioner take effect when the contract is next issued or renewed.
111.17 	(c) Effective for services rendered on or after January 1, 2003, the commissioner 
111.18 	shall withhold five percent of managed care plan payments under this section and 
111.19 	county-based purchasing plan payments under section 256B.692 for the prepaid medical 
111.20 	assistance program pending completion of performance targets. Each performance target 
111.21 	must be quantifiable, objective, measurable, and reasonably attainable, except in the case 
111.22 	of a performance target based on a federal or state law or rule. Criteria for assessment 
111.23 	of each performance target must be outlined in writing prior to the contract effective 
111.24 	date. Clinical or utilization performance targets and their related criteria must consider 
111.25 	evidence-based research and reasonable interventions when available or applicable to the 
111.26 	populations served, and must be developed with input from external clinical experts and 
111.27 	stakeholders, including managed care and county-based purchasing plans and providers.
111.28 	The managed care plan must demonstrate, to the commissioner's satisfaction, that the data 
111.29 	submitted regarding attainment of the performance target is accurate. The commissioner 
111.30 	shall periodically change the administrative measures used as performance targets in 
111.31 	order to improve plan performance across a broader range of administrative services. 
111.32 	The performance targets must include measurement of plan efforts to contain spending 
111.33 	on health care services and administrative activities. The commissioner may adopt 
111.34 	plan-specific performance targets that take into account factors affecting only one plan, 
111.35 	including characteristics of the plan's enrollee population. The withheld funds must be 
112.1 	returned no sooner than July of the following year if performance targets in the contract 
112.2 	are achieved. The commissioner may exclude special demonstration projects under 
112.3 	subdivision 23.
112.4 	(d) Effective for services rendered on or after January 1, 2009, through December 
112.5 	31, 2009, the commissioner shall withhold three percent of managed care plan payments 
112.6 	under this section and county-based purchasing plan payments under section 256B.692 
112.7 	for the prepaid medical assistance program. The withheld funds must be returned no 
112.8 	sooner than July 1 and no later than July 31 of the following year. The commissioner may 
112.9 	exclude special demonstration projects under subdivision 23.
112.10 	(e) Effective for services provided on or after January 1, 2010, the commissioner 
112.11 	shall require that managed care plans use the assessment and authorization processes, 
112.12 	forms, timelines, standards, documentation, and data reporting requirements, protocols, 
112.13 	billing processes, and policies consistent with medical assistance fee-for-service or the 
112.14 	Department of Human Services contract requirements consistent with medical assistance 
112.15 	fee-for-service or the Department of Human Services contract requirements for all 
112.16 	personal care assistance services under section 256B.0659.
112.17 	(f) Effective for services rendered on or after January 1, 2010, through December 
112.18 	31, 2010, the commissioner shall withhold 4.5 percent of managed care plan payments 
112.19 	under this section and county-based purchasing plan payments under section 256B.692 
112.20 	for the prepaid medical assistance program. The withheld funds must be returned no 
112.21 	sooner than July 1 and no later than July 31 of the following year. The commissioner may 
112.22 	exclude special demonstration projects under subdivision 23.
112.23 	(g) Effective for services rendered on or after January 1, 2011, through December 
112.24 	31, 2011, the commissioner shall include as part of the performance targets described 
112.25 	in paragraph (c) a reduction in the health plan's emergency room utilization rate for 
112.26 	state health care program enrollees by a measurable rate of five percent from the plan's 
112.27 	utilization rate for state health care program enrollees for the previous calendar year. 
112.28 	Effective for services rendered on or after January 1, 2012, the commissioner shall include 
112.29 	as part of the performance targets described in paragraph (c) a reduction in the health 
112.30 	plan's emergency department utilization rate for medical assistance and MinnesotaCare 
112.31 	enrollees, as determined by the commissioner. For 2012, the reduction shall be based on 
112.32 	the health plan's utilization in 2009. To earn the return of the withhold each year, the 
112.33 	managed care plan or county-based purchasing plan must achieve a qualifying reduction 
112.34 	of no less than ten percent of the plan's emergency department utilization rate for medical 
112.35 	assistance and MinnesotaCare enrollees, excluding Medicare enrollees in programs 
112.36 	described in subdivisions 23 and 28, compared to the previous calendar measurement 
113.1 	 year until the final performance target is reached. When measuring performance, the 
113.2 	commissioner must consider the difference in health risk in a plan's membership in the 
113.3 	baseline year compared to the measurement year, and work with the managed care or 
113.4 	county-based purchasing plan to account for differences that they agree are significant.
113.5 	The withheld funds must be returned no sooner than July 1 and no later than July 
113.6 	31 of the following calendar year if the managed care plan or county-based purchasing 
113.7 	plan demonstrates to the satisfaction of the commissioner that a reduction in the utilization 
113.8 	rate was achieved.
113.9 	The withhold described in this paragraph shall continue for each consecutive 
113.10 	contract period until the plan's emergency room utilization rate for state health care 
113.11 	program enrollees is reduced by 25 percent of the plan's emergency room utilization 
113.12 	rate for medical assistance and MinnesotaCare enrollees for calendar year 2011 2009. 
113.13 	Hospitals shall cooperate with the health plans in meeting this performance target and 
113.14 	shall accept payment withholds that may be returned to the hospitals if the performance 
113.15 	target is achieved.
113.16 	(h) Effective for services rendered on or after January 1, 2012, the commissioner 
113.17 	shall include as part of the performance targets described in paragraph (c) a reduction 
113.18 	in the plan's hospitalization admission rate for medical assistance and MinnesotaCare 
113.19 	enrollees, as determined by the commissioner. To earn the return of the withhold each 
113.20 	year, the managed care plan or county-based purchasing plan must achieve a qualifying 
113.21 	reduction of no less than five percent of the plan's hospital admission rate for medical 
113.22 	assistance and MinnesotaCare enrollees, excluding Medicare enrollees in programs 
113.23 	described in subdivisions 23 and 28, compared to the previous calendar year until the final 
113.24 	performance target is reached. When measuring performance, the commissioner must 
113.25 	evaluate the difference in health risk in a plan's membership in the baseline year compared 
113.26 	to the measurement year, and work with the managed care or county-based purchasing 
113.27 	plan to account for differences that they agree are significant.
113.28 	The withheld funds must be returned no sooner than July 1 and no later than July 
113.29 	31 of the following calendar year if the managed care plan or county-based purchasing 
113.30 	plan demonstrates to the satisfaction of the commissioner that this reduction in the 
113.31 	hospitalization rate was achieved.
113.32 	The withhold described in this paragraph shall continue until there is a 25 percent 
113.33 	reduction in the hospital admission rate compared to the hospital admission rates in 
113.34 	calendar year 2011, as determined by the commissioner. The hospital admissions in this 
113.35 	performance target do not include the admissions applicable to the subsequent hospital 
113.36 	admission performance target under paragraph (i). Hospitals shall cooperate with the 
114.1 	plans in meeting this performance target and shall accept payment withholds that may be 
114.2 	returned to the hospitals if the performance target is achieved.
114.3 	(i) Effective for services rendered on or after January 1, 2012, the commissioner 
114.4 	shall include as part of the performance targets described in paragraph (c) a reduction in 
114.5 	the plan's hospitalization admission rates for subsequent hospitalizations within 30 days 
114.6 	of a previous hospitalization of a patient regardless of the reason, for medical assistance 
114.7 	and MinnesotaCare enrollees, as determined by the commissioner. To earn the return of 
114.8 	the withhold each year, the managed care plan or county-based purchasing plan must 
114.9 	achieve a qualifying reduction of the subsequent hospitalization rate for medical assistance 
114.10 	and MinnesotaCare enrollees, excluding Medicare enrollees in programs described in 
114.11 	subdivisions 23 and 28, of no less than five percent compared to the previous calendar 
114.12 	year until the final performance target is reached.
114.13 	The withheld funds must be returned no sooner than July 1 and no later than July 31 
114.14 	of the following calendar year if the managed care plan or county-based purchasing plan 
114.15 	demonstrates to the satisfaction of the commissioner that a qualifying reduction in the 
114.16 	subsequent hospitalization rate was achieved.
114.17 	The withhold described in this paragraph must continue for each consecutive 
114.18 	contract period until the plan's subsequent hospitalization rate for medical assistance 
114.19 	and MinnesotaCare enrollees, excluding Medicare enrollees in programs described in 
114.20 	subdivisions 23 and 28, is reduced by 25 percent of the plan's subsequent hospitalization 
114.21 	rate for calendar year 2011. Hospitals shall cooperate with the plans in meeting this 
114.22 	performance target and shall accept payment withholds that must be returned to the 
114.23 	hospitals if the performance target is achieved.
114.24 	(j) Effective for services rendered on or after January 1, 2011, through December 31, 
114.25 	2011, the commissioner shall withhold 4.5 percent of managed care plan payments under 
114.26 	this section and county-based purchasing plan payments under section 256B.692 for the 
114.27 	prepaid medical assistance program. The withheld funds must be returned no sooner than 
114.28 	July 1 and no later than July 31 of the following year. The commissioner may exclude 
114.29 	special demonstration projects under subdivision 23.
114.30 	(k) Effective for services rendered on or after January 1, 2012, through December 
114.31 	31, 2012, the commissioner shall withhold 4.5 percent of managed care plan payments 
114.32 	under this section and county-based purchasing plan payments under section 256B.692 
114.33 	for the prepaid medical assistance program. The withheld funds must be returned no 
114.34 	sooner than July 1 and no later than July 31 of the following year. The commissioner may 
114.35 	exclude special demonstration projects under subdivision 23.
115.1 	(l) Effective for services rendered on or after January 1, 2013, through December 31, 
115.2 	2013, the commissioner shall withhold 4.5 percent of managed care plan payments under 
115.3 	this section and county-based purchasing plan payments under section 256B.692 for the 
115.4 	prepaid medical assistance program. The withheld funds must be returned no sooner than 
115.5 	July 1 and no later than July 31 of the following year. The commissioner may exclude 
115.6 	special demonstration projects under subdivision 23.
115.7 	(m) Effective for services rendered on or after January 1, 2014, the commissioner 
115.8 	shall withhold three percent of managed care plan payments under this section and 
115.9 	county-based purchasing plan payments under section 256B.692 for the prepaid medical 
115.10 	assistance program. The withheld funds must be returned no sooner than July 1 and 
115.11 	no later than July 31 of the following year. The commissioner may exclude special 
115.12 	demonstration projects under subdivision 23.
115.13 	(n) A managed care plan or a county-based purchasing plan under section 256B.692 
115.14 	may include as admitted assets under section 62D.044 any amount withheld under this 
115.15 	section that is reasonably expected to be returned.
115.16 	(o) Contracts between the commissioner and a prepaid health plan are exempt from 
115.17 	the set-aside and preference provisions of section 16C.16, subdivisions 6, paragraph 
115.18 	(a), and 7.
115.19 	(p) The return of the withhold under paragraphs (d), (f), and (j) to (m) is not subject 
115.20 	to the requirements of paragraph (c).

115.21 	Sec. 17. Minnesota Statutes 2011 Supplement, section 256B.69, subdivision 28, 
115.22 	is amended to read:
115.23 		Subd. 28.Medicare special needs plans; medical assistance basic health 
115.24 	care. (a) The commissioner may contract with demonstration providers and current or 
115.25 	former sponsors of qualified Medicare-approved special needs plans, to provide medical 
115.26 	assistance basic health care services to persons with disabilities, including those with 
115.27 	developmental disabilities. Basic health care services include:
115.28 	(1) those services covered by the medical assistance state plan except for ICF/MR 
115.29 	services, home and community-based waiver services, case management for persons with 
115.30 	developmental disabilities under section 256B.0625, subdivision 20a, and personal care 
115.31 	and certain home care services defined by the commissioner in consultation with the 
115.32 	stakeholder group established under paragraph (d); and
115.33 	(2) basic health care services may also include risk for up to 100 days of nursing 
115.34 	facility services for persons who reside in a noninstitutional setting and home health 
116.1 	services related to rehabilitation as defined by the commissioner after consultation with 
116.2 	the stakeholder group.
116.3 	The commissioner may exclude other medical assistance services from the basic 
116.4 	health care benefit set. Enrollees in these plans can access any excluded services on the 
116.5 	same basis as other medical assistance recipients who have not enrolled.
116.6 	(b) Beginning January 1, 2007, the commissioner may contract with demonstration 
116.7 	providers and current and former sponsors of qualified Medicare special needs plans, to 
116.8 	provide basic health care services under medical assistance to persons who are dually 
116.9 	eligible for both Medicare and Medicaid and those Social Security beneficiaries eligible 
116.10 	for Medicaid but in the waiting period for Medicare. The commissioner shall consult with 
116.11 	the stakeholder group under paragraph (d) in developing program specifications for these 
116.12 	services. The commissioner shall report to the chairs of the house of representatives and 
116.13 	senate committees with jurisdiction over health and human services policy and finance by 
116.14 	February 1, 2007, on implementation of these programs and the need for increased funding 
116.15 	for the ombudsman for managed care and other consumer assistance and protections 
116.16 	needed due to enrollment in managed care of persons with disabilities. Payment for 
116.17 	Medicaid services provided under this subdivision for the months of May and June will 
116.18 	be made no earlier than July 1 of the same calendar year.
116.19 	(c) Notwithstanding subdivision 4, beginning January 1, 2012, the commissioner 
116.20 	shall enroll persons with disabilities in managed care under this section, unless the 
116.21 	individual chooses to opt out of enrollment. The commissioner shall establish enrollment 
116.22 	and opt out procedures consistent with applicable enrollment procedures under this 
116.23 	subdivision section.
116.24 	(d) The commissioner shall establish a state-level stakeholder group to provide 
116.25 	advice on managed care programs for persons with disabilities, including both MnDHO 
116.26 	and contracts with special needs plans that provide basic health care services as described 
116.27 	in paragraphs (a) and (b). The stakeholder group shall provide advice on program 
116.28 	expansions under this subdivision and subdivision 23, including:
116.29 	(1) implementation efforts;
116.30 	(2) consumer protections; and
116.31 	(3) program specifications such as quality assurance measures, data collection and 
116.32 	reporting, and evaluation of costs, quality, and results.
116.33 	(e) Each plan under contract to provide medical assistance basic health care services 
116.34 	shall establish a local or regional stakeholder group, including representatives of the 
116.35 	counties covered by the plan, members, consumer advocates, and providers, for advice on 
116.36 	issues that arise in the local or regional area.
117.1 	(f) The commissioner is prohibited from providing the names of potential enrollees 
117.2 	to health plans for marketing purposes. The commissioner shall mail no more than 
117.3 	two sets of marketing materials per contract year to potential enrollees on behalf of 
117.4 	health plans, at the health plan's request. The marketing materials shall be mailed by the 
117.5 	commissioner within 30 days of receipt of these materials from the health plan. The health 
117.6 	plans shall cover any costs incurred by the commissioner for mailing marketing materials.

117.7 	Sec. 18. Minnesota Statutes 2010, section 256L.05, subdivision 3, is amended to read:
117.8 		Subd. 3.Effective date of coverage. (a) The effective date of coverage is the 
117.9 	first day of the month following the month in which eligibility is approved and the first 
117.10 	premium payment has been received. As provided in section 256B.057, coverage for 
117.11 	newborns is automatic from the date of birth and must be coordinated with other health 
117.12 	coverage. The effective date of coverage for eligible newly adoptive children added to a 
117.13 	family receiving covered health services is the month of placement. The effective date 
117.14 	of coverage for other new members added to the family is the first day of the month 
117.15 	following the month in which the change is reported. All eligibility criteria must be met 
117.16 	by the family at the time the new family member is added. The income of the new family 
117.17 	member is included with the family's gross income and the adjusted premium begins in 
117.18 	the month the new family member is added.
117.19 	(b) The initial premium must be received by the last working day of the month for 
117.20 	coverage to begin the first day of the following month.
117.21 	(c) Benefits are not available until the day following discharge if an enrollee is 
117.22 	hospitalized on the first day of coverage.
117.23 	(d) Notwithstanding any other law to the contrary, benefits under sections 256L.01 to 
117.24 	256L.18 are secondary to a plan of insurance or benefit program under which an eligible 
117.25 	person may have coverage and the commissioner shall use cost avoidance techniques to 
117.26 	ensure coordination of any other health coverage for eligible persons. The commissioner 
117.27 	shall identify eligible persons who may have coverage or benefits under other plans of 
117.28 	insurance or who become eligible for medical assistance.
117.29 	(e) The effective date of coverage for individuals or families who are exempt from 
117.30 	paying premiums under section 256L.15, subdivision 1, paragraph (d), is the first day of 
117.31 	the month following the month in which verification of American Indian status is received 
117.32 	or eligibility is approved, whichever is later.

117.33 	Sec. 19. Minnesota Statutes 2011 Supplement, section 256L.12, subdivision 9, is 
117.34 	amended to read:
118.1 		Subd. 9.Rate setting; performance withholds. (a) Rates will be prospective, 
118.2 	per capita, where possible. The commissioner may allow health plans to arrange for 
118.3 	inpatient hospital services on a risk or nonrisk basis. The commissioner shall consult with 
118.4 	an independent actuary to determine appropriate rates.
118.5 	(b) For services rendered on or after January 1, 2004, the commissioner shall 
118.6 	withhold five percent of managed care plan payments and county-based purchasing 
118.7 	plan payments under this section pending completion of performance targets. Each 
118.8 	performance target must be quantifiable, objective, measurable, and reasonably attainable, 
118.9 	except in the case of a performance target based on a federal or state law or rule. Criteria 
118.10 	for assessment of each performance target must be outlined in writing prior to the contract 
118.11 	effective date. Clinical or utilization performance targets and their related criteria must 
118.12 	consider evidence-based research and reasonable interventions, when available or 
118.13 	applicable to the populations served, and must be developed with input from external 
118.14 	clinical experts and stakeholders, including managed care and county-based purchasing 
118.15 	plans and providers. The managed care plan must demonstrate, to the commissioner's 
118.16 	satisfaction, that the data submitted regarding attainment of the performance target is 
118.17 	accurate. The commissioner shall periodically change the administrative measures used 
118.18 	as performance targets in order to improve plan performance across a broader range of 
118.19 	administrative services. The performance targets must include measurement of plan 
118.20 	efforts to contain spending on health care services and administrative activities. The 
118.21 	commissioner may adopt plan-specific performance targets that take into account factors 
118.22 	affecting only one plan, such as characteristics of the plan's enrollee population. The 
118.23 	withheld funds must be returned no sooner than July 1 and no later than July 31 of the 
118.24 	following calendar year if performance targets in the contract are achieved.
118.25 	(c) For services rendered on or after January 1, 2011, the commissioner shall 
118.26 	withhold an additional three percent of managed care plan or county-based purchasing 
118.27 	plan payments under this section. The withheld funds must be returned no sooner than 
118.28 	July 1 and no later than July 31 of the following calendar year. The return of the withhold 
118.29 	under this paragraph is not subject to the requirements of paragraph (b).
118.30 	(d) Effective for services rendered on or after January 1, 2011, through December 
118.31 	31, 2011, the commissioner shall include as part of the performance targets described in 
118.32 	paragraph (b) a reduction in the plan's emergency room utilization rate for state health 
118.33 	care program enrollees by a measurable rate of five percent from the plan's utilization 
118.34 	rate for the previous calendar year. Effective for services rendered on or after January 
118.35 	1, 2012, the commissioner shall include as part of the performance targets described in 
118.36 	paragraph (b) a reduction in the health plan's emergency department utilization rate for 
119.1 	medical assistance and MinnesotaCare enrollees, as determined by the commissioner. For 
119.2 	2012, the reduction shall be based on the health plan's utilization in 2009. To earn the 
119.3 	return of the withhold each year, the managed care plan or county-based purchasing plan 
119.4 	must achieve a qualifying reduction of no less than ten percent of the plan's utilization 
119.5 	rate for medical assistance and MinnesotaCare enrollees, excluding Medicare enrollees
119.6 	in programs described in section 256B.69, subdivisions 23 and 28, compared to the 
119.7 	previous calendar measurement year, until the final performance target is reached. When 
119.8 	measuring performance, the commissioner must evaluate the difference in health risk in 
119.9 	a plan's membership in the baseline year compared to the measurement year, and work 
119.10 	with the managed care or county-based purchasing plan to account for differences that 
119.11 	they agree are significant.
119.12 	The withheld funds must be returned no sooner than July 1 and no later than July 
119.13 	31 of the following calendar year if the managed care plan or county-based purchasing 
119.14 	plan demonstrates to the satisfaction of the commissioner that a reduction in the utilization 
119.15 	rate was achieved.
119.16 	The withhold described in this paragraph shall continue for each consecutive contract 
119.17 	period until the plan's emergency room utilization rate for state health care program 
119.18 	enrollees is reduced by 25 percent of the plan's emergency room utilization rate for medical 
119.19 	assistance and MinnesotaCare enrollees for calendar year 2011. Hospitals shall cooperate 
119.20 	with the health plans in meeting this performance target and shall accept payment 
119.21 	withholds that may be returned to the hospitals if the performance target is achieved.
119.22 	(e) Effective for services rendered on or after January 1, 2012, the commissioner 
119.23 	shall include as part of the performance targets described in paragraph (b) a reduction 
119.24 	in the plan's hospitalization admission rate for medical assistance and MinnesotaCare 
119.25 	enrollees, as determined by the commissioner. To earn the return of the withhold each 
119.26 	year, the managed care plan or county-based purchasing plan must achieve a qualifying 
119.27 	reduction of no less than five percent of the plan's hospital admission rate for medical 
119.28 	assistance and MinnesotaCare enrollees, excluding Medicare enrollees in programs 
119.29 	described in section 256B.69, subdivisions 23 and 28, compared to the previous calendar 
119.30 	year, until the final performance target is reached. When measuring performance, the 
119.31 	commissioner must evaluate the difference in health risk in a plan's membership in the 
119.32 	baseline year compared to the measurement year, and work with the managed care or 
119.33 	county-based purchasing plan to account for differences that they agree are significant.
119.34 	The withheld funds must be returned no sooner than July 1 and no later than July 
119.35 	31 of the following calendar year if the managed care plan or county-based purchasing 
120.1 	plan demonstrates to the satisfaction of the commissioner that this reduction in the 
120.2 	hospitalization rate was achieved.
120.3 	The withhold described in this paragraph shall continue until there is a 25 percent 
120.4 	reduction in the hospitals admission rate compared to the hospital admission rate for 
120.5 	calendar year 2011 as determined by the commissioner. Hospitals shall cooperate with the 
120.6 	plans in meeting this performance target and shall accept payment withholds that may be 
120.7 	returned to the hospitals if the performance target is achieved. The hospital admissions 
120.8 	in this performance target do not include the admissions applicable to the subsequent 
120.9 	hospital admission performance target under paragraph (f).
120.10 	(f) Effective for services provided on or after January 1, 2012, the commissioner 
120.11 	shall include as part of the performance targets described in paragraph (b) a reduction 
120.12 	in the plan's hospitalization rate for a subsequent hospitalization within 30 days of a 
120.13 	previous hospitalization of a patient regardless of the reason, for medical assistance and 
120.14 	MinnesotaCare enrollees, as determined by the commissioner. To earn the return of the 
120.15 	withhold each year, the managed care plan or county-based purchasing plan must achieve 
120.16 	a qualifying reduction of the subsequent hospital admissions rate for medical assistance 
120.17 	and MinnesotaCare enrollees, excluding Medicare enrollees described in section 256B.69, 
120.18 	subdivisions 23 and 28, of no less than five percent compared to the previous calendar 
120.19 	year until the final performance target is reached.
120.20 	The withheld funds must be returned no sooner than July 1 and no later than July 31 
120.21 	of the following calendar year if the managed care plan or county-based purchasing plan 
120.22 	demonstrates to the satisfaction of the commissioner that a reduction in the subsequent 
120.23 	hospitalization rate was achieved.
120.24 	The withhold described in this paragraph must continue for each consecutive 
120.25 	contract period until the plan's subsequent hospitalization rate for medical assistance and 
120.26 	MinnesotaCare enrollees is reduced by 25 percent of the plan's subsequent hospitalization 
120.27 	rate for calendar year 2011. Hospitals shall cooperate with the plans in meeting this 
120.28 	performance target and shall accept payment withholds that must be returned to the 
120.29 	hospitals if the performance target is achieved.
120.30 	(g) A managed care plan or a county-based purchasing plan under section 256B.692 
120.31 	may include as admitted assets under section 62D.044 any amount withheld under this 
120.32 	section that is reasonably expected to be returned.

120.33 	Sec. 20. Minnesota Statutes 2011 Supplement, section 256L.15, subdivision 1, is 
120.34 	amended to read:
121.1 		Subdivision 1.Premium determination. (a) Families with children and individuals 
121.2 	shall pay a premium determined according to subdivision 2.
121.3 	(b) Pregnant women and children under age two are exempt from the provisions 
121.4 	of section 256L.06, subdivision 3, paragraph (b), clause (3), requiring disenrollment 
121.5 	for failure to pay premiums. For pregnant women, this exemption continues until the 
121.6 	first day of the month following the 60th day postpartum. Women who remain enrolled 
121.7 	during pregnancy or the postpartum period, despite nonpayment of premiums, shall be 
121.8 	disenrolled on the first of the month following the 60th day postpartum for the penalty 
121.9 	period that otherwise applies under section 256L.06, unless they begin paying premiums.
121.10 	(c) Members of the military and their families who meet the eligibility criteria 
121.11 	for MinnesotaCare upon eligibility approval made within 24 months following the end 
121.12 	of the member's tour of active duty shall have their premiums paid by the commissioner. 
121.13 	The effective date of coverage for an individual or family who meets the criteria of this 
121.14 	paragraph shall be the first day of the month following the month in which eligibility is 
121.15 	approved. This exemption applies for 12 months.
121.16 	(d) Beginning July 1, 2009, American Indians enrolled in MinnesotaCare and their 
121.17 	families shall have their premiums waived by the commissioner in accordance with 
121.18 	section 5006 of the American Recovery and Reinvestment Act of 2009, Public Law 111-5. 
121.19 	An individual must document status as an American Indian, as defined under Code of 
121.20 	Federal Regulations, title 42, section 447.50, to qualify for the waiver of premiums.

121.21 	EFFECTIVE DATE. This section is effective retroactively from July 1, 2009.

121.22 	Sec. 21. Minnesota Statutes 2010, section 514.982, subdivision 1, is amended to read:
121.23 		Subdivision 1.Contents. A medical assistance lien notice must be dated and 
121.24 	must contain:
121.25 	(1) the full name, last known address, and last four digits of the Social Security 
121.26 	number of the medical assistance recipient;
121.27 	(2) a statement that medical assistance payments have been made to or for the 
121.28 	benefit of the medical assistance recipient named in the notice, specifying the first date 
121.29 	of eligibility for benefits;
121.30 	(3) a statement that all interests in real property owned by the persons named in the 
121.31 	notice may be subject to or affected by the rights of the agency to be reimbursed for 
121.32 	medical assistance benefits; and
121.33 	(4) the legal description of the real property upon which the lien attaches, and 
121.34 	whether the property is registered property.

122.1 	Sec. 22. HEALTH SERVICES ADVISORY COUNCIL.
 122.2 	The Health Services Advisory Council shall review currently available literature 
122.3 	regarding the efficacy of various treatments for autism spectrum disorder, including 
122.4 	an evaluation of age-based variation in the appropriateness of existing medical and 
122.5 	behavioral interventions. The council shall recommend to the commissioner of human 
122.6 	services authorization criteria for services based on existing evidence. The council may 
122.7 	recommend coverage with ongoing collection of outcomes evidence in circumstances 
122.8 	where evidence is currently unavailable, or where the strength of the evidence is low. The 
122.9 	council shall make this recommendation by December 31, 2012.

122.10 	Sec. 23.  REPEALER.
 122.11 	Minnesota Statutes 2010, section 256.01, subdivision 18b, is repealed.

122.12 	ARTICLE 6
122.13 	TECHNICAL

122.14 	Section 1. Minnesota Statutes 2010, section 144A.071, subdivision 5a, is amended to 
122.15 	read:
122.16 		Subd. 5a.Cost estimate of a moratorium exception project. (a) For the 
122.17 	purposes of this section and section 144A.073, the cost estimate of a moratorium 
122.18 	exception project shall include the effects of the proposed project on the costs of the state 
122.19 	subsidy for community-based services, nursing services, and housing in institutional 
122.20 	and noninstitutional settings. The commissioner of health, in cooperation with the 
122.21 	commissioner of human services, shall define the method for estimating these costs in the 
122.22 	permanent rule implementing section 144A.073. The commissioner of human services 
122.23 	shall prepare an estimate of the total state annual long-term costs of each moratorium 
122.24 	exception proposal.
122.25 	(b) The interest rate to be used for estimating the cost of each moratorium exception 
122.26 	project proposal shall be the lesser of either the prime rate plus two percentage points, or 
122.27 	the posted yield for standard conventional fixed rate mortgages of the Federal Home Loan 
122.28 	Mortgage Corporation plus two percentage points as published in the Wall Street Journal 
122.29 	and in effect 56 days prior to the application deadline. If the applicant's proposal uses this 
122.30 	interest rate, the commissioner of human services, in determining the facility's actual 
122.31 	property-related payment rate to be established upon completion of the project must use 
122.32 	the actual interest rate obtained by the facility for the project's permanent financing up to 
122.33 	the maximum permitted under subdivision 6 Minnesota Rules, part 9549.0060, subpart 6.
123.1 	The applicant may choose an alternate interest rate for estimating the project's cost. 
123.2 	If the applicant makes this election, the commissioner of human services, in determining 
123.3 	the facility's actual property-related payment rate to be established upon completion of the 
123.4 	project, must use the lesser of the actual interest rate obtained for the project's permanent 
123.5 	financing or the interest rate which was used to estimate the proposal's project cost. For 
123.6 	succeeding rate years, the applicant is at risk for financing costs in excess of the interest 
123.7 	rate selected.

123.8 	Sec. 2. REVISOR'S INSTRUCTION.
 123.9 	(a) In Minnesota Statutes, sections 256B.038, 256B.0911, 256B.0918, 256B.092, 
123.10 	256B.097, 256B.49, and 256B.765, the revisor of statutes shall delete the word "traumatic" 
123.11 	when it comes before the word "brain."
123.12 	(b) In Minnesota Statutes, section 256B.093, subdivision 1, clauses (4) and (5), and 
123.13 	subdivision 3, clause (2), the revisor of statutes shall delete the word "traumatic" when it 
123.14 	comes before the word "brain."
123.15 	(c) In Minnesota Statutes, sections 144.0724 and 144G.05, the revisor of statutes 
123.16 	shall delete "TBI" and replace it with "BI."