1.1A bill for an act1.2relating to human services; changing a requirement for electronic claims and 1.3electronic transactions; making changes to health care and disability services 1.4provisions; providing for a supplemental agreement to a contract for community 1.5social services; making changes to family stabilization services provisions; 1.6requiring procedures to establish a reciprocal child support agreement with 1.7Bermuda; changing provisions for the public pool exemption; amending 1.8Minnesota Statutes 2010, sections 62J.497, subdivision 2; 62J.536, subdivision 1.91; 256.0112, by adding a subdivision; 256.962, by adding a subdivision; 1.10256J.575, subdivisions 1, 2, 5, 6, 8; Minnesota Statutes 2011 Supplement, 1.11sections 144.1222, subdivision 5; 256B.0911, subdivision 3a; 256B.0915, 1.12subdivisions 3e, 3h.1.13BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:1.14ARTICLE 11.15HEALTH CARE1.16    Section 1. Minnesota Statutes 2010, section 62J.497, subdivision 2, is amended to read:1.17    Subd. 2. Requirements for electronic prescribing. (a) Effective January 1, 2011, 1.18all providers, group purchasers, prescribers, and dispensers must establish, maintain, 1.19and use an electronic prescription drug program. This program must comply with the 1.20applicable standards in this section for transmitting, directly or through an intermediary, 1.21prescriptions and prescription-related information using electronic media.1.22    (b) If transactions described in this section are conducted, they must be done 1.23electronically using the standards described in this section. Nothing in this section 1.24requires providers, group purchasers, prescribers, or dispensers to electronically conduct 1.25transactions that are expressly prohibited by other sections or federal law.1.26    (c) Providers, group purchasers, prescribers, and dispensers must use either HL7 1.27messages or the NCPDP SCRIPT Standard to transmit prescriptions or prescription-related 2.1information internally when the sender and the recipient are part of the same legal entity. If 2.2an entity sends prescriptions outside the entity, it must use the NCPDP SCRIPT Standard 2.3or other applicable standards required by this section. Any pharmacy within an entity 2.4must be able to receive electronic prescription transmittals from outside the entity using 2.5the adopted NCPDP SCRIPT Standard. This exemption does not supersede any Health 2.6Insurance Portability and Accountability Act (HIPAA) requirement that may require the 2.7use of a HIPAA transaction standard within an organization.2.8(d) Notwithstanding paragraph (a), any clinic with two or fewer practicing 2.9physicians is exempt from this subdivision if the clinic is making a good-faith effort to 2.10meet the electronic health records system requirement under section 62J.495 that includes 2.11an electronic prescribing component. This paragraph expires January 1, 2015.2.12EFFECTIVE DATE.This section is effective retroactively from January 1, 2011.2.13    Sec. 2. Minnesota Statutes 2010, section 62J.536, subdivision 1, is amended to read:2.14    Subdivision 1. Electronic claims and eligibility transactions required. (a) 2.15Beginning January 15, 2009, all group purchasers must accept from health care providers 2.16the eligibility for a health plan transaction described under Code of Federal Regulations, 2.17title 45, part 162, subpart L. Beginning July 15, 2009, all group purchasers must accept 2.18from health care providers the health care claims or equivalent encounter information 2.19transaction described under Code of Federal Regulations, title 45, part 162, subpart K.2.20    (b) Beginning January 15, 2009, all group purchasers must transmit to providers the 2.21eligibility for a health plan transaction described under Code of Federal Regulations, title 2.2245, part 162, subpart L. Beginning December 15, 2009, all group purchasers must transmit 2.23to providers the health care payment and remittance advice transaction described under 2.24Code of Federal Regulations, title 45, part 162, subpart P.2.25    (c) Beginning January 15, 2009, all health care providers must submit to group 2.26purchasers the eligibility for a health plan transaction described under Code of Federal 2.27Regulations, title 45, part 162, subpart L. Beginning July 15, 2009, all health care 2.28providers must submit to group purchasers the health care claims or equivalent encounter 2.29information transaction described under Code of Federal Regulations, title 45, part 162, 2.30subpart K.2.31    (d) Beginning January 15, 2009, all health care providers must accept from group 2.32purchasers the eligibility for a health plan transaction described under Code of Federal 2.33Regulations, title 45, part 162, subpart L. Beginning December 15, 2009, all health care 2.34providers must accept from group purchasers the health care payment and remittance 3.1advice transaction described under Code of Federal Regulations, title 45, part 162, subpart 3.2P.3.3(e) Beginning January 1, 2012, all health care providers, health care clearinghouses, 3.4and group purchasers must provide an appropriate, standard, electronic acknowledgment 3.5when receiving the health care claims or equivalent encounter information transaction or 3.6the health care payment and remittance advice transaction. The acknowledgment provided 3.7must be based on one or more of the following American National Standards Institute, 3.8Accredited Standards Committee X12 standard transactions or National Council for 3.9Prescription Drug Program (NCPDP) standards:3.10(1) TA1;3.11(2) 997;3.12(3) 999; or3.13(4) (3) 277CA.; or3.14(4) the appropriate NCPDP response standard as the electronic acknowledgment.3.15Health care providers, health care clearinghouses, and group purchasers may send and 3.16receive more than one type of standard acknowledgment as mutually agreed upon. The 3.17mutually agreed upon acknowledgments must be exchanged electronically. Electronic 3.18exchanges of acknowledgments do not include e-mail or facsimile.3.19    (f) Each of the transactions described in paragraphs (a) to (e) shall require the use 3.20of a single, uniform companion guide to the implementation guides described under 3.21Code of Federal Regulations, title 45, part 162. The companion guides will be developed 3.22pursuant to subdivision 2.3.23    (g) Notwithstanding any other provisions in sections 
         62J.50 to 
         62J.61, all group 3.24purchasers and health care providers must exchange claims and eligibility information 3.25electronically using the transactions, companion guides, implementation guides, and 3.26timelines required under this subdivision. Group purchasers may not impose any fee on 3.27providers or providers' clearinghouses for the use of the transactions prescribed in this 3.28subdivision. Health care providers may not impose a fee on group purchasers or group 3.29purchasers' clearinghouses for the use of the transactions prescribed in this subdivision. 3.30A clearinghouse may not charge a fee solely to receive a standard transaction from a 3.31health care provider, a health care provider's clearinghouse, a group purchaser, or a group 3.32purchaser's clearinghouse when it is not an agent of the sending entity. A clearinghouse 3.33may not charge a fee solely to send a standard transaction to a health care provider, a health 3.34care provider's clearinghouse, a group purchaser, or a group purchaser's clearinghouse 3.35when it is not an agent of the receiving entity.4.1    (h) Nothing in this subdivision shall prohibit group purchasers and health care 4.2providers from using a direct data entry, Web-based methodology for complying with 4.3the requirements of this subdivision. Any direct data entry method for conducting 4.4the transactions specified in this subdivision must be consistent with the data content 4.5component of the single, uniform companion guides required in paragraph (f) and the 4.6implementation guides described under Code of Federal Regulations, title 45, part 162.4.7EFFECTIVE DATE.This section is effective July 1, 2012.4.8    Sec. 3. Minnesota Statutes 2010, section 256.962, is amended by adding a subdivision 4.9to read:4.10    Subd. 8.Eligibility end dates.The commissioner shall develop and implement a 4.11process by January 1, 2013, to provide eligibility end dates upon request from the managed 4.12care and county-based purchasing plans for medical assistance and MinnesotaCare 4.13enrollees.4.14ARTICLE 24.15HUMAN SERVICES4.16    Section 1. Minnesota Statutes 2010, section 256.0112, is amended by adding a 4.17subdivision to read:4.18    Subd. 9.Contracting for performance.In addition to the agreements in 4.19subdivision 8, a local agency may negotiate a supplemental agreement to a contract 4.20executed between a lead agency and an approved vendor under subdivision 6 for the 4.21purposes of contracting for specific performance. The supplemental agreement may 4.22augment the lead contract requirements and rates for services authorized by that local 4.23agency only. The additional provisions must be negotiated with the vendor and designed 4.24to encourage successful, timely, and cost-effective outcomes for clients, and may establish 4.25incentive payments, penalties, performance-related reporting requirements, and similar 4.26conditions. The per diem rate allowed under this subdivision must not be less than the rate 4.27established in the lead county contract. Nothing in the supplemental agreement between 4.28a local agency and an approved vendor binds the lead agency or other local agencies to 4.29the terms and conditions of the supplemental agreement.4.30    Sec. 2. Minnesota Statutes 2010, section 256J.575, subdivision 1, is amended to read:4.31    Subdivision 1. Purpose.(a) The Family stabilization services serve families who 4.32are not making significant progress within the regular employment and training services 5.1track of the Minnesota family investment program (MFIP) due to a variety of barriers to 5.2employment.5.3    (b) The goal of the services is to stabilize and improve the lives of families at risk 5.4of long-term welfare dependency or family instability due to employment barriers such 5.5as physical disability, mental disability, age, or providing care for a disabled household 5.6member. These services promote and support families to achieve the greatest possible 5.7degree of self-sufficiency.5.8    Sec. 3. Minnesota Statutes 2010, section 256J.575, subdivision 2, is amended to read:5.9    Subd. 2. Definitions. The terms used in this section have the meanings given them 5.10in paragraphs (a) to (d) and (b).5.11    (a) "Case manager" means the county-designated staff person or employment 5.12services counselor.5.13    (b) "Case management" "Family stabilization services" means the programs, 5.14activities, and services provided by or through the county agency or through the 5.15employment services agency to participating families, including. Services include, but 5.16are not limited to, assessment as defined in section 256J.521, subdivision 1, information,5.17referrals, and assistance in the preparation and implementation of a family stabilization 5.18plan under subdivision 5.5.19    (c) (b) "Family stabilization plan" means a plan developed by a case manager 5.20and with the participant, which identifies the participant's most appropriate path to 5.21unsubsidized employment, family stability, and barrier reduction, taking into account the 5.22family's circumstances.5.23    (d) "Family stabilization services" means programs, activities, and services in this 5.24section that provide participants and their family members with assistance regarding, 5.25but not limited to:5.26    (1) obtaining and retaining unsubsidized employment;5.27    (2) family stability;5.28    (3) economic stability; and5.29    (4) barrier reduction.5.30    The goal of the services is to achieve the greatest degree of economic self-sufficiency 5.31and family well-being possible for the family under the circumstances.5.32    Sec. 4. Minnesota Statutes 2010, section 256J.575, subdivision 5, is amended to read:5.33    Subd. 5. Case management; Family stabilization plans; coordinated services.5.34    (a) The county agency or employment services provider shall provide family stabilization 6.1services to families through a case management model. A case manager shall be assigned 6.2to each participating family within 30 days after the family is determined to be eligible 6.3for family stabilization services. The case manager, with the full involvement of the 6.4participant, shall recommend, and the county agency shall establish and modify as 6.5necessary, a family stabilization plan for each participating family.  Once a participant 6.6has been determined eligible for family stabilization services, the county agency or 6.7employment services provider must attempt to meet with the participant to develop a 6.8plan within 30 days.6.9    (b) If a participant is already assigned to a county case manager or a 6.10county-designated case manager in social services, disability services, or housing services 6.11that case manager already assigned may be the case manager for purposes of these services.6.12    (b) The family stabilization plan must include:6.13    (1) each participant's plan for long-term self-sufficiency, including an employment 6.14goal where applicable;6.15    (2) an assessment of each participant's strengths and barriers, and any special 6.16circumstances of the participant's family that impact, or are likely to impact, the 6.17participant's progress towards the goals in the plan; and6.18    (3) an identification of the services, supports, education, training, and 6.19accommodations needed to reduce or overcome any barriers to enable the family to 6.20achieve self-sufficiency and to fulfill each caregiver's personal and family responsibilities.6.21    (c) The case manager and the participant shall meet within 30 days of the family's 6.22referral to the case manager. The initial family stabilization plan must be completed within 6.2330 days of the first meeting with the case manager. The case manager shall establish a 6.24schedule for periodic review of the family stabilization plan that includes personal contact 6.25with the participant at least once per month. In addition, the case manager shall review 6.26and, if necessary, modify the plan under the following circumstances:6.27    (1) there is a lack of satisfactory progress in achieving the goals of the plan;6.28    (2) the participant has lost unsubsidized or subsidized employment;6.29    (3) a family member has failed or is unable to comply with a family stabilization 6.30plan requirement;6.31    (4) services, supports, or other activities required by the plan are unavailable;6.32    (5) changes to the plan are needed to promote the well-being of the children; or6.33    (6) the participant and case manager determine that the plan is no longer appropriate 6.34for any other reason.7.1Participants determined eligible for family stabilization services must have access to 7.2employment and training services under sections 256J.515 to 256J.575, to the extent these 7.3services are available to other MFIP participants.7.4    Sec. 5. Minnesota Statutes 2010, section 256J.575, subdivision 6, is amended to read:7.5    Subd. 6. Cooperation with services requirements.(a) A participant who is eligible 7.6for family stabilization services under this section shall comply with paragraphs (b) to (d).7.7    (b) Participants shall engage in family stabilization plan services for the appropriate 7.8number of hours per week that the activities are scheduled and available, based on the 7.9needs of the participant and the participant's family, unless good cause exists for not 7.10doing so, as defined in section 
         256J.57, subdivision 1. The appropriate number of hours 7.11must be based on the participant's plan.7.12    (c) The case managercounty agency or employment services agency shall review 7.13the participant's progress toward the goals in the family stabilization plan every six 7.14months to determine whether conditions have changed, including whether revisions to 7.15the plan are needed.7.16    (d) A participant's requirement to comply with any or all family stabilization plan 7.17requirements under this subdivision is excused when the case management services, 7.18training and educational services, or family support services identified in the participant's 7.19family stabilization plan are unavailable for reasons beyond the control of the participant, 7.20including when money appropriated is not sufficient to provide the services.7.21    Sec. 6. Minnesota Statutes 2010, section 256J.575, subdivision 8, is amended to read:7.22    Subd. 8. Funding. (a) The commissioner of human services shall treat MFIP 7.23expenditures made to or on behalf of any minor child under this section, who is part of a 7.24household that meets criteria in subdivision 3, as expenditures under a separately funded 7.25state program. These expenditures shall not count toward the state's maintenance of effort 7.26requirements under the federal TANF program.7.27    (b) A family is no longer part of a separately funded program under this section if 7.28the caregiver no longer meets the criteria for family stabilization services in subdivision 7.293, or if it is determined at recertification that a caregiver with a child under the age of six 7.30is working at least 87 hours per month in paid or unpaid employment, or a caregiver 7.31without a child under the age of six is working at least 130 hours per month in paid or 7.32unpaid employment, whichever occurs sooner.7.33    Sec. 7. RECIPROCAL AGREEMENT; CHILD SUPPORT ENFORCEMENT.8.1The commissioner of human services shall initiate procedures no later than October 8.21, 2012, to enter into a reciprocal agreement with Bermuda for the establishment and 8.3enforcement of child support obligations under United States Code, title 42, section 8.4659a(d).8.5EFFECTIVE DATE.This section is effective upon Bermuda's written acceptance 8.6and agreement to enforce Minnesota child support orders. If Bermuda does not accept and 8.7declines to enforce Minnesota orders, this section expires December 31, 2013.8.8ARTICLE 38.9DISABILITY SERVICES8.10    Section 1. Minnesota Statutes 2011 Supplement, section 256B.0911, subdivision 3a, 8.11is amended to read:8.12    Subd. 3a. Assessment and support planning. (a) Persons requesting assessment, 8.13services planning, or other assistance intended to support community-based living, 8.14including persons who need assessment in order to determine waiver or alternative care 8.15program eligibility, must be visited by a long-term care consultation team within 15 8.16calendar days after the date on which an assessment was requested or recommended. After 8.17January 1, 2011, these requirements also apply to personal care assistance services, private 8.18duty nursing, and home health agency services, on timelines established in subdivision 5. 8.19Face-to-face assessments must be conducted according to paragraphs (b) to (i).8.20    (b) The county may utilize a team of either the social worker or public health nurse, 8.21or both. After January 1, 2011, lead agencies shall use certified assessors to conduct the 8.22assessment in a face-to-face interview. The consultation team members must confer 8.23regarding the most appropriate care for each individual screened or assessed.8.24    (c) The assessment must be comprehensive and include a person-centered 8.25assessment of the health, psychological, functional, environmental, and social needs of 8.26referred individuals and provide information necessary to develop a support plan that 8.27meets the consumers needs, using an assessment form provided by the commissioner.8.28    (d) The assessment must be conducted in a face-to-face interview with the person 8.29being assessed and the person's legal representative, as required by legally executed 8.30documents, and other individuals as requested by the person, who can provide information 8.31on the needs, strengths, and preferences of the person necessary to develop a support plan 8.32that ensures the person's health and safety, but who is not a provider of service or has any 8.33financial interest in the provision of services. For persons who are to be assessed for 8.34elderly waiver customized living services under section 256B.0915, with the permission 9.1of the person being assessed or the person's designated or legal representative, the client's 9.2current or proposed provider of services may submit a copy of the provider's nursing 9.3assessment or written report outlining its recommendations regarding the client's care 9.4needs. The person conducting the assessment will notify the provider of the date by which 9.5this information is to be submitted. This information shall be provided to the person 9.6conducting the assessment prior to the assessment.9.7    (e) The person, or the person's legal representative, must be provided with written 9.8recommendations for community-based services, including consumer-directed options, 9.9or institutional care that include documentation that the most cost-effective alternatives 9.10available were offered to the individual, and alternatives to residential settings, including, 9.11but not limited to, foster care settings that are not the primary residence of the license 9.12holder. For purposes of this requirement, "cost-effective alternatives" means community 9.13services and living arrangements that cost the same as or less than institutional care.9.14    (f) If the person chooses to use community-based services, the person or the person's 9.15legal representative must be provided with a written community support plan, regardless 9.16of whether the individual is eligible for Minnesota health care programs. A person may 9.17request assistance in identifying community supports without participating in a complete 9.18assessment. Upon a request for assistance identifying community support, the person must 9.19be transferred or referred to the services available under sections 
         256.975, subdivision 7, 9.20and 
         256.01, subdivision 24, for telephone assistance and follow up.9.21    (g) The person has the right to make the final decision between institutional 9.22placement and community placement after the recommendations have been provided, 9.23except as provided in subdivision 4a, paragraph (c).9.24    (h) The team must give the person receiving assessment or support planning, or 9.25the person's legal representative, materials, and forms supplied by the commissioner 9.26containing the following information:9.27    (1) the need for and purpose of preadmission screening if the person selects nursing 9.28facility placement;9.29    (2) the role of the long-term care consultation assessment and support planning in 9.30waiver and alternative care program eligibility determination;9.31    (3) information about Minnesota health care programs;9.32    (4) the person's freedom to accept or reject the recommendations of the team;9.33    (5) the person's right to confidentiality under the Minnesota Government Data 9.34Practices Act, chapter 13;10.1    (6) the long-term care consultant's decision regarding the person's need for 10.2institutional level of care as determined under criteria established in section 
         144.0724, 10.3subdivision 11
         , or 
         256B.092; and10.4    (7) the person's right to appeal the decision regarding the need for nursing facility 10.5level of care or the county's final decisions regarding public programs eligibility according 10.6to section 
         256.045, subdivision 3.10.7    (i) Face-to-face assessment completed as part of eligibility determination for 10.8the alternative care, elderly waiver, community alternatives for disabled individuals, 10.9community alternative care, and traumatic brain injury waiver programs under sections 10.10256B.0915
         , 
         256B.0917, and 
         256B.49 is valid to establish service eligibility for no more 10.11than 60 calendar days after the date of assessment. The effective eligibility start date 10.12for these programs can never be prior to the date of assessment. If an assessment was 10.13completed more than 60 days before the effective waiver or alternative care program 10.14eligibility start date, assessment and support plan information must be updated in a 10.15face-to-face visit and documented in the department's Medicaid Management Information 10.16System (MMIS). The effective date of program eligibility in this case cannot be prior to 10.17the date the updated assessment is completed.10.18    Sec. 2. Minnesota Statutes 2011 Supplement, section 256B.0915, subdivision 3e, 10.19is amended to read:10.20    Subd. 3e. Customized living service rate. (a) Payment for customized living 10.21services shall be a monthly rate authorized by the lead agency within the parameters 10.22established by the commissioner. The payment agreement must delineate the amount of 10.23each component service included in the recipient's customized living service plan. The 10.24lead agency, with input from the provider of customized living services, shall ensure that 10.25there is a documented need within the parameters established by the commissioner for all 10.26component customized living services authorized.10.27(b) The payment rate must be based on the amount of component services to be 10.28provided utilizing component rates established by the commissioner. Counties and tribes 10.29shall use tools issued by the commissioner to develop and document customized living 10.30service plans and rates.10.31(c) Component service rates must not exceed payment rates for comparable elderly 10.32waiver or medical assistance services and must reflect economies of scale. Customized 10.33living services must not include rent or raw food costs.10.34    (d) With the exception of individuals described in subdivision 3a, paragraph (b), the 10.35individualized monthly authorized payment for the customized living service plan shall 11.1not exceed 50 percent of the greater of either the statewide or any of the geographic 11.2groups' weighted average monthly nursing facility rate of the case mix resident class 11.3to which the elderly waiver eligible client would be assigned under Minnesota Rules, 11.4parts 9549.0050 to 9549.0059, less the maintenance needs allowance as described 11.5in subdivision 1d, paragraph (a), until the July 1 of the state fiscal year in which the 11.6resident assessment system as described in section 
         256B.438 for nursing home rate 11.7determination is implemented. Effective on July 1 of the state fiscal year in which 11.8the resident assessment system as described in section 
         256B.438 for nursing home 11.9rate determination is implemented and July 1 of each subsequent state fiscal year, the 11.10individualized monthly authorized payment for the services described in this clause shall 11.11not exceed the limit which was in effect on June 30 of the previous state fiscal year 11.12updated annually based on legislatively adopted changes to all service rate maximums for 11.13home and community-based service providers.11.14(e) Effective July 1, 2011, the individualized monthly payment for the customized 11.15living service plan for individuals described in subdivision 3a, paragraph (b), must be the 11.16monthly authorized payment limit for customized living for individuals classified as case 11.17mix A, reduced by 25 percent. This rate limit must be applied to all new participants 11.18enrolled in the program on or after July 1, 2011, who meet the criteria described in 11.19subdivision 3a, paragraph (b). This monthly limit also applies to all other participants who 11.20meet the criteria described in subdivision 3a, paragraph (b), at reassessment.11.21    (f) Customized living services are delivered by a provider licensed by the 11.22Department of Health as a class A or class F home care provider and provided in a 11.23building that is registered as a housing with services establishment under chapter 144D. 11.24Licensed home care providers are subject to section 
         256B.0651, subdivision 14.11.25(g) A provider may not bill or otherwise charge an elderly waiver participant or their 11.26family for additional units of any allowable component service beyond those available 11.27under the service rate limits described in paragraph (d), nor for additional units of any 11.28allowable component service beyond those approved in the service plan by the lead agency.11.29    Sec. 3. Minnesota Statutes 2011 Supplement, section 256B.0915, subdivision 3h, 11.30is amended to read:11.31    Subd. 3h. Service rate limits; 24-hour customized living services. (a) The 11.32payment rate for 24-hour customized living services is a monthly rate authorized by the 11.33lead agency within the parameters established by the commissioner of human services. 11.34The payment agreement must delineate the amount of each component service included 11.35in each recipient's customized living service plan. The lead agency, with input from 12.1the provider of customized living services, shall ensure that there is a documented need 12.2within the parameters established by the commissioner for all component customized 12.3living services authorized. The lead agency shall not authorize 24-hour customized living 12.4services unless there is a documented need for 24-hour supervision.12.5(b) For purposes of this section, "24-hour supervision" means that the recipient 12.6requires assistance due to needs related to one or more of the following:12.7    (1) intermittent assistance with toileting, positioning, or transferring;12.8    (2) cognitive or behavioral issues;12.9    (3) a medical condition that requires clinical monitoring; or12.10    (4) for all new participants enrolled in the program on or after July 1, 2011, and 12.11all other participants at their first reassessment after July 1, 2011, dependency in at 12.12least three of the following activities of daily living as determined by assessment under 12.13section 
         256B.0911: bathing; dressing; grooming; walking; or eating when the dependency 12.14score in eating is three or greater; and needs medication management and at least 50 12.15hours of service per month. The lead agency shall ensure that the frequency and mode 12.16of supervision of the recipient and the qualifications of staff providing supervision are 12.17described and meet the needs of the recipient.12.18(c) The payment rate for 24-hour customized living services must be based on the 12.19amount of component services to be provided utilizing component rates established by the 12.20commissioner. Counties and tribes will use tools issued by the commissioner to develop 12.21and document customized living plans and authorize rates.12.22(d) Component service rates must not exceed payment rates for comparable elderly 12.23waiver or medical assistance services and must reflect economies of scale.12.24(e) The individually authorized 24-hour customized living payments, in combination 12.25with the payment for other elderly waiver services, including case management, must not 12.26exceed the recipient's community budget cap specified in subdivision 3a. Customized 12.27living services must not include rent or raw food costs.12.28(f) The individually authorized 24-hour customized living payment rates shall not 12.29exceed the 95 percentile of statewide monthly authorizations for 24-hour customized 12.30living services in effect and in the Medicaid management information systems on March 12.3131, 2009, for each case mix resident class under Minnesota Rules, parts 9549.0050 12.32to 9549.0059, to which elderly waiver service clients are assigned. When there are 12.33fewer than 50 authorizations in effect in the case mix resident class, the commissioner 12.34shall multiply the calculated service payment rate maximum for the A classification by 12.35the standard weight for that classification under Minnesota Rules, parts 9549.0050 to 12.369549.0059, to determine the applicable payment rate maximum. Service payment rate 13.1maximums shall be updated annually based on legislatively adopted changes to all service 13.2rates for home and community-based service providers.13.3    (g) Notwithstanding the requirements of paragraphs (d) and (f), the commissioner 13.4may establish alternative payment rate systems for 24-hour customized living services in 13.5housing with services establishments which are freestanding buildings with a capacity of 13.616 or fewer, by applying a single hourly rate for covered component services provided 13.7in either:13.8    (1) licensed corporate adult foster homes; or13.9    (2) specialized dementia care units which meet the requirements of section 
         144D.065 13.10and in which:13.11    (i) each resident is offered the option of having their own apartment; or13.12    (ii) the units are licensed as board and lodge establishments with maximum capacity 13.13of eight residents, and which meet the requirements of Minnesota Rules, part 9555.6205, 13.14subparts 1, 2, 3, and 4, item A.13.15(h) A provider may not bill or otherwise charge an elderly waiver participant or their 13.16family for additional units of any allowable component service beyond those available 13.17under the service rate limits described in paragraph (e), nor for additional units of any 13.18allowable component service beyond those approved in the service plan by the lead agency.13.19ARTICLE 413.20DEPARTMENT OF HEALTH13.21    Section 1. Minnesota Statutes 2011 Supplement, section 144.1222, subdivision 5, 13.22is amended to read:13.23    Subd. 5. Swimming pond exemption Exemptions. (a) A public swimming pond 13.24in existence before January 1, 2008, is not a public pool for purposes of this section and 13.25section 
         157.16, and is exempt from the requirements for public swimming pools under 13.26Minnesota Rules, chapter 4717.13.27(b) A naturally treated swimming pool located in the city of Minneapolis is not 13.28a public pool for purposes of this section and section 157.16, and is exempt from the 13.29requirements for public swimming pools under Minnesota Rules, chapter 4717.13.30    (b) (c) Notwithstanding paragraph paragraphs (a) and (b), a public swimming pond 13.31and a naturally treated swimming pool must meet the requirements for public pools 13.32described in subdivisions 1c and 1d.13.33    (c) (d) For purposes of this subdivision, a "public swimming pond" means an 13.34artificial body of water contained within a lined, sand-bottom basin, intended for public 13.35swimming, relaxation, or recreational use that includes a water circulation system for 14.1maintaining water quality and does not include any portion of a naturally occurring lake 14.2or stream.14.3(e) For purposes of this subdivision, a "naturally treated swimming pool" means an 14.4artificial body of water contained in a basin, intended for public swimming, relaxation, or 14.5recreational use that uses a chemical free filtration system for maintaining water quality 14.6through natural processes, including the use of plants, beneficial bacteria, and microbes.14.7EFFECTIVE DATE.This section is effective the day following final enactment.