1.1A bill for an act1.2relating to state government; establishing the health and human services budget; 1.3modifying provisions related to health care, continuing care, nursing facility 1.4admission, children and family services, human services licensing, chemical 1.5and mental health, program integrity, managed care organizations, waiver 1.6provider standards, home care, and the Department of Health; redesigning 1.7home and community-based services; establishing community first services and 1.8supports and Northstar Care for Children; providing for fraud investigations 1.9in the child care assistance program; establishing autism early intensive 1.10intervention benefits; creating a human services performance council; making 1.11technical changes; requiring a study; requiring reports; appropriating money; 1.12repealing MinnesotaCare;amending Minnesota Statutes 2012, sections 13.381, 1.13subdivisions 2, 10; 13.411, subdivision 7; 13.461, by adding subdivisions; 1.1416A.724, subdivision 3; 16C.10, subdivision 5; 16C.155, subdivision 1; 62J.692, 1.15subdivisions 1, 3, 4, 5, 7a, 9, by adding a subdivision; 62Q.19, subdivision 1.161; 103I.005, by adding a subdivision; 103I.521; 119B.05, subdivision 1; 1.17119B.09, subdivision 5; 119B.125, subdivision 1; 119B.13, subdivisions 1, 1.187; 144.051, by adding subdivisions; 144.0724, subdivisions 4, 6; 144.123, 1.19subdivision 1; 144.125, subdivision 1; 144.212; 144.213; 144.215, subdivisions 1.203, 4; 144.216, subdivision 1; 144.217, subdivision 2; 144.218, subdivision 5; 1.21144.225, subdivisions 1, 4, 7, 8; 144.226; 144.966, subdivisions 2, 3a; 144.98, 1.22subdivisions 3, 5, by adding subdivisions; 144.99, subdivision 4; 144A.071, 1.23subdivision 4b; 144A.351; 144A.43; 144A.44; 144A.45; 144D.01, subdivision 4; 1.24145.906; 145.986; 145A.17, subdivision 1; 145C.01, subdivision 7; 148B.17, 1.25subdivision 2; 148E.065, subdivision 4a; 149A.02, subdivisions 1a, 2, 3, 4, 5, 1.2616, 23, 27, 34, 35, 37, by adding subdivisions; 149A.03; 149A.65, by adding 1.27subdivisions; 149A.70, subdivisions 1, 2, 3, 5; 149A.71, subdivisions 2, 4; 1.28149A.72, subdivisions 3, 9, by adding a subdivision; 149A.73, subdivisions 1, 1.292, 4; 149A.74; 149A.91, subdivision 9; 149A.93, subdivisions 3, 6; 149A.94; 1.30149A.96, subdivision 9; 151.01, subdivision 27; 151.19, subdivisions 1, 3; 1.31151.26, subdivision 1; 151.37, subdivision 4; 151.47, subdivision 1, by adding 1.32a subdivision; 151.49; 152.126; 174.30, subdivision 1; 214.12, by adding 1.33a subdivision; 214.40, subdivision 1; 243.166, subdivisions 4b, 7; 245.03, 1.34subdivision 1; 245.462, subdivision 20; 245.4661, subdivisions 5, 6; 245.4682, 1.35subdivision 2; 245.4875, subdivision 8; 245.4881, subdivision 1; 245A.02, 1.36subdivisions 1, 9, 10, 14; 245A.03, subdivisions 7, 8, 9; 245A.04, subdivision 1.3713; 245A.042, subdivision 3; 245A.07, subdivisions 2a, 3; 245A.08, subdivision 1.382a; 245A.10; 245A.11, subdivisions 2a, 7, 7a, 7b, 8; 245A.1435; 245A.144; 1.39245A.1444; 245A.16, subdivision 1; 245A.40, subdivision 5; 245A.50; 245C.04, 2.1by adding a subdivision; 245C.08, subdivision 1; 245C.32, subdivision 2.22; 245D.02; 245D.03; 245D.04; 245D.05; 245D.06; 245D.07; 245D.09; 2.3245D.10; 246.18, subdivision 8, by adding a subdivision; 252.27, subdivision 2.42a; 252.291, by adding a subdivision; 253B.10, subdivision 1; 254B.04, 2.5subdivision 1; 254B.13; 256.01, subdivisions 2, 24, 34, by adding subdivisions; 2.6256.82, subdivision 3; 256.9657, subdivision 3; 256.969, subdivisions 3a, 2.729; 256.975, subdivision 7, by adding subdivisions; 256.9754, subdivision 2.85, by adding subdivisions; 256B.02, by adding subdivisions; 256B.021, by 2.9adding subdivisions; 256B.04, subdivisions 18, 21, by adding a subdivision; 2.10256B.055, subdivisions 3a, 6, 10, 14, 15, by adding a subdivision; 256B.056, 2.11subdivisions 1, 1c, 3, 4, as amended, 5c, 10, by adding a subdivision; 256B.057, 2.12subdivisions 1, 10, by adding a subdivision; 256B.059, subdivision 1; 256B.06, 2.13subdivision 4; 256B.0623, subdivision 2; 256B.0625, subdivisions 13e, 19c, 31, 2.1439, 48, 56, 58, by adding subdivisions; 256B.0631, subdivision 1; 256B.064, 2.15subdivisions 1a, 1b, 2; 256B.0659, subdivision 21; 256B.0755, subdivision 3; 2.16256B.0756; 256B.0911, subdivisions 1, 1a, 3a, 4d, 6, 7, by adding a subdivision; 2.17256B.0913, subdivision 4, by adding a subdivision; 256B.0915, subdivisions 3a, 2.185, by adding a subdivision; 256B.0916, by adding a subdivision; 256B.0917, 2.19subdivisions 6, 13, by adding subdivisions; 256B.092, subdivisions 11, 12, by 2.20adding a subdivision; 256B.0943, subdivisions 1, 2, 7, by adding a subdivision; 2.21256B.0946; 256B.095; 256B.0951, subdivisions 1, 4; 256B.0952, subdivisions 1, 2.225; 256B.0955; 256B.097, subdivisions 1, 3; 256B.196, subdivision 2; 256B.431, 2.23subdivision 44; 256B.434, subdivision 4; 256B.437, subdivision 6; 256B.439, 2.24subdivisions 1, 2, 3, 4, by adding a subdivision; 256B.441, subdivisions 13, 2.2553, 55, 56, 62; 256B.49, subdivisions 11a, 12, 14, 15, by adding subdivisions; 2.26256B.4912, subdivisions 1, 2, 3, 7, by adding subdivisions; 256B.4913, 2.27subdivisions 5, 6, by adding a subdivision; 256B.492; 256B.493, subdivision 2; 2.28256B.501, by adding a subdivision; 256B.5011, subdivision 2; 256B.5012, by 2.29adding a subdivision; 256B.69, subdivisions 5c, 31, by adding a subdivision; 2.30256B.694; 256B.76, subdivisions 1, 2, 4, by adding a subdivision; 256B.761; 2.31256B.764; 256B.766; 256D.44, subdivision 5; 256I.05, subdivision 1e, by 2.32adding a subdivision; 256J.08, subdivision 24; 256J.21, subdivision 3; 256J.24, 2.33subdivisions 5, 5a, 7; 256J.621; 256J.626, subdivision 7; 256K.45; 256L.01, 2.34subdivisions 3a, 5, by adding subdivisions; 256L.02, subdivision 2, by adding 2.35subdivisions; 256L.03, subdivisions 1, 1a, 3, 5, 6, by adding a subdivision; 2.36256L.04, subdivisions 1, 7, 8, 10, 12, by adding subdivisions; 256L.05, 2.37subdivisions 1, 2, 3, 3c; 256L.06, subdivision 3; 256L.07, subdivisions 1, 2, 3; 2.38256L.09, subdivision 2; 256L.11, subdivisions 1, 3; 256L.15, subdivisions 1, 2; 2.39256M.40, subdivision 1; 257.75, subdivision 7; 257.85, subdivision 11; 259A.05, 2.40subdivision 5; 259A.20, subdivision 4; 260B.007, subdivisions 6, 16; 260C.007, 2.41subdivisions 6, 31; 260C.635, subdivision 1; 299C.093; 471.59, subdivision 1; 2.42517.001; 518A.60; 524.5-118, subdivision 1, by adding a subdivision; 524.5-303; 2.43524.5-316; 524.5-403; 524.5-420; 626.556, subdivisions 2, 3, 10d; 626.557, 2.44subdivisions 4, 9, 9a, 9e; 626.5572, subdivision 13; Laws 1998, chapter 407, 2.45article 6, section 116; Laws 2011, First Special Session chapter 9, article 7, 2.46section 39, subdivision 14; Laws 2012, chapter 247, article 1, section 28; article 2.476, section 4; Laws 2013, chapter 1, sections 1; 6; proposing coding for new law in 2.48Minnesota Statutes, chapters 144; 144A; 145; 149A; 151; 214; 245; 245A; 245D; 2.49254B; 256B; 256J; 256L; proposing coding for new law as Minnesota Statutes, 2.50chapter 245E; repealing Minnesota Statutes 2012, sections 62J.693; 103I.005, 2.51subdivision 20; 144.123, subdivision 2; 144A.46; 144A.461; 149A.025; 2.52149A.20, subdivision 8; 149A.30, subdivision 2; 149A.40, subdivision 8; 2.53149A.45, subdivision 6; 149A.50, subdivision 6; 149A.51, subdivision 7; 2.54149A.52, subdivision 5a; 149A.53, subdivision 9; 151.19, subdivision 2; 151.25; 2.55151.45; 151.47, subdivision 2; 151.48; 245A.655; 245B.01; 245B.02; 245B.03; 2.56245B.031; 245B.04; 245B.05, subdivisions 1, 2, 3, 5, 6, 7; 245B.055; 245B.06; 2.57245B.07; 245B.08; 245D.08; 256B.055, subdivisions 3, 5, 10b; 256B.056, 2.58subdivision 5b; 256B.057, subdivisions 1c, 2; 256B.0911, subdivisions 4a, 4b, 3.14c; 256B.0917, subdivisions 1, 2, 3, 4, 5, 7, 8, 9, 10, 11, 12, 14; 256B.096, 3.2subdivisions 1, 2, 3, 4; 256B.49, subdivision 16a; 256B.4913, subdivisions 1, 2, 3.33, 4; 256B.5012, subdivision 13; 256J.24, subdivision 6; 256L.01, subdivisions 3.43, 4a; 256L.02, subdivision 3; 256L.03, subdivision 4; 256L.031; 256L.04, 3.5subdivisions 1b, 2a, 7a, 9; 256L.07, subdivisions 1, 4, 5, 8, 9; 256L.09, 3.6subdivisions 1, 4, 5, 6, 7; 256L.11, subdivisions 2a, 5, 6; 256L.12, subdivisions 3.71, 2, 3, 4, 5, 6, 7, 8, 9a, 9b; 256L.17, subdivisions 1, 2, 3, 4, 5; 485.14; 3.8609.093; Laws 2011, First Special Session chapter 9, article 7, section 54, as 3.9amended; Minnesota Rules, parts 4668.0002; 4668.0003; 4668.0005; 4668.0008; 3.104668.0012; 4668.0016; 4668.0017; 4668.0019; 4668.0030; 4668.0035; 3.114668.0040; 4668.0050; 4668.0060; 4668.0065; 4668.0070; 4668.0075; 3.124668.0080; 4668.0100; 4668.0110; 4668.0120; 4668.0130; 4668.0140; 3.134668.0150; 4668.0160; 4668.0170; 4668.0180; 4668.0190; 4668.0200; 3.144668.0218; 4668.0220; 4668.0230; 4668.0240; 4668.0800; 4668.0805; 3.154668.0810; 4668.0815; 4668.0820; 4668.0825; 4668.0830; 4668.0835; 3.164668.0840; 4668.0845; 4668.0855; 4668.0860; 4668.0865; 4668.0870; 3.174669.0001; 4669.0010; 4669.0020; 4669.0030; 4669.0040; 4669.0050.3.18BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:3.19ARTICLE 13.20AFFORDABLE CARE ACT IMPLEMENTATION; BETTER HEALTH 3.21CARE FOR MORE MINNESOTANS3.22    Section 1. Minnesota Statutes 2012, section 16A.724, subdivision 3, is amended to read:3.23    Subd. 3. MinnesotaCare federal receipts.Receipts received as a result of federal 3.24participation pertaining to administrative costs of the Minnesota health care reform waiver 3.25shall be deposited as nondedicated revenue in the health care access fund. Receipts 3.26received as a result of federal participation pertaining to grants shall be deposited in the 3.27federal fund and shall offset health care access funds for payments to providers. All federal 3.28funding received by Minnesota for implementation and administration of MinnesotaCare 3.29as a basic health program, as authorized in section 1331 of the Affordable Care Act, 3.30Public Law 111-148, as amended by Public Law 111-152, is dedicated to that program and 3.31shall be deposited into the health care access fund. Federal funding that is received for 3.32implementing and administering MinnesotaCare as a basic health program and deposited in 3.33the fund shall be used only for that program to purchase health care coverage for enrollees 3.34and reduce enrollee premiums and cost-sharing or provide additional enrollee benefits.3.35EFFECTIVE DATE.This section is effective January 1, 2015.3.36    Sec. 2. Minnesota Statutes 2012, section 254B.04, subdivision 1, is amended to read:3.37    Subdivision 1. Eligibility. (a) Persons eligible for benefits under Code of Federal 3.38Regulations, title 25, part 20, persons eligible for medical assistance benefits under 3.39sections 
         256B.055, 
         256B.056, and 
         256B.057, subdivisions 1, 2, 5, and 6, or who meet 3.40the income standards of section 
         256B.056, subdivision 4, and persons eligible for general 4.1assistance medical care under section 
         256D.03, subdivision 3, are entitled to chemical 4.2dependency fund services. State money appropriated for this paragraph must be placed in 4.3a separate account established for this purpose.4.4Persons with dependent children who are determined to be in need of chemical 4.5dependency treatment pursuant to an assessment under section 
         626.556, subdivision 10, or 4.6a case plan under section 
         260C.201, subdivision 6, or 
         260C.212, shall be assisted by the 4.7local agency to access needed treatment services. Treatment services must be appropriate 4.8for the individual or family, which may include long-term care treatment or treatment in a 4.9facility that allows the dependent children to stay in the treatment facility. The county 4.10shall pay for out-of-home placement costs, if applicable.4.11(b) A person not entitled to services under paragraph (a), but with family income 4.12that is less than 215 percent of the federal poverty guidelines for the applicable family 4.13size, shall be eligible to receive chemical dependency fund services within the limit 4.14of funds appropriated for this group for the fiscal year. If notified by the state agency 4.15of limited funds, a county must give preferential treatment to persons with dependent 4.16children who are in need of chemical dependency treatment pursuant to an assessment 4.17under section 
         626.556, subdivision 10, or a case plan under section 
         260C.201, subdivision 4.186
         , or 
         260C.212. A county may spend money from its own sources to serve persons under 4.19this paragraph. State money appropriated for this paragraph must be placed in a separate 4.20account established for this purpose.4.21(c) Persons whose income is between 215 percent and 412 percent of the federal 4.22poverty guidelines for the applicable family size shall be eligible for chemical dependency 4.23services on a sliding fee basis, within the limit of funds appropriated for this group for the 4.24fiscal year. Persons eligible under this paragraph must contribute to the cost of services 4.25according to the sliding fee scale established under subdivision 3. A county may spend 4.26money from its own sources to provide services to persons under this paragraph. State 4.27money appropriated for this paragraph must be placed in a separate account established 4.28for this purpose.4.29    Sec. 3. Minnesota Statutes 2012, section 256.01, is amended by adding a subdivision 4.30to read:4.31    Subd. 35.Federal approval.(a) The commissioner shall seek federal authority 4.32from the U.S. Department of Health and Human Services necessary to operate a health 4.33coverage program for Minnesotans with incomes up to 275 percent of the federal poverty 4.34guidelines (FPG). The proposal shall seek to secure all federal funding available from at 4.35least the following services:5.1(1) all premium tax credits and cost sharing subsidies available under United States 5.2Code, title 26, section 36B, and United States Code, title 42, section 18071, for individuals 5.3with incomes above 133 percent and at or below 275 percent of the federal poverty 5.4guidelines who would otherwise be enrolled in the Minnesota Insurance Marketplace as 5.5defined in section 62V.02;5.6(2) Medicaid funding; and 5.7(3) other funding sources identified by the commissioner that support coverage or 5.8care redesign in Minnesota.5.9(b) Funding received shall be used to design and implement a health coverage 5.10program that creates a single streamlined program and meets the needs of Minnesotans with 5.11incomes up to 275 percent of the federal poverty guidelines. The program must incorporate:5.12(1) payment reform characteristics included in the health care delivery system and 5.13accountable care organization payment models;5.14(2) flexibility in benefit set design such that benefits can be targeted to meet enrollee 5.15needs in different income and health status situations and can provide a more seamless 5.16transition from public to private health care coverage;5.17(3) flexibility in co-payment or premium structures to incent patients to seek 5.18high-quality, low-cost care settings; and5.19(4) flexibility in premium structures to ease the transition from public to private 5.20health care coverage.5.21(c) The commissioner shall develop and submit a proposal consistent with the above 5.22criteria and shall seek all federal authority necessary to implement the health coverage 5.23program. In developing the request, the commissioner shall consult with appropriate 5.24stakeholder groups and consumers.5.25(d) The commissioner is authorized to seek any available waivers or federal 5.26approvals to accomplish the goals under paragraph (b) prior to 2017.5.27(e) The commissioner shall report to the chairs and ranking minority members of 5.28the legislative committees with jurisdiction over health and human services policy and 5.29financing by January 15, 2015, on the progress of receiving a federal waiver and shall 5.30make recommendations on any legislative changes necessary to accomplish the project 5.31in this subdivision. Any implementation of the waiver that requires a state financial 5.32contribution shall be contingent on legislative action approving the contribution.5.33(f) The commissioner is authorized to accept and expend federal funds that support 5.34the purposes of this subdivision.6.1    Sec. 4. Minnesota Statutes 2012, section 256B.02, is amended by adding a subdivision 6.2to read:6.3    Subd. 18.Caretaker relative."Caretaker relative" means a relative, by blood, 6.4adoption, or marriage, of a child under age 19 with whom the child is living and who 6.5assumes primary responsibility for the child's care.6.6EFFECTIVE DATE.This section is effective January 1, 2014.6.7    Sec. 5. Minnesota Statutes 2012, section 256B.02, is amended by adding a subdivision 6.8to read:6.9    Subd. 19.Insurance affordability program."Insurance affordability program" 6.10means one of the following programs:6.11(1) medical assistance under this chapter;6.12(2) a program that provides advance payments of the premium tax credits established 6.13under section 36B of the Internal Revenue Code or cost-sharing reductions established 6.14under section 1402 of the Affordable Care Act;6.15(3) MinnesotaCare as defined in chapter 256L; and6.16(4) a Basic Health Plan as defined in section 1331 of the Affordable Care Act.6.17EFFECTIVE DATE.This section is effective the day following final enactment.6.18    Sec. 6. Minnesota Statutes 2012, section 256B.04, subdivision 18, is amended to read:6.19    Subd. 18. Applications for medical assistance. (a) The state agency may take6.20 shall accept applications for medical assistance and conduct eligibility determinations for 6.21MinnesotaCare enrollees by telephone, via mail, in-person, online via an Internet Web 6.22site, and through other commonly available electronic means.6.23    (b) The commissioner of human services shall modify the Minnesota health care 6.24programs application form to add a question asking applicants whether they have ever 6.25served in the United States military.6.26    (c) For each individual who submits an application or whose eligibility is subject to 6.27renewal or whose eligibility is being redetermined pursuant to a change in circumstances, 6.28if the agency determines the individual is not eligible for medical assistance, the agency 6.29shall determine potential eligibility for other insurance affordability programs.6.30EFFECTIVE DATE.This section is effective January 1, 2014.6.31    Sec. 7. Minnesota Statutes 2012, section 256B.055, subdivision 3a, is amended to read:7.1    Subd. 3a. Families with children.Beginning July 1, 2002, Medical assistance may 7.2be paid for a person who is a child under the age of 18, or age 18 if a full-time student 7.3in a secondary school, or in the equivalent level of vocational or technical training, and 7.4reasonably expected to complete the program before reaching age 19; the parent or 7.5stepparent of a dependent child under the age of 19, including a pregnant woman; or a 7.6caretaker relative of a dependent child under the age of 19.7.7EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal 7.8approval, whichever is later. The commissioner of human services shall notify the revisor 7.9of statutes when federal approval is obtained.7.10    Sec. 8. Minnesota Statutes 2012, section 256B.055, subdivision 6, is amended to read:7.11    Subd. 6. Pregnant women; needy unborn child. Medical assistance may be paid 7.12for a pregnant woman who has written verification of a positive pregnancy test from a 7.13physician or licensed registered nurse, who meets the other eligibility criteria of this 7.14section and whose unborn child would be eligible as a needy child under subdivision 10 if 7.15born and living with the woman. In accordance with Code of Federal Regulations, title 7.1642, section 435.956, the commissioner must accept self-attestation of pregnancy unless 7.17the agency has information that is not reasonably compatible with such attestation. For 7.18purposes of this subdivision, a woman is considered pregnant for 60 days postpartum.7.19EFFECTIVE DATE.This section is effective January 1, 2014.7.20    Sec. 9. Minnesota Statutes 2012, section 256B.055, subdivision 10, is amended to read:7.21    Subd. 10. Infants. Medical assistance may be paid for an infant less than one year 7.22of age, whose mother was eligible for and receiving medical assistance at the time of birth 7.23or who is less than two years of age and is in a family with countable income that is equal 7.24to or less than the income standard established under section 
         256B.057, subdivision 1.7.25EFFECTIVE DATE.This section is effective January 1, 2014.7.26    Sec. 10. Minnesota Statutes 2012, section 256B.055, subdivision 15, is amended to read:7.27    Subd. 15. Adults without children. Medical assistance may be paid for a person 7.28who is:7.29(1) at least age 21 and under age 65;7.30(2) not pregnant;7.31(3) not entitled to Medicare Part A or enrolled in Medicare Part B under Title XVIII 7.32of the Social Security Act;8.1(4) not an adult in a family with children as defined in section 256L.01, subdivision 8.23a; and not otherwise eligible under subdivision 7 as a person who meets the categorical 8.3eligibility requirements of the supplemental security income program;8.4(5) not enrolled under subdivision 7 as a person who would meet the categorical 8.5eligibility requirements of the supplemental security income program except for excess 8.6income or assets; and8.7(5) (6) not described in another subdivision of this section.8.8EFFECTIVE DATE.This section is effective January 1, 2014.8.9    Sec. 11. Minnesota Statutes 2012, section 256B.055, is amended by adding a 8.10subdivision to read:8.11    Subd. 17.Adults who were in foster care at the age of 18.Medical assistance may 8.12be paid for a person under 26 years of age who was in foster care under the commissioner's 8.13responsibility on the date of attaining 18 years of age, and who was enrolled in medical 8.14assistance under the state plan or a waiver of the plan while in foster care, in accordance 8.15with section 2004 of the Affordable Care Act.8.16EFFECTIVE DATE.This section is effective January 1, 2014.8.17    Sec. 12. Minnesota Statutes 2012, section 256B.056, subdivision 1, is amended to read:8.18    Subdivision 1. Residency. To be eligible for medical assistance, a person must 8.19reside in Minnesota, or, if absent from the state, be deemed to be a resident of Minnesota,8.20 in accordance with the rules of the state agency Code of Federal Regulations, title 42, 8.21section 435.403.8.22EFFECTIVE DATE.This section is effective January 1, 2014.8.23    Sec. 13. Minnesota Statutes 2012, section 256B.056, subdivision 1c, is amended to read:8.24    Subd. 1c. Families with children income methodology. (a)(1) [Expired, 1Sp2003 8.25c 14 art 12 s 17]8.26(2) For applications processed within one calendar month prior to July 1, 2003, 8.27eligibility shall be determined by applying the income standards and methodologies in 8.28effect prior to July 1, 2003, for any months in the six-month budget period before July 8.291, 2003, and the income standards and methodologies in effect on July 1, 2003, for any 8.30months in the six-month budget period on or after that date. The income standards for 8.31each month shall be added together and compared to the applicant's total countable income 8.32for the six-month budget period to determine eligibility.9.1(3) For children ages one through 18 whose eligibility is determined under section 9.2256B.057, subdivision 2, the following deductions shall be applied to income counted 9.3toward the child's eligibility as allowed under the state's AFDC plan in effect as of July 9.416, 1996: $90 work expense, dependent care, and child support paid under court order. 9.5This clause is effective October 1, 2003.9.6(b) For families with children whose eligibility is determined using the standard 9.7specified in section 256B.056, subdivision 4, paragraph (c), 17 percent of countable 9.8earned income shall be disregarded for up to four months and the following deductions 9.9shall be applied to each individual's income counted toward eligibility as allowed under 9.10the state's AFDC plan in effect as of July 16, 1996: dependent care and child support paid 9.11under court order.9.12(c) If the four-month disregard in paragraph (b) has been applied to the wage 9.13earner's income for four months, the disregard shall not be applied again until the wage 9.14earner's income has not been considered in determining medical assistance eligibility for 9.1512 consecutive months.9.16(d) (b) The commissioner shall adjust the income standards under this section each 9.17July 1 by the annual update of the federal poverty guidelines following publication by the 9.18United States Department of Health and Human Services except that the income standards 9.19shall not go below those in effect on July 1, 2009.9.20(e) (c) For children age 18 or under, annual gifts of $2,000 or less by a tax-exempt 9.21organization to or for the benefit of the child with a life-threatening illness must be 9.22disregarded from income.9.23    Sec. 14. Minnesota Statutes 2012, section 256B.056, subdivision 3, is amended to read:9.24    Subd. 3. Asset limitations for certain individuals and families. (a) To be 9.25eligible for medical assistance, a person must not individually own more than $3,000 in 9.26assets, or if a member of a household with two family members, husband and wife, or 9.27parent and child, the household must not own more than $6,000 in assets, plus $200 for 9.28each additional legal dependent. In addition to these maximum amounts, an eligible 9.29individual or family may accrue interest on these amounts, but they must be reduced to the 9.30maximum at the time of an eligibility redetermination. The accumulation of the clothing 9.31and personal needs allowance according to section 
         256B.35 must also be reduced to the 9.32maximum at the time of the eligibility redetermination. The value of assets that are not 9.33considered in determining eligibility for medical assistance is the value of those assets 9.34excluded under the supplemental security income program for aged, blind, and disabled 9.35persons, with the following exceptions:10.1(1) household goods and personal effects are not considered;10.2(2) capital and operating assets of a trade or business that the local agency determines 10.3are necessary to the person's ability to earn an income are not considered;10.4(3) motor vehicles are excluded to the same extent excluded by the supplemental 10.5security income program;10.6(4) assets designated as burial expenses are excluded to the same extent excluded by 10.7the supplemental security income program. Burial expenses funded by annuity contracts 10.8or life insurance policies must irrevocably designate the individual's estate as contingent 10.9beneficiary to the extent proceeds are not used for payment of selected burial expenses;10.10(5) for a person who no longer qualifies as an employed person with a disability due 10.11to loss of earnings, assets allowed while eligible for medical assistance under section 10.12256B.057, subdivision 9
         , are not considered for 12 months, beginning with the first month 10.13of ineligibility as an employed person with a disability, to the extent that the person's total 10.14assets remain within the allowed limits of section 
         256B.057, subdivision 9, paragraph (d);10.15    (6) when a person enrolled in medical assistance under section 
         256B.057, subdivision 10.169
         , is age 65 or older and has been enrolled during each of the 24 consecutive months 10.17before the person's 65th birthday, the assets owned by the person and the person's spouse 10.18must be disregarded, up to the limits of section 
         256B.057, subdivision 9, paragraph (d), 10.19when determining eligibility for medical assistance under section 
         256B.055, subdivision 10.207
         . The income of a spouse of a person enrolled in medical assistance under section 10.21256B.057, subdivision 9
         , during each of the 24 consecutive months before the person's 10.2265th birthday must be disregarded when determining eligibility for medical assistance 10.23under section 
         256B.055, subdivision 7. Persons eligible under this clause are not subject to 10.24the provisions in section 
         256B.059. A person whose 65th birthday occurs in 2012 or 2013 10.25is required to have qualified for medical assistance under section 
         256B.057, subdivision 9, 10.26prior to age 65 for at least 20 months in the 24 months prior to reaching age 65; and10.27(7) effective July 1, 2009, certain assets owned by American Indians are excluded as 10.28required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public 10.29Law 111-5. For purposes of this clause, an American Indian is any person who meets the 10.30definition of Indian according to Code of Federal Regulations, title 42, section 
         447.50.10.31(b) No asset limit shall apply to persons eligible under section 
         256B.055, subdivision 10.3215.10.33EFFECTIVE DATE.This section is effective January 1, 2014.10.34    Sec. 15. Minnesota Statutes 2012, section 256B.056, subdivision 4, as amended by 10.35Laws 2013, chapter 1, section 5, is amended to read:11.1    Subd. 4. Income. (a) To be eligible for medical assistance, a person eligible under 11.2section 
         256B.055, subdivisions 7, 7a, and 12, may have income up to 100 percent of 11.3the federal poverty guidelines. Effective January 1, 2000, and each successive January, 11.4recipients of supplemental security income may have an income up to the supplemental 11.5security income standard in effect on that date.11.6(b) To be eligible for medical assistance, families and children may have an income 11.7up to 133-1/3 percent of the AFDC income standard in effect under the July 16, 1996, 11.8AFDC state plan. Effective July 1, 2000, the base AFDC standard in effect on July 16, 11.91996, shall be increased by three percent.11.10(c) (b) Effective January 1, 2014, to be eligible for medical assistance, under section 11.11256B.055, subdivision 3a
         , a parent or caretaker relative may have an income up to 133 11.12percent of the federal poverty guidelines for the household size.11.13(d) (c) To be eligible for medical assistance under section 
         256B.055, subdivision 11.1415
         , a person may have an income up to 133 percent of federal poverty guidelines for 11.15the household size.11.16(e) (d) To be eligible for medical assistance under section 
         256B.055, subdivision 11.1716
         , a child age 19 to 20 may have an income up to 133 percent of the federal poverty 11.18guidelines for the household size.11.19(f) (e) To be eligible for medical assistance under section 256B.055, subdivision 3a, 11.20a child under age 19 may have income up to 275 percent of the federal poverty guidelines 11.21for the household size or an equivalent standard when converted using modified adjusted 11.22gross income methodology as required under the Affordable Care Act. Children who are 11.23enrolled in medical assistance as of December 31, 2013, and are determined ineligible 11.24for medical assistance because of the elimination of income disregards under modified 11.25adjusted gross income methodology as defined in subdivision 1a remain eligible for 11.26medical assistance under the Children's Health Insurance Program Reauthorization Act 11.27of 2009, Public Law 111-3, until the date of their next regularly scheduled eligibility 11.28redetermination as required in section 256B.056, subdivision 7a.11.29(f) In computing income to determine eligibility of persons under paragraphs (a) to 11.30(e) who are not residents of long-term care facilities, the commissioner shall disregard 11.31increases in income as required by Public Laws 94-566, section 503; 99-272; and 99-509. 11.32For persons eligible under paragraph (a), veteran aid and attendance benefits and Veterans 11.33Administration unusual medical expense payments are considered income to the recipient.11.34EFFECTIVE DATE.This section is effective January 1, 2014.11.35    Sec. 16. Minnesota Statutes 2012, section 256B.056, subdivision 5c, is amended to read:12.1    Subd. 5c. Excess income standard. (a) The excess income standard for families 12.2with children parents and caretaker relatives, pregnant women, infants, and children ages 12.3two through 20 is the standard specified in subdivision 4, paragraph (b).12.4(b) The excess income standard for a person whose eligibility is based on blindness, 12.5disability, or age of 65 or more years is 70 percent of the federal poverty guidelines for the 12.6family size. Effective July 1, 2002, the excess income standard for this paragraph shall 12.7equal 75 percent of the federal poverty guidelines.12.8EFFECTIVE DATE.This section is effective January 1, 2014.12.9    Sec. 17. Minnesota Statutes 2012, section 256B.056, is amended by adding a 12.10subdivision to read:12.11    Subd. 7a.Periodic renewal of eligibility.(a) The commissioner shall make an 12.12annual redetermination of eligibility based on information contained in the enrollee's case 12.13file and other information available to the agency, including but not limited to information 12.14accessed through an electronic database, without requiring the enrollee to submit any 12.15information when sufficient data is available for the agency to renew eligibility.12.16(b) If the commissioner cannot renew eligibility in accordance with paragraph (a), 12.17the commissioner must provide the enrollee with a prepopulated renewal form containing 12.18eligibility information available to the agency and permit the enrollee to submit the form 12.19with any corrections or additional information to the agency and sign the renewal form via 12.20any of the modes of submission specified in section 256B.04, subdivision 18.12.21(c) An enrollee who is terminated for failure to complete the renewal process may 12.22subsequently submit the renewal form and required information within four months after 12.23the date of termination and have coverage reinstated without a lapse, if otherwise eligible 12.24under this chapter.12.25(d) Notwithstanding paragraph (a), individuals eligible under subdivision 5 shall be 12.26required to renew eligibility every six months.12.27EFFECTIVE DATE.This section is effective January 1, 2014.12.28    Sec. 18. Minnesota Statutes 2012, section 256B.056, subdivision 10, is amended to read:12.29    Subd. 10. Eligibility verification. (a) The commissioner shall require women who 12.30are applying for the continuation of medical assistance coverage following the end of the 12.3160-day postpartum period to update their income and asset information and to submit 12.32any required income or asset verification.13.1    (b) The commissioner shall determine the eligibility of private-sector health care 13.2coverage for infants less than one year of age eligible under section 
         256B.055, subdivision 13.310
         , or 
         256B.057, subdivision 1, paragraph (d), and shall pay for private-sector coverage 13.4if this is determined to be cost-effective.13.5    (c) The commissioner shall verify assets and income for all applicants, and for all 13.6recipients upon renewal.13.7    (d) The commissioner shall utilize information obtained through the electronic 13.8service established by the secretary of the United States Department of Health and Human 13.9Services and other available electronic data sources in Code of Federal Regulations, title 13.1042, sections 435.940 to 435.956, to verify eligibility requirements. The commissioner 13.11shall establish standards to define when information obtained electronically is reasonably 13.12compatible with information provided by applicants and enrollees, including use of 13.13self-attestation, to accomplish real-time eligibility determinations and maintain program 13.14integrity.13.15EFFECTIVE DATE.This section is effective January 1, 2014.13.16    Sec. 19. Minnesota Statutes 2012, section 256B.057, subdivision 1, is amended to read:13.17    Subdivision 1. Infants and pregnant women. (a)(1) An infant less than one year13.18 two years of age or a pregnant woman who has written verification of a positive pregnancy 13.19test from a physician or licensed registered nurse is eligible for medical assistance if the 13.20individual's countable family household income is equal to or less than 275 percent of the 13.21federal poverty guideline for the same family household size or an equivalent standard 13.22when converted using modified adjusted gross income methodology as required under 13.23the Affordable Care Act. For purposes of this subdivision, "countable family income" 13.24means the amount of income considered available using the methodology of the AFDC 13.25program under the state's AFDC plan as of July 16, 1996, as required by the Personal 13.26Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), Public 13.27Law 104-193, except for the earned income disregard and employment deductions.13.28    (2) For applications processed within one calendar month prior to the effective date, 13.29eligibility shall be determined by applying the income standards and methodologies in 13.30effect prior to the effective date for any months in the six-month budget period before 13.31that date and the income standards and methodologies in effect on the effective date for 13.32any months in the six-month budget period on or after that date. The income standards 13.33for each month shall be added together and compared to the applicant's total countable 13.34income for the six-month budget period to determine eligibility.13.35    (b)(1) [Expired, 1Sp2003 c 14 art 12 s 19]14.1    (2) For applications processed within one calendar month prior to July 1, 2003, 14.2eligibility shall be determined by applying the income standards and methodologies in 14.3effect prior to July 1, 2003, for any months in the six-month budget period before July 1, 14.42003, and the income standards and methodologies in effect on the expiration date for any 14.5months in the six-month budget period on or after July 1, 2003. The income standards 14.6for each month shall be added together and compared to the applicant's total countable 14.7income for the six-month budget period to determine eligibility.14.8    (3) An amount equal to the amount of earned income exceeding 275 percent of 14.9the federal poverty guideline, up to a maximum of the amount by which the combined 14.10total of 185 percent of the federal poverty guideline plus the earned income disregards 14.11and deductions allowed under the state's AFDC plan as of July 16, 1996, as required 14.12by the Personal Responsibility and Work Opportunity Act of 1996 (PRWORA), Public 14.13Law 104-193, exceeds 275 percent of the federal poverty guideline will be deducted for 14.14pregnant women and infants less than one year of age.14.15    (c) Dependent care and child support paid under court order shall be deducted from 14.16the countable income of pregnant women.14.17    (d) (b) An infant born to a woman who was eligible for and receiving medical 14.18assistance on the date of the child's birth shall continue to be eligible for medical assistance 14.19without redetermination until the child's first birthday.14.20EFFECTIVE DATE.This section is effective January 1, 2014.14.21    Sec. 20. Minnesota Statutes 2012, section 256B.057, subdivision 10, is amended to read:14.22    Subd. 10. Certain persons needing treatment for breast or cervical cancer. (a) 14.23Medical assistance may be paid for a person who:14.24(1) has been screened for breast or cervical cancer by the Minnesota breast and 14.25cervical cancer control program, and program funds have been used to pay for the person's 14.26screening;14.27(2) according to the person's treating health professional, needs treatment, including 14.28diagnostic services necessary to determine the extent and proper course of treatment, for 14.29breast or cervical cancer, including precancerous conditions and early stage cancer;14.30(3) meets the income eligibility guidelines for the Minnesota breast and cervical 14.31cancer control program;14.32(4) is under age 65;14.33(5) is not otherwise eligible for medical assistance under United States Code, title 14.3442, section 1396a(a)(10)(A)(i); and15.1(6) is not otherwise covered under creditable coverage, as defined under United 15.2States Code, title 42, section 1396a(aa).15.3(b) Medical assistance provided for an eligible person under this subdivision shall 15.4be limited to services provided during the period that the person receives treatment for 15.5breast or cervical cancer.15.6(c) A person meeting the criteria in paragraph (a) is eligible for medical assistance 15.7without meeting the eligibility criteria relating to income and assets in section 256B.056, 15.8subdivisions 1a to 5b 5a.15.9EFFECTIVE DATE.This section is effective January 1, 2014.15.10    Sec. 21. Minnesota Statutes 2012, section 256B.057, is amended by adding a 15.11subdivision to read:15.12    Subd. 12.Presumptive eligibility determinations made by qualified hospitals.15.13The commissioner shall establish a process to qualify hospitals that are participating 15.14providers under the medical assistance program to determine presumptive eligibility for 15.15medical assistance for applicants who may have a basis of eligibility using the modified 15.16adjusted gross income methodology as defined in section 256B.056, subdivision 1a, 15.17paragraph (b), clause (1).15.18EFFECTIVE DATE.This section is effective January 1, 2014.15.19    Sec. 22. Minnesota Statutes 2012, section 256B.059, subdivision 1, is amended to read:15.20    Subdivision 1. Definitions. (a) For purposes of this section and sections 
         256B.05815.21and 
         256B.0595, the terms defined in this subdivision have the meanings given them.15.22    (b) "Community spouse" means the spouse of an institutionalized spouse.15.23    (c) "Spousal share" means one-half of the total value of all assets, to the extent that 15.24either the institutionalized spouse or the community spouse had an ownership interest at 15.25the time of the first continuous period of institutionalization.15.26    (d) "Assets otherwise available to the community spouse" means assets individually 15.27or jointly owned by the community spouse, other than assets excluded by subdivision 5, 15.28paragraph (c).15.29    (e) "Community spouse asset allowance" is the value of assets that can be transferred 15.30under subdivision 3.15.31    (f) "Institutionalized spouse" means a person who is:15.32    (1) in a hospital, nursing facility, or intermediate care facility for persons with 15.33developmental disabilities, or receiving home and community-based services under section 16.1256B.0915
         , 256B.092, or 256B.49 and is expected to remain in the facility or institution 16.2or receive the home and community-based services for at least 30 consecutive days; and16.3    (2) married to a person who is not in a hospital, nursing facility, or intermediate 16.4care facility for persons with developmental disabilities, and is not receiving home and 16.5community-based services under section 
         256B.0915, 
         256B.092, or 
         256B.49.16.6    (g) "For the sole benefit of" means no other individual or entity can benefit in any 16.7way from the assets or income at the time of a transfer or at any time in the future.16.8    (h) "Continuous period of institutionalization" means a 30-consecutive-day period 16.9of time in which a person is expected to stay in a medical or long-term care facility, or 16.10receive home and community-based services that would qualify for coverage under the 16.11elderly waiver (EW) or alternative care (AC) programs section 256B.0913, 256B.0915, 16.12256B.092, or 256B.49. For a stay in a facility, the 30-consecutive-day period begins 16.13on the date of entry into a medical or long-term care facility. For receipt of home and 16.14community-based services, the 30-consecutive-day period begins on the date that the 16.15following conditions are met:16.16    (1) the person is receiving services that meet the nursing facility level of care 16.17determined by a long-term care consultation;16.18    (2) the person has received the long-term care consultation within the past 60 days;16.19    (3) the services are paid by the EW program under section 
         256B.0915 or the AC 16.20program under section256B.0913, 256B.0915, 256B.092, or 256B.49 or would qualify 16.21for payment under the EW or AC programs those sections if the person were otherwise 16.22eligible for either program, and but for the receipt of such services the person would have 16.23resided in a nursing facility; and16.24    (4) the services are provided by a licensed provider qualified to provide home and 16.25community-based services.16.26EFFECTIVE DATE.This section is effective January 1, 2014.16.27    Sec. 23. Minnesota Statutes 2012, section 256B.06, subdivision 4, is amended to read:16.28    Subd. 4. Citizenship requirements. (a) Eligibility for medical assistance is limited 16.29to citizens of the United States, qualified noncitizens as defined in this subdivision, and 16.30other persons residing lawfully in the United States. Citizens or nationals of the United 16.31States must cooperate in obtaining satisfactory documentary evidence of citizenship or 16.32nationality according to the requirements of the federal Deficit Reduction Act of 2005, 16.33Public Law 109-171.16.34(b) "Qualified noncitizen" means a person who meets one of the following 16.35immigration criteria:17.1(1) admitted for lawful permanent residence according to United States Code, title 8;17.2(2) admitted to the United States as a refugee according to United States Code, 17.3title 8, section 1157;17.4(3) granted asylum according to United States Code, title 8, section 1158;17.5(4) granted withholding of deportation according to United States Code, title 8, 17.6section 1253(h);17.7(5) paroled for a period of at least one year according to United States Code, title 8, 17.8section 1182(d)(5);17.9(6) granted conditional entrant status according to United States Code, title 8, 17.10section 1153(a)(7);17.11(7) determined to be a battered noncitizen by the United States Attorney General 17.12according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, 17.13title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;17.14(8) is a child of a noncitizen determined to be a battered noncitizen by the United 17.15States Attorney General according to the Illegal Immigration Reform and Immigrant 17.16Responsibility Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill, 17.17Public Law 104-200; or17.18(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public 17.19Law 96-422, the Refugee Education Assistance Act of 1980.17.20(c) All qualified noncitizens who were residing in the United States before August 17.2122, 1996, who otherwise meet the eligibility requirements of this chapter, are eligible for 17.22medical assistance with federal financial participation.17.23(d) Beginning December 1, 1996, qualified noncitizens who entered the United 17.24States on or after August 22, 1996, and who otherwise meet the eligibility requirements 17.25of this chapter are eligible for medical assistance with federal participation for five years 17.26if they meet one of the following criteria:17.27(1) refugees admitted to the United States according to United States Code, title 8, 17.28section 1157;17.29(2) persons granted asylum according to United States Code, title 8, section 1158;17.30(3) persons granted withholding of deportation according to United States Code, 17.31title 8, section 1253(h);17.32(4) veterans of the United States armed forces with an honorable discharge for 17.33a reason other than noncitizen status, their spouses and unmarried minor dependent 17.34children; or17.35(5) persons on active duty in the United States armed forces, other than for training, 17.36their spouses and unmarried minor dependent children.18.1 Beginning July 1, 2010, children and pregnant women who are noncitizens 18.2described in paragraph (b) or who are lawfully present in the United States as defined 18.3in Code of Federal Regulations, title 8, section 103.12, and who otherwise meet 18.4eligibility requirements of this chapter, are eligible for medical assistance with federal 18.5financial participation as provided by the federal Children's Health Insurance Program 18.6Reauthorization Act of 2009, Public Law 111-3.18.7(e) Nonimmigrants who otherwise meet the eligibility requirements of this chapter 18.8are eligible for the benefits as provided in paragraphs (f) to (h). For purposes of this 18.9subdivision, a "nonimmigrant" is a person in one of the classes listed in United States 18.10Code, title 8, section 1101(a)(15).18.11(f) Payment shall also be made for care and services that are furnished to noncitizens, 18.12regardless of immigration status, who otherwise meet the eligibility requirements of 18.13this chapter, if such care and services are necessary for the treatment of an emergency 18.14medical condition.18.15(g) For purposes of this subdivision, the term "emergency medical condition" means 18.16a medical condition that meets the requirements of United States Code, title 42, section 18.171396b(v).18.18(h)(1) Notwithstanding paragraph (g), services that are necessary for the treatment 18.19of an emergency medical condition are limited to the following:18.20(i) services delivered in an emergency room or by an ambulance service licensed 18.21under chapter 144E that are directly related to the treatment of an emergency medical 18.22condition;18.23(ii) services delivered in an inpatient hospital setting following admission from an 18.24emergency room or clinic for an acute emergency condition; and18.25(iii) follow-up services that are directly related to the original service provided 18.26to treat the emergency medical condition and are covered by the global payment made 18.27to the provider.18.28    (2) Services for the treatment of emergency medical conditions do not include:18.29(i) services delivered in an emergency room or inpatient setting to treat a 18.30nonemergency condition;18.31(ii) organ transplants, stem cell transplants, and related care;18.32(iii) services for routine prenatal care;18.33(iv) continuing care, including long-term care, nursing facility services, home health 18.34care, adult day care, day training, or supportive living services;18.35(v) elective surgery;19.1(vi) outpatient prescription drugs, unless the drugs are administered or dispensed as 19.2part of an emergency room visit;19.3(vii) preventative health care and family planning services;19.4(viii) dialysis;19.5(ix) chemotherapy or therapeutic radiation services;19.6(x) rehabilitation services;19.7(xi) physical, occupational, or speech therapy;19.8(xii) transportation services;19.9(xiii) case management;19.10(xiv) prosthetics, orthotics, durable medical equipment, or medical supplies;19.11(xv) dental services;19.12(xvi) hospice care;19.13(xvii) audiology services and hearing aids;19.14(xviii) podiatry services;19.15(xix) chiropractic services;19.16(xx) immunizations;19.17(xxi) vision services and eyeglasses;19.18(xxii) waiver services;19.19(xxiii) individualized education programs; or19.20(xxiv) chemical dependency treatment.19.21(i) Beginning July 1, 2009, Pregnant noncitizens who are undocumented, 19.22nonimmigrants, or lawfully present in the United States as defined in Code of Federal 19.23Regulations, title 8, section 103.12, ineligible for federally funded medical assistance 19.24because of immigration status are not covered by a group health plan or health insurance 19.25coverage according to Code of Federal Regulations, title 42, section 457.310, and who 19.26otherwise meet the eligibility requirements of this chapter, are eligible for medical 19.27assistance through the period of pregnancy, including labor and delivery, and 60 days 19.28postpartum, to the extent federal funds are available under title XXI of the Social Security 19.29Act, and the state children's health insurance program.19.30(j) Beginning October 1, 2003, persons who are receiving care and rehabilitation 19.31services from a nonprofit center established to serve victims of torture and are otherwise 19.32ineligible for medical assistance under this chapter are eligible for medical assistance 19.33without federal financial participation. These individuals are eligible only for the period 19.34during which they are receiving services from the center. Individuals eligible under this 19.35paragraph shall not be required to participate in prepaid medical assistance.19.36EFFECTIVE DATE.This section is effective January 1, 2014.20.1    Sec. 24. Minnesota Statutes 2012, section 256B.0755, subdivision 3, is amended to read:20.2    Subd. 3. Accountability. (a) Health care delivery systems must accept responsibility 20.3for the quality of care based on standards established under subdivision 1, paragraph (b), 20.4clause (10), and the cost of care or utilization of services provided to its enrollees under 20.5subdivision 1, paragraph (b), clause (1).20.6(b) A health care delivery system may contract and coordinate with providers and 20.7clinics for the delivery of services and shall contract with community health clinics, 20.8federally qualified health centers, community mental health centers or programs, county 20.9agencies, and rural clinics to the extent practicable.20.10(c) A health care delivery system must demonstrate how its services will be 20.11coordinated with other services affecting its attributed patients' health, quality of care, and 20.12cost of care that are provided by other providers and county agencies in the local service 20.13area. The health care delivery system must document how other providers and counties, 20.14including county-based purchasing plans, will provide services to attributed patients of 20.15the health care delivery system, and how it will address applicable local needs, priorities, 20.16and public health goals. As part of this documentation, the health care delivery system 20.17must describe the involvement of local providers and counties, including county-based 20.18purchasing plans, in developing the application to participate in the demonstration project.20.19EFFECTIVE DATE.This section is effective July 1, 2013, and applies to health 20.20care delivery system contracts entered into on or after that date.20.21    Sec. 25. Minnesota Statutes 2012, section 256B.694, is amended to read:20.22256B.694 SOLE-SOURCE OR SINGLE-PLAN MANAGED CARE 20.23CONTRACT.20.24    (a) MS 2010 [Expired, 2008 c 364 s 10]20.25    (b) The commissioner shall consider, and may approve, contracting on a 20.26single-health plan basis with other county-based purchasing plans, or with other qualified 20.27health plans that have coordination arrangements with counties, to serve persons with a 20.28disability who voluntarily enroll enrolled in state public health care programs, in order 20.29to promote better coordination or integration of health care services, social services and 20.30other community-based services, provided that all requirements applicable to health plan 20.31purchasing, including those in section 
         256B.69, subdivision 23, are satisfied. Nothing in 20.32this paragraph supersedes or modifies the requirements in paragraph (a).21.1    Sec. 26. Minnesota Statutes 2012, section 256L.01, is amended by adding a subdivision 21.2to read:21.3    Subd. 1b.Affordable Care Act. "Affordable Care Act" means Public Law 111-148, 21.4as amended by the federal Health Care and Education Reconciliation Act of 2010, Public 21.5Law 111-152, and any amendments to, or regulations or guidance issued under, those acts.21.6    Sec. 27. Minnesota Statutes 2012, section 256L.01, subdivision 3a, is amended to read:21.7    Subd. 3a. Family with children. (a) "Family with children" means:21.8(1) parents and their children residing in the same household; or21.9(2) grandparents, foster parents, relative caretakers as defined in the medical 21.10assistance program, or legal guardians; and their wards who are children residing in the 21.11same household. "Family" has the meaning given for family and family size as defined 21.12in Code of Federal Regulations, title 26, section 1.36B-1.21.13(b) The term includes children who are temporarily absent from the household in 21.14settings such as schools, camps, or parenting time with noncustodial parents.21.15EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal 21.16approval, whichever is later. The commissioner of human services shall notify the revisor 21.17of statutes when federal approval is obtained.21.18    Sec. 28. Minnesota Statutes 2012, section 256L.01, subdivision 5, is amended to read:21.19    Subd. 5. Income.(a) "Income" has the meaning given for earned and unearned 21.20income for families and children in the medical assistance program, according to the 21.21state's aid to families with dependent children plan in effect as of July 16, 1996. The 21.22definition does not include medical assistance income methodologies and deeming 21.23requirements. The earned income of full-time and part-time students under age 19 is 21.24not counted as income. Public assistance payments and supplemental security income 21.25are not excluded income modified adjusted gross income, as defined in Code of Federal 21.26Regulations, title 26, section 1.36B-1.21.27(b) For purposes of this subdivision, and unless otherwise specified in this section, 21.28the commissioner shall use reasonable methods to calculate gross earned and unearned 21.29income including, but not limited to, projecting income based on income received within 21.30the past 30 days, the last 90 days, or the last 12 months.21.31EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal 21.32approval, whichever is later. The commissioner of human services shall notify the revisor 21.33of statutes when federal approval is obtained.22.1    Sec. 29. Minnesota Statutes 2012, section 256L.01, is amended by adding a subdivision 22.2to read:22.3    Subd. 6.Minnesota Insurance Marketplace."Minnesota Insurance Marketplace" 22.4means the Minnesota Insurance Marketplace as defined in section 62V.02.22.5    Sec. 30. Minnesota Statutes 2012, section 256L.01, is amended by adding a subdivision 22.6to read:22.7    Subd. 7.Participating entity."Participating entity" means a health carrier as 22.8defined in section 62A.01, subdivision 2; a county-based purchasing plan established 22.9under section 256B.692; an accountable care organization or other entity operating a 22.10health care delivery systems demonstration project authorized under section 256B.0755; 22.11an entity operating a county integrated health care delivery network pilot project 22.12authorized under section 256B.0756; or a network of health care providers established to 22.13offer services under MinnesotaCare.22.14EFFECTIVE DATE.This section is effective January 1, 2015.22.15    Sec. 31. Minnesota Statutes 2012, section 256L.02, subdivision 2, is amended to read:22.16    Subd. 2. Commissioner's duties.(a) The commissioner shall establish an office 22.17for the state administration of this plan. The plan shall be used to provide covered health 22.18services for eligible persons. Payment for these services shall be made to all eligible 22.19providers participating entities under contract with the commissioner. The commissioner 22.20shall adopt rules to administer the MinnesotaCare program. The commissioner shall 22.21establish marketing efforts to encourage potentially eligible persons to receive information 22.22about the program and about other medical care programs administered or supervised by 22.23the Department of Human Services.22.24(b) A toll-free telephone number and Web site must be used to provide information 22.25about medical programs and to promote access to the covered services.22.26EFFECTIVE DATE.Paragraph (a) is effective January 1, 2015. Paragraph (b) is 22.27effective January 1, 2014.22.28    Sec. 32. Minnesota Statutes 2012, section 256L.02, is amended by adding a subdivision 22.29to read:22.30    Subd. 6.Federal approval.(a) The commissioner of human services shall seek 22.31federal approval to implement the MinnesotaCare program under this chapter as a basic 22.32health program. In any agreement with the Centers for Medicare and Medicaid Services 23.1to operate MinnesotaCare as a basic health program, the commissioner shall seek to 23.2include procedures to ensure that federal funding is predictable, stable, and sufficient 23.3to sustain ongoing operation of MinnesotaCare. These procedures must address issues 23.4related to the timing of federal payments, payment reconciliation, enrollee risk adjustment, 23.5and minimization of state financial risk. The commissioner shall consult with the 23.6commissioner of management and budget, when developing the proposal for establishing 23.7MinnesotaCare as a basic health program to be submitted to the Centers for Medicare 23.8and Medicaid Services.23.9(b) The commissioner of human services, in consultation with the commissioner 23.10of management and budget, shall work with the Centers for Medicare and Medicaid 23.11Services to establish a process for reconciliation and adjustment of federal payments that 23.12balances state and federal liability over time. The commissioner of human services shall 23.13request that the United States secretary of health and human services hold the state, and 23.14enrollees, harmless in the reconciliation process for the first three years, to allow the state 23.15to develop a statistically valid methodology for predicting enrollment trends and their 23.16net effect on federal payments.23.17(c) The commissioner of human services, through December 31, 2015, may modify 23.18the MinnesotaCare program as specified in this chapter, if it is necessary to enhance 23.19health benefits, expand provider access, or reduce cost-sharing and premiums in order 23.20to comply with the terms and conditions of federal approval as a basic health program. 23.21The commissioner may not reduce benefits, impose greater limits on access to providers, 23.22or increase cost-sharing and premiums by enrollees under the authority granted by this 23.23paragraph. If the commissioner modifies the terms and requirements for MinnesotaCare 23.24under this paragraph, the commissioner shall provide the legislature with notice of 23.25implementation of the modifications at least ten working days before notifying enrollees 23.26and participating entities. The costs of any changes to the program necessary to comply 23.27with federal approval shall not become part of the program's base funding for purposes of 23.28future budget forecasts.23.29EFFECTIVE DATE.This section is effective the day following final enactment.23.30    Sec. 33. Minnesota Statutes 2012, section 256L.02, is amended by adding a subdivision 23.31to read:23.32    Subd. 7.Coordination with Minnesota Insurance Marketplace.MinnesotaCare 23.33shall be considered a public health care program for purposes of chapter 62V.23.34EFFECTIVE DATE.This section is effective January 1, 2014.24.1    Sec. 34. Minnesota Statutes 2012, section 256L.03, subdivision 1, is amended to read:24.2    Subdivision 1. Covered health services. (a) "Covered health services" means the 24.3health services reimbursed under chapter 256B, with the exception of inpatient hospital 24.4services, special education services, private duty nursing services, adult dental care 24.5services other than services covered under section 
         256B.0625, subdivision 9, orthodontic 24.6services, nonemergency medical transportation services, personal care assistance and case 24.7management services, and nursing home or intermediate care facilities services, inpatient 24.8mental health services, and chemical dependency services.24.9    (b) No public funds shall be used for coverage of abortion under MinnesotaCare 24.10except where the life of the female would be endangered or substantial and irreversible 24.11impairment of a major bodily function would result if the fetus were carried to term; or 24.12where the pregnancy is the result of rape or incest.24.13    (c) Covered health services shall be expanded as provided in this section.24.14EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal 24.15approval, whichever is later. The commissioner of human services shall notify the revisor 24.16of statutes when federal approval is obtained.24.17    Sec. 35. Minnesota Statutes 2012, section 256L.03, subdivision 1a, is amended to read:24.18    Subd. 1a. Pregnant women and Children; MinnesotaCare health care reform 24.19waiver.Beginning January 1, 1999, Children and pregnant women are eligible for coverage 24.20of all services that are eligible for reimbursement under the medical assistance program 24.21according to chapter 256B, except that abortion services under MinnesotaCare shall be 24.22limited as provided under subdivision 1. Pregnant women and Children are exempt from 24.23the provisions of subdivision 5, regarding co-payments. Pregnant women and Children 24.24who are lawfully residing in the United States but who are not "qualified noncitizens" under 24.25title IV of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, 24.26Public Law 104-193, Statutes at Large, volume 110, page 2105, are eligible for coverage 24.27of all services provided under the medical assistance program according to chapter 256B.24.28EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal 24.29approval, whichever is later. The commissioner of human services shall notify the revisor 24.30of statutes when federal approval is obtained.24.31    Sec. 36. Minnesota Statutes 2012, section 256L.03, subdivision 3, is amended to read:24.32    Subd. 3. Inpatient hospital services. (a) Covered health services shall include 24.33inpatient hospital services, including inpatient hospital mental health services and inpatient 25.1hospital and residential chemical dependency treatment, subject to those limitations 25.2necessary to coordinate the provision of these services with eligibility under the medical 25.3assistance spenddown. The inpatient hospital benefit for adult enrollees who qualify under 25.4section 256L.04, subdivision 7, or who qualify under section 256L.04, subdivisions 1 and 25.52, with family gross income that exceeds 200 percent of the federal poverty guidelines or 25.6215 percent of the federal poverty guidelines on or after July 1, 2009, and who are not 25.7pregnant, is subject to an annual limit of $10,000.25.8    (b) Admissions for inpatient hospital services paid for under section 
         256L.11, 25.9subdivision 3
         , must be certified as medically necessary in accordance with Minnesota 25.10Rules, parts 9505.0500 to 9505.0540, except as provided in clauses (1) and (2):25.11    (1) all admissions must be certified, except those authorized under rules established 25.12under section 
         254A.03, subdivision 3, or approved under Medicare; and25.13    (2) payment under section 
         256L.11, subdivision 3, shall be reduced by five percent 25.14for admissions for which certification is requested more than 30 days after the day of 25.15admission. The hospital may not seek payment from the enrollee for the amount of the 25.16payment reduction under this clause.25.17EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal 25.18approval, whichever is later. The commissioner of human services shall notify the revisor 25.19of statutes when federal approval is obtained.25.20    Sec. 37. Minnesota Statutes 2012, section 256L.03, is amended by adding a subdivision 25.21to read:25.22    Subd. 4a.Loss ratio.Health coverage provided through the MinnesotaCare 25.23program must have a medical loss ratio of at least 85 percent, as defined using the loss 25.24ratio methodology described in section 1001 of the Affordable Care Act.25.25EFFECTIVE DATE.This section is effective January 1, 2015.25.26    Sec. 38. Minnesota Statutes 2012, section 256L.03, subdivision 5, is amended to read:25.27    Subd. 5. Cost-sharing. (a) Except as otherwise provided in paragraphs (b) and (c)25.28 this subdivision, the MinnesotaCare benefit plan shall include the following cost-sharing 25.29requirements for all enrollees:25.30    (1) ten percent of the paid charges for inpatient hospital services for adult enrollees, 25.31subject to an annual inpatient out-of-pocket maximum of $1,000 per individual;25.32    (2) (1) $3 per prescription for adult enrollees;25.33    (3) (2) $25 for eyeglasses for adult enrollees;26.1    (4) (3) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means 26.2an episode of service which is required because of a recipient's symptoms, diagnosis, or 26.3established illness, and which is delivered in an ambulatory setting by a physician or 26.4physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse, 26.5audiologist, optician, or optometrist;26.6    (5) (4) $6 for nonemergency visits to a hospital-based emergency room for services 26.7provided through December 31, 2010, and $3.50 effective January 1, 2011; and26.8(6) (5) a family deductible equal to the maximum amount allowed under Code of 26.9Federal Regulations, title 42, part 447.54.26.10    (b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of 26.11children under the age of 21.26.12    (c) (b) Paragraph (a) does not apply to pregnant women and children under the 26.13age of 21.26.14    (d) (c) Paragraph (a), clause (4) (3), does not apply to mental health services.26.15    (e) Adult enrollees with family gross income that exceeds 200 percent of the federal 26.16poverty guidelines or 215 percent of the federal poverty guidelines on or after July 1, 2009, 26.17and who are not pregnant shall be financially responsible for the coinsurance amount, if 26.18applicable, and amounts which exceed the $10,000 inpatient hospital benefit limit.26.19    (f) When a MinnesotaCare enrollee becomes a member of a prepaid health plan, 26.20or changes from one prepaid health plan to another during a calendar year, any charges 26.21submitted towards the $10,000 annual inpatient benefit limit, and any out-of-pocket 26.22expenses incurred by the enrollee for inpatient services, that were submitted or incurred 26.23prior to enrollment, or prior to the change in health plans, shall be disregarded.26.24(g) (d) MinnesotaCare reimbursements to fee-for-service providers and payments to 26.25managed care plans or county-based purchasing plans shall not be increased as a result of 26.26the reduction of the co-payments in paragraph (a), clause (5) (4), effective January 1, 2011.26.27(h) (e) The commissioner, through the contracting process under section 
         256L.12, 26.28may allow managed care plans and county-based purchasing plans to waive the family 26.29deductible under paragraph (a), clause (6) (5). The value of the family deductible shall not 26.30be included in the capitation payment to managed care plans and county-based purchasing 26.31plans. Managed care plans and county-based purchasing plans shall certify annually to the 26.32commissioner the dollar value of the family deductible.26.33EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal 26.34approval, whichever is later. The commissioner of human services shall notify the revisor 26.35of statutes when federal approval is obtained.27.1    Sec. 39. Minnesota Statutes 2012, section 256L.03, subdivision 6, is amended to read:27.2    Subd. 6. Lien. When the state agency provides, pays for, or becomes liable for 27.3covered health services, the agency shall have a lien for the cost of the covered health 27.4services upon any and all causes of action accruing to the enrollee, or to the enrollee's 27.5legal representatives, as a result of the occurrence that necessitated the payment for the 27.6covered health services. All liens under this section shall be subject to the provisions 27.7of section 
         256.015. For purposes of this subdivision, "state agency" includes prepaid 27.8health plans participating entities, under contract with the commissioner according to 27.9sections 256B.69, 256D.03, subdivision 4, paragraph (c), and 256L.12; and county-based 27.10purchasing entities under section 256B.692 section 256L.121.27.11EFFECTIVE DATE.This section is effective January 1, 2015.27.12    Sec. 40. Minnesota Statutes 2012, section 256L.04, subdivision 1, is amended to read:27.13    Subdivision 1. Families with children.(a) Families with children with family 27.14income above 133 percent of the federal poverty guidelines and equal to or less than 27.15275 200 percent of the federal poverty guidelines for the applicable family size shall be 27.16eligible for MinnesotaCare according to this section. All other provisions of sections 27.17256L.01
          to 
         256L.18, including the insurance-related barriers to enrollment under section 27.18256L.07, shall apply unless otherwise specified.27.19    (b) Parents who enroll in the MinnesotaCare program must also enroll their children, 27.20if the children are eligible. Children may be enrolled separately without enrollment by 27.21parents. However, if one parent in the household enrolls, both parents must enroll, unless 27.22other insurance is available. If one child from a family is enrolled, all children must 27.23be enrolled, unless other insurance is available. If one spouse in a household enrolls, 27.24the other spouse in the household must also enroll, unless other insurance is available. 27.25Families cannot choose to enroll only certain uninsured members.27.26    (c) Beginning October 1, 2003, the dependent sibling definition no longer applies 27.27to the MinnesotaCare program. These persons are no longer counted in the parental 27.28household and may apply as a separate household.27.29    (d) Parents are not eligible for MinnesotaCare if their gross income exceeds $57,500.27.30(e) Children deemed eligible for MinnesotaCare under section 256L.07, subdivision 27.318, are exempt from the eligibility requirements of this subdivision.27.32EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal 27.33approval, whichever is later. The commissioner of human services shall notify the revisor 27.34of statutes when federal approval is obtained.28.1    Sec. 41. Minnesota Statutes 2012, section 256L.04, is amended by adding a subdivision 28.2to read:28.3    Subd. 1c.General requirements.To be eligible for coverage under MinnesotaCare, 28.4a person must meet the eligibility requirements of this section. A person eligible for 28.5MinnesotaCare shall not be considered a qualified individual under section 1312 of the 28.6Affordable Care Act, and is not eligible for enrollment in a qualified health plan offered 28.7through the Minnesota Insurance Marketplace under chapter 62V.28.8EFFECTIVE DATE.This section is effective January 1, 2014.28.9    Sec. 42. Minnesota Statutes 2012, section 256L.04, subdivision 7, is amended to read:28.10    Subd. 7. Single adults and households with no children.(a) The definition of 28.11eligible persons includes all individuals and households families with no children who 28.12have gross family incomes that are above 133 percent and equal to or less than 200 percent 28.13of the federal poverty guidelines for the applicable family size.28.14    (b) Effective July 1, 2009, the definition of eligible persons includes all individuals 28.15and households with no children who have gross family incomes that are equal to or less 28.16than 250 percent of the federal poverty guidelines.28.17EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal 28.18approval, whichever is later. The commissioner of human services shall notify the revisor 28.19of statutes when federal approval is obtained.28.20    Sec. 43. Minnesota Statutes 2012, section 256L.04, subdivision 8, is amended to read:28.21    Subd. 8. Applicants potentially eligible for medical assistance. (a) Individuals 28.22who receive supplemental security income or retirement, survivors, or disability benefits 28.23due to a disability, or other disability-based pension, who qualify under subdivision 7, but 28.24who are potentially eligible for medical assistance without a spenddown shall be allowed 28.25to enroll in MinnesotaCare for a period of 60 days, so long as the applicant meets all other 28.26conditions of eligibility. The commissioner shall identify and refer the applications of 28.27such individuals to their county social service agency. The county and the commissioner 28.28shall cooperate to ensure that the individuals obtain medical assistance coverage for any 28.29months for which they are eligible.28.30(b) The enrollee must cooperate with the county social service agency in determining 28.31medical assistance eligibility within the 60-day enrollment period. Enrollees who do not 28.32cooperate with medical assistance within the 60-day enrollment period shall be disenrolled 28.33from the plan within one calendar month. Persons disenrolled for nonapplication for 29.1medical assistance may not reenroll until they have obtained a medical assistance 29.2eligibility determination. Persons disenrolled for noncooperation with medical assistance 29.3may not reenroll until they have cooperated with the county agency and have obtained a 29.4medical assistance eligibility determination.29.5(c) Beginning January 1, 2000, Counties that choose to become MinnesotaCare 29.6enrollment sites shall consider MinnesotaCare applications to also be applications for 29.7medical assistance. Applicants who are potentially eligible for medical assistance, except 29.8for those described in paragraph (a), may choose to enroll in either MinnesotaCare or 29.9medical assistance.29.10(d) The commissioner shall redetermine provider payments made under 29.11MinnesotaCare to the appropriate medical assistance payments for those enrollees who 29.12subsequently become eligible for medical assistance.29.13EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal 29.14approval, whichever is later. The commissioner of human services shall notify the revisor 29.15of statutes when federal approval is obtained.29.16    Sec. 44. Minnesota Statutes 2012, section 256L.04, subdivision 10, is amended to read:29.17    Subd. 10. Citizenship requirements.(a) Eligibility for MinnesotaCare is limited to 29.18citizens or nationals of the United States, qualified noncitizens, and other persons residing29.19 lawfully in the United States present noncitizens as defined in Code of Federal Regulations, 29.20title 8, section 103.12. Undocumented noncitizens and nonimmigrants are ineligible for 29.21MinnesotaCare. For purposes of this subdivision, a nonimmigrant is an individual in one 29.22or more of the classes listed in United States Code, title 8, section 1101(a)(15), and an 29.23undocumented noncitizen is an individual who resides in the United States without the 29.24approval or acquiescence of the United States Citizenship and Immigration Services. 29.25Families with children who are citizens or nationals of the United States must cooperate in 29.26obtaining satisfactory documentary evidence of citizenship or nationality according to the 29.27requirements of the federal Deficit Reduction Act of 2005, Public Law 109-171.29.28(b) Notwithstanding subdivisions 1 and 7, eligible persons include families and 29.29individuals who are lawfully present and ineligible for medical assistance by reason of 29.30immigration status and who have incomes equal to or less than 200 percent of federal 29.31poverty guidelines.29.32EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal 29.33approval, whichever is later. The commissioner of human services shall notify the revisor 29.34of statutes when federal approval is obtained.30.1    Sec. 45. Minnesota Statutes 2012, section 256L.04, subdivision 12, is amended to read:30.2    Subd. 12. Persons in detention.Beginning January 1, 1999, An applicant or 30.3enrollee residing in a correctional or detention facility is not eligible for MinnesotaCare, 30.4unless the applicant or enrollee is awaiting disposition of charges. An enrollee residing in 30.5a correctional or detention facility is not eligible at renewal of eligibility under section 30.6256L.05, subdivision 3a.30.7EFFECTIVE DATE.This section is effective January 1, 2014.30.8    Sec. 46. Minnesota Statutes 2012, section 256L.04, is amended by adding a subdivision 30.9to read:30.10    Subd. 14.Coordination with medical assistance.(a) Individuals eligible for 30.11medical assistance under chapter 256B are not eligible for MinnesotaCare under this 30.12section.30.13(b) The commissioner shall coordinate eligibility and coverage to ensure that 30.14individuals transitioning between medical assistance and MinnesotaCare have seamless 30.15eligibility and access to health care services.30.16EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal 30.17approval, whichever is later. The commissioner of human services shall notify the revisor 30.18of statutes when federal approval is obtained.30.19    Sec. 47. Minnesota Statutes 2012, section 256L.05, subdivision 1, is amended to read:30.20    Subdivision 1. Application assistance and information availability. (a) Applicants 30.21may submit applications online, in person, by mail, or by phone in accordance with the 30.22Affordable Care Act, and by any other means by which medical assistance applications 30.23may be submitted. Applicants may submit applications through the Minnesota Insurance 30.24Marketplace or through the MinnesotaCare program. Applications and application 30.25assistance must be made available at provider offices, local human services agencies, 30.26school districts, public and private elementary schools in which 25 percent or more of 30.27the students receive free or reduced price lunches, community health offices, Women, 30.28Infants and Children (WIC) program sites, Head Start program sites, public housing 30.29councils, crisis nurseries, child care centers, early childhood education and preschool 30.30program sites, legal aid offices, and libraries, and at any other locations at which medical 30.31assistance applications must be made available. These sites may accept applications and 30.32forward the forms to the commissioner or local county human services agencies that 31.1choose to participate as an enrollment site. Otherwise, applicants may apply directly to the 31.2commissioner or to participating local county human services agencies.31.3(b) Application assistance must be available for applicants choosing to file an online 31.4application through the Minnesota Insurance Marketplace.31.5EFFECTIVE DATE.This section is effective January 1, 2014.31.6    Sec. 48. Minnesota Statutes 2012, section 256L.05, subdivision 2, is amended to read:31.7    Subd. 2. Commissioner's duties.  The commissioner or county agency shall use 31.8electronic verification through the Minnesota Insurance Marketplace as the primary 31.9method of income verification. If there is a discrepancy between reported income 31.10and electronically verified income, an individual may be required to submit additional 31.11verification to the extent permitted under the Affordable Care Act. In addition, the 31.12commissioner shall perform random audits to verify reported income and eligibility. The 31.13commissioner may execute data sharing arrangements with the Department of Revenue 31.14and any other governmental agency in order to perform income verification related to 31.15eligibility and premium payment under the MinnesotaCare program.31.16EFFECTIVE DATE.This section is effective January 1, 2014.31.17    Sec. 49. Minnesota Statutes 2012, section 256L.05, subdivision 3, is amended to read:31.18    Subd. 3. Effective date of coverage. (a) The effective date of coverage is the 31.19first day of the month following the month in which eligibility is approved and the first 31.20premium payment has been received. As provided in section 256B.057, coverage for 31.21newborns is automatic from the date of birth and must be coordinated with other health 31.22coverage. The effective date of coverage for eligible newly adoptive children added to a 31.23family receiving covered health services is the month of placement. The effective date 31.24of coverage for other new members added to the family is the first day of the month 31.25following the month in which the change is reported. All eligibility criteria must be met 31.26by the family at the time the new family member is added. The income of the new family 31.27member is included with the family's modified adjusted gross income and the adjusted 31.28premium begins in the month the new family member is added.31.29(b) The initial premium must be received by the last working day of the month for 31.30coverage to begin the first day of the following month.31.31(c) Benefits are not available until the day following discharge if an enrollee is 31.32hospitalized on the first day of coverage.32.1(d) (c) Notwithstanding any other law to the contrary, benefits under sections 32.2256L.01
          to 
         256L.18 are secondary to a plan of insurance or benefit program under which 32.3an eligible person may have coverage and the commissioner shall use cost avoidance 32.4techniques to ensure coordination of any other health coverage for eligible persons. The 32.5commissioner shall identify eligible persons who may have coverage or benefits under 32.6other plans of insurance or who become eligible for medical assistance.32.7(e) (d) The effective date of coverage for individuals or families who are exempt 32.8from paying premiums under section 
         256L.15, subdivision 1, paragraph (d), is the first 32.9day of the month following the month in which verification of American Indian status 32.10is received or eligibility is approved, whichever is later.32.11(f) (e) The effective date of coverage for children eligible under section 
         256L.07, 32.12subdivision 8, is the first day of the month following the date of termination from foster 32.13care or release from a juvenile residential correctional facility.32.14EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal 32.15approval, whichever is later. The commissioner of human services shall notify the revisor 32.16of statutes when federal approval is obtained.32.17    Sec. 50. Minnesota Statutes 2012, section 256L.05, subdivision 3c, is amended to read:32.18    Subd. 3c. Retroactive coverage. Notwithstanding subdivision 3, the effective 32.19date of coverage shall be the first day of the month following termination from medical 32.20assistance for families and individuals who are eligible for MinnesotaCare and who 32.21submitted a written request for retroactive MinnesotaCare coverage with a completed 32.22application within 30 days of the mailing of notification of termination from medical 32.23assistance. The applicant must provide all required verifications within 30 days of the 32.24written request for verification. For retroactive coverage, premiums must be paid in full 32.25for any retroactive month, current month, and next month within 30 days of the premium 32.26billing. General assistance medical care recipients may qualify for retroactive coverage 32.27under this subdivision at six-month renewal.32.28EFFECTIVE DATE.This section is effective January 1, 2014.32.29    Sec. 51. Minnesota Statutes 2012, section 256L.06, subdivision 3, is amended to read:32.30    Subd. 3. Commissioner's duties and payment. (a) Premiums are dedicated to the 32.31commissioner for MinnesotaCare.32.32    (b) The commissioner shall develop and implement procedures to: (1) require 32.33enrollees to report changes in income; (2) adjust sliding scale premium payments, based 33.1upon both increases and decreases in enrollee income, at the time the change in income 33.2is reported; and (3) disenroll enrollees from MinnesotaCare for failure to pay required 33.3premiums. Failure to pay includes payment with a dishonored check, a returned automatic 33.4bank withdrawal, or a refused credit card or debit card payment. The commissioner may 33.5demand a guaranteed form of payment, including a cashier's check or a money order, as 33.6the only means to replace a dishonored, returned, or refused payment.33.7    (c) Premiums are calculated on a calendar month basis and may be paid on a 33.8monthly, quarterly, or semiannual basis, with the first payment due upon notice from the 33.9commissioner of the premium amount required. The commissioner shall inform applicants 33.10and enrollees of these premium payment options. Premium payment is required before 33.11enrollment is complete and to maintain eligibility in MinnesotaCare. Premium payments 33.12received before noon are credited the same day. Premium payments received after noon 33.13are credited on the next working day.33.14    (d) Nonpayment of the premium will result in disenrollment from the plan effective 33.15for the calendar month for which the premium was due. Persons disenrolled for 33.16nonpayment or who voluntarily terminate coverage from the program may not reenroll 33.17until four calendar months have elapsed. Persons disenrolled for nonpayment who pay 33.18all past due premiums as well as current premiums due, including premiums due for the 33.19period of disenrollment, within 20 days of disenrollment, shall be reenrolled retroactively 33.20to the first day of disenrollment. Persons disenrolled for nonpayment or who voluntarily 33.21terminate coverage from the program may not reenroll for four calendar months unless 33.22the person demonstrates good cause for nonpayment. Good cause does not exist if a 33.23person chooses to pay other family expenses instead of the premium. The commissioner 33.24shall define good cause in rule.33.25EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal 33.26approval, whichever is later. The commissioner of human services shall notify the revisor 33.27of statutes when federal approval is obtained.33.28    Sec. 52. Minnesota Statutes 2012, section 256L.07, subdivision 1, is amended to read:33.29    Subdivision 1. General requirements.(a) Children enrolled in the original 33.30children's health plan as of September 30, 1992, children who enrolled in the 33.31MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549, 33.32article 4, section 17, and children who have family gross incomes that are equal to or 33.33less than 200 percent of the federal poverty guidelines are eligible without meeting the 33.34requirements of subdivision 2 and the four-month requirement in subdivision 3, as long as 33.35they maintain continuous coverage in the MinnesotaCare program or medical assistance.34.1    Parents Families and individuals enrolled in MinnesotaCare under section 
         256L.04, 34.2subdivision 1
         , whose income increases above 275 200 percent of the federal poverty 34.3guidelines, are no longer eligible for the program and shall be disenrolled by the 34.4commissioner. Beginning January 1, 2008, Individuals enrolled in MinnesotaCare under 34.5section 256L.04, subdivision 7, whose income increases above 200 percent of the federal 34.6poverty guidelines or 250 percent of the federal poverty guidelines on or after July 1, 34.72009, are no longer eligible for the program and shall be disenrolled by the commissioner.34.8 For persons disenrolled under this subdivision, MinnesotaCare coverage terminates the 34.9last day of the calendar month following the month in which the commissioner determines 34.10that the income of a family or individual exceeds program income limits.34.11    (b) Children may remain enrolled in MinnesotaCare if their gross family income as 34.12defined in section 256L.01, subdivision 4, is greater than 275 percent of federal poverty 34.13guidelines. The premium for children remaining eligible under this paragraph shall be the 34.14maximum premium determined under section 256L.15, subdivision 2, paragraph (b).34.15    (c) Notwithstanding paragraph (a), parents are not eligible for MinnesotaCare if 34.16gross household income exceeds $57,500 for the 12-month period of eligibility.34.17EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal 34.18approval, whichever is later. The commissioner of human services shall notify the revisor 34.19of statutes when federal approval is obtained.34.20    Sec. 53. Minnesota Statutes 2012, section 256L.07, subdivision 2, is amended to read:34.21    Subd. 2. Must not have access to employer-subsidized minimum essential34.22 coverage. (a) To be eligible, a family or individual must not have access to subsidized 34.23health coverage through an employer and must not have had access to employer-subsidized 34.24coverage through a current employer for 18 months prior to application or reapplication. 34.25A family or individual whose employer-subsidized coverage is lost due to an employer 34.26terminating health care coverage as an employee benefit during the previous 18 months is 34.27not eligible that is affordable and provides minimum value as defined in Code of Federal 34.28Regulations, title 26, section 1.36B-2.34.29(b) This subdivision does not apply to a family or individual who was enrolled 34.30in MinnesotaCare within six months or less of reapplication and who no longer has 34.31employer-subsidized coverage due to the employer terminating health care coverage as an 34.32employee benefit. This subdivision does not apply to children with family gross incomes 34.33that are equal to or less than 200 percent of federal poverty guidelines.34.34(c) For purposes of this requirement, subsidized health coverage means health 34.35coverage for which the employer pays at least 50 percent of the cost of coverage for 35.1the employee or dependent, or a higher percentage as specified by the commissioner. 35.2Children are eligible for employer-subsidized coverage through either parent, including 35.3the noncustodial parent. The commissioner must treat employer contributions to Internal 35.4Revenue Code Section 125 plans and any other employer benefits intended to pay 35.5health care costs as qualified employer subsidies toward the cost of health coverage for 35.6employees for purposes of this subdivision.35.7EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal 35.8approval, whichever is later. The commissioner of human services shall notify the revisor 35.9of statutes when federal approval is obtained.35.10    Sec. 54. Minnesota Statutes 2012, section 256L.07, subdivision 3, is amended to read:35.11    Subd. 3. Other health coverage. (a) Families and individuals enrolled in the 35.12MinnesotaCare program must have no To be eligible, a family or individual must not have 35.13minimum essential health coverage while enrolled, as defined by section 5000A of the 35.14Internal Revenue Code. Children with family gross incomes equal to or greater than 200 35.15percent of federal poverty guidelines, and adults, must have had no health coverage for 35.16at least four months prior to application and renewal. Children enrolled in the original 35.17children's health plan and children in families with income equal to or less than 200 35.18percent of the federal poverty guidelines, who have other health insurance, are eligible if 35.19the coverage:35.20(1) lacks two or more of the following:35.21(i) basic hospital insurance;35.22(ii) medical-surgical insurance;35.23(iii) prescription drug coverage;35.24(iv) dental coverage; or35.25(v) vision coverage;35.26(2) requires a deductible of $100 or more per person per year; or35.27(3) lacks coverage because the child has exceeded the maximum coverage for a 35.28particular diagnosis or the policy excludes a particular diagnosis.35.29The commissioner may change this eligibility criterion for sliding scale premiums 35.30in order to remain within the limits of available appropriations. The requirement of no 35.31health coverage does not apply to newborns.35.32(b) Coverage purchased as provided under section 256L.031, subdivision 2, medical 35.33assistance, and the Civilian Health and Medical Program of the Uniformed Service, 35.34CHAMPUS, or other coverage provided under United States Code, title 10, subtitle A, 36.1part II, chapter 55, are not considered insurance or health coverage for purposes of the 36.2four-month requirement described in this subdivision.36.3(c) (b) For purposes of this subdivision, an applicant or enrollee who is entitled to 36.4Medicare Part A or enrolled in Medicare Part B coverage under title XVIII of the Social 36.5Security Act, United States Code, title 42, sections 1395c to 1395w-152, is considered 36.6to have minimum essential health coverage. An applicant or enrollee who is entitled to 36.7premium-free Medicare Part A may not refuse to apply for or enroll in Medicare coverage 36.8to establish eligibility for MinnesotaCare.36.9(d) Applicants who were recipients of medical assistance within one month of 36.10application must meet the provisions of this subdivision and subdivision 2.36.11(e) Cost-effective health insurance that was paid for by medical assistance is not 36.12considered health coverage for purposes of the four-month requirement under this 36.13section, except if the insurance continued after medical assistance no longer considered it 36.14cost-effective or after medical assistance closed.36.15EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal 36.16approval, whichever is later. The commissioner of human services shall notify the revisor 36.17of statutes when federal approval is obtained.36.18    Sec. 55. Minnesota Statutes 2012, section 256L.09, subdivision 2, is amended to read:36.19    Subd. 2. Residency requirement. To be eligible for health coverage under the 36.20MinnesotaCare program, pregnant women, individuals, and families with children must 36.21meet the residency requirements as provided by Code of Federal Regulations, title 42, 36.22section 435.403, except that the provisions of section 256B.056, subdivision 1, shall apply 36.23upon receipt of federal approval.36.24EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal 36.25approval, whichever is later. The commissioner of human services shall notify the revisor 36.26of statutes when federal approval is obtained.36.27    Sec. 56. Minnesota Statutes 2012, section 256L.11, subdivision 1, is amended to read:36.28    Subdivision 1. Medical assistance rate to be used.(a) Payment to providers 36.29under sections 256L.01 to 256L.11 this chapter shall be at the same rates and conditions 36.30established for medical assistance, except as provided in subdivisions 2 to 6 this section.36.31(b) Effective for services provided on or after July 1, 2009, total payments for basic 36.32care services shall be reduced by three percent, in accordance with section 256B.766. 37.1Payments made to managed care and county-based purchasing plans shall be reduced for 37.2services provided on or after October 1, 2009, to reflect this reduction.37.3(c) Effective for services provided on or after July 1, 2009, payment rates for 37.4physician and professional services shall be reduced as described under section 256B.76, 37.5subdivision 1, paragraph (c). Payments made to managed care and county-based 37.6purchasing plans shall be reduced for services provided on or after October 1, 2009, 37.7to reflect this reduction.37.8EFFECTIVE DATE.This section is effective January 1, 2014.37.9    Sec. 57. Minnesota Statutes 2012, section 256L.11, subdivision 3, is amended to read:37.10    Subd. 3. Inpatient hospital services. Inpatient hospital services provided under 37.11section 
         256L.03, subdivision 3, shall be paid for as provided in subdivisions 4 to 6 at the 37.12medical assistance rate.37.13EFFECTIVE DATE.This section is effective January 1, 2014.37.14    Sec. 58. [256L.121] SERVICE DELIVERY.37.15    Subdivision 1.Competitive process.The commissioner of human services shall 37.16establish a competitive process for entering into contracts with participating entities for 37.17the offering of standard health plans through MinnesotaCare. Coverage through standard 37.18health plans must be available to enrollees beginning January 1, 2015. Each standard health 37.19plan must cover the health services listed in, and meet the requirements of, section 256L.03. 37.20The competitive process must meet the requirements of section 1331 of the Affordable 37.21Care Act and be designed to ensure enrollee access to high-quality health care coverage 37.22options. The commissioner, to the extent feasible, shall seek to ensure that enrollees have 37.23a choice of coverage from more than one participating entity within a geographic area.37.24    Subd. 2.Other requirements for participating entities.The commissioner shall 37.25require participating entities, as a condition of contract, to document to the commissioner:37.26(1) the provision of culturally and linguistically appropriate services, including 37.27marketing materials, to MinnesotaCare enrollees; and37.28(2) the inclusion in provider networks of providers designated as essential 37.29community providers under section 62Q.19.37.30    Subd. 3.Coordination with state-administered health programs.The 37.31commissioner shall coordinate the administration of the MinnesotaCare program with 37.32medical assistance to maximize efficiency and improve the continuity of care. This 37.33includes, but is not limited to:38.1(1) establishing geographic areas for MinnesotaCare that are consistent with the 38.2geographic areas of the medical assistance program, within which participating entities 38.3may offer health plans;38.4(2) requiring, as a condition of participation in MinnesotaCare, participating entities 38.5to also participate in the medical assistance program;38.6    (3) complying with sections 256B.69, subdivision 3a; 256B.692, subdivision 1; and 38.7256B.694 when contracting with MinnesotaCare participating entities;38.8(4) providing MinnesotaCare enrollees, to the extent possible, with the option to 38.9remain in the same health plan and provider network, if they later become eligible for 38.10medical assistance or coverage through the Minnesota Insurance Marketplace and if, in 38.11the case of becoming eligible for medical assistance, the enrollee's MinnesotaCare health 38.12plan is also a medical assistance health plan in the enrollee's county of residence; and38.13(5) establishing requirements and criteria for selection that ensure that covered 38.14health care services will be coordinated with local public health, social services, long-term 38.15care services, mental health services, and other local services affecting enrollees' health, 38.16access, and quality of care.38.17EFFECTIVE DATE.This section is effective the day following final enactment.38.18    Sec. 59. Minnesota Statutes 2012, section 256L.15, subdivision 1, is amended to read:38.19    Subdivision 1. Premium determination. (a) Families with children and individuals 38.20shall pay a premium determined according to subdivision 2.38.21    (b) Pregnant women and children under age two are exempt from the provisions 38.22of section 256L.06, subdivision 3, paragraph (b), clause (3), requiring disenrollment 38.23for failure to pay premiums. For pregnant women, this exemption continues until the 38.24first day of the month following the 60th day postpartum. Women who remain enrolled 38.25during pregnancy or the postpartum period, despite nonpayment of premiums, shall be 38.26disenrolled on the first of the month following the 60th day postpartum for the penalty 38.27period that otherwise applies under section 256L.06, unless they begin paying premiums.38.28    (c) (b) Members of the military and their families who meet the eligibility criteria 38.29for MinnesotaCare upon eligibility approval made within 24 months following the end 38.30of the member's tour of active duty shall have their premiums paid by the commissioner. 38.31The effective date of coverage for an individual or family who meets the criteria of this 38.32paragraph shall be the first day of the month following the month in which eligibility is 38.33approved. This exemption applies for 12 months.38.34(d)(c) Beginning July 1, 2009, American Indians enrolled in MinnesotaCare and 38.35their families shall have their premiums waived by the commissioner in accordance with 39.1section 5006 of the American Recovery and Reinvestment Act of 2009, Public Law 111-5. 39.2An individual must document status as an American Indian, as defined under Code of 39.3Federal Regulations, title 42, section 
         447.50, to qualify for the waiver of premiums.39.4EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal 39.5approval, whichever is later. The commissioner of human services shall notify the revisor 39.6of statutes when federal approval is obtained.39.7    Sec. 60. Minnesota Statutes 2012, section 256L.15, subdivision 2, is amended to read:39.8    Subd. 2. Sliding fee scale; monthly gross individual or family income. (a) The 39.9commissioner shall establish a sliding fee scale to determine the percentage of monthly39.10gross individual or family income that households at different income levels must pay to 39.11obtain coverage through the MinnesotaCare program. The sliding fee scale must be based 39.12on the enrollee's monthly gross individual or family income. The sliding fee scale must 39.13contain separate tables based on enrollment of one, two, or three or more persons. Until 39.14June 30, 2009, the sliding fee scale begins with a premium of 1.5 percent of monthly gross 39.15individual or family income for individuals or families with incomes below the limits for 39.16the medical assistance program for families and children in effect on January 1, 1999, and 39.17proceeds through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and 39.188.8 percent. These percentages are matched to evenly spaced income steps ranging from 39.19the medical assistance income limit for families and children in effect on January 1, 1999, 39.20to 275200 percent of the federal poverty guidelines for the applicable family size, up to a 39.21family size of five. The sliding fee scale for a family of five must be used for families of 39.22more than five. The sliding fee scale and percentages are not subject to the provisions of 39.23chapter 14. If a family or individual reports increased income after enrollment, premiums 39.24shall be adjusted at the time the change in income is reported.39.25    (b) Children in families whose gross income is above 275 percent of the federal 39.26poverty guidelines shall pay the maximum premium. The maximum premium is defined 39.27as a base charge for one, two, or three or more enrollees so that if all MinnesotaCare 39.28cases paid the maximum premium, the total revenue would equal the total cost of 39.29MinnesotaCare medical coverage and administration. In this calculation, administrative 39.30costs shall be assumed to equal ten percent of the total. The costs of medical coverage 39.31for pregnant women and children under age two and the enrollees in these groups shall 39.32be excluded from the total. The maximum premium for two enrollees shall be twice the 39.33maximum premium for one, and the maximum premium for three or more enrollees shall 39.34be three times the maximum premium for one.40.1    (c)Beginning July 1, 2009,(b) MinnesotaCare enrollees shall pay premiums 40.2according to the premium scale specified in paragraph (d) (c), with the exception that 40.3children in families with income at or below 200 percent of the federal poverty guidelines 40.4shall pay no premiums. For purposes of paragraph (d) (c), "minimum" means a monthly 40.5premium of $4.40.6    (d) the following premium scale is established for individuals and families with 40.7gross family incomes of 275 percent of the federal poverty guidelines or less:

40.8Federal Poverty Guideline RangePercent of Average Gross Monthly Income40.90-45%minimum40.1040.1146-54%$4 or 1.1% of family income, whichever is greater40.1255-81%1.6%40.1382-109%2.2%40.14110-136%2.9%40.15137-164%3.6%40.16165-191%4.6%40.17192-219%5.6%40.18220-248%6.5%40.19249-275%7.2%

40.20(c) Effective January 1, 2014, the following premium scale is established for 40.21individuals and families with incomes of 200 percent of federal poverty guidelines or less:

40.22Federal Poverty Guideline RangePercent of Average Income40.230-45%minimum40.2440.2546-54%$4 or .25% of family income, whichever is greater40.2655-81%.5%40.2782-109%1.0%40.28110-136%1.5%40.29137-164%2.0%40.30165-191%2.5%40.31192-200%3.0%

40.32EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal 40.33approval, whichever is later. The commissioner of human services shall notify the revisor 40.34of statutes when federal approval is obtained.40.35    Sec. 61. Laws 2013, chapter 1, section 1, the effective date, is amended to read:40.36EFFECTIVE DATE.This section is effective January 1, 2014 July 1, 2013.41.1    Sec. 62. DETERMINATION OF FUNDING ADEQUACY FOR 41.2MINNESOTACARE.41.3The commissioners of revenue and management and budget, in consultation with 41.4the commissioner of human services, shall conduct an assessment of health care taxes, 41.5including the gross premiums tax, the provider tax, and Medicaid surcharges, and their 41.6relationship to the long-term solvency of the health care access fund, as part of the state 41.7revenue and expenditure forecast in November 2013. The commissioners shall determine 41.8the amount of state funding that will be required after December 31, 2019, in addition 41.9to the federal payments made available under section 1331 of the Affordable Care Act, 41.10for the MinnesotaCare program. The commissioners shall evaluate the stability and 41.11likelihood of long-term federal funding for the MinnesotaCare program under section 41.121331. The commissioners shall report the results of this assessment to the chairs and 41.13ranking minority members of the legislative committees with jurisdiction over human 41.14services, finances, and taxes by January 15, 2014, along with recommendations for 41.15changes to state revenue for the health care access fund, if state funding continues to 41.16be required beyond December 31, 2019. 41.17    Sec. 63. REVISOR'S INSTRUCTION.41.18The revisor shall remove cross-references to the sections repealed in this act 41.19wherever they appear in Minnesota Statutes and Minnesota Rules and make changes 41.20necessary to correct the punctuation, grammar, or structure of the remaining text and 41.21preserve its meaning.41.22    Sec. 64.  REPEALER.41.23(a) Minnesota Statutes 2012, sections 256L.01, subdivision 4a; 256L.02, subdivision 41.243; 256L.031; 256L.04, subdivisions 1b, 7a, and 9; and 256L.11, subdivisions 2a, 5, and 41.256, are repealed, effective January 1, 2014.41.26(b) Minnesota Statutes 2012, sections 256L.01, subdivision 3; 256L.03, subdivision 41.274; 256L.04, subdivision 2a; 256L.07, subdivisions 1, 4, 5, 8, and 9; 256L.09, subdivisions 41.281, 4, 5, 6, and 7; 256L.12, subdivisions 1, 2, 3, 4, 5, 6, 7, 8, 9a, and 9b; and 256L.17, 41.29subdivisions 1, 2, 3, 4, and 5, are repealed effective January 1, 2015.41.30(c) Minnesota Statutes 2012, sections 256B.055, subdivisions 3, 5, and 10b; 41.31256B.056, subdivision 5b; and 256B.057, subdivisions 1c and 2, are repealed.42.1ARTICLE 242.2CONTINGENT REFORM 2020; REDESIGNING HOME AND 42.3COMMUNITY-BASED SERVICES42.4    Section 1. Minnesota Statutes 2012, section 144.0724, subdivision 4, is amended to read:42.5    Subd. 4. Resident assessment schedule. (a) A facility must conduct and 42.6electronically submit to the commissioner of health case mix assessments that conform 42.7with the assessment schedule defined by Code of Federal Regulations, title 42, section 42.8483.20, and published by the United States Department of Health and Human Services, 42.9Centers for Medicare and Medicaid Services, in the Long Term Care Assessment 42.10Instrument User's Manual, version 3.0, and subsequent updates when issued by the 42.11Centers for Medicare and Medicaid Services. The commissioner of health may substitute 42.12successor manuals or question and answer documents published by the United States 42.13Department of Health and Human Services, Centers for Medicare and Medicaid Services, 42.14to replace or supplement the current version of the manual or document.42.15(b) The assessments used to determine a case mix classification for reimbursement 42.16include the following:42.17(1) a new admission assessment must be completed by day 14 following admission;42.18(2) an annual assessment which must have an assessment reference date (ARD) 42.19within 366 days of the ARD of the last comprehensive assessment;42.20(3) a significant change assessment must be completed within 14 days of the 42.21identification of a significant change; and42.22(4) all quarterly assessments must have an assessment reference date (ARD) within 42.2392 days of the ARD of the previous assessment.42.24(c) In addition to the assessments listed in paragraph (b), the assessments used to 42.25determine nursing facility level of care include the following:42.26(1) preadmission screening completed under section 
         256B.0911, subdivision 4a, by a 42.27county, tribe, or managed care organization under contract with the Department of Human 42.28Services 256.975, subdivision 7a, by the Senior LinkAge Line or Disability Linkage Line 42.29or other organization under contract with the Minnesota Board on Aging; and42.30(2) a nursing facility level of care determination as provided for under section 42.31256B.0911, subdivision 4e, as part of a face-to-face long-term care consultation assessment 42.32completed under section 
         256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or 42.33managed care organization under contract with the Department of Human Services.43.1    Sec. 2. Minnesota Statutes 2012, section 144A.351, is amended to read:43.2144A.351 BALANCING LONG-TERM CARE SERVICES AND SUPPORTS: 43.3REPORT AND STUDY REQUIRED.43.4    Subdivision 1.Report requirements. The commissioners of health and human 43.5services, with the cooperation of counties and in consultation with stakeholders, including 43.6persons who need or are using long-term care services and supports, lead agencies, 43.7regional entities, senior, disability, and mental health organization representatives, service 43.8providers, and community members shall prepare a report to the legislature by August 15, 43.92013, and biennially thereafter, regarding the status of the full range of long-term care 43.10services and supports for the elderly and children and adults with disabilities and mental 43.11illnesses in Minnesota. The report shall address:43.12    (1) demographics and need for long-term care services and supports in Minnesota;43.13    (2) summary of county and regional reports on long-term care gaps, surpluses, 43.14imbalances, and corrective action plans;43.15    (3) status of long-term care services and related mental health services, housing 43.16options, and supports by county and region including:43.17    (i) changes in availability of the range of long-term care services and housing options;43.18    (ii) access problems, including access to the least restrictive and most integrated 43.19services and settings, regarding long-term care services; and43.20    (iii) comparative measures of long-term care services availability, including serving 43.21people in their home areas near family, and changes over time; and43.22    (4) recommendations regarding goals for the future of long-term care services and 43.23supports, policy and fiscal changes, and resource development and transition needs.43.24    Subd. 2.Critical access study.The commissioner shall conduct a onetime study to 43.25assess local capacity and availability of home and community-based services for older 43.26adults, people with disabilities, and people with mental illnesses. The study must assess 43.27critical access at the community level and identify potential strategies to build home and 43.28community-based service capacity in critical access areas. The report shall be submitted 43.29to the legislature no later than August 15, 2015.43.30    Sec. 3. Minnesota Statutes 2012, section 148E.065, subdivision 4a, is amended to read:43.31    Subd. 4a. City, county, and state social workers. (a) Beginning July 1, 2016, the 43.32licensure of city, county, and state agency social workers is voluntary, except an individual 43.33who is newly employed by a city or state agency after July 1, 2016, must be licensed 43.34if the individual who provides social work services, as those services are defined in 44.1section 
         148E.010, subdivision 11, paragraph (b), is presented to the public by any title 44.2incorporating the words "social work" or "social worker."44.3(b) City, county, and state agencies employing social workers and staff who are 44.4designated to perform mandated duties under sections 256.975, subdivisions 7 to 7c and 44.5256.01, subdivision 24, are not required to employ licensed social workers.44.6    Sec. 4. Minnesota Statutes 2012, section 256.01, subdivision 2, is amended to read:44.7    Subd. 2. Specific powers. Subject to the provisions of section 
         241.021, subdivision 44.82
         , the commissioner of human services shall carry out the specific duties in paragraphs (a) 44.9through (cc) (dd):44.10    (a) Administer and supervise all forms of public assistance provided for by state law 44.11and other welfare activities or services as are vested in the commissioner. Administration 44.12and supervision of human services activities or services includes, but is not limited to, 44.13assuring timely and accurate distribution of benefits, completeness of service, and quality 44.14program management. In addition to administering and supervising human services 44.15activities vested by law in the department, the commissioner shall have the authority to:44.16    (1) require county agency participation in training and technical assistance programs 44.17to promote compliance with statutes, rules, federal laws, regulations, and policies 44.18governing human services;44.19    (2) monitor, on an ongoing basis, the performance of county agencies in the 44.20operation and administration of human services, enforce compliance with statutes, rules, 44.21federal laws, regulations, and policies governing welfare services and promote excellence 44.22of administration and program operation;44.23    (3) develop a quality control program or other monitoring program to review county 44.24performance and accuracy of benefit determinations;44.25    (4) require county agencies to make an adjustment to the public assistance benefits 44.26issued to any individual consistent with federal law and regulation and state law and rule 44.27and to issue or recover benefits as appropriate;44.28    (5) delay or deny payment of all or part of the state and federal share of benefits and 44.29administrative reimbursement according to the procedures set forth in section 
         256.017;44.30    (6) make contracts with and grants to public and private agencies and organizations, 44.31both profit and nonprofit, and individuals, using appropriated funds; and44.32    (7) enter into contractual agreements with federally recognized Indian tribes with 44.33a reservation in Minnesota to the extent necessary for the tribe to operate a federally 44.34approved family assistance program or any other program under the supervision of the 44.35commissioner. The commissioner shall consult with the affected county or counties in 45.1the contractual agreement negotiations, if the county or counties wish to be included, 45.2in order to avoid the duplication of county and tribal assistance program services. The 45.3commissioner may establish necessary accounts for the purposes of receiving and 45.4disbursing funds as necessary for the operation of the programs.45.5    (b) Inform county agencies, on a timely basis, of changes in statute, rule, federal law, 45.6regulation, and policy necessary to county agency administration of the programs.45.7    (c) Administer and supervise all child welfare activities; promote the enforcement of 45.8laws protecting disabled, dependent, neglected and delinquent children, and children born 45.9to mothers who were not married to the children's fathers at the times of the conception 45.10nor at the births of the children; license and supervise child-caring and child-placing 45.11agencies and institutions; supervise the care of children in boarding and foster homes or 45.12in private institutions; and generally perform all functions relating to the field of child 45.13welfare now vested in the State Board of Control.45.14    (d) Administer and supervise all noninstitutional service to disabled persons, 45.15including those who are visually impaired, hearing impaired, or physically impaired 45.16or otherwise disabled. The commissioner may provide and contract for the care and 45.17treatment of qualified indigent children in facilities other than those located and available 45.18at state hospitals when it is not feasible to provide the service in state hospitals.45.19    (e) Assist and actively cooperate with other departments, agencies and institutions, 45.20local, state, and federal, by performing services in conformity with the purposes of Laws 45.211939, chapter 431.45.22    (f) Act as the agent of and cooperate with the federal government in matters of 45.23mutual concern relative to and in conformity with the provisions of Laws 1939, chapter 45.24431, including the administration of any federal funds granted to the state to aid in the 45.25performance of any functions of the commissioner as specified in Laws 1939, chapter 431, 45.26and including the promulgation of rules making uniformly available medical care benefits 45.27to all recipients of public assistance, at such times as the federal government increases its 45.28participation in assistance expenditures for medical care to recipients of public assistance, 45.29the cost thereof to be borne in the same proportion as are grants of aid to said recipients.45.30    (g) Establish and maintain any administrative units reasonably necessary for the 45.31performance of administrative functions common to all divisions of the department.45.32    (h) Act as designated guardian of both the estate and the person of all the wards of 45.33the state of Minnesota, whether by operation of law or by an order of court, without any 45.34further act or proceeding whatever, except as to persons committed as developmentally 45.35disabled. For children under the guardianship of the commissioner or a tribe in Minnesota 45.36recognized by the Secretary of the Interior whose interests would be best served by 46.1adoptive placement, the commissioner may contract with a licensed child-placing agency 46.2or a Minnesota tribal social services agency to provide adoption services. A contract 46.3with a licensed child-placing agency must be designed to supplement existing county 46.4efforts and may not replace existing county programs or tribal social services, unless the 46.5replacement is agreed to by the county board and the appropriate exclusive bargaining 46.6representative, tribal governing body, or the commissioner has evidence that child 46.7placements of the county continue to be substantially below that of other counties. Funds 46.8encumbered and obligated under an agreement for a specific child shall remain available 46.9until the terms of the agreement are fulfilled or the agreement is terminated.46.10    (i) Act as coordinating referral and informational center on requests for service for 46.11newly arrived immigrants coming to Minnesota.46.12    (j) The specific enumeration of powers and duties as hereinabove set forth shall in no 46.13way be construed to be a limitation upon the general transfer of powers herein contained.46.14    (k) Establish county, regional, or statewide schedules of maximum fees and charges 46.15which may be paid by county agencies for medical, dental, surgical, hospital, nursing and 46.16nursing home care and medicine and medical supplies under all programs of medical 46.17care provided by the state and for congregate living care under the income maintenance 46.18programs.46.19    (l) Have the authority to conduct and administer experimental projects to test methods 46.20and procedures of administering assistance and services to recipients or potential recipients 46.21of public welfare. To carry out such experimental projects, it is further provided that the 46.22commissioner of human services is authorized to waive the enforcement of existing specific 46.23statutory program requirements, rules, and standards in one or more counties. The order 46.24establishing the waiver shall provide alternative methods and procedures of administration, 46.25shall not be in conflict with the basic purposes, coverage, or benefits provided by law, and 46.26in no event shall the duration of a project exceed four years. It is further provided that no 46.27order establishing an experimental project as authorized by the provisions of this section 46.28shall become effective until the following conditions have been met:46.29    (1) the secretary of health and human services of the United States has agreed, for 46.30the same project, to waive state plan requirements relative to statewide uniformity; and46.31    (2) a comprehensive plan, including estimated project costs, shall be approved by 46.32the Legislative Advisory Commission and filed with the commissioner of administration.46.33    (m) According to federal requirements, establish procedures to be followed by 46.34local welfare boards in creating citizen advisory committees, including procedures for 46.35selection of committee members.47.1    (n) Allocate federal fiscal disallowances or sanctions which are based on quality 47.2control error rates for the aid to families with dependent children program formerly 47.3codified in sections 
         256.72 to 
         256.87, medical assistance, or food stamp program in the 47.4following manner:47.5    (1) one-half of the total amount of the disallowance shall be borne by the county 47.6boards responsible for administering the programs. For the medical assistance and the 47.7AFDC program formerly codified in sections 
         256.72 to 
         256.87, disallowances shall be 47.8shared by each county board in the same proportion as that county's expenditures for the 47.9sanctioned program are to the total of all counties' expenditures for the AFDC program 47.10formerly codified in sections 
         256.72 to 
         256.87, and medical assistance programs. For the 47.11food stamp program, sanctions shall be shared by each county board, with 50 percent of 47.12the sanction being distributed to each county in the same proportion as that county's 47.13administrative costs for food stamps are to the total of all food stamp administrative costs 47.14for all counties, and 50 percent of the sanctions being distributed to each county in the 47.15same proportion as that county's value of food stamp benefits issued are to the total of 47.16all benefits issued for all counties. Each county shall pay its share of the disallowance 47.17to the state of Minnesota. When a county fails to pay the amount due hereunder, the 47.18commissioner may deduct the amount from reimbursement otherwise due the county, or 47.19the attorney general, upon the request of the commissioner, may institute civil action 47.20to recover the amount due; and47.21    (2) notwithstanding the provisions of clause (1), if the disallowance results from 47.22knowing noncompliance by one or more counties with a specific program instruction, and 47.23that knowing noncompliance is a matter of official county board record, the commissioner 47.24may require payment or recover from the county or counties, in the manner prescribed in 47.25clause (1), an amount equal to the portion of the total disallowance which resulted from the 47.26noncompliance, and may distribute the balance of the disallowance according to clause (1).47.27    (o) Develop and implement special projects that maximize reimbursements and 47.28result in the recovery of money to the state. For the purpose of recovering state money, 47.29the commissioner may enter into contracts with third parties. Any recoveries that result 47.30from projects or contracts entered into under this paragraph shall be deposited in the 47.31state treasury and credited to a special account until the balance in the account reaches 47.32$1,000,000. When the balance in the account exceeds $1,000,000, the excess shall be 47.33transferred and credited to the general fund. All money in the account is appropriated to 47.34the commissioner for the purposes of this paragraph.47.35    (p) Have the authority to make direct payments to facilities providing shelter 47.36to women and their children according to section 
         256D.05, subdivision 3. Upon 48.1the written request of a shelter facility that has been denied payments under section 48.2256D.05, subdivision 3
         , the commissioner shall review all relevant evidence and make 48.3a determination within 30 days of the request for review regarding issuance of direct 48.4payments to the shelter facility. Failure to act within 30 days shall be considered a 48.5determination not to issue direct payments.48.6    (q) Have the authority to establish and enforce the following county reporting 48.7requirements:48.8    (1) the commissioner shall establish fiscal and statistical reporting requirements 48.9necessary to account for the expenditure of funds allocated to counties for human 48.10services programs. When establishing financial and statistical reporting requirements, the 48.11commissioner shall evaluate all reports, in consultation with the counties, to determine if 48.12the reports can be simplified or the number of reports can be reduced;48.13    (2) the county board shall submit monthly or quarterly reports to the department 48.14as required by the commissioner. Monthly reports are due no later than 15 working days 48.15after the end of the month. Quarterly reports are due no later than 30 calendar days after 48.16the end of the quarter, unless the commissioner determines that the deadline must be 48.17shortened to 20 calendar days to avoid jeopardizing compliance with federal deadlines 48.18or risking a loss of federal funding. Only reports that are complete, legible, and in the 48.19required format shall be accepted by the commissioner;48.20    (3) if the required reports are not received by the deadlines established in clause (2), 48.21the commissioner may delay payments and withhold funds from the county board until 48.22the next reporting period. When the report is needed to account for the use of federal 48.23funds and the late report results in a reduction in federal funding, the commissioner shall 48.24withhold from the county boards with late reports an amount equal to the reduction in 48.25federal funding until full federal funding is received;48.26    (4) a county board that submits reports that are late, illegible, incomplete, or not 48.27in the required format for two out of three consecutive reporting periods is considered 48.28noncompliant. When a county board is found to be noncompliant, the commissioner 48.29shall notify the county board of the reason the county board is considered noncompliant 48.30and request that the county board develop a corrective action plan stating how the 48.31county board plans to correct the problem. The corrective action plan must be submitted 48.32to the commissioner within 45 days after the date the county board received notice 48.33of noncompliance;48.34    (5) the final deadline for fiscal reports or amendments to fiscal reports is one year 48.35after the date the report was originally due. If the commissioner does not receive a report 48.36by the final deadline, the county board forfeits the funding associated with the report for 49.1that reporting period and the county board must repay any funds associated with the 49.2report received for that reporting period;49.3    (6) the commissioner may not delay payments, withhold funds, or require repayment 49.4under clause (3) or (5) if the county demonstrates that the commissioner failed to 49.5provide appropriate forms, guidelines, and technical assistance to enable the county to 49.6comply with the requirements. If the county board disagrees with an action taken by the 49.7commissioner under clause (3) or (5), the county board may appeal the action according 49.8to sections 
         14.57 to 
         14.69; and49.9    (7) counties subject to withholding of funds under clause (3) or forfeiture or 49.10repayment of funds under clause (5) shall not reduce or withhold benefits or services to 49.11clients to cover costs incurred due to actions taken by the commissioner under clause 49.12(3) or (5).49.13    (r) Allocate federal fiscal disallowances or sanctions for audit exceptions when 49.14federal fiscal disallowances or sanctions are based on a statewide random sample in direct 49.15proportion to each county's claim for that period.49.16    (s) Be responsible for ensuring the detection, prevention, investigation, and 49.17resolution of fraudulent activities or behavior by applicants, recipients, and other 49.18participants in the human services programs administered by the department.49.19    (t) Require county agencies to identify overpayments, establish claims, and utilize 49.20all available and cost-beneficial methodologies to collect and recover these overpayments 49.21in the human services programs administered by the department.49.22    (u) Have the authority to administer a drug rebate program for drugs purchased 49.23pursuant to the prescription drug program established under section 
         256.955 after the 49.24beneficiary's satisfaction of any deductible established in the program. The commissioner 49.25shall require a rebate agreement from all manufacturers of covered drugs as defined in 49.26section 
         256B.0625, subdivision 13. Rebate agreements for prescription drugs delivered on 49.27or after July 1, 2002, must include rebates for individuals covered under the prescription 49.28drug program who are under 65 years of age. For each drug, the amount of the rebate shall 49.29be equal to the rebate as defined for purposes of the federal rebate program in United 49.30States Code, title 42, section 1396r-8. The manufacturers must provide full payment 49.31within 30 days of receipt of the state invoice for the rebate within the terms and conditions 49.32used for the federal rebate program established pursuant to section 1927 of title XIX of 49.33the Social Security Act. The manufacturers must provide the commissioner with any 49.34information necessary to verify the rebate determined per drug. The rebate program shall 49.35utilize the terms and conditions used for the federal rebate program established pursuant to 49.36section 1927 of title XIX of the Social Security Act.50.1    (v) Have the authority to administer the federal drug rebate program for drugs 50.2purchased under the medical assistance program as allowed by section 1927 of title XIX 50.3of the Social Security Act and according to the terms and conditions of section 1927. 50.4Rebates shall be collected for all drugs that have been dispensed or administered in an 50.5outpatient setting and that are from manufacturers who have signed a rebate agreement 50.6with the United States Department of Health and Human Services.50.7    (w) Have the authority to administer a supplemental drug rebate program for drugs 50.8purchased under the medical assistance program. The commissioner may enter into 50.9supplemental rebate contracts with pharmaceutical manufacturers and may require prior 50.10authorization for drugs that are from manufacturers that have not signed a supplemental 50.11rebate contract. Prior authorization of drugs shall be subject to the provisions of section 50.12256B.0625, subdivision 13
         .50.13    (x) Operate the department's communication systems account established in Laws 50.141993, First Special Session chapter 1, article 1, section 2, subdivision 2, to manage shared 50.15communication costs necessary for the operation of the programs the commissioner 50.16supervises. A communications account may also be established for each regional 50.17treatment center which operates communications systems. Each account must be used 50.18to manage shared communication costs necessary for the operations of the programs the 50.19commissioner supervises. The commissioner may distribute the costs of operating and 50.20maintaining communication systems to participants in a manner that reflects actual usage. 50.21Costs may include acquisition, licensing, insurance, maintenance, repair, staff time and 50.22other costs as determined by the commissioner. Nonprofit organizations and state, county, 50.23and local government agencies involved in the operation of programs the commissioner 50.24supervises may participate in the use of the department's communications technology and 50.25share in the cost of operation. The commissioner may accept on behalf of the state any 50.26gift, bequest, devise or personal property of any kind, or money tendered to the state for 50.27any lawful purpose pertaining to the communication activities of the department. Any 50.28money received for this purpose must be deposited in the department's communication 50.29systems accounts. Money collected by the commissioner for the use of communication 50.30systems must be deposited in the state communication systems account and is appropriated 50.31to the commissioner for purposes of this section.50.32    (y) Receive any federal matching money that is made available through the medical 50.33assistance program for the consumer satisfaction survey. Any federal money received for 50.34the survey is appropriated to the commissioner for this purpose. The commissioner may 50.35expend the federal money received for the consumer satisfaction survey in either year of 50.36the biennium.51.1    (z) Designate community information and referral call centers and incorporate 51.2cost reimbursement claims from the designated community information and referral 51.3call centers into the federal cost reimbursement claiming processes of the department 51.4according to federal law, rule, and regulations. Existing information and referral centers 51.5provided by Greater Twin Cities United Way or existing call centers for which Greater 51.6Twin Cities United Way has legal authority to represent, shall be included in these 51.7designations upon review by the commissioner and assurance that these services are 51.8accredited and in compliance with national standards. Any reimbursement is appropriated 51.9to the commissioner and all designated information and referral centers shall receive 51.10payments according to normal department schedules established by the commissioner 51.11upon final approval of allocation methodologies from the United States Department of 51.12Health and Human Services Division of Cost Allocation or other appropriate authorities.51.13    (aa) Develop recommended standards for foster care homes that address the 51.14components of specialized therapeutic services to be provided by foster care homes with 51.15those services.51.16    (bb) Authorize the method of payment to or from the department as part of the 51.17human services programs administered by the department. This authorization includes the 51.18receipt or disbursement of funds held by the department in a fiduciary capacity as part of 51.19the human services programs administered by the department.51.20    (cc) Have the authority to administer a drug rebate program for drugs purchased for 51.21persons eligible for general assistance medical care under section 
         256D.03, subdivision 3. 51.22For manufacturers that agree to participate in the general assistance medical care rebate 51.23program, the commissioner shall enter into a rebate agreement for covered drugs as 51.24defined in section 
         256B.0625, subdivisions 13 and 13d. For each drug, the amount of the 51.25rebate shall be equal to the rebate as defined for purposes of the federal rebate program in 51.26United States Code, title 42, section 1396r-8. The manufacturers must provide payment 51.27within the terms and conditions used for the federal rebate program established under 51.28section 1927 of title XIX of the Social Security Act. The rebate program shall utilize 51.29the terms and conditions used for the federal rebate program established under section 51.301927 of title XIX of the Social Security Act.51.31    Effective January 1, 2006, drug coverage under general assistance medical care shall 51.32be limited to those prescription drugs that:51.33    (1) are covered under the medical assistance program as described in section 51.34256B.0625, subdivisions 13 and 13d
         ; and51.35    (2) are provided by manufacturers that have fully executed general assistance 51.36medical care rebate agreements with the commissioner and comply with such agreements. 52.1Prescription drug coverage under general assistance medical care shall conform to 52.2coverage under the medical assistance program according to section 
         256B.0625, 52.3subdivisions 13 to 13g
         .52.4    The rebate revenues collected under the drug rebate program are deposited in the 52.5general fund.52.6(dd) Designate the agencies that operate the Senior LinkAge Line under section 52.7256.975, subdivision 7, and the Disability Linkage Line under subdivision 24 as the state 52.8of Minnesota Aging and the Disability Resource Centers under United States Code, title 52.942, section 3001, the Older Americans Act Amendments of 2006, and incorporate cost 52.10reimbursement claims from the designated centers into the federal cost reimbursement 52.11claiming processes of the department according to federal law, rule, and regulations. Any 52.12reimbursement must be appropriated to the commissioner and all Aging and Disability 52.13Resource Center designated agencies shall receive payments of grant funding that supports 52.14the activity and generates the federal financial participation according to Board on Aging 52.15administrative granting mechanisms.52.16    Sec. 5. Minnesota Statutes 2012, section 256.01, subdivision 24, is amended to read:52.17    Subd. 24. Disability Linkage Line. The commissioner shall establish the Disability 52.18Linkage Line, towhich shall serve people with disabilities as the designated Aging and 52.19Disability Resource Center under United States Code, title 42, section 3001, the Older 52.20Americans Act Amendments of 2006, in partnership with the Senior LinkAge Line and 52.21shall serve as Minnesota's neutral access point for statewide disability information and 52.22assistance and must be available during business hours through a statewide toll-free 52.23number and the Internet. The Disability Linkage Line shall:52.24(1) deliver information and assistance based on national and state standards;52.25    (2) provide information about state and federal eligibility requirements, benefits, 52.26and service options;52.27(3) provide benefits and options counseling;52.28    (4) make referrals to appropriate support entities;52.29    (5) educate people on their options so they can make well-informed choices and link 52.30them to quality profiles;52.31    (6) help support the timely resolution of service access and benefit issues;52.32(7) inform people of their long-term community services and supports;52.33(8) provide necessary resources and supports that can lead to employment and 52.34increased economic stability of people with disabilities; and53.1(9) serve as the technical assistance and help center for the Web-based tool, 53.2Minnesota's Disability Benefits 101.org.; and53.3(10) provide preadmission screening for individuals under 60 years of age using 53.4the procedures as defined in section 256.975, subdivisions 7a to 7c, and 256B.0911, 53.5subdivision 4d.53.6    Sec. 6. Minnesota Statutes 2012, section 256.975, subdivision 7, is amended to read:53.7    Subd. 7. Consumer information and assistance and long-term care options 53.8counseling; Senior LinkAge Line. (a) The Minnesota Board on Aging shall operate a 53.9statewide service to aid older Minnesotans and their families in making informed choices 53.10about long-term care options and health care benefits. Language services to persons 53.11with limited English language skills may be made available. The service, known as 53.12Senior LinkAge Line, shall serve older adults as the designated Aging and Disability 53.13Resource Center under United States Code, title 42, section 3001, the Older Americans 53.14Act Amendments of 2006, in partnership with the Disability LinkAge Line under section 53.15256.01, subdivision 24, and must be available during business hours through a statewide 53.16toll-free number and must also be available through the Internet. The Minnesota Board 53.17on Aging shall consult with, and when appropriate work through, the area agencies on 53.18aging to provide and maintain the telephone infrastructure and related support for the 53.19Aging and Disability Resource Center partners that agree by memorandum to access the 53.20infrastructure, including the designated providers of the Senior LinkAge Line and the 53.21Disability Linkage Line.53.22    (b) The service must provide long-term care options counseling by assisting older 53.23adults, caregivers, and providers in accessing information and options counseling about 53.24choices in long-term care services that are purchased through private providers or available 53.25through public options. The service must:53.26    (1) develop a comprehensive database that includes detailed listings in both 53.27consumer- and provider-oriented formats;53.28    (2) make the database accessible on the Internet and through other telecommunication 53.29and media-related tools;53.30    (3) link callers to interactive long-term care screening tools and make these tools 53.31available through the Internet by integrating the tools with the database;53.32    (4) develop community education materials with a focus on planning for long-term 53.33care and evaluating independent living, housing, and service options;53.34    (5) conduct an outreach campaign to assist older adults and their caregivers in 53.35finding information on the Internet and through other means of communication;54.1    (6) implement a messaging system for overflow callers and respond to these callers 54.2by the next business day;54.3    (7) link callers with county human services and other providers to receive more 54.4in-depth assistance and consultation related to long-term care options;54.5    (8) link callers with quality profiles for nursing facilities and other home and 54.6community-based services providers developed by the commissioner commissioners of 54.7health and human services;54.8    (9) incorporate information about the availability of housing options, as well as 54.9registered housing with services and consumer rights within the MinnesotaHelp.info 54.10network long-term care database to facilitate consumer comparison of services and costs 54.11among housing with services establishments and with other in-home services and to 54.12support financial self-sufficiency as long as possible. Housing with services establishments 54.13and their arranged home care providers shall provide information that will facilitate price 54.14comparisons, including delineation of charges for rent and for services available. The 54.15commissioners of health and human services shall align the data elements required by 54.16section 
         144G.06, the Uniform Consumer Information Guide, and this section to provide 54.17consumers standardized information and ease of comparison of long-term care options. 54.18The commissioner of human services shall provide the data to the Minnesota Board on 54.19Aging for inclusion in the MinnesotaHelp.info network long-term care database;54.20(10) provide long-term care options counseling. Long-term care options counselors 54.21shall:54.22(i) for individuals not eligible for case management under a public program or public 54.23funding source, provide interactive decision support under which consumers, family 54.24members, or other helpers are supported in their deliberations to determine appropriate 54.25long-term care choices in the context of the consumer's needs, preferences, values, and 54.26individual circumstances, including implementing a community support plan;54.27(ii) provide Web-based educational information and collateral written materials to 54.28familiarize consumers, family members, or other helpers with the long-term care basics, 54.29issues to be considered, and the range of options available in the community;54.30(iii) provide long-term care futures planning, which means providing assistance to 54.31individuals who anticipate having long-term care needs to develop a plan for the more 54.32distant future; and54.33(iv) provide expertise in benefits and financing options for long-term care, including 54.34Medicare, long-term care insurance, tax or employer-based incentives, reverse mortgages, 54.35private pay options, and ways to access low or no-cost services or benefits through 54.36volunteer-based or charitable programs;55.1(11) using risk management and support planning protocols, provide long-term care 55.2options counseling to current residents of nursing homes deemed appropriate for discharge 55.3by the commissioner and older adults who request service after consultation with the 55.4Senior LinkAge Line under clause (12). In order to meet this requirement, The Senior 55.5LinkAge Line shall also receive referrals from the residents or staff of nursing homes. The 55.6Senior LinkAge Line shall identify and contact residents deemed appropriate for discharge 55.7by developing targeting criteria in consultation with the commissioner who shall provide 55.8designated Senior LinkAge Line contact centers with a list of nursing home residents that 55.9meet the criteria as being appropriate for discharge planning via a secure Web portal. 55.10Senior LinkAge Line shall provide these residents, if they indicate a preference to 55.11receive long-term care options counseling, with initial assessment, review of risk factors, 55.12independent living support consultation, or and, if appropriate, a referral to:55.13(i) long-term care consultation services under section 
         256B.0911;55.14(ii) designated care coordinators of contracted entities under section 
         256B.035 for 55.15persons who are enrolled in a managed care plan; or55.16(iii) the long-term care consultation team for those who are appropriate eligible55.17 for relocation service coordination due to high-risk factors or psychological or physical 55.18disability; and55.19(12) develop referral protocols and processes that will assist certified health care 55.20homes and hospitals to identify at-risk older adults and determine when to refer these 55.21individuals to the Senior LinkAge Line for long-term care options counseling under this 55.22section. The commissioner is directed to work with the commissioner of health to develop 55.23protocols that would comply with the health care home designation criteria and protocols 55.24available at the time of hospital discharge. The commissioner shall keep a record of the 55.25number of people who choose long-term care options counseling as a result of this section.55.26    Sec. 7. Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision 55.27to read:55.28    Subd. 7a.Preadmission screening activities related to nursing facility 55.29admissions.(a) All individuals seeking admission to Medicaid certified nursing facilities, 55.30including certified boarding care facilities, must be screened prior to admission regardless 55.31of income, assets, or funding sources for nursing facility care, except as described in 55.32subdivision 7b, paragraphs (a) and (b). The purpose of the screening is to determine the 55.33need for nursing facility level of care as described in section 256B.0911, subdivision 55.344e, and to complete activities required under federal law related to mental illness and 55.35developmental disability as outlined in paragraph (b).56.1(b) A person who has a diagnosis or possible diagnosis of mental illness or 56.2developmental disability must receive a preadmission screening before admission 56.3regardless of the exemptions outlined in subdivision 7b, paragraphs (a) and (b), to identify 56.4the need for further evaluation and specialized services, unless the admission prior to 56.5screening is authorized by the local mental health authority or the local developmental 56.6disabilities case manager, or unless authorized by the county agency according to Public 56.7Law 101-508.56.8(c) The following criteria apply to the preadmission screening:56.9(1) requests for preadmission screenings must be submitted via an online form 56.10developed by the commissioner;56.11(2) the Senior LinkAge Line must use forms and criteria developed by the 56.12commissioner to identify persons who require referral for further evaluation and 56.13determination of the need for specialized services; and56.14(3) the evaluation and determination of the need for specialized services must be 56.15done by:56.16(i) a qualified independent mental health professional, for persons with a primary or 56.17secondary diagnosis of a serious mental illness; or56.18(ii) a qualified developmental disability professional, for persons with a primary or 56.19secondary diagnosis of developmental disability. For purposes of this requirement, a 56.20qualified developmental disability professional must meet the standards for a qualified 56.21developmental disability professional under Code of Federal Regulations, title 42, section 56.22483.430.56.23(d) The local county mental health authority or the state developmental disability 56.24authority under Public Law Numbers 100-203 and 101-508 may prohibit admission to a 56.25nursing facility if the individual does not meet the nursing facility level of care criteria or 56.26needs specialized services as defined in Public Law Numbers 100-203 and 101-508. For 56.27purposes of this section, "specialized services" for a person with developmental disability 56.28means active treatment as that term is defined under Code of Federal Regulations, title 56.2942, section 483.440(a)(1).56.30(e) In assessing a person's needs, the screener shall:56.31(1) use an automated system designated by the commissioner;56.32(2) consult with care transitions coordinators or physician; and56.33(3) consider the assessment of the individual's physician.56.34Other personnel may be included in the level of care determination as deemed 56.35necessary by the screener.56.36EFFECTIVE DATE.This section is effective October 1, 2013.57.1    Sec. 8. Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision 57.2to read:57.3    Subd. 7b.Exemptions and emergency admissions.(a) Exemptions from the federal 57.4screening requirements outlined in subdivision 7a, paragraphs (b) and (c), are limited to:57.5(1) a person who, having entered an acute care facility from a certified nursing 57.6facility, is returning to a certified nursing facility; or57.7(2) a person transferring from one certified nursing facility in Minnesota to another 57.8certified nursing facility in Minnesota.57.9(b) Persons who are exempt from preadmission screening for purposes of level of 57.10care determination include:57.11(1) persons described in paragraph (a);57.12(2) an individual who has a contractual right to have nursing facility care paid for 57.13indefinitely by the Veterans' Administration;57.14(3) an individual enrolled in a demonstration project under section 256B.69, 57.15subdivision 8, at the time of application to a nursing facility; and57.16(4) an individual currently being served under the alternative care program or under 57.17a home and community-based services waiver authorized under section 1915(c) of the 57.18federal Social Security Act.57.19(c) Persons admitted to a Medicaid-certified nursing facility from the community 57.20on an emergency basis as described in paragraph (d) or from an acute care facility on a 57.21nonworking day must be screened the first working day after admission.57.22(d) Emergency admission to a nursing facility prior to screening is permitted when 57.23all of the following conditions are met:57.24(1) a person is admitted from the community to a certified nursing or certified 57.25boarding care facility during Senior LinkAge Line nonworking hours for ages 60 and 57.26older and Disability Linkage Line nonworking hours for under age 60;57.27(2) a physician has determined that delaying admission until preadmission screening 57.28is completed would adversely affect the person's health and safety;57.29(3) there is a recent precipitating event that precludes the client from living safely in 57.30the community, such as sustaining an injury, sudden onset of acute illness, or a caregiver's 57.31inability to continue to provide care;57.32(4) the attending physician has authorized the emergency placement and has 57.33documented the reason that the emergency placement is recommended; and57.34(5) the Senior LinkAge Line or Disability Linkage Line is contacted on the first 57.35working day following the emergency admission.58.1Transfer of a patient from an acute care hospital to a nursing facility is not considered 58.2an emergency except for a person who has received hospital services in the following 58.3situations: hospital admission for observation, care in an emergency room without hospital 58.4admission, or following hospital 24-hour bed care and from whom admission is being 58.5sought on a nonworking day.58.6(e) A nursing facility must provide written information to all persons admitted 58.7regarding the person's right to request and receive long-term care consultation services as 58.8defined in section 256B.0911, subdivision 1a. The information must be provided prior to 58.9the person's discharge from the facility and in a format specified by the commissioner.58.10EFFECTIVE DATE.This section is effective October 1, 2013.58.11    Sec. 9. Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision 58.12to read:58.13    Subd. 7c.Screening requirements.(a) A person may be screened for nursing 58.14facility admission by telephone or in a face-to-face screening interview. The Senior 58.15LinkAge Line shall identify each individual's needs using the following categories:58.16(1) the person needs no face-to-face long-term care consultation assessment 58.17completed under section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or 58.18managed care organization under contract with the Department of Human Services to 58.19determine the need for nursing facility level of care based on information obtained from 58.20other health care professionals;58.21(2) the person needs an immediate face-to-face long-term care consultation 58.22assessment completed under section 256B.0911, subdivision 3a, 3b, or 4d, by a county, 58.23tribe, or managed care organization under contract with the Department of Human 58.24Services to determine the need for nursing facility level of care and complete activities 58.25required under subdivision 7a; or58.26(3) the person may be exempt from screening requirements as outlined in subdivision 58.277b, but will need transitional assistance after admission or in-person follow-along after 58.28a return home.58.29(b) Individuals between the ages of 60 and 64 who are admitted to nursing facilities 58.30with only a telephone screening must receive a face-to-face assessment from the long-term 58.31care consultation team member of the county in which the facility is located or from the 58.32recipient's county case manager within 40 calendar days of admission as described in 58.33section 256B.0911, subdivision 4d, paragraph (c).58.34(c) Persons admitted on a nonemergency basis to a Medicaid-certified nursing 58.35facility must be screened prior to admission.59.1(d) Screenings provided by the Senior LinkAge Line must include processes 59.2to identify persons who may require transition assistance described in subdivision 7, 59.3paragraph (b), clause (12), and section 256B.0911, subdivision 3b.59.4EFFECTIVE DATE.This section is effective October 1, 2013.59.5    Sec. 10. Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision 59.6to read:59.7    Subd. 7d.Payment for preadmission screening.Funding for preadmission 59.8screening shall be provided to the Minnesota Board on Aging for the population 60 59.9years of age and older by the Department of Human Services to cover screener salaries 59.10and expenses to provide the services described in subdivisions 7a to 7c. The Minnesota 59.11Board on Aging shall employ, or contract with other agencies to employ, within the limits 59.12of available funding, sufficient personnel to provide preadmission screening and level of 59.13care determination services and shall seek to maximize federal funding for the service as 59.14provided under section 256.01, subdivision 2, paragraph (dd).59.15EFFECTIVE DATE.This section is effective October 1, 2013.59.16    Sec. 11. Minnesota Statutes 2012, section 256.9754, is amended by adding a 59.17subdivision to read:59.18    Subd. 3a.Priority for other grants.The commissioner of health shall give 59.19priority to a grantee selected under subdivision 3 when awarding technology-related 59.20grants, if the grantee is using technology as a part of a proposal, unless that priority 59.21conflicts with existing state or federal guidance related to grant awards by the Department 59.22of Health. The commissioner of transportation shall give priority to a grantee selected 59.23under subdivision 3 when distributing transportation-related funds to create transportation 59.24options for older adults.59.25    Sec. 12. Minnesota Statutes 2012, section 256.9754, is amended by adding a 59.26subdivision to read:59.27    Subd. 3b.State waivers.The commissioner of health may waive applicable state 59.28laws and rules on a time-limited basis if the commissioner of health determines that a 59.29participating grantee requires a waiver in order to achieve demonstration project goals.59.30    Sec. 13. Minnesota Statutes 2012, section 256.9754, subdivision 5, is amended to read:60.1    Subd. 5. Grant preference. The commissioner of human services shall give 60.2preference when awarding grants under this section to areas where nursing facility 60.3closures have occurred or are occurring or areas with service needs identified by section 60.4144A.351. The commissioner may award grants to the extent grant funds are available 60.5and to the extent applications are approved by the commissioner. Denial of approval of an 60.6application in one year does not preclude submission of an application in a subsequent 60.7year. The maximum grant amount is limited to $750,000.60.8    Sec. 14. Minnesota Statutes 2012, section 256B.021, is amended by adding a 60.9subdivision to read:60.10    Subd. 4a.Evaluation.The commissioner shall evaluate the projects contained in 60.11subdivision 4, paragraphs (f), clauses (2) and (12), and (h). The evaluation must include:60.12(1) an impact assessment focusing on program outcomes, especially those 60.13experienced directly by the person receiving services;60.14(2) study samples drawn from the population of interest for each project; and60.15(3) a time series analysis to examine aggregate trends in average monthly 60.16utilization, expenditures, and other outcomes in the targeted populations before and after 60.17implementation of the initiatives.60.18    Sec. 15. Minnesota Statutes 2012, section 256B.021, is amended by adding a 60.19subdivision to read:60.20    Subd. 6.Work, empower, and encourage independence.As provided under 60.21subdivision 4, paragraph (e), upon federal approval, the commissioner shall establish a 60.22demonstration project to provide navigation, employment supports, and benefits planning 60.23services to a targeted group of federally funded Medicaid recipients to begin July 1, 2014. 60.24This demonstration shall promote economic stability, increase independence, and reduce 60.25applications for disability benefits while providing a positive impact on the health and 60.26future of participants.60.27    Sec. 16. Minnesota Statutes 2012, section 256B.021, is amended by adding a 60.28subdivision to read:60.29    Subd. 7.Housing stabilization.As provided under subdivision 4, paragraph (e), 60.30upon federal approval, the commissioner shall establish a demonstration project to provide 60.31service coordination, outreach, in-reach, tenancy support, and community living assistance 60.32to a targeted group of federally funded Medicaid recipients to begin January 1, 2014. This 61.1demonstration shall promote housing stability, reduce costly medical interventions, and 61.2increase opportunities for independent community living.61.3    Sec. 17. Minnesota Statutes 2012, section 256B.0911, subdivision 1, is amended to read:61.4    Subdivision 1. Purpose and goal. (a) The purpose of long-term care consultation 61.5services is to assist persons with long-term or chronic care needs in making care 61.6decisions and selecting support and service options that meet their needs and reflect 61.7their preferences. The availability of, and access to, information and other types of 61.8assistance, including assessment and support planning, is also intended to prevent or delay 61.9institutional placements and to provide access to transition assistance after admission. 61.10Further, the goal of these services is to contain costs associated with unnecessary 61.11institutional admissions. Long-term consultation services must be available to any person 61.12regardless of public program eligibility. The commissioner of human services shall seek 61.13to maximize use of available federal and state funds and establish the broadest program 61.14possible within the funding available.61.15(b) These services must be coordinated with long-term care options counseling 61.16provided under subdivision 4d, section 
         256.975, subdivision subdivisions 7 to 7c, and 61.17section 
         256.01, subdivision 24. The lead agency providing long-term care consultation 61.18services shall encourage the use of volunteers from families, religious organizations, social 61.19clubs, and similar civic and service organizations to provide community-based services.61.20    Sec. 18. Minnesota Statutes 2012, section 256B.0911, subdivision 1a, is amended to 61.21read:61.22    Subd. 1a. Definitions. For purposes of this section, the following definitions apply:61.23    (a) Until additional requirements apply under paragraph (b), "long-term care 61.24consultation services" means:61.25    (1) intake for and access to assistance in identifying services needed to maintain an 61.26individual in the most inclusive environment;61.27    (2) providing recommendations for and referrals to cost-effective community 61.28services that are available to the individual;61.29    (3) development of an individual's person-centered community support plan;61.30    (4) providing information regarding eligibility for Minnesota health care programs;61.31    (5) face-to-face long-term care consultation assessments, which may be completed 61.32in a hospital, nursing facility, intermediate care facility for persons with developmental 61.33disabilities (ICF/DDs), regional treatment centers, or the person's current or planned 61.34residence;62.1    (6) federally mandated preadmission screening activities described under 62.2subdivisions 4a and 4b;62.3    (7) (6) determination of home and community-based waiver and other service 62.4eligibility as required under sections 
         256B.0913, 
         256B.0915, and 
         256B.49, including level 62.5of care determination for individuals who need an institutional level of care as determined 62.6under section 
         256B.0911, subdivision 4a, paragraph (d) 4e, based on assessment and 62.7community support plan development, appropriate referrals to obtain necessary diagnostic 62.8information, and including an eligibility determination for consumer-directed community 62.9supports;62.10    (8) (7) providing recommendations for institutional placement when there are no 62.11cost-effective community services available;62.12    (9) (8) providing access to assistance to transition people back to community settings 62.13after institutional admission; and62.14(10) (9) providing information about competitive employment, with or without 62.15supports, for school-age youth and working-age adults and referrals to the Disability 62.16Linkage Line and Disability Benefits 101 to ensure that an informed choice about 62.17competitive employment can be made. For the purposes of this subdivision, "competitive 62.18employment" means work in the competitive labor market that is performed on a full-time 62.19or part-time basis in an integrated setting, and for which an individual is compensated at or 62.20above the minimum wage, but not less than the customary wage and level of benefits paid 62.21by the employer for the same or similar work performed by individuals without disabilities.62.22(b) Upon statewide implementation of lead agency requirements in subdivisions 2b, 62.232c, and 3a, "long-term care consultation services" also means:62.24(1) service eligibility determination for state plan home care services identified in:62.25(i) section 
         256B.0625, subdivisions 7, 19a, and 19c;62.26(ii) section 
         256B.0657; or62.27(iii) consumer support grants under section 
         256.476;62.28(2) notwithstanding provisions in Minnesota Rules, parts 9525.0004 to 9525.0024, 62.29determination of eligibility for case management services available under sections 62.30256B.0621, subdivision 2
         , paragraph (4), and 
         256B.0924 and Minnesota Rules, part 62.319525.0016;62.32(3) determination of institutional level of care, home and community-based service 62.33waiver, and other service eligibility as required under section 
         256B.092, determination 62.34of eligibility for family support grants under section 
         252.32, semi-independent living 62.35services under section 
         252.275, and day training and habilitation services under section 62.36256B.092
         ; and63.1(4) obtaining necessary diagnostic information to determine eligibility under clauses 63.2(2) and (3).63.3    (c) "Long-term care options counseling" means the services provided by the linkage 63.4lines as mandated by sections 
         256.01, subdivision 24, and 
         256.975, subdivision 7, and 63.5also includes telephone assistance and follow up once a long-term care consultation 63.6assessment has been completed.63.7    (d) "Minnesota health care programs" means the medical assistance program under 63.8chapter 256B and the alternative care program under section 
         256B.0913.63.9    (e) "Lead agencies" means counties administering or tribes and health plans under 63.10contract with the commissioner to administer long-term care consultation assessment and 63.11support planning services.63.12    Sec. 19. Minnesota Statutes 2012, section 256B.0911, subdivision 3a, is amended to 63.13read:63.14    Subd. 3a. Assessment and support planning. (a) Persons requesting assessment, 63.15services planning, or other assistance intended to support community-based living, 63.16including persons who need assessment in order to determine waiver or alternative care 63.17program eligibility, must be visited by a long-term care consultation team within 20 63.18calendar days after the date on which an assessment was requested or recommended. 63.19Upon statewide implementation of subdivisions 2b, 2c, and 5, this requirement also 63.20applies to an assessment of a person requesting personal care assistance services and 63.21private duty nursing. The commissioner shall provide at least a 90-day notice to lead 63.22agencies prior to the effective date of this requirement. Face-to-face assessments must be 63.23conducted according to paragraphs (b) to (i).63.24    (b) The lead agency may utilize a team of either the social worker or public health 63.25nurse, or both. Upon implementation of subdivisions 2b, 2c, and 5, lead agencies shall 63.26use certified assessors to conduct the assessment. The consultation team members must 63.27confer regarding the most appropriate care for each individual screened or assessed. For 63.28a person with complex health care needs, a public health or registered nurse from the 63.29team must be consulted.63.30    (c) The assessment must be comprehensive and include a person-centered assessment 63.31of the health, psychological, functional, environmental, and social needs of referred 63.32individuals and provide information necessary to develop a community support plan that 63.33meets the consumers needs, using an assessment form provided by the commissioner.63.34    (d) The assessment must be conducted in a face-to-face interview with the person 63.35being assessed and the person's legal representative, and other individuals as requested by 64.1the person, who can provide information on the needs, strengths, and preferences of the 64.2person necessary to develop a community support plan that ensures the person's health and 64.3safety, but who is not a provider of service or has any financial interest in the provision 64.4of services. For persons who are to be assessed for elderly waiver customized living 64.5services under section 
         256B.0915, with the permission of the person being assessed or 64.6the person's designated or legal representative, the client's current or proposed provider 64.7of services may submit a copy of the provider's nursing assessment or written report 64.8outlining its recommendations regarding the client's care needs. The person conducting 64.9the assessment will notify the provider of the date by which this information is to be 64.10submitted. This information shall be provided to the person conducting the assessment 64.11prior to the assessment.64.12    (e) If the person chooses to use community-based services, the person or the person's 64.13legal representative must be provided with a written community support plan within 40 64.14calendar days of the assessment visit, regardless of whether the individual is eligible for 64.15Minnesota health care programs. The written community support plan must include:64.16(1) a summary of assessed needs as defined in paragraphs (c) and (d);64.17(2) the individual's options and choices to meet identified needs, including all 64.18available options for case management services and providers;64.19(3) identification of health and safety risks and how those risks will be addressed, 64.20including personal risk management strategies;64.21(4) referral information; and64.22(5) informal caregiver supports, if applicable.64.23For a person determined eligible for state plan home care under subdivision 1a, 64.24paragraph (b), clause (1), the person or person's representative must also receive a copy of 64.25the home care service plan developed by the certified assessor.64.26(f) A person may request assistance in identifying community supports without 64.27participating in a complete assessment. Upon a request for assistance identifying 64.28community support, the person must be transferred or referred to long-term care options 64.29counseling services available under sections 
         256.975, subdivision 7, and 
         256.01, 64.30subdivision 24, for telephone assistance and follow up.64.31    (g) The person has the right to make the final decision between institutional 64.32placement and community placement after the recommendations have been provided, 64.33except as provided in section 256.975, subdivision 4a, paragraph (c) 7a, paragraph (d).64.34    (h) The lead agency must give the person receiving assessment or support planning, 64.35or the person's legal representative, materials, and forms supplied by the commissioner 64.36containing the following information:65.1    (1) written recommendations for community-based services and consumer-directed 65.2options;65.3(2) documentation that the most cost-effective alternatives available were offered to 65.4the individual. For purposes of this clause, "cost-effective" means community services and 65.5living arrangements that cost the same as or less than institutional care. For an individual 65.6found to meet eligibility criteria for home and community-based service programs under 65.7section 
         256B.0915 or 
         256B.49, "cost-effectiveness" has the meaning found in the federally 65.8approved waiver plan for each program;65.9(3) the need for and purpose of preadmission screening conducted by long-term care 65.10options counselors according to sections 256.975, subdivisions 7a to 7c, and 256.01, 65.11subdivision 24, if the person selects nursing facility placement. If the individual selects 65.12nursing facility placement, the lead agency shall forward information needed to complete 65.13the level of care determinations and screening for developmental disability and mental 65.14illness collected during the assessment to the long-term care options counselor using forms 65.15provided by the commissioner;65.16    (4) the role of long-term care consultation assessment and support planning in 65.17eligibility determination for waiver and alternative care programs, and state plan home 65.18care, case management, and other services as defined in subdivision 1a, paragraphs (a), 65.19clause (7), and (b);65.20    (5) information about Minnesota health care programs;65.21    (6) the person's freedom to accept or reject the recommendations of the team;65.22    (7) the person's right to confidentiality under the Minnesota Government Data 65.23Practices Act, chapter 13;65.24    (8) the certified assessor's decision regarding the person's need for institutional level 65.25of care as determined under criteria established in section 256B.0911, subdivision 4a, 65.26paragraph (d) 4e, and the certified assessor's decision regarding eligibility for all services 65.27and programs as defined in subdivision 1a, paragraphs (a), clause (7), and (b); and65.28    (9) the person's right to appeal the certified assessor's decision regarding eligibility 65.29for all services and programs as defined in subdivision 1a, paragraphs (a), clause (7), and 65.30(b), and incorporating the decision regarding the need for institutional level of care or the 65.31lead agency's final decisions regarding public programs eligibility according to section 65.32256.045, subdivision 3
         .65.33    (i) Face-to-face assessment completed as part of eligibility determination for 65.34the alternative care, elderly waiver, community alternatives for disabled individuals, 65.35community alternative care, and brain injury waiver programs under sections 
         256B.0913, 66.1256B.0915
         , and 
         256B.49 is valid to establish service eligibility for no more than 60 66.2calendar days after the date of assessment.66.3(j) The effective eligibility start date for programs in paragraph (i) can never be 66.4prior to the date of assessment. If an assessment was completed more than 60 days 66.5before the effective waiver or alternative care program eligibility start date, assessment 66.6and support plan information must be updated in a face-to-face visit and documented in 66.7the department's Medicaid Management Information System (MMIS). Notwithstanding 66.8retroactive medical assistance coverage of state plan services, the effective date of 66.9eligibility for programs included in paragraph (i) cannot be prior to the date the most 66.10recent updated assessment is completed.66.11    Sec. 20. Minnesota Statutes 2012, section 256B.0911, subdivision 4d, is amended to 66.12read:66.13    Subd. 4d. Preadmission screening of individuals under 65 60 years of age. (a) 66.14It is the policy of the state of Minnesota to ensure that individuals with disabilities or 66.15chronic illness are served in the most integrated setting appropriate to their needs and have 66.16the necessary information to make informed choices about home and community-based 66.17service options.66.18    (b) Individuals under 65 60 years of age who are admitted to a Medicaid-certified66.19 nursing facility from a hospital must be screened prior to admission as outlined in 66.20subdivisions 4a through 4c according to the requirements outlined in section 256.975, 66.21subdivisions 7a to 7c. This shall be provided by the Disability Linkage Line as required 66.22under section 256.01, subdivision 24.66.23    (c) Individuals under 65 years of age who are admitted to nursing facilities with 66.24only a telephone screening must receive a face-to-face assessment from the long-term 66.25care consultation team member of the county in which the facility is located or from the 66.26recipient's county case manager within 40 calendar days of admission.66.27    (d) Individuals under 65 years of age who are admitted to a nursing facility 66.28without preadmission screening according to the exemption described in subdivision 4b, 66.29paragraph (a), clause (3), and who remain in the facility longer than 30 days must receive 66.30a face-to-face assessment within 40 days of admission.66.31    (e) (d) At the face-to-face assessment, the long-term care consultation team member 66.32or county case manager must perform the activities required under subdivision 3b.66.33    (f) (e) For individuals under 21 years of age, a screening interview which 66.34recommends nursing facility admission must be face-to-face and approved by the 66.35commissioner before the individual is admitted to the nursing facility.67.1    (g) (f) In the event that an individual under 65 60 years of age is admitted to a 67.2nursing facility on an emergency basis, the county Disability Linkage Line must be 67.3notified of the admission on the next working day, and a face-to-face assessment as 67.4described in paragraph (c) must be conducted within 40 calendar days of admission.67.5    (h) (g) At the face-to-face assessment, the long-term care consultation team member 67.6or the case manager must present information about home and community-based options, 67.7including consumer-directed options, so the individual can make informed choices. If the 67.8individual chooses home and community-based services, the long-term care consultation 67.9team member or case manager must complete a written relocation plan within 20 working 67.10days of the visit. The plan shall describe the services needed to move out of the facility 67.11and a time line for the move which is designed to ensure a smooth transition to the 67.12individual's home and community.67.13    (i) (h) An individual under 65 years of age residing in a nursing facility shall receive 67.14a face-to-face assessment at least every 12 months to review the person's service choices 67.15and available alternatives unless the individual indicates, in writing, that annual visits are 67.16not desired. In this case, the individual must receive a face-to-face assessment at least 67.17once every 36 months for the same purposes.67.18    (j) (i) Notwithstanding the provisions of subdivision 6, the commissioner may pay 67.19county agencies directly for face-to-face assessments for individuals under 65 years of age 67.20who are being considered for placement or residing in a nursing facility. Until September 67.2130, 2013, payments for individuals under 65 years of age shall be made as described 67.22in this subdivision.67.23(j) Funding for preadmission screening shall be provided to the Disability Linkage 67.24Line for the under 60 population by the Department of Human Services to cover screener 67.25salaries and expenses to provide the services described in subdivisions 7a to 7c. The 67.26Disability Linkage Line shall employ, or contract with other agencies to employ, within 67.27the limits of available funding, sufficient personnel to provide preadmission screening and 67.28level of care determination services and shall seek to maximize federal funding for the 67.29service as provided under section 256.01, subdivision 2, paragraph (dd).67.30EFFECTIVE DATE.This section is effective October 1, 2013.67.31    Sec. 21. Minnesota Statutes 2012, section 256B.0911, is amended by adding a 67.32subdivision to read:67.33    Subd. 4e.Determination of institutional level of care.The determination of the 67.34need for nursing facility, hospital, and intermediate care facility levels of care must be 67.35made according to criteria developed by the commissioner, and in section 256B.092, 68.1using forms developed by the commissioner. Effective January 1, 2014, for individuals 68.2age 21 and older, the determination of need for nursing facility level of care shall be 68.3based on criteria in section 144.0724, subdivision 11. For individuals under age 21, the 68.4determination of the need for nursing facility level of care must be made according to 68.5criteria developed by the commissioner until criteria in section 144.0724, subdivision 11, 68.6becomes effective on or after October 1, 2019.68.7    Sec. 22. Minnesota Statutes 2012, section 256B.0911, subdivision 6, is amended to read:68.8    Subd. 6. Payment for long-term care consultation services. (a) Until September 68.930, 2013, payment for long-term care consultation face-to-face assessment shall be made 68.10as described in this subdivision.68.11    (b) The total payment for each county must be paid monthly by certified nursing 68.12facilities in the county. The monthly amount to be paid by each nursing facility for each 68.13fiscal year must be determined by dividing the county's annual allocation for long-term 68.14care consultation services by 12 to determine the monthly payment and allocating the 68.15monthly payment to each nursing facility based on the number of licensed beds in the 68.16nursing facility. Payments to counties in which there is no certified nursing facility must be 68.17made by increasing the payment rate of the two facilities located nearest to the county seat.68.18    (b) (c) The commissioner shall include the total annual payment determined under 68.19paragraph (a) for each nursing facility reimbursed under section 
         256B.431, 
         256B.434, 68.20or 
         256B.441.68.21    (c) (d) In the event of the layaway, delicensure and decertification, or removal 68.22from layaway of 25 percent or more of the beds in a facility, the commissioner may 68.23adjust the per diem payment amount in paragraph (b) (c) and may adjust the monthly 68.24payment amount in paragraph (a) (b). The effective date of an adjustment made under this 68.25paragraph shall be on or after the first day of the month following the effective date of the 68.26layaway, delicensure and decertification, or removal from layaway.68.27    (d) (e) Payments for long-term care consultation services are available to the county 68.28or counties to cover staff salaries and expenses to provide the services described in 68.29subdivision 1a. The county shall employ, or contract with other agencies to employ, 68.30within the limits of available funding, sufficient personnel to provide long-term care 68.31consultation services while meeting the state's long-term care outcomes and objectives as 68.32defined in subdivision 1. The county shall be accountable for meeting local objectives 68.33as approved by the commissioner in the biennial home and community-based services 68.34quality assurance plan on a form provided by the commissioner.69.1    (e) (f) Notwithstanding section 
         256B.0641, overpayments attributable to payment 69.2of the screening costs under the medical assistance program may not be recovered from 69.3a facility.69.4    (f) (g) The commissioner of human services shall amend the Minnesota medical 69.5assistance plan to include reimbursement for the local consultation teams.69.6    (g) (h) Until the alternative payment methodology in paragraph (h) (i) is implemented, 69.7the county may bill, as case management services, assessments, support planning, and 69.8follow-along provided to persons determined to be eligible for case management under 69.9Minnesota health care programs. No individual or family member shall be charged for an 69.10initial assessment or initial support plan development provided under subdivision 3a or 3b.69.11(h) (i) The commissioner shall develop an alternative payment methodology, 69.12effective on October 1, 2013, for long-term care consultation services that includes 69.13the funding available under this subdivision, and for assessments authorized under 69.14sections 
         256B.092 and 
         256B.0659. In developing the new payment methodology, the 69.15commissioner shall consider the maximization of other funding sources, including federal 69.16administrative reimbursement through federal financial participation funding, for all 69.17long-term care consultation and preadmission screening activity. The alternative payment 69.18methodology shall include the use of the appropriate time studies and the state financing 69.19of nonfederal share as part of the state's medical assistance program.69.20    Sec. 23. Minnesota Statutes 2012, section 256B.0911, subdivision 7, is amended to read:69.21    Subd. 7. Reimbursement for certified nursing facilities. (a) Medical assistance 69.22reimbursement for nursing facilities shall be authorized for a medical assistance recipient 69.23only if a preadmission screening has been conducted prior to admission or the county has 69.24authorized an exemption. Medical assistance reimbursement for nursing facilities shall 69.25not be provided for any recipient who the local screener has determined does not meet the 69.26level of care criteria for nursing facility placement in section 
         144.0724, subdivision 11, or, 69.27if indicated, has not had a level II OBRA evaluation as required under the federal Omnibus 69.28Budget Reconciliation Act of 1987 completed unless an admission for a recipient with 69.29mental illness is approved by the local mental health authority or an admission for a 69.30recipient with developmental disability is approved by the state developmental disability 69.31authority.69.32    (b) The nursing facility must not bill a person who is not a medical assistance 69.33recipient for resident days that preceded the date of completion of screening activities 69.34as required under section 256.975, subdivisions 4a, 4b, and 4c 7a to 7c. The nursing 70.1facility must include unreimbursed resident days in the nursing facility resident day totals 70.2reported to the commissioner.70.3    Sec. 24. Minnesota Statutes 2012, section 256B.0913, subdivision 4, is amended to read:70.4    Subd. 4. Eligibility for funding for services for nonmedical assistance recipients.70.5    (a) Funding for services under the alternative care program is available to persons who 70.6meet the following criteria:70.7    (1) the person has been determined by a community assessment under section 70.8256B.0911
          to be a person who would require the level of care provided in a nursing 70.9facility, as determined under section 256B.0911, subdivision 4a, paragraph (d) 4e, but for 70.10the provision of services under the alternative care program;70.11    (2) the person is age 65 or older;70.12    (3) the person would be eligible for medical assistance within 135 days of admission 70.13to a nursing facility;70.14    (4) the person is not ineligible for the payment of long-term care services by the 70.15medical assistance program due to an asset transfer penalty under section 
         256B.0595 or 70.16equity interest in the home exceeding $500,000 as stated in section 
         256B.056;70.17    (5) the person needs long-term care services that are not funded through other 70.18state or federal funding, or other health insurance or other third-party insurance such as 70.19long-term care insurance;70.20    (6) except for individuals described in clause (7), the monthly cost of the alternative 70.21care services funded by the program for this person does not exceed 75 percent of the 70.22monthly limit described under section 
         256B.0915, subdivision 3a. This monthly limit 70.23does not prohibit the alternative care client from payment for additional services, but in no 70.24case may the cost of additional services purchased under this section exceed the difference 70.25between the client's monthly service limit defined under section 
         256B.0915, subdivision 70.263
         , and the alternative care program monthly service limit defined in this paragraph. If 70.27care-related supplies and equipment or environmental modifications and adaptations are or 70.28will be purchased for an alternative care services recipient, the costs may be prorated on a 70.29monthly basis for up to 12 consecutive months beginning with the month of purchase. 70.30If the monthly cost of a recipient's other alternative care services exceeds the monthly 70.31limit established in this paragraph, the annual cost of the alternative care services shall be 70.32determined. In this event, the annual cost of alternative care services shall not exceed 12 70.33times the monthly limit described in this paragraph;70.34    (7) for individuals assigned a case mix classification A as described under section 70.35256B.0915, subdivision 3a
         , paragraph (a), with (i) no dependencies in activities of daily 71.1living, or (ii) up to two dependencies in bathing, dressing, grooming, walking, and eating 71.2when the dependency score in eating is three or greater as determined by an assessment 71.3performed under section 
         256B.0911, the monthly cost of alternative care services funded 71.4by the program cannot exceed $593 per month for all new participants enrolled in 71.5the program on or after July 1, 2011. This monthly limit shall be applied to all other 71.6participants who meet this criteria at reassessment. This monthly limit shall be increased 71.7annually as described in section 
         256B.0915, subdivision 3a, paragraph (a). This monthly 71.8limit does not prohibit the alternative care client from payment for additional services, but 71.9in no case may the cost of additional services purchased exceed the difference between the 71.10client's monthly service limit defined in this clause and the limit described in clause (6) 71.11for case mix classification A; and71.12(8) the person is making timely payments of the assessed monthly fee.71.13A person is ineligible if payment of the fee is over 60 days past due, unless the person 71.14agrees to:71.15    (i) the appointment of a representative payee;71.16    (ii) automatic payment from a financial account;71.17    (iii) the establishment of greater family involvement in the financial management of 71.18payments; or71.19    (iv) another method acceptable to the lead agency to ensure prompt fee payments.71.20    The lead agency may extend the client's eligibility as necessary while making 71.21arrangements to facilitate payment of past-due amounts and future premium payments. 71.22Following disenrollment due to nonpayment of a monthly fee, eligibility shall not be 71.23reinstated for a period of 30 days.71.24    (b) Alternative care funding under this subdivision is not available for a person who 71.25is a medical assistance recipient or who would be eligible for medical assistance without a 71.26spenddown or waiver obligation. A person whose initial application for medical assistance 71.27and the elderly waiver program is being processed may be served under the alternative care 71.28program for a period up to 60 days. If the individual is found to be eligible for medical 71.29assistance, medical assistance must be billed for services payable under the federally 71.30approved elderly waiver plan and delivered from the date the individual was found eligible 71.31for the federally approved elderly waiver plan. Notwithstanding this provision, alternative 71.32care funds may not be used to pay for any service the cost of which: (i) is payable by 71.33medical assistance; (ii) is used by a recipient to meet a waiver obligation; or (iii) is used to 71.34pay a medical assistance income spenddown for a person who is eligible to participate in the 71.35federally approved elderly waiver program under the special income standard provision.72.1    (c) Alternative care funding is not available for a person who resides in a licensed 72.2nursing home, certified boarding care home, hospital, or intermediate care facility, except 72.3for case management services which are provided in support of the discharge planning 72.4process for a nursing home resident or certified boarding care home resident to assist with 72.5a relocation process to a community-based setting.72.6    (d) Alternative care funding is not available for a person whose income is greater 72.7than the maintenance needs allowance under section 
         256B.0915, subdivision 1d, but equal 72.8to or less than 120 percent of the federal poverty guideline effective July 1 in the fiscal 72.9year for which alternative care eligibility is determined, who would be eligible for the 72.10elderly waiver with a waiver obligation.72.11    Sec. 25. Minnesota Statutes 2012, section 256B.0913, is amended by adding a 72.12subdivision to read:72.13    Subd. 17.Essential community supports grants.(a) Notwithstanding subdivisions 72.141 to 14, the purpose of the essential community supports grant program is to provide 72.15targeted services to persons age 65 and older who need essential community support, but 72.16whose needs do not meet the level of care required for nursing facility placement under 72.17section 144.0724, subdivision 11.72.18(b) Essential community supports grants are available not to exceed $400 per person 72.19per month. Essential community supports service grants may be used as authorized within 72.20an authorization period not to exceed 12 months. Grants must be available to a person who:72.21(1) is age 65 or older;72.22(2) is not eligible for medical assistance;72.23(3) would otherwise be financially eligible for the alternative care program under 72.24subdivision 4;72.25(4) has received a community assessment under section 256B.0911, subdivision 3a 72.26or 3b, and does not require the level of care provided in a nursing facility;72.27(5) has a community support plan; and72.28(6) has been determined by a community assessment under section 256B.0911, 72.29subdivision 3a or 3b, to be a person who would require provision of at least one of the 72.30following services, as defined in the approved elderly waiver plan, in order to maintain 72.31their community residence:72.32(i) caregiver support;72.33(ii) homemaker support;72.34(iii) chores; or72.35(iv) a personal emergency response device or system.73.1(c) The person receiving any of the essential community supports in this subdivision 73.2must also receive service coordination, not to exceed $600 in a 12-month authorization 73.3period, as part of their community support plan.73.4(d) A person who has been determined to be eligible for an essential community 73.5supports grant must be reassessed at least annually and continue to meet the criteria in 73.6paragraph (b) to remain eligible for an essential community supports grant.73.7(e) The commissioner is authorized to use federal matching funds for essential 73.8community supports as necessary and to meet demand for essential community supports 73.9grants as outlined in paragraphs (f) and (g), and that amount of federal funds is 73.10appropriated to the commissioner for this purpose.73.11(f) Upon federal approval and following a reasonable implementation period 73.12determined by the commissioner, essential community supports are available to an 73.13individual who:73.14(1) is receiving nursing facility services or home and community-based long-term 73.15services and supports under section 256B.0915 or 256B.49 on the effective date of 73.16implementation of the revised nursing facility level of care under section 144.0724, 73.17subdivision 11;73.18(2) meets one of the following criteria:73.19(i) due to the implementation of the revised nursing facility level of care, loses 73.20eligibility for continuing medical assistance payment of nursing facility services at the 73.21first reassessment under section 144.0724, subdivision 11, paragraph (b), that occurs on or 73.22after the effective date of the revised nursing facility level of care criteria under section 73.23144.0724, subdivision 11; or73.24(ii) due to the implementation of the revised nursing facility level of care, loses 73.25eligibility for continuing medical assistance payment of home and community-based 73.26long-term services and supports under section 256B.0915 or 256B.49 at the first 73.27reassessment required under those sections that occurs on or after the effective date of 73.28implementation of the revised nursing facility level of care under section 144.0724, 73.29subdivision 11;73.30(3) is not eligible for personal care attendant services; and73.31(4) has an assessed need for one or more of the supportive services offered under 73.32essential community supports.73.33Individuals eligible under this paragraph includes individuals who continue to be 73.34eligible for medical assistance state plan benefits and those who are not or are no longer 73.35financially eligible for medical assistance.74.1(g) Upon federal approval and following a reasonable implementation period 74.2determined by the commissioner, the services available through essential community 74.3supports include the services and grants provided in paragraphs (b) and (c), home-delivered 74.4meals, and community living assistance as defined by the commissioner. These services 74.5are available to all eligible recipients including those outlined in paragraphs (b) and (f). 74.6Recipients are eligible if they have a need for any of these services and meet all other 74.7eligibility criteria.74.8    Sec. 26. Minnesota Statutes 2012, section 256B.0915, subdivision 5, is amended to read:74.9    Subd. 5. Assessments and reassessments for waiver clients. (a) Each client 74.10shall receive an initial assessment of strengths, informal supports, and need for services 74.11in accordance with section 
         256B.0911, subdivisions 3, 3a, and 3b. A reassessment of a 74.12client served under the elderly waiver must be conducted at least every 12 months and at 74.13other times when the case manager determines that there has been significant change in 74.14the client's functioning. This may include instances where the client is discharged from 74.15the hospital. There must be a determination that the client requires nursing facility level 74.16of care as defined in section 256B.0911, subdivision 4a, paragraph (d) 4e, at initial and 74.17subsequent assessments to initiate and maintain participation in the waiver program.74.18(b) Regardless of other assessments identified in section 
         144.0724, subdivision 74.194, as appropriate to determine nursing facility level of care for purposes of medical 74.20assistance payment for nursing facility services, only face-to-face assessments conducted 74.21according to section 
         256B.0911, subdivisions 3a and 3b, that result in a nursing facility 74.22level of care determination will be accepted for purposes of initial and ongoing access to 74.23waiver service payment.74.24    Sec. 27. Minnesota Statutes 2012, section 256B.0917, is amended by adding a 74.25subdivision to read:74.26    Subd. 1a.Home and community-based services for older adults.(a) The purpose 74.27of projects selected by the commissioner of human services under this section is to 74.28make strategic changes in the long-term services and supports system for older adults 74.29including statewide capacity for local service development and technical assistance, and 74.30statewide availability of home and community-based services for older adult services, 74.31caregiver support and respite care services, and other supports in the state of Minnesota. 74.32These projects are intended to create incentives for new and expanded home and 74.33community-based services in Minnesota in order to:75.1(1) reach older adults early in the progression of their need for long-term services 75.2and supports, providing them with low-cost, high-impact services that will prevent or 75.3delay the use of more costly services;75.4(2) support older adults to live in the most integrated, least restrictive community 75.5setting;75.6(3) support the informal caregivers of older adults;75.7(4) develop and implement strategies to integrate long-term services and supports 75.8with health care services, in order to improve the quality of care and enhance the quality 75.9of life of older adults and their informal caregivers;75.10(5) ensure cost-effective use of financial and human resources;75.11(6) build community-based approaches and community commitment to delivering 75.12long-term services and supports for older adults in their own homes;75.13(7) achieve a broad awareness and use of lower-cost in-home services as an 75.14alternative to nursing homes and other residential services;75.15(8) strengthen and develop additional home and community-based services and 75.16alternatives to nursing homes and other residential services; and75.17(9) strengthen programs that use volunteers.75.18(b) The services provided by these projects are available to older adults who are 75.19eligible for medical assistance and the elderly waiver under section 256B.0915, the 75.20alternative care program under section 256B.0913, or essential community supports grant 75.21under subdivision 14, paragraph (b), and to persons who have their own funds to pay for 75.22services.75.23    Sec. 28. Minnesota Statutes 2012, section 256B.0917, is amended by adding a 75.24subdivision to read:75.25    Subd. 1b.Definitions.(a) For purposes of this section, the following terms have 75.26the meanings given.75.27(b) "Community" means a town; township; city; or targeted neighborhood within a 75.28city; or a consortium of towns, townships, cities, or specific neighborhoods within a city.75.29(c) "Core home and community-based services provider" means a Faith in Action, 75.30Living at Home Block Nurse, Congregational Nurse, or similar community-based 75.31program governed by a board, the majority of whose members reside within the program's 75.32service area, that organizes and uses volunteers and paid staff to deliver nonmedical 75.33services intended to assist older adults to identify and manage risks and to maintain their 75.34community living and integration in the community.76.1(d) "Eldercare development partnership" means a team of representatives of county 76.2social service and public health agencies, the area agency on aging, local nursing home 76.3providers, local home care providers, and other appropriate home and community-based 76.4providers in the area agency's planning and service area.76.5(e) "Long-term services and supports" means any service available under the 76.6elderly waiver program or alternative care grant programs, nursing facility services, 76.7transportation services, caregiver support and respite care services, and other home and 76.8community-based services identified as necessary either to maintain lifestyle choices for 76.9older adults or to support them to remain in their own home.76.10(f) "Older adult" refers to an individual who is 65 years of age or older.76.11    Sec. 29. Minnesota Statutes 2012, section 256B.0917, is amended by adding a 76.12subdivision to read:76.13    Subd. 1c.Eldercare development partnerships.The commissioner of human 76.14services shall select and contract with eldercare development partnerships sufficient to 76.15provide statewide availability of service development and technical assistance using a 76.16request for proposals process. Eldercare development partnerships shall:76.17(1) develop a local long-term services and supports strategy consistent with state 76.18goals and objectives;76.19(2) identify and use existing local skills, knowledge, and relationships, and build 76.20on these assets;76.21(3) coordinate planning for funds to provide services to older adults, including funds 76.22received under Title III of the Older Americans Act, Title XX of the Social Security Act, 76.23and the Local Public Health Act;76.24(4) target service development and technical assistance where nursing facility 76.25closures have occurred or are occurring or in areas where service needs have been 76.26identified through activities under section 144A.351;76.27(5) provide sufficient staff for development and technical support in its designated 76.28area; and76.29(6) designate a single public or nonprofit member of the eldercare development 76.30partnerships to apply grant funding and manage the project.76.31    Sec. 30. Minnesota Statutes 2012, section 256B.0917, subdivision 6, is amended to read:76.32    Subd. 6. Caregiver support and respite care projects. (a) The commissioner 76.33shall establish up to 36 projects to expand the respite care network in the state and to 76.34support caregivers in their responsibilities for care. The purpose of each project shall 77.1be to availability of caregiver support and respite care services for family and other 77.2caregivers. The commissioner shall use a request for proposals to select nonprofit entities 77.3to administer the projects. Projects shall:77.4(1) establish a local coordinated network of volunteer and paid respite workers;77.5(2) coordinate assignment of respite workers care services to clients and care 77.6receivers and assure the health and safety of the client; and caregivers of older adults;77.7(3) provide training for caregivers and ensure that support groups are available 77.8in the community.77.9(b) The caregiver support and respite care funds shall be available to the four to six 77.10local long-term care strategy projects designated in subdivisions 1 to 5.77.11(c) The commissioner shall publish a notice in the State Register to solicit proposals 77.12from public or private nonprofit agencies for the projects not included in the four to six 77.13local long-term care strategy projects defined in subdivision 2. A county agency may, 77.14alone or in combination with other county agencies, apply for caregiver support and 77.15respite care project funds. A public or nonprofit agency within a designated SAIL project 77.16area may apply for project funds if the agency has a letter of agreement with the county 77.17or counties in which services will be developed, stating the intention of the county or 77.18counties to coordinate their activities with the agency requesting a grant.77.19(d) The commissioner shall select grantees based on the following criteria:77.20(1) the ability of the proposal to demonstrate need in the area served, as evidenced 77.21by a community needs assessment or other demographic data;77.22(2) the ability of the proposal to clearly describe how the project77.23(3) assure the health and safety of the older adults;77.24(4) identify at-risk caregivers;77.25(5) provide information, education, and training for caregivers in the designated 77.26community; and77.27(6) demonstrate the need in the proposed service area particularly where nursing 77.28facility closures have occurred or are occurring or areas with service needs identified 77.29by section 144A.351. Preference must be given for projects that reach underserved 77.30populations.77.31(b) Projects must clearly describe:77.32(1) how they will achieve the their purpose defined in paragraph (b);77.33(3) the ability of the proposal to reach underserved populations;77.34(4) the ability of the proposal to demonstrate community commitment to the project, 77.35as evidenced by letters of support and cooperation as well as formation of a community 77.36task force;78.1(5) the ability of the proposal to clearly describe (2) the process for recruiting, 78.2training, and retraining volunteers; and78.3(6) the inclusion in the proposal of the (3) a plan to promote the project in the 78.4designated community, including outreach to persons needing the services.78.5(e) (c) Funds for all projects under this subdivision may be used to:78.6(1) hire a coordinator to develop a coordinated network of volunteer and paid respite 78.7care services and assign workers to clients;78.8(2) recruit and train volunteer providers;78.9(3) train provide information, training, and education to caregivers;78.10(4) ensure the development of support groups for caregivers;78.11(5) (4) advertise the availability of the caregiver support and respite care project; and78.12(6) (5) purchase equipment to maintain a system of assigning workers to clients.78.13(f) (d) Project funds may not be used to supplant existing funding sources.78.14    Sec. 31. Minnesota Statutes 2012, section 256B.0917, is amended by adding a 78.15subdivision to read:78.16    Subd. 7a.Core home and community-based services.The commissioner shall 78.17select and contract with core home and community-based services providers for projects 78.18to provide services and supports to older adults both with and without family and other 78.19informal caregivers using a request for proposals process. Projects must:78.20(1) have a credible, public, or private nonprofit sponsor providing ongoing financial 78.21support;78.22(2) have a specific, clearly defined geographic service area;78.23(3) use a practice framework designed to identify high-risk older adults and help them 78.24take action to better manage their chronic conditions and maintain their community living;78.25(4) have a team approach to coordination and care, ensuring that the older adult 78.26participants, their families, and the formal and informal providers are all part of planning 78.27and providing services;78.28(5) provide information, support services, homemaking services, counseling, and 78.29training for the older adults and family caregivers;78.30(6) encourage service area or neighborhood residents and local organizations to 78.31collaborate in meeting the needs of older adults in their geographic service areas;78.32(7) recruit, train, and direct the use of volunteers to provide informal services and 78.33other appropriate support to older adults and their caregivers; and78.34(8) provide coordination and management of formal and informal services to older 78.35adults and their families using less expensive alternatives.79.1    Sec. 32. Minnesota Statutes 2012, section 256B.0917, subdivision 13, is amended to 79.2read:79.3    Subd. 13. Community service grants. The commissioner shall award contracts 79.4for grants to public and private nonprofit agencies to establish services that strengthen 79.5a community's ability to provide a system of home and community-based services 79.6for elderly persons. The commissioner shall use a request for proposal process. The 79.7commissioner shall give preference when awarding grants under this section to areas 79.8where nursing facility closures have occurred or are occurring or to areas with service 79.9needs identified under section 144A.351. The commissioner shall consider grants for:79.10(1) caregiver support and respite care projects under subdivision 6;79.11(2) the living-at-home/block nurse grant under subdivisions 7 to 10; and79.12(3) services identified as needed for community transition.79.13    Sec. 33. Minnesota Statutes 2012, section 256B.439, subdivision 1, is amended to read:79.14    Subdivision 1. Development and implementation of quality profiles. (a) The 79.15commissioner of human services, in cooperation with the commissioner of health, 79.16shall develop and implement a quality profile system profiles for nursing facilities and, 79.17beginning not later than July 1, 2004 2014, other providers of long-term care services, 79.18except when the quality profile system would duplicate requirements under section 79.19256B.5011
         , 
         256B.5012, or 
         256B.5013. The system quality profiles  must be developed 79.20and implemented to the extent possible without the collection of significant amounts of 79.21new data. To the extent possible, the system using existing data sets maintained by the 79.22commissioners of health and human services to the extent possible. The profiles  must 79.23incorporate or be coordinated with information on quality maintained by area agencies on 79.24aging, long-term care trade associations, the ombudsman offices, counties, tribes, health 79.25plans, and other entities and the long-term care database maintained under section 256.975, 79.26subdivision 7. The system profiles must be designed to provide information on quality to:79.27(1) consumers and their families to facilitate informed choices of service providers;79.28(2) providers to enable them to measure the results of their quality improvement 79.29efforts and compare quality achievements with other service providers; and79.30(3) public and private purchasers of long-term care services to enable them to 79.31purchase high-quality care.79.32(b) The system profiles must be developed in consultation with the long-term care 79.33task force, area agencies on aging, and representatives of consumers, providers, and labor 79.34unions. Within the limits of available appropriations, the commissioners may employ 79.35consultants to assist with this project.80.1    Sec. 34. Minnesota Statutes 2012, section 256B.439, subdivision 2, is amended to read:80.2    Subd. 2. Quality measurement tools. The commissioners shall identify and apply 80.3existing quality measurement tools to:80.4(1) emphasize quality of care and its relationship to quality of life; and80.5(2) address the needs of various users of long-term care services, including, but not 80.6limited to, short-stay residents, persons with behavioral problems, persons with dementia, 80.7and persons who are members of minority groups.80.8    The tools must be identified and applied, to the extent possible, without requiring 80.9providers to supply information beyond current state and federal requirements.80.10    Sec. 35. Minnesota Statutes 2012, section 256B.439, subdivision 3, is amended to read:80.11    Subd. 3. Consumer surveys of nursing facilities residents. Following 80.12identification of the quality measurement tool, the commissioners shall conduct surveys 80.13of long-term care service consumers of nursing facilities to develop quality profiles 80.14of providers. To the extent possible, surveys must be conducted face-to-face by state 80.15employees or contractors. At the discretion of the commissioners, surveys may be 80.16conducted by telephone or by provider staff. Surveys must be conducted periodically to 80.17update quality profiles of individual service nursing facilities providers.80.18    Sec. 36. Minnesota Statutes 2012, section 256B.439, is amended by adding a 80.19subdivision to read:80.20    Subd. 3a.Home and community-based services report card in cooperation with 80.21the commissioner of health.The commissioner shall work with existing Department 80.22of Human Services advisory groups to develop recommendations for a home and 80.23community-based services report card. Health and human services staff that regulate 80.24home and community-based services as provided in chapter 245D and licensed home care 80.25as provided in chapter 144A shall be consulted. The advisory groups shall consider the 80.26requirements from the Minnesota consumer information guide under section 144G.06 as a 80.27base for development of the home and community-based services report card to compare 80.28the housing options available to consumers. Other items to be considered by the advisory 80.29groups in developing recommendations include:80.30(1) defining the goals of the report card, including measuring outcomes, providing 80.31consumer information, and defining vehicle-for-pay performance;80.32(2) developing separate measures for programs for the elderly population and for 80.33persons with disabilities;80.34(3) the sources of information needed that are standardized and contain sufficient data;81.1(4) the financial support needed for creating and publicizing the housing information 81.2guide, and ongoing funding for data collection and staffing to monitor, report, and analyze;81.3(5) a recognition that home and community-based services settings exist with 81.4significant variations in size, settings, and services available;81.5(6) ensuring that consumer choice and consumer information is retained and valued; 81.6and81.7(7) the applicability of these measures to providers based on payor source, size, and 81.8population served.81.9The advisory groups shall discuss whether there are additional funding, resources, 81.10and research needed. The commissioner shall report recommendations to the chairs and 81.11ranking minority members of the legislative committees and divisions with jurisdiction 81.12over health and human services issues by August 1, 2014. The report card shall be 81.13available on July 1, 2015.81.14    Sec. 37. Minnesota Statutes 2012, section 256B.439, subdivision 4, is amended to read:81.15    Subd. 4. Dissemination of quality profiles. By July 1, 2003 2014, the 81.16commissioners shall implement a system public awareness effort to disseminate the quality 81.17profiles developed from consumer surveys using the quality measurement tool. Profiles 81.18may be disseminated to through the Senior LinkAge Line and Disability Linkage Line and 81.19to consumers, providers, and purchasers of long-term care services through all feasible 81.20printed and electronic outlets. The commissioners may conduct a public awareness 81.21campaign to inform potential users regarding profile contents and potential uses.81.22    Sec. 38. Minnesota Statutes 2012, section 256B.441, subdivision 13, is amended to read:81.23    Subd. 13. External fixed costs. "External fixed costs" means costs related to the 81.24nursing home surcharge under section 
         256.9657, subdivision 1; licensure fees under 81.25section 
         144.122; until September 30, 2013, long-term care consultation fees under 81.26section 
         256B.0911, subdivision 6; family advisory council fee under section 
         144A.33; 81.27scholarships under section 
         256B.431, subdivision 36; planned closure rate adjustments 81.28under section 
         256B.437; or single bed room incentives under section 
         256B.431, 81.29subdivision 42
         ; property taxes and property insurance; and PERA.81.30    Sec. 39. Minnesota Statutes 2012, section 256B.441, subdivision 53, is amended to read:81.31    Subd. 53. Calculation of payment rate for external fixed costs. The commissioner 81.32shall calculate a payment rate for external fixed costs.82.1    (a) For a facility licensed as a nursing home, the portion related to section 
         256.9657 82.2shall be equal to $8.86. For a facility licensed as both a nursing home and a boarding care 82.3home, the portion related to section 
         256.9657 shall be equal to $8.86 multiplied by the 82.4result of its number of nursing home beds divided by its total number of licensed beds.82.5    (b) The portion related to the licensure fee under section 
         144.122, paragraph (d), 82.6shall be the amount of the fee divided by actual resident days.82.7    (c) The portion related to scholarships shall be determined under section 
         256B.431, 82.8subdivision 36.82.9    (d)  Until September 30, 2013, the portion related to long-term care consultation shall 82.10be determined according to section 
         256B.0911, subdivision 6.82.11    (e) The portion related to development and education of resident and family advisory 82.12councils under section 
         144A.33 shall be $5 divided by 365.82.13    (f) The portion related to planned closure rate adjustments shall be as determined 82.14under section 
         256B.437, subdivision 6, and Minnesota Statutes 2010, section 
         256B.436. 82.15Planned closure rate adjustments that take effect before October 1, 2014, shall no longer 82.16be included in the payment rate for external fixed costs beginning October 1, 2016. 82.17Planned closure rate adjustments that take effect on or after October 1, 2014, shall no 82.18longer be included in the payment rate for external fixed costs beginning on October 1 of 82.19the first year not less than two years after their effective date.82.20    (g) The portions related to property insurance, real estate taxes, special assessments, 82.21and payments made in lieu of real estate taxes directly identified or allocated to the nursing 82.22facility shall be the actual amounts divided by actual resident days.82.23    (h) The portion related to the Public Employees Retirement Association shall be 82.24actual costs divided by resident days.82.25    (i) The single bed room incentives shall be as determined under section 
         256B.431, 82.26subdivision 42. Single bed room incentives that take effect before October 1, 2014, shall 82.27no longer be included in the payment rate for external fixed costs beginning October 1, 82.282016. Single bed room incentives that take effect on or after October 1, 2014, shall no 82.29longer be included in the payment rate for external fixed costs beginning on October 1 of 82.30the first year not less than two years after their effective date.82.31    (j) The payment rate for external fixed costs shall be the sum of the amounts in 82.32paragraphs (a) to (i).82.33    Sec. 40. Minnesota Statutes 2012, section 256B.49, subdivision 12, is amended to read:82.34    Subd. 12. Informed choice. Persons who are determined likely to require the level 82.35of care provided in a nursing facility as determined under section 256B.0911, subdivision 83.14e, or a hospital shall be informed of the home and community-based support alternatives 83.2to the provision of inpatient hospital services or nursing facility services. Each person 83.3must be given the choice of either institutional or home and community-based services 83.4using the provisions described in section 
         256B.77, subdivision 2, paragraph (p).83.5    Sec. 41. Minnesota Statutes 2012, section 256B.49, subdivision 14, is amended to read:83.6    Subd. 14. Assessment and reassessment. (a) Assessments and reassessments 83.7shall be conducted by certified assessors according to section 256B.0911, subdivision 2b. 83.8With the permission of the recipient or the recipient's designated legal representative, 83.9the recipient's current provider of services may submit a written report outlining their 83.10recommendations regarding the recipient's care needs prepared by a direct service 83.11employee with at least 20 hours of service to that client. The person conducting the 83.12assessment or reassessment must notify the provider of the date by which this information 83.13is to be submitted. This information shall be provided to the person conducting the 83.14assessment and the person or the person's legal representative and must be considered 83.15prior to the finalization of the assessment or reassessment.83.16(b) There must be a determination that the client requires a hospital level of care or a 83.17nursing facility level of care as defined in section 
         256B.0911, subdivision 4a, paragraph 83.18(d) 4e, at initial and subsequent assessments to initiate and maintain participation in the 83.19waiver program.83.20(c) Regardless of other assessments identified in section 
         144.0724, subdivision 4, as 83.21appropriate to determine nursing facility level of care for purposes of medical assistance 83.22payment for nursing facility services, only face-to-face assessments conducted according 83.23to section 
         256B.0911, subdivisions 3a, 3b, and 4d, that result in a hospital level of care 83.24determination or a nursing facility level of care determination must be accepted for 83.25purposes of initial and ongoing access to waiver services payment.83.26(d) Recipients who are found eligible for home and community-based services under 83.27this section before their 65th birthday may remain eligible for these services after their 83.2865th birthday if they continue to meet all other eligibility factors.83.29(e) The commissioner shall develop criteria to identify recipients whose level of 83.30functioning is reasonably expected to improve and reassess these recipients to establish 83.31a baseline assessment. Recipients who meet these criteria must have a comprehensive 83.32transitional service plan developed under subdivision 15, paragraphs (b) and (c), and be 83.33reassessed every six months until there has been no significant change in the recipient's 83.34functioning for at least 12 months. After there has been no significant change in the 83.35recipient's functioning for at least 12 months, reassessments of the recipient's strengths, 84.1informal support systems, and need for services shall be conducted at least every 12 84.2months and at other times when there has been a significant change in the recipient's 84.3functioning. Counties, case managers, and service providers are responsible for 84.4conducting these reassessments and shall complete the reassessments out of existing funds.84.5    Sec. 42. [256B.85] COMMUNITY FIRST SERVICES AND SUPPORTS.84.6    Subdivision 1.Basis and scope.(a) Upon federal approval, the commissioner 84.7shall establish a medical assistance state plan option for the provision of home and 84.8community-based personal assistance service and supports called "community first 84.9services and supports (CFSS)."84.10(b) CFSS is a participant-controlled method of selecting and providing services 84.11and supports that allows the participant maximum control of the services and supports. 84.12Participants may choose the degree to which they direct and manage their supports by 84.13choosing to have a significant and meaningful role in the management of services and 84.14supports including by directly employing support workers with the necessary supports 84.15to perform that function.84.16(c) CFSS is available statewide to eligible individuals to assist with accomplishing 84.17activities of daily living (ADLs), instrumental activities of daily living (IADLs), and 84.18health-related procedures and tasks through hands-on assistance to accomplish the task 84.19or constant supervision and cueing to accomplish the task; and to assist with acquiring, 84.20maintaining, and enhancing the skills necessary to accomplish ADLs, IADLs, and 84.21health-related procedures and tasks. CFSS allows payment for certain supports and goods 84.22such as environmental modifications and technology that are intended to replace or 84.23decrease the need for human assistance.84.24(d) Upon federal approval, CFSS will replace the personal care assistance program 84.25under sections 256.476, 256B.0625, subdivisions 19a and 19c, and 256B.0659.84.26    Subd. 2.Definitions.(a) For the purposes of this section, the terms defined in 84.27this subdivision have the meanings given.84.28(b) "Activities of daily living" or "ADLs" means eating, toileting, grooming, 84.29dressing, bathing, mobility, positioning, and transferring.84.30(c) "Agency-provider model" means a method of CFSS under which a qualified 84.31agency provides services and supports through the agency's own employees and policies. 84.32The agency must allow the participant to have a significant role in the selection and 84.33dismissal of support workers of their choice for the delivery of their specific services 84.34and supports.85.1(d) "Behavior" means a description of a need for services and supports used to 85.2determine the home care rating and additional service units. The presence of Level I 85.3behavior is used to determine the home care rating. "Level I behavior" means physical 85.4aggression towards self or others or destruction of property that requires the immediate 85.5response of another person. If qualified for a home care rating as described in subdivision 85.68, additional service units can be added as described in subdivision 8, paragraph (f), for 85.7the following behaviors:85.8(1) Level I behavior;85.9(2) increased vulnerability due to cognitive deficits or socially inappropriate 85.10behavior; or85.11(3) increased need for assistance for recipients who are verbally aggressive or 85.12resistive to care so that time needed to perform activities of daily living is increased.85.13(e) "Complex health-related needs" means an intervention listed in clauses (1) to 85.14(8) that has been ordered by a physician, and is specified in a community support plan, 85.15including:85.16(1) tube feedings requiring:85.17(i) a gastrojejunostomy tube; or85.18(ii) continuous tube feeding lasting longer than 12 hours per day;85.19(2) wounds described as:85.20(i) stage III or stage IV; 85.21(ii) multiple wounds;85.22(iii) requiring sterile or clean dressing changes or a wound vac; or85.23(iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require 85.24specialized  care;85.25(3) parenteral therapy described as:85.26(i) IV therapy more than two times per week lasting longer than four hours for 85.27each  treatment; or85.28(ii) total parenteral nutrition (TPN) daily; 85.29(4) respiratory interventions, including:85.30(i) oxygen required more than eight hours per day;85.31(ii) respiratory vest more than one time per day;  85.32(iii) bronchial drainage treatments more than two times per day;85.33(iv) sterile or clean suctioning more than six times per day;85.34(v) dependence on another to apply respiratory ventilation augmentation devices 85.35such as  BiPAP and CPAP; and85.36(vi) ventilator dependence under section 256B.0652;86.1(5) insertion and maintenance of catheter, including: 86.2(i) sterile catheter changes more than one time per month;86.3(ii) clean intermittent catheterization, and including self-catheterization more than 86.4six times  per day; or86.5(iii) bladder irrigations;86.6(6) bowel program more than two times per week requiring more than 30 minutes to 86.7perform  each time;86.8(7) neurological intervention, including: 86.9(i) seizures more than two times per week and requiring significant physical 86.10assistance  to maintain safety; or86.11(ii) swallowing disorders diagnosed by a physician and requiring specialized 86.12assistance  from another on a daily basis; and86.13(8) other congenital or acquired diseases creating a need for significantly increased 86.14direct  hands-on assistance and interventions in six to eight activities of daily living.86.15(f) "Community first services and supports" or "CFSS" means the assistance and 86.16supports program under this section needed for accomplishing activities of daily living, 86.17instrumental activities of daily living, and health-related tasks through hands-on assistance 86.18to complete the task or supervision and cueing to complete the task, or the purchase of 86.19goods as defined in subdivision 7, paragraph (a), clause (2), that replace the need for 86.20human assistance.86.21(g) "Community first services and supports service delivery plan" or "service delivery 86.22plan" means a written summary of the services and supports, that is based on the community 86.23support plan identified in section 256B.0911 and coordinated services and support plan 86.24and budget identified in section 256B.0915, subdivision 6, if applicable, that is determined 86.25by the participant to meet the assessed needs, using a person-centered planning process.86.26(h) "Critical activities of daily living" means transferring, mobility, eating, and 86.27toileting.86.28(i) "Dependency" in activities of daily living means a person requires hands-on 86.29assistance or constant supervision and cueing to accomplish  one or more of the activities 86.30of daily living every day or on the days during the week that the activity is performed; 86.31however, a child may not be found to be dependent in an activity of daily living if, 86.32because of the child's age, an adult would either perform the activity for the child or assist 86.33the child with the activity. Assistance needed is the assistance appropriate for a typical 86.34child of the same age.86.35(j) "Extended CFSS" means CFSS services and supports under the agency–provider 86.36model included in a service plan through one of the home and community-based services 87.1waivers authorized under sections 256B.0915; 256B.092, subdivision 5; and 256B.49, 87.2which exceed the amount, duration, and frequency of the state plan CFSS services for 87.3participants.87.4(k) "Financial management services contractor or vendor" means a qualified 87.5organization having a written contract with the department to provide services necessary to 87.6use the budget model under subdivision 13, that include but are not limited to: participant 87.7education and technical assistance; CFSS service delivery planning and budgeting; billing, 87.8making payments, and monitoring of spending; and assisting the participant in fulfilling 87.9employer-related requirements in accordance with Section 3504 of the IRS code and 87.10the IRS Revenue Procedure 70-6.87.11(l) "Budget model" means a service delivery method of CFSS that uses an 87.12individualized CFSS service delivery plan and service budget and assistance from the 87.13financial management services contractor to facilitate participant employment of support 87.14workers and the acquisition of supports and goods.87.15(m) "Health-related procedures and tasks" means procedures and tasks related to 87.16the specific needs of an individual that can be delegated or assigned by a state-licensed 87.17healthcare or behavioral health professional and performed by a support worker.87.18(n) "Instrumental activities of daily living" means activities related to living 87.19independently in the community, including but not limited to: meal planning, preparation, 87.20and cooking; shopping for food, clothing, or other essential items; laundry; housecleaning; 87.21assistance with medications; managing money; communicating needs, preferences, and 87.22activities; arranging supports; and assistance with traveling around and participating 87.23in the community.87.24(o) "Legal representative" means parent of a minor, a court-appointed guardian, or 87.25another representative with legal authority to make decisions about services and supports 87.26for the participant. Other representatives with legal authority to make decisions include 87.27but are not limited to a health care agent or an attorney-in-fact authorized through a health 87.28care directive or power of attorney.87.29(p) "Medication assistance" means providing verbal or visual reminders to take  87.30regularly scheduled medication, and includes any of the following supports listed in clauses 87.31(1) to (3) and other types of assistance, except that a support worker may not determine 87.32medication dose or time for medication or inject medications into veins, muscles, or skin:87.33(1) under the direction of the participant or the participant's representative, bringing  87.34medications to the participant including medications given through a nebulizer, opening a  87.35container of previously set-up medications, emptying the container into the participant's  88.1hand, opening and giving the medication in the original container to the participant, or  88.2bringing to the participant liquids or food to accompany the medication;88.3(2) organizing medications as directed by the participant or the participant's  88.4representative; and88.5(3) providing verbal or visual reminders to perform regularly scheduled medications.88.6(q) "Participant's representative" means a parent, family member, advocate, or 88.7other adult authorized by the participant to serve as a representative in connection with 88.8the provision of CFSS. This authorization must be in writing or by another method 88.9that clearly indicates the participant's free choice. The participant's representative must 88.10have no financial interest in the provision of any services included in the participant's 88.11service delivery plan and must be capable of providing the support necessary to assist 88.12the participant in the use of CFSS. If through the assessment process described in 88.13subdivision 5 a participant is determined to be in need of a participant's representative, one 88.14must be selected. If the participant is unable to assist in the selection of a participant's 88.15representative, the legal representative shall appoint one. Two persons may be designated 88.16as a participant's representative for reasons such as divided households and court-ordered 88.17custodies. Duties of a participant's representatives may include:88.18(1) being available while care is provided in a method agreed upon by the participant 88.19or the participant's legal representative and documented in the participant's CFSS service 88.20delivery plan;88.21(2) monitoring CFSS services to ensure the participant's CFSS service delivery 88.22plan is being followed; and88.23(3) reviewing and signing CFSS time sheets after services are provided to provide 88.24verification of the CFSS services.88.25(r) "Person-centered planning process" means a process that is driven by the 88.26participant for discovering and planning services and supports that ensures the participant 88.27makes informed choices and decisions. The person-centered planning process must:88.28(1) include people chosen by the participant;88.29(2) provide necessary information and support to ensure that the participant directs 88.30the process to the maximum extent possible, and is enabled to make informed choices 88.31and decisions;88.32(3) be timely and occur at time and locations of convenience to the participant;88.33(4) reflect cultural considerations of the participant;88.34(5) include strategies for solving conflict or disagreement within the process, 88.35including clear conflict-of-interest guidelines for all planning;89.1(6) offer choices to the participant regarding the services and supports they receive 89.2and from whom;89.3(7) include a method for the participant to request updates to the plan; and89.4(8) record the alternative home and community-based settings that were considered 89.5by the participant.89.6(s) "Shared services" means the provision of CFSS services by the same CFSS 89.7support worker to two or three participants who voluntarily enter into an agreement to 89.8receive services at the same time and in the same setting by the same provider.89.9(t) "Support specialist" means a professional with the skills and ability to assist the 89.10participant using either the agency provider model under subdivision 11 or the flexible 89.11spending model under subdivision 13, in services including but not limited to assistance 89.12regarding:89.13(1) the development, implementation, and evaluation of the CFSS service delivery 89.14plan under subdivision 6;89.15(2) recruitment, training, or supervision, including supervision of health-related 89.16tasks or behavioral supports appropriately delegated by a health care professional, and 89.17evaluation of support workers; and89.18(3) facilitating the use of informal and community supports, goods, or resources.89.19(u) "Support worker" means an employee of the agency provider or of the participant 89.20who has direct contact with the participant and provides services as specified within the 89.21participant's service delivery plan.89.22(v) "Wages and benefits" means the hourly wages and salaries, the employer's 89.23share of FICA taxes, Medicare taxes, state and federal unemployment taxes, workers' 89.24compensation, mileage reimbursement, health and dental insurance, life insurance, 89.25disability insurance, long-term care insurance, uniform allowance, contributions to 89.26employee retirement accounts, or other forms of employee compensation and benefits.89.27    Subd. 3.Eligibility.(a) CFSS is available to a person who meets one of the 89.28following:89.29(1) is a recipient of medical assistance as determined under section 256B.055, 89.30256B.056, or 256B.057, subdivisions 5 and 9;89.31(2) is a recipient of the alternative care program under section 256B.0913;89.32(3) is a waiver recipient as defined under section 256B.0915, 256B.092, 256B.093, 89.33or 256B.49; or89.34(4) has medical services identified in a participant's individualized education 89.35program and is eligible for services as determined in section 256B.0625, subdivision 26.90.1(b) In addition to meeting the eligibility criteria in paragraph (a), a person must also 90.2meet all of the following:90.3(1) require assistance and be determined dependent in one activity of daily living or 90.4Level I behavior based on assessment under section 256B.0911;90.5(2) is not a recipient under the family support grant under section 252.32;90.6(3) lives in the person's own apartment or home including a family foster care setting 90.7licensed under chapter 245A, but not in corporate foster care under chapter 245A; or a 90.8noncertified boarding care or boarding and lodging establishments under chapter 157. 90.9    Subd. 4.Eligibility for other services.Selection of CFSS by a participant must not 90.10restrict access to other medically necessary care and services furnished under the state 90.11plan medical assistance benefit or other services available through alternative care.90.12    Subd. 5.Assessment requirements.(a) The assessment of functional need must:90.13(1) be conducted by a certified assessor according to the criteria established in 90.14section 256B.0911, subdivision 3a;90.15(2) be conducted face-to-face, initially and at least annually thereafter, or when there 90.16is a significant change in the participant's condition or a change in the need for services 90.17and supports; and90.18(3) be completed using the format established by the commissioner.90.19(b) A participant who is residing in a facility may be assessed and choose CFSS for 90.20the purpose of using CFSS to return to the community as described in subdivisions 3 90.21and 7, paragraph (a), clause (5).90.22(c) The results of the assessment and any recommendations and authorizations for 90.23CFSS must be determined and communicated in writing by the lead agency's certified 90.24assessor as defined in section 256B.0911 to the participant and the agency-provider or 90.25financial management services provider chosen by the participant within 40 calendar days 90.26and must include the participant's right to appeal under section 256.045, subdivision 3.90.27(d)  The lead agency assessor may request a temporary authorization for CFSS 90.28services. Authorization for a temporary level of CFSS services is limited to the time 90.29specified by the commissioner, but shall not exceed 45 days. The level of services 90.30authorized under this provision shall have no bearing on a future authorization.90.31    Subd. 6.Community first services and support service delivery plan.(a) The 90.32CFSS service delivery plan must be developed, implemented, and evaluated through a 90.33person-centered planning process by the participant, or the participant's representative 90.34or legal representative who may be assisted by a support specialist. The CFSS service 90.35delivery plan must reflect the services and supports that are important to the participant 90.36and for the participant to meet the needs assessed by the certified assessor and identified 91.1in the community support plan under section 256B.0911 or the coordinated services and 91.2support plan identified in section 256B.0915, subdivision 6, if applicable. The CFSS 91.3service delivery plan must be reviewed by the participant and the agency-provider or 91.4financial management services contractor at least annually upon reassessment, or when 91.5there is a significant change in the participant's condition, or a change in the need for 91.6services and supports.91.7(b) The commissioner shall establish the format and criteria for the CFSS service 91.8delivery plan.91.9(c) The CFSS service delivery plan must be person-centered and:91.10(1) specify the agency-provider or financial management services contractor selected 91.11by the participant;91.12(2) reflect the setting in which the participant resides that is chosen by the participant;91.13(3) reflect the participant's strengths and preferences;91.14(4) include the means to address the clinical and support needs as identified through 91.15an assessment of functional needs;91.16(5) include individually identified goals and desired outcomes;91.17(6) reflect the services and supports, paid and unpaid, that will assist the participant 91.18to achieve identified goals, and the providers of those services and supports, including 91.19natural supports;91.20(7) identify the amount and frequency of face-to-face supports and amount and 91.21frequency of remote supports and technology that will be used;91.22(8) identify risk factors and measures in place to minimize them, including 91.23individualized backup plans;91.24(9) be understandable to the participant and the individuals providing support;91.25(10) identify the individual or entity responsible for monitoring the plan;91.26(11) be finalized and agreed to in writing by the participant and signed by all 91.27individuals and providers responsible for its implementation;91.28(12) be distributed to the participant and other people involved in the plan; and91.29(13) prevent the provision of unnecessary or inappropriate care.91.30(d) The total units of agency-provider services or the budget allocation amount for 91.31the budget model include both annual totals and a monthly average amount that cover 91.32the number of months of the service authorization. The amount used each month may 91.33vary, but additional funds must not be provided above the annual service authorization 91.34amount unless a change in condition is assessed and authorized by the certified assessor 91.35and documented in the community support plan, coordinated services and supports plan, 91.36and service delivery plan.92.1    Subd. 7.Community first services and supports; covered services. Services 92.2and supports covered under CFSS include:92.3(1) assistance to accomplish activities of daily living (ADLs), instrumental activities 92.4of daily living (IADLs), and health-related procedures and tasks through hands-on 92.5assistance to complete the task or supervision and cueing to complete the task;92.6(2) assistance to acquire, maintain, or enhance the skills necessary for the participant 92.7to accomplish activities of daily living, instrumental activities of daily living, or 92.8health-related tasks;92.9(3) expenditures for items, services, supports, environmental modifications, or 92.10goods, including assistive technology. These expenditures must:92.11(i) relate to a need identified in a participant's CFSS service delivery plan; 92.12(ii) increase independence or substitute for human assistance to the extent that 92.13expenditures would otherwise be made for human assistance for the participant's assessed 92.14needs; 92.15(4) observation and redirection for behavior or symptoms where there is a need for 92.16assistance. A recipient qualifies as having a need for assistance due to behaviors if the 92.17recipient's behavior requires assistance at least four times per week and shows one or 92.18more of the following behaviors:92.19(i) physical aggression towards self or others, or destruction of property that requires 92.20the immediate response of another person;92.21(ii) increased vulnerability due to cognitive deficits or socially inappropriate 92.22behavior; or92.23(iii) increased need for assistance for recipients who are verbally aggressive or 92.24resistive to care so that time needed to perform activities of daily living is increased;92.25(5) back-up systems or mechanisms, such as the use of pagers or other electronic 92.26devices, to ensure continuity of the participant's services and supports;92.27(6) transition costs, including:92.28(i) deposits for rent and utilities;92.29(ii) first month's rent and utilities;92.30(iii) bedding;92.31(iv) basic kitchen supplies;92.32(v) other necessities, to the extent that these necessities are not otherwise covered 92.33under any other funding that the participant is eligible to receive; and92.34(vi) other required necessities for an individual to make the transition from a nursing 92.35facility, institution for mental diseases, or intermediate care facility for persons with 93.1developmental disabilities to a community-based home setting where the participant 93.2resides; and93.3(7) services by a support specialist defined under subdivision 2 that are chosen 93.4by the participant.93.5    Subd. 8.Determination of CFSS service methodology.(a) All community first 93.6services and supports must be authorized by the commissioner or the commissioner's  93.7designee before services begin, except for the assessments established in section  93.8256B.0911. The authorization for CFSS must be completed as soon as possible following 93.9an assessment but no later than 40 calendar days from the date of the assessment.93.10(b) The amount of CFSS authorized must be based on the recipient's home  care 93.11rating described in subdivision 8, paragraphs (d) and (e), and any additional service units 93.12for which the person qualifies as described in subdivision 8, paragraph (f). 93.13(c) The home care rating shall be determined by the commissioner or the  93.14commissioner's designee based on information submitted to the commissioner identifying  93.15the following for a recipient:93.16(1) the total number of dependencies of activities of daily living as defined in  93.17subdivision 2, paragraph (b);93.18(2) the presence of complex health-related needs as defined in subdivision 2, 93.19paragraph (e); and93.20(3) the presence of Level I behavior as defined in subdivision 2, paragraph (d), 93.21clause (1).93.22(d) The methodology to determine  the total service units for CFSS for each home 93.23care rating is based on the median paid units  per day for each home care rating from 93.24fiscal year 2007 data for the PCA program.93.25(e) Each  home care rating is designated by the letters P through Z and EN and  has 93.26the following base number of service units assigned:93.27(i) P home care rating requires Level 1 behavior or one to three dependencies in 93.28ADLs and qualifies one for five service units;93.29(ii) Q home care rating requires Level 1 behavior and one to three dependencies in 93.30ADLs and qualifies one for six service units;  93.31(iii) R home care rating requires complex health-related needs and one to three 93.32dependencies in ADLs and qualifies one for seven service units; 93.33(iv) S home care rating requires four to six dependencies in ADLs and qualifies 93.34one for ten service units;93.35(v) T home care rating requires four to six dependencies in ADLs and Level 1 93.36behavior and qualifies one for 11 service units;94.1(vi) U home care rating requires four to six dependencies in ADLs and a complex 94.2health need and qualifies one for 14 service units;94.3(vii) V home care rating requires seven to eight dependencies in ADLs and qualifies 94.4one for 17 service units; 94.5(viii) W home care rating requires seven to eight dependencies in ADLs and Level 1 94.6behavior and qualifies one for 20 service units;94.7(ix) Z home care rating requires seven to eight dependencies in ADLs and a complex 94.8health related need and qualifies one for 30 service units; and94.9(x) EN home care rating includes ventilator dependency as defined in section 94.10256B.0651, subdivision 1, paragraph (g). Recipients who meet the definition of 94.11ventilator-dependent and the EN home care rating and utilize a combination of CFSS 94.12and other home care services are limited to a total of 96 service units per day for those 94.13services in combination. Additional units may be authorized when a recipient's assessment 94.14indicates a need for two staff to perform activities. Additional time is limited to 16 service 94.15units per day.94.16(f) Additional service units are provided  through the assessment and identification of 94.17the following:94.18(1) 30 additional minutes per day for a dependency in each critical activity of daily  94.19living as defined in subdivision 2, paragraph (h);94.20(2) 30 additional minutes per day for each complex health-related function as  94.21defined in subdivision 2, paragraph (e); and   94.22(3) 30 additional minutes per day for each behavior issue as defined in subdivision 2, 94.23paragraph (d). 94.24    Subd. 9.Noncovered services.(a) Services or supports that are not eligible for 94.25payment under this section include those that:94.26(1) are not authorized by the certified assessor or included in the written service 94.27delivery plan;94.28(2) are provided prior to the authorization of services and the approval of the written 94.29CFSS service delivery plan;94.30(3) are duplicative of other paid services in the written service delivery plan;94.31(4) supplant natural unpaid supports that appropriately meet a need in the service 94.32plan, are provided voluntarily to the participant and are selected by the participant in lieu 94.33of other services and supports;94.34(5) are not effective means to meet the participant's needs; and94.35(6) are available through other funding sources, including, but not limited to, funding 94.36through Title IV-E of the Social Security Act.95.1(b) Additional services, goods, or supports that are not covered include:95.2(1) those that are not for the direct benefit of the participant, except that services for 95.3caregivers such as training to improve the ability to provide CFSS are considered to directly 95.4benefit the participant if chosen by the participant and approved in the support plan;95.5(2) any fees incurred by the participant, such as Minnesota health care programs fees 95.6and co-pays, legal fees, or costs related to advocate agencies;95.7(3) insurance, except for insurance costs related to employee coverage;95.8(4) room and board costs for the participant with the exception of allowable 95.9transition costs in subdivision 7, clause (6);95.10(5) services, supports, or goods that are not related to the assessed needs;95.11(6) special education and related services provided under the Individuals with 95.12Disabilities Education Act and vocational rehabilitation services provided under the 95.13Rehabilitation Act of 1973;95.14(7) assistive technology devices and assistive technology services other than those 95.15for back-up systems or mechanisms to ensure continuity of service and supports listed in 95.16subdivision 7;95.17(8) medical supplies and equipment;95.18(9) environmental modifications, except as specified in subdivision 7;95.19(10) expenses for travel, lodging, or meals related to training the participant, the 95.20participant's representative, legal representative, or paid or unpaid caregivers that exceed 95.21$500 in a 12-month period;95.22(11) experimental treatments;95.23(12) any service or good covered by other medical assistance state plan services, 95.24including prescription and over-the-counter medications, compounds, and solutions and 95.25related fees, including premiums and co-payments;95.26(13) membership dues or costs, except when the service is necessary and appropriate 95.27to treat a physical condition or to improve or maintain the participant's physical condition. 95.28The condition must be identified in the participant's CFSS plan and monitored by a 95.29physician enrolled in a Minnesota health care program;95.30(14) vacation expenses other than the cost of direct services;95.31(15) vehicle maintenance or modifications not related to the disability, health 95.32condition, or physical need; and95.33(16) tickets and related costs to attend sporting or other recreational or entertainment 95.34events.96.1    Subd. 10.Provider qualifications and general requirements.(a) 96.2Agency-providers delivering services under the agency-provider model under subdivision 96.311 or financial management service (FMS) contractors under subdivision 13 shall:96.4(1) enroll as a medical assistance Minnesota health care programs provider and meet 96.5all applicable provider standards;96.6(2) comply with medical assistance provider enrollment requirements;96.7(3) demonstrate compliance with law and policies of CFSS as determined by the 96.8commissioner;96.9(4) comply with background study requirements under chapter 245C;96.10(5) verify and maintain records of all services and expenditures by the participant, 96.11including hours worked by support workers and support specialists;96.12(6) not engage in any agency-initiated direct contact or marketing in person, by 96.13telephone, or other electronic means to potential participants, guardians, family member, 96.14or participants' representatives;96.15(7) pay support workers and support specialists based upon actual hours of services 96.16provided;96.17(8) withhold and pay all applicable federal and state payroll taxes;96.18(9) make arrangements and pay unemployment insurance, taxes, workers' 96.19compensation, liability insurance, and other benefits, if any;96.20(10) enter into a written agreement with the participant, participant's representative, 96.21or legal representative that assigns roles and responsibilities to be performed before 96.22services, supports, or goods are provided using a format established by the commissioner;96.23(11) report maltreatment as required under sections 626.556 and 626.557; and96.24(12) provide the participant with a copy of the service-related rights under 96.25subdivision 19 at the start of services and supports.96.26(b) The commissioner shall develop policies and procedures designed to ensure 96.27program integrity and fiscal accountability for goods and services provided in this section 96.28in consultation with the implementation council described in subdivision 21.96.29    Subd. 11.Agency-provider model.(a) The agency-provider model is limited to  96.30the services provided by support workers and support specialists who are employed by 96.31an agency-provider that is licensed according to chapter 245A or meets other criteria 96.32established by the commissioner, including required training.96.33(b) The agency-provider shall allow the participant to have a significant role in the 96.34selection and dismissal of the support workers for the delivery of the   services and supports 96.35specified in the participant's service delivery plan.97.1(c) A participant may use authorized units of CFSS services as needed within  a 97.2service authorization that is not greater than 12 months. Using authorized units in a 97.3flexible manner in either the agency-provider model or the budget model  does not increase 97.4the total amount of services and supports authorized for a  participant or included in the 97.5participant's service delivery plan.97.6(d) A participant may share CFSS services. Two or three CFSS participants may  97.7share services at the same time provided by the same support worker.97.8(e) The agency-provider must use a minimum of 72.5 percent of the revenue  97.9generated by the medical assistance payment for CFSS for support worker wages and 97.10benefits. The agency-provider must document how this requirement is being met. The 97.11revenue generated by the support specialist and the reasonable costs associated with the 97.12support specialist must not be used in making this calculation.97.13(f) The agency-provider model must be used by individuals who have been restricted 97.14by the Minnesota restricted recipient program under Minnesota Rules, parts 9505.2160 97.15to 9505.2245.97.16    Subd. 12.Requirements for initial enrollment of CFSS provider agencies. (a)  97.17All CFSS provider agencies must provide, at the time of enrollment as a CFSS provider  97.18agency in a format determined by the commissioner, information and documentation that  97.19includes, but is not limited to, the following:97.20(1) the CFSS provider agency's current contact information including address,  97.21telephone number, and e-mail address;97.22(2) proof of surety bond coverage in the amount of $50,000 or ten percent of the  97.23provider's payments from Medicaid in the previous year, whichever is less;97.24(3) proof of fidelity bond coverage in the amount of $20,000;97.25(4) proof of workers' compensation insurance coverage;97.26(5) proof of liability insurance;97.27(6) a description of the CFSS provider agency's organization identifying the names  97.28or all owners, managing employees, staff, board of directors, and the affiliations of the  97.29directors, owners, or staff to other service providers;97.30(7) a copy of the CFSS provider agency's written policies and procedures including:  97.31hiring of employees; training requirements; service delivery; and employee and consumer  97.32safety including process for notification and resolution of consumer grievances,  97.33identification and prevention of communicable diseases, and employee misconduct;97.34(8) copies of all other forms the CFSS provider agency uses in the course of daily  97.35business including, but not limited to:98.1(i) a copy of the CFSS provider agency's time sheet if the time sheet varies from  98.2the standard time sheet for CFSS services approved by the commissioner, and a letter  98.3requesting approval of the CFSS provider agency's nonstandard time sheet;98.4(ii) the CFSS provider agency's template for the CFSS care plan; and98.5(iii) the CFSS provider agency's template for the written agreement in subdivision 98.621 for recipients using the CFSS choice option, if applicable;98.7(9) a list of all training and classes that the CFSS provider agency requires of its  98.8staff providing CFSS services;98.9(10) documentation that the CFSS provider agency and staff have successfully  98.10completed all the training required by this section;98.11(11) documentation of the agency's marketing practices;98.12(12) disclosure of ownership, leasing, or management of all residential properties   98.13that is used or could be used for providing home care services;98.14(13) documentation that the agency will use the following percentages of revenue  98.15generated from the medical assistance rate paid for CFSS services for employee personal  98.16care assistant wages and benefits: 72.5 percent of revenue from CFSS providers. The  98.17revenue generated by the support specialist and the reasonable costs associated with the  98.18support specialist shall not be used in making this calculation; and 98.19(14) documentation that the agency does not burden recipients' free exercise of their  98.20right to choose service providers by requiring personal care assistants to sign an agreement  98.21not to work with any particular CFSS recipient or for another CFSS provider agency after  98.22leaving the agency and that the agency is not taking action on any such agreements or 98.23requirements regardless of the date signed.98.24(b) CFSS provider agencies shall provide to the commissioner the information 98.25specified in paragraph (a).98.26(c) All CFSS provider agencies shall require all employees in management and 98.27supervisory positions and owners of the agency who are active in the day-to-day 98.28management and operations of the agency to complete mandatory training as determined 98.29by the commissioner. Employees in management and supervisory positions and owners 98.30who are active in the day-to-day operations of an agency who have completed the required  98.31training as an employee with a CFSS provider agency do not need to repeat the required 98.32training if they are hired by another agency, if they have completed the training within 98.33the past three years. CFSS provider agency billing staff shall complete training about 98.34CFSS program financial management. Any new owners or employees in management 98.35and supervisory positions involved in the day-to-day operations are required to complete 98.36mandatory training as a requisite of working for the agency. CFSS provider agencies 99.1certified for participation in Medicare as home health agencies are exempt from the 99.2training required in this subdivision. 99.3    Subd. 13.Budget model. (a) Under the budget model participants can exercise 99.4more responsibility and control over the services and supports described and budgeted 99.5within the CFSS service delivery plan. Under this model, participants may use their 99.6budget allocation to:99.7(1) directly employ support workers;99.8(2) obtain supports and goods as defined in subdivision 7; and99.9(3) choose a range of support assistance services from the financial management 99.10services (FMS) contractor related to:99.11(i) assistance in managing the budget to meet the service delivery plan needs, 99.12consistent with federal and state laws and regulations;99.13(ii) the employment, training, supervision, and evaluation of workers by the 99.14participant;99.15(iii) acquisition and payment for supports and goods; and99.16(iv) evaluation of individual service outcomes as needed for the scope of the  99.17participant's degree of control and responsibility.99.18(b) Participants who are unable to fulfill any of the functions listed in paragraph (a) 99.19may authorize a legal representative or participant's representative to do so on their behalf.99.20(c) The FMS contractor shall not provide CFSS services and supports under the  99.21agency-provider service model. The FMS contractor shall provide service functions as 99.22determined by the commissioner that include but are not limited to:99.23(1) information and consultation about CFSS;99.24(2) assistance with the development of the service delivery plan and budget model 99.25as requested by the participant;99.26(3) billing and making payments for budget model expenditures;99.27(4) assisting participants in fulfilling employer-related requirements according to 99.28Internal Revenue Code Procedure 70-6, section 3504, Agency Employer Tax Liability,  99.29regulation 137036-08, which includes assistance with filing and paying payroll taxes, and 99.30obtaining worker compensation coverage;99.31(5) data recording and reporting of participant spending; and99.32(6) other duties established in the contract with the department.99.33(d) A participant who requests to purchase goods and supports along with support  99.34worker services under the agency-provider model must use the budget model  with 99.35a service delivery plan that specifies the amount of services to be authorized to the 99.36agency-provider and the expenditures to be paid by the FMS contractor.100.1(e) The FMS contractor shall:100.2(1) not limit or restrict the participant's choice of service or support providers or  100.3service delivery models consistent with any applicable state and federal requirements;100.4(2) provide the participant and the targeted case manager, if applicable, with a 100.5monthly written summary of the spending for services and supports that were billed 100.6against the spending budget;100.7(3) be knowledgeable of state and federal employment regulations under the Fair 100.8Labor Standards Act of 1938, and comply with the requirements under the Internal 100.9Revenue Service Revenue Code Procedure 70-6, Section 35-4, Agency Employer Tax 100.10Liability for vendor or fiscal employer agent, and any requirements necessary to process 100.11employer and employee deductions, provide appropriate and timely submission of 100.12employer tax liabilities, and maintain documentation to support medical assistance claims;100.13(4) have current and adequate liability insurance and bonding and sufficient cash 100.14flow as determined by the commissioner and have on staff or under contract a certified 100.15public accountant or an individual with a baccalaureate degree in accounting;100.16(5) assume fiscal accountability for state funds designated for the program; and100.17(6) maintain documentation of receipts, invoices, and bills to track all services and 100.18supports expenditures for any goods purchased and maintain time records of support 100.19workers. The documentation and time records must be maintained for a minimum of 100.20five years from the claim date and be available for audit or review upon request by the 100.21commissioner. Claims submitted by the FMS contractor to the commissioner for payment 100.22must correspond with services, amounts, and time periods as authorized in the participant's 100.23spending budget and service plan.100.24(f) The commissioner of human services shall:100.25(1) establish rates and payment methodology for the FMS contractor;100.26(2) identify a process to ensure quality and performance standards for the FMS 100.27contractor and ensure statewide access to FMS contractors; and 100.28(3) establish a uniform protocol for delivering and administering CFSS services 100.29to be used by eligible FMS contractors.100.30(g) The commissioner of human services shall disenroll or exclude participants from 100.31the budget model and transfer them to the agency-provider model under the following 100.32circumstances that include but are not limited to:100.33(1) when a participant has been restricted by the Minnesota restricted recipient 100.34program, the participant may be excluded for a specified time period under Minnesota 100.35Rules, parts 9505.2160 to 9505.2245;101.1(2) when a participant exits the budget model during the participant's service plan 101.2year. Upon transfer, the participant shall not access the budget  model for the remainder of 101.3that service plan year; or 101.4(3) when the department determines that the participant or participant's representative 101.5or legal representative cannot manage participant responsibilities under the budget model. 101.6The commissioner must develop policies for determining if a participant  is unable to 101.7manage responsibilities under a budget model.101.8(h) A participant may appeal under section 256.045, subdivision 3, in writing to the 101.9department to contest the department's decision under paragraph (c), clause (3), to remove 101.10or exclude the participant from the budget model.101.11    Subd. 14.Participant's responsibilities under budget model.(a) A  participant 101.12using the budget model must use an FMS contractor or vendor that is  under contract with 101.13the department. Upon a determination of eligibility and completion of the assessment and 101.14community support plan, the participant shall choose a FMS contractor from a list of 101.15eligible vendors maintained by the department.101.16(b) When the participant, participant's representative, or legal representative chooses 101.17to be the employer of the support worker, they are responsible for the hiring and supervision 101.18of the support worker, including, but not limited to, recruiting, interviewing, training, and 101.19discharging the support worker consistent with federal  and state laws and regulations.101.20(c) In addition to the employer responsibilities in paragraph (b), the participant,  101.21participant's representative, or legal representative is responsible for:101.22(1) tracking the services provided and all expenditures for goods or other supports;101.23(2) preparing and submitting time sheets, signed by both the participant and support 101.24worker, to the FMS contractor on a regular basis and in a timely manner according to 101.25the FMS contractor's procedures;  101.26(3) notifying the FMS contractor within ten days of any changes in circumstances  101.27affecting the CFSS service plan or in the participant's place of residence including, but  101.28not limited to, any hospitalization of the participant or change in the participant's address,  101.29telephone number, or employment;101.30(4) notifying the FMS contractor of any changes in the employment status of each 101.31participant support worker; and  101.32(5) reporting any problems resulting from the quality of services rendered by the  101.33support worker to the FMS contractor. If the participant is unable to resolve any problems  101.34resulting from the quality of service rendered by the support worker with the assistance of  101.35the FMS contractor, the participant shall report the situation to the department.  102.1    Subd. 15.Documentation of support services provided.(a) Support services 102.2provided to a participant by a support worker employed by either an agency-provider 102.3or the participant acting as the employer must be documented daily by each support 102.4worker, on a time sheet form approved by the commissioner. All documentation may be 102.5Web-based, electronic, or paper documentation. The completed form must be submitted 102.6on a monthly basis to the provider or the participant and the FMS contractor selected by 102.7the participant to provide assistance with meeting the participant's employer obligations 102.8and kept in the recipient's health record.102.9(b) The activity documentation must correspond to the written service delivery plan 102.10and be reviewed by the agency provider or the participant and the FMS contractor when 102.11the participant is acting as the employer of the support worker.102.12(c) The time sheet must be on a form approved by the commissioner documenting 102.13time the support worker provides services in the home. The following criteria must be 102.14included in the time sheet:102.15(1) full name of the support worker and individual provider number;102.16(2) provider name and telephone numbers, if an agency-provider is responsible for 102.17delivery services under the written service plan;102.18(3) full name of the participant;102.19(4) consecutive dates, including month, day, and year, and arrival and departure 102.20times with a.m. or p.m. notations;102.21(5) signatures of the participant or the participant's representative;102.22(6) personal signature of the support worker;102.23(7) any shared care provided, if applicable;102.24(8) a statement that it is a federal crime to provide false information on CFSS 102.25billings for medical assistance payments; and102.26(9) dates and location of recipient stays in a hospital, care facility, or incarceration.102.27    Subd. 16.Support workers requirements.(a) Support workers shall:102.28(1) enroll with the department as a support worker after a background study under 102.29chapter 245C has been completed and the support worker has received a notice from the 102.30commissioner that:102.31(i) the support worker is not disqualified under section 245C.14; or102.32(ii) is disqualified, but the support worker has received a set-aside of the 102.33disqualification under section 245C.22; 102.34(2) have the ability to effectively communicate with the participant or the  102.35participant's representative;103.1(3) have the skills and ability to provide the services and supports according to the 103.2person's CFSS service delivery plan and respond appropriately to the participant's needs;103.3(4) not be a participant of CFSS, unless the support services provided by the support 103.4worker differ from those provided to the support worker;103.5(5) complete the basic standardized training as determined by the commissioner 103.6before completing enrollment. The training must be available in languages other than 103.7English and to those who need accommodations due to disabilities. Support worker 103.8training must include successful completion of the following training components: basic 103.9first aid, vulnerable adult, child maltreatment, OSHA universal precautions, basic roles 103.10and responsibilities of support workers including information about basic body mechanics,  103.11emergency preparedness, orientation to positive behavioral practices, orientation to 103.12responding to a mental health crisis, fraud issues, time cards and documentation, and an 103.13overview of person-centered planning and self-direction. Upon completion of the training 103.14components, the support worker must pass the certification test to provide assistance 103.15to participants;103.16(6) complete training and orientation on the participant's individual needs; and103.17(7) maintain the privacy and confidentiality of the participant, and not independently 103.18determine the medication dose or time for medications for the participant.103.19(b) The commissioner may deny or terminate a support worker's provider enrollment 103.20and provider number if the support worker:103.21(1) lacks the skills, knowledge, or ability to adequately or safely perform the  103.22required work;103.23(2) fails to provide the authorized services required by the participant employer;103.24(3) has been intoxicated by alcohol or drugs while providing authorized services to  103.25the participant or while in the participant's home;103.26(4) has manufactured or distributed drugs while providing authorized services to the  103.27participant or while in the participant's home; or103.28(5) has been excluded as a provider by the commissioner of human services, or the  103.29United States Department of Health and Human Services, Office of Inspector General,  103.30from participation in Medicaid, Medicare, or any other federal health care program.103.31(c) A support worker may appeal in writing to the commissioner to contest the 103.32decision to terminate the support worker's provider enrollment and provider number.103.33    Subd. 17.Support specialist requirements and payments.The commissioner 103.34shall develop qualifications, scope of functions, and payment rates and service limits for a 103.35support specialist that may provide additional or specialized assistance necessary to plan, 103.36implement, arrange, augment, or evaluate services and supports.104.1    Subd. 18.Service unit and budget allocation requirements and limits.(a) For the  104.2agency-provider model, services will be authorized in units of service. The total service  104.3unit amount must be established based upon the assessed need for CFSS services, and  must 104.4not exceed the maximum number of units available as determined under  subdivision 8.104.5(b) For the budget model, the budget allocation allowed for services and supports 104.6is established by multiplying the number of units authorized under subdivision 8 by the 104.7payment rate established by the commissioner.104.8    Subd. 19.Support system.(a) The commissioner shall provide information, 104.9consultation, training, and assistance to ensure the participant is able to manage the   104.10services and supports and budgets, if applicable. This support shall include individual 104.11consultation on how to select and employ workers, manage responsibilities under CFSS, 104.12and evaluate personal outcomes.104.13(b) The commissioner shall provide assistance with the development of risk   104.14management agreements.104.15    Subd. 20.Service-related rights.(a) Participants must be provided with adequate 104.16information, counseling, training, and assistance, as needed, to ensure that the participant 104.17is able to choose and manage services, models, and budgets. This support shall include  104.18information regarding:104.19(1) person-centered planning;104.20(2) the range and scope of individual choices;104.21(3) the process for changing plans, services and budgets;104.22(4) the grievance  process;104.23(5) individual rights;104.24(6) identifying and assessing appropriate services;104.25(7) risks and responsibilities; and104.26(8) risk management.104.27(b) The commissioner must ensure that the participant has a copy of the most recent 104.28community support plan and service delivery plan.104.29(c) A participant who appeals a reduction in previously authorized CFSS services 104.30may continue previously authorized services pending an appeal in accordance with section 104.31256.045.104.32(d) If the units of service or budget allocation for CFSS are reduced, denied, or 104.33terminated, the commissioner must provide notice of the reasons for the reduction in the 104.34participant's notice of denial, termination, or reduction.104.35(e) If all or part of a service delivery plan is denied approval, the commissioner must 104.36provide a notice that describes the basis of the denial.105.1    Subd. 21.Development and Implementation Council.The commissioner 105.2shall establish a Development and Implementation Council of which the majority of  105.3members are individuals with disabilities, elderly individuals, and their representatives. 105.4The commissioner shall consult and collaborate with the council when developing and 105.5implementing this section for at least the first five years of operation. The commissioner, 105.6in consultation with the council, shall provide recommendations on how to improve the 105.7quality and integrity of CFSS, reduce the paper documentation required in subdivisions 105.810, 12, and 15, make use of electronic means of documentation and online reporting in 105.9order to reduce administrative costs and improve training to the legislative chairs of the 105.10health and human services policy and finance committees by February 1, 2014.105.11    Subd. 22.Quality assurance and risk management system.(a) The commissioner 105.12shall establish quality assurance and risk management measures for use in developing and 105.13implementing CFSS, including those that (1) recognize the roles and responsibilities of 105.14those involved in obtaining CFSS, and (2) ensure the appropriateness of such plans and 105.15budgets based upon a recipient's resources and capabilities. Risk management measures 105.16must include background studies, and backup and emergency plans, including disaster 105.17planning.105.18(b) The commissioner shall provide ongoing technical assistance and resource and  105.19educational materials for CFSS participants. 105.20(c) Performance assessment measures, such as a participant's satisfaction with the 105.21services and supports, and ongoing monitoring of health and well-being shall be identified 105.22in consultation with the council established in subdivision 21.105.23(d) Data reporting requirements will be developed in consultation with the council 105.24established in subdivision 21.105.25    Subd. 23.Commissioner's access.When the commissioner is investigating a  105.26possible overpayment of Medicaid funds, the commissioner must be given immediate 105.27access without prior notice to the agency provider or FMS contractor's office during  105.28regular business hours and to documentation and records related to services provided and 105.29submission of claims for services provided. Denying the commissioner access to records 105.30is cause for immediate suspension of payment and terminating the agency provider's  105.31enrollment according to section 256B.064 or terminating the FMS contract.105.32    Subd. 24.CFSS agency-providers; background studies.CFSS agency-providers 105.33enrolled to provide personal care assistance services under the medical assistance program 105.34shall comply with the following:105.35(1) owners who have a five percent interest or more and all managing employees 105.36are subject to a background study as provided in chapter 245C. This applies to currently 106.1enrolled CFSS agency-providers and those agencies seeking enrollment as a CFSS 106.2agency-provider. "Managing employee" has the same meaning as Code of Federal  106.3Regulations, title 42, section 455. An organization is barred from enrollment if:106.4(i) the organization has not initiated background studies on owners managing 106.5employees; or106.6(ii) the organization has initiated background studies on owners and managing 106.7employees, but the commissioner has sent the organization a notice that an owner or 106.8managing employee of the organization has been disqualified under section 245C.14, and 106.9the owner or managing employee has not received a set-aside of the disqualification 106.10under section 245C.22;106.11(2) a background study must be initiated and completed for all support specialists; and106.12(3) a background study must be initiated and completed for all support workers.106.13EFFECTIVE DATE.This section is effective upon federal approval but no earlier 106.14than January 1, 2014. The service will begin 90 days after federal approval or January 1, 106.152014, whichever is later. The commissioner of human services shall notify the revisor of 106.16statutes when this occurs.106.17    Sec. 43. Minnesota Statutes 2012, section 256I.05, is amended by adding a subdivision 106.18to read:106.19    Subd. 1o.Supplementary service rate; exemptions.A county agency shall not 106.20negotiate a supplementary service rate under this section for any individual that has been 106.21determined to be eligible for Housing Stability Services as approved by the Centers 106.22for Medicare and Medicaid Services, and who resides in an establishment voluntarily 106.23registered under section 144D.025, as a supportive housing establishment or participates 106.24in the Minnesota supportive housing demonstration program under section 256I.04, 106.25subdivision 3, paragraph (a), clause (4).106.26    Sec. 44. Minnesota Statutes 2012, section 626.557, subdivision 4, is amended to read:106.27    Subd. 4. Reporting. (a) Except as provided in paragraph (b), a mandated reporter 106.28shall immediately make an oral report to the common entry point. The common entry 106.29point may accept electronic reports submitted through a Web-based reporting system 106.30established by the commissioner. Use of a telecommunications device for the deaf or other 106.31similar device shall be considered an oral report. The common entry point may not require 106.32written reports. To the extent possible, the report must be of sufficient content to identify 106.33the vulnerable adult, the caregiver, the nature and extent of the suspected maltreatment, 106.34any evidence of previous maltreatment, the name and address of the reporter, the time, 107.1date, and location of the incident, and any other information that the reporter believes 107.2might be helpful in investigating the suspected maltreatment. A mandated reporter may 107.3disclose not public data, as defined in section 
         13.02, and medical records under sections 107.4144.291
          to 144.298, to the extent necessary to comply with this subdivision.107.5(b) A boarding care home that is licensed under sections 
         144.50 to 
         144.58 and 107.6certified under Title 19 of the Social Security Act, a nursing home that is licensed under 107.7section 
         144A.02 and certified under Title 18 or Title 19 of the Social Security Act, or a 107.8hospital that is licensed under sections 
         144.50 to 
         144.58 and has swing beds certified under 107.9Code of Federal Regulations, title 42, section 
         482.66, may submit a report electronically 107.10to the common entry point instead of submitting an oral report. The report may be a 107.11duplicate of the initial report the facility submits electronically to the commissioner of 107.12health to comply with the reporting requirements under Code of Federal Regulations, title 107.1342, section 
         483.13. The commissioner of health may modify these reporting requirements 107.14to include items required under paragraph (a) that are not currently included in the 107.15electronic reporting form.107.16EFFECTIVE DATE.This section is effective July 1, 2014.107.17    Sec. 45. Minnesota Statutes 2012, section 626.557, subdivision 9, is amended to read:107.18    Subd. 9. Common entry point designation. (a) Each county board shall designate 107.19a common entry point for reports of suspected maltreatment. Two or more county boards 107.20may jointly designate a single The commissioner of human services shall establish a107.21 common entry point effective July 1, 2014. The common entry point is the unit responsible 107.22for receiving the report of suspected maltreatment under this section.107.23(b) The common entry point must be available 24 hours per day to take calls from 107.24reporters of suspected maltreatment. The common entry point shall use a standard intake 107.25form that includes:107.26(1) the time and date of the report;107.27(2) the name, address, and telephone number of the person reporting;107.28(3) the time, date, and location of the incident;107.29(4) the names of the persons involved, including but not limited to, perpetrators, 107.30alleged victims, and witnesses;107.31(5) whether there was a risk of imminent danger to the alleged victim;107.32(6) a description of the suspected maltreatment;107.33(7) the disability, if any, of the alleged victim;107.34(8) the relationship of the alleged perpetrator to the alleged victim;107.35(9) whether a facility was involved and, if so, which agency licenses the facility;108.1(10) any action taken by the common entry point;108.2(11) whether law enforcement has been notified;108.3(12) whether the reporter wishes to receive notification of the initial and final 108.4reports; and108.5(13) if the report is from a facility with an internal reporting procedure, the name, 108.6mailing address, and telephone number of the person who initiated the report internally.108.7(c) The common entry point is not required to complete each item on the form prior 108.8to dispatching the report to the appropriate lead investigative agency.108.9(d) The common entry point shall immediately report to a law enforcement agency 108.10any incident in which there is reason to believe a crime has been committed.108.11(e) If a report is initially made to a law enforcement agency or a lead investigative 108.12agency, those agencies shall take the report on the appropriate common entry point intake 108.13forms and immediately forward a copy to the common entry point.108.14(f) The common entry point staff must receive training on how to screen and 108.15dispatch reports efficiently and in accordance with this section.108.16(g) The commissioner of human services shall maintain a centralized database 108.17for the collection of common entry point data, lead investigative agency data including 108.18maltreatment report disposition, and appeals data. The common entry point shall 108.19have access to the centralized database and must log the reports into the database and 108.20immediately identify and locate prior reports of abuse, neglect, or exploitation.108.21(h) When appropriate, the common entry point staff must refer calls that do not 108.22allege the abuse, neglect, or exploitation of a vulnerable adult to other organizations 108.23that might resolve the reporter's concerns.108.24(i) a common entry point must be operated in a manner that enables the 108.25commissioner of human services to:108.26(1) track critical steps in the reporting, evaluation, referral, response, disposition, 108.27and investigative process to ensure compliance with all requirements for all reports;108.28(2) maintain data to facilitate the production of aggregate statistical reports for 108.29monitoring patterns of abuse, neglect, or exploitation;108.30(3) serve as a resource for the evaluation, management, and planning of preventative 108.31and remedial services for vulnerable adults who have been subject to abuse, neglect, 108.32or exploitation;108.33(4) set standards, priorities, and policies to maximize the efficiency and effectiveness 108.34of the common entry point; and108.35(5) track and manage consumer complaints related to the common entry point.109.1(j) The commissioners of human services and health shall collaborate on the 109.2creation of a system for referring reports to the lead investigative agencies. This system 109.3shall enable the commissioner of human services to track critical steps in the reporting, 109.4evaluation, referral, response, disposition, investigation, notification, determination, and 109.5appeal processes.109.6    Sec. 46. Minnesota Statutes 2012, section 626.557, subdivision 9e, is amended to read:109.7    Subd. 9e. Education requirements. (a) The commissioners of health, human 109.8services, and public safety shall cooperate in the development of a joint program for 109.9education of lead investigative agency investigators in the appropriate techniques for 109.10investigation of complaints of maltreatment. This program must be developed by July 109.111, 1996. The program must include but need not be limited to the following areas: (1) 109.12information collection and preservation; (2) analysis of facts; (3) levels of evidence; (4) 109.13conclusions based on evidence; (5) interviewing skills, including specialized training to 109.14interview people with unique needs; (6) report writing; (7) coordination and referral 109.15to other necessary agencies such as law enforcement and judicial agencies; (8) human 109.16relations and cultural diversity; (9) the dynamics of adult abuse and neglect within family 109.17systems and the appropriate methods for interviewing relatives in the course of the 109.18assessment or investigation; (10) the protective social services that are available to protect 109.19alleged victims from further abuse, neglect, or financial exploitation; (11) the methods by 109.20which lead investigative agency investigators and law enforcement workers cooperate in 109.21conducting assessments and investigations in order to avoid duplication of efforts; and 109.22(12) data practices laws and procedures, including provisions for sharing data.109.23(b) The commissioner of human services shall conduct an outreach campaign to 109.24promote the common entry point for reporting vulnerable adult maltreatment. This 109.25campaign shall use the Internet and other means of communication.109.26(b) (c) The commissioners of health, human services, and public safety shall offer at 109.27least annual education to others on the requirements of this section, on how this section is 109.28implemented, and investigation techniques.109.29(c) (d) The commissioner of human services, in coordination with the commissioner 109.30of public safety shall provide training for the common entry point staff as required in this 109.31subdivision and the program courses described in this subdivision, at least four times 109.32per year. At a minimum, the training shall be held twice annually in the seven-county 109.33metropolitan area and twice annually outside the seven-county metropolitan area. The 109.34commissioners shall give priority in the program areas cited in paragraph (a) to persons 109.35currently performing assessments and investigations pursuant to this section.110.1(d) (e) The commissioner of public safety shall notify in writing law enforcement 110.2personnel of any new requirements under this section. The commissioner of public 110.3safety shall conduct regional training for law enforcement personnel regarding their 110.4responsibility under this section.110.5(e) (f) Each lead investigative agency investigator must complete the education 110.6program specified by this subdivision within the first 12 months of work as a lead 110.7investigative agency investigator.110.8A lead investigative agency investigator employed when these requirements take 110.9effect must complete the program within the first year after training is available or as soon 110.10as training is available.110.11All lead investigative agency investigators having responsibility for investigation 110.12duties under this section must receive a minimum of eight hours of continuing education 110.13or in-service training each year specific to their duties under this section.110.14    Sec. 47. FEDERAL APPROVAL.110.15This article is contingent on federal approval.110.16    Sec. 48.  REPEALER.110.17(a) Minnesota Statutes 2012, sections 245A.655; and 256B.0917, subdivisions 1, 2, 110.183, 4, 5, 7, 8, 9, 10, 11, 12, and 14, are repealed.110.19(b) Minnesota Statutes 2012, section 256B.0911, subdivisions 4a, 4b, and 4c, are 110.20repealed effective October 1, 2013.110.21ARTICLE 3110.22SAFE AND HEALTHY DEVELOPMENT OF CHILDREN, 110.23YOUTH, AND FAMILIES110.24    Section 1. Minnesota Statutes 2012, section 119B.05, subdivision 1, is amended to read:110.25    Subdivision 1. Eligible participants. Families eligible for child care assistance 110.26under the MFIP child care program are:110.27    (1) MFIP participants who are employed or in job search and meet the requirements 110.28of section 
         119B.10;110.29    (2) persons who are members of transition year families under section 
         119B.011, 110.30subdivision 20
         , and meet the requirements of section 
         119B.10;110.31    (3) families who are participating in employment orientation or job search, or 110.32other employment or training activities that are included in an approved employability 110.33development plan under section 
         256J.95;111.1    (4) MFIP families who are participating in work job search, job support, 111.2employment, or training activities as required in their employment plan, or in appeals, 111.3hearings, assessments, or orientations according to chapter 256J;111.4    (5) MFIP families who are participating in social services activities under chapter 111.5256J or mental health treatment as required in their employment plan approved according 111.6to chapter 256J;111.7    (6) families who are participating in services or activities that are included in an 111.8approved family stabilization plan under section 
         256J.575;111.9    (7) MFIP child-only cases under section 256J.88, for up to 20 hours of child care 111.10per child per week under the following conditions: (i) child care will be authorized if the 111.11child's primary caregiver is receiving SSI for a disability related to depression or other 111.12serious mental illness; and (ii) child care will only be authorized for children five years 111.13of age or younger. The child's authorized care under this clause is not conditional based 111.14on the primary caregiver participating in an authorized activity under section 119B.07 or 111.15119B.11. Medical appointments, treatment, or therapy are considered authorized activities 111.16for participants in this category;111.17    (8) families who are participating in programs as required in tribal contracts under 111.18section 
         119B.02, subdivision 2, or 
         256.01, subdivision 2; and111.19    (8)(9) families who are participating in the transition year extension under section 111.20119B.011, subdivision 20a
         .111.21    Sec. 2. Minnesota Statutes 2012, section 119B.09, subdivision 5, is amended to read:111.22    Subd. 5. Provider choice. Parents may choose child care providers as defined under 111.23section 
         119B.011, subdivision 19, that best meet the needs of their family. Beginning 111.24July 1, 2018, parents or guardians must choose a rated provider under section 124D.142 111.25for their children not yet attending kindergarten, unless a waiver is granted by the 111.26commissioner of human services. Counties shall make resources available to parents in 111.27choosing quality child care services. Counties may require a parent to sign a release 111.28stating their knowledge and responsibilities in choosing a legal provider described under 111.29section 
         119B.011, subdivision 19. When a county knows that a particular provider is 111.30unsafe, or that the circumstances of the child care arrangement chosen by the parent are 111.31unsafe, the county may deny a child care subsidy. A county may not restrict access to a 111.32general category of provider allowed under section 
         119B.011, subdivision 19.111.33    Sec. 3. Minnesota Statutes 2012, section 119B.125, subdivision 1, is amended to read:112.1    Subdivision 1. Authorization.(a) Except as provided in subdivision 5, a county 112.2must authorize the provider chosen by an applicant or a participant before the county can 112.3authorize payment for care provided by that provider. The commissioner must establish 112.4the requirements necessary for authorization of providers. 112.5(b) In order to be authorized, a provider must:112.6(1) beginning July 1, 2018, participate in the quality rating and improvement system 112.7under section 124D.142; and112.8(2) beginning July 1, 2020, have at least a one- or two-star rating in the quality 112.9rating and improvement system.112.10(c) In order to comply with federal regulations, the requirements in paragraph (b) do 112.11not apply to unlicensed or license-exempt providers. In addition, the commissioner has 112.12the authority to waive the requirements in paragraph (b), if: (1) the parents' authorized 112.13activities occur during times when care is not available from providers participating in 112.14the quality rating and improvement system, (2) a family lives in an area where care from 112.15providers participating in the quality rating and improvement system is not available, or 112.16(3) no providers participating in the quality rating and improvement system are willing 112.17or able to care for one or all of the children in the family.112.18(d) A provider must be reauthorized every two years. A legal, nonlicensed family 112.19child care provider also must be reauthorized when another person over the age of 13 joins 112.20the household, a current household member turns 13, or there is reason to believe that a 112.21household member has a factor that prevents authorization. The provider is required to 112.22report all family changes that would require reauthorization. When a provider has been 112.23authorized for payment for providing care for families in more than one county, the county 112.24responsible for reauthorization of that provider is the county of the family with a current 112.25authorization for that provider and who has used the provider for the longest length of time.112.26    Sec. 4. Minnesota Statutes 2012, section 119B.13, subdivision 1, is amended to read:112.27    Subdivision 1. Subsidy restrictions. (a) Beginning October 31, 2011 July 1, 2014, 112.28the maximum rate paid for child care assistance in any county or multicounty region under 112.29the child care fund shall be the rate for like-care arrangements in the county effective July 112.301, 2006 2012, decreased increased  by 2.5 two percent.112.31    (b) Biennially, beginning in 2012, the commissioner shall survey rates charged 112.32by child care providers in Minnesota to determine the 75th percentile for like-care 112.33arrangements in counties. When the commissioner determines that, using the 112.34commissioner's established protocol, the number of providers responding to the survey is 112.35too small to determine the 75th percentile rate for like-care arrangements in a county or 113.1multicounty region, the commissioner may establish the 75th percentile maximum rate 113.2based on like-care arrangements in a county, region, or category that the commissioner 113.3deems to be similar.113.4    (c) A rate which includes a special needs rate paid under subdivision 3 or under a 113.5school readiness service agreement paid under section 119B.231, may be in excess of the 113.6maximum rate allowed under this subdivision.113.7    (d) The department shall monitor the effect of this paragraph on provider rates. The 113.8county shall pay the provider's full charges for every child in care up to the maximum 113.9established. The commissioner shall determine the maximum rate for each type of care 113.10on an hourly, full-day, and weekly basis, including special needs and disability care. The 113.11maximum payment to a provider for one day of care must not exceed the daily rate. The 113.12maximum payment to a provider for one week of care must not exceed the weekly rate.113.13(e) Child care providers receiving reimbursement under this chapter must not be 113.14paid activity fees or an additional amount above the maximum rates for care provided 113.15during nonstandard hours for families receiving assistance.113.16    (f) When the provider charge is greater than the maximum provider rate allowed, 113.17the parent is responsible for payment of the difference in the rates in addition to any 113.18family co-payment fee.113.19    (g) All maximum provider rates changes shall be implemented on the Monday 113.20following the effective date of the maximum provider rate.113.21    Sec. 5. Minnesota Statutes 2012, section 119B.13, subdivision 7, is amended to read:113.22    Subd. 7. Absent days. (a) Licensed child care providers and license-exempt centers 113.23must not be reimbursed for more than ten 25 full-day absent days per child, excluding 113.24holidays, in a fiscal year, or for more than ten consecutive full-day absent days. Legal 113.25nonlicensed family child care providers must not be reimbursed for absent days. If a child 113.26attends for part of the time authorized to be in care in a day, but is absent for part of the 113.27time authorized to be in care in that same day, the absent time must be reimbursed but the 113.28time must not count toward the ten 25 absent day days limit. Child care providers must 113.29only be reimbursed for absent days if the provider has a written policy for child absences 113.30and charges all other families in care for similar absences.113.31(b) Notwithstanding paragraph (a), children in families may exceed the ten 25 absent 113.32days limit if at least one parent: (1) is under the age of 21; (2) does not have a high school 113.33or general equivalency diploma; and (3) is a student in a school district or another similar 113.34program that provides or arranges for child care, parenting support, social services, career 113.35and employment supports, and academic support to achieve high school graduation, upon 114.1request of the program and approval of the county. If a child attends part of an authorized 114.2day, payment to the provider must be for the full amount of care authorized for that day.114.3    (c) Child care providers must be reimbursed for up to ten federal or state holidays or 114.4designated holidays per year when the provider charges all families for these days and the 114.5holiday or designated holiday falls on a day when the child is authorized to be in attendance. 114.6Parents may substitute other cultural or religious holidays for the ten recognized state and 114.7federal holidays. Holidays do not count toward the ten 25 absent day days limit.114.8    (d) A family or child care provider must not be assessed an overpayment for an 114.9absent day payment unless (1) there was an error in the amount of care authorized for the 114.10family, (2) all of the allowed full-day absent payments for the child have been paid, or (3) 114.11the family or provider did not timely report a change as required under law.114.12    (e) The provider and family shall receive notification of the number of absent days 114.13used upon initial provider authorization for a family and ongoing notification of the 114.14number of absent days used as of the date of the notification.114.15    Sec. 6. Minnesota Statutes 2012, section 245A.07, subdivision 2a, is amended to read:114.16    Subd. 2a. Immediate suspension expedited hearing. (a) Within five working days 114.17of receipt of the license holder's timely appeal, the commissioner shall request assignment 114.18of an administrative law judge. The request must include a proposed date, time, and place 114.19of a hearing. A hearing must be conducted by an administrative law judge within 30 114.20calendar days of the request for assignment, unless an extension is requested by either 114.21party and granted by the administrative law judge for good cause. The commissioner shall 114.22issue a notice of hearing by certified mail or personal service at least ten working days 114.23before the hearing. The scope of the hearing shall be limited solely to the issue of whether 114.24the temporary immediate suspension should remain in effect pending the commissioner's 114.25final order under section 
         245A.08, regarding a licensing sanction issued under subdivision 114.263 following the immediate suspension. The burden of proof in expedited hearings under 114.27this subdivision shall be limited to the commissioner's demonstration that reasonable 114.28cause exists to believe that the license holder's actions or failure to comply with applicable 114.29law or rule poses, or if the actions of other individuals or conditions in the program 114.30poses an imminent risk of harm to the health, safety, or rights of persons served by the 114.31program. "Reasonable cause" means there exist specific articulable facts or circumstances 114.32which provide the commissioner with a reasonable suspicion that there is an imminent 114.33risk of harm to the health, safety, or rights of persons served by the program. When the 114.34commissioner has determined there is reasonable cause to order the temporary immediate 114.35suspension of a license based on a violation of safe sleep requirements, as defined in 115.1section 245A.1435, the commissioner is not required to demonstrate that an infant died or 115.2was injured as a result of the safe sleep violations.115.3    (b) The administrative law judge shall issue findings of fact, conclusions, and a 115.4recommendation within ten working days from the date of hearing. The parties shall have 115.5ten calendar days to submit exceptions to the administrative law judge's report. The 115.6record shall close at the end of the ten-day period for submission of exceptions. The 115.7commissioner's final order shall be issued within ten working days from the close of the 115.8record. Within 90 calendar days after a final order affirming an immediate suspension, the 115.9commissioner shall make a determination regarding whether a final licensing sanction 115.10shall be issued under subdivision 3. The license holder shall continue to be prohibited 115.11from operation of the program during this 90-day period.115.12    (c) When the final order under paragraph (b) affirms an immediate suspension, and a 115.13final licensing sanction is issued under subdivision 3 and the license holder appeals that 115.14sanction, the license holder continues to be prohibited from operation of the program 115.15pending a final commissioner's order under section 
         245A.08, subdivision 5, regarding the 115.16final licensing sanction.115.17    Sec. 7. Minnesota Statutes 2012, section 245A.1435, is amended to read:115.18245A.1435 REDUCTION OF RISK OF SUDDEN UNEXPECTED INFANT 115.19DEATH SYNDROME IN LICENSED PROGRAMS.115.20    (a) When a license holder is placing an infant to sleep, the license holder must 115.21place the infant on the infant's back, unless the license holder has documentation from 115.22the infant's parent physician directing an alternative sleeping position for the infant. The 115.23parent physician directive must be on a form approved by the commissioner and must 115.24include a statement that the parent or legal guardian has read the information provided by 115.25the Minnesota Sudden Infant Death Center, related to the risk of SIDS and the importance 115.26of placing an infant or child on its back to sleep to reduce the risk of SIDS. remain on file 115.27at the licensed location. An infant who independently rolls onto its stomach after being 115.28placed to sleep on its back may be allowed to remain sleeping on its stomach if the infant 115.29is at least six months of age or the license holder has a signed statement from the parent 115.30indicating that the infant regularly rolls over at home.115.31(b) The license holder must place the infant in a crib directly on a firm mattress with 115.32a fitted crib sheet that fits tightly on the mattress and overlaps the mattress so it cannot be 115.33dislodged by pulling on the corner of the sheet. The license holder must not place pillows, 115.34quilts, comforters, sheepskin, pillow-like stuffed toys, or other soft products in the crib 115.35with the infant The license holder must place the infant in a crib directly on a firm mattress 116.1with a fitted sheet that is appropriate to the mattress size, that fits tightly on the mattress, 116.2and overlaps the underside of the mattress so it cannot be dislodged by pulling on the corner 116.3of the sheet with reasonable effort. The license holder must not place anything in the crib 116.4with the infant except for the infant's pacifier. The requirements of this section apply to 116.5license holders serving infants up to and including 12 months younger than one year of age. 116.6Licensed child care providers must meet the crib requirements under section 
         245A.146.116.7(c) If an infant falls asleep before being placed in a crib, the license holder must 116.8move the infant to a crib as soon as practicable, and must keep the infant within sight of 116.9the license holder until the infant is placed in a crib. When an infant falls asleep while 116.10being held, the license holder must consider the supervision needs of other children in 116.11care when determining how long to hold the infant before placing the infant in a crib to 116.12sleep. The sleeping infant must not be in a position where the airway may be blocked or 116.13with anything covering the infant's face.116.14(d) Placing a swaddled infant down to sleep in a licensed setting is not recommended 116.15for an infant of any age and is prohibited for any infant who has begun to roll over 116.16independently. However, with the written consent of a parent or guardian according to this 116.17paragraph, a license holder may place the infant who has not yet begun to roll over on its 116.18own down to sleep in a one-piece sleeper equipped with an attached system that fastens 116.19securely only across the upper torso, with no constriction of the hips or legs, to create a 116.20swaddle. Prior to any use of swaddling for sleep by a provider licensed under this chapter, 116.21the license holder must obtain informed written consent for the use of swaddling from the 116.22parent or guardian of the infant on a form provided by the commissioner and prepared in 116.23partnership with the Minnesota Sudden Infant Death Center.116.24    Sec. 8. Minnesota Statutes 2012, section 245A.144, is amended to read:116.25245A.144 TRAINING ON RISK OF SUDDEN UNEXPECTED INFANT 116.26DEATH AND SHAKEN BABY SYNDROME ABUSIVE HEAD TRAUMA FOR 116.27CHILD FOSTER CARE PROVIDERS.116.28    (a) Licensed child foster care providers that care for infants or children through five 116.29years of age must document that before staff persons and caregivers assist in the care 116.30of infants or children through five years of age, they are instructed on the standards in 116.31section 
         245A.1435 and receive training on reducing the risk of sudden unexpected infant 116.32death syndrome and shaken baby syndrome for abusive head trauma from shaking infants 116.33and young children. This section does not apply to emergency relative placement under 116.34section 
         245A.035. The training on reducing the risk of sudden unexpected infant death 116.35syndrome and shaken baby syndrome abusive head trauma may be provided as:117.1    (1) orientation training to child foster care providers, who care for infants or children 117.2through five years of age, under Minnesota Rules, part 2960.3070, subpart 1; or117.3    (2) in-service training to child foster care providers, who care for infants or children 117.4through five years of age, under Minnesota Rules, part 2960.3070, subpart 2.117.5    (b) Training required under this section must be at least one hour in length and must 117.6be completed at least once every five years. At a minimum, the training must address 117.7the risk factors related to sudden unexpected infant death syndrome and shaken baby 117.8syndrome abusive head trauma, means of reducing the risk of sudden unexpected infant 117.9death syndrome and shaken baby syndrome abusive head trauma, and license holder 117.10communication with parents regarding reducing the risk of sudden unexpected infant 117.11death syndrome and shaken baby syndrome abusive head trauma.117.12    (c) Training for child foster care providers must be approved by the county or 117.13private licensing agency that is responsible for monitoring the child foster care provider 117.14under section 
         245A.16. The approved training fulfills, in part, training required under 117.15Minnesota Rules, part 2960.3070.117.16    Sec. 9. Minnesota Statutes 2012, section 245A.1444, is amended to read:117.17245A.1444 TRAINING ON RISK OF SUDDEN UNEXPECTED INFANT 117.18DEATH SYNDROME AND SHAKEN BABY SYNDROME ABUSIVE HEAD 117.19TRAUMA BY OTHER PROGRAMS.117.20    A licensed chemical dependency treatment program that serves clients with infants 117.21or children through five years of age, who sleep at the program and a licensed children's 117.22residential facility that serves infants or children through five years of age, must document 117.23that before program staff persons or volunteers assist in the care of infants or children 117.24through five years of age, they are instructed on the standards in section 
         245A.1435 and 117.25receive training on reducing the risk of sudden unexpected infant death syndrome and 117.26shaken baby syndrome abusive head trauma from shaking infants and young children. The 117.27training conducted under this section may be used to fulfill training requirements under 117.28Minnesota Rules, parts 2960.0100, subpart 3; and 9530.6490, subpart 4, item B.117.29    This section does not apply to child care centers or family child care programs 117.30governed by sections 
         245A.40 and 
         245A.50.117.31    Sec. 10. [245A.1446] FAMILY CHILD CARE DIAPERING AREA 117.32DISINFECTION.117.33Notwithstanding Minnesota Rules, part 9502.0435, a family child care provider may 117.34disinfect the diaper changing surface with either a solution of at least two teaspoons 118.1of chlorine bleach to one quart of water or with a surface disinfectant that meets the 118.2following criteria:118.3(1) the manufacturer's label or instructions state that the product is registered with 118.4the United States Environmental Protection Agency;118.5(2) the manufacturer's label or instructions state that the disinfectant is effective 118.6against Staphylococcus aureus, Salmonella choleraesuis, and Pseudomonas aeruginosa;118.7(3) the manufacturer's label or instructions state that the disinfectant is effective with 118.8a ten minute or less contact time;118.9(4) the disinfectant is clearly labeled by the manufacturer with directions for mixing 118.10and use;118.11(5) the disinfectant is used only in accordance with the manufacturer's directions; and118.12(6) the product does not include triclosan or derivatives of triclosan.118.13    Sec. 11. [245A.147] FAMILY CHILD CARE INFANT SLEEP SUPERVISION 118.14REQUIREMENTS.118.15    Subdivision 1.In-person checks on infants.(a) License holders that serve infants 118.16are encouraged to monitor sleeping infants by conducting in-person checks on each infant 118.17in their care every 30 minutes.118.18(b) Upon enrollment of an infant in a family child care program, the license holder is 118.19encouraged to conduct in-person checks on the sleeping infant every 15 minutes, during 118.20the first four months of care.118.21(c) When an infant has an upper respiratory infection, the license holder is 118.22encouraged to conduct in-person checks on the sleeping infant every 15 minutes 118.23throughout the hours of sleep.118.24    Subd. 2.Use of audio or visual monitoring devices.In addition to conducting 118.25the in-person checks encouraged under subdivision 1, license holders serving infants are 118.26encouraged to use and maintain an audio or visual monitoring device to monitor each 118.27sleeping infant in care during all hours of sleep.118.28    Sec. 12. [245A.152] CHILD CARE LICENSE HOLDER INSURANCE.118.29(a) A license holder must provide a written notice to all parents or guardians of all 118.30children to be accepted for care prior to admission stating whether the license holder has 118.31liability insurance. This notice may be incorporated into and provided on the admission 118.32form used by the license holder.118.33(b) If the license holder has liability insurance:119.1(1) the license holder shall inform parents in writing that a current certificate of 119.2coverage for insurance is available for inspection to all parents or guardians of children 119.3receiving services and to all parents seeking services from the family child care program;119.4(2) the notice must provide the parent or guardian with the date of expiration or 119.5next renewal of the policy; and119.6(3) upon the expiration date of the policy, the license holder must provide a new 119.7written notice indicating whether the insurance policy has lapsed or whether the license 119.8holder has renewed the policy.119.9If the policy was renewed, the license holder must provide the new expiration date of the 119.10policy in writing to the parents or guardians.119.11(c) If the license holder does not have liability insurance, the license holder must 119.12provide an annual notice on a form developed and made available by the commissioner, 119.13to the parents or guardians of children in care indicating that the license holder does not 119.14carry liability insurance.119.15(d) The license holder must notify all parents and guardians in writing immediately 119.16of any change in insurance status.119.17(e) The license holder must make available upon request the certificate of liability 119.18insurance to the parents of children in care, to the commissioner, and to county licensing 119.19agents.119.20(f) The license holder must document, with the signature of the parent or guardian, 119.21that the parent or guardian received the notices required by this section.119.22    Sec. 13. Minnesota Statutes 2012, section 245A.40, subdivision 5, is amended to read:119.23    Subd. 5. Sudden unexpected infant death syndrome and shaken baby syndrome119.24abusive head trauma training. (a) License holders must document that before staff 119.25persons and volunteers care for infants, they are instructed on the standards in section 119.26245A.1435
          and receive training on reducing the risk of sudden unexpected infant death 119.27syndrome. In addition, license holders must document that before staff persons care for 119.28infants or children under school age, they receive training on the risk of shaken baby 119.29syndrome abusive head trauma from shaking infants and young children. The training 119.30in this subdivision may be provided as orientation training under subdivision 1 and 119.31in-service training under subdivision 7.119.32    (b) Sudden unexpected infant death syndrome reduction training required under 119.33this subdivision must be at least one-half hour in length and must be completed at least 119.34once every five years year. At a minimum, the training must address the risk factors 119.35related to sudden unexpected infant death syndrome, means of reducing the risk of sudden 120.1unexpected infant death syndrome in child care, and license holder communication with 120.2parents regarding reducing the risk of sudden unexpected infant death syndrome.120.3    (c) Shaken baby syndrome Abusive head trauma training under this subdivision 120.4must be at least one-half hour in length and must be completed at least once every five 120.5years year. At a minimum, the training must address the risk factors related to shaken 120.6baby syndrome for shaking infants and young children, means to reduce the risk of shaken 120.7baby syndrome abusive head trauma in child care, and license holder communication with 120.8parents regarding reducing the risk of shaken baby syndrome abusive head trauma.120.9(d) The commissioner shall make available for viewing a video presentation on the 120.10dangers associated with shaking infants and young children. The video presentation must 120.11be part of the orientation and annual in-service training of licensed child care center 120.12staff persons caring for children under school age. The commissioner shall provide to 120.13child care providers and interested individuals, at cost, copies of a video approved by the 120.14commissioner of health under section 
         144.574 on the dangers associated with shaking 120.15infants and young children.120.16    Sec. 14. Minnesota Statutes 2012, section 245A.50, is amended to read:120.17245A.50 FAMILY CHILD CARE TRAINING REQUIREMENTS.120.18    Subdivision 1. Initial training. (a) License holders, caregivers, and substitutes must 120.19comply with the training requirements in this section.120.20    (b) Helpers who assist with care on a regular basis must complete six hours of 120.21training within one year after the date of initial employment.120.22    Subd. 2. Child growth and development and behavior guidance training. (a) For 120.23purposes of family and group family child care, the license holder and each adult caregiver 120.24who provides care in the licensed setting for more than 30 days in any 12-month period 120.25shall complete and document at least two four hours of child growth and development 120.26and behavior guidance training within the first year of prior to initial licensure, and before 120.27caring for children. For purposes of this subdivision, "child growth and development 120.28training" means training in understanding how children acquire language and develop 120.29physically, cognitively, emotionally, and socially. "Behavior guidance training" means 120.30training in the understanding of the functions of child behavior and strategies for managing 120.31challenging situations. Child growth and development and behavior guidance training 120.32must be repeated annually. Training curriculum shall be developed or approved by the 120.33commissioner of human services by January 1, 2014.120.34    (b) Notwithstanding paragraph (a), individuals are exempt from this requirement if 120.35they:121.1    (1) have taken a three-credit course on early childhood development within the 121.2past five years;121.3    (2) have received a baccalaureate or master's degree in early childhood education or 121.4school-age child care within the past five years;121.5    (3) are licensed in Minnesota as a prekindergarten teacher, an early childhood 121.6educator, a kindergarten to grade 6 teacher with a prekindergarten specialty, an early 121.7childhood special education teacher, or an elementary teacher with a kindergarten 121.8endorsement; or121.9    (4) have received a baccalaureate degree with a Montessori certificate within the 121.10past five years.121.11    Subd. 3. First aid. (a) When children are present in a family child care home 121.12governed by Minnesota Rules, parts 9502.0315 to 9502.0445, at least one staff person 121.13must be present in the home who has been trained in first aid. The first aid training must 121.14have been provided by an individual approved to provide first aid instruction. First aid 121.15training may be less than eight hours and persons qualified to provide first aid training 121.16include individuals approved as first aid instructors. First aid training must be repeated 121.17every two years.121.18    (b) A family child care provider is exempt from the first aid training requirements 121.19under this subdivision related to any substitute caregiver who provides less than 30 hours 121.20of care during any 12-month period.121.21    (c) Video training reviewed and approved by the county licensing agency satisfies 121.22the training requirement of this subdivision.121.23    Subd. 4. Cardiopulmonary resuscitation. (a) When children are present in a family 121.24child care home governed by Minnesota Rules, parts 9502.0315 to 9502.0445, at least 121.25one staff person must be present in the home who has been trained in cardiopulmonary 121.26resuscitation (CPR) and in the treatment of obstructed airways that includes CPR 121.27techniques for infants and children. The CPR training must have been provided by an 121.28individual approved to provide CPR instruction, must be repeated at least once every three121.29 two years, and must be documented in the staff person's records.121.30    (b) A family child care provider is exempt from the CPR training requirement in 121.31this subdivision related to any substitute caregiver who provides less than 30 hours of 121.32care during any 12-month period.121.33    (c) Video training reviewed and approved by the county licensing agency satisfies 121.34the training requirement of this subdivision. Persons providing CPR training must use 121.35CPR training that has been developed:122.1    (1) by the American Heart Association or the American Red Cross and incorporates 122.2psychomotor skills to support the instruction; or122.3    (2) using nationally recognized, evidence-based guidelines for CPR training and 122.4incorporates psychomotor skills to support the instruction.122.5    Subd. 5. Sudden unexpected infant death syndrome and shaken baby syndrome122.6 abusive head trauma training. (a) License holders must document that before staff 122.7persons, caregivers, and helpers assist in the care of infants, they are instructed on the 122.8standards in section 
         245A.1435 and receive training on reducing the risk of sudden 122.9unexpected infant death syndrome. In addition, license holders must document that before 122.10staff persons, caregivers, and helpers assist in the care of infants and children under 122.11school age, they receive training on reducing the risk of shaken baby syndrome abusive 122.12head trauma from shaking infants and young children. The training in this subdivision 122.13may be provided as initial training under subdivision 1 or ongoing annual training under 122.14subdivision 7.122.15    (b) Sudden unexpected infant death syndrome reduction training required under this 122.16subdivision must be at least one-half hour in length and must be completed in person122.17 at least once every five years two years. On the years when the license holder is not 122.18receiving the in-person training on sudden unexpected infant death reduction, the license 122.19holder must receive sudden unexpected infant death reduction training through a video 122.20of no more than one hour in length developed or approved by the commissioner. At a 122.21minimum, the training must address the risk factors related to sudden unexpected infant 122.22death syndrome, means of reducing the risk of sudden unexpected infant death syndrome122.23 in child care, and license holder communication with parents regarding reducing the risk 122.24of sudden unexpected infant death syndrome.122.25    (c) Shaken baby syndrome Abusive head trauma training required under this 122.26subdivision must be at least one-half hour in length and must be completed at least once 122.27every five years year. At a minimum, the training must address the risk factors related 122.28to shaken baby syndrome shaking infants and young children, means of reducing the 122.29risk of shaken baby syndrome abusive head trauma in child care, and license holder 122.30communication with parents regarding reducing the risk of shaken baby syndrome abusive 122.31head trauma.122.32(d) Training for family and group family child care providers must be developed 122.33by the commissioner in conjunction with the Minnesota Sudden Infant Death Center 122.34and approved by the county licensing agency by the Minnesota Center for Professional 122.35Development.123.1    (e) The commissioner shall make available for viewing by all licensed child care 123.2providers a video presentation on the dangers associated with shaking infants and young 123.3children. The video presentation shall be part of the initial and ongoing annual training of 123.4licensed child care providers, caregivers, and helpers caring for children under school age. 123.5The commissioner shall provide to child care providers and interested individuals, at cost, 123.6copies of a video approved by the commissioner of health under section 144.574 on the 123.7dangers associated with shaking infants and young children.123.8    Subd. 6. Child passenger restraint systems; training requirement. (a) A license 123.9holder must comply with all seat belt and child passenger restraint system requirements 123.10under section 
         169.685.123.11    (b) Family and group family child care programs licensed by the Department of 123.12Human Services that serve a child or children under nine years of age must document 123.13training that fulfills the requirements in this subdivision.123.14    (1) Before a license holder, staff person, caregiver, or helper transports a child or 123.15children under age nine in a motor vehicle, the person placing the child or children in a 123.16passenger restraint must satisfactorily complete training on the proper use and installation 123.17of child restraint systems in motor vehicles. Training completed under this subdivision may 123.18be used to meet initial training under subdivision 1 or ongoing training under subdivision 7.123.19    (2) Training required under this subdivision must be at least one hour in length, 123.20completed at initial training, and repeated at least once every five years. At a minimum, 123.21the training must address the proper use of child restraint systems based on the child's 123.22size, weight, and age, and the proper installation of a car seat or booster seat in the motor 123.23vehicle used by the license holder to transport the child or children.123.24    (3) Training under this subdivision must be provided by individuals who are certified 123.25and approved by the Department of Public Safety, Office of Traffic Safety. License holders 123.26may obtain a list of certified and approved trainers through the Department of Public 123.27Safety Web site or by contacting the agency.123.28    (c) Child care providers that only transport school-age children as defined in section 123.29245A.02, subdivision 19
         , paragraph (f), in child care buses as defined in section 
         169.448, 123.30subdivision 1, paragraph (e), are exempt from this subdivision.123.31    Subd. 7. Training requirements for family and group family child care. For 123.32purposes of family and group family child care, the license holder and each primary 123.33caregiver must complete eight 16 hours of ongoing training each year. For purposes 123.34of this subdivision, a primary caregiver is an adult caregiver who provides services in 123.35the licensed setting for more than 30 days in any 12-month period. Repeat of topical 123.36training requirements in subdivisions 2 to 8 shall count toward the annual 16-hour training 124.1requirement. Additional ongoing training subjects to meet the annual 16-hour training 124.2requirement must be selected from the following areas:124.3    (1) "child growth and development training" has the meaning given in under124.4 subdivision 2, paragraph (a);124.5    (2) "learning environment and curriculum" includes, including training in 124.6establishing an environment and providing activities that provide learning experiences to 124.7meet each child's needs, capabilities, and interests;124.8    (3) "assessment and planning for individual needs" includes, including training in 124.9observing and assessing what children know and can do in order to provide curriculum 124.10and instruction that addresses their developmental and learning needs, including children 124.11with special needs and bilingual children or children for whom English is not their 124.12primary language;124.13    (4) "interactions with children" includes, including training in establishing 124.14supportive relationships with children, guiding them as individuals and as part of a group;124.15    (5) "families and communities" includes, including training in working 124.16collaboratively with families and agencies or organizations to meet children's needs and to 124.17encourage the community's involvement;124.18    (6) "health, safety, and nutrition" includes, including training in establishing and 124.19maintaining an environment that ensures children's health, safety, and nourishment, 124.20including child abuse, maltreatment, prevention, and reporting; home and fire safety; child 124.21injury prevention; communicable disease prevention and control; first aid; and CPR; and124.22    (7) "program planning and evaluation" includes, including training in establishing, 124.23implementing, evaluating, and enhancing program operations.; and124.24(8) behavior guidance, including training in the understanding of the functions of 124.25child behavior and strategies for managing behavior.124.26    Subd. 8. Other required training requirements. (a) The training required of 124.27family and group family child care providers and staff must include training in the cultural 124.28dynamics of early childhood development and child care. The cultural dynamics and 124.29disabilities training and skills development of child care providers must be designed to 124.30achieve outcomes for providers of child care that include, but are not limited to:124.31    (1) an understanding and support of the importance of culture and differences in 124.32ability in children's identity development;124.33    (2) understanding the importance of awareness of cultural differences and 124.34similarities in working with children and their families;124.35    (3) understanding and support of the needs of families and children with differences 124.36in ability;125.1    (4) developing skills to help children develop unbiased attitudes about cultural 125.2differences and differences in ability;125.3    (5) developing skills in culturally appropriate caregiving; and125.4    (6) developing skills in appropriate caregiving for children of different abilities.125.5    The commissioner shall approve the curriculum for cultural dynamics and disability 125.6training.125.7    (b) The provider must meet the training requirement in section 
         245A.14, subdivision 125.811
         , paragraph (a), clause (4), to be eligible to allow a child cared for at the family child 125.9care or group family child care home to use the swimming pool located at the home.125.10    Subd. 9.Supervising for safety; training requirement.Effective July 1, 2014, 125.11all family child care license holders and each adult caregiver who provides care in the 125.12licensed family child care home for more than 30 days in any 12-month period shall 125.13complete and document at least six hours approved training on supervising for safety 125.14prior to initial licensure, and before caring for children. At least two hours of training 125.15on supervising for safety must be repeated annually. For purposes of this subdivision, 125.16"supervising for safety" includes supervision basics, supervision outdoors, equipment and 125.17materials, illness, injuries, and disaster preparedness. The commissioner shall develop 125.18the supervising for safety curriculum by January 1, 2014.125.19    Subd. 10.Approved training.(a) County licensing staff must accept training 125.20approved by the Minnesota Center for Professional Development, including:125.21(1) face-to-face or classroom training;125.22(2) online training; and125.23(3) relationship-based professional development, such as mentoring, coaching, 125.24and consulting.125.25(b) New and increased training requirements under this section must not be imposed 125.26on providers until the commissioner establishes statewide accessibility to the required 125.27provider training.125.28    Sec. 15. Minnesota Statutes 2012, section 252.27, subdivision 2a, is amended to read:125.29    Subd. 2a. Contribution amount. (a) The natural or adoptive parents of a minor 125.30child, including a child determined eligible for medical assistance without consideration of 125.31parental income, must contribute to the cost of services used by making monthly payments 125.32on a sliding scale based on income, unless the child is married or has been married, parental 125.33rights have been terminated, or the child's adoption is subsidized according to section 125.34259.67
          or through title IV-E of the Social Security Act. The parental contribution is a partial 125.35or full payment for medical services provided for diagnostic, therapeutic, curing, treating, 126.1mitigating, rehabilitation, maintenance, and personal care services as defined in United 126.2States Code, title 26, section 213, needed by the child with a chronic illness or disability.126.3    (b) For households with adjusted gross income equal to or greater than 100 percent 126.4of federal poverty guidelines, the parental contribution shall be computed by applying the 126.5following schedule of rates to the adjusted gross income of the natural or adoptive parents:126.6    (1) if the adjusted gross income is equal to or greater than 100 percent of federal 126.7poverty guidelines and less than 175 percent of federal poverty guidelines, the parental 126.8contribution is $4 per month;126.9    (2) if the adjusted gross income is equal to or greater than 175 percent of federal 126.10poverty guidelines and less than or equal to 545 percent of federal poverty guidelines, 126.11the parental contribution shall be determined using a sliding fee scale established by the 126.12commissioner of human services which begins at one percent of adjusted gross income 126.13at 175 percent of federal poverty guidelines and increases to 7.5 percent of adjusted 126.14gross income for those with adjusted gross income up to 545 percent of federal poverty 126.15guidelines;126.16    (3) if the adjusted gross income is greater than 545 percent of federal poverty 126.17guidelines and less than 675 percent of federal poverty guidelines, the parental 126.18contribution shall be 7.5 percent of adjusted gross income;126.19    (4) if the adjusted gross income is equal to or greater than 675 percent of federal 126.20poverty guidelines and less than 975 percent of federal poverty guidelines, the parental 126.21contribution shall be determined using a sliding fee scale established by the commissioner 126.22of human services which begins at 7.5 percent of adjusted gross income at 675 percent of 126.23federal poverty guidelines and increases to ten percent of adjusted gross income for those 126.24with adjusted gross income up to 975 percent of federal poverty guidelines; and126.25    (5) if the adjusted gross income is equal to or greater than 975 percent of federal 126.26poverty guidelines, the parental contribution shall be 12.5 percent of adjusted gross income.126.27    If the child lives with the parent, the annual adjusted gross income is reduced by 126.28$2,400 prior to calculating the parental contribution. If the child resides in an institution 126.29specified in section 
         256B.35, the parent is responsible for the personal needs allowance 126.30specified under that section in addition to the parental contribution determined under this 126.31section. The parental contribution is reduced by any amount required to be paid directly to 126.32the child pursuant to a court order, but only if actually paid.126.33    (c) The household size to be used in determining the amount of contribution under 126.34paragraph (b) includes natural and adoptive parents and their dependents, including the 126.35child receiving services. Adjustments in the contribution amount due to annual changes 127.1in the federal poverty guidelines shall be implemented on the first day of July following 127.2publication of the changes.127.3    (d) For purposes of paragraph (b), "income" means the adjusted gross income of the 127.4natural or adoptive parents determined according to the previous year's federal tax form, 127.5except, effective retroactive to July 1, 2003, taxable capital gains to the extent the funds 127.6have been used to purchase a home shall not be counted as income.127.7    (e) The contribution shall be explained in writing to the parents at the time eligibility 127.8for services is being determined. The contribution shall be made on a monthly basis 127.9effective with the first month in which the child receives services. Annually upon 127.10redetermination or at termination of eligibility, if the contribution exceeded the cost of 127.11services provided, the local agency or the state shall reimburse that excess amount to 127.12the parents, either by direct reimbursement if the parent is no longer required to pay a 127.13contribution, or by a reduction in or waiver of parental fees until the excess amount is 127.14exhausted. All reimbursements must include a notice that the amount reimbursed may be 127.15taxable income if the parent paid for the parent's fees through an employer's health care 127.16flexible spending account under the Internal Revenue Code, section 125, and that the 127.17parent is responsible for paying the taxes owed on the amount reimbursed.127.18    (f) The monthly contribution amount must be reviewed at least every 12 months; 127.19when there is a change in household size; and when there is a loss of or gain in income 127.20from one month to another in excess of ten percent. The local agency shall mail a written 127.21notice 30 days in advance of the effective date of a change in the contribution amount. 127.22A decrease in the contribution amount is effective in the month that the parent verifies a 127.23reduction in income or change in household size.127.24    (g) Parents of a minor child who do not live with each other shall each pay the 127.25contribution required under paragraph (a). An amount equal to the annual court-ordered 127.26child support payment actually paid on behalf of the child receiving services shall be 127.27deducted from the adjusted gross income of the parent making the payment prior to 127.28calculating the parental contribution under paragraph (b).127.29    (h) The contribution under paragraph (b) shall be increased by an additional five 127.30percent if the local agency determines that insurance coverage is available but not 127.31obtained for the child. For purposes of this section, "available" means the insurance is a 127.32benefit of employment for a family member at an annual cost of no more than five percent 127.33of the family's annual income. For purposes of this section, "insurance" means health 127.34and accident insurance coverage, enrollment in a nonprofit health service plan, health 127.35maintenance organization, self-insured plan, or preferred provider organization.128.1    Parents who have more than one child receiving services shall not be required 128.2to pay more than the amount for the child with the highest expenditures. There shall 128.3be no resource contribution from the parents. The parent shall not be required to pay 128.4a contribution in excess of the cost of the services provided to the child, not counting 128.5payments made to school districts for education-related services. Notice of an increase in 128.6fee payment must be given at least 30 days before the increased fee is due.128.7    (i) The contribution under paragraph (b) shall be reduced by $300 per fiscal year if, 128.8in the 12 months prior to July 1:128.9    (1) the parent applied for insurance for the child;128.10    (2) the insurer denied insurance;128.11    (3) the parents submitted a complaint or appeal, in writing to the insurer, submitted 128.12a complaint or appeal, in writing, to the commissioner of health or the commissioner of 128.13commerce, or litigated the complaint or appeal; and128.14    (4) as a result of the dispute, the insurer reversed its decision and granted insurance.128.15    For purposes of this section, "insurance" has the meaning given in paragraph (h).128.16    A parent who has requested a reduction in the contribution amount under this 128.17paragraph shall submit proof in the form and manner prescribed by the commissioner or 128.18county agency, including, but not limited to, the insurer's denial of insurance, the written 128.19letter or complaint of the parents, court documents, and the written response of the insurer 128.20approving insurance. The determinations of the commissioner or county agency under this 128.21paragraph are not rules subject to chapter 14.128.22(j) Notwithstanding paragraph (b), for the period from July 1, 2010, to June 30, 128.232015, the parental contribution shall be computed by applying the following contribution 128.24schedule to the adjusted gross income of the natural or adoptive parents:128.25(1) if the adjusted gross income is equal to or greater than 100 percent of federal 128.26poverty guidelines and less than 175 percent of federal poverty guidelines, the parental 128.27contribution is $4 per month;128.28(2) if the adjusted gross income is equal to or greater than 175 percent of federal 128.29poverty guidelines and less than or equal to 525 percent of federal poverty guidelines, 128.30the parental contribution shall be determined using a sliding fee scale established by the 128.31commissioner of human services which begins at one percent of adjusted gross income 128.32at 175 percent of federal poverty guidelines and increases to eight percent of adjusted 128.33gross income for those with adjusted gross income up to 525 percent of federal poverty 128.34guidelines;129.1(3) if the adjusted gross income is greater than 525 percent of federal poverty 129.2guidelines and less than 675 percent of federal poverty guidelines, the parental 129.3contribution shall be 9.5 percent of adjusted gross income;129.4(4) if the adjusted gross income is equal to or greater than 675 percent of federal 129.5poverty guidelines and less than 900 percent of federal poverty guidelines, the parental 129.6contribution shall be determined using a sliding fee scale established by the commissioner 129.7of human services which begins at 9.5 percent of adjusted gross income at 675 percent of 129.8federal poverty guidelines and increases to 12 percent of adjusted gross income for those 129.9with adjusted gross income up to 900 percent of federal poverty guidelines; and129.10(5) if the adjusted gross income is equal to or greater than 900 percent of federal 129.11poverty guidelines, the parental contribution shall be 13.5 percent of adjusted gross 129.12income. If the child lives with the parent, the annual adjusted gross income is reduced by 129.13$2,400 prior to calculating the parental contribution. If the child resides in an institution 129.14specified in section 256B.35, the parent is responsible for the personal needs allowance 129.15specified under that section in addition to the parental contribution determined under this 129.16section. The parental contribution is reduced by any amount required to be paid directly to 129.17the child pursuant to a court order, but only if actually paid.129.18    Sec. 16. Minnesota Statutes 2012, section 256.82, subdivision 3, is amended to read:129.19    Subd. 3. Setting foster care standard rates. The commissioner shall annually 129.20establish minimum standard maintenance rates for foster care maintenance and difficulty 129.21of care payments for all children in foster care. Any increase in rates shall in no case 129.22exceed three percent per annum. The foster care rates in effect on January 1, 2013, shall 129.23remain in effect until December 13, 2015.129.24    Sec. 17. Minnesota Statutes 2012, section 256J.08, subdivision 24, is amended to read:129.25    Subd. 24. Disregard. "Disregard" means earned income that is not counted when 129.26determining initial eligibility in the initial income test in section 256J.21, subdivision 3,129.27 or income that is not counted when determining ongoing eligibility and calculating the 129.28amount of the assistance payment for participants. The commissioner shall determine 129.29the amount of the disregard according to section 256J.24, subdivision 10 for ongoing 129.30eligibility shall be 50 percent of gross earned income.129.31EFFECTIVE DATE.This section is effective October 1, 2013, or upon approval 129.32from the United States Department of Agriculture, whichever is later.129.33    Sec. 18. Minnesota Statutes 2012, section 256J.21, subdivision 3, is amended to read:130.1    Subd. 3. Initial income test. The county agency shall determine initial eligibility 130.2by considering all earned and unearned income that is not excluded under subdivision 2. 130.3To be eligible for MFIP, the assistance unit's countable income minus the disregards in 130.4paragraphs (a) and (b) must be below the transitional standard of assistance family wage 130.5level according to section 
         256J.24 for that size assistance unit.130.6(a) The initial eligibility determination must disregard the following items:130.7(1) the employment disregard is 18 percent of the gross earned income whether or 130.8not the member is working full time or part time;130.9(2) dependent care costs must be deducted from gross earned income for the actual 130.10amount paid for dependent care up to a maximum of $200 per month for each child less 130.11than two years of age, and $175 per month for each child two years of age and older under 130.12this chapter and chapter 119B;130.13(3) all payments made according to a court order for spousal support or the support 130.14of children not living in the assistance unit's household shall be disregarded from the 130.15income of the person with the legal obligation to pay support, provided that, if there has 130.16been a change in the financial circumstances of the person with the legal obligation to pay 130.17support since the support order was entered, the person with the legal obligation to pay 130.18support has petitioned for a modification of the support order; and130.19(4) an allocation for the unmet need of an ineligible spouse or an ineligible child 130.20under the age of 21 for whom the caregiver is financially responsible and who lives with 130.21the caregiver according to section 
         256J.36.130.22(b) Notwithstanding paragraph (a), when determining initial eligibility for applicant 130.23units when at least one member has received MFIP in this state within four months of 130.24the most recent application for MFIP, apply the disregard as defined in section 
         256J.08, 130.25subdivision 24
         , for all unit members.130.26After initial eligibility is established, the assistance payment calculation is based on 130.27the monthly income test.130.28EFFECTIVE DATE.This section is effective October 1, 2013, or upon approval 130.29from the United States Department of Agriculture, whichever is later.130.30    Sec. 19. Minnesota Statutes 2012, section 256J.24, subdivision 5, is amended to read:130.31    Subd. 5. MFIP transitional standard. The MFIP transitional standard is based 130.32on the number of persons in the assistance unit eligible for both food and cash assistance 130.33unless the restrictions in subdivision 6 on the birth of a child apply. The amount of the 130.34transitional standard is published annually by the Department of Human Services.131.1EFFECTIVE DATE.This section is effective July 1, 2014.131.2    Sec. 20. Minnesota Statutes 2012, section 256J.24, subdivision 5a, is amended to read:131.3    Subd. 5a. Food portion ofAdjustments to the MFIP transitional standard.(a) 131.4Effective October 1, 2015, the commissioner shall adjust the MFIP transitional standard as 131.5needed to reflect a onetime increase in the cash portion of 16 percent.131.6(b) When any adjustments are made in the Supplemental Nutrition Assistance 131.7Program, the commissioner shall adjust the food portion of the MFIP transitional standard 131.8as needed to reflect adjustments to the Supplemental Nutrition Assistance Program. The 131.9commissioner shall publish the transitional standard including a breakdown of the cash 131.10and food portions for an assistance unit of sizes one to ten in the State Register whenever 131.11an adjustment is made.131.12    Sec. 21. Minnesota Statutes 2012, section 256J.24, subdivision 7, is amended to read:131.13    Subd. 7. Family wage level. The family wage level is 110 percent of the transitional 131.14standard under subdivision 5 or 6, when applicable, and is the standard used when there is 131.15earned income in the assistance unit. As specified in section 256J.21. If there is earned 131.16income in the assistance unit, earned income is subtracted from the family wage level to 131.17determine the amount of the assistance payment, as specified in section 256J.21. The 131.18assistance payment may not exceed the transitional standard under subdivision 5 or 6, 131.19or the shared household standard under subdivision 9, whichever is applicable, for the 131.20assistance unit.131.21EFFECTIVE DATE.This section is effective October 1, 2013, or upon approval 131.22from the United States Department of Agriculture, whichever is later.131.23    Sec. 22. Minnesota Statutes 2012, section 256J.621, is amended to read:131.24256J.621 WORK PARTICIPATION CASH BENEFITS.131.25    Subdivision 1.Program characteristics. (a) Effective October 1, 2009, upon 131.26exiting the diversionary work program (DWP) or upon terminating the Minnesota family 131.27investment program with earnings, a participant who is employed may be eligible for work 131.28participation cash benefits of $25 per month to assist in meeting the family's basic needs 131.29as the participant continues to move toward self-sufficiency.131.30    (b) To be eligible for work participation cash benefits, the participant shall not 131.31receive MFIP or diversionary work program assistance during the month and the 131.32participant or participants must meet the following work requirements:132.1    (1) if the participant is a single caregiver and has a child under six years of age, the 132.2participant must be employed at least 87 hours per month;132.3    (2) if the participant is a single caregiver and does not have a child under six years of 132.4age, the participant must be employed at least 130 hours per month; or132.5    (3) if the household is a two-parent family, at least one of the parents must be 132.6employed 130 hours per month.132.7    Whenever a participant exits the diversionary work program or is terminated from 132.8MFIP and meets the other criteria in this section, work participation cash benefits are 132.9available for up to 24 consecutive months.132.10    (c) Expenditures on the program are maintenance of effort state funds under 132.11a separate state program for participants under paragraph (b), clauses (1) and (2). 132.12Expenditures for participants under paragraph (b), clause (3), are nonmaintenance of effort 132.13funds. Months in which a participant receives work participation cash benefits under this 132.14section do not count toward the participant's MFIP 60-month time limit.132.15    Subd. 2.Program suspension.(a) Effective December 1, 2013, the work 132.16participation cash benefits program shall be suspended.132.17(b) The commissioner of human services may reinstate the work participation cash 132.18benefits program if the United States Department of Human Services determines that the 132.19state of Minnesota did not meet the federal TANF work participation rate and sends a 132.20notice of penalty to reduce Minnesota's federal TANF block grant authorized under title I 132.21of Public Law 104-193, the Personal Responsibility and Work Opportunity Reconciliation 132.22Act of 1996, and under Public Law 109-171, the Deficit Reduction Act of 2005.132.23(c) The commissioner shall notify the chairs and ranking minority members of the 132.24legislative committees with jurisdiction over human services policy and finance of the 132.25potential penalty and the commissioner's plans to reinstate the work participation cash 132.26benefit program within 30 days of the date the commissioner receives notification that 132.27the state failed to meet the federal work participation rate.132.28    Sec. 23. Minnesota Statutes 2012, section 256J.626, subdivision 7, is amended to read:132.29    Subd. 7. Performance base funds.(a) For the purpose of this section, the following 132.30terms have the meanings given.132.31(1) "Caseload Reduction Credit" (CRC) means the measure of how much Minnesota 132.32TANF and separate state program caseload has fallen relative to federal fiscal year 2005 132.33based on caseload data from October 1 to September 30.132.34(2) "TANF participation rate target" means a 50 percent participation rate reduced by 132.35the CRC for the previous year.133.1(b)(a) For calendar year 20102016 and yearly thereafter, each county and tribe will133.2must be allocated 95 percent of their initial calendar year allocation. Allocations for 133.3counties and tribes will must be allocated additional fundsadjusted based on performance 133.4as follows:133.5    (1) a county or tribe that achieves the TANF participation rate target or a five 133.6percentage point improvement over the previous year's TANF participation rate under 133.7section 256J.751, subdivision 2, clause (7), as averaged across 12 consecutive months for 133.8the most recent year for which the measurements are available, will receive an additional 133.9allocation equal to 2.5 percent of its initial allocation;133.10    (2)(1) a county or tribe that performs within or above its range of expected 133.11performance on the annualized three-year self-support index under section 
         256J.751, 133.12subdivision 2
         , clause (6), willmust receive an additional allocation equal to 2.5five 133.13percent of its initial allocation; and133.14    (3) a county or tribe that does not achieve the TANF participation rate target or 133.15a five percentage point improvement over the previous year's TANF participation rate 133.16under section 256J.751, subdivision 2, clause (7), as averaged across 12 consecutive 133.17months for the most recent year for which the measurements are available, will not 133.18receive an additional 2.5 percent of its initial allocation until after negotiating a multiyear 133.19improvement plan with the commissioner; or133.20    (4)(2) a county or tribe that does not perform within or aboveperforms below its 133.21range of expected performance on the annualized three-year self-support index under 133.22section 
         256J.751, subdivision 2, clause (6), will not receive an additional allocation equal 133.23to 2.5 percent of its initial allocation until after negotiating for a single year, may receive 133.24an additional allocation of up to five percent of its initial allocation. A county or tribe that 133.25continues to perform below its range of expected performance for two consecutive years 133.26must negotiate  a multiyear improvement plan with the commissioner. If no improvement 133.27is shown by the end of the multiyear plan, the commissioner may decrease the county's or 133.28tribe's performance-based funds by up to five percent. The decrease must remain in effect 133.29until the county or tribe performs within or above its range of expected performance.133.30    (c) (b) For calendar year 20092016 and yearly thereafter, performance-based funds 133.31for a federally approved tribal TANF program in which the state and tribe have in place a 133.32contract under section 
         256.01, addressing consolidated funding, willmust be allocated 133.33as follows:133.34    (1) a tribe that achieves the participation rate approved in its federal TANF plan 133.35using the average of 12 consecutive months for the most recent year for which the 134.1measurements are available, will receive an additional allocation equal to 2.5 percent of 134.2its initial allocation; and134.3    (2)(1) a tribe that performs within or above its range of expected performance on the 134.4annualized three-year self-support index under section 
         256J.751, subdivision 2, clause (6), 134.5willmust receive an additional allocation equal to 2.5 percent of its initial allocation; or134.6    (3) a tribe that does not achieve the participation rate approved in its federal TANF 134.7plan using the average of 12 consecutive months for the most recent year for which the 134.8measurements are available, will not receive an additional allocation equal to 2.5 percent 134.9of its initial allocation until after negotiating a multiyear improvement plan with the 134.10commissioner; or134.11    (4)(2) a tribe that does not perform within or aboveperforms below its range of 134.12expected performance on the annualized three-year self-support index under section 134.13256J.751, subdivision 2
         , clause (6), will not receive an additional allocation equal to 2.5 134.14percent until after negotiating for a single year may receive an additional allocation of up 134.15to five percent of its initial allocation. A county or tribe that continues to perform below 134.16its range of expected performance for two consecutive years must negotiate  a multiyear 134.17improvement plan with the commissioner. If no improvement is shown by the end of the 134.18multiyear plan, the commissioner may decrease the tribe's performance-based funds by 134.19up to five percent. The decrease must remain in effect until the tribe performs within or 134.20above its range of expected performance.134.21    (d)(c) Funds remaining unallocated after the performance-based allocations in 134.22paragraphparagraphs (a) and (b) are available to the commissioner for innovation projects 134.23under subdivision 5.134.24     (1)(d) If available funds are insufficient to meet county and tribal allocations under 134.25paragraphparagraphs (a) and (b), the commissioner may make available for allocation 134.26funds that are unobligated and available from the innovation projects through the end of 134.27the current biennium shall proportionally prorate funds to counties and tribes that qualify 134.28for an additional allocation under paragraphs (a), clause (1), and (b), clause (1).134.29    (2) If after the application of clause (1) funds remain insufficient to meet county and 134.30tribal allocations under paragraph (b), the commissioner must proportionally reduce the 134.31allocation of each county and tribe with respect to their maximum allocation available 134.32under paragraph (b).134.33    Sec. 24. [256J.78] TANF DEMONSTRATION PROJECTS OR WAIVER FROM 134.34FEDERAL RULES AND REGULATIONS.135.1    Subdivision 1.Duties of the commissioner.The commissioner of human services 135.2may pursue TANF demonstration projects or waivers of TANF requirements from the 135.3United States Department of Health and Human Services as needed to allow the state to 135.4build a more results-oriented Minnesota Family Investment Program to better meet the 135.5needs of Minnesota families.135.6    Subd. 2.Purpose.The purpose of the TANF demonstration projects or waivers is to:135.7(1) replace the federal TANF process measure and its complex administrative 135.8requirements with state-developed outcomes measures that track adult employment and 135.9exits from MFIP cash assistance;135.10(2) simplify programmatic and administrative requirements; and135.11(3) make other policy or programmatic changes that improve the performance of the 135.12program and the outcomes for participants.135.13    Subd. 3.Report to legislature.The commissioner shall report to the members of 135.14the legislative committees having jurisdiction over human services issues by March 1, 135.152014, regarding the progress of this waiver or demonstration project.135.16EFFECTIVE DATE.This section is effective the day following final enactment.135.17    Sec. 25. Minnesota Statutes 2012, section 256K.45, is amended to read:135.18256K.45 RUNAWAY AND HOMELESS YOUTH ACT.135.19    Subdivision 1.Grant program established.The commissioner of human services 135.20shall establish a Homeless Youth Act fund and award grants to providers who are 135.21committed to serving homeless youth and youth at risk of homelessness, to provide 135.22street and community outreach and drop-in programs, emergency shelter programs, 135.23and integrated supportive housing and transitional living programs, consistent with the 135.24program descriptions in this act to reduce the incidence of homelessness among youth.135.25    Subdivision 1.Subd. 1a.Definitions. (a) The definitions in this subdivision apply 135.26to this section.135.27(b) "Commissioner" means the commissioner of human services.135.28(c) "Homeless youth" means a person 21 years of age or younger who is 135.29unaccompanied by a parent or guardian and is without shelter where appropriate care and 135.30supervision are available, whose parent or legal guardian is unable or unwilling to provide 135.31shelter and care, or who lacks a fixed, regular, and adequate nighttime residence. The 135.32following are not fixed, regular, or adequate nighttime residences:135.33(1) a supervised publicly or privately operated shelter designed to provide temporary 135.34living accommodations;136.1(2) an institution or a publicly or privately operated shelter designed to provide 136.2temporary living accommodations;136.3(3) transitional housing;136.4(4) a temporary placement with a peer, friend, or family member that has not offered 136.5permanent residence, a residential lease, or temporary lodging for more than 30 days; or136.6(5) a public or private place not designed for, nor ordinarily used as, a regular 136.7sleeping accommodation for human beings.136.8Homeless youth does not include persons incarcerated or otherwise detained under 136.9federal or state law.136.10(d) "Youth at risk of homelessness" means a person 21 years of age or younger 136.11whose status or circumstances indicate a significant danger of experiencing homelessness 136.12in the near future. Status or circumstances that indicate a significant danger may include: 136.13(1) youth exiting out-of-home placements; (2) youth who previously were homeless; (3) 136.14youth whose parents or primary caregivers are or were previously homeless; (4) youth 136.15who are exposed to abuse and neglect in their homes; (5) youth who experience conflict 136.16with parents due to chemical or alcohol dependency, mental health disabilities, or other 136.17disabilities; and (6) runaways.136.18(e) "Runaway" means an unmarried child under the age of 18 years who is absent 136.19from the home of a parent or guardian or other lawful placement without the consent of 136.20the parent, guardian, or lawful custodian.136.21    Subd. 2. Homeless and runaway youth report. The commissioner shall develop a136.22report for homeless youth, youth at risk of homelessness, and runaways. The report shall 136.23include coordination of services as defined under subdivisions 3 to 5 prepare a biennial 136.24report, beginning in February 2015, which provides meaningful information to the 136.25legislative committees having jurisdiction over the issue of homeless youth, that includes, 136.26but is not limited to: (1) a list of the areas of the state with the greatest need for services 136.27and housing for homeless youth, and the level and nature of the needs identified; (2) details 136.28about grants made; (3) the distribution of funds throughout the state based on population 136.29need; (4) follow-up information, if available, on the status of homeless youth and whether 136.30they have stable housing two years after services are provided; and (5) any other outcomes 136.31for populations served to determine the effectiveness of the programs and use of funding.136.32    Subd. 3. Street and community outreach and drop-in program. Youth drop-in 136.33centers must provide walk-in access to crisis intervention and ongoing supportive services 136.34including one-to-one case management services on a self-referral basis. Street and 136.35community outreach programs must locate, contact, and provide information, referrals, 137.1and services to homeless youth, youth at risk of homelessness, and runaways. Information, 137.2referrals, and services provided may include, but are not limited to:137.3(1) family reunification services;137.4(2) conflict resolution or mediation counseling;137.5(3) assistance in obtaining temporary emergency shelter;137.6(4) assistance in obtaining food, clothing, medical care, or mental health counseling;137.7(5) counseling regarding violence, prostitution, substance abuse, sexually transmitted 137.8diseases, and pregnancy;137.9(6) referrals to other agencies that provide support services to homeless youth, 137.10youth at risk of homelessness, and runaways;137.11(7) assistance with education, employment, and independent living skills;137.12(8) aftercare services;137.13(9) specialized services for highly vulnerable runaways and homeless youth, 137.14including teen parents, emotionally disturbed and mentally ill youth, and sexually 137.15exploited youth; and137.16(10) homelessness prevention.137.17    Subd. 4. Emergency shelter program. (a) Emergency shelter programs must 137.18provide homeless youth and runaways with referral and walk-in access to emergency, 137.19short-term residential care. The program shall provide homeless youth and runaways with 137.20safe, dignified shelter, including private shower facilities, beds, and at least one meal each 137.21day; and shall assist a runaway and homeless youth with reunification with the family or 137.22legal guardian when required or appropriate.137.23(b) The services provided at emergency shelters may include, but are not limited to:137.24(1) family reunification services;137.25(2) individual, family, and group counseling;137.26(3) assistance obtaining clothing;137.27(4) access to medical and dental care and mental health counseling;137.28(5) education and employment services;137.29(6) recreational activities;137.30(7) advocacy and referral services;137.31(8) independent living skills training;137.32(9) aftercare and follow-up services;137.33(10) transportation; and137.34(11) homelessness prevention.137.35    Subd. 5. Supportive housing and transitional living programs. Transitional 137.36living programs must help homeless youth and youth at risk of homelessness to find and 138.1maintain safe, dignified housing. The program may also provide rental assistance and 138.2related supportive services, or refer youth to other organizations or agencies that provide 138.3such services. Services provided may include, but are not limited to:138.4(1) educational assessment and referrals to educational programs;138.5(2) career planning, employment, work skill training, and independent living skills 138.6training;138.7(3) job placement;138.8(4) budgeting and money management;138.9(5) assistance in securing housing appropriate to needs and income;138.10(6) counseling regarding violence, prostitution, substance abuse, sexually transmitted 138.11diseases, and pregnancy;138.12(7) referral for medical services or chemical dependency treatment;138.13(8) parenting skills;138.14(9) self-sufficiency support services or life skill training;138.15(10) aftercare and follow-up services; and138.16(11) homelessness prevention.138.17    Subd. 6. Funding.Any Funds appropriated for this section may be expended on 138.18programs described under subdivisions 3 to 5, technical assistance, and capacity building. 138.19Up to four percent of funds appropriated may be used for the purpose of monitoring and 138.20evaluating runaway and homeless youth programs receiving funding under this section. 138.21Funding shall be directed to meet the greatest need, with a significant share of the funding 138.22focused on homeless youth providers in greater Minnesota to meet the greatest need 138.23on a statewide basis.138.24    Sec. 26. Minnesota Statutes 2012, section 256M.40, subdivision 1, is amended to read:138.25    Subdivision 1. Formula. The commissioner shall allocate state funds appropriated 138.26under this chapter to each county board on a calendar year basis in an amount determined 138.27according to the formula in paragraphs (a) to (e).138.28(a) For calendar years 2011 and 2012, the commissioner shall allocate available 138.29funds to each county in proportion to that county's share in calendar year 2010.138.30(b) For calendar year 2013 and each calendar year thereafter, the commissioner shall 138.31allocate available funds to each county as follows:138.32(1) 75 percent must be distributed on the basis of the county share in calendar year 138.332012;138.34(2) five percent must be distributed on the basis of the number of persons residing in 138.35the county as determined by the most recent data of the state demographer;139.1(3) ten percent must be distributed on the basis of the number of vulnerable children 139.2that are subjects of reports under chapter 260C and sections 
         626.556 and 
         626.5561, and in 139.3the county as determined by the most recent data of the commissioner; and139.4(4) ten percent must be distributed on the basis of the number of vulnerable adults 139.5that are subjects of reports under section 
         626.557 in the county as determined by the most 139.6recent data of the commissioner.139.7(c) For calendar year 2014, the commissioner shall allocate available funds to each 139.8county as follows:139.9(1) 50 percent must be distributed on the basis of the county share in calendar year 139.102012;139.11(2) Ten percent must be distributed on the basis of the number of persons residing in 139.12the county as determined by the most recent data of the state demographer;139.13(3) 20 percent must be distributed on the basis of the number of vulnerable children 139.14that are subjects of reports under chapter 260C and sections 626.556 and 626.5561, in the 139.15county as determined by the most recent data of the commissioner; and139.16(4) 20 percent must be distributed on the basis of the number of vulnerable adults 139.17that are subjects of reports under section 626.557 in the county as determined by the 139.18most recent data of the commissioner The commissioner is precluded from changing the 139.19formula under this subdivision or recommending a change to the legislature without 139.20public review and input.139.21(d) For calendar year 2015, the commissioner shall allocate available funds to each 139.22county as follows:139.23(1) 25 percent must be distributed on the basis of the county share in calendar year 139.242012;139.25(2) 15 percent must be distributed on the basis of the number of persons residing in 139.26the county as determined by the most recent data of the state demographer;139.27(3) 30 percent must be distributed on the basis of the number of vulnerable children 139.28that are subjects of reports under chapter 260C and sections 626.556 and 626.5561, in the 139.29county as determined by the most recent data of the commissioner; and139.30(4) 30 percent must be distributed on the basis of the number of vulnerable adults 139.31that are subjects of reports under section 626.557 in the county as determined by the most 139.32recent data of the commissioner.139.33(e) For calendar year 2016 and each calendar year thereafter, the commissioner shall 139.34allocate available funds to each county as follows:139.35(1) 20 percent must be distributed on the basis of the number of persons residing in 139.36the county as determined by the most recent data of the state demographer;140.1(2) 40 percent must be distributed on the basis of the number of vulnerable children 140.2that are subjects of reports under chapter 260C and sections 626.556 and 626.5561, in the 140.3county as determined by the most recent data of the commissioner; and140.4(3) 40 percent must be distributed on the basis of the number of vulnerable adults 140.5that are subjects of reports under section 626.557 in the county as determined by the most 140.6recent data of the commissioner.140.7    Sec. 27. Minnesota Statutes 2012, section 257.85, subdivision 11, is amended to read:140.8    Subd. 11. Financial considerations. (a) Payment of relative custody assistance 140.9under a relative custody assistance agreement is subject to the availability of state funds 140.10and payments may be reduced or suspended on order of the commissioner if insufficient 140.11funds are available Beginning July 1, 2013, relative custody assistance shall be a forecasted 140.12program, and the commissioner, with the approval of the commissioner of management 140.13and budget, may transfer unencumbered appropriation balances within fiscal years of 140.14each biennium to other forecasted programs of the Department of Human Services. The 140.15commissioner shall inform the chairs and ranking minority members of the senate Health 140.16and Human Services Finance Division and the house of representatives Health and Human 140.17Services Finance Committee quarterly about transfers made under this provision.140.18(b) Upon receipt from a local agency of a claim for reimbursement, the commissioner 140.19shall reimburse the local agency in an amount equal to 100 percent of the relative custody 140.20assistance payments provided to relative custodians. The local agency may not seek and 140.21the commissioner shall not provide reimbursement for the administrative costs associated 140.22with performing the duties described in subdivision 4.140.23(c) For the purposes of determining eligibility or payment amounts under MFIP, 140.24relative custody assistance payments shall be excluded in determining the family's 140.25available income.140.26    Sec. 28. Minnesota Statutes 2012, section 259A.05, subdivision 5, is amended to read:140.27    Subd. 5. Transfer of funds.The commissioner of human services may transfer 140.28funds into the adoption assistance account when a deficit in the adoption assistance 140.29program occurs Beginning July 1, 2013, adoption assistance shall be a forecasted program 140.30and the commissioner, with the approval of the commissioner of management and budget, 140.31may transfer unencumbered appropriation balances within fiscal years of each biennium to 140.32other forecasted programs of the Department of Human Services. The commissioner shall 140.33inform the chairs and ranking minority members of the senate Health and Human Services 141.1Finance Division and the house of representatives Health and Human Services Finance 141.2Committee quarterly about transfers made under this provision.141.3    Sec. 29. Minnesota Statutes 2012, section 259A.20, subdivision 4, is amended to read:141.4    Subd. 4. Reimbursement for special nonmedical expenses. (a) Reimbursement 141.5for special nonmedical expenses is available to children, except those eligible for adoption 141.6assistance based on being an at-risk child.141.7(b) Reimbursements under this paragraph shall be made only after the adoptive 141.8parent documents that the requested service was denied by the local social service agency, 141.9community agencies, the local school district, the local public health department, the 141.10parent's insurance provider, or the child's program. The denial must be for an eligible 141.11service or qualified item under the program requirements of the applicable agency or 141.12organization.141.13(c) Reimbursements must be previously authorized, adhere to the requirements and 141.14procedures prescribed by the commissioner, and be limited to:141.15(1) child care for a child age 12 and younger, or for a child age 13 or 14 who has a 141.16documented disability that requires special instruction for and services by the child care 141.17provider. Child care reimbursements may be made if all available adult caregivers are 141.18employed, unemployed due to a disability as defined in section 259A.01, subdivision 14,141.19 or attending educational or vocational training programs. Documentation from a qualified 141.20expert that is dated within the last 12 months must be provided to verify the disability. If a 141.21parent is attending an educational or vocational training program, child care reimbursement 141.22is limited to no more than the time necessary to complete the credit requirements for an 141.23associate or baccalaureate degree as determined by the educational institution. Child 141.24care reimbursement is not limited for an adoptive parent completing basic or remedial 141.25education programs needed to prepare for postsecondary education or employment;141.26(2) respite care provided for the relief of the child's parent up to 504 hours of respite 141.27care annually;141.28(3) camping up to 14 days per state fiscal year for a child to attend a special needs 141.29camp. The camp must be accredited by the American Camp Association as a special needs 141.30camp in order to be eligible for camp reimbursement;141.31(4) postadoption counseling to promote the child's integration into the adoptive 141.32family that is provided by the placing agency during the first year following the date of the 141.33adoption decree. Reimbursement is limited to 12 sessions of postadoption counseling;141.34(5) family counseling that is required to meet the child's special needs. 141.35Reimbursement is limited to the prorated portion of the counseling fees allotted to the 142.1family when the adoptive parent's health insurance or Medicaid pays for the child's 142.2counseling but does not cover counseling for the rest of the family members;142.3(6) home modifications to accommodate the child's special needs upon which 142.4eligibility for adoption assistance was approved. Reimbursement is limited to once every 142.5five years per child;142.6(7) vehicle modifications to accommodate the child's special needs upon which 142.7eligibility for adoption assistance was approved. Reimbursement is limited to once every 142.8five years per family; and142.9(8) burial expenses up to $1,000, if the special needs, upon which eligibility for 142.10adoption assistance was approved, resulted in the death of the child.142.11(d) The adoptive parent shall submit statements for expenses incurred between July 142.121 and June 30 of a given fiscal year to the state adoption assistance unit within 60 days 142.13after the end of the fiscal year in order for reimbursement to occur.142.14    Sec. 30. Minnesota Statutes 2012, section 260B.007, subdivision 6, is amended to read:142.15    Subd. 6. Delinquent child. (a) Except as otherwise provided in paragraphs (b) 142.16and (c), "delinquent child" means a child:142.17(1) who has violated any state or local law, except as provided in section 
         260B.225, 142.18subdivision 1
         , and except for juvenile offenders as described in subdivisions 16 to 18;142.19(2) who has violated a federal law or a law of another state and whose case has been 142.20referred to the juvenile court if the violation would be an act of delinquency if committed 142.21in this state or a crime or offense if committed by an adult;142.22(3) who has escaped from confinement to a state juvenile correctional facility after 142.23being committed to the custody of the commissioner of corrections; or142.24(4) who has escaped from confinement to a local juvenile correctional facility after 142.25being committed to the facility by the court.142.26(b) The term delinquent child does not include a child alleged to have committed 142.27murder in the first degree after becoming 16 years of age, but the term delinquent child 142.28does include a child alleged to have committed attempted murder in the first degree.142.29(c) The term delinquent child does not include a child under the age of 16 years142.30 alleged to have engaged in conduct which would, if committed by an adult, violate any 142.31federal, state, or local law relating to being hired, offering to be hired, or agreeing to be 142.32hired by another individual to engage in sexual penetration or sexual conduct.142.33EFFECTIVE DATE.This section is effective August 1, 2014, and applies to 142.34offenses committed on or after that date.143.1    Sec. 31. Minnesota Statutes 2012, section 260B.007, subdivision 16, is amended to read:143.2    Subd. 16. Juvenile petty offender; juvenile petty offense. (a) "Juvenile petty 143.3offense" includes a juvenile alcohol offense, a juvenile controlled substance offense, 143.4a violation of section 
         609.685, or a violation of a local ordinance, which by its terms 143.5prohibits conduct by a child under the age of 18 years which would be lawful conduct if 143.6committed by an adult.143.7(b) Except as otherwise provided in paragraph (c), "juvenile petty offense" also 143.8includes an offense that would be a misdemeanor if committed by an adult.143.9(c) "Juvenile petty offense" does not include any of the following:143.10(1) a misdemeanor-level violation of section 
         518B.01, 
         588.20, 
         609.224, 
         609.2242, 143.11609.324
         , subdivision 2 or 3,609.5632, 
         609.576, 
         609.66, 
         609.746, 
         609.748, 
         609.79, 143.12or 
         617.23;143.13(2) a major traffic offense or an adult court traffic offense, as described in section 143.14260B.225
         ;143.15(3) a misdemeanor-level offense committed by a child whom the juvenile court 143.16previously has found to have committed a misdemeanor, gross misdemeanor, or felony 143.17offense; or143.18(4) a misdemeanor-level offense committed by a child whom the juvenile court 143.19has found to have committed a misdemeanor-level juvenile petty offense on two or 143.20more prior occasions, unless the county attorney designates the child on the petition 143.21as a juvenile petty offender notwithstanding this prior record. As used in this clause, 143.22"misdemeanor-level juvenile petty offense" includes a misdemeanor-level offense that 143.23would have been a juvenile petty offense if it had been committed on or after July 1, 1995.143.24(d) A child who commits a juvenile petty offense is a "juvenile petty offender." The 143.25term juvenile petty offender does not include a child under the age of 16 years alleged 143.26to have violated any law relating to being hired, offering to be hired, or agreeing to be 143.27hired by another individual to engage in sexual penetration or sexual conduct which, if 143.28committed by an adult, would be a misdemeanor.143.29EFFECTIVE DATE.This section is effective August 1, 2014, and applies to 143.30offenses committed on or after that date.143.31    Sec. 32. Minnesota Statutes 2012, section 260C.007, subdivision 6, is amended to read:143.32    Subd. 6. Child in need of protection or services. "Child in need of protection or 143.33services" means a child who is in need of protection or services because the child:143.34    (1) is abandoned or without parent, guardian, or custodian;144.1    (2)(i) has been a victim of physical or sexual abuse as defined in section 
         626.556, 144.2subdivision 2, (ii) resides with or has resided with a victim of child abuse as defined in 144.3subdivision 5 or domestic child abuse as defined in subdivision 13, (iii) resides with or 144.4would reside with a perpetrator of domestic child abuse as defined in subdivision 13 or 144.5child abuse as defined in subdivision 5 or 13, or (iv) is a victim of emotional maltreatment 144.6as defined in subdivision 15;144.7    (3) is without necessary food, clothing, shelter, education, or other required care 144.8for the child's physical or mental health or morals because the child's parent, guardian, 144.9or custodian is unable or unwilling to provide that care;144.10    (4) is without the special care made necessary by a physical, mental, or emotional 144.11condition because the child's parent, guardian, or custodian is unable or unwilling to 144.12provide that care;144.13    (5) is medically neglected, which includes, but is not limited to, the withholding of 144.14medically indicated treatment from a disabled infant with a life-threatening condition. The 144.15term "withholding of medically indicated treatment" means the failure to respond to the 144.16infant's life-threatening conditions by providing treatment, including appropriate nutrition, 144.17hydration, and medication which, in the treating physician's or physicians' reasonable 144.18medical judgment, will be most likely to be effective in ameliorating or correcting all 144.19conditions, except that the term does not include the failure to provide treatment other 144.20than appropriate nutrition, hydration, or medication to an infant when, in the treating 144.21physician's or physicians' reasonable medical judgment:144.22    (i) the infant is chronically and irreversibly comatose;144.23    (ii) the provision of the treatment would merely prolong dying, not be effective in 144.24ameliorating or correcting all of the infant's life-threatening conditions, or otherwise be 144.25futile in terms of the survival of the infant; or144.26    (iii) the provision of the treatment would be virtually futile in terms of the survival 144.27of the infant and the treatment itself under the circumstances would be inhumane;144.28    (6) is one whose parent, guardian, or other custodian for good cause desires to be 144.29relieved of the child's care and custody, including a child who entered foster care under a 144.30voluntary placement agreement between the parent and the responsible social services 144.31agency under section 
         260C.227;144.32    (7) has been placed for adoption or care in violation of law;144.33    (8) is without proper parental care because of the emotional, mental, or physical 144.34disability, or state of immaturity of the child's parent, guardian, or other custodian;145.1    (9) is one whose behavior, condition, or environment is such as to be injurious or 145.2dangerous to the child or others. An injurious or dangerous environment may include, but 145.3is not limited to, the exposure of a child to criminal activity in the child's home;145.4    (10) is experiencing growth delays, which may be referred to as failure to thrive, that 145.5have been diagnosed by a physician and are due to parental neglect;145.6    (11) has engaged in prostitution as defined in section 609.321, subdivision 9 is a 145.7sexually exploited youth;145.8    (12) has committed a delinquent act or a juvenile petty offense before becoming 145.9ten years old;145.10    (13) is a runaway;145.11    (14) is a habitual truant;145.12    (15) has been found incompetent to proceed or has been found not guilty by reason 145.13of mental illness or mental deficiency in connection with a delinquency proceeding, a 145.14certification under section 
         260B.125, an extended jurisdiction juvenile prosecution, or a 145.15proceeding involving a juvenile petty offense; or145.16(16) has a parent whose parental rights to one or more other children were 145.17involuntarily terminated or whose custodial rights to another child have been involuntarily 145.18transferred to a relative and there is a case plan prepared by the responsible social services 145.19agency documenting a compelling reason why filing the termination of parental rights 145.20petition under section 
         260C.301, subdivision 3, is not in the best interests of the child; or.145.21(17) is a sexually exploited youth.145.22EFFECTIVE DATE.This section is effective August 1, 2014.145.23    Sec. 33. Minnesota Statutes 2012, section 260C.007, subdivision 31, is amended to read:145.24    Subd. 31. Sexually exploited youth. "Sexually exploited youth" means an 145.25individual who:145.26(1) is alleged to have engaged in conduct which would, if committed by an adult, 145.27violate any federal, state, or local law relating to being hired, offering to be hired, or 145.28agreeing to be hired by another individual to engage in sexual penetration or sexual conduct;145.29(2) is a victim of a crime described in section 
         609.342, 
         609.343, 609.344,609.345, 145.30609.3451
         , 
         609.3453, 
         609.352, 
         617.246, or 
         617.247;145.31(3) is a victim of a crime described in United States Code, title 18, section 2260; 145.322421; 2422; 2423; 2425; 2425A; or 2256; or145.33(4) is a sex trafficking victim as defined in section 
         609.321, subdivision 7b.145.34EFFECTIVE DATE.This section is effective the day following final enactment.146.1    Sec. 34. Minnesota Statutes 2012, section 518A.60, is amended to read:146.2518A.60 COLLECTION; ARREARS ONLY.146.3(a) Remedies available for the collection and enforcement of support in this chapter 146.4and chapters 256, 257, 518, and 518C also apply to cases in which the child or children 146.5for whom support is owed are emancipated and the obligor owes past support or has an 146.6accumulated arrearage as of the date of the youngest child's emancipation. Child support 146.7arrearages under this section include arrearages for child support, medical support, child 146.8care, pregnancy and birth expenses, and unreimbursed medical expenses as defined in 146.9section 
         518A.41, subdivision 1, paragraph (h).146.10(b) This section applies retroactively to any support arrearage that accrued on or 146.11before June 3, 1997, and to all arrearages accruing after June 3, 1997.146.12(c) Past support or pregnancy and confinement expenses ordered for which the 146.13obligor has specific court ordered terms for repayment may not be enforced using 146.14drivers' and occupational or professional license suspension, credit bureau reporting, and 146.15additional income withholding under section 
         518A.53, subdivision 10, paragraph (a), 146.16unless the obligor fails to comply with the terms of the court order for repayment.146.17(d) If an arrearage exists at the time a support order would otherwise terminate 146.18and section 
         518A.53, subdivision 10, paragraph (c), does not apply to this section, the 146.19arrearage shall be repaid in an amount equal to the current support order until all arrears 146.20have been paid in full, absent a court order to the contrary.146.21(e) If an arrearage exists according to a support order which fails to establish a 146.22monthly support obligation in a specific dollar amount, the public authority, if it provides 146.23child support services, or the obligee, may establish a payment agreement which shall 146.24equal what the obligor would pay for current support after application of section 
         518A.34, 146.25plus an additional 20 percent of the current support obligation, until all arrears have been 146.26paid in full. If the obligor fails to enter into or comply with a payment agreement, the 146.27public authority, if it provides child support services, or the obligee, may move the district 146.28court or child support magistrate, if section 
         484.702 applies, for an order establishing 146.29repayment terms.146.30(f) If there is no longer a current support order because all of the children of the 146.31order are emancipated, the public authority may discontinue child support services and 146.32close its case under title IV-D of the Social Security Act if:146.33(1) the arrearage is under $500; or146.34(2) the arrearage is considered unenforceable by the public authority because there 146.35have been no collections for three years, and all administrative and legal remedies have 146.36been attempted or are determined by the public authority to be ineffective because the 147.1obligor is unable to pay, the obligor has no known income or assets, and there is no 147.2reasonable prospect that the obligor will be able to pay in the foreseeable future.147.3    (g) At least 60 calendar days before the discontinuation of services under paragraph 147.4(f), the public authority must mail a written notice to the obligee and obligor at the 147.5obligee's and obligor's last known addresses that the public authority intends to close the 147.6child support enforcement case and explaining each party's rights. Seven calendar days 147.7after the first notice is mailed, the public authority must mail a second notice under this 147.8paragraph to the obligee.147.9    (h) The case must be kept open if the obligee responds before case closure and 147.10provides information that could reasonably lead to collection of arrears. If the case is 147.11closed, the obligee may later request that the case be reopened by completing a new 147.12application for services, if there is a change in circumstances that could reasonably lead to 147.13the collection of arrears.147.14    Sec. 35. Laws 1998, chapter 407, article 6, section 116, is amended to read:147.15    Sec. 116. EBT TRANSACTION COSTS; APPROVAL FROM LEGISLATURE.147.16    The commissioner of human services shall request and receive approval from the 147.17legislature before adjusting the payment todiscontinue the state subsidy to retailers for 147.18electronic benefit transfer transaction costs Supplemental Nutrition Assistance Program 147.19transactions when the federal government discontinues the federal subsidy to the same.147.20    Sec. 36. DIRECTION TO COMMISSIONERS; INCOME AND ASSET 147.21EXCLUSION.147.22(a) The commissioner of human services shall not count conditional cash transfers 147.23made to families participating in a family independence demonstration as income or 147.24assets for purposes of determining or redetermining eligibility for child care assistance 147.25programs under Minnesota Statutes, chapter 119B; general assistance under Minnesota 147.26Statutes, chapter 256D; group residential housing under Minnesota Statutes, chapter 256I; 147.27the Minnesota family investment program, work benefit program, or diversionary work 147.28program under Minnesota Statutes, chapter 256J, during the duration of the demonstration.147.29(b) The commissioner of human services shall not count conditional cash transfers 147.30made to families participating in a family independence demonstration as income or assets 147.31for purposes of determining or redetermining eligibility for medical assistance under 147.32Minnesota Statutes, chapter 256B, and MinnesotaCare under Minnesota Statutes, chapter 147.33256L, except that for enrollees subject to a modified adjusted gross income calculation to 147.34determine eligibility, the conditional cash transfer payments shall be counted as income if 148.1they are included on the enrollee's federal tax return as income, or if the payments can be 148.2taken into account in the month of receipt as a lump sum payment.148.3(c) The commissioner of the Minnesota Housing Finance Agency shall not count 148.4conditional cash transfers made to families participating in a family independence 148.5demonstration as income or assets for purposes of determining or redetermining eligibility 148.6for housing assistance programs under Minnesota Statutes, section 462A.201, during 148.7the duration of the demonstration.148.8(d) For the purposes of this section:148.9(1) "conditional cash transfer" means a payment made to a participant in a family 148.10independence demonstration by a sponsoring organization to incent, support, or facilitate 148.11participation; and 148.12(2) "family independence demonstration" means an initiative sponsored or 148.13cosponsored by a governmental or nongovernmental organization, the goal of which is 148.14to facilitate individualized goal-setting and peer support for cohorts of no more than 12 148.15families each toward the development of financial and nonfinancial assets that enable the 148.16participating families to achieve financial independence.148.17(e) The citizens league shall provide a report to the legislative committees having 148.18jurisdiction over human services issues by July 1, 2016, informing the legislature on the 148.19progress and outcomes of the demonstration under this section.148.20    Sec. 37. UNIFORM BENEFITS FOR CHILDREN IN FOSTER CARE, 148.21PERMANENT RELATIVE CARE, AND ADOPTION ASSISTANCE.148.22Using available resources, the commissioner of human services, in consultation with 148.23representatives of the judicial branch, county human services, and tribes participating in 148.24the American Indian child welfare initiative under Minnesota Statutes, section 256.01, 148.25subdivision 14b, together with other appropriate stakeholders, which might include 148.26communities of color; youth in foster care or those who have aged out of care; kinship 148.27caregivers, foster parents, adoptive parents, foster and adoptive agencies; guardians ad 148.28litem; and experts in permanency, adoption, child development, and the effects of trauma, 148.29and the use of medical assistance home and community-based waivers for persons with 148.30disabilities, shall analyze benefits and services available to children in family foster care 148.31under Minnesota Rules, parts 9560.0650 to 9560.0656, relative custody assistance under 148.32Minnesota Statutes, section 257.85, and adoption assistance under Minnesota Statutes, 148.33chapter 259A. The goal of the analysis is to establish a uniform set of benefits available 148.34to children in foster care, permanent relative care, and adoption so that the benefits 148.35can follow the child rather than being tied to the child's legal status. Included in the 149.1analysis is possible accessing of federal title IV-E through guardianship assistance. The 149.2commissioner shall report findings and conclusions to the chairs and ranking minority 149.3members of the legislative committees and divisions with jurisdiction over health and 149.4human services policy and finance by January 15, 2014, and include draft legislation 149.5establishing uniform benefits.149.6    Sec. 38. WAIVER PROCESS RELATED TO CHILD CARE PROVIDER 149.7CHOICE.149.8The commissioner of human services, within available appropriations, shall develop 149.9a simple waiver process related to Minnesota Statutes, section 119B.09, subdivision 5, 149.10that requires the parent or guardian to submit notice of a preferred alternative child care 149.11arrangement. The commissioner must monitor the waiver process and report on the usage 149.12of waivers to the legislature.149.13    Sec. 39.  REPEALER.149.14(a) Minnesota Statutes 2012, section 256J.24, subdivision 6, is repealed effective 149.15July 1, 2014.149.16(b) Minnesota Statutes 2012, section 609.093, is repealed effective the day following 149.17final enactment.149.18ARTICLE 4149.19STRENGTHENING CHEMICAL AND MENTAL HEALTH SERVICES149.20    Section 1. Minnesota Statutes 2012, section 245.462, subdivision 20, is amended to read:149.21    Subd. 20. Mental illness. (a) "Mental illness" means an organic disorder of the brain 149.22or a clinically significant disorder of thought, mood, perception, orientation, memory, or 149.23behavior that is detailed in a diagnostic codes list published by the commissioner, and that 149.24seriously limits a person's capacity to function in primary aspects of daily living such as 149.25personal relations, living arrangements, work, and recreation.149.26    (b) An "adult with acute mental illness" means an adult who has a mental illness that 149.27is serious enough to require prompt intervention.149.28    (c) For purposes of case management and community support services, a "person 149.29with serious and persistent mental illness" means an adult who has a mental illness and 149.30meets at least one of the following criteria:149.31    (1) the adult has undergone two or more episodes of inpatient care for a mental 149.32illness within the preceding 24 months;150.1    (2) the adult has experienced a continuous psychiatric hospitalization or residential 150.2treatment exceeding six months' duration within the preceding 12 months;150.3    (3) the adult has been treated by a crisis team two or more times within the preceding 150.424 months;150.5    (4) the adult:150.6    (i) has a diagnosis of schizophrenia, bipolar disorder, major depression, 150.7schizoaffective disorder, or borderline personality disorder;150.8    (ii) indicates a significant impairment in functioning; and150.9    (iii) has a written opinion from a mental health professional, in the last three years, 150.10stating that the adult is reasonably likely to have future episodes requiring inpatient or 150.11residential treatment, of a frequency described in clause (1) or (2), unless ongoing case 150.12management or community support services are provided;150.13    (5) the adult has, in the last three years, been committed by a court as a person who is 150.14mentally ill under chapter 253B, or the adult's commitment has been stayed or continued; or150.15    (6) the adult (i) was eligible under clauses (1) to (5), but the specified time period 150.16has expired or the adult was eligible as a child under section 
         245.4871, subdivision 6; and 150.17(ii) has a written opinion from a mental health professional, in the last three years, stating 150.18that the adult is reasonably likely to have future episodes requiring inpatient or residential 150.19treatment, of a frequency described in clause (1) or (2), unless ongoing case management 150.20or community support services are provided; or150.21    (7) the adult was eligible as a child under section 245.4871, subdivision 6, and is 150.22age 21 or younger.150.23    Sec. 2. Minnesota Statutes 2012, section 245.4661, subdivision 5, is amended to read:150.24    Subd. 5. Planning for pilot projects.(a) Each local plan for a pilot project, with 150.25the exception of the placement of a Minnesota specialty treatment facility as defined in 150.26paragraph (c), must be developed under the direction of the county board, or multiple 150.27county boards acting jointly, as the local mental health authority. The planning process 150.28for each pilot shall include, but not be limited to, mental health consumers, families, 150.29advocates, local mental health advisory councils, local and state providers, representatives 150.30of state and local public employee bargaining units, and the department of human services. 150.31As part of the planning process, the county board or boards shall designate a managing 150.32entity responsible for receipt of funds and management of the pilot project.150.33(b) For Minnesota specialty treatment facilities, the commissioner shall issue a 150.34request for proposal for regions in which a need has been identified for services.151.1(c) For purposes of this section, Minnesota specialty treatment facility is defined as 151.2an intensive rehabilitative mental health service under section 256B.0622, subdivision 2, 151.3paragraph (b).151.4    Sec. 3. Minnesota Statutes 2012, section 245.4661, subdivision 6, is amended to read:151.5    Subd. 6. Duties of commissioner. (a) For purposes of the pilot projects, the 151.6commissioner shall facilitate integration of funds or other resources as needed and 151.7requested by each project. These resources may include:151.8(1) residential services funds administered under Minnesota Rules, parts 9535.2000 151.9to 9535.3000, in an amount to be determined by mutual agreement between the project's 151.10managing entity and the commissioner of human services after an examination of the 151.11county's historical utilization of facilities located both within and outside of the county 151.12and licensed under Minnesota Rules, parts 9520.0500 to 9520.0690;151.13(2) community support services funds administered under Minnesota Rules, parts 151.149535.1700 to 9535.1760;151.15(3) other mental health special project funds;151.16(4) medical assistance, general assistance medical care, MinnesotaCare and group 151.17residential housing if requested by the project's managing entity, and if the commissioner 151.18determines this would be consistent with the state's overall health care reform efforts; and151.19(5) regional treatment center resources consistent with section 
         246.0136, subdivision 151.201
         .; and151.21(6) funds transferred from section 246.18, subdivision 8, for grants to providers to 151.22participate in mental health specialty treatment services, awarded to providers through 151.23a request for proposal process.151.24(b) The commissioner shall consider the following criteria in awarding start-up and 151.25implementation grants for the pilot projects:151.26(1) the ability of the proposed projects to accomplish the objectives described in 151.27subdivision 2;151.28(2) the size of the target population to be served; and151.29(3) geographical distribution.151.30(c) The commissioner shall review overall status of the projects initiatives at least 151.31every two years and recommend any legislative changes needed by January 15 of each 151.32odd-numbered year.151.33(d) The commissioner may waive administrative rule requirements which are 151.34incompatible with the implementation of the pilot project.152.1(e) The commissioner may exempt the participating counties from fiscal sanctions 152.2for noncompliance with requirements in laws and rules which are incompatible with the 152.3implementation of the pilot project.152.4(f) The commissioner may award grants to an entity designated by a county board or 152.5group of county boards to pay for start-up and implementation costs of the pilot project.152.6    Sec. 4. Minnesota Statutes 2012, section 245.4682, subdivision 2, is amended to read:152.7    Subd. 2. General provisions. (a) In the design and implementation of reforms to 152.8the mental health system, the commissioner shall:152.9    (1) consult with consumers, families, counties, tribes, advocates, providers, and 152.10other stakeholders;152.11    (2) bring to the legislature, and the State Advisory Council on Mental Health, by 152.12January 15, 2008, recommendations for legislation to update the role of counties and to 152.13clarify the case management roles, functions, and decision-making authority of health 152.14plans and counties, and to clarify county retention of the responsibility for the delivery of 152.15social services as required under subdivision 3, paragraph (a);152.16    (3) withhold implementation of any recommended changes in case management 152.17roles, functions, and decision-making authority until after the release of the report due 152.18January 15, 2008;152.19    (4) ensure continuity of care for persons affected by these reforms including 152.20ensuring client choice of provider by requiring broad provider networks and developing 152.21mechanisms to facilitate a smooth transition of service responsibilities;152.22    (5) provide accountability for the efficient and effective use of public and private 152.23resources in achieving positive outcomes for consumers;152.24    (6) ensure client access to applicable protections and appeals; and152.25    (7) make budget transfers necessary to implement the reallocation of services and 152.26client responsibilities between counties and health care programs that do not increase the 152.27state and county costs and efficiently allocate state funds.152.28    (b) When making transfers under paragraph (a) necessary to implement movement 152.29of responsibility for clients and services between counties and health care programs, 152.30the commissioner, in consultation with counties, shall ensure that any transfer of state 152.31grants to health care programs, including the value of case management transfer grants 152.32under section 
         256B.0625, subdivision 20, does not exceed the value of the services being 152.33transferred for the latest 12-month period for which data is available. The commissioner 152.34may make quarterly adjustments based on the availability of additional data during the 152.35first four quarters after the transfers first occur. If case management transfer grants under 153.1section 
         256B.0625, subdivision 20, are repealed and the value, based on the last year prior 153.2to repeal, exceeds the value of the services being transferred, the difference becomes an 153.3ongoing part of each county's adult and children's mental health grants under sections 153.4245.4661
         , 245.4889, and 
         256E.12.153.5    (c) This appropriation is not authorized to be expended after December 31, 2010, 153.6unless approved by the legislature.153.7    Sec. 5. Minnesota Statutes 2012, section 245.4875, subdivision 8, is amended to read:153.8    Subd. 8. Transition services. The county board may continue to provide mental 153.9health services as defined in sections 
         245.487 to 
         245.4889 to persons over 18 years of 153.10age, but under 21 years of age, if the person was receiving case management or family 153.11community support services prior to age 18, and if one of the following conditions is met:153.12(1) the person is receiving special education services through the local school 153.13district; or153.14(2) it is in the best interest of the person to continue services defined in sections 153.15245.487
          to 
         245.4889; or153.16(3) the person is requesting services and the services are medically necessary.153.17    Sec. 6. Minnesota Statutes 2012, section 245.4881, subdivision 1, is amended to read:153.18    Subdivision 1. Availability of case management services. (a) The county board 153.19shall provide case management services for each child with severe emotional disturbance 153.20who is a resident of the county and the child's family who request or consent to the services. 153.21Case management services may be continuedmust be offered to be provided for a child with 153.22a serious emotional disturbance who is over the age of 18 consistent with section 
         245.4875, 153.23subdivision 8
         , or the child's legal representative, provided the child's service needs can be 153.24met within the children's service system. Before discontinuing case management services 153.25under this subdivision for children between the ages of 17 and 21, a transition plan 153.26must be developed. The transition plan must be developed with the child and, with the 153.27consent of a child age 18 or over, the child's parent, guardian, or legal representative. The 153.28transition plan should include plans for health insurance, housing, education, employment, 153.29and treatment. Staffing ratios must be sufficient to serve the needs of the clients. The case 153.30manager must meet the requirements in section 
         245.4871, subdivision 4.153.31(b) Except as permitted by law and the commissioner under demonstration projects, 153.32case management services provided to children with severe emotional disturbance eligible 153.33for medical assistance must be billed to the medical assistance program under sections 153.34256B.02, subdivision 8
         , and 
         256B.0625.154.1(c) Case management services are eligible for reimbursement under the medical 154.2assistance program. Costs of mentoring, supervision, and continuing education may be 154.3included in the reimbursement rate methodology used for case management services under 154.4the medical assistance program.154.5    Sec. 7. Minnesota Statutes 2012, section 246.18, subdivision 8, is amended to read:154.6    Subd. 8. State-operated services account.(a) The state-operated services account is 154.7established in the special revenue fund. Revenue generated by new state-operated services 154.8listed under this section established after July 1, 2010, that are not enterprise activities must 154.9be deposited into the state-operated services account, unless otherwise specified in law:154.10(1) intensive residential treatment services;154.11(2) foster care services; and154.12(3) psychiatric extensive recovery treatment services.154.13(b) Funds deposited in the state-operated services account are available to the 154.14commissioner of human services for the purposes of:154.15(1) providing services needed to transition individuals from institutional settings 154.16within state-operated services to the community when those services have no other 154.17adequate funding source; 154.18(2) grants to providers participating in mental health specialty treatment services 154.19under section 245.4661; and154.20(3) to fund the operation of the Intensive Residential Treatment Service program in 154.21Willmar.154.22    Sec. 8. Minnesota Statutes 2012, section 246.18, is amended by adding a subdivision 154.23to read:154.24    Subd. 9.Transfers.The commissioner may transfer state mental health grant funds 154.25to the account in subdivision 8 for noncovered allowable costs of a provider certified and 154.26licensed under section 256B.0622 and operating under section 246.014.154.27    Sec. 9. Minnesota Statutes 2012, section 253B.10, subdivision 1, is amended to read:154.28    Subdivision 1. Administrative requirements.(a) When a person is committed, 154.29the court shall issue a warrant or an order committing the patient to the custody of the 154.30head of the treatment facility. The warrant or order shall state that the patient meets the 154.31statutory criteria for civil commitment. 154.32(b) The commissioner shall prioritize patients being admitted from jail or a 154.33correctional institution who are:155.1(1) ordered confined in a state hospital for an examination under Minnesota Rules of 155.2Criminal Procedure, rules 20.01, subdivision 4, paragraph (a), and 20.02, subdivision 2;155.3(2) under civil commitment for competency treatment and continuing supervision 155.4under Minnesota Rules of Criminal Procedure, rule 20.01, subdivision 7;155.5(3) found not guilty by reason of mental illness under Minnesota Rules of Criminal 155.6Procedure, rule 20.02, subdivision 8, and under civil commitment or are ordered to be 155.7detained in a state hospital or other facility pending completion of the civil commitment 155.8proceedings; or155.9(4) committed under this chapter to the commissioner after dismissal of the patient's 155.10criminal charges.155.11Patients described in this paragraph must be admitted to a service operated by the 155.12commissioner within 48 hours. The commitment must be ordered by the court as provided 155.13in section 253B.09, subdivision 1, paragraph (c).155.14(c) Upon the arrival of a patient at the designated treatment facility, the head of the 155.15facility shall retain the duplicate of the warrant and endorse receipt upon the original 155.16warrant or acknowledge receipt of the order. The endorsed receipt or acknowledgment 155.17must be filed in the court of commitment. After arrival, the patient shall be under the 155.18control and custody of the head of the treatment facility.155.19(d) Copies of the petition for commitment, the court's findings of fact and 155.20conclusions of law, the court order committing the patient, the report of the examiners, 155.21and the prepetition report shall be provided promptly to the treatment facility.155.22    Sec. 10. Minnesota Statutes 2012, section 254B.13, is amended to read:155.23254B.13 PILOT PROJECTS; CHEMICAL HEALTH CARE.155.24    Subdivision 1. Authorization for navigator pilot projects. The commissioner may 155.25approve and implement navigator pilot projects developed under the planning process 155.26required under Laws 2009, chapter 79, article 7, section 26, to provide alternatives to and 155.27enhance coordination of the delivery of chemical health services required under section 155.28254B.03
         .155.29    Subd. 2. Program design and implementation. (a) The commissioner and 155.30counties participating in the navigator pilot projects shall continue to work in partnership 155.31to refine and implement the navigator pilot projects initiated under Laws 2009, chapter 155.3279, article 7, section 26.155.33(b) The commissioner and counties participating in the navigator pilot projects shall 155.34complete the planning phase by June 30, 2010, and, if approved by the commissioner for 156.1implementation, enter into agreements governing the operation of the navigator pilot 156.2projects with implementation scheduled no earlier than July 1, 2010.156.3    Subd. 2a.Eligibility for navigator pilot program.(a) To be considered for 156.4participation in a navigator pilot program, an individual must:156.5(1) be a resident of a county with an approved navigator program;156.6(2) be eligible for consolidated chemical dependency treatment fund services;156.7(3) be a voluntary participant in the navigator program;156.8(4) satisfy one of the following items:156.9(i) have at least one severity rating of three or above in dimension four, five, or six in 156.10a comprehensive assessment under Minnesota Rules, part 9530.6422; or156.11(ii) have at least one severity rating of two or above in dimension four, five, or six in 156.12a comprehensive assessment under Minnesota Rules, part 9530.6422, and be currently 156.13participating in a Rule 31 treatment program under Minnesota Rules, parts 9530.6405 to 156.149530.6505, or be within 60 days following discharge after participation in a Rule 31 156.15treatment program; and156.16(5) have had at least two treatment episodes in the past two years, not limited 156.17to episodes reimbursed by the consolidated chemical dependency treatment funds. An 156.18admission to an emergency room, a detoxification program, or a hospital may be substituted 156.19for one treatment episode if it resulted from the individual's substance use disorder.156.20(b) New eligibility criteria may be added as mutually agreed upon by the 156.21commissioner and participating navigator programs.156.22    Subd. 3. Program evaluation. The commissioner shall evaluate navigator pilot 156.23projects under this section and report the results of the evaluation to the chairs and 156.24ranking minority members of the legislative committees with jurisdiction over chemical 156.25health issues by January 15, 2014. Evaluation of the navigator pilot projects must be 156.26based on outcome evaluation criteria negotiated with the navigator pilot projects prior 156.27to implementation.156.28    Subd. 4. Notice of navigator pilot project discontinuation. Each county's 156.29participation in the navigator pilot project may be discontinued for any reason by the county 156.30or the commissioner of human services after 30 days' written notice to the other party. 156.31Any unspent funds held for the exiting county's pro rata share in the special revenue fund 156.32under the authority in subdivision 5, paragraph (d), shall be transferred to the consolidated 156.33chemical dependency treatment fund following discontinuation of the pilot project.156.34    Subd. 5. Duties of commissioner. (a) Notwithstanding any other provisions in 156.35this chapter, the commissioner may authorize navigator pilot projects to use chemical 156.36dependency treatment funds to pay for nontreatment navigator pilot services:157.1(1) in addition to those authorized under section 
         254B.03, subdivision 2, paragraph 157.2(a); and157.3(2) by vendors in addition to those authorized under section 
         254B.05 when not 157.4providing chemical dependency treatment services.157.5(b) For purposes of this section, "nontreatment navigator pilot services" include 157.6navigator services, peer support, family engagement and support, housing support, rent 157.7subsidies, supported employment, and independent living skills.157.8(c) State expenditures for chemical dependency services and nontreatment navigator 157.9pilot services provided by or through the navigator pilot projects must not be greater than 157.10the chemical dependency treatment fund expected share of forecasted expenditures in the 157.11absence of the navigator pilot projects. The commissioner may restructure the schedule of 157.12payments between the state and participating counties under the local agency share and 157.13division of cost provisions under section 
         254B.03, subdivisions 3 and 4, as necessary to 157.14facilitate the operation of the navigator pilot projects.157.15(d) To the extent that state fiscal year expenditures within a pilot project are less 157.16than the expected share of forecasted expenditures in the absence of the pilot projects, 157.17the commissioner shall deposit the unexpended funds in a separate account within the 157.18consolidated chemical dependency treatment fund, and make these funds available for 157.19expenditure by the pilot projects the following year. To the extent that treatment and 157.20nontreatment pilot services expenditures within the pilot project exceed the amount 157.21expected in the absence of the pilot projects, the pilot project county or counties are 157.22responsible for the portion of nontreatment pilot services expenditures in excess of the 157.23otherwise expected share of forecasted expenditures.157.24(e) (d) The commissioner may waive administrative rule requirements that are 157.25incompatible with the implementation of the navigator pilot project, except that any 157.26chemical dependency treatment funded under this section must continue to be provided 157.27by a licensed treatment provider.157.28(f) (e) The commissioner shall not approve or enter into any agreement related to 157.29navigator pilot projects authorized under this section that puts current or future federal 157.30funding at risk.157.31(f) The commissioner shall provide participating navigator pilot projects with 157.32transactional data, reports, provider data, and other data generated by county activity to 157.33assess and measure outcomes. This information must be transmitted or made available in 157.34an acceptable form to participating navigator pilot projects at least once every six months 157.35or within a reasonable time following the commissioner's receipt of information from the 157.36counties needed to comply with this paragraph.158.1    Subd. 6. Duties of county board. The county board, or other county entity that 158.2is approved to administer a navigator pilot project, shall:158.3(1) administer the navigator pilot project in a manner consistent with the objectives 158.4described in subdivision 2 and the planning process in subdivision 5;158.5(2) ensure that no one is denied chemical dependency treatment services for which 158.6they would otherwise be eligible under section 
         254A.03, subdivision 3; and158.7(3) provide the commissioner with timely and pertinent information as negotiated in 158.8agreements governing operation of the navigator pilot projects.158.9    Subd. 7.Managed care.An individual who is eligible for the navigator pilot 158.10program under subdivision 2a is excluded from mandatory enrollment in managed care 158.11until these services are included in the health plan's benefit set.158.12    Subd. 8.Authorization for continuation of navigator pilots.The navigator pilot 158.13projects implemented pursuant to subdivision 1 are authorized to continue operation after 158.14July 1, 2013, under existing agreements governing operation of the pilot projects.158.15EFFECTIVE DATE.The amendments to subdivisions 1 to 6 and 8 are effective 158.16August 1, 2013. Subdivision 7 is effective July 1, 2013.158.17    Sec. 11. [254B.14] CONTINUUM OF CARE PILOT PROJECTS; CHEMICAL 158.18HEALTH CARE.158.19    Subdivision 1.Authorization for continuum of care pilot projects.The 158.20commissioner shall establish chemical dependency continuum of care pilot projects to 158.21begin implementing the measures developed with stakeholder input and identified in the 158.22report completed pursuant to Laws 2012, chapter 247, article 5, section 8. The pilot 158.23projects are intended to improve the effectiveness and efficiency of the service continuum 158.24for chemically dependent individuals in Minnesota while reducing duplication of efforts 158.25and promoting scientifically supported practices.158.26    Subd. 2.Program implementation.(a) The commissioner, in coordination with 158.27representatives of the Minnesota Association of County Social Service Administrators 158.28and the Minnesota Inter-County Association, shall develop a process for identifying and 158.29selecting interested counties and providers for participation in the continuum of care pilot 158.30projects. There will be three pilot projects; one representing the northern region, one for 158.31the metro region, and one for the southern region. The selection process of counties and 158.32providers must include consideration of population size, geographic distribution, cultural 158.33and racial demographics, and provider accessibility. The commissioner shall identify 158.34counties and providers that are selected for participation in the continuum of care pilot 158.35projects no later than September 30, 2013.159.1(b) The commissioner and entities participating in the continuum of care pilot 159.2projects shall enter into agreements governing the operation of the continuum of care pilot 159.3projects. The agreements shall identify pilot project outcomes and include timelines for 159.4implementation and beginning operation of the pilot projects.159.5(c) Entities that are currently participating in the navigator pilot project are 159.6eligible to participate in the continuum of care pilot project subsequent to or instead of 159.7participating in the navigator pilot project.159.8(d) The commissioner may waive administrative rule requirements that are 159.9incompatible with implementation of the continuum of care pilot projects.159.10(e) Notwithstanding section 254A.19, the commissioner may designate noncounty 159.11entities to complete chemical use assessments and placement authorizations required 159.12under section 254A.19 and Minnesota Rules, parts 9530.6600 to 9530.6655. Section 159.13254A.19, subdivision 3, is applicable to the continuum of care pilot projects at the 159.14discretion of the commissioner.159.15    Subd. 3.Program design.(a) The operation of the pilot projects shall include:159.16(1) new services that are responsive to the chronic nature of substance use disorder;159.17(2) telehealth services, when appropriate to address barriers to services;159.18(3) services that assure integration with the mental health delivery system when 159.19appropriate;159.20(4) services that address the needs of diverse populations; and159.21(5) an assessment and access process that permits clients to present directly to a 159.22service provider for a substance use disorder assessment and authorization of services.159.23(b) Prior to implementation of the continuum of care pilot projects, a utilization 159.24review process must be developed and agreed to by the commissioner, participating 159.25counties, and providers. The utilization review process shall be described in the 159.26agreements governing operation of the continuum of care pilot projects.159.27    Subd. 4.Notice of project discontinuation.Each entity's participation in the 159.28continuum of care pilot project may be discontinued for any reason by the county or the 159.29commissioner after 30 days' written notice to the entity.159.30    Subd. 5.Duties of commissioner.(a) Notwithstanding any other provisions in this 159.31chapter, the commissioner may authorize chemical dependency treatment funds to pay for 159.32nontreatment services arranged by continuum of care pilot projects. Individuals who are 159.33currently accessing Rule 31 treatment services are eligible for concurrent participation in 159.34the continuum of care pilot projects.160.1(b) County expenditures for continuum of care pilot project services shall not 160.2be greater than their expected share of forecasted expenditures in the absence of the 160.3continuum of care pilot projects.160.4EFFECTIVE DATE.This section is effective August 1, 2013.160.5    Sec. 12. [256B.0616] MENTAL HEALTH CERTIFIED FAMILY PEER 160.6SPECIALIST.160.7    Subdivision 1.Scope.Medical assistance covers mental health certified family peer 160.8specialists services, as established in subdivision 2, subject to federal approval, if provided 160.9to recipients who have an emotional disturbance or severe emotional disturbance under 160.10chapter 245, and are provided by a certified family peer specialist who has completed the 160.11training under subdivision 5. A family peer specialist cannot provide services to the 160.12peer specialist's family.160.13    Subd. 2.Establishment.The commissioner of human services shall establish a 160.14certified family peer specialists program model which:160.15(1) provides nonclinical family peer support counseling, building on the strengths 160.16of families and helping them achieve desired outcomes;160.17(2) collaborates with others providing care or support to the family;160.18(3) provides nonadversarial advocacy;160.19(4) promotes the individual family culture in the treatment milieu;160.20(5) links parents to other parents in the community;160.21(6) offers support and encouragement;160.22(7) assists parents in developing coping mechanisms and problem-solving skills;160.23(8) promotes resiliency, self-advocacy, development of natural supports, and 160.24maintenance of skills learned in other support services;160.25(9) establishes and provides peer led parent support groups; and160.26(10) increases the child's ability to function better within the child's home, school, 160.27and community by educating parents on community resources, assisting with problem 160.28solving, and educating parents on mental illnesses.160.29    Subd. 3.Eligibility.Family peer support services may be located in inpatient 160.30hospitalization, partial hospitalization, residential treatment, treatment foster care, day 160.31treatment, children's therapeutic services and supports, or crisis services.160.32    Subd. 4.Peer support specialist program providers.The commissioner shall 160.33develop a process to certify family peer support specialist programs, in accordance with 160.34the federal guidelines, in order for the program to bill for reimbursable services. Family 161.1peer support programs must operate within an existing mental health community provider 161.2or center.161.3    Subd. 5.Certified family peer specialist training and certification.The 161.4commissioner shall develop a training and certification process for certified family peer 161.5specialists who must be at least 21 years of age and have a high school diploma or its 161.6equivalent. The candidates must have raised or are currently raising a child with a mental 161.7illness, have had experience navigating the children's mental health system, and must 161.8demonstrate leadership and advocacy skills and a strong dedication to family-driven and 161.9family-focused services. The training curriculum must teach participating family peer 161.10specialists specific skills relevant to providing peer support to other parents. In addition 161.11to initial training and certification, the commissioner shall develop ongoing continuing 161.12educational workshops on pertinent issues related to family peer support counseling.161.13    Sec. 13. Minnesota Statutes 2012, section 256B.0623, subdivision 2, is amended to read:161.14    Subd. 2. Definitions. For purposes of this section, the following terms have the 161.15meanings given them.161.16(a) "Adult rehabilitative mental health services" means mental health services 161.17which are rehabilitative and enable the recipient to develop and enhance psychiatric 161.18stability, social competencies, personal and emotional adjustment, and independent living, 161.19parenting skills, and community skills, when these abilities are impaired by the symptoms 161.20of mental illness. Adult rehabilitative mental health services are also appropriate when 161.21provided to enable a recipient to retain stability and functioning, if the recipient would 161.22be at risk of significant functional decompensation or more restrictive service settings 161.23without these services.161.24(1) Adult rehabilitative mental health services instruct, assist, and support the 161.25recipient in areas such as: interpersonal communication skills, community resource 161.26utilization and integration skills, crisis assistance, relapse prevention skills, health care 161.27directives, budgeting and shopping skills, healthy lifestyle skills and practices, cooking 161.28and nutrition skills, transportation skills, medication education and monitoring, mental 161.29illness symptom management skills, household management skills, employment-related 161.30skills, parenting skills, and transition to community living services.161.31(2) These services shall be provided to the recipient on a one-to-one basis in the 161.32recipient's home or another community setting or in groups.161.33(b) "Medication education services" means services provided individually or in 161.34groups which focus on educating the recipient about mental illness and symptoms; the role 161.35and effects of medications in treating symptoms of mental illness; and the side effects of 162.1medications. Medication education is coordinated with medication management services 162.2and does not duplicate it. Medication education services are provided by physicians, 162.3pharmacists, physician's assistants, or registered nurses.162.4(c) "Transition to community living services" means services which maintain 162.5continuity of contact between the rehabilitation services provider and the recipient and 162.6which facilitate discharge from a hospital, residential treatment program under Minnesota 162.7Rules, chapter 9505, board and lodging facility, or nursing home. Transition to community 162.8living services are not intended to provide other areas of adult rehabilitative mental health 162.9services.162.10    Sec. 14. Minnesota Statutes 2012, section 256B.0625, subdivision 48, is amended to 162.11read:162.12    Subd. 48. Psychiatric consultation to primary care practitioners.Effective 162.13January 1, 2006, Medical assistance covers consultation provided by a psychiatrist, 162.14psychologist, or an advanced practice registered nurse certified in psychiatric mental 162.15health via telephone, e-mail, facsimile, or other means of communication to primary care 162.16practitioners, including pediatricians. The need for consultation and the receipt of the 162.17consultation must be documented in the patient record maintained by the primary care 162.18practitioner. If the patient consents, and subject to federal limitations and data privacy 162.19provisions, the consultation may be provided without the patient present.162.20    Sec. 15. Minnesota Statutes 2012, section 256B.0625, subdivision 56, is amended to 162.21read:162.22    Subd. 56. Medical service coordination. (a)(1)  Medical assistance covers in-reach 162.23community-based service coordination that is performed through a hospital emergency 162.24department as an eligible procedure under a state healthcare program for a frequent user. 162.25A frequent user is defined as an individual who has frequented the hospital emergency 162.26department for services three or more times in the previous four consecutive months. 162.27In-reach community-based service coordination includes navigating services to address a 162.28client's mental health, chemical health, social, economic, and housing needs, or any other 162.29activity targeted at reducing the incidence of emergency room and other nonmedically 162.30necessary health care utilization.162.31(2) Medical assistance covers in-reach community-based service coordination that 162.32is performed through a hospital emergency department or inpatient psychiatric unit 162.33for a child or young adult up to age 21 with a serious emotional disturbance who has 162.34frequented the hospital emergency room two or more times in the previous consecutive 163.1three months or been admitted to an inpatient psychiatric unit two or more times in the 163.2previous consecutive four months, or is being discharged to a shelter. 163.3    (b) Reimbursement must be made in 15-minute increments and allowed for up to 60 163.4days posthospital discharge based upon the specific identified emergency department visit 163.5or inpatient admitting event. In-reach community-based service coordination shall seek to 163.6connect frequent users with existing covered services available to them, including, but not 163.7limited to, targeted case management, waiver case management, or care coordination in a 163.8health care home. For children and young adults with a serious emotional disturbance, 163.9in-reach community-based service coordination includes navigating and arranging for 163.10community-based services prior to discharge to address a client's mental health, chemical 163.11health, social, educational, family support and housing needs, or any other activity targeted 163.12at reducing multiple incidents of emergency room use, inpatient readmissions, and other 163.13nonmedically necessary health care utilization. In-reach services shall seek to connect 163.14them with existing covered services, including targeted case management, waiver case 163.15management, care coordination in a health care home, children's therapeutic services and 163.16supports, crisis services, and respite care. Eligible in-reach service coordinators must hold 163.17a minimum of a bachelor's degree in social work, public health, corrections, or a related 163.18field. The commissioner shall submit any necessary application for waivers to the Centers 163.19for Medicare and Medicaid Services to implement this subdivision.163.20    (c)(1) For the purposes of this subdivision, "in-reach community-based service 163.21coordination" means the practice of a community-based worker with training, knowledge, 163.22skills, and ability to access a continuum of services, including housing, transportation, 163.23chemical and mental health treatment, employment, education, and peer support services, 163.24by working with an organization's staff to transition an individual back into the individual's 163.25living environment. In-reach community-based service coordination includes working 163.26with the individual during their discharge and for up to a defined amount of time in the 163.27individual's living environment, reducing the individual's need for readmittance.163.28    (2) Hospitals utilizing in-reach service coordinators shall report annually to the 163.29commissioner on the number of adults, children, and adolescents served; the postdischarge 163.30services which they accessed; and emergency department/psychiatric hospitalization 163.31readmissions. The commissioner shall ensure that services and payments provided under 163.32in-reach care coordination do not duplicate services or payments provided under section 163.33256B.0753, 256B.0755, or 256B.0625, subdivision 20.163.34    Sec. 16. Minnesota Statutes 2012, section 256B.0625, is amended by adding a 163.35subdivision to read:164.1    Subd. 61.Family psychoeducation services.Effective July 1, 2013, or upon 164.2federal approval, whichever is later, medical assistance covers family psychoeducation 164.3services provided to a child up to age 21 with a diagnosed mental health condition when 164.4identified in the child's individual treatment plan and provided by a licensed mental health 164.5professional, as defined in Minnesota Rules, part 9505.0371, subpart 5, item A, or a 164.6clinical trainee, as defined in Minnesota Rules, part 9505.0371, subpart 5, item C, who 164.7has determined it medically necessary to involve family members in the child's care. For 164.8the purposes of this subdivision, "family psychoeducation services" means information 164.9or demonstration provided to an individual or family as part of an individual, family, 164.10multifamily group, or peer group session to explain, educate, and support the child and 164.11family in understanding a child's symptoms of mental illness, the impact on the child's 164.12development, and needed components of treatment and skill development so that the 164.13individual, family, or group can help the child to prevent relapse, prevent the acquisition 164.14of comorbid disorders, and to achieve optimal mental health and long-term resilience.164.15    Sec. 17. Minnesota Statutes 2012, section 256B.0625, is amended by adding a 164.16subdivision to read:164.17    Subd. 62.Mental health clinical care consultation.Effective July 1, 2013, or upon 164.18federal approval, whichever is later, medical assistance covers clinical care consultation 164.19for a person up to age 21 who is diagnosed with a complex mental health condition or a 164.20mental health condition that co-occurs with other complex and chronic conditions, when 164.21described in the person's individual treatment plan and provided by a licensed mental 164.22health professional, as defined in Minnesota Rules, part 9505.0371, subpart 5, item A, or a 164.23clinical trainee, as defined in Minnesota Rules, part 9505.0371, subpart 5, item C. For the 164.24purposes of this subdivision, "clinical care consultation" means communication from a 164.25treating mental health professional to other providers or educators not under the clinical 164.26supervision of the treating mental health professional who are working with the same client 164.27to inform, inquire, and instruct regarding the client's symptoms; strategies for effective 164.28engagement, care, and intervention needs; treatment expectations across service settings; 164.29and to direct and coordinate clinical service components provided to the client and family.164.30    Sec. 18. Minnesota Statutes 2012, section 256B.0943, subdivision 1, is amended to read:164.31    Subdivision 1. Definitions. For purposes of this section, the following terms have 164.32the meanings given them.164.33(a) "Children's therapeutic services and supports" means the flexible package of 164.34mental health services for children who require varying therapeutic and rehabilitative 165.1levels of intervention. The services are time-limited interventions that are delivered using 165.2various treatment modalities and combinations of services designed to reach treatment 165.3outcomes identified in the individual treatment plan.165.4(b) "Clinical supervision" means the overall responsibility of the mental health 165.5professional for the control and direction of individualized treatment planning, service 165.6delivery, and treatment review for each client. A mental health professional who is an 165.7enrolled Minnesota health care program provider accepts full professional responsibility 165.8for a supervisee's actions and decisions, instructs the supervisee in the supervisee's work, 165.9and oversees or directs the supervisee's work.165.10(c) "County board" means the county board of commissioners or board established 165.11under sections 
         402.01 to 
         402.10 or 
         471.59.165.12(d) "Crisis assistance" has the meaning given in section 
         245.4871, subdivision 9a.165.13(e) "Culturally competent provider" means a provider who understands and can 165.14utilize to a client's benefit the client's culture when providing services to the client. A 165.15provider may be culturally competent because the provider is of the same cultural or 165.16ethnic group as the client or the provider has developed the knowledge and skills through 165.17training and experience to provide services to culturally diverse clients.165.18(f) "Day treatment program" for children means a site-based structured program 165.19consisting of group psychotherapy for more than three individuals and other intensive 165.20therapeutic services provided by a multidisciplinary team, under the clinical supervision 165.21of a mental health professional.165.22(g) "Diagnostic assessment" has the meaning given in section 
         245.4871, subdivision 165.2311
         .165.24(h) "Direct service time" means the time that a mental health professional, mental 165.25health practitioner, or mental health behavioral aide spends face-to-face with a client 165.26and the client's family. Direct service time includes time in which the provider obtains 165.27a client's history or provides service components of children's therapeutic services and 165.28supports. Direct service time does not include time doing work before and after providing 165.29direct services, including scheduling, maintaining clinical records, consulting with others 165.30about the client's mental health status, preparing reports, receiving clinical supervision, 165.31and revising the client's individual treatment plan.165.32(i) "Direction of mental health behavioral aide" means the activities of a mental 165.33health professional or mental health practitioner in guiding the mental health behavioral 165.34aide in providing services to a client. The direction of a mental health behavioral aide 165.35must be based on the client's individualized treatment plan and meet the requirements in 165.36subdivision 6, paragraph (b), clause (5).166.1(j) "Emotional disturbance" has the meaning given in section 
         245.4871, subdivision 166.215
         . For persons at least age 18 but under age 21, mental illness has the meaning given in 166.3section 
         245.462, subdivision 20, paragraph (a).166.4(k) "Individual behavioral plan" means a plan of intervention, treatment, and 166.5services for a child written by a mental health professional or mental health practitioner, 166.6under the clinical supervision of a mental health professional, to guide the work of the 166.7mental health behavioral aide.166.8(l) "Individual treatment plan" has the meaning given in section 
         245.4871, 166.9subdivision 21
         .166.10(m) "Mental health behavioral aide services" means medically necessary one-on-one 166.11activities performed by a trained paraprofessional to assist a child retain or generalize 166.12psychosocial skills as taught by a mental health professional or mental health practitioner 166.13and as described in the child's individual treatment plan and individual behavior plan. 166.14Activities involve working directly with the child or child's family as provided in 166.15subdivision 9, paragraph (b), clause (4).166.16(n) "Mental health professional" means an individual as defined in section 
         245.4871, 166.17subdivision 27
         , clauses (1) to (6), or tribal vendor as defined in section 
         256B.02, 166.18subdivision 7
         , paragraph (b).166.19    (o) "Mental health service plan development" includes:166.20    (1) the development, review, and revision of a child's individual treatment plan, 166.21as provided in Minnesota Rules, part 9505.0371, subpart 7, including involvement of 166.22the client or client's parents, primary caregiver, or other person authorized to consent to 166.23mental health services for the client, and including arrangement of treatment and support 166.24activities specified in the individual treatment plan; and166.25    (2) administering standardized outcome measurement instruments, determined 166.26and updated by the commissioner, as periodically needed to evaluate the effectiveness 166.27of treatment for children receiving clinical services and reporting outcome measures, 166.28as required by the commissioner.166.29(o) (p) "Preschool program" means a day program licensed under Minnesota Rules, 166.30parts 9503.0005 to 9503.0175, and enrolled as a children's therapeutic services and 166.31supports provider to provide a structured treatment program to a child who is at least 33 166.32months old but who has not yet attended the first day of kindergarten.166.33(p) (q) "Skills training" means individual, family, or group training, delivered 166.34by or under the direction of a mental health professional, designed to facilitate the 166.35acquisition of psychosocial skills that are medically necessary to rehabilitate the child 166.36to an age-appropriate developmental trajectory heretofore disrupted by a psychiatric 167.1illness or to self-monitor, compensate for, cope with, counteract, or replace skills deficits 167.2or maladaptive skills acquired over the course of a psychiatric illness. Skills training 167.3is subject to the following requirements:167.4(1) a mental health professional or a mental health practitioner must provide skills 167.5training;167.6(2) the child must always be present during skills training; however, a brief absence 167.7of the child for no more than ten percent of the session unit may be allowed to redirect or 167.8instruct family members;167.9(3) skills training delivered to children or their families must be targeted to the 167.10specific deficits or maladaptations of the child's mental health disorder and must be 167.11prescribed in the child's individual treatment plan;167.12(4) skills training delivered to the child's family must teach skills needed by parents 167.13to enhance the child's skill development and to help the child use in daily life the skills 167.14previously taught by a mental health professional or mental health practitioner and to 167.15develop or maintain a home environment that supports the child's progressive use skills;167.16(5) group skills training may be provided to multiple recipients who, because of the 167.17nature of their emotional, behavioral, or social dysfunction, can derive mutual benefit from 167.18interaction in a group setting, which must be staffed as follows:167.19(i) one mental health professional or one mental health practitioner under supervision 167.20of a licensed mental health professional must work with a group of four to eight clients; or167.21(ii) two mental health professionals or two mental health practitioners under 167.22supervision of a licensed mental health professional, or one professional plus one 167.23practitioner must work with a group of nine to 12 clients.167.24    Sec. 19. Minnesota Statutes 2012, section 256B.0943, subdivision 2, is amended to read:167.25    Subd. 2. Covered service components of children's therapeutic services and 167.26supports. (a) Subject to federal approval, medical assistance covers medically necessary 167.27children's therapeutic services and supports as defined in this section that an eligible 167.28provider entity certified under subdivision 4 provides to a client eligible under subdivision 167.293.167.30(b) The service components of children's therapeutic services and supports are:167.31(1) individual, family, and group psychotherapy;167.32(2) individual, family, or group skills training provided by a mental health 167.33professional or mental health practitioner;167.34(3) crisis assistance;167.35(4) mental health behavioral aide services; and168.1(5) direction of a mental health behavioral aide.;168.2(6) mental health service plan development;168.3(7) clinical care consultation provided by a mental health professional under section 168.4256B.0625, subdivision 62; 168.5(8) family psychoeducation under section 256B.0625, subdivision 61; and168.6(9) services provided by a family peer specialist under section 256B.0616.168.7(c) Service components in paragraph (b) may be combined to constitute therapeutic 168.8programs, including day treatment programs and therapeutic preschool programs.168.9    Sec. 20. Minnesota Statutes 2012, section 256B.0943, subdivision 7, is amended to read:168.10    Subd. 7. Qualifications of individual and team providers. (a) An individual 168.11or team provider working within the scope of the provider's practice or qualifications 168.12may provide service components of children's therapeutic services and supports that are 168.13identified as medically necessary in a client's individual treatment plan.168.14(b) An individual provider must be qualified as:168.15(1) a mental health professional as defined in subdivision 1, paragraph (n); or168.16(2) a mental health practitioner as defined in section 
         245.4871, subdivision 26. The 168.17mental health practitioner must work under the clinical supervision of a mental health 168.18professional; or168.19(3) a mental health behavioral aide working under the clinical supervision of a 168.20mental health professional to implement the rehabilitative mental health services identified 168.21in the client's individual treatment plan and individual behavior plan.168.22(A) A level I mental health behavioral aide must:168.23(i) be at least 18 years old;168.24(ii) have a high school diploma or general equivalency diploma (GED) or two years 168.25of experience as a primary caregiver to a child with severe emotional disturbance within 168.26the previous ten years; and168.27(iii) meet preservice and continuing education requirements under subdivision 8.168.28(B) A level II mental health behavioral aide must:168.29(i) be at least 18 years old;168.30(ii) have an associate or bachelor's degree or 4,000 hours of experience in delivering 168.31clinical services in the treatment of mental illness concerning children or adolescents or 168.32complete a certificate program established under subdivision 8a; and168.33(iii) meet preservice and continuing education requirements in subdivision 8.169.1(c) A preschool program multidisciplinary team must include at least one mental 169.2health professional and one or more of the following individuals under the clinical 169.3supervision of a mental health professional:169.4(i) a mental health practitioner; or169.5(ii) a program person, including a teacher, assistant teacher, or aide, who meets the 169.6qualifications and training standards of a level I mental health behavioral aide.169.7(d) A day treatment multidisciplinary team must include at least one mental health 169.8professional and one mental health practitioner.169.9    Sec. 21. Minnesota Statutes 2012, section 256B.0943, is amended by adding a 169.10subdivision to read:169.11    Subd. 8a.Level II mental health behavioral aide.The commissioner of human 169.12services, in collaboration with the Board of Trustees of the Minnesota State Colleges and 169.13Universities, shall develop a certificate program of not fewer than 11 credits for level II 169.14mental health behavioral aides. The program shall include classroom and field-based 169.15learning. The program components must include, but not be limited to, mental illnesses 169.16in children, parent and family perspectives, skill training, documentation and reporting, 169.17communication skills, and cultural competence.169.18    Sec. 22. Minnesota Statutes 2012, section 256B.0946, is amended to read:169.19256B.0946 INTENSIVE TREATMENT IN FOSTER CARE.169.20    Subdivision 1. Required covered service components. (a) Effective July 1, 2006,169.21 upon enactment and subject to federal approval, medical assistance covers medically 169.22necessary intensive treatment services described under paragraph (b) that are provided 169.23by a provider entity eligible under subdivision 3 to a client eligible under subdivision 2 169.24who is placed in a treatment foster home licensed under Minnesota Rules, parts 2960.3000 169.25to 2960.3340.169.26(b) Intensive treatment services to children with severe emotional disturbance mental 169.27illness residing in treatment foster care family settings must meet the relevant standards 169.28for mental health services under sections 245.487 to 245.4889. In addition, that comprise169.29 specific required service components provided in clauses (1) to (5), are reimbursed by 169.30medical assistance must when they meet the following standards:169.31(1) case management service component must meet the standards in Minnesota 169.32Rules, parts 9520.0900 to 9520.0926 and 9505.0322, excluding subparts 6 and 10;170.1(1) psychotherapy provided by a mental health professional as defined in Minnesota 170.2Rules, part 9505.0371, subpart 5, item A, or a clinical trainee, as defined in Minnesota 170.3Rules, part 9505.0371, subpart 5, item C;170.4(2) psychotherapy, crisis assistance, and skills training components must meet the170.5 provided according to standards for children's therapeutic services and supports in section 170.6256B.0943
         ; and170.7(3) individual family, and group psychoeducation services under supervision of, 170.8defined in subdivision 1a, paragraph (q), provided by a mental health professional. or a 170.9clinical trainee;170.10(4) clinical care consultation, as defined in subdivision 1a, and provided by a mental 170.11health professional or a clinical trainee; and170.12(5) service delivery payment requirements as provided under subdivision 4.170.13    Subd. 1a.Definitions.For the purposes of this section, the following terms have 170.14the meanings given them.170.15(a) "Clinical care consultation" means communication from a treating clinician to 170.16other providers working with the same client to inform, inquire, and instruct regarding 170.17the client's symptoms, strategies for effective engagement, care and intervention needs, 170.18and treatment expectations across service settings, including but not limited to the client's 170.19school, social services, day care, probation, home, primary care, medication prescribers, 170.20disabilities services, and other mental health providers and to direct and coordinate clinical 170.21service components provided to the client and family.170.22(b) "Clinical supervision" means the documented time a clinical supervisor and 170.23supervisee spend together to discuss the supervisee's work, to review individual client 170.24cases, and for the supervisee's professional development. It includes the documented 170.25oversight and supervision responsibility for planning, implementation, and evaluation of 170.26services for a client's mental health treatment.170.27(c) "Clinical supervisor" means the mental health professional who is responsible 170.28for clinical supervision.170.29(d) "Clinical trainee" has the meaning given in Minnesota Rules, part 9505.0371, 170.30subpart 5, item C;170.31(e) "Crisis assistance" has the meaning given in section 245.4871, subdivision 9a, 170.32including the development of a plan that addresses prevention and intervention strategies 170.33to be used in a potential crisis, but does not include actual crisis intervention.170.34(f) "Culturally appropriate" means providing mental health services in a manner that 170.35incorporates the child's cultural influences, as defined in Minnesota Rules, part 9505.0370, 171.1subpart 9, into interventions as a way to maximize resiliency factors and utilize cultural 171.2strengths and resources to promote overall wellness.171.3(g) "Culture" means the distinct ways of living and understanding the world that 171.4are used by a group of people and are transmitted from one generation to another or 171.5adopted by an individual.171.6(h) "Diagnostic assessment" has the meaning given in Minnesota Rules, part 171.79505.0370, subpart 11.171.8(i) "Family" means a person who is identified by the client or the client's parent or 171.9guardian as being important to the client's mental health treatment. Family may include, 171.10but is not limited to, parents, foster parents, children, spouse, committed partners, former 171.11spouses, persons related by blood or adoption, persons who are a part of the client's 171.12permanency plan, or persons who are presently residing together as a family unit.171.13(j) "Foster care" has the meaning given in section 260C.007, subdivision 18.171.14(k) "Foster family setting" means the foster home in which the license holder resides.171.15(l) "Individual treatment plan" has the meaning given in Minnesota Rules, part 171.169505.0370, subpart 15.171.17(m) "Mental health practitioner" has the meaning given in Minnesota Rules, part 171.189505.0370, subpart 17.171.19(n) "Mental health professional" has the meaning given in Minnesota Rules, part 171.209505.0370, subpart 18.171.21(o) "Mental illness" has the meaning given in Minnesota Rules, part 9505.0370, 171.22subpart 20.171.23(p) "Parent" has the meaning given in section 260C.007, subdivision 25.171.24(q) "Psychoeducation services" means information or demonstration provided to 171.25an individual, family, or group to explain, educate, and support the individual, family, or 171.26group in understanding a child's symptoms of mental illness, the impact on the child's 171.27development, and needed components of treatment and skill development so that the 171.28individual, family, or group can help the child to prevent relapse, prevent the acquisition 171.29of comorbid disorders, and to achieve optimal mental health and long-term resilience.171.30(r) "Psychotherapy" has the meaning given in Minnesota Rules, part 9505.0370, 171.31subpart 27.171.32(s) "Team consultation and treatment planning" means the coordination of treatment 171.33plans and consultation among providers in a group concerning the treatment needs of the 171.34child, including disseminating the child's treatment service schedule to all members of the 171.35service team. Team members must include all mental health professionals working with 171.36the child, a parent, the child unless the team lead or parent deem it clinically inappropriate, 172.1and at least two of the following: an individualized education program case manager; 172.2probation agent; children's mental health case manager; child welfare worker, including 172.3adoption or guardianship worker; primary care provider; foster parent; and any other 172.4member of the child's service team.172.5    Subd. 2. Determination of client eligibility.A client's eligibility to receive 172.6treatment foster care under this section shall be determined by An eligible recipient is an 172.7individual, from birth through age 20, who is currently placed in a foster home licensed 172.8under Minnesota Rules, parts 2960.3000 to 2960.3340, and has received a diagnostic 172.9assessment, and an evaluation of level of care needed, and development of an individual 172.10treatment plan, as defined in paragraphs (a) to (c) and (b).172.11(a) The diagnostic assessment must:172.12(1) meet criteria described in Minnesota Rules, part 9505.0372, subpart 1, and be 172.13conducted by a psychiatrist, licensed psychologist, or licensed independent clinical social 172.14worker that is mental health professional or a clinical trainee;172.15(2) determine whether or not a child meets the criteria for mental illness, as defined 172.16in Minnesota Rules, part 9505.0370, subpart 20;172.17(3) document that intensive treatment services are medically necessary within a 172.18foster family setting to ameliorate identified symptoms and functional impairments;172.19(4) be  performed within 180 days prior to before the start of service; and172.20(2) include current diagnoses on all five axes of the client's current mental health 172.21status;172.22(3) determine whether or not a child meets the criteria for severe emotional 172.23disturbance in section 245.4871, subdivision 6, or for serious and persistent mental illness 172.24in section 245.462, subdivision 20; and172.25(4) be completed annually until age 18. For individuals between age 18 and 21, 172.26unless a client's mental health condition has changed markedly since the client's most 172.27recent diagnostic assessment, annual updating is necessary. For the purpose of this section, 172.28"updating" means a written summary, including current diagnoses on all five axes, by a 172.29mental health professional of the client's current mental status and service needs.172.30(5) be completed as either a standard or extended diagnostic assessment annually to 172.31determine continued eligibility for the service.172.32(b) The evaluation of level of care must be conducted by the placing county with 172.33an instrument, tribe, or case manager in conjunction with the diagnostic assessment as 172.34described by Minnesota Rules, part 9505.0372, subpart 1, item B, using a validated tool172.35 approved by the commissioner of human services and not subject to the rulemaking 172.36process, consistent with section 245.4885, subdivision 1, paragraph (d), the result of which 173.1evaluation demonstrates that the child requires intensive intervention without 24-hour 173.2medical monitoring. The commissioner shall update the list of approved level of care 173.3instruments tools annually and publish on the department's Web site.173.4(c) The individual treatment plan must be:173.5(1) based on the information in the client's diagnostic assessment;173.6(2) developed through a child-centered, family driven planning process that identifies 173.7service needs and individualized, planned, and culturally appropriate interventions that 173.8contain specific measurable treatment goals and objectives for the client and treatment 173.9strategies for the client's family and foster family;173.10(3) reviewed at least once every 90 days and revised; and173.11(4) signed by the client or, if appropriate, by the client's parent or other person 173.12authorized by statute to consent to mental health services for the client.173.13    Subd. 3. Eligible mental health services providers.(a) Eligible providers for 173.14intensive children's mental health services in a foster family setting must be certified 173.15by the state and have a service provision contract with a county board or a reservation 173.16tribal council and must be able to demonstrate the ability to provide all of the services 173.17required in this section.173.18(b) For purposes of this section, a provider agency must have an individual 173.19placement agreement for each recipient and must be a licensed child placing agency, under 173.20Minnesota Rules, parts 9543.0010 to 9543.0150, and either be:173.21(1) a county county-operated entity certified by the state;173.22(2) an Indian Health Services facility operated by a tribe or tribal organization under 173.23funding authorized by United States Code, title 25, sections 450f to 450n, or title 3 of the 173.24Indian Self-Determination Act, Public Law 93-638, section 638 (facilities or providers); or173.25(3) a noncounty entity under contract with a county board.173.26(c) Certified providers that do not meet the service delivery standards required in 173.27this section shall be subject to a decertification process.173.28(d) For the purposes of this section, all services delivered to a client must be 173.29provided by a mental health professional or a clinical trainee.173.30    Subd. 4. Eligible provider responsibilitiesService delivery payment 173.31requirements. (a) To be an eligible provider for payment under this section, a provider 173.32must develop and practice written policies and procedures for treatment foster care services173.33 intensive treatment in foster care, consistent with subdivision 1, paragraph (b), clauses (1), 173.34(2), and (3) and comply with the following requirements in paragraphs (b) to (n).173.35(b) In delivering services under this section, a treatment foster care provider must 173.36ensure that staff caseload size reasonably enables the provider to play an active role in 174.1service planning, monitoring, delivering, and reviewing for discharge planning to meet 174.2the needs of the client, the client's foster family, and the birth family, as specified in each 174.3client's individual treatment plan.174.4(b) A qualified clinical supervisor, as defined in and performing in compliance with 174.5Minnesota Rules, part 9505.0371, subpart 5, item D, must supervise the treatment and 174.6provision of services described in this section.174.7(c) Each client receiving treatment services must receive an extended diagnostic 174.8assessment, as described in Minnesota Rules, part 9505.0372, subpart 1, item C, within 174.930 days of enrollment in this service unless the client has a previous extended diagnostic 174.10assessment that the client, parent, and mental health professional agree still accurately 174.11describes the client's current mental health functioning.174.12(d) Each previous and current mental health, school, and physical health treatment 174.13provider must be contacted to request documentation of treatment and assessments that the 174.14eligible client has received and this information must be reviewed and incorporated into 174.15the diagnostic assessment and team consultation and treatment planning review process.174.16(e) Each client receiving treatment must be assessed for a trauma history and 174.17the client's treatment plan must document how the results of the assessment will be 174.18incorporated into treatment.174.19(f) Each client receiving treatment services must have an individual treatment plan 174.20that is reviewed, evaluated, and signed every 90 days using the team consultation and 174.21treatment planning process, as defined in subdivision 1a, paragraph (s).174.22(g) Care consultation, as defined in subdivision 1a, paragraph (a), must be provided 174.23in accordance with the client's individual treatment plan.174.24(h) Each client must have a crisis assistance plan within ten days of initiating 174.25services and must have access to clinical phone support 24 hours per day, seven days per 174.26week, during the course of treatment, and the crisis plan must demonstrate coordination 174.27with the local or regional mobile crisis intervention team.174.28(i) Services must be delivered and documented at least three days per week, equaling 174.29at least six hours of treatment per week, unless reduced units of service are specified on 174.30the treatment plan as part of transition or on a discharge plan to another service or level of 174.31care. Documentation must comply with Minnesota Rules, parts 9505.2175 and 9505.2197.174.32(j) Location of service delivery must be in the client's home, day care setting, 174.33school, or other community-based setting that is specified on the client's individualized 174.34treatment plan.174.35(k) Treatment must be developmentally and culturally appropriate for the client.175.1(l) Services must be delivered in continual collaboration and consultation with the 175.2client's medical providers and, in particular, with prescribers of psychotropic medications, 175.3including those prescribed on an off-label basis, and members of the service team must be 175.4aware of the medication regimen and potential side effects.175.5(m) Parents, siblings, foster parents, and members of the child's permanency plan 175.6must be involved in treatment and service delivery unless otherwise noted in the treatment 175.7plan.175.8(n) Transition planning for the child must be conducted starting with the first 175.9treatment plan and must be addressed throughout treatment to support the child's 175.10permanency plan and postdischarge mental health service needs.175.11    Subd. 5. Service authorization. The commissioner will administer authorizations 175.12for services under this section in compliance with section 
         256B.0625, subdivision 25.175.13    Subd. 6. Excluded services. (a) Services in clauses (1) to (4) (7) are not covered 175.14under this section and are not eligible for medical assistance payment as components of 175.15intensive treatment in foster care services, but may be billed separately:175.16(1) treatment foster care services provided in violation of medical assistance policy 175.17in Minnesota Rules, part 9505.0220;175.18(2) service components of children's therapeutic services and supports 175.19simultaneously provided by more than one treatment foster care provider;175.20(3) home and community-based waiver services; and175.21(4) treatment foster care services provided to a child without a level of care 175.22determination according to section 245.4885, subdivision 1.175.23(1) inpatient psychiatric hospital treatment;175.24(2) mental health targeted case management;175.25(3) partial hospitalization;175.26(4) medication management;175.27(5) children's mental health day treatment services;175.28(6) crisis response services under section 256B.0944; and175.29(7) transportation.175.30(b) Children receiving intensive treatment in foster care services are not eligible for 175.31medical assistance reimbursement for the following services while receiving intensive 175.32treatment in foster care:175.33(1) mental health case management services under section 256B.0625, subdivision 175.3420; and175.35(2) (1) psychotherapy and skill skills training components of children's therapeutic 175.36services and supports under section 
         256B.0625, subdivision 35b.;176.1(2) mental health behavioral aide services as defined in section 256B.0943, 176.2subdivision 1, paragraph (m);176.3(3) home and community-based waiver services;176.4(4) mental health residential treatment; and176.5(5) room and board costs as defined in section 256I.03, subdivision 6.176.6    Subd. 7.Medical assistance payment and rate setting.The commissioner shall 176.7establish a single daily per-client encounter rate for intensive treatment in foster care 176.8services. The rate must be constructed to cover only eligible services delivered to an 176.9eligible recipient by an eligible provider, as prescribed in subdivision 1, paragraph (b).176.10    Sec. 23. Minnesota Statutes 2012, section 256B.761, is amended to read:176.11256B.761 REIMBURSEMENT FOR MENTAL HEALTH SERVICES.176.12(a) Effective for services rendered on or after July 1, 2001, payment for medication 176.13management provided to psychiatric patients, outpatient mental health services, day 176.14treatment services, home-based mental health services, and family community support 176.15services shall be paid at the lower of (1) submitted charges, or (2) 75.6 percent of the 176.1650th percentile of 1999 charges.176.17(b) Effective July 1, 2001, the medical assistance rates for outpatient mental health 176.18services provided by an entity that operates: (1) a Medicare-certified comprehensive 176.19outpatient rehabilitation facility; and (2) a facility that was certified prior to January 1, 176.201993, with at least 33 percent of the clients receiving rehabilitation services in the most 176.21recent calendar year who are medical assistance recipients, will be increased by 38 percent, 176.22when those services are provided within the comprehensive outpatient rehabilitation 176.23facility and provided to residents of nursing facilities owned by the entity.176.24(c) The commissioner shall establish three levels of payment for mental health 176.25diagnostic assessment, based on three levels of complexity. The aggregate payment under 176.26the tiered rates must not exceed the projected aggregate payments for mental health 176.27diagnostic assessment under the previous single rate. The new rate structure is effective 176.28January 1, 2011, or upon federal approval, whichever is later.176.29(d) In addition to rate increases otherwise provided, the commissioner may 176.30restructure coverage policy and rates to improve access to adult rehabilitative mental 176.31health services under section 256B.0623 and related mental health support services under 176.32section 256B.021, subdivision 4, paragraph (f), clause (2). For state fiscal years 2015 and 176.332016, the projected state share of increased costs due to this paragraph is transferred 176.34from adult mental health grants under sections 245.4661 and 256E.12. The transfer for 176.35fiscal year 2016 is a permanent base adjustment for subsequent fiscal years. Payments 177.1made to managed care plans and county-based purchasing plans under sections 256B.69, 177.2256B.692, and 256L.12 shall reflect the rate changes described in this paragraph.177.3    Sec. 24. Minnesota Statutes 2012, section 256I.05, subdivision 1e, is amended to read:177.4    Subd. 1e. Supplementary rate for certain facilities. (a) Notwithstanding the 177.5provisions of subdivisions 1a and 1c, beginning July 1, 2005, a county agency shall 177.6negotiate a supplementary rate in addition to the rate specified in subdivision 1, not to 177.7exceed $700 per month, including any legislatively authorized inflationary adjustments, 177.8for a group residential housing provider that:177.9(1) is located in Hennepin County and has had a group residential housing contract 177.10with the county since June 1996;177.11(2) operates in three separate locations a 75-bed facility, a 50-bed facility, and a 177.1226-bed facility; and177.13(3) serves a chemically dependent clientele, providing 24 hours per day supervision 177.14and limiting a resident's maximum length of stay to 13 months out of a consecutive 177.1524-month period.177.16(b) Notwithstanding subdivisions 1a and 1c, a county agency shall negotiate a 177.17supplementary rate in addition to the rate specified in subdivision 1, not to exceed $700 177.18per month, including any legislatively authorized inflationary adjustments, of a group 177.19residential provider that:177.20(1) is located in St. Louis County and has had a group residential housing contract 177.21with the county since 2006;177.22(2) operates a 62-bed facility; and177.23(3) serves a chemically dependent adult male clientele, providing 24 hours per 177.24day supervision and limiting a resident's maximum length of stay to 13 months out of 177.25a consecutive 24-month period.177.26(c) Notwithstanding subdivisions 1a and 1c, beginning July 1, 2013, a county agency 177.27shall negotiate a supplementary rate in addition to the rate specified in subdivision 1, not 177.28to exceed $700 per month, including any legislatively authorized inflationary adjustments, 177.29for the group residential provider described under paragraphs (a) and (b), not to exceed 177.30an additional 115 beds.177.31    Sec. 25. CHILD AND ADOLESCENT BEHAVIORAL HEALTH SERVICES.177.32The commissioner of human services shall, in consultation with children's mental 177.33health community providers, hospitals providing care to children, children's mental health 177.34advocates, and other interested parties, develop recommendations and legislation, if 178.1necessary, for the state-operated child and adolescent behavioral health services facility 178.2to ensure that:178.3(1) the facility and the services provided meet the needs of children with serious 178.4emotional disturbances, autism spectrum disorders, reactive attachment disorder, PTSD, 178.5serious emotional disturbance co-occurring with a developmental disability, borderline 178.6personality disorder, schizophrenia, fetal alcohol spectrum disorders, brain injuries, 178.7violent tendencies, and complex medical issues;178.8(2) qualified personnel and staff can be recruited who have specific expertise and 178.9training to treat the children in the facility; and178.10(3) the treatment provided at the facility is high-quality, effective treatment.178.11    Sec. 26. PILOT PROVIDER INPUT SURVEY OF PEDIATRIC SERVICES AND 178.12CHILDREN'S MENTAL HEALTH SERVICES.178.13(a) To assess the efficiency and other operational issues in the management of the 178.14health care delivery system, the commissioner of human services shall initiate a provider 178.15survey. The pilot survey shall consist of an electronic survey of providers of pediatric 178.16home health care services and children's mental health services to identify and measure 178.17issues that arise in dealing with the management of medical assistance. To the maximum 178.18degree possible, existing technology shall be used and interns sought to analyze the results.178.19(b) The survey questions must focus on seven key business functions provided 178.20by medical assistance contractors: provider inquiries; provider outreach and education; 178.21claims processing; appeals; provider enrollment; medical review; and provider audit and 178.22reimbursement. The commissioner must consider the results of the survey in evaluating 178.23and renewing managed care and fee-for-service management contracts.178.24(c) The commissioner shall report by January 15, 2014, the results of the survey to 178.25the chairs of the health and human services policy and finance committees and shall 178.26make recommendations on the value of implementing an annual survey with a rotating 178.27list of provider groups as a component of the continuous quality improvement system for 178.28medical assistance.178.29    Sec. 27. MENTALLY ILL AND DANGEROUS COMMITMENTS 178.30STAKEHOLDERS GROUP.178.31(a) The commissioner of human services, in consultation with the state court 178.32administrator, shall convene a stakeholder group to develop recommendations for the 178.33legislature that address issues raised in the February 2013 Office of the Legislative 178.34Auditor report on State-Operated Services for persons committed to the commissioner as 179.1mentally ill and dangerous under Minnesota Statutes, section 253B.18. Stakeholders must 179.2include representatives from the Department of Human Services, county human services, 179.3county attorneys, commitment defense attorneys, the ombudsman for mental health and 179.4developmental disabilities, the federal protection and advocacy system, and consumers 179.5and advocates for persons with mental illnesses.179.6(b) The stakeholder group shall provide recommendations in the following areas:179.7(1) the role of the special review board, including the scope of authority of the 179.8special review board and the authority of the commissioner to accept or reject special 179.9review board recommendations;179.10(2) review of special review board decisions by the district court;179.11(3) annual district court review of commitment, scope of court authority, and 179.12appropriate review criteria;179.13(4) options, including annual court hearing and review, as alternatives to 179.14indeterminate commitment under Minnesota Statutes, section 253B.18; and 179.15(5) extension of the right to petition the court under Minnesota Statutes, 179.16section 253B.17, to those committed under Minnesota Statutes, section 253B.18. 179.17The commissioner of human services and the state court administrator shall provide 179.18relevant data for the group's consideration in developing these recommendations, 179.19including numbers of proceedings in each category and costs associated with court and 179.20administrative proceedings under Minnesota Statutes, section 253B.18.179.21(c) By January 15, 2014, the commissioner of human services shall submit the 179.22recommendations of the stakeholder group to the chairs and ranking minority members 179.23of the committees of the legislature with jurisdiction over civil commitment and human 179.24services issues.179.25ARTICLE 5179.26DEPARTMENT OF HUMAN SERVICES PROGRAM INTEGRITY AND 179.27OFFICE OF INSPECTOR GENERAL179.28    Section 1. Minnesota Statutes 2012, section 13.461, is amended by adding a 179.29subdivision to read:179.30    Subd. 7b.Child care provider and recipient fraud investigations.Data related 179.31to child care fraud and recipient fraud investigations are governed by section 245E.01, 179.32subdivision 15.179.33    Sec. 2. Minnesota Statutes 2012, section 243.166, subdivision 7, is amended to read:180.1    Subd. 7. Use of data.(a) Except as otherwise provided in subdivision 7a or sections 180.2244.052
          and 
         299C.093, the data provided under this section is private data on individuals 180.3under section 
         13.02, subdivision 12.180.4(b)  The data may be used only for by law enforcement and corrections agencies for180.5 law enforcement and corrections purposes.180.6(c) The commissioner of human services is authorized to have access to the data for:180.7(1) state-operated services, as defined in section 
         246.014, are also authorized to 180.8have access to the data for the purposes described in section 
         246.13, subdivision 2, 180.9paragraph (b); and180.10(2) purposes of completing background studies under chapter 245C.180.11    Sec. 3. Minnesota Statutes 2012, section 245C.04, is amended by adding a subdivision 180.12to read:180.13    Subd. 4a.Agency background studies.(a) The commissioner shall develop and 180.14implement an electronic process for the regular transfer of new criminal case information 180.15that is added to the Minnesota court information system. The commissioner's system 180.16must include for review only information that relates to individuals who have been the 180.17subject of a background study under this chapter that remain affiliated with the agency 180.18that initiated the background study. For purposes of this paragraph, an individual remains 180.19affiliated with an agency that initiated the background study until the agency informs the 180.20commissioner that the individual is no longer affiliated. When any individual no longer 180.21affiliated according to this paragraph returns to a position requiring a background study 180.22under this chapter, the agency with whom the individual is again affiliated shall initiate 180.23a new background study regardless of the length of time the individual was no longer 180.24affiliated with the agency.180.25(b) The commissioner shall develop and implement an online system for agencies that 180.26initiate background studies under this chapter to access and maintain records of background 180.27studies initiated by that agency. The system must show all active background study subjects 180.28affiliated with that agency and the status of each individual's background study. Each 180.29agency that initiates background studies must use this system to notify the commissioner 180.30of discontinued affiliation for purposes of the processes required under paragraph (a).180.31    Sec. 4. Minnesota Statutes 2012, section 245C.08, subdivision 1, is amended to read:180.32    Subdivision 1. Background studies conducted by Department of Human 180.33Services. (a) For a background study conducted by the Department of Human Services, 180.34the commissioner shall review:181.1    (1) information related to names of substantiated perpetrators of maltreatment of 181.2vulnerable adults that has been received by the commissioner as required under section 181.3626.557, subdivision 9c
         , paragraph (j);181.4    (2) the commissioner's records relating to the maltreatment of minors in licensed 181.5programs, and from findings of maltreatment of minors as indicated through the social 181.6service information system;181.7    (3) information from juvenile courts as required in subdivision 4 for individuals 181.8listed in section 
         245C.03, subdivision 1, paragraph (a), when there is reasonable cause;181.9    (4) information from the Bureau of Criminal Apprehension, including information 181.10regarding a background study subject's registration in Minnesota as a predatory offender 181.11under section 243.166;181.12    (5) except as provided in clause (6), information from the national crime information 181.13system when the commissioner has reasonable cause as defined under section 
         245C.05, 181.14subdivision 5; and181.15    (6) for a background study related to a child foster care application for licensure or 181.16adoptions, the commissioner shall also review:181.17    (i) information from the child abuse and neglect registry for any state in which the 181.18background study subject has resided for the past five years; and181.19    (ii) information from national crime information databases, when the background 181.20study subject is 18 years of age or older.181.21    (b) Notwithstanding expungement by a court, the commissioner may consider 181.22information obtained under paragraph (a), clauses (3) and (4), unless the commissioner 181.23received notice of the petition for expungement and the court order for expungement is 181.24directed specifically to the commissioner.181.25    (c) The commissioner shall also review criminal case information received according 181.26to section 245C.04, subdivision 4a, from the Minnesota court information system that 181.27relates to individuals who have already been studied under this chapter and who remain 181.28affiliated with the agency that initiated the background study.181.29    Sec. 5. Minnesota Statutes 2012, section 245C.32, subdivision 2, is amended to read:181.30    Subd. 2. Use. (a) The commissioner may also use these systems and records to 181.31obtain and provide criminal history data from the Bureau of Criminal Apprehension, 181.32criminal history data held by the commissioner, and data about substantiated maltreatment 181.33under section 
         626.556 or 
         626.557, for other purposes, provided that:181.34(1) the background study is specifically authorized in statute; or182.1(2) the request is made with the informed consent of the subject of the study as 182.2provided in section 
         13.05, subdivision 4.182.3(b) An individual making a request under paragraph (a), clause (2), must agree in 182.4writing not to disclose the data to any other individual without the consent of the subject 182.5of the data.182.6(c) The commissioner may recover the cost of obtaining and providing background 182.7study data by charging the individual or entity requesting the study a fee of no more 182.8than $20 per study. The fees collected under this paragraph are appropriated to the 182.9commissioner for the purpose of conducting background studies.182.10(d) The commissioner shall recover the cost of obtaining background study data 182.11required under section 524.5-118 through a fee of $50 per study for an individual who 182.12has not lived outside Minnesota for the past ten years, and a fee of $100 for an individual 182.13who has resided outside of Minnesota for any period during the ten years preceding the 182.14background study. The commissioner shall recover, from the individual, any additional 182.15fees charged by other states' licensing agencies that are associated with these data requests. 182.16Fees under subdivision 3 also apply when criminal history data from the National Criminal 182.17Records Repository is required.182.18    Sec. 6. [245E.01] CHILD CARE PROVIDER AND RECIPIENT FRAUD 182.19INVESTIGATIONS WITHIN THE CHILD CARE ASSISTANCE PROGRAM.182.20    Subdivision 1.Definitions.(a) For purposes of this section, the terms defined in this 182.21subdivision have the meanings given them.182.22(b) "Applicant" has the meaning given in section 119B.011, subdivision 2.182.23(c) "Child care assistance program" means any of the assistance programs under 182.24chapter 119B.182.25(d) "Commissioner" means the commissioner of human services.182.26(e) "Controlling individual" has the meaning given in section 245A.02, subdivision 182.275a.182.28(f) "County" means a local county child care assistance program staff or 182.29subcontracted staff, or a county investigator acting on behalf of the commissioner.182.30(g) "Department" means the Department of Human Services.182.31(h) "Financial misconduct" or "misconduct" means an entity's or individual's acts or 182.32omissions that result in fraud and abuse or error against the Department of Human Services.182.33(i) "Identify" means to furnish the full name, current or last known address, phone 182.34number, and e-mail address of the individual or business entity.182.35(j) "License holder" has the meaning given in section 245A.02, subdivision 9.183.1(k) "Mail" means the use of any mail service with proof of delivery and receipt.183.2(l) "Provider" means either a provider as defined in section 119B.011, subdivision 183.319, or a legal unlicensed provider as defined in section 119B.011, subdivision 16.183.4(m) "Recipient" means a family receiving assistance as defined under section 183.5119B.011, subdivision 13.183.6(n) "Terminate" means revocation of participation in the child care assistance 183.7program.183.8    Subd. 2.Investigating provider or recipient financial misconduct.The 183.9department shall investigate alleged or suspected financial misconduct by providers and 183.10errors related to payments issued by the child care assistance program under this chapter. 183.11Recipients, employees, and staff may be investigated when the evidence shows that their 183.12conduct is related to the financial misconduct of a provider, license holder, or controlling 183.13individual.183.14    Subd. 3.Scope of investigations.(a) The department may contact any person, 183.15agency, organization, or other entity that is necessary to an investigation.183.16(b) The department may examine or interview any individual, document, or piece of 183.17evidence that may lead to information that is relevant to child care assistance program 183.18benefits, payments, and child care provider authorizations. This includes, but is not 183.19limited to:183.20(1) child care assistance program payments;183.21(2) services provided by the program or related to child care assistance program 183.22recipients;183.23(3) services provided to a provider;183.24(4) provider financial records of any type;183.25(5) daily attendance records of the children receiving services from the provider;183.26(6) billings; and183.27(7) verification of the credentials of a license holder, controlling individual, 183.28employee, staff person, contractor, subcontractor, and entities under contract with the 183.29provider to provide services or maintain service and the provider's financial records 183.30related to those services.183.31    Subd. 4.Determination of investigation.After completing its investigation, the 183.32department shall issue one of the following determinations:183.33(1) no violation of child care assistance requirements occurred;183.34(2) there is insufficient evidence to show that a violation of child care assistance 183.35requirements occurred;184.1(3) a preponderance of evidence shows a violation of child care assistance program 184.2law, rule, or policy; or184.3(4) there exists a credible allegation of fraud.184.4    Subd. 5.Actions or administrative sanctions.(a) In addition to section 256.98, 184.5after completing the determination under subdivision 4, the department may take one or 184.6more of the actions or sanctions specified in this subdivision.184.7(b) The department may take the following actions:184.8(1) refer the investigation to law enforcement or a county attorney for possible 184.9criminal prosecution;184.10(2) refer relevant information to the department's licensing division, the child care 184.11assistance program, the Department of Education, the federal child and adult care food 184.12program, or appropriate child or adult protection agency;184.13(3) enter into a settlement agreement with a provider, license holder, controlling 184.14individual, or recipient; or184.15(4) refer the matter for review by a prosecutorial agency with appropriate jurisdiction 184.16for possible civil action under the Minnesota False Claims Act, chapter 15C.184.17(c) The department may impose sanctions by:184.18(1) pursuing administrative disqualification through hearings or waivers;184.19(2) establishing and seeking monetary recovery or recoupment; or 184.20(3) issuing an order of corrective action that states the practices that are violations of 184.21child care assistance program policies, laws, or regulations, and that they must be corrected.184.22    Subd. 6.Duty to provide access.(a) A provider, license holder, controlling 184.23individual, employee, staff person, or recipient has an affirmative duty to provide access 184.24upon request to information specified under subdivision 8 or the program facility.184.25(b) Failure to provide access may result in denial or termination of authorizations for 184.26or payments to a recipient, provider, license holder, or controlling individual in the child 184.27care assistance program.184.28(c) When a provider fails to provide access, a 15-day notice of denial or termination 184.29must be issued to the provider, which prohibits the provider from participating in the child 184.30care assistance program. Notice must be sent to recipients whose children are under the 184.31provider's care pursuant to Minnesota Rules, part 3400.0185.184.32(d) If the provider continues to fail to provide access at the expiration of the 15-day 184.33notice period, child care assistance program payments to the provider must be denied 184.34beginning the 16th day following notice of the initial failure or refusal to provide access. 184.35The department may rescind the denial based upon good cause if the provider submits in 184.36writing a good cause basis for having failed or refused to provide access. The writing must 185.1be postmarked no later than the 15th day following the provider's notice of initial failure 185.2to provide access. Additionally, the provider, license holder, or controlling individual 185.3must immediately provide complete, ongoing access to the department. Repeated failures 185.4to provide access must, after the initial failure or for any subsequent failure, result in 185.5termination from participation in the child care assistance program.185.6(e) The department, at its own expense, may photocopy or otherwise duplicate 185.7records referenced in subdivision 8. Photocopying must be done on the provider's 185.8premises on the day of the request or other mutually agreeable time, unless removal of 185.9records is specifically permitted by the provider. If requested, a provider, license holder, 185.10or controlling individual, or a designee, must assist the investigator in duplicating any 185.11record, including a hard copy or electronically stored data, on the day of the request.185.12(f) A provider, license holder, controlling individual, employee, or staff person must 185.13grant the department access during the department's normal business hours, and any hours 185.14that the program is operated, to examine the provider's program or the records listed in 185.15subdivision 8. A provider shall make records available at the provider's place of business 185.16on the day for which access is requested, unless the provider and the department both agree 185.17otherwise. The department's normal business hours are 8:00 a.m. to 5:00 p.m., Monday 185.18through Friday, excluding state holidays as defined in section 645.44, subdivision 5.185.19    Subd. 7.Honest and truthful statements.It shall be unlawful for a provider, 185.20license holder, controlling individual, or recipient to:185.21(1) falsify, conceal, or cover up by any trick, scheme, or device a material fact;185.22(2) make any materially false, fictitious, or fraudulent statement or representation; or185.23(3) make or use any false writing or document knowing the same to contain any 185.24materially false, fictitious, or fraudulent statement or entry related to any child care 185.25assistance program services that the provider, license holder, or controlling individual 185.26supplies or in relation to any child care assistance payments received by a provider, license 185.27holder, or controlling individual or to any fraud investigator or law enforcement officer 185.28conducting a financial misconduct investigation.185.29    Subd. 8.Record retention.(a) The following records must be maintained, 185.30controlled, and made immediately accessible to license holders, providers, and controlling 185.31individuals. The records must be organized and labeled to correspond to categories that 185.32make them easy to identify so that they can be made available immediately upon request 185.33to an investigator acting on behalf of the commissioner at the provider's place of business:185.34(1) payroll ledgers, canceled checks, bank deposit slips, and any other accounting 185.35records;186.1(2) daily attendance records required by and that comply with section 119B.125, 186.2subdivision 6;186.3(3) billing transmittal forms requesting payments from the child care assistance 186.4program and billing adjustments related to child care assistance program payments;186.5(4) records identifying all persons, corporations, partnerships, and entities with an 186.6ownership or controlling interest in the provider's child care business;186.7(5) employee records identifying those persons currently employed by the provider's 186.8child care business or who have been employed by the business at any time within the 186.9previous five years. The records must include each employee's name, hourly and annual 186.10salary, qualifications, position description, job title, and dates of employment. In addition, 186.11employee records that must be made available include the employee's time sheets, current 186.12home address of the employee or last known address of any former employee, and 186.13documentation of background studies required under chapter 119B or 245C;186.14(6) records related to transportation of children in care, including but not limited to:186.15(i) the dates and times that transportation is provided to children for transportation to 186.16and from the provider's business location for any purpose. For transportation related to 186.17field trips or locations away from the provider's business location, the names and addresses 186.18of those field trips and locations must also be provided;186.19(ii) the name, business address, phone number, and Web site address, if any, of the 186.20transportation service utilized; and186.21(iii) all billing or transportation records related to the transportation.186.22(b) A provider, license holder, or controlling individual must retain all records 186.23in paragraph (a) for at least six years after the date the record is created. Microfilm or 186.24electronically stored records satisfy the record keeping requirements of this subdivision.186.25(c) A provider, license holder, or controlling individual who withdraws or is 186.26terminated from the child care assistance program must retain the records required under 186.27this subdivision and make them available to the department on demand.186.28(d) If the ownership of a provider changes, the transferor, unless otherwise provided 186.29by law or by written agreement with the transferee, is responsible for maintaining, 186.30preserving, and upon request from the department, making available the records related to 186.31the provider that were generated before the date of the transfer. Any written agreement 186.32affecting this provision must be held in the possession of the transferor and transferee. 186.33The written agreement must be provided to the department or county immediately upon 186.34request, and the written agreement must be retained by the transferor and transferee for six 186.35years after the agreement is fully executed.187.1(e) In the event of an appealed case, the provider must retain all records required in 187.2this subdivision for the duration of the appeal or six years, whichever is longer.187.3(f) A provider's use of electronic record keeping or electronic signatures is governed 187.4by chapter 325L.187.5    Subd. 9.Factors regarding imposition of administrative sanctions.(a) The 187.6department shall consider the following factors in determining the administrative sanctions 187.7to be imposed:187.8(1) nature and extent of financial misconduct;187.9(2) history of financial misconduct;187.10(3) actions taken or recommended by other state agencies, other divisions of the 187.11department, and court and administrative decisions;187.12(4) prior imposition of sanctions;187.13(5) size and type of provider;187.14(6) information obtained through an investigation from any source;187.15(7) convictions or pending criminal charges; and187.16(8) any other information relevant to the acts or omissions related to the financial 187.17misconduct.187.18(b) Any single factor under paragraph (a) may be determinative of the department's 187.19decision of whether and what sanctions are imposed.187.20    Subd. 10.Written notice of department sanction.(a) The department shall give 187.21notice in writing to a person of an administrative sanction that is to be imposed. The notice 187.22shall be sent by mail as defined in subdivision 1, paragraph (k).187.23(b) The notice shall state:187.24(1) the factual basis for the department's determination;187.25(2) the sanction the department intends to take;187.26(3) the dollar amount of the monetary recovery or recoupment, if any;187.27(4) how the dollar amount was computed;187.28(5) the right to dispute the department's determination and to provide evidence;187.29(6) the right to appeal the department's proposed sanction; and187.30(7) the option to meet informally with department staff, and to bring additional 187.31documentation or information, to resolve the issues.187.32(c) In cases of determinations resulting in denial or termination of payments, in 187.33addition to the requirements of paragraph (b), the notice must state:187.34(1) the length of the denial or termination;187.35(2) the requirements and procedures for reinstatement; and188.1(3) the provider's right to submit documents and written arguments against the 188.2denial or termination of payments for review by the department before the effective date 188.3of denial or termination.188.4(d) The submission of documents and written argument for review by the department 188.5under paragraph (b), clause (5) or (7), or paragraph (c), clause (3), does not stay the 188.6deadline for filing an appeal.188.7(e) Unless timely appealed, the effective date of the proposed sanction shall be 30 188.8days after the license holder's, provider's, controlling individual's, or recipient's receipt of 188.9the notice. If a timely appeal is made, the proposed sanction shall be delayed pending 188.10the final outcome of the appeal. Implementation of a proposed sanction following the 188.11resolution of a timely appeal may be postponed if, in the opinion of the department, the 188.12delay of sanction is necessary to protect the health or safety of children in care. The 188.13department may consider the economic hardship of a person in implementing the proposed 188.14sanction, but economic hardship shall not be a determinative factor in implementing the 188.15proposed sanction.188.16(f) Requests for an informal meeting to attempt to resolve issues and requests 188.17for appeals must be sent or delivered to the department's Office of Inspector General, 188.18Financial Fraud and Abuse Division.188.19    Subd. 11.Appeal of department sanction under this section.(a) If the department 188.20does not pursue a criminal action against a provider, license holder, controlling individual, 188.21or recipient for financial misconduct, but the department imposes an administrative 188.22sanction, any individual or entity against whom the sanction was imposed may appeal the 188.23department's administrative sanction under this section pursuant to section 119B.16 or 188.24256.045 with the additional requirements in clauses (1) to (4). An appeal must specify:188.25(1) each disputed item, the reason for the dispute, and an estimate of the dollar 188.26amount involved for each disputed item, if appropriate;188.27(2) the computation that is believed to be correct, if appropriate;188.28(3) the authority in the statute or rule relied upon for each disputed item; and188.29(4) the name, address, and phone number of the person at the provider's place of 188.30business with whom contact may be made regarding the appeal.188.31(b) An appeal is considered timely only if postmarked or received by the 188.32department's Office of Inspector General, Financial Fraud and Abuse Division within 30 188.33days after receiving a notice of department sanction.188.34(c) Before the appeal hearing, the department may deny or terminate authorizations 188.35or payment to the entity or individual if the department determines that the action is 188.36necessary to protect the public welfare or the interests of the child care assistance program.189.1    Subd. 12.Consolidated hearings with licensing sanction.If a financial 189.2misconduct sanction has an appeal hearing right and it is timely appealed, and a licensing 189.3sanction exists for which there is an appeal hearing right and the sanction is timely 189.4appealed, and the overpayment recovery action and licensing sanction involve the same 189.5set of facts, the overpayment recovery action and licensing sanction must be consolidated 189.6in the contested case hearing related to the licensing sanction.189.7    Subd. 13.Grounds for and methods of monetary recovery.(a) The department 189.8may obtain monetary recovery from a provider who has been improperly paid by the 189.9child care assistance program, regardless of whether the error was intentional or county 189.10error. The department does not need to establish a pattern as a precondition of monetary 189.11recovery of erroneous or false billing claims, duplicate billing claims, or billing claims 189.12based on false statements or financial misconduct.189.13(b) The department shall obtain monetary recovery from providers by the following 189.14means:189.15(1) permitting voluntary repayment of money, either in lump-sum payment or 189.16installment payments;189.17(2) using any legal collection process;189.18(3) deducting or withholding program payments; or189.19(4) utilizing the means set forth in chapter 16D.189.20    Subd. 14.Reporting of suspected fraudulent activity.(a) A person who, in 189.21good faith, makes a report of or testifies in any action or proceeding in which financial 189.22misconduct is alleged, and who is not involved in, has not participated in, or has not aided 189.23and abetted, conspired, or colluded in the financial misconduct, shall have immunity from 189.24any liability, civil or criminal, that results by reason of the person's report or testimony. 189.25For the purpose of any proceeding, the good faith of any person reporting or testifying 189.26under this provision shall be presumed.189.27(b) If a person that is or has been involved in, participated in, aided and abetted, 189.28conspired, or colluded in the financial misconduct reports the financial misconduct, 189.29the department may consider that person's report and assistance in investigating the 189.30misconduct as a mitigating factor in the department's pursuit of civil, criminal, or 189.31administrative remedies.189.32    Subd. 15.Data privacy.Data of any kind obtained or created in relation to a provider 189.33or recipient investigation under this section is defined, classified, and protected the same as 189.34all other data under section 13.46, and this data has the same classification as licensing data.189.35    Subd. 16.Monetary recovery; random sample extrapolation.The department is 189.36authorized to calculate the amount of monetary recovery from a provider, license holder, or 190.1controlling individual based upon extrapolation from a statistical random sample of claims 190.2submitted by the provider, license holder, or controlling individual and paid by the child 190.3care assistance program. The department's random sample extrapolation shall constitute a 190.4rebuttable presumption of the accuracy of the calculation of monetary recovery. If the 190.5presumption is not rebutted by the provider, license holder, or controlling individual in the 190.6appeal process, the department shall use the extrapolation as the monetary recovery figure. 190.7The department may use sampling and extrapolation to calculate the amount of monetary 190.8recovery if the claims to be reviewed represent services to 50 or more children in care.190.9    Subd. 17.Effect of department's monetary penalty determination.Unless 190.10a timely and proper appeal is received by the department's Office of Inspector General, 190.11Financial Fraud and Abuse Division, the department's administrative determination or 190.12sanction shall be considered a final department determination.190.13    Subd. 18.Office of Inspector General recoveries.Overpayment recoveries 190.14resulting from child care provider fraud investigations initiated by the department's Office 190.15of Inspector General's fraud investigations staff are excluded from the county recovery 190.16provision in section 119B.11, subdivision 3.190.17    Sec. 7. Minnesota Statutes 2012, section 256B.04, subdivision 21, is amended to read:190.18    Subd. 21. Provider enrollment. (a) If the commissioner or the Centers for 190.19Medicare and Medicaid Services determines that a provider is designated "high-risk," the 190.20commissioner may withhold payment from providers within that category upon initial 190.21enrollment for a 90-day period. The withholding for each provider must begin on the date 190.22of the first submission of a claim.190.23(b) An enrolled provider that is also licensed by the commissioner under chapter 190.24245A must designate an individual as the entity's compliance officer. The compliance 190.25officer must:190.26(1) develop policies and procedures to assure adherence to medical assistance laws 190.27and regulations and to prevent inappropriate claims submissions;190.28(2) train the employees of the provider entity, and any agents or subcontractors of 190.29the provider entity including billers, on the policies and procedures under clause (1);190.30(3) respond to allegations of improper conduct related to the provision or billing of 190.31medical assistance services, and implement action to remediate any resulting problems;190.32(4) use evaluation techniques to monitor compliance with medical assistance laws 190.33and regulations;190.34(5) promptly report to the commissioner any identified violations of medical 190.35assistance laws or regulations; and191.1    (6) within 60 days of discovery by the provider of a medical assistance 191.2reimbursement overpayment, report the overpayment to the commissioner and make 191.3arrangements with the commissioner for the commissioner's recovery of the overpayment.191.4The commissioner may require, as a condition of enrollment in medical assistance, that a 191.5provider within a particular industry sector or category establish a compliance program that 191.6contains the core elements established by the Centers for Medicare and Medicaid Services.191.7(c) The commissioner may revoke the enrollment of an ordering or rendering 191.8provider for a period of not more than one year, if the provider fails to maintain and, upon 191.9request from the commissioner, provide access to documentation relating to written orders 191.10or requests for payment for durable medical equipment, certifications for home health 191.11services, or referrals for other items or services written or ordered by such provider, when 191.12the commissioner has identified a pattern of a lack of documentation. A pattern means a 191.13failure to maintain documentation or provide access to documentation on more than one 191.14occasion. Nothing in this paragraph limits the authority of the commissioner to sanction a 191.15provider under the provisions of section 
         256B.064.191.16(d) The commissioner shall terminate or deny the enrollment of any individual or 191.17entity if the individual or entity has been terminated from participation in Medicare or 191.18under the Medicaid program or Children's Health Insurance Program of any other state.191.19(e) As a condition of enrollment in medical assistance, the commissioner shall 191.20require that a provider designated "moderate" or "high-risk" by the Centers for Medicare 191.21and Medicaid Services or the Minnesota Department of Human Services commissioner191.22 permit the Centers for Medicare and Medicaid Services, its agents, or its designated 191.23contractors and the state agency, its agents, or its designated contractors to conduct 191.24unannounced on-site inspections of any provider location. The commissioner shall publish 191.25in the Minnesota Health Care Program Provider Manual a list of provider types designated 191.26"limited," "moderate," or "high-risk," based on the criteria and standards used to designate 191.27Medicare providers in Code of Federal Regulations, title 42, section 424.518. The list and 191.28criteria are not subject to the requirements of chapter 14. The commissioner's designations 191.29are not subject to administrative appeal.191.30(f) As a condition of enrollment in medical assistance, the commissioner shall 191.31require that a high-risk provider, or a person with a direct or indirect ownership interest in 191.32the provider of five percent or higher, consent to criminal background checks, including 191.33fingerprinting, when required to do so under state law or by a determination by the 191.34commissioner or the Centers for Medicare and Medicaid Services that a provider is 191.35designated high-risk for fraud, waste, or abuse.192.1(g) As a condition of enrollment, all durable medical equipment, prosthetics, 192.2orthotics, and supplies (DMEPOS) suppliers operating in Minnesota are required to name 192.3the Department of Human Services, in addition to the Centers for Medicare and Medicaid 192.4Services, as an obligee on all surety performance bonds required pursuant to section 192.54312(a) of the Balanced Budget Act of 1997, Public Law 105-33, amending Social 192.6Security Act, section 1834(a). The performance bond must also allow for recovery of 192.7costs and fees in pursuing a claim on the bond.192.8(h) The Department of Human Services may require a provider to purchase a 192.9performance surety bond as a condition of initial enrollment, reenrollment, reinstatement, 192.10or continued enrollment if: (1) the provider fails to demonstrate financial viability; (2) the 192.11department determines there is significant evidence of or potential for fraud and abuse 192.12by the provider; or (3) the provider or category of providers is designated high-risk 192.13pursuant to paragraph (a) and Code of Federal Regulations, title 42, section 455.450, or 192.14the department otherwise finds it is in the best interest of the Medicaid program to do so. 192.15The performance bond must be in an amount of $100,000 or ten percent of the provider's 192.16payments from Medicaid during the immediately preceding 12 months, whichever is 192.17greater. The performance bond must name the Department of Human Services as an 192.18obligee and must allow for recovery of costs and fees in pursuing a claim on the bond.192.19EFFECTIVE DATE.This section is effective the day following final enactment.192.20    Sec. 8. Minnesota Statutes 2012, section 256B.04, is amended by adding a subdivision 192.21to read:192.22    Subd. 22.Application fee.(a) The commissioner must collect and retain federally 192.23required nonrefundable application fees to pay for provider screening activities in 192.24accordance with Code of Federal Regulations, title 42, section 455, subpart E. The 192.25enrollment application must be made under the procedures specified by the commissioner, 192.26in the form specified by the commissioner, and accompanied by an application fee 192.27described in paragraph (b), or a request for a hardship exception as described in the 192.28specified procedures. Application fees must be deposited in the provider screening account 192.29in the special revenue fund. Amounts in the provider screening account are appropriated 192.30to the commissioner for costs associated with the provider screening activities required 192.31in Code of Federal Regulations, title 42, section 455, subpart E. The commissioner 192.32shall conduct screening activities as required by Code of Federal Regulations, title 42, 192.33section 455, subpart E, and as otherwise provided by law, to include database checks, 192.34unannounced pre- and postenrollment site visits, fingerprinting, and criminal background 193.1studies. The commissioner must revalidate all providers under this subdivision at least 193.2once every five years.193.3(b) The application fee under this subdivision is $532 for the calendar year 2013. 193.4For calendar year 2014 and subsequent years, the fee:193.5(1) is adjusted by the percentage change to the consumer price index for all urban 193.6consumers, United States city average, for the 12-month period ending with June of the 193.7previous year. The resulting fee must be announced in the Federal Register;193.8(2) is effective from January 1 to December 31 of a calendar year;193.9(3) is required on the submission of an initial application, an application to establish 193.10a new practice location, an application for reenrollment when the provider is not enrolled 193.11at the time of application of reenrollment, or at revalidation when required by federal 193.12regulation; and193.13(4) must be in the amount in effect for the calendar year during which the application 193.14for enrollment, new practice location, or reenrollment is being submitted.193.15(c) The application fee under this subdivision cannot be charged to:193.16(1) providers who are enrolled in Medicare or who provide documentation of 193.17payment of the fee to, and enrollment with, another state;193.18(2) providers who are enrolled but are required to submit new applications for 193.19purposes of reenrollment; or193.20(3) a provider who enrolls as an individual.193.21EFFECTIVE DATE.This section is effective the day following final enactment.193.22    Sec. 9. Minnesota Statutes 2012, section 256B.064, subdivision 1a, is amended to read:193.23    Subd. 1a. Grounds for sanctions against vendors. The commissioner may 193.24impose sanctions against a vendor of medical care for any of the following: (1) fraud, 193.25theft, or abuse in connection with the provision of medical care to recipients of public 193.26assistance; (2) a pattern of presentment of false or duplicate claims or claims for services 193.27not medically necessary; (3) a pattern of making false statements of material facts for 193.28the purpose of obtaining greater compensation than that to which the vendor is legally 193.29entitled; (4) suspension or termination as a Medicare vendor; (5) refusal to grant the state 193.30agency access during regular business hours to examine all records necessary to disclose 193.31the extent of services provided to program recipients and appropriateness of claims for 193.32payment; (6) failure to repay an overpayment or a fine finally established under this 193.33section; and (7) failure to correct errors in the maintenance of health service or financial 193.34records for which a fine was imposed or after issuance of a warning by the commissioner; 193.35and (8) any reason for which a vendor could be excluded from participation in the 194.1Medicare program under section 1128, 1128A, or 1866(b)(2) of the Social Security Act. 194.2The determination of services not medically necessary may be made by the commissioner 194.3in consultation with a peer advisory task force appointed by the commissioner on the 194.4recommendation of appropriate professional organizations. The task force expires as 194.5provided in section 
         15.059, subdivision 5.194.6    Sec. 10. Minnesota Statutes 2012, section 256B.064, subdivision 1b, is amended to read:194.7    Subd. 1b. Sanctions available. The commissioner may impose the following 194.8sanctions for the conduct described in subdivision 1a: suspension or withholding of 194.9payments to a vendor and suspending or terminating participation in the program, or 194.10imposition of a fine under subdivision 2, paragraph (f). When imposing sanctions under 194.11this section, the commissioner shall consider the nature, chronicity, or severity of the 194.12conduct and the effect of the conduct on the health and safety of persons served by the 194.13vendor. Regardless of imposition of sanctions, the commissioner may make a referral 194.14to the appropriate state licensing board.194.15    Sec. 11. Minnesota Statutes 2012, section 256B.064, subdivision 2, is amended to read:194.16    Subd. 2. Imposition of monetary recovery and sanctions. (a) The commissioner 194.17shall determine any monetary amounts to be recovered and sanctions to be imposed upon 194.18a vendor of medical care under this section. Except as provided in paragraphs (b) and 194.19(d), neither a monetary recovery nor a sanction will be imposed by the commissioner 194.20without prior notice and an opportunity for a hearing, according to chapter 14, on the 194.21commissioner's proposed action, provided that the commissioner may suspend or reduce 194.22payment to a vendor of medical care, except a nursing home or convalescent care facility, 194.23after notice and prior to the hearing if in the commissioner's opinion that action is 194.24necessary to protect the public welfare and the interests of the program.194.25(b) Except when the commissioner finds good cause not to suspend payments under 194.26Code of Federal Regulations, title 42, section 
         455.23 (e) or (f), the commissioner shall 194.27withhold or reduce payments to a vendor of medical care without providing advance 194.28notice of such withholding or reduction if either of the following occurs:194.29(1) the vendor is convicted of a crime involving the conduct described in subdivision 194.301a; or194.31(2) the commissioner determines there is a credible allegation of fraud for which an 194.32investigation is pending under the program. A credible allegation of fraud is an allegation 194.33which has been verified by the state, from any source, including but not limited to:194.34(i) fraud hotline complaints;195.1(ii) claims data mining; and195.2(iii) patterns identified through provider audits, civil false claims cases, and law 195.3enforcement investigations.195.4Allegations are considered to be credible when they have an indicia of reliability 195.5and the state agency has reviewed all allegations, facts, and evidence carefully and acts 195.6judiciously on a case-by-case basis.195.7(c) The commissioner must send notice of the withholding or reduction of payments 195.8under paragraph (b) within five days of taking such action unless requested in writing by a 195.9law enforcement agency to temporarily withhold the notice. The notice must:195.10(1) state that payments are being withheld according to paragraph (b);195.11(2) set forth the general allegations as to the nature of the withholding action, but 195.12need not disclose any specific information concerning an ongoing investigation;195.13(3) except in the case of a conviction for conduct described in subdivision 1a, state 195.14that the withholding is for a temporary period and cite the circumstances under which 195.15withholding will be terminated;195.16(4) identify the types of claims to which the withholding applies; and195.17(5) inform the vendor of the right to submit written evidence for consideration by 195.18the commissioner.195.19The withholding or reduction of payments will not continue after the commissioner 195.20determines there is insufficient evidence of fraud by the vendor, or after legal proceedings 195.21relating to the alleged fraud are completed, unless the commissioner has sent notice of 195.22intention to impose monetary recovery or sanctions under paragraph (a).195.23(d) The commissioner shall suspend or terminate a vendor's participation in the 195.24program without providing advance notice and an opportunity for a hearing when the 195.25suspension or termination is required because of the vendor's exclusion from participation 195.26in Medicare. Within five days of taking such action, the commissioner must send notice of 195.27the suspension or termination. The notice must:195.28(1) state that suspension or termination is the result of the vendor's exclusion from 195.29Medicare;195.30(2) identify the effective date of the suspension or termination; and195.31(3) inform the vendor of the need to be reinstated to Medicare before reapplying 195.32for participation in the program.195.33(e) Upon receipt of a notice under paragraph (a) that a monetary recovery or 195.34sanction is to be imposed, a vendor may request a contested case, as defined in section 195.3514.02, subdivision 3
         , by filing with the commissioner a written request of appeal. The 195.36appeal request must be received by the commissioner no later than 30 days after the date 196.1the notification of monetary recovery or sanction was mailed to the vendor. The appeal 196.2request must specify:196.3(1) each disputed item, the reason for the dispute, and an estimate of the dollar 196.4amount involved for each disputed item;196.5(2) the computation that the vendor believes is correct;196.6(3) the authority in statute or rule upon which the vendor relies for each disputed item;196.7(4) the name and address of the person or entity with whom contacts may be made 196.8regarding the appeal; and196.9(5) other information required by the commissioner.196.10(f) The commissioner may order a vendor to forfeit a fine for failure to fully document 196.11services according to standards in this chapter and Minnesota Rules, chapter 9505. The 196.12commissioner may assess fines if specific required components of documentation are 196.13missing. The fine for incomplete documentation shall equal 20 percent of the amount paid 196.14on the claims for reimbursement submitted by the vendor, or up to $5,000, whichever is less.196.15(g) The vendor shall pay the fine assessed on or before the payment date specified. If 196.16the vendor fails to pay the fine, the commissioner may withhold or reduce payments and 196.17recover the amount of the fine. A timely appeal shall stay payment of the fine until the 196.18commissioner issues a final order.196.19    Sec. 12. Minnesota Statutes 2012, section 256B.0659, subdivision 21, is amended to 196.20read:196.21    Subd. 21. Requirements for initial enrollment of personal care assistance 196.22provider agencies. (a) All personal care assistance provider agencies must provide, at the 196.23time of enrollment as a personal care assistance provider agency in a format determined 196.24by the commissioner, information and documentation that includes, but is not limited to, 196.25the following:196.26    (1) the personal care assistance provider agency's current contact information 196.27including address, telephone number, and e-mail address;196.28    (2) proof of surety bond coverage in the amount of $50,000 $100,000 or ten percent 196.29of the provider's payments from Medicaid in the previous year, whichever is less more. 196.30The performance bond must be in a form approved by the commissioner, must be renewed 196.31annually, and must allow for recovery of costs and fees in pursuing a claim on the bond;196.32    (3) proof of fidelity bond coverage in the amount of $20,000;196.33    (4) proof of workers' compensation insurance coverage;196.34    (5) proof of liability insurance;197.1    (6) a description of the personal care assistance provider agency's organization 197.2identifying the names of all owners, managing employees, staff, board of directors, and 197.3the affiliations of the directors, owners, or staff to other service providers;197.4    (7) a copy of the personal care assistance provider agency's written policies and 197.5procedures including: hiring of employees; training requirements; service delivery; 197.6and employee and consumer safety including process for notification and resolution 197.7of consumer grievances, identification and prevention of communicable diseases, and 197.8employee misconduct;197.9    (8) copies of all other forms the personal care assistance provider agency uses in 197.10the course of daily business including, but not limited to:197.11    (i) a copy of the personal care assistance provider agency's time sheet if the time 197.12sheet varies from the standard time sheet for personal care assistance services approved 197.13by the commissioner, and a letter requesting approval of the personal care assistance 197.14provider agency's nonstandard time sheet;197.15    (ii) the personal care assistance provider agency's template for the personal care 197.16assistance care plan; and197.17    (iii) the personal care assistance provider agency's template for the written 197.18agreement in subdivision 20 for recipients using the personal care assistance choice 197.19option, if applicable;197.20    (9) a list of all training and classes that the personal care assistance provider agency 197.21requires of its staff providing personal care assistance services;197.22    (10) documentation that the personal care assistance provider agency and staff have 197.23successfully completed all the training required by this section;197.24    (11) documentation of the agency's marketing practices;197.25    (12) disclosure of ownership, leasing, or management of all residential properties 197.26that is used or could be used for providing home care services;197.27    (13) documentation that the agency will use the following percentages of revenue 197.28generated from the medical assistance rate paid for personal care assistance services 197.29for employee personal care assistant wages and benefits: 72.5 percent of revenue in the 197.30personal care assistance choice option and 72.5 percent of revenue from other personal 197.31care assistance providers. The revenue generated by the qualified professional and the 197.32reasonable costs associated with the qualified professional shall not be used in making 197.33this calculation; and197.34    (14) effective May 15, 2010, documentation that the agency does not burden 197.35recipients' free exercise of their right to choose service providers by requiring personal 197.36care assistants to sign an agreement not to work with any particular personal care 198.1assistance recipient or for another personal care assistance provider agency after leaving 198.2the agency and that the agency is not taking action on any such agreements or requirements 198.3regardless of the date signed.198.4    (b) Personal care assistance provider agencies shall provide the information specified 198.5in paragraph (a) to the commissioner at the time the personal care assistance provider 198.6agency enrolls as a vendor or upon request from the commissioner. The commissioner 198.7shall collect the information specified in paragraph (a) from all personal care assistance 198.8providers beginning July 1, 2009.198.9    (c) All personal care assistance provider agencies shall require all employees in 198.10management and supervisory positions and owners of the agency who are active in the 198.11day-to-day management and operations of the agency to complete mandatory training 198.12as determined by the commissioner before enrollment of the agency as a provider. 198.13Employees in management and supervisory positions and owners who are active in 198.14the day-to-day operations of an agency who have completed the required training as 198.15an employee with a personal care assistance provider agency do not need to repeat 198.16the required training if they are hired by another agency, if they have completed the 198.17training within the past three years. By September 1, 2010, the required training must 198.18be available with meaningful access according to title VI of the Civil Rights Act and 198.19federal regulations adopted under that law or any guidance from the United States Health 198.20and Human Services Department. The required training must be available online or by 198.21electronic remote connection. The required training must provide for competency testing. 198.22Personal care assistance provider agency billing staff shall complete training about 198.23personal care assistance program financial management. This training is effective July 1, 198.242009. Any personal care assistance provider agency enrolled before that date shall, if it 198.25has not already, complete the provider training within 18 months of July 1, 2009. Any new 198.26owners or employees in management and supervisory positions involved in the day-to-day 198.27operations are required to complete mandatory training as a requisite of working for the 198.28agency. Personal care assistance provider agencies certified for participation in Medicare 198.29as home health agencies are exempt from the training required in this subdivision. When 198.30available, Medicare-certified home health agency owners, supervisors, or managers must 198.31successfully complete the competency test.198.32EFFECTIVE DATE.This section is effective the day following final enactment.198.33    Sec. 13. Minnesota Statutes 2012, section 299C.093, is amended to read:198.34299C.093 DATABASE OF REGISTERED PREDATORY OFFENDERS.199.1The superintendent of the Bureau of Criminal Apprehension shall maintain a 199.2computerized data system relating to individuals required to register as predatory offenders 199.3under section 
         243.166. To the degree feasible, the system must include the data required 199.4to be provided under section 
         243.166, subdivisions 4 and 4a, and indicate the time period 199.5that the person is required to register. The superintendent shall maintain this data in a 199.6manner that ensures that it is readily available to law enforcement agencies. This data is 199.7private data on individuals under section 
         13.02, subdivision 12, but may be used for law 199.8enforcement and corrections purposes. The commissioner of human services has access 199.9to the data for state-operated services, as defined in section 
         246.014, are also authorized 199.10to have access to the data for the purposes described in section 
         246.13, subdivision 2, 199.11paragraph (b), and for purposes of conducting background studies under chapter 245C.199.12    Sec. 14. Minnesota Statutes 2012, section 524.5-118, subdivision 1, is amended to read:199.13    Subdivision 1. When required; exception. (a) The court shall require a background 199.14study under this section:199.15(1) before the appointment of a guardian or conservator, unless a background study 199.16has been done on the person under this section within the previous fivetwo years; and199.17(2) once every fivetwo years after the appointment, if the person continues to serve 199.18as a guardian or conservator.199.19(b) The background study must include:199.20(1) criminal history data from the Bureau of Criminal Apprehension, other criminal 199.21history data held by the commissioner of human services, and data regarding whether the 199.22person has been a perpetrator of substantiated maltreatment of a vulnerable adult and a199.23or minor.;199.24(c) The court shall request a search of the(2) criminal history data from the National 199.25Criminal Records Repository if the proposed guardian or conservator has not resided in 199.26Minnesota for the previous fiveten years or if the Bureau of Criminal Apprehension 199.27information received from the commissioner of human services under subdivision 2, 199.28paragraph (b), indicates that the subject is a multistate offender or that the individual's 199.29multistate offender status is undetermined.; and199.30(3) state licensing agency data if a search of the database or databases of the agencies 199.31listed in subdivision 2a shows that the proposed guardian or conservator has ever held a 199.32professional license directly related to the responsibilities of a professional fiduciary from 199.33an agency listed in subdivision 2a that was conditioned, suspended, revoked, or canceled.199.34(d) (c) If the guardian or conservator is not an individual, the background study must 199.35be done on all individuals currently employed by the proposed guardian or conservator 200.1who will be responsible for exercising powers and duties under the guardianship or 200.2conservatorship.200.3(e) (d) If the court determines that it would be in the best interests of the ward or 200.4protected person to appoint a guardian or conservator before the background study can 200.5be completed, the court may make the appointment pending the results of the study, 200.6however, the background study must then be completed as soon as reasonably possible 200.7after appointment, no later than 30 days after appointment.200.8(f) (e) The fee for conducting a background study for appointment of a professional 200.9guardian or conservator must be paid by the guardian or conservator. In other cases, 200.10the fee must be paid as follows:200.11(1) if the matter is proceeding in forma pauperis, the fee is an expense for purposes 200.12of section 
         524.5-502, paragraph (a);200.13(2) if there is an estate of the ward or protected person, the fee must be paid from 200.14the estate; or200.15(3) in the case of a guardianship or conservatorship of the person that is not 200.16proceeding in forma pauperis, the court may order that the fee be paid by the guardian or 200.17conservator or by the court.200.18(g) (f) The requirements of this subdivision do not apply if the guardian or 200.19conservator is:200.20(1) a state agency or county;200.21(2) a parent or guardian of a proposed ward or protected person who has a 200.22developmental disability, if the parent or guardian has raised the proposed ward or 200.23protected person in the family home until the time the petition is filed, unless counsel 200.24appointed for the proposed ward or protected person under section 
         524.5-205, paragraph 200.25(d)
         ; 
         524.5-304, paragraph (b); 
         524.5-405, paragraph (a); or 
         524.5-406, paragraph (b), 200.26recommends a background study; or200.27(3) a bank with trust powers, bank and trust company, or trust company, organized 200.28under the laws of any state or of the United States and which is regulated by the 200.29commissioner of commerce or a federal regulator.200.30    Sec. 15. Minnesota Statutes 2012, section 524.5-118, is amended by adding a 200.31subdivision to read:200.32    Subd. 2a.Procedure; state licensing agency data.(a) The court shall request the 200.33commissioner of human services to provide the court within 25 working days of receipt of 200.34the request with licensing agency data for licenses directly related to the responsibilities of 200.35a professional fiduciary from the following agencies in Minnesota:201.1(1) Lawyers Responsibility Board;201.2(2) State Board of Accountancy;201.3(3) Board of Social Work;201.4(4) Board of Psychology;201.5(5) Board of Nursing;201.6(6) Board of Medical Practice;201.7(7) Department of Education;201.8(8) Department of Commerce;201.9(9) Board of Chiropractic Examiners;201.10(10) Board of Dentistry;201.11(11) Board of Marriage and Family Therapy;201.12(12) Department of Human Services; and201.13(13) Peace Officer Standards and Training (POST) Board.201.14(b) The commissioner shall enter into agreements with these agencies to provide for 201.15electronic access to the relevant licensing data by the commissioner.201.16(c) The commissioner shall provide to the court the electronically available data 201.17maintained in the agency's database, including whether the proposed guardian or 201.18conservator is or has been licensed by the agency, and if the licensing agency database 201.19indicates a disciplinary action or a sanction against the individual's license, including a 201.20condition, suspension, revocation, or cancellation.201.21(d) If the proposed guardian or conservator has resided in a state other than 201.22Minnesota in the previous ten years, licensing agency data under this section shall also 201.23include the licensing agency data from any other state where the proposed guardian or 201.24conservator reported to have resided during the previous ten years. If the proposed 201.25guardian or conservator has or has had a professional license in another state that is 201.26directly related to the responsibilities of a professional fiduciary from one of the agencies 201.27listed under paragraph (a), state licensing agency data shall also include data from the 201.28relevant licensing agency of that state.201.29(e) The commissioner is not required to repeat a search for Minnesota or out-of-state 201.30licensing data on an individual if the commissioner has provided this information to the 201.31court within the prior two years.201.32(f) If an individual has continuously resided in Minnesota since a previous 201.33background study under this section was completed, the commissioner is not required to 201.34repeat a search for records in another state.202.1    Sec. 16. Minnesota Statutes 2012, section 524.5-303, is amended to read:202.2524.5-303 JUDICIAL APPOINTMENT OF GUARDIAN: PETITION.202.3(a) An individual or a person interested in the individual's welfare may petition for 202.4a determination of incapacity, in whole or in part, and for the appointment of a limited 202.5or unlimited guardian for the individual.202.6(b) The petition must set forth the petitioner's name, residence, current address if 202.7different, relationship to the respondent, and interest in the appointment and, to the extent 202.8known, state or contain the following with respect to the respondent and the relief requested:202.9(1) the respondent's name, age, principal residence, current street address, and, if 202.10different, the address of the dwelling in which it is proposed that the respondent will 202.11reside if the appointment is made;202.12(2) the name and address of the respondent's:202.13(i) spouse, or if the respondent has none, an adult with whom the respondent has 202.14resided for more than six months before the filing of the petition; and202.15(ii) adult children or, if the respondent has none, the respondent's parents and adult 202.16brothers and sisters, or if the respondent has none, at least one of the adults nearest in 202.17kinship to the respondent who can be found;202.18(3) the name of the administrative head and address of the institution where the 202.19respondent is a patient, resident, or client of any hospital, nursing home, home care 202.20agency, or other institution;202.21(4) the name and address of any legal representative for the respondent;202.22(5) the name, address, and telephone number of any person nominated as guardian 202.23by the respondent in any manner permitted by law, including a health care agent nominated 202.24in a health care directive;202.25(6) the name, address, and telephone number of any proposed guardian and the 202.26reason why the proposed guardian should be selected;202.27(7) the name and address of any health care agent or proxy appointed pursuant to 202.28a health care directive as defined in section 
         145C.01, a living will under chapter 145B, 202.29or other similar document executed in another state and enforceable under the laws of 202.30this state;202.31(8) the reason why guardianship is necessary, including a brief description of the 202.32nature and extent of the respondent's alleged incapacity;202.33(9) if an unlimited guardianship is requested, the reason why limited guardianship 202.34is inappropriate and, if a limited guardianship is requested, the powers to be granted to 202.35the limited guardian; and203.1(10) a general statement of the respondent's property with an estimate of its value, 203.2including any insurance or pension, and the source and amount of any other anticipated 203.3income or receipts.203.4(c) The petition must also set forth the following information regarding the proposed 203.5guardian or any employee of the guardian responsible for exercising powers and duties 203.6under the guardianship:203.7(1) whether the proposed guardian has ever been removed for cause from serving as 203.8a guardian or conservator and, if so, the case number and court location; and203.9(2) if the proposed guardian is a professional guardian or conservator, a summary of 203.10the proposed guardian's educational background and relevant work and other experience.;203.11(3) whether the proposed guardian has ever applied for or held, at any time, any 203.12professional license from an agency listed under section 524.5-118, subdivision 2a, and if 203.13so, the name of the licensing agency, and as applicable, the license number and status; 203.14whether the license is active or has been denied, conditioned, suspended, revoked, or 203.15canceled; and the basis for the denial, condition, suspension, revocation, or cancellation 203.16of the license;203.17(4) whether the proposed guardian has ever been found civilly liable in an action 203.18that involved fraud, misrepresentation, material omission, misappropriation, theft, or 203.19conversion, and if so, the case number and court location;203.20(5) whether the proposed guardian has ever filed for or received protection under the 203.21bankruptcy laws, and if so, the case number and court location;203.22(6) whether the proposed guardian has any outstanding civil monetary judgments 203.23against the proposed guardian, and if so, the case number, court location, and outstanding 203.24amount owed;203.25(7) whether an order for protection or harassment restraining order has ever been 203.26issued against the proposed guardian, and if so, the case number and court location; and203.27(8) whether the proposed guardian has ever been convicted of a crime other than a 203.28petty misdemeanor or traffic offense, and if so, the case number and the crime of which 203.29the guardian was convicted.203.30    Sec. 17. Minnesota Statutes 2012, section 524.5-316, is amended to read:203.31524.5-316 REPORTS; MONITORING OF GUARDIANSHIP; COURT 203.32ORDERS.203.33(a) A guardian shall report to the court in writing on the condition of the ward at least 203.34annually and whenever ordered by the court. A copy of the report must be provided to the 203.35ward and to interested persons of record with the court. A report must state or contain:204.1(1) the current mental, physical, and social condition of the ward;204.2(2) the living arrangements for all addresses of the ward during the reporting period;204.3(3) any restrictions placed on the ward's right to communication and visitation with 204.4persons of the ward's choice and the factual bases for those restrictions;204.5(4) the medical, educational, vocational, and other services provided to the ward and 204.6the guardian's opinion as to the adequacy of the ward's care;204.7(5) a recommendation as to the need for continued guardianship and any 204.8recommended changes in the scope of the guardianship;204.9(6) an address and telephone number where the guardian can be contacted; and204.10(7) whether the guardian has ever been removed for cause from serving as a guardian 204.11or conservator and, if so, the case number and court location;204.12(8) any changes occurring that would affect the accuracy of information contained 204.13in the most recent criminal background study of the guardian conducted under section 204.14524.5-118; and204.15(9) (7) if applicable, the amount of reimbursement for services rendered to the ward 204.16that the guardian received during the previous year that were not reimbursed by county 204.17contract.204.18(b) A guardian shall report to the court in writing within 30 days of the occurrence of 204.19any of the events listed in this paragraph. The guardian must report any of the occurrences 204.20in this paragraph and follow the same reporting requirements in this paragraph for 204.21any employee of the guardian responsible for exercising powers and duties under the 204.22guardianship. A copy of the report must be provided to the ward and to interested persons 204.23of record with the court. A guardian shall report when:204.24(1) the guardian is removed for cause from serving as a guardian or conservator, and 204.25if so, the case number and court location;204.26(2) the guardian has a professional license from an agency listed under section 204.27524.5-118, subdivision 2a, denied, conditioned, suspended, revoked, or canceled, and 204.28if so, the licensing agency and license number, and the basis for denial, condition, 204.29suspension, revocation, or cancellation of the license;204.30(3) the guardian is found civilly liable in an action that involves fraud, 204.31misrepresentation, material omission, misappropriation, theft, or conversion, and if so, the 204.32case number and court location;204.33(4) the guardian files for or receives protection under the bankruptcy laws, and 204.34if so, the case number and court location;204.35(5) a civil monetary judgment is entered against the guardian, and if so, the case 204.36number, court location, and outstanding amount owed;205.1(6) the guardian is convicted of a crime other than a petty misdemeanor or traffic 205.2offense, and if so, the case number and court location; or205.3(7) an order for protection or harassment restraining order is issued against the 205.4guardian, and if so, the case number and court location.205.5(b) (c) A ward or interested person of record with the court may submit to the court a 205.6written statement disputing statements or conclusions regarding the condition of the ward 205.7or addressing any disciplinary or legal action that are is contained in the report guardian's 205.8reports and may petition the court for an order that is in the best interests of the ward or 205.9for other appropriate relief.205.10(c) (d) An interested person may notify the court in writing that the interested person 205.11does not wish to receive copies of reports required under this section.205.12(d) (e) The court may appoint a visitor to review a report, interview the ward or 205.13guardian, and make any other investigation the court directs.205.14(e) (f) The court shall establish a system for monitoring guardianships, including the 205.15filing and review of annual reports. If an annual report is not filed within 60 days of the 205.16required date, the court shall issue an order to show cause.205.17(g) If a guardian fails to comply with this section, the court may decline to appoint that 205.18person as a guardian or conservator, or may remove a person as guardian or conservator.205.19    Sec. 18. Minnesota Statutes 2012, section 524.5-403, is amended to read:205.20524.5-403 ORIGINAL PETITION FOR APPOINTMENT OR PROTECTIVE 205.21ORDER.205.22(a) The following may petition for the appointment of a conservator or for any 205.23other appropriate protective order:205.24(1) the person to be protected;205.25(2) an individual interested in the estate, affairs, or welfare of the person to be 205.26protected; or205.27(3) a person who would be adversely affected by lack of effective management of 205.28the property and business affairs of the person to be protected.205.29(b) The petition must set forth the petitioner's name, residence, current address 205.30if different, relationship to the respondent, and interest in the appointment or other 205.31protective order, and, to the extent known, state or contain the following with respect to 205.32the respondent and the relief requested:205.33(1) the respondent's name, age, principal residence, current street address, and, if 205.34different, the address of the dwelling where it is proposed that the respondent will reside if 205.35the appointment is made;206.1(2) if the petition alleges impairment in the respondent's ability to receive and 206.2evaluate information, a brief description of the nature and extent of the respondent's 206.3alleged impairment;206.4(3) if the petition alleges that the respondent is missing, detained, or unable to 206.5return to the United States, a statement of the relevant circumstances, including the time 206.6and nature of the disappearance or detention and a description of any search or inquiry 206.7concerning the respondent's whereabouts;206.8(4) the name and address of the respondent's:206.9(i) spouse, or if the respondent has none, an adult with whom the respondent has 206.10resided for more than six months before the filing of the petition; and206.11(ii) adult children or, if the respondent has none, the respondent's parents and adult 206.12brothers and sisters or, if the respondent has none, at least one of the adults nearest in 206.13kinship to the respondent who can be found;206.14(5) the name of the administrative head and address of the institution where the 206.15respondent is a patient, resident, or client of any hospital, nursing home, home care 206.16agency, or other institution;206.17(6) the name and address of any legal representative for the respondent;206.18(7) the name and address of any health care agent or proxy appointed pursuant to 206.19a health care directive as defined in section 
         145C.01, a living will under chapter 145B, 206.20or other similar document executed in another state and enforceable under the laws of 206.21this state;206.22(8) a general statement of the respondent's property with an estimate of its value, 206.23including any insurance or pension, and the source and amount of other anticipated 206.24income or receipts; and206.25(9) the reason why a conservatorship or other protective order is in the best interest 206.26of the respondent.206.27(c) If a conservatorship is requested, the petition must also set forth to the extent 206.28known:206.29(1) the name, address, and telephone number of any proposed conservator and the 206.30reason why the proposed conservator should be selected;206.31(2) the name, address, and telephone number of any person nominated as conservator 206.32by the respondent if the respondent has attained 14 years of age; and206.33(3) the type of conservatorship requested and, if an unlimited conservatorship, 206.34the reason why limited conservatorship is inappropriate or, if a limited conservatorship, 206.35the property to be placed under the conservator's control and any limitation on the 206.36conservator's powers and duties.207.1(d) The petition must also set forth the following information regarding the proposed 207.2conservator or any employee of the conservator responsible for exercising powers and 207.3duties under the conservatorship:207.4(1) whether the proposed conservator has ever been removed for cause from serving 207.5as a guardian or conservator and, if so, the case number and court location; and207.6(2) if the proposed conservator is a professional guardian or conservator, a summary 207.7of the proposed conservator's educational background and relevant work and other 207.8experience.;207.9(3) whether the proposed conservator has ever applied for or held, at any time, any 207.10professional license from an agency listed under section 524.5-118, subdivision 2a, and if 207.11so, the name of the licensing agency, and as applicable, the license number and status; 207.12whether the license is active or has been denied, conditioned, suspended, revoked, or 207.13canceled; and the basis for the denial, condition, suspension, revocation, or cancellation 207.14of the license;207.15(4) whether the proposed conservator has ever been found civilly liable in an action 207.16that involved fraud, misrepresentation, material omission, misappropriation, theft, or 207.17conversion, and if so, the case number and court location;207.18(5) whether the proposed conservator has ever filed for or received protection under 207.19the bankruptcy laws, and if so, the case number and court location;207.20(6) whether the proposed conservator has any outstanding civil monetary judgments 207.21against the proposed conservator, and if so, the case number, court location, and 207.22outstanding amount owed;207.23(7) whether an order for protection or harassment restraining order has ever been 207.24issued against the proposed conservator, and if so, the case number and court location; and207.25(8) whether the proposed conservator has ever been convicted of a crime other than 207.26a petty misdemeanor or traffic offense, and if so, the case number and the crime of which 207.27the conservator was convicted.207.28    Sec. 19. Minnesota Statutes 2012, section 524.5-420, is amended to read:207.29524.5-420 REPORTS; APPOINTMENT OF VISITOR; MONITORING; 207.30COURT ORDERS.207.31(a) A conservator shall report to the court for administration of the estate annually 207.32unless the court otherwise directs, upon resignation or removal, upon termination of the 207.33conservatorship, and at other times as the court directs. An order, after notice and hearing, 207.34allowing an intermediate report of a conservator adjudicates liabilities concerning the 208.1matters adequately disclosed in the accounting. An order, after notice and hearing, allowing 208.2a final report adjudicates all previously unsettled liabilities relating to the conservatorship.208.3(b) A report must state or contain a listing of the assets of the estate under the 208.4conservator's control and a listing of the receipts, disbursements, and distributions during 208.5the reporting period.208.6(c) The report must also state:208.7(1) an address and telephone number where the conservator can be contacted;.208.8(2) whether the conservator has ever been removed for cause from serving as a 208.9guardian or conservator and, if so, the case number and court locations; and208.10(3) any changes occurring that would affect the accuracy of information contained in 208.11the most recent criminal background study of the conservator conducted under section 208.12524.5-118.208.13(d) A conservator shall report to the court in writing within 30 days of the occurrence 208.14of any of the events listed in this paragraph. The conservator must report any of the 208.15occurrences in this paragraph and follow the same reporting requirements in this paragraph 208.16for any employee of the conservator responsible for exercising powers and duties under 208.17the conservatorship. A copy of the report must be provided to the protected person and to 208.18interested persons of record with the court. A conservator shall report when:208.19(1) the conservator is removed for cause from serving as a guardian or conservator, 208.20and if so, the case number and court location;208.21(2) the conservator has a professional license from an agency listed under section 208.22524.5-118, subdivision 2a, denied, conditioned, suspended, revoked, or canceled, and 208.23if so, the licensing agency and license number, and the basis for denial, condition, 208.24suspension, revocation, or cancellation of the license;208.25(3) the conservator is found civilly liable in an action that involves fraud, 208.26misrepresentation, material omission, misappropriation, theft, or conversion, and if so, the 208.27case number and court location;208.28(4) the conservator files for or receives protection under the bankruptcy laws, and 208.29if so, the case number and court location;208.30(5) a civil monetary judgment is entered against the conservator, and if so, the case 208.31number, court location, and outstanding amount owed;208.32(6) the conservator is convicted of a crime other than a petty misdemeanor or traffic 208.33offense, and if so, the case number and court location; or208.34(7) an order for protection or harassment restraining order is issued against the 208.35conservator, and if so, the case number and court location.209.1(d) (e) A protected person or an interested person of record with the court may 209.2submit to the court a written statement disputing account statements regarding the 209.3administration of the estate or addressing any disciplinary or legal action that are is209.4 contained in the report reports and may petition the court for any order that is in the best 209.5interests of the protected person and the estate or for other appropriate relief.209.6(e) (f) An interested person may notify the court in writing that the interested person 209.7does not wish to receive copies of reports required under this section.209.8(f) (g) The court may appoint a visitor to review a report or plan, interview the 209.9protected person or conservator, and make any other investigation the court directs. In 209.10connection with a report, the court may order a conservator to submit the assets of the 209.11estate to an appropriate examination to be made in a manner the court directs.209.12(g) (h) The court shall establish a system for monitoring of conservatorships, 209.13including the filing and review of conservators' reports and plans. If an annual report is 209.14not filed within 60 days of the required date, the court shall issue an order to show cause.209.15(i) If a conservator fails to comply with this section, the court may decline to appoint 209.16that person as a guardian or conservator, or may remove a person as guardian or conservator.209.17    Sec. 20. INSTRUCTIONS TO THE COMMISSIONER.209.18    In collaboration with labor organizations, the commissioner of human services shall 209.19develop clear and consistent standards for state-operated services programs to:209.20    (1) address direct service staffing shortages;209.21    (2) identify and help resolve workplace safety issues; and209.22    (3) elevate the use and visibility of performance measures and objectives related to 209.23overtime use.209.24ARTICLE 6209.25HEALTH CARE209.26    Section 1. Minnesota Statutes 2012, section 245.03, subdivision 1, is amended to read:209.27    Subdivision 1. Establishment. There is created a Department of Human Services. 209.28A commissioner of human services shall be appointed by the governor under the 209.29provisions of section 
         15.06. The commissioner shall be selected on the basis of ability and 209.30experience in welfare and without regard to political affiliations. The commissioner shall209.31 may appoint a up to two deputy commissioner commissioners.209.32    Sec. 2. Minnesota Statutes 2012, section 256.9657, subdivision 3, is amended to read:210.1    Subd. 3. Surcharge on HMOs and community integrated service networks. (a) 210.2Effective October 1, 1992, each health maintenance organization with a certificate of 210.3authority issued by the commissioner of health under chapter 62D and each community 210.4integrated service network licensed by the commissioner under chapter 62N shall pay to 210.5the commissioner of human services a surcharge equal to six-tenths of one percent of the 210.6total premium revenues of the health maintenance organization or community integrated 210.7service network as reported to the commissioner of health according to the schedule in 210.8subdivision 4.210.9(b) Effective July 1, 2013, to June 30, 2015, the surcharge under paragraph (a) is 210.10increased to 1.48 percent.210.11(c) For purposes of this subdivision, total premium revenue means:210.12(1) premium revenue recognized on a prepaid basis from individuals and groups 210.13for provision of a specified range of health services over a defined period of time which 210.14is normally one month, excluding premiums paid to a health maintenance organization 210.15or community integrated service network from the Federal Employees Health Benefit 210.16Program;210.17(2) premiums from Medicare wraparound subscribers for health benefits which 210.18supplement Medicare coverage;210.19(3) Medicare revenue, as a result of an arrangement between a health maintenance 210.20organization or a community integrated service network and the Centers for Medicare 210.21and Medicaid Services of the federal Department of Health and Human Services, for 210.22services to a Medicare beneficiary, excluding Medicare revenue that states are prohibited 210.23from taxing under sections 1854, 1860D-12, and 1876 of title XVIII of the federal Social 210.24Security Act, codified as United States Code, title 42, sections 1395mm, 1395w-112, and 210.251395w-24, respectively, as they may be amended from time to time; and210.26(4) medical assistance revenue, as a result of an arrangement between a health 210.27maintenance organization or community integrated service network and a Medicaid state 210.28agency, for services to a medical assistance beneficiary.210.29If advance payments are made under clause (1) or (2) to the health maintenance 210.30organization or community integrated service network for more than one reporting period, 210.31the portion of the payment that has not yet been earned must be treated as a liability.210.32(c) (d)  When a health maintenance organization or community integrated service 210.33network merges or consolidates with or is acquired by another health maintenance 210.34organization or community integrated service network, the surviving corporation or the 210.35new corporation shall be responsible for the annual surcharge originally imposed on 210.36each of the entities or corporations subject to the merger, consolidation, or acquisition, 211.1regardless of whether one of the entities or corporations does not retain a certificate of 211.2authority under chapter 62D or a license under chapter 62N.211.3(d) (e)  Effective July 1 of each year, the surviving corporation's or the new 211.4corporation's surcharge shall be based on the revenues earned in the second previous 211.5calendar year by all of the entities or corporations subject to the merger, consolidation, 211.6or acquisition regardless of whether one of the entities or corporations does not retain a 211.7certificate of authority under chapter 62D or a license under chapter 62N until the total 211.8premium revenues of the surviving corporation include the total premium revenues of all 211.9the merged entities as reported to the commissioner of health.211.10(e) (f)  When a health maintenance organization or community integrated service 211.11network, which is subject to liability for the surcharge under this chapter, transfers, 211.12assigns, sells, leases, or disposes of all or substantially all of its property or assets, liability 211.13for the surcharge imposed by this chapter is imposed on the transferee, assignee, or buyer 211.14of the health maintenance organization or community integrated service network.211.15(f) (g)  In the event a health maintenance organization or community integrated 211.16service network converts its licensure to a different type of entity subject to liability 211.17for the surcharge under this chapter, but survives in the same or substantially similar 211.18form, the surviving entity remains liable for the surcharge regardless of whether one of 211.19the entities or corporations does not retain a certificate of authority under chapter 62D 211.20or a license under chapter 62N.211.21(g) (h)  The surcharge assessed to a health maintenance organization or community 211.22integrated service network ends when the entity ceases providing services for premiums 211.23and the cessation is not connected with a merger, consolidation, acquisition, or conversion.211.24    Sec. 3. Minnesota Statutes 2012, section 256.969, subdivision 3a, is amended to read:211.25    Subd. 3a. Payments. (a) Acute care hospital billings under the medical 211.26assistance program must not be submitted until the recipient is discharged. However, 211.27the commissioner shall establish monthly interim payments for inpatient hospitals that 211.28have individual patient lengths of stay over 30 days regardless of diagnostic category. 211.29Except as provided in section 
         256.9693, medical assistance reimbursement for treatment 211.30of mental illness shall be reimbursed based on diagnostic classifications. Individual 211.31hospital payments established under this section and sections 
         256.9685, 
         256.9686, and 211.32256.9695
         , in addition to third-party and recipient liability, for discharges occurring during 211.33the rate year shall not exceed, in aggregate, the charges for the medical assistance covered 211.34inpatient services paid for the same period of time to the hospital. This payment limitation 211.35shall be calculated separately for medical assistance and general assistance medical 212.1care services. The limitation on general assistance medical care shall be effective for 212.2admissions occurring on or after July 1, 1991. Services that have rates established under 212.3subdivision 11 or 12, must be limited separately from other services. After consulting with 212.4the affected hospitals, the commissioner may consider related hospitals one entity and 212.5may merge the payment rates while maintaining separate provider numbers. The operating 212.6and property base rates per admission or per day shall be derived from the best Medicare 212.7and claims data available when rates are established. The commissioner shall determine 212.8the best Medicare and claims data, taking into consideration variables of recency of the 212.9data, audit disposition, settlement status, and the ability to set rates in a timely manner. 212.10The commissioner shall notify hospitals of payment rates by December 1 of the year 212.11preceding the rate year. The rate setting data must reflect the admissions data used to 212.12establish relative values. Base year changes from 1981 to the base year established for the 212.13rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited 212.14to the limits ending June 30, 1987, on the maximum rate of increase under subdivision 212.151. The commissioner may adjust base year cost, relative value, and case mix index data 212.16to exclude the costs of services that have been discontinued by the October 1 of the year 212.17preceding the rate year or that are paid separately from inpatient services. Inpatient stays 212.18that encompass portions of two or more rate years shall have payments established based 212.19on payment rates in effect at the time of admission unless the date of admission preceded 212.20the rate year in effect by six months or more. In this case, operating payment rates for 212.21services rendered during the rate year in effect and established based on the date of 212.22admission shall be adjusted to the rate year in effect by the hospital cost index.212.23    (b) For fee-for-service admissions occurring on or after July 1, 2002, the total 212.24payment, before third-party liability and spenddown, made to hospitals for inpatient 212.25services is reduced by .5 percent from the current statutory rates.212.26    (c) In addition to the reduction in paragraph (b), the total payment for fee-for-service 212.27admissions occurring on or after July 1, 2003, made to hospitals for inpatient services 212.28before third-party liability and spenddown, is reduced five percent from the current 212.29statutory rates. Mental health services within diagnosis related groups 424 to 432, and 212.30facilities defined under subdivision 16 are excluded from this paragraph.212.31    (d) In addition to the reduction in paragraphs (b) and (c), the total payment for 212.32fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for 212.33inpatient services before third-party liability and spenddown, is reduced 6.0 percent 212.34from the current statutory rates. Mental health services within diagnosis related groups 212.35424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph. 212.36Notwithstanding section 
         256.9686, subdivision 7, for purposes of this paragraph, medical 213.1assistance does not include general assistance medical care. Payments made to managed 213.2care plans shall be reduced for services provided on or after January 1, 2006, to reflect 213.3this reduction.213.4    (e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for 213.5fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made 213.6to hospitals for inpatient services before third-party liability and spenddown, is reduced 213.73.46 percent from the current statutory rates. Mental health services with diagnosis related 213.8groups 424 to 432 and facilities defined under subdivision 16 are excluded from this 213.9paragraph. Payments made to managed care plans shall be reduced for services provided 213.10on or after January 1, 2009, through June 30, 2009, to reflect this reduction.213.11    (f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for 213.12fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2011, made 213.13to hospitals for inpatient services before third-party liability and spenddown, is reduced 213.141.9 percent from the current statutory rates. Mental health services with diagnosis related 213.15groups 424 to 432 and facilities defined under subdivision 16 are excluded from this 213.16paragraph. Payments made to managed care plans shall be reduced for services provided 213.17on or after July 1, 2009, through June 30, 2011, to reflect this reduction.213.18    (g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment 213.19for fee-for-service admissions occurring on or after July 1, 2011, made to hospitals for 213.20inpatient services before third-party liability and spenddown, is reduced 1.79 percent 213.21from the current statutory rates. Mental health services with diagnosis related groups 213.22424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph. 213.23Payments made to managed care plans shall be reduced for services provided on or after 213.24July 1, 2011, to reflect this reduction.213.25(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total 213.26payment for fee-for-service admissions occurring on or after July 1, 2009, made to 213.27hospitals for inpatient services before third-party liability and spenddown, is reduced 213.28one percent from the current statutory rates. Facilities defined under subdivision 16 are 213.29excluded from this paragraph. Payments made to managed care plans shall be reduced for 213.30services provided on or after October 1, 2009, to reflect this reduction.213.31(i) In addition to the reductions in paragraphs (b), (c), (d), (g), and (h), the total 213.32payment for fee-for-service admissions occurring on or after July 1, 2011, made to 213.33hospitals for inpatient services before third-party liability and spenddown, is reduced 213.341.96 percent from the current statutory rates. Facilities defined under subdivision 16 are 213.35excluded from this paragraph. Payments made to managed care plans shall be reduced for 213.36services provided on or after January 1, 2011, to reflect this reduction.214.1(j) For admissions occurring on or after January 1, 2015, the rate for inpatient 214.2hospital services must be increased 1.4 percent from the rate in effect on December 31, 214.32014. Payments made to managed care plans and county-based purchasing plans shall 214.4not be adjusted to reflect payments under this paragraph.214.5    Sec. 4. Minnesota Statutes 2012, section 256.969, subdivision 29, is amended to read:214.6    Subd. 29. Reimbursement for the fee increase for the early hearing detection 214.7and intervention program.(a) For admissions occurring on or after July 1, 2010, 214.8payment rates shall be adjusted to include the increase to the fee that is effective on July 1, 214.92010, for the early hearing detection and intervention program recipients under section 214.10144.125, subdivision 1
         , that is paid by the hospital for public program recipients. This 214.11payment increase shall be in effect until the increase is fully recognized in the base year 214.12cost under subdivision 2b. This payment shall be included in payments to contracted 214.13managed care organizations.214.14    (b) For admissions occurring on or after July 1, 2013, payment rates shall be adjusted 214.15to include the increase to the fee that is effective July 1, 2013, for the early hearing 214.16detection and intervention program under section 144.125, subdivision 1, paragraph (d), 214.17that is paid by the hospital for medical assistance and MinnesotaCare program enrollees. 214.18This payment increase shall be in effect until the increase is fully recognized in the 214.19base-year cost under subdivision 2b. This payment shall be included in payments to 214.20managed care plans and county-based purchasing plans.214.21    Sec. 5. Minnesota Statutes 2012, section 256B.055, subdivision 14, is amended to read:214.22    Subd. 14. Persons detained by law. (a) Medical assistance may be paid for an 214.23inmate of a correctional facility who is conditionally released as authorized under section 214.24241.26
         , 
         244.065, or 
         631.425, if the individual does not require the security of a public 214.25detention facility and is housed in a halfway house or community correction center, or 214.26under house arrest and monitored by electronic surveillance in a residence approved 214.27by the commissioner of corrections, and if the individual meets the other eligibility 214.28requirements of this chapter.214.29    (b) An individual who is enrolled in medical assistance, and who is charged with a 214.30crime and incarcerated for less than 12 months shall be suspended from eligibility at the 214.31time of incarceration until the individual is released. Upon release, medical assistance 214.32eligibility is reinstated without reapplication using a reinstatement process and form, if the 214.33individual is otherwise eligible.215.1    (c) An individual, regardless of age, who is considered an inmate of a public 215.2institution as defined in Code of Federal Regulations, title 42, section 435.1010, and 215.3who meets the eligibility requirements in section 256B.056, is not eligible for medical 215.4assistance, except for covered services received while an inpatient in a medical institution 215.5as defined in Code of Federal Regulations, title 42, section 435.1010. Security issues, 215.6including costs, related to the inpatient treatment of an inmate are the responsibility of the 215.7entity with jurisdiction over the inmate.215.8EFFECTIVE DATE.This section is effective January 1, 2014.215.9    Sec. 6. Minnesota Statutes 2012, section 256B.06, subdivision 4, is amended to read:215.10    Subd. 4. Citizenship requirements. (a) Eligibility for medical assistance is limited 215.11to citizens of the United States, qualified noncitizens as defined in this subdivision, and 215.12other persons residing lawfully in the United States. Citizens or nationals of the United 215.13States must cooperate in obtaining satisfactory documentary evidence of citizenship or 215.14nationality according to the requirements of the federal Deficit Reduction Act of 2005, 215.15Public Law 109-171.215.16(b) "Qualified noncitizen" means a person who meets one of the following 215.17immigration criteria:215.18(1) admitted for lawful permanent residence according to United States Code, title 8;215.19(2) admitted to the United States as a refugee according to United States Code, 215.20title 8, section 1157;215.21(3) granted asylum according to United States Code, title 8, section 1158;215.22(4) granted withholding of deportation according to United States Code, title 8, 215.23section 1253(h);215.24(5) paroled for a period of at least one year according to United States Code, title 8, 215.25section 1182(d)(5);215.26(6) granted conditional entrant status according to United States Code, title 8, 215.27section 1153(a)(7);215.28(7) determined to be a battered noncitizen by the United States Attorney General 215.29according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, 215.30title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;215.31(8) is a child of a noncitizen determined to be a battered noncitizen by the United 215.32States Attorney General according to the Illegal Immigration Reform and Immigrant 215.33Responsibility Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill, 215.34Public Law 104-200; or216.1(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public 216.2Law 96-422, the Refugee Education Assistance Act of 1980.216.3(c) All qualified noncitizens who were residing in the United States before August 216.422, 1996, who otherwise meet the eligibility requirements of this chapter, are eligible for 216.5medical assistance with federal financial participation.216.6(d) Beginning December 1, 1996, qualified noncitizens who entered the United 216.7States on or after August 22, 1996, and who otherwise meet the eligibility requirements 216.8of this chapter are eligible for medical assistance with federal participation for five years 216.9if they meet one of the following criteria:216.10(1) refugees admitted to the United States according to United States Code, title 8, 216.11section 1157;216.12(2) persons granted asylum according to United States Code, title 8, section 1158;216.13(3) persons granted withholding of deportation according to United States Code, 216.14title 8, section 1253(h);216.15(4) veterans of the United States armed forces with an honorable discharge for 216.16a reason other than noncitizen status, their spouses and unmarried minor dependent 216.17children; or216.18(5) persons on active duty in the United States armed forces, other than for training, 216.19their spouses and unmarried minor dependent children.216.20 Beginning July 1, 2010, children and pregnant women who are noncitizens 216.21described in paragraph (b) or who are lawfully present in the United States as defined 216.22in Code of Federal Regulations, title 8, section 103.12, and who otherwise meet 216.23eligibility requirements of this chapter, are eligible for medical assistance with federal 216.24financial participation as provided by the federal Children's Health Insurance Program 216.25Reauthorization Act of 2009, Public Law 111-3.216.26(e) Nonimmigrants who otherwise meet the eligibility requirements of this chapter 216.27are eligible for the benefits as provided in paragraphs (f) to (h). For purposes of this 216.28subdivision, a "nonimmigrant" is a person in one of the classes listed in United States 216.29Code, title 8, section 1101(a)(15).216.30(f) Payment shall also be made for care and services that are furnished to noncitizens, 216.31regardless of immigration status, who otherwise meet the eligibility requirements of 216.32this chapter, if such care and services are necessary for the treatment of an emergency 216.33medical condition.216.34(g) For purposes of this subdivision, the term "emergency medical condition" means 216.35a medical condition that meets the requirements of United States Code, title 42, section 216.361396b(v).217.1(h)(1) Notwithstanding paragraph (g), services that are necessary for the treatment 217.2of an emergency medical condition are limited to the following:217.3(i) services delivered in an emergency room or by an ambulance service licensed 217.4under chapter 144E that are directly related to the treatment of an emergency medical 217.5condition;217.6(ii) services delivered in an inpatient hospital setting following admission from an 217.7emergency room or clinic for an acute emergency condition; and217.8(iii) follow-up services that are directly related to the original service provided 217.9to treat the emergency medical condition and are covered by the global payment made 217.10to the provider.217.11    (2) Services for the treatment of emergency medical conditions do not include:217.12(i) services delivered in an emergency room or inpatient setting to treat a 217.13nonemergency condition;217.14(ii) organ transplants, stem cell transplants, and related care;217.15(iii) services for routine prenatal care;217.16(iv) continuing care, including long-term care, nursing facility services, home health 217.17care, adult day care, day training, or supportive living services;217.18(v) elective surgery;217.19(vi) outpatient prescription drugs, unless the drugs are administered or dispensed as 217.20part of an emergency room visit;217.21(vii) preventative health care and family planning services;217.22(viii) dialysis;217.23(ix) chemotherapy or therapeutic radiation services;217.24(x) (viii) rehabilitation services;217.25(xi) (ix) physical, occupational, or speech therapy;217.26(xii) (x) transportation services;217.27(xiii) (xi) case management;217.28(xiv) (xii) prosthetics, orthotics, durable medical equipment, or medical supplies;217.29(xv) (xiii) dental services;217.30(xvi) (xiv) hospice care;217.31(xvii) (xv) audiology services and hearing aids;217.32(xviii) (xvi) podiatry services;217.33(xix) (xvii) chiropractic services;217.34(xx) (xviii) immunizations;217.35(xxi) (xix) vision services and eyeglasses;217.36(xxii) (xx) waiver services;218.1(xxiii) (xxi) individualized education programs; or218.2(xxiv) (xxii) chemical dependency treatment.218.3(i) Beginning July 1, 2009, pregnant noncitizens who are undocumented, 218.4nonimmigrants, or lawfully present in the United States as defined in Code of Federal 218.5Regulations, title 8, section 103.12, are not covered by a group health plan or health 218.6insurance coverage according to Code of Federal Regulations, title 42, section 457.310, 218.7and who otherwise meet the eligibility requirements of this chapter, are eligible for 218.8medical assistance through the period of pregnancy, including labor and delivery, and 60 218.9days postpartum, to the extent federal funds are available under title XXI of the Social 218.10Security Act, and the state children's health insurance program.218.11(j) Beginning October 1, 2003, persons who are receiving care and rehabilitation 218.12services from a nonprofit center established to serve victims of torture and are otherwise 218.13ineligible for medical assistance under this chapter are eligible for medical assistance 218.14without federal financial participation. These individuals are eligible only for the period 218.15during which they are receiving services from the center. Individuals eligible under this 218.16paragraph shall not be required to participate in prepaid medical assistance.218.17(k) Notwithstanding paragraph (h), clause (2), the following services are covered as 218.18emergency medical conditions under paragraph (f) except where coverage is prohibited 218.19under federal law:218.20(1) dialysis services provided in a hospital or freestanding dialysis facility; and218.21(2) surgery and the administration of chemotherapy, radiation, and related services 218.22necessary to treat cancer if the recipient has a cancer diagnosis that is not in remission 218.23and requires surgery, chemotherapy, or radiation treatment.218.24    (l) The commissioner or its third party medical review agent may authorize payment 218.25for follow-up care and alternative services, including, but not limited to, long-term care 218.26services that would not otherwise be paid for under this subdivision if the commissioner 218.27determines that the services, if provided, will directly prevent a medical emergency from 218.28immediately occurring.218.29    Sec. 7. Minnesota Statutes 2012, section 256B.0625, subdivision 13e, is amended to 218.30read:218.31    Subd. 13e. Payment rates. (a) The basis for determining the amount of payment 218.32shall be the lower of the actual acquisition costs of the drugs or the maximum allowable 218.33cost by the commissioner plus the fixed dispensing fee; or the usual and customary price 218.34charged to the public. The amount of payment basis must be reduced to reflect all discount 218.35amounts applied to the charge by any provider/insurer agreement or contract for submitted 219.1charges to medical assistance programs. The net submitted charge may not be greater 219.2than the patient liability for the service. The pharmacy dispensing fee shall be $3.65, 219.3except that the dispensing fee for intravenous solutions which must be compounded by the 219.4pharmacist shall be $8 per bag, $14 per bag for cancer chemotherapy products, and $30 219.5per bag for total parenteral nutritional products dispensed in one liter quantities, or $44 per 219.6bag for total parenteral nutritional products dispensed in quantities greater than one liter. 219.7Actual acquisition cost includes quantity and other special discounts except time and cash 219.8discounts. The actual acquisition cost of a drug shall be estimated by the commissioner at 219.9wholesale acquisition cost plus four percent for independently owned pharmacies located 219.10in a designated rural area within Minnesota, and at wholesale acquisition cost plus two 219.11percent for all other pharmacies. A pharmacy is "independently owned" if it is one of four 219.12or fewer pharmacies under the same ownership nationally. A "designated rural area" means 219.13an area defined as a small rural area or isolated rural area according to the four-category 219.14classification of the Rural Urban Commuting Area system developed for the United States 219.15Health Resources and Services Administration. Wholesale acquisition cost is defined as the 219.16manufacturer's list price for a drug or biological to wholesalers or direct purchasers in the 219.17United States, not including prompt pay or other discounts, rebates, or reductions in price, 219.18for the most recent month for which information is available, as reported in wholesale price 219.19guides or other publications of drug or biological pricing data. The maximum allowable 219.20cost of a multisource drug may be set by the commissioner and it shall be comparable to, 219.21but no higher than, the maximum amount paid by other third-party payors in this state who 219.22have maximum allowable cost programs. Establishment of the amount of payment for 219.23drugs shall not be subject to the requirements of the Administrative Procedure Act.219.24    (b) An additional dispensing fee of $.30 may be added to the dispensing fee paid 219.25to pharmacists for legend drug prescriptions dispensed to residents of long-term care 219.26facilities when a unit dose blister card system, approved by the department, is used. Under 219.27this type of dispensing system, the pharmacist must dispense a 30-day supply of drug. The 219.28National Drug Code (NDC) from the drug container used to fill the blister card must be 219.29identified on the claim to the department. The unit dose blister card containing the drug 219.30must meet the packaging standards set forth in Minnesota Rules, part 6800.2700, that 219.31govern the return of unused drugs to the pharmacy for reuse. The pharmacy provider will 219.32be required to credit the department for the actual acquisition cost of all unused drugs that 219.33are eligible for reuse. The commissioner may permit the drug clozapine to be dispensed in 219.34a quantity that is less than a 30-day supply.219.35    (c) Whenever a maximum allowable cost has been set for a multisource drug, 219.36payment shall be the lower of the usual and customary price charged to the public or the 220.1maximum allowable cost established by the commissioner unless prior authorization 220.2for the brand name product has been granted according to the criteria established by 220.3the Drug Formulary Committee as required by subdivision 13f, paragraph (a), and the 220.4prescriber has indicated "dispense as written" on the prescription in a manner consistent 220.5with section 
         151.21, subdivision 2.220.6    (d) The basis for determining the amount of payment for drugs administered in an 220.7outpatient setting shall be the lower of the usual and customary cost submitted by the 220.8provider or, 106 percent of the average sales price as determined by the United States 220.9Department of Health and Human Services pursuant to title XVIII, section 1847a of the 220.10federal Social Security Act, the specialty pharmacy rate, or the maximum allowable cost 220.11set by the commissioner. If average sales price is unavailable, the amount of payment 220.12must be lower of the usual and customary cost submitted by the provider or, the wholesale 220.13acquisition cost, the specialty pharmacy rate, or the maximum allowable cost set by the 220.14commissioner. The payment for drugs administered in an outpatient setting shall be made 220.15to the administering facility or practitioner. A retail or specialty pharmacy dispensing a 220.16drug for administration in an outpatient setting is not eligible for direct reimbursement.220.17    (e) The commissioner may negotiate lower reimbursement rates for specialty 220.18pharmacy products than the rates specified in paragraph (a). The commissioner may 220.19require individuals enrolled in the health care programs administered by the department 220.20to obtain specialty pharmacy products from providers with whom the commissioner has 220.21negotiated lower reimbursement rates. Specialty pharmacy products are defined as those 220.22used by a small number of recipients or recipients with complex and chronic diseases 220.23that require expensive and challenging drug regimens. Examples of these conditions 220.24include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis 220.25C, growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms 220.26of cancer. Specialty pharmaceutical products include injectable and infusion therapies, 220.27biotechnology drugs, antihemophilic factor products, high-cost therapies, and therapies 220.28that require complex care. The commissioner shall consult with the formulary committee 220.29to develop a list of specialty pharmacy products subject to this paragraph. In consulting 220.30with the formulary committee in developing this list, the commissioner shall take into 220.31consideration the population served by specialty pharmacy products, the current delivery 220.32system and standard of care in the state, and access to care issues. The commissioner shall 220.33have the discretion to adjust the reimbursement rate to prevent access to care issues.220.34(f) Home infusion therapy services provided by home infusion therapy pharmacies 220.35must be paid at rates according to subdivision 8d.220.36EFFECTIVE DATE.This section is effective January 1, 2014.221.1    Sec. 8. Minnesota Statutes 2012, section 256B.0625, is amended by adding a 221.2subdivision to read:221.3    Subd. 28b.Doula services.Medical assistance covers doula services provided by a 221.4certified doula as defined in section 148.995, subdivision 2, of the mother's choice. For 221.5purposes of this section, "doula services" means childbirth education and support services, 221.6including emotional and physical support provided during pregnancy, labor, birth, and 221.7postpartum.221.8EFFECTIVE DATE.This section is effective July 1, 2014, or upon federal 221.9approval, whichever is later, and applies to services provided on or after the effective date.221.10    Sec. 9. Minnesota Statutes 2012, section 256B.0625, subdivision 31, is amended to read:221.11    Subd. 31. Medical supplies and equipment. (a) Medical assistance covers medical 221.12supplies and equipment. Separate payment outside of the facility's payment rate shall 221.13be made for wheelchairs and wheelchair accessories for recipients who are residents 221.14of intermediate care facilities for the developmentally disabled. Reimbursement for 221.15wheelchairs and wheelchair accessories for ICF/MR recipients shall be subject to the same 221.16conditions and limitations as coverage for recipients who do not reside in institutions. A 221.17wheelchair purchased outside of the facility's payment rate is the property of the recipient. 221.18The commissioner may set reimbursement rates for specified categories of medical 221.19supplies at levels below the Medicare payment rate.221.20(b) Vendors of durable medical equipment, prosthetics, orthotics, or medical supplies 221.21must enroll as a Medicare provider.221.22(c) When necessary to ensure access to durable medical equipment, prosthetics, 221.23orthotics, or medical supplies, the commissioner may exempt a vendor from the Medicare 221.24enrollment requirement if:221.25(1) the vendor supplies only one type of durable medical equipment, prosthetic, 221.26orthotic, or medical supply;221.27(2) the vendor serves ten or fewer medical assistance recipients per year;221.28(3) the commissioner finds that other vendors are not available to provide same or 221.29similar durable medical equipment, prosthetics, orthotics, or medical supplies; and221.30(4) the vendor complies with all screening requirements in this chapter and Code of 221.31Federal Regulations, title 42, part 455. The commissioner may also exempt a vendor from 221.32the Medicare enrollment requirement if the vendor is accredited by a Centers for Medicare 221.33and Medicaid Services approved national accreditation organization as complying with 221.34the Medicare program's supplier and quality standards and the vendor serves primarily 221.35pediatric patients.222.1(d) Durable medical equipment means a device or equipment that:222.2(1) can withstand repeated use;222.3(2) is generally not useful in the absence of an illness, injury, or disability; and222.4(3) is provided to correct or accommodate a physiological disorder or physical 222.5condition or is generally used primarily for a medical purpose.222.6(e) Electronic tablets may be considered durable medical equipment if the electronic 222.7tablet will be used as an augmentative and alternative communication system as defined 222.8under subdivision 31a, paragraph (a). To be covered by medical assistance, the device 222.9must be locked in order to prevent use not related to communication.222.10    Sec. 10. Minnesota Statutes 2012, section 256B.0625, is amended by adding a 222.11subdivision to read:222.12    Subd. 31b.Preferred diabetic testing supply program.(a) The commissioner 222.13shall implement a point-of-sale preferred diabetic testing supply program by January 1, 222.142014. Medical assistance coverage for diabetic testing supplies shall conform to the 222.15limitations established under the program. The commissioner may enter into a contract 222.16with a vendor for the purpose of participating in a preferred diabetic testing supply list and 222.17supplemental rebate program. The commissioner shall ensure that any contract meets all 222.18federal requirements and maximizes federal financial participation. The commissioner 222.19shall maintain an accurate and up-to-date list on the department's Web site.222.20(b) The commissioner may add to, delete from, and otherwise modify the preferred 222.21diabetic testing supply program drug list after consulting with the Drug Formulary 222.22Committee and appropriate medial specialists and providing public notice and the 222.23opportunity for public comment.222.24(c) The commissioner shall adopt and administer the preferred diabetic testing 222.25supply program as part of the administration of the diabetic testing supply rebate program. 222.26Reimbursement for diabetic testing supplies not on the preferred diabetic testing supply 222.27list may be subject to prior authorization.222.28(d) All claims for diabetic testing supplies in categories on the preferred diabetic 222.29testing supply list must be submitted by enrolled pharmacy providers using the most 222.30current National Council of Prescription Drug Providers electronic claims standard.222.31(e) For purposes of this subdivision, "preferred diabetic testing supply list" means a 222.32list of diabetic testing supplies selected by the commissioner, for which prior authorization 222.33is not required.222.34(f) The commissioner shall seek any federal waivers or approvals necessary to 222.35implement this subdivision.223.1    Sec. 11. Minnesota Statutes 2012, section 256B.0625, subdivision 39, is amended to 223.2read:223.3    Subd. 39. Childhood immunizations. Providers who administer pediatric vaccines 223.4within the scope of their licensure, and who are enrolled as a medical assistance provider, 223.5must enroll in the pediatric vaccine administration program established by section 13631 223.6of the Omnibus Budget Reconciliation Act of 1993. Medical assistance shall pay an 223.7$8.50 fee per dose for administration of the vaccine to children eligible for medical 223.8assistance. Medical assistance does not pay for vaccines that are available at no cost from 223.9the pediatric vaccine administration program.223.10    Sec. 12. Minnesota Statutes 2012, section 256B.0625, subdivision 58, is amended to 223.11read:223.12    Subd. 58. Early and periodic screening, diagnosis, and treatment services.223.13Medical assistance covers early and periodic screening, diagnosis, and treatment services 223.14(EPSDT). The payment amount for a complete EPSDT screening shall not include charges 223.15for vaccines that are available at no cost to the provider and shall not exceed the rate 223.16established per Minnesota Rules, part 9505.0445, item M, effective October 1, 2010.223.17    Sec. 13. Minnesota Statutes 2012, section 256B.0625, is amended by adding a 223.18subdivision to read:223.19    Subd. 61.Payment for multiple services provided on the same day.The 223.20commissioner shall not prohibit payment, including supplemental payments, for mental 223.21health services or dental services provided to a patient by a clinic or health care 223.22professional solely because the mental health or dental services were provided on the same 223.23day as other covered health services furnished by the same provider.223.24    Sec. 14. Minnesota Statutes 2012, section 256B.0631, subdivision 1, is amended to read:223.25    Subdivision 1. Cost-sharing. (a) Except as provided in subdivision 2, the medical 223.26assistance benefit plan shall include the following cost-sharing for all recipients, effective 223.27for services provided on or after September 1, 2011:223.28    (1) $3 per nonpreventive visit, except as provided in paragraph (b). For purposes 223.29of this subdivision, a visit means an episode of service which is required because of 223.30a recipient's symptoms, diagnosis, or established illness, and which is delivered in an 223.31ambulatory setting by a physician or physician ancillary, chiropractor, podiatrist, nurse 223.32midwife, advanced practice nurse, audiologist, optician, or optometrist;224.1    (2) $3.50 for nonemergency visits to a hospital-based emergency room, except that 224.2this co-payment shall be increased to $20 upon federal approval;224.3    (3) $3 per brand-name drug prescription and $1 per generic drug prescription, 224.4subject to a $12 per month maximum for prescription drug co-payments. No co-payments 224.5shall apply to antipsychotic drugs when used for the treatment of mental illness;224.6(4) effective January 1, 2012, a family deductible equal to the maximum amount 224.7allowed under Code of Federal Regulations, title 42, part 447.54; and224.8    (5) for individuals identified by the commissioner with income at or below 100 224.9percent of the federal poverty guidelines, total monthly cost-sharing must not exceed five 224.10percent of family income. For purposes of this paragraph, family income is the total 224.11earned and unearned income of the individual and the individual's spouse, if the spouse is 224.12enrolled in medical assistance and also subject to the five percent limit on cost-sharing.224.13    (b) Recipients of medical assistance are responsible for all co-payments and 224.14deductibles in this subdivision.224.15(c) Notwithstanding paragraph (b), the commissioner, through the contracting 224.16process under sections 
         256B.69 and 
         256B.692, may allow managed care plans and 224.17county-based purchasing plans to waive the family deductible under paragraph (a), 224.18clause (4). The value of the family deductible shall not be included in the capitation 224.19payment to managed care plans and county-based purchasing plans. Managed care plans 224.20and county-based purchasing plans shall certify annually to the commissioner the dollar 224.21value of the family deductible.224.22(d) Notwithstanding paragraph (b), the commissioner may shall waive the collection 224.23of the family deductible described under paragraph (a), clause (4), from individuals and 224.24allow long-term care and waivered service providers to assume responsibility for payment.224.25(e) Notwithstanding paragraph (b), the commissioner, through the contracting 224.26process under section 256B.0756 shall allow the pilot program in Hennepin County to 224.27waive co-payments. The value of the co-payments shall not be included as part of the 224.28payment system for the integrated health care delivery networks under the pilot program.224.29    Sec. 15. Minnesota Statutes 2012, section 256B.0756, is amended to read:224.30256B.0756 HENNEPIN AND RAMSEY COUNTIES PILOT PROGRAM.224.31(a) The commissioner, upon federal approval of a new waiver request or amendment 224.32of an existing demonstration, may establish a pilot program in Hennepin County or Ramsey 224.33County, or both, to test alternative and innovative integrated health care delivery networks.224.34(b) Individuals eligible for the pilot program shall be individuals who are eligible for 224.35medical assistance under section 256B.055, subdivision 15, and who reside in Hennepin 225.1County or Ramsey County. The commissioner may identify individuals to be enrolled 225.2in the Hennepin County pilot program by zip code or by whether the individuals would 225.3benefit from an integrated health care delivery network.225.4(c) Individuals enrolled in the pilot program shall be enrolled in an integrated 225.5health care delivery network in their county of residence. The integrated health care 225.6delivery network in Hennepin County shall be a network, such as an accountable care 225.7organization or a community-based collaborative care network, created by or including 225.8Hennepin County Medical Center. The integrated health care delivery network in Ramsey 225.9County shall be a network, such as an accountable care organization or community-based 225.10collaborative care network, created by or including Regions Hospital.225.11(d) The commissioner shall cap pilot program enrollment at 7,000 enrollees for 225.12Hennepin County and 3,500 enrollees for Ramsey County.225.13(e) (d) In developing a payment system for the pilot programs, the commissioner 225.14shall establish a total cost of care for the recipients enrolled in the pilot programs that 225.15equals the cost of care that would otherwise be spent for these enrollees in the prepaid 225.16medical assistance program.225.17(f) Counties may transfer funds necessary to support the nonfederal share of 225.18payments for integrated health care delivery networks in their county. Such transfers per 225.19county shall not exceed 15 percent of the expected expenses for county enrollees.225.20(g) (e) The commissioner shall apply to the federal government for, or as appropriate, 225.21cooperate with counties, providers, or other entities that are applying for any applicable 225.22grant or demonstration under the Patient Protection and Affordable Health Care Act, Public 225.23Law 111-148, or the Health Care and Education Reconciliation Act of 2010, Public Law 225.24111-152, that would further the purposes of or assist in the creation of an integrated health 225.25care delivery network for the purposes of this subdivision, including, but not limited to, a 225.26global payment demonstration or the community-based collaborative care network grants.225.27    Sec. 16. Minnesota Statutes 2012, section 256B.196, subdivision 2, is amended to read:225.28    Subd. 2. Commissioner's duties. (a) For the purposes of this subdivision and 225.29subdivision 3, the commissioner shall determine the fee-for-service outpatient hospital 225.30services upper payment limit for nonstate government hospitals. The commissioner shall 225.31then determine the amount of a supplemental payment to Hennepin County Medical 225.32Center and Regions Hospital for these services that would increase medical assistance 225.33spending in this category to the aggregate upper payment limit for all nonstate government 225.34hospitals in Minnesota. In making this determination, the commissioner shall allot the 225.35available increases between Hennepin County Medical Center and Regions Hospital 226.1based on the ratio of medical assistance fee-for-service outpatient hospital payments to 226.2the two facilities. The commissioner shall adjust this allotment as necessary based on 226.3federal approvals, the amount of intergovernmental transfers received from Hennepin and 226.4Ramsey Counties, and other factors, in order to maximize the additional total payments. 226.5The commissioner shall inform Hennepin County and Ramsey County of the periodic 226.6intergovernmental transfers necessary to match federal Medicaid payments available 226.7under this subdivision in order to make supplementary medical assistance payments to 226.8Hennepin County Medical Center and Regions Hospital equal to an amount that when 226.9combined with existing medical assistance payments to nonstate governmental hospitals 226.10would increase total payments to hospitals in this category for outpatient services to 226.11the aggregate upper payment limit for all hospitals in this category in Minnesota. Upon 226.12receipt of these periodic transfers, the commissioner shall make supplementary payments 226.13to Hennepin County Medical Center and Regions Hospital.226.14    (b) For the purposes of this subdivision and subdivision 3, the commissioner shall 226.15determine an upper payment limit for physicians and other billing professionals affiliated 226.16with Hennepin County Medical Center and with Regions Hospital. The upper payment 226.17limit shall be based on the average commercial rate or be determined using another method 226.18acceptable to the Centers for Medicare and Medicaid Services. The commissioner shall 226.19inform Hennepin County and Ramsey County of the periodic intergovernmental transfers 226.20necessary to match the federal Medicaid payments available under this subdivision in order 226.21to make supplementary payments to physicians and other billing professionals affiliated 226.22with Hennepin County Medical Center and to make supplementary payments to physicians 226.23and other billing professionals affiliated with Regions Hospital through HealthPartners 226.24Medical Group equal to the difference between the established medical assistance 226.25payment for physician and other billing professional services and the upper payment limit. 226.26Upon receipt of these periodic transfers, the commissioner shall make supplementary 226.27payments to physicians and other billing professionals affiliated with Hennepin County 226.28Medical Center and shall make supplementary payments to physicians and other billing 226.29professionals affiliated with Regions Hospital through HealthPartners Medical Group.226.30    (c) Beginning January 1, 2010, Hennepin County and Ramsey County may make 226.31monthly voluntary intergovernmental transfers to the commissioner in amounts not to 226.32exceed $12,000,000 per year from Hennepin County and $6,000,000 per year from 226.33Ramsey County. The commissioner shall increase the medical assistance capitation 226.34payments to any licensed health plan under contract with the medical assistance program 226.35that agrees to make enhanced payments to Hennepin County Medical Center or Regions 226.36Hospital. The increase shall be in an amount equal to the annual value of the monthly 227.1transfers plus federal financial participation, with each health plan receiving its pro rata 227.2share of the increase based on the pro rata share of medical assistance admissions to 227.3Hennepin County Medical Center and Regions Hospital by those plans. Upon the request 227.4of the commissioner, health plans shall submit individual-level cost data for verification 227.5purposes. The commissioner may ratably reduce these payments on a pro rata basis in 227.6order to satisfy federal requirements for actuarial soundness. If payments are reduced, 227.7transfers shall be reduced accordingly. Any licensed health plan that receives increased 227.8medical assistance capitation payments under the intergovernmental transfer described in 227.9this paragraph shall increase its medical assistance payments to Hennepin County Medical 227.10Center and Regions Hospital by the same amount as the increased payments received in 227.11the capitation payment described in this paragraph.227.12    (d) For the purposes of this subdivision and subdivision 3, the commissioner shall 227.13determine an upper payment limit for ambulance services affiliated with Hennepin County 227.14Medical Center. The upper payment limit shall be based on the average commercial 227.15rate or be determined using another method acceptable to the Centers for Medicare and 227.16Medicaid Services. The commissioner shall inform Hennepin County of the periodic 227.17intergovernmental transfers necessary to match the federal Medicaid payments available 227.18under this subdivision in order to make supplementary payments to Hennepin County 227.19Medical Center equal to the difference between the established medical assistance 227.20payment for ambulance services and the upper payment limit. Upon receipt of these 227.21periodic transfers, the commissioner shall make supplementary payments to Hennepin 227.22County Medical Center.227.23    (e) The commissioner shall inform the transferring governmental entities on an 227.24ongoing basis of the need for any changes needed in the intergovernmental transfers in 227.25order to continue the payments under paragraphs (a) to (c) (d), at their maximum level, 227.26including increases in upper payment limits, changes in the federal Medicaid match, and 227.27other factors.227.28    (e) (f)  The payments in paragraphs (a) to (c) (d)  shall be implemented independently 227.29of each other, subject to federal approval and to the receipt of transfers under subdivision 3.227.30    Sec. 17. Minnesota Statutes 2012, section 256B.69, subdivision 5c, is amended to read:227.31    Subd. 5c. Medical education and research fund. (a) The commissioner of human 227.32services shall transfer each year to the medical education and research fund established 227.33under section 
         62J.692, an amount specified in this subdivision. The commissioner shall 227.34calculate the following:228.1(1) an amount equal to the reduction in the prepaid medical assistance payments as 228.2specified in this clause. Until January 1, 2002, the county medical assistance capitation 228.3base rate prior to plan specific adjustments and after the regional rate adjustments under 228.4subdivision 5b is reduced 6.3 percent for Hennepin County, two percent for the remaining 228.5metropolitan counties, and no reduction for nonmetropolitan Minnesota counties; and after 228.6January 1, 2002, the county medical assistance capitation base rate prior to plan specific 228.7adjustments is reduced 6.3 percent for Hennepin County, two percent for the remaining 228.8metropolitan counties, and 1.6 percent for nonmetropolitan Minnesota counties. Nursing 228.9facility and elderly waiver payments and demonstration project payments operating 228.10under subdivision 23 are excluded from this reduction. The amount calculated under 228.11this clause shall not be adjusted for periods already paid due to subsequent changes to 228.12the capitation payments;228.13(2) beginning July 1, 2003, $4,314,000 from the capitation rates paid under this 228.14section;228.15(3) beginning July 1, 2002, an additional $12,700,000 from the capitation rates 228.16paid under this section; and228.17(4) beginning July 1, 2003, an additional $4,700,000 from the capitation rates paid 228.18under this section.228.19(b) This subdivision shall be effective upon approval of a federal waiver which 228.20allows federal financial participation in the medical education and research fund. The 228.21amount specified under paragraph (a), clauses (1) to (4), shall not exceed the total amount 228.22transferred for fiscal year 2009. Any excess shall first reduce the amounts specified under 228.23paragraph (a), clauses (2) to (4). Any excess following this reduction shall proportionally 228.24reduce the amount specified under paragraph (a), clause (1).228.25(c) Beginning September 1, 2011, of the amount in paragraph (a), the commissioner 228.26shall transfer $21,714,000 each fiscal year to the medical education and research fund.228.27(d) Beginning September 1, 2011, of the amount in paragraph (a), following the 228.28transfer under paragraph (c), the commissioner shall transfer to the medical education 228.29research fund $23,936,000 in fiscal years 2012 and 2013 and $36,744,000 $43,148,000 in 228.30fiscal year 2014 and thereafter.228.31    Sec. 18. Minnesota Statutes 2012, section 256B.69, subdivision 31, is amended to read:228.32    Subd. 31. Payment reduction. (a) Beginning September 1, 2011, the commissioner 228.33shall reduce payments and limit future rate increases paid to managed care plans and 228.34county-based purchasing plans. The limits in paragraphs (a) to (f) shall be achieved 228.35on a statewide aggregate basis by program. The commissioner may use competitive 229.1bidding, payment reductions, or other reductions to achieve the reductions and limits 229.2in this subdivision.229.3(b) Beginning September 1, 2011, the commissioner shall reduce payments to 229.4managed care plans and county-based purchasing plans as follows:229.5(1) 2.0 percent for medical assistance elderly basic care. This shall not apply 229.6to Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver 229.7services;229.8(2) 2.82 percent for medical assistance families and children;229.9(3) 10.1 percent for medical assistance adults without children; and229.10(4) 6.0 percent for MinnesotaCare families and children.229.11(c) Beginning January 1, 2012, the commissioner shall limit rates paid to managed 229.12care plans and county-based purchasing plans for calendar year 2012 to a percentage of 229.13the rates in effect on August 31, 2011, as follows:229.14(1) 98 percent for medical assistance elderly basic care. This shall not apply to 229.15Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver 229.16services;229.17(2) 97.18 percent for medical assistance families and children;229.18(3) 89.9 percent for medical assistance adults without children; and229.19(4) 94 percent for MinnesotaCare families and children.229.20(d) Beginning January 1, 2013, to December 31, 2013, the commissioner shall limit 229.21the maximum annual trend increases to rates paid to managed care plans and county-based 229.22purchasing plans as follows:229.23(1) 7.5 percent for medical assistance elderly basic care. This shall not apply 229.24to Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver 229.25services;229.26(2) 5.0 percent for medical assistance special needs basic care;229.27(3) 2.0 percent for medical assistance families and children;229.28(4) 3.0 percent for medical assistance adults without children;229.29(5) 3.0 percent for MinnesotaCare families and children; and229.30(6) 3.0 percent for MinnesotaCare adults without children.229.31(e) The commissioner may limit trend increases to less than the maximum. 229.32Beginning July January 1, 2014, the commissioner shall limit the maximum annual trend 229.33increases to rates paid to managed care plans and county-based purchasing plans as 229.34follows for calendar years 2014 and, 2015, 2016, and 2017:230.1(1) 7.5 6.0  percent for medical assistance elderly basic care. This shall not apply 230.2to Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver 230.3services;230.4(2) 5.0 0.5  percent for medical assistance special needs basic care;230.5(3) 2.0 0.5 percent for medical assistance families and children;230.6(4) 3.0 0  percent for medical assistance adults without children;230.7(5) 3.0 percent for MinnesotaCare families and children; and230.8(6) 4.0 percent for MinnesotaCare adults without children.230.9The commissioner may limit trend increases to less than the maximum.230.10    Sec. 19. Minnesota Statutes 2012, section 256B.69, is amended by adding a 230.11subdivision to read:230.12    Subd. 34.Risk corridors.(a) Effective for services rendered on or after January 1, 230.132014, the commissioner shall establish risk corridors that are actuarially sound for each 230.14managed care plan and each county-based purchasing plan providing services under this 230.15section and section 256B.692. The risk corridors shall be calculated annually based on the 230.16calendar year's net underwriting gain or loss. If the managed care plan or county-based 230.17purchasing plan achieved a net underwriting gain of greater than three percent of 230.18revenue, any excess must be repaid to the commissioner by July 31 of the year following 230.19calculation of the risk corridor year. If the managed care plan or county-based purchasing 230.20plan has incurred a net underwriting loss greater than three percent of total revenue, any 230.21excess must be repaid to the managed care plan or county-based purchasing plan by 230.22the commissioner by July 31 of the year following calculation of the risk corridor year. 230.23Determination of total revenues and net underwriting gain or loss must be based on the 230.24Minnesota supplement report #1 that is filed on April 1 of the year following calculation 230.25of the risk corridor and adjusted for the actual withhold calculation under subdivision 5a 230.26and section 256L.12, subdivision 9. The report must be filed with the commissioner of 230.27health and must be made available on the Department of Health's Web site.230.28(b) This subdivision shall not apply to the special demonstration projects under 230.29subdivisions 23 and 28.230.30    Sec. 20. Minnesota Statutes 2012, section 256B.76, subdivision 1, is amended to read:230.31    Subdivision 1. Physician reimbursement.  (a) Effective for services rendered on 230.32or after October 1, 1992, the commissioner shall make payments for physician services 230.33as follows:231.1    (1) payment for level one Centers for Medicare and Medicaid Services' common 231.2procedural coding system codes titled "office and other outpatient services," "preventive 231.3medicine new and established patient," "delivery, antepartum, and postpartum care," 231.4"critical care," cesarean delivery and pharmacologic management provided to psychiatric 231.5patients, and level three codes for enhanced services for prenatal high risk, shall be paid 231.6at the lower of (i) submitted charges, or (ii) 25 percent above the rate in effect on June 231.730, 1992. If the rate on any procedure code within these categories is different than the 231.8rate that would have been paid under the methodology in section 
         256B.74, subdivision 2, 231.9then the larger rate shall be paid;231.10    (2) payments for all other services shall be paid at the lower of (i) submitted charges, 231.11or (ii) 15.4 percent above the rate in effect on June 30, 1992; and231.12    (3) all physician rates shall be converted from the 50th percentile of 1982 to the 50th 231.13percentile of 1989, less the percent in aggregate necessary to equal the above increases 231.14except that payment rates for home health agency services shall be the rates in effect 231.15on September 30, 1992.231.16    (b) Effective for services rendered on or after January 1, 2000, payment rates for 231.17physician and professional services shall be increased by three percent over the rates 231.18in effect on December 31, 1999, except for home health agency and family planning 231.19agency services. The increases in this paragraph shall be implemented January 1, 2000, 231.20for managed care.231.21(c) Effective for services rendered on or after July 1, 2009, payment rates for 231.22physician and professional services shall be reduced by five percent, except that for the 231.23period July 1, 2009, through June 30, 2010, payment rates shall be reduced by 6.5 percent 231.24for the medical assistance and general assistance medical care programs, over the rates in 231.25effect on June 30, 2009. This reduction and the reductions in paragraph (d) do not apply 231.26to office or other outpatient visits, preventive medicine visits and family planning visits 231.27billed by physicians, advanced practice nurses, or physician assistants in a family planning 231.28agency or in one of the following primary care practices: general practice, general internal 231.29medicine, general pediatrics, general geriatrics, and family medicine. This reduction 231.30and the reductions in paragraph (d) do not apply to federally qualified health centers, 231.31rural health centers, and Indian health services. Effective October 1, 2009, payments 231.32made to managed care plans and county-based purchasing plans under sections 
         256B.69, 231.33256B.692
         , and 
         256L.12 shall reflect the payment reduction described in this paragraph.231.34(d) Effective for services rendered on or after July 1, 2010, payment rates for 231.35physician and professional services shall be reduced an additional seven percent over 231.36the five percent reduction in rates described in paragraph (c). This additional reduction 232.1does not apply to physical therapy services, occupational therapy services, and speech 232.2pathology and related services provided on or after July 1, 2010. This additional reduction 232.3does not apply to physician services billed by a psychiatrist or an advanced practice nurse 232.4with a specialty in mental health. Effective October 1, 2010, payments made to managed 232.5care plans and county-based purchasing plans under sections 
         256B.69, 
         256B.692, and 232.6256L.12
          shall reflect the payment reduction described in this paragraph.232.7(e) Effective for services rendered on or after September 1, 2011, through June 30, 232.82013, payment rates for physician and professional services shall be reduced three percent 232.9from the rates in effect on August 31, 2011. This reduction does not apply to physical 232.10therapy services, occupational therapy services, and speech pathology and related services.232.11(f) Effective for services rendered on or after January 1, 2015, payment rates for 232.12physician and professional services, including physical therapy, occupational therapy, 232.13speech pathology, and mental health services shall be increased by five percent from 232.14the rates in effect on December 31, 2014. This increase does not apply to federally 232.15qualified health centers, rural health centers, and Indian health services. Payments made to 232.16managed care plans and county-based purchasing plans shall not be adjusted to reflect 232.17payments under this paragraph.232.18    Sec. 21. Minnesota Statutes 2012, section 256B.76, subdivision 2, is amended to read:232.19    Subd. 2. Dental reimbursement.  (a) Effective for services rendered on or after 232.20October 1, 1992, the commissioner shall make payments for dental services as follows:232.21    (1) dental services shall be paid at the lower of (i) submitted charges, or (ii) 25 232.22percent above the rate in effect on June 30, 1992; and232.23    (2) dental rates shall be converted from the 50th percentile of 1982 to the 50th 232.24percentile of 1989, less the percent in aggregate necessary to equal the above increases.232.25    (b) Beginning October 1, 1999, the payment for tooth sealants and fluoride treatments 232.26shall be the lower of (1) submitted charge, or (2) 80 percent of median 1997 charges.232.27    (c) Effective for services rendered on or after January 1, 2000, payment rates for 232.28dental services shall be increased by three percent over the rates in effect on December 232.2931, 1999.232.30    (d) Effective for services provided on or after January 1, 2002, payment for 232.31diagnostic examinations and dental x-rays provided to children under age 21 shall be the 232.32lower of (1) the submitted charge, or (2) 85 percent of median 1999 charges.232.33    (e) The increases listed in paragraphs (b) and (c) shall be implemented January 1, 232.342000, for managed care.233.1(f) Effective for dental services rendered on or after October 1, 2010, by a 233.2state-operated dental clinic, payment shall be paid on a reasonable cost basis that is based 233.3on the Medicare principles of reimbursement. This payment shall be effective for services 233.4rendered on or after January 1, 2011, to recipients enrolled in managed care plans or 233.5county-based purchasing plans.233.6(g) Beginning in fiscal year 2011, if the payments to state-operated dental clinics 233.7in paragraph (f), including state and federal shares, are less than $1,850,000 per fiscal 233.8year, a supplemental state payment equal to the difference between the total payments 233.9in paragraph (f) and $1,850,000 shall be paid from the general fund to state-operated 233.10services for the operation of the dental clinics.233.11(h) If the cost-based payment system for state-operated dental clinics described in 233.12paragraph (f) does not receive federal approval, then state-operated dental clinics shall be 233.13designated as critical access dental providers under subdivision 4, paragraph (b), and shall 233.14receive the critical access dental reimbursement rate as described under subdivision 4, 233.15paragraph (a).233.16(i) Effective for services rendered on or after September 1, 2011, through June 30, 233.172013, payment rates for dental services shall be reduced by three percent. This reduction 233.18does not apply to state-operated dental clinics in paragraph (f).233.19(j) Effective for services rendered on or after January 1, 2015, payment rates for 233.20dental services shall be increased by five percent from the rates in effect on December 233.2131, 2014. This increase does not apply to state-operated dental clinics in paragraph 233.22(f), federally qualified health centers, rural health centers, and Indian health services. 233.23Effective January 1, 2015, payments made to managed care plans and county-based 233.24purchasing plans under sections 256B.69, 256B.692, and chapter 256L shall reflect the 233.25payment increase described in this paragraph.233.26    Sec. 22. Minnesota Statutes 2012, section 256B.76, subdivision 4, is amended to read:233.27    Subd. 4. Critical access dental providers.  (a) Effective for dental services rendered 233.28on or after January 1, 2002, the commissioner shall increase reimbursements to dentists 233.29and dental clinics deemed by the commissioner to be critical access dental providers. 233.30For dental services rendered on or after July 1, 2007, the commissioner shall increase 233.31reimbursement by 30 35 percent above the reimbursement rate that would otherwise be 233.32paid to the critical access dental provider. The commissioner shall pay the managed 233.33care plans and county-based purchasing plans in amounts sufficient to reflect increased 233.34reimbursements to critical access dental providers as approved by the commissioner.234.1(b) The commissioner shall designate the following dentists and dental clinics as 234.2critical access dental providers:234.3    (1) nonprofit community clinics that:234.4(i) have nonprofit status in accordance with chapter 317A;234.5(ii) have tax exempt status in accordance with the Internal Revenue Code, section 234.6501(c)(3);234.7(iii) are established to provide oral health services to patients who are low income, 234.8uninsured, have special needs, and are underserved;234.9(iv) have professional staff familiar with the cultural background of the clinic's 234.10patients;234.11(v) charge for services on a sliding fee scale designed to provide assistance to 234.12low-income patients based on current poverty income guidelines and family size;234.13(vi) do not restrict access or services because of a patient's financial limitations 234.14or public assistance status; and234.15(vii) have free care available as needed;234.16    (2) federally qualified health centers, rural health clinics, and public health clinics;234.17    (3) city or county owned and operated hospital-based dental clinics;234.18(4) a dental clinic or dental group owned and operated by a nonprofit corporation in 234.19accordance with chapter 317A with more than 10,000 patient encounters per year with 234.20patients who are uninsured or covered by medical assistance, general assistance medical 234.21care, or MinnesotaCare; and234.22(5) a dental clinic owned and operated by the University of Minnesota or the 234.23Minnesota State Colleges and Universities system.; and234.24(6) private practicing dentists if:234.25(i) the dentist's office is located within a health professional shortage area as defined 234.26under Code of Federal Regulations, title 42, part 5, and United States Code, title 42, 234.27section 254E;234.28(ii) more than 50 percent of the dentist's patient encounters per year are with patients 234.29who are uninsured or covered by medical assistance or MinnesotaCare;234.30(iii) the dentist does not restrict access or services because of a patient's financial 234.31limitations or public assistance status; and234.32(iv) the level of service provided by the dentist is critical to maintaining adequate 234.33levels of patient access within the service area in which the dentist operates.234.34    (c) The commissioner may designate a dentist or dental clinic as a critical access 234.35dental provider if the dentist or dental clinic is willing to provide care to patients covered 235.1by medical assistance, general assistance medical care, or MinnesotaCare at a level which 235.2significantly increases access to dental care in the service area.235.3(d) (c) A designated critical access clinic shall receive the reimbursement rate 235.4specified in paragraph (a) for dental services provided off site at a private dental office if 235.5the following requirements are met:235.6(1) the designated critical access dental clinic is located within a health professional 235.7shortage area as defined under Code of Federal Regulations, title 42, part 5, and United 235.8States Code, title 42, section 254E, and is located outside the seven-county metropolitan 235.9area;235.10(2) the designated critical access dental clinic is not able to provide the service 235.11and refers the patient to the off-site dentist;235.12(3) the service, if provided at the critical access dental clinic, would be reimbursed 235.13at the critical access reimbursement rate;235.14(4) the dentist and allied dental professionals providing the services off site are 235.15licensed and in good standing under chapter 150A;235.16(5) the dentist providing the services is enrolled as a medical assistance provider;235.17(6) the critical access dental clinic submits the claim for services provided off site 235.18and receives the payment for the services; and235.19(7) the critical access dental clinic maintains dental records for each claim submitted 235.20under this paragraph, including the name of the dentist, the off-site location, and the 235.21license number of the dentist and allied dental professionals providing the services.235.22    Sec. 23. Minnesota Statutes 2012, section 256B.76, is amended by adding a 235.23subdivision to read:235.24    Subd. 7.Payment for certain primary care services and immunization 235.25administration.Payment for certain primary care services and immunization 235.26administration services rendered on or after January 1, 2013, through December 31, 2014, 235.27shall be made in accordance with section 1902(a)(13) of the Social Security Act.235.28    Sec. 24. Minnesota Statutes 2012, section 256B.764, is amended to read:235.29256B.764 REIMBURSEMENT FOR FAMILY PLANNING SERVICES.235.30    (a) Effective for services rendered on or after July 1, 2007, payment rates for family 235.31planning services shall be increased by 25 percent over the rates in effect June 30, 2007, 235.32when these services are provided by a community clinic as defined in section 
         145.9268, 235.33subdivision 1.236.1    (b) Effective for services rendered on or after July 1, 2014, payment rates for 236.2family planning services shall be increased by 20 percent over the rates in effect June 236.330, 2014, when these services are provided by a community clinic as defined in section 236.4145.9268, subdivision 1. The commissioner shall adjust capitation rates to managed care 236.5and county-based purchasing plans to reflect this increase, and shall require plans to pass 236.6on the full amount of the rate increase to eligible community clinics, in the form of higher 236.7payment rates for family planning services.236.8    Sec. 25. Minnesota Statutes 2012, section 256B.766, is amended to read:236.9256B.766 REIMBURSEMENT FOR BASIC CARE SERVICES.236.10(a) Effective for services provided on or after July 1, 2009, total payments for basic 236.11care services, shall be reduced by three percent, except that for the period July 1, 2009, 236.12through June 30, 2011, total payments shall be reduced by 4.5 percent for the medical 236.13assistance and general assistance medical care programs, prior to third-party liability and 236.14spenddown calculation. Effective July 1, 2010, the commissioner shall classify physical 236.15therapy services, occupational therapy services, and speech-language pathology and 236.16related services as basic care services. The reduction in this paragraph shall apply to 236.17physical therapy services, occupational therapy services, and speech-language pathology 236.18and related services provided on or after July 1, 2010.236.19(b) Payments made to managed care plans and county-based purchasing plans shall 236.20be reduced for services provided on or after October 1, 2009, to reflect the reduction 236.21effective July 1, 2009, and payments made to the plans shall be reduced effective October 236.221, 2010, to reflect the reduction effective July 1, 2010.236.23(c) Effective for services provided on or after September 1, 2011, through June 30, 236.242013, total payments for outpatient hospital facility fees shall be reduced by five percent 236.25from the rates in effect on August 31, 2011.236.26(d) Effective for services provided on or after September 1, 2011, through June 236.2730, 2013, total payments for ambulatory surgery centers facility fees, medical supplies 236.28and durable medical equipment not subject to a volume purchase contract, prosthetics 236.29and orthotics, renal dialysis services, laboratory services, public health nursing services, 236.30physical therapy services, occupational therapy services, speech therapy services, 236.31eyeglasses not subject to a volume purchase contract, hearing aids not subject to a volume 236.32purchase contract, and  anesthesia services, and hospice services shall be reduced by three 236.33percent from the rates in effect on August 31, 2011.236.34(e) Effective for services provided on or after January 1, 2015, payments for 236.35ambulatory surgery centers facility fees, medical supplies and durable medical equipment 237.1not subject to a volume purchase contract, prosthetics and orthotics, hospice services, 237.2renal dialysis services, laboratory services, public health nursing services, eyeglasses 237.3not subject to a volume purchase contract, and hearing aids not subject to a volume 237.4purchase contract shall be increased by three percent. Payments made to managed care 237.5plans and county-based purchasing plans shall not be adjusted to reflect payments under 237.6this paragraph.237.7(e) (f) This section does not apply to physician and professional services, inpatient 237.8hospital services, family planning services, mental health services, dental services, 237.9prescription drugs, medical transportation, federally qualified health centers, rural health 237.10centers, Indian health services, and Medicare cost-sharing.237.11    Sec. 26. Laws 2012, chapter 247, article 1, section 28, is amended to read:237.12    Sec. 28. EMERGENCY MEDICAL ASSISTANCE STUDY.237.13(a) The commissioner of human services shall convene a work group to develop a 237.14plan to provide coordinated and cost-effective health care and coverage for individuals 237.15who meet eligibility standards for emergency medical assistance and who are ineligible 237.16for other state public programs. The commissioner shall consult with work group shall 237.17consist of representatives of  relevant stakeholders in the development of the plan, 237.18including but not limited to safety net hospitals, nonprofit health care coverage programs, 237.19nonprofit community clinics, and counties. The commissioner work group shall consider 237.20the following elements:237.21(1) strategies to provide individuals with the most appropriate care in the appropriate 237.22setting, utilizing higher quality and lower cost providers;237.23(2) payment mechanisms to encourage providers to manage the care of these 237.24populations, and to produce lower cost of care and better patient outcomes;237.25(3) ensure coverage and payment options that address the unique needs of those 237.26needing episodic care, chronic care, and long-term care services;237.27(4) strategies for coordinating health care and nonhealth care services, and 237.28integrating with existing coverage; and237.29(5) other issues and strategies to ensure cost-effective and coordinated delivery 237.30of coverage and services.237.31(b) The commissioner shall submit the plan of the work group to the chairs and 237.32ranking minority members of the legislative committees with jurisdiction over health and 237.33human services policy and financing by January 15 July 15, 2013.237.34EFFECTIVE DATE.This section is effective the day following final enactment.238.1    Sec. 27. Laws 2013, chapter 1, section 6, is amended to read:238.2    Sec. 6. TRANSFER.238.3(a) The commissioner of management and budget shall transfer from the health care 238.4access fund to the general fund up to $21,319,000 in fiscal year 2014; up to $42,314,000 238.5in fiscal year 2015; up to $56,147,000 in fiscal year 2016; and up to $64,683,000 in fiscal 238.6year 2017.238.7(b) The commissioner of human services shall determine the difference between the 238.8actual cost to the medical assistance program of adding 19- and 20-year-olds and parents 238.9and relative caretaker populations with income between 100 and 138 percent of the federal 238.10poverty guidelines and the cost of adding those populations that was estimated during the 238.112013 legislative session based on the data from the February 2013 forecast.238.12(c) For each fiscal year from 2014 to 2017, the commissioner of human services 238.13shall certify and report to the commissioner of management and budget the actual cost 238.14difference of adding 19- and 20-year-olds and parents and relative caretaker populations 238.15with income between 100 and 138 percent of the federal poverty guidelines, as determined 238.16under paragraph (b), by June 30 of each fiscal year. In each fiscal year, the commissioner 238.17of management and budget shall reduce the transfer under paragraph (a) by the amount 238.18of the costs certified under paragraph (b). If, for any fiscal year, the amount of the cost 238.19difference determined under paragraph (b) exceeds the amount of the transfer, the transfer 238.20for that year must be zero.238.21    Sec. 28. 340B PROVIDER PRESCRIPTION DRUGS REIMBURSEMENT 238.22STUDY.238.23(a) The commissioner of human services shall study and make recommendations on 238.24changes to standardize the medical assistance reimbursement rates for prescription drugs 238.25obtained through the federal 340B Program and dispensed to medical assistance enrollees. 238.26The study must examine the current medical assistance rate 340B providers are receiving 238.27through claims submissions and make recommendations on an overall reimbursement 238.28discount that will pay the same for drugs dispensed through the 340B Program as is paid 238.29for drugs dispensed by non340B providers, taking into consideration any federal rebate.238.30(b) The commissioner shall consult with 340B providers that would be most 238.31affected by a change in the reimbursement formula, including but not limited to safety net 238.32hospitals, children's hospitals, community health centers, and family planning clinics.238.33(c) The commissioner shall submit recommendations to the chairs and ranking 238.34minority members of the legislative committees and divisions with jurisdiction over health 238.35and human services policy and finance by January 15, 2014.239.1    Sec. 29. DENTAL ACCESS AND REIMBURSEMENT REPORT.239.2    Subdivision 1.Study.(a) The commissioner of human services shall study 239.3the current oral health and dental services delivery system for state public health 239.4care programs to improve access and ensure cost-effective delivery of services. The 239.5commissioner shall make recommendations on modifying the delivery of services and 239.6reimbursement methods, including modifications to the critical access dental provider 239.7payments under Minnesota Statutes, section 256B.76, subdivision 4.239.8(b) The commissioner shall consult with dental providers enrolled in Minnesota 239.9health care programs, including providers who serve substantial numbers of low-income 239.10and uninsured patients and are currently receiving enhanced critical access dental provider 239.11payments.239.12    Subd. 2.Service delivery and reimbursement methods.The recommendations 239.13must address:239.14(1) targeting state funding and critical access dental payments to improve access 239.15to oral health services for individuals enrolled in Minnesota health care programs who 239.16are not receiving timely and appropriate dental services;239.17(2) encouraging the use of cost-effective service delivery methods, workforce 239.18innovations, and the delivery of preventive services, including, but not limited to, dental 239.19sealants that will reduce dental disease and future costs of treatment;239.20(3) improving access in all geographic areas of the state;239.21(4) encouraging the use of tele-dentistry and mobile dental equipment to serve 239.22underserved patients and communities;239.23(5) evaluating the use of a single administrator delivery model;239.24(6) compensating providers for the added costs to providers of serving low-income 239.25and underserved patients and populations who experience the greatest oral health 239.26disparities in terms of incidence of oral health disease and access to and utilization of 239.27needed oral health services;239.28(7) encouraging coordination of oral health care with other health care services;239.29(8) preventing overtreatment, fraud, and abuse; and239.30(9) reducing administrative costs for the state and for dental providers.239.31    Subd. 3.Report.The commissioner shall submit a report on the recommendations to 239.32the chairs and ranking minority members of the of the legislative committees and divisions 239.33with jurisdiction over health and human services policy and finance by December 15, 2013.239.34    Sec. 30. TAX FORM POSTING.240.1Any nonprofit organization that receives state grant funds from the commissioner of 240.2human services or the commissioner of health shall annually post the organization's 990 240.3tax form on its Web site, if the organization has a Web site.240.4ARTICLE 7240.5CONTINUING CARE240.6    Section 1. Minnesota Statutes 2012, section 144.0724, subdivision 6, is amended to read:240.7    Subd. 6. Penalties for late or nonsubmission.(a) A facility that fails to complete 240.8or submit an assessment for a RUG-III or RUG-IV classification within seven days of the 240.9time requirements in subdivisions 4 and 5 is subject to a reduced rate for that resident. 240.10The reduced rate shall be the lowest rate for that facility. The reduced rate is effective on 240.11the day of admission for new admission assessments or on the day that the assessment 240.12was due for all other assessments and continues in effect until the first day of the month 240.13following the date of submission of the resident's assessment.240.14    (b) If loss of revenue due to penalties incurred by a facility for any period of 92 days 240.15are equal to or greater than 1.0 percent of the total operating costs on the facility's most 240.16recent annual statistical and cost report, a facility may apply to the commissioner of 240.17human services for a reduction in the total penalty amount. The commissioner of human 240.18services, in consultation with the commissioner of health, may, at the sole discretion of 240.19the commissioner of human services, limit the penalty for residents covered by medical 240.20assistance to 15 days.240.21    Sec. 2. Minnesota Statutes 2012, section 144A.071, subdivision 4b, is amended to read:240.22    Subd. 4b. Licensed beds on layaway status. A licensed and certified nursing 240.23facility may lay away, upon prior written notice to the commissioner of health, licensed 240.24and certified beds. A nursing facility may not discharge a resident in order to lay away 240.25a bed. Notice to the commissioner shall be given 60 days prior to the effective date of 240.26the layaway. Beds on layaway shall have the same status as voluntarily delicensed and 240.27decertified beds and shall not be subject to license fees and license surcharge fees. In 240.28addition, beds on layaway may be removed from layaway at any time on or after one year240.29 six months  after the effective date of layaway in the facility of origin, with a 60-day notice 240.30to the commissioner. A nursing facility that removes beds from layaway may not place 240.31beds on layaway status for one year six months  after the effective date of the removal from 240.32layaway. The commissioner may approve the immediate removal of beds from layaway if 240.33necessary to provide access to those nursing home beds to residents relocated from other 240.34nursing homes due to emergency situations or closure. In the event approval is granted, 241.1the one-year six-month  restriction on placing beds on layaway after a removal of beds 241.2from layaway shall not apply. Beds may remain on layaway for up to ten years. The 241.3commissioner may approve placing and removing beds on layaway at any time during 241.4renovation or construction related to a moratorium project approved under this section 241.5or section 
         144A.073. Nursing facilities are not required to comply with any licensure or 241.6certification requirements for beds on layaway status.241.7    Sec. 3. Minnesota Statutes 2012, section 245A.03, subdivision 7, is amended to read:241.8    Subd. 7. Licensing moratorium. (a) The commissioner shall not issue an 241.9initial license for child foster care licensed under Minnesota Rules, parts 2960.3000 to 241.102960.3340, or adult foster care licensed under Minnesota Rules, parts 9555.5105 to 241.119555.6265, under this chapter for a physical location that will not be the primary residence 241.12of the license holder for the entire period of licensure. If a license is issued during this 241.13moratorium, and the license holder changes the license holder's primary residence away 241.14from the physical location of the foster care license, the commissioner shall revoke the 241.15license according to section 
         245A.07. Exceptions to the moratorium include:241.16(1) foster care settings that are required to be registered under chapter 144D;241.17(2) foster care licenses replacing foster care licenses in existence on May 15, 2009, 241.18and determined to be needed by the commissioner under paragraph (b);241.19(3) new foster care licenses determined to be needed by the commissioner under 241.20paragraph (b) for the closure of a nursing facility, ICF/MR, or regional treatment center, or;241.21 restructuring of state-operated services that limits the capacity of state-operated facilities;241.22(4) new foster care licenses determined to be needed by the commissioner under 241.23paragraph (b) for persons requiring hospital level care; or241.24(5) new foster care licenses determined to be needed by the commissioner for the 241.25transition of people from personal care assistance to the home and community-based 241.26services.241.27(b) The commissioner shall determine the need for newly licensed foster care homes 241.28as defined under this subdivision. As part of the determination, the commissioner shall 241.29consider the availability of foster care capacity in the area in which the licensee seeks to 241.30operate, and the recommendation of the local county board. The determination by the 241.31commissioner must be final. A determination of need is not required for a change in 241.32ownership at the same address.241.33(c) The commissioner shall study the effects of the license moratorium under this 241.34subdivision and shall report back to the legislature by January 15, 2011. This study shall 241.35include, but is not limited to the following:242.1(1) the overall capacity and utilization of foster care beds where the physical location 242.2is not the primary residence of the license holder prior to and after implementation 242.3of the moratorium;242.4(2) the overall capacity and utilization of foster care beds where the physical 242.5location is the primary residence of the license holder prior to and after implementation 242.6of the moratorium; and242.7(3) the number of licensed and occupied ICF/MR beds prior to and after 242.8implementation of the moratorium.242.9(d) (c) When a foster care recipient moves out of a foster home that is not the primary 242.10residence of the license holder according to section 
         256B.49, subdivision 15, paragraph 242.11(f), the county shall immediately inform the Department of Human Services Licensing 242.12Division. The department shall decrease the statewide licensed capacity for foster care 242.13settings where the physical location is not the primary residence of the license holder, if 242.14the voluntary changes described in paragraph (f) (e) are not sufficient to meet the savings 242.15required by reductions in licensed bed capacity under Laws 2011, First Special Session 242.16chapter 9, article 7, sections 1 and 40, paragraph (f), and maintain statewide long-term 242.17care residential services capacity within budgetary limits. Implementation of the statewide 242.18licensed capacity reduction shall begin on July 1, 2013. The commissioner shall delicense 242.19up to 128 beds by June 30, 2014, using the needs determination process. Under this 242.20paragraph, the commissioner has the authority to reduce unused licensed capacity of a 242.21current foster care program to accomplish the consolidation or closure of settings. Under 242.22this paragraph, the commissioner has the authority to manage statewide capacity, including 242.23adjusting the capacity available to each county and adjusting statewide available capacity, 242.24to meet the statewide needs identified through the process in paragraph (e). A decreased 242.25licensed capacity according to this paragraph is not subject to appeal under this chapter.242.26(e) (d) Residential settings that would otherwise be subject to the decreased license 242.27capacity established in paragraph (d) (c) shall be exempt under the following circumstances:242.28(1) until August 1, 2013, the license holder's beds occupied by residents whose 242.29primary diagnosis is mental illness and the license holder is:242.30(i) a provider of assertive community treatment (ACT) or adult rehabilitative mental 242.31health services (ARMHS) as defined in section 
         256B.0623;242.32(ii) a mental health center certified under Minnesota Rules, parts 9520.0750 to 242.339520.0870;242.34(iii) a mental health clinic certified under Minnesota Rules, parts 9520.0750 to 242.359520.0870; or243.1(iv) a provider of intensive residential treatment services (IRTS) licensed under 243.2Minnesota Rules, parts 9520.0500 to 9520.0670; or243.3(2) the license holder's beds occupied by residents whose primary diagnosis is 243.4mental illness and the license holder is certified under the requirements in subdivision 6a.243.5(f) (e) A resource need determination process, managed at the state level, using the 243.6available reports required by section 
         144A.351, and other data and information shall 243.7be used to determine where the reduced capacity required under paragraph (d) (c) will 243.8be implemented. The commissioner shall consult with the stakeholders described in 243.9section 
         144A.351, and employ a variety of methods to improve the state's capacity to 243.10meet long-term care service needs within budgetary limits, including seeking proposals 243.11from service providers or lead agencies to change service type, capacity, or location to 243.12improve services, increase the independence of residents, and better meet needs identified 243.13by the long-term care services reports and statewide data and information. By February 243.141 of each, 2013, and August 1, 2014, and each following year, the commissioner shall 243.15provide information and data on the overall capacity of licensed long-term care services, 243.16actions taken under this subdivision to manage statewide long-term care services and 243.17supports resources, and any recommendations for change to the legislative committees 243.18with jurisdiction over health and human services budget.243.19    (g) (f) At the time of application and reapplication for licensure, the applicant and the 243.20license holder that are subject to the moratorium or an exclusion established in paragraph 243.21(a) are required to inform the commissioner whether the physical location where the foster 243.22care will be provided is or will be the primary residence of the license holder for the entire 243.23period of licensure. If the primary residence of the applicant or license holder changes, the 243.24applicant or license holder must notify the commissioner immediately. The commissioner 243.25shall print on the foster care license certificate whether or not the physical location is the 243.26primary residence of the license holder.243.27    (h) (g) License holders of foster care homes identified under paragraph (g) (f) that 243.28are not the primary residence of the license holder and that also provide services in the 243.29foster care home that are covered by a federally approved home and community-based 243.30services waiver, as authorized under section 
         256B.0915, 
         256B.092, or 
         256B.49, must 243.31inform the human services licensing division that the license holder provides or intends to 243.32provide these waiver-funded services. These license holders must be considered registered 243.33under section 
         256B.092, subdivision 11, paragraph (c), and this registration status must 243.34be identified on their license certificates.244.1    Sec. 4. Minnesota Statutes 2012, section 252.291, is amended by adding a subdivision 244.2to read:244.3    Subd. 2b. Nicollet County facility project.The commissioner of health shall 244.4certify one additional bed in an intermediate care facility for persons with developmental 244.5disabilities in Nicollet County.244.6    Sec. 5. Minnesota Statutes 2012, section 256B.0915, subdivision 3a, is amended to read:244.7    Subd. 3a. Elderly waiver cost limits. (a) The monthly limit for the cost of 244.8waivered services to an individual elderly waiver client except for individuals described in 244.9paragraph paragraphs (b) and (d) shall be the weighted average monthly nursing facility 244.10rate of the case mix resident class to which the elderly waiver client would be assigned 244.11under Minnesota Rules, parts 9549.0050 to 9549.0059, less the recipient's maintenance 244.12needs allowance as described in subdivision 1d, paragraph (a), until the first day of the 244.13state fiscal year in which the resident assessment system as described in section 
         256B.438244.14for nursing home rate determination is implemented. Effective on the first day of the state 244.15fiscal year in which the resident assessment system as described in section 
         256B.438 for 244.16nursing home rate determination is implemented and the first day of each subsequent state 244.17fiscal year, the monthly limit for the cost of waivered services to an individual elderly 244.18waiver client shall be the rate of the case mix resident class to which the waiver client 244.19would be assigned under Minnesota Rules, parts 9549.0050 to 9549.0059, in effect on 244.20the last day of the previous state fiscal year, adjusted by any legislatively adopted home 244.21and community-based services percentage rate adjustment.244.22    (b) The monthly limit for the cost of waivered services to an individual elderly 244.23waiver client assigned to a case mix classification A under paragraph (a) with:244.24(1) no dependencies in activities of daily living; or244.25(2) up to two dependencies in bathing, dressing, grooming, walking, and eating 244.26when the dependency score in eating is three or greater as determined by an assessment 244.27performed under section 
         256B.0911 shall be $1,750 per month effective on July 1, 2011, 244.28for all new participants enrolled in the program on or after July 1, 2011. This monthly 244.29limit shall be applied to all other participants who meet this criteria at reassessment. This 244.30monthly limit shall be increased annually as described in paragraph (a).244.31(c) If extended medical supplies and equipment or environmental modifications are 244.32or will be purchased for an elderly waiver client, the costs may be prorated for up to 244.3312 consecutive months beginning with the month of purchase. If the monthly cost of a 244.34recipient's waivered services exceeds the monthly limit established in paragraph (a) or 244.35(b), the annual cost of all waivered services shall be determined. In this event, the annual 245.1cost of all waivered services shall not exceed 12 times the monthly limit of waivered 245.2services as described in paragraph (a) or (b).245.3(d) Effective July 1, 2013, the monthly cost limit of waiver services, including 245.4any necessary home care services described in section 256B.0651, subdivision 2, for 245.5individuals who meet the criteria as ventilator-dependent given in section 256B.0651, 245.6subdivision 1, paragraph (g), shall be the average of the monthly medical assistance 245.7amount established for home care services as described in section 256B.0652, subdivision 245.87, and the annual average contracted amount established by the commissioner for nursing 245.9facility services for ventilator-dependent individuals. This monthly limit shall be increased 245.10annually as described in paragraph (a).245.11    Sec. 6. Minnesota Statutes 2012, section 256B.0915, is amended by adding a 245.12subdivision to read:245.13    Subd. 3j.Individual community living support.Upon federal approval, there 245.14is established a new service called individual community living support (ICLS) that is 245.15available on the elderly waiver. ICLS providers may not be the landlord of recipients, nor 245.16have any interest in the recipient's housing. ICLS must be delivered in a single-family 245.17home or apartment where the service recipient or their family owns or rents, as 245.18demonstrated by a lease agreement, and maintains control over the individual unit. Case 245.19managers or care coordinators must develop individual ICLS plans in consultation with 245.20the client using a tool developed by the commissioner. The commissioner shall establish 245.21payment rates and mechanisms to align payments with the type and amount of service 245.22provided, assure statewide uniformity for payment rates, and assure cost-effectiveness. 245.23Licensing standards for ICLS shall be reviewed jointly by the Departments of Health and 245.24Human Services to avoid conflict with provider regulatory standards pursuant to section 245.25144A.43 and chapter 245D. 245.26    Sec. 7. Minnesota Statutes 2012, section 256B.0916, is amended by adding a 245.27subdivision to read:245.28    Subd. 11.Excess spending.County and tribal agencies are responsible for spending 245.29in excess of the allocation made by the commissioner. In the event a county or tribal 245.30agency spends in excess of the allocation made by the commissioner for a given allocation 245.31period, they must submit a corrective action plan to the commissioner. The plan must state 245.32the actions the agency will take to correct their overspending for the year following the 245.33period when the overspending occurred. Failure to correct overspending shall result in 245.34recoupment of spending in excess of the allocation. Nothing in this subdivision shall be 246.1construed as reducing the county's responsibility to offer and make available feasible 246.2home and community-based options to eligible waiver recipients within the resources 246.3allocated to them for that purpose.246.4    Sec. 8. Minnesota Statutes 2012, section 256B.092, subdivision 11, is amended to read:246.5    Subd. 11. Residential support services. (a) Upon federal approval, there is 246.6established a new service called residential support that is available on the community 246.7alternative care, community alternatives for disabled individuals, developmental 246.8disabilities, and brain injury waivers. Existing waiver service descriptions must be 246.9modified to the extent necessary to ensure there is no duplication between other services. 246.10Residential support services must be provided by vendors licensed as a community 246.11residential setting as defined in section 
         245A.11, subdivision 8.246.12    (b) Residential support services must meet the following criteria:246.13    (1) providers of residential support services must own or control the residential site;246.14    (2) the residential site must not be the primary residence of the license holder;246.15    (3) the residential site must have a designated program supervisor responsible for 246.16program oversight, development, and implementation of policies and procedures;246.17    (4) the provider of residential support services must provide supervision, training, 246.18and assistance as described in the person's coordinated service and support plan; and246.19    (5) the provider of residential support services must meet the requirements of 246.20licensure and additional requirements of the person's coordinated service and support plan.246.21    (c) Providers of residential support services that meet the definition in paragraph 246.22(a) must be registered using a process determined by the commissioner beginning July 246.231, 2009. Providers licensed to provide child foster care under Minnesota Rules, parts 246.242960.3000 to 2960.3340, or adult foster care licensed under Minnesota Rules, parts 246.259555.5105 to 9555.6265, and that meet the requirements in section 
         245A.03, subdivision 246.267
         , paragraph (g) (f), are considered registered under this section.246.27    Sec. 9. Minnesota Statutes 2012, section 256B.092, subdivision 12, is amended to read:246.28    Subd. 12. Waivered services statewide priorities. (a) The commissioner shall 246.29establish statewide priorities for individuals on the waiting list for developmental 246.30disabilities (DD) waiver services, as of January 1, 2010. The statewide priorities must 246.31include, but are not limited to, individuals who continue to have a need for waiver services 246.32after they have maximized the use of state plan services and other funding resources, 246.33including natural supports, prior to accessing waiver services, and who meet at least one 246.34of the following criteria:247.1(1) no longer require the intensity of services provided where they are currently 247.2living; or247.3(2) make a request to move from an institutional setting.247.4(b) After the priorities in paragraph (a) are met, priority must also be given to 247.5individuals who meet at least one of the following criteria:247.6(1) have unstable living situations due to the age, incapacity, or sudden loss of 247.7the primary caregivers;247.8(2) are moving from an institution due to bed closures;247.9(3) experience a sudden closure of their current living arrangement;247.10(4) require protection from confirmed abuse, neglect, or exploitation;247.11(5) experience a sudden change in need that can no longer be met through state plan 247.12services or other funding resources alone; or247.13(6) meet other priorities established by the department.247.14(b) (c) When allocating resources to lead agencies, the commissioner must take into 247.15consideration the number of individuals waiting who meet statewide priorities and the 247.16lead agencies' current use of waiver funds and existing service options. The commissioner 247.17has the authority to transfer funds between counties, groups of counties, and tribes to 247.18accommodate statewide priorities and resource needs while accounting for a necessary 247.19base level reserve amount for each county, group of counties, and tribe.247.20(c) The commissioner shall evaluate the impact of the use of statewide priorities and 247.21provide recommendations to the legislature on whether to continue the use of statewide 247.22priorities in the November 1, 2011, annual report required by the commissioner in sections 247.23256B.0916, subdivision 7, and 256B.49, subdivision 21.247.24    Sec. 10. Minnesota Statutes 2012, section 256B.092, is amended by adding a 247.25subdivision to read:247.26    Subd. 14.Reduce avoidable behavioral crisis emergency room admissions, 247.27psychiatric inpatient hospitalizations, and commitments to institutions.(a) Persons 247.28receiving home and community-based services authorized under this section who have 247.29had two or more admissions within a calendar year to an emergency room, psychiatric 247.30unit, or institution must receive consultation from a mental health professional as defined 247.31in section 245.462, subdivision 18, or a behavioral professional as defined in the home 247.32and community-based services state plan within 30 days of discharge. The mental health 247.33professional or behavioral professional must:247.34(1) conduct a functional assessment of the crisis incident as defined in section 247.35245D.02, subdivision 11, which led to the hospitalization with the goal of developing 248.1proactive strategies as well as necessary reactive strategies to reduce the likelihood of 248.2future avoidable hospitalizations due to a behavioral crisis;248.3(2) use the results of the functional assessment to amend the coordinated service and 248.4support plan set forth in section 245D.02, subdivision 4b, to address the potential need 248.5for additional staff training, increased staffing, access to crisis mobility services, mental 248.6health services, use of technology, and crisis stabilization services in section 256B.0624, 248.7subdivision 7; and 248.8(3) identify the need for additional consultation, testing, and mental health crisis 248.9intervention team services as defined in section 245D.02, subdivision 20, psychotropic 248.10medication use and monitoring under section 245D.051, and the frequency and duration 248.11of ongoing consultation. 248.12(b) For the purposes of this subdivision, "institution" includes, but is not limited to, 248.13the Anoka-Metro Regional Treatment Center and the Minnesota Security Hospital.248.14    Sec. 11. Minnesota Statutes 2012, section 256B.095, is amended to read:248.15256B.095 QUALITY ASSURANCE SYSTEM ESTABLISHED.248.16    (a) Effective July 1, 1998, a quality assurance system for persons with developmental 248.17disabilities, which includes an alternative quality assurance licensing system for programs, 248.18is established in Dodge, Fillmore, Freeborn, Goodhue, Houston, Mower, Olmsted, Rice, 248.19Steele, Wabasha, and Winona Counties for the purpose of improving the quality of 248.20services provided to persons with developmental disabilities. A county, at its option, may 248.21choose to have all programs for persons with developmental disabilities located within 248.22the county licensed under chapter 245A using standards determined under the alternative 248.23quality assurance licensing system or may continue regulation of these programs under the 248.24licensing system operated by the commissioner. The project expires on June 30, 2014.248.25    (b) Effective July 1, 2003, a county not listed in paragraph (a) may apply to 248.26participate in the quality assurance system established under paragraph (a). The 248.27commission established under section 
         256B.0951 may, at its option, allow additional 248.28counties to participate in the system.248.29    (c) Effective July 1, 2003, any county or group of counties not listed in paragraph (a) 248.30may establish a quality assurance system under this section. A new system established 248.31under this section shall have the same rights and duties as the system established 248.32under paragraph (a). A new system shall be governed by a commission under section 248.33256B.0951
         . The commissioner shall appoint the initial commission members based 248.34on recommendations from advocates, families, service providers, and counties in the 248.35geographic area included in the new system. Counties that choose to participate in a 249.1new system shall have the duties assigned under section 
         256B.0952. The new system 249.2shall establish a quality assurance process under section 
         256B.0953. The provisions of 249.3section 
         256B.0954 shall apply to a new system established under this paragraph. The 249.4commissioner shall delegate authority to a new system established under this paragraph 249.5according to section 
         256B.0955.249.6    (d) Effective July 1, 2007, the quality assurance system may be expanded to include 249.7programs for persons with disabilities and older adults.249.8(e) Effective July 1, 2013, a provider of service located in a county listed in 249.9paragraph (a) that is a non-opted-in county may opt in to the quality assurance system 249.10provided the county where services are provided indicates its agreement with a county 249.11with a delegation agreement with the Department of Human Services.249.12EFFECTIVE DATE.This section is effective July 1, 2013.249.13    Sec. 12. Minnesota Statutes 2012, section 256B.0951, subdivision 1, is amended to read:249.14    Subdivision 1. Membership. The Quality Assurance Commission is established. 249.15The commission consists of at least 14 but not more than 21 members as follows: at 249.16least three but not more than five members representing advocacy organizations; at 249.17least three but not more than five members representing consumers, families, and their 249.18legal representatives; at least three but not more than five members representing service 249.19providers; at least three but not more than five members representing counties; and the 249.20commissioner of human services or the commissioner's designee. The first commission 249.21shall establish membership guidelines for the transition and recruitment of membership for 249.22the commission's ongoing existence. Members of the commission who do not receive a 249.23salary or wages from an employer for time spent on commission duties may receive a per 249.24diem payment when performing commission duties and functions. All members may be 249.25reimbursed for expenses related to commission activities. Notwithstanding the provisions 249.26of section 15.059, subdivision 5, the commission expires on June 30, 2014.249.27    Sec. 13. Minnesota Statutes 2012, section 256B.0951, subdivision 4, is amended to read:249.28    Subd. 4. Commission's authority to recommend variances of licensing 249.29standards. The commission may recommend to the commissioners of human services 249.30and health variances from the standards governing licensure of programs for persons with 249.31developmental disabilities in order to improve the quality of services by implementing 249.32an alternative developmental disabilities licensing system if the commission determines 249.33that the alternative licensing system does not adversely affect the health or safety of 250.1persons being served by the licensed program nor compromise the qualifications of staff 250.2to provide services.250.3    Sec. 14. Minnesota Statutes 2012, section 256B.0952, subdivision 1, is amended to read:250.4    Subdivision 1. Notification. Counties or providers shall give notice to the 250.5commission and commissioners of human services and health of intent to join the 250.6alternative quality assurance licensing system. A county or provider choosing to participate 250.7in the alternative quality assurance licensing system commits to participate for three years.250.8    Sec. 15. Minnesota Statutes 2012, section 256B.0952, subdivision 5, is amended to read:250.9    Subd. 5. Quality assurance teams. Quality assurance teams shall be comprised 250.10of county staff; providers; consumers, families, and their legal representatives; members 250.11of advocacy organizations; and other involved community members. Team members 250.12must satisfactorily complete the training program approved by the commission and must 250.13demonstrate performance-based competency. Team members are not considered to be 250.14county employees for purposes of workers' compensation, unemployment insurance, or 250.15state retirement laws solely on the basis of participation on a quality assurance team. The 250.16county may pay A per diem may be paid to team members for time spent on alternative 250.17quality assurance process matters. All team members may be reimbursed for expenses 250.18related to their participation in the alternative process.250.19    Sec. 16. Minnesota Statutes 2012, section 256B.0955, is amended to read:250.20256B.0955 DUTIES OF THE COMMISSIONER OF HUMAN SERVICES.250.21(a) Effective July 1, 1998, the commissioner of human services shall delegate 250.22authority to perform licensing functions and activities, in accordance with section 250.23245A.16
         , to counties participating in the alternative quality assurance licensing system. 250.24The commissioner shall not license or reimburse a facility, program, or service for persons 250.25with developmental disabilities in a county that participates in the alternative quality 250.26assurance licensing system if the commissioner has received from the appropriate county 250.27notification that the facility, program, or service has been reviewed by a quality assurance 250.28team and has failed to qualify for licensure.250.29(b) The commissioner may conduct random licensing inspections based on outcomes 250.30adopted under section 
         256B.0951 at facilities, programs, and services governed by the 250.31alternative quality assurance licensing system. The role of such random inspections shall 250.32be to verify that the alternative quality assurance licensing system protects the safety 251.1and well-being of consumers and maintains the availability of high-quality services for 251.2persons with developmental disabilities.251.3EFFECTIVE DATE.This section is effective July 1, 2013.251.4    Sec. 17. Minnesota Statutes 2012, section 256B.097, subdivision 1, is amended to read:251.5    Subdivision 1. Scope. (a) In order to improve the quality of services provided to 251.6Minnesotans with disabilities and to meet the requirements of the federally approved home 251.7and community-based waivers under section 1915c of the Social Security Act, a State 251.8Quality Assurance, Quality Improvement, and Licensing System for Minnesotans receiving 251.9disability services is enacted. This system is a partnership between the Department of 251.10Human Services and the State Quality Council established under subdivision 3.251.11    (b) This system is a result of the recommendations from the Department of Human 251.12Services' licensing and alternative quality assurance study mandated under Laws 2005, 251.13First Special Session chapter 4, article 7, section 57, and presented to the legislature 251.14in February 2007.251.15    (c) The disability services eligible under this section include:251.16    (1) the home and community-based services waiver programs for persons with 251.17developmental disabilities under section 
         256B.092, subdivision 4, or section 
         256B.49, 251.18including brain injuries and services for those who qualify for nursing facility level of care 251.19or hospital facility level of care and any other services licensed under chapter 245D;251.20    (2) home care services under section 
         256B.0651;251.21    (3) family support grants under section 
         252.32;251.22    (4) consumer support grants under section 
         256.476;251.23    (5) semi-independent living services under section 
         252.275; and251.24    (6) services provided through an intermediate care facility for the developmentally 251.25disabled.251.26    (d) For purposes of this section, the following definitions apply:251.27    (1) "commissioner" means the commissioner of human services;251.28    (2) "council" means the State Quality Council under subdivision 3;251.29    (3) "Quality Assurance Commission" means the commission under section 251.30256B.0951
         ; and251.31    (4) "system" means the State Quality Assurance, Quality Improvement and 251.32Licensing System under this section.251.33    Sec. 18. Minnesota Statutes 2012, section 256B.097, subdivision 3, is amended to read:252.1    Subd. 3. State Quality Council. (a) There is hereby created a State Quality 252.2Council which must define regional quality councils, and carry out a community-based, 252.3person-directed quality review component, and a comprehensive system for effective 252.4incident reporting, investigation, analysis, and follow-up.252.5    (b) By August 1, 2011, the commissioner of human services shall appoint the 252.6members of the initial State Quality Council. Members shall include representatives 252.7from the following groups:252.8    (1) disability service recipients and their family members;252.9    (2) during the first two four years of the State Quality Council, there must be at least 252.10three members from the Region 10 stakeholders. As regional quality councils are formed 252.11under subdivision 4, each regional quality council shall appoint one member;252.12    (3) disability service providers;252.13    (4) disability advocacy groups; and252.14    (5) county human services agencies and staff from the Department of Human 252.15Services and Ombudsman for Mental Health and Developmental Disabilities.252.16    (c) Members of the council who do not receive a salary or wages from an employer 252.17for time spent on council duties may receive a per diem payment when performing council 252.18duties and functions.252.19    (d) The State Quality Council shall:252.20    (1) assist the Department of Human Services in fulfilling federally mandated 252.21obligations by monitoring disability service quality and quality assurance and 252.22improvement practices in Minnesota;252.23    (2) establish state quality improvement priorities with methods for achieving results 252.24and provide an annual report to the legislative committees with jurisdiction over policy 252.25and funding of disability services on the outcomes, improvement priorities, and activities 252.26undertaken by the commission during the previous state fiscal year;252.27(3) identify issues pertaining to financial and personal risk that impede Minnesotans 252.28with disabilities from optimizing choice of community-based services; and252.29(4) recommend to the chairs and ranking minority members of the legislative 252.30committees with jurisdiction over human services and civil law by January 15, 2013252.31 2014, statutory and rule changes related to the findings under clause (3) that promote 252.32individualized service and housing choices balanced with appropriate individualized 252.33protection.252.34    (e) The State Quality Council, in partnership with the commissioner, shall:252.35    (1) approve and direct implementation of the community-based, person-directed 252.36system established in this section;253.1    (2) recommend an appropriate method of funding this system, and determine the 253.2feasibility of the use of Medicaid, licensing fees, as well as other possible funding options;253.3    (3) approve measurable outcomes in the areas of health and safety, consumer 253.4evaluation, education and training, providers, and systems;253.5    (4) establish variable licensure periods not to exceed three years based on outcomes 253.6achieved; and253.7    (5) in cooperation with the Quality Assurance Commission, design a transition plan 253.8for licensed providers from Region 10 into the alternative licensing system by July 1, 2013.253.9    (f) The State Quality Council shall notify the commissioner of human services that a 253.10facility, program, or service has been reviewed by quality assurance team members under 253.11subdivision 4, paragraph (b), clause (13), and qualifies for a license.253.12    (g) The State Quality Council, in partnership with the commissioner, shall establish 253.13an ongoing review process for the system. The review shall take into account the 253.14comprehensive nature of the system which is designed to evaluate the broad spectrum of 253.15licensed and unlicensed entities that provide services to persons with disabilities. The 253.16review shall address efficiencies and effectiveness of the system.253.17    (h) The State Quality Council may recommend to the commissioner certain 253.18variances from the standards governing licensure of programs for persons with disabilities 253.19in order to improve the quality of services so long as the recommended variances do 253.20not adversely affect the health or safety of persons being served or compromise the 253.21qualifications of staff to provide services.253.22    (i) The safety standards, rights, or procedural protections referenced under 253.23subdivision 2, paragraph (c), shall not be varied. The State Quality Council may make 253.24recommendations to the commissioner or to the legislature in the report required under 253.25paragraph (c) regarding alternatives or modifications to the safety standards, rights, or 253.26procedural protections referenced under subdivision 2, paragraph (c).253.27    (j) The State Quality Council may hire staff to perform the duties assigned in this 253.28subdivision.253.29    Sec. 19. Minnesota Statutes 2012, section 256B.431, subdivision 44, is amended to read:253.30    Subd. 44. Property rate increase increases for a facility in Bloomington effective 253.31November 1, 2010 certain nursing facilities.(a) Notwithstanding any other law to the 253.32contrary, money available for moratorium projects under section 
         144A.073, subdivision 253.3311
         , shall be used, effective November 1, 2010, to fund an approved moratorium exception 253.34project for a nursing facility in Bloomington licensed for 137 beds as of November 1, 253.352010, up to a total property rate adjustment of $19.33.254.1(b) Effective June 1, 2012, any nursing facility in McLeod County licensed for 110 254.2beds shall have its replacement-cost-new limit under subdivision 17e adjusted to allow 254.3$1,129,463 of a completed construction project to increase the property payment rate. 254.4Notwithstanding any other law to the contrary, money available under section 144A.073, 254.5subdivision 11, after the completion of the moratorium exception approval process in 2013 254.6under section 144A.073, subdivision 3, shall be used to reduce the fiscal impact to the 254.7medical assistance budget for the increase in the replacement-cost-new limit.254.8(c) Effective July 1, 2012, any nursing facility in Dakota County licensed for 254.961 beds shall have their replacement-cost-new limit under subdivision 17e adjusted to 254.10allow $1,407,624 of a completed construction project to increase their property payment 254.11rate. Effective September 1, 2013, or later, their replacement-cost-new limit under 254.12subdivision 17e shall be adjusted to allow $1,244,599 of a completed construction project 254.13to increase the property payment rate. Notwithstanding any other law to the contrary, 254.14money available under section 144A.073, subdivision 11, after the completion of the 254.15moratorium exception approval process in 2013 under section 144A.073, subdivision 3, 254.16shall be used to reduce the fiscal impact to the medical assistance budget for the increase 254.17in the replacement-cost-new limit.254.18EFFECTIVE DATE.Paragraph (b) is effective retroactively from June 1, 2012. 254.19Paragraph (c) is effective retroactively from July 1, 2012.254.20    Sec. 20. Minnesota Statutes 2012, section 256B.434, subdivision 4, is amended to read:254.21    Subd. 4. Alternate rates for nursing facilities. (a) For nursing facilities which 254.22have their payment rates determined under this section rather than section 
         256B.431, the 254.23commissioner shall establish a rate under this subdivision. The nursing facility must enter 254.24into a written contract with the commissioner.254.25    (b) A nursing facility's case mix payment rate for the first rate year of a facility's 254.26contract under this section is the payment rate the facility would have received under 254.27section 
         256B.431.254.28    (c) A nursing facility's case mix payment rates for the second and subsequent years 254.29of a facility's contract under this section are the previous rate year's contract payment 254.30rates plus an inflation adjustment and, for facilities reimbursed under this section or 254.31section 
         256B.431, an adjustment to include the cost of any increase in Health Department 254.32licensing fees for the facility taking effect on or after July 1, 2001. The index for the 254.33inflation adjustment must be based on the change in the Consumer Price Index-All Items 254.34(United States City average) (CPI-U) forecasted by the commissioner of management and 254.35budget's national economic consultant, as forecasted in the fourth quarter of the calendar 255.1year preceding the rate year. The inflation adjustment must be based on the 12-month 255.2period from the midpoint of the previous rate year to the midpoint of the rate year for 255.3which the rate is being determined. For the rate years beginning on July 1, 1999, July 1, 255.42000, July 1, 2001, July 1, 2002, July 1, 2003, July 1, 2004, July 1, 2005, July 1, 2006, 255.5July 1, 2007, July 1, 2008, October 1, 2009, and October 1, 2010, this paragraph shall 255.6apply only to the property-related payment rate. For the rate years beginning on October 255.71, 2011, and October 1, 2012, October 1, 2013, October 1, 2014, October 1, 2015, and 255.8October 1, 2016, the rate adjustment under this paragraph shall be suspended. Beginning 255.9in 2005, adjustment to the property payment rate under this section and section 
         256B.431255.10shall be effective on October 1. In determining the amount of the property-related payment 255.11rate adjustment under this paragraph, the commissioner shall determine the proportion of 255.12the facility's rates that are property-related based on the facility's most recent cost report.255.13    (d) The commissioner shall develop additional incentive-based payments of up to 255.14five percent above a facility's operating payment rate for achieving outcomes specified 255.15in a contract. The commissioner may solicit contract amendments and implement those 255.16which, on a competitive basis, best meet the state's policy objectives. The commissioner 255.17shall limit the amount of any incentive payment and the number of contract amendments 255.18under this paragraph to operate the incentive payments within funds appropriated for this 255.19purpose. The contract amendments may specify various levels of payment for various 255.20levels of performance. Incentive payments to facilities under this paragraph may be in the 255.21form of time-limited rate adjustments or onetime supplemental payments. In establishing 255.22the specified outcomes and related criteria, the commissioner shall consider the following 255.23state policy objectives:255.24    (1) successful diversion or discharge of residents to the residents' prior home or other 255.25community-based alternatives;255.26    (2) adoption of new technology to improve quality or efficiency;255.27    (3) improved quality as measured in the Nursing Home Report Card;255.28    (4) reduced acute care costs; and255.29    (5) any additional outcomes proposed by a nursing facility that the commissioner 255.30finds desirable.255.31    (e) Notwithstanding the threshold in section 
         256B.431, subdivision 16, facilities that 255.32take action to come into compliance with existing or pending requirements of the life 255.33safety code provisions or federal regulations governing sprinkler systems must receive 255.34reimbursement for the costs associated with compliance if all of the following conditions 255.35are met:256.1    (1) the expenses associated with compliance occurred on or after January 1, 2005, 256.2and before December 31, 2008;256.3    (2) the costs were not otherwise reimbursed under subdivision 4f or section 256.4144A.071
          or 
         144A.073; and256.5    (3) the total allowable costs reported under this paragraph are less than the minimum 256.6threshold established under section 
         256B.431, subdivision 15, paragraph (e), and 256.7subdivision 16.256.8The commissioner shall use money appropriated for this purpose to provide to qualifying 256.9nursing facilities a rate adjustment beginning October 1, 2007, and ending September 30, 256.102008. Nursing facilities that have spent money or anticipate the need to spend money 256.11to satisfy the most recent life safety code requirements by (1) installing a sprinkler 256.12system or (2) replacing all or portions of an existing sprinkler system may submit to the 256.13commissioner by June 30, 2007, on a form provided by the commissioner the actual 256.14costs of a completed project or the estimated costs, based on a project bid, of a planned 256.15project. The commissioner shall calculate a rate adjustment equal to the allowable 256.16costs of the project divided by the resident days reported for the report year ending 256.17September 30, 2006. If the costs from all projects exceed the appropriation for this 256.18purpose, the commissioner shall allocate the money appropriated on a pro rata basis to the 256.19qualifying facilities by reducing the rate adjustment determined for each facility by an 256.20equal percentage. Facilities that used estimated costs when requesting the rate adjustment 256.21shall report to the commissioner by January 31, 2009, on the use of this money on a 256.22form provided by the commissioner. If the nursing facility fails to provide the report, the 256.23commissioner shall recoup the money paid to the facility for this purpose. If the facility 256.24reports expenditures allowable under this subdivision that are less than the amount received 256.25in the facility's annualized rate adjustment, the commissioner shall recoup the difference.256.26    Sec. 21. Minnesota Statutes 2012, section 256B.437, subdivision 6, is amended to read:256.27    Subd. 6. Planned closure rate adjustment. (a) The commissioner of human 256.28services shall calculate the amount of the planned closure rate adjustment available under 256.29subdivision 3, paragraph (b), for up to 5,140 beds according to clauses (1) to (4):256.30(1) the amount available is the net reduction of nursing facility beds multiplied 256.31by $2,080;256.32(2) the total number of beds in the nursing facility or facilities receiving the planned 256.33closure rate adjustment must be identified;256.34(3) capacity days are determined by multiplying the number determined under 256.35clause (2) by 365; and257.1(4) the planned closure rate adjustment is the amount available in clause (1), divided 257.2by capacity days determined under clause (3).257.3(b) A planned closure rate adjustment under this section is effective on the first day 257.4of the month following completion of closure of the facility designated for closure in 257.5the application and becomes part of the nursing facility's total operating external fixed257.6 payment rate.257.7(c) Applicants may use the planned closure rate adjustment to allow for a property 257.8payment for a new nursing facility or an addition to an existing nursing facility or as 257.9an operating payment external fixed rate adjustment. Applications approved under this 257.10subdivision are exempt from other requirements for moratorium exceptions under section 257.11144A.073
         , subdivisions 2 and 3.257.12(d) Upon the request of a closing facility, the commissioner must allow the facility a 257.13closure rate adjustment as provided under section 
         144A.161, subdivision 10.257.14(e) A facility that has received a planned closure rate adjustment may reassign it 257.15to another facility that is under the same ownership at any time within three years of its 257.16effective date. The amount of the adjustment shall be computed according to paragraph (a).257.17(f) If the per bed dollar amount specified in paragraph (a), clause (1), is increased, 257.18the commissioner shall recalculate planned closure rate adjustments for facilities that 257.19delicense beds under this section on or after July 1, 2001, to reflect the increase in the per 257.20bed dollar amount. The recalculated planned closure rate adjustment shall be effective 257.21from the date the per bed dollar amount is increased.257.22(g) For planned closures approved after June 30, 2009, the commissioner of human 257.23services shall calculate the amount of the planned closure rate adjustment available under 257.24subdivision 3, paragraph (b), according to paragraph (a), clauses (1) to (4).257.25(h) Beginning Between July 16, 2011, and June 30, 2013, the commissioner shall no 257.26longer not accept applications for planned closure rate adjustments under subdivision 3.257.27    Sec. 22. Minnesota Statutes 2012, section 256B.441, subdivision 55, is amended to read:257.28    Subd. 55. Phase-in of rebased operating payment rates.  (a) For the rate years 257.29beginning October 1, 2008, to October 1, 2015, the operating payment rate calculated 257.30under this section shall be phased in by blending the operating rate with the operating 257.31payment rate determined under section 
         256B.434. For purposes of this subdivision, the 257.32rate to be used that is determined under section 
         256B.434 shall not include the portion of 257.33the operating payment rate related to performance-based incentive payments under section 257.34256B.434, subdivision 4
         , paragraph (d).:258.1    (1)  for the rate year beginning October 1, 2008, the operating payment rate for each 258.2facility shall be 13 percent of the operating payment rate from this section, and 87 percent 258.3of the operating payment rate from section 
         256B.434.;258.4    (2) for the rate period from October 1, 2009, to September 30, 2013, no rate 258.5adjustments shall be implemented under this section, but shall be determined under 258.6section 
         256B.434.;258.7    (3) for the rate year beginning October 1, 2013, the operating payment rate for each 258.8facility shall be 65 15.4 percent of the operating payment rate from this section, and 35258.9 84.6 percent of the operating payment rate from section 
         256B.434.; and258.10    (4) for the rate year beginning October 1, 2014 2015, the operating payment rate for 258.11each facility shall be 82 24.3 percent of the operating payment rate from this section, and 258.1218 75.7  percent of the operating payment rate from section 
         256B.434.258.13     for the rate year beginning October 1, 2015, the operating payment rate for each 258.14facility shall be the operating payment rate determined under this section. The blending 258.15of operating payment rates under this section shall be performed separately for each 258.16RUG's class.258.17    (b) For the rate year beginning October 1, 2008, the commissioner shall apply limits 258.18to the operating payment rate increases under paragraph (a) by creating a minimum 258.19percentage increase and a maximum percentage increase.:258.20    (1) each nursing facility that receives a blended October 1, 2008, operating payment 258.21rate increase under paragraph (a) of less than one percent, when compared to its operating 258.22payment rate on September 30, 2008, computed using rates with RUG's weight of 
         1.00, 258.23shall receive a rate adjustment of one percent.;258.24    (2) the commissioner shall determine a maximum percentage increase that will 258.25result in savings equal to the cost of allowing the minimum increase in clause (1). Nursing 258.26facilities with a blended October 1, 2008, operating payment rate increase under paragraph 258.27(a) greater than the maximum percentage increase determined by the commissioner, when 258.28compared to its operating payment rate on September 30, 2008, computed using rates with 258.29a RUG's weight of 
         1.00, shall receive the maximum percentage increase.;258.30    (3) nursing facilities with a blended October 1, 2008, operating payment rate 258.31increase under paragraph (a) greater than one percent and less than the maximum 258.32percentage increase determined by the commissioner, when compared to its operating 258.33payment rate on September 30, 2008, computed using rates with a RUG's weight of 
         1.00, 258.34shall receive the blended October 1, 2008, operating payment rate increase determined 258.35under paragraph (a).; and259.1    (4) the October 1, 2009, through October 1, 2015, operating payment rate for 259.2facilities receiving the maximum percentage increase determined in clause (2) shall be 259.3the amount determined under paragraph (a) less the difference between the amount 259.4determined under paragraph (a) for October 1, 2008, and the amount allowed under clause 259.5(2). This rate restriction does not apply to rate increases provided in any other section.259.6    (c) A portion of the funds received under this subdivision that are in excess of 259.7operating payment rates that a facility would have received under section 
         256B.434, as 259.8determined in accordance with clauses (1) to (3), shall be subject to the requirements in 259.9section 
         256B.434, subdivision 19, paragraphs (b) to (h).:259.10    (1) determine the amount of additional funding available to a facility, which shall be 259.11equal to total medical assistance resident days from the most recent reporting year times 259.12the difference between the blended rate determined in paragraph (a) for the rate year being 259.13computed and the blended rate for the prior year.;259.14    (2) determine the portion of all operating costs, for the most recent reporting year, 259.15that are compensation related. If this value exceeds 75 percent, use 75 percent.;259.16    (3) subtract the amount determined in clause (2) from 75 percent.; and259.17    (4) the portion of the fund received under this subdivision that shall be subject to the 259.18requirements in section 
         256B.434, subdivision 19, paragraphs (b) to (h), shall equal the 259.19amount determined in clause (1) times the amount determined in clause (3).259.20    Sec. 23. Minnesota Statutes 2012, section 256B.441, subdivision 56, is amended to read:259.21    Subd. 56. Hold harmless. For the rate years beginning October 1, 2008, to October 259.221, 2016, no nursing facility shall receive an operating cost payment rate less than its 259.23operating cost payment rate under section 
         256B.434. For rate years beginning between 259.24October 1, 2009, and October 1, 2015, no nursing facility shall receive an operating 259.25payment rate less than its operating payment rate in effect on September 30, 2009. The 259.26comparison of operating payment rates under this section shall be made for a RUG's 259.27rate with a weight of 1.00.259.28    Sec. 24. Minnesota Statutes 2012, section 256B.441, subdivision 62, is amended to read:259.29    Subd. 62. Repeal of rebased operating payment rates. Notwithstanding 259.30subdivision 54 or 55, no further steps toward phase-in of rebased operating payment rates 259.31shall be taken, except for subdivision 55, paragraph (a), clauses (3) and (4).259.32    Sec. 25. Minnesota Statutes 2012, section 256B.49, subdivision 11a, is amended to read:260.1    Subd. 11a. Waivered services statewide priorities. (a) The commissioner shall 260.2establish statewide priorities for individuals on the waiting list for community alternative 260.3care, community alternatives for disabled individuals, and brain injury waiver services, 260.4as of January 1, 2010. The statewide priorities must include, but are not limited to, 260.5individuals who continue to have a need for waiver services after they have maximized the 260.6use of state plan services and other funding resources, including natural supports, prior to 260.7accessing waiver services, and who meet at least one of the following criteria:260.8(1) no longer require the intensity of services provided where they are currently 260.9living; or260.10(2) make a request to move from an institutional setting.260.11(b) After the priorities in paragraph (a) are met, priority must also be given to 260.12individuals who meet at least one of the following criteria:260.13(1) have unstable living situations due to the age, incapacity, or sudden loss of 260.14the primary caregivers;260.15(2) are moving from an institution due to bed closures;260.16(3) experience a sudden closure of their current living arrangement;260.17(4) require protection from confirmed abuse, neglect, or exploitation;260.18(5) experience a sudden change in need that can no longer be met through state plan 260.19services or other funding resources alone; or260.20(6) meet other priorities established by the department.260.21(b) (c) When allocating resources to lead agencies, the commissioner must take into 260.22consideration the number of individuals waiting who meet statewide priorities and the 260.23lead agencies' current use of waiver funds and existing service options. The commissioner 260.24has the authority to transfer funds between counties, groups of counties, and tribes to 260.25accommodate statewide priorities and resource needs while accounting for a necessary 260.26base level reserve amount for each county, group of counties, and tribe.260.27(c) The commissioner shall evaluate the impact of the use of statewide priorities and 260.28provide recommendations to the legislature on whether to continue the use of statewide 260.29priorities in the November 1, 2011, annual report required by the commissioner in sections 260.30256B.0916, subdivision 7, and 256B.49, subdivision 21.260.31    Sec. 26. Minnesota Statutes 2012, section 256B.49, subdivision 15, is amended to read:260.32    Subd. 15. Coordinated service and support plan; comprehensive transitional 260.33service plan; maintenance service plan. (a) Each recipient of home and community-based 260.34waivered services shall be provided a copy of the written coordinated service and support 260.35plan which meets the requirements in section 
         256B.092, subdivision 1b.261.1(b) In developing the comprehensive transitional service plan, the individual 261.2receiving services, the case manager, and the guardian, if applicable, will identify the 261.3transitional service plan fundamental service outcome and anticipated timeline to achieve 261.4this outcome. Within the first 20 days following a recipient's request for an assessment or 261.5reassessment, the transitional service planning team must be identified. A team leader must 261.6be identified who will be responsible for assigning responsibility and communicating with 261.7team members to ensure implementation of the transition plan and ongoing assessment and 261.8communication process. The team leader should be an individual, such as the case manager 261.9or guardian, who has the opportunity to follow the recipient to the next level of service.261.10Within ten days following an assessment, a comprehensive transitional service plan 261.11must be developed incorporating elements of a comprehensive functional assessment and 261.12including short-term measurable outcomes and timelines for achievement of and reporting 261.13on these outcomes. Functional milestones must also be identified and reported according 261.14to the timelines agreed upon by the transitional service planning team. In addition, the 261.15comprehensive transitional service plan must identify additional supports that may assist 261.16in the achievement of the fundamental service outcome such as the development of greater 261.17natural community support, increased collaboration among agencies, and technological 261.18supports.261.19The timelines for reporting on functional milestones will prompt a reassessment of 261.20services provided, the units of services, rates, and appropriate service providers. It is 261.21the responsibility of the transitional service planning team leader to review functional 261.22milestone reporting to determine if the milestones are consistent with observable skills 261.23and that milestone achievement prompts any needed changes to the comprehensive 261.24transitional service plan.261.25For those whose fundamental transitional service outcome involves the need to 261.26procure housing, a plan for the recipient to seek the resources necessary to secure the least 261.27restrictive housing possible should be incorporated into the plan, including employment 261.28and public supports such as housing access and shelter needy funding.261.29(c) Counties and other agencies responsible for funding community placement and 261.30ongoing community supportive services are responsible for the implementation of the 261.31comprehensive transitional service plans. Oversight responsibilities include both ensuring 261.32effective transitional service delivery and efficient utilization of funding resources.261.33(d) Following one year of transitional services, the transitional services planning team 261.34will make a determination as to whether or not the individual receiving services requires 261.35the current level of continuous and consistent support in order to maintain the recipient's 261.36current level of functioning. Recipients who are determined to have not had a significant 262.1change in functioning for 12 months must move from a transitional to a maintenance 262.2service plan. Recipients on a maintenance service plan must be reassessed to determine if 262.3the recipient would benefit from a transitional service plan at least every 12 months and at 262.4other times when there has been a significant change in the recipient's functioning. This 262.5assessment should consider any changes to technological or natural community supports.262.6(e) When a county is evaluating denials, reductions, or terminations of home and 262.7community-based services under section 
         256B.49 for an individual, the case manager 262.8shall offer to meet with the individual or the individual's guardian in order to discuss 262.9the prioritization of service needs within the coordinated service and support plan, 262.10comprehensive transitional service plan, or maintenance service plan. The reduction in 262.11the authorized services for an individual due to changes in funding for waivered services 262.12may not exceed the amount needed to ensure medically necessary services to meet the 262.13individual's health, safety, and welfare.262.14(f) At the time of reassessment, local agency case managers shall assess each recipient 262.15of community alternatives for disabled individuals or brain injury waivered services 262.16currently residing in a licensed adult foster home that is not the primary residence of the 262.17license holder, or in which the license holder is not the primary caregiver, to determine if 262.18that recipient could appropriately be served in a community-living setting. If appropriate 262.19for the recipient, the case manager shall offer the recipient, through a person-centered 262.20planning process, the option to receive alternative housing and service options. In the 262.21event that the recipient chooses to transfer from the adult foster home, the vacated bed 262.22shall not be filled with another recipient of waiver services and group residential housing 262.23and the licensed capacity shall be reduced accordingly, unless the savings required by the 262.24licensed bed closure reductions under Laws 2011, First Special Session chapter 9, article 7, 262.25sections 1 and 40, paragraph (f), for foster care settings where the physical location is not 262.26the primary residence of the license holder are met through voluntary changes described 262.27in section 
         245A.03, subdivision 7, paragraph (f) (e), or as provided under paragraph (a), 262.28clauses (3) and (4). If the adult foster home becomes no longer viable due to these transfers, 262.29the county agency, with the assistance of the department, shall facilitate a consolidation of 262.30settings or closure. This reassessment process shall be completed by July 1, 2013.262.31    Sec. 27. Minnesota Statutes 2012, section 256B.49, is amended by adding a 262.32subdivision to read:262.33    Subd. 25.Reduce avoidable behavioral crisis emergency room admissions, 262.34psychiatric inpatient hospitalizations, and commitments to institutions.(a) Persons 262.35receiving home and community-based services authorized under this section who have 263.1two or more admissions within a calendar year to an emergency room, psychiatric unit, 263.2or institution must receive consultation from a mental health professional as defined in 263.3section 245.462, subdivision 18, or a behavioral professional as defined in the home and 263.4community-based services state plan within 30 days of discharge. The mental health 263.5professional or behavioral professional must:263.6(1) conduct a functional assessment of the crisis incident as defined in section 263.7245D.02, subdivision 11, which led to the hospitalization with the goal of developing 263.8proactive strategies as well as necessary reactive strategies to reduce the likelihood of 263.9future avoidable hospitalizations due to a behavioral crisis;263.10(2) use the results of the functional assessment to amend the coordinated service and 263.11support plan in section 245D.02, subdivision 4b, to address the potential need for additional 263.12staff training, increased staffing, access to crisis mobility services, mental health services, 263.13use of technology, and crisis stabilization services in section 256B.0624, subdivision 7; and263.14(3) identify the need for additional consultation, testing, mental health crisis 263.15intervention team services as defined in section 245D.02, subdivision 20, psychotropic 263.16medication use and monitoring under section 245D.051, and the frequency and duration 263.17of ongoing consultation. 263.18(b) For the purposes of this subdivision, "institution" includes, but is not limited to, 263.19the Anoka-Metro Regional Treatment Center and the Minnesota Security Hospital.263.20    Sec. 28. Minnesota Statutes 2012, section 256B.49, is amended by adding a 263.21subdivision to read:263.22    Subd. 26.Excess allocations.County and tribal agencies will be responsible for 263.23authorizations in excess of the allocation made by the commissioner. In the event a county 263.24or tribal agency authorizes in excess of the allocation made by the commissioner for a 263.25given allocation period, the county or tribal agency must submit a corrective action plan to 263.26the commissioner. The plan must state the actions the agency will take to correct their 263.27overauthorization for the year following the period when the overspending occurred. 263.28Failure to correct overauthorizations shall result in recoupment of authorizations in excess 263.29of the allocation. Nothing in this subdivision shall be construed as reducing the county's 263.30responsibility to offer and make available feasible home and community-based options to 263.31eligible waiver recipients within the resources allocated to them for that purpose.263.32    Sec. 29. Minnesota Statutes 2012, section 256B.492, is amended to read:263.33256B.492 HOME AND COMMUNITY-BASED SETTINGS FOR PEOPLE 263.34WITH DISABILITIES.264.1(a) Individuals receiving services under a home and community-based waiver under 264.2section 
         256B.092 or 
         256B.49 may receive services in the following settings:264.3(1) an individual's own home or family home;264.4(2) a licensed adult foster care setting of up to five people; and264.5(3) community living settings as defined in section 
         256B.49, subdivision 23, where 264.6individuals with disabilities may reside in all of the units in a building of four or fewer 264.7units, and no more than the greater of four or 25 percent of the units in a multifamily 264.8building of more than four units, unless required by the Housing Opportunities for Persons 264.9with AIDS Program.264.10(b) The settings in paragraph (a) must not:264.11(1) be located in a building that is a publicly or privately operated facility that 264.12provides institutional treatment or custodial care;264.13(2) be located in a building on the grounds of or adjacent to a public or private 264.14institution;264.15(3) be a housing complex designed expressly around an individual's diagnosis or 264.16disability, unless required by the Housing Opportunities for Persons with AIDS Program;264.17(4) be segregated based on a disability, either physically or because of setting 264.18characteristics, from the larger community; and264.19(5) have the qualities of an institution which include, but are not limited to: 264.20regimented meal and sleep times, limitations on visitors, and lack of privacy. Restrictions 264.21agreed to and documented in the person's individual service plan shall not result in a 264.22residence having the qualities of an institution as long as the restrictions for the person are 264.23not imposed upon others in the same residence and are the least restrictive alternative, 264.24imposed for the shortest possible time to meet the person's needs.264.25(c) The provisions of paragraphs (a) and (b) do not apply to any setting in which 264.26individuals receive services under a home and community-based waiver as of July 1, 264.272012, and the setting does not meet the criteria of this section.264.28(d) Notwithstanding paragraph (c), a program in Hennepin County established as 264.29part of a Hennepin County demonstration project is qualified for the exception allowed 264.30under paragraph (c).264.31(e) The commissioner shall submit an amendment to the waiver plan no later than 264.32December 31, 2012.264.33    Sec. 30. Minnesota Statutes 2012, section 256B.493, subdivision 2, is amended to read:264.34    Subd. 2. Planned closure process needs determination. The commissioner shall 264.35announce and implement a program for planned closure of adult foster care homes. Planned 265.1closure shall be the preferred method for achieving necessary budgetary savings required by 265.2the licensed bed closure budget reduction in section 
         245A.03, subdivision 7, paragraph (d)265.3 (c). If additional closures are required to achieve the necessary savings, the commissioner 265.4shall use the process and priorities in section 
         245A.03, subdivision 7, paragraph (d) (c).265.5    Sec. 31. Minnesota Statutes 2012, section 256B.501, is amended by adding a 265.6subdivision to read:265.7    Subd. 14.Rate adjustment for ICF/DD in Cottonwood County.The 265.8commissioner of health shall decertify three beds in an intermediate care facility for 265.9persons with developmental disabilities with 21 certified beds located in Cottonwood 265.10County. The total payment rate shall be $282.62 per bed, per day.265.11    Sec. 32. Minnesota Statutes 2012, section 256B.5012, is amended by adding a 265.12subdivision to read:265.13    Subd. 15.ICF/DD rate increases effective January 1, 2015, and July 1, 2015.(a) 265.14Notwithstanding subdivision 12, for each facility reimbursed under this section, for the rate 265.15period beginning January 1, 2015, the commissioner shall increase operating payments 265.16equal to one percent of the operating payment rates in effect on December 31, 2014. 265.17For the rate period beginning July 1, 2015, the commissioner shall increase operating 265.18payments equal to one percent of the operating payment rates in effect on June 30, 2015.265.19(b) For each facility, the commissioner shall apply the rate increase based on 265.20occupied beds, using the percentage specified in this subdivision multiplied by the total 265.21payment rate, including the variable rate, but excluding the property-related payment 265.22rate in effect on the preceding date. The total rate increase shall include the adjustment 265.23provided in section 256B.501, subdivision 12.265.24    Sec. 33. Minnesota Statutes 2012, section 256D.44, subdivision 5, is amended to read:265.25    Subd. 5. Special needs. In addition to the state standards of assistance established in 265.26subdivisions 1 to 4, payments are allowed for the following special needs of recipients of 265.27Minnesota supplemental aid who are not residents of a nursing home, a regional treatment 265.28center, or a group residential housing facility.265.29    (a) The county agency shall pay a monthly allowance for medically prescribed 265.30diets if the cost of those additional dietary needs cannot be met through some other 265.31maintenance benefit. The need for special diets or dietary items must be prescribed by 265.32a licensed physician. Costs for special diets shall be determined as percentages of the 265.33allotment for a one-person household under the thrifty food plan as defined by the United 266.1States Department of Agriculture. The types of diets and the percentages of the thrifty 266.2food plan that are covered are as follows:266.3    (1) high protein diet, at least 80 grams daily, 25 percent of thrifty food plan;266.4    (2) controlled protein diet, 40 to 60 grams and requires special products, 100 percent 266.5of thrifty food plan;266.6    (3) controlled protein diet, less than 40 grams and requires special products, 125 266.7percent of thrifty food plan;266.8    (4) low cholesterol diet, 25 percent of thrifty food plan;266.9    (5) high residue diet, 20 percent of thrifty food plan;266.10    (6) pregnancy and lactation diet, 35 percent of thrifty food plan;266.11    (7) gluten-free diet, 25 percent of thrifty food plan;266.12    (8) lactose-free diet, 25 percent of thrifty food plan;266.13    (9) antidumping diet, 15 percent of thrifty food plan;266.14    (10) hypoglycemic diet, 15 percent of thrifty food plan; or266.15    (11) ketogenic diet, 25 percent of thrifty food plan.266.16    (b) Payment for nonrecurring special needs must be allowed for necessary home 266.17repairs or necessary repairs or replacement of household furniture and appliances using 266.18the payment standard of the AFDC program in effect on July 16, 1996, for these expenses, 266.19as long as other funding sources are not available.266.20    (c) A fee for guardian or conservator service is allowed at a reasonable rate 266.21negotiated by the county or approved by the court. This rate shall not exceed five percent 266.22of the assistance unit's gross monthly income up to a maximum of $100 per month. If the 266.23guardian or conservator is a member of the county agency staff, no fee is allowed.266.24    (d) The county agency shall continue to pay a monthly allowance of $68 for 266.25restaurant meals for a person who was receiving a restaurant meal allowance on June 1, 266.261990, and who eats two or more meals in a restaurant daily. The allowance must continue 266.27until the person has not received Minnesota supplemental aid for one full calendar month 266.28or until the person's living arrangement changes and the person no longer meets the criteria 266.29for the restaurant meal allowance, whichever occurs first.266.30    (e) A fee of ten percent of the recipient's gross income or $25, whichever is less, 266.31is allowed for representative payee services provided by an agency that meets the 266.32requirements under SSI regulations to charge a fee for representative payee services. This 266.33special need is available to all recipients of Minnesota supplemental aid regardless of 266.34their living arrangement.266.35    (f)(1) Notwithstanding the language in this subdivision, an amount equal to the 266.36maximum allotment authorized by the federal Food Stamp Program for a single individual 267.1which is in effect on the first day of July of each year will be added to the standards of 267.2assistance established in subdivisions 1 to 4 for adults under the age of 65 who qualify 267.3as shelter needy and are: (i) relocating from an institution, or an adult mental health 267.4residential treatment program under section 
         256B.0622; (ii) eligible for the self-directed 267.5supports option as defined under section 
         256B.0657, subdivision 2; or (iii) home and 267.6community-based waiver recipients living in their own home or rented or leased apartment 267.7which is not owned, operated, or controlled by a provider of service not related by blood 267.8or marriage, unless allowed under paragraph (g).267.9    (2) Notwithstanding subdivision 3, paragraph (c), an individual eligible for the 267.10shelter needy benefit under this paragraph is considered a household of one. An eligible 267.11individual who receives this benefit prior to age 65 may continue to receive the benefit 267.12after the age of 65.267.13    (3) "Shelter needy" means that the assistance unit incurs monthly shelter costs that 267.14exceed 40 percent of the assistance unit's gross income before the application of this 267.15special needs standard. "Gross income" for the purposes of this section is the applicant's or 267.16recipient's income as defined in section 
         256D.35, subdivision 10, or the standard specified 267.17in subdivision 3, paragraph (a) or (b), whichever is greater. A recipient of a federal or 267.18state housing subsidy, that limits shelter costs to a percentage of gross income, shall not be 267.19considered shelter needy for purposes of this paragraph.267.20(g) Notwithstanding this subdivision, to access housing and services as provided 267.21in paragraph (f), the recipient may choose housing that may be owned, operated, or 267.22controlled by the recipient's service provider. In a multifamily building of more than four 267.23units, the maximum number of units that may be used by recipients of this program shall 267.24be the greater of four units or 25 percent of the units in the building, unless required by the 267.25Housing Opportunities for Persons with AIDS Program. In multifamily buildings of four 267.26or fewer units, all of the units may be used by recipients of this program. When housing is 267.27controlled by the service provider, the individual may choose the individual's own service 267.28provider as provided in section 
         256B.49, subdivision 23, clause (3). When the housing is 267.29controlled by the service provider, the service provider shall implement a plan with the 267.30recipient to transition the lease to the recipient's name. Within two years of signing the 267.31initial lease, the service provider shall transfer the lease entered into under this subdivision 267.32to the recipient. In the event the landlord denies this transfer, the commissioner may 267.33approve an exception within sufficient time to ensure the continued occupancy by the 267.34recipient. This paragraph expires June 30, 2016.268.1    Sec. 34. Laws 2011, First Special Session chapter 9, article 7, section 39, subdivision 268.214, is amended to read:268.3    Subd. 14. Assessment and reassessment. (a) Assessments of each recipient's 268.4strengths, informal support systems, and need for services shall be completed within 20 268.5working days of the recipient's request as provided in section 
         256B.0911. Reassessment 268.6of each recipient's strengths, support systems, and need for services shall be conducted 268.7at least every 12 months and at other times when there has been a significant change in 268.8the recipient's functioning.268.9(b) There must be a determination that the client requires a hospital level of care or a 268.10nursing facility level of care as defined in section 
         256B.0911, subdivision 4a, paragraph 268.11(d), at initial and subsequent assessments to initiate and maintain participation in the 268.12waiver program.268.13(c) Regardless of other assessments identified in section 
         144.0724, subdivision 4, as 268.14appropriate to determine nursing facility level of care for purposes of medical assistance 268.15payment for nursing facility services, only face-to-face assessments conducted according 268.16to section 
         256B.0911, subdivisions 3a, 3b, and 4d, that result in a hospital level of care 268.17determination or a nursing facility level of care determination must be accepted for 268.18purposes of initial and ongoing access to waiver services payment.268.19(d) Persons with developmental disabilities who apply for services under the nursing 268.20facility level waiver programs shall be screened for the appropriate level of care according 268.21to section 
         256B.092.268.22(e) Recipients who are found eligible for home and community-based services under 268.23this section before their 65th birthday may remain eligible for these services after their 268.2465th birthday if they continue to meet all other eligibility factors.268.25(f) The commissioner shall develop criteria to identify recipients whose level of 268.26functioning is reasonably expected to improve and reassess these recipients to establish 268.27a baseline assessment. Recipients who meet these criteria must have a comprehensive 268.28transitional service plan developed under subdivision 15, paragraphs (b) and (c), and be 268.29reassessed every six months until there has been no significant change in the recipient's 268.30functioning for at least 12 months. After there has been no significant change in the 268.31recipient's functioning for at least 12 months, reassessments of the recipient's strengths, 268.32informal support systems, and need for services shall be conducted at least every 12 268.33months and at other times when there has been a significant change in the recipient's 268.34functioning. Counties, case managers, and service providers are responsible for 268.35conducting these reassessments and shall complete the reassessments out of existing funds.269.1    Sec. 35. Laws 2012, chapter 247, article 6, section 4, is amended to read:

269.2269.3Sec. 4. BOARD OF NURSING HOME ADMINISTRATORS$-0-$10,000

269.4Administrative Services Unit. This 269.5appropriation is to provide a grant to the 269.6Minnesota Ambulance Association to 269.7coordinate and prepare an assessment of 269.8the extent and costs of uncompensated care 269.9as a direct result of emergency responses 269.10on interstate highways in Minnesota. 269.11The study will collect appropriate 269.12information from medical response units 269.13and ambulance services regulated under 269.14Minnesota Statutes, chapter 144E, and to 269.15the extent possible, firefighting agencies. 269.16In preparing the assessment, the Minnesota 269.17Ambulance Association shall consult with 269.18its membership, the Minnesota Fire Chiefs 269.19Association, the Office of the State Fire 269.20Marshal, and the Emergency Medical 269.21Services Regulatory Board. The findings 269.22of the assessment will be reported to the 269.23chairs and ranking minority members of the 269.24legislative committees with jurisdiction over 269.25health and public safety by January 1, 2013.269.26 This is a onetime appropriation.269.27    Sec. 36. DIRECTION TO COMMISSIONER.269.28    The commissioner of human services shall request authority, in whatever form is 269.29necessary, from the federal Centers for Medicare and Medicaid Services to allow persons 269.30under age 65 participating in the home and community-based services waivers to continue 269.31to use the disregard of the nonassisted spouse's income and assets instead of the spousal 269.32impoverishment provisions under the federal Patient Protection and Affordable Care Act, 269.33Public Law 111-148, section 2404, as amended by the federal Health Care and Education 269.34Reconciliation Act of 2010, Public Law 111-152, and any amendments to, or regulations 269.35or guidance issued under, those acts.270.1    Sec. 37. RECOMMENDATIONS ON RAISING THE ASSET LIMITS FOR 270.2SENIORS AND PERSONS WITH DISABILITIES.270.3    The commissioner of human services shall consult with interested stakeholders to 270.4develop recommendations and a request for a federal 1115 demonstration waiver in order 270.5to increase the asset limit for individuals eligible for medical assistance due to disability 270.6or age who are not residing in a nursing facility, intermediate care facility for persons 270.7with developmental disabilities, or other institution whose costs for room and board are 270.8covered by medical assistance or state funds. The recommendations must be provided to 270.9the legislative committees and divisions with jurisdiction over health and human services 270.10policy and finance by February 1, 2014.270.11    Sec. 38. NURSING HOME LEVEL OF CARE REPORT.270.12    (a) The commissioner of human services shall report on the impact of the 270.13modification to the nursing facility level of care to be implemented January 1, 2014, 270.14including the following:270.15    (1) the number of individuals who lose eligibility for home and community-based 270.16services waivers under Minnesota Statutes, sections 256B.0915 and 256B.49, and 270.17alternative care under Minnesota Statutes, section 256B.0913;270.18    (2) the number of individuals who lose eligibility for medical assistance; and 270.19    (3) for individuals reported under clauses (1) and (2), and to the extent possible:270.20    (i) their living situation before and after nursing facility level of care implementation; 270.21and270.22    (ii) the programs or services they received before and after nursing facility level of 270.23care implementation, including, but not limited to, personal care assistant services and 270.24essential community supports.270.25    (b) The commissioner of human services shall report to the chairs and ranking 270.26minority members of the legislative committees and divisions with jurisdiction over health 270.27and human services policy and finance with the information required under paragraph 270.28(a). A preliminary report shall be submitted on October 1, 2014, and a final report shall 270.29be submitted February 15, 2015.270.30    Sec. 39. ASSISTIVE TECHNOLOGY EQUIPMENT FOR HOME AND 270.31COMMUNITY-BASED SERVICES WAIVERS FUNDING DEVELOPMENT.270.32(a) For the purposes of this section, "assistive technology equipment" includes 270.33computer tablets, passive sensors, and other forms of technology allowing increased 270.34safety and independence, and used by those receiving services through a home and 271.1community-based services waiver under Minnesota Statutes, sections 256B.0915, 271.2256B.092, and 256B.49.271.3(b) The commissioner of human services shall develop recommendations for 271.4assistive technology equipment funding to enable individuals receiving services identified 271.5in paragraph (a) to live in the least restrictive setting possible. In developing the funding, 271.6the commissioner shall examine funding for the following:271.7(1) an assessment process to match the appropriate assistive technology equipment 271.8with the waiver recipient, including when the recipient's condition changes or progresses;271.9(2) the use of monitoring services, if applicable, to the assistive technology 271.10equipment identified in clause (1);271.11(3) the leasing of assistive technology equipment as a possible alternative to 271.12purchasing the equipment; and271.13(4) ongoing support services, such as technological support.271.14(c) The commissioner shall provide the chairs and ranking minority members of the 271.15legislative committees and divisions with jurisdiction over health and human services 271.16policy and finance a recommendation for implementing an assistive technology equipment 271.17program as developed in paragraph (b) by February 1, 2014.271.18    Sec. 40. PROVIDER RATE AND GRANT INCREASES EFFECTIVE JANUARY 271.191, 2015, AND JULY 1, 2015.271.20(a) The commissioner of human services shall increase reimbursement rates, grants, 271.21allocations, individual limits, and rate limits, as applicable, by one percent for the rate 271.22period beginning January 1, 2015, and by one percent for the rate period beginning July 1, 271.232015, for services rendered on or after those dates. County or tribal contracts for services 271.24specified in this section must be amended to pass through these rate increases within 60 271.25days of the effective date.271.26(b) The rate changes described in this section must be provided to:271.27(1) home and community-based waivered services for persons with developmental 271.28disabilities or related conditions, including consumer-directed community supports, under 271.29Minnesota Statutes, section 256B.501;271.30(2) waivered services under community alternatives for disabled individuals, 271.31including consumer-directed community supports, under Minnesota Statutes, section 271.32256B.49;271.33(3) community alternative care waivered services, including consumer-directed 271.34community supports, under Minnesota Statutes, section 256B.49;272.1(4) brain injury waivered services, including consumer-directed community 272.2supports, under Minnesota Statutes, section 256B.49;272.3(5) home and community-based waivered services for the elderly under Minnesota 272.4Statutes, section 256B.0915;272.5(6) nursing services and home health services under Minnesota Statutes, section 272.6256B.0625, subdivision 6a;272.7(7) personal care services and qualified professional supervision of personal care 272.8services under Minnesota Statutes, section 256B.0625, subdivisions 6a and 19a;272.9(8) private duty nursing services under Minnesota Statutes, section 256B.0625, 272.10subdivision 7;272.11(9) day training and habilitation services for adults with developmental disabilities 272.12or related conditions under Minnesota Statutes, sections 252.40 to 252.46, including the 272.13additional cost of rate adjustments on day training and habilitation services, provided as a 272.14social service, under Minnesota Statutes, section 256M.60;272.15(10) alternative care services under Minnesota Statutes, section 256B.0913;272.16(11) living skills training programs for persons with intractable epilepsy who need 272.17assistance in the transition to independent living under Laws 1988, chapter 689;272.18(12) semi-independent living services (SILS) under Minnesota Statutes, section 272.19252.275, including SILS funding under county social services grants formerly funded 272.20under Minnesota Statutes, chapter 256I;272.21(13) consumer support grants under Minnesota Statutes, section 256.476;272.22(14) family support grants under Minnesota Statutes, section 252.32;272.23(15) housing access grants under Minnesota Statutes, section 256B.0658;272.24(16) self-advocacy grants under Laws 2009, chapter 101; and272.25(17) technology grants under Laws 2009, chapter 79.272.26(c) A managed care plan receiving state payments for the services in this section 272.27must include these increases in their payments to providers. To implement the rate increase 272.28in this section, capitation rates paid by the commissioner to managed care organizations 272.29under Minnesota Statutes, section 256B.69, shall reflect a one percent increase for the 272.30specified services for the period beginning January 1, 2015.272.31(d) Counties shall increase the budget for each recipient of consumer-directed 272.32community supports by the amounts in paragraph (a) on the effective dates in paragraph (a).272.33    Sec. 41. SAFETY NET FOR HOME AND COMMUNITY-BASED SERVICES 272.34WAIVERS.273.1The commissioner of human services shall submit a request by December 31, 2013, 273.2to the federal government to amend the home and community-based services waivers for 273.3individuals with disabilities authorized under Minnesota Statutes, section 256B.49, to 273.4modify the financial management of the home and community-based services waivers 273.5to provide a state-administered safety net when costs for an individual increase above 273.6an identified threshold. The implementation of the safety net may result in a decreased 273.7allocation for individual counties, tribes, or collaboratives of counties or tribes, but must 273.8not result in a net decreased statewide allocation.273.9    Sec. 42. SHARED LIVING MODEL.273.10The commissioner of human services shall develop and promote a shared living model 273.11option for individuals receiving services through the home and community-based services 273.12waivers for individuals with disabilities, authorized under Minnesota Statutes, section 273.13256B.092 or 256B.49, as an option for individuals who require 24-hour assistance. The 273.14option must be a companion model with a limit of one or two individuals receiving support 273.15in the home, planned respite for the caregiver, and the availability of intensive training 273.16and support on the needs of the individual or individuals. Any necessary amendments to 273.17implement the model must be submitted to the federal government by December 31, 2013.273.18    Sec. 43. MONEY FOLLOWS THE PERSON GRANT.273.19The commissioner of human services shall submit to the federal government all 273.20necessary waiver amendments to implement the Money Follows the Person federal grant 273.21by December 31, 2013.273.22    Sec. 44.  REPEALER.273.23Minnesota Statutes 2012, sections 256B.096, subdivisions 1, 2, 3, and 4; and 273.24256B.5012, subdivision 13; and Laws 2011, First Special Session chapter 9, article 7, 273.25section 54, as amended by Laws 2012, chapter 247, article 4, section 42, and Laws 2012, 273.26chapter 298, section 3,  are repealed.273.27ARTICLE 8273.28WAIVER PROVIDER STANDARDS273.29    Section 1. Minnesota Statutes 2012, section 13.461, is amended by adding a 273.30subdivision to read:274.1    Subd. 7c.Human services license holders.Section 245D.095, subdivision 3, 274.2requires certain license holders to protect service recipient records in accordance with 274.3specified provisions of this chapter.274.4    Sec. 2. Minnesota Statutes 2012, section 145C.01, subdivision 7, is amended to read:274.5    Subd. 7. Health care facility. "Health care facility" means a hospital or other entity 274.6licensed under sections 
         144.50 to 
         144.58, a nursing home licensed to serve adults under 274.7section 
         144A.02, a home care provider licensed under sections 
         144A.43 to 
         144A.47, 274.8an adult foster care provider licensed under chapter 245A and Minnesota Rules, parts 274.99555.5105 to 9555.6265, a community residential setting licensed under chapter 245D, or 274.10a hospice provider licensed under sections 
         144A.75 to 
         144A.755.274.11    Sec. 3. Minnesota Statutes 2012, section 243.166, subdivision 4b, is amended to read:274.12    Subd. 4b. Health care facility; notice of status. (a) For the purposes of this 274.13subdivision, "health care facility" means a facility:274.14(1) licensed by the commissioner of health as a hospital, boarding care home or 274.15supervised living facility under sections 
         144.50 to 
         144.58, or a nursing home under 274.16chapter 144A;274.17(2) registered by the commissioner of health as a housing with services establishment 274.18as defined in section 
         144D.01; or274.19(3) licensed by the commissioner of human services as a residential facility under 274.20chapter 245A to provide adult foster care, adult mental health treatment, chemical 274.21dependency treatment to adults, or residential services to persons with developmental274.22 disabilities.274.23(b) Prior to admission to a health care facility, a person required to register under 274.24this section shall disclose to:274.25(1) the health care facility employee processing the admission the person's status 274.26as a registered predatory offender under this section; and274.27(2) the person's corrections agent, or if the person does not have an assigned 274.28corrections agent, the law enforcement authority with whom the person is currently 274.29required to register, that inpatient admission will occur.274.30(c) A law enforcement authority or corrections agent who receives notice under 274.31paragraph (b) or who knows that a person required to register under this section is 274.32planning to be admitted and receive, or has been admitted and is receiving health care 274.33at a health care facility shall notify the administrator of the facility and deliver a fact 274.34sheet to the administrator containing the following information: (1) name and physical 275.1description of the offender; (2) the offender's conviction history, including the dates of 275.2conviction; (3) the risk level classification assigned to the offender under section 
         244.052, 275.3if any; and (4) the profile of likely victims.275.4(d) Except for a hospital licensed under sections 
         144.50 to 
         144.58, if a health care 275.5facility receives a fact sheet under paragraph (c) that includes a risk level classification for 275.6the offender, and if the facility admits the offender, the facility shall distribute the fact 275.7sheet to all residents at the facility. If the facility determines that distribution to a resident 275.8is not appropriate given the resident's medical, emotional, or mental status, the facility 275.9shall distribute the fact sheet to the patient's next of kin or emergency contact.275.10    Sec. 4. [245.8251] POSITIVE SUPPORT STRATEGIES AND EMERGENCY 275.11MANUAL RESTRAINT; LICENSED FACILITIES AND PROGRAMS.275.12    Subdivision 1.Rules.The commissioner of human services shall, within 24 months 275.13of enactment of this section, adopt rules governing the use of positive support strategies, 275.14safety interventions, and emergency use of manual restraint in facilities and services 275.15licensed under chapter 245D.275.16    Subd. 2.Data collection.(a) The commissioner shall, with stakeholder input, 275.17develop data collection elements specific to incidents on the use of controlled procedures 275.18with persons receiving services from providers regulated under Minnesota Rules, parts 275.199525.2700 to 9525.2810, and incidents involving persons receiving services from 275.20providers identified to be licensed under chapter 245D effective January 1, 2014. Providers 275.21shall report the data in a format and at a frequency provided by the commissioner of 275.22human services.275.23(b) Beginning July 1, 2013, providers regulated under Minnesota Rules, parts 275.249525.2700 to 9525.2810, shall submit data regarding the use of all controlled procedures 275.25in a format and at a frequency provided by the commissioner.275.26    Sec. 5. Minnesota Statutes 2012, section 245A.02, subdivision 10, is amended to read:275.27    Subd. 10. Nonresidential program. "Nonresidential program" means care, 275.28supervision, rehabilitation, training or habilitation of a person provided outside the 275.29person's own home and provided for fewer than 24 hours a day, including adult day 275.30care programs; and chemical dependency or chemical abuse programs that are located 275.31in a nursing home or hospital and receive public funds for providing chemical abuse or 275.32chemical dependency treatment services under chapter 254B. Nonresidential programs 275.33include home and community-based services and semi-independent living services for 276.1persons with developmental disabilities or persons age 65 and older that are provided in 276.2or outside of a person's own home under chapter 245D.276.3    Sec. 6. Minnesota Statutes 2012, section 245A.02, subdivision 14, is amended to read:276.4    Subd. 14. Residential program. "Residential program" means a program 276.5that provides 24-hour-a-day care, supervision, food, lodging, rehabilitation, training, 276.6education, habilitation, or treatment outside a person's own home, including a program 276.7in an intermediate care facility for four or more persons with developmental disabilities; 276.8and chemical dependency or chemical abuse programs that are located in a hospital 276.9or nursing home and receive public funds for providing chemical abuse or chemical 276.10dependency treatment services under chapter 254B. Residential programs include home 276.11and community-based services for persons with developmental disabilities or persons age 276.1265 and older that are provided in or outside of a person's own home under chapter 245D.276.13    Sec. 7. Minnesota Statutes 2012, section 245A.03, subdivision 7, is amended to read:276.14    Subd. 7. Licensing moratorium. (a) The commissioner shall not issue an initial 276.15license for child foster care licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, 276.16or adult foster care licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, under 276.17this chapter for a physical location that will not be the primary residence of the license 276.18holder for the entire period of licensure. If a license is issued during this moratorium, and 276.19the license holder changes the license holder's primary residence away from the physical 276.20location of the foster care license, the commissioner shall revoke the license according 276.21to section 
         245A.07. The commissioner shall not issue an initial license for a community 276.22residential setting licensed under chapter 245D. Exceptions to the moratorium include:276.23(1) foster care settings that are required to be registered under chapter 144D;276.24(2) foster care licenses replacing foster care licenses in existence on May 15, 2009, or 276.25community residential setting licenses replacing adult foster care licenses in existence on 276.26December 31, 2013, and determined to be needed by the commissioner under paragraph (b);276.27(3) new foster care licenses or community residential setting licenses determined to 276.28be needed by the commissioner under paragraph (b) for the closure of a nursing facility, 276.29ICF/MR, or regional treatment center, or restructuring of state-operated services that 276.30limits the capacity of state-operated facilities;276.31(4) new foster care licenses or community residential setting licenses determined 276.32to be needed by the commissioner under paragraph (b) for persons requiring hospital 276.33level care; or277.1(5) new foster care licenses or community residential setting licenses determined to 277.2be needed by the commissioner for the transition of people from personal care assistance 277.3to the home and community-based services.277.4(b) The commissioner shall determine the need for newly licensed foster care 277.5homes or community residential settings as defined under this subdivision. As part of the 277.6determination, the commissioner shall consider the availability of foster care capacity in 277.7the area in which the licensee seeks to operate, and the recommendation of the local 277.8county board. The determination by the commissioner must be final. A determination of 277.9need is not required for a change in ownership at the same address.277.10(c) The commissioner shall study the effects of the license moratorium under this 277.11subdivision and shall report back to the legislature by January 15, 2011. This study shall 277.12include, but is not limited to the following:277.13(1) the overall capacity and utilization of foster care beds where the physical location 277.14is not the primary residence of the license holder prior to and after implementation 277.15of the moratorium;277.16(2) the overall capacity and utilization of foster care beds where the physical 277.17location is the primary residence of the license holder prior to and after implementation 277.18of the moratorium; and277.19(3) the number of licensed and occupied ICF/MR beds prior to and after 277.20implementation of the moratorium.277.21(d) When a foster care recipient resident served by the program moves out of a 277.22foster home that is not the primary residence of the license holder according to section 277.23256B.49, subdivision 15
         , paragraph (f), or the community residential setting, the county 277.24shall immediately inform the Department of Human Services Licensing Division. 277.25The department shall decrease the statewide licensed capacity for foster care settings 277.26where the physical location is not the primary residence of the license holder, or for 277.27community residential settings, if the voluntary changes described in paragraph (f) are 277.28not sufficient to meet the savings required by reductions in licensed bed capacity under 277.29Laws 2011, First Special Session chapter 9, article 7, sections 1 and 40, paragraph (f), 277.30and maintain statewide long-term care residential services capacity within budgetary 277.31limits. Implementation of the statewide licensed capacity reduction shall begin on July 277.321, 2013. The commissioner shall delicense up to 128 beds by June 30, 2014, using the 277.33needs determination process. Under this paragraph, the commissioner has the authority 277.34to reduce unused licensed capacity of a current foster care program, or the community 277.35residential settings, to accomplish the consolidation or closure of settings. A decreased 277.36licensed capacity according to this paragraph is not subject to appeal under this chapter.278.1(e) Residential settings that would otherwise be subject to the decreased license 278.2capacity established in paragraph (d) shall be exempt under the following circumstances:278.3(1) until August 1, 2013, the license holder's beds occupied by residents whose 278.4primary diagnosis is mental illness and the license holder is:278.5(i) a provider of assertive community treatment (ACT) or adult rehabilitative mental 278.6health services (ARMHS) as defined in section 
         256B.0623;278.7(ii) a mental health center certified under Minnesota Rules, parts 9520.0750 to 278.89520.0870;278.9(iii) a mental health clinic certified under Minnesota Rules, parts 9520.0750 to 278.109520.0870; or278.11(iv) a provider of intensive residential treatment services (IRTS) licensed under 278.12Minnesota Rules, parts 9520.0500 to 9520.0670; or278.13(2) the license holder is certified under the requirements in subdivision 6a or section 278.14245D.33.278.15(f) A resource need determination process, managed at the state level, using the 278.16available reports required by section 
         144A.351, and other data and information shall 278.17be used to determine where the reduced capacity required under paragraph (d) will be 278.18implemented. The commissioner shall consult with the stakeholders described in section 278.19144A.351
         , and employ a variety of methods to improve the state's capacity to meet 278.20long-term care service needs within budgetary limits, including seeking proposals from 278.21service providers or lead agencies to change service type, capacity, or location to improve 278.22services, increase the independence of residents, and better meet needs identified by the 278.23long-term care services reports and statewide data and information. By February 1 of each 278.24year, the commissioner shall provide information and data on the overall capacity of 278.25licensed long-term care services, actions taken under this subdivision to manage statewide 278.26long-term care services and supports resources, and any recommendations for change to 278.27the legislative committees with jurisdiction over health and human services budget.278.28    (g) At the time of application and reapplication for licensure, the applicant and the 278.29license holder that are subject to the moratorium or an exclusion established in paragraph 278.30(a) are required to inform the commissioner whether the physical location where the foster 278.31care will be provided is or will be the primary residence of the license holder for the entire 278.32period of licensure. If the primary residence of the applicant or license holder changes, the 278.33applicant or license holder must notify the commissioner immediately. The commissioner 278.34shall print on the foster care license certificate whether or not the physical location is the 278.35primary residence of the license holder.279.1    (h) License holders of foster care homes identified under paragraph (g) that are not 279.2the primary residence of the license holder and that also provide services in the foster care 279.3home that are covered by a federally approved home and community-based services 279.4waiver, as authorized under section 
         256B.0915, 
         256B.092, or 
         256B.49, must inform the 279.5human services licensing division that the license holder provides or intends to provide 279.6these waiver-funded services. These license holders must be considered registered under 279.7section 256B.092, subdivision 11, paragraph (c), and this registration status must be 279.8identified on their license certificates.279.9    Sec. 8. Minnesota Statutes 2012, section 245A.03, subdivision 8, is amended to read:279.10    Subd. 8. Excluded providers seeking licensure. Nothing in this section shall 279.11prohibit a program that is excluded from licensure under subdivision 2, paragraph 279.12(a), clause (28) (26), from seeking licensure. The commissioner shall ensure that any 279.13application received from such an excluded provider is processed in the same manner as 279.14all other applications for child care center licensure.279.15    Sec. 9. Minnesota Statutes 2012, section 245A.042, subdivision 3, is amended to read:279.16    Subd. 3. Implementation. (a) The commissioner shall implement the 279.17responsibilities of this chapter according to the timelines in paragraphs (b) and (c) 279.18only within the limits of available appropriations or other administrative cost recovery 279.19methodology.279.20(b) The licensure of home and community-based services according to this section 279.21shall be implemented January 1, 2014. License applications shall be received and 279.22processed on a phased-in schedule as determined by the commissioner beginning July 279.231, 2013. Licenses will be issued thereafter upon the commissioner's determination that 279.24the application is complete according to section 
         245A.04.279.25(c) Within the limits of available appropriations or other administrative cost recovery 279.26methodology, implementation of compliance monitoring must be phased in after January 279.271, 2014.279.28(1) Applicants who do not currently hold a license issued under this chapter 245B279.29 must receive an initial compliance monitoring visit after 12 months of the effective date of 279.30the initial license for the purpose of providing technical assistance on how to achieve and 279.31maintain compliance with the applicable law or rules governing the provision of home and 279.32community-based services under chapter 245D. If during the review the commissioner 279.33finds that the license holder has failed to achieve compliance with an applicable law or 279.34rule and this failure does not imminently endanger the health, safety, or rights of the 280.1persons served by the program, the commissioner may issue a licensing review report with 280.2recommendations for achieving and maintaining compliance.280.3(2) Applicants who do currently hold a license issued under this chapter must receive 280.4a compliance monitoring visit after 24 months of the effective date of the initial license.280.5(d) Nothing in this subdivision shall be construed to limit the commissioner's 280.6authority to suspend or revoke a license or issue a fine at any time under section 
         245A.07, 280.7or make issue correction orders and make a license conditional for failure to comply with 280.8applicable laws or rules under section 
         245A.06, based on the nature, chronicity, or severity 280.9of the violation of law or rule and the effect of the violation on the health, safety, or 280.10rights of persons served by the program.280.11    Sec. 10. Minnesota Statutes 2012, section 245A.08, subdivision 2a, is amended to read:280.12    Subd. 2a. Consolidated contested case hearings. (a) When a denial of a license 280.13under section 
         245A.05 or a licensing sanction under section 
         245A.07, subdivision 3, is 280.14based on a disqualification for which reconsideration was requested and which was not 280.15set aside under section 
         245C.22, the scope of the contested case hearing shall include the 280.16disqualification and the licensing sanction or denial of a license, unless otherwise specified 280.17in this subdivision. When the licensing sanction or denial of a license is based on a 280.18determination of maltreatment under section 
         626.556 or 
         626.557, or a disqualification for 280.19serious or recurring maltreatment which was not set aside, the scope of the contested case 280.20hearing shall include the maltreatment determination, disqualification, and the licensing 280.21sanction or denial of a license, unless otherwise specified in this subdivision. In such 280.22cases, a fair hearing under section 
         256.045 shall not be conducted as provided for in 280.23sections 
         245C.27, 626.556, subdivision 10i, and 
         626.557, subdivision 9d.280.24    (b) Except for family child care and child foster care, reconsideration of a 280.25maltreatment determination under sections 
         626.556, subdivision 10i, and 
         626.557, 280.26subdivision 9d, and reconsideration of a disqualification under section 
         245C.22, shall 280.27not be conducted when:280.28    (1) a denial of a license under section 
         245A.05, or a licensing sanction under section 280.29245A.07
         , is based on a determination that the license holder is responsible for maltreatment 280.30or the disqualification of a license holder is based on serious or recurring maltreatment;280.31    (2) the denial of a license or licensing sanction is issued at the same time as the 280.32maltreatment determination or disqualification; and280.33    (3) the license holder appeals the maltreatment determination or disqualification, 280.34and denial of a license or licensing sanction. In these cases, a fair hearing shall not be 280.35conducted under sections 
         245C.27, 
         626.556, subdivision 10i, and 
         626.557, subdivision 281.19d. The scope of the contested case hearing must include the maltreatment determination, 281.2disqualification, and denial of a license or licensing sanction.281.3    Notwithstanding clauses (1) to (3), if the license holder appeals the maltreatment 281.4determination or disqualification, but does not appeal the denial of a license or a licensing 281.5sanction, reconsideration of the maltreatment determination shall be conducted under 281.6sections 
         626.556, subdivision 10i, and 
         626.557, subdivision 9d, and reconsideration of the 281.7disqualification shall be conducted under section 
         245C.22. In such cases, a fair hearing 281.8shall also be conducted as provided under sections 
         245C.27, 
         626.556, subdivision 10i, and 281.9626.557, subdivision 9d
         .281.10    (c) In consolidated contested case hearings regarding sanctions issued in family child 281.11care, child foster care, family adult day services, and adult foster care, and community 281.12residential settings, the county attorney shall defend the commissioner's orders in 281.13accordance with section 
         245A.16, subdivision 4.281.14    (d) The commissioner's final order under subdivision 5 is the final agency action 281.15on the issue of maltreatment and disqualification, including for purposes of subsequent 281.16background studies under chapter 245C and is the only administrative appeal of the final 281.17agency determination, specifically, including a challenge to the accuracy and completeness 281.18of data under section 
         13.04.281.19    (e) When consolidated hearings under this subdivision involve a licensing sanction 281.20based on a previous maltreatment determination for which the commissioner has issued 281.21a final order in an appeal of that determination under section 
         256.045, or the individual 281.22failed to exercise the right to appeal the previous maltreatment determination under 281.23section 
         626.556, subdivision 10i, or 
         626.557, subdivision 9d, the commissioner's order is 281.24conclusive on the issue of maltreatment. In such cases, the scope of the administrative 281.25law judge's review shall be limited to the disqualification and the licensing sanction or 281.26denial of a license. In the case of a denial of a license or a licensing sanction issued to 281.27a facility based on a maltreatment determination regarding an individual who is not the 281.28license holder or a household member, the scope of the administrative law judge's review 281.29includes the maltreatment determination.281.30    (f) The hearings of all parties may be consolidated into a single contested case 281.31hearing upon consent of all parties and the administrative law judge, if:281.32    (1) a maltreatment determination or disqualification, which was not set aside under 281.33section 
         245C.22, is the basis for a denial of a license under section 
         245A.05 or a licensing 281.34sanction under section 
         245A.07;281.35    (2) the disqualified subject is an individual other than the license holder and upon 281.36whom a background study must be conducted under section 
         245C.03; and282.1    (3) the individual has a hearing right under section 
         245C.27.282.2    (g) When a denial of a license under section 
         245A.05 or a licensing sanction under 282.3section 
         245A.07 is based on a disqualification for which reconsideration was requested 282.4and was not set aside under section 
         245C.22, and the individual otherwise has no hearing 282.5right under section 
         245C.27, the scope of the administrative law judge's review shall 282.6include the denial or sanction and a determination whether the disqualification should 282.7be set aside, unless section 
         245C.24 prohibits the set-aside of the disqualification. In 282.8determining whether the disqualification should be set aside, the administrative law judge 282.9shall consider the factors under section 
         245C.22, subdivision 4, to determine whether the 282.10individual poses a risk of harm to any person receiving services from the license holder.282.11    (h) Notwithstanding section 
         245C.30, subdivision 5, when a licensing sanction 282.12under section 
         245A.07 is based on the termination of a variance under section 
         245C.30, 282.13subdivision 4
         , the scope of the administrative law judge's review shall include the sanction 282.14and a determination whether the disqualification should be set aside, unless section 282.15245C.24
          prohibits the set-aside of the disqualification. In determining whether the 282.16disqualification should be set aside, the administrative law judge shall consider the factors 282.17under section 
         245C.22, subdivision 4, to determine whether the individual poses a risk of 282.18harm to any person receiving services from the license holder.282.19    Sec. 11. Minnesota Statutes 2012, section 245A.10, is amended to read:282.20245A.10 FEES.282.21    Subdivision 1. Application or license fee required, programs exempt from fee.282.22(a) Unless exempt under paragraph (b), the commissioner shall charge a fee for evaluation 282.23of applications and inspection of programs which are licensed under this chapter.282.24(b) Except as provided under subdivision 2, no application or license fee shall be 282.25charged for child foster care, adult foster care, or family and group family child care, or 282.26a community residential setting.282.27    Subd. 2. County fees for background studies and licensing inspections. (a) For 282.28purposes of family and group family child care licensing under this chapter, a county 282.29agency may charge a fee to an applicant or license holder to recover the actual cost of 282.30background studies, but in any case not to exceed $100 annually. A county agency may 282.31also charge a license fee to an applicant or license holder not to exceed $50 for a one-year 282.32license or $100 for a two-year license.282.33    (b) A county agency may charge a fee to a legal nonlicensed child care provider or 282.34applicant for authorization to recover the actual cost of background studies completed 282.35under section 
         119B.125, but in any case not to exceed $100 annually.283.1    (c) Counties may elect to reduce or waive the fees in paragraph (a) or (b):283.2    (1) in cases of financial hardship;283.3    (2) if the county has a shortage of providers in the county's area;283.4    (3) for new providers; or283.5    (4) for providers who have attained at least 16 hours of training before seeking 283.6initial licensure.283.7    (d) Counties may allow providers to pay the applicant fees in paragraph (a) or (b) on 283.8an installment basis for up to one year. If the provider is receiving child care assistance 283.9payments from the state, the provider may have the fees under paragraph (a) or (b) 283.10deducted from the child care assistance payments for up to one year and the state shall 283.11reimburse the county for the county fees collected in this manner.283.12    (e) For purposes of adult foster care and child foster care licensing, and licensing 283.13the physical plant of a community residential setting, under this chapter, a county agency 283.14may charge a fee to a corporate applicant or corporate license holder to recover the actual 283.15cost of licensing inspections, not to exceed $500 annually.283.16    (f) Counties may elect to reduce or waive the fees in paragraph (e) under the 283.17following circumstances:283.18(1) in cases of financial hardship;283.19(2) if the county has a shortage of providers in the county's area; or283.20(3) for new providers.283.21    Subd. 3. Application fee for initial license or certification. (a) For fees required 283.22under subdivision 1, an applicant for an initial license or certification issued by the 283.23commissioner shall submit a $500 application fee with each new application required 283.24under this subdivision. An applicant for an initial day services facility license under 283.25chapter 245D shall submit a $250 application fee with each new application. The 283.26application fee shall not be prorated, is nonrefundable, and is in lieu of the annual license 283.27or certification fee that expires on December 31. The commissioner shall not process an 283.28application until the application fee is paid.283.29(b) Except as provided in clauses (1) to (4) (3), an applicant shall apply for a license 283.30to provide services at a specific location.283.31(1) For a license to provide residential-based habilitation services to persons with 283.32developmental disabilities under chapter 245B, an applicant shall submit an application 283.33for each county in which the services will be provided. Upon licensure, the license 283.34holder may provide services to persons in that county plus no more than three persons 283.35at any one time in each of up to ten additional counties. A license holder in one county 283.36may not provide services under the home and community-based waiver for persons with 284.1developmental disabilities to more than three people in a second county without holding 284.2a separate license for that second county. Applicants or licensees providing services 284.3under this clause to not more than three persons remain subject to the inspection fees 284.4established in section 245A.10, subdivision 2, for each location. The license issued by 284.5the commissioner must state the name of each additional county where services are being 284.6provided to persons with developmental disabilities. A license holder must notify the 284.7commissioner before making any changes that would alter the license information listed 284.8under section 245A.04, subdivision 7, paragraph (a), including any additional counties 284.9where persons with developmental disabilities are being served. For a license to provide 284.10home and community-based services to persons with disabilities or age 65 and older under 284.11chapter 245D, an applicant shall submit an application to provide services statewide.284.12(2) For a license to provide supported employment, crisis respite, or 284.13semi-independent living services to persons with developmental disabilities under chapter 284.14245B, an applicant shall submit a single application to provide services statewide.284.15(3) For a license to provide independent living assistance for youth under section 284.16245A.22
         , an applicant shall submit a single application to provide services statewide.284.17(4) (3) For a license for a private agency to provide foster care or adoption services 284.18under Minnesota Rules, parts 9545.0755 to 9545.0845, an applicant shall submit a single 284.19application to provide services statewide.284.20(c) The initial application fee charged under this subdivision does not include the 284.21temporary license surcharge under section 16E.22.284.22    Subd. 4. License or certification fee for certain programs. (a) Child care centers 284.23shall pay an annual nonrefundable license fee based on the following schedule:

284.24284.25Licensed CapacityChild Care Center
                  		License Fee284.261 to 24 persons$200284.2725 to 49 persons$300284.2850 to 74 persons$400284.2975 to 99 persons$500284.30100 to 124 persons$600284.31125 to 149 persons$700284.32150 to 174 persons$800284.33175 to 199 persons$900284.34200 to 224 persons$1,000284.35225 or more persons$1,100

284.36    (b) A day training and habilitation program serving persons with developmental 284.37disabilities or related conditions shall pay an annual nonrefundable license fee based on 284.38the following schedule:

285.1Licensed CapacityLicense Fee285.21 to 24 persons$800285.325 to 49 persons$1,000285.450 to 74 persons$1,200285.575 to 99 persons$1,400285.6100 to 124 persons$1,600285.7125 to 149 persons$1,800285.8150 or more persons$2,000

285.9Except as provided in paragraph (c), when a day training and habilitation program 285.10serves more than 50 percent of the same persons in two or more locations in a community, 285.11the day training and habilitation program shall pay a license fee based on the licensed 285.12capacity of the largest facility and the other facility or facilities shall be charged a license 285.13fee based on a licensed capacity of a residential program serving one to 24 persons.285.14    (c) When a day training and habilitation program serving persons with developmental 285.15disabilities or related conditions seeks a single license allowed under section 245B.07, 285.16subdivision 12, clause (2) or (3), the licensing fee must be based on the combined licensed 285.17capacity for each location.285.18(d) A program licensed to provide supported employment services to persons 285.19with developmental disabilities under chapter 245B shall pay an annual nonrefundable 285.20license fee of $650.285.21(e) A program licensed to provide crisis respite services to persons with 285.22developmental disabilities under chapter 245B shall pay an annual nonrefundable license 285.23fee of $700.285.24(f) A program licensed to provide semi-independent living services to persons 285.25with developmental disabilities under chapter 245B shall pay an annual nonrefundable 285.26license fee of $700.285.27(g) A program licensed to provide residential-based habilitation services under the 285.28home and community-based waiver for persons with developmental disabilities shall pay 285.29an annual license fee that includes a base rate of $690 plus $60 times the number of clients 285.30served on the first day of July of the current license year.285.31(h) A residential program certified by the Department of Health as an intermediate 285.32care facility for persons with developmental disabilities (ICF/MR) and a noncertified 285.33residential program licensed to provide health or rehabilitative services for persons 285.34with developmental disabilities shall pay an annual nonrefundable license fee based on 285.35the following schedule:

285.36Licensed CapacityLicense Fee285.371 to 24 persons$535286.125 to 49 persons$735286.250 or more persons$935

286.3(b) A program licensed to provide one or more of the home and community-based 286.4services and supports identified under chapter 245D to persons with disabilities or age 286.565 and older, shall pay an annual nonrefundable license fee that includes a base rate of 286.6$563, plus $46 times the number of persons served on the last day of June of the current 286.7license year for programs serving ten or more persons. The fee is limited to a maximum of 286.8200 persons, regardless of the actual number of persons served. Programs serving nine 286.9or fewer persons pay only the base rate.286.10(c) A facility licensed under chapter 245D to provide day services shall pay an 286.11annual nonrefundable license fee of $100.286.12(i) (d) A chemical dependency treatment program licensed under Minnesota Rules, 286.13parts 9530.6405 to 9530.6505, to provide chemical dependency treatment shall pay an 286.14annual nonrefundable license fee based on the following schedule:

286.15Licensed CapacityLicense Fee286.161 to 24 persons$600286.1725 to 49 persons$800286.1850 to 74 persons$1,000286.1975 to 99 persons$1,200286.20100 or more persons$1,400

286.21(j) (e) A chemical dependency program licensed under Minnesota Rules, parts 286.229530.6510 to 9530.6590, to provide detoxification services shall pay an annual 286.23nonrefundable license fee based on the following schedule:

286.24Licensed CapacityLicense Fee286.251 to 24 persons$760286.2625 to 49 persons$960286.2750 or more persons$1,160

286.28(k) (f) Except for child foster care, a residential facility licensed under Minnesota 286.29Rules, chapter 2960, to serve children shall pay an annual nonrefundable license fee 286.30based on the following schedule:

286.31Licensed CapacityLicense Fee286.321 to 24 persons$1,000286.3325 to 49 persons$1,100286.3450 to 74 persons$1,200286.3575 to 99 persons$1,300286.36100 or more persons$1,400

287.1(l) (g) A residential facility licensed under Minnesota Rules, parts 9520.0500 to 287.29520.0670, to serve persons with mental illness shall pay an annual nonrefundable license 287.3fee based on the following schedule:

287.4Licensed CapacityLicense Fee287.51 to 24 persons$2,525287.625 or more persons$2,725

287.7(m) (h) A residential facility licensed under Minnesota Rules, parts 9570.2000 to 287.89570.3400, to serve persons with physical disabilities shall pay an annual nonrefundable 287.9license fee based on the following schedule:

287.10Licensed CapacityLicense Fee287.111 to 24 persons$450287.1225 to 49 persons$650287.1350 to 74 persons$850287.1475 to 99 persons$1,050287.15100 or more persons$1,250

287.16(n) (i) A program licensed to provide independent living assistance for youth under 287.17section 
         245A.22 shall pay an annual nonrefundable license fee of $1,500.287.18(o) (j) A private agency licensed to provide foster care and adoption services under 287.19Minnesota Rules, parts 9545.0755 to 9545.0845, shall pay an annual nonrefundable 287.20license fee of $875.287.21(p) (k) A program licensed as an adult day care center licensed under Minnesota 287.22Rules, parts 9555.9600 to 9555.9730, shall pay an annual nonrefundable license fee based 287.23on the following schedule:

287.24Licensed CapacityLicense Fee287.251 to 24 persons$500287.2625 to 49 persons$700287.2750 to 74 persons$900287.2875 to 99 persons$1,100287.29100 or more persons$1,300

287.30(q) (l) A program licensed to provide treatment services to persons with sexual 287.31psychopathic personalities or sexually dangerous persons under Minnesota Rules, parts 287.329515.3000 to 9515.3110, shall pay an annual nonrefundable license fee of $20,000.287.33(r) (m) A mental health center or mental health clinic requesting certification for 287.34purposes of insurance and subscriber contract reimbursement under Minnesota Rules, 287.35parts 9520.0750 to 9520.0870, shall pay a certification fee of $1,550 per year. If the 287.36mental health center or mental health clinic provides services at a primary location with 288.1satellite facilities, the satellite facilities shall be certified with the primary location without 288.2an additional charge.288.3    Subd. 6. License not issued until license or certification fee is paid. The 288.4commissioner shall not issue a license or certification until the license or certification fee 288.5is paid. The commissioner shall send a bill for the license or certification fee to the billing 288.6address identified by the license holder. If the license holder does not submit the license or 288.7certification fee payment by the due date, the commissioner shall send the license holder 288.8a past due notice. If the license holder fails to pay the license or certification fee by the 288.9due date on the past due notice, the commissioner shall send a final notice to the license 288.10holder informing the license holder that the program license will expire on December 31 288.11unless the license fee is paid before December 31. If a license expires, the program is no 288.12longer licensed and, unless exempt from licensure under section 
         245A.03, subdivision 2, 288.13must not operate after the expiration date. After a license expires, if the former license 288.14holder wishes to provide licensed services, the former license holder must submit a new 288.15license application and application fee under subdivision 3.288.16    Subd. 7. Human services licensing fees to recover expenditures. Notwithstanding 288.17section 
         16A.1285, subdivision 2, related to activities for which the commissioner charges 288.18a fee, the commissioner must plan to fully recover direct expenditures for licensing 288.19activities under this chapter over a five-year period. The commissioner may have 288.20anticipated expenditures in excess of anticipated revenues in a biennium by using surplus 288.21revenues accumulated in previous bienniums.288.22    Subd. 8. Deposit of license fees. A human services licensing account is created in 288.23the state government special revenue fund. Fees collected under subdivisions 3 and 4 must 288.24be deposited in the human services licensing account and are annually appropriated to the 288.25commissioner for licensing activities authorized under this chapter.288.26EFFECTIVE DATE.This section is effective July 1, 2013.288.27    Sec. 12. Minnesota Statutes 2012, section 245A.11, subdivision 2a, is amended to read:288.28    Subd. 2a. Adult foster care and community residential setting license capacity.288.29(a) The commissioner shall issue adult foster care and community residential setting288.30 licenses with a maximum licensed capacity of four beds, including nonstaff roomers and 288.31boarders, except that the commissioner may issue a license with a capacity of five beds, 288.32including roomers and boarders, according to paragraphs (b) to (f).288.33(b) An adult foster care The license holder may have a maximum license capacity 288.34of five if all persons in care are age 55 or over and do not have a serious and persistent 288.35mental illness or a developmental disability.289.1(c) The commissioner may grant variances to paragraph (b) to allow a foster care 289.2provider facility with a licensed capacity of five persons to admit an individual under the 289.3age of 55 if the variance complies with section 
         245A.04, subdivision 9, and approval of 289.4the variance is recommended by the county in which the licensed foster care provider289.5 facility is located.289.6(d) The commissioner may grant variances to paragraph (b) to allow the use of a fifth 289.7bed for emergency crisis services for a person with serious and persistent mental illness 289.8or a developmental disability, regardless of age, if the variance complies with section 289.9245A.04, subdivision 9
         , and approval of the variance is recommended by the county in 289.10which the licensed foster care provider facility is located.289.11(e) The commissioner may grant a variance to paragraph (b) to allow for the use of a 289.12fifth bed for respite services, as defined in section 
         245A.02, for persons with disabilities, 289.13regardless of age, if the variance complies with sections 
         245A.03, subdivision 7, and 289.14245A.04, subdivision 9
         , and approval of the variance is recommended by the county in 289.15which the licensed foster care provider facility is licensed located. Respite care may be 289.16provided under the following conditions:289.17(1) staffing ratios cannot be reduced below the approved level for the individuals 289.18being served in the home on a permanent basis;289.19(2) no more than two different individuals can be accepted for respite services in 289.20any calendar month and the total respite days may not exceed 120 days per program in 289.21any calendar year;289.22(3) the person receiving respite services must have his or her own bedroom, which 289.23could be used for alternative purposes when not used as a respite bedroom, and cannot be 289.24the room of another person who lives in the foster care home facility; and289.25(4) individuals living in the foster care home facility must be notified when the 289.26variance is approved. The provider must give 60 days' notice in writing to the residents 289.27and their legal representatives prior to accepting the first respite placement. Notice must 289.28be given to residents at least two days prior to service initiation, or as soon as the license 289.29holder is able if they receive notice of the need for respite less than two days prior to 289.30initiation, each time a respite client will be served, unless the requirement for this notice is 289.31waived by the resident or legal guardian.289.32(f) The commissioner may issue an adult foster care or community residential setting289.33 license with a capacity of five adults if the fifth bed does not increase the overall statewide 289.34capacity of licensed adult foster care or community residential setting beds in homes that 289.35are not the primary residence of the license holder, as identified in a plan submitted to the 290.1commissioner by the county, when the capacity is recommended by the county licensing 290.2agency of the county in which the facility is located and if the recommendation verifies that:290.3(1) the facility meets the physical environment requirements in the adult foster 290.4care licensing rule;290.5(2) the five-bed living arrangement is specified for each resident in the resident's:290.6(i) individualized plan of care;290.7(ii) individual service plan under section 
         256B.092, subdivision 1b, if required; or290.8(iii) individual resident placement agreement under Minnesota Rules, part 290.99555.5105, subpart 19, if required;290.10(3) the license holder obtains written and signed informed consent from each 290.11resident or resident's legal representative documenting the resident's informed choice 290.12to remain living in the home and that the resident's refusal to consent would not have 290.13resulted in service termination; and290.14(4) the facility was licensed for adult foster care before March 1, 2011.290.15(g) The commissioner shall not issue a new adult foster care license under paragraph 290.16(f) after June 30, 2016. The commissioner shall allow a facility with an adult foster care 290.17license issued under paragraph (f) before June 30, 2016, to continue with a capacity of five 290.18adults if the license holder continues to comply with the requirements in paragraph (f).290.19    Sec. 13. Minnesota Statutes 2012, section 245A.11, subdivision 7, is amended to read:290.20    Subd. 7. Adult foster care; variance for alternate overnight supervision. (a) The 290.21commissioner may grant a variance under section 
         245A.04, subdivision 9, to rule parts 290.22requiring a caregiver to be present in an adult foster care home during normal sleeping 290.23hours to allow for alternative methods of overnight supervision. The commissioner may 290.24grant the variance if the local county licensing agency recommends the variance and the 290.25county recommendation includes documentation verifying that:290.26    (1) the county has approved the license holder's plan for alternative methods of 290.27providing overnight supervision and determined the plan protects the residents' health, 290.28safety, and rights;290.29    (2) the license holder has obtained written and signed informed consent from 290.30each resident or each resident's legal representative documenting the resident's or legal 290.31representative's agreement with the alternative method of overnight supervision; and290.32    (3) the alternative method of providing overnight supervision, which may include 290.33the use of technology, is specified for each resident in the resident's: (i) individualized 290.34plan of care; (ii) individual service plan under section 
         256B.092, subdivision 1b, if 291.1required; or (iii) individual resident placement agreement under Minnesota Rules, part 291.29555.5105, subpart 19, if required.291.3    (b) To be eligible for a variance under paragraph (a), the adult foster care license 291.4holder must not have had a conditional license issued under section 
         245A.06, or any 291.5other licensing sanction issued under section 
         245A.07 during the prior 24 months based 291.6on failure to provide adequate supervision, health care services, or resident safety in 291.7the adult foster care home.291.8    (c) A license holder requesting a variance under this subdivision to utilize 291.9technology as a component of a plan for alternative overnight supervision may request 291.10the commissioner's review in the absence of a county recommendation. Upon receipt of 291.11such a request from a license holder, the commissioner shall review the variance request 291.12with the county.291.13(d) A variance granted by the commissioner according to this subdivision before 291.14January 1, 2014, to a license holder for an adult foster care home must transfer with the 291.15license when the license converts to a community residential setting license under chapter 291.16245D. The terms and conditions of the variance remain in effect as approved at the time 291.17the variance was granted.291.18    Sec. 14. Minnesota Statutes 2012, section 245A.11, subdivision 7a, is amended to read:291.19    Subd. 7a. Alternate overnight supervision technology; adult foster care license291.20 and community residential setting licenses. (a) The commissioner may grant an 291.21applicant or license holder an adult foster care or community residential setting license 291.22for a residence that does not have a caregiver in the residence during normal sleeping 291.23hours as required under Minnesota Rules, part 9555.5105, subpart 37, item B, or section 291.24245D.02, subdivision 33b, but uses monitoring technology to alert the license holder 291.25when an incident occurs that may jeopardize the health, safety, or rights of a foster 291.26care recipient. The applicant or license holder must comply with all other requirements 291.27under Minnesota Rules, parts 9555.5105 to 9555.6265, or applicable requirements under 291.28chapter 245D, and the requirements under this subdivision. The license printed by the 291.29commissioner must state in bold and large font:291.30    (1) that the facility is under electronic monitoring; and291.31    (2) the telephone number of the county's common entry point for making reports of 291.32suspected maltreatment of vulnerable adults under section 
         626.557, subdivision 9.291.33(b) Applications for a license under this section must be submitted directly to 291.34the Department of Human Services licensing division. The licensing division must 291.35immediately notify the host county and lead county contract agency and the host county 292.1licensing agency. The licensing division must collaborate with the county licensing 292.2agency in the review of the application and the licensing of the program.292.3    (c) Before a license is issued by the commissioner, and for the duration of the 292.4license, the applicant or license holder must establish, maintain, and document the 292.5implementation of written policies and procedures addressing the requirements in 292.6paragraphs (d) through (f).292.7    (d) The applicant or license holder must have policies and procedures that:292.8    (1) establish characteristics of target populations that will be admitted into the home, 292.9and characteristics of populations that will not be accepted into the home;292.10    (2) explain the discharge process when a foster care recipient resident served by the 292.11program requires overnight supervision or other services that cannot be provided by the 292.12license holder due to the limited hours that the license holder is on site;292.13    (3) describe the types of events to which the program will respond with a physical 292.14presence when those events occur in the home during time when staff are not on site, and 292.15how the license holder's response plan meets the requirements in paragraph (e), clause 292.16(1) or (2);292.17    (4) establish a process for documenting a review of the implementation and 292.18effectiveness of the response protocol for the response required under paragraph (e), 292.19clause (1) or (2). The documentation must include:292.20    (i) a description of the triggering incident;292.21    (ii) the date and time of the triggering incident;292.22    (iii) the time of the response or responses under paragraph (e), clause (1) or (2);292.23    (iv) whether the response met the resident's needs;292.24    (v) whether the existing policies and response protocols were followed; and292.25    (vi) whether the existing policies and protocols are adequate or need modification.292.26    When no physical presence response is completed for a three-month period, the 292.27license holder's written policies and procedures must require a physical presence response 292.28drill to be conducted for which the effectiveness of the response protocol under paragraph 292.29(e), clause (1) or (2), will be reviewed and documented as required under this clause; and292.30    (5) establish that emergency and nonemergency phone numbers are posted in a 292.31prominent location in a common area of the home where they can be easily observed by a 292.32person responding to an incident who is not otherwise affiliated with the home.292.33    (e) The license holder must document and include in the license application which 292.34response alternative under clause (1) or (2) is in place for responding to situations that 292.35present a serious risk to the health, safety, or rights of people receiving foster care services 292.36in the home residents served by the program:293.1    (1) response alternative (1) requires only the technology to provide an electronic 293.2notification or alert to the license holder that an event is underway that requires a response. 293.3Under this alternative, no more than ten minutes will pass before the license holder will be 293.4physically present on site to respond to the situation; or293.5    (2) response alternative (2) requires the electronic notification and alert system under 293.6alternative (1), but more than ten minutes may pass before the license holder is present on 293.7site to respond to the situation. Under alternative (2), all of the following conditions are met:293.8    (i) the license holder has a written description of the interactive technological 293.9applications that will assist the license holder in communicating with and assessing the 293.10needs related to the care, health, and safety of the foster care recipients. This interactive 293.11technology must permit the license holder to remotely assess the well being of the foster 293.12care recipient resident served by the program without requiring the initiation of the 293.13foster care recipient. Requiring the foster care recipient to initiate a telephone call does 293.14not meet this requirement;293.15(ii) the license holder documents how the remote license holder is qualified and 293.16capable of meeting the needs of the foster care recipients and assessing foster care 293.17recipients' needs under item (i) during the absence of the license holder on site;293.18(iii) the license holder maintains written procedures to dispatch emergency response 293.19personnel to the site in the event of an identified emergency; and293.20    (iv) each foster care recipient's resident's individualized plan of care, individual 293.21service plan coordinated service and support plan under section sections 256B.0913, 293.22subdivision 8; 256B.0915, subdivision 6; 256B.092, subdivision 1b; and 256B.49, 293.23subdivision 15, if required, or individual resident placement agreement under Minnesota 293.24Rules, part 9555.5105, subpart 19, if required, identifies the maximum response time, 293.25which may be greater than ten minutes, for the license holder to be on site for that foster 293.26care recipient resident.293.27    (f) Each foster care recipient's resident's placement agreement, individual service 293.28agreement, and plan must clearly state that the adult foster care or community residential 293.29setting license category is a program without the presence of a caregiver in the residence 293.30during normal sleeping hours; the protocols in place for responding to situations that 293.31present a serious risk to the health, safety, or rights of foster care recipients residents 293.32served by the program under paragraph (e), clause (1) or (2); and a signed informed 293.33consent from each foster care recipient resident served by the program or the person's 293.34legal representative documenting the person's or legal representative's agreement with 293.35placement in the program. If electronic monitoring technology is used in the home, the 293.36informed consent form must also explain the following:294.1    (1) how any electronic monitoring is incorporated into the alternative supervision 294.2system;294.3    (2) the backup system for any electronic monitoring in times of electrical outages or 294.4other equipment malfunctions;294.5    (3) how the caregivers or direct support staff are trained on the use of the technology;294.6    (4) the event types and license holder response times established under paragraph (e);294.7    (5) how the license holder protects the foster care recipient's each resident's privacy 294.8related to electronic monitoring and related to any electronically recorded data generated 294.9by the monitoring system. A foster care recipient resident served by the program may 294.10not be removed from a program under this subdivision for failure to consent to electronic 294.11monitoring. The consent form must explain where and how the electronically recorded 294.12data is stored, with whom it will be shared, and how long it is retained; and294.13    (6) the risks and benefits of the alternative overnight supervision system.294.14    The written explanations under clauses (1) to (6) may be accomplished through 294.15cross-references to other policies and procedures as long as they are explained to the 294.16person giving consent, and the person giving consent is offered a copy.294.17(g) Nothing in this section requires the applicant or license holder to develop or 294.18maintain separate or duplicative policies, procedures, documentation, consent forms, or 294.19individual plans that may be required for other licensing standards, if the requirements of 294.20this section are incorporated into those documents.294.21(h) The commissioner may grant variances to the requirements of this section 294.22according to section 
         245A.04, subdivision 9.294.23(i) For the purposes of paragraphs (d) through (h), "license holder" has the meaning 294.24under section 245A.2, subdivision 9, and additionally includes all staff, volunteers, and 294.25contractors affiliated with the license holder.294.26(j) For the purposes of paragraph (e), the terms "assess" and "assessing" mean to 294.27remotely determine what action the license holder needs to take to protect the well-being 294.28of the foster care recipient.294.29(k) The commissioner shall evaluate license applications using the requirements 294.30in paragraphs (d) to (f). The commissioner shall provide detailed application forms, 294.31including a checklist of criteria needed for approval.294.32(l) To be eligible for a license under paragraph (a), the adult foster care or community 294.33residential setting license holder must not have had a conditional license issued under 294.34section 
         245A.06 or any licensing sanction under section 
         245A.07 during the prior 24 294.35months based on failure to provide adequate supervision, health care services, or resident 294.36safety in the adult foster care home or community residential setting.295.1(m) The commissioner shall review an application for an alternative overnight 295.2supervision license within 60 days of receipt of the application. When the commissioner 295.3receives an application that is incomplete because the applicant failed to submit required 295.4documents or that is substantially deficient because the documents submitted do not meet 295.5licensing requirements, the commissioner shall provide the applicant written notice 295.6that the application is incomplete or substantially deficient. In the written notice to the 295.7applicant, the commissioner shall identify documents that are missing or deficient and 295.8give the applicant 45 days to resubmit a second application that is substantially complete. 295.9An applicant's failure to submit a substantially complete application after receiving 295.10notice from the commissioner is a basis for license denial under section 
         245A.05. The 295.11commissioner shall complete subsequent review within 30 days.295.12(n) Once the application is considered complete under paragraph (m), the 295.13commissioner will approve or deny an application for an alternative overnight supervision 295.14license within 60 days.295.15(o) For the purposes of this subdivision, "supervision" means:295.16(1) oversight by a caregiver or direct support staff as specified in the individual 295.17resident's place agreement or coordinated service and support plan and awareness of the 295.18resident's needs and activities; and295.19(2) the presence of a caregiver or direct support staff in a residence during normal 295.20sleeping hours, unless a determination has been made and documented in the individual's295.21 coordinated service and support plan that the individual does not require the presence of a 295.22caregiver or direct support staff during normal sleeping hours.295.23    Sec. 15. Minnesota Statutes 2012, section 245A.11, subdivision 7b, is amended to read:295.24    Subd. 7b. Adult foster care data privacy and security. (a) An adult foster care295.25 or community residential setting license holder who creates, collects, records, maintains, 295.26stores, or discloses any individually identifiable recipient data, whether in an electronic 295.27or any other format, must comply with the privacy and security provisions of applicable 295.28privacy laws and regulations, including:295.29(1) the federal Health Insurance Portability and Accountability Act of 1996 295.30(HIPAA), Public Law 104-1; and the HIPAA Privacy Rule, Code of Federal Regulations, 295.31title 45, part 160, and subparts A and E of part 164; and295.32(2) the Minnesota Government Data Practices Act as codified in chapter 13.295.33(b) For purposes of licensure, the license holder shall be monitored for compliance 295.34with the following data privacy and security provisions:296.1(1) the license holder must control access to data on foster care recipients residents 296.2served by the program according to the definitions of public and private data on individuals 296.3under section 
         13.02; classification of the data on individuals as private under section 296.413.46, subdivision 2
         ; and control over the collection, storage, use, access, protection, 296.5and contracting related to data according to section 
         13.05, in which the license holder is 296.6assigned the duties of a government entity;296.7(2) the license holder must provide each foster care recipient resident served by 296.8the program with a notice that meets the requirements under section 
         13.04, in which 296.9the license holder is assigned the duties of the government entity, and that meets the 296.10requirements of Code of Federal Regulations, title 45, part 
         164.52. The notice shall 296.11describe the purpose for collection of the data, and to whom and why it may be disclosed 296.12pursuant to law. The notice must inform the recipient individual that the license holder 296.13uses electronic monitoring and, if applicable, that recording technology is used;296.14(3) the license holder must not install monitoring cameras in bathrooms;296.15(4) electronic monitoring cameras must not be concealed from the foster care 296.16recipients residents served by the program; and296.17(5) electronic video and audio recordings of foster care recipients residents served 296.18by the program shall be stored by the license holder for five days unless: (i) a foster care 296.19recipient resident served by the program or legal representative requests that the recording 296.20be held longer based on a specific report of alleged maltreatment; or (ii) the recording 296.21captures an incident or event of alleged maltreatment under section 
         626.556 or 
         626.557 or 296.22a crime under chapter 609. When requested by a recipient resident served by the program296.23 or when a recording captures an incident or event of alleged maltreatment or a crime, the 296.24license holder must maintain the recording in a secured area for no longer than 30 days 296.25to give the investigating agency an opportunity to make a copy of the recording. The 296.26investigating agency will maintain the electronic video or audio recordings as required in 296.27section 
         626.557, subdivision 12b.296.28(c) The commissioner shall develop, and make available to license holders and 296.29county licensing workers, a checklist of the data privacy provisions to be monitored 296.30for purposes of licensure.296.31    Sec. 16. Minnesota Statutes 2012, section 245A.11, subdivision 8, is amended to read:296.32    Subd. 8. Community residential setting license. (a) The commissioner shall 296.33establish provider standards for residential support services that integrate service standards 296.34and the residential setting under one license. The commissioner shall propose statutory 296.35language and an implementation plan for licensing requirements for residential support 297.1services to the legislature by January 15, 2012, as a component of the quality outcome 297.2standards recommendations required by Laws 2010, chapter 352, article 1, section 24.297.3(b) Providers licensed under chapter 245B, and providing, contracting, or arranging 297.4for services in settings licensed as adult foster care under Minnesota Rules, parts 9555.5105 297.5to 9555.6265, or child foster care under Minnesota Rules, parts 2960.3000 to 2960.3340; 297.6and meeting the provisions of section 256B.092, subdivision 11, paragraph (b) section 297.7245D.02, subdivision 4a, must be required to obtain a community residential setting license.297.8    Sec. 17. Minnesota Statutes 2012, section 245A.16, subdivision 1, is amended to read:297.9    Subdivision 1. Delegation of authority to agencies. (a) County agencies and 297.10private agencies that have been designated or licensed by the commissioner to perform 297.11licensing functions and activities under section 
         245A.04 and background studies for family 297.12child care under chapter 245C; to recommend denial of applicants under section 
         245A.05; 297.13to issue correction orders, to issue variances, and recommend a conditional license under 297.14section 
         245A.06, or to recommend suspending or revoking a license or issuing a fine under 297.15section 
         245A.07, shall comply with rules and directives of the commissioner governing 297.16those functions and with this section. The following variances are excluded from the 297.17delegation of variance authority and may be issued only by the commissioner:297.18    (1) dual licensure of family child care and child foster care, dual licensure of child 297.19and adult foster care, and adult foster care and family child care;297.20    (2) adult foster care maximum capacity;297.21    (3) adult foster care minimum age requirement;297.22    (4) child foster care maximum age requirement;297.23    (5) variances regarding disqualified individuals except that county agencies may 297.24issue variances under section 
         245C.30 regarding disqualified individuals when the county 297.25is responsible for conducting a consolidated reconsideration according to sections 
         245C.25 297.26and 
         245C.27, subdivision 2, clauses (a) and (b), of a county maltreatment determination 297.27and a disqualification based on serious or recurring maltreatment; and297.28    (6) the required presence of a caregiver in the adult foster care residence during 297.29normal sleeping hours; and297.30    (7) variances for community residential setting licenses under chapter 245D.297.31Except as provided in section 
         245A.14, subdivision 4, paragraph (e), a county agency 297.32must not grant a license holder a variance to exceed the maximum allowable family child 297.33care license capacity of 14 children.297.34    (b) County agencies must report information about disqualification reconsiderations 297.35under sections 
         245C.25 and 
         245C.27, subdivision 2, paragraphs (a) and (b), and variances 298.1granted under paragraph (a), clause (5), to the commissioner at least monthly in a format 298.2prescribed by the commissioner.298.3    (c) For family day care programs, the commissioner may authorize licensing reviews 298.4every two years after a licensee has had at least one annual review.298.5    (d) For family adult day services programs, the commissioner may authorize 298.6licensing reviews every two years after a licensee has had at least one annual review.298.7    (e) A license issued under this section may be issued for up to two years.298.8    Sec. 18. Minnesota Statutes 2012, section 245D.02, is amended to read:298.9245D.02 DEFINITIONS.298.10    Subdivision 1. Scope. The terms used in this chapter have the meanings given 298.11them in this section.298.12    Subd. 2. Annual and annually. "Annual" and "annually" have the meaning given 298.13in section 
         245A.02, subdivision 2b.298.14    Subd. 2a.Authorized representative."Authorized representative" means a parent, 298.15family member, advocate, or other adult authorized by the person or the person's legal 298.16representative, to serve as a representative in connection with the provision of services 298.17licensed under this chapter. This authorization must be in writing or by another method 298.18that clearly indicates the person's free choice. The authorized representative must have no 298.19financial interest in the provision of any services included in the person's service delivery 298.20plan and must be capable of providing the support necessary to assist the person in the use 298.21of home and community-based services licensed under this chapter.298.22    Subd. 3. Case manager. "Case manager" means the individual designated 298.23to provide waiver case management services, care coordination, or long-term care 298.24consultation, as specified in sections 
         256B.0913, 
         256B.0915, 
         256B.092, and 
         256B.49, 298.25or successor provisions.298.26    Subd. 3a.Certification."Certification" means the commissioner's written 298.27authorization for a license holder to provide specialized services based on certification 298.28standards in section 245D.33. The term certification and its derivatives have the same 298.29meaning and may be substituted for the term licensure and its derivatives in this chapter 298.30and chapter 245A.298.31    Subd. 4. Commissioner. "Commissioner" means the commissioner of the 298.32Department of Human Services or the commissioner's designated representative.298.33    Subd. 4a.Community residential setting."Community residential setting" means 298.34a residential program as identified in section 245A.11, subdivision 8, where residential 298.35supports and services identified in section 245D.03, subdivision 1, paragraph (c), clause 299.1(3), items (i) and (ii), are provided and the license holder is the owner, lessor, or tenant 299.2of the facility licensed according to this chapter, and the license holder does not reside 299.3in the facility.299.4    Subd. 4b.Coordinated service and support plan."Coordinated service and support 299.5plan" has the meaning given in sections 256B.0913, subdivision 8; 256B.0915, subdivision 299.66; 256B.092, subdivision 1b; and 256B.49, subdivision 15, or successor provisions.299.7    Subd. 4c.Coordinated service and support plan addendum."Coordinated 299.8service and support plan addendum" means the documentation that this chapter requires 299.9of the license holder for each person receiving services.299.10    Subd. 4d.Corporate foster care."Corporate foster care" means a child foster 299.11residence setting licensed according to Minnesota Rules, parts 2960.0010 to 2960.3340, 299.12or an adult foster care home licensed according to Minnesota Rules, parts 9555.5105 to 299.139555.6265, where the license holder does not live in the home.299.14    Subd. 4e.Cultural competence or culturally competent."Cultural competence" 299.15or "culturally competent" means the ability and the will to respond to the unique needs of 299.16a person that arise from the person's culture and the ability to use the person's culture as a 299.17resource or tool to assist with the intervention and help meet the person's needs.299.18    Subd. 4f.Day services facility."Day services facility" means a facility licensed 299.19according to this chapter at which persons receive day services licensed under this chapter 299.20from the license holder's direct support staff for a cumulative total of more than 30 days 299.21within any 12-month period and the license holder is the owner, lessor, or tenant of the 299.22facility.299.23    Subd. 5. Department. "Department" means the Department of Human Services.299.24    Subd. 6. Direct contact. "Direct contact" has the meaning given in section 
         245C.02, 299.25subdivision 11
         , and is used interchangeably with the term "direct support service."299.26    Subd. 6a.Direct support staff or staff."Direct support staff" or "staff" means 299.27employees of the license holder who have direct contact with persons served by the 299.28program and includes temporary staff or subcontractors, regardless of employer, providing 299.29program services for hire under the control of the license holder who have direct contact 299.30with persons served by the program.299.31    Subd. 7. Drug. "Drug" has the meaning given in section 
         151.01, subdivision 5.299.32    Subd. 8. Emergency. "Emergency" means any event that affects the ordinary 299.33daily operation of the program including, but not limited to, fires, severe weather, natural 299.34disasters, power failures, or other events that threaten the immediate health and safety of 299.35a person receiving services and that require calling 911, emergency evacuation, moving 300.1to an emergency shelter, or temporary closure or relocation of the program to another 300.2facility or service site for more than 24 hours.300.3    Subd. 8a.Emergency use of manual restraint."Emergency use of manual 300.4restraint" means using a manual restraint when a person poses an imminent risk of 300.5physical harm to self or others and is the least restrictive intervention that would achieve 300.6safety. Property damage, verbal aggression, or a person's refusal to receive or participate 300.7in treatment or programming on their own, do not constitute an emergency.300.8    Subd. 8b.Expanded support team."Expanded support team" means the members 300.9of the support team defined in subdivision 46, and a licensed health or mental health 300.10professional or other licensed, certified, or qualified professionals or consultants working 300.11with the person and included in the team at the request of the person or the person's legal 300.12representative.300.13    Subd. 8c.Family foster care."Family foster care" means a child foster family 300.14setting licensed according to Minnesota Rules, parts 2960.0010 to 2960.3340, or an adult 300.15foster care home licensed according to Minnesota Rules, parts 9555.5105 to 9555.6265, 300.16where the license holder lives in the home.300.17    Subd. 9. Health services. "Health services" means any service or treatment 300.18consistent with the physical and mental health needs of the person, such as medication 300.19administration and monitoring, medical, dental, nutritional, health monitoring, wellness 300.20education, and exercise.300.21    Subd. 10. Home and community-based services. "Home and community-based 300.22services" means the services subject to the provisions of this chapter identified in section 300.23245D.03, subdivision 1, and as defined in:300.24(1) the federal federally approved waiver plans governed by United States Code, 300.25title 42, sections 1396 et seq., or the state's alternative care program according to section 300.26256B.0913, including the waivers for persons with disabilities under section 256B.49, 300.27subdivision 11, including the brain injury (BI) waiver, plan; the community alternative 300.28care (CAC) waiver, plan; the community alternatives for disabled individuals (CADI) 300.29waiver, plan; the developmental disability (DD) waiver, plan under section 256B.092, 300.30subdivision 5; the elderly waiver (EW), and plan under section 256B.0915, subdivision 1; 300.31or successor plans respective to each waiver; or300.32(2) the alternative care (AC) program under section 256B.0913.300.33    Subd. 11. Incident. "Incident" means an occurrence that affects the which involves 300.34a person and requires the program to make a response that is not a part of the program's 300.35 ordinary provision of services to a that person, and includes any of the following:300.36(1) serious injury of a person as determined by section 
         245.91, subdivision 6;301.1(2) a person's death;301.2(3) any medical emergency, unexpected serious illness, or significant unexpected 301.3change in an illness or medical condition, or the mental health status of a person that 301.4requires calling the program to call 911 or a mental health crisis intervention team, 301.5physician treatment, or hospitalization;301.6(4) any mental health crisis that requires the program to call 911 or a mental health 301.7crisis intervention team;301.8(5) an act or situation involving a person that requires the program to call 911, 301.9law enforcement, or the fire department;301.10(4) (6) a person's unauthorized or unexplained absence from a program;301.11(5) (7)physical aggression conduct by a person receiving services against another 301.12person receiving services that causes physical pain, injury, or persistent emotional distress, 301.13including, but not limited to, hitting, slapping, kicking, scratching, pinching, biting, 301.14pushing, and spitting;:301.15(i) is so severe, pervasive, or objectively offensive that it substantially interferes with 301.16a person's opportunities to participate in or receive service or support;301.17(ii) places the person in actual and reasonable fear of harm;301.18(iii) places the person in actual and reasonable fear of damage to property of the 301.19person; or301.20(iv) substantially disrupts the orderly operation of the program;301.21(6) (8) any sexual activity between persons receiving services involving force or 301.22coercion as defined under section 
         609.341, subdivisions 3 and 14; or301.23(9) any emergency use of manual restraint as identified in section 245D.061; or301.24(7) (10) a report of alleged or suspected child or vulnerable adult maltreatment 301.25under section 
         626.556 or 
         626.557.301.26    Subd. 11a.Intermediate care facility for persons with developmental disabilities 301.27or ICF/DD."Intermediate care facility for persons with developmental disabilities" or 301.28"ICF/DD" means a residential program licensed to serve four or more persons with 301.29developmental disabilities under section 252.28 and chapter 245A and licensed as a 301.30supervised living facility under chapter 144, which together are certified by the Department 301.31of Health as an intermediate care facility for persons with developmental disabilities.301.32    Subd. 11b.Least restrictive alternative."Least restrictive alternative" means 301.33the alternative method for providing supports and services that is the least intrusive and 301.34most normalized given the level of supervision and protection required for the person. 301.35This level of supervision and protection allows risk taking to the extent that there is no 301.36reasonable likelihood that serious harm will happen to the person or others.302.1    Subd. 12. Legal representative. "Legal representative" means the parent of a 302.2person who is under 18 years of age, a court-appointed guardian, or other representative 302.3with legal authority to make decisions about services for a person. Other representatives 302.4with legal authority to make decisions include but are not limited to a health care agent or 302.5an attorney-in-fact authorized through a health care directive or power of attorney.302.6    Subd. 13. License. "License" has the meaning given in section 
         245A.02, 302.7subdivision 8
         .302.8    Subd. 14. Licensed health professional. "Licensed health professional" means a 302.9person licensed in Minnesota to practice those professions described in section 
         214.01, 302.10subdivision 2
         .302.11    Subd. 15. License holder. "License holder" has the meaning given in section 302.12245A.02, subdivision 9
         .302.13    Subd. 16. Medication. "Medication" means a prescription drug or over-the-counter 302.14drug. For purposes of this chapter, "medication" includes dietary supplements.302.15    Subd. 17.Medication administration."Medication administration" means 302.16performing the following set of tasks to ensure a person takes both prescription and 302.17over-the-counter medications and treatments according to orders issued by appropriately 302.18licensed professionals, and includes the following:302.19(1) checking the person's medication record;302.20(2) preparing the medication for administration;302.21(3) administering the medication to the person;302.22(4) documenting the administration of the medication or the reason for not 302.23administering the medication; and302.24(5) reporting to the prescriber or a nurse any concerns about the medication, 302.25including side effects, adverse reactions, effectiveness, or the person's refusal to take the 302.26medication or the person's self-administration of the medication.302.27    Subd. 18.Medication assistance."Medication assistance" means providing verbal 302.28or visual reminders to take regularly scheduled medication, which includes either of 302.29the following:302.30(1) bringing to the person and opening a container of previously set up medications 302.31and emptying the container into the person's hand or opening and giving the medications 302.32in the original container to the person, or bringing to the person liquids or food to 302.33accompany the medication; or302.34(2) providing verbal or visual reminders to perform regularly scheduled treatments 302.35and exercises.303.1    Subd. 19.Medication management."Medication management" means the 303.2provision of any of the following:303.3(1) medication-related services to a person;303.4(2) medication setup;303.5(3) medication administration;303.6(4) medication storage and security;303.7(5) medication documentation and charting;303.8(6) verification and monitoring of effectiveness of systems to ensure safe medication 303.9handling and administration;303.10(7) coordination of medication refills;303.11(8) handling changes to prescriptions and implementation of those changes;303.12(9) communicating with the pharmacy; or303.13(10) coordination and communication with prescriber.303.14For the purposes of this chapter, medication management does not mean "medication 303.15therapy management services" as identified in section 256B.0625, subdivision 13h.303.16    Subd. 20. Mental health crisis intervention team. "Mental health crisis 303.17intervention team" means a mental health crisis response providers provider as identified 303.18in section 
         256B.0624, subdivision 2, paragraph (d), for adults, and in section 
         256B.0944, 303.19subdivision 1
         , paragraph (d), for children.303.20    Subd. 20a.Most integrated setting."Most integrated setting" means a setting that 303.21enables individuals with disabilities to interact with nondisabled persons to the fullest 303.22extent possible.303.23    Subd. 21. Over-the-counter drug. "Over-the-counter drug" means a drug that 303.24is not required by federal law to bear the statement "Caution: Federal law prohibits 303.25dispensing without prescription."303.26    Subd. 21a.Outcome."Outcome" means the behavior, action, or status attained by 303.27the person that can be observed, measured, and determined reliable and valid.303.28    Subd. 22. Person. "Person" has the meaning given in section 
         245A.02, subdivision 303.2911
         .303.30    Subd. 23. Person with a disability. "Person with a disability" means a person 303.31determined to have a disability by the commissioner's state medical review team as 303.32identified in section 
         256B.055, subdivision 7, the Social Security Administration, or 303.33the person is determined to have a developmental disability as defined in Minnesota 303.34Rules, part 9525.0016, subpart 2, item B, or a related condition as defined in section 303.35252.27, subdivision 1a
         .304.1    Subd. 23a.Physician."Physician" means a person who is licensed under chapter 304.2147.304.3    Subd. 24. Prescriber. "Prescriber" means a licensed practitioner as defined in 304.4section 151.01, subdivision 23, person who is authorized under section 148.235; 151.01, 304.5subdivision 23; or151.37 to prescribe drugs. For the purposes of this chapter, the term 304.6"prescriber" is used interchangeably with "physician."304.7    Subd. 25. Prescription drug. "Prescription drug" has the meaning given in section 304.8151.01, subdivision 17 16.304.9    Subd. 26. Program. "Program" means either the nonresidential or residential 304.10program as defined in section 
         245A.02, subdivisions 10 and 14.304.11    Subd. 27. Psychotropic medication. "Psychotropic medication" means any 304.12medication prescribed to treat the symptoms of mental illness that affect thought processes, 304.13mood, sleep, or behavior. The major classes of psychotropic medication are antipsychotic 304.14(neuroleptic), antidepressant, antianxiety, mood stabilizers, anticonvulsants, and 304.15stimulants and nonstimulants for the treatment of attention deficit/hyperactivity disorder. 304.16Other miscellaneous medications are considered to be a psychotropic medication when 304.17they are specifically prescribed to treat a mental illness or to control or alter behavior.304.18    Subd. 28. Restraint. "Restraint" means physical or mechanical limiting of the free 304.19and normal movement of body or limbs.304.20    Subd. 29. Seclusion. "Seclusion" means separating a person from others in a way 304.21that prevents social contact and prevents the person from leaving the situation if he or she 304.22chooses the placement of a person alone in a room from which exit is prohibited by a staff 304.23person or a mechanism such as a lock, a device, or an object positioned to hold the door 304.24closed or otherwise prevent the person from leaving the room.304.25    Subd. 29a.Self-determination."Self-determination" means the person makes 304.26decisions independently, plans for the person's own future, determines how money is spent 304.27for the person's supports, and takes responsibility for making these decisions. If a person 304.28has a legal representative, the legal representative's decision-making authority is limited to 304.29the scope of authority granted by the court or allowed in the document authorizing the 304.30legal representative to act.304.31    Subd. 29b.Semi-independent living services."Semi-independent living services" 304.32has the meaning given in section 252.275.304.33    Subd. 30. Service. "Service" means care, training, supervision, counseling, 304.34consultation, or medication assistance assigned to the license holder in the coordinated 304.35service and support plan.305.1    Subd. 31.Service plan."Service plan" means the individual service plan or 305.2individual care plan identified in sections 256B.0913, 256B.0915, 256B.092, and 256B.49, 305.3or successor provisions, and includes any support plans or service needs identified as 305.4a result of long-term care consultation, or a support team meeting that includes the 305.5participation of the person, the person's legal representative, and case manager, or assigned 305.6to a license holder through an authorized service agreement.305.7    Subd. 32. Service site. "Service site" means the location where the service is 305.8provided to the person, including, but not limited to, a facility licensed according to 305.9chapter 245A; a location where the license holder is the owner, lessor, or tenant; a person's 305.10own home; or a community-based location.305.11    Subd. 33.Staff."Staff" means an employee who will have direct contact with a 305.12person served by the facility, agency, or program.305.13    Subd. 33a.Supervised living facility."Supervised living facility" has the meaning 305.14given in Minnesota Rules, part 4665.0100, subpart 10.305.15    Subd. 33b.Supervision.(a) "Supervision" means:305.16(1) oversight by direct support staff as specified in the person's coordinated service 305.17and support plan or coordinated service and support plan addendum and awareness of 305.18the person's needs and activities;305.19(2) responding to situations that present a serious risk to the health, safety, or rights 305.20of the person while services are being provided; and305.21(3) the presence of direct support staff at a service site while services are being 305.22provided, unless a determination has been made and documented in the person's coordinated 305.23service and support plan or coordinated service and support plan addendum that the person 305.24does not require the presence of direct support staff while services are being provided.305.25(b) For the purposes of this definition, "while services are being provided," means 305.26any period of time during which the license holder will seek reimbursement for services.305.27    Subd. 34. Support team. "Support team" means the service planning team 305.28identified in section 
         256B.49, subdivision 15, or the interdisciplinary team identified in 305.29Minnesota Rules, part 9525.0004, subpart 14.305.30    Subd. 34a.Time out."Time out" means removing a person involuntarily from an 305.31ongoing activity to a room, either locked or unlocked, or otherwise separating a person 305.32from others in a way that prevents social contact and prevents the person from leaving 305.33the situation if the person chooses. For the purpose of chapter 245D, "time out" does 305.34not mean voluntary removal or self-removal for the purpose of calming, prevention of 305.35escalation, or de-escalation of behavior for a period of up to 15 minutes. "Time out" 305.36does not include a person voluntarily moving from an ongoing activity to an unlocked 306.1room or otherwise separating from a situation or social contact with others if the person 306.2chooses. For the purposes of this definition, "voluntarily" means without being forced, 306.3compelled, or coerced.306.4    Subd. 35.Unit of government."Unit of government" means every city, county, 306.5town, school district, other political subdivisions of the state, and any agency of the state 306.6or the United States, and includes any instrumentality of a unit of government.306.7    Subd. 35a.Treatment."Treatment" means the provision of care, other than 306.8medications, ordered or prescribed by a licensed health or mental health professional, 306.9provided to a person to cure, rehabilitate, or ease symptoms.306.10    Subd. 36. Volunteer. "Volunteer" means an individual who, under the direction of the 306.11license holder, provides direct services without pay to a person served by the license holder.306.12EFFECTIVE DATE.This section is effective January 1, 2014.306.13    Sec. 19. Minnesota Statutes 2012, section 245D.03, is amended to read:306.14245D.03 APPLICABILITY AND EFFECT.306.15    Subdivision 1. Applicability. (a) The commissioner shall regulate the provision of 306.16home and community-based services to persons with disabilities and persons age 65 and 306.17older pursuant to this chapter. The licensing standards in this chapter govern the provision 306.18of the following basic support services: and intensive support services.306.19(1) housing access coordination as defined under the current BI, CADI, and DD 306.20waiver plans or successor plans;306.21(2) respite services as defined under the current CADI, BI, CAC, DD, and EW 306.22waiver plans or successor plans when the provider is an individual who is not an employee 306.23of a residential or nonresidential program licensed by the Department of Human Services 306.24or the Department of Health that is otherwise providing the respite service;306.25(3) behavioral programming as defined under the current BI and CADI waiver 306.26plans or successor plans;306.27(4) specialist services as defined under the current DD waiver plan or successor plans;306.28(5) companion services as defined under the current BI, CADI, and EW waiver 306.29plans or successor plans, excluding companion services provided under the Corporation 306.30for National and Community Services Senior Companion Program established under the 306.31Domestic Volunteer Service Act of 1973, Public Law 98-288;306.32(6) personal support as defined under the current DD waiver plan or successor plans;306.33(7) 24-hour emergency assistance, on-call and personal emergency response as 306.34defined under the current CADI and DD waiver plans or successor plans;307.1(8) night supervision services as defined under the current BI waiver plan or 307.2successor plans;307.3(9) homemaker services as defined under the current CADI, BI, CAC, DD, and EW 307.4waiver plans or successor plans, excluding providers licensed by the Department of Health 307.5under chapter 144A and those providers providing cleaning services only;307.6(10) independent living skills training as defined under the current BI and CADI 307.7waiver plans or successor plans;307.8(11) prevocational services as defined under the current BI and CADI waiver plans 307.9or successor plans;307.10(12) structured day services as defined under the current BI waiver plan or successor 307.11plans; or307.12(13) supported employment as defined under the current BI and CADI waiver plans 307.13or successor plans.307.14(b) Basic support services provide the level of assistance, supervision, and care that 307.15is necessary to ensure the health and safety of the person and do not include services that 307.16are specifically directed toward the training, treatment, habilitation, or rehabilitation of 307.17the person. Basic support services include:307.18(1) in-home and out-of-home respite care services as defined in section 245A.02, 307.19subdivision 15, and under the brain injury, community alternative care, community 307.20alternatives for disabled individuals, developmental disability, and elderly waiver plans;307.21(2) companion services as defined under the brain injury, community alternatives for 307.22disabled individuals, and elderly waiver plans, excluding companion services provided 307.23under the Corporation for National and Community Services Senior Companion Program 307.24established under the Domestic Volunteer Service Act of 1973, Public Law 98-288;307.25(3) personal support as defined under the developmental disability waiver plan;307.26(4) 24-hour emergency assistance, personal emergency response as defined under the 307.27community alternatives for disabled individuals and developmental disability waiver plans;307.28(5) night supervision services as defined under the brain injury waiver plan; and307.29(6) homemaker services as defined under the community alternatives for disabled 307.30individuals, brain injury, community alternative care, developmental disability, and elderly 307.31waiver plans, excluding providers licensed by the Department of Health under chapter 307.32144A and those providers providing cleaning services only.307.33(c) Intensive support services provide assistance, supervision, and care that is 307.34necessary to ensure the health and safety of the person and services specifically directed 307.35toward the training, habilitation, or rehabilitation of the person. Intensive support services 307.36include:308.1(1) intervention services, including:308.2(i) behavioral support services as defined under the brain injury and community 308.3alternatives for disabled individuals waiver plans;308.4(ii) in-home or out-of-home crisis respite services as defined under the developmental 308.5disability waiver plan; and308.6(iii) specialist services as defined under the current developmental disability waiver 308.7plan;308.8(2) in-home support services, including:308.9(i) in-home family support and supported living services as defined under the 308.10developmental disability waiver plan;308.11(ii) independent living services training as defined under the brain injury and 308.12community alternatives for disabled individuals waiver plans; and308.13(iii) semi-independent living services;308.14(3) residential supports and services, including:308.15(i) supported living services as defined under the developmental disability waiver 308.16plan provided in a family or corporate child foster care residence, a family adult foster 308.17care residence, a community residential setting, or a supervised living facility;308.18(ii) foster care services as defined in the brain injury, community alternative care, 308.19and community alternatives for disabled individuals waiver plans provided in a family or 308.20corporate child foster care residence, a family adult foster care residence, or a community 308.21residential setting; and308.22(iii) residential services provided in a supervised living facility that is certified by 308.23the Department of Health as an ICF/DD;308.24(4) day services, including:308.25(i) structured day services as defined under the brain injury waiver plan;308.26(ii) day training and habilitation services under sections 252.40 to 252.46, and as 308.27defined under the developmental disability waiver plan; and308.28(iii) prevocational services as defined under the brain injury and community 308.29alternatives for disabled individuals waiver plans; and308.30(5) supported employment as defined under the brain injury, developmental 308.31disability, and community alternatives for disabled individuals waiver plans.308.32    Subd. 2. Relationship to other standards governing home and community-based 308.33services. (a) A license holder governed by this chapter is also subject to the licensure 308.34requirements under chapter 245A.308.35(b) A license holder concurrently providing child foster care services licensed 308.36according to Minnesota Rules, chapter 2960, to the same person receiving a service licensed 309.1under this chapter is exempt from section 245D.04 as it applies to the person. A corporate 309.2or family child foster care site controlled by a license holder and providing services 309.3governed by this chapter is exempt from compliance with section 245D.04. This exemption 309.4applies to foster care homes where at least one resident is receiving residential supports 309.5and services licensed according to this chapter. This chapter does not apply to corporate or 309.6family child foster care homes that do not provide services licensed under this chapter.309.7(c) A family adult foster care site controlled by a license holder and providing 309.8services governed by this chapter is exempt from compliance with Minnesota Rules, parts 309.99555.6185; 9555.6225, subpart 8; 9555.6235, item C; 9555.6245; 9555.6255, subpart 309.102; and 9555.6265. These exemptions apply to family adult foster care homes where at 309.11least one resident is receiving residential supports and services licensed according to this 309.12chapter. This chapter does not apply to family adult foster care homes that do not provide 309.13services licensed under this chapter.309.14(d) A license holder providing services licensed according to this chapter in a 309.15supervised living facility is exempt from compliance with sections 245D.04; 245D.05, 309.16subdivision 2; and 245D.06, subdivision 2, clauses (1), (4), and (5).309.17(e) A license holder providing residential services to persons in an ICF/DD is exempt 309.18from compliance with sections 245D.04; 245D.05, subdivision 1b; 245D.06, subdivision 309.192, clauses (4) and (5); 245D.071, subdivisions 4 and 5; 245D.081, subdivision 2; 245D.09, 309.20subdivision 7; 245D.095, subdivision 2; and 245D.11, subdivision 3.309.21(c) (f) A license holder concurrently providing home care homemaker services 309.22registered licensed according to sections 144A.43 to 144A.49 to the same person receiving 309.23home management services licensed under this chapter and registered according to chapter 309.24144A is exempt from compliance with section 
         245D.04as it applies to the person.309.25(d) A license holder identified in subdivision 1, clauses (1), (5), and (9), is exempt 309.26from compliance with sections 245A.65, subdivision 2, paragraph (a), and 626.557, 309.27subdivision 14, paragraph (b).309.28(e) Notwithstanding section 245D.06, subdivision 5, a license holder providing 309.29structured day, prevocational, or supported employment services under this chapter 309.30and day training and habilitation or supported employment services licensed under 309.31chapter 245B within the same program is exempt from compliance with this chapter 309.32when the license holder notifies the commissioner in writing that the requirements under 309.33chapter 245B will be met for all persons receiving these services from the program. For 309.34the purposes of this paragraph, if the license holder has obtained approval from the 309.35commissioner for an alternative inspection status according to section 245B.031, that 309.36approval will apply to all persons receiving services in the program.310.1(g) Nothing in this chapter prohibits a license holder from concurrently serving 310.2persons without disabilities or people who are or are not age 65 and older, provided this 310.3chapter's standards are met as well as other relevant standards.310.4(h) The documentation required under sections 245D.07 and 245D.071 must meet 310.5the individual program plan requirements identified in section 256B.092 or successor 310.6provisions.310.7    Subd. 3. Variance. If the conditions in section 
         245A.04, subdivision 9, are met, 310.8the commissioner may grant a variance to any of the requirements in this chapter, except 310.9sections 
         245D.04, and 245D.10, subdivision 4, paragraph (b) 245D.06, subdivision 4, 310.10paragraph (b), and 245D.061, subdivision 3, or provisions governing data practices and 310.11information rights of persons.310.12    Subd. 4.License holders with multiple 245D licenses.(a) When a person changes 310.13service from one license to a different license held by the same license holder, the license 310.14holder is exempt from the requirements in section 245D.10, subdivision 4, paragraph (b).310.15(b) When a staff person begins providing direct service under one or more licenses 310.16held by the same license holder, other than the license for which staff orientation was 310.17initially provided according to section 245D.09, subdivision 4, the license holder is 310.18exempt from those staff orientation requirements, except the staff person must review each 310.19person's service plan and medication administration procedures in accordance with section 310.20245D.09, subdivision 4, paragraph (c), if not previously reviewed by the staff person.310.21    Subd. 5.Program certification.An applicant or a license holder may apply for 310.22program certification as identified in section 245D.33.310.23EFFECTIVE DATE.This section is effective January 1, 2014.310.24    Sec. 20. Minnesota Statutes 2012, section 245D.04, is amended to read:310.25245D.04 SERVICE RECIPIENT RIGHTS.310.26    Subdivision 1. License holder responsibility for individual rights of persons 310.27served by the program.  The license holder must:310.28(1) provide each person or each person's legal representative with a written notice 310.29that identifies the service recipient rights in subdivisions 2 and 3, and an explanation of 310.30those rights within five working days of service initiation and annually thereafter;310.31(2) make reasonable accommodations to provide this information in other formats 310.32or languages as needed to facilitate understanding of the rights by the person and the 310.33person's legal representative, if any;311.1(3) maintain documentation of the person's or the person's legal representative's 311.2receipt of a copy and an explanation of the rights; and311.3(4) ensure the exercise and protection of the person's rights in the services provided 311.4by the license holder and as authorized in the coordinated service and support plan.311.5    Subd. 2. Service-related rights. A person's service-related rights include the right to:311.6(1) participate in the development and evaluation of the services provided to the 311.7person;311.8(2) have services and supports identified in the coordinated service and support plan 311.9and the coordinated service and support plan addendum provided in a manner that respects 311.10and takes into consideration the person's preferences according to the requirements in 311.11sections 245D.07 and 245D.071;311.12(3) refuse or terminate services and be informed of the consequences of refusing 311.13or terminating services;311.14(4) know, in advance, limits to the services available from the license holder, 311.15including the license holder's knowledge, skill, and ability to meet the person's service and 311.16support needs based on the information required in section 245D.031, subdivision 2;311.17(5) know conditions and terms governing the provision of services, including the 311.18license holder's admission criteria and policies and procedures related to temporary 311.19service suspension and service termination;311.20(6) a coordinated transfer to ensure continuity of care when there will be a change 311.21in the provider;311.22(7) know what the charges are for services, regardless of who will be paying for the 311.23services, and be notified of changes in those charges;311.24(7) (8) know, in advance, whether services are covered by insurance, government 311.25funding, or other sources, and be told of any charges the person or other private party 311.26may have to pay; and311.27(8) (9) receive services from an individual who is competent and trained, who has 311.28professional certification or licensure, as required, and who meets additional qualifications 311.29identified in the person's coordinated service and support plan. or coordinated service and 311.30support plan addendum.311.31    Subd. 3. Protection-related rights. (a) A person's protection-related rights include 311.32the right to:311.33(1) have personal, financial, service, health, and medical information kept private, 311.34and be advised of disclosure of this information by the license holder;311.35(2) access records and recorded information about the person in accordance with 311.36applicable state and federal law, regulation, or rule;312.1(3) be free from maltreatment;312.2(4) be free from restraint, time out, or seclusion used for a purpose other than except 312.3for emergency use of manual restraint to protect the person from imminent danger to self 312.4or others according to the requirements in section 245D.06;312.5(5) receive services in a clean and safe environment when the license holder is the 312.6owner, lessor, or tenant of the service site;312.7(6) be treated with courtesy and respect and receive respectful treatment of the 312.8person's property;312.9(7) reasonable observance of cultural and ethnic practice and religion;312.10(8) be free from bias and harassment regarding race, gender, age, disability, 312.11spirituality, and sexual orientation;312.12(9) be informed of and use the license holder's grievance policy and procedures, 312.13including knowing how to contact persons responsible for addressing problems and to 312.14appeal under section 
         256.045;312.15(10) know the name, telephone number, and the Web site, e-mail, and street 312.16addresses of protection and advocacy services, including the appropriate state-appointed 312.17ombudsman, and a brief description of how to file a complaint with these offices;312.18(11) assert these rights personally, or have them asserted by the person's family, 312.19authorized representative, or legal representative, without retaliation;312.20(12) give or withhold written informed consent to participate in any research or 312.21experimental treatment;312.22(13) associate with other persons of the person's choice;312.23(14) personal privacy; and312.24(15) engage in chosen activities.312.25(b) For a person residing in a residential site licensed according to chapter 245A, 312.26or where the license holder is the owner, lessor, or tenant of the residential service site, 312.27protection-related rights also include the right to:312.28(1) have daily, private access to and use of a non-coin-operated telephone for local 312.29calls and long-distance calls made collect or paid for by the person;312.30(2) receive and send, without interference, uncensored, unopened mail or electronic 312.31correspondence or communication; and312.32(3) have use of and free access to common areas in the residence; and 312.33(4) privacy for visits with the person's spouse, next of kin, legal counsel, religious 312.34advisor, or others, in accordance with section 
         363A.09 of the Human Rights Act, including 312.35privacy in the person's bedroom.313.1(c) Restriction of a person's rights under subdivision 2, clause (10), or paragraph (a), 313.2clauses (13) to (15), or paragraph (b) is allowed only if determined necessary to ensure 313.3the health, safety, and well-being of the person. Any restriction of those rights must be 313.4documented in the person's coordinated service and support plan for the person and or 313.5coordinated service and support plan addendum. The restriction must be implemented 313.6in the least restrictive alternative manner necessary to protect the person and provide 313.7support to reduce or eliminate the need for the restriction in the most integrated setting 313.8and inclusive manner. The documentation must include the following information:313.9(1) the justification for the restriction based on an assessment of the person's 313.10vulnerability related to exercising the right without restriction;313.11(2) the objective measures set as conditions for ending the restriction;313.12(3) a schedule for reviewing the need for the restriction based on the conditions for 313.13ending the restriction to occur, at a minimum, every three months for persons who do not 313.14have a legal representative and annually for persons who do have a legal representative313.15semiannually from the date of initial approval, at a minimum, or more frequently if 313.16requested by the person, the person's legal representative, if any, and case manager; and313.17(4) signed and dated approval for the restriction from the person, or the person's 313.18legal representative, if any. A restriction may be implemented only when the required 313.19approval has been obtained. Approval may be withdrawn at any time. If approval is 313.20withdrawn, the right must be immediately and fully restored.313.21EFFECTIVE DATE.This section is effective January 1, 2014.313.22    Sec. 21. Minnesota Statutes 2012, section 245D.05, is amended to read:313.23245D.05 HEALTH SERVICES.313.24    Subdivision 1. Health needs. (a) The license holder is responsible for providing313.25 meeting health services service needs assigned in the coordinated service and support plan 313.26andor the coordinated service and support plan addendum, consistent with the person's 313.27health needs. The license holder is responsible for promptly notifying the person or313.28 the person's legal representative, if any, and the case manager of changes in a person's 313.29physical and mental health needs affecting assigned health services service needs assigned 313.30to the license holder in the coordinated service and support plan or the coordinated service 313.31and support plan addendum, when discovered by the license holder, unless the license 313.32holder has reason to know the change has already been reported. The license holder 313.33must document when the notice is provided.314.1(b) When assigned in the service plan, If responsibility for meeting the person's 314.2health service needs has been assigned to the license holder in the coordinated service and 314.3support plan or the coordinated service and support plan addendum, the license holder is 314.4required to must maintain documentation on how the person's health needs will be met, 314.5including a description of the procedures the license holder will follow in order to:314.6(1) provide medication administration,assistance or medication assistance, or 314.7medication management administration according to this chapter;314.8(2) monitor health conditions according to written instructions from the person's 314.9physician or a licensed health professional;314.10(3) assist with or coordinate medical, dental, and other health service appointments; or314.11(4) use medical equipment, devices, or adaptive aides or technology safely and 314.12correctly according to written instructions from the person's physician or a licensed 314.13health professional.314.14    Subd. 1a.Medication setup.For the purposes of this subdivision, "medication 314.15setup" means the arranging of medications according to instructions from the pharmacy, 314.16the prescriber, or a licensed nurse, for later administration when the license holder 314.17is assigned responsibility for medication assistance or medication administration in 314.18the coordinated service and support plan or the coordinated service and support plan 314.19addendum. A prescription label or the prescriber's written or electronically recorded order 314.20for the prescription is sufficient to constitute written instructions from the prescriber. The 314.21license holder must document in the person's medication administration record: dates 314.22of setup, name of medication, quantity of dose, times to be administered, and route of 314.23administration at time of setup; and, when the person will be away from home, to whom 314.24the medications were given.314.25    Subd. 1b.Medication assistance.If responsibility for medication assistance 314.26is assigned to the license holder in the coordinated service and support plan or the 314.27coordinated service and support plan addendum, the license holder must ensure that 314.28the requirements of subdivision 2, paragraph (b), have been met when staff provides 314.29medication assistance to enable a person to self-administer medication or treatment when 314.30the person is capable of directing the person's own care, or when the person's legal 314.31representative is present and able to direct care for the person. For the purposes of this 314.32subdivision, "medication assistance" means any of the following:314.33(1) bringing to the person and opening a container of previously set up medications, 314.34emptying the container into the person's hand, or opening and giving the medications in 314.35the original container to the person;314.36(2) bringing to the person liquids or food to accompany the medication; or315.1(3) providing reminders to take regularly scheduled medication or perform regularly 315.2scheduled treatments and exercises.315.3    Subd. 2. Medication administration. (a) If responsibility for medication 315.4administration is assigned to the license holder in the coordinated service and support plan 315.5or the coordinated service and support plan addendum, the license holder must implement 315.6the following medication administration procedures to ensure a person takes medications 315.7and treatments as prescribed:315.8(1) checking the person's medication record;315.9(2) preparing the medication as necessary;315.10(3) administering the medication or treatment to the person;315.11(4) documenting the administration of the medication or treatment or the reason for 315.12not administering the medication or treatment; and315.13(5) reporting to the prescriber or a nurse any concerns about the medication or 315.14treatment, including side effects, effectiveness, or a pattern of the person refusing to 315.15take the medication or treatment as prescribed. Adverse reactions must be immediately 315.16reported to the prescriber or a nurse.315.17(b)(1) The license holder must ensure that the following criteria requirements in 315.18clauses (2) to (4) have been met before staff that is not a licensed health professional 315.19administersadministering medication or treatment:.315.20(1) (2) The license holder must obtain written authorization has been obtained from 315.21the person or the person's legal representative to administer medication or treatment 315.22orders; and must obtain reauthorization annually as needed. If the person or the person's 315.23legal representative refuses to authorize the license holder to administer medication, the 315.24medication must not be administered. The refusal to authorize medication administration 315.25must be reported to the prescriber as expediently as possible.315.26(2) (3) The staff person has completed responsible for administering the medication 315.27or treatment must complete medication administration training according to section 315.28245D.09, subdivision 4, paragraph 4a, paragraphs (a) and (c), clause (2); and, as applicable 315.29to the person, paragraph (d).315.30(3) The medication or treatment will be administered under administration 315.31procedures established for the person in consultation with a licensed health professional. 315.32written instruction from the person's physician may constitute the medication 315.33administration procedures. A prescription label or the prescriber's order for the 315.34prescription is sufficient to constitute written instructions from the prescriber. A licensed 315.35health professional may delegate medication administration procedures.316.1(4) For a license holder providing intensive support services, the medication or 316.2treatment must be administered according to the license holder's medication administration 316.3policy and procedures as required under section 245D.11, subdivision 2, clause (3).316.4(b) (c) The license holder must ensure the following information is documented in 316.5the person's medication administration record:316.6(1) the information on the current prescription label or the prescriber's current written 316.7or electronically recorded order or prescription that includes directions for the person's 316.8name, description of the medication or treatment to be provided, and the frequency and 316.9other information needed to safely and correctly administering administer the medication 316.10or treatment to ensure effectiveness;316.11(2) information on any discomforts, risks, or other side effects that are reasonable to 316.12expect, and any contraindications to its use. This information must be readily available 316.13to all staff administering the medication;316.14(3) the possible consequences if the medication or treatment is not taken or 316.15administered as directed;316.16(4) instruction from the prescriber on when and to whom to report the following:316.17(i) if the a dose of medication or treatment is not administered or treatment is not 316.18performed as prescribed, whether by error by the staff or the person or by refusal by 316.19the person; and316.20(ii) the occurrence of possible adverse reactions to the medication or treatment;316.21(5) notation of any occurrence of a dose of medication not being administered or 316.22treatment not performed as prescribed, whether by error by the staff or the person or by 316.23refusal by the person, or of adverse reactions, and when and to whom the report was 316.24made; and316.25(6) notation of when a medication or treatment is started, administered, changed, or 316.26discontinued.316.27(c) The license holder must ensure that the information maintained in the medication 316.28administration record is current and is regularly reviewed with the person or the person's 316.29legal representative and the staff administering the medication to identify medication 316.30administration issues or errors. At a minimum, the review must be conducted every three 316.31months or more often if requested by the person or the person's legal representative. 316.32Based on the review, the license holder must develop and implement a plan to correct 316.33medication administration issues or errors. If issues or concerns are identified related to 316.34the medication itself, the license holder must report those as required under subdivision 4.316.35    Subd. 3.Medication assistance.The license holder must ensure that the 316.36requirements of subdivision 2, paragraph (a), have been met when staff provides assistance 317.1to enable a person to self-administer medication when the person is capable of directing 317.2the person's own care, or when the person's legal representative is present and able to 317.3direct care for the person.317.4    Subd. 4. Reviewing and reporting medication and treatment issues.The 317.5following medication administration issues must be reported to the person or the person's 317.6legal representative and case manager as they occur or following timelines established 317.7in the person's service plan or as requested in writing by the person or the person's legal 317.8representative, or the case manager: (a) When assigned responsibility for medication 317.9administration, the license holder must ensure that the information maintained in 317.10the medication administration record is current and is regularly reviewed to identify 317.11medication administration errors. At a minimum, the review must be conducted every 317.12three months, or more frequently as directed in the coordinated service and support plan 317.13or coordinated service and support plan addendum or as requested by the person or the 317.14person's legal representative. Based on the review, the license holder must develop and 317.15implement a plan to correct patterns of medication administration errors when identified.317.16(b) If assigned responsibility for medication assistance or medication administration, 317.17the license holder must report the following to the person's legal representative and case 317.18manager as they occur or as otherwise directed in the coordinated service and support plan 317.19or the coordinated service and support plan addendum:317.20(1) any reports made to the person's physician or prescriber required under 317.21subdivision 2, paragraph (b) (c), clause (4);317.22(2) a person's refusal or failure to take or receive medication or treatment as 317.23prescribed; or317.24(3) concerns about a person's self-administration of medication or treatment.317.25    Subd. 5. Injectable medications. Injectable medications may be administered 317.26according to a prescriber's order and written instructions when one of the following 317.27conditions has been met:317.28(1) a registered nurse or licensed practical nurse will administer the subcutaneous or 317.29intramuscular injection;317.30(2) a supervising registered nurse with a physician's order has delegated the 317.31administration of subcutaneous injectable medication to an unlicensed staff member 317.32and has provided the necessary training; or317.33(3) there is an agreement signed by the license holder, the prescriber, and the 317.34person or the person's legal representative specifying what subcutaneous injections may 317.35be given, when, how, and that the prescriber must retain responsibility for the license 318.1holder's giving the injections. A copy of the agreement must be placed in the person's 318.2service recipient record.318.3Only licensed health professionals are allowed to administer psychotropic 318.4medications by injection.318.5EFFECTIVE DATE.This section is effective January 1, 2014.318.6    Sec. 22. [245D.051] PSYCHOTROPIC MEDICATION USE AND 318.7MONITORING.318.8    Subdivision 1.Conditions for psychotropic medication administration.(a) 318.9When a person is prescribed a psychotropic medication and the license holder is assigned 318.10responsibility for administration of the medication in the person's coordinated service 318.11and support plan or the coordinated service and support plan addendum, the license 318.12holder must ensure that the requirements in paragraphs (b) to (d) and section 245D.05, 318.13subdivision 2, are met.318.14(b) Use of the medication must be included in the person's coordinated service and 318.15support plan or in the coordinated service and support plan addendum and based on a 318.16prescriber's current written or electronically recorded prescription.318.17(c) The license holder must develop, implement, and maintain the following 318.18documentation in the person's coordinated service and support plan addendum according 318.19to the requirements in sections 245D.07 and 245D.071:318.20(1) a description of the target symptoms that the psychotropic medication is to 318.21alleviate; and318.22(2) documentation methods the license holder will use to monitor and measure 318.23changes in the target symptoms that are to be alleviated by the psychotropic medication if 318.24required by the prescriber. The license holder must collect and report on medication and 318.25symptom-related data as instructed by the prescriber. The license holder must provide 318.26the monitoring data to the expanded support team for review every three months, or as 318.27otherwise requested by the person or the person's legal representative.318.28For the purposes of this section, "target symptom" refers to any perceptible 318.29diagnostic criteria for a person's diagnosed mental disorder as defined by the Diagnostic 318.30and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TR) or 318.31successive editions that has been identified for alleviation.318.32(d) If a person is prescribed a psychotropic medication, monitoring the use of the 318.33psychotropic medication must be assigned to the license holder in the coordinated service 318.34and support plan or the coordinated service and support plan addendum. The assigned 318.35license holder must monitor the psychotropic medication as required by this section.319.1    Subd. 2.Refusal to authorize psychotropic medication.If the person or the 319.2person's legal representative refuses to authorize the administration of a psychotropic 319.3medication as ordered by the prescriber, the license holder must follow the requirement 319.4in section 245D.05, subdivision 2, paragraph (b), clause (2). After reporting the refusal 319.5to the prescriber, the license holder must follow any directives or orders given by the 319.6prescriber. A court order must be obtained to override the refusal. Refusal to authorize 319.7administration of a specific psychotropic medication is not grounds for service termination 319.8and does not constitute an emergency. A decision to terminate services must be reached in 319.9compliance with section 245D.10, subdivision 3.319.10EFFECTIVE DATE.This section is effective January 1, 2014.319.11    Sec. 23. Minnesota Statutes 2012, section 245D.06, is amended to read:319.12245D.06 PROTECTION STANDARDS.319.13    Subdivision 1. Incident response and reporting.  (a) The license holder must 319.14respond to all incidents under section 
         245D.02, subdivision 11, that occur while providing 319.15services to protect the health and safety of and minimize risk of harm to the person.319.16(b) The license holder must maintain information about and report incidents to the 319.17person's legal representative or designated emergency contact and case manager within 24 319.18hours of an incident occurring while services are being provided, or within 24 hours of 319.19discovery or receipt of information that an incident occurred, unless the license holder 319.20has reason to know that the incident has already been reported, or as otherwise directed 319.21in a person's coordinated service and support plan or coordinated service and support 319.22plan addendum. An incident of suspected or alleged maltreatment must be reported as 319.23required under paragraph (d), and an incident of serious injury or death must be reported 319.24as required under paragraph (e).319.25(c) When the incident involves more than one person, the license holder must not 319.26disclose personally identifiable information about any other person when making the report 319.27to each person and case manager unless the license holder has the consent of the person.319.28(d) Within 24 hours of reporting maltreatment as required under section 
         626.556319.29or 
         626.557, the license holder must inform the case manager of the report unless there is 319.30reason to believe that the case manager is involved in the suspected maltreatment. The 319.31license holder must disclose the nature of the activity or occurrence reported and the 319.32agency that received the report.319.33(e) The license holder must report the death or serious injury of the person to the legal 319.34representative, if any, and case manager, as required in paragraph (b) and to  the Department 320.1of Human Services Licensing Division, and the Office of Ombudsman for Mental Health 320.2and Developmental Disabilities as required under section 
         245.94, subdivision 2a, within 320.324 hours of the death, or receipt of information that the death occurred, unless the license 320.4holder has reason to know that the death has already been reported.320.5(f) When a death or serious injury occurs in a facility certified as an intermediate 320.6care facility for persons with developmental disabilities, the death or serious injury must 320.7be reported to the Department of Health, Office of Health Facility Complaints, and the 320.8Office of Ombudsman for Mental Health and Developmental Disabilities, as required 320.9under sections 245.91 and 245.94, subdivision 2a, unless the license holder has reason to 320.10know that the death has already been reported.320.11(f) (g) The license holder must conduct a an internal review of incident reports of 320.12deaths and serious injuries that occurred while services were being provided and that 320.13were not reported by the program as alleged or suspected maltreatment, for identification 320.14of incident patterns, and implementation of corrective action as necessary to reduce 320.15occurrences. The review must include an evaluation of whether related policies and 320.16procedures were followed, whether the policies and procedures were adequate, whether 320.17there is a need for additional staff training, whether the reported event is similar to past 320.18events with the persons or the services involved, and whether there is a need for corrective 320.19action by the license holder to protect the health and safety of persons receiving services. 320.20Based on the results of this review, the license holder must develop, document, and 320.21implement a corrective action plan designed to correct current lapses and prevent future 320.22lapses in performance by staff or the license holder, if any.320.23(h) The license holder must verbally report the emergency use of manual restraint of 320.24a person as required in paragraph (b), within 24 hours of the occurrence. The license holder 320.25must ensure the written report and internal review of all incident reports of the emergency 320.26use of manual restraints are completed according to the requirements in section 245D.061.320.27    Subd. 2. Environment and safety. The license holder must:320.28(1) ensure the following when the license holder is the owner, lessor, or tenant 320.29of the an unlicensed service site:320.30(i) the service site is a safe and hazard-free environment;320.31(ii) doors are locked or toxic substances or dangerous items normally accessible are 320.32inaccessible to persons served by the program are stored in locked cabinets, drawers, or 320.33containers only to protect the safety of a person receiving services and not as a substitute 320.34for staff supervision or interactions with a person who is receiving services. If doors are 320.35locked or toxic substances or dangerous items normally accessible to persons served by the 320.36program are stored in locked cabinets, drawers, or containers are made inaccessible, the 321.1license holder must justify and document how this determination was made in consultation 321.2with the person or person's legal representative, and how access will otherwise be provided 321.3to the person and all other affected persons receiving services; and document an assessment 321.4of the physical plant, its environment, and its population identifying the risk factors which 321.5require toxic substances or dangerous items to be inaccessible and a statement of specific 321.6measures to be taken to minimize the safety risk to persons receiving services;321.7(iii) doors are locked from the inside to prevent a person from exiting only when 321.8necessary to protect the safety of a person receiving services and not as a substitute for 321.9staff supervision or interactions with the person. If doors are locked from the inside, the 321.10license holder must document an assessment of the physical plant, the environment and 321.11the population served, identifying the risk factors which require the use of locked doors, 321.12and a statement of specific measures to be taken to minimize the safety risk to persons 321.13receiving services at the service site; and321.14(iii) (iv) a staff person is available on site who is trained in basic first aid and, when 321.15required in a person's coordinated service and support plan or coordinated service and 321.16support plan addendum, cardiopulmonary resuscitation, "CPR," whenever persons are 321.17present and staff are required to be at the site to provide direct service. The CPR training 321.18must include in-person instruction, hands-on practice, and an observed skills assessment 321.19under the direct supervision of a CPR instructor;321.20(2) maintain equipment, vehicles, supplies, and materials owned or leased by the 321.21license holder in good condition when used to provide services;321.22(3) follow procedures to ensure safe transportation, handling, and transfers of the 321.23person and any equipment used by the person, when the license holder is responsible for 321.24transportation of a person or a person's equipment;321.25(4) be prepared for emergencies and follow emergency response procedures to 321.26ensure the person's safety in an emergency; and321.27(5) follow universal precautions and sanitary practices, including hand washing, for 321.28infection prevention and control, and to prevent communicable diseases.321.29    Subd. 3.Compliance with fire and safety codes.When services are provided at a321.30 service site licensed according to chapter 245A or where the license holder is the owner, 321.31lessor, or tenant of the service site, the license holder must document compliance with 321.32applicable building codes, fire and safety codes, health rules, and zoning ordinances, or 321.33document that an appropriate waiver has been granted.321.34    Subd. 4. Funds and property. (a) Whenever the license holder assists a person 321.35with the safekeeping of funds or other property according to section 
         245A.04, subdivision 321.3613
         , the license holder must have obtain written authorization to do so from the person or 322.1the person's legal representative and the case manager. Authorization must be obtained 322.2within five working days of service initiation and renewed annually thereafter. At the time 322.3initial authorization is obtained, the license holder must survey, document, and implement 322.4the preferences of the person or the person's legal representative and the case manager 322.5for frequency of receiving a statement that itemizes receipts and disbursements of funds 322.6or other property. The license holder must document changes to these preferences when 322.7they are requested.322.8(b) A license holder or staff person may not accept powers-of-attorney from a 322.9person receiving services from the license holder for any purpose, and may not accept an 322.10appointment as guardian or conservator of a person receiving services from the license 322.11holder. This does not apply to license holders that are Minnesota counties or other 322.12units of government or to staff persons employed by license holders who were acting 322.13as power-of-attorney, guardian, or conservator attorney-in-fact for specific individuals 322.14prior to April 23, 2012 implementation of this chapter. The license holder must maintain 322.15documentation of the power-of-attorney, guardianship, or conservatorship in the service 322.16recipient record.322.17(c) Upon the transfer or death of a person, any funds or other property of the person 322.18must be surrendered to the person or the person's legal representative, or given to the 322.19executor or administrator of the estate in exchange for an itemized receipt.322.20    Subd. 5. Prohibitions. (a) The license holder is prohibited from using psychotropic 322.21medication chemical restraints, mechanical restraint practices, manual restraints, time out, 322.22or seclusion as a substitute for adequate staffing, for a behavioral or therapeutic program 322.23to reduce or eliminate behavior, as punishment, or for staff convenience, or for any reason 322.24other than as prescribed.322.25(b) The license holder is prohibited from using restraints or seclusion under any 322.26circumstance, unless the commissioner has approved a variance request from the license 322.27holder that allows for the emergency use of restraints and seclusion according to terms 322.28and conditions approved in the variance. Applicants and license holders who have 322.29reason to believe they may be serving an individual who will need emergency use of 322.30restraints or seclusion may request a variance on the application or reapplication, and 322.31the commissioner shall automatically review the request for a variance as part of the 322.32application or reapplication process. License holders may also request the variance any 322.33time after issuance of a license. In the event a license holder uses restraint or seclusion for 322.34any reason without first obtaining a variance as required, the license holder must report 322.35the unauthorized use of restraint or seclusion to the commissioner within 24 hours of the 322.36occurrence and request the required variance.323.1(b) For the purposes of this subdivision, "chemical restraint" means the 323.2administration of a drug or medication to control the person's behavior or restrict the 323.3person's freedom of movement and is not a standard treatment of dosage for the person's 323.4medical or psychological condition.323.5(c) For the purposes of this subdivision, "mechanical restraint practice" means the 323.6use of any adaptive equipment or safety device to control the person's behavior or restrict 323.7the person's freedom of movement and not as ordered by a licensed health professional. 323.8Mechanical restraint practices include, but are not limited to, the use of bed rails or similar 323.9devices on a bed to prevent the person from getting out of bed, chairs that prevent a person 323.10from rising, or placing a person in a wheelchair so close to a wall that the wall prevents 323.11the person from rising. Wrist bands or devices on clothing that trigger electronic alarms to 323.12warn staff that a person is leaving a room or area do not, in and of themselves, restrict 323.13freedom of movement and should not be considered restraints.323.14(d) A license holder must not use manual restraints, time out, or seclusion under any 323.15circumstance, except for emergency use of manual restraints according to the requirements 323.16in section 245D.061 or the use of controlled procedures with a person with a developmental 323.17disability as governed by Minnesota Rules, parts 9525.2700 to 9525.2810, or its successor 323.18provisions. License holders implementing nonemergency use of manual restraint, or any 323.19other programmatic use of mechanical restraint, time out, or seclusion with persons who 323.20do not have a developmental disability that is not subject to the requirements of Minnesota 323.21Rules, parts 9525.2700 to 9525.2810, must submit a variance request to the commissioner 323.22for continued use of the procedure within three months of implementation of this chapter.323.23EFFECTIVE DATE.This section is effective January 1, 2014.323.24    Sec. 24. [245D.061] EMERGENCY USE OF MANUAL RESTRAINTS.323.25    Subdivision 1.Standards for emergency use of manual restraints.Except 323.26for the emergency use of controlled procedures with a person with a developmental 323.27disability as governed by Minnesota Rules, part 9525.2770, or its successor provisions, 323.28the license holder must ensure that emergency use of manual restraints complies with the 323.29requirements of this chapter and the license holder's policy and procedures as required 323.30under subdivision 10.323.31    Subd. 2.Definitions.(a) The terms used in this section have the meaning given 323.32them in this subdivision.323.33(b) "Manual restraint" means physical intervention intended to hold a person 323.34immobile or limit a person's voluntary movement by using body contact as the only source 323.35of physical restraint.324.1(c) "Mechanical restraint" means the use of devices, materials, or equipment attached 324.2or adjacent to the person's body, or the use of practices which restrict freedom of movement 324.3or normal access to one's body or body parts, or limits a person's voluntary movement 324.4or holds a person immobile as an intervention precipitated by a person's behavior. The 324.5term does apply to mechanical restraint used to prevent injury with persons who engage in 324.6self-injurious behaviors, such as head-banging, gouging, or other actions resulting in tissue 324.7damage that have caused or could cause medical problems resulting from the self-injury.324.8    Subd. 3.Conditions for emergency use of manual restraint.Emergency use of 324.9manual restraint must meet the following conditions:324.10(1) immediate intervention must be needed to protect the person or others from 324.11imminent risk of physical harm; and324.12(2) the type of manual restraint used must be the least restrictive intervention to 324.13eliminate the immediate risk of harm and effectively achieve safety. The manual restraint 324.14must end when the threat of harm ends.324.15    Subd. 4.Permitted instructional techniques and therapeutic conduct.(a) Use of 324.16physical contact as therapeutic conduct or as an instructional technique as identified in 324.17paragraphs (b) and (c), is permitted and is not subject to the requirements of this section 324.18when such use is addressed in a person's coordinated service and support plan addendum 324.19and the required conditions have been met. For the purposes of this subdivision, 324.20"therapeutic conduct" has the meaning given in section 626.5572, subdivision 20.324.21(b) Physical contact or instructional techniques must use the least restrictive 324.22alternative possible to meet the needs of the person and may be used:324.23(1) to calm or comfort a person by holding that person with no resistance from 324.24that person; 324.25(2) to protect a person known to be at risk of injury due to frequent falls as a result of 324.26a medical condition; or324.27(3) to position a person with physical disabilities in a manner specified in the 324.28person's coordinated service and support plan addendum.324.29(c) Restraint may be used as therapeutic conduct:324.30(1) to allow a licensed health care professional to safely conduct a medical 324.31examination or to provide medical treatment ordered by a licensed health care professional 324.32to a person necessary to promote healing or recovery from an acute, meaning short-term, 324.33medical condition;324.34(2) to facilitate the person's completion of a task or response when the person does 324.35not resist or the person's resistance is minimal in intensity and duration;325.1(3) to briefly block or redirect a person's limbs or body without holding the person 325.2or limiting the person's movement to interrupt the person's behavior that may result in 325.3injury to self or others; or325.4(4) to assist in the safe evacuation of a person in the event of an emergency or to 325.5redirect a person who is at imminent risk of harm in a dangerous situation.325.6(d) A plan for using restraint as therapeutic conduct must be developed according to 325.7the requirements in sections 245D.07 and 245D.071, and must include methods to reduce 325.8or eliminate the use of and need for restraint.325.9    Subd. 5.Restrictions when implementing emergency use of manual restraint.325.10(a) Emergency use of manual restraint procedures must not:325.11(1) be implemented with a child in a manner that constitutes sexual abuse, neglect, 325.12physical abuse, or mental injury, as defined in section 626.556, subdivision 2;325.13(2) be implemented with an adult in a manner that constitutes abuse or neglect as 325.14defined in section 626.5572, subdivisions 2 and 17;325.15(3) be implemented in a manner that violates a person's rights and protections 325.16identified in section 245D.04;325.17(4) restrict a person's normal access to a nutritious diet, drinking water, adequate 325.18ventilation, necessary medical care, ordinary hygiene facilities, normal sleeping 325.19conditions, or necessary clothing, or to any protection required by state licensing standards 325.20and federal regulations governing the program;325.21(5) deny the person visitation or ordinary contact with legal counsel, a legal 325.22representative, or next of kin;325.23(6) be used as a substitute for adequate staffing, for the convenience of staff, as 325.24punishment, or as a consequence if the person refuses to participate in the treatment 325.25or services provided by the program; or325.26(7) use prone restraint. For the purposes of this section, "prone restraint" means use 325.27of manual restraint that places a person in a face-down position. This does not include 325.28brief physical holding of a person who, during an emergency use of manual restraint, rolls 325.29into a prone position, and the person is restored to a standing, sitting, or side-lying position 325.30as quickly as possible. Applying back or chest pressure while a person is in the prone or 325.31supine position or face-up is prohibited.325.32    Subd. 6.Monitoring emergency use of manual restraint.The license holder shall 325.33monitor a person's health and safety during an emergency use of a manual restraint. Staff 325.34monitoring the procedure must not be the staff implementing the procedure when possible. 325.35The license holder shall complete a monitoring form, approved by the commissioner, for 325.36each incident involving the emergency use of a manual restraint.326.1    Subd. 7.Reporting emergency use of manual restraint incident.(a) Within 326.2three calendar days after an emergency use of a manual restraint, the staff person who 326.3implemented the emergency use must report in writing to the designated coordinator the 326.4following information about the emergency use: 326.5(1) the staff and persons receiving services who were involved in the incident 326.6leading up to the emergency use of manual restraint;326.7(2) a description of the physical and social environment, including who was present 326.8before and during the incident leading up to the emergency use of manual restraint;326.9(3) a description of what less restrictive alternative measures were attempted to 326.10de-escalate the incident and maintain safety before the manual restraint was implemented 326.11that identifies when, how, and how long the alternative measures were attempted before 326.12manual restraint was implemented;326.13(4) a description of the mental, physical, and emotional condition of the person who 326.14was restrained, and other persons involved in the incident leading up to, during, and 326.15following the manual restraint;326.16(5) whether there was any injury to the person who was restrained or other persons 326.17involved in the incident, including staff, before or as a result of the use of manual 326.18restraint; and326.19(6) whether there was an attempt to debrief with the staff, and, if not contraindicated, 326.20with the person who was restrained and other persons who were involved in or who 326.21witnessed the restraint, following the incident and the outcome of the debriefing. If the 326.22debriefing was not conducted at the time the incident report was made, the report should 326.23identify whether a debriefing is planned.326.24(b) Each single incident of emergency use of manual restraint must be reported 326.25separately. For the purposes of this subdivision, an incident of emergency use of manual 326.26restraint is a single incident when the following conditions have been met:326.27(1) after implementing the manual restraint, staff attempt to release the person at the 326.28moment staff believe the person's conduct no longer poses an imminent risk of physical 326.29harm to self or others and less restrictive strategies can be implemented to maintain safety;326.30(2) upon the attempt to release the restraint, the person's behavior immediately 326.31re-escalates; and326.32(3) staff must immediately reimplement the restraint in order to maintain safety.326.33    Subd. 8.Internal review of emergency use of manual restraint.(a) Within five 326.34working days of the emergency use of manual restraint, the license holder must complete 326.35an internal review of each report of emergency use of manual restraint. The review must 326.36include an evaluation of whether:327.1(1) the person's service and support strategies developed according to sections 327.2245D.07 and 245D.071 need to be revised;327.3(2) related policies and procedures were followed;327.4(3) the policies and procedures were adequate;327.5(4) there is a need for additional staff training;327.6(5) the reported event is similar to past events with the persons, staff, or the services 327.7involved; and327.8(6) there is a need for corrective action by the license holder to protect the health 327.9and safety of persons.327.10(b) Based on the results of the internal review, the license holder must develop, 327.11document, and implement a corrective action plan for the program designed to correct 327.12current lapses and prevent future lapses in performance by individuals or the license 327.13holder, if any. The corrective action plan, if any, must be implemented within 30 days of 327.14the internal review being completed.327.15    Subd. 9.Expanded support team review.Within five working days after the 327.16completion of the internal review required in subdivision 8, the license holder must consult 327.17with the expanded support team following the emergency use of manual restraint to:327.18(1) discuss the incident reported in subdivision 7, to define the antecedent or event 327.19that gave rise to the behavior resulting in the manual restraint and identify the perceived 327.20function the behavior served; and327.21(2) determine whether the person's coordinated service and support plan addendum 327.22needs to be revised according to sections 245D.07 and 245D.071 to positively and 327.23effectively help the person maintain stability and to reduce or eliminate future occurrences 327.24requiring emergency use of manual restraint.327.25    Subd. 10.Emergency use of manual restraints policy and procedures.The 327.26license holder must develop, document, and implement a policy and procedures that 327.27promote service recipient rights and protect health and safety during the emergency use of 327.28manual restraints. The policy and procedures must comply with the requirements of this 327.29section and must specify the following:327.30(1) a description of the positive support strategies and techniques staff must use to 327.31attempt to de-escalate a person's behavior before it poses an imminent risk of physical 327.32harm to self or others;327.33(2) a description of the types of manual restraints the license holder allows staff to 327.34use on an emergency basis, if any. If the license holder will not allow the emergency use 327.35of manual restraint, the policy and procedure must identify the alternative measures the 328.1license holder will require staff to use when a person's conduct poses an imminent risk of 328.2physical harm to self or others and less restrictive strategies would not achieve safety;328.3(3) instructions for safe and correct implementation of the allowed manual restraint 328.4procedures;328.5(4) the training that staff must complete and the timelines for completion, before they 328.6may implement an emergency use of manual restraint. In addition to the training on this 328.7policy and procedure and the orientation and annual training required in section 245D.09, 328.8subdivision 4, the training for emergency use of manual restraint must incorporate the 328.9following subjects:328.10(i) alternatives to manual restraint procedures, including techniques to identify 328.11events and environmental factors that may escalate conduct that poses an imminent risk of 328.12physical harm to self or others;328.13(ii) de-escalation methods, positive support strategies, and how to avoid power 328.14struggles;328.15(iii) simulated experiences of administering and receiving manual restraint 328.16procedures allowed by the license holder on an emergency basis;328.17(iv) how to properly identify thresholds for implementing and ceasing restrictive 328.18procedures;328.19(v) how to recognize, monitor, and respond to the person's physical signs of distress, 328.20including positional asphyxia; 328.21(vi) the physiological and psychological impact on the person and the staff when 328.22restrictive procedures are used;328.23(vii) the communicative intent of behaviors; and328.24(viii) relationship building;328.25(5) the procedures and forms to be used to monitor the emergency use of manual 328.26restraints, including what must be monitored and the frequency of monitoring per 328.27each incident of emergency use of manual restraint, and the person or position who is 328.28responsible for monitoring the use;328.29(6) the instructions, forms, and timelines required for completing and submitting an 328.30incident report by the person or persons who implemented the manual restraint; and328.31(7) the procedures and timelines for conducting the internal review and the expanded 328.32support team review, and the person or position responsible for completing the reviews and 328.33who is responsible for ensuring that corrective action is taken or the person's coordinated 328.34service and support plan addendum is revised, when determined necessary.328.35EFFECTIVE DATE.This section is effective January 1, 2014.329.1    Sec. 25. Minnesota Statutes 2012, section 245D.07, is amended to read:329.2245D.07 SERVICE NEEDS PLANNING AND DELIVERY.329.3    Subdivision 1. Provision of services. The license holder must provide services as 329.4specified assigned in the coordinated service and support plan and assigned to the license 329.5holder. The provision of services must comply with the requirements of this chapter and 329.6the federal waiver plans.329.7    Subd. 1a.Person-centered planning and service delivery.(a) The license holder 329.8must provide services in response to the person's identified needs, interests, preferences, 329.9and desired outcomes as specified in the coordinated service and support plan, the 329.10coordinated service and support plan addendum, and in compliance with the requirements 329.11of this chapter. License holders providing intensive support services must also provide 329.12outcome-based services according to the requirements in section 245D.071.329.13(b) Services must be provided in a manner that supports the person's preferences, 329.14daily needs, and activities and accomplishment of the person's personal goals and service 329.15outcomes, consistent with the principles of:329.16(1) person-centered service planning and delivery that:329.17(i) identifies and supports what is important to the person as well as what is 329.18important for the person, including preferences for when, how, and by whom direct 329.19support service is provided;329.20(ii) uses that information to identify outcomes the person desires; and329.21(iii) respects each person's history, dignity, and cultural background;329.22(2) self-determination that supports and provides:329.23(i) opportunities for the development and exercise of functional and age-appropriate 329.24skills, decision making and choice, personal advocacy, and communication; and329.25(ii) the affirmation and protection of each person's civil and legal rights;329.26(3) providing the most integrated setting and inclusive service delivery that supports, 329.27promotes, and allows:329.28(i) inclusion and participation in the person's community as desired by the person 329.29in a manner that enables the person to interact with nondisabled persons to the fullest 329.30extent possible and supports the person in developing and maintaining a role as a valued 329.31community member;329.32(ii) opportunities for self-sufficiency as well as developing and maintaining social 329.33relationships and natural supports; and329.34(iii) a balance between risk and opportunity, meaning the least restrictive supports or 329.35interventions necessary are provided in the most integrated settings in the most inclusive 330.1manner possible to support the person to engage in activities of the person's own choosing 330.2that may otherwise present a risk to the person's health, safety, or rights.330.3    Subd. 2. Service planning requirements for basic support services.(a) License 330.4holders providing basic support services must meet the requirements of this subdivision.330.5(b) Within 15 days of service initiation the license holder must complete a 330.6preliminary coordinated service and support plan addendum based on the coordinated 330.7service and support plan.330.8(c) Within 60 days of service initiation the license holder must review and revise as 330.9needed the preliminary coordinated service and support plan addendum to document the 330.10services that will be provided including how, when, and by whom services will be provided, 330.11and the person responsible for overseeing the delivery and coordination of services.330.12(d) The license holder must participate in service planning and support team 330.13meetings related to for the person following stated timelines established in the person's330.14 coordinated service and support plan or as requested by the support team, the person, or 330.15the person's legal representative, the support team or the expanded support team.330.16    Subd. 3. Reports. The license holder must provide written reports regarding the 330.17person's progress or status as requested by the person, the person's legal representative, the 330.18case manager, or the team.330.19EFFECTIVE DATE.This section is effective January 1, 2014.330.20    Sec. 26. [245D.071] SERVICE PLANNING AND DELIVERY; INTENSIVE 330.21SUPPORT SERVICES.330.22    Subdivision 1.Requirements for intensive support services.A license holder 330.23providing intensive support services identified in section 245D.03, subdivision 1, 330.24paragraph (c), must comply with the requirements in section 245D.07, subdivisions 1 330.25and 3, and this section.330.26    Subd. 2.Abuse prevention.Prior to or upon initiating services, the license holder 330.27must develop, document, and implement an abuse prevention plan according to section 330.28245A.65, subdivision 2.330.29    Subd. 3.Assessment and initial service planning.(a) Within 15 days of service 330.30initiation the license holder must complete a preliminary coordinated service and support 330.31plan addendum based on the coordinated service and support plan.330.32(b) Within 45 days of service initiation the license holder must meet with the person, 330.33the person's legal representative, the case manager, and other members of the support team 330.34or expanded support team to assess and determine the following based on the person's 331.1coordinated service and support plan and the requirements in subdivision 4 and section 331.2245D.07, subdivision 1a:331.3(1) the scope of the services to be provided to support the person's daily needs 331.4and activities;331.5(2) the person's desired outcomes and the supports necessary to accomplish the 331.6person's desired outcomes;331.7(3) the person's preferences for how services and supports are provided;331.8(4) whether the current service setting is the most integrated setting available and 331.9appropriate for the person; and331.10(5) how services must be coordinated across other providers licensed under this 331.11chapter serving the same person to ensure continuity of care for the person.331.12(c) Within the scope of services, the license holder must, at a minimum, assess 331.13the following areas:331.14(1) the person's ability to self-manage health and medical needs to maintain or 331.15improve physical, mental, and emotional well-being, including, when applicable, allergies, 331.16seizures, choking, special dietary needs, chronic medical conditions, self-administration 331.17of medication or treatment orders, preventative screening, and medical and dental 331.18appointments;331.19(2) the person's ability to self-manage personal safety to avoid injury or accident in 331.20the service setting, including, when applicable, risk of falling, mobility, regulating water 331.21temperature, community survival skills, water safety skills, and sensory disabilities; and331.22(3) the person's ability to self-manage symptoms or behavior that may otherwise 331.23result in an incident as defined in section 245D.02, subdivision 11, clauses (4) to 331.24(7), suspension or termination of services by the license holder, or other symptoms 331.25or behaviors that may jeopardize the health and safety of the person or others. The 331.26assessments must produce information about the person that is descriptive of the person's 331.27overall strengths, functional skills and abilities, and behaviors or symptoms.331.28    Subd. 4.Service outcomes and supports.(a) Within ten working days of the 331.2945-day meeting, the license holder must develop and document the service outcomes and 331.30supports based on the assessments completed under subdivision 3 and the requirements 331.31in section 245D.07, subdivision 1a. The outcomes and supports must be included in the 331.32coordinated service and support plan addendum.331.33(b) The license holder must document the supports and methods to be implemented 331.34to support the accomplishment of outcomes related to acquiring, retaining, or improving 331.35skills. The documentation must include:332.1(1) the methods or actions that will be used to support the person and to accomplish 332.2the service outcomes, including information about:332.3(i) any changes or modifications to the physical and social environments necessary 332.4when the service supports are provided;332.5(ii) any equipment and materials required; and332.6(iii) techniques that are consistent with the person's communication mode and 332.7learning style;332.8(2) the measurable and observable criteria for identifying when the desired outcome 332.9has been achieved and how data will be collected;332.10(3) the projected starting date for implementing the supports and methods and 332.11the date by which progress towards accomplishing the outcomes will be reviewed and 332.12evaluated; and332.13(4) the names of the staff or position responsible for implementing the supports 332.14and methods.332.15(c) Within 20 working days of the 45-day meeting, the license holder must obtain 332.16dated signatures from the person or the person's legal representative and case manager 332.17to document completion and approval of the assessment and coordinated service and 332.18support plan addendum.332.19    Subd. 5.Progress reviews.(a) The license holder must give the person or the 332.20person's legal representative and case manager an opportunity to participate in the ongoing 332.21review and development of the methods used to support the person and accomplish 332.22outcomes identified in subdivisions 3 and 4. The license holder, in coordination with 332.23the person's support team or expanded support team, must meet with the person, the 332.24person's legal representative, and the case manager, and participate in progress review 332.25meetings following stated timelines established in the person's coordinated service and 332.26support plan or coordinated service and support plan addendum or within 30 days of a 332.27written request by the person, the person's legal representative, or the case manager, 332.28at a minimum of once per year.332.29(b) The license holder must summarize the person's progress toward achieving the 332.30identified outcomes and make recommendations and identify the rationale for changing, 332.31continuing, or discontinuing implementation of supports and methods identified in 332.32subdivision 4 in a written report sent to the person or the person's legal representative 332.33and case manager five working days prior to the review meeting, unless the person, the 332.34person's legal representative, or the case manager request to receive the report at the 332.35time of the meeting.333.1(c) Within ten working days of the progress review meeting, the license holder 333.2must obtain dated signatures from the person or the person's legal representative and 333.3the case manager to document approval of any changes to the coordinated service and 333.4support plan addendum.333.5EFFECTIVE DATE.This section is effective January 1, 2014.333.6    Sec. 27. [245D.081] PROGRAM COORDINATION, EVALUATION, AND 333.7OVERSIGHT.333.8    Subdivision 1.Program coordination and evaluation.(a) The license holder 333.9is responsible for:333.10(1) coordination of service delivery and evaluation for each person served by the 333.11program as identified in subdivision 2; and333.12(2) program management and oversight that includes evaluation of the program 333.13quality and program improvement for services provided by the license holder as identified 333.14in subdivision 3.333.15(b) The same person may perform the functions in paragraph (a) if the work and 333.16education qualifications are met in subdivisions 2 and 3.333.17    Subd. 2.Coordination and evaluation of individual service delivery.(a) Delivery 333.18and evaluation of services provided by the license holder must be coordinated by a 333.19designated staff person. The designated coordinator must provide supervision, support, 333.20and evaluation of activities that include:333.21(1) oversight of the license holder's responsibilities assigned in the person's 333.22coordinated service and support plan and the coordinated service and support plan 333.23addendum;333.24(2) taking the action necessary to facilitate the accomplishment of the outcomes 333.25according to the requirements in section 245D.07;333.26(3) instruction and assistance to direct support staff implementing the coordinated 333.27service and support plan and the service outcomes, including direct observation of service 333.28delivery sufficient to assess staff competency; and333.29(4) evaluation of the effectiveness of service delivery, methodologies, and progress on 333.30the person's outcomes based on the measurable and observable criteria for identifying when 333.31the desired outcome has been achieved according to the requirements in section 245D.07.333.32(b) The license holder must ensure that the designated coordinator is competent to 333.33perform the required duties identified in paragraph (a) through education and training in 333.34human services and disability-related fields, and work experience in providing direct care 333.35services and supports to persons with disabilities. The designated coordinator must have 334.1the skills and ability necessary to develop effective plans and to design and use data 334.2systems to measure effectiveness of services and supports. The license holder must verify 334.3and document competence according to the requirements in section 245D.09, subdivision 334.43. The designated coordinator must minimally have:334.5(1) a baccalaureate degree in a field related to human services, and one year of 334.6full-time work experience providing direct care services to persons with disabilities or 334.7persons age 65 and older;334.8(2) an associate degree in a field related to human services, and two years of 334.9full-time work experience providing direct care services to persons with disabilities or 334.10persons age 65 and older;334.11(3) a diploma in a field related to human services from an accredited postsecondary 334.12institution and three years of full-time work experience providing direct care services to 334.13persons with disabilities or persons age 65 and older; or334.14(4) a minimum of 50 hours of education and training related to human services 334.15and disabilities; and334.16(5) four years of full-time work experience providing direct care services to persons 334.17with disabilities or persons age 65 and older under the supervision of a staff person who 334.18meets the qualifications identified in clauses (1) to (3).334.19    Subd. 3.Program management and oversight.(a) The license holder must 334.20designate a managerial staff person or persons to provide program management and 334.21oversight of the services provided by the license holder. The designated manager is 334.22responsible for the following:334.23(1) maintaining a current understanding of the licensing requirements sufficient to 334.24ensure compliance throughout the program as identified in section 245A.04, subdivision 334.251, paragraph (e), and when applicable, as identified in section 256B.04, subdivision 21, 334.26paragraph (b);334.27(2) ensuring the duties of the designated coordinator are fulfilled according to the 334.28requirements in subdivision 2;334.29(3) ensuring the program implements corrective action identified as necessary 334.30by the program following review of incident and emergency reports according to the 334.31requirements in section 245D.11, subdivision 2, clause (7). An internal review of 334.32incident reports of alleged or suspected maltreatment must be conducted according to the 334.33requirements in section 245A.65, subdivision 1, paragraph (b);334.34(4) evaluation of satisfaction of persons served by the program, the person's legal 334.35representative, if any, and the case manager, with the service delivery and progress 335.1towards accomplishing outcomes identified in sections 245D.07 and 245D.071, and 335.2ensuring and protecting each person's rights as identified in section 245D.04;335.3(5) ensuring staff competency requirements are met according to the requirements in 335.4section 245D.09, subdivision 3, and ensuring staff orientation and training is provided 335.5according to the requirements in section 245D.09, subdivisions 4, 4a, and 5;335.6(6) ensuring corrective action is taken when ordered by the commissioner and that 335.7the terms and condition of the license and any variances are met; and335.8(7) evaluating the information identified in clauses (1) to (6) to develop, document, 335.9and implement ongoing program improvements.335.10(b) The designated manager must be competent to perform the duties as required and 335.11must minimally meet the education and training requirements identified in subdivision 335.122, paragraph (b), and have a minimum of three years of supervisory level experience in 335.13a program providing direct support services to persons with disabilities or persons age 335.1465 and older.335.15EFFECTIVE DATE.This section is effective January 1, 2014.335.16    Sec. 28. Minnesota Statutes 2012, section 245D.09, is amended to read:335.17245D.09 STAFFING STANDARDS.335.18    Subdivision 1. Staffing requirements.  The license holder must provide the level of335.19 direct service support staff sufficient supervision, assistance, and training necessary:335.20(1) to ensure the health, safety, and protection of rights of each person; and335.21(2) to be able to implement the responsibilities assigned to the license holder in each 335.22person's coordinated service and support plan or identified in the coordinated service and 335.23support plan addendum, according to the requirements of this chapter.335.24    Subd. 2. Supervision of staff having direct contact. Except for a license holder 335.25who is the sole direct service support staff, the license holder must provide adequate 335.26supervision of staff providing direct service support to ensure the health, safety, and 335.27protection of rights of each person and implementation of the responsibilities assigned to 335.28the license holder in each person's service plan coordinated service and support plan or 335.29coordinated service and support plan addendum.335.30    Subd. 3. Staff qualifications. (a) The license holder must ensure that staff is335.31 providing direct support, or staff who have responsibilities related to supervising or 335.32managing the provision of direct support service, are competent as demonstrated through335.33 skills and knowledge training, experience, and education to meet the person's needs 335.34and additional requirements as written in the coordinated service and support plan or 336.1coordinated service and support plan addendum, or when otherwise required by the case 336.2manager or the federal waiver plan. The license holder must verify and maintain evidence 336.3of staff competency, including documentation of:336.4(1) education and experience qualifications relevant to the job responsibilities 336.5assigned to the staff and the needs of the general population of persons served by the 336.6program, including a valid degree and transcript, or a current license, registration, or 336.7certification, when a degree or licensure, registration, or certification is required by this 336.8chapter or in the coordinated service and support plan or coordinated service and support 336.9plan addendum;336.10(2) completion of required demonstrated competency in the orientation and training336.11 areas required under this chapter, including and when applicable, completion of continuing 336.12education required to maintain professional licensure, registration, or certification 336.13requirements. Competency in these areas is determined by the license holder through 336.14knowledge testing and observed skill assessment conducted by the trainer or instructor; and336.15(3) except for a license holder who is the sole direct service support staff, periodic336.16 performance evaluations completed by the license holder of the direct service support staff 336.17person's ability to perform the job functions based on direct observation.336.18(b) Staff under 18 years of age may not perform overnight duties or administer 336.19medication.336.20    Subd. 4. Orientation to program requirements.(a) Except for a license holder 336.21who does not supervise any direct service support staff, within 90 days of hiring direct 336.22service staff 60 days of hire, unless stated otherwise, the license holder must provide 336.23and ensure completion of 30 hours of orientation for direct support staff that combines 336.24supervised on-the-job training with review of and instruction on in the following areas:336.25(1) the job description and how to complete specific job functions, including:336.26(i) responding to and reporting incidents as required under section 
         245D.06, 336.27subdivision 1; and336.28(ii) following safety practices established by the license holder and as required in 336.29section 
         245D.06, subdivision 2;336.30(2) the license holder's current policies and procedures required under this chapter, 336.31including their location and access, and staff responsibilities related to implementation 336.32of those policies and procedures;336.33(3) data privacy requirements according to sections 
         13.01 to 
         13.10 and 
         13.46, the 336.34federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), and staff 336.35responsibilities related to complying with data privacy practices;337.1(4) the service recipient rights under section 245D.04, and staff responsibilities 337.2related to ensuring the exercise and protection of those rights according to the requirements 337.3in section 245D.04;337.4(5) sections 
         245A.65, 
         245A.66, 
         626.556, and 
         626.557, governing maltreatment 337.5reporting and service planning for children and vulnerable adults, and staff responsibilities 337.6related to protecting persons from maltreatment and reporting maltreatment. This 337.7orientation must be provided within 72 hours of first providing direct contact services and 337.8annually thereafter according to section 245A.65, subdivision 3;337.9(6) what constitutes use of restraints, seclusion, and psychotropic medications, 337.10and staff responsibilities related to the prohibitions of their use the principles of 337.11person-centered service planning and delivery as identified in section 245D.07, subdivision 337.121a, and how they apply to direct support service provided by the staff person; and337.13(7) other topics as determined necessary in the person's coordinated service and 337.14support plan by the case manager or other areas identified by the license holder.337.15(b) License holders who provide direct service themselves must complete the 337.16orientation required in paragraph (a), clauses (3) to (7).337.17    Subd. 4a.Orientation to individual service recipient needs.(c) (a) Before 337.18providing having unsupervised direct service to contact with a person served by the 337.19program, or for whom the staff person has not previously provided direct service support, 337.20or any time the plans or procedures identified in clauses (1) and (2) paragraphs (b) to 337.21(f) are revised, the staff person must review and receive instruction on the following 337.22as it relates requirements in paragraphs (b) to (f) as they relate to the staff person's job 337.23functions for that person:.337.24(b) Training and competency evaluations must include the following:337.25(1) appropriate and safe techniques in personal hygiene and grooming, including 337.26hair care, bathing, care of teeth, gums, oral prosthetic devices, and other activities of daily 337.27living (ADLs) as defined under section 256B.0659, subdivision 1;337.28(2) an understanding of what constitutes a healthy diet according to data from the 337.29Centers for Disease Control and Prevention and the skills necessary to prepare that diet;337.30(3) skills necessary to provide appropriate support in instrumental activities of daily 337.31living (IADLs) as defined under section 256B.0659, subdivision 1; and337.32(4) demonstrated competence in providing first aid.337.33(1) (c) The staff person must review and receive instruction on the person's337.34 coordinated service and support plan or coordinated service and support plan addendum as 337.35it relates to the responsibilities assigned to the license holder, and when applicable, the 337.36person's individual abuse prevention plan according to section 245A.65, to achieve and 338.1demonstrate an understanding of the person as a unique individual, and how to implement 338.2those plans; and.338.3(2) (d) The staff person must review and receive instruction on medication 338.4administration procedures established for the person when medication administration is338.5 assigned to the license holder according to section 
         245D.05, subdivision 1, paragraph 338.6(b). Unlicensed staff may administer medications only after successful completion of a 338.7medication administration training, from a training curriculum developed by a registered 338.8nurse, clinical nurse specialist in psychiatric and mental health nursing, certified nurse 338.9practitioner, physician's assistant, or physician incorporating. The training curriculum 338.10must incorporate an observed skill assessment conducted by the trainer to ensure staff 338.11demonstrate the ability to safely and correctly follow medication procedures.338.12Medication administration must be taught by a registered nurse, clinical nurse 338.13specialist, certified nurse practitioner, physician's assistant, or physician if, at the time of 338.14service initiation or any time thereafter, the person has or develops a health care condition 338.15that affects the service options available to the person because the condition requires:338.16(i) (1) specialized or intensive medical or nursing supervision; and338.17(ii) (2) nonmedical service providers to adapt their services to accommodate the 338.18health and safety needs of the person; and.338.19(iii) necessary training in order to meet the health service needs of the person as 338.20determined by the person's physician.338.21(e) The staff person must review and receive instruction on the safe and correct 338.22operation of medical equipment used by the person to sustain life, including but not 338.23limited to ventilators, feeding tubes, or endotracheal tubes. The training must be provided 338.24by a licensed health care professional or a manufacturer's representative and incorporate 338.25an observed skill assessment to ensure staff demonstrate the ability to safely and correctly 338.26operate the equipment according to the treatment orders and the manufacturer's instructions.338.27(f) The staff person must review and receive instruction on what constitutes use of 338.28restraints, time out, and seclusion, including chemical restraint, and staff responsibilities 338.29related to the prohibitions of their use according to the requirements in section 245D.06, 338.30subdivision 5, why such procedures are not effective for reducing or eliminating symptoms 338.31or undesired behavior and why they are not safe, and the safe and correct use of manual 338.32restraint on an emergency basis according to the requirements in section 245D.061.338.33(g) In the event of an emergency service initiation, the license holder must ensure 338.34the training required in this subdivision occurs within 72 hours of the direct support staff 338.35person first having unsupervised contact with the person receiving services. The license 339.1holder must document the reason for the unplanned or emergency service initiation and 339.2maintain the documentation in the person's service recipient record.339.3(h) License holders who provide direct support services themselves must complete 339.4the orientation required in subdivision 4, clauses (3) to (7).339.5    Subd. 5. Annual training.(a) A license holder must provide annual training 339.6to direct service support staff on the topics identified in subdivision 4, paragraph (a),339.7 clauses (3) to (6) (7), and subdivision 4a. A license holder must provide a minimum of 24 339.8hours of annual training to direct service staff with fewer than five years of documented 339.9experience and 12 hours of annual training to direct service staff with five or more years 339.10of documented experience in topics described in subdivisions 4 and 4a, paragraphs (a) 339.11to (h). Training on relevant topics received from sources other than the license holder 339.12may count toward training requirements.339.13(b) A license holder providing behavioral programming, specialist services, personal 339.14support, 24-hour emergency assistance, night supervision, independent living skills, 339.15structured day, prevocational, or supported employment services must provide a minimum 339.16of eight hours of annual training to direct service staff that addresses:339.17(1) topics related to the general health, safety, and service needs of the population 339.18served by the license holder; and339.19(2) other areas identified by the license holder or in the person's current service plan.339.20Training on relevant topics received from sources other than the license holder 339.21may count toward training requirements.339.22(c) When the license holder is the owner, lessor, or tenant of the service site and 339.23whenever a person receiving services is present at the site, the license holder must have 339.24a staff person available on site who is trained in basic first aid and, when required in a 339.25person's service plan, cardiopulmonary resuscitation.339.26    Subd. 5a.Alternative sources of training. Orientation or training received by the 339.27staff person from sources other than the license holder in the same subjects as identified 339.28in subdivision 4 may count toward the orientation and annual training requirements if 339.29received in the 12-month period before the staff person's date of hire. The license holder 339.30must maintain documentation of the training received from other sources and of each staff 339.31person's competency in the required area according to the requirements in subdivision 3.339.32    Subd. 6. Subcontractors and temporary staff. If the license holder uses a 339.33subcontractor or temporary staff to perform services licensed under this chapter on the 339.34license holder's behalf, the license holder must ensure that the subcontractor or temporary 339.35staff meets and maintains compliance with all requirements under this chapter that apply 339.36to the services to be provided, including training, orientation, and supervision necessary 340.1to fulfill their responsibilities. The license holder must ensure that a background study 340.2has been completed according to the requirements in sections 245C.03, subdivision 1, 340.3and 245C.04. Subcontractors and temporary staff hired by the license holder must meet 340.4the Minnesota licensing requirements applicable to the disciplines in which they are 340.5providing services. The license holder must maintain documentation that the applicable 340.6requirements have been met.340.7    Subd. 7. Volunteers. The license holder must ensure that volunteers who provide 340.8direct support services to persons served by the program receive the training, orientation, 340.9and supervision necessary to fulfill their responsibilities. The license holder must ensure 340.10that a background study has been completed according to the requirements in sections 340.11245C.03, subdivision 1, and 245C.04. The license holder must maintain documentation 340.12that the applicable requirements have been met.340.13    Subd. 8.Staff orientation and training plan.The license holder must develop 340.14a staff orientation and training plan documenting when and how compliance with 340.15subdivisions 4, 4a, and 5 will be met.340.16EFFECTIVE DATE.This section is effective January 1, 2014.340.17    Sec. 29. [245D.091] INTERVENTION SERVICES.340.18    Subdivision 1.Licensure requirements.An individual meeting the staff 340.19qualification requirements of this section who is an employee of a program licensed 340.20according to this chapter and providing behavioral support services, specialist services, 340.21or crisis respite services is not required to hold a separate license under this chapter. 340.22An individual meeting the staff qualifications of this section who is not providing these 340.23services as an employee of a program licensed according to this chapter must obtain a 340.24license according to this chapter.340.25    Subd. 2.Behavior professional qualifications.A behavior professional, as defined 340.26in the brain injury and community alternatives for disabled individuals waiver plans or 340.27successor plans, must have competencies in areas related to:340.28(1) ethical considerations;340.29(2) functional assessment;340.30(3) functional analysis;340.31(4) measurement of behavior and interpretation of data;340.32(5) selecting intervention outcomes and strategies;340.33(6) behavior reduction and elimination strategies that promote least restrictive 340.34approved alternatives;340.35(7) data collection;341.1(8) staff and caregiver training;341.2(9) support plan monitoring;341.3(10) co-occurring mental disorders or neuro-cognitive disorder;341.4(11) demonstrated expertise with populations being served; and341.5(12) must be a:341.6(i) psychologist licensed under sections 148.88 to 148.98, who has stated to the 341.7Board of Psychology competencies in the above identified areas;341.8(ii) clinical social worker licensed as an independent clinical social worker under 341.9chapter 148D, or a person with a master's degree in social work from an accredited college 341.10or university, with at least 4,000 hours of post-master's supervised experience in the 341.11delivery of clinical services in the areas identified in clauses (1) to (11);341.12(iii) physician licensed under chapter 147 and certified by the American Board 341.13of Psychiatry and Neurology or eligible for board certification in psychiatry with 341.14competencies in the areas identified in clauses (1) to (11);341.15(iv) licensed professional clinical counselor licensed under sections 148B.29 to 341.16148B.39 with at least 4,000 hours of post-master's supervised experience in the delivery 341.17of clinical services who has demonstrated competencies in the areas identified in clauses 341.18(1) to (11);341.19(v) person with a master's degree from an accredited college or university in one 341.20of the behavioral sciences or related fields, with at least 4,000 hours of post-master's 341.21supervised experience in the delivery of clinical services with demonstrated competencies 341.22in the areas identified in clauses (1) to (11); or341.23(vi) registered nurse who is licensed under sections 148.171 to 148.285, and who is 341.24certified as a clinical specialist or as a nurse practitioner in adult or family psychiatric and 341.25mental health nursing by a national nurse certification organization, or who has a master's 341.26degree in nursing or one of the behavioral sciences or related fields from an accredited 341.27college or university or its equivalent, with at least 4,000 hours of post-master's supervised 341.28experience in the delivery of clinical services.341.29    Subd. 3.Behavior analyst qualifications.(a) A behavior analyst, as defined in 341.30the brain injury and community alternatives for disabled individuals waiver plans or 341.31successor plans, must:341.32(1) have obtained a baccalaureate degree, master's degree, or PhD in a social services 341.33discipline; or341.34(2) meet the qualifications of a mental health practitioner as defined in section 341.35245.462, subdivision 17.341.36(b) In addition, a behavior analyst must:342.1(1) have four years of supervised experience working with individuals who exhibit 342.2challenging behaviors as well as co-occurring mental disorders or neuro-cognitive disorder;342.3(2) have received ten hours of instruction in functional assessment and functional 342.4analysis;342.5(3) have received 20 hours of instruction in the understanding of the function of 342.6behavior;342.7(4) have received ten hours of instruction on design of positive practices behavior 342.8support strategies;342.9(5) have received 20 hours of instruction on the use of behavior reduction approved 342.10strategies used only in combination with behavior positive practices strategies;342.11(6) be determined by a behavior professional to have the training and prerequisite 342.12skills required to provide positive practice strategies as well as behavior reduction 342.13approved and permitted intervention to the person who receives behavioral support; and342.14(7) be under the direct supervision of a behavior professional.342.15    Subd. 4.Behavior specialist qualifications.(a) A behavior specialist, as defined 342.16in the brain injury and community alternatives for disabled individuals waiver plans or 342.17successor plans, must meet the following qualifications:342.18(1) have an associate's degree in a social services discipline; or342.19(2) have two years of supervised experience working with individuals who exhibit 342.20challenging behaviors as well as co-occurring mental disorders or neuro-cognitive disorder.342.21(b) In addition, a behavior specialist must:342.22(1) have received a minimum of four hours of training in functional assessment;342.23(2) have received 20 hours of instruction in the understanding of the function of 342.24behavior;342.25(3) have received ten hours of instruction on design of positive practices behavioral 342.26support strategies;342.27(4) be determined by a behavior professional to have the training and prerequisite 342.28skills required to provide positive practices strategies as well as behavior reduction 342.29approved intervention to the person who receives behavioral support; and342.30(5) be under the direct supervision of a behavior professional.342.31    Subd. 5.Specialist services qualifications.An individual providing specialist 342.32services, as defined in the developmental disabilities waiver plan or successor plan, must 342.33have:342.34(1) the specific experience and skills required of the specialist to meet the needs of 342.35the person identified by the person's service planning team; and343.1(2) the qualifications of the specialist identified in the person's coordinated service 343.2and support plan.343.3EFFECTIVE DATE.This section is effective January 1, 2014.343.4    Sec. 30. [245D.095] RECORD REQUIREMENTS.343.5    Subdivision 1.Record-keeping systems.The license holder must ensure that the 343.6content and format of service recipient, personnel, and program records are uniform and 343.7legible according to the requirements of this chapter.343.8    Subd. 2.Admission and discharge register.The license holder must keep a written 343.9or electronic register, listing in chronological order the dates and names of all persons 343.10served by the program who have been admitted, discharged, or transferred, including 343.11service terminations initiated by the license holder and deaths.343.12    Subd. 3.Service recipient record.(a) The license holder must maintain a record of 343.13current services provided to each person on the premises where the services are provided 343.14or coordinated. When the services are provided in a licensed facility, the records must 343.15be maintained at the facility, otherwise the records must be maintained at the license 343.16holder's program office. The license holder must protect service recipient records against 343.17loss, tampering, or unauthorized disclosure according to the requirements in sections 343.1813.01 to 13.10 and 13.46.343.19(b) The license holder must maintain the following information for each person:343.20(1) an admission form signed by the person or the person's legal representative 343.21that includes:343.22(i) identifying information, including the person's name, date of birth, address, 343.23and telephone number; and343.24(ii) the name, address, and telephone number of the person's legal representative, if 343.25any, and a primary emergency contact, the case manager, and family members or others as 343.26identified by the person or case manager;343.27(2) service information, including service initiation information, verification of the 343.28person's eligibility for services, documentation verifying that services have been provided 343.29as identified in the coordinated service and support plan or coordinated service and support 343.30plan addendum according to paragraph (a), and date of admission or readmission;343.31(3) health information, including medical history, special dietary needs, and 343.32allergies, and when the license holder is assigned responsibility for meeting the person's 343.33health service needs according to section 245D.05:344.1(i) current orders for medication, treatments, or medical equipment and a signed 344.2authorization from the person or the person's legal representative to administer or assist in 344.3administering the medication or treatments, if applicable;344.4(ii) a signed statement authorizing the license holder to act in a medical emergency 344.5when the person's legal representative, if any, cannot be reached or is delayed in arriving;344.6(iii) medication administration procedures;344.7(iv) a medication administration record documenting the implementation of the 344.8medication administration procedures, and the medication administration record reviews, 344.9including any agreements for administration of injectable medications by the license 344.10holder according to the requirements in section 245D.05; and344.11(v) a medical appointment schedule when the license holder is assigned 344.12responsibility for assisting with medical appointments;344.13(4) the person's current coordinated service and support plan or that portion of the 344.14plan assigned to the license holder;344.15(5) copies of the individual abuse prevention plan and assessments as required under 344.16section 245D.071, subdivisions 2 and 3;344.17(6) a record of other service providers serving the person when the person's 344.18coordinated service and support plan or coordinated service and support plan addendum 344.19identifies the need for coordination between the service providers, that includes a contact 344.20person and telephone numbers, services being provided, and names of staff responsible for 344.21coordination;344.22(7) documentation of orientation to service recipient rights according to section 344.23245D.04, subdivision 1, and maltreatment reporting policies and procedures according to 344.24section 245A.65, subdivision 1, paragraph (c);344.25(8) copies of authorizations to handle a person's funds, according to section 245D.06, 344.26subdivision 4, paragraph (a);344.27(9) documentation of complaints received and grievance resolution;344.28(10) incident reports involving the person, required under section 245D.06, 344.29subdivision 1;344.30(11) copies of written reports regarding the person's status when requested according 344.31to section 245D.07, subdivision 3, progress review reports as required under section 344.32245D.071, subdivision 5, progress or daily log notes that are recorded by the program, 344.33and reports received from other agencies involved in providing services or care to the 344.34person; and344.35(12) discharge summary, including service termination notice and related 344.36documentation, when applicable.345.1    Subd. 4.Access to service recipient records.The license holder must ensure that 345.2the following people have access to the information in subdivision 1 in accordance with 345.3applicable state and federal laws, regulations, or rules:345.4(1) the person, the person's legal representative, and anyone properly authorized 345.5by the person;345.6(2) the person's case manager;345.7(3) staff providing services to the person unless the information is not relevant to 345.8carrying out the coordinated service and support plan or coordinated service and support 345.9plan addendum; and345.10(4) the county child or adult foster care licensor, when services are also licensed as 345.11child or adult foster care.345.12    Subd. 5.Personnel records.(a) The license holder must maintain a personnel 345.13record of each employee to document and verify staff qualifications, orientation, and 345.14training. The personnel record must include:345.15(1) the employee's date of hire, completed application, an acknowledgement signed 345.16by the employee that job duties were reviewed with the employee and the employee 345.17understands those duties, and documentation that the employee meets the position 345.18requirements as determined by the license holder;345.19 (2) documentation of staff qualifications, orientation, training, and performance 345.20evaluations as required under section 245D.09, subdivisions 3 to 5, including the date 345.21the training was completed, the number of hours per subject area, and the name of the 345.22trainer or instructor; and345.23(3) a completed background study as required under chapter 245C.345.24(b) For employees hired after January 1, 2014, the license holder must maintain 345.25documentation in the personnel record or elsewhere, sufficient to determine the date of the 345.26employee's first supervised direct contact with a person served by the program, and the 345.27date of first unsupervised direct contact with a person served by the program.345.28EFFECTIVE DATE.This section is effective January 1, 2014.345.29    Sec. 31. Minnesota Statutes 2012, section 245D.10, is amended to read:345.30245D.10 POLICIES AND PROCEDURES.345.31    Subdivision 1. Policy and procedure requirements. The A license holder345.32 providing either basic or intensive supports and services must establish, enforce, and 345.33maintain policies and procedures as required in this chapter, chapter 245A, and other 346.1applicable state and federal laws and regulations governing the provision of home and 346.2community-based services licensed according to this chapter.346.3    Subd. 2. Grievances. The license holder must establish policies and procedures 346.4that provide promote service recipient rights by providing a simple complaint process for 346.5persons served by the program and their authorized representatives to bring a grievance that:346.6(1) provides staff assistance with the complaint process when requested, and the 346.7addresses and telephone numbers of outside agencies to assist the person;346.8(2) allows the person to bring the complaint to the highest level of authority in the 346.9program if the grievance cannot be resolved by other staff members, and that provides 346.10the name, address, and telephone number of that person;346.11(3) requires the license holder to promptly respond to all complaints affecting a 346.12person's health and safety. For all other complaints, the license holder must provide an 346.13initial response within 14 calendar days of receipt of the complaint. All complaints must 346.14be resolved within 30 calendar days of receipt or the license holder must document the 346.15reason for the delay and a plan for resolution;346.16(4) requires a complaint review that includes an evaluation of whether:346.17(i) related policies and procedures were followed and adequate;346.18(ii) there is a need for additional staff training;346.19(iii) the complaint is similar to past complaints with the persons, staff, or services 346.20involved; and346.21(iv) there is a need for corrective action by the license holder to protect the health 346.22and safety of persons receiving services;346.23(5) based on the review in clause (4), requires the license holder to develop, 346.24document, and implement a corrective action plan designed to correct current lapses and 346.25prevent future lapses in performance by staff or the license holder, if any;346.26(6) provides a written summary of the complaint and a notice of the complaint 346.27resolution to the person and case manager that:346.28(i) identifies the nature of the complaint and the date it was received;346.29(ii) includes the results of the complaint review;346.30(iii) identifies the complaint resolution, including any corrective action; and346.31(7) requires that the complaint summary and resolution notice be maintained in the 346.32service recipient record.346.33    Subd. 3. Service suspension and service termination. (a) The license holder must 346.34establish policies and procedures for temporary service suspension and service termination 346.35that promote continuity of care and service coordination with the person and the case 346.36manager and with other licensed caregivers, if any, who also provide support to the person.347.1(b) The policy must include the following requirements:347.2(1) the license holder must notify the person or the person's legal representative and 347.3case manager in writing of the intended termination or temporary service suspension, and 347.4the person's right to seek a temporary order staying the termination of service according to 347.5the procedures in section 
         256.045, subdivision 4a, or 6, paragraph (c);347.6(2) notice of the proposed termination of services, including those situations 347.7that began with a temporary service suspension, must be given at least 60 days before 347.8the proposed termination is to become effective when a license holder is providing 347.9independent living skills training, structured day, prevocational or supported employment 347.10services to the person intensive supports and services identified in section 245D.03, 347.11subdivision 1, paragraph (c), and 30 days prior to termination for all other services 347.12licensed under this chapter;347.13(3) the license holder must provide information requested by the person or case 347.14manager when services are temporarily suspended or upon notice of termination;347.15(4) prior to giving notice of service termination or temporary service suspension, 347.16the license holder must document actions taken to minimize or eliminate the need for 347.17service suspension or termination;347.18(5) during the temporary service suspension or service termination notice period, 347.19the license holder will work with the appropriate county agency to develop reasonable 347.20alternatives to protect the person and others;347.21(6) the license holder must maintain information about the service suspension or 347.22termination, including the written termination notice, in the service recipient record; and347.23(7) the license holder must restrict temporary service suspension to situations in 347.24which the person's behavior causes immediate and serious danger to the health and safety 347.25of the person or others conduct poses an imminent risk of physical harm to self or others 347.26and less restrictive or positive support strategies would not achieve safety.347.27    Subd. 4. Availability of current written policies and procedures. (a) The license 347.28holder must review and update, as needed, the written policies and procedures required 347.29under this chapter.347.30(b)(1) The license holder must inform the person and case manager of the policies 347.31and procedures affecting a person's rights under section 
         245D.04, and provide copies of 347.32those policies and procedures, within five working days of service initiation.347.33(2) If a license holder only provides basic services and supports, this includes the:347.34(i) grievance policy and procedure required under subdivision 2; and347.35(ii) service suspension and termination policy and procedure required under 347.36subdivision 3.348.1(3) For all other license holders this includes the:348.2(i) policies and procedures in clause (2);348.3(ii) emergency use of manual restraints policy and procedure required under 348.4subdivision 3a; and348.5(iii) data privacy requirements under section 245D.11, subdivision 3.348.6(c) The license holder must provide a written notice to all persons or their legal 348.7representatives and case managers at least 30 days before implementing any revised 348.8policies and procedures procedural revisions to policies affecting a person's service-related 348.9or protection-related rights under section 
         245D.04 and maltreatment reporting policies and 348.10procedures. The notice must explain the revision that was made and include a copy of the 348.11revised policy and procedure. The license holder must document the reason reasonable 348.12cause for not providing the notice at least 30 days before implementing the revisions.348.13(d) Before implementing revisions to required policies and procedures, the license 348.14holder must inform all employees of the revisions and provide training on implementation 348.15of the revised policies and procedures.348.16(e) The license holder must annually notify all persons, or their legal representatives, 348.17and case managers of any procedural revisions to policies required under this chapter, 348.18other than those in paragraph (c). Upon request, the license holder must provide the 348.19person, or the person's legal representative, and case manager with copies of the revised 348.20policies and procedures.348.21EFFECTIVE DATE.This section is effective January 1, 2014.348.22    Sec. 32. [245D.11] POLICIES AND PROCEDURES; INTENSIVE SUPPORT 348.23SERVICES.348.24    Subdivision 1.Policy and procedure requirements.A license holder providing 348.25intensive support services as identified in section 245D.03, subdivision 1, paragraph (c), 348.26must establish, enforce, and maintain policies and procedures as required in this section.348.27    Subd. 2.Health and safety.The license holder must establish policies and 348.28procedures that promote health and safety by ensuring:348.29(1) use of universal precautions and sanitary practices in compliance with section 348.30245D.06, subdivision 2, clause (5);348.31(2) if the license holder operates a residential program, health service coordination 348.32and care according to the requirements in section 245D.05, subdivision 1;348.33(3) safe medication assistance and administration according to the requirements 348.34in sections 245D.05, subdivisions 1a, 2, and 5, and 245D.051, that are established in 348.35consultation with a registered nurse, nurse practitioner, physician's assistant, or medical 349.1doctor and require completion of medication administration training according to the 349.2requirements in section 245D.09, subdivision 4a, paragraph (c). Medication assistance 349.3and administration includes, but is not limited to:349.4(i) providing medication-related services for a person;349.5(ii) medication setup;349.6(iii) medication administration;349.7(iv) medication storage and security;349.8(v) medication documentation and charting;349.9(vi) verification and monitoring of effectiveness of systems to ensure safe medication 349.10handling and administration;349.11(vii) coordination of medication refills;349.12(viii) handling changes to prescriptions and implementation of those changes;349.13(ix) communicating with the pharmacy; and349.14(x) coordination and communication with prescriber;349.15(4) safe transportation, when the license holder is responsible for transportation of 349.16persons, with provisions for handling emergency situations according to the requirements 349.17in section 245D.06, subdivision 2, clauses (2) to (4);349.18(5) a plan for ensuring the safety of persons served by the program in emergencies as 349.19defined in section 245D.02, subdivision 8, and procedures for staff to report emergencies 349.20to the license holder. A license holder with a community residential setting or a day service 349.21facility license must ensure the policy and procedures comply with the requirements in 349.22section 245D.22, subdivision 4;349.23(6) a plan for responding to all incidents as defined in section 245D.02, subdivision 349.2411; and reporting all incidents required to be reported according to section 245D.06, 349.25subdivision 1. The plan must:349.26(i) provide the contact information of a source of emergency medical care and 349.27transportation; and349.28(ii) require staff to first call 911 when the staff believes a medical emergency may be 349.29life threatening, or to call the mental health crisis intervention team when the person is 349.30experiencing a mental health crisis; and349.31(7) a procedure for the review of incidents and emergencies to identify trends or 349.32patterns, and corrective action if needed. The license holder must establish and maintain 349.33a record-keeping system for the incident and emergency reports. Each incident and 349.34emergency report file must contain a written summary of the incident. The license holder 349.35must conduct a review of incident reports for identification of incident patterns, and 350.1implementation of corrective action as necessary to reduce occurrences. Each incident 350.2report must include:350.3(i) the name of the person or persons involved in the incident. It is not necessary 350.4to identify all persons affected by or involved in an emergency unless the emergency 350.5resulted in an incident;350.6(ii) the date, time, and location of the incident or emergency;350.7(iii) a description of the incident or emergency;350.8(iv) a description of the response to the incident or emergency and whether a person's 350.9coordinated service and support plan addendum or program policies and procedures were 350.10implemented as applicable;350.11(v) the name of the staff person or persons who responded to the incident or 350.12emergency; and350.13(vi) the determination of whether corrective action is necessary based on the results 350.14of the review.350.15    Subd. 3.Data privacy.The license holder must establish policies and procedures that 350.16promote service recipient rights by ensuring data privacy according to the requirements in:350.17(1) the Minnesota Government Data Practices Act, section 13.46, and all other 350.18applicable Minnesota laws and rules in handling all data related to the services provided; 350.19and350.20(2) the Health Insurance Portability and Accountability Act of 1996 (HIPAA), to the 350.21extent that the license holder performs a function or activity involving the use of protected 350.22health information as defined under Code of Federal Regulations, title 45, section 164.501, 350.23including, but not limited to, providing health care services; health care claims processing 350.24or administration; data analysis, processing, or administration; utilization review; quality 350.25assurance; billing; benefit management; practice management; repricing; or as otherwise 350.26provided by Code of Federal Regulations, title 45, section 160.103. The license holder 350.27must comply with the Health Insurance Portability and Accountability Act of 1996 and 350.28its implementing regulations, Code of Federal Regulations, title 45, parts 160 to 164, 350.29and all applicable requirements.350.30    Subd. 4.Admission criteria.The license holder must establish policies and 350.31procedures that promote continuity of care by ensuring that admission or service initiation 350.32criteria:350.33(1) is consistent with the license holder's registration information identified in the 350.34requirements in section 245D.031, subdivision 2, and with the service-related rights 350.35identified in section 245D.04, subdivisions 2, clauses (4) to (7), and 3, clause (8);351.1(2) identifies the criteria to be applied in determining whether the license holder 351.2can develop services to meet the needs specified in the person's coordinated service and 351.3support plan;351.4(3) requires a license holder providing services in a health care facility to comply 351.5with the requirements in section 243.166, subdivision 4b, to provide notification to 351.6residents when a registered predatory offender is admitted into the program or to a 351.7potential admission when the facility was already serving a registered predatory offender. 351.8For purposes of this clause, "health care facility" means a facility licensed by the 351.9commissioner as a residential facility under chapter 245A to provide adult foster care or 351.10residential services to persons with disabilities; and351.11(4) requires that when a person or the person's legal representative requests services 351.12from the license holder, a refusal to admit the person must be based on an evaluation of 351.13the person's assessed needs and the license holder's lack of capacity to meet the needs of 351.14the person. The license holder must not refuse to admit a person based solely on the 351.15type of residential services the person is receiving, or solely on the person's severity of 351.16disability, orthopedic or neurological handicaps, sight or hearing impairments, lack of 351.17communication skills, physical disabilities, toilet habits, behavioral disorders, or past 351.18failure to make progress. Documentation of the basis for refusal must be provided to the 351.19person or the person's legal representative and case manager upon request.351.20EFFECTIVE DATE.This section is effective January 1, 2014.351.21    Sec. 33. [245D.21] FACILITY LICENSURE REQUIREMENTS AND 351.22APPLICATION PROCESS.351.23    Subdivision 1.Community residential settings and day service facilities.For 351.24purposes of this section, "facility" means both a community residential setting and day 351.25service facility and the physical plant.351.26    Subd. 2.Inspections and code compliance.(a) Physical plants must comply with 351.27applicable state and local fire, health, building, and zoning codes.351.28(b)(1) The facility must be inspected by a fire marshal or their delegate within 351.2912 months before initial licensure to verify that it meets the applicable occupancy 351.30requirements as defined in the State Fire Code and that the facility complies with the fire 351.31safety standards for that occupancy code contained in the State Fire Code.351.32(2) The fire marshal inspection of a community residential setting must verify the 351.33residence is a dwelling unit within a residential occupancy as defined in section 9.117 of 351.34the State Fire Code. A home safety checklist, approved by the commissioner, must be 352.1completed for a community residential setting by the license holder and the commissioner 352.2before the satellite license is reissued.352.3(3) The facility shall be inspected according to the facility capacity specified on the 352.4initial application form.352.5(4) If the commissioner has reasonable cause to believe that a potentially hazardous 352.6condition may be present or the licensed capacity is increased, the commissioner shall 352.7request a subsequent inspection and written report by a fire marshal to verify the absence 352.8of hazard.352.9(5) Any condition cited by a fire marshal, building official, or health authority as 352.10hazardous or creating an immediate danger of fire or threat to health and safety must be 352.11corrected before a license is issued by the department, and for community residential 352.12settings, before a license is reissued.352.13(c) The facility must maintain in a permanent file the reports of health, fire, and 352.14other safety inspections.352.15(d) The facility's plumbing, ventilation, heating, cooling, lighting, and other 352.16fixtures and equipment, including elevators or food service, if provided, must conform to 352.17applicable health, sanitation, and safety codes and regulations.352.18EFFECTIVE DATE.This section is effective January 1, 2014.352.19    Sec. 34. [245D.22] FACILITY SANITATION AND HEALTH.352.20    Subdivision 1.General maintenance.The license holder must maintain the interior 352.21and exterior of buildings, structures, or enclosures used by the facility, including walls, 352.22floors, ceilings, registers, fixtures, equipment, and furnishings in good repair and in a 352.23sanitary and safe condition. The facility must be clean and free from accumulations of 352.24dirt, grease, garbage, peeling paint, mold, vermin, and insects. The license holder must 352.25correct building and equipment deterioration, safety hazards, and unsanitary conditions.352.26    Subd. 2.Hazards and toxic substances.The license holder must ensure that 352.27service sites owned or leased by the license holder are free from hazards that would 352.28threaten the health or safety of a person receiving services by ensuring the requirements 352.29in paragraphs (a) to (g) are met.352.30(a) Chemicals, detergents, and other hazardous or toxic substances must not be 352.31stored with food products or in any way that poses a hazard to persons receiving services.352.32(b) The license holder must install handrails and nonslip surfaces on interior and 352.33exterior runways, stairways, and ramps according to the applicable building code.353.1(c) If there are elevators in the facility, the license holder must have elevators 353.2inspected each year. The date of the inspection, any repairs needed, and the date the 353.3necessary repairs were made must be documented.353.4(d) The license holder must keep stairways, ramps, and corridors free of obstructions.353.5(e) Outside property must be free from debris and safety hazards. Exterior stairs and 353.6walkways must be kept free of ice and snow.353.7(f) Heating, ventilation, air conditioning units, and other hot surfaces and moving 353.8parts of machinery must be shielded or enclosed.353.9(g) Use of dangerous items or equipment by persons served by the program must be 353.10allowed in accordance with the person's coordinated service and support plan addendum 353.11or the program abuse prevention plan, if not addressed in the coordinated service and 353.12support plan addendum.353.13    Subd. 3.Storage and disposal of medication.Schedule II controlled substances in 353.14the facility that are named in section 152.02, subdivision 3, must be stored in a locked 353.15storage area permitting access only by persons and staff authorized to administer the 353.16medication. This must be incorporated into the license holder's medication administration 353.17policy and procedures required under section 245D.11, subdivision 2, clause (3). 353.18Medications must be disposed of according to the Environmental Protection Agency 353.19recommendations.353.20    Subd. 4.First aid must be available on site.(a) A staff person trained in first 353.21aid must be available on site and, when required in a person's coordinated service and 353.22support plan or coordinated service and support plan addendum, be able to provide 353.23cardiopulmonary resuscitation, whenever persons are present and staff are required to be 353.24at the site to provide direct service. The CPR training must include in-person instruction, 353.25hands-on practice, and an observed skills assessment under the direct supervision of a 353.26CPR instructor.353.27(b) A facility must have first aid kits readily available for use by, and that meet 353.28the needs of, persons receiving services and staff. At a minimum, the first aid kit must 353.29be equipped with accessible first aid supplies including bandages, sterile compresses, 353.30scissors, an ice bag or cold pack, an oral or surface thermometer, mild liquid soap, 353.31adhesive tape, and first aid manual.353.32    Subd. 5.Emergencies.(a) The license holder must have a written plan for 353.33responding to emergencies as defined in section 245D.02, subdivision 8, to ensure the 353.34safety of persons served in the facility. The plan must include:353.35(1) procedures for emergency evacuation and emergency sheltering, including:353.36(i) how to report a fire or other emergency;354.1(ii) procedures to notify, relocate, and evacuate occupants, including use of adaptive 354.2procedures or equipment to assist with the safe evacuation of persons with physical or 354.3sensory disabilities; and354.4(iii) instructions on closing off the fire area, using fire extinguishers, and activating 354.5and responding to alarm systems;354.6(2) a floor plan that identifies:354.7(i) the location of fire extinguishers;354.8(ii) the location of audible or visual alarm systems, including but not limited to 354.9manual fire alarm boxes, smoke detectors, fire alarm enunciators and controls, and 354.10sprinkler systems;354.11(iii) the location of exits, primary and secondary evacuation routes, and accessible 354.12egress routes, if any; and354.13(iv) the location of emergency shelter within the facility;354.14(3) a site plan that identifies:354.15(i) designated assembly points outside the facility;354.16(ii) the locations of fire hydrants; and354.17(iii) the routes of fire department access;354.18(4) the responsibilities each staff person must assume in case of emergency;354.19(5) procedures for conducting quarterly drills each year and recording the date of 354.20each drill in the file of emergency plans;354.21(6) procedures for relocation or service suspension when services are interrupted 354.22for more than 24 hours;354.23(7) for a community residential setting with three or more dwelling units, a floor 354.24plan that identifies the location of enclosed exit stairs; and354.25(8) an emergency escape plan for each resident.354.26(b) The license holder must:354.27(1) maintain a log of quarterly fire drills on file in the facility;354.28(2) provide an emergency response plan that is readily available to staff and persons 354.29receiving services;354.30(3) inform each person of a designated area within the facility where the person 354.31should go for emergency shelter during severe weather and the designated assembly points 354.32outside the facility; and354.33(4) maintain emergency contact information for persons served at the facility that 354.34can be readily accessed in an emergency.355.1    Subd. 6.Emergency equipment.The facility must have a flashlight and a portable 355.2radio or television set that do not require electricity and can be used if a power failure 355.3occurs.355.4    Subd. 7.Telephone and posted numbers.A facility must have a non-coin operated 355.5telephone that is readily accessible. A list of emergency numbers must be posted in a 355.6prominent location. When an area has a 911 number or a mental health crisis intervention 355.7team number, both numbers must be posted and the emergency number listed must be 355.8911. In areas of the state without a 911 number, the numbers listed must be those of the 355.9local fire department, police department, emergency transportation, and poison control 355.10center. The names and telephone numbers of each person's representative, physician, and 355.11dentist must be readily available.355.12EFFECTIVE DATE.This section is effective January 1, 2014.355.13    Sec. 35. [245D.23] COMMUNITY RESIDENTIAL SETTINGS; SATELLITE 355.14LICENSURE REQUIREMENTS AND APPLICATION PROCESS.355.15    Subdivision 1.Separate satellite license required for separate sites.(a) A license 355.16holder providing residential support services must obtain a separate satellite license for 355.17each community residential setting located at separate addresses when the community 355.18residential settings are to be operated by the same license holder. For purposes of this 355.19chapter, a community residential setting is a satellite of the home and community-based 355.20services license.355.21(b) Community residential settings are permitted single-family use homes. After a 355.22license has been issued, the commissioner shall notify the local municipality where the 355.23residence is located of the approved license.355.24    Subd. 2.Notification to local agency.The license holder must notify the local 355.25agency within 24 hours of the onset of changes in a residence resulting from construction, 355.26remodeling, or damages requiring repairs that require a building permit or may affect a 355.27licensing requirement in this chapter.355.28    Subd. 3.Alternate overnight supervision.A license holder granted an alternate 355.29overnight supervision technology adult foster care license according to section 245A.11, 355.30subdivision 7a, that converts to a community residential setting satellite license according 355.31to this chapter, must retain that designation.355.32EFFECTIVE DATE.This section is effective January 1, 2014.356.1    Sec. 36. [245D.24] COMMUNITY RESIDENTIAL SETTINGS; PHYSICAL 356.2PLANT AND ENVIRONMENT.356.3    Subdivision 1.Occupancy.The residence must meet the definition of a dwelling 356.4unit in a residential occupancy.356.5    Subd. 2.Common area requirements.The living area must be provided with an 356.6adequate number of furnishings for the usual functions of daily living and social activities. 356.7The dining area must be furnished to accommodate meals shared by all persons living in 356.8the residence. These furnishings must be in good repair and functional to meet the daily 356.9needs of the persons living in the residence.356.10    Subd. 3.Bedrooms.(a) People receiving services must mutually consent, in 356.11writing, to sharing a bedroom with one another. No more than two people receiving 356.12services may share one bedroom.356.13(b) A single occupancy bedroom must have at least 80 square feet of floor space with 356.14a 7-1/2 foot ceiling. A double occupancy room must have at least 120 square feet of floor 356.15space with a 7-1/2 foot ceiling. Bedrooms must be separated from halls, corridors, and 356.16other habitable rooms by floor to ceiling walls containing no openings except doorways 356.17and must not serve as a corridor to another room used in daily living.356.18(c) A person's personal possessions and items for the person's own use are the only 356.19items permitted to be stored in a person's bedroom.356.20(d) Unless otherwise documented through assessment as a safety concern for the 356.21person, each person must be provided with the following furnishings:356.22(1) a separate bed of proper size and height for the convenience and comfort of the 356.23person, with a clean mattress in good repair;356.24(2) clean bedding appropriate for the season for each person;356.25(3) an individual cabinet, or dresser, shelves, and a closet, for storage of personal 356.26possessions and clothing; and356.27(4) a mirror for grooming.356.28(e) When possible, a person must be allowed to have items of furniture that the 356.29person personally owns in the bedroom, unless doing so would interfere with safety 356.30precautions, violate a building or fire code, or interfere with another person's use of the 356.31bedroom. A person may choose not to have a cabinet, dresser, shelves, or a mirror in the 356.32bedroom, as otherwise required under paragraph (d), clause (3) or (4). A person may 356.33choose to use a mattress other than an innerspring mattress and may choose not to have 356.34the mattress on a mattress frame or support. If a person chooses not to have a piece of 356.35required furniture, the license holder must document this choice and is not required to 356.36provide the item. If a person chooses to use a mattress other than an innerspring mattress 357.1or chooses not to have a mattress frame or support, the license holder must document this 357.2choice and allow the alternative desired by the person.357.3(f) A person must be allowed to bring personal possessions into the bedroom 357.4and other designated storage space, if such space is available, in the residence. The 357.5person must be allowed to accumulate possessions to the extent the residence is able to 357.6accommodate them, unless doing so is contraindicated for the person's physical or mental 357.7health, would interfere with safety precautions or another person's use of the bedroom, or 357.8would violate a building or fire code. The license holder must allow for locked storage 357.9of personal items. Any restriction on the possession or locked storage of personal items, 357.10including requiring a person to use a lock provided by the license holder, must comply 357.11with section 245D.04, subdivision 3, paragraph (c), and allow the person to be present if 357.12and when the license holder opens the lock.357.13EFFECTIVE DATE.This section is effective January 1, 2014.357.14    Sec. 37. [245D.25] COMMUNITY RESIDENTIAL SETTINGS; FOOD AND 357.15WATER.357.16    Subdivision 1.Water.Potable water from privately owned wells must be tested 357.17annually by a Department of Health-certified laboratory for coliform bacteria and nitrate 357.18nitrogens to verify safety. The health authority may require retesting and corrective 357.19measures if results exceed state water standards in Minnesota Rules, chapter 4720, or in 357.20the event of flooding or an incident which may put the well at risk of contamination. To 357.21prevent scalding, the water temperature of faucets must not exceed 120 degrees Fahrenheit.357.22    Subd. 2.Food.Food served must meet any special dietary needs of a person as 357.23prescribed by the person's physician or dietitian. Three nutritionally balanced meals a day 357.24must be served or made available to persons, and nutritious snacks must be available 357.25between meals.357.26    Subd. 3.Food safety.Food must be obtained, handled, and properly stored to 357.27prevent contamination, spoilage, or a threat to the health of a person.357.28EFFECTIVE DATE.This section is effective January 1, 2014.357.29    Sec. 38. [245D.26] COMMUNITY RESIDENTIAL SETTINGS; SANITATION 357.30AND HEALTH.357.31    Subdivision 1.Goods provided by the license holder.Individual clean bed linens 357.32appropriate for the season and the person's comfort, including towels and wash cloths, 357.33must be available for each person. Usual or customary goods for the operation of a 358.1residence which are communally used by all persons receiving services living in the 358.2residence must be provided by the license holder, including household items for meal 358.3preparation, cleaning supplies to maintain the cleanliness of the residence, window 358.4coverings on windows for privacy, toilet paper, and hand soap.358.5    Subd. 2.Personal items.Personal health and hygiene items must be stored in a 358.6safe and sanitary manner.358.7    Subd. 3.Pets and service animals.Pets and service animals housed within 358.8the residence must be immunized and maintained in good health as required by local 358.9ordinances and state law. The license holder must ensure that the person and the person's 358.10representative are notified before admission of the presence of pets in the residence.358.11    Subd. 4.Smoking in the residence.License holders must comply with the 358.12requirements of the Minnesota Clean Indoor Air Act, sections 144.411 to 144.417, when 358.13smoking is permitted in the residence.358.14    Subd. 5.Weapons.Weapons and ammunition must be stored separately in locked 358.15areas that are inaccessible to a person receiving services. For purposes of this subdivision, 358.16"weapons" means firearms and other instruments or devices designed for and capable of 358.17producing bodily harm.358.18EFFECTIVE DATE.This section is effective January 1, 2014.358.19    Sec. 39. [245D.27] DAY SERVICES FACILITIES; SATELLITE LICENSURE 358.20REQUIREMENTS AND APPLICATION PROCESS.358.21Except for day service facilities on the same or adjoining lot, the license holder 358.22providing day services must apply for a separate license for each facility-based service 358.23site when the license holder is the owner, lessor, or tenant of the service site at which 358.24persons receive day services and the license holder's employees who provide day services 358.25are present for a cumulative total of more than 30 days within any 12-month period. For 358.26purposes of this chapter, a day services facility license is a satellite license of the day 358.27services program. A day services program may operate multiple licensed day service 358.28facilities in one or more counties in the state. For the purposes of this section, "adjoining 358.29lot" means day services facilities that are next door to or across the street from one another.358.30EFFECTIVE DATE.This section is effective January 1, 2014.358.31    Sec. 40. [245D.28] DAY SERVICES FACILITIES; PHYSICAL PLANT AND 358.32SPACE REQUIREMENTS.359.1    Subdivision 1.Facility capacity and useable space requirements.(a) The facility 359.2capacity of each day service facility must be determined by the amount of primary space 359.3available, the scheduling of activities at other service sites, and the space requirements of 359.4all persons receiving services at the facility, not just the licensed services. The facility 359.5capacity must specify the maximum number of persons that may receive services on 359.6site at any one time.359.7(b) When a facility is located in a multifunctional organization, the facility may 359.8share common space with the multifunctional organization if the required available 359.9primary space for use by persons receiving day services is maintained while the facility is 359.10operating. The license holder must comply at all times with all applicable fire and safety 359.11codes under section 245A.04, subdivision 2a, and adequate supervision requirements 359.12under section 245D.31 for all persons receiving day services.359.13(c) A day services facility must have a minimum of 40 square feet of primary space 359.14available for each person receiving services who is present at the site at any one time. 359.15Primary space does not include:359.16(1) common areas, such as hallways, stairways, closets, utility areas, bathrooms, 359.17and kitchens;359.18(2) floor areas beneath stationary equipment; or359.19(3) any space occupied by persons associated with the multifunctional organization 359.20while persons receiving day services are using common space.359.21    Subd. 2.Individual personal articles.Each person must be provided space in a 359.22closet, cabinet, on a shelf, or a coat hook for storage of personal items for the person's own 359.23use while receiving services at the facility, unless doing so would interfere with safety 359.24precautions, another person's work space, or violate a building or fire code.359.25EFFECTIVE DATE.This section is effective January 1, 2014.359.26    Sec. 41. [245D.29] DAY SERVICES FACILITIES; HEALTH AND SAFETY 359.27REQUIREMENTS.359.28    Subdivision 1.Refrigeration.If the license holder provides refrigeration at service 359.29sites owned or leased by the license holder for storing perishable foods and perishable 359.30portions of bag lunches, whether the foods are supplied by the license holder or the 359.31persons receiving services, the refrigeration must have a temperature of 40 degrees 359.32Fahrenheit or less.359.33    Subd. 2.Drinking water.Drinking water must be available to all persons 359.34receiving services. If a person is unable to request or obtain drinking water, it must be 360.1provided according to that person's individual needs. Drinking water must be provided in 360.2single-service containers or from drinking fountains accessible to all persons.360.3    Subd. 3.Individuals who become ill during the day.There must be an area in 360.4which a person receiving services can rest if:360.5(1) the person becomes ill during the day; 360.6(2) the person does not live in a licensed residential site;360.7(3) the person requires supervision; and360.8(4) there is not a caretaker immediately available. Supervision must be provided 360.9until the caretaker arrives to bring the person home.360.10    Subd. 4.Safety procedures.The license holder must establish general written 360.11safety procedures that include criteria for selecting, training, and supervising persons who 360.12work with hazardous machinery, tools, or substances. Safety procedures specific to each 360.13person's activities must be explained and be available in writing to all staff members 360.14and persons receiving services.360.15EFFECTIVE DATE.This section is effective January 1, 2014.360.16    Sec. 42. [245D.31] DAY SERVICES FACILITIES; STAFF RATIO AND 360.17FACILITY COVERAGE.360.18    Subdivision 1.Scope.This section applies only to facility-based day services.360.19    Subd. 2.Factors.(a) The number of direct support service staff members that a 360.20license holder must have on duty at the facility at a given time to meet the minimum 360.21staffing requirements established in this section varies according to:360.22(1) the number of persons who are enrolled and receiving direct support services 360.23at that given time;360.24(2) the staff ratio requirement established under subdivision 3 for each person who 360.25is present; and360.26(3) whether the conditions described in subdivision 8 exist and warrant additional 360.27staffing beyond the number determined to be needed under subdivision 7.360.28(b) The commissioner must consider the factors in paragraph (a) in determining a 360.29license holder's compliance with the staffing requirements and must further consider 360.30whether the staff ratio requirement established under subdivision 3 for each person 360.31receiving services accurately reflects the person's need for staff time.360.32    Subd. 3.Staff ratio requirement for each person receiving services.The case 360.33manager, in consultation with the interdisciplinary team, must determine at least once each 360.34year which of the ratios in subdivisions 4, 5, and 6 is appropriate for each person receiving 360.35services on the basis of the characteristics described in subdivisions 4, 5, and 6. The ratio 361.1assigned each person and the documentation of how the ratio was arrived at must be kept 361.2in each person's individual service plan. Documentation must include an assessment of the 361.3person with respect to the characteristics in subdivisions 4, 5, and 6 recorded on a standard 361.4assessment form required by the commissioner.361.5    Subd. 4.Person requiring staff ratio of one to four.A person must be assigned a 361.6staff ratio requirement of one to four if:361.7(1) on a daily basis the person requires total care and monitoring or constant 361.8hand-over-hand physical guidance to successfully complete at least three of the following 361.9activities: toileting, communicating basic needs, eating, ambulating; or is not capable of 361.10taking appropriate action for self-preservation under emergency conditions; or361.11(2) the person engages in conduct that poses an imminent risk of physical harm to 361.12self or others at a documented level of frequency, intensity, or duration requiring frequent 361.13daily ongoing intervention and monitoring as established in the person's coordinated 361.14service and support plan or coordinated service and support plan addendum.361.15    Subd. 5.Person requiring staff ratio of one to eight.A person must be assigned a 361.16staff ratio requirement of one to eight if:361.17(1) the person does not meet the requirements in subdivision 4; and361.18(2) on a daily basis the person requires verbal prompts or spot checks and minimal 361.19or no physical assistance to successfully complete at least four of the following activities: 361.20toileting, communicating basic needs, eating, ambulating, or taking appropriate action for 361.21self-preservation under emergency conditions.361.22    Subd. 6.Person requiring staff ratio of one to six.A person who does not have 361.23any of the characteristics described in subdivision 4 or 5 must be assigned a staff ratio 361.24requirement of one to six.361.25    Subd. 7.Determining number of direct support service staff required.The 361.26minimum number of direct support service staff members required at any one time to 361.27meet the combined staff ratio requirements of the persons present at that time can be 361.28determined by the following steps:361.29(1) assign to each person in attendance the three-digit decimal below that corresponds 361.30to the staff ratio requirement assigned to that person. A staff ratio requirement of one to 361.31four equals 0.250. A staff ratio requirement of one to eight equals 0.125. A staff ratio 361.32requirement of one to six equals 0.166. A staff ratio requirement of one to ten equals 0.100;361.33(2) add all of the three-digit decimals (one three-digit decimal for every person in 361.34attendance) assigned in clause (1);361.35(3) when the sum in clause (2) falls between two whole numbers, round off the sum 361.36to the larger of the two whole numbers; and362.1(4) the larger of the two whole numbers in clause (3) equals the number of direct 362.2support service staff members needed to meet the staff ratio requirements of the persons 362.3in attendance.362.4    Subd. 8.Staff to be included in calculating minimum staffing requirement.362.5Only staff providing direct support must be counted as staff members in calculating 362.6the staff-to-participant ratio. A volunteer may be counted as a direct support staff in 362.7calculating the staff to participant ratio if the volunteer meets the same standards and 362.8requirements as paid staff. No person receiving services must be counted as or be 362.9substituted for a staff member in calculating the staff-to-participant ratio.362.10    Subd. 9.Conditions requiring additional direct support staff.The license holder 362.11must increase the number of direct support staff members present at any one time beyond 362.12the number arrived at in subdivision 4 if necessary when any one or combination of the 362.13following circumstances can be documented by the commissioner as existing:362.14(1) the health and safety needs of the persons receiving services cannot be met by 362.15the number of staff members available under the staffing pattern in effect even though the 362.16number has been accurately calculated under subdivision 7; or362.17(2) the person's conduct frequently presents an imminent risk of physical harm to 362.18self or others.362.19    Subd. 10.Supervision requirements.(a) At no time must one direct support 362.20staff member be assigned responsibility for supervision and training of more than ten 362.21persons receiving supervision and training, except as otherwise stated in each person's risk 362.22management plan.362.23(b) In the temporary absence of the director or a supervisor, a direct support staff 362.24member must be designated to supervise the center.362.25    Subd. 11.Multifunctional programs.A multifunctional program may count other 362.26employees of the organization besides direct support staff of the day service facility in 362.27calculating the staff-to-participant ratio if the employee is assigned to the day services 362.28facility for a specified amount of time, during which the employee is not assigned to 362.29another organization or program.362.30EFFECTIVE DATE.This section is effective January 1, 2014.362.31    Sec. 43. [245D.32] ALTERNATIVE LICENSING INSPECTIONS.362.32    Subdivision 1.Eligibility for an alternative licensing inspection.(a) A license 362.33holder providing services licensed under this chapter, with a qualifying accreditation and 362.34meeting the eligibility criteria in paragraphs (b) and (c), may request approval for an 362.35alternative licensing inspection when all services provided under the license holder's 363.1license are accredited. A license holder with a qualifying accreditation and meeting 363.2the eligibility criteria in paragraphs (b) and (c) may request approval for an alternative 363.3licensing inspection for individual community residential settings or day services facilities 363.4licensed under this chapter.363.5(b) In order to be eligible for an alternative licensing inspection, the program must 363.6have had at least one inspection by the commissioner following issuance of the initial 363.7license. For programs operating a day services facility, each facility must have had at least 363.8one on-site inspection by the commissioner following issuance of the initial license.363.9(c) In order to be eligible for an alternative licensing inspection, the program must 363.10have been in substantial and consistent compliance at the time of the last licensing 363.11inspection and during the current licensing period. For purposes of this section, 363.12"substantial and consistent compliance" means:363.13(1) the license holder's license was not made conditional, suspended, or revoked;363.14(2) there have been no substantiated allegations of maltreatment against the license 363.15holder;363.16(3) there were no program deficiencies identified that would jeopardize the health, 363.17safety, or rights of persons being served; and363.18(4) the license holder maintained substantial compliance with the other requirements 363.19of chapters 245A and 245C and other applicable laws and rules.363.20(d) For the purposes of this section, the license holder's license includes services 363.21licensed under this chapter that were previously licensed under chapter 245B until 363.22December 31, 2013.363.23    Subd. 2.Qualifying accreditation.The commissioner must accept a three-year 363.24accreditation from the Commission on Accreditation of Rehabilitation Facilities (CARF) 363.25as a qualifying accreditation.363.26    Subd. 3.Request for approval of an alternative inspection status.(a) A request 363.27for an alternative inspection must be made on the forms and in the manner prescribed 363.28by the commissioner. When submitting the request, the license holder must submit all 363.29documentation issued by the accrediting body verifying that the license holder has obtained 363.30and maintained the qualifying accreditation and has complied with recommendations 363.31or requirements from the accrediting body during the period of accreditation. Based 363.32on the request and the additional required materials, the commissioner may approve 363.33an alternative inspection status.363.34(b) The commissioner must notify the license holder in writing that the request for 363.35an alternative inspection status has been approved. Approval must be granted until the 363.36end of the qualifying accreditation period.364.1(c) The license holder must submit a written request for approval to be renewed 364.2one month before the end of the current approval period according to the requirements 364.3in paragraph (a). If the license holder does not submit a request to renew approval as 364.4required, the commissioner must conduct a licensing inspection.364.5    Subd. 4.Programs approved for alternative licensing inspection; deemed 364.6compliance licensing requirements.(a) A license holder approved for alternative 364.7licensing inspection under this section is required to maintain compliance with all 364.8licensing standards according to this chapter.364.9(b) A license holder approved for alternative licensing inspection under this section 364.10must be deemed to be in compliance with all the requirements of this chapter, and the 364.11commissioner must not perform routine licensing inspections.364.12(c) Upon receipt of a complaint regarding the services of a license holder approved 364.13for alternative licensing inspection under this section, the commissioner must investigate 364.14the complaint and may take any action as provided under section 245A.06 or 245A.07.364.15    Subd. 5.Investigations of alleged or suspected maltreatment.Nothing in this 364.16section changes the commissioner's responsibilities to investigate alleged or suspected 364.17maltreatment of a minor under section 626.556 or a vulnerable adult under section 626.557.364.18    Subd. 6.Termination or denial of subsequent approval.Following approval of 364.19an alternative licensing inspection, the commissioner may terminate or deny subsequent 364.20approval of an alternative licensing inspection if the commissioner determines that:364.21(1) the license holder has not maintained the qualifying accreditation;364.22(2) the commissioner has substantiated maltreatment for which the license holder or 364.23facility is determined to be responsible during the qualifying accreditation period; or364.24(3) during the qualifying accreditation period, the license holder has been issued 364.25an order for conditional license, fine, suspension, or license revocation that has not been 364.26reversed upon appeal.364.27    Subd. 7.Appeals.The commissioner's decision that the conditions for approval for 364.28an alternative licensing inspection have not been met is final and not subject to appeal 364.29under the provisions of chapter 14.364.30    Subd. 8.Commissioner's programs.Home and community-based services licensed 364.31under this chapter for which the commissioner is the license holder with a qualifying 364.32accreditation are excluded from being approved for an alternative licensing inspection.364.33EFFECTIVE DATE.This section is effective January 1, 2014.364.34    Sec. 44. [245D.33] ADULT MENTAL HEALTH CERTIFICATION STANDARDS.365.1(a) The commissioner of human services shall issue a mental health certification 365.2for services licensed under this chapter when a license holder is determined to have met 365.3the requirements under paragraph (b). This certification is voluntary for license holders. 365.4The certification shall be printed on the license and identified on the commissioner's 365.5public Web site.365.6(b) The requirements for certification are:365.7(1) all staff have received at least seven hours of annual training covering all of 365.8the following topics:365.9(i) mental health diagnoses;365.10(ii) mental health crisis response and de-escalation techniques;365.11(iii) recovery from mental illness;365.12(iv) treatment options, including evidence-based practices;365.13(v) medications and their side effects;365.14(vi) co-occurring substance abuse and health conditions; and365.15(vii) community resources;365.16(2) a mental health professional, as defined in section 245.462, subdivision 18, or a 365.17mental health practitioner as defined in section 245.462, subdivision 17, is available 365.18for consultation and assistance;365.19(3) there is a plan and protocol in place to address a mental health crisis; and365.20(4) each person's individual service and support plan identifies who is providing 365.21clinical services and their contact information, and includes an individual crisis prevention 365.22and management plan developed with the person.365.23(c) License holders seeking certification under this section must request this 365.24certification on forms and in the manner prescribed by the commissioner.365.25(d) If the commissioner finds that the license holder has failed to comply with the 365.26certification requirements under paragraph (b), the commissioner may issue a correction 365.27order and an order of conditional license in accordance with section 245A.06 or may 365.28issue a sanction in accordance with section 245A.07, including and up to removal of 365.29the certification.365.30(e) A denial of the certification or the removal of the certification based on a 365.31determination that the requirements under paragraph (b) have not been met is not subject to 365.32appeal. A license holder that has been denied a certification or that has had a certification 365.33removed may again request certification when the license holder is in compliance with the 365.34requirements of paragraph (b).365.35EFFECTIVE DATE.This section is effective January 1, 2014.366.1    Sec. 45. Minnesota Statutes 2012, section 256B.092, subdivision 11, is amended to read:366.2    Subd. 11. Residential support services. (a) Upon federal approval, there is 366.3established a new service called residential support that is available on the community 366.4alternative care, community alternatives for disabled individuals, developmental 366.5disabilities, and brain injury waivers. Existing waiver service descriptions must be 366.6modified to the extent necessary to ensure there is no duplication between other services. 366.7Residential support services must be provided by vendors licensed as a community 366.8residential setting as defined in section 
         245A.11, subdivision 8, a foster care setting 366.9licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, or an adult foster care 366.10setting licensed under Minnesota Rules, parts 9555.5105 to 9555.6265.366.11    (b) Residential support services must meet the following criteria:366.12    (1) providers of residential support services must own or control the residential site;366.13    (2) the residential site must not be the primary residence of the license holder;366.14    (3) (1) the residential site must have a designated program supervisor person366.15 responsible for program management, oversight, development, and implementation of 366.16policies and procedures;366.17    (4) (2) the provider of residential support services must provide supervision, training, 366.18and assistance as described in the person's coordinated service and support plan; and366.19    (5) (3) the provider of residential support services must meet the requirements of 366.20licensure and additional requirements of the person's coordinated service and support plan.366.21    (c) Providers of residential support services that meet the definition in paragraph (a) 366.22must be registered using a process determined by the commissioner beginning July 1, 2009366.23 must be licensed according to chapter 245D. Providers licensed to provide child foster care 366.24under Minnesota Rules, parts 2960.3000 to 2960.3340, or adult foster care licensed under 366.25Minnesota Rules, parts 9555.5105 to 9555.6265, and that meet the requirements in section 366.26245A.03, subdivision 7
         , paragraph (g), are considered registered under this section.366.27    Sec. 46. Minnesota Statutes 2012, section 256B.4912, subdivision 1, is amended to read:366.28    Subdivision 1. Provider qualifications.(a) For the home and community-based 366.29waivers providing services to seniors and individuals with disabilities under sections 366.30256B.0913, 256B.0915, 256B.092, and 256B.49, the commissioner shall establish:366.31(1) agreements with enrolled waiver service providers to ensure providers meet 366.32Minnesota health care program requirements;366.33(2) regular reviews of provider qualifications, and including requests of proof of 366.34documentation; and366.35(3) processes to gather the necessary information to determine provider qualifications.367.1    (b) Beginning July 1, 2012, staff that provide direct contact, as defined in section 367.2245C.02, subdivision 11
         , for services specified in the federally approved waiver plans 367.3must meet the requirements of chapter 245C prior to providing waiver services and as 367.4part of ongoing enrollment. Upon federal approval, this requirement must also apply to 367.5consumer-directed community supports.367.6    (c) Beginning January 1, 2014, service owners and managerial officials overseeing 367.7the management or policies of services that provide direct contact as specified in the 367.8federally approved waiver plans must meet the requirements of chapter 245C prior to 367.9reenrollment or, for new providers, prior to initial enrollment if they have not already done 367.10so as a part of service licensure requirements.367.11    Sec. 47. Minnesota Statutes 2012, section 256B.4912, subdivision 7, is amended to read:367.12    Subd. 7. Applicant and license holder training. An applicant or license holder 367.13for the home and community-based waivers providing services to seniors and individuals 367.14with disabilities under sections 256B.0913, 256B.0915, 256B.092, and 256B.49 that is 367.15not enrolled as a Minnesota health care program home and community-based services 367.16waiver provider at the time of application must ensure that at least one controlling 367.17individual completes a onetime training on the requirements for providing home and 367.18community-based services from a qualified source as determined by the commissioner, 367.19before a provider is enrolled or license is issued. Within six months of enrollment, a newly 367.20enrolled home and community-based waiver service provider must ensure that at least one 367.21controlling individual has completed training on waiver and related program billing.367.22    Sec. 48. Minnesota Statutes 2012, section 256B.4912, is amended by adding a 367.23subdivision to read:367.24    Subd. 8.Data on use of emergency use of manual restraint.Beginning July 1, 367.252013, facilities and services to be licensed under chapter 245D shall submit data regarding 367.26the use of emergency use of manual restraint as identified in section 245D.061 in a format 367.27and at a frequency identified by the commissioner.367.28    Sec. 49. Minnesota Statutes 2012, section 256B.4912, is amended by adding a 367.29subdivision to read:367.30    Subd. 9.Definitions.(a) For the purposes of this section, the following terms 367.31have the meanings given them. 368.1(b) "Controlling individual" means a public body, governmental agency, business 368.2entity, officer, owner, or managerial official whose responsibilities include the direction of 368.3the management or policies of a program.368.4(c) "Managerial official" means an individual who has decision-making authority 368.5related to the operation of the program and responsibility for the ongoing management of 368.6or direction of the policies, services, or employees of the program.368.7(d) "Owner" means an individual who has direct or indirect ownership interest in 368.8a corporation or partnership, or business association enrolling with the Department of 368.9Human Services as a provider of waiver services.368.10    Sec. 50. Minnesota Statutes 2012, section 256B.4912, is amended by adding a 368.11subdivision to read:368.12    Subd. 10.Enrollment requirements.All home and community-based waiver 368.13providers must provide, at the time of enrollment and within 30 days of a request, in a 368.14format determined by the commissioner, information and documentation that includes, but 368.15is not limited to, the following:368.16(1) proof of surety bond coverage in the amount of $50,000 or ten percent of the 368.17provider's payments from Medicaid in the previous calendar year, whichever is greater;368.18(2) proof of fidelity bond coverage in the amount of $20,000; and368.19(3) proof of liability insurance.368.20    Sec. 51. Minnesota Statutes 2012, section 626.557, subdivision 9a, is amended to read:368.21    Subd. 9a. Evaluation and referral of reports made to common entry point unit.368.22    The common entry point must screen the reports of alleged or suspected maltreatment for 368.23immediate risk and make all necessary referrals as follows:368.24    (1) if the common entry point determines that there is an immediate need for 368.25adult protective services, the common entry point agency shall immediately notify the 368.26appropriate county agency;368.27    (2) if the report contains suspected criminal activity against a vulnerable adult, the 368.28common entry point shall immediately notify the appropriate law enforcement agency;368.29    (3) the common entry point shall refer all reports of alleged or suspected 368.30maltreatment to the appropriate lead investigative agency as soon as possible, but in any 368.31event no longer than two working days; and368.32    (4) if the report involves services licensed by the Department of Human Services 368.33and subject to chapter 245D, the common entry point shall refer the report to the county as 369.1the lead agency according to clause (3), but shall also notify the Department of Human 369.2Services of the report; and369.3    (5) (4) if the report contains information about a suspicious death, the common 369.4entry point shall immediately notify the appropriate law enforcement agencies, the local 369.5medical examiner, and the ombudsman for mental health and developmental disabilities 369.6established under section 
         245.92. Law enforcement agencies shall coordinate with the 369.7local medical examiner and the ombudsman as provided by law.369.8    Sec. 52. Minnesota Statutes 2012, section 626.5572, subdivision 13, is amended to read:369.9    Subd. 13. Lead investigative agency. "Lead investigative agency" is the primary 369.10administrative agency responsible for investigating reports made under section 
         626.557.369.11(a) The Department of Health is the lead investigative agency for facilities or 369.12services licensed or required to be licensed as hospitals, home care providers, nursing 369.13homes, boarding care homes, hospice providers, residential facilities that are also federally 369.14certified as intermediate care facilities that serve people with developmental disabilities, 369.15or any other facility or service not listed in this subdivision that is licensed or required to 369.16be licensed by the Department of Health for the care of vulnerable adults. "Home care 369.17provider" has the meaning provided in section 
         144A.43, subdivision 4, and applies when 369.18care or services are delivered in the vulnerable adult's home, whether a private home or a 369.19housing with services establishment registered under chapter 144D, including those that 369.20offer assisted living services under chapter 144G.369.21(b) Except as provided under paragraph (c), for services licensed according to 369.22chapter 245D, The Department of Human Services is the lead investigative agency for 369.23facilities or services licensed or required to be licensed as adult day care, adult foster care, 369.24programs for people with developmental disabilities, family adult day services, mental 369.25health programs, mental health clinics, chemical dependency programs, the Minnesota 369.26sex offender program, or any other facility or service not listed in this subdivision that is 369.27licensed or required to be licensed by the Department of Human Services.369.28(c) The county social service agency or its designee is the lead investigative agency 369.29for all other reports, including, but not limited to, reports involving vulnerable adults 369.30receiving services from a personal care provider organization under section 
         256B.0659, 369.31or receiving home and community-based services licensed by the Department of Human 369.32Services and subject to chapter 245D.369.33    Sec. 53. INTEGRATED LICENSING SYSTEM FOR HOME CARE AND HOME 369.34AND COMMUNITY-BASED SERVICES.370.1(a) The Department of Health Compliance Monitoring Division and the Department 370.2of Human Services Licensing Division shall jointly develop an integrated licensing system 370.3for providers of both home care services subject to licensure under Minnesota Statutes, 370.4chapter 144A, and for home and community-based services subject to licensure under 370.5Minnesota Statutes, chapter 245D. The integrated licensing system shall:370.6(1) require only one license of any provider of services under Minnesota Statutes, 370.7sections 144A.43 to 144A.482, and 245D.03, subdivision 1;370.8(2) promote quality services that recognize a person's individual needs and protect 370.9the person's health, safety, rights, and well-being;370.10(3) promote provider accountability through application requirements, compliance 370.11inspections, investigations, and enforcement actions;370.12(4) reference other applicable requirements in existing state and federal laws, 370.13including the federal Affordable Care Act;370.14(5) establish internal procedures to facilitate ongoing communications between the 370.15agencies and with providers and services recipients about the regulatory activities;370.16(6) create a link between the agency Web sites so that providers and the public can 370.17access the same information regardless of which Web site is accessed initially; and370.18(7) collect data on identified outcome measures as necessary for the agencies to 370.19report to the Centers for Medicare and Medicaid Services.370.20(b) The joint recommendations for legislative changes to implement the integrated 370.21licensing system are due to the legislature by February 15, 2014.370.22(c) Before implementation of the integrated licensing system, providers licensed as 370.23home care providers under Minnesota Statutes, chapter 144A, may also provide home 370.24and community-based services subject to licensure under Minnesota Statutes, chapter 370.25245D, without obtaining a home and community-based services license under Minnesota 370.26Statutes, chapter 245D. During this time, the conditions under clauses (1) to (3) shall 370.27apply to these providers:370.28(1) the provider must comply with all requirements under Minnesota Statutes, chapter 370.29245D, for services otherwise subject to licensure under Minnesota Statutes, chapter 245D;370.30(2) a violation of requirements under Minnesota Statutes, chapter 245D, may be 370.31enforced by the Department of Health under the enforcement authority set forth in 370.32Minnesota Statutes, section 144A.475; and370.33(3) the Department of Health will provide information to the Department of Human 370.34Services about each provider licensed under this section, including the provider's license 370.35application, licensing documents, inspections, information about complaints received, and 370.36investigations conducted for possible violations of Minnesota Statutes, chapter 245D.371.1    Sec. 54.  REPEALER.371.2(a) Minnesota Statutes 2012, sections 245B.01; 245B.02; 245B.03; 245B.031; 371.3245B.04; 245B.05, subdivisions 1, 2, 3, 5, 6, and 7; 245B.055; 245B.06; 245B.07; and 371.4245B.08, are repealed effective January 1, 2014. 371.5(b) Minnesota Statutes 2012, section 245D.08, is repealed.371.6ARTICLE 9371.7WAIVER PROVIDER STANDARDS TECHNICAL CHANGES371.8    Section 1. Minnesota Statutes 2012, section 16C.10, subdivision 5, is amended to read:371.9    Subd. 5. Specific purchases. The solicitation process described in this chapter is 371.10not required for acquisition of the following:371.11(1) merchandise for resale purchased under policies determined by the commissioner;371.12(2) farm and garden products which, as determined by the commissioner, may be 371.13purchased at the prevailing market price on the date of sale;371.14(3) goods and services from the Minnesota correctional facilities;371.15(4) goods and services from rehabilitation facilities and extended employment 371.16providers that are certified by the commissioner of employment and economic 371.17development, and day training and habilitation services licensed under sections 245B.01 371.18to 245B.08 chapter 245D;371.19(5) goods and services for use by a community-based facility operated by the 371.20commissioner of human services;371.21(6) goods purchased at auction or when submitting a sealed bid at auction provided 371.22that before authorizing such an action, the commissioner consult with the requesting 371.23agency to determine a fair and reasonable value for the goods considering factors 371.24including, but not limited to, costs associated with submitting a bid, travel, transportation, 371.25and storage. This fair and reasonable value must represent the limit of the state's bid;371.26(7) utility services where no competition exists or where rates are fixed by law or 371.27ordinance; and371.28(8) goods and services from Minnesota sex offender program facilities.371.29EFFECTIVE DATE.This section is effective January 1, 2014.371.30    Sec. 2. Minnesota Statutes 2012, section 16C.155, subdivision 1, is amended to read:371.31    Subdivision 1. Service contracts. The commissioner of administration shall 371.32ensure that a portion of all contracts for janitorial services; document imaging; 371.33document shredding; and mailing, collating, and sorting services be awarded by the 372.1state to rehabilitation programs and extended employment providers that are certified 372.2by the commissioner of employment and economic development, and day training and 372.3habilitation services licensed under sections 245B.01 to 245B.08 chapter 245D. The 372.4amount of each contract awarded under this section may exceed the estimated fair market 372.5price as determined by the commissioner for the same goods and services by up to six 372.6percent. The aggregate value of the contracts awarded to eligible providers under this 372.7section in any given year must exceed 19 percent of the total value of all contracts for 372.8janitorial services; document imaging; document shredding; and mailing, collating, and 372.9sorting services entered into in the same year. For the 19 percent requirement to be 372.10applicable in any given year, the contract amounts proposed by eligible providers must be 372.11within six percent of the estimated fair market price for at least 19 percent of the contracts 372.12awarded for the corresponding service area.372.13EFFECTIVE DATE.This section is effective January 1, 2014.372.14    Sec. 3. Minnesota Statutes 2012, section 144D.01, subdivision 4, is amended to read:372.15    Subd. 4. Housing with services establishment or establishment. (a) "Housing 372.16with services establishment" or "establishment" means:372.17(1) an establishment providing sleeping accommodations to one or more adult 372.18residents, at least 80 percent of which are 55 years of age or older, and offering or 372.19providing, for a fee, one or more regularly scheduled health-related services or two or 372.20more regularly scheduled supportive services, whether offered or provided directly by the 372.21establishment or by another entity arranged for by the establishment; or372.22(2) an establishment that registers under section 
         144D.025.372.23(b) Housing with services establishment does not include:372.24(1) a nursing home licensed under chapter 144A;372.25(2) a hospital, certified boarding care home, or supervised living facility licensed 372.26under sections 
         144.50 to 
         144.56;372.27(3) a board and lodging establishment licensed under chapter 157 and Minnesota 372.28Rules, parts 9520.0500 to 9520.0670, 9525.0215 to 9525.0355, 9525.0500 to 9525.0660, 372.29or 9530.4100 to 9530.4450, or under chapter 245B 245D;372.30(4) a board and lodging establishment which serves as a shelter for battered women 372.31or other similar purpose;372.32(5) a family adult foster care home licensed by the Department of Human Services;372.33(6) private homes in which the residents are related by kinship, law, or affinity with 372.34the providers of services;373.1(7) residential settings for persons with developmental disabilities in which the 373.2services are licensed under Minnesota Rules, parts 9525.2100 to 9525.2140, or applicable 373.3successor rules or laws;373.4(8) a home-sharing arrangement such as when an elderly or disabled person or 373.5single-parent family makes lodging in a private residence available to another person 373.6in exchange for services or rent, or both;373.7(9) a duly organized condominium, cooperative, common interest community, or 373.8owners' association of the foregoing where at least 80 percent of the units that comprise the 373.9condominium, cooperative, or common interest community are occupied by individuals 373.10who are the owners, members, or shareholders of the units; or373.11(10) services for persons with developmental disabilities that are provided under 373.12a license according to Minnesota Rules, parts 9525.2000 to 9525.2140 in effect until 373.13January 1, 1998, or under chapter 245B 245D.373.14EFFECTIVE DATE.This section is effective January 1, 2014.373.15    Sec. 4. Minnesota Statutes 2012, section 174.30, subdivision 1, is amended to read:373.16    Subdivision 1. Applicability. (a) The operating standards for special transportation 373.17service adopted under this section do not apply to special transportation provided by:373.18(1) a common carrier operating on fixed routes and schedules;373.19(2) a volunteer driver using a private automobile;373.20(3) a school bus as defined in section 
         169.011, subdivision 71; or373.21(4) an emergency ambulance regulated under chapter 144.373.22(b) The operating standards adopted under this section only apply to providers 373.23of special transportation service who receive grants or other financial assistance from 373.24either the state or the federal government, or both, to provide or assist in providing that 373.25service; except that the operating standards adopted under this section do not apply 373.26to any nursing home licensed under section 
         144A.02, to any board and care facility 373.27licensed under section 
         144.50, or to any day training and habilitation services, day care, 373.28or group home facility licensed under sections 
         245A.01 to 
         245A.19 unless the facility or 373.29program provides transportation to nonresidents on a regular basis and the facility receives 373.30reimbursement, other than per diem payments, for that service under rules promulgated 373.31by the commissioner of human services.373.32(c) Notwithstanding paragraph (b), the operating standards adopted under this 373.33section do not apply to any vendor of services licensed under chapter 245B 245D that 373.34provides transportation services to consumers or residents of other vendors licensed under 374.1chapter 245B 245D and transports 15 or fewer persons, including consumers or residents 374.2and the driver.374.3EFFECTIVE DATE.This section is effective January 1, 2014.374.4    Sec. 5. Minnesota Statutes 2012, section 245A.02, subdivision 1, is amended to read:374.5    Subdivision 1. Scope. The terms used in this chapter and chapter 245B have the 374.6meanings given them in this section.374.7EFFECTIVE DATE.This section is effective January 1, 2014.374.8    Sec. 6. Minnesota Statutes 2012, section 245A.02, subdivision 9, is amended to read:374.9    Subd. 9. License holder. "License holder" means an individual, corporation, 374.10partnership, voluntary association, or other organization that is legally responsible for the 374.11operation of the program, has been granted a license by the commissioner under this chapter 374.12or chapter 245B245D and the rules of the commissioner, and is a controlling individual.374.13EFFECTIVE DATE.This section is effective January 1, 2014.374.14    Sec. 7. Minnesota Statutes 2012, section 245A.03, subdivision 9, is amended to read:374.15    Subd. 9. Permitted services by an individual who is related. Notwithstanding 374.16subdivision 2, paragraph (a), clause (1), and subdivision 7, an individual who is related to a 374.17person receiving supported living services may provide licensed services to that person if:374.18(1) the person who receives supported living services received these services in a 374.19residential site on July 1, 2005;374.20(2) the services under clause (1) were provided in a corporate foster care setting for 374.21adults and were funded by the developmental disabilities home and community-based 374.22services waiver defined in section 
         256B.092;374.23(3) the individual who is related obtains and maintains both a license under chapter 374.24245B 245D and an adult foster care license under Minnesota Rules, parts 9555.5105 374.25to 9555.6265; and374.26(4) the individual who is related is not the guardian of the person receiving supported 374.27living services.374.28EFFECTIVE DATE.This section is effective January 1, 2014.374.29    Sec. 8. Minnesota Statutes 2012, section 245A.04, subdivision 13, is amended to read:375.1    Subd. 13. Funds and property; other requirements. (a) A license holder must 375.2ensure that persons served by the program retain the use and availability of personal funds 375.3or property unless restrictions are justified in the person's individual plan. This subdivision 375.4does not apply to programs governed by the provisions in section 245B.07, subdivision 10.375.5(b) The license holder must ensure separation of funds of persons served by the 375.6program from funds of the license holder, the program, or program staff.375.7(c) Whenever the license holder assists a person served by the program with the 375.8safekeeping of funds or other property, the license holder must:375.9(1) immediately document receipt and disbursement of the person's funds or other 375.10property at the time of receipt or disbursement, including the person's signature, or the 375.11signature of the conservator or payee; and375.12(2) return to the person upon the person's request, funds and property in the license 375.13holder's possession subject to restrictions in the person's treatment plan, as soon as 375.14possible, but no later than three working days after the date of request.375.15(d) License holders and program staff must not:375.16(1) borrow money from a person served by the program;375.17(2) purchase personal items from a person served by the program;375.18(3) sell merchandise or personal services to a person served by the program;375.19(4) require a person served by the program to purchase items for which the license 375.20holder is eligible for reimbursement; or375.21(5) use funds of persons served by the program to purchase items for which the 375.22facility is already receiving public or private payments.375.23EFFECTIVE DATE.This section is effective January 1, 2014.375.24    Sec. 9. Minnesota Statutes 2012, section 245A.07, subdivision 3, is amended to read:375.25    Subd. 3. License suspension, revocation, or fine. (a) The commissioner may 375.26suspend or revoke a license, or impose a fine if:375.27(1) a license holder fails to comply fully with applicable laws or rules;375.28(2) a license holder, a controlling individual, or an individual living in the household 375.29where the licensed services are provided or is otherwise subject to a background study has 375.30a disqualification which has not been set aside under section 
         245C.22;375.31(3) a license holder knowingly withholds relevant information from or gives false 375.32or misleading information to the commissioner in connection with an application for 375.33a license, in connection with the background study status of an individual, during an 375.34investigation, or regarding compliance with applicable laws or rules; or376.1(4) after July 1, 2012, and upon request by the commissioner, a license holder fails 376.2to submit the information required of an applicant under section 
         245A.04, subdivision 1, 376.3paragraph (f) or (g).376.4A license holder who has had a license suspended, revoked, or has been ordered 376.5to pay a fine must be given notice of the action by certified mail or personal service. If 376.6mailed, the notice must be mailed to the address shown on the application or the last 376.7known address of the license holder. The notice must state the reasons the license was 376.8suspended, revoked, or a fine was ordered.376.9    (b) If the license was suspended or revoked, the notice must inform the license 376.10holder of the right to a contested case hearing under chapter 14 and Minnesota Rules, parts 376.111400.8505 to 1400.8612. The license holder may appeal an order suspending or revoking 376.12a license. The appeal of an order suspending or revoking a license must be made in writing 376.13by certified mail or personal service. If mailed, the appeal must be postmarked and sent to 376.14the commissioner within ten calendar days after the license holder receives notice that the 376.15license has been suspended or revoked. If a request is made by personal service, it must be 376.16received by the commissioner within ten calendar days after the license holder received 376.17the order. Except as provided in subdivision 2a, paragraph (c), if a license holder submits 376.18a timely appeal of an order suspending or revoking a license, the license holder may 376.19continue to operate the program as provided in section 
         245A.04, subdivision 7, paragraphs 376.20(g) and (h), until the commissioner issues a final order on the suspension or revocation.376.21    (c)(1) If the license holder was ordered to pay a fine, the notice must inform the 376.22license holder of the responsibility for payment of fines and the right to a contested case 376.23hearing under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The appeal 376.24of an order to pay a fine must be made in writing by certified mail or personal service. If 376.25mailed, the appeal must be postmarked and sent to the commissioner within ten calendar 376.26days after the license holder receives notice that the fine has been ordered. If a request is 376.27made by personal service, it must be received by the commissioner within ten calendar 376.28days after the license holder received the order.376.29    (2) The license holder shall pay the fines assessed on or before the payment date 376.30specified. If the license holder fails to fully comply with the order, the commissioner 376.31may issue a second fine or suspend the license until the license holder complies. If the 376.32license holder receives state funds, the state, county, or municipal agencies or departments 376.33responsible for administering the funds shall withhold payments and recover any payments 376.34made while the license is suspended for failure to pay a fine. A timely appeal shall stay 376.35payment of the fine until the commissioner issues a final order.377.1    (3) A license holder shall promptly notify the commissioner of human services, 377.2in writing, when a violation specified in the order to forfeit a fine is corrected. If upon 377.3reinspection the commissioner determines that a violation has not been corrected as 377.4indicated by the order to forfeit a fine, the commissioner may issue a second fine. The 377.5commissioner shall notify the license holder by certified mail or personal service that a 377.6second fine has been assessed. The license holder may appeal the second fine as provided 377.7under this subdivision.377.8    (4) Fines shall be assessed as follows: the license holder shall forfeit $1,000 for 377.9each determination of maltreatment of a child under section 
         626.556 or the maltreatment 377.10of a vulnerable adult under section 
         626.557 for which the license holder is determined 377.11responsible for the maltreatment under section 
         626.556, subdivision 10e, paragraph (i), 377.12or 
         626.557, subdivision 9c, paragraph (c); the license holder shall forfeit $200 for each 377.13occurrence of a violation of law or rule governing matters of health, safety, or supervision, 377.14including but not limited to the provision of adequate staff-to-child or adult ratios, and 377.15failure to comply with background study requirements under chapter 245C; and the license 377.16holder shall forfeit $100 for each occurrence of a violation of law or rule other than 377.17those subject to a $1,000 or $200 fine above. For purposes of this section, "occurrence" 377.18means each violation identified in the commissioner's fine order. Fines assessed against a 377.19license holder that holds a license to provide the residential-based habilitationhome and 377.20community-based services, as defined under identified in section 
         245B.02, subdivision 377.2120 245D.03, subdivision 1, and a community residential setting or day services facility 377.22license to provide foster care under chapter 245D where the services are provided, may be 377.23assessed against both licenses for the same occurrence, but the combined amount of the 377.24fines shall not exceed the amount specified in this clause for that occurrence.377.25    (5) When a fine has been assessed, the license holder may not avoid payment by 377.26closing, selling, or otherwise transferring the licensed program to a third party. In such an 377.27event, the license holder will be personally liable for payment. In the case of a corporation, 377.28each controlling individual is personally and jointly liable for payment.377.29(d) Except for background study violations involving the failure to comply with an 377.30order to immediately remove an individual or an order to provide continuous, direct 377.31supervision, the commissioner shall not issue a fine under paragraph (c) relating to a 377.32background study violation to a license holder who self-corrects a background study 377.33violation before the commissioner discovers the violation. A license holder who has 377.34previously exercised the provisions of this paragraph to avoid a fine for a background 377.35study violation may not avoid a fine for a subsequent background study violation unless at 378.1least 365 days have passed since the license holder self-corrected the earlier background 378.2study violation.378.3EFFECTIVE DATE.This section is effective January 1, 2014.378.4    Sec. 10. Minnesota Statutes 2012, section 256B.0625, subdivision 19c, is amended to 378.5read:378.6    Subd. 19c. Personal care. Medical assistance covers personal care assistance 378.7services provided by an individual who is qualified to provide the services according to 378.8subdivision 19a and sections 
         256B.0651 to 
         256B.0656, provided in accordance with a 378.9plan, and supervised by a qualified professional.378.10"Qualified professional" means a mental health professional as defined in section 378.11245.462, subdivision 18
         , clauses (1) to (6), or 
         245.4871, subdivision 27, clauses (1) to (6); 378.12or a registered nurse as defined in sections 
         148.171 to 
         148.285, a licensed social worker 378.13as defined in sections 
         148E.010 and 
         148E.055, or a qualified developmental disabilities 378.14specialist under section 245B.07, subdivision 4 designated coordinator under section 378.15245D.081, subdivision 2. The qualified professional shall perform the duties required in 378.16section 
         256B.0659.378.17EFFECTIVE DATE.This section is effective January 1, 2014.378.18    Sec. 11. Minnesota Statutes 2012, section 256B.5011, subdivision 2, is amended to read:378.19    Subd. 2. Contract provisions. (a) The service contract with each intermediate 378.20care facility must include provisions for:378.21(1) modifying payments when significant changes occur in the needs of the 378.22consumers;378.23(2) appropriate and necessary statistical information required by the commissioner;378.24(3) annual aggregate facility financial information; and378.25(4) additional requirements for intermediate care facilities not meeting the standards 378.26set forth in the service contract.378.27(b) The commissioner of human services and the commissioner of health, in 378.28consultation with representatives from counties, advocacy organizations, and the provider 378.29community, shall review the consolidated standards under chapter 245B andthe home and 378.30community-based services standards under chapter 245D and the supervised living facility 378.31rule under Minnesota Rules, chapter 4665, to determine what provisions in Minnesota 378.32Rules, chapter 4665, may be waived by the commissioner of health for intermediate care 378.33facilities in order to enable facilities to implement the performance measures in their 379.1contract and provide quality services to residents without a duplication of or increase in 379.2regulatory requirements.379.3EFFECTIVE DATE.This section is effective January 1, 2014.379.4    Sec. 12. Minnesota Statutes 2012, section 471.59, subdivision 1, is amended to read:379.5    Subdivision 1. Agreement. Two or more governmental units, by agreement entered 379.6into through action of their governing bodies, may jointly or cooperatively exercise 379.7any power common to the contracting parties or any similar powers, including those 379.8which are the same except for the territorial limits within which they may be exercised. 379.9The agreement may provide for the exercise of such powers by one or more of the 379.10participating governmental units on behalf of the other participating units. The term 379.11"governmental unit" as used in this section includes every city, county, town, school 379.12district, independent nonprofit firefighting corporation, other political subdivision of 379.13this or another state, another state, federally recognized Indian tribe, the University 379.14of Minnesota, the Minnesota Historical Society, nonprofit hospitals licensed under 379.15sections 
         144.50 to 
         144.56, rehabilitation facilities and extended employment providers 379.16that are certified by the commissioner of employment and economic development, day 379.17training and habilitation services licensed under sections 245B.01 to 245B.08,day and 379.18supported employment services licensed under chapter 245D, and any agency of the state 379.19of Minnesota or the United States, and includes any instrumentality of a governmental 379.20unit. For the purpose of this section, an instrumentality of a governmental unit means an 379.21instrumentality having independent policy-making and appropriating authority.379.22EFFECTIVE DATE.This section is effective January 1, 2014.379.23    Sec. 13. Minnesota Statutes 2012, section 626.556, subdivision 2, is amended to read:379.24    Subd. 2. Definitions. As used in this section, the following terms have the meanings 379.25given them unless the specific content indicates otherwise:379.26    (a) "Family assessment" means a comprehensive assessment of child safety, risk 379.27of subsequent child maltreatment, and family strengths and needs that is applied to a 379.28child maltreatment report that does not allege substantial child endangerment. Family 379.29assessment does not include a determination as to whether child maltreatment occurred 379.30but does determine the need for services to address the safety of family members and the 379.31risk of subsequent maltreatment.379.32    (b) "Investigation" means fact gathering related to the current safety of a child 379.33and the risk of subsequent maltreatment that determines whether child maltreatment 380.1occurred and whether child protective services are needed. An investigation must be used 380.2when reports involve substantial child endangerment, and for reports of maltreatment in 380.3facilities required to be licensed under chapter 245A or 245B; under sections 
         144.50 to 380.4144.58
          and 
         241.021; in a school as defined in sections 
         120A.05, subdivisions 9, 11, and 380.513, and 
         124D.10; or in a nonlicensed personal care provider association as defined in 380.6sections 
         256B.04, subdivision 16, and 
         256B.0625, subdivision 19a.380.7    (c) "Substantial child endangerment" means a person responsible for a child's care, 380.8and in the case of sexual abuse includes a person who has a significant relationship to the 380.9child as defined in section 
         609.341, or a person in a position of authority as defined in 380.10section 
         609.341, who by act or omission commits or attempts to commit an act against a 380.11child under their care that constitutes any of the following:380.12    (1) egregious harm as defined in section 
         260C.007, subdivision 14;380.13    (2) sexual abuse as defined in paragraph (d);380.14    (3) abandonment under section 
         260C.301, subdivision 2;380.15    (4) neglect as defined in paragraph (f), clause (2), that substantially endangers the 380.16child's physical or mental health, including a growth delay, which may be referred to as 380.17failure to thrive, that has been diagnosed by a physician and is due to parental neglect;380.18    (5) murder in the first, second, or third degree under section 
         609.185, 
         609.19, or 380.19609.195
         ;380.20    (6) manslaughter in the first or second degree under section 
         609.20 or 
         609.205;380.21    (7) assault in the first, second, or third degree under section 
         609.221, 
         609.222, or 380.22609.223
         ;380.23    (8) solicitation, inducement, and promotion of prostitution under section 
         609.322;380.24    (9) criminal sexual conduct under sections 
         609.342 to 
         609.3451;380.25    (10) solicitation of children to engage in sexual conduct under section 
         609.352;380.26    (11) malicious punishment or neglect or endangerment of a child under section 380.27609.377
          or 
         609.378;380.28    (12) use of a minor in sexual performance under section 
         617.246; or380.29    (13) parental behavior, status, or condition which mandates that the county attorney 380.30file a termination of parental rights petition under section 
         260C.301, subdivision 3, 380.31paragraph (a).380.32    (d) "Sexual abuse" means the subjection of a child by a person responsible for the 380.33child's care, by a person who has a significant relationship to the child, as defined in 380.34section 
         609.341, or by a person in a position of authority, as defined in section 
         609.341, 380.35subdivision 10, to any act which constitutes a violation of section 
         609.342 (criminal sexual 380.36conduct in the first degree), 
         609.343 (criminal sexual conduct in the second degree), 381.1609.344
          (criminal sexual conduct in the third degree), 
         609.345 (criminal sexual conduct 381.2in the fourth degree), or 
         609.3451 (criminal sexual conduct in the fifth degree). Sexual 381.3abuse also includes any act which involves a minor which constitutes a violation of 381.4prostitution offenses under sections 
         609.321 to 
         609.324 or 
         617.246. Sexual abuse includes 381.5threatened sexual abuse which includes the status of a parent or household member 381.6who has committed a violation which requires registration as an offender under section 381.7243.166, subdivision 1b, paragraph (a) or (b), or required registration under section 381.8243.166, subdivision 1b, paragraph (a) or (b).381.9    (e) "Person responsible for the child's care" means (1) an individual functioning 381.10within the family unit and having responsibilities for the care of the child such as a 381.11parent, guardian, or other person having similar care responsibilities, or (2) an individual 381.12functioning outside the family unit and having responsibilities for the care of the child 381.13such as a teacher, school administrator, other school employees or agents, or other lawful 381.14custodian of a child having either full-time or short-term care responsibilities including, 381.15but not limited to, day care, babysitting whether paid or unpaid, counseling, teaching, 381.16and coaching.381.17    (f) "Neglect" means the commission or omission of any of the acts specified under 381.18clauses (1) to (9), other than by accidental means:381.19    (1) failure by a person responsible for a child's care to supply a child with necessary 381.20food, clothing, shelter, health, medical, or other care required for the child's physical or 381.21mental health when reasonably able to do so;381.22    (2) failure to protect a child from conditions or actions that seriously endanger the 381.23child's physical or mental health when reasonably able to do so, including a growth delay, 381.24which may be referred to as a failure to thrive, that has been diagnosed by a physician and 381.25is due to parental neglect;381.26    (3) failure to provide for necessary supervision or child care arrangements 381.27appropriate for a child after considering factors as the child's age, mental ability, physical 381.28condition, length of absence, or environment, when the child is unable to care for the 381.29child's own basic needs or safety, or the basic needs or safety of another child in their care;381.30    (4) failure to ensure that the child is educated as defined in sections 
         120A.22 and 381.31260C.163, subdivision 11
         , which does not include a parent's refusal to provide the parent's 381.32child with sympathomimetic medications, consistent with section 
         125A.091, subdivision 5;381.33    (5) nothing in this section shall be construed to mean that a child is neglected solely 381.34because the child's parent, guardian, or other person responsible for the child's care in 381.35good faith selects and depends upon spiritual means or prayer for treatment or care of 381.36disease or remedial care of the child in lieu of medical care; except that a parent, guardian, 382.1or caretaker, or a person mandated to report pursuant to subdivision 3, has a duty to report 382.2if a lack of medical care may cause serious danger to the child's health. This section does 382.3not impose upon persons, not otherwise legally responsible for providing a child with 382.4necessary food, clothing, shelter, education, or medical care, a duty to provide that care;382.5    (6) prenatal exposure to a controlled substance, as defined in section 
         253B.02, 382.6subdivision 2, used by the mother for a nonmedical purpose, as evidenced by withdrawal 382.7symptoms in the child at birth, results of a toxicology test performed on the mother at 382.8delivery or the child at birth, medical effects or developmental delays during the child's 382.9first year of life that medically indicate prenatal exposure to a controlled substance, or the 382.10presence of a fetal alcohol spectrum disorder;382.11    (7) "medical neglect" as defined in section 
         260C.007, subdivision 6, clause (5);382.12    (8) chronic and severe use of alcohol or a controlled substance by a parent or 382.13person responsible for the care of the child that adversely affects the child's basic needs 382.14and safety; or382.15    (9) emotional harm from a pattern of behavior which contributes to impaired 382.16emotional functioning of the child which may be demonstrated by a substantial and 382.17observable effect in the child's behavior, emotional response, or cognition that is not 382.18within the normal range for the child's age and stage of development, with due regard to 382.19the child's culture.382.20    (g) "Physical abuse" means any physical injury, mental injury, or threatened injury, 382.21inflicted by a person responsible for the child's care on a child other than by accidental 382.22means, or any physical or mental injury that cannot reasonably be explained by the child's 382.23history of injuries, or any aversive or deprivation procedures, or regulated interventions, 382.24that have not been authorized under section 
         121A.67 or 
         245.825.382.25    Abuse does not include reasonable and moderate physical discipline of a child 382.26administered by a parent or legal guardian which does not result in an injury. Abuse does 382.27not include the use of reasonable force by a teacher, principal, or school employee as 382.28allowed by section 
         121A.582. Actions which are not reasonable and moderate include, 382.29but are not limited to, any of the following that are done in anger or without regard to the 382.30safety of the child:382.31    (1) throwing, kicking, burning, biting, or cutting a child;382.32    (2) striking a child with a closed fist;382.33    (3) shaking a child under age three;382.34    (4) striking or other actions which result in any nonaccidental injury to a child 382.35under 18 months of age;382.36    (5) unreasonable interference with a child's breathing;383.1    (6) threatening a child with a weapon, as defined in section 
         609.02, subdivision 6;383.2    (7) striking a child under age one on the face or head;383.3    (8) purposely giving a child poison, alcohol, or dangerous, harmful, or controlled 383.4substances which were not prescribed for the child by a practitioner, in order to control or 383.5punish the child; or other substances that substantially affect the child's behavior, motor 383.6coordination, or judgment or that results in sickness or internal injury, or subjects the 383.7child to medical procedures that would be unnecessary if the child were not exposed 383.8to the substances;383.9    (9) unreasonable physical confinement or restraint not permitted under section 383.10609.379
         , including but not limited to tying, caging, or chaining; or383.11    (10) in a school facility or school zone, an act by a person responsible for the child's 383.12care that is a violation under section 
         121A.58.383.13    (h) "Report" means any report received by the local welfare agency, police 383.14department, county sheriff, or agency responsible for assessing or investigating 383.15maltreatment pursuant to this section.383.16    (i) "Facility" means:383.17    (1) a licensed or unlicensed day care facility, residential facility, agency, hospital, 383.18sanitarium, or other facility or institution required to be licensed under sections 
         144.50 to 383.19144.58
         , 
         241.021, or 
         245A.01 to 
         245A.16, or chapter 245B 245D;383.20    (2) a school as defined in sections 
         120A.05, subdivisions 9, 11, and 13; and 383.21124D.10
         ; or383.22    (3) a nonlicensed personal care provider organization as defined in sections 
         256B.04, 383.23subdivision 16, and 
         256B.0625, subdivision 19a.383.24    (j) "Operator" means an operator or agency as defined in section 
         245A.02.383.25    (k) "Commissioner" means the commissioner of human services.383.26    (l) "Practice of social services," for the purposes of subdivision 3, includes but is 383.27not limited to employee assistance counseling and the provision of guardian ad litem and 383.28parenting time expeditor services.383.29    (m) "Mental injury" means an injury to the psychological capacity or emotional 383.30stability of a child as evidenced by an observable or substantial impairment in the child's 383.31ability to function within a normal range of performance and behavior with due regard to 383.32the child's culture.383.33    (n) "Threatened injury" means a statement, overt act, condition, or status that 383.34represents a substantial risk of physical or sexual abuse or mental injury. Threatened 383.35injury includes, but is not limited to, exposing a child to a person responsible for the 383.36child's care, as defined in paragraph (e), clause (1), who has:384.1    (1) subjected a child to, or failed to protect a child from, an overt act or condition 384.2that constitutes egregious harm, as defined in section 
         260C.007, subdivision 14, or a 384.3similar law of another jurisdiction;384.4    (2) been found to be palpably unfit under section 
         260C.301, paragraph (b), clause 384.5(4), or a similar law of another jurisdiction;384.6    (3) committed an act that has resulted in an involuntary termination of parental rights 384.7under section 
         260C.301, or a similar law of another jurisdiction; or384.8    (4) committed an act that has resulted in the involuntary transfer of permanent 384.9legal and physical custody of a child to a relative under Minnesota Statutes 2010, section 384.10260C.201, subdivision 11
         , paragraph (d), clause (1), section 
         260C.515, subdivision 4, or a 384.11similar law of another jurisdiction.384.12A child is the subject of a report of threatened injury when the responsible social 384.13services agency receives birth match data under paragraph (o) from the Department of 384.14Human Services.384.15(o) Upon receiving data under section 
         144.225, subdivision 2b, contained in a 384.16birth record or recognition of parentage identifying a child who is subject to threatened 384.17injury under paragraph (n), the Department of Human Services shall send the data to the 384.18responsible social services agency. The data is known as "birth match" data. Unless the 384.19responsible social services agency has already begun an investigation or assessment of the 384.20report due to the birth of the child or execution of the recognition of parentage and the 384.21parent's previous history with child protection, the agency shall accept the birth match 384.22data as a report under this section. The agency may use either a family assessment or 384.23investigation to determine whether the child is safe. All of the provisions of this section 384.24apply. If the child is determined to be safe, the agency shall consult with the county 384.25attorney to determine the appropriateness of filing a petition alleging the child is in need 384.26of protection or services under section 
         260C.007, subdivision 6, clause (16), in order to 384.27deliver needed services. If the child is determined not to be safe, the agency and the county 384.28attorney shall take appropriate action as required under section 
         260C.301, subdivision 3.384.29    (p) Persons who conduct assessments or investigations under this section shall take 384.30into account accepted child-rearing practices of the culture in which a child participates 384.31and accepted teacher discipline practices, which are not injurious to the child's health, 384.32welfare, and safety.384.33    (q) "Accidental" means a sudden, not reasonably foreseeable, and unexpected 384.34occurrence or event which:384.35    (1) is not likely to occur and could not have been prevented by exercise of due 384.36care; and385.1    (2) if occurring while a child is receiving services from a facility, happens when the 385.2facility and the employee or person providing services in the facility are in compliance 385.3with the laws and rules relevant to the occurrence or event.385.4(r) "Nonmaltreatment mistake" means:385.5(1) at the time of the incident, the individual was performing duties identified in the 385.6center's child care program plan required under Minnesota Rules, part 9503.0045;385.7(2) the individual has not been determined responsible for a similar incident that 385.8resulted in a finding of maltreatment for at least seven years;385.9(3) the individual has not been determined to have committed a similar 385.10nonmaltreatment mistake under this paragraph for at least four years;385.11(4) any injury to a child resulting from the incident, if treated, is treated only with 385.12remedies that are available over the counter, whether ordered by a medical professional or 385.13not; and385.14(5) except for the period when the incident occurred, the facility and the individual 385.15providing services were both in compliance with all licensing requirements relevant to the 385.16incident.385.17This definition only applies to child care centers licensed under Minnesota 385.18Rules, chapter 9503. If clauses (1) to (5) apply, rather than making a determination of 385.19substantiated maltreatment by the individual, the commissioner of human services shall 385.20determine that a nonmaltreatment mistake was made by the individual.385.21EFFECTIVE DATE.This section is effective January 1, 2014.385.22    Sec. 14. Minnesota Statutes 2012, section 626.556, subdivision 3, is amended to read:385.23    Subd. 3. Persons mandated to report. (a) A person who knows or has reason 385.24to believe a child is being neglected or physically or sexually abused, as defined in 385.25subdivision 2, or has been neglected or physically or sexually abused within the preceding 385.26three years, shall immediately report the information to the local welfare agency, agency 385.27responsible for assessing or investigating the report, police department, or the county 385.28sheriff if the person is:385.29    (1) a professional or professional's delegate who is engaged in the practice of 385.30the healing arts, social services, hospital administration, psychological or psychiatric 385.31treatment, child care, education, correctional supervision, probation and correctional 385.32services, or law enforcement; or385.33    (2) employed as a member of the clergy and received the information while 385.34engaged in ministerial duties, provided that a member of the clergy is not required by 386.1this subdivision to report information that is otherwise privileged under section 
         595.02, 386.2subdivision 1
         , paragraph (c).386.3    The police department or the county sheriff, upon receiving a report, shall 386.4immediately notify the local welfare agency or agency responsible for assessing or 386.5investigating the report, orally and in writing. The local welfare agency, or agency 386.6responsible for assessing or investigating the report, upon receiving a report, shall 386.7immediately notify the local police department or the county sheriff orally and in writing. 386.8The county sheriff and the head of every local welfare agency, agency responsible 386.9for assessing or investigating reports, and police department shall each designate a 386.10person within their agency, department, or office who is responsible for ensuring that 386.11the notification duties of this paragraph and paragraph (b) are carried out. Nothing in 386.12this subdivision shall be construed to require more than one report from any institution, 386.13facility, school, or agency.386.14    (b) Any person may voluntarily report to the local welfare agency, agency responsible 386.15for assessing or investigating the report, police department, or the county sheriff if the 386.16person knows, has reason to believe, or suspects a child is being or has been neglected or 386.17subjected to physical or sexual abuse. The police department or the county sheriff, upon 386.18receiving a report, shall immediately notify the local welfare agency or agency responsible 386.19for assessing or investigating the report, orally and in writing. The local welfare agency or 386.20agency responsible for assessing or investigating the report, upon receiving a report, shall 386.21immediately notify the local police department or the county sheriff orally and in writing.386.22    (c) A person mandated to report physical or sexual child abuse or neglect occurring 386.23within a licensed facility shall report the information to the agency responsible for 386.24licensing the facility under sections 
         144.50 to 
         144.58; 
         241.021; 
         245A.01 to 
         245A.16; or 386.25chapter 245B 245D; or a nonlicensed personal care provider organization as defined in 386.26sections 
         256B.04, subdivision 16; and 
         256B.0625, subdivision 19. A health or corrections 386.27agency receiving a report may request the local welfare agency to provide assistance 386.28pursuant to subdivisions 10, 10a, and 10b. A board or other entity whose licensees 386.29perform work within a school facility, upon receiving a complaint of alleged maltreatment, 386.30shall provide information about the circumstances of the alleged maltreatment to the 386.31commissioner of education. Section 
         13.03, subdivision 4, applies to data received by the 386.32commissioner of education from a licensing entity.386.33    (d) Any person mandated to report shall receive a summary of the disposition of 386.34any report made by that reporter, including whether the case has been opened for child 386.35protection or other services, or if a referral has been made to a community organization, 386.36unless release would be detrimental to the best interests of the child. Any person who is 387.1not mandated to report shall, upon request to the local welfare agency, receive a concise 387.2summary of the disposition of any report made by that reporter, unless release would be 387.3detrimental to the best interests of the child.387.4    (e) For purposes of this section, "immediately" means as soon as possible but in 387.5no event longer than 24 hours.387.6EFFECTIVE DATE.This section is effective January 1, 2014.387.7    Sec. 15. Minnesota Statutes 2012, section 626.556, subdivision 10d, is amended to read:387.8    Subd. 10d. Notification of neglect or abuse in facility. (a) When a report is 387.9received that alleges neglect, physical abuse, sexual abuse, or maltreatment of a child while 387.10in the care of a licensed or unlicensed day care facility, residential facility, agency, hospital, 387.11sanitarium, or other facility or institution required to be licensed according to sections 387.12144.50
          to 
         144.58; 
         241.021; or 
         245A.01 to 
         245A.16; or chapter 245B 245D, or a school as 387.13defined in sections 
         120A.05, subdivisions 9, 11, and 13; and 
         124D.10; or a nonlicensed 387.14personal care provider organization as defined in section 
         256B.04, subdivision 16, and 387.15256B.0625, subdivision 19a
         , the commissioner of the agency responsible for assessing 387.16or investigating the report or local welfare agency investigating the report shall provide 387.17the following information to the parent, guardian, or legal custodian of a child alleged to 387.18have been neglected, physically abused, sexually abused, or the victim of maltreatment 387.19of a child in the facility: the name of the facility; the fact that a report alleging neglect, 387.20physical abuse, sexual abuse, or maltreatment of a child in the facility has been received; 387.21the nature of the alleged neglect, physical abuse, sexual abuse, or maltreatment of a child 387.22in the facility; that the agency is conducting an assessment or investigation; any protective 387.23or corrective measures being taken pending the outcome of the investigation; and that a 387.24written memorandum will be provided when the investigation is completed.387.25(b) The commissioner of the agency responsible for assessing or investigating the 387.26report or local welfare agency may also provide the information in paragraph (a) to the 387.27parent, guardian, or legal custodian of any other child in the facility if the investigative 387.28agency knows or has reason to believe the alleged neglect, physical abuse, sexual 387.29abuse, or maltreatment of a child in the facility has occurred. In determining whether 387.30to exercise this authority, the commissioner of the agency responsible for assessing 387.31or investigating the report or local welfare agency shall consider the seriousness of the 387.32alleged neglect, physical abuse, sexual abuse, or maltreatment of a child in the facility; the 387.33number of children allegedly neglected, physically abused, sexually abused, or victims of 387.34maltreatment of a child in the facility; the number of alleged perpetrators; and the length 387.35of the investigation. The facility shall be notified whenever this discretion is exercised.388.1(c) When the commissioner of the agency responsible for assessing or investigating 388.2the report or local welfare agency has completed its investigation, every parent, guardian, 388.3or legal custodian previously notified of the investigation by the commissioner or 388.4local welfare agency shall be provided with the following information in a written 388.5memorandum: the name of the facility investigated; the nature of the alleged neglect, 388.6physical abuse, sexual abuse, or maltreatment of a child in the facility; the investigator's 388.7name; a summary of the investigation findings; a statement whether maltreatment was 388.8found; and the protective or corrective measures that are being or will be taken. The 388.9memorandum shall be written in a manner that protects the identity of the reporter and 388.10the child and shall not contain the name, or to the extent possible, reveal the identity of 388.11the alleged perpetrator or of those interviewed during the investigation. If maltreatment 388.12is determined to exist, the commissioner or local welfare agency shall also provide the 388.13written memorandum to the parent, guardian, or legal custodian of each child in the facility 388.14who had contact with the individual responsible for the maltreatment. When the facility is 388.15the responsible party for maltreatment, the commissioner or local welfare agency shall also 388.16provide the written memorandum to the parent, guardian, or legal custodian of each child 388.17who received services in the population of the facility where the maltreatment occurred. 388.18This notification must be provided to the parent, guardian, or legal custodian of each child 388.19receiving services from the time the maltreatment occurred until either the individual 388.20responsible for maltreatment is no longer in contact with a child or children in the facility 388.21or the conclusion of the investigation. In the case of maltreatment within a school facility, 388.22as defined in sections 
         120A.05, subdivisions 9, 11, and 13, and 
         124D.10, the commissioner 388.23of education need not provide notification to parents, guardians, or legal custodians of 388.24each child in the facility, but shall, within ten days after the investigation is completed, 388.25provide written notification to the parent, guardian, or legal custodian of any student 388.26alleged to have been maltreated. The commissioner of education may notify the parent, 388.27guardian, or legal custodian of any student involved as a witness to alleged maltreatment.388.28EFFECTIVE DATE.This section is effective January 1, 2014.388.29    Sec. 16.  REPEALER.388.30Minnesota Statutes 2012, section 256B.49, subdivision 16a, is repealed effective 388.31January 1, 2014.389.1ARTICLE 10389.2HEALTH-RELATED LICENSING BOARDS389.3    Section 1. Minnesota Statutes 2012, section 13.411, subdivision 7, is amended to read:389.4    Subd. 7. Examining and licensing boards. (a) Health licensing boards. Data 389.5held by health licensing boards are classified under sections 
         214.10, subdivision 8, and 389.6214.25, subdivision 1
         .389.7(b) Combined boards data. Data held by licensing boards participating in a health 389.8professional services program are classified under sections 
         214.34 and 
         214.35.389.9(c) Criminal background checks. Criminal history record information obtained by 389.10a health-related licensing board is classified under section 214.075, subdivision 7.389.11    Sec. 2. Minnesota Statutes 2012, section 148B.17, subdivision 2, is amended to read:389.12    Subd. 2. Licensure and application fees. Nonrefundable licensure and application 389.13fees charged established by the board are as follows shall not exceed the following amounts:389.14(1) application fee for national examination is $220 $110;389.15(2) application fee for Licensed Marriage and Family Therapist (LMFT) state 389.16examination is $110;389.17(3) initial LMFT license fee is prorated, but cannot exceed $125;389.18(4) annual renewal fee for LMFT license is $125;389.19(5) late fee for initial Licensed Associate Marriage and Family Therapist LAMFT389.20LMFT license renewal is $50;389.21(6) application fee for LMFT licensure by reciprocity is $340 $220;389.22(7) fee for initial Licensed Associate Marriage and Family Therapist (LAMFT) 389.23license is $75;389.24(8) annual renewal fee for LAMFT license is $75;389.25(9) late fee for LAMFT renewal is $50 $25;389.26(10) fee for reinstatement of license is $150; and389.27(11) fee for emeritus status is $125.389.28    Sec. 3. Minnesota Statutes 2012, section 151.01, subdivision 27, is amended to read:389.29    Subd. 27. Practice of pharmacy. "Practice of pharmacy" means:389.30    (1) interpretation and evaluation of prescription drug orders;389.31    (2) compounding, labeling, and dispensing drugs and devices (except labeling by 389.32a manufacturer or packager of nonprescription drugs or commercially packaged legend 389.33drugs and devices);390.1    (3) participation in clinical interpretations and monitoring of drug therapy for 390.2assurance of safe and effective use of drugs;390.3    (4) participation in drug and therapeutic device selection; drug administration for first 390.4dosage and medical emergencies; drug regimen reviews; and drug or drug-related research;390.5    (5) participation in administration of influenza vaccines to all eligible individuals ten 390.6years of age and older and all other vaccines to patients 18 years of age and older under 390.7standing orders from a physician licensed under chapter 147 or by written protocol with a 390.8physician licensed under chapter 147 provided that:390.9    (i) the standing orders or protocol include, at a minimum, the name, dosage, and 390.10route of each vaccine that may be given, the patient population to whom the vaccine may 390.11be given, contraindications and precautions to the vaccine, the procedure for handling an 390.12adverse reaction, the name and signature of the physician, the address of the physician, a 390.13phone number at which the physician can be contacted, and the date and time period for 390.14which the standing orders or protocol are valid;390.15    (i) (ii) the pharmacist is trained in has successfully completed a program approved 390.16by the American Accreditation Council of Pharmaceutical for Pharmacy Education, 390.17specifically for the administration of immunizations, or graduated from a college of 390.18pharmacy in 2001 or thereafter; and a program approved according to rules adopted by 390.19the board;390.20    (iii) the pharmacist completes continuing education concerning the administration of 390.21immunizations, as required by Minnesota Rules;390.22    (iv) the pharmacist has a current cardiopulmonary resuscitation certificate;390.23    (ii) (v) the pharmacist reports the administration of the immunization to the patient's 390.24primary physician or clinic or to the Minnesota Immunization Information Connection;390.25    (vi) the pharmacist complies with guidelines for vaccines and immunizations 390.26established by the federal Advisory Committee on Immunization Practices (ACIP), except 390.27that a pharmacist does not need to comply with those guidelines if administering a vaccine 390.28pursuant to a valid, patient-specific order issued by a physician licensed under chapter 147 390.29when the order is consistent with United States Food and Drug Administration-approved 390.30labeling of the vaccine; and390.31    (vii) the pharmacist complies with Centers for Disease Control and Prevention 390.32guidelines relating to immunization schedules, vaccine storage and handling, and vaccine 390.33administration and documentation;390.34    (6) participation in the practice of managing drug therapy and modifying drug 390.35therapy, according to section 151.21, subdivision 1, according to a written protocol 390.36between the specific pharmacist and the individual dentist, optometrist, physician, 391.1podiatrist, or veterinarian who is responsible for the patient's care and authorized to 391.2independently prescribe drugs. Any significant changes in drug therapy must be reported 391.3by the pharmacist to the patient's medical record;391.4    (7) participation in the storage of drugs and the maintenance of records;391.5    (8) responsibility for participation in patient counseling on therapeutic values, 391.6content, hazards, and uses of drugs and devices; and391.7    (9) offering or performing those acts, services, operations, or transactions necessary 391.8in the conduct, operation, management, and control of a pharmacy.391.9    Sec. 4. Minnesota Statutes 2012, section 151.19, subdivision 1, is amended to read:391.10    Subdivision 1. Pharmacy registration licensure requirements.The board shall 391.11require and provide for the annual registration of every pharmacy now or hereafter doing 391.12business within this state. Upon the payment of any applicable fee specified in section 391.13151.065, the board shall issue a registration certificate in such form as it may prescribe to 391.14such persons as may be qualified by law to conduct a pharmacy. Such certificate shall 391.15be displayed in a conspicuous place in the pharmacy for which it is issued and expire on 391.16the 30th day of June following the date of issue. It shall be unlawful for any person to 391.17conduct a pharmacy unless such certificate has been issued to the person by the board. (a) 391.18No person shall operate a pharmacy without first obtaining a license from the board and 391.19paying any applicable fee specified in section 151.065. The license shall be displayed in a 391.20conspicuous place in the pharmacy for which it is issued and expires on June 30 following 391.21the date of issue. It is unlawful for any person to operate a pharmacy unless the license 391.22has been issued to the person by the board.391.23    (b) Application for a pharmacy license under this section shall be made in a manner 391.24specified by the board.391.25    (c) No license shall be issued or renewed for a pharmacy located within the state 391.26unless the applicant agrees to operate the pharmacy in a manner prescribed by federal and 391.27state law and according to rules adopted by the board. No license shall be issued for a 391.28pharmacy located outside of the state unless the applicant agrees to operate the pharmacy 391.29in a manner prescribed by federal law and, when dispensing medications for residents of 391.30this state, the laws of this state, and Minnesota Rules.391.31    (d) No license shall be issued or renewed for a pharmacy that is required to be 391.32licensed or registered by the state in which it is physically located unless the applicant 391.33supplies the board with proof of such licensure or registration.392.1    (e) The board shall require a separate license for each pharmacy located within 392.2the state and for each pharmacy located outside of the state at which any portion of the 392.3dispensing process occurs for drugs dispensed to residents of this state.392.4    (f) The board shall not issue an initial or renewed license for a pharmacy unless the 392.5pharmacy passes an inspection conducted by an authorized representative of the board. In 392.6the case of a pharmacy located outside of the state, the board may require the applicant to 392.7pay the cost of the inspection, in addition to the license fee in section 151.065, unless the 392.8applicant furnishes the board with a report, issued by the appropriate regulatory agency of 392.9the state in which the facility is located, of an inspection that has occurred within the 24 392.10months immediately preceding receipt of the license application by the board. The board 392.11may deny licensure unless the applicant submits documentation satisfactory to the board 392.12that any deficiencies noted in an inspection report have been corrected.392.13    (g) The board shall not issue an initial or renewed license for a pharmacy located 392.14outside of the state unless the applicant discloses and certifies:392.15    (1) the location, names, and titles of all principal corporate officers and all 392.16pharmacists who are involved in dispensing drugs to residents of this state;392.17    (2) that it maintains its records of drugs dispensed to residents of this state so that the 392.18records are readily retrievable from the records of other drugs dispensed;392.19    (3) that it agrees to cooperate with, and provide information to, the board concerning 392.20matters related to dispensing drugs to residents of this state;392.21    (4) that, during its regular hours of operation, but no less than six days per week, for 392.22a minimum of 40 hours per week, a toll-free telephone service is provided to facilitate 392.23communication between patients in this state and a pharmacist at the pharmacy who has 392.24access to the patients' records; the toll-free number must be disclosed on the label affixed 392.25to each container of drugs dispensed to residents of this state; and392.26    (5) that, upon request of a resident of a long-term care facility located in this 392.27state, the resident's authorized representative, or a contract pharmacy or licensed health 392.28care facility acting on behalf of the resident, the pharmacy will dispense medications 392.29prescribed for the resident in unit-dose packaging or, alternatively, comply with section 392.30151.415, subdivision 5.392.31    Sec. 5. Minnesota Statutes 2012, section 151.19, subdivision 3, is amended to read:392.32    Subd. 3. Sale of federally restricted medical gases.The board shall require and 392.33provide for the annual registration of every person or establishment not licensed as a 392.34pharmacy or a practitioner engaged in the retail sale or distribution of federally restricted 392.35medical gases. Upon the payment of any applicable fee specified in section 151.065, the 393.1board shall issue a registration certificate in such form as it may prescribe to those persons 393.2or places that may be qualified to sell or distribute federally restricted medical gases. The 393.3certificate shall be displayed in a conspicuous place in the business for which it is issued 393.4and expire on the date set by the board. It is unlawful for a person to sell or distribute 393.5federally restricted medical gases unless a certificate has been issued to that person by the 393.6board. (a) A person or establishment not licensed as a pharmacy or a practitioner shall not 393.7engage in the retail sale or distribution of federally restricted medical gases without first 393.8obtaining a registration from the board and paying the applicable fee specified in section 393.9151.065. The registration shall be displayed in a conspicuous place in the business for 393.10which it is issued and expires on the date set by the board. It is unlawful for a person to 393.11sell or distribute federally restricted medical gases unless a certificate has been issued to 393.12that person by the board.393.13    (b) Application for a medical gas distributor registration under this section shall be 393.14made in a manner specified by the board.393.15    (c) No registration shall be issued or renewed for a medical gas distributor located 393.16within the state unless the applicant agrees to operate in a manner prescribed by federal 393.17and state law and according to the rules adopted by the board. No license shall be issued 393.18for a medical gas distributor located outside of the state unless the applicant agrees to 393.19operate in a manner prescribed by federal law and, when distributing medical gases for 393.20residents of this state, the laws of this state and Minnesota Rules.393.21    (d) No registration shall be issued or renewed for a medical gas distributor that is 393.22required to be licensed or registered by the state in which it is physically located unless the 393.23applicant supplies the board with proof of the licensure or registration. The board may, by 393.24rule, establish standards for the registration of a medical gas distributor that is not required 393.25to be licensed or registered by the state in which it is physically located.393.26    (e) The board shall require a separate registration for each medical gas distributor 393.27located within the state and for each facility located outside of the state from which 393.28medical gases are distributed to residents of this state.393.29    (f) The board shall not issue an initial or renewed registration for a medical gas 393.30distributor unless the medical gas distributor passes an inspection conducted by an 393.31authorized representative of the board. In the case of a medical gas distributor located 393.32outside of the state, the board may require the applicant to pay the cost of the inspection, 393.33in addition to the license fee in section 151.065, unless the applicant furnishes the board 393.34with a report, issued by the appropriate regulatory agency of the state in which the facility 393.35is located, of an inspection that has occurred within the 24 months immediately preceding 393.36receipt of the license application by the board. The board may deny licensure unless the 394.1applicant submits documentation satisfactory to the board that any deficiencies noted in 394.2an inspection report have been corrected.394.3    Sec. 6. [151.252] LICENSING OF DRUG MANUFACTURERS; FEES; 394.4PROHIBITIONS.394.5    Subdivision 1.Requirements.(a) No person shall act as a manufacturer without 394.6first obtaining a license from the board and paying any applicable fee specified in section 394.7151.065.394.8    (b) Application for a manufacturer license under this section shall be made in a 394.9manner specified by the board.394.10    (c) No license shall be issued or renewed for a manufacturer unless the applicant 394.11agrees to operate in a manner prescribed by federal and state law and according to 394.12Minnesota Rules.394.13    (d) No license shall be issued or renewed for a manufacturer that is required to 394.14be registered pursuant to United State Code, title 21, section 360, unless the applicant 394.15supplies the board with proof of registration. The board may establish by rule the 394.16standards for licensure of manufacturers that are not required to be registered under United 394.17States Code, title 21, section 360.394.18    (e) No license shall be issued or renewed for a manufacturer that is required to be 394.19licensed or registered by the state in which it is physically located unless the applicant 394.20supplies the board with proof of licensure or registration. The board may establish, by 394.21rule, standards for the licensure of a manufacturer that is not required to be licensed or 394.22registered by the state in which it is physically located.394.23    (f) The board shall require a separate license for each facility located within the state 394.24at which manufacturing occurs and for each facility located outside of the state at which 394.25drugs that are shipped into the state are manufactured.394.26    (g) The board shall not issue an initial or renewed license for a manufacturing 394.27facility unless the facility passes an inspection conducted by an authorized representative 394.28of the board. In the case of a manufacturing facility located outside of the state, the board 394.29may require the applicant to pay the cost of the inspection, in addition to the license fee 394.30in section 151.065, unless the applicant furnishes the board with a report, issued by the 394.31appropriate regulatory agency of the state in which the facility is located or by the United 394.32States Food and Drug Administration, of an inspection that has occurred within the 24 394.33months immediately preceding receipt of the license application by the board. The board 394.34may deny licensure unless the applicant submits documentation satisfactory to the board 394.35that any deficiencies noted in an inspection report have been corrected.395.1    Subd. 2.Prohibition.It is unlawful for any person engaged in manufacturing to sell 395.2legend drugs to anyone located in this state except as provided in this chapter.395.3    Sec. 7. Minnesota Statutes 2012, section 151.26, subdivision 1, is amended to read:395.4    Subdivision 1. Generally. Nothing in this chapter shall subject a person duly 395.5licensed in this state to practice medicine, dentistry, or veterinary medicine, to inspection 395.6by the State Board of Pharmacy, nor prevent the person from administering drugs, 395.7medicines, chemicals, or poisons in the person's practice, nor prevent a duly licensed 395.8practitioner from furnishing to a patient properly packaged and labeled drugs, medicines, 395.9chemicals, or poisons as may be considered appropriate in the treatment of such patient; 395.10unless the person is engaged in the dispensing, sale, or distribution of drugs and the board 395.11provides reasonable notice of an inspection.395.12    Except for the provisions of section 
         151.37, nothing in this chapter applies to or 395.13interferes with the dispensing, in its original package and at no charge to the patient, of 395.14a legend drug, other than a controlled substance, that was packaged by a manufacturer 395.15and provided to the dispenser for distributiondispensing as a professional sample, so 395.16long as the sample is prepared and distributed pursuant to Code of Federal Regulations, 395.17title 21, section 203, subpart D.395.18    Nothing in this chapter shall prevent the sale of drugs, medicines, chemicals, or 395.19poisons at wholesale to licensed physicians, dentists and veterinarians for use in their 395.20practice, nor to hospitals for use therein.395.21    Nothing in this chapter shall prevent the sale of drugs, chemicals, or poisons either 395.22at wholesale or retail for use for commercial purposes, or in the arts, nor interfere with the 395.23sale of insecticides, as defined in Minnesota Statutes 1974, section 
         24.069, and nothing in 395.24this chapter shall prevent the sale of common household preparations and other drugs, 395.25chemicals, and poisons sold exclusively for use for nonmedicinal purposes.395.26    Nothing in this chapter shall apply to or interfere with the vending or retailing 395.27of any nonprescription medicine or drug not otherwise prohibited by statute which is 395.28prepackaged, fully prepared by the manufacturer or producer for use by the consumer, and 395.29labeled in accordance with the requirements of the state or federal Food and Drug Act; nor 395.30to the manufacture, wholesaling, vending, or retailing of flavoring extracts, toilet articles, 395.31cosmetics, perfumes, spices, and other commonly used household articles of a chemical 395.32nature, for use for nonmedicinal purposes. Nothing in this chapter shall prevent the sale of 395.33drugs or medicines by licensed pharmacists at a discount to persons over 65 years of age.395.34    Sec. 8. Minnesota Statutes 2012, section 151.37, subdivision 4, is amended to read:396.1    Subd. 4. Research.(a) Any qualified person may use legend drugs in the course 396.2of a bona fide research project, but cannot administer or dispense such drugs to human 396.3beings unless such drugs are prescribed, dispensed, and administered by a person lawfully 396.4authorized to do so.396.5    (b) Drugs may be dispensed or distributed by a pharmacy licensed by the board for 396.6use by, or administration to, patients enrolled in a bona fide research study that is being 396.7conducted pursuant to either an investigational new drug application approved by the 396.8United States Food and Drug Administration or that has been approved by an institutional 396.9review board. For the purposes of this subdivision only:396.10    (1) a prescription drug order is not required for a pharmacy to dispense a research 396.11drug, unless the study protocol requires the pharmacy to receive such an order;396.12    (2) notwithstanding the prescription labeling requirements found in this chapter or 396.13the rules promulgated by the board, a research drug may be labeled as required by the 396.14study protocol; and396.15    (3) dispensing and distribution of research drugs by pharmacies shall not be 396.16considered compounding, manufacturing, or wholesaling under this chapter.396.17    (c) An entity that is under contract to a federal agency for the purpose of distributing 396.18drugs for bona fide research studies is exempt from the drug wholesaler licensing 396.19requirements of this chapter. Any other entity is exempt from the drug wholesaler 396.20licensing requirements of this chapter if the board finds that the entity is licensed or 396.21registered according to the laws of the state in which it is physically located and it is 396.22distributing drugs for use by, or administration to, patients enrolled in a bona fide research 396.23study that is being conducted pursuant to either an investigational new drug application 396.24approved by the United States Food and Drug Administration or that has been approved 396.25by an institutional review board.396.26EFFECTIVE DATE.This section is effective the day following final enactment.396.27    Sec. 9. Minnesota Statutes 2012, section 151.47, subdivision 1, is amended to read:396.28    Subdivision 1. Requirements.(a) All wholesale drug distributors are subject to the 396.29requirements in paragraphs (a) to (f) of this subdivision.396.30    (a) (b) No person or distribution outlet shall act as a wholesale drug distributor 396.31without first obtaining a license from the board and paying any applicable fee specified 396.32in section 
         151.065.396.33    (c) Application for a wholesale drug distributor license under this section shall be 396.34made in a manner specified by the board.397.1    (b) (d) No license shall be issued or renewed for a wholesale drug distributor to 397.2operate unless the applicant agrees to operate in a manner prescribed by federal and state 397.3law and according to the rules adopted by the board.397.4    (c) The board may require a separate license for each facility directly or indirectly 397.5owned or operated by the same business entity within the state, or for a parent entity 397.6with divisions, subsidiaries, or affiliate companies within the state, when operations 397.7are conducted at more than one location and joint ownership and control exists among 397.8all the entities.397.9    (e) No license may be issued or renewed for a drug wholesale distributor that is 397.10required to be licensed or registered by the state in which it is physically located unless 397.11the applicant supplies the board with proof of licensure or registration. The board may 397.12establish, by rule, standards for the licensure of a drug wholesale distributor that is not 397.13required to be licensed or registered by the state in which it is physically located.397.14    (f) The board shall require a separate license for each drug wholesale distributor 397.15facility located within the state and for each drug wholesale distributor facility located 397.16outside of the state from which drugs are shipped into the state or to which drugs are 397.17reverse distributed.397.18    (g) The board shall not issue an initial or renewed license for a drug wholesale 397.19distributor facility unless the facility passes an inspection conducted by an authorized 397.20representative of the board. In the case of a drug wholesale distributor facility located 397.21outside of the state, the board may require the applicant to pay the cost of the inspection, 397.22in addition to the license fee in section 151.065, unless the applicant furnishes the board 397.23with a report, issued by the appropriate regulatory agency of the state in which the facility 397.24is located, of an inspection that has occurred within the 24 months immediately preceding 397.25receipt of the license application by the board.  The board may deny licensure unless the 397.26applicant submits documentation satisfactory to the board that any deficiencies noted in 397.27an inspection report have been corrected.397.28    (d) (h) As a condition for receiving and retaining a wholesale drug distributor license 397.29issued under sections 
         151.42 to 
         151.51, an applicant shall satisfy the board that it has 397.30and will continuously maintain:397.31    (1) adequate storage conditions and facilities;397.32    (2) minimum liability and other insurance as may be required under any applicable 397.33federal or state law;397.34    (3) a viable security system that includes an after hours central alarm, or comparable 397.35entry detection capability; restricted access to the premises; comprehensive employment 397.36applicant screening; and safeguards against all forms of employee theft;398.1    (4) a system of records describing all wholesale drug distributor activities set forth 398.2in section 
         151.44 for at least the most recent two-year period, which shall be reasonably 398.3accessible as defined by board regulations in any inspection authorized by the board;398.4    (5) principals and persons, including officers, directors, primary shareholders, 398.5and key management executives, who must at all times demonstrate and maintain their 398.6capability of conducting business in conformity with sound financial practices as well 398.7as state and federal law;398.8    (6) complete, updated information, to be provided to the board as a condition for 398.9obtaining and retaining a license, about each wholesale drug distributor to be licensed, 398.10including all pertinent corporate licensee information, if applicable, or other ownership, 398.11principal, key personnel, and facilities information found to be necessary by the board;398.12    (7) written policies and procedures that assure reasonable wholesale drug distributor 398.13preparation for, protection against, and handling of any facility security or operation 398.14problems, including, but not limited to, those caused by natural disaster or government 398.15emergency, inventory inaccuracies or product shipping and receiving, outdated product 398.16or other unauthorized product control, appropriate disposition of returned goods, and 398.17product recalls;398.18    (8) sufficient inspection procedures for all incoming and outgoing product 398.19shipments; and398.20    (9) operations in compliance with all federal requirements applicable to wholesale 398.21drug distribution.398.22    (e) (i)  An agent or employee of any licensed wholesale drug distributor need not 398.23seek licensure under this section.398.24    (f) A wholesale drug distributor shall file with the board an annual report, in a 398.25form and on the date prescribed by the board, identifying all payments, honoraria, 398.26reimbursement or other compensation authorized under section 151.461, clauses (3) to 398.27(5), paid to practitioners in Minnesota during the preceding calendar year. The report 398.28shall identify the nature and value of any payments totaling $100 or more, to a particular 398.29practitioner during the year, and shall identify the practitioner. Reports filed under this 398.30provision are public data.398.31    Sec. 10. Minnesota Statutes 2012, section 151.47, is amended by adding a subdivision 398.32to read:398.33    Subd. 3.Prohibition.It is unlawful for any person engaged in wholesale drug 398.34distribution to sell drugs to a person located within the state or to receive drugs in reverse 398.35distribution from a person located within the state except as provided in this chapter.399.1    Sec. 11. Minnesota Statutes 2012, section 151.49, is amended to read:399.2151.49 LICENSE RENEWAL APPLICATION PROCEDURES.399.3    Application blanks or notices for renewal of a license required by sections 
         151.42399.4to 
         151.51 shall be mailed or otherwise provided to each licensee on or before the first 399.5day of the month prior to the month in which the license expires and, if application for 399.6renewal of the license with the required fee and supporting documents is not made before 399.7the expiration date, the existing license or renewal shall lapse and become null and void 399.8upon the date of expiration.399.9    Sec. 12. Minnesota Statutes 2012, section 152.126, is amended to read:399.10152.126 CONTROLLED SUBSTANCES PRESCRIPTION ELECTRONIC 399.11REPORTING SYSTEM PRESCRIPTION MONITORING PROGRAM.399.12    Subdivision 1. Definitions.(a) For purposes of this section, the terms defined in 399.13this subdivision have the meanings given.399.14    (a) (b) "Board" means the Minnesota State Board of Pharmacy established under 399.15chapter 151.399.16    (b) (c) "Controlled substances" means those substances listed in section 
         152.02, 399.17subdivisions 3 to 5 6, and those substances defined by the board pursuant to section 399.18152.02, subdivisions 7
         , 8, and 12. For the purpose of this section only, "controlled 399.19substances" includes tramadol and butalbital.399.20    (c) (d) "Dispense" or "dispensing" has the meaning given in section 
         151.01, 399.21subdivision 30
         . Dispensing does not include the direct administering of a controlled 399.22substance to a patient by a licensed health care professional.399.23    (d) (e) "Dispenser" means a person authorized by law to dispense a controlled 399.24substance, pursuant to a valid prescription. For the purposes of this section, a dispenser does 399.25not include a licensed hospital pharmacy that distributes controlled substances for inpatient 399.26hospital care or a veterinarian who is dispensing prescriptions under section 
         156.18.399.27    (e) (f) "Prescriber" means a licensed health care professional who is authorized to 399.28prescribe a controlled substance under section 
         152.12, subdivision 1.399.29    (f) (g) "Prescription" has the meaning given in section 
         151.01, subdivision 16.399.30    Subd. 1a. Treatment of intractable pain. This section is not intended to limit or 399.31interfere with the legitimate prescribing of controlled substances for pain. No prescriber 399.32shall be subject to disciplinary action by a health-related licensing board for prescribing a 399.33controlled substance according to the provisions of section 
         152.125.400.1    Subd. 2. Prescription electronic reporting system. (a) The board shall establish 400.2by January 1, 2010, an electronic system for reporting the information required under 400.3subdivision 4 for all controlled substances dispensed within the state.400.4    (b) The board may contract with a vendor for the purpose of obtaining technical 400.5assistance in the design, implementation, operation, and maintenance of the electronic 400.6reporting system.400.7    Subd. 3. Prescription Electronic Reporting Monitoring Program Advisory 400.8Committee. (a) The board shall convene an advisory committee. The committee must 400.9include at least one representative of:400.10    (1) the Department of Health;400.11    (2) the Department of Human Services;400.12    (3) each health-related licensing board that licenses prescribers;400.13    (4) a professional medical association, which may include an association of pain 400.14management and chemical dependency specialists;400.15    (5) a professional pharmacy association;400.16    (6) a professional nursing association;400.17    (7) a professional dental association;400.18    (8) a consumer privacy or security advocate; and400.19    (9) a consumer or patient rights organization; and400.20    (10) an association of medical examiners and coroners.400.21    (b) The advisory committee shall advise the board on the development and operation 400.22of the electronic reporting system prescription monitoring program, including, but not 400.23limited to:400.24    (1) technical standards for electronic prescription drug reporting;400.25    (2) proper analysis and interpretation of prescription monitoring data; and400.26    (3) an evaluation process for the program.400.27    Subd. 4. Reporting requirements; notice. (a) Each dispenser must submit the 400.28following data to the board or its designated vendor, subject to the notice required under 400.29paragraph (d):400.30    (1) name of the prescriber;400.31    (2) national provider identifier of the prescriber;400.32    (3) name of the dispenser;400.33    (4) national provider identifier of the dispenser;400.34    (5) prescription number;400.35    (6) name of the patient for whom the prescription was written;400.36    (7) address of the patient for whom the prescription was written;401.1    (8) date of birth of the patient for whom the prescription was written;401.2    (9) date the prescription was written;401.3    (10) date the prescription was filled;401.4    (11) name and strength of the controlled substance;401.5    (12) quantity of controlled substance prescribed;401.6    (13) quantity of controlled substance dispensed; and401.7    (14) number of days supply.401.8    (b) The dispenser must submit the required information by a procedure and in a 401.9format established by the board. The board may allow dispensers to omit data listed in this 401.10subdivision or may require the submission of data not listed in this subdivision provided 401.11the omission or submission is necessary for the purpose of complying with the electronic 401.12reporting or data transmission standards of the American Society for Automation in 401.13Pharmacy, the National Council on Prescription Drug Programs, or other relevant national 401.14standard-setting body.401.15    (c) A dispenser is not required to submit this data for those controlled substance 401.16prescriptions dispensed for:401.17    (1) individuals residing in licensed skilled nursing or intermediate care facilities;401.18    (2) individuals receiving assisted living services under chapter 144G or through a 401.19medical assistance home and community-based waiver;401.20    (3) individuals receiving medication intravenously;401.21    (4) individuals receiving hospice and other palliative or end-of-life care; and401.22    (5) individuals receiving services from a home care provider regulated under 401.23chapter 144A. individuals residing in a health care facility as defined in section 151.58, 401.24subdivision 2, paragraph (b), when a drug is distributed through the use of an automated 401.25drug distribution system according to section 151.58; and401.26    (2) individuals receiving a drug sample that was packaged by a manufacturer and 401.27provided to the dispenser for dispensing as a professional sample pursuant to Code of 401.28Federal Regulations, title 21, section 203, subpart D.401.29    (d) A dispenser must not submit data under this subdivision unless provide a 401.30conspicuous notice of the reporting requirements of this section is given to the patient for 401.31whom the prescription was written.401.32    Subd. 5. Use of data by board. (a) The board shall develop and maintain a database 401.33of the data reported under subdivision 4. The board shall maintain data that could identify 401.34an individual prescriber or dispenser in encrypted form. The database may be used by 401.35permissible users identified under subdivision 6 for the identification of:402.1    (1) individuals receiving prescriptions for controlled substances from prescribers 402.2who subsequently obtain controlled substances from dispensers in quantities or with a 402.3frequency inconsistent with generally recognized standards of use for those controlled 402.4substances, including standards accepted by national and international pain management 402.5associations; and402.6    (2) individuals presenting forged or otherwise false or altered prescriptions for 402.7controlled substances to dispensers.402.8    (b) No permissible user identified under subdivision 6 may access the database 402.9for the sole purpose of identifying prescribers of controlled substances for unusual or 402.10excessive prescribing patterns without a valid search warrant or court order.402.11    (c) No personnel of a state or federal occupational licensing board or agency may 402.12access the database for the purpose of obtaining information to be used to initiate or 402.13substantiate a disciplinary action against a prescriber.402.14    (d) Data reported under subdivision 4 shall be retained by the board in the an active402.15 database for a 12-month period, and shall be removed from the active database no later 402.16than 12 months from the last day of the month during which the data was received. The 402.17board may transfer the data into a database that may only be used by the authorized staff 402.18of the board for the purposes of administering, operating, and maintaining the prescription 402.19monitoring program and conducting trend analyses and other studies as necessary to 402.20evaluate the effectiveness of the program. No data that can be used to identify an 402.21individual may be transferred into this database.402.22    Subd. 6. Access to reporting system data. (a) Except as indicated in this 402.23subdivision, the data submitted to the board under subdivision 4 is private data on 402.24individuals as defined in section 
         13.02, subdivision 12, and not subject to public disclosure.402.25    (b) Except as specified in subdivision 5, the following persons shall be considered 402.26permissible users and may access the data submitted under subdivision 4 in the same or 402.27similar manner, and for the same or similar purposes, as those persons who are authorized 402.28to access similar private data on individuals under federal and state law:402.29    (1) a prescriber or an agent or employee of the prescriber to whom the prescriber has 402.30delegated the task of accessing the data, to the extent the information relates specifically to 402.31a current patient, to whom the prescriber is prescribing or considering prescribing any 402.32controlled substance or to whom the prescriber is providing other medical treatment for 402.33which access to the data may be necessary and with the provision that the prescriber remains 402.34responsible for the use or misuse of data accessed by a delegated agent or employee;402.35    (2) a dispenser or an agent or employee of the dispenser to whom the dispenser has 402.36delegated the task of accessing the data, to the extent the information relates specifically 403.1to a current patient to whom that dispenser is dispensing or considering dispensing any 403.2controlled substance or to whom the dispenser is providing other pharmaceutical care for 403.3which access to the data may be necessary and with the provision that the dispenser remains 403.4responsible for the use or misuse of data accessed by a delegated agent or employee;403.5    (3) a licensed pharmacist who is providing pharmaceutical care for which access to 403.6the data may be necessary or when consulted by a prescriber who is requesting data in 403.7accordance with clause (1);403.8    (3) (4) an individual who is the recipient of a controlled substance prescription for 403.9which data was submitted under subdivision 4, or a guardian of the individual, parent or 403.10guardian of a minor, or health care agent of the individual acting under a health care 403.11directive under chapter 145C;403.12    (4) (5) personnel of the board specifically assigned to conduct a bona fide 403.13investigation of a specific licensee;403.14    (5) (6) personnel of the board engaged in the collection of controlled substance 403.15prescription information as part of the assigned duties and responsibilities under this 403.16section;403.17    (6) (7) authorized personnel of a vendor under contract with the board who are 403.18engaged in the design, implementation, operation, and maintenance of the electronic 403.19reporting system prescription monitoring program as part of the assigned duties and 403.20responsibilities of their employment, provided that access to data is limited to the 403.21minimum amount necessary to carry out such duties and responsibilities;403.22    (7) (8) federal, state, and local law enforcement authorities acting pursuant to a 403.23valid search warrant; and403.24    (8) (9) personnel of the medical assistance program Minnesota health care programs403.25 assigned to use the data collected under this section to identify and manage recipients 403.26whose usage of controlled substances may warrant restriction to a single primary care 403.27physician provider, a single outpatient pharmacy, or and a single hospital; and403.28    (10) a coroner or medical examiner, or an agent or employee of the coroner or 403.29medical examiner to whom the coroner or medical examiner has delegated the task of 403.30accessing the data, conducting an investigation pursuant to section 390.11, and with the 403.31provision that the coroner or medical examiner remains responsible for the use or misuse 403.32of data accessed by a delegated agent or employee.403.33    For purposes of clause (3) (4), access by an individual includes persons in the 403.34definition of an individual under section 
         13.02.403.35    (c) Any permissible user identified in paragraph (b), who directly accesses 403.36the data electronically, shall implement and maintain a comprehensive information 404.1security program that contains administrative, technical, and physical safeguards that 404.2are appropriate to the user's size and complexity, and the sensitivity of the personal 404.3information obtained. The permissible user shall identify reasonably foreseeable internal 404.4and external risks to the security, confidentiality, and integrity of personal information 404.5that could result in the unauthorized disclosure, misuse, or other compromise of the 404.6information and assess the sufficiency of any safeguards in place to control the risks.404.7    (d) The board shall not release data submitted under this section unless it is provided 404.8with evidence, satisfactory to the board, that the person requesting the information is 404.9entitled to receive the data.404.10    (e) The board shall not release the name of a prescriber without the written consent 404.11of the prescriber or a valid search warrant or court order. The board shall provide a 404.12mechanism for a prescriber to submit to the board a signed consent authorizing the release 404.13of the prescriber's name when data containing the prescriber's name is requested.404.14    (f) The board shall maintain a log of all persons who access the data for a period of 404.15at least five years and shall ensure that any permissible user complies with paragraph (c) 404.16prior to attaining direct access to the data.404.17    (g) (f) Section 
         13.05, subdivision 6, shall apply to any contract the board enters into 404.18pursuant to subdivision 2. A vendor shall not use data collected under this section for 404.19any purpose not specified in this section.404.20    (g) The board may participate in an interstate prescription monitoring program data 404.21exchange system provided that permissible users in other states may have access to the data 404.22only as allowed under this section and that section 13.05, subdivision 6, shall apply to any 404.23contract or memorandum of understanding that the board enters into under this paragraph.404.24    Subd. 7. Disciplinary action. (a) A dispenser who knowingly fails to submit data to 404.25the board as required under this section is subject to disciplinary action by the appropriate 404.26health-related licensing board.404.27    (b) A prescriber or dispenser authorized to access the data who knowingly discloses 404.28the data in violation of state or federal laws relating to the privacy of health care data 404.29shall be subject to disciplinary action by the appropriate health-related licensing board, 404.30and appropriate civil penalties.404.31    Subd. 8.Evaluation and reporting.(a) The board shall evaluate the prescription 404.32electronic reporting system to determine if the system is negatively impacting appropriate 404.33prescribing practices of controlled substances. The board may contract with a vendor to 404.34design and conduct the evaluation.404.35    (b) The board shall submit the evaluation of the system to the legislature by July 404.3615, 2011.405.1    Subd. 9. Immunity from liability; no requirement to obtain information. (a) A 405.2pharmacist, prescriber, or other dispenser making a report to the program in good faith 405.3under this section is immune from any civil, criminal, or administrative liability, which 405.4might otherwise be incurred or imposed as a result of the report, or on the basis that the 405.5pharmacist or prescriber did or did not seek or obtain or use information from the program.405.6    (b) Nothing in this section shall require a pharmacist, prescriber, or other dispenser 405.7to obtain information about a patient from the program, and the pharmacist, prescriber, 405.8or other dispenser, if acting in good faith, is immune from any civil, criminal, or 405.9administrative liability that might otherwise be incurred or imposed for requesting, 405.10receiving, or using information from the program.405.11    Subd. 10. Funding. (a) The board may seek grants and private funds from nonprofit 405.12charitable foundations, the federal government, and other sources to fund the enhancement 405.13and ongoing operations of the prescription electronic reporting system monitoring 405.14program established under this section. Any funds received shall be appropriated to the 405.15board for this purpose. The board may not expend funds to enhance the program in a way 405.16that conflicts with this section without seeking approval from the legislature.405.17    (b) Notwithstanding any other section, the administrative services unit for the 405.18health-related licensing boards shall apportion between the Board of Medical Practice, the 405.19Board of Nursing, the Board of Dentistry, the Board of Podiatric Medicine, the Board of 405.20Optometry, the Board of Veterinary Medicine, and the Board of Pharmacy an amount to 405.21be paid through fees by each respective board. The amount apportioned to each board 405.22shall equal each board's share of the annual appropriation to the Board of Pharmacy 405.23from the state government special revenue fund for operating the prescription electronic 405.24reporting system monitoring program under this section. Each board's apportioned share 405.25shall be based on the number of prescribers or dispensers that each board identified in 405.26this paragraph licenses as a percentage of the total number of prescribers and dispensers 405.27licensed collectively by these boards. Each respective board may adjust the fees that the 405.28boards are required to collect to compensate for the amount apportioned to each board by 405.29the administrative services unit.405.30    Sec. 13. [214.075] HEALTH-RELATED LICENSING BOARDS; CRIMINAL 405.31BACKGROUND CHECKS.405.32    Subdivision 1.Applications.(a) By January 1, 2018, each health-related licensing 405.33board, as defined in section 214.01, subdivision 2, shall require applicants for initial 405.34licensure, licensure by endorsement, or reinstatement or other relicensure after a lapse 405.35in licensure, as defined by the individual health-related licensing boards, to submit to 406.1a criminal history records check of state data completed by the Bureau of Criminal 406.2Apprehension (BCA) and a national criminal history records check, including a search of 406.3the records of the Federal Bureau of Investigation (FBI).406.4(b) An applicant must complete a criminal background check if more than one year 406.5has elapsed since the applicant last submitted a background check to the board.406.6    Subd. 2.Investigations.If a health-related licensing board has reasonable cause 406.7to believe a licensee has been charged with or convicted of a crime in this or any other 406.8jurisdiction, the health-related licensing board may require the licensee to submit to a 406.9criminal history records check of state data completed by the BCA and a national criminal 406.10history records check, including a search of the records of the FBI.406.11    Subd. 3.Consent form; fees; fingerprints.(a) In order to effectuate the federal 406.12and state level, fingerprint-based criminal background check, the applicant or licensee 406.13must submit a completed criminal history records check consent form and a full set of 406.14fingerprints to the respective health-related licensing board or a designee in the manner 406.15and form specified by the board. 406.16(b) The applicant or licensee is responsible for all fees associated with preparation of 406.17the fingerprints, the criminal records check consent form, and the criminal background 406.18check. The fees for the criminal records background check shall be set by the BCA and 406.19the FBI and are not refundable. The fees shall be submitted to the respective health-related 406.20licensing board by the applicant or licensee as prescribed by the respective board. 406.21    (c) All fees received by the health-related licensing boards under this subdivision 406.22shall be deposited in a dedicated account in the special revenue fund and are appropriated 406.23to the Board of Nursing Home Administrators for the administrative services unit to pay 406.24for the criminal background checks conducted by the Bureau of Criminal Apprehension 406.25and Federal Bureau of Investigation.406.26    Subd. 4.Refusal to consent.(a) The health-related licensing boards shall not issue 406.27a license to any applicant who refuses to consent to a criminal background check or fails 406.28to submit fingerprints within 90 days after submission of an application for licensure. Any 406.29fees paid by the applicant to the board shall be forfeited if the applicant refuses to consent 406.30to the criminal background check or fails to submit the required fingerprints.406.31(b) The failure of a licensee to submit to a criminal background check as provided in 406.32subdivision 3 is grounds for disciplinary action by the respective health licensing board.406.33    Subd. 5.Submission of fingerprints to the Bureau of Criminal Apprehension.406.34The health-related licensing board or designee shall submit applicant or licensee 406.35fingerprints to the BCA. The BCA shall perform a check for state criminal justice 406.36information and shall forward the applicant's or licensee's fingerprints to the FBI to 407.1perform a check for national criminal justice information regarding the applicant or 407.2licensee. The BCA shall report to the board the results of the state and national criminal 407.3justice information checks.407.4    Subd. 6.Alternatives to fingerprint-based criminal background checks.The 407.5health-related licensing board may require an alternative method of criminal history 407.6checks for an applicant or licensee who has submitted at least three sets of fingerprints in 407.7accordance with this section that have been unreadable by the BCA or the FBI.407.8    Subd. 7.Data practices.Criminal history record information obtained by the 407.9health-related licensing board under this section is private data on individuals under 407.10section 13.02, subdivision 12.407.11    Subd. 8.Opportunity to challenge accuracy of report.Prior to taking disciplinary 407.12action against an applicant or a licensee based on a criminal conviction, the health-related 407.13licensing board shall provide the applicant or the licensee an opportunity to complete or 407.14challenge the accuracy of the criminal history information reported to the board. The 407.15applicant or licensee shall have 30 calendar days following notice from the board of 407.16the intent to deny licensure or to take disciplinary action to request an opportunity to 407.17correct or complete the record prior to the board taking disciplinary action based on the 407.18information reported to the board. The board shall provide the applicant up to 180 days to 407.19challenge the accuracy or completeness of the report with the agency responsible for the 407.20record. This subdivision does not affect the right of the subject of the data to contest the 407.21accuracy or completeness under section 13.04, subdivision 4.407.22    Subd. 9.Instructions to the board; plans.The health-related licensing boards, in 407.23collaboration with the commissioner of human services and the BCA, shall establish a 407.24plan for completing criminal background checks of all licensees who were licensed before 407.25the effective date requirement under subdivision 1. The plan must seek to minimize 407.26duplication of requirements for background checks of licensed health professionals. The 407.27plan for background checks of current licensees shall be developed no later than January 407.281, 2017, and may be contingent upon the implementation of a system by the BCA or FBI 407.29in which any new crimes that an applicant or licensee commits after an initial background 407.30check are flagged in the BCA's or FBI's database and reported back to the board. The plan 407.31shall include recommendations for any necessary statutory changes.407.32    Sec. 14. Minnesota Statutes 2012, section 214.12, is amended by adding a subdivision 407.33to read:407.34    Subd. 4.Parental depression.The health-related licensing boards that regulate 407.35professions that serve caregivers at risk of depression, or their children, including 408.1behavioral health and therapy, chiropractic, marriage and family therapy, medical practice, 408.2nursing, psychology, and social work, shall provide educational materials to licensees on 408.3the subject of parental depression and its potential effects on children if unaddressed, 408.4including how to:408.5(1) screen mothers for depression;408.6(2) identify children who are affected by their mother's depression; and408.7(3) provide treatment or referral information on needed services.408.8    Sec. 15. Minnesota Statutes 2012, section 214.40, subdivision 1, is amended to read:408.9    Subdivision 1. Definitions. (a) The definitions in this subdivision apply to this 408.10section.408.11(b) "Administrative services unit" means the administrative services unit for the 408.12health-related licensing boards.408.13(c) "Charitable organization" means a charitable organization within the meaning of 408.14section 501(c)(3) of the Internal Revenue Code that has as a purpose the sponsorship or 408.15support of programs designed to improve the quality, awareness, and availability of health 408.16care services and that serves as a funding mechanism for providing those services.408.17(d) "Health care facility or organization" means a health care facility licensed under 408.18chapter 144 or 144A, or a charitable organization.408.19(e) "Health care provider" means a physician licensed under chapter 147, physician 408.20assistant registered licensed and practicing under chapter 147A, nurse licensed and 408.21registered to practice under chapter 148, or dentist or, dental hygienist, or dental therapist408.22 licensed under chapter 150A, or an advanced dental therapist licensed and certified under 408.23chapter 150A.408.24(f) "Health care services" means health promotion, health monitoring, health 408.25education, diagnosis, treatment, minor surgical procedures, the administration of local 408.26anesthesia for the stitching of wounds, and primary dental services, including preventive, 408.27diagnostic, restorative, and emergency treatment. Health care services do not include the 408.28administration of general anesthesia or surgical procedures other than minor surgical 408.29procedures.408.30(g) "Medical professional liability insurance" means medical malpractice insurance 408.31as defined in section 
         62F.03.408.32EFFECTIVE DATE.This section is effective the day following final enactment.408.33    Sec. 16. INCLUSION OF OTHER HEALTH-RELATED OCCUPATIONS TO 408.34CRIMINAL BACKGROUND CHECKS.409.1(a) If the Department of Health is not reviewed by the Sunset Advisory Commission 409.2according to the schedule in Minnesota Statutes, section 3D.21, the commissioner 409.3of health, as the regulator for occupational therapy practitioners, speech-language 409.4pathologists, audiologists, and hearing instrument dispensers, shall require applicants 409.5for licensure or renewal to submit to a criminal history records check as required under 409.6Minnesota Statutes, section 214.075, for other health-related licensed occupations 409.7regulated by the health-related licensing boards.409.8(b) Any statutory changes necessary to include the commissioner of health to 409.9Minnesota Statutes, section 214.075, shall be included in the plan required in Minnesota 409.10Statutes, section 214.075, subdivision 9.409.11    Sec. 17.  REPEALER.409.12Minnesota Statutes 2012, sections 151.19, subdivision 2; 151.25; 151.45; 151.47, 409.13subdivision 2; and 151.48, are repealed.409.14ARTICLE 11409.15HOME CARE PROVIDERS409.16    Section 1. Minnesota Statutes 2012, section 13.381, subdivision 2, is amended to read:409.17    Subd. 2. Health occupations data. (a) Health-related licensees and registrants.409.18The collection, analysis, reporting, and use of data on individuals licensed or registered by 409.19the commissioner of health or health-related licensing boards are governed by sections 409.20144.051, subdivision 2 subdivisions 2 to 6, and 
         144.052.409.21(b) Health services personnel. Data collected by the commissioner of health for the 409.22database on health services personnel are classified under section 
         144.1485.409.23    Sec. 2. Minnesota Statutes 2012, section 13.381, subdivision 10, is amended to read:409.24    Subd. 10. Home care and hospice provider. Data regarding a home care provider 409.25under sections 
         144A.43 to 
         144A.47 are governed by section 
         144A.45. Data regarding 409.26home care provider background studies are governed by section 144A.476, subdivision 1. 409.27Data regarding a hospice provider under sections 
         144A.75 to 
         144A.755 are governed by 409.28sections 
         144A.752 and 
         144A.754.409.29    Sec. 3. Minnesota Statutes 2012, section 144.051, is amended by adding a subdivision 409.30to read:409.31    Subd. 3.Data classification; private data.For providers regulated pursuant to 409.32sections 144A.43 to 144A.482, the following data collected, created, or maintained by 410.1the commissioner are classified as private data on individuals as defined in section 13.02, 410.2subdivision 12:410.3(1) data submitted by or on behalf of applicants for licenses prior to issuance of 410.4the license;410.5(2) the identity of complainants who have made reports concerning licensees or 410.6applicants unless the complainant consents to the disclosure;410.7(3) the identity of individuals who provide information as part of surveys and 410.8investigations;410.9(4) Social Security numbers; and410.10(5) health record data.410.11    Sec. 4. Minnesota Statutes 2012, section 144.051, is amended by adding a subdivision 410.12to read:410.13    Subd. 4.Data classification; public data.For providers regulated pursuant to 410.14sections 144A.43 to 144A.482, the following data collected, created, or maintained by the 410.15commissioner are public:410.16(1) all application data on licensees, license numbers, license status;410.17(2) licensing information about licenses previously held under this chapter;410.18(3) correction orders, including information about compliance with the order and 410.19whether the fine was paid;410.20(4) final enforcement actions pursuant to chapter 14;410.21(5) orders for hearing, findings of fact and conclusions of law; and410.22(6) when the licensee and department agree to resolve the matter without a hearing, 410.23the agreement and specific reasons for the agreement are public data.410.24    Sec. 5. Minnesota Statutes 2012, section 144.051, is amended by adding a subdivision 410.25to read:410.26    Subd. 5.Data classification; confidential data.For providers regulated pursuant to 410.27sections 144A.43 to 144A.482, the following data collected, created, or maintained by 410.28the Department of Health are classified as confidential data on individuals as defined in 410.29section 13.02, subdivision 3: active investigative data relating to the investigation of 410.30potential violations of law by a licensee including data from the survey process before the 410.31correction order is issued by the department.410.32    Sec. 6. Minnesota Statutes 2012, section 144.051, is amended by adding a subdivision 410.33to read:411.1    Subd. 6.Release of private or confidential data.For providers regulated pursuant 411.2to sections 144A.43 to 144A.482, the department may release private or confidential data, 411.3except Social Security numbers, to the appropriate state, federal, or local agency and law 411.4enforcement office to facilitate investigative or enforcement efforts or further the public 411.5health protective process. Types of offices include Adult Protective Services, Office of the 411.6Ombudsmen for Long-Term Care and Office of the Ombudsmen for Mental Health and 411.7Developmental Disabilities, health licensing boards, the Department of Human Services, 411.8county or city attorney's offices, police, and local or county public health offices.411.9    Sec. 7. Minnesota Statutes 2012, section 144A.43, is amended to read:411.10144A.43 DEFINITIONS.411.11    Subdivision 1. Applicability. The definitions in this section apply to sections 411.12144.699, subdivision 2
         , and 
         144A.43 to 
         144A.47 144A.482. 411.13    Subd. 1a.Agent."Agent" means the person upon whom all notices and orders shall 411.14be served and who is authorized to accept service of notices and orders on behalf of 411.15the home care provider.411.16    Subd. 1b.Applicant."Applicant" means an individual, organization, association, 411.17corporation, unit of government, or other entity that applies for a temporary license, 411.18license, or renewal of their home care provider license under section 144A.472.411.19    Subd. 1c.Client."Client" means a person to whom home care services are provided.411.20    Subd. 1d.Client record."Client record" means all records that document 411.21information about the home care services provided to the client by the home care provider.411.22    Subd. 1e.Client representative."Client representative" means a person who, 411.23because of the client's needs, makes decisions about the client's care on behalf of the 411.24client. A client representative may be a guardian, health care agent, family member, or 411.25other agent of the client. Nothing in this section expands or diminishes the rights of 411.26persons to act on behalf of clients under other law.411.27    Subd. 2. Commissioner. "Commissioner" means the commissioner of health.411.28    Subd. 2a.Controlled substance."Controlled substance" has the meaning given 411.29in section 152.01, subdivision 4.411.30    Subd. 2b.Department."Department" means the Minnesota Department of Health.411.31    Subd. 2c.Dietary supplement."Dietary supplement" means a product taken by 411.32mouth that contains a "dietary ingredient" intended to supplement the diet. Dietary 411.33ingredients may include vitamins, minerals, herbs or other botanicals, amino acids, and 411.34substances such as enzymes, organ tissue, glandulars, or metabolites.412.1    Subd. 2d.Dietitian."Dietitian" is a person licensed under sections 148.621 to 412.2148.633.412.3    Subd. 2e.Dietetics or nutrition practice."Dietetics or nutrition practice" is 412.4performed by a licensed dietitian or licensed nutritionist and includes the activities of 412.5assessment, setting priorities and objectives, providing nutrition counseling, developing 412.6and implementing nutrition care services, and evaluating and maintaining appropriate 412.7standards of quality of nutrition care under sections 148.621 to 148.633.412.8    Subd. 3. Home care service. "Home care service" means any of the following 412.9services when delivered in a place of residence tothe home of a person whose illness, 412.10disability, or physical condition creates a need for the service:412.11(1) nursing services, including the services of a home health aide;412.12(2) personal care services not included under sections 148.171 to 148.285; 412.13(3) physical therapy;412.14(4) speech therapy;412.15(5) respiratory therapy;412.16(6) occupational therapy;412.17(7) nutritional services;412.18(8) home management services when provided to a person who is unable to perform 412.19these activities due to illness, disability, or physical condition. Home management 412.20services include at least two of the following services: housekeeping, meal preparation, 412.21and shopping;412.22(9) medical social services;412.23(10) the provision of medical supplies and equipment when accompanied by the 412.24provision of a home care service; and412.25(11) other similar medical services and health-related support services identified by 412.26the commissioner in rule.412.27"Home care service" does not include the following activities conducted by the 412.28commissioner of health or a board of health as defined in section 145A.02, subdivision 2: 412.29communicable disease investigations or testing; administering or monitoring a prescribed 412.30therapy necessary to control or prevent a communicable disease; or the monitoring 412.31of an individual's compliance with a health directive as defined in section 144.4172, 412.32subdivision 6. 412.33(1) assistive tasks as defined in section 144A.471, subdivision 6, provided by 412.34unlicensed personnel;413.1(2) services provided by a registered nurse or licensed practical nurse, physical 413.2therapist, respiratory therapist, occupational therapist, speech-language pathologist, 413.3dietitian or nutritionist, or social worker;413.4(3) medication and treatment management services; or413.5(4) the provision of durable medical equipment services when provided with any of 413.6the home care services listed in clauses (1) to (3).413.7    Subd. 3a.Hands-on-assistance."Hands-on-assistance" means physical help by 413.8another person without which the client is not able to perform the activity.413.9    Subd. 3b.Home."Home" means the client's temporary or permanent place of 413.10residence.413.11    Subd. 4. Home care provider. "Home care provider" means an individual, 413.12organization, association, corporation, unit of government, or other entity that is regularly 413.13engaged in the delivery of at least one home care service, directly or by contractual 413.14arrangement, of home care services in a client's home for a fee and who has a valid current 413.15temporary license or license issued under sections 144A.43 to 144A.482. At least one 413.16home care service must be provided directly, although additional home care services may 413.17be provided by contractual arrangements. "Home care provider" does not include:413.18(1) any home care or nursing services conducted by and for the adherents of any 413.19recognized church or religious denomination for the purpose of providing care and 413.20services for those who depend upon spiritual means, through prayer alone, for healing;413.21(2) an individual who only provides services to a relative;413.22(3) an individual not connected with a home care provider who provides assistance 413.23with home management services or personal care needs if the assistance is provided 413.24primarily as a contribution and not as a business;413.25(4) an individual not connected with a home care provider who shares housing with 413.26and provides primarily housekeeping or homemaking services to an elderly or disabled 413.27person in return for free or reduced-cost housing;413.28(5) an individual or agency providing home-delivered meal services;413.29(6) an agency providing senior companion services and other older American 413.30volunteer programs established under the Domestic Volunteer Service Act of 1973, 413.31Public Law 98-288;413.32(7) an employee of a nursing home licensed under this chapter or an employee of a 413.33boarding care home licensed under sections 144.50 to 144.56 who responds to occasional 413.34emergency calls from individuals residing in a residential setting that is attached to or 413.35located on property contiguous to the nursing home or boarding care home; 414.1(8) a member of a professional corporation organized under chapter 319B that does 414.2not regularly offer or provide home care services as defined in subdivision 3;414.3(9) the following organizations established to provide medical or surgical services 414.4that do not regularly offer or provide home care services as defined in subdivision 3: 414.5a business trust organized under sections 318.01 to 318.04, a nonprofit corporation 414.6organized under chapter 317A, a partnership organized under chapter 323, or any other 414.7entity determined by the commissioner; 414.8(10) an individual or agency that provides medical supplies or durable medical 414.9equipment, except when the provision of supplies or equipment is accompanied by a 414.10home care service;414.11(11) an individual licensed under chapter 147; or414.12(12) an individual who provides home care services to a person with a developmental 414.13disability who lives in a place of residence with a family, foster family, or primary caregiver.414.14    Subd. 5.Medication reminder."Medication reminder" means providing a verbal 414.15or visual reminder to a client to take medication. This includes bringing the medication 414.16to the client and providing liquids or nutrition to accompany medication that a client is 414.17self-administering.414.18    Subd. 6.License."License" means a basic or comprehensive home care license 414.19issued by the commissioner to a home care provider.414.20    Subd. 7.Licensed health professional."Licensed health professional" means a 414.21person, other than a registered nurse or licensed practical nurse, who provides home care 414.22services within the scope of practice of the person's health occupation license, registration, 414.23or certification as regulated and who is licensed by the appropriate Minnesota state board 414.24or agency.414.25    Subd. 8.Licensee."Licensee" means a home care provider that is licensed under 414.26this chapter.414.27    Subd. 9.Managerial official."Managerial official" means an administrator, 414.28director, officer, trustee, or employee of a home care provider, however designated, who 414.29has the authority to establish or control business policy.414.30    Subd. 10.Medication."Medication" means a prescription or over-the-counter drug. 414.31For purposes of this chapter only, medication includes dietary supplements.414.32    Subd. 11.Medication administration."Medication administration" means 414.33performing a set of tasks to ensure a client takes medications, and includes the following:414.34(1) checking the client's medication record;414.35(2) preparing the medication as necessary;414.36(3) administering the medication to the client;415.1(4) documenting the administration or reason for not administering the medication; 415.2and415.3(5) reporting to a nurse any concerns about the medication, the client, or the client's 415.4refusal to take the medication.415.5    Subd. 12.Medication management."Medication management" means the 415.6provision of any of the following medication-related services to a client:415.7(1) performing medication setup;415.8(2) administering medication;415.9(3) storing and securing medications;415.10(4) documenting medication activities;415.11(5) verifying and monitoring effectiveness of systems to ensure safe handling and 415.12administration;415.13(6) coordinating refills;415.14(7) handling and implementing changes to prescriptions;415.15(8) communicating with the pharmacy about the client's medications; and415.16(9) coordinating and communicating with the prescriber.415.17    Subd. 13.Medication setup."Medication setup" means arranging medications by a 415.18nurse, pharmacy, or authorized prescriber for later administration by the client or by 415.19comprehensive home care staff.415.20    Subd. 14.Nurse."Nurse" means a person who is licensed under sections 148.171 to 415.21148.285.415.22    Subd. 15.Occupational therapist."Occupational therapist" means a person who is 415.23licensed under sections 148.6401 to 148.6450.415.24    Subd. 16.Over-the-counter drug."Over-the-counter drug" means a drug that is 415.25not required by federal law to bear the symbol "Rx only."415.26    Subd. 17.Owner."Owner" means a proprietor, general partner, limited partner who 415.27has five percent or more of equity interest in a limited partnership, a person who owns or 415.28controls voting stock in a corporation in an amount equal to or greater than five percent of 415.29the shares issued and outstanding, or a corporation that owns equity interest in a licensee 415.30or applicant for a license.415.31    Subd. 18.Pharmacist."Pharmacist" has the meaning given in section 151.01, 415.32subdivision 3.415.33    Subd. 19.Physical therapist."Physical therapist" means a person who is licensed 415.34under sections 148.65 to 148.78.415.35    Subd. 20.Physician."Physician" means a person who is licensed under chapter 147.416.1    Subd. 21.Prescriber."Prescriber" means a person who is authorized by sections 416.2148.235; 151.01, subdivision 23; and 151.37, to prescribe prescription drugs.416.3    Subd. 22.Prescription."Prescription" has the meaning given in section 151.01, 416.4subdivision 16.416.5    Subd. 23.Regularly scheduled."Regularly scheduled" means ordered or planned 416.6to be completed at predetermined times or according to a predetermined routine.416.7    Subd. 24.Reminder."Reminder" means providing a verbal or visual reminder 416.8to a client.416.9    Subd. 25.Respiratory therapist."Respiratory therapist" means a person who 416.10is licensed under chapter 147C.416.11    Subd. 26.Revenues."Revenues" means all money received by a licensee derived 416.12from the provisions of home care services, including fees for services and appropriations 416.13of public money for home care services.416.14    Subd. 27.Service plan."Service plan" means the written plan between the client or 416.15client's representative and the temporary licensee or licensee about the services that will 416.16be provided to the client.416.17    Subd. 28.Social worker."Social worker" means a person who is licensed under 416.18chapter 148D or 148E.416.19    Subd. 29.Speech language pathologist."Speech language pathologist" has the 416.20meaning given in section 148.512.416.21    Subd. 30.Standby assistance."Standby assistance" means the presence of another 416.22person within arm's reach to minimize the risk of injury while performing daily activities 416.23through physical intervention or cuing.416.24    Subd. 31.Substantial compliance."Substantial compliance" means complying 416.25with the requirements in this chapter sufficiently to prevent unacceptable health or safety 416.26risks to the home care client.416.27    Subd. 32.Survey."Survey" means an inspection of a licensee or applicant for 416.28licensure for compliance with this chapter.416.29    Subd. 33.Surveyor."Surveyor" means a staff person of the department authorized 416.30to conduct surveys of home care providers and applicants.416.31    Subd. 34.Temporary license."Temporary license" means the initial basic or 416.32comprehensive home care license the department issues after approval of a complete 416.33written application and before the department completes the temporary license survey and 416.34determines that the temporary licensee is in substantial compliance.417.1    Subd. 35.Treatment or therapy."Treatment" or "therapy" means the provision 417.2of care, other than medications, ordered or prescribed by a licensed health professional 417.3provided to a client to cure, rehabilitate, or ease symptoms.417.4    Subd. 36.Unit of government."Unit of government" means every city, county, 417.5town, school district, other political subdivisions of the state, and any agency of the state 417.6or federal government, which includes any instrumentality of a unit of government.417.7    Subd. 37.Unlicensed personnel."Unlicensed personnel" are individuals not 417.8otherwise licensed or certified by a governmental health board or agency who provide 417.9home care services in the client's home.417.10    Subd. 38.Verbal."Verbal" means oral and not in writing.417.11    Sec. 8. Minnesota Statutes 2012, section 144A.44, is amended to read:417.12144A.44 HOME CARE BILL OF RIGHTS.417.13    Subdivision 1. Statement of rights. A person who receives home care services 417.14has these rights:417.15(1) the right to receive written information about rights in advance ofbefore 417.16receiving care or during the initial evaluation visit before the initiation of treatment417.17 services, including what to do if rights are violated;417.18(2) the right to receive care and services according to a suitable and up-to-date plan, 417.19and subject to accepted health care, medical or nursing standards, to take an active part 417.20in creating and changing the plan developing, modifying, and evaluating care the plan417.21 and services;417.22(3) the right to be told in advance of before receiving care about the services that will 417.23be provided, the disciplines that will furnish care the type and disciplines of staff who will 417.24be providing the services, the frequency of visits proposed to be furnished, other choices 417.25that are available for addressing home care needs, and the consequences of these choices 417.26including the potential consequences of refusing these services;417.27(4) the right to be told in advance of any change recommended changes by the 417.28provider in the service plan of care and to take an active part in any change decisions 417.29about changes to the service plan;417.30(5) the right to refuse services or treatment;417.31(6) the right to know, in advance before receiving services or during the initial 417.32visit, any limits to the services available from a home care provider, and the provider's 417.33grounds for a termination of services;418.1(7) the right to know in advance of receiving care whether the services are covered 418.2by health insurance, medical assistance, or other health programs, the charges for services 418.3that will not be covered by Medicare, and the charges that the individual may have to pay;418.4(8) (7) the right to know be told before services are initiated what the provider 418.5charges are for the services, no matter who will be paying the bill and if known, to what 418.6extent payment may be expected from health insurance, public programs or other sources, 418.7and what charges the client may be responsible for paying;418.8(9)(8) the right to know that there may be other services available in the community, 418.9including other home care services and providers, and to know where to go for find418.10 information about these services;418.11(10) (9) the right to choose freely among available providers and to change providers 418.12after services have begun, within the limits of health insurance, long-term care insurance, 418.13medical assistance, or other health programs;418.14(11) (10) the right to have personal, financial, and medical information kept private, 418.15and to be advised of the provider's policies and procedures regarding disclosure of such 418.16information;418.17(12) (11) the right to be allowed access tothe client's own records and written 418.18information from those records in accordance with sections 
         144.291 to 144.298;418.19(13) (12) the right to be served by people who are properly trained and competent 418.20to perform their duties;418.21(14) (13) the right to be treated with courtesy and respect, and to have the patient's418.22 client's property treated with respect;418.23(15) (14) the right to be free from physical and verbal abuse, neglect, financial 418.24exploitation, and all forms of maltreatment covered under the Vulnerable Adults Act and 418.25the Maltreatment of Minors Act;418.26(16) (15) the right to reasonable, advance notice of changes in services or charges, 418.27including;418.28(16) the right to know the provider's reason for termination of services;418.29(17) the right to at least ten days' advance notice of the termination of a service by a 418.30provider, except in cases where:418.31(i) the recipient of services client engages in conduct that significantly alters the 418.32conditions of employment as specified in the employment contract between terms of 418.33the service plan with the home care provider and the individual providing home care 418.34services, or creates;418.35(ii) the client, person who lives with the client, or others create an abusive or unsafe 418.36work environment for the individual person providing home care services; or419.1(ii) (iii) an emergency for the informal caregiver or a significant change in the 419.2recipient's client's condition has resulted in service needs that exceed the current service 419.3provider agreement plan and that cannot be safely met by the home care provider;419.4(17) (18) the right to a coordinated transfer when there will be a change in the 419.5provider of services;419.6(18) (19) the right to voice grievances regarding treatment or care that is complain 419.7about services that are provided, or fails to be, furnished, or regarding fail to be provided, 419.8and  the lack of courtesy or respect to the patientclient or the patient'sclient's property;419.9(19) (20) the right to know how to contact an individual associated with the home 419.10care provider who is responsible for handling problems and to have the home care provider 419.11investigate and attempt to resolve the grievance or complaint;419.12(20) (21) the right to know the name and address of the state or county agency to 419.13contact for additional information or assistance; and419.14(21) (22) the right to assert these rights personally, or have them asserted by 419.15the patient's family or guardian when the patient has been judged incompetent, client's 419.16representative or by anyone on behalf of the client, without retaliation.419.17    Subd. 2. Interpretation and enforcement of rights. These rights are established 419.18for the benefit of persons clients who receive home care services. "Home care services" 419.19means home care services as defined in section 144A.43, subdivision 3, and unlicensed 419.20personal care assistance services, including services covered by medical assistance under 419.21section 256B.0625, subdivision 19a.All home care providers, including those exempted 419.22under section 144A.471, must comply with this section. The commissioner shall enforce 419.23this section and the home care bill of rights requirement against home care providers 419.24exempt from licensure in the same manner as for licensees. A home care provider may 419.25not request or require a person client to surrender any of these rights as a condition of 419.26receiving services. A guardian or conservator or, when there is no guardian or conservator, 419.27a designated person, may seek to enforce these rights. This statement of rights does not 419.28replace or diminish other rights and liberties that may exist relative to persons clients419.29 receiving home care services, persons providing home care services, or providers licensed 419.30under Laws 1987, chapter 378. A copy of these rights must be provided to an individual 419.31at the time home care services, including personal care assistance services, are initiated. 419.32The copy shall also contain the address and phone number of the Office of Health Facility 419.33Complaints and the Office of Ombudsman for Long-Term Care and a brief statement 419.34describing how to file a complaint with these offices. Information about how to contact 419.35the Office of Ombudsman for Long-Term Care shall be included in notices of change in 420.1client fees and in notices where home care providers initiate transfer or discontinuation of 420.2services sections 144A.43 to 144A.482.420.3    Sec. 9. Minnesota Statutes 2012, section 144A.45, is amended to read:420.4144A.45 REGULATION OF HOME CARE SERVICES.420.5    Subdivision 1. Rules Regulations. The commissioner shall adopt rules for the 420.6regulation of regulate home care providers pursuant to sections 
         144A.43 to 
         144A.47420.7 144A.482. The rules regulations shall include the following:420.8    (1) provisions to assure, to the extent possible, the health, safety and well-being, 420.9and appropriate treatment of persons who receive home care services while respecting 420.10clients' autonomy and choice;420.11    (2) requirements that home care providers furnish the commissioner with specified 420.12information necessary to implement sections 
         144A.43 to 
         144A.47 144A.482;420.13    (3) standards of training of home care provider personnel, which may vary according 420.14to the nature of the services provided or the health status of the consumer;420.15(4) standards for provision of home care services;420.16    (4) (5) standards for medication management which may vary according to the 420.17nature of the services provided, the setting in which the services are provided, or the 420.18status of the consumer. Medication management includes the central storage, handling, 420.19distribution, and administration of medications;420.20    (5) (6) standards for supervision of home care services requiring supervision by a 420.21registered nurse or other appropriate health care professional which must occur on site 420.22at least every 62 days, or more frequently if indicated by a clinical assessment, and in 420.23accordance with sections 148.171 to 148.285 and rules adopted thereunder, except that a 420.24person performing home care aide tasks for a class B licensee providing paraprofessional 420.25services does not require nursing supervision;420.26    (6) (7) standards for client evaluation or assessment which may vary according to 420.27the nature of the services provided or the status of the consumer;420.28    (7) (8) requirements for the involvement of a consumer's physician client's health 420.29care provider, the documentation of physicians' health care providers' orders, if required, 420.30and the consumer's treatment client's service plan, and;420.31(9) the maintenance of accurate, current clinical client records;420.32    (8) (10) the establishment of different classes basic and comprehensive levels of 420.33licenses for different types of providers and different standards and requirements for 420.34different kinds of home carebased on services provided; and421.1    (9) operating procedures required to implement (11) provisions to enforce these 421.2regulations and the home care bill of rights.421.3    Subd. 1a.Home care aide tasks.Notwithstanding the provisions of Minnesota 421.4Rules, part 4668.0110, subpart 1, item E, home care aide tasks also include assisting 421.5toileting, transfers, and ambulation if the client is ambulatory and if the client has no 421.6serious acute illness or infectious disease.421.7    Subd. 1b.Home health aide qualifications.Notwithstanding the provisions of 421.8Minnesota Rules, part 4668.0100, subpart 5, a person may perform home health aide tasks 421.9if the person maintains current registration as a nursing assistant on the Minnesota nursing 421.10assistant registry. Maintaining current registration on the Minnesota nursing assistant 421.11registry satisfies the documentation requirements of Minnesota Rules, part 4668.0110, 421.12subpart 3.421.13    Subd. 2. Regulatory functions.(a) The commissioner shall:421.14(1) evaluate, monitor, and license, survey, and monitor without advance notice,  home 421.15care providers in accordance with sections 
         144A.45 to 144A.47 144A.43 to 144A.482;421.16(2) inspect the office and records of a provider during regular business hours without 421.17advance notice to the home care provider;421.18(2) survey every temporary licensee within one year of the temporary license issuance 421.19date subject to the temporary licensee providing home care services to a client or clients;421.20(3) survey all licensed home care providers on an interval that will promote the 421.21health and safety of clients;421.22(3) (4) with the consent of the consumer client, visit the home where services are 421.23being provided;421.24(4) (5) issue correction orders and assess civil penalties in accordance with section 421.25144.653, subdivisions 5 to 8
         , for violations of sections 
         144A.43 to 
         144A.47 or the rules 421.26adopted under those sections 144A.482;421.27(5) (6) take action as authorized in section 
         144A.46, subdivision 3 144A.475; and421.28(6) (7) take other action reasonably required to accomplish the purposes of sections 421.29144A.43
          to 
         144A.47 144A.482.421.30(b) In the exercise of the authority granted in sections 144A.43 to 144A.47, the 421.31commissioner shall comply with the applicable requirements of section 144.122, the 421.32Government Data Practices Act, and the Administrative Procedure Act.421.33    Subd. 4.Medicaid reimbursement.Notwithstanding the provisions of section 421.34256B.37 or state plan requirements to the contrary, certification by the federal Medicare 421.35program must not be a requirement of Medicaid payment for services delivered under 421.36section 144A.4605.422.1    Subd. 5.Home care providers; services for Alzheimer's disease or related 422.2disorder.(a) If a home care provider licensed under section 144A.46 or 144A.4605 markets 422.3or otherwise promotes services for persons with Alzheimer's disease or related disorders, 422.4the facility's direct care staff and their supervisors must be trained in dementia care.422.5(b) Areas of required training include:422.6(1) an explanation of Alzheimer's disease and related disorders;422.7(2) assistance with activities of daily living;422.8(3) problem solving with challenging behaviors; and422.9(4) communication skills.422.10(c) The licensee shall provide to consumers in written or electronic form a 422.11description of the training program, the categories of employees trained, the frequency 422.12of training, and the basic topics covered.422.13    Sec. 10. [144A.471] HOME CARE PROVIDER AND HOME CARE SERVICES.422.14    Subdivision 1.License required.A home care provider may not open, operate, 422.15manage, conduct, maintain, or advertise itself as a home care provider or provide home 422.16care services in Minnesota without a temporary or current home care provider license 422.17issued by the commissioner of health.422.18    Subd. 2.Determination of direct home care service."Direct home care service" 422.19means a home care service provided to a client by the home care provider or its employees, 422.20and not by contract. Factors that must be considered in determining whether an individual 422.21or a business entity provides at least one home care service directly include, but are not 422.22limited to, whether the individual or business entity:422.23    (1) has the right to control, and does control, the types of services provided;422.24(2) has the right to control, and does control, when and how the services are provided;422.25    (3) establishes the charges;422.26(4) collects fees from the clients or receives payment from third-party payers on 422.27the clients' behalf;422.28(5) pays individuals providing services compensation on an hourly, weekly, or 422.29similar basis;422.30(6) treats the individuals providing services as employees for the purposes of payroll 422.31taxes and workers' compensation insurance; and422.32(7) holds itself out as a provider of home care services or acts in a manner that 422.33leads clients or potential clients to believe that it is a home care provider providing home 422.34care services.422.35    None of the factors listed in this subdivision is solely determinative.423.1    Subd. 3.Determination of regularly engaged."Regularly engaged" means 423.2providing, or offering to provide, home care services as a regular part of a business. The 423.3following factors must be considered by the commissioner in determining whether an 423.4individual or a business entity is regularly engaged in providing home care services:423.5    (1) whether the individual or business entity states or otherwise promotes that the 423.6individual or business entity provides home care services;423.7    (2) whether persons receiving home care services constitute a substantial part of the 423.8individual's or the business entity's clientele; and423.9(3) whether the home care services provided are other than occasional or incidental 423.10to the provision of services other than home care services.423.11    None of the factors listed in this subdivision is solely determinative.423.12    Subd. 4.Penalties for operating without license.A person involved in the 423.13management, operation, or control of a home care provider that operates without an 423.14appropriate license is guilty of a misdemeanor. This section does not apply to a person 423.15who has no legal authority to affect or change decisions related to the management, 423.16operation, or control of a home care provider.423.17    Subd. 5.Basic and comprehensive levels of licensure.An applicant seeking 423.18to become a home care provider must apply for either a basic or comprehensive home 423.19care license.423.20    Subd. 6.Basic home care license provider.Home care services that can be 423.21provided with a basic home care license are assistive tasks provided by licensed or 423.22unlicensed personnel that include:423.23(1) assisting with dressing, self-feeding, oral hygiene, hair care, grooming, toileting, 423.24and bathing;423.25(2) providing standby assistance;423.26(3) providing verbal or visual reminders to the client to take regularly scheduled 423.27medication which includes bringing the client previously set-up medication, medication in 423.28original containers, or liquid or food to accompany the medication;423.29(4) providing verbal or visual reminders to the client to perform regularly scheduled 423.30treatments and exercises;423.31(5) preparing modified diets ordered by a licensed health professional; and423.32(6) assisting with laundry, housekeeping, meal preparation, shopping, or other 423.33household chores and services if the provider is also providing at least one of the activities 423.34in clauses (1) to (5)424.1    Subd. 7.Comprehensive home care license provider.Home care services that 424.2may be provided with a comprehensive home care license include any of the basic home 424.3care services listed in subdivision 6, and one or more of the following:424.4(1) services of an advanced practice nurse, registered nurse, licensed practical 424.5nurse, physical therapist, respiratory therapist, occupational therapist, speech-language 424.6pathologist, dietitian or nutritionist, or social worker;424.7(2) tasks delegated to unlicensed personnel by a registered nurse or assigned by a 424.8licensed health professional within the person's scope of practice;424.9(3) medication management services;424.10(4) hands-on assistance with transfers and mobility;424.11(5) assisting clients with eating when the clients have complicating eating problems 424.12as identified in the client record or through an assessment such as difficulty swallowing, 424.13recurrent lung aspirations, or requiring the use of a tube or parenteral or intravenous 424.14instruments to be fed; or424.15(6) providing other complex or specialty health care services.424.16    Subd. 8.Exemptions from home care services licensure.(a) Except as otherwise 424.17provided in this chapter, home care services that are provided by the state, counties, or 424.18other units of government must be licensed under this chapter.424.19(b) An exemption under this subdivision does not excuse the exempted individual or 424.20organization from complying with applicable provisions of the home care bill of rights 424.21in section 144A.44. The following individuals or organizations are exempt from the 424.22requirement to obtain a home care provider license:424.23(1) an individual or organization that offers, provides, or arranges for personal care 424.24assistance services under the medical assistance program as authorized under sections 424.25256B.04, subdivision 16; 256B.0625, subdivision 19a; and 256B.0659;424.26(2) a provider that is licensed by the commissioner of human services to provide 424.27semi-independent living services for persons with developmental disabilities under section 424.28252.275 and Minnesota Rules, parts 9525.0900 to 9525.1020;424.29(3) a provider that is licensed by the commissioner of human services to provide 424.30home and community-based services for persons with developmental disabilities under 424.31section 256B.092 and Minnesota Rules, parts 9525.1800 to 9525.1930;424.32(4) an individual or organization that provides only home management services, if 424.33the individual or organization is registered under section 144A.482; or 424.34(5) an individual who is licensed in this state as a nurse, dietitian, social worker, 424.35occupational therapist, physical therapist, or speech-language pathologist who provides 425.1health care services in the home independently and not through any contractual or 425.2employment relationship with a home care provider or other organization.425.3    Subd. 9.Exclusions from home care licensure.The following are excluded from 425.4home care licensure and are not required to provide the home care bill of rights:425.5(1) an individual or business entity providing only coordination of home care that 425.6includes one or more of the following:425.7(i) determination of whether a client needs home care services, or assisting a client 425.8in determining what services are needed;425.9(ii) referral of clients to a home care provider;425.10(iii) administration of payments for home care services; or425.11(iv) administration of a health care home established under section 256B.0751;425.12(2) an individual who is not an employee of a licensed home care provider if the 425.13individual:425.14(i) only provides services as an independent contractor to one or more licensed 425.15home care providers;425.16(ii) provides no services under direct agreements or contracts with clients; and425.17(iii) is contractually bound to perform services in compliance with the contracting 425.18home care provider's policies and service plans;425.19(3) a business that provides staff to home care providers, such as a temporary 425.20employment agency, if the business:425.21(i) only provides staff under contract to licensed or exempt providers;425.22(ii) provides no services under direct agreements with clients; and425.23(iii) is contractually bound to perform services under the contracting home care 425.24provider's direction and supervision;425.25(4) any home care services conducted by and for the adherents of any recognized 425.26church or religious denomination for its members through spiritual means, or by prayer 425.27for healing;425.28(5) an individual who only provides home care services to a relative;425.29(6) an individual not connected with a home care provider that provides assistance 425.30with basic home care needs if the assistance is provided primarily as a contribution and 425.31not as a business;425.32(7) an individual not connected with a home care provider that shares housing with 425.33and provides primarily housekeeping or homemaking services to an elderly or disabled 425.34person in return for free or reduced-cost housing;425.35(8) an individual or provider providing home-delivered meal services;426.1(9) an individual providing senior companion services and other Older American 426.2Volunteer Programs (OAVP) established under the Domestic Volunteer Service Act of 426.31973, United States Code, title 42, chapter 66;426.4(10) an employee of a nursing home licensed under this chapter or an employee of a 426.5boarding care home licensed under sections 144.50 to 144.56 who responds to occasional 426.6emergency calls from individuals residing in a residential setting that is attached to or 426.7located on property contiguous to the nursing home or boarding care home;426.8(11) a member of a professional corporation organized under chapter 319B that 426.9does not regularly offer or provide home care services as defined in section 144A.43, 426.10subdivision 3;426.11(12) the following organizations established to provide medical or surgical services 426.12that do not regularly offer or provide home care services as defined in section 144A.43, 426.13subdivision 3: a business trust organized under sections 318.01 to 318.04, a nonprofit 426.14corporation organized under chapter 317A, a partnership organized under chapter 323, or 426.15any other entity determined by the commissioner;426.16(13) an individual or agency that provides medical supplies or durable medical 426.17equipment, except when the provision of supplies or equipment is accompanied by a 426.18home care service;426.19(14) a physician licensed under chapter 147;426.20(15) an individual who provides home care services to a person with a developmental 426.21disability who lives in a place of residence with a family, foster family, or primary caregiver;426.22(16) a business that only provides services that are primarily instructional and not 426.23medical services or health-related support services;426.24(17) an individual who performs basic home care services for no more than 14 hours 426.25each calendar week to no more than one client;426.26(18) an individual or business licensed as hospice as defined in sections 144A.75 to 426.27144A.755 who is not providing home care services independent of hospice service;426.28(19) activities conducted by the commissioner of health or a board of health as 426.29defined in section 145A.02, subdivision 2, including communicable disease investigations 426.30or testing; or426.31(20) administering or monitoring a prescribed therapy necessary to control or 426.32prevent a communicable disease, or the monitoring of an individual's compliance with a 426.33health directive as defined in section 144.4172, subdivision 6.426.34    Sec. 11. [144A.472] HOME CARE PROVIDER LICENSE; APPLICATION 426.35AND RENEWAL.427.1    Subdivision 1.License applications.Each application for a home care provider 427.2license must include information sufficient to show that the applicant meets the 427.3requirements of licensure, including:427.4    (1) the applicant's name, e-mail address, physical address, and mailing address, 427.5including the name of the county in which the applicant resides and has a principal 427.6place of business;427.7(2) the initial license fee in the amount specified in subdivision 7;427.8(3) e-mail address, physical address, mailing address, and telephone number of the 427.9principal administrative office;427.10(4) e-mail address, physical address, mailing address, and telephone number of 427.11each branch office, if any;427.12(5) names, e-mail and mailing addresses, and telephone numbers of all owners 427.13and managerial officials;427.14(6) documentation of compliance with the background study requirements of section 427.15144A.476 for all persons involved in the management, operation, or control of the home 427.16care provider;427.17(7) documentation of a background study as required by section 144.057 for any 427.18individual seeking employment, paid or volunteer, with the home care provider;427.19(8) evidence of workers' compensation coverage as required by sections 176.181 427.20and 176.182;427.21(9) documentation of liability coverage, if the provider has it;427.22(10) identification of the license level the provider is seeking;427.23(11) documentation that identifies the managerial official who is in charge of 427.24day-to-day operations and attestation that the person has reviewed and understands the 427.25home care provider regulations;427.26(12) documentation that the applicant has designated one or more owners, 427.27managerial officials, or employees as an agent or agents, which shall not affect the legal 427.28responsibility of any other owner or managerial official under this chapter;427.29(13) the signature of the officer or managing agent on behalf of an entity, corporation, 427.30association, or unit of government;427.31(14) verification that the applicant has the following policies and procedures in place 427.32so that if a license is issued, the applicant will implement the policies and procedures 427.33and keep them current:427.34    (i) requirements in sections 626.556, reporting of maltreatment of minors, and 427.35626.557, reporting of maltreatment of vulnerable adults;427.36(ii) conducting and handling background studies on employees;428.1(iii) orientation, training, and competency evaluations of home care staff, and a 428.2process for evaluating staff performance;428.3(iv) handling complaints from clients, family members, or client representatives 428.4regarding staff or services provided by staff;428.5(v) conducting initial evaluation of clients' needs and the providers' ability to provide 428.6those services;428.7(vi) conducting initial and ongoing client evaluations and assessments and how 428.8changes in a client's condition are identified, managed, and communicated to staff and 428.9other health care providers as appropriate;428.10(vii) orientation to and implementation of the home care client bill of rights;428.11(viii) infection control practices;428.12(ix) reminders for medications, treatments, or exercises, if provided; and428.13(x) conducting appropriate screenings, or documentation of prior screenings, to 428.14show that staff are free of tuberculosis, consistent with current United States Centers for 428.15Disease Control standards; and428.16(15) other information required by the department.428.17    Subd. 2.Comprehensive home care license applications.In addition to the 428.18information and fee required in subdivision 1, applicants applying for a comprehensive 428.19home care license must also provide verification that the applicant has the following 428.20policies and procedures in place so that if a license is issued, the applicant will implement 428.21the policies and procedures in this subdivision and keep them current:428.22(1) conducting initial and ongoing assessments of the client's needs by a registered 428.23nurse or appropriate licensed health professional, including how changes in the client's 428.24conditions are identified, managed, and communicated to staff and other health care 428.25providers, as appropriate;428.26(2) ensuring that nurses and licensed health professionals have current and valid 428.27licenses to practice;428.28(3) medication and treatment management;428.29(4) delegation of home care tasks by registered nurses or licensed health professionals;428.30(5) supervision of registered nurses and licensed health professionals; and428.31(6) supervision of unlicensed personnel performing delegated home care tasks.428.32    Subd. 3.License renewal.(a) Except as provided in section 144A.475, a license 428.33may be renewed for a period of one year if the licensee satisfies the following:428.34(1) submits an application for renewal in the format provided by the commissioner 428.35at least 30 days before expiration of the license;428.36(2) submits the renewal fee in the amount specified in subdivision 7;429.1(3) has provided home care services within the past 12 months;429.2(4) complies with sections 144A.43 to 144A.4799;429.3(5) provides information sufficient to show that the applicant meets the requirements 429.4of licensure, including items required under subdivision 1;429.5(6) provides verification that all policies under subdivision 1 are current; and 429.6(7) provides any other information deemed necessary by the commissioner.429.7(b) A renewal applicant who holds a comprehensive home care license must also 429.8provide verification that policies listed under subdivision 2 are current.429.9    Subd. 4.Multiple units.Multiple units or branches of a licensee must be separately 429.10licensed if the commissioner determines that the units cannot adequately share supervision 429.11and administration of services from the main office.429.12    Subd. 5.Transfers prohibited; changes in ownership.Any home care license 429.13issued by the commissioner may not be transferred to another party. Before acquiring 429.14ownership of a home care provider business, a prospective applicant must apply for a 429.15new temporary license. A change of ownership is a transfer of operational control to 429.16a different business entity, and includes:429.17(1) transfer of the business to a different or new corporation;429.18(2) in the case of a partnership, the dissolution or termination of the partnership under 429.19chapter 323A, with the business continuing by a successor partnership or other entity; 429.20(3) relinquishment of control of the provider to another party, including to a contract 429.21management firm that is not under the control of the owner of the business' assets;429.22(4) transfer of the business by a sole proprietor to another party or entity; or429.23(5) in the case of a privately held corporation, the change in ownership or control of 429.2450 percent or more of the outstanding voting stock.429.25    Subd. 6.Notification of changes of information.The temporary licensee or 429.26licensee shall notify the commissioner in writing within ten working days after any 429.27change in the information required in subdivision 1, except the information required in 429.28subdivision 1, clause (5), is required at the time of license renewal.429.29    Subd. 7.Fees; application, change of ownership, and renewal.(a) An applicant 429.30seeking a temporary home care licensure must submit the following application fee to the 429.31commissioner along with a completed application:429.32(1) basic home care provider, $2,100; or429.33(2) comprehensive home care provider, $4,200.429.34(b) A home care provider who is filing a change of ownership as required under 429.35subdivision 5 must submit the following application fee to the commissioner, along with 429.36the documentation required for the change of ownership:430.1(1) basic home care provider, $2,100; or430.2(2) comprehensive home care provider, $4,200.430.3(c) A home care provider who is seeking to renew the provider's license shall pay a 430.4fee to the commissioner based on revenues derived from the provision of home care 430.5services during the calendar year prior to the year in which the application is submitted, 430.6according to the following schedule:430.7License Renewal Fee

430.8Provider Annual RevenueFee430.9greater than $1,500,000$6,625430.10430.11greater than $1,275,000 and no more than $1,500,000$5,797430.12430.13greater than $1,100,000 and no more than $1,275,000$4,969430.14430.15greater than $950,000 and no more than $1,100,000$4,141430.16430.17greater than $850,000 and no more than $950,000$3,727430.18430.19greater than $750,000 and no more than $850,000$3,313430.20430.21greater than $650,000 and no more than $750,000$2,898430.22430.23greater than $550,000 and no more than $650,000$2,485430.24430.25greater than $450,000 and no more than $550,000$2,070430.26430.27greater than $350,000 and no more than $450,000$1,656430.28430.29greater than $250,000 and no more than $350,000$1,242430.30430.31greater than $100,000 and no more than $250,000$828430.32430.33greater than $50,000 and no more than $100,000$500430.34430.35greater than $25,000 and no more than $50,000$400430.36no more than $25,000$200

430.37(d) If requested, the home care provider shall provide the commissioner information 430.38to verify the provider's annual revenues or other information as needed, including copies 430.39of documents submitted to the Department of Revenue.430.40(e) At each annual renewal, a home care provider may elect to pay the highest 430.41renewal fee for its license category, and not provide annual revenue information to the 430.42commissioner.431.1(f) A temporary license or license applicant, or temporary licensee or licensee that 431.2knowingly provides the commissioner incorrect revenue amounts for the purpose of 431.3paying a lower license fee, shall be subject to a civil penalty in the amount of double the 431.4fee the provider should have paid.431.5(g) Fees and penalties collected under this section shall be deposited in the state 431.6treasury and credited to the special state government revenue fund.431.7    Sec. 12. [144A.473] ISSUANCE OF TEMPORARY LICENSE AND LICENSE 431.8RENEWAL.431.9    Subdivision 1.Temporary license and renewal of license.(a) The department 431.10shall review each application to determine the applicant's knowledge of and compliance 431.11with Minnesota home care regulations. Before granting a temporary license or renewing a 431.12license, the commissioner may further evaluate the applicant or licensee by requesting 431.13additional information or documentation or by conducting an on-site survey of the 431.14applicant to determine compliance with sections 144A.43 to 144A.482.431.15(b) Within 14 calendar days after receiving an application for a license, 431.16the commissioner shall acknowledge receipt of the application in writing. The 431.17acknowledgment must indicate whether the application appears to be complete or whether 431.18additional information is required before the application will be considered complete.431.19(c) Within 90 days after receiving a complete application, the commissioner shall 431.20issue a temporary license, renew the license, or deny the license.431.21(d) The commissioner shall issue a license that contains the home care provider's 431.22name, address, license level, expiration date of the license, and unique license number. All 431.23licenses are valid for one year from the date of issuance.431.24    Subd. 2.Temporary license.(a) For new license applicants, the commissioner 431.25shall issue a temporary license for either the basic or comprehensive home care level. A 431.26temporary license is effective for one year from the date of issuance. Temporary licensees 431.27must comply with sections 144A.43 to 144A.482.431.28(b) During the temporary license year, the commissioner shall survey the temporary 431.29licensee after the commissioner is notified or has evidence that the temporary licensee 431.30is providing home care services.431.31(c) Within five days of beginning the provision of services, the temporary 431.32licensee must notify the commissioner that it is serving clients. The notification to the 431.33commissioner may be mailed or e-mailed to the commissioner at the address provided by 431.34the commissioner. If the temporary licensee does not provide home care services during 432.1the temporary license year, then the temporary license expires at the end of the year and 432.2the applicant must reapply for a temporary home care license.432.3(d) A temporary licensee may request a change in the level of licensure prior to 432.4being surveyed and granted a license by notifying the commissioner in writing and 432.5providing additional documentation or materials required to update or complete the 432.6changed temporary license application. The applicant must pay the difference between the 432.7application fees when changing from the basic to the comprehensive level of licensure. 432.8No refund will be made if the provider chooses to change the license application to the 432.9basic level.432.10(e) If the temporary licensee notifies the commissioner that the licensee has clients 432.11within 45 days prior to the temporary license expiration, the commissioner may extend the 432.12temporary license for up to 60 days in order to allow the commissioner to complete the 432.13on-site survey required under this section and follow-up survey visits.432.14    Subd. 3.Temporary licensee survey.(a) If the temporary licensee is in substantial 432.15compliance with the survey, the commissioner shall issue either a basic or comprehensive 432.16home care license. If the temporary licensee is not in substantial compliance with the 432.17survey, the commissioner shall not issue a basic or comprehensive license and there will 432.18be no contested hearing right under chapter 14.432.19(b) If the temporary licensee whose basic or comprehensive license has been denied 432.20disagrees with the conclusions of the commissioner, then the licensee may request a 432.21reconsideration by the commissioner or commissioner's designee. The reconsideration 432.22request process will be conducted internally by the commissioner or commissioner's 432.23designee, and chapter 14 does not apply.432.24(c) The temporary licensee requesting reconsideration must make the request in 432.25writing and must list and describe the reasons why the licensee disagrees with the decision 432.26to deny the basic or comprehensive home care license.432.27(d) A temporary licensee whose license is denied must comply with the requirements 432.28for notification and transfer of clients in section 144A.475, subdivision 5.432.29    Sec. 13. [144A.474] SURVEYS AND INVESTIGATIONS.432.30    Subdivision 1.Surveys.The commissioner shall conduct surveys of each home 432.31care provider. By June 30, 2016, the commissioner shall conduct a survey of home care 432.32providers on a frequency of at least once every three years. Survey frequency may be 432.33based on the license level, the provider's compliance history, number of clients served, 432.34or other factors as determined by the department deemed necessary to ensure the health, 432.35safety, and welfare of clients and compliance with the law.433.1    Subd. 2.Types of home care surveys.(a) "Initial full survey" is the survey 433.2conducted of a new temporary licensee after the department is notified or has evidence that 433.3the licensee is providing home care services to determine if the provider is in compliance 433.4with home care requirements. Initial surveys must be completed within 14 months after 433.5the department's issuance of a temporary basic or comprehensive license.433.6(b) "Core survey" means periodic inspection of home care providers to determine 433.7ongoing compliance with the home care requirements focusing on the essential health and 433.8safety requirements.  Core surveys are available to licensed home care providers who have 433.9been licensed for three years, and been surveyed at least once in the past three years, 433.10with the latest survey having no widespread violation or violations beyond Level 1 as 433.11provided in subdivision 11.   Providers must also have not had any substantiated licensing 433.12complaints, substantiated complaints against the agency under the Vulnerable Adults 433.13Act or Maltreatment of Minors Act, or an enforcement action as authorized in section  433.14144A.475 in the past three years. The core survey for basic license level providers will 433.15review compliance in the following areas:433.16(1) reporting of maltreatment;433.17(2) orientation to and implementation of home care client bill of rights;433.18(3) statement of home care services;433.19(4) initial evaluation of clients and initiation of services;433.20(5) basic license level client review and monitoring;433.21(6) service plan implementation and changes to the service plan;433.22(7) client complaint and investigative process;433.23(8) competency of unlicensed personnel; and433.24(9) infection control.433.25For comprehensive license level providers, the core survey will include everything 433.26in the basic license level core survey plus these areas: 433.27(1) assessment, monitoring, and reassessments of clients; and433.28(2) medication, treatment, and therapy management. 433.29(c) "Full survey" means the periodic inspection of home care providers to determine 433.30ongoing compliance with the home care requirements that cover the core survey areas and 433.31all the legal requirements for home care providers. A full survey will be conducted for 433.32all temporary licensees, providers who do not meet the requirements needed for a core 433.33survey, and when a surveyor identifies unacceptable client health or safety risks during a 433.34core survey.  A full survey will include all the tasks identified as part of the core survey 433.35and any additional review deemed necessary by the department, including additional 433.36observation, interviewing, or records review of additional clients and staff.  434.1(d) "Follow-up surveys" are conducted to determine if a home care provider has 434.2corrected deficient issues and systems identified during a core survey, full survey, or 434.3complaint investigation. Follow-up surveys may be conducted via phone, e-mail, fax, 434.4mail, or on-site reviews. Follow-up surveys, other than complaint surveys, shall be 434.5concluded with an exit conference and written information provided on the process for 434.6requesting a reconsideration of the survey results.434.7(e) Upon receiving information alleging that a home care provider has violated or 434.8is currently violating a requirement of sections  144A.43 to 144A.482, the commissioner 434.9shall investigate the complaint according to sections 144A.51 to 144A.54.434.10    Subd. 3.Survey process. The survey process for core surveys shall include the 434.11following as applicable to the particular licensee and setting surveyed:434.12(1) presurvey review of  pertinent documents and notification to the ombudsman 434.13for long-term care;  434.14(2) an entrance conference with available staff; 434.15(3) communication with managerial officials or the RN in charge, if available, and 434.16ongoing communication with key staff throughout the survey regarding information 434.17needed by the surveyor, clarifications regarding home care requirements, and applicable 434.18standards of practice;434.19(4) presentation of written contact information to the provider about the survey staff 434.20conducting the survey, the supervisor, and the process for requesting a reconsideration of 434.21the survey results;434.22(5) a brief tour of a sampling of  the housing with services establishments in which 434.23the provider is providing home care services; 434.24(6) a sample selection of home care clients;434.25(7) information gathering through client and staff observations, client and staff 434.26interviews, and reviews of records, policies, procedures, practices, and other agency 434.27information; 434.28(8) interviews of client's family members, if available, with client's consent when the 434.29client can legally give consent;434.30(9) except for complaint surveys conducted by the Office of Health Facilities 434.31Complaints, an on-site exit conference with preliminary findings shared and discussed 434.32with the provider, documentation that an exit conference occurred, and written information 434.33on the process for requesting a reconsideration of the survey results; and434.34(10) postsurvey analysis of findings and formulation of survey results, including 434.35correction orders when applicable.435.1    Subd. 4.Scheduling surveys.Surveys and investigations shall be conducted 435.2without advance notice to home care providers. Surveyors may contact the home care 435.3provider on the day of a survey to arrange for someone to be available at the survey site. 435.4The contact does not constitute advance notice.435.5    Subd. 5.Information provided by home care provider.The home care provider 435.6shall provide accurate and truthful information to the department during a survey, 435.7investigation, or other licensing activities.435.8    Subd. 6.Providing client records.Upon request of a surveyor, home care providers 435.9shall provide a list of current and past clients or client representatives that includes 435.10addresses and telephone numbers and any other information requested about the services 435.11to clients within a reasonable period of time.435.12    Subd. 7.Contacting and visiting clients.Surveyors may contact or visit a home 435.13care provider's clients to gather information without notice to the home care provider. 435.14Before visiting a client, a surveyor shall obtain the client's or client's representative's 435.15permission by telephone, mail, or in person. Surveyors shall inform all clients or client's 435.16representatives of their right to decline permission for a visit.435.17    Subd. 8.Correction orders.(a) A correction order may be issued whenever the 435.18commissioner finds upon survey or during a complaint investigation that a home care 435.19provider, managerial official, or an employee of the provider is not in compliance with 435.20sections 144A.43 to 144A.482. The correction order shall cite the specific statute and 435.21document areas of noncompliance and the time allowed for correction.435.22(b) The commissioner shall mail copies of any correction order to the last known 435.23address of the home care provider. A copy of each correction order and copies of any 435.24documentation supplied to the commissioner shall be kept on file by the home care 435.25provider, and public documents shall be made available for viewing by any person upon 435.26request. Copies may be kept electronically.435.27(c) By the correction order date, the home care provider must document in the 435.28provider's records any action taken to comply with the correction order. The commissioner 435.29may request a copy of this documentation and the home care provider's action to respond 435.30to the correction order in future surveys, upon a complaint investigation, and as otherwise 435.31needed.435.32    Subd. 9.Follow-up surveys.For providers that have Level III or Level IV 435.33violations or any violations determined to be widespread, the department shall conduct a 435.34follow-up survey within 90 calendar days of the survey. When conducting a follow-up 435.35survey, the surveyor will focus on whether the previous violations have been corrected and 435.36may also address any new violations that are observed while evaluating the corrections 436.1that have been made. If a new violation is identified on a follow-up survey, no fine will be 436.2imposed unless it is not corrected on the next follow-up survey.436.3    Subd. 10.Performance incentive.A licensee is eligible for a performance 436.4incentive if there are no violations identified in a core or full survey.  The performance 436.5incentive is a ten percent discount on the licensee's next home care renewal license fee.436.6    Subd. 11.Fines.(a) Fines and enforcement actions under this subdivision may be 436.7assessed based on the level and scope of the violations described in paragraph (c) as follows:436.8(1) Level I, no fines or enforcement;436.9(2) Level II, fines ranging from $0 to $500, in addition to any of the enforcement 436.10mechanisms authorized in section 144A.475 for widespread violations;436.11(3) Level III, fines ranging from $500 to $1,000, in addition to any of the 436.12enforcement mechanisms authorized in section 144A.475; and436.13(4) Level IV, fines ranging from $1,000 to $5,000, in addition to any of the 436.14enforcement mechanisms authorized in section 144A.475.436.15(b) Correction orders for violations will be categorized by both level and scope as 436.16follows, and fines will be assessed accordingly: 436.17(1) level of violation:436.18(i) Level I, a violation that has no potential to cause more than a minimal impact on 436.19the client and does not affect health or safety;436.20(ii) Level II, a violation that did not harm the client's health or safety, but had the 436.21potential to have harmed a client's health or safety, but not likely to cause serious injury, 436.22impairment, or death;436.23(iii) Level III, a violation that harmed a client's health or safety, not including serious 436.24injury, impairment, or death, or a violation that has the potential to lead to serious injury, 436.25impairment, or death; and436.26(iv) Level IV, a violation that results in serious injury, impairment or death.436.27(2) scope of violation: 436.28(i) isolated, when one or a limited number of clients are affected, or one or a limited 436.29number of staff are involved,  or the situation has occurred only occasionally;436.30(ii) pattern,  when more than a limited number of clients are affected, more than a 436.31limited number of staff are involved, or the situation has had repeated occurrences but 436.32is not found to be pervasive; or436.33(iii) widespread; when problems are pervasive or represent a systemic failure that 436.34has affected or has the potential to affect a large portion or all of the clients.436.35(c) If the commissioner finds that the applicant or a home care provider required 436.36to be licensed under sections 144A.43 to 144A.482 has not corrected violations by the 437.1date specified in the correction order or conditional license resulting from a survey or 437.2complaint investigation, the commissioner may impose a fine. A notice of noncompliance 437.3with a correction order must be mailed to the applicant's or provider's last known address. 437.4The noncompliance notice must list the violations not corrected.437.5(d) The license holder must pay the fines assessed on or before the payment date 437.6specified. If the license holder fails to fully comply with the order, the commissioner 437.7may issue a second fine or suspend the license until the license holder complies by 437.8paying the fine. A timely appeal shall stay payment of the fine until the commissioner 437.9issues a final order.437.10(e) A license holder shall promptly notify the commissioner in writing when a 437.11violation specified in the order is corrected. If upon reinspection, the commissioner 437.12determines that a violation has not been corrected as indicated by the order, the 437.13commissioner may issue a second fine. The commissioner shall notify the license holder by 437.14mail to the last known address in the licensing record that a second fine has been assessed. 437.15The license holder may appeal the second fine as provided under this subdivision.437.16(f) A home care provider that has been assessed a fine under this subdivision has a 437.17right to a reconsideration or a hearing under this section and chapter 14.437.18(g) When a fine has been assessed, the license holder may not avoid payment by 437.19closing, selling, or otherwise transferring the licensed program to a third party. In such an 437.20event, the license holder shall be liable for payment of the fine. 437.21(h) In addition to any fine imposed under this section, the commissioner may assess 437.22costs related to an investigation that results in a final order assessing a fine or other 437.23enforcement action authorized by this chapter.437.24(i) Fines collected under this subdivision shall be deposited in the state government 437.25special revenue fund and credited to an account separate from the revenue collected under 437.26section 144A.472. Subject to an appropriation by the legislature, the revenue from the 437.27fines collected may be used by the commissioner for special projects to improve home care 437.28in Minnesota as recommended by the advisory council established in section 144A.4799.437.29    Subd. 12.Reconsideration.(a) The commissioner shall make available to home 437.30care providers a correction order reconsideration process.  This process may be used 437.31to challenge the correction order issued, including the level and scope described in 437.32subdivision 11, and any fine assessed. During the correction order reconsideration 437.33request, the issuance of the correction orders under reconsideration are not stayed, but 437.34the department will post information on the Web site with the correction order that the 437.35licensee has requested a reconsideration review and that the review is pending.438.1(b) A licensed home care provider may request from the commissioner, in writing, 438.2a correction order reconsideration regarding any correction order issued to the provider. 438.3The correction order reconsideration shall not be reviewed by any surveyor, investigator, 438.4or supervisor that participated in the writing or reviewing of the correction order being 438.5disputed. The correction order reconsiderations may be conducted in person by telephone, 438.6by another electronic form, or in writing, as determined by the commissioner. The 438.7commissioner shall respond in writing to the request from a home care provider for 438.8a correction order reconsideration within 60 days of the date the provider requests a 438.9reconsideration. The commissioner's response shall identify the commissioner's decision 438.10regarding each citation challenged by the home care provider.438.11(c) The findings of a correction order reconsideration process shall be one or more of 438.12the following:438.13(1) supported in full: the correction order is supported in full, with no deletion of 438.14findings to the citation;438.15(2) supported in substance: the correction order is supported, but one or more 438.16findings are deleted or modified without any change in the citation;438.17 (3) correction order cited an incorrect home care licensing requirement: the correction 438.18order is amended by changing the correction order to the appropriate statutory reference;438.19(4) correction order was issued under an incorrect citation: the correction order is 438.20amended to be issued under the more appropriate correction order citation;438.21(5) the correction order is rescinded;438.22(6) fine is amended: it is determined the fine assigned to the correction order was 438.23applied incorrectly; or438.24(7) the level or scope of the citation is modified based on the reconsideration. 438.25(d) If the correction order findings are changed by the commissioner, the 438.26commissioner shall update the correction order on the Web site accordingly.438.27    Subd. 13.Home care surveyor training.Before conducting a home care survey, 438.28each home care surveyor must receive training on the following topics: 438.29(1) Minnesota home care licensure requirements;438.30(2) Minnesota home care client bill of rights;438.31(3) Minnesota Vulnerable Adults Act and Reporting of Maltreatment of Minors;438.32(4) principles of documentation;438.33(5) survey protocol and processes;438.34(6) Offices of the Ombudsman roles;438.35(7) Office of Health Facility Complaints;438.36(8) Minnesota landlord and tenant, and housing with services laws;439.1(9) types of payors for home care services; and 439.2(10) Minnesota Nurse Practice Act for nurse surveyors.439.3Materials used for this training will be posted on the Department of Health Web 439.4site.  Requisite understanding of these topics will be reviewed as part of the quality 439.5improvement plan in section 30.439.6    Sec. 14. [144A.475] ENFORCEMENT.439.7    Subdivision 1.Conditions.(a) The commissioner may refuse to grant a temporary 439.8license or refuse to renew a license, may suspend or revoke a license, or may impose a 439.9conditional license if the home care provider or owner or managerial official of the home 439.10care provider:439.11(1) is in violation of, or during the term of the license has violated, any of the 439.12requirements in sections 144A.471 to 144A.482;439.13(2) permits, aids, or abets the commission of any illegal act in the provision of 439.14home care;439.15(3) performs any act detrimental to the health, safety, and welfare of a client;439.16(4) obtains the license by fraud or misrepresentation;439.17(5) knowingly made or makes a false statement of a material fact in the application 439.18for a license or in any other record or report required by this chapter;439.19(6) denies representatives of the department access to any part of the home care 439.20provider's books, records, files, or employees;439.21(7) interferes with or impedes a representative of the department in contacting the 439.22home care provider's clients;439.23(8) interferes with or impedes a representative of the department in the enforcement 439.24of this chapter or has failed to fully cooperate with an inspection, survey, or investigation 439.25by the department;439.26(9) destroys or makes unavailable any records or other evidence relating to the home 439.27care provider's compliance with this chapter;439.28(10) refuses to initiate a background study under section 144.057 or 245A.04;439.29(11) fails to timely pay any fines assessed by the department;439.30(12) violates any local, city, or township ordinance relating to home care services;439.31(13) has repeated incidents of personnel performing services beyond their 439.32competency level; or439.33(14) has operated beyond the scope of the home care provider's license level.439.34    (b) A violation by a contractor providing the home care services of the home care 439.35provider is a violation by the home care provider.440.1    Subd. 2.Terms to suspension or conditional license.A suspension or conditional 440.2license designation may include terms that must be completed or met before a suspension 440.3or conditional license designation is lifted. A conditional license designation may include 440.4restrictions or conditions that are imposed on the provider. Terms for a suspension or 440.5conditional license may include one or more of the following and the scope of each will be 440.6determined by the commissioner:440.7(1) requiring a consultant to review, evaluate, and make recommended changes to 440.8the home care provider's practices and submit reports to the commissioner at the cost of 440.9the home care provider;440.10(2) requiring supervision of the home care provider or staff practices at the cost 440.11of the home care provider by an unrelated person who has sufficient knowledge and 440.12qualifications to oversee the practices and who will submit reports to the commissioner;440.13(3) requiring the home care provider or employees to obtain training at the cost of 440.14the home care provider;440.15(4) requiring the home care provider to submit reports to the commissioner;440.16(5) prohibiting the home care provider from taking any new clients for a period 440.17of time; or440.18(6) any other action reasonably required to accomplish the purpose of this 440.19subdivision and section 144A.45, subdivision 2.440.20    Subd. 3.Notice.Prior to any suspension, revocation, or refusal to renew a license, 440.21the home care provider shall be entitled to notice and a hearing as provided by sections 440.2214.57 to 14.69. In addition to any other remedy provided by law, the commissioner may, 440.23without a prior contested case hearing, temporarily suspend a license or prohibit delivery 440.24of services by a provider for not more than 90 days if the commissioner determines that 440.25the health or safety of a consumer is in imminent danger, provided:440.26(1) advance notice is given to the home care provider;440.27(2) after notice, the home care provider fails to correct the problem;440.28(3) the commissioner has reason to believe that other administrative remedies are not 440.29likely to be effective; and440.30(4) there is an opportunity for a contested case hearing within the 90 days.440.31    Subd. 4.Time limits for appeals.To appeal the assessment of civil penalties 440.32under section 144A.45, subdivision 2, clause (5), and an action against a license under 440.33this section, a provider must request a hearing no later than 15 days after the provider 440.34receives notice of the action.440.35    Subd. 5.Plan required.(a) The process of suspending or revoking a license 440.36must include a plan for transferring affected clients to other providers by the home care 441.1provider, which will be monitored by the commissioner. Within three business days of 441.2being notified of the final revocation or suspension action, the home care provider shall 441.3provide the commissioner, the lead agencies as defined in section 256B.0911, and the 441.4ombudsman for long-term care with the following information:441.5(1) a list of all clients, including full names and all contact information on file;441.6(2) a list of each client's representative or emergency contact person, including full 441.7names and all contact information on file;441.8(3) the location or current residence of each client;441.9(4) the payor sources for each client, including payor source identification numbers; 441.10and441.11(5) for each client, a copy of the client's service plan, and a list of the types of 441.12services being provided.441.13(b) The revocation or suspension notification requirement is satisfied by mailing the 441.14notice to the address in the license record. The home care provider shall cooperate with 441.15the commissioner and the lead agencies during the process of transferring care of clients to 441.16qualified providers. Within three business days of being notified of the final revocation or 441.17suspension action, the home care provider must notify and disclose to each of the home 441.18care provider's clients, or the client's representative or emergency contact persons, that 441.19the commissioner is taking action against the home care provider's license by providing a 441.20copy of the revocation or suspension notice issued by the commissioner.441.21    Subd. 6.Owners and managerial officials; refusal to grant license.(a) The owner 441.22and managerial officials of a home care provider whose Minnesota license has not been 441.23renewed or that has been revoked because of noncompliance with applicable laws or rules 441.24shall not be eligible to apply for and shall not be granted a home care license, including 441.25other licenses under this chapter, or be given status as an enrolled personal care assistance 441.26provider agency or personal care assistant by the Department of Human Services under 441.27section 256B.0659 for five years following the effective date of the nonrenewal or 441.28revocation. If the owner and managerial officials already have enrollment status, their 441.29enrollment will be terminated by the Department of Human Services.441.30(b) The commissioner shall not issue a license to a home care provider for five 441.31years following the effective date of license nonrenewal or revocation if the owner or 441.32managerial official, including any individual who was an owner or managerial official 441.33of another home care provider, had a Minnesota license that was not renewed or was 441.34revoked as described in paragraph (a).441.35(c) Notwithstanding subdivision 1, the commissioner shall not renew, or shall 441.36suspend or revoke, the license of any home care provider that includes any individual 442.1as an owner or managerial official who was an owner or managerial official of a home 442.2care provider whose Minnesota license was not renewed or was revoked as described in 442.3paragraph (a) for five years following the effective date of the nonrenewal or revocation.442.4(d) The commissioner shall notify the home care provider 30 days in advance of 442.5the date of nonrenewal, suspension, or revocation of the license. Within ten days after 442.6the receipt of the notification, the home care provider may request, in writing, that the 442.7commissioner stay the nonrenewal, revocation, or suspension of the license. The home 442.8care provider shall specify the reasons for requesting the stay; the steps that will be taken 442.9to attain or maintain compliance with the licensure laws and regulations; any limits on the 442.10authority or responsibility of the owners or managerial officials whose actions resulted in 442.11the notice of nonrenewal, revocation, or suspension; and any other information to establish 442.12that the continuing affiliation with these individuals will not jeopardize client health, safety, 442.13or well-being. The commissioner shall determine whether the stay will be granted within 442.1430 days of receiving the provider's request. The commissioner may propose additional 442.15restrictions or limitations on the provider's license and require that the granting of the stay 442.16be contingent upon compliance with those provisions. The commissioner shall take into 442.17consideration the following factors when determining whether the stay should be granted:442.18(1) the threat that continued involvement of the owners and managerial officials with 442.19the home care provider poses to client health, safety, and well-being;442.20(2) the compliance history of the home care provider; and442.21(3) the appropriateness of any limits suggested by the home care provider.442.22    If the commissioner grants the stay, the order shall include any restrictions or 442.23limitation on the provider's license. The failure of the provider to comply with any 442.24restrictions or limitations shall result in the immediate removal of the stay and the 442.25commissioner shall take immediate action to suspend, revoke, or not renew the license.442.26    Subd. 7.Request for hearing.A request for a hearing must be in writing and must:442.27(1) be mailed or delivered to the department or the commissioner's designee;442.28(2) contain a brief and plain statement describing every matter or issue contested; and442.29(3) contain a brief and plain statement of any new matter that the applicant or home 442.30care provider believes constitutes a defense or mitigating factor.442.31    Subd. 8.Informal conference.At any time, the applicant or home care provider 442.32and the commissioner may hold an informal conference to exchange information, clarify 442.33issues, or resolve issues.442.34    Subd. 9.Injunctive relief.In addition to any other remedy provided by law, the 442.35commissioner may bring an action in district court to enjoin a person who is involved in 442.36the management, operation, or control of a home care provider or an employee of the 443.1home care provider from illegally engaging in activities regulated by sections 144A.43 to 443.2144A.482. The commissioner may bring an action under this subdivision in the district 443.3court in Ramsey County or in the district in which a home care provider is providing 443.4services. The court may grant a temporary restraining order in the proceeding if continued 443.5activity by the person who is involved in the management, operation, or control of a home 443.6care provider, or by an employee of the home care provider, would create an imminent 443.7risk of harm to a recipient of home care services.443.8    Subd. 10.Subpoena.In matters pending before the commissioner under sections 443.9144A.43 to 144A.482, the commissioner may issue subpoenas and compel the attendance 443.10of witnesses and the production of all necessary papers, books, records, documents, and 443.11other evidentiary material. If a person fails or refuses to comply with a subpoena or 443.12order of the commissioner to appear or testify regarding any matter about which the 443.13person may be lawfully questioned or to produce any papers, books, records, documents, 443.14or evidentiary materials in the matter to be heard, the commissioner may apply to the 443.15district court in any district, and the court shall order the person to comply with the 443.16commissioner's order or subpoena. The commissioner of health may administer oaths to 443.17witnesses or take their affirmation. Depositions may be taken in or outside the state in the 443.18manner provided by law for the taking of depositions in civil actions. A subpoena or other 443.19process or paper may be served on a named person anywhere in the state by an officer 443.20authorized to serve subpoenas in civil actions, with the same fees and mileage and in the 443.21same manner as prescribed by law for a process issued out of a district court. A person 443.22subpoenaed under this subdivision shall receive the same fees, mileage, and other costs 443.23that are paid in proceedings in district court.443.24    Sec. 15. [144A.476] BACKGROUND STUDIES.443.25    Subdivision 1.Prior criminal convictions; owner and managerial officials.(a) 443.26Before the commissioner issues a temporary license or renews a license, an owner or 443.27managerial official is required to complete a background study under section 144.057. No 443.28person may be involved in the management, operation, or control of a home care provider 443.29if the person has been disqualified under chapter 245C. If an individual is disqualified 443.30under section 144.057 or chapter 245C, the individual may request reconsideration of 443.31the disqualification. If the individual requests reconsideration and the commissioner 443.32sets aside or rescinds the disqualification, the individual is eligible to be involved in the 443.33management, operation, or control of the provider. If an individual has a disqualification 443.34under section 245C.15, subdivision 1, and the disqualification is affirmed, the individual's 444.1disqualification is barred from a set aside, and the individual must not be involved in the 444.2management, operation, or control of the provider.444.3(b) For purposes of this section, owners of a home care provider subject to the 444.4background check requirement are those individuals whose ownership interest provides 444.5sufficient authority or control to affect or change decisions related to the operation of the 444.6home care provider. An owner includes a sole proprietor, a general partner, or any other 444.7individual whose individual ownership interest can affect the management and direction 444.8of the policies of the home care provider.444.9(c) For the purposes of this section, managerial officials subject to the background 444.10check requirement are individuals who provide direct contact as defined in section 444.11245C.02, subdivision 11, or individuals who have the responsibility for the ongoing 444.12management or direction of the policies, services, or employees of the home care provider. 444.13Data collected under this subdivision shall be classified as private data on individuals as 444.14defined in section 13.02, subdivision 12.444.15(d) The department shall not issue any license if the applicant, owner, or managerial 444.16official has been unsuccessful in having a background study disqualification set aside 444.17under section 144.057 and chapter 245C; if the owner or managerial official, as an owner 444.18or managerial official of another home care provider, was substantially responsible for 444.19the other home care provider's failure to substantially comply with sections 144A.43 to 444.20144A.482; or if an owner that has ceased doing business, either individually or as an 444.21owner of a home care provider, was issued a correction order for failing to assist clients in 444.22violation of this chapter.444.23    Subd. 2.Employees, contractors, and volunteers.(a) Employees, contractors, 444.24and volunteers of a home care provider are subject to the background study required by 444.25section 144.057, and may be disqualified under chapter 245C. Nothing in this section shall 444.26be construed to prohibit a home care provider from requiring self-disclosure of criminal 444.27conviction information.444.28(b) Termination of an employee in good faith reliance on information or records 444.29obtained under paragraph (a) or subdivision 1, regarding a confirmed conviction does not 444.30subject the home care provider to civil liability or liability for unemployment benefits.444.31    Sec. 16. [144A.477] COMPLIANCE.444.32    Subdivision 1.Medicare-certified providers; coordination of surveys.If feasible, 444.33the commissioner shall survey licensees to determine compliance with this chapter at the 444.34same time as surveys for certification for Medicare if Medicare certification is based on 444.35compliance with the federal conditions of participation and on survey and enforcement 445.1by the Department of Health as agent for the United States Department of Health and 445.2Human Services.445.3    Subd. 2.Medicare-certified providers; equivalent requirements.For home care 445.4providers licensed to provide comprehensive home care services that are also certified for 445.5participation in Medicare as a home health agency under Code of Federal Regulations, 445.6title 42, part 484, the following state licensure regulations are considered equivalent to 445.7the federal requirements:445.8(1) quality management, section 144A.479, subdivision 3;445.9(2) personnel records, section 144A.479, subdivision 7;445.10(3) acceptance of clients, section 144A.4791, subdivision 4;445.11(4) referrals, section 144A.4791, subdivision 5;445.12(5) client assessment, sections 144A.4791, subdivision 8, and 144A.4792, 445.13subdivisions 2 and 3;445.14(6) individualized monitoring and reassessment, sections 144A.4791, subdivision 445.158, and 144A.4792, subdivisions 2 and 3;445.16(7) individualized service plan, sections 144A.4791, subdivision 9, 144A.4792, 445.17subdivision 5, and 144A.4793, subdivision 3;445.18(8) client complaint and investigation process, section 144A.4791, subdivision 11;445.19(9) prescription orders, section 144A.4792, subdivisions 13 to 16;445.20(10) client records, section 144A.4794, subdivisions 1 to 3;445.21(11) qualifications for unlicensed personnel performing delegated tasks, section 445.22144A.4795;445.23(12) training and competency staff, section 144A.4795;445.24(13) training and competency for unlicensed personnel, section 144A.4795, 445.25subdivision 7;445.26(14) delegation of home care services, section 144A.4795, subdivision 4;445.27(15) availability of contact person, section 144A.4797, subdivision 1; and445.28(16) supervision of staff, section 144A.4797, subdivisions 2 and 3.445.29Violations of the requirements in clauses (1) to (16) may lead to enforcement actions 445.30under section 144A.474.445.31    Sec. 17. [144A.478] INNOVATION VARIANCE.445.32    Subdivision 1.Definition.For purposes of this section, "innovation variance" 445.33means a specified alternative to a requirement of this chapter. An innovation variance may 445.34be granted to allow a home care provider to offer home care services of a type or in a 445.35manner that is innovative, will not impair the services provided, will not adversely affect 446.1the health, safety, or welfare of the clients, and is likely to improve the services provided. 446.2The innovative variance cannot change any of the client's rights under section 144A.44.446.3    Subd. 2.Conditions.The commissioner may impose conditions on the granting of 446.4an innovation variance that the commissioner considers necessary.446.5    Subd. 3.Duration and renewal.The commissioner may limit the duration of any 446.6innovation variance and may renew a limited innovation variance.446.7    Subd. 4.Applications; innovation variance.An application for innovation 446.8variance from the requirements of this chapter may be made at any time, must be made in 446.9writing to the commissioner, and must specify the following:446.10(1) the statute or law from which the innovation variance is requested;446.11(2) the time period for which the innovation variance is requested;446.12(3) the specific alternative action that the licensee proposes;446.13(4) the reasons for the request; and446.14(5) justification that an innovation variance will not impair the services provided; 446.15will not adversely affect the health, safety, or welfare of clients; and is likely to improve 446.16the services provided.446.17The commissioner may require additional information from the home care provider before 446.18acting on the request.446.19    Subd. 5.Grants and denials.The commissioner shall grant or deny each request 446.20for an innovation variance in writing within 45 days of receipt of a complete request. 446.21Notice of a denial shall contain the reasons for the denial. The terms of a requested 446.22innovation variance may be modified upon agreement between the commissioner and 446.23the home care provider.446.24    Subd. 6.Violation of innovation variances.A failure to comply with the terms of 446.25an innovation variance shall be deemed to be a violation of this chapter.446.26    Subd. 7.Revocation or denial of renewal.The commissioner shall revoke or 446.27deny renewal of an innovation variance if:446.28(1) it is determined that the innovation variance is adversely affecting the health, 446.29safety, or welfare of the licensee's clients;446.30(2) the home care provider has failed to comply with the terms of the innovation 446.31variance;446.32(3) the home care provider notifies the commissioner in writing that it wishes to 446.33relinquish the innovation variance and be subject to the statute previously varied; or446.34(4) the revocation or denial is required by a change in law.447.1    Sec. 18. [144A.479] HOME CARE PROVIDER RESPONSIBILITIES; 447.2BUSINESS OPERATION.447.3    Subdivision 1.Display of license.The original current license must be displayed 447.4in the home care provider's principal business office and copies must be displayed in 447.5any branch office. The home care provider must provide a copy of the license to any 447.6person who requests it.447.7    Subd. 2.Advertising.Home care providers shall not use false, fraudulent, 447.8or misleading advertising in the marketing of services. For purposes of this section, 447.9advertising includes any verbal, written, or electronic means of communicating to 447.10potential clients about the availability, nature, or terms of home care services.447.11    Subd. 3.Quality management.The home care provider shall engage in quality 447.12management appropriate to the size of the home care provider and relevant to the type 447.13of services the home care provider provides. The quality management activity means 447.14evaluating the quality of care by periodically reviewing client services, complaints made, 447.15and other issues that have occurred and determining whether changes in services, staffing, 447.16or other procedures need to be made in order to ensure safe and competent services to 447.17clients. Documentation about quality management activity must be available for two 447.18years. Information about quality management must be available to the commissioner at 447.19the time of the survey, investigation, or renewal.447.20    Subd. 4.Provider restrictions.(a) This subdivision does not apply to licensees 447.21that are Minnesota counties or other units of government.447.22(b) A home care provider or staff cannot accept powers-of-attorney from clients for 447.23any purpose, and may not accept appointments as guardians or conservators of clients.447.24(c) A home care provider cannot serve as a client's representative. 447.25    Subd. 5.Handling of client's finances and property.(a) A home care provider 447.26may assist clients with household budgeting, including paying bills and purchasing 447.27household goods, but may not otherwise manage a client's property. A home care provider 447.28must provide a client with receipts for all transactions and purchases paid with the client's 447.29funds. When receipts are not available, the transaction or purchase must be documented. 447.30A home care provider must maintain records of all such transactions.447.31(b) A home care provider or staff may not borrow a client's funds or personal or 447.32real property, nor in any way convert a client's property to the home care provider's or 447.33staff's possession.447.34(c) Nothing in this section precludes a home care provider or staff from accepting 447.35gifts of minimal value, or precludes the acceptance of donations or bequests made to a 448.1home care provider that are exempt from income tax under section 501(c) of the Internal 448.2Revenue Code of 1986.448.3    Subd. 6.Reporting maltreatment of vulnerable adults and minors.(a) All 448.4home care providers must comply with requirements for the reporting of maltreatment 448.5of minors in section 626.556 and the requirements for the reporting of maltreatment 448.6of vulnerable adults in section 626.557. Home care providers must report suspected 448.7maltreatment of minors and vulnerable adults to the common entry point. Each home 448.8care provider must establish and implement a written procedure to ensure that all cases 448.9of suspected maltreatment are reported.448.10(b) Each home care provider must develop and implement an individual abuse 448.11prevention plan for each vulnerable minor or adult for whom home care services are 448.12provided by a home care provider. The plan shall contain an individualized review or 448.13assessment of the person's susceptibility to abuse by another individual, including other 448.14vulnerable adults or minors; the person's risk of abusing other vulnerable adults or minors; 448.15and statements of the specific measures to be taken to minimize the risk of abuse to that 448.16person and other vulnerable adults or minors. For purposes of the abuse prevention plan, 448.17the term abuse includes self-abuse.448.18    Subd. 7.Employee records.The home care provider must maintain current records 448.19of each paid employee, regularly scheduled volunteers providing home care services, 448.20and each individual contractor providing home care services. The records must include 448.21the following information:448.22(1) evidence of current professional licensure, registration, or certification, if 448.23licensure, registration, or certification is required by this statute, or other rules;448.24(2) records of orientation, required annual training and infection control training, 448.25and competency evaluations;448.26(3) current job description, including qualifications, responsibilities, and 448.27identification of staff providing supervision;448.28(4) documentation of annual performance reviews which identify areas of 448.29improvement needed and training needs;448.30(5) for individuals providing home care services, verification that required health 448.31screenings under section 144A.4798 have taken place and the dates of those screenings; and448.32(6) documentation of the background study as required under section 144.057.448.33Each employee record must be retained for at least three years after a paid employee, 448.34home care volunteer, or contractor ceases to be employed by or under contract with the 448.35home care provider. If a home care provider ceases operation, employee records must be 448.36maintained for three years.449.1    Sec. 19. [144A.4791] HOME CARE PROVIDER RESPONSIBILITIES WITH 449.2RESPECT TO CLIENTS.449.3    Subdivision 1.Home care bill of rights; notification to client.(a) The home care 449.4provider shall make all reasonable efforts to provide the client or the client's representative 449.5a written notice of the rights under section 144A.44 before the initiation of services. The 449.6home care provider shall make all reasonable efforts to provide the notice in a language 449.7the client or client's representative understands. If a written version is not effective or 449.8available, the notice may be provided verbally.449.9(b) In addition to the text of the home care bill of rights in section 144A.44, 449.10subdivision 1, the notice shall also contain the following statement describing how to file 449.11a complaint with these offices.449.12"If you have a complaint about the provider or the person providing your 449.13home care services, you may call, write, or visit the Office of Health Facility 449.14Complaints, Minnesota Department of Health. You may also contact the Office of 449.15Ombudsman for Long-Term Care or the Office of Ombudsman for Mental Health 449.16and Developmental Disabilities."449.17The statement should include the telephone number, Web site address, e-mail 449.18address, mailing address, and street address of the Office of Health Facility Complaints at 449.19the Minnesota Department of Health, the Office of the Ombudsman for Long-Term Care, 449.20and the Office of the Ombudsman for Mental Health and Developmental Disabilities. The 449.21statement should also include the home care provider's name, address, e-mail, telephone 449.22number, and name or title of the person at the provider to whom problems or complaints 449.23may be directed. It must also include a statement that the home care provider will not 449.24retaliate because of a complaint.449.25(c) The home care provider shall obtain written acknowledgment of the client's 449.26receipt of the home care bill of rights or shall document why an acknowledgment cannot 449.27be obtained. The acknowledgment may be obtained from the client or the client's 449.28representative. Acknowledgment of receipt shall be retained in the client's record.449.29    Subd. 2.Notice of services for dementia, Alzheimer's disease, or related 449.30disorders.The home care provider that provides services to clients with dementia shall 449.31provide in written or electronic form, to clients and families or other persons who request 449.32it, a description of the training program and related training it provides, including the 449.33categories of employees trained, the frequency of training, and the basic topics covered. 449.34This information satisfies the disclosure requirements in section 325F.72, subdivision 449.352, clause (4).450.1    Subd. 3.Statement of home care services.Prior to the initiation of services, 450.2a home care provider must provide to the client or the client's representative a written 450.3statement which identifies if they have a basic or comprehensive home care license, the 450.4services they are authorized to provide, and which services they cannot provide under the 450.5scope of their license. The home care provider shall obtain written acknowledgment 450.6from the clients that they have provided the statement or must document why they could 450.7not obtain the acknowledgment.450.8    Subd. 4.Acceptance of clients.No home care provider may accept a person as a 450.9client unless the home care provider has staff, sufficient in qualifications, competency, 450.10and numbers, to adequately provide the services agreed to in the service plan and that 450.11are within the provider's scope of practice.450.12    Subd. 5.Referrals.If a home care provider reasonably believes that a client is in 450.13need of another medical or health service, including a licensed health professional, or 450.14social service provider, the home care provider shall:450.15(1) determine the client's preferences with respect to obtaining the service; and450.16(2) inform the client of resources available, if known, to assist the client in obtaining 450.17services.450.18    Subd. 6.Initiation of services.When a provider initiates services and the 450.19individualized review or assessment required in subdivisions 7 and 8 has not been 450.20completed, the provider must complete a temporary plan and agreement with the client for 450.21services.450.22    Subd. 7.Basic individualized client review and monitoring.(a) When services 450.23being provided are basic home care services, an individualized initial review of the client's 450.24needs and preferences must be conducted at the client's residence with the client or client's 450.25representative. This initial review must be completed within 30 days after the initiation of 450.26the home care services.450.27(b) Client monitoring and review must be conducted as needed based on changes 450.28in the needs of the client and cannot exceed 90 days from the date of the last review. 450.29The monitoring and review may be conducted at the client's residence or through the 450.30utilization of telecommunication methods based on practice standards that meet the 450.31individual client's needs.450.32    Subd. 8.Comprehensive assessment, monitoring, and reassessment.(a) When 450.33the services being provided are comprehensive home care services, an individualized 450.34initial assessment must be conducted in-person by a registered nurse. When the services 450.35are provided by other licensed health professionals, the assessment must be conducted by 451.1the appropriate health professional. This initial assessment must be completed within five 451.2days after initiation of home care services.451.3(b) Client monitoring and reassessment must be conducted in the client's home no 451.4more than 14 days after initiation of services.451.5(c) Ongoing client monitoring and reassessment must be conducted as needed based 451.6on changes in the needs of the client and cannot exceed 90 days from the last date of the 451.7assessment. The monitoring and reassessment may be conducted at the client's residence 451.8or through the utilization of telecommunication methods based on practice standards that 451.9meet the individual client's needs.451.10    Subd. 9.Service plan, implementation, and revisions to service plan.(a) No later 451.11than 14 days after the initiation of services, a home care provider shall finalize a current 451.12written service plan.451.13(b) The service plan and any revisions must include a signature or other 451.14authentication by the home care provider and by the client or the client's representative 451.15documenting agreement on the services to be provided. The service plan must be revised, 451.16if needed, based on client review or reassessment under subdivisions 7 and 8. The provider 451.17must provide information to the client about changes to the provider's fee for services and 451.18how to contact the Office of the Ombudsman for Long-Term Care.451.19(c) The home care provider must implement and provide all services required by 451.20the current service plan.451.21(d) The service plan and revised service plan must be entered into the client's record, 451.22including notice of a change in a client's fees when applicable.451.23(e) Staff providing home care services must be informed of the current written 451.24service plan.451.25(f) The service plan must include:451.26(1) a description of the home care services to be provided, the fees for services, and 451.27the frequency of each service, according to the client's current review or assessment and 451.28client preferences;451.29(2) the identification of the staff or categories of staff who will provide the services;451.30(3) the schedule and methods of monitoring reviews or assessments of the client;451.31(4) the frequency of sessions of supervision of staff and type of personnel who 451.32will supervise staff; and451.33(5) a contingency plan that includes:451.34(i) the action to be taken by the home care provider and by the client or client's 451.35representative if the scheduled service cannot be provided;452.1(ii) information and method for a client or client's representative to contact the 452.2home care provider;452.3(iii) names and contact information of persons the client wishes to have notified 452.4in an emergency or if there is a significant adverse change in the client's condition, 452.5including identification of and information as to who has authority to sign for the client in 452.6an emergency; and452.7(iv) the circumstances in which emergency medical services are not to be summoned 452.8consistent with chapters 145B and 145C, and declarations made by the client under those 452.9chapters.452.10    Subd. 10.Termination of service plan.(a) If a home care provider terminates a 452.11service plan with a client, and the client continues to need home care services, the home 452.12care provider shall provide the client and the client's representative, if any, with a written 452.13notice of termination which includes the following information:452.14(1) the effective date of termination;452.15(2) the reason for termination;452.16(3) a list of known licensed home care providers in the client's immediate geographic 452.17area;452.18(4) a statement that the home care provider will participate in a coordinated transfer 452.19of care of the client to another home care provider, health care provider, or caregiver, as 452.20required by the home care bill of rights, section 144A.44, subdivision 1, clause (17);452.21(5) the name and contact information of a person employed by the home care 452.22provider with whom the client may discuss the notice of termination; and452.23(6) if applicable, a statement that the notice of termination of home care services 452.24does not constitute notice of termination of the housing with services contract with a 452.25housing with services establishment.452.26(b) When the home care provider voluntarily discontinues services to all clients, the 452.27home care provider must notify the commissioner, lead agencies, and the ombudsman for 452.28long-term care about its clients and comply with the requirements in this subdivision.452.29    Subd. 11.Client complaint and investigative process.(a) The home care 452.30provider must have a written policy and system for receiving, investigating, reporting, 452.31and attempting to resolve complaints from its clients or clients' representatives. The 452.32policy should clearly identify the process by which clients may file a complaint or concern 452.33about home care services and an explicit statement that the home care provider will not 452.34discriminate or retaliate against a client for expressing concerns or complaints. A home 452.35care provider must have a process in place to conduct investigations of complaints made 452.36by the client or the client's representative about the services in the client's plan that are or 453.1are not being provided or other items covered in the client's home care bill of rights. This 453.2complaint system must provide reasonable accommodations for any special needs of the 453.3client or client's representative if requested.453.4(b) The home care provider must document the complaint, name of the client, 453.5investigation, and resolution of each complaint filed. The home care provider must 453.6maintain a record of all activities regarding complaints received, including the date the 453.7complaint was received, and the home care provider's investigation and resolution of the 453.8complaint. This complaint record must be kept for each event for at least two years after 453.9the date of entry and must be available to the commissioner for review.453.10(c) The required complaint system must provide for written notice to each client or 453.11client's representative that includes:453.12(1) the client's right to complain to the home care provider about the services received;453.13(2) the name or title of the person or persons with the home care provider to contact 453.14with complaints;453.15(3) the method of submitting a complaint to the home care provider; and453.16(4) a statement that the provider is prohibited against retaliation according to 453.17paragraph (d).453.18(d) A home care provider must not take any action that negatively affects a client 453.19in retaliation for a complaint made or a concern expressed by the client or the client's 453.20representative.453.21    Subd. 12.Disaster planning and emergency preparedness plan.The home care 453.22provider must have a written plan of action to facilitate the management of the client's care 453.23and services in response to a natural disaster, such as flood and storms, or other emergencies 453.24that may disrupt the home care provider's ability to provide care or services. The licensee 453.25must provide adequate orientation and training of staff on emergency preparedness.453.26    Subd. 13.Request for discontinuation of life-sustaining treatment.(a) If a 453.27client, family member, or other caregiver of the client requests that an employee or other 453.28agent of the home care provider discontinue a life-sustaining treatment, the employee or 453.29agent receiving the request:453.30(1) shall take no action to discontinue the treatment; and453.31(2) shall promptly inform their supervisor or other agent of the home care provider 453.32of the client's request.453.33(b) Upon being informed of a request for termination of treatment, the home care 453.34provider shall promptly:453.35(1) inform the client that the request will be made known to the physician who 453.36ordered the client's treatment;454.1(2) inform the physician of the client's request; and454.2(3) work with the client and the client's physician to comply with the provisions of 454.3the Health Care Directive Act in chapter 145C.454.4(c) This section does not require the home care provider to discontinue treatment, 454.5except as may be required by law or court order.454.6(d) This section does not diminish the rights of clients to control their treatments, 454.7refuse services, or terminate their relationships with the home care provider.454.8(e) This section shall be construed in a manner consistent with chapter 145B or 454.9145C, whichever applies, and declarations made by clients under those chapters.454.10    Sec. 20. [144A.4792] MEDICATION MANAGEMENT.454.11    Subdivision 1.Medication management services; comprehensive home care 454.12license.(a) This subdivision applies only to home care providers with a comprehensive 454.13home care license that provides medication management services to clients. Medication 454.14management services may not be provided by a home care provider that has a basic 454.15home care license.454.16(b) A comprehensive home care provider who provides medication management 454.17services must develop, implement, and maintain current written medication management 454.18policies and procedures. The policies and procedures must be developed under the 454.19supervision and direction of a registered nurse, licensed health professional, or pharmacist 454.20consistent with current practice standards and guidelines.454.21(c) The written policies and procedures must address requesting and receiving 454.22prescriptions for medications; preparing and giving medications; verifying that 454.23prescription drugs are administered as prescribed; documenting medication management 454.24activities; controlling and storing medications; monitoring and evaluating medication use; 454.25resolving medication errors; communicating with the prescriber, pharmacist, client, and 454.26client representative, if any; disposing of unused medications; and educating clients and 454.27client representatives about medications. When controlled substances are being managed, 454.28the policies and procedures must also identify how the provider will ensure security and 454.29accountability for the overall management, control, and disposition of those substances in 454.30compliance with state and federal regulations and with subdivision 22.454.31    Subd. 2.Provision of medication management services.(a) For each client who 454.32requests medication management services, the comprehensive home care provider shall, 454.33prior to providing medication management services, have a registered nurse, licensed 454.34health professional, or authorized prescriber under section 151.37 conduct an assessment 454.35to determine what medication management services will be provided and how the services 455.1will be provided. This assessment must be conducted face-to-face with the client. The 455.2assessment must include an identification and review of all medications the client is known 455.3to be taking. The review and identification must include indications for medications, side 455.4effects, contraindications, allergic or adverse reactions, and actions to address these issues.455.5(b) The assessment must identify interventions needed in management of 455.6medications to prevent diversion of medication by the client or others who may have 455.7access to the medications. Diversion of medications means the misuse, theft, or illegal 455.8or improper disposition of medications.455.9    Subd. 3.Individualized medication monitoring and reassessment.The 455.10comprehensive home care provider must monitor and reassess the client's medication 455.11management services as needed under subdivision 14 when the client presents with 455.12symptoms or other issues that may be medication-related and, at a minimum, annually.455.13    Subd. 4.Client refusal.The home care provider must document in the client's 455.14record any refusal for an assessment for medication management by the client. The 455.15provider must discuss with the client the possible consequences of the client's refusal and 455.16document the discussion in the client's record.455.17    Subd. 5.Individualized medication management plan.(a) For each client 455.18receiving medication management services, the comprehensive home care provider must 455.19prepare and include in the service plan a written statement of the medication management 455.20services that will be provided to the client. The provider must develop and maintain a 455.21current individualized medication management record for each client based on the client's 455.22assessment that contains the following:455.23(1) a statement describing the medication management services that will be provided;455.24(2) a description of storage of medications based on the client's needs and 455.25preferences, risk of diversion, and consistent with the manufacturer's directions;455.26(3) documentation of specific client instructions relating to the administration 455.27of medications;455.28(4) identification of persons responsible for monitoring medication supplies and 455.29ensuring that medication refills are ordered on a timely basis;455.30(5) identification of medication management tasks that may be delegated to 455.31unlicensed personnel;455.32(6) procedures for staff notifying a registered nurse or appropriate licensed health 455.33professional when a problem arises with medication management services; and455.34(7) any client-specific requirements relating to documenting medication 455.35administration, verification that all medications are administered as prescribed, and 455.36monitoring of medication use to prevent possible complications or adverse reactions.456.1(b) The medication management record must be current and updated when there are 456.2any changes.456.3    Subd. 6.Administration of medication.Medications may be administered by a 456.4nurse, physician, or other licensed health practitioner authorized to administer medications 456.5or by unlicensed personnel who have been delegated medication administration tasks by 456.6a registered nurse.456.7    Subd. 7.Delegation of medication administration.When administration of 456.8medications is delegated to unlicensed personnel, the comprehensive home care provider 456.9must ensure that the registered nurse has:456.10(1) instructed the unlicensed personnel in the proper methods to administer the 456.11medications, and the unlicensed personnel has demonstrated ability to competently follow 456.12the procedures;456.13(2) specified, in writing, specific instructions for each client and documented those 456.14instructions in the client's records; and456.15(3) communicated with the unlicensed personnel about the individual needs of 456.16the client.456.17    Subd. 8.Documentation of administration of medications.Each medication 456.18administered by comprehensive home care provider staff must be documented in the 456.19client's record. The documentation must include the signature and title of the person 456.20who administered the medication. The documentation must include the medication 456.21name, dosage, date and time administered, and method and route of administration. The 456.22staff must document the reason why medication administration was not completed as 456.23prescribed and document any follow-up procedures that were provided to meet the client's 456.24needs when medication was not administered as prescribed and in compliance with the 456.25client's medication management plan.456.26    Subd. 9.Documentation of medication set up.Documentation of dates of 456.27medication set up, name of medication, quantity of dose, times to be administered, route 456.28of administration, and name of person completing medication set up must be done at 456.29time of set up.456.30    Subd. 10.Medications management for clients who will be away from home.456.31(a) A home care provider that is providing medication management services to the client 456.32and controls the client's access to the medications must develop and implement policies 456.33and procedures for giving accurate and current medications to clients for planned or 456.34unplanned times away from home according to the client's individualized medication 456.35management plan.456.36The policy and procedures must state that: 457.1(1) for planned time away, the medications must be obtained from the pharmacy or 457.2set up by the registered nurse according to appropriate state and federal laws and nursing 457.3standards of  practice;457.4(2) for unplanned time away, when the pharmacy is not able to provide the 457.5medications, a licensed nurse or unlicensed personnel shall give the client or the client's 457.6representative medications in  amounts and dosages needed for the length of the anticipated 457.7absence, not to exceed 120 hours;457.8(3) the client, or the client's representative, must be provided written information 457.9on medications, including any special instructions for administering or handling the 457.10medications, including controlled substances;457.11(4) the medications must be placed in a medication container or containers 457.12appropriate to the provider's medication system and must be labeled with the client's name 457.13and the dates and times that the medications are scheduled; and457.14(5) the client or client's representative must be provided in writing the home  care 457.15provider's name and information on how to contact them.457.16(b) For unplanned time away when the licensed nurse is not available, the registered 457.17nurse may delegate this task to unlicensed personnel if: 457.18(1) the registered nurse has trained and determined the unlicensed staff to be 457.19competent to follow the procedures for giving medications to clients;457.20(2) the registered nurse has developed written procedures for the unlicensed 457.21personnel, including any special instructions or procedures regarding controlled substances 457.22that are prescribed for the client.  The procedures must address: 457.23(i) the type of container or containers to be used for the medications appropriate to 457.24the provider's medication system;457.25(ii) how the container or containers must be labeled;457.26(iii) the written information about the medications to be given to the client or the 457.27client' s representative;457.28(iv) how the unlicensed staff will document in the client's record that medications 457.29have been given to the client or the client's responsible person, including documenting the 457.30date the medications were given to the client or the client's responsible person and who 457.31received the medications, the person who gave the medications to the client, the number of 457.32medications that were given to the client, and other required information;457.33(v) how the registered nurse will be notified that medications have been given to 457.34the client or the client's responsible person and whether the registered nurse needs to 457.35be contacted before the medications are given to the client or the client's responsible 457.36person; and458.1(vi) a review by the registered nurse of the completion of this task to verify that this 458.2task was completed accurately by the unlicensed personnel.458.3    Subd. 11.Prescribed and nonprescribed medication.The comprehensive home 458.4care provider must determine whether it will require a prescription for all medications it 458.5manages. The comprehensive home care provider must inform the client or the client's 458.6representative whether the comprehensive home care provider requires a prescription 458.7for all over-the-counter and dietary supplements before the comprehensive home care 458.8provider will agree to manage those medications.458.9    Subd. 12.Medications; over-the-counter; dietary supplements not prescribed.458.10A comprehensive home care provider providing medication management services for 458.11over-the-counter drugs or dietary supplements must retain those items in the original labeled 458.12container with directions for use prior to setting up for immediate or later administration. 458.13The provider must verify that the medications are up-to-date and stored as appropriate.458.14    Subd. 13.Prescriptions.There must be a current written or electronically recorded 458.15prescription as defined in Minnesota Rules, part 6800.0100, subpart 11a, for all prescribed 458.16medications that the comprehensive home care provider is managing for the client.458.17    Subd. 14.Renewal of prescriptions.Prescriptions must be renewed at least 458.18every 12 months or more frequently as indicated by the assessment in subdivision 2. 458.19Prescriptions for controlled substances must comply with chapter 152.458.20    Subd. 15.Verbal prescription orders.Verbal prescription orders from an 458.21authorized prescriber must be received by a nurse or pharmacist. The order must be 458.22handled according to Minnesota Rules, part 6800.6200. 458.23    Subd. 16.Written or electronic prescription.When a written or electronic 458.24prescription is received, it must be communicated to the registered nurse in charge and 458.25recorded or placed in the client's record.458.26    Subd. 17.Records confidential.A prescription or order received verbally, in 458.27writing, or electronically must be kept according to sections 144.291 to 144.298 and 458.28144A.44.458.29    Subd. 18.Medications provided by client or family members.When the 458.30comprehensive home care provider is aware of any medications or dietary supplements 458.31that are being used by the client and are not included in the assessment for medication 458.32management services, the staff must advise the registered nurse and document that in 458.33the client's record.458.34    Subd. 19.Storage of drugs.A comprehensive home care provider providing 458.35storage of medications outside of the client's private living space must store all prescription 459.1drugs in securely locked and substantially constructed compartments according to the 459.2manufacturer's directions and permit only authorized personnel to have access.459.3    Subd. 20.Prescription drugs.A prescription drug, prior to being set up for 459.4immediate or later administration, must be kept in the original container in which it was 459.5dispensed by the pharmacy bearing the original prescription label with legible information 459.6including the expiration or beyond-use date of a time-dated drug.459.7    Subd. 21.Prohibitions.No prescription drug supply for one client may be used or 459.8saved for use by anyone other than the client.459.9    Subd. 22.Disposition of drugs.(a) Any current medications being managed by the 459.10comprehensive home care provider must be given to the client or the client's representative 459.11when the client's service plan ends or medication management services are no longer part 459.12of the service plan. Medications that have been stored in the client's private living space 459.13for a client that is deceased or that have been discontinued or that have expired may be 459.14given to the client or the client's representative for disposal.459.15(b) The comprehensive home care provider will dispose of any medications 459.16remaining with the comprehensive home care provider that are discontinued or expired or 459.17upon the termination of the service contract or the client's death according to state and 459.18federal regulations for disposition of drugs and controlled substances.459.19(c) Upon disposition, the comprehensive home care provider must document in the 459.20client's record the disposition of the medications including the medication's name, strength, 459.21prescription number as applicable, quantity, to whom the medications were given, date of 459.22disposition, and names of staff and other individuals involved in the disposition.459.23    Subd. 23.Loss or spillage.(a) Comprehensive home care providers providing 459.24medication management must develop and implement procedures for loss or spillage of all 459.25controlled substances defined in Minnesota Rules, part 6800.4220. These procedures must 459.26require that when a spillage of a controlled substance occurs, a notation must be made 459.27in the client's record explaining the spillage and the actions taken. The notation must 459.28be signed by the person responsible for the spillage and include verification that any 459.29contaminated substance was disposed of according to state or federal regulations.459.30(b) The procedures must require the comprehensive home care provider of 459.31medication management to investigate any known loss or unaccounted for prescription 459.32drugs and take appropriate action required under state or federal regulations and document 459.33the investigation in required records.459.34    Sec. 21. [144A.4793] TREATMENT AND THERAPY MANAGEMENT 459.35SERVICES.460.1    Subdivision 1.Providers with a comprehensive home care license.This section 460.2applies only to home care providers with a comprehensive home care license that provide 460.3treatment or therapy management services to clients. Treatment or therapy management 460.4services cannot be provided by a home care provider that has a basic home care license.460.5    Subd. 2.Policies and procedures.(a) A comprehensive home care provider who 460.6provides treatment and therapy management services must develop, implement, and 460.7maintain up-to-date written treatment or therapy management policies and procedures. 460.8The policies and procedures must be developed under the supervision and direction of 460.9a registered nurse or appropriate licensed health professional consistent with current 460.10practice standards and guidelines.460.11(b) The written policies and procedures must address requesting and receiving 460.12orders or prescriptions for treatments or therapies, providing the treatment or therapy, 460.13documenting of treatment or therapy activities, educating and communicating with clients 460.14about treatments or therapy they are receiving, monitoring and evaluating the treatment 460.15and therapy, and communicating with the prescriber.460.16    Subd. 3.Individualized treatment or therapy management plan.For each 460.17client receiving management of ordered or prescribed treatments or therapy services, the 460.18comprehensive home care provider must prepare and include in the service plan a written 460.19statement of the treatment or therapy services that will be provided to the client. The 460.20provider must also develop and maintain a current individualized treatment and therapy 460.21management record for each client that contains at least the following:460.22(1) a statement of the type of services that will be provided;460.23(2) documentation of specific client instructions relating to the treatments or therapy 460.24administration;460.25(3) identification of treatment or therapy tasks that will be delegated to unlicensed 460.26personnel; 460.27(4) procedures for notifying a registered nurse or appropriate licensed health 460.28professional when a problem arises with treatments or therapy services; and460.29(5) any client-specific requirements relating to documentation of treatment and 460.30therapy received, verification that all treatments and therapy was administered as 460.31prescribed, and monitoring of treatment or therapy to prevent possible complications or 460.32adverse reactions. The treatment or therapy management record must be current and 460.33updated when there are any changes.460.34    Subd. 4.Administration of treatments and therapy.Ordered or prescribed 460.35treatments or therapies must be administered by a nurse, physician, or other licensed health 460.36professional authorized to perform the treatment or therapy, or may be delegated or assigned 461.1to unlicensed personnel by the licensed health professional according to the appropriate 461.2practice standards for delegation or assignment. When administration of a treatment or 461.3therapy is delegated or assigned to unlicensed personnel, the home care provider must 461.4ensure that the registered nurse or authorized licensed health professional has:461.5(1) instructed the unlicensed personnel in the proper methods with respect to each 461.6client and has demonstrated their ability to competently follow the procedures;461.7(2) specified, in writing, specific instructions for each client and documented those 461.8instructions in the client's record; and461.9(3) communicated with the unlicensed personnel about the individual needs of 461.10the client.461.11    Subd. 5.Documentation of administration of treatments and therapies.Each 461.12treatment or therapy administered by a comprehensive home care provider must be 461.13documented in the client's record. The documentation must include the signature and title 461.14of the person who administered the treatment or therapy and must include the date and 461.15time of administration. When treatment or therapies are not administered as ordered or 461.16prescribed, the provider must document the reason why it was not administered and any 461.17follow-up procedures that were provided to meet the client's needs.461.18    Subd. 6.Orders or prescriptions.There must be an up-to-date written or 461.19electronically recorded order or prescription for all treatments and therapies. The order 461.20must contain the name of the client, description of the treatment or therapy to be provided, 461.21and the frequency and other information needed to administer the treatment or therapy.461.22    Sec. 22. [144A.4794] CLIENT RECORD REQUIREMENTS.461.23    Subdivision 1.Client record.(a) The home care provider must maintain records 461.24for each client to whom it is providing services. Entries in the client records must be 461.25current, legible, permanently recorded, dated, and authenticated with the name and title 461.26of the person making the entry.461.27(b) Client records, whether written or electronic, must be protected against loss, 461.28tampering, or unauthorized disclosure in compliance with chapter 13 and other applicable 461.29relevant federal and state laws. The home care provider shall establish and implement 461.30written procedures to control use, storage, and security of client's records and establish 461.31criteria for release of client information.461.32(c) The home care provider may not disclose to any other person any personal, 461.33financial, medical, or other information about the client, except:461.34(1) as may be required by law;462.1(2) to employees or contractors of the home care provider, another home care 462.2provider, other health care practitioner or provider, or inpatient facility needing 462.3information in order to provide services to the client, but only such information that 462.4is necessary for the provision of services;462.5(3) to persons authorized in writing by the client or the client's representative to 462.6receive the information, including third-party payers; and462.7(4) to representatives of the commissioner authorized to survey or investigate home 462.8care providers under this chapter or federal laws.462.9    Subd. 2.Access to records.The home care provider must ensure that the 462.10appropriate records are readily available to employees or contractors authorized to access 462.11the records. Client records must be maintained in a manner that allows for timely access, 462.12printing, or transmission of the records.462.13    Subd. 3.Contents of client record.Contents of a client record include the 462.14following for each client:462.15(1) identifying information, including the client's name, date of birth, address, and 462.16telephone number;462.17(2) the name, address, and telephone number of an emergency contact, family 462.18members, client's representative, if any, or others as identified;462.19(3) names, addresses, and telephone numbers of the client's health and medical 462.20service providers and other home care providers, if known;462.21(4) health information, including medical history, allergies, and when the provider 462.22is managing medications, treatments or therapies that require documentation, and other 462.23relevant health records;462.24(5) client's advance directives, if any;462.25(6) the home care provider's current and previous assessments and service plans;462.26(7) all records of communications pertinent to the client's home care services;462.27(8) documentation of significant changes in the client's status and actions taken in 462.28response to the needs of the client including reporting to the appropriate supervisor or 462.29health care professional;462.30(9) documentation of incidents involving the client and actions taken in response 462.31to the needs of the client including reporting to the appropriate supervisor or health 462.32care professional;462.33(10) documentation that services have been provided as identified in the service plan;462.34(11) documentation that the client has received and reviewed the home care bill 462.35of rights;463.1(12) documentation that the client has been provided the statement of disclosure on 463.2limitations of services under section 144A.4791, subdivision 3;463.3(13) documentation of complaints received and resolution;463.4(14) discharge summary, including service termination notice and related 463.5documentation, when applicable; and463.6(15) other documentation required under this chapter and relevant to the client's 463.7services or status.463.8    Subd. 4.Transfer of client records.If a client transfers to another home care 463.9provider or other health care practitioner or provider, or is admitted to an inpatient facility, 463.10the home care provider, upon request of the client or the client's representative, shall take 463.11steps to ensure a coordinated transfer including sending a copy or summary of the client's 463.12record to the new home care provider, facility, or the client, as appropriate.463.13    Subd. 5.Record retention.Following the client's discharge or termination of 463.14services, a home care provider must retain a client's record for at least five years, or as 463.15otherwise required by state or federal regulations. Arrangements must be made for secure 463.16storage and retrieval of client records if the home care provider ceases business.463.17    Sec. 23. [144A.4795] HOME CARE PROVIDER RESPONSIBILITIES; STAFF.463.18    Subdivision 1.Qualifications, training, and competency.All staff providing 463.19home care services must be trained and competent in the provision of home care services 463.20consistent with current practice standards appropriate to the client's needs.463.21    Subd. 2.Licensed health professionals and nurses.(a) Licensed health 463.22professionals and nurses providing home care services as an employee of a licensed home 463.23care provider must possess current Minnesota license or registration to practice.463.24(b) Licensed health professionals and registered nurses must be competent in 463.25assessing client needs, planning appropriate home care services to meet client needs, 463.26implementing services, and supervising staff if assigned.463.27(c) Nothing in this section limits or expands the rights of nurses or licensed health 463.28professionals to provide services within the scope of their licenses or registrations, as 463.29provided by law.463.30    Subd. 3.Unlicensed personnel.(a) Unlicensed personnel providing basic home 463.31care services must have:463.32(1) successfully completed a training and competency evaluation appropriate to 463.33the services provided by the home care provider and the topics listed in subdivision 7, 463.34paragraph (b); or464.1(2) demonstrated competency by satisfactorily completing a written or oral test on 464.2the tasks the unlicensed personnel will perform and in the topics listed in subdivision 464.37, paragraph (b); and successfully demonstrate competency of topics in subdivision 7, 464.4paragraph (b), clauses (5), (7), and (8), by a practical skills test.464.5Unlicensed personnel providing home care services for a basic home care provider may 464.6not perform delegated nursing or therapy tasks.464.7(b) Unlicensed personnel performing delegated nursing tasks for a comprehensive 464.8home care provider must have:464.9(1) successfully completed training and demonstrated competency by successfully 464.10completing a written or oral test of the topics in subdivision 7, paragraphs (b) and (c), and 464.11a practical skills test on tasks listed in subdivision 7, paragraphs (b), clauses (5) and (7), 464.12and (c), clauses (3), (5), (6), and (7), and all the delegated tasks they will perform; or464.13(2) satisfy the current requirements of Medicare for training or competency of home 464.14health aides or nursing assistants, as provided by Code of Federal Regulations, title 42, 464.15section 483 or section 484.36; or464.16(3) before April 19, 1993, completed a training course for nursing assistants that was 464.17approved by the commissioner.464.18(c) Unlicensed personnel performing therapy or treatment tasks delegated or 464.19assigned by a licensed health professional must meet the requirements for delegated 464.20tasks in subdivision 4 and any other training or competency requirements within the 464.21licensed health professional scope of practice relating to delegation or assignment of tasks 464.22to unlicensed personnel.464.23    Subd. 4.Delegation of home care tasks.A registered nurse or licensed health 464.24professional may delegate tasks only to staff that are competent and possess the knowledge 464.25and skills consistent with the complexity of the tasks and according to the appropriate 464.26Minnesota Practice Act. The comprehensive home care provider must establish and 464.27implement a system to communicate up-to-date information to the registered nurse or 464.28licensed health professional regarding the current available staff and their competency so 464.29the registered nurse or licensed health professional has sufficient information to determine 464.30the appropriateness of delegating tasks to meet individual client needs and preferences.464.31    Subd. 5.Individual contractors.When a home care provider contracts with an 464.32individual contractor excluded from licensure under section 144A.471 to provide home 464.33care services, the contractor must meet the same requirements required by this section for 464.34personnel employed by the home care provider.464.35    Subd. 6.Temporary staff.When a home care provider contracts with a temporary 464.36staffing agency excluded from licensure under section 144A.471, those individuals must 465.1meet the same requirements required by this section for personnel employed by the home 465.2care provider and shall be treated as if they are staff of the home care provider.465.3    Subd. 7.Requirements for instructors, training content, and competency 465.4evaluations for unlicensed personnel.(a) Instructors and competency evaluators must 465.5meet the following requirements:465.6(1) training and competency evaluations of unlicensed personnel providing basic 465.7home care services must be conducted by individuals with work experience and training in 465.8providing home care services listed in section 144A.471, subdivisions 6 and 7; and465.9(2) training and competency evaluations of unlicensed personnel providing 465.10comprehensive home care services must be conducted by a registered nurse, or another 465.11instructor may provide training in conjunction with the registered nurse. If the home care 465.12provider is providing services by licensed health professionals only, then that specific 465.13training and competency evaluation may be conducted by the licensed health professionals 465.14as appropriate.465.15(b) Training and competency evaluations for all unlicensed personnel must include 465.16the following:465.17(1) documentation requirements for all services provided;465.18(2) reports of changes in the client's condition to the supervisor designated by the 465.19home care provider;465.20(3) basic infection control, including blood-borne pathogens;465.21(4) maintenance of a clean and safe environment;465.22(5) appropriate and safe techniques in personal hygiene and grooming, including:465.23(i) hair care and bathing;465.24(ii) care of teeth, gums, and oral prosthetic devices;465.25(iii) care and use of hearing aids; and465.26(iv) dressing and assisting with toileting;465.27(6) training on the prevention of falls for providers working with the elderly or 465.28individuals at risk of falls;465.29(7) standby assistance techniques and how to perform them;465.30(8) medication, exercise, and treatment reminders;465.31(9) basic nutrition, meal preparation, food safety, and assistance with eating;465.32(10) preparation of modified diets as ordered by a licensed health professional;465.33(11) communication skills that include preserving the dignity of the client and 465.34showing respect for the client and the client's preferences, cultural background, and family;465.35(12) awareness of confidentiality and privacy;466.1(13) understanding appropriate boundaries between staff and clients and the client's 466.2family;466.3(14) procedures to utilize in handling various emergency situations; and466.4(15) awareness of commonly used health technology equipment and assistive devices.466.5(c) In addition to paragraph (b), training and competency evaluation for unlicensed 466.6personnel providing comprehensive home care services must include:466.7(1) observation, reporting, and documenting of client status;466.8(2) basic knowledge of body functioning and changes in body functioning, injuries, 466.9or other observed changes that must be reported to appropriate personnel;466.10(3) reading and recording temperature, pulse, and respirations of the client;466.11(4) recognizing physical, emotional, cognitive, and developmental needs of the client;466.12(5) safe transfer techniques and ambulation;466.13(6) range of motioning and positioning; and466.14(7) administering medications or treatments as required.466.15(d) When the registered nurse or licensed health professional delegates tasks, they 466.16must ensure that prior to the delegation the unlicensed personnel is trained in the proper 466.17methods to perform the tasks or procedures for each client and are able to demonstrate 466.18the ability to competently follow the procedures and perform the tasks. If an unlicensed 466.19personnel has not regularly performed the delegated home care task for a period of 24 466.20consecutive months, the unlicensed personnel must demonstrate competency in the task 466.21to the registered nurse or appropriate licensed health professional. The registered nurse 466.22or licensed health professional must document instructions for the delegated tasks in 466.23the client's record.466.24    Sec. 24. [144A.4796] ORIENTATION AND ANNUAL TRAINING 466.25REQUIREMENTS.466.26    Subdivision 1.Orientation of staff and supervisors to home care.All staff 466.27providing and supervising direct home care services must complete an orientation to home 466.28care licensing requirements and regulations before providing home care services to clients. 466.29The orientation may be incorporated into the training required under subdivision 6. The 466.30orientation need only be completed once for each staff person and is not transferable 466.31to another home care provider.466.32    Subd. 2.Content.The orientation must contain the following topics:466.33    (1) an overview of sections 144A.43 to 144A.4798;466.34(2) introduction and review of all the provider's policies and procedures related to 466.35the provision of home care services;467.1(3) handling of emergencies and use of emergency services;467.2(4) compliance with and reporting the maltreatment of minors or vulnerable adults 467.3under sections 626.556 and 626.557;467.4(5) home care bill of rights, under section 144A.44;467.5(6) handling of clients' complaints, reporting of complaints, and where to report 467.6complaints including information on the Office of Health Facility Complaints and the 467.7Common Entry Point;467.8(7) consumer advocacy services of the Office of Ombudsman for Long-Term Care, 467.9Office of Ombudsman for Mental Health and Developmental Disabilities, Managed Care 467.10Ombudsman at the Department of Human Services, county managed care advocates, 467.11or other relevant advocacy services; and467.12(8) review of the types of home care services the employee will be providing and 467.13the provider's scope of licensure.467.14    Subd. 3.Verification and documentation of orientation.Each home care provider 467.15shall retain evidence in the employee record of each staff person having completed the 467.16orientation required by this section.467.17    Subd. 4.Orientation to client.Staff providing home care services must be oriented 467.18specifically to each individual client and the services to be provided. This orientation may 467.19be provided in person, orally, in writing, or electronically.467.20    Subd. 5.Training required relating to Alzheimer's disease and related disorders.467.21For home care providers that provide services for persons with Alzheimer's or related 467.22disorders, all direct care staff and supervisors working with these clients must receive 467.23training that includes a current explanation of Alzheimer's disease and related disorders, 467.24effective approaches to use to problem solve when working with a client's challenging 467.25behaviors, and how to communicate with clients who have Alzheimer's or related disorders.467.26    Subd. 6.Required annual training.All staff that perform direct home care 467.27services must complete at least eight hours of annual training for each 12 months of 467.28employment. The training may be obtained from the home care provider or another source 467.29and must include topics relevant to the provision of home care services. The annual 467.30training must include:467.31(1) training on reporting of maltreatment of minors under section 626.556 and 467.32maltreatment of vulnerable adults under section 626.557, whichever is applicable to the 467.33services provided;467.34(2) review of the home care bill of rights in section 144A.44;467.35(3) review of infection control techniques used in the home and implementation of 467.36infection control standards including a review of hand washing techniques; the need for 468.1and use of protective gloves, gowns, and masks; appropriate disposal of contaminated 468.2materials and equipment, such as dressings, needles, syringes, and razor blades; 468.3disinfecting reusable equipment; disinfecting environmental surfaces; and reporting of 468.4communicable diseases; and468.5(4) review of the provider's policies and procedures relating to the provision of home 468.6care services and how to implement those policies and procedures.468.7    Subd. 7.Documentation.A home care provider must retain documentation in the 468.8employee records of the staff that have satisfied the orientation and training requirements 468.9of this section.468.10    Sec. 25. [144A.4797] PROVISION OF SERVICES.468.11    Subdivision 1.Availability of contact person to staff.(a) A home care provider 468.12with a basic home care license must have a person available to staff for consultation on 468.13items relating to the provision of services or about the client.468.14(b) A home care provider with a comprehensive home care license must have a 468.15registered nurse available for consultation to staff performing delegated nursing tasks 468.16and must have an appropriate licensed health professional available if performing other 468.17delegated services such as therapies.468.18(c) The appropriate contact person must be readily available either in person, by 468.19telephone, or by other means to the staff at times when the staff is providing services.468.20    Subd. 2.Supervision of staff; basic home care services.(a) Staff who perform 468.21basic home care services must be supervised periodically where the services are being 468.22provided to verify that the work is being performed competently and to identify problems 468.23and solutions to address issues relating to the staff's ability to provide the services. The 468.24supervision of the unlicensed personnel must be done by staff of the home care provider 468.25having the authority, skills, and ability to provide the supervision of unlicensed personnel 468.26and who can implement changes as needed, and train staff.468.27(b) Supervision includes direct observation of unlicensed personnel while they 468.28are providing the services and may also include indirect methods of gaining input such 468.29as gathering feedback from the client. Supervisory review of staff must be provided at a 468.30frequency based on the staff person's competency and performance.468.31(c) For an individual who is licensed as a home care provider, this section does 468.32not apply.468.33    Subd. 3.Supervision of staff performing delegated nursing or therapy home 468.34care tasks.(a) Staff who perform delegated nursing or therapy home care tasks must 468.35be supervised by an appropriately licensed health professional or a registered nurse 469.1periodically where the services are being provided to verify that the work is being 469.2performed competently and to identify problems and solutions related to the staff person's 469.3ability to perform the tasks. Supervision of staff performing medication or treatment 469.4administration shall be provided by a registered nurse or appropriately licensed health 469.5professional and must include observation of the staff administering the medication or 469.6treatment and the interaction with the client.469.7(b) The direct supervision of staff performing delegated tasks must be provided 469.8within 30 days after the individual begins working for the home care provider and 469.9thereafter as needed based on performance. This requirement also applies to staff who 469.10have not performed delegated tasks for one year or longer.469.11    Subd. 4.Documentation.A home care provider must retain documentation of 469.12supervision activities in the personnel records.469.13    Subd. 5.Exemption.This section does not apply to an individual licensed under 469.14sections 144A.43 to 144A.4799.469.15    Sec. 26. [144A.4798] EMPLOYEE HEALTH STATUS.469.16    Subdivision 1.Tuberculosis (TB) prevention and control.A home care provider 469.17must establish and maintain a TB prevention and control program based on the most 469.18current guidelines issued by the Centers for Disease Control and Prevention (CDC). 469.19Components of a TB prevention and control program include screening all staff providing 469.20home care services, both paid and unpaid, at the time of hire for active TB disease and 469.21latent TB infection, and developing and implementing a written TB infection control plan. 469.22The commissioner shall make the most recent CDC standards available to home care 469.23providers on the department's Web site.469.24    Subd. 2.Communicable diseases.A home care provider must follow 469.25current federal or state guidelines for prevention, control, and reporting of human 469.26immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus, or other 469.27communicable diseases as defined in Minnesota Rules, part 4605.7040.469.28    Sec. 27. [144A.4799] DEPARTMENT OF HEALTH LICENSED HOME CARE 469.29PROVIDER ADVISORY COUNCIL.469.30    Subdivision 1.Membership.The commissioner of health shall appoint eight 469.31persons to a home care provider advisory council consisting of the following:469.32(1) three public members as defined in section 214.02 who shall be either persons 469.33who are currently receiving home care services or have family members receiving home 470.1care services, or persons who have family members who have received home care services 470.2within five years of the application date;470.3(2) three Minnesota home care licensees representing basic and comprehensive 470.4levels of licensure who may be a managerial official, an administrator, a supervising 470.5registered nurse, or an unlicensed personnel performing home care tasks;470.6(3) one member representing the Minnesota Board of Nursing; and470.7(4) one member representing the ombudsman for long-term care.470.8    Subd. 2.Organizations and meetings.The advisory council shall be organized 470.9and administered under section 15.059 with per diems and costs paid within the limits of 470.10available appropriations. Meetings will be held quarterly and hosted by the department. 470.11Subcommittees may be developed as necessary by the commissioner. Advisory council 470.12meetings are subject to the Open Meeting Law under chapter 13D.470.13    Subd. 3.Duties.At the commissioner's request, the advisory council shall provide 470.14advice regarding regulations of Department of Health licensed home care providers in 470.15this chapter such as:470.16(1) advice to the commissioner regarding community standards for home care 470.17practices;470.18(2) advice to the commissioner on enforcement of licensing standards and whether 470.19certain disciplinary actions are appropriate;470.20(3) advice to the commissioner about ways of distributing information to licensees 470.21and consumers of home care;470.22(4) advice to the commissioner about training standards;470.23(5) identify emerging issues and opportunities in the home care field, including the 470.24use of technology in home and telehealth capabilities; and470.25(6) perform other duties as directed by the commissioner.470.26    Sec. 28. [144A.481] HOME CARE LICENSING IMPLEMENTATION FOR 470.27NEW LICENSEES AND TRANSITION PERIOD FOR CURRENT LICENSEES.470.28    Subdivision 1.Temporary home care licenses and changes of ownership.(a) 470.29Beginning January 1, 2014, all temporary license applicants must apply for either a 470.30temporary basic or comprehensive home care license.470.31(b) Temporary home care licenses issued beginning January 1, 2014, will be 470.32issued according to the provisions in sections 144A.43 to 144A.4799 and fees in section 470.33144A.472 and will be required to comply with this chapter.470.34(c) No temporary licenses will be accepted or issued between December 1, 2013, 470.35and December 31, 2013.471.1(d) Beginning October 1, 2013, changes in ownership applications will require 471.2payment of the new fees listed in section 144A.472. Providers who are providing 471.3nursing, delegated nursing, or professional health care services, must submit the fee for 471.4comprehensive home care providers, and all other providers must submit the fee for basic 471.5home care providers as provided in section 144A.472. Change of ownership applicants will 471.6be issued a new home care license based on the licensure law in effect on June 30, 2013.471.7    Subd. 2.Current home care licensees with licenses prior to July 1, 2013.(a) 471.8Beginning July 1, 2014, department licensed home care providers must apply for either 471.9the basic or comprehensive home care license on their regularly scheduled renewal date.471.10(b) By June 30, 2015, all home care providers must either have a basic or 471.11comprehensive home care license or temporary license.471.12    Subd. 3.Renewal and change of ownership application of home care licensure 471.13during transition period.Renewal and change of ownership applications of home care 471.14licenses issued beginning July 1, 2014, will be issued according to sections 144A.43 471.15to 144A.4799, and upon license renewal or issuance of a new license for a change of 471.16ownership, providers must comply with sections 144A.43 to 144A.4799. Prior to renewal, 471.17providers must comply with the home care licensure law in effect on June 30, 2013.471.18The fees charged for licenses renewed between July 1, 2014, and June 30, 2016, 471.19shall be the lesser of 200 percent or $1,000, except where the 200 percent or $1,000 471.20increase exceeds the actual renewal fee charged, with a maximum renewal fee of $6,625.471.21For fiscal year 2014 only the fees for providers with revenues greater than $25,000 471.22and no more than $100,000 will be $313 and for providers with revenues no more than 471.23$25,000 the fee will be $125.471.24The license renewal fee schedule in section 144A.472 will be effective July 1, 2016.471.25    Sec. 29. [144A.482] REGISTRATION OF HOME MANAGEMENT 471.26PROVIDERS.471.27(a) For purposes of this section, a home management provider is an individual or 471.28organization that provides at least two of the following services: housekeeping, meal 471.29preparation, and shopping, to a person who is unable to perform these activities due to 471.30illness, disability, or physical condition.471.31(b) A person or organization that provides only home management services may not 471.32operate in the state without a current certificate of registration issued by the commissioner 471.33of health. To obtain a certificate of registration, the person or organization must annually 471.34submit to the commissioner the name, mailing and physical address, e-mail address, and 471.35telephone number of the individual or organization and a signed statement declaring that 472.1the individual or organization is aware that the home care bill of rights applies to their 472.2clients and that the person or organization will comply with the home care bill of rights 472.3provisions contained in section 144A.44. An individual or organization applying for a 472.4certificate must also provide the name, business address, and telephone number of each of 472.5the individuals responsible for the management or direction of the organization. 472.6(c) The commissioner shall charge an annual registration fee of $20 for individuals 472.7and $50 for organizations. The registration fee shall be deposited in the state treasury and 472.8credited to the state government special revenue fund.472.9(d) A home care provider that provides home management services and other home 472.10care services must be licensed, but licensure requirements other than the home care bill of 472.11rights do not apply to those employees or volunteers who provide only home management 472.12services to clients who do not receive any other home care services from the provider. 472.13A licensed home care provider need not be registered as a home management service 472.14provider, but must provide an orientation on the home care bill of rights to its employees 472.15or volunteers who provide home management services.472.16(e) An individual who provides home management services under this section must, 472.17within 120 days after beginning to provide services, attend an orientation session approved 472.18by the commissioner that provides training on the home care bill of rights and an orientation 472.19on the aging process and the needs and concerns of elderly and disabled persons.472.20(f) The commissioner may suspend or revoke a provider's certificate of registration 472.21or assess fines for violation of the home care bill of rights. Any fine assessed for a 472.22violation of the home care bill of rights by a provider registered under this section shall be 472.23in the amount established in the licensure rules for home care providers. As a condition 472.24of registration, a provider must cooperate fully with any investigation conducted by the 472.25commissioner, including providing specific information requested by the commissioner on 472.26clients served and the employees and volunteers who provide services. Fines collected 472.27under this paragraph shall be deposited in the state treasury and credited to the fund 472.28specified in the statute or rule in which the penalty was established.472.29(g) The commissioner may use any of the powers granted in sections 144A.43 to 472.30144A.4799 to administer the registration system and enforce the home care bill of rights 472.31under this section.472.32    Sec. 30. AGENCY QUALITY IMPROVEMENT PROGRAM.472.33    Subdivision 1.Annual legislative report on home care licensing.The 472.34commissioner shall establish a quality improvement program for the home care survey 472.35and home care complaint investigation processes.  The commissioner shall submit to the 473.1legislature an annual report, beginning October 1, 2015, and each October 1 thereafter. 473.2Each report will review the previous state fiscal year of home care licensing and regulatory 473.3activities.  The report must include, but is not limited to, an analysis of:473.4(1) the number of FTE's in the Compliance Monitoring Division, including the 473.5Office of Health Facilities Complaint units assigned to home care licensing, survey, 473.6investigation, and enforcement process;473.7(2) numbers of and descriptive information about licenses issued, complaints 473.8received and investigated, including allegations made and correction orders issued, 473.9surveys completed and timelines, correction order reconsiderations, and results;473.10(3) descriptions of emerging trends in home care provision and areas of concern 473.11identified by the department in its regulation of home care providers;473.12(4) information and data regarding performance improvement projects underway 473.13and planned by the commissioner in the area of home care surveys; and 473.14(5) work of the Department of Health Home Care Advisory Council.473.15    Subd. 2.Study of correction order appeal process.Starting July 1, 2015, the 473.16commissioner shall study whether to add a correction order appeal process conducted by 473.17an independent reviewer, such as an administrative law judge or other office, and submit a 473.18report to the legislature by February 1, 2016.  The commissioner shall review home care 473.19regulatory systems in other states as part of that study.  The commissioner shall consult 473.20with the home care providers and representatives.  473.21    Sec. 31. INTEGRATED LICENSING SYSTEM FOR HOME CARE AND HOME 473.22AND COMMUNITY-BASED SERVICES.473.23(a) The Department of Health Compliance Monitoring Division and the Department 473.24of Human Services Licensing Division shall jointly develop an integrated licensing system 473.25for providers of both home care services subject to licensure under Minnesota Statutes, 473.26chapter 144A, and for home and community-based services subject to licensure under 473.27Minnesota Statutes, chapter 245D. The integrated licensing system shall:473.28(1) require only one license of any provider of services under Minnesota Statutes, 473.29sections 144A.43 to 144A.482, and 245D.03, subdivision 1;473.30(2) promote quality services that recognize a person's individual needs and protect 473.31the person's health, safety, rights, and well-being;473.32(3) promote provider accountability through application requirements, compliance 473.33inspections, investigations, and enforcement actions;473.34(4) reference other applicable requirements in existing state and federal laws, 473.35including the federal Affordable Care Act;474.1(5) establish internal procedures to facilitate ongoing communications between the 474.2agencies, and with providers and services recipients about the regulatory activities;474.3(6) create a link between the agency Web sites so that providers and the public can 474.4access the same information regardless of which Web site is accessed initially; and474.5(7) collect data on identified outcome measures as necessary for the agencies to 474.6report to the Centers for Medicare and Medicaid Services.474.7(b) The joint recommendations for legislative changes to implement the integrated 474.8licensing system are due to the legislature by February 15, 2014.474.9(c) Before implementation of the integrated licensing system, providers licensed as 474.10home care providers under Minnesota Statutes, chapter 144A, may also provide home 474.11and community-based services subject to licensure under Minnesota Statutes, chapter 474.12245D, without obtaining a home and community-based services license under Minnesota 474.13Statutes, chapter 245D. During this time, the conditions under clauses (1) to (3) shall 474.14apply to these providers:474.15(1) the provider must comply with all requirements under Minnesota Statutes, chapter 474.16245D, for services otherwise subject to licensure under Minnesota Statutes, chapter 245D;474.17(2) a violation of requirements under Minnesota Statutes, chapter 245D, may be 474.18enforced by the Department of Health under the enforcement authority set forth in 474.19Minnesota Statutes, section 144A.475; and474.20(3) the Department of Health will provide information to the Department of Human 474.21Services about each provider licensed under this section, including the provider's license 474.22application, licensing documents, inspections, information about complaints received, and 474.23investigations conducted for possible violations of Minnesota Statutes, chapter 245D.474.24    Sec. 32. STUDY OF CORRECTION ORDER APPEAL PROCESS.474.25Beginning July 1, 2015, the commissioner of health shall study whether to use 474.26a correction order appeal process conducted by an independent reviewer, such as 474.27an administrative law judge or other office. The commissioner shall review home 474.28care regulatory systems in other states and consult with the home care providers and 474.29representatives. By February 1, 2016, the commissioner shall submit a report to the chairs 474.30and ranking minority members of the committees of the legislature with jurisdiction over 474.31health and human services and judiciary issues with any recommendations regarding 474.32an independent appeal process.474.33    Sec. 33.  REPEALER.474.34(a) Minnesota Statutes 2012, sections 144A.46; and 144A.461, are repealed.475.1(b) Minnesota Rules, parts 4668.0002; 4668.0003; 4668.0005; 4668.0008; 475.24668.0012; 4668.0016; 4668.0017; 4668.0019; 4668.0030; 4668.0035; 4668.0040; 475.34668.0050; 4668.0060; 4668.0065; 4668.0070; 4668.0075; 4668.0080; 4668.0100; 475.44668.0110; 4668.0120; 4668.0130; 4668.0140; 4668.0150; 4668.0160; 4668.0170; 475.54668.0180; 4668.0190; 4668.0200; 4668.0218; 4668.0220; 4668.0230; 4668.0240; 475.64668.0800; 4668.0805; 4668.0810; 4668.0815; 4668.0820; 4668.0825; 4668.0830; 475.74668.0835; 4668.0840; 4668.0845; 4668.0855; 4668.0860; 4668.0865; 4668.0870; 475.84669.0001; 4669.0010; 4669.0020; 4669.0030; 4669.0040; and 4669.0050, are repealed.475.9    Sec. 34. EFFECTIVE DATE.475.10Sections 1 to 33 are effective the day following final enactment, unless a different 475.11effective date is specified.475.12ARTICLE 12475.13HEALTH DEPARTMENT475.14    Section 1. Minnesota Statutes 2012, section 62J.692, subdivision 1, is amended to read:475.15    Subdivision 1. Definitions. For purposes of this section, the following definitions 475.16apply:475.17    (a) "Accredited clinical training" means the clinical training provided by a medical 475.18education program that is accredited through an organization recognized by the Department 475.19of Education, the Centers for Medicare and Medicaid Services, or another national body 475.20who reviews the accrediting organizations for multiple disciplines and whose standards 475.21for recognizing accrediting organizations are reviewed and approved by the commissioner 475.22of health in consultation with the Medical Education and Research Advisory Committee.475.23    (b) "Commissioner" means the commissioner of health.475.24    (c) "Clinical medical education program" means the accredited clinical training of 475.25physicians (medical students and residents), doctor of pharmacy practitioners, doctors 475.26of chiropractic, dentists, advanced practice nurses (clinical nurse specialists, certified 475.27registered nurse anesthetists, nurse practitioners, and certified nurse midwives), and475.28 physician assistants, dental therapists and advanced dental therapists, psychologists, 475.29clinical social workers, community paramedics, and community health workers.475.30    (d) "Sponsoring institution" means a hospital, school, or consortium located in 475.31Minnesota that sponsors and maintains primary organizational and financial responsibility 475.32for a clinical medical education program in Minnesota and which is accountable to the 475.33accrediting body.476.1    (e) "Teaching institution" means a hospital, medical center, clinic, or other 476.2organization that conducts a clinical medical education program in Minnesota.476.3    (f) "Trainee" means a student or resident involved in a clinical medical education 476.4program.476.5    (g) "Eligible trainee FTE's" means the number of trainees, as measured by full-time 476.6equivalent counts, that are at training sites located in Minnesota with currently active 476.7medical assistance enrollment status and a National Provider Identification (NPI) number 476.8where training occurs in either an inpatient or ambulatory patient care setting and where 476.9the training is funded, in part, by patient care revenues. Training that occurs in nursing 476.10facility settings is not eligible for funding under this section.476.11    Sec. 2. Minnesota Statutes 2012, section 62J.692, subdivision 3, is amended to read:476.12    Subd. 3. Application process. (a) A clinical medical education program conducted 476.13in Minnesota by a teaching institution to train physicians, doctor of pharmacy practitioners, 476.14dentists, chiropractors, or physician assistants is, dental therapists and advanced dental 476.15therapists, psychologists, clinical social workers, community paramedics, or community 476.16health workers are eligible for funds under subdivision 4 if the program:476.17(1) is funded, in part, by patient care revenues;476.18(2) occurs in patient care settings that face increased financial pressure as a result 476.19of competition with nonteaching patient care entities; and476.20(3) emphasizes primary care or specialties that are in undersupply in Minnesota.476.21(b) A clinical medical education program for advanced practice nursing is eligible for 476.22funds under subdivision 4 if the program meets the eligibility requirements in paragraph 476.23(a), clauses (1) to (3), and is sponsored by the University of Minnesota Academic Health 476.24Center, the Mayo Foundation, or institutions that are part of the Minnesota State Colleges 476.25and Universities system or members of the Minnesota Private College Council.476.26(c) Applications must be submitted to the commissioner by a sponsoring institution 476.27on behalf of an eligible clinical medical education program and must be received by 476.28October 31 of each year for distribution in the following year. An application for funds 476.29must contain the following information:476.30(1) the official name and address of the sponsoring institution and the official 476.31name and site address of the clinical medical education programs on whose behalf the 476.32sponsoring institution is applying;476.33(2) the name, title, and business address of those persons responsible for 476.34administering the funds;477.1(3) for each clinical medical education program for which funds are being sought; 477.2the type and specialty orientation of trainees in the program; the name, site address, and 477.3medical assistance provider number and national provider identification number of each 477.4training site used in the program; the federal tax identification number of each training site 477.5used in the program, where available; the total number of trainees at each training site; and 477.6the total number of eligible trainee FTEs at each site; and477.7(4) other supporting information the commissioner deems necessary to determine 477.8program eligibility based on the criteria in paragraphs (a) and (b) and to ensure the 477.9equitable distribution of funds.477.10(d) An application must include the information specified in clauses (1) to (3) for 477.11each clinical medical education program on an annual basis for three consecutive years. 477.12After that time, an application must include the information specified in clauses (1) to (3) 477.13when requested, at the discretion of the commissioner:477.14(1) audited clinical training costs per trainee for each clinical medical education 477.15program when available or estimates of clinical training costs based on audited financial 477.16data;477.17(2) a description of current sources of funding for clinical medical education costs, 477.18including a description and dollar amount of all state and federal financial support, 477.19including Medicare direct and indirect payments; and477.20(3) other revenue received for the purposes of clinical training.477.21(e) An applicant that does not provide information requested by the commissioner 477.22shall not be eligible for funds for the current funding cycle.477.23    Sec. 3. Minnesota Statutes 2012, section 62J.692, subdivision 4, is amended to read:477.24    Subd. 4. Distribution of funds. (a) The commissioner shall annually distribute the 477.25available medical education funds to all qualifying applicants based on a distribution 477.26formula that reflects a summation of two factors:477.27    (1) a public program volume factor, which is determined by the total volume of 477.28public program revenue received by each training site as a percentage of all public 477.29program revenue received by all training sites in the fund pool; and477.30    (2) a supplemental public program volume factor, which is determined by providing 477.31a supplemental payment of 20 percent of each training site's grant to training sites whose 477.32public program revenue accounted for at least 0.98 percent of the total public program 477.33revenue received by all eligible training sites. Grants to training sites whose public 477.34program revenue accounted for less than 0.98 percent of the total public program revenue 478.1received by all eligible training sites shall be reduced by an amount equal to the total 478.2value of the supplemental payment.478.3    Public program revenue for the distribution formula includes revenue from medical 478.4assistance, prepaid medical assistance, general assistance medical care, and prepaid 478.5general assistance medical care. Training sites that receive no public program revenue 478.6are ineligible for funds available under this subdivision. For purposes of determining 478.7training-site level grants to be distributed under paragraph (a), total statewide average 478.8costs per trainee for medical residents is based on audited clinical training costs per trainee 478.9in primary care clinical medical education programs for medical residents. Total statewide 478.10average costs per trainee for dental residents is based on audited clinical training costs 478.11per trainee in clinical medical education programs for dental students. Total statewide 478.12average costs per trainee for pharmacy residents is based on audited clinical training costs 478.13per trainee in clinical medical education programs for pharmacy students. Training sites 478.14whose training site level grant is less than $1,000 $5,000, based on the formula described 478.15in this paragraph, or that train fewer than 0.1 FTE eligible trainees, are ineligible for 478.16funds available under this subdivision. No training sites shall receive a grant per FTE 478.17trainee that is in excess of the 95th percentile grant per FTE across all eligible training 478.18sites; grants in excess of this amount will be redistributed to other eligible sites based on 478.19the formula described in this paragraph.478.20    (b) Funds distributed shall not be used to displace current funding appropriations 478.21from federal or state sources.478.22    (c) Funds shall be distributed to the sponsoring institutions indicating the amount 478.23to be distributed to each of the sponsor's clinical medical education programs based on 478.24the criteria in this subdivision and in accordance with the commissioner's approval letter. 478.25Each clinical medical education program must distribute funds allocated under paragraph 478.26(a) to the training sites as specified in the commissioner's approval letter. Sponsoring 478.27institutions, which are accredited through an organization recognized by the Department 478.28of Education or the Centers for Medicare and Medicaid Services, may contract directly 478.29with training sites to provide clinical training. To ensure the quality of clinical training, 478.30those accredited sponsoring institutions must:478.31    (1) develop contracts specifying the terms, expectations, and outcomes of the clinical 478.32training conducted at sites; and478.33    (2) take necessary action if the contract requirements are not met. Action may include 478.34the withholding of payments under this section or the removal of students from the site.478.35    (d) Use of funds is limited to expenses related to clinical training program costs for 478.36eligible programs.479.1    (e) Any funds not distributed in accordance with the commissioner's approval letter 479.2must be returned to the medical education and research fund within 30 days of receiving 479.3notice from the commissioner. The commissioner shall distribute returned funds to the 479.4appropriate training sites in accordance with the commissioner's approval letter.479.5    (e) (f) A maximum of $150,000 of the funds dedicated to the commissioner 479.6under section 
         297F.10, subdivision 1, clause (2), may be used by the commissioner for 479.7administrative expenses associated with implementing this section.479.8    Sec. 4. Minnesota Statutes 2012, section 62J.692, subdivision 5, is amended to read:479.9    Subd. 5. Report. (a) Sponsoring institutions receiving funds under this section 479.10must sign and submit a medical education grant verification report (GVR) to verify that 479.11the correct grant amount was forwarded to each eligible training site. If the sponsoring 479.12institution fails to submit the GVR by the stated deadline, or to request and meet 479.13the deadline for an extension, the sponsoring institution is required to return the full 479.14amount of funds received to the commissioner within 30 days of receiving notice from 479.15the commissioner. The commissioner shall distribute returned funds to the appropriate 479.16training sites in accordance with the commissioner's approval letter.479.17    (b) The reports must provide verification of the distribution of the funds and must 479.18include:479.19    (1) the total number of eligible trainee FTEs in each clinical medical education 479.20program;479.21    (2) the name of each funded program and, for each program, the dollar amount 479.22distributed to each training site and a training site expenditure report;479.23    (3) documentation of any discrepancies between the initial grant distribution notice 479.24included in the commissioner's approval letter and the actual distribution;479.25    (4) a statement by the sponsoring institution stating that the completed grant 479.26verification report is valid and accurate; and479.27    (5) other information the commissioner, with advice from the advisory committee,479.28 deems appropriate to evaluate the effectiveness of the use of funds for medical education.479.29    (c) By February 15 of Each year, the commissioner, with advice from the 479.30advisory committee, shall provide an annual summary report to the legislature on the 479.31implementation of this section.479.32    Sec. 5. Minnesota Statutes 2012, section 62J.692, subdivision 7a, is amended to read:479.33    Subd. 7a. Clinical medical education innovations grants. (a) The commissioner 479.34shall award grants to teaching institutions and clinical training sites for projects that 480.1increase dental access for underserved populations and promote innovative clinical 480.2training of dental professionals.480.3(b) $1,000,000 of the funds dedicated to the commissioner under section 297F.10, 480.4subdivision 1, clause (2), plus any federal financial participation on these funds, shall 480.5be distributed by the commissioner for primary care development grants pursuant to 480.6paragraph (c).480.7(c) The commissioner shall award grants to teaching institutions and clinical training 480.8sites for projects that increase the supply and availability of primary care providers for 480.9public program enrollees, improve access for underserved and rural populations, and 480.10promote interdisciplinary and team training of primary care providers and related personnel.480.11(d) In awarding the grants, the commissioner, in consultation with the commissioner 480.12of human services, shall consider the following:480.13(1) potential to successfully increase access to an underserved population;480.14(2) the long-term viability of the project to improve access beyond the period 480.15of initial funding;480.16(3) evidence of collaboration between the applicant and local communities;480.17(4) the efficiency in the use of the funding; and480.18(5) the priority level of the project in relation to state clinical education, access, 480.19and workforce goals.480.20(b) (e) The commissioner shall periodically evaluate the priorities in awarding the 480.21innovations grants in order to ensure that the priorities meet the changing workforce 480.22needs of the state.480.23    Sec. 6. Minnesota Statutes 2012, section 62J.692, subdivision 9, is amended to read:480.24    Subd. 9. Review of eligible providers. The commissioner and the Medical 480.25Education and Research Costs Advisory Committee may review provider groups included 480.26in the definition of a clinical medical education program to assure that the distribution 480.27of the funds continue to be consistent with the purpose of this section. The results of 480.28any such reviews must be reported to the chairs and ranking minority members of the 480.29legislative committees with jurisdiction over health care policy and finance.480.30    Sec. 7. Minnesota Statutes 2012, section 62J.692, is amended by adding a subdivision 480.31to read:480.32    Subd. 11.Distribution of funds.If federal approval is not received for the formula 480.33described in subdivision 4, paragraph (a), 100 percent of available medical education 481.1and research funds shall be distributed based on a distribution formula that reflects as 481.2summation of two factors:481.3(1) a public program volume factor, that is determined by the total volume of public 481.4program revenue received by each training site as a percentage of all public program 481.5revenue received by all training sites in the fund pool; and481.6(2) a supplemental public program volume factor, that is determined by providing a 481.7supplemental payment of 20 percent of each training site's grant to training sites whose 481.8public program revenue accounted for a least 0.98 percent of the total public program 481.9revenue received by all eligible training sites. Grants to training sites whose public 481.10program revenue accounted for less than 0.98 percent of the total public program revenue 481.11received by all eligible training sites shall be reduced by an amount equal to the total 481.12value of the supplemental payment.481.13    Sec. 8. Minnesota Statutes 2012, section 62Q.19, subdivision 1, is amended to read:481.14    Subdivision 1. Designation. (a) The commissioner shall designate essential 481.15community providers. The criteria for essential community provider designation shall be 481.16the following:481.17(1) a demonstrated ability to integrate applicable supportive and stabilizing services 481.18with medical care for uninsured persons and high-risk and special needs populations, 481.19underserved, and other special needs populations; and481.20(2) a commitment to serve low-income and underserved populations by meeting the 481.21following requirements:481.22(i) has nonprofit status in accordance with chapter 317A;481.23(ii) has tax-exempt status in accordance with the Internal Revenue Service Code, 481.24section 501(c)(3);481.25(iii) charges for services on a sliding fee schedule based on current poverty income 481.26guidelines; and481.27(iv) does not restrict access or services because of a client's financial limitation;481.28(3) status as a local government unit as defined in section 
         62D.02, subdivision 11, a 481.29hospital district created or reorganized under sections 
         447.31 to 
         447.37, an Indian tribal 481.30government, an Indian health service unit, or a community health board as defined in 481.31chapter 145A;481.32(4) a former state hospital that specializes in the treatment of cerebral palsy, spina 481.33bifida, epilepsy, closed head injuries, specialized orthopedic problems, and other disabling 481.34conditions;482.1(5) a sole community hospital. For these rural hospitals, the essential community 482.2provider designation applies to all health services provided, including both inpatient and 482.3outpatient services. For purposes of this section, "sole community hospital" means a 482.4rural hospital that:482.5(i) is eligible to be classified as a sole community hospital according to Code 482.6of Federal Regulations, title 42, section 412.92, or is located in a community with a 482.7population of less than 5,000 and located more than 25 miles from a like hospital currently 482.8providing acute short-term services;482.9(ii) has experienced net operating income losses in two of the previous three 482.10most recent consecutive hospital fiscal years for which audited financial information is 482.11available; and482.12(iii) consists of 40 or fewer licensed beds; or482.13(6) a birth center licensed under section 
         144.615; or482.14(7) a hospital or affiliated specialty clinic that:482.15(i) serves patients who are predominately under the age of 21;482.16(ii) provides intensive specialty pediatric services that are only routinely provided 482.17in less than five hospitals in the state; and482.18(iii) serves children from at least half the counties in the state.482.19(b) Prior to designation, the commissioner shall publish the names of all applicants 482.20in the State Register. The public shall have 30 days from the date of publication to submit 482.21written comments to the commissioner on the application. No designation shall be made 482.22by the commissioner until the 30-day period has expired.482.23(c) The commissioner may designate an eligible provider as an essential community 482.24provider for all the services offered by that provider or for specific services designated by 482.25the commissioner.482.26(d) For the purpose of this subdivision, supportive and stabilizing services include at 482.27a minimum, transportation, child care, cultural, and linguistic services where appropriate.482.28    Sec. 9. Minnesota Statutes 2012, section 103I.005, is amended by adding a subdivision 482.29to read:482.30    Subd. 1a.Bored geothermal heat exchanger."Bored geothermal heat exchanger" 482.31means an earth-coupled heating or cooling device consisting of a sealed closed-loop 482.32piping system installed in a boring in the ground to transfer heat to or from the surrounding 482.33earth with no discharge.483.1    Sec. 10. Minnesota Statutes 2012, section 103I.521, is amended to read:483.2103I.521 FEES DEPOSITED WITH COMMISSIONER OF MANAGEMENT 483.3AND BUDGET.483.4Unless otherwise specified, fees collected for licenses or registration by the 483.5commissioner under this chapter shall be deposited in the state treasury and credited to 483.6the state government special revenue fund.483.7    Sec. 11. Minnesota Statutes 2012, section 144.123, subdivision 1, is amended to read:483.8    Subdivision 1. Who must pay. Except for the limitation contained in this section, 483.9the commissioner of health shall charge a handling fee may enter into a contractual 483.10agreement to recover costs incurred for analysis for diagnostic purposes for each specimen 483.11submitted to the Department of Health for analysis for diagnostic purposes by any hospital, 483.12private laboratory, private clinic, or physician. No fee shall be charged to any entity which 483.13receives direct or indirect financial assistance from state or federal funds administered by 483.14the Department of Health, including any public health department, nonprofit community 483.15clinic, sexually transmitted disease clinic, or similar entity. No fee will be charged The 483.16commissioner shall not charge for any biological materials submitted to the Department 483.17of Health as a requirement of Minnesota Rules, part 4605.7040, or for those biological 483.18materials requested by the department to gather information for disease prevention or 483.19control purposes. The commissioner of health may establish other exceptions to the 483.20handling fee as may be necessary to protect the public's health. All fees collected pursuant 483.21to this section shall be deposited in the state treasury and credited to the state government 483.22special revenue fund. Funds generated in a contractual agreement made pursuant to this 483.23section shall be deposited in a special account and are appropriated to the commissioner 483.24for purposes of providing the services specified in the contracts. All such contractual 483.25agreements shall be processed in accordance with the provisions of chapter 16C.483.26EFFECTIVE DATE.This section is effective July 1, 2014.483.27    Sec. 12. Minnesota Statutes 2012, section 144.125, subdivision 1, is amended to read:483.28    Subdivision 1. Duty to perform testing.(a) It is the duty of (1) the administrative 483.29officer or other person in charge of each institution caring for infants 28 days or less 483.30of age, (2) the person required in pursuance of the provisions of section 
         144.215, to 483.31register the birth of a child, or (3) the nurse midwife or midwife in attendance at the 483.32birth, to arrange to have administered to every infant or child in its care tests for heritable 484.1and congenital disorders according to subdivision 2 and rules prescribed by the state 484.2commissioner of health.484.3    (b) Testing and the, recording and of test results, reporting of test results, and 484.4follow-up of infants with heritable congenital disorders, including hearing loss detected 484.5through the early hearing detection and intervention program in section 144.966, shall be 484.6performed at the times and in the manner prescribed by the commissioner of health. The 484.7commissioner shall charge a fee so that the total of fees collected will approximate the 484.8costs of conducting the tests and implementing and maintaining a system to follow-up 484.9infants with heritable or congenital disorders, including hearing loss detected through the 484.10early hearing detection and intervention program under section 144.966.484.11    (c) The fee is $101 per specimen. Effective July 1, 2010, the fee shall be increased 484.12to $106 to support the newborn screening program, including tests administered under 484.13this section and section 144.966, shall be $135 per specimen. The increased fee amount 484.14shall be deposited in the general fund. Costs associated with capital expenditures and 484.15the development of new procedures may be prorated over a three-year period when 484.16calculating the amount of the fees. This fee amount shall be deposited in the state treasury 484.17and credited to the state government special revenue fund.484.18(d) The fee to offset the cost of the support services provided under section 144.966, 484.19subdivision 3a, shall be $15 per specimen. This fee shall be deposited in the state treasury 484.20and credited to the general fund.484.21    Sec. 13. [144.1251] NEWBORN SCREENING FOR CRITICAL CONGENITAL 484.22HEART DISEASE (CCHD).484.23    Subdivision 1.Required testing and reporting.(a) Each licensed hospital or 484.24state-licensed birthing center or facility that provides maternity and newborn care services 484.25shall provide screening for congenital heart disease to all newborns prior to discharge 484.26using pulse oximetry screening. The screening must occur after the infant is 24 hours old, 484.27before discharge from the nursery. If discharge occurs before the infant is 24 hours old, 484.28the screening must occur as close as possible to the time of discharge.484.29(b) For premature infants (less than 36 weeks of gestation) and infants admitted to a 484.30higher-level nursery (special care or intensive care), pulse oximetry must be performed 484.31when medically appropriate prior to discharge.484.32(c) Results of the screening must be reported to the Department of Health.484.33    Subd. 2.Implementation.The Department of Health shall:484.34(1) communicate the screening protocol requirements;485.1(2) make information and forms available to the hospitals, birthing centers, and other 485.2facilities that are required to provide the screening, health care providers who provide 485.3prenatal care and care to newborns, and expectant parents and parents of newborns. The 485.4information and forms must include screening protocol and reporting requirements and 485.5parental options;485.6(3) provide training to ensure compliance with and appropriate implementation of 485.7the screening;485.8(4) establish the mechanism for the required data collection and reporting of 485.9screening and follow-up diagnostic results to the Department of Health according to the 485.10Department of Health's recommendations;485.11(5) coordinate the implementation of universal standardized screening;485.12(6) act as a resource for providers as the screening program is implemented, and in 485.13consultation with the Advisory Committee on Heritable and Congenital Disorders, develop 485.14and implement policies for early medical and developmental intervention services and 485.15long-term follow-up services for children and their families identified with a CCHD; and485.16(7) comply with sections 144.125 to 144.128.485.17    Sec. 14. Minnesota Statutes 2012, section 144.212, is amended to read:485.18144.212 DEFINITIONS.485.19    Subdivision 1. Scope. As used in sections 
         144.211 to 
         144.227, the following terms 485.20have the meanings given.485.21    Subd. 1a. Amendment. "Amendment" means completion or correction of made 485.22to certification items on  a vital record. after a certification has been issued or more 485.23than one year after the event, whichever occurs first, that does not result in a sealed or 485.24replaced record.485.25    Subd. 1b.Authorized representative."Authorized representative" means an agent 485.26designated in a written and witnessed statement signed by the subject of the record or 485.27other qualified applicant.485.28    Subd. 1c.Certification item."Certification item" means all individual items 485.29appearing on a certificate of birth and the demographic and legal items on a certificate 485.30of death.485.31    Subd. 2. Commissioner. "Commissioner" means the commissioner of health.485.32    Subd. 2a.Correction."Correction" means a change made to a noncertification 485.33item, including information collected for medical and statistical purposes. A correction 485.34also means a change to a certification item within one year of the event provided that no 485.35certification, whether paper or electronic, has been issued.486.1    Subd. 2b.Court of competent jurisdiction."Court of competent jurisdiction" 486.2means a court within the United States with jurisdiction over the individual and such other 486.3individuals that the court deems necessary.486.4    Subd. 2a 2c. Delayed registration. "Delayed registration" means registration of a 486.5record of birth or death filed one or more years after the date of birth or death.486.6    Subd. 2d.Disclosure."Disclosure" means to make available or make known 486.7personally identifiable information contained in a vital record, by any means of 486.8communication.486.9    Subd. 3. File. "File" means to present a vital record or report for registration to the 486.10Office of the State Registrar Vital Records and to have the vital record or report accepted 486.11for registration by the Office of the State Registrar Vital Records.486.12    Subd. 4. Final disposition. "Final disposition" means the burial, interment, 486.13cremation, removal from the state, or other authorized disposition of a dead body or 486.14dead fetus.486.15    Subd. 4a. Institution. "Institution" means a public or private establishment that:486.16(1) provides inpatient or outpatient medical, surgical, or diagnostic care or treatment; 486.17or486.18(2) provides nursing, custodial, or domiciliary care, or to which persons are 486.19committed by law.486.20    Subd. 4b.Legal representative."Legal representative" means a licensed attorney 486.21representing an individual.486.22    Subd. 4c.Local issuance office."Local issuance office" means a county 486.23governmental office authorized by the state registrar to issue certified birth and death 486.24records.486.25    Subd. 4d.Record."Record" means a report of a vital event that has been registered 486.26by the state registrar.486.27    Subd. 5. Registration. "Registration" means the process by which vital records 486.28are completed, filed, and incorporated into the official records of the Office of the State 486.29Registrar.486.30    Subd. 6. State registrar. "State registrar" means the commissioner of health or a 486.31designee.486.32    Subd. 7. System of vital statistics. "System of vital statistics" includes the 486.33registration, collection, preservation, amendment, verification, maintenance of the security 486.34and integrity of, and certification of vital records, the collection of other reports required 486.35by sections 
         144.211 to 
         144.227, and related activities including the tabulation, analysis, 486.36publication, and dissemination of vital statistics.487.1    Subd. 7a.Verification."Verification" means a confirmation of the information on a 487.2vital record based on the facts contained in a certification.487.3    Subd. 8. Vital record. "Vital record" means a record or report of birth, stillbirth, 487.4death, marriage, dissolution and annulment, and data related thereto. The birth record is 487.5not a medical record of the mother or the child.487.6    Subd. 9. Vital statistics. "Vital statistics" means the data derived from records and 487.7reports of birth, death, fetal death, induced abortion, marriage, dissolution and annulment, 487.8and related reports.487.9    Subd. 10.Local registrar."Local registrar" means an individual designated under 487.10section 144.214, subdivision 1, to perform the duties of a local registrar.487.11    Subd. 11. Consent to disclosure. "Consent to disclosure" means an affidavit filed 487.12with the state registrar which sets forth the following information:487.13(1) the current name and address of the affiant;487.14(2) any previous name by which the affiant was known;487.15(3) the original and adopted names, if known, of the adopted child whose original 487.16birth record is to be disclosed;487.17(4) the place and date of birth of the adopted child;487.18(5) the biological relationship of the affiant to the adopted child; and487.19(6) the affiant's consent to disclosure of information from the original birth record of 487.20the adopted child.487.21    Sec. 15. Minnesota Statutes 2012, section 144.213, is amended to read:487.22144.213 OFFICE OF THE STATE REGISTRAR VITAL RECORDS.487.23    Subdivision 1. Creation; state registrar; Office of Vital Records. The 487.24commissioner shall establish an Office of the State RegistrarVital Records under the 487.25supervision of the state registrar. The commissioner shall furnish to local registrars the 487.26forms necessary for correct reporting of vital statistics, and shall instruct the local registrars 487.27in the collection and compilation of the data. The commissioner shall promulgate rules for 487.28the collection, filing, and registering of vital statistics information by the state and local 487.29registrars registrar, physicians, morticians, and others. Except as otherwise provided in 487.30sections 
         144.211 to 
         144.227, rules previously promulgated by the commissioner relating to 487.31the collection, filing and registering of vital statistics shall remain in effect until repealed, 487.32modified or superseded by a rule promulgated by the commissioner.487.33    Subd. 2. General duties.(a) The state registrar shall coordinate the work of 487.34local registrars to maintain a statewide system of vital statistics. The state registrar is 487.35responsible for the administration and enforcement of sections 
         144.211 to 
         144.227, and 488.1shall supervise local registrars in the enforcement of sections 
         144.211 to 
         144.227 and the 488.2rules promulgated thereunder. Local issuance offices that fail to comply with the statutes 488.3or rules or to properly train employees may have their issuance privileges and access to 488.4the vital records system revoked.488.5(b) To preserve vital records the state registrar is authorized to prepare typewritten, 488.6photographic, electronic or other reproductions of original records and files in the Office 488.7of Vital Records. The reproductions when certified by the state registrar shall be accepted 488.8as the original records.488.9(c) The state registrar shall also:488.10(1) establish, designate, and eliminate offices in the state to aid in the efficient 488.11issuance of vital records;488.12(2) direct the activities of all persons engaged in activities pertaining to the operation 488.13of the system of vital statistics;488.14(3) develop and conduct training programs to promote uniformity of policy and 488.15procedures throughout the state in matters pertaining to the system of vital statistics; and488.16(4) prescribe, furnish, and distribute all forms required by sections 144.211 to 488.17144.227 and any rules adopted under these sections, and prescribe other means for the 488.18transmission of data, including electronic submission, that will accomplish the purpose of 488.19complete, accurate, and timely reporting and registration.488.20    Subd. 3.Record keeping.To preserve vital records the state registrar is authorized 488.21to prepare typewritten, photographic, electronic or other reproductions of original records 488.22and files in the Office of the State Registrar. The reproductions when certified by the state 488.23or local registrar shall be accepted as the original records.488.24    Sec. 16. [144.2131] SECURITY OF VITAL RECORDS SYSTEM.488.25The state registrar shall:488.26(1) authenticate all users of the system of vital statistics and document that all users 488.27require access based on their official duties;488.28(2) authorize authenticated users of the system of vital statistics to access specific 488.29components of the vital statistics systems necessary for their official roles and duties;488.30(3) establish separation of duties between staff roles that may be susceptible to fraud 488.31or misuse and routinely perform audits of staff work for the purposes of identifying fraud 488.32or misuse within the vital statistics system;488.33(4) require that authenticated and authorized users of the system of vital 488.34statistics maintain a specified level of training related to security and provide written 488.35acknowledgment of security procedures and penalties;489.1(5) validate data submitted for registration through site visits or with independent 489.2sources outside the registration system at a frequency specified by the state registrar to 489.3maximize the integrity of the data collected;489.4(6) protect personally identifiable information and maintain systems pursuant to 489.5applicable state and federal laws;489.6(7) accept a report of death if the decedent was born in Minnesota or if the decedent 489.7was a resident of Minnesota from the United States Department of Defense or the United 489.8States Department of State when the death of a United States citizen occurs outside the 489.9United States;489.10(8) match death records registered in Minnesota and death records provided from 489.11other jurisdictions to live birth records in Minnesota;489.12(9) match death records received from the United States Department of Defense 489.13or the United States Department of State for deaths of United States citizens occurring 489.14outside the United States to live birth records in Minnesota;489.15(10) work with law enforcement to initiate and provide evidence for active fraud 489.16investigations;489.17(11) provide secure workplace, storage, and technology environments that have 489.18limited role-based access;489.19(12) maintain overt, covert, and forensic security measures for certifications, 489.20verifications, and automated systems that are part of the vital statistics system; and489.21(13) comply with applicable state and federal laws and rules associated with 489.22information technology systems and related information security requirements.489.23    Sec. 17. Minnesota Statutes 2012, section 144.215, subdivision 3, is amended to read:489.24    Subd. 3. Father's name; child's name. In any case in which paternity of a child is 489.25determined by a court of competent jurisdiction, a declaration of parentage is executed 489.26under section 257.34, or a recognition of parentage is executed under section 
         257.75, the 489.27name of the father shall be entered on the birth record. If the order of the court declares 489.28the name of the child, it shall also be entered on the birth record. If the order of the court 489.29does not declare the name of the child, or there is no court order, then upon the request of 489.30both parents in writing, the surname of the child shall be defined by both parents.489.31    Sec. 18. Minnesota Statutes 2012, section 144.215, subdivision 4, is amended to read:489.32    Subd. 4. Social Security number registration. (a) Parents of a child born within 489.33this state shall give the parents' Social Security numbers to the Office of the State Registrar490.1 Vital Records at the time of filing the birth record, but the numbers shall not appear on 490.2the certified record.490.3(b) The Social Security numbers are classified as private data, as defined in section 490.413.02, subdivision 12, on individuals, but the Office of the State Registrar Vital Records490.5 shall provide a Social Security number to the public authority responsible for child support 490.6services upon request by the public authority for use in the establishment of parentage and 490.7the enforcement of child support obligations.490.8    Sec. 19. Minnesota Statutes 2012, section 144.216, subdivision 1, is amended to read:490.9    Subdivision 1. Reporting a foundling. Whoever finds a live born infant of unknown 490.10parentage shall report within five days to the Office of the State Registrar Vital Records490.11 such information as the commissioner may by rule require to identify the foundling.490.12    Sec. 20. Minnesota Statutes 2012, section 144.217, subdivision 2, is amended to read:490.13    Subd. 2. Court petition. If a delayed record of birth is rejected under subdivision 490.141, a person may petition the appropriate court in the county in which the birth allegedly 490.15occurred for an order establishing a record of the date and place of the birth and the 490.16parentage of the person whose birth is to be registered. The petition shall state:490.17(1) that the person for whom a delayed record of birth is sought was born in this state;490.18(2) that no record of birth can be found in the Office of the State Registrar Vital 490.19Records;490.20(3) that diligent efforts by the petitioner have failed to obtain the evidence required 490.21in subdivision 1;490.22(4) that the state registrar has refused to register a delayed record of birth; and490.23(5) other information as may be required by the court.490.24    Sec. 21. Minnesota Statutes 2012, section 144.218, subdivision 5, is amended to read:490.25    Subd. 5. Replacement of vital records. Upon the order of a court of this state, upon 490.26the request of a court of another state, upon the filing of a declaration of parentage under 490.27section 257.34, or upon the filing of a recognition of parentage with a the state registrar, a 490.28replacement birth record must be registered consistent with the findings of the court, the 490.29declaration of parentage, or the recognition of parentage.490.30    Sec. 22. [144.2181] AMENDMENT AND CORRECTION OF VITAL RECORDS.491.1(a) A vital record registered under sections 144.212 to 144.227 may be amended 491.2or corrected only according to sections 144.212 to 144.227 and rules adopted by the 491.3commissioner of health to protect the integrity and accuracy of vital records.491.4(b)(1) A vital record that is amended under this section shall indicate that it has been 491.5amended, except as otherwise provided in this section or by rule.491.6(2) Electronic documentation shall be maintained by the state registrar that 491.7identifies the evidence upon which the amendment or correction was based, the date 491.8of the amendment or correction, and the identity of the authorized person making the 491.9amendment or correction.491.10(c) Upon receipt of a certified copy of an order of a court of competent jurisdiction 491.11changing the name of a person whose birth is registered in Minnesota and upon request of 491.12such person if 18 years of age or older or having the status of emancipated minor, the state 491.13registrar shall amend the birth record to show the new name. If the person is a minor or 491.14an incapacitated person then a parent, guardian, or legal representative of the minor or 491.15incapacitated person may make the request.491.16(d) When an applicant does not submit the minimum documentation required for 491.17amending a vital record or when the state registrar has cause to question the validity 491.18or completeness of the applicant's statements or the documentary evidence, and the 491.19deficiencies are not corrected, the state registrar shall not amend the vital record. The 491.20state registrar shall advise the applicant of the reason for this action and shall further 491.21advise the applicant of the right of appeal to a court with competent jurisdiction over 491.22the Department of Health.491.23    Sec. 23. Minnesota Statutes 2012, section 144.225, subdivision 1, is amended to read:491.24    Subdivision 1. Public information; access to vital records. Except as otherwise 491.25provided for in this section and section 
         144.2252, information contained in vital records 491.26shall be public information. Physical access to vital records shall be subject to the 491.27supervision and regulation of the state and local registrarsregistrar and their employees 491.28pursuant to rules promulgated by the commissioner in order to protect vital records from 491.29loss, mutilation or destruction and to prevent improper disclosure of vital records which 491.30are confidential or private data on individuals, as defined in section 
         13.02, subdivisions 491.313 and 12.491.32    Sec. 24. Minnesota Statutes 2012, section 144.225, subdivision 4, is amended to read:491.33    Subd. 4. Access to records for research purposes. The state registrar may permit 491.34persons performing medical research access to the information restricted in subdivision 492.12 or 2a if those persons agree in writing not to disclose private or confidential data on 492.2individuals.492.3    Sec. 25. Minnesota Statutes 2012, section 144.225, subdivision 7, is amended to read:492.4    Subd. 7. Certified birth or death record. (a) The state or local registrar or local 492.5issuance office shall issue a certified birth or death record or a statement of no vital record 492.6found to an individual upon the individual's proper completion of an attestation provided 492.7by the commissioner and payment of the required fee:492.8    (1) to a person who has a tangible interest in the requested vital record. A person 492.9who has a tangible interest is:492.10    (i) the subject of the vital record;492.11    (ii) a child of the subject;492.12    (iii) the spouse of the subject;492.13    (iv) a parent of the subject;492.14    (v) the grandparent or grandchild of the subject;492.15    (vi) if the requested record is a death record, a sibling of the subject;492.16    (vii) the party responsible for filing the vital record;492.17    (viii) the legal custodian, guardian or conservator, or health care agent of the subject;492.18    (ix) a personal representative, by sworn affidavit of the fact that the certified copy is 492.19required for administration of the estate;492.20    (x) a successor of the subject, as defined in section 
         524.1-201, if the subject is 492.21deceased, by sworn affidavit of the fact that the certified copy is required for administration 492.22of the estate;492.23    (xi) if the requested record is a death record, a trustee of a trust by sworn affidavit of 492.24the fact that the certified copy is needed for the proper administration of the trust;492.25    (xii) a person or entity who demonstrates that a certified vital record is necessary for 492.26the determination or protection of a personal or property right, pursuant to rules adopted 492.27by the commissioner; or492.28    (xiii) adoption agencies in order to complete confidential postadoption searches as 492.29required by section 
         259.83;492.30    (2) to any local, state, or federal governmental agency upon request if the certified 492.31vital record is necessary for the governmental agency to perform its authorized duties. 492.32An authorized governmental agency includes the Department of Human Services, the 492.33Department of Revenue, and the United States Citizenship and Immigration Services;492.34    (3) to an attorney upon evidence of the attorney's license;493.1    (4) pursuant to a court order issued by a court of competent jurisdiction. For 493.2purposes of this section, a subpoena does not constitute a court order; or493.3    (5) to a representative authorized by a person under clauses (1) to (4).493.4    (b) The state or local registrar or local issuance office shall also issue a certified 493.5death record to an individual described in paragraph (a), clause (1), items (ii) to (viii), if, 493.6on behalf of the individual, a licensed mortician furnishes the registrar with a properly 493.7completed attestation in the form provided by the commissioner within 180 days of the 493.8time of death of the subject of the death record. This paragraph is not subject to the 493.9requirements specified in Minnesota Rules, part 4601.2600, subpart 5, item B.493.10    Sec. 26. Minnesota Statutes 2012, section 144.225, subdivision 8, is amended to read:493.11    Subd. 8. Standardized format for certified birth and death records.No later than 493.12July 1, 2000, The commissioner shall develop maintain a standardized format for certified 493.13birth records and death records issued by the state and local registrars registrar and local 493.14issuance offices. The format shall incorporate security features in accordance with this 493.15section. The standardized format must be implemented on a statewide basis by July 1, 2001.493.16    Sec. 27. Minnesota Statutes 2012, section 144.226, is amended to read:493.17144.226 FEES.493.18    Subdivision 1. Which services are for fee. The fees for the following services shall 493.19be the following or an amount prescribed by rule of the commissioner:493.20(a) The fee for the issuance of administrative review and processing of a request for493.21 a certified vital record or a certification that the vital record cannot be found is $9. No 493.22fee shall be charged for a certified birth, stillbirth, or death record that is reissued within 493.23one year of the original issue, if an amendment is made to the vital record and if the 493.24previously issued vital record is surrendered. The fee is payable at the time of application 493.25and is nonrefundable.493.26(b) The fee for processing a request for the replacement of a birth record for 493.27all events, except when filing a recognition of parentage pursuant to section 
         257.73, 493.28subdivision 1
         , is $40. The fee is payable at the time of application and is nonrefundable.493.29(c) The fee for administrative review and processing of a request for the filing of a 493.30delayed registration of birth, stillbirth, or death is $40. The fee is payable at the time of 493.31application and is nonrefundable. This fee includes one subsequent review of the request 493.32if the request is not acceptable upon the initial receipt.493.33(d) The fee for administrative review and processing of a request for the amendment 493.34of any vital record when requested more than 45 days after the filing of the vital record is 494.1$40. No fee shall be charged for an amendment requested within 45 days after the filing 494.2of the vital record. The fee is payable at the time of application and is nonrefundable. 494.3This fee includes one subsequent review of the request if the request is not acceptable 494.4upon the initial receipt.494.5(e) The fee for administrative review and processing of a request for the verification 494.6of information from vital records is $9 when the applicant furnishes the specific 494.7information to locate the vital record. When the applicant does not furnish specific 494.8information, the fee is $20 per hour for staff time expended. Specific information includes 494.9the correct date of the event and the correct name of the registrant subject of the record. 494.10Fees charged shall approximate the costs incurred in searching and copying the vital 494.11records. The fee is payable at the time of application and is nonrefundable.494.12(f) The fee for administrative review and processing of a request for the issuance 494.13of a copy of any document on file pertaining to a vital record or statement that a related 494.14document cannot be found is $9. The fee is payable at the time of application and is 494.15nonrefundable.494.16    Subd. 2. Fees to state government special revenue fund. Fees collected under 494.17this section by the state registrar shall be deposited in the state treasury and credited to 494.18the state government special revenue fund.494.19    Subd. 3. Birth record surcharge. (a) In addition to any fee prescribed under 494.20subdivision 1, there shall be a nonrefundable surcharge of $3 for each certified birth or 494.21stillbirth record and for a certification that the vital record cannot be found. The local or494.22 state registrar or local issuance office shall forward this amount to the commissioner of 494.23management and budget for deposit into the account for the children's trust fund for the 494.24prevention of child abuse established under section 
         256E.22. This surcharge shall not be 494.25charged under those circumstances in which no fee for a certified birth or stillbirth record 494.26is permitted under subdivision 1, paragraph (a). Upon certification by the commissioner of 494.27management and budget that the assets in that fund exceed $20,000,000, this surcharge 494.28shall be discontinued.494.29(b) In addition to any fee prescribed under subdivision 1, there shall be a 494.30nonrefundable surcharge of $10 for each certified birth record. The local or state registrar 494.31or local issuance office shall forward this amount to the commissioner of management and 494.32budget for deposit in the general fund. This surcharge shall not be charged under those 494.33circumstances in which no fee for a certified birth record is permitted under subdivision 1, 494.34paragraph (a).494.35    Subd. 4. Vital records surcharge.(a) In addition to any fee prescribed under 494.36subdivision 1, there is a nonrefundable surcharge of $2 $4 for each certified and 495.1noncertified birth, stillbirth, or death record, and for a certification that the record cannot 495.2be found. The local issuance office or state registrar shall forward this amount to the 495.3commissioner of management and budget to be deposited into the state government special 495.4revenue fund. This surcharge shall not be charged under those circumstances in which no 495.5fee for a birth, stillbirth, or death record is permitted under subdivision 1, paragraph (a).495.6(b) Effective August 1, 2005, the surcharge in paragraph (a) is $4.495.7    Subd. 5. Electronic verification. A fee for the electronic verification or electronic 495.8certification of a vital event, when the information being verified or certified is obtained 495.9from a certified birth or death record, shall be established through contractual or 495.10interagency agreements with interested local, state, or federal government agencies.495.11    Subd. 6. Alternative payment methods. Notwithstanding subdivision 1, alternative 495.12payment methods may be approved and implemented by the state registrar or a local 495.13registrar issuance office.495.14    Sec. 28. [144.492] DEFINITIONS.495.15    Subdivision 1.Applicability.For the purposes of sections 144.492 to 144.494, the 495.16terms defined in this section have the meanings given them.495.17    Subd. 2.Commissioner."Commissioner" means the commissioner of health.495.18    Subd. 3.Joint commission."Joint commission" means the independent, 495.19not-for-profit organization that accredits and certifies health care organizations and 495.20programs in the United States.495.21    Subd. 4.Stroke."Stroke" means the sudden death of brain cells in a localized 495.22area due to inadequate blood flow.495.23    Sec. 29. [144.493] CRITERIA.495.24    Subdivision 1.Comprehensive stroke center.A hospital meets the criteria for a 495.25comprehensive stroke center if the hospital has been certified as a comprehensive stroke 495.26center by the joint commission or another nationally recognized accreditation entity.495.27    Subd. 2.Primary stroke center.A hospital meets the criteria for a primary stroke 495.28center if the hospital has been certified as a primary stroke center by the joint commission 495.29or another nationally recognized accreditation entity.495.30    Subd. 3.Acute stroke ready hospital.A hospital meets the criteria for an acute 495.31stroke ready hospital if the hospital has the following elements of an acute stroke ready 495.32hospital:495.33(1) an acute stroke team available or on-call 24 hours a days, seven days a week;496.1(2) written stroke protocols, including triage, stabilization of vital functions, initial 496.2diagnostic tests, and use of medications;496.3(3) a written plan and letter of cooperation with emergency medical services regarding 496.4triage and communication that are consistent with regional patient care procedures;496.5(4) emergency department personnel who are trained in diagnosing and treating 496.6acute stroke;496.7(5) the capacity to complete basic laboratory tests, electrocardiograms, and chest 496.8x-rays 24 hours a day, seven days a week;496.9(6) the capacity to perform and interpret brain injury imaging studies 24 hours a 496.10days, seven days a week;496.11(7) written protocols that detail available emergent therapies and reflect current 496.12treatment guidelines, which include performance measures and are revised at least annually;496.13(8) a neurosurgery coverage plan, call schedule, and a triage and transportation plan;496.14(9) transfer protocols and agreements for stroke patients; and496.15(10) a designated medical director with experience and expertise in acute stroke care.496.16    Sec. 30. [144.494] DESIGNATING STROKE HOSPITALS.496.17    Subdivision 1.Naming privileges.Unless it has been designated a stroke hospital 496.18by the commissioner, the joint commission, or another nationally recognized accreditation 496.19entity, no hospital shall use the term "stroke center" or "stroke hospital" in its name or its 496.20advertising or shall otherwise indicate it has stroke treatment capabilities.496.21    Subd. 2.Designation.A hospital that voluntarily meets the criteria for a 496.22comprehensive stroke center, primary stroke center, or acute stroke ready hospital may 496.23apply to the commissioner for designation, and upon the commissioner's review and 496.24approval of the application, shall be designated as a comprehensive stroke center, a 496.25primary stroke center, or an acute stroke ready hospital for a three-year period. If a hospital 496.26loses its certification as a comprehensive stroke center or primary stroke center from 496.27the joint commission or other nationally recognized accreditation entity, its Minnesota 496.28designation will be immediately withdrawn. Prior to the expiration of the three-year 496.29designation, a hospital seeking to remain part of the voluntary acute stroke system may 496.30reapply to the commissioner for designation.496.31    Sec. 31. [144.554] HEALTH FACILITIES CONSTRUCTION PLAN 496.32SUBMITTAL AND FEES.496.33For hospitals, nursing homes, boarding care homes, residential hospices, supervised 496.34living facilities, freestanding outpatient surgical centers, and end-stage renal disease 497.1facilities, the commissioner shall collect a fee for the review and approval of architectural, 497.2mechanical, and electrical plans and specifications submitted before construction begins 497.3for each project relative to construction of new buildings, additions to existing buildings, 497.4or for remodeling or alterations of existing buildings. All fees collected in this section 497.5shall be deposited in the state treasury and credited to the state government special revenue 497.6fund. Fees must be paid at the time of submission of final plans for review and are not 497.7refundable. The fee is calculated as follows:

497.8Construction project total estimated costFee497.9$0 - $10,000$30497.10$10,001 - $50,000$150497.11$50,001 - $100,000$300497.12$100,001 - $150,000$450497.13$150,001 - $200,000$600497.14$200,001 - $250,000$750497.15$250,001 - $300,000$900497.16$300,001 - $350,000$1,050497.17$350,001 - $400,000$1,200497.18$400,001 - $450,000$1,350497.19$450,001 - $500,000$1,500497.20$500,001 - $550,000$1,650497.21$550,001 - $600,000$1,800497.22$600,001 - $650,000$1,950497.23$650,001 - $700,000$2,100497.24$700,001 - $750,000$2,250497.25$750,001 - $800,000$2,400497.26$800,001 - $850,000$2,550497.27$850,001 - $900,000$2,700497.28$900,001 - $950,000$2,850497.29$950,001 - $1,000,000$3,000497.30$1,000,001 - $1,050,000$3,150497.31$1,050,001 - $1,100,000$3,300497.32$1,100,001 - $1,150,000$3,450497.33$1,150,001 - $1,200,000$3,600497.34$1,200,001 - $1,250,000$3,750497.35$1,250,001 - $1,300,000$3,900497.36$1,300,001 - $1,350,000$4,050497.37$1,350,001 - $1,400,000$4,200497.38$1,400,001 - $1,450,000$4,350497.39$1,450,001 - $1,500,000$4,500497.40$1,500,001 and over$4,800

497.41    Sec. 32. Minnesota Statutes 2012, section 144.966, subdivision 2, is amended to read:498.1    Subd. 2. Newborn Hearing Screening Advisory Committee. (a) The 498.2commissioner of health shall establish a Newborn Hearing Screening Advisory Committee 498.3to advise and assist the Department of Health and the Department of Education in:498.4    (1) developing protocols and timelines for screening, rescreening, and diagnostic 498.5audiological assessment and early medical, audiological, and educational intervention 498.6services for children who are deaf or hard-of-hearing;498.7    (2) designing protocols for tracking children from birth through age three that may 498.8have passed newborn screening but are at risk for delayed or late onset of permanent 498.9hearing loss;498.10    (3) designing a technical assistance program to support facilities implementing the 498.11screening program and facilities conducting rescreening and diagnostic audiological 498.12assessment;498.13    (4) designing implementation and evaluation of a system of follow-up and tracking; 498.14and498.15    (5) evaluating program outcomes to increase effectiveness and efficiency and ensure 498.16culturally appropriate services for children with a confirmed hearing loss and their families.498.17    (b) The commissioner of health shall appoint at least one member from each of the 498.18following groups with no less than two of the members being deaf or hard-of-hearing:498.19    (1) a representative from a consumer organization representing culturally deaf 498.20persons;498.21    (2) a parent with a child with hearing loss representing a parent organization;498.22    (3) a consumer from an organization representing oral communication options;498.23    (4) a consumer from an organization representing cued speech communication 498.24options;498.25    (5) an audiologist who has experience in evaluation and intervention of infants 498.26and young children;498.27    (6) a speech-language pathologist who has experience in evaluation and intervention 498.28of infants and young children;498.29    (7) two primary care providers who have experience in the care of infants and young 498.30children, one of which shall be a pediatrician;498.31    (8) a representative from the early hearing detection intervention teams;498.32    (9) a representative from the Department of Education resource center for the deaf 498.33and hard-of-hearing or the representative's designee;498.34    (10) a representative of the Commission of Deaf, DeafBlind and Hard-of-Hearing 498.35Minnesotans;499.1    (11) a representative from the Department of Human Services Deaf and 499.2Hard-of-Hearing Services Division;499.3    (12) one or more of the Part C coordinators from the Department of Education, the 499.4Department of Health, or the Department of Human Services or the department's designees;499.5    (13) the Department of Health early hearing detection and intervention coordinators;499.6    (14) two birth hospital representatives from one rural and one urban hospital;499.7    (15) a pediatric geneticist;499.8    (16) an otolaryngologist;499.9    (17) a representative from the Newborn Screening Advisory Committee under 499.10this subdivision; and499.11    (18) a representative of the Department of Education regional low-incidence 499.12facilitators.499.13The commissioner must complete the appointments required under this subdivision by 499.14September 1, 2007.499.15    (c) The Department of Health member shall chair the first meeting of the committee. 499.16At the first meeting, the committee shall elect a chair from its membership. The committee 499.17shall meet at the call of the chair, at least four times a year. The committee shall adopt 499.18written bylaws to govern its activities. The Department of Health shall provide technical 499.19and administrative support services as required by the committee. These services shall 499.20include technical support from individuals qualified to administer infant hearing screening, 499.21rescreening, and diagnostic audiological assessments.499.22    Members of the committee shall receive no compensation for their service, but 499.23shall be reimbursed as provided in section 
         15.059 for expenses incurred as a result of 499.24their duties as members of the committee.499.25    (d) This subdivision expires June 30, 2013 2019.499.26    Sec. 33. Minnesota Statutes 2012, section 144.966, subdivision 3a, is amended to read:499.27    Subd. 3a. Support services to families.(a) The commissioner shall contract with a 499.28nonprofit organization to provide support and assistance to families with children who are 499.29deaf or have a hearing loss. The family support provided must include:499.30    (1) direct hearing loss specific parent-to-parent assistance and unbiased information 499.31on communication, educational, and medical options; and499.32    (2) individualized deaf or hard-of-hearing mentors who provide education, including 499.33instruction in American Sign Language as an available option. 499.34The commissioner shall give preference to a nonprofit organization that has the ability to 499.35provide these services throughout the state.500.1    (b) Family participation in the support and assistance services is voluntary.500.2    Sec. 34. Minnesota Statutes 2012, section 144.98, subdivision 3, is amended to read:500.3    Subd. 3. Annual fees. (a) An application for accreditation under subdivision 6 must 500.4be accompanied by the annual fees specified in this subdivision. The annual fees include:500.5(1) base accreditation fee, $1,500 $600;500.6(2) sample preparation techniques fee, $200 per technique;500.7(3) an administrative fee for laboratories located outside this state, $3,750 $2,000; and500.8(4) test category fees.500.9(b) For the programs in subdivision 3a, the commissioner may accredit laboratories 500.10for fields of testing under the categories listed in clauses (1) to (10) upon completion of 500.11the application requirements provided by subdivision 6 and receipt of the fees for each 500.12category under each program that accreditation is requested. The categories offered and 500.13related fees include:500.14(1) microbiology, $450 $200;500.15(2) inorganics, $450 $200;500.16(3) metals, $1,000 $500;500.17(4) volatile organics, $1,300 $1,000;500.18(5) other organics, $1,300 $1,000;500.19(6) radiochemistry, $1,500 $750;500.20(7) emerging contaminants, $1,500 $1,000;500.21(8) agricultural contaminants, $1,250 $1,000;500.22(9) toxicity (bioassay), $1,000 $500; and500.23(10) physical characterization, $250.500.24(c) The total annual fee includes the base fee, the sample preparation techniques 500.25fees, the test category fees per program, and, when applicable, an administrative fee for 500.26out-of-state laboratories.500.27EFFECTIVE DATE.This section is effective the day following final enactment.500.28    Sec. 35. Minnesota Statutes 2012, section 144.98, subdivision 5, is amended to read:500.29    Subd. 5. State government special revenue fund. Fees collected by the 500.30commissioner under this section must be deposited in the state treasury and credited to 500.31the state government special revenue fund.500.32EFFECTIVE DATE.This section is effective the day following final enactment.501.1    Sec. 36. Minnesota Statutes 2012, section 144.98, is amended by adding a subdivision 501.2to read:501.3    Subd. 10.Establishing a selection committee.(a) The commissioner shall 501.4establish a selection committee for the purpose of recommending approval of qualified 501.5laboratory assessors and assessment bodies. Committee members shall demonstrate 501.6competence in assessment practices. The committee shall initially consist of seven 501.7members appointed by the commissioner as follows:501.8(1) one member from a municipal laboratory accredited by the commissioner;501.9(2) one member from an industrial treatment laboratory accredited by the 501.10commissioner;501.11(3) one member from a commercial laboratory located in this state and accredited by 501.12the commissioner;501.13(4) one member from a commercial laboratory located outside the state and 501.14accredited by the commissioner;501.15(5) one member from a nongovernmental client of environmental laboratories;501.16(6) one member from a professional organization with a demonstrated interest in 501.17environmental laboratory data and accreditation; and501.18(7) one employee of the laboratory accreditation program administered by the 501.19department.501.20(b) Committee appointments begin on January 1 and end on December 31 of the 501.21same year.501.22(c) The commissioner shall appoint persons to fill vacant committee positions, 501.23expand the total number of appointed positions, or change the designated positions upon 501.24the advice of the committee.501.25(d) The commissioner shall rescind the appointment of a selection committee 501.26member for sufficient cause as the commissioner determines, such as:501.27(1) neglect of duty;501.28(2) failure to notify the commissioner of a real or perceived conflict of interest;501.29(3) nonconformance with committee procedures;501.30(4) failure to demonstrate competence in assessment practices; or501.31(5) official misconduct.501.32(e) Members of the selection committee shall be compensated according to the 501.33provisions in section 15.059, subdivision 3.501.34    Sec. 37. Minnesota Statutes 2012, section 144.98, is amended by adding a subdivision 501.35to read:502.1    Subd. 11.Activities of the selection committee.(a) The selection committee 502.2shall determine assessor and assessment body application requirements, the frequency 502.3of application submittal, and the application review schedule. The commissioner shall 502.4publish the application requirements and procedures on the accreditation program Web site.502.5(b) In its selection process, the committee shall ensure its application requirements 502.6and review process:502.7(1) meet the standards implemented in subdivision 2a;502.8(2) ensure assessors have demonstrated competence in technical disciplines offered 502.9for accreditation by the commissioner; and502.10(3) consider any history of repeated nonconformance or complaints regarding 502.11assessors or assessment bodies.502.12(c) The selection committee shall consider an application received from qualified 502.13applicants and shall supply a list of recommended assessors and assessment bodies to 502.14the commissioner of health no later than 90 days after the commissioner notifies the 502.15committee of the need for review of applications.502.16    Sec. 38. Minnesota Statutes 2012, section 144.98, is amended by adding a subdivision 502.17to read:502.18    Subd. 12.Commissioner approval of assessors and scheduling of assessments.502.19(a) The commissioner shall approve assessors who:502.20(1) are employed by the commissioner for the purpose of accrediting laboratories 502.21and demonstrate competence in assessment practices for environmental laboratories; or502.22(2) are employed by a state or federal agency with established agreements for 502.23mutual assistance or recognition with the commissioner and demonstrate competence in 502.24assessment practices for environmental laboratories.502.25(b) The commissioner may approve other assessors or assessment bodies who are 502.26recommended by the selection committee according to subdivision 11, paragraph (c). The 502.27commissioner shall publish the list of assessors and assessment bodies approved from the 502.28recommendations.502.29(c) The commissioner shall rescind approval for an assessor or assessment body for 502.30sufficient cause as the commissioner determines, such as:502.31(1) failure to meet the minimum qualifications for performing assessments;502.32(2) lack of availability;502.33(3) nonconformance with the applicable laws, rules, standards, policies, and 502.34procedures;503.1(4) misrepresentation of application information regarding qualifications and 503.2training; or503.3(5) excessive cost to perform the assessment activities.503.4    Sec. 39. Minnesota Statutes 2012, section 144.98, is amended by adding a subdivision 503.5to read:503.6    Subd. 13.Laboratory requirements for assessor selection and scheduling 503.7assessments.(a) A laboratory accredited or seeking accreditation that requires an 503.8assessment by the commissioner must select an assessor, group of assessors, or an 503.9assessment body from the published list specified in subdivision 12, paragraph (b). An 503.10accredited laboratory must complete an assessment and make all corrective actions at least 503.11once every 24 months. Unless the commissioner grants interim accreditation, a laboratory 503.12seeking accreditation must complete an assessment and make all corrective actions 503.13prior to, but no earlier than, 18 months prior to the date the application is submitted to 503.14the commissioner.503.15(b) A laboratory shall not select the same assessor more than twice in succession 503.16for assessments of the same facility unless the laboratory receives written approval 503.17from the commissioner for the selection. The laboratory must supply a written request 503.18to the commissioner for approval and must justify the reason for the request and provide 503.19the alternate options considered.503.20(c) A laboratory must select assessors appropriate to the size and scope of the 503.21laboratory's application or existing accreditation.503.22(d) A laboratory must enter into its own contract for direct payment of the assessors 503.23or assessment body. The contract must authorize the assessor, assessment body, or 503.24subcontractors to release all records to the commissioner regarding the assessment activity, 503.25when the assessment is performed in compliance with this statute.503.26(e) A laboratory must agree to permit other assessors as selected by the commissioner 503.27to participate in the assessment activities.503.28(f) If the laboratory determines no approved assessor is available to perform 503.29the assessment, the laboratory must notify the commissioner in writing and provide a 503.30justification for the determination. If the commissioner confirms no approved assessor 503.31is available, the commissioner may designate an alternate assessor from those approved 503.32in subdivision 12, paragraph (a), or the commissioner may delay the assessment until 503.33an assessor is available. If an approved alternate assessor performs the assessment, the 503.34commissioner may collect fees equivalent to the cost of performing the assessment 503.35activities.504.1(g) Fees collected under this section are deposited in a special account and are 504.2annually appropriated to the commissioner for the purpose of performing assessment 504.3activities.504.4EFFECTIVE DATE.This section is effective the day following final enactment.504.5    Sec. 40. Minnesota Statutes 2012, section 144.99, subdivision 4, is amended to read:504.6    Subd. 4. Administrative penalty orders. (a) The commissioner may issue an 504.7order requiring violations to be corrected and administratively assessing monetary 504.8penalties for violations of the statutes, rules, and other actions listed in subdivision 1. The 504.9procedures in section 
         144.991 must be followed when issuing administrative penalty 504.10orders. Except in the case of repeated or serious violations, the penalty assessed in the 504.11order must be forgiven if the person who is subject to the order demonstrates in writing 504.12to the commissioner before the 31st day after receiving the order that the person has 504.13corrected the violation or has developed a corrective plan acceptable to the commissioner. 504.14The maximum amount of an administrative penalty order is $10,000 for each violator for 504.15all violations by that violator identified in an inspection or review of compliance.504.16(b) Notwithstanding paragraph (a), the commissioner may issue to a large public 504.17water supply, serving a population of more than 10,000 persons, an administrative penalty 504.18order imposing a penalty of at least $1,000 per day per violation, not to exceed $10,000 504.19for each violation of sections 
         144.381 to 
         144.385 and rules adopted thereunder.504.20(c) Notwithstanding paragraph (a), the commissioner may issue to a certified lead 504.21firm or person performing regulated lead work, an administrative penalty order imposing a 504.22penalty of at least $5,000 per violation per day, not to exceed $10,000 for each violation of 504.23sections 144.9501 to 144.9512 and rules adopted thereunder. All revenue collected from 504.24monetary penalties in this section shall be deposited in the state treasury and credited to 504.25the state government special revenue fund.504.26    Sec. 41. Minnesota Statutes 2012, section 145.906, is amended to read:504.27145.906 POSTPARTUM DEPRESSION EDUCATION AND INFORMATION.504.28(a) The commissioner of health shall work with health care facilities, licensed health 504.29and mental health care professionals, the women, infants, and children (WIC) program, 504.30mental health advocates, consumers, and families in the state to develop materials and 504.31information about postpartum depression, including treatment resources, and develop 504.32policies and procedures to comply with this section.505.1(b) Physicians, traditional midwives, and other licensed health care professionals 505.2providing prenatal care to women must have available to women and their families 505.3information about postpartum depression.505.4(c) Hospitals and other health care facilities in the state must provide departing new 505.5mothers and fathers and other family members, as appropriate, with written information 505.6about postpartum depression, including its symptoms, methods of coping with the illness, 505.7and treatment resources.505.8(d) Information about postpartum depression, including its symptoms, potential 505.9impact on families, and treatment resources, must be available at WIC sites.505.10(e) The commissioner of health, in collaboration with the commissioner of human 505.11services and to the extent authorized by the federal Centers for Disease Control and 505.12Prevention, shall review the materials and information related to postpartum depression to 505.13determine their effectiveness in transmitting the information in a way that reduces racial 505.14health disparities as reported in surveys of maternal attitudes and experiences before, 505.15during, and after pregnancy, including those conducted by the commissioner of health. The 505.16commissioner shall implement changes to reduce racial health disparities in the information 505.17reviewed, as needed, and ensure that women of color are receiving the information.505.18    Sec. 42. [145.907] MATERNAL DEPRESSION; DEFINITION.505.19"Maternal depression" means depression or other perinatal mood or anxiety disorder 505.20experienced by a woman during pregnancy or during the first year following the birth of 505.21her child.505.22    Sec. 43. Minnesota Statutes 2012, section 145.986, is amended to read:505.23145.986 STATEWIDE HEALTH IMPROVEMENT PROGRAM.505.24    Subdivision 1. Grants to local communities Purpose.The purpose of the statewide 505.25health improvement program is to:505.26(1) address the top three leading preventable causes of illness and death: tobacco use 505.27and exposure, poor diet, and lack of regular physical activity;505.28(2) promote the development, availability, and use of evidence-based, community 505.29level, comprehensive strategies to create healthy communities; and505.30(3) measure the impact of the evidence-based, community health improvement 505.31practices which over time work to contain health care costs and reduce chronic diseases.505.32    Subd. 1a.Grants to local communities. (a) Beginning July 1, 2009, the 505.33commissioner of health shall award competitive grants to community health boards 505.34established pursuant to section 
         145A.09 and tribal governments to convene, coordinate, 506.1and implement evidence-based strategies targeted at reducing the percentage of 506.2Minnesotans who are obese or overweight and to reduce the use of tobacco.506.3    (b) Grantee activities shall:506.4    (1) be based on scientific evidence;506.5    (2) be based on community input;506.6    (3) address behavior change at the individual, community, and systems levels;506.7    (4) occur in community, school, worksite, and health care settings; and506.8    (5) be focused on policy, systems, and environmental changes that support healthy 506.9behaviors.; and506.10(6) address the health disparities and inequities that exist in the grantee's community.506.11    (c) To receive a grant under this section, community health boards and tribal 506.12governments must submit proposals to the commissioner. A local match of ten percent 506.13of the total funding allocation is required. This local match may include funds donated 506.14by community partners.506.15    (d) In order to receive a grant, community health boards and tribal governments 506.16must submit a health improvement plan to the commissioner of health for approval. The 506.17commissioner may require the plan to identify a community leadership team, community 506.18partners, and a community action plan that includes an assessment of area strengths and 506.19needs, proposed action strategies, technical assistance needs, and a staffing plan.506.20    (e) The grant recipient must implement the health improvement plan, evaluate the 506.21effectiveness of the interventions strategies, and modify or discontinue interventions506.22strategies found to be ineffective.506.23    (f) By January 15, 2011, the commissioner of health shall recommend whether any 506.24funding should be distributed to community health boards and tribal governments based 506.25on health disparities demonstrated in the populations served.506.26    (g) (f) Grant recipients shall report their activities and their progress toward the 506.27outcomes established under subdivision 2 to the commissioner in a format and at a time 506.28specified by the commissioner.506.29    (h) (g) All grant recipients shall be held accountable for making progress toward 506.30the measurable outcomes established in subdivision 2. The commissioner shall require a 506.31corrective action plan and may reduce the funding level of grant recipients that do not 506.32make adequate progress toward the measurable outcomes.506.33(h) Notwithstanding paragraph (a), the commissioner may award funding to 506.34convene, coordinate, and implement evidence-based strategies targeted at reducing other 506.35risk factors, aside from tobacco use and exposure, poor diet, and lack of regular physical 507.1activity, that are associated with chronic disease and may impact public health. The 507.2commissioner shall develop a criteria and procedures to allocate funding under this section.507.3    Subd. 2. Outcomes. (a) The commissioner shall set measurable outcomes to meet 507.4the goals specified in subdivision 1, and annually review the progress of grant recipients 507.5in meeting the outcomes.507.6    (b) The commissioner shall measure current public health status, using existing 507.7measures and data collection systems when available, to determine baseline data against 507.8which progress shall be monitored.507.9    Subd. 3. Technical assistance and oversight.(a) The commissioner shall provide 507.10content expertise, technical expertise, and training to grant recipients and advice on 507.11evidence-based strategies, including those based on populations and types of communities 507.12served. The commissioner shall ensure that the statewide health improvement program 507.13meets the outcomes established under subdivision 2 by conducting a comprehensive 507.14statewide evaluation and assisting grant recipients to modify or discontinue interventions 507.15found to be ineffective.507.16(b) For the purposes of carrying out the grant program under this section, including 507.17for administrative purposes, the commissioner shall award contracts to appropriate entities 507.18to assist in training and provide technical assistance to grantees.507.19(c) Contracts awarded under paragraph (b) may be used to provide technical 507.20assistance and training in the areas of:507.21(1) community engagement and capacity building;507.22(2) tribal support;507.23(3) community asset building and risk behavior reduction;507.24(4) legal;507.25(5) communications;507.26(6) community, school, health care, work site, and other site-specific strategies; and507.27(7) health equity.507.28    Subd. 4. Evaluation.(a) Using the outcome measures established in subdivision 3, 507.29the commissioner shall conduct a biennial evaluation of the statewide health improvement 507.30program funded under this section. Grant recipients shall cooperate with the commissioner 507.31in the evaluation and provide the commissioner with the information necessary to conduct 507.32the evaluation.507.33(b) Grant recipients will collect, monitor, and submit to the Department of Health 507.34baseline and annual data and provide information to improve the quality and impact of 507.35community health improvement strategies.508.1(c) For the purposes of carrying out the grant program under this section, including 508.2for administrative purposes, the commissioner shall award contracts to appropriate entities 508.3to assist in designing and implementing evaluation systems.508.4(d) Contracts awarded under paragraph (c) may be used to:508.5(1) develop grantee monitoring and reporting systems to track grantee progress, 508.6including aggregated and disaggregated data;508.7(2) manage, analyze, and report program evaluation data results; and508.8(3) utilize innovative support tools to analyze and predict the impact of prevention 508.9strategies on health outcomes and state health care costs over time.508.10    Subd. 5. Report. The commissioner shall submit a biennial report to the legislature 508.11on the statewide health improvement program funded under this section. These reports 508.12The report must include information on each grant recipients recipient, including the 508.13activities that were conducted by the grantee using grant funds, evaluation data, and 508.14outcome measures, if available.the grantee's progress toward achieving the measurable 508.15outcomes established under subdivision 2, and the data provided to the commissioner by 508.16the grantee to measure these outcomes for grant activities. The commissioner shall provide 508.17information on grants in which a corrective action plan was required under subdivision 508.181a, the types of plan action, and the progress that has been made toward meeting the 508.19measurable outcomes. In addition, the commissioner shall provide recommendations 508.20on future areas of focus for health improvement. These reports are due by January 15 508.21of every other year, beginning in 2010. In the report due on January 15, 2010, the 508.22commissioner shall include recommendations on a sustainable funding source for the 508.23statewide health improvement program other than the health care access fundIn the report 508.24due on January 15, 2014, the commissioner shall include a description of the contracts 508.25awarded under subdivision 4, paragraph (c), and the monitoring and evaluation systems 508.26that were designed and implemented under these contracts. 508.27    Subd. 6. Supplantation of existing funds. Community health boards and tribal 508.28governments must use funds received under this section to develop new programs, expand 508.29current programs that work to reduce the percentage of Minnesotans who are obese or 508.30overweight or who use tobacco, or replace discontinued state or federal funds previously 508.31used to reduce the percentage of Minnesotans who are obese or overweight or who use 508.32tobacco. Funds must not be used to supplant current state or local funding to community 508.33health boards or tribal governments used to reduce the percentage of Minnesotans who are 508.34obese or overweight or to reduce tobacco use.508.35    Sec. 44. Minnesota Statutes 2012, section 145A.17, subdivision 1, is amended to read:509.1    Subdivision 1. Establishment; goals. The commissioner shall establish a program 509.2to fund family home visiting programs designed to foster healthy beginnings, improve 509.3pregnancy outcomes, promote school readiness, prevent child abuse and neglect, reduce 509.4juvenile delinquency, promote positive parenting and resiliency in children, and promote 509.5family health and economic self-sufficiency for children and families. The commissioner 509.6shall promote partnerships, collaboration, and multidisciplinary visiting done by teams of 509.7professionals and paraprofessionals from the fields of public health nursing, social work, 509.8and early childhood education. A program funded under this section must serve families 509.9at or below 200 percent of the federal poverty guidelines, and other families determined 509.10to be at risk, including but not limited to being at risk for child abuse, child neglect, or 509.11juvenile delinquency. Programs must begin prenatally whenever possible and must be 509.12targeted to families with:509.13    (1) adolescent parents;509.14    (2) a history of alcohol or other drug abuse;509.15    (3) a history of child abuse, domestic abuse, or other types of violence;509.16    (4) a history of domestic abuse, rape, or other forms of victimization;509.17    (5) reduced cognitive functioning;509.18    (6) a lack of knowledge of child growth and development stages;509.19    (7) low resiliency to adversities and environmental stresses;509.20    (8) insufficient financial resources to meet family needs;509.21    (9) a history of homelessness;509.22    (10) a risk of long-term welfare dependence or family instability due to employment 509.23barriers; or509.24(11) a serious mental health disorder, including maternal depression as defined in 509.25section 145.907; or509.26    (11) (12) other risk factors as determined by the commissioner.509.27    Sec. 45. Minnesota Statutes 2012, section 149A.02, subdivision 1a, is amended to read:509.28    Subd. 1a. Alkaline hydrolysis. "Alkaline hydrolysis" means the reduction of a dead 509.29human body to essential elements through exposure to a combination of heat and alkaline 509.30hydrolysis and the repositioning or movement of the body during the process to facilitate 509.31reduction, a water-based dissolution process using alkaline chemicals, heat, agitation, and 509.32pressure to accelerate natural decomposition; the processing of the hydrolyzed remains 509.33after removal from the alkaline hydrolysis chamber, vessel; placement of the processed 509.34remains in a hydrolyzed remains container,; and release of the hydrolyzed remains to an 509.35appropriate party. Alkaline hydrolysis is a form of final disposition.510.1    Sec. 46. Minnesota Statutes 2012, section 149A.02, is amended by adding a 510.2subdivision to read:510.3    Subd. 1b.Alkaline hydrolysis container."Alkaline hydrolysis container" means a 510.4hydrolyzable or biodegradable closed container or pouch resistant to leakage of bodily 510.5fluids that encases the body and into which a dead human body is placed prior to insertion 510.6into an alkaline hydrolysis vessel. Alkaline hydrolysis containers may be hydrolyzable or 510.7biodegradable alternative containers or caskets.510.8    Sec. 47. Minnesota Statutes 2012, section 149A.02, is amended by adding a 510.9subdivision to read:510.10    Subd. 1c.Alkaline hydrolysis facility."Alkaline hydrolysis facility" means a 510.11building or structure containing one or more alkaline hydrolysis vessels for the alkaline 510.12hydrolysis of dead human bodies.510.13    Sec. 48. Minnesota Statutes 2012, section 149A.02, is amended by adding a 510.14subdivision to read:510.15    Subd. 1d.Alkaline hydrolysis vessel."Alkaline hydrolysis vessel" means the 510.16container in which the alkaline hydrolysis of a dead human body is performed.510.17    Sec. 49. Minnesota Statutes 2012, section 149A.02, subdivision 2, is amended to read:510.18    Subd. 2. Alternative container. "Alternative container" means a nonmetal 510.19receptacle or enclosure, without ornamentation or a fixed interior lining, which is designed 510.20for the encasement of dead human bodies and is made of hydrolyzable or biodegradable 510.21materials, corrugated cardboard, fiberboard, pressed-wood, or other like materials.510.22    Sec. 50. Minnesota Statutes 2012, section 149A.02, subdivision 3, is amended to read:510.23    Subd. 3. Arrangements for disposition. "Arrangements for disposition" means 510.24any action normally taken by a funeral provider in anticipation of or preparation for the 510.25entombment, burial in a cemetery, alkaline hydrolysis, or cremation of a dead human body.510.26    Sec. 51. Minnesota Statutes 2012, section 149A.02, subdivision 4, is amended to read:510.27    Subd. 4. Cash advance item. "Cash advance item" means any item of service 510.28or merchandise described to a purchaser as a "cash advance," "accommodation," "cash 510.29disbursement," or similar term. A cash advance item is also any item obtained from a 510.30third party and paid for by the funeral provider on the purchaser's behalf. Cash advance 510.31items include, but are not limited to, cemetery, alkaline hydrolysis,  or crematory services, 511.1pallbearers, public transportation, clergy honoraria, flowers, musicians or singers, obituary 511.2notices, gratuities, and death records.511.3    Sec. 52. Minnesota Statutes 2012, section 149A.02, subdivision 5, is amended to read:511.4    Subd. 5. Casket. "Casket" means a rigid container which is designed for the 511.5encasement of a dead human body and is usually constructed of hydrolyzable or 511.6biodegradable materials, wood, metal, fiberglass, plastic, or like material, and ornamented 511.7and lined with fabric.511.8    Sec. 53. Minnesota Statutes 2012, section 149A.02, is amended by adding a 511.9subdivision to read:511.10    Subd. 12a.Crypt."Crypt" means a space in a mausoleum of sufficient size, used or 511.11intended to be used, to entomb human remains, cremated remains, or hydrolyzed remains.511.12    Sec. 54. Minnesota Statutes 2012, section 149A.02, is amended by adding a 511.13subdivision to read:511.14    Subd. 12b.Direct alkaline hydrolysis."Direct alkaline hydrolysis" means a 511.15final disposition of a dead human body by alkaline hydrolysis, without formal viewing, 511.16visitation, or ceremony with the body present.511.17    Sec. 55. Minnesota Statutes 2012, section 149A.02, subdivision 16, is amended to read:511.18    Subd. 16. Final disposition. "Final disposition" means the acts leading to and the 511.19entombment, burial in a cemetery, alkaline hydrolysis, or cremation of a dead human body.511.20    Sec. 56. Minnesota Statutes 2012, section 149A.02, subdivision 23, is amended to read:511.21    Subd. 23. Funeral services. "Funeral services" means any services which may 511.22be used to: (1) care for and prepare dead human bodies for burial, alkaline hydrolysis, 511.23cremation, or other final disposition; and (2) arrange, supervise, or conduct the funeral 511.24ceremony or the final disposition of dead human bodies.511.25    Sec. 57. Minnesota Statutes 2012, section 149A.02, is amended by adding a 511.26subdivision to read:511.27    Subd. 24a.Holding facility."Holding facility" means a secure enclosed room or 511.28confined area within a funeral establishment, crematory, or alkaline hydrolysis facility 511.29used for temporary storage of human remains awaiting final disposition.512.1    Sec. 58. Minnesota Statutes 2012, section 149A.02, is amended by adding a 512.2subdivision to read:512.3    Subd. 24b.Hydrolyzed remains."Hydrolyzed remains" means the remains of a 512.4dead human body following the alkaline hydrolysis process. Hydrolyzed remains does not 512.5include pacemakers, prostheses, or similar foreign materials.512.6    Sec. 59. Minnesota Statutes 2012, section 149A.02, is amended by adding a 512.7subdivision to read:512.8    Subd. 24c.Hydrolyzed remains container."Hydrolyzed remains container" means 512.9a receptacle in which hydrolyzed remains are placed. For purposes of this chapter, a 512.10hydrolyzed remains container is interchangeable with "urn" or similar keepsake storage 512.11jewelry.512.12    Sec. 60. Minnesota Statutes 2012, section 149A.02, is amended by adding a 512.13subdivision to read:512.14    Subd. 26a.Inurnment."Inurnment" means placing hydrolyzed or cremated remains 512.15in a hydrolyzed or cremated remains container suitable for placement, burial, or shipment.512.16    Sec. 61. Minnesota Statutes 2012, section 149A.02, subdivision 27, is amended to read:512.17    Subd. 27. Licensee. "Licensee" means any person or entity that has been issued 512.18a license to practice mortuary science, to operate a funeral establishment, to operate an 512.19alkaline hydrolysis facility, or to operate a crematory by the Minnesota commissioner 512.20of health.512.21    Sec. 62. Minnesota Statutes 2012, section 149A.02, is amended by adding a 512.22subdivision to read:512.23    Subd. 30a.Niche."Niche" means a space in a columbarium used, or intended to be 512.24used, for the placement of hydrolyzed or cremated remains.512.25    Sec. 63. Minnesota Statutes 2012, section 149A.02, is amended by adding a 512.26subdivision to read:512.27    Subd. 32a.Placement."Placement" means the placing of a container holding 512.28hydrolyzed or cremated remains in a crypt, vault, or niche.512.29    Sec. 64. Minnesota Statutes 2012, section 149A.02, subdivision 34, is amended to read:513.1    Subd. 34. Preparation of the body. "Preparation of the body" means placement of 513.2the body into an appropriate cremation or alkaline hydrolysis container, embalming of 513.3the body or such items of care as washing, disinfecting, shaving, positioning of features, 513.4restorative procedures, application of cosmetics, dressing, and casketing.513.5    Sec. 65. Minnesota Statutes 2012, section 149A.02, subdivision 35, is amended to read:513.6    Subd. 35. Processing. "Processing" means the removal of foreign objects, drying or 513.7cooling, and the reduction of the hydrolyzed or cremated remains by mechanical means 513.8including, but not limited to, grinding, crushing, or pulverizing, to a granulated appearance 513.9appropriate for final disposition.513.10    Sec. 66. Minnesota Statutes 2012, section 149A.02, subdivision 37, is amended to read:513.11    Subd. 37. Public transportation. "Public transportation" means all manner of 513.12transportation via common carrier available to the general public including airlines, buses, 513.13railroads, and ships. For purposes of this chapter, a livery service providing transportation 513.14to private funeral establishments, alkaline hydrolysis facilities,  or crematories is not public 513.15transportation.513.16    Sec. 67. Minnesota Statutes 2012, section 149A.02, is amended by adding a 513.17subdivision to read:513.18    Subd. 37c.Scattering."Scattering" means the authorized dispersal of hydrolyzed 513.19or cremated remains in a defined area of a dedicated cemetery or in areas where no local 513.20prohibition exists provided that the hydrolyzed or cremated remains are not distinguishable 513.21to the public, are not in a container, and that the person who has control over disposition 513.22of the hydrolyzed or cremated remains has obtained written permission of the property 513.23owner or governing agency to scatter on the property.513.24    Sec. 68. Minnesota Statutes 2012, section 149A.02, is amended by adding a 513.25subdivision to read:513.26    Subd. 41.Vault."Vault" means a space in a mausoleum of sufficient size, used or 513.27intended to be used, to entomb human remains, cremated remains, or hydrolyzed remains. 513.28Vault may also mean a sealed and lined casket enclosure.513.29    Sec. 69. Minnesota Statutes 2012, section 149A.03, is amended to read:513.30149A.03 DUTIES OF COMMISSIONER.513.31    The commissioner shall:514.1    (1) enforce all laws and adopt and enforce rules relating to the:514.2    (i) removal, preparation, transportation, arrangements for disposition, and final 514.3disposition of dead human bodies;514.4    (ii) licensure and professional conduct of funeral directors, morticians, interns, 514.5practicum students, and clinical students;514.6    (iii) licensing and operation of a funeral establishment; and514.7(iv) licensing and operation of an alkaline hydrolysis facility; and514.8    (iv)(v) licensing and operation of a crematory;514.9    (2) provide copies of the requirements for licensure and permits to all applicants;514.10    (3) administer examinations and issue licenses and permits to qualified persons 514.11and other legal entities;514.12    (4) maintain a record of the name and location of all current licensees and interns;514.13    (5) perform periodic compliance reviews and premise inspections of licensees;514.14    (6) accept and investigate complaints relating to conduct governed by this chapter;514.15    (7) maintain a record of all current preneed arrangement trust accounts;514.16    (8) maintain a schedule of application, examination, permit, and licensure fees, 514.17initial and renewal, sufficient to cover all necessary operating expenses;514.18    (9) educate the public about the existence and content of the laws and rules for 514.19mortuary science licensing and the removal, preparation, transportation, arrangements 514.20for disposition, and final disposition of dead human bodies to enable consumers to file 514.21complaints against licensees and others who may have violated those laws or rules;514.22    (10) evaluate the laws, rules, and procedures regulating the practice of mortuary 514.23science in order to refine the standards for licensing and to improve the regulatory and 514.24enforcement methods used; and514.25    (11) initiate proceedings to address and remedy deficiencies and inconsistencies in 514.26the laws, rules, or procedures governing the practice of mortuary science and the removal, 514.27preparation, transportation, arrangements for disposition, and final disposition of dead 514.28human bodies.514.29    Sec. 70. [149A.54] LICENSE TO OPERATE AN ALKALINE HYDROLYSIS 514.30FACILITY.514.31    Subdivision 1.License requirement.Except as provided in section 149A.01, 514.32subdivision 3, a place or premise shall not be maintained, managed, or operated which 514.33is devoted to or used in the holding and alkaline hydrolysis of a dead human body 514.34without possessing a valid license to operate an alkaline hydrolysis facility issued by the 514.35commissioner of health.515.1    Subd. 2.Requirements for an alkaline hydrolysis facility.(a) An alkaline 515.2hydrolysis facility licensed under this section must consist of:515.3(1) a building or structure that complies with applicable local and state building 515.4codes, zoning laws and ordinances, wastewater management and environmental standards, 515.5containing one or more alkaline hydrolysis vessels for the alkaline hydrolysis of dead 515.6human bodies;515.7(2) a method approved by the commissioner of health to dry the hydrolyzed remains 515.8and which is located within the licensed facility;515.9(3) a means approved by the commissioner of health for refrigeration of dead human 515.10bodies awaiting alkaline hydrolysis;515.11(4) an appropriate means of processing hydrolyzed remains to a granulated 515.12appearance appropriate for final disposition; and515.13(5) an appropriate holding facility for dead human bodies awaiting alkaline 515.14hydrolysis.515.15(b) An alkaline hydrolysis facility licensed under this section may also contain a 515.16display room for funeral goods.515.17    Subd. 3.Application procedure; documentation; initial inspection.An 515.18application to license and operate an alkaline hydrolysis facility shall be submitted to the 515.19commissioner of health. A completed application includes:515.20(1) a completed application form, as provided by the commissioner;515.21(2) proof of business form and ownership;515.22(3) proof of liability insurance coverage or other financial documentation, as 515.23determined by the commissioner, that demonstrates the applicant's ability to respond in 515.24damages for liability arising from the ownership, maintenance management, or operation 515.25of an alkaline hydrolysis facility; and515.26(4) copies of wastewater and other environmental regulatory permits and 515.27environmental regulatory licenses necessary to conduct operations.515.28Upon receipt of the application and appropriate fee, the commissioner shall review and 515.29verify all information. Upon completion of the verification process and resolution of any 515.30deficiencies in the application information, the commissioner shall conduct an initial 515.31inspection of the premises to be licensed. After the inspection and resolution of any 515.32deficiencies found and any reinspections as may be necessary, the commissioner shall 515.33make a determination, based on all the information available, to grant or deny licensure. If 515.34the commissioner's determination is to grant the license, the applicant shall be notified and 515.35the license shall issue and remain valid for a period prescribed on the license, but not to 515.36exceed one calendar year from the date of issuance of the license. If the commissioner's 516.1determination is to deny the license, the commissioner must notify the applicant in writing 516.2of the denial and provide the specific reason for denial.516.3    Subd. 4.Nontransferability of license.A license to operate an alkaline hydrolysis 516.4facility is not assignable or transferable and shall not be valid for any entity other than the 516.5one named. Each license issued to operate an alkaline hydrolysis facility is valid only for the 516.6location identified on the license. A 50 percent or more change in ownership or location of 516.7the alkaline hydrolysis facility automatically terminates the license. Separate licenses shall 516.8be required of two or more persons or other legal entities operating from the same location.516.9    Subd. 5.Display of license.Each license to operate an alkaline hydrolysis 516.10facility must be conspicuously displayed in the alkaline hydrolysis facility at all times. 516.11Conspicuous display means in a location where a member of the general public within the 516.12alkaline hydrolysis facility will be able to observe and read the license.516.13    Subd. 6.Period of licensure.All licenses to operate an alkaline hydrolysis facility 516.14issued by the commissioner are valid for a period of one calendar year beginning on July 1 516.15and ending on June 30, regardless of the date of issuance.516.16    Subd. 7.Reporting changes in license information.Any change of license 516.17information must be reported to the commissioner, on forms provided by the 516.18commissioner, no later than 30 calendar days after the change occurs. Failure to report 516.19changes is grounds for disciplinary action.516.20    Subd. 8.Notification to the commissioner.If the licensee is operating under a 516.21wastewater or an environmental permit or license that is subsequently revoked, denied, 516.22or terminated, the licensee shall notify the commissioner.516.23    Subd. 9.Application information.All information submitted to the commissioner 516.24for a license to operate an alkaline hydrolysis facility is classified as licensing data under 516.25section 13.41, subdivision 5.516.26    Sec. 71. [149A.55] RENEWAL OF LICENSE TO OPERATE AN ALKALINE 516.27HYDROLYSIS FACILITY.516.28    Subdivision 1.Renewal required.All licenses to operate an alkaline hydrolysis 516.29facility issued by the commissioner expire on June 30 following the date of issuance of the 516.30license and must be renewed to remain valid.516.31    Subd. 2.Renewal procedure and documentation.Licensees who wish to renew 516.32their licenses must submit to the commissioner a completed renewal application no later 516.33than June 30 following the date the license was issued. A completed renewal application 516.34includes:516.35(1) a completed renewal application form, as provided by the commissioner; and517.1(2) proof of liability insurance coverage or other financial documentation, as 517.2determined by the commissioner, that demonstrates the applicant's ability to respond in 517.3damages for liability arising from the ownership, maintenance, management, or operation 517.4of an alkaline hydrolysis facility.517.5Upon receipt of the completed renewal application, the commissioner shall review and 517.6verify the information. Upon completion of the verification process and resolution of 517.7any deficiencies in the renewal application information, the commissioner shall make a 517.8determination, based on all the information available, to reissue or refuse to reissue the 517.9license. If the commissioner's determination is to reissue the license, the applicant shall 517.10be notified and the license shall issue and remain valid for a period prescribed on the 517.11license, but not to exceed one calendar year from the date of issuance of the license. If 517.12the commissioner's determination is to refuse to reissue the license, section 149A.09, 517.13subdivision 2, applies.517.14    Subd. 3.Penalty for late filing.Renewal applications received after the expiration 517.15date of a license will result in the assessment of a late filing penalty. The late filing penalty 517.16must be paid before the reissuance of the license and received by the commissioner no 517.17later than 31 calendar days after the expiration date of the license.517.18    Subd. 4.Lapse of license.Licenses to operate alkaline hydrolysis facilities 517.19shall automatically lapse when a completed renewal application is not received by the 517.20commissioner within 31 calendar days after the expiration date of a license, or a late 517.21filing penalty assessed under subdivision 3 is not received by the commissioner within 31 517.22calendar days after the expiration of a license.517.23    Subd. 5.Effect of lapse of license.Upon the lapse of a license, the person to whom 517.24the license was issued is no longer licensed to operate an alkaline hydrolysis facility in 517.25Minnesota. The commissioner shall issue a cease and desist order to prevent the lapsed 517.26license holder from operating an alkaline hydrolysis facility in Minnesota and may pursue 517.27any additional lawful remedies as justified by the case.517.28    Subd. 6.Restoration of lapsed license.The commissioner may restore a lapsed 517.29license upon receipt and review of a completed renewal application, receipt of the late 517.30filing penalty, and reinspection of the premises, provided that the receipt is made within 517.31one calendar year from the expiration date of the lapsed license and the cease and desist 517.32order issued by the commissioner has not been violated. If a lapsed license is not restored 517.33within one calendar year from the expiration date of the lapsed license, the holder of the 517.34lapsed license cannot be relicensed until the requirements in section 149A.54 are met.517.35    Subd. 7.Reporting changes in license information.Any change of license 517.36information must be reported to the commissioner, on forms provided by the 518.1commissioner, no later than 30 calendar days after the change occurs. Failure to report 518.2changes is grounds for disciplinary action.518.3    Subd. 8.Application information.All information submitted to the commissioner 518.4by an applicant for renewal of licensure to operate an alkaline hydrolysis facility is 518.5classified as licensing data under section 13.41, subdivision 5.518.6    Sec. 72. Minnesota Statutes 2012, section 149A.65, is amended by adding a 518.7subdivision to read:518.8    Subd. 6.Alkaline hydrolysis facilities.The initial and renewal fee for an alkaline 518.9hydrolysis facility is $300. The late fee charge for a license renewal is $25.518.10    Sec. 73. Minnesota Statutes 2012, section 149A.65, is amended by adding a 518.11subdivision to read:518.12    Subd. 7.State government special revenue fund.Fees collected by the 518.13commissioner under this section must be deposited in the state treasury and credited to 518.14the state government special revenue fund.518.15    Sec. 74. Minnesota Statutes 2012, section 149A.70, subdivision 1, is amended to read:518.16    Subdivision 1. Use of titles. Only a person holding a valid license to practice 518.17mortuary science issued by the commissioner may use the title of mortician, funeral 518.18director, or any other title implying that the licensee is engaged in the business or practice 518.19of mortuary science. Only the holder of a valid license to operate an alkaline hydrolysis 518.20facility issued by the commissioner may use the title of alkaline hydrolysis facility, water 518.21cremation, water-reduction, biocremation, green-cremation, resomation, dissolution, or 518.22any other title, word, or term implying that the licensee operates an alkaline hydrolysis 518.23facility. Only the holder of a valid license to operate a funeral establishment issued by the 518.24commissioner may use the title of funeral home, funeral chapel, funeral service, or any 518.25other title, word, or term implying that the licensee is engaged in the business or practice 518.26of mortuary science. Only the holder of a valid license to operate a crematory issued by 518.27the commissioner may use the title of crematory, crematorium, green-cremation, or any 518.28other title, word, or term implying that the licensee operates a crematory or crematorium.518.29    Sec. 75. Minnesota Statutes 2012, section 149A.70, subdivision 2, is amended to read:518.30    Subd. 2. Business location. A funeral establishment, alkaline hydrolysis facility,  or 518.31crematory shall not do business in a location that is not licensed as a funeral establishment, 519.1alkaline hydrolysis facility,  or crematory and shall not advertise a service that is available 519.2from an unlicensed location.519.3    Sec. 76. Minnesota Statutes 2012, section 149A.70, subdivision 3, is amended to read:519.4    Subd. 3. Advertising. No licensee, clinical student, practicum student, or intern 519.5shall publish or disseminate false, misleading, or deceptive advertising. False, misleading, 519.6or deceptive advertising includes, but is not limited to:519.7    (1) identifying, by using the names or pictures of, persons who are not licensed to 519.8practice mortuary science in a way that leads the public to believe that those persons will 519.9provide mortuary science services;519.10    (2) using any name other than the names under which the funeral establishment, 519.11alkaline hydrolysis facility,  or crematory is known to or licensed by the commissioner;519.12    (3) using a surname not directly, actively, or presently associated with a licensed 519.13funeral establishment, alkaline hydrolysis facility,  or crematory, unless the surname had 519.14been previously and continuously used by the licensed funeral establishment, alkaline 519.15hydrolysis facility,  or crematory; and519.16    (4) using a founding or establishing date or total years of service not directly or 519.17continuously related to a name under which the funeral establishment, alkaline hydrolysis 519.18facility,  or crematory is currently or was previously licensed.519.19    Any advertising or other printed material that contains the names or pictures of 519.20persons affiliated with a funeral establishment, alkaline hydrolysis facility,  or crematory 519.21shall state the position held by the persons and shall identify each person who is licensed 519.22or unlicensed under this chapter.519.23    Sec. 77. Minnesota Statutes 2012, section 149A.70, subdivision 5, is amended to read:519.24    Subd. 5. Reimbursement prohibited. No licensee, clinical student, practicum 519.25student, or intern shall offer, solicit, or accept a commission, fee, bonus, rebate, or other 519.26reimbursement in consideration for recommending or causing a dead human body to 519.27be disposed of by a specific body donation program, funeral establishment, alkaline 519.28hydrolysis facility, crematory, mausoleum, or cemetery.519.29    Sec. 78. Minnesota Statutes 2012, section 149A.71, subdivision 2, is amended to read:519.30    Subd. 2. Preventive requirements. (a) To prevent unfair or deceptive acts or 519.31practices, the requirements of this subdivision must be met.519.32    (b) Funeral providers must tell persons who ask by telephone about the funeral 519.33provider's offerings or prices any accurate information from the price lists described in 520.1paragraphs (c) to (e) and any other readily available information that reasonably answers 520.2the questions asked.520.3    (c) Funeral providers must make available for viewing to people who inquire in 520.4person about the offerings or prices of funeral goods or burial site goods, separate printed 520.5or typewritten price lists using a ten-point font or larger. Each funeral provider must have a 520.6separate price list for each of the following types of goods that are sold or offered for sale:520.7    (1) caskets;520.8    (2) alternative containers;520.9    (3) outer burial containers;520.10(4) alkaline hydrolysis containers;520.11    (4) (5) cremation containers;520.12(6) hydrolyzed remains containers;520.13    (5)(7) cremated remains containers;520.14    (6)(8) markers; and520.15    (7)(9) headstones.520.16    (d) Each separate price list must contain the name of the funeral provider's place 520.17of business, address, and telephone number and a caption describing the list as a price 520.18list for one of the types of funeral goods or burial site goods described in paragraph (c), 520.19clauses (1) to (7) (9). The funeral provider must offer the list upon beginning discussion 520.20of, but in any event before showing, the specific funeral goods or burial site goods and 520.21must provide a photocopy of the price list, for retention, if so asked by the consumer. The 520.22list must contain, at least, the retail prices of all the specific funeral goods and burial site 520.23goods offered which do not require special ordering, enough information to identify each, 520.24and the effective date for the price list. However, funeral providers are not required to 520.25make a specific price list available if the funeral providers place the information required 520.26by this paragraph on the general price list described in paragraph (e).520.27    (e) Funeral providers must give a printed price list, for retention, to persons who 520.28inquire in person about the funeral goods, funeral services, burial site goods, or burial site 520.29services or prices offered by the funeral provider. The funeral provider must give the list 520.30upon beginning discussion of either the prices of or the overall type of funeral service or 520.31disposition or specific funeral goods, funeral services, burial site goods, or burial site 520.32services offered by the provider. This requirement applies whether the discussion takes 520.33place in the funeral establishment or elsewhere. However, when the deceased is removed 520.34for transportation to the funeral establishment, an in-person request for authorization to 520.35embalm does not, by itself, trigger the requirement to offer the general price list. If the 520.36provider, in making an in-person request for authorization to embalm, discloses that 521.1embalming is not required by law except in certain special cases, the provider is not 521.2required to offer the general price list. Any other discussion during that time about prices 521.3or the selection of funeral goods, funeral services, burial site goods, or burial site services 521.4triggers the requirement to give the consumer a general price list. The general price list 521.5must contain the following information:521.6    (1) the name, address, and telephone number of the funeral provider's place of 521.7business;521.8    (2) a caption describing the list as a "general price list";521.9    (3) the effective date for the price list;521.10    (4) the retail prices, in any order, expressed either as a flat fee or as the prices per 521.11hour, mile, or other unit of computation, and other information described as follows:521.12    (i) forwarding of remains to another funeral establishment, together with a list of 521.13the services provided for any quoted price;521.14    (ii) receiving remains from another funeral establishment, together with a list of 521.15the services provided for any quoted price;521.16    (iii) separate prices for each alkaline hydrolysis or cremation offered by the funeral 521.17provider, with the price including an alternative container or alkaline hydrolysis or 521.18cremation container, any alkaline hydrolysis or crematory charges, and a description of the 521.19services and container included in the price, where applicable, and the price of alkaline 521.20hydrolysis or cremation where the purchaser provides the container;521.21    (iv) separate prices for each immediate burial offered by the funeral provider, 521.22including a casket or alternative container, and a description of the services and container 521.23included in that price, and the price of immediate burial where the purchaser provides the 521.24casket or alternative container;521.25    (v) transfer of remains to the funeral establishment or other location;521.26    (vi) embalming;521.27    (vii) other preparation of the body;521.28    (viii) use of facilities, equipment, or staff for viewing;521.29    (ix) use of facilities, equipment, or staff for funeral ceremony;521.30    (x) use of facilities, equipment, or staff for memorial service;521.31    (xi) use of equipment or staff for graveside service;521.32    (xii) hearse or funeral coach;521.33    (xiii) limousine; and521.34    (xiv) separate prices for all cemetery-specific goods and services, including all goods 521.35and services associated with interment and burial site goods and services and excluding 521.36markers and headstones;522.1    (5) the price range for the caskets offered by the funeral provider, together with the 522.2statement "A complete price list will be provided at the funeral establishment or casket 522.3sale location." or the prices of individual caskets, as disclosed in the manner described 522.4in paragraphs (c) and (d);522.5    (6) the price range for the alternative containers offered by the funeral provider, 522.6together with the statement "A complete price list will be provided at the funeral 522.7establishment or alternative container sale location." or the prices of individual alternative 522.8containers, as disclosed in the manner described in paragraphs (c) and (d);522.9    (7) the price range for the outer burial containers offered by the funeral provider, 522.10together with the statement "A complete price list will be provided at the funeral 522.11establishment or outer burial container sale location." or the prices of individual outer 522.12burial containers, as disclosed in the manner described in paragraphs (c) and (d);522.13(8) the price range for the alkaline hydrolysis container offered by the funeral 522.14provider, together with the statement: "A complete price list will be provided at the funeral 522.15establishment or alkaline hydrolysis container sale location.", or the prices of individual 522.16alkaline hydrolysis containers, as disclosed in the manner described in paragraphs (c) 522.17and (d);522.18(9) the price range for the hydrolyzed remains container offered by the funeral 522.19provider, together with the statement: "A complete price list will be provided at the 522.20funeral establishment or hydrolyzed remains container sale location.", or the prices 522.21of individual hydrolyzed remains container, as disclosed in the manner described in 522.22paragraphs (c) and (d);522.23    (8)(10) the price range for the cremation containers offered by the funeral provider, 522.24together with the statement "A complete price list will be provided at the funeral 522.25establishment or cremation container sale location." or the prices of individual cremation 522.26containers and cremated remains containers, as disclosed in the manner described in 522.27paragraphs (c) and (d);522.28    (9)(11) the price range for the cremated remains containers offered by the funeral 522.29provider, together with the statement, "A complete price list will be provided at the funeral 522.30establishment or cremation cremated remains container sale location," or the prices of 522.31individual cremation containers as disclosed in the manner described in paragraphs (c) 522.32and (d);522.33    (10)(12) the price for the basic services of funeral provider and staff, together with a 522.34list of the principal basic services provided for any quoted price and, if the charge cannot 522.35be declined by the purchaser, the statement "This fee for our basic services will be added 522.36to the total cost of the funeral arrangements you select. (This fee is already included in 523.1our charges for alkaline hydrolysis, direct cremations, immediate burials, and forwarding 523.2or receiving remains.)" If the charge cannot be declined by the purchaser, the quoted 523.3price shall include all charges for the recovery of unallocated funeral provider overhead, 523.4and funeral providers may include in the required disclosure the phrase "and overhead" 523.5after the word "services." This services fee is the only funeral provider fee for services, 523.6facilities, or unallocated overhead permitted by this subdivision to be nondeclinable, 523.7unless otherwise required by law;523.8    (11)(13) the price range for the markers and headstones offered by the funeral 523.9provider, together with the statement "A complete price list will be provided at the funeral 523.10establishment or marker or headstone sale location." or the prices of individual markers 523.11and headstones, as disclosed in the manner described in paragraphs (c) and (d); and523.12    (12)(14) any package priced funerals offered must be listed in addition to and 523.13following the information required in this paragraph (e) and must clearly state the funeral 523.14goods and services being offered, the price being charged for those goods and services, 523.15and the discounted savings.523.16    (f) Funeral providers must give an itemized written statement, for retention, to each 523.17consumer who arranges an at-need funeral or other disposition of human remains at the 523.18conclusion of the discussion of the arrangements. The itemized written statement must be 523.19signed by the consumer selecting the goods and services as required in section 
         149A.80. 523.20If the statement is provided by a funeral establishment, the statement must be signed by 523.21the licensed funeral director or mortician planning the arrangements. If the statement is 523.22provided by any other funeral provider, the statement must be signed by an authorized 523.23agent of the funeral provider. The statement must list the funeral goods, funeral services, 523.24burial site goods, or burial site services selected by that consumer and the prices to be paid 523.25for each item, specifically itemized cash advance items (these prices must be given to the 523.26extent then known or reasonably ascertainable if the prices are not known or reasonably 523.27ascertainable, a good faith estimate shall be given and a written statement of the actual 523.28charges shall be provided before the final bill is paid), and the total cost of goods and 523.29services selected. At the conclusion of an at-need arrangement, the funeral provider is 523.30required to give the consumer a copy of the signed itemized written contract that must 523.31contain the information required in this paragraph.523.32    (g) Upon receiving actual notice of the death of an individual with whom a funeral 523.33provider has entered a preneed funeral agreement, the funeral provider must provide 523.34a copy of all preneed funeral agreement documents to the person who controls final 523.35disposition of the human remains or to the designee of the person controlling disposition. 523.36The person controlling final disposition shall be provided with these documents at the time 524.1of the person's first in-person contact with the funeral provider, if the first contact occurs 524.2in person at a funeral establishment, alkaline hydrolysis facility, crematory, or other place 524.3of business of the funeral provider. If the contact occurs by other means or at another 524.4location, the documents must be provided within 24 hours of the first contact.524.5    Sec. 79. Minnesota Statutes 2012, section 149A.71, subdivision 4, is amended to read:524.6    Subd. 4. Casket, alternate container, alkaline hydrolysis containers, and 524.7cremation container sales; records; required disclosures. Any funeral provider who 524.8sells or offers to sell a casket, alternate container, alkaline hydrolysis container, hydrolyzed 524.9remains container, or cremation container, or cremated remains container to the public 524.10must maintain a record of each sale that includes the name of the purchaser, the purchaser's 524.11mailing address, the name of the decedent, the date of the decedent's death, and the place 524.12of death. These records shall be open to inspection by the regulatory agency. Any funeral 524.13provider selling a casket, alternate container, or cremation container to the public, and not 524.14having charge of the final disposition of the dead human body, shall provide a copy of the 524.15statutes and rules controlling the removal, preparation, transportation, arrangements for 524.16disposition, and final disposition of a dead human body. This subdivision does not apply to 524.17morticians, funeral directors, funeral establishments, crematories, or wholesale distributors 524.18of caskets, alternate containers, alkaline hydrolysis containers, or cremation containers.524.19    Sec. 80. Minnesota Statutes 2012, section 149A.72, subdivision 3, is amended to read:524.20    Subd. 3. Casket for alkaline hydrolysis or cremation provisions; deceptive acts 524.21or practices. In selling or offering to sell funeral goods or funeral services to the public, it 524.22is a deceptive act or practice for a funeral provider to represent that a casket is required for 524.23alkaline hydrolysis or cremations by state or local law or otherwise.524.24    Sec. 81. Minnesota Statutes 2012, section 149A.72, is amended by adding a 524.25subdivision to read:524.26    Subd. 3a.Casket for alkaline hydrolysis provision; preventive measures.To 524.27prevent deceptive acts or practices, funeral providers must place the following disclosure 524.28in immediate conjunction with the prices shown for alkaline hydrolysis: "Minnesota 524.29law does not require you to purchase a casket for alkaline hydrolysis. If you want to 524.30arrange for alkaline hydrolysis, you can use an alkaline hydrolysis container. An alkaline 524.31hydrolysis container is a hydrolyzable or biodegradable closed container or pouch resistant 524.32to leakage of bodily fluids that encases the body and into which a dead human body is 524.33placed prior to insertion into an alkaline hydrolysis vessel. The containers we provide 525.1are (specify containers provided)." This disclosure is required only if the funeral provider 525.2arranges alkaline hydrolysis.525.3    Sec. 82. Minnesota Statutes 2012, section 149A.72, subdivision 9, is amended to read:525.4    Subd. 9. Deceptive acts or practices. In selling or offering to sell funeral goods, 525.5funeral services, burial site goods, or burial site services to the public, it is a deceptive act 525.6or practice for a funeral provider to represent that federal, state, or local laws, or particular 525.7cemeteries, alkaline hydrolysis facilities, or crematories, require the purchase of any funeral 525.8goods, funeral services, burial site goods, or burial site services when that is not the case.525.9    Sec. 83. Minnesota Statutes 2012, section 149A.73, subdivision 1, is amended to read:525.10    Subdivision 1. Casket for alkaline hydrolysis or cremation provisions; deceptive 525.11acts or practices. In selling or offering to sell funeral goods, funeral services, burial site 525.12goods, or burial site services to the public, it is a deceptive act or practice for a funeral 525.13provider to require that a casket be purchased for alkaline hydrolysis or cremation.525.14    Sec. 84. Minnesota Statutes 2012, section 149A.73, subdivision 2, is amended to read:525.15    Subd. 2. Casket for alkaline hydrolysis or cremation; preventive requirements.525.16To prevent unfair or deceptive acts or practices, if funeral providers arrange for alkaline 525.17hydrolysis or cremations, they must make a an alkaline hydrolysis container or cremation 525.18container available for alkaline hydrolysis or cremations.525.19    Sec. 85. Minnesota Statutes 2012, section 149A.73, subdivision 4, is amended to read:525.20    Subd. 4. Required purchases of funeral goods or services; preventive 525.21requirements. To prevent unfair or deceptive acts or practices, funeral providers must 525.22place the following disclosure in the general price list, immediately above the prices 525.23required by section 
         149A.71, subdivision 2, paragraph (e), clauses (4) to (10): "The goods 525.24and services shown below are those we can provide to our customers. You may choose 525.25only the items you desire. If legal or other requirements mean that you must buy any items 525.26you did not specifically ask for, we will explain the reason in writing on the statement we 525.27provide describing the funeral goods, funeral services, burial site goods, and burial site 525.28services you selected." However, if the charge for "services of funeral director and staff" 525.29cannot be declined by the purchaser, the statement shall include the sentence "However, 525.30any funeral arrangements you select will include a charge for our basic services." between 525.31the second and third sentences of the sentences specified in this subdivision. The statement 525.32may include the phrase "and overhead" after the word "services" if the fee includes a 526.1charge for the recovery of unallocated funeral overhead. If the funeral provider does 526.2not include this disclosure statement, then the following disclosure statement must be 526.3placed in the statement of funeral goods, funeral services, burial site goods, and burial site 526.4services selected, as described in section 
         149A.71, subdivision 2, paragraph (f): "Charges 526.5are only for those items that you selected or that are required. If we are required by law or 526.6by a cemetery, alkaline hydrolysis facility, or crematory to use any items, we will explain 526.7the reasons in writing below." A funeral provider is not in violation of this subdivision by 526.8failing to comply with a request for a combination of goods or services which would be 526.9impossible, impractical, or excessively burdensome to provide.526.10    Sec. 86. Minnesota Statutes 2012, section 149A.74, is amended to read:526.11149A.74 FUNERAL SERVICES PROVIDED WITHOUT PRIOR APPROVAL.526.12    Subdivision 1. Services provided without prior approval; deceptive acts or 526.13practices. In selling or offering to sell funeral goods or funeral services to the public, it 526.14is a deceptive act or practice for any funeral provider to embalm a dead human body 526.15unless state or local law or regulation requires embalming in the particular circumstances 526.16regardless of any funeral choice which might be made, or prior approval for embalming 526.17has been obtained from an individual legally authorized to make such a decision. In 526.18seeking approval to embalm, the funeral provider must disclose that embalming is not 526.19required by law except in certain circumstances; that a fee will be charged if a funeral 526.20is selected which requires embalming, such as a funeral with viewing; and that no 526.21embalming fee will be charged if the family selects a service which does not require 526.22embalming, such as direct alkaline hydrolysis, direct cremation, or immediate burial.526.23    Subd. 2. Services provided without prior approval; preventive requirement.526.24To prevent unfair or deceptive acts or practices, funeral providers must include on 526.25the itemized statement of funeral goods or services, as described in section 
         149A.71, 526.26subdivision 2
         , paragraph (f), the statement "If you selected a funeral that may require 526.27embalming, such as a funeral with viewing, you may have to pay for embalming. You do 526.28not have to pay for embalming you did not approve if you selected arrangements such 526.29as direct alkaline hydrolysis, direct cremation, or immediate burial. If we charged for 526.30embalming, we will explain why below."526.31    Sec. 87. Minnesota Statutes 2012, section 149A.91, subdivision 9, is amended to read:526.32    Subd. 9. Embalmed Bodies awaiting final disposition. All embalmed bodies 526.33awaiting final disposition shall be kept in an appropriate holding facility or preparation 526.34and embalming room. The holding facility must be secure from access by anyone except 527.1the authorized personnel of the funeral establishment, preserve the dignity and integrity of 527.2the body, and protect the health and safety of the personnel of the funeral establishment.527.3    Sec. 88. Minnesota Statutes 2012, section 149A.93, subdivision 3, is amended to read:527.4    Subd. 3. Disposition permit. A disposition permit is required before a body can 527.5be buried, entombed, alkaline hydrolyzed, or cremated. No disposition permit shall be 527.6issued until a fact of death record has been completed and filed with the local or state 527.7registrar of vital statistics.527.8    Sec. 89. Minnesota Statutes 2012, section 149A.93, subdivision 6, is amended to read:527.9    Subd. 6. Conveyances permitted for transportation. A dead human body may be 527.10transported by means of private vehicle or private aircraft, provided that the body must be 527.11encased in an appropriate container, that meets the following standards:527.12    (1) promotes respect for and preserves the dignity of the dead human body;527.13    (2) shields the body from being viewed from outside of the conveyance;527.14    (3) has ample enclosed area to accommodate a cot, stretcher, rigid tray, casket, 527.15alternative container, alkaline hydrolysis container, or cremation container in a horizontal 527.16position;527.17    (4) is designed to permit loading and unloading of the body without excessive tilting 527.18of the cot, stretcher, rigid tray, casket, alternative container, alkaline hydrolysis container,527.19 or cremation container; and527.20    (5) if used for the transportation of more than one dead human body at one time, 527.21the vehicle must be designed so that a body or container does not rest directly on top of 527.22another body or container and that each body or container is secured to prevent the body 527.23or container from excessive movement within the conveyance.527.24    A vehicle that is a dignified conveyance and was specified for use by the deceased 527.25or by the family of the deceased may be used to transport the body to the place of final 527.26disposition.527.27    Sec. 90. Minnesota Statutes 2012, section 149A.94, is amended to read:527.28149A.94 FINAL DISPOSITION.527.29    Subdivision 1. Generally. Every dead human body lying within the state, except 527.30unclaimed bodies delivered for dissection by the medical examiner, those delivered for 527.31anatomical study pursuant to section 
         149A.81, subdivision 2, or lawfully carried through 527.32the state for the purpose of disposition elsewhere; and the remains of any dead human 527.33body after dissection or anatomical study, shall be decently buried, or entombed in a 528.1public or private cemetery, alkaline hydrolyzed or cremated, within a reasonable time 528.2after death. Where final disposition of a body will not be accomplished within 72 hours 528.3following death or release of the body by a competent authority with jurisdiction over the 528.4body, the body must be properly embalmed, refrigerated, or packed with dry ice. A body 528.5may not be kept in refrigeration for a period exceeding six calendar days, or packed in dry 528.6ice for a period that exceeds four calendar days, from the time of death or release of the 528.7body from the coroner or medical examiner.528.8    Subd. 3. Permit required. No dead human body shall be buried, entombed, or 528.9cremated without a disposition permit. The disposition permit must be filed with the person 528.10in charge of the place of final disposition. Where a dead human body will be transported out 528.11of this state for final disposition, the body must be accompanied by a certificate of removal.528.12    Subd. 4. Alkaline hydrolysis or cremation. Inurnment of alkaline hydrolyzed or 528.13cremated remains and release to an appropriate party is considered final disposition and no 528.14further permits or authorizations are required for transportation, interment, entombment, or 528.15placement of the cremated remains, except as provided in section 
         149A.95, subdivision 16.528.16    Sec. 91. [149A.941] ALKALINE HYDROLYSIS FACILITIES AND ALKALINE 528.17HYDROLYSIS.528.18    Subdivision 1.License required.A dead human body may only be hydrolyzed in 528.19this state at an alkaline hydrolysis facility licensed by the commissioner of health.528.20    Subd. 2.General requirements.Any building to be used as an alkaline hydrolysis 528.21facility must comply with all applicable local and state building codes, zoning laws and 528.22ordinances, wastewater management regulations, and environmental statutes, rules, and 528.23standards. An alkaline hydrolysis facility must have, on site, a purpose built human 528.24alkaline hydrolysis system approved by the commissioner of health, a system approved by 528.25the commissioner of health for drying the hydrolyzed remains, a motorized mechanical 528.26device approved by the commissioner of health for processing hydrolyzed remains and 528.27must have in the building a holding facility approved by the commissioner of health for 528.28the retention of dead human bodies awaiting alkaline hydrolysis. The holding facility 528.29must be secure from access by anyone except the authorized personnel of the alkaline 528.30hydrolysis facility, preserve the dignity of the remains, and protect the health and safety of 528.31the alkaline hydrolysis facility personnel.528.32    Subd. 3.Lighting and ventilation.The room where the alkaline hydrolysis vessel 528.33is located and the room where the chemical storage takes place shall be properly lit and 528.34ventilated with an exhaust fan that provides at least 12 air changes per hour.529.1    Subd. 4.Plumbing connections.All plumbing fixtures, water supply lines, 529.2plumbing vents, and waste drains shall be properly vented and connected pursuant to the 529.3Minnesota Plumbing Code. The alkaline hydrolysis facility shall be equipped with a 529.4functional sink with hot and cold running water.529.5    Subd. 5.Flooring, walls, ceiling, doors, and windows.The room where the 529.6alkaline hydrolysis vessel is located and the room where the chemical storage takes place 529.7shall have nonporous flooring, so that a sanitary condition is provided. The walls and 529.8ceiling of the room where the alkaline hydrolysis vessel is located and the room where 529.9the chemical storage takes place shall run from floor to ceiling and be covered with tile, 529.10or by plaster or sheetrock painted with washable paint or other appropriate material so 529.11that a sanitary condition is provided. The doors, walls, ceiling, and windows shall be 529.12constructed to prevent odors from entering any other part of the building. All windows 529.13or other openings to the outside must be screened and all windows must be treated in a 529.14manner that prevents viewing into the room where the alkaline hydrolysis vessel is located 529.15and the room where the chemical storage takes place. A viewing window for authorized 529.16family members or their designees is not a violation of this subdivision.529.17    Subd. 6.Equipment and supplies.The alkaline hydrolysis facility must have a 529.18functional emergency eye wash and quick drench shower.529.19    Subd. 7.Access and privacy.(a) The room where the alkaline hydrolysis vessel is 529.20located and the room where the chemical storage takes place must be private and have no 529.21general passageway through it. The room shall, at all times, be secure from the entrance of 529.22unauthorized persons. Authorized persons are:529.23(1) licensed morticians;529.24(2) registered interns or students as described in section 149A.91, subdivision 6;529.25(3) public officials or representatives in the discharge of their official duties; 529.26(4) trained alkaline hydrolysis facility operators; and529.27(5) the persons with the right to control the dead human body as defined in section 529.28149A.80, subdivision 2, and their designees.529.29    (b) Each door allowing ingress or egress shall carry a sign that indicates that the 529.30room is private and access is limited. All authorized persons who are present in or enter 529.31the room where the alkaline hydrolysis vessel is located while a body is being prepared for 529.32final disposition must be attired according to all applicable state and federal regulations 529.33regarding the control of infectious disease and occupational and workplace health and 529.34safety.529.35    Subd. 8.Sanitary conditions and permitted use.The room where the alkaline 529.36hydrolysis vessel is located and the room where the chemical storage takes place and all 530.1fixtures, equipment, instruments, receptacles, clothing, and other appliances or supplies 530.2stored or used in the room must be maintained in a clean and sanitary condition at all times.530.3    Subd. 9.Boiler use.When a boiler is required by the manufacturer of the alkaline 530.4hydrolysis vessel for its operation, all state and local regulations for that boiler must be 530.5followed.530.6    Subd. 10.Occupational and workplace safety.All applicable provisions of state 530.7and federal regulations regarding exposure to workplace hazards and accidents shall be 530.8followed in order to protect the health and safety of all authorized persons at the alkaline 530.9hydrolysis facility.530.10    Subd. 11.Licensed personnel.A licensed alkaline hydrolysis facility must employ 530.11a licensed mortician to carry out the process of alkaline hydrolysis of a dead human body. 530.12It is the duty of the licensed alkaline hydrolysis facility to provide proper procedures for 530.13all personnel, and the licensed alkaline hydrolysis facility shall be strictly accountable for 530.14compliance with this chapter and other applicable state and federal regulations regarding 530.15occupational and workplace health and safety.530.16    Subd. 12.Authorization to hydrolyze required.No alkaline hydrolysis facility 530.17shall hydrolyze or cause to be hydrolyzed any dead human body or identifiable body part 530.18without receiving written authorization to do so from the person or persons who have the 530.19legal right to control disposition as described in section 149A.80 or the person's legal 530.20designee. The written authorization must include:530.21(1) the name of the deceased and the date of death of the deceased;530.22(2) a statement authorizing the alkaline hydrolysis facility to hydrolyze the body;530.23(3) the name, address, telephone number, relationship to the deceased, and signature 530.24of the person or persons with legal right to control final disposition or a legal designee;530.25(4) directions for the disposition of any nonhydrolyzed materials or items recovered 530.26from the alkaline hydrolysis vessel;530.27(5) acknowledgment that the hydrolyzed remains will be dried and mechanically 530.28reduced to a granulated appearance and placed in an appropriate container and 530.29authorization to place any hydrolyzed remains that a selected urn or container will not 530.30accommodate into a temporary container;530.31(6) acknowledgment that, even with the exercise of reasonable care, it is not possible 530.32to recover all particles of the hydrolyzed remains and that some particles may inadvertently 530.33become commingled with particles of other hydrolyzed remains that remain in the alkaline 530.34hydrolysis vessel or other mechanical devices used to process the hydrolyzed remains;530.35(7) directions for the ultimate disposition of the hydrolyzed remains; and531.1(8) a statement that includes, but is not limited to, the following information: 531.2"During the alkaline hydrolysis process, chemical dissolution using heat, water, and an 531.3alkaline solution is used to chemically break down the human tissue and the hydrolyzable 531.4alkaline hydrolysis container. After the process is complete, the liquid effluent solution 531.5contains the chemical by-products of the alkaline hydrolysis process except for the 531.6deceased's bone fragments. The solution is cooled and released according to local 531.7environmental regulations. A water rinse is applied to the hydrolyzed remains which are 531.8then dried and processed to facilitate inurnment or scattering."531.9    Subd. 13.Limitation of liability.A licensed alkaline hydrolysis facility acting in 531.10good faith, with reasonable reliance upon an authorization to hydrolyze, pursuant to an 531.11authorization to hydrolyze and in an otherwise lawful manner, shall be held harmless from 531.12civil liability and criminal prosecution for any actions taken by the alkaline hydrolysis 531.13facility.531.14    Subd. 14.Acceptance of delivery of body.(a) No dead human body shall be 531.15accepted for final disposition by alkaline hydrolysis unless:531.16(1) encased in an appropriate alkaline hydrolysis container;531.17(2) accompanied by a disposition permit issued pursuant to section 149A.93, 531.18subdivision 3, including a photocopy of the completed death record or a signed release 531.19authorizing alkaline hydrolysis of the body received from the coroner or medical 531.20examiner; and531.21(3) accompanied by an alkaline hydrolysis authorization that complies with 531.22subdivision 12.531.23    (b) An alkaline hydrolysis facility shall refuse to accept delivery of an alkaline 531.24hydrolysis container where there is:531.25(1) evidence of leakage of fluids from the alkaline hydrolysis container;531.26(2) a known dispute concerning hydrolysis of the body delivered;531.27(3) a reasonable basis for questioning any of the representations made on the written 531.28authorization to hydrolyze; or531.29(4) any other lawful reason.531.30    Subd. 15.Bodies awaiting hydrolysis.A dead human body must be hydrolyzed 531.31within 24 hours of the alkaline hydrolysis facility accepting legal and physical custody of 531.32the body.531.33    Subd. 16.Handling of alkaline hydrolysis containers for dead human bodies.531.34All alkaline hydrolysis facility employees handling alkaline hydrolysis containers for 531.35dead human bodies shall use universal precautions and otherwise exercise all reasonable 532.1precautions to minimize the risk of transmitting any communicable disease from the body. 532.2No dead human body shall be removed from the container in which it is delivered.532.3    Subd. 17.Identification of body.All licensed alkaline hydrolysis facilities shall 532.4develop, implement, and maintain an identification procedure whereby dead human 532.5bodes can be identified from the time the alkaline hydrolysis facility accepts delivery 532.6of the remains until the hydrolyzed remains are released to an authorized party. After 532.7hydrolyzation, an identifying disk, tab, or other permanent label shall be placed within the 532.8hydrolyzed remains container before the hydrolyzed remains are released from the alkaline 532.9hydrolysis facility. Each identification disk, tab, or label shall have a number that shall 532.10be recorded on all paperwork regarding the decedent. This procedure shall be designed 532.11to reasonably ensure that the proper body is hydrolyzed and that the hydrolyzed remains 532.12are returned to the appropriate party. Loss of all or part of the hydrolyzed remains or the 532.13inability to individually identify the hydrolyzed remains is a violation of this subdivision.532.14    Subd. 18.Alkaline hydrolysis vessel for human remains.A licensed alkaline 532.15hydrolysis facility shall knowingly hydrolyze only dead human bodies or human remains 532.16in an alkaline hydrolysis vessel, along with the alkaline hydrolysis container used for 532.17infectious disease control.532.18    Subd. 19.Alkaline hydrolysis procedures; privacy.The final disposition of 532.19dead human bodies by alkaline hydrolysis shall be done in privacy. Unless there is 532.20written authorization from the person with the legal right to control the disposition, 532.21only authorized alkaline hydrolysis facility personnel shall be permitted in the alkaline 532.22hydrolysis area while any dead human body is in the alkaline hydrolysis area awaiting 532.23alkaline hydrolysis, in the alkaline hydrolysis vessel, being removed from the alkaline 532.24hydrolysis vessel, or being processed and placed in a hydrolyzed remains container.532.25    Subd. 20.Alkaline hydrolysis procedures; commingling of hydrolyzed remains 532.26prohibited.Except with the express written permission of the person with the legal right 532.27to control the disposition, no alkaline hydrolysis facility shall hydrolyze more than one 532.28dead human body at the same time and in the same alkaline hydrolysis vessel, or introduce 532.29a second dead human body into an alkaline hydrolysis vessel until reasonable efforts have 532.30been employed to remove all fragments of the preceding hydrolyzed remains, or hydrolyze 532.31a dead human body and other human remains at the same time and in the same alkaline 532.32hydrolysis vessel. This section does not apply where commingling of human remains 532.33during alkaline hydrolysis is otherwise provided by law. The fact that there is incidental 532.34and unavoidable residue in the alkaline hydrolysis vessel used in a prior hydrolyzation is 532.35not a violation of this subdivision.533.1    Subd. 21.Alkaline hydrolysis procedures; removal from alkaline hydrolysis 533.2vessel.Upon completion of the alkaline hydrolysis process, reasonable efforts shall be 533.3made to remove from the alkaline hydrolysis vessel all of the recoverable hydrolyzed 533.4remains and nonhydrolyzed materials or items. Further, all reasonable efforts shall be 533.5made to separate and recover the nonhydrolyzed materials or items from the hydrolyzed 533.6human remains and dispose of these materials in a lawful manner, by the alkaline 533.7hydrolysis facility. The hydrolyzed human remains shall be placed in an appropriate 533.8container to be transported to the processing area.533.9    Subd. 22.Drying device or mechanical processor procedures; commingling of 533.10hydrolyzed remains prohibited.Except with the express written permission of the 533.11person with the legal right to control the final disposition or otherwise provided by 533.12law, no alkaline hydrolysis facility shall dry or mechanically process the hydrolyzed 533.13human remains of more than one body at a time in the same drying device or mechanical 533.14processor, or introduce the hydrolyzed human remains of a second body into a drying 533.15device or mechanical processor until processing of any preceding hydrolyzed human 533.16remains has been terminated and reasonable efforts have been employed to remove all 533.17fragments of the preceding hydrolyzed remains. The fact that there is incidental and 533.18unavoidable residue in the drying device, the mechanical processor, or any container used 533.19in a prior alkaline hydrolysis process, is not a violation of this provision.533.20    Subd. 23.Alkaline hydrolysis procedures; processing hydrolyzed remains.The 533.21hydrolyzed human remains shall be dried and then reduced by a motorized mechanical 533.22device to a granulated appearance appropriate for final disposition and placed in an 533.23alkaline hydrolysis remains container along with the appropriate identifying disk, tab, 533.24or permanent label. Processing must take place within the licensed alkaline hydrolysis 533.25facility. Dental gold, silver or amalgam, jewelry, or mementos, to the extent that they 533.26can be identified, may be removed prior to processing the hydrolyzed remains, only by 533.27staff licensed or registered by the commissioner of health; however, any dental gold and 533.28silver, jewelry, or mementos that are removed shall be returned to the hydrolyzed remains 533.29container unless otherwise directed by the person or persons having the right to control the 533.30final disposition. Every person who removes or possesses dental gold or silver, jewelry, 533.31or mementos from any hydrolyzed remains without specific written permission of the 533.32person or persons having the right to control those remains is guilty of a misdemeanor. 533.33The fact that residue and any unavoidable dental gold or dental silver, or other precious 533.34metals remain in the alkaline hydrolysis vessel or other equipment or any container used 533.35in a prior hydrolysis is not a violation of this section.534.1    Subd. 24.Alkaline hydrolysis procedures; container of insufficient capacity.534.2If a hydrolyzed remains container is of insufficient capacity to accommodate all 534.3hydrolyzed remains of a given dead human body, subject to directives provided in the 534.4written authorization to hydrolyze, the alkaline hydrolysis facility shall place the excess 534.5hydrolyzed remains in a secondary alkaline hydrolysis remains container and attach the 534.6second container, in a manner so as not to be easily detached through incidental contact, to 534.7the primary alkaline hydrolysis remains container. The secondary container shall contain a 534.8duplicate of the identification disk, tab, or permanent label that was placed in the primary 534.9container and all paperwork regarding the given body shall include a notation that the 534.10hydrolyzed remains were placed in two containers. Keepsake jewelry or similar miniature 534.11hydrolyzed remains containers are not subject to the requirements of this subdivision.534.12    Subd. 25.Disposition procedures; commingling of hydrolyzed remains 534.13prohibited.No hydrolyzed remains shall be disposed of or scattered in a manner or in 534.14a location where the hydrolyzed remains are commingled with those of another person 534.15without the express written permission of the person with the legal right to control 534.16disposition or as otherwise provided by law. This subdivision does not apply to the 534.17scattering or burial of hydrolyzed remains at sea or in a body of water from individual 534.18containers, to the scattering or burial of hydrolyzed remains in a dedicated cemetery, to 534.19the disposal in a dedicated cemetery of accumulated residue removed from an alkaline 534.20hydrolysis vessel or other alkaline hydrolysis equipment, to the inurnment of members 534.21of the same family in a common container designed for the hydrolyzed remains of more 534.22than one body, or to the inurnment in a container or interment in a space that has been 534.23previously designated, at the time of sale or purchase, as being intended for the inurnment 534.24or interment of the hydrolyzed remains of more than one person.534.25    Subd. 26.Alkaline hydrolysis procedures; disposition of accumulated residue.534.26Every alkaline hydrolysis facility shall provide for the removal and disposition in a 534.27dedicated cemetery of any accumulated residue from any alkaline hydrolysis vessel, 534.28drying device, mechanical processor, container, or other equipment used in alkaline 534.29hydrolysis. Disposition of accumulated residue shall be according to the regulations of the 534.30dedicated cemetery and any applicable local ordinances.534.31    Subd. 27.Alkaline hydrolysis procedures; release of hydrolyzed remains.534.32Following completion of the hydrolyzation, the inurned hydrolyzed remains shall be 534.33released according to the instructions given on the written authorization to hydrolyze. If 534.34the hydrolyzed remains are to be shipped, they must be securely packaged and transported 534.35by a method which has an internal tracing system available and which provides for a 534.36receipt signed by the person accepting delivery. Where there is a dispute over release 535.1or disposition of the hydrolyzed remains, an alkaline hydrolysis facility may deposit 535.2the hydrolyzed remains with a court of competent jurisdiction pending resolution of the 535.3dispute or retain the hydrolyzed remains until the person with the legal right to control 535.4disposition presents satisfactory indication that the dispute is resolved.535.5    Subd. 28.Unclaimed hydrolyzed remains.If, after 30 calendar days following 535.6the inurnment, the hydrolyzed remains are not claimed or disposed of according to the 535.7written authorization to hydrolyze, the alkaline hydrolysis facility or funeral establishment 535.8may give written notice, by certified mail, to the person with the legal right to control 535.9the final disposition or a legal designee, that the hydrolyzed remains are unclaimed and 535.10requesting further release directions. Should the hydrolyzed remains be unclaimed 120 535.11calendar days following the mailing of the written notification, the alkaline hydrolysis 535.12facility or funeral establishment may dispose of the hydrolyzed remains in any lawful 535.13manner deemed appropriate.535.14    Subd. 29.Required records.Every alkaline hydrolysis facility shall create and 535.15maintain on its premises or other business location in Minnesota an accurate record of 535.16every hydrolyzation provided. The record shall include all of the following information 535.17for each hydrolyzation:535.18(1) the name of the person or funeral establishment delivering the body for alkaline 535.19hydrolysis;535.20(2) the name of the deceased and the identification number assigned to the body;535.21(3) the date of acceptance of delivery;535.22(4) the names of the alkaline hydrolysis vessel, drying device, and mechanical 535.23processor operator;535.24(5) the time and date that the body was placed in and removed from the alkaline 535.25hydrolysis vessel;535.26(6) the time and date that processing and inurnment of the hydrolyzed remains 535.27was completed;535.28(7) the time, date, and manner of release of the hydrolyzed remains;535.29(8) the name and address of the person who signed the authorization to hydrolyze;535.30(9) all supporting documentation, including any transit or disposition permits, a 535.31photocopy of the death record, and the authorization to hydrolyze; and535.32(10) the type of alkaline hydrolysis container.535.33    Subd. 30.Retention of records.Records required under subdivision 29 shall be 535.34maintained for a period of three calendar years after the release of the hydrolyzed remains. 535.35Following this period and subject to any other laws requiring retention of records, the 535.36alkaline hydrolysis facility may then place the records in storage or reduce them to 536.1microfilm, microfiche, laser disc, or any other method that can produce an accurate 536.2reproduction of the original record, for retention for a period of ten calendar years from 536.3the date of release of the hydrolyzed remains. At the end of this period and subject to any 536.4other laws requiring retention of records, the alkaline hydrolysis facility may destroy 536.5the records by shredding, incineration, or any other manner that protects the privacy of 536.6the individuals identified.536.7    Sec. 92. Minnesota Statutes 2012, section 149A.96, subdivision 9, is amended to read:536.8    Subd. 9. Hydrolyzed and cremated remains. Subject to section 
         149A.95, 536.9subdivision 16
         , inurnment of the hydrolyzed or cremated remains and release to an 536.10appropriate party is considered final disposition and no further permits or authorizations 536.11are required for disinterment, transportation, or placement of the hydrolyzed or cremated 536.12remains.536.13    Sec. 93. Minnesota Statutes 2012, section 257.75, subdivision 7, is amended to read:536.14    Subd. 7. Hospital and Department of Health; recognition form. Hospitals that 536.15provide obstetric services and the state registrar of vital statistics shall distribute the 536.16educational materials and recognition of parentage forms prepared by the commissioner of 536.17human services to new parents, shall assist parents in understanding the recognition of 536.18parentage form, including following the provisions for notice under subdivision 5, shall 536.19provide notary services for parents who complete the recognition of parentage form, and 536.20shall timely file the completed recognition of parentage form with the Office of the State 536.21Registrar of Vital Statistics Records unless otherwise instructed by the Office of the State 536.22Registrar of Vital Statistics Records. On and after January 1, 1994, hospitals may not 536.23distribute the declaration of parentage forms.536.24    Sec. 94. Minnesota Statutes 2012, section 260C.635, subdivision 1, is amended to read:536.25    Subdivision 1. Legal effect. (a) Upon adoption, the adopted child becomes the legal 536.26child of the adopting parent and the adopting parent becomes the legal parent of the child 536.27with all the rights and duties between them of a birth parent and child.536.28(b) The child shall inherit from the adoptive parent and the adoptive parent's 536.29relatives the same as though the child were the birth child of the parent, and in case of the 536.30child's death intestate, the adoptive parent and the adoptive parent's relatives shall inherit 536.31the child's estate as if the child had been the adoptive parent's birth child.536.32(c) After a decree of adoption is entered, the birth parents or previous legal parents 536.33of the child shall be relieved of all parental responsibilities for the child except child 537.1support that has accrued to the date of the order for guardianship to the commissioner 537.2which continues to be due and owing. The child's birth or previous legal parent shall not 537.3exercise or have any rights over the adopted child or the adopted child's property, person, 537.4privacy, or reputation.537.5(d) The adopted child shall not owe the birth parents or the birth parent's relatives 537.6any legal duty nor shall the adopted child inherit from the birth parents or kindred unless 537.7otherwise provided for in a will of the birth parent or kindred.537.8    (e) Upon adoption, the court shall complete a certificate of adoption form and mail 537.9the form to the Office of the State Registrar Vital Records at the Minnesota Department 537.10of Health. Upon receiving the certificate of adoption, the state registrar shall register a 537.11replacement vital record in the new name of the adopted child as required under section 537.12144.218
         .537.13    Sec. 95. Minnesota Statutes 2012, section 517.001, is amended to read:537.14517.001 DEFINITION.537.15As used in this chapter, "local registrar" has the meaning given in section 144.212, 537.16subdivision 10 means an individual designated by the county board of commissioners to 537.17register marriages.537.18    Sec. 96. FUNERAL ESTABLISHMENTS; BRANCH LOCATIONS.537.19    The commissioner of health shall review the statutory requirements for preparation 537.20and embalming rooms and develop legislation with input from stakeholders that provides 537.21appropriate health and safety protection for funeral home locations where deceased bodies 537.22are present, but are branch locations associated through a majority ownership of a licensed 537.23funeral establishment that meets the requirements of Minnesota Statutes, sections 149A.50 537.24and 149A.92, subdivisions 2 to 10. The review shall include consideration of distance 537.25between the main location and branch, and other health and safety issues.537.26    Sec. 97. REVISOR'S INSTRUCTION.537.27The revisor shall substitute the term "vertical heat exchangers" or "vertical 537.28heat exchanger" with "bored geothermal heat exchangers" or "bored geothermal heat 537.29exchanger" wherever it appears in Minnesota Statutes, sections 103I.005, subdivisions 537.302 and 12; 103I.101, subdivisions 2 and 5; 103I.105; 103I.205, subdivision 4; 103I.208, 537.31subdivision 2; 103I.501; 103I.531, subdivision 5; and 103I.641, subdivisions 1, 2, and 3.537.32    Sec. 98.  REPEALER.538.1(a) Minnesota Statutes 2012, sections 62J.693; 103I.005, subdivision 20; 149A.025; 538.2149A.20, subdivision 8; 149A.30, subdivision 2; 149A.40, subdivision 8; 149A.45, 538.3subdivision 6; 149A.50, subdivision 6; 149A.51, subdivision 7; 149A.52, subdivision 5a; 538.4149A.53, subdivision 9; and 485.14, are repealed.538.5(b) Minnesota Statutes 2012, section 144.123, subdivision 2, is repealed effective 538.6July 1, 2014.538.7ARTICLE 13538.8PAYMENT METHODOLOGIES FOR HOME AND 538.9COMMUNITY-BASED SERVICES538.10    Section 1. Minnesota Statutes 2012, section 256B.4912, subdivision 2, is amended to 538.11read:538.12    Subd. 2. Payment methodologies. (a) The commissioner shall establish, as defined 538.13under section 256B.4914, statewide payment methodologies that meet federal waiver 538.14requirements for home and community-based waiver services for individuals with 538.15disabilities. The payment methodologies must abide by the principles of transparency 538.16and equitability across the state. The methodologies must involve a uniform process of 538.17structuring rates for each service and must promote quality and participant choice.538.18    (b) As of January 1, 2012, counties shall not implement changes to established 538.19processes for rate-setting methodologies for individuals using components of or data 538.20from research rates.538.21    Sec. 2. Minnesota Statutes 2012, section 256B.4912, subdivision 3, is amended to read:538.22    Subd. 3. Payment requirements. The payment methodologies established under 538.23this section shall accommodate:538.24(1) supervision costs;538.25(2) staffing patterns staff compensation;538.26(3) staffing and supervisory patterns;538.27(3) (4) program-related expenses;538.28(4) (5) general and administrative expenses; and538.29(5) (6) consideration of recipient intensity.538.30    Sec. 3. Minnesota Statutes 2012, section 256B.4913, is amended by adding a 538.31subdivision to read:538.32    Subd. 4a.Rate stabilization adjustment.(a) The commissioner of human services 538.33shall adjust individual reimbursement rates by no more than 1.0 percent per year effective 539.1January 1, 2016. Rates determined under section 256B.4914 must be adjusted so that 539.2the unit rate varies no more than 1.0 percent per year from the rate effective December 539.31 of the prior calendar year. This adjustment is made annually for three calendar years 539.4from the date of implementation.539.5(b) Rate stabilization adjustment applies to services that are authorized in a 539.6recipient's service plan prior to January 1, 2016.539.7(c) Exemptions shall be made only when there is a significant change in the 539.8recipient's assessed needs that results in a service authorization change. Exemption 539.9adjustments shall be limited to the difference in the authorized framework rate specific to 539.10change in assessed need. Exemptions shall be managed within lead agencies' budgets per 539.11existing allocation procedures.539.12(d) This subdivision expires January 1, 2019.539.13    Sec. 4. Minnesota Statutes 2012, section 256B.4913, subdivision 5, is amended to read:539.14    Subd. 5. Stakeholder consultation. The commissioner shall continue consultation 539.15on regular intervals with the existing stakeholder group established as part of the 539.16rate-setting methodology process and others, to gather input, concerns, and data, and 539.17exchange ideas for the legislative proposals for to assist in the full implementation of539.18 the new rate payment system and to make pertinent information available to the public 539.19through the department's Web site.539.20    Sec. 5. Minnesota Statutes 2012, section 256B.4913, subdivision 6, is amended to read:539.21    Subd. 6. Implementation.(a) The commissioner may shall implement changes 539.22no sooner than on January 1, 2014, to payment rates for individuals receiving home and 539.23community-based waivered services after the enactment of legislation that establishes 539.24specific payment methodology frameworks, processes for rate calculations, and specific 539.25values to populate the payment methodology frameworks disability waiver rates system.539.26(b) On January 1, 2014, all new service authorizations must use the disability waiver 539.27rates system. Beginning January 1, 2014, all renewing individual service plans must use the 539.28disability waiver rates system as reassessment and reauthorization occurs. By December 539.2931, 2014, data for all recipients must be entered into the disability waiver rates system.539.30    Sec. 6. [256B.4914] HOME AND COMMUNITY-BASED SERVICES WAIVERS; 539.31RATE SETTING.540.1    Subdivision 1.Application.The payment methodologies in this section apply to 540.2home and community-based services waivers under sections 256B.092 and 256B.49. This 540.3section does not change existing waiver policies and procedures.540.4    Subd. 2.Definitions.(a) For purposes of this section, the following terms have the 540.5meanings given them, unless the context clearly indicates otherwise.540.6(b) "Commissioner" means the commissioner of human services.540.7(c) "Component value" means underlying factors that are part of the cost of providing 540.8services that are built into the waiver rates methodology to calculate service rates.540.9(d) "Customized living tool" means a methodology for setting service rates that 540.10delineates and documents the amount of each component service included in a recipient's 540.11customized living service plan.540.12(e) "Disability waiver rates system" means a statewide system that establishes rates 540.13that are based on uniform processes and captures the individualized nature of waiver 540.14services and recipient needs.540.15(f) "Lead agency" means a county, partnership of counties, or tribal agency charged 540.16with administering waivered services under sections 256B.092 and 256B.49.540.17(g) "Median" means the amount that divides distribution into two equal groups, 540.18one-half above the median and one-half below the median.540.19(h) "Payment or rate" means reimbursement to an eligible provider for services 540.20provided to a qualified individual based on an approved service authorization.540.21(i) "Rates management system" means a Web-based software application that uses 540.22a framework and component values, as determined by the commissioner, to establish 540.23service rates.540.24(j) "Recipient" means a person receiving home and community-based services 540.25funded under any of the disability waivers.540.26    Subd. 3.Applicable services.Applicable services are those authorized under 540.27the state's home and community-based services waivers under sections 256B.092 and 540.28256B.49, including the following, as defined in the federally approved home and 540.29community-based services plan:540.30(1) 24 hour customized living;540.31(2) adult day care;540.32(3) adult day care bath;540.33(4) behavioral programming;540.34(5) companion services;540.35(6) customized living;540.36(7) day training and habilitation;541.1(8) housing access coordination;541.2(9) independent living skills;541.3(10) in-home family support;541.4(11) night supervision;541.5(12) personal support;541.6(13) prevocational services;541.7(14) residential care services;541.8(15) residential support services;541.9(16) respite services;541.10(17) structured day services;541.11(18) supported employment services;541.12(19) supported living services;541.13(20) transportation services; and541.14(21) other services as approved by the federal government in the state home and 541.15community-based services plan.541.16    Subd. 4.Data collection for rate determination.(a) Rates for all applicable home 541.17and community-based waivered services, including rate exceptions under subdivision 12, 541.18are set via the rates management system.541.19(b) Only data and information in the rates management system may be used to 541.20calculate an individual's rate.541.21(c) Service providers, with information from the community support plan, shall enter 541.22values and information needed to calculate an individual's rate into the rates management 541.23system. These values and information include:541.24(1) shared staffing hours;541.25(2) individual staffing hours;541.26(3) staffing ratios;541.27(4) information to document variable levels of service qualification for variable 541.28levels of reimbursement in each framework;541.29(5) shared or individualized arrangements for unit-based services, including the 541.30staffing ratio; and541.31(6) number of trips and miles for transportation services.541.32(d) Updates to individual data shall include:541.33(1) data for each individual that is updated annually when renewing service plans; and541.34(2) requests by individuals or lead agencies to update a rate whenever there is a 541.35change in an individual's service needs, with accompanying documentation.542.1(e) Lead agencies shall review and approve values to calculate the final payment rate 542.2for each individual. Lead agencies must notify the individual and the service provider 542.3of the final agreed-upon values and rate. If a value used was mistakenly or erroneously 542.4entered and used to calculate a rate, a provider may petition lead agencies to correct it. 542.5Lead agencies must respond to these requests.542.6    Subd. 5.Base wage index and standard component values.(a) The base wage 542.7index is established to determine staffing costs associated with providing services to 542.8individuals receiving home and community-based services. For purposes of developing 542.9and calculating the proposed base wage, Minnesota-specific wages taken from job 542.10descriptions and standard occupational classification (SOC) codes from the Bureau of 542.11Labor Statistics as defined in the most recent edition of the Occupational Handbook shall 542.12be used. The base wage index shall be calculated as follows:542.13(1) for residential direct-care basic staff, 50 percent of the median wage for personal 542.14and home health aide (SOC code 39-9021); 30 percent of the median wage for nursing 542.15aide (SOC code 31-1012); and 20 percent of the median wage for social and human 542.16services aide (SOC code 21-1093);542.17(2) for residential direct-care intensive staff, 20 percent of the median wage for home 542.18health aide (SOC code 31-1011); 20 percent of the median wage for personal and home 542.19health aide (SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code 542.2021-1012); 20 percent of the median wage for psychiatric technician (SOC code 29-2053); 542.21and 20 percent of the median wage for social and human services aide (SOC code 21-1093);542.22(3) for day services, 20 percent of the median wage for nursing aide (SOC code 542.2331-1012); 20 percent of the median wage for psychiatric technician (SOC code 29-2053); 542.24and 60 percent of the median wage for social and human services code (SOC code 21-1093);542.25(4) for residential asleep-overnight staff, the wage will be $7.66 per hour, except in 542.26a family foster care setting, the wage is $2.80 per hour;542.27(5) for behavior program analyst staff, 100 percent of the median wage for mental 542.28health counselors (SOC code 21-1014);542.29(6) for behavior program professional staff, 100 percent of the median wage for 542.30clinical counseling and school psychologist (SOC code 19-3031);542.31(7) for behavior program specialist staff, 100 percent of the median wage for 542.32psychiatric technicians (SOC code 29-2053);542.33(8) for supportive living services staff, 20 percent of the median wage for nursing 542.34aide (SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC 542.35code 29-2053); and 60 percent of the median wage for social and human services aide 542.36(SOC code 21-1093);543.1(9) for housing access coordination staff, 50 percent of the median wage for 543.2community and social services specialist (SOC code 21-1099); and 50 percent of the 543.3median wage for social and human services aide (SOC code 21-1093);543.4(10) for in-home family support staff, 20 percent of the median wage for nursing 543.5aide (SOC code 31-1012); 30 percent of community social service specialist (SOC code 543.621-1099); 40 percent of the median wage for social and human services aide (SOC code 543.721-1093); and ten percent of the median wage for psychiatric technician (SOC code 543.829-2053);543.9(11) for independent living skills staff, 40 percent of the median wage for community 543.10social service specialist (SOC code 21-1099); 50 percent of the median wage for social 543.11and human services aide (SOC code 21-1093); and ten percent of the median wage for 543.12psychiatric technician (SOC code 29-2053);543.13(12) for supported employment staff, 20 percent of the median wage for nursing aide 543.14(SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC 543.15code 29-2053); and 60 percent of the median wage for social and human services aide 543.16(SOC code 21-1093);543.17(13) for adult companion staff, 50 percent of the median wage for personal and home 543.18care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides, 543.19orderlies, and attendants (SOC code 31-1012);543.20(14) for night supervision staff, 20 percent of the median wage for home health aide 543.21(SOC code 31-1011); 20 percent of the median wage for personal and home health aide 543.22(SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code 31-1012); 543.2320 percent of the median wage for psychiatric technician (SOC code 29-2053); and 20 543.24percent of the median wage for social and human services aide (SOC code 21-1093);543.25(15) for respite staff, 50 percent of the median wage for personal and home care aide 543.26(SOC code 39-9021); and 50 percent of the median wage for nursing aides, orderlies, and 543.27attendants (SOC code 31-1012);543.28(16) for personal support staff, 50 percent of the median wage for personal and home 543.29care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides, 543.30orderlies, and attendants (SOC code 31-1012); and543.31(17) for supervisory staff, the basic wage is $17.43 per hour with exception of the 543.32supervisor of behavior analyst and behavior specialists, which shall be $30.75 per hour.543.33(b) Component values for residential support services, excluding family foster 543.34care, are:543.35(1) supervisory span of control ratio: 11 percent;543.36(2) employee vacation, sick, and training allowance ratio: 8.71 percent;544.1(3) employee-related cost ratio: 23.6 percent;544.2(4) general administrative support ratio: 13.25 percent;544.3(5) program-related expense ratio: 1.3 percent; and544.4(6) absence and utilization factor ratio: 3.9 percent.544.5(c) Component values for family foster care are:544.6(1) supervisory span of control ratio: 11 percent;544.7(2) employee vacation, sick, and training allowance ratio: 8.71 percent;544.8(3) employee-related cost ratio: 23.6 percent;544.9(4) general administrative support ratio: 3.3 percent; and544.10(5) program-related expense ratio: 1.3 percent.544.11(d) Component values for day services for all services are:544.12(1) supervisory span of control ratio: 11 percent;544.13(2) employee vacation, sick, and training allowance ratio: 8.71 percent;544.14(3) employee-related cost ratio: 23.6 percent;544.15(4) program plan support ratio: 5.6 percent;544.16(5) client programming and support ratio: ten percent;544.17(6) general administrative support ratio: 13.25 percent;544.18(7) program-related expense ratio: 1.8 percent; and544.19(8) absence and utilization factor ratio: 3.9 percent.544.20(e) Component values for unit-based with program services are:544.21(1) supervisory span of control ratio: 11 percent;544.22(2) employee vacation, sick, and training allowance ratio: 8.71 percent;544.23(3) employee-related cost ratio: 23.6 percent; 544.24(4) program plan supports ratio: 3.1 percent;544.25(5) client programming and supports ratio: 8.6 percent;544.26(6) general administrative support ratio: 13.25 percent;544.27(7) program-related expense ratio: 6.1 percent; and544.28(8) absence and utilization factor ratio: 3.9 percent.544.29(f) Component values for unit-based services without programming except respite 544.30are:544.31(1) supervisory span of control ratio: 11 percent;544.32(2) employee vacation, sick, and training allowance ratio: 8.71 percent;544.33(3) employee-related cost ratio: 23.6 percent;544.34(4) program plan support ratio: 3.1 percent;544.35(5) client programming and support ratio: 8.6 percent;544.36(6) general administrative support ratio: 13.25 percent;545.1(7) program-related expense ratio: 6.1 percent; and545.2(8) absence and utilization factor ratio: 3.9 percent.545.3(g) Component values for unit-based services without programming for respite are:545.4(1) supervisory span of control ratio: 11 percent;545.5(2) employee vacation, sick, and training allowance ratio: 8.71 percent;545.6(3) employee-related cost ratio: 23.6 percent;545.7(4) general administrative support ratio: 13.25 percent;545.8(5) program-related expense ratio: 6.1 percent; and545.9(6) absence and utilization factor ratio: 3.9 percent.545.10(h) On July 1, 2017, the commissioner shall update the base wage index in paragraph 545.11(b) based on the wage data by standard occupational code (SOC) from the Bureau of 545.12Labor Statistics available on December 31, 2016. The commissioner shall publish these 545.13updated values and load them into the rate management system. This adjustment occurs 545.14every five years. For adjustments in 2021 and beyond, the commissioner shall use the data 545.15available on December 31 of the calendar year five years prior.545.16(i) On July 1, 2017, the commissioner shall update the framework components in 545.17paragraph (c) for changes in the Consumer Price Index. The commissioner will adjust 545.18these values higher or lower by the percentage change in the Consumer Price Index-All 545.19Items, United States city average (CPI-U) from January 1, 2014, to January 1, 2017. The 545.20commissioner shall publish these updated values and load them into the rate management 545.21system. This adjustment occurs every five years. For adjustments in 2021 and beyond, the 545.22commissioner shall use the data available on January 1 of the calendar year four years 545.23prior and January 1 of the current calendar year.545.24    Subd. 6.Payments for residential support services.(a) Payments for residential 545.25support services, as defined in sections 256B.092, subdivision 11, and 256B.49, 545.26subdivision 22, must be calculated as follows:545.27(1) determine the number of units of service to meet a recipient's needs;545.28(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics 545.29national and Minnesota-specific rates or rates derived by the commissioner as provided 545.30in subdivision 5.  This is defined as the direct-care rate;545.31(3) for a recipient requiring customization for deaf and hard-of-hearing language 545.32accessibility under subdivision 12, add the customization rate provided in subdivision 12 545.33to the result of clause (2). This is defined as the customized direct-care rate;545.34(4) multiply the number of residential services direct staff hours by the appropriate 545.35staff wage in subdivision 5, paragraph (a), or the customized direct-care rate;546.1(5) multiply the number of direct staff hours by the product of the supervision span 546.2of control ratio in subdivision 5, paragraph (b), clause (1), and the appropriate supervision 546.3wage in subdivision 5, paragraph (a), clause (17);546.4(6) combine the results of clauses (4) and (5), and multiply the result by one plus 546.5the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b), 546.6clause (2). This is defined as the direct staffing cost;546.7(7) for employee-related expenses, multiply the direct staffing cost by one plus the 546.8employee-related cost ratio in subdivision 5, paragraph (b), clause (3);546.9(8) for client programming and supports, the commissioner shall add $2,179; and546.10(9) for transportation, if provided, the commissioner shall add $1,680, or $3,000 if 546.11customized for adapted transport, per year.546.12(b) The total rate shall be calculated using the following steps:546.13(1) subtotal paragraph (a), clauses (7) to (9);546.14(2) sum the standard general and administrative rate, the program-related expense 546.15ratio, and the absence and utilization ratio; and546.16(3) divide the result of clause (1) by one minus the result of clause (2). This is 546.17the total payment amount.546.18    Subd. 7.Payments for day programs.Payments for services with day programs 546.19including adult day care, day treatment and habilitation, prevocational services, and 546.20structured day services must be calculated as follows:546.21(1) determine the number of units of service to meet a recipient's needs;546.22(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics 546.23Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5;546.24(3) for a recipient requiring customization for deaf and hard-of-hearing language 546.25accessibility under subdivision 12, add the customization rate provided in subdivision 12 546.26to the result of clause (2). This is defined as the customized direct-care rate;546.27(4) multiply the number of day program direct staff hours by the appropriate staff 546.28wage in subdivision 5, paragraph (a), or the customized direct-care rate;546.29(5) multiply the number of day direct staff hours by the product of the supervision 546.30span of control ratio in subdivision 5, paragraph (d), clause (1), and the appropriate 546.31supervision wage in subdivision 5, paragraph (a), clause (17);546.32(6) combine the results of clauses (4) and (5), and multiply the result by one plus 546.33the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (d), 546.34clause (2). This is defined as the direct staffing rate;546.35(7) for program plan support, multiply the result of clause (6) by one plus the 546.36program plan support ratio in subdivision 5, paragraph (d), clause (4);547.1(8) for employee-related expenses, multiply the result of clause (7) by one plus the 547.2employee-related cost ratio in subdivision 5, paragraph (d), clause (3);547.3(9) for client programming and supports, multiply the result of clause (8) by one plus 547.4the client programming and support ratio in subdivision 5, paragraph (d), clause (5);547.5(10) for program facility costs, add $8.30 per week with consideration of staffing 547.6ratios to meet individual needs;547.7(11) for adult day bath services, add $7.01 per 15 minute unit;547.8(12) this is the subtotal rate;547.9(13) sum the standard general and administrative rate, the program-related expense 547.10ratio, and the absence and utilization factor ratio;547.11(14) divide the result of clause (12) by one minus the result of clause (13). This is 547.12the total payment amount;547.13(15) for transportation provided as part of day training and habilitation for an 547.14individual who does not require a lift, add:547.15(i) $10.50 for a trip between zero and ten miles for a nonshared ride in a vehicle 547.16without a lift, $8.83 for a shared ride in a vehicle without a lift, and $9.25 for a shared 547.17ride in a vehicle with a lift;547.18(ii) $15.75 for a trip between 11 and 20 miles for a nonshared ride in a vehicle 547.19without a lift, $10.58 for a shared ride in a vehicle without a lift, and $11.88 for a shared 547.20ride in a vehicle with a lift;547.21(iii) $25.75 for a trip between 21 and 50 miles for a nonshared ride in a vehicle 547.22without a lift, $13.92 for a shared ride in a vehicle without a lift, and $16.88 for a shared 547.23ride in a vehicle with a lift; or547.24(iv) $33.50 for a trip of 51 miles or more for a nonshared ride in a vehicle without a 547.25lift, $16.50 for a shared ride in a vehicle without a lift. and $20.75 for a shared ride in a 547.26vehicle with a lift;547.27(16) for transportation provide as part of day training and habilitation for an 547.28individual who does require a lift, add:547.29(i) $19.05 for a trip between zero and ten miles for a nonshared ride in a vehicle with 547.30a lift, and $15.05 for a shared ride in a vehicle with a lift;547.31(ii) $32.16 for a trip between 11 and 20 miles for a nonshared ride in a vehicle with a 547.32lift, and $28.16 for a shared ride in a vehicle with a lift;547.33(iii) $58.76 for a trip between 21 and 50 miles for a nonshared ride in a vehicle with 547.34a lift, and $58.76 for a shared ride in a vehicle with a lift; or547.35(iv) $80.93 for a trip of 51 miles or more for a nonshared ride in a vehicle with a 547.36lift, and $80.93 for a shared ride in a vehicle with a lift.548.1    Subd. 8.Payments for unit-based services with programming.Payments for 548.2unit-based with program services, including behavior programming, housing access 548.3coordination, in-home family support, independent living skills training, hourly supported 548.4living services, and supported employment provided to an individual outside of any day or 548.5residential service plan must be calculated as follows, unless the services are authorized 548.6separately under subdivision 6 or 7:548.7(1) determine the number of units of service to meet a recipient's needs;548.8(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics 548.9Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5;548.10(3) for a recipient requiring customization for deaf and hard-of-hearing language 548.11accessibility under subdivision 12, add the customization rate provided in subdivision 12 548.12to the result of clause (2). This is defined as the customized direct-care rate;548.13(4) multiply the number of direct staff hours by the appropriate staff wage in 548.14subdivision 5, paragraph (a), or the customized direct care rate;548.15(5) multiply the number of direct staff hours by the product of the supervision span 548.16of control ratio in subdivision 5, paragraph (e), clause (1), and the appropriate supervision 548.17wage in subdivision 5, paragraph (a), clause (17);548.18(6) combine the results of clauses (4) and (5), and multiply the result by one plus 548.19the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (e), 548.20clause (2). This is defined as the direct staffing rate;548.21(7) for program plan support, multiply the result of clause (6) by one plus the 548.22program plan supports ratio in subdivision 5, paragraph (e), clause (4);548.23(8) for employee-related expenses, multiply the result of clause (7) by one plus the 548.24employee-related cost ratio in subdivision 5, paragraph (e), clause (3);548.25(9) for client programming and supports, multiply the result of clause (8) by one plus 548.26the client programming and supports ratio in subdivision 5, paragraph (e), clause (5);548.27(10) this is the subtotal rate;548.28(11) sum the standard general and administrative rate, the program-related expense 548.29ratio, and the absence and utilization factor ratio; and548.30(12) divide the result of clause (10) by one minus the result of clause (11). This is 548.31the total payment amount.548.32    Subd. 9.Payments for unit-based services without programming.Payments 548.33for unit-based without program services, including night supervision, personal support, 548.34respite, and companion care provided to an individual outside of any day or residential 548.35service plan must be calculated as follows unless the services are authorized separately 548.36under subdivision 6 or 7:549.1(1) for all services except respite, determine the number of units of service to meet 549.2a recipient's needs;549.3(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics 549.4Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;549.5(3) for a recipient requiring customization for deaf and hard-of-hearing language 549.6accessibility under subdivision 12, add the customization rate provided in subdivision 12 549.7to the result of clause (2). This is defined as the customized direct care rate;549.8(4) multiply the number of direct staff hours by the appropriate staff wage in 549.9subdivision 5 or the customized direct care rate;549.10(5) multiply the number of direct staff hours by the product of the supervision span 549.11of control ratio in subdivision 5, paragraph (f), clause (1), and the appropriate supervision 549.12wage in subdivision 5, paragraph (a), clause (17);549.13(6) combine the results of clauses (4) and (5), and multiply the result by one plus 549.14the employee vacation, sick, and training allowance ratio in, subdivision 5, paragraph (f), 549.15clause (2). This is defined as the direct staffing rate;549.16(7) for program plan support, multiply the result of clause (6) by one plus the 549.17program plan support ratio in subdivision 5, paragraph (f), clause (4);549.18(8) for employee-related expenses, multiply the result of clause (7) by one plus the 549.19employee-related cost ratio in subdivision 5, paragraph (f), clause (3);549.20(9) for client programming and supports, multiply the result of clause (8) by one plus 549.21the client programming and support ratio in subdivision 5, paragraph (f), clause (5);549.22(10) this is the subtotal rate;549.23(11) sum the standard general and administrative rate, the program-related expense 549.24ratio, and the absence and utilization factor ratio;549.25(12) divide the result of clause (10) by one minus the result of clause (11). This is 549.26the total payment amount;549.27(13) for respite services, determine the number of daily units of service to meet an 549.28individual's needs;549.29(14) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics 549.30Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;549.31(15) for a recipient requiring deaf and hard-of-hearing customization under 549.32subdivision 12, add the customization rate provided in subdivision 12 to the result of 549.33clause (14). This is defined as the customized direct care rate;549.34(16) multiply the number of direct staff hours by the appropriate staff wage in 549.35subdivision 5, paragraph (a);550.1(17) multiply the number of direct staff hours by the product of the supervisory span 550.2of control ratio in subdivision 5, paragraph (g), clause (1), and the appropriate supervision 550.3wage in subdivision 5, paragraph (a), clause (17);550.4(18) combine the results of clauses (16) and (17), and multiply the result by one plus 550.5the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (g), 550.6clause (2). This is defined as the direct staffing rate;550.7(19) for employee-related expenses, multiply the result of clause (18) by one plus 550.8the employee-related cost ratio in subdivision 5, paragraph (g), clause (3).550.9(20) this is the subtotal rate;550.10(21) sum the standard general and administrative rate, the program-related expense 550.11ratio, and the absence and utilization factor ratio; and550.12(22) divide the result of clause (20) by one minus the result of clause (21). This is 550.13the total payment amount.550.14    Subd. 10.Updating payment values and additional information.(a) The 550.15commissioner shall develop and implement uniform procedures to refine terms and update 550.16or adjust values used to calculate payment rates in this section. For calendar year 2014, 550.17the commissioner shall use the values, terms, and procedures provided in this section.550.18(b) The commissioner shall work with stakeholders to assess efficacy of values 550.19and payment rates. The commissioner shall report back to the legislature with proposed 550.20changes for component values and recommendations for revisions on the schedule 550.21provided in paragraphs (c) and (d).550.22(c) The commissioner shall work with stakeholders to continue refining a 550.23subset of component values, which are to be referred to as interim values, and report 550.24recommendations to the legislature by February 15, 2014. Interim component values are: 550.25transportation rates for day training and habilitation; transportation for adult day, structured 550.26day, and prevocational services; geographic difference factor; day program facility rate; 550.27services where monitoring technology replaces staff time; shared services for independent 550.28living skills training; and supported employment and billing for indirect services.550.29(d) The commissioner shall report and make recommendations to the legislature on: 550.30February 15, 2015; February 15, 2017; February 15, 2019; and February 15, 2021. After 550.312021 reports shall be provided on a four-year cycle.550.32(e) The commissioner shall provide a public notice via LISTSERV in October of 550.33each year beginning October 1, 2014. The notice shall contain information detailing 550.34legislatively approved changes in: calculation values, including derived wage rates 550.35and related employee and administrative factors; services utilization; county and tribal 550.36allocation changes; and information on adjustments to be made to calculation values 551.1and timing of those adjustments. Information in this notice shall be effective January 551.21 of the following year.551.3    Subd. 11.Payment implementation.Upon implementation of the payment 551.4methodologies under this section, those payment rates supersede rates established in county 551.5contracts for recipients receiving waiver services under section 256B.092 or 256B.49.551.6    Subd. 12.Customization of rates for individuals. (a) For persons determined to 551.7have higher needs based on being deaf or hard-of-hearing, the direct-care costs must be 551.8increased by an adjustment factor prior to calculating the rate under subdivisions 6, 7, 8, 551.9and 9. The customization rate with respect to deaf or hard-of-hearing persons shall be 551.10$2.50 per hour for waiver recipients who meet the respective criteria as determined by 551.11the commissioner.  551.12(b) For the purposes of this section, "deaf or hard-of-hearing" means:551.13(1) the person has a developmental disability and an assessment score which 551.14indicates a hearing impairment that is severe or that the person has no useful hearing;551.15(2) the person has a developmental disability and an expressive communications 551.16score that indicates the person uses single signs or gestures, uses an augmentative 551.17communication aid, or does not have functional communication, or the person's expressive 551.18communications is unknown; and551.19(3) the person has a developmental disability and a communication score which 551.20indicates the person comprehends signs, gestures and modeling prompts or does not 551.21comprehend verbal, visual or gestural communication or that the person's receptive 551.22communication score is unknown; or551.23(4) the person receives long-term care services and has an assessment score that 551.24indicates they hear only very loud sounds, have no useful hearing, or a determination 551.25cannot be made; and the person receives long-term care services and has an assessment 551.26that indicates the person communicates needs with sign language, symbol board, written 551.27messages, gestures or an interpreter; communicates with inappropriate content, makes 551.28garbled sounds or displays echolalia, or does not communicate needs.551.29    Subd. 13.Transportation.The commissioner shall require that the purchase 551.30of transportation services be cost-effective and be limited to market rates where the 551.31transportation mode is generally available and accessible.551.32    Subd. 14.Exceptions.(a) In a format prescribed by the commissioner, lead 551.33agencies must identify individuals with exceptional needs that cannot be met under the 551.34disability waiver rate system. The commissioner shall use that information to evaluate 551.35and, if necessary, approve an alternative payment rate for those individuals.551.36(b) Lead agencies must submit exceptions requests to the state.552.1(c) An application for a rate exception may be submitted for the following criteria:552.2(1) an individual has service needs that cannot be met through additional units 552.3of service; or552.4(2) an individual's rate determined under subdivisions 6, 7, 8, and 9 results in an 552.5individual being discharged.552.6(d) Exception requests will include the following information:552.7(1) the service needs required by each individual that are not accounted for in 552.8subdivisions 6, 7, 8, and 9;552.9(2) the service rate requested and the difference from the rate determined in 552.10subdivisions 6, 7, 8, and 9;552.11(3) a basis for the underlying costs used for the rate exception and any accompanying 552.12documentation;552.13(4) the duration of the rate exception; and552.14(5) any contingencies for approval.552.15(e) Approved rate exceptions shall be managed within lead agency allocations under 552.16sections 256B.092 and 256B.49.552.17(f) Individual disability waiver recipients may request that a lead agency submit an 552.18exceptions request. A lead agency that denies such a request shall notify the individual 552.19waiver recipient of its decision and the reasons for denying the request in writing no later 552.20than 30 days after the individual's request has been made.552.21(g) The commissioner shall determine whether to approve or deny an exception 552.22request no more than 30 days after receiving the request. If the commissioner denies the 552.23request, the commissioner shall notify the lead agency and the individual disability waiver 552.24recipient in writing of the reasons for the denial.552.25(h) The individual disability waiver recipient may appeal any denial of an exception 552.26request by either the lead agency or the commissioner, pursuant to sections 256.045 and 552.27256.0451. When the denial of an exception request results in the proposed demission of a 552.28waiver recipient from a residential or day habilitation program, the commissioner shall 552.29issue a temporary stay of demission, when requested by the disability waiver recipient, 552.30consistent with the provisions of section 256.045, subdivisions 4a and 6, paragraph (c). 552.31The temporary stay shall remain in effect until the lead agency can provide an informed 552.32choice of appropriate, alternative services to the disability waiver.552.33(i) Providers may petition lead agencies to update values that were entered 552.34incorrectly or erroneously into the rate management system, based on past service level 552.35discussions and determination in subdivision 4, without applying for a rate exception.553.1    Subd. 15.County or tribal allocations.(a) Upon implementation of the disability 553.2waiver rates management system on January 1, 2014, the commissioner shall establish 553.3a method of tracking and reporting the fiscal impact of the disability waiver rates 553.4management system on individual lead agencies.553.5(b) Beginning January 1, 2014, and continuing through full implementation on 553.6December 31, 2017, the commissioner shall make annual adjustments to lead agencies' 553.7home and community-based waivered service budget allocations to adjust for rate 553.8differences and the resulting impact on county allocations upon implementation of the 553.9disability waiver rates system.553.10    Subd. 16.Budget neutrality adjustment.The commissioner shall calculate the 553.11total spending for all home and community-based waiver services under the payments as 553.12defined in subdivisions 6, 7, 8, and 9 for all recipients as of July 1, 2013, and compare it to 553.13spending for services defined for subdivisions 6, 7, 8, and 9 under current law. If spending 553.14for services in one particular subdivision differs, there will be a percentage adjustment 553.15to increase or decrease individual rates for the services defined in each subdivision so 553.16aggregate spending matches projections under current law.553.17    Subd. 17.Implementation.(a) On January 1, 2014, the commissioner shall fully 553.18implement the calculation of rates for waivered services under sections 256B.092 and 553.19256B.49 without additional legislative approval.553.20(b) The commissioner shall phase in the application of rates determined in 553.21subdivisions 6 to 9 for two years.553.22(c) The commissioner shall preserve rates in effect on December 31, 2013, for 553.23the two-year period.553.24(d) The commissioner shall calculate and measure the difference in cost per 553.25individual using the historical rate and the rates under subdivisions 6 to 9 for all existing 553.26individuals. This measurement shall occur statewide, and for individuals in every county. 553.27The commissioner shall provide the results of this analysis by county for calendar year 553.282014 to the legislative committees and divisions with jurisdiction over health and human 553.29services finance by February 15, 2015.553.30(e) The commissioner shall calculate the average rate per unit for each service by 553.31county. For individuals enrolled after January 1, 2014, individuals will receive the higher 553.32of the rate produced under subdivisions 6 to 9, or the by-county average rate.553.33(f) On January 1, 2016, the rates determined in subdivisions 6 to 9 shall be applied.553.34    Sec. 7.  REPEALER.553.35Minnesota Statutes 2012, section 256B.4913, subdivisions 1, 2, 3, and 4, is repealed.554.1ARTICLE 14554.2HEALTH AND HUMAN SERVICES APPROPRIATIONS

554.3Section 1. HEALTH AND HUMAN SERVICES APPROPRIATIONS.

554.4The sums shown in the columns marked "Appropriations" are appropriated to the 554.5agencies and for the purposes specified in this article. The appropriations are from the 554.6general fund, or another named fund, and are available for the fiscal years indicated 554.7for each purpose. The figures "2014" and "2015" used in this article mean that the 554.8appropriations listed under them are available for the fiscal year ending June 30, 2014, or 554.9June 30, 2015, respectively. "The first year" is fiscal year 2014. "The second year" is fiscal 554.10year 2015. "The biennium" is fiscal years 2014 and 2015.

554.11APPROPRIATIONS554.12Available for the Year554.13Ending June 30554.1420142015

554.15554.16Sec. 2. COMMISSIONER OF HUMAN SERVICES

554.17Subdivision 1.Total Appropriation$ 6,411,182,000$ 6,392,303,000

554.18Appropriations by Fund554.1920142015554.20General 5,807,515,000 5,831,770,000554.21554.22State Government Special Revenue3,815,0004,915,000554.23Health Care Access 340,047,000 298,915,000554.24Federal TANF257,915,000254,813,000554.25Lottery Prize Fund1,890,0001,890,000

554.26Receipts for Systems Projects. 554.27Appropriations and federal receipts for 554.28information systems projects for MAXIS, 554.29PRISM, MMIS, and SSIS must be deposited 554.30in the state system account authorized 554.31in Minnesota Statutes, section 256.014. 554.32Money appropriated for computer projects 554.33approved by the commissioner of Minnesota 554.34information technology services, funded 554.35by the legislature, and approved by the 554.36commissioner of management and budget, 555.1may be transferred from one project to 555.2another and from development to operations 555.3as the commissioner of human services 555.4considers necessary. Any unexpended 555.5balance in the appropriation for these 555.6projects does not cancel but is available for 555.7ongoing development and operations.555.8Nonfederal Share Transfers. The 555.9nonfederal share of activities for which 555.10federal administrative reimbursement is 555.11appropriated to the commissioner may be 555.12transferred to the special revenue fund.555.13ARRA Supplemental Nutrition Assistance 555.14Benefit Increases. The funds provided for 555.15food support benefit increases under the 555.16Supplemental Nutrition Assistance Program 555.17provisions of the American Recovery and 555.18Reinvestment Act (ARRA) of 2009 must be 555.19used for benefit increases beginning July 1, 555.202009.555.21Supplemental Nutrition Assistance 555.22Program Employment and Training. 555.23(1) Notwithstanding Minnesota Statutes, 555.24sections 256D.051, subdivisions 1a, 6b, 555.25and 6c, and 256J.626, federal Supplemental 555.26Nutrition Assistance employment and 555.27training funds received as reimbursement of 555.28MFIP consolidated fund grant expenditures 555.29for diversionary work program participants 555.30and child care assistance program 555.31expenditures must be deposited in the general 555.32fund. The amount of funds must be limited to 555.33$4,900,000 per year in fiscal years 2014 and 555.342015, and to $4,400,000 per year in fiscal 556.1years 2016 and 2017, contingent on approval 556.2by the federal Food and Nutrition Service.556.3(2) Consistent with the receipt of the federal 556.4funds, the commissioner may adjust the 556.5level of working family credit expenditures 556.6claimed as TANF maintenance of effort. 556.7Notwithstanding any contrary provision in 556.8this article, this rider expires June 30, 2017.556.9TANF Maintenance of Effort. (a) In order 556.10to meet the basic maintenance of effort 556.11(MOE) requirements of the TANF block grant 556.12specified under Code of Federal Regulations, 556.13title 45, section 263.1, the commissioner may 556.14only report nonfederal money expended for 556.15allowable activities listed in the following 556.16clauses as TANF/MOE expenditures:556.17(1) MFIP cash, diversionary work program, 556.18and food assistance benefits under Minnesota 556.19Statutes, chapter 256J;556.20(2) the child care assistance programs 556.21under Minnesota Statutes, sections 119B.03 556.22and 119B.05, and county child care 556.23administrative costs under Minnesota 556.24Statutes, section 119B.15;556.25(3) state and county MFIP administrative 556.26costs under Minnesota Statutes, chapters 556.27256J and 256K;556.28(4) state, county, and tribal MFIP 556.29employment services under Minnesota 556.30Statutes, chapters 256J and 256K;556.31(5) expenditures made on behalf of legal 556.32noncitizen MFIP recipients who qualify for 556.33the MinnesotaCare program under Minnesota 556.34Statutes, chapter 256L;557.1(6) qualifying working family credit 557.2expenditures under Minnesota Statutes, 557.3section 290.0671;557.4(7) qualifying Minnesota education credit 557.5expenditures under Minnesota Statutes, 557.6section 290.0674; and557.7(8) qualifying Head Start expenditures under 557.8Minnesota Statutes, section 119A.50.557.9(b) The commissioner shall ensure that 557.10sufficient qualified nonfederal expenditures 557.11are made each year to meet the state's 557.12TANF/MOE requirements. For the activities 557.13listed in paragraph (a), clauses (2) to 557.14(8), the commissioner may only report 557.15expenditures that are excluded from the 557.16definition of assistance under Code of 557.17Federal Regulations, title 45, section 260.31.557.18(c) For fiscal years beginning with state fiscal 557.19year 2003, the commissioner shall ensure 557.20that the maintenance of effort used by the 557.21commissioner of management and budget 557.22for the February and November forecasts 557.23required under Minnesota Statutes, section 557.2416A.103, contains expenditures under 557.25paragraph (a), clause (1), equal to at least 16 557.26percent of the total required under Code of 557.27Federal Regulations, title 45, section 263.1.557.28(d) The requirement in Minnesota Statutes, 557.29section 256.011, subdivision 3, that federal 557.30grants or aids secured or obtained under that 557.31subdivision be used to reduce any direct 557.32appropriations provided by law, do not apply 557.33if the grants or aids are federal TANF funds.557.34(e) For the federal fiscal years beginning on 557.35or after October 1, 2007, the commissioner 558.1may not claim an amount of TANF/MOE in 558.2excess of the 75 percent standard in Code 558.3of Federal Regulations, title 45, section 558.4263.1(a)(2), except:558.5(1) to the extent necessary to meet the 80 558.6percent standard under Code of Federal 558.7Regulations, title 45, section 263.1(a)(1), 558.8if it is determined by the commissioner 558.9that the state will not meet the TANF work 558.10participation target rate for the current year;558.11(2) to provide any additional amounts 558.12under Code of Federal Regulations, title 45, 558.13section 264.5, that relate to replacement of 558.14TANF funds due to the operation of TANF 558.15penalties; and558.16(3) to provide any additional amounts that 558.17may contribute to avoiding or reducing 558.18TANF work participation penalties through 558.19the operation of the excess MOE provisions 558.20of Code of Federal Regulations, title 45, 558.21section 261.43(a)(2).558.22For the purposes of clauses (1) to (3), 558.23the commissioner may supplement the 558.24MOE claim with working family credit 558.25expenditures or other qualified expenditures 558.26to the extent such expenditures are otherwise 558.27available after considering the expenditures 558.28allowed in this subdivision and subdivisions 558.292 and 3.558.30(f) Notwithstanding any contrary provision 558.31in this article, paragraphs (a) to (e) expire 558.32June 30, 2017.558.33Working Family Credit Expenditures 558.34as TANF/MOE. The commissioner may 558.35claim as TANF maintenance of effort up to 559.1$6,707,000 per year of working family credit 559.2expenditures in each fiscal year.

559.3559.4Subd. 2.Working Family Credit to be Claimed for TANF/MOE

559.5The commissioner may count the following 559.6amounts of working family credit 559.7expenditures as TANF/MOE:559.8(1) fiscal year 2014, $45,196,000;559.9(2) fiscal year 2015, $41,885,000;559.10(3) fiscal year 2016, $8,869,000; and559.11(4) fiscal year 2017, $11,181,000.

559.12559.13Subd. 3.TANF Transfer to Federal Child Care and Development Fund

559.14(a) The following TANF fund amounts 559.15are appropriated to the commissioner for 559.16purposes of MFIP/transition year child care 559.17assistance under Minnesota Statutes, section 559.18119B.05:559.19(1) fiscal year 2014; $14,020,000; and559.20(2) fiscal year 2015, $14,020,000.559.21(b) The commissioner shall authorize the 559.22transfer of sufficient TANF funds to the 559.23federal child care and development fund to 559.24meet this appropriation and shall ensure that 559.25all transferred funds are expended according 559.26to federal child care and development fund 559.27regulations.

559.28Subd. 4.Central Office

559.29The amounts that may be spent from this 559.30appropriation for each purpose are as follows:

559.31(a) Operations

559.32Appropriations by Fund559.33General88,876,00091,189,000560.1560.2State Government Special Revenue3,690,0004,790,000560.3Health Care Access 13,177,00013,004,000560.4Federal TANF100,000100,000

560.5DHS Receipt Center Accounting. The 560.6commissioner is authorized to transfer 560.7appropriations to, and account for DHS 560.8receipt center operations in, the special 560.9revenue fund.560.10Administrative Recovery; Set-Aside. The 560.11commissioner may invoice local entities 560.12through the SWIFT accounting system as an 560.13alternative means to recover the actual cost 560.14of administering the following provisions:560.15(1) Minnesota Statutes, section 125A.744, 560.16subdivision 3;560.17(2) Minnesota Statutes, section 245.495, 560.18paragraph (b);560.19(3) Minnesota Statutes, section 256B.0625, 560.20subdivision 20, paragraph (k);560.21(4) Minnesota Statutes, section 256B.0924, 560.22subdivision 6, paragraph (g);560.23(5) Minnesota Statutes, section 256B.0945, 560.24subdivision 4, paragraph (d); and560.25(6) Minnesota Statutes, section 256F.10, 560.26subdivision 6, paragraph (b).560.27Systems Modernization. The following 560.28amounts are appropriated for transfer to 560.29the state systems account authorized in 560.30Minnesota Statutes, section 256.014:560.31(1) $1,825,000 in fiscal year 2014 and 560.32$2,502,000 in fiscal year 2015 is for the 560.33state share of Medicaid-allocated costs of 560.34the health insurance exchange information 561.1technology and operational structure. The 561.2funding base is $3,222,000 in fiscal year 2016 561.3and $3,037,000 in fiscal year 2017 but shall 561.4not be included in the base thereafter; and561.5(2) $1,000,000 in fiscal year 2014 and 561.6$2,000,000 in fiscal year 2015 are for the 561.7modernization and streamlining of agency 561.8eligibility and child support systems. The 561.9funding base is $2,000,000 in fiscal year 561.102016 and $2,000,000 in fiscal year 2017 but 561.11shall not be included in the base thereafter.561.12The unexpended balance of the $1,000,000 561.13appropriation in fiscal year 2014 and the 561.14$2,000,000 appropriation in fiscal year 2015 561.15must be transferred from the Department of 561.16Human Services state systems account to 561.17the Office of Enterprise Technology when 561.18the Office of Enterprise Technology has 561.19negotiated a federally approved internal 561.20service fund rates and billing process with 561.21sufficient internal accounting controls to 561.22properly maximize federal reimbursement 561.23to Minnesota for human services system 561.24modernization projects, but not later than 561.25June 30, 2015.561.26If contingent funding is fully or partially 561.27disbursed under article 15, section 3, and 561.28transferred to the state systems account, the 561.29unexpended balance of that appropriation 561.30must be transferred to the Office of Enterprise 561.31Technology in accordance with this clause. 561.32Contingent funding must not exceed 561.33$15,463,000 for the biennium.561.34Base Adjustment. The general fund base 561.35is increased by $646,000 in fiscal year 2016 562.1and $461,000 in fiscal year 2017. The health 562.2access fund base is decreased by $551,000 in 562.3fiscal years 2016 and 2017.

562.4(b) Children and Families

562.5Appropriations by Fund562.6General7,569,0007,519,000562.7Federal TANF2,282,0002,282,000

562.8Financial Institution Data Match and 562.9Payment of Fees. The commissioner is 562.10authorized to allocate up to $310,000 each 562.11year in fiscal years 2014 and 2015 from the 562.12PRISM special revenue account to make 562.13payments to financial institutions in exchange 562.14for performing data matches between account 562.15information held by financial institutions 562.16and the public authority's database of child 562.17support obligors as authorized by Minnesota 562.18Statutes, section 13B.06, subdivision 7.

562.19(c) Health Care

562.20Appropriations by Fund562.21General 13,643,000 13,227,000562.22Health Care Access24,602,00026,728,000

562.23Base Adjustment.  The general fund base 562.24is decreased by $86,000 in fiscal year 2016 562.25and by $86,000 in fiscal year 2017. The 562.26health care access fund base is increased 562.27by $7,956,000 in fiscal year 2016 and by 562.28$6,354,000 in fiscal year 2017.

562.29(d) Continuing Care

562.30Appropriations by Fund562.31General17,361,00017,426,000562.32562.33State Government Special Revenue125,000125,000

563.1Base Adjustment. The general fund base is 563.2decreased by $1,000 in fiscal year 2016 and 563.3by $1,000 in fiscal year 2017.

563.4(e) Chemical and Mental Health

563.5Appropriations by Fund563.6General4,313,0004,179,000563.7Lottery Prize Fund157,000157,000

563.8Subd. 5.Forecasted Programs

563.9The amounts that may be spent from this 563.10appropriation for each purpose are as follows:

563.11(a) MFIP/DWP

563.12Appropriations by Fund563.13General73,742,00079,302,000563.14Federal TANF80,342,00076,851,000

563.15(b) MFIP Child Care Assistance62,030,00064,731,000

563.16(c) General Assistance54,787,00056,068,000

563.17General Assistance Standard. The 563.18commissioner shall set the monthly standard 563.19of assistance for general assistance units 563.20consisting of an adult recipient who is 563.21childless and unmarried or living apart 563.22from parents or a legal guardian at $203. 563.23The commissioner may reduce this amount 563.24according to Laws 1997, chapter 85, article 563.253, section 54.563.26Emergency General Assistance. The 563.27amount appropriated for emergency general 563.28assistance funds is limited to no more 563.29than $6,729,812 in fiscal year 2014 and 563.30$6,729,812 in fiscal year 2015. Funds 563.31to counties shall be allocated by the 563.32commissioner using the allocation method in 563.33Minnesota Statutes, section 256D.06.

563.34(d) MN Supplemental Assistance38,646,00039,821,000

564.1(e) Group Residential Housing140,447,000149,984,000

564.2(f) MinnesotaCare 299,290,000 257,020,000

564.3This appropriation is from the health care 564.4access fund.

564.5(g) Medical Assistance 4,609,672,000 4,615,440,000

564.6Medical Eligibility for Inmates in Medical 564.7Institutions. The commissioner of human 564.8services shall execute an interagency 564.9agreement with the commissioner of 564.10corrections to recover the medical assistance 564.11cost attributable to medical assistance 564.12eligibility for inmates of public institutions 564.13admitted to hospitals on an inpatient basis. 564.14The amount that must be recovered from 564.15the Department of Corrections shall include 564.16all state medical assistance costs, including 564.17administrative costs, attributable to inmates 564.18under state and county jurisdiction admitted 564.19to hospitals on an inpatient basis.564.20Support Services for Deaf and 564.21Hard-of-Hearing. $121,000 in fiscal 564.22year 2014 and $141,000 in fiscal year 2015; 564.23and $10,000 in fiscal year 2014 and $13,000 564.24in fiscal year 2015 are from the health care 564.25access fund for the hospital reimbursement 564.26increase in Minnesota Statutes, section 564.27256.969, subdivision 29, paragraph (b).

564.28(h) Alternative Care47,058,00047,078,000

564.29Alternative Care Transfer. Any money 564.30allocated to the alternative care program that 564.31is not spent for the purposes indicated does 564.32not cancel but shall be transferred to the 564.33medical assistance account.

564.34(i) CD Treatment Fund81,440,00074,875,000

565.1Balance Transfer. The commissioner must 565.2transfer $18,188,000 from the consolidated 565.3chemical dependency treatment fund to the 565.4general fund by September 30, 2013.

565.5Subd. 6.Grant Programs

565.6The amounts that may be spent from this 565.7appropriation for each purpose are as follows:

565.8(a) Support Services Grants

565.9Appropriations by Fund565.10General11,333,00011,133,000565.11Federal TANF94,611,00094,611,000

565.12Paid Work Experience. $1,159,000 in fiscal 565.13year 2014, and $1,009,000 in fiscal year 565.142015 is from the general fund for paid work 565.15experience for long-term MFIP recipients. 565.16Paid work includes full and partial wage 565.17subsidies and other related services such as 565.18job development, marketing, preworksite 565.19training, job coaching, and postplacement 565.20services. Unexpended funds for fiscal year 565.212014 do not cancel but are available for this 565.22purpose in fiscal year 2015.565.23Work Study Funding for MFIP 565.24Participants. $250,000 each year is from 565.25the general fund to pilot work study jobs for 565.26MFIP recipients in approved postsecondary 565.27education programs. This is a onetime 565.28appropriation. Unexpended funds for fiscal 565.29year 2014 do not cancel but are available for 565.30this purpose in fiscal year 2015.565.31Base Adjustment. The general fund base is 565.32decreased by $2,418,000 in fiscal years 2016 565.33and 2017.

565.34565.35(b) Basic Sliding Fee Child Care Assistance Grants39,039,00040,391,000

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

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

566.3Federal Child Support Demonstration 566.4Grants. Federal administrative 566.5reimbursement resulting from the federal 566.6child support grant expenditures authorized 566.7under United States Code, title 42, section 566.81315, is appropriated to the commissioner 566.9for this activity.

566.10(e) Children's Services Grants

566.11Appropriations by Fund566.12General49,810,00050,260,000566.13Federal TANF140,000140,000

566.14Adoption Assistance and Relative Custody 566.15Assistance. The commissioner may transfer 566.16unencumbered appropriation balances for 566.17adoption assistance and relative custody 566.18assistance between fiscal years and between 566.19programs.566.20Title IV-E Adoption Assistance. Additional 566.21federal reimbursements to the state as a result 566.22of the Fostering Connections to Success 566.23and Increasing Adoptions Act's expanded 566.24eligibility for Title IV-E adoption assistance 566.25are appropriated for postadoption services, 566.26including a parent-to-parent support network.566.27Privatized Adoption Grants. Federal 566.28reimbursement for privatized adoption grant 566.29and foster care recruitment grant expenditures 566.30is appropriated to the commissioner for 566.31adoption grants and foster care and adoption 566.32administrative purposes.566.33Adoption Assistance Incentive Grants.566.34 Federal funds available during fiscal years 567.12014 and 2015 for adoption incentive grants 567.2are appropriated for postadoption services, 567.3including a parent-to-parent support network.567.4Base Adjustment. The general fund base is 567.5decreased by $466,000 in fiscal year 2016 567.6and by $822,000 in fiscal year 2017.

567.7(f) Child and Community Service Grants53,301,00053,301,000

567.8(g) Child and Economic Support Grants20,972,00020,973,000

567.9Minnesota Food Assistance Program. 567.10Unexpended funds for the Minnesota food 567.11assistance program for fiscal year 2014 do 567.12not cancel but are available for this purpose 567.13in fiscal year 2015.567.14Family Assets for Independence. $250,000 567.15each year is for the Family Assets for 567.16Independence Minnesota program. This 567.17appropriation is available in either year of the 567.18biennium and may be transferred between 567.19fiscal years. 567.20Food Shelf Programs. $500,000 in fiscal 567.21year 2014 and $500,000 in fiscal year 567.222015 are for food shelf programs under 567.23Minnesota Statutes, section 256E.34. If the 567.24appropriation for either year is insufficient, 567.25the appropriation for the other year is 567.26available for it.567.27Homeless Youth Act. $4,000,000 is for 567.28purposes of Minnesota Statutes, section 567.29256K.45.567.30Safe Harbor Shelter and Housing. 567.31$2,000,000 in fiscal year 2014 and 567.32$2,000,000 in fiscal year 2015 is for a safe 567.33harbor shelter and housing fund for housing 568.1and supportive services for youth who are 568.2sexually exploited. 

568.3(h) Health Care Grants

568.4Appropriations by Fund568.5General190,000190,000568.6Health Care Access 2,228,0001,413,000

568.7Emergency Medical Assistance Referral 568.8and Assistance Grants. (a) The 568.9commissioner of human services shall 568.10award grants to nonprofit programs that 568.11provide immigration legal services based 568.12on indigency to provide legal services for 568.13immigration assistance to individuals with 568.14emergency medical conditions or complex 568.15and chronic health conditions who are not 568.16currently eligible for medical assistance 568.17or other public health care programs, but 568.18who may meet eligibility requirements with 568.19immigration assistance.568.20(b) The grantees, in collaboration with 568.21hospitals and safety net providers, shall 568.22provide referral assistance to connect 568.23individuals identified in paragraph (a) with 568.24alternative resources and services to assist in 568.25meeting their health care needs. $100,000 568.26is appropriated in fiscal year 2014 and 568.27$100,000 in fiscal year 2015. This is a 568.28onetime appropriation.568.29(c) The programs receiving grants under 568.30paragraph (a) must report to the commissioner 568.31of human services the number of individuals 568.32who were provided immigration assistance 568.33under the grants and who were eventually 568.34determined to be eligible for medical 568.35assistance or another public health care 569.1program due to this assistance. The 569.2commissioner shall report this information to 569.3the chairs and ranking minority members of 569.4the legislative committees with jurisdiction 569.5over human services policy and finance by 569.6January 1, 2015.569.7Base Adjustment. The general fund is 569.8decreased by $100,000 in fiscal year 2016 569.9and $100,000 in fiscal year 2017. The health 569.10care access fund is decreased by $1,223,000 569.11in fiscal years 2016 and 2017.

569.12(i) Aging and Adult Services Grants22,043,00022,910,000

569.13Base Adjustment. The general fund is 569.14increased by $5,000 in fiscal year 2016 and 569.15$5,000 in fiscal year 2017.

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

569.17(k) Disabilities Grants17,844,00017,426,000

569.18Advocating Change Together. $310,000 in 569.19fiscal year 2014 is for a grant to Advocating 569.20Change Together (ACT) to maintain and 569.21promote services for persons with intellectual 569.22and developmental disabilities throughout 569.23the state. Of this appropriation:569.24(1) $120,000 is for direct costs associated 569.25with the delivery and evaluation of 569.26peer-to-peer training programs administered 569.27throughout the state, focusing on education, 569.28employment, housing, transportation, and 569.29voting;569.30(2) $100,000 is for delivery of statewide 569.31conferences focusing on leadership and 569.32skill development within the disability 569.33community; and570.1(3) $90,000 is for administrative and general 570.2operating costs associated with managing 570.3or maintaining facilities, program delivery, 570.4staff, and technology. This is a onetime 570.5appropriation.570.6Base Adjustment. The general fund base 570.7is increased by $448,000 in fiscal year 2016 570.8and by $470,000 in fiscal year 2017.

570.9(l) Adult Mental Health Grants

570.10Appropriations by Fund570.11General70,777,00069,108,000570.12Health Care Access750,000750,000570.13Lottery Prize1,733,0001,733,000

570.14Problem Gambling. $225,000 in fiscal year 570.152014 and $225,000 in fiscal year 2015 is 570.16appropriated from the lottery prize fund for a 570.17grant to the state affiliate recognized by the 570.18National Council on Problem Gambling. The 570.19affiliate must provide services to increase 570.20public awareness of problem gambling, 570.21education and training for individuals and 570.22organizations providing effective treatment 570.23services to problem gamblers and their 570.24families, and research relating to problem 570.25gambling. 570.26Funding Usage. Up to 75 percent of a fiscal 570.27year's appropriations for adult mental health 570.28grants may be used to fund allocations in that 570.29portion of the fiscal year ending December 570.3031.570.31Base Adjustment. The general fund base is 570.32decreased by $4,197,000 in fiscal year 2016 570.33and by $4,197,000 in fiscal year 2017.

570.34(m) Child Mental Health Grants15,233,00015,234,000

571.1Mental Health First Aid Training. $45,000 571.2for the biennium ending June 30, 2015, is 571.3to train teachers, social service personnel, 571.4law enforcement, and others who come into 571.5contact with children with mental illnesses, 571.6in children and adolescents mental health 571.7first aid training.571.8Funding Usage. Up to 75 percent of a fiscal 571.9year's appropriation for child mental health 571.10grants may be used to fund allocations in that 571.11portion of the fiscal year ending December 571.1231.

571.13(n) CD Treatment Support Grants1,996,0001,636,000

571.14SBIRT Training. $300,000 each year is 571.15for grants to train primary care clinicians to 571.16provide substance abuse brief intervention 571.17and referral to treatment (SBIRT). This is a 571.18onetime appropriation.571.19Fetal Alcohol Syndrome Grant. (a) 571.20$360,000 is appropriated in fiscal year 2014 571.21to the commissioner of human services for 571.22a grant to the Minnesota Organization on 571.23Fetal Alcohol Syndrome (MOFAS). This is a 571.24onetime appropriation.571.25(b) Grant money must be used to reduce the 571.26incidence of FASD and other prenatal drug 571.27related effects in children in Minnesota by 571.28identifying and serving pregnant women 571.29suspected of or known to use or abuse 571.30alcohol or other drugs. The grant recipient 571.31must provide intensive services to chemically 571.32dependent women in order to increase 571.33positive birth outcomes and report to the 571.34commissioner necessary data to prepare 571.35the required report to the legislature. The 572.1organization may retain two percent of the 572.2grant money for administrative costs. 572.3(c) A grant recipient must report to the 572.4commissioner of human services annually 572.5by January 15 on the services and programs 572.6funded by the appropriation. The report must 572.7include measurable outcomes, including 572.8the number of pregnant women served and 572.9toxic-free babies born in the previous year.572.10Base Adjustment. The general fund base is 572.11decreased by $300,000 in fiscal year 2016 572.12and $300,000 in fiscal year 2017.

572.13Subd. 7.State-Operated Services

572.14Transfer Authority Related to 572.15State-Operated Services. Money 572.16appropriated for state-operated services 572.17may be transferred between fiscal years 572.18of the biennium with the approval of the 572.19commissioner of management and budget.572.20The amounts that may be spent from the 572.21appropriation for each purpose are as follows:

572.22(a) SOS Mental Health115,738,000115,738,000

572.23Dedicated Receipts Available. Of the 572.24revenue received under Minnesota Statutes, 572.25section 246.18, subdivision 8, paragraph 572.26(a), $1,000,000 each year is available for 572.27the purposes of paragraph (b), clause (1), 572.28of that subdivision, $1,000,000 each year 572.29is available to transfer to the adult mental 572.30health budget activity for the purposes of 572.31paragraph (b), clause (2), of that subdivision, 572.32and up to $2,713,000 each year is available 572.33for the purposes of paragraph (b), clause (3), 572.34of that subdivision.

573.1(b) SOS MN Security Hospital69,582,00069,582,000

573.2Subd. 8.Sex Offender Program76,769,00079,745,000

573.3Transfer Authority Related to Minnesota 573.4Sex Offender Program. Money 573.5appropriated for the Minnesota sex offender 573.6program may be transferred between fiscal 573.7years of the biennium with the approval of the 573.8commissioner of management and budget.

573.9Subd. 9.Technical Activities80,440,00080,829,000

573.10This appropriation is from the federal TANF 573.11fund.573.12Base Adjustment. The federal TANF fund 573.13base is increased by $278,000 in fiscal year 573.142016 and increased by $651,000 in fiscal 573.15year 2017.

573.16Subd. 10.Transfer.

573.17Sec. 3. COMMISSIONER OF HEALTH

573.18Subdivision 1.Total Appropriation$ 158,912,000$ 155,115,000

573.19Appropriations by Fund573.2020142015573.21General 79,476,000 74,256,000573.22573.23State Government Special Revenue48,680,00050,703,000573.24Health Care Access18,743,00018,143,000573.25Federal TANF11,713,00011,713,000573.26Special Revenue300,000300,000

573.27The amounts that may be spent for each 573.28purpose are specified in the following 573.29subdivisions.

573.30Subd. 2.Health Improvement

573.31Appropriations by Fund573.32General 52,864,000 47,644,000573.33573.34State Government Special Revenue1,033,0001,033,000574.1Health Care Access9,219,0009,219,000574.2Federal TANF11,713,00011,713,000

574.3Statewide Health Improvement Program. 574.4$7,500,000 in fiscal year 2014 and 574.5$7,500,000 in fiscal year 2015 is from the 574.6health care access fund for the statewide 574.7health improvement program under 574.8Minnesota Statutes, section 145.986.574.9Of the appropriation in fiscal year 2014, 574.10$10,000 is for the commissioner of 574.11management and budget to develop and 574.12implement a return on taxpayer investment 574.13(ROTI) methodology and practice related 574.14to the state health improvement program. 574.15In developing the methodology, the 574.16commissioner shall assess ROTI initiatives 574.17in other states, design implications for 574.18Minnesota, and identify one or more 574.19Minnesota institutions of higher education 574.20capable of providing rigorous and consistent 574.21nonpartisan institutional support for ROTI. 574.22The commissioner shall consult with 574.23representatives of other state agencies, 574.24counties, legislative staff, Minnesota 574.25institutions of higher education, and other 574.26stakeholders in developing the methodology. 574.27The commissioner shall report the results to 574.28the chairs and ranking minority members of 574.29the legislative committees and divisions with 574.30jurisdiction over health and human services, 574.31taxes, and finance by March 15, 2015.574.32Statewide Cancer Surveillance System. Of 574.33the general fund appropriation, $350,000 in 574.34fiscal year 2014 and $350,000 in fiscal year 574.352015 is to develop and implement a new 575.1cancer reporting system under Minnesota 575.2Statutes, sections 144.671 to 144.69. Any 575.3information technology development or 575.4support costs necessary for the cancer 575.5surveillance system must be incorporated 575.6into the agency's service level agreement and 575.7paid to the Office of Enterprise Technology.575.8Minnesota Poison Information Center.575.9 $250,000 in fiscal year 2014 and $250,000 575.10in fiscal year 2015 from the general fund 575.11is for regional poison information centers 575.12according to Minnesota Statutes, section 575.13145.93.575.14Text Message Suicide Prevention Program.575.15 $1,500,000 for the biennium ending June 30, 575.162015, is for a grant to a nonprofit organization 575.17to establish and implement a statewide text 575.18message suicide prevention program. The 575.19program shall implement a suicide prevention 575.20counseling text line designed to use text 575.21messaging to connect with crisis counselors 575.22and to obtain emergency information and 575.23referrals to local resources in the local 575.24community. The program shall include 575.25training within schools and communities to 575.26encourage the use of the program.575.27Support Services for Deaf and 575.28Hard-of-Hearing. (a) $365,000 in fiscal 575.29year 2014 and $349,000 in fiscal year 2015 575.30are for providing support services to families 575.31as required under Minnesota Statutes, section 575.32144.966, subdivision 3a.575.33(b) $164,000 in fiscal year 2014 and $156,000 575.34in fiscal year 2015 are for home-based 575.35education in American Sign Language for 576.1families with children who are deaf or have 576.2hearing loss, as required under Minnesota 576.3Statutes, section 144.966, subdivision 3a.576.4Reproductive Health Strategic Plan to 576.5Reduce Health Disparities for Somali 576.6Women. To the extent funds are available 576.7for fiscal years 2014 and 2015 for grants 576.8provided pursuant to Minnesota Statutes, 576.9section 145.928, the commissioner 576.10shall provide a grant to a Somali-based 576.11organization located in the metropolitan area 576.12to develop a reproductive health strategic 576.13plan to eliminate reproductive health 576.14disparities for Somali women. The plan shall 576.15develop initiatives to provide educational 576.16and information resources to health care 576.17providers, community organizations, and 576.18Somali women to ensure effective interaction 576.19with Somali culture and western medicine 576.20and the delivery of appropriate health care 576.21services, and the achievement of better health 576.22outcomes for Somali women. The plan must 576.23engage health care providers, the Somali 576.24community, and Somali health-centered 576.25organizations. The commissioner shall 576.26submit a report to the chairs and ranking 576.27minority members of the senate and house 576.28committees with jurisdiction over health 576.29policy on the strategic plan developed under 576.30this grant for eliminating reproductive health 576.31disparities for Somali women. The report 576.32must be submitted by February 15, 2014.576.33TANF Appropriations. (1) $1,156,000 of 576.34the TANF funds is appropriated each year of 576.35the biennium to the commissioner for family 577.1planning grants under Minnesota Statutes, 577.2section 145.925.577.3(2) $3,579,000 of the TANF funds is 577.4appropriated each year of the biennium to 577.5the commissioner for home visiting and 577.6nutritional services listed under Minnesota 577.7Statutes, section 145.882, subdivision 7, 577.8clauses (6) and (7). Funds must be distributed 577.9to community health boards according to 577.10Minnesota Statutes, section 145A.131, 577.11subdivision 1.577.12(3) $2,000,000 of the TANF funds is 577.13appropriated each year of the biennium to 577.14the commissioner for decreasing racial and 577.15ethnic disparities in infant mortality rates 577.16under Minnesota Statutes, section 145.928, 577.17subdivision 7.577.18(4) $4,978,000 of the TANF funds is 577.19appropriated each year of the biennium to the 577.20commissioner for the family home visiting 577.21grant program according to Minnesota 577.22Statutes, section 145A.17. $4,000,000 of the 577.23funding must be distributed to community 577.24health boards according to Minnesota 577.25Statutes, section 145A.131, subdivision 1. 577.26$978,000 of the funding must be distributed 577.27to tribal governments based on Minnesota 577.28Statutes, section 145A.14, subdivision 2a.577.29(5) The commissioner may use up to 6.23 577.30percent of the funds appropriated each fiscal 577.31year to conduct the ongoing evaluations 577.32required under Minnesota Statutes, section 577.33145A.17, subdivision 7, and training and 577.34technical assistance as required under 578.1Minnesota Statutes, section 145A.17, 578.2subdivisions 4 and 5.578.3TANF Carryforward. Any unexpended 578.4balance of the TANF appropriation in the 578.5first year of the biennium does not cancel but 578.6is available for the second year.

578.7Subd. 3.Policy Quality and Compliance

578.8Appropriations by Fund578.9General9,391,0009,391,000578.10578.11State Government Special Revenue14,434,00016,454,000578.12Health Care Access9,524,0008,924,000

578.13Base Level Adjustment. The state 578.14government special revenue fund base shall 578.15be reduced by $2,000 in fiscal year 2017. The 578.16health care access base shall be increased by 578.17$600,000 in fiscal year 2016 and decreased 578.18by $600,000 in fiscal year 2017.

578.19Subd. 4.Health Protection

578.20Appropriations by Fund578.21General9,449,0009,449,000578.22578.23State Government Special Revenue33,213,00033,216,000578.24Special Revenue300,000300,000

578.25Infectious Disease Laboratory. Of the 578.26general fund appropriation, $200,000 in 578.27fiscal year 2014 and $200,000 in fiscal year 578.282015 are to monitor infectious disease trends 578.29and investigate infectious disease outbreaks.578.30Surveillance for Elevated Blood Lead 578.31Levels. Of the general fund appropriation, 578.32$100,000 in fiscal year 2014 and $100,000 578.33in fiscal year 2015 are for the blood lead 578.34surveillance system under Minnesota 578.35Statutes, section 144.9502.579.1Base Level Adjustment. The state 579.2government special revenue base is increased 579.3by $6,000 in fiscal year 2016 and by $13,000 579.4in fiscal year 2017.

579.5Subd. 5.Administrative Support Services7,772,0007,772,000

579.6Regional Support for Local Public Health 579.7Departments. $350,000 in fiscal year 579.82014 and $350,000 in fiscal year 2015 is 579.9for regional staff who provide specialized 579.10expertise to local public health departments.

579.11Sec. 4. HEALTH-RELATED BOARDS

579.12Subdivision 1.Total Appropriation$ 17,335,000$ 17,285,000

579.13This appropriation is from the state 579.14government special revenue fund.579.15The amounts that may be spent for each 579.16purpose are specified in the following 579.17subdivisions.

579.18Subd. 2.Board of Chiropractic Examiners470,000470,000

579.19Subd. 3.Board of Dentistry1,820,0001,820,000

579.20Health Professional Services Program. Of 579.21this appropriation, $704,000 in fiscal year 579.222014 and $704,000 in fiscal year 2015 from 579.23the state government special revenue fund are 579.24for the health professional services program.

579.25579.26Subd. 4.Board of Dietetic and Nutrition Practice111,000111,000

579.27579.28Subd. 5.Board of Marriage and Family Therapy168,000168,000

579.29Subd. 6.Board of Medical Practice3,867,0003,867,000

579.30Subd. 7.Board of Nursing3,637,0003,637,000

579.31579.32Subd. 8.Board of Nursing Home Administrators 1,632,000 1,582,000

580.1Administrative Services Unit - Operating 580.2Costs. Of this appropriation, $676,000 580.3in fiscal year 2014 and $626,000 in 580.4fiscal year 2015 are for operating costs 580.5of the administrative services unit. The 580.6administrative services unit may receive 580.7and expend reimbursements for services 580.8performed by other agencies.580.9Administrative Services Unit - Volunteer 580.10Health Care Provider Program. Of this 580.11appropriation, $150,000 in fiscal year 2014 580.12and $150,000 in fiscal year 2015 are to pay 580.13for medical professional liability coverage 580.14required under Minnesota Statutes, section 580.15214.40.580.16Administrative Services Unit - Contested 580.17Cases and Other Legal Proceedings. Of 580.18this appropriation, $200,000 in fiscal year 580.192014 and $200,000 in fiscal year 2015 are 580.20for costs of contested case hearings and other 580.21unanticipated costs of legal proceedings 580.22involving health-related boards funded 580.23under this section. Upon certification of a 580.24health-related board to the administrative 580.25services unit that the costs will be incurred 580.26and that there is insufficient money available 580.27to pay for the costs out of money currently 580.28available to that board, the administrative 580.29services unit is authorized to transfer money 580.30from this appropriation to the board for 580.31payment of those costs with the approval 580.32of the commissioner of management and 580.33budget.

580.34Subd. 9.Board of Optometry107,000107,000

580.35Subd. 10.Board of Pharmacy2,555,0002,555,000

581.1Prescription Electronic Reporting. Of 581.2this appropriation, $356,000 in fiscal year 581.32014 and $356,000 in fiscal year 2015 from 581.4the state government special revenue fund 581.5are to the board to operate the prescription 581.6monitoring program in Minnesota Statutes, 581.7section 152.126.

581.8Subd. 11.Board of Physical Therapy346,000346,000

581.9Subd. 12.Board of Podiatry76,00076,000

581.10Subd. 13.Board of Psychology847,000847,000

581.11Subd. 14.Board of Social Work1,054,0001,054,000

581.12Subd. 15.Board of Veterinary Medicine230,000230,000

581.13581.14Subd. 16.Board of Behavioral Health and Therapy415,000415,000

581.15581.16Sec. 5. EMERGENCY MEDICAL SERVICES REGULATORY BOARD$2,741,000$2,741,000

581.17Regional Grants. $585,000 in fiscal year 581.182014 and $585,000 in fiscal year 2015 are 581.19for regional emergency medical services 581.20programs, to be distributed equally to the 581.21eight emergency medical service regions.581.22Cooper/Sams Volunteer Ambulance 581.23Program. $700,000 in fiscal year 2014 and 581.24$700,000 in fiscal year 2015 are for the 581.25Cooper/Sams volunteer ambulance program 581.26under Minnesota Statutes, section 144E.40.581.27(a) Of this amount, $611,000 in fiscal year 581.282014 and $611,000 in fiscal year 2015 581.29are for the ambulance service personnel 581.30longevity award and incentive program under 581.31Minnesota Statutes, section 144E.40.581.32(b) Of this amount, $89,000 in fiscal year 581.332014 and $89,000 in fiscal year 2015 are 582.1for the operations of the ambulance service 582.2personnel longevity award and incentive 582.3program under Minnesota Statutes, section 582.4144E.40.582.5Ambulance Training Grant. $361,000 in 582.6fiscal year 2014 and $361,000 in fiscal year 582.72015 are for training grants.582.8EMSRB Board Operations. $1,095,000 in 582.9fiscal year 2014 and $1,095,000 in fiscal year 582.102015 are for operations.

582.11Sec. 6. COUNCIL ON DISABILITY$614,000$614,000

582.12582.13582.14Sec. 7. OMBUDSMAN FOR MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES$1,654,000$1,654,000

582.15Sec. 8. OMBUDSPERSON FOR FAMILIES$333,000$334,000

582.16    Sec. 9. Minnesota Statutes 2012, section 256.01, subdivision 34, is amended to read:582.17    Subd. 34. Federal administrative reimbursement dedicated. Federal 582.18administrative reimbursement resulting from the following activities is appropriated to the 582.19commissioner for the designated purposes:582.20(1) reimbursement for the Minnesota senior health options project; and582.21(2) reimbursement related to prior authorization and inpatient admission certification 582.22by a professional review organization. A portion of these funds must be used for activities 582.23to decrease unnecessary pharmaceutical costs in medical assistance.; and582.24(3) reimbursement resulting from the federal child support grant expenditures 582.25authorized under United States Code, title 42, section 1315.582.26    Sec. 10. Minnesota Statutes 2012, section 256.01, is amended by adding a subdivision 582.27to read:582.28    Subd. 35.Federal reimbursement for privatized adoption grants.Federal 582.29reimbursement for privatized adoption grant and foster care recruitment grant expenditures 582.30is appropriated to the commissioner for adoption grants and foster care and adoption 582.31administrative purposes.583.1    Sec. 11. Minnesota Statutes 2012, section 256.01, is amended by adding a subdivision 583.2to read:583.3    Subd. 36.DHS receipt center accounting.The commissioner may transfer 583.4appropriations to, and account for DHS receipt center operations in, the special revenue 583.5fund.583.6    Sec. 12. TRANSFERS AND ADJUSTMENTS.583.7(a) The appropriation in subdivision 5, paragraph (g), includes up to $53,391,000 583.8in fiscal year 2014; $216,637,000 in fiscal year 2015; $261,660,000 in fiscal year 2016; 583.9and $279,984,000 in fiscal year 2017, for medical assistance eligibility and administration 583.10changes related to:583.11(1) eligibility for children age two to 18 with income up to 275 percent of the federal 583.12poverty guidelines;583.13(2) eligibility for pregnant women with income up to 275 percent of the federal 583.14poverty guidelines;583.15(3) Affordable Care Act enrollment and renewal processes, including elimination 583.16of six-month renewals, ex parte eligibility reviews, preprinted renewal forms, changes 583.17in verification requirements, and other changes in the eligibility determination and 583.18enrollment and renewal process;583.19(4) automatic eligibility for children who turn 18 in foster care until they reach age 26;583.20(5) eligibility related to spousal impoverishment provisions for waiver recipients; and583.21(6) presumptive eligibility determinations by hospitals.583.22(b) The commissioner of the Department of Human Services shall determine the 583.23difference between the actual costs to the medical assistance program attributable to 583.24the program changes in paragraph (a), clauses (1) to (6), and the costs of paragraph (a), 583.25clauses (1) to (6), that were estimated during the 2013 legislative session based on data 583.26from the 2013 February forecast. The costs in this paragraph must be calculated between 583.27beginning January 1, 2014, and June 30, 2017.583.28(c) For each fiscal year from 2014 to 2017, the commissioner of human services 583.29shall certify the actual cost differences to the medical assistance program determined 583.30under paragraph (b), and report the costs to the commissioner of management and budget 583.31by June 30 of each fiscal year. In each fiscal year, the commissioner of management 583.32and budget shall reduce the transfer from the health care access fund under section 3 583.33by the amounts determined in paragraph (b). If for any fiscal year the amount of the 583.34cost difference determined under paragraph (b) exceeds the amount of the transfer under 583.35section 14, the transfer for that year must be zero.584.1(d) This section expires on January 1, 2018.584.2    Sec. 13. HEALTH CARE ACCESS FUND TRANSFER TO GENERAL FUND 584.3FOR MINNESOTACARE POPULATIONS.584.4(a) The commissioner of Minnesota management and budget shall transfer from the 584.5health care access fund to the general fund $53,391,000 in fiscal year 2014; $216,637,000 584.6in fiscal year 2015; $261,660,000 in fiscal year 2016; and $279,984,000 in fiscal year 584.72017, for medical assistance changes in section 12.584.8(b) This section expires on January 1, 2018.584.9    Sec. 14. HEALTH CARE ACCESS FUND TRANSFER TO GENERAL FUND.584.10(a) The commissioner of Minnesota management and budget shall transfer from the 584.11health care access fund to the general fund $133,765,000 in fiscal year 2014; $23,893,000 584.12in fiscal year 2015; $48,371,000 in fiscal year 2016; and $32,325,000 in fiscal year 2017. 584.13For each fiscal year, the commissioner must reduce the amount of the transfer under this 584.14section according to section 12, paragraph (c).584.15(b) This section expires on January 1, 2018.584.16    Sec. 15. TRANSFERS.584.17    Subdivision 1.Grants.The commissioner of human services, with the approval of 584.18the commissioner of management and budget, may transfer unencumbered appropriation 584.19balances for the biennium ending June 30, 2015, within fiscal years among the MFIP, 584.20general assistance, general assistance medical care under Minnesota Statutes 2009 584.21Supplement, section 256D.03, subdivision 3, medical assistance, MinnesotaCare, MFIP 584.22child care assistance under Minnesota Statutes, section 119B.05, Minnesota supplemental 584.23aid, group residential housing programs, the entitlement portion of the chemical 584.24dependency consolidated treatment fund, and between fiscal years of the biennium. The 584.25commissioner shall inform the chairs and ranking minority members of the senate Health 584.26and Human Services Finance Division and the house of representatives Health and Human 584.27Services Finance Committee quarterly about transfers made under this provision.584.28    Subd. 2.Administration.Positions, salary money, and nonsalary administrative 584.29money may be transferred within the Departments of Human Services and Health as the 584.30commissioners consider necessary, with the advance approval of the commissioner of 584.31management and budget. The commissioner shall inform the chairs and ranking minority 584.32members of the senate Health and Human Services Finance Division and the house of 585.1representatives Health and Human Services Finance Committee quarterly about transfers 585.2made under this provision.585.3    Sec. 16. INDIRECT COSTS NOT TO FUND PROGRAMS.585.4The commissioners of health and human services shall not use indirect cost 585.5allocations to pay for the operational costs of any program for which they are responsible.585.6    Sec. 17. EXPIRATION OF UNCODIFIED LANGUAGE.585.7All uncodified language contained in this article expires on June 30, 2015, unless a 585.8different expiration date is explicit.585.9    Sec. 18. EFFECTIVE DATE.585.10This article is effective July 1, 2013, unless a different effective date is specified.585.11ARTICLE 15585.12REFORM 2020 CONTINGENT APPROPRIATIONS

585.13Section 1. HEALTH AND HUMAN SERVICES APPROPRIATIONS.

585.14The sums shown in the columns marked "Appropriations" are appropriated to the 585.15agencies and for the purposes specified in this article. The appropriations are from the 585.16general fund, or another named fund, and are available for the fiscal years indicated 585.17for each purpose. The figures "2014" and "2015" used in this article mean that the 585.18appropriations listed under them are available for the fiscal year ending June 30, 2014, or 585.19June 30, 2015, respectively. "The first year" is fiscal year 2014. "The second year" is fiscal 585.20year 2015. "The biennium" is fiscal years 2014 and 2015.

585.21APPROPRIATIONS585.22Available for the Year585.23Ending June 30585.2420142015

585.25585.26Sec. 2. COMMISSIONER OF HUMAN SERVICES

585.27Subdivision 1.Total Appropriation817,000895,000

585.28Subd. 2.Central Office

585.29The amounts that may be spent from this 585.30appropriation for each purpose are as follows:

585.31(a) Operations4,688,00011,643,000

586.1Base Adjustment. The general fund base is 586.2decreased by $11,056,000 in fiscal year 2016 586.3and $11,056,000 in fiscal year 2017.

586.4(b) Continuing Care2,334,0002,556,000

586.5Base Adjustment. The general fund base is 586.6decreased by $2,000 in fiscal year 2016 and 586.7by $27,000,000 in fiscal year 2017.

586.8(c) Group Residential Housing(1,166,000)(8,602,000)

586.9(d) Medical Assistance(2,647,000)(2,627,000)

586.10(e) Alternative Care(7,386,000)(6,851,000)

586.11(f) Child and Community Service Grants3,000,0003,000,000

586.12(g) Aging and Adult Services Grants1,430,0001,237,000

586.13Gaps Analysis. In fiscal year 2014, and 586.14in each even-numbered year thereafter, 586.15$435,000 is appropriated to conduct an 586.16analysis of gaps in long-term care services 586.17under Minnesota Statutes, section 144A.351. 586.18This is a biennial appropriation. The base is 586.19increased by $435,000 in fiscal year 2016. 586.20Notwithstanding any contrary provisions in 586.21this article, this provision does not expire.586.22Base Adjustment. The general fund base is 586.23increased by $597,000 in fiscal year 2016, 586.24and by $100,000 in fiscal year 2017.

586.25(h) Disabilities Grants(564,000)(539,000)

586.26Base Adjustment. The general fund base is 586.27increased by $25,000 in fiscal year 2016 and 586.28by $25,000 in fiscal year 2017.586.29    Sec. 3. FEDERAL APPROVAL.586.30(a) The implementation of this article is contingent on federal approval.586.31(b) Upon full or partial approval of the waiver application, the commissioner of 586.32human services shall submit to the commissioner of management and budget a plan for 587.1implementing the provisions in this article that received federal approval as well as any 587.2provisions that do not require federal approval. The plan must:587.3(1) include fiscal estimates that, with federal administrative reimbursement, do 587.4not increase the general fund appropriations to the commissioner of human services in 587.5fiscal years 2014 and 2015; and587.6(2) include a fiscal estimate for the systems modernization appropriation, which 587.7cannot exceed $15,463,000 for the biennium ending June 30, 2015.587.8(c) Upon approval by the commissioner of management and budget, the 587.9commissioner of human services may implement the plan.587.10(d) The commissioner of management and budget must notify the chairs and ranking 587.11minority members of the legislative committees with jurisdiction over health and human 587.12services finance when the plan is approved. The plan must be made publicly available.587.13    Sec. 4. IMPLEMENTATION OF REFORM 2020 CONTINGENT PROVISIONS 587.14AND ADJUSTMENTS TO APPROPRIATIONS AND PLANNING ESTIMATES.587.15Upon approval of the plan in section 3, the commissioner of management and 587.16budget shall make necessary adjustments to the appropriations in this article to reflect the 587.17effective date of federal approval. The adjustments must include the nondedicated revenue 587.18attributable to the provisions of this article and the related planning estimates for fiscal 587.19years 2016 and 2017 must reflect the revised fiscal estimates attributable to the provisions 587.20in this article. The revised appropriations for fiscal years 2014 and 2015 shall be included 587.21in the forecast and must not increase the appropriations to the commissioner of human 587.22services for fiscal years 2014 and 2015. If the adjustments to the planning estimates for 587.23fiscal years 2016 and 2017 result in increased general fund expenditure estimates for 587.24the commissioner of human services attributable to the provisions in this article, when 587.25compared to the planning estimates attributable to the provision in this article made in the 587.26February 2013 forecast, none of the provisions in this article shall be implemented.587.27ARTICLE 16587.28HUMAN SERVICES FORECAST ADJUSTMENTS

587.29587.30Section 1. COMMISSIONER OF HUMAN SERVICES

587.31Subdivision 1.Total Appropriation$(161,031,000)

587.32Appropriations by Fund587.332013587.34General Fund(158,668,000)588.1Health Care Access(7,179,000)588.2TANF4,816,000

588.3Subd. 2.Forecasted Programs588.4(a) MFIP/DWP Grants

588.5Appropriations by Fund588.6General Fund(8,211,000)588.7TANF4,399,000

588.8(b) MFIP Child Care Assistance Grants10,113,000

588.9(c) General Assistance Grants3,230,000

588.10(d) Minnesota Supplemental Aid Grants(1,008,000)

588.11(e) Group Residential Housing Grants(5,423,000)

588.12(f) MinnesotaCare Grants(7,179,000)

588.13This appropriation is from the health care 588.14access fund.

588.15(g) Medical Assistance Grants(159,733,000)

588.16(h) Alternative Care Grants-0-

588.17(i) CD Entitlement Grants2,364,000

588.18Subd. 3.Technical Activities417,000

588.19This appropriation is from the TANF fund.588.20EFFECTIVE DATE.This section is effective the day following final enactment.