HF 2414
2nd Engrossment - 91st Legislature (2019 - 2020)
Posted on 05/01/2019 12:16 p.m.
4.12 4.13
4.14 4.15 4.16 4.17 4.18
4.19
4.20 4.21 4.22 4.23 4.24 4.25 4.26 4.27 4.28 4.29 4.30 4.31 4.32 4.33 4.34 5.1 5.2
5.3
5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 5.12 5.13 5.14
5.15
5.16 5.17 5.18 5.19 5.20 5.21 5.22 5.23 5.24 5.25 5.26 5.27 5.28
5.29
6.1 6.2 6.3 6.4 6.5
6.6
6.7 6.8 6.9 6.10 6.11 6.12 6.13 6.14 6.15 6.16 6.17 6.18 6.19 6.20 6.21 6.22 6.23 6.24 6.25 6.26 6.27 6.28 6.29 6.30 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9 7.10 7.11
7.12
7.13 7.14 7.15 7.16 7.17 7.18 7.19
7.20
7.21 7.22 7.23 7.24 7.25 7.26 7.27 7.28 7.29 7.30 7.31 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9 8.10 8.11 8.12
8.13
8.14 8.15 8.16 8.17 8.18 8.19 8.20 8.21 8.22 8.23 8.24 8.25 8.26 8.27 8.28 8.29 8.30 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 9.9 9.10 9.11 9.12 9.13 9.14 9.15
9.16 9.17 9.18 9.19 9.20 9.21 9.22 9.23 9.24 9.25 9.26 9.27 9.28 9.29 9.30 9.31 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9
10.10
10.11 10.12 10.13 10.14 10.15 10.16 10.17 10.18 10.19 10.20 10.21 10.22 10.23 10.24 10.25 10.26 10.27 10.28 10.29 10.30 10.31 11.1 11.2 11.3
11.4
11.5 11.6 11.7 11.8 11.9 11.10 11.11 11.12 11.13 11.14 11.15
11.16
11.17 11.18 11.19 11.20 11.21 11.22 11.23 11.24 11.25 11.26 11.27 11.28 11.29 11.30 11.31 11.32 12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 12.9 12.10 12.11 12.12 12.13 12.14 12.15 12.16 12.17 12.18 12.19 12.20 12.21 12.22 12.23 12.24 12.25 12.26 12.27 12.28
12.29 12.30
13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 13.9 13.10 13.11 13.12 13.13 13.14
13.15
13.16 13.17 13.18 13.19 13.20 13.21 13.22 13.23 13.24 13.25 13.26 13.27 13.28 13.29 13.30 13.31 13.32 14.1 14.2 14.3 14.4 14.5 14.6 14.7 14.8 14.9 14.10 14.11 14.12 14.13 14.14 14.15 14.16 14.17
14.18
14.19 14.20 14.21 14.22 14.23 14.24 14.25 14.26 14.27
14.28
15.1 15.2 15.3 15.4 15.5 15.6 15.7 15.8 15.9 15.10 15.11
15.12
15.13 15.14 15.15 15.16 15.17 15.18 15.19 15.20 15.21
15.22
15.23 15.24 15.25 15.26 15.27
15.28
15.29 15.30 15.31 16.1 16.2 16.3 16.4 16.5 16.6 16.7 16.8 16.9 16.10 16.11 16.12 16.13 16.14 16.15 16.16 16.17 16.18 16.19 16.20 16.21 16.22 16.23 16.24 16.25 16.26 16.27 16.28 16.29 16.30 17.1 17.2 17.3 17.4 17.5 17.6 17.7 17.8 17.9 17.10
17.11
17.12 17.13 17.14 17.15 17.16 17.17 17.18 17.19 17.20 17.21 17.22 17.23 17.24 17.25 17.26 17.27 17.28 17.29 17.30 18.1 18.2 18.3 18.4 18.5 18.6 18.7 18.8 18.9 18.10 18.11 18.12 18.13
18.14 18.15
18.16 18.17 18.18 18.19 18.20 18.21 18.22 18.23 18.24 18.25 18.26 18.27 18.28 18.29 18.30 18.31 19.1 19.2 19.3 19.4 19.5 19.6 19.7 19.8 19.9
19.10 19.11 19.12 19.13 19.14 19.15 19.16 19.17 19.18 19.19 19.20 19.21 19.22 19.23 19.24 19.25 19.26 19.27 19.28 19.29 19.30 19.31 19.32 19.33 19.34 20.1 20.2 20.3 20.4 20.5 20.6 20.7 20.8 20.9 20.10 20.11 20.12 20.13 20.14 20.15 20.16 20.17 20.18 20.19 20.20 20.21 20.22 20.23 20.24 20.25 20.26 20.27 20.28 20.29 20.30 21.1 21.2 21.3 21.4 21.5 21.6 21.7 21.8 21.9 21.10 21.11 21.12 21.13 21.14 21.15 21.16 21.17 21.18 21.19 21.20 21.21 21.22 21.23 21.24 21.25 21.26 21.27 21.28 21.29
21.30 21.31 21.32 22.1 22.2 22.3 22.4 22.5
22.6
22.7 22.8 22.9 22.10 22.11 22.12 22.13 22.14 22.15 22.16 22.17 22.18 22.19 22.20 22.21 22.22 22.23 22.24 22.25 22.26 22.27 22.28 22.29 22.30 22.31 22.32 22.33 23.1 23.2 23.3 23.4 23.5 23.6 23.7 23.8 23.9 23.10 23.11
23.12 23.13 23.14 23.15 23.16 23.17 23.18 23.19 23.20 23.21
23.22 23.23 23.24 23.25 23.26 23.27 23.28 23.29 23.30 23.31 24.1 24.2 24.3 24.4 24.5 24.6 24.7 24.8 24.9 24.10 24.11 24.12 24.13 24.14
24.15 24.16 24.17 24.18 24.19 24.20 24.21 24.22 24.23 24.24
24.25 24.26 24.27 24.28 24.29 24.30 24.31 24.32 24.33 25.1 25.2 25.3 25.4 25.5 25.6 25.7 25.8 25.9 25.10 25.11 25.12 25.13 25.14 25.15 25.16 25.17 25.18 25.19 25.20 25.21 25.22 25.23 25.24 25.25 25.26 25.27 25.28 25.29 25.30 25.31 25.32 25.33 26.1 26.2 26.3 26.4 26.5 26.6 26.7 26.8 26.9 26.10 26.11 26.12 26.13 26.14 26.15 26.16 26.17 26.18 26.19 26.20 26.21 26.22 26.23 26.24 26.25 26.26 26.27 26.28 26.29 26.30 26.31 26.32 27.1 27.2 27.3 27.4 27.5 27.6 27.7 27.8 27.9 27.10 27.11 27.12 27.13 27.14 27.15 27.16 27.17 27.18 27.19 27.20 27.21 27.22 27.23 27.24 27.25 27.26 27.27 27.28 27.29 27.30 27.31 27.32 27.33 27.34
28.1 28.2 28.3 28.4 28.5 28.6 28.7 28.8 28.9 28.10 28.11 28.12 28.13 28.14 28.15 28.16 28.17 28.18 28.19 28.20 28.21 28.22 28.23 28.24 28.25 28.26 28.27 28.28 28.29 28.30 28.31 28.32 28.33 28.34 29.1 29.2 29.3 29.4 29.5 29.6 29.7 29.8 29.9 29.10 29.11 29.12 29.13 29.14 29.15 29.16 29.17 29.18 29.19 29.20 29.21 29.22 29.23 29.24 29.25 29.26 29.27 29.28 29.29 29.30 29.31 29.32 29.33 29.34 30.1 30.2
30.3 30.4 30.5 30.6 30.7 30.8 30.9 30.10 30.11 30.12 30.13 30.14 30.15 30.16 30.17 30.18 30.19 30.20 30.21 30.22 30.23 30.24 30.25 30.26 30.27 30.28 30.29 30.30 30.31 30.32 31.1 31.2 31.3 31.4 31.5 31.6 31.7 31.8 31.9 31.10 31.11 31.12 31.13 31.14 31.15 31.16 31.17 31.18 31.19 31.20 31.21 31.22 31.23 31.24 31.25 31.26 31.27 31.28 31.29 31.30 31.31 31.32 31.33 31.34 32.1 32.2 32.3 32.4 32.5 32.6 32.7 32.8 32.9 32.10 32.11 32.12 32.13 32.14 32.15 32.16 32.17 32.18 32.19 32.20 32.21 32.22 32.23 32.24 32.25 32.26 32.27 32.28 32.29 32.30 32.31 32.32 33.1 33.2 33.3 33.4 33.5 33.6 33.7 33.8 33.9 33.10 33.11 33.12 33.13 33.14 33.15 33.16 33.17 33.18 33.19 33.20 33.21 33.22 33.23 33.24 33.25 33.26 33.27 33.28 33.29 33.30 33.31 33.32
34.1 34.2 34.3 34.4 34.5 34.6 34.7 34.8 34.9 34.10 34.11 34.12 34.13 34.14 34.15 34.16 34.17 34.18 34.19 34.20 34.21 34.22 34.23 34.24 34.25 34.26 34.27 34.28 34.29 34.30 34.31 34.32 35.1 35.2 35.3 35.4 35.5 35.6 35.7 35.8 35.9 35.10 35.11 35.12 35.13 35.14 35.15 35.16 35.17 35.18 35.19 35.20 35.21 35.22 35.23 35.24 35.25 35.26 35.27 35.28 35.29 35.30
36.1 36.2 36.3 36.4 36.5 36.6 36.7 36.8 36.9 36.10 36.11 36.12 36.13 36.14 36.15 36.16 36.17 36.18 36.19
36.20 36.21 36.22 36.23 36.24 36.25 36.26 36.27 36.28 36.29 36.30 36.31 36.32 37.1 37.2 37.3 37.4 37.5 37.6 37.7 37.8 37.9 37.10 37.11 37.12 37.13 37.14 37.15 37.16 37.17 37.18 37.19 37.20 37.21 37.22 37.23 37.24 37.25 37.26 37.27 37.28 37.29 37.30 37.31 38.1 38.2 38.3 38.4 38.5 38.6
38.7 38.8 38.9 38.10 38.11 38.12 38.13 38.14 38.15 38.16 38.17 38.18 38.19 38.20 38.21 38.22 38.23 38.24 38.25 38.26 38.27 38.28 38.29 38.30 38.31 39.1 39.2 39.3 39.4 39.5 39.6 39.7 39.8 39.9 39.10 39.11 39.12 39.13 39.14 39.15 39.16 39.17 39.18 39.19 39.20 39.21 39.22 39.23 39.24 39.25 39.26 39.27 39.28 39.29 39.30 39.31 39.32 39.33 40.1 40.2 40.3 40.4 40.5 40.6 40.7 40.8 40.9 40.10 40.11 40.12 40.13 40.14 40.15 40.16 40.17 40.18 40.19 40.20 40.21 40.22 40.23 40.24 40.25 40.26
40.27 40.28 40.29 40.30 40.31 40.32 41.1 41.2 41.3 41.4 41.5 41.6 41.7 41.8 41.9 41.10 41.11 41.12 41.13 41.14 41.15 41.16 41.17 41.18 41.19 41.20 41.21 41.22 41.23 41.24 41.25 41.26 41.27 41.28 41.29
42.1 42.2 42.3 42.4 42.5 42.6 42.7 42.8 42.9 42.10 42.11
42.12 42.13 42.14 42.15 42.16 42.17 42.18 42.19 42.20 42.21 42.22 42.23 42.24
42.25
42.26 42.27 42.28 42.29 42.30 42.31 42.32 43.1 43.2 43.3 43.4 43.5 43.6 43.7 43.8 43.9 43.10 43.11 43.12 43.13 43.14 43.15 43.16 43.17 43.18 43.19 43.20 43.21 43.22 43.23 43.24 43.25 43.26 43.27 43.28 43.29 43.30 43.31 43.32 43.33 43.34 44.1 44.2 44.3 44.4 44.5 44.6 44.7 44.8 44.9 44.10 44.11 44.12 44.13 44.14 44.15 44.16 44.17 44.18 44.19 44.20 44.21 44.22 44.23 44.24 44.25 44.26 44.27 44.28 44.29 44.30 44.31 44.32 44.33 44.34 44.35 45.1 45.2 45.3 45.4 45.5 45.6 45.7 45.8 45.9 45.10 45.11 45.12 45.13 45.14 45.15 45.16 45.17 45.18 45.19 45.20 45.21 45.22 45.23 45.24 45.25 45.26 45.27 45.28 45.29 45.30 45.31 45.32 45.33 45.34 45.35 46.1 46.2 46.3 46.4 46.5 46.6 46.7 46.8 46.9 46.10 46.11 46.12 46.13 46.14 46.15 46.16 46.17 46.18 46.19 46.20 46.21 46.22 46.23 46.24 46.25 46.26 46.27 46.28 46.29 46.30 46.31 46.32 46.33 46.34 46.35 47.1 47.2 47.3 47.4 47.5 47.6 47.7 47.8 47.9 47.10 47.11 47.12 47.13 47.14 47.15 47.16 47.17 47.18 47.19 47.20 47.21 47.22 47.23 47.24 47.25 47.26 47.27 47.28 47.29 47.30 47.31 47.32 47.33 47.34 47.35 48.1 48.2 48.3 48.4 48.5 48.6 48.7 48.8 48.9 48.10 48.11 48.12 48.13 48.14 48.15 48.16 48.17 48.18 48.19 48.20 48.21 48.22 48.23 48.24 48.25 48.26 48.27 48.28 48.29 48.30 48.31 48.32 48.33 48.34 48.35 49.1 49.2 49.3 49.4 49.5 49.6 49.7 49.8 49.9 49.10 49.11 49.12 49.13 49.14 49.15 49.16 49.17 49.18 49.19
49.20 49.21 49.22 49.23 49.24 49.25 49.26 49.27 49.28 49.29 49.30 49.31 49.32 49.33 50.1 50.2 50.3 50.4 50.5 50.6 50.7 50.8 50.9 50.10 50.11
50.12 50.13
50.14 50.15 50.16 50.17 50.18 50.19 50.20 50.21
50.22 50.23 50.24 50.25 50.26 50.27 50.28 50.29 50.30 50.31
51.1 51.2 51.3 51.4 51.5 51.6 51.7 51.8 51.9 51.10 51.11 51.12 51.13 51.14 51.15 51.16 51.17 51.18 51.19 51.20 51.21 51.22 51.23 51.24 51.25 51.26 51.27 51.28 51.29 51.30 51.31 51.32 51.33 51.34 52.1 52.2
52.3 52.4 52.5 52.6 52.7 52.8 52.9 52.10 52.11 52.12 52.13
52.14 52.15 52.16 52.17 52.18 52.19 52.20 52.21 52.22 52.23 52.24 52.25 52.26 52.27 52.28 52.29 52.30 53.1 53.2 53.3 53.4 53.5 53.6 53.7 53.8 53.9 53.10 53.11
53.12 53.13 53.14 53.15 53.16 53.17 53.18
53.19 53.20 53.21 53.22 53.23 53.24 53.25 53.26
53.27
53.28 53.29 53.30 54.1 54.2 54.3 54.4 54.5 54.6 54.7
54.8
54.9 54.10 54.11 54.12 54.13
54.14 54.15
54.16 54.17 54.18 54.19 54.20 54.21 54.22 54.23 54.24 54.25 54.26 54.27 54.28 54.29 54.30 55.1 55.2 55.3 55.4 55.5 55.6 55.7 55.8 55.9 55.10 55.11 55.12 55.13 55.14 55.15 55.16 55.17 55.18 55.19 55.20 55.21 55.22 55.23 55.24 55.25 55.26 55.27 55.28 55.29 55.30 55.31 55.32 56.1 56.2 56.3 56.4 56.5 56.6 56.7 56.8 56.9 56.10 56.11 56.12 56.13 56.14 56.15 56.16 56.17 56.18 56.19 56.20 56.21 56.22 56.23 56.24 56.25 56.26 56.27 56.28 56.29 56.30 57.1 57.2 57.3 57.4 57.5 57.6 57.7 57.8 57.9 57.10 57.11 57.12 57.13 57.14 57.15 57.16 57.17 57.18 57.19 57.20 57.21 57.22 57.23 57.24 57.25 57.26 57.27 57.28 57.29 57.30 57.31 57.32 58.1 58.2 58.3 58.4 58.5 58.6 58.7 58.8 58.9 58.10 58.11 58.12 58.13 58.14 58.15 58.16 58.17 58.18 58.19 58.20 58.21 58.22 58.23 58.24 58.25 58.26 58.27 58.28 58.29 58.30 58.31 58.32 58.33 58.34 59.1 59.2 59.3 59.4 59.5 59.6 59.7 59.8 59.9 59.10 59.11 59.12 59.13 59.14 59.15 59.16 59.17 59.18 59.19 59.20 59.21 59.22
59.23
59.24 59.25 59.26 59.27 59.28 59.29 59.30 59.31 59.32 60.1 60.2 60.3 60.4 60.5 60.6 60.7 60.8 60.9 60.10 60.11 60.12 60.13 60.14 60.15 60.16 60.17 60.18 60.19
60.20 60.21 60.22 60.23 60.24 60.25
60.26
60.27 60.28 60.29 60.30 60.31 61.1 61.2 61.3 61.4 61.5 61.6 61.7 61.8 61.9 61.10 61.11 61.12 61.13 61.14 61.15 61.16 61.17 61.18 61.19 61.20 61.21 61.22 61.23 61.24 61.25 61.26 61.27 61.28 61.29 61.30 61.31 61.32 62.1 62.2 62.3 62.4 62.5 62.6 62.7 62.8
62.9 62.10 62.11 62.12 62.13 62.14 62.15 62.16 62.17 62.18 62.19 62.20 62.21 62.22 62.23 62.24 62.25 62.26 62.27 62.28 62.29 62.30 62.31 62.32 62.33 63.1
63.2
63.3 63.4 63.5 63.6 63.7 63.8 63.9 63.10 63.11 63.12 63.13 63.14 63.15 63.16 63.17 63.18 63.19 63.20
63.21
63.22 63.23 63.24 63.25 63.26 63.27 63.28 63.29 63.30 64.1 64.2 64.3 64.4 64.5 64.6 64.7 64.8 64.9 64.10 64.11 64.12 64.13 64.14 64.15 64.16 64.17 64.18 64.19 64.20 64.21
64.22
64.23 64.24 64.25 64.26 64.27 64.28 64.29 64.30 64.31 64.32 64.33 65.1 65.2 65.3 65.4 65.5 65.6 65.7 65.8 65.9 65.10 65.11 65.12 65.13 65.14 65.15 65.16 65.17 65.18 65.19 65.20 65.21 65.22 65.23 65.24 65.25 65.26 65.27 65.28 65.29 65.30 65.31 66.1 66.2 66.3 66.4
66.5
66.6 66.7 66.8 66.9 66.10 66.11 66.12 66.13 66.14 66.15 66.16 66.17 66.18 66.19 66.20 66.21 66.22 66.23 66.24 66.25 66.26 66.27 66.28 66.29 66.30 66.31 66.32 66.33 67.1 67.2 67.3 67.4 67.5 67.6 67.7 67.8 67.9 67.10 67.11 67.12 67.13 67.14 67.15 67.16 67.17 67.18 67.19 67.20 67.21 67.22 67.23
67.24
67.25 67.26 67.27 67.28 67.29 67.30 67.31 67.32 68.1 68.2
68.3 68.4 68.5 68.6 68.7 68.8 68.9 68.10 68.11 68.12 68.13 68.14 68.15 68.16 68.17 68.18 68.19 68.20 68.21 68.22 68.23 68.24 68.25 68.26 68.27 68.28 68.29
68.30
69.1 69.2 69.3 69.4 69.5 69.6
69.7
69.8 69.9 69.10 69.11 69.12 69.13
69.14
69.15 69.16 69.17 69.18
69.19
69.20 69.21 69.22 69.23 69.24 69.25
69.26
69.27 69.28 69.29 69.30 70.1 70.2
70.3
70.4 70.5 70.6 70.7 70.8
70.9
70.10 70.11 70.12 70.13 70.14 70.15 70.16 70.17 70.18 70.19 70.20 70.21 70.22 70.23 70.24 70.25 70.26 70.27 70.28 70.29 70.30 70.31
71.1 71.2 71.3 71.4 71.5 71.6 71.7 71.8 71.9 71.10 71.11 71.12 71.13 71.14 71.15 71.16 71.17 71.18 71.19 71.20 71.21
71.22
71.23 71.24 71.25 71.26 71.27 71.28 71.29 71.30 71.31 72.1
72.2
72.3 72.4 72.5 72.6 72.7 72.8 72.9 72.10 72.11 72.12 72.13 72.14 72.15 72.16 72.17 72.18 72.19 72.20 72.21 72.22 72.23
72.24
72.25 72.26 72.27 72.28 72.29 72.30 72.31 73.1 73.2 73.3 73.4 73.5 73.6 73.7 73.8 73.9 73.10 73.11 73.12 73.13 73.14 73.15 73.16 73.17 73.18 73.19 73.20 73.21 73.22 73.23 73.24 73.25 73.26 73.27 73.28 73.29 73.30 73.31 73.32 73.33 73.34 74.1 74.2 74.3 74.4 74.5 74.6 74.7 74.8 74.9 74.10 74.11 74.12 74.13 74.14 74.15 74.16 74.17 74.18 74.19 74.20 74.21 74.22 74.23 74.24 74.25 74.26 74.27 74.28 74.29 74.30 74.31 74.32 75.1 75.2 75.3 75.4 75.5 75.6 75.7 75.8 75.9 75.10 75.11 75.12 75.13 75.14 75.15 75.16 75.17 75.18 75.19 75.20 75.21 75.22 75.23 75.24 75.25 75.26 75.27 75.28 75.29 75.30 75.31 76.1 76.2 76.3 76.4 76.5 76.6 76.7 76.8 76.9 76.10 76.11 76.12 76.13 76.14 76.15 76.16 76.17 76.18
76.19
76.20 76.21 76.22 76.23 76.24 76.25 76.26 76.27 76.28 76.29 76.30 76.31
76.32
77.1 77.2 77.3 77.4 77.5 77.6 77.7 77.8 77.9 77.10 77.11 77.12 77.13 77.14 77.15 77.16 77.17 77.18 77.19 77.20 77.21 77.22 77.23 77.24 77.25 77.26 77.27 77.28 77.29 77.30 77.31 77.32 77.33 78.1 78.2 78.3 78.4 78.5 78.6 78.7 78.8 78.9 78.10 78.11 78.12 78.13 78.14 78.15 78.16
78.17 78.18
78.19 78.20 78.21 78.22 78.23 78.24 78.25 78.26 78.27 78.28 78.29 78.30 79.1 79.2 79.3 79.4 79.5 79.6 79.7
79.8
79.9 79.10 79.11 79.12 79.13 79.14 79.15 79.16 79.17 79.18 79.19 79.20 79.21 79.22 79.23 79.24 79.25 79.26 79.27 79.28 79.29 79.30 80.1 80.2 80.3 80.4 80.5 80.6 80.7 80.8 80.9 80.10 80.11 80.12 80.13 80.14 80.15 80.16 80.17 80.18 80.19 80.20 80.21 80.22 80.23 80.24 80.25 80.26 80.27 80.28 80.29 80.30 80.31 80.32 81.1 81.2 81.3 81.4 81.5 81.6 81.7 81.8 81.9 81.10 81.11 81.12 81.13 81.14 81.15 81.16 81.17 81.18 81.19 81.20 81.21
81.22
81.23 81.24 81.25 81.26 81.27 81.28 81.29 81.30 81.31 81.32 82.1 82.2 82.3 82.4 82.5 82.6 82.7 82.8 82.9 82.10 82.11 82.12
82.13
82.14 82.15 82.16 82.17 82.18 82.19 82.20 82.21 82.22 82.23 82.24 82.25 82.26 82.27 82.28 82.29 82.30 83.1 83.2
83.3 83.4 83.5 83.6 83.7 83.8 83.9 83.10 83.11 83.12 83.13 83.14 83.15 83.16 83.17 83.18
83.19
83.20 83.21 83.22 83.23 83.24 83.25 83.26 83.27 83.28 83.29 83.30 83.31 84.1 84.2 84.3 84.4 84.5 84.6 84.7 84.8 84.9 84.10 84.11 84.12 84.13 84.14 84.15 84.16 84.17 84.18 84.19 84.20 84.21 84.22 84.23 84.24 84.25 84.26 84.27 84.28 84.29 84.30 84.31 84.32 84.33 84.34 85.1 85.2 85.3 85.4 85.5 85.6 85.7 85.8 85.9 85.10 85.11 85.12 85.13 85.14 85.15 85.16 85.17 85.18 85.19 85.20 85.21 85.22 85.23 85.24 85.25 85.26 85.27 85.28 85.29 85.30 85.31 85.32 85.33
86.1
86.2 86.3 86.4 86.5 86.6 86.7 86.8 86.9 86.10 86.11 86.12 86.13 86.14 86.15 86.16 86.17 86.18 86.19 86.20 86.21 86.22 86.23 86.24 86.25 86.26 86.27 86.28 86.29 86.30 86.31 87.1 87.2 87.3 87.4 87.5 87.6 87.7 87.8 87.9
87.10 87.11
87.12 87.13 87.14 87.15 87.16 87.17 87.18 87.19 87.20 87.21 87.22 87.23 87.24 87.25 87.26 87.27 87.28 87.29 87.30
87.31
88.1 88.2 88.3 88.4 88.5 88.6 88.7 88.8 88.9 88.10 88.11 88.12 88.13 88.14 88.15 88.16 88.17 88.18 88.19 88.20 88.21 88.22 88.23 88.24 88.25 88.26 88.27 88.28 88.29 88.30 88.31
88.32 88.33
89.1 89.2 89.3 89.4 89.5 89.6 89.7 89.8 89.9 89.10 89.11 89.12 89.13 89.14 89.15 89.16 89.17 89.18 89.19 89.20 89.21 89.22 89.23 89.24 89.25 89.26
89.27
89.28 89.29 89.30 89.31 89.32 89.33 90.1 90.2 90.3 90.4 90.5 90.6 90.7 90.8 90.9 90.10 90.11 90.12 90.13 90.14 90.15 90.16 90.17 90.18 90.19 90.20 90.21 90.22 90.23 90.24 90.25 90.26 90.27 90.28 90.29 90.30 90.31 90.32 90.33 90.34 91.1 91.2 91.3 91.4 91.5 91.6 91.7 91.8 91.9 91.10 91.11
91.12 91.13 91.14 91.15 91.16 91.17 91.18 91.19 91.20 91.21 91.22 91.23 91.24 91.25 91.26 91.27 91.28 91.29 91.30 91.31 91.32 92.1 92.2 92.3 92.4 92.5 92.6 92.7 92.8 92.9 92.10 92.11 92.12 92.13 92.14 92.15 92.16 92.17 92.18 92.19 92.20 92.21 92.22 92.23 92.24 92.25 92.26 92.27 92.28 92.29 92.30 92.31 92.32 92.33 92.34 92.35 93.1 93.2 93.3 93.4 93.5 93.6 93.7 93.8 93.9 93.10 93.11 93.12 93.13 93.14 93.15 93.16 93.17 93.18 93.19 93.20 93.21 93.22 93.23 93.24 93.25 93.26 93.27 93.28 93.29 93.30 93.31 93.32 93.33 94.1 94.2 94.3 94.4
94.5
94.6 94.7 94.8 94.10 94.9 94.11 94.12 94.13 94.14 94.15 94.16 94.17 94.18 94.19 94.20 94.21 94.22 94.23 94.24 94.25 94.26 94.27 94.28 94.29 94.30 94.31 94.32 94.33 94.34 94.35 94.36 95.1 95.2 95.3 95.4 95.5 95.6 95.7 95.8 95.9 95.10 95.11 95.12 95.13 95.14 95.15 95.16 95.17 95.18 95.19 95.20 95.21 95.22 95.23 95.24 95.25 95.26 95.27 95.28 95.29 95.30 95.31 95.32 95.33 95.34 95.35 95.36 95.37 95.38 95.39 95.40 95.41 95.42 95.43 95.44 95.45 95.46 96.1 96.2 96.3 96.4 96.5 96.6 96.7 96.8 96.9 96.10 96.11 96.12 96.13 96.14 96.15 96.16 96.17 96.18 96.19 96.20 96.21 96.22 96.23 96.24 96.25 96.26 96.27 96.28 96.29 96.30 96.31 96.32 96.33 96.34 96.35 96.36 96.37 96.38 97.1 97.2 97.3 97.4 97.5 97.6 97.7 97.8 97.9 97.10 97.11 97.12 97.13 97.14 97.15 97.16 97.17 97.18 97.19 97.20 97.21 97.22 97.23 97.24 97.25 97.26 97.27 97.28 97.29 97.30 97.31 97.32 97.33 98.1 98.2 98.3 98.4 98.5 98.6 98.7 98.8 98.9 98.10 98.11 98.12 98.13 98.14 98.15 98.16 98.17 98.18 98.19 98.20 98.21 98.22 98.23
98.24 98.25 98.26 98.27 98.28 98.29 98.30 98.31 98.32 98.33 99.1 99.2 99.3 99.4 99.5 99.6 99.7 99.8 99.9 99.10 99.11 99.12 99.13 99.14 99.15 99.16 99.17 99.18 99.19 99.20 99.21 99.22 99.23 99.24 99.25 99.26 99.27 99.28 99.29 99.30 99.31 99.32 100.1 100.2 100.3 100.4 100.5 100.6 100.7 100.8 100.9 100.10 100.11 100.12 100.13 100.14 100.15 100.16 100.17 100.18 100.19 100.20 100.21 100.22 100.23 100.24 100.25
100.26
100.27 100.28 100.29 100.30 100.31 101.1 101.2 101.3 101.4 101.5 101.6 101.7 101.8 101.9 101.10 101.11 101.12 101.13 101.14 101.15
101.16
101.17 101.18 101.19 101.20 101.21 101.22
101.23
101.24 101.25 101.26 101.27 101.28 101.29 102.1 102.2 102.3 102.4 102.5 102.6 102.7 102.8
102.9
102.10 102.11 102.12 102.13 102.14 102.15 102.16 102.17 102.18 102.19 102.20 102.21 102.22 102.23
102.24
102.25 102.26 102.27 102.28 102.29 102.30
102.31
103.1 103.2 103.3 103.4 103.5 103.6 103.7 103.8 103.9
103.10
103.11 103.12 103.13 103.14 103.15 103.16 103.17 103.18 103.19 103.20 103.21 103.22
103.23
103.24 103.25 103.26 103.27 103.28 103.29 103.30 103.31 104.1 104.2 104.3 104.4 104.5 104.6 104.7 104.8 104.9 104.10 104.11 104.12 104.13 104.14 104.15 104.16 104.17 104.18 104.19 104.20 104.21 104.22 104.23 104.24 104.25 104.26 104.27 104.28 104.29 104.30 104.31 104.32 105.1 105.2 105.3 105.4 105.5 105.6 105.7 105.8 105.9 105.10 105.11 105.12 105.13 105.14 105.15 105.16 105.17 105.18 105.19 105.20 105.21
105.22
105.23 105.24 105.25 105.26 105.27 105.28 105.29 105.30 105.31 106.1 106.2 106.3 106.4 106.5 106.6 106.7 106.8 106.9 106.10 106.11 106.12 106.13 106.14
106.15
106.16 106.17 106.18 106.19 106.20 106.21 106.22 106.23 106.24 106.25 106.26 106.27 106.28 106.29 106.30 107.1 107.2 107.3 107.4 107.5 107.6 107.7 107.8 107.9 107.10 107.11 107.12 107.13 107.14 107.15 107.16 107.17 107.18 107.19 107.20 107.21 107.22
107.23
107.24 107.25 107.26
107.27 107.28 107.29 107.30 107.31 107.32 108.1 108.2 108.3 108.4 108.5 108.6 108.7 108.8 108.9 108.10 108.11 108.12 108.13 108.14 108.15 108.16 108.17 108.18 108.19 108.20 108.21 108.22 108.23 108.24 108.25 108.26 108.27 108.28 108.29 109.1 109.2 109.3 109.4 109.5 109.6 109.7 109.8 109.9 109.10 109.11 109.12 109.13 109.14 109.15 109.16 109.17 109.18 109.19 109.20 109.21 109.22 109.23 109.24 109.25 109.26 109.27 109.28 109.29 109.30 109.31 110.1 110.2 110.3 110.4 110.5 110.6 110.7 110.8 110.9 110.10 110.11 110.12 110.13 110.14 110.15 110.16 110.17 110.18 110.19 110.20 110.21 110.22 110.23 110.24 110.25 110.26 110.27 110.28 110.29 110.30 110.31 110.32 110.33 111.1 111.2 111.3 111.4 111.5 111.6 111.7 111.8 111.9 111.10 111.11 111.12 111.13 111.14 111.15 111.16 111.17 111.18 111.19 111.20 111.21 111.22 111.23 111.24 111.25 111.26 111.27 111.28 111.29 111.30 111.31 111.32 112.1 112.2 112.3 112.4 112.5 112.6 112.7 112.8 112.9 112.10 112.11 112.12 112.13 112.14 112.15 112.16 112.17 112.18 112.19 112.20 112.21 112.22 112.23 112.24 112.25 112.26 112.27 112.28 112.29 112.30 112.31 112.32 112.33 113.1 113.2 113.3 113.4 113.5 113.6 113.7 113.8 113.9 113.10 113.11 113.12 113.13 113.14 113.15 113.16 113.17 113.18 113.19 113.20 113.21 113.22 113.23 113.24 113.25 113.26 113.27 113.28 113.29 113.30 113.31 113.32 113.33 114.1 114.2 114.3 114.4 114.5 114.6 114.7 114.8 114.9 114.10 114.11 114.12 114.13 114.14 114.15 114.16 114.17 114.18 114.19 114.20 114.21 114.22 114.23 114.24 114.25 114.26 114.27 114.28 114.29 114.30 114.31 115.1 115.2 115.3 115.4 115.5 115.6 115.7 115.8 115.9 115.10 115.11 115.12 115.13 115.14 115.15 115.16 115.17 115.18 115.19 115.20 115.21 115.22 115.23 115.24 115.25 115.26 115.27 115.28 115.29 116.1 116.2 116.3 116.4 116.5 116.6 116.7 116.8 116.9 116.10 116.11 116.12 116.13 116.14 116.15 116.16 116.17 116.18 116.19 116.20 116.21 116.22 116.23 116.24 116.25 116.26 116.27 116.28 116.29 117.1 117.2 117.3 117.4 117.5 117.6 117.7 117.8 117.9 117.10 117.11 117.12 117.13 117.14 117.15 117.16 117.17 117.18 117.19 117.20 117.21 117.22 117.23 117.24 117.25 117.26 117.27 117.28 117.29 117.30 117.31 118.1 118.2 118.3 118.4 118.5 118.6 118.7 118.8 118.9 118.10 118.11 118.12 118.13 118.14 118.15 118.16
118.17
118.18 118.19 118.20 118.21 118.22 118.23 118.24 118.25 118.26 118.27 118.28 118.29 118.30 118.31 118.32 118.33 119.1 119.2 119.3 119.4 119.5 119.6 119.7 119.8 119.9 119.10 119.11 119.12 119.13 119.14 119.15 119.16 119.17 119.18 119.19 119.20 119.21 119.22 119.23 119.24 119.25 119.26 119.27 119.28 119.29 119.30 119.31 119.32 120.1 120.2 120.3 120.4 120.5 120.6 120.7 120.8 120.9 120.10 120.11 120.12 120.13 120.14 120.15 120.16 120.17 120.18 120.19 120.20 120.21 120.22 120.23 120.24 120.25 120.26 120.27 120.28 120.29 120.30 121.1 121.2 121.3
121.4
121.5 121.6 121.7 121.8 121.9 121.10 121.11 121.12 121.13 121.14 121.15 121.16 121.17 121.18 121.19 121.20 121.21 121.22 121.23 121.24 121.25 121.26 121.27 121.28 121.29 121.30 122.1 122.2 122.3 122.4 122.5 122.6 122.7 122.8 122.9 122.10 122.11 122.12 122.13 122.14 122.15 122.16 122.17 122.18 122.19 122.20 122.21 122.22 122.23 122.24 122.25 122.26 122.27 122.28 122.29 122.30 122.31 123.1 123.2 123.3 123.4 123.5 123.6 123.7 123.8 123.9 123.10 123.11 123.12 123.13 123.14 123.15 123.16 123.17 123.18 123.19 123.20 123.21 123.22 123.23 123.24 123.25 123.26 123.27 123.28 123.29 123.30 123.31 123.32 123.33 124.1 124.2 124.3 124.4 124.5 124.6 124.7 124.8 124.9 124.10 124.11 124.12 124.13 124.14 124.15 124.16 124.17 124.18 124.19 124.20 124.21 124.22 124.23 124.24 124.25 124.26 124.27 124.28 124.29 124.30 124.31 124.32 124.33 124.34 125.1 125.2 125.3 125.4 125.5 125.6 125.7 125.8 125.9 125.10 125.11 125.12 125.13 125.14 125.15 125.16 125.17 125.18 125.19 125.20 125.21 125.22 125.23 125.24 125.25 125.26 125.27 125.28 125.29 125.30 125.31 125.32 125.33 126.1 126.2 126.3 126.4 126.5 126.6 126.7 126.8 126.9 126.10 126.11 126.12 126.13 126.14 126.15 126.16 126.17 126.18 126.19 126.20 126.21 126.22 126.23 126.24 126.25 126.26 126.27 126.28 126.29 126.30 126.31 126.32 126.33 126.34 127.1 127.2 127.3 127.4 127.5 127.6 127.7 127.8 127.9 127.10 127.11 127.12 127.13 127.14 127.15 127.16 127.17 127.18 127.19 127.20 127.21 127.22 127.23 127.24 127.25 127.26 127.27 127.28 127.29 127.30 127.31 128.1 128.2 128.3 128.4 128.5 128.6 128.7 128.8 128.9 128.10 128.11 128.12 128.13 128.14 128.15 128.16 128.17 128.18 128.19 128.20 128.21 128.22 128.23 128.24 128.25 128.26 128.27 128.28 128.29 128.30 128.31 129.1 129.2 129.3 129.4 129.5 129.6 129.7 129.8 129.9 129.10 129.11 129.12 129.13 129.14 129.15 129.16 129.17 129.18 129.19 129.20 129.21 129.22 129.23 129.24 129.25 129.26 129.27 129.28 129.29 129.30 129.31 130.1 130.2 130.3 130.4 130.5 130.6 130.7 130.8 130.9 130.10 130.11 130.12 130.13 130.14 130.15 130.16 130.17 130.18 130.19 130.20 130.21 130.22 130.23 130.24 130.25 130.26 130.27 130.28 130.29 130.30
130.31
131.1 131.2 131.3 131.4 131.5 131.6 131.7 131.8 131.9 131.10 131.11 131.12 131.13 131.14 131.15 131.16 131.17 131.18 131.19 131.20 131.21 131.22 131.23 131.24 131.25
131.26
131.27 131.28 131.29 131.30
132.1
132.2 132.3 132.4 132.5 132.6 132.7
132.8
132.9 132.10 132.11 132.12 132.13 132.14 132.15 132.16 132.17 132.18 132.19 132.20 132.21 132.22 132.23 132.24 132.25 132.26 132.27 132.28 132.29 132.30 132.31 132.32 133.1 133.2 133.3 133.4 133.5 133.6 133.7 133.8 133.9 133.10 133.11 133.12 133.13 133.14 133.15 133.16 133.17 133.18 133.19 133.20 133.21 133.22 133.23 133.24 133.25 133.26
133.27
133.28 133.29 133.30 133.31 133.32 134.1 134.2 134.3 134.4 134.5 134.6 134.7 134.8 134.9 134.10 134.11 134.12 134.13 134.14 134.15 134.16 134.17 134.18 134.19 134.20 134.21 134.22 134.23 134.24 134.25 134.26 134.27 134.28 134.29 134.30
134.31
135.1 135.2 135.3 135.4 135.5 135.6 135.7 135.8 135.9 135.10 135.11 135.12 135.13 135.14 135.15 135.16 135.17 135.18 135.19 135.20 135.21 135.22 135.23 135.24 135.25 135.26 135.27 135.28 135.29 135.30 135.31 135.32 136.1 136.2 136.3 136.4 136.5 136.6 136.7 136.8 136.9 136.10 136.11 136.12 136.13 136.14 136.15 136.16 136.17 136.18 136.19 136.20 136.21 136.22 136.23 136.24
136.25
136.26 136.27 136.28 136.29 136.30 137.1 137.2 137.3 137.4 137.5 137.6 137.7 137.8 137.9 137.10 137.11 137.12 137.13 137.14
137.15
137.16 137.17 137.18 137.19 137.20
137.21
137.22 137.23 137.24 137.25 137.26 137.27 137.28 137.29 137.30 138.1 138.2 138.3 138.4 138.5 138.6 138.7 138.8 138.9 138.10 138.11 138.12 138.13 138.14 138.15 138.16 138.17 138.18 138.19 138.20 138.21 138.22 138.23 138.24 138.25 138.26 138.27 138.28 138.29 138.30 138.31
139.1 139.2 139.3 139.4 139.5
139.6 139.7
139.8 139.9 139.10 139.11 139.12 139.13 139.14
139.15
139.16 139.17 139.18 139.19 139.20 139.21 139.22 139.23
139.24 139.25 139.26 139.27 139.28 139.29 140.1 140.2 140.3 140.4 140.5 140.6 140.7 140.8 140.9 140.10 140.11 140.12 140.13 140.14 140.15 140.16 140.17 140.18 140.19 140.20 140.21
140.22 140.23 140.24 140.25 140.26 140.27 140.28 140.29 140.30 140.31 141.1 141.2 141.3 141.4 141.5 141.6 141.7 141.8 141.9 141.10 141.11 141.12 141.13 141.14 141.15 141.16 141.17 141.18 141.19 141.20 141.21 141.22 141.23 141.24 141.25 141.26 141.27 141.28 141.29 141.30 141.31 141.32 142.1 142.2 142.3 142.4
142.5 142.6 142.7 142.8 142.9 142.10 142.11
142.12 142.13 142.14 142.15 142.16 142.17 142.18 142.19 142.20 142.21 142.22 142.23 142.24 142.25 142.26 142.27 142.28 142.29 142.30 142.31 143.1 143.2
143.3
143.4 143.5 143.6 143.7 143.8 143.9 143.10 143.11 143.12 143.13 143.14 143.15 143.16 143.17 143.18 143.19 143.20 143.21 143.22 143.23 143.24 143.25 143.26 143.27 143.28 143.29 143.30 143.31 143.32 143.33 144.1 144.2
144.3 144.4
144.5 144.6 144.7 144.8 144.9 144.10 144.11 144.12 144.13 144.14 144.15 144.16 144.17 144.18 144.19 144.20 144.21 144.22 144.23 144.24 144.25 144.26 144.27 144.28
145.1 145.2 145.3 145.4 145.5 145.6 145.7 145.8 145.9 145.10 145.11 145.12 145.13 145.14 145.15 145.16 145.17 145.18 145.19 145.20 145.21 145.22 145.23 145.24 145.25 145.26 145.27 145.28 145.29 145.30 145.31 145.32 145.33 146.1 146.2 146.3 146.4 146.5 146.6 146.7 146.8 146.9 146.10 146.11 146.12 146.13 146.14 146.15 146.16 146.17 146.18 146.19 146.20 146.21 146.22 146.23 146.24
146.25 146.26
146.27 146.28 146.29 146.30 146.31 146.32 147.1 147.2 147.3 147.4 147.5 147.6 147.7 147.8 147.9 147.10 147.11 147.12 147.13 147.14 147.15 147.16 147.17 147.18 147.19 147.20 147.21 147.22 147.23 147.24
147.25 147.26
147.27 147.28 147.29 147.30 148.1 148.2
148.3 148.4
148.5 148.6 148.7 148.8 148.9 148.10 148.11 148.12 148.13 148.14 148.15 148.16 148.17 148.18 148.19 148.20 148.21 148.22 148.23 148.24 148.25 148.26 148.27 148.28 148.29 149.1 149.2 149.3 149.4 149.5
149.6 149.7 149.8 149.9 149.10 149.11 149.12 149.13 149.14
149.15 149.16 149.17 149.18 149.19 149.20 149.21 149.22 149.23 149.24 149.25 149.26 149.27 149.28 149.29 149.30 149.31 150.1 150.2 150.3 150.4 150.5 150.6 150.7 150.8 150.9 150.10 150.11 150.12 150.13 150.14
150.15
150.16 150.17 150.18 150.19 150.20 150.21 150.22 150.23 150.24 150.25 150.26 150.27 150.28 150.29 150.30 150.31 150.32 150.33 151.1 151.2 151.3 151.4 151.5 151.6 151.7 151.8 151.9 151.10 151.11 151.12 151.13 151.14 151.15 151.16 151.17 151.18 151.19 151.20 151.21 151.22 151.23 151.24 151.25 151.26 151.27 151.28 151.29 151.30 151.31 151.32 151.33 152.1 152.2
152.3 152.4 152.5 152.6 152.7 152.8 152.9 152.10 152.11 152.12 152.13 152.14 152.15 152.16 152.17 152.18 152.19 152.20 152.21 152.22 152.23 152.24 152.25 152.26 152.27 152.28 152.29 152.30 152.31 152.32 152.33 153.1 153.2 153.3 153.4 153.5 153.6 153.7 153.8 153.9 153.10 153.11 153.12 153.13 153.14 153.15
153.16 153.17 153.18 153.19 153.20 153.21 153.22 153.23 153.24 153.25 153.26 153.27 153.28 153.29 153.30 153.31 153.32 153.33 153.34 154.1 154.2 154.3 154.4 154.5 154.6 154.7 154.8 154.9 154.10 154.11 154.12 154.13 154.14 154.15 154.16 154.17 154.18 154.19 154.20 154.21 154.22 154.23 154.24 154.25 154.26 154.27 154.28 154.29 154.30 154.31 154.32
155.1 155.2 155.3 155.4 155.5 155.6 155.7 155.8 155.9 155.10 155.11 155.12 155.13 155.14 155.15 155.16 155.17 155.18 155.19 155.20 155.21 155.22 155.23 155.24 155.25 155.26 155.27 155.28 155.29 155.30 155.31 155.32 155.33 155.34 156.1 156.2 156.3 156.4 156.5 156.6 156.7 156.8 156.9 156.10 156.11 156.12 156.13 156.14 156.15 156.16 156.17 156.18 156.19 156.20 156.21 156.22 156.23 156.24 156.25 156.26 156.27 156.28 156.29 156.30 156.31 156.32 156.33 157.1 157.2 157.3 157.4 157.5 157.6 157.7 157.8 157.9 157.10 157.11 157.12 157.13 157.14 157.15 157.16 157.17
157.18
157.19 157.20 157.21 157.22 157.23 157.24 157.25 157.26 157.27 157.28 157.29 157.30 157.31 158.1 158.2 158.3 158.4 158.5 158.6 158.7 158.8 158.9 158.10 158.11 158.12 158.13 158.14 158.15 158.16 158.17 158.18 158.19 158.20 158.21 158.22 158.23 158.24 158.25 158.26
158.27 158.28 158.29 158.30 158.31 159.1 159.2 159.3 159.4 159.5 159.6 159.7 159.8 159.9 159.10 159.11 159.12 159.13 159.14 159.15 159.16 159.17 159.18 159.19 159.20 159.21 159.22 159.23 159.24 159.25 159.26 159.27 159.28 159.29 159.30 159.31 159.32 159.33 159.34 160.1 160.2 160.3
160.4 160.5 160.6 160.7 160.8 160.9 160.10 160.11 160.12 160.13 160.14 160.15 160.16 160.17 160.18 160.19 160.20 160.21 160.22 160.23 160.24 160.25 160.26 160.27 160.28 160.29 160.30 160.31 160.32 160.33 160.34 161.1 161.2 161.3 161.4 161.5 161.6 161.7 161.8 161.9 161.10 161.11 161.12 161.13 161.14 161.15 161.16 161.17 161.18 161.19 161.20 161.21 161.22 161.23 161.24 161.25 161.26 161.27 161.28 161.29 161.30 161.31 161.32 161.33 161.34 161.35 162.1 162.2 162.3 162.4 162.5 162.6 162.7 162.8 162.9 162.10 162.11 162.12 162.13 162.14 162.15 162.16 162.17 162.18 162.19 162.20 162.21 162.22 162.23 162.24 162.25 162.26 162.27 162.28 162.29 162.30 162.31 162.32 162.33 162.34 163.1 163.2 163.3 163.4 163.5 163.6
163.7 163.8
163.9 163.10 163.11 163.12 163.13 163.14 163.15 163.16 163.17 163.18 163.19 163.20 163.21 163.22 163.23 163.24
163.25
163.26 163.27 163.28 163.29 163.30 163.31 164.1 164.2 164.3 164.4 164.5 164.6 164.7 164.8 164.9
164.10
164.11 164.12 164.13 164.14 164.15 164.16 164.17 164.18
164.19
164.20 164.21 164.22 164.23 164.24 164.25 164.26
164.27 164.28 164.29 164.30 164.31 165.1
165.2 165.3 165.4 165.5 165.6
165.7
165.8 165.9 165.10 165.11
165.12
165.13 165.14 165.15 165.16 165.17
165.18
165.19 165.20 165.21 165.22 165.23 165.24 165.25 165.26 165.27 165.28 165.29 165.30
166.1
166.2 166.3 166.4 166.5 166.6 166.7 166.8 166.9 166.10 166.11 166.12 166.13 166.14 166.15 166.16 166.17 166.18 166.19 166.20 166.21 166.22 166.23 166.24 166.25 166.26 166.27 166.28 166.29 166.30 166.31 166.32 167.1 167.2 167.3 167.4 167.5 167.6 167.7 167.8
167.9 167.10
167.11 167.12 167.13 167.14 167.15 167.16 167.17 167.18 167.19 167.20 167.21 167.22 167.23 167.24 167.25 167.26 167.27 167.28 167.29
168.1 168.2 168.3 168.4 168.5 168.6 168.7 168.8 168.9
168.10
168.11 168.12 168.13 168.14 168.15 168.16 168.17 168.18
168.19
168.20 168.21 168.22 168.23 168.24 168.25 168.26 168.27 168.28 168.29 169.1 169.2 169.3 169.4 169.5 169.6 169.7 169.8 169.9 169.10 169.11 169.12
169.13
169.14 169.15 169.16 169.17 169.18 169.19 169.20 169.21 169.22 169.23
169.24
169.25 169.26 169.27 169.28
169.29
170.1 170.2 170.3 170.4 170.5 170.6 170.7 170.8 170.9 170.10 170.11 170.12
170.13
170.14 170.15 170.16 170.17 170.18 170.19 170.20 170.21 170.22
170.23
170.24 170.25 170.26 170.27 170.28 170.29 171.1 171.2 171.3 171.4 171.5 171.6 171.7 171.8 171.9 171.10
171.11
171.12 171.13 171.14 171.15 171.16 171.17
171.18
171.19 171.20 171.21 171.22 171.23 171.24 171.25 171.26 171.27 171.28 171.29 171.30
171.31
172.1 172.2 172.3 172.4 172.5 172.6 172.7
172.8
172.9 172.10 172.11 172.12 172.13 172.14 172.15 172.16
172.17
172.18 172.19 172.20 172.21 172.22 172.23 172.24 172.25 172.26 172.27 172.28 172.29 172.30 173.1 173.2 173.3 173.4 173.5 173.6 173.7 173.8
173.9
173.10 173.11 173.12 173.13 173.14 173.15 173.16 173.17 173.18 173.19 173.20 173.21 173.22 173.23 173.24 173.25
173.26 173.27 173.28 173.29 173.30 173.31 173.32 174.1 174.2 174.3 174.4 174.5 174.6 174.7 174.8 174.9 174.10 174.11 174.12 174.13 174.14 174.15 174.16 174.17 174.18 174.19 174.20 174.21 174.22 174.23 174.24 174.25 174.26 174.27 174.28 174.29 174.30 174.31 174.32 174.33 175.1 175.2
175.3 175.4 175.5 175.6 175.7 175.8 175.9 175.10 175.11 175.12 175.13 175.14 175.15 175.16 175.17 175.18 175.19 175.20 175.21 175.22 175.23 175.24 175.25 175.26 175.27 175.28 175.29 175.30 175.31 175.32 175.33 176.1 176.2 176.3 176.4 176.5 176.6 176.7 176.8 176.9 176.10 176.11 176.12 176.13 176.14 176.15 176.16 176.17 176.18 176.19 176.20 176.21 176.22 176.23 176.24 176.25 176.26 176.27 176.28 176.29 176.30 176.31 176.32 176.33 176.34
177.1 177.2 177.3 177.4 177.5 177.6 177.7 177.8 177.9 177.10 177.11 177.12 177.13 177.14 177.15 177.16 177.17 177.18 177.19 177.20 177.21 177.22 177.23 177.24 177.25 177.26 177.27 177.28 177.29 177.30 177.31 177.32 177.33
178.1 178.2 178.3 178.4 178.5 178.6 178.7 178.8 178.9 178.10 178.11 178.12 178.13 178.14 178.15 178.16 178.17
178.18 178.19 178.20 178.21 178.22 178.23 178.24 178.25 178.26 178.27 178.28 178.29
178.30 178.31 178.32 178.33 179.1 179.2 179.3 179.4 179.5 179.6 179.7 179.8 179.9 179.10 179.11 179.12 179.13 179.14 179.15 179.16 179.17 179.18 179.19 179.20 179.21 179.22 179.23 179.24 179.25 179.26 179.27 179.28 179.29 179.30 179.31 179.32 180.1 180.2 180.3 180.4 180.5 180.6 180.7 180.8 180.9 180.10 180.11 180.12 180.13 180.14 180.15 180.16 180.17 180.18 180.19 180.20 180.21 180.22 180.23 180.24 180.25 180.26 180.27 180.28 180.29 180.30 180.31 180.32 181.1 181.2 181.3 181.4 181.5 181.6 181.7 181.8 181.9 181.10 181.11 181.12 181.13 181.14 181.15
181.16 181.17 181.18 181.19 181.20 181.21 181.22 181.23 181.24 181.25 181.26 181.27 181.28 181.29 181.30 181.31 181.32 181.33 182.1 182.2 182.3 182.4 182.5 182.6 182.7 182.8
182.9 182.10 182.11 182.12 182.13 182.14 182.15 182.16 182.17 182.18 182.19 182.20
182.21 182.22 182.23 182.24 182.25 182.26 182.27 182.28 182.29 182.30 182.31 182.32 183.1 183.2 183.3 183.4 183.5 183.6 183.7
183.8 183.9 183.10 183.11 183.12 183.13 183.14 183.15 183.16 183.17 183.18 183.19 183.20 183.21 183.22 183.23 183.24 183.25
183.26
183.27 183.28 183.29 183.30 183.31 183.32 183.33 184.1 184.2 184.3 184.4 184.5 184.6 184.7 184.8 184.9 184.10 184.11 184.12 184.13 184.14 184.15 184.16 184.17 184.18
184.19
184.20 184.21 184.22 184.23 184.24 184.25 184.26 184.27 184.28 184.29 184.30 184.31 184.32 184.33 185.1 185.2 185.3 185.4 185.5 185.6 185.7 185.8 185.9 185.10
185.11
185.12 185.13 185.14 185.15 185.16 185.17 185.18 185.19 185.20 185.21 185.22 185.23 185.24 185.25 185.26 185.27 185.28 185.29 185.30
186.1 186.2 186.3 186.4 186.5 186.6 186.7 186.8 186.9 186.10 186.11 186.12 186.13 186.14 186.15 186.16 186.17
186.18 186.19 186.20 186.21 186.22 186.23 186.24 186.25 186.26 186.27 186.28 186.29 186.30 186.31 187.1 187.2 187.3 187.4 187.5 187.6 187.7 187.8 187.9 187.10 187.11 187.12 187.13
187.14 187.15 187.16 187.17 187.18 187.19 187.20 187.21 187.22 187.23 187.24 187.25 187.26 187.27 187.28 187.29
188.1 188.2 188.3 188.4 188.5 188.6 188.7 188.8 188.9 188.10 188.11 188.12 188.13 188.14 188.15 188.16
188.17 188.18 188.19 188.20 188.21 188.22 188.23 188.24 188.25 188.26 188.27 188.28 188.29 189.1 189.2 189.3 189.4 189.5 189.6 189.7 189.8 189.9 189.10 189.11
189.12
189.13 189.14 189.15 189.16 189.17 189.18 189.19 189.20 189.21 189.22 189.23 189.24 189.25 189.26 189.27 189.28 189.29 189.30 189.31 189.32 189.33 190.1 190.2 190.3 190.4 190.5 190.6 190.7 190.8 190.9 190.10 190.11 190.12 190.13 190.14 190.15 190.16 190.17 190.18 190.19 190.20 190.21 190.22 190.23 190.24 190.25 190.26 190.27 190.28 190.29 190.30 190.31 191.1 191.2 191.3 191.4 191.5 191.6
191.7 191.8 191.9 191.10 191.11 191.12 191.13 191.14 191.15 191.16 191.17 191.18 191.19 191.20 191.21 191.22 191.23 191.24 191.25 191.26 191.27 191.28 191.29 191.30 192.1 192.2 192.3 192.4 192.5 192.6 192.7 192.8 192.9 192.10 192.11 192.12 192.13 192.14 192.15 192.16 192.17 192.18 192.19 192.20 192.21 192.22 192.23 192.24 192.25 192.26
192.27 192.28 192.29 192.30 192.31
192.32
193.1 193.2
193.3 193.4 193.5 193.6 193.7 193.8 193.9 193.10 193.11 193.12 193.13 193.14 193.15 193.16 193.17 193.18 193.19 193.20 193.21 193.22 193.23 193.24 193.25 193.26 193.27 193.28 193.29 193.30 193.31 193.32 193.33
194.1 194.2 194.3 194.4 194.5 194.6 194.7 194.8 194.9 194.10 194.11 194.12 194.13 194.14 194.15 194.16 194.17 194.18 194.19 194.20 194.21 194.22 194.23 194.24 194.25 194.26 194.27 194.28
194.29
195.1 195.2 195.3 195.4 195.5 195.6 195.7
195.8 195.9 195.10 195.11 195.12 195.13 195.14 195.15 195.16 195.17
195.18 195.19 195.20 195.21
195.22 195.23
195.24 195.25 195.26 195.27 195.28 195.29 195.30 195.31 196.1 196.2 196.3 196.4 196.5 196.6 196.7 196.8 196.9 196.10 196.11 196.12 196.13 196.14 196.15 196.16 196.17 196.18 196.19 196.20 196.21 196.22 196.23 196.24 196.25 196.26 196.27 196.28 196.29 196.30 196.31 197.1 197.2
197.3 197.4 197.5 197.6 197.7 197.8 197.9 197.10 197.11 197.12 197.13 197.14
197.15
197.16 197.17 197.18 197.19 197.20 197.21 197.22 197.23 197.24 197.25 197.26 197.27 197.28 197.29 197.30 197.31 197.32 198.1 198.2 198.3 198.4 198.5 198.6 198.7 198.8 198.9 198.10 198.11 198.12 198.13 198.14 198.15 198.16 198.17 198.18 198.19 198.20 198.21 198.22 198.23 198.24 198.25 198.26 198.27 198.28 198.29 198.30 198.31 198.32 198.33 198.34 198.35 199.1 199.2 199.3 199.4 199.5 199.6 199.7 199.8 199.9
199.10 199.11 199.12 199.13 199.14 199.15 199.16 199.17 199.18 199.19 199.20 199.21 199.22 199.23 199.24 199.25 199.26 199.27 199.28 199.29 199.30 199.31 199.32 200.1 200.2 200.3 200.4 200.5 200.6 200.7 200.8 200.9 200.10 200.11 200.12 200.13 200.14 200.15 200.16 200.17 200.18 200.19 200.20 200.21 200.22 200.23 200.24 200.25 200.26 200.27 200.28 200.29 200.30 200.31 200.32 201.1 201.2 201.3 201.4 201.5 201.6 201.7 201.8 201.9 201.10 201.11 201.12 201.13
201.14
201.15 201.16 201.17 201.18 201.19 201.20 201.21 201.22 201.23 201.24 201.25 201.26 201.27 201.28 201.29 201.30 201.31 201.32 201.33 202.1 202.2 202.3 202.4 202.5 202.6 202.7 202.8 202.9 202.10 202.11 202.12 202.13 202.14 202.15 202.16 202.17 202.18 202.19 202.20 202.21 202.22 202.23 202.24 202.25 202.26 202.27 202.28 202.29 202.30 202.31 202.32 202.33 202.34 203.1 203.2 203.3 203.4 203.5
203.6 203.7 203.8 203.9 203.10 203.11 203.12 203.13 203.14 203.15 203.16 203.17 203.18 203.19 203.20 203.21 203.22 203.23 203.24 203.25 203.26 203.27 203.28 203.29 203.30 203.31 204.1 204.2 204.3 204.4 204.5 204.6 204.7 204.8 204.9 204.10 204.11 204.12 204.13 204.14 204.15 204.16 204.17 204.18 204.19 204.20 204.21 204.22 204.23 204.24 204.25 204.26 204.27 204.28 204.29 204.30 204.31 204.32 204.33 204.34 204.35 205.1 205.2 205.3 205.4 205.5 205.6 205.7 205.8 205.9 205.10 205.11 205.12
205.13
205.14 205.15 205.16 205.17 205.18 205.19 205.20 205.21 205.22 205.23 205.24 205.25 205.26 205.27 205.28 205.29 205.30 205.31 205.32 206.1 206.2 206.3 206.4 206.5 206.6 206.7 206.8 206.9 206.10 206.11 206.12 206.13 206.14 206.15 206.16 206.17 206.18 206.19 206.20 206.21 206.22 206.23 206.24 206.25 206.26 206.27 206.28 206.29 206.30 206.31 206.32 207.1 207.2 207.3 207.4 207.5 207.6 207.7 207.8 207.9 207.10 207.11 207.12 207.13 207.14 207.15 207.16 207.17 207.18 207.19 207.20 207.21 207.22 207.23 207.24 207.25 207.26 207.27 207.28 207.29 207.30 207.31 207.32 207.33 208.1 208.2 208.3 208.4 208.5 208.6 208.7 208.8 208.9 208.10 208.11 208.12 208.13 208.14 208.15 208.16 208.17 208.18 208.19 208.20 208.21 208.22 208.23 208.24 208.25 208.26 208.27 208.28 208.29 208.30 208.31 208.32 209.1 209.2 209.3 209.4 209.5 209.6 209.7 209.8 209.9 209.10 209.11 209.12 209.13 209.14 209.15 209.16 209.17 209.18 209.19 209.20 209.21 209.22 209.23 209.24 209.25 209.26 209.27 209.28 209.29 209.30 209.31 209.32 209.33 210.1 210.2 210.3 210.4 210.5 210.6 210.7 210.8 210.9 210.10 210.11 210.12 210.13 210.14 210.15 210.16 210.17 210.18 210.19 210.20 210.21 210.22 210.23 210.24 210.25 210.26 210.27 210.28 210.29 210.30 210.31 210.32 210.33 210.34 210.35 211.1 211.2 211.3 211.4 211.5 211.6 211.7 211.8 211.9 211.10 211.11 211.12 211.13 211.14 211.15 211.16 211.17 211.18 211.19 211.20 211.21 211.22 211.23 211.24 211.25 211.26 211.27 211.28 211.29 211.30 211.31 211.32 211.33 211.34 211.35 212.1 212.2 212.3 212.4 212.5 212.6 212.7 212.8 212.9 212.10 212.11 212.12 212.13 212.14 212.15 212.16 212.17 212.18 212.19 212.20 212.21 212.22 212.23 212.24 212.25 212.26 212.27 212.28 212.29 212.30 212.31 212.32 212.33 213.1 213.2 213.3 213.4 213.5 213.6 213.7 213.8 213.9 213.10 213.11 213.12 213.13 213.14 213.15 213.16 213.17 213.18 213.19 213.20 213.21 213.22 213.23
213.24 213.25 213.26 213.27 213.28 213.29 213.30 213.31 213.32 213.33 214.1 214.2 214.3 214.4 214.5 214.6 214.7 214.8 214.9 214.10 214.11 214.12 214.13 214.14 214.15 214.16 214.17 214.18 214.19 214.20 214.21 214.22 214.23 214.24 214.25 214.26 214.27 214.28 214.29 214.30 214.31 214.32 214.33 214.34 215.1 215.2 215.3 215.4 215.5 215.6 215.7 215.8 215.9 215.10 215.11 215.12 215.13 215.14 215.15 215.16 215.17 215.18 215.19 215.20 215.21 215.22 215.23 215.24 215.25 215.26 215.27 215.28 215.29 215.30 215.31 215.32 215.33 215.34 216.1 216.2 216.3 216.4 216.5 216.6 216.7 216.8 216.9 216.10
216.11 216.12 216.13 216.14 216.15 216.16 216.17 216.18 216.19 216.20 216.21 216.22 216.23 216.24 216.25 216.26 216.27 216.28 216.29 216.30 216.31 216.32 217.1 217.2 217.3 217.4 217.5 217.6 217.7
217.8
217.9 217.10 217.11 217.12 217.13 217.14 217.15 217.16 217.17 217.18 217.19 217.20
217.21
217.22 217.23 217.24 217.25 217.26 217.27 217.28 217.29 217.30 217.31 217.32 217.33
218.1
218.2 218.3 218.4 218.5 218.6 218.7 218.8 218.9 218.10 218.11 218.12 218.13 218.14 218.15 218.16 218.17 218.18 218.19 218.20 218.21 218.22 218.23 218.24
218.25
218.26 218.27 218.28 218.29 218.30 218.31 219.1 219.2 219.3 219.4 219.5 219.6 219.7 219.8 219.9 219.10 219.11 219.12 219.13 219.14 219.15 219.16 219.17
219.18
219.19 219.20 219.21 219.22
219.23 219.24 219.25 219.26 219.27 219.28 219.29 219.30 219.31 219.32 220.1 220.2
220.3
220.4 220.5 220.6 220.7 220.8
220.9 220.10 220.11 220.12 220.13
220.14 220.15 220.16 220.17 220.18 220.19 220.20 220.21 220.22 220.23 220.24 220.25 220.26 220.27 220.28 220.29 220.30 221.1 221.2 221.3 221.4 221.5 221.6 221.7 221.8 221.9 221.10 221.11 221.12 221.13 221.14 221.15 221.16 221.17 221.18 221.19 221.20 221.21 221.22 221.23 221.24 221.25 221.26 221.27 221.28 221.29 221.30 221.31 222.1 222.2 222.3
222.4
222.5 222.6 222.7 222.8 222.9 222.10 222.11 222.12 222.13 222.14 222.15 222.16 222.17 222.18 222.19 222.20 222.21 222.22 222.23 222.24 222.25 222.26 222.27 222.28 222.29 222.30 222.31 222.32 223.1 223.2 223.3 223.4 223.5 223.6
223.7 223.8 223.9 223.10 223.11 223.12 223.13 223.14 223.15 223.16 223.17 223.18 223.19 223.20 223.21 223.22 223.23 223.24 223.25 223.26
223.27 223.28 223.29 223.30 223.31 224.1 224.2 224.3 224.4 224.5 224.6 224.7 224.8
224.9
224.10 224.11 224.12 224.13 224.14 224.15 224.16 224.17 224.18 224.19 224.20 224.21
224.22
224.23 224.24 224.25 224.26 224.27 224.28 224.29 224.30 225.1 225.2 225.3 225.4 225.5 225.6 225.7 225.8 225.9 225.10 225.11 225.12 225.13 225.14 225.15 225.16 225.17 225.18 225.19 225.20
225.21 225.22 225.23 225.24 225.25 225.26 225.27 225.28 225.29 225.30 225.31 226.1 226.2 226.3 226.4 226.5 226.6 226.7 226.8 226.9 226.10 226.11 226.12 226.13 226.14 226.15 226.16 226.17 226.18 226.19 226.20 226.21 226.22 226.23 226.24 226.25 226.26
226.27
226.28 226.29 226.30 226.31 227.1 227.2 227.3 227.4 227.5 227.6 227.7 227.8 227.9 227.10 227.11 227.12 227.13 227.14 227.15 227.16 227.17 227.18 227.19 227.20 227.21 227.22 227.23 227.24 227.25 227.26 227.27 227.28 227.29 227.30 227.31 227.32 227.33 227.34 228.1 228.2 228.3 228.4 228.5 228.6 228.7 228.8 228.9 228.10 228.11 228.12 228.13 228.14 228.15 228.16 228.17 228.18 228.19 228.20 228.21 228.22 228.23 228.24 228.25 228.26 228.27 228.28 228.29 228.30 228.31 228.32 228.33 228.34 229.1 229.2 229.3 229.4 229.5 229.6 229.7 229.8 229.9 229.10 229.11 229.12 229.13 229.14 229.15 229.16 229.17 229.18 229.19 229.20 229.21 229.22 229.23 229.24 229.25 229.26 229.27 229.28 229.29 229.30 229.31 229.32 229.33 229.34 229.35 230.1 230.2 230.3 230.4 230.5 230.6 230.7 230.8 230.9 230.10 230.11 230.12 230.13 230.14 230.15 230.16 230.17 230.18 230.19 230.20 230.21 230.22 230.23 230.24 230.25 230.26 230.27 230.28 230.29 230.30 230.31 231.1 231.2 231.3 231.4 231.5 231.6 231.7 231.8 231.9
231.10 231.11 231.12 231.13 231.14 231.15 231.16 231.17 231.18 231.19 231.20 231.21 231.22 231.23 231.24 231.25 231.26 231.27 231.28 231.29 231.30 232.1 232.2 232.3 232.4 232.5 232.6 232.7 232.8 232.9 232.10 232.11 232.12 232.13 232.14 232.15 232.16 232.17 232.18 232.19 232.20 232.21 232.22 232.23 232.24 232.25 232.26 232.27 232.28 232.29 232.30 232.31 232.32 232.33 233.1 233.2 233.3 233.4 233.5 233.6 233.7 233.8
233.9 233.10 233.11 233.12 233.13 233.14 233.15 233.16 233.17 233.18 233.19 233.20 233.21 233.22 233.23 233.24 233.25 233.26 233.27 233.28 233.29 233.30 233.31 233.32 234.1 234.2 234.3 234.4 234.5 234.6 234.7 234.8 234.9 234.10 234.11 234.12 234.13 234.14 234.15 234.16 234.17 234.18 234.19 234.20 234.21 234.22 234.23 234.24 234.25 234.26 234.27 234.28 234.29 234.30 234.31 234.32
235.1 235.2 235.3 235.4 235.5 235.6 235.7 235.8 235.9 235.10 235.11 235.12 235.13 235.14 235.15 235.16 235.17 235.18 235.19 235.20 235.21 235.22 235.23 235.24 235.25 235.26 235.27 235.28 235.29 235.30 235.31 235.32 235.33 236.1 236.2 236.3 236.4 236.5 236.6 236.7 236.8 236.9 236.10 236.11 236.12 236.13 236.14 236.15 236.16 236.17 236.18 236.19 236.20 236.21 236.22 236.23 236.24 236.25 236.26 236.27 236.28 236.29 236.30 236.31 236.32 237.1 237.2 237.3 237.4 237.5 237.6 237.7 237.8 237.9 237.10 237.11 237.12 237.13
237.14 237.15 237.16 237.17 237.18 237.19 237.20 237.21 237.22 237.23 237.24 237.25 237.26 237.27 237.28 237.29 237.30 237.31 237.32 238.1 238.2 238.3 238.4 238.5 238.6 238.7 238.8 238.9 238.10 238.11 238.12 238.13 238.14
238.15 238.16 238.17 238.18 238.19 238.20 238.21 238.22 238.23 238.24
238.25
238.26 238.27 238.28 238.29 238.30 238.31 239.1 239.2 239.3 239.4 239.5 239.6 239.7 239.8 239.9 239.10 239.11 239.12 239.13 239.14 239.15 239.16 239.17 239.18 239.19 239.20 239.21 239.22 239.23 239.24 239.25 239.26 239.27 239.28 239.29 239.30 239.31 239.32 240.1 240.2 240.3
240.4 240.5 240.6 240.7 240.8 240.9 240.10 240.11 240.12 240.13 240.14 240.15 240.16 240.17 240.18 240.19 240.20 240.21 240.22 240.23 240.24 240.25 240.26 240.27
240.28 240.29 240.30 240.31 241.1 241.2
241.3
241.4 241.5 241.6 241.7 241.8
241.9 241.10 241.11 241.12 241.13 241.14 241.15 241.16 241.17
241.18 241.19
241.20 241.21 241.22 241.23
241.24 241.25
241.26 241.27 241.28 241.29 242.1 242.2
242.3 242.4
242.5 242.6 242.7 242.8
242.9 242.10
242.11 242.12 242.13 242.14 242.15 242.16 242.17
242.18 242.19
242.20 242.21 242.22 242.23 242.24 242.25 242.26 242.27 242.28 242.29 242.30
243.1 243.2
243.3 243.4 243.5 243.6 243.7 243.8 243.9
243.10 243.11
243.12 243.13 243.14 243.15 243.16 243.17 243.18 243.19 243.20 243.21
243.22 243.23
243.24 243.25 243.26 243.27 243.28 243.29 243.30 244.1 244.2 244.3 244.4 244.5 244.6 244.7 244.8 244.9 244.10 244.11 244.12 244.13 244.14 244.15 244.16 244.17 244.18 244.19 244.20
244.21 244.22
244.23 244.24 244.25 244.26 244.27 244.28 244.29 244.30 245.1 245.2 245.3 245.4 245.5 245.6 245.7 245.8 245.9 245.10 245.11 245.12
245.13 245.14
245.15 245.16 245.17 245.18 245.19 245.20 245.21 245.22 245.23 245.24 245.25 245.26 245.27 245.28 245.29 245.30 245.31 246.1 246.2 246.3 246.4 246.5 246.6 246.7 246.8 246.9 246.10 246.11 246.12 246.13 246.14 246.15 246.16 246.17 246.18 246.19 246.20 246.21 246.22 246.23 246.24 246.25 246.26 246.27 246.28 246.29 246.30 246.31 246.32 246.33 247.1 247.2 247.3 247.4 247.5
247.6 247.7
247.8 247.9 247.10 247.11 247.12 247.13
247.14 247.15 247.16 247.17 247.18 247.19 247.20 247.21
247.22 247.23 247.24 247.25 247.26 247.27 247.28 247.29 247.30 248.1 248.2 248.3 248.4 248.5 248.6 248.7 248.8 248.9 248.10 248.11 248.12 248.13 248.14 248.15 248.16 248.17 248.18 248.19 248.20 248.21 248.22 248.23 248.24 248.25 248.26 248.27 248.28 248.29 248.30 248.31 249.1 249.2 249.3 249.4 249.5 249.6 249.7 249.8 249.9 249.10 249.11 249.12 249.13 249.14 249.15 249.16 249.17 249.18 249.19 249.20 249.21 249.22 249.23 249.24 249.25 249.26 249.27 249.28 249.29 249.30 250.1 250.2 250.3 250.4 250.5 250.6 250.7 250.8 250.9 250.10 250.11 250.12 250.13 250.14 250.15 250.16 250.17 250.18 250.19 250.20 250.21 250.22 250.23 250.24 250.25 250.26 250.27
250.28 250.29 250.30
251.1 251.2 251.3 251.4 251.5 251.6 251.7 251.8
251.9
251.10 251.11 251.12 251.13 251.14 251.15 251.16 251.17 251.18 251.19 251.20 251.21 251.22 251.23 251.24 251.25 251.26 251.27 251.28
251.29 251.30 251.31
252.1 252.2 252.3 252.4 252.5 252.6 252.7 252.8 252.9 252.10 252.11 252.12 252.13 252.14 252.15 252.16 252.17 252.18 252.19 252.20 252.21 252.22 252.23 252.24 252.25 252.26 252.27 252.28 252.29 252.30 252.31 252.32 252.33 252.34 253.1 253.2 253.3 253.4 253.5 253.6 253.7 253.8 253.9 253.10 253.11 253.12 253.13 253.14 253.15 253.16 253.17 253.18 253.19 253.20 253.21 253.22 253.23 253.24 253.25 253.26 253.27 253.28 253.29 253.30 253.31 253.32 253.33 254.1 254.2 254.3 254.4 254.5 254.6 254.7 254.8 254.9 254.10 254.11 254.12 254.13 254.14 254.15 254.16 254.17 254.18 254.19 254.20 254.21 254.22 254.23 254.24 254.25 254.26 254.27 254.28
254.29 254.30 254.31 254.32 255.1 255.2 255.3 255.4 255.5 255.6 255.7
255.8
255.9 255.10 255.11 255.12 255.13 255.14 255.15 255.16 255.17 255.18 255.19 255.20
255.21 255.22 255.23 255.24 255.25 255.26 255.27 255.28 255.29 255.30 255.31 255.32 256.1 256.2 256.3 256.4 256.5 256.6 256.7 256.8 256.9 256.10 256.11 256.12 256.13 256.14 256.15
256.16 256.17 256.18
256.19 256.20 256.21
256.22
256.23 256.24 256.25 256.26 256.27 256.28 256.29
256.30
257.1 257.2 257.3 257.4 257.5
257.6
257.7 257.8 257.9 257.10
257.11
257.12 257.13 257.14 257.15 257.16 257.17 257.18 257.19 257.20 257.21 257.22
257.23
257.24 257.25 257.26 257.27 257.28 257.29 258.1 258.2 258.3 258.4 258.5 258.6 258.7 258.8 258.9 258.10 258.11 258.12 258.13 258.14 258.15 258.16 258.17 258.18
258.19
258.20 258.21 258.22 258.23 258.24 258.25 258.26 258.27 258.28 258.29 258.30 259.1 259.2 259.3 259.4 259.5 259.6
259.7
259.8 259.9 259.10 259.11 259.12 259.13 259.14 259.15 259.16 259.17 259.18 259.19 259.20 259.21 259.22 259.23 259.24 259.25 259.26 259.27 259.28
259.29
260.1 260.2 260.3 260.4 260.5 260.6 260.7 260.8 260.9 260.10 260.11 260.12 260.13 260.14 260.15 260.16 260.17 260.18 260.19 260.20
260.21
260.22 260.23 260.24 260.25 260.26 260.27 260.28 260.29 260.30 260.31 260.32 261.1 261.2 261.3 261.4 261.5 261.6 261.7 261.8 261.9 261.10 261.11 261.12 261.13 261.14 261.15 261.16 261.17 261.18 261.19 261.20 261.21
261.22 261.23 261.24 261.25 261.26 261.27 261.28 261.29 261.30 261.31 261.32
262.1 262.2 262.3 262.4 262.5 262.6 262.7 262.8 262.9 262.10 262.11 262.12 262.13 262.14 262.15 262.16 262.17 262.18 262.19 262.20 262.21 262.22 262.23 262.24 262.25 262.26 262.27 262.28 262.29 262.30 262.31 262.32 263.1 263.2 263.3 263.4 263.5 263.6 263.7 263.8 263.9 263.10 263.11 263.12 263.13 263.14 263.15 263.16 263.17 263.18 263.19 263.20 263.21 263.22 263.23
263.24
263.25 263.26 263.27 263.28 263.29 263.30 263.31 263.32 264.1 264.2 264.3 264.4
264.5
264.6 264.7 264.8 264.9 264.10 264.11 264.12 264.13 264.14 264.15 264.16 264.17 264.18 264.19 264.20 264.21 264.22 264.23 264.24 264.25 264.26 264.27 264.28 264.29 264.30 264.31 264.32 265.1 265.2 265.3 265.4 265.5 265.6 265.7 265.8 265.9 265.10 265.11 265.12 265.13 265.14 265.15 265.16 265.17 265.18 265.19 265.20 265.21 265.22 265.23 265.24 265.25 265.26 265.27 265.28 265.29 265.30 265.31 265.32 265.33 266.1 266.2 266.3 266.4 266.5 266.6 266.7 266.8 266.9 266.10 266.11 266.12 266.13 266.14 266.15 266.16 266.17 266.18 266.19 266.20 266.21 266.22 266.23 266.24
266.25 266.26 266.27 266.28 266.29 266.30 266.31 266.32 266.33 267.1 267.2 267.3 267.4 267.5 267.6 267.7 267.8 267.9 267.10 267.11 267.12 267.13 267.14 267.15 267.16 267.17 267.18 267.19 267.20 267.21 267.22 267.23 267.24
267.25
267.26 267.27 267.28 267.29 267.30 267.31 268.1 268.2 268.3 268.4 268.5 268.6 268.7 268.8 268.9 268.10 268.11 268.12 268.13 268.14 268.15 268.16 268.17 268.18 268.19 268.20 268.21 268.22 268.23 268.24 268.25 268.26 268.27 268.28 268.29 269.1 269.2
269.3
269.4 269.5 269.6 269.7 269.8 269.9 269.10 269.11
269.12
269.13 269.14 269.15 269.16 269.17 269.18 269.19 269.20 269.21 269.22 269.23 269.24 269.25 269.26 269.27 269.28 269.29 269.30 269.31 269.32 270.1 270.2 270.3 270.4 270.5 270.6 270.7 270.8 270.9 270.10 270.11 270.12 270.13 270.14 270.15 270.16 270.17 270.18 270.19 270.20 270.21 270.22 270.23 270.24 270.25 270.26 270.27 270.28 270.29
270.30 270.31 270.32
271.1 271.2 271.3 271.4 271.5 271.6
271.7 271.8 271.9 271.10 271.11 271.12 271.13 271.14 271.15 271.16 271.17 271.18 271.19 271.20 271.21 271.22 271.23 271.24 271.25 271.26 271.27 271.28 271.29 271.30 271.31 271.32 272.1 272.2 272.3 272.4 272.5 272.6 272.7 272.8 272.9 272.10 272.11 272.12 272.13 272.14 272.15 272.16 272.17 272.18 272.19 272.20 272.21 272.22 272.23 272.24 272.25 272.26 272.27 272.28 272.29 272.30 272.31 272.32 273.1 273.2 273.3 273.4 273.5
273.6
273.7 273.8 273.9 273.10 273.11 273.12 273.13 273.14 273.15 273.16 273.17 273.18 273.19 273.20 273.21 273.22 273.23
273.24
273.25 273.26 273.27 273.28 273.29 273.30 273.31 274.1 274.2 274.3 274.4 274.5 274.6 274.7 274.8 274.9 274.10 274.11 274.12 274.13 274.14 274.15 274.16 274.17 274.18 274.19 274.20 274.21 274.22 274.23 274.24 274.25 274.26 274.27 274.28 274.29 274.30 274.31 275.1 275.2 275.3 275.4 275.5 275.6 275.7 275.8 275.9 275.10 275.11 275.12 275.13 275.14 275.15 275.16 275.17 275.18 275.19 275.20 275.21 275.22 275.23 275.24 275.25 275.26 275.27 275.28 275.29 275.30 275.31 276.1 276.2 276.3 276.4 276.5 276.6 276.7 276.8 276.9
276.10 276.11 276.12 276.13 276.14 276.15 276.16 276.17 276.18 276.19 276.20 276.21 276.22 276.23 276.24 276.25 276.26 276.27 276.28 276.29 276.30 277.1 277.2 277.3 277.4 277.5 277.6 277.7 277.8 277.9 277.10 277.11 277.12 277.13 277.14 277.15 277.16 277.17 277.18 277.19 277.20 277.21 277.22 277.23 277.24
277.25
277.26 277.27 277.28 277.29 277.30 277.31 278.1 278.2 278.3 278.4 278.5 278.6 278.7 278.8 278.9 278.10 278.11 278.12 278.13 278.14 278.15 278.16 278.17 278.18 278.19 278.20 278.21 278.22 278.23 278.24 278.25 278.26 278.27 278.28 278.29 278.30 278.31 278.32 279.1 279.2 279.3 279.4 279.5 279.6 279.7 279.8 279.9 279.10 279.11 279.12 279.13 279.14 279.15 279.16 279.17 279.18 279.19 279.20 279.21 279.22 279.23 279.24 279.25 279.26 279.27 279.28 279.29 279.30 279.31 279.32 280.1 280.2 280.3 280.4 280.5 280.6 280.7 280.8 280.9 280.10 280.11 280.12 280.13 280.14 280.15 280.16 280.17 280.18 280.19 280.20 280.21 280.22 280.23 280.24 280.25 280.26 280.27 280.28 280.29 280.30 281.1 281.2 281.3 281.4 281.5 281.6 281.7 281.8 281.9 281.10 281.11 281.12 281.13 281.14 281.15 281.16 281.17 281.18 281.19 281.20 281.21 281.22 281.23 281.24 281.25 281.26 281.27 282.1 282.2 282.3 282.4 282.5 282.6 282.7 282.8 282.9 282.10 282.11 282.12 282.13 282.14 282.15 282.16 282.17 282.18 282.19 282.20 282.21 282.22 282.23 282.24 282.25 282.26 282.27 282.28 282.29 282.30 283.1 283.2 283.3 283.4 283.5 283.6 283.7 283.8 283.9 283.10 283.11 283.12 283.13 283.14 283.15 283.16 283.17 283.18 283.19 283.20 283.21 283.22 283.23 283.24 283.25 283.26 283.27 283.28 283.29 283.30 283.31
283.32 283.33 284.1 284.2 284.3 284.4 284.5
284.6 284.7 284.8 284.9 284.10 284.11 284.12 284.13 284.14 284.15 284.16 284.17 284.18 284.19 284.20 284.21 284.22 284.23 284.24 284.25 284.26 284.27 284.28 284.29 285.1 285.2 285.3 285.4 285.5
285.6
285.7 285.8 285.9 285.10 285.11 285.12 285.13 285.14 285.15 285.16 285.17 285.18 285.19 285.20 285.21 285.22 285.23 285.24 285.25 285.26 285.27 285.28 285.29 285.30 286.1 286.2 286.3 286.4 286.5 286.6 286.7 286.8 286.9 286.10 286.11 286.12 286.13 286.14 286.15 286.16 286.17 286.18 286.19 286.20 286.21 286.22 286.23 286.24 286.25 286.26 286.27 286.28 286.29 286.30 286.31
287.1 287.2 287.3
287.4 287.5 287.6 287.7 287.8 287.9 287.10 287.11 287.12 287.13 287.14 287.15 287.16 287.17 287.18 287.19 287.20 287.21 287.22 287.23 287.24 287.25 287.26 287.27 287.28 287.29 287.30 287.31 288.1 288.2 288.3 288.4 288.5 288.6 288.7 288.8 288.9 288.10 288.11 288.12 288.13 288.14 288.15 288.16 288.17 288.18 288.19 288.20 288.21 288.22 288.23 288.24 288.25 288.26 288.27 288.28 288.29 288.30 288.31 289.1 289.2 289.3 289.4 289.5 289.6 289.7 289.8
289.9 289.10 289.11
289.12 289.13 289.14 289.15 289.16 289.17 289.18 289.19 289.20 289.21 289.22 289.23 289.24 289.25 289.26 289.27 289.28 289.29 289.30 289.31 289.32 290.1 290.2 290.3 290.4 290.5 290.6 290.7 290.8 290.9 290.10 290.11 290.12 290.13 290.14 290.15 290.16 290.17 290.18 290.19 290.20 290.21 290.22 290.23 290.24 290.25 290.26 290.27 290.28 290.29
290.30 290.31 290.32
291.1 291.2 291.3 291.4 291.5 291.6 291.7 291.8 291.9 291.10 291.11 291.12 291.13 291.14 291.15 291.16 291.17 291.18 291.19 291.20 291.21 291.22 291.23 291.24 291.25 291.26 291.27 291.28 291.29 291.30 291.31 291.32 292.1 292.2 292.3 292.4 292.5 292.6 292.7 292.8 292.9 292.10 292.11 292.12 292.13 292.14 292.15 292.16 292.17 292.18 292.19 292.20 292.21 292.22 292.23 292.24 292.25 292.26 292.27 292.28 292.29 292.30 292.31 292.32
293.1 293.2 293.3
293.4 293.5 293.6 293.7 293.8 293.9 293.10 293.11 293.12 293.13 293.14 293.15 293.16 293.17 293.18 293.19 293.20 293.21 293.22 293.23 293.24 293.25 293.26 293.27 293.28 293.29 293.30 293.31 293.32 294.1 294.2 294.3 294.4 294.5 294.6 294.7 294.8 294.9 294.10 294.11 294.12 294.13 294.14 294.15 294.16 294.17 294.18 294.19 294.20 294.21 294.22 294.23 294.24 294.25 294.26 294.27 294.28 294.29 294.30 294.31 295.1 295.2 295.3 295.4 295.5 295.6 295.7 295.8 295.9 295.10 295.11 295.12 295.13 295.14 295.15 295.16 295.17 295.18 295.19 295.20 295.21 295.22 295.23 295.24 295.25
295.26 295.27
295.28 295.29 295.30 295.31 295.32 295.33 296.1 296.2 296.3 296.4 296.5 296.6 296.7 296.8 296.9 296.10 296.11 296.12 296.13 296.14 296.15 296.16 296.17 296.18 296.19 296.20 296.21 296.22 296.23 296.24 296.25 296.26 296.27 296.28 296.29 296.30 296.31 297.1 297.2 297.3 297.4 297.5 297.6 297.7 297.8 297.9 297.10 297.11 297.12 297.13 297.14 297.15 297.16 297.17 297.18 297.19 297.20 297.21 297.22 297.23 297.24 297.25 297.26
297.27
297.28 297.29 297.30 297.31 298.1 298.2 298.3 298.4 298.5 298.6 298.7 298.8 298.9 298.10 298.11 298.12 298.13 298.14 298.15 298.16 298.17 298.18 298.19 298.20 298.21 298.22 298.23 298.24 298.25 298.26 298.27 298.28 298.29 298.30 298.31 298.32 299.1 299.2 299.3 299.4 299.5 299.6 299.7 299.8 299.9 299.10 299.11 299.12 299.13 299.14 299.15 299.16 299.17 299.18 299.19 299.20 299.21 299.22 299.23 299.24 299.25 299.26 299.27 299.28 299.29 299.30 299.31 299.32
299.33
300.1 300.2 300.3 300.4 300.5 300.6 300.7 300.8 300.9 300.10 300.11
300.12 300.13 300.14 300.15 300.16 300.17 300.18 300.19 300.20 300.21 300.22 300.23 300.24 300.25 300.26 300.27 300.28 300.29
300.30
301.1 301.2 301.3 301.4 301.5 301.6 301.7 301.8 301.9 301.10 301.11
301.12
301.13 301.14 301.15 301.16 301.17 301.18 301.19 301.20 301.21 301.22 301.23 301.24 301.25 301.26 301.27 301.28 301.29 301.30 301.31 301.32 302.1 302.2 302.3 302.4 302.5 302.6 302.7 302.8 302.9 302.10 302.11 302.12 302.13 302.14 302.15 302.16 302.17 302.18
302.19
302.20 302.21 302.22 302.23 302.24 302.25 302.26 302.27 302.28 302.29 302.30 303.1 303.2 303.3 303.4 303.5 303.6 303.7 303.8 303.9 303.10 303.11 303.12 303.13 303.14 303.15 303.16 303.17 303.18 303.19 303.20 303.21
303.22 303.23 303.24 303.25 303.26 303.27 303.28 303.29 303.30 303.31 303.32 304.1 304.2 304.3 304.4 304.5 304.6 304.7 304.8 304.9 304.10 304.11 304.12 304.13 304.14 304.15 304.16 304.17 304.18 304.19 304.20 304.21 304.22 304.23 304.24 304.25 304.26 304.27 304.28 304.29 304.30 304.31 304.32 305.1 305.2 305.3 305.4 305.5 305.6 305.7 305.8 305.9 305.10 305.11 305.12 305.13 305.14 305.15 305.16 305.17 305.18 305.19 305.20 305.21 305.22 305.23 305.24 305.25 305.26
305.27 305.28 305.29 305.30 305.31 305.32 306.1 306.2 306.3 306.4 306.5 306.6 306.7 306.8 306.9 306.10 306.11 306.12 306.13 306.14 306.15 306.16 306.17 306.18 306.19 306.20 306.21 306.22 306.23 306.24 306.25 306.26 306.27 306.28 306.29 306.30 307.1 307.2 307.3 307.4 307.5 307.6 307.7 307.8 307.9 307.10 307.11 307.12 307.13 307.14 307.15 307.16 307.17
307.18
307.19 307.20 307.21 307.22 307.23 307.24 307.25 307.26 307.27 307.28 307.29 307.30 308.1 308.2 308.3 308.4 308.5 308.6 308.7 308.8 308.9 308.10 308.11 308.12 308.13 308.14 308.15 308.16 308.17 308.18 308.19 308.20 308.21 308.22 308.23 308.24 308.25 308.26 308.27 308.28 308.29 308.30 308.31 308.32 309.1 309.2 309.3 309.4 309.5 309.6 309.7 309.8 309.9 309.10 309.11 309.12 309.13 309.14 309.15 309.16 309.17 309.18 309.19 309.20 309.21 309.22 309.23 309.24 309.25 309.26 309.27 309.28 309.29 309.30 310.1 310.2 310.3 310.4 310.5
310.6 310.7 310.8 310.9
310.10 310.11 310.12 310.13 310.14 310.15 310.16 310.17 310.18 310.19 310.20 310.21 310.22 310.23 310.24 310.25 310.26 310.27 310.28 310.29 311.1 311.2 311.3 311.4 311.5 311.6 311.7 311.8 311.9 311.10 311.11 311.12 311.13 311.14 311.15 311.16 311.17 311.18 311.19 311.20 311.21 311.22 311.23 311.24 311.25 311.26 311.27 311.28 311.29 311.30 311.31 311.32 312.1 312.2 312.3 312.4 312.5 312.6 312.7 312.8 312.9 312.10 312.11 312.12 312.13 312.14 312.15 312.16 312.17 312.18 312.19 312.20 312.21 312.22 312.23 312.24 312.25 312.26 312.27 312.28 312.29 312.30 312.31
313.1 313.2 313.3 313.4
313.5
313.6 313.7 313.8 313.9 313.10 313.11 313.12 313.13 313.14 313.15 313.16 313.17 313.18 313.19 313.20 313.21 313.22 313.23 313.24 313.25 313.26
313.27 313.28 313.29 313.30 313.31 313.32
314.1 314.2 314.3 314.4
314.5 314.6 314.7 314.8 314.9 314.10
314.11 314.12 314.13 314.14 314.15 314.16 314.17 314.18 314.19 314.20 314.21 314.22 314.23 314.24 314.25 314.26 314.27 314.28 314.29 314.30 314.31 314.32 314.33 315.1 315.2
315.3
315.4 315.5 315.6 315.7 315.8 315.9 315.10 315.11 315.12 315.13 315.14 315.15 315.16 315.17
315.18 315.19 315.20 315.21 315.22 315.23 315.24 315.25 315.26 315.27 315.28 315.29 315.30 315.31 315.32 316.1 316.2 316.3 316.4 316.5 316.6 316.7 316.8 316.9 316.10 316.11 316.12 316.13
316.14 316.15 316.16 316.17 316.18 316.19 316.20 316.21 316.22 316.23 316.24 316.25 316.26 316.27
316.28 316.29 316.30 316.31 316.32
317.1 317.2 317.3 317.4
317.5 317.6 317.7 317.8 317.9
317.10 317.11
317.12 317.13
317.14 317.15 317.16 317.17 317.18
317.19 317.20 317.21 317.22 317.23 317.24 317.25 317.26 317.27 317.28 318.1 318.2 318.3 318.4 318.5 318.6 318.7 318.8 318.9 318.10 318.11 318.12 318.13 318.14 318.15 318.16 318.17 318.18 318.19
318.20 318.21 318.22 318.23 318.24 318.25 318.26 318.27 319.1 319.2 319.3 319.4 319.5 319.6 319.7 319.8 319.9 319.10 319.11 319.12 319.13 319.14 319.15 319.16 319.17 319.18 319.19 319.20 319.21 319.22 319.23 319.24 319.25 319.26 319.27 319.28 319.29 320.1 320.2 320.3 320.4 320.5 320.6
320.7
320.8 320.9 320.10 320.11 320.12 320.13 320.14 320.15 320.16 320.17 320.18 320.19 320.20 320.21 320.22 320.23 320.24 320.25 320.26 320.27 320.28 320.29 320.30 321.1 321.2 321.3 321.4 321.5 321.6 321.7 321.8 321.9 321.10 321.11 321.12 321.13 321.14 321.15 321.16
321.17
321.18 321.19 321.20 321.21 321.22 321.23 321.24 321.25 321.26 321.27 321.28 321.29 321.30 321.31 322.1 322.2 322.3 322.4 322.5 322.6 322.7 322.8 322.9 322.10 322.11 322.12 322.13 322.14 322.15 322.16 322.17 322.18 322.19 322.20 322.21 322.22 322.23 322.24 322.25 322.26 322.27 322.28 322.29 322.30 322.31 322.32 323.1 323.2 323.3 323.4 323.5 323.6 323.7 323.8 323.9 323.10 323.11 323.12 323.13 323.14 323.15 323.16 323.17 323.18 323.19 323.20 323.21 323.22 323.23 323.24 323.25 323.26 323.27 323.28 323.29 323.30 323.31 323.32 323.33 324.1 324.2 324.3 324.4 324.5 324.6 324.7 324.8 324.9 324.10 324.11 324.12 324.13 324.14 324.15 324.16 324.17 324.18 324.19 324.20 324.21 324.22 324.23 324.24 324.25 324.26 324.27 324.28 324.29 324.30 324.31 324.32 324.33 324.34 325.1 325.2 325.3 325.4 325.5 325.6 325.7 325.8 325.9 325.10 325.11 325.12 325.13 325.14
325.15 325.16 325.17
325.18 325.19 325.20 325.21 325.22 325.23 325.24 325.25 325.26 325.27 325.28 325.29 325.30 325.31 325.32 326.1 326.2 326.3 326.4
326.5 326.6 326.7 326.8 326.9 326.10 326.11 326.12 326.13 326.14 326.15 326.16 326.17 326.18 326.19 326.20 326.21 326.22 326.23 326.24 326.25 326.26 326.27 326.28 326.29 326.30
326.31 326.32 326.33
327.1 327.2 327.3 327.4 327.5 327.6 327.7 327.8 327.9
327.10
327.11 327.12 327.13 327.14 327.15 327.16 327.17 327.18 327.19 327.20 327.21 327.22 327.23 327.24 327.25 327.26 327.27 327.28 327.29 327.30 327.31 327.32 327.33 327.34 328.1 328.2 328.3 328.4 328.5 328.6 328.7 328.8 328.9 328.10 328.11 328.12 328.13 328.14 328.15 328.16 328.17 328.18 328.19
328.20
328.21 328.22 328.23 328.24 328.25 328.26 328.27 328.28 328.29 328.30 328.31 328.32 328.33
329.1
329.2 329.3 329.4 329.5 329.6 329.7 329.8 329.9 329.10 329.11 329.12 329.13 329.14 329.15 329.16 329.17 329.18
329.19
329.20 329.21 329.22 329.23 329.24 329.25 329.26 329.27 329.28 329.29 329.30 330.1 330.2 330.3 330.4 330.5 330.6 330.7 330.8 330.9 330.10 330.11 330.12 330.13 330.14 330.15 330.16 330.17 330.18 330.19 330.20 330.21
330.22
330.23 330.24 330.25 330.26 330.27 330.28 330.29 330.30 330.31 331.1 331.2 331.3
331.4
331.5 331.6 331.7 331.8 331.9 331.10 331.11 331.12
331.13
331.14 331.15 331.16 331.17 331.18 331.19 331.20 331.21 331.22 331.23 331.24 331.25 331.26 331.27 331.28 331.29 331.30 332.1 332.2 332.3 332.4 332.5
332.6
332.7 332.8 332.9 332.10 332.11 332.12 332.13 332.14 332.15 332.16 332.17 332.18 332.19 332.20 332.21 332.22 332.23 332.24 332.25 332.26 332.27 332.28 332.29 332.30 332.31 333.1 333.2 333.3 333.4 333.5 333.6 333.7 333.8 333.9 333.10 333.11 333.12 333.13 333.14
333.15 333.16 333.17
333.18 333.19 333.20 333.21 333.22 333.23 333.24 333.25 333.26 333.27 333.28 333.29 333.30 333.31 333.32 334.1 334.2 334.3 334.4 334.5
334.6 334.7 334.8 334.9 334.10 334.11 334.12 334.13 334.14 334.15 334.16 334.17
334.18
334.19 334.20 334.21 334.22 334.23
334.24
334.25 334.26 334.27 334.28 334.29 334.30 334.31 334.32 335.1 335.2 335.3 335.4 335.5 335.6 335.7 335.8 335.9 335.10 335.11 335.12 335.13 335.14 335.15 335.16 335.17 335.18 335.19 335.20 335.21 335.22 335.23 335.24 335.25 335.26 335.27 335.28 335.29 335.30 335.31
335.32
336.1 336.2 336.3 336.4 336.5 336.6 336.7 336.8 336.9 336.10 336.11 336.12 336.13
336.14 336.15 336.16
336.17 336.18 336.19 336.20 336.21 336.22 336.23 336.24 336.25 336.26 336.27 336.28 336.29 336.30
336.31
337.1 337.2 337.3 337.4 337.5 337.6 337.7 337.8 337.9 337.10 337.11 337.12 337.13 337.14 337.15
337.16
337.17 337.18 337.19 337.20 337.21 337.22 337.23 337.24 337.25 337.26 337.27 337.28 337.29 337.30 337.31 337.32
337.33
338.1 338.2 338.3 338.4 338.5 338.6 338.7 338.8 338.9 338.10 338.11 338.12 338.13 338.14 338.15 338.16 338.17 338.18 338.19 338.20 338.21 338.22 338.23 338.24 338.25 338.26 338.27 338.28 338.29 338.30
338.31
339.1 339.2 339.3 339.4 339.5 339.6 339.7 339.8 339.9 339.10 339.11 339.12 339.13 339.14 339.15 339.16 339.17
339.18
339.19 339.20 339.21 339.22 339.23 339.24 339.25 339.26 339.27 339.28 339.29 339.30 339.31 340.1 340.2 340.3 340.4 340.5 340.6 340.7 340.8 340.9 340.10 340.11 340.12 340.13 340.14
340.15
340.16 340.17 340.18 340.19 340.20 340.21 340.22 340.23 340.24 340.25 340.26 340.27 340.28 340.29 341.1 341.2 341.3 341.4 341.5 341.6 341.7 341.8 341.9 341.10 341.11 341.12 341.13 341.14 341.15 341.16 341.17 341.18 341.19 341.20 341.21 341.22 341.23 341.24 341.25 341.26 341.27 341.28 341.29 341.30 341.31 342.1 342.2 342.3 342.4 342.5 342.6 342.7 342.8 342.9 342.10 342.11 342.12 342.13 342.14 342.15 342.16 342.17 342.18 342.19 342.20 342.21 342.22 342.23 342.24
342.25 342.26 342.27 342.28 342.29 342.30 342.31 343.1 343.2 343.3 343.4 343.5 343.6 343.7 343.8 343.9 343.10
343.11
343.12 343.13 343.14 343.15 343.16 343.17 343.18 343.19 343.20 343.21
343.22
343.23 343.24 343.25 343.26 343.27 343.28 343.29 343.30 343.31 344.1 344.2 344.3 344.4 344.5 344.6 344.7 344.8 344.9 344.10 344.11 344.12 344.13 344.14 344.15 344.16 344.17 344.18 344.19 344.20 344.21 344.22 344.23 344.24 344.25 344.26 344.27 344.28 344.29 344.30 344.31
345.1 345.2 345.3 345.4 345.5 345.6 345.7 345.8 345.9 345.10 345.11 345.12 345.13 345.14 345.15 345.16 345.17 345.18 345.19 345.20 345.21 345.22 345.23 345.24 345.25 345.26 345.27 345.28 345.29 345.30 345.31 345.32 345.33 345.34 345.35 346.1 346.2 346.3 346.4 346.5 346.6 346.7 346.8 346.9 346.10 346.11 346.12 346.13 346.14 346.15 346.16
346.17 346.18
346.19 346.20 346.21 346.22 346.23 346.24 346.25 346.26 346.27 346.28 346.29 346.30 346.31 346.32 347.1 347.2
347.3
347.4 347.5 347.6 347.7 347.8 347.9 347.10 347.11 347.12 347.13 347.14 347.15 347.16 347.17 347.18 347.19 347.20 347.21 347.22 347.23 347.24 347.25 347.26 347.27 347.28 347.29 347.30 347.31 347.32 347.33 348.1 348.2 348.3 348.4 348.5 348.6 348.7 348.8 348.9 348.10 348.11 348.12
348.13 348.14 348.15 348.16 348.17 348.18 348.19 348.20 348.21 348.22 348.23 348.24 348.25 348.26 348.27 348.28 348.29
348.30
349.1 349.2 349.3 349.4 349.5 349.6 349.7 349.8 349.9 349.10 349.11 349.12 349.13 349.14 349.15 349.16 349.17 349.18 349.19 349.20 349.21 349.22 349.23 349.24 349.25 349.26 349.27 349.28 349.29 349.30
349.31
350.1 350.2 350.3 350.4 350.5 350.6 350.7 350.8 350.9 350.10 350.11 350.12
350.13
350.14 350.15 350.16 350.17 350.18 350.19 350.20 350.21 350.22 350.23 350.24 350.25 350.26 350.27 350.28 350.29
350.30
351.1 351.2 351.3 351.4 351.5 351.6 351.7 351.8 351.9 351.10 351.11 351.12 351.13 351.14 351.15 351.16 351.17 351.18 351.19 351.20 351.21 351.22 351.23 351.24
351.25 351.26
351.27 351.28
351.29
352.1 352.2
352.3 352.4
352.5
352.6 352.7 352.8 352.9 352.10 352.11 352.12 352.13 352.14 352.15 352.16 352.17 352.18 352.19 352.20 352.21 352.22 352.23 352.24 352.25 352.26 352.27 352.28 352.29 353.1 353.2 353.3 353.4 353.5 353.6 353.7 353.8 353.9 353.10 353.11 353.12 353.13 353.14 353.15 353.16 353.17 353.18 353.19 353.20 353.21 353.22 353.23 353.24 353.25 353.26 353.27 353.28 353.29 354.1 354.2 354.3 354.4 354.5 354.6 354.7 354.8 354.9 354.10 354.11 354.12 354.13 354.14 354.15 354.16 354.17 354.18 354.19 354.20 354.21 354.22 354.23 354.24 354.25
354.26
354.27 354.28 354.29 354.30 354.31 355.1 355.2 355.3 355.4 355.5 355.6 355.7 355.8 355.9 355.10 355.11 355.12 355.13 355.14
355.15
355.16 355.17 355.18 355.19 355.20 355.21 355.22 355.23 355.24 355.25 355.26 355.27 355.28 355.29 355.30 355.31 356.1 356.2 356.3 356.4 356.5 356.6 356.7 356.8 356.9 356.10 356.11 356.12 356.13 356.14 356.15 356.16 356.17 356.18 356.19 356.20
356.21 356.22 356.23 356.24 356.25 356.26 356.27 356.28 356.29 356.30 356.31 356.32 357.1 357.2 357.3 357.4 357.5 357.6 357.7 357.8 357.9 357.10 357.11 357.12 357.13 357.14 357.15 357.16 357.17 357.18 357.19 357.20 357.21 357.22 357.23 357.24 357.25 357.26 357.27
357.28 357.29
358.1 358.2
358.3 358.4 358.5 358.6 358.7 358.8 358.9 358.10 358.11 358.12 358.13
358.14 358.15 358.16 358.17 358.18 358.19 358.20 358.21 358.22 358.23 358.24 358.25 358.26 358.27
358.28 358.29 358.30 358.31 359.1 359.2 359.3 359.4 359.5 359.6 359.7 359.8 359.9 359.10 359.11 359.12 359.13 359.14 359.15 359.16 359.17 359.18 359.19 359.20 359.21
359.22 359.23 359.24 359.25 359.26 359.27 359.28 359.29 359.30 359.31 359.32 359.33 360.1 360.2 360.3 360.4 360.5 360.6 360.7 360.8 360.9 360.10 360.11 360.12 360.13 360.14 360.15 360.16 360.17 360.18 360.19 360.20 360.21 360.22 360.23 360.24 360.25
360.26 360.27 360.28 360.29 360.30 360.31 360.32 361.1 361.2 361.3 361.4 361.5 361.6 361.7 361.8 361.9 361.10 361.11 361.12 361.13 361.14 361.15 361.16 361.17 361.18 361.19 361.20 361.21 361.22 361.23 361.24 361.25 361.26 361.27 361.28
361.29 361.30 361.31 361.32 362.1 362.2 362.3 362.4 362.5 362.6 362.7 362.8 362.9 362.10 362.11 362.12 362.13 362.14 362.15 362.16 362.17 362.18 362.19 362.20 362.21 362.22 362.23 362.24
362.25 362.26 362.27 362.28 362.29 362.30 362.31 362.32 362.33 363.1 363.2 363.3 363.4 363.5 363.6 363.7
363.8 363.9 363.10 363.11 363.12 363.13 363.14 363.15 363.16 363.17 363.18 363.19 363.20 363.21 363.22 363.23 363.24 363.25 363.26 363.27
363.28 363.29 363.30 363.31 364.1 364.2 364.3 364.4 364.5 364.6 364.7 364.8 364.9 364.10 364.11 364.12 364.13 364.14 364.15 364.16 364.17 364.18 364.19 364.20 364.21 364.22 364.23 364.24 364.25 364.26 364.27 364.28 364.29
365.1 365.2 365.3 365.4 365.5 365.6 365.7 365.8
365.9 365.10 365.11 365.12 365.13 365.14 365.15 365.16 365.17 365.18 365.19 365.20 365.21 365.22 365.23 365.24 365.25 365.26 365.27 365.28 365.29 365.30 365.31 365.32 366.1 366.2 366.3 366.4 366.5 366.6 366.7 366.8 366.9 366.10 366.11 366.12 366.13 366.14 366.15 366.16 366.17 366.18 366.19 366.20 366.21 366.22 366.23 366.24 366.25 366.26 366.27 366.28 366.29 366.30 367.1 367.2 367.3 367.4 367.5 367.6 367.7 367.8 367.9 367.10 367.11 367.12 367.13 367.14 367.15 367.16 367.17 367.18 367.19 367.20 367.21 367.22
367.23 367.24 367.25 367.26 367.27 367.28 367.29 367.30 367.31 367.32 368.1 368.2 368.3 368.4 368.5 368.6 368.7 368.8 368.9 368.10 368.11 368.12 368.13 368.14 368.15 368.16 368.17 368.18 368.19 368.20 368.21 368.22 368.23 368.24
368.25 368.26 368.27 368.28 368.29 368.30 368.31
369.1 369.2 369.3 369.4 369.5 369.6 369.7
369.8 369.9 369.10 369.11
369.12 369.13 369.14 369.15 369.16 369.17 369.18 369.19 369.20 369.21 369.22 369.23 369.24 369.25 369.26
369.27 369.28 369.29 369.30 369.31 369.32 370.1 370.2 370.3 370.4 370.5 370.6 370.7 370.8 370.9 370.10 370.11 370.12 370.13 370.14
370.15 370.16 370.17 370.18 370.19 370.20 370.21 370.22 370.23 370.24 370.25 370.26 370.27 370.28 370.29 370.30 370.31 370.32 370.33
371.1 371.2 371.3 371.4 371.5 371.6 371.7 371.8 371.9 371.10 371.11 371.12 371.13 371.14 371.15 371.16 371.17 371.18 371.19 371.20 371.21 371.22 371.23 371.24 371.25 371.26 371.27 371.28 371.29 371.30 371.31 372.1 372.2 372.3 372.4 372.5 372.6 372.7
372.8 372.9 372.10 372.11 372.12 372.13 372.14 372.15 372.16 372.17 372.18 372.19 372.20 372.21 372.22 372.23 372.24 372.25 372.26 372.27 372.28 372.29 372.30
373.1 373.2 373.3 373.4 373.5 373.6 373.7 373.8 373.9 373.10 373.11 373.12 373.13 373.14 373.15 373.16 373.17 373.18 373.19 373.20 373.21 373.22 373.23 373.24 373.25 373.26 373.27 373.28
373.29 373.30 373.31 374.1 374.2 374.3 374.4 374.5 374.6
374.7 374.8 374.9 374.10 374.11 374.12 374.13 374.14 374.15 374.16 374.17 374.18 374.19 374.20 374.21 374.22 374.23 374.24 374.25 374.26 374.27 374.28 374.29 374.30 374.31 374.32 374.33 375.1 375.2 375.3
375.4 375.5 375.6 375.7 375.8 375.9 375.10 375.11 375.12 375.13 375.14 375.15 375.16 375.17 375.18 375.19 375.20 375.21 375.22 375.23
375.24 375.25 375.26 375.27 375.28 375.29 375.30 375.31 375.32 375.33 376.1 376.2 376.3 376.4 376.5 376.6 376.7 376.8 376.9 376.10 376.11 376.12 376.13 376.14 376.15 376.16
376.17 376.18 376.19 376.20 376.21 376.22 376.23 376.24 376.25 376.26 376.27 376.28 376.29 376.30 376.31 376.32 377.1 377.2 377.3 377.4 377.5 377.6 377.7 377.8 377.9 377.10 377.11 377.12 377.13 377.14
377.15 377.16 377.17 377.18 377.19 377.20 377.21 377.22 377.23 377.24 377.25 377.26 377.27 377.28 377.29 377.30 377.31 378.1 378.2 378.3
378.4 378.5 378.6 378.7 378.8 378.9 378.10 378.11 378.12 378.13
378.14 378.15 378.16 378.17
378.18 378.19 378.20 378.21 378.22 378.23 378.24 378.25 378.26 378.27 378.28 378.29 378.30 378.31 379.1 379.2 379.3 379.4 379.5 379.6 379.7 379.8 379.9 379.10 379.11 379.12 379.13 379.14 379.15 379.16 379.17 379.18 379.19 379.20 379.21 379.22 379.23 379.24 379.25
379.26 379.27 379.28 379.29 379.30 379.31 379.32
380.1 380.2 380.3 380.4 380.5 380.6 380.7
380.8 380.9 380.10 380.11 380.12 380.13 380.14
380.15 380.16 380.17 380.18 380.19 380.20 380.21 380.22 380.23 380.24 380.25 380.26 380.27 380.28 380.29
380.30 380.31 380.32 381.1 381.2 381.3 381.4 381.5 381.6 381.7 381.8 381.9 381.10 381.11 381.12 381.13 381.14 381.15 381.16 381.17 381.18 381.19 381.20 381.21
381.22 381.23 381.24 381.25 381.26 381.27 381.28 381.29 381.30 381.31 381.32 381.33 381.34 382.1 382.2 382.3 382.4 382.5 382.6 382.7 382.8 382.9 382.10
382.11 382.12 382.13 382.14 382.15 382.16 382.17 382.18 382.19 382.20 382.21 382.22 382.23 382.24 382.25 382.26 382.27 382.28 382.29 382.30 383.1 383.2 383.3 383.4 383.5 383.6 383.7 383.8 383.9 383.10 383.11 383.12 383.13 383.14 383.15 383.16 383.17 383.18
383.19 383.20 383.21 383.22 383.23 383.24 383.25 383.26 383.27 383.28 383.29 383.30 383.31 383.32 384.1 384.2 384.3 384.4 384.5 384.6 384.7 384.8 384.9 384.10
384.11 384.12 384.13 384.14 384.15 384.16 384.17 384.18
384.19 384.20 384.21 384.22 384.23 384.24 384.25 384.26 384.27 384.28 384.29 384.30
385.1 385.2 385.3 385.4 385.5 385.6 385.7 385.8 385.9 385.10 385.11 385.12 385.13 385.14 385.15 385.16 385.17 385.18 385.19 385.20 385.21 385.22 385.23 385.24 385.25 385.26 385.27 385.28 385.29 385.30 385.31 385.32 386.1 386.2 386.3 386.4 386.5 386.6 386.7 386.8 386.9 386.10 386.11 386.12 386.13 386.14 386.15 386.16 386.17 386.18 386.19 386.20 386.21 386.22 386.23 386.24 386.25 386.26 386.27 386.28 386.29 386.30 386.31 386.32 387.1 387.2 387.3 387.4 387.5 387.6 387.7 387.8 387.9 387.10 387.11 387.12 387.13 387.14
387.15 387.16 387.17 387.18 387.19 387.20 387.21 387.22 387.23 387.24 387.25 387.26 387.27 387.28 387.29 387.30 387.31 387.32 388.1 388.2 388.3 388.4 388.5 388.6 388.7 388.8 388.9 388.10 388.11 388.12 388.13 388.14 388.15 388.16 388.17 388.18 388.19 388.20 388.21 388.22 388.23 388.24 388.25 388.26 388.27 388.28 388.29 388.30 389.1 389.2 389.3 389.4 389.5 389.6 389.7 389.8 389.9 389.10 389.11 389.12 389.13 389.14 389.15 389.16 389.17 389.18 389.19 389.20 389.21 389.22 389.23 389.24 389.25 389.26 389.27 389.28 389.29 389.30 389.31 389.32
390.1 390.2 390.3 390.4 390.5 390.6 390.7 390.8 390.9 390.10 390.11 390.12 390.13 390.14 390.15
390.16 390.17 390.18 390.19 390.20 390.21 390.22 390.23 390.24 390.25 390.26 390.27 390.28 390.29 390.30 391.1 391.2 391.3 391.4 391.5 391.6 391.7 391.8 391.9 391.10 391.11 391.12 391.13 391.14 391.15 391.16 391.17 391.18 391.19 391.20 391.21 391.22 391.23 391.24 391.25 391.26 391.27 391.28 391.29 391.30 391.31 391.32 392.1 392.2 392.3 392.4 392.5 392.6 392.7 392.8 392.9 392.10 392.11 392.12 392.13 392.14 392.15 392.16 392.17 392.18 392.19 392.20 392.21 392.22 392.23 392.24 392.25 392.26 392.27 392.28 392.29 392.30 392.31 392.32 392.33 392.34 393.1 393.2 393.3 393.4 393.5 393.6 393.7 393.8 393.9 393.10 393.11 393.12 393.13 393.14 393.15 393.16 393.17 393.18 393.19 393.20 393.21 393.22 393.23 393.24 393.25 393.26 393.27 393.28 393.29 393.30 394.1 394.2 394.3 394.4 394.5 394.6 394.7 394.8 394.9 394.10 394.11 394.12 394.13 394.14 394.15 394.16 394.17 394.18 394.19 394.20 394.21 394.22 394.23 394.24 394.25 394.26 394.27 394.28 394.29 395.1 395.2 395.3 395.4 395.5 395.6 395.7 395.8 395.9 395.10 395.11 395.12 395.13 395.14 395.15 395.16 395.17 395.18 395.19 395.20 395.21 395.22 395.23 395.24 395.25 395.26 395.27 395.28 395.29 395.30 395.31 396.1 396.2 396.3 396.4 396.5 396.6 396.7 396.8 396.9 396.10 396.11
396.12 396.13 396.14 396.15 396.16 396.17 396.18 396.19 396.20 396.21 396.22 396.23 396.24 396.25 396.26 396.27 396.28 396.29 396.30 396.31 397.1 397.2 397.3 397.4 397.5 397.6 397.7 397.8 397.9 397.10 397.11 397.12 397.13 397.14 397.15 397.16 397.17 397.18 397.19 397.20 397.21 397.22 397.23 397.24 397.25 397.26 397.27 397.28 397.29 397.30 397.31 397.32 398.1 398.2 398.3 398.4 398.5 398.6 398.7 398.8 398.9 398.10 398.11 398.12 398.13 398.14 398.15 398.16 398.17
398.18 398.19 398.20 398.21 398.22 398.23 398.24 398.25 398.26 398.27 398.28 398.29 398.30 398.31 399.1 399.2 399.3 399.4 399.5 399.6 399.7 399.8 399.9 399.10 399.11 399.12 399.13 399.14 399.15
399.16 399.17 399.18 399.19 399.20 399.21 399.22 399.23 399.24 399.25 399.26 399.27 399.28 400.1 400.2 400.3 400.4 400.5 400.6 400.7 400.8 400.9 400.10 400.11 400.12 400.13 400.14 400.15 400.16 400.17 400.18
400.19 400.20 400.21 400.22 400.23 400.24 400.25 400.26 400.27 400.28 400.29 400.30 400.31 401.1 401.2 401.3 401.4 401.5 401.6 401.7 401.8 401.9 401.10 401.11 401.12 401.13 401.14 401.15 401.16 401.17 401.18 401.19 401.20 401.21 401.22 401.23 401.24 401.25 401.26 401.27 401.28 401.29 401.30 401.31 401.32 402.1 402.2 402.3 402.4 402.5 402.6 402.7 402.8 402.9 402.10 402.11 402.12 402.13 402.14 402.15 402.16 402.17 402.18 402.19 402.20 402.21 402.22 402.23 402.24 402.25 402.26 402.27 402.28 402.29 402.30 402.31 402.32 403.1 403.2 403.3 403.4 403.5 403.6 403.7 403.8 403.9 403.10 403.11 403.12 403.13 403.14 403.15 403.16 403.17 403.18 403.19
403.20 403.21 403.22 403.23 403.24 403.25
403.26 403.27 403.28 403.29 403.30 403.31 403.32
404.1 404.2 404.3 404.4
404.5 404.6 404.7 404.8 404.9
404.10 404.11 404.12 404.13 404.14 404.15 404.16 404.17 404.18 404.19 404.20 404.21 404.22 404.23 404.24 404.25 404.26 404.27 404.28 404.29 404.30 404.31 405.1 405.2 405.3 405.4 405.5 405.6 405.7 405.8 405.9 405.10 405.11 405.12 405.13 405.14 405.15 405.16 405.17 405.18 405.19 405.20 405.21 405.22 405.23 405.24 405.25 405.26 405.27 405.28 405.29 405.30 405.31 405.32 405.33 405.34 405.35 406.1 406.2 406.3 406.4 406.5 406.6 406.7 406.8 406.9 406.10 406.11 406.12 406.13 406.14 406.15 406.16 406.17 406.18 406.19 406.20 406.21 406.22 406.23 406.24 406.25 406.26 406.27 406.28 406.29 406.30 406.31 406.32 406.33 407.1 407.2 407.3 407.4 407.5 407.6 407.7 407.8 407.9 407.10 407.11 407.12 407.13 407.14 407.15 407.16 407.17 407.18 407.19 407.20 407.21 407.22 407.23 407.24 407.25 407.26 407.27 407.28 407.29 407.30 407.31 407.32 407.33
408.1 408.2 408.3 408.4 408.5 408.6 408.7 408.8 408.9 408.10 408.11 408.12 408.13 408.14 408.15 408.16 408.17 408.18 408.19 408.20 408.21 408.22 408.23 408.24 408.25 408.26 408.27 408.28 408.29 408.30 409.1 409.2 409.3 409.4 409.5 409.6
409.7 409.8 409.9 409.10 409.11 409.12 409.13 409.14 409.15 409.16 409.17 409.18 409.19 409.20 409.21 409.22 409.23 409.24 409.25 409.26 409.27 409.28
409.29 409.30 409.31 410.1 410.2 410.3 410.4 410.5 410.6 410.7 410.8 410.9 410.10 410.11 410.12 410.13 410.14 410.15 410.16 410.17 410.18 410.19 410.20 410.21 410.22 410.23 410.24 410.25 410.26 410.27 410.28 410.29 410.30 410.31 410.32 410.33 411.1 411.2 411.3 411.4 411.5 411.6 411.7 411.8 411.9
411.10 411.11 411.12 411.13 411.14 411.15 411.16 411.17 411.18 411.19 411.20 411.21 411.22 411.23 411.24 411.25 411.26 411.27 411.28 411.29 411.30 411.31 411.32 412.1 412.2 412.3 412.4 412.5 412.6 412.7 412.8 412.9 412.10 412.11 412.12 412.13 412.14 412.15 412.16 412.17 412.18 412.19 412.20 412.21 412.22 412.23 412.24 412.25 412.26 412.27 412.28 412.29 412.30 412.31 412.32
413.1 413.2 413.3 413.4 413.5 413.6 413.7 413.8 413.9 413.10 413.11 413.12 413.13 413.14 413.15 413.16 413.17 413.18 413.19 413.20 413.21 413.22 413.23 413.24 413.25 413.26 413.27 413.28 413.29 413.30 413.31 413.32 413.33 414.1 414.2 414.3 414.4 414.5 414.6 414.7 414.8 414.9 414.10 414.11 414.12 414.13 414.14 414.15 414.16 414.17 414.18 414.19 414.20 414.21 414.22 414.23 414.24 414.25 414.26 414.27 414.28 414.29 414.30 414.31 414.32 414.33 415.1 415.2 415.3 415.4 415.5 415.6 415.7 415.8 415.9 415.10 415.11 415.12 415.13 415.14 415.15 415.16 415.17 415.18 415.19 415.20 415.21 415.22 415.23 415.24 415.25 415.26 415.27 415.28 415.29 415.30 415.31 415.32 416.1 416.2 416.3 416.4 416.5 416.6 416.7 416.8 416.9 416.10 416.11 416.12 416.13 416.14 416.15 416.16 416.17 416.18 416.19 416.20 416.21 416.22 416.23 416.24 416.25 416.26 416.27 416.28 416.29 416.30 416.31 416.32
417.1 417.2 417.3 417.4 417.5 417.6 417.7 417.8 417.9 417.10 417.11 417.12 417.13 417.14 417.15 417.16 417.17 417.18 417.19 417.20 417.21 417.22 417.23 417.24 417.25 417.26 417.27 417.28 417.29 417.30 417.31 417.32 418.1 418.2 418.3 418.4 418.5 418.6 418.7 418.8 418.9 418.10 418.11 418.12 418.13 418.14 418.15 418.16 418.17 418.18 418.19 418.20 418.21 418.22 418.23 418.24 418.25 418.26 418.27 418.28 418.29 418.30 418.31 418.32 418.33 419.1 419.2 419.3 419.4 419.5 419.6 419.7 419.8 419.9 419.10 419.11 419.12 419.13 419.14 419.15 419.16 419.17 419.18 419.19 419.20
419.21 419.22 419.23 419.24 419.25 419.26 419.27 419.28 419.29 419.30 419.31 419.32 420.1 420.2 420.3 420.4 420.5 420.6 420.7 420.8 420.9 420.10 420.11 420.12 420.13 420.14 420.15 420.16 420.17 420.18 420.19 420.20 420.21 420.22 420.23 420.24 420.25 420.26 420.27 420.28 420.29 420.30 420.31 420.32 420.33 420.34 421.1 421.2 421.3 421.4 421.5 421.6 421.7 421.8 421.9 421.10 421.11 421.12 421.13 421.14 421.15 421.16 421.17 421.18 421.19 421.20 421.21 421.22 421.23 421.24
421.25 421.26 421.27 421.28 421.29 421.30 421.31 421.32
422.1 422.2 422.3 422.4 422.5 422.6 422.7 422.8 422.9 422.10 422.11 422.12 422.13 422.14 422.15 422.16 422.17 422.18 422.19 422.20 422.21 422.22 422.23 422.24 422.25 422.26 422.27 422.28 422.29 422.30
422.31 422.32 422.33 423.1 423.2 423.3 423.4 423.5 423.6 423.7 423.8
423.9 423.10 423.11 423.12 423.13 423.14 423.15 423.16 423.17 423.18 423.19 423.20 423.21 423.22 423.23 423.24 423.25 423.26 423.27 423.28 423.29 423.30 424.1 424.2 424.3 424.4 424.5 424.6 424.7 424.8 424.9 424.10 424.11 424.12 424.13 424.14 424.15 424.16 424.17 424.18 424.19 424.20 424.21 424.22 424.23 424.24 424.25 424.26 424.27 424.28 424.29 424.30 425.1 425.2
425.3 425.4 425.5 425.6 425.7 425.8 425.9 425.10 425.11 425.12 425.13 425.14 425.15 425.16 425.17 425.18 425.19 425.20 425.21 425.22 425.23 425.24 425.25 425.26 425.27 425.28 425.29 425.30 425.31 425.32 426.1 426.2 426.3 426.4 426.5 426.6 426.7 426.8 426.9 426.10 426.11 426.12 426.13 426.14 426.15 426.16 426.17 426.18 426.19 426.20 426.21 426.22 426.23 426.24 426.25 426.26 426.27 426.28 426.29 426.30 426.31 427.1 427.2 427.3 427.4 427.5 427.6 427.7 427.8 427.9
427.10 427.11 427.12 427.13 427.14 427.15 427.16 427.17 427.18 427.19 427.20 427.21 427.22 427.23 427.24 427.25 427.26 427.27 427.28 427.29 427.30 427.31 427.32 428.1 428.2 428.3 428.4 428.5 428.6 428.7 428.8 428.9 428.10 428.11 428.12 428.13 428.14 428.15 428.16 428.17 428.18 428.19 428.20 428.21 428.22 428.23 428.24 428.25 428.26 428.27 428.28 428.29 428.30 428.31 428.32 429.1 429.2 429.3 429.4 429.5 429.6 429.7 429.8 429.9 429.10 429.11 429.12
429.13 429.14 429.15 429.16 429.17 429.18 429.19 429.20 429.21 429.22 429.23 429.24 429.25
429.26 429.27 429.28 429.29 430.1 430.2 430.3 430.4 430.5 430.6 430.7
430.8 430.9 430.10 430.11 430.12 430.13 430.14 430.15 430.16 430.17 430.18 430.19 430.20 430.21 430.22 430.23 430.24 430.25 430.26 430.27 430.28 430.29 430.30 430.31 430.32 430.33 431.1 431.2 431.3 431.4 431.5 431.6 431.7
431.8 431.9 431.10 431.11 431.12 431.13 431.14 431.15 431.16 431.17 431.18 431.19 431.20 431.21 431.22 431.23 431.24 431.25 431.26 431.27 431.28 431.29 431.30
432.1 432.2 432.3 432.4 432.5 432.6 432.7 432.8 432.9 432.10 432.11 432.12 432.13 432.14 432.15 432.16 432.17 432.18 432.19 432.20 432.21 432.22 432.23 432.24 432.25 432.26 432.27 432.28 432.29 432.30 432.31 432.32
433.1 433.2 433.3 433.4 433.5 433.6 433.7 433.8 433.9 433.10 433.11 433.12 433.13 433.14 433.15 433.16 433.17 433.18 433.19 433.20 433.21 433.22 433.23 433.24 433.25 433.26 433.27 433.28 433.29 433.30 433.31 433.32 433.33 434.1 434.2 434.3 434.4 434.5 434.6 434.7 434.8 434.9 434.10 434.11 434.12 434.13 434.14 434.15 434.16 434.17 434.18 434.19 434.20 434.21 434.22 434.23 434.24 434.25 434.26 434.27 434.28 434.29
434.30 434.31 434.32 435.1 435.2 435.3 435.4 435.5 435.6 435.7 435.8 435.9 435.10 435.11 435.12 435.13 435.14 435.15 435.16 435.17 435.18 435.19 435.20 435.21 435.22 435.23 435.24 435.25 435.26 435.27 435.28 435.29 435.30 435.31 435.32 436.1 436.2 436.3 436.4 436.5 436.6 436.7 436.8 436.9 436.10 436.11 436.12 436.13 436.14 436.15 436.16 436.17 436.18 436.19 436.20 436.21 436.22 436.23 436.24 436.25 436.26 436.27 436.28 436.29 436.30 436.31 437.1 437.2 437.3 437.4 437.5 437.6
437.7 437.8 437.9 437.10 437.11 437.12 437.13 437.14 437.15 437.16 437.17 437.18 437.19 437.20 437.21 437.22 437.23 437.24 437.25 437.26 437.27 437.28 437.29 437.30
438.1 438.2 438.3 438.4 438.5 438.6 438.7 438.8 438.9 438.10 438.11 438.12 438.13 438.14 438.15 438.16 438.17 438.18 438.19 438.20 438.21 438.22 438.23 438.24 438.25 438.26 438.27 438.28 438.29 438.30 438.31 439.1 439.2 439.3 439.4 439.5 439.6 439.7 439.8 439.9 439.10 439.11 439.12 439.13 439.14 439.15 439.16 439.17 439.18 439.19 439.20 439.21 439.22 439.23 439.24 439.25 439.26 439.27 439.28 439.29 439.30 439.31 439.32 439.33 439.34 439.35 440.1 440.2 440.3 440.4 440.5 440.6 440.7 440.8 440.9 440.10 440.11 440.12 440.13 440.14 440.15
440.16 440.17 440.18 440.19 440.20 440.21 440.22 440.23 440.24 440.25 440.26 440.27 440.28 440.29 440.30 440.31 440.32 441.1 441.2 441.3 441.4 441.5 441.6 441.7 441.8 441.9 441.10 441.11 441.12 441.13 441.14 441.15
441.16 441.17 441.18 441.19 441.20 441.21 441.22 441.23 441.24 441.25 441.26 441.27 441.28 441.29 441.30 441.31 441.32 441.33
442.1 442.2 442.3 442.4 442.5 442.6 442.7 442.8 442.9 442.10 442.11 442.12 442.13 442.14 442.15 442.16 442.17 442.18 442.19 442.20
442.21 442.22 442.23 442.24 442.25 442.26 442.27 442.28 442.29 442.30 443.1 443.2 443.3 443.4 443.5 443.6 443.7 443.8 443.9 443.10 443.11
443.12 443.13 443.14 443.15 443.16 443.17 443.18 443.19 443.20 443.21 443.22 443.23 443.24 443.25 443.26 443.27 443.28 443.29 443.30 443.31 444.1 444.2 444.3 444.4 444.5 444.6 444.7 444.8 444.9 444.10 444.11 444.12 444.13 444.14 444.15 444.16 444.17 444.18 444.19 444.20 444.21 444.22 444.23 444.24 444.25 444.26 444.27 444.28 444.29 444.30 444.31
445.1 445.2 445.3 445.4 445.5 445.6 445.7 445.8 445.9 445.10 445.11 445.12 445.13 445.14 445.15 445.16 445.17 445.18 445.19 445.20 445.21 445.22 445.23 445.24 445.25 445.26 445.27 445.28 445.29 445.30 445.31 445.32 446.1 446.2 446.3 446.4 446.5 446.6 446.7 446.8 446.9
446.10 446.11 446.12 446.13 446.14 446.15 446.16 446.17 446.18 446.19 446.20 446.21 446.22 446.23 446.24 446.25 446.26 446.27 446.28 446.29 446.30 446.31 447.1 447.2 447.3 447.4 447.5 447.6 447.7 447.8 447.9 447.10 447.11 447.12 447.13 447.14 447.15 447.16 447.17 447.18 447.19 447.20 447.21 447.22 447.23 447.24 447.25 447.26 447.27 447.28 447.29 447.30 448.1 448.2 448.3 448.4 448.5 448.6 448.7 448.8 448.9 448.10 448.11 448.12 448.13 448.14
448.15 448.16 448.17 448.18 448.19 448.20 448.21 448.22 448.23 448.24 448.25 448.26
448.27 448.28 448.29 448.30 448.31 449.1 449.2 449.3 449.4 449.5 449.6 449.7 449.8 449.9 449.10 449.11 449.12 449.13 449.14 449.15 449.16 449.17 449.18 449.19 449.20 449.21 449.22 449.23 449.24 449.25 449.26 449.27 449.28 449.29 449.30 449.31 449.32 450.1 450.2 450.3 450.4 450.5 450.6 450.7 450.8 450.9 450.10 450.11 450.12 450.13 450.14 450.15 450.16 450.17 450.18 450.19 450.20 450.21 450.22 450.23 450.24 450.25 450.26 450.27 450.28 450.29
451.1 451.2 451.3 451.4 451.5 451.6
451.7 451.8 451.9 451.10 451.11 451.12 451.13 451.14 451.15 451.16 451.17 451.18
451.19 451.20 451.21 451.22 451.23 451.24 451.25 451.26 451.27 451.28 451.29 451.30 451.31 451.32 452.1 452.2 452.3 452.4 452.5 452.6
452.7 452.8 452.9 452.10 452.11 452.12 452.13 452.14 452.15 452.16 452.17 452.18 452.19 452.20 452.21 452.22 452.23 452.24 452.25 452.26 452.27 452.28 452.29 452.30 452.31 452.32 453.1 453.2 453.3 453.4 453.5 453.6 453.7 453.8 453.9 453.10 453.11 453.12 453.13 453.14 453.15 453.16 453.17 453.18 453.19 453.20 453.21 453.22
453.23 453.24 453.25 453.26 453.27 453.28 453.29 453.30 453.31 453.32 453.33 454.1 454.2 454.3 454.4
454.5 454.6 454.7 454.8 454.9 454.10 454.11 454.12 454.13 454.14 454.15 454.16 454.17 454.18
454.19 454.20 454.21 454.22 454.23 454.24 454.25
454.26 454.27 454.28 454.29 454.30 454.31 454.32 455.1 455.2 455.3 455.4 455.5 455.6 455.7 455.8 455.9 455.10 455.11 455.12 455.13 455.14 455.15 455.16 455.17 455.18 455.19 455.20 455.21 455.22 455.23 455.24 455.25 455.26 455.27 455.28 455.29 455.30 456.1 456.2 456.3 456.4 456.5 456.6 456.7 456.8 456.9 456.10
456.11 456.12 456.13 456.14 456.15 456.16 456.17 456.18 456.19 456.20 456.21 456.22 456.23 456.24 456.25 456.26 456.27 456.28 456.29 456.30 456.31 457.1 457.2 457.3 457.4 457.5 457.6 457.7 457.8 457.9 457.10 457.11 457.12 457.13 457.14 457.15 457.16 457.17 457.18 457.19 457.20 457.21 457.22 457.23 457.24 457.25 457.26
457.27 457.28 457.29 457.30 457.31 458.1 458.2 458.3 458.4 458.5 458.6 458.7 458.8 458.9 458.10 458.11 458.12 458.13
458.14 458.15 458.16 458.17 458.18 458.19 458.20 458.21 458.22 458.23 458.24 458.25 458.26 458.27 458.28 458.29 458.30 458.31 458.32 458.33 459.1 459.2 459.3 459.4 459.5 459.6 459.7 459.8 459.9 459.10 459.11 459.12 459.13 459.14 459.15 459.16
459.17 459.18 459.19 459.20 459.21 459.22 459.23 459.24 459.25 459.26 459.27 459.28 459.29
459.30 459.31 459.32 460.1 460.2 460.3 460.4 460.5 460.6 460.7 460.8 460.9 460.10 460.11 460.12 460.13 460.14 460.15 460.16 460.17 460.18 460.19 460.20 460.21 460.22 460.23 460.24 460.25 460.26 460.27 460.28 460.29 460.30 460.31 460.32 461.1 461.2 461.3 461.4 461.5 461.6 461.7 461.8 461.9 461.10 461.11 461.12 461.13 461.14 461.15 461.16 461.17 461.18 461.19 461.20 461.21 461.22 461.23 461.24 461.25 461.26 461.27 461.28 461.29 461.30 461.31 461.32 462.1 462.2 462.3 462.4 462.5 462.6 462.7 462.8 462.9 462.10 462.11 462.12 462.13 462.14 462.15 462.16 462.17 462.18 462.19 462.20 462.21 462.22 462.23 462.24 462.25 462.26 462.27 462.28 462.29 462.30 463.1 463.2 463.3 463.4 463.5 463.6 463.7 463.8 463.9 463.10 463.11 463.12 463.13 463.14 463.15 463.16 463.17 463.18 463.19 463.20 463.21 463.22 463.23 463.24 463.25 463.26 463.27 463.28 463.29 463.30 463.31 463.32 464.1 464.2 464.3 464.4 464.5 464.6 464.7 464.8 464.9 464.10 464.11 464.12 464.13 464.14 464.15 464.16 464.17 464.18 464.19 464.20 464.21 464.22 464.23 464.24
464.25 464.26 464.27 464.28 464.29 464.30 464.31 465.1 465.2 465.3 465.4 465.5 465.6
465.7 465.8 465.9 465.10 465.11 465.12 465.13 465.14 465.15 465.16 465.17 465.18 465.19 465.20 465.21 465.22 465.23 465.24 465.25 465.26 465.27 465.28 465.29 465.30 465.31 465.32 466.1 466.2
466.3 466.4 466.5 466.6 466.7 466.8 466.9 466.10 466.11 466.12 466.13 466.14 466.15 466.16 466.17 466.18 466.19 466.20 466.21 466.22 466.23 466.24 466.25 466.26 466.27 466.28 466.29 466.30 466.31 466.32 466.33 467.1 467.2 467.3 467.4 467.5 467.6 467.7 467.8 467.9 467.10 467.11 467.12 467.13 467.14 467.15 467.16 467.17 467.18 467.19 467.20 467.21 467.22 467.23 467.24 467.25 467.26 467.27 467.28 467.29 467.30 467.31 467.32 467.33 467.34 468.1 468.2 468.3 468.4 468.5 468.6 468.7 468.8 468.9 468.10 468.11 468.12 468.13 468.14 468.15 468.16 468.17 468.18 468.19 468.20 468.21 468.22 468.23 468.24 468.25 468.26 468.27 468.28 468.29 468.30 468.31 468.32 468.33 468.34 469.1 469.2 469.3 469.4 469.5 469.6 469.7 469.8 469.9 469.10 469.11 469.12 469.13 469.14 469.15 469.16 469.17 469.18 469.19 469.20 469.21 469.22 469.23 469.24 469.25 469.26 469.27 469.28 469.29 469.30 469.31 469.32
470.1 470.2 470.3 470.4 470.5 470.6 470.7 470.8 470.9 470.10 470.11 470.12 470.13 470.14 470.15
470.16 470.17 470.18 470.19 470.20 470.21 470.22 470.23 470.24 470.25 470.26 470.27 470.28 470.29 470.30 471.1 471.2 471.3 471.4 471.5 471.6 471.7 471.8 471.9
471.10 471.11 471.12 471.13 471.14 471.15 471.16 471.17 471.18 471.19 471.20 471.21 471.22 471.23 471.24 471.25 471.26 471.27
471.28 471.29 471.30 471.31 471.32 472.1 472.2 472.3 472.4 472.5 472.6 472.7 472.8 472.9 472.10 472.11 472.12 472.13 472.14 472.15 472.16 472.17 472.18 472.19 472.20 472.21 472.22 472.23 472.24 472.25 472.26 472.27 472.28 472.29 472.30 472.31 472.32 472.33 473.1 473.2 473.3 473.4 473.5
473.6 473.7 473.8 473.9 473.10 473.11 473.12 473.13 473.14 473.15 473.16 473.17 473.18 473.19 473.20 473.21 473.22 473.23 473.24 473.25 473.26 473.27 473.28 473.29 473.30 473.31 473.32 474.1 474.2 474.3 474.4 474.5 474.6 474.7 474.8 474.9 474.10 474.11 474.12 474.13 474.14 474.15 474.16 474.17 474.18 474.19 474.20 474.21 474.22 474.23 474.24 474.25 474.26 474.27 474.28 474.29 474.30 474.31 474.32 474.33 475.1 475.2 475.3 475.4 475.5 475.6 475.7 475.8 475.9 475.10 475.11 475.12 475.13 475.14 475.15 475.16 475.17 475.18 475.19 475.20 475.21 475.22 475.23 475.24 475.25 475.26 475.27 475.28 475.29 475.30 475.31 475.32 475.33 476.1 476.2 476.3 476.4 476.5 476.6 476.7 476.8 476.9 476.10 476.11 476.12 476.13 476.14 476.15 476.16 476.17 476.18 476.19 476.20 476.21 476.22 476.23 476.24 476.25 476.26 476.27 476.28 476.29 476.30 476.31 476.32 476.33 476.34 477.1 477.2 477.3 477.4
477.5 477.6 477.7 477.8 477.9 477.10 477.11 477.12 477.13 477.14 477.15 477.16 477.17 477.18 477.19 477.20 477.21 477.22 477.23 477.24 477.25 477.26 477.27 477.28 477.29 477.30 478.1 478.2
478.3 478.4 478.5 478.6 478.7 478.8 478.9 478.10 478.11 478.12 478.13 478.14 478.15 478.16 478.17 478.18 478.19 478.20 478.21 478.22 478.23 478.24 478.25 478.26 478.27 478.28 478.29 478.30 478.31 479.1 479.2 479.3 479.4 479.5
479.6 479.7 479.8 479.9 479.10 479.11 479.12 479.13 479.14 479.15 479.16 479.17 479.18 479.19 479.20 479.21 479.22 479.23 479.24 479.25 479.26 479.27 479.28 479.29 479.30 479.31 479.32 479.33 479.34 480.1 480.2 480.3 480.4 480.5 480.6 480.7 480.8 480.9 480.10 480.11 480.12 480.13 480.14 480.15 480.16 480.17 480.18 480.19 480.20 480.21 480.22 480.23 480.24 480.25 480.26 480.27 480.28 480.29 480.30 480.31 480.32 480.33 480.34 481.1 481.2 481.3 481.4 481.5 481.6 481.7 481.8 481.9 481.10 481.11 481.12 481.13 481.14 481.15 481.16 481.17 481.18 481.19 481.20 481.21 481.22 481.23 481.24 481.25 481.26 481.27 481.28 481.29 481.30 481.31 481.32 481.33 481.34 482.1 482.2 482.3 482.4 482.5 482.6 482.7 482.8 482.9 482.10 482.11 482.12 482.13 482.14 482.15 482.16 482.17 482.18 482.19 482.20 482.21 482.22 482.23 482.24 482.25 482.26 482.27 482.28 482.29 482.30 482.31 482.32 483.1 483.2 483.3 483.4 483.5 483.6 483.7 483.8 483.9 483.10 483.11 483.12
483.13 483.14 483.15 483.16 483.17 483.18 483.19 483.20 483.21 483.22 483.23 483.24 483.25 483.26 483.27 483.28 483.29 483.30 483.31 483.32 484.1 484.2 484.3
484.4 484.5 484.6 484.7 484.8 484.9 484.10 484.11 484.12 484.13 484.14 484.15 484.16 484.17 484.18 484.19 484.20 484.21 484.22 484.23 484.24 484.25 484.26 484.27 484.28 484.29 484.30 484.31 484.32 484.33 485.1 485.2 485.3 485.4 485.5 485.6 485.7 485.8 485.9 485.10 485.11 485.12 485.13 485.14
485.15 485.16 485.17 485.18 485.19 485.20 485.21 485.22 485.23 485.24
485.25 485.26 485.27 485.28 485.29 485.30 486.1 486.2 486.3 486.4 486.5 486.6 486.7 486.8 486.9 486.10 486.11 486.12 486.13 486.14
486.15 486.16 486.17 486.18 486.19 486.20 486.21 486.22 486.23 486.24 486.25 486.26 486.27 486.28 486.29 486.30 487.1 487.2 487.3 487.4 487.5 487.6 487.7 487.8 487.9 487.10
487.11 487.12 487.13 487.14 487.15 487.16 487.17 487.18 487.19 487.20 487.21 487.22 487.23 487.24 487.25 487.26 487.27 487.28 487.29 487.30 487.31 487.32 487.33 488.1 488.2 488.3 488.4 488.5 488.6 488.7 488.8 488.9 488.10 488.11 488.12 488.13 488.14 488.15 488.16 488.17 488.18 488.19 488.20 488.21 488.22 488.23 488.24 488.25 488.26 488.27 488.28 488.29 488.30 488.31 488.32 488.33 489.1 489.2 489.3 489.4 489.5 489.6 489.7 489.8 489.9 489.10 489.11 489.12 489.13 489.14 489.15 489.16 489.17 489.18
489.19 489.20 489.21 489.22 489.23 489.24 489.25 489.26 489.27 489.28 489.29 489.30 489.31 489.32 489.33
490.1 490.2 490.3 490.4 490.5 490.6 490.7 490.8 490.9 490.10 490.11 490.12 490.13 490.14 490.15 490.16 490.17 490.18 490.19 490.20
490.21 490.22 490.23 490.24 490.25 490.26 490.27 490.28 490.29 491.1 491.2 491.3 491.4 491.5 491.6 491.7 491.8 491.9
491.10 491.11 491.12 491.13 491.14 491.15 491.16 491.17 491.18 491.19 491.20 491.21 491.22 491.23 491.24 491.25 491.26 491.27 491.28 491.29
492.1 492.2 492.3 492.4 492.5 492.6 492.7 492.8 492.9 492.10 492.11 492.12 492.13 492.14 492.15 492.16 492.17 492.18 492.19 492.20 492.21 492.22 492.23 492.24 492.25 492.26 492.27 492.28 492.29 492.30 492.31 493.1 493.2 493.3 493.4 493.5 493.6 493.7 493.8 493.9 493.10 493.11 493.12 493.13 493.14 493.15 493.16 493.17 493.18 493.19 493.20 493.21 493.22 493.23 493.24 493.25 493.26 493.27 493.28 493.29 493.30 493.31 494.1 494.2 494.3 494.4 494.5 494.6 494.7 494.8 494.9 494.10 494.11 494.12 494.13 494.14 494.15
494.16 494.17 494.18 494.19 494.20 494.21 494.22 494.23 494.24 494.25 494.26 494.27 494.28 494.29 494.30 495.1 495.2 495.3 495.4 495.5 495.6 495.7 495.8
495.9 495.10 495.11 495.12 495.13 495.14 495.15 495.16 495.17 495.18 495.19 495.20 495.21 495.22 495.23 495.24 495.25
495.26 495.27 495.28 495.29 495.30 496.1 496.2 496.3 496.4 496.5 496.6 496.7 496.8 496.9 496.10 496.11 496.12 496.13 496.14 496.15 496.16 496.17 496.18 496.19 496.20 496.21 496.22 496.23 496.24 496.25 496.26 496.27 496.28 496.29 496.30 496.31 497.1 497.2 497.3 497.4 497.5 497.6 497.7 497.8 497.9 497.10 497.11 497.12 497.13 497.14
497.15 497.16 497.17 497.18 497.19 497.20 497.21 497.22 497.23 497.24 497.25 497.26 497.27 497.28 497.29 497.30 498.1 498.2 498.3 498.4 498.5
498.6 498.7 498.8 498.9 498.10
498.11 498.12 498.13 498.14 498.15 498.16 498.17 498.18 498.19 498.20 498.21 498.22 498.23 498.24 498.25 498.26 498.27 498.28 498.29 498.30 499.1 499.2 499.3 499.4 499.5 499.6 499.7 499.8 499.9 499.10 499.11 499.12 499.13 499.14 499.15 499.16 499.17 499.18 499.19 499.20 499.21 499.22 499.23 499.24 499.25 499.26 499.27 499.28 499.29 499.30 499.31 500.1 500.2 500.3 500.4 500.5 500.6 500.7 500.8 500.9 500.10 500.11 500.12 500.13 500.14 500.15 500.16 500.17 500.18 500.19 500.20 500.21 500.22 500.23 500.24 500.25 500.26 500.27 500.28 500.29 501.1 501.2
501.3 501.4 501.5 501.6 501.7 501.8 501.9 501.10 501.11 501.12 501.13 501.14 501.15 501.16 501.17 501.18 501.19
501.20 501.21 501.22 501.23 501.24 501.25 501.26 501.27 501.28 501.29 501.30 502.1 502.2 502.3 502.4 502.5 502.6 502.7 502.8 502.9 502.10 502.11 502.12 502.13 502.14 502.15 502.16 502.17 502.18 502.19 502.20 502.21 502.22 502.23 502.24 502.25 502.26 502.27 502.28 502.29 502.30 502.31 503.1 503.2 503.3 503.4
503.5 503.6 503.7 503.8 503.9 503.10 503.11 503.12 503.13 503.14 503.15 503.16 503.17 503.18 503.19 503.20 503.21 503.22 503.23 503.24 503.25 503.26 503.27 503.28 503.29 503.30 503.31 504.1 504.2 504.3 504.4 504.5 504.6 504.7 504.8 504.9 504.10 504.11 504.12 504.13 504.14 504.15 504.16 504.17 504.18 504.19 504.20 504.21 504.22 504.23 504.24 504.25 504.26 504.27 504.28 504.29 504.30 505.1 505.2 505.3 505.4 505.5 505.6 505.7 505.8 505.9 505.10 505.11 505.12
505.13 505.14 505.15 505.16 505.17 505.18 505.19 505.20 505.21 505.22 505.23 505.24 505.25 505.26 505.27 505.28 505.29 505.30 505.31 506.1 506.2 506.3 506.4 506.5 506.6 506.7 506.8 506.9 506.10 506.11 506.12 506.13 506.14 506.15 506.16 506.17 506.18 506.19 506.20 506.21 506.22 506.23 506.24 506.25 506.26 506.27
506.28 506.29 506.30 506.31 506.32 506.33 507.1 507.2 507.3 507.4 507.5 507.6 507.7 507.8 507.9 507.10 507.11 507.12 507.13
507.14 507.15 507.16 507.17 507.18 507.19 507.20 507.21 507.22 507.23 507.24 507.25 507.26 507.27 507.28 507.29 507.30 508.1 508.2 508.3 508.4 508.5 508.6 508.7 508.8 508.9 508.10 508.11 508.12 508.13 508.14 508.15 508.16 508.17 508.18 508.19 508.20 508.21 508.22 508.23 508.24 508.25 508.26 508.27 508.28 508.29 508.30 508.31 509.1 509.2 509.3 509.4 509.5 509.6 509.7 509.8 509.9 509.10 509.11 509.12 509.13 509.14 509.15 509.16 509.17 509.18 509.19 509.20 509.21 509.22
509.23 509.24 509.25 509.26 509.27 509.28 509.29 509.30 510.1 510.2 510.3 510.4 510.5
510.6 510.7 510.8 510.9 510.10 510.11 510.12 510.13 510.14 510.15 510.16 510.17 510.18 510.19
510.20 510.21 510.22 510.23 510.24 510.25 510.26 510.27 510.28 510.29 510.30 510.31 510.32 510.33
511.1 511.2 511.3 511.4 511.5 511.6 511.7 511.8 511.9
511.10 511.11
511.12 511.13 511.14 511.15 511.16 511.17 511.18 511.19 511.20 511.21 511.22 511.23 511.24 511.25 511.26 511.27 511.28 511.29 511.30 511.31 512.1 512.2 512.3 512.4 512.5 512.6 512.7 512.8 512.9 512.10 512.11
512.12
512.13 512.14 512.15 512.16 512.17 512.18 512.19 512.20 512.21 512.22 512.23 512.24 512.25 512.26 512.27
512.28 512.29 512.30 512.31 512.32 513.1 513.2 513.3 513.4 513.5
513.6 513.7 513.8 513.9 513.10 513.11 513.12 513.13 513.14 513.15 513.16 513.17 513.18 513.19 513.20 513.21 513.22 513.23 513.24 513.25 513.26 513.27 513.28
513.29 513.30 513.31 513.32 514.1 514.2 514.3 514.4 514.5 514.6 514.7 514.8 514.9 514.10 514.11 514.12 514.13 514.14 514.15 514.16 514.17 514.18 514.19 514.20 514.21 514.22 514.23 514.24 514.25 514.26 514.27 514.28 514.29 514.30 514.31 514.32 514.33 515.1 515.2 515.3 515.4 515.5 515.6 515.7 515.8 515.9 515.10 515.11 515.12 515.13 515.14 515.15 515.16 515.17 515.18 515.19 515.20 515.21 515.22 515.23 515.24 515.25 515.26 515.27
515.28 515.29 515.30 515.31 515.32 515.33 516.1 516.2 516.3 516.4 516.5 516.6 516.7 516.8 516.9 516.10 516.11 516.12 516.13 516.14
516.15
516.16 516.17 516.18 516.19 516.20 516.21 516.22 516.23 516.24 516.25 516.26 516.27 516.28 516.29 516.30 516.31 517.1 517.2 517.3 517.4 517.5 517.6 517.7 517.8 517.9 517.10 517.11 517.12 517.13 517.14 517.15 517.16 517.17 517.18 517.19 517.20 517.21 517.22
517.23
517.24 517.25 517.26 517.27 517.28 517.29 517.30 517.31 517.32 518.1 518.2 518.3 518.4 518.5 518.6 518.7 518.8 518.9 518.10 518.11 518.12 518.13 518.14 518.15 518.16 518.17 518.18 518.19 518.20 518.21 518.22 518.23
518.24
518.25 518.26 518.27 518.28 518.29 518.30 518.31 518.32 518.33
519.1
519.2 519.3 519.4 519.5 519.6 519.7 519.8 519.9 519.10 519.11 519.12 519.13 519.14 519.15 519.16 519.17 519.18 519.19 519.20 519.21 519.22 519.23 519.24 519.25 519.26 519.27 519.28 519.29 519.30 519.31 519.32 520.1 520.2 520.3 520.4 520.5 520.6 520.7 520.8 520.9 520.10 520.11 520.12 520.13 520.14 520.15 520.16 520.17 520.18 520.19 520.20 520.21 520.22 520.23 520.24 520.25 520.26 520.27 520.28 520.29 520.30 520.31 521.1 521.2 521.3 521.4 521.5 521.6 521.7 521.8 521.9 521.10 521.11 521.12 521.13 521.14 521.15 521.16 521.17 521.18 521.19 521.20 521.21 521.22 521.23 521.24 521.25 521.26 521.27 521.28 521.29 521.30 521.31 521.32 521.33 521.34 522.1 522.2 522.3 522.4 522.5 522.6 522.7 522.8 522.9 522.10 522.11 522.12 522.13 522.14 522.15 522.16 522.17 522.18 522.19 522.20 522.21 522.22
522.23 522.24 522.25 522.26 522.27 522.28 522.29 522.30 522.31 522.32 523.1 523.2 523.3 523.4 523.5 523.6 523.7 523.8 523.9 523.10 523.11 523.12 523.13 523.14 523.15 523.16 523.17 523.18 523.19 523.20 523.21 523.22 523.23 523.24 523.25 523.26 523.27 523.28 523.29 523.30 523.31 523.32 523.33 523.34 523.35 524.1 524.2 524.3 524.4 524.5 524.6 524.7 524.8 524.9 524.10 524.11 524.12 524.13 524.14 524.15 524.16 524.17 524.18 524.19 524.20 524.21 524.22 524.23 524.24 524.25 524.26 524.27 524.28 524.29 524.30 524.31 524.32 524.33 524.34 525.1 525.2 525.3 525.4 525.5 525.6 525.7 525.8
525.9 525.10 525.11 525.12 525.13 525.14 525.15 525.16 525.17 525.18 525.19 525.20 525.21 525.22 525.23 525.24 525.25 525.26 525.27 525.28 525.29 525.30 525.31 525.32 526.1 526.2 526.3 526.4 526.5 526.6 526.7 526.8 526.9 526.10 526.11 526.12 526.13 526.14 526.15 526.16 526.17 526.18 526.19 526.20 526.21 526.22 526.23 526.24 526.25 526.26 526.27 526.28 526.29 526.30 526.31 526.32 526.33 527.1 527.2 527.3 527.4 527.5 527.6 527.7 527.8 527.9 527.10 527.11
527.12 527.13
527.14 527.15 527.16 527.17 527.18 527.19 527.20 527.21 527.22 527.23 527.24 527.25 527.26 527.27 527.28 527.29
527.30 527.31 527.32 527.33 528.1 528.2 528.3
528.4 528.5 528.6 528.7 528.8 528.9 528.10 528.11 528.12 528.13 528.14 528.15 528.16 528.17 528.18 528.19 528.20 528.21 528.22 528.23 528.24 528.25 528.26 528.27 528.28 528.29 528.30 529.1 529.2
529.3 529.4 529.5 529.6 529.7 529.8 529.9 529.10 529.11 529.12 529.13 529.14 529.15 529.16 529.17 529.18 529.19 529.20 529.21 529.22 529.23 529.24 529.25 529.26 529.27 529.28 529.29 529.30 529.31 529.32 530.1 530.2 530.3 530.4 530.5 530.6 530.7 530.8 530.9 530.10 530.11 530.12 530.13 530.14 530.15 530.16 530.17 530.18 530.19 530.20 530.21 530.22 530.23 530.24 530.25 530.26 530.27 530.28 530.29 530.30 530.31 530.32 530.33 531.1 531.2 531.3 531.4 531.5 531.6 531.7 531.8 531.9 531.10 531.11 531.12 531.13 531.14 531.15 531.16 531.17 531.18 531.19 531.20 531.21 531.22 531.23 531.24 531.25 531.26 531.27 531.28 531.29 531.30 531.31 531.32 531.33 531.34 532.1 532.2 532.3 532.4 532.5 532.6 532.7 532.8 532.9 532.10 532.11 532.12 532.13 532.14 532.15 532.16 532.17 532.18 532.19
532.20
532.21 532.22 532.23 532.24 532.25 532.26 532.27 532.28 532.29 532.30 532.31 532.32 532.33 533.1 533.2 533.3 533.4 533.5 533.6 533.7 533.8 533.9 533.10 533.11 533.12 533.13 533.14 533.15 533.16 533.17 533.18 533.19 533.20 533.21 533.22 533.23 533.24
533.25
533.26 533.27 533.28 533.29 533.30 533.31
534.1 534.2 534.3
534.4 534.5 534.6 534.7 534.8 534.9 534.10 534.11 534.12 534.13 534.14 534.15 534.16 534.17 534.18 534.19 534.20 534.21 534.22 534.23 534.24 534.25 534.26 534.27 534.28 534.29 534.30 534.31 534.32 534.33 535.1 535.2 535.3 535.4 535.5 535.6 535.7 535.8 535.9 535.10 535.11 535.12 535.13 535.14 535.15 535.16 535.17 535.18 535.19 535.20 535.21 535.22 535.23 535.24 535.25 535.26
535.27
535.28 535.29 535.30 535.31 535.32 535.33 536.1 536.2
536.3 536.4 536.5 536.6 536.7 536.8 536.9 536.10 536.11 536.12 536.13 536.14 536.15 536.16 536.17 536.18 536.19 536.20 536.21 536.22 536.23 536.24 536.25 536.26 536.27 536.28 536.29 536.30 536.31 537.1 537.2 537.3 537.4 537.5 537.6 537.7 537.8 537.9 537.10 537.11 537.12 537.13 537.14 537.15 537.16 537.17 537.18 537.19 537.20 537.21 537.22 537.23 537.24 537.25 537.26 537.27 537.28 537.29
537.30 537.31 537.32 537.33
538.1 538.2 538.3 538.4 538.5 538.6 538.7 538.8 538.9 538.10 538.11 538.12 538.13 538.14 538.15 538.16 538.17 538.18 538.19 538.20 538.21 538.22 538.23 538.24 538.25 538.26 538.27 538.28 538.29 539.1 539.2 539.3 539.4 539.5 539.6 539.7 539.8 539.9 539.10 539.11 539.12 539.13 539.14 539.15 539.16 539.17 539.18 539.19 539.20 539.21 539.22
539.23 539.24 539.25 539.26 539.27 539.28 539.29 539.30 539.31 540.1 540.2 540.3 540.4 540.5 540.6 540.7 540.8 540.9 540.10 540.11 540.12 540.13 540.14 540.15 540.16 540.17 540.18 540.19 540.20 540.21 540.22 540.23 540.24 540.25 540.26 540.27 540.28 540.29 540.30 540.31 540.32 540.33 541.1 541.2 541.3 541.4 541.5 541.6 541.7 541.8 541.9 541.10 541.11 541.12 541.13
541.14 541.15 541.16
541.17 541.18 541.19 541.20 541.21 541.22 541.23 541.24 541.25 541.26 541.27 541.28 541.29 541.30 541.31 541.32 542.1 542.2 542.3 542.4 542.5 542.6 542.7 542.8 542.9 542.10
542.11 542.12 542.13 542.14 542.15 542.16 542.17 542.18 542.19 542.20 542.21 542.22 542.23 542.24 542.25 542.26 542.27 542.28 542.29 542.30 542.31 542.32 542.33 542.34 543.1 543.2 543.3 543.4 543.5 543.6 543.7 543.8 543.9 543.10 543.11 543.12 543.13 543.14 543.15 543.16 543.17 543.18 543.19 543.20 543.21 543.22 543.23 543.24 543.25 543.26 543.27 543.28 543.29 543.30 543.31 543.32 543.33 543.34 543.35 543.36 544.1 544.2 544.3 544.4 544.5 544.6 544.7 544.8 544.9 544.10 544.11 544.12 544.13 544.14 544.15 544.16 544.17 544.18 544.19 544.20 544.21 544.22 544.23 544.24 544.25 544.26 544.27 544.28 544.29 544.30 544.31 544.32 544.33 544.34 544.35 545.1 545.2 545.3 545.4 545.5 545.6 545.7 545.8 545.9 545.10 545.11 545.12 545.13 545.14 545.15 545.16 545.17 545.18 545.19 545.20 545.21 545.22 545.23 545.24 545.25 545.26 545.27 545.28 545.29 545.30 545.31 545.32 545.33 545.34 545.35 546.1 546.2 546.3 546.4 546.5 546.6 546.7 546.8 546.9
546.10 546.11 546.12 546.13
546.14 546.15 546.16 546.17 546.18 546.19 546.20 546.21 546.22 546.23 546.24 546.25 546.26 546.27 546.28 546.29 546.30 546.31 546.32 547.1 547.2 547.3 547.4 547.5 547.6 547.7 547.8 547.9 547.10 547.11 547.12 547.13 547.14 547.15 547.16 547.17 547.18 547.19 547.20 547.21 547.22 547.23 547.24 547.25 547.26 547.27 547.28 547.29 547.30 547.31 547.32
548.1 548.2
548.3 548.4 548.5 548.6 548.7 548.8 548.9 548.10 548.11 548.12 548.13 548.14 548.15 548.16 548.17 548.18 548.19 548.20 548.21 548.22 548.23 548.24 548.25 548.26 548.27 548.28 548.29 548.30 548.31 548.32 549.1 549.2 549.3 549.4 549.5 549.6 549.7 549.8 549.9 549.10 549.11 549.12 549.13 549.14 549.15 549.16 549.17 549.18 549.19 549.20 549.21 549.22 549.23 549.24 549.25 549.26 549.27 549.28 549.29 549.30 549.31 549.32 550.1 550.2 550.3 550.4 550.5 550.6 550.7 550.8 550.9 550.10 550.11 550.12 550.13 550.14 550.15 550.16 550.17 550.18 550.19 550.20 550.21 550.22 550.23 550.24 550.25 550.26 550.27 550.28 550.29 550.30 550.31 551.1 551.2 551.3 551.4 551.5 551.6 551.7 551.8 551.9 551.10 551.11 551.12 551.13 551.14 551.15 551.16 551.17 551.18 551.19 551.20 551.21 551.22 551.23 551.24 551.25 551.26 551.27 551.28 551.29 551.30 551.31 552.1 552.2 552.3 552.4 552.5 552.6 552.7 552.8 552.9 552.10 552.11 552.12 552.13 552.14 552.15 552.16 552.17 552.18 552.19
552.20
552.21 552.22 552.23 552.24 552.25 552.26
552.27
552.28 552.29 552.30 552.31 553.1 553.2 553.3 553.4 553.5 553.6 553.7 553.8
553.9
553.10 553.11 553.12 553.13 553.14 553.15 553.16 553.17 553.18 553.19 553.20 553.21 553.22 553.23 553.24 553.25 553.26 553.27 553.28 553.29 553.30 553.31 553.32 553.33 553.34 554.1 554.2 554.3 554.4 554.5 554.6 554.7 554.8 554.9 554.10 554.11 554.12 554.13 554.14 554.15 554.16 554.17 554.18 554.19 554.20 554.21 554.22 554.23 554.24 554.25 554.26 554.27 554.28 554.29 554.30 554.31 554.32 555.1 555.2 555.3 555.4 555.5 555.6 555.7 555.8 555.9 555.10 555.11 555.12 555.13 555.14 555.15 555.16 555.17 555.18 555.19 555.20 555.21 555.22 555.23 555.24 555.25 555.26 555.27 555.28 555.29 555.30 555.31 555.32 555.33 555.34 556.1 556.2 556.3 556.4 556.5 556.6 556.7 556.8 556.9 556.10 556.11 556.12 556.13 556.14 556.15 556.16 556.17 556.18 556.19 556.20 556.21 556.22 556.23 556.24 556.25 556.26 556.27 556.28 556.29 557.1 557.2 557.3 557.4 557.5 557.6 557.7 557.8 557.9 557.10 557.11 557.12 557.13 557.14 557.15 557.16 557.17 557.18 557.19 557.20 557.21 557.22 557.23 557.24 557.25 557.26 557.27 557.28 557.29 557.30 557.31 557.32 558.1 558.2 558.3 558.4 558.5 558.6 558.7 558.8 558.9 558.10 558.11 558.12 558.13 558.14 558.15 558.16 558.17 558.18 558.19 558.20 558.21 558.22 558.23 558.24 558.25 558.26 558.27 558.28 558.29 558.30 558.31 558.32 558.33 558.34 559.1 559.2 559.3 559.4
559.5 559.6 559.7 559.8 559.9 559.10 559.11 559.12 559.13 559.14 559.15 559.16 559.17 559.18 559.19 559.20 559.21 559.22 559.23 559.24 559.25 559.26 559.27 559.28 559.29 559.30 559.31 560.1 560.2 560.3 560.4 560.5 560.6 560.7 560.8 560.9 560.10 560.11 560.12 560.13 560.14 560.15 560.16
560.17 560.18 560.19
560.20 560.21 560.22 560.23 560.24 560.25 560.26 560.27 560.28 560.29 560.30 560.31
560.32
561.1 561.2 561.3 561.4 561.5 561.6 561.7 561.8 561.9 561.10 561.11 561.12 561.13 561.14 561.15 561.16 561.17 561.18 561.19 561.20 561.21 561.22 561.23 561.24 561.25 561.26 561.27 561.28 561.29 561.30 561.31 562.1 562.2 562.3 562.4 562.5 562.6 562.7 562.8
562.9 562.10 562.11
562.12 562.13 562.14 562.15 562.16 562.17 562.18 562.19 562.20 562.21 562.22 562.23 562.24 562.25 562.26
562.27 562.28 562.29 562.30 562.31 562.32 563.1 563.2 563.3 563.4 563.5 563.6 563.7 563.8 563.9 563.10 563.11 563.12
563.13
563.14 563.15 563.16 563.17 563.18 563.19 563.20 563.21 563.22 563.23 563.24 563.25 563.26 563.27 563.28 563.29 563.30 563.31 563.32 564.1 564.2 564.3 564.4 564.5 564.6 564.7 564.8 564.9 564.10 564.11 564.12 564.13 564.14 564.15 564.16 564.17 564.18 564.19 564.20 564.21 564.22 564.23 564.24 564.25 564.26 564.27 564.28 564.29 564.30 564.31 565.1 565.2 565.3 565.4 565.5 565.6 565.7 565.8 565.9 565.10 565.11 565.12 565.13 565.14 565.15 565.16 565.17 565.18 565.19 565.20 565.21 565.22 565.23 565.24 565.25 565.26 565.27 565.28 565.29 565.30 565.31 565.32 565.33 565.34 565.35 566.1 566.2 566.3 566.4 566.5 566.6 566.7 566.8 566.9 566.10
566.11
566.12 566.13 566.14 566.15 566.16 566.17 566.18 566.19 566.20 566.21 566.22
566.23
566.24 566.25 566.26 566.27
566.28 566.29 566.30 566.31 567.1 567.2 567.3 567.4 567.5 567.6 567.7 567.8 567.9 567.10 567.11 567.12 567.13 567.14 567.15 567.16 567.17 567.18 567.19 567.20 567.21 567.22 567.23 567.24 567.25 567.26 567.27 567.28 567.29 567.30 567.31 567.32 567.33 568.1 568.2 568.3 568.4 568.5 568.6 568.7 568.8 568.9 568.10 568.11 568.12 568.13 568.14 568.15 568.16 568.17 568.18 568.19 568.20 568.21 568.22 568.23 568.24 568.25 568.26 568.27 568.28 568.29 568.30 568.31 568.32 568.33 568.34 569.1 569.2 569.3 569.4 569.5 569.6 569.7 569.8 569.9 569.10 569.11 569.12 569.13 569.14 569.15 569.16
569.17 569.18 569.19
569.20 569.21 569.22 569.23 569.24 569.25 569.26 569.27
569.28 569.29 569.30 569.31 569.32 569.33 570.1 570.2 570.3 570.4 570.5 570.6 570.7
570.8 570.9 570.10 570.11 570.12 570.13 570.14 570.15 570.16 570.17 570.18 570.19 570.20 570.21 570.22 570.23 570.24 570.25 570.26 570.27 570.28 570.29 570.30 570.31 570.32 570.33 570.34 571.1 571.2 571.3 571.4 571.5 571.6 571.7 571.8 571.9 571.10 571.11 571.12
571.13 571.14 571.15 571.16 571.17 571.18
571.19 571.20 571.21 571.22 571.23 571.24 571.25 571.26 571.27 571.28 571.29 571.30 572.1 572.2
572.3 572.4 572.5 572.6 572.7 572.8 572.9 572.10 572.11 572.12 572.13 572.14
572.15 572.16 572.17 572.18 572.19 572.20 572.21 572.22 572.23 572.24 572.25 572.26 572.27 572.28 572.29 572.30 572.31 572.32
572.33
573.1 573.2 573.3 573.4 573.5 573.6 573.7 573.8 573.9 573.10
573.11 573.12 573.13 573.14 573.15 573.16 573.17 573.18 573.19 573.20 573.21 573.22 573.23 573.24 573.25 573.26 573.27 573.28 573.29 573.30 573.31 573.32 573.33 574.1 574.2 574.3 574.4 574.5 574.6 574.7 574.8 574.9 574.10 574.11 574.12 574.13 574.14 574.15 574.16 574.17 574.18 574.19 574.20 574.21 574.22 574.23 574.24 574.25 574.26 574.27 574.28 574.29 574.30 574.31 574.32 574.33 574.34 575.1 575.2 575.3 575.4 575.5 575.6 575.7 575.8 575.9 575.10 575.11 575.12 575.13 575.14 575.15 575.16 575.17 575.18 575.19 575.20 575.21 575.22 575.23 575.24 575.25 575.26 575.27 575.28 575.29 575.30 575.31 575.32 575.33 575.34 576.1 576.2 576.3 576.4 576.5 576.6 576.7 576.8 576.9 576.10 576.11 576.12 576.13 576.14 576.15 576.16 576.17 576.18 576.19 576.20 576.21 576.22 576.23 576.24 576.25 576.26 576.27 576.28 576.29 576.30 576.31 576.32 576.33 577.1 577.2 577.3 577.4 577.5 577.6 577.7 577.8 577.9 577.10 577.11 577.12 577.13 577.14 577.15 577.16 577.17 577.18 577.19 577.20 577.21 577.22 577.23 577.24 577.25 577.26 577.27 577.28 577.29 577.30 577.31 577.32 577.33 577.34 578.1 578.2 578.3 578.4 578.5 578.6 578.7 578.8 578.9 578.10 578.11 578.12 578.13 578.14 578.15 578.16 578.17
578.18 578.19 578.20 578.21 578.22 578.23 578.24
578.25 578.26 578.27 578.28 578.29 578.30 578.31
579.1 579.2
579.3 579.4 579.5 579.6 579.7 579.8 579.9 579.10 579.11 579.12 579.13 579.14 579.15 579.16 579.17 579.18 579.19 579.20 579.21 579.22 579.23 579.24 579.25 579.26 579.27 579.28 579.29 579.30 579.31 580.1 580.2 580.3 580.4 580.5 580.6 580.7 580.8 580.9 580.10 580.11 580.12 580.13 580.14 580.15 580.16 580.17 580.18 580.19
580.20
580.21 580.22 580.23 580.24 580.25 580.26 580.27 580.28 580.29 580.30 580.31 580.32 580.33 581.1 581.2 581.3 581.4 581.5 581.6 581.7 581.8 581.9 581.10 581.11 581.12 581.13 581.14 581.15 581.16 581.17 581.18 581.19 581.20 581.21 581.22 581.23 581.24 581.25 581.26 581.27 581.28 581.29 581.30 581.31 581.32 582.1 582.2 582.3 582.4 582.5 582.6 582.7 582.8 582.9 582.10 582.11
582.12 582.13
582.14 582.15 582.16 582.17 582.18 582.19 582.20 582.21 582.22 582.23 582.24 582.25 582.26 582.27 582.28 582.29 583.1 583.2 583.3 583.4 583.5 583.6 583.7 583.8 583.9 583.10 583.11 583.12 583.13 583.14 583.15 583.16 583.17 583.18
583.19 583.20 583.21 583.22 583.23 583.24 583.25 583.26 583.27 583.28 583.29 583.30 583.31 583.32 584.1 584.2 584.3 584.4 584.5 584.6 584.7 584.8 584.9 584.10 584.11 584.12 584.13 584.14
584.15 584.16 584.17 584.18
584.19 584.20 584.21 584.22 584.23
584.24 584.25 584.26 584.27 584.28 584.29 584.30 585.1 585.2 585.3 585.4 585.5 585.6 585.7 585.8 585.9 585.10
585.11
585.12 585.13 585.14 585.15 585.16 585.17 585.18 585.19 585.20 585.21 585.22 585.23 585.24 585.25 585.26 585.27 585.28 585.29 585.30 586.1 586.2 586.3 586.4 586.5 586.6 586.7 586.8 586.9 586.10 586.11 586.12 586.13 586.14 586.15 586.16 586.17 586.18 586.19 586.20 586.21 586.22 586.23 586.24 586.25 586.26 586.27 586.28 586.29 586.30 586.31 586.32 586.33
586.34
587.1 587.2 587.3 587.4 587.5 587.6 587.7 587.8 587.9 587.10
587.11
587.12 587.13 587.14 587.15 587.16 587.17 587.18 587.19 587.20 587.21 587.22 587.23 587.24 587.25 587.26 587.27 587.28 587.29 587.30 587.31 587.32 587.33 588.1 588.2 588.3 588.4 588.5
588.6 588.7 588.8 588.9 588.10 588.11 588.12 588.13 588.14 588.15 588.16 588.17 588.18 588.19 588.20 588.21 588.22 588.23 588.24 588.25 588.26 588.27 588.28 588.29 588.30 588.31 589.1 589.2 589.3 589.4 589.5 589.6 589.7 589.8 589.9 589.10 589.11 589.12 589.13 589.14 589.15 589.16 589.17 589.18 589.19 589.20 589.21 589.22 589.23 589.24 589.25 589.26 589.27 589.28 589.29 589.30 589.31 589.32 589.33 589.34 590.1 590.2 590.3 590.4 590.5 590.6 590.7 590.8 590.9 590.10
590.11 590.12 590.13 590.14 590.15 590.16 590.17 590.18 590.19 590.20 590.21 590.22 590.23 590.24 590.25 590.26 590.27 590.28 590.29 590.30 590.31 590.32 590.33 590.34 591.1 591.2 591.3 591.4 591.5 591.6 591.7 591.8 591.9 591.10 591.11 591.12 591.13 591.14 591.15 591.16 591.17 591.18 591.19 591.20 591.21 591.22 591.23 591.24 591.25 591.26 591.27
592.1 592.2 592.3 592.4 592.5
592.6
592.7 592.8 592.9 592.10 592.11 592.12 592.13 592.14 592.15 592.16 592.17 592.18 592.19 592.20 592.21
592.22 592.23 592.24
592.25 592.26 592.27 592.28 592.29 592.30 592.31 593.1 593.2 593.3 593.4 593.5 593.6 593.7 593.8 593.9 593.10 593.11
593.12
593.13 593.14 593.15 593.16 593.17 593.18 593.19 593.20 593.21 593.22
593.23 593.24 593.25 593.26 593.27 593.28 593.29 593.30 593.31 593.32 594.1 594.2 594.3 594.4 594.5 594.6 594.7 594.8 594.9 594.10 594.11 594.12 594.13 594.14 594.15 594.16 594.17 594.18 594.19 594.20 594.21 594.22 594.23 594.24 594.25 594.26 594.27 594.28 594.29 594.30 594.31 594.32 595.1 595.2 595.3 595.4 595.5 595.6 595.7 595.8 595.9 595.10 595.11 595.12 595.13 595.14 595.15 595.16 595.17 595.18 595.19 595.20 595.21 595.22 595.23 595.24 595.25 595.26 595.27 595.28 595.29 595.30 595.31 596.1 596.2 596.3 596.4 596.5 596.6 596.7 596.8 596.9 596.10 596.11
596.12
596.13 596.14 596.15 596.16 596.17 596.18 596.19 596.20 596.21 596.22 596.23 596.24 596.25 596.26 596.27
596.28
597.1 597.2 597.3 597.4 597.5 597.6 597.7 597.8 597.9 597.10 597.11 597.12 597.13 597.14 597.15 597.16 597.17 597.18 597.19 597.20 597.21 597.22 597.23 597.24 597.25 597.26 597.27 597.28 597.29 597.30 598.1 598.2 598.3 598.4 598.5 598.6 598.7 598.8 598.9 598.10 598.11 598.12 598.13 598.14 598.15 598.16 598.17 598.18 598.19 598.20 598.21 598.22 598.23 598.24 598.25 598.26 598.27 598.28 598.29 598.30 598.31 599.1 599.2 599.3 599.4 599.5 599.6 599.7 599.8 599.9 599.10 599.11 599.12 599.13 599.14 599.15 599.16 599.17 599.18 599.19 599.20 599.21 599.22 599.23 599.24 599.25 599.26 599.27 599.28 599.29 599.30 600.1 600.2 600.3 600.4 600.5 600.6 600.7 600.8 600.9 600.10 600.11 600.12 600.13 600.14 600.15 600.16
600.17 600.18
600.19 600.20 600.21 600.22 600.23 600.24 600.25 600.26 600.27 600.28 600.29 600.30 600.31 600.32 601.1 601.2 601.3 601.4 601.5 601.6 601.7 601.8 601.9 601.10 601.11 601.12 601.13
601.14
601.15 601.16 601.17 601.18 601.19 601.20 601.21 601.22 601.23 601.24 601.25 601.26 601.27
601.28
602.1 602.2 602.3 602.4 602.5
602.6 602.7
602.8 602.9 602.10 602.11 602.12
602.13 602.14
602.15 602.16 602.17 602.18 602.19 602.20 602.21 602.22 602.23 602.24 602.25 602.26 602.27 602.28 602.29 602.30 603.1 603.2 603.3 603.4 603.5 603.6 603.7 603.8 603.9 603.10 603.11 603.12 603.13 603.14 603.15 603.16 603.17 603.18 603.19 603.20 603.21 603.22 603.23 603.24 603.25 603.26 603.27 603.28
603.29 603.30
604.1 604.2 604.3 604.4 604.5 604.6 604.7 604.8 604.9 604.10 604.11 604.12 604.13 604.14 604.15 604.16 604.17 604.18 604.19 604.20 604.21 604.22 604.23 604.24 604.25 604.26 604.27 604.28 604.29 604.30 604.31 604.32 605.1 605.2 605.3 605.4 605.5 605.6 605.7 605.8 605.9 605.10 605.11 605.12 605.13 605.14 605.15 605.16 605.17 605.18 605.19 605.20 605.21 605.22 605.23 605.24 605.25 605.26 605.27 605.28 605.29 605.30 605.31 606.1 606.2 606.3 606.4
606.5 606.6 606.7 606.8 606.9 606.10 606.11
606.12 606.13 606.14 606.15 606.16 606.17
606.18 606.19
606.20 606.21 606.22 606.23 606.24 606.25 606.26 606.27 606.28 606.29 606.30 606.31 606.32 606.33 607.1 607.2 607.3 607.4 607.5 607.6 607.7 607.8 607.9 607.10 607.11 607.12 607.13 607.14 607.15 607.16 607.17 607.18 607.19 607.20 607.21 607.22 607.23 607.24 607.25 607.26 607.27 607.28 607.29 607.30 607.31
607.32 607.33 607.34 608.1 608.2 608.3 608.4 608.5 608.6 608.7 608.8 608.9 608.10 608.11 608.12 608.13
608.14 608.15
608.16 608.17 608.18 608.19 608.20 608.21 608.22
608.23 608.24 608.25 608.26 608.27 608.28 608.29 608.30 608.31 608.32 608.33 609.1 609.2 609.3 609.4 609.5 609.6
609.7 609.8 609.9 609.10 609.11 609.12 609.13 609.14 609.15 609.16 609.17 609.18 609.19 609.20 609.21 609.22 609.23 609.24 609.25 609.26 609.27 609.28
609.29 609.30 609.31 609.32 610.1 610.2 610.3 610.4 610.5 610.6 610.7 610.8 610.9 610.10 610.11 610.12 610.13 610.14 610.15 610.16 610.17 610.18 610.19 610.20 610.21 610.22 610.23 610.24 610.25 610.26 610.27 610.28 610.29 610.30 610.31 610.32 610.33 611.1 611.2 611.3 611.4 611.5 611.6 611.7 611.8 611.9 611.10 611.11 611.12 611.13 611.14 611.15 611.16 611.17 611.18 611.19 611.20 611.21 611.22 611.23 611.24 611.25 611.26 611.27 611.28 611.29 611.30
611.31 611.32 611.33 612.1 612.2 612.3 612.4 612.5 612.6 612.7 612.8 612.9 612.10 612.11 612.12 612.13 612.14 612.15
612.16 612.17
612.18
612.19 612.20
612.21 612.22 612.23 612.24 612.25 612.26 612.27 612.28 612.29 612.30 612.31 612.32 613.1 613.2
613.3 613.4 613.5 613.6 613.7 613.8 613.9 613.10 613.11 613.12 613.13 613.14 613.15 613.16 613.17 613.18 613.19 613.20 613.21 613.22 613.23 613.24 613.25 613.26 613.27 613.28 613.29 613.30 613.31 613.32 614.1 614.2 614.3 614.4 614.5 614.6 614.7 614.8
614.9 614.10 614.11 614.12 614.13
614.14 614.15 614.16 614.17 614.18 614.19 614.20 614.21 614.22 614.23 614.24 614.25 614.26 614.27 614.28 614.29 615.1 615.2 615.3 615.4 615.5 615.6 615.7 615.8 615.9 615.10 615.11 615.12 615.13 615.14 615.15 615.16 615.17 615.18
615.19 615.20
615.21 615.22 615.23 615.24 615.25 615.26 615.27 615.28 615.29 615.30 615.31 616.1 616.2 616.3 616.4 616.5 616.6 616.7 616.8 616.9 616.10 616.11 616.12 616.13 616.14 616.15 616.16 616.17 616.18 616.19 616.20 616.21 616.22 616.23 616.24 616.25 616.26 616.27 616.28 616.29 616.30 616.31 616.32 617.1 617.2 617.3 617.4 617.5
617.6 617.7 617.8
617.9 617.10 617.11 617.12 617.13 617.14 617.15 617.16 617.17 617.18 617.19 617.20 617.21 617.22 617.23 617.24 617.25 617.26 617.27 617.28 617.29 617.30 618.1 618.2 618.3 618.4 618.5 618.6 618.7 618.8 618.9 618.10 618.11 618.12 618.13 618.14 618.15 618.16 618.17 618.18 618.19 618.20 618.21 618.22 618.23 618.24 618.25 618.26 618.27 618.28 618.29 619.1 619.2 619.3 619.4 619.5 619.6 619.7 619.8 619.9 619.10 619.11 619.12 619.13 619.14 619.15 619.16 619.17 619.18 619.19 619.20 619.21 619.22 619.23 619.24 619.25 619.26 619.27 619.28 619.29 619.30 620.1 620.2 620.3 620.4 620.5 620.6 620.7 620.8
620.9 620.10 620.11 620.12 620.13 620.14 620.15 620.16 620.17 620.18 620.19 620.20 620.21 620.22 620.23 620.24 620.25 620.26 620.27 620.28 620.29 620.30 620.31 620.32 621.1 621.2 621.3 621.4 621.5 621.6 621.7 621.8 621.9 621.10 621.11 621.12 621.13 621.14 621.15 621.16 621.17 621.18 621.19 621.20 621.21 621.22 621.23 621.24 621.25 621.26 621.27 621.28 621.29 621.30 621.31 621.32 622.1 622.2 622.3 622.4 622.5 622.6 622.7 622.8 622.9 622.10 622.11 622.12 622.13 622.14 622.15
622.16 622.17 622.18 622.19 622.20 622.21 622.22 622.23 622.24 622.25 622.26 622.27
622.28 622.29 622.30 623.1 623.2 623.3 623.4 623.5 623.6 623.7 623.8 623.9 623.10 623.11 623.12 623.13 623.14 623.15 623.16 623.17
623.18 623.19 623.20 623.21 623.22 623.23 623.24 623.25 623.26 623.27 623.28 623.29 623.30 623.31 623.32 623.33 624.1 624.2 624.3 624.4 624.5 624.6 624.7 624.8 624.9 624.10 624.11 624.12 624.13 624.14 624.15 624.16 624.17 624.18 624.19 624.20 624.21 624.22 624.23 624.24 624.25 624.26 624.27 624.28 624.29 624.30 625.1 625.2 625.3 625.4 625.5 625.6 625.7 625.8 625.9 625.10 625.11 625.12 625.13 625.14 625.15 625.16 625.17 625.18 625.19 625.20 625.21 625.22 625.23 625.24 625.25 625.26 625.27 625.28 625.29 625.30 625.31 625.32 626.1 626.2 626.3 626.4 626.5 626.6 626.7 626.8 626.9 626.10 626.11 626.12 626.13 626.14 626.15 626.16
626.17 626.18 626.19 626.20 626.21 626.22 626.23 626.24 626.25 626.26 626.27 626.28 626.29 626.30 626.31 627.1 627.2 627.3 627.4 627.5 627.6 627.7 627.8 627.9 627.10 627.11 627.12 627.13 627.14 627.15 627.16 627.17 627.18 627.19 627.20 627.21 627.22 627.23 627.24 627.25 627.26 627.27
627.28 627.29 627.30 627.31 627.32 627.33 628.1 628.2 628.3 628.4 628.5 628.6 628.7 628.8 628.9 628.10 628.11 628.12 628.13 628.14 628.15 628.16 628.17 628.18 628.19 628.20 628.21 628.22 628.23 628.24 628.25 628.26 628.27 628.28 628.29 628.30 628.31 628.32
629.1 629.2 629.3 629.4 629.5 629.6 629.7 629.8 629.9 629.10 629.11 629.12 629.13 629.14 629.15 629.16 629.17 629.18 629.19 629.20 629.21 629.22 629.23 629.24 629.25 629.26 629.27 629.28 629.29 629.30 629.31 630.1 630.2 630.3 630.4 630.5 630.6 630.7 630.8 630.9 630.10 630.11 630.12 630.13 630.14 630.15 630.16 630.17 630.18 630.19 630.20 630.21 630.22 630.23 630.24 630.25 630.26 630.27 630.28 630.29 630.30 631.1 631.2 631.3 631.4 631.5 631.6 631.7 631.8 631.9 631.10 631.11 631.12 631.13 631.14 631.15 631.16 631.17 631.18 631.19 631.20 631.21 631.22 631.23 631.24 631.25 631.26 631.27 631.28 631.29 631.30 631.31 632.1 632.2 632.3 632.4 632.5 632.6
632.7 632.8 632.9 632.10 632.11 632.12 632.13 632.14 632.15 632.16 632.17 632.18 632.19 632.20 632.21 632.22 632.23 632.24 632.25 632.26 632.27 632.28 632.29 632.30 632.31 632.32
633.1 633.2 633.3 633.4 633.5 633.6 633.7 633.8 633.9 633.10 633.11 633.12 633.13 633.14 633.15 633.16 633.17 633.18 633.19 633.20 633.21 633.22 633.23 633.24 633.25
633.26 633.27 633.28 633.29 633.30 633.31 634.1 634.2 634.3 634.4 634.5
634.6 634.7 634.8 634.9 634.10
634.11 634.12 634.13 634.14 634.15 634.16 634.17 634.18 634.19
634.20 634.21 634.22 634.23 634.24 634.25
634.26 634.27 634.28 634.29 634.30 635.1 635.2 635.3 635.4 635.5 635.6
635.7 635.8 635.9 635.10 635.11 635.12 635.13 635.14 635.15 635.16 635.17 635.18 635.19 635.20 635.21 635.22 635.23 635.24 635.25 635.26 635.27 635.28 635.29 635.30 635.31
636.1 636.2 636.3 636.4 636.5 636.6 636.7 636.8 636.9 636.10 636.11 636.12 636.13 636.14 636.15 636.16 636.17 636.18 636.19 636.20 636.21 636.22 636.23 636.24 636.25 636.26
636.27 636.28 636.29 636.30 636.31 636.32 637.1 637.2 637.3 637.4 637.5 637.6 637.7 637.8 637.9 637.10 637.11 637.12 637.13 637.14 637.15 637.16 637.17 637.18 637.19 637.20 637.21 637.22 637.23 637.24 637.25 637.26 637.27 637.28 637.29 637.30 637.31 637.32 637.33 637.34 638.1 638.2 638.3 638.4 638.5 638.6 638.7 638.8 638.9 638.10 638.11 638.12 638.13 638.14 638.15 638.16 638.17 638.18 638.19 638.20 638.21 638.22 638.23 638.24 638.25 638.26 638.27 638.28 638.29 638.30 638.31 638.32 638.33 639.1 639.2 639.3 639.4 639.5 639.6 639.7 639.8 639.9 639.10 639.11 639.12 639.13 639.14 639.15 639.16 639.17 639.18 639.19 639.20 639.21 639.22 639.23 639.24 639.25 639.26 639.27 639.28 639.29 639.30 639.31 639.32 640.1 640.2 640.3 640.4 640.5 640.6 640.7 640.8 640.9 640.10 640.11 640.12 640.13 640.14 640.15 640.16 640.17 640.18 640.19 640.20 640.21 640.22 640.23 640.24 640.25 640.26 640.27 640.28
640.29 640.30 640.31 640.32
641.1 641.2 641.3 641.4 641.5 641.6 641.7 641.8 641.9 641.10 641.11 641.12 641.13 641.14 641.15 641.16 641.17
641.18 641.19 641.20 641.21 641.22 641.23 641.24 641.25
641.26 641.27 641.28 641.29 641.30 641.31 642.1 642.2 642.3 642.4 642.5 642.6 642.7 642.8 642.9 642.10 642.11 642.12 642.13 642.14 642.15 642.16 642.17 642.18 642.19 642.20 642.21 642.22 642.23 642.24 642.25 642.26 642.27 642.28 642.29 642.30
643.1 643.2 643.3 643.4 643.5 643.6 643.7 643.8 643.9 643.10 643.11 643.12 643.13 643.14 643.15 643.16 643.17 643.18 643.19 643.20 643.21 643.22 643.23 643.24 643.25 643.26 643.27 643.28 643.29 643.30 643.31 643.32 643.33 644.1 644.2 644.3 644.4 644.5 644.6 644.7
644.8 644.9 644.10 644.11 644.12 644.13 644.14 644.15 644.16 644.17 644.18 644.19 644.20 644.21 644.22 644.23 644.24 644.25 644.26 644.27 644.28 644.29 644.30 644.31 644.32 644.33 645.1 645.2 645.3 645.4 645.5 645.6 645.7 645.8 645.9 645.10 645.11 645.12 645.13 645.14 645.15 645.16 645.17 645.18 645.19 645.20 645.21 645.22 645.23 645.24
645.25 645.26 645.27 645.28 645.29 645.30 645.31 645.32 645.33 645.34 646.1 646.2 646.3 646.4 646.5 646.6 646.7 646.8 646.9 646.10 646.11 646.12 646.13 646.14 646.15 646.16 646.17 646.18 646.19 646.20 646.21 646.22 646.23 646.24 646.25 646.26 646.27 646.28 646.29 646.30 647.1 647.2 647.3 647.4 647.5 647.6 647.7 647.8 647.9 647.10 647.11 647.12 647.13 647.14 647.15 647.16 647.17 647.18 647.19 647.20 647.21 647.22 647.23 647.24 647.25 647.26 647.27 647.28 647.29 647.30 647.31 647.32 648.1 648.2 648.3 648.4 648.5 648.6 648.7 648.8 648.9 648.10 648.11 648.12 648.13 648.14
648.15 648.16 648.17 648.18
648.19 648.20 648.21 648.22 648.23 648.24 648.25 648.26 648.27 648.28 648.29 648.30 648.31 648.32 649.1 649.2 649.3 649.4 649.5 649.6 649.7 649.8 649.9 649.10 649.11 649.12 649.13 649.14 649.15 649.16 649.17 649.18 649.19 649.20 649.21 649.22 649.23 649.24 649.25 649.26 649.27 649.28 649.29 649.30 649.31 649.32 650.1 650.2 650.3 650.4 650.5 650.6 650.7 650.8 650.9 650.10 650.11 650.12 650.13 650.14 650.15 650.16 650.17 650.18 650.19 650.20 650.21 650.22 650.23 650.24 650.25 650.26 650.27 650.28 650.29 650.30 650.31 650.32 651.1 651.2 651.3 651.4 651.5 651.6 651.7 651.8 651.9 651.10 651.11 651.12 651.13 651.14 651.15 651.16 651.17 651.18 651.19 651.20 651.21 651.22 651.23 651.24 651.25 651.26 651.27 651.28 651.29 651.30 651.31 651.32 652.1 652.2 652.3 652.4 652.5 652.6 652.7 652.8 652.9 652.10 652.11 652.12 652.13 652.14 652.15 652.16 652.17 652.18 652.19 652.20 652.21 652.22 652.23 652.24 652.25 652.26 652.27 652.28 652.29 652.30 652.31 652.32 653.1 653.2 653.3 653.4 653.5 653.6 653.7 653.8 653.9 653.10 653.11 653.12 653.13 653.14 653.15 653.16 653.17 653.18 653.19 653.20 653.21 653.22 653.23 653.24 653.25 653.26 653.27 653.28 653.29 653.30 653.31 653.32 654.1 654.2 654.3 654.4 654.5 654.6 654.7 654.8 654.9 654.10 654.11 654.12 654.13 654.14 654.15 654.16 654.17 654.18 654.19 654.20 654.21 654.22 654.23 654.24 654.25 654.26 654.27 654.28 654.29 654.30 654.31 654.32 654.33 655.1 655.2 655.3 655.4 655.5 655.6 655.7 655.8 655.9 655.10 655.11 655.12 655.13 655.14 655.15 655.16 655.17 655.18 655.19 655.20 655.21 655.22 655.23 655.24 655.25 655.26 655.27 655.28 655.29 655.30 655.31 655.32 656.1 656.2 656.3 656.4 656.5 656.6 656.7 656.8 656.9 656.10 656.11 656.12 656.13 656.14 656.15 656.16 656.17 656.18 656.19 656.20 656.21 656.22 656.23 656.24 656.25 656.26 656.27 656.28 656.29 656.30 656.31 656.32 657.1 657.2 657.3 657.4 657.5 657.6 657.7
657.8 657.9 657.10
657.11 657.12 657.13 657.14 657.15 657.16 657.17 657.18 657.19 657.20 657.21 657.22 657.23 657.24 657.25 657.26 657.27 657.28 657.29
658.1 658.2 658.3 658.4 658.5 658.6 658.7 658.8 658.9 658.10 658.11 658.12 658.13 658.14 658.15 658.16 658.17 658.18 658.19 658.20 658.21 658.22 658.23 658.24 658.25 658.26 658.27 658.28 658.29 658.30 659.1 659.2 659.3 659.4 659.5 659.6 659.7 659.8 659.9 659.10 659.11 659.12 659.13 659.14 659.15 659.16 659.17 659.18 659.19 659.20 659.21 659.22 659.23 659.24 659.25 659.26 659.27 659.28 659.29 660.1 660.2 660.3 660.4 660.5 660.6 660.7 660.8 660.9 660.10 660.11 660.12 660.13 660.14 660.15 660.16 660.17 660.18 660.19 660.20 660.21 660.22 660.23 660.24 660.25 660.26 660.27 660.28 660.29 660.30 660.31 661.1 661.2 661.3 661.4 661.5 661.6 661.7 661.8 661.9 661.10 661.11 661.12 661.13 661.14 661.15 661.16 661.17 661.18 661.19 661.20 661.21 661.22 661.23 661.24 661.25 661.26 661.27 661.28 661.29 661.30 661.31 662.1 662.2 662.3 662.4 662.5 662.6 662.7 662.8 662.9 662.10 662.11 662.12 662.13 662.14 662.15 662.16 662.17 662.18 662.19 662.20 662.21 662.22 662.23 662.24 662.25 662.26 662.27 662.28 662.29 662.30 662.31
663.1 663.2 663.3 663.4 663.5 663.6 663.7 663.8 663.9 663.10 663.11 663.12 663.13 663.14 663.15 663.16 663.17 663.18 663.19 663.20
663.21 663.22 663.23 663.24 663.25 663.26 663.27 663.28 663.29 663.30 663.31 664.1 664.2 664.3 664.4 664.5 664.6 664.7 664.8 664.9 664.10 664.11
664.12 664.13
664.14 664.15 664.16 664.17 664.18 664.19 664.20 664.21 664.22 664.23 664.24 664.25 664.26 664.27 664.28 664.29 664.30 665.1 665.2 665.3 665.4 665.5 665.6 665.7 665.8 665.9 665.10 665.11 665.12 665.13 665.14 665.15 665.16 665.17 665.18 665.19 665.20 665.21 665.22 665.23 665.24 665.25 665.26 665.27 666.1 666.2 666.3 666.4 666.5 666.6 666.7 666.8 666.9 666.10 666.11 666.12 666.13 666.14 666.15 666.16 666.17 666.18 666.19 666.20 666.21 666.22 666.23 666.24 666.25 666.26 666.27 666.28 667.1 667.2 667.3 667.4 667.5 667.6 667.7 667.8 667.9 667.10 667.11 667.12 667.13 667.14 667.15 667.16 667.17 667.18 667.19 667.20 667.21 667.22 667.23 667.24 667.25 667.26 667.27 667.28 668.1 668.2 668.3 668.4 668.5 668.6 668.7 668.8 668.9 668.10 668.11 668.12 668.13 668.14 668.15 668.16 668.17 668.18 668.19 668.20 668.21 668.22 668.23 668.24 668.25 668.26 668.27 669.1 669.2 669.3 669.4 669.5 669.6 669.7 669.8 669.9 669.10 669.11 669.12 669.13 669.14 669.15 669.16 669.17 669.18 669.19 669.20 669.21 669.22 669.23 669.24 669.25 669.26 669.27 670.1 670.2 670.3 670.4 670.5 670.6 670.7 670.8 670.9 670.10 670.11 670.12 670.13 670.14 670.15 670.16 670.17 670.18 670.19 670.20 670.21 670.22 670.23 670.24 670.25 670.26 670.27 670.28 670.29 671.1 671.2 671.3 671.4 671.5 671.6 671.7 671.8 671.9 671.10 671.11 671.12 671.13 671.14 671.15 671.16 671.17 671.18 671.19 671.20 671.21 671.22 671.23 671.24 671.25 671.26 671.27 671.28 671.29 672.1 672.2 672.3 672.4 672.5 672.6 672.7 672.8 672.9 672.10 672.11 672.12 672.13 672.14 672.15 672.16 672.17 672.18 672.19 672.20 672.21 672.22 672.23 672.24 672.25 672.26 672.27 672.28 673.1 673.2 673.3 673.4 673.5 673.6 673.7 673.8 673.9 673.10 673.11 673.12 673.13 673.14 673.15 673.16 673.17 673.18 673.19 673.20 673.21 673.22 673.23 673.24 673.25 673.26 673.27 673.28 673.29 673.30 673.31 674.1 674.2 674.3 674.4 674.5 674.6 674.7 674.8 674.9 674.10 674.11 674.12 674.13 674.14 674.15 674.16 674.17 674.18 674.19 674.20 674.21 674.22 674.23 674.24 674.25 674.26 674.27 674.28 674.29 674.30 674.31 674.32 674.33 675.1 675.2 675.3 675.4 675.5 675.6 675.7 675.8 675.9 675.10 675.11 675.12 675.13 675.14 675.15 675.16 675.17 675.18 675.19 675.20 675.21 675.22 675.23 675.24 675.25 675.26 675.27 675.28 675.29 675.30 676.1 676.2 676.3 676.4 676.5 676.6 676.7 676.8 676.9 676.10 676.11 676.12 676.13 676.14 676.15 676.16 676.17 676.18 676.19 676.20 676.21 676.22 676.23 676.24 676.25 676.26 676.27 676.28 676.29 676.30 677.1 677.2 677.3 677.4 677.5 677.6 677.7 677.8 677.9 677.10 677.11 677.12
677.13 677.14
677.15 677.16 677.17 677.18 677.19 677.20 677.21 677.22 677.23 677.24 677.25 677.26 677.27 677.28 677.29 678.1 678.2 678.3 678.4 678.5 678.6 678.7 678.8 678.9 678.10 678.11 678.12 678.13 678.14 678.15 678.16 678.17 678.18 678.19 678.20 678.21 678.22 678.23 678.24 678.25 678.26 678.27 678.28 678.29 679.1 679.2 679.3 679.4 679.5 679.6 679.7 679.8 679.9 679.10 679.11 679.12 679.13 679.14 679.15 679.16 679.17 679.18 679.19 679.20 679.21 679.22 679.23 679.24 679.25 679.26 679.27 679.28 680.1 680.2 680.3 680.4 680.5 680.6 680.7 680.8 680.9 680.10 680.11 680.12 680.13 680.14 680.15 680.16 680.17 680.18 680.19 680.20 680.21 680.22 680.23 680.24 680.25 680.26 680.27 680.28 680.29 681.1 681.2 681.3 681.4 681.5 681.6 681.7 681.8 681.9
681.10 681.11
681.12 681.13 681.14 681.15
681.16 681.17 681.18 681.19
681.20 681.21 681.22 681.23 681.24 681.25 681.26 681.27 681.28 681.29 682.1 682.2 682.3 682.4
682.5 682.6 682.7 682.8 682.9 682.10 682.11 682.12 682.13 682.14 682.15 682.16 682.17 682.18 682.19 682.20 682.21 682.22 682.23
682.24 682.25 682.26 682.27 682.28 682.29 682.30 683.1 683.2 683.3 683.4 683.5 683.6 683.7 683.8 683.9 683.10 683.11 683.12 683.13 683.14 683.15 683.16 683.17 683.18 683.19 683.20 683.21 683.22 683.23 683.24 683.25 683.26 683.27 683.28 683.29 683.30 684.1 684.2 684.3 684.4 684.5 684.6 684.7 684.8 684.9
684.10 684.11 684.12 684.13 684.14 684.15 684.16
684.17 684.18 684.19 684.20 684.21 684.22 684.23 684.24 684.25 684.26 684.27 684.28 684.29 684.30 685.1 685.2 685.3 685.4 685.5 685.6 685.7 685.8 685.9 685.10
685.11 685.12 685.13 685.14
685.15 685.16 685.17 685.18
685.19 685.20 685.21
685.22 685.23
685.24 685.25 685.26 685.27 685.28 685.29 686.1 686.2 686.3 686.4 686.5 686.6 686.7 686.8 686.9 686.10 686.11 686.12 686.13 686.14 686.15 686.16 686.17 686.18 686.19 686.20 686.21 686.22 686.23 686.24 686.25 686.26 686.27 686.28 686.29 687.1 687.2 687.3 687.4
687.5 687.6 687.7 687.8 687.9 687.10 687.11 687.12 687.13 687.14 687.15 687.16 687.17 687.18 687.19 687.20
687.21
687.22 687.23 687.24 687.25 687.26 687.27 688.1 688.2 688.3 688.4 688.5 688.6 688.7 688.8 688.9 688.10 688.11
688.12
688.13 688.14 688.15 688.16 688.17 688.18 688.19 688.20 688.21 688.22 688.23 688.24
688.25
689.1 689.2 689.3 689.4 689.5 689.6 689.7 689.8 689.9 689.10 689.11 689.12 689.13 689.14 689.15 689.16 689.17
689.18 689.19 689.20 689.21 689.22
689.23 689.24 689.25 689.26
689.27 689.28
690.1 690.2
690.3 690.4
690.5 690.6
690.7 690.8 690.9
690.10 690.11 690.12 690.13 690.14 690.15 690.16
690.17 690.18 690.19 690.20 690.21 690.22 690.23 690.24 690.25 690.26 690.27 691.1 691.2 691.3 691.4
691.5
691.6 691.7 691.8 691.9 691.10 691.11 691.12 691.13 691.14 691.15 691.16 691.17 691.18 691.19 691.20 691.21 691.22 691.23 691.24
691.25
692.1 692.2 692.3 692.4 692.5 692.6 692.7 692.8 692.9 692.10 692.11 692.12 692.13 692.14 692.15 692.16 692.17 692.18 692.19 692.20 692.21 692.22 692.23 692.24 692.25 692.26 692.27 692.28 692.29 693.1 693.2 693.3 693.4 693.5 693.6 693.7 693.8 693.9 693.10 693.11 693.12 693.13 693.14 693.15 693.16 693.17 693.18 693.19 693.20 693.21 693.22 693.23 693.24 693.25 693.26 693.27 693.28 693.29 693.30
694.1 694.2 694.3 694.4 694.5 694.6 694.7 694.8 694.9 694.10 694.11 694.12 694.13
694.14
694.15 694.16 694.17 694.18 694.19 694.20 694.21 694.22 694.23 694.24 694.25 694.26 694.27 694.28 694.29 694.30 694.31 695.1 695.2 695.3 695.4 695.5 695.6 695.7 695.8 695.9 695.10 695.11 695.12 695.13 695.14 695.15 695.16 695.17
695.18
695.19 695.20 695.21 695.22 695.23
695.24
695.25 695.26 695.27 695.28 695.29 695.30
696.1
696.2 696.3 696.4 696.5 696.6 696.7
696.8 696.9 696.10 696.11 696.12 696.13 696.14 696.15 696.16 696.17 696.18 696.19 696.20 696.21 696.22 696.23 696.24 696.25
696.26 696.27 696.28 696.29 696.30 696.31 696.32 697.1 697.2
697.3 697.4 697.5 697.6 697.7 697.8 697.9 697.10 697.11 697.12 697.13 697.14 697.15 697.16 697.17 697.18 697.19 697.20 697.21 697.22 697.23 697.24
697.25 697.26
698.1 698.2 698.3 698.4 698.5 698.6 698.7 698.8 698.9 698.10 698.11 698.12 698.13 698.14 698.15 698.16 698.17 698.18 698.19 698.20
698.21 698.22 698.23 698.24 698.25 698.26 698.27 698.28 698.29 699.1 699.2 699.3 699.4 699.5 699.6 699.7 699.8
699.9 699.10 699.11 699.12 699.13 699.14 699.15 699.16 699.17 699.18 699.19 699.20 699.21 699.22 699.23 699.24 699.25 699.26 699.27 699.28 699.29 699.30 699.31 699.32 700.1 700.2 700.3 700.4 700.5 700.6 700.7 700.8 700.9 700.10 700.11 700.12 700.13 700.14 700.15 700.16 700.17 700.18 700.19 700.20 700.21 700.22 700.23 700.24 700.25 700.26 700.27 700.28 700.29 700.30 700.31 700.32 700.33 700.34 701.1 701.2 701.3 701.4 701.5 701.6 701.7 701.8 701.9 701.10 701.11 701.12 701.13 701.14 701.15 701.16 701.17 701.18 701.19 701.20 701.21 701.22 701.23 701.24 701.25 701.26 701.27 701.28 701.29 701.30 701.31 701.32 701.33 701.34 702.1 702.2 702.3 702.4 702.5 702.6 702.7 702.8 702.9 702.10 702.11 702.12 702.13 702.14 702.15 702.16 702.17 702.18 702.19 702.20 702.21 702.22 702.23 702.24 702.25 702.26 702.27 702.28 702.29 702.30 702.31 702.32 702.33 703.1 703.2 703.3 703.4 703.5 703.6 703.7 703.8 703.9 703.10 703.11 703.12 703.13 703.14 703.15 703.16 703.17 703.18 703.19
703.20 703.21 703.22 703.23 703.24 703.25 703.26
703.27 703.28 703.29 703.30 703.31 704.1 704.2 704.3 704.4 704.5 704.6 704.7 704.8 704.9 704.10 704.11 704.12 704.13 704.14 704.15
704.16 704.17 704.18 704.19 704.20 704.21 704.22 704.23 704.24 704.25 704.26 704.27 704.28 704.29 704.30 705.1 705.2 705.3
705.4 705.5 705.6 705.7 705.8 705.9 705.10 705.11 705.12 705.13 705.14 705.15 705.16 705.17 705.18 705.19 705.20 705.21 705.22 705.23 705.24 705.25 705.26 705.27 705.28 705.29 705.30 705.31 705.32 706.1 706.2 706.3 706.4 706.5 706.6 706.7 706.8 706.9 706.10 706.11 706.12 706.13 706.14 706.15 706.16 706.17 706.18 706.19 706.20 706.21 706.22 706.23 706.24 706.25 706.26 706.27 706.28 706.29 706.30 706.31 706.32 707.1 707.2 707.3 707.4 707.5 707.6 707.7 707.8 707.9 707.10 707.11 707.12
707.13 707.14 707.15 707.16 707.17 707.18 707.19 707.20 707.21 707.22 707.23 707.24 707.25 707.26 707.27 707.28 707.29 707.30 707.31 708.1 708.2 708.3 708.4 708.5 708.6 708.7 708.8 708.9 708.10 708.11 708.12 708.13 708.14 708.15
708.16 708.17 708.18 708.19 708.20 708.21 708.22 708.23 708.24 708.25 708.26 708.27 708.28 708.29 708.30 708.31 708.32 709.1 709.2 709.3 709.4 709.5 709.6 709.7 709.8 709.9 709.10 709.11 709.12 709.13 709.14 709.15 709.16
709.17 709.18 709.19 709.20 709.21 709.22 709.23 709.24 709.25 709.26 709.27 709.28 709.29 709.30 709.31 709.32 710.1 710.2 710.3 710.4 710.5 710.6 710.7 710.8 710.9 710.10 710.11 710.12 710.13 710.14 710.15 710.16
710.17 710.18 710.19 710.20 710.21 710.22 710.23 710.24 710.25
710.26 710.27 710.28 710.29 710.30 710.31 711.1 711.2 711.3 711.4 711.5 711.6 711.7 711.8 711.9 711.10 711.11 711.12 711.13 711.14 711.15
711.16 711.17 711.18 711.19
711.20 711.21 711.22 711.23 711.24 711.25 711.26 711.27 711.28 711.29 711.30 712.1 712.2 712.3 712.4 712.5 712.6 712.7 712.8 712.9 712.10 712.11 712.12 712.13 712.14 712.15 712.16 712.17 712.18 712.19 712.20 712.21 712.22 712.23 712.24 712.25 712.26
712.27 712.28 712.29 712.30 713.1 713.2 713.3 713.4 713.5 713.6 713.7 713.8 713.9 713.10 713.11 713.12 713.13 713.14 713.15
713.16 713.17 713.18 713.19 713.20
713.21 713.22 713.23 713.24 713.25 713.26 713.27 713.28 713.29 713.30 714.1 714.2 714.3 714.4 714.5 714.6 714.7 714.8 714.9 714.10 714.11 714.12 714.13 714.14 714.15 714.16 714.17 714.18 714.19 714.20 714.21 714.22 714.23 714.24 714.25 714.26 714.27 714.28 714.29 714.30 714.31 714.32 714.33 715.1 715.2 715.3 715.4 715.5 715.6 715.7 715.8 715.9 715.10 715.11 715.12 715.13 715.14 715.15 715.16 715.17 715.18 715.19 715.20 715.21 715.22 715.23 715.24 715.25 715.26 715.27 715.28 715.29 715.30 715.31 715.32 715.33 716.1 716.2 716.3 716.4 716.5 716.6 716.7 716.8 716.9 716.10 716.11 716.12 716.13 716.14 716.15 716.16 716.17 716.18 716.19 716.20 716.21 716.22 716.23 716.24 716.25 716.26 716.27 716.28 716.29 716.30 717.1 717.2 717.3 717.4 717.5 717.6 717.7 717.8 717.9 717.10 717.11 717.12 717.13 717.14 717.15 717.16 717.17 717.18 717.19 717.20 717.21 717.22 717.23 717.24 717.25 717.26 717.27 717.28 717.29 717.30 718.1 718.2 718.3 718.4 718.5 718.6 718.7 718.8 718.9 718.10 718.11 718.12 718.13 718.14 718.15 718.16 718.17 718.18 718.19 718.20 718.21 718.22 718.23 718.24 718.25 718.26 718.27 718.28 718.29 718.30 718.31 719.1 719.2 719.3 719.4 719.5 719.6 719.7 719.8 719.9 719.10 719.11 719.12 719.13 719.14 719.15 719.16 719.17 719.18 719.19 719.20 719.21 719.22 719.23 719.24 719.25 719.26 719.27 719.28 719.29 719.30 720.1 720.2 720.3 720.4 720.5 720.6 720.7 720.8 720.9 720.10 720.11 720.12 720.13 720.14 720.15 720.16 720.17 720.18 720.19 720.20 720.21
720.22 720.23 720.24 720.25 720.26 720.27 720.28
720.29 720.30 720.31 721.1 721.2 721.3 721.4 721.5 721.6 721.7 721.8 721.9 721.10 721.11 721.12 721.13 721.14 721.15 721.16 721.17 721.18 721.19 721.20 721.21 721.22 721.23 721.24 721.25 721.26 721.27 721.28 721.29 721.30 721.31 721.32 722.1 722.2 722.3 722.4 722.5 722.6 722.7 722.8 722.9 722.10 722.11 722.12 722.13 722.14 722.15 722.16 722.17 722.18 722.19 722.20 722.21 722.22 722.23 722.24 722.25 722.26 722.27 722.28 722.29 722.30 722.31 722.32
723.1 723.2 723.3 723.4 723.5 723.6 723.7 723.8 723.9 723.10 723.11 723.12 723.13 723.14 723.15 723.16 723.17 723.18 723.19 723.20 723.21 723.22 723.23 723.24 723.25 723.26 723.27 723.28 723.29 723.30 723.31 723.32 723.33 723.34 724.1 724.2 724.3 724.4 724.5 724.6 724.7 724.8 724.9 724.10 724.11 724.12 724.13 724.14 724.15 724.16 724.17 724.18 724.19 724.20 724.21 724.22 724.23 724.24 724.25 724.26 724.27 724.28 724.29 724.30 724.31 724.32 725.1 725.2 725.3 725.4 725.5 725.6 725.7 725.8 725.9 725.10 725.11 725.12 725.13 725.14 725.15 725.16 725.17 725.18 725.19 725.20 725.21 725.22 725.23 725.24 725.25 725.26 725.27 725.28 725.29 725.30 725.31
726.1 726.2 726.3 726.4 726.5 726.6 726.7 726.8 726.9 726.10 726.11 726.12 726.13 726.14 726.15 726.16 726.17 726.18 726.19 726.20 726.21 726.22 726.23 726.24 726.25 726.26 726.27 726.28 726.29 726.30 726.31 726.32 726.33 727.1 727.2 727.3 727.4 727.5 727.6 727.7 727.8 727.9 727.10 727.11 727.12 727.13 727.14 727.15 727.16 727.17 727.18 727.19 727.20 727.21 727.22 727.23 727.24 727.25 727.26 727.27 727.28 727.29 727.30 727.31 727.32 727.33 728.1 728.2 728.3 728.4 728.5 728.6 728.7 728.8 728.9 728.10 728.11 728.12 728.13 728.14 728.15 728.16 728.17
728.18 728.19 728.20 728.21 728.22 728.23 728.24 728.25 728.26 728.27 728.28 728.29 728.30 728.31 728.32 729.1 729.2 729.3 729.4 729.5 729.6 729.7 729.8 729.9 729.10 729.11 729.12 729.13 729.14 729.15 729.16 729.17 729.18 729.19 729.20 729.21 729.22 729.23 729.24 729.25 729.26 729.27 729.28 729.29 729.30 729.31 729.32 729.33 730.1 730.2 730.3 730.4 730.5 730.6 730.7 730.8 730.9 730.10 730.11 730.12 730.13 730.14 730.15 730.16 730.17 730.18 730.19 730.20 730.21 730.22 730.23 730.24 730.25 730.26 730.27 730.28 730.29 730.30 730.31 730.32 730.33 730.34 731.1 731.2 731.3 731.4 731.5 731.6 731.7 731.8 731.9 731.10 731.11 731.12 731.13 731.14 731.15 731.16 731.17 731.18 731.19 731.20 731.21 731.22 731.23 731.24 731.25 731.26 731.27 731.28 731.29 731.30 731.31 731.32 731.33 732.1 732.2 732.3 732.4 732.5 732.6 732.7 732.8 732.9 732.10 732.11 732.12 732.13 732.14 732.15 732.16 732.17 732.18 732.19 732.20 732.21 732.22 732.23 732.24 732.25 732.26 732.27
732.28 732.29 732.30 732.31 732.32 732.33 733.1 733.2 733.3 733.4 733.5
733.6 733.7 733.8 733.9 733.10 733.11 733.12 733.13 733.14
733.15 733.16 733.17 733.18
733.19
733.20 733.21
733.22 733.23 733.24 733.25 733.26 733.27 733.28 733.29 733.30 733.31 734.1 734.2 734.3 734.4 734.5 734.6 734.7 734.8 734.9 734.10 734.11 734.12 734.13 734.14 734.15 734.16 734.17
734.18 734.19
734.20 734.21 734.22 734.23 734.24 734.25 734.26
734.27 734.28 734.29 734.30 734.31 735.1 735.2
735.3 735.4 735.5 735.6
735.7 735.8 735.9 735.10 735.11 735.12 735.13 735.14 735.15 735.16 735.17 735.18 735.19 735.20 735.21 735.22 735.23 735.24 735.25
735.26 735.27 735.28 735.29 736.1 736.2 736.3 736.4 736.5 736.6 736.7 736.8 736.9
736.10 736.11 736.12 736.13 736.14 736.15 736.16 736.17 736.18 736.19 736.20 736.21 736.22 736.23 736.24 736.25 736.26 736.27 736.28 736.29 736.30 736.31 736.32 736.33 737.1 737.2 737.3 737.4 737.5 737.6 737.7 737.8 737.9 737.10 737.11 737.12
737.13 737.14 737.15 737.16 737.17 737.18 737.19 737.20 737.21 737.22 737.23 737.24 737.25 737.26 737.27 737.28 738.1 738.2 738.3 738.4 738.5 738.6 738.7 738.8 738.9 738.10 738.11 738.12 738.13 738.14 738.15 738.16 738.17 738.18 738.19 738.20 738.21 738.22
738.23 738.24 738.25 738.26 738.27 738.28 738.29 738.30
739.1 739.2 739.3 739.4 739.5 739.6 739.7 739.8 739.9 739.10 739.11 739.12 739.13 739.14 739.15 739.16 739.17 739.18 739.19
739.20 739.21 739.22 739.23
739.24 739.25 739.26 739.27 739.28 739.29 739.30
740.1 740.2 740.3 740.4 740.5 740.6
740.7 740.8 740.9 740.10 740.11 740.12 740.13 740.14 740.15 740.16 740.17 740.18 740.19
740.20 740.21 740.22 740.23 740.24 740.25 740.26 740.27 740.28 740.29 740.30 740.31 740.32 741.1 741.2 741.3 741.4 741.5 741.6 741.7 741.8 741.9 741.10 741.11 741.12
741.13 741.14 741.15 741.16 741.17 741.18 741.19 741.20 741.21 741.22 741.23 741.24
741.25
741.26 741.27 741.28 741.29 741.30 741.31 742.1 742.2 742.3 742.4 742.5 742.6 742.7 742.8 742.9 742.10 742.11 742.12 742.13 742.14 742.15 742.16 742.17 742.18 742.19 742.20 742.21 742.22 742.23
742.24 742.25 742.26 742.27 742.28 742.29 742.30 742.31 743.1 743.2 743.3 743.4 743.5
743.6 743.7 743.8 743.9 743.10 743.11 743.12 743.13 743.14 743.15 743.16 743.17 743.18 743.19 743.20 743.21 743.22 743.23 743.24 743.25 743.26 743.27 743.28 743.29 743.30 744.1 744.2 744.3 744.4 744.5 744.6 744.7 744.8 744.9 744.10 744.11 744.12 744.13 744.14
744.15 744.16 744.17 744.18 744.19 744.20
744.21
744.22 744.23 744.24 744.25 744.26 744.27 744.28 744.29 744.30 744.31 745.1 745.2 745.3 745.4 745.5 745.6 745.7
745.8 745.9 745.10 745.11 745.12 745.13 745.14 745.15 745.16 745.17 745.18 745.19 745.20 745.21 745.22 745.23 745.24 745.25 745.26 745.27 745.28 745.29 745.30 745.31
746.1 746.2
746.3 746.4 746.5 746.6 746.7 746.8
746.9 746.10 746.11
746.12 746.13 746.14 746.15 746.16 746.17 746.18 746.19
746.20 746.21 746.22 746.23 746.24 746.25 746.26 746.27 746.28 746.29 746.30 746.31
747.1 747.2 747.3 747.4 747.5 747.6 747.7 747.8 747.9 747.10 747.11 747.12 747.13 747.14
747.15 747.16 747.17 747.18 747.19 747.20 747.21 747.22 747.23 747.24 747.25 747.26 747.27 747.28 747.29 747.30 747.31 747.32 747.33 748.1 748.2
748.3 748.4 748.5 748.6 748.7 748.8 748.9 748.10 748.11 748.12 748.13 748.14
748.15 748.16 748.17 748.18 748.19 748.20 748.21 748.22 748.23 748.24 748.25 748.26 748.27
748.28 748.29 748.30 748.31 748.32 749.1 749.2 749.3
749.4 749.5 749.6 749.7 749.8 749.9 749.10 749.11 749.12 749.13 749.14 749.15 749.16 749.17 749.18 749.19 749.20 749.21 749.22 749.23 749.24 749.25 749.26 749.27 749.28 749.29 749.30 749.31 749.32 749.33 750.1 750.2 750.3 750.4 750.5
750.6 750.7 750.8 750.9 750.10 750.11 750.12 750.13 750.14 750.15 750.16 750.17 750.18 750.19 750.20 750.21 750.22 750.23 750.24 750.25 750.26 750.27 750.28 750.29 750.30 750.31 751.1 751.2 751.3 751.4 751.5 751.6 751.7 751.8 751.9 751.10 751.11 751.12 751.13 751.14 751.15 751.16 751.17 751.18 751.19 751.20 751.21 751.22 751.23 751.24 751.25 751.26 751.27 751.28 751.29 751.30 752.1 752.2 752.3 752.4 752.5 752.6 752.7 752.8
752.9
752.10 752.11 752.12 752.13 752.14 752.15 752.16 752.17 752.18 752.19
752.20 752.21 752.22 752.23 752.24 752.25 752.26 752.27 752.28
753.1 753.2 753.3 753.4 753.5 753.6
753.7 753.8 753.9 753.10 753.11
753.12 753.13 753.14 753.15 753.16 753.17 753.18 753.19 753.20 753.21 753.22 753.23 753.24 753.25 753.26 753.27 753.28 753.29 753.30 753.31 754.1 754.2 754.3 754.4 754.5 754.6
754.7 754.8 754.9 754.10 754.11 754.12 754.13 754.14 754.15 754.16 754.17 754.18 754.19 754.20 754.21 754.22 754.23 754.24 754.25 754.26 754.27 754.28 754.29 754.30 754.31 754.32 754.33 755.1 755.2 755.3 755.4 755.5 755.6 755.7 755.8 755.9 755.10 755.11 755.12 755.13 755.14 755.15 755.16 755.17 755.18 755.19 755.20 755.21 755.22 755.23 755.24 755.25 755.26 755.27 755.28 755.29 755.30 755.31 755.32 755.33 755.34 755.35 755.36 755.37 756.1 756.2 756.3 756.4 756.5 756.6 756.7 756.8 756.9 756.10 756.11 756.12 756.13 756.14 756.15
756.16
756.17 756.18 756.19 756.20 756.21 756.22 756.23 756.24 756.25 756.26 756.27 756.28 756.29 756.30 756.31 756.32 757.1 757.2 757.3 757.4 757.5 757.6 757.7 757.8 757.9 757.10 757.11 757.12 757.13 757.14 757.15 757.16 757.17 757.18 757.19 757.20 757.21 757.22 757.23 757.24 757.25 757.26 757.27 757.28 757.29 757.30 757.31 757.32 757.33 757.34 758.1 758.2 758.3 758.4 758.5 758.6 758.7 758.8 758.9 758.10 758.11 758.12 758.13 758.14 758.15 758.16 758.17 758.18 758.19 758.20 758.21 758.22 758.23
758.24 758.25 758.26 758.27 758.28 758.29 758.30 758.31 758.32 759.1 759.2 759.3 759.4 759.5 759.6 759.7 759.8 759.9 759.10 759.11 759.12 759.13 759.14 759.15 759.16 759.17 759.18 759.19 759.20 759.21 759.22 759.23 759.24 759.25 759.26 759.27 759.28 759.29 759.30 759.31 760.1 760.2 760.3 760.4 760.5 760.6 760.7 760.8 760.9 760.10 760.11
760.12 760.13 760.14 760.15 760.16 760.17 760.18 760.19 760.20 760.21 760.22 760.23 760.24 760.25 760.26 760.27 760.28 760.29 760.30 760.31 761.1 761.2 761.3 761.4 761.5 761.6 761.7 761.8 761.9 761.10
761.11 761.12 761.13 761.14 761.15 761.16 761.17 761.18 761.19 761.20 761.21 761.22 761.23 761.24 761.25 761.26 761.27 761.28 761.29 761.30 762.1 762.2
762.3 762.4 762.5 762.6 762.7 762.8 762.9 762.10 762.11 762.12 762.13 762.14 762.15 762.16 762.17 762.18 762.19 762.20 762.21 762.22 762.23 762.24 762.25 762.26
762.27 762.28 762.29 762.30 762.31 763.1 763.2 763.3 763.4 763.5 763.6 763.7 763.8 763.9 763.10 763.11 763.12 763.13 763.14 763.15 763.16 763.17 763.18 763.19 763.20 763.21 763.22 763.23 763.24 763.25 763.26 763.27 763.28
763.29 763.30 763.31 763.32 763.33 764.1 764.2 764.3 764.4 764.5 764.6 764.7 764.8 764.9 764.10 764.11 764.12 764.13 764.14 764.15 764.16
764.17 764.18 764.19 764.20 764.21 764.22 764.23 764.24 764.25 764.26 764.27 764.28 764.29 764.30 764.31 764.32 765.1 765.2 765.3 765.4 765.5 765.6 765.7 765.8 765.9 765.10
765.11 765.12 765.13 765.14 765.15 765.16 765.17 765.18 765.19
765.20 765.21 765.22 765.23 765.24 765.25 765.26
765.27 765.28 765.29 765.30 765.31 765.32 766.1 766.2 766.3 766.4 766.5
766.6 766.7 766.8 766.9 766.10 766.11 766.12 766.13 766.14 766.15 766.16 766.17 766.18 766.19
766.20 766.21 766.22 766.23 766.24 766.25 766.26 766.27 766.28 766.29 766.30 766.31 767.1 767.2 767.3 767.4 767.5 767.6 767.7 767.8 767.9 767.10 767.11 767.12 767.13 767.14 767.15 767.16 767.17 767.18 767.19 767.20 767.21 767.22 767.23 767.24 767.25
767.26 767.27 767.28 767.29 767.30 767.31 768.1 768.2 768.3 768.4 768.5 768.6 768.7 768.8 768.9 768.10 768.11 768.12 768.13 768.14 768.15 768.16
768.17 768.18 768.19 768.20 768.21 768.22 768.23 768.24 768.25 768.26 768.27 768.28 768.29 768.30 768.31 768.32 768.33
769.1 769.2 769.3 769.4 769.5 769.6 769.7 769.8 769.9 769.10 769.11 769.12 769.13 769.14 769.15 769.16 769.17 769.18 769.19 769.20 769.21 769.22 769.23 769.24 769.25
769.26 769.27 769.28 769.29 769.30 769.31 769.32 770.1 770.2 770.3 770.4 770.5 770.6 770.7 770.8 770.9 770.10 770.11 770.12 770.13 770.14 770.15 770.16 770.17 770.18 770.19 770.20 770.21 770.22 770.23 770.24 770.25 770.26 770.27 770.28 770.29 770.30 770.31 770.32 771.1 771.2 771.3 771.4 771.5 771.6 771.7 771.8
771.9 771.10 771.11 771.12 771.13 771.14 771.15
771.16 771.17 771.18 771.19 771.20 771.21 771.22 771.23 771.24 771.25 771.26 771.27 771.28 771.29 771.30 771.31 772.1 772.2 772.3 772.4 772.5 772.6 772.7 772.8 772.9 772.10 772.11 772.12 772.13
772.14 772.15 772.16 772.17 772.18 772.19 772.20 772.21 772.22 772.23 772.24 772.25 772.26 772.27
772.28 772.29 772.30 772.31 772.32 773.1 773.2 773.3 773.4 773.5 773.6 773.7 773.8 773.9 773.10 773.11 773.12 773.13 773.14 773.15 773.16 773.17 773.18 773.19 773.20 773.21
773.22 773.23 773.24 773.25 773.26 773.27 773.28 773.29 773.30 773.31 773.32 773.33 774.1
774.2 774.3 774.4 774.5 774.6 774.7 774.8 774.9 774.10 774.11 774.12 774.13 774.14 774.15 774.16 774.17 774.18 774.19 774.20 774.21 774.22 774.23 774.24 774.25 774.26 774.27 774.28
775.1 775.2 775.3 775.4 775.5 775.6 775.7 775.8 775.9 775.10 775.11 775.12 775.13 775.14 775.15 775.16 775.17 775.18 775.19
775.20 775.21 775.22 775.23 775.24 775.25 775.26 775.27 775.28 775.29 775.30 775.31 775.32 776.1 776.2 776.3 776.4 776.5 776.6 776.7 776.8 776.9 776.10 776.11 776.12 776.13 776.14 776.15 776.16 776.17 776.18 776.19 776.20 776.21 776.22 776.23 776.24 776.25 776.26 776.27 776.28 776.29 776.30 776.31 776.32 777.1 777.2 777.3 777.4 777.5 777.6 777.7 777.8 777.9 777.10 777.11 777.12 777.13 777.14 777.15 777.16 777.17 777.18 777.19 777.20 777.21 777.22 777.23 777.24 777.25 777.26 777.27 777.28 777.29 777.30 777.31 777.32 778.1 778.2 778.3 778.4 778.5 778.6 778.7
778.8 778.9 778.10 778.11 778.12 778.13 778.14 778.15 778.16 778.17 778.18 778.19 778.20 778.21 778.22 778.23 778.24 778.25 778.26 778.27 778.28 778.29 778.30 778.31 778.32 778.33 779.1 779.2
779.3 779.4 779.5 779.6 779.7 779.8 779.9 779.10
779.11 779.12 779.13 779.14 779.15 779.16 779.17 779.18 779.19 779.20
779.21 779.22 779.23 779.24 779.25 779.26 779.27 779.28 779.29 779.30 779.31 780.1 780.2 780.3 780.4 780.5 780.6 780.7 780.8 780.9 780.10 780.11 780.12 780.13 780.14 780.15 780.16 780.17 780.18 780.19 780.20 780.21 780.22 780.23 780.24 780.25 780.26 780.27 780.28 780.29 780.30 780.31 780.32 781.1 781.2 781.3 781.4 781.5
781.6 781.7 781.8 781.9 781.10 781.11 781.12 781.13 781.14 781.15 781.16 781.17 781.18 781.19 781.20 781.21 781.22 781.23 781.24 781.25 781.26 781.27
781.28 781.29 781.30 781.31 781.32 782.1 782.2 782.3 782.4 782.5
782.6 782.7 782.8 782.9 782.10 782.11 782.12 782.13 782.14 782.15 782.16 782.17 782.18 782.19 782.20 782.21 782.22 782.23 782.24 782.25 782.26 782.27 782.28 782.29 782.30 782.31 783.1 783.2
783.3 783.4 783.5 783.6 783.7 783.8 783.9 783.10 783.11 783.12 783.13 783.14 783.15 783.16 783.17 783.18 783.19 783.20 783.21 783.22 783.23 783.24 783.25 783.26 783.27 783.28 783.29 783.30 783.31 784.1 784.2 784.3 784.4 784.5 784.6 784.7 784.8 784.9 784.10 784.11 784.12 784.13 784.14 784.15 784.16 784.17 784.18 784.19 784.20 784.21 784.22 784.23 784.24 784.25 784.26 784.27 784.28 784.29 784.30 785.1 785.2 785.3 785.4 785.5 785.6 785.7 785.8 785.9 785.10 785.11 785.12 785.13 785.14 785.15 785.16 785.17 785.18 785.19 785.20 785.21 785.22 785.23 785.24 785.25 785.26 785.27 785.28 785.29 785.30 785.31 785.32 786.1 786.2 786.3 786.4 786.5 786.6 786.7
786.8 786.9 786.10 786.11 786.12 786.13 786.14 786.15 786.16 786.17 786.18 786.19 786.20 786.21 786.22 786.23 786.24 786.25 786.26 786.27 786.28 786.29 787.1 787.2 787.3 787.4 787.5 787.6 787.7 787.8 787.9 787.10 787.11 787.12 787.13 787.14 787.15 787.16 787.17 787.18 787.19 787.20 787.21 787.22 787.23 787.24 787.25 787.26 787.27 787.28 787.29 787.30 788.1 788.2 788.3 788.4 788.5 788.6 788.7 788.8 788.9 788.10
788.11 788.12 788.13 788.14
788.15 788.16 788.17 788.18
788.19 788.20 788.21 788.22 788.23 788.24 788.25 788.26 788.27 788.28 788.29 788.30 789.1 789.2
789.3 789.4 789.5 789.6
789.7 789.8 789.9 789.10 789.11 789.12 789.13 789.14 789.15 789.16 789.17
789.18 789.19 789.20 789.21 789.22
789.23 789.24 789.25 789.26 789.27 789.28 789.29 789.30 790.1 790.2 790.3 790.4 790.5 790.6 790.7 790.8 790.9 790.10 790.11 790.12 790.13 790.14 790.15 790.16
790.17
790.18 790.19 790.20 790.21 790.22 790.23 790.24 790.25 790.26 790.27 790.28 790.29 791.1 791.2 791.3 791.4 791.5 791.6 791.7 791.8 791.9 791.10 791.11 791.12 791.13 791.14 791.15 791.16 791.17 791.18 791.19 791.20 791.21 791.22 791.23 791.24 791.25 791.26 791.27 791.28
791.29 791.30 791.31 792.1 792.2 792.3 792.4 792.5 792.6 792.7 792.8
792.9 792.10 792.11 792.12 792.13 792.14 792.15 792.16 792.17 792.18 792.19
792.20 792.21 792.22 792.23 792.24 792.25 792.26 792.27 792.28 792.29 792.30
792.31 792.32 793.1 793.2 793.3 793.4 793.5 793.6 793.7 793.8 793.9 793.10 793.11 793.12 793.13 793.14 793.15 793.16 793.17 793.18 793.19 793.20 793.21 793.22 793.23 793.24 793.25 793.26 793.27 793.28 793.29 793.30 793.31 793.32 793.33 793.34 794.1 794.2
794.3 794.4 794.5 794.6 794.7 794.8 794.9 794.10 794.11 794.12 794.13 794.14 794.15 794.16 794.17 794.18 794.19 794.20 794.21 794.22 794.23 794.24 794.25 794.26 794.27 794.28 794.29 794.30 794.31 794.32 795.1 795.2 795.3
795.4 795.5 795.6 795.7 795.8 795.9 795.10 795.11 795.12 795.13 795.14 795.15 795.16 795.17 795.18 795.19 795.20 795.21 795.22 795.23 795.24 795.25
795.26 795.27 795.28 795.29 795.30 795.31 795.32
796.1 796.2 796.3 796.4 796.5 796.6 796.7 796.8 796.9 796.10 796.11 796.12 796.13 796.14 796.15 796.16 796.17 796.18 796.19 796.20 796.21 796.22 796.23 796.24 796.25 796.26 796.27 796.28 796.29 796.30 796.31 796.32 797.1 797.2 797.3
797.4 797.5 797.6 797.7 797.8 797.9 797.10 797.11 797.12 797.13 797.14 797.15 797.16 797.17 797.18 797.19 797.20 797.21 797.22 797.23 797.24 797.25 797.26 797.27 797.28 797.29 797.30 797.31 798.1 798.2 798.3 798.4 798.5 798.6 798.7 798.8
798.9 798.10 798.11 798.12 798.13 798.14 798.15 798.16 798.17 798.18 798.19 798.20 798.21 798.22 798.23 798.24 798.25 798.26 798.27 798.28 798.29 798.30 798.31 798.32 798.33 798.34 799.1 799.2 799.3 799.4 799.5 799.6 799.7 799.8 799.9 799.10 799.11 799.12 799.13 799.14 799.15 799.16 799.17 799.18 799.19 799.20 799.21 799.22 799.23 799.24 799.25 799.26 799.27 799.28 799.29 799.30 799.31 799.32 800.1 800.2 800.3 800.4 800.5 800.6 800.7 800.8 800.9 800.10 800.11 800.12 800.13 800.14 800.15
800.16 800.17 800.18 800.19 800.20 800.21 800.22 800.23 800.24 800.25 800.26 800.27
800.28 800.29 800.30 800.31 800.32 801.1 801.2 801.3 801.4 801.5 801.6 801.7 801.8 801.9 801.10 801.11 801.12 801.13 801.14 801.15 801.16 801.17 801.18 801.19 801.20 801.21 801.22 801.23 801.24 801.25 801.26 801.27 801.28 801.29 801.30 801.31 802.1 802.2 802.3 802.4 802.5 802.6
802.7 802.8 802.9 802.10 802.11 802.12 802.13 802.14 802.15 802.16 802.17 802.18 802.19 802.20 802.21 802.22
802.23 802.24 802.25 802.26 802.27 802.28 802.29 802.30 802.31 802.32 803.1 803.2 803.3 803.4 803.5 803.6 803.7 803.8 803.9 803.10 803.11 803.12 803.13 803.14 803.15 803.16 803.17 803.18 803.19 803.20 803.21 803.22 803.23 803.24 803.25 803.26 803.27 803.28 803.29 803.30 803.31 803.32 803.33 804.1 804.2 804.3 804.4 804.5
804.6 804.7 804.8 804.9 804.10 804.11 804.12 804.13 804.14
804.15 804.16 804.17 804.18 804.19 804.20 804.21 804.22 804.23
804.24 804.25 804.26 804.27 804.28 804.29 804.30 804.31 804.32 805.1 805.2 805.3 805.4 805.5 805.6 805.7 805.8 805.9 805.10 805.11
805.12 805.13 805.14 805.15 805.16 805.17 805.18 805.19 805.20 805.21 805.22 805.23
805.24 805.25 805.26 805.27 805.28 805.29 805.30 806.1 806.2 806.3 806.4 806.5 806.6 806.7 806.8 806.9 806.10 806.11 806.12 806.13 806.14
806.15 806.16 806.17 806.18 806.19 806.20 806.21 806.22 806.23 806.24 806.25 806.26 806.27 806.28
806.29 806.30
807.1 807.2 807.3 807.4 807.5 807.6 807.7 807.8 807.9 807.10 807.11 807.12 807.13 807.14 807.15 807.16
807.17 807.18 807.19 807.20 807.21 807.22 807.23 807.24
807.25 807.26 807.27 807.28 807.29 807.30 807.31 807.32 807.33 808.1 808.2 808.3 808.4 808.5
808.6 808.7 808.8 808.9 808.10 808.11 808.12 808.13 808.14 808.15 808.16 808.17 808.18 808.19 808.20 808.21 808.22 808.23 808.24 808.25 808.26 808.27 808.28 808.29 808.30 808.31 809.1 809.2 809.3 809.4 809.5 809.6 809.7
809.8 809.9 809.10 809.11 809.12 809.13
809.14 809.15 809.16 809.17 809.18 809.19 809.20 809.21 809.22 809.23 809.24
809.25 809.26 809.27 809.28 809.29 809.30 809.31 809.32 810.1 810.2 810.3 810.4 810.5 810.6 810.7 810.8 810.9 810.10 810.11 810.12 810.13
810.14 810.15 810.16 810.17 810.18 810.19 810.20 810.21 810.22 810.23 810.24 810.25 810.26 810.27 810.28 810.29 810.30
811.1 811.2 811.3 811.4 811.5 811.6 811.7 811.8 811.9 811.10 811.11 811.12 811.13 811.14 811.15 811.16 811.17 811.18 811.19 811.20 811.21 811.22 811.23 811.24 811.25 811.26 811.27 811.28 811.29 811.30 811.31 811.32 811.33 811.34 812.1 812.2 812.3 812.4 812.5 812.6 812.7 812.8 812.9 812.10 812.11 812.12 812.13 812.14 812.15 812.16 812.17 812.18 812.19 812.20 812.21 812.22 812.23 812.24 812.25 812.26 812.27 812.28 812.29 812.30 812.31 812.32 813.1 813.2 813.3 813.4 813.5 813.6 813.7 813.8 813.9 813.10 813.11 813.12 813.13 813.14 813.15 813.16 813.17 813.18
813.19 813.20 813.21 813.22 813.23 813.24 813.25 813.26 813.27 813.28 813.29 813.30 813.31 813.32 813.33 814.1 814.2 814.3 814.4 814.5 814.6 814.7 814.8 814.9 814.10 814.11 814.12 814.13 814.14 814.15 814.16 814.17 814.18 814.19 814.20 814.21 814.22 814.23 814.24 814.25 814.26 814.27 814.28 814.29 814.30
814.31 814.32 814.33 814.34 815.1 815.2 815.3 815.4 815.5 815.6 815.7 815.8 815.9 815.10 815.11 815.12 815.13 815.14 815.15 815.16 815.17 815.18 815.19 815.20 815.21 815.22 815.23 815.24 815.25 815.26 815.27 815.28
816.1 816.2 816.3 816.4
816.5 816.6 816.7 816.8 816.9 816.10
816.11 816.12
816.13 816.14 816.15 816.16 816.17 816.18 816.19 816.20 816.21 816.22 816.23 816.24 816.25 816.26 816.27 816.28 816.29 816.30 817.1 817.2 817.3 817.4 817.5 817.6 817.7 817.8 817.9 817.10 817.11 817.12 817.13 817.14 817.15 817.16 817.17 817.18 817.19 817.20 817.21 817.22 817.23 817.24 817.25 817.26
817.27
817.28 817.29 817.30 817.31 818.1 818.2 818.3 818.4 818.5 818.6 818.7 818.8 818.9 818.10
818.11
818.12 818.13 818.14 818.15 818.16 818.17 818.18 818.19 818.20 818.21
818.22
818.23 818.24 818.25 818.26 818.27 818.28 818.29 818.30 818.31 818.32 819.1 819.2 819.3 819.4 819.5 819.6 819.7 819.8 819.9 819.10 819.11 819.12 819.13 819.14 819.15 819.16 819.17 819.18 819.19 819.20 819.21 819.22 819.23 819.24 819.25
819.26 819.27
819.28 819.29 819.30 819.31 819.32 820.1 820.2 820.3 820.4 820.5 820.6 820.7 820.8 820.9 820.10 820.11
820.12 820.13
820.14 820.15 820.16 820.17 820.18 820.19 820.20 820.21 820.22 820.23 820.24 820.25 820.26 820.27 820.28 820.29 820.30 820.31 821.1 821.2 821.3 821.4 821.5 821.6
821.7 821.8
821.9 821.10 821.11 821.12 821.13 821.14 821.15 821.16 821.17 821.18 821.19 821.20 821.21 821.22 821.23 821.24 821.25 821.26
821.27 821.28
821.29 821.30 822.1 822.2 822.3 822.4 822.5 822.6 822.7 822.8 822.9 822.10 822.11 822.12 822.13 822.14 822.15 822.16 822.17 822.18 822.19 822.20 822.21 822.22 822.23 822.24 822.25 822.26 822.27 822.28
822.29 822.30
822.31 822.32 822.33 823.1 823.2 823.3 823.4 823.5 823.6 823.7 823.8 823.9 823.10 823.11 823.12 823.13 823.14 823.15 823.16 823.17 823.18 823.19 823.20 823.21 823.22 823.23 823.24 823.25 823.26 823.27 823.28 823.29 823.30 823.31 823.32 823.33 823.34 824.1 824.2
824.3 824.4
824.5 824.6 824.7
824.8 824.9 824.10 824.11 824.12 824.13 824.14 824.15
824.16 824.17 824.18 824.19 824.20 824.21 824.22 824.23 824.24 824.25
824.26 824.27 824.28
825.1 825.2 825.3 825.4
825.5 825.6 825.7 825.8 825.9 825.10 825.11 825.12 825.13 825.14 825.15 825.16 825.17 825.18 825.19 825.20 825.21 825.22 825.23 825.24 825.25 825.26 825.27
825.28 825.29 825.30 825.31 825.32 826.1 826.2 826.3 826.4 826.5 826.6
826.7
826.8 826.9 826.10 826.11 826.12 826.13 826.14 826.15 826.16 826.17 826.18 826.19 826.20
826.21 826.22 826.23 826.24 826.25 826.26 826.27 826.28 826.29 826.30 826.31 826.32
827.1 827.2 827.3 827.4 827.5 827.6 827.7 827.8 827.9 827.10 827.11 827.12 827.13 827.14 827.15 827.16 827.17 827.18 827.19 827.20 827.21 827.22 827.23 827.24 827.25 827.26 827.27 827.28 827.29 827.30 827.31 827.32 827.33 828.1 828.2 828.3 828.4 828.5 828.6
828.7 828.8 828.9 828.10 828.11 828.12 828.13 828.14 828.15
828.16 828.17 828.18 828.19 828.20 828.21 828.22 828.23 828.24 828.25
828.26 828.27 828.28 828.29 828.30 828.31 828.32 829.1 829.2 829.3 829.4 829.5 829.6 829.7 829.8 829.9 829.10 829.11 829.12 829.13 829.14 829.15 829.16 829.17 829.18 829.19 829.20 829.21
829.22 829.23 829.24 829.25 829.26 829.27 829.28 829.29 829.30 829.31 829.32 830.1 830.2 830.3 830.4 830.5 830.6 830.7 830.8
830.9 830.10 830.11 830.12 830.13 830.14 830.15 830.16 830.17 830.18 830.19 830.20 830.21 830.22 830.23 830.24 830.25 830.26 830.27 830.28 830.29 830.30 830.31 830.32 831.1 831.2 831.3 831.4 831.5 831.6 831.7 831.8 831.9 831.10 831.11 831.12 831.13 831.14 831.15 831.16 831.17 831.18 831.19 831.20 831.21 831.22 831.23 831.24 831.25 831.26 831.27 831.28 831.29 831.30 831.31 831.32 831.33 832.1 832.2 832.3 832.4 832.5 832.6 832.7 832.8 832.9
832.10 832.11 832.12
832.13 832.14 832.15 832.16 832.17 832.18 832.19 832.20 832.21 832.22 832.23 832.24 832.25 832.26 832.27 832.28 832.29 832.30 832.31
833.1 833.2
833.3 833.4 833.5 833.6 833.7 833.8 833.9 833.10 833.11 833.12 833.13 833.14 833.15 833.16 833.17 833.18 833.19 833.20 833.21
833.22 833.23 833.24 833.25 833.26 833.27 833.28 833.29 833.30
834.1 834.2 834.3 834.4 834.5 834.6 834.7 834.8 834.9 834.10 834.11
834.12 834.13 834.14 834.15 834.16 834.17 834.18 834.19 834.20 834.21 834.22 834.23 834.24 834.25 834.26 834.27 834.28 834.29 834.30 835.1 835.2 835.3
835.4 835.5 835.6 835.7 835.8 835.9 835.10 835.11 835.12 835.13 835.14 835.15 835.16 835.17 835.18 835.19 835.20 835.21 835.22 835.23 835.24 835.25 835.26 835.27 835.28 835.29 835.30 835.31 835.32 835.33 836.1 836.2 836.3 836.4 836.5 836.6 836.7 836.8 836.9 836.10
836.11 836.12 836.13 836.14 836.15 836.16 836.17 836.18 836.19 836.20 836.21 836.22 836.23 836.24 836.25 836.26 836.27 836.28 836.29 836.30 836.31 836.32 836.33 836.34 837.1 837.2 837.3
837.4 837.5 837.6 837.7 837.8 837.9 837.10 837.11 837.12 837.13 837.14 837.15 837.16 837.17 837.18 837.19 837.20 837.21 837.22 837.23 837.24 837.25 837.26 837.27 837.28 837.29 837.30 838.1 838.2
838.3 838.4 838.5 838.6 838.7 838.8 838.9 838.10 838.11 838.12 838.13 838.14 838.15 838.16 838.17 838.18 838.19 838.20 838.21 838.22
838.23 838.24
838.25 838.26 838.27 838.28 838.29 838.30 839.1 839.2 839.3 839.4 839.5 839.6 839.7 839.8 839.9 839.10 839.11 839.12 839.13 839.14 839.15 839.16 839.17 839.18 839.19 839.20 839.21 839.22 839.23 839.24 839.25 839.26 839.27 839.28 839.29 839.30 839.31 839.32 839.33 839.34 840.1 840.2 840.3 840.4 840.5 840.6 840.7 840.8 840.9 840.10 840.11 840.12 840.13 840.14 840.15 840.16 840.17 840.18 840.19 840.20 840.21 840.22 840.23 840.24 840.25 840.26 840.27 840.28
840.29 840.30 840.31 841.1 841.2 841.3 841.4 841.5 841.6 841.7 841.8 841.9 841.10 841.11 841.12 841.13 841.14 841.15 841.16 841.17 841.18 841.19 841.20 841.21 841.22 841.23 841.24 841.25 841.26 841.27 841.28 841.29 841.30 841.31 841.32 842.1 842.2 842.3 842.4 842.5 842.6 842.7 842.8 842.9 842.10 842.11 842.12 842.13 842.14 842.15 842.16 842.17 842.18 842.19 842.20 842.21 842.22 842.23 842.24 842.25 842.26 842.27 842.28 842.29 842.30 842.31 842.32 843.1 843.2 843.3 843.4 843.5 843.6 843.7 843.8 843.9 843.10 843.11 843.12 843.13 843.14 843.15 843.16 843.17 843.18 843.19 843.20 843.21 843.22 843.23 843.24 843.25 843.26 843.27 843.28 843.29 843.30 843.31 843.32 844.1 844.2 844.3 844.4 844.5 844.6 844.7 844.8 844.9 844.10 844.11 844.12 844.13 844.14 844.15 844.16 844.17 844.18 844.19 844.20 844.21 844.22 844.23 844.24 844.25
844.26 844.27
844.28 844.29 844.30 844.31 844.32 845.1 845.2 845.3 845.4 845.5 845.6 845.7 845.8 845.9 845.10
845.11 845.12
845.13 845.14 845.15 845.16 845.17 845.18 845.19 845.20 845.21 845.22 845.23 845.24 845.25 845.26 845.27 845.28 845.29 845.30 845.31 845.32 846.1 846.2 846.3 846.4 846.5 846.6 846.7 846.8 846.9 846.10 846.11 846.12 846.13 846.14 846.15 846.16 846.17 846.18 846.19 846.20 846.21 846.22 846.23 846.24 846.25 846.26 846.27 846.28 846.29 846.30 846.31 846.32 846.33 847.1 847.2 847.3 847.4 847.5 847.6 847.7 847.8 847.9 847.10 847.11 847.12 847.13 847.14 847.15 847.16 847.17 847.18 847.19 847.20 847.21 847.22 847.23 847.24 847.25 847.26 847.27 847.28 847.29 847.30 847.31 848.1 848.2 848.3 848.4 848.5 848.6 848.7 848.8 848.9 848.10 848.11 848.12 848.13 848.14
848.15 848.16 848.17 848.18 848.19 848.20 848.21 848.22 848.23 848.24 848.25 848.26 848.27 848.28 848.29 848.30 848.31 848.32 848.33 849.1 849.2 849.3 849.4 849.5 849.6 849.7 849.8 849.9 849.10 849.11 849.12 849.13 849.14 849.15 849.16 849.17 849.18 849.19 849.20 849.21 849.22 849.23 849.24 849.25 849.26 849.27 849.28 849.29 849.30 849.31 849.32 849.33 849.34 850.1 850.2 850.3 850.4 850.5 850.6 850.7 850.8 850.9 850.10 850.11 850.12
850.13 850.14
850.15 850.16 850.17 850.18 850.19 850.20 850.21 850.22 850.23 850.24 850.25 850.26 850.27 850.28 850.29 850.30 850.31 850.32 850.33 851.1 851.2 851.3 851.4 851.5 851.6 851.7 851.8 851.9 851.10 851.11 851.12 851.13 851.14 851.15 851.16 851.17 851.18 851.19 851.20 851.21 851.22 851.23 851.24 851.25 851.26 851.27 851.28 851.29 851.30 851.31 851.32 851.33
852.1
852.2 852.3 852.4 852.5 852.6 852.7 852.8 852.9 852.10
852.11 852.12 852.13 852.14 852.15 852.16 852.17 852.18
852.19
852.20 852.21 852.22 852.23 852.24 852.25
852.26 852.27
852.28 852.29 852.30 853.1 853.2 853.3 853.4 853.5 853.6 853.7 853.8 853.9 853.10 853.11 853.12 853.13 853.14 853.15 853.16 853.17 853.18 853.19 853.20
853.21 853.22
853.23 853.24 853.25 853.26 853.27 853.28
853.29 853.30 853.31 854.1 854.2 854.3 854.4 854.5 854.6 854.7 854.8 854.9 854.10 854.11 854.12 854.13 854.14 854.15 854.16 854.17 854.18 854.19 854.20 854.21 854.22 854.23 854.24 854.25 854.26 854.27 854.28 854.29 854.30 854.31 854.32 854.33 855.1 855.2 855.3 855.4 855.5 855.6 855.7 855.8 855.9 855.10 855.11 855.12 855.13 855.14 855.15 855.16 855.17 855.18 855.19 855.20 855.21 855.22 855.23 855.24 855.25 855.26 855.27 855.28
855.29 855.30 855.31 855.32 856.1 856.2 856.3 856.4 856.5 856.6 856.7 856.8 856.9 856.10 856.11 856.12 856.13 856.14 856.15 856.16 856.17 856.18 856.19 856.20 856.21 856.22 856.23 856.24 856.25 856.26 856.27 856.28 856.29 856.30 856.31 856.32 856.33 856.34 857.1 857.2 857.3 857.4 857.5 857.6 857.7 857.8 857.9 857.10 857.11 857.12 857.13 857.14 857.15 857.16 857.17 857.18 857.19 857.20 857.21 857.22 857.23 857.24 857.25 857.26 857.27 857.28 857.29 857.30 857.31 857.32 858.1 858.2 858.3 858.4 858.5 858.6 858.7 858.8 858.9 858.10 858.11 858.12 858.13 858.14 858.15 858.16 858.17 858.18 858.19 858.20 858.21 858.22 858.23 858.24 858.25 858.26 858.27 858.28 858.29 858.30 858.31 859.1 859.2 859.3 859.4 859.5 859.6 859.7 859.8 859.9 859.10 859.11 859.12 859.13 859.14 859.15 859.16 859.17 859.18 859.19 859.20 859.21 859.22 859.23 859.24 859.25 859.26 859.27 859.28 859.29 859.30 859.31 859.32 859.33 859.34 860.1 860.2 860.3 860.4 860.5 860.6 860.7 860.8 860.9 860.10 860.11 860.12 860.13 860.14 860.15 860.16 860.17 860.18 860.19 860.20 860.21 860.22 860.23 860.24 860.25 860.26 860.27 860.28 860.29 860.30 860.31 860.32 860.33 860.34 861.1 861.2 861.3 861.4 861.5 861.6 861.7 861.8 861.9 861.10 861.11 861.12 861.13 861.14 861.15 861.16 861.17 861.18 861.19 861.20 861.21 861.22 861.23 861.24 861.25 861.26 861.27 861.28 861.29 861.30 861.31 861.32 861.33 861.34 862.1 862.2 862.3 862.4 862.5 862.6 862.7 862.8 862.9
862.10 862.11 862.12 862.13 862.14 862.15 862.16 862.17 862.18 862.19 862.20 862.21 862.22 862.23 862.24 862.25 862.26 862.27 862.28 862.29 862.30
862.31
863.1 863.2 863.3 863.4 863.5 863.6 863.7 863.8 863.9 863.10 863.11 863.12 863.13 863.14 863.15 863.16
863.17 863.18 863.19 863.20 863.21 863.22 863.23 863.24 863.25 863.26 863.27 863.28 863.29 863.30 863.31 864.1 864.2 864.3 864.4 864.5 864.6 864.7 864.8
864.9
864.10 864.11 864.12 864.13 864.14 864.15 864.16 864.17
864.18 864.19 864.20
864.21 864.22 864.23
864.24 864.25
864.26 864.27 864.28 864.29 865.1 865.2 865.3 865.4 865.5 865.6 865.7 865.8 865.9 865.10 865.11 865.12 865.13 865.14 865.15 865.16 865.17 865.18 865.19 865.20 865.21 865.22 865.23 865.24 865.25 865.26 865.27 865.28 865.29 865.30 865.31 866.1 866.2 866.3 866.4 866.5 866.6 866.7 866.8 866.9 866.10 866.11 866.12 866.13 866.14 866.15 866.16 866.17 866.18 866.19 866.20 866.21 866.22 866.23 866.24 866.25 866.26 866.27 866.28 866.29 866.30 866.31 867.1 867.2 867.3 867.4 867.5 867.6
867.7
867.8 867.9 867.10 867.11 867.12 867.13 867.14 867.15 867.16 867.17 867.18 867.19 867.20 867.21 867.22 867.23 867.24 867.25 867.26 867.27 867.28 867.29 867.30 867.31 868.1 868.2 868.3 868.4 868.5 868.6 868.7 868.8 868.9 868.10 868.11 868.12 868.13 868.14 868.15 868.16 868.17 868.18 868.19 868.20 868.21 868.22 868.23 868.24 868.25 868.26 868.27 868.28 868.29 868.30 869.1 869.2 869.3 869.4 869.5 869.6 869.7 869.8 869.9 869.10 869.11 869.12 869.13 869.14 869.15 869.16 869.17
869.18 869.19
869.20 869.21 869.22 869.23 869.24 869.25 869.26 869.27 869.28 869.29 869.30 869.31 870.1 870.2 870.3 870.4 870.5 870.6
870.7 870.8
870.9 870.10 870.11 870.12 870.13 870.14 870.15 870.16 870.17 870.18 870.19 870.20 870.21 870.22 870.23 870.24 870.25 870.26 870.27 870.28 870.29 870.30 870.31 871.1 871.2 871.3 871.4 871.5 871.6 871.7 871.8 871.9 871.10 871.11 871.12 871.13 871.14 871.15 871.16 871.17 871.18
871.19
871.20 871.21 871.22 871.23 871.24 871.25 871.26 871.27 871.28 871.29 871.30 872.1 872.2 872.3 872.4 872.5 872.6 872.7 872.8 872.9 872.10 872.11 872.12 872.13 872.14 872.15 872.16 872.17 872.18 872.19 872.20 872.21 872.22 872.23 872.24 872.25 872.26 872.27 872.28 872.29 872.30 872.31 873.1 873.2 873.3 873.4 873.5 873.6 873.7 873.8 873.9 873.10 873.11 873.12 873.13 873.14 873.15 873.16 873.17 873.18 873.19 873.20 873.21 873.22 873.23 873.24 873.25 873.26 873.27 873.28 873.29 873.30 873.31 873.32 873.33 874.1 874.2 874.3 874.4 874.5 874.6 874.7 874.8 874.9 874.10 874.11 874.12 874.13 874.14 874.15 874.16 874.17 874.18 874.19 874.20 874.21 874.22 874.23 874.24 874.25 874.26 874.27 874.28 874.29 874.30 874.31 874.32 874.33 875.1 875.2 875.3 875.4 875.5 875.6 875.7 875.8 875.9 875.10 875.11 875.12 875.13 875.14 875.15 875.16 875.17 875.18 875.19 875.20 875.21 875.22 875.23 875.24 875.25 875.26 875.27 875.28 875.29 875.30 875.31 875.32 875.33 876.1 876.2 876.3 876.4 876.5 876.6
876.7
876.8 876.9 876.10 876.11 876.12 876.13 876.14 876.15 876.16 876.17 876.18 876.19 876.20 876.21 876.22 876.23 876.24 876.25 876.26 876.27 876.28 876.29 876.30 876.31 877.1 877.2 877.3 877.4 877.5 877.6 877.7 877.8 877.9 877.10 877.11 877.12 877.13 877.14 877.15 877.16 877.17 877.18 877.19 877.20 877.21 877.22 877.23 877.24 877.25 877.26 877.27 877.28 877.29 878.1 878.2 878.3 878.4 878.5 878.6 878.7 878.8 878.9 878.10 878.11 878.12 878.13 878.14
878.15
878.16 878.17 878.18 878.19 878.20 878.21 878.22 878.23 878.24 878.25 878.26 878.27 878.28 878.29 878.30
878.31
879.1 879.2 879.3 879.4 879.5 879.6 879.7 879.8 879.9 879.10 879.11 879.12 879.13 879.14 879.15 879.16 879.17 879.18 879.19 879.20 879.21 879.22 879.23 879.24 879.25 879.26 879.27 879.28 879.29 879.30 880.1 880.2 880.3 880.4 880.5 880.6 880.7 880.8 880.9 880.10 880.11 880.12 880.13 880.14 880.15 880.16 880.17 880.18 880.19 880.20 880.21 880.22 880.23 880.24 880.25 880.26 880.27 880.28 880.29 880.30 880.31 880.32 880.33 881.1 881.2 881.3 881.4 881.5 881.6 881.7 881.8 881.9 881.10 881.11 881.12 881.13 881.14 881.15 881.16 881.17 881.18 881.19 881.20 881.21 881.22 881.23 881.24 881.25 881.26 881.27 881.28 881.29 881.30 881.31 881.32 881.33 881.34 882.1 882.2 882.3 882.4 882.5 882.6 882.7 882.8 882.9 882.10 882.11 882.12 882.13 882.14 882.15 882.16 882.17 882.18 882.19 882.20 882.21 882.22 882.23 882.24 882.25 882.26 882.27 882.28 882.29 882.30 882.31 882.32 882.33 883.1 883.2 883.3 883.4 883.5 883.6 883.7 883.8 883.9 883.10 883.11 883.12 883.13 883.14 883.15 883.16 883.17 883.18 883.19 883.20 883.21 883.22 883.23 883.24 883.25 883.26 883.27 883.28 883.29 883.30 884.1 884.2 884.3 884.4 884.5 884.6 884.7 884.8 884.9 884.10 884.11 884.12 884.13 884.14 884.15 884.16 884.17 884.18 884.19 884.20 884.21 884.22 884.23 884.24 884.25 884.26 884.27 884.28 884.29 884.30 884.31 885.1 885.2 885.3 885.4 885.5 885.6 885.7 885.8 885.9 885.10 885.11 885.12 885.13 885.14 885.15 885.16 885.17 885.18 885.19 885.20 885.21 885.22 885.23 885.24 885.25 885.26 885.27 885.28 885.29 885.30 885.31 885.32 886.1 886.2 886.3 886.4 886.5 886.6 886.7 886.8 886.9 886.10 886.11 886.12 886.13 886.14 886.15 886.16 886.17 886.18 886.19 886.20 886.21 886.22 886.23 886.24 886.25 886.26 886.27 886.28 886.29 886.30 886.31 886.32 887.1 887.2 887.3 887.4 887.5 887.6 887.7 887.8 887.9
887.10 887.11
887.12 887.13 887.14 887.15 887.16 887.17
887.18
887.19 887.20 887.21 887.22 887.23 887.24 887.25 887.26 887.27
887.28
888.1 888.2 888.3 888.4 888.5 888.6 888.7 888.8 888.9 888.10 888.11 888.12 888.13 888.14 888.15 888.16 888.17 888.18 888.19 888.20 888.21 888.22 888.23 888.24 888.25 888.26 888.27 888.28 888.29 888.30 888.31 889.1 889.2 889.3 889.4 889.5 889.6 889.7 889.8 889.9 889.10 889.11 889.12 889.13 889.14 889.15 889.16 889.17 889.18 889.19 889.20 889.21 889.22 889.23 889.24 889.25 889.26 889.27 889.28 889.29 889.30 889.31 890.1 890.2 890.3 890.4 890.5 890.6 890.7 890.8 890.9 890.10 890.11 890.12 890.13 890.14 890.15 890.16 890.17 890.18 890.19 890.20 890.21 890.22 890.23 890.24 890.25 890.26 890.27 890.28 890.29 890.30 890.31 890.32 891.1 891.2 891.3 891.4 891.5 891.6
891.7 891.8 891.9 891.10
891.11 891.12 891.13 891.14 891.15 891.16 891.17 891.18 891.19 891.20 891.21 891.22 891.23 891.24 891.25 891.26 891.27 891.28 891.29 891.30 891.31 891.32 891.33 892.1 892.2 892.3 892.4 892.5 892.6 892.7 892.8 892.9 892.10 892.11 892.12 892.13 892.14 892.15 892.16 892.17 892.18 892.19 892.20 892.21 892.22 892.23 892.24 892.25 892.26 892.27 892.28
892.29 892.30 892.31 892.32
893.1 893.2 893.3 893.4 893.5 893.6 893.7 893.8 893.9 893.10 893.11 893.12 893.13 893.14 893.15 893.16 893.17 893.18 893.19 893.20 893.21 893.22 893.23 893.24 893.25 893.26 893.27 893.28 893.29 893.30 893.31 893.32 893.33 894.1 894.2 894.3 894.4 894.5 894.6 894.7 894.8 894.9 894.10 894.11 894.12 894.13 894.14 894.15 894.16 894.17 894.18 894.19 894.20 894.21 894.22 894.23
894.24 894.25 894.26 894.27
895.1 895.2 895.3 895.4 895.5 895.6 895.7 895.8 895.9 895.10 895.11
895.12 895.13
895.14 895.15 895.16 895.17 895.18 895.19 895.20
895.21
895.22 895.23 895.24 895.25 895.26
895.27
896.1 896.2 896.3 896.4
896.5 896.6
896.7 896.8 896.9 896.10 896.11 896.12 896.13 896.14 896.15 896.16 896.17 896.18 896.19 896.20 896.21 896.22 896.23 896.24 896.25 896.26 896.27 896.28 896.29 897.1 897.2 897.3 897.4 897.5 897.6 897.7 897.8 897.9 897.10 897.11 897.12 897.13 897.14 897.15 897.16 897.17 897.18 897.19 897.20 897.21 897.22 897.23 897.24 897.25 897.26 897.27 897.28 897.29 897.30 897.31 898.1 898.2 898.3 898.4 898.5 898.6 898.7 898.8 898.9 898.10 898.11 898.12 898.13 898.14
898.15 898.16 898.17 898.18 898.19 898.20 898.21 898.22 898.23 898.24 898.25
898.26 898.27 898.28 898.29 898.30
899.1 899.2 899.3 899.4 899.5 899.6 899.7 899.8 899.9 899.10 899.11 899.12 899.13 899.14 899.15 899.16 899.17 899.18 899.19 899.20 899.21 899.22 899.23 899.24 899.25 899.26 899.27 899.28 899.29 899.30 899.31 900.1 900.2 900.3 900.4 900.5 900.6 900.7 900.8 900.9 900.10 900.11 900.12 900.13 900.14 900.15 900.16 900.17 900.18 900.19 900.20 900.21 900.22 900.23 900.24 900.25 900.26 900.27 900.28 900.29 900.30 900.31 900.32 901.1 901.2
901.3 901.4 901.5 901.6 901.7 901.8 901.9 901.10 901.11 901.12 901.13 901.14 901.15 901.16 901.17 901.18 901.19 901.20 901.21 901.22 901.23 901.24 901.25 901.26
901.27 901.28 901.29 901.30 902.1 902.2 902.3 902.4 902.5 902.6 902.7 902.8 902.9 902.10
902.11 902.12 902.13 902.14 902.15 902.16 902.17 902.18 902.19 902.20 902.21 902.22 902.23 902.24 902.25
902.26 902.27 902.28 902.29 902.30 902.31 903.1 903.2 903.3 903.4 903.5 903.6 903.7 903.8 903.9 903.10
903.11 903.12 903.13 903.14
903.15
903.16 903.17 903.18 903.19 903.20
903.21
903.22 903.23
903.24 903.25 903.26 903.27 903.28 903.29 903.30 904.1 904.2 904.3 904.4 904.5 904.6 904.7 904.8 904.9 904.10 904.11 904.12 904.13 904.14 904.15 904.16 904.17 904.18 904.19 904.20 904.21 904.22 904.23 904.24 904.25 904.26 904.27 904.28 904.29 904.30 904.31 904.32 904.33 904.34 904.35 904.36 904.37 905.1 905.2 905.3 905.4 905.5 905.6 905.7 905.8 905.9 905.10 905.11 905.12 905.13 905.14 905.15 905.16 905.17 905.18 905.19 905.20 905.21 905.22 905.23 905.24 905.25 905.26 905.27 905.28
905.29 905.30 905.31 905.32 905.33 905.34 906.1 906.2 906.3 906.4 906.5 906.6 906.7 906.8 906.9 906.10 906.11 906.12 906.13 906.14 906.15 906.16 906.17 906.18 906.19 906.20 906.21 906.22 906.23 906.24 906.25 906.26 906.27 906.28 906.29 906.30 906.31 907.1 907.2 907.3 907.4 907.5 907.6 907.7 907.8 907.9 907.10 907.11 907.12 907.13 907.14 907.15 907.16 907.17 907.18 907.19 907.20 907.21 907.22 907.23 907.24 907.25 907.26 907.27 907.28 907.29 907.30 907.31 908.1 908.2 908.3 908.4 908.5 908.6 908.7 908.8 908.9 908.10 908.11 908.12 908.13 908.14 908.15 908.16 908.17 908.18 908.19 908.20 908.21 908.22 908.23 908.24 908.25 908.26 908.27 908.28 908.29 908.30 909.1 909.2 909.3 909.4 909.5 909.6 909.7 909.8 909.9 909.10 909.11 909.12 909.13 909.14 909.15 909.16 909.17 909.18 909.19 909.20 909.21 909.22 909.23 909.24 909.25 909.26 909.27 909.28 909.29 909.30 909.31 910.1 910.2 910.3 910.4 910.5 910.6 910.7 910.8 910.9 910.10 910.11 910.12 910.13 910.14 910.15 910.16 910.17 910.18 910.19 910.20 910.21 910.22 910.23 910.24 910.25 910.26 910.27 910.28 910.29 910.30 910.31 911.1 911.2 911.3 911.4 911.5 911.6 911.7 911.8 911.9 911.10 911.11 911.12 911.13 911.14 911.15 911.16 911.17 911.18 911.19 911.20 911.21 911.22 911.23 911.24 911.25 911.26 911.27 911.28 911.29 911.30 911.31 911.32 912.1 912.2 912.3 912.4 912.5 912.6 912.7 912.8 912.9 912.10 912.11 912.12 912.13 912.14 912.15 912.16 912.17 912.18 912.19 912.20 912.21 912.22 912.23 912.24 912.25 912.26 912.27 912.28 912.29 912.30 912.31 913.1 913.2 913.3 913.4 913.5 913.6 913.7 913.8 913.9 913.10 913.11 913.12 913.13 913.14 913.15 913.16 913.17 913.18 913.19 913.20 913.21 913.22 913.23 913.24 913.25 913.26 913.27 913.28 913.29 913.30 913.31 913.32 914.1 914.2 914.3 914.4 914.5 914.6 914.7 914.8 914.9 914.10 914.11 914.12 914.13 914.14 914.15 914.16 914.17 914.18 914.19 914.20 914.21 914.22 914.23 914.24 914.25 914.26 914.27 914.28 914.29 914.30 915.1 915.2 915.3 915.4 915.5 915.6 915.7 915.8 915.9 915.10 915.11 915.12 915.13 915.14 915.15 915.16 915.17 915.18 915.19 915.20 915.21 915.22 915.23 915.24 915.25 915.26 915.27 915.28 915.29 915.30 915.31 916.1 916.2 916.3 916.4 916.5 916.6 916.7 916.8 916.9 916.10 916.11 916.12 916.13
916.14 916.15 916.16 916.17 916.18 916.19 916.20 916.21 916.22 916.23 916.24 916.25 916.26 916.27 916.28 916.29 916.30
917.1 917.2 917.3 917.4 917.5 917.6 917.7 917.8 917.9 917.10 917.11 917.12 917.13 917.14 917.15 917.16 917.17 917.18 917.19 917.20 917.21 917.22 917.23 917.24 917.25 917.26 917.27 917.28 917.29 917.30 917.31 917.32 917.33 918.1 918.2 918.3 918.4 918.5 918.6 918.7 918.8 918.9 918.10 918.11 918.12 918.13 918.14 918.15 918.16 918.17 918.18 918.19 918.20 918.21 918.22
918.23 918.24 918.25 918.26 918.27 918.28 918.29 918.30 918.31 919.1 919.2 919.3 919.4 919.5 919.6 919.7 919.8 919.9 919.10 919.11 919.12 919.13 919.14 919.15 919.16 919.17 919.18 919.19 919.20 919.21 919.22 919.23 919.24 919.25 919.26 919.27 919.28 919.29 919.30 920.1 920.2 920.3 920.4 920.5 920.6 920.7 920.8 920.9 920.10 920.11 920.12 920.13 920.14 920.15 920.16 920.17 920.18 920.19 920.20 920.21 920.22 920.23 920.24 920.25 920.26 920.27 920.28 920.29 920.30 920.31 920.32 920.33 921.1 921.2 921.3 921.4 921.5 921.6 921.7 921.8 921.9 921.10 921.11
921.12 921.13 921.14 921.15 921.16 921.17 921.18 921.19 921.20 921.21 921.22 921.23 921.24 921.25 921.26 921.27 921.28 921.29 921.30 922.1 922.2 922.3 922.4 922.5 922.6 922.7 922.8
922.9 922.10 922.11 922.12 922.13 922.14 922.15 922.16 922.17 922.18 922.19 922.20 922.21 922.22 922.23 922.24 922.25 922.26 922.27 922.28 922.29 922.30 922.31 922.32 922.33 923.1 923.2 923.3
923.4 923.5 923.6 923.7 923.8 923.9 923.10 923.11 923.12 923.13 923.14
923.15 923.16 923.17 923.18
923.19 923.20 923.21 923.22 923.23 923.24 923.25 923.26 923.27 923.28 923.29 923.30 924.1 924.2 924.3 924.4 924.5 924.6 924.7 924.8 924.9 924.10 924.11 924.12 924.13 924.14 924.15 924.16 924.17 924.18
924.19 924.20 924.21 924.22 924.23 924.24 924.25 924.26 924.27 924.28 924.29 924.30 924.31 925.1 925.2 925.3 925.4 925.5 925.6 925.7 925.8 925.9 925.10 925.11 925.12 925.13 925.14 925.15 925.16 925.17 925.18 925.19 925.20 925.21 925.22 925.23 925.24 925.25 925.26 925.27 925.28 925.29 925.30 925.31 926.1 926.2 926.3 926.4 926.5 926.6 926.7 926.8 926.9 926.10 926.11 926.12 926.13 926.14 926.15 926.16 926.17 926.18 926.19 926.20 926.21 926.22 926.23 926.24 926.25 926.26 926.27 926.28 926.29 926.30 926.31 927.1 927.2 927.3 927.4 927.5 927.6 927.7 927.8 927.9 927.10 927.11 927.12 927.13 927.14 927.15 927.16 927.17 927.18 927.19 927.20 927.21 927.22 927.23 927.24 927.25 927.26 927.27 927.28 927.29 927.30 927.31 928.1 928.2 928.3 928.4 928.5 928.6 928.7 928.8 928.9 928.10 928.11 928.12 928.13 928.14 928.15 928.16 928.17 928.18 928.19 928.20 928.21 928.22 928.23 928.24 928.25 928.26 928.27 928.28 928.29 928.30 928.31 928.32 929.1 929.2 929.3 929.4 929.5 929.6 929.7 929.8 929.9 929.10 929.11 929.12 929.13 929.14 929.15 929.16 929.17 929.18 929.19 929.20 929.21 929.22 929.23 929.24 929.25 929.26 929.27
929.28
930.1 930.2 930.3 930.4 930.5 930.6 930.7 930.8 930.9 930.10 930.11 930.12 930.13 930.14 930.15 930.16 930.17 930.18 930.19 930.20 930.21 930.22 930.23 930.24 930.25 930.26 930.27 930.28 930.29 930.30
931.1 931.2 931.3 931.4 931.5 931.6 931.7 931.8 931.9 931.10 931.11 931.12 931.13 931.14 931.15 931.16 931.17 931.18 931.19
931.20
931.21 931.22 931.23 931.24 931.25 931.26 931.27 931.28 931.29 931.30 931.31 931.32 932.1 932.2 932.3 932.4 932.5 932.6 932.7 932.8 932.9 932.10 932.11 932.12 932.13 932.14 932.15 932.16 932.17 932.18 932.19 932.20 932.21 932.22 932.23 932.24 932.25 932.26 932.27 932.28 932.29 932.30 932.31 932.32 933.1 933.2 933.3 933.4 933.5 933.6 933.7 933.8 933.9 933.10 933.11 933.12 933.13 933.14 933.15 933.16 933.17 933.18 933.19 933.20 933.21 933.22 933.23 933.24 933.25 933.26 933.27
933.28 933.29 933.30 933.31 933.32 934.1 934.2 934.3 934.4 934.5 934.6 934.7 934.8 934.9 934.10 934.11 934.12 934.13 934.14 934.15 934.16 934.17 934.18 934.19 934.20 934.21 934.22 934.23 934.24 934.25 934.26 934.27 934.28 934.29 934.30 934.31 934.32 935.1 935.2 935.3 935.4 935.5 935.6 935.7 935.8 935.9 935.10 935.11 935.12 935.13 935.14 935.15 935.16 935.17 935.18 935.19 935.20 935.21 935.22 935.23 935.24 935.25 935.26 935.27 935.28 935.29 935.30 935.31 935.32 936.1 936.2 936.3 936.4 936.5 936.6 936.7 936.8 936.9 936.10 936.11 936.12 936.13 936.14 936.15 936.16 936.17 936.18 936.19 936.20 936.21 936.22 936.23 936.24 936.25 936.26 936.27 936.28 936.29 937.1 937.2 937.3 937.4 937.5 937.6 937.7 937.8 937.9 937.10 937.11 937.12 937.13 937.14 937.15 937.16 937.17 937.18 937.19 937.20 937.21 937.22 937.23 937.24 937.25 937.26
937.27 937.28 937.29 937.30 937.31 938.1 938.2 938.3 938.4 938.5 938.6 938.7 938.8 938.9 938.10 938.11 938.12 938.13 938.14 938.15 938.16 938.17 938.18 938.19 938.20 938.21 938.22 938.23 938.24 938.25 938.26 938.27 938.28 938.29 938.30 938.31 938.32 938.33 938.34 939.1 939.2 939.3 939.4 939.5 939.6 939.7 939.8 939.9 939.10 939.11 939.12 939.13 939.14 939.15 939.16 939.17 939.18 939.19 939.20 939.21 939.22 939.23 939.24 939.25 939.26 939.27 939.28 939.29 939.30 939.31 939.32 939.33 940.1 940.2 940.3 940.4 940.5 940.6 940.7 940.8 940.9 940.10 940.11 940.12 940.13 940.14 940.15 940.16 940.17 940.18 940.19 940.20 940.21 940.22 940.23 940.24 940.25 940.26 940.27 940.28 940.29 940.30 940.31 941.1 941.2 941.3 941.4 941.5 941.6 941.7 941.8 941.9 941.10 941.11 941.12 941.13 941.14 941.15 941.16 941.17 941.18 941.19 941.20 941.21 941.22 941.23 941.24 941.25 941.26 941.27 941.28 941.29 941.30 941.31 942.1 942.2 942.3 942.4 942.5 942.6
942.7 942.8 942.9 942.10 942.11 942.12 942.13 942.14 942.15 942.16 942.17 942.18 942.19 942.20 942.21 942.22 942.23 942.24 942.25 942.26 942.27 942.28 942.29 942.30 942.31 942.32 942.33 943.1 943.2 943.3 943.4 943.5 943.6 943.7
943.8 943.9 943.10 943.11 943.12 943.13 943.14 943.15 943.16 943.17 943.18 943.19 943.20 943.21 943.22 943.23 943.24 943.25 943.26 943.27 943.28 943.29 943.30 943.31 943.32 943.33 943.34 944.1 944.2 944.3 944.4 944.5 944.6 944.7 944.8 944.9 944.10 944.11 944.12 944.13 944.14 944.15 944.16 944.17 944.18 944.19 944.20 944.21 944.22 944.23 944.24 944.25 944.26 944.27 944.28 944.29 944.30 944.31 945.1 945.2 945.3 945.4 945.5 945.6 945.7 945.8 945.9 945.10 945.11 945.12 945.13 945.14 945.15 945.16 945.17 945.18 945.19 945.20 945.21 945.22 945.23 945.24 945.25 945.26 945.27 945.28 945.29 945.30 945.31 945.32 945.33 946.1 946.2 946.3 946.4 946.5 946.6 946.7 946.8 946.9 946.10 946.11 946.12 946.13 946.14 946.15 946.16 946.17 946.18 946.19 946.20 946.21 946.22 946.23 946.24 946.25 946.26 946.27 946.28 946.29 946.30 946.31 947.1 947.2 947.3 947.4 947.5 947.6 947.7 947.8 947.9 947.10 947.11 947.12 947.13 947.14 947.15 947.16 947.17 947.18 947.19 947.20 947.21 947.22 947.23 947.24 947.25 947.26 947.27 947.28 947.29 947.30 947.31 948.1 948.2 948.3 948.4 948.5 948.6 948.7 948.8 948.9 948.10 948.11 948.12 948.13 948.14 948.15 948.16 948.17 948.18 948.19 948.20 948.21 948.22 948.23 948.24 948.25 948.26 948.27 948.28 948.29 948.30 948.31 948.32 948.33 949.1 949.2 949.3 949.4 949.5 949.6 949.7 949.8 949.9 949.10 949.11 949.12
949.13 949.14 949.15 949.16 949.17 949.18 949.19 949.20 949.21 949.22 949.23 949.24 949.25 949.26 949.27 949.28 949.29 949.30 949.31 949.32 950.1 950.2 950.3 950.4 950.5 950.6 950.7 950.8 950.9 950.10 950.11 950.12 950.13 950.14 950.15 950.16 950.17 950.18 950.19 950.20 950.21 950.22 950.23 950.24 950.25 950.26 950.27 950.28 950.29 950.30 950.31 950.32 951.1 951.2 951.3 951.4 951.5 951.6 951.7 951.8 951.9 951.10 951.11
951.12 951.13 951.14 951.15 951.16 951.17 951.18 951.19 951.20 951.21 951.22 951.23 951.24 951.25 951.26 951.27 951.28 951.29 951.30 951.31 952.1 952.2 952.3 952.4 952.5 952.6 952.7 952.8 952.9 952.10 952.11 952.12 952.13 952.14 952.15 952.16 952.17 952.18 952.19 952.20 952.21 952.22 952.23 952.24 952.25 952.26 952.27 952.28 952.29 952.30 952.31 953.1 953.2 953.3 953.4 953.5 953.6 953.7 953.8 953.9 953.10 953.11 953.12 953.13
953.14 953.15 953.16 953.17 953.18 953.19 953.20 953.21 953.22 953.23 953.24 953.25 953.26 953.27 953.28 953.29 953.30 953.31 954.1 954.2 954.3 954.4 954.5 954.6 954.7 954.8 954.9 954.10 954.11 954.12 954.13 954.14 954.15 954.16 954.17 954.18 954.19 954.20 954.21 954.22 954.23 954.24 954.25 954.26 954.27 954.28 954.29 954.30 954.31 954.32 955.1 955.2 955.3 955.4 955.5 955.6 955.7 955.8 955.9 955.10 955.11 955.12 955.13 955.14 955.15 955.16 955.17 955.18 955.19 955.20 955.21 955.22 955.23 955.24 955.25 955.26 955.27 955.28 955.29 955.30 955.31 956.1 956.2
956.3 956.4 956.5 956.6 956.7 956.8 956.9 956.10 956.11 956.12 956.13 956.14 956.15 956.16 956.17 956.18 956.19 956.20 956.21 956.22 956.23 956.24 956.25 956.26 956.27 956.28 956.29 956.30 957.1 957.2 957.3
957.4 957.5 957.6 957.7 957.8 957.9 957.10 957.11 957.12 957.13 957.14 957.15 957.16 957.17 957.18 957.19 957.20 957.21 957.22 957.23 957.24 957.25 957.26 957.27 957.28 957.29 957.30 957.31 957.32 958.1 958.2 958.3 958.4 958.5 958.6 958.7 958.8 958.9 958.10 958.11 958.12 958.13 958.14 958.15 958.16 958.17 958.18 958.19 958.20 958.21 958.22 958.23 958.24 958.25 958.26 958.27 958.28 958.29 958.30 958.31 958.32 959.1 959.2 959.3 959.4 959.5 959.6 959.7 959.8
959.9 959.10 959.11 959.12 959.13 959.14 959.15 959.16 959.17 959.18 959.19 959.20 959.21 959.22 959.23 959.24 959.25 959.26 959.27 959.28 959.29 959.30 960.1 960.2 960.3 960.4 960.5 960.6 960.7 960.8 960.9 960.10 960.11 960.12 960.13 960.14 960.15 960.16 960.17 960.18 960.19 960.20 960.21 960.22 960.23 960.24 960.25 960.26 960.27 960.28 960.29 960.30 961.1 961.2 961.3 961.4 961.5 961.6 961.7 961.8 961.9 961.10 961.11 961.12 961.13 961.14 961.15 961.16 961.17 961.18 961.19 961.20 961.21 961.22 961.23 961.24 961.25 961.26 961.27 961.28 961.29 961.30 962.1 962.2 962.3 962.4
962.5 962.6 962.7 962.8 962.9 962.10 962.11 962.12 962.13 962.14 962.15 962.16 962.17 962.18 962.19 962.20 962.21 962.22 962.23 962.24 962.25 962.26 962.27 962.28 962.29 962.30 962.31 963.1 963.2 963.3 963.4 963.5 963.6 963.7 963.8 963.9 963.10 963.11 963.12 963.13 963.14 963.15 963.16 963.17 963.18 963.19 963.20 963.21 963.22 963.23 963.24 963.25 963.26 963.27 963.28 963.29 963.30 963.31 963.32 963.33 964.1 964.2 964.3 964.4 964.5 964.6 964.7 964.8 964.9 964.10 964.11 964.12 964.13 964.14 964.15 964.16 964.17 964.18 964.19 964.20 964.21 964.22 964.23 964.24 964.25 964.26 964.27 964.28 964.29 964.30 964.31 964.32 964.33 964.34 965.1 965.2 965.3 965.4 965.5 965.6 965.7 965.8 965.9 965.10 965.11 965.12 965.13 965.14 965.15 965.16 965.17 965.18 965.19 965.20 965.21 965.22 965.23 965.24 965.25 965.26 965.27 965.28 965.29 965.30 966.1 966.2 966.3 966.4 966.5 966.6 966.7 966.8 966.9 966.10 966.11 966.12 966.13 966.14 966.15 966.16 966.17
966.18 966.19 966.20 966.21 966.22 966.23 966.24 966.25 966.26 966.27 966.28 966.29 966.30 966.31 967.1 967.2 967.3 967.4 967.5 967.6 967.7 967.8 967.9 967.10 967.11 967.12 967.13 967.14 967.15 967.16 967.17 967.18 967.19 967.20 967.21 967.22 967.23 967.24 967.25 967.26 967.27 967.28 967.29 967.30 967.31 968.1 968.2 968.3 968.4 968.5 968.6 968.7 968.8 968.9 968.10 968.11 968.12 968.13 968.14 968.15 968.16 968.17 968.18 968.19 968.20 968.21 968.22 968.23 968.24 968.25 968.26 968.27 968.28 968.29 968.30 969.1 969.2 969.3 969.4 969.5 969.6 969.7 969.8 969.9 969.10 969.11 969.12 969.13 969.14 969.15 969.16 969.17 969.18 969.19 969.20 969.21 969.22 969.23 969.24 969.25 969.26 969.27 969.28 969.29 969.30 969.31 969.32 970.1 970.2 970.3 970.4 970.5 970.6 970.7 970.8
970.9 970.10 970.11 970.12 970.13 970.14 970.15 970.16 970.17 970.18 970.19 970.20 970.21 970.22 970.23 970.24 970.25 970.26 970.27 970.28 970.29 970.30 970.31 970.32 971.1 971.2 971.3 971.4 971.5 971.6 971.7 971.8 971.9 971.10 971.11 971.12 971.13 971.14 971.15 971.16 971.17 971.18 971.19 971.20 971.21 971.22 971.23 971.24 971.25 971.26 971.27
971.28 971.29 971.30 971.31 971.32 972.1 972.2 972.3 972.4 972.5 972.6 972.7 972.8 972.9 972.10
972.11
972.12 972.13 972.14 972.15 972.16 972.17 972.18 972.19 972.20 972.21 972.22 972.23 972.24 972.25 972.26 972.27 972.28 972.29 972.30 973.1 973.2 973.3 973.4 973.5 973.6 973.7 973.8 973.9 973.10 973.11 973.12 973.13 973.14
973.15 973.16 973.17 973.18 973.19 973.20 973.21 973.22 973.23 973.24 973.25 973.26 973.27 973.28 973.29 973.30 973.31 974.1 974.2 974.3 974.4 974.5 974.6 974.7 974.8 974.9 974.10 974.11 974.12 974.13 974.14 974.15 974.16 974.17 974.18 974.19 974.20 974.21 974.22 974.23 974.24 974.25 974.26 974.27 974.28 974.29 974.30 974.31 974.32 974.33 974.34 975.1 975.2 975.3 975.4 975.5
975.6 975.7 975.8 975.9 975.10 975.11 975.12 975.13 975.14 975.15 975.16 975.17 975.18 975.19 975.20 975.21 975.22 975.23 975.24 975.25 975.26 975.27 975.28 975.29 975.30 975.31 976.1 976.2 976.3 976.4 976.5 976.6 976.7 976.8 976.9 976.10 976.11 976.12 976.13 976.14 976.15 976.16 976.17 976.18 976.19 976.20 976.21 976.22 976.23 976.24 976.25 976.26 976.27 976.28 976.29 976.30 976.31 976.32 976.33 977.1 977.2 977.3 977.4 977.5 977.6 977.7 977.8 977.9
977.10 977.11 977.12 977.13 977.14 977.15 977.16 977.17 977.18 977.19 977.20 977.21 977.22 977.23 977.24 977.25 977.26 977.27 977.28 977.29 977.30 977.31 977.32 978.1 978.2 978.3 978.4 978.5 978.6 978.7 978.8 978.9 978.10 978.11 978.12 978.13
978.14 978.15 978.16 978.17 978.18 978.19 978.20 978.21 978.22 978.23 978.24 978.25 978.26 978.27 978.28 978.29 979.1 979.2 979.3 979.4 979.5 979.6 979.7 979.8 979.9 979.10 979.11 979.12 979.13 979.14 979.15 979.16 979.17 979.18 979.19 979.20 979.21 979.22 979.23 979.24 979.25 979.26 979.27 979.28 979.29 979.30 980.1 980.2 980.3 980.4 980.5 980.6 980.7 980.8 980.9 980.10 980.11 980.12 980.13 980.14 980.15 980.16 980.17 980.18 980.19 980.20 980.21 980.22 980.23 980.24 980.25 980.26 980.27 980.28 980.29 980.30 980.31 980.32 981.1 981.2 981.3 981.4 981.5 981.6 981.7 981.8 981.9 981.10 981.11 981.12 981.13 981.14 981.15 981.16 981.17 981.18 981.19 981.20 981.21 981.22 981.23 981.24 981.25 981.26 981.27 981.28 981.29 981.30 981.31 981.32 981.33 982.1 982.2 982.3 982.4 982.5 982.6 982.7 982.8 982.9 982.10 982.11 982.12 982.13 982.14 982.15 982.16 982.17 982.18 982.19 982.20 982.21 982.22 982.23 982.24 982.25 982.26 982.27 982.28 982.29 982.30 982.31 982.32 983.1 983.2 983.3 983.4 983.5 983.6 983.7 983.8 983.9 983.10 983.11 983.12 983.13 983.14 983.15 983.16 983.17 983.18 983.19 983.20 983.21 983.22 983.23 983.24 983.25 983.26 983.27 983.28 983.29 983.30 983.31 983.32 983.33 984.1 984.2 984.3 984.4 984.5 984.6 984.7 984.8 984.9 984.10 984.11 984.12 984.13 984.14 984.15 984.16 984.17 984.18 984.19 984.20 984.21 984.22 984.23 984.24 984.25 984.26 984.27 984.28 984.29 984.30 984.31 984.32 984.33 984.34 985.1 985.2 985.3 985.4 985.5 985.6 985.7 985.8 985.9 985.10 985.11 985.12 985.13 985.14 985.15 985.16 985.17 985.18 985.19 985.20 985.21 985.22 985.23 985.24 985.25 985.26 985.27 985.28 985.29 985.30 985.31 985.32 985.33 985.34 986.1 986.2 986.3 986.4 986.5 986.6 986.7 986.8 986.9 986.10 986.11 986.12 986.13 986.14 986.15 986.16 986.17 986.18 986.19 986.20 986.21 986.22 986.23 986.24 986.25 986.26 986.27 986.28 986.29 986.30 986.31 986.32 986.33 987.1 987.2 987.3 987.4 987.5 987.6 987.7 987.8 987.9 987.10 987.11 987.12
987.13 987.14 987.15 987.16 987.17 987.18 987.19 987.20 987.21 987.22 987.23 987.24 987.25 987.26 987.27 987.28 987.29 987.30 987.31 988.1 988.2 988.3 988.4 988.5 988.6 988.7 988.8 988.9 988.10 988.11 988.12 988.13 988.14 988.15 988.16 988.17 988.18 988.19
988.20 988.21 988.22 988.23 988.24 988.25 988.26 988.27 988.28 988.29 988.30 988.31 989.1 989.2 989.3 989.4 989.5 989.6 989.7 989.8 989.9 989.10 989.11 989.12 989.13 989.14 989.15
989.16 989.17 989.18 989.19 989.20 989.21 989.22 989.23 989.24 989.25 989.26 989.27 989.28 989.29 989.30 990.1 990.2 990.3 990.4 990.5 990.6 990.7 990.8 990.9
990.10 990.11 990.12 990.13 990.14 990.15 990.16 990.17 990.18 990.19 990.20 990.21 990.22 990.23
990.24 990.25 990.26 990.27 990.28
991.1 991.2 991.3
991.4 991.5 991.6 991.7 991.8 991.9 991.10 991.11 991.12 991.13 991.14 991.15 991.16 991.17 991.18 991.19 991.20 991.21 991.22 991.23 991.24 991.25 991.26 991.27 991.28 991.29 991.30 991.31 991.32 991.33 992.1 992.2 992.3 992.4 992.5 992.6 992.7 992.8 992.9 992.10 992.11 992.12 992.13
992.14 992.15 992.16 992.17 992.18 992.19 992.20 992.21 992.22 992.23 992.24 992.25 992.26 992.27 992.28 992.29 992.30 992.31 993.1 993.2 993.3 993.4 993.5 993.6 993.7 993.8 993.9 993.10 993.11 993.12 993.13 993.14 993.15 993.16 993.17 993.18
993.19 993.20 993.21 993.22 993.23 993.24 993.25 993.26 993.27 993.28 993.29 994.1 994.2 994.3 994.4 994.5 994.6 994.7 994.8 994.9 994.10 994.11 994.12 994.13 994.14 994.15 994.16 994.17 994.18 994.19 994.20 994.21
994.22 994.23 994.24 994.25 994.26 994.27 994.28 994.29 994.30 994.31 994.32 995.1 995.2 995.3 995.4 995.5 995.6 995.7 995.8 995.9 995.10 995.11 995.12 995.13 995.14 995.15 995.16 995.17 995.18 995.19 995.20 995.21 995.22 995.23 995.24 995.25 995.26 995.27 995.28 995.29 996.1 996.2 996.3 996.4 996.5 996.6 996.7
996.8 996.9
996.10 996.11 996.12 996.13 996.14 996.15 996.16 996.17 996.18 996.19 996.20 996.21 996.22
996.23 996.24 996.25 996.26 996.27 996.28 996.29
997.1 997.2 997.3 997.4 997.5 997.6 997.7 997.8 997.9
997.10 997.11 997.12 997.13 997.14 997.15 997.16 997.17 997.18 997.19 997.20 997.21 997.22 997.23 997.24 997.25 997.26 997.27 997.28 997.29 997.30 997.31 997.32 997.33 998.1 998.2 998.3 998.4 998.5 998.6 998.7 998.8 998.9 998.10
998.11 998.12 998.13 998.14 998.15 998.16 998.17 998.18 998.19 998.20 998.21 998.22 998.23 998.24 998.25 998.26 998.27
998.28 998.29 998.30 998.31 998.32 999.1 999.2 999.3 999.4 999.5 999.6 999.7 999.8
999.9 999.10 999.11 999.12 999.13 999.14 999.15 999.16 999.17 999.18 999.19 999.20 999.21 999.22 999.23 999.24 999.25 999.26 999.27 999.28 999.29 999.30 999.31 1000.1 1000.2
1000.3 1000.4 1000.5 1000.6 1000.7 1000.8 1000.9 1000.10 1000.11 1000.12 1000.13 1000.14 1000.15 1000.16
1000.17 1000.18 1000.19 1000.20 1000.21 1000.22 1000.23 1000.24 1000.25 1000.26 1000.27 1000.28 1000.29 1000.30 1000.31 1001.1 1001.2 1001.3 1001.4 1001.5 1001.6 1001.7 1001.8 1001.9 1001.10 1001.11 1001.12 1001.13 1001.14 1001.15 1001.16 1001.17 1001.18 1001.19 1001.20 1001.21 1001.22 1001.23 1001.24 1001.25 1001.26 1001.27 1001.28 1001.29 1001.30 1001.31 1002.1 1002.2 1002.3 1002.4 1002.5 1002.6 1002.7 1002.8 1002.9 1002.10 1002.11 1002.12 1002.13 1002.14 1002.15 1002.16 1002.17 1002.18 1002.19 1002.20 1002.21 1002.22 1002.23 1002.24 1002.25 1002.26 1002.27 1002.28 1002.29 1002.30 1002.31 1003.1 1003.2 1003.3
1003.4 1003.5 1003.6 1003.7 1003.8 1003.9 1003.10 1003.11 1003.12 1003.13 1003.14 1003.15 1003.16 1003.17 1003.18 1003.19 1003.20
1003.21 1003.22 1003.23 1003.24 1003.25 1003.26 1003.27 1003.28 1003.29 1003.30 1004.1 1004.2 1004.3 1004.4 1004.5 1004.6 1004.7 1004.8 1004.9 1004.10 1004.11 1004.12 1004.13 1004.14 1004.15 1004.16 1004.17 1004.18 1004.19 1004.20 1004.21 1004.22 1004.23 1004.24 1004.25 1004.26 1004.27 1004.28 1004.29 1004.30 1004.31 1005.1 1005.2 1005.3 1005.4 1005.5 1005.6 1005.7 1005.8 1005.9 1005.10 1005.11 1005.12 1005.13 1005.14 1005.15 1005.16 1005.17 1005.18 1005.19 1005.20 1005.21 1005.22 1005.23 1005.24 1005.25 1005.26 1005.27 1005.28 1005.29 1005.30
1005.31 1005.32
1006.1 1006.2 1006.3 1006.4 1006.5 1006.6 1006.7 1006.8 1006.9 1006.10 1006.11 1006.12 1006.13 1006.14 1006.15 1006.16 1006.17 1006.18 1006.19 1006.20 1006.21 1006.22 1006.23 1006.24 1006.25 1006.26 1006.27 1006.28 1006.29 1006.30 1006.31 1006.32 1006.33 1006.34 1006.35 1007.1 1007.2 1007.3 1007.4 1007.5 1007.6 1007.7 1007.8 1007.9 1007.10 1007.11 1007.12 1007.13 1007.14 1007.15 1007.16 1007.17 1007.18 1007.19 1007.20 1007.21 1007.22 1007.23 1007.24 1007.25 1007.26 1007.27 1007.28 1007.29 1007.30 1007.31 1007.32 1007.33 1007.34 1007.35 1007.36 1008.1 1008.2 1008.3 1008.4 1008.5 1008.6 1008.7 1008.8 1008.9 1008.10 1008.11 1008.12 1008.13 1008.14
1008.15
1008.16 1008.17 1008.18 1008.19 1008.20 1008.21 1008.22 1008.23
1008.24 1008.25 1008.26 1008.27 1008.28 1008.29 1008.30 1009.1 1009.2 1009.3 1009.4 1009.5 1009.6 1009.7 1009.8 1009.9 1009.10 1009.11 1009.12 1009.13 1009.14 1009.15 1009.16 1009.17 1009.18 1009.19 1009.20 1009.21 1009.22 1009.23 1009.24 1009.25 1009.26 1009.27 1009.28 1009.29 1009.30 1009.31 1009.32 1010.1 1010.2 1010.3 1010.4 1010.5 1010.6 1010.7 1010.8 1010.9 1010.10 1010.11 1010.12 1010.13 1010.14 1010.15 1010.16 1010.17 1010.18 1010.19 1010.20 1010.21 1010.22 1010.23 1010.24 1010.25 1010.26 1010.27 1010.28 1010.29 1010.30 1010.31 1010.32 1010.33 1010.34 1011.1 1011.2 1011.3 1011.4 1011.5 1011.6
1011.7 1011.8 1011.9 1011.10 1011.11 1011.12 1011.13 1011.14 1011.15 1011.16 1011.17 1011.18 1011.19 1011.20 1011.21 1011.22 1011.23 1011.24 1011.25 1011.26 1011.27 1011.28 1011.29 1011.30 1011.31 1011.32 1011.33 1011.34 1012.1 1012.2 1012.3 1012.4 1012.5
1012.6 1012.7 1012.8 1012.9 1012.10 1012.11 1012.12 1012.13 1012.14 1012.15 1012.16 1012.17 1012.18 1012.19 1012.20 1012.21 1012.22 1012.23 1012.24 1012.25 1012.26 1012.27 1012.28 1012.29 1012.30 1012.31 1012.32 1012.33 1013.1 1013.2 1013.3 1013.4
1013.5 1013.6 1013.7 1013.8 1013.9 1013.10 1013.11 1013.12 1013.13 1013.14 1013.15 1013.16 1013.17 1013.18 1013.19 1013.20 1013.21 1013.22 1013.23 1013.24 1013.25 1013.26 1013.27 1013.28 1013.29 1013.30 1013.31 1013.32 1013.33 1013.34 1014.1 1014.2 1014.3
1014.4 1014.5 1014.6 1014.7 1014.8 1014.9 1014.10 1014.11 1014.12 1014.13 1014.14 1014.15 1014.16 1014.17 1014.18 1014.19 1014.20 1014.21 1014.22 1014.23
1014.24 1014.25 1014.26 1014.27 1014.28 1014.29 1014.30 1014.31 1015.1 1015.2 1015.3 1015.4 1015.5 1015.6 1015.7 1015.8 1015.9 1015.10 1015.11 1015.12 1015.13 1015.14 1015.15 1015.16 1015.17 1015.18 1015.19 1015.20 1015.21 1015.22 1015.23 1015.24 1015.25 1015.26 1015.27 1015.28 1015.29 1015.30 1016.1 1016.2 1016.3 1016.4 1016.5 1016.6 1016.7 1016.8 1016.9 1016.10 1016.11 1016.12 1016.13 1016.14 1016.15 1016.16
1016.17 1016.18 1016.19 1016.20 1016.21
1016.22 1016.23 1016.24 1016.25 1016.26 1016.27 1016.28 1016.29 1016.30 1016.31 1017.1 1017.2 1017.3 1017.4 1017.5 1017.6 1017.7 1017.8 1017.9 1017.10 1017.11 1017.12 1017.13 1017.14 1017.15 1017.16 1017.17 1017.18 1017.19 1017.20 1017.21 1017.22 1017.23 1017.24 1017.25 1017.26 1017.27 1017.28 1017.29 1017.30 1017.31 1018.1 1018.2 1018.3 1018.4 1018.5
1018.6 1018.7 1018.8 1018.9 1018.10 1018.11 1018.12 1018.13 1018.14 1018.15 1018.16 1018.17
1018.18 1018.19 1018.20 1018.21 1018.22 1018.23 1018.24 1018.25 1018.26 1018.27 1018.28 1018.29 1018.30 1019.1 1019.2 1019.3
1019.4 1019.5 1019.6 1019.7 1019.8 1019.9 1019.10 1019.11 1019.12 1019.13 1019.14 1019.15 1019.16 1019.17
1019.18 1019.19 1019.20 1019.21 1019.22
1019.23 1019.24 1019.25 1019.26
1020.1 1020.2
1020.3 1020.4 1020.5 1020.6 1020.7 1020.8 1020.9 1020.10 1020.11 1020.12 1020.13
1020.14 1020.15 1020.16 1020.17 1020.18 1020.19 1020.20 1020.21 1020.22 1020.23 1020.24 1020.25 1020.26 1020.27 1020.28 1020.29 1020.30 1020.31 1020.32 1020.33 1021.1 1021.2 1021.3 1021.4 1021.5 1021.6 1021.7 1021.8 1021.9 1021.10 1021.11 1021.12 1021.13 1021.14 1021.15 1021.16 1021.17 1021.18 1021.19 1021.20
1021.21 1021.22 1021.23 1021.24 1021.25 1021.26 1021.27 1021.28 1021.29 1021.30 1021.31 1021.32 1022.1 1022.2 1022.3 1022.4 1022.5 1022.6
1022.7
1022.8 1022.9 1022.10 1022.11 1022.12 1022.13 1022.14 1022.15 1022.16 1022.17 1022.18 1022.19
1022.20 1022.21 1022.22 1022.23 1022.24 1022.25 1022.26
1022.27 1022.28 1022.29 1022.30 1022.31 1023.1 1023.2
1023.3 1023.4 1023.5 1023.6 1023.7 1023.8 1023.9 1023.10 1023.11 1023.12 1023.13 1023.14 1023.15 1023.16 1023.17 1023.18 1023.19 1023.20 1023.21 1023.22 1023.23 1023.24 1023.25 1023.26 1023.27 1023.28 1023.29 1023.30 1023.31
1024.1 1024.2 1024.3 1024.4 1024.5 1024.6 1024.7 1024.8 1024.9
1024.10 1024.11 1024.12 1024.13 1024.14 1024.15 1024.16 1024.17 1024.18 1024.19 1024.20 1024.21
1024.22 1024.23 1024.24 1024.25 1024.26 1024.27 1024.28 1024.29 1024.30 1024.31 1024.32 1025.1 1025.2 1025.3 1025.4 1025.5 1025.6 1025.7 1025.8 1025.9 1025.10 1025.11 1025.12 1025.13 1025.14 1025.15 1025.16 1025.17 1025.18 1025.19 1025.20 1025.21 1025.22 1025.23 1025.24 1025.25 1025.26 1025.27 1025.28 1025.29 1025.30 1025.31 1026.1 1026.2 1026.3 1026.4 1026.5 1026.6 1026.7 1026.8 1026.9 1026.10 1026.11 1026.12 1026.13 1026.14 1026.15 1026.16 1026.17 1026.18 1026.19 1026.20 1026.21 1026.22 1026.23 1026.24 1026.25 1026.26 1026.27 1026.28 1026.29 1026.30 1026.31 1026.32 1027.1 1027.2 1027.3
1027.4 1027.5 1027.6 1027.7 1027.8 1027.9 1027.10 1027.11 1027.12 1027.13 1027.14 1027.15 1027.16 1027.17 1027.18 1027.19 1027.20 1027.21 1027.22 1027.23 1027.24 1027.25 1027.26 1027.27 1027.28 1027.29 1027.30 1027.31 1027.32 1027.33 1028.1 1028.2 1028.3 1028.4 1028.5 1028.6
1028.7 1028.8
1028.9 1028.10 1028.11 1028.12 1028.13 1028.14 1028.15 1028.16 1028.17 1028.18 1028.19
1028.20 1028.21 1028.22 1028.23 1028.24 1028.25 1028.26 1028.27 1028.28 1028.29 1028.30 1028.31 1028.32 1028.33 1028.34 1028.35 1029.1 1029.2 1029.3 1029.4 1029.5 1029.6 1029.7 1029.8 1029.9 1029.10 1029.11 1029.12 1029.13 1029.14 1029.15 1029.16 1029.17 1029.18
1029.19 1029.20
1029.21 1029.22
1029.23 1029.24 1029.25 1029.26 1029.27 1029.28 1029.29 1029.30 1030.1 1030.2 1030.3 1030.4
1030.5 1030.6 1030.7 1030.8 1030.9 1030.10 1030.11 1030.12 1030.13 1030.14 1030.15 1030.16 1030.17 1030.18 1030.19 1030.20 1030.21 1030.22 1030.23 1030.24 1030.25 1030.26 1030.27 1030.28 1030.29 1030.30 1030.31 1031.1 1031.2 1031.3 1031.4 1031.5 1031.6 1031.7 1031.8 1031.9 1031.10 1031.11 1031.12 1031.13 1031.14 1031.15 1031.16 1031.17 1031.18 1031.19 1031.20 1031.21 1031.22 1031.23 1031.24 1031.25 1031.26 1031.27 1031.28 1031.29 1031.30 1031.31 1031.32 1031.33 1032.1 1032.2 1032.3 1032.4 1032.5 1032.6 1032.7 1032.8 1032.9 1032.10 1032.11 1032.12 1032.13 1032.14 1032.15 1032.16 1032.17 1032.18 1032.19 1032.20 1032.21 1032.22 1032.23 1032.24 1032.25 1032.26 1032.27 1032.28 1032.29 1032.30 1032.31 1032.32 1032.33 1032.34 1033.1 1033.2 1033.3 1033.4 1033.5 1033.6 1033.7 1033.8 1033.9 1033.10 1033.11 1033.12 1033.13 1033.14 1033.15 1033.16 1033.17 1033.18 1033.19 1033.20 1033.21 1033.22 1033.23 1033.24 1033.25 1033.26 1033.27 1033.28 1033.29 1033.30 1033.31 1033.32 1033.33 1033.34 1033.35 1034.1 1034.2 1034.3 1034.4 1034.5 1034.6 1034.7 1034.8 1034.9 1034.10 1034.11 1034.12 1034.13 1034.14 1034.15 1034.16 1034.17 1034.18 1034.19 1034.20 1034.21 1034.22 1034.23 1034.24 1034.25 1034.26 1034.27 1034.28 1034.29 1034.30 1034.31 1034.32 1034.33 1034.34 1035.1 1035.2 1035.3 1035.4 1035.5 1035.6 1035.7 1035.8 1035.9 1035.10 1035.11 1035.12 1035.13 1035.14 1035.15 1035.16 1035.17 1035.18 1035.19 1035.20 1035.21 1035.22 1035.23 1035.24 1035.25 1035.26 1035.27 1035.28 1035.29 1035.30 1035.31 1035.32 1035.33 1035.34 1036.1 1036.2 1036.3 1036.4 1036.5 1036.6 1036.7 1036.8 1036.9 1036.10 1036.11 1036.12 1036.13 1036.14 1036.15 1036.16 1036.17 1036.18 1036.19 1036.20 1036.21 1036.22 1036.23 1036.24 1036.25 1036.26 1036.27 1036.28 1036.29 1036.30 1036.31 1036.32 1036.33 1036.34 1036.35 1037.1 1037.2 1037.3 1037.4 1037.5 1037.6 1037.7 1037.8 1037.9 1037.10 1037.11 1037.12 1037.13 1037.14 1037.15 1037.16 1037.17 1037.18 1037.19 1037.20 1037.21 1037.22 1037.23 1037.24 1037.25 1037.26 1037.27 1037.28 1037.29 1037.30 1037.31 1037.32 1037.33 1037.34 1037.35 1038.1 1038.2 1038.3 1038.4 1038.5 1038.6 1038.7 1038.8 1038.9 1038.10 1038.11 1038.12 1038.13 1038.14 1038.15 1038.16 1038.17 1038.18 1038.19 1038.20 1038.21 1038.22 1038.23 1038.24 1038.25 1038.26 1038.27 1038.28 1038.29 1038.30 1038.31 1038.32 1038.33 1038.34 1039.1 1039.2 1039.3 1039.4 1039.5 1039.6 1039.7 1039.8 1039.9 1039.10 1039.11 1039.12 1039.13 1039.14 1039.15 1039.16 1039.17 1039.18 1039.19 1039.20 1039.21 1039.22 1039.23 1039.24 1039.25 1039.26 1039.27 1039.28 1039.29 1039.30 1039.31 1039.32 1039.33 1039.34 1039.35 1040.1 1040.2 1040.3 1040.4 1040.5 1040.6 1040.7 1040.8 1040.9 1040.10 1040.11 1040.12 1040.13 1040.14 1040.15 1040.16 1040.17 1040.18 1040.19 1040.20 1040.21 1040.22 1040.23 1040.24 1040.25 1040.26 1040.27 1040.28 1040.29 1040.30 1040.31 1040.32 1040.33 1041.1 1041.2 1041.3 1041.4 1041.5 1041.6 1041.7 1041.8 1041.9 1041.10 1041.11 1041.12 1041.13 1041.14 1041.15 1041.16 1041.17 1041.18 1041.19 1041.20 1041.21 1041.22 1041.23 1041.24 1041.25 1041.26 1041.27 1041.28 1041.29 1041.30 1041.31 1041.32 1041.33 1041.34 1042.1 1042.2 1042.3 1042.4 1042.5 1042.6 1042.7 1042.8 1042.9 1042.10 1042.11 1042.12 1042.13 1042.14 1042.15 1042.16 1042.17 1042.18 1042.19 1042.20 1042.21 1042.22 1042.23 1042.24 1042.25 1042.26 1042.27 1042.28 1042.29 1042.30 1042.31 1042.32 1042.33 1042.34 1043.1 1043.2 1043.3 1043.4 1043.5 1043.6 1043.7 1043.8 1043.9 1043.10 1043.11 1043.12 1043.13 1043.14 1043.15 1043.16 1043.17 1043.18 1043.19 1043.20 1043.21 1043.22 1043.23 1043.24 1043.25 1043.26 1043.27 1043.28 1043.29 1043.30 1043.31 1043.32 1043.33 1043.34 1044.1 1044.2 1044.3 1044.4 1044.5 1044.6 1044.7 1044.8 1044.9 1044.10 1044.11 1044.12 1044.13 1044.14 1044.15 1044.16 1044.17 1044.18 1044.19 1044.20 1044.21 1044.22 1044.23 1044.24 1044.25 1044.26 1044.27 1044.28 1044.29 1044.30 1044.31 1044.32 1044.33 1044.34 1045.1 1045.2 1045.3 1045.4 1045.5 1045.6 1045.7 1045.8 1045.9 1045.10 1045.11 1045.12 1045.13 1045.14 1045.15 1045.16 1045.17 1045.18 1045.19 1045.20 1045.21 1045.22 1045.23 1045.24 1045.25 1045.26 1045.27 1045.28 1045.29 1045.30 1045.31 1045.32 1045.33 1045.34 1045.35 1046.1 1046.2 1046.3 1046.4 1046.5 1046.6 1046.7 1046.8 1046.9 1046.10 1046.11 1046.12 1046.13 1046.14 1046.15 1046.16 1046.17 1046.18 1046.19 1046.20 1046.21 1046.22 1046.23 1046.24 1046.25 1046.26 1046.27 1046.28 1046.29 1046.30 1046.31 1046.32 1046.33 1046.34 1046.35 1047.1 1047.2 1047.3 1047.4 1047.5 1047.6 1047.7 1047.8 1047.9 1047.10 1047.11 1047.12 1047.13 1047.14 1047.15 1047.16 1047.17 1047.18 1047.19 1047.20 1047.21 1047.22 1047.23 1047.24 1047.25 1047.26 1047.27 1047.28 1047.29 1047.30 1047.31 1047.32 1047.33 1047.34 1048.1 1048.2 1048.3 1048.4 1048.5 1048.6 1048.7 1048.8 1048.9 1048.10 1048.11 1048.12 1048.13 1048.14 1048.15 1048.16 1048.17 1048.18 1048.19 1048.20 1048.21 1048.22 1048.23 1048.24 1048.25 1048.26 1048.27 1048.28 1048.29 1048.30 1048.31 1048.32 1048.33 1048.34 1048.35 1048.36 1049.1 1049.2 1049.3 1049.4 1049.5 1049.6 1049.7 1049.8 1049.9 1049.10 1049.11 1049.12 1049.13 1049.14 1049.15 1049.16 1049.17 1049.18 1049.19 1049.20 1049.21 1049.22 1049.23 1049.24 1049.25 1049.26 1049.27 1049.28 1049.29 1049.30 1049.31 1049.32 1049.33 1049.34 1050.1 1050.2 1050.3 1050.4 1050.5 1050.6 1050.7 1050.8 1050.9 1050.10 1050.11 1050.12 1050.13 1050.14 1050.15 1050.16 1050.17 1050.18 1050.19 1050.20 1050.21 1050.22 1050.23 1050.24 1050.25 1050.26 1050.27 1050.28 1050.29 1050.30 1050.31 1050.32 1050.33 1050.34 1051.1 1051.2 1051.3 1051.4 1051.5 1051.6 1051.7 1051.8 1051.9 1051.10 1051.11 1051.12 1051.13 1051.14 1051.15 1051.16 1051.17 1051.18 1051.19 1051.20 1051.21 1051.22 1051.23 1051.24 1051.25 1051.26 1051.27 1051.28 1051.29 1051.30 1051.31 1051.32 1051.33 1052.1 1052.2 1052.3 1052.4 1052.5 1052.6 1052.7 1052.8 1052.9 1052.10 1052.11 1052.12 1052.13 1052.14 1052.15 1052.16 1052.17 1052.18 1052.19 1052.20 1052.21 1052.22 1052.23 1052.24 1052.25 1052.26 1052.27 1052.28 1052.29 1052.30 1052.31 1052.32 1052.33 1052.34 1053.1 1053.2 1053.3 1053.4 1053.5 1053.6 1053.7 1053.8 1053.9 1053.10 1053.11 1053.12 1053.13 1053.14 1053.15 1053.16 1053.17 1053.18 1053.19 1053.20 1053.21 1053.22 1053.23 1053.24 1053.25 1053.26 1053.27 1053.28 1053.29 1053.30 1053.31 1053.32 1053.33 1053.34 1053.35 1054.1 1054.2 1054.3 1054.4 1054.5 1054.6 1054.7 1054.8 1054.9 1054.10 1054.11 1054.12 1054.13 1054.14 1054.15 1054.16 1054.17 1054.18 1054.19 1054.20 1054.21 1054.22 1054.23 1054.24 1054.25 1054.26 1054.27 1054.28 1054.29 1054.30 1054.31 1054.32 1054.33 1054.34 1054.35 1055.1 1055.2 1055.3 1055.4 1055.5 1055.6 1055.7 1055.8 1055.9 1055.10 1055.11 1055.12 1055.13 1055.14 1055.15 1055.16 1055.17 1055.18 1055.19 1055.20 1055.21 1055.22 1055.23 1055.24 1055.25 1055.26 1055.27 1055.28 1055.29 1055.30 1055.31 1055.32 1056.1 1056.2 1056.3 1056.4 1056.5 1056.6 1056.7 1056.8 1056.9 1056.10 1056.11 1056.12 1056.13 1056.14 1056.15 1056.16 1056.17 1056.18 1056.19 1056.20 1056.21 1056.22 1056.23 1056.24 1056.25 1056.26 1056.27 1056.28 1056.29
1056.30 1056.31 1056.32 1056.33 1057.1 1057.2 1057.3 1057.4 1057.5 1057.6 1057.7 1057.8 1057.9 1057.10 1057.11 1057.12 1057.13 1057.14 1057.15 1057.16 1057.17 1057.18 1057.19 1057.20 1057.21 1057.22 1057.23 1057.24 1057.25 1057.26 1057.27 1057.28 1057.29 1057.30 1057.31 1057.32 1057.33 1057.34 1057.35 1058.1 1058.2 1058.3 1058.4 1058.5 1058.6 1058.7 1058.8 1058.9 1058.10 1058.11 1058.12 1058.13 1058.14 1058.15 1058.16 1058.17 1058.18 1058.19 1058.20 1058.21 1058.22 1058.23 1058.24 1058.25 1058.26 1058.27 1058.28 1058.29 1058.30 1058.31 1058.32 1058.33 1058.34 1059.1 1059.2 1059.3 1059.4 1059.5 1059.6 1059.7 1059.8 1059.9 1059.10 1059.11 1059.12 1059.13 1059.14 1059.15 1059.16 1059.17 1059.18 1059.19 1059.20 1059.21 1059.22 1059.23 1059.24 1059.25 1059.26 1059.27 1059.28 1059.29 1059.30 1059.31 1059.32 1059.33 1059.34 1060.1 1060.2 1060.3 1060.4 1060.5 1060.6 1060.7 1060.8 1060.9 1060.10 1060.11 1060.12 1060.13 1060.14 1060.15 1060.16 1060.17 1060.18 1060.19 1060.20 1060.21 1060.22 1060.23 1060.24 1060.25 1060.26 1060.27 1060.28 1060.29 1060.30 1060.31 1060.32 1060.33 1060.34 1060.35 1061.1 1061.2 1061.3 1061.4 1061.5 1061.6 1061.7 1061.8 1061.9 1061.10 1061.11 1061.12 1061.13 1061.14 1061.15 1061.16 1061.17 1061.18 1061.19 1061.20 1061.21 1061.22 1061.23 1061.24 1061.25 1061.26 1061.27 1061.28 1061.29 1061.30 1061.31 1061.32 1061.33 1061.34 1062.1 1062.2 1062.3 1062.4 1062.5 1062.6 1062.7 1062.8 1062.9 1062.10 1062.11 1062.12 1062.13 1062.14 1062.15 1062.16 1062.17 1062.18 1062.19 1062.20 1062.21 1062.22 1062.23 1062.24 1062.25 1062.26 1062.27 1062.28 1062.29 1062.30 1062.31 1062.32 1062.33 1062.34 1062.35 1063.1 1063.2 1063.3 1063.4 1063.5 1063.6 1063.7 1063.8 1063.9 1063.10 1063.11 1063.12 1063.13 1063.14 1063.15 1063.16 1063.17 1063.18 1063.19 1063.20 1063.21 1063.22 1063.23 1063.24 1063.25 1063.26 1063.27 1063.28 1063.29 1063.30 1063.31 1063.32 1063.33 1063.34 1063.35 1064.1 1064.2 1064.3 1064.4 1064.5 1064.6 1064.7 1064.8 1064.9 1064.10 1064.11 1064.12 1064.13 1064.14 1064.15 1064.16 1064.17 1064.18 1064.19 1064.20 1064.21 1064.22 1064.23 1064.24 1064.25 1064.26 1064.27 1064.28 1064.29 1064.30 1064.31 1064.32
1064.33 1064.34 1065.1 1065.2 1065.3 1065.4 1065.5 1065.6 1065.7 1065.8 1065.9 1065.10 1065.11 1065.12 1065.13 1065.14 1065.15 1065.16 1065.17 1065.18 1065.19 1065.20 1065.21 1065.22 1065.23 1065.24 1065.25 1065.26 1065.27 1065.28 1065.29 1065.30 1065.31 1065.32 1066.1 1066.2 1066.3 1066.4 1066.5 1066.6 1066.7 1066.8 1066.9 1066.10 1066.11 1066.12 1066.13 1066.14 1066.15 1066.16 1066.17 1066.18 1066.19 1066.20 1066.21 1066.22 1066.23 1066.24 1066.25 1066.26 1066.27 1066.28 1066.29 1066.30 1066.31 1066.32 1066.33 1066.34 1066.35 1067.1 1067.2 1067.3 1067.4 1067.5 1067.6 1067.7 1067.8 1067.9 1067.10 1067.11 1067.12 1067.13 1067.14 1067.15 1067.16 1067.17 1067.18 1067.19 1067.20 1067.21 1067.22 1067.23 1067.24 1067.25 1067.26
1067.27 1067.28 1067.29 1067.30 1067.31 1067.32 1067.33 1068.1 1068.2 1068.3 1068.4 1068.5 1068.6 1068.7 1068.8 1068.9 1068.10 1068.11 1068.12 1068.13 1068.14 1068.15 1068.16 1068.17 1068.18 1068.19 1068.20 1068.21 1068.22 1068.23 1068.24 1068.25 1068.26 1068.27 1068.28
1068.29
1068.30 1068.31 1068.32 1068.33 1068.34 1069.1 1069.2 1069.3
1069.4
1069.5 1069.6 1069.7 1069.8 1069.9 1069.10 1069.11 1069.12 1069.13 1069.14 1069.15 1069.16 1069.17 1069.18 1069.19
1069.20 1069.21 1069.22 1069.23 1069.24 1069.25 1069.26 1069.27 1069.28 1069.29 1069.30 1069.31 1069.32 1069.33 1070.1 1070.2
1070.3 1070.4 1070.5 1070.6 1070.7
1070.8 1070.9 1070.10 1070.11 1070.12 1070.13
1070.14 1070.15 1070.16 1070.17 1070.18 1070.19 1070.20 1070.21 1070.22 1070.23 1070.24 1070.25 1070.26 1070.27 1070.28 1070.29 1070.30 1070.31 1070.32
1071.1 1071.2 1071.3
1071.4 1071.5 1071.6
1071.7 1071.8
A bill for an act
relating to state government; establishing the health and human services budget;
modifying provisions governing children and families, operations, direct care and
treatment, continuing care for older adults, disability services, chemical and mental
health, mental health uniform service standards, health care, prescription drugs,
health-related licensing boards, Department of Health programs, health coverage,
resident rights and consumer protections, independent senior living facilities,
dementia care services for assisted living facilities with dementia care, assisted
living licensure conforming changes, third-party logistics providers and wholesale
distributors, and prescription drug pricing; establishing OneCare Buy-In;
establishing pharmacy benefit manager licensure; establishing prescription drug
repository program; establishing insulin assistance program; establishing OneCare
Buy-In reserve account; establishing assisted living licensure; requiring reports;
making technical changes; modifying civil and criminal penalties; providing for
rulemaking; modifying fees; making forecast adjustments; appropriating money;
amending Minnesota Statutes 2018, sections 8.31, subdivision 1; 13.46, subdivisions
2, 3; 13.461, subdivision 28; 13.69, subdivision 1; 13.851, by adding a subdivision;
15C.02; 16A.151, subdivision 2; 16A.724, subdivision 2; 18K.02, subdivision 3;
18K.03; 62A.021, by adding subdivisions; 62A.152, subdivision 3; 62A.25,
subdivision 2; 62A.28, subdivision 2; 62A.30, by adding a subdivision; 62A.3094,
subdivision 1; 62A.65, subdivision 7; 62A.671, subdivision 6; 62D.02, subdivision
4; 62D.03, subdivision 1; 62D.05, subdivision 1; 62D.06, subdivision 1; 62D.12,
by adding a subdivision; 62D.124, subdivisions 1, 2, 3, by adding subdivisions;
62D.17, subdivision 1; 62D.19; 62D.30, subdivision 8; 62E.02, subdivision 3;
62E.23, subdivision 4; 62J.23, subdivision 2; 62J.497, subdivision 1; 62K.075;
62K.10, subdivisions 2, 3, 4, 5; 62Q.01, by adding a subdivision; 62Q.184,
subdivisions 1, 3; 62Q.47; 62Q.81; 103I.005, subdivisions 2, 8a, 17a; 103I.205,
subdivisions 1, 4, 9; 103I.208, subdivision 1; 103I.235, subdivision 3; 103I.301,
subdivision 6, by adding a subdivision; 103I.601, subdivision 4; 119B.011,
subdivisions 19, 20, by adding a subdivision; 119B.02, subdivisions 3, 6, 7;
119B.025, subdivision 1, by adding a subdivision; 119B.03, subdivision 9; 119B.05,
subdivision 1; 119B.09, subdivisions 1, 7; 119B.095, subdivision 2, by adding a
subdivision; 119B.125, subdivision 6; 119B.13, subdivisions 1, 6, 7; 119B.16,
subdivisions 1, 1a, 1b, by adding subdivisions; 124D.142; 124D.165, subdivision
4; 125A.515, subdivisions 1, 3, 4, 5, 7, 8; 144.051, subdivisions 4, 5, 6; 144.057,
subdivisions 1, 3; 144.0724, subdivisions 4, 5, 8; 144.121, subdivision 1a, by
adding a subdivision; 144.122; 144.225, subdivisions 2, 2a, 7; 144.3831, subdivision
1; 144.412; 144.413, subdivisions 1, 4; 144.414, subdivisions 2, 3; 144.416;
144.4165; 144.4167, subdivision 4; 144.417, subdivision 4; 144.562, subdivision
2; 144.966, subdivision 2; 144.99, subdivision 1; 144A.04, subdivision 5; 144A.071,
subdivisions 1a, 2, 3, 4a, 4c, 5a; 144A.073, subdivision 3c; 144A.20, subdivision
1; 144A.24; 144A.26; 144A.43, subdivisions 11, 30, by adding a subdivision;
144A.44, subdivision 1; 144A.471, subdivisions 7, 9; 144A.472, subdivisions 5,
7; 144A.473; 144A.474, subdivisions 2, 9, 11; 144A.475, subdivisions 1, 2, 3b,
5; 144A.476, subdivision 1; 144A.479, subdivision 7; 144A.4791, subdivisions
1, 3, 6, 7, 8, 9, 10; 144A.4792, subdivisions 1, 2, 5, 10; 144A.4793, subdivision
6; 144A.4796, subdivision 2; 144A.4797, subdivision 3; 144A.4798; 144A.4799;
144A.484, subdivision 1; 145.4235, subdivisions 2, 3, 4, by adding a subdivision;
145.928, subdivisions 1, 7; 147.37; 147D.27, by adding a subdivision; 147E.40,
subdivision 1; 147F.17, subdivision 1; 148.59; 148.6445, subdivisions 1, 2, 2a, 3,
4, 5, 6, 10; 148.7815, subdivision 1; 148B.5301, subdivision 2; 148E.0555,
subdivision 6; 148E.120, subdivision 2; 148E.180; 148F.11, subdivision 1;
150A.06, by adding subdivisions; 150A.091, by adding subdivisions; 151.01,
subdivisions 23, 31, 35, by adding a subdivision; 151.06, by adding a subdivision;
151.065, subdivisions 1, 2, 3, 6; 151.071, subdivisions 1, 2; 151.15, subdivision
1, by adding subdivisions; 151.19, subdivisions 1, 3; 151.21, subdivision 7, by
adding a subdivision; 151.211, subdivision 2, by adding a subdivision; 151.252,
subdivisions 1, 1a, 3; 151.253, by adding a subdivision; 151.32; 151.40,
subdivisions 1, 2; 151.43; 151.46; 151.47, subdivision 1, by adding a subdivision;
152.01, subdivision 23; 152.02, subdivisions 2, 3; 152.11, by adding a subdivision;
152.12, by adding a subdivision; 152.125, subdivision 3; 152.126, subdivisions 1,
6, 7, by adding a subdivision; 152.22, subdivisions 6, 11, 13, 14, by adding
subdivisions; 152.25, subdivisions 1, 1a, 1c, 4; 152.27, subdivisions 2, 3, 4, 5, 6;
152.28, subdivision 1; 152.29, subdivisions 1, 2, 3; 152.31; 152.32, subdivision
2; 152.33, subdivisions 1, 2; 152.34; 152.36, subdivision 2; 171.171; 214.25,
subdivision 2; 237.50, subdivisions 4a, 6a, 10a, 11, by adding subdivisions; 237.51,
subdivisions 1, 5a; 237.52, subdivision 5; 237.53; 245.095; 245.462, subdivisions
6, 8, 9, 14, 17, 18, 21, 23, by adding a subdivision; 245.4661, subdivision 9;
245.467, subdivisions 2, 3; 245.469, subdivisions 1, 2; 245.470, subdivision 1;
245.4712, subdivision 2; 245.472, subdivision 2; 245.4863; 245.4871, subdivisions
9a, 10, 11a, 17, 21, 26, 27, 29, 32, 34; 245.4876, subdivisions 2, 3; 245.4879,
subdivisions 1, 2; 245.488, subdivision 1; 245.4889, subdivision 1; 245.696, by
adding a subdivision; 245.735, subdivision 3; 245A.02, subdivisions 3, 5a, 8, 9,
12, 14, 18, by adding subdivisions; 245A.03, subdivisions 1, 3; 245A.04,
subdivisions 1, 2, 4, 6, 7, 10, by adding subdivisions; 245A.05; 245A.07,
subdivisions 1, 2, 2a, 3; 245A.10, subdivision 4; 245A.14, subdivisions 4, 8, by
adding subdivisions; 245A.145, subdivisions 1, 2; 245A.151; 245A.16, subdivision
1, by adding a subdivision; 245A.18, subdivision 2; 245A.40; 245A.41; 245A.50;
245A.51, subdivision 3, by adding subdivisions; 245A.66, subdivisions 2, 3;
245C.02, subdivision 6a, by adding subdivisions; 245C.03, subdivision 1, by
adding a subdivision; 245C.05, subdivisions 2c, 2d, 4, 5, 5a; 245C.08, subdivisions
1, 3; 245C.10, by adding a subdivision; 245C.13, subdivision 2, by adding a
subdivision; 245C.14, subdivision 1; 245C.15, subdivisions 2, 3, 4, by adding a
subdivision; 245C.22, subdivisions 4, 5; 245C.24; 245C.30, subdivisions 1, 2, 3;
245C.32, subdivision 2; 245D.03, subdivision 1; 245D.071, subdivision 1;
245D.081, subdivision 3; 245E.01, subdivision 8; 245E.02, by adding a subdivision;
245F.05, subdivision 2; 245H.01, by adding subdivisions; 245H.03, by adding a
subdivision; 245H.07; 245H.10, subdivision 1; 245H.11; 245H.12; 245H.13,
subdivision 5, by adding subdivisions; 245H.14, subdivisions 1, 3, 4, 5, 6; 245H.15,
subdivision 1; 246.54, by adding a subdivision; 246B.10; 252.27, subdivision 2a;
252.275, subdivision 3; 252.28, subdivision 1; 252.41, subdivisions 3, 4, 5, 6, 7,
9; 252.42; 252.43; 252.44; 252.45; 254A.03, subdivision 3; 254B.02, subdivision
1; 254B.03, subdivisions 2, 4; 254B.04, subdivision 1; 254B.05, subdivisions 1a,
5; 254B.06, subdivisions 1, 2; 256.01, subdivision 14b; 256.046, subdivision 1,
by adding a subdivision; 256.478; 256.9365; 256.962, subdivision 5; 256.969,
subdivisions 2b, 3a, 9, 17, 19; 256.98, subdivision 8; 256B.02, subdivision 7;
256B.04, subdivisions 14, 21, 22; 256B.055, subdivision 2; 256B.056, subdivisions
3, 5c; 256B.0615, subdivision 1; 256B.0616, subdivisions 1, 3; 256B.0622,
subdivisions 1, 2, 3a, 4, 5a, 7, 7a, 7b, 7d; 256B.0623, subdivisions 1, 2, 3, 4, 5, 6,
7, 8, 10, 11, 12; 256B.0624, subdivisions 2, 4, 5, 6, 7, 8, 9, 11; 256B.0625,
subdivisions 3b, 5, 5l, 9, 13, 13d, 13e, 13f, 17, 19c, 23, 24, 30, 31, 42, 45a, 48,
49, 56a, 57, 61, 62, 65, by adding subdivisions; 256B.064, subdivisions 1a, 1b, 2,
by adding subdivisions; 256B.0644; 256B.0651, subdivision 17; 256B.0658;
256B.0659, subdivisions 11, 12, 21, 24, 28, by adding a subdivision; 256B.0757,
subdivisions 2, 4, 8, by adding subdivisions; 256B.0915, subdivisions 3a, 3b;
256B.092, subdivision 13; 256B.0941, subdivisions 1, 3; 256B.0943, subdivisions
1, 2, 3, 4, 5, 6, 7, 8, 9, 11; 256B.0944, subdivisions 1, 3, 4, 5, 6, 7, 8, 9; 256B.0946,
subdivisions 1, 1a, 2, 3, 4, 6; 256B.0947, subdivisions 1, 2, 3, 3a, 5, 6, 7a;
256B.0949, subdivisions 2, 4, 5a, by adding a subdivision; 256B.27, subdivision
3; 256B.434, subdivisions 1, 3; 256B.49, subdivision 24; 256B.4912, by adding
subdivisions; 256B.4913, subdivisions 4a, 5; 256B.4914, subdivisions 2, 4, 5, 6,
7, 8, 9, 10, 10a, 14, 15, by adding a subdivision; 256B.69, subdivisions 6, 6d, 35,
by adding subdivisions; 256B.76, subdivisions 2, 4; 256B.766; 256B.79,
subdivisions 2, 3, 4, 5, 6; 256B.85, subdivisions 3, 10, 11, 12, 16, by adding a
subdivision; 256I.03, subdivision 15; 256I.04, subdivisions 1, 2a, 2f; 256I.05,
subdivision 1c; 256I.06, subdivision 8; 256J.24, subdivision 5; 256L.03, by adding
a subdivision; 256L.07, subdivision 2, by adding a subdivision; 256L.11,
subdivisions 2, 7; 256L.121, subdivision 3; 256M.41, subdivision 3, by adding a
subdivision; 256R.02, subdivisions 8, 19, by adding subdivisions; 256R.08,
subdivision 1; 256R.10, by adding a subdivision; 256R.16, subdivision 1; 256R.21,
by adding a subdivision; 256R.23, subdivision 5; 256R.24; 256R.25; 256R.26;
256R.44; 256R.47; 256R.50, subdivision 6; 260C.007, subdivision 18, by adding
a subdivision; 260C.178, subdivision 1; 260C.201, subdivisions 1, 2, 6; 260C.212,
subdivision 2; 260C.452, subdivision 4; 260C.503, subdivision 1; 270B.12, by
adding a subdivision; 290.0131, by adding a subdivision; 295.51, subdivision 1a;
295.52, subdivision 8; 295.57, subdivision 3; 295.582, subdivision 1; 297I.05,
subdivision 5; 317A.811, by adding a subdivision; 325F.69, by adding a
subdivision; 325F.72, subdivisions 1, 2, 4; 461.12, subdivisions 2, 3, 4, 5, 6, 8;
461.18; 518A.32, subdivision 3; 609.685; 609.6855; 626.556, subdivision 10;
626.5561, subdivision 1; 626.5572, subdivision 6; 628.26; 641.15, subdivision 3a;
Laws 2003, First Special Session chapter 14, article 13C, section 2, subdivision
6, as amended; Laws 2017, First Special Session chapter 6, article 1, section 45;
article 3, section 49; article 5, section 11; article 8, sections 71; 72; proposing
coding for new law in Minnesota Statutes, chapters 10; 62A; 62C; 62D; 62K; 62Q;
62V; 119B; 137; 144; 144A; 144G; 145; 148; 151; 214; 245; 245A; 245D; 256;
256B; 256L; 256M; 256R; 260C; 290; 461; 609; proposing coding for new law
as Minnesota Statutes, chapters 62W; 144I; 144J; 144K; 245I; 256T; 317B;
repealing Minnesota Statutes 2018, sections 62A.021, subdivisions 1, 3; 119B.125,
subdivision 8; 119B.16, subdivision 2; 144.414, subdivision 5; 144A.071,
subdivision 4d; 144A.441; 144A.442; 144A.45, subdivision 6; 144A.472,
subdivision 4; 144A.481; 144D.01; 144D.015; 144D.02; 144D.025; 144D.03;
144D.04; 144D.045; 144D.05; 144D.06; 144D.065; 144D.066; 144D.07; 144D.08;
144D.09; 144D.10; 144D.11; 144G.01; 144G.02; 144G.03; 144G.04; 144G.05;
144G.06; 151.214, subdivision 2; 151.42; 151.44; 151.49; 151.50; 151.51; 151.55;
151.60; 151.61; 151.62; 151.63; 151.64; 151.65; 151.66; 151.67; 151.68; 151.69;
151.70; 151.71; 214.17; 214.18; 214.19; 214.20; 214.21; 214.22; 214.23; 214.24;
245.462, subdivision 4a; 245E.06, subdivisions 2, 4, 5; 245H.10, subdivision 2;
246.18, subdivisions 8, 9; 252.41, subdivision 8; 252.431; 252.451; 254B.03,
subdivision 4a; 256B.0615, subdivisions 2, 4, 5; 256B.0616, subdivisions 2, 4, 5;
256B.0624, subdivision 10; 256B.0625, subdivision 63; 256B.0659, subdivision
22; 256B.0705; 256B.0943, subdivision 10; 256B.0944, subdivision 10; 256B.0946,
subdivision 5; 256B.0947, subdivision 9; 256B.431, subdivisions 3a, 3f, 3g, 3i,
10, 13, 15, 16, 17, 17a, 17c, 17d, 17e, 18, 21, 22, 30, 45; 256B.434, subdivisions
4, 4f, 4i, 4j, 6, 10; 256B.4913, subdivisions 4a, 6, 7; 256B.79, subdivision 7;
256L.11, subdivisions 2a, 6a; 256R.36; 256R.40; 256R.41; Laws 2010, First
Special Session chapter 1, article 25, section 3, subdivision 10; Laws 2011, First
Special Session chapter 9, article 6, section 97, subdivision 6; Minnesota Rules,
parts 2960.3030, subpart 3; 3400.0185, subpart 5; 6400.6970; 7200.6100;
7200.6105; 9502.0425, subparts 4, 16, 17; 9503.0155, subpart 8; 9505.0370;
9505.0371; 9505.0372; 9520.0010; 9520.0020; 9520.0030; 9520.0040; 9520.0050;
9520.0060; 9520.0070; 9520.0080; 9520.0090; 9520.0100; 9520.0110; 9520.0120;
9520.0130; 9520.0140; 9520.0150; 9520.0160; 9520.0170; 9520.0180; 9520.0190;
9520.0200; 9520.0210; 9520.0230; 9549.0057; 9549.0060, subparts 4, 5, 6, 7, 10,
11, 14.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
ARTICLE 1
CHILDREN AND FAMILIES
Section 1.
Minnesota Statutes 2018, section 119B.011, is amended by adding a subdivision
to read:
new text begin Subd. 13b. new text end
new text begin Homeless. new text end
new text begin
"Homeless" means a self-declared housing status as defined in
the McKinney-Vento Homeless Assistance Act and United States Code, title 42, section
11302, paragraph (a).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 21, 2020.
new text end
Sec. 2.
Minnesota Statutes 2018, section 119B.011, subdivision 19, is amended to read:
Subd. 19.
Provider.
"Provider" means:
(1) an individual or child care center or facilitydeleted text begin , either licensed or unlicensed, providing
legal child care services as defineddeleted text end new text begin licensed to provide child carenew text end under deleted text begin section 245A.03deleted text end new text begin
chapter 245A when operating within the terms of the licensenew text end ; deleted text begin or
deleted text end
(2)new text begin a license exempt center required to be certified under chapter 245H;
new text end
new text begin (3)new text end an individual or child care center or facility deleted text begin holdingdeleted text end new text begin that: (i) holds new text end a valid child care
license issued by another state or a tribe deleted text begin and providingdeleted text end new text begin ; (ii) providesnew text end child care services in
the licensing state or in the area under the licensing tribe's jurisdictionnew text begin ; and (iii) is in
compliance with federal health and safety requirements as certified by the licensing state
or tribe, or as determined by receipt of child care development block grant funds in the
licensing state; or
new text end
new text begin (4) a legal nonlicensed child care provider as defined under section 119B.011, subdivision
16, providing legal child care servicesnew text end . A deleted text begin legally unlicensed familydeleted text end new text begin legal nonlicensed new text end child
care provider must be at least 18 years of age, and not a member of the MFIP assistance
unit or a member of the family receiving child care assistance to be authorized under this
chapter.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 3.
Minnesota Statutes 2018, section 119B.011, subdivision 20, is amended to read:
Subd. 20.
Transition year families.
"Transition year families" means families who have
received MFIP assistance, or who were eligible to receive MFIP assistance after choosing
to discontinue receipt of the cash portion of MFIP assistance under section 256J.31,
subdivision 12, or families who have received DWP assistance under section 256J.95 for
at least deleted text begin threedeleted text end new text begin onenew text end of the last six months before losing eligibility for MFIP or DWP.
Notwithstanding Minnesota Rules, parts 3400.0040, subpart 10, and 3400.0090, subpart 2,
transition year child care may be used to support employment, approved education or training
programs, or job search that meets the requirements of section 119B.10. Transition year
child care is not available to families who have been disqualified from MFIP or DWP due
to fraud.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 23, 2020.
new text end
Sec. 4.
Minnesota Statutes 2018, section 119B.02, subdivision 3, is amended to read:
Subd. 3.
Supervision of countiesnew text begin and providersnew text end .
new text begin (a) new text end The commissioner shall supervise
child care programs administered by the counties through standard-setting, technical
assistance to the counties, approval of county child care fund plans, and distribution of
public money for services. The commissioner shall provide training and other support
services to assist counties in planning for and implementing child care assistance programs.
The commissioner shall adopt rules under chapter 14 that establish minimum administrative
standards for the provision of child care services by county boards of commissioners.
new text begin
(b) The commissioner shall:
new text end
new text begin
(1) provide technical assistance and training to child care providers about proper billing
and attendance record-keeping procedures for reimbursement under this chapter; and
new text end
new text begin
(2) ensure that the training and technical assistance provided to child care providers is
linguistically and culturally accessible.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2020.
new text end
Sec. 5.
Minnesota Statutes 2018, section 119B.02, subdivision 7, is amended to read:
Subd. 7.
Child care market rate survey.
deleted text begin Biennially,deleted text end The commissioner shall new text begin conduct
the next new text end survey new text begin of new text end prices charged by child care providers in Minnesota new text begin in state fiscal year
2021 and every three years thereafter new text end to determine the 75th percentile for like-care
arrangements in county price clusters.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 6.
Minnesota Statutes 2018, section 119B.025, subdivision 1, is amended to read:
Subdivision 1.
Applications.
(a) new text begin Except as provided in paragraph (c), clause (4), new text end the
county shall verify the following at all initial child care applications using the universal
application:
(1) identity of adults;
(2) presence of the minor child in the home, if questionable;
(3) relationship of minor child to the parent, stepparent, legal guardian, eligible relative
caretaker, or the spouses of any of the foregoing;
(4) age;
(5) immigration status, if related to eligibility;
(6) Social Security number, if given;
(7) counted income;
(8) spousal support and child support payments made to persons outside the household;
(9) residence; and
(10) inconsistent information, if related to eligibility.
(b) The county must mail a notice of approval or denial of assistance to the applicant
within 30 calendar days after receiving the application. The county may extend the response
time by 15 calendar days if the applicant is informed of the extension.
new text begin
(c) For an applicant who declares that the applicant is homeless and who meets the
definition of homeless in section 119B.011, subdivision 13b, the county must:
new text end
new text begin
(1) if information is needed to determine eligibility, send a request for information to
the applicant within five working days after receiving the application;
new text end
new text begin
(2) if the applicant is eligible, send a notice of approval of assistance within five working
days after receiving the application;
new text end
new text begin
(3) if the applicant is ineligible, send a notice of denial of assistance within 30 days after
receiving the application. The county may extend the response time by 15 calendar days if
the applicant is informed of the extension;
new text end
new text begin
(4) not require verifications required by paragraph (a) before issuing the notice of approval
or denial; and
new text end
new text begin
(5) follow limits set by the commissioner for how frequently expedited application
processing may be used for an applicant under this paragraph.
new text end
new text begin
(d) An applicant who declares that the applicant is homeless must submit proof of
eligibility within three months of the date the application was received. If proof of eligibility
is not submitted within three months, eligibility ends. A 15-day adverse action notice is
required to end eligibility.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 21, 2020.
new text end
Sec. 7.
Minnesota Statutes 2018, section 119B.025, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin Information to applicants; child care fraud. new text end
new text begin
At the time of initial application
and at redetermination, the county must provide written notice to the applicant or participant
listing the activities that constitute child care fraud and the consequences of committing
child care fraud. An applicant or participant shall acknowledge receipt of the child care
fraud notice in writing.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 1, 2019.
new text end
Sec. 8.
Minnesota Statutes 2018, section 119B.03, subdivision 9, is amended to read:
Subd. 9.
Portability pool.
(a) The commissioner shall establish a pool of up to five
percent of the annual appropriation for the basic sliding fee program to provide continuous
child care assistance for eligible families who move between Minnesota counties. At the
end of each allocation period, any unspent funds in the portability pool must be used for
assistance under the basic sliding fee program. If expenditures from the portability pool
exceed the amount of money available, the reallocation pool must be reduced to cover these
shortages.
(b) deleted text begin To be eligible for portable basic sliding fee assistance,deleted text end A family that has moved from
a county in which it was receiving basic sliding fee assistance to a county with a waiting
list for the basic sliding fee program must:
(1) meet the income and eligibility guidelines for the basic sliding fee program; and
(2) notify deleted text begin the new county of residence within 60 days of moving and submit information
to the new county of residence to verify eligibility for the basic sliding fee programdeleted text end new text begin the
family's previous county of residence of the family's move to a new county of residencenew text end .
(c) The receiving county must:
(1) accept administrative responsibility for applicants for portable basic sliding fee
assistance at the end of the two months of assistance under the Unitary Residency Act;
(2) continue new text begin portability pool new text end basic sliding fee assistance deleted text begin for the lesser of six months ordeleted text end
until the family is able to receive assistance under the county's regular basic sliding program;
and
(3) notify the commissioner through the quarterly reporting process of any family that
meets the criteria of the portable basic sliding fee assistance pool.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective December 2, 2019.
new text end
Sec. 9.
Minnesota Statutes 2018, section 119B.05, subdivision 1, is amended to read:
Subdivision 1.
Eligible participants.
Families eligible for child care assistance under
the MFIP child care program are:
(1) MFIP participants who are employed or in job search and meet the requirements of
section 119B.10;
(2) persons who are members of transition year families under section 119B.011,
subdivision 20, and meet the requirements of section 119B.10;
(3) families who are participating in employment orientation or job search, or other
employment or training activities that are included in an approved employability development
plan under section 256J.95;
(4) MFIP families who are participating in work job search, job support, employment,
or training activities as required in their employment plan, or in appeals, hearings,
assessments, or orientations according to chapter 256J;
(5) MFIP families who are participating in social services activities under chapter 256J
as required in their employment plan approved according to chapter 256J;
(6) families who are participating in services or activities that are included in an approved
family stabilization plan under section 256J.575;
(7) families who are participating in programs as required in tribal contracts under section
119B.02, subdivision 2, or 256.01, subdivision 2;
(8) families who are participating in the transition year extension under section 119B.011,
subdivision 20a;
(9) student parents as defined under section 119B.011, subdivision 19b;deleted text begin and
deleted text end
(10) student parents who turn 21 years of age and who continue to meet the other
requirements under section 119B.011, subdivision 19b. A student parent continues to be
eligible until the student parent is approved for basic sliding fee child care assistance or
until the student parent's redetermination, whichever comes first. At the student parent's
redetermination, if the student parent was not approved for basic sliding fee child care
assistance, a student parent's eligibility ends following a 15-day adverse action noticedeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(11) MFIP child-only cases under section 256J.88, for up to 20 hours of child care per
week for children six years of age and younger, as recommended by the treating mental
health professional, when either the child's primary caregiver has a diagnosis of a mental
illness and is in need of intensive treatment, or the child is in need of a consistent caregiver.
new text end
Sec. 10.
Minnesota Statutes 2018, section 119B.09, subdivision 1, is amended to read:
Subdivision 1.
General eligibility requirements.
(a) Child care services must be
available to families who need child care to find or keep employment or to obtain the training
or education necessary to find employment and who:
(1) have household income less than or equal to 67 percent of the state median income,
adjusted for family size, at application and redetermination, and meet the requirements of
section 119B.05; receive MFIP assistance; and are participating in employment and training
services under chapter 256J; or
(2) have household income less than or equal to 47 percent of the state median income,
adjusted for family size, at application and less than or equal to 67 percent of the state
median income, adjusted for family size, at redetermination.
(b) Child care services must be made available as in-kind services.
(c) All applicants for child care assistance and families currently receiving child care
assistance must be assisted and required to cooperate in establishment of paternity and
enforcement of child support obligations for all children in the family at application and
redetermination as a condition of program eligibility. For purposes of this section, a family
is considered to meet the requirement for cooperation when the family complies with the
requirements of section 256.741.
(d) All applicants for child care assistance and families currently receiving child care
assistance must pay the co-payment fee under section 119B.12, subdivision 2, as a condition
of eligibility. The co-payment fee may include additional recoupment fees due to a child
care assistance program overpayment.
new text begin
(e) If a family has one child with a child care authorization and the child reaches 13
years of age or the child has a disability and reaches 15 years of age, the family remains
eligible until the redetermination.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective June 29, 2020.
new text end
Sec. 11.
Minnesota Statutes 2018, section 119B.095, subdivision 2, is amended to read:
Subd. 2.
Maintain steady child care authorizations.
(a) Notwithstanding Minnesota
Rules, chapter 3400, the amount of child care authorized under section 119B.10 for
employment, education, or an MFIP or DWP employment plan shall continue at the same
number of hours or more hours until redetermination, including:
(1) when the other parent moves in and is employed or has an education plan under
section 119B.10, subdivision 3, or has an MFIP or DWP employment plan; or
(2) when the participant's work hours are reduced or a participant temporarily stops
working or attending an approved education program. Temporary changes include, but are
not limited to, a medical leave, seasonal employment fluctuations, or a school break between
semesters.
(b) The county may increase the amount of child care authorized at any time if the
participant verifies the need for increased hours for authorized activities.
(c) The county may reduce the amount of child care authorized if a parent requests a
reduction or because of a change in:
(1) the child's school schedule;
(2) the custody schedule; or
(3) the provider's availability.
(d) The amount of child care authorized for a family subject to subdivision 1, paragraph
(b), must change when the participant's activity schedule changes. Paragraph (a) does not
apply to a family subject to subdivision 1, paragraph (b).
new text begin
(e) When a child reaches 13 years of age or a child with a disability reaches 15 years of
age, the amount of child care authorized shall continue at the same number of hours or more
hours until redetermination.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective June 29, 2020.
new text end
Sec. 12.
Minnesota Statutes 2018, section 119B.095, is amended by adding a subdivision
to read:
new text begin Subd. 3. new text end
new text begin Assistance for persons who are homeless. new text end
new text begin
An applicant who is homeless and
eligible for child care assistance is exempt from the activity participation requirements under
this chapter for three months. The applicant under this subdivision is eligible for 60 hours
of child care assistance per service period for three months from the date the county receives
the application. Additional hours may be authorized as needed based on the applicant's
participation in employment, education, or MFIP or DWP employment plan. To continue
receiving child care assistance after the initial three months, the applicant must verify that
the applicant meets eligibility and activity requirements for child care assistance under this
chapter.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 21, 2020.
new text end
Sec. 13.
Minnesota Statutes 2018, section 119B.13, subdivision 1, is amended to read:
Subdivision 1.
Subsidy restrictions.
(a) Beginning deleted text begin February 3, 2014,deleted text end new text begin September 20,
2019,new text end the maximum rate paid for child care assistance in any county or county price cluster
under the child care fund shall be the greater of the 25th percentile of the deleted text begin 2011deleted text end new text begin 2018new text end child
care provider rate survey new text begin under section 119B.02, subdivision 7, new text end or the maximum rate effective
deleted text begin November deleted text end deleted text begin 28, 2011deleted text end new text begin February 3, 2014new text end . For a child care provider located within the boundaries
of a city located in two or more of the counties of Benton, Sherburne, and Stearns, the
maximum rate paid for child care assistance shall be equal to the maximum rate paid in the
county with the highest maximum reimbursement rates or the provider's charge, whichever
is less. The commissioner may: (1) assign a county with no reported provider prices to a
similar price cluster; and (2) consider county level access when determining final price
clusters.
(b) A rate which includes a special needs rate paid under subdivision 3 may be in excess
of the maximum rate allowed under this subdivision.
(c) The department shall monitor the effect of this paragraph on provider rates. The
county shall pay the provider's full charges for every child in care up to the maximum
established. The commissioner shall determine the maximum rate for each type of care on
an hourly, full-day, and weekly basis, including special needs and disability care.
(d) If a child uses one provider, the maximum payment for one day of care must not
exceed the daily rate. The maximum payment for one week of care must not exceed the
weekly rate.
(e) If a child uses two providers under section 119B.097, the maximum payment must
not exceed:
(1) the daily rate for one day of care;
(2) the weekly rate for one week of care by the child's primary provider; and
(3) two daily rates during two weeks of care by a child's secondary provider.
(f) Child care providers receiving reimbursement under this chapter must not be paid
activity fees or an additional amount above the maximum rates for care provided during
nonstandard hours for families receiving assistance.
(g) If the provider charge is greater than the maximum provider rate allowed, the parent
is responsible for payment of the difference in the rates in addition to any family co-payment
fee.
(h) All maximum provider rates changes shall be implemented on the Monday following
the effective date of the maximum provider rate.
(i) deleted text begin Notwithstanding Minnesota Rules, part 3400.0130, subpart 7, maximum registration
fees in effect on January 1, 2013, shall remain in effect.deleted text end new text begin The maximum registration fee paid
for child care assistance in any county or county price cluster under the child care fund shall
be the greater of the 25th percentile of the 2018 child care provider rate survey under section
119B.02, subdivision 7, or the registration fee in effect February 3, 2014. Maximum
registration fees must be set for licensed family child care and for child care centers. For a
child care provider located within the boundaries of a city located in two or more of the
counties of Benton, Sherburne, and Stearns, the maximum registration fee paid for child
care assistance shall be equal to the maximum registration fee paid in the county with the
highest maximum registration fee or the provider's charge, whichever is less.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraph (a) is effective September 20, 2019. Paragraph (i) is
effective September 23, 2019.
new text end
Sec. 14.
Minnesota Statutes 2018, section 119B.16, subdivision 1, is amended to read:
Subdivision 1.
Fair hearing allowednew text begin for applicants and recipientsnew text end .
new text begin (a) new text end An applicant
or recipient adversely affected by new text begin an action of new text end a county agency deleted text begin actiondeleted text end new text begin or the commissioner,
for an action taken directly against the applicant or recipient,new text end may request new text begin and receive new text end a fair
hearing in accordance with new text begin this subdivision and new text end section 256.045.new text begin An applicant or recipient
does not have a right to a fair hearing if a county agency or the commissioner takes action
against a provider.
new text end
new text begin
(b) A county agency must offer an informal conference to an applicant or recipient who
is entitled to a fair hearing under this section. A county agency must advise an applicant or
recipient that a request for a conference is optional and does not delay or replace the right
to a fair hearing.
new text end
new text begin
(c) If a provider's authorization is suspended, denied, or revoked, a county agency or
the commissioner must mail notice to each child care assistance program recipient receiving
care from the provider.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective February 26, 2021.
new text end
Sec. 15.
Minnesota Statutes 2018, section 119B.16, subdivision 1a, is amended to read:
Subd. 1a.
Fair hearing allowed for providers.
(a) This subdivision applies to providers
caring for children receiving child care assistance.
deleted text begin
(b) A provider to whom a county agency has assigned responsibility for an overpayment
may request a fair hearing in accordance with section 256.045 for the limited purpose of
challenging the assignment of responsibility for the overpayment and the amount of the
overpayment. The scope of the fair hearing does not include the issues of whether the
provider wrongfully obtained public assistance in violation of section 256.98 or was properly
disqualified under section 256.98, subdivision 8, paragraph (c), unless the fair hearing has
been combined with an administrative disqualification hearing brought against the provider
under section 256.046.
deleted text end
new text begin
(b) A provider may request a fair hearing according to sections 256.045 and 256.046
only if a county agency or the commissioner:
new text end
new text begin
(1) denies or revokes a provider's authorization, unless the action entitles the provider
to an administrative review under section 119B.161;
new text end
new text begin
(2) assigns responsibility for an overpayment to a provider under section 119B.11,
subdivision 2a;
new text end
new text begin
(3) establishes an overpayment for failure to comply with section 119B.125, subdivision
6;
new text end
new text begin
(4) seeks monetary recovery or recoupment under section 245E.02, subdivision 4,
paragraph (c), clause (2);
new text end
new text begin
(5) initiates an administrative fraud disqualification hearing; or
new text end
new text begin
(6) issues a payment and the provider disagrees with the amount of the payment.
new text end
new text begin
(c) A provider may request a fair hearing by submitting a written request to the
Department of Human Services, Appeals Division. A provider's request must be received
by the Appeals Division no later than 30 days after the date a county or the commissioner
mails the notice.
new text end
new text begin
(d) The provider's appeal request must contain the following:
new text end
new text begin
(1) each disputed item, the reason for the dispute, and, if applicable, an estimate of the
dollar amount involved for each disputed item;
new text end
new text begin
(2) the computation the provider believes to be correct, if applicable;
new text end
new text begin
(3) the statute or rule relied on for each disputed item; and
new text end
new text begin
(4) the name, address, and telephone number of the person at the provider's place of
business with whom contact may be made regarding the appeal.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective February 26, 2021.
new text end
Sec. 16.
Minnesota Statutes 2018, section 119B.16, subdivision 1b, is amended to read:
Subd. 1b.
Joint fair hearings.
deleted text begin When a provider requests a fair hearing under subdivision
1a, the family in whose case the overpayment was created must be made a party to the fair
hearing. All other issues raised by the family must be resolved in the same proceeding.
When a family requests a fair hearing and claims that the county should have assigned
responsibility for an overpayment to a provider, the provider must be made a party to the
fair hearing.deleted text end The human services judge assigned to a fair hearing may join a family or a
provider as a party to the fair hearing whenever joinder of that party is necessary to fully
and fairly resolve deleted text begin overpaymentdeleted text end issues raised in the appeal.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective February 26, 2021.
new text end
Sec. 17.
Minnesota Statutes 2018, section 119B.16, is amended by adding a subdivision
to read:
new text begin Subd. 1c. new text end
new text begin Notice to providers. new text end
new text begin
(a) Before taking an action appealable under subdivision
1a, paragraph (b), a county agency or the commissioner must mail written notice to the
provider against whom the action is being taken. Unless otherwise specified under chapter
119B or 245E or Minnesota Rules, chapter 3400, a county agency or the commissioner must
mail the written notice at least 15 calendar days before the adverse action's effective date.
new text end
new text begin
(b) The notice shall state (1) the factual basis for the department's determination, (2) the
action the department intends to take, (3) the dollar amount of the monetary recovery or
recoupment, if known, and (4) the provider's right to appeal the department's proposed
action.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective February 26, 2021.
new text end
Sec. 18.
Minnesota Statutes 2018, section 119B.16, is amended by adding a subdivision
to read:
new text begin Subd. 3. new text end
new text begin Fair hearing stayed. new text end
new text begin
(a) If a county agency or the commissioner denies or
revokes a provider's authorization based on a licensing action under section 245A.07, and
the provider appeals, the provider's fair hearing must be stayed until the commissioner issues
an order as required under section 245A.08, subdivision 5.
new text end
new text begin
(b) If the commissioner denies or revokes a provider's authorization based on
decertification under section 245H.07, and the provider appeals, the provider's fair hearing
must be stayed until the commissioner issues a final order as required under section 245H.07.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective February 26, 2021.
new text end
Sec. 19.
Minnesota Statutes 2018, section 119B.16, is amended by adding a subdivision
to read:
new text begin Subd. 4. new text end
new text begin Final department action. new text end
new text begin
Unless the commissioner receives a timely and
proper request for an appeal, a county agency's or the commissioner's action shall be
considered a final department action.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective February 26, 2021.
new text end
Sec. 20.
new text begin
[119B.161] ADMINISTRATIVE REVIEW.
new text end
new text begin Subdivision 1. new text end
new text begin Applicability. new text end
new text begin
A provider has the right to an administrative review under
this section if (1) a payment was suspended under chapter 245E, or (2) the provider's
authorization was denied or revoked under section 119B.13, subdivision 6, paragraph (d),
clause (1) or (2).
new text end
new text begin Subd. 2. new text end
new text begin Notice. new text end
new text begin
(a) A county agency or the commissioner must mail written notice to
a provider within five days of suspending payment or denying or revoking the provider's
authorization under subdivision 1.
new text end
new text begin
(b) The notice must:
new text end
new text begin
(1) state the provision under which a county agency or the commissioner is denying,
revoking, or suspending the provider's authorization or suspending payment to the provider;
new text end
new text begin
(2) set forth the general allegations leading to the denial, revocation, or suspension of
the provider's authorization. The notice need not disclose any specific information concerning
an ongoing investigation;
new text end
new text begin
(3) state that the denial, revocation, or suspension of the provider's authorization is for
a temporary period and explain the circumstances under which the action expires; and
new text end
new text begin
(4) inform the provider of the right to submit written evidence and argument for
consideration by the commissioner.
new text end
new text begin
(c) Notwithstanding Minnesota Rules, part 3400.0185, if a county agency or the
commissioner suspends payment to a provider under chapter 245E or denies or revokes a
provider's authorization under section 119B.13, subdivision 6, paragraph (d), clause (1) or
(2), a county agency or the commissioner must send notice of service authorization closure
to each affected family. The notice sent to an affected family is effective on the date the
notice is created.
new text end
new text begin Subd. 3. new text end
new text begin Duration. new text end
new text begin
If a provider's payment is suspended under chapter 245E or a
provider's authorization is denied or revoked under section 119B.13, subdivision 6, paragraph
(d), clause (1) or (2), the provider's denial, revocation, temporary suspension, or payment
suspension remains in effect until:
new text end
new text begin
(1) the commissioner or a law enforcement authority determines that there is insufficient
evidence warranting the action and a county agency or the commissioner does not pursue
an additional administrative remedy under chapter 245E or section 256.98; or
new text end
new text begin
(2) all criminal, civil, and administrative proceedings related to the provider's alleged
misconduct conclude and any appeal rights are exhausted.
new text end
new text begin Subd. 4. new text end
new text begin Good cause exception. new text end
new text begin
The commissioner may find that good cause exists not
to deny, revoke, or suspend a provider's authorization, or not to continue a denial, revocation,
or suspension of a provider's authorization if any of the following are applicable:
new text end
new text begin
(1) a law enforcement authority specifically requested that a provider's authorization
not be denied, revoked, or suspended because that action may compromise an ongoing
investigation;
new text end
new text begin
(2) the commissioner determines that the denial, revocation, or suspension should be
removed based on the provider's written submission; or
new text end
new text begin
(3) the commissioner determines that the denial, revocation, or suspension is not in the
best interests of the program.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective February 26, 2021.
new text end
Sec. 21.
new text begin
[119B.195] RETAINING EARLY EDUCATORS THROUGH ATTAINING
INCENTIVES NOW (REETAIN) GRANT PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment; purpose. new text end
new text begin
The retaining early educators through attaining
incentives now (REETAIN) grant program is established to provide competitive grants to
incentivize well-trained child care professionals to stay in the workforce to create more
consistent care for children over time.
new text end
new text begin Subd. 2. new text end
new text begin Administration. new text end
new text begin
(a) The commissioner must administer the REETAIN grant
program, and must provide a grant to a nonprofit organization with demonstrated ability to
manage benefit programs for child care professionals.
new text end
new text begin
(b) Up to ten percent of grant funds may be used for administration of the grant program.
new text end
new text begin Subd. 3. new text end
new text begin Application. new text end
new text begin
Applicants must apply for the REETAIN grant program in the
manner and according to the timelines established by the commissioner.
new text end
new text begin Subd. 4. new text end
new text begin Eligibility. new text end
new text begin
(a) Applicants must:
new text end
new text begin
(1) be licensed to provide child care or work for a licensed child care program;
new text end
new text begin
(2) work directly with children at least 30 hours per week;
new text end
new text begin
(3) be in their current position for at least 12 months;
new text end
new text begin
(4) be willing to stay in their current position for at least 12 months after receiving a
grant under this section;
new text end
new text begin
(5) have a career lattice step of five or higher;
new text end
new text begin
(6) have a current membership with the Minnesota quality improvement and registry
tool; and
new text end
new text begin
(7) meet any other requirements established by the commissioner.
new text end
new text begin
(b) Grant recipients must sign a contract agreeing to remain in their current position for
12 months.
new text end
new text begin Subd. 5. new text end
new text begin Grant awards. new text end
new text begin
(a) To the extent that funding is available, a child care
professional's annual amount for the REETAIN grant must not exceed an amount determined
by the commissioner. A child care professional must apply each year to compete for an
award, and may receive up to one award per year.
new text end
new text begin
(b) Grant funds may be used for program supplies, training, or personal expenses.
new text end
new text begin Subd. 6. new text end
new text begin Report. new text end
new text begin
Annually by January 1, the commissioner must report to the legislative
committees with jurisdiction over early childhood on the number of grants awarded and
outcomes of the grant program.
new text end
new text begin EFFECTIVE DATE; APPLICATION. new text end
new text begin
This section is effective July 1, 2019. The first
report under subdivision 6 is due by January 1, 2021.
new text end
Sec. 22.
Minnesota Statutes 2018, section 245C.32, subdivision 2, is amended to read:
Subd. 2.
Use.
(a) The commissioner may also use these systems and records to obtain
and provide criminal history data from the Bureau of Criminal Apprehension, criminal
history data held by the commissioner, and data about substantiated maltreatment under
section 626.556 or 626.557, for other purposes, provided that:
(1) the background study is specifically authorized in statute; or
(2) the request is made with the informed consent of the subject of the study as provided
in section 13.05, subdivision 4.
(b) An individual making a request under paragraph (a), clause (2), must agree in writing
not to disclose the data to any other individual without the consent of the subject of the data.
(c) The commissioner may recover the cost of obtaining and providing background study
data by charging the individual or entity requesting the study a fee of no more than $20 per
study. The fees collected under this paragraph are appropriated to the commissioner for the
purpose of conducting background studies.
(d) The commissioner shall recover the cost of obtaining background study data required
under section 524.5-118 through a fee of $50 per study for an individual who has not lived
outside Minnesota for the past ten years, and a fee of $100 for an individual who has resided
outside of Minnesota for any period during the ten years preceding the background study.
The commissioner shall recover, from the individual, any additional fees charged by other
states' licensing agencies that are associated with these data requests. Fees under subdivision
3 also apply when criminal history data from the National Criminal Records Repository is
required.
new text begin
(e) According to paragraph (a), the commissioner shall use the systems and records
described in this chapter to provide summary data about maltreatment under sections 626.556
or 626.557 to government entities seeking this data for the purposes of child protection.
new text end
Sec. 23.
Minnesota Statutes 2018, section 256.01, subdivision 14b, is amended to read:
Subd. 14b.
American Indian child welfare projects.
(a) The commissioner of human
services may authorize projects to deleted text begin testdeleted text end new text begin initiatenew text end tribal delivery of child welfare services to
American Indian children and their parents and custodians living on the reservation. The
commissioner has authority to solicit and determine which tribes may participate in a project.
Grants may be issued to Minnesota Indian tribes to support the projects. The commissioner
may waive existing state rules as needed to accomplish the projects. The commissioner may
authorize projects to use alternative methods of (1) new text begin screening, new text end investigatingnew text begin ,new text end and assessing
reports of child maltreatment, and (2) administrative reconsideration, administrative appeal,
and judicial appeal of maltreatment determinations, provided the alternative methods used
by the projects comply with the provisions of sections 256.045 and 626.556 deleted text begin dealingdeleted text end new text begin that
dealnew text end with the rights of individuals who are the subjects of reports or investigations, including
notice and appeal rights and data practices requirements.new text begin The commissioner shall only
authorize alternative methods that comply with the public policy under section 626.556,
subdivision 1.new text end The commissioner may seek any federal approvals necessary to carry out the
projects as well as seek and use any funds available to the commissioner, including use of
federal funds, foundation funds, existing grant funds, and other funds. The commissioner
is authorized to advance state funds as necessary to operate the projects. Federal
reimbursement applicable to the projects is appropriated to the commissioner for the purposes
of the projects. The projects must be required to address responsibility for safety, permanency,
and well-being of children.
(b) For the purposes of this section, "American Indian child" means a person under 21
years old and who is a tribal member or eligible for membership in one of the tribes chosen
for a project under this subdivision and who is residing on the reservation of that tribe.
(c) In order to qualify for an American Indian child welfare project, a tribe must:
(1) be one of the existing tribes with reservation land in Minnesota;
(2) have a tribal court with jurisdiction over child custody proceedings;
(3) have a substantial number of children for whom determinations of maltreatment have
occurred;
(4)new text begin (i)new text end have capacity to respond to reports of abuse and neglect under section 626.556;new text begin
or (ii) have codified the tribe's screening, investigation, and assessment of reports of child
maltreatment procedures, if authorized to use an alternative method by the commissioner
under paragraph (a);
new text end
(5) provide a wide range of services to families in need of child welfare services; and
(6) have a tribal-state title IV-E agreement in effect.
(d) Grants awarded under this section may be used for the nonfederal costs of providing
child welfare services to American Indian children on the tribe's reservation, including costs
associated with:
(1) assessment and prevention of child abuse and neglect;
(2) family preservation;
(3) facilitative, supportive, and reunification services;
(4) out-of-home placement for children removed from the home for child protective
purposes; and
(5) other activities and services approved by the commissioner that further the goals of
providing safety, permanency, and well-being of American Indian children.
(e) When a tribe has initiated a project and has been approved by the commissioner to
assume child welfare responsibilities for American Indian children of that tribe under this
section, the affected county social service agency is relieved of responsibility for responding
to reports of abuse and neglect under section 626.556 for those children during the time
within which the tribal project is in effect and funded. The commissioner shall work with
tribes and affected counties to develop procedures for data collection, evaluation, and
clarification of ongoing role and financial responsibilities of the county and tribe for child
welfare services prior to initiation of the project. Children who have not been identified by
the tribe as participating in the project shall remain the responsibility of the county. Nothing
in this section shall alter responsibilities of the county for law enforcement or court services.
(f) Participating tribes may conduct children's mental health screenings under section
245.4874, subdivision 1, paragraph (a), clause (12), for children who are eligible for the
initiative and living on the reservation and who meet one of the following criteria:
(1) the child must be receiving child protective services;
(2) the child must be in foster care; or
(3) the child's parents must have had parental rights suspended or terminated.
Tribes may access reimbursement from available state funds for conducting the screenings.
Nothing in this section shall alter responsibilities of the county for providing services under
section 245.487.
(g) Participating tribes may establish a local child mortality review panel. In establishing
a local child mortality review panel, the tribe agrees to conduct local child mortality reviews
for child deaths or near-fatalities occurring on the reservation under subdivision 12. Tribes
with established child mortality review panels shall have access to nonpublic data and shall
protect nonpublic data under subdivision 12, paragraphs (c) to (e). The tribe shall provide
written notice to the commissioner and affected counties when a local child mortality review
panel has been established and shall provide data upon request of the commissioner for
purposes of sharing nonpublic data with members of the state child mortality review panel
in connection to an individual case.
(h) The commissioner shall collect information on outcomes relating to child safety,
permanency, and well-being of American Indian children who are served in the projects.
Participating tribes must provide information to the state in a format and completeness
deemed acceptable by the state to meet state and federal reporting requirements.
(i) In consultation with the White Earth Band, the commissioner shall develop and submit
to the chairs and ranking minority members of the legislative committees with jurisdiction
over health and human services a plan to transfer legal responsibility for providing child
protective services to White Earth Band member children residing in Hennepin County to
the White Earth Band. The plan shall include a financing proposal, definitions of key terms,
statutory amendments required, and other provisions required to implement the plan. The
commissioner shall submit the plan by January 15, 2012.
Sec. 24.
Minnesota Statutes 2018, section 256J.24, subdivision 5, is amended to read:
Subd. 5.
MFIP transitional standard.
new text begin (a) new text end The MFIP transitional standard is based on
the number of persons in the assistance unit eligible for both food and cash assistance. The
amount of the transitional standard is published annually by the Department of Human
Services.
new text begin
(b) The amount of the MFIP cash assistance portion of the transitional standard is
increased $100 per month per household. This increase shall be reflected in the MFIP cash
assistance portion of the transitional standard published annually by the commissioner.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective February 1, 2020.
new text end
Sec. 25.
Minnesota Statutes 2018, section 256M.41, subdivision 3, is amended to read:
Subd. 3.
Payments deleted text begin based on performancedeleted text end .
deleted text begin (a)deleted text end The commissioner shall make payments
under this section to each county deleted text begin board on a calendar year basis in an amount determined
under paragraph (b)deleted text end new text begin on or before July 10 of each yearnew text end .
deleted text begin
(b) Calendar year allocations under subdivision 1 shall be paid to counties in the following
manner:
deleted text end
deleted text begin
(1) 80 percent of the allocation as determined in subdivision 1 must be paid to counties
on or before July 10 of each year;
deleted text end
deleted text begin
(2) ten percent of the allocation shall be withheld until the commissioner determines if
the county has met the performance outcome threshold of 90 percent based on face-to-face
contact with alleged child victims. In order to receive the performance allocation, the county
child protection workers must have a timely face-to-face contact with at least 90 percent of
all alleged child victims of screened-in maltreatment reports. The standard requires that
each initial face-to-face contact occur consistent with timelines defined in section 626.556,
subdivision 10, paragraph (i). The commissioner shall make threshold determinations in
January of each year and payments to counties meeting the performance outcome threshold
shall occur in February of each year. Any withheld funds from this appropriation for counties
that do not meet this requirement shall be reallocated by the commissioner to those counties
meeting the requirement; and
deleted text end
deleted text begin
(3) ten percent of the allocation shall be withheld until the commissioner determines
that the county has met the performance outcome threshold of 90 percent based on
face-to-face visits by the case manager. In order to receive the performance allocation, the
total number of visits made by caseworkers on a monthly basis to children in foster care
and children receiving child protection services while residing in their home must be at least
90 percent of the total number of such visits that would occur if every child were visited
once per month. The commissioner shall make such determinations in January of each year
and payments to counties meeting the performance outcome threshold shall occur in February
of each year. Any withheld funds from this appropriation for counties that do not meet this
requirement shall be reallocated by the commissioner to those counties meeting the
requirement. For 2015, the commissioner shall only apply the standard for monthly foster
care visits.
deleted text end
deleted text begin
(c) The commissioner shall work with stakeholders and the Human Services Performance
Council under section 402A.16 to develop recommendations for specific outcome measures
that counties should meet in order to receive funds withheld under paragraph (b), and include
in those recommendations a determination as to whether the performance measures under
paragraph (b) should be modified or phased out. The commissioner shall report the
recommendations to the legislative committees having jurisdiction over child protection
issues by January 1, 2018.
deleted text end
Sec. 26.
Minnesota Statutes 2018, section 256M.41, is amended by adding a subdivision
to read:
new text begin Subd. 4. new text end
new text begin County performance on child protection measures. new text end
new text begin
The commissioner shall
set child protection measures and standards. The commissioner shall require an
underperforming county to demonstrate that the county designated sufficient funds and
implemented a reasonable strategy to improve child protection performance, including the
provision of a performance improvement plan and additional remedies identified by the
commissioner. The commissioner may redirect up to 20 percent of a county's funds under
this section toward the performance improvement plan. Sanctions under section 256M.20,
subdivision 3, related to noncompliance with federal performance standards also apply.
new text end
Sec. 27.
Minnesota Statutes 2018, section 260C.007, subdivision 18, is amended to read:
Subd. 18.
Foster care.
new text begin (a) new text end "Foster care" means deleted text begin 24 hourdeleted text end new text begin 24-hournew text end substitute care for
deleted text begin children placed away from their parents or guardian anddeleted text end new text begin a childnew text end for whom a responsible
social services agency has placement and care responsibilitydeleted text begin . "Foster care" includes, but is
not limited to, placementdeleted text end new text begin and:
new text end
new text begin (1) who is placed away from the child's parent or guardiannew text end in foster family homes, foster
homes of relatives, group homes, emergency shelters, residential facilities not excluded in
this subdivision, child care institutions, and preadoptive homesdeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(2) who is colocated with the child's parent or guardian in a licensed residential
family-based substance use disorder treatment program as defined in subdivision 22a; or
new text end
new text begin
(3) who is returned to the care of the child's parent or guardian from whom the child
was removed under a trial home visit pursuant to section 260C.201, subdivision 1, paragraph
(a), clause (3).
new text end
new text begin (b)new text end A child is in foster care under this definition regardless of whether the facility is
licensed and payments are made for the cost of care. Nothing in this definition creates any
authority to place a child in a home or facility that is required to be licensed which is not
licensed. "Foster care" does not include placement in any of the following facilities: hospitals,
inpatient chemical dependency treatment facilitiesnew text begin where the child is the recipient of the
treatmentnew text end , facilities that are primarily for delinquent children, any corrections facility or
program within a particular correction's facility not meeting requirements for title IV-E
facilities as determined by the commissioner, facilities to which a child is committed under
the provision of chapter 253B, forestry camps, or jails. Foster care is intended to provide
for a child's safety or to access treatment. Foster care must not be used as a punishment or
consequence for a child's behavior.
Sec. 28.
Minnesota Statutes 2018, section 260C.007, is amended by adding a subdivision
to read:
new text begin Subd. 22a. new text end
new text begin
Licensed residential family-based substance use disorder treatment
program.
new text end
new text begin
"Licensed residential family-based substance use disorder treatment program"
means a residential treatment facility that provides the parent or guardian with parenting
skills training, parent education, or individual and family counseling, under an organizational
structure and treatment framework that involves understanding, recognizing, and responding
to the effects of all types of trauma according to recognized principles of a trauma-informed
approach and trauma-specific interventions to address the consequences of trauma and
facilitate healing.
new text end
Sec. 29.
Minnesota Statutes 2018, section 260C.178, subdivision 1, is amended to read:
Subdivision 1.
Hearing and release requirements.
(a) If a child was taken into custody
under section 260C.175, subdivision 1, clause (1) or (2), item (ii), the court shall hold a
hearing within 72 hours of the time the child was taken into custody, excluding Saturdays,
Sundays, and holidays, to determine whether the child should continue in custody.
(b) Unless there is reason to believe that the child would endanger self or others or not
return for a court hearing, or that the child's health or welfare would be immediately
endangered, the child shall be released to the custody of a parent, guardian, custodian, or
other suitable person, subject to reasonable conditions of release including, but not limited
to, a requirement that the child undergo a chemical use assessment as provided in section
260C.157, subdivision 1.
(c) If the court determines there is reason to believe that the child would endanger self
or others or not return for a court hearing, or that the child's health or welfare would be
immediately endangered if returned to the care of the parent or guardian who has custody
and from whom the child was removed, the court shall order the child into foster carenew text begin as
defined in section 260C.007, subdivision 18,new text end under the legal responsibility of the responsible
social services agency or responsible probation or corrections agency for the purposes of
protective care as that term is used in the juvenile court rules or into the home of a
noncustodial parent and order the noncustodial parent to comply with any conditions the
court determines to be appropriate to the safety and care of the child, including cooperating
with paternity establishment proceedings in the case of a man who has not been adjudicated
the child's father. The court shall not give the responsible social services legal custody and
order a trial home visit at any time prior to adjudication and disposition under section
260C.201, subdivision 1, paragraph (a), clause (3), but may order the child returned to the
care of the parent or guardian who has custody and from whom the child was removed and
order the parent or guardian to comply with any conditions the court determines to be
appropriate to meet the safety, health, and welfare of the child.
(d) In determining whether the child's health or welfare would be immediately
endangered, the court shall consider whether the child would reside with a perpetrator of
domestic child abuse.
(e) The court, before determining whether a child should be placed in or continue in
foster care under the protective care of the responsible agency, shall also make a
determination, consistent with section 260.012 as to whether reasonable efforts were made
to prevent placement or whether reasonable efforts to prevent placement are not required.
In the case of an Indian child, the court shall determine whether active efforts, according
to section 260.762 and the Indian Child Welfare Act of 1978, United States Code, title 25,
section 1912(d), were made to prevent placement. The court shall enter a finding that the
responsible social services agency has made reasonable efforts to prevent placement when
the agency establishes either:
(1) that it has actually provided services or made efforts in an attempt to prevent the
child's removal but that such services or efforts have not proven sufficient to permit the
child to safely remain in the home; or
(2) that there are no services or other efforts that could be made at the time of the hearing
that could safely permit the child to remain home or to return home. When reasonable efforts
to prevent placement are required and there are services or other efforts that could be ordered
which would permit the child to safely return home, the court shall order the child returned
to the care of the parent or guardian and the services or efforts put in place to ensure the
child's safety. When the court makes a prima facie determination that one of the
circumstances under paragraph (g) exists, the court shall determine that reasonable efforts
to prevent placement and to return the child to the care of the parent or guardian are not
required.
If the court finds the social services agency's preventive or reunification efforts have
not been reasonable but further preventive or reunification efforts could not permit the child
to safely remain at home, the court may nevertheless authorize or continue the removal of
the child.
(f) The court may not order or continue the foster care placement of the child unless the
court makes explicit, individualized findings that continued custody of the child by the
parent or guardian would be contrary to the welfare of the child and that placement is in the
best interest of the child.
(g) At the emergency removal hearing, or at any time during the course of the proceeding,
and upon notice and request of the county attorney, the court shall determine whether a
petition has been filed stating a prima facie case that:
(1) the parent has subjected a child to egregious harm as defined in section 260C.007,
subdivision 14;
(2) the parental rights of the parent to another child have been involuntarily terminated;
(3) the child is an abandoned infant under section 260C.301, subdivision 2, paragraph
(a), clause (2);
(4) the parents' custodial rights to another child have been involuntarily transferred to a
relative under Minnesota Statutes 2010, section 260C.201, subdivision 11, paragraph (e),
clause (1); section 260C.515, subdivision 4; or a similar law of another jurisdiction;
(5) the parent has committed sexual abuse as defined in section 626.556, subdivision 2,
against the child or another child of the parent;
(6) the parent has committed an offense that requires registration as a predatory offender
under section 243.166, subdivision 1b, paragraph (a) or (b); or
(7) the provision of services or further services for the purpose of reunification is futile
and therefore unreasonable.
(h) When a petition to terminate parental rights is required under section 260C.301,
subdivision 4, or 260C.503, subdivision 2, but the county attorney has determined not to
proceed with a termination of parental rights petition, and has instead filed a petition to
transfer permanent legal and physical custody to a relative under section 260C.507, the
court shall schedule a permanency hearing within 30 days of the filing of the petition.
(i) If the county attorney has filed a petition under section 260C.307, the court shall
schedule a trial under section 260C.163 within 90 days of the filing of the petition except
when the county attorney determines that the criminal case shall proceed to trial first under
section 260C.503, subdivision 2, paragraph (c).
(j) If the court determines the child should be ordered into foster care and the child's
parent refuses to give information to the responsible social services agency regarding the
child's father or relatives of the child, the court may order the parent to disclose the names,
addresses, telephone numbers, and other identifying information to the responsible social
services agency for the purpose of complying with sections 260C.151, 260C.212, 260C.215,
and 260C.221.
(k) If a child ordered into foster care has siblings, whether full, half, or step, who are
also ordered into foster care, the court shall inquire of the responsible social services agency
of the efforts to place the children together as required by section 260C.212, subdivision 2,
paragraph (d), if placement together is in each child's best interests, unless a child is in
placement for treatment or a child is placed with a previously noncustodial parent who is
not a parent to all siblings. If the children are not placed together at the time of the hearing,
the court shall inquire at each subsequent hearing of the agency's reasonable efforts to place
the siblings together, as required under section 260.012. If any sibling is not placed with
another sibling or siblings, the agency must develop a plan to facilitate visitation or ongoing
contact among the siblings as required under section 260C.212, subdivision 1, unless it is
contrary to the safety or well-being of any of the siblings to do so.
(l) When the court has ordered the child into foster care or into the home of a noncustodial
parent, the court may order a chemical dependency evaluation, mental health evaluation,
medical examination, and parenting assessment for the parent as necessary to support the
development of a plan for reunification required under subdivision 7 and section 260C.212,
subdivision 1, or the child protective services plan under section 626.556, subdivision 10,
and Minnesota Rules, part 9560.0228.
Sec. 30.
new text begin
[260C.190] FAMILY-FOCUSED RESIDENTIAL PLACEMENT.
new text end
new text begin Subdivision 1. new text end
new text begin Placement. new text end
new text begin
(a) An agency with legal responsibility for a child under
section 260C.178, subdivision 1, paragraph (c), or legal custody of a child under section
260C.201, subdivision 1, paragraph (a), clause (3), may colocate a child with a parent who
is receiving services in a licensed residential family-based substance use disorder treatment
program for up to 12 months.
new text end
new text begin
(b) During the child's placement under paragraph (a), the agency: (1) may visit the child
as the agency deems necessary and appropriate; (2) shall continue to have access to
information under section 260C.208; and (3) shall continue to provide appropriate services
to both the parent and the child.
new text end
new text begin
(c) The agency may terminate the child's placement under paragraph (a) to protect the
child's health, safety, or welfare and may remove the child to foster care without a prior
court order or authorization.
new text end
new text begin Subd. 2. new text end
new text begin Case plans. new text end
new text begin
(a) Before a child may be colocated with a parent in a licensed
residential family-based substance use disorder treatment program, a recommendation that
the child's placement with a parent is in the child's best interests must be documented in the
child's case plan. Each child must have a written case plan developed with the parent and
the treatment program staff that describes the safety plan for the child and the treatment
program's responsibilities if the parent leaves or is discharged without completing the
program. The treatment program must be provided with a copy of the case plan that includes
the recommendations and safety plan at the time the child is colocated with the parent.
new text end
new text begin
(b) An out-of-home placement plan under section 260C.212, subdivision 1, must be
completed no later than 30 days from when a child is colocated with a parent in a licensed
residential family-based substance use disorder treatment program. The written plan
developed with parent and treatment program staff in paragraph (a) may be updated and
must be incorporated into the out-of-home placement plan. The treatment program must be
provided with a copy of the child's out-of-home placement plan.
new text end
new text begin Subd. 3. new text end
new text begin Required reviews and permanency proceedings. new text end
new text begin
(a) For a child colocated
with a parent under subdivision 1, court reviews must occur according to section 260C.202.
new text end
new text begin
(b) If a child has been in foster care for six months, a court review under section 260C.202
may be conducted in lieu of a permanency progress review hearing under section 260C.204
when the child is colocated with a parent consistent with section 260C.503, subdivision 3,
paragraph (c), in a licensed residential family-based substance use disorder treatment
program.
new text end
new text begin
(c) If the child is colocated with a parent in a licensed residential family-based substance
use disorder treatment program 12 months after the child was placed in foster care, the
agency must file a report with the court regarding the parent's progress in the treatment
program and the agency's reasonable efforts to finalize the child's safe and permanent return
to the care and custody of the parent consistent with section 260C.503, subdivision 3,
paragraph (c), in lieu of filing a petition required under section 260C.505.
new text end
new text begin
(d) The court shall make findings regarding the reasonable efforts of the agency to
finalize the child's return home as the permanency disposition order in the child's best
interests. The court may continue the child's foster care placement colocated with a parent
in a licensed residential family-based substance use disorder treatment program for up to
12 months. When a child has been in foster care placement for 12 months, but the duration
of the colocation with a parent in a licensed residential family-based substance use disorder
treatment program is less than 12 months, the court may continue the colocation with the
total time spent in foster care not exceeding 15 out of the most recent 22 months. If the
court finds that the agency fails to make reasonable efforts to finalize the child's return home
as the permanency disposition order in the child's best interests, the court may order additional
efforts to support the child remaining in the care of the parent.
new text end
new text begin
(e) If a parent leaves or is discharged from a licensed residential family-based substance
use disorder treatment program without completing the program, the child's placement under
this section is terminated and the agency may remove the child to foster care without a prior
court order or authorization. Within three days of any termination of a child's placement,
the agency shall notify the court and each party.
new text end
new text begin
(f) If a parent leaves or is discharged from a licensed residential family-based substance
use disorder treatment program without completing the program and the child has been in
foster care for less than six months, the court must hold a review hearing within ten days
of receiving notice of a termination of a child's placement and must order an alternative
disposition under section 260C.201.
new text end
new text begin
(g) If a parent leaves or is discharged from a licensed residential family-based substance
use disorder treatment program without completing the program and the child is colocated
with a parent and the child has been in foster care for more than six months but less than
12 months, the court must conduct a permanency progress review hearing under section
260C.204 no later than 30 days after the day the parent leaves or is discharged.
new text end
new text begin
(h) If a parent leaves or is discharged from a licensed residential family-based substance
use disorder treatment program without completing the program and the child is colocated
with a parent and the child has been in foster care for more than 12 months, the court shall
begin permanency proceedings under sections 260C.503 to 260C.521.
new text end
Sec. 31.
Minnesota Statutes 2018, section 260C.201, subdivision 1, is amended to read:
Subdivision 1.
Dispositions.
(a) If the court finds that the child is in need of protection
or services or neglected and in foster care, it shall enter an order making any of the following
dispositions of the case:
(1) place the child under the protective supervision of the responsible social services
agency or child-placing agency in the home of a parent of the child under conditions
prescribed by the court directed to the correction of the child's need for protection or services:
(i) the court may order the child into the home of a parent who does not otherwise have
legal custody of the child, however, an order under this section does not confer legal custody
on that parent;
(ii) if the court orders the child into the home of a father who is not adjudicated, the
father must cooperate with paternity establishment proceedings regarding the child in the
appropriate jurisdiction as one of the conditions prescribed by the court for the child to
continue in the father's home; and
(iii) the court may order the child into the home of a noncustodial parent with conditions
and may also order both the noncustodial and the custodial parent to comply with the
requirements of a case plan under subdivision 2; or
(2) transfer legal custody to one of the following:
(i) a child-placing agency; or
(ii) the responsible social services agency. In making a foster care placement for a child
whose custody has been transferred under this subdivision, the agency shall make an
individualized determination of how the placement is in the child's best interests using the
consideration for relatives deleted text begin anddeleted text end new text begin ,new text end the best interest factors in section 260C.212, subdivision 2,
paragraph (b)new text begin , and may include a child colocated with a parent in a licensed residential
family-based substance use disorder treatment program under section 260C.190new text end ; or
(3) order a trial home visit without modifying the transfer of legal custody to the
responsible social services agency under clause (2). Trial home visit means the child is
returned to the care of the parent or guardian from whom the child was removed for a period
not to exceed six months. During the period of the trial home visit, the responsible social
services agency:
(i) shall continue to have legal custody of the child, which means the agency may see
the child in the parent's home, at school, in a child care facility, or other setting as the agency
deems necessary and appropriate;
(ii) shall continue to have the ability to access information under section 260C.208;
(iii) shall continue to provide appropriate services to both the parent and the child during
the period of the trial home visit;
(iv) without previous court order or authorization, may terminate the trial home visit in
order to protect the child's health, safety, or welfare and may remove the child to foster care;
(v) shall advise the court and parties within three days of the termination of the trial
home visit when a visit is terminated by the responsible social services agency without a
court order; and
(vi) shall prepare a report for the court when the trial home visit is terminated whether
by the agency or court order which describes the child's circumstances during the trial home
visit and recommends appropriate orders, if any, for the court to enter to provide for the
child's safety and stability. In the event a trial home visit is terminated by the agency by
removing the child to foster care without prior court order or authorization, the court shall
conduct a hearing within ten days of receiving notice of the termination of the trial home
visit by the agency and shall order disposition under this subdivision or deleted text begin conduct a permanency
hearing under subdivision 11 or 11adeleted text end new text begin commence permanency proceedings under sections
260C.503 to 260C.515new text end . The time period for the hearing may be extended by the court for
good cause shown and if it is in the best interests of the child as long as the total time the
child spends in foster care without a permanency hearing does not exceed 12 months;
(4) if the child has been adjudicated as a child in need of protection or services because
the child is in need of special services or care to treat or ameliorate a physical or mental
disability or emotional disturbance as defined in section 245.4871, subdivision 15, the court
may order the child's parent, guardian, or custodian to provide it. The court may order the
child's health plan company to provide mental health services to the child. Section 62Q.535
applies to an order for mental health services directed to the child's health plan company.
If the health plan, parent, guardian, or custodian fails or is unable to provide this treatment
or care, the court may order it provided. Absent specific written findings by the court that
the child's disability is the result of abuse or neglect by the child's parent or guardian, the
court shall not transfer legal custody of the child for the purpose of obtaining special
treatment or care solely because the parent is unable to provide the treatment or care. If the
court's order for mental health treatment is based on a diagnosis made by a treatment
professional, the court may order that the diagnosing professional not provide the treatment
to the child if it finds that such an order is in the child's best interests; or
(5) if the court believes that the child has sufficient maturity and judgment and that it is
in the best interests of the child, the court may order a child 16 years old or older to be
allowed to live independently, either alone or with others as approved by the court under
supervision the court considers appropriate, if the county board, after consultation with the
court, has specifically authorized this dispositional alternative for a child.
(b) If the child was adjudicated in need of protection or services because the child is a
runaway or habitual truant, the court may order any of the following dispositions in addition
to or as alternatives to the dispositions authorized under paragraph (a):
(1) counsel the child or the child's parents, guardian, or custodian;
(2) place the child under the supervision of a probation officer or other suitable person
in the child's own home under conditions prescribed by the court, including reasonable rules
for the child's conduct and the conduct of the parents, guardian, or custodian, designed for
the physical, mental, and moral well-being and behavior of the child;
(3) subject to the court's supervision, transfer legal custody of the child to one of the
following:
(i) a reputable person of good moral character. No person may receive custody of two
or more unrelated children unless licensed to operate a residential program under sections
245A.01 to 245A.16; or
(ii) a county probation officer for placement in a group foster home established under
the direction of the juvenile court and licensed pursuant to section 241.021;
(4) require the child to pay a fine of up to $100. The court shall order payment of the
fine in a manner that will not impose undue financial hardship upon the child;
(5) require the child to participate in a community service project;
(6) order the child to undergo a chemical dependency evaluation and, if warranted by
the evaluation, order participation by the child in a drug awareness program or an inpatient
or outpatient chemical dependency treatment program;
(7) if the court believes that it is in the best interests of the child or of public safety that
the child's driver's license or instruction permit be canceled, the court may order the
commissioner of public safety to cancel the child's license or permit for any period up to
the child's 18th birthday. If the child does not have a driver's license or permit, the court
may order a denial of driving privileges for any period up to the child's 18th birthday. The
court shall forward an order issued under this clause to the commissioner, who shall cancel
the license or permit or deny driving privileges without a hearing for the period specified
by the court. At any time before the expiration of the period of cancellation or denial, the
court may, for good cause, order the commissioner of public safety to allow the child to
apply for a license or permit, and the commissioner shall so authorize;
(8) order that the child's parent or legal guardian deliver the child to school at the
beginning of each school day for a period of time specified by the court; or
(9) require the child to perform any other activities or participate in any other treatment
programs deemed appropriate by the court.
To the extent practicable, the court shall enter a disposition order the same day it makes
a finding that a child is in need of protection or services or neglected and in foster care, but
in no event more than 15 days after the finding unless the court finds that the best interests
of the child will be served by granting a delay. If the child was under eight years of age at
the time the petition was filed, the disposition order must be entered within ten days of the
finding and the court may not grant a delay unless good cause is shown and the court finds
the best interests of the child will be served by the delay.
(c) If a child who is 14 years of age or older is adjudicated in need of protection or
services because the child is a habitual truant and truancy procedures involving the child
were previously dealt with by a school attendance review board or county attorney mediation
program under section 260A.06 or 260A.07, the court shall order a cancellation or denial
of driving privileges under paragraph (b), clause (7), for any period up to the child's 18th
birthday.
(d) In the case of a child adjudicated in need of protection or services because the child
has committed domestic abuse and been ordered excluded from the child's parent's home,
the court shall dismiss jurisdiction if the court, at any time, finds the parent is able or willing
to provide an alternative safe living arrangement for the child, as defined in Laws 1997,
chapter 239, article 10, section 2.
(e) When a parent has complied with a case plan ordered under subdivision 6 and the
child is in the care of the parent, the court may order the responsible social services agency
to monitor the parent's continued ability to maintain the child safely in the home under such
terms and conditions as the court determines appropriate under the circumstances.
Sec. 32.
Minnesota Statutes 2018, section 260C.201, subdivision 2, is amended to read:
Subd. 2.
Written findings.
(a) Any order for a disposition authorized under this section
shall contain written findings of fact to support the disposition and case plan ordered and
shall also set forth in writing the following information:
(1) why the best interests and safety of the child are served by the disposition and case
plan ordered;
(2) what alternative dispositions or services under the case plan were considered by the
court and why such dispositions or services were not appropriate in the instant case;
(3) when legal custody of the child is transferred, the appropriateness of the particular
placement made or to be made by the placing agency using the factors in section 260C.212,
subdivision 2, paragraph (b)new text begin , or the appropriateness of a child colocated with a parent in a
licensed residential family-based substance use disorder treatment program under section
260C.190new text end ;
(4) whether reasonable efforts to finalize the permanent plan for the child consistent
with section 260.012 were made including reasonable efforts:
(i) to prevent the child's placement and to reunify the child with the parent or guardian
from whom the child was removed at the earliest time consistent with the child's safety.
The court's findings must include a brief description of what preventive and reunification
efforts were made and why further efforts could not have prevented or eliminated the
necessity of removal or that reasonable efforts were not required under section 260.012 or
260C.178, subdivision 1;
(ii) to identify and locate any noncustodial or nonresident parent of the child and to
assess such parent's ability to provide day-to-day care of the child, and, where appropriate,
provide services necessary to enable the noncustodial or nonresident parent to safely provide
day-to-day care of the child as required under section 260C.219, unless such services are
not required under section 260.012 or 260C.178, subdivision 1;
(iii) to make the diligent search for relatives and provide the notices required under
section 260C.221; a finding made pursuant to a hearing under section 260C.202 that the
agency has made diligent efforts to conduct a relative search and has appropriately engaged
relatives who responded to the notice under section 260C.221 and other relatives, who came
to the attention of the agency after notice under section 260C.221 was sent, in placement
and case planning decisions fulfills the requirement of this item;
(iv) to identify and make a foster care placement in the home of an unlicensed relative,
according to the requirements of section 245A.035, a licensed relative, or other licensed
foster care provider who will commit to being the permanent legal parent or custodian for
the child in the event reunification cannot occur, but who will actively support the
reunification plan for the child; and
(v) to place siblings together in the same home or to ensure visitation is occurring when
siblings are separated in foster care placement and visitation is in the siblings' best interests
under section 260C.212, subdivision 2, paragraph (d); and
(5) if the child has been adjudicated as a child in need of protection or services because
the child is in need of special services or care to treat or ameliorate a mental disability or
emotional disturbance as defined in section 245.4871, subdivision 15, the written findings
shall also set forth:
(i) whether the child has mental health needs that must be addressed by the case plan;
(ii) what consideration was given to the diagnostic and functional assessments performed
by the child's mental health professional and to health and mental health care professionals'
treatment recommendations;
(iii) what consideration was given to the requests or preferences of the child's parent or
guardian with regard to the child's interventions, services, or treatment; and
(iv) what consideration was given to the cultural appropriateness of the child's treatment
or services.
(b) If the court finds that the social services agency's preventive or reunification efforts
have not been reasonable but that further preventive or reunification efforts could not permit
the child to safely remain at home, the court may nevertheless authorize or continue the
removal of the child.
(c) If the child has been identified by the responsible social services agency as the subject
of concurrent permanency planning, the court shall review the reasonable efforts of the
agency to develop a permanency plan for the child that includes a primary plan which is
for reunification with the child's parent or guardian and a secondary plan which is for an
alternative, legally permanent home for the child in the event reunification cannot be achieved
in a timely manner.
Sec. 33.
Minnesota Statutes 2018, section 260C.201, subdivision 6, is amended to read:
Subd. 6.
Case plan.
(a) For each disposition ordered where the child is placed away
from a parent or guardian, the court shall order the responsible social services agency to
prepare a written out-of-home placement plan according to the requirements of section
260C.212, subdivision 1.new text begin When a foster child is colocated with a parent in a licensed
residential family-based substance use disorder treatment program under section 260C.190,
the case plan must specify the recommendation for the colocation before the child is colocated
with the parent.
new text end
(b) In cases where the child is not placed out of the home or is ordered into the home of
a noncustodial parent, the responsible social services agency shall prepare a plan for delivery
of social services to the child and custodial parent under section 626.556, subdivision 10,
or any other case plan required to meet the needs of the child. The plan shall be designed
to safely maintain the child in the home or to reunite the child with the custodial parent.
(c) The court may approve the case plan as presented or modify it after hearing from
the parties. Once the plan is approved, the court shall order all parties to comply with it. A
copy of the approved case plan shall be attached to the court's order and incorporated into
it by reference.
(d) A party has a right to request a court review of the reasonableness of the case plan
upon a showing of a substantial change of circumstances.
Sec. 34.
Minnesota Statutes 2018, section 260C.212, subdivision 2, is amended to read:
Subd. 2.
Placement decisions based on best interests of the child.
(a) The policy of
the state of Minnesota is to ensure that the child's best interests are met by requiring an
individualized determination of the needs of the child and of how the selected placement
will serve the needs of the child being placed. The authorized child-placing agency shall
place a child, released by court order or by voluntary release by the parent or parents, in a
family foster home selected by considering placement with relatives and important friends
in the following order:
(1) with an individual who is related to the child by blood, marriage, or adoption; or
(2) with an individual who is an important friend with whom the child has resided or
had significant contact.
For an Indian child, the agency shall follow the order of placement preferences in the Indian
Child Welfare Act of 1978, United States Code, title 25, section 1915.
(b) Among the factors the agency shall consider in determining the needs of the child
are the following:
(1) the child's current functioning and behaviors;
(2) the medical needs of the child;
(3) the educational needs of the child;
(4) the developmental needs of the child;
(5) the child's history and past experience;
(6) the child's religious and cultural needs;
(7) the child's connection with a community, school, and faith community;
(8) the child's interests and talents;
(9) the child's relationship to current caretakers, parents, siblings, and relatives;
(10) the reasonable preference of the child, if the court, or the child-placing agency in
the case of a voluntary placement, deems the child to be of sufficient age to express
preferences; and
(11) for an Indian child, the best interests of an Indian child as defined in section 260.755,
subdivision 2a.
(c) Placement of a child cannot be delayed or denied based on race, color, or national
origin of the foster parent or the child.
(d) Siblings should be placed together for foster care and adoption at the earliest possible
time unless it is documented that a joint placement would be contrary to the safety or
well-being of any of the siblings or unless it is not possible after reasonable efforts by the
responsible social services agency. In cases where siblings cannot be placed together, the
agency is required to provide frequent visitation or other ongoing interaction between
siblings unless the agency documents that the interaction would be contrary to the safety
or well-being of any of the siblings.
(e) Except for emergency placement as provided for in section 245A.035, the following
requirements must be satisfied before the approval of a foster or adoptive placement in a
related or unrelated home: (1) a completed background study under section 245C.08; and
(2) a completed review of the written home study required under section 260C.215,
subdivision 4, clause (5), or 260C.611, to assess the capacity of the prospective foster or
adoptive parent to ensure the placement will meet the needs of the individual child.
new text begin
(f) The agency must determine whether colocation with a parent who is receiving services
in a licensed residential family-based substance use disorder treatment program is in the
child's best interests according to paragraph (b) and include that determination in the child's
case plan. The agency may consider additional factors not identified in paragraph (b). The
agency's determination must be documented in the child's case plan before the child is
colocated with a parent.
new text end
Sec. 35.
new text begin
[260C.228] VOLUNTARY FOSTER CARE; CHILD IS COLOCATED
WITH PARENT IN TREATMENT PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Generally. new text end
new text begin
When a parent requests assistance from an agency and both
the parent and agency agree that a child's placement in foster care and colocation with a
parent in a licensed residential family-based substance use treatment facility as defined by
section 260C.007, subdivision 22a, is in the child's best interests, the agency must specify
the recommendation for the placement in the child's case plan. After the child's case plan
includes the recommendation, the agency and the parent may enter into a written voluntary
placement agreement on a form approved by the commissioner.
new text end
new text begin Subd. 2. new text end
new text begin Judicial review. new text end
new text begin
(a) A judicial review of a child's voluntary placement is
required within 165 days of the date the voluntary agreement was signed. The agency
responsible for the child's placement in foster care shall request the judicial review.
new text end
new text begin
(b) The agency must forward a written report to the court at least five business days
prior to the judicial review in paragraph (a). The report must contain:
new text end
new text begin
(i) a statement regarding whether the colocation of the child with a parent in a licensed
residential family-based substance use disorder treatment program meets the child's needs
and continues to be in the child's best interests;
new text end
new text begin
(ii) the child's name, dates of birth, race, gender, and current address;
new text end
new text begin
(iii) the names, race, dates of birth, residences, and post office addresses of the child's
parents or custodian;
new text end
new text begin
(iv) a statement regarding the child's eligibility for membership or enrollment in an
Indian tribe and the agency's compliance with applicable provisions of sections 260.751 to
260.835;
new text end
new text begin
(v) the name and address of the licensed residential family-based substance use disorder
treatment program where the child and parent or custodian are colocated;
new text end
new text begin
(vi) a copy of the out-of-home placement plan under section 260C.212, subdivisions 1
and 3;
new text end
new text begin
(vii) a written summary of the proceedings of any administrative review required under
section 260C.203; and
new text end
new text begin
(viii) any other information the agency, parent or custodian, child, or licensed residential
family-based substance use disorder treatment program wants the court to consider.
new text end
new text begin
(c) The agency must inform a child, if the child is 12 years of age or older; the child's
parent; and the licensed residential family-based substance use disorder treatment program
of the reporting and court review requirements of this section and of their rights to submit
information to the court as follows:
new text end
new text begin
(1) if the child, the child's parent, or the licensed residential family-based substance use
disorder treatment program wants to send information to the court, the agency shall advise
those persons of the reporting date and the date by which the agency must receive the
information to submit to the court with the agency's report; and
new text end
new text begin
(2) the agency must inform the child, the child's parent, and the licensed residential
family-based substance use disorder treatment program that they have the right to be heard
in person by the court. An in-person hearing must be held if requested by the child, parent
or legal guardian, or licensed residential family-based substance use disorder treatment
program.
new text end
new text begin
(d) If, at the time required for the agency's report under this section, a child 12 years of
age or older disagrees about the placement colocating the child with the parent in a licensed
residential family-based substance use disorder treatment program or services provided
under the out-of-home placement plan under section 260C.212, subdivision 1, the agency
shall include information regarding the child's disagreement and to the extent possible the
basis for the child's disagreement in the report.
new text end
new text begin
(e) Regardless of whether an in-person hearing is requested within ten days of receiving
the agency's report, the court has jurisdiction to and must determine:
new text end
new text begin
(i) whether the voluntary foster care arrangement is in the child's best interests;
new text end
new text begin
(ii) whether the parent and agency are appropriately planning for the child; and
new text end
new text begin
(iii) if a child 12 years of age or older disagrees with the foster care placement colocating
the child with the parent in a licensed residential family-based substance use disorder
treatment program or services provided under the out-of-home placement plan, whether to
appoint counsel and a guardian ad litem for the child according to section 260C.163.
new text end
new text begin
(f) Unless requested by the parent, representative of the licensed residential family-based
substance use disorder treatment program, or child, an in-person hearing is not required for
the court to make findings and issue an order.
new text end
new text begin
(g) If the court finds the voluntary foster care arrangement is in the child's best interests
and that the agency and parent are appropriately planning for the child, the court shall issue
an order containing explicit individualized findings to support the court's determination.
The individual findings shall be based on the agency's written report and other materials
submitted to the court. The court may make this determination notwithstanding the child's
disagreement, if any, reported to the court under paragraph (d).
new text end
new text begin
(h) The court shall send a copy of the order to the county attorney, the agency, the parent,
a child 12 years of age or older, and the licensed residential family-based substance use
disorder treatment program.
new text end
new text begin
(i) If the court finds continuing the voluntary foster care arrangement is not in the child's
best interests or that the agency or the parent is not appropriately planning for the child, the
court shall notify the agency, the parent, the licensed residential family-based substance
use disorder treatment program, a child 12 years of age or older, and the county attorney of
the court's determination and the basis for the court's determination. The court shall set the
matter for hearing and appoint a guardian ad litem for the child under section 260C.163,
subdivision 5.
new text end
new text begin Subd. 3. new text end
new text begin Termination. new text end
new text begin
The voluntary placement agreement terminates at the parent's
discharge from the licensed residential family-based substance use disorder treatment
program, or upon receipt of a written and dated request from the parent, unless the request
specifies a later date. If the child's voluntary foster care placement meets the calculated time
to require a permanency proceeding under section 260C.503, subdivision 3, paragraph (a),
and the child is not returned home, the agency must file a petition according to section
260C.141 or 260C.505.
new text end
Sec. 36.
Minnesota Statutes 2018, section 260C.452, subdivision 4, is amended to read:
Subd. 4.
Administrative or court review of placements.
(a) When the child is 14 years
of age or older, the court, in consultation with the child, shall review the independent living
plan according to section 260C.203, paragraph (d).
(b) The responsible social services agency shall file a copy of the notification required
in subdivision 3 with the court. If the responsible social services agency does not file the
notice by the time the child is 17-1/2 years of age, the court shall require the responsible
social services agency to file the notice.
(c) The court shall ensure that the responsible social services agency assists the child in
obtaining the following documents before the child leaves foster care: a Social Security
card; an official or certified copy of the child's birth certificate; a state identification card
or driver's license, tribal enrollment identification card, green card, or school visa; health
insurance information; the child's school, medical, and dental records; a contact list of the
child's medical, dental, and mental health providers; and contact information for the child's
siblings, if the siblings are in foster care.
(d) For a child who will be discharged from foster care at 18 years of age or older, the
responsible social services agency must develop a personalized transition plan as directed
by the child during the 90-day period immediately prior to the expected date of discharge.
The transition plan must be as detailed as the child elects and include specific options,
including but not limited to:
(1) affordable housing with necessary supports that does not include a homeless shelter;
(2) health insurance, including eligibility for medical assistance as defined in section
256B.055, subdivision 17;
(3) education, including application to the Education and Training Voucher Program;
(4) local opportunities for mentors and continuing support services, including the Healthy
Transitions and Homeless Prevention program, if available;
(5) workforce supports and employment services;
(6) a copy of the child's consumer credit report as defined in section 13C.001 and
assistance in interpreting and resolving any inaccuracies in the report, at no cost to the child;
(7) information on executing a health care directive under chapter 145C and on the
importance of designating another individual to make health care decisions on behalf of the
child if the child becomes unable to participate in decisions; deleted text begin and
deleted text end
(8) appropriate contact information through 21 years of age if the child needs information
or help dealing with a crisis situationdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(9) official documentation that the youth was previously in foster care.
new text end
Sec. 37.
Minnesota Statutes 2018, section 260C.503, subdivision 1, is amended to read:
Subdivision 1.
Required permanency proceedings.
new text begin (a) new text end Except for children in foster
care pursuant to chapter 260D, where the child is in foster care or in the care of a noncustodial
or nonresident parent, the court shall commence proceedings to determine the permanent
status of a child by holding the admit-deny hearing required under section 260C.507 not
later than 12 months after the child is placed in foster care or in the care of a noncustodial
or nonresident parent. Permanency proceedings for children in foster care pursuant to chapter
260D shall be according to section 260D.07.
new text begin
(b) Permanency proceedings for a foster child who is colocated with a parent in a licensed
residential family-based substance use disorder treatment program shall be conducted
according to section 260C.190.
new text end
Sec. 38.
Minnesota Statutes 2018, section 518A.32, subdivision 3, is amended to read:
Subd. 3.
Parent not considered voluntarily unemployed, underemployed, or employed
on a less than full-time basis.
A parent is not considered voluntarily unemployed,
underemployed, or employed on a less than full-time basis upon a showing by the parent
that:
(1) the unemployment, underemployment, or employment on a less than full-time basis
is temporary and will ultimately lead to an increase in income;
(2) the unemployment, underemployment, or employment on a less than full-time basis
represents a bona fide career change that outweighs the adverse effect of that parent's
diminished income on the child; or
(3) the unemployment, underemployment, or employment on a less than full-time basis
is because a parent is physically or mentally incapacitated or due to incarcerationdeleted text begin , except
where the reason for incarceration is the parent's nonpayment of supportdeleted text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 39.
Minnesota Statutes 2018, section 626.556, subdivision 10, is amended to read:
Subd. 10.
Duties of local welfare agency and local law enforcement agency upon
receipt of report; mandatory notification between police or sheriff and agency.
(a) The
police department or the county sheriff shall immediately notify the local welfare agency
or agency responsible for child protection reports under this section orally and in writing
when a report is received. The local welfare agency or agency responsible for child protection
reports shall immediately notify the local police department or the county sheriff orally and
in writing when a report is received. The county sheriff and the head of every local welfare
agency, agency responsible for child protection reports, and police department shall each
designate a person within their agency, department, or office who is responsible for ensuring
that the notification duties of this paragraph are carried out. When the alleged maltreatment
occurred on tribal land, the local welfare agency or agency responsible for child protection
reports and the local police department or the county sheriff shall immediately notify the
tribe's social services agency and tribal law enforcement orally and in writing when a report
is received.
(b) Upon receipt of a report, the local welfare agency shall determine whether to conduct
a family assessment or an investigation as appropriate to prevent or provide a remedy for
child maltreatment. The local welfare agency:
(1) shall conduct an investigation on reports involving sexual abuse or substantial child
endangerment;
(2) shall begin an immediate investigation if, at any time when it is using a family
assessment response, it determines that there is reason to believe that sexual abuse or
substantial child endangerment or a serious threat to the child's safety exists;
(3) may conduct a family assessment for reports that do not allege sexual abuse or
substantial child endangerment. In determining that a family assessment is appropriate, the
local welfare agency may consider issues of child safety, parental cooperation, and the need
for an immediate response;
(4) may conduct a family assessment on a report that was initially screened and assigned
for an investigation. In determining that a complete investigation is not required, the local
welfare agency must document the reason for terminating the investigation and notify the
local law enforcement agency if the local law enforcement agency is conducting a joint
investigation; and
(5) shall provide immediate notice, according to section 260.761, subdivision 2, to an
Indian child's tribe when the agency has reason to believe the family assessment or
investigation may involve an Indian child. For purposes of this clause, "immediate notice"
means notice provided within 24 hours.
If the report alleges neglect, physical abuse, or sexual abuse by a parent, guardian, or
individual functioning within the family unit as a person responsible for the child's care, or
sexual abuse by a person with a significant relationship to the child when that person resides
in the child's household or by a sibling, the local welfare agency shall immediately conduct
a family assessment or investigation as identified in clauses (1) to (4). In conducting a family
assessment or investigation, the local welfare agency shall gather information on the existence
of substance abuse and domestic violence and offer services for purposes of preventing
future child maltreatment, safeguarding and enhancing the welfare of the abused or neglected
minor, and supporting and preserving family life whenever possible. If the report alleges a
violation of a criminal statute involving sexual abuse, physical abuse, or neglect or
endangerment, under section 609.378, the local law enforcement agency and local welfare
agency shall coordinate the planning and execution of their respective investigation and
assessment efforts to avoid a duplication of fact-finding efforts and multiple interviews.
Each agency shall prepare a separate report of the results of its investigation or assessment.
In cases of alleged child maltreatment resulting in death, the local agency may rely on the
fact-finding efforts of a law enforcement investigation to make a determination of whether
or not maltreatment occurred. When necessary the local welfare agency shall seek authority
to remove the child from the custody of a parent, guardian, or adult with whom the child is
living. In performing any of these duties, the local welfare agency shall maintain appropriate
records.
If the family assessment or investigation indicates there is a potential for abuse of alcohol
or other drugs by the parent, guardian, or person responsible for the child's care, the local
welfare agency shall conduct a chemical use assessment pursuant to Minnesota Rules, part
9530.6615.
(c) When a local agency receives a report or otherwise has information indicating that
a child who is a client, as defined in section 245.91, has been the subject of physical abuse,
sexual abuse, or neglect at an agency, facility, or program as defined in section 245.91, it
shall, in addition to its other duties under this section, immediately inform the ombudsman
established under sections 245.91 to 245.97. The commissioner of education shall inform
the ombudsman established under sections 245.91 to 245.97 of reports regarding a child
defined as a client in section 245.91 that maltreatment occurred at a school as defined in
section 120A.05, subdivisions 9, 11, and 13, and chapter 124E.
(d) Authority of the local welfare agency responsible for assessing or investigating the
child abuse or neglect report, the agency responsible for assessing or investigating the report,
and of the local law enforcement agency for investigating the alleged abuse or neglect
includes, but is not limited to, authority to interview, without parental consent, the alleged
victim and any other minors who currently reside with or who have resided with the alleged
offender. The interview may take place at school or at any facility or other place where the
alleged victim or other minors might be found or the child may be transported to, and the
interview conducted at, a place appropriate for the interview of a child designated by the
local welfare agency or law enforcement agency. The interview may take place outside the
presence of the alleged offender or parent, legal custodian, guardian, or school official. For
family assessments, it is the preferred practice to request a parent or guardian's permission
to interview the child prior to conducting the child interview, unless doing so would
compromise the safety assessment. Except as provided in this paragraph, the parent, legal
custodian, or guardian shall be notified by the responsible local welfare or law enforcement
agency no later than the conclusion of the investigation or assessment that this interview
has occurred. Notwithstanding rule 32 of the Minnesota Rules of Procedure for Juvenile
Courts, the juvenile court may, after hearing on an ex parte motion by the local welfare
agency, order that, where reasonable cause exists, the agency withhold notification of this
interview from the parent, legal custodian, or guardian. If the interview took place or is to
take place on school property, the order shall specify that school officials may not disclose
to the parent, legal custodian, or guardian the contents of the notification of intent to interview
the child on school property, as provided under this paragraph, and any other related
information regarding the interview that may be a part of the child's school record. A copy
of the order shall be sent by the local welfare or law enforcement agency to the appropriate
school official.
(e) When the local welfare, local law enforcement agency, or the agency responsible
for assessing or investigating a report of maltreatment determines that an interview should
take place on school property, written notification of intent to interview the child on school
property must be received by school officials prior to the interview. The notification shall
include the name of the child to be interviewed, the purpose of the interview, and a reference
to the statutory authority to conduct an interview on school property. For interviews
conducted by the local welfare agency, the notification shall be signed by the chair of the
local social services agency or the chair's designee. The notification shall be private data
on individuals subject to the provisions of this paragraph. School officials may not disclose
to the parent, legal custodian, or guardian the contents of the notification or any other related
information regarding the interview until notified in writing by the local welfare or law
enforcement agency that the investigation or assessment has been concluded, unless a school
employee or agent is alleged to have maltreated the child. Until that time, the local welfare
or law enforcement agency or the agency responsible for assessing or investigating a report
of maltreatment shall be solely responsible for any disclosures regarding the nature of the
assessment or investigation.
Except where the alleged offender is believed to be a school official or employee, the
time and place, and manner of the interview on school premises shall be within the discretion
of school officials, but the local welfare or law enforcement agency shall have the exclusive
authority to determine who may attend the interview. The conditions as to time, place, and
manner of the interview set by the school officials shall be reasonable and the interview
shall be conducted not more than 24 hours after the receipt of the notification unless another
time is considered necessary by agreement between the school officials and the local welfare
or law enforcement agency. Where the school fails to comply with the provisions of this
paragraph, the juvenile court may order the school to comply. Every effort must be made
to reduce the disruption of the educational program of the child, other students, or school
staff when an interview is conducted on school premises.
(f) Where the alleged offender or a person responsible for the care of the alleged victim
or other minor prevents access to the victim or other minor by the local welfare agency, the
juvenile court may order the parents, legal custodian, or guardian to produce the alleged
victim or other minor for questioning by the local welfare agency or the local law
enforcement agency outside the presence of the alleged offender or any person responsible
for the child's care at reasonable places and times as specified by court order.
(g) Before making an order under paragraph (f), the court shall issue an order to show
cause, either upon its own motion or upon a verified petition, specifying the basis for the
requested interviews and fixing the time and place of the hearing. The order to show cause
shall be served personally and shall be heard in the same manner as provided in other cases
in the juvenile court. The court shall consider the need for appointment of a guardian ad
litem to protect the best interests of the child. If appointed, the guardian ad litem shall be
present at the hearing on the order to show cause.
(h) The commissioner of human services, the ombudsman for mental health and
developmental disabilities, the local welfare agencies responsible for investigating reports,
the commissioner of education, and the local law enforcement agencies have the right to
enter facilities as defined in subdivision 2 and to inspect and copy the facility's records,
including medical records, as part of the investigation. Notwithstanding the provisions of
chapter 13, they also have the right to inform the facility under investigation that they are
conducting an investigation, to disclose to the facility the names of the individuals under
investigation for abusing or neglecting a child, and to provide the facility with a copy of
the report and the investigative findings.
(i) The local welfare agency responsible for conducting a family assessment or
investigation shall collect available and relevant information to determine child safety, risk
of subsequent child maltreatment, and family strengths and needs and share not public
information with an Indian's tribal social services agency without violating any law of the
state that may otherwise impose duties of confidentiality on the local welfare agency in
order to implement the tribal state agreement. The local welfare agency or the agency
responsible for investigating the report shall collect available and relevant information to
ascertain whether maltreatment occurred and whether protective services are needed.
Information collected includes, when relevant, information with regard to the person reporting
the alleged maltreatment, including the nature of the reporter's relationship to the child and
to the alleged offender, and the basis of the reporter's knowledge for the report; the child
allegedly being maltreated; the alleged offender; the child's caretaker; and other collateral
sources having relevant information related to the alleged maltreatment. new text begin As a part of
determining whether child protective services are needed, the local welfare agency
responsible for conducting the family assessment or investigation shall submit a request to
the commissioner of human services to collect child abuse and neglect records maintained
in each state other than Minnesota where the alleged offender has resided in the preceding
five years. The commissioner shall send out-of-state child abuse and neglect records inquiries
to the relevant states within three business days of receiving the request from the local
welfare agency. The commissioner shall forward the results of these inquiries to the local
welfare agency responsible for conducting the family assessment or investigation as they
are received. The commissioner shall inform the local welfare agency if the commissioner
does not receive a response from all states with records required to be searched within 20
business days.new text end The local welfare agency or the agency responsible for investigating the
report may make a determination of no maltreatment early in an investigation, and close
the case and retain immunity, if the collected information shows no basis for a full
investigation.
Information relevant to the assessment or investigation must be asked for, and may
include:
(1) the child's sex and age; prior reports of maltreatment, including any maltreatment
reports that were screened out and not accepted for assessment or investigation; information
relating to developmental functioning; credibility of the child's statement; and whether the
information provided under this clause is consistent with other information collected during
the course of the assessment or investigation;
(2) the alleged offender's agedeleted text begin ,deleted text end new text begin andnew text end a record check for prior deleted text begin reports of maltreatment, anddeleted text end
criminal charges and convictions. The local welfare agency or the agency responsible for
assessing or investigating the report must provide the alleged offender with an opportunity
to make a statement. The alleged offender may submit supporting documentation relevant
to the assessment or investigation;
(3) collateral source information regarding the alleged maltreatment and care of the
child. Collateral information includes, when relevant: (i) a medical examination of the child;
(ii) prior medical records relating to the alleged maltreatment or the care of the child
maintained by any facility, clinic, or health care professional and an interview with the
treating professionals; and (iii) interviews with the child's caretakers, including the child's
parent, guardian, foster parent, child care provider, teachers, counselors, family members,
relatives, and other persons who may have knowledge regarding the alleged maltreatment
and the care of the child; and
(4) information on the existence of domestic abuse and violence in the home of the child,
and substance abuse.
Nothing in this paragraph precludes the local welfare agency, the local law enforcement
agency, or the agency responsible for assessing or investigating the report from collecting
other relevant information necessary to conduct the assessment or investigation.
Notwithstanding sections 13.384 or 144.291 to 144.298, the local welfare agency has access
to medical data and records for purposes of clause (3). Notwithstanding the data's
classification in the possession of any other agency, data acquired by the local welfare
agency or the agency responsible for assessing or investigating the report during the course
of the assessment or investigation are private data on individuals and must be maintained
in accordance with subdivision 11. Data of the commissioner of education collected or
maintained during and for the purpose of an investigation of alleged maltreatment in a school
are governed by this section, notwithstanding the data's classification as educational,
licensing, or personnel data under chapter 13.
In conducting an assessment or investigation involving a school facility as defined in
subdivision 2, paragraph (c), the commissioner of education shall collect investigative
reports and data that are relevant to a report of maltreatment and are from local law
enforcement and the school facility.
(j) Upon receipt of a report, the local welfare agency shall conduct a face-to-face contact
with the child reported to be maltreated and with the child's primary caregiver sufficient to
complete a safety assessment and ensure the immediate safety of the child. The face-to-face
contact with the child and primary caregiver shall occur immediately if sexual abuse or
substantial child endangerment is alleged and within five calendar days for all other reports.
If the alleged offender was not already interviewed as the primary caregiver, the local welfare
agency shall also conduct a face-to-face interview with the alleged offender in the early
stages of the assessment or investigation. At the initial contact, the local child welfare agency
or the agency responsible for assessing or investigating the report must inform the alleged
offender of the complaints or allegations made against the individual in a manner consistent
with laws protecting the rights of the person who made the report. The interview with the
alleged offender may be postponed if it would jeopardize an active law enforcement
investigation.
(k) When conducting an investigation, the local welfare agency shall use a question and
answer interviewing format with questioning as nondirective as possible to elicit spontaneous
responses. For investigations only, the following interviewing methods and procedures must
be used whenever possible when collecting information:
(1) audio recordings of all interviews with witnesses and collateral sources; and
(2) in cases of alleged sexual abuse, audio-video recordings of each interview with the
alleged victim and child witnesses.
(l) In conducting an assessment or investigation involving a school facility as defined
in subdivision 2, paragraph (c), the commissioner of education shall collect available and
relevant information and use the procedures in paragraphs (j) and (k), and subdivision 3d,
except that the requirement for face-to-face observation of the child and face-to-face interview
of the alleged offender is to occur in the initial stages of the assessment or investigation
provided that the commissioner may also base the assessment or investigation on investigative
reports and data received from the school facility and local law enforcement, to the extent
those investigations satisfy the requirements of paragraphs (j) and (k), and subdivision 3d.
Sec. 40.
Minnesota Statutes 2018, section 626.5561, subdivision 1, is amended to read:
Subdivision 1.
Reports required.
(a) Except as provided in paragraph (b), a person
mandated to report under section 626.556, subdivision 3, shall immediately report to the
local welfare agency if the person knows or has reason to believe that a woman is pregnant
and has used a controlled substance for a nonmedical purpose during the pregnancy,
including, but not limited to, tetrahydrocannabinol, or has consumed alcoholic beverages
during the pregnancy in any way that is habitual or excessive.
(b) A health care professional or a social service professional who is mandated to report
under section 626.556, subdivision 3, is exempt from reporting under paragraph (a) deleted text begin a
woman's use or consumption of tetrahydrocannabinol or alcoholic beverages during
pregnancydeleted text end if the professional is providingnew text begin or collaborating with other professionals to providenew text end
the woman with prenatal care or other health care services.
(c) Any person may make a voluntary report if the person knows or has reason to believe
that a woman is pregnant and has used a controlled substance for a nonmedical purpose
during the pregnancy, including, but not limited to, tetrahydrocannabinol, or has consumed
alcoholic beverages during the pregnancy in any way that is habitual or excessive.
(d) An oral report shall be made immediately by telephone or otherwise. An oral report
made by a person required to report shall be followed within 72 hours, exclusive of weekends
and holidays, by a report in writing to the local welfare agency. Any report shall be of
sufficient content to identify the pregnant woman, the nature and extent of the use, if known,
and the name and address of the reporter. The local welfare agency shall accept a report
made under paragraph (c) notwithstanding refusal by a voluntary reporter to provide the
reporter's name or address as long as the report is otherwise sufficient.
(e) For purposes of this section, "prenatal care" means the comprehensive package of
medical and psychological support provided throughout the pregnancy.
Sec. 41. new text begin TITLE.
new text end
new text begin
Sections 39 and 42 shall be known as "Heaven's Law."
new text end
Sec. 42. new text begin INTERSTATE TRANSFER OF CHILD PROTECTION DATA.
new text end
new text begin
The commissioner of human services is directed to investigate and report to the legislature
on potential improvements and advancements in the sharing of child maltreatment data
between states, including consideration for interstate compacts or interstate agreements to
improve access to child maltreatment investigative and determination data to protect the
welfare of children in Minnesota and throughout the country. The commissioner shall report
to the legislature on challenges and solutions to the sharing of data on child maltreatment
between states no later than February 1, 2020.
new text end
Sec. 43. new text begin INSTRUCTION TO COMMISSIONER.
new text end
new text begin
All individuals in connection with a licensed children's residential facility required to
complete a background study under Minnesota Statutes, chapter 245C, must complete a
new background study consistent with the obligations and requirements of this article. The
commissioner of human services shall establish a schedule for (1) individuals in connection
with a licensed children's residential facility that serves children eligible to receive federal
Title IV-E funding to complete the new background study by March 1, 2020, and (2)
individuals in connection with a licensed children's residential facility that serves children
not eligible to receive federal Title IV-E funding to complete the new background study by
March 1, 2021.
new text end
Sec. 44. new text begin CHILD WELFARE TRAINING ACADEMY.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment; purpose. new text end
new text begin
The commissioner of human services shall
modify the Child Welfare Training System developed pursuant to Minnesota Statutes,
section 626.5591, subdivision 2, according to this section. The new training framework
shall be known as the Child Welfare Training Academy.
new text end
new text begin Subd. 2. new text end
new text begin Administration. new text end
new text begin
(a) The Child Welfare Training Academy must be administered
through five regional hubs in northwest, northeast, southwest, southeast, and central
Minnesota. Each hub must deliver training targeted to the needs of the hub's particular
region, taking into account varying demographics, resources, and practice outcomes.
new text end
new text begin
(b) The Child Welfare Training Academy must use training methods best suited to the
training content. National best practices in adult learning must be used to the greatest extent
possible, including online learning methodologies, coaching, mentoring, and simulated skill
application.
new text end
new text begin
(c) Content of training delivered by the Child Welfare Training Academy must be
informed using multidisciplinary approaches and must include input from stakeholders,
including but not limited to child welfare professionals, resource parents, biological parents
and caregivers, and other community members with expertise in child welfare racial
disparities and implicit bias. Content must be structured to reflect the variety of communities
served by the child welfare system in Minnesota and must be informed with attention to
both child safety and the evidence-based understanding that maintaining family relationships
and preventing out-of-home placement are essential to child well-being. Training delivered
by the Child Welfare Training Academy must emphasize racial disparities and
disproportionate child welfare outcomes that exist in Minnesota and must include specific
content on recognizing and addressing implicit bias.
new text end
new text begin
(d) Each child welfare worker and supervisor must complete a certification, including
a competency-based knowledge test and a skills demonstration, at the completion of the
worker's or supervisor's initial training and biennially thereafter. The commissioner shall
develop ongoing training requirements and a method for tracking certifications.
new text end
new text begin
(e) The Child Welfare Training Academy must serve the primary training audiences of
(1) county and tribal child welfare workers, (2) county and tribal child welfare supervisors,
and (3) staff at private agencies providing out-of-home placement services for children
involved in Minnesota's county and tribal child welfare system.
new text end
new text begin Subd. 3. new text end
new text begin Partnerships. new text end
new text begin
The commissioner of human services shall enter into a partnership
with the University of Minnesota to collaborate in the administration of workforce training.
new text end
new text begin Subd. 4. new text end
new text begin Rulemaking. new text end
new text begin
The commissioner of human services may adopt rules as necessary
to establish the Child Welfare Training Academy.
new text end
Sec. 45. new text begin CHILD WELFARE CASELOAD STUDY.
new text end
new text begin
(a) The commissioner of human services shall conduct a child welfare caseload study
to collect data on (1) the number of child welfare workers in Minnesota, and (2) the amount
of time that child welfare workers spend on different components of child welfare work.
The study must be completed by October 1, 2020.
new text end
new text begin
(b) The commissioner shall report the results of the child welfare caseload study to the
governor and to the chairs and ranking minority members of the committees in the house
of representatives and senate with jurisdiction over human services by December 1, 2020.
new text end
new text begin
(c) After the child welfare caseload study is complete, the commissioner shall work with
counties and other stakeholders to develop a process for ongoing monitoring of child welfare
workers' caseloads.
new text end
Sec. 46. new text begin FIRST CHILDREN'S FINANCE CHILD CARE SITE ASSISTANCE.
new text end
new text begin Subdivision 1. new text end
new text begin Purposes. new text end
new text begin
Grants to First Children's Finance are for loans to improve
child care or early childhood education sites, or loans to plan, design, and construct or
expand licensed and legal nonlicensed sites to increase the availability of child care or early
childhood education.
new text end
new text begin Subd. 2. new text end
new text begin Financing program. new text end
new text begin
(a) First Children's Finance must use grant funds to:
new text end
new text begin
(1) establish a revolving loan fund to make loans to existing, expanding, and newly
licensed and legally unlicensed child care and early childhood education sites;
new text end
new text begin
(2) establish a fund to guarantee private loans to improve or construct a child care or
early childhood education site;
new text end
new text begin
(3) establish a fund to provide forgivable loans or grants to match all or part of a loan
made under this section;
new text end
new text begin
(4) establish a fund as a reserve against bad debt; and
new text end
new text begin
(5) establish a fund to provide business planning assistance for child care providers.
new text end
new text begin
(b) First Children's Finance must establish the terms and conditions for loans and loan
guarantees including interest rates, repayment agreements, private match requirements, and
conditions for loan forgiveness. A minimum interest rate for loans must be established to
ensure that necessary loan administration costs are covered. Interest earnings may be used
for administrative expenses.
new text end
new text begin Subd. 3. new text end
new text begin Reporting. new text end
new text begin
First Children's Finance must:
new text end
new text begin
(1) by September 30, 2020, and September 30, 2021, report to the commissioner of
human services the purposes for which the money was used during the past fiscal year,
including a description of projects supported by the financing, an account of loans made
during the calendar year, the financing program's assets and liabilities, and an explanation
of administrative expenses; and
new text end
new text begin
(2) submit to the commissioner of human services a copy of the report of an independent
audit performed in accordance with generally accepted accounting practices and auditing
standards, for each fiscal year in which grants are received.
new text end
Sec. 47. new text begin DIRECTION TO COMMISSIONER; HOMELESS YOUTH ACCESS TO
BIRTH RECORDS AND MINNESOTA IDENTIFICATION CARDS.
new text end
new text begin
No later than January 15, 2020, the commissioner of human services, in consultation
with the commissioners of health and public safety, shall report to the chairs and ranking
minority members of the legislative committees and divisions with jurisdiction over the
Homeless Youth Act with recommendations on providing homeless youth with access to
birth records and Minnesota identification cards at no cost.
new text end
Sec. 48. new text begin DIRECTION TO COMMISSIONER; FAMILY FIRST PREVENTION
KINSHIP SERVICES.
new text end
new text begin
The commissioner of human services shall review opportunities to implement kinship
navigator models that support placement of children with relative foster parents in anticipation
of reimbursement for eligible services under the Family First Prevention Services Act.
Kinship navigator models would assist relative foster parents with home studies and licensing
requirements and provide ongoing support to the relative caregivers and children in
out-of-home placement with relatives.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 49. new text begin DIRECTION TO COMMISSIONER; RELATIVE SEARCH.
new text end
new text begin
The commissioner of human services shall develop and provide guidance to assist local
social services agencies in conducting relative searches under Minnesota Statutes, section
260C.221. The commissioner shall issue a bulletin containing relative search guidance by
January 1, 2020. Guidance from the commissioner shall relate to:
new text end
new text begin
(1) easily understandable methods of relative notification;
new text end
new text begin
(2) resources for local social services agency child welfare staff to improve engagement
and communication with relatives and kin; and
new text end
new text begin
(3) providing information to relatives and kin about all permanency options, sustaining
relationships, visitation options, and supporting permanency.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 50. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2018, sections 119B.16, subdivision 2; and 245E.06, subdivisions
2, 4, and 5,
new text end
new text begin
and
new text end
new text begin
Minnesota Rules, part 3400.0185, subpart 5,
new text end
new text begin
are repealed effective February
26, 2021.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Rules, part 2960.3030, subpart 3,
new text end
new text begin
is repealed.
new text end
ARTICLE 2
OPERATIONS
Section 1.
Minnesota Statutes 2018, section 13.46, subdivision 2, is amended to read:
Subd. 2.
General.
(a) Data on individuals collected, maintained, used, or disseminated
by the welfare system are private data on individuals, and shall not be disclosed except:
(1) according to section 13.05;
(2) according to court order;
(3) according to a statute specifically authorizing access to the private data;
(4) to an agent of the welfare system and an investigator acting on behalf of a county,
the state, or the federal government, including a law enforcement person or attorney in the
investigation or prosecution of a criminal, civil, or administrative proceeding relating to the
administration of a program;
(5) to personnel of the welfare system who require the data to verify an individual's
identity; determine eligibility, amount of assistance, and the need to provide services to an
individual or family across programs; coordinate services for an individual or family;
evaluate the effectiveness of programs; assess parental contribution amounts; and investigate
suspected fraud;
(6) to administer federal funds or programs;
(7) between personnel of the welfare system working in the same program;
(8) to the Department of Revenue to assess parental contribution amounts for purposes
of section 252.27, subdivision 2a, administer and evaluate tax refund or tax credit programs
and to identify individuals who may benefit from these programs. The following information
may be disclosed under this paragraph: an individual's and their dependent's names, dates
of birth, Social Security numbers, income, addresses, and other data as required, upon
request by the Department of Revenue. Disclosures by the commissioner of revenue to the
commissioner of human services for the purposes described in this clause are governed by
section 270B.14, subdivision 1. Tax refund or tax credit programs include, but are not limited
to, the dependent care credit under section 290.067, the Minnesota working family credit
under section 290.0671, the property tax refund and rental credit under section 290A.04,
and the Minnesota education credit under section 290.0674;
(9) between the Department of Human Services, the Department of Employment and
Economic Development, and when applicable, the Department of Education, for the following
purposes:
(i) to monitor the eligibility of the data subject for unemployment benefits, for any
employment or training program administered, supervised, or certified by that agency;
(ii) to administer any rehabilitation program or child care assistance program, whether
alone or in conjunction with the welfare system;
(iii) to monitor and evaluate the Minnesota family investment program or the child care
assistance program by exchanging data on recipients and former recipients of food support,
cash assistance under chapter 256, 256D, 256J, or 256K, child care assistance under chapter
119B, medical programs under chapter 256B or 256L, or a medical program formerly
codified under chapter 256D; and
(iv) to analyze public assistance employment services and program utilization, cost,
effectiveness, and outcomes as implemented under the authority established in Title II,
Sections 201-204 of the Ticket to Work and Work Incentives Improvement Act of 1999.
Health records governed by sections 144.291 to 144.298 and "protected health information"
as defined in Code of Federal Regulations, title 45, section 160.103, and governed by Code
of Federal Regulations, title 45, parts 160-164, including health care claims utilization
information, must not be exchanged under this clause;
(10) to appropriate parties in connection with an emergency if knowledge of the
information is necessary to protect the health or safety of the individual or other individuals
or persons;
(11) data maintained by residential programs as defined in section 245A.02 may be
disclosed to the protection and advocacy system established in this state according to Part
C of Public Law 98-527 to protect the legal and human rights of persons with developmental
disabilities or other related conditions who live in residential facilities for these persons if
the protection and advocacy system receives a complaint by or on behalf of that person and
the person does not have a legal guardian or the state or a designee of the state is the legal
guardian of the person;
(12) to the county medical examiner or the county coroner for identifying or locating
relatives or friends of a deceased person;
(13) data on a child support obligor who makes payments to the public agency may be
disclosed to the Minnesota Office of Higher Education to the extent necessary to determine
eligibility under section 136A.121, subdivision 2, clause (5);
(14) participant Social Security numbers and names collected by the telephone assistance
program may be disclosed to the Department of Revenue to conduct an electronic data
match with the property tax refund database to determine eligibility under section 237.70,
subdivision 4a;
(15) the current address of a Minnesota family investment program participant may be
disclosed to law enforcement officers who provide the name of the participant and notify
the agency that:
(i) the participant:
(A) is a fugitive felon fleeing to avoid prosecution, or custody or confinement after
conviction, for a crime or attempt to commit a crime that is a felony under the laws of the
jurisdiction from which the individual is fleeing; or
(B) is violating a condition of probation or parole imposed under state or federal law;
(ii) the location or apprehension of the felon is within the law enforcement officer's
official duties; and
(iii) the request is made in writing and in the proper exercise of those duties;
(16) the current address of a recipient of general assistance may be disclosed to probation
officers and corrections agents who are supervising the recipient and to law enforcement
officers who are investigating the recipient in connection with a felony level offense;
(17) information obtained from food support applicant or recipient households may be
disclosed to local, state, or federal law enforcement officials, upon their written request, for
the purpose of investigating an alleged violation of the Food Stamp Act, according to Code
of Federal Regulations, title 7, section 272.1(c);
(18) the address, Social Security number, and, if available, photograph of any member
of a household receiving food support shall be made available, on request, to a local, state,
or federal law enforcement officer if the officer furnishes the agency with the name of the
member and notifies the agency that:
(i) the member:
(A) is fleeing to avoid prosecution, or custody or confinement after conviction, for a
crime or attempt to commit a crime that is a felony in the jurisdiction the member is fleeing;
(B) is violating a condition of probation or parole imposed under state or federal law;
or
(C) has information that is necessary for the officer to conduct an official duty related
to conduct described in subitem (A) or (B);
(ii) locating or apprehending the member is within the officer's official duties; and
(iii) the request is made in writing and in the proper exercise of the officer's official duty;
(19) the current address of a recipient of Minnesota family investment program, general
assistance, or food support may be disclosed to law enforcement officers who, in writing,
provide the name of the recipient and notify the agency that the recipient is a person required
to register under section 243.166, but is not residing at the address at which the recipient is
registered under section 243.166;
(20) certain information regarding child support obligors who are in arrears may be
made public according to section 518A.74;
(21) data on child support payments made by a child support obligor and data on the
distribution of those payments excluding identifying information on obligees may be
disclosed to all obligees to whom the obligor owes support, and data on the enforcement
actions undertaken by the public authority, the status of those actions, and data on the income
of the obligor or obligee may be disclosed to the other party;
(22) data in the work reporting system may be disclosed under section 256.998,
subdivision 7;
(23) to the Department of Education for the purpose of matching Department of Education
student data with public assistance data to determine students eligible for free and
reduced-price meals, meal supplements, and free milk according to United States Code,
title 42, sections 1758, 1761, 1766, 1766a, 1772, and 1773; to allocate federal and state
funds that are distributed based on income of the student's family; and to verify receipt of
energy assistance for the telephone assistance plan;
(24) the current address and telephone number of program recipients and emergency
contacts may be released to the commissioner of health or a community health board as
defined in section 145A.02, subdivision 5, when the commissioner or community health
board has reason to believe that a program recipient is a disease case, carrier, suspect case,
or at risk of illness, and the data are necessary to locate the person;
(25) to other state agencies, statewide systems, and political subdivisions of this state,
including the attorney general, and agencies of other states, interstate information networks,
federal agencies, and other entities as required by federal regulation or law for the
administration of the child support enforcement program;
(26) to personnel of public assistance programs as defined in section 256.741, for access
to the child support system database for the purpose of administration, including monitoring
and evaluation of those public assistance programs;
(27) to monitor and evaluate the Minnesota family investment program by exchanging
data between the Departments of Human Services and Education, on recipients and former
recipients of food support, cash assistance under chapter 256, 256D, 256J, or 256K, child
care assistance under chapter 119B, medical programs under chapter 256B or 256L, or a
medical program formerly codified under chapter 256D;
(28) to evaluate child support program performance and to identify and prevent fraud
in the child support program by exchanging data between the Department of Human Services,
Department of Revenue under section 270B.14, subdivision 1, paragraphs (a) and (b),
without regard to the limitation of use in paragraph (c), Department of Health, Department
of Employment and Economic Development, and other state agencies as is reasonably
necessary to perform these functions;
(29) counties new text begin and the Department of Human Services new text end operating child care assistance
programs under chapter 119B may disseminate data on program participants, applicants,
and providers to the commissioner of education;
(30) child support data on the child, the parents, and relatives of the child may be
disclosed to agencies administering programs under titles IV-B and IV-E of the Social
Security Act, as authorized by federal law;
(31) to a health care provider governed by sections 144.291 to 144.298, to the extent
necessary to coordinate services;
(32) to the chief administrative officer of a school to coordinate services for a student
and family; data that may be disclosed under this clause are limited to name, date of birth,
gender, and address; or
(33) to county correctional agencies to the extent necessary to coordinate services and
diversion programs; data that may be disclosed under this clause are limited to name, client
demographics, program, case status, and county worker information.
(b) Information on persons who have been treated for drug or alcohol abuse may only
be disclosed according to the requirements of Code of Federal Regulations, title 42, sections
2.1 to 2.67.
(c) Data provided to law enforcement agencies under paragraph (a), clause (15), (16),
(17), or (18), or paragraph (b), are investigative data and are confidential or protected
nonpublic while the investigation is active. The data are private after the investigation
becomes inactive under section 13.82, subdivision 5, paragraph (a) or (b).
(d) Mental health data shall be treated as provided in subdivisions 7, 8, and 9, but are
not subject to the access provisions of subdivision 10, paragraph (b).
For the purposes of this subdivision, a request will be deemed to be made in writing if
made through a computer interface system.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 2.
Minnesota Statutes 2018, section 13.46, subdivision 3, is amended to read:
Subd. 3.
Investigative data.
(a) Data on persons, including data on vendors of services,
licensees, and applicants that is collected, maintained, used, or disseminated by the welfare
system in an investigation, authorized by statute, and relating to the enforcement of rules
or law are confidential data on individuals pursuant to section 13.02, subdivision 3, or
protected nonpublic data not on individuals pursuant to section 13.02, subdivision 13, and
shall not be disclosed except:
(1) pursuant to section 13.05;
(2) pursuant to statute or valid court order;
(3) to a party named in a civil or criminal proceeding, administrative or judicial, for
preparation of defense; deleted text begin or
deleted text end
new text begin
(4) to an agent of the welfare system or an investigator acting on behalf of a county,
state, or federal government, including a law enforcement officer or attorney in the
investigation or prosecution of a criminal, civil, or administrative proceeding, unless the
commissioner of human services determines that disclosure may compromise a Department
of Human Services ongoing investigation; or
new text end
deleted text begin (4)deleted text end new text begin (5)new text end to provide notices required or permitted by statute.
The data referred to in this subdivision shall be classified as public data upon submission
to an administrative law judge or court in an administrative or judicial proceeding. Inactive
welfare investigative data shall be treated as provided in section 13.39, subdivision 3.
(b) Notwithstanding any other provision in law, the commissioner of human services
shall provide all active and inactive investigative data, including the name of the reporter
of alleged maltreatment under section 626.556 or 626.557, to the ombudsman for mental
health and developmental disabilities upon the request of the ombudsman.
(c) Notwithstanding paragraph (a) and section 13.39, the existence of an investigation
by the commissionernew text begin of human servicesnew text end of possible overpayments of public funds to a service
provider or recipient may be disclosed if the commissioner determines that it will not
compromise the investigation.
Sec. 3.
Minnesota Statutes 2018, section 13.461, subdivision 28, is amended to read:
Subd. 28.
Child care assistance program.
Data collected, maintained, used, or
disseminated by the welfare system pertaining to persons selected as legal nonlicensed child
care providers by families receiving child care assistance are classified under section 119B.02,
subdivision 6new text begin , paragraph (a)new text end .new text begin Child care assistance program payment data is classified under
section 119B.02, subdivision 6, paragraph (b).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 4.
Minnesota Statutes 2018, section 15C.02, is amended to read:
15C.02 LIABILITY FOR CERTAIN ACTS.
(a) A person who commits any act described in clauses (1) to (7) is liable to the state or
the political subdivision for a civil penalty deleted text begin of not less than $5,500 and not more than $11,000
per false or fraudulent claimdeleted text end new text begin in the amounts set forth in the federal False Claims Act, United
States Code, title 31, section 3729, and as modified by the federal Civil Penalties Inflation
Adjustment Act Improvements Act of 2015new text end , plus three times the amount of damages that
the state or the political subdivision sustains because of the act of that person, except as
otherwise provided in paragraph (b):
(1) knowingly presents, or causes to be presented, a false or fraudulent claim for payment
or approval;
(2) knowingly makes or uses, or causes to be made or used, a false record or statement
material to a false or fraudulent claim;
(3) knowingly conspires to commit a violation of clause (1), (2), (4), (5), (6), or (7);
(4) has possession, custody, or control of property or money used, or to be used, by the
state or a political subdivision and knowingly delivers or causes to be delivered less than
all of that money or property;
(5) is authorized to make or deliver a document certifying receipt for money or property
used, or to be used, by the state or a political subdivision and, intending to defraud the state
or a political subdivision, makes or delivers the receipt without completely knowing that
the information on the receipt is true;
(6) knowingly buys, or receives as a pledge of an obligation or debt, public property
from an officer or employee of the state or a political subdivision who lawfully may not
sell or pledge the property; or
(7) knowingly makes or uses, or causes to be made or used, a false record or statement
material to an obligation to pay or transmit money or property to the state or a political
subdivision, or knowingly conceals or knowingly and improperly avoids or decreases an
obligation to pay or transmit money or property to the state or a political subdivision.
(b) Notwithstanding paragraph (a), the court may assess not less than two times the
amount of damages that the state or the political subdivision sustains because of the act of
the person if:
(1) the person committing a violation under paragraph (a) furnished an officer or
employee of the state or the political subdivision responsible for investigating the false or
fraudulent claim violation with all information known to the person about the violation
within 30 days after the date on which the person first obtained the information;
(2) the person fully cooperated with any investigation by the state or the political
subdivision of the violation; and
(3) at the time the person furnished the state or the political subdivision with information
about the violation, no criminal prosecution, civil action, or administrative action had been
commenced under this chapter with respect to the violation and the person did not have
actual knowledge of the existence of an investigation into the violation.
(c) A person violating this section is also liable to the state or the political subdivision
for the costs of a civil action brought to recover any penalty or damages.
(d) A person is not liable under this section for mere negligence, inadvertence, or mistake
with respect to activities involving a false or fraudulent claim.
Sec. 5.
Minnesota Statutes 2018, section 119B.02, subdivision 6, is amended to read:
Subd. 6.
Data.
new text begin (a) new text end Data collected, maintained, used, or disseminated by the welfare
system pertaining to persons selected as legal nonlicensed child care providers by families
receiving child care assistance shall be treated as licensing data as provided in section 13.46,
subdivision 4.
new text begin
(b) For purposes of this paragraph, "child care assistance program payment data" means
data for a specified time period showing (1) that a child care assistance program payment
under this chapter was made, and (2) the amount of child care assistance payments made
to a child care center. Child care assistance program payment data may include the number
of families and children on whose behalf payments were made for the specified time period.
Any child care assistance program payment data that may identify a specific child care
assistance recipient or benefit paid on behalf of a specific child care assistance recipient,
as determined by the commissioner, is private data on individuals as defined in section
13.02, subdivision 12. Data related to a child care assistance payment is public if the data
relates to a child care assistance payment made to a licensed child care center or a child
care center exempt from licensure and:
new text end
new text begin
(1) the child care center receives payment of more than $100,000 from the child care
assistance program under this chapter in a period of one year or less; or
new text end
new text begin
(2) when the commissioner or county agency either:
new text end
new text begin
(i) disqualified the center from receipt of a payment from the child care assistance
program under this chapter for wrongfully obtaining child care assistance under section
256.98, subdivision 8, paragraph (c);
new text end
new text begin
(ii) refused a child care authorization, revoked a child care authorization, stopped
payment, or denied payment for a bill for the center under section 119B.13, subdivision 6,
paragraph (d); or
new text end
new text begin
(iii) made a finding of financial misconduct under section 245E.02.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 6.
Minnesota Statutes 2018, section 119B.09, subdivision 7, is amended to read:
Subd. 7.
Date of eligibility for assistance.
(a) The date of eligibility for child care
assistance under this chapter is the later of the date the application was received by the
county; the beginning date of employment, education, or training; the date the infant is born
for applicants to the at-home infant care program; or the date a determination has been made
that the applicant is a participant in employment and training services under Minnesota
Rules, part 3400.0080, or chapter 256J.
(b) Payment ceases for a family under the at-home infant child care program when a
family has used a total of 12 months of assistance as specified under section 119B.035.
Payment of child care assistance for employed persons on MFIP is effective the date of
employment or the date of MFIP eligibility, whichever is later. Payment of child care
assistance for MFIP or DWP participants in employment and training services is effective
the date of commencement of the services or the date of MFIP or DWP eligibility, whichever
is later. Payment of child care assistance for transition year child care must be made
retroactive to the date of eligibility for transition year child care.
(c) Notwithstanding paragraph (b), payment of child care assistance for participants
eligible under section 119B.05 may only be made retroactive for a maximum of deleted text begin sixdeleted text end new text begin threenew text end
months from the date of application for child care assistance.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 7.
Minnesota Statutes 2018, section 119B.125, subdivision 6, is amended to read:
Subd. 6.
Record-keeping requirement.
new text begin (a) As a condition of payment, new text end all providers
receiving child care assistance payments mustnew text begin :
new text end
new text begin (1)new text end keep new text begin accurate and legible new text end daily attendance records at the site where services are
delivered for children receiving child care assistancenew text begin ;new text end and
deleted text begin mustdeleted text end new text begin (2) new text end make those records available immediately to the county or the commissioner
upon request. new text begin Any records not provided to a county or the commissioner at the date and
time of the request are deemed inadmissible if offered as evidence by the provider in any
proceeding to contest an overpayment or disqualification of the provider.
new text end
deleted text begin Thedeleted text end new text begin (b) As a condition of payment,new text end attendance records must be completed daily and
include the date, the first and last name of each child in attendance, and the times when
each child is dropped off and picked up. To the extent possible, the times that the child was
dropped off to and picked up from the child care provider must be entered by the person
dropping off or picking up the child. The daily attendance records must be retained at the
site where services are delivered for six years after the date of service.
new text begin (c)new text end A county or the commissioner may deny new text begin or revoke a provider's new text end authorization deleted text begin as a
child care provider to any applicant, rescind authorization of any provider,deleted text end new text begin to receive child
care assistance payments under section 119B.13, subdivision 6, paragraph (d), pursue a
fraud disqualification under section 256.98, take an action against the provider under chapter
245E,new text end or establish an new text begin attendance record new text end overpayment deleted text begin claim in the systemdeleted text end new text begin under paragraph
(d)new text end against a current or former provider, when the county or the commissioner knows or
has reason to believe that the provider has not complied with the record-keeping requirement
in this subdivision. deleted text begin A provider's failure to produce attendance records as requested on more
than one occasion constitutes grounds for disqualification as a provider.
deleted text end
new text begin
(d) To calculate an attendance record overpayment under this subdivision, the
commissioner or county agency shall subtract the maximum daily rate from the total amount
paid to a provider for each day that a child's attendance record is missing, unavailable,
incomplete, inaccurate, or otherwise inadequate.
new text end
new text begin
(e) The commissioner shall develop criteria for a county to determine an attendance
record overpayment under this subdivision.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 8.
Minnesota Statutes 2018, section 119B.13, subdivision 6, is amended to read:
Subd. 6.
Provider payments.
(a) new text begin A provider shall bill only for services documented
according to section 119B.125, subdivision 6. new text end The provider shall bill for services provided
within ten days of the end of the service period. Payments under the child care fund shall
be made within 21 days of receiving a complete bill from the provider. Counties or the state
may establish policies that make payments on a more frequent basis.
(b) If a provider has received an authorization of care and been issued a billing form for
an eligible family, the bill must be submitted within 60 days of the last date of service on
the bill. A bill submitted more than 60 days after the last date of service must be paid if the
county determines that the provider has shown good cause why the bill was not submitted
within 60 days. Good cause must be defined in the county's child care fund plan under
section 119B.08, subdivision 3, and the definition of good cause must include county error.
Any bill submitted more than a year after the last date of service on the bill must not be
paid.
(c) If a provider provided care for a time period without receiving an authorization of
care and a billing form for an eligible family, payment of child care assistance may only be
made retroactively for a maximum of six months from the date the provider is issued an
authorization of care and billing form.
(d) A county or the commissioner may refuse to issue a child care authorization to a
licensed or legal nonlicensed provider, revoke an existing child care authorization to a
licensed or legal nonlicensed provider, stop payment issued to a licensed or legal nonlicensed
provider, or refuse to pay a bill submitted by a licensed or legal nonlicensed provider if:
(1) the provider admits to intentionally giving the county materially false information
on the provider's billing forms;
(2) a county or the commissioner finds by a preponderance of the evidence that the
provider intentionally gave the county materially false information on the provider's billing
forms, or provided false attendance records to a county or the commissioner;
(3) the provider is in violation of child care assistance program rules, until the agency
determines those violations have been corrected;
(4) the provider is operating after:
(i) an order of suspension of the provider's license issued by the commissioner;
(ii) an order of revocation of the provider's license; or
(iii) a final order of conditional license issued by the commissioner for as long as the
conditional license is in effect;
(5) the provider submits false attendance reports or refuses to provide documentation
of the child's attendance upon request; deleted text begin or
deleted text end
(6) the provider gives false child care price informationdeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(7) the provider fails to report decreases in a child's attendance as required under section
119B.125, subdivision 9.
new text end
(e) For purposes of paragraph (d), clauses (3), (5), deleted text begin anddeleted text end (6), new text begin and (7), new text end the county or the
commissioner may withhold the provider's authorization or payment for a period of time
not to exceed three months beyond the time the condition has been corrected.
(f) A county's payment policies must be included in the county's child care plan under
section 119B.08, subdivision 3. If payments are made by the state, in addition to being in
compliance with this subdivision, the payments must be made in compliance with section
16A.124.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 9.
Minnesota Statutes 2018, section 119B.13, subdivision 7, is amended to read:
Subd. 7.
Absent days.
(a) Licensed child care providers and license-exempt centers
must not be reimbursed for more than 25 full-day absent days per child, excluding holidays,
in a deleted text begin fiscaldeleted text end new text begin calendarnew text end year, or for more than ten consecutive full-day absent days. new text begin "Absent
day" means any day that the child is authorized and scheduled to be in care with a licensed
provider or license-exempt center, and the child is absent from the care for the entire day.
new text end Legal nonlicensed family child care providers must not be reimbursed for absent days. If a
child attends for part of the time authorized to be in care in a day, but is absent for part of
the time authorized to be in care in that same day, the absent time must be reimbursed but
the time must not count toward the absent days limit. Child care providers must only be
reimbursed for absent days if the provider has a written policy for child absences and charges
all other families in care for similar absences.
(b) Notwithstanding paragraph (a), children with documented medical conditions that
cause more frequent absences may exceed the 25 absent days limit, or ten consecutive
full-day absent days limit. Absences due to a documented medical condition of a parent or
sibling who lives in the same residence as the child receiving child care assistance do not
count against the absent days limit in a deleted text begin fiscaldeleted text end new text begin calendarnew text end year. Documentation of medical
conditions must be on the forms and submitted according to the timelines established by
the commissioner. A public health nurse or school nurse may verify the illness in lieu of a
medical practitioner. If a provider sends a child home early due to a medical reason,
including, but not limited to, fever or contagious illness, the child care center director or
lead teacher may verify the illness in lieu of a medical practitioner.
(c) Notwithstanding paragraph (a), children in families may exceed the absent days limit
if at least one parent: (1) is under the age of 21; (2) does not have a high school diploma or
commissioner of education-selected high school equivalency certification; and (3) is a
student in a school district or another similar program that provides or arranges for child
care, parenting support, social services, career and employment supports, and academic
support to achieve high school graduation, upon request of the program and approval of the
county. If a child attends part of an authorized day, payment to the provider must be for the
full amount of care authorized for that day.
(d) Child care providers must be reimbursed for up to ten federal or state holidays or
designated holidays per year when the provider charges all families for these days and the
holiday or designated holiday falls on a day when the child is authorized to be in attendance.
Parents may substitute other cultural or religious holidays for the ten recognized state and
federal holidays. Holidays do not count toward the absent days limit.
(e) A family or child care provider must not be assessed an overpayment for an absent
day payment unless (1) there was an error in the amount of care authorized for the family,
(2) all of the allowed full-day absent payments for the child have been paid, or (3) the family
or provider did not timely report a change as required under law.
(f) The provider and family shall receive notification of the number of absent days used
upon initial provider authorization for a family and ongoing notification of the number of
absent days used as of the date of the notification.
(g) For purposes of this subdivision, "absent days limit" means 25 full-day absent days
per child, excluding holidays, in a deleted text begin fiscaldeleted text end new text begin calendarnew text end year; and ten consecutive full-day absent
days.
new text begin
(h) For purposes of this subdivision, "holidays limit" means ten full-day holidays per
child, excluding absent days, in a calendar year.
new text end
new text begin
(i) If a day meets the criteria of an absent day or a holiday under this subdivision, the
provider must bill that day as an absent day or holiday. A provider's failure to properly bill
an absent day or a holiday results in an overpayment, regardless of whether the child reached,
or is exempt from, the absent days limit or holidays limit for the calendar year.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 10.
Minnesota Statutes 2018, section 144.057, subdivision 3, is amended to read:
Subd. 3.
Reconsiderations.
The commissioner of health shall review and decide
reconsideration requests, including the granting of variances, in accordance with the
procedures and criteria contained in chapter 245C. new text begin The commissioner must set aside a
disqualification for an individual who requests reconsideration and who meets the criteria
described in section 245C.22, subdivision 4, paragraph (d). new text end The commissioner's decision
shall be provided to the individual and to the Department of Human Services. The
commissioner's decision to grant or deny a reconsideration of disqualification is the final
administrative agency action, except for the provisions under sections 245C.25, 245C.27,
and 245C.28, subdivision 3.
Sec. 11.
Minnesota Statutes 2018, section 245.095, is amended to read:
245.095 LIMITS ON RECEIVING PUBLIC FUNDS.
Subdivision 1.
Prohibition.
new text begin (a) new text end If a provider, vendor, or individual enrolled, licensed,
deleted text begin ordeleted text end receiving funds under a grant contractnew text begin , or registerednew text end in any program administered by the
commissionernew text begin , including under the commissioner's powers and authorities in section 256.01,new text end
is excluded from deleted text begin anydeleted text end new text begin thatnew text end program deleted text begin administered by the commissioner, including under the
commissioner's powers and authorities in section 256.01deleted text end , the commissioner shallnew text begin :
new text end
new text begin (1) new text end prohibit the excluded provider, vendor, or individual from enrolling deleted text begin ordeleted text end new text begin ,new text end becoming
licensednew text begin , receiving grant funds, or registeringnew text end in any other program administered by the
commissionerdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(2) disenroll, revoke or suspend a license, disqualify, or debar the excluded provider,
vendor, or individual in any other program administered by the commissioner.
new text end
new text begin (b)new text end The duration of this prohibitionnew text begin , disenrollment, revocation, suspension,
disqualification, or debarmentnew text end must last for the longest applicable sanction or disqualifying
period in effect for the provider, vendor, or individual permitted by state or federal law.
Subd. 2.
Definitions.
(a) For purposes of this section, the following definitions have the
meanings given them.
(b) "Excluded" means disenrolled, deleted text begin subject to license revocation or suspension,
disqualified, or subject to vendor debarmentdeleted text end new text begin disqualified, having a license that has been
revoked or suspended under chapter 245A, or debarred or suspendednew text end under Minnesota Rules,
part 1230.1150new text begin , or excluded pursuant to section 256B.064, subdivision 3new text end .
(c) "Individual" means a natural person providing products or services as a provider or
vendor.
(d) "Provider" deleted text begin meansdeleted text end new text begin includes any entity or individual receiving payment from a program
administered by the Department of Human Services, andnew text end an owner, controlling individual,
license holder, director, or managerial officialnew text begin of an entity receiving payment from a program
administered by the Department of Human Servicesnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 12.
Minnesota Statutes 2018, section 245A.02, subdivision 3, is amended to read:
Subd. 3.
Applicant.
"Applicant" means an individual, deleted text begin corporation, partnership, voluntary
association, controlling individual, or otherdeleted text end organizationnew text begin , or government entity, as defined
in section 13.02, subdivision 7a,new text end that deleted text begin has applied for licensure under this chapter and the
rules of the commissionerdeleted text end new text begin is subject to licensure under this chapter and that has applied for
but not yet been granted a license under this chapternew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 13.
Minnesota Statutes 2018, section 245A.02, is amended by adding a subdivision
to read:
new text begin Subd. 3b. new text end
new text begin Authorized agent. new text end
new text begin
"Authorized agent" means the controlling individual
designated by the license holder responsible for communicating with the commissioner of
human services on all matters related to this chapter and on whom service of all notices and
orders must be made pursuant to section 245A.04, subdivision 1.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 14.
Minnesota Statutes 2018, section 245A.02, subdivision 8, is amended to read:
Subd. 8.
License.
"License" means a certificate issued by the commissioner new text begin under section
245A.04 new text end authorizing the license holder to provide a specified program for a specified period
of time and in accordance with the terms of the license and the rules of the commissioner.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 15.
Minnesota Statutes 2018, section 245A.02, subdivision 9, is amended to read:
Subd. 9.
License holder.
"License holder" means an individual, deleted text begin corporation, partnership,
voluntary association, or otherdeleted text end organizationnew text begin , or government entitynew text end that is legally responsible
for the operation of the programnew text begin or servicenew text end , new text begin and new text end has been granted a license by the
commissioner under this chapter deleted text begin or chapter 245Ddeleted text end and the rules of the commissionerdeleted text begin , and
is a controlling individualdeleted text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 16.
Minnesota Statutes 2018, section 245A.02, is amended by adding a subdivision
to read:
new text begin Subd. 10c. new text end
new text begin Organization. new text end
new text begin
"Organization" means a domestic or foreign corporation,
nonprofit corporation, limited liability company, partnership, limited partnership, limited
liability partnership, association, voluntary association, and any other legal or commercial
entity. For purposes of this chapter, organization does not include a government entity.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 17.
Minnesota Statutes 2018, section 245A.02, subdivision 12, is amended to read:
Subd. 12.
Private agency.
"Private agency" means an deleted text begin individual, corporation, partnership,
voluntary association or otherdeleted text end organization, other than a county agency, or a court with
jurisdiction, that places persons who cannot remain in their own homes in residential
programs, foster care, or adoptive homes.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 18.
Minnesota Statutes 2018, section 245A.02, subdivision 14, is amended to read:
Subd. 14.
Residential program.
new text begin (a) Except as provided in paragraph (b), new text end "residential
program" means a program that provides 24-hour-a-day care, supervision, food, lodging,
rehabilitation, training, education, habilitation, or treatment outside a person's own home,
including a program in an intermediate care facility for four or more persons with
developmental disabilities; and chemical dependency or chemical abuse programs that are
located in a hospital or nursing home and receive public funds for providing chemical abuse
or chemical dependency treatment services under chapter 254B. deleted text begin Residential programs
include home and community-based services for persons with disabilities or persons age
65 and older that are provided in or outside of a person's own home under chapter 245D.
deleted text end
new text begin
(b) For a residential program under chapter 245D, "residential program" means a single
or multifamily dwelling that is under the control, either directly or indirectly, of the service
provider licensed under chapter 245D and in which at least one person receives services
under chapter 245D, including residential supports and services under section 245D.03,
subdivision 1, paragraph (c), clause (3); out-of-home crisis respite services under section
245D.03, subdivision 1, paragraph (c), clause (1), item (ii); and out-of-home respite services
under section 245D.03, subdivision 1, paragraph (b), clause (1). A residential program does
not include out-of-home respite services when a case manager has determined that an
unlicensed site meets the assessed needs of the person. A residential program also does not
include multifamily dwellings where persons receive integrated community supports, even
if authorization to provide these supports is granted under chapter 245D and approved in
the federal waiver.
new text end
Sec. 19.
Minnesota Statutes 2018, section 245A.02, subdivision 18, is amended to read:
Subd. 18.
Supervision.
new text begin (a) new text end For purposes ofnew text begin licensednew text end child care centers, "supervision"
means when a program staff personnew text begin :
new text end
new text begin (1)new text end is deleted text begin within sight and hearing of a child at all times so that the program staffdeleted text end new text begin accountable
for the child's care;
new text end
new text begin (2)new text end can intervene to protect the health and safety of the childdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(3) is within sight and hearing of the child at all times except as described in paragraphs
(b) to (d).
new text end
new text begin (b)new text end When an infant is placed in a crib room to sleep, supervision occurs when anew text begin programnew text end
staff person is within sight or hearing of the infant. When supervision of a crib room is
provided by sight or hearing, the center must have a plan to address the other supervision
deleted text begin componentdeleted text end new text begin componentsnew text end .
new text begin
(c) When a single school-age child uses the restroom within the licensed space,
supervision occurs when a program staff person has knowledge of the child's activity and
location and checks on the child at least every five minutes. When a school-age child uses
the restroom outside the licensed space, including but not limited to field trips, supervision
occurs when staff accompany children to the restroom.
new text end
new text begin
(d) When a school-age child leaves the classroom but remains within the licensed space
to deliver or retrieve items from the child's personal storage space, supervision occurs when
a program staff person has knowledge of the child's activity and location and checks on the
child at least every five minutes.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 20.
Minnesota Statutes 2018, section 245A.03, subdivision 1, is amended to read:
Subdivision 1.
License required.
Unless licensed by the commissionernew text begin under this chapternew text end ,
an individual, deleted text begin corporation, partnership, voluntary association, otherdeleted text end organization, or
deleted text begin controlling individualdeleted text end new text begin government entitynew text end must not:
(1) operate a residential or a nonresidential program;
(2) receive a child or adult for care, supervision, or placement in foster care or adoption;
(3) help plan the placement of a child or adult in foster care or adoption or engage in
placement activities as defined in section 259.21, subdivision 9, in this state, whether or not
the adoption occurs in this state; or
(4) advertise a residential or nonresidential program.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 21.
Minnesota Statutes 2018, section 245A.03, subdivision 3, is amended to read:
Subd. 3.
Unlicensed programs.
(a) It is a misdemeanor for an individual, deleted text begin corporation,
partnership, voluntary association, otherdeleted text end organization, or deleted text begin a controlling individualdeleted text end new text begin government
entitynew text end to provide a residential or nonresidential program without a license new text begin issued under this
chapter new text end and in willful disregard of this chapter unless the program is excluded from licensure
under subdivision 2.
(b) The commissioner may ask the appropriate county attorney or the attorney general
to begin proceedings to secure a court order against the continued operation of the program,
if an individual, deleted text begin corporation, partnership, voluntary association, otherdeleted text end organization, or
deleted text begin controlling individualdeleted text end new text begin government entitynew text end has:
(1) failed to apply for a license new text begin under this chapter new text end after receiving notice that a license is
required or continues to operate without a license after receiving notice that a license is
required;
(2) continued to operate without a license after deleted text begin thedeleted text end new text begin anew text end license new text begin issued under this chapter
new text end has been revoked or suspended under deleted text begin section 245A.07deleted text end new text begin this chapternew text end , and the commissioner
has issued a final order affirming the revocation or suspension, or the license holder did not
timely appeal the sanction; or
(3) continued to operate without a license after deleted text begin thedeleted text end new text begin a temporary immediate suspension
of anew text end license has been deleted text begin temporarily suspended under section 245A.07deleted text end new text begin issued under this chapternew text end .
new text begin (c) new text end The county attorney and the attorney general have a duty to cooperate with the
commissioner.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 22.
Minnesota Statutes 2018, section 245A.04, subdivision 1, is amended to read:
Subdivision 1.
Application for licensure.
(a) An individual, deleted text begin corporation, partnership,
voluntary association, otherdeleted text end organization deleted text begin or controlling individualdeleted text end new text begin , or government entitynew text end
that is subject to licensure under section 245A.03 must apply for a license. The application
must be made on the forms and in the manner prescribed by the commissioner. The
commissioner shall provide the applicant with instruction in completing the application and
provide information about the rules and requirements of other state agencies that affect the
applicant. An applicant seeking licensure in Minnesota with headquarters outside of
Minnesota must have a program office located within new text begin 30 miles of new text end the deleted text begin statedeleted text end new text begin Minnesota bordernew text end .new text begin
An applicant who intends to buy or otherwise acquire a program or services licensed under
this chapter that is owned by another license holder must apply for a license under this
chapter and comply with the application procedures in this section and section 245A.03.
new text end
The commissioner shall act on the application within 90 working days after a complete
application and any required reports have been received from other state agencies or
departments, counties, municipalities, or other political subdivisions. The commissioner
shall not consider an application to be complete until the commissioner receives all of the
deleted text begin informationdeleted text end required deleted text begin under section 245C.05deleted text end new text begin informationnew text end .
When the commissioner receives an application for initial licensure that is incomplete
because the applicant failed to submit required documents or that is substantially deficient
because the documents submitted do not meet licensing requirements, the commissioner
shall provide the applicant written notice that the application is incomplete or substantially
deficient. In the written notice to the applicant the commissioner shall identify documents
that are missing or deficient and give the applicant 45 days to resubmit a second application
that is substantially complete. An applicant's failure to submit a substantially complete
application after receiving notice from the commissioner is a basis for license denial under
section 245A.05.
(b) An application for licensure must identify all controlling individuals new text begin as defined in
section 245A.02, subdivision 5a, new text end and must deleted text begin specify andeleted text end new text begin designate one individual to be the
authorizednew text end agent deleted text begin who is responsible for dealing with the commissioner of human services
on all matters provided for in this chapter and on whom service of all notices and orders
must be madedeleted text end . new text begin The application must be signed by the authorized agent and must include
the authorized agent's first, middle, and last name; mailing address; and e-mail address. By
submitting an application for licensure, the authorized agent consents to electronic
communication with the commissioner throughout the application process. new text end The new text begin authorized
new text end agent must be authorized to accept service on behalf of all of the controlling individuals deleted text begin of
the programdeleted text end .new text begin A government entity that holds multiple licenses under this chapter may
designate one authorized agent for all licenses issued under this chapter or may designate
a different authorized agent for each license.new text end Service on the new text begin authorized new text end agent is service on
all of the controlling individuals deleted text begin of the programdeleted text end . It is not a defense to any action arising
under this chapter that service was not made on each controlling individual deleted text begin of the programdeleted text end .
The designation of deleted text begin one or moredeleted text end new text begin anew text end controlling deleted text begin individualsdeleted text end new text begin individualnew text end as deleted text begin agentsdeleted text end new text begin the authorized
agentnew text end under this paragraph does not affect the legal responsibility of any other controlling
individual under this chapter.
(c) An applicant or license holder must have a policy that prohibits license holders,
employees, subcontractors, and volunteers, when directly responsible for persons served
by the program, from abusing prescription medication or being in any manner under the
influence of a chemical that impairs the individual's ability to provide services or care. The
license holder must train employees, subcontractors, and volunteers about the program's
drug and alcohol policy.
(d) An applicant and license holder must have a program grievance procedure that permits
persons served by the program and their authorized representatives to bring a grievance to
the highest level of authority in the program.
(e) deleted text begin The applicant must be able to demonstrate competent knowledge of the applicable
requirements of this chapter and chapter 245C, and the requirements of other licensing
statutes and rules applicable to the program or services for which the applicant is seeking
to be licensed. Effective January 1, 2013,deleted text end new text begin The commissioner may limit communication
during the application process to the authorized agent or the controlling individuals identified
on the license application and for whom a background study was initiated under chapter
245C.new text end The commissioner may require the applicant, except for child foster care, to
demonstrate competence in the applicable licensing requirements by successfully completing
a written examination. The commissioner may develop a prescribed written examination
format.
(f) When an applicant is an individual, the deleted text begin individualdeleted text end new text begin applicantnew text end must provide:
(1) the applicant's taxpayer identification numbers including the Social Security numbernew text begin
or Minnesota tax identification numbernew text end , and federal employer identification number if the
applicant has employees;
(2) new text begin at the request of the commissioner, a copy of the most recent filing with the secretary
of state that includes new text end the complete business name, if anydeleted text begin , anddeleted text end new text begin ;
new text end
new text begin (3) new text end if doing business under a different name, the doing business as (DBA) name, as
registered with the secretary of state; deleted text begin and
deleted text end
deleted text begin
(3) a notarized signature of the applicant.
deleted text end
new text begin
(4) if applicable, the applicant's National
Provider Identifier (NPI) number and Unique Minnesota Provider Identifier (UMPI) number;
and
new text end
new text begin
(5) at the request of the commissioner, the notarized signature of the applicant or
authorized agent.
new text end
(g) When an applicant is deleted text begin a nonindividualdeleted text end new text begin an organizationnew text end , the applicant must provide
deleted text begin thedeleted text end :
(1) new text begin the new text end applicant's taxpayer identification numbers including the Minnesota tax
identification number and federal employer identification number;
(2) new text begin at the request of the commissioner, a copy of the most recent filing with the secretary
of state that includes the new text end complete business name, and if doing business under a different
name, the doing business as (DBA) name, as registered with the secretary of state;
(3) new text begin the new text end first, middle, and last name, and address for all individuals who will be controlling
individuals, including all officers, owners, and managerial officials as defined in section
245A.02, subdivision 5a, and the date that the background study was initiated by the applicant
for each controlling individual; deleted text begin and
deleted text end
deleted text begin
(4) first, middle, and last name, mailing address, and notarized signature of the agent
authorized by the applicant to accept service on behalf of the controlling individuals.
deleted text end
new text begin
(4) if applicable, the applicant's NPI number and UMPI number;
new text end
new text begin
(5) the documents that created the organization and that determine the organization's
internal governance and the relations among the persons that own the organization, have
an interest in the organization, or are members of the organization, in each case as provided
or authorized by the organization's governing statute, which may include a partnership
agreement, bylaws, articles of organization, organizational chart, and operating agreement,
or comparable documents as provided in the organization's governing statute; and
new text end
new text begin
(6) the notarized signature of the applicant or authorized agent.
new text end
new text begin
(h) When the applicant is a government entity, the applicant must provide:
new text end
new text begin
(1) the name of the government agency, political subdivision, or other unit of government
seeking the license and the name of the program or services that will be licensed;
new text end
new text begin
(2) the applicant's taxpayer identification numbers including the Minnesota tax
identification number and federal employer identification number;
new text end
new text begin
(3) a letter signed by the manager, administrator, or other executive of the government
entity authorizing the submission of the license application; and
new text end
new text begin
(4) if applicable, the applicant's NPI number and UMPI number.
new text end
deleted text begin (h)deleted text end new text begin (i)new text end At the time of application for licensure or renewal of a licensenew text begin under this chapternew text end ,
the applicant or license holder must acknowledge on the form provided by the commissioner
if the applicant or license holder elects to receive any public funding reimbursement from
the commissioner for services provided under the license that:
(1) the applicant's or license holder's compliance with the provider enrollment agreement
or registration requirements for receipt of public funding may be monitored by the
commissioner as part of a licensing investigation or licensing inspection; and
(2) noncompliance with the provider enrollment agreement or registration requirements
for receipt of public funding that is identified through a licensing investigation or licensing
inspection, or noncompliance with a licensing requirement that is a basis of enrollment for
reimbursement for a service, may result in:
(i) a correction order or a conditional license under section 245A.06, or sanctions under
section 245A.07;
(ii) nonpayment of claims submitted by the license holder for public program
reimbursement;
(iii) recovery of payments made for the service;
(iv) disenrollment in the public payment program; or
(v) other administrative, civil, or criminal penalties as provided by law.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 23.
Minnesota Statutes 2018, section 245A.04, subdivision 2, is amended to read:
Subd. 2.
Notification of affected municipality.
The commissioner must not issue a
license new text begin under this chapter new text end without giving 30 calendar days' written notice to the affected
municipality or other political subdivision unless the program is considered a permitted
single-family residential use under sections 245A.11 and 245A.14. new text begin The commissioner may
provide notice through electronic communication. new text end The notification must be given before
the first issuance of a license new text begin under this chapter new text end and annually after that time if annual
notification is requested in writing by the affected municipality or other political subdivision.
State funds must not be made available to or be spent by an agency or department of state,
county, or municipal government for payment to a residential or nonresidential program
licensed under this chapter until the provisions of this subdivision have been complied with
in full. The provisions of this subdivision shall not apply to programs located in hospitals.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 24.
Minnesota Statutes 2018, section 245A.04, subdivision 4, is amended to read:
Subd. 4.
Inspections; waiver.
(a) Before issuing deleted text begin an initialdeleted text end new text begin anew text end licensenew text begin under this chapternew text end ,
the commissioner shall conduct an inspection of the program. The inspection must include
but is not limited to:
(1) an inspection of the physical plant;
(2) an inspection of records and documents;
deleted text begin
(3) an evaluation of the program by consumers of the program;
deleted text end
deleted text begin (4)deleted text end new text begin (3)new text end observation of the program in operation; and
deleted text begin (5)deleted text end new text begin (4)new text end an inspection for the health, safety, and fire standards in licensing requirements
for a child care license holder.
deleted text begin
For the purposes of this subdivision, "consumer" means a person who receives the
services of a licensed program, the person's legal guardian, or the parent or individual having
legal custody of a child who receives the services of a licensed program.
deleted text end
(b) The deleted text begin evaluation required in paragraph (a), clause (3), or thedeleted text end observation in paragraph
(a), clause deleted text begin (4)deleted text end new text begin (3)new text end , is not required prior to issuing deleted text begin an initialdeleted text end new text begin anew text end license under subdivision 7. If
the commissioner issues deleted text begin an initialdeleted text end new text begin anew text end license under deleted text begin subdivision 7deleted text end new text begin this chapternew text end , these
requirements must be completed within one year after the issuance of deleted text begin an initialdeleted text end new text begin thenew text end license.
(c) Before completing a licensing inspection in a family child care program or child care
center, the licensing agency must offer the license holder an exit interview to discuss
violations new text begin or potential violations new text end of law or rule observed during the inspection and offer
technical assistance on how to comply with applicable laws and rules. deleted text begin Nothing in this
paragraph limits the ability of the commissioner to issue a correction order or negative
action for violations of law or rule not discussed in an exit interview or in the event that a
license holder chooses not to participate in an exit interview.deleted text end new text begin The commissioner shall not
issue a correction order or negative licensing action for violations of law or rule not discussed
in an exit interview, unless a license holder chooses not to participate in an exit interview
or not to complete the exit interview. If the license holder is unable to complete the exit
interview, the licensing agency must offer an alternate time for the license holder to complete
the exit interview.
new text end
new text begin
(d) If a family child care license holder disputes a county licensor's interpretation of a
licensing requirement during a licensing inspection or exit interview, the license holder
may, within five business days after the exit interview or licensing inspection, request
clarification from the commissioner, in writing, in a manner prescribed by the commissioner.
The license holder's request must describe the county licensor's interpretation of the licensing
requirement at issue, and explain why the license holder believes the county licensor's
interpretation is inaccurate. The commissioner and the county must include the license
holder in all correspondence regarding the disputed interpretation, and must provide an
opportunity for the license holder to contribute relevant information that may impact the
commissioner's decision. The county licensor must not issue a correction order related to
the disputed licensing requirement until the commissioner has provided clarification to the
license holder about the licensing requirement.
new text end
deleted text begin (d)deleted text end new text begin (e)new text end The commissioner or the county shall inspect at least annually a child care provider
licensed under this chapter and Minnesota Rules, chapter 9502 or 9503, for compliance
with applicable licensing standards.
deleted text begin (e)deleted text end new text begin (f)new text end No later than November 19, 2017, the commissioner shall make publicly available
on the department's website the results of inspection reports of all child care providers
licensed under this chapter and under Minnesota Rules, chapter 9502 or 9503, and the
number of deaths, serious injuries, and instances of substantiated child maltreatment that
occurred in licensed child care settings each year.
new text begin EFFECTIVE DATE. new text end
new text begin
The amendments to paragraphs (a) and (b) are effective January
1, 2020. The amendments to paragraphs (c) to (f) are effective September 30, 2019.
new text end
Sec. 25.
Minnesota Statutes 2018, section 245A.04, subdivision 6, is amended to read:
Subd. 6.
Commissioner's evaluation.
new text begin (a) new text end Before issuing, denying, suspending, revoking,
or making conditional a license, the commissioner shall evaluate information gathered under
this section. The commissioner's evaluation shall consider new text begin the applicable requirements of
statutes and rules for the program or services for which the applicant seeks a license,
including the disqualification standards set forth in chapter 245C, and shall evaluate new text end facts,
conditions, or circumstances concerningnew text begin :
new text end
new text begin (1) new text end the program's operationdeleted text begin ,deleted text end new text begin ;
new text end
new text begin (2) new text end the well-being of persons served by the programdeleted text begin ,deleted text end new text begin ;
new text end
new text begin (3) new text end available deleted text begin consumerdeleted text end evaluations of the programdeleted text begin , anddeleted text end new text begin by persons receiving services;
new text end
new text begin (4) new text end information about the qualifications of the personnel employed by the applicant or
license holderdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(5) the applicant's or license holder's ability to demonstrate competent knowledge of the
applicable requirements of statutes and rules, including this chapter and chapter 245C, for
which the applicant seeks a license or the license holder is licensed.
new text end
new text begin (b) new text end The commissioner shall new text begin also new text end evaluate the results of the study required in subdivision
3 and determine whether a risk of harm to the persons served by the program exists. In
conducting this evaluation, the commissioner shall apply the disqualification standards set
forth in chapter 245C.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 26.
Minnesota Statutes 2018, section 245A.04, subdivision 7, is amended to read:
Subd. 7.
Grant of license; license extension.
(a) If the commissioner determines that
the program complies with all applicable rules and laws, the commissioner shall issue a
licensenew text begin consistent with this section or, if applicable, a temporary change of ownership license
under section 245A.043new text end . At minimum, the license shall state:
(1) the name of the license holder;
(2) the address of the program;
(3) the effective date and expiration date of the license;
(4) the type of license;
(5) the maximum number and ages of persons that may receive services from the program;
and
(6) any special conditions of licensure.
(b) The commissioner may issue deleted text begin an initialdeleted text end new text begin anew text end license for a period not to exceed two years
if:
(1) the commissioner is unable to conduct the evaluation or observation required by
subdivision 4, paragraph (a), deleted text begin clauses (3) anddeleted text end new text begin clausenew text end (4), because the program is not yet
operational;
(2) certain records and documents are not available because persons are not yet receiving
services from the program; and
(3) the applicant complies with applicable laws and rules in all other respects.
(c) A decision by the commissioner to issue a license does not guarantee that any person
or persons will be placed or cared for in the licensed program. deleted text begin A license shall not be
transferable to another individual, corporation, partnership, voluntary association, other
organization, or controlling individual or to another location.
deleted text end
deleted text begin
(d) A license holder must notify the commissioner and obtain the commissioner's approval
before making any changes that would alter the license information listed under paragraph
(a).
deleted text end
deleted text begin (e)deleted text end new text begin (d)new text end Except as provided in paragraphs deleted text begin (g)deleted text end new text begin (f)new text end and deleted text begin (h)deleted text end new text begin (g)new text end , the commissioner shall not
issue or reissue a license if the applicant, license holder, or controlling individual has:
(1) been disqualified and the disqualification was not set aside and no variance has been
granted;
(2) been denied a license new text begin under this chapter, new text end within the past two years;
(3) had a license new text begin issued under this chapter new text end revoked within the past five years;
(4) an outstanding debt related to a license fee, licensing fine, or settlement agreement
for which payment is delinquent; or
(5) failed to submit the information required of an applicant under subdivision 1,
paragraph (f) or (g), after being requested by the commissioner.
When a license new text begin issued under this chapter new text end is revoked under clause (1) or (3), the license
holder and controlling individual may not hold any license under chapter 245A deleted text begin or 245Ddeleted text end for
five years following the revocation, and other licenses held by the applicant, license holder,
or controlling individual shall also be revoked.
deleted text begin (f)deleted text end new text begin (e) new text end The commissioner shall not issue or reissue a license new text begin under this chapter new text end if an
individual living in the household where the deleted text begin licenseddeleted text end services will be provided as specified
under section 245C.03, subdivision 1, has been disqualified and the disqualification has not
been set aside and no variance has been granted.
deleted text begin (g)deleted text end new text begin (f)new text end Pursuant to section 245A.07, subdivision 1, paragraph (b), when a license new text begin issued
under this chapter new text end has been suspended or revoked and the suspension or revocation is under
appeal, the program may continue to operate pending a final order from the commissioner.
If the license under suspension or revocation will expire before a final order is issued, a
temporary provisional license may be issued provided any applicable license fee is paid
before the temporary provisional license is issued.
deleted text begin (h)deleted text end new text begin (g)new text end Notwithstanding paragraph deleted text begin (g)deleted text end new text begin (f)new text end , when a revocation is based on the
disqualification of a controlling individual or license holder, and the controlling individual
or license holder is ordered under section 245C.17 to be immediately removed from direct
contact with persons receiving services or is ordered to be under continuous, direct
supervision when providing direct contact services, the program may continue to operate
only if the program complies with the order and submits documentation demonstrating
compliance with the order. If the disqualified individual fails to submit a timely request for
reconsideration, or if the disqualification is not set aside and no variance is granted, the
order to immediately remove the individual from direct contact or to be under continuous,
direct supervision remains in effect pending the outcome of a hearing and final order from
the commissioner.
deleted text begin (i)deleted text end new text begin (h)new text end For purposes of reimbursement for meals only, under the Child and Adult Care
Food Program, Code of Federal Regulations, title 7, subtitle B, chapter II, subchapter A,
part 226, relocation within the same county by a licensed family day care provider, shall
be considered an extension of the license for a period of no more than 30 calendar days or
until the new license is issued, whichever occurs first, provided the county agency has
determined the family day care provider meets licensure requirements at the new location.
deleted text begin (j)deleted text end new text begin (i)new text end Unless otherwise specified by statute, all licenses new text begin issued under this chapter new text end expire
at 12:01 a.m. on the day after the expiration date stated on the license. A license holder must
apply for and be granted a new license to operate the program or the program must not be
operated after the expiration date.
deleted text begin (k)deleted text end new text begin (j)new text end The commissioner shall not issue or reissue a license new text begin under this chapter new text end if it has
been determined that a tribal licensing authority has established jurisdiction to license the
program or service.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 27.
Minnesota Statutes 2018, section 245A.04, is amended by adding a subdivision
to read:
new text begin Subd. 7a. new text end
new text begin Notification required. new text end
new text begin
(a) A license holder must notify the commissioner, in
a manner prescribed by the commissioner, and obtain the commissioner's approval before
making any change that would alter the license information listed under subdivision 7,
paragraph (a).
new text end
new text begin
(b) A license holder must also notify the commissioner, in a manner prescribed by the
commissioner, before making any change:
new text end
new text begin
(1) to the license holder's authorized agent as defined in section 245A.02, subdivision
3b;
new text end
new text begin
(2) to the license holder's controlling individual as defined in section 245A.02, subdivision
5a;
new text end
new text begin
(3) to the license holder information on file with the secretary of state;
new text end
new text begin
(4) in the location of the program or service licensed under this chapter; and
new text end
new text begin
(5) to the federal or state tax identification number associated with the license holder.
new text end
new text begin
(c) When, for reasons beyond the license holder's control, a license holder cannot provide
the commissioner with prior notice of the changes in paragraph (b), clauses (1) to (3), the
license holder must notify the commissioner by the tenth business day after the change and
must provide any additional information requested by the commissioner.
new text end
new text begin
(d) When a license holder notifies the commissioner of a change to the license holder
information on file with the secretary of state, the license holder must provide amended
articles of incorporation and other documentation of the change.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 28.
Minnesota Statutes 2018, section 245A.04, is amended by adding a subdivision
to read:
new text begin Subd. 9a. new text end
new text begin Child foster home variances for capacity. new text end
new text begin
(a) The commissioner, or the
commissioner of corrections under section 241.021, may grant a variance for a licensed
family foster parent to allow additional foster children if:
new text end
new text begin
(1) the variance is needed to allow: (i) a parenting youth in foster care to remain with
the child of the parenting youth; (ii) siblings to remain together; (iii) a child with an
established meaningful relationship with the family to remain with the family; or (iv) a
family with special training or skills to provide care to a child who has a severe disability;
new text end
new text begin
(2) there is no risk of harm to a child currently in the home;
new text end
new text begin
(3) the structural characteristics of the home, including sleeping space, accommodates
additional foster children;
new text end
new text begin
(4) the home remains in compliance with applicable zoning, health, fire, and building
codes; and
new text end
new text begin
(5) the statement of intended use specifies conditions for an exception to capacity limits
and specifies how the license holder will maintain a ratio of adults to children that ensures
the safety and appropriate supervision of all the children in the home.
new text end
new text begin
(b) A variance granted to a family foster home under Minnesota Rules, part 2960.3030,
subpart 3, prior to October 1, 2019, remains in effect until January 1, 2020.
new text end
Sec. 29.
Minnesota Statutes 2018, section 245A.04, subdivision 10, is amended to read:
Subd. 10.
Adoption agency; additional requirements.
In addition to the other
requirements of this section, an individualdeleted text begin , corporation, partnership, voluntary association,
otherdeleted text end new text begin ornew text end organizationdeleted text begin , or controlling individualdeleted text end applying for a license to place children for
adoption must:
(1) incorporate as a nonprofit corporation under chapter 317A;
(2) file with the application for licensure a copy of the disclosure form required under
section 259.37, subdivision 2;
(3) provide evidence that a bond has been obtained and will be continuously maintained
throughout the entire operating period of the agency, to cover the cost of transfer of records
to and storage of records by the agency which has agreed, according to rule established by
the commissioner, to receive the applicant agency's records if the applicant agency voluntarily
or involuntarily ceases operation and fails to provide for proper transfer of the records. The
bond must be made in favor of the agency which has agreed to receive the records; and
(4) submit a certified audit to the commissioner each year the license is renewed as
required under section 245A.03, subdivision 1.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 30.
new text begin
[245A.043] LICENSE APPLICATION AFTER CHANGE OF OWNERSHIP.
new text end
new text begin Subdivision 1. new text end
new text begin Transfer prohibited. new text end
new text begin
A license issued under this chapter is only valid
for a premises and individual, organization, or government entity identified by the
commissioner on the license. A license is not transferable or assignable.
new text end
new text begin Subd. 2. new text end
new text begin Change in ownership. new text end
new text begin
(a) If the commissioner determines that there is a change
in ownership, the commissioner shall require submission of a new license application. This
subdivision does not apply to a licensed program or service located in a home where the
license holder resides. A change in ownership occurs when:
new text end
new text begin
(1) the license holder sells or transfers 100 percent of the property, stock, or assets;
new text end
new text begin
(2) the license holder merges with another organization;
new text end
new text begin
(3) the license holder consolidates with two or more organizations, resulting in the
creation of a new organization;
new text end
new text begin
(4) there is a change to the federal tax identification number associated with the license
holder; or
new text end
new text begin
(5) all controlling individuals associated with the original application have changed.
new text end
new text begin
(b) Notwithstanding paragraph (a), clauses (1) and (5), no change in ownership has
occurred if at least one controlling individual has been listed as a controlling individual for
the license for at least the previous 12 months.
new text end
new text begin Subd. 3. new text end
new text begin Change of ownership process. new text end
new text begin
(a) When a change in ownership is proposed
and the party intends to assume operation without an interruption in service longer than 60
days after acquiring the program or service, the license holder must provide the commissioner
with written notice of the proposed change on a form provided by the commissioner at least
60 days before the anticipated date of the change in ownership. For purposes of this
subdivision and subdivision 4, "party" means the party that intends to operate the service
or program.
new text end
new text begin
(b) The party must submit a license application under this chapter on the form and in
the manner prescribed by the commissioner at least 30 days before the change in ownership
is complete, and must include documentation to support the upcoming change. The party
must comply with background study requirements under chapter 245C and shall pay the
application fee required under section 245A.10. A party that intends to assume operation
without an interruption in service longer than 60 days after acquiring the program or service
is exempt from the requirements of Minnesota Rules, part 9530.6800.
new text end
new text begin
(c) The commissioner may streamline application procedures when the party is an existing
license holder under this chapter and is acquiring a program licensed under this chapter or
service in the same service class as one or more licensed programs or services the party
operates and those licenses are in substantial compliance. For purposes of this subdivision,
"substantial compliance" means within the previous 12 months the commissioner did not
(1) issue a sanction under section 245A.07 against a license held by the party, or (2) make
a license held by the party conditional according to section 245A.06.
new text end
new text begin
(d) Except when a temporary change in ownership license is issued pursuant to
subdivision 4, the existing license holder is solely responsible for operating the program
according to applicable laws and rules until a license under this chapter is issued to the
party.
new text end
new text begin
(e) If a licensing inspection of the program or service was conducted within the previous
12 months and the existing license holder's record demonstrates substantial compliance with
the applicable licensing requirements, the commissioner may waive the party's inspection
required by section 245A.04, subdivision 4. The party must submit to the commissioner (1)
proof that the premises was inspected by a fire marshal or that the fire marshal deemed an
inspection was not warranted, and (2) proof that the premises was inspected for compliance
with the building code or no inspection was deemed warranted.
new text end
new text begin
(f) If the party is seeking a license for a program or service that has an outstanding action
under section 245A.06 or 245A.07, the party must submit a letter as part of the application
process identifying how the party has or will come into full compliance with the licensing
requirements.
new text end
new text begin
(g) The commissioner shall evaluate the party's application according to section 245A.04,
subdivision 6. If the commissioner determines that the party has remedied or demonstrates
the ability to remedy the outstanding actions under section 245A.06 or 245A.07 and has
determined that the program otherwise complies with all applicable laws and rules, the
commissioner shall issue a license or conditional license under this chapter. The conditional
license remains in effect until the commissioner determines that the grounds for the action
are corrected or no longer exist.
new text end
new text begin
(h) The commissioner may deny an application as provided in section 245A.05. An
applicant whose application was denied by the commissioner may appeal the denial according
to section 245A.05.
new text end
new text begin
(i) This subdivision does not apply to a licensed program or service located in a home
where the license holder resides.
new text end
new text begin Subd. 4. new text end
new text begin Temporary change in ownership license. new text end
new text begin
(a) After receiving the party's
application pursuant to subdivision 3, upon the written request of the existing license holder
and the party, the commissioner may issue a temporary change in ownership license to the
party while the commissioner evaluates the party's application. Until a decision is made to
grant or deny a license under this chapter, the existing license holder and the party shall
both be responsible for operating the program or service according to applicable laws and
rules, and the sale or transfer of the existing license holder's ownership interest in the licensed
program or service does not terminate the existing license.
new text end
new text begin
(b) The commissioner may issue a temporary change in ownership license when a license
holder's death, divorce, or other event affects the ownership of the program and an applicant
seeks to assume operation of the program or service to ensure continuity of the program or
service while a license application is evaluated.
new text end
new text begin
(c) This subdivision applies to any program or service licensed under this chapter.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 31.
Minnesota Statutes 2018, section 245A.05, is amended to read:
245A.05 DENIAL OF APPLICATION.
(a) The commissioner may deny a license if an applicant or controlling individual:
(1) fails to submit a substantially complete application after receiving notice from the
commissioner under section 245A.04, subdivision 1;
(2) fails to comply with applicable laws or rules;
(3) knowingly withholds relevant information from or gives false or misleading
information to the commissioner in connection with an application for a license or during
an investigation;
(4) has a disqualification that has not been set aside under section 245C.22 and no
variance has been granted;
(5) has an individual living in the household who received a background study under
section 245C.03, subdivision 1, paragraph (a), clause (2), who has a disqualification that
has not been set aside under section 245C.22, and no variance has been granted;
(6) is associated with an individual who received a background study under section
245C.03, subdivision 1, paragraph (a), clause (6), who may have unsupervised access to
children or vulnerable adults, and who has a disqualification that has not been set aside
under section 245C.22, and no variance has been granted; deleted text begin or
deleted text end
(7) fails to comply with section 245A.04, subdivision 1, paragraph (f) or (g)deleted text begin .deleted text end new text begin ;
new text end
new text begin
(8) fails to demonstrate competent knowledge as required by section 245A.04, subdivision
6;
new text end
new text begin
(9) has a history of noncompliance as a license holder or controlling individual with
applicable laws or rules, including but not limited to this chapter and chapters 119B and
245C;
new text end
new text begin
(10) is prohibited from holding a license according to section 245.095; or
new text end
new text begin
(11) for family child foster care, has nondisqualifying background study information,
as described in section 245C.05, subdivision 4, that reflects on the individual's ability to
safely provide care to foster children.
new text end
(b) An applicant whose application has been denied by the commissioner must be given
notice of the denial, which must state the reasons for the denial in plain language. Notice
must be given by certified mail or personal service. The notice must state the reasons the
application was denied and must inform the applicant of the right to a contested case hearing
under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The applicant may
appeal the denial by notifying the commissioner in writing by certified mail or personal
service. If mailed, the appeal must be postmarked and sent to the commissioner within 20
calendar days after the applicant received the notice of denial. If an appeal request is made
by personal service, it must be received by the commissioner within 20 calendar days after
the applicant received the notice of denial. Section 245A.08 applies to hearings held to
appeal the commissioner's denial of an application.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020, except paragraph (a),
clause (11), is effective March 1, 2020.
new text end
Sec. 32.
new text begin
[245A.055] CLOSING A LICENSE.
new text end
new text begin Subdivision 1. new text end
new text begin Inactive programs. new text end
new text begin
The commissioner shall close a license if the
commissioner determines that a licensed program has not been serving any client for a
consecutive period of 12 months or longer. The license holder is not prohibited from
reapplying for a license if the license holder's license was closed under this chapter.
new text end
new text begin Subd. 2. new text end
new text begin Reconsideration of closure. new text end
new text begin
If a license is closed, the commissioner must
notify the license holder of closure by certified mail or personal service. If mailed, the notice
of closure must be mailed to the last known address of the license holder and must inform
the license holder why the license was closed and that the license holder has the right to
request reconsideration of the closure. If the license holder believes that the license was
closed in error, the license holder may ask the commissioner to reconsider the closure. The
license holder's request for reconsideration must be made in writing and must include
documentation that the licensed program has served a client in the previous 12 months. The
request for reconsideration must be postmarked and sent to the commissioner within 20
calendar days after the license holder receives the notice of closure. A timely request for
reconsideration stays imposition of the license closure until the commissioner issues a
decision on the request for reconsideration.
new text end
new text begin Subd. 3. new text end
new text begin Reconsideration final. new text end
new text begin
The commissioner's disposition of a request for
reconsideration is final and not subject to appeal under chapter 14.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 33.
Minnesota Statutes 2018, section 245A.07, subdivision 1, is amended to read:
Subdivision 1.
Sanctions; appeals; license.
(a) In addition to making a license conditional
under section 245A.06, the commissioner may suspend or revoke the license, impose a fine,
or secure an injunction against the continuing operation of the program of a license holder
who does not comply with applicable law or rulenew text begin or who has nondisqualifying background
study information, as described in section 245C.05, subdivision 4, that reflects on the license
holder's ability to safely provide care to foster childrennew text end . When applying sanctions authorized
under this section, the commissioner shall consider the nature, chronicity, or severity of the
violation of law or rule and the effect of the violation on the health, safety, or rights of
persons served by the program.
(b) If a license holder appeals the suspension or revocation of a license and the license
holder continues to operate the program pending a final order on the appeal, the commissioner
shall issue the license holder a temporary provisional license. Unless otherwise specified
by the commissioner, variances in effect on the date of the license sanction under appeal
continue under the temporary provisional license. If a license holder fails to comply with
applicable law or rule while operating under a temporary provisional license, the
commissioner may impose additional sanctions under this section and section 245A.06, and
may terminate any prior variance. If a temporary provisional license is set to expire, a new
temporary provisional license shall be issued to the license holder upon payment of any fee
required under section 245A.10. The temporary provisional license shall expire on the date
the final order is issued. If the license holder prevails on the appeal, a new nonprovisional
license shall be issued for the remainder of the current license period.
(c) If a license holder is under investigation and the license new text begin issued under this chapter new text end is
due to expire before completion of the investigation, the program shall be issued a new
license upon completion of the reapplication requirements and payment of any applicable
license fee. Upon completion of the investigation, a licensing sanction may be imposed
against the new license under this section, section 245A.06, or 245A.08.
(d) Failure to reapply or closure of a license new text begin issued under this chapter new text end by the license
holder prior to the completion of any investigation shall not preclude the commissioner
from issuing a licensing sanction under this sectiondeleted text begin ,deleted text end new text begin ornew text end section 245A.06deleted text begin , or 245A.08deleted text end at the
conclusion of the investigation.
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraph (a) is effective March 1, 2020. Paragraphs (c) and (d)
are effective January 1, 2020.
new text end
Sec. 34.
Minnesota Statutes 2018, section 245A.07, subdivision 2, is amended to read:
Subd. 2.
Temporary immediate suspension.
(a) The commissioner shall act immediately
to temporarily suspend a license new text begin issued under this chapter new text end if:
(1) the license holder's actions or failure to comply with applicable law or rule, or the
actions of other individuals or conditions in the program, pose an imminent risk of harm to
the health, safety, or rights of persons served by the program; deleted text begin or
deleted text end
(2) while the program continues to operate pending an appeal of an order of revocation,
the commissioner identifies one or more subsequent violations of law or rule which may
adversely affect the health or safety of persons served by the programdeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(3) the license holder is criminally charged in state or federal court with an offense that
involves fraud or theft against a program administered by the commissioner.
new text end
(b) No state funds shall be made available or be expended by any agency or department
of state, county, or municipal government for use by a license holder regulated under this
chapter while a license new text begin issued under this chapter new text end is under immediate suspension. A notice
stating the reasons for the immediate suspension and informing the license holder of the
right to an expedited hearing under chapter 14 and Minnesota Rules, parts 1400.8505 to
1400.8612, must be delivered by personal service to the address shown on the application
or the last known address of the license holder. The license holder may appeal an order
immediately suspending a license. The appeal of an order immediately suspending a license
must be made in writing by certified mail deleted text begin ordeleted text end new text begin ,new text end personal servicenew text begin , or other means expressly set
forth in the commissioner's ordernew text end . If mailed, the appeal must be postmarked and sent to the
commissioner within five calendar days after the license holder receives notice that the
license has been immediately suspended. If a request is made by personal service, it must
be received by the commissioner within five calendar days after the license holder received
the order. A license holder and any controlling individual shall discontinue operation of the
program upon receipt of the commissioner's order to immediately suspend the license.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 35.
Minnesota Statutes 2018, section 245A.07, subdivision 2a, is amended to read:
Subd. 2a.
Immediate suspension expedited hearing.
(a) Within five working days of
receipt of the license holder's timely appeal, the commissioner shall request assignment of
an administrative law judge. The request must include a proposed date, time, and place of
a hearing. A hearing must be conducted by an administrative law judge within 30 calendar
days of the request for assignment, unless an extension is requested by either party and
granted by the administrative law judge for good cause. The commissioner shall issue a
notice of hearing by certified mail or personal service at least ten working days before the
hearing. The scope of the hearing shall be limited solely to the issue of whether the temporary
immediate suspension should remain in effect pending the commissioner's final order under
section 245A.08, regarding a licensing sanction issued under subdivision 3 following the
immediate suspension. For suspensions under subdivision 2, paragraph (a), clause (1), the
burden of proof in expedited hearings under this subdivision shall be limited to the
commissioner's demonstration that reasonable cause exists to believe that the license holder's
actions or failure to comply with applicable law or rule poses, or the actions of other
individuals or conditions in the program poses an imminent risk of harm to the health, safety,
or rights of persons served by the program. "Reasonable cause" means there exist specific
articulable facts or circumstances which provide the commissioner with a reasonable
suspicion that there is an imminent risk of harm to the health, safety, or rights of persons
served by the program. When the commissioner has determined there is reasonable cause
to order the temporary immediate suspension of a license based on a violation of safe sleep
requirements, as defined in section 245A.1435, the commissioner is not required to
demonstrate that an infant died or was injured as a result of the safe sleep violations. For
suspensions under subdivision 2, paragraph (a), clause (2), the burden of proof in expedited
hearings under this subdivision shall be limited to the commissioner's demonstration by a
preponderance of new text begin the new text end evidence that, since the license was revoked, the license holder
committed additional violations of law or rule which may adversely affect the health or
safety of persons served by the program.
(b) The administrative law judge shall issue findings of fact, conclusions, and a
recommendation within ten working days from the date of hearing. The parties shall have
ten calendar days to submit exceptions to the administrative law judge's report. The record
shall close at the end of the ten-day period for submission of exceptions. The commissioner's
final order shall be issued within ten working days from the close of the record. When an
appeal of a temporary immediate suspension is withdrawn or dismissed, the commissioner
shall issue a final order affirming the temporary immediate suspension within ten calendar
days of the commissioner's receipt of the withdrawal or dismissal. Within 90 calendar days
after a final order affirming an immediate suspension, the commissioner shall make a
determination regarding whether a final licensing sanction shall be issued under subdivision
3. The license holder shall continue to be prohibited from operation of the program during
this 90-day period.
(c) When the final order under paragraph (b) affirms an immediate suspension, and a
final licensing sanction is issued under subdivision 3 and the license holder appeals that
sanction, the license holder continues to be prohibited from operation of the program pending
a final commissioner's order under section 245A.08, subdivision 5, regarding the final
licensing sanction.
new text begin
(d) For suspensions under subdivision 2, paragraph (a), clause (3), the burden of proof
in expedited hearings under this subdivision shall be limited to the commissioner's
demonstration by a preponderance of the evidence that a criminal complaint and warrant
or summons was issued for the license holder that was not dismissed, and that the criminal
charge is an offense that involves fraud or theft against a program administered by the
commissioner.
new text end
Sec. 36.
Minnesota Statutes 2018, section 245A.07, subdivision 3, is amended to read:
Subd. 3.
License suspension, revocation, or fine.
(a) The commissioner may suspend
or revoke a license, or impose a fine if:
(1) a license holder fails to comply fully with applicable laws or rulesnew text begin including but not
limited to the requirements of this chapter and chapter 245Cnew text end ;
(2) a license holder, a controlling individual, or an individual living in the household
where the licensed services are provided or is otherwise subject to a background study has
deleted text begin adeleted text end new text begin been disqualified and thenew text end disqualification deleted text begin which hasdeleted text end new text begin wasnew text end not deleted text begin beendeleted text end set aside deleted text begin under section
245C.22deleted text end new text begin and no variance has been grantednew text end ;
(3) a license holder knowingly withholds relevant information from or gives false or
misleading information to the commissioner in connection with an application for a license,
in connection with the background study status of an individual, during an investigation,
or regarding compliance with applicable laws or rules; deleted text begin or
deleted text end
(4) deleted text begin after July 1, 2012, and upon request by the commissioner, a license holder fails to
submit the information required of an applicant under section 245A.04, subdivision 1,
paragraph (f) or (g).deleted text end new text begin a license holder is excluded from any program administered by the
commissioner under section 245.095; or
new text end
new text begin
(5) revocation is required under section 245A.04, subdivision 7, paragraph (d).
new text end
A license holder who has had a license new text begin issued under this chapter new text end suspended, revoked,
or has been ordered to pay a fine must be given notice of the action by certified mail or
personal service. If mailed, the notice must be mailed to the address shown on the application
or the last known address of the license holder. The notice must state in plain language the
reasons the license was suspended or revoked, or a fine was ordered.
(b) If the license was suspended or revoked, the notice must inform the license holder
of the right to a contested case hearing under chapter 14 and Minnesota Rules, parts
1400.8505 to 1400.8612. The license holder may appeal an order suspending or revoking
a license. The appeal of an order suspending or revoking a license must be made in writing
by certified mail or personal service. If mailed, the appeal must be postmarked and sent to
the commissioner within ten calendar days after the license holder receives notice that the
license has been suspended or revoked. If a request is made by personal service, it must be
received by the commissioner within ten calendar days after the license holder received the
order. Except as provided in subdivision 2a, paragraph (c), if a license holder submits a
timely appeal of an order suspending or revoking a license, the license holder may continue
to operate the program as provided in section 245A.04, subdivision 7, paragraphs deleted text begin (g)deleted text end new text begin (f)new text end
and deleted text begin (h)deleted text end new text begin (g)new text end , until the commissioner issues a final order on the suspension or revocation.
(c)(1) If the license holder was ordered to pay a fine, the notice must inform the license
holder of the responsibility for payment of fines and the right to a contested case hearing
under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The appeal of an
order to pay a fine must be made in writing by certified mail or personal service. If mailed,
the appeal must be postmarked and sent to the commissioner within ten calendar days after
the license holder receives notice that the fine has been ordered. If a request is made by
personal service, it must be received by the commissioner within ten calendar days after
the license holder received the order.
(2) The license holder shall pay the fines assessed on or before the payment date specified.
If the license holder fails to fully comply with the order, the commissioner may issue a
second fine or suspend the license until the license holder complies. If the license holder
receives state funds, the state, county, or municipal agencies or departments responsible for
administering the funds shall withhold payments and recover any payments made while the
license is suspended for failure to pay a fine. A timely appeal shall stay payment of the fine
until the commissioner issues a final order.
(3) A license holder shall promptly notify the commissioner of human services, in writing,
when a violation specified in the order to forfeit a fine is corrected. If upon reinspection the
commissioner determines that a violation has not been corrected as indicated by the order
to forfeit a fine, the commissioner may issue a second fine. The commissioner shall notify
the license holder by certified mail or personal service that a second fine has been assessed.
The license holder may appeal the second fine as provided under this subdivision.
(4) Fines shall be assessed as follows:
(i) the license holder shall forfeit $1,000 for each determination of maltreatment of a
child under section 626.556 or the maltreatment of a vulnerable adult under section 626.557
for which the license holder is determined responsible for the maltreatment under section
626.556, subdivision 10e, paragraph (i), or 626.557, subdivision 9c, paragraph (c);
(ii) if the commissioner determines that a determination of maltreatment for which the
license holder is responsible is the result of maltreatment that meets the definition of serious
maltreatment as defined in section 245C.02, subdivision 18, the license holder shall forfeit
$5,000;
(iii) for a program that operates out of the license holder's home and a program licensed
under Minnesota Rules, parts 9502.0300 to deleted text begin 9502.0495deleted text end new text begin 9502.0445new text end , the fine assessed against
the license holder shall not exceed $1,000 for each determination of maltreatment;
(iv) the license holder shall forfeit $200 for each occurrence of a violation of law or rule
governing matters of health, safety, or supervision, including but not limited to the provision
of adequate staff-to-child or adult ratios, and failure to comply with background study
requirements under chapter 245C; and
(v) the license holder shall forfeit $100 for each occurrence of a violation of law or rule
other than those subject to a $5,000, $1,000, or $200 fine in items (i) to (iv).
For purposes of this section, "occurrence" means each violation identified in the
commissioner's fine order. Fines assessed against a license holder that holds a license to
provide home and community-based services, as identified in section 245D.03, subdivision
1, and a community residential setting or day services facility license under chapter 245D
where the services are provided, may be assessed against both licenses for the same
occurrence, but the combined amount of the fines shall not exceed the amount specified in
this clause for that occurrence.
(5) When a fine has been assessed, the license holder may not avoid payment by closing,
selling, or otherwise transferring the licensed program to a third party. In such an event, the
license holder will be personally liable for payment. In the case of a corporation, each
controlling individual is personally and jointly liable for payment.
(d) Except for background study violations involving the failure to comply with an order
to immediately remove an individual or an order to provide continuous, direct supervision,
the commissioner shall not issue a fine under paragraph (c) relating to a background study
violation to a license holder who self-corrects a background study violation before the
commissioner discovers the violation. A license holder who has previously exercised the
provisions of this paragraph to avoid a fine for a background study violation may not avoid
a fine for a subsequent background study violation unless at least 365 days have passed
since the license holder self-corrected the earlier background study violation.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 37.
Minnesota Statutes 2018, section 245A.10, subdivision 4, is amended to read:
Subd. 4.
License or certification fee for certain programs.
(a) Child care centers shall
pay an annual nonrefundable license fee based on the following schedule:
| Licensed Capacity |
Child Care Center License Fee |
|
| 1 to 24 persons |
$200 |
|
| 25 to 49 persons |
$300 |
|
| 50 to 74 persons |
$400 |
|
| 75 to 99 persons |
$500 |
|
| 100 to 124 persons |
$600 |
|
| 125 to 149 persons |
$700 |
|
| 150 to 174 persons |
$800 |
|
| 175 to 199 persons |
$900 |
|
| 200 to 224 persons |
$1,000 |
|
| 225 or more persons |
$1,100 |
(b)(1) A program licensed to provide one or more of the home and community-based
services and supports identified under chapter 245D to persons with disabilities or age 65
and older, shall pay an annual nonrefundable license fee based on revenues derived from
the provision of services that would require licensure under chapter 245D during the calendar
year immediately preceding the year in which the license fee is paid, according to the
following schedule:
| License Holder Annual Revenue |
License Fee |
|
| less than or equal to $10,000 |
deleted text begin
$200
deleted text end
new text begin
$240 new text end |
|
| greater than $10,000 but less than or equal to $25,000 |
deleted text begin
$300
deleted text end
new text begin
$360 new text end |
|
| greater than $25,000 but less than or equal to $50,000 |
deleted text begin
$400
deleted text end
new text begin
$480 new text end |
|
| greater than $50,000 but less than or equal to $100,000 |
deleted text begin
$500
deleted text end
new text begin
$600 new text end |
|
| greater than $100,000 but less than or equal to $150,000 |
deleted text begin
$600
deleted text end
new text begin
$720 new text end |
|
| greater than $150,000 but less than or equal to $200,000 |
deleted text begin
$800
deleted text end
new text begin
$960 new text end |
|
| greater than $200,000 but less than or equal to $250,000 |
deleted text begin
$1,000
deleted text end
new text begin
$1,200 new text end |
|
| greater than $250,000 but less than or equal to $300,000 |
deleted text begin
$1,200
deleted text end
new text begin
$1,440 new text end |
|
| greater than $300,000 but less than or equal to $350,000 |
deleted text begin
$1,400
deleted text end
new text begin
$1,680 new text end |
|
| greater than $350,000 but less than or equal to $400,000 |
deleted text begin
$1,600
deleted text end
new text begin
$1,920 new text end |
|
| greater than $400,000 but less than or equal to $450,000 |
deleted text begin
$1,800
deleted text end
new text begin
$2,160 new text end |
|
| greater than $450,000 but less than or equal to $500,000 |
deleted text begin
$2,000
deleted text end
new text begin
$2,400 new text end |
|
| greater than $500,000 but less than or equal to $600,000 |
deleted text begin
$2,250
deleted text end
new text begin
$2,700 new text end |
|
| greater than $600,000 but less than or equal to $700,000 |
deleted text begin
$2,500
deleted text end
new text begin
$3,000 new text end |
|
| greater than $700,000 but less than or equal to $800,000 |
deleted text begin
$2,750
deleted text end
new text begin
$3,300 new text end |
|
| greater than $800,000 but less than or equal to $900,000 |
deleted text begin
$3,000
deleted text end
new text begin
$3,600 new text end |
|
| greater than $900,000 but less than or equal to $1,000,000 |
deleted text begin
$3,250
deleted text end
new text begin
$3,900 new text end |
|
| greater than $1,000,000 but less than or equal to $1,250,000 |
deleted text begin
$3,500
deleted text end
new text begin
$4,200 new text end |
|
| greater than $1,250,000 but less than or equal to $1,500,000 |
deleted text begin
$3,750
deleted text end
new text begin
$4,500 new text end |
|
| greater than $1,500,000 but less than or equal to $1,750,000 |
deleted text begin
$4,000
deleted text end
new text begin
$4,800 new text end |
|
| greater than $1,750,000 but less than or equal to $2,000,000 |
deleted text begin
$4,250
deleted text end
new text begin
$5,100 new text end |
|
| greater than $2,000,000 but less than or equal to $2,500,000 |
deleted text begin
$4,500
deleted text end
new text begin
$5,400 new text end |
|
| greater than $2,500,000 but less than or equal to $3,000,000 |
deleted text begin
$4,750
deleted text end
new text begin
$5,700 new text end |
|
| greater than $3,000,000 but less than or equal to $3,500,000 |
deleted text begin
$5,000
deleted text end
new text begin
$6,000 new text end |
|
| greater than $3,500,000 but less than or equal to $4,000,000 |
deleted text begin
$5,500
deleted text end
new text begin
$6,600 new text end |
|
| greater than $4,000,000 but less than or equal to $4,500,000 |
deleted text begin
$6,000
deleted text end
new text begin
$7,200 new text end |
|
| greater than $4,500,000 but less than or equal to $5,000,000 |
deleted text begin
$6,500
deleted text end
new text begin
$7,800 new text end |
|
| greater than $5,000,000 but less than or equal to $7,500,000 |
deleted text begin
$7,000
deleted text end
new text begin
$9,000 new text end |
|
| greater than $7,500,000 but less than or equal to $10,000,000 |
deleted text begin
$8,500
deleted text end
new text begin
$13,500 new text end |
|
| greater than $10,000,000 but less than or equal to $12,500,000 |
deleted text begin
$10,000
deleted text end
new text begin
$18,000 new text end |
|
| greater than $12,500,000 but less than or equal to $15,000,000 |
deleted text begin
$14,000
deleted text end
new text begin
$22,500 new text end |
|
| greater than $15,000,000new text begin but less than or equal to $17,500,000 new text end |
deleted text begin
$18,000
deleted text end
new text begin
$27,000 new text end |
|
|
new text begin
greater than $17,500,000 but less than or equal to $20,000,000 new text end |
new text begin
$31,500 new text end |
|
|
new text begin
greater than $20,000,000 but less than or equal to $25,000,000 new text end |
new text begin
$36,000 new text end |
|
|
new text begin
greater than $25,000,000 but less than or equal to $30,000,000 new text end |
new text begin
$45,000 new text end |
|
|
new text begin
greater than $30,000,000 but less than or equal to $35,000,000 new text end |
new text begin
$54,000 new text end |
|
|
new text begin
greater than $35,000,000 but less than or equal to $40,000,000 new text end |
new text begin
$63,000 new text end |
|
|
new text begin
greater than $40,000,000 new text end |
new text begin
$72,000 new text end |
(2) If requested, the license holder shall provide the commissioner information to verify
the license holder's annual revenues or other information as needed, including copies of
documents submitted to the Department of Revenue.
(3) At each annual renewal, a license holder may elect to pay the highest renewal fee,
and not provide annual revenue information to the commissioner.
(4) A license holder that knowingly provides the commissioner incorrect revenue amounts
for the purpose of paying a lower license fee shall be subject to a civil penalty in the amount
of double the fee the provider should have paid.
deleted text begin
(5) Notwithstanding clause (1), a license holder providing services under one or more
licenses under chapter 245B that are in effect on May 15, 2013, shall pay an annual license
fee for calendar years 2014, 2015, and 2016, equal to the total license fees paid by the license
holder for all licenses held under chapter 245B for calendar year 2013. For calendar year
2017 and thereafter, the license holder shall pay an annual license fee according to clause
(1).
deleted text end
(c) A chemical dependency treatment program licensed under chapter 245G, to provide
chemical dependency treatment shall pay an annual nonrefundable license fee based on the
following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$600 |
|
| 25 to 49 persons |
$800 |
|
| 50 to 74 persons |
$1,000 |
|
| 75 to 99 persons |
$1,200 |
|
| 100 or more persons |
$1,400 |
(d) A chemical dependency program licensed under Minnesota Rules, parts 9530.6510
to 9530.6590, to provide detoxification services shall pay an annual nonrefundable license
fee based on the following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$760 |
|
| 25 to 49 persons |
$960 |
|
| 50 or more persons |
$1,160 |
(e) Except for child foster care, a residential facility licensed under Minnesota Rules,
chapter 2960, to serve children shall pay an annual nonrefundable license fee based on the
following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$1,000 |
|
| 25 to 49 persons |
$1,100 |
|
| 50 to 74 persons |
$1,200 |
|
| 75 to 99 persons |
$1,300 |
|
| 100 or more persons |
$1,400 |
(f) A residential facility licensed under Minnesota Rules, parts 9520.0500 to 9520.0670,
to serve persons with mental illness shall pay an annual nonrefundable license fee based on
the following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$2,525 |
|
| 25 or more persons |
$2,725 |
(g) A residential facility licensed under Minnesota Rules, parts 9570.2000 to 9570.3400,
to serve persons with physical disabilities shall pay an annual nonrefundable license fee
based on the following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$450 |
|
| 25 to 49 persons |
$650 |
|
| 50 to 74 persons |
$850 |
|
| 75 to 99 persons |
$1,050 |
|
| 100 or more persons |
$1,250 |
(h) A program licensed to provide independent living assistance for youth under section
245A.22 shall pay an annual nonrefundable license fee of $1,500.
(i) A private agency licensed to provide foster care and adoption services under Minnesota
Rules, parts 9545.0755 to 9545.0845, shall pay an annual nonrefundable license fee of $875.
(j) A program licensed as an adult day care center licensed under Minnesota Rules, parts
9555.9600 to 9555.9730, shall pay an annual nonrefundable license fee based on the
following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$500 |
|
| 25 to 49 persons |
$700 |
|
| 50 to 74 persons |
$900 |
|
| 75 to 99 persons |
$1,100 |
|
| 100 or more persons |
$1,300 |
(k) A program licensed to provide treatment services to persons with sexual psychopathic
personalities or sexually dangerous persons under Minnesota Rules, parts 9515.3000 to
9515.3110, shall pay an annual nonrefundable license fee of $20,000.
(l) A mental health center or mental health clinic requesting certification for purposes
of insurance and subscriber contract reimbursement under Minnesota Rules, parts 9520.0750
to 9520.0870, shall pay a certification fee of $1,550 per year. If the mental health center or
mental health clinic provides services at a primary location with satellite facilities, the
satellite facilities shall be certified with the primary location without an additional charge.
Sec. 38.
Minnesota Statutes 2018, section 245A.14, subdivision 4, is amended to read:
Subd. 4.
Special family day care homes.
Nonresidential child care programs serving
14 or fewer children that are conducted at a location other than the license holder's own
residence shall be licensed under this section and the rules governing family day care or
group family day care if:
(a) the license holder is the primary provider of care and the nonresidential child care
program is conducted in a dwelling that is located on a residential lot;
(b) the license holder is an employer who may or may not be the primary provider of
care, and the purpose for the child care program is to provide child care services to children
of the license holder's employees;
(c) the license holder is a church or religious organization;
(d) the license holder is a community collaborative child care provider. For purposes of
this subdivision, a community collaborative child care provider is a provider participating
in a cooperative agreement with a community action agency as defined in section 256E.31;
(e) the license holder is a not-for-profit agency that provides child care in a dwelling
located on a residential lot and the license holder maintains two or more contracts with
community employers or other community organizations to provide child care services.
The county licensing agency may grant a capacity variance to a license holder licensed
under this paragraph to exceed the licensed capacity of 14 children by no more than five
children during transition periods related to the work schedules of parents, if the license
holder meets the following requirements:
(1) the program does not exceed a capacity of 14 children more than a cumulative total
of four hours per day;
(2) the program meets a one to seven staff-to-child ratio during the variance period;
(3) all employees receive at least an extra four hours of training per year than required
in the rules governing family child care each year;
(4) the facility has square footage required per child under Minnesota Rules, part
9502.0425;
(5) the program is in compliance with local zoning regulations;
(6) the program is in compliance with the applicable fire code as follows:
(i) if the program serves more than five children older than 2-1/2 years of age, but no
more than five children 2-1/2 years of age or less, the applicable fire code is educational
occupancy, as provided in Group E Occupancy under the Minnesota State Fire Code deleted text begin 2003deleted text end new text begin
2015new text end , Section 202; or
(ii) if the program serves more than five children 2-1/2 years of age or less, the applicable
fire code is Group I-4 Occupancies, as provided in the Minnesota State Fire Code deleted text begin 2003deleted text end new text begin
2015new text end , Section 202new text begin , unless the rooms in which the children are cared for are located on a
level of exit discharge and each of these child care rooms has an exit door directly to the
exterior, then the applicable fire code is Group E occupancies, as provided in the Minnesota
State Fire Code 2015, Section 202new text end ; and
(7) any age and capacity limitations required by the fire code inspection and square
footage determinations shall be printed on the license; or
(f) the license holder is the primary provider of care and has located the licensed child
care program in a commercial space, if the license holder meets the following requirements:
(1) the program is in compliance with local zoning regulations;
(2) the program is in compliance with the applicable fire code as follows:
(i) if the program serves more than five children older than 2-1/2 years of age, but no
more than five children 2-1/2 years of age or less, the applicable fire code is educational
occupancy, as provided in Group E Occupancy under the Minnesota State Fire Code deleted text begin 2003deleted text end new text begin
2015new text end , Section 202; or
(ii) if the program serves more than five children 2-1/2 years of age or less, the applicable
fire code is Group I-4 Occupancies, as provided under the Minnesota State Fire Code deleted text begin 2003deleted text end new text begin
2015new text end , Section 202;
(3) any age and capacity limitations required by the fire code inspection and square
footage determinations are printed on the license; and
(4) the license holder prominently displays the license issued by the commissioner which
contains the statement "This special family child care provider is not licensed as a child
care center."
new text begin
(g) The commissioner may approve two or more licenses under paragraphs (a) to (f) to
be issued at the same location or under one contiguous roof, if each license holder is able
to demonstrate compliance with all applicable rules and laws. Each license holder must
operate the license holder's respective licensed program as a distinct program and within
the capacity, age, and ratio distributions of each license.
new text end
new text begin
(h) The commissioner may grant variances to this section to allow a primary provider
of care, a not-for-profit organization, a church or religious organization, an employer, or a
community collaborative to be licensed to provide child care under paragraphs (e) and (f)
if the license holder meets the other requirements of the statute.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 39.
Minnesota Statutes 2018, section 245A.14, subdivision 8, is amended to read:
Subd. 8.
Experienced aides; child care centers.
(a) An individual employed as an aide
at a child care center may work with children without being directly supervised for an
amount of time that does not exceed 25 percent of the child care center's daily hours if:
(1) a teacher is in the facility;
deleted text begin
(2) the individual has received within the last three years first aid training that meets the
requirements under section 245A.40, subdivision 3, and CPR training that meets the
requirements under section 245A.40, subdivision 4;
deleted text end
deleted text begin (3)deleted text end new text begin (2)new text end the individual is at least 20 years old; and
deleted text begin (4)deleted text end new text begin (3)new text end the individual has at least 4,160 hours of child care experience as a staff member
in a licensed child care center or as the license holder of a family day care home, 120 days
of which must be in the employment of the current company.
(b) A child care center that uses experienced aides under this subdivision must notify
parents or guardians by posting the notification in each classroom that uses experienced
aides, identifying which staff member is the experienced aide. Records of experienced aide
usage must be kept on site and given to the commissioner upon request.
(c) A child care center may not use the experienced aide provision for one year following
two determined experienced aide violations within a one-year period.
(d) A child care center may use one experienced aide per every four full-time child care
classroom staff.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 40.
Minnesota Statutes 2018, section 245A.14, is amended by adding a subdivision
to read:
new text begin Subd. 16. new text end
new text begin Valid driver's license. new text end
new text begin
Notwithstanding any law to the contrary, when a
licensed child care center provides transportation for children or contracts to provide
transportation for children, a person who has a current, valid driver's license appropriate to
the vehicle driven may transport the child.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 41.
Minnesota Statutes 2018, section 245A.14, is amended by adding a subdivision
to read:
new text begin Subd. 17. new text end
new text begin Reusable water bottles or cups. new text end
new text begin
Notwithstanding any law to the contrary, a
licensed child care center may provide drinking water to a child in a reusable water bottle
or reusable cup if the center develops and ensures implementation of a written policy that
at a minimum includes the following procedures:
new text end
new text begin
(1) each day the water bottle or cup is used, the child care center cleans and sanitizes
the water bottle or cup using procedures that comply with the Food Code under Minnesota
Rules, chapter 4626;
new text end
new text begin
(2) a water bottle or cup is assigned to a specific child and labeled with the child's first
and last name;
new text end
new text begin
(3) water bottles and cups are stored in a manner that reduces the risk of a child using
the wrong water bottle or cup; and
new text end
new text begin
(4) a water bottle or cup is used only for water.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 42.
Minnesota Statutes 2018, section 245A.145, subdivision 1, is amended to read:
Subdivision 1.
Policies and procedures.
(a) deleted text begin All licensed child care providersdeleted text end new text begin The
Department of Human Servicesnew text end must develop policies and procedures for reporting suspected
child maltreatment that fulfill the requirements in section 626.556 and deleted text begin must develop policies
and procedures for reporting complaints about the operation of a child care program. The
policies and procedures must include the telephone numbers of the local county child
protection agency for reporting suspected maltreatment; the county licensing agency for
family and group family child care providers; and the state licensing agency for child care
centers.deleted text end new text begin provide the policies and procedures to all licensed child care providers. The policies
and procedures must be written in plain language.
new text end
(b) The policies and procedures required in paragraph (a) must:
(1) be provided to the parents of all children at the time of enrollment in the child care
program; and
(2) be made available upon request.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 43.
Minnesota Statutes 2018, section 245A.145, subdivision 2, is amended to read:
Subd. 2.
Licensing agency phone number displayed.
deleted text begin By July 1, 2002,deleted text end A new or
renewed child care license must includenew text begin the licensing agency's telephone number andnew text end a
statement that informs parents who have deleted text begin concernsdeleted text end new text begin questionsnew text end about their child's care that
they may call the licensing agency. deleted text begin The commissioner shall print the telephone number for
the licensing agency in bold and large font on the license issued to child care providers.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 44.
new text begin
[245A.149] SUPERVISION OF FAMILY CHILD CARE LICENSE
HOLDER'S OWN CHILD.
new text end
new text begin
Notwithstanding Minnesota Rules, part 9502.0365, subpart 5, an individual may supervise
the family child care license holder's own child both inside and outside of the licensed space,
and is exempt from the requirements of this chapter and Minnesota Rules, chapter 9502, if
the individual:
new text end
new text begin
(1) is related to the license holder, as defined in section 245A.02, subdivision 13;
new text end
new text begin
(2) is not a designated caregiver, helper, or substitute for the licensed program; and
new text end
new text begin
(3) is involved only in the care of the license holder's own child.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 45.
Minnesota Statutes 2018, section 245A.151, is amended to read:
245A.151 FIRE MARSHAL INSPECTION.
When licensure under this chapternew text begin or certification under chapter 245Hnew text end requires an
inspection by a fire marshal to determine compliance with the State Fire Code under section
299F.011, a local fire code inspector approved by the state fire marshal may conduct the
inspection. If a community does not have a local fire code inspector or if the local fire code
inspector does not perform the inspection, the state fire marshal must conduct the inspection.
A local fire code inspector or the state fire marshal may recover the cost of these inspections
through a fee of no more than $50 per inspection charged to the applicant or license holdernew text begin
or license-exempt child care center certification holdernew text end . The fees collected by the state fire
marshal under this section are appropriated to the commissioner of public safety for the
purpose of conducting the inspections.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 46.
Minnesota Statutes 2018, section 245A.16, subdivision 1, is amended to read:
Subdivision 1.
Delegation of authority to agencies.
(a) County agencies and private
agencies that have been designated or licensed by the commissioner to perform licensing
functions and activities under section 245A.04 and background studies for family child care
under chapter 245C; to recommend denial of applicants under section 245A.05; to issue
correction orders, to issue variances, and recommend a conditional license under section
245A.06; or to recommend suspending or revoking a license or issuing a fine under section
245A.07, shall comply with rules and directives of the commissioner governing those
functions and with this section. The following variances are excluded from the delegation
of variance authority and may be issued only by the commissioner:
(1) dual licensure of family child care and child foster care, dual licensure of child and
adult foster care, and adult foster care and family child care;
(2) adult foster care maximum capacity;
(3) adult foster care minimum age requirement;
(4) child foster care maximum age requirement;
(5) variances regarding disqualified individuals except that, before the implementation
of NETStudy 2.0, county agencies may issue variances under section 245C.30 regarding
disqualified individuals when the county is responsible for conducting a consolidated
reconsideration according to sections 245C.25 and 245C.27, subdivision 2, clauses (a) and
(b), of a county maltreatment determination and a disqualification based on serious or
recurring maltreatment;
(6) the required presence of a caregiver in the adult foster care residence during normal
sleeping hours; deleted text begin and
deleted text end
(7) variances to requirements relating to chemical use problems of a license holder or a
household member of a license holderdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(8) variances to section 245A.53 for a time-limited period. If the commissioner grants
a variance under this clause, the license holder must provide notice of the variance to all
parents and guardians of the children in care.
new text end
Except as provided in section 245A.14, subdivision 4, paragraph (e), a county agency must
not grant a license holder a variance to exceed the maximum allowable family child care
license capacity of 14 children.
(b) Before the implementation of NETStudy 2.0, county agencies must report information
about disqualification reconsiderations under sections 245C.25 and 245C.27, subdivision
2, paragraphs (a) and (b), and variances granted under paragraph (a), clause (5), to the
commissioner at least monthly in a format prescribed by the commissioner.
(c) For family child care programs, the commissioner shall require a county agency to
conduct one unannounced licensing review at least annually.
(d) For family adult day services programs, the commissioner may authorize licensing
reviews every two years after a licensee has had at least one annual review.
(e) A license issued under this section may be issued for up to two years.
(f) During implementation of chapter 245D, the commissioner shall consider:
(1) the role of counties in quality assurance;
(2) the duties of county licensing staff; and
(3) the possible use of joint powers agreements, according to section 471.59, with counties
through which some licensing duties under chapter 245D may be delegated by the
commissioner to the counties.
Any consideration related to this paragraph must meet all of the requirements of the corrective
action plan ordered by the federal Centers for Medicare and Medicaid Services.
(g) Licensing authority specific to section 245D.06, subdivisions 5, 6, 7, and 8, or
successor provisions; and section 245D.061 or successor provisions, for family child foster
care programs providing out-of-home respite, as identified in section 245D.03, subdivision
1, paragraph (b), clause (1), is excluded from the delegation of authority to county and
private agencies.
(h) A county agency shall report to the commissioner, in a manner prescribed by the
commissioner, the following information for a licensed family child care program:
(1) the results of each licensing review completed, including the date of the review, and
any licensing correction order issued; deleted text begin and
deleted text end
(2) any death, serious injury, or determination of substantiated maltreatmentdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(3) any fires that require the service of a fire department within 48 hours of the fire. The
information under this clause must also be reported to the State Fire Marshal within 48
hours of the fire.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 47.
Minnesota Statutes 2018, section 245A.16, is amended by adding a subdivision
to read:
new text begin Subd. 9. new text end
new text begin Licensed family child foster care. new text end
new text begin
(a) Before recommending to deny a license
under section 245A.05 or revoke a license under section 245A.07 for nondisqualifying
background study information received under section 245C.05, subdivision 4, paragraph
(a), clause (3), for licensed family child foster care a county agency or private agency that
has been designated or licensed by the commissioner must review the following:
new text end
new text begin
(1) the type of crime;
new text end
new text begin
(2) the number of crimes;
new text end
new text begin
(3) the nature of the offenses;
new text end
new text begin
(4) the age of the individual at the time of conviction;
new text end
new text begin
(5) the length of time that has elapsed since the last conviction;
new text end
new text begin
(6) the relationship of the crime and the capacity to care for a child;
new text end
new text begin
(7) evidence of rehabilitation;
new text end
new text begin
(8) information or knowledge from community members regarding the individual's
capacity to provide foster care;
new text end
new text begin
(9) a statement from the study subject;
new text end
new text begin
(10) a statement from the license holder; and
new text end
new text begin
(11) other aggravating and mitigating factors.
new text end
new text begin
(b) The county or private licensing agency must send a summary of the review completed
according to paragraph (a), on a form developed by the commissioner, to the commissioner
and include any recommendation for licensing action. The commissioner shall retain the
final authority and responsibility for determining licensing actions.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2020.
new text end
Sec. 48.
Minnesota Statutes 2018, section 245A.18, subdivision 2, is amended to read:
Subd. 2.
Child passenger restraint systems; training requirement.
(a) Programs
licensed by the Department of Human Services under Minnesota Rules, chapter 2960, that
serve a child or children under deleted text begin ninedeleted text end new text begin eightnew text end years of age must document training that fulfills
the requirements in this subdivision.
(b) Before a license holder, staff person, or caregiver transports a child or children under
age deleted text begin ninedeleted text end new text begin eightnew text end in a motor vehicle, the person transporting the child must satisfactorily
complete training on the proper use and installation of child restraint systems in motor
vehicles. Training completed under this section may be used to meet initial or ongoing
training under Minnesota Rules, part 2960.3070, subparts 1 and 2.
deleted text begin
For all providers licensed prior to July 1, 2006, the training required in this subdivision
must be obtained by December 31, 2007.
deleted text end
(c) Training required under this section must be deleted text begin at least one hour in length,deleted text end completed
at orientation or initial trainingdeleted text begin ,deleted text end and repeated at least once every five years. At a minimum,
the training must address the proper use of child restraint systems based on the child's size,
weight, and age, and the proper installation of a car seat or booster seat in the motor vehicle
used by the license holder to transport the child or children.
(d) Training under paragraph (c) must be provided by individuals who are certified and
approved by the Department of Public Safety, Office of Traffic Safety. License holders may
obtain a list of certified and approved trainers through the Department of Public Safety
website or by contacting the agency.
deleted text begin
(e) Child care providers that only transport school age children as defined in section
245A.02, subdivision 16, in school buses as defined in section 169.011, subdivision 71,
paragraphs (c) to (f), are exempt from this subdivision.
deleted text end
new text begin
(e) Notwithstanding paragraph (a), for an emergency relative placement under section
245A.035, the commissioner may grant a variance to the training required by this subdivision
for a relative who completes a child seat safety check up. The child seat safety check up
trainer must be approved by the Department of Public Safety, Office of Traffic Safety, and
must provide one-on-one instruction on placing a child of a specific age in the exact child
passenger restraint in the motor vehicle in which the child will be transported. Once granted
a variance, and if all other licensing requirements are met, the relative applicant may receive
a license and may transport a relative foster child younger than eight years of age. A child
seat safety check up must be completed each time a child requires a different size car seat
according to car seat and vehicle manufacturer guidelines. A relative license holder must
complete training that meets the other requirements of this subdivision prior to placement
of another foster child younger than eight years of age in the home or prior to the renewal
of the child foster care license.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 49.
new text begin
[245A.24] MANDATORY REPORTING.
new text end
new text begin
All licensors whether employed by a county or the Department of Human Services must
immediately report any suspected fraud to the appropriate authorities.
new text end
Sec. 50.
Minnesota Statutes 2018, section 245A.40, is amended to read:
245A.40 CHILD CARE CENTER TRAINING REQUIREMENTS.
Subdivision 1.
Orientation.
new text begin (a) new text end The child care center license holder must ensure that
deleted text begin everydeleted text end new text begin the director,new text end staff deleted text begin person and volunteer isdeleted text end new text begin persons, substitutes, and unsupervised
volunteers arenew text end given orientation training and successfully deleted text begin completesdeleted text end new text begin completenew text end the training
before starting assigned duties. deleted text begin The orientation training in this subdivision applies to
volunteers who will have direct contact with or access to children and who are not under
the direct supervision of a staff person. Completion of the orientation must be documented
in the individual's personnel record.deleted text end The orientation training must include information about:
(1) the center's philosophy, child care program, and procedures for maintaining health
and safety according to section 245A.41 and Minnesota Rules, part 9503.0140, and handling
emergencies and accidents according to Minnesota Rules, part 9503.0110;
(2) specific job responsibilities;
(3) the behavior guidance standards in Minnesota Rules, part 9503.0055; deleted text begin and
deleted text end
(4) the reporting responsibilities in section 626.556, and Minnesota Rules, part
9503.0130deleted text begin .deleted text end new text begin ;
new text end
new text begin
(5) the center's drug and alcohol policy under section 245A.04, subdivision 1, paragraph
(c);
new text end
new text begin
(6) the center's risk reduction plan as required under section 245A.66, subdivision 2;
new text end
new text begin
(7) at least one-half hour of training on the standards under section 245A.1435 and on
reducing the risk of sudden unexpected infant death as required in subdivision 5, if applicable;
new text end
new text begin
(8) at least one-half hour of training on the risk of abusive head trauma as required for
the director and staff under subdivision 5a, if applicable; and
new text end
new text begin
(9) training required by a child's individual child care program plan as required under
Minnesota Rules, part 9503.0065, subpart 3, if applicable.
new text end
new text begin
(b) In addition to paragraph (a), before having unsupervised direct contact with a child,
the director and staff persons within the first 90 days of employment, and substitutes and
unsupervised volunteers within 90 days after the first date of direct contact with a child,
must complete:
new text end
new text begin
(1) pediatric first aid, in accordance with subdivision 3; and
new text end
new text begin
(2) pediatric cardiopulmonary resuscitation, in accordance with subdivision 4.
new text end
new text begin
(c) In addition to paragraph (b), the director and staff persons within the first 90 days
of employment, and substitutes and unsupervised volunteers within 90 days from the first
date of direct contact with a child, must complete training in child development, in accordance
with subdivision 2.
new text end
new text begin
(d) The license holder must ensure that documentation, as required in subdivision 10,
identifies the number of hours completed for each topic with a minimum training time
identified, if applicable, and that all required content is included.
new text end
new text begin
(e) Training in this subdivision must not be used to meet in-service training requirements
in subdivision 7.
new text end
new text begin
(f) Training completed within the previous 12 months under paragraphs (a), clauses (7)
and (8), and (c) are transferable to another child care center.
new text end
new text begin Subd. 1a. new text end
new text begin Definitions. new text end
new text begin
(a) For the purposes of this section, the following terms have the
meanings given.
new text end
new text begin
(b) "Substitute" means an adult who is temporarily filling a position as a director, teacher,
assistant teacher, or aide in a licensed child care center for less than 240 hours total in a
calendar year due to the absence of a regularly employed staff person.
new text end
new text begin
(c) "Staff person" means an employee of a child care center who provides direct contact
services to children.
new text end
new text begin
(d) "Unsupervised volunteer" means an individual who:
new text end
new text begin
(1) assists in the care of a child in care;
new text end
new text begin
(2) is not under the continuous direct supervision of a staff person; and
new text end
new text begin
(3) is not employed by the child care center.
new text end
Subd. 2.
Child development and learning training.
(a) deleted text begin For purposes of child care
centers,deleted text end The director and all staff deleted text begin hired after July 1, 2006,deleted text end new text begin persons, substitutes, and
unsupervised volunteersnew text end shall complete deleted text begin and document at least two hours ofdeleted text end child development
and learning training within the first 90 days of employment.new text begin The director and staff persons,
not including substitutes, must complete at least two hours of training on child development
and learning. The training for substitutes and unsupervised volunteers is not required to be
of a minimum length.new text end For purposes of this subdivision, "child development and learning
training" meansnew text begin anynew text end training innew text begin Knowledge and Competency Area I: Child Development
and Learning, which is training innew text end understanding how children develop physically,
cognitively, emotionally, and socially and learn as part of the children's family, culture, and
community. deleted text begin Training completed under this subdivision may be used to meet the in-service
training requirements under subdivision 7.
deleted text end
(b) Notwithstanding paragraph (a), individuals are exempt from this requirement if they:
(1) have taken a three-credit college course on early childhood development within the
past five years;
(2) have received a baccalaureate or master's degree in early childhood education or
school-age child care within the past five years;
(3) are licensed in Minnesota as a prekindergarten teacher, an early childhood educator,
a kindergarten to sixth grade teacher with a prekindergarten specialty, an early childhood
special education teacher, or an elementary teacher with a kindergarten endorsement; or
(4) have received a baccalaureate degree with a Montessori certificate within the past
five years.
new text begin
(c) The director and staff persons, not including substitutes, must complete at least two
hours of child development and learning training every second calendar year.
new text end
new text begin
(d) Substitutes and unsupervised volunteers must complete child development and
learning training every second calendar year. There is no minimum number of training hours
required.
new text end
new text begin
(e) Except for training required under paragraph (a), training completed under this
subdivision may be used to meet the in-service training requirements under subdivision 7.
new text end
Subd. 3.
First aid.
(a) deleted text begin All teachers and assistant teachers in a child care center governed
by Minnesota Rules, parts 9503.0005 to 9503.0170, and at least one staff person during
field trips and when transporting children in care, must satisfactorily complete pediatric
first aid training within 90 days of the start of work, unless the training has been completed
within the previous two years.deleted text end new text begin Unless training has been completed within the previous two
years, the director, staff persons, substitutes, and unsupervised volunteers must satisfactorily
complete pediatric first aid training prior to having unsupervised direct contact with a child,
but not to exceed the first 90 days of employment.
new text end
(b) deleted text begin Notwithstanding paragraph (a), which allows 90 days to complete training, at least
one staff person who has satisfactorily completed pediatric first aid training must be present
at all times in the center, during field trips, and when transporting children in care.deleted text end new text begin Pediatric
first aid training must be repeated at least every second calendar year. First aid training
under this subdivision must be provided by an individual approved as a first aid instructor
and must not be used to meet in-service training requirements under subdivision 7.
new text end
deleted text begin
(c) The pediatric first aid training must be repeated at least every two years, documented
in the person's personnel record and indicated on the center's staffing chart, and provided
by an individual approved as a first aid instructor. This training may be less than eight hours.
deleted text end
Subd. 4.
Cardiopulmonary resuscitation.
deleted text begin
(a) All teachers and assistant teachers in a
child care center governed by Minnesota Rules, parts 9503.0005 to 9503.0170, and at least
one staff person during field trips and when transporting children in care, must satisfactorily
complete training in cardiopulmonary resuscitation (CPR) that includes CPR techniques
for infants and children and in the treatment of obstructed airways. The CPR training must
be completed within 90 days of the start of work, unless the training has been completed
within the previous two years. The CPR training must have been provided by an individual
approved to provide CPR instruction, must be repeated at least once every two years, and
must be documented in the staff person's records.
deleted text end
deleted text begin
(b) Notwithstanding paragraph (a), which allows 90 days to complete training, at least
one staff person who has satisfactorily completed cardiopulmonary resuscitation training
must be present at all times in the center, during field trips, and when transporting children
in care.
deleted text end
deleted text begin
(c) CPR training may be provided for less than four hours.
deleted text end
deleted text begin
(d) Persons providing CPR training must use CPR training that has been developed:
deleted text end
deleted text begin
(1) by the American Heart Association or the American Red Cross and incorporates
psychomotor skills to support the instruction; or
deleted text end
deleted text begin
(2) using nationally recognized, evidence-based guidelines for CPR and incorporates
psychomotor skills to support the instruction.
deleted text end
new text begin
(a) Unless training has been completed within the previous two years, the director, staff
persons, substitutes, and unsupervised volunteers must satisfactorily complete pediatric
cardiopulmonary resuscitation (CPR) training that meets the requirements of this subdivision.
Pediatric CPR training must be completed prior to having unsupervised direct contact with
a child, but not to exceed the first 90 days of employment.
new text end
new text begin
(b) Pediatric CPR training must be provided by an individual approved to provide
pediatric CPR instruction.
new text end
new text begin
(c) The Pediatric CPR training must:
new text end
new text begin
(1) cover CPR techniques for infants and children and the treatment of obstructed airways;
new text end
new text begin
(2) include instruction, hands-on practice, and an in-person, observed skills assessment
under the direct supervision of a CPR instructor; and
new text end
new text begin
(3) be developed by the American Heart Association, the American Red Cross, or another
organization that uses nationally recognized, evidence-based guidelines for CPR.
new text end
new text begin
(d) Pediatric CPR training must be repeated at least once every second calendar year.
new text end
new text begin
(e) Pediatric CPR training in this subdivision must not be used to meet in-service training
requirements under subdivision 7.
new text end
Subd. 5.
Sudden unexpected infant death deleted text begin and abusive head traumadeleted text end training.
new text begin
(a)
Before caring for infants, the director, staff persons, substitutes, and unsupervised volunteers
must receive training on the standards under section 245A.1435 and on reducing the risk
of sudden unexpected infant death during orientation and each calendar year thereafter.
new text end
new text begin
(b) Sudden unexpected infant death reduction training required under this subdivision
must be at least one-half hour in length. At a minimum, the training must address the risk
factors related to sudden unexpected infant death, means of reducing the risk of sudden
unexpected infant death in child care, and license holder communication with parents
regarding reducing the risk of sudden unexpected infant death.
new text end
new text begin
(c) Except if completed during orientation, training taken under this subdivision may
be used to meet the in-service training requirements under subdivision 7.
new text end
new text begin Subd. 5a. new text end
new text begin Abusive head trauma training. new text end
deleted text begin
(a) License holders must document that
before staff persons and volunteers care for infants, they are instructed on the standards in
section 245A.1435 and receive training on reducing the risk of sudden unexpected infant
death. In addition, license holders must document that before staff persons care for infants
or children under school age, they receive training on the risk of abusive head trauma from
shaking infants and young children. The training in this subdivision may be provided as
orientation training under subdivision 1 and in-service training under subdivision 7.
deleted text end
new text begin
(a)
Before caring for children under school age, the director, staff persons, substitutes, and
unsupervised volunteers must receive training on the risk of abusive head trauma during
orientation and each calendar year thereafter.
new text end
deleted text begin
(b) Sudden unexpected infant death reduction training required under this subdivision
must be at least one-half hour in length and must be completed at least once every year. At
a minimum, the training must address the risk factors related to sudden unexpected infant
death, means of reducing the risk of sudden unexpected infant death in child care, and license
holder communication with parents regarding reducing the risk of sudden unexpected infant
death.
deleted text end
deleted text begin (c)deleted text end new text begin (b)new text end Abusive head trauma training under this subdivision must be at least one-half
hour in length deleted text begin and must be completed at least once every yeardeleted text end . At a minimum, the training
must address the risk factors related to shaking infants and young children, means to reduce
the risk of abusive head trauma in child care, and license holder communication with parents
regarding reducing the risk of abusive head trauma.
new text begin
(c) Except if completed during orientation, training taken under this subdivision may
be used to meet the in-service training requirements under subdivision 7.
new text end
(d) The commissioner shall make available for viewing a video presentation on the
dangers associated with shaking infants and young children, which may be used in
conjunction with the annual training required under paragraph deleted text begin (c)deleted text end new text begin (a)new text end .
Subd. 6.
Child passenger restraint systemsdeleted text begin ; training requirementdeleted text end .
deleted text begin
(a) A license
holder must comply with all seat belt and child passenger restraint system requirements
under section 169.685. (b) Child care centers that serve a child or children under nine years
of age must document training that fulfills the requirements in this subdivision.
deleted text end
deleted text begin (1)deleted text end new text begin (a)new text end Before a license holder transports a child or children under age deleted text begin ninedeleted text end new text begin eightnew text end in a
motor vehicle, the person placing the child or children in a passenger restraint must
satisfactorily complete training on the proper use and installation of child restraint systems
in motor vehicles. deleted text begin Training completed under this subdivision may be used to meet orientation
training under subdivision 1 and in-service training under subdivision 7.
deleted text end
deleted text begin (2)deleted text end new text begin (b)new text end Training required under this subdivision must be deleted text begin at least one hour in length,
completed at orientation, anddeleted text end repeated at least once every five years. At a minimum, the
training must address the proper use of child restraint systems based on the child's size,
weight, and age, and the proper installation of a car seat or booster seat in the motor vehicle
used by the license holder to transport the child or children.
deleted text begin (3)deleted text end new text begin (c)new text end Training required under this subdivision must be provided by individuals who
are certified and approved by the Department of Public Safety, Office of Traffic Safety.
License holders may obtain a list of certified and approved trainers through the Department
of Public Safety website or by contacting the agency.
deleted text begin (4)deleted text end new text begin (d)new text end Child care providers that only transport school-age children as defined in section
245A.02, subdivision 16, in child care buses as defined in section 169.448, subdivision 1,
paragraph (e), are exempt from this subdivision.
new text begin
(e) Training completed under this subdivision may be used to meet in-service training
requirements under subdivision 7. Training completed within the previous five years is
transferable upon a staff person's change in employment to another child care center.
new text end
Subd. 7.
In-service.
(a) A license holder must ensure that the center director deleted text begin and all staff
who have direct contact with a child complete annual in-service training. In-service training
requirements must be met by a staff person's participation in the following training areas:deleted text end new text begin ,
staff persons, substitutes, and unsupervised volunteers complete in-service training each
calendar year.
new text end
new text begin
(b) The center director and staff persons who work more than 20 hours per week must
complete 24 hours of in-service training each calendar year. Staff persons who work 20
hours or less per week must complete 12 hours of in-service training each calendar year.
Substitutes and unsupervised volunteers must complete the requirements of paragraphs (e)
to (h) and do not otherwise have a minimum number of hours of training to complete.
new text end
new text begin
(c) The number of in-service training hours may be prorated for individuals not employed
for an entire year.
new text end
new text begin
(d) Each year, in-service training must include:
new text end
new text begin
(1) the center's procedures for maintaining health and safety according to section 245A.41
and Minnesota Rules, part 9503.0140, and handling emergencies and accidents according
to Minnesota Rules, part 9503.0110;
new text end
new text begin
(2) the reporting responsibilities under section 626.556 and Minnesota Rules, part
9503.0130;
new text end
new text begin
(3) at least one-half hour of training on the standards under section 245A.1435 and on
reducing the risk of sudden unexpected infant death as required under subdivision 5, if
applicable; and
new text end
new text begin
(4) at least one-half hour of training on the risk of abusive head trauma from shaking
infants and young children as required under subdivision 5a, if applicable.
new text end
new text begin
(e) Each year, or when a change is made, whichever is more frequent, in-service training
must be provided on: (1) the center's risk reduction plan under section 245A.66, subdivision
2; and (2) a child's individual child care program plan as required under Minnesota Rules,
part 9503.0065, subpart 3.
new text end
new text begin
(f) At least once every two calendar years, the in-service training must include:
new text end
new text begin
(1) child development and learning training under subdivision 2;
new text end
new text begin
(2) pediatric first aid that meets the requirements of subdivision 3;
new text end
new text begin
(3) pediatric cardiopulmonary resuscitation training that meets the requirements of
subdivision 4;
new text end
new text begin
(4) cultural dynamics training to increase awareness of cultural differences; and
new text end
new text begin
(5) disabilities training to increase awareness of differing abilities of children.
new text end
new text begin
(g) At least once every five years, in-service training must include child passenger
restraint training that meets the requirements of subdivision 6, if applicable.
new text end
new text begin
(h) The remaining hours of the in-service training requirement must be met by completing
training in the following content areas of the Minnesota Knowledge and Competency
Framework:
new text end
(1)new text begin Content area I:new text end child development and learning;
(2)new text begin Content area II:new text end developmentally appropriate learning experiences;
(3)new text begin Content area III:new text end relationships with families;
(4)new text begin Content area IV:new text end assessment, evaluation, and individualization;
(5)new text begin Content area V:new text end historical and contemporary development of early childhood
education;
(6)new text begin Content area VI:new text end professionalism; deleted text begin and
deleted text end
(7)new text begin Content area VII:new text end health, safety, and nutritionnew text begin ; and
new text end
new text begin (8) Content area VIII: application through clinical experiencesnew text end .
deleted text begin (b)deleted text end new text begin (i)new text end For purposes of this subdivision, the following terms have the meanings given
them.
(1) "Child development and learning training" deleted text begin has the meaning given it in subdivision
2, paragraph (a).deleted text end new text begin means training in understanding how children develop physically,
cognitively, emotionally, and socially and learn as part of the children's family, culture, and
community.
new text end
(2) "Developmentally appropriate learning experiences" means creating positive learning
experiences, promoting cognitive development, promoting social and emotional development,
promoting physical development, and promoting creative development.
(3) "Relationships with families" means training on building a positive, respectful
relationship with the child's family.
(4) "Assessment, evaluation, and individualization" means training in observing,
recording, and assessing development; assessing and using information to plan; and assessing
and using information to enhance and maintain program quality.
(5) "Historical and contemporary development of early childhood education" means
training in past and current practices in early childhood education and how current events
and issues affect children, families, and programs.
(6) "Professionalism" means training in knowledge, skills, and abilities that promote
ongoing professional development.
(7) "Health, safety, and nutrition" means training in establishing health practices, ensuring
safety, and providing healthy nutrition.
new text begin
(8) "Application through clinical experiences" means clinical experiences in which a
person applies effective teaching practices using a range of educational programming models.
new text end
deleted text begin
(c) The director and all program staff persons must annually complete a number of hours
of in-service training equal to at least two percent of the hours for which the director or
program staff person is annually paid, unless one of the following is applicable.
deleted text end
deleted text begin
(1) A teacher at a child care center must complete one percent of working hours of
in-service training annually if the teacher:
deleted text end
deleted text begin
(i) possesses a baccalaureate or master's degree in early childhood education or school-age
care;
deleted text end
deleted text begin
(ii) is licensed in Minnesota as a prekindergarten teacher, an early childhood educator,
a kindergarten to sixth grade teacher with a prekindergarten specialty, an early childhood
special education teacher, or an elementary teacher with a kindergarten endorsement; or
deleted text end
deleted text begin
(iii) possesses a baccalaureate degree with a Montessori certificate.
deleted text end
deleted text begin
(2) A teacher or assistant teacher at a child care center must complete one and one-half
percent of working hours of in-service training annually if the individual is:
deleted text end
deleted text begin
(i) a registered nurse or licensed practical nurse with experience working with infants;
deleted text end
deleted text begin
(ii) possesses a Montessori certificate, a technical college certificate in early childhood
development, or a child development associate certificate; or
deleted text end
deleted text begin
(iii) possesses an associate of arts degree in early childhood education, a baccalaureate
degree in child development, or a technical college diploma in early childhood development.
deleted text end
deleted text begin
(d) The number of required training hours may be prorated for individuals not employed
full time or for an entire year.
deleted text end
deleted text begin
(e) The annual in-service training must be completed within the calendar year for which
it was required. In-service training completed by staff persons is transferable upon a staff
person's change in employment to another child care program.
deleted text end
deleted text begin (f)deleted text end new text begin (j)new text end The license holder must ensure thatdeleted text begin , when a staff person completes in-service
training, the training is documented in the staff person's personnel record. The documentation
must include the date training was completed, the goal of the training and topics covered,
trainer's name and organizational affiliation, trainer's signed statement that training was
successfully completed,deleted text end new text begin documentation, as required in subdivision 10, includes the number
of total training hours required to be completed, name of the training, the Minnesota
Knowledge and Competency Framework content area, number of hours completed,new text end and the
director's approval of the training.
new text begin
(k) In-service training completed by a staff person that is not specific to that child care
center is transferable upon a staff person's change in employment to another child care
program.
new text end
deleted text begin Subd. 8. deleted text end
deleted text begin Cultural dynamics and disabilities training for child care providers. deleted text end
deleted text begin
(a)
The training required of licensed child care center staff must include training in the cultural
dynamics of early childhood development and child care. The cultural dynamics and
disabilities training and skills development of child care providers must be designed to
achieve outcomes for providers of child care that include, but are not limited to:
deleted text end
deleted text begin
(1) an understanding and support of the importance of culture and differences in ability
in children's identity development;
deleted text end
deleted text begin
(2) understanding the importance of awareness of cultural differences and similarities
in working with children and their families;
deleted text end
deleted text begin
(3) understanding and support of the needs of families and children with differences in
ability;
deleted text end
deleted text begin
(4) developing skills to help children develop unbiased attitudes about cultural differences
and differences in ability;
deleted text end
deleted text begin
(5) developing skills in culturally appropriate caregiving; and
deleted text end
deleted text begin
(6) developing skills in appropriate caregiving for children of different abilities.
deleted text end
deleted text begin
(b) Curriculum for cultural dynamics and disability training shall be approved by the
commissioner.
deleted text end
deleted text begin
(c) The commissioner shall amend current rules relating to the training of the licensed
child care center staff to require cultural dynamics training. Timelines established in the
rule amendments for complying with the cultural dynamics training requirements must be
based on the commissioner's determination that curriculum materials and trainers are available
statewide.
deleted text end
deleted text begin
(d) For programs caring for children with special needs, the license holder shall ensure
that any additional staff training required by the child's individual child care program plan
required under Minnesota Rules, part 9503.0065, subpart 3, is provided.
deleted text end
deleted text begin Subd. 9. deleted text end
deleted text begin Ongoing health and safety training. deleted text end
deleted text begin
A staff person's orientation training on
maintaining health and safety and handling emergencies and accidents, as required in
subdivision 1, must be repeated at least once each calendar year by each staff person. The
completion of the annual training must be documented in the staff person's personnel record.
deleted text end
new text begin Subd. 10. new text end
new text begin Documentation. new text end
new text begin
All training must be documented and maintained on site in
each personnel record. In addition to any requirements for each training provided in this
section, documentation for each staff person must include the staff person's first date of
direct contact and first date of unsupervised contact with a child in care.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 51.
Minnesota Statutes 2018, section 245A.41, is amended to read:
245A.41 CHILD CARE CENTER HEALTH AND SAFETY REQUIREMENTS.
Subdivision 1.
Allergy prevention and response.
(a) Before admitting a child for care,
the license holder must obtain documentation of any known allergy from the child's parent
or legal guardian or the child's source of medical care. If a child has a known allergy, the
license holder must maintain current information about the allergy in the child's record and
develop an individual child care program plan as specified in Minnesota Rules, part
9503.0065, subpart 3. The individual child care program plan must include but not be limited
to a description of the allergy, specific triggers, avoidance techniques, symptoms of an
allergic reaction, and procedures for responding to an allergic reaction, including medication,
dosages, and a doctor's contact information.
(b) The license holder must ensure that each staff person who is responsible for carrying
out the individual child care program plan review and follow the plan. Documentation of a
staff person's review must be kept on site.
(c) At least deleted text begin annuallydeleted text end new text begin once each calendar yearnew text end or following any changes made to
allergy-related information in the child's record, the license holder must update the child's
individual child care program plan and inform each staff person who is responsible for
carrying out the individual child care program plan of the change. The license holder must
keep on site documentation that a staff person was informed of a change.
(d) A child's allergy information must be available at all times including on site, when
on field trips, or during transportation. A child's food allergy information must be readily
available to a staff person in the area where food is prepared and served to the child.
(e) The license holder must contact the child's parent or legal guardian as soon as possible
in any instance of exposure or allergic reaction that requires medication or medical
intervention. The license holder must call emergency medical services when epinephrine
is administered to a child in the license holder's care.
Subd. 2.
Handling and disposal of bodily fluids.
The licensed child care center must
comply with the following procedures for safely handling and disposing of bodily fluids:
(1) surfaces that come in contact with potentially infectious bodily fluids, including
blood and vomit, must be cleaned and disinfected according to Minnesota Rules, part
9503.0005, subpart 11;
(2) blood-contaminated material must be disposed of in a plastic bag with a secure tie;
(3) sharp items used for a child with special care needs must be disposed of in a "sharps
container." The sharps container must be stored out of reach of a child;
(4) the license holder must have the following bodily fluid disposal supplies in the center:
disposable gloves, disposal bags, and eye protection; and
(5) the license holder must ensure that each staff person deleted text begin is trained ondeleted text end new text begin followsnew text end universal
precautions to reduce the risk of spreading infectious disease. deleted text begin A staff person's completion
of the training must be documented in the staff person's personnel record.
deleted text end
Subd. 3.
Emergency preparedness.
(a) deleted text begin No later than September 30, 2017,deleted text end A licensed
child care center must have a written emergency plan for emergencies that require evacuation,
sheltering, or other protection of a child, such as fire, natural disaster, intruder, or other
threatening situation that may pose a health or safety hazard to a child. The plan must be
written on a form developed by the commissioner and must include:
(1) procedures for an evacuation, relocation, shelter-in-place, or lockdown;
(2) a designated relocation site and evacuation route;
(3) procedures for notifying a child's parent or legal guardian of the evacuation, relocation,
shelter-in-place, or lockdown, including procedures for reunification with families;
(4) accommodations for a child with a disability or a chronic medical condition;
(5) procedures for storing a child's medically necessary medicine that facilitates easy
removal during an evacuation or relocation;
(6) procedures for continuing operations in the period during and after a crisis; deleted text begin and
deleted text end
(7) procedures for communicating with local emergency management officials, law
enforcement officials, or other appropriate state or local authoritiesnew text begin ; and
new text end
new text begin (8) accommodations for infants and toddlersnew text end .
(b) The license holder must train staff persons on the emergency plan at orientation,
when changes are made to the plan, and at least once each calendar year. Training must be
documented in each staff person's personnel file.
(c) The license holder must conduct drills according to the requirements in Minnesota
Rules, part 9503.0110, subpart 3. The date and time of the drills must be documented.
(d) The license holder must review and update the emergency plan annually.
Documentation of the annual emergency plan review shall be maintained in the program's
administrative records.
(e) The license holder must include the emergency plan in the program's policies and
procedures as specified under section 245A.04, subdivision 14. The license holder must
provide a physical or electronic copy of the emergency plan to the child's parent or legal
guardian upon enrollment.
(f) The relocation site and evacuation route must be posted in a visible place as part of
the written procedures for emergencies and accidents in Minnesota Rules, part 9503.0140,
subpart 21.
new text begin Subd. 4. new text end
new text begin Child passenger restraint requirements. new text end
new text begin
A license holder must comply with
all seat belt and child passenger restraint system requirements under section 169.685.
new text end
new text begin Subd. 5. new text end
new text begin Telephone requirement in licensed child care centers. new text end
new text begin
(a) A working telephone
which is capable of making outgoing calls and receiving incoming calls must be located
within the licensed child care center at all times. Staff must have access to a working
telephone while providing care and supervision to children in care, even if the care occurs
outside of the child care facility. A license holder may use a cellular telephone to meet the
requirements of this subdivision.
new text end
new text begin
(b) If a cellular telephone is used to satisfy the requirements of this subdivision, the
cellular telephone must be accessible to staff, be stored in a centrally located area when not
in use, and be sufficiently charged for use at all times.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 52.
Minnesota Statutes 2018, section 245A.50, is amended to read:
245A.50 FAMILY CHILD CARE TRAINING REQUIREMENTS.
Subdivision 1.
Initial training.
(a) License holders, caregivers, deleted text begin anddeleted text end substitutesnew text begin , and
helpersnew text end must comply with the training requirements in this section.
deleted text begin
(b) Helpers who assist with care on a regular basis must complete six hours of training
within one year after the date of initial employment.
deleted text end
new text begin
(b) The license holder, before initial licensure, and a caregiver, before caring for a child,
must complete:
new text end
new text begin
(1) the six-hour Supervising for Safety for Family Child Care course developed by the
commissioner;
new text end
new text begin
(2) a two-hour course in Knowledge and Competency Area I: Child Development and
Learning, as required by subdivision 2;
new text end
new text begin
(3) a two-hour course in behavior guidance that may be fulfilled by completing any
course in Knowledge and Competency Area II-C: Promoting Social and Emotional
Development, as required by subdivision 2;
new text end
new text begin
(4) pediatric first aid, as required by subdivision 3;
new text end
new text begin
(5) pediatric cardiopulmonary resuscitation, as required by subdivision 4;
new text end
new text begin
(6) if applicable, training in reducing the risk of sudden unexpected infant death and
abusive head trauma as required by subdivision 5; and
new text end
new text begin
(7) if applicable, training in child passenger restraint as required by subdivision 6.
new text end
new text begin
The license holder or caregiver may take one four-hour course that covers both clauses (2)
and (3) to meet the requirements of this subdivision.
new text end
new text begin
(c) Before caring for a child, each substitute must complete:
new text end
new text begin
(1) the four-hour Basics of Licensed Family Child Care for Substitutes course developed
by the commissioner;
new text end
new text begin
(2) pediatric first aid, as required by subdivision 3;
new text end
new text begin
(3) pediatric cardiopulmonary resuscitation, as required by subdivision 4;
new text end
new text begin
(4) if applicable, training in reducing the risk of sudden unexpected infant death and
abusive head trauma as required by subdivision 5; and
new text end
new text begin
(5) if applicable, training in child passenger restraint as required by subdivision 6.
new text end
new text begin
(d) Each helper must complete:
new text end
new text begin
(1) if applicable, before assisting with the care of a child under school age, training in
reducing the risk of sudden unexpected infant death and abusive head trauma, as required
by subdivision 5;
new text end
new text begin
(2) within 90 days of the start of employment, the one-hour Child Development for
Helpers course developed by the commissioner; and
new text end
new text begin
(3) if applicable, training in child passenger restraint as required by subdivision 6.
new text end
new text begin
(e) Before caring for a child or assisting in the care of a child, the license holder must
train each caregiver and substitute on:
new text end
new text begin
(1) the emergency plan required under section 245A.51, subdivision 3, paragraph (b);
new text end
new text begin
(2) allergy prevention and response required under section 245A.51, subdivision 1,
paragraph (b); and
new text end
new text begin
(3) the drug and alcohol policy required under section 245A.04, subdivision 1, paragraph
(c).
new text end
deleted text begin (c)deleted text end new text begin (f)new text end Training requirements established under this section that must be completed prior
to initial licensure must be satisfied only by a newly licensed child care provider or by a
child care provider who has not held an active child care license in Minnesota in the previous
12 months. A child care provider who relocates within the state or who voluntarily cancels
a license or allows the license to lapse for a period of less than 12 months and who seeks
reinstatement of the lapsed or canceled license within 12 months of the lapse or cancellation
must satisfy the annual, ongoing training requirements, and is not required to satisfy the
training requirements that must be completed prior to initial licensure.
new text begin Subd. 1a. new text end
new text begin Definitions. new text end
new text begin
(a) For the purposes of this section, the following terms have the
meanings given them.
new text end
new text begin
(b) "Basics of Family Child Care for Substitutes" means a class developed by the
commissioner that includes the following topics: prevention and control of infectious
diseases; administering medication; preventing and responding to allergies; ensuring building
and physical premise safety; handling and storing biological contaminants; preventing and
reporting abuse and child maltreatment; emergency preparedness; and child development.
new text end
new text begin
(c) "Caregiver" means an adult other than the license holder who supervises children
for a cumulative total of 300 or more hours in any calendar year.
new text end
new text begin
(d) "Helper" means a minor, ages 13 through 17, who assists in the care of the children.
new text end
new text begin
(e) "Substitute" means an adult who assumes the responsibility of a provider for a
cumulative total of not more than 300 hours in any calendar year.
new text end
Subd. 2.
Child development and learning and behavior guidance training.
(a) deleted text begin For
purposes of family and group family child care,deleted text end The license holder and each deleted text begin adultdeleted text end caregiver
deleted text begin who provides care in the licensed setting for more than 30 days in any 12-month perioddeleted text end
shall complete deleted text begin and documentdeleted text end at least four hours of child growth and learning and behavior
guidance training prior to initial licensure, and before caring for children. deleted text begin For purposes of
this subdivision, "child development and learning training" means training in understanding
how children develop physically, cognitively, emotionally, and socially and learn as part
of the children's family, culture, and community. "Behavior guidance training" means
training in the understanding of the functions of child behavior and strategies for managing
challenging situations. At least two hours of child development and learning or behavior
guidance training must be repeated annually. Training curriculum shall be developed or
approved by the commissioner of human services.
deleted text end
(b) Notwithstanding paragraph (a), individuals are exempt from this requirement if they:
(1) have taken a three-credit course on early childhood development within the past five
years;
(2) have received a baccalaureate or master's degree in early childhood education or
school-age child care within the past five years;
(3) are licensed in Minnesota as a prekindergarten teacher, an early childhood educator,
a kindergarten to grade 6 teacher with a prekindergarten specialty, an early childhood special
education teacher, or an elementary teacher with a kindergarten endorsement; or
(4) have received a baccalaureate degree with a Montessori certificate within the past
five years.
new text begin
(c) The license holder and each caregiver must complete at least two hours of child
development training annually that may be fulfilled by completing any course in Knowledge
and Competency Area I: Child Development and Learning; or behavior guidance training
that may be fulfilled by completing any course in Knowledge and Competency Area II-C:
Promoting Social and Emotional Development. The commissioner shall develop or approve
training curriculum.
new text end
Subd. 3.
First aid.
(a) deleted text begin When children are present in a family child care home governed
by Minnesota Rules, parts 9502.0315 to 9502.0445, at least one staff person must be present
in the home who has been trained in first aid.deleted text end new text begin The license holder must complete pediatric
first aid training before licensure and each caregiver and substitute must complete pediatric
first aid training before caring for children.new text end The first aid training must have been provided
by an individual approved to provide first aid instruction. First aid training may be less than
eight hours and persons qualified to provide first aid training include individuals approved
as first aid instructors. deleted text begin First aid training must be repeated every two years.
deleted text end
(b) deleted text begin A family child care provider is exempt from the first aid training requirements under
this subdivision related to any substitute caregiver who provides less than 30 hours of care
during any 12-month period.deleted text end new text begin The license holder, each caregiver and each substitute must
complete additional pediatric first aid training every two years.
new text end
(c) Video training reviewed and approved by the county licensing agency satisfies the
training requirement of this subdivision.
Subd. 4.
Cardiopulmonary resuscitation.
(a) deleted text begin When children are present in a family
child care home governed by Minnesota Rules, parts 9502.0315 to 9502.0445, at least one
caregiver must be present in the home who has been trained in cardiopulmonary resuscitation
(CPR), including CPR techniques for infants and children, and in the treatment of obstructed
airways. The CPR training must have been provided by an individual approved to provide
CPR instruction, must be repeated at least once every two years, and must be documented
in the caregiver's records.deleted text end new text begin The family child care license holder must complete pediatric
cardiopulmonary resuscitation (CPR) training prior to licensure. Caregivers and substitutes
must complete pediatric CPR training prior to caring for children. Training that has been
completed in the previous two years fulfills this requirement.
new text end
(b) deleted text begin A family child care provider is exempt from the CPR training requirement in this
subdivision related to any substitute caregiver who provides less than 30 hours of care during
any 12-month period.deleted text end new text begin The CPR training must be provided by an individual approved to
provide CPR instruction.
new text end
(c) deleted text begin Persons providing CPR training must use CPR training that has been developed:deleted text end new text begin The
Pediatric CPR training must:
new text end
deleted text begin
(1) by the American Heart Association or the American Red Cross and incorporates
psychomotor skills to support the instruction; or
deleted text end
deleted text begin
(2) using nationally recognized, evidence-based guidelines for CPR training and
incorporates psychomotor skills to support the instruction.
deleted text end
new text begin
(1) cover CPR techniques for infants and children and the treatment of obstructed airways;
new text end
new text begin
(2) include instruction, hands-on practice, and an in-person observed skills assessment
under the direct supervision of a CPR instructor; and
new text end
new text begin
(3) be developed by the American Heart Association, the American Red Cross, or another
organization that uses nationally recognized, evidence-based guidelines for CPR.
new text end
new text begin
(d) License holders, caregivers, and substitutes must complete pediatric CPR training
at least once every two years.
new text end
Subd. 5.
Sudden unexpected infant death and abusive head trauma training.
(a)new text begin
The license holder must complete training on reducing the risk of sudden unexpected infant
death prior to caring for infants.new text end License holders must deleted text begin documentdeleted text end new text begin ensurenew text end that before deleted text begin staff
persons,deleted text end caregivers,new text begin substitutes,new text end and helpers assist in the care of infants, they are instructed
on the standards in section 245A.1435 and receive training on reducing the risk of sudden
unexpected infant death.
new text begin (b) The license holder must complete training on reducing the risk of abusive head
trauma, prior to caring for infants and children under school age.new text end In addition, license holders
must deleted text begin documentdeleted text end new text begin ensurenew text end that before deleted text begin staff persons,deleted text end caregivers,new text begin substitutes,new text end and helpers assist
in the care of infants and children under school age, they receive training on reducing the
risk of abusive head trauma deleted text begin from shaking infants and young childrendeleted text end . deleted text begin The training in this
subdivision may be provided as initial training under subdivision 1 or ongoing annual
training under subdivision 7.
deleted text end
deleted text begin (b)deleted text end new text begin (c)new text end Sudden unexpected infant death reduction training required under this subdivision
must, at a minimum, address the risk factors related to sudden unexpected infant death,
means of reducing the risk of sudden unexpected infant death in child care, and license
holder communication with parents regarding reducing the risk of sudden unexpected infant
death.
deleted text begin (c)deleted text end new text begin (d)new text end Abusive head trauma training required under this subdivision must, at a minimum,
address the risk factors related to shaking infants and young children, means of reducing
the risk of abusive head trauma in child care, and license holder communication with parents
regarding reducing the risk of abusive head trauma.
deleted text begin (d)deleted text end new text begin (e)new text end Training for family and group family child care providers must be developed by
the commissioner deleted text begin in conjunction with the Minnesota Sudden Infant Death Centerdeleted text end and
approved by deleted text begin the Minnesota Center for Professional Developmentdeleted text end new text begin Achieve - The MN Center
for Professional Developmentnew text end . Sudden unexpected infant death reduction training and
abusive head trauma training may be provided in a single course of no more than two hours
in length.
deleted text begin (e)deleted text end new text begin (f)new text end Sudden unexpected infant death reduction training and abusive head trauma
training required under this subdivision must be completed in person or as allowed under
subdivision 10, clause (1) or (2), at least once every two years. On the years when the license
holder deleted text begin isdeleted text end new text begin , caregiver, substitute, and helper arenew text end not receiving training in person or as allowed
under subdivision 10, clause (1) or (2), the license holdernew text begin , caregiver, substitute, and helpernew text end
must receive sudden unexpected infant death reduction training and abusive head trauma
training through a video of no more than one hour in length. The video must be developed
or approved by the commissioner.
deleted text begin (f)deleted text end new text begin (g)new text end An individual who is related to the license holder as defined in section 245A.02,
subdivision 13, and who is involved only in the care of the license holder's own infant or
child under school age and who is not designated to be a caregiver, helper, or substitute, as
defined in Minnesota Rules, part 9502.0315, for the licensed program, is exempt from the
sudden unexpected infant death and abusive head trauma training.
Subd. 6.
Child passenger restraint systems; training requirement.
deleted text begin
(a) A license
holder must comply with all seat belt and child passenger restraint system requirements
under section 169.685.
deleted text end
deleted text begin
(b) Family and group family child care programs licensed by the Department of Human
Services that serve a child or children under nine years of age must document training that
fulfills the requirements in this subdivision.
deleted text end
new text begin (a) new text end (1) deleted text begin Beforedeleted text end A license holder, deleted text begin staff person, caregiver, or helperdeleted text end new text begin caregiver, or substitutenew text end
deleted text begin transportsdeleted text end new text begin may transportnew text end a child or children under age deleted text begin ninedeleted text end new text begin eightnew text end in a motor vehicledeleted text begin ,deleted text end new text begin .new text end deleted text begin the
persondeleted text end new text begin Beforenew text end placing the child or children in a passenger restraintnew text begin , the personnew text end must
satisfactorily complete training on the proper use and installation of child restraint systems
in motor vehicles. Training completed under this subdivision may be used to meet initial
training under subdivision 1 or ongoing training under subdivision 7.
(2) Training required under this subdivision must be deleted text begin at least one hour in length, completed
at initial training, anddeleted text end repeated at least once every five years.
new text begin (3)new text end At a minimum, the training must address the proper use of child restraint systems
based on the child's size, weight, and age, and the proper installation of a car seat or booster
seat in the motor vehicle used by the license holder to transport the child or children.
deleted text begin (3)deleted text end new text begin (4)new text end Training under this subdivision must be provided by individuals who are certified
and approved by the Department of Public Safety, Office of Traffic Safety. License holders
may obtain a list of certified and approved trainers through the Department of Public Safety
website or by contacting the agency.
deleted text begin (c)deleted text end new text begin (b)new text end Child care providers that only transport school-age children as defined in section
245A.02, subdivision 19, paragraph (f), in child care buses as defined in section 169.448,
subdivision 1, paragraph (e), are exempt from this subdivision.
Subd. 7.
new text begin Ongoing new text end training requirements for family and group family child carenew text begin
license holders and caregiversnew text end .
deleted text begin For purposes of family and group family child care,deleted text end new text begin (a)new text end
The license holder and each deleted text begin primarydeleted text end caregiver must complete 16 hours of ongoing training
each year. deleted text begin For purposes of this subdivision, a primary caregiver is an adult caregiver who
provides services in the licensed setting for more than 30 days in any 12-month period.
Repeat of topical training requirements in subdivisions 2 to 8 shall count toward the annual
16-hour training requirement.
deleted text end
new text begin
(b) The license holder and caregiver must annually complete ongoing training as follows:
new text end
new text begin
(1) as required by subdivision 2, a two-hour course in: child development that may be
fulfilled by any course in Knowledge and Competency Area I: Child Development and
Learning; or behavior guidance that may be fulfilled by any course in Knowledge and
Competency Area II-C: Promoting Social and Emotional Development;
new text end
new text begin
(2) a two-hour course in active supervision that may be fulfilled by any course in:
Knowledge and Competency Area VII-A: Establishing Healthy Practices; or Knowledge
and Competency Area VII-B: Ensuring Safety; and
new text end
new text begin
(3) if applicable, ongoing training in reducing the risk of sudden unexpected infant death
and abusive head trauma, as required under subdivision 5.
new text end
new text begin
(c) At least once every two years, the license holder and caregiver must complete ongoing
training as follows:
new text end
new text begin
(1) training in pediatric first aid as required under subdivision 3;
new text end
new text begin
(2) training in pediatric CPR as required under subdivision 4; and
new text end
new text begin
(3) a two-hour course on accommodating children with disabilities or on cultural
dynamics that may be fulfilled by completing any course in Knowledge and Competency
Area III: Relationships with Families.
new text end
new text begin
(d) At least once every five years, the license holder and caregiver must complete ongoing
training as follows:
new text end
new text begin
(1) the two-hour courses Health and Safety I and Health and Safety II; and
new text end
new text begin
(2) if applicable, ongoing training in child passenger restraint, as required under
subdivision 6.
new text end
new text begin (e)new text end Additional ongoing training subjects to meet the annual 16-hour training requirement
must be selected from deleted text begin the following areasdeleted text end new text begin training in the following content areas of the
Minnesota Knowledge and Competency Frameworknew text end :
(1)new text begin Content area I:new text end child development and learningnew text begin , includingnew text end training deleted text begin under subdivision
2, paragraph (a)deleted text end new text begin in understanding how children develop physically, cognitively, emotionally,
and socially; and learn as part of the childrens' family, culture, and communitynew text end ;
(2)new text begin Content area II:new text end developmentally appropriate learning experiences, including training
in creating positive learning experiences, promoting cognitive development, promoting
social and emotional development, promoting physical development, promoting creative
development; and behavior guidance;
(3)new text begin Content area III:new text end relationships with families, including training in building a positive,
respectful relationship with the child's family;
(4)new text begin Content area IV:new text end assessment, evaluation, and individualization, including training
in observing, recording, and assessing development; assessing and using information to
plan; and assessing and using information to enhance and maintain program quality;
(5)new text begin Content area V:new text end historical and contemporary development of early childhood
education, including training in past and current practices in early childhood education and
how current events and issues affect children, families, and programs;
(6)new text begin Content area VI:new text end professionalism, including training in knowledge, skills, and abilities
that promote ongoing professional development; and
(7)new text begin Content area VII:new text end health, safety, and nutrition, including training in establishing
healthy practices; ensuring safety; and providing healthy nutrition.
Subd. 8.
deleted text begin Other required training requirementsdeleted text end new text begin Ongoing training requirements for
substitutes and helpersnew text end .
deleted text begin
(a) The training required of family and group family child care
providers and staff must include training in the cultural dynamics of early childhood
development and child care. The cultural dynamics and disabilities training and skills
development of child care providers must be designed to achieve outcomes for providers
of child care that include, but are not limited to:
deleted text end
deleted text begin
(1) an understanding and support of the importance of culture and differences in ability
in children's identity development;
deleted text end
deleted text begin
(2) understanding the importance of awareness of cultural differences and similarities
in working with children and their families;
deleted text end
deleted text begin
(3) understanding and support of the needs of families and children with differences in
ability;
deleted text end
deleted text begin
(4) developing skills to help children develop unbiased attitudes about cultural differences
and differences in ability;
deleted text end
deleted text begin
(5) developing skills in culturally appropriate caregiving; and
deleted text end
deleted text begin
(6) developing skills in appropriate caregiving for children of different abilities.
deleted text end
deleted text begin
The commissioner shall approve the curriculum for cultural dynamics and disability
training.
deleted text end
deleted text begin
(b) The provider must meet the training requirement in section 245A.14, subdivision
11, paragraph (a), clause (4), to be eligible to allow a child cared for at the family child care
or group family child care home to use the swimming pool located at the home.
deleted text end
new text begin
(a) Each substitute must complete ongoing training on the following schedule:
new text end
new text begin
(1) annually, if applicable, training in reducing the risk of sudden unexpected infant
death and abusive head trauma as required under subdivision 5;
new text end
new text begin
(2) at least once every two years: (i) training in pediatric first aid as required under
subdivision 3; (ii) training in pediatric CPR as required under subdivision 4; and (iii) the
four-hour Basics of Licensed Family Child Care for Substitutes course; and
new text end
new text begin
(3) at least once every five years, if applicable, training in child passenger restraints, as
required under subdivision 6.
new text end
new text begin
(b) Each helper must complete training on the following schedule:
new text end
new text begin
(1) annually, if applicable, training in reducing the risk of sudden unexpected infant
death and abusive head trauma as required under subdivision 5; and
new text end
new text begin
(2) at least once every two years: (i) the one-hour course Basics of Child Development
for Helpers; or (ii) any course in Knowledge and Competency Area I: Child Development
and Learning.
new text end
deleted text begin Subd. 9. deleted text end
deleted text begin Supervising for safety; training requirement. deleted text end
deleted text begin
(a) Before initial licensure and
before caring for a child, all family child care license holders and each adult caregiver who
provides care in the licensed family child care home for more than 30 days in any 12-month
period shall complete and document the completion of the six-hour Supervising for Safety
for Family Child Care course developed by the commissioner.
deleted text end
deleted text begin
(b) The family child care license holder and each adult caregiver who provides care in
the licensed family child care home for more than 30 days in any 12-month period shall
complete and document:
deleted text end
deleted text begin
(1) the annual completion of a two-hour active supervision course developed by the
commissioner; and
deleted text end
deleted text begin
(2) the completion at least once every five years of the two-hour courses Health and
Safety I and Health and Safety II. A license holder's or adult caregiver's completion of either
training in a given year meets the annual active supervision training requirement in clause
(1).
deleted text end
Subd. 10.
Approved training.
County licensing staff must accept training approved by
deleted text begin the Minnesota Center for Professional Developmentdeleted text end new text begin Achieve - the MN Center for
Professional Developmentnew text end , including:
(1) face-to-face or classroom training;
(2) online training; and
(3) relationship-based professional development, such as mentoring, coaching, and
consulting.
Subd. 11.
Provider training.
New and increased training requirements under this section
must not be imposed on providers until the commissioner establishes statewide accessibility
to the required provider training.
new text begin Subd. 12. new text end
new text begin Documentation. new text end
new text begin
The license holder must document the date of a completed
training required by this section for the license holder, each caregiver, substitute, and helper.
new text end
new text begin Subd. 13. new text end
new text begin Training exemption. new text end
new text begin
An individual who is related to the license holder, as
defined in section 245A.02, subdivision 13, who is involved only in the care of the family
child care license holder's own child and who is not a designated caregiver, helper, or
substitute for the licensed program is exempt from the training requirements in this section.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 53.
Minnesota Statutes 2018, section 245A.51, subdivision 3, is amended to read:
Subd. 3.
Emergency preparedness plan.
(a) deleted text begin No later than September 30, 2017,deleted text end A
licensed family child care provider must have a written emergency preparedness plan for
emergencies that require evacuation, sheltering, or other protection of children, such as fire,
natural disaster, intruder, or other threatening situation that may pose a health or safety
hazard to children. The plan must be written on a form developed by the commissioner and
updated at least annually. The plan must include:
(1) procedures for an evacuation, relocation, shelter-in-place, or lockdown;
(2) a designated relocation site and evacuation route;
(3) procedures for notifying a child's parent or legal guardian of the evacuation,
shelter-in-place, or lockdown, including procedures for reunification with families;
(4) accommodations for a child with a disability or a chronic medical condition;
(5) procedures for storing a child's medically necessary medicine that facilitate easy
removal during an evacuation or relocation;
(6) procedures for continuing operations in the period during and after a crisis; deleted text begin and
deleted text end
(7) procedures for communicating with local emergency management officials, law
enforcement officials, or other appropriate state or local authoritiesnew text begin ; and
new text end
new text begin (8) accommodations for infants and toddlersnew text end .
(b) The license holder must train caregivers before the caregiver provides care and at
least annually on the emergency preparedness plan and document completion of this training.
(c) The license holder must conduct drills according to the requirements in Minnesota
Rules, part 9502.0435, subpart 8. The date and time of the drills must be documented.
(d) The license holder must have the emergency preparedness plan available for review
and posted in a prominent location. The license holder must provide a physical or electronic
copy of the plan to the child's parent or legal guardian upon enrollment.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 54.
Minnesota Statutes 2018, section 245A.51, is amended by adding a subdivision
to read:
new text begin Subd. 4. new text end
new text begin Transporting children. new text end
new text begin
A license holder must ensure compliance with all seat
belt and child passenger restraint system requirements under section 169.685.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 55.
Minnesota Statutes 2018, section 245A.51, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin Telephone requirement. new text end
new text begin
Notwithstanding Minnesota Rules, part 9502.0435,
subpart 8, item B, a license holder is not required to post a list of emergency numbers. A
license holder may use a cellular telephone to meet the requirements of Minnesota Rules,
part 9502.0435, subpart 8, if the cellular telephone is sufficiently charged for use at all times.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 56.
new text begin
[245A.52] FAMILY CHILD CARE PHYSICAL SPACE REQUIREMENTS.
new text end
new text begin Subdivision 1. new text end
new text begin Means of escape. new text end
new text begin
(a) (1) At least one emergency escape route separate
from the main exit from the space must be available in each room used for sleeping by
anyone receiving licensed care, and (2) a basement used for child care. One means of escape
must be a stairway or door leading to the floor of exit discharge. The other must be a door
or window leading directly outside. A window used as an emergency escape route must be
openable without special knowledge.
new text end
new text begin
(b) In homes with construction that began before May 2, 2016, the interior of the window
leading directly outside must have a net clear opening area of not less than 4.5 square feet
or 648 square inches and have minimum clear opening dimensions of 20 inches wide and
20 inches high. The opening must be no higher than 48 inches from the floor. The height
to the window may be measured from a platform if a platform is located below the window.
new text end
new text begin
(c) In homes with construction that began on or after May 2, 2016, the interior of the
window leading directly outside must have minimum clear opening dimensions of 20 inches
wide and 24 inches high. The net clear opening dimensions shall be the result of normal
operation of the opening. The opening must be no higher than 44 inches from the floor.
new text end
new text begin
(d) Additional requirements are dependent on the distance of the openings from the
ground outside the window: (1) windows or other openings with a sill height not more than
44 inches above or below the finished ground level adjacent to the opening (grade-floor
emergency escape and rescue openings) must have a minimum opening of five square feet;
and (2) non-grade floor emergency escape and rescue openings must have a minimum
opening of 5.7 square feet.
new text end
new text begin Subd. 2. new text end
new text begin Door to attached garage. new text end
new text begin
Notwithstanding Minnesota Rules, part 9502.0425,
subpart 5, day care residences with an attached garage are not required to have a self-closing
door to the residence. The door to the residence may be a steel insulated door if the door is
at least 1-3/8 inches thick.
new text end
new text begin Subd. 3. new text end
new text begin Heating and venting systems. new text end
new text begin
Notwithstanding Minnesota Rules, part
9502.0425, subpart 7, items that can be ignited and support combustion, including but not
limited to plastic, fabric, and wood products must not be located within 18 inches of a gas
or fuel-oil heater or furnace. If a license holder produces manufacturer instructions listing
a smaller distance, then the manufacturer instructions control the distance combustible items
must be from gas, fuel-oil, or solid-fuel burning heaters or furnaces.
new text end
new text begin Subd. 4. new text end
new text begin Fire extinguisher. new text end
new text begin
A portable, operational, multipurpose, dry chemical fire
extinguisher with a minimum 2 A 10 BC rating must be located in or near the kitchen and
cooking areas of the residence at all times. The fire extinguisher must be serviced annually
by a qualified inspector. All caregivers must know how to properly use the fire extinguisher.
new text end
new text begin Subd. 5. new text end
new text begin Carbon monoxide and smoke alarms. new text end
new text begin
(a) All homes must have an approved
and operational carbon monoxide alarm installed within ten feet of each room used for
sleeping children in care.
new text end
new text begin
(b) Smoke alarms that have been listed by the Underwriter Laboratory must be properly
installed and maintained on all levels including basements, but not including crawl spaces
and uninhabitable attics, and in hallways outside rooms used for sleeping children in care.
new text end
new text begin
(c) In homes with construction that began on or after May 2, 2016, smoke alarms must
be installed and maintained in each room used for sleeping children in care.
new text end
new text begin Subd. 6. new text end
new text begin Updates. new text end
new text begin
After readoption of the Minnesota State Fire Code, the fire marshal
must notify the commissioner of any changes that conflict with this section and Minnesota
Rules, chapter 9502. The state fire marshal must identify necessary statutory changes to
align statutes with the revised code. The commissioner must recommend updates to sections
of chapter 245A that are derived from the Minnesota State Fire Code in the legislative
session following readoption of the code.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 57.
new text begin
[245A.53] SUBSTITUTE CAREGIVERS AND REPLACEMENTS IN
FAMILY CHILD CARE.
new text end
new text begin Subdivision 1. new text end
new text begin Total hours allowed. new text end
new text begin
Notwithstanding Minnesota Rules, part 9502.0365,
subpart 5, the use of a substitute caregiver in a licensed family child care program must be
limited to a cumulative total of not more than 400 hours in a calendar year. The license
holder must document the name, dates, and number of hours of the substitute who provided
care.
new text end
new text begin Subd. 2. new text end
new text begin Emergency replacement supervision. new text end
new text begin
(a) A license holder may allow an adult
who has not completed the training requirements under this chapter or the background study
requirements under chapter 245C to supervise children in a family child care program in
an emergency. For purposes of this subdivision, an emergency is a situation in which:
new text end
new text begin
(1) the license holder has begun operating the family child care program for the day and
for reasons beyond the license holder's control, including, but not limited to a serious illness
or injury, accident, or situation requiring the license holder's immediate attention, the license
holder needs to leave the licensed space and close the program for the day; and
new text end
new text begin
(2) the parents or guardians of the children attending the program are contacted to pick
up their children as soon as is practicable.
new text end
new text begin
(b) The license holder must make reasonable efforts to minimize the time the emergency
replacement has unsupervised contact with the children in care, not to exceed 24 hours per
emergency incident.
new text end
new text begin
(c) The license holder shall not knowingly use a person as an emergency replacement
who has committed an action or has been convicted of a crime that would cause the person
to be disqualified from providing care to children, if a background study was conducted
under chapter 245C.
new text end
new text begin
(d) To the extent practicable, the license holder must attempt to arrange for emergency
care by a substitute caregiver before using an emergency replacement.
new text end
new text begin
(e) To the extent practicable, the license holder must notify the county licensing agency
within seven days that an emergency replacement was used, and specify the circumstances
that led to the use of the emergency replacement. The county licensing agency must notify
the commissioner within three business days after receiving the license holder's notice that
an emergency replacement was used, and specify the circumstances that led to the use of
the emergency replacement.
new text end
new text begin
(f) Notwithstanding the requirements in Minnesota Rules, part 9502.0405, a license
holder is not required to provide the names of persons who may be used as substitutes or
replacements in emergencies to parents or the county licensing agency.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 58.
Minnesota Statutes 2018, section 245A.66, subdivision 2, is amended to read:
Subd. 2.
Child care centers; risk reduction plan.
(a) Child care centers licensed under
this chapter and Minnesota Rules, chapter 9503, must develop a risk reduction plan that
identifies the general risks to children served by the child care center. The license holder
must establish procedures to minimize identified risks, train staff on the procedures, and
annually review the procedures.
(b) The risk reduction plan must include an assessment of risk to children the center
serves or intends to serve and identify specific risks based on the outcome of the assessment.
The assessment of risk must be based on the following:
(1) an assessment of the risks presented by the physical plant where the licensed services
are provided, including an evaluation of the following factors: the condition and design of
the facility and its outdoor space, bathrooms, storage areas, and accessibility of medications
and cleaning products that are harmful to children when children are not supervised and the
existence of areas that are difficult to supervise; and
(2) an assessment of the risks presented by the environment for each facility and for
each site, including an evaluation of the following factors: the type of grounds and terrain
surrounding the building and the proximity to hazards, busy roads, and publicly accessed
businesses.
(c) The risk reduction plan must include a statement of measures that will be taken to
minimize the risk of harm presented to children for each risk identified in the assessment
required under paragraph (b) related to the physical plant and environment. At a minimum,
the stated measures must include the development and implementation of specific policies
and procedures or reference to existing policies and procedures that minimize the risks
identified.
(d) In addition to any program-specific risks identified in paragraph (b), the plan must
include development and implementation of specific policies and procedures or refer to
existing policies and procedures that minimize the risk of harm or injury to children,
including:
(1) closing children's fingers in doors, including cabinet doors;
(2) leaving children in the community without supervision;
(3) children leaving the facility without supervision;
(4) caregiver dislocation of children's elbows;
(5) burns from hot food or beverages, whether served to children or being consumed by
caregivers, and the devices used to warm food and beverages;
(6) injuries from equipment, such as scissors and glue guns;
(7) sunburn;
(8) feeding children foods to which they are allergic;
(9) children falling from changing tables; and
(10) children accessing dangerous items or chemicals or coming into contact with residue
from harmful cleaning products.
(e) The plan shall prohibit the accessibility of hazardous items to children.
(f) The plan must include specific policies and procedures to ensure adequate supervision
of children at all times as defined under section 245A.02, subdivision 18, with particular
emphasis on:
(1) times when children are transitioned from one area within the facility to another;
(2) nap-time supervision, including infant crib rooms as specified under section 245A.02,
subdivision 18, which requires that when an infant is placed in a crib to sleep, supervision
occurs when a staff person is within sight or hearing of the infant. When supervision of a
crib room is provided by sight or hearing, the center must have a plan to address the other
supervision components;
(3) child drop-off and pick-up times;
(4) supervision during outdoor play and on community activities, including but not
limited to field trips and neighborhood walks; deleted text begin and
deleted text end
(5) supervision of children in hallwaysdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(6) supervision of school-age children when using the restroom and visiting the child's
personal storage space.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 59.
Minnesota Statutes 2018, section 245A.66, subdivision 3, is amended to read:
Subd. 3.
deleted text begin Orientation todeleted text end new text begin Yearly review ofnew text end risk reduction plan deleted text begin and annual review of
plandeleted text end .
deleted text begin
(a) The license holder shall ensure that all mandated reporters, as defined in section
626.556, subdivision 3, who are under the control of the license holder, receive an orientation
to the risk reduction plan prior to first providing unsupervised direct contact services, as
defined in section 245C.02, subdivision 11, to children, not to exceed 14 days from the first
supervised direct contact, and annually thereafter. The license holder must document the
orientation to the risk reduction plan in the mandated reporter's personnel records.
deleted text end
deleted text begin (b)deleted text end The license holder must review the risk reduction plan deleted text begin annuallydeleted text end new text begin each calendar yearnew text end
and document the deleted text begin annualdeleted text end review. When conducting the review, the license holder must
consider incidents that have occurred in the center since the last review, including:
(1) the assessment factors in the plan;
(2) the internal reviews conducted under this section, if any;
(3) substantiated maltreatment findings, if any; and
(4) incidents that caused injury or harm to a child, if any, that occurred since the last
review.
Following any change to the risk reduction plan, the license holder must inform deleted text begin mandated
reportersdeleted text end new text begin staff personsnew text end , under the control of the license holder, of the changes in the risk
reduction plan, and document that the deleted text begin mandated reportersdeleted text end new text begin staffnew text end were informed of the changes.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 60.
Minnesota Statutes 2018, section 245C.02, is amended by adding a subdivision
to read:
new text begin Subd. 5a. new text end
new text begin License-exempt child care center certification holder. new text end
new text begin
"License-exempt
child care center certification holder" has the meaning given for "certification holder" in
section 245H.01, subdivision 4.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 61.
Minnesota Statutes 2018, section 245C.02, subdivision 6a, is amended to read:
Subd. 6a.
Child care background study subject.
new text begin (a) new text end "Child care background study
subject" means an individual who is affiliated with a licensed child care center, certified
license exempt child care center, licensed family child care program, or legal nonlicensed
child care provider authorized under chapter 119B, andnew text begin who isnew text end :
(1) deleted text begin who isdeleted text end employed by a child care provider for compensation;
(2) deleted text begin whose activities involvedeleted text end new text begin assisting innew text end the deleted text begin supervisiondeleted text end new text begin carenew text end of a child for a child care
provider; deleted text begin or
deleted text end
deleted text begin
(3) who is required to have a background study under section 245C.03, subdivision 1.
deleted text end
new text begin
(3) a person applying for licensure, certification, or enrollment;
new text end
new text begin
(4) a controlling individual as defined in section 245A.02, subdivision 5a;
new text end
new text begin
(5) an individual 13 years of age or older who lives in the household where the licensed
program will be provided and who is not receiving licensed services from the program;
new text end
new text begin
(6) an individual ten to 12 years of age who lives in the household where the licensed
services will be provided when the commissioner has reasonable cause as defined in section
245C.02, subdivision 15;
new text end
new text begin
(7) an individual who, without providing direct contact services at a licensed program,
certified program, or program authorized under chapter 119B, may have unsupervised access
to a child receiving services from a program when the commissioner has reasonable cause
as defined in section 245C.02, subdivision 15; or
new text end
new text begin
(8) a volunteer, contractor, prospective employee, or other individual who has
unsupervised physical access to a child served by a program and who is not under direct,
continuous supervision by an individual listed in clause (1) or (5), regardless of whether
the individual provides program services.
new text end
new text begin
(b) Notwithstanding paragraph (a), an individual who is providing services that are not
part of the child care program is not required to have a background study if:
new text end
new text begin
(1) the child receiving services is signed out of the child care program for the duration
that the services are provided;
new text end
new text begin
(2) the licensed child care center, certified license exempt child care center, licensed
family child care program, or legal nonlicensed child care provider authorized under chapter
119B has obtained advanced written permission from the parent authorizing the child to
receive the services, which is maintained in the child's record;
new text end
new text begin
(3) the licensed child care center, certified license exempt child care center, licensed
family child care program, or legal nonlicensed child care provider authorized under chapter
119B maintains documentation on-site that identifies the individual service provider and
the services being provided; and
new text end
new text begin
(4) the licensed child care center, certified license exempt child care center, licensed
family child care program, or legal nonlicensed child care provider authorized under chapter
119B ensures that the service provider does not have unsupervised access to a child not
receiving the provider's services.
new text end
Sec. 62.
Minnesota Statutes 2018, section 245C.02, is amended by adding a subdivision
to read:
new text begin Subd. 6b. new text end
new text begin Children's residential facility. new text end
new text begin
"Children's residential facility" means a
children's residential facility licensed by the commissioner of corrections or the commissioner
of human services under Minnesota Rules, chapter 2960.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019, for background studies
initiated on or after that date.
new text end
Sec. 63.
Minnesota Statutes 2018, section 245C.02, is amended by adding a subdivision
to read:
new text begin Subd. 12a. new text end
new text begin Licensed family child foster care. new text end
new text begin
"Licensed family child foster care"
includes providers who have submitted an application for family child foster care licensure
under section 245A.04, subdivision 1. Licensed family child foster care does not include
foster residence settings that meet the licensing requirements of Minnesota Rules, parts
2960.3200 to 2960.3230.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2020.
new text end
Sec. 64.
Minnesota Statutes 2018, section 245C.02, is amended by adding a subdivision
to read:
new text begin Subd. 20. new text end
new text begin Substance use disorder treatment field. new text end
new text begin
"Substance use disorder treatment
field" means a program exclusively serving individuals 18 years of age and older and that
is required to be:
new text end
new text begin
(1) licensed under chapter 245G; or
new text end
new text begin
(2) registered under section 157.17 as a board and lodge establishment that predominantly
serves individuals being treated for or recovering from a substance use disorder.
new text end
Sec. 65.
Minnesota Statutes 2018, section 245C.03, subdivision 1, is amended to read:
Subdivision 1.
Licensed programs.
(a) The commissioner shall conduct a background
study on:
(1) the person or persons applying for a license;
(2) an individual age 13 and over living in the household where the licensed program
will be provided who is not receiving licensed services from the program;
(3) current or prospective employees or contractors of the applicant who will have direct
contact with persons served by the facility, agency, or program;
(4) volunteers or student volunteers who will have direct contact with persons served
by the program to provide program services if the contact is not under the continuous, direct
supervision by an individual listed in clause (1) or (3);
(5) an individual age ten to 12 living in the household where the licensed services will
be provided when the commissioner has reasonable cause as defined in section 245C.02,
subdivision 15;
(6) an individual who, without providing direct contact services at a licensed program,
may have unsupervised access to children or vulnerable adults receiving services from a
program, when the commissioner has reasonable cause as defined in section 245C.02,
subdivision 15;
(7) all controlling individuals as defined in section 245A.02, subdivision 5a; and
(8) new text begin notwithstanding the other requirements in this subdivision, new text end child care background
study subjects as defined in section 245C.02, subdivision 6a.
deleted text begin
(b) Paragraph (a), clauses (2), (5), and (6), apply to legal nonlicensed child care and
certified license-exempt child care programs.
deleted text end
deleted text begin (c)deleted text end new text begin (b)new text end For child foster care when the license holder resides in the home where foster
care services are provided, a short-term substitute caregiver providing direct contact services
for a child for less than 72 hours of continuous care is not required to receive a background
study under this chapter.
Sec. 66.
Minnesota Statutes 2018, section 245C.05, subdivision 2c, is amended to read:
Subd. 2c.
Privacy notice to background study subject.
(a) Prior to initiating each
background study, the entity initiating the study must provide the commissioner's privacy
notice to the background study subject required under section 13.04, subdivision 2. The
notice must be available through the commissioner's electronic NETStudy and NETStudy
2.0 systems and shall include the information in paragraphs (b) and (c).
(b) The background study subject shall be informed that any previous background studies
that received a set-aside will be reviewed, and without further contact with the background
study subject, the commissioner may notify the agency that initiated the subsequent
background study:
(1) that the individual has a disqualification that has been set aside for the program or
agency that initiated the study;
(2) the reason for the disqualification; and
(3) that information about the decision to set aside the disqualification will be available
to the license holder upon request without the consent of the background study subject.
(c) The background study subject must also be informed that:
(1) the subject's fingerprints collected for purposes of completing the background study
under this chapter must not be retained by the Department of Public Safety, Bureau of
Criminal Apprehension, or by the commissioner. The Federal Bureau of Investigation will
deleted text begin only retain fingerprints of subjects with a criminal historydeleted text end new text begin not retain background study
subjects' fingerprintsnew text end ;
(2) effective upon implementation of NETStudy 2.0, the subject's photographic image
will be retained by the commissioner, and if the subject has provided the subject's Social
Security number for purposes of the background study, the photographic image will be
available to prospective employers and agencies initiating background studies under this
chapter to verify the identity of the subject of the background study;
(3) the commissioner's authorized fingerprint collection vendor shall, for purposes of
verifying the identity of the background study subject, be able to view the identifying
information entered into NETStudy 2.0 by the entity that initiated the background study,
but shall not retain the subject's fingerprints, photograph, or information from NETStudy
2.0. The authorized fingerprint collection vendor shall retain no more than the subject's
name and the date and time the subject's fingerprints were recorded and sent, only as
necessary for auditing and billing activities;
(4) the commissioner shall provide the subject notice, as required in section 245C.17,
subdivision 1, paragraph (a), when an entity initiates a background study on the individual;
(5) the subject may request in writing a report listing the entities that initiated a
background study on the individual as provided in section 245C.17, subdivision 1, paragraph
(b);
(6) the subject may request in writing that information used to complete the individual's
background study in NETStudy 2.0 be destroyed if the requirements of section 245C.051,
paragraph (a), are met; and
(7) notwithstanding clause (6), the commissioner shall destroy:
(i) the subject's photograph after a period of two years when the requirements of section
245C.051, paragraph (c), are met; and
(ii) any data collected on a subject under this chapter after a period of two years following
the individual's death as provided in section 245C.051, paragraph (d).
Sec. 67.
Minnesota Statutes 2018, section 245C.05, subdivision 2d, is amended to read:
Subd. 2d.
Fingerprint data notification.
The commissioner of human services shall
notify all background study subjects under this chapter that the Department of Human
Services, Department of Public Safety, and the Bureau of Criminal Apprehension do not
retain fingerprint data after a background study is completed, and that the Federal Bureau
deleted text begin of Investigation only retains the fingerprints of subjects who have a criminal historydeleted text end new text begin of
Investigation will not retain background study subjects' fingerprintsnew text end .
Sec. 68.
Minnesota Statutes 2018, section 245C.05, subdivision 4, is amended to read:
Subd. 4.
Electronic transmission.
(a) For background studies conducted by the
Department of Human Services, the commissioner shall implement a secure system for the
electronic transmission of:
(1) background study information to the commissioner;
(2) background study results to the license holder;
(3) background study results new text begin and relevant underlying investigative informationnew text end to county
and private agencies for background studies conducted by the commissioner for child foster
carenew text begin , including a summary of nondisqualifying results, except as prohibited by lawnew text end ; and
(4) background study results to county agencies for background studies conducted by
the commissioner for adult foster care and family adult day services and, upon
implementation of NETStudy 2.0, family child care and legal nonlicensed child care
authorized under chapter 119B.
(b) Unless the commissioner has granted a hardship variance under paragraph (c), a
license holder or an applicant must use the electronic transmission system known as
NETStudy or NETStudy 2.0 to submit all requests for background studies to the
commissioner as required by this chapter.
(c) A license holder or applicant whose program is located in an area in which high-speed
Internet is inaccessible may request the commissioner to grant a variance to the electronic
transmission requirement.
new text begin
(d) Section 245C.08, subdivision 3, paragraph (c), applies to results transmitted under
this subdivision.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2020.
new text end
Sec. 69.
Minnesota Statutes 2018, section 245C.05, subdivision 5, is amended to read:
Subd. 5.
Fingerprints and photograph.
(a) Notwithstanding paragraph (b), for
background studies conducted by the commissioner for child foster care,new text begin children's residential
facilities,new text end adoptions, or a transfer of permanent legal and physical custody of a child, the
subject of the background study, who is 18 years of age or older, shall provide the
commissioner with a set of classifiable fingerprints obtained from an authorized agency for
a national criminal history record check.
(b) For background studies initiated on or after the implementation of NETStudy 2.0,
except as provided under subdivision 5a, every subject of a background study must provide
the commissioner with a set of the background study subject's classifiable fingerprints and
photograph. The photograph and fingerprints must be recorded at the same time by the
commissioner's authorized fingerprint collection vendor and sent to the commissioner
through the commissioner's secure data system described in section 245C.32, subdivision
1a, paragraph (b).
(c) The fingerprints shall be submitted by the commissioner to the Bureau of Criminal
Apprehension and, when specifically required by law, submitted to the Federal Bureau of
Investigation for a national criminal history record check.
(d) The fingerprints must not be retained by the Department of Public Safety, Bureau
of Criminal Apprehension, or the commissioner. The Federal Bureau of Investigation will
deleted text begin only retain fingerprints of subjects with a criminal historydeleted text end new text begin not retain background study
subjects' fingerprintsnew text end .
(e) The commissioner's authorized fingerprint collection vendor shall, for purposes of
verifying the identity of the background study subject, be able to view the identifying
information entered into NETStudy 2.0 by the entity that initiated the background study,
but shall not retain the subject's fingerprints, photograph, or information from NETStudy
2.0. The authorized fingerprint collection vendor shall retain no more than the name and
date and time the subject's fingerprints were recorded and sent, only as necessary for auditing
and billing activities.
(f) For any background study conducted under this chapter, the subject shall provide the
commissioner with a set of classifiable fingerprints when the commissioner has reasonable
cause to require a national criminal history record check as defined in section 245C.02,
subdivision 15a.
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraph (a) is effective July 1, 2019, for background studies
initiated on or after that date.
new text end
Sec. 70.
Minnesota Statutes 2018, section 245C.05, subdivision 5a, is amended to read:
Subd. 5a.
Background study requirements for minors.
(a) A background study
completed under this chapter on a subject who is required to be studied under section
245C.03, subdivision 1, and is 17 years of age or younger shall be completed by the
commissioner for:
(1) a legal nonlicensed child care provider authorized under chapter 119B;
(2) a licensed family child care program; or
(3) a licensed foster care home.
(b) The subject shall submit to the commissioner only the information under subdivision
1, paragraph (a).
(c) A subject who is 17 years of age or younger is required to submit fingerprints and a
photograph, and the commissioner shall conduct a national criminal history record check,
if:
(1) the commissioner has reasonable cause to require a national criminal history record
check defined in section 245C.02, subdivision 15a; or
(2) under paragraph (a), clauses (1) and (2), the subject is employed by the provider or
supervises children served by the program.
new text begin
(d) A subject who is 17 years of age or younger is required to submit
non-fingerprint-based data according to section 245C.08, subdivision 1, paragraph (a),
clause (6), item (iii), and the commissioner shall conduct the check if:
new text end
new text begin
(1) the commissioner has reasonable cause to require a national criminal history record
check defined in section 245C.02, subdivision 15a; or
new text end
new text begin
(2) the subject is employed by the provider or supervises children served by the program
under paragraph (a), clauses (1) and (2).
new text end
Sec. 71.
Minnesota Statutes 2018, section 245C.08, subdivision 1, is amended to read:
Subdivision 1.
Background studies conducted by Department of Human Services.
(a)
For a background study conducted by the Department of Human Services, the commissioner
shall review:
(1) information related to names of substantiated perpetrators of maltreatment of
vulnerable adults that has been received by the commissioner as required under section
626.557, subdivision 9c, paragraph (j);
(2) the commissioner's records relating to the maltreatment of minors in licensed
programs, and from findings of maltreatment of minors as indicated through the social
service information system;
(3) information from juvenile courts as required in subdivision 4 for individuals listed
in section 245C.03, subdivision 1, paragraph (a), when there is reasonable cause;
(4) information from the Bureau of Criminal Apprehension, including information
regarding a background study subject's registration in Minnesota as a predatory offender
under section 243.166;
(5) except as provided in clause (6), information received as a result of submission of
fingerprints for a national criminal history record check, as defined in section 245C.02,
subdivision 13c, when the commissioner has reasonable cause for a national criminal history
record check as defined under section 245C.02, subdivision 15a, or as required under section
144.057, subdivision 1, clause (2);
(6) for a background study related to a child foster care application for licensure,new text begin children's
residential facilities,new text end a transfer of permanent legal and physical custody of a child under
sections 260C.503 to 260C.515, or adoptions, and for a background study required for
family child care, certified license-exempt child care, child care centers, and legal nonlicensed
child care authorized under chapter 119B, the commissioner shall also review:
(i) information from the child abuse and neglect registry for any state in which the
background study subject has resided for the past five years; deleted text begin and
deleted text end
(ii) when the background study subject is 18 years of age or older, or a minor under
section 245C.05, subdivision 5a, paragraph (c), information received following submission
of fingerprints for a national criminal history record check; and
new text begin
(iii) when the background study subject is 18 years of age or older or a minor under
section 245C.05, subdivision 5a, paragraph (d), for licensed family child care, certified
license-exempt child care, licensed child care centers, and legal nonlicensed child care
authorized under chapter 119B, information obtained using non-fingerprint-based data
including information from the criminal and sex offender registries for any state in which
the background study subject resided for the past five years and information from the national
crime information database and the national sex offender registry; and
new text end
(7) for a background study required for family child care, certified license-exempt child
care centers, licensed child care centers, and legal nonlicensed child care authorized under
chapter 119B, the background study shall also include, to the extent practicable, a name
and date-of-birth search of the National Sex Offender Public website.
(b) Notwithstanding expungement by a court, the commissioner may consider information
obtained under paragraph (a), clauses (3) and (4), unless the commissioner received notice
of the petition for expungement and the court order for expungement is directed specifically
to the commissioner.
(c) The commissioner shall also review criminal case information received according
to section 245C.04, subdivision 4a, from the Minnesota court information system that relates
to individuals who have already been studied under this chapter and who remain affiliated
with the agency that initiated the background study.
(d) When the commissioner has reasonable cause to believe that the identity of a
background study subject is uncertain, the commissioner may require the subject to provide
a set of classifiable fingerprints for purposes of completing a fingerprint-based record check
with the Bureau of Criminal Apprehension. Fingerprints collected under this paragraph
shall not be saved by the commissioner after they have been used to verify the identity of
the background study subject against the particular criminal record in question.
(e) The commissioner may inform the entity that initiated a background study under
NETStudy 2.0 of the status of processing of the subject's fingerprints.
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraph (a) is effective July 1, 2019, for background studies
initiated on or after that date.
new text end
Sec. 72.
Minnesota Statutes 2018, section 245C.08, subdivision 3, is amended to read:
Subd. 3.
Arrest and investigative information.
(a) For any background study completed
under this section, if the commissioner has reasonable cause to believe the information is
pertinent to the disqualification of an individual, the commissioner also may review arrest
and investigative information from:
(1) the Bureau of Criminal Apprehension;
(2) the deleted text begin commissionerdeleted text end new text begin commissionersnew text end of healthnew text begin and human servicesnew text end ;
(3) a county attorney;
(4) a county sheriff;
(5) a county agency;
(6) a local chief of police;
(7) other states;
(8) the courts;
(9) the Federal Bureau of Investigation;
(10) the National Criminal Records Repository; and
(11) criminal records from other states.
(b) new text begin Except when specifically required by law, new text end the commissioner is not required to conduct
more than one review of a subject's records from the Federal Bureau of Investigation if a
review of the subject's criminal history with the Federal Bureau of Investigation has already
been completed by the commissioner and there has been no break in the subject's affiliation
with the deleted text begin license holder whodeleted text end new text begin entity thatnew text end initiated the background study.
new text begin
(c) If the commissioner conducts a national criminal history record check when required
by law and uses the information from the national criminal history record check to make a
disqualification determination, the data obtained is private data and cannot be shared with
county agencies, private agencies, or prospective employers of the background study subject.
new text end
new text begin
(d) If the commissioner conducts a national criminal history record check when required
by law and uses the information from the national criminal history record check to make a
disqualification determination, the license holder or entity that submitted the study is not
required to obtain a copy of the background study subject's disqualification letter under
section 245C.17, subdivision 3.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective for background studies requested on or
after October 1, 2019.
new text end
Sec. 73.
Minnesota Statutes 2018, section 245C.10, is amended by adding a subdivision
to read:
new text begin Subd. 14. new text end
new text begin Children's residential facilities. new text end
new text begin
The commissioner shall recover the cost of
background studies initiated by a licensed children's residential facility through a fee of no
more than $51 per study. Fees collected under this subdivision are appropriated to the
commissioner for purposes of conducting background studies.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019, for background studies
initiated on or after that date.
new text end
Sec. 74.
Minnesota Statutes 2018, section 245C.13, subdivision 2, is amended to read:
Subd. 2.
Direct contact pending completion of background study.
The subject of a
background study may not perform any activity requiring a background study under
paragraph (b) until the commissioner has issued one of the notices under paragraph (a).
(a) Notices from the commissioner required prior to activity under paragraph (b) include:
(1) a notice of the study results under section 245C.17 stating that:
(i) the individual is not disqualified; or
(ii) more time is needed to complete the study but the individual is not required to be
removed from direct contact or access to people receiving services prior to completion of
the study as provided under section 245C.17, subdivision 1, paragraph (b) or (c). The notice
that more time is needed to complete the study must also indicate whether the individual is
required to be under continuous direct supervision prior to completion of the background
study;
(2) a notice that a disqualification has been set aside under section 245C.23; or
(3) a notice that a variance has been granted related to the individual under section
245C.30.
(b)new text begin For a background study affiliated with a licensed child care center or certified license
exempt child care center, the notice sent under paragraph (a), clause (1), item (ii), must
require the individual to be under continuous direct supervision prior to completion of the
background study except as permitted in subdivision 3.
new text end
new text begin (c)new text end Activities prohibited prior to receipt of notice under paragraph (a) include:
(1) being issued a license;
(2) living in the household where the licensed program will be provided;
(3) providing direct contact services to persons served by a program unless the subject
is under continuous direct supervision; deleted text begin or
deleted text end
(4) having access to persons receiving services if the background study was completed
under section 144.057, subdivision 1, or 245C.03, subdivision 1, paragraph (a), clause (2),
(5), or (6), unless the subject is under continuous direct supervisiondeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(5) for licensed child care center and certified license exempt child care centers, providing
direct contact services to persons served by the program.
new text end
Sec. 75.
Minnesota Statutes 2018, section 245C.13, is amended by adding a subdivision
to read:
new text begin Subd. 3. new text end
new text begin Other state information. new text end
new text begin
If the commissioner has not received criminal, sex
offender, or maltreatment information from another state that is required to be reviewed
under this chapter within ten days of requesting the information, and the lack of the
information is the only reason that a notice is issued under subdivision 2, paragraph (a),
clause (1), item (ii), the commissioner may issue a notice under subdivision 2, paragraph
(a), clause (1), item (i). The commissioner may take action on information received from
other states after issuing a notice under subdivision 2, paragraph (a), clause (1), item (ii).
new text end
Sec. 76.
Minnesota Statutes 2018, section 245C.14, subdivision 1, is amended to read:
Subdivision 1.
Disqualification from direct contact.
(a) The commissioner shall
disqualify an individual who is the subject of a background study from any position allowing
direct contact with persons receiving services from the license holder or entity identified in
section 245C.03, upon receipt of information showing, or when a background study
completed under this chapter shows any of the following:
(1) a conviction of, admission to, or Alford plea to one or more crimes listed in section
245C.15, regardless of whether the conviction or admission is a felony, gross misdemeanor,
or misdemeanor level crime;
(2) a preponderance of the evidence indicates the individual has committed an act or
acts that meet the definition of any of the crimes listed in section 245C.15, regardless of
whether the preponderance of the evidence is for a felony, gross misdemeanor, or
misdemeanor level crime; or
(3) an investigation results in an administrative determination listed under section
245C.15, subdivision 4, paragraph (b).
(b) No individual who is disqualified following a background study under section
245C.03, subdivisions 1 and 2, may be retained in a position involving direct contact with
persons served by a program or entity identified in section 245C.03, unless the commissioner
has provided written notice under section 245C.17 stating that:
(1) the individual may remain in direct contact during the period in which the individual
may request reconsideration as provided in section 245C.21, subdivision 2;
(2) the commissioner has set aside the individual's disqualification for that program or
entity identified in section 245C.03, as provided in section 245C.22, subdivision 4; or
(3) the license holder has been granted a variance for the disqualified individual under
section 245C.30.
new text begin
(c) Notwithstanding paragraph (a), for the purposes of a background study affiliated
with a licensed family child foster care provider, the commissioner shall disqualify an
individual who is the subject of a background study from any position allowing direct contact
with persons receiving services from the license holder or entity identified in section 245C.03,
upon receipt of information showing, or when a background study completed under this
chapter is disqualifying under section 245C.15, subdivision 6.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2020.
new text end
Sec. 77.
Minnesota Statutes 2018, section 245C.15, subdivision 2, is amended to read:
Subd. 2.
15-year disqualification.
(a) An individual is disqualified under section 245C.14
if: (1) less than 15 years have passed since the discharge of the sentence imposed, if any,
for the offense; and (2) the individual has committed a felony-level violation of any of the
following offenses: sections 256.98 (wrongfully obtaining assistance); 268.182 (fraud);
393.07, subdivision 10, paragraph (c) (federal Food Stamp Program fraud); 609.165 (felon
ineligible to possess firearm); 609.2112, 609.2113, or 609.2114 (criminal vehicular homicide
or injury); 609.215 (suicide); 609.223 or 609.2231 (assault in the third or fourth degree);
repeat offenses under 609.224 (assault in the fifth degree); 609.229 (crimes committed for
benefit of a gang); 609.2325 (criminal abuse of a vulnerable adult); 609.2335 (financial
exploitation of a vulnerable adult); 609.235 (use of drugs to injure or facilitate crime);
609.24 (simple robbery); 609.255 (false imprisonment); 609.2664 (manslaughter of an
unborn child in the first degree); 609.2665 (manslaughter of an unborn child in the second
degree); 609.267 (assault of an unborn child in the first degree); 609.2671 (assault of an
unborn child in the second degree); 609.268 (injury or death of an unborn child in the
commission of a crime); 609.27 (coercion); 609.275 (attempt to coerce); 609.466 (medical
assistance fraud); 609.495 (aiding an offender); 609.498, subdivision 1 or 1b (aggravated
first-degree or first-degree tampering with a witness); 609.52 (theft); 609.521 (possession
of shoplifting gear); 609.525 (bringing stolen goods into Minnesota); 609.527 (identity
theft); 609.53 (receiving stolen property); 609.535 (issuance of dishonored checks); 609.562
(arson in the second degree); 609.563 (arson in the third degree); 609.582 (burglary); 609.59
(possession of burglary tools); 609.611 (insurance fraud); 609.625 (aggravated forgery);
609.63 (forgery); 609.631 (check forgery; offering a forged check); 609.635 (obtaining
signature by false pretense); 609.66 (dangerous weapons); 609.67 (machine guns and
short-barreled shotguns); 609.687 (adulteration); 609.71 (riot); 609.713 (terroristic threats);
new text begin (criminal penalties for acts involving human services programs); new text end 609.82 (fraud in
obtaining credit); 609.821 (financial transaction card fraud); 617.23 (indecent exposure),
not involving a minor; repeat offenses under 617.241 (obscene materials and performances;
distribution and exhibition prohibited; penalty); 624.713 (certain persons not to possess
firearms); chapter 152 (drugs; controlled substance); or Minnesota Statutes 2012, section
609.21; or a felony-level conviction involving alcohol or drug use.
(b) An individual is disqualified under section 245C.14 if less than 15 years has passed
since the individual's aiding and abetting, attempt, or conspiracy to commit any of the
offenses listed in paragraph (a), as each of these offenses is defined in Minnesota Statutes.
(c) An individual is disqualified under section 245C.14 if less than 15 years has passed
since the termination of the individual's parental rights under section 260C.301, subdivision
1, paragraph (b), or subdivision 3.
(d) An individual is disqualified under section 245C.14 if less than 15 years has passed
since the discharge of the sentence imposed for an offense in any other state or country, the
elements of which are substantially similar to the elements of the offenses listed in paragraph
(a).
(e) If the individual studied commits one of the offenses listed in paragraph (a), but the
sentence or level of offense is a gross misdemeanor or misdemeanor, the individual is
disqualified but the disqualification look-back period for the offense is the period applicable
to the gross misdemeanor or misdemeanor disposition.
(f) When a disqualification is based on a judicial determination other than a conviction,
the disqualification period begins from the date of the court order. When a disqualification
is based on an admission, the disqualification period begins from the date of an admission
in court. When a disqualification is based on an Alford Plea, the disqualification period
begins from the date the Alford Plea is entered in court. When a disqualification is based
on a preponderance of evidence of a disqualifying act, the disqualification date begins from
the date of the dismissal, the date of discharge of the sentence imposed for a conviction for
a disqualifying crime of similar elements, or the date of the incident, whichever occurs last.
Sec. 78.
Minnesota Statutes 2018, section 245C.15, subdivision 3, is amended to read:
Subd. 3.
Ten-year disqualification.
(a) An individual is disqualified under section
245C.14 if: (1) less than ten years have passed since the discharge of the sentence imposed,
if any, for the offense; and (2) the individual has committed a gross misdemeanor-level
violation of any of the following offenses: sections 256.98 (wrongfully obtaining assistance);
268.182 (fraud); 393.07, subdivision 10, paragraph (c) (federal Food Stamp Program fraud);
609.2112, 609.2113, or 609.2114 (criminal vehicular homicide or injury); 609.221 or 609.222
(assault in the first or second degree); 609.223 or 609.2231 (assault in the third or fourth
degree); 609.224 (assault in the fifth degree); 609.224, subdivision 2, paragraph (c) (assault
in the fifth degree by a caregiver against a vulnerable adult); 609.2242 and 609.2243
(domestic assault); 609.23 (mistreatment of persons confined); 609.231 (mistreatment of
residents or patients); 609.2325 (criminal abuse of a vulnerable adult); 609.233 (criminal
neglect of a vulnerable adult); 609.2335 (financial exploitation of a vulnerable adult);
609.234 (failure to report maltreatment of a vulnerable adult); 609.265 (abduction); 609.275
(attempt to coerce); 609.324, subdivision 1a (other prohibited acts; minor engaged in
prostitution); 609.33 (disorderly house); 609.377 (malicious punishment of a child); 609.378
(neglect or endangerment of a child); 609.466 (medical assistance fraud); 609.52 (theft);
609.525 (bringing stolen goods into Minnesota); 609.527 (identity theft); 609.53 (receiving
stolen property); 609.535 (issuance of dishonored checks); 609.582 (burglary); 609.59
(possession of burglary tools); 609.611 (insurance fraud); 609.631 (check forgery; offering
a forged check); 609.66 (dangerous weapons); 609.71 (riot); 609.72, subdivision 3 (disorderly
conduct against a vulnerable adult); repeat offenses under 609.746 (interference with privacy);
609.749, subdivision 2 (stalking); new text begin (criminal penalties for acts involving human
services programs); new text end 609.82 (fraud in obtaining credit); 609.821 (financial transaction card
fraud); 617.23 (indecent exposure), not involving a minor; 617.241 (obscene materials and
performances); 617.243 (indecent literature, distribution); 617.293 (harmful materials;
dissemination and display to minors prohibited); or Minnesota Statutes 2012, section 609.21;
or violation of an order for protection under section 518B.01, subdivision 14.
(b) An individual is disqualified under section 245C.14 if less than ten years has passed
since the individual's aiding and abetting, attempt, or conspiracy to commit any of the
offenses listed in paragraph (a), as each of these offenses is defined in Minnesota Statutes.
(c) An individual is disqualified under section 245C.14 if less than ten years has passed
since the discharge of the sentence imposed for an offense in any other state or country, the
elements of which are substantially similar to the elements of any of the offenses listed in
paragraph (a).
(d) If the individual studied commits one of the offenses listed in paragraph (a), but the
sentence or level of offense is a misdemeanor disposition, the individual is disqualified but
the disqualification lookback period for the offense is the period applicable to misdemeanors.
(e) When a disqualification is based on a judicial determination other than a conviction,
the disqualification period begins from the date of the court order. When a disqualification
is based on an admission, the disqualification period begins from the date of an admission
in court. When a disqualification is based on an Alford Plea, the disqualification period
begins from the date the Alford Plea is entered in court. When a disqualification is based
on a preponderance of evidence of a disqualifying act, the disqualification date begins from
the date of the dismissal, the date of discharge of the sentence imposed for a conviction for
a disqualifying crime of similar elements, or the date of the incident, whichever occurs last.
Sec. 79.
Minnesota Statutes 2018, section 245C.15, subdivision 4, is amended to read:
Subd. 4.
Seven-year disqualification.
(a) An individual is disqualified under section
245C.14 if: (1) less than seven years has passed since the discharge of the sentence imposed,
if any, for the offense; and (2) the individual has committed a misdemeanor-level violation
of any of the following offenses: sections 256.98 (wrongfully obtaining assistance); 268.182
(fraud); 393.07, subdivision 10, paragraph (c) (federal Food Stamp Program fraud); 609.2112,
609.2113, or 609.2114 (criminal vehicular homicide or injury); 609.221 (assault in the first
degree); 609.222 (assault in the second degree); 609.223 (assault in the third degree);
609.2231 (assault in the fourth degree); 609.224 (assault in the fifth degree); 609.2242
(domestic assault); 609.2335 (financial exploitation of a vulnerable adult); 609.234 (failure
to report maltreatment of a vulnerable adult); 609.2672 (assault of an unborn child in the
third degree); 609.27 (coercion); violation of an order for protection under 609.3232
(protective order authorized; procedures; penalties); 609.466 (medical assistance fraud);
609.52 (theft); 609.525 (bringing stolen goods into Minnesota); 609.527 (identity theft);
609.53 (receiving stolen property); 609.535 (issuance of dishonored checks); 609.611
(insurance fraud); 609.66 (dangerous weapons); 609.665 (spring guns); 609.746 (interference
with privacy); 609.79 (obscene or harassing telephone calls); 609.795 (letter, telegram, or
package; opening; harassment); new text begin (criminal penalties for acts involving human services
programs); new text end 609.82 (fraud in obtaining credit); 609.821 (financial transaction card fraud);
617.23 (indecent exposure), not involving a minor; 617.293 (harmful materials; dissemination
and display to minors prohibited); or Minnesota Statutes 2012, section 609.21; or violation
of an order for protection under section 518B.01 (Domestic Abuse Act).
(b) An individual is disqualified under section 245C.14 if less than seven years has
passed since a determination or disposition of the individual's:
(1) failure to make required reports under section 626.556, subdivision 3, or 626.557,
subdivision 3, for incidents in which: (i) the final disposition under section 626.556 or
626.557 was substantiated maltreatment, and (ii) the maltreatment was recurring or serious;
or
(2) substantiated serious or recurring maltreatment of a minor under section 626.556, a
vulnerable adult under section 626.557, or serious or recurring maltreatment in any other
state, the elements of which are substantially similar to the elements of maltreatment under
section 626.556 or 626.557 for which: (i) there is a preponderance of evidence that the
maltreatment occurred, and (ii) the subject was responsible for the maltreatment.
(c) An individual is disqualified under section 245C.14 if less than seven years has
passed since the individual's aiding and abetting, attempt, or conspiracy to commit any of
the offenses listed in paragraphs (a) and (b), as each of these offenses is defined in Minnesota
Statutes.
(d) An individual is disqualified under section 245C.14 if less than seven years has
passed since the discharge of the sentence imposed for an offense in any other state or
country, the elements of which are substantially similar to the elements of any of the offenses
listed in paragraphs (a) and (b).
(e) When a disqualification is based on a judicial determination other than a conviction,
the disqualification period begins from the date of the court order. When a disqualification
is based on an admission, the disqualification period begins from the date of an admission
in court. When a disqualification is based on an Alford Plea, the disqualification period
begins from the date the Alford Plea is entered in court. When a disqualification is based
on a preponderance of evidence of a disqualifying act, the disqualification date begins from
the date of the dismissal, the date of discharge of the sentence imposed for a conviction for
a disqualifying crime of similar elements, or the date of the incident, whichever occurs last.
(f) An individual is disqualified under section 245C.14 if less than seven years has passed
since the individual was disqualified under section 256.98, subdivision 8.
Sec. 80.
Minnesota Statutes 2018, section 245C.15, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin Licensed family child foster care disqualifications. new text end
new text begin
(a) Notwithstanding
subdivisions 1 to 5, for a background study affiliated with a licensed family child foster
care, an individual is disqualified under section 245C.14, regardless of how much time has
passed, if the individual committed an act that resulted in a felony-level conviction for:
609.185 (murder in the first degree); 609.19 (murder in the second degree); 609.195 (murder
in the third degree); 609.20 (manslaughter in the first degree); 609.205 (manslaughter in
the second degree); 609.2112 (criminal vehicular homicide); 609.223, subdivision 2 (assault
in the third degree, past pattern of child abuse); 609.223, subdivision 3 (assault in the third
degree, victim under four); a felony offense under sections 609.2242 and 609.2243 (domestic
assault), spousal abuse, child abuse or neglect, or a crime against children; 609.2247
(domestic assault by strangulation); 609.25 (kidnapping); 609.255 (false imprisonment);
609.265 (abduction); 609.2661 (murder of an unborn child in the first degree); 609.2662
(murder of an unborn child in the second degree); 609.2663 (murder of an unborn child in
the third degree); 609.2664 (manslaughter of an unborn child in the first degree); 609.2665
(manslaughter of an unborn child in the second degree); 609.267 (assault of an unborn child
in the first degree); 609.2671 (assault of an unborn child in the second degree); 609.268
(injury or death of an unborn child in the commission of a crime); 609.324, subdivision 1
(other prohibited acts; engaging in, hiring, or agreeing to hire minor to engage in prostitution);
609.342 (criminal sexual conduct in the first degree); 609.343 (criminal sexual conduct in
the second degree); 609.344 (criminal sexual conduct in the third degree); 609.345 (criminal
sexual conduct in the fourth degree); 609.3451 (criminal sexual conduct in the fifth degree);
609.3453 (criminal sexual predatory conduct); 609.352 (solicitation of children to engage
in sexual conduct); 609.377 (malicious punishment of a child); 609.378 (neglect or
endangerment of a child); 617.246 (use of minors in sexual performance prohibited); or
617.247 (possession of pictorial representations of minors).
new text end
new text begin
(b) Notwithstanding subdivisions 1 to 5, for the purposes of a background study affiliated
with a licensed family foster care license, an individual is disqualified under section 245C.14,
regardless of how much time has passed, if the individual:
new text end
new text begin
(1) committed an action under paragraph (d) that resulted in death or involved sexual
abuse;
new text end
new text begin
(2) committed an act that resulted in a felony-level conviction for section 609.746
(interference with privacy);
new text end
new text begin
(3) committed an act that resulted in a gross misdemeanor-level conviction for section
609.3451 (criminal sexual conduct in the fifth degree); or
new text end
new text begin
(4) committed an act against or involving a minor that resulted in a felony-level conviction
for: section 609.221 (assault in the first degree); 609.222 (assault in the second degree);
609.223, subdivision 1 (assault in the third degree); 609.2231 (assault in the fourth degree);
or 609.224, subdivision 4 (assault in the fifth degree).
new text end
new text begin
(c) Notwithstanding subdivisions 1 to 5, for a background study affiliated with a licensed
family child foster care license, an individual is disqualified under section 245C.14 if:
new text end
new text begin
(1) less than five years have passed since the termination of parental rights under section
260C.301, subdivision 1, paragraph (b);
new text end
new text begin
(2) less than five years have passed since a felony-level conviction for: 152.021
(controlled substance crime in the first degree); 152.022 (controlled substance crime in the
second degree); 152.023 (controlled substance crime in the third degree); 152.024 (controlled
substance crime in the fourth degree); 152.025 (controlled substance crime in the fifth
degree); 152.0261 (importing controlled substances across state borders); 152.0262,
subdivision 1, paragraph (b) (possession of substance with intent to manufacture
methamphetamine); 152.027, subdivision 6, paragraph (c) (sale or possession of synthetic
cannabinoids); 152.096 (conspiracies prohibited); 152.097 (simulated controlled substances);
152.136 (anhydrous ammonia; prohibited conduct; criminal penalties; civil liabilities);
152.137 (methamphetamine-related crimes involving children or vulnerable adults); 169A.24
(felony first-degree driving while impaired); 609.2113 (criminal vehicular operation; bodily
harm); 609.2114 (criminal vehicular operation; unborn child); 609.228 (great bodily harm
caused by distribution of drugs); 609.2325 (criminal abuse of a vulnerable adult); 609.235
(use of drugs to injure or facilitate a crime); 609.66, subdivision 1e (felony drive-by
shooting); 609.687 (adulteration); or 609.855, subdivision 5 (shooting at or in a public
transit vehicle or facility); or
new text end
new text begin
(3) less than five years have passed since a felony-level conviction for an act not against
or involving a minor under: section 609.221 (assault in the first degree); 609.222 (assault
in the second degree); 609.223, subdivision 1 (assault in the third degree); 609.2231 (assault
in the fourth degree); or 609.224, subdivision 4 (assault in the fifth degree).
new text end
new text begin
(d) Notwithstanding subdivisions 1 to 5, except as provided in paragraph (a), for a
background study affiliated with a licensed family child foster care license, an individual
is disqualified under section 245C.14 if less than five years have passed since:
new text end
new text begin
(1) a determination or disposition of the individual's failure to make required reports
under section 626.556, subdivision 3, or 626.557, subdivision 3, for incidents in which the
final disposition under section 626.556 or 626.557 was substantiated maltreatment and the
maltreatment was recurring or serious;
new text end
new text begin
(2) a determination or disposition of the individual's substantiated serious or recurring
maltreatment of a minor under section 626.556, a vulnerable adult under section 626.557,
or serious or recurring maltreatment in any other state, the elements of which are substantially
similar to the elements of maltreatment under section 626.556 or 626.557 and meet the
definition of serious maltreatment or recurring maltreatment;
new text end
new text begin
(3) the termination of the individual's parental rights under section 260C.301, subdivision
1, paragraph (a); or
new text end
new text begin
(4) a gross misdemeanor-level conviction for: section 609.746 (interference with privacy);
609.2242 and 609.2243 (domestic assault); 609.377 (malicious punishment of a child); or
609.378 (neglect or endangerment of a child).
new text end
new text begin
(e) An individual is disqualified under this subdivision if the individual is convicted of
an offense in any other state or country and the elements of the offense are substantially
similar to any of the offenses listed in this subdivision.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2020.
new text end
Sec. 81.
Minnesota Statutes 2018, section 245C.22, subdivision 4, is amended to read:
Subd. 4.
Risk of harm; set aside.
(a) The commissioner may set aside the disqualification
if the commissioner finds that the individual has submitted sufficient information to
demonstrate that the individual does not pose a risk of harm to any person served by the
applicant, license holder, or other entities as provided in this chapter.
(b) In determining whether the individual has met the burden of proof by demonstrating
the individual does not pose a risk of harm, the commissioner shall consider:
(1) the nature, severity, and consequences of the event or events that led to the
disqualification;
(2) whether there is more than one disqualifying event;
(3) the age and vulnerability of the victim at the time of the event;
(4) the harm suffered by the victim;
(5) vulnerability of persons served by the program;
(6) the similarity between the victim and persons served by the program;
(7) the time elapsed without a repeat of the same or similar event;
(8) documentation of successful completion by the individual studied of training or
rehabilitation pertinent to the event; and
(9) any other information relevant to reconsideration.
(c) If the individual requested reconsideration on the basis that the information relied
upon to disqualify the individual was incorrect or inaccurate and the commissioner determines
that the information relied upon to disqualify the individual is correct, the commissioner
must also determine if the individual poses a risk of harm to persons receiving services in
accordance with paragraph (b).
new text begin
(d) For an individual seeking employment in the substance use disorder treatment field,
the commissioner shall set aside the disqualification if the following criteria are met:
new text end
new text begin
(1) the individual is not disqualified for a crime of violence as listed under section
624.712, subdivision 5, except for the following crimes: crimes listed under section 152.021,
subdivision 2 or 2a; 152.022, subdivision 2; 152.023, subdivision 2; 152.024; or 152.025;
new text end
new text begin
(2) the individual is not disqualified under section 245C.15, subdivision 1;
new text end
new text begin
(3) the individual is not disqualified under section 245C.15, subdivision 4, paragraph
(b);
new text end
new text begin
(4) the individual provided documentation of successful completion of treatment, at least
one year prior to the date of the request for reconsideration, at a program licensed under
chapter 245G, and has had no disqualifying crimes or conduct under section 245C.15 after
the successful completion of treatment;
new text end
new text begin
(5) the individual provided documentation demonstrating abstinence from controlled
substances, as defined in section 152.01, subdivision 4, for the period of one year prior to
the date of the request for reconsideration; and
new text end
new text begin
(6) the individual is seeking employment in the substance use disorder treatment field.
new text end
Sec. 82.
Minnesota Statutes 2018, section 245C.22, subdivision 5, is amended to read:
Subd. 5.
Scope of set-aside.
(a) If the commissioner sets aside a disqualification under
this section, the disqualified individual remains disqualified, but may hold a license and
have direct contact with or access to persons receiving services. Except as provided in
paragraph (b), the commissioner's set-aside of a disqualification is limited solely to the
licensed program, applicant, or agency specified in the set aside notice under section 245C.23.
For personal care provider organizations, the commissioner's set-aside may further be limited
to a specific individual who is receiving services. For new background studies required
under section 245C.04, subdivision 1, paragraph (h), if an individual's disqualification was
previously set aside for the license holder's program and the new background study results
in no new information that indicates the individual may pose a risk of harm to persons
receiving services from the license holder, the previous set-aside shall remain in effect.
(b) If the commissioner has previously set aside an individual's disqualification for one
or more programs or agencies, and the individual is the subject of a subsequent background
study for a different program or agency, the commissioner shall determine whether the
disqualification is set aside for the program or agency that initiated the subsequent
background study. A notice of a set-aside under paragraph (c) shall be issued within 15
working days if all of the following criteria are met:
(1) the subsequent background study was initiated in connection with a program licensed
or regulated under the same provisions of law and rule for at least one program for which
the individual's disqualification was previously set aside by the commissioner;
(2) the individual is not disqualified for an offense specified in section 245C.15,
subdivision 1 or 2;
(3) the commissioner has received no new information to indicate that the individual
may pose a risk of harm to any person served by the program; and
(4) the previous set-aside was not limited to a specific person receiving services.
new text begin
(c) Notwithstanding paragraph (b), clause (2), for an individual who is employed in the
substance use disorder field, if the commissioner has previously set aside an individual's
disqualification for one or more programs or agencies in the substance use disorder treatment
field, and the individual is the subject of a subsequent background study for a different
program or agency in the substance use disorder treatment field, the commissioner shall set
aside the disqualification for the program or agency in the substance use disorder treatment
field that initiated the subsequent background study when the criteria under paragraph (b),
clauses (1), (3), and (4), are met and the individual is not disqualified for an offense specified
in section 254C.15, subdivision 1. A notice of a set-aside under paragraph (d) shall be issued
within 15 working days.
new text end
deleted text begin (c)deleted text end new text begin (d)new text end When a disqualification is set aside under paragraph (b), the notice of background
study results issued under section 245C.17, in addition to the requirements under section
245C.17, shall state that the disqualification is set aside for the program or agency that
initiated the subsequent background study. The notice must inform the individual that the
individual may request reconsideration of the disqualification under section 245C.21 on the
basis that the information used to disqualify the individual is incorrect.
Sec. 83.
Minnesota Statutes 2018, section 245C.24, is amended to read:
245C.24 DISQUALIFICATION; BAR TO SET ASIDE A DISQUALIFICATION;
REQUEST FOR VARIANCE.
Subdivision 1.
Minimum disqualification periods.
The disqualification periods under
subdivisions 3 deleted text begin and 4deleted text end new text begin to 6new text end are the minimum applicable disqualification periods. The
commissioner may determine that an individual should continue to be disqualified from
licensure because the individual continues to pose a risk of harm to persons served by that
individual, even after the minimum disqualification period has passed.
Subd. 2.
Permanent bar to set aside a disqualification.
(a) Except as provided in
deleted text begin paragraphdeleted text end new text begin paragraphsnew text end (b)deleted text begin ,deleted text end new text begin to (d),new text end the commissioner may not set aside the disqualification
of any individual disqualified pursuant to this chapter, regardless of how much time has
passed, if the individual was disqualified for a crime or conduct listed in section 245C.15,
subdivision 1.
(b) For an individual deleted text begin in the chemical dependency or corrections fielddeleted text end who was disqualified
for a crime or conduct listed under section 245C.15, subdivision 1, and deleted text begin whose disqualification
was set aside prior to July 1, 2005deleted text end new text begin more than 20 years have passed since the discharge of
the sentence imposed or, if the disqualification is not based on a conviction, more than 20
years have passed since the individual committed the act upon which the disqualification
was basednew text end , the commissioner must consider granting anew text begin set aside ornew text end variance pursuant to
sectionnew text begin 245C.22 ornew text end 245C.30 for the license holder for a program dealing primarily with
adults. deleted text begin A request for reconsideration evaluated under this paragraph must include a letter
of recommendation from the license holder that was subject to the prior set-aside decision
addressing the individual's quality of care to children or vulnerable adults and the
circumstances of the individual's departure from that servicedeleted text end new text begin This paragraph does not apply
to a person disqualified based on a violation of sections 609.342 to 609.3453; 617.23,
subdivision 2, clause (1), or subdivision 3, clause (1); 617.246; or 617.247new text end .
(c) When a licensed foster care provider adopts an individual who had received foster
care services from the provider for over six months, and the adopted individual is required
to receive a background study under section 245C.03, subdivision 1, paragraph (a), clause
(2) or (6), the commissioner may grant a variance to the license holder under section 245C.30
to permit the adopted individual with a permanent disqualification to remain affiliated with
the license holder under the conditions of the variance when the variance is recommended
by the county of responsibility for each of the remaining individuals in placement in the
home and the licensing agency for the home.
new text begin
(d) For an individual 18 years of age or older affiliated with a licensed family child foster
care program, the commissioner must not set aside the disqualification of any individual
disqualified pursuant to this chapter, regardless of how much time has passed, if the individual
was disqualified for a crime or conduct listed in section 245C.15, subdivision 6, paragraph
(a). This paragraph does not apply to an individual younger than 18 years of age at the time
the background study is submitted.
new text end
Subd. 3.
Ten-year bar to set aside disqualification.
(a) The commissioner may not set
aside the disqualification of an individual in connection with a license to provide family
child care for childrendeleted text begin , foster care for children in the provider's home,deleted text end or foster care or day
care services for adults in the provider's home if: (1) less than ten years has passed since
the discharge of the sentence imposed, if any, for the offense; or (2) when disqualified based
on a preponderance of new text begin the new text end evidence determination under section 245C.14, subdivision 1,
paragraph (a), clause (2), or an admission under section 245C.14, subdivision 1, paragraph
(a), clause (1), and less than ten years has passed since the individual committed the act or
admitted to committing the act, whichever is later; and (3) the individual has committed a
violation of any of the following offenses: sections 609.165 (felon ineligible to possess
firearm); criminal vehicular homicide or criminal vehicular operation causing death under
609.2112, 609.2113, or 609.2114 (criminal vehicular homicide or injury); 609.215 (aiding
suicide or aiding attempted suicide); felony violations under 609.223 or 609.2231 (assault
in the third or fourth degree); 609.229 (crimes committed for benefit of a gang); 609.713
(terroristic threats); 609.235 (use of drugs to injure or to facilitate crime); 609.24 (simple
robbery); 609.255 (false imprisonment); 609.562 (arson in the second degree); 609.71 (riot);
609.498, subdivision 1 or 1b (aggravated first-degree or first-degree tampering with a
witness); burglary in the first or second degree under 609.582 (burglary); 609.66 (dangerous
weapon); 609.665 (spring guns); 609.67 (machine guns and short-barreled shotguns);
609.749, subdivision 2 (gross misdemeanor stalking); 152.021 or 152.022 (controlled
substance crime in the first or second degree); 152.023, subdivision 1, clause (3) or (4) or
subdivision 2, clause (4) (controlled substance crime in the third degree); 152.024,
subdivision 1, clause (2), (3), or (4) (controlled substance crime in the fourth degree);
609.224, subdivision 2, paragraph (c) (fifth-degree assault by a caregiver against a vulnerable
adult); 609.23 (mistreatment of persons confined); 609.231 (mistreatment of residents or
patients); 609.2325 (criminal abuse of a vulnerable adult); 609.233 (criminal neglect of a
vulnerable adult); 609.2335 (financial exploitation of a vulnerable adult); 609.234 (failure
to report); 609.265 (abduction); 609.2664 to 609.2665 (manslaughter of an unborn child in
the first or second degree); 609.267 to 609.2672 (assault of an unborn child in the first,
second, or third degree); 609.268 (injury or death of an unborn child in the commission of
a crime); repeat offenses under 617.23 (indecent exposure); 617.293 (disseminating or
displaying harmful material to minors); a felony-level conviction involving alcohol or drug
use, a gross misdemeanor offense under 609.324, subdivision 1 (other prohibited acts); a
gross misdemeanor offense under 609.378 (neglect or endangerment of a child); a gross
misdemeanor offense under 609.377 (malicious punishment of a child); 609.72, subdivision
3 (disorderly conduct against a vulnerable adult); or 624.713 (certain persons not to possess
firearms); or Minnesota Statutes 2012, section 609.21.
(b) The commissioner may not set aside the disqualification of an individual if less than
ten years have passed since the individual's aiding and abetting, attempt, or conspiracy to
commit any of the offenses listed in paragraph (a) as each of these offenses is defined in
Minnesota Statutes.
(c) The commissioner may not set aside the disqualification of an individual if less than
ten years have passed since the discharge of the sentence imposed for an offense in any
other state or country, the elements of which are substantially similar to the elements of any
of the offenses listed in paragraph (a).
Subd. 4.
Seven-year bar to set aside disqualification.
The commissioner may not set
aside the disqualification of an individual in connection with a license to provide family
child care for childrendeleted text begin , foster care for children in the provider's home,deleted text end or foster care or day
care services for adults in the provider's home if within seven years preceding the study:
(1) the individual committed an act that constitutes maltreatment of a child under section
626.556, subdivision 10e, and the maltreatment resulted in substantial bodily harm as defined
in section 609.02, subdivision 7a, or substantial mental or emotional harm as supported by
competent psychological or psychiatric evidence; or
(2) the individual was determined under section 626.557 to be the perpetrator of a
substantiated incident of maltreatment of a vulnerable adult that resulted in substantial
bodily harm as defined in section 609.02, subdivision 7a, or substantial mental or emotional
harm as supported by competent psychological or psychiatric evidence.
new text begin Subd. 5. new text end
new text begin Five-year bar to set aside disqualification. new text end
new text begin
The commissioner must not set
aside the disqualification of an individual 18 years of age or older in connection with a
family child foster care license if the individual is disqualified under section 245C.15,
subdivision 6, paragraph (c). This paragraph does not apply to an individual younger than
18 years of age at the time the background study is submitted.
new text end
new text begin Subd. 6. new text end
new text begin
Five-year bar to set aside disqualification; children's residential
facilities.
new text end
new text begin
The commissioner shall not set aside the disqualification of an individual in
connection with a license for a children's residential facility who was convicted of a felony
within the past five years for: (1) physical assault or battery; or (2) a drug-related offense.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2020, except subdivision 6 is
effective for background studies initiated on or after July 1, 2019.
new text end
Sec. 84.
Minnesota Statutes 2018, section 245C.30, subdivision 1, is amended to read:
Subdivision 1.
License holder new text begin and license-exempt child care center certification
holder new text end variance.
(a) Except for any disqualification under section 245C.15, subdivision 1,
when the commissioner has not set aside a background study subject's disqualification, and
there are conditions under which the disqualified individual may provide direct contact
services or have access to people receiving services that minimize the risk of harm to people
receiving services, the commissioner may grant a time-limited variance to a license holdernew text begin
or license-exempt child care center certification holdernew text end .
(b) The variance shall state the reason for the disqualification, the services that may be
provided by the disqualified individual, and the conditions with which the license holdernew text begin ,
license-exempt child care center certification holder,new text end or applicant must comply for the
variance to remain in effect.
(c) Except for programs licensed to provide family child care, foster care for children
in the provider's own home, or foster care or day care services for adults in the provider's
own home, the variance must be requested by the license holdernew text begin or license-exempt child
care center certification holdernew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 85.
Minnesota Statutes 2018, section 245C.30, subdivision 2, is amended to read:
Subd. 2.
Disclosure of reason for disqualification.
(a) The commissioner may not grant
a variance for a disqualified individual unless the applicantnew text begin , license-exempt child care center
certification holder,new text end or license holder requests the variance and the disqualified individual
provides written consent for the commissioner to disclose to the applicantnew text begin , license-exempt
child care center certification holder,new text end or license holder the reason for the disqualification.
(b) This subdivision does not apply to programs licensed to provide family child care
for children, foster care for children in the provider's own home, or foster care or day care
services for adults in the provider's own home. When the commissioner grants a variance
for a disqualified individual in connection with a license to provide the services specified
in this paragraph, the disqualified individual's consent is not required to disclose the reason
for the disqualification to the license holder in the variance issued under subdivision 1,
provided that the commissioner may not disclose the reason for the disqualification if the
disqualification is based on a felony-level conviction for a drug-related offense within the
past five years.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 86.
Minnesota Statutes 2018, section 245C.30, subdivision 3, is amended to read:
Subd. 3.
Consequences for failing to comply with conditions of variance.
When a
license holdernew text begin or license-exempt child care center certification holdernew text end permits a disqualified
individual to provide any services for which the subject is disqualified without complying
with the conditions of the variance, the commissioner may terminate the variance effective
immediately and subject the license holder to a licensing action under sections 245A.06
and 245A.07new text begin or a license-exempt child care center certification holder to an action under
sections 245H.06 and 245H.07new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 87.
Minnesota Statutes 2018, section 245E.01, subdivision 8, is amended to read:
Subd. 8.
Financial misconduct or misconduct.
"Financial misconduct" or "misconduct"
means an entity's or individual's acts or omissions that result in fraud and abuse or error
against the Department of Human Services. Financial misconduct includesnew text begin : (1)new text end acting as a
recruiter offering conditional employment on behalf of a provider that has received funds
from the child care assistance programnew text begin ; and (2) committing an act or acts that meet the
definition of offenses listed in sections 609.816 and 609.817new text end .
Sec. 88.
Minnesota Statutes 2018, section 245E.02, is amended by adding a subdivision
to read:
new text begin Subd. 1a. new text end
new text begin Provider definitions. new text end
new text begin
For the purposes of this section, "provider" includes:
new text end
new text begin
(1) individuals or entities meeting the definition of provider in section 245E.01,
subdivision 12; and
new text end
new text begin
(2) owners and controlling individuals of entities identified in clause (1).
new text end
Sec. 89.
Minnesota Statutes 2018, section 245H.01, is amended by adding a subdivision
to read:
new text begin Subd. 7. new text end
new text begin Substitute. new text end
new text begin
"Substitute" means an adult who is temporarily filling a position
as a staff person for less than 240 hours total in a calendar year due to the absence of a
regularly employed staff person who provides direct contact services to a child.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 90.
Minnesota Statutes 2018, section 245H.01, is amended by adding a subdivision
to read:
new text begin Subd. 8. new text end
new text begin Staff person. new text end
new text begin
"Staff person" means an employee of a certified center who
provides direct contact services to children.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 91.
Minnesota Statutes 2018, section 245H.01, is amended by adding a subdivision
to read:
new text begin Subd. 9. new text end
new text begin Unsupervised volunteer. new text end
new text begin
"Unsupervised volunteer" means an individual who:
(1) assists in the care of a child in care; (2) is not under the continuous direct supervision
of a staff person; and (3) is not employed by the certified center.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 92.
Minnesota Statutes 2018, section 245H.03, is amended by adding a subdivision
to read:
new text begin Subd. 4. new text end
new text begin Reconsideration of certification denial. new text end
new text begin
(a) The applicant may request
reconsideration of the denial by notifying the commissioner by certified mail or personal
service. The request must be made in writing. If sent by certified mail, the request must be
postmarked and sent to the commissioner within ten calendar days after the applicant received
the order. If a request is made by personal service, it must be received by the commissioner
within ten calendar days after the applicant received the order. The applicant may submit
with the request for reconsideration a written argument or evidence in support of the request
for reconsideration.
new text end
new text begin
(b) The commissioner's disposition of a request for reconsideration is final and not
subject to appeal under chapter 14.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 93.
Minnesota Statutes 2018, section 245H.07, is amended to read:
245H.07 DECERTIFICATION.
new text begin Subdivision 1. new text end
new text begin Generally. new text end
(a) The commissioner may decertify a center if a certification
holder:
(1) failed to comply with an applicable law or rule; deleted text begin or
deleted text end
(2) knowingly withheld relevant information from or gave false or misleading information
to the commissioner in connection with an application for certification, in connection with
the background study status of an individual, during an investigation, or regarding compliance
with applicable laws or rulesdeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(3) has authorization to receive child care assistance payments revoked pursuant to
chapter 119B.
new text end
(b) When considering decertification, the commissioner shall consider the nature,
chronicity, or severity of the violation of law or rule.
(c) When a center is decertified, the center is ineligible to receive a child care assistance
paymentnew text begin under chapter 119Bnew text end .
new text begin Subd. 2. new text end
new text begin Reconsideration of decertification. new text end
new text begin
(a) The certification holder may request
reconsideration of the decertification by notifying the commissioner by certified mail or
personal service. The request must be made in writing. If sent by certified mail, the request
must be postmarked and sent to the commissioner within ten calendar days after the
certification holder received the order. If a request is made by personal service, it must be
received by the commissioner within ten calendar days after the certification holder received
the order. With the request for reconsideration, the certification holder may submit a written
argument or evidence in support of the request for reconsideration.
new text end
new text begin
(b) The commissioner's disposition of a request for reconsideration is final and not
subject to appeal under chapter 14.
new text end
new text begin Subd. 3. new text end
new text begin Decertification due to maltreatment. new text end
new text begin
If the commissioner decertifies a center
pursuant to subdivision 1, paragraph (a), clause (1), based on a determination that the center
was responsible for maltreatment, and if the center requests reconsideration of the
decertification according to subdivision 2, paragraph (a), and appeals the maltreatment
determination under section 626.556, subdivision 10i, the final decertification determination
is stayed until the commissioner issues a final decision regarding the maltreatment appeal.
new text end
new text begin Subd. 4. new text end
new text begin Decertification due to revocation of child care assistance. new text end
new text begin
If the commissioner
decertifies a center that had payments revoked pursuant to chapter 119B, and if the center
appeals the revocation of the center's authorization to receive child care assistance payments,
the final decertification determination is stayed until the appeal of the center's authorization
under chapter 119B is resolved. If the center also requests reconsideration of the
decertification, the center must do so according to subdivision 2, paragraph (a). The final
decision on reconsideration is stayed until the appeal of the center's authorization under
chapter 119B is resolved.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
Subdivisions 1 to 3 are effective September 30, 2019. Subdivision
4 is effective February 26, 2021.
new text end
Sec. 94.
Minnesota Statutes 2018, section 245H.10, subdivision 1, is amended to read:
Subdivision 1.
deleted text begin Documentationdeleted text end new text begin Individuals to be studiednew text end .
(a) The applicant or
certification holder must submit deleted text begin and maintain documentation ofdeleted text end a completed background
study fordeleted text begin :deleted text end new text begin each child care background study subject as defined in section 245C.02, subdivision
6a.
new text end
deleted text begin
(1) each person applying for the certification;
deleted text end
deleted text begin
(2) each person identified as a center operator or program operator as defined in section
245H.01, subdivision 3;
deleted text end
deleted text begin
(3) each current or prospective staff person or contractor of the certified center who will
have direct contact with a child served by the center;
deleted text end
deleted text begin
(4) each volunteer who has direct contact with a child served by the center if the contact
is not under the continuous, direct supervision by an individual listed in clause (1), (2), or
(3); and
deleted text end
deleted text begin
(5) each managerial staff person of the certification holder with oversight and supervision
of the certified center.
deleted text end
(b) To be accepted for certification, a background study on every individual deleted text begin in paragraph
(a), clause (1),deleted text end new text begin applying for certificationnew text end must be completed under chapter 245C and result
in a not disqualified determination under section 245C.14 or a disqualification that was set
aside under section 245C.22.
Sec. 95.
Minnesota Statutes 2018, section 245H.11, is amended to read:
245H.11 REPORTING.
(a) The certification holder must complynew text begin and must have written policies for staff to
complynew text end with the reporting requirements for abuse and neglect specified in section 626.556.
A person mandated to report physical or sexual child abuse or neglect occurring within a
certified center shall report the information to the commissioner.
(b) The certification holder must inform the commissioner within 24 hours of:
(1) the death of a child in the program; and
(2) any injury to a child in the program that required treatment by a physician.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 96.
Minnesota Statutes 2018, section 245H.12, is amended to read:
245H.12 FEES.
deleted text begin
The commissioner shall consult with stakeholders to develop an administrative fee to
implement this chapter. By February 15, 2019, the commissioner shall provide
recommendations on the amount of an administrative fee to the legislative committees with
jurisdiction over health and human services policy and finance.
deleted text end
new text begin
A certified center must pay
an initial application fee of $200. For calendar year 2020 and thereafter, a certified center
shall pay an annual nonrefundable certification fee of $100.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 97.
Minnesota Statutes 2018, section 245H.13, subdivision 5, is amended to read:
Subd. 5.
Building and physical premises; free of hazards.
(a) deleted text begin The certified center
must document compliance with the State Fire Code by providingdeleted text end new text begin To be accepted for
certification, the applicant must demonstrate compliance with the State Fire Code, section
299F.011, by either:
new text end
new text begin (1) providing new text end documentation of a fire marshal inspection completed within the previous
three years by a state fire marshal or a local fire code inspector trained by the state fire
marshaldeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(2) complying with the fire marshal inspection requirements according to section
245A.151.
new text end
(b) The certified center must designate a primary indoor and outdoor space used for
child care on a facility site floor plan.
(c) The certified center must ensure the areas used by a child are clean and in good repair,
with structurally sound and functional furniture and equipment that is appropriate to the
age and size of a child who uses the area.
(d) The certified center must ensure hazardous items including but not limited to sharp
objects, medicines, cleaning supplies, poisonous plants, and chemicals are out of reach of
a child.
(e) The certified center must safely handle and dispose of bodily fluids and other
potentially infectious fluids by using gloves, disinfecting surfaces that come in contact with
potentially infectious bodily fluids, and disposing of bodily fluid in a securely sealed plastic
bag.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 98.
Minnesota Statutes 2018, section 245H.13, is amended by adding a subdivision
to read:
new text begin Subd. 7. new text end
new text begin Risk reduction plan. new text end
new text begin
(a) The certified center must develop a risk reduction
plan that identifies risks to children served by the child care center. The assessment of risk
must include risks presented by (1) the physical plant where the certified services are
provided, including electrical hazards; and (2) the environment, including the proximity to
busy roads and bodies of water.
new text end
new text begin
(b) The certification holder must establish policies and procedures to minimize identified
risks. After any change to the risk reduction plan, the certification holder must inform staff
of the change in the risk reduction plan and document that staff were informed of the change.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 99.
Minnesota Statutes 2018, section 245H.13, is amended by adding a subdivision
to read:
new text begin Subd. 8. new text end
new text begin Required policies. new text end
new text begin
A certified center must have written policies for health and
safety items in subdivisions 1 to 6.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 100.
Minnesota Statutes 2018, section 245H.13, is amended by adding a subdivision
to read:
new text begin Subd. 9. new text end
new text begin Behavior guidance. new text end
new text begin
The certified center must ensure that staff and volunteers
use positive behavior guidance and do not subject children to:
new text end
new text begin
(1) corporal punishment, including but not limited to rough handling, shoving, hair
pulling, ear pulling, shaking, slapping, kicking, biting, pinching, hitting, and spanking;
new text end
new text begin
(2) humiliation;
new text end
new text begin
(3) abusive language;
new text end
new text begin
(4) the use of mechanical restraints, including tying;
new text end
new text begin
(5) the use of physical restraints other than to physically hold a child when containment
is necessary to protect a child or others from harm; or
new text end
new text begin
(6) the withholding or forcing of food and other basic needs.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 101.
Minnesota Statutes 2018, section 245H.13, is amended by adding a subdivision
to read:
new text begin Subd. 10. new text end
new text begin Supervision. new text end
new text begin
Staff must supervise each child at all times. Staff are responsible
for the ongoing activity of each child, appropriate visual or auditory awareness, physical
proximity, and knowledge of activity requirements and each child's needs. Staff must
intervene when necessary to ensure a child's safety. In determining the appropriate level of
supervision of a child, staff must consider: (1) the age of a child; (2) individual differences
and abilities; (3) indoor and outdoor layout of the child care program; and (4) environmental
circumstances, hazards, and risks.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 102.
Minnesota Statutes 2018, section 245H.14, subdivision 1, is amended to read:
Subdivision 1.
First aid and cardiopulmonary resuscitation.
deleted text begin
At least one designated
staff person who completed pediatric first aid training and pediatric cardiopulmonary
resuscitation (CPR) training must be present at all times at the program, during field trips,
and when transporting a child. The designated staff person must repeat pediatric first aid
training and pediatric CPR training at least once every two years.
deleted text end
new text begin
(a) Before having unsupervised direct contact with a child, but within the first 90 days
of employment for the director and all staff persons, and within 90 days after the first date
of direct contact with a child for substitutes and unsupervised volunteers, each person must
successfully complete pediatric first aid and pediatric cardiopulmonary resuscitation (CPR)
training, unless the training has been completed within the previous two calendar years.
Staff must complete the pediatric first aid and pediatric CPR training at least every other
calendar year and the center must document the training in the staff person's personnel
record.
new text end
new text begin
(b) Training completed under this subdivision may be used to meet the in-service training
requirements under subdivision 6.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 103.
Minnesota Statutes 2018, section 245H.14, subdivision 3, is amended to read:
Subd. 3.
Abusive head trauma.
A certified center that cares for a child deleted text begin through four
years of agedeleted text end new text begin under school agenew text end must ensure thatnew text begin the director and allnew text end staff persons deleted text begin and
volunteersdeleted text end new text begin , including substitutes and unsupervised volunteers,new text end receive training on abusive
head trauma deleted text begin from shaking infants and young childrendeleted text end before assisting in the care of a child
deleted text begin through four years of agedeleted text end new text begin under school agenew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 104.
Minnesota Statutes 2018, section 245H.14, subdivision 4, is amended to read:
Subd. 4.
Child development.
The certified center must ensure deleted text begin each staff person completes
at least two hours ofdeleted text end new text begin that the director and all staff persons completenew text end child development and
learning training within deleted text begin 14deleted text end new text begin 90new text end days of employment and deleted text begin annuallydeleted text end new text begin every second calendar yearnew text end
thereafter. new text begin Substitutes and unsupervised volunteers must complete child development and
learning training within 90 days after the first date of direct contact with a child and every
second calendar year thereafter.new text end new text begin The director and staff persons not including substitutes
must complete at least two hours of training on child development. The training for substitutes
and unsupervised volunteers is not required to be of a minimum length.new text end For purposes of
this subdivision, "child development and learning training" means how a child develops
physically, cognitively, emotionally, and socially and learns as part of the child's family,
culture, and community.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 105.
Minnesota Statutes 2018, section 245H.14, subdivision 5, is amended to read:
Subd. 5.
Orientation.
The certified center must ensure deleted text begin each staff person isdeleted text end new text begin the director
and all staff persons, substitutes, and unsupervised volunteers arenew text end trained at orientation on
health and safety requirements in sections 245H.11, 245H.13, 245H.14, and 245H.15. The
certified center must provide deleted text begin staff with andeleted text end orientation within 14 days deleted text begin of employmentdeleted text end new text begin after
the first date of direct contact with a childnew text end . Before the completion of orientation, deleted text begin a staff
persondeleted text end new text begin these individualsnew text end must be supervised while providing direct care to a child.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 106.
Minnesota Statutes 2018, section 245H.14, subdivision 6, is amended to read:
Subd. 6.
In service.
(a) The certified center must ensure deleted text begin eachdeleted text end new text begin that the director and allnew text end
staff deleted text begin person isdeleted text end new text begin persons, including substitutes and unsupervised volunteers, arenew text end trained at
least deleted text begin annuallydeleted text end new text begin once each calendar yearnew text end on health and safety requirements in sections 245H.11,
245H.13, 245H.14, and 245H.15.
(b) new text begin The director and new text end each staff personnew text begin , not including substitutes,new text end must deleted text begin annuallydeleted text end complete
at least six hours of trainingnew text begin each calendar yearnew text end . Training required under paragraph (a) may
be used toward the hourly training requirements of this subdivision.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 107.
Minnesota Statutes 2018, section 245H.15, subdivision 1, is amended to read:
Subdivision 1.
Written emergency plan.
(a) A certified center must have a written
emergency plan for emergencies that require evacuation, sheltering, or other protection of
children, such as fire, natural disaster, intruder, or other threatening situation that may pose
a health or safety hazard to children. The plan must be written on a form developed by the
commissioner and reviewed and updated at least once each calendar year. The annual review
of the emergency plan must be documented.
(b) The plan must include:
(1) procedures for an evacuation, relocation, shelter-in-place, or lockdown;
(2) a designated relocation site and evacuation route;
(3) procedures for notifying a child's parent or legal guardian of the relocation and
reunification with families;
(4) accommodations for a child with a disability or a chronic medical condition;
(5) procedures for storing a child's medically necessary medicine that facilitates easy
removal during an evacuation or relocation;
(6) procedures for continuing operations in the period during and after a crisis; deleted text begin and
deleted text end
(7) procedures for communicating with local emergency management officials, law
enforcement officials, or other appropriate state or local authoritiesdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(8) accommodations for infants and toddlers.
new text end
(c) The certification holder must have an emergency plan available for review upon
request by the child's parent or legal guardian.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
Sec. 108.
Minnesota Statutes 2018, section 256.046, subdivision 1, is amended to read:
Subdivision 1.
Hearing authority.
A local agency must initiate an administrative fraud
disqualification hearing for individualsdeleted text begin , including child care providers caring for children
receiving child care assistance,deleted text end accused of wrongfully obtaining assistance or intentional
program violations, in lieu of a criminal action when it has not been pursued, in the Minnesota
family investment program and any affiliated program to include the diversionary work
program and the work participation cash benefit program, child care assistance programs,
general assistance, family general assistance program formerly codified in section 256D.05,
subdivision 1, clause (15), Minnesota supplemental aid, food stamp programs, MinnesotaCare
for adults without children, and upon federal approval, all categories of medical assistance
and remaining categories of MinnesotaCare except for children through age 18. The
Department of Human Services, in lieu of a local agency, may initiate an administrative
fraud disqualification hearing when the state agency is directly responsible for administration
or investigation of the program for which benefits were wrongfully obtained. The hearing
is subject to the requirements of deleted text begin sectiondeleted text end new text begin sectionsnew text end 256.045 new text begin and 256.0451 new text end and the requirements
in Code of Federal Regulations, title 7, section 273.16.
Sec. 109.
Minnesota Statutes 2018, section 256.046, is amended by adding a subdivision
to read:
new text begin Subd. 3. new text end
new text begin
Administrative disqualification of child care providers caring for children
receiving child care assistance.
new text end
new text begin
(a) The department or local agency shall pursue an
administrative disqualification, if the child care provider is accused of committing an
intentional program violation, in lieu of a criminal action when it has not been pursued.
Intentional program violations include intentionally making false or misleading statements;
intentionally misrepresenting, concealing, or withholding facts; and repeatedly and
intentionally violating program regulations under chapters 119B and 245E. Intent may be
proven by demonstrating a pattern of conduct that violates program rules under chapters
119B and 245E.
new text end
new text begin
(b) To initiate an administrative disqualification, a local agency or the commissioner
must mail written notice to the provider against whom the action is being taken. Unless
otherwise specified under chapter 119B or 245E or Minnesota Rules, chapter 3400, a local
agency or the commissioner must mail the written notice at least 15 calendar days before
the adverse action's effective date. The notice shall state (1) the factual basis for the agency's
determination, (2) the action the agency intends to take, (3) the dollar amount of the monetary
recovery or recoupment, if known, and (4) the provider's right to appeal the agency's proposed
action.
new text end
new text begin
(c) The provider may appeal an administrative disqualification by submitting a written
request to the Department of Human Services, Appeals Division. A provider's request must
be received by the Appeals Division no later than 30 days after the date a local agency or
the commissioner mails the notice.
new text end
new text begin
(d) The provider's appeal request must contain the following:
new text end
new text begin
(1) each disputed item, the reason for the dispute, and, if applicable, an estimate of the
dollar amount involved for each disputed item;
new text end
new text begin
(2) the computation the provider believes to be correct, if applicable;
new text end
new text begin
(3) the statute or rule relied on for each disputed item; and
new text end
new text begin
(4) the name, address, and telephone number of the person at the provider's place of
business with whom contact may be made regarding the appeal.
new text end
new text begin
(e) On appeal, the issuing agency bears the burden of proof to demonstrate by a
preponderance of the evidence that the provider committed an intentional program violation.
new text end
new text begin
(f) The hearing is subject to the requirements of sections 256.045 and 256.0451. The
human services judge may combine a fair hearing and administrative disqualification hearing
into a single hearing if the factual issues arise out of the same or related circumstances and
the provider receives prior notice that the hearings will be combined.
new text end
new text begin
(g) A provider found to have committed an intentional program violation and is
administratively disqualified shall be disqualified, for a period of three years for the first
offense and permanently for any subsequent offense, from receiving any payments from
any child care program under chapter 119B.
new text end
new text begin
(h) Unless a timely and proper appeal made under this section is received by the
department, the administrative determination of the department is final and binding.
new text end
Sec. 110.
Minnesota Statutes 2018, section 256.98, subdivision 8, is amended to read:
Subd. 8.
Disqualification from program.
(a) Any person found to be guilty of
wrongfully obtaining assistance by a federal or state court or by an administrative hearing
determination, or waiver thereof, through a disqualification consent agreement, or as part
of any approved diversion plan under section 401.065, or any court-ordered stay which
carries with it any probationary or other conditions, in the Minnesota family investment
program and any affiliated program to include the diversionary work program and the work
participation cash benefit program, the food stamp or food support program, the general
assistance program, housing support under chapter 256I, or the Minnesota supplemental
aid program shall be disqualified from that program. In addition, any person disqualified
from the Minnesota family investment program shall also be disqualified from the food
stamp or food support program. The needs of that individual shall not be taken into
consideration in determining the grant level for that assistance unit:
(1) for one year after the first offense;
(2) for two years after the second offense; and
(3) permanently after the third or subsequent offense.
The period of program disqualification shall begin on the date stipulated on the advance
notice of disqualification without possibility of postponement for administrative stay or
administrative hearing and shall continue through completion unless and until the findings
upon which the sanctions were imposed are reversed by a court of competent jurisdiction.
The period for which sanctions are imposed is not subject to review. The sanctions provided
under this subdivision are in addition to, and not in substitution for, any other sanctions that
may be provided for by law for the offense involved. A disqualification established through
hearing or waiver shall result in the disqualification period beginning immediately unless
the person has become otherwise ineligible for assistance. If the person is ineligible for
assistance, the disqualification period begins when the person again meets the eligibility
criteria of the program from which they were disqualified and makes application for that
program.
(b) A family receiving assistance through child care assistance programs under chapter
119B with a family member who is found to be guilty of wrongfully obtaining child care
assistance by a federal court, state court, or an administrative hearing determination or
waiver, through a disqualification consent agreement, as part of an approved diversion plan
under section 401.065, or a court-ordered stay with probationary or other conditions, is
disqualified from child care assistance programs. The disqualifications must be for periods
of one year and two years for the first and second offenses, respectively. Subsequent
violations must result in permanent disqualification. During the disqualification period,
disqualification from any child care program must extend to all child care programs and
must be immediately applied.
(c) A provider caring for children receiving assistance through child care assistance
programs under chapter 119B is disqualified from receiving payment for child care services
from the child care assistance program under chapter 119B when the provider is found to
have wrongfully obtained child care assistance by a federal court, state court, or an
administrative hearing determination or waiver under section 256.046, through a
disqualification consent agreement, as part of an approved diversion plan under section
401.065, or a court-ordered stay with probationary or other conditions. The disqualification
must be for a period of deleted text begin one yeardeleted text end new text begin three yearsnew text end for the first offense deleted text begin and two years for the second
offensedeleted text end . Any subsequent violation must result in permanent disqualification. The
disqualification period must be imposed immediately after a determination is made under
this paragraph. During the disqualification period, the provider is disqualified from receiving
payment from any child care program under chapter 119B.
(d) Any person found to be guilty of wrongfully obtaining MinnesotaCare for adults
without children and upon federal approval, all categories of medical assistance and
remaining categories of MinnesotaCare, except for children through age 18, by a federal or
state court or by an administrative hearing determination, or waiver thereof, through a
disqualification consent agreement, or as part of any approved diversion plan under section
401.065, or any court-ordered stay which carries with it any probationary or other conditions,
is disqualified from that program. The period of disqualification is one year after the first
offense, two years after the second offense, and permanently after the third or subsequent
offense. The period of program disqualification shall begin on the date stipulated on the
advance notice of disqualification without possibility of postponement for administrative
stay or administrative hearing and shall continue through completion unless and until the
findings upon which the sanctions were imposed are reversed by a court of competent
jurisdiction. The period for which sanctions are imposed is not subject to review. The
sanctions provided under this subdivision are in addition to, and not in substitution for, any
other sanctions that may be provided for by law for the offense involved.
Sec. 111.
Minnesota Statutes 2018, section 256B.02, subdivision 7, is amended to read:
Subd. 7.
Vendor of medical care.
(a) "Vendor of medical care" means any person or
persons furnishing, within the scope of the vendor's respective license, any or all of the
following goods or services: medical, surgical, hospital, ambulatory surgical center services,
optical, visual, dental and nursing services; drugs and medical supplies; appliances;
laboratory, diagnostic, and therapeutic services; nursing home and convalescent care;
screening and health assessment services provided by public health nurses as defined in
section 145A.02, subdivision 18; health care services provided at the residence of the patient
if the services are performed by a public health nurse and the nurse indicates in a statement
submitted under oath that the services were actually provided; and such other deleted text begin medicaldeleted text end
services or supplies provided or prescribed by persons authorized by state law to give such
services and supplies. The term includes, but is not limited to, directors and officers of
corporations or members of partnerships who, either individually or jointly with another or
others, have the legal control, supervision, or responsibility of submitting claims for
reimbursement to the medical assistance program. The term only includes directors and
officers of corporations who personally receive a portion of the distributed assets upon
liquidation or dissolution, and their liability is limited to the portion of the claim that bears
the same proportion to the total claim as their share of the distributed assets bears to the
total distributed assets.
(b) "Vendor of medical care" also includes any person who is credentialed as a health
professional under standards set by the governing body of a federally recognized Indian
tribe authorized under an agreement with the federal government according to United States
Code, title 25, section 450f, to provide health services to its members, and who through a
tribal facility provides covered services to American Indian people within a contract health
service delivery area of a Minnesota reservation, as defined under Code of Federal
Regulations, title 42, section 36.22.
(c) A federally recognized Indian tribe that intends to implement standards for
credentialing health professionals must submit the standards to the commissioner of human
services, along with evidence of meeting, exceeding, or being exempt from corresponding
state standards. The commissioner shall maintain a copy of the standards and supporting
evidence, and shall use those standards to enroll tribal-approved health professionals as
medical assistance providers. For purposes of this section, "Indian" and "Indian tribe" mean
persons or entities that meet the definition in United States Code, title 25, section 450b.
Sec. 112.
Minnesota Statutes 2018, section 256B.064, subdivision 1a, is amended to read:
Subd. 1a.
Grounds for sanctions against vendors.
The commissioner may impose
sanctions against a vendor of medical care for any of the following: (1) fraud, theft, or abuse
in connection with the provision of medical care to recipients of public assistance; (2) a
pattern of presentment of false or duplicate claims or claims for services not medically
necessary; (3) a pattern of making false statements of material facts for the purpose of
obtaining greater compensation than that to which the vendor is legally entitled; (4)
suspension or termination as a Medicare vendor; (5) refusal to grant the state agency access
during regular business hours to examine all records necessary to disclose the extent of
services provided to program recipients and appropriateness of claims for payment; (6)
failure to repay an overpayment or a fine finally established under this section; (7) failure
to correct errors in the maintenance of health service or financial records for which a fine
was imposed or after issuance of a warning by the commissioner; deleted text begin anddeleted text end (8) any reason for
which a vendor could be excluded from participation in the Medicare program under section
1128, 1128A, or 1866(b)(2) of the Social Security Actdeleted text begin .deleted text end new text begin ; and (9) there is a preponderance of
the evidence that the vendor committed an act or acts that meet the definition of offenses
listed in section 609.817.
new text end
Sec. 113.
Minnesota Statutes 2018, section 256B.064, subdivision 1b, is amended to read:
Subd. 1b.
Sanctions available.
The commissioner may impose the following sanctions
for the conduct described in subdivision 1a: suspension or withholding of payments to a
vendor and suspending or terminating participation in the program, or imposition of a fine
under subdivision 2, paragraph (f). When imposing sanctions under this section, the
commissioner shall consider the nature, chronicity, or severity of the conduct and the effect
of the conduct on the health and safety of persons served by the vendor. new text begin The commissioner
shall suspend a vendor's participation in the program for a minimum of five years if, for an
offense related to a provision of a health service under medical assistance or health care
fraud, the vendor is convicted of a crime, received a stay of adjudication, or entered a
court-ordered diversion program. new text end Regardless of imposition of sanctions, the commissioner
may make a referral to the appropriate state licensing board.
Sec. 114.
Minnesota Statutes 2018, section 256B.064, subdivision 2, is amended to read:
Subd. 2.
Imposition of monetary recovery and sanctions.
(a) The commissioner shall
determine any monetary amounts to be recovered and sanctions to be imposed upon a vendor
of medical care under this section. Except as provided in paragraphs (b) and (d), neither a
monetary recovery nor a sanction will be imposed by the commissioner without prior notice
and an opportunity for a hearing, according to chapter 14, on the commissioner's proposed
action, provided that the commissioner may suspend or reduce payment to a vendor of
medical care, except a nursing home or convalescent care facility, after notice and prior to
the hearing if in the commissioner's opinion that action is necessary to protect the public
welfare and the interests of the program.
(b) Except when the commissioner finds good cause not to suspend payments under
Code of Federal Regulations, title 42, section 455.23 (e) or (f), the commissioner shall
withhold or reduce payments to a vendor of medical care without providing advance notice
of such withholding or reduction if either of the following occurs:
(1) the vendor is convicted of a crime involving the conduct described in subdivision
1a; or
(2) the commissioner determines there is a credible allegation of fraud for which an
investigation is pending under the program. A credible allegation of fraud is an allegation
which has been verified by the state, from any source, including but not limited to:
(i) fraud hotline complaints;
(ii) claims data mining; and
(iii) patterns identified through provider audits, civil false claims cases, and law
enforcement investigations.
Allegations are considered to be credible when they have an indicia of reliability and
the state agency has reviewed all allegations, facts, and evidence carefully and acts
judiciously on a case-by-case basis.
(c) The commissioner must send notice of the withholding or reduction of payments
under paragraph (b) within five days of taking such action unless requested in writing by a
law enforcement agency to temporarily withhold the notice. The notice must:
(1) state that payments are being withheld according to paragraph (b);
(2) set forth the general allegations as to the nature of the withholding action, but need
not disclose any specific information concerning an ongoing investigation;
(3) except in the case of a conviction for conduct described in subdivision 1a, state that
the withholding is for a temporary period and cite the circumstances under which withholding
will be terminated;
(4) identify the types of claims to which the withholding applies; and
(5) inform the vendor of the right to submit written evidence for consideration by the
commissioner.
The withholding or reduction of payments will not continue after the commissioner
determines there is insufficient evidence of fraud by the vendor, or after legal proceedings
relating to the alleged fraud are completed, unless the commissioner has sent notice of
intention to impose monetary recovery or sanctions under paragraph (a).new text begin Upon conviction
for a crime related to the provision, management, or administration of a health service under
medical assistance, a payment held pursuant to this section by the commissioner or a managed
care organization that contracts with the commissioner under section 256B.035 is forfeited
by the commissioner or managed care organization, regardless of the amount charged in
the criminal complaint or the amount of criminal restitution ordered.
new text end
(d) The commissioner shall suspend or terminate a vendor's participation in the program
without providing advance notice and an opportunity for a hearing when the suspension or
termination is required because of the vendor's exclusion from participation in Medicare.
Within five days of taking such action, the commissioner must send notice of the suspension
or termination. The notice must:
(1) state that suspension or termination is the result of the vendor's exclusion from
Medicare;
(2) identify the effective date of the suspension or termination; and
(3) inform the vendor of the need to be reinstated to Medicare before reapplying for
participation in the program.
(e) Upon receipt of a notice under paragraph (a) that a monetary recovery or sanction is
to be imposed, a vendor may request a contested case, as defined in section 14.02, subdivision
3, by filing with the commissioner a written request of appeal. The appeal request must be
received by the commissioner no later than 30 days after the date the notification of monetary
recovery or sanction was mailed to the vendor. The appeal request must specify:
(1) each disputed item, the reason for the dispute, and an estimate of the dollar amount
involved for each disputed item;
(2) the computation that the vendor believes is correct;
(3) the authority in statute or rule upon which the vendor relies for each disputed item;
(4) the name and address of the person or entity with whom contacts may be made
regarding the appeal; and
(5) other information required by the commissioner.
(f) The commissioner may order a vendor to forfeit a fine for failure to fully document
services according to standards in this chapter and Minnesota Rules, chapter 9505. The
commissioner may assess fines if specific required components of documentation are
missing. The fine for incomplete documentation shall equal 20 percent of the amount paid
on the claims for reimbursement submitted by the vendor, or up to $5,000, whichever is
less.new text begin If the commissioner determines that a vendor repeatedly violated this chapter or
Minnesota Rules, chapter 9505, related to the provision of services to program recipients
and the submission of claims for payment, the commissioner may order a vendor to forfeit
a fine based on the nature, severity, and chronicity of the violations in an amount of up to
$5,000 or 20 percent of the value of the claims, whichever is greater.
new text end
(g) The vendor shall pay the fine assessed on or before the payment date specified. If
the vendor fails to pay the fine, the commissioner may withhold or reduce payments and
recover the amount of the fine. A timely appeal shall stay payment of the fine until the
commissioner issues a final order.
Sec. 115.
Minnesota Statutes 2018, section 256B.064, is amended by adding a subdivision
to read:
new text begin Subd. 3. new text end
new text begin Vendor mandates on prohibited payments. new text end
new text begin
(a) The commissioner shall
maintain and publish a list of each excluded individual and entity that was convicted of a
crime related to the provision, management, or administration of a medical assistance health
service, or suspended or terminated under subdivision 2. Medical assistance payments cannot
be made by a vendor for items or services furnished either directly or indirectly by an
excluded individual or entity, or at the direction of excluded individuals or entities.
new text end
new text begin
(b) The vendor must check the exclusion list on a monthly basis and document the date
and time the exclusion list was checked and the name and title of the person who checked
the exclusion list. The vendor must immediately terminate payments to an individual or
entity on the exclusion list.
new text end
new text begin
(c) A vendor's requirement to check the exclusion list and to terminate payments to
individuals or entities on the exclusion list applies to each individual or entity on the
exclusion list, even if the named individual or entity is not responsible for direct patient
care or direct submission of a claim to medical assistance.
new text end
new text begin
(d) A vendor that pays medical assistance program funds to an individual or entity on
the exclusion list must refund any payment related to either items or services rendered by
an individual or entity on the exclusion list from the date the individual or entity is first paid
or the date the individual or entity is placed on the exclusion list, whichever is later, and a
vendor may be subject to:
new text end
new text begin
(1) sanctions under subdivision 2;
new text end
new text begin
(2) a civil monetary penalty of up to $25,000 for each determination by the department
that the vendor employed or contracted with an individual or entity on the exclusion list;
and
new text end
new text begin
(3) other fines or penalties allowed by law.
new text end
Sec. 116.
Minnesota Statutes 2018, section 256B.064, is amended by adding a subdivision
to read:
new text begin Subd. 4. new text end
new text begin Notice. new text end
new text begin
(a) The notice required under subdivision 2 shall be served by first class
mail at the address submitted to the department by the vendor. Service is complete upon
mailing. The commissioner shall place an affidavit of the first class mailing in the vendor's
file as an indication of the address and the date of mailing.
new text end
new text begin
(b) The department shall give notice in writing to a recipient placed in the Minnesota
restricted recipient program under section 256B.0646 and Minnesota Rules, part 9505.2200.
The notice shall be sent by first class mail to the recipient's current address on file with the
department. A recipient placed in the Minnesota restricted recipient program may contest
the placement by submitting a written request for a hearing to the department within 90
days of the notice being mailed.
new text end
Sec. 117.
Minnesota Statutes 2018, section 256B.064, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin Immunity; good faith reporters. new text end
new text begin
(a) A person who makes a good faith report
is immune from any civil or criminal liability that might otherwise arise from reporting or
participating in the investigation. Nothing in this subdivision affects a vendor's responsibility
for an overpayment established under this subdivision.
new text end
new text begin
(b) A person employed by a lead investigative agency who is conducting or supervising
an investigation or enforcing the law according to the applicable law or rule is immune from
any civil or criminal liability that might otherwise arise from the person's actions, if the
person is acting in good faith and exercising due care.
new text end
new text begin
(c) For purposes of this subdivision, "person" includes a natural person or any form of
a business or legal entity.
new text end
new text begin
(d) After an investigation is complete, the reporter's name must be kept confidential.
The subject of the report may compel disclosure of the reporter's name only with the consent
of the reporter or upon a written finding by a district court that the report was false and there
is evidence that the report was made in bad faith. This subdivision does not alter disclosure
responsibilities or obligations under the Rules of Criminal Procedure, except that when the
identity of the reporter is relevant to a criminal prosecution the district court shall conduct
an in-camera review before determining whether to order disclosure of the reporter's identity.
new text end
Sec. 118.
new text begin
[256B.0646] MINNESOTA RESTRICTED RECIPIENT PROGRAM;
PERSONAL CARE ASSISTANCE SERVICES.
new text end
new text begin
(a) When a recipient's use of personal care assistance services or community first services
and supports under section 256B.85 results in abusive or fraudulent billing, the commissioner
may place a recipient in the Minnesota restricted recipient program under Minnesota Rules,
part 9505.2165. A recipient placed in the Minnesota restricted recipient program under this
section must: (1) use a designated traditional personal care assistance provider agency; and
(2) obtain a new assessment under section 256B.0911, including consultation with a registered
or public health nurse on the long-term care consultation team pursuant to section 256B.0911,
subdivision 3, paragraph (b), clause (2).
new text end
new text begin
(b) A recipient must comply with additional conditions for the use of personal care
assistance services or community first services and supports if the commissioner determines
it is necessary to prevent future misuse of personal care assistance services or abusive or
fraudulent billing. Additional conditions may include but are not limited to restricting service
authorizations for a duration of no more than one month and requiring a qualified professional
to monitor and report services on a monthly basis.
new text end
new text begin
(c) A recipient placed in the Minnesota restricted recipient program under this section
may appeal the placement according to section 256.045.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 119.
Minnesota Statutes 2018, section 256B.0651, subdivision 17, is amended to
read:
Subd. 17.
Recipient protection.
(a) Providers of home care services must provide each
recipient with a copy of the home care bill of rights under section 144A.44 at least 30 days
prior to terminating services to a recipient, if the termination results from provider sanctions
under section 256B.064, such as a payment withhold, a suspension of participation, or a
termination of participation. If a home care provider determines it is unable to continue
providing services to a recipient, the provider must notify the recipient, the recipient's
responsible party, and the commissioner 30 days prior to terminating services to the recipient
because of an action under section 256B.064, and must assist the commissioner and lead
agency in supporting the recipient in transitioning to another home care provider of the
recipient's choice.
(b) In the event of a payment withhold from a home care provider, a suspension of
participation, or a termination of participation of a home care provider under section
256B.064, the commissioner may inform the Office of Ombudsman for Long-Term Care
and the lead agencies for all recipients with active service agreements with the provider. At
the commissioner's request, the lead agencies must contact recipients to ensure that the
recipients are continuing to receive needed care, and that the recipients have been given
free choice of provider if they transfer to another home care provider. In addition, the
commissioner or the commissioner's delegate may directly notify recipients who receive
care from the provider that payments have been new text begin or will be new text end withheld or that the provider's
participation in medical assistance has been new text begin or will be new text end suspended or terminated, if the
commissioner determines that notification is necessary to protect the welfare of the recipients.
For purposes of this subdivision, "lead agencies" means counties, tribes, and managed care
organizations.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 120.
Minnesota Statutes 2018, section 256B.0659, subdivision 12, is amended to
read:
Subd. 12.
Documentation of personal care assistance services provided.
(a) Personal
care assistance services for a recipient must be documented daily by each personal care
assistant, on a time sheet form approved by the commissioner. All documentation may be
web-based, electronic, or paper documentation. The completed form must be submitted on
a monthly basis to the provider and kept in the recipient's health record.
(b) The activity documentation must correspond to the personal care assistance care plan
and be reviewed by the qualified professional.
(c) The personal care assistant time sheet must be on a form approved by the
commissioner documenting time the personal care assistant provides services in the home.
The following criteria must be included in the time sheet:
(1) full name of personal care assistant and individual provider number;
(2) provider name and telephone numbers;
(3) full name of recipientnew text begin and either the recipient's medical assistance identification
number or date of birthnew text end ;
(4) consecutive dates, including month, day, and year, and arrival and departure times
with a.m. or p.m. notations;
(5) signatures of recipient or the responsible party;
(6) personal signature of the personal care assistant;
(7) any shared care provided, if applicable;
(8) a statement that it is a federal crime to provide false information on personal care
service billings for medical assistance payments; and
(9) dates and location of recipient stays in a hospital, care facility, or incarceration.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 121.
Minnesota Statutes 2018, section 256B.27, subdivision 3, is amended to read:
Subd. 3.
Access to medical records.
The commissioner of human services, with the
written consent of the recipient, on file with the local welfare agency, shall be allowed
access to all personal medical records of medical assistance recipients solely for the purposes
of investigating whether or not: (a) a vendor of medical care has submitted a claim for
reimbursement, a cost report or a rate application which is duplicative, erroneous, or false
in whole or in part, or which results in the vendor obtaining greater compensation than the
vendor is legally entitled to; or (b) the medical care was medically necessary. deleted text begin The vendor
of medical care shall receive notification from the commissioner at least 24 hours before
the commissioner gains access to such records.deleted text end new text begin When the commissioner is investigating a
possible overpayment of Medicaid funds, the commissioner must be given immediate access
without prior notice to the vendor's office during regular business hours and to documentation
and records related to services provided and submission of claims for services provided.
Denying the commissioner access to records is cause for the vendor's immediate suspension
of payment or termination according to section 256B.064.new text end The determination of provision
of services not medically necessary shall be made by the commissioner. Notwithstanding
any other law to the contrary, a vendor of medical care shall not be subject to any civil or
criminal liability for providing access to medical records to the commissioner of human
services pursuant to this section.
Sec. 122.
Minnesota Statutes 2018, section 256B.4912, is amended by adding a subdivision
to read:
new text begin Subd. 11. new text end
new text begin Home and community-based service billing requirements. new text end
new text begin
(a) A home and
community-based service is eligible for reimbursement if:
new text end
new text begin
(1) the service is provided according to a federally approved waiver plan as authorized
under sections 256B.0913, 256B.0915, 256B.092, and 256B.49;
new text end
new text begin
(2) if applicable, the service is provided on days and times during the days and hours of
operation specified on any license required under chapter 245A or 245D; and
new text end
new text begin
(3) the provider complies with subdivisions 12 to 15, if applicable.
new text end
new text begin
(b) The provider must maintain documentation that, upon employment and annually
thereafter, staff providing a service have attested to reviewing and understanding the
following statement: "It is a federal crime to provide materially false information on service
billings for medical assistance or services provided under a federally approved waiver plan
as authorized under Minnesota Statutes, sections 256B.0913, 256B.0915, 256B.092, and
256B.49."
new text end
new text begin
(c) The department may recover payment according to section 256B.064 and Minnesota
Rules, parts 9505.2160 to 9505.2245, for a service that does not satisfy this subdivision.
new text end
Sec. 123.
Minnesota Statutes 2018, section 256B.4912, is amended by adding a subdivision
to read:
new text begin Subd. 12. new text end
new text begin Home and community-based service documentation requirements. new text end
new text begin
(a)
Documentation may be collected and maintained electronically or in paper form by providers
and must be produced upon request by the commissioner.
new text end
new text begin
(b) Documentation of a delivered service must be in English and must be legible according
to the standard of a reasonable person.
new text end
new text begin
(c) If the service is reimbursed at an hourly or specified minute-based rate, each
documentation of the provision of a service, unless otherwise specified, must include:
new text end
new text begin
(1) the date the documentation occurred;
new text end
new text begin
(2) the day, month, and year when the service was provided;
new text end
new text begin
(3) the start and stop times with a.m. and p.m. designations, except for case management
services as defined under sections 256B.0913, subdivision 7; 256B.0915, subdivision 1a;
256B.092, subdivision 1a; and 256B.49, subdivision 13;
new text end
new text begin
(4) the service name or description of the service provided; and
new text end
new text begin
(5) the name, signature, and title, if any, of the provider of service. If the service is
provided by multiple staff members, the provider may designate a staff member responsible
for verifying services and completing the documentation required by this paragraph.
new text end
new text begin
(d) If the service is reimbursed at a daily rate or does not meet the requirements in
paragraph (c), each documentation of the provision of a service, unless otherwise specified,
must include:
new text end
new text begin
(1) the date the documentation occurred;
new text end
new text begin
(2) the day, month, and year when the service was provided;
new text end
new text begin
(3) the service name or description of the service provided; and
new text end
new text begin
(4) the name, signature, and title, if any, of the person providing the service. If the service
is provided by multiple staff, the provider may designate a staff member responsible for
verifying services and completing the documentation required by this paragraph.
new text end
Sec. 124.
Minnesota Statutes 2018, section 256B.4912, is amended by adding a subdivision
to read:
new text begin Subd. 13. new text end
new text begin Waiver transportation documentation and billing requirements. new text end
new text begin
(a) A
waiver transportation service must be a waiver transportation service that: (1) is not covered
by medical transportation under the Medicaid state plan; and (2) is not included as a
component of another waiver service.
new text end
new text begin
(b) In addition to the documentation requirements in subdivision 12, a waiver
transportation service provider must maintain:
new text end
new text begin
(1) odometer and other records pursuant to section 256B.0625, subdivision 17b, paragraph
(b), clause (3), sufficient to distinguish an individual trip with a specific vehicle and driver
for a waiver transportation service that is billed directly by the mile. A common carrier as
defined by Minnesota Rules, part 9505.0315, subpart 1, item B, or a publicly operated transit
system provider are exempt from this clause; and
new text end
new text begin
(2) documentation demonstrating that a vehicle and a driver meet the standards determined
by the Department of Human Services on vehicle and driver qualifications in section
256B.0625, subdivision 17, paragraph (c).
new text end
Sec. 125.
Minnesota Statutes 2018, section 256B.4912, is amended by adding a subdivision
to read:
new text begin Subd. 14. new text end
new text begin Equipment and supply documentation requirements. new text end
new text begin
(a) In addition to the
requirements in subdivision 12, an equipment and supply services provider must for each
documentation of the provision of a service include:
new text end
new text begin
(1) the recipient's assessed need for the equipment or supply;
new text end
new text begin
(2) the reason the equipment or supply is not covered by the Medicaid state plan;
new text end
new text begin
(3) the type and brand name of the equipment or supply delivered to or purchased by
the recipient, including whether the equipment or supply was rented or purchased;
new text end
new text begin
(4) the quantity of the equipment or supply delivered or purchased; and
new text end
new text begin
(5) the cost of the equipment or supply if the amount paid for the service depends on
the cost.
new text end
new text begin
(b) A provider must maintain a copy of the shipping invoice or a delivery service tracking
log or other documentation showing the date of delivery that proves the equipment or supply
was delivered to the recipient or a receipt if the equipment or supply was purchased by the
recipient.
new text end
Sec. 126.
Minnesota Statutes 2018, section 256B.4912, is amended by adding a subdivision
to read:
new text begin Subd. 15. new text end
new text begin Adult day service documentation and billing requirements. new text end
new text begin
(a) In addition
to the requirements in subdivision 12, a provider of adult day services as defined in section
245A.02, subdivision 2a, and licensed under Minnesota Rules, parts 9555.9600 to 9555.9730,
must maintain documentation of:
new text end
new text begin
(1) a needs assessment and current plan of care according to section 245A.143,
subdivisions 4 to 7, or Minnesota Rules, part 9555.9700, for each recipient, if applicable;
new text end
new text begin
(2) attendance records as specified under section 245A.14, subdivision 14, paragraph
(c), including the date of attendance with the day, month, and year; and the pickup and
drop-off time in hours and minutes with a.m. and p.m. designations;
new text end
new text begin
(3) the monthly and quarterly program requirements in Minnesota Rules, part 9555.9710,
subparts 1, items E and H; 3; 4; and 6, if applicable;
new text end
new text begin
(4) the name and qualification of each registered physical therapist, registered nurse,
and registered dietitian who provides services to the adult day services or nonresidential
program; and
new text end
new text begin
(5) the location where the service was provided. If the location is an alternate location
from the usual place of service, the documentation must include the address, or a description
if the address is not available, of both the origin site and destination site; the length of time
at the alternate location with a.m. and p.m. designations; and a list of participants who went
to the alternate location.
new text end
new text begin
(b) A provider must not exceed the provider's licensed capacity. If a provider exceeds
the provider's licensed capacity, the department must recover all Minnesota health care
programs payments from the date the provider exceeded licensed capacity.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2019.
new text end
Sec. 127.
new text begin
[609.817] CRIMINAL PENALTIES FOR ACTS INVOLVING HUMAN
SERVICES PROGRAMS.
new text end
new text begin Subdivision 1. new text end
new text begin Prohibited payments made relating to human services programs. new text end
new text begin
A
person is in violation of this section if the person knowingly and willfully offers or pays
any remuneration, including any kickback, bribe, or rebate, directly or indirectly, overtly
or covertly, in cash or in kind, to another person:
new text end
new text begin
(1) to induce that person to apply for, receive, or induce another person to apply for or
receive an item or service for which payment may be made in whole or in part by a local
social services agency as defined in chapter 393 or by the Department of Human Services,
or administered by the commissioner of human services; or
new text end
new text begin
(2) in return for purchasing, leasing, ordering, or arranging for or inducing the purchasing,
leasing, or ordering of any good, facility, service, or item for which payment may be made
in whole or in part, or which is administered in whole or in part by a local social services
agency as defined in chapter 393, the Department of Human Services, or the United States
Department of Health and Human Services.
new text end
new text begin Subd. 2. new text end
new text begin Receipt of prohibited payments relating to human services programs. new text end
new text begin
A
person is in violation of this section if the person knowingly and willfully solicits or receives
any remuneration, including any kickback, bribe, or rebate, directly or indirectly, overtly
or covertly, in cash or in kind:
new text end
new text begin
(1) in return for applying for or receiving a human services benefit, service, or grant for
which payment may be made in whole or in part by a local services agency as defined in
chapter 393 or the Department of Human Services, or is administered by the commissioner
of human services; or
new text end
new text begin
(2) in return for purchasing, leasing, ordering, or arranging for or inducing the purchasing,
leasing, or ordering of any good, facility, service, or item for which payment may be made
in whole or in part, or which is administered in whole or in part, by the Department of
Human Services, a local social services agency as defined in chapter 393, or the United
States Department of Health and Human Services.
new text end
new text begin Subd. 3. new text end
new text begin Payments exempt. new text end
new text begin
This section does not apply to remuneration exempted from
the Anti-Kickback Statute under United States Code, title 42, section 1320a-7b(b)(3), or
remuneration excepted from liability by Code of Federal Regulations, title 42, section
1001.952.
new text end
new text begin Subd. 4. new text end
new text begin Penalties. new text end
new text begin
(a) A person who violates subdivision 1 or 2 may be sentenced
according to section 609.52, subdivision 3.
new text end
new text begin
(1) For a violation of subdivision 1, for the purposes of sentencing under section 609.52,
subdivision 3, the calculated value is equal to the value of the good, facility, service, or item
that was obtained as a direct or indirect result of the prohibited payment.
new text end
new text begin
(2) For a violation of subdivision 2, for the purposes of sentencing under section 609.52,
subdivision 3, the calculated value is equal to the value of the prohibited payment solicited
or received in violation of subdivision 2.
new text end
new text begin
(b) A claim for any good, facility, service, or item rendered or claimed to have been
rendered in violation of this section is noncompensable and unenforceable at the time the
claim is made.
new text end
new text begin Subd. 5. new text end
new text begin Aggregation. new text end
new text begin
In any prosecution under this section, the value of the money or
property or services received by the defendant within any six-month period may be
aggregated and the defendant charged accordingly in applying the provisions of subdivision
6.
new text end
new text begin Subd. 6. new text end
new text begin Venue. new text end
new text begin
Notwithstanding section 627.01, an offense committed under this section
may be prosecuted in the county where any part of the offense occurred, provided that when
two or more offenses are committed by the same person in two or more counties, the accused
may be prosecuted in any county in which one of the offenses was committed for all of the
offenses aggregated under this subdivision.
new text end
new text begin Subd. 7. new text end
new text begin False claims. new text end
new text begin
In addition to the penalties provided for in this section, a claim
that includes items or services resulting from a violation of this section constitutes a false
or fraudulent claim for purposes of section 15C.02.
new text end
new text begin Subd. 8. new text end
new text begin Actual knowledge or specific intent not required. new text end
new text begin
With respect to a violation
of this section, a person need not have actual knowledge of this section or specific intent to
commit a violation of this section.
new text end
Sec. 128.
Minnesota Statutes 2018, section 628.26, is amended to read:
628.26 LIMITATIONS.
(a) Indictments or complaints for any crime resulting in the death of the victim may be
found or made at any time after the death of the person killed.
(b) Indictments or complaints for a violation of section 609.25 may be found or made
at any time after the commission of the offense.
(c) Indictments or complaints for violation of section 609.282 may be found or made at
any time after the commission of the offense if the victim was under the age of 18 at the
time of the offense.
(d) Indictments or complaints for violation of section 609.282 where the victim was 18
years of age or older at the time of the offense, or 609.42, subdivision 1, clause (1) or (2),
shall be found or made and filed in the proper court within six years after the commission
of the offense.
(e) Indictments or complaints for violation of sections 609.322 and 609.342 to 609.345,
if the victim was under the age of 18 years at the time the offense was committed, shall be
found or made and filed in the proper court within the later of nine years after the commission
of the offense or three years after the offense was reported to law enforcement authorities.
(f) Notwithstanding the limitations in paragraph (e), indictments or complaints for
violation of sections 609.322 and 609.342 to 609.344 may be found or made and filed in
the proper court at any time after commission of the offense, if physical evidence is collected
and preserved that is capable of being tested for its DNA characteristics. If this evidence is
not collected and preserved and the victim was 18 years old or older at the time of the
offense, the prosecution must be commenced within nine years after the commission of the
offense.
(g) Indictments or complaints for violation of sections 609.466 and 609.52, subdivision
2, new text begin paragraph (a), new text end clause (3), item (iii), new text begin and 609.817, new text end shall be found or made and filed in the
proper court within six years after the commission of the offense.
(h) Indictments or complaints for violation of section 609.2335, 609.52, subdivision 2,
clause (3), items (i) and (ii), (4), (15), or (16), 609.631, or 609.821, where the value of the
property or services stolen is more than $35,000, or for violation of section 609.527 where
the offense involves eight or more direct victims or the total combined loss to the direct and
indirect victims is more than $35,000, shall be found or made and filed in the proper court
within five years after the commission of the offense.
(i) Except for violations relating to false material statements, representations or omissions,
indictments or complaints for violations of section 609.671 shall be found or made and filed
in the proper court within five years after the commission of the offense.
(j) Indictments or complaints for violation of sections 609.561 to 609.563, shall be found
or made and filed in the proper court within five years after the commission of the offense.
(k) In all other cases, indictments or complaints shall be found or made and filed in the
proper court within three years after the commission of the offense.
(l) The limitations periods contained in this section shall exclude any period of time
during which the defendant was not an inhabitant of or usually resident within this state.
(m) The limitations periods contained in this section for an offense shall not include any
period during which the alleged offender participated under a written agreement in a pretrial
diversion program relating to that offense.
(n) The limitations periods contained in this section shall not include any period of time
during which physical evidence relating to the offense was undergoing DNA analysis, as
defined in section 299C.155, unless the defendant demonstrates that the prosecuting or law
enforcement agency purposefully delayed the DNA analysis process in order to gain an
unfair advantage.
Sec. 129. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Rules, parts 9502.0425, subparts 4, 16, and 17; and 9503.0155, subpart
8,
new text end
new text begin
are repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2018, section 245H.10, subdivision 2,
new text end
new text begin
is repealed.
new text end
new text begin
(c)
new text end
new text begin
Minnesota Statutes 2018, section 119B.125, subdivision 8,
new text end
new text begin
is repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2019.
new text end
ARTICLE 3
DIRECT CARE AND TREATMENT
Section 1.
Minnesota Statutes 2018, section 246.54, is amended by adding a subdivision
to read:
new text begin Subd. 3. new text end
new text begin Administrative review of county liability for cost of care. new text end
new text begin
(a) The county of
financial responsibility may submit a written request for administrative review by the
commissioner of the county's payment of the cost of care when a delay in discharge of a
client from a regional treatment center, state-operated community-based behavioral health
hospital, or other state-operated facility results from the following actions by the facility:
new text end
new text begin
(1) the facility did not provide notice to the county that the facility has determined that
it is clinically appropriate for a client to be discharged;
new text end
new text begin
(2) the notice to the county that the facility has determined that it is clinically appropriate
for a client to be discharged was communicated on a holiday or weekend;
new text end
new text begin
(3) the required documentation or procedures for discharge were not completed in order
for the discharge to occur in a timely manner; or
new text end
new text begin
(4) the facility disagrees with the county's discharge plan.
new text end
new text begin
(b) The county of financial responsibility may not appeal the determination that it is
clinically appropriate for a client to be discharged from a regional treatment center,
state-operated community-based behavioral health hospital, or other state-operated facility.
new text end
new text begin
(c) The commissioner must evaluate the request for administrative review and determine
if the facility's actions listed in paragraph (a) caused undue delay in discharging the client.
If the commissioner determines that the facility's actions listed in paragraph (a) caused
undue delay in discharging the client, the county's liability must be reduced to the level of
the cost of care for a client whose stay in a facility is determined to be clinically appropriate,
effective on the date of the facility's action or failure to act that caused the delay. The
commissioner's determination under this subdivision is final and not subject to appeal.
new text end
new text begin
(d) If a county's liability is reduced pursuant to paragraph (c), a county's liability must
return to the level of the cost of care for a client whose stay in a facility is determined to no
longer be appropriate effective on the date the facility rectifies the action or failure to act
that caused the delay under paragraph (a).
new text end
new text begin
(e) Any difference in the county cost of care liability resulting from administrative review
under this subdivision must not be billed to the client or applied to future reimbursement
from the client's estate or relatives.
new text end
Sec. 2.
Minnesota Statutes 2018, section 246B.10, is amended to read:
246B.10 LIABILITY OF COUNTY; REIMBURSEMENT.
new text begin (a) new text end The civilly committed sex offender's county shall pay to the state a portion of the
cost of care provided in the Minnesota sex offender program to a civilly committed sex
offender who has legally settled in that county.
new text begin (b)new text end A county's payment must be made from the county's own sources of revenue and
payments mustnew text begin :
new text end
new text begin
(1) equal ten percent of the cost of care, as determined by the commissioner, for each
day or portion of a day that the civilly committed sex offender spends at the facility for
individuals admitted to the Minnesota sex offender program before August 1, 2011; or
new text end
new text begin (2)new text end equal 25 percent of the cost of care, as determined by the commissioner, for each
day or portion of a daydeleted text begin ,deleted text end that the civilly committed sex offendernew text begin :
new text end
new text begin (i) new text end spends at the facilitydeleted text begin .deleted text end new text begin for individuals admitted to the Minnesota sex offender program
on or after August 1, 2011; or
new text end
new text begin
(ii) receives services within a program operated by the Minnesota sex offender program
while on provisional discharge.
new text end
new text begin (c) The county is responsible for paying the state the remaining amountnew text end if payments
received by the state under this chapter exceednew text begin :
new text end
new text begin
(1) 90 percent of the cost of care for individuals admitted to the Minnesota sex offender
program before August 1, 2011; or
new text end
new text begin (2)new text end 75 percent of the cost of caredeleted text begin , the county is responsible for paying the state the
remaining amountdeleted text end new text begin for individuals:
new text end
new text begin
(i) admitted to the Minnesota sex offender program on or after August 1, 2011; or
new text end
new text begin (ii) receiving services within a program operated by the Minnesota sex offender program
while on provisional dischargenew text end .
new text begin (d)new text end The county is not entitled to reimbursement from the civilly committed sex offender,
the civilly committed sex offender's estate, or from the civilly committed sex offender's
relatives, except as provided in section 246B.07.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 3. new text begin DIRECTION TO COMMISSIONER; REPORT REQUIRED.
new text end
new text begin
No later than January 1, 2023, the commissioner of human services must submit a report
to the chairs and ranking minority members of the legislative committees with jurisdiction
over human services that provides an update on county and state efforts to reduce the number
of days clients spend in state-operated facilities after discharge from the facility has been
determined to be clinically appropriate. The report must also include information on the
fiscal impact of clinically inappropriate stays in these facilities.
new text end
Sec. 4. new text begin DIRECTION TO COMMISSIONER; DISCHARGE COORDINATION
WITH COUNTIES.
new text end
new text begin
The commissioner of human services shall consult with and seek feedback from counties
across the state to develop alternative approaches for the housing of individuals provisionally
discharged and discharged from direct care and treatment programs according to the
provisions of Minnesota Statutes, chapter 253D, to incentivize local development of
placements and supports. The approaches must consider the management of implementation
costs and oversight of these individuals, and potential future financial incentives for host
counties or counties within a court district for accepting and hosting discharged individuals
who the county originally committed to the program.
new text end
Sec. 5. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2018, section 246.18, subdivisions 8 and 9,
new text end
new text begin
are repealed.
new text end
new text begin
(b)
new text end
new text begin
Laws 2010, First Special Session chapter 1, article 25, section 3, subdivision 10,
new text end
new text begin
is
repealed.
new text end
ARTICLE 4
CONTINUING CARE FOR OLDER ADULTS
Section 1.
Minnesota Statutes 2018, section 144.0724, subdivision 4, is amended to read:
Subd. 4.
Resident assessment schedule.
(a) A facility must conduct and electronically
submit to the commissioner of health MDS assessments that conform with the assessment
schedule defined by Code of Federal Regulations, title 42, section 483.20, and published
by the United States Department of Health and Human Services, Centers for Medicare and
Medicaid Services, in the Long Term Care Assessment Instrument User's Manual, version
3.0, and subsequent updates when issued by the Centers for Medicare and Medicaid Services.
The commissioner of health may substitute successor manuals or question and answer
documents published by the United States Department of Health and Human Services,
Centers for Medicare and Medicaid Services, to replace or supplement the current version
of the manual or document.
(b) The assessments used to determine a case mix classification for reimbursement
include the following:
(1) a new admission assessment;
(2) an annual assessment which must have an assessment reference date (ARD) within
92 days of the previous assessment and the previous comprehensive assessment;
(3) a significant change in status assessment must be completed within 14 days of the
identification of a significant change, whether improvement or decline, and regardless of
the amount of time since the last significant change in status assessmentdeleted text begin ;deleted text end new text begin . Effective for
rehabilitation therapy completed on or after January 1, 2020, a facility must complete a
significant change in status assessment if for any reason all speech, occupational, and
physical therapies have ended. The ARD of the significant change in status assessment must
be the eighth day after all speech, occupational, and physical therapies have ended. The last
day on which rehabilitation therapy was furnished is considered day zero when determining
the ARD for the significant change in status assessment;
new text end
(4) all quarterly assessments must have an assessment reference date (ARD) within 92
days of the ARD of the previous assessment;
(5) any significant correction to a prior comprehensive assessment, if the assessment
being corrected is the current one being used for RUG classification; deleted text begin and
deleted text end
(6) any significant correction to a prior quarterly assessment, if the assessment being
corrected is the current one being used for RUG classificationdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(7) modifications to the most recent assessment in clauses (1) to (6).
new text end
(c) In addition to the assessments listed in paragraph (b), the assessments used to
determine nursing facility level of care include the following:
(1) preadmission screening completed under section 256.975, subdivisions 7a to 7c, by
the Senior LinkAge Line or other organization under contract with the Minnesota Board on
Aging; and
(2) a nursing facility level of care determination as provided for under section 256B.0911,
subdivision 4e, as part of a face-to-face long-term care consultation assessment completed
under section 256B.0911, by a county, tribe, or managed care organization under contract
with the Department of Human Services.
Sec. 2.
Minnesota Statutes 2018, section 144.0724, subdivision 5, is amended to read:
Subd. 5.
Short stays.
(a) A facility must submit to the commissioner of health an
admission assessment for all residents who stay in the facility 14 days or less.
(b) Notwithstanding the admission assessment requirements of paragraph (a), a facility
may elect to accept a short stay rate with a case mix index of 1.0 for all facility residents
who stay 14 days or less in lieu of submitting an admission assessment. Facilities shall make
this election annually.
(c) Nursing facilities must elect one of the options described in paragraphs (a) and (b)
by reporting to the commissioner of health, as prescribed by the commissioner. The election
is effective on July 1 each year.
new text begin
(d) An admission assessment is not required regardless of the facility's election status
when a resident is admitted to and discharged from the facility on the same day.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective for admissions on or after July 1, 2019.
new text end
Sec. 3.
Minnesota Statutes 2018, section 144.0724, subdivision 8, is amended to read:
Subd. 8.
Request for reconsideration of resident classifications.
(a) The resident, or
resident's representative, or the nursing facility or boarding care home may request that the
commissioner of health reconsider the assigned reimbursement classificationnew text begin including any
items changed during the audit processnew text end . The request for reconsideration must be submitted
in writing to the commissioner within 30 days of the day the resident or the resident's
representative receives the resident classification notice. The request for reconsideration
must include the name of the resident, the name and address of the facility in which the
resident resides, the reasons for the reconsideration, and documentation supporting the
request. The documentation accompanying the reconsideration request is limited to deleted text begin a copy
of the MDS that determined the classification and otherdeleted text end documents that would support or
change the MDS findings.
(b) Upon request, the nursing facility must give the resident or the resident's representative
a copy of the assessment form and the other documentation that was given to the
commissioner of health to support the assessment findings. The nursing facility shall also
provide access to and a copy of other information from the resident's record that has been
requested by or on behalf of the resident to support a resident's reconsideration request. A
copy of any requested material must be provided within three working days of receipt of a
written request for the information. Notwithstanding any law to the contrary, the facility
may not charge a fee for providing copies of the requested documentation. If a facility fails
to provide the material within this time, it is subject to the issuance of a correction order
and penalty assessment under sections 144.653 and 144A.10. Notwithstanding those sections,
any correction order issued under this subdivision must require that the nursing facility
immediately comply with the request for information and that as of the date of the issuance
of the correction order, the facility shall forfeit to the state a $100 fine for the first day of
noncompliance, and an increase in the $100 fine by $50 increments for each day the
noncompliance continues.
(c) In addition to the information required under paragraphs (a) and (b), a reconsideration
request from a nursing facility must contain the following information: (i) the date the
reimbursement classification notices were received by the facility; (ii) the date the
classification notices were distributed to the resident or the resident's representative; and
(iii) a copy of a notice sent to the resident or to the resident's representative. This notice
must inform the resident or the resident's representative that a reconsideration of the resident's
classification is being requested, the reason for the request, that the resident's rate will change
if the request is approved by the commissioner, the extent of the change, that copies of the
facility's request and supporting documentation are available for review, and that the resident
also has the right to request a reconsideration. If the facility fails to provide the required
information listed in item (iii) with the reconsideration request, the commissioner may
request that the facility provide the information within 14 calendar days. The reconsideration
request must be denied if the information is then not provided, and the facility may not
make further reconsideration requests on that specific reimbursement classification.
(d) Reconsideration by the commissioner must be made by individuals not involved in
reviewing the assessment, audit, or reconsideration that established the disputed classification.
The reconsideration must be based upon the assessment that determined the classification
and upon the information provided to the commissioner under paragraphs (a) and (b). If
necessary for evaluating the reconsideration request, the commissioner may conduct on-site
reviews. Within 15 working days of receiving the request for reconsideration, the
commissioner shall affirm or modify the original resident classification. The original
classification must be modified if the commissioner determines that the assessment resulting
in the classification did not accurately reflect characteristics of the resident at the time of
the assessment. The resident and the nursing facility or boarding care home shall be notified
within five working days after the decision is made. A decision by the commissioner under
this subdivision is the final administrative decision of the agency for the party requesting
reconsideration.
(e) The resident classification established by the commissioner shall be the classification
that applies to the resident while the request for reconsideration is pending. If a request for
reconsideration applies to an assessment used to determine nursing facility level of care
under subdivision 4, paragraph (c), the resident shall continue to be eligible for nursing
facility level of care while the request for reconsideration is pending.
(f) The commissioner may request additional documentation regarding a reconsideration
necessary to make an accurate reconsideration determination.
Sec. 4.
Minnesota Statutes 2018, section 144A.071, subdivision 1a, is amended to read:
Subd. 1a.
Definitions.
For purposes of sections 144A.071 to 144A.073, the following
terms have the meanings given them:
(a) "Attached fixtures" has the meaning given in Minnesota Rules, part 9549.0020,
subpart 6.
(b) deleted text begin "Buildings"deleted text end new text begin "Building"new text end has the meaning given in deleted text begin Minnesota Rules, part 9549.0020,
subpart 7deleted text end new text begin section 256R.261, subdivision 4new text end .
(c) "Capital assets" has the meaning given in section deleted text begin 256B.421, subdivision 16deleted text end new text begin 256R.02,
subdivision 8new text end .
(d) "Commenced construction" means that all of the following conditions were met: the
final working drawings and specifications were approved by the commissioner of health;
the construction contracts were let; a timely construction schedule was developed, stipulating
dates for beginning, achieving various stages, and completing construction; and all zoning
and building permits were applied for.
(e) "Completion date" means the date on which clearance for the construction project
is issued, or if a clearance for the construction project is not required, the date on which the
construction project assets are available for facility use.
(f) "Construction" means any erection, building, alteration, reconstruction, modernization,
or improvement necessary to comply with the nursing home licensure rules.
(g) "Construction project" means:
(1) a capital asset addition to, or replacement of a nursing home or certified boarding
care home that results in new space or the remodeling of or renovations to existing facility
space; and
(2) the remodeling or renovation of existing facility space the use of which is modified
as a result of the project described in clause (1). This existing space and the project described
in clause (1) must be used for the functions as designated on the construction plans on
completion of the project described in clause (1) for a period of not less than 24 months.
(h) "Depreciation guidelines" deleted text begin means the most recent publication of "The Estimated
Useful Lives of Depreciable Hospital Assets," issued by the American Hospital Association,
840 North Lake Shore Drive, Chicago, Illinois, 60611deleted text end new text begin has the meaning given in section
256R.261, subdivision 9new text end .
(i) "New licensed" or "new certified beds" means:
(1) newly constructed beds in a facility or the construction of a new facility that would
increase the total number of licensed nursing home beds or certified boarding care or nursing
home beds in the state; or
(2) newly licensed nursing home beds or newly certified boarding care or nursing home
beds that result from remodeling of the facility that involves relocation of beds but does not
result in an increase in the total number of beds, except when the project involves the upgrade
of boarding care beds to nursing home beds, as defined in section 144A.073, subdivision
1. "Remodeling" includes any of the type of conversion, renovation, replacement, or
upgrading projects as defined in section 144A.073, subdivision 1.
deleted text begin
(j) "Project construction costs" means the cost of the following items that have a
completion date within 12 months before or after the completion date of the project described
in item (g), clause (1):
deleted text end
deleted text begin
(1) facility capital asset additions;
deleted text end
deleted text begin
(2) replacements;
deleted text end
deleted text begin
(3) renovations;
deleted text end
deleted text begin
(4) remodeling projects;
deleted text end
deleted text begin
(5) construction site preparation costs;
deleted text end
deleted text begin
(6) related soft costs; and
deleted text end
deleted text begin
(7) the cost of new technology implemented as part of the construction project and
depreciable equipment directly identified to the project, if the construction costs for clauses
(1) to (6) exceed the threshold for additions and replacements stated in section 256B.431,
subdivision 16. Technology and depreciable equipment shall be included in the project
construction costs unless a written election is made by the facility, to not include it in the
facility's appraised value for purposes of Minnesota Rules, part 9549.0020, subpart 5. Debt
incurred for purchase of technology and depreciable equipment shall be included as allowable
debt for purposes of Minnesota Rules, part 9549.0060, subpart 5, items A and C, unless the
written election is to not include it. Any new technology and depreciable equipment included
in the project construction costs that the facility elects not to include in its appraised value
and allowable debt shall be treated as provided in section 256B.431, subdivision 17,
deleted text end
deleted text begin
paragraph (b). Written election under this paragraph must be included in the facility's request
for the rate change related to the project, and this election may not be changed.
deleted text end
deleted text begin
(k) "Technology" means information systems or devices that make documentation,
charting, and staff time more efficient or encourage and allow for care through alternative
settings including, but not limited to, touch screens, monitors, hand-helds, swipe cards,
motion detectors, pagers, telemedicine, medication dispensers, and equipment to monitor
vital signs and self-injections, and to observe skin and other conditions.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 5.
Minnesota Statutes 2018, section 144A.071, subdivision 2, is amended to read:
Subd. 2.
Moratorium.
The commissioner of health, in coordination with the
commissioner of human services, shall deny each request for new licensed or certified
nursing home or certified boarding care beds except as provided in subdivision 3 or 4a, or
section 144A.073. "Certified bed" means a nursing home bed or a boarding care bed certified
by the commissioner of health for the purposes of the medical assistance program, under
United States Code, title 42, sections 1396 et seq. Certified beds in facilities which do not
allow medical assistance intake shall be deemed to be decertified for purposes of this section
only.
The commissioner of human services, in coordination with the commissioner of health,
shall deny any request to issue a license under section 252.28 and chapter 245A to a nursing
home or boarding care home, if that license would result in an increase in the medical
assistance reimbursement amount.
In addition, the commissioner of health must not approve any construction project whose
cost exceeds deleted text begin $1,000,000deleted text end new text begin $1,500,000new text end , unless:
(a) any construction costs exceeding deleted text begin $1,000,000deleted text end new text begin $1,500,000new text end are not added to the facility's
appraised value and are not included in the facility's payment rate for reimbursement under
the medical assistance program; or
(b) the project:
(1) has been approved through the process described in section 144A.073;
(2) meets an exception in subdivision 3 or 4a;
(3) is necessary to correct violations of state or federal law issued by the commissioner
of health;
(4) is necessary to repair or replace a portion of the facility that was damaged by fire,
lightning, ground shifts, or other such hazards, including environmental hazards, provided
that the provisions of subdivision 4a, clause (a), are met;
(5) as of May 1, 1992, the facility has submitted to the commissioner of health written
documentation evidencing that the facility meets the "commenced construction" definition
as specified in subdivision 1a, paragraph (d), or that substantial steps have been taken prior
to April 1, 1992, relating to the construction project. "Substantial steps" require that the
facility has made arrangements with outside parties relating to the construction project and
include the hiring of an architect or construction firm, submission of preliminary plans to
the Department of Health or documentation from a financial institution that financing
arrangements for the construction project have been made; or
(6) is being proposed by a licensed nursing facility that is not certified to participate in
the medical assistance program and will not result in new licensed or certified beds.
Prior to the final plan approval of any construction project, the deleted text begin commissionerdeleted text end new text begin
commissionersnew text end of health new text begin and human services new text end shall be provided with an itemized cost estimate
for the project construction costs. If a construction project is anticipated to be completed in
phases, the total estimated cost of all phases of the project shall be submitted to the
deleted text begin commissionerdeleted text end new text begin commissionersnew text end and shall be considered as one construction project. Once the
construction project is completed and prior to the final clearance by the deleted text begin commissionerdeleted text end new text begin
commissionersnew text end , the total project construction costs for the construction project shall be
submitted to the deleted text begin commissionerdeleted text end new text begin commissionersnew text end . If the final project construction cost exceeds
the dollar threshold in this subdivision, the commissioner of human services shall not
recognize any of the project construction costs or the related financing costs in excess of
this threshold in establishing the facility's property-related payment rate.
The dollar thresholds for construction projects are as follows: for construction projects
other than those authorized in clauses (1) to (6), the dollar threshold is $1,000,000. For
projects authorized after July 1, 1993, under clause (1), the dollar threshold is the cost
estimate submitted with a proposal for an exception under section 144A.073, plus inflation
as calculated according to section 256B.431, subdivision 3f, paragraph (a). For projects
authorized under clauses (2) to (4), the dollar threshold is the itemized estimate project
construction costs submitted to the commissioner of health at the time of final plan approval,
plus inflation as calculated according to section 256B.431, subdivision 3f, paragraph (a).
The commissioner of health shall adopt rules to implement this section or to amend the
emergency rules for granting exceptions to the moratorium on nursing homes under section
144A.073.
Sec. 6.
Minnesota Statutes 2018, section 144A.071, subdivision 3, is amended to read:
Subd. 3.
Exceptions authorizing increase in beds; hardship areas.
(a) The
commissioner of health, in coordination with the commissioner of human services, may
approve the addition of new licensed and Medicare and Medicaid certified nursing home
beds, using the criteria and process set forth in this subdivision.
(b) The commissioner, in cooperation with the commissioner of human services, shall
consider the following criteria when determining that an area of the state is a hardship area
with regard to access to nursing facility services:
(1) a low number of beds per thousand in a specified area using as a standard the beds
per thousand people age 65 and older, in five year age groups, using data from the most
recent census and population projections, weighted by each group's most recent nursing
home utilization, of the county at the 20th percentile, as determined by the commissioner
of human services;
(2) a high level of out-migration for nursing facility services associated with a described
area from the county or counties of residence to other Minnesota counties, as determined
by the commissioner of human services, using as a standard an amount greater than the
out-migration of the county ranked at the 50th percentile;
(3) an adequate level of availability of noninstitutional long-term care services measured
as public spending for home and community-based long-term care services per individual
age 65 and older, in five year age groups, using data from the most recent census and
population projections, weighted by each group's most recent nursing home utilization, as
determined by the commissioner of human services using as a standard an amount greater
than the 50th percentile of counties;
(4) there must be a declaration of hardship resulting from insufficient access to nursing
home beds by local county agencies and area agencies on aging; and
(5) other factors that may demonstrate the need to add new nursing facility beds.
(c) On August 15 of odd-numbered years, the commissioner, in cooperation with the
commissioner of human services, may publish in the State Register a request for information
in which interested parties, using the data provided under section 144A.351, along with any
other relevant data, demonstrate that a specified area is a hardship area with regard to access
to nursing facility services. For a response to be considered, the commissioner must receive
it by November 15. The commissioner shall make responses to the request for information
available to the public and shall allow 30 days for comment. The commissioner shall review
responses and comments and determine if any areas of the state are to be declared hardship
areas.
(d) For each designated hardship area determined in paragraph (c), the commissioner
shall publish a request for proposals in accordance with section 144A.073 and Minnesota
Rules, parts 4655.1070 to 4655.1098. The request for proposals must be published in the
State Register by March 15 following receipt of responses to the request for information.
The request for proposals must specify the number of new beds which may be added in the
designated hardship area, which must not exceed the number which, if added to the existing
number of beds in the area, including beds in layaway status, would have prevented it from
being determined to be a hardship area under paragraph (b), clause (1). Beginning July 1,
2011, the number of new beds approved must not exceed 200 beds statewide per biennium.
After June 30, 2019, the number of new beds that may be approved in a biennium must not
exceed 300 statewide. For a proposal to be considered, the commissioner must receive it
within six months of the publication of the request for proposals. The commissioner shall
review responses to the request for proposals and shall approve or disapprove each proposal
by the following July 15, in accordance with section 144A.073 and Minnesota Rules, parts
4655.1070 to 4655.1098. The commissioner shall base approvals or disapprovals on a
comparison and ranking of proposals using only the criteria in subdivision 4a. Approval of
a proposal expires after 18 months unless the facility has added the new beds using existing
space, subject to approval by the commissioner, or has commenced construction as defined
in subdivision 1a, paragraph (d). If, after the approved beds have been added, fewer than
50 percent of the beds in a facility are newly licensed, the operating payment rates previously
in effect shall remain. If, after the approved beds have been added, 50 percent or more of
the beds in a facility are newly licensed, operatingnew text begin and external fixednew text end payment rates shall
be determined according to deleted text begin Minnesota Rules, part 9549.0057, using the limits under sections
256R.23, subdivision 5, and 256R.24, subdivision 3. External fixed costs payment rates
must be determined according to section 256R.25deleted text end new text begin section 256R.21, subdivision 5new text end . Property
payment rates for facilities with beds added under this subdivision must be determined deleted text begin in
the same manner as rate determinations resulting from projects approved and completed
under section 144A.073deleted text end new text begin under section 256R.26new text end .
(e) The commissioner may:
(1) certify or license new beds in a new facility that is to be operated by the commissioner
of veterans affairs or when the costs of constructing and operating the new beds are to be
reimbursed by the commissioner of veterans affairs or the United States Veterans
Administration; and
(2) license or certify beds in a facility that has been involuntarily delicensed or decertified
for participation in the medical assistance program, provided that an application for
relicensure or recertification is submitted to the commissioner by an organization that is
not a related organization as defined in section 256R.02, subdivision 43, to the prior licensee
within 120 days after delicensure or decertification.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 7.
Minnesota Statutes 2018, section 144A.071, subdivision 4a, is amended to read:
Subd. 4a.
Exceptions for replacement beds.
It is in the best interest of the state to
ensure that nursing homes and boarding care homes continue to meet the physical plant
licensing and certification requirements by permitting certain construction projects. Facilities
should be maintained in condition to satisfy the physical and emotional needs of residents
while allowing the state to maintain control over nursing home expenditure growth.
The commissioner of health in coordination with the commissioner of human services,
may approve the renovation, replacement, upgrading, or relocation of a nursing home or
boarding care home, under the following conditions:
(a) to license or certify beds in a new facility constructed to replace a facility or to make
repairs in an existing facility that was destroyed or damaged after June 30, 1987, by fire,
lightning, or other hazard provided:
(i) destruction was not caused by the intentional act of or at the direction of a controlling
person of the facility;
(ii) at the time the facility was destroyed or damaged the controlling persons of the
facility maintained insurance coverage for the type of hazard that occurred in an amount
that a reasonable person would conclude was adequate;
(iii) the net proceeds from an insurance settlement for the damages caused by the hazard
are applied to the cost of the new facility or repairs;
(iv) the number of licensed and certified beds in the new facility does not exceed the
number of licensed and certified beds in the destroyed facility; and
(v) the commissioner determines that the replacement beds are needed to prevent an
inadequate supply of beds.
Project construction costs incurred for repairs authorized under this clause shall not be
considered in the dollar threshold amount defined in subdivision 2;
(b) to license or certify beds that are moved from one location to another within a nursing
home facility, provided the total costs of remodeling performed in conjunction with the
relocation of beds does not exceed $1,000,000;
(c) to license or certify beds in a project recommended for approval under section
144A.073;
(d) to license or certify beds that are moved from an existing state nursing home to a
different state facility, provided there is no net increase in the number of state nursing home
beds;
(e) to certify and license as nursing home beds boarding care beds in a certified boarding
care facility if the beds meet the standards for nursing home licensure, or in a facility that
was granted an exception to the moratorium under section 144A.073, and if the cost of any
remodeling of the facility does not exceed $1,000,000. If boarding care beds are licensed
as nursing home beds, the number of boarding care beds in the facility must not increase
beyond the number remaining at the time of the upgrade in licensure. The provisions
contained in section 144A.073 regarding the upgrading of the facilities do not apply to
facilities that satisfy these requirements;
(f) to license and certify up to 40 beds transferred from an existing facility owned and
operated by the Amherst H. Wilder Foundation in the city of St. Paul to a new unit at the
same location as the existing facility that will serve persons with Alzheimer's disease and
other related disorders. The transfer of beds may occur gradually or in stages, provided the
total number of beds transferred does not exceed 40. At the time of licensure and certification
of a bed or beds in the new unit, the commissioner of health shall delicense and decertify
the same number of beds in the existing facility. As a condition of receiving a license or
certification under this clause, the facility must make a written commitment to the
commissioner of human services that it will not seek to receive an increase in its
property-related payment rate as a result of the transfers allowed under this paragraph;
(g) to license and certify nursing home beds to replace currently licensed and certified
boarding care beds which may be located either in a remodeled or renovated boarding care
or nursing home facility or in a remodeled, renovated, newly constructed, or replacement
nursing home facility within the identifiable complex of health care facilities in which the
currently licensed boarding care beds are presently located, provided that the number of
boarding care beds in the facility or complex are decreased by the number to be licensed as
nursing home beds and further provided that, if the total costs of new construction,
replacement, remodeling, or renovation exceed ten percent of the appraised value of the
facility or $200,000, whichever is less, the facility makes a written commitment to the
commissioner of human services that it will not seek to receive an increase in its
property-related payment rate by reason of the new construction, replacement, remodeling,
or renovation. The provisions contained in section 144A.073 regarding the upgrading of
facilities do not apply to facilities that satisfy these requirements;
(h) to license as a nursing home and certify as a nursing facility a facility that is licensed
as a boarding care facility but not certified under the medical assistance program, but only
if the commissioner of human services certifies to the commissioner of health that licensing
the facility as a nursing home and certifying the facility as a nursing facility will result in
a net annual savings to the state general fund of $200,000 or more;
(i) to certify, after September 30, 1992, and prior to July 1, 1993, existing nursing home
beds in a facility that was licensed and in operation prior to January 1, 1992;
(j) to license and certify new nursing home beds to replace beds in a facility acquired
by the Minneapolis Community Development Agency as part of redevelopment activities
in a city of the first class, provided the new facility is located within three miles of the site
of the old facility. Operating and property costs for the new facility must be determined and
allowed under section 256B.431 or 256B.434 or chapter 256R;
(k) to license and certify up to 20 new nursing home beds in a community-operated
hospital and attached convalescent and nursing care facility with 40 beds on April 21, 1991,
that suspended operation of the hospital in April 1986. The commissioner of human services
shall provide the facility with the same per diem property-related payment rate for each
additional licensed and certified bed as it will receive for its existing 40 beds;
(l) to license or certify beds in renovation, replacement, or upgrading projects as defined
in section 144A.073, subdivision 1, so long as the cumulative total costs of the facility's
remodeling projects do not exceed $1,000,000;
(m) to license and certify beds that are moved from one location to another for the
purposes of converting up to five four-bed wards to single or double occupancy rooms in
a nursing home that, as of January 1, 1993, was county-owned and had a licensed capacity
of 115 beds;
(n) to allow a facility that on April 16, 1993, was a 106-bed licensed and certified nursing
facility located in Minneapolis to layaway all of its licensed and certified nursing home
beds. These beds may be relicensed and recertified in a newly constructed teaching nursing
home facility affiliated with a teaching hospital upon approval by the legislature. The
proposal must be developed in consultation with the interagency committee on long-term
care planning. The beds on layaway status shall have the same status as voluntarily delicensed
and decertified beds, except that beds on layaway status remain subject to the surcharge in
section 256.9657. This layaway provision expires July 1, 1998;
(o) to allow a project which will be completed in conjunction with an approved
moratorium exception project for a nursing home in southern Cass County and which is
directly related to that portion of the facility that must be repaired, renovated, or replaced,
to correct an emergency plumbing problem for which a state correction order has been
issued and which must be corrected by August 31, 1993;
(p) to allow a facility that on April 16, 1993, was a 368-bed licensed and certified nursing
facility located in Minneapolis to layaway, upon 30 days prior written notice to the
commissioner, up to 30 of the facility's licensed and certified beds by converting three-bed
wards to single or double occupancy. Beds on layaway status shall have the same status as
voluntarily delicensed and decertified beds except that beds on layaway status remain subject
to the surcharge in section 256.9657, remain subject to the license application and renewal
fees under section 144A.07 and shall be subject to a $100 per bed reactivation fee. In
addition, at any time within three years of the effective date of the layaway, the beds on
layaway status may be:
(1) relicensed and recertified upon relocation and reactivation of some or all of the beds
to an existing licensed and certified facility or facilities located in Pine River, Brainerd, or
International Falls; provided that the total project construction costs related to the relocation
of beds from layaway status for any facility receiving relocated beds may not exceed the
dollar threshold provided in subdivision 2 unless the construction project has been approved
through the moratorium exception process under section 144A.073;
(2) relicensed and recertified, upon reactivation of some or all of the beds within the
facility which placed the beds in layaway status, if the commissioner has determined a need
for the reactivation of the beds on layaway status.
The property-related payment rate of a facility placing beds on layaway status must be
adjusted by the incremental change in its rental per diem after recalculating the rental per
diem as provided in section 256B.431, subdivision 3a, paragraph (c). The property-related
payment rate for a facility relicensing and recertifying beds from layaway status must be
adjusted by the incremental change in its rental per diem after recalculating its rental per
diem using the number of beds after the relicensing to establish the facility's capacity day
divisor, which shall be effective the first day of the month following the month in which
the relicensing and recertification became effective. Any beds remaining on layaway status
more than three years after the date the layaway status became effective must be removed
from layaway status and immediately delicensed and decertified;
(q) to license and certify beds in a renovation and remodeling project to convert 12
four-bed wards into 24 two-bed rooms, expand space, and add improvements in a nursing
home that, as of January 1, 1994, met the following conditions: the nursing home was located
in Ramsey County; had a licensed capacity of 154 beds; and had been ranked among the
top 15 applicants by the 1993 moratorium exceptions advisory review panel. The total
project construction cost estimate for this project must not exceed the cost estimate submitted
in connection with the 1993 moratorium exception process;
(r) to license and certify up to 117 beds that are relocated from a licensed and certified
138-bed nursing facility located in St. Paul to a hospital with 130 licensed hospital beds
located in South St. Paul, provided that the nursing facility and hospital are owned by the
same or a related organization and that prior to the date the relocation is completed the
hospital ceases operation of its inpatient hospital services at that hospital. After relocation,
the nursing facility's status shall be the same as it was prior to relocation. The nursing
facility's property-related payment rate resulting from the project authorized in this paragraph
shall become effective no earlier than April 1, 1996. For purposes of calculating the
incremental change in the facility's rental per diem resulting from this project, the allowable
appraised value of the nursing facility portion of the existing health care facility physical
plant prior to the renovation and relocation may not exceed $2,490,000;
(s) to license and certify two beds in a facility to replace beds that were voluntarily
delicensed and decertified on June 28, 1991;
(t) to allow 16 licensed and certified beds located on July 1, 1994, in a 142-bed nursing
home and 21-bed boarding care home facility in Minneapolis, notwithstanding the licensure
and certification after July 1, 1995, of the Minneapolis facility as a 147-bed nursing home
facility after completion of a construction project approved in 1993 under section 144A.073,
to be laid away upon 30 days' prior written notice to the commissioner. Beds on layaway
status shall have the same status as voluntarily delicensed or decertified beds except that
they shall remain subject to the surcharge in section 256.9657. The 16 beds on layaway
status may be relicensed as nursing home beds and recertified at any time within five years
of the effective date of the layaway upon relocation of some or all of the beds to a licensed
and certified facility located in Watertown, provided that the total project construction costs
related to the relocation of beds from layaway status for the Watertown facility may not
exceed the dollar threshold provided in subdivision 2 unless the construction project has
been approved through the moratorium exception process under section 144A.073.
The property-related payment rate of the facility placing beds on layaway status must
be adjusted by the incremental change in its rental per diem after recalculating the rental
per diem as provided in section 256B.431, subdivision 3a, paragraph (c). The property-related
payment rate for the facility relicensing and recertifying beds from layaway status must be
adjusted by the incremental change in its rental per diem after recalculating its rental per
diem using the number of beds after the relicensing to establish the facility's capacity day
divisor, which shall be effective the first day of the month following the month in which
the relicensing and recertification became effective. Any beds remaining on layaway status
more than five years after the date the layaway status became effective must be removed
from layaway status and immediately delicensed and decertified;
(u) to license and certify beds that are moved within an existing area of a facility or to
a newly constructed addition which is built for the purpose of eliminating three- and four-bed
rooms and adding space for dining, lounge areas, bathing rooms, and ancillary service areas
in a nursing home that, as of January 1, 1995, was located in Fridley and had a licensed
capacity of 129 beds;
(v) to relocate 36 beds in Crow Wing County and four beds from Hennepin County to
a 160-bed facility in Crow Wing County, provided all the affected beds are under common
ownership;
(w) to license and certify a total replacement project of up to 49 beds located in Norman
County that are relocated from a nursing home destroyed by flood and whose residents were
relocated to other nursing homes. The operating cost payment rates for the new nursing
facility shall be determined based on the interim and settle-up payment provisions of
deleted text begin Minnesota Rules, part 9549.0057,deleted text end new text begin section 256R.27new text end and the reimbursement provisions of
chapter 256R. Property-related reimbursement rates shall be determined under section
256R.26, taking into account any federal or state flood-related loans or grants provided to
the facility;
(x) to license and certify to the licensee of a nursing home in Polk County that was
destroyed by flood in 1997 replacement projects with a total of up to 129 beds, with at least
25 beds to be located in Polk County and up to 104 beds distributed among up to three other
counties. These beds may only be distributed to counties with fewer than the median number
of age intensity adjusted beds per thousand, as most recently published by the commissioner
of human services. If the licensee chooses to distribute beds outside of Polk County under
this paragraph, prior to distributing the beds, the commissioner of health must approve the
location in which the licensee plans to distribute the beds. The commissioner of health shall
consult with the commissioner of human services prior to approving the location of the
proposed beds. The licensee may combine these beds with beds relocated from other nursing
facilities as provided in section 144A.073, subdivision 3c. The operating payment rates for
the new nursing facilities shall be determined based on the interim and settle-up payment
provisions of Minnesota Rules, parts 9549.0010 to 9549.0080. Property-related
reimbursement rates shall be determined under section 256R.26. If the replacement beds
permitted under this paragraph are combined with beds from other nursing facilities, the
rates shall be calculated as the weighted average of rates determined as provided in this
paragraph and section 256R.50;
(y) to license and certify beds in a renovation and remodeling project to convert 13
three-bed wards into 13 two-bed rooms and 13 single-bed rooms, expand space, and add
improvements in a nursing home that, as of January 1, 1994, met the following conditions:
the nursing home was located in Ramsey County, was not owned by a hospital corporation,
had a licensed capacity of 64 beds, and had been ranked among the top 15 applicants by
the 1993 moratorium exceptions advisory review panel. The total project construction cost
estimate for this project must not exceed the cost estimate submitted in connection with the
1993 moratorium exception process;
(z) to license and certify up to 150 nursing home beds to replace an existing 285 bed
nursing facility located in St. Paul. The replacement project shall include both the renovation
of existing buildings and the construction of new facilities at the existing site. The reduction
in the licensed capacity of the existing facility shall occur during the construction project
as beds are taken out of service due to the construction process. Prior to the start of the
construction process, the facility shall provide written information to the commissioner of
health describing the process for bed reduction, plans for the relocation of residents, and
the estimated construction schedule. The relocation of residents shall be in accordance with
the provisions of law and rule;
(aa) to allow the commissioner of human services to license an additional 36 beds to
provide residential services for the physically disabled under Minnesota Rules, parts
9570.2000 to 9570.3400, in a 198-bed nursing home located in Red Wing, provided that
the total number of licensed and certified beds at the facility does not increase;
(bb) to license and certify a new facility in St. Louis County with 44 beds constructed
to replace an existing facility in St. Louis County with 31 beds, which has resident rooms
on two separate floors and an antiquated elevator that creates safety concerns for residents
and prevents nonambulatory residents from residing on the second floor. The project shall
include the elimination of three- and four-bed rooms;
(cc) to license and certify four beds in a 16-bed certified boarding care home in
Minneapolis to replace beds that were voluntarily delicensed and decertified on or before
March 31, 1992. The licensure and certification is conditional upon the facility periodically
assessing and adjusting its resident mix and other factors which may contribute to a potential
institution for mental disease declaration. The commissioner of human services shall retain
the authority to audit the facility at any time and shall require the facility to comply with
any requirements necessary to prevent an institution for mental disease declaration, including
delicensure and decertification of beds, if necessary;
(dd) to license and certify 72 beds in an existing facility in Mille Lacs County with 80
beds as part of a renovation project. The renovation must include construction of an addition
to accommodate ten residents with beginning and midstage dementia in a self-contained
living unit; creation of three resident households where dining, activities, and support spaces
are located near resident living quarters; designation of four beds for rehabilitation in a
self-contained area; designation of 30 private rooms; and other improvements;
(ee) to license and certify beds in a facility that has undergone replacement or remodeling
as part of a planned closure under section 256R.40;
(ff) to license and certify a total replacement project of up to 124 beds located in Wilkin
County that are in need of relocation from a nursing home significantly damaged by flood.
The operating cost payment rates for the new nursing facility shall be determined based on
the interim and settle-up payment provisions of deleted text begin Minnesota Rules, part 9549.0057,deleted text end new text begin section
256R.27new text end and the reimbursement provisions of chapter 256R. Property-related reimbursement
rates shall be determined under section 256R.26, taking into account any federal or state
flood-related loans or grants provided to the facility;
(gg) to allow the commissioner of human services to license an additional nine beds to
provide residential services for the physically disabled under Minnesota Rules, parts
9570.2000 to 9570.3400, in a 240-bed nursing home located in Duluth, provided that the
total number of licensed and certified beds at the facility does not increase;
(hh) to license and certify up to 120 new nursing facility beds to replace beds in a facility
in Anoka County, which was licensed for 98 beds as of July 1, 2000, provided the new
facility is located within four miles of the existing facility and is in Anoka County. Operating
and property rates shall be determined and allowed under chapter 256R and Minnesota
Rules, parts 9549.0010 to 9549.0080; or
(ii) to transfer up to 98 beds of a 129-licensed bed facility located in Anoka County that,
as of March 25, 2001, is in the active process of closing, to a 122-licensed bed nonprofit
nursing facility located in the city of Columbia Heights or its affiliate. The transfer is effective
when the receiving facility notifies the commissioner in writing of the number of beds
accepted. The commissioner shall place all transferred beds on layaway status held in the
name of the receiving facility. The layaway adjustment provisions of section 256B.431,
subdivision 30, do not apply to this layaway. The receiving facility may only remove the
beds from layaway for recertification and relicensure at the receiving facility's current site,
or at a newly constructed facility located in Anoka County. The receiving facility must
receive statutory authorization before removing these beds from layaway status, or may
remove these beds from layaway status if removal from layaway status is part of a
moratorium exception project approved by the commissioner under section 144A.073.
Sec. 8.
Minnesota Statutes 2018, section 144A.071, subdivision 4c, is amended to read:
Subd. 4c.
Exceptions for replacement beds after June 30, 2003.
(a) The commissioner
of health, in coordination with the commissioner of human services, may approve the
renovation, replacement, upgrading, or relocation of a nursing home or boarding care home,
under the following conditions:
(1) to license and certify an 80-bed city-owned facility in Nicollet County to be
constructed on the site of a new city-owned hospital to replace an existing 85-bed facility
attached to a hospital that is also being replaced. The threshold allowed for this project
under section 144A.073 shall be the maximum amount available to pay the additional
medical assistance costs of the new facility;
(2) to license and certify 29 beds to be added to an existing 69-bed facility in St. Louis
County, provided that the 29 beds must be transferred from active or layaway status at an
existing facility in St. Louis County that had 235 beds on April 1, 2003.
The licensed capacity at the 235-bed facility must be reduced to 206 beds, but the payment
rate at that facility shall not be adjusted as a result of this transfer. The operating payment
rate of the facility adding beds after completion of this project shall be the same as it was
on the day prior to the day the beds are licensed and certified. This project shall not proceed
unless it is approved and financed under the provisions of section 144A.073;
(3) to license and certify a new 60-bed facility in Austin, provided that: (i) 45 of the new
beds are transferred from a 45-bed facility in Austin under common ownership that is closed
and 15 of the new beds are transferred from a 182-bed facility in Albert Lea under common
ownership; (ii) the commissioner of human services is authorized by the 2004 legislature
to negotiate budget-neutral planned nursing facility closures; and (iii) money is available
from planned closures of facilities under common ownership to make implementation of
this clause budget-neutral to the state. The bed capacity of the Albert Lea facility shall be
reduced to 167 beds following the transfer. Of the 60 beds at the new facility, 20 beds shall
be used for a special care unit for persons with Alzheimer's disease or related dementias;
(4) to license and certify up to 80 beds transferred from an existing state-owned nursing
facility in Cass County to a new facility located on the grounds of the Ah-Gwah-Ching
campus. The operating cost payment rates for the new facility shall be determined based
on the interim and settle-up payment provisions of deleted text begin Minnesota Rules, part 9549.0057,deleted text end new text begin section
256R.27new text end and the reimbursement provisions of chapter 256R. The property payment rate for
the first three years of operation shall be $35 per day. For subsequent years, the property
payment rate of $35 per day shall be adjusted for inflation as provided in section 256B.434,
subdivision 4, paragraph (c), as long as the facility has a contract under section 256B.434;
(5) to initiate a pilot program to license and certify up to 80 beds transferred from an
existing county-owned nursing facility in Steele County relocated to the site of a new acute
care facility as part of the county's Communities for a Lifetime comprehensive plan to create
innovative responses to the aging of its population. Upon relocation to the new site, the
nursing facility shall delicense 28 beds. The payment rate for external fixed costs for the
new facility shall be increased by an amount as calculated according to items (i) to (v):
(i) compute the estimated decrease in medical assistance residents served by the nursing
facility by multiplying the decrease in licensed beds by the historical percentage of medical
assistance resident days;
(ii) compute the annual savings to the medical assistance program from the delicensure
of 28 beds by multiplying the anticipated decrease in medical assistance residents, determined
in item (i), by the existing facility's weighted average payment rate multiplied by 365;
(iii) compute the anticipated annual costs for community-based services by multiplying
the anticipated decrease in medical assistance residents served by the nursing facility,
determined in item (i), by the average monthly elderly waiver service costs for individuals
in Steele County multiplied by 12;
(iv) subtract the amount in item (iii) from the amount in item (ii);
(v) divide the amount in item (iv) by an amount equal to the relocated nursing facility's
occupancy factor under section 256B.431, subdivision 3f, paragraph (c), multiplied by the
historical percentage of medical assistance resident days; and
(6) to consolidate and relocate nursing facility beds to a new site in Goodhue County
and to integrate these services with other community-based programs and services under a
communities for a lifetime pilot program and comprehensive plan to create innovative
responses to the aging of its population. Two nursing facilities, one for 84 beds and one for
65 beds, in the city of Red Wing licensed on July 1, 2015, shall be consolidated into a newly
renovated 64-bed nursing facility resulting in the delicensure of 85 beds. Notwithstanding
the carryforward of the approval authority in section 144A.073, subdivision 11, the funding
approved in April 2009 by the commissioner of health for a project in Goodhue County
shall not carry forward. The closure of the 85 beds shall not be eligible for a planned closure
rate adjustment under section 256R.40. The construction project permitted in this clause
shall not be eligible for a threshold project rate adjustment under section 256B.434,
subdivision 4f. The payment rate for external fixed costs for the new facility shall be
increased by an amount as calculated according to items (i) to (vi):
(i) compute the estimated decrease in medical assistance residents served by both nursing
facilities by multiplying the difference between the occupied beds of the two nursing facilities
for the reporting year ending September 30, 2009, and the projected occupancy of the facility
at 95 percent occupancy by the historical percentage of medical assistance resident days;
(ii) compute the annual savings to the medical assistance program from the delicensure
by multiplying the anticipated decrease in the medical assistance residents, determined in
item (i), by the hospital-owned nursing facility weighted average payment rate multiplied
by 365;
(iii) compute the anticipated annual costs for community-based services by multiplying
the anticipated decrease in medical assistance residents served by the facilities, determined
in item (i), by the average monthly elderly waiver service costs for individuals in Goodhue
County multiplied by 12;
(iv) subtract the amount in item (iii) from the amount in item (ii);
(v) multiply the amount in item (iv) by 57.2 percent; and
(vi) divide the difference of the amount in item (iv) and the amount in item (v) by an
amount equal to the relocated nursing facility's occupancy factor under section 256B.431,
subdivision 3f, paragraph (c), multiplied by the historical percentage of medical assistance
resident days.
(b) Projects approved under this subdivision shall be treated in a manner equivalent to
projects approved under subdivision 4a.
Sec. 9.
Minnesota Statutes 2018, section 144A.071, subdivision 5a, is amended to read:
Subd. 5a.
Cost estimate of a moratorium exception project.
deleted text begin (a)deleted text end For the purposes of
this section and section 144A.073, the cost estimate of a moratorium exception project shall
include the effects of the proposed project on the costs of the state subsidy for
community-based services, nursing services, and housing in institutional and noninstitutional
settings. The commissioner of health, in cooperation with the commissioner of human
services, shall define the method for estimating these costs in the permanent rule
implementing section 144A.073. The commissioner of human services shall prepare an
estimate of thenew text begin property-related payment rate to be established upon completion of the
project andnew text end total state annual long-term costs of each moratorium exception proposal.new text begin The
property-related payment rate estimate shall be made using the actual cost of the project
but the final property rate must be based on the appraisal and subject to the limitations in
section 256R.26, subdivision 6.
new text end
deleted text begin
(b) The interest rate to be used for estimating the cost of each moratorium exception
project proposal shall be the lesser of either the prime rate plus two percentage points, or
the posted yield for standard conventional fixed rate mortgages of the Federal Home Loan
Mortgage Corporation plus two percentage points as published in the Wall Street Journal
and in effect 56 days prior to the application deadline. If the applicant's proposal uses this
interest rate, the commissioner of human services, in determining the facility's actual
property-related payment rate to be established upon completion of the project must use the
actual interest rate obtained by the facility for the project's permanent financing up to the
maximum permitted under Minnesota Rules, part 9549.0060, subpart 6.
deleted text end
deleted text begin
The applicant may choose an alternate interest rate for estimating the project's cost. If
the applicant makes this election, the commissioner of human services, in determining the
facility's actual property-related payment rate to be established upon completion of the
project, must use the lesser of the actual interest rate obtained for the project's permanent
financing or the interest rate which was used to estimate the proposal's project cost. For
succeeding rate years, the applicant is at risk for financing costs in excess of the interest
rate selected.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 10.
Minnesota Statutes 2018, section 144A.073, subdivision 3c, is amended to read:
Subd. 3c.
deleted text begin Cost neutraldeleted text end Relocation projects.
deleted text begin (a)deleted text end Notwithstanding subdivision 3, the
commissioner may at any time accept proposals, or amendments to proposals previously
approved under this section, for relocations deleted text begin that are cost neutral with respect to state costs
as defined in section 144A.071, subdivision 5adeleted text end . The commissioner, in consultation with the
commissioner of human services, shall evaluate proposals according to subdivision 4a,
clauses (1), (4), (5), (6), and (8), and other criteria established in rule or law. deleted text begin The
commissioner of human services shall determine the allowable payment rates of the facility
receiving the beds in accordance with section 256R.50.deleted text end The commissioner shall approve or
disapprove a project within 90 days.
deleted text begin
(b) For the purposes of paragraph (a), cost neutrality shall be measured over the first
three 12-month periods of operation after completion of the project.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 11.
Minnesota Statutes 2018, section 256B.434, subdivision 1, is amended to read:
Subdivision 1.
deleted text begin Alternative payment demonstration project establisheddeleted text end new text begin Contractual
agreementsnew text end .
deleted text begin The commissioner of human services shall establish a contractual alternative
payment demonstration project for paying for nursing facility services under the medical
assistance program. A nursing facility may apply to be paid under the contractual alternative
payment demonstration project instead of the cost-based payment system established under
section 256B.431. A nursing facilitydeleted text end new text begin Nursing facilities located in Minnesota new text end electing to deleted text begin use
the alternative payment demonstration projectdeleted text end new text begin enroll as a medical assistance provider new text end must
enter into a contract with the commissioner. Payment rates and procedures deleted text begin for facilities
electing to use the alternative payment demonstration projectdeleted text end are determined and governed
by this section and by the terms of the contract. The commissioner may negotiate different
contract terms for different nursing facilities.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 12.
Minnesota Statutes 2018, section 256B.434, subdivision 3, is amended to read:
Subd. 3.
Duration and termination of contracts.
deleted text begin
(a) Subject to available resources,
the commissioner may begin to execute contracts with nursing facilities November 1, 1995.
deleted text end
deleted text begin (b)deleted text end new text begin (a)new text end All contracts entered into under this section are for a term not to exceed four
years. Either party may terminate a contract at any time without cause by providing 90
calendar days advance written notice to the other party. The decision to terminate a contract
is not appealable. deleted text begin Notwithstanding section 16C.05, subdivision 2, paragraph (a), clause (5),
the contract shall be renegotiated for additional terms of up to four years, unless either party
provides written notice of termination.deleted text end The provisions of the contract shall be renegotiated
at a minimum of every four years by the parties prior to the expiration date of the contract.
The parties may voluntarily deleted text begin renegotiatedeleted text end new text begin amendnew text end the terms of the contract at any time by
mutual agreement.
deleted text begin (c)deleted text end new text begin (b)new text end If a nursing facility fails to comply with the terms of a contract, the commissioner
shall provide reasonable notice regarding the breach of contract and a reasonable opportunity
for the facility to come into compliance. If the facility fails to come into compliance or to
remain in compliance, the commissioner may terminate the contract. deleted text begin If a contract is
terminated, the contract payment remains in effect for the remainder of the rate year in
which the contract was terminated, but in all other respects the provisions of this section
do not apply to that facility effective the date the contract is terminated. The contract shall
contain a provision governing the transition back to the cost-based reimbursement system
established under section 256B.431 and Minnesota Rules, parts 9549.0010 to 9549.0080.
A contract entered into under this section may be amended by mutual agreement of the
parties.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 13.
new text begin
[256M.42] ADULT PROTECTION GRANT ALLOCATIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Formula. new text end
new text begin
(a) The commissioner shall allocate state money appropriated
under this section to each county board and tribal government approved by the commissioner
to assume county agency duties for adult protective services or as a lead investigative agency
under section 626.557 on an annual basis in an amount determined according to the following
formula:
new text end
new text begin
(1) 25 percent must be allocated on the basis of the number of reports of suspected
vulnerable adult maltreatment under sections 626.557 and 626.5572, when the county or
tribe is responsible as determined by the most recent data of the commissioner; and
new text end
new text begin
(2) 75 percent must be allocated on the basis of the number of screened-in reports for
adult protective services or vulnerable adult maltreatment investigations under sections
626.557 and 626.5572, when the county or tribe is responsible as determined by the most
recent data of the commissioner.
new text end
new text begin
(b) The commissioner is precluded from changing the formula under this subdivision
or recommending a change to the legislature without public review and input.
new text end
new text begin Subd. 2. new text end
new text begin Payment. new text end
new text begin
The commissioner shall make allocations for the state fiscal year
starting July 1, 2019, and to each county board or tribal government on or before October
10, 2019. The commissioner shall make allocations under subdivision 1 to each county
board or tribal government each year thereafter on or before July 10.
new text end
new text begin Subd. 3. new text end
new text begin Prohibition on supplanting existing money. new text end
new text begin
Money received under this section
must be used for staffing for protection of vulnerable adults or to expand adult protective
services. Money must not be used to supplant current county or tribe expenditures for these
purposes.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 14.
Minnesota Statutes 2018, section 256R.02, subdivision 8, is amended to read:
Subd. 8.
Capital assets.
"Capital assets" means a nursing facility's buildings, deleted text begin attached
fixturesdeleted text end new text begin fixed equipmentnew text end , land improvements, leasehold improvements, and all additions to
or replacements of those assets used directly for resident care.
Sec. 15.
Minnesota Statutes 2018, section 256R.02, subdivision 19, is amended to read:
Subd. 19.
External fixed costs.
"External fixed costs" means costs related to the nursing
home surcharge under section 256.9657, subdivision 1; licensure fees under section 144.122;
family advisory council fee under section 144A.33; scholarships under section 256R.37;
deleted text begin planned closure rate adjustments under section 256R.40; consolidation rate adjustments
under section 144A.071, subdivisions 4c, paragraph (a), clauses (5) and (6), and 4d;
single-bed room incentives under section 256R.41;deleted text end property taxes, new text begin special new text end assessments, and
payments in lieu of taxes; employer health insurance costs; quality improvement incentive
payment rate adjustments under section 256R.39; performance-based incentive payments
under section 256R.38; special dietary needs under section 256R.51; rate adjustments for
compensation-related costs for minimum wage changes under section 256R.49 provided
on or after January 1, 2018; and Public Employees Retirement Association employer costs.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 16.
Minnesota Statutes 2018, section 256R.02, is amended by adding a subdivision
to read:
new text begin Subd. 25a. new text end
new text begin Interim payment rates. new text end
new text begin
"Interim payment rates" means the total operating
and external fixed costs payment rates determined by anticipated costs and resident days
reported on an interim cost report as described in section 256R.27.
new text end
Sec. 17.
Minnesota Statutes 2018, section 256R.02, is amended by adding a subdivision
to read:
new text begin Subd. 47a. new text end
new text begin Settle up payment rates. new text end
new text begin
"Settle up payment rates" means the total operating
and external fixed costs payment rates determined by actual allowable costs and resident
days reported on a settle up cost report as described under section 256R.27.
new text end
Sec. 18.
Minnesota Statutes 2018, section 256R.08, subdivision 1, is amended to read:
Subdivision 1.
Reporting of financial statements.
(a) No later than February 1 of each
year, a nursing facility shall:
(1) provide the state agency with a copy of its audited financial statements or its working
trial balance;
(2) provide the state agency with a statement of ownership for the facility;
(3) provide the state agency with separate, audited financial statements or working trial
balances for every other facility owned in whole or in part by an individual or entity that
has an ownership interest in the facility;
new text begin
(4) provide the state agency with information regarding whether the licensee, or a general
partner, director, or officer of the licensee, has an ownership or control interest of five
percent or more in a related party or related organization that provides any service to the
skilled nursing facility. If the licensee, or the general partner, director, or officer of the
licensee has such an interest, the licensee shall disclose all services provided to the skilled
nursing facility, the number of individuals who provide that service at the skilled nursing
facility, and any other information requested by the state agency. If goods, fees, and services
collectively worth $10,000 or more per year are delivered to the skilled nursing facility, the
disclosure required pursuant to this subdivision shall include the related party and related
organization profit and loss statement, and the Payroll-Based Journal public use data;
new text end
deleted text begin (4)deleted text end new text begin (5)new text end upon request, provide the state agency with separate, audited financial statements
or working trial balances for every organization with which the facility conducts business
and which is owned in whole or in part by an individual or entity which has an ownership
interest in the facility;
deleted text begin (5)deleted text end new text begin (6)new text end provide the state agency with copies of leases, purchase agreements, and other
documents related to the lease or purchase of the nursing facility; and
deleted text begin (6)deleted text end new text begin (7)new text end upon request, provide the state agency with copies of leases, purchase agreements,
and other documents related to the acquisition of equipment, goods, and services which are
claimed as allowable costs.
(b) Audited financial statements submitted under paragraph (a) must include a balance
sheet, income statement, statement of the rate or rates charged to private paying residents,
statement of retained earnings, statement of cash flows, notes to the financial statements,
audited applicable supplemental information, and the public accountant's report. Public
accountants must conduct audits in accordance with chapter 326A. The cost of an audit
shall not be an allowable cost unless the nursing facility submits its audited financial
statements in the manner otherwise specified in this subdivision. A nursing facility must
permit access by the state agency to the public accountant's audit work papers that support
the audited financial statements submitted under paragraph (a).
(c) Documents or information provided to the state agency pursuant to this subdivision
shall be public.
(d) If the requirements of paragraphs (a) and (b) are not met, the reimbursement rate
may be reduced to 80 percent of the rate in effect on the first day of the fourth calendar
month after the close of the reporting period and the reduction shall continue until the
requirements are met.
new text begin
(e) Licensees shall provide the information required in this section to the commissioner
in a manner prescribed by the commissioner.
new text end
new text begin
(f) For purposes of this section, the following terms have the meanings given:
new text end
new text begin
(1) "profit and loss statement" means the most recent annual statement on profits and
losses finalized by a related party for the most recent year available; and
new text end
new text begin
(2) "related party" means an organization related to the licensee provider or that is under
common ownership or control, as defined in Code of Federal Regulations, title 42, section
413.17(b).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective November 1, 2019.
new text end
Sec. 19.
Minnesota Statutes 2018, section 256R.10, is amended by adding a subdivision
to read:
new text begin Subd. 8. new text end
new text begin Pilot projects for energy-related programs. new text end
new text begin
(a) The commissioner shall
develop a pilot project to reduce overall energy consumption and evaluate the financial
impacts associated with property assessed clean energy (PACE) approved projects in nursing
facilities.
new text end
new text begin
(b) Notwithstanding section 256R.02, subdivision 48a, the commissioner may make
payments to facilities for the allowable costs of special assessments for approved
energy-related program payments authorized under sections 216C.435 and 216C.436. The
commissioner shall limit the amount of any payment and the number of contract amendments
under this subdivision to operate the energy-related program within funds appropriated for
this purpose.
new text end
new text begin
(c) The commissioner shall approve proposals through a contract which shall specify
the level of payment, provided that each facility demonstrates:
new text end
new text begin
(1) completion of a facility-specific energy assessment or energy audit and recommended
energy conservation measures that, in aggregate, meet the cost-effectiveness requirements
of section 216B.241;
new text end
new text begin
(2) a completed PACE application and recommended approval by a PACE program
administrator authorized under sections 216C.435 and 216C.436; and
new text end
new text begin
(3) the facility's reported spending on utilities per resident day since calendar year 2016
is higher than average for similar facilities.
new text end
new text begin
(d) Payments to facilities under this subdivision shall be in the form of time-limited rate
adjustments which shall be included in the external fixed costs payment rate under section
256R.25. The commissioner shall select from facilities which meet the requirements of
paragraph (c) using a competitive application process.
new text end
new text begin
(e) Allowable costs for special assessments for approved energy-related program
payments cannot exceed the amount of debt service for net expenditures for the project and
must meet the cost-effective energy improvements requirements described in section
216C.435, subdivision 3a. Any credits or rebates related to the project must be offset. A
project cost is not an allowable cost on the cost report as a special assessment if it has been
or will be used to increase the facility's property rate.
new text end
new text begin
(f) The external fixed costs payment rate for the PACE allowable costs shall be reduced
by an amount equal to the utility per diem included in the other operating payment rate
under section 256R.24, that is associated with the energy project.
new text end
Sec. 20.
Minnesota Statutes 2018, section 256R.16, subdivision 1, is amended to read:
Subdivision 1.
Calculation of a quality score.
(a) The commissioner shall determine
a quality score for each nursing facility using quality measures established in section
256B.439, according to methods determined by the commissioner in consultation with
stakeholders and experts, and using the most recently available data as provided in the
Minnesota Nursing Home Report Card. These methods shall be exempt from the rulemaking
requirements under chapter 14.
(b) For each quality measure, a score shall be determined with the number of points
assigned as determined by the commissioner using the methodology established according
to this subdivision. The determination of the quality measures to be used and the methods
of calculating scores may be revised annually by the commissioner.
(c) The quality score shall include up to 50 points related to the Minnesota quality
indicators score derived from the minimum data set, up to 40 points related to the resident
quality of life score derived from the consumer survey conducted under section 256B.439,
subdivision 3, and up to ten points related to the state inspection results score.
(d) The commissioner, in cooperation with the commissioner of health, may adjust the
formula in paragraph (c), or the methodology for computing the total quality score, deleted text begin effective
July 1 of any year,deleted text end with five months advance public notice. In changing the formula, the
commissioner shall consider quality measure priorities registered by report card users, advice
of stakeholders, and available research.
Sec. 21.
Minnesota Statutes 2018, section 256R.21, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin Total payment rate for new facilities. new text end
new text begin
For a new nursing facility created under
section 144A.073, subdivision 3c, the total payment rate must be determined according to
this section, except:
new text end
new text begin
(1) the direct care payment rate used in subdivision 2, clause (1), must be determined
according to section 256R.27;
new text end
new text begin
(2) the other care-related payment rate used in subdivision 2, clause (2), must be
determined according to section 256R.27;
new text end
new text begin
(3) the external fixed costs payment rate used in subdivision 4, clause (2), must be
determined according to section 256R.27; and
new text end
new text begin
(4) the property payment rate used in subdivision 4, clause (3), must be determined
according to section 256R.26.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 22.
Minnesota Statutes 2018, section 256R.23, subdivision 5, is amended to read:
Subd. 5.
Determination of total care-related payment rate limits.
The commissioner
must determine each facility's total care-related payment rate limit by:
(1) multiplying the facility's quality score, as determined under section 256R.16,
subdivision 1new text begin , paragraph (d)new text end , by deleted text begin 0.5625deleted text end new text begin 2.0new text end ;
(2) deleted text begin adding 89.375 todeleted text end new text begin subtracting 40.0 fromnew text end the amount determined in clause (1), and
dividing the total by 100; deleted text begin and
deleted text end
(3) multiplying the amount determined in clause (2) by the median total care-related
cost per daydeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(4) multiplying the amount determined in clause (3) by the most-recent available
Core-Based Statistical Area wage indices established by the Centers for Medicare and
Medicaid Services for the Skilled Nursing Facility Prospective Payment System.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 23.
Minnesota Statutes 2018, section 256R.24, is amended to read:
256R.24 OTHER OPERATING PAYMENT RATE.
Subdivision 1.
Determination of deleted text begin other operatingdeleted text end new text begin laundry, housekeeping, and dietarynew text end
cost per day.
Each facility's deleted text begin other operatingdeleted text end new text begin laundry, housekeeping, and dietarynew text end cost per
day is deleted text begin its other operatingdeleted text end new text begin equal to its laundry, housekeeping, and dietarynew text end costs divided by
the sum of the facility's resident days.
Subd. 2.
Determination of the deleted text begin median other operating cost per daydeleted text end new text begin mediansnew text end .
The
commissioner must determine thenew text begin laundry, housekeeping, and dietarynew text end median deleted text begin other operatingdeleted text end
cost pernew text begin residentnew text end day using the cost reports from nursing facilities in Anoka, Carver, Dakota,
Hennepin, Ramsey, Scott, and Washington Counties.
Subd. 3.
Determination of deleted text begin the other operatingdeleted text end payment ratenew text begin for laundry,
housekeeping, and dietarynew text end .
A facility's deleted text begin other operatingdeleted text end payment ratenew text begin for laundry,
housekeeping, and dietarynew text end equals 105 percent of the median deleted text begin other operating cost per daydeleted text end new text begin
for laundry, housekeeping, and dietary cost as determined in subdivision 2new text end .
new text begin Subd. 4. new text end
new text begin Administrative, maintenance, and plant operations. new text end
new text begin
(a) The payment rate
for administrative, maintenance, and plant operations is $48.57 per day effective January
1, 2020. For the rate period January 1, 2021, through December 31, 2023, this payment rate
is increased by one percent annually on January 1.
new text end
new text begin
(b) For rate years beginning on and after January 1, 2024, this payment rate is adjusted
by a forecasting market basket and forecasting index. The adjustment factor must come
from the Information Handling Services Healthcare Cost Review, the Skilled Nursing
Facility Total Market Basket Index, and the four-quarter moving average percentage change
line or a comparable index if this index ceases to be published. The commissioner shall use
the fourth quarter index of the upcoming calendar year from the forecast published for the
third quarter of the calendar year immediately prior to the rate year for which the rate is
being determined.
new text end
new text begin Subd. 5. new text end
new text begin Determination of the other operating payment rate. new text end
new text begin
A facility's other
operating payment rate equals the sum of the factors determined in subdivisions 3 and 4.
new text end
Sec. 24.
Minnesota Statutes 2018, section 256R.25, is amended to read:
256R.25 EXTERNAL FIXED COSTS PAYMENT RATE.
(a) The payment rate for external fixed costs is the sum of the amounts in paragraphs
(b) to deleted text begin (n)deleted text end new text begin (k)new text end .
(b) For a facility licensed as a nursing home, the portion related to the provider surcharge
under section 256.9657 is equal to $8.86 per resident day. For a facility licensed as both a
nursing home and a boarding care home, the portion related to the provider surcharge under
section 256.9657 is equal to $8.86 per resident day multiplied by the result of its number
of nursing home beds divided by its total number of licensed beds.
(c) The portion related to the licensure fee under section 144.122, paragraph (d), is the
amount of the fee divided by the sum of the facility's resident days.
(d) The portion related to development and education of resident and family advisory
councils under section 144A.33 is $5 per resident day divided by 365.
(e) The portion related to scholarships is determined under section 256R.37.
deleted text begin
(f) The portion related to planned closure rate adjustments is as determined under section
256R.40, subdivision 5, and Minnesota Statutes 2010, section 256B.436.
deleted text end
deleted text begin
(g) The portion related to consolidation rate adjustments shall be as determined under
section 144A.071, subdivisions 4c, paragraph (a), clauses (5) and (6), and 4d.
deleted text end
deleted text begin
(h) The portion related to single-bed room incentives is as determined under section
256R.41.
deleted text end
deleted text begin (i)deleted text end new text begin (f)new text end The portions related to real estate taxes, special assessments, and payments made
in lieu of real estate taxes directly identified or allocated to the nursing facility are the deleted text begin actualdeleted text end new text begin
allowablenew text end amounts divided by the sum of the facility's resident days. Allowable costs under
this paragraph for payments made by a nonprofit nursing facility that are in lieu of real
estate taxes shall not exceed the amount which the nursing facility would have paid to a
city or township and county for fire, police, sanitation services, and road maintenance costs
had real estate taxes been levied on that property for those purposes.
deleted text begin (j)deleted text end new text begin (g)new text end The portion related to employer health insurance costs is the allowable costs
divided by the sum of the facility's resident days.
deleted text begin (k)deleted text end new text begin (h)new text end The portion related to the Public Employees Retirement Association is deleted text begin actualdeleted text end new text begin
allowablenew text end costs divided by the sum of the facility's resident days.
deleted text begin (l)deleted text end new text begin (i)new text end The portion related to quality improvement incentive payment rate adjustments
is the amount determined under section 256R.39.
deleted text begin (m)deleted text end new text begin (j)new text end The portion related to performance-based incentive payments is the amount
determined under section 256R.38.
deleted text begin (n)deleted text end new text begin (k)new text end The portion related to special dietary needs is the amount determined under
section 256R.51.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January, 1, 2020.
new text end
Sec. 25.
Minnesota Statutes 2018, section 256R.26, is amended to read:
256R.26 PROPERTY PAYMENT RATE.
new text begin Subdivision 1. new text end
new text begin Generally. new text end
deleted text begin
The property payment rate for a nursing facility is the property
rate established for the facility under sections 256B.431 and 256B.434.
deleted text end
new text begin
(a) For rate years
beginning on or after January 1, 2020, the commissioner shall reimburse nursing facilities
participating in the medical assistance program for the rental use of real estate and depreciable
assets according to this section and sections 256R.261 to 256R.27. The property payment
rate made under this methodology is the only payment for costs related to capital assets,
including depreciation expense, interest and lease expenses for all depreciable assets, also
including depreciable movable equipment, land improvements, and land.
new text end
new text begin
(b) The commercial valuation system selected by the commissioner must be utilized in
all appraisals. The appraisal is not intended to exactly reflect market value, and no
adjustments or substitutions are permitted for any alternative analysis of properties than the
selected commercial valuation system.
new text end
new text begin
(c) Based on the valuation of a building and fixed equipment, the property appraisal
firm selected by the commissioner must produce a report detailing both the depreciated
replacement cost (DRC) and undepreciated replacement cost (URC) of the nursing facility.
The valuation excludes depreciable movable equipment, land, or land improvements. The
valuation must be adjusted for any shared area included in the DRC and URC not used for
nursing facility purposes. Physical plant for central office operations is not included in the
appraisal.
new text end
new text begin
(d) The appraisal initially may include the full value of all shared areas. The DRC, URC,
and square footage are established by an appraisal and must be adjusted to reflect only the
nursing facility usage of shared areas in the final nursing facility values. The adjustment
must be based on a Medicare-approved allocation basis for the type of service provided by
each area. Shared areas outside the appraised space must be added to the DRC, URC, and
related square footage using the average of each value from the space in the appraisal.
new text end
new text begin Subd. 2. new text end
new text begin Appraised value. new text end
new text begin
For rate years beginning on or after January 1, 2020, the
DRC and URC are based on the appraisals of a building and attached fixtures as determined
by the contracted property appraisal firm using a commercial valuation system selected by
the commissioner.
new text end
new text begin Subd. 3. new text end
new text begin Initial rate year. new text end
new text begin
The property payment rate calculated under section 256R.265
for the initial rate year effective January 1, 2020, must be a per diem amount based on the
DRC and URC of a nursing facility's building and attached fixtures, as estimated by a
commercial property appraisal firm in 2016. The initial values for both the DRC and URC,
adjusted for nonnursing facility space, must be increased by six percent.
new text end
new text begin Subd. 4. new text end
new text begin Subsequent rate years. new text end
new text begin
(a) Beginning in calendar year 2020, the commissioner
shall contract with a property appraisal firm to appraise the building and attached fixtures
for nursing facilities using the commercial valuation system. Approximately one-third of
the nursing facilities must be appraised each year.
new text end
new text begin
(b) If a nursing facility wishes to appeal findings of fact in the appraisal report, the
nursing facility must request a revision within 20 calendar days after receipt of the appraisal
report.
new text end
new text begin
(c) The property payment rate for rate year beginning January 1, 2021, for the one-third
of nursing facilities that are newly appraised in 2020 must be based upon new DRCs and
URCs for buildings and attached fixtures as determined by the contracted property appraisal
firm.
new text end
new text begin
(d) The property payment rate for rate years beginning January 1, 2021, and January 1,
2022, for the remainder of the nursing facilities that were not previously appraised, must
use the net DRC and URC used in the January 1, 2020, property payment rates adjusted for
inflation before any formula limitations are applied. The index for the inflation adjustment
must be based on the change in the United States All-Items Consumer Price Index (CPI-U)
forecasted by the Reports and Forecasts Division of the Department of Human Services in
the third quarter of the calendar year preceding the rate year. The inflation adjustment must
be based on the 12-month period from the midpoint of the previous rate year to the midpoint
of the rate year for which the rate is being determined. Nursing facilities under this paragraph
must have the property payment rates beginning January 1, 2022, and January 1, 2023,
based on new replacement costs and depreciated values as determined in appraisals based
on the three-year cycle.
new text end
new text begin
(e) For the nursing facilities that have an on-site property appraisal conducted by the
commissioner's designee after the initial 2016 appraisal, the most recent appraisal must be
used in subsequent years until a new on-site property appraisal is conducted. In the years
after the initial appraisal, the most recent DRC and URC must be updated through the
commercial valuation system. These valuations are updates only and not subject to revisions
of any of the original valuations or appeal by the nursing facility.
new text end
new text begin Subd. 5. new text end
new text begin Special reappraisals. new text end
new text begin
(a) A nursing facility that completes an addition to or
replacement of a building or attached fixtures as approved in section 144A.073 after January
1, 2020, may request a property rate adjustment effective the first of January, April, July,
or October after project completion. The nursing facility must submit all cost data related
to the project to the commissioner within 90 days of project completion. The commissioner
must add the nursing facility to the next group of scheduled appraisals. The nursing facility's
updated appraisal must be used to calculate a revised property rate effective the first of
January, April, July, or October after project completion. If an updated appraisal cannot be
scheduled within 90 days of the effective date of the revised property, the commissioner
must establish an interim valuation which must be adjusted retroactively when the updated
appraisal is available. For a nursing facility with projects approved under section 144A.073
prior to January 1, 2020, moratorium project construction adjustments must be calculated
under Minnesota Statutes 2018, section 256B.434, subdivision 4f, and the adjustment added
to the nursing facility's hold harmless rate effective the first of January, April, July, or
October after project completion. This adjustment is in addition to the updated appraisal
described in this paragraph.
new text end
new text begin
(b) A nursing facility that completes a threshold construction project after January 1,
2020, may submit a project rate adjustment request to the commissioner if the building
improvement or addition costs exceed $300,000 and the threshold construction project is
not reflected in an appraisal used for rate setting. The cost must be incurred by the nursing
facility, or if the nursing facility is leased and the cost is incurred by the lease holder, the
provider's lease has been increased for the project. Threshold project costs exceeding a total
of $1,500,000 within a three-year period, or a prorated amount if the appraisals are less than
three years apart, must not be recognized. The property payment rate must be updated to
reflect the new DRC and URC values effective the first of January or July after project
completion. In subsequent property payment rate calculations, an addition to the DRC and
URC must be eliminated once a full appraisal is complete for the nursing facility after project
completion. At the option of the commissioner, the appraisal schedule may be adjusted for
nursing facilities completing threshold projects. Threshold project costs are not considered
if the costs were incurred prior to the date of the last appraisal.
new text end
new text begin
(c) Effective January 1, 2020, a nursing facility new to the medical assistance program
must have the building and fixed equipment appraised by the property appraisal firm upon
completion of construction of the nursing facility, or, if not newly constructed, upon entering
the medical assistance program. If an appraisal cannot be scheduled within 90 days of the
certification date, the commissioner must establish an interim valuation to be adjusted
retroactively when the appraisal is available.
new text end
new text begin Subd. 6. new text end
new text begin Limitation on appraisal valuations. new text end
new text begin
Effective for appraisals conducted on or
after January 1, 2020, the increase in the URC is limited to $500,000 per year since the last
completed appraisal plus any completed project costs approved under section 144A.073.
Any limitation to the URC must be applied in the same proportion to the DRC.
new text end
new text begin Subd. 7. new text end
new text begin Total hold harmless rate. new text end
new text begin
(a) Total hold harmless rate includes planned closure
adjustments under Minnesota Statutes 2018, section 256R.40, subdivision 5; consolidation
adjustments under section 144A.071, subdivisions 4c, paragraph (a), clauses (5) and (6),
and 4d; equity incentives under sections 256B.431, subdivision 16, and Minnesota Statutes
2018, 256B.434, subdivision 4f; single-bed incentives under Minnesota Statutes 2018,
section 256R.41; project construction costs under Minnesota Statutes 2018, section 144A.071,
subdivision 1a, paragraph (j); and all components of the property payment rate under section
256R.26 in effect on December 31, 2019.
new text end
new text begin
(b) For moratorium projects as defined under sections 144A.071 and 144A.073 that are
eligible for rate adjustments approved prior to January 1, 2020, but not reflected in the rate
on December 31, 2019, the moratorium rate adjustments determined under Minnesota
Statutes 2018, sections 256B.431, subdivisions 3f, 17, 17a, 17c, 17d, 17e, 21, 30, and 45,
and 256B.434, subdivisions 4f and 4j, must be added to the total hold harmless rate in effect
on the first of January, April, July, or October after project completion.
new text end
new text begin
(c) Effective January 1, 2020, rate adjustments under Minnesota Statutes 2018, section
256R.25, paragraphs (f) to (h) from previous rate years shall be included in the total hold
harmless rate.
new text end
new text begin
(d) This subdivision expires effective January 1, 2026.
new text end
new text begin Subd. 8. new text end
new text begin Phase out of hold harmless rate. new text end
new text begin
(a) For a nursing facility that has a higher
total hold harmless rate than the rate calculated in section 256R.265, the nursing facility
must receive 100 percent of the total hold harmless rate for the rate year beginning January
1, 2020.
new text end
new text begin
(b) For rate years beginning January 1, 2021, to January 1, 2024, the property payment
rate is a blending of the total hold harmless rate and the property rate determined in section
256R.265, plus any adjustments issued for construction projects between appraisals, if a
higher rate results. If not, the property payment rate is determined according to section
256R.265.
new text end
new text begin
(c) For the rate year beginning January 1, 2021, for eligible nursing facilities, the property
payment rate is 80 percent of the total hold harmless rate and 20 percent of the property
payment rate calculated in section 256R.265.
new text end
new text begin
(d) For the rate year beginning January 1, 2022, for eligible nursing facilities, the property
payment rate is 60 percent of the total hold harmless rate and 40 percent of the property
payment rate calculated in section 256R.265.
new text end
new text begin
(e) For the rate year beginning January 1, 2023, for eligible nursing facilities, the property
payment rate is 40 percent of the total hold harmless rate and 60 percent of the property
payment rate calculated in section 256R.265.
new text end
new text begin
(f) For the rate year beginning January 1, 2024, for eligible nursing facilities, the property
payment rate is 20 percent of the total hold harmless rate and 80 percent of the property
payment rate calculated in section 256R.265.
new text end
new text begin
(g) For rate years beginning January 1, 2025, and thereafter, the property payment rate
is as calculated under section 256R.265.
new text end
new text begin
(h) This subdivision expires effective January 1, 2026.
new text end
Sec. 26.
new text begin
[256R.261] NURSING FACILITY PROPERTY RATE DEFINITIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
For purposes of sections 256R.26 to 256R.27, the following
terms have the meanings given them.
new text end
new text begin Subd. 2. new text end
new text begin Addition. new text end
new text begin
"Addition" means an extension, enlargement, or expansion of the
nursing facility for the purpose of increasing the number of licensed beds or improving
resident care.
new text end
new text begin Subd. 3. new text end
new text begin Appraisal. new text end
new text begin
"Appraisal" means an evaluation of the nursing facility's physical
real estate conducted by a property appraisal firm selected by the commissioner to establish
the valuation of a building and fixed equipment.
new text end
new text begin Subd. 4. new text end
new text begin Building. new text end
new text begin
"Building" means the physical plant and fixed equipment used directly
for resident care and licensed under chapter 144A or sections 144.50 to 144.56. Building
excludes buildings or portions of buildings used by central, affiliated, or corporate offices.
new text end
new text begin Subd. 5. new text end
new text begin Commercial valuation system. new text end
new text begin
"Commercial valuation system" means a
commercially available building valuation system selected by the commissioner.
new text end
new text begin Subd. 6. new text end
new text begin Depreciable movable equipment. new text end
new text begin
"Depreciable movable equipment" means
the standard movable care equipment and support service equipment generally used in
nursing facilities. Depreciable movable equipment includes equipment specified in the major
movable equipment table of the depreciation guidelines. The general characteristics of this
equipment are: (1) a relatively fixed location in the building; (2) capable of being moved
as distinguished from building equipment; (3) a unit cost sufficient to justify ledger control;
and (4) sufficient size and identity to make control feasible by means of identification tags.
new text end
new text begin Subd. 7. new text end
new text begin Depreciated replacement cost or DRC. new text end
new text begin
"Depreciated replacement cost" or
"DRC" means the depreciated replacement cost determined by an appraisal using the
commercial valuation system. DRC excludes costs related to parking structures.
new text end
new text begin Subd. 8. new text end
new text begin Depreciation expense. new text end
new text begin
"Depreciation expense" means the portion of a capital
asset deemed to be consumed or expired over the life of the asset.
new text end
new text begin Subd. 9. new text end
new text begin Depreciation guidelines. new text end
new text begin
"Depreciation guidelines" means the most recent
publication of "Estimated Useful Lives of Depreciable Hospital Assets" issued by the
American Hospital Association.
new text end
new text begin Subd. 10. new text end
new text begin Equipment allowance. new text end
new text begin
"Equipment allowance" means the component of the
property-related payment rate which is a payment for the use of depreciable movable
equipment.
new text end
new text begin Subd. 11. new text end
new text begin Fair rental value system. new text end
new text begin
"Fair rental value system" means a system that
establishes a price for the use of a space based on an appraised value of the property. The
price is established without consideration of the actual accounting cost to construct or
remodel the property. The price is the nursing facility value, subject to limits, multiplied
by an established rental rate.
new text end
new text begin Subd. 12. new text end
new text begin Fixed equipment. new text end
new text begin
"Fixed equipment" means equipment affixed to the building
and not subject to transfer, including but not limited to wiring, electrical fixtures, plumbing,
elevators, and heating and air conditioning systems.
new text end
new text begin Subd. 13. new text end
new text begin Land improvement. new text end
new text begin
"Land improvement" means improvement to the land
surrounding the nursing facility directly used for nursing facility operations as specified in
the land improvements table of the depreciation guidelines. Land improvement includes
construction of auxiliary buildings including sheds, garages, storage buildings, and parking
structures.
new text end
new text begin Subd. 14. new text end
new text begin Rental rate. new text end
new text begin
"Rental rate" means the percentage applied to the allowable value
of the building and attached fixtures per year in the property payment calculation as
determined by the commissioner.
new text end
new text begin Subd. 15. new text end
new text begin Shared area. new text end
new text begin
"Shared area" means square footage that a nursing facility shares
with a non-nursing facility operation to provide a support service.
new text end
new text begin Subd. 16. new text end
new text begin Threshold project. new text end
new text begin
"Threshold project" means additions to a building or fixed
equipment that exceed the costs specified in section 256R.26, subdivision 5, paragraph (b).
Threshold projects exclude land, land improvements, and depreciable movable equipment
purchases.
new text end
new text begin Subd. 17. new text end
new text begin Undepreciated replacement cost or URC. new text end
new text begin
"Undepreciated replacement cost"
or "URC" means the undepreciated replacement cost determined by the appraisal for building
and attached fixtures using a commercial valuation system. URC excludes costs related to
parking structures.
new text end
new text begin Subd. 18. new text end
new text begin Undepreciated replacement cost (URC) per bed limit. new text end
new text begin
"Undepreciated
replacement cost (URC) per bed limit" means the maximum allowed URC per nursing
facility bed as established by the commissioner based on values across the industry and
compared to an industry standard for reasonableness.
new text end
Sec. 27.
new text begin
[256R.265] PROPERTY RATE CALCULATION UNDER FAIR RENTAL
VALUE SYSTEM.
new text end
new text begin Subdivision 1. new text end
new text begin Square feet per bed limit. new text end
new text begin
The square feet per bed limit is calculated as
follows:
new text end
new text begin
(1) the URC of the nursing facility from the appraisal is divided by the total allowable
square feet;
new text end
new text begin
(2) the total allowable square feet per bed is calculated by dividing the actual square
feet from the appraisal, after adjustment for non-nursing facility area, by the number of
licensed beds three months prior to the beginning of the rate year limited to the following
maximum. The allowable square feet maximum is 800 square feet per bed plus 25 percent
of the square feet over 800 up to 1,200 square feet per bed. Square feet over 1,200 square
feet per bed is not recognized; and
new text end
new text begin
(3) the total allowable square feet per bed in clause (2) is multiplied by the amount in
clause (1) and by the number of licensed beds three months prior to the beginning of the
rate year to determine the square feet per bed limit.
new text end
new text begin Subd. 2. new text end
new text begin Total URC limit. new text end
new text begin
The total URC limit is calculated as follows:
new text end
new text begin
(1) the square feet per bed limit as determined in subdivision 1 is divided by the number
of licensed beds three months prior to the beginning of the rate year to determine allowable
URC per bed for each nursing facility, adjusted for square feet limitation;
new text end
new text begin
(2) the allowable URC per bed, adjusted for square feet limitation, for all nursing facilities
is placed in an array annually to determine the value at the 75th percentile. This is the limit
for the URC per bed for non-single beds;
new text end
new text begin
(3) the value determined in clause (2) is multiplied by 115 percent to determine the limit
for the URC per bed for single beds;
new text end
new text begin
(4) the number of non-single-licensed beds three months prior to the beginning of the
rate year is multiplied by the amount in clause (2);
new text end
new text begin
(5) the number of single-licensed beds three months prior to the beginning of the rate
year is multiplied by the amount in clause (3); and
new text end
new text begin
(6) the amounts in clauses (4) and (5) are summed to determine the total URC limit;
new text end
new text begin Subd. 3. new text end
new text begin Calculation of total property rate. new text end
new text begin
The total property rate is calculated as
follows:
new text end
new text begin
(1) the lower of the allowable URC based on square feet per bed limit as determined
under subdivision 1 or the total URC limit in subdivision 2 is the final allowed URC;
new text end
new text begin
(2) the final allowed URC determined in clause (1) is divided by the URC from the
appraisal to determine the allowed percentage. The allowed percentage is multiplied by the
depreciated replacement value from the appraisal, adjusted for non-nursing facility area, to
determine the final allowed depreciated replacement value;
new text end
new text begin
(3) the number of licensed beds three months prior to the beginning of the rate year is
multiplied by $5,305 to determine reimbursement for land and land improvements. There
is no separate addition to the property rate for parking structures;
new text end
new text begin
(4) the values in clauses (2) and (3) are summed and then multiplied by the rental rate
of 5.5 percent to determine allowable property reimbursement;
new text end
new text begin
(5) the allowable property reimbursement determined in clause (4) is divided by 90
percent of capacity days to determine the building property rate. Capacity days are determined
by multiplying the number of licensed beds three months prior to the beginning of the report
year by 365;
new text end
new text begin
(6) for the rate year beginning January 1, 2020, the equipment allowance is $2.77 per
resident day. For the rate year beginning January 1, 2021, the equipment allowance must
be adjusted annually for inflation. The index for the inflation adjustment must be based on
the change in the United States All Items Consumer Price Index (CPI-U) forecasted by the
Reports and Forecasts Division of the Department of Human Services in the third quarter
of the calendar year preceding the rate year. The inflation adjustment must be based on the
12-month period from the midpoint of the previous rate year to the midpoint of the rate year
for which the rate is being determined; and
new text end
new text begin
(7) the sum of the building property rate and the equipment allowance is the total property
rate.
new text end
Sec. 28.
new text begin
[256R.27] INTERIM AND SETTLE UP PAYMENT RATES.
new text end
new text begin Subdivision 1. new text end
new text begin Generally. new text end
new text begin
(a) The commissioner shall determine the interim payment
rates and settle up payment rates for a newly constructed nursing facility, or a nursing facility
with an increase in licensed capacity of 50 percent or more, according to subdivisions 2 and
3.
new text end
new text begin
(b) The nursing facility must submit a written application to the commissioner to receive
interim payment rates. In its application, the nursing facility must state any reasons for
noncompliance with this chapter.
new text end
new text begin
(c) The effective date of the interim payment rates is the earlier of either the first day a
resident is admitted to the newly constructed nursing facility or the date the nursing facility
bed is certified for the medical assistance program. The interim payment rates must not be
in effect for more than 17 months.
new text end
new text begin
(d) The nursing facility must continue to receive the interim payment rates until the
settle up payment rates are determined under subdivision 3.
new text end
new text begin
(e) For the 15-month period following the settle up reporting period, the settle up payment
rates must be determined according to subdivision 3, paragraph (c).
new text end
new text begin
(f) The settle up payment rates are effective retroactively to the beginning of the interim
cost reporting period and are effective until the end of the interim rate period.
new text end
new text begin
(g) The total operating and external fixed costs payment rate for the rate year beginning
January 1 following the 15-month period in paragraph (e) must be determined under this
chapter.
new text end
new text begin Subd. 2. new text end
new text begin Determination of interim payment rates. new text end
new text begin
(a) The nursing facility shall submit
an interim cost report in a format similar to the Minnesota Statistical and Cost Report and
other supporting information as required by this chapter for the reporting year in which the
nursing facility plans to begin operation at least 60 days before the first day a resident is
admitted to the newly constructed nursing facility bed. The interim cost report must include
the nursing facility's anticipated interim costs and anticipated interim resident days for each
resident class in the interim cost report. The anticipated interim resident days for each
resident class is multiplied by the weight for that resident class to determine the anticipated
interim standardized days as defined in section 256R.02, subdivision 50, and resident days
as defined in section 256R.02, subdivision 45, for the reporting period.
new text end
new text begin
(b) The interim total operating payment rate is determined according to this section,
except that:
new text end
new text begin
(1) the anticipated interim costs and anticipated interim resident days reported on the
interim cost report and the anticipated interim standardized days as defined by section
256R.02, subdivision 50, must be used for the interim;
new text end
new text begin
(2) the commissioner shall use anticipated interim costs and anticipated interim
standardized days in determining the allowable historical direct care cost per standardized
day as determined under section 256R.23, subdivision 2;
new text end
new text begin
(3) the commissioner shall use anticipated interim costs and anticipated interim resident
days in determining the allowable historical other care-related cost per resident day as
determined under section 256R.23, subdivision 3;
new text end
new text begin
(4) the commissioner shall use anticipated interim costs and anticipated interim resident
days to determine the allowable historical external fixed costs per day under section 256R.25,
paragraphs (b) to (k);
new text end
new text begin
(5) the total care-related payment rate limits established in section 256R.23, subdivision
5, and in effect at the beginning of the interim period, must be increased by ten percent; and
new text end
new text begin
(6) the other operating payment rate as determined under section 256R.24 in effect for
the rate year must be used for the other operating cost per day.
new text end
new text begin Subd. 3. new text end
new text begin Determination of settle up payment rates. new text end
new text begin
(a) When the interim payment
rates begin between May 1 and September 30, the nursing facility shall file settle up cost
reports for the period from the beginning of the interim payment rates through September
30 of the following year.
new text end
new text begin
(b) When the interim payment rates begin between October 1 and April 30, the nursing
facility shall file settle up cost reports for the period from the beginning of the interim
payment rates to the first September 30 following the beginning of the interim payment
rates.
new text end
new text begin
(c) The settle up total operating payment rate is determined according to this section,
except that:
new text end
new text begin
(1) the allowable costs and resident days reported on the settle up cost report and the
standardized days as defined by section 256R.02, subdivision 50, must be used for the
interim and settle-up period;
new text end
new text begin
(2) the commissioner shall use the allowable costs and standardized days in clause (1)
to determine the allowable historical direct care cost per standardized day as determined
under section 256R.23, subdivision 2;
new text end
new text begin
(3) the commissioner shall use the allowable costs and the allowable resident days to
determine both the allowable historical other care-related cost per resident day as determined
under section 256R.23, subdivision 3;
new text end
new text begin
(4) the commissioner shall use the allowable costs and the allowable resident days to
determine the allowable historical external fixed costs per day under section 256R.25,
paragraphs (b) to (k);
new text end
new text begin
(5) the total care-related payment limits established in section 256R.23, subdivision 5,
are the limits for the settle up reporting periods. If the interim period includes more than
one July 1 date, the commissioner shall use the total care-related payment rate limit
established in section 256R.23, subdivision 5, increased by ten percent for the second July
1 date; and
new text end
new text begin
(6) the other operating payment rate as determined under section 256R.24 in effect for
the rate year must be used for the other operating cost per day.
new text end
Sec. 29.
new text begin
[256R.28] INTERIM AND SETTLE UP PAYMENT RATES FOR NEW
OWNERS AND OPERATORS.
new text end
new text begin Subdivision 1. new text end
new text begin Generally. new text end
new text begin
(a) A nursing facility that undergoes a change of ownership
or operator resulting in a change of licensee, as determined by the commissioner of health
under chapter 144A, after December 31, 2019, must receive interim payment rates and settle
up payment rates according to this section.
new text end
new text begin
(b) The effective date of the interim rates is the effective date of the new license. The
interim payment rates must not be in effect for more than 26 months.
new text end
new text begin
(c) The nursing facility must continue to receive the interim payment rates until the settle
up payment rates are determined under subdivision 3.
new text end
new text begin
(d) The settle up payment rates are effective retroactively to the effective date of the
new license and remain effective until the end of the interim rate period.
new text end
new text begin
(e) For the 15-month period following the settle up payment, rates must be determined
according to subdivision 3, paragraph (c).
new text end
new text begin
(f) The total operating and external fixed costs payment rates for the rate year beginning
January 1 following the 15-month period in paragraph (e) must be determined under section
256R.21.
new text end
new text begin Subd. 2. new text end
new text begin Determination of interim payment rates. new text end
new text begin
The interim total payment rates
must be the rates established under section 256R.21.
new text end
new text begin Subd. 3. new text end
new text begin Determination of settle up payment rates. new text end
new text begin
(a) When the interim payment
rates begin between May 1 and September 30, the nursing facility shall file settle up cost
reports for the period from the beginning of the interim payment rates through September
30 of the following year.
new text end
new text begin
(b) When the interim payment rates begin between October 1 and April 30, the nursing
facility shall file settle up cost reports for the period from the beginning of the interim
payment rates to the first September 30 following the beginning of the interim payment
rates.
new text end
new text begin
(c) The settle up total payment rates are determined according to section 256R.21, except
that the commissioner shall:
new text end
new text begin
(1) use the allowable costs and the resident days from the settle up cost reports to
determine the allowable external fixed costs payment rate; and
new text end
new text begin
(2) use the allowable costs and the resident days from the settle up cost reports to
determine the total care-related payment rate.
new text end
Sec. 30.
Minnesota Statutes 2018, section 256R.44, is amended to read:
256R.44 RATE ADJUSTMENT FOR PRIVATE ROOMS FOR MEDICAL
NECESSITY.
The amount paid for a private room is deleted text begin 111.5deleted text end new text begin 110new text end percent of the established total payment
rate for a resident if the resident is a medical assistance recipient and the private room is
considered a medical necessity for the resident or others who are affected by the resident's
conditiondeleted text begin , except as provided in Minnesota Rules, part 9549.0060, subpart 11, item Cdeleted text end .
Conditions requiring a private room must be determined by the resident's attending physician
and submitted to the commissioner for approval or denial by the commissioner on the basis
of medical necessity.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 31.
Minnesota Statutes 2018, section 256R.47, is amended to read:
256R.47 RATE ADJUSTMENT FOR CRITICAL ACCESS NURSING
FACILITIES.
(a) The commissioner, in consultation with the commissioner of health, may designate
certain nursing facilities as critical access nursing facilities. The designation shall be granted
on a competitive basis, within the limits of funds appropriated for this purpose.
(b) The commissioner shall request proposals from nursing facilities every two years.
Proposals must be submitted in the form and according to the timelines established by the
commissioner. In selecting applicants to designate, the commissioner, in consultation with
the commissioner of health, and with input from stakeholders, shall develop criteria designed
to preserve access to nursing facility services in isolated areas, rebalance long-term care,
and improve quality. To the extent practicable, the commissioner shall ensure an even
distribution of designations across the state.
(c) The commissioner shall allow the benefits in clauses (1) to (5) for nursing facilities
designated as critical access nursing facilities:
(1) partial rebasing, with the commissioner allowing a designated facility operating
payment rates being the sum of up to 60 percent of the operating payment rate determined
in accordance with section 256R.21, subdivision 3, and at least 40 percent, with the sum of
the two portions being equal to 100 percent, of the operating payment rate that would have
been allowed had the facility not been designated. The commissioner may adjust these
percentages by up to 20 percent and may approve a request for less than the amount allowed;
(2) enhanced payments for leave days. Notwithstanding section 256R.43, upon
designation as a critical access nursing facility, the commissioner shall limit payment for
leave days to 60 percent of that nursing facility's total payment rate for the involved resident,
and shall allow this payment only when the occupancy of the nursing facility, inclusive of
bed hold days, is equal to or greater than 90 percent;
(3) two designated critical access nursing facilities, with up to 100 beds in active service,
may jointly apply to the commissioner of health for a waiver of Minnesota Rules, part
4658.0500, subpart 2, in order to jointly employ a director of nursing. The commissioner
of health shall consider each waiver request independently based on the criteria under
Minnesota Rules, part 4658.0040;
(4) the minimum threshold under section 256B.431, subdivision 15, paragraph (e), shall
be 40 percent of the amount that would otherwise apply; and
(5) the quality-based rate limits under section 256R.23, subdivisions 5 to 7, apply to
designated critical access nursing facilities.
(d) Designation of a critical access nursing facility is for a period of two years, after
which the benefits allowed under paragraph (c) shall be removed. Designated facilities may
apply for continued designation.
(e) This section is suspended and no state or federal funding shall be appropriated or
allocated for the purposes of this section from January 1, 2016, deleted text begin to December 31, 2019.deleted text end new text begin
through December 31, 2023.
new text end
Sec. 32.
Minnesota Statutes 2018, section 256R.50, subdivision 6, is amended to read:
Subd. 6.
Determination of rate adjustment.
(a) If the amount determined in subdivision
5 is less than or equal to the amount determined in subdivision 4, the commissioner shall
allow a total payment rate equal to the amount used in subdivision 5, clause (3).
(b) If the amount determined in subdivision 5 is greater than the amount determined in
subdivision 4, the commissioner shall allow a rate with a case mix index of 1.0 that when
used in subdivision 5, clause (3), results in the amount determined in subdivision 5 being
equal to the amount determined in subdivision 4.
(c) If the commissioner relies upon provider estimates in subdivision 5, clause (1) or
(2), then annually, for three years after the rates determined in this section take effect, the
commissioner shall determine the accuracy of the alternative factors of medical assistance
case load and the facility average case mix index used in this section and shall reduce the
total payment rate if the factors used result in medical assistance costs exceeding the amount
in subdivision 4. If the actual medical assistance costs exceed the estimates by more than
five percent, the commissioner shall also recover the difference between the estimated costs
in subdivision 5 and the actual costs according to section 256B.0641. The commissioner
may require submission of data from the receiving facility needed to implement this
paragraph.
(d) When beds approved for relocation are put into active service at the destination
facility, rates determined in this section must be adjusted by any adjustment amounts that
were implemented after the date of the letter of approval.
new text begin
(e) Rate adjustments determined under this subdivision expire after three full rate years
following the effective date of the rate adjustment. This subdivision expires when the final
rate adjustment determined under this subdivision expires.
new text end
Sec. 33. new text begin DIRECTION TO COMMISSIONER; MORATORIUM EXCEPTION
FUNDING.
new text end
new text begin
In fiscal year 2020, the commissioner of health may approve moratorium exception
projects under Minnesota Statutes, section 144A.073, for which the full annualized state
share of medical assistance costs does not exceed $1,500,000 plus any carryover of previous
appropriations for this purpose.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 34. new text begin REVISOR INSTRUCTION.
new text end
new text begin
In Minnesota Statutes, the revisor of statutes shall renumber the nursing facility
contracting provisions that are currently coded as section 256B.434, subdivisions 1 and 3,
as amended by this act, as a section in chapter 256R and revise any statutory cross-references
consistent with that recoding.
new text end
Sec. 35. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2018, sections 144A.071, subdivision 4d; 256R.40; and 256R.41,
new text end
new text begin
are repealed effective July 1, 2019.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2018, sections 256B.431, subdivisions 3a, 3f, 3g, 3i, 10, 13, 15,
16, 17, 17a, 17c, 17d, 17e, 18, 21, 22, 30, and 45; 256B.434, subdivisions 4, 4f, 4i, and 4j;
and 256R.36,
new text end
new text begin
and
new text end
new text begin
Minnesota Rules, parts 9549.0057; and 9549.0060, subparts 4, 5, 6, 7,
10, 11, and 14,
new text end
new text begin
are repealed effective January 1, 2020.
new text end
new text begin
(c)
new text end
new text begin
Minnesota Statutes 2018, section 256B.434, subdivisions 6 and 10,
new text end
new text begin
are repealed
effective the day following final enactment.
new text end
ARTICLE 5
DISABILITY SERVICES
Section 1.
Minnesota Statutes 2018, section 237.50, subdivision 4a, is amended to read:
Subd. 4a.
Deaf.
"Deaf" means a hearing loss of such severity that the deleted text begin individualdeleted text end new text begin personnew text end
must depend primarily upon visual communication such as writing, lip reading, sign language,
and gestures.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
new text end
Sec. 2.
Minnesota Statutes 2018, section 237.50, is amended by adding a subdivision to
read:
new text begin Subd. 4c. new text end
new text begin Discounted telecommunications or Internet services. new text end
new text begin
"Discounted
telecommunications or Internet services" means private, nonprofit, and public programs
intended to subsidize or reduce the monthly costs of telecommunications or Internet services
for a person who meets a program's eligibility requirements.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
new text end
Sec. 3.
Minnesota Statutes 2018, section 237.50, subdivision 6a, is amended to read:
Subd. 6a.
Hard-of-hearing.
"Hard-of-hearing" means a hearing loss resulting in a
functional limitation, but not to the extent that the deleted text begin individualdeleted text end new text begin personnew text end must depend primarily
upon visual communicationnew text begin in all interactionsnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
new text end
Sec. 4.
Minnesota Statutes 2018, section 237.50, is amended by adding a subdivision to
read:
new text begin Subd. 6b. new text end
new text begin Interconnectivity product. new text end
new text begin
"Interconnectivity product" means a device,
accessory, or application for which the primary function is use with a telecommunications
device. Interconnectivity product may include a cell phone amplifier, hearing aid streamer,
Bluetooth-enabled device that connects to a wireless telecommunications device, advanced
communications application for a smartphone, or other applicable technology.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
new text end
Sec. 5.
Minnesota Statutes 2018, section 237.50, subdivision 10a, is amended to read:
Subd. 10a.
Telecommunications device.
"Telecommunications device" means a device
that (1) allows a person with a communication disability to have access to
telecommunications services as defined in subdivision 13, and (2) is specifically selected
by the Department of Human Services for its capacity to allow persons with communication
disabilities to use telecommunications services in a manner that is functionally equivalent
to the ability of deleted text begin an individualdeleted text end new text begin a personnew text end who does not have a communication disability. A
telecommunications device may include a ring signaler, an amplified telephone, a hands-free
telephone, a text telephone, a captioned telephone, a wireless device, a device that produces
Braille output for use with a telephone, and any other device the Department of Human
Services deems appropriate.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
new text end
Sec. 6.
Minnesota Statutes 2018, section 237.50, subdivision 11, is amended to read:
Subd. 11.
Telecommunications Relay Services.
"Telecommunications Relay Services"
or "TRS" means the telecommunications transmission services required under Federal
Communications Commission regulations at Code of Federal Regulations, title 47, sections
64.604 to 64.606. TRS allows deleted text begin an individualdeleted text end new text begin a personnew text end who has a communication disability
to use telecommunications services in a manner that is functionally equivalent to the ability
of deleted text begin an individualdeleted text end new text begin a personnew text end who does not have a communication disability.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
new text end
Sec. 7.
Minnesota Statutes 2018, section 237.51, subdivision 1, is amended to read:
Subdivision 1.
Creation.
new text begin (a) new text end The commissioner of commerce shall:
(1) administer through interagency agreement with the commissioner of human services
a program to distribute telecommunications devices new text begin and interconnectivity productsnew text end to eligible
persons who have communication disabilities; and
(2) contract with one or more qualified vendors that serve persons who have
communication disabilities to provide telecommunications relay services.
new text begin (b) new text end For purposes of sections 237.51 to 237.56, the Department of Commerce and any
organization with which it contracts pursuant to this section or section 237.54, subdivision
2, are not telephone companies or telecommunications carriers as defined in section 237.01.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
new text end
Sec. 8.
Minnesota Statutes 2018, section 237.51, subdivision 5a, is amended to read:
Subd. 5a.
Commissioner of human services duties.
(a) In addition to any duties specified
elsewhere in sections 237.51 to 237.56, the commissioner of human services shall:
(1) define economic hardship, special needs, and household criteria so as to determine
the priority of eligible applicants for initial distribution of devices new text begin and products new text end and to
determine circumstances necessitating provision of more than one telecommunications
device per household;
(2) establish a method to verify eligibility requirements;
(3) establish specifications for telecommunications devices new text begin and interconnectivity productsnew text end
to be provided under section 237.53, subdivision 3;
(4) inform the public and specifically persons who have communication disabilities of
the program; deleted text begin and
deleted text end
(5) provide devices new text begin and products new text end based on the assessed need of eligible applicantsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(6) assist a person with completing an application for discounted telecommunications
or Internet services.
new text end
(b) The commissioner may establish an advisory board to advise the department in
carrying out the duties specified in this section and to advise the commissioner of commerce
in carrying out duties under section 237.54. If so established, the advisory board must
include, at a minimum, the following persons:
(1) at least one member who is deaf;
(2) at least one member who has a speech disability;
(3) at least one member who has a physical disability that makes it difficult or impossible
for the person to access telecommunications services; and
(4) at least one member who is hard-of-hearing.
new text begin (c) new text end The membership terms, compensation, and removal of members and the filling of
membership vacancies are governed by section 15.059. Advisory board meetings shall be
held at the discretion of the commissioner.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
new text end
Sec. 9.
Minnesota Statutes 2018, section 237.52, subdivision 5, is amended to read:
Subd. 5.
Expenditures.
(a) Money in the fund may only be used for:
(1) expenses of the Department of Commerce, including personnel cost, public relations,
advisory board members' expenses, preparation of reports, and other reasonable expenses
not to exceed ten percent of total program expenditures;
(2) reimbursing the commissioner of human services for purchases made or services
provided pursuant to section 237.53; and
(3) contracting for the provision of TRS required by section 237.54.
(b) All costs directly associated with the establishment of the program, the purchase and
distribution of telecommunications devicesdeleted text begin ,deleted text end new text begin and interconnectivity products, new text end and the provision
of TRS are either reimbursable or directly payable from the fund after authorization by the
commissioner of commerce. The commissioner of commerce shall contract with one or
more TRS providers to indemnify the telecommunications service providers for any fines
imposed by the Federal Communications Commission related to the failure of the relay
service to comply with federal service standards. Notwithstanding section 16A.41, the
commissioner may advance money to the TRS providers if the providers establish to the
commissioner's satisfaction that the advance payment is necessary for the provision of the
service. The advance payment may be used only for working capital reserve for the operation
of the service. The advance payment must be offset or repaid by the end of the contract
fiscal year together with interest accrued from the date of payment.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
new text end
Sec. 10.
Minnesota Statutes 2018, section 237.53, is amended to read:
237.53 TELECOMMUNICATIONS deleted text begin DEVICEdeleted text end new text begin DEVICES AND
INTERCONNECTIVITY PRODUCTSnew text end .
Subdivision 1.
Application.
A person applying for a telecommunications devicenew text begin or
interconnectivity productnew text end under this section must apply to the program administrator on a
form prescribed by the Department of Human Services.
Subd. 2.
Eligibility.
To be eligible to obtain a telecommunications devicenew text begin or
interconnectivity productnew text end under this section, a person must:
(1) be able to benefit from and use the equipment for its intended purpose;
(2) have a communication disability;
(3) be a resident of the state;
(4) be a resident in a household that has a median income at or below the applicable
median household income in the state, except a person who is deafblind applying for a
Braille device may reside in a household that has a median income no more than 150 percent
of the applicable median household income in the state; and
(5) be a resident in a household that has telecommunications service or that has made
application for service and has been assigned a telephone number; or a resident in a residential
care facility, such as a nursing home or group home where telecommunications service is
not included as part of overall service provision.
new text begin Subd. 2a. new text end
new text begin Assessment of needs. new text end
new text begin
After a person is determined to be eligible for the
program, the commissioner of human services shall assess the person's telecommunications
needs to determine: (1) the type of telecommunications device that provides the person with
functionally equivalent access to telecommunications services; and (2) appropriate
interconnectivity products for the person.
new text end
Subd. 3.
Distribution.
The commissioner of human services shall new text begin (1) new text end purchase deleted text begin and
distributedeleted text end a sufficient number of telecommunications devices new text begin and interconnectivity productsnew text end
so that each eligible household receives appropriate devicesnew text begin and productsnew text end as determined
under section 237.51, subdivision 5adeleted text begin . The commissioner of human services shalldeleted text end new text begin , and (2)new text end
distribute the devices new text begin and products new text end to eligible households free of charge.
Subd. 4.
Training; new text begin information; new text end maintenance.
The commissioner of human services
shall maintain the telecommunications devices new text begin and interconnectivity productsnew text end until the
warranty period expires, and provide training, without charge, to first-time users of the
devicesdeleted text begin .deleted text end new text begin and products. The commissioner shall provide information about assistive
communications devices and products that may benefit a program participant and about
where a person may obtain or purchase assistive communications devices and products.
Assistive communications devices and products include a pocket talker for a person who
is hard-of-hearing, a communication board for a person with a speech disability, a one-to-one
video communication application for a person who is deaf, and other devices and products
designed to facilitate effective communication for a person with a communication disability.
new text end
Subd. 6.
Ownership.
Telecommunications devices new text begin and interconnectivity productsnew text end
purchased pursuant to subdivision 3new text begin , clause (1),new text end are the property of the state of Minnesota.
Policies and procedures for the return of new text begin distributed new text end devices deleted text begin from individuals who withdraw
from the program or whose eligibility status changesdeleted text end new text begin and productsnew text end shall be determined by
the commissioner of human services.
Subd. 7.
Standards.
The telecommunications devices distributed under this section must
comply with the electronic industries alliance standards and be approved by the Federal
Communications Commission. The commissioner of human services must provide each
eligible person a choice of several models of devices, the retail value of which may not
exceed $600 for a text telephone, and a retail value of $7,000 for a Braille device, or an
amount authorized by the Department of Human Services for all other telecommunications
devices deleted text begin anddeleted text end new text begin ,new text end auxiliary equipmentnew text begin , and interconnectivity productsnew text end it deems cost-effective
and appropriate to distribute according to sections 237.51 to 237.56.
new text begin Subd. 9. new text end
new text begin Discounted telecommunications or Internet services assistance. new text end
new text begin
The
commissioner of human services shall assist a person who is applying for telecommunication
devices and products in applying for discounted telecommunications or Internet services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
new text end
Sec. 11.
Minnesota Statutes 2018, section 245C.03, is amended by adding a subdivision
to read:
new text begin Subd. 13. new text end
new text begin Early intensive developmental and behavioral intervention providers. new text end
new text begin
The
commissioner shall conduct background studies according to this chapter when initiated by
an early intensive developmental and behavioral intervention provider under section
256B.0949.
new text end
Sec. 12.
Minnesota Statutes 2018, section 245C.10, is amended by adding a subdivision
to read:
new text begin Subd. 14. new text end
new text begin Early intensive developmental and behavioral intervention providers. new text end
new text begin
The
commissioner shall recover the cost of background studies required under section 245C.03,
subdivision 13, for the purposes of early intensive developmental and behavioral intervention
under section 256B.0949, through a fee of no more than $32 per study charged to the enrolled
agency. Fees collected under this subdivision are appropriated to the commissioner for the
purpose of conducting background studies.
new text end
Sec. 13.
Minnesota Statutes 2018, section 245D.03, subdivision 1, is amended to read:
Subdivision 1.
Applicability.
(a) The commissioner shall regulate the provision of home
and community-based services to persons with disabilities and persons age 65 and older
pursuant to this chapter. The licensing standards in this chapter govern the provision of
basic support services and intensive support services.
(b) Basic support services provide the level of assistance, supervision, and care that is
necessary to ensure the health and welfare of the person and do not include services that
are specifically directed toward the training, treatment, habilitation, or rehabilitation of the
person. Basic support services include:
(1) in-home and out-of-home respite care services as defined in section 245A.02,
subdivision 15, and under the brain injury, community alternative care, community access
for disability inclusion, developmental disability, and elderly waiver plans, excluding
out-of-home respite care provided to children in a family child foster care home licensed
under Minnesota Rules, parts 2960.3000 to 2960.3100, when the child foster care license
holder complies with the requirements under section 245D.06, subdivisions 5, 6, 7, and 8,
or successor provisions; and section 245D.061 or successor provisions, which must be
stipulated in the statement of intended use required under Minnesota Rules, part 2960.3000,
subpart 4;
(2) adult companion services as defined under the brain injury, community access for
disability inclusion, and elderly waiver plans, excluding adult companion services provided
under the Corporation for National and Community Services Senior Companion Program
established under the Domestic Volunteer Service Act of 1973, Public Law 98-288;
(3) personal support as defined under the developmental disability waiver plan;
(4) 24-hour emergency assistance, personal emergency response as defined under the
community access for disability inclusion and developmental disability waiver plans;
(5) night supervision services as defined under the brain injury waiver plan;
(6) homemaker services as defined under the community access for disability inclusion,
brain injury, community alternative care, developmental disability, and elderly waiver plans,
excluding providers licensed by the Department of Health under chapter 144A and those
providers providing cleaning services only; deleted text begin and
deleted text end
(7) individual community living support under section 256B.0915, subdivision 3jdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(8) individualized home supports services as defined under the brain injury, community
alternative care, and community access for disability inclusion, and developmental disability
waiver plans.
new text end
(c) Intensive support services provide assistance, supervision, and care that is necessary
to ensure the health and welfare of the person and services specifically directed toward the
training, habilitation, or rehabilitation of the person. Intensive support services include:
(1) intervention services, including:
(i) behavioral support services as defined under the brain injury and community access
for disability inclusion waiver plans;
(ii) in-home or out-of-home crisis respite services as defined under the developmental
disability waiver plan; and
(iii) specialist services as defined under the current developmental disability waiver
plan;
(2) in-home support services, including:
(i) in-home family support and supported living services as defined under the
developmental disability waiver plan;
(ii) independent living services training as defined under the brain injury and community
access for disability inclusion waiver plans;
(iii) semi-independent living services; deleted text begin and
deleted text end
deleted text begin
(iv) individualized home supports services as defined under the brain injury, community
alternative care, and community access for disability inclusion waiver plans;
deleted text end
new text begin
(iv) individualized home support with training services as defined under the brain injury,
community alternative care, community access for disability inclusion, and developmental
disability waiver plans; and
new text end
new text begin
(v) individualized home support with family training services as defined under the brain
injury, community alternative care, community access for disability inclusion, and
developmental disability waiver plans;
new text end
(3) residential supports and services, including:
(i) supported living services as defined under the developmental disability waiver plan
provided in a family or corporate child foster care residence, a family adult foster care
residence, a community residential setting, or a supervised living facility;
(ii) foster care services as defined in the brain injury, community alternative care, and
community access for disability inclusion waiver plans provided in a family or corporate
child foster care residence, a family adult foster care residence, or a community residential
setting; deleted text begin and
deleted text end
(iii)new text begin community residential services as defined under the brain injury, community
alternative care, community access for disability inclusion, and developmental disability
waiver plans provided in a corporate child foster care residence, a community residential
setting, or a supervised living facility;
new text end
new text begin
(iv) family residential services as defined in the brain injury, community alternative
care, community access for disability inclusion, and developmental disability waiver plans
provided in a family child foster care residence or a family adult foster care residence; and
new text end
new text begin (v)new text end residential services provided to more than four persons with developmental disabilities
in a supervised living facility, including ICFs/DD;
(4) day services, including:
(i) structured day services as defined under the brain injury waiver plan;
(ii)new text begin day services under sections 252.41 to 252.46, and as defined under the brain injury,
community alternative care, community access for disability inclusion, and developmental
disability waiver plans;
new text end
new text begin (iii)new text end day training and habilitation services under sections 252.41 to 252.46, and as defined
under the developmental disability waiver plan; and
deleted text begin (iii)deleted text end new text begin (iv)new text end prevocational services as defined under the brain injury deleted text begin anddeleted text end new text begin , community
alternative care,new text end community access for disability inclusionnew text begin , and developmental disabilitynew text end
waiver plans; and
(5) employment exploration services as defined under the brain injury, community
alternative care, community access for disability inclusion, and developmental disability
waiver plans;
(6) employment development services as defined under the brain injury, community
alternative care, community access for disability inclusion, and developmental disability
waiver plans; deleted text begin and
deleted text end
(7) employment support services as defined under the brain injury, community alternative
care, community access for disability inclusion, and developmental disability waiver plansdeleted text begin .deleted text end new text begin ;
and
new text end
new text begin
(8) integrated community support as defined under the brain injury and community
access for disability inclusion waiver plans beginning January 1, 2021, and community
alternative care and developmental disability waiver plans beginning January 1, 2023.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2021, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 14.
Minnesota Statutes 2018, section 245D.071, subdivision 1, is amended to read:
Subdivision 1.
Requirements for intensive support services.
Except for services
identified in section 245D.03, subdivision 1, paragraph (c), clauses (1) and (2),new text begin item (ii),new text end a
license holder providing intensive support services identified in section 245D.03, subdivision
1, paragraph (c), must comply with the requirements in this section and section 245D.07,
subdivisions 1new text begin , 1a,new text end and 3. Services identified in section 245D.03, subdivision 1, paragraph
(c), clauses (1) and (2),new text begin item (ii),new text end must comply with the requirements in section 245D.07,
subdivision 2.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 15.
new text begin
[245D.12] INTEGRATED COMMUNITY SUPPORTS; SETTING
CAPACITY REPORT.
new text end
new text begin
(a) The license holder providing integrated community support, as defined in section
245D.03, subdivision 1, paragraph (c), clause (8), must submit a setting capacity report to
the commissioner to ensure the identified location of service delivery meets the criteria of
the home and community-based service requirements as specified in section 256B.492.
new text end
new text begin
(b) The license holder shall provide the setting capacity report on the forms and in the
manner prescribed by the commissioner. The report must include:
new text end
new text begin
(1) the address of the multifamily housing building where the license holder delivers
integrated community supports and owns, leases, or has a direct or indirect financial
relationship with the property owner;
new text end
new text begin
(2) the total number of living units in the multifamily housing building described in
clause (1) where integrated community supports are delivered;
new text end
new text begin
(3) the total number of living units in the multifamily housing building described in
clause (1), including the living units identified in clause (2); and
new text end
new text begin
(4) the percentage of living units that are controlled by the license holder in the
multifamily housing building by dividing clause (2) by clause (3).
new text end
new text begin
(c) Only one license holder may deliver integrated community supports at the address
of the multifamily housing building.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective upon the date of federal approval. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end
Sec. 16.
Minnesota Statutes 2018, section 252.27, subdivision 2a, is amended to read:
Subd. 2a.
Contribution amount.
(a) The natural or adoptive parents of a minor child,
including a child determined eligible for medical assistance without consideration of parental
income, must contribute to the cost of services used by making monthly payments on a
sliding scale based on income, unless the child is married or has been married, parental
rights have been terminated, or the child's adoption is subsidized according to chapter 259A
or through title IV-E of the Social Security Act. The parental contribution is a partial or full
payment for medical services provided for diagnostic, therapeutic, curing, treating, mitigating,
rehabilitation, maintenance, and personal care services as defined in United States Code,
title 26, section 213, needed by the child with a chronic illness or disability.
(b) For households with adjusted gross income equal to or greater than 275 percent of
federal poverty guidelines, the parental contribution shall be computed by applying the
following schedule of rates to the adjusted gross income of the natural or adoptive parents:
(1) if the adjusted gross income is equal to or greater than 275 percent of federal poverty
guidelines and less than or equal to 545 percent of federal poverty guidelines, the parental
contribution shall be determined using a sliding fee scale established by the commissioner
of human services which begins at deleted text begin 1.94deleted text end new text begin 1.65new text end percent of adjusted gross income at 275 percent
of federal poverty guidelines and increases to deleted text begin 5.29deleted text end new text begin 4.5new text end percent of adjusted gross income for
those with adjusted gross income up to 545 percent of federal poverty guidelines;
(2) if the adjusted gross income is greater than 545 percent of federal poverty guidelines
and less than 675 percent of federal poverty guidelines, the parental contribution shall be
deleted text begin 5.29deleted text end new text begin 4.5new text end percent of adjusted gross income;
(3) if the adjusted gross income is equal to or greater than 675 percent of federal poverty
guidelines and less than 975 percent of federal poverty guidelines, the parental contribution
shall be determined using a sliding fee scale established by the commissioner of human
services which begins at deleted text begin 5.29deleted text end new text begin 4.5new text end percent of adjusted gross income at 675 percent of federal
poverty guidelines and increases to deleted text begin 7.05deleted text end new text begin 5.99new text end percent of adjusted gross income for those
with adjusted gross income up to 975 percent of federal poverty guidelines; and
(4) if the adjusted gross income is equal to or greater than 975 percent of federal poverty
guidelines, the parental contribution shall be deleted text begin 8.81deleted text end new text begin 7.49new text end percent of adjusted gross income.
If the child lives with the parent, the annual adjusted gross income is reduced by $2,400
prior to calculating the parental contribution. If the child resides in an institution specified
in section 256B.35, the parent is responsible for the personal needs allowance specified
under that section in addition to the parental contribution determined under this section.
The parental contribution is reduced by any amount required to be paid directly to the child
pursuant to a court order, but only if actually paid.
(c) The household size to be used in determining the amount of contribution under
paragraph (b) includes natural and adoptive parents and their dependents, including the
child receiving services. Adjustments in the contribution amount due to annual changes in
the federal poverty guidelines shall be implemented on the first day of July following
publication of the changes.
(d) For purposes of paragraph (b), "income" means the adjusted gross income of the
natural or adoptive parents determined according to the previous year's federal tax form,
except, effective retroactive to July 1, 2003, taxable capital gains to the extent the funds
have been used to purchase a home shall not be counted as income.
(e) The contribution shall be explained in writing to the parents at the time eligibility
for services is being determined. The contribution shall be made on a monthly basis effective
with the first month in which the child receives services. Annually upon redetermination
or at termination of eligibility, if the contribution exceeded the cost of services provided,
the local agency or the state shall reimburse that excess amount to the parents, either by
direct reimbursement if the parent is no longer required to pay a contribution, or by a
reduction in or waiver of parental fees until the excess amount is exhausted. All
reimbursements must include a notice that the amount reimbursed may be taxable income
if the parent paid for the parent's fees through an employer's health care flexible spending
account under the Internal Revenue Code, section 125, and that the parent is responsible
for paying the taxes owed on the amount reimbursed.
(f) The monthly contribution amount must be reviewed at least every 12 months; when
there is a change in household size; and when there is a loss of or gain in income from one
month to another in excess of ten percent. The local agency shall mail a written notice 30
days in advance of the effective date of a change in the contribution amount. A decrease in
the contribution amount is effective in the month that the parent verifies a reduction in
income or change in household size.
(g) Parents of a minor child who do not live with each other shall each pay the
contribution required under paragraph (a). An amount equal to the annual court-ordered
child support payment actually paid on behalf of the child receiving services shall be deducted
from the adjusted gross income of the parent making the payment prior to calculating the
parental contribution under paragraph (b).
(h) The contribution under paragraph (b) shall be increased by an additional five percent
if the local agency determines that insurance coverage is available but not obtained for the
child. For purposes of this section, "available" means the insurance is a benefit of employment
for a family member at an annual cost of no more than five percent of the family's annual
income. For purposes of this section, "insurance" means health and accident insurance
coverage, enrollment in a nonprofit health service plan, health maintenance organization,
self-insured plan, or preferred provider organization.
Parents who have more than one child receiving services shall not be required to pay
more than the amount for the child with the highest expenditures. There shall be no resource
contribution from the parents. The parent shall not be required to pay a contribution in
excess of the cost of the services provided to the child, not counting payments made to
school districts for education-related services. Notice of an increase in fee payment must
be given at least 30 days before the increased fee is due.
(i) The contribution under paragraph (b) shall be reduced by $300 per fiscal year if, in
the 12 months prior to July 1:
(1) the parent applied for insurance for the child;
(2) the insurer denied insurance;
(3) the parents submitted a complaint or appeal, in writing to the insurer, submitted a
complaint or appeal, in writing, to the commissioner of health or the commissioner of
commerce, or litigated the complaint or appeal; and
(4) as a result of the dispute, the insurer reversed its decision and granted insurance.
For purposes of this section, "insurance" has the meaning given in paragraph (h).
A parent who has requested a reduction in the contribution amount under this paragraph
shall submit proof in the form and manner prescribed by the commissioner or county agency,
including, but not limited to, the insurer's denial of insurance, the written letter or complaint
of the parents, court documents, and the written response of the insurer approving insurance.
The determinations of the commissioner or county agency under this paragraph are not rules
subject to chapter 14.
Sec. 17.
Minnesota Statutes 2018, section 252.275, subdivision 3, is amended to read:
Subd. 3.
Reimbursement.
Counties shall be reimbursed for all expenditures made
pursuant to subdivision 1 at a rate of deleted text begin 70deleted text end new text begin 85 new text end percent, up to the allocation determined pursuant
to subdivisions 4 and 4b. However, the commissioner shall not reimburse costs of services
for any person if the costs exceed the state share of the average medical assistance costs for
services provided by intermediate care facilities for a person with a developmental disability
for the same fiscal year, and shall not reimburse costs of a onetime living allowance for any
person if the costs exceed $1,500 in a state fiscal year. The commissioner may make
payments to each county in quarterly installments. The commissioner may certify an advance
of up to 25 percent of the allocation. Subsequent payments shall be made on a reimbursement
basis for reported expenditures and may be adjusted for anticipated spending patterns.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 18.
Minnesota Statutes 2018, section 252.28, subdivision 1, is amended to read:
Subdivision 1.
Determinationsdeleted text begin ; redeterminationsdeleted text end .
In conjunction with the appropriate
deleted text begin countydeleted text end new text begin lead agencynew text end boards, the commissioner of human services shall determinedeleted text begin , and shall
redetermine at least every four years,deleted text end the need, deleted text begin anticipateddeleted text end growth deleted text begin ordeleted text end new text begin ,new text end decline in need deleted text begin until
the next anticipated redeterminationdeleted text end , location, size, and programnew text begin servicesnew text end of public and
private day training and habilitation services deleted text begin for persons with developmental disabilitiesdeleted text end new text begin ,
structured day services, prevocational services, and adult day services for people with
disabilities funded under medical assistance and the home and community-based services
waivers under sections 256B.092 and 256B.49new text end . This subdivision does not apply to
semi-independent living services and residential-based habilitation services provided to
four or fewer persons at a single site funded as home and community-based services. A
determination of need shall not be required for a change in ownership.
Sec. 19.
Minnesota Statutes 2018, section 252.41, subdivision 3, is amended to read:
Subd. 3.
Day deleted text begin training and habilitationdeleted text end services for adults with deleted text begin developmentaldeleted text end
disabilities.
(a) "Day deleted text begin training and habilitationdeleted text end services for adults with deleted text begin developmentaldeleted text end
disabilities" means services that:
(1) include supervision, training, assistancenew text begin , supportnew text end , deleted text begin center-baseddeleted text end new text begin facility-basednew text end
work-related activities, or other community-integrated activities designed and implemented
in accordance with the deleted text begin individual service and individual habilitation plansdeleted text end new text begin coordinated
service and support plan and coordinated service and support plan addendumnew text end required undernew text begin
sections 245D.02, subdivision 4, paragraphs (b) and (c), and 256B.092, subdivision 1b, andnew text end
Minnesota Rules, deleted text begin partsdeleted text end new text begin partnew text end 9525.0004 deleted text begin to 9525.0036deleted text end new text begin , subpart 12new text end , to help an adult reach and
maintain the highest possible level of independence, productivity, and integration into the
community; deleted text begin and
deleted text end
(2)new text begin include day support services, prevocational services, day training and habilitation
services, structured day services, and adult day services as defined in Minnesota's federally
approved disability waiver plans; and
new text end
new text begin (3)new text end are provided by a vendor licensed under sections 245A.01 to 245A.16 deleted text begin anddeleted text end new text begin , 245D.27
to 245D.31,new text end 252.28, subdivision 2,new text begin and 252.41 to 252.46, and Minnesota Rules, parts
9525.1200 to 9525.1330,new text end to provide day deleted text begin training and habilitationdeleted text end services.
(b) Day deleted text begin training and habilitationdeleted text end services reimbursable under this section do not include
special education and related services as defined in the Education of the Individuals with
Disabilities Act, United States Code, title 20, chapter 33, section 1401, clauses (6) and (17),
or vocational services funded under section 110 of the Rehabilitation Act of 1973, United
States Code, title 29, section 720, as amended.
(c) Day deleted text begin training and habilitationdeleted text end services do not include employment exploration,
employment development, or employment support services as defined in the home and
community-based services waivers for people with disabilities authorized under sections
256B.092 and 256B.49.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2021, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 20.
Minnesota Statutes 2018, section 252.41, subdivision 4, is amended to read:
Subd. 4.
Independence.
"Independence" means the extent to which persons with
deleted text begin developmentaldeleted text end disabilities exert control and choice over their own lives.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2021.
new text end
Sec. 21.
Minnesota Statutes 2018, section 252.41, subdivision 5, is amended to read:
Subd. 5.
Integration.
"Integration" means that persons with deleted text begin developmentaldeleted text end disabilities:
(1) use the same community resources that are used by and available to individuals who
are not disabled;
(2) participate in the same community activities in which nondisabled individuals
participate; and
(3) regularly interact and have contact with nondisabled individuals.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2021.
new text end
Sec. 22.
Minnesota Statutes 2018, section 252.41, subdivision 6, is amended to read:
Subd. 6.
Productivity.
"Productivity" means that persons with deleted text begin developmentaldeleted text end disabilities:
(1) engage in income-producing work designed to improve their income level,
employment status, or job advancement; or
(2) engage in activities that contribute to a business, household, or community.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2021.
new text end
Sec. 23.
Minnesota Statutes 2018, section 252.41, subdivision 7, is amended to read:
Subd. 7.
Regional center.
"Regional center" means any state-operated facility under
the direct administrative authority of the commissioner that serves persons with
deleted text begin developmentaldeleted text end disabilities.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2021.
new text end
Sec. 24.
Minnesota Statutes 2018, section 252.41, subdivision 9, is amended to read:
Subd. 9.
Vendor.
"Vendor" means a deleted text begin nonprofitdeleted text end legal entity that:
(1) is licensed under sections 245A.01 to 245A.16 deleted text begin anddeleted text end new text begin , 245D.27 to 245D.31,new text end 252.28,
subdivision 2,new text begin and 252.41 to 252.46, and Minnesota Rules, parts 9525.1200 to 9525.1330,new text end
to provide day deleted text begin training and habilitationdeleted text end services to adults with deleted text begin developmentaldeleted text end disabilities;
and
(2) does not have a financial interest in the legal entity that provides residential services
to the same person or persons to whom it provides day deleted text begin training and habilitationdeleted text end services.
This clause does not apply to regional treatment centers, state-operated, community-based
programs operating according to section 252.50 until July 1, 2000, or vendors licensed prior
to April 15, 1983.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2021.
new text end
Sec. 25.
Minnesota Statutes 2018, section 252.42, is amended to read:
252.42 SERVICE PRINCIPLES.
The design and delivery of services eligible for reimbursement should reflect the
following principles:
(1) services must suit a person's chronological age and be provided in the least restrictive
environment possible, consistent with the needs identified in the person's deleted text begin individual service
and individual habilitation plans underdeleted text end new text begin coordinated service and support plan and coordinated
service and support plan addendum required under sections 256B.092, subdivision 1b, and
245D.02, subdivision 4, paragraphs (b) and (c), andnew text end Minnesota Rules, parts 9525.0004 deleted text begin to
9525.0036deleted text end new text begin , subpart 12new text end ;
(2) a person with a deleted text begin developmentaldeleted text end disability whose individual deleted text begin service and individual
habilitation plansdeleted text end new text begin coordinated service and support plans and coordinated service and support
plan addendumsnew text end authorize employment or employment-related activities shall be given the
opportunity to participate in employment and employment-related activities in which
nondisabled persons participate;
(3) a person with a deleted text begin developmentaldeleted text end disability participating in work shall be paid wages
commensurate with the rate for comparable work and productivity except as regional centers
are governed by section 246.151;
(4) a person with a deleted text begin developmentaldeleted text end disability shall receive services which include services
offered in settings used by the general public and designed to increase the person's active
participation in ordinary community activities;
(5) a person with a deleted text begin developmentaldeleted text end disability shall participate in the patterns, conditions,
and rhythms of everyday living and working that are consistent with the norms of the
mainstream of society.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2021.
new text end
Sec. 26.
Minnesota Statutes 2018, section 252.43, is amended to read:
252.43 COMMISSIONER'S DUTIES.
The commissioner shall supervise deleted text begin county boards'deleted text end new text begin lead agencies'new text end provision of day deleted text begin training
and habilitationdeleted text end services to adults with deleted text begin developmentaldeleted text end disabilities. The commissioner shall:
(1) determine the need for day deleted text begin training and habilitationdeleted text end services under section deleted text begin 252.28deleted text end new text begin
256B.4914new text end ;
(2) establish payment rates as provided under section 256B.4914;
(3)new text begin add transportation costs to the day services payment rate;
new text end
new text begin (4)new text end adopt rules for the administration and provision of day deleted text begin training and habilitationdeleted text end
services under deleted text begin sections 252.41 to 252.46 anddeleted text end sections 245A.01 to 245A.16 deleted text begin anddeleted text end new text begin ,new text end 252.28,
subdivision 2new text begin , and 252.41 to 252.46, and Minnesota Rules, parts 9525.1200 to 9525.1330new text end ;
deleted text begin (4)deleted text end new text begin (5)new text end enter into interagency agreements necessary to ensure effective coordination and
provision of day deleted text begin training and habilitationdeleted text end services;
deleted text begin (5)deleted text end new text begin (6)new text end monitor and evaluate the costs and effectiveness of day deleted text begin training and habilitationdeleted text end
services; and
deleted text begin (6)deleted text end new text begin (7)new text end provide information and technical help to deleted text begin county boardsdeleted text end new text begin lead agenciesnew text end and vendors
in their administration and provision of day deleted text begin training and habilitationdeleted text end services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2021.
new text end
Sec. 27.
Minnesota Statutes 2018, section 252.44, is amended to read:
252.44 deleted text begin COUNTYdeleted text end new text begin LEAD AGENCYnew text end BOARD RESPONSIBILITIES.
When the need for day deleted text begin training and habilitationdeleted text end services in a countynew text begin or tribenew text end has been
determined under section 252.28, the board of commissioners for that deleted text begin countydeleted text end new text begin lead agencynew text end
shall:
(1) authorize the delivery of services according to the deleted text begin individual service and habilitation
plansdeleted text end new text begin coordinated service and support plans and coordinated service and support plan
addendumsnew text end required as part of the deleted text begin county'sdeleted text end new text begin lead agency'snew text end provision of case management
services undernew text begin sections 256B.0913, subdivision 8; 256B.0915, subdivision 6; 256B.092,
subdivision 1b; and 256B.49, subdivision 15, andnew text end Minnesota Rules, parts 9525.0004 to
9525.0036deleted text begin . For calendar years for which section 252.46, subdivisions 2 to 10, apply, the
county board shall not authorize a change in service days from the number of days authorized
for the previous calendar year unless there is documentation for the change in the individual
service plan. An increase in service days must also be supported by documentation that the
goals and objectives assigned to the vendor cannot be met more economically and effectively
by other available community services and that without the additional days of service the
individual service plan could not be implemented in a manner consistent with the service
principles in section 252.42deleted text end ;
(2) ensure that transportation is provided or arranged by the vendor in the most efficient
and reasonable way possible; and
(3) monitor and evaluate the cost and effectiveness of the services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2021.
new text end
Sec. 28.
Minnesota Statutes 2018, section 252.45, is amended to read:
252.45 VENDOR'S DUTIES.
Anew text begin day servicenew text end vendor enrolled with the commissioner is responsible for items under
clauses (1), (2), and (3), and extends only to the provision of services that are reimbursable
under state and federal law. A vendor providing day deleted text begin training and habilitationdeleted text end services shall:
(1) provide the amount and type of services authorized in the individual service plan
undernew text begin coordinated service and support plan and coordinated service and support plan
addendum required under sections 245D.02, subdivision 4, paragraphs (b) and (c), and
256B.092, subdivision 1b, andnew text end Minnesota Rules, deleted text begin partsdeleted text end new text begin partnew text end 9525.0004 deleted text begin to 9525.0036deleted text end new text begin , subpart
12new text end ;
(2) design the services to achieve the outcomes assigned to the vendor in the deleted text begin individual
service plandeleted text end new text begin coordinated service and support plan and coordinated service and support plan
addendum required under sections 245D.02, subdivision 4, paragraphs (a) and (b), and
256B.092, subdivision 1b, and Minnesota Rules, part 9525.0004, subpart 12new text end ;
(3) provide or arrange for transportation of persons receiving services to and from service
sites;
(4) enter into agreements with community-based intermediate care facilities for persons
with developmental disabilities to ensure compliance with applicable federal regulations;
and
(5) comply with state and federal law.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2021.
new text end
Sec. 29.
Minnesota Statutes 2018, section 256.9365, is amended to read:
256.9365 PURCHASE OF deleted text begin CONTINUATIONdeleted text end new text begin HEALTH CAREnew text end COVERAGE FOR
deleted text begin AIDS PATIENTSdeleted text end new text begin PEOPLE LIVING WITH HIVnew text end .
Subdivision 1.
Program established.
The commissioner of human services shall establish
a program to pay deleted text begin privatedeleted text end new text begin the cost ofnew text end health plan premiumsnew text begin and cost sharing for prescriptions,
including co-payments, deductibles, and coinsurancenew text end for persons who have contracted human
immunodeficiency virus (HIV) to enable them to continue coverage under new text begin or enroll in new text end a
group or individual health plan. If a person is determined to be eligible under subdivision
2, the commissioner shall pay the deleted text begin portion of the group plan premium for which the individual
is responsible, if the individual is responsible for at least 50 percent of the cost of the
premium, or pay the individual plan premiumdeleted text end new text begin health insurance premiums and prescription
cost sharing, including co-payments and deductibles required under section 256B.0631new text end .
The commissioner shall not pay for that portion of a premium that is attributable to other
family members or dependentsnew text begin or is paid by the individual's employernew text end .
Subd. 2.
Eligibility requirements.
To be eligible for the program, an applicant must
deleted text begin satisfy the following requirements:deleted text end new text begin meet all eligibility requirements for Part B of the Ryan
White HIV/AIDS Treatment Extension Act of 2009, Public Law 111-87, and enroll in the
Minnesota Ryan White program.
new text end
deleted text begin
(1) the applicant must provide a physician's, advanced practice registered nurse's, or
physician assistant's statement verifying that the applicant is infected with HIV and is, or
within three months is likely to become, too ill to work in the applicant's current employment
because of HIV-related disease;
deleted text end
deleted text begin
(2) the applicant's monthly gross family income must not exceed 300 percent of the
federal poverty guidelines, after deducting medical expenses and insurance premiums;
deleted text end
deleted text begin
(3) the applicant must not own assets with a combined value of more than $25,000; and
deleted text end
deleted text begin
(4) if applying for payment of group plan premiums, the applicant must be covered by
an employer's or former employer's group insurance plan.
deleted text end
Subd. 3.
Cost-effective coverage.
Requirements for the payment of individual plan
premiums under subdivision 2deleted text begin , clause (5),deleted text end must be designed to ensure that the state cost of
paying an individual plan premium does not exceed the estimated state cost that would
otherwise be incurred in the medical assistance program. The commissioner shall purchase
the most cost-effective coverage available for eligible individuals.
Sec. 30.
Minnesota Statutes 2018, section 256B.0658, is amended to read:
256B.0658 HOUSING ACCESS GRANTS.
The commissioner of human services shall award through a competitive process contracts
for grants to public and private agencies to support and assist individuals deleted text begin eligible for publicly
funded home and community-based services, including state plan home caredeleted text end new text begin with a disability
as defined in section 256B.051, subdivision 2, paragraph (e)new text end , to access housing. Grants may
be awarded to agencies that may include, but are not limited to, the following supports:
assessment to ensure suitability of housing, accompanying an individual to look at housing,
filling out applications and rental agreements, meeting with landlords, helping with Section
8 or other program applications, helping to develop a budget, obtaining furniture and
household goods, if necessary, and assisting with any problems that may arise with housing.
Sec. 31.
Minnesota Statutes 2018, section 256B.0659, subdivision 11, is amended to read:
Subd. 11.
Personal care assistant; requirements.
(a) A personal care assistant must
meet the following requirements:
(1) be at least 18 years of age with the exception of persons who are 16 or 17 years of
age with these additional requirements:
(i) supervision by a qualified professional every 60 days; and
(ii) employment by only one personal care assistance provider agency responsible for
compliance with current labor laws;
(2) be employed by a personal care assistance provider agency;
(3) enroll with the department as a personal care assistant after clearing a background
study. Except as provided in subdivision 11a, before a personal care assistant provides
services, the personal care assistance provider agency must initiate a background study on
the personal care assistant under chapter 245C, and the personal care assistance provider
agency must have received a notice from the commissioner that the personal care assistant
is:
(i) not disqualified under section 245C.14; or
(ii) is disqualified, but the personal care assistant has received a set aside of the
disqualification under section 245C.22;
(4) be able to effectively communicate with the recipient and personal care assistance
provider agency;
(5) be able to provide covered personal care assistance services according to the recipient's
personal care assistance care plan, respond appropriately to recipient needs, and report
changes in the recipient's condition to the supervising qualified professional or physician;
(6) not be a consumer of personal care assistance services;
(7) maintain daily written records including, but not limited to, time sheets under
subdivision 12;
(8) effective January 1, 2010, complete standardized training as determined by the
commissioner before completing enrollment. The training must be available in languages
other than English and to those who need accommodations due to disabilities. Personal care
assistant training must include successful completion of the following training components:
basic first aid, vulnerable adult, child maltreatment, OSHA universal precautions, basic
roles and responsibilities of personal care assistants including information about assistance
with lifting and transfers for recipients, emergency preparedness, orientation to positive
behavioral practices, fraud issues, and completion of time sheets. Upon completion of the
training components, the personal care assistant must demonstrate the competency to provide
assistance to recipients;
(9) complete training and orientation on the needs of the recipient; and
(10) be limited to providing and being paid for up to 275 hours per month of personal
care assistance services regardless of the number of recipients being served or the number
of personal care assistance provider agencies enrolled with. The number of hours worked
per day shall not be disallowed by the department unless in violation of the law.
(b) A legal guardian may be a personal care assistant if the guardian is not being paid
for the guardian services and meets the criteria for personal care assistants in paragraph (a).
(c) Persons who do not qualify as a personal care assistant include parents, stepparents,
and legal guardians of minors; spouses; paid legal guardians of adults; family foster care
providers, except as otherwise allowed in section 256B.0625, subdivision 19a; and staff of
a residential setting.
new text begin
(d) Personal care assistance services qualify for the enhanced rate described in subdivision
17a if the personal care assistant providing the services:
new text end
new text begin
(1) provides services, according to the care plan in subdivision 7, to a recipient who
qualifies for 12 or more hours per day of personal care assistance services; and
new text end
new text begin
(2) satisfies the current requirements of Medicare for training and competency or
competency evaluation of home health aides or nursing assistants, as provided in the Code
of Federal Regulations, title 42, section 483.151 or 484.36, or alternative state-approved
training or competency requirements.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 32.
Minnesota Statutes 2018, section 256B.0659, is amended by adding a subdivision
to read:
new text begin Subd. 17a. new text end
new text begin Enhanced rate. new text end
new text begin
An enhanced rate of 107.5 percent of the rate paid for
personal care assistance services shall be paid for services provided to persons who qualify
for 12 or more hours of personal care assistance services per day when provided by a personal
care assistant who meets the requirements of subdivision 11, paragraph (d). The enhanced
rate for personal care assistance services includes, and is not in addition to, any rate
adjustments implemented by the commissioner on July 1, 2019, to comply with the terms
of a collective bargaining agreement between the state of Minnesota and an exclusive
representative of individual providers under section 179A.54, that provides for wage increases
for individual providers who serve participants assessed to need 12 or more hours of personal
care assistance services per day.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 33.
Minnesota Statutes 2018, section 256B.0659, subdivision 21, is amended to read:
Subd. 21.
Requirements for provider enrollment of personal care assistance provider
agencies.
(a) All personal care assistance provider agencies must provide, at the time of
enrollment, reenrollment, and revalidation as a personal care assistance provider agency in
a format determined by the commissioner, information and documentation that includes,
but is not limited to, the following:
(1) the personal care assistance provider agency's current contact information including
address, telephone number, and e-mail address;
(2) proof of surety bond coverage. Upon new enrollment, or if the provider's Medicaid
revenue in the previous calendar year is up to and including $300,000, the provider agency
must purchase a surety bond of $50,000. If the Medicaid revenue in the previous year is
over $300,000, the provider agency must purchase a surety bond of $100,000. The surety
bond must be in a form approved by the commissioner, must be renewed annually, and must
allow for recovery of costs and fees in pursuing a claim on the bond;
(3) proof of fidelity bond coverage in the amount of $20,000;
(4) proof of workers' compensation insurance coverage;
(5) proof of liability insurance;
(6) a description of the personal care assistance provider agency's organization identifying
the names of all owners, managing employees, staff, board of directors, and the affiliations
of the directors, owners, or staff to other service providers;
(7) a copy of the personal care assistance provider agency's written policies and
procedures including: hiring of employees; training requirements; service delivery; and
employee and consumer safety including process for notification and resolution of consumer
grievances, identification and prevention of communicable diseases, and employee
misconduct;
(8) copies of all other forms the personal care assistance provider agency uses in the
course of daily business including, but not limited to:
(i) a copy of the personal care assistance provider agency's time sheet if the time sheet
varies from the standard time sheet for personal care assistance services approved by the
commissioner, and a letter requesting approval of the personal care assistance provider
agency's nonstandard time sheet;
(ii) the personal care assistance provider agency's template for the personal care assistance
care plan; and
(iii) the personal care assistance provider agency's template for the written agreement
in subdivision 20 for recipients using the personal care assistance choice option, if applicable;
(9) a list of all training and classes that the personal care assistance provider agency
requires of its staff providing personal care assistance services;
(10) documentation that the personal care assistance provider agency and staff have
successfully completed all the training required by this section;
(11) documentation of the agency's marketing practices;
(12) disclosure of ownership, leasing, or management of all residential properties that
is used or could be used for providing home care services;
(13) documentation that the agency will use the following percentages of revenue
generated from the medical assistance rate paid for personal care assistance services for
employee personal care assistant wages and benefits: 72.5 percent of revenue in the personal
care assistance choice option and 72.5 percent of revenue from other personal care assistance
providersnew text begin , except for other personal care assistance providers, all of the revenue generated
by a medical assistance rate increase due to a collective bargaining agreement under section
179A.54 must be used for employee personal care assistant wages and benefitsnew text end . The revenue
generated by the qualified professional and the reasonable costs associated with the qualified
professional shall not be used in making this calculation; and
(14) effective May 15, 2010, documentation that the agency does not burden recipients'
free exercise of their right to choose service providers by requiring personal care assistants
to sign an agreement not to work with any particular personal care assistance recipient or
for another personal care assistance provider agency after leaving the agency and that the
agency is not taking action on any such agreements or requirements regardless of the date
signed.
(b) Personal care assistance provider agencies shall provide the information specified
in paragraph (a) to the commissioner at the time the personal care assistance provider agency
enrolls as a vendor or upon request from the commissioner. The commissioner shall collect
the information specified in paragraph (a) from all personal care assistance providers
beginning July 1, 2009.
(c) All personal care assistance provider agencies shall require all employees in
management and supervisory positions and owners of the agency who are active in the
day-to-day management and operations of the agency to complete mandatory training as
determined by the commissioner before enrollment of the agency as a provider. Employees
in management and supervisory positions and owners who are active in the day-to-day
operations of an agency who have completed the required training as an employee with a
personal care assistance provider agency do not need to repeat the required training if they
are hired by another agency, if they have completed the training within the past three years.
By September 1, 2010, the required training must be available with meaningful access
according to title VI of the Civil Rights Act and federal regulations adopted under that law
or any guidance from the United States Health and Human Services Department. The
required training must be available online or by electronic remote connection. The required
training must provide for competency testing. Personal care assistance provider agency
billing staff shall complete training about personal care assistance program financial
management. This training is effective July 1, 2009. Any personal care assistance provider
agency enrolled before that date shall, if it has not already, complete the provider training
within 18 months of July 1, 2009. Any new owners or employees in management and
supervisory positions involved in the day-to-day operations are required to complete
mandatory training as a requisite of working for the agency. Personal care assistance provider
agencies certified for participation in Medicare as home health agencies are exempt from
the training required in this subdivision. When available, Medicare-certified home health
agency owners, supervisors, or managers must successfully complete the competency test.
Sec. 34.
Minnesota Statutes 2018, section 256B.0659, subdivision 24, is amended to read:
Subd. 24.
Personal care assistance provider agency; general duties.
A personal care
assistance provider agency shall:
(1) enroll as a Medicaid provider meeting all provider standards, including completion
of the required provider training;
(2) comply with general medical assistance coverage requirements;
(3) demonstrate compliance with law and policies of the personal care assistance program
to be determined by the commissioner;
(4) comply with background study requirements;
(5) verify and keep records of hours worked by the personal care assistant and qualified
professional;
(6) not engage in any agency-initiated direct contact or marketing in person, by phone,
or other electronic means to potential recipients, guardians, or family members;
(7) pay the personal care assistant and qualified professional based on actual hours of
services provided;
(8) withhold and pay all applicable federal and state taxes;
(9) effective January 1, 2010, document that the agency uses a minimum of 72.5 percent
of the revenue generated by the medical assistance rate for personal care assistance services
for employee personal care assistant wages and benefits. The revenue generated by the
qualified professional and the reasonable costs associated with the qualified professional
shall not be used in making this calculation;
(10) make the arrangements and pay unemployment insurance, taxes, workers'
compensation, liability insurance, and other benefits, if any;
(11) enter into a written agreement under subdivision 20 before services are provided;
(12) report suspected neglect and abuse to the common entry point according to section
256B.0651;
(13) provide the recipient with a copy of the home care bill of rights at start of service;
deleted text begin and
deleted text end
(14) request reassessments at least 60 days prior to the end of the current authorization
for personal care assistance services, on forms provided by the commissionerdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(15) document that the additional revenue the agency receives for the enhanced rate is
passed on, in wages and benefits, to the personal care assistant who provided services to a
recipient who is eligible for the enhanced rate.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 35.
Minnesota Statutes 2018, section 256B.0659, subdivision 28, is amended to read:
Subd. 28.
Personal care assistance provider agency; required documentation.
(a)
Required documentation must be completed and kept in the personal care assistance provider
agency file or the recipient's home residence. The required documentation consists of:
(1) employee files, including:
(i) applications for employment;
(ii) background study requests and results;
(iii) orientation records about the agency policies;
(iv) trainings completed with demonstration of competencenew text begin , including verification of
the completion of training required under subdivision 11, paragraph (d), if personal care
assistance services eligible for the enhanced rate are provided and submitted for
reimbursement under this sectionnew text end ;
(v) supervisory visits;
(vi) evaluations of employment; and
(vii) signature on fraud statement;
(2) recipient files, including:
(i) demographics;
(ii) emergency contact information and emergency backup plan;
(iii) personal care assistance service plan;
(iv) personal care assistance care plan;
(v) month-to-month service use plan;
(vi) all communication records;
(vii) start of service information, including the written agreement with recipient; and
(viii) date the home care bill of rights was given to the recipient;
(3) agency policy manual, including:
(i) policies for employment and termination;
(ii) grievance policies with resolution of consumer grievances;
(iii) staff and consumer safety;
(iv) staff misconduct; and
(v) staff hiring, service delivery, staff and consumer safety, staff misconduct, and
resolution of consumer grievances;
(4) time sheets for each personal care assistant along with completed activity sheets for
each recipient served; and
(5) agency marketing and advertising materials and documentation of marketing activities
and costs.
(b) The commissioner may assess a fine of up to $500 on provider agencies that do not
consistently comply with the requirements of this subdivision.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 36.
new text begin
[256B.0715] DIRECT CARE WORKFORCE REPORT.
new text end
new text begin
The commissioner of human services shall annually assess the direct care workforce
and publish findings in a direct care workforce report each August beginning August 1,
2020. This report shall consider the number of workers employed, the number of regular
hours worked, the number of overtime hours worked, the regular wages and benefits paid,
the overtime wages paid, retention rates, and job vacancies across providers of home and
community-based services disability waiver services, state plan home care services, state
plan personal care assistance services, and community first services and supports.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 37.
Minnesota Statutes 2018, section 256B.0915, subdivision 3a, is amended to read:
Subd. 3a.
Elderly waiver cost limits.
(a) Effective on the first day of the state fiscal
year in which the resident assessment system as described in section 256R.17 for nursing
home rate determination is implemented and the first day of each subsequent state fiscal
year, the monthly limit for the cost of waivered services to an individual elderly waiver
client shall be the monthly limit of the case mix resident class to which the waiver client
would be assigned under Minnesota Rules, parts 9549.0051 to 9549.0059, in effect on the
last day of the previous state fiscal year, adjusted by any legislatively adopted home and
community-based services percentage rate adjustment. If a legislatively authorized increase
is service-specific, the monthly cost limit shall be adjusted based on the overall average
increase to the elderly waiver program.
(b) The monthly limit for the cost of waivered services under paragraph (a) to an
individual elderly waiver client assigned to a case mix classification A with:
(1) no dependencies in activities of daily living; or
(2) up to two dependencies in bathing, dressing, grooming, walking, and eating when
the dependency score in eating is three or greater as determined by an assessment performed
under section 256B.0911 shall be $1,750 per month effective on July 1, 2011, for all new
participants enrolled in the program on or after July 1, 2011. This monthly limit shall be
applied to all other participants who meet this criteria at reassessment. This monthly limit
shall be increased annually as described in paragraphs (a) and (e).
(c) If extended medical supplies and equipment or environmental modifications are or
will be purchased for an elderly waiver client, the costs may be prorated for up to 12
consecutive months beginning with the month of purchase. If the monthly cost of a recipient's
waivered services exceeds the monthly limit established in paragraph (a), (b), (d), or (e),
the annual cost of all waivered services shall be determined. In this event, the annual cost
of all waivered services shall not exceed 12 times the monthly limit of waivered services
as described in paragraph (a), (b), (d), or (e).
(d) Effective July 1, 2013, the monthly cost limit of waiver services, including any
necessary home care services described in section 256B.0651, subdivision 2, for individuals
who meet the criteria as ventilator-dependent given in section 256B.0651, subdivision 1,
paragraph (g), shall be the average of the monthly medical assistance amount established
for home care services as described in section 256B.0652, subdivision 7, and the annual
average contracted amount established by the commissioner for nursing facility services
for ventilator-dependent individuals. This monthly limit shall be increased annually as
described in paragraphs (a) and (e).
(e) Effective January 1, 2018, and each January 1 thereafter, the monthly cost limits for
elderly waiver services in effect on the previous December 31 shall be increased by the
difference between any legislatively adopted home and community-based provider rate
increases effective on January 1 or since the previous January 1 and the average statewide
percentage increase in nursing facility operating payment rates under chapter 256R, effective
the previous January 1. This paragraph shall only apply if the average statewide percentage
increase in nursing facility operating payment rates is greater than any legislatively adopted
home and community-based provider rate increases effective on January 1, or occurring
since the previous January 1.
new text begin
(f) The commissioner shall approve an exception to the monthly case mix budget cap
in paragraph (a) to account for the additional cost of providing enhanced rate personal care
assistance services under section 256B.0659 or 256B.85. The exception shall not exceed
107.5 percent of the budget otherwise available to the individual. The exception must be
reapproved on an annual basis at the time of a participant's annual reassessment.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 38.
Minnesota Statutes 2018, section 256B.0949, is amended by adding a subdivision
to read:
new text begin Subd. 16a. new text end
new text begin Background studies. new text end
new text begin
The requirements for background studies under this
section shall be met by an early intensive developmental and behavioral intervention services
agency through the commissioner's NETStudy system as provided under sections 245C.03,
subdivision 13, and 245C.10, subdivision 14.
new text end
Sec. 39.
Minnesota Statutes 2018, section 256B.4913, subdivision 4a, is amended to read:
Subd. 4a.
Rate stabilization adjustment.
(a) For purposes of this subdivision,
"implementation period" means the period beginning January 1, 2014, and ending on the
last day of the month in which the rate management system is populated with the data
necessary to calculate rates for substantially all individuals receiving home and
community-based waiver services under sections 256B.092 and 256B.49. "Banding period"
means the time period beginning on January 1, 2014, and ending upon the expiration of the
12-month period defined in paragraph (c), clause (5).
(b) For purposes of this subdivision, the historical rate for all service recipients means
the individual reimbursement rate for a recipient in effect on December 1, 2013, except
that:
(1) for a day service recipient who was not authorized to receive these waiver services
prior to January 1, 2014; added a new service or services on or after January 1, 2014; or
changed providers on or after January 1, 2014, the historical rate must be the weighted
average authorized rate for the provider number in the county of service, effective December
1, 2013; or
(2) for a unit-based service with programming or a unit-based service without
programming recipient who was not authorized to receive these waiver services prior to
January 1, 2014; added a new service or services on or after January 1, 2014; or changed
providers on or after January 1, 2014, the historical rate must be the weighted average
authorized rate for each provider number in the county of service, effective December 1,
2013; or
(3) for residential service recipients who change providers on or after January 1, 2014,
the historical rate must be set by each lead agency within their county aggregate budget
using their respective methodology for residential services effective December 1, 2013, for
determining the provider rate for a similarly situated recipient being served by that provider.
(c) The commissioner shall adjust individual reimbursement rates determined under this
section so that the unit rate is no higher or lower than:
(1) 0.5 percent from the historical rate for the implementation period;
(2) 0.5 percent from the rate in effect in clause (1), for the 12-month period immediately
following the time period of clause (1);
(3) 0.5 percent from the rate in effect in clause (2), for the 12-month period immediately
following the time period of clause (2);
(4) 1.0 percent from the rate in effect in clause (3), for the 12-month period immediately
following the time period of clause (3);
(5) 1.0 percent from the rate in effect in clause (4), for the 12-month period immediately
following the time period of clause (4);new text begin and
new text end
(6) no adjustment to the rate in effect in clause (5) for the 12-month period immediately
following the time period of clause (5). During this banding rate period, the commissioner
shall not enforce any rate decrease or increase that would otherwise result from the end of
the banding period. deleted text begin The commissioner shall, upon enactment, seek federal approval for the
addition of this banding period; and
deleted text end
deleted text begin
(7) one percent from the rate in effect in clause (6) for the 12-month period immediately
following the time period of clause (6).
deleted text end
(d) The commissioner shall review all changes to rates that were in effect on December
1, 2013, to verify that the rates in effect produce the equivalent level of spending and service
unit utilization on an annual basis as those in effect on October 31, 2013.
(e) By December 31, 2014, the commissioner shall complete the review in paragraph
(d), adjust rates to provide equivalent annual spending, and make appropriate adjustments.
(f) During the banding period, the Medicaid Management Information System (MMIS)
service agreement rate must be adjusted to account for change in an individual's need. The
commissioner shall adjust the Medicaid Management Information System (MMIS) service
agreement rate by:
(1) calculating a service rate under section 256B.4914, subdivision 6, 7, 8, or 9, for the
individual with variables reflecting the level of service in effect on December 1, 2013;
(2) calculating a service rate under section 256B.4914, subdivision 6, 7, 8, or 9, for the
individual with variables reflecting the updated level of service at the time of application;
and
(3) adding to or subtracting from the Medicaid Management Information System (MMIS)
service agreement rate, the difference between the values in clauses (1) and (2).
(g) This subdivision must not apply to rates for recipients served by providers new to a
given county after January 1, 2014. Providers of personal supports services who also acted
as fiscal support entities must be treated as new providers as of January 1, 2014.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 40.
Minnesota Statutes 2018, section 256B.4913, subdivision 5, is amended to read:
Subd. 5.
Stakeholder consultation and county training.
(a) The commissioner shall
continue consultation on regular intervals with the existing stakeholder group established
as part of the rate-setting methodology process and others, to gather input, concerns, and
data, to assist in the deleted text begin full implementationdeleted text end new text begin ongoing administrationnew text end of the deleted text begin newdeleted text end rate payment
system and to make pertinent information available to the public through the department's
website.
(b) The commissioner shall offer training at least annually for county personnel
responsible for administering the rate-setting framework in a manner consistent with this
section and section 256B.4914.
(c) The commissioner shall maintain an online instruction manual explaining the
rate-setting framework. The manual shall be consistent with this section and section
256B.4914, and shall be accessible to all stakeholders including recipients, representatives
of recipients, county or tribal agencies, and license holders.
(d) The commissioner shall not defer to the county or tribal agency on matters of technical
application of the rate-setting framework, and a county or tribal agency shall not set rates
in a manner that conflicts with this section or section 256B.4914.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 41.
Minnesota Statutes 2018, section 256B.4914, subdivision 2, is amended to read:
Subd. 2.
Definitions.
(a) For purposes of this section, the following terms have the
meanings given them, unless the context clearly indicates otherwise.
(b) "Commissioner" means the commissioner of human services.
new text begin
(c) "Comparable occupations" means the occupations, excluding direct care staff, as
represented by the Bureau of Labor Statistics standard occupational classification codes
that have the same classification for:
new text end
new text begin
(1) typical education needed for entry;
new text end
new text begin
(2) work experience in a related occupation; and
new text end
new text begin
(3) typical on-the-job training competency as the most predominant classification for
direct care staff.
new text end
deleted text begin (c)deleted text end new text begin (d)new text end "Component value" means underlying factors that are part of the cost of providing
services that are built into the waiver rates methodology to calculate service rates.
deleted text begin (d)deleted text end new text begin (e)new text end "Customized living tool" means a methodology for setting service rates that
delineates and documents the amount of each component service included in a recipient's
customized living service plan.
new text begin
(f) "Direct care staff" means employees providing direct service to people receiving
services under this section. Direct care staff excludes executive, managerial, and
administrative staff.
new text end
deleted text begin (e)deleted text end new text begin (g)new text end "Disability waiver rates system" means a statewide system that establishes rates
that are based on uniform processes and captures the individualized nature of waiver services
and recipient needs.
deleted text begin (f)deleted text end new text begin (h)new text end "Individual staffing" means the time spent as a one-to-one interaction specific to
an individual recipient by staff to provide direct support and assistance with activities of
daily living, instrumental activities of daily living, and training to participants, and is based
on the requirements in each individual's coordinated service and support plan under section
245D.02, subdivision 4b; any coordinated service and support plan addendum under section
245D.02, subdivision 4c; and an assessment tool. Provider observation of an individual's
needs must also be considered.
deleted text begin (g)deleted text end new text begin (i)new text end "Lead agency" means a county, partnership of counties, or tribal agency charged
with administering waivered services under sections 256B.092 and 256B.49.
deleted text begin (h)deleted text end new text begin (j)new text end "Median" means the amount that divides distribution into two equal groups,
one-half above the median and one-half below the median.
deleted text begin (i)deleted text end new text begin (k)new text end "Payment or rate" means reimbursement to an eligible provider for services
provided to a qualified individual based on an approved service authorization.
deleted text begin (j)deleted text end new text begin (l)new text end "Rates management system" means a web-based software application that uses a
framework and component values, as determined by the commissioner, to establish service
rates.
deleted text begin (k)deleted text end new text begin (m)new text end "Recipient" means a person receiving home and community-based services
funded under any of the disability waivers.
deleted text begin (l)deleted text end new text begin (n)new text end "Shared staffing" means time spent by employees, not defined under paragraph
(f), providing or available to provide more than one individual with direct support and
assistance with activities of daily living as defined under section 256B.0659, subdivision
1, paragraph (b); instrumental activities of daily living as defined under section 256B.0659,
subdivision 1, paragraph (i); ancillary activities needed to support individual services; and
training to participants, and is based on the requirements in each individual's coordinated
service and support plan under section 245D.02, subdivision 4b; any coordinated service
and support plan addendum under section 245D.02, subdivision 4c; an assessment tool; and
provider observation of an individual's service need. Total shared staffing hours are divided
proportionally by the number of individuals who receive the shared service provisions.
deleted text begin (m)deleted text end new text begin (o)new text end "Staffing ratio" means the number of recipients a service provider employee
supports during a unit of service based on a uniform assessment tool, provider observation,
case history, and the recipient's services of choice, and not based on the staffing ratios under
section 245D.31.
deleted text begin (n)deleted text end new text begin (p)new text end "Unit of service" means the following:
(1) for residential support services under subdivision 6, a unit of service is a day. Any
portion of any calendar day, within allowable Medicaid rules, where an individual spends
time in a residential setting is billable as a day;
(2) for day services under subdivision 7:
(i) for day training and habilitation services, a unit of service is either:
(A) a day unit of service is defined as six or more hours of time spent providing direct
services and transportation; or
(B) a partial day unit of service is defined as fewer than six hours of time spent providing
direct services and transportation; and
(C) for new day service recipients after January 1, 2014, 15 minute units of service must
be used for fewer than six hours of time spent providing direct services and transportation;
(ii) for adult day and structured day services, a unit of service is a day or 15 minutes. A
day unit of service is six or more hours of time spent providing direct services;
new text begin
(iii) for day support services, a unit of service is 15 minutes; and
new text end
deleted text begin (iii)deleted text end new text begin (iv)new text end for prevocational services, a unit of service is a day or an hour. A day unit of
service is six or more hours of time spent providing direct service;
(3) for unit-based services with programming under subdivision 8:
(i) for supported living services, a unit of service is a day or 15 minutes. When a day
rate is authorized, any portion of a calendar day where an individual receives services is
billable as a day; and
(ii) for all other services, a unit of service is 15 minutes; and
(4) for unit-based services without programming under subdivision 9, a unit of service
is 15 minutes.
Sec. 42.
Minnesota Statutes 2018, section 256B.4914, subdivision 4, is amended to read:
Subd. 4.
Data collection for rate determination.
(a) Rates for applicable home and
community-based waivered services, including rate exceptions under subdivision 12, are
set by the rates management system.
deleted text begin
(b) Data for services under section 256B.4913, subdivision 4a, shall be collected in a
manner prescribed by the commissioner.
deleted text end
deleted text begin (c)deleted text end new text begin (b)new text end Data and information in the rates management system may be used to calculate
an individual's rate.
deleted text begin (d)deleted text end new text begin (c)new text end Service providers, with information from the community support plan and
oversight by lead agencies, shall provide values and information needed to calculate an
individual's rate into the rates management system. The determination of service levels must
be part of a discussion with members of the support team as defined in section 245D.02,
subdivision 34. This discussion must occur prior to the final establishment of each individual's
rate. The values and information include:
(1) shared staffing hours;
(2) individual staffing hours;
(3) direct registered nurse hours;
(4) direct licensed practical nurse hours;
(5) staffing ratios;
(6) information to document variable levels of service qualification for variable levels
of reimbursement in each framework;
(7) shared or individualized arrangements for unit-based services, including the staffing
ratio;
(8) number of trips and miles for transportation services; and
(9) service hours provided through monitoring technology.
deleted text begin (e)deleted text end new text begin (d)new text end Updates to individual data must include:
(1) data for each individual that is updated annually when renewing service plans; and
(2) requests by individuals or lead agencies to update a rate whenever there is a change
in an individual's service needs, with accompanying documentation.
deleted text begin (f)deleted text end new text begin (e)new text end Lead agencies shall review and approve all services reflecting each individual's
needs, and the values to calculate the final payment rate for services with variables under
subdivisions 6, 7, 8, and 9 for each individual. Lead agencies must notify the individual and
the service provider of the final agreed-upon values and rate, and provide information that
is identical to what was entered into the rates management system. If a value used was
mistakenly or erroneously entered and used to calculate a rate, a provider may petition lead
agencies to correct it. Lead agencies must respond to these requests. When responding to
the request, the lead agency must consider:
(1) meeting the health and welfare needs of the individual or individuals receiving
services by service site, identified in their coordinated service and support plan under section
245D.02, subdivision 4b, and any addendum under section 245D.02, subdivision 4c;
(2) meeting the requirements for staffing under subdivision 2, paragraphs deleted text begin (f)deleted text end new text begin (h)new text end , deleted text begin (i)deleted text end new text begin (n)new text end ,
and deleted text begin (m)deleted text end new text begin (o)new text end ; and meeting or exceeding the licensing standards for staffing required under
section 245D.09, subdivision 1; and
(3) meeting the staffing ratio requirements under subdivision 2, paragraph deleted text begin (n)deleted text end new text begin (o)new text end , and
meeting or exceeding the licensing standards for staffing required under section 245D.31.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 43.
Minnesota Statutes 2018, section 256B.4914, subdivision 5, is amended to read:
Subd. 5.
Base wage index and standard component values.
(a) The base wage index
is established to determine staffing costs associated with providing services to individuals
receiving home and community-based services. For purposes of developing and calculating
the proposed base wage, Minnesota-specific wages taken from job descriptions and standard
occupational classification (SOC) codes from the Bureau of Labor Statistics as defined in
the most recent edition of the Occupational Handbook must be used. The base wage index
must be calculated as follows:
(1) for residential direct care staff, the sum of:
(i) 15 percent of the subtotal of 50 percent of the median wage for personal and home
health aide (SOC code 39-9021); 30 percent of the median wage for nursing assistant (SOC
code 31-1014); and 20 percent of the median wage for social and human services aide (SOC
code 21-1093); and
(ii) 85 percent of the subtotal of 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing assistant (SOC code
31-1014); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 20 percent of the median wage for social and human services aide (SOC code 21-1093);
(2) for day services, 20 percent of the median wage for nursing assistant (SOC code
31-1014); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 60 percent of the median wage for social and human services aide (SOC code 21-1093);
(3) for residential asleep-overnight staff, the wage is the minimum wage in Minnesota
for large employers, except in a family foster care setting, the wage is 36 percent of the
minimum wage in Minnesota for large employers;
(4) for behavior program analyst staff, 100 percent of the median wage for mental health
counselors (SOC code 21-1014);
(5) for behavior program professional staff, 100 percent of the median wage for clinical
counseling and school psychologist (SOC code 19-3031);
(6) for behavior program specialist staff, 100 percent of the median wage for psychiatric
technicians (SOC code 29-2053);
(7) for supportive living services staff, 20 percent of the median wage for nursing assistant
(SOC code 31-1014); 20 percent of the median wage for psychiatric technician (SOC code
29-2053); and 60 percent of the median wage for social and human services aide (SOC code
21-1093);
(8) for housing access coordination staff, 100 percent of the median wage for community
and social services specialist (SOC code 21-1099);
(9) for in-home family support staff, 20 percent of the median wage for nursing aide
(SOC code 31-1012); 30 percent of the median wage for community social service specialist
(SOC code 21-1099); 40 percent of the median wage for social and human services aide
(SOC code 21-1093); and ten percent of the median wage for psychiatric technician (SOC
code 29-2053);
(10) for individualized home supports services staff, 40 percent of the median wage for
community social service specialist (SOC code 21-1099); 50 percent of the median wage
for social and human services aide (SOC code 21-1093); and ten percent of the median
wage for psychiatric technician (SOC code 29-2053);
(11) for independent living skills staff, 40 percent of the median wage for community
social service specialist (SOC code 21-1099); 50 percent of the median wage for social and
human services aide (SOC code 21-1093); and ten percent of the median wage for psychiatric
technician (SOC code 29-2053);
(12) for independent living skills specialist staff, 100 percent of mental health and
substance abuse social worker (SOC code 21-1023);
(13) for supported employment staff, 20 percent of the median wage for nursing assistant
(SOC code 31-1014); 20 percent of the median wage for psychiatric technician (SOC code
29-2053); and 60 percent of the median wage for social and human services aide (SOC code
21-1093);
(14) for employment support services staff, 50 percent of the median wage for
rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for
community and social services specialist (SOC code 21-1099);
(15) for employment exploration services staff, 50 percent of the median wage for
rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for
community and social services specialist (SOC code 21-1099);
(16) for employment development services staff, 50 percent of the median wage for
education, guidance, school, and vocational counselors (SOC code 21-1012); and 50 percent
of the median wage for community and social services specialist (SOC code 21-1099);
(17) for adult companion staff, 50 percent of the median wage for personal and home
care aide (SOC code 39-9021); and 50 percent of the median wage for nursing assistant
(SOC code 31-1014);
(18) for night supervision staff, 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing assistant (SOC code
31-1014); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 20 percent of the median wage for social and human services aide (SOC code 21-1093);
(19) for respite staff, 50 percent of the median wage for personal and home care aide
(SOC code 39-9021); and 50 percent of the median wage for nursing assistant (SOC code
31-1014);
(20) for personal support staff, 50 percent of the median wage for personal and home
care aide (SOC code 39-9021); and 50 percent of the median wage for nursing assistant
(SOC code 31-1014);
(21) for supervisory staff, 100 percent of the median wage for community and social
services specialist (SOC code 21-1099), with the exception of the supervisor of behavior
professional, behavior analyst, and behavior specialists, which is 100 percent of the median
wage for clinical counseling and school psychologist (SOC code 19-3031);
(22) for registered nurse staff, 100 percent of the median wage for registered nurses
(SOC code 29-1141); and
(23) for licensed practical nurse staff, 100 percent of the median wage for licensed
practical nurses (SOC code 29-2061).
(b) Component values for residential support services are:
new text begin
(1) competitive workforce factor: 4.7 percent;
new text end
deleted text begin (1)deleted text end new text begin (2)new text end supervisory span of control ratio: 11 percent;
deleted text begin (2)deleted text end new text begin (3)new text end employee vacation, sick, and training allowance ratio: 8.71 percent;
deleted text begin (3)deleted text end new text begin (4)new text end employee-related cost ratio: 23.6 percent;
deleted text begin (4)deleted text end new text begin (5)new text end general administrative support ratio: 13.25 percent;
deleted text begin (5)deleted text end new text begin (6)new text end program-related expense ratio: 1.3 percent; and
deleted text begin (6)deleted text end new text begin (7)new text end absence and utilization factor ratio: 3.9 percent.
(c) Component values for family foster care are:
new text begin
(1) competitive workforce factor: 4.7 percent;
new text end
deleted text begin (1)deleted text end new text begin (2)new text end supervisory span of control ratio: 11 percent;
deleted text begin (2)deleted text end new text begin (3)new text end employee vacation, sick, and training allowance ratio: 8.71 percent;
deleted text begin (3)deleted text end new text begin (4)new text end employee-related cost ratio: 23.6 percent;
deleted text begin (4)deleted text end new text begin (5)new text end general administrative support ratio: 3.3 percent;
deleted text begin (5)deleted text end new text begin (6)new text end program-related expense ratio: 1.3 percent; and
deleted text begin (6)deleted text end new text begin (7)new text end absence factor: 1.7 percent.
(d) Component values for day services for all services are:
new text begin
(1) competitive workforce factor: 4.7 percent;
new text end
deleted text begin (1)deleted text end new text begin (2)new text end supervisory span of control ratio: 11 percent;
deleted text begin (2)deleted text end new text begin (3)new text end employee vacation, sick, and training allowance ratio: 8.71 percent;
deleted text begin (3)deleted text end new text begin (4)new text end employee-related cost ratio: 23.6 percent;
deleted text begin (4)deleted text end new text begin (5)new text end program plan support ratio: 5.6 percent;
deleted text begin (5)deleted text end new text begin (6)new text end client programming and support ratio: ten percent;
deleted text begin (6)deleted text end new text begin (7)new text end general administrative support ratio: 13.25 percent;
deleted text begin (7)deleted text end new text begin (8)new text end program-related expense ratio: 1.8 percent; and
deleted text begin (8)deleted text end new text begin (9)new text end absence and utilization factor ratio: 9.4 percent.
(e) Component values for unit-based services with programming are:
new text begin
(1) competitive workforce factor: 4.7 percent;
new text end
deleted text begin (1)deleted text end new text begin (2)new text end supervisory span of control ratio: 11 percent;
deleted text begin (2)deleted text end new text begin (3)new text end employee vacation, sick, and training allowance ratio: 8.71 percent;
deleted text begin (3)deleted text end new text begin (4)new text end employee-related cost ratio: 23.6 percent;
deleted text begin (4)deleted text end new text begin (5)new text end program plan supports ratio: 15.5 percent;
deleted text begin (5)deleted text end new text begin (6)new text end client programming and supports ratio: 4.7 percent;
deleted text begin (6)deleted text end new text begin (7)new text end general administrative support ratio: 13.25 percent;
deleted text begin (7)deleted text end new text begin (8)new text end program-related expense ratio: 6.1 percent; and
deleted text begin (8)deleted text end new text begin (9)new text end absence and utilization factor ratio: 3.9 percent.
(f) Component values for unit-based services without programming except respite are:
new text begin
(1) competitive workforce factor: 4.7 percent;
new text end
deleted text begin (1)deleted text end new text begin (2)new text end supervisory span of control ratio: 11 percent;
deleted text begin (2)deleted text end new text begin (3)new text end employee vacation, sick, and training allowance ratio: 8.71 percent;
deleted text begin (3)deleted text end new text begin (4)new text end employee-related cost ratio: 23.6 percent;
deleted text begin (4)deleted text end new text begin (5)new text end program plan support ratio: 7.0 percent;
deleted text begin (5)deleted text end new text begin (6)new text end client programming and support ratio: 2.3 percent;
deleted text begin (6)deleted text end new text begin (7)new text end general administrative support ratio: 13.25 percent;
deleted text begin (7)deleted text end new text begin (8)new text end program-related expense ratio: 2.9 percent; and
deleted text begin (8)deleted text end new text begin (9)new text end absence and utilization factor ratio: 3.9 percent.
(g) Component values for unit-based services without programming for respite are:
new text begin
(1) competitive workforce factor: 4.7 percent;
new text end
deleted text begin (1)deleted text end new text begin (2)new text end supervisory span of control ratio: 11 percent;
deleted text begin (2)deleted text end new text begin (3)new text end employee vacation, sick, and training allowance ratio: 8.71 percent;
deleted text begin (3)deleted text end new text begin (4)new text end employee-related cost ratio: 23.6 percent;
deleted text begin (4)deleted text end new text begin (5)new text end general administrative support ratio: 13.25 percent;
deleted text begin (5)deleted text end new text begin (6)new text end program-related expense ratio: 2.9 percent; and
deleted text begin (6)deleted text end new text begin (7)new text end absence and utilization factor ratio: 3.9 percent.
(h) deleted text begin On July 1, 2017, the commissioner shall update the base wage index in paragraph
(a) based on the wage data by standard occupational code (SOC) from the Bureau of Labor
Statistics available on December 31, 2016. The commissioner shall publish these updated
values and load them into the rate management system.deleted text end On July 1, 2022, and every deleted text begin fivedeleted text end new text begin twonew text end
years thereafter, the commissioner shall update the base wage index in paragraph (a) based
on the most recently available wage data by SOC from the Bureau of Labor Statistics. The
commissioner shall publish these updated values and load them into the rate management
system.
new text begin
(i) On July 1, 2022, and July 1, 2024, the commissioner shall increase paragraph (b),
clause (1); paragraph (c), clause (1); paragraph (d), clause (1); paragraph (e), clause (1);
paragraph (f), clause (1); and paragraph (g), clause (1), by two percentage points.
new text end
new text begin
(j) Beginning January 1, 2026, the commissioner shall report to the chairs and ranking
minority members of the legislative committees and divisions with jurisdiction over health
and human services policy and finance an analysis of the competitive workforce factor. The
report must include recommendations to update the competitive workforce factor using:
new text end
new text begin
(1) the most recently available wage data by SOC code for the weighted average wage
for direct care staff for residential services and direct care staff for day services;
new text end
new text begin
(2) the most recently available wage data by SOC code of the weighted average wage
of comparable occupations; and
new text end
new text begin
(3) workforce data as required under subdivision 10a, paragraph (g).
new text end
new text begin
The commissioner shall not recommend an increase or decrease of the competitive workforce
factor from the current value by more than two percentage points. If, after a biennial analysis
for the next report, the competitive workforce factor is less than or equal to zero, the
commissioner shall recommend a competitive workforce factor of zero.
new text end
deleted text begin (i) On July 1, 2017, the commissioner shall update the framework components in
paragraph (d), clause (5); paragraph (e), clause (5); and paragraph (f), clause (5); subdivision
6, clauses (8) and (9); and subdivision 7, clauses (10), (16), and (17), for changes in the
Consumer Price Index. The commissioner will adjust these values higher or lower by the
percentage change in the Consumer Price Index-All Items, United States city average
(CPI-U) from January 1, 2014, to January 1, 2017. The commissioner shall publish these
updated values and load them into the rate management system.deleted text end new text begin (k)new text end On July 1, 2022, and
every deleted text begin fivedeleted text end new text begin twonew text end years thereafter, the commissioner shall update the framework components
in paragraph (d), clause (5); paragraph (e), clause (5); and paragraph (f), clause (5);
subdivision 6, clauses (8) and (9); and subdivision 7, clauses (10), (16), and (17), for changes
in the Consumer Price Index. The commissioner shall adjust these values higher or lower
by the percentage change in the CPI-U from the date of the previous update to the deleted text begin date of
thedeleted text end data most recently available prior to the scheduled update. The commissioner shall
publish these updated values and load them into the rate management system.
new text begin
(l) Upon the implementation of the updates under paragraphs (h) and (k), rate adjustments
authorized under section 256B.439, subdivision 7; Laws 2013, chapter 108, article 7, section
60; and Laws 2014, chapter 312, article 27, section 75, shall be removed from service rates
calculated under this section.
new text end
new text begin
(m) Any rate adjustments applied to the service rates calculated under this section outside
of the cost components and rate methodology specified in this section shall be removed
from rate calculations upon implementation of the updates under paragraphs (h) and (k).
new text end
deleted text begin (j)deleted text end new text begin (n)new text end In this subdivision, if Bureau of Labor Statistics occupational codes or Consumer
Price Index items are unavailable in the future, the commissioner shall recommend to the
legislature codes or items to update and replace missing component values.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020, or upon federal approval,
except:
new text end
new text begin
(1) paragraphs (h) and (k) are effective July 1, 2022, or upon federal approval, whichever
is later; and
new text end
new text begin
(2) paragraph (l) is effective retroactively from July 1, 2018.
new text end
new text begin
The commissioner of human services shall notify the revisor of statutes when federal approval
is obtained or denied.
new text end
Sec. 44.
Minnesota Statutes 2018, section 256B.4914, is amended by adding a subdivision
to read:
new text begin Subd. 5a. new text end
new text begin Direct care staff; compensation. new text end
new text begin
(a) A provider paid with rates determined
under subdivision 6 must use a minimum of 66 percent of the revenue generated by rates
determined under subdivision 6 for direct care staff compensation.
new text end
new text begin
(b) A provider paid with rates determined under subdivision 7 must use a minimum of
45 percent of the revenue generated by rates determined under subdivision 7 for direct care
staff compensation.
new text end
new text begin
(c) A provider paid with rates determined under subdivision 8 or 9 must use a minimum
of 55 percent of the revenue generated by rates determined under subdivisions 8 and 9 for
direct care staff compensation.
new text end
new text begin
(d) Applicable compensation under this subdivision includes:
new text end
new text begin
(1) wages;
new text end
new text begin
(2) Social Security and Medicare taxes;
new text end
new text begin
(3) federal unemployment insurance tax;
new text end
new text begin
(4) state unemployment insurance tax;
new text end
new text begin
(5) workers' compensation insurance;
new text end
new text begin
(6) health insurance;
new text end
new text begin
(7) dental insurance;
new text end
new text begin
(8) vision insurance;
new text end
new text begin
(9) life insurance;
new text end
new text begin
(10) short-term disability insurance;
new text end
new text begin
(11) long-term disability insurance;
new text end
new text begin
(12) retirement spending;
new text end
new text begin
(13) tuition reimbursement;
new text end
new text begin
(14) wellness programs;
new text end
new text begin
(15) paid vacation time;
new text end
new text begin
(16) paid sick time; or
new text end
new text begin
(17) other items of monetary value provided to direct care staff.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 45.
Minnesota Statutes 2018, section 256B.4914, subdivision 6, is amended to read:
Subd. 6.
Payments for residential support services.
(a) Payments for residential support
services, as defined in sections 256B.092, subdivision 11, and 256B.49, subdivision 22,
must be calculated as follows:
(1) determine the number of shared staffing and individual direct staff hours to meet a
recipient's needs provided on site or through monitoring technology;
(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5deleted text begin . This is defined as the direct-care ratedeleted text end ;
new text begin
(3) except for subdivision 5, paragraph (a), clauses (3) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (b), clause (1);
new text end
deleted text begin (3)deleted text end new text begin (4)new text end for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause deleted text begin (2)deleted text end new text begin (3)new text end deleted text begin . This is defined as the customized direct-care ratedeleted text end ;
deleted text begin (4)deleted text end new text begin (5)new text end multiply the number of shared and individual direct staff hours provided on site
or through monitoring technology and nursing hours by the appropriate staff wages deleted text begin in
subdivision 5, paragraph (a), or the customized direct-care ratedeleted text end ;
deleted text begin (5)deleted text end new text begin (6)new text end multiply the number of shared and individual direct staff hours provided on site
or through monitoring technology and nursing hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (b), clause deleted text begin (1)deleted text end new text begin (2)new text end , and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);
deleted text begin (6)deleted text end new text begin (7)new text end combine the results of clauses deleted text begin (4) anddeleted text end (5) new text begin and (6)new text end , excluding any shared and
individual direct staff hours provided through monitoring technology, and multiply the
result by one plus the employee vacation, sick, and training allowance ratio in subdivision
5, paragraph (b), clause deleted text begin (2)deleted text end new text begin (3)new text end . This is defined as the direct staffing cost;
deleted text begin (7)deleted text end new text begin (8)new text end for employee-related expenses, multiply the direct staffing cost, excluding any
shared and individual direct staff hours provided through monitoring technology, by one
plus the employee-related cost ratio in subdivision 5, paragraph (b), clause deleted text begin (3)deleted text end new text begin (4)new text end ;
deleted text begin (8)deleted text end new text begin (9)new text end for client programming and supports, the commissioner shall add $2,179; and
deleted text begin (9)deleted text end new text begin (10)new text end for transportation, if provided, the commissioner shall add $1,680, or $3,000 if
customized for adapted transport, based on the resident with the highest assessed need.
(b) The total rate must be calculated using the following steps:
(1) subtotal paragraph (a), clauses deleted text begin (7) to (9)deleted text end new text begin (8) to (10)new text end , and the direct staffing cost of
any shared and individual direct staff hours provided through monitoring technology that
was excluded in clause deleted text begin (7)deleted text end new text begin (8)new text end ;
(2) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization ratio;
(3) divide the result of clause (1) by one minus the result of clause (2). This is the total
payment amount; and
(4) adjust the result of clause (3) by a factor to be determined by the commissioner to
adjust for regional differences in the cost of providing services.
(c) The payment methodology for customized living, 24-hour customized living, and
residential care services must be the customized living tool. Revisions to the customized
living tool must be made to reflect the services and activities unique to disability-related
recipient needs.
deleted text begin
(d) For individuals enrolled prior to January 1, 2014, the days of service authorized must
meet or exceed the days of service used to convert service agreements in effect on December
1, 2013, and must not result in a reduction in spending or service utilization due to conversion
during the implementation period under section 256B.4913, subdivision 4a. If during the
implementation period, an individual's historical rate, including adjustments required under
section 256B.4913, subdivision 4a, paragraph (c), is equal to or greater than the rate
determined in this subdivision, the number of days authorized for the individual is 365.
deleted text end
deleted text begin (e)deleted text end new text begin (d)new text end The number of days authorized for all individuals enrolling deleted text begin after January 1, 2014,deleted text end
in residential services must include every day that services start and end.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 46.
Minnesota Statutes 2018, section 256B.4914, subdivision 7, is amended to read:
Subd. 7.
Payments for day programs.
Payments for services with day programs
including adult day deleted text begin caredeleted text end new text begin servicesnew text end , day treatment and habilitation, new text begin day support services,
new text end prevocational services, and structured day services must be calculated as follows:
(1) determine the number of units of service and staffing ratio to meet a recipient's needs:
(i) the staffing ratios for the units of service provided to a recipient in a typical week
must be averaged to determine an individual's staffing ratio; and
(ii) the commissioner, in consultation with service providers, shall develop a uniform
staffing ratio worksheet to be used to determine staffing ratios under this subdivision;
(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;
new text begin
(3) except for subdivision 5, paragraph (a), clauses (3) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (d), clause (1);
new text end
deleted text begin (3)deleted text end new text begin (4)new text end for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause deleted text begin (2)deleted text end new text begin (3)new text end deleted text begin . This is defined as the customized direct-care ratedeleted text end ;
deleted text begin (4)deleted text end new text begin (5)new text end multiply the number of day program direct staff hours and nursing hours by the
appropriate staff wage deleted text begin in subdivision 5, paragraph (a), or the customized direct-care ratedeleted text end ;
deleted text begin (5)deleted text end new text begin (6)new text end multiply the number of day direct staff hours by the product of the supervision
span of control ratio in subdivision 5, paragraph (d), clause deleted text begin (1)deleted text end new text begin (2)new text end , and the appropriate
supervision wage in subdivision 5, paragraph (a), clause (21);
deleted text begin (6)deleted text end new text begin (7)new text end combine the results of clauses deleted text begin (4) anddeleted text end (5)new text begin and (6)new text end , and multiply the result by one
plus the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph
(d), clause deleted text begin (2)deleted text end new text begin (3)new text end . This is defined as the direct staffing rate;
deleted text begin (7)deleted text end new text begin (8)new text end for program plan support, multiply the result of clause deleted text begin (6)deleted text end new text begin (7)new text end by one plus the
program plan support ratio in subdivision 5, paragraph (d), clause deleted text begin (4)deleted text end new text begin (5)new text end ;
deleted text begin (8)deleted text end new text begin (9)new text end for employee-related expenses, multiply the result of clause deleted text begin (7)deleted text end new text begin (8)new text end by one plus
the employee-related cost ratio in subdivision 5, paragraph (d), clause deleted text begin (3)deleted text end new text begin (4)new text end ;
deleted text begin (9)deleted text end new text begin (10)new text end for client programming and supports, multiply the result of clause deleted text begin (8)deleted text end new text begin (9)new text end by
one plus the client programming and support ratio in subdivision 5, paragraph (d), clause
deleted text begin (5)deleted text end new text begin (6)new text end ;
deleted text begin (10)deleted text end new text begin (11)new text end for program facility costs, add $19.30 per week with consideration of staffing
ratios to meet individual needs;
deleted text begin (11)deleted text end new text begin (12)new text end for adult day bath services, add $7.01 per 15 minute unit;
deleted text begin (12)deleted text end new text begin (13)new text end this is the subtotal rate;
deleted text begin (13)deleted text end new text begin (14)new text end sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization factor ratio;
deleted text begin (14)deleted text end new text begin (15)new text end divide the result of clause deleted text begin (12)deleted text end new text begin (13)new text end by one minus the result of clause deleted text begin (13)deleted text end new text begin (14)new text end .
This is the total payment amount;
deleted text begin (15)deleted text end new text begin (16)new text end adjust the result of clause deleted text begin (14)deleted text end new text begin (15)new text end by a factor to be determined by the
commissioner to adjust for regional differences in the cost of providing services;
deleted text begin (16)deleted text end new text begin (17)new text end for transportation provided as part of day training and habilitation for an
individual who does not require a lift, add:
(i) $10.50 for a trip between zero and ten miles for a nonshared ride in a vehicle without
a lift, $8.83 for a shared ride in a vehicle without a lift, and $9.25 for a shared ride in a
vehicle with a lift;
(ii) $15.75 for a trip between 11 and 20 miles for a nonshared ride in a vehicle without
a lift, $10.58 for a shared ride in a vehicle without a lift, and $11.88 for a shared ride in a
vehicle with a lift;
(iii) $25.75 for a trip between 21 and 50 miles for a nonshared ride in a vehicle without
a lift, $13.92 for a shared ride in a vehicle without a lift, and $16.88 for a shared ride in a
vehicle with a lift; or
(iv) $33.50 for a trip of 51 miles or more for a nonshared ride in a vehicle without a lift,
$16.50 for a shared ride in a vehicle without a lift, and $20.75 for a shared ride in a vehicle
with a lift;
deleted text begin (17)deleted text end new text begin (18)new text end for transportation provided as part of day training and habilitation for an
individual who does require a lift, add:
(i) $19.05 for a trip between zero and ten miles for a nonshared ride in a vehicle with a
lift, and $15.05 for a shared ride in a vehicle with a lift;
(ii) $32.16 for a trip between 11 and 20 miles for a nonshared ride in a vehicle with a
lift, and $28.16 for a shared ride in a vehicle with a lift;
(iii) $58.76 for a trip between 21 and 50 miles for a nonshared ride in a vehicle with a
lift, and $58.76 for a shared ride in a vehicle with a lift; or
(iv) $80.93 for a trip of 51 miles or more for a nonshared ride in a vehicle with a lift,
and $80.93 for a shared ride in a vehicle with a lift.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 47.
Minnesota Statutes 2018, section 256B.4914, subdivision 8, is amended to read:
Subd. 8.
Payments for unit-based services with programming.
Payments for unit-based
services with programming, including deleted text begin behavior programmingdeleted text end new text begin employment exploration
services, employment development servicesnew text end , housing access coordination, new text begin individualized
home supports with family training, individualized home supports with training, new text end in-home
family support, independent living skills training, deleted text begin independent living skills specialist services,
individualized home supports, hourly supported living services, employment exploration
services, employment development services, supported employment, and employment
supportdeleted text end new text begin and hourly supported livingnew text end services provided to an individual outside of any day
or residential service plan must be calculated as follows, unless the services are authorized
separately under subdivision 6 or 7:
(1) determine the number of units of service to meet a recipient's needs;
(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;
new text begin
(3) except for subdivision 5, paragraph (a), clauses (3) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (e), clause (1);
new text end
deleted text begin (3)deleted text end new text begin (4)new text end for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause deleted text begin (2)deleted text end new text begin (3)new text end deleted text begin . This is defined as the customized direct-care ratedeleted text end ;
deleted text begin (4)deleted text end new text begin (5)new text end multiply the number of direct staff hours by the appropriate staff wage deleted text begin in
subdivision 5, paragraph (a), or the customized direct-care ratedeleted text end ;
deleted text begin (5)deleted text end new text begin (6)new text end multiply the number of direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (e), clause deleted text begin (1)deleted text end new text begin (2)new text end , and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);
deleted text begin (6)deleted text end new text begin (7)new text end combine the results of clauses deleted text begin (4) anddeleted text end (5)new text begin and (6)new text end , and multiply the result by one
plus the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph
(e), clause deleted text begin (2)deleted text end new text begin (3)new text end . This is defined as the direct staffing rate;
deleted text begin (7)deleted text end new text begin (8)new text end for program plan support, multiply the result of clause deleted text begin (6)deleted text end new text begin (7)new text end by one plus the
program plan supports ratio in subdivision 5, paragraph (e), clause deleted text begin (4)deleted text end new text begin (5)new text end ;
deleted text begin (8)deleted text end new text begin (9)new text end for employee-related expenses, multiply the result of clause deleted text begin (7)deleted text end new text begin (8)new text end by one plus
the employee-related cost ratio in subdivision 5, paragraph (e), clause deleted text begin (3)deleted text end new text begin (4)new text end ;
deleted text begin (9)deleted text end new text begin (10)new text end for client programming and supports, multiply the result of clause deleted text begin (8)deleted text end new text begin (9)new text end by
one plus the client programming and supports ratio in subdivision 5, paragraph (e), clause
deleted text begin (5)deleted text end new text begin (6)new text end ;
deleted text begin (10)deleted text end new text begin (11)new text end this is the subtotal rate;
deleted text begin (11)deleted text end new text begin (12)new text end sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization factor ratio;
deleted text begin (12)deleted text end new text begin (13)new text end divide the result of clause deleted text begin (10)deleted text end new text begin (11)new text end by one minus the result of clause deleted text begin (11)deleted text end new text begin (12)new text end .
This is the total payment amount;
deleted text begin (13)deleted text end new text begin (14)new text end for supported employment provided in a shared manner, divide the total payment
amount in clause deleted text begin (12)deleted text end new text begin (13)new text end by the number of service recipients, not to exceed three. For
employment support services provided in a shared manner, divide the total payment amount
in clause deleted text begin (12)deleted text end new text begin (13)new text end by the number of service recipients, not to exceed six. For independent
living skills training and individualized home supports provided in a shared manner, divide
the total payment amount in clause deleted text begin (12)deleted text end new text begin (13)new text end by the number of service recipients, not to
exceed two; and
deleted text begin (14)deleted text end new text begin (15)new text end adjust the result of clause deleted text begin (13)deleted text end new text begin (14)new text end by a factor to be determined by the
commissioner to adjust for regional differences in the cost of providing services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 48.
Minnesota Statutes 2018, section 256B.4914, subdivision 9, is amended to read:
Subd. 9.
Payments for unit-based services without programming.
Payments for
unit-based services without programming, including night supervision, personal support,
respite, and companion care provided to an individual outside of any day or residential
service plan must be calculated as follows unless the services are authorized separately
under subdivision 6 or 7:
(1) for all services except respite, determine the number of units of service to meet a
recipient's needs;
(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
new text begin
(3) except for subdivision 5, paragraph (a), clauses (3) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (f), clause (1);
new text end
deleted text begin (3)deleted text end new text begin (4)new text end for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause deleted text begin (2)deleted text end new text begin (3)new text end deleted text begin . This is defined as the customized direct care ratedeleted text end ;
deleted text begin (4)deleted text end new text begin (5)new text end multiply the number of direct staff hours by the appropriate staff wage deleted text begin in
subdivision 5 or the customized direct care ratedeleted text end ;
deleted text begin (5)deleted text end new text begin (6)new text end multiply the number of direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (f), clause deleted text begin (1)deleted text end new text begin (2)new text end , and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);
deleted text begin (6)deleted text end new text begin (7)new text end combine the results of clauses deleted text begin (4) anddeleted text end (5)new text begin and (6)new text end , and multiply the result by one
plus the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph
(f), clause deleted text begin (2)deleted text end new text begin (3)new text end . This is defined as the direct staffing rate;
deleted text begin (7)deleted text end new text begin (8)new text end for program plan support, multiply the result of clause deleted text begin (6)deleted text end new text begin (7)new text end by one plus the
program plan support ratio in subdivision 5, paragraph (f), clause deleted text begin (4)deleted text end new text begin (5)new text end ;
deleted text begin (8)deleted text end new text begin (9)new text end for employee-related expenses, multiply the result of clause deleted text begin (7)deleted text end new text begin (8)new text end by one plus
the employee-related cost ratio in subdivision 5, paragraph (f), clause deleted text begin (3)deleted text end new text begin (4)new text end ;
deleted text begin (9)deleted text end new text begin (10)new text end for client programming and supports, multiply the result of clause deleted text begin (8)deleted text end new text begin (9)new text end by
one plus the client programming and support ratio in subdivision 5, paragraph (f), clause
deleted text begin (5)deleted text end new text begin (6)new text end ;
deleted text begin (10)deleted text end new text begin (11)new text end this is the subtotal rate;
deleted text begin (11)deleted text end new text begin (12)new text end sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization factor ratio;
deleted text begin (12)deleted text end new text begin (13)new text end divide the result of clause deleted text begin (10)deleted text end new text begin (11)new text end by one minus the result of clause deleted text begin (11)deleted text end new text begin (12)new text end .
This is the total payment amount;
deleted text begin (13)deleted text end new text begin (14)new text end for respite services, determine the number of day units of service to meet an
individual's needs;
deleted text begin (14)deleted text end new text begin (15)new text end personnel hourly wage rates must be based on the 2009 Bureau of Labor
Statistics Minnesota-specific rate or rates derived by the commissioner as provided in
subdivision 5;
new text begin
(16) except for subdivision 5, paragraph (a), clauses (3) and (21) to (23), multiply the
result of clause (15) by the product of one plus the competitive workforce factor in
subdivision 5, paragraph (g), clause (1);
new text end
deleted text begin (15)deleted text end new text begin (17)new text end for a recipient requiring deaf and hard-of-hearing customization under
subdivision 12, add the customization rate provided in subdivision 12 to the result of clause
deleted text begin (14)deleted text end new text begin (16)new text end deleted text begin . This is defined as the customized direct care ratedeleted text end ;
deleted text begin (16)deleted text end new text begin (18)new text end multiply the number of direct staff hours by the appropriate staff wage deleted text begin in
subdivision 5, paragraph (a)deleted text end ;
deleted text begin (17)deleted text end new text begin (19)new text end multiply the number of direct staff hours by the product of the supervisory
span of control ratio in subdivision 5, paragraph (g), clause deleted text begin (1)deleted text end new text begin (2)new text end , and the appropriate
supervision wage in subdivision 5, paragraph (a), clause (21);
deleted text begin (18)deleted text end new text begin (20)new text end combine the results of clauses deleted text begin (16)deleted text end new text begin (18)new text end and deleted text begin (17)deleted text end new text begin (19)new text end , and multiply the result
by one plus the employee vacation, sick, and training allowance ratio in subdivision 5,
paragraph (g), clause deleted text begin (2)deleted text end new text begin (3)new text end . This is defined as the direct staffing rate;
deleted text begin (19)deleted text end new text begin (21)new text end for employee-related expenses, multiply the result of clause deleted text begin (18)deleted text end new text begin (20)new text end by one
plus the employee-related cost ratio in subdivision 5, paragraph (g), clause deleted text begin (3)deleted text end new text begin (4)new text end ;
deleted text begin (20)deleted text end new text begin (22)new text end this is the subtotal rate;
deleted text begin (21)deleted text end new text begin (23)new text end sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization factor ratio;
deleted text begin (22)deleted text end new text begin (24)new text end divide the result of clause deleted text begin (20)deleted text end new text begin (22)new text end by one minus the result of clause deleted text begin (21)deleted text end new text begin (23)new text end .
This is the total payment amount; and
deleted text begin (23)deleted text end new text begin (25)new text end adjust the result of clauses deleted text begin (12)deleted text end new text begin (13)new text end and deleted text begin (22)deleted text end new text begin (24)new text end by a factor to be determined
by the commissioner to adjust for regional differences in the cost of providing services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 49.
Minnesota Statutes 2018, section 256B.4914, subdivision 10, is amended to read:
Subd. 10.
Updating payment values and additional information.
deleted text begin
(a) From January
1, 2014, through December 31, 2017, the commissioner shall develop and implement uniform
procedures to refine terms and adjust values used to calculate payment rates in this section.
deleted text end
deleted text begin (b)deleted text end new text begin (a)new text end No later than July 1, 2014, the commissioner shall, within available resources,
begin to conduct research and gather data and information from existing state systems or
other outside sources on the following items:
(1) differences in the underlying cost to provide services and care across the state; and
(2) mileage, vehicle type, lift requirements, incidents of individual and shared rides, and
units of transportation for all day services, which must be collected from providers using
the rate management worksheet and entered into the rates management system; and
(3) the distinct underlying costs for services provided by a license holder under sections
245D.05, 245D.06, 245D.07, 245D.071, 245D.081, and 245D.09, and for services provided
by a license holder certified under section 245D.33.
deleted text begin
(c) Beginning January 1, 2014, through December 31, 2018, using a statistically valid
set of rates management system data, the commissioner, in consultation with stakeholders,
shall analyze for each service the average difference in the rate on December 31, 2013, and
the framework rate at the individual, provider, lead agency, and state levels. The
commissioner shall issue semiannual reports to the stakeholders on the difference in rates
by service and by county during the banding period under section 256B.4913, subdivision
4a. The commissioner shall issue the first report by October 1, 2014, and the final report
shall be issued by December 31, 2018.
deleted text end
deleted text begin (d)deleted text end new text begin (b)new text end No later than July 1, 2014, the commissioner, in consultation with stakeholders,
shall begin the review and evaluation of the following values already in subdivisions 6 to
9, or issues that impact all services, including, but not limited to:
(1) values for transportation rates;
(2) values for services where monitoring technology replaces staff time;
(3) values for indirect services;
(4) values for nursing;
(5) values for the facility use rate in day services, and the weightings used in the day
service ratios and adjustments to those weightings;
(6) values for workers' compensation as part of employee-related expenses;
(7) values for unemployment insurance as part of employee-related expenses;
(8)new text begin direct care workforce labor market measures;
new text end
new text begin (9)new text end any changes in state or federal law with a direct impact on the underlying cost of
providing home and community-based services; and
deleted text begin (9)deleted text end new text begin (10)new text end outcome measures, determined by the commissioner, for home and
community-based services rates determined under this section.
deleted text begin (e)deleted text end new text begin (c)new text end The commissioner shall report to the chairs and the ranking minority members
of the legislative committees and divisions with jurisdiction over health and human services
policy and finance with the information and data gathered under paragraphs deleted text begin (b) to (d)deleted text end new text begin (a)
and (b)new text end on deleted text begin the following dates:
deleted text end
deleted text begin
(1) January 15, 2015, with preliminary results and data;
deleted text end
deleted text begin
(2) January 15, 2016, with a status implementation update, and additional data and
summary information;
deleted text end
deleted text begin
(3) January 15, 2017, with the full report; and
deleted text end
deleted text begin (4)deleted text end January 15, deleted text begin 2020deleted text end new text begin 2021new text end , with deleted text begin anotherdeleted text end new text begin anew text end full report, and a full report once every four
years thereafter.
deleted text begin (f) The commissioner shall implement a regional adjustment factor to all rate calculations
in subdivisions 6 to 9, effective no later than January 1, 2015.deleted text end new text begin (d)new text end Beginning deleted text begin July 1, 2017deleted text end new text begin
January 1, 2022new text end , the commissioner shall renew analysis and implement changes to the
regional adjustment factors deleted text begin when adjustments required under subdivision 5, paragraph (h),
occurdeleted text end new text begin once every six yearsnew text end . Prior to implementation, the commissioner shall consult with
stakeholders on the methodology to calculate the adjustment.
deleted text begin (g)deleted text end new text begin (e)new text end The commissioner shall provide a public notice via LISTSERV in October of
each year deleted text begin beginning October 1, 2014,deleted text end containing information detailing legislatively approved
changes in:
(1) calculation values including derived wage rates and related employee and
administrative factors;
(2) service utilization;
(3) county and tribal allocation changes; and
(4) information on adjustments made to calculation values and the timing of those
adjustments.
The information in this notice must be effective January 1 of the following year.
deleted text begin (h)deleted text end new text begin (f)new text end When the available shared staffing hours in a residential setting are insufficient
to meet the needs of an individual who enrolled in residential services after January 1, 2014,
deleted text begin or insufficient to meet the needs of an individual with a service agreement adjustment
described in section 256B.4913, subdivision 4a, paragraph (f),deleted text end then individual staffing hours
shall be used.
deleted text begin
(i) The commissioner shall study the underlying cost of absence and utilization for day
services. Based on the commissioner's evaluation of the data collected under this paragraph,
the commissioner shall make recommendations to the legislature by January 15, 2018, for
changes, if any, to the absence and utilization factor ratio component value for day services.
deleted text end
deleted text begin (j) Beginning July 1, 2017,deleted text end new text begin (g)new text end The commissioner shall collect transportation and trip
information for all day services through the rates management system.
new text begin
(h) The commissioner, in consultation with stakeholders, shall study value-based models
and outcome-based payment strategies for fee-for-service home and community-based
services and report to the legislative committees with jurisdiction over the disability waiver
rate system by October 1, 2020, with recommended strategies to: (1) promote new models
of care, services, and reimbursement structures that require more efficient use of public
dollars while improving the outcomes most valued by the individuals served; (2) assist
clients and their families in evaluating options and stretching individual budget funds; (3)
support individualized, person-centered planning and individual budget choices; and (4)
create a broader range of client options geographically or targeted at culturally competent
models for racial and ethnic minority groups.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment, except
the amendment to paragraph (f) is effective January 1, 2020.
new text end
Sec. 50.
Minnesota Statutes 2018, section 256B.4914, subdivision 10a, is amended to
read:
Subd. 10a.
Reporting and analysis of cost data.
(a) The commissioner must ensure
that wage values and component values in subdivisions 5 to 9 reflect the cost to provide the
service. As determined by the commissioner, in consultation with stakeholders identified
in section 256B.4913, subdivision 5, a provider enrolled to provide services with rates
determined under this section must submit requested cost data to the commissioner to support
research on the cost of providing services that have rates determined by the disability waiver
rates system. Requested cost data may include, but is not limited to:
(1) worker wage costs;
(2) benefits paid;
(3) supervisor wage costs;
(4) executive wage costs;
(5) vacation, sick, and training time paid;
(6) taxes, workers' compensation, and unemployment insurance costs paid;
(7) administrative costs paid;
(8) program costs paid;
(9) transportation costs paid;
(10) vacancy rates; and
(11) other data relating to costs required to provide services requested by the
commissioner.
(b) At least once in any five-year period, a provider must submit cost data for a fiscal
year that ended not more than 18 months prior to the submission date. The commissioner
shall provide each provider a 90-day notice prior to its submission due date. If a provider
fails to submit required reporting data, the commissioner shall provide notice to providers
that have not provided required data 30 days after the required submission date, and a second
notice for providers who have not provided required data 60 days after the required
submission date. The commissioner shall temporarily suspend payments to the provider if
cost data is not received 90 days after the required submission date. Withheld payments
shall be made once data is received by the commissioner.
(c) The commissioner shall conduct a random validation of data submitted under
paragraph (a) to ensure data accuracy. The commissioner shall analyze cost documentation
in paragraph (a) and provide recommendations for adjustments to cost components.
(d) The commissioner shall analyze cost documentation in paragraph (a) and, in
consultation with stakeholders identified in section 256B.4913, subdivision 5, may submit
recommendations on component values and inflationary factor adjustments to the chairs
and ranking minority members of the legislative committees with jurisdiction over human
services every four years beginning January 1, 2020. The commissioner shall make
recommendations in conjunction with reports submitted to the legislature according to
subdivision 10, paragraph (e). The commissioner shall release cost data in an aggregate
form, and cost data from individual providers shall not be released except as provided for
in current law.
(e) The commissioner, in consultation with stakeholders identified in section 256B.4913,
subdivision 5, shall develop and implement a process for providing training and technical
assistance necessary to support provider submission of cost documentation required under
paragraph (a).
new text begin
(f) Beginning November 1, 2019, providers enrolled to provide services with rates
determined under this section shall submit labor market data to the commissioner annually,
including but not limited to:
new text end
new text begin
(1) number of direct care staff;
new text end
new text begin
(2) wages of direct care staff;
new text end
new text begin
(3) overtime wages of direct care staff;
new text end
new text begin
(4) hours worked by direct care staff;
new text end
new text begin
(5) overtime hours worked by direct care staff;
new text end
new text begin
(6) benefits provided to direct care staff;
new text end
new text begin
(7) direct care staff job vacancies; and
new text end
new text begin
(8) direct care staff retention rates.
new text end
new text begin
(g) Beginning February 1, 2020, the commissioner shall publish annual reports on
provider and state-level labor market data, including but not limited to the data obtained
under paragraph (f).
new text end
new text begin
(h) The commissioner shall temporarily suspend payments to the provider if data
requested under paragraph (f) is not received 90 days after the required submission date.
The commissioner shall make withheld payments once data is received by the commissioner.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 51.
Minnesota Statutes 2018, section 256B.4914, subdivision 14, is amended to read:
Subd. 14.
Exceptions.
(a) In a format prescribed by the commissioner, lead agencies
must identify individuals with exceptional needs that cannot be met under the disability
waiver rate system. The commissioner shall use that information to evaluate and, if necessary,
approve an alternative payment rate for those individuals. Whether granted, denied, or
modified, the commissioner shall respond to all exception requests in writing. The
commissioner shall include in the written response the basis for the action and provide
notification of the right to appeal under paragraph (h).
(b) Lead agencies must act on an exception request within 30 days and notify the initiator
of the request of their recommendation in writing. A lead agency shall submit all exception
requests along with its recommendation to the commissioner.
(c) An application for a rate exception may be submitted for the following criteria:
(1) an individual has service needs that cannot be met through additional units of service;
(2) an individual's rate determined under subdivisions 6, 7, 8, and 9 is so insufficient
that it has resulted in an individual receiving a notice of discharge from the individual's
provider; or
(3) an individual's service needs, including behavioral changes, require a level of service
which necessitates a change in provider or which requires the current provider to propose
service changes beyond those currently authorized.
(d) Exception requests must include the following information:
(1) the service needs required by each individual that are not accounted for in subdivisions
6, 7, 8, and 9;
(2) the service rate requested and the difference from the rate determined in subdivisions
6, 7, 8, and 9;
(3) a basis for the underlying costs used for the rate exception and any accompanying
documentation; and
(4) any contingencies for approval.
(e) Approved rate exceptions shall be managed within lead agency allocations under
sections 256B.092 and 256B.49.
(f) Individual disability waiver recipients, an interested party, or the license holder that
would receive the rate exception increase may request that a lead agency submit an exception
request. A lead agency that denies such a request shall notify the individual waiver recipient,
interested party, or license holder of its decision and the reasons for denying the request in
writing no later than 30 days after the request has been made and shall submit its denial to
the commissioner in accordance with paragraph (b). The reasons for the denial must be
based on the failure to meet the criteria in paragraph (c).
(g) The commissioner shall determine whether to approve or deny an exception request
no more than 30 days after receiving the request. If the commissioner denies the request,
the commissioner shall notify the lead agency and the individual disability waiver recipient,
the interested party, and the license holder in writing of the reasons for the denial.
(h) The individual disability waiver recipient may appeal any denial of an exception
request by either the lead agency or the commissioner, pursuant to sections 256.045 and
256.0451. When the denial of an exception request results in the proposed demission of a
waiver recipient from a residential or day habilitation program, the commissioner shall issue
a temporary stay of demission, when requested by the disability waiver recipient, consistent
with the provisions of section 256.045, subdivisions 4a and 6, paragraph (c). The temporary
stay shall remain in effect until the lead agency can provide an informed choice of
appropriate, alternative services to the disability waiver.
(i) Providers may petition lead agencies to update values that were entered incorrectly
or erroneously into the rate management system, based on past service level discussions
and determination in subdivision 4, without applying for a rate exception.
(j) The starting date for the rate exception will be the later of the date of the recipient's
change in support or the date of the request to the lead agency for an exception.
(k) The commissioner shall track all exception requests received and their dispositions.
The commissioner shall issue quarterly public exceptions statistical reports, including the
number of exception requests received and the numbers granted, denied, withdrawn, and
pending. The report shall include the average amount of time required to process exceptions.
deleted text begin
(l) No later than January 15, 2016, the commissioner shall provide research findings on
the estimated fiscal impact, the primary cost drivers, and common population characteristics
of recipients with needs that cannot be met by the framework rates.
deleted text end
deleted text begin
(m) No later than July 1, 2016, the commissioner shall develop and implement, in
consultation with stakeholders, a process to determine eligibility for rate exceptions for
individuals with rates determined under the methodology in section 256B.4913, subdivision
4a. Determination of eligibility for an exception will occur as annual service renewals are
completed.
deleted text end
deleted text begin (n)deleted text end new text begin (l)new text end Approved rate exceptions deleted text begin will be implemented at such time that the individual's
rate is no longer banded anddeleted text end remain in effect in all cases until an individual's needs change
as defined in paragraph (c).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020.
new text end
Sec. 52.
Minnesota Statutes 2018, section 256B.4914, subdivision 15, is amended to read:
Subd. 15.
County or tribal allocations.
(a) deleted text begin Upon implementation of the disability waiver
rates management system on January 1, 2014,deleted text end The commissioner shall establish a method
of tracking and reporting the fiscal impact of the disability waiver rates management system
on individual lead agencies.
(b) deleted text begin Beginning January 1, 2014,deleted text end The commissioner shall make annual adjustments to
lead agencies' home and community-based waivered service budget allocations to adjust
for rate differences and the resulting impact on county allocations upon implementation of
the disability waiver rates system.
(c) Lead agencies exceeding their allocations shall be subject to the provisions under
sections 256B.0916, subdivision 11, and 256B.49, subdivision 26.
Sec. 53.
Minnesota Statutes 2018, section 256B.85, subdivision 3, is amended to read:
Subd. 3.
Eligibility.
(a) CFSS is available to a person who meets one of the following:
(1) is an enrollee of medical assistance as determined under section 256B.055, 256B.056,
or 256B.057, subdivisions 5 and 9;
(2) is a participant in the alternative care program under section 256B.0913;
(3) is a waiver participant as defined under section 256B.0915, 256B.092, 256B.093, or
256B.49; or
(4) has medical services identified in a person's individualized education program and
is eligible for services as determined in section 256B.0625, subdivision 26.
(b) In addition to meeting the eligibility criteria in paragraph (a), a person must also
meet all of the following:
(1) require assistance and be determined dependent in one activity of daily living or
Level I behavior based on assessment under section 256B.0911; and
(2) is not a participant under a family support grant under section 252.32.
new text begin
(c) A pregnant woman eligible for medical assistance under section 256B.055, subdivision
6, is eligible for CFSS without federal financial participation if the woman: (1) is eligible
for CFSS under paragraphs (a) and (b); and (2) does not meet institutional level of care, as
determined under section 256B.0911.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 54.
Minnesota Statutes 2018, section 256B.85, is amended by adding a subdivision
to read:
new text begin Subd. 7a. new text end
new text begin Enhanced rate. new text end
new text begin
An enhanced rate of 107.5 percent of the rate paid for CFSS
must be paid for services provided to persons who qualify for 12 or more hours of CFSS
per day when provided by a support worker who meets the requirements of subdivision 16,
paragraph (e). The enhanced rate for CFSS includes, and is not in addition to, any rate
adjustments implemented by the commissioner on July 1, 2019, to comply with the terms
of a collective bargaining agreement between the state of Minnesota and an exclusive
representative of individual providers under section 179A.54 that provides for wage increases
for individual providers who serve participants assessed to need 12 or more hours of CFSS
per day.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 55.
Minnesota Statutes 2018, section 256B.85, subdivision 10, is amended to read:
Subd. 10.
Agency-provider and FMS provider qualifications and duties.
(a)
Agency-providers identified in subdivision 11 and FMS providers identified in subdivision
13a shall:
(1) enroll as a medical assistance Minnesota health care programs provider and meet all
applicable provider standards and requirements;
(2) demonstrate compliance with federal and state laws and policies for CFSS as
determined by the commissioner;
(3) comply with background study requirements under chapter 245C and maintain
documentation of background study requests and results;
(4) verify and maintain records of all services and expenditures by the participant,
including hours worked by support workers;
(5) not engage in any agency-initiated direct contact or marketing in person, by telephone,
or other electronic means to potential participants, guardians, family members, or participants'
representatives;
(6) directly provide services and not use a subcontractor or reporting agent;
(7) meet the financial requirements established by the commissioner for financial
solvency;
(8) have never had a lead agency contract or provider agreement discontinued due to
fraud, or have never had an owner, board member, or manager fail a state or FBI-based
criminal background check while enrolled or seeking enrollment as a Minnesota health care
programs provider; and
(9) have an office located in Minnesota.
(b) In conducting general duties, agency-providers and FMS providers shall:
(1) pay support workers based upon actual hours of services provided;
(2) pay for worker training and development services based upon actual hours of services
provided or the unit cost of the training session purchased;
(3) withhold and pay all applicable federal and state payroll taxes;
(4) make arrangements and pay unemployment insurance, taxes, workers' compensation,
liability insurance, and other benefits, if any;
(5) enter into a written agreement with the participant, participant's representative, or
legal representative that assigns roles and responsibilities to be performed before services,
supports, or goods are provided;
(6) report maltreatment as required under sections 626.556 and 626.557; deleted text begin and
deleted text end
(7) comply with any data requests from the department consistent with the Minnesota
Government Data Practices Act under chapter 13deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(8) maintain documentation for the requirements under subdivision 16, paragraph (e),
clause (2), to qualify for an enhanced rate under this section.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 56.
Minnesota Statutes 2018, section 256B.85, subdivision 11, is amended to read:
Subd. 11.
Agency-provider model.
(a) The agency-provider model includes services
provided by support workers and staff providing worker training and development services
who are employed by an agency-provider that meets the criteria established by the
commissioner, including required training.
(b) The agency-provider shall allow the participant to have a significant role in the
selection and dismissal of the support workers for the delivery of the services and supports
specified in the participant's CFSS service delivery plan.
(c) A participant may use authorized units of CFSS services as needed within a service
agreement that is not greater than 12 months. Using authorized units in a flexible manner
in either the agency-provider model or the budget model does not increase the total amount
of services and supports authorized for a participant or included in the participant's CFSS
service delivery plan.
(d) A participant may share CFSS services. Two or three CFSS participants may share
services at the same time provided by the same support worker.
(e) The agency-provider must use a minimum of 72.5 percent of the revenue generated
by the medical assistance payment for CFSS for support worker wages and benefitsnew text begin , except
all of the revenue generated by a medical assistance rate increase due to a collective
bargaining agreement under section 179A.54 must be used for support worker wages and
benefitsnew text end . The agency-provider must document how this requirement is being met. The
revenue generated by the worker training and development services and the reasonable costs
associated with the worker training and development services must not be used in making
this calculation.
(f) The agency-provider model must be used by individuals who are restricted by the
Minnesota restricted recipient program under Minnesota Rules, parts 9505.2160 to
9505.2245.
(g) Participants purchasing goods under this model, along with support worker services,
must:
(1) specify the goods in the CFSS service delivery plan and detailed budget for
expenditures that must be approved by the consultation services provider, case manager, or
care coordinator; and
(2) use the FMS provider for the billing and payment of such goods.
Sec. 57.
Minnesota Statutes 2018, section 256B.85, subdivision 12, is amended to read:
Subd. 12.
Requirements for enrollment of CFSS agency-providers.
(a) All CFSS
agency-providers must provide, at the time of enrollment, reenrollment, and revalidation
as a CFSS agency-provider in a format determined by the commissioner, information and
documentation that includes, but is not limited to, the following:
(1) the CFSS agency-provider's current contact information including address, telephone
number, and e-mail address;
(2) proof of surety bond coverage. Upon new enrollment, or if the agency-provider's
Medicaid revenue in the previous calendar year is less than or equal to $300,000, the
agency-provider must purchase a surety bond of $50,000. If the agency-provider's Medicaid
revenue in the previous calendar year is greater than $300,000, the agency-provider must
purchase a surety bond of $100,000. The surety bond must be in a form approved by the
commissioner, must be renewed annually, and must allow for recovery of costs and fees in
pursuing a claim on the bond;
(3) proof of fidelity bond coverage in the amount of $20,000;
(4) proof of workers' compensation insurance coverage;
(5) proof of liability insurance;
(6) a description of the CFSS agency-provider's organization identifying the names of
all owners, managing employees, staff, board of directors, and the affiliations of the directors
and owners to other service providers;
(7) a copy of the CFSS agency-provider's written policies and procedures including:
hiring of employees; training requirements; service delivery; and employee and consumer
safety, including the process for notification and resolution of participant grievances, incident
response, identification and prevention of communicable diseases, and employee misconduct;
(8) copies of all other forms the CFSS agency-provider uses in the course of daily
business including, but not limited to:
(i) a copy of the CFSS agency-provider's time sheet; and
(ii) a copy of the participant's individual CFSS service delivery plan;
(9) a list of all training and classes that the CFSS agency-provider requires of its staff
providing CFSS services;
(10) documentation that the CFSS agency-provider and staff have successfully completed
all the training required by this section;
(11) documentation of the agency-provider's marketing practices;
(12) disclosure of ownership, leasing, or management of all residential properties that
are used or could be used for providing home care services;
(13) documentation that the agency-provider will use at least the following percentages
of revenue generated from the medical assistance rate paid for CFSS services for CFSS
support worker wages and benefits: 72.5 percent of revenue from CFSS providersnew text begin , except
100 percent of the revenue generated by a medical assistance rate increase due to a collective
bargaining agreement under section 179A.54 must be used for support worker wages and
benefitsnew text end . The revenue generated by the worker training and development services and the
reasonable costs associated with the worker training and development services shall not be
used in making this calculation; and
(14) documentation that the agency-provider does not burden participants' free exercise
of their right to choose service providers by requiring CFSS support workers to sign an
agreement not to work with any particular CFSS participant or for another CFSS
agency-provider after leaving the agency and that the agency is not taking action on any
such agreements or requirements regardless of the date signed.
(b) CFSS agency-providers shall provide to the commissioner the information specified
in paragraph (a).
(c) All CFSS agency-providers shall require all employees in management and
supervisory positions and owners of the agency who are active in the day-to-day management
and operations of the agency to complete mandatory training as determined by the
commissioner. Employees in management and supervisory positions and owners who are
active in the day-to-day operations of an agency who have completed the required training
as an employee with a CFSS agency-provider do not need to repeat the required training if
they are hired by another agency, if they have completed the training within the past three
years. CFSS agency-provider billing staff shall complete training about CFSS program
financial management. Any new owners or employees in management and supervisory
positions involved in the day-to-day operations are required to complete mandatory training
as a requisite of working for the agency.
(d) The commissioner shall send annual review notifications to agency-providers 30
days prior to renewal. The notification must:
(1) list the materials and information the agency-provider is required to submit;
(2) provide instructions on submitting information to the commissioner; and
(3) provide a due date by which the commissioner must receive the requested information.
Agency-providers shall submit all required documentation for annual review within 30 days
of notification from the commissioner. If an agency-provider fails to submit all the required
documentation, the commissioner may take action under subdivision 23a.
Sec. 58.
Minnesota Statutes 2018, section 256B.85, subdivision 16, is amended to read:
Subd. 16.
Support workers requirements.
(a) Support workers shall:
(1) enroll with the department as a support worker after a background study under chapter
245C has been completed and the support worker has received a notice from the
commissioner that the support worker:
(i) is not disqualified under section 245C.14; or
(ii) is disqualified, but has received a set-aside of the disqualification under section
245C.22;
(2) have the ability to effectively communicate with the participant or the participant's
representative;
(3) have the skills and ability to provide the services and supports according to the
participant's CFSS service delivery plan and respond appropriately to the participant's needs;
(4) complete the basic standardized CFSS training as determined by the commissioner
before completing enrollment. The training must be available in languages other than English
and to those who need accommodations due to disabilities. CFSS support worker training
must include successful completion of the following training components: basic first aid,
vulnerable adult, child maltreatment, OSHA universal precautions, basic roles and
responsibilities of support workers including information about basic body mechanics,
emergency preparedness, orientation to positive behavioral practices, orientation to
responding to a mental health crisis, fraud issues, time cards and documentation, and an
overview of person-centered planning and self-direction. Upon completion of the training
components, the support worker must pass the certification test to provide assistance to
participants;
(5) complete employer-directed training and orientation on the participant's individual
needs;
(6) maintain the privacy and confidentiality of the participant; and
(7) not independently determine the medication dose or time for medications for the
participant.
(b) The commissioner may deny or terminate a support worker's provider enrollment
and provider number if the support worker:
(1) does not meet the requirements in paragraph (a);
(2) fails to provide the authorized services required by the employer;
(3) has been intoxicated by alcohol or drugs while providing authorized services to the
participant or while in the participant's home;
(4) has manufactured or distributed drugs while providing authorized services to the
participant or while in the participant's home; or
(5) has been excluded as a provider by the commissioner of human services, or by the
United States Department of Health and Human Services, Office of Inspector General, from
participation in Medicaid, Medicare, or any other federal health care program.
(c) A support worker may appeal in writing to the commissioner to contest the decision
to terminate the support worker's provider enrollment and provider number.
(d) A support worker must not provide or be paid for more than 275 hours of CFSS per
month, regardless of the number of participants the support worker serves or the number
of agency-providers or participant employers by which the support worker is employed.
The department shall not disallow the number of hours per day a support worker works
unless it violates other law.
new text begin
(e) CFSS qualify for an enhanced rate if the support worker providing the services:
new text end
new text begin
(1) provides services, within the scope of CFSS described in subdivision 7, to a participant
who qualifies for 12 or more hours per day of CFSS; and
new text end
new text begin
(2) satisfies the current requirements of Medicare for training and competency or
competency evaluation of home health aides or nursing assistants, as provided in the Code
of Federal Regulations, title 42, section 483.151 or 484.36, or alternative state-approved
training or competency requirements.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 59.
Laws 2017, First Special Session chapter 6, article 1, section 45, is amended to
read:
Sec. 45.
CONSUMER-DIRECTED COMMUNITY SUPPORTS BUDGET
METHODOLOGY deleted text begin EXCEPTION FOR PERSONS LEAVING INSTITUTIONS AND
CRISIS RESIDENTIAL SETTINGSdeleted text end .
new text begin Subdivision 1. new text end
new text begin
Exception for persons leaving institutions and crisis residential
settings.
new text end
(a) By September 30, 2017, the commissioner shall establish an institutional and
crisis bed consumer-directed community supports budget exception process in the home
and community-based services waivers under Minnesota Statutes, sections 256B.092 and
256B.49. This budget exception process shall be available for any individual who:
(1) is not offered available and appropriate services within 60 days since approval for
discharge from the individual's current institutional setting; and
(2) requires services that are more expensive than appropriate services provided in a
noninstitutional setting using the consumer-directed community supports option.
(b) Institutional settings for purposes of this exception include intermediate care facilities
for persons with developmental disabilities; nursing facilities; acute care hospitals; Anoka
Metro Regional Treatment Center; Minnesota Security Hospital; and crisis beds. The budget
exception shall be limited to no more than the amount of appropriate services provided in
a noninstitutional setting as determined by the lead agency managing the individual's home
and community-based services waiver. The lead agency shall notify the Department of
Human Services of the budget exception.
new text begin Subd. 2. new text end
new text begin Shared services. new text end
new text begin
(a) Medical assistance payments for shared services under
consumer-directed community supports are limited to this subdivision.
new text end
new text begin
(b) For purposes of this subdivision, "shared services" means services provided at the
same time by the same direct care worker for individuals who have entered into an agreement
to share consumer-directed community support services.
new text end
new text begin
(c) Shared services may include services in the personal assistance category as outlined
in the consumer-directed community supports community support plan and shared services
agreement, except:
new text end
new text begin
(1) services for more than three individuals provided by one worker at one time;
new text end
new text begin
(2) use of more than one worker for the shared services; and
new text end
new text begin
(3) a child care program licensed under chapter 245A or operated by a local school
district or private school.
new text end
new text begin
(d) The individuals or, as needed, their representatives shall develop the plan for shared
services when developing or amending the consumer-directed community supports plan,
and must follow the consumer-directed community supports process for approval of the
plan by the lead agency. The plan for shared services in an individual's consumer-directed
community supports plan shall include the intention to utilize shared services based on
individuals' needs and preferences.
new text end
new text begin
(e) Individuals sharing services must use the same financial management services
provider.
new text end
new text begin
(f) Individuals whose consumer-directed community supports community support plans
include the intention to utilize shared services must also jointly develop, with the support
of their representatives as needed, a shared services agreement. This agreement must include:
new text end
new text begin
(1) the names of the individuals receiving shared services;
new text end
new text begin
(2) the individuals' representative, if identified in their consumer-directed community
supports plans, and their duties;
new text end
new text begin
(3) the names of the case managers;
new text end
new text begin
(4) the financial management services provider;
new text end
new text begin
(5) the shared services that must be provided;
new text end
new text begin
(6) the schedule for shared services;
new text end
new text begin
(7) the location where shared services must be provided;
new text end
new text begin
(8) the training specific to each individual served;
new text end
new text begin
(9) the training specific to providing shared services to the individuals identified in the
agreement;
new text end
new text begin
(10) instructions to follow all required documentation for time and services provided;
new text end
new text begin
(11) a contingency plan for each of the individuals that accounts for service provision
and billing in the absence of one of the individuals in a shared services setting due to illness
or other circumstances;
new text end
new text begin
(12) signatures of all parties involved in the shared services; and
new text end
new text begin
(13) agreement by each of the individuals who are sharing services on the number of
shared hours for services provided.
new text end
new text begin
(g) Any individual or any individual's representative may withdraw from participating
in a shared services agreement at any time.
new text end
new text begin
(h) The lead agency for each individual must authorize the use of the shared services
option based on the criteria that the shared service is appropriate to meet the needs, health,
and safety of each individual for whom they provide case management or care coordination.
new text end
new text begin
(i) Nothing in this subdivision must be construed to reduce the total authorized
consumer-directed community supports budget for an individual.
new text end
new text begin
(j) No later than September 30, 2019, the commissioner of human services shall:
new text end
new text begin
(1) submit an amendment to the Centers for Medicare and Medicaid Services for the
home and community-based services waivers authorized under Minnesota Statutes, sections
256B.092 and 256B.49, to allow for a shared services option under consumer-directed
community supports; and
new text end
new text begin
(2) with stakeholder input, develop guidance for shared services in consumer-directed
community-supports within the Community Based Services Manual. Guidance must include:
new text end
new text begin
(i) recommendations for negotiating payment for one-to-two and one-to-three services;
and
new text end
new text begin
(ii) a template of the shared services agreement.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 1, 2019, or upon federal approval,
whichever is later, except for subdivision 2, paragraph (j), which is effective the day
following final enactment. The commissioner of human services shall notify the revisor of
statutes when federal approval is obtained.
new text end
Sec. 60.
Laws 2017, First Special Session chapter 6, article 3, section 49, is amended to
read:
Sec. 49. ELECTRONIC deleted text begin SERVICE DELIVERY DOCUMENTATION SYSTEMdeleted text end new text begin
VISIT VERIFICATIONnew text end .
Subdivision 1.
Documentation; establishment.
The commissioner of human services
shall establish implementation requirements and standards for deleted text begin andeleted text end electronic deleted text begin service delivery
documentation systemdeleted text end new text begin visit verificationnew text end to comply with the 21st Century Cures Act, Public
Law 114-255. Within available appropriations, the commissioner shall take steps to comply
with the electronic visit verification requirements in the 21st Century Cures Act, Public
Law 114-255.
Subd. 2.
Definitions.
(a) For purposes of this section, the terms in this subdivision have
the meanings given them.
(b) "Electronic deleted text begin service delivery documentationdeleted text end new text begin visit verificationnew text end " means the electronic
documentation of the:
(1) type of service performed;
(2) individual receiving the service;
(3) date of the service;
(4) location of the service delivery;
(5) individual providing the service; and
(6) time the service begins and ends.
(c) "Electronic deleted text begin service delivery documentationdeleted text end new text begin visit verificationnew text end system" means a system
that provides electronic deleted text begin service delivery documentationdeleted text end new text begin verification of servicesnew text end that complies
with the 21st Century Cures Act, Public Law 114-255, and the requirements of subdivision
3.
(d) "Service" means one of the following:
(1) personal care assistance services as defined in Minnesota Statutes, section 256B.0625,
subdivision 19a, and provided according to Minnesota Statutes, section 256B.0659; deleted text begin or
deleted text end
(2) community first services and supports under Minnesota Statutes, section 256B.85new text begin ;
new text end
new text begin
(3) home health services under Minnesota Statutes, section 256B.0625, subdivision 6a;
or
new text end
new text begin (4) other medical supplies and equipment or home and community-based services that
are required to be electronically verified by the 21st Century Cures Act, Public Law 114-255new text end .
Subd. 3.
Requirements.
(a) In developing implementation requirements for deleted text begin andeleted text end electronic
deleted text begin service delivery documentation systemdeleted text end new text begin visit verificationnew text end , the commissioner shall deleted text begin consider
electronic visit verification systems and other electronic service delivery documentation
methods. The commissioner shall convene stakeholders that will be impacted by an electronic
service delivery system, including service providers and their representatives, service
recipients and their representatives, and, as appropriate, those with expertise in the
development and operation of an electronic service delivery documentation system, todeleted text end ensure
that the requirements:
(1) are minimally administratively and financially burdensome to a provider;
(2) are minimally burdensome to the service recipient and the least disruptive to the
service recipient in receiving and maintaining allowed services;
(3) consider existing best practices and use of electronic deleted text begin service delivery documentationdeleted text end new text begin
visit verificationnew text end ;
(4) are conducted according to all state and federal laws;
(5) are effective methods for preventing fraud when balanced against the requirements
of clauses (1) and (2); and
(6) are consistent with the Department of Human Services' policies related to covered
services, flexibility of service use, and quality assurance.
(b) The commissioner shall make training available to providers on the electronic deleted text begin service
delivery documentationdeleted text end new text begin visit verificationnew text end system requirements.
(c) The commissioner shall establish baseline measurements related to preventing fraud
and establish measures to determine the effect of electronic deleted text begin service delivery documentationdeleted text end new text begin
visit verificationnew text end requirements on program integrity.
new text begin
(d) The commissioner shall make a state-selected electronic visit verification system
available to providers of services.
new text end
new text begin Subd. 3a. new text end
new text begin Provider requirements. new text end
new text begin
(a) A provider of services may select any electronic
visit verification system that meets the requirements established by the commissioner.
new text end
new text begin
(b) All electronic visit verification systems used by providers to comply with the
requirements established by the commissioner must provide data to the commissioner in a
format and at a frequency to be established by the commissioner.
new text end
new text begin
(c) Providers must implement the electronic visit verification systems required under
this section by a date established by the commissioner to be set after the state-selected
electronic visit verification systems for personal care services and home health services are
in production. For purposes of this paragraph, "personal care services" and "home health
services" have the meanings given in United States Code, title 42, section 1396b(l)(5).
Reimbursement rates for providers must not be reduced as a result of federal action to reduce
the federal medical assistance percentage under the 21st Century Cures Act, Public Law
114-255.
new text end
deleted text begin Subd. 4. deleted text end
deleted text begin Legislative report. deleted text end
deleted text begin
(a) The commissioner shall submit a report by January 15,
2018, to the chairs and ranking minority members of the legislative committees with
jurisdiction over human services with recommendations, based on the requirements of
subdivision 3, to establish electronic service delivery documentation system requirements
and standards. The report shall identify:
deleted text end
deleted text begin
(1) the essential elements necessary to operationalize a base-level electronic service
delivery documentation system to be implemented by January 1, 2019; and
deleted text end
deleted text begin
(2) enhancements to the base-level electronic service delivery documentation system to
be implemented by January 1, 2019, or after, with projected operational costs and the costs
and benefits for system enhancements.
deleted text end
deleted text begin
(b) The report must also identify current regulations on service providers that are either
inefficient, minimally effective, or will be unnecessary with the implementation of an
electronic service delivery documentation system.
deleted text end
Sec. 61. new text begin INDIVIDUAL PROVIDERS OF DIRECT SUPPORT SERVICES.
new text end
new text begin
The labor agreement between the state of Minnesota and the Service Employees
International Union Healthcare Minnesota, submitted to the Legislative Coordinating
Commission on March 11, 2019, is ratified.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 62. new text begin RATE INCREASE FOR DIRECT SUPPORT SERVICES PROVIDERS
WORKFORCE NEGOTIATIONS.
new text end
new text begin
(a) Effective July 1, 2019, if the labor agreement between the state of Minnesota and
the Service Employees International Union Healthcare Minnesota under Minnesota Statutes,
section 179A.54, is approved pursuant to Minnesota Statutes, section 3.855, the commissioner
of human services shall:
new text end
new text begin
(1) increase reimbursement rates, individual budgets, grants, or allocations by 2.37
percent for services provided on or after July 1, 2019, to implement the minimum hourly
wage, holiday, and paid time off provisions of that agreement; and
new text end
new text begin
(2) for services provided on or after July 1, 2019, to eligible service recipients, provide
an enhanced rate of 7.5 percent for personal care assistance and community first services
and supports and an enhanced budget increased by 7.5 percent for consumer-directed
community supports and the consumer support grant. Eligible service recipients are persons
identified by the state through assessment who are eligible for at least 12 hours of personal
care assistance each day and are served by workers who have completed designated training
approved by the commissioner. The enhanced rate and enhanced budget includes, and is
not in addition to, any previously implemented enhanced rates or enhanced budgets for
eligible service recipients.
new text end
new text begin
(b) The rate changes described in this section apply to direct support services provided
through a covered program, as defined in Minnesota Statutes, section 256B.0711, subdivision
1.
new text end
Sec. 63. new text begin DIRECTION TO COMMISSIONER; SKILLED NURSE VISIT RATES.
new text end
new text begin
The commissioner of human services shall ensure that skilled nurse visits reimbursed
under Minnesota Statutes, section 256B.0653, are coded, specific to the category of the
nurse performing the visit, using code sets compliant with the Health Insurance Portability
and Accountability Act, Public Law 104-191. "Skilled nurse visit" has the meaning given
in Minnesota Statutes, section 256B.0653, subdivision 2, paragraph (j).
new text end
Sec. 64. new text begin DIRECTION TO COMMISSIONER; INTERAGENCY AGREEMENTS.
new text end
new text begin
By October 1, 2019, the Department of Commerce, Public Utilities Commission, and
Department of Human Services must amend all interagency agreements necessary to
implement sections 1 to 10.
new text end
Sec. 65. new text begin DIRECTION TO COMMISSIONER; FEDERAL AUTHORITY FOR
RECONFIGURED WAIVER SERVICES.
new text end
new text begin
The commissioner of human services shall seek necessary federal authority to implement
new and reconfigured waiver services under section 66. The commissioner of human services
shall notify the revisor of statutes when federal approval is obtained and when new services
are fully implemented.
new text end
Sec. 66. new text begin DISABILITY WAIVER RECONFIGURATION.
new text end
new text begin Subdivision 1. new text end
new text begin Intent. new text end
new text begin
It is the intent of the legislature to reform the medical assistance
waiver programs for people with disabilities to simplify administration of the programs,
incentivize inclusive person-centered supports, enhance each person's personal authority
over the person's service choice, align benefits across waivers, encourage equity across
programs and populations, and promote long-term sustainability of needed services. To the
maximum extent possible, the disability waiver reconfiguration must maintain service
stability and continuity of care, while promoting the most independent and integrated
supports of each person's choosing in both short- and long-term planning.
new text end
new text begin Subd. 2. new text end
new text begin Report. new text end
new text begin
By January 15, 2021, the commissioner of human services shall submit
a report to the members of the legislative committees with jurisdiction over human services
on any necessary waivers, state plan amendments, requests for new funding or realignment
of existing funds, any changes to state statute or rule, and any other federal authority
necessary to implement this section. The report must include information about the
commissioner's work to collect feedback and input from providers, persons accessing home
and community-based services waivers and their families, and client advocacy organizations.
new text end
new text begin Subd. 3. new text end
new text begin Proposal. new text end
new text begin
By January 15, 2021, the commissioner shall develop a proposal to
reconfigure the medical assistance waivers provided in sections 256B.092 and 256B.49.
The proposal shall include all necessary plans for implementing two home and
community-based services waiver programs, as authorized under section 1915(c) of the
Social Security Act that serve persons who are determined to require the levels of care
provided in a nursing home, a hospital, a neurobehavioral hospital, or an intermediate care
facility for persons with developmental disabilities. Before submitting the final report to
the legislature, the commissioner shall publish a draft report with sufficient time for interested
persons to offer additional feedback.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 67. new text begin DIRECT CARE WORKFORCE RATE METHODOLOGY STUDY.
new text end
new text begin
The commissioner of human services, in consultation with stakeholders, shall evaluate
the feasibility of developing a rate methodology for the personal care assistance program,
under Minnesota Statutes, section 256B.0659, and community first services and supports,
under Minnesota Statutes, section 256B.85, similar to the disability waiver rate system
under Minnesota Statutes, section 256B.4914, including determining the component values
and factors to include in such a rate methodology; consider aligning any rate methodology
with the collective bargaining agreement and negotiation cycle under Minnesota Statutes,
section 179A.54; recommend strategies for ensuring adequate, competitive wages for direct
care workers; develop methods and determine the necessary resources for the commissioner
to more consistently collect and audit data from the direct care industry; and report
recommendations, including proposed legislation, to the chairs and ranking minority members
of the legislative committees with jurisdiction over human services policy and finance by
February 1, 2020.
new text end
Sec. 68. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; TEFRA
OPTION IMPROVEMENT MEASURES.
new text end
new text begin
(a) The commissioner of human services shall, using existing appropriations, develop
content to be included on the MNsure website explaining the TEFRA option under medical
assistance for applicants who indicate during the application process that a child in the
family has a disability.
new text end
new text begin
(b) The commissioner shall develop a cover letter explaining the TEFRA option under
medical assistance, as well as the application and renewal process, to be disseminated with
the DHS-6696A form to applicants who may qualify for medical assistance under the TEFRA
option. The commissioner shall provide the content and the form to the executive director
of MNsure for inclusion on the MNsure website. The commissioner shall also develop and
implement education and training for lead agency staff statewide to improve understanding
of the medical assistance TEFRA enrollment and renewal processes and procedures.
new text end
new text begin
(c) The commissioner shall convene a stakeholder group that shall consider improvements
to the TEFRA option enrollment and renewal processes, including but not limited to revisions
to, or the development of, application and renewal paperwork specific to the TEFRA option;
possible technology solutions; and county processes.
new text end
new text begin
(d) The stakeholder group must include representatives from the Department of Human
Services Health Care Division, MNsure, representatives from at least two counties in the
metropolitan area and from at least one county in greater Minnesota, the Arc Minnesota,
Gillette Children's Specialty Healthcare, the Autism Society of Minnesota, Proof Alliance,
the Minnesota Consortium for Citizens with Disabilities, and other interested stakeholders
as identified by the commissioner of human services.
new text end
new text begin
(e) The stakeholder group shall submit a report of the group's recommended
improvements and any associated costs to the commissioner by December 31, 2020. The
group shall also provide copies of the report to each stakeholder group member. The
commissioner shall provide a copy of the report to the legislative committees with jurisdiction
over medical assistance.
new text end
Sec. 69. new text begin DIRECTION TO COMMISSIONER; DIRECT CARE STAFF
COMPENSATION REPORT.
new text end
new text begin
By January 15, 2022, the commissioner of human services, in consultation with
stakeholders, shall report to the chairs and ranking minority members of the legislative
committees and divisions with jurisdiction over health and human services policy and finance
with recommendations for:
new text end
new text begin
(1) the implementation of penalties for providers who do not meet the compensation
levels identified in Minnesota Statutes, section 256B.4914, subdivision 5a;
new text end
new text begin
(2) the implementation of good cause exemptions for providers who have not met the
compensation levels identified in Minnesota Statutes, section 256B.4914, subdivision 5a;
and
new text end
new text begin
(3) the rebasing of compensation levels identified in Minnesota Statutes, section
256B.4914, subdivision 5a, using data reported under Minnesota Statutes, section 256B.4914,
subdivision 10a.
new text end
Sec. 70. new text begin REVISOR INSTRUCTION.
new text end
new text begin
The revisor of statutes, in consultation with the House Research Department, Office of
Senate Counsel, Research and Fiscal Analysis, and Department of Human Services, shall
prepare legislation for the 2020 legislative session to codify laws governing
consumer-directed community supports in Minnesota Statutes, chapter 256B.
new text end
Sec. 71. new text begin REVISOR INSTRUCTION.
new text end
new text begin
The revisor of statutes shall renumber Minnesota Statutes, section 256B.4913, subdivision
5, as a subdivision in Minnesota Statutes, section 256B.4914. The revisor shall also make
necessary cross-reference changes in Minnesota Statutes consistent with the renumbering.
new text end
Sec. 72. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2018, section 256B.0705,
new text end
new text begin
is repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2018, sections 252.431; and 252.451,
new text end
new text begin
are repealed.
new text end
new text begin
(c)
new text end
new text begin
Minnesota Statutes 2018, sections 252.41, subdivision 8; and 256B.4913, subdivisions
4a, 6, and 7,
new text end
new text begin
are repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraph (a) is effective the day following final enactment.
Paragraph (b) is effective September 1, 2019. Paragraph (c) is effective January 1, 2020.
new text end
ARTICLE 6
CHEMICAL AND MENTAL HEALTH
Section 1.
Minnesota Statutes 2018, section 13.851, is amended by adding a subdivision
to read:
new text begin Subd. 12. new text end
new text begin Mental health screening. new text end
new text begin
The treatment of data collected by a sheriff or local
corrections agency related to individuals who may have a mental illness is governed by
section 641.15, subdivision 3a.
new text end
Sec. 2.
Minnesota Statutes 2018, section 245.4661, subdivision 9, is amended to read:
Subd. 9.
Services and programs.
(a) The following deleted text begin threedeleted text end new text begin fournew text end distinct grant programs
are funded under this section:
(1) mental health crisis services;
(2) housing with supports for adults with serious mental illness; deleted text begin and
deleted text end
(3) projects for assistance in transitioning from homelessness (PATH program)deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(4) culturally specific mental health and substance use disorder provider consultation.
new text end
(b) In addition, the following are eligible for grant funds:
(1) community education and prevention;
(2) client outreach;
(3) early identification and intervention;
(4) adult outpatient diagnostic assessment and psychological testing;
(5) peer support services;
(6) community support program services (CSP);
(7) adult residential crisis stabilization;
(8) supported employment;
(9) assertive community treatment (ACT);
(10) housing subsidies;
(11) basic living, social skills, and community intervention;
(12) emergency response services;
(13) adult outpatient psychotherapy;
(14) adult outpatient medication management;
(15) adult mobile crisis services;
(16) adult day treatment;
(17) partial hospitalization;
(18) adult residential treatment;
(19) adult mental health targeted case management;
(20) intensive community rehabilitative services (ICRS); and
(21) transportation.
Sec. 3.
Minnesota Statutes 2018, section 245.4889, subdivision 1, is amended to read:
Subdivision 1.
Establishment and authority.
(a) The commissioner is authorized to
make grants from available appropriations to assist:
(1) counties;
(2) Indian tribes;
(3) children's collaboratives under section 124D.23 or 245.493; or
(4) mental health service providers.
(b) The following services are eligible for grants under this section:
(1) services to children with emotional disturbances as defined in section 245.4871,
subdivision 15, and their families;
(2) transition services under section 245.4875, subdivision 8, for young adults under
age 21 and their families;
(3) respite care services for children with severe emotional disturbances who are at risk
of out-of-home placement;
(4) children's mental health crisis services;
(5) mental health services for people from cultural and ethnic minorities;
(6) children's mental health screening and follow-up diagnostic assessment and treatment;
(7) services to promote and develop the capacity of providers to use evidence-based
practices in providing children's mental health services;
(8) school-linked mental health servicesdeleted text begin , including transportation for children receiving
school-linked mental health services when school is not in sessiondeleted text end new text begin under section 245.4901new text end ;
(9) building evidence-based mental health intervention capacity for children birth to age
five;
(10) suicide prevention and counseling services that use text messaging statewide;
(11) mental health first aid training;
(12) training for parents, collaborative partners, and mental health providers on the
impact of adverse childhood experiences and trauma and development of an interactive
website to share information and strategies to promote resilience and prevent trauma;
(13) transition age services to develop or expand mental health treatment and supports
for adolescents and young adults 26 years of age or younger;
(14) early childhood mental health consultation;
(15) evidence-based interventions for youth at risk of developing or experiencing a first
episode of psychosis, and a public awareness campaign on the signs and symptoms of
psychosis;
(16) psychiatric consultation for primary care practitioners; and
(17) providers to begin operations and meet program requirements when establishing a
new children's mental health program. These may be start-up grants.
(c) Services under paragraph (b) must be designed to help each child to function and
remain with the child's family in the community and delivered consistent with the child's
treatment plan. Transition services to eligible young adults under this paragraph must be
designed to foster independent living in the community.
new text begin
(d) As a condition of receiving grant funds, a grantee shall obtain all available third-party
reimbursement sources, if applicable.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 4.
new text begin
[245.4901] SCHOOL-LINKED MENTAL HEALTH GRANTS.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The commissioner of human services shall establish a
school-linked mental health grant program to provide early identification and intervention
for students with mental health needs and to build the capacity of schools to support students
with mental health needs in the classroom.
new text end
new text begin Subd. 2. new text end
new text begin Eligible applicants. new text end
new text begin
An eligible applicant for school-linked mental health grants
is an entity that is:
new text end
new text begin
(1) certified under Minnesota Rules, parts 9520.0750 to 9520.0870;
new text end
new text begin
(2) a community mental health center under section 256B.0625, subdivision 5;
new text end
new text begin
(3) an Indian health service facility or a facility owned and operated by a tribe or tribal
organization operating under United States Code, title 25, section 5321;
new text end
new text begin
(4) a provider of children's therapeutic services and supports as defined in section
256B.0943; or
new text end
new text begin
(5) enrolled in medical assistance as a mental health or substance use disorder provider
agency and employs at least two full-time equivalent mental health professionals qualified
according to section 245I.16, subdivision 2, or two alcohol and drug counselors licensed or
exempt from licensure under chapter 148F who are qualified to provide clinical services to
children and families.
new text end
new text begin Subd. 3. new text end
new text begin Allowable grant activities and related expenses. new text end
new text begin
(a) Allowable grant activities
and related expenses may include but are not limited to:
new text end
new text begin
(1) identifying and diagnosing mental health conditions of students;
new text end
new text begin
(2) delivering mental health treatment and services to students and their families,
including via telemedicine consistent with section 256B.0625, subdivision 3b;
new text end
new text begin
(3) supporting families in meeting their child's needs, including navigating health care,
social service, and juvenile justice systems;
new text end
new text begin
(4) providing transportation for students receiving school-linked mental health services
when school is not in session;
new text end
new text begin
(5) building the capacity of schools to meet the needs of students with mental health
concerns, including school staff development activities for licensed and nonlicensed staff;
and
new text end
new text begin
(6) purchasing equipment, connection charges, on-site coordination, set-up fees, and
site fees in order to deliver school-linked mental health services via telemedicine.
new text end
new text begin
(b) Grantees shall obtain all available third-party reimbursement sources as a condition
of receiving a grant. For purposes of this grant program, a third-party reimbursement source
excludes a public school as defined in section 120A.20, subdivision 1. Grantees shall serve
students regardless of health coverage status or ability to pay.
new text end
new text begin Subd. 4. new text end
new text begin Data collection and outcome measurement. new text end
new text begin
Grantees shall provide data to
the commissioner for the purpose of evaluating the effectiveness of the school-linked mental
health grant program.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 5.
Minnesota Statutes 2018, section 245.735, subdivision 3, is amended to read:
Subd. 3.
Certified community behavioral health clinics.
(a) The commissioner shall
establish a state certification process for certified community behavioral health clinics
(CCBHCs) deleted text begin to be eligible for the prospective payment system in paragraph (f)deleted text end . Entities that
choose to be CCBHCs must:
(1) comply with the CCBHC criteria published by the United States Department of
Health and Human Services;
(2) employ or contract for clinic staff who have backgrounds in diverse disciplines,
including licensed mental health professionalsnew text begin and licensed alcohol and drug counselorsnew text end ,
and staff who are culturally and linguistically trained to deleted text begin servedeleted text end new text begin meetnew text end the needs of the deleted text begin clinic's
patientdeleted text end populationnew text begin the clinic servesnew text end ;
(3) ensure that clinic services are available and accessible to deleted text begin patientsdeleted text end new text begin individuals and
familiesnew text end of all ages and genders and that crisis management services are available 24 hours
per day;
(4) establish fees for clinic services for deleted text begin nonmedical assistance patientsdeleted text end new text begin individuals who
are not enrolled in medical assistancenew text end using a sliding fee scale that ensures that services to
patients are not denied or limited due to deleted text begin a patient'sdeleted text end new text begin an individual'snew text end inability to pay for services;
(5) comply with quality assurance reporting requirements and other reporting
requirements, including any required reporting of encounter data, clinical outcomes data,
and quality data;
(6) provide crisis mental health new text begin and substance use new text end services, withdrawal management
services, emergency crisis intervention services, and stabilization services; screening,
assessment, and diagnosis services, including risk assessments and level of care
determinations; deleted text begin patient-centereddeleted text end new text begin person- and family-centerednew text end treatment planning; outpatient
mental health and substance use services; targeted case management; psychiatric
rehabilitation services; peer support and counselor services and family support services;
and intensive community-based mental health services, including mental health services
for members of the armed forces and veterans;
(7) provide coordination of care across settings and providers to ensure seamless
transitions for deleted text begin patientsdeleted text end new text begin individuals being servednew text end across the full spectrum of health services,
including acute, chronic, and behavioral needs. Care coordination may be accomplished
through partnerships or formal contracts with:
(i) counties, health plans, pharmacists, pharmacies, rural health clinics, federally qualified
health centers, inpatient psychiatric facilities, substance use and detoxification facilities, or
community-based mental health providers; and
(ii) other community services, supports, and providers, including schools, child welfare
agencies, juvenile and criminal justice agencies, Indian health services clinics, tribally
licensed health care and mental health facilities, urban Indian health clinics, Department of
Veterans Affairs medical centers, outpatient clinics, drop-in centers, acute care hospitals,
and hospital outpatient clinics;
(8) be certified as mental health clinics under section 245.69, subdivision 2;
deleted text begin
(9) be certified to provide integrated treatment for co-occurring mental illness and
substance use disorders in adults or children under Minnesota Rules, chapter 9533, effective
July 1, 2017;
deleted text end
deleted text begin (10)deleted text end new text begin (9)new text end comply with standards relating to mental health services in deleted text begin Minnesota Rules,deleted text end
deleted text begin parts deleted text end deleted text begin to deleted text end new text begin chapter 245I and section 256B.0671new text end ;
deleted text begin (11)deleted text end new text begin (10)new text end be licensed to provide deleted text begin chemical dependencydeleted text end new text begin substance use disordernew text end treatment
under chapter 245G;
deleted text begin (12)deleted text end new text begin (11)new text end be certified to provide children's therapeutic services and supports under section
256B.0943;
deleted text begin (13)deleted text end new text begin (12)new text end be certified to provide adult rehabilitative mental health services under section
256B.0623;
deleted text begin (14)deleted text end new text begin (13)new text end be enrolled to provide mental health crisis response services under deleted text begin sectiondeleted text end
new text begin sectionsnew text end 256B.0624 new text begin and 256B.0944new text end ;
deleted text begin (15)deleted text end new text begin (14)new text end be enrolled to provide mental health targeted case management under section
256B.0625, subdivision 20;
deleted text begin (16)deleted text end new text begin (15)new text end comply with standards relating to mental health case management in Minnesota
Rules, parts 9520.0900 to 9520.0926; deleted text begin and
deleted text end
deleted text begin (17)deleted text end new text begin (16)new text end provide services that comply with the evidence-based practices described in
paragraph (e)deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(17) comply with standards relating to peer services under sections 256B.0615,
256B.0616, and 245G.07, subdivision 1, paragraph (a), clause (5), as applicable when peer
services are provided.
new text end
(b) If an entity is unable to provide one or more of the services listed in paragraph (a),
clauses (6) to (17), the commissioner may certify the entity as a CCBHC, if the entity has
a current contract with another entity that has the required authority to provide that service
and that meets federal CCBHC criteria as a designated collaborating organization, or, to
the extent allowed by the federal CCBHC criteria, the commissioner may approve a referral
arrangement. The CCBHC must meet federal requirements regarding the type and scope of
services to be provided directly by the CCBHC.
(c) Notwithstanding any other law that requires a county contract or other form of county
approval for certain services listed in paragraph (a), clause (6), a clinic that otherwise meets
CCBHC requirements may receive the prospective payment under deleted text begin paragraph (f)deleted text end new text begin section
256B.0625, subdivision 5m,new text end for those services without a county contract or county approval.
There is no county share when medical assistance pays the CCBHC prospective payment.
As part of the certification process in paragraph (a), the commissioner shall require a letter
of support from the CCBHC's host county confirming that the CCBHC and the county or
counties it serves have an ongoing relationship to facilitate access and continuity of care,
especially for individuals who are uninsured or who may go on and off medical assistance.
(d) When the standards listed in paragraph (a) or other applicable standards conflict or
address similar issues in duplicative or incompatible ways, the commissioner may grant
variances to state requirements if the variances do not conflict with federal requirements.
If standards overlap, the commissioner may substitute all or a part of a licensure or
certification that is substantially the same as another licensure or certification. The
commissioner shall consult with stakeholders, as described in subdivision 4, before granting
variances under this provision.new text begin For the CCBHC that is certified but not approved for
prospective payment under section 256B.0625, subdivision 5m, the commissioner may
grant a variance under this paragraph if the variance does not increase the state share of
costs.
new text end
(e) The commissioner shall issue a list of required evidence-based practices to be
delivered by CCBHCs, and may also provide a list of recommended evidence-based practices.
The commissioner may update the list to reflect advances in outcomes research and medical
services for persons living with mental illnesses or substance use disorders. The commissioner
shall take into consideration the adequacy of evidence to support the efficacy of the practice,
the quality of workforce available, and the current availability of the practice in the state.
At least 30 days before issuing the initial list and any revisions, the commissioner shall
provide stakeholders with an opportunity to comment.
deleted text begin
(f) The commissioner shall establish standards and methodologies for a prospective
payment system for medical assistance payments for services delivered by certified
community behavioral health clinics, in accordance with guidance issued by the Centers
for Medicare and Medicaid Services. During the operation of the demonstration project,
payments shall comply with federal requirements for an enhanced federal medical assistance
percentage. The commissioner may include quality bonus payment in the prospective
payment system based on federal criteria and on a clinic's provision of the evidence-based
practices in paragraph (e). The prospective payment system does not apply to MinnesotaCare.
Implementation of the prospective payment system is effective July 1, 2017, or upon federal
approval, whichever is later.
deleted text end
deleted text begin
(g) The commissioner shall seek federal approval to continue federal financial
participation in payment for CCBHC services after the federal demonstration period ends
for clinics that were certified as CCBHCs during the demonstration period and that continue
to meet the CCBHC certification standards in paragraph (a). Payment for CCBHC services
shall cease effective July 1, 2019, if continued federal financial participation for the payment
of CCBHC services cannot be obtained.
deleted text end
deleted text begin
(h) The commissioner may certify at least one CCBHC located in an urban area and at
least one CCBHC located in a rural area, as defined by federal criteria. To the extent allowed
by federal law, the commissioner may limit the number of certified clinics so that the
projected claims for certified clinics will not exceed the funds budgeted for this purpose.
The commissioner shall give preference to clinics that:
deleted text end
deleted text begin
(1) provide a comprehensive range of services and evidence-based practices for all age
groups, with services being fully coordinated and integrated; and
deleted text end
deleted text begin
(2) enhance the state's ability to meet the federal priorities to be selected as a CCBHC
demonstration state.
deleted text end
deleted text begin (i)deleted text end new text begin (f)new text end The commissioner shall recertify CCBHCs at least every three years. The
commissioner shall establish a process for decertification and shall require corrective action,
medical assistance repayment, or decertification of a CCBHC that no longer meets the
requirements in this section or that fails to meet the standards provided by the commissioner
in the application and certification process.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 6.
Minnesota Statutes 2018, section 245F.05, subdivision 2, is amended to read:
Subd. 2.
Admission criteria.
For an individual to be admitted to a withdrawal
management program, the program must make a determination that the program services
are appropriate to the needs of the individual. A program may only admit individuals deleted text begin who
meet the admission criteria anddeleted text end who, at the time of admissiondeleted text begin :deleted text end new text begin , meet the criteria for admission
as determined by current American Society of Addiction Medicine standards for appropriate
level of withdrawal management.
new text end
deleted text begin
(1) are impaired as the result of intoxication;
deleted text end
deleted text begin
(2) are experiencing physical, mental, or emotional problems due to intoxication or
withdrawal from alcohol or other drugs;
deleted text end
deleted text begin
(3) are being held under apprehend and hold orders under section 253B.07, subdivision
2b;
deleted text end
deleted text begin
(4) have been committed under chapter 253B and need temporary placement;
deleted text end
deleted text begin
(5) are held under emergency holds or peace and health officer holds under section
253B.05, subdivision 1 or 2; or
deleted text end
deleted text begin
(6) need to stay temporarily in a protective environment because of a crisis related to
substance use disorder. Individuals satisfying this clause may be admitted only at the request
of the county of fiscal responsibility, as determined according to section 256G.02, subdivision
4. Individuals admitted according to this clause must not be restricted to the facility.
deleted text end
Sec. 7.
Minnesota Statutes 2018, section 254A.03, subdivision 3, is amended to read:
Subd. 3.
Rules for substance use disorder care.
(a) The commissioner of human
services shall establish by rule criteria to be used in determining the appropriate level of
chemical dependency care for each recipient of public assistance seeking treatment for
substance misuse or substance use disorder. Upon federal approval of a comprehensive
assessment as a Medicaid benefit, or on July 1, 2018, whichever is later, and notwithstanding
the criteria in Minnesota Rules, parts 9530.6600 to 9530.6655, an eligible vendor of
comprehensive assessments under section 254B.05 may determine and approve the
appropriate level of substance use disorder treatment for a recipient of public assistance.
The process for determining an individual's financial eligibility for the consolidated chemical
dependency treatment fund or determining an individual's enrollment in or eligibility for a
publicly subsidized health plan is not affected by the individual's choice to access a
comprehensive assessment for placement.
(b) The commissioner shall develop and implement a utilization review process for
publicly funded treatment placements to monitor and review the clinical appropriateness
and timeliness of all publicly funded placements in treatment.
new text begin
(c) If a screen result is positive for alcohol or substance misuse, a brief screening for
alcohol or substance use disorder that is provided to a recipient of public assistance within
a primary care clinic, hospital, or other medical setting or school setting establishes medical
necessity and approval for an initial set of substance use disorder services identified in
section 254B.05, subdivision 5. The initial set of services approved for a recipient whose
screen result is positive may include any combination of up to four hours of individual or
group substance use disorder treatment, two hours of substance use disorder treatment
coordination, or two hours of substance use disorder peer support services provided by a
qualified individual according to chapter 245G. A recipient must obtain an assessment
pursuant to paragraph (a) to be approved for additional treatment services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
Contingent upon federal approval, this section is effective July
1, 2019. The commissioner of human services shall notify the revisor of statutes when
federal approval is obtained or denied.
new text end
Sec. 8.
Minnesota Statutes 2018, section 254B.02, subdivision 1, is amended to read:
Subdivision 1.
Chemical dependency treatment allocation.
The chemical dependency
treatment appropriation shall be placed in a special revenue account. deleted text begin The commissioner
shall annually transfer funds from the chemical dependency fund to pay for operation of
the drug and alcohol abuse normative evaluation system and to pay for all costs incurred
by adding two positions for licensing of chemical dependency treatment and rehabilitation
programs located in hospitals for which funds are not otherwise appropriated.deleted text end The deleted text begin remainder
of thedeleted text end money in the special revenue account must be used according to the requirements in
this chapter.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 9.
Minnesota Statutes 2018, section 254B.03, subdivision 2, is amended to read:
Subd. 2.
Chemical dependency fund payment.
(a) Payment from the chemical
dependency fund is limited to payments for services other than detoxification licensed under
Minnesota Rules, parts 9530.6510 to 9530.6590, that, if located outside of federally
recognized tribal lands, would be required to be licensed by the commissioner as a chemical
dependency treatment or rehabilitation program under sections 245A.01 to 245A.16, and
services other than detoxification provided in another state that would be required to be
licensed as a chemical dependency program if the program were in the state. Out of state
vendors must also provide the commissioner with assurances that the program complies
substantially with state licensing requirements and possesses all licenses and certifications
required by the host state to provide chemical dependency treatment. Vendors receiving
payments from the chemical dependency fund must not require co-payment from a recipient
of benefits for services provided under this subdivision. The vendor is prohibited from using
the client's public benefits to offset the cost of services paid under this section. The vendor
shall not require the client to use public benefits for room or board costs. This includes but
is not limited to cash assistance benefits under chapters 119B, 256D, and 256J, or SNAP
benefits. Retention of SNAP benefits is a right of a client receiving services through the
consolidated chemical dependency treatment fund or through state contracted managed care
entities. Payment from the chemical dependency fund shall be made for necessary room
and board costs provided by vendors deleted text begin certified according todeleted text end new text begin meeting the criteria under new text end section
254B.05new text begin , subdivision 1anew text end , or in a community hospital licensed by the commissioner of health
according to sections 144.50 to 144.56 to a client who is:
(1) determined to meet the criteria for placement in a residential chemical dependency
treatment program according to rules adopted under section 254A.03, subdivision 3; and
(2) concurrently receiving a chemical dependency treatment service in a program licensed
by the commissioner and reimbursed by the chemical dependency fund.
(b) A county may, from its own resources, provide chemical dependency services for
which state payments are not made. A county may elect to use the same invoice procedures
and obtain the same state payment services as are used for chemical dependency services
for which state payments are made under this section if county payments are made to the
state in advance of state payments to vendors. When a county uses the state system for
payment, the commissioner shall make monthly billings to the county using the most recent
available information to determine the anticipated services for which payments will be made
in the coming month. Adjustment of any overestimate or underestimate based on actual
expenditures shall be made by the state agency by adjusting the estimate for any succeeding
month.
(c) The commissioner shall coordinate chemical dependency services and determine
whether there is a need for any proposed expansion of chemical dependency treatment
services. The commissioner shall deny vendor certification to any provider that has not
received prior approval from the commissioner for the creation of new programs or the
expansion of existing program capacity. The commissioner shall consider the provider's
capacity to obtain clients from outside the state based on plans, agreements, and previous
utilization history, when determining the need for new treatment services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 10.
Minnesota Statutes 2018, section 254B.03, subdivision 4, is amended to read:
Subd. 4.
Division of costs.
(a) Except for services provided by a county under section
254B.09, subdivision 1, or services provided under section 256B.69, the county shall, out
of local money, pay the state for 22.95 percent of the cost of chemical dependency services,
deleted text begin includingdeleted text end new text begin except fornew text end those services provided to persons deleted text begin eligible fordeleted text end new text begin enrolled innew text end medical
assistance under chapter 256Bnew text begin and room and board services under section 254B.05,
subdivision 5, paragraph (b), clause (12)new text end . Counties may use the indigent hospitalization
levy for treatment and hospital payments made under this section.
(b) 22.95 percent of any state collections from private or third-party pay, less 15 percent
for the cost of payment and collections, must be distributed to the county that paid for a
portion of the treatment under this section.
deleted text begin
(c) For fiscal year 2017 only, the 22.95 percentages under paragraphs (a) and (b) are
equal to 20.2 percent.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 11.
Minnesota Statutes 2018, section 254B.04, subdivision 1, is amended to read:
Subdivision 1.
Eligibility.
new text begin (a)new text end Persons eligible for benefits under Code of Federal
Regulations, title 25, part 20, deleted text begin and persons eligible for medical assistance benefits under
sections 256B.055, 256B.056, and 256B.057, subdivisions 1, 5, and 6, ordeleted text end who meet the
income standards of section 256B.056, subdivision 4,new text begin and are not enrolled in medical
assistance,new text end are entitled to chemical dependency fund services. State money appropriated
for this paragraph must be placed in a separate account established for this purpose.
new text begin (b) new text end Persons with dependent children who are determined to be in need of chemical
dependency treatment pursuant to an assessment under section 626.556, subdivision 10, or
a case plan under section 260C.201, subdivision 6, or 260C.212, shall be assisted by the
local agency to access needed treatment services. Treatment services must be appropriate
for the individual or family, which may include long-term care treatment or treatment in a
facility that allows the dependent children to stay in the treatment facility. The county shall
pay for out-of-home placement costs, if applicable.
new text begin
(c) Notwithstanding paragraph (a), persons enrolled in medical assistance are eligible
for room and board services under section 254B.05, subdivision 5, paragraph (b), clause
(12).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 1, 2019.
new text end
Sec. 12.
Minnesota Statutes 2018, section 254B.05, subdivision 1a, is amended to read:
Subd. 1a.
Room and board provider requirements.
(a) Effective January 1, 2000,
vendors of room and board are eligible for chemical dependency fund payment if the vendor:
(1) has rules prohibiting residents bringing chemicals into the facility or using chemicals
while residing in the facility and provide consequences for infractions of those rules;
(2) is determined to meet applicable health and safety requirements;
(3) is not a jail or prison;
(4) is not concurrently receiving funds under chapter 256I for the recipient;
(5) admits individuals who are 18 years of age or older;
(6) is registered as a board and lodging or lodging establishment according to section
157.17;
(7) has awake staff on site 24 hours per day;
(8) has staff who are at least 18 years of age and meet the requirements of section
245G.11, subdivision 1, paragraph (b);
(9) has emergency behavioral procedures that meet the requirements of section 245G.16;
(10) meets the requirements of section 245G.08, subdivision 5, if administering
medications to clients;
(11) meets the abuse prevention requirements of section 245A.65, including a policy on
fraternization and the mandatory reporting requirements of section 626.557;
(12) documents coordination with the treatment provider to ensure compliance with
section 254B.03, subdivision 2;
(13) protects client funds and ensures freedom from exploitation by meeting the
provisions of section 245A.04, subdivision 13;
(14) has a grievance procedure that meets the requirements of section 245G.15,
subdivision 2; and
(15) has sleeping and bathroom facilities for men and women separated by a door that
is locked, has an alarm, or is supervised by awake staff.
(b) Programs licensed according to Minnesota Rules, chapter 2960, are exempt from
paragraph (a), clauses (5) to (15).
new text begin
(c) Licensed programs providing intensive residential treatment services or residential
crisis stabilization services pursuant to section 256B.0622 or 256B.0624 are eligible vendors
of room and board and are exempt from paragraph (a), clauses (6) to (15).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 1, 2019.
new text end
Sec. 13.
Minnesota Statutes 2018, section 254B.06, subdivision 1, is amended to read:
Subdivision 1.
State collections.
The commissioner is responsible for all collections
from persons determined to be partially responsible for the cost of care of an eligible person
receiving services under Laws 1986, chapter 394, sections 8 to 20. The commissioner may
initiate, or request the attorney general to initiate, necessary civil action to recover the unpaid
cost of care. The commissioner may collect all third-party payments for chemical dependency
services provided under Laws 1986, chapter 394, sections 8 to 20, including private insurance
and federal Medicaid and Medicare financial participation. deleted text begin The commissioner shall deposit
in a dedicated account a percentage of collections to pay for the cost of operating the chemical
dependency consolidated treatment fund invoice processing and vendor payment system,
billing, and collections.deleted text end The remaining receipts must be deposited in the chemical dependency
fund.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 14.
Minnesota Statutes 2018, section 254B.06, subdivision 2, is amended to read:
Subd. 2.
Allocation of collections.
deleted text begin (a) The commissioner shall allocate all federal
financial participation collections to a special revenue account.deleted text end The commissioner shall
allocate 77.05 percent of patient payments and third-party payments to the special revenue
account and 22.95 percent to the county financially responsible for the patient.
deleted text begin
(b) For fiscal year 2017 only, the commissioner's allocation to the special revenue account
shall be increased from 77.05 percent to 79.8 percent and the county financial responsibility
shall be reduced from 22.95 percent to 20.2 percent.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 15.
Minnesota Statutes 2018, section 256.478, is amended to read:
256.478 deleted text begin HOME AND COMMUNITY-BASED SERVICES TRANSITIONS
GRANTSdeleted text end new text begin TRANSITION TO COMMUNITY INITIATIVEnew text end .
new text begin Subdivision 1. new text end
new text begin Eligibility. new text end
new text begin
(a) An individual is eligible for the transition to community
initiative if the individual meets the following criteria:
new text end
new text begin
(1) without the additional resources available through the transitions to community
initiative the individual would otherwise remain at the Anoka-Metro Regional Treatment
Center, a state-operated community behavioral health hospital, or the Minnesota Security
Hospital;
new text end
new text begin
(2) the individual's discharge would be significantly delayed without the additional
resources available through the transitions to community initiative; and
new text end
new text begin
(3) the individual met treatment objectives and no longer needs hospital-level care or a
secure treatment setting.
new text end
new text begin
(b) An individual who is in a community hospital and on the waiting list for the
Anoka-Metro Regional Treatment Center, but for whom alternative community placement
would be appropriate is eligible for the transition to community initiative upon the
commissioner's approval.
new text end
new text begin Subd. 2. new text end
new text begin Transition grants. new text end
The commissioner shall make available deleted text begin home and
community-based servicesdeleted text end transition new text begin to community new text end grants to deleted text begin servedeleted text end new text begin assistnew text end individuals deleted text begin who
do not meet eligibility criteria for the medical assistance program under section 256B.056
or 256B.057, but who otherwise meet the criteria under section 256B.092, subdivision 13,
or 256B.49, subdivision 24deleted text end new text begin who met the criteria under subdivision 1new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 16.
Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 5m. new text end
new text begin Certified community behavioral health clinic services. new text end
new text begin
(a) Medical
assistance covers certified community behavioral health clinic (CCBHC) services that meet
the requirements of section 245.735, subdivision 3.
new text end
new text begin
(b) The commissioner shall establish standards and methodologies for a prospective
payment system for medical assistance payments for services delivered by a CCBHC, in
accordance with guidance issued by the Centers for Medicare and Medicaid Services. The
commissioner shall include a quality bonus payment in the prospective payment system
based on federal criteria.
new text end
new text begin
(c) To the extent allowed by federal law, the commissioner may limit the number of
CCBHCs for the prospective payment system in paragraph (b) to ensure that the projected
claims do not exceed the money appropriated for this purpose. The commissioner shall
apply the following priorities, in the order listed, to give preference to clinics that:
new text end
new text begin
(1) provide a comprehensive range of services and evidence-based practices for all age
groups, with services being fully coordinated and integrated;
new text end
new text begin
(2) are certified as CCBHCs during the federal CCBHC demonstration period;
new text end
new text begin
(3) receive CCBHC grants from the United States Department of Health and Human
Services; or
new text end
new text begin
(4) focus on serving individuals in tribal areas and other underserved communities.
new text end
new text begin
(d) Unless otherwise indicated in applicable federal requirements, the prospective payment
system must continue to be based on the federal instructions issued for the federal CCBHC
demonstration, except:
new text end
new text begin
(1) the commissioner shall rebase CCBHC rates at least every three years;
new text end
new text begin
(2) the commissioner shall provide for a 60-day appeals process of the rebasing;
new text end
new text begin
(3) the prohibition against inclusion of new facilities in the demonstration does not apply
after the demonstration ends;
new text end
new text begin
(4) the prospective payment rate under this section does not apply to services rendered
by CCBHCs to individuals who are dually eligible for Medicare and medical assistance
when Medicare is the primary payer for the service. An entity that receives a prospective
payment system rate that overlaps with the CCBHC rate is not eligible for the CCBHC rate;
new text end
new text begin
(5) payments for CCBHC services to individuals enrolled in managed care shall be
coordinated with the state's phase-out of CCBHC wrap payments;
new text end
new text begin
(6) initial prospective payment rates for CCBHCs certified after July 1, 2019, shall be
based on rates for comparable CCBHCs. If no comparable provider exists, the commissioner
shall compute a CCBHC-specific rate based upon the CCBHC's audited costs adjusted for
changes in the scope of services; and
new text end
new text begin
(7) the prospective payment rate for each CCBHC shall be adjusted annually by the
Medicare Economic Index as defined for the CCBHC federal demonstration.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
Contingent upon federal approval, this section is effective July
1, 2019. The commissioner of human services shall notify the revisor of statutes when
federal approval is obtained or denied.
new text end
Sec. 17.
Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 20c. new text end
new text begin
Integrated care model; mental health case management services by
Center for Victims of Torture.
new text end
new text begin
(a) The commissioner of human services, in collaboration
with the Center for Victims of Torture, shall develop a pilot project to support the continued
testing of an integrated care model for the delivery of mental health targeted case management
at one designated service site. For purposes of this subdivision, "center" means the Center
for Victims of Torture.
new text end
new text begin
(b) The commissioner of human services shall contract directly with the center for the
provision of the services described in paragraph (c). The services shall be paid at $695 per
member per month and shall be funded using 100 percent state funding.
new text end
new text begin
(c) Individuals who are eligible to receive medical assistance under this chapter, who
are eligible to receive mental health targeted case management as described under section
245.4711, and who are being served by the center shall be served using the integrated care
model and must be evaluated using the center's social functioning tool.
new text end
new text begin
(d) The commissioner of human services, in collaboration with the center, shall also
evaluate whether the center's social functioning tool can be adapted for use with the general
medical assistance population. Beginning July 1, 2020, and annually thereafter until the
evaluation is complete, the commissioner of human services shall report on the results of
the evaluation to the legislative committees with jurisdiction over human services.
new text end
Sec. 18.
Minnesota Statutes 2018, section 256B.0625, subdivision 24, is amended to read:
Subd. 24.
Other medical or remedial care.
Medical assistance covers any other medical
or remedial care licensed and recognized under state law unless otherwise prohibited by
lawdeleted text begin , except licensed chemical dependency treatment programs or primary treatment or
extended care treatment units in hospitals that are covered under chapter 254B. The
commissioner shall include chemical dependency services in the state medical assistance
plan for federal reporting purposes, but payment must be made under chapter 254Bdeleted text end . The
commissioner shall publish in the State Register a list of elective surgeries that require a
second medical opinion before medical assistance reimbursement, and the criteria and
standards for deciding whether an elective surgery should require a second medical opinion.
The list and criteria and standards are not subject to the requirements of sections 14.01 to
14.69.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 19.
Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 24a. new text end
new text begin Substance use disorder services. new text end
new text begin
Medical assistance covers substance use
disorder treatment services according to section 254B.05, subdivision 5, except for room
and board.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 20.
Minnesota Statutes 2018, section 256B.0625, subdivision 45a, is amended to
read:
Subd. 45a.
Psychiatric residential treatment facility services for persons younger
than 21 years of age.
(a) Medical assistance covers psychiatric residential treatment facility
services, according to section 256B.0941, for persons younger than 21 years of age.
Individuals who reach age 21 at the time they are receiving services are eligible to continue
receiving services until they no longer require services or until they reach age 22, whichever
occurs first.
(b) For purposes of this subdivision, "psychiatric residential treatment facility" means
a facility other than a hospital that provides psychiatric services, as described in Code of
Federal Regulations, title 42, sections 441.151 to 441.182, to individuals under age 21 in
an inpatient setting.
(c) The commissioner shall enroll up to 150 certified psychiatric residential treatment
facility services beds deleted text begin at up to six sitesdeleted text end . new text begin The commissioner may enroll an additional 80
certified psychiatric residential treatment facility services beds beginning July 1, 2020, and
an additional 70 certified psychiatric residential treatment facility services beds beginning
July 1, 2023.new text end The commissioner shall select psychiatric residential treatment facility services
providers through a request for proposals process. Providers of state-operated services may
respond to the request for proposals.new text begin The commissioner shall prioritize programs that
demonstrate the capacity to serve children and youth with aggressive and risky behaviors
toward themselves or others, multiple diagnoses, neurodevelopmental disorders, or complex
trauma related issues.
new text end
new text begin
(d) Notwithstanding the limit on the number of certified psychiatric residential treatment
facility services beds under paragraph (c), providers of children's residential treatment under
section 256B.0945, who are enrolled to provide services as of July 1, 2019, may submit a
letter of intent to develop a psychiatric residential treatment facility program in a format
developed by the commissioner. Each letter of intent must demonstrate the need for
psychiatric residential treatment facility services, the proposed bed capacity for the program,
and the capacity of the organization to develop and deliver psychiatric residential treatment
facility services. The letter of intent must also include a description of the proposed services
and physical site as well as specific information about the population that the program plans
to serve. The commissioner shall respond to the letter of intent within 60 days of receiving
all requested information with a determination of whether the program is approved, or with
specific recommended actions required to obtain approval. Programs that receive an approved
letter of intent must initiate the processes required by the commissioner to enroll as a provider
of psychiatric residential treatment facility services within 30 days of receiving notice of
approval. The commissioner shall process letters of intent in the order received. A program
approved under this paragraph may not increase bed capacity when converting to provide
psychiatric residential treatment facility services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 21.
Minnesota Statutes 2018, section 256B.0625, subdivision 57, is amended to read:
Subd. 57.
Payment for Part B Medicare crossover claims.
(a) Effective for services
provided on or after January 1, 2012, medical assistance payment for an enrollee's
cost-sharing associated with Medicare Part B is limited to an amount up to the medical
assistance total allowed, when the medical assistance rate exceeds the amount paid by
Medicare.
(b) Excluded from this limitation are payments for mental health services and payments
for dialysis services provided to end-stage renal disease patients. The exclusion for mental
health services does not apply to payments for physician services provided by psychiatrists
and advanced practice nurses with a specialty in mental health.
(c) Excluded from this limitation are payments to federally qualified health centers deleted text begin anddeleted text end new text begin ,new text end
rural health clinicsnew text begin , and CCBHCs subject to the prospective payment system under
subdivision 5mnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
Contingent upon federal approval, this section is effective July
1, 2019. The commissioner of human services shall notify the revisor of statutes when
federal approval is obtained or denied.
new text end
Sec. 22.
Minnesota Statutes 2018, section 256B.0757, subdivision 2, is amended to read:
Subd. 2.
Eligible individual.
new text begin
(a) The commissioner may develop health home models
in accordance with United States Code, title 42, section 1396w-4(h)(1).
new text end
new text begin (b) new text end An individual is eligible for health home services under this section if the individual
is eligible for medical assistance under this chapter and deleted text begin has at leastdeleted text end deleted text begin :
deleted text end
deleted text begin
(1) two chronic conditions;
deleted text end
deleted text begin
(2) one chronic condition and is at risk of having a second chronic condition;
deleted text end
deleted text begin
(3) one serious and persistent mental health condition; or
deleted text end
deleted text begin (4)deleted text end new text begin hasnew text end a condition that meets the definitionnew text begin of serious mental illness as describednew text end in
section 245.462, subdivision 20, paragraph (a), ornew text begin emotional disturbance as defined in sectionnew text end
245.4871, subdivision 15, clause (2)deleted text begin ; and has a current diagnostic assessment as defined in
Minnesota Rules, part 9505.0372, subpart 1, item B or C, as performed or reviewed by a
mental health professional employed by or under contract with the behavioral health homedeleted text end new text begin .
new text end
The commissioner shall establish criteria for determining continued eligibility.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 23.
Minnesota Statutes 2018, section 256B.0757, is amended by adding a subdivision
to read:
new text begin Subd. 2a. new text end
new text begin Discharge criteria. new text end
new text begin
(a) An individual may be discharged from behavioral
health home services if:
new text end
new text begin
(1) the behavioral health home services provider is unable to locate, contact, and engage
the individual for a period of greater than three months after persistent efforts by the
behavioral health home services provider; or
new text end
new text begin
(2) the individual is unwilling to participate in behavioral health home services as
demonstrated by the individual's refusal to meet with the behavioral health home services
provider, or refusal to identify the individual's health and wellness goals or the activities or
support necessary to achieve these goals.
new text end
new text begin
(b) Before discharge from behavioral health home services, the behavioral health home
services provider must offer a face-to-face meeting with the individual and the individual's
identified supports, to discuss options available to the individual, including maintaining
behavioral health home services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 24.
Minnesota Statutes 2018, section 256B.0757, subdivision 4, is amended to read:
Subd. 4.
Designated provider.
deleted text begin (a)deleted text end Health home services are voluntary and an eligible
individual may choose any designated provider. The commissioner shall establish designated
providers to serve as health homes and provide the services described in subdivision 3 to
individuals eligible under subdivision 2. The commissioner shall apply for grants as provided
under section 3502 of the Patient Protection and Affordable Care Act to establish health
homes and provide capitated payments to designated providers. For purposes of this section,
"designated provider" means a provider, clinical practice or clinical group practice, rural
clinic, community health center, community mental health center, or any other entity that
is determined by the commissioner to be qualified to be a health home for eligible individuals.
This determination must be based on documentation evidencing that the designated provider
has the systems and infrastructure in place to provide health home services and satisfies the
qualification standards established by the commissioner in consultation with stakeholders
and approved by the Centers for Medicare and Medicaid Services.
deleted text begin
(b) The commissioner shall develop and implement certification standards for designated
providers under this subdivision.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 25.
Minnesota Statutes 2018, section 256B.0757, is amended by adding a subdivision
to read:
new text begin Subd. 4a. new text end
new text begin Behavioral health home services provider requirements. new text end
new text begin
A behavioral
health home services provider must:
new text end
new text begin
(1) be an enrolled Minnesota Health Care Programs provider;
new text end
new text begin
(2) provide a medical assistance covered primary care or behavioral health service;
new text end
new text begin
(3) utilize an electronic health record;
new text end
new text begin
(4) utilize an electronic patient registry that contains the data elements required by the
commissioner;
new text end
new text begin
(5) demonstrate the organization's capacity to administer screenings approved by the
commissioner for substance use disorder or alcohol and tobacco use;
new text end
new text begin
(6) demonstrate the organization's capacity to refer an individual to resources appropriate
to the individual's screening results;
new text end
new text begin
(7) have policies and procedures to track referrals to ensure that the referral met the
individual's needs;
new text end
new text begin
(8) conduct a brief needs assessment when an individual begins receiving behavioral
health home services. The brief needs assessment must be completed with input from the
individual and the individual's identified supports. The brief needs assessment must address
the individual's immediate safety and transportation needs and potential barriers to
participating in behavioral health home services;
new text end
new text begin
(9) conduct a health wellness assessment within 60 days after intake that contains all
required elements identified by the commissioner;
new text end
new text begin
(10) conduct a health action plan that contains all required elements identified by the
commissioner. The plan must be completed within 90 days after intake and must be updated
at least once every six months, or more frequently if significant changes to an individual's
needs or goals occur;
new text end
new text begin
(11) agree to cooperate with and participate in the state's monitoring and evaluation of
behavioral health home services; and
new text end
new text begin
(12) obtain the individual's written consent to begin receiving behavioral health home
services using a form approved by the commissioner.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 26.
Minnesota Statutes 2018, section 256B.0757, is amended by adding a subdivision
to read:
new text begin Subd. 4b. new text end
new text begin
Behavioral health home provider training and practice transformation
requirements.
new text end
new text begin
(a) The behavioral health home services provider must ensure that all staff
delivering behavioral health home services receive adequate preservice and ongoing training,
including:
new text end
new text begin
(1) training approved by the commissioner that describes the goals and principles of
behavioral health home services; and
new text end
new text begin
(2) training on evidence-based practices to promote an individual's ability to successfully
engage with medical, behavioral health, and social services to achieve the individual's health
and wellness goals.
new text end
new text begin
(b) The behavioral health home services provider must ensure that staff are capable of
implementing culturally responsive services, as determined by the individual's culture,
beliefs, values, and language as identified in the individual's health wellness assessment.
new text end
new text begin
(c) The behavioral health home services provider must participate in the department's
practice transformation activities to support continued skill and competency development
in the provision of integrated medical, behavioral health, and social services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 27.
Minnesota Statutes 2018, section 256B.0757, is amended by adding a subdivision
to read:
new text begin Subd. 4c. new text end
new text begin Behavioral health home staff qualifications. new text end
new text begin
(a) A behavioral health home
services provider must maintain staff with required professional qualifications appropriate
to the setting.
new text end
new text begin
(b) If behavioral health home services are offered in a mental health setting, the
integration specialist must be a registered nurse licensed under the Minnesota Nurse Practice
Act, sections 148.171 to 148.285.
new text end
new text begin
(c) If behavioral health home services are offered in a primary care setting, the integration
specialist must be a mental health professional as defined in section 245.462, subdivision
18, clauses (1) to (6), or 245.4871, subdivision 27, clauses (1) to (6).
new text end
new text begin
(d) If behavioral health home services are offered in either a primary care setting or
mental health setting, the systems navigator must be a mental health practitioner as defined
in section 245.462, subdivision 17, or a community health worker as defined in section
256B.0625, subdivision 49.
new text end
new text begin
(e) If behavioral health home services are offered in either a primary care setting or
mental health setting, the qualified health home specialist must be one of the following:
new text end
new text begin
(1) a peer support specialist as defined in section 256B.0615;
new text end
new text begin
(2) a family peer support specialist as defined in section 256B.0616;
new text end
new text begin
(3) a case management associate as defined in section 245.462, subdivision 4, paragraph
(g), or 245.4871, subdivision 4, paragraph (j);
new text end
new text begin
(4) a mental health rehabilitation worker as defined in section 256B.0623, subdivision
5, clause (4);
new text end
new text begin
(5) a community paramedic as defined in section 144E.28, subdivision 9;
new text end
new text begin
(6) a peer recovery specialist as defined in section 245G.07, subdivision 1, clause (5);
or
new text end
new text begin
(7) a community health worker as defined in section 256B.0625, subdivision 49.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 28.
Minnesota Statutes 2018, section 256B.0757, is amended by adding a subdivision
to read:
new text begin Subd. 4d. new text end
new text begin Behavioral health home service delivery standards. new text end
new text begin
(a) A behavioral health
home services provider must meet the following service delivery standards:
new text end
new text begin
(1) establish and maintain processes to support the coordination of an individual's primary
care, behavioral health, and dental care;
new text end
new text begin
(2) maintain a team-based model of care, including regular coordination and
communication between behavioral health home services team members;
new text end
new text begin
(3) use evidence-based practices that recognize and are tailored to the medical, social,
economic, behavioral health, functional impairment, cultural, and environmental factors
affecting the individual's health and health care choices;
new text end
new text begin
(4) use person-centered planning practices to ensure the individual's health action plan
accurately reflects the individual's preferences, goals, resources, and optimal outcomes for
the individual and the individual's identified supports;
new text end
new text begin
(5) use the patient registry to identify individuals and population subgroups requiring
specific levels or types of care and provide or refer the individual to needed treatment,
intervention, or services;
new text end
new text begin
(6) utilize the Department of Human Services Partner Portal to identify past and current
treatment or services and identify potential gaps in care;
new text end
new text begin
(7) deliver services consistent with the standards for frequency and face-to-face contact
required by the commissioner;
new text end
new text begin
(8) ensure that a diagnostic assessment is completed for each individual receiving
behavioral health home services within six months of the start of behavioral health home
services;
new text end
new text begin
(9) deliver services in locations and settings that meet the needs of the individual;
new text end
new text begin
(10) provide a central point of contact to ensure that individuals and the individual's
identified supports can successfully navigate the array of services that impact the individual's
health and well-being;
new text end
new text begin
(11) have capacity to assess an individual's readiness for change and the individual's
capacity to integrate new health care or community supports into the individual's life;
new text end
new text begin
(12) offer or facilitate the provision of wellness and prevention education on
evidenced-based curriculums specific to the prevention and management of common chronic
conditions;
new text end
new text begin
(13) help an individual set up and prepare for medical, behavioral health, social service,
or community support appointments, including accompanying the individual to appointments
as appropriate, and providing follow-up with the individual after these appointments;
new text end
new text begin
(14) offer or facilitate the provision of health coaching related to chronic disease
management and the navigation of complex systems of care to the individual, the individual's
family, and identified supports;
new text end
new text begin
(15) connect the individual, the individual's family, and identified supports to appropriate
support services that help the individual overcome access or service barriers, increase
self-sufficiency skills, and improve overall health;
new text end
new text begin
(16) provide effective referrals and timely access to services; and
new text end
new text begin
(17) establish a continuous quality improvement process for providing behavioral health
home services.
new text end
new text begin
(b) The behavioral health home services provider must also create a plan, in partnership
with the individual and the individual's identified supports, to support the individual after
discharge from a hospital, residential treatment program, or other setting. The plan must
include protocols for:
new text end
new text begin
(1) maintaining contact between the behavioral health home services team member, the
individual, and the individual's identified supports during and after discharge;
new text end
new text begin
(2) linking the individual to new resources as needed;
new text end
new text begin
(3) reestablishing the individual's existing services and community and social supports;
and
new text end
new text begin
(4) following up with appropriate entities to transfer or obtain the individual's service
records as necessary for continued care.
new text end
new text begin
(c) If the individual is enrolled in a managed care plan, a behavioral health home services
provider must:
new text end
new text begin
(1) notify the behavioral health home services contact designated by the managed care
plan within 30 days of when the individual begins behavioral health home services; and
new text end
new text begin
(2) adhere to the managed care plan communication and coordination requirements
described in the behavioral health home services manual.
new text end
new text begin
(d) Before terminating behavioral health home services, the behavioral health home
services provider must:
new text end
new text begin
(1) provide a 60-day notice of termination of behavioral health home services to all
individuals receiving behavioral health home services, the commissioner, and managed care
plans, if applicable; and
new text end
new text begin
(2) refer individuals receiving behavioral health home services to a new behavioral
health home services provider.
new text end
Sec. 29.
Minnesota Statutes 2018, section 256B.0757, is amended by adding a subdivision
to read:
new text begin Subd. 4e. new text end
new text begin Behavioral health home provider variances. new text end
new text begin
(a) The commissioner may
grant a variance to specific requirements under subdivisions 4a, 4b, 4c, or 4d for a behavioral
health home services provider according to this subdivision.
new text end
new text begin
(b) The commissioner may grant a variance if the commissioner finds that:
new text end
new text begin
(1) failure to grant the variance would result in hardship or injustice to the applicant;
new text end
new text begin
(2) the variance would be consistent with the public interest; and
new text end
new text begin
(3) the variance would not reduce the level of services provided to individuals served
by the organization.
new text end
new text begin
(c) The commissioner may grant a variance from one or more requirements to permit
an applicant to offer behavioral health home services of a type or in a manner that is
innovative, if the commissioner finds that the variance does not impede the achievement of
the criteria in subdivisions 4a, 4b, 4c, or 4d and may improve the behavioral health home
services provided by the applicant.
new text end
new text begin
(d) The commissioner's decision to grant or deny a variance request is final and not
subject to appeal.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 30.
Minnesota Statutes 2018, section 256B.0757, subdivision 8, is amended to read:
Subd. 8.
Evaluation and continued development.
(a) For continued certification under
this section,new text begin behavioralnew text end health homes must meet process, outcome, and quality standards
developed and specified by the commissioner. The commissioner shall collect data from
health homes as necessary to monitor compliance with certification standards.
(b) The commissioner may contract with a private entity to evaluate patient and family
experiences, health care utilization, and costs.
(c) The commissioner shall utilize findings from the implementation of deleted text begin behavioraldeleted text end health
homes to determine populations to serve under subsequent health home models for individuals
with chronic conditions.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 31.
new text begin
[256B.0759] SUBSTANCE USE DISORDER DEMONSTRATION PROJECT.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The commissioner shall develop and implement a medical
assistance demonstration project to test reforms of Minnesota's substance use disorder
treatment system to ensure individuals with substance use disorders have access to a full
continuum of high quality care.
new text end
new text begin Subd. 2. new text end
new text begin Provider participation. new text end
new text begin
Substance use disorder treatment providers may elect
to participate in the demonstration project and meet the requirements of subdivision 3. To
participate, a provider must notify the commissioner of the provider's intent to participate
in a format required by the commissioner and enroll as a demonstration project provider.
new text end
new text begin Subd. 3. new text end
new text begin Provider standards. new text end
new text begin
(a) The commissioner shall establish requirements for
participating providers that are consistent with the federal requirements of the demonstration
project.
new text end
new text begin
(b) A participating residential provider must obtain applicable licensure under chapters
245F and 245G or other applicable standards for the services provided and must:
new text end
new text begin
(1) deliver services in accordance with American Society of Addiction Medicine (ASAM)
standards;
new text end
new text begin
(2) maintain formal patient referral arrangements with providers delivering step-up or
step-down levels of care in accordance with ASAM standards; and
new text end
new text begin
(3) provide or arrange for medication-assisted treatment services if requested by a client
for whom an effective medication exists.
new text end
new text begin
(c) A participating outpatient provider must obtain applicable licensure under chapter
245G or other applicable standards for the services provided and must:
new text end
new text begin
(1) deliver services in accordance with ASAM standards; and
new text end
new text begin
(2) maintain formal patient referral arrangements with providers delivering step-up or
step-down levels of care in accordance with ASAM standards.
new text end
new text begin
(d) If the provider standards under chapter 245G or other applicable standards conflict
or are duplicative, the commissioner may grant variances to the standards if the variances
do not conflict with federal requirements. The commissioner shall publish service
components, service standards, and staffing requirements for participating providers that
are consistent with ASAM standards and federal requirements.
new text end
new text begin Subd. 4. new text end
new text begin Provider payment rates. new text end
new text begin
(a) Payment rates for participating providers must
be increased for services provided to medical assistance enrollees.
new text end
new text begin
(b) For substance use disorder services under section 254B.05, subdivision 5, paragraph
(b), clause (8), payment rates must be increased by 15 percent over the rates in effect on
January 1, 2020.
new text end
new text begin
(c) For substance use disorder services under section 254B.05, subdivision 5, paragraph
(b), clauses (1), (6), (7), and (10), payment rates must be increased by ten percent over the
rates in effect on January 1, 2021.
new text end
new text begin Subd. 5. new text end
new text begin Federal approval. new text end
new text begin
The commissioner shall seek federal approval to implement
the demonstration project under this section and to receive federal financial participation.
new text end
Sec. 32.
Minnesota Statutes 2018, section 256B.0915, subdivision 3b, is amended to read:
Subd. 3b.
Cost limits for elderly waiver applicants who reside in a nursing facilitynew text begin
or another eligible facilitynew text end .
(a) For a person who is a nursing facility resident at the time
of requesting a determination of eligibility for elderly waivered services, a monthly
conversion budget limit for the cost of elderly waivered services may be requested. The
monthly conversion budget limit for the cost of elderly waiver services shall be deleted text begin the resident
class assigned under Minnesota Rules, parts 9549.0050 to 9549.0059, for that resident in
the nursing facility where the resident currently resides until July 1 of the state fiscal year
in which the resident assessment system as described in section 256B.438 for nursing home
rate determination is implemented. Effective on July 1 of the state fiscal year in which the
resident assessment system as described in section 256B.438 for nursing home rate
determination is implemented, the monthly conversion budget limit for the cost of elderly
waiver services shall bedeleted text end based on the per diem nursing facility rate as determined by the
resident assessment system as described in section deleted text begin 256B.438deleted text end new text begin 256R.17new text end for residents in the
nursing facility where the elderly waiver applicant currently resides. The monthly conversion
budget limit shall be calculated by multiplying the per diem by 365, divided by 12, and
reduced by the recipient's maintenance needs allowance as described in subdivision 1d. The
initially approved monthly conversion budget limit shall be adjusted annually as described
in subdivision 3a, paragraph (a). The limit under this deleted text begin subdivisiondeleted text end new text begin paragraphnew text end only applies to
persons discharged from a nursing facility after a minimum 30-day stay and found eligible
for waivered services on or after July 1, 1997. For conversions from the nursing home to
the elderly waiver with consumer directed community support services, the nursing facility
per diem used to calculate the monthly conversion budget limit must be reduced by a
percentage equal to the percentage difference between the consumer directed services budget
limit that would be assigned according to the federally approved waiver plan and the
corresponding community case mix cap, but not to exceed 50 percent.
(b) new text begin A person who meets elderly waiver eligibility criteria and the eligibility criteria under
section 256.478, subdivision 1, is eligible for a special monthly budget limit for the cost of
elderly waivered services up to $21,610 per month. The special monthly budget limit must
be adjusted annually as described in subdivision 3a, paragraphs (a) and (e). For a person
using a special monthly budget limit under the elderly waiver with consumer-directed
community support services, the special monthly budget limit must be reduced as described
in paragraph (a).
new text end
new text begin
(c) The commissioner may provide an additional payment for documented costs between
a threshold determined by the commissioner and the special monthly budget limit to a
managed care plan for elderly waiver services provided to a person who is: (1) eligible for
a special monthly budget limit under paragraph (b); and (2) enrolled in a managed care plan
that provides elderly waiver services under section 256B.69.
new text end
new text begin
(d) For monthly conversion budget limits under paragraph (a) and special monthly budget
limits under paragraph (b), the service rate limits for adult foster care under subdivision 3d
and for customized living under subdivision 3e may be exceeded if necessary for the provider
to meet identified needs and provide services as approved in the coordinated service and
support plan, if the total cost of all services does not exceed the monthly conversion or
special monthly budget limit. Service rates must be established using tools provided by the
commissioner.
new text end
new text begin (e) new text end The following costs must be included in determining the total monthly costs for the
waiver client:
(1) cost of all waivered services, including specialized supplies and equipment and
environmental accessibility adaptations; and
(2) cost of skilled nursing, home health aide, and personal care services reimbursable
by medical assistance.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes once federal approval is obtained.
new text end
Sec. 33.
Minnesota Statutes 2018, section 256B.092, subdivision 13, is amended to read:
Subd. 13.
Waiver allocations for transition populations.
(a) The commissioner shall
make available additional waiver allocations and additional necessary resources deleted text begin to assure
timely discharges from the Anoka-Metro Regional Treatment Center and the Minnesota
Security Hospital in St. Peterdeleted text end for individuals who meet the deleted text begin followingdeleted text end new text begin eligibility new text end criteriadeleted text begin :deleted text end new text begin
established under section 256.478, subdivision 1.
new text end
deleted text begin
(1) are otherwise eligible for the developmental disabilities waiver under this section;
deleted text end
deleted text begin
(2) who would otherwise remain at the Anoka-Metro Regional Treatment Center or the
Minnesota Security Hospital;
deleted text end
deleted text begin
(3) whose discharge would be significantly delayed without the available waiver
allocation; and
deleted text end
deleted text begin
(4) who have met treatment objectives and no longer meet hospital level of care.
deleted text end
(b) Additional waiver allocations under this subdivision must meet cost-effectiveness
requirements of the federal approved waiver plan.
(c) Any corporate foster care home developed under this subdivision must be considered
an exception under section 245A.03, subdivision 7, paragraph (a).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 34.
Minnesota Statutes 2018, section 256B.0941, subdivision 3, is amended to read:
Subd. 3.
Per diem rate.
(a) The commissioner shall establish deleted text begin a statewidedeleted text end new text begin onenew text end per diem
ratenew text begin per providernew text end for psychiatric residential treatment facility services for individuals 21
years of age or younger. The rate for a provider must not exceed the rate charged by that
provider for the same service to other payers. Payment must not be made to more than one
entity for each individual for services provided under this section on a given day. The
commissioner shall set rates prospectively for the annual rate period. The commissioner
shall require providers to submit annual cost reports on a uniform cost reporting form and
shall use submitted cost reports to inform the rate-setting process. The cost reporting shall
be done according to federal requirements for Medicare cost reports.
(b) The following are included in the rate:
(1) costs necessary for licensure and accreditation, meeting all staffing standards for
participation, meeting all service standards for participation, meeting all requirements for
active treatment, maintaining medical records, conducting utilization review, meeting
inspection of care, and discharge planning. The direct services costs must be determined
using the actual cost of salaries, benefits, payroll taxes, and training of direct services staff
and service-related transportation; and
(2) payment for room and board provided by facilities meeting all accreditation and
licensing requirements for participation.
(c) A facility may submit a claim for payment outside of the per diem for professional
services arranged by and provided at the facility by an appropriately licensed professional
who is enrolled as a provider with Minnesota health care programs. Arranged services must
be billed by the facility on a separate claim, and the facility shall be responsible for payment
to the provider. These services must be included in the individual plan of care and are subject
to prior authorization by the state's medical review agent.
(d) Medicaid shall reimburse for concurrent services as approved by the commissioner
to support continuity of care and successful discharge from the facility. "Concurrent services"
means services provided by another entity or provider while the individual is admitted to a
psychiatric residential treatment facility. Payment for concurrent services may be limited
and these services are subject to prior authorization by the state's medical review agent.
Concurrent services may include targeted case management, assertive community treatment,
clinical care consultation, team consultation, and treatment planning.
(e) Payment rates under this subdivision shall not include the costs of providing the
following services:
(1) educational services;
(2) acute medical care or specialty services for other medical conditions;
(3) dental services; and
(4) pharmacy drug costs.
(f) For purposes of this section, "actual cost" means costs that are allowable, allocable,
reasonable, and consistent with federal reimbursement requirements in Code of Federal
Regulations, title 48, chapter 1, part 31, relating to for-profit entities, and the Office of
Management and Budget Circular Number A-122, relating to nonprofit entities.
Sec. 35.
Minnesota Statutes 2018, section 256B.49, subdivision 24, is amended to read:
Subd. 24.
Waiver allocations for transition populations.
(a) The commissioner shall
make available additional waiver allocations and additional necessary resources deleted text begin to assure
timely discharges from the Anoka-Metro Regional Treatment Center and the Minnesota
Security Hospital in St. Peterdeleted text end for individuals who meet the deleted text begin followingdeleted text end new text begin eligibility new text end criteriadeleted text begin :deleted text end new text begin
established under section 256.478, subdivision 1.
new text end
deleted text begin
(1) are otherwise eligible for the brain injury, community access for disability inclusion,
or community alternative care waivers under this section;
deleted text end
deleted text begin
(2) who would otherwise remain at the Anoka-Metro Regional Treatment Center or the
Minnesota Security Hospital;
deleted text end
deleted text begin
(3) whose discharge would be significantly delayed without the available waiver
allocation; and
deleted text end
deleted text begin
(4) who have met treatment objectives and no longer meet hospital level of care.
deleted text end
(b) Additional waiver allocations under this subdivision must meet cost-effectiveness
requirements of the federal approved waiver plan.
(c) Any corporate foster care home developed under this subdivision must be considered
an exception under section 245A.03, subdivision 7, paragraph (a).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 36.
Minnesota Statutes 2018, section 256I.04, subdivision 1, is amended to read:
Subdivision 1.
Individual eligibility requirements.
An individual is eligible for and
entitled to a housing support payment to be made on the individual's behalf if the agency
has approved the setting where the individual will receive housing support and the individual
meets the requirements in paragraph (a), (b), or (c).
(a) The individual is aged, blind, or is over 18 years of age with a disability as determined
under the criteria used by the title II program of the Social Security Act, and meets the
resource restrictions and standards of section 256P.02, and the individual's countable income
after deducting the (1) exclusions and disregards of the SSI program, (2) the medical
assistance personal needs allowance under section 256B.35, and (3) an amount equal to the
income actually made available to a community spouse by an elderly waiver participant
under the provisions of sections 256B.0575, paragraph (a), clause (4), and 256B.058,
subdivision 2, is less than the monthly rate specified in the agency's agreement with the
provider of housing support in which the individual resides.
(b) The individual meets a category of eligibility under section 256D.05, subdivision 1,
paragraph (a), clauses (1), (3), (4) to (8), and (13), and paragraph (b), if applicable, and the
individual's resources are less than the standards specified by section 256P.02, and the
individual's countable income as determined under section 256P.06, less the medical
assistance personal needs allowance under section 256B.35 is less than the monthly rate
specified in the agency's agreement with the provider of housing support in which the
individual resides.
(c) The individual deleted text begin receives licensed residential crisis stabilization services under section
256B.0624, subdivision 7, and is receiving medical assistance. The individual may receive
concurrent housing support payments if receiving licensed residential crisis stabilization
services under section 256B.0624, subdivision 7.deleted text end new text begin lacks a fixed, adequate, nighttime residence
upon discharge from a residential behavioral health treatment program, as determined by
treatment staff from the residential behavioral health treatment program. An individual is
eligible under this paragraph for up to three months, including a full or partial month from
the individual's move-in date at a setting approved for housing support following discharge
from treatment, plus two full months.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 1, 2019.
new text end
Sec. 37.
Minnesota Statutes 2018, section 256I.04, subdivision 2f, is amended to read:
Subd. 2f.
Required services.
new text begin (a) new text end In licensed and registered settings under subdivision
2a, providers shall ensure that participants have at a minimum:
(1) food preparation and service for three nutritional meals a day on site;
(2) a bed, clothing storage, linen, bedding, laundering, and laundry supplies or service;
(3) housekeeping, including cleaning and lavatory supplies or service; and
(4) maintenance and operation of the building and grounds, including heat, water, garbage
removal, electricity, telephone for the site, cooling, supplies, and parts and tools to repair
and maintain equipment and facilities.
new text begin
(b) In addition, when providers serve participants described in subdivision 1, paragraph
(c), the providers are required to assist the participants in applying for continuing housing
support payments before the end of the eligibility period.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 1, 2019.
new text end
Sec. 38.
Minnesota Statutes 2018, section 256I.06, subdivision 8, is amended to read:
Subd. 8.
Amount of housing support payment.
(a) The amount of a room and board
payment to be made on behalf of an eligible individual is determined by subtracting the
individual's countable income under section 256I.04, subdivision 1, for a whole calendar
month from the room and board rate for that same month. The housing support payment is
determined by multiplying the housing support rate times the period of time the individual
was a resident or temporarily absent under section 256I.05, subdivision 1c, paragraph (d).
(b) For an individual with earned income under paragraph (a), prospective budgeting
must be used to determine the amount of the individual's payment for the following six-month
period. An increase in income shall not affect an individual's eligibility or payment amount
until the month following the reporting month. A decrease in income shall be effective the
first day of the month after the month in which the decrease is reported.
(c) For an individual who receives deleted text begin licensed residential crisis stabilization services under
section 256B.0624, subdivision 7,deleted text end new text begin housing support payments under section 256I.04,
subdivision 1, paragraph (c),new text end the amount ofnew text begin thenew text end housing support payment is determined by
multiplying the housing support rate times the period of time the individual was a resident.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 1, 2019.
new text end
Sec. 39.
Minnesota Statutes 2018, section 641.15, subdivision 3a, is amended to read:
Subd. 3a.
Intake procedure; approved mental health screening.
new text begin (a)new text end As part of its
intake procedure for new deleted text begin prisonersdeleted text end new text begin inmatesnew text end , the sheriff or local corrections shall use a mental
health screening tool approved by the commissioner of corrections in consultation with the
commissioner of human services and local corrections staff to identify persons who may
have mental illness.
new text begin
(b) Names of persons who have screened positive or may have a mental illness may be
shared with the local county social services agency. The jail may refer an offender to county
personnel of the welfare system, as defined in section 13.46, subdivision 1, paragraph (c),
in order to arrange for services upon discharge and may share private data on the offender
as necessary to:
new text end
new text begin
(1) provide assistance in filling out an application for medical assistance or
MinnesotaCare;
new text end
new text begin
(2) make a referral for case management as provided under section 245.467, subdivision
4;
new text end
new text begin
(3) provide assistance in obtaining a state photo identification;
new text end
new text begin
(4) secure a timely appointment with a psychiatrist or other appropriate community
mental health provider;
new text end
new text begin
(5) provide prescriptions for a 30-day supply of all necessary medications; or
new text end
new text begin
(6) coordinate behavioral health services.
new text end
new text begin
(c) Notwithstanding section 138.17, if an offender is referred to a government entity
within the welfare system pursuant to paragraph (b), and the offender refuses all services
from the entity, the entity must, within 15 days of the refusal, destroy all private data on
the offender that it created or received because of the referral.
new text end
Sec. 40.
Laws 2017, First Special Session chapter 6, article 8, section 71, the effective
date, is amended to read:
EFFECTIVE DATE.
This section is effective for services provided on July 1, 2017,
deleted text begin through April 30, 2019, and expires May 1, 2019deleted text end new text begin and thereafternew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 30, 2019.
new text end
Sec. 41.
Laws 2017, First Special Session chapter 6, article 8, section 72, the effective
date, is amended to read:
EFFECTIVE DATE.
This section is effective for services provided on July 1, 2017,
deleted text begin through April 30, 2019, and expires May 1, 2019deleted text end new text begin and thereafternew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 30, 2019.
new text end
Sec. 42. new text begin COMMUNITY COMPETENCY RESTORATION TASK FORCE.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment; purpose. new text end
new text begin
The Community Competency Restoration Task
Force is established to evaluate and study community competency restoration programs and
develop recommendations to address the needs of individuals deemed incompetent to stand
trial.
new text end
new text begin Subd. 2. new text end
new text begin Membership. new text end
new text begin
(a) The Community Competency Restoration Task Force consists
of the following members, appointed as follows:
new text end
new text begin
(1) a representative appointed by the governor's office;
new text end
new text begin
(2) the commissioner of human services or designee;
new text end
new text begin
(3) the commissioner of corrections or designee;
new text end
new text begin
(4) a representative from direct care and treatment services with experience in competency
evaluations, appointed by the commissioner of human services;
new text end
new text begin
(5) a representative appointed by the designated State Protection and Advocacy system;
new text end
new text begin
(6) the ombudsman for mental health and developmental disabilities;
new text end
new text begin
(7) a representative appointed by the Minnesota Hospital Association;
new text end
new text begin
(8) a representative appointed by the Association of Minnesota Counties;
new text end
new text begin
(9) three representatives appointed by the Minnesota Association of County Social
Service Administrators: one from the seven-county metropolitan area, as defined under
Minnesota Statutes, section 473.121, subdivision 2, and two from outside the seven-county
metropolitan area;
new text end
new text begin
(10) a representative appointed by the Minnesota Board of Public Defense;
new text end
new text begin
(11) two representatives appointed by the Minnesota County Attorneys Association;
new text end
new text begin
(12) a representative appointed by the Minnesota Chiefs of Police Association;
new text end
new text begin
(13) a representative appointed by the Minnesota Psychiatric Society;
new text end
new text begin
(14) a representative appointed by the Minnesota Psychological Association;
new text end
new text begin
(15) a representative appointed by the State Court Administrator;
new text end
new text begin
(16) a representative appointed by the Minnesota Association of Community Mental
Health Programs;
new text end
new text begin
(17) a representative appointed by the Minnesota Sheriffs' Association;
new text end
new text begin
(18) a representative appointed by the Minnesota Sentencing Guidelines Commission;
new text end
new text begin
(19) a jail administrator appointed by the Minnesota Sheriffs' Association;
new text end
new text begin
(20) a representative from an organization providing reentry services appointed by the
commissioner of corrections;
new text end
new text begin
(21) a representative from a mental health advocacy organization appointed by the
commissioner of human services;
new text end
new text begin
(22) a person with direct experience with competency restoration appointed by the
commissioner of human services;
new text end
new text begin
(23) representatives from organizations representing racial and ethnic groups
overrepresented in the justice system appointed by the commissioner of corrections;
new text end
new text begin
(24) a representative appointed by the Minnesota Assistance Council for Veterans; and
new text end
new text begin
(25) a crime victim appointed by the commissioner of corrections.
new text end
new text begin
(b) Appointments to the task force must be made no later than July 15, 2019, and members
of the task force may be compensated as provided under Minnesota Statutes, section 15.059,
subdivision 3.
new text end
new text begin Subd. 3. new text end
new text begin Duties. new text end
new text begin
The task force must:
new text end
new text begin
(1) identify current services and resources available for individuals in the criminal justice
system who have been found incompetent to stand trial;
new text end
new text begin
(2) analyze current trends of competency referrals by county and the impact of any
diversion projects or stepping-up initiatives;
new text end
new text begin
(3) analyze selected case reviews and other data to identify risk levels of those individuals,
service usage, housing status, and health insurance status prior to being jailed;
new text end
new text begin
(4) research how other states address this issue, including funding and structure of
community competency restoration programs, and jail-based programs; and
new text end
new text begin
(5) develop recommendations to address the growing number of individuals deemed
incompetent to stand trial including increasing prevention and diversion efforts, providing
a timely process for reducing the amount of time individuals remain in the criminal justice
system, determining how to provide and fund competency restoration services in the
community, and defining the role of the counties and state in providing competency
restoration.
new text end
new text begin Subd. 4. new text end
new text begin Officers; meetings. new text end
new text begin
(a) The commissioner of human services shall convene
the first meeting of the task force no later than August 1, 2019.
new text end
new text begin
(b) The task force must elect a chair and vice-chair from among its members and may
elect other officers as necessary.
new text end
new text begin
(c) The task force is subject to the Minnesota Open Meeting Law under Minnesota
Statutes, chapter 13D.
new text end
new text begin Subd. 5. new text end
new text begin Staff. new text end
new text begin
(a) The commissioner of human services must provide staff assistance
to support the task force's work.
new text end
new text begin
(b) The task force may utilize the expertise of the Council of State Governments Justice
Center.
new text end
new text begin Subd. 6. new text end
new text begin Report required. new text end
new text begin
(a) By February 1, 2020, the task force shall submit a report
on its progress and findings to the chairs and ranking minority members of the legislative
committees with jurisdiction over mental health and corrections.
new text end
new text begin
(b) By February 1, 2021, the task force must submit a written report including
recommendations to address the growing number of individuals deemed incompetent to
stand trial to the chairs and ranking minority members of the legislative committees with
jurisdiction over mental health and corrections.
new text end
new text begin Subd. 7. new text end
new text begin Expiration. new text end
new text begin
The task force expires upon submission of the report in subdivision
6, paragraph (b), or February 1, 2021, whichever is later.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 43. new text begin DIRECTION TO COMMISSIONER; IMPROVING SCHOOL-LINKED
MENTAL HEALTH GRANT PROGRAM.
new text end
new text begin
(a) The commissioner of human services, in collaboration with the commissioner of
education, representatives from the education community, mental health providers, and
advocates, shall assess the school-linked mental health grant program under Minnesota
Statutes, section 245.4901, and develop recommendations for improvements. The assessment
must include but is not limited to the following:
new text end
new text begin
(1) promoting stability among current grantees and school partners;
new text end
new text begin
(2) assessing the minimum number of full-time equivalents needed per school site to
effectively carry out the program;
new text end
new text begin
(3) developing a funding formula that promotes sustainability and consistency across
grant cycles;
new text end
new text begin
(4) reviewing current data collection and evaluation; and
new text end
new text begin
(5) analyzing the impact on outcomes when a school has a school-linked mental health
program, a multi-tier system of supports, and sufficient school support personnel to meet
the needs of students.
new text end
new text begin
(b) The commissioner shall provide a report of the findings of the assessment and
recommendations, including any necessary statutory changes, to the legislative committees
with jurisdiction over mental health and education by January 15, 2020.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 44. new text begin DIRECTION TO COMMISSIONER; CCBHC RATE METHODOLOGY.
new text end
new text begin
(a) The commissioner of human services shall develop recommendations for a rate
methodology that reflects each CCBHC's reasonable cost of providing the services described
in Minnesota Statutes, section 245.735, subdivision 3, consistent with applicable federal
requirements. In developing the rate methodology, the commissioner shall consider guidance
issued by the Centers for Medicare and Medicaid Services for the Section 223 Demonstration
Program for CCBHC and costs associated with the following:
new text end
new text begin
(1) a new CCBHC service that is not incorporated in the baseline prospective payment
system rate, or a deletion of a CCBHC service that is incorporated in the baseline rate;
new text end
new text begin
(2) a change in service due to amended regulatory requirements or rules;
new text end
new text begin
(3) a change in types of services due to a change in applicable technology and medical
practice utilized by the clinic;
new text end
new text begin
(4) a change in the scope of a project approved by the commissioner; and
new text end
new text begin
(5) a Minnesota-specific quality incentive program for CCBHCs that achieve target
performance on select quality measures. The commissioner shall develop the quality incentive
program, in consultation with stakeholders, with the following requirements:
new text end
new text begin
(i) the same terms of performance must apply to all CCBHCs;
new text end
new text begin
(ii) quality payments must be in addition to the prospective payment rate and must not
exceed an amount equal to five percent of total medical assistance payments for CCBHC
services provided during the applicable time period; and
new text end
new text begin
(iii) the quality measures must be consistent with measures used by the commissioner
for other health care programs.
new text end
new text begin
(b) By February 15, 2020, the commissioner of human services shall consult with CCBHC
providers to develop the rate methodology under paragraph (a). The commissioner shall
report to the chairs and ranking minority members of the legislative committees with
jurisdiction over mental health services and medical assistance on the recommendations to
the CCBHC rate methodology including any necessary statutory updates required for federal
approval.
new text end
new text begin
(c) The commissioner shall consult with CCBHCs and other providers receiving a
prospective payment system rate to study a rate methodology that eliminates potential
duplication of payment for CCBHC providers who also receive a separate prospective
payment system rate. By February 15, 2021, the commissioner shall report to the chairs and
ranking minority members of the legislative committees with jurisdiction over mental health
services and medical assistance on findings and recommendations related to the rate
methodology study under this paragraph, including any necessary statutory updates to
implement recommendations.
new text end
Sec. 45. new text begin DIRECTION TO COMMISSIONER; CONTINUUM OF CARE-BASED
RATE METHODOLOGY.
new text end
new text begin Subdivision 1. new text end
new text begin Rate methodology. new text end
new text begin
(a) The commissioner of human services shall develop
a comprehensive rate methodology for the consolidated chemical dependency treatment
fund that reimburses substance use disorder treatment providers for the full continuum of
care. The continuum of care-based rate methodology must replace the current rates with a
uniform statewide methodology that accurately reflects provider expenses for providing
required elements of substance use disorder outpatient and residential services.
new text end
new text begin
(b) The continuum of care-based rate methodology must include:
new text end
new text begin
(1) payment methodologies for substance use disorder treatment services provided under
the consolidated chemical dependency treatment fund: (i) by a state-operated vendor and,
if the criteria for patient placement is equivalent, by private vendors; or (ii) for persons who
have been civilly committed to the commissioner, present the most complex and difficult
care needs, and are a potential threat to the community;
new text end
new text begin
(2) compensation to providers who provide culturally competent consultation resources;
and
new text end
new text begin
(3) cost-based reimbursement for substance use disorder providers that use sustainable
business models that individualize care and retain individuals in ongoing care at the lowest
medically appropriate level.
new text end
new text begin
(c) The commissioner of human services may contract with a health care policy consultant
or other entity to:
new text end
new text begin
(1) provide stakeholder facilitation and provider outreach services to develop the
continuum of care-based rate methodology; and
new text end
new text begin
(2) provide technical services to develop the continuum of care-based rate methodology.
new text end
new text begin
(d) The commissioner of human services must develop comprehensive substance use
disorder billing guidance for the continuum of care-based rate methodology.
new text end
new text begin
(e) In developing the continuum of care-based rate methodology, the commissioner of
human services must consult with the following stakeholders:
new text end
new text begin
(1) representatives of at least one provider operating residential treatment services, one
provider operating out-patient treatment services, one provider operating an opioid treatment
program, and one provider operating both residential and out-patient treatment services;
new text end
new text begin
(2) representatives of providers who operate in the seven-county metropolitan area and
providers who operate in greater Minnesota; and
new text end
new text begin
(3) representatives of both for-profit and nonprofit providers.
new text end
new text begin Subd. 2. new text end
new text begin Reports. new text end
new text begin
(a) By November 1, 2020, the commissioner of human services shall
report to the legislature on any modifications to the licensure standards necessary to align
provider qualifications with the continuum of care-based rate methodology.
new text end
new text begin
(b) The commissioner of human services shall propose legislation for the 2021 legislative
session necessary to fully implement the continuum of care-based rate methodology.
new text end
Sec. 46. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2018, section 254B.03, subdivision 4a,
new text end
new text begin
is repealed.
new text end
ARTICLE 7
MENTAL HEALTH UNIFORM SERVICE STANDARDS
Section 1.
Minnesota Statutes 2018, section 62A.152, subdivision 3, is amended to read:
Subd. 3.
Provider discrimination prohibited.
All group policies and group subscriber
contracts that provide benefits for mental or nervous disorder treatments in a hospital must
provide direct reimbursement for those services if performed by a mental health professionaldeleted text begin ,
as defined in sections deleted text begin 245.462, subdivision 18deleted text end , clauses (1) to (5); and deleted text begin 245.4871, subdivision
27deleted text end , clauses (1) to (5),deleted text end new text begin qualified according to section 245I.16, subdivision 2,new text end to the extent
that the services and treatment are within the scope of mental health professional licensure.
This subdivision is intended to provide payment of benefits for mental or nervous disorder
treatments performed by a licensed mental health professional in a hospital and is not
intended to change or add benefits for those services provided in policies or contracts to
which this subdivision applies.
Sec. 2.
Minnesota Statutes 2018, section 62A.3094, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For purposes of this section, the terms defined in
paragraphs (b) to (d) have the meanings given.
(b) "Autism spectrum disorders" means the conditions as determined by criteria set forth
in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of
the American Psychiatric Association.
(c) "Medically necessary care" means health care services appropriate, in terms of type,
frequency, level, setting, and duration, to the enrollee's condition, and diagnostic testing
and preventative services. Medically necessary care must be consistent with generally
accepted practice parameters as determined by physicians and licensed psychologists who
typically manage patients who have autism spectrum disorders.
(d) "Mental health professional" means a mental health professional as deleted text begin defined in section
245.4871, subdivision 27deleted text end new text begin described in section 245I.16, subdivision 2new text end , clause (1), (2), (3),
(4), or (6), who has training and expertise in autism spectrum disorder and child development.
Sec. 3.
Minnesota Statutes 2018, section 148B.5301, subdivision 2, is amended to read:
Subd. 2.
Supervision.
(a) To qualify as a LPCC, an applicant must have completed
4,000 hours of post-master's degree supervised professional practice in the delivery of
clinical services in the diagnosis and treatment of mental illnesses and disorders in both
children and adults. The supervised practice shall be conducted according to the requirements
in paragraphs (b) to (e).
(b) The supervision must have been received under a contract that defines clinical practice
and supervision from a mental health professional deleted text begin as defined in section deleted text end deleted text begin , subdivision
18, clauses (1) to (6), or deleted text end deleted text begin 245.4871, subdivision 27deleted text end deleted text begin , clauses (1) to (6),deleted text end new text begin qualified according
to section 245I.16, subdivision 2,new text end or by a board-approved supervisor, who has at least two
years of postlicensure experience in the delivery of clinical services in the diagnosis and
treatment of mental illnesses and disorders. All supervisors must meet the supervisor
requirements in Minnesota Rules, part 2150.5010.
(c) The supervision must be obtained at the rate of two hours of supervision per 40 hours
of professional practice. The supervision must be evenly distributed over the course of the
supervised professional practice. At least 75 percent of the required supervision hours must
be received in person. The remaining 25 percent of the required hours may be received by
telephone or by audio or audiovisual electronic device. At least 50 percent of the required
hours of supervision must be received on an individual basis. The remaining 50 percent
may be received in a group setting.
(d) The supervised practice must include at least 1,800 hours of clinical client contact.
(e) The supervised practice must be clinical practice. Supervision includes the observation
by the supervisor of the successful application of professional counseling knowledge, skills,
and values in the differential diagnosis and treatment of psychosocial function, disability,
or impairment, including addictions and emotional, mental, and behavioral disorders.
Sec. 4.
Minnesota Statutes 2018, section 148E.0555, subdivision 6, is amended to read:
Subd. 6.
Qualifications during grandfathering for licensure as LICSW.
(a) To be
licensed as a licensed independent clinical social worker, an applicant for licensure under
this section must provide evidence satisfactory to the board that the individual has:
(1) completed a graduate degree in social work from a program accredited by the Council
on Social Work Education, the Canadian Association of Schools of Social Work, or a similar
accrediting body designated by the board; or
(2) completed a graduate degree and is a mental health professional according to section
deleted text begin 245.462, subdivision 18deleted text end deleted text begin , clauses (1) to (6)deleted text end new text begin 245I.16, subdivision 2new text end .
(b) To be licensed as a licensed independent clinical social worker, an applicant for
licensure under this section must provide evidence satisfactory to the board that the individual
has:
(1) practiced clinical social work as defined in section 148E.010, subdivision 6, including
both diagnosis and treatment, and has met the supervised practice requirements specified
in sections 148E.100 to 148E.125, excluding the 1,800 hours of direct clinical client contact
specified in section 148E.115, subdivision 1, except that supervised practice hours obtained
prior to August 1, 2011, must meet the requirements in Minnesota Statutes 2010, sections
148D.100 to 148D.125;
(2) submitted a completed, signed application and the license fee in section 148E.180;
(3) for applications submitted electronically, provided an attestation as specified by the
board;
(4) submitted the criminal background check fee and a form provided by the board
authorizing a criminal background check;
(5) paid the license fee in section 148E.180; and
(6) not engaged in conduct that was or would be in violation of the standards of practice
specified in Minnesota Statutes 2010, sections 148D.195 to 148D.240, and sections 148E.195
to 148E.240. If the applicant has engaged in conduct that was or would be in violation of
the standards of practice, the board may take action according to sections 148E.255 to
148E.270.
(c) An application which is not completed, signed, and accompanied by the correct
license fee must be returned to the applicant, along with any fee submitted, and is void.
(d) By submitting an application for licensure, an applicant authorizes the board to
investigate any information provided or requested in the application. The board may request
that the applicant provide additional information, verification, or documentation.
(e) Within one year of the time the board receives an application for licensure, the
applicant must meet all the requirements and provide all of the information requested by
the board.
Sec. 5.
Minnesota Statutes 2018, section 148E.120, subdivision 2, is amended to read:
Subd. 2.
Alternate supervisors.
(a) The board may approve an alternate supervisor as
determined in this subdivision. The board shall approve up to 25 percent of the required
supervision hours by a licensed mental health professional who is competent and qualified
to provide supervision according to the mental health professional's respective licensing
board, as established by section deleted text begin , subdivision 18, clauses (1) to (6), or deleted text end deleted text begin 245.4871,
subdivision 27deleted text end deleted text begin , clauses (1) to (6)deleted text end new text begin 245I.16, subdivision 2new text end .
(b) The board shall approve up to 100 percent of the required supervision hours by an
alternate supervisor if the board determines that:
(1) there are five or fewer supervisors in the county where the licensee practices social
work who meet the applicable licensure requirements in subdivision 1;
(2) the supervisor is an unlicensed social worker who is employed in, and provides the
supervision in, a setting exempt from licensure by section 148E.065, and who has
qualifications equivalent to the applicable requirements specified in sections 148E.100 to
148E.115;
(3) the supervisor is a social worker engaged in authorized social work practice in Iowa,
Manitoba, North Dakota, Ontario, South Dakota, or Wisconsin, and has the qualifications
equivalent to the applicable requirements in sections 148E.100 to 148E.115; or
(4) the applicant or licensee is engaged in nonclinical authorized social work practice
outside of Minnesota and the supervisor meets the qualifications equivalent to the applicable
requirements in sections 148E.100 to 148E.115, or the supervisor is an equivalent mental
health professional, as determined by the board, who is credentialed by a state, territorial,
provincial, or foreign licensing agency; or
(5) the applicant or licensee is engaged in clinical authorized social work practice outside
of Minnesota and the supervisor meets qualifications equivalent to the applicable
requirements in section 148E.115, or the supervisor is an equivalent mental health
professional as determined by the board, who is credentialed by a state, territorial, provincial,
or foreign licensing agency.
(c) In order for the board to consider an alternate supervisor under this section, the
licensee must:
(1) request in the supervision plan and verification submitted according to section
148E.125 that an alternate supervisor conduct the supervision; and
(2) describe the proposed supervision and the name and qualifications of the proposed
alternate supervisor. The board may audit the information provided to determine compliance
with the requirements of this section.
Sec. 6.
Minnesota Statutes 2018, section 148F.11, subdivision 1, is amended to read:
Subdivision 1.
Other professionals.
(a) Nothing in this chapter prevents members of
other professions or occupations from performing functions for which they are qualified or
licensed. This exception includes, but is not limited to: licensed physicians; registered nurses;
licensed practical nurses; licensed psychologists and licensed psychological practitioners;
members of the clergy provided such services are provided within the scope of regular
ministries; American Indian medicine men and women; licensed attorneys; probation officers;
licensed marriage and family therapists; licensed social workers; social workers employed
by city, county, or state agencies; licensed professional counselors; licensed professional
clinical counselors; licensed school counselors; registered occupational therapists or
occupational therapy assistants; Upper Midwest Indian Council on Addictive Disorders
(UMICAD) certified counselors when providing services to Native American people; city,
county, or state employees when providing assessments or case management under Minnesota
Rules, chapter 9530; and individuals defined in section 256B.0623, subdivision 5, clauses
(1) deleted text begin and (2)deleted text end new text begin to (4)new text end , providing integrated dual diagnosis treatment in adult mental health
rehabilitative programs certified by the Department of Human Services under section
256B.0622 or 256B.0623.
(b) Nothing in this chapter prohibits technicians and resident managers in programs
licensed by the Department of Human Services from discharging their duties as provided
in Minnesota Rules, chapter 9530.
(c) Any person who is exempt from licensure under this section must not use a title
incorporating the words "alcohol and drug counselor" or "licensed alcohol and drug
counselor" or otherwise hold himself or herself out to the public by any title or description
stating or implying that he or she is engaged in the practice of alcohol and drug counseling,
or that he or she is licensed to engage in the practice of alcohol and drug counseling, unless
that person is also licensed as an alcohol and drug counselor. Persons engaged in the practice
of alcohol and drug counseling are not exempt from the board's jurisdiction solely by the
use of one of the titles in paragraph (a).
Sec. 7.
Minnesota Statutes 2018, section 245.462, subdivision 6, is amended to read:
Subd. 6.
Community support services program.
"Community support services program"
means services, other than inpatient or residential treatment services, provided or coordinated
by an identified program and staff under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health
professional designed to help adults with serious and persistent mental illness to function
and remain in the community. A community support services program includes:
(1) client outreach,
(2) medication monitoring,
(3) assistance in independent living skills,
(4) development of employability and work-related opportunities,
(5) crisis assistance,
(6) psychosocial rehabilitation,
(7) help in applying for government benefits, and
(8) housing support services.
The community support services program must be coordinated with the case management
services specified in section 245.4711.
Sec. 8.
Minnesota Statutes 2018, section 245.462, subdivision 8, is amended to read:
Subd. 8.
Day treatment services.
"Day treatment," "day treatment services," or "day
treatment program" means deleted text begin a structured program of treatment and care provided to an adult
in or by: (1) a hospital accredited by the joint commission on accreditation of health
organizations and licensed under sections 144.50 to 144.55; (2) a community mental health
center under section 245.62; or (3) an entity that is under contract with the county board to
operate a program that meets the requirements of section 245.4712, subdivision 2, and
Minnesota Rules, parts 9505.0170 to 9505.0475. Day treatment consists of group
psychotherapy and other intensive therapeutic services that are provided at least two days
a week by a multidisciplinary staff under the clinical supervision of a mental health
professional. Day treatment may include education and consultation provided to families
and other individuals as part of the treatment process. The services are aimed at stabilizing
the adult's mental health status, providing mental health services, and developing and
improving the adult's independent living and socialization skills. The goal of day treatment
is to reduce or relieve mental illness and to enable the adult to live in the community. Day
treatment services are not a part of inpatient or residential treatment services. Day treatment
services are distinguished from day care by their structured therapeutic program of
psychotherapy services. The commissioner may limit medical assistance reimbursement
for day treatment to 15 hours per week per persondeleted text end new text begin the treatment services described under
section 256B.0625, subdivision 23new text end .
Sec. 9.
Minnesota Statutes 2018, section 245.462, subdivision 9, is amended to read:
Subd. 9.
Diagnostic assessment.
deleted text begin (a)deleted text end "Diagnostic assessment" deleted text begin has the meaning given indeleted text end
deleted text begin Minnesota Rules, part 9505.0370, subpart 11, and is delivered as provided in Minnesota
Rules, part 9505.0372, subpart 1, items A, B, C, and E. Diagnostic assessment includes a
standard, extended, or brief diagnostic assessment, or an adult updatedeleted text end new text begin means the assessment
described under section 256B.0671, subdivisions 2 to 4new text end .
deleted text begin
(b) A brief diagnostic assessment must include a face-to-face interview with the client
and a written evaluation of the client by a mental health professional or a clinical trainee,
as provided in Minnesota Rules, part 9505.0371, subpart 5, item C. The professional or
clinical trainee must gather initial components of a standard diagnostic assessment, including
the client's:
deleted text end
deleted text begin
(1) age;
deleted text end
deleted text begin
(2) description of symptoms, including reason for referral;
deleted text end
deleted text begin
(3) history of mental health treatment;
deleted text end
deleted text begin
(4) cultural influences and their impact on the client; and
deleted text end
deleted text begin
(5) mental status examination.
deleted text end
deleted text begin
(c) On the basis of the initial components, the professional or clinical trainee must draw
a provisional clinical hypothesis. The clinical hypothesis may be used to address the client's
immediate needs or presenting problem.
deleted text end
deleted text begin
(d) Treatment sessions conducted under authorization of a brief assessment may be used
to gather additional information necessary to complete a standard diagnostic assessment or
an extended diagnostic assessment.
deleted text end
deleted text begin
(e) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (b), prior to completion of a client's initial diagnostic assessment, a client is eligible
for psychological testing as part of the diagnostic process.
deleted text end
deleted text begin
(f) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (c), prior to completion of a client's initial diagnostic assessment, but in conjunction
with the diagnostic assessment process, a client is eligible for up to three individual or family
psychotherapy sessions or family psychoeducation sessions or a combination of the above
sessions not to exceed three sessions.
deleted text end
deleted text begin
(g) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item B, subitem (3),
unit (a), a brief diagnostic assessment may be used for a client's family who requires a
language interpreter to participate in the assessment.
deleted text end
Sec. 10.
Minnesota Statutes 2018, section 245.462, subdivision 14, is amended to read:
Subd. 14.
Individual treatment plan.
"Individual treatment plan" means deleted text begin a written plan
of intervention, treatment, and services for an adult with mental illness that is developed
by a service provider under the clinical supervision of a mental health professional on the
basis of a diagnostic assessment. The plan identifies goals and objectives of treatment,
treatment strategy, a schedule for accomplishing treatment goals and objectives, and the
individual responsible for providing treatment to the adult with mental illnessdeleted text end new text begin the individual
treatment plan described under section 256B.0671, subdivisions 5 and 6new text end .
Sec. 11.
Minnesota Statutes 2018, section 245.462, subdivision 17, is amended to read:
Subd. 17.
Mental health practitioner.
deleted text begin (a)deleted text end "Mental health practitioner" means a person
deleted text begin providing services to adults with mental illness or children with emotional disturbance who
is qualified in at least one of the ways described in paragraphs (b) to (g). A mental health
practitioner for a child client must have training working with children. A mental health
practitioner for an adult client must have training working with adultsdeleted text end new text begin qualified according
to section 245I.16, subdivision 4new text end .
deleted text begin
(b) For purposes of this subdivision, a practitioner is qualified through relevant
coursework if the practitioner completes at least 30 semester hours or 45 quarter hours in
behavioral sciences or related fields and:
deleted text end
deleted text begin
(1) has at least 2,000 hours of supervised experience in the delivery of services to adults
or children with:
deleted text end
deleted text begin
(i) mental illness, substance use disorder, or emotional disturbance; or
deleted text end
deleted text begin
(ii) traumatic brain injury or developmental disabilities and completes training on mental
illness, recovery from mental illness, mental health de-escalation techniques, co-occurring
mental illness and substance abuse, and psychotropic medications and side effects;
deleted text end
deleted text begin
(2) is fluent in the non-English language of the ethnic group to which at least 50 percent
of the practitioner's clients belong, completes 40 hours of training in the delivery of services
to adults with mental illness or children with emotional disturbance, and receives clinical
supervision from a mental health professional at least once a week until the requirement of
2,000 hours of supervised experience is met;
deleted text end
deleted text begin
(3) is working in a day treatment program under section 245.4712, subdivision 2; or
deleted text end
deleted text begin
(4) has completed a practicum or internship that (i) requires direct interaction with adults
or children served, and (ii) is focused on behavioral sciences or related fields.
deleted text end
deleted text begin
(c) For purposes of this subdivision, a practitioner is qualified through work experience
if the person:
deleted text end
deleted text begin
(1) has at least 4,000 hours of supervised experience in the delivery of services to adults
or children with:
deleted text end
deleted text begin
(i) mental illness, substance use disorder, or emotional disturbance; or
deleted text end
deleted text begin
(ii) traumatic brain injury or developmental disabilities and completes training on mental
illness, recovery from mental illness, mental health de-escalation techniques, co-occurring
mental illness and substance abuse, and psychotropic medications and side effects; or
deleted text end
deleted text begin
(2) has at least 2,000 hours of supervised experience in the delivery of services to adults
or children with:
deleted text end
deleted text begin
(i) mental illness, emotional disturbance, or substance use disorder, and receives clinical
supervision as required by applicable statutes and rules from a mental health professional
at least once a week until the requirement of 4,000 hours of supervised experience is met;
or
deleted text end
deleted text begin
(ii) traumatic brain injury or developmental disabilities; completes training on mental
illness, recovery from mental illness, mental health de-escalation techniques, co-occurring
mental illness and substance abuse, and psychotropic medications and side effects; and
receives clinical supervision as required by applicable statutes and rules at least once a week
from a mental health professional until the requirement of 4,000 hours of supervised
experience is met.
deleted text end
deleted text begin
(d) For purposes of this subdivision, a practitioner is qualified through a graduate student
internship if the practitioner is a graduate student in behavioral sciences or related fields
and is formally assigned by an accredited college or university to an agency or facility for
clinical training.
deleted text end
deleted text begin
(e) For purposes of this subdivision, a practitioner is qualified by a bachelor's or master's
degree if the practitioner:
deleted text end
deleted text begin
(1) holds a master's or other graduate degree in behavioral sciences or related fields; or
deleted text end
deleted text begin
(2) holds a bachelor's degree in behavioral sciences or related fields and completes a
practicum or internship that (i) requires direct interaction with adults or children served,
and (ii) is focused on behavioral sciences or related fields.
deleted text end
deleted text begin
(f) For purposes of this subdivision, a practitioner is qualified as a vendor of medical
care if the practitioner meets the definition of vendor of medical care in section 256B.02,
subdivision 7, paragraphs (b) and (c), and is serving a federally recognized tribe.
deleted text end
deleted text begin
(g) For purposes of medical assistance coverage of diagnostic assessments, explanations
of findings, and psychotherapy under section 256B.0625, subdivision 65, a mental health
practitioner working as a clinical trainee means that the practitioner's clinical supervision
experience is helping the practitioner gain knowledge and skills necessary to practice
effectively and independently. This may include supervision of direct practice, treatment
team collaboration, continued professional learning, and job management. The practitioner
must also:
deleted text end
deleted text begin
(1) comply with requirements for licensure or board certification as a mental health
professional, according to the qualifications under Minnesota Rules, part 9505.0371, subpart
5, item A, including supervised practice in the delivery of mental health services for the
treatment of mental illness; or
deleted text end
deleted text begin
(2) be a student in a bona fide field placement or internship under a program leading to
completion of the requirements for licensure as a mental health professional according to
the qualifications under Minnesota Rules, part 9505.0371, subpart 5, item A.
deleted text end
deleted text begin
(h) For purposes of this subdivision, "behavioral sciences or related fields" has the
meaning given in section 256B.0623, subdivision 5, paragraph (d).
deleted text end
deleted text begin
(i) Notwithstanding the licensing requirements established by a health-related licensing
board, as defined in section 214.01, subdivision 2, this subdivision supersedes any other
statute or rule.
deleted text end
Sec. 12.
Minnesota Statutes 2018, section 245.462, subdivision 18, is amended to read:
Subd. 18.
Mental health professional.
"Mental health professional" means a person
deleted text begin providing clinical services in the treatment of mental illness who is qualified in at least one
of the following ways:deleted text end new text begin qualified according to section 245I.16, subdivision 2.
new text end
deleted text begin
(1) in psychiatric nursing: a registered nurse who is licensed under sections 148.171 to
148.285; and:
deleted text end
deleted text begin
(i) who is certified as a clinical specialist or as a nurse practitioner in adult or family
psychiatric and mental health nursing by a national nurse certification organization; or
deleted text end
deleted text begin
(ii) who has a master's degree in nursing or one of the behavioral sciences or related
fields from an accredited college or university or its equivalent, with at least 4,000 hours
of post-master's supervised experience in the delivery of clinical services in the treatment
of mental illness;
deleted text end
deleted text begin
(2) in clinical social work: a person licensed as an independent clinical social worker
under chapter 148D, or a person with a master's degree in social work from an accredited
college or university, with at least 4,000 hours of post-master's supervised experience in
the delivery of clinical services in the treatment of mental illness;
deleted text end
deleted text begin
(3) in psychology: an individual licensed by the Board of Psychology under sections
148.88 to 148.98 who has stated to the Board of Psychology competencies in the diagnosis
and treatment of mental illness;
deleted text end
deleted text begin
(4) in psychiatry: a physician licensed under chapter 147 and certified by the American
Board of Psychiatry and Neurology or eligible for board certification in psychiatry, or an
osteopathic physician licensed under chapter 147 and certified by the American Osteopathic
Board of Neurology and Psychiatry or eligible for board certification in psychiatry;
deleted text end
deleted text begin
(5) in marriage and family therapy: the mental health professional must be a marriage
and family therapist licensed under sections 148B.29 to 148B.39 with at least two years of
post-master's supervised experience in the delivery of clinical services in the treatment of
mental illness;
deleted text end
deleted text begin
(6) in licensed professional clinical counseling, the mental health professional shall be
a licensed professional clinical counselor under section 148B.5301 with at least 4,000 hours
of post-master's supervised experience in the delivery of clinical services in the treatment
of mental illness; or
deleted text end
deleted text begin
(7) in allied fields: a person with a master's degree from an accredited college or university
in one of the behavioral sciences or related fields, with at least 4,000 hours of post-master's
supervised experience in the delivery of clinical services in the treatment of mental illness.
deleted text end
Sec. 13.
Minnesota Statutes 2018, section 245.462, subdivision 21, is amended to read:
Subd. 21.
Outpatient services.
"Outpatient services" means mental health services,
excluding day treatment and community support services programs, provided by or under
the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional to adults with mental
illness who live outside a hospital. Outpatient services include clinical activities such as
individual, group, and family therapy; individual treatment planning; diagnostic assessments;
medication management; and psychological testing.
Sec. 14.
Minnesota Statutes 2018, section 245.462, subdivision 23, is amended to read:
Subd. 23.
Residential treatment.
"Residential treatment" means a 24-hour-a-day program
under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional, in a community
residential setting other than an acute care hospital or regional treatment center inpatient
unit, that must be licensed as a residential treatment program for adults with mental illness
under Minnesota Rules, parts 9520.0500 to 9520.0670new text begin ,new text end or other rules adopted by the
commissioner.
Sec. 15.
Minnesota Statutes 2018, section 245.462, is amended by adding a subdivision
to read:
new text begin Subd. 27. new text end
new text begin Treatment supervision. new text end
new text begin
"Treatment supervision" means the treatment
supervision described under section 245I.18.
new text end
Sec. 16.
Minnesota Statutes 2018, section 245.467, subdivision 2, is amended to read:
Subd. 2.
Diagnostic assessment.
deleted text begin
All providers of residential, acute care hospital inpatient,
and regional treatment centers must complete a diagnostic assessment for each of their
clients within five days of admission. Providers of day treatment services must complete a
diagnostic assessment within five days after the adult's second visit or within 30 days after
intake, whichever occurs first. In cases where a diagnostic assessment is available and has
been completed within three years preceding admission, only an adult diagnostic assessment
update is necessary. An "adult diagnostic assessment update" means a written summary by
a mental health professional of the adult's current mental health status and service needs
and includes a face-to-face interview with the adult. If the adult's mental health status has
changed markedly since the adult's most recent diagnostic assessment, a new diagnostic
assessment is required. Compliance with the provisions of this subdivision does not ensure
eligibility for medical assistance reimbursement under chapter 256B.
deleted text end
new text begin
Providers of services
governed by this section shall complete a diagnostic assessment according to the standards
of section 256B.0671, including for services to a person not eligible for medical assistance.
new text end
Sec. 17.
Minnesota Statutes 2018, section 245.467, subdivision 3, is amended to read:
Subd. 3.
Individual treatment plans.
deleted text begin
All providers of outpatient services, day treatment
services, residential treatment, acute care hospital inpatient treatment, and all regional
treatment centers must develop an individual treatment plan for each of their adult clients.
The individual treatment plan must be based on a diagnostic assessment. To the extent
possible, the adult client shall be involved in all phases of developing and implementing
the individual treatment plan. Providers of residential treatment and acute care hospital
inpatient treatment, and all regional treatment centers must develop the individual treatment
plan within ten days of client intake and must review the individual treatment plan every
90 days after intake. Providers of day treatment services must develop the individual
treatment plan before the completion of five working days in which service is provided or
within 30 days after the diagnostic assessment is completed or obtained, whichever occurs
first. Providers of outpatient services must develop the individual treatment plan within 30
days after the diagnostic assessment is completed or obtained or by the end of the second
session of an outpatient service, not including the session in which the diagnostic assessment
was provided, whichever occurs first. Outpatient and day treatment services providers must
review the individual treatment plan every 90 days after intake.
deleted text end
new text begin
Providers of services
governed by this section shall complete an individual treatment plan according to the
standards of section 256B.0671, subdivisions 5 and 6, including for services to a person not
eligible for medical assistance.
new text end
Sec. 18.
Minnesota Statutes 2018, section 245.469, subdivision 1, is amended to read:
Subdivision 1.
Availability of emergency services.
deleted text begin By July 1, 1988,deleted text end County boards
must provide or contract for enough emergency services within the county to meet the needs
of adults in the county who are experiencing an emotional crisis or mental illness. Clients
may be required to pay a fee according to section 245.481. new text begin Emergency service providers
shall not delay the timely provision of emergency service because of delays in determining
this fee or because of the unwillingness or inability of the client to pay the fee. new text end Emergency
services must include assessment, crisis intervention, and appropriate case disposition. new text begin A
tribal authority that accepts crisis grant funding has the same responsibilities as county
boards within the tribal authority's designated service area. new text end Emergency services must:
(1) promote the safety and emotional stability of adults with mental illness or emotional
crises;
(2) minimize further deterioration of adults with mental illness or emotional crises;
(3) help adults with mental illness or emotional crises to obtain ongoing care and
treatment; deleted text begin and
deleted text end
(4) prevent placement in settings that are more intensive, costly, or restrictive than
necessary and appropriate to meet client needsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(5) provide support, psychoeducation, and referrals to family members, friends, service
providers, or other third parties on behalf of a recipient in need of emergency services.
new text end
Sec. 19.
Minnesota Statutes 2018, section 245.469, subdivision 2, is amended to read:
Subd. 2.
Specific requirements.
(a) The county board shall require that all service
providers of emergency services to adults with mental illness provide immediate direct
access to a mental health professional during regular business hours. For evenings, weekends,
and holidays, the service may be by direct toll-free telephone access to a mental health
professional,new text begin a clinical trainee, ornew text end a mental health practitionerdeleted text begin , or until January 1, 1991, a
designated person with training in human services who receives clinical supervision from
a mental health professionaldeleted text end .
(b) The commissioner may waive the requirement in paragraph (a) that the evening,
weekend, and holiday service be provided by a mental health professionalnew text begin , clinical trainee,new text end
or mental health practitioner deleted text begin after January 1, 1991,deleted text end if the county documents that:
(1) mental health professionalsnew text begin , clinical trainees,new text end or mental health practitioners are
unavailable to provide this service;
(2) services are provided by a designated person with training in human services who
receives deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision from a mental health professional; and
(3) the service provider is not also the provider of fire and public safety emergency
services.
(c) The commissioner may waive the requirement in paragraph (b), clause (3), that the
evening, weekend, and holiday service not be provided by the provider of fire and public
safety emergency services if:
(1) every person who will be providing the first telephone contact has received at least
eight hours of training on emergency mental health services reviewed by the state advisory
council on mental health and then approved by the commissioner;
(2) every person who will be providing the first telephone contact will annually receive
at least four hours of continued training on emergency mental health services deleted text begin reviewed bydeleted text end
deleted text begin the state advisory council on mental health and thendeleted text end approved by the commissioner;
(3) the local social service agency has provided public education about available
emergency mental health services and can assure potential users of emergency services that
their calls will be handled appropriately;
(4) the local social service agency agrees to provide the commissioner with accurate
data on the number of emergency mental health service calls receivednew text begin and their responsesnew text end ;
(5) the local social service agency agrees to monitor the frequency and quality of
emergency services; and
(6) the local social service agency describes how it will comply with paragraph (d).
(d) Whenever emergency service during nonbusiness hours is provided by anyone other
than a mental health professional, a mental health professional must be available on call for
an emergency assessment and crisis intervention services, and must be available for at least
telephone consultation within 30 minutes.
Sec. 20.
Minnesota Statutes 2018, section 245.470, subdivision 1, is amended to read:
Subdivision 1.
Availability of outpatient services.
(a) County boards must provide or
contract for enough outpatient services within the county to meet the needs of adults with
mental illness residing in the county. Services may be provided directly by the county
through county-operated mental health centers or mental health clinics approved by the
commissioner under section 245.69, subdivision 2; by contract with privately operated
mental health centers or mental health clinics approved by the commissioner under section
245.69, subdivision 2; by contract with hospital mental health outpatient programs certified
by the Joint Commission on Accreditation of Hospital Organizations; or by contract with
a licensed mental health professional deleted text begin as defined in section 245.462, subdivision 18, clauses
(1) to (6)deleted text end . Clients may be required to pay a fee according to section 245.481. Outpatient
services include:
(1) conducting diagnostic assessments;
(2) conducting psychological testing;
(3) developing or modifying individual treatment plans;
(4) making referrals and recommending placements as appropriate;
(5) treating an adult's mental health needs through therapy;
(6) prescribing and managing medication and evaluating the effectiveness of prescribed
medication; and
(7) preventing placement in settings that are more intensive, costly, or restrictive than
necessary and appropriate to meet client needs.
(b) County boards may request a waiver allowing outpatient services to be provided in
a nearby trade area if it is determined that the client can best be served outside the county.
Sec. 21.
Minnesota Statutes 2018, section 245.4712, subdivision 2, is amended to read:
Subd. 2.
Day treatment services provided.
(a) Day treatment services must be developed
as a part of the community support services available to adults with serious and persistent
mental illness residing in the county. Adults may be required to pay a fee according to
section 245.481. Day treatment services must be designed to:
(1) provide a structured environment for treatment;
(2) provide support for residing in the community;
(3) prevent placement in settings that are more intensive, costly, or restrictive than
necessary and appropriate to meet client need;
(4) coordinate with or be offered in conjunction with a local education agency's special
education program; and
(5) operate on a continuous basis throughout the year.
(b) For purposes of complying with medical assistance requirements, an adult day
treatment program must comply with the method of deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision specified
in deleted text begin Minnesota Rules, part 9505.0371, subpart 4deleted text end new text begin section 245I.18new text end . deleted text begin The clinical supervision
must be performed by a qualified supervisor who satisfies the requirements of Minnesota
Rules, part 9505.0371, subpart 5.
deleted text end
A day treatment program must demonstrate compliance with this deleted text begin clinicaldeleted text end new text begin treatmentnew text end
supervision requirement by the commissioner's review and approval of the program according
to deleted text begin Minnesota Rules, part 9505.0372, subpart 8deleted text end new text begin section 256B.0625, subdivision 23new text end .
(c) County boards may request a waiver from including day treatment services if they
can document that:
(1) an alternative plan of care exists through the county's community support services
for clients who would otherwise need day treatment services;
(2) day treatment, if included, would be duplicative of other components of the
community support services; and
(3) county demographics and geography make the provision of day treatment services
cost ineffective and infeasible.
Sec. 22.
Minnesota Statutes 2018, section 245.472, subdivision 2, is amended to read:
Subd. 2.
Specific requirements.
Providers of residential services must be licensed under
applicable rules adopted by the commissioner and must deleted text begin be clinically superviseddeleted text end new text begin provide
treatment supervisionnew text end by a mental health professional. deleted text begin Persons employed in facilities licensed
under Minnesota Rules, parts 9520.0500 to 9520.0670, in the capacity of program director
as of July 1, 1987, in accordance with Minnesota Rules, parts 9520.0500 to 9520.0670, may
be allowed to continue providing clinical supervision within a facility, provided they continue
to be employed as a program director in a facility licensed under Minnesota Rules, parts
9520.0500 to 9520.0670.
deleted text end
Sec. 23.
Minnesota Statutes 2018, section 245.4863, is amended to read:
245.4863 INTEGRATED CO-OCCURRING DISORDER TREATMENT.
(a) The commissioner shall require individuals who perform chemical dependency
assessments to screen clients for co-occurring mental health disorders, and staff who perform
mental health diagnostic assessments to screen for co-occurring substance use disorders.
Screening tools must be approved by the commissioner. If a client screens positive for a
co-occurring mental health or substance use disorder, the individual performing the screening
must document what actions will be taken in response to the results and whether further
assessments must be performed.
(b) Notwithstanding paragraph (a), screening is not required when:
(1) the presence of co-occurring disorders was documented for the client in the past 12
months;
(2) the client is currently receiving co-occurring disorders treatment;
(3) the client is being referred for co-occurring disorders treatment; or
(4) a mental health professional, as deleted text begin defined in Minnesota Rules, part 9505.0370, subpart
18deleted text end new text begin provided by section 245I.16, subdivision 2new text end , who is competent to perform diagnostic
assessments of co-occurring disorders is performing a diagnostic assessment that meets the
requirements in Minnesota Rules, part 9533.0090, subpart 5, to identify whether the client
may have co-occurring mental health and chemical dependency disorders. If an individual
is identified to have co-occurring mental health and substance use disorders, the assessing
mental health professional must document what actions will be taken to address the client's
co-occurring disorders.
(c) The commissioner shall adopt rules as necessary to implement this section. The
commissioner shall ensure that the rules are effective on July 1, 2013, thereby establishing
a certification process for integrated dual disorder treatment providers and a system through
which individuals receive integrated dual diagnosis treatment if assessed as having both a
substance use disorder and either a serious mental illness or emotional disturbance.
(d) The commissioner shall apply for any federal waivers necessary to secure, to the
extent allowed by law, federal financial participation for the provision of integrated dual
diagnosis treatment to persons with co-occurring disorders.
Sec. 24.
Minnesota Statutes 2018, section 245.4871, subdivision 9a, is amended to read:
Subd. 9a.
Crisis deleted text begin assistancedeleted text end new text begin planningnew text end .
"Crisis deleted text begin assistancedeleted text end new text begin planningnew text end " means deleted text begin assistance to
the child, the child's family, and all providers of services to the child to: recognize factors
precipitating a mental health crisis, identify behaviors related to the crisis, and be informed
of available resources to resolve the crisis. Crisis assistance requires the development of a
plan which addresses prevention and intervention strategies to be used in a potential crisis.
Other interventions include: (1) arranging for admission to acute care hospital inpatient
treatment; (2) crisis placement; (3) community resources for follow-up; and (4) emotional
support to the family during crisis. Crisis assistance does not include services designed to
secure the safety of a child who is at risk of abuse or neglect or necessary emergency services.deleted text end new text begin
the development of a written plan to assist a child's family in preventing and addressing a
potential crisis and is distinct from the immediate provision of mental health mobile crisis
intervention services as defined in section 256B.0944. The plan must address prevention,
de-escalation, and intervention strategies to be used in a crisis. The plan identifies factors
that might precipitate a crisis, behaviors or symptoms related to the emergence of a crisis,
and the resources available to resolve a crisis. The plan must include planning for the
following potential needs: (1) acute care; (2) crisis placement; (3) community resources for
follow-up; and (4) emotional support to the family during crisis. Crisis planning excludes
services designed to secure the safety of a child who is at risk of abuse or neglect or necessary
emergency services.
new text end
Sec. 25.
Minnesota Statutes 2018, section 245.4871, subdivision 10, is amended to read:
Subd. 10.
Day treatment services.
"Day treatment," "day treatment services," or "day
treatment program" means a structured program of treatment and care provided to a child
in:
(1) an outpatient hospital accredited by the Joint Commission on Accreditation of Health
Organizations and licensed under sections 144.50 to 144.55;
(2) a community mental health center under section 245.62;
(3) an entity that is under contract with the county board to operate a program that meets
the requirements of section 245.4884, subdivision 2, and Minnesota Rules, parts 9505.0170
to 9505.0475; deleted text begin or
deleted text end
(4) an entity that operates a program that meets the requirements of section 245.4884,
subdivision 2, and Minnesota Rules, parts 9505.0170 to 9505.0475, that is under contract
with an entity that is under contract with a county boarddeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(5) an entity that operates a program certified under section 256B.0943.
new text end
Day treatment consists of group psychotherapy and other intensive therapeutic services
that are provided for a minimum two-hour time block by a multidisciplinary staff under the
clinical supervision of a mental health professional. Day treatment may include education
and consultation provided to families and other individuals as an extension of the treatment
process. The services are aimed at stabilizing the child's mental health status, and developing
and improving the child's daily independent living and socialization skills. Day treatment
services are distinguished from day care by their structured therapeutic program of
psychotherapy services. Day treatment services are not a part of inpatient hospital or
residential treatment services.
A day treatment service must be available to a child up to 15 hours a week throughout
the year and must be coordinated with, integrated with, or part of an education program
offered by the child's school.
Sec. 26.
Minnesota Statutes 2018, section 245.4871, subdivision 11a, is amended to read:
Subd. 11a.
Diagnostic assessment.
deleted text begin (a)deleted text end "Diagnostic assessment" deleted text begin has the meaning given
in Minnesota Rules, part 9505.0370, subpart 11, and is delivered as provided in Minnesota
Rules, part 9505.0372, subpart 1, items A, B, C, and E. Diagnostic assessment includes a
standard, extended, or brief diagnostic assessment, or an adult update.deleted text end new text begin means the assessment
described under section 256B.0671, subdivisions 2 to 4.
new text end
deleted text begin
(b) A brief diagnostic assessment must include a face-to-face interview with the client
and a written evaluation of the client by a mental health professional or a clinical trainee,
as provided in Minnesota Rules, part 9505.0371, subpart 5, item C. The professional or
clinical trainee must gather initial components of a standard diagnostic assessment, including
the client's:
deleted text end
deleted text begin
(1) age;
deleted text end
deleted text begin
(2) description of symptoms, including reason for referral;
deleted text end
deleted text begin
(3) history of mental health treatment;
deleted text end
deleted text begin
(4) cultural influences and their impact on the client; and
deleted text end
deleted text begin
(5) mental status examination.
deleted text end
deleted text begin
(c) On the basis of the brief components, the professional or clinical trainee must draw
a provisional clinical hypothesis. The clinical hypothesis may be used to address the client's
immediate needs or presenting problem.
deleted text end
deleted text begin
(d) Treatment sessions conducted under authorization of a brief assessment may be used
to gather additional information necessary to complete a standard diagnostic assessment or
an extended diagnostic assessment.
deleted text end
deleted text begin
(e) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (b), prior to completion of a client's initial diagnostic assessment, a client is eligible
for psychological testing as part of the diagnostic process.
deleted text end
deleted text begin
(f) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (c), prior to completion of a client's initial diagnostic assessment, but in conjunction
with the diagnostic assessment process, a client is eligible for up to three individual or family
psychotherapy sessions or family psychoeducation sessions or a combination of the above
sessions not to exceed three sessions.
deleted text end
Sec. 27.
Minnesota Statutes 2018, section 245.4871, subdivision 17, is amended to read:
Subd. 17.
Family community support services.
"Family community support services"
means services provided under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health
professional and designed to help each child with severe emotional disturbance to function
and remain with the child's family in the community. Family community support services
do not include acute care hospital inpatient treatment, residential treatment services, or
regional treatment center services. Family community support services include:
(1) client outreach to each child with severe emotional disturbance and the child's family;
(2) medication monitoring where necessary;
(3) assistance in developing independent living skills;
(4) assistance in developing parenting skills necessary to address the needs of the child
with severe emotional disturbance;
(5) assistance with leisure and recreational activities;
(6) crisis assistance, including crisis placement and respite care;
(7) professional home-based family treatment;
(8) foster care with therapeutic supports;
(9) day treatment;
(10) assistance in locating respite care and special needs day care; and
(11) assistance in obtaining potential financial resources, including those benefits listed
in section 245.4884, subdivision 5.
Sec. 28.
Minnesota Statutes 2018, section 245.4871, subdivision 21, is amended to read:
Subd. 21.
Individual treatment plan.
"Individual treatment plan" means deleted text begin a written plan
of intervention, treatment, and services for a child with an emotional disturbance that is
developed by a service provider under the clinical supervision of a mental health professional
on the basis of a diagnostic assessment. An individual treatment plan for a child must be
developed in conjunction with the family unless clinically inappropriate. The plan identifies
goals and objectives of treatment, treatment strategy, a schedule for accomplishing treatment
goals and objectives, and the individuals responsible for providing treatment to the child
with an emotional disturbancedeleted text end new text begin the individual treatment plan described under section
256B.0671, subdivisions 5 and 6new text end .
Sec. 29.
Minnesota Statutes 2018, section 245.4871, subdivision 26, is amended to read:
Subd. 26.
Mental health practitioner.
"Mental health practitioner" deleted text begin has the meaning
given indeleted text end new text begin means a person qualified according to new text end section deleted text begin 245.462, subdivision 17deleted text end new text begin 245I.16,
subdivision 4new text end .
Sec. 30.
Minnesota Statutes 2018, section 245.4871, subdivision 27, is amended to read:
Subd. 27.
Mental health professional.
"Mental health professional" means a person
deleted text begin providing clinical services in the diagnosis and treatment of children's emotional disorders.
A mental health professional must have training and experience in working with children
consistent with the age group to which the mental health professional is assigned. A mental
health professional must be qualified in at least one of the following ways:deleted text end new text begin qualified according
to section 245I.16, subdivision 2.
new text end
deleted text begin
(1) in psychiatric nursing, the mental health professional must be a registered nurse who
is licensed under sections 148.171 to 148.285 and who is certified as a clinical specialist in
child and adolescent psychiatric or mental health nursing by a national nurse certification
organization or who has a master's degree in nursing or one of the behavioral sciences or
related fields from an accredited college or university or its equivalent, with at least 4,000
hours of post-master's supervised experience in the delivery of clinical services in the
treatment of mental illness;
deleted text end
deleted text begin
(2) in clinical social work, the mental health professional must be a person licensed as
an independent clinical social worker under chapter 148D, or a person with a master's degree
in social work from an accredited college or university, with at least 4,000 hours of
post-master's supervised experience in the delivery of clinical services in the treatment of
mental disorders;
deleted text end
deleted text begin
(3) in psychology, the mental health professional must be an individual licensed by the
board of psychology under sections 148.88 to 148.98 who has stated to the board of
psychology competencies in the diagnosis and treatment of mental disorders;
deleted text end
deleted text begin
(4) in psychiatry, the mental health professional must be a physician licensed under
chapter 147 and certified by the American Board of Psychiatry and Neurology or eligible
for board certification in psychiatry or an osteopathic physician licensed under chapter 147
and certified by the American Osteopathic Board of Neurology and Psychiatry or eligible
for board certification in psychiatry;
deleted text end
deleted text begin
(5) in marriage and family therapy, the mental health professional must be a marriage
and family therapist licensed under sections 148B.29 to 148B.39 with at least two years of
post-master's supervised experience in the delivery of clinical services in the treatment of
mental disorders or emotional disturbances;
deleted text end
deleted text begin
(6) in licensed professional clinical counseling, the mental health professional shall be
a licensed professional clinical counselor under section 148B.5301 with at least 4,000 hours
of post-master's supervised experience in the delivery of clinical services in the treatment
of mental disorders or emotional disturbances; or
deleted text end
deleted text begin
(7) in allied fields, the mental health professional must be a person with a master's degree
from an accredited college or university in one of the behavioral sciences or related fields,
with at least 4,000 hours of post-master's supervised experience in the delivery of clinical
services in the treatment of emotional disturbances.
deleted text end
Sec. 31.
Minnesota Statutes 2018, section 245.4871, subdivision 29, is amended to read:
Subd. 29.
Outpatient services.
"Outpatient services" means mental health services,
excluding day treatment and community support services programs, provided by or under
the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional to children with emotional
disturbances who live outside a hospital. Outpatient services include clinical activities such
as individual, group, and family therapy; individual treatment planning; diagnostic
assessments; medication management; and psychological testing.
Sec. 32.
Minnesota Statutes 2018, section 245.4871, subdivision 32, is amended to read:
Subd. 32.
Residential treatment.
"Residential treatment" means a 24-hour-a-day program
under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional, in a community
residential setting other than an acute care hospital or regional treatment center inpatient
unit, that must be licensed as a residential treatment program for children with emotional
disturbances under Minnesota Rules, parts 2960.0580 to 2960.0700, or other rules adopted
by the commissioner.
Sec. 33.
Minnesota Statutes 2018, section 245.4871, subdivision 34, is amended to read:
Subd. 34.
Therapeutic support of foster care.
"Therapeutic support of foster care"
means the mental health training and mental health support services and deleted text begin clinicaldeleted text end new text begin treatmentnew text end
supervision provided by a mental health professional to foster families caring for children
with severe emotional disturbance to provide a therapeutic family environment and support
for the child's improved functioning.new text begin Therapeutic support of foster care includes services
provided under section 256B.0946.
new text end
Sec. 34.
Minnesota Statutes 2018, section 245.4876, subdivision 2, is amended to read:
Subd. 2.
Diagnostic assessment.
deleted text begin
All residential treatment facilities and acute care
hospital inpatient treatment facilities that provide mental health services for children must
complete a diagnostic assessment for each of their child clients within five working days
of admission. Providers of day treatment services for children must complete a diagnostic
assessment within five days after the child's second visit or 30 days after intake, whichever
occurs first. In cases where a diagnostic assessment is available and has been completed
within 180 days preceding admission, only updating is necessary. "Updating" means a
written summary by a mental health professional of the child's current mental health status
and service needs. If the child's mental health status has changed markedly since the child's
most recent diagnostic assessment, a new diagnostic assessment is required. Compliance
with the provisions of this subdivision does not ensure eligibility for medical assistance
reimbursement under chapter 256B.
deleted text end
new text begin
Providers of services governed by this section shall
complete a diagnostic assessment according to the standards of section 256B.0671, including
for services to a person not eligible for medical assistance.
new text end
Sec. 35.
Minnesota Statutes 2018, section 245.4876, subdivision 3, is amended to read:
Subd. 3.
Individual treatment plans.
deleted text begin
All providers of outpatient services, day treatment
services, professional home-based family treatment, residential treatment, and acute care
hospital inpatient treatment, and all regional treatment centers that provide mental health
services for children must develop an individual treatment plan for each child client. The
individual treatment plan must be based on a diagnostic assessment. To the extent appropriate,
the child and the child's family shall be involved in all phases of developing and
implementing the individual treatment plan. Providers of residential treatment, professional
home-based family treatment, and acute care hospital inpatient treatment, and regional
treatment centers must develop the individual treatment plan within ten working days of
client intake or admission and must review the individual treatment plan every 90 days after
intake, except that the administrative review of the treatment plan of a child placed in a
residential facility shall be as specified in sections 260C.203 and 260C.212, subdivision 9.
Providers of day treatment services must develop the individual treatment plan before the
completion of five working days in which service is provided or within 30 days after the
diagnostic assessment is completed or obtained, whichever occurs first. Providers of
outpatient services must develop the individual treatment plan within 30 days after the
diagnostic assessment is completed or obtained or by the end of the second session of an
outpatient service, not including the session in which the diagnostic assessment was provided,
whichever occurs first. Providers of outpatient and day treatment services must review the
individual treatment plan every 90 days after intake.
deleted text end
new text begin
Providers of services governed by this
section shall complete an individual treatment plan according to the standards of section
256B.0671, subdivisions 5 and 6, including for services to a person not eligible for medical
assistance.
new text end
Sec. 36.
Minnesota Statutes 2018, section 245.4879, subdivision 1, is amended to read:
Subdivision 1.
Availability of emergency services.
County boards must provide or
contract for enough mental health emergency services within the county to meet the needs
of children, and children's families when clinically appropriate, in the county who are
experiencing an emotional crisis or emotional disturbance. The county board shall ensure
that parents, providers, and county residents are informed about when and how to access
emergency mental health services for children. A child or the child's parent may be required
to pay a fee according to section 245.481. Emergency service providers shall not delay the
timely provision of emergency service because of delays in determining this fee or because
of the unwillingness or inability of the parent to pay the fee. Emergency services must
include assessment, crisis intervention, and appropriate case disposition.new text begin A tribal authority
that accepts crisis grant funding has the same responsibilities as county boards within the
tribal authority's designated service area.new text end Emergency services must:
(1) promote the safety and emotional stability of children with emotional disturbances
or emotional crises;
(2) minimize further deterioration of the child with emotional disturbance or emotional
crisis;
(3) help each child with an emotional disturbance or emotional crisis to obtain ongoing
care and treatment; deleted text begin and
deleted text end
(4) prevent placement in settings that are more intensive, costly, or restrictive than
necessary and appropriate to meet the child's needsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(5) provide support, psychoeducation, and referrals to family members, service providers,
or other third parties on behalf of a client in need of emergency services.
new text end
Sec. 37.
Minnesota Statutes 2018, section 245.4879, subdivision 2, is amended to read:
Subd. 2.
Specific requirements.
(a) The county board shall require that all service
providers of emergency services to the child with an emotional disturbance provide immediate
direct access to a mental health professional during regular business hours. For evenings,
weekends, and holidays, the service may be by direct toll-free telephone access to a mental
health professional,new text begin a clinical trainee, ornew text end a mental health practitionerdeleted text begin , or until January 1,
1991, a designated person with training in human services who receives clinical supervision
from a mental health professionaldeleted text end .
(b) The commissioner may waive the requirement in paragraph (a) that the evening,
weekend, and holiday service be provided by a mental health professionalnew text begin , clinical trainee,new text end
or mental health practitioner deleted text begin after January 1, 1991,deleted text end if the county documents that:
(1) mental health professionalsnew text begin , clinical trainees,new text end or mental health practitioners are
unavailable to provide this service;
(2) services are provided by a designated person with training in human services who
receives deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision from a mental health professional; and
(3) the service provider is not also the provider of fire and public safety emergency
services.
(c) The commissioner may waive the requirement in paragraph (b), clause (3), that the
evening, weekend, and holiday service not be provided by the provider of fire and public
safety emergency services if:
(1) every person who will be providing the first telephone contact has received at least
eight hours of training on emergency mental health services reviewed by the state advisory
council on mental health and then approved by the commissioner;
(2) every person who will be providing the first telephone contact will annually receive
at least four hours of continued training on emergency mental health services reviewed by
the state advisory council on mental health and then approved by the commissioner;
(3) the local social service agency has provided public education about available
emergency mental health services and can assure potential users of emergency services that
their calls will be handled appropriately;
(4) the local social service agency agrees to provide the commissioner with accurate
data on the number of emergency mental health service calls received;
(5) the local social service agency agrees to monitor the frequency and quality of
emergency services; and
(6) the local social service agency describes how it will comply with paragraph (d).
(d) When emergency service during nonbusiness hours is provided by anyone other than
a mental health professional, a mental health professional must be available on call for an
emergency assessment and crisis intervention services, and must be available for at least
telephone consultation within 30 minutes.
Sec. 38.
Minnesota Statutes 2018, section 245.488, subdivision 1, is amended to read:
Subdivision 1.
Availability of outpatient services.
(a) County boards must provide or
contract for enough outpatient services within the county to meet the needs of each child
with emotional disturbance residing in the county and the child's family. Services may be
provided directly by the county through county-operated mental health centers or mental
health clinics approved by the commissioner under section 245.69, subdivision 2; by contract
with privately operated mental health centers or mental health clinics approved by the
commissioner under section 245.69, subdivision 2; by contract with hospital mental health
outpatient programs certified by the Joint Commission on Accreditation of Hospital
Organizations; or by contract with a licensed mental health professional deleted text begin as defined in section
245.4871, subdivision 27, clauses (1) to (6)deleted text end . A child or a child's parent may be required to
pay a fee based in accordance with section 245.481. Outpatient services include:
(1) conducting diagnostic assessments;
(2) conducting psychological testing;
(3) developing or modifying individual treatment plans;
(4) making referrals and recommending placements as appropriate;
(5) treating the child's mental health needs through therapy; and
(6) prescribing and managing medication and evaluating the effectiveness of prescribed
medication.
(b) County boards may request a waiver allowing outpatient services to be provided in
a nearby trade area if it is determined that the child requires necessary and appropriate
services that are only available outside the county.
(c) Outpatient services offered by the county board to prevent placement must be at the
level of treatment appropriate to the child's diagnostic assessment.
Sec. 39.
Minnesota Statutes 2018, section 245.696, is amended by adding a subdivision
to read:
new text begin Subd. 3. new text end
new text begin
Certification of mental health peer specialists and mental health family
peer specialists.
new text end
new text begin
The commissioner shall develop a process to certify mental health peer
specialists and mental health family peer specialists according to federal guidelines and
section 245I.16, subdivisions 10 to 13, for a provider entity to bill for reimbursable services.
The training and certification curriculum must teach individuals specific skills relevant to
providing peer support as appropriate for individual or family peers.
new text end
Sec. 40.
new text begin
[245I.01] PURPOSE AND CITATION.
new text end
new text begin Subdivision 1. new text end
new text begin Citation. new text end
new text begin
This chapter may be cited as the "Mental Health Uniform
Service Standards Act."
new text end
new text begin Subd. 2. new text end
new text begin Purpose. new text end
new text begin
In accordance with sections 245.461 and 245.487, to create a system
of mental health care that is unified, accountable, and comprehensive, and to promote the
recovery of Minnesotans from mental illnesses, the state's public policy is to support quality
outpatient and residential mental health services reimbursable by public and private health
insurance programs. Further, the state's public policy is to ensure the safety, rights, and
well-being of individuals served in these programs.
new text end
new text begin Subd. 3. new text end
new text begin Variances. new text end
new text begin
If the conditions in section 245A.04, subdivision 9, are met, the
commissioner may grant variances to the requirements in this chapter that do not affect a
client's health or safety.
new text end
Sec. 41.
new text begin
[245I.02] DEFINITIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Scope. new text end
new text begin
For purposes of this chapter the terms in this section have the
meanings given them.
new text end
new text begin Subd. 2. new text end
new text begin Approval. new text end
new text begin
"Approval" means the documented review of, opportunity to request
changes to, and agreement with a treatment document by a treatment supervisor or by a
client. Approval may be demonstrated by written signature, secure electronic signature, or
documented oral approval.
new text end
new text begin Subd. 3. new text end
new text begin Behavioral sciences or related fields. new text end
new text begin
"Behavioral sciences or related fields"
means an education from an accredited college or university in a field including but not
limited to social work, psychology, sociology, community counseling, family social science,
child development, child psychology, community mental health, addiction counseling,
counseling and guidance, special education, and other similar fields as approved by the
commissioner.
new text end
new text begin Subd. 4. new text end
new text begin Certified rehabilitation specialist. new text end
new text begin
"Certified rehabilitation specialist" means
a staff person qualified according to section 245I.16, subdivision 8.
new text end
new text begin Subd. 5. new text end
new text begin Child. new text end
new text begin
"Child" means a client under 18 years of age, or a client under 21 years
of age who is eligible for a service otherwise provided to persons under 18 years of age.
new text end
new text begin Subd. 6. new text end
new text begin Client. new text end
new text begin
"Client" means a person who is seeking or receiving services regulated
under this chapter. For the purpose of consent to services, this term includes a parent,
guardian, or other individual authorized to consent to services by law.
new text end
new text begin Subd. 7. new text end
new text begin Clinical trainee. new text end
new text begin
"Clinical trainee" means a staff person qualified according
to section 245I.16, subdivision 6.
new text end
new text begin Subd. 8. new text end
new text begin Clinician. new text end
new text begin
"Clinician" means a mental health professional or clinical trainee
who is performing diagnostic assessment, testing, or psychotherapy.
new text end
new text begin Subd. 9. new text end
new text begin Commissioner. new text end
new text begin
"Commissioner" means the commissioner of human services
or the commissioner's designee.
new text end
new text begin Subd. 10. new text end
new text begin Diagnostic assessment. new text end
new text begin
"Diagnostic assessment" means the evaluation and
report of a client's potential diagnoses conducted by a clinician. For a client receiving
publicly funded services, a diagnostic assessment must meet the standards of section
256B.0671, subdivisions 2 to 4.
new text end
new text begin Subd. 11. new text end
new text begin Diagnostic formulation. new text end
new text begin
"Diagnostic formulation" means a written analysis
and explanation of the information obtained from a clinical assessment to develop a
hypothesis about the cause and nature of the presenting problems and identify a framework
for developing the most suitable treatment approach.
new text end
new text begin Subd. 12. new text end
new text begin Individual treatment plan. new text end
new text begin
"Individual treatment plan" means the formulation
of planned services that are responsive to the needs and goals of a client. For a client receiving
publicly funded services, an individual treatment plan must meet the standards of section
256B.0671, subdivisions 5 and 6.
new text end
new text begin Subd. 13. new text end
new text begin Mental health behavioral aide. new text end
new text begin
"Mental health behavioral aide" means a
staff person qualified according to section 245I.16, subdivision 16.
new text end
new text begin Subd. 14. new text end
new text begin Mental health certified family peer specialist. new text end
new text begin
"Mental health certified
family peer specialist" means a staff person qualified according to section 245I.16,
subdivision 12.
new text end
new text begin Subd. 15. new text end
new text begin Mental health certified peer specialist. new text end
new text begin
"Mental health certified peer
specialist" means a staff person qualified according to section 245I.16, subdivision 10.
new text end
new text begin Subd. 16. new text end
new text begin Mental health practitioner. new text end
new text begin
"Mental health practitioner" means a staff person
qualified according to section 245I.16, subdivision 4.
new text end
new text begin Subd. 17. new text end
new text begin Mental health professional. new text end
new text begin
"Mental health professional" means a staff person
qualified according to section 245I.16, subdivision 2.
new text end
new text begin Subd. 18. new text end
new text begin Mental health rehabilitation worker. new text end
new text begin
"Mental health rehabilitation worker"
means a staff person qualified according to section 245I.16, subdivision 14.
new text end
new text begin Subd. 19. new text end
new text begin Personnel file. new text end
new text begin
"Personnel file" means the set of records under section 245I.13,
paragraph (a). Personnel files excludes information related to a person's employment not
enumerated in section 245I.13.
new text end
new text begin Subd. 20. new text end
new text begin Provider entity. new text end
new text begin
"Provider entity" means the organization, governmental unit,
corporation, or other legal body that is enrolled, certified, licensed, or otherwise authorized
by the commissioner to provide the services described in this chapter.
new text end
new text begin Subd. 21. new text end
new text begin Responsivity factors. new text end
new text begin
"Responsivity factors" means the factors other than the
diagnostic formulation that may modify an individual's treatment needs. This includes
learning style, ability, cognitive function, cultural background, and personal circumstance.
Documentation of responsivity factors includes an analysis of how an individual's strengths
may be reflected in the planned delivery of services.
new text end
new text begin Subd. 22. new text end
new text begin Risk factors. new text end
new text begin
"Risk factors" means factors that predispose a client to engage
in potentially harmful behaviors to themselves or others.
new text end
new text begin Subd. 23. new text end
new text begin Strengths. new text end
new text begin
"Strengths" means inner characteristics, virtues, external
relationships, activities, and connections to resources that contribute to resilience and core
competencies and can be built on to support recovery.
new text end
new text begin Subd. 24. new text end
new text begin Trauma. new text end
new text begin
"Trauma" means an event, series of events, or set of circumstances
that is experienced by an individual as physically or emotionally harmful or life threatening
and has lasting adverse effects on the individual's functioning and mental, physical, social,
emotional, or spiritual well-being. Trauma includes the cumulative emotional or
psychological harm of group traumatic experiences, transmitted across generations within
a community, often associated with racial and ethnic population groups in the country who
have suffered major intergenerational losses.
new text end
new text begin Subd. 25. new text end
new text begin Treatment supervision. new text end
new text begin
"Treatment supervision" means the direction and
evaluation of individual assessment, treatment planning, and service delivery for each client
when services are delivered by an individual who is not a licensed mental health professional
or certified rehabilitation specialist as provided by section 245I.18.
new text end
Sec. 42.
new text begin
[245I.10] TRAINING REQUIRED.
new text end
new text begin Subdivision 1. new text end
new text begin Training plan. new text end
new text begin
A provider entity must develop a plan to ensure that staff
persons receive orientation and ongoing training. The plan must include:
new text end
new text begin
(1) a formal process to evaluate the training needs of each staff person. An annual
performance evaluation satisfies this requirement;
new text end
new text begin
(2) a description of how the provider entity conducts annual training, including whether
annual training is based on a staff person's hire date or a specified annual cycle determined
by the program; and
new text end
new text begin
(3) a description of how the provider entity determines when a staff person needs
additional training, including the timelines in which the additional training is provided.
new text end
new text begin Subd. 2. new text end
new text begin Documentation of orientation and training. new text end
new text begin
(a) The provider entity must
provide training in accordance with the training plan and must document that orientation
and training was provided. All training programs and materials used by the provider entity
must be available for review by regulatory agencies. The documentation must include the
following:
new text end
new text begin
(1) topic covered in the training;
new text end
new text begin
(2) identification of the trainee;
new text end
new text begin
(3) name and credentials of the trainer;
new text end
new text begin
(4) method of evaluating competency upon completion of training;
new text end
new text begin
(5) date of training; and
new text end
new text begin
(6) length of training, in hours.
new text end
new text begin
(b) Documentation of a continuing education credit accepted by the governing
health-related licensing board is sufficient for purposes of this subdivision.
new text end
new text begin Subd. 3. new text end
new text begin Orientation. new text end
new text begin
(a) Before providing direct contact services, a staff person must
receive orientation on:
new text end
new text begin
(1) patient rights as identified in section 144.651;
new text end
new text begin
(2) vulnerable adult and minor maltreatment requirements in sections 245A.65,
subdivision 3; 626.556, subdivisions 2, 3, and 7; 626.557; and 626.5572;
new text end
new text begin
(3) the Minnesota Health Records Act, including confidentiality, family engagement
according to section 144.294, and client privacy;
new text end
new text begin
(4) program policies and procedures;
new text end
new text begin
(5) emergency procedures appropriate to the position, including but not limited to fires,
inclement weather, missing persons, and medical emergencies;
new text end
new text begin
(6) professional boundaries;
new text end
new text begin
(7) behavior management, crisis intervention, and stabilization techniques;
new text end
new text begin
(8) specific needs of individuals served by the program, including but not limited to
developmental status, cognitive functioning, and physical and mental abilities; and
new text end
new text begin
(9) training related to the specific activities and job functions for which the staff person
is responsible to carry out, including documentation of the delivery of services.
new text end
new text begin
(b) A staff person must receive orientation on the following topics within 90 calendar
days of a staff person first providing direct contact services:
new text end
new text begin
(1) trauma-informed care;
new text end
new text begin
(2) family- and person-centered individual treatment plans, seeking partnership with
parents and identified supports, and shared decision making and engagement;
new text end
new text begin
(3) treatment for co-occurring substance use problems, including the definitions of
co-occurring disorders, prevalence of co-occurring disorders, common signs and symptoms
of co-occurring disorders, and the etiology of co-occurring disorders;
new text end
new text begin
(4) psychotropic medications, side effects, and safe medication management;
new text end
new text begin
(5) family systems and promoting culturally appropriate support networks;
new text end
new text begin
(6) culturally responsive treatment practices;
new text end
new text begin
(7) recovery concepts and principles;
new text end
new text begin
(8) building resiliency through a strength-based approach;
new text end
new text begin
(9) person-centered planning and positive support strategies; and
new text end
new text begin
(10) other training relevant to the staff person's role and responsibilities.
new text end
new text begin
(c) A provider entity may deem a staff person to have met an orientation requirement
in paragraph (b) if the staff person has received equivalent postsecondary education in the
previous four years or training experience in the previous two years. The training plan must
describe the process and location for verification and documentation of previous training
experience.
new text end
new text begin
(d) A provider entity may deem a mental health professional to have met a requirement
of paragraph (a), clauses (6) to (9), and paragraph (b) after an evaluation of the mental health
professional's competency, including by interview.
new text end
new text begin Subd. 4. new text end
new text begin Annual training. new text end
new text begin
(a) A provider entity shall ensure that staff persons who are
not licensed mental health professionals receive 15 hours of training each year after the first
year of employment.
new text end
new text begin
(b) A licensed mental health professional must follow specific training requirements as
determined by the professional's governing health-related licensing board.
new text end
new text begin
(c) All staff persons, including licensed mental health professionals, must receive annual
training on the topics in subdivision 3, paragraph (a), clauses (2) and (5).
new text end
new text begin
(d) The selection of additional training topics must be based on program needs and staff
persons' competency.
new text end
new text begin Subd. 5. new text end
new text begin Training for services provided to children. new text end
new text begin
(a) Training and orientation
required under this section for a staff person working with children must be aligned to the
developmental characteristics of the children served in the program and address the needs
of children in the context of the family, support system, and culture. This includes orientation
under subdivision 3 on the following topics: (1) child development; (2) working with children
and children's support systems; (3) adverse childhood experiences, cognitive functioning,
and physical and mental abilities; and (4) understanding family perspective.
new text end
new text begin
(b) For a mental health behavioral aide, orientation in the first 90 days of service must
include a parent team training utilizing a curriculum approved by the commissioner.
new text end
Sec. 43.
new text begin
[245I.13] PERSONNEL FILES.
new text end
new text begin
(a) For each staff person, a provider entity shall maintain a personnel file that includes:
new text end
new text begin
(1) verification of the staff person's qualifications including training, education, and
licensure;
new text end
new text begin
(2) documentation related to the staff person's background study;
new text end
new text begin
(3) the date of hire;
new text end
new text begin
(4) the effective date of specific duties and responsibilities including the date that the
staff person begins direct contact with a client;
new text end
new text begin
(5) documentation of orientation;
new text end
new text begin
(6) records of training, license renewal, and educational activities completed during the
staff person's employment;
new text end
new text begin
(7) annual job performance evaluations; and
new text end
new text begin
(8) records of clinical supervision, if applicable.
new text end
new text begin
(b) Personnel files must be made accessible to the commissioner upon request. Personnel
files must be readily accessible for review but need not be kept in a single location.
new text end
Sec. 44.
new text begin
[245I.16] PROVIDER QUALIFICATIONS AND SCOPE OF PRACTICE.
new text end
new text begin Subdivision 1. new text end
new text begin Tribal providers. new text end
new text begin
For purposes of this section, a tribal entity may
credential an individual under section 256B.02, subdivision 7, paragraphs (b) and (c).
new text end
new text begin Subd. 2. new text end
new text begin Mental health professional qualifications. new text end
new text begin
The following individuals may
provide services as a mental health professional:
new text end
new text begin
(1) a registered nurse who is licensed under sections 148.171 to 148.285 and is certified
as a (i) clinical nurse specialist in child or adolescent, family, or adult psychiatric and mental
health nursing by a national certification organization, or (ii) nurse practitioner in adult or
family psychiatric and mental health nursing by a national nurse certification organization;
new text end
new text begin
(2) a licensed independent clinical social worker as defined in section 148E.050,
subdivision 5;
new text end
new text begin
(3) a psychologist licensed by the Board of Psychology under sections 148.88 to 148.98;
new text end
new text begin
(4) a physician licensed under chapter 147 if the physician is: (i) certified by the American
Board of Psychiatry and Neurology; (ii) certified by the American Osteopathic Board of
Neurology and Psychiatry; or (iii) eligible for board certification in psychiatry;
new text end
new text begin
(5) a marriage and family therapist licensed under sections 148B.29 to 148B.39; or
new text end
new text begin
(6) a licensed professional clinical counselor licensed under section 148B.5301.
new text end
new text begin Subd. 3. new text end
new text begin Mental health professional scope of practice. new text end
new text begin
A mental health professional
shall maintain a valid license with the mental health professional's governing health-related
licensing board and shall only provide services within the scope of practice as determined
by the health-related licensing board.
new text end
new text begin Subd. 4. new text end
new text begin Mental health practitioner qualifications. new text end
new text begin
(a) An individual who is qualified
in at least one of the ways described in paragraphs (b) to (d) may serve as a mental health
practitioner.
new text end
new text begin
(b) An individual is qualified through relevant coursework if the individual completes
at least 30 semester hours or 45 quarter hours in behavioral sciences or related fields and:
new text end
new text begin
(1) has at least 2,000 hours of supervised experience in the delivery of services to adults
or children with: (i) mental illness, substance use disorder, or emotional disturbance; or (ii)
traumatic brain injury or developmental disabilities and completes training on mental illness,
recovery from mental illness, mental health de-escalation techniques, co-occurring mental
illness and substance use disorder, and psychotropic medications and side effects;
new text end
new text begin
(2) is fluent in the non-English language of the ethnic group to which at least 50 percent
of the individual's clients belong, completes 40 hours of training in the delivery of services
to adults with mental illness or children with emotional disturbance, and receives treatment
supervision from a mental health professional at least once per week until the requirement
of 2,000 hours of supervised experience is met;
new text end
new text begin
(3) is working in a day treatment program under section 245.4712, subdivision 2; or
new text end
new text begin
(4) has completed a practicum or internship that (i) requires direct interaction with adults
or children served, and (ii) is focused on behavioral sciences or related fields.
new text end
new text begin
(c) An individual is qualified through work experience if the individual:
new text end
new text begin
(1) has at least 4,000 hours of supervised experience in the delivery of services to adults
or children with: (i) mental illness, substance use disorder, or emotional disturbance; or (ii)
traumatic brain injury or developmental disabilities and completes training on mental illness,
recovery from mental illness, mental health de-escalation techniques, co-occurring mental
illness and substance use disorder, and psychotropic medications and side effects; or
new text end
new text begin
(2) has at least 2,000 hours of supervised experience in the delivery of services to adults
or children with: (i) mental illness, emotional disturbance, or substance use disorder, and
receives treatment supervision as required by applicable statutes and rules from a mental
health professional at least once per week until the requirement of 4,000 hours of supervised
experience is met; or (ii) traumatic brain injury or developmental disabilities, completes
training on mental illness, recovery from mental illness, mental health de-escalation
techniques, co-occurring mental illness and substance use disorder, and psychotropic
medications and side effects, and receives treatment supervision as required by applicable
statutes and rules at least once per week from a mental health professional until the
requirement of 4,000 hours of supervised experience is met.
new text end
new text begin
(d) An individual is qualified by a bachelor's or master's degree if the individual: (1)
holds a master's or other graduate degree in behavioral sciences or related fields; or (2)
holds a bachelor's degree in behavioral sciences or related fields and completes a practicum
or internship that (i) requires direct interaction with adults or children served, and (ii) is
focused on behavioral sciences or related fields.
new text end
new text begin Subd. 5. new text end
new text begin Mental health practitioner scope of practice. new text end
new text begin
(a) A mental health practitioner
must perform services under the treatment supervision of a mental health professional.
new text end
new text begin
(b) A mental health practitioner may perform client education, functional assessments
for adult clients, level of care assessments, rehabilitative interventions, and skills building;
provide direction to a mental health rehabilitation worker or mental health behavioral aide;
and propose individual treatment plans.
new text end
new text begin
(c) A mental health practitioner who provides services according to section 256B.0624
or 256B.0944 may perform crisis assessment and intervention.
new text end
new text begin Subd. 6. new text end
new text begin Clinical trainee qualifications. new text end
new text begin
(a) A clinical trainee is a staff person who is
enrolled in or has completed an accredited graduate program of study intended to prepare
the individual for independent licensure as a mental health professional and who: (1)
participates in a practicum or internship supervised by a mental health professional; or (2)
is completing postgraduate hours, according to the requirements of a health-related licensing
board.
new text end
new text begin
(b) A clinical trainee is responsible for notifying and applying to a health-related licensing
board to ensure the requirements of the health-related licensing board are met. As permitted
by a health-related licensing board, treatment supervision under this chapter may be integrated
into a plan to meet the supervisory requirements of the health-related licensing board but
does not supersede those requirements.
new text end
new text begin Subd. 7. new text end
new text begin Clinical trainee scope of practice. new text end
new text begin
(a) A clinical trainee, under treatment
supervision of a mental health professional, may perform psychotherapy, diagnostic
assessments, and services that a mental health practitioner may deliver. A clinical trainee
shall not provide treatment supervision. A clinical trainee may provide direction to a mental
health behavioral aide or mental health rehabilitation worker.
new text end
new text begin
(b) A psychological clinical trainee under the treatment supervision of a psychologist
may perform psychological testing.
new text end
new text begin
(c) A clinical trainee shall not deliver services in violation of the practice act of a
health-related licensing board, including failure to obtain licensure, if required.
new text end
new text begin Subd. 8. new text end
new text begin Certified rehabilitation specialist qualifications. new text end
new text begin
A certified rehabilitation
specialist shall have:
new text end
new text begin
(1) a master's degree from an accredited college or university in behavioral sciences or
related fields as defined in section 245I.02, subdivision 3;
new text end
new text begin
(2) at least 4,000 hours of postmaster's supervised experience in the delivery of mental
health services; and
new text end
new text begin
(3) a valid national certification as a certified rehabilitation counselor or certified
psychosocial rehabilitation practitioner.
new text end
new text begin Subd. 9. new text end
new text begin Certified rehabilitation specialist scope of practice. new text end
new text begin
A certified rehabilitation
specialist shall provide services based on a client's diagnostic assessment. A certified
rehabilitation specialist may provide supervision for mental health certified peer specialists,
mental health practitioners, and mental health rehabilitation workers, but is prohibited from
performing a diagnostic assessment.
new text end
new text begin Subd. 10. new text end
new text begin Mental health certified peer specialist qualifications. new text end
new text begin
A mental health
certified peer specialist shall:
new text end
new text begin
(1) be 21 years of age or older;
new text end
new text begin
(2) have been diagnosed with a mental illness;
new text end
new text begin
(3) be a current or former mental health services client; and
new text end
new text begin
(4) have a valid certification as a mental health certified peer specialist according to
section 245.696, subdivision 3.
new text end
new text begin Subd. 11. new text end
new text begin Mental health certified peer specialist scope of practice. new text end
new text begin
A mental health
certified peer specialist shall:
new text end
new text begin
(1) provide peer support that is individualized to the client;
new text end
new text begin
(2) promote recovery goals, self-sufficiency, self-advocacy, and the development of
natural supports; and
new text end
new text begin
(3) support the maintenance of skills learned in other services.
new text end
new text begin Subd. 12. new text end
new text begin Mental health certified family peer specialist qualifications. new text end
new text begin
A mental
health certified family peer specialist shall:
new text end
new text begin
(1) be 21 years of age or older;
new text end
new text begin
(2) have raised or be currently raising a child with a mental illness;
new text end
new text begin
(3) have experience navigating the children's mental health system; and
new text end
new text begin
(4) have a valid certification as a mental health certified family peer specialist according
to section 245.696, subdivision 3.
new text end
new text begin Subd. 13. new text end
new text begin Mental health certified family peer specialist scope of practice. new text end
new text begin
A mental
health certified family peer specialist shall provide services to increase the child's ability to
function better within the child's home, school, and community. The mental health certified
family peer specialist shall:
new text end
new text begin
(1) provide family peer support, to build on strengths of families and help families
achieve desired outcomes;
new text end
new text begin
(2) provide nonadversarial advocacy that encourages partnership and promotes positive
change and growth;
new text end
new text begin
(3) support families to advocate for culturally appropriate services for a child in each
treatment setting;
new text end
new text begin
(4) promote resiliency, self-advocacy, and development of natural supports;
new text end
new text begin
(5) support the maintenance of skills learned in other services;
new text end
new text begin
(6) establish and lead parent support groups;
new text end
new text begin
(7) assist parents to develop coping and problem-solving skills; and
new text end
new text begin
(8) educate parents about mental illnesses and community resources, including resources
that connect parents with similar experiences.
new text end
new text begin Subd. 14. new text end
new text begin Mental health rehabilitation worker qualifications. new text end
new text begin
(a) A mental health
rehabilitation worker shall (1) be 21 years of age or older; (2) have a high school diploma
or equivalent; and (3) meet the qualification requirements in paragraph (b).
new text end
new text begin
(b) In addition to the requirements of paragraph (a), a mental health rehabilitation worker
shall also:
new text end
new text begin
(1) be fluent in the non-English language or competent in the culture of the ethnic group
to which at least 20 percent of the mental health rehabilitation worker's clients belong;
new text end
new text begin
(2) have an associate of arts degree;
new text end
new text begin
(3) have two years of full-time postsecondary education or a total of 15 semester hours
or 23 quarter hours in behavioral sciences or related fields;
new text end
new text begin
(4) be a registered nurse;
new text end
new text begin
(5) have within the previous ten years three years of personal life experience with mental
illness;
new text end
new text begin
(6) have within the previous ten years three years of life experience as a primary caregiver
to an adult with a mental illness, traumatic brain injury, substance use disorder, or
developmental disability; or
new text end
new text begin
(7) have within the previous ten years 2,000 hours of supervised work experience in
delivering mental health services to adults with a mental illness, traumatic brain injury,
substance use disorder, or developmental disability.
new text end
new text begin
(c) If the mental health rehabilitation worker provides crisis residential services, intensive
residential treatment services, partial hospitalization, or day treatment services, the mental
health rehabilitation worker shall: (1) satisfy paragraph (b), clause (1); and (2) have 40 hours
of additional continuing education on mental health topics during the first year of
employment.
new text end
new text begin Subd. 15. new text end
new text begin Mental health rehabilitation worker scope of practice. new text end
new text begin
(a) A mental health
rehabilitation worker under supervision of a mental health practitioner or mental health
professional may provide rehabilitative mental health services identified in the client's
individual treatment plan and individual behavior plan.
new text end
new text begin
(b) A mental health rehabilitation worker who solely acts and is scheduled as overnight
staff is exempt from the additional qualification requirements in subdivision 14, paragraphs
(a), clause (3), and (b).
new text end
new text begin Subd. 16. new text end
new text begin Mental health behavioral aide qualifications. new text end
new text begin
(a) A level 1 mental health
behavioral aide shall:
new text end
new text begin
(1) be 18 years of age or older; and
new text end
new text begin
(2) have a high school diploma or commissioner of education-selected high school
equivalency certification; or two years of experience as a primary caregiver to a child with
severe emotional disturbance within the previous ten years.
new text end
new text begin
(b) A level 2 mental health behavioral aide shall:
new text end
new text begin
(1) be 18 years of age or older; and
new text end
new text begin
(2) have an associate or bachelor's degree or be certified by a program under section
256B.0943, subdivision 8a.
new text end
new text begin Subd. 17. new text end
new text begin Mental health behavioral aide scope of practice. new text end
new text begin
The mental health
behavioral aide under supervision of a mental health professional may provide rehabilitative
mental health services identified in the client's individual treatment plan and individual
behavior plan.
new text end
Sec. 45.
new text begin
[245I.18] TREATMENT SUPERVISION.
new text end
new text begin Subdivision 1. new text end
new text begin Generally. new text end
new text begin
(a) A provider entity shall ensure that a mental health
professional provides treatment supervision for each staff person who provides services to
a client and who is not a mental health professional or certified rehabilitation specialist.
Treatment supervision shall be based on a staff person's written treatment supervision plan.
new text end
new text begin
(b) Treatment supervision must focus on the client's treatment needs and the ability of
the staff person receiving treatment supervision to provide services, including:
new text end
new text begin
(1) review and evaluation of the interventions delivered;
new text end
new text begin
(2) instruction on alternative strategies if a client is not achieving treatment goals;
new text end
new text begin
(3) review and evaluation of assessments, treatment plans, and progress notes for accuracy
and appropriateness;
new text end
new text begin
(4) approval of diagnostic assessments and individual treatment plans within five business
days of initial completion by the supervisee;
new text end
new text begin
(5) instruction on the cultural norms or values of the clients and communities served by
the provider entity and any impact on treatment;
new text end
new text begin
(6) evaluation of and feedback on the competencies of direct service staff persons; and
new text end
new text begin
(7) coaching, teaching, and practicing skills with staff persons.
new text end
new text begin
(c) A treatment supervisor's responsibility for a supervisee is limited to services provided
by the associated provider entity. If a supervisee is employed by multiple provider entities,
each entity is responsible for furnishing the necessary treatment supervision.
new text end
new text begin Subd. 2. new text end
new text begin Permitted modalities. new text end
new text begin
(a) Treatment supervision must be conducted face-to-face,
including telemedicine, according to the Minnesota Telemedicine Act, sections 62A.67 to
62A.672.
new text end
new text begin
(b) Treatment supervision may be conducted using individual, small group, or team
modalities. "Individual supervision" means one or more mental health professionals and
one staff person receiving treatment supervision. "Small group supervision" means one or
more mental health professionals and two to six staff persons receiving treatment supervision.
"Team supervision" is defined by the service lines for which it may be used.
new text end
new text begin Subd. 3. new text end
new text begin Treatment supervision planning. new text end
new text begin
(a) A written treatment supervision plan
shall be developed by a mental health professional who is qualified to provide treatment
supervision and the staff person receiving the treatment supervision. The treatment
supervision plan must be completed and implemented within 30 days of a new staff person's
employment. The treatment supervision plan must be reviewed and updated at least annually.
new text end
new text begin
(b) The treatment supervision plan must include:
new text end
new text begin
(1) the name and qualifications of the staff person receiving treatment supervision;
new text end
new text begin
(2) the name of the provider entity under which the staff person is receiving treatment
supervision;
new text end
new text begin
(3) the name and licensure of a mental health professional providing treatment
supervision;
new text end
new text begin
(4) the number of hours of individual and group supervision the staff person receiving
treatment supervision must complete and the location of the record if the record is kept
outside of an individual personnel file;
new text end
new text begin
(5) procedures that the staff person receiving treatment supervision shall use to respond
to client emergencies; and
new text end
new text begin
(6) the authorized scope of practice for the staff person receiving treatment supervision,
including a description of responsibilities with the provider entity, a description of client
population, and treatment methods and modalities.
new text end
new text begin Subd. 4. new text end
new text begin Treatment supervision record. new text end
new text begin
(a) A provider entity shall ensure treatment
supervision is documented in each staff person's treatment supervision record.
new text end
new text begin
(b) The treatment supervision record must include:
new text end
new text begin
(1) the date and duration of the supervision;
new text end
new text begin
(2) identification of the supervision type as individual, small group, or team supervision;
new text end
new text begin
(3) the name of the mental health professional providing treatment supervision;
new text end
new text begin
(4) subsequent actions that the staff person receiving treatment supervision shall take;
and
new text end
new text begin
(5) the date and signature of the mental health professional providing treatment
supervision.
new text end
new text begin Subd. 5. new text end
new text begin
Supervision and direct observation of mental health rehabilitation workers
and behavioral aides.
new text end
new text begin
(a) A mental health practitioner, clinical trainee, or mental health
professional shall directly observe a mental health behavioral aide or a mental health
rehabilitation worker while the mental health behavioral aide or mental health rehabilitation
worker provides services to clients. The amount of direct observation shall be no less than
twice per month for the first six months and once per month thereafter. The staff performing
the observation shall approve the progress note for the service observed.
new text end
new text begin
(b) For a rehabilitation worker qualified under section 245I.16, subdivision 14, paragraph
(b), clause (1), the treatment supervision in the first 2,000 hours of work shall be no less
than:
new text end
new text begin
(1) monthly individual treatment supervision; and
new text end
new text begin
(2) twice per month direct observation.
new text end
Sec. 46.
new text begin
[245I.32] CLIENT FILES.
new text end
new text begin Subdivision 1. new text end
new text begin Generally. new text end
new text begin
A provider entity must maintain a file of current and accurate
client records on the premises where the service is provided or coordinated. Each entry in
the record must be signed and dated by the staff person making the entry.
new text end
new text begin Subd. 2. new text end
new text begin Record retention. new text end
new text begin
A provider entity must retain client records of a discharged
client for a minimum of seven years from the date of discharge. A provider entity that ceases
to provide treatment service must retain client records for a minimum of seven years from
the date the provider entity stopped providing the service and must notify the commissioner
of the location of the client records and the name of the individual responsible for maintaining
the client records.
new text end
new text begin Subd. 3. new text end
new text begin Contents. new text end
new text begin
Client files must contain the following, as applicable:
new text end
new text begin
(1) diagnostic assessments;
new text end
new text begin
(2) functional assessments;
new text end
new text begin
(3) individual treatment plans;
new text end
new text begin
(4) individual abuse prevention plans;
new text end
new text begin
(5) crisis plans;
new text end
new text begin
(6) documentation of releases of information;
new text end
new text begin
(7) emergency contacts for the client;
new text end
new text begin
(8) documentation of the date of service; signature of the person providing the service;
nature, extent, and units of service; and place of service delivery;
new text end
new text begin
(9) record of all medication prescribed or administered by staff;
new text end
new text begin
(10) documentation of any contact made with the client's other mental health providers,
case manager, family members, primary caregiver, or legal representative or the reason the
provider did not contact the client's family members or primary caregiver;
new text end
new text begin
(11) documentation of any contact made with other persons interested in the client,
including representatives of the courts, corrections systems, or schools;
new text end
new text begin
(12) written information by the client that the client requests be included in the file;
new text end
new text begin
(13) health care directive; and
new text end
new text begin
(14) the date and reason the provider entity's services are discontinued.
new text end
Sec. 47.
new text begin
[245I.33] DOCUMENTATION STANDARDS.
new text end
new text begin Subdivision 1. new text end
new text begin Generally. new text end
new text begin
As a condition of payment, a provider entity must ensure that
documentation complies with this section and Minnesota Rules, parts 9505.2175 and
9505.2197. The department must recover medical assistance payments for a service not
documented in a client file according to this section.
new text end
new text begin Subd. 2. new text end
new text begin Documentation standards. new text end
new text begin
A provider entity must ensure that all documentation
required under this chapter:
new text end
new text begin
(1) is typed or legible, if handwritten;
new text end
new text begin
(2) identifies the client or staff person on each page, as applicable;
new text end
new text begin
(3) is signed and dated by the staff person who completes the documentation, including
the staff person's credentials; and
new text end
new text begin
(4) is cosigned and dated by the staff person providing treatment supervision as required
under this chapter, including the staff person's credentials.
new text end
new text begin Subd. 3. new text end
new text begin Progress notes. new text end
new text begin
A provider entity shall use a progress note to promptly document
each occurrence of a mental health service provided to a client. A progress note must include
the following:
new text end
new text begin
(1) the type of service;
new text end
new text begin
(2) the date of service, including the start and stop time;
new text end
new text begin
(3) the location of service;
new text end
new text begin
(4) the scope of service, including: (i) the goal and objective targeted; (ii) the intervention
delivered and the methods used; (iii) the client's response or reaction to intervention; (iv)
the plan for the next session; and (v) the service modality;
new text end
new text begin
(5) the signature and the printed name and credentials of the staff person who provided
the service;
new text end
new text begin
(6) the mental health provider travel documentation requirements under section
256B.0625, if applicable; and
new text end
new text begin
(7) other significant observations, including
new text end
new text begin
(i) current risk factors the client may be
experiencing;
new text end
new text begin
(ii) emergency interventions;
new text end
new text begin
(iii) consultations with or referrals to other
professionals, family, or significant others;
new text end
new text begin
(iv) a summary of the effectiveness of treatment,
prognosis, or discharge planning;
new text end
new text begin
(v) test results and medications; or
new text end
new text begin
(vi) changes in mental
or physical symptoms.
new text end
Sec. 48.
Minnesota Statutes 2018, section 254B.05, subdivision 5, is amended to read:
Subd. 5.
Rate requirements.
(a) The commissioner shall establish rates for substance
use disorder services and service enhancements funded under this chapter.
(b) Eligible substance use disorder treatment services include:
(1) outpatient treatment services that are licensed according to sections 245G.01 to
245G.17, or applicable tribal license;
(2) on July 1, 2018, or upon federal approval, whichever is later, comprehensive
assessments provided according to sections 245.4863, paragraph (a), and 245G.05deleted text begin , and
Minnesota Rules, part 9530.6422deleted text end ;
(3) on July 1, 2018, or upon federal approval, whichever is later, care coordination
services provided according to section 245G.07, subdivision 1, paragraph (a), clause (6);
(4) on July 1, 2018, or upon federal approval, whichever is later, peer recovery support
services provided according to section 245G.07, subdivision 1, paragraph (a), clause (5);
(5) on July 1, 2019, or upon federal approval, whichever is later, withdrawal management
services provided according to chapter 245F;
(6) medication-assisted therapy services that are licensed according to sections 245G.01
to 245G.17 and 245G.22, or applicable tribal license;
(7) medication-assisted therapy plus enhanced treatment services that meet the
requirements of clause (6) and provide nine hours of clinical services each week;
(8) high, medium, and low intensity residential treatment services that are licensed
according to sections 245G.01 to 245G.17 and 245G.21 or applicable tribal license which
provide, respectively, 30, 15, and five hours of clinical services each week;
(9) hospital-based treatment services that are licensed according to sections 245G.01 to
245G.17 or applicable tribal license and licensed as a hospital under sections 144.50 to
144.56;
(10) adolescent treatment programs that are licensed as outpatient treatment programs
according to sections 245G.01 to 245G.18 or as residential treatment programs according
to Minnesota Rules, parts 2960.0010 to 2960.0220, and 2960.0430 to 2960.0490, or
applicable tribal license;
(11) high-intensity residential treatment services that are licensed according to sections
245G.01 to 245G.17 and 245G.21 or applicable tribal license, which provide 30 hours of
clinical services each week provided by a state-operated vendor or to clients who have been
civilly committed to the commissioner, present the most complex and difficult care needs,
and are a potential threat to the community; and
(12) room and board facilities that meet the requirements of subdivision 1a.
(c) The commissioner shall establish higher rates for programs that meet the requirements
of paragraph (b) and one of the following additional requirements:
(1) programs that serve parents with their children if the program:
(i) provides on-site child care during the hours of treatment activity that:
(A) is licensed under chapter 245A as a child care center under Minnesota Rules, chapter
9503; or
(B) meets the licensure exclusion criteria of section 245A.03, subdivision 2, paragraph
(a), clause (6), and meets the requirements under section 245G.19, subdivision 4; or
(ii) arranges for off-site child care during hours of treatment activity at a facility that is
licensed under chapter 245A as:
(A) a child care center under Minnesota Rules, chapter 9503; or
(B) a family child care home under Minnesota Rules, chapter 9502;
(2) culturally specific programs as defined in section 254B.01, subdivision 4a, or
programs or subprograms serving special populations, if the program or subprogram meets
the following requirements:
(i) is designed to address the unique needs of individuals who share a common language,
racial, ethnic, or social background;
(ii) is governed with significant input from individuals of that specific background; and
(iii) employs individuals to provide individual or group therapy, at least 50 percent of
whom are of that specific background, except when the common social background of the
individuals served is a traumatic brain injury or cognitive disability and the program employs
treatment staff who have the necessary professional training, as approved by the
commissioner, to serve clients with the specific disabilities that the program is designed to
serve;
(3) programs that offer medical services delivered by appropriately credentialed health
care staff in an amount equal to two hours per client per week if the medical needs of the
client and the nature and provision of any medical services provided are documented in the
client file; and
(4) programs that offer services to individuals with co-occurring mental health and
chemical dependency problems if:
(i) the program meets the co-occurring requirements in section 245G.20;
(ii) 25 percent of the counseling staff are licensed mental health professionalsdeleted text begin , as defineddeleted text end
deleted text begin in section deleted text end deleted text begin 245.462, subdivision 18deleted text end deleted text begin , clauses (1) to (6),deleted text end new text begin qualified according to section 245I.16,
subdivision 2,new text end or are students or licensing candidates under the supervision of a licensed
alcohol and drug counselor supervisor and licensed mental health professional, except that
no more than 50 percent of the mental health staff may be students or licensing candidates
with time documented to be directly related to provisions of co-occurring services;
(iii) clients scoring positive on a standardized mental health screen receive a mental
health diagnostic assessment within ten days of admission;
(iv) the program has standards for multidisciplinary case review that include a monthly
review for each client that, at a minimum, includes a licensed mental health professional
and licensed alcohol and drug counselor, and their involvement in the review is documented;
(v) family education is offered that addresses mental health and substance abuse disorders
and the interaction between the two; and
(vi) co-occurring counseling staff shall receive eight hours of co-occurring disorder
training annually.
(d) In order to be eligible for a higher rate under paragraph (c), clause (1), a program
that provides arrangements for off-site child care must maintain current documentation at
the chemical dependency facility of the child care provider's current licensure to provide
child care services. Programs that provide child care according to paragraph (c), clause (1),
must be deemed in compliance with the licensing requirements in section 245G.19.
(e) Adolescent residential programs that meet the requirements of Minnesota Rules,
parts 2960.0430 to 2960.0490 and 2960.0580 to 2960.0690, are exempt from the requirements
in paragraph (c), clause (4), items (i) to (iv).
(f) Subject to federal approval, chemical dependency services that are otherwise covered
as direct face-to-face services may be provided via two-way interactive video. The use of
two-way interactive video must be medically appropriate to the condition and needs of the
person being served. Reimbursement shall be at the same rates and under the same conditions
that would otherwise apply to direct face-to-face services. The interactive video equipment
and connection must comply with Medicare standards in effect at the time the service is
provided.
Sec. 49.
Minnesota Statutes 2018, section 256B.0615, subdivision 1, is amended to read:
Subdivision 1.
Scope.
Medical assistance covers mental health certified peer specialist
servicesdeleted text begin , as established in subdivision 2, subject to federal approval, if provided to recipients
who are eligible for services under sections 256B.0622, 256B.0623, and 256B.0624 and
aredeleted text end provided by a certified peer specialist who deleted text begin has completed the training under subdivision
5deleted text end new text begin is qualified according to section 245I.16, subdivision 10new text end .
Sec. 50.
Minnesota Statutes 2018, section 256B.0616, subdivision 1, is amended to read:
Subdivision 1.
Scope.
Medical assistance covers mental health certified family peer
specialists servicesdeleted text begin , as established in subdivision 2, subject to federal approval, if provided
to recipients who have an emotional disturbance or severe emotional disturbance under
chapter 245,deleted text end and are provided by a certified family peer specialist who deleted text begin has completed the
training under subdivision 5deleted text end new text begin is qualified according to section 245I.16, subdivision 12new text end . A
family peer specialist cannot provide services to the peer specialist's family.
Sec. 51.
Minnesota Statutes 2018, section 256B.0616, subdivision 3, is amended to read:
Subd. 3.
Eligibility.
Family peer support services may be deleted text begin located indeleted text end new text begin provided to recipients
ofnew text end inpatient hospitalization, partial hospitalization, residential treatment,new text begin intensivenew text end treatmentnew text begin
innew text end foster care, day treatment, children's therapeutic services and supports, or crisis services.
Sec. 52.
Minnesota Statutes 2018, section 256B.0622, subdivision 1, is amended to read:
Subdivision 1.
Scope.
deleted text begin Subject to federal approval,deleted text end Medical assistance covers medically
necessary, assertive community treatment for clients as defined in subdivision 2a and
intensive residential treatment services for clients as defined in subdivision 3, when the
services are provided by an entity meeting the standards in this section.
Sec. 53.
Minnesota Statutes 2018, section 256B.0622, subdivision 2, is amended to read:
Subd. 2.
Definitions.
(a) For purposes of this section, the following terms have the
meanings given them.
(b) "ACT team" means the group of interdisciplinary mental health staff who work as
a team to provide assertive community treatment.
(c) "Assertive community treatment" means intensive nonresidential treatment and
rehabilitative mental health services provided according to the assertive community treatment
model. Assertive community treatment provides a single, fixed point of responsibility for
treatment, rehabilitation, and support needs for clients. Services are offered 24 hours per
day, seven days per week, in a community-based setting.
deleted text begin
(d) "Individual treatment plan" means the document that results from a person-centered
planning process of determining real-life outcomes with clients and developing strategies
to achieve those outcomes.
deleted text end
deleted text begin
(e) "Assertive engagement" means the use of collaborative strategies to engage clients
to receive services.
deleted text end
deleted text begin
(f) "Benefits and finance support" means assisting clients in capably managing financial
affairs. Services include, but are not limited to, assisting clients in applying for benefits;
assisting with redetermination of benefits; providing financial crisis management; teaching
and supporting budgeting skills and asset development; and coordinating with a client's
representative payee, if applicable.
deleted text end
new text begin
(d) "Clinical trainee" means a staff person qualified according to section 245I.16,
subdivision 6.
new text end
deleted text begin (g)deleted text end new text begin (e)new text end "Co-occurring disorder treatment" means the treatment of co-occurring mental
illness and substance use disorders and is characterized by assertive outreach, stage-wise
comprehensive treatment, treatment goal setting, and flexibility to work within each stage
of treatment. Services include, but are not limited to, assessing and tracking clients' stages
of change readiness and treatment; applying the appropriate treatment based on stages of
change, such as outreach and motivational interviewing techniques to work with clients in
earlier stages of change readiness and cognitive behavioral approaches and relapse prevention
to work with clients in later stages of change; and facilitating access to community supports.
deleted text begin (h)deleted text end new text begin (f)new text end "Crisis assessment and intervention" means mental health crisis response services
as defined in section 256B.0624, subdivision 2, paragraphs (c) to (e).
deleted text begin
(i) "Employment services" means assisting clients to work at jobs of their choosing.
Services must follow the principles of the individual placement and support (IPS)
employment model, including focusing on competitive employment; emphasizing individual
client preferences and strengths; ensuring employment services are integrated with mental
health services; conducting rapid job searches and systematic job development according
to client preferences and choices; providing benefits counseling; and offering all services
in an individualized and time-unlimited manner. Services shall also include educating clients
about opportunities and benefits of work and school and assisting the client in learning job
skills, navigating the work place, and managing work relationships.
deleted text end
deleted text begin
(j) "Family psychoeducation and support" means services provided to the client's family
and other natural supports to restore and strengthen the client's unique social and family
relationships. Services include, but are not limited to, individualized psychoeducation about
the client's illness and the role of the family and other significant people in the therapeutic
process; family intervention to restore contact, resolve conflict, and maintain relationships
with family and other significant people in the client's life; ongoing communication and
collaboration between the ACT team and the family; introduction and referral to family
self-help programs and advocacy organizations that promote recovery and family
engagement, individual supportive counseling, parenting training, and service coordination
to help clients fulfill parenting responsibilities; coordinating services for the child and
restoring relationships with children who are not in the client's custody; and coordinating
with child welfare and family agencies, if applicable. These services must be provided with
the client's agreement and consent.
deleted text end
deleted text begin
(k) "Housing access support" means assisting clients to find, obtain, retain, and move
to safe and adequate housing of their choice. Housing access support includes, but is not
limited to, locating housing options with a focus on integrated independent settings; applying
for housing subsidies, programs, or resources; assisting the client in developing relationships
with local landlords; providing tenancy support and advocacy for the individual's tenancy
rights at the client's home; and assisting with relocation.
deleted text end
new text begin
(g) "Individual treatment plan" means a plan described under section 256B.0671,
subdivisions 5 and 6.
new text end
deleted text begin (l)deleted text end new text begin (h)new text end "Individual treatment team" means a minimum of three members of the ACT
team who are responsible for consistently carrying out most of a client's assertive community
treatment services.
deleted text begin (m)deleted text end new text begin (i)new text end "Intensive residential treatment services treatment team" means all staff who
provide intensive residential treatment services under this section to clients. deleted text begin At a minimum,
this includes the clinical supervisor; mental health professionals as defined in section 245.462,
subdivision 18, clauses (1) to (6); mental health practitioners as defined in section 245.462,
subdivision 17; mental health rehabilitation workers under section 256B.0623, subdivision
5, paragraph (a), clause (4); and mental health certified peer specialists under section
256B.0615.
deleted text end
deleted text begin (n)deleted text end new text begin (j)new text end "Intensive residential treatment services" means short-term, time-limited services
provided in a residential setting to clients who are in need of more restrictive settings and
are at risk of significant functional deterioration if they do not receive these services. Services
are designed to develop and enhance psychiatric stability, personal and emotional adjustment,
self-sufficiency, and skills to live in a more independent setting. Services must be directed
toward a targeted discharge date with specified client outcomes.
deleted text begin
(o) "Medication assistance and support" means assisting clients in accessing medication,
developing the ability to take medications with greater independence, and providing
medication setup. This includes the prescription, administration, and order of medication
by appropriate medical staff.
deleted text end
deleted text begin
(p) "Medication education" means educating clients on the role and effects of medications
in treating symptoms of mental illness and the side effects of medications.
deleted text end
new text begin
(k) "Mental health certified peer specialist" means a staff person qualified according to
section 245I.16, subdivision 10.
new text end
new text begin
(l) "Mental health practitioner" means a staff person qualified according to section
245I.16, subdivision 4.
new text end
new text begin
(m) "Mental health professional" means a staff person qualified according to section
245I.16, subdivision 2.
new text end
new text begin
(n) "Mental health rehabilitation worker" means a staff person qualified according to
section 245I.16, subdivision 14.
new text end
deleted text begin (q)deleted text end new text begin (o)new text end "Overnight staff" means a member of the intensive residential treatment services
team who is responsible during hours when clients are typically asleep.
deleted text begin
(r) "Mental health certified peer specialist services" has the meaning given in section
256B.0615.
deleted text end
deleted text begin (s)deleted text end new text begin (p)new text end "Physical health services" means any service or treatment to meet the physical
health needs of the client to support the client's mental health recovery. Services include,
but are not limited to, education on primary health issues, including wellness education;
medication administration and monitoring; providing and coordinating medical screening
and follow-up; scheduling routine and acute medical and dental care visits; tobacco cessation
strategies; assisting clients in attending appointments; communicating with other providers;
and integrating all physical and mental health treatment.
deleted text begin (t)deleted text end new text begin (q)new text end "Primary team member" means the person who leads and coordinates the activities
of the individual treatment team and is the individual treatment team member who has
primary responsibility for establishing and maintaining a therapeutic relationship with the
client on a continuing basis.
deleted text begin (u)deleted text end new text begin (r)new text end "Rehabilitative mental health services" means mental health services that are
rehabilitative and enable the client to develop and enhance psychiatric stability, social
competencies, personal and emotional adjustment, independent living, parenting skills, and
community skills, when these abilities are impaired by the symptoms of mental illness.
deleted text begin (v)deleted text end new text begin (s)new text end "Symptom management" means supporting clients in identifying and targeting
the symptoms and occurrence patterns of their mental illness and developing strategies to
reduce the impact of those symptoms.
deleted text begin (w)deleted text end new text begin (t)new text end "Therapeutic interventions" means empirically supported techniques to address
specific symptoms and behaviors such as anxiety, psychotic symptoms, emotional
dysregulation, and trauma symptoms. Interventions include empirically supported
psychotherapies including, but not limited to, cognitive behavioral therapy, exposure therapy,
acceptance and commitment therapy, interpersonal therapy, and motivational interviewing.
deleted text begin (x)deleted text end new text begin (u)new text end "Wellness self-management and prevention" means a combination of approaches
to working with the client to build and apply skills related to recovery, and to support the
client in participating in leisure and recreational activities, civic participation, and meaningful
structure.
Sec. 54.
Minnesota Statutes 2018, section 256B.0622, subdivision 3a, is amended to read:
Subd. 3a.
Provider certification and contract requirements for assertive community
treatment.
(a) The assertive community treatment provider must:
(1) have a contract with the host county to provide assertive community treatment
services; and
(2) have each ACT team be certified by the state following the certification process and
procedures developed by the commissioner. The certification process determines whether
the ACT team meets the standards for assertive community treatment under this section deleted text begin as
well asdeleted text end new text begin , chapter 245I, andnew text end minimum program fidelity standards as measured by a nationally
recognized fidelity tool approved by the commissioner. Recertification must occur at least
every three years.
(b) An ACT team certified under this subdivision must meet the following standards:
(1) have capacity to recruit, hire, manage, and train required ACT team members;
(2) have adequate administrative ability to ensure availability of services;
deleted text begin
(3) ensure adequate preservice and ongoing training for staff;
deleted text end
deleted text begin
(4) ensure that staff is capable of implementing culturally specific services that are
culturally responsive and appropriate as determined by the client's culture, beliefs, values,
and language as identified in the individual treatment plan;
deleted text end
deleted text begin (5)deleted text end new text begin (3)new text end ensure flexibility in service delivery to respond to the changing and intermittent
care needs of a client as identified by the client and the individual treatment plan;
deleted text begin
(6) develop and maintain client files, individual treatment plans, and contact charting;
deleted text end
deleted text begin
(7) develop and maintain staff training and personnel files;
deleted text end
deleted text begin (8)deleted text end new text begin (4)new text end submit information as required by the state;
deleted text begin (9)deleted text end new text begin (5)new text end keep all necessary records required by law;
deleted text begin
(10) comply with all applicable laws;
deleted text end
deleted text begin (11)deleted text end new text begin (6)new text end be an enrolled Medicaid provider;
deleted text begin (12)deleted text end new text begin (7)new text end establish and maintain a quality assurance plan to determine specific service
outcomes and the client's satisfaction with services; and
deleted text begin (13)deleted text end new text begin (8)new text end develop and maintain written policies and procedures regarding service provision
and administration of the provider entity.
(c) The commissioner may intervene at any time and decertify an ACT team with cause.
The commissioner shall establish a process for decertification of an ACT team and shall
require corrective action, medical assistance repayment, or decertification of an ACT team
that no longer meets the requirements in this section or that fails to meet the clinical quality
standards or administrative standards provided by the commissioner in the application and
certification process. The decertification is subject to appeal to the state.
Sec. 55.
Minnesota Statutes 2018, section 256B.0622, subdivision 4, is amended to read:
Subd. 4.
Provider entity licensure and contract requirements for intensive residential
treatment services.
(a) The intensive residential treatment services provider entity must:
(1) be licensed under Minnesota Rules, parts 9520.0500 to 9520.0670;
(2) not exceed 16 beds per site; and
(3) comply with the additional standards in this sectionnew text begin and chapter 245Inew text end .
(b) The commissioner shall develop procedures for counties and providers to submit
other documentation as needed to allow the commissioner to determine whether the standards
in this section are met.
(c) A provider entity must specify in the provider entity's application what geographic
area and populations will be served by the proposed program. A provider entity must
document that the capacity or program specialties of existing programs are not sufficient
to meet the service needs of the target population. A provider entity must submit evidence
of ongoing relationships with other providers and levels of care to facilitate referrals to and
from the proposed program.
(d) A provider entity must submit documentation that the provider entity requested a
statement of need from each county board and tribal authority that serves as a local mental
health authority in the proposed service area. The statement of need must specify if the local
mental health authority supports or does not support the need for the proposed program and
the basis for this determination. If a local mental health authority does not respond within
60 days of the receipt of the request, the commissioner shall determine the need for the
program based on the documentation submitted by the provider entity.
Sec. 56.
Minnesota Statutes 2018, section 256B.0622, subdivision 5a, is amended to read:
Subd. 5a.
Standards for intensive residential rehabilitative mental health services.
(a)
The standards in this subdivision apply to intensive residential mental health services.
(b) The provider of intensive residential treatment services must have sufficient staff to
provide 24-hour-per-day coverage to deliver the rehabilitative services described in the
treatment plan and to safely supervise and direct the activities of clients, given the client's
level of behavioral and psychiatric stability, cultural needs, and vulnerability. The provider
must have the capacity within the facility to provide integrated services for chemical
dependency, illness management services, and family education, when appropriate.
(c) At a minimum:
(1) staff must provide direction and supervision whenever clients are present in the
facility;
(2) staff must remain awake during all work hours;
(3) there must be a staffing ratio of at least one to nine clients for each day and evening
shift. If more than nine clients are present at the residential site, there must be a minimum
of two staff during day and evening shifts, one of whom must be a mental health practitioner
or mental health professional;
(4) if services are provided to clients who need the services of a medical professional,
the provider shall ensure that these services are provided either by the provider's own medical
staff or through referral to a medical professional; and
(5) the provider must ensure the timely availability of a licensed registered nurse, either
directly employed or under contract, who is responsible for ensuring the effectiveness and
safety of medication administration in the facility and assessing clients for medication side
effects and drug interactions.
(d) Services must be provided by qualified staff as defined in section 256B.0623,
subdivision 5deleted text begin , who are trained and supervised according to section 256B.0623, subdivision
6, except that mental health rehabilitation workers acting as overnight staff are not required
to comply with section 256B.0623, subdivision 5, paragraph (a), clause (4), item (iv)deleted text end .
(e) The deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor must be an active member of the intensive residential
services treatment team. The team must meet with the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor at least
weekly to discuss clients' progress and make rapid adjustments to meet clients' needs. The
team meeting shall include client-specific case reviews and general treatment discussions
among team members. Client-specific case reviews and planning must be documented in
the client's treatment record.
(f) Treatment staff must have prompt access in person or by telephone to a mental health
practitioner or mental health professional. The provider must have the capacity to promptly
and appropriately respond to emergent needs and make any necessary staffing adjustments
to ensure the health and safety of clients.
(g) The initial functional assessment must be completed within ten days of intake and
updated at least every 30 days, or prior to discharge from the service, whichever comes
first.
(h) The initial individual treatment plan must be completed within 24 hours of admission.
Within ten days of admission, the initial treatment plan must be refined and further developed,
except for providers certified according to Minnesota Rules, parts 9533.0010 to 9533.0180.
The individual treatment plan must be reviewed with the client and updated at least monthly.
Sec. 57.
Minnesota Statutes 2018, section 256B.0622, subdivision 7, is amended to read:
Subd. 7.
Assertive community treatment service standards.
(a) ACT teams must
offer and have the capacity to directly provide the following services:
(1) assertive engagementnew text begin using collaborative strategies to encourage clients to receive
servicesnew text end ;
(2) benefits and finance supportdeleted text begin ;deleted text end new text begin that assists clients to capably manage financial affairs.
Services include but are not limited to assisting clients in applying for benefits, assisting
with redetermination of benefits, providing financial crisis management, teaching and
supporting budgeting skills and asset development, and coordinating with a client's
representative payee, if applicable;
new text end
(3) co-occurring disorder treatment;
(4) crisis assessment and intervention;
(5) employment servicesdeleted text begin ;deleted text end new text begin that assists clients to work at jobs of their choosing. Services
must follow the principles of the individual placement and support employment model,
including focusing on competitive employment, emphasizing individual client preferences
and strengths, ensuring employment services are integrated with mental health services,
conducting rapid job searches and systematic job development according to client preferences
and choices, providing benefits counseling, and offering all services in an individualized
and time-unlimited manner. Services must also include educating clients about opportunities
and benefits of work and school and assisting the client in learning job skills, navigating
the workplace, workplace accommodations, and managing work relationships;
new text end
(6) family psychoeducation and supportdeleted text begin ;deleted text end new text begin provided to the client's family and other natural
supports to restore and strengthen the client's unique social and family relationships. Services
include but are not limited to individualized psychoeducation about the client's illness and
the role of the family and other significant people in the therapeutic process; family
intervention to restore contact, resolve conflict, and maintain relationships with family and
other significant people in the client's life; ongoing communication and collaboration between
the ACT team and the family; introduction and referral to family self-help programs and
advocacy organizations that promote recovery and family engagement, individual supportive
counseling, parenting training, and service coordination to help clients fulfill parenting
responsibilities; coordinating services for the child and restoring relationships with children
who are not in the client's custody; and coordinating with child welfare and family agencies,
if applicable. These services must be provided with the client's agreement and consent;
new text end
(7) housing access supportdeleted text begin ;deleted text end new text begin that assists clients to find, obtain, retain, and move to safe
and adequate housing of their choice. Housing access support includes but is not limited to
locating housing options with a focus on integrated independent settings; applying for
housing subsidies, programs, or resources; assisting the client in developing relationships
with local landlords; providing tenancy support and advocacy for the individual's tenancy
rights at the client's home; and assisting with relocation;
new text end
(8) medication assistance and supportdeleted text begin ;deleted text end new text begin that assists clients in accessing medication,
developing the ability to take medications with greater independence, and providing
medication setup. Medication assistance and support includes assisting the client with the
prescription, administration, and ordering of medication by appropriate medical staff;
new text end
(9) medication educationdeleted text begin ;deleted text end new text begin that educates clients on the role and effects of medications in
treating symptoms of mental illness and the side effects of medications;
new text end
(10) mental health certified peer specialists services;
(11) physical health services;
(12) rehabilitative mental health services;
(13) symptom management;
(14) therapeutic interventions;
(15) wellness self-management and prevention; and
(16) other services based on client needs as identified in a client's assertive community
treatment individual treatment plan.
(b) ACT teams must ensure the provision of all services necessary to meet a client's
needs as identified in the client's individual treatment plan.
Sec. 58.
Minnesota Statutes 2018, section 256B.0622, subdivision 7a, is amended to read:
Subd. 7a.
Assertive community treatment team staff requirements and roles.
(a)
The required treatment staff qualifications and roles for an ACT team are:
(1) the team leader:
(i) shall be a deleted text begin licenseddeleted text end mental health professional deleted text begin who is qualified under Minnesota Rules,
part 9505.0371, subpart 5, item Adeleted text end . Individuals who are not licensed but who are eligible
for licensure and are otherwise qualified may also fulfill this role but must obtain full
licensure within 24 months of assuming the role of team leader;
(ii) must be an active member of the ACT team and provide some direct services to
clients;
(iii) must be a single full-time staff member, dedicated to the ACT team, who is
responsible for overseeing the administrative operations of the team, providing deleted text begin clinical
oversightdeleted text end new text begin treatment supervisionnew text end of services in conjunction with the psychiatrist or psychiatric
care provider, and supervising team members to ensure delivery of best and ethical practices;
and
(iv) must be available to provide overall deleted text begin clinical oversightdeleted text end new text begin treatment supervisionnew text end to the
ACT team after regular business hours and on weekends and holidays. The team leader may
delegate this duty to another qualified member of the ACT team;
(2) the psychiatric care provider:
(i) must be a deleted text begin licensed psychiatrist certified by the American Board of Psychiatry and
Neurology or eligible for board certification or certified by the American Osteopathic Board
of Neurology and Psychiatry or eligible for board certification, or a psychiatric nurse who
is qualified under Minnesota Rules, part 9505.0371, subpart 5, item Adeleted text end new text begin mental health
professional permitted to prescribe psychiatric medications as part of the professional's
scope of practicenew text end . The psychiatric care provider must have demonstrated clinical experience
working with individuals with serious and persistent mental illness;
(ii) shall collaborate with the team leader in sharing overall clinical responsibility for
screening and admitting clients; monitoring clients' treatment and team member service
delivery; educating staff on psychiatric and nonpsychiatric medications, their side effects,
and health-related conditions; actively collaborating with nurses; and helping provide deleted text begin clinicaldeleted text end new text begin
treatmentnew text end supervision to the team;
(iii) shall fulfill the following functions for assertive community treatment clients:
provide assessment and treatment of clients' symptoms and response to medications, including
side effects; provide brief therapy to clients; provide diagnostic and medication education
to clients, with medication decisions based on shared decision making; monitor clients'
nonpsychiatric medical conditions and nonpsychiatric medications; and conduct home and
community visits;
(iv) shall serve as the point of contact for psychiatric treatment if a client is hospitalized
for mental health treatment and shall communicate directly with the client's inpatient
psychiatric care providers to ensure continuity of care;
(v) shall have a minimum full-time equivalency that is prorated at a rate of 16 hours per
50 clients. Part-time psychiatric care providers shall have designated hours to work on the
team, with sufficient blocks of time on consistent days to carry out the provider's clinical,
supervisory, and administrative responsibilities. No more than two psychiatric care providers
may share this role;
(vi) may not provide specific roles and responsibilities by telemedicine unless approved
by the commissioner; and
(vii) shall provide psychiatric backup to the program after regular business hours and
on weekends and holidays. The psychiatric care provider may delegate this duty to another
qualified psychiatric provider;
(3) the nursing staff:
(i) shall consist of one to three registered nurses or advanced practice registered nurses,
of whom at least one has a minimum of one-year experience working with adults with
serious mental illness and a working knowledge of psychiatric medications. No more than
two individuals can share a full-time equivalent position;
(ii) are responsible for managing medication, administering and documenting medication
treatment, and managing a secure medication room; and
(iii) shall develop strategies, in collaboration with clients, to maximize taking medications
as prescribed; screen and monitor clients' mental and physical health conditions and
medication side effects; engage in health promotion, prevention, and education activities;
communicate and coordinate services with other medical providers; facilitate the development
of the individual treatment plan for clients assigned; and educate the ACT team in monitoring
psychiatric and physical health symptoms and medication side effects;
(4) the co-occurring disorder specialist:
(i) shall be a full-time equivalent co-occurring disorder specialist who has received
specific training on co-occurring disorders that is consistent with national evidence-based
practices. The training must include practical knowledge of common substances and how
they affect mental illnesses, the ability to assess substance use disorders and the client's
stage of treatment, motivational interviewing, and skills necessary to provide counseling to
clients at all different stages of change and treatment. The co-occurring disorder specialist
may also be an individual who is a licensed alcohol and drug counselor as described in
section 148F.01, subdivision 5, or a counselor who otherwise meets the training, experience,
and other requirements in section 245G.11, subdivision 5. No more than two co-occurring
disorder specialists may occupy this role; and
(ii) shall provide or facilitate the provision of co-occurring disorder treatment to clients.
The co-occurring disorder specialist shall serve as a consultant and educator to fellow ACT
team members on co-occurring disorders;
(5) the vocational specialist:
(i) shall be a full-time vocational specialist who has at least one-year experience providing
employment services or advanced education that involved field training in vocational services
to individuals with mental illness. An individual who does not meet these qualifications
may also serve as the vocational specialist upon completing a training plan approved by the
commissioner;
(ii) shall provide or facilitate the provision of vocational services to clients. The vocational
specialist serves as a consultant and educator to fellow ACT team members on these services;
and
(iii) deleted text begin shoulddeleted text end new text begin shallnew text end not refer individuals to receive any type of vocational services or linkage
by providers outside of the ACT team;
(6) the mental health certified peer specialist:
(i) shall be a full-time equivalent deleted text begin mental health certified peer specialist as defined in
section 256B.0615deleted text end . No more than two individuals can share this position. The mental health
certified peer specialist is a fully integrated team member who provides highly individualized
services in the community and promotes the self-determination and shared decision-making
abilities of clients. This requirement may be waived due to workforce shortages upon
approval of the commissioner;
(ii) must provide coaching, mentoring, and consultation to the clients to promote recovery,
self-advocacy, and self-direction, promote wellness management strategies, and assist clients
in developing advance directives; and
(iii) must model recovery values, attitudes, beliefs, and personal action to encourage
wellness and resilience, provide consultation to team members, promote a culture where
the clients' points of view and preferences are recognized, understood, respected, and
integrated into treatment, and serve in a manner equivalent to other team members;
(7) the program administrative assistant shall be a full-time office-based program
administrative assistant position assigned to solely work with the ACT team, providing a
range of supports to the team, clients, and families; and
(8) additional staff:
(i) shall be based on team size. Additional treatment team staff may include deleted text begin licenseddeleted text end
mental health professionals deleted text begin as defined in Minnesota Rules, part 9505.0371, subpart 5, item
Adeleted text end ; mental health practitioners deleted text begin as defined in section 245.462, subdivision 17; a mental health
practitioner working as adeleted text end new text begin ;new text end clinical deleted text begin trainee according to Minnesota Rules, part 9505.0371,
subpart 5, item Cdeleted text end new text begin traineesnew text end ; or mental health rehabilitation workers deleted text begin as defined in section
256B.0623, subdivision 5, paragraph (a), clause (4)deleted text end . These individuals shall have the
knowledge, skills, and abilities required by the population served to carry out rehabilitation
and support functions; and
(ii) shall be selected based on specific program needs or the population served.
(b) Each ACT team must clearly document schedules for all ACT team members.
(c) Each ACT team member must serve as a primary team member for clients assigned
by the team leader and are responsible for facilitating the individual treatment plan process
for those clients. The primary team member for a client is the responsible team member
knowledgeable about the client's life and circumstances and writes the individual treatment
plan. The primary team member provides individual supportive therapy or counseling, and
provides primary support and education to the client's family and support system.
(d) Members of the ACT team must have strong clinical skills, professional qualifications,
experience, and competency to provide a full breadth of rehabilitation services. Each staff
member shall be proficient in their respective discipline and be able to work collaboratively
as a member of a multidisciplinary team to deliver the majority of the treatment,
rehabilitation, and support services clients require to fully benefit from receiving assertive
community treatment.
(e) Each ACT team member must fulfill training requirements established by the
commissioner.
Sec. 59.
Minnesota Statutes 2018, section 256B.0622, subdivision 7b, is amended to read:
Subd. 7b.
Assertive community treatment program size and opportunities.
(a) Each
ACT team shall maintain an annual average caseload that does not exceed 100 clients.
Staff-to-client ratios shall be based on team size as follows:
(1) a small ACT team must:
(i) employ at least six but no more than seven full-time treatment team staff, excluding
the program assistant and the psychiatric care provider;
(ii) serve an annual average maximum of no more than 50 clients;
(iii) ensure at least one full-time equivalent position for every eight clients served;
(iv) schedule ACT team staff for at least eight-hour shift coverage on weekdays and
on-call duty to provide crisis services and deliver services after hours when staff are not
working;
(v) provide crisis services during business hours if the small ACT team does not have
sufficient staff numbers to operate an after-hours on-call system. During all other hours,
the ACT team may arrange for coverage for crisis assessment and intervention services
through a reliable crisis-intervention provider as long as there is a mechanism by which the
ACT team communicates routinely with the crisis-intervention provider and the on-call
ACT team staff are available to see clients face-to-face when necessary or if requested by
the crisis-intervention services provider;
(vi) adjust schedules and provide staff to carry out the needed service activities in the
evenings or on weekend days or holidays, when necessary;
(vii) arrange for and provide psychiatric backup during all hours the psychiatric care
provider is not regularly scheduled to work. If availability of the ACT team's psychiatric
care provider during all hours is not feasible, alternative psychiatric prescriber backup must
be arranged and a mechanism of timely communication and coordination established in
writing; and
(viii) be composed of, at minimum, one full-time team leader, at least 16 hours each
week per 50 clients of psychiatric provider time, or equivalent if fewer clients, one full-time
equivalent nursing, one full-time substance abuse specialist, one full-time equivalent mental
health certified peer specialist, one full-time vocational specialist, one full-time program
assistant, and at least one additional full-time ACT team member who has mental health
professionalnew text begin , clinical trainee,new text end or new text begin mental health new text end practitioner status; and
(2) a midsize ACT team shall:
(i) be composed of, at minimum, one full-time team leader, at least 16 hours of psychiatry
time for 51 clients, with an additional two hours for every six clients added to the team, 1.5
to two full-time equivalent nursing staff, one full-time substance abuse specialist, one
full-time equivalent mental health certified peer specialist, one full-time vocational specialist,
one full-time program assistant, and at least 1.5 to two additional full-time equivalent ACT
members, with at least one dedicated full-time staff member with mental health professional
status. Remaining team members may have mental health professionalnew text begin , clinical trainee,new text end or
new text begin mental health new text end practitioner status;
(ii) employ seven or more treatment team full-time equivalents, excluding the program
assistant and the psychiatric care provider;
(iii) serve an annual average maximum caseload of 51 to 74 clients;
(iv) ensure at least one full-time equivalent position for every nine clients served;
(v) schedule ACT team staff for a minimum of ten-hour shift coverage on weekdays
and six- to eight-hour shift coverage on weekends and holidays. In addition to these minimum
specifications, staff are regularly scheduled to provide the necessary services on a
client-by-client basis in the evenings and on weekends and holidays;
(vi) schedule ACT team staff on-call duty to provide crisis services and deliver services
when staff are not working;
(vii) have the authority to arrange for coverage for crisis assessment and intervention
services through a reliable crisis-intervention provider as long as there is a mechanism by
which the ACT team communicates routinely with the crisis-intervention provider and the
on-call ACT team staff are available to see clients face-to-face when necessary or if requested
by the crisis-intervention services provider; and
(viii) arrange for and provide psychiatric backup during all hours the psychiatric care
provider is not regularly scheduled to work. If availability of the psychiatric care provider
during all hours is not feasible, alternative psychiatric prescriber backup must be arranged
and a mechanism of timely communication and coordination established in writing;
(3) a large ACT team must:
(i) be composed of, at minimum, one full-time team leader, at least 32 hours each week
per 100 clients, or equivalent of psychiatry time, three full-time equivalent nursing staff,
one full-time substance abuse specialist, one full-time equivalent mental health certified
peer specialist, one full-time vocational specialist, one full-time program assistant, and at
least two additional full-time equivalent ACT team members, with at least one dedicated
full-time staff member with mental health professional status. Remaining team members
may have mental health professionalnew text begin , clinical trainee,new text end or mental health practitioner status;
(ii) employ nine or more treatment team full-time equivalents, excluding the program
assistant and psychiatric care provider;
(iii) serve an annual average maximum caseload of 75 to 100 clients;
(iv) ensure at least one full-time equivalent position for every nine individuals served;
(v) schedule staff to work two eight-hour shifts, with a minimum of two staff on the
second shift providing services at least 12 hours per day weekdays. For weekends and
holidays, the team must operate and schedule ACT team staff to work one eight-hour shift,
with a minimum of two staff each weekend day and every holiday;
(vi) schedule ACT team staff on-call duty to provide crisis services and deliver services
when staff are not working; and
(vii) arrange for and provide psychiatric backup during all hours the psychiatric care
provider is not regularly scheduled to work. If availability of the ACT team psychiatric care
provider during all hours is not feasible, alternative psychiatric backup must be arranged
and a mechanism of timely communication and coordination established in writing.
(b) An ACT team of any size may have a staff-to-client ratio that is lower than the
requirements described in paragraph (a) upon approval by the commissioner, but may not
exceed a one-to-ten staff-to-client ratio.
Sec. 60.
Minnesota Statutes 2018, section 256B.0622, subdivision 7d, is amended to read:
Subd. 7d.
Assertive community treatment assessment and individual treatment
plan.
(a) An initial assessment, including a diagnostic assessment that meets the requirements
of deleted text begin Minnesota Rules, part 9505.0372, subpart 1,deleted text end new text begin section 256B.0671, subdivisions 2 and 3,new text end
and a 30-day treatment plan shall be completed the day of the client's admission to assertive
community treatment by the ACT team leader or the psychiatric care provider, with
participation by designated ACT team members and the client. The team leader, psychiatric
care provider, or other mental health professional designated by the team leader or psychiatric
care provider, must update the client's diagnostic assessment at least annually.
(b) An initial functional assessment must be completed within ten days of intake and
updated every six months for assertive community treatment, or prior to discharge from the
service, whichever comes first.
(c) Within 30 days of the client's assertive community treatment admission, the ACT
team shall complete an in-depth assessment of the domains listed under section 245.462,
subdivision 11a.
(d) Each part of the in-depth assessment areas shall be completed by each respective
team specialist or an ACT team member with skill and knowledge in the area being assessed.
The assessments are based upon all available information, including that from client interview
family and identified natural supports, and written summaries from other agencies, including
police, courts, county social service agencies, outpatient facilities, and inpatient facilities,
where applicable.
(e) Between 30 and 45 days after the client's admission to assertive community treatment,
the entire ACT team must hold a comprehensive case conference, where all team members,
including the psychiatric provider, present information discovered from the completed
in-depth assessments and provide treatment recommendations. The conference must serve
as the basis for the first six-month treatment plan, which must be written by the primary
team member.
(f) The client's psychiatric care provider, primary team member, and individual treatment
team members shall assume responsibility for preparing the written narrative of the results
from the psychiatric and social functioning history timeline and the comprehensive
assessment.
(g) The primary team member and individual treatment team members shall be assigned
by the team leader in collaboration with the psychiatric care provider by the time of the first
treatment planning meeting or 30 days after admission, whichever occurs first.
(h) Individual treatment plans must be developed through the following treatment
planning process:
(1) The individual treatment plan shall be developed in collaboration with the client and
the client's preferred natural supports, and guardian, if applicable and appropriate. The ACT
team shall evaluate, together with each client, the client's needs, strengths, and preferences
and develop the individual treatment plan collaboratively. The ACT team shall make every
effort to ensure that the client and the client's family and natural supports, with the client's
consent, are in attendance at the treatment planning meeting, are involved in ongoing
meetings related to treatment, and have the necessary supports to fully participate. The
client's participation in the development of the individual treatment plan shall be documented.
(2) The client and the ACT team shall work together to formulate and prioritize the
issues, set goals, research approaches and interventions, and establish the plan. The plan is
individually tailored so that the treatment, rehabilitation, and support approaches and
interventions achieve optimum symptom reduction, help fulfill the personal needs and
aspirations of the client, take into account the cultural beliefs and realities of the individual,
and improve all the aspects of psychosocial functioning that are important to the client. The
process supports strengths, rehabilitation, and recovery.
(3) Each client's individual treatment plan shall identify service needs, strengths and
capacities, and barriers, and set specific and measurable short- and long-term goals for each
service need. The individual treatment plan must clearly specify the approaches and
interventions necessary for the client to achieve the individual goals, when the interventions
shall happen, and identify which ACT team member shall carry out the approaches and
interventions.
(4) The primary team member and the individual treatment team, together with the client
and the client's family and natural supports with the client's consent, are responsible for
reviewing and rewriting the treatment goals and individual treatment plan whenever there
is a major decision point in the client's course of treatment or at least every six months.
(5) The primary team member shall prepare a summary that thoroughly describes in
writing the client's and the individual treatment team's evaluation of the client's progress
and goal attainment, the effectiveness of the interventions, and the satisfaction with services
since the last individual treatment plan. The client's most recent diagnostic assessment must
be included with the treatment plan summary.
(6) The individual treatment plan and review must be deleted text begin signeddeleted text end new text begin approvednew text end or acknowledged
by the client, the primary team member, the team leader, the psychiatric care provider, and
all individual treatment team members. A copy of the deleted text begin signeddeleted text end individual treatment plan is
made available to the client.
Sec. 61.
Minnesota Statutes 2018, section 256B.0623, subdivision 1, is amended to read:
Subdivision 1.
Scope.
Medical assistance covers adult rehabilitative mental health
services as defined in subdivision 2, deleted text begin subject to federal approval,deleted text end if provided to recipients
as defined in subdivision 3 and provided by a qualified provider entity meeting the standards
in this section and by a qualified individual provider working within the provider's scope
of practice and identified in the recipient's individual treatment plan deleted text begin as defineddeleted text end new text begin describednew text end
in section deleted text begin 245.462, subdivision 14deleted text end new text begin 256B.0671, subdivisions 5 and 6new text end , and if determined to
be medically necessary according to section 62Q.53.
Sec. 62.
Minnesota Statutes 2018, section 256B.0623, subdivision 2, is amended to read:
Subd. 2.
Definitions.
For purposes of this section, the following terms have the meanings
given them.
(a) "Adult rehabilitative mental health services" means mental health services which are
rehabilitative and enable the recipient to develop and enhance psychiatric stability, social
competencies, personal and emotional adjustment, independent living, parenting skills, and
community skills, when these abilities are impaired by the symptoms of mental illness.
deleted text begin Adult rehabilitative mental health services are also appropriate when provided to enable a
recipient to retain stability and functioning, if the recipient would be at risk of significant
functional decompensation or more restrictive service settings without these services.
deleted text end
deleted text begin
(1) Adult rehabilitative mental health services instruct, assist, and support the recipient
in areas such as: interpersonal communication skills, community resource utilization and
integration skills, crisis assistance, relapse prevention skills, health care directives, budgeting
and shopping skills, healthy lifestyle skills and practices, cooking and nutrition skills,
transportation skills, medication education and monitoring, mental illness symptom
management skills, household management skills, employment-related skills, parenting
skills, and transition to community living services.
deleted text end
deleted text begin
(2) These services shall be provided to the recipient on a one-to-one basis in the recipient's
home or another community setting or in groups.
deleted text end
(b) "Medication education services" means services provided individually or in groups
which focus on educating the recipient about mental illness and symptoms; the role and
effects of medications in treating symptoms of mental illness; and the side effects of
medications. Medication education is coordinated with medication management services
and does not duplicate it. Medication education services are provided by physicians,
pharmacists, physician assistants, or registered nurses.
(c) "Transition to community living services" means services which maintain continuity
of contact between the rehabilitation services provider and the recipient and which facilitate
discharge from a hospital, residential treatment program under Minnesota Rules, chapter
9505, board and lodging facility, or nursing home. Transition to community living services
are not intended to provide other areas of adult rehabilitative mental health services.
Sec. 63.
Minnesota Statutes 2018, section 256B.0623, subdivision 3, is amended to read:
Subd. 3.
Eligibility.
An eligible recipient is an individual who:
(1) is age 18 or older;
(2) is diagnosed with a medical condition, such as mental illness or traumatic brain
injury, for which adult rehabilitative mental health services are needed;
(3) has substantial disability and functional impairment in three or more of the areas
listed in section 245.462, subdivision 11a, so that self-sufficiency is markedly reduced; and
(4) has had a recent diagnostic assessment deleted text begin or an adult diagnostic assessment updatedeleted text end by
a qualified professional that documents adult rehabilitative mental health services are
medically necessary to address identified disability and functional impairments and individual
recipient goals.
Sec. 64.
Minnesota Statutes 2018, section 256B.0623, subdivision 4, is amended to read:
Subd. 4.
Provider entity standards.
(a) The provider entity must be certified by the
state following the certification process and procedures developed by the commissioner.
(b) The certification process is a determination as to whether the entity meets the standards
in this subdivisionnew text begin and chapter 245Inew text end . The certification must specify which adult rehabilitative
mental health services the entity is qualified to provide.
(c) A noncounty provider entity must obtain additional certification from each county
in which it will provide services. The additional certification must be based on the adequacy
of the entity's knowledge of that county's local health and human service system, and the
ability of the entity to coordinate its services with the other services available in that county.
A county-operated entity must obtain this additional certification from any other county in
which it will provide services.
(d) new text begin State-level new text end recertification must occur at least every three years.
(e) The commissioner may intervene at any time and decertify providers with cause.
The decertification is subject to appeal to the state. A county board may recommend that
the state decertify a provider for cause.
(f) The adult rehabilitative mental health services provider entity must meet the following
standards:
(1) have capacity to recruit, hire, manage, and train deleted text begin mental health professionals, mental
health practitioners, and mental health rehabilitation workersdeleted text end new text begin qualified staffnew text end ;
(2) have adequate administrative ability to ensure availability of services;
deleted text begin
(3) ensure adequate preservice and inservice and ongoing training for staff;
deleted text end
deleted text begin (4)deleted text end new text begin (3)new text end ensure that deleted text begin mental health professionals, mental health practitioners, and mental
health rehabilitation workersdeleted text end new text begin staff new text end are skilled in the delivery of the specific adult rehabilitative
mental health services provided to the individual eligible recipient;
deleted text begin
(5) ensure that staff is capable of implementing culturally specific services that are
culturally competent and appropriate as determined by the recipient's culture, beliefs, values,
and language as identified in the individual treatment plan;
deleted text end
deleted text begin (6)deleted text end new text begin (4)new text end ensure enough flexibility in service delivery to respond to the changing and
intermittent care needs of a recipient as identified by the recipient and the individual treatment
plan;
deleted text begin
(7) ensure that the mental health professional or mental health practitioner, who is under
the clinical supervision of a mental health professional, involved in a recipient's services
participates in the development of the individual treatment plan;
deleted text end
deleted text begin (8)deleted text end new text begin (5)new text end assist the recipient in arranging needed crisis assessment, intervention, and
stabilization services;
deleted text begin (9)deleted text end new text begin (6)new text end ensure that services are coordinated with other recipient mental health services
providers and the county mental health authority and the federally recognized American
Indian authority and necessary others after obtaining the consent of the recipient. Services
must also be coordinated with the recipient's case manager or care coordinator if the recipient
is receiving case management or care coordination services;
deleted text begin
(10) develop and maintain recipient files, individual treatment plans, and contact charting;
deleted text end
deleted text begin
(11) develop and maintain staff training and personnel files;
deleted text end
deleted text begin (12)deleted text end new text begin (7)new text end submit information as required by the state;
deleted text begin
(13) establish and maintain a quality assurance plan to evaluate the outcome of services
provided;
deleted text end
deleted text begin (14)deleted text end new text begin (8)new text end keep all necessary records required by law;
deleted text begin (15)deleted text end new text begin (9)new text end deliver services as required by section 245.461;
deleted text begin
(16) comply with all applicable laws;
deleted text end
deleted text begin (17)deleted text end new text begin (10)new text end be an enrolled Medicaid provider;
deleted text begin (18)deleted text end new text begin (11)new text end maintain a quality assurance plan to determine specific service outcomes and
the recipient's satisfaction with services; and
deleted text begin (19)deleted text end new text begin (12)new text end develop and maintain written policies and procedures regarding service
provision and administration of the provider entity.
Sec. 65.
Minnesota Statutes 2018, section 256B.0623, subdivision 5, is amended to read:
Subd. 5.
Qualifications of provider staff.
deleted text begin (a)deleted text end Adult rehabilitative mental health services
must be provided by qualified individual provider staff of a certified provider entity.
Individual provider staff must be qualified deleted text begin underdeleted text end new text begin asnew text end one of the following deleted text begin criteriadeleted text end new text begin providersnew text end :
(1) a mental health professional deleted text begin as defined in section 245.462, subdivision 18, clauses
(1) to (6). If the recipient has a current diagnostic assessment by a licensed mental health
professional as defined in section 245.462, subdivision 18, clauses (1) to (6), recommending
receipt of adult mental health rehabilitative services, the definition of mental health
professional for purposes of this section includes a person who is qualified under section
245.462, subdivision 18, clause (7), and who holds a current and valid national certification
as a certified rehabilitation counselor or certified psychosocial rehabilitation practitionerdeleted text end new text begin
qualified according to section 245I.16, subdivision 2new text end ;
new text begin
(2) a certified rehabilitation specialist qualified according to section 245I.16, subdivision
8;
new text end
new text begin
(3) a clinical trainee qualified according to section 245I.16, subdivision 6;
new text end
deleted text begin (2)deleted text end new text begin (4)new text end a mental health practitioner deleted text begin as defined in section 245.462, subdivision 17. The
mental health practitioner must work under the clinical supervision of a mental health
professionaldeleted text end new text begin qualified according to section 245I.16, subdivision 4new text end ;
deleted text begin (3)deleted text end new text begin (5)new text end a new text begin mental health new text end certified peer specialist deleted text begin under section 256B.0615. The certified
peer specialist must work under the clinical supervision of a mental health professionaldeleted text end new text begin
qualified according to section 245I.16, subdivision 10new text end ; or
deleted text begin (4)deleted text end new text begin (6)new text end a mental health rehabilitation workernew text begin qualified according to section 245I.16,
subdivision 14new text end . deleted text begin A mental health rehabilitation worker means a staff person working under
the direction of a mental health practitioner or mental health professional and under the
clinical supervision of a mental health professional in the implementation of rehabilitative
mental health services as identified in the recipient's individual treatment plan who:
deleted text end
deleted text begin
(i) is at least 21 years of age;
deleted text end
deleted text begin
(ii) has a high school diploma or equivalent;
deleted text end
deleted text begin
(iii) has successfully completed 30 hours of training during the two years immediately
prior to the date of hire, or before provision of direct services, in all of the following areas:
recovery from mental illness, mental health de-escalation techniques, recipient rights,
recipient-centered individual treatment planning, behavioral terminology, mental illness,
co-occurring mental illness and substance abuse, psychotropic medications and side effects,
functional assessment, local community resources, adult vulnerability, recipient
confidentiality; and
deleted text end
deleted text begin
(iv) meets the qualifications in paragraph (b).
deleted text end
deleted text begin
(b) In addition to the requirements in paragraph (a), a mental health rehabilitation worker
must also meet the qualifications in clause (1), (2), or (3):
deleted text end
deleted text begin
(1) has an associates of arts degree, two years of full-time postsecondary education, or
a total of 15 semester hours or 23 quarter hours in behavioral sciences or related fields; is
a registered nurse; or within the previous ten years has:
deleted text end
deleted text begin
(i) three years of personal life experience with serious mental illness;
deleted text end
deleted text begin
(ii) three years of life experience as a primary caregiver to an adult with a serious mental
illness, traumatic brain injury, substance use disorder, or developmental disability; or
deleted text end
deleted text begin
(iii) 2,000 hours of supervised work experience in the delivery of mental health services
to adults with a serious mental illness, traumatic brain injury, substance use disorder, or
developmental disability;
deleted text end
deleted text begin
(2)(i) is fluent in the non-English language or competent in the culture of the ethnic
group to which at least 20 percent of the mental health rehabilitation worker's clients belong;
deleted text end
deleted text begin
(ii) receives during the first 2,000 hours of work, monthly documented individual clinical
supervision by a mental health professional;
deleted text end
deleted text begin
(iii) has 18 hours of documented field supervision by a mental health professional or
mental health practitioner during the first 160 hours of contact work with recipients, and at
least six hours of field supervision quarterly during the following year;
deleted text end
deleted text begin
(iv) has review and cosignature of charting of recipient contacts during field supervision
by a mental health professional or mental health practitioner; and
deleted text end
deleted text begin
(v) has 15 hours of additional continuing education on mental health topics during the
first year of employment and 15 hours during every additional year of employment; or
deleted text end
deleted text begin
(3) for providers of crisis residential services, intensive residential treatment services,
partial hospitalization, and day treatment services:
deleted text end
deleted text begin
(i) satisfies clause (2), items (ii) to (iv); and
deleted text end
deleted text begin
(ii) has 40 hours of additional continuing education on mental health topics during the
first year of employment.
deleted text end
deleted text begin
(c) A mental health rehabilitation worker who solely acts and is scheduled as overnight
staff is not required to comply with paragraph (a), clause (4), item (iv).
deleted text end
deleted text begin
(d) For purposes of this subdivision, "behavioral sciences or related fields" means an
education from an accredited college or university and includes but is not limited to social
work, psychology, sociology, community counseling, family social science, child
development, child psychology, community mental health, addiction counseling, counseling
and guidance, special education, and other fields as approved by the commissioner.
deleted text end
Sec. 66.
Minnesota Statutes 2018, section 256B.0623, subdivision 6, is amended to read:
Subd. 6.
Required training and supervision.
(a) deleted text begin Mental health rehabilitation workers
must receive ongoing continuing education training of at least 30 hours every two years in
areas of mental illness and mental health services and other areas specific to the population
being served. Mental health rehabilitation workers must also be subject to the ongoing
direction and clinical supervision standards in paragraphs (c) and (d)deleted text end new text begin Staff must receive
training in accordance with section 245I.10new text end .
deleted text begin
(b) Mental health practitioners must receive ongoing continuing education training as
required by their professional license; or if the practitioner is not licensed, the practitioner
must receive ongoing continuing education training of at least 30 hours every two years in
areas of mental illness and mental health services. Mental health practitioners must meet
the ongoing clinical supervision standards in paragraph (c).
deleted text end
deleted text begin (c) Clinical supervision may be provided by a full- or part-time qualified professional
employed by or under contract with the provider entity. Clinical supervision may be provided
by interactive videoconferencing according to procedures developed by the commissioner.deleted text end new text begin
(b) Treatment supervision must be provided according to section 245I.18.new text end A mental health
professional providing deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of staff delivering adult rehabilitative
mental health services must provide the following guidance:
deleted text begin
(1) review the information in the recipient's file;
deleted text end
deleted text begin
(2) review and approve initial and updates of individual treatment plans;
deleted text end
deleted text begin (3)deleted text end new text begin (1)new text end meet with deleted text begin mental health rehabilitation workers and practitioners, individually or
in small groups,deleted text end new text begin staff receiving directionnew text end at least monthly to discuss treatment topics of
interest deleted text begin to the workers and practitionersdeleted text end ;
deleted text begin (4) meet with mental health rehabilitation workers and practitioners, individually or in
small groups, at least monthly todeleted text end new text begin (2)new text end discuss treatment plans of recipientsdeleted text begin , and approve by
signature and document in the recipient's file any resulting plan updatesdeleted text end ;
deleted text begin (5) meet at least monthly with the directing mental health practitioner, if there is one,
todeleted text end new text begin (3)new text end review needs of the adult rehabilitative mental health services program, review staff
on-site observations and evaluate mental health rehabilitation workers, plan staff training,
new text begin and new text end review program evaluation and developmentdeleted text begin , and consult with the directing practitioner;
anddeleted text end new text begin ;
new text end
deleted text begin
(6) be available for urgent consultation as the individual recipient needs or the situation
necessitates.
deleted text end
deleted text begin
(d) An adult rehabilitative mental health services provider entity must have a treatment
director who is a mental health practitioner or mental health professional. The treatment
director must ensure the following:
deleted text end
deleted text begin
(1) while delivering direct services to recipients, a newly hired mental health rehabilitation
worker must be directly observed delivering services to recipients by a mental health
practitioner or mental health professional for at least six hours per 40 hours worked during
the first 160 hours that the mental health rehabilitation worker works;
deleted text end
deleted text begin
(2) the mental health rehabilitation worker must receive ongoing on-site direct service
observation by a mental health professional or mental health practitioner for at least six
hours for every six months of employment;
deleted text end
deleted text begin (3)deleted text end new text begin (4) reviewnew text end progress notes deleted text begin are revieweddeleted text end from on-site service observation prepared by
the mental health rehabilitation worker and mental health practitioner for accuracy and
consistency with actual recipient contact and the individual treatment plan and goals;
deleted text begin (4)deleted text end new text begin (5) ensurenew text end immediate availability by phone or in person for consultation by a mental
health professional or a mental health practitioner to the mental health rehabilitation services
worker during service provision;new text begin and
new text end
deleted text begin
(5) oversee the identification of changes in individual recipient treatment strategies,
revise the plan, and communicate treatment instructions and methodologies as appropriate
to ensure that treatment is implemented correctly;
deleted text end
deleted text begin
(6) model service practices which: respect the recipient, include the recipient in planning
and implementation of the individual treatment plan, recognize the recipient's strengths,
collaborate and coordinate with other involved parties and providers;
deleted text end
deleted text begin (7)deleted text end new text begin (6)new text end ensure that mental health practitioners and mental health rehabilitation workers
are able to effectively communicate with the recipients, significant others, and providersdeleted text begin ;
anddeleted text end new text begin .
new text end
deleted text begin
(8) oversee the record of the results of on-site observation and charting evaluation and
corrective actions taken to modify the work of the mental health practitioners and mental
health rehabilitation workers.
deleted text end
deleted text begin
(e) A mental health practitioner who is providing treatment direction for a provider entity
must receive supervision at least monthly from a mental health professional to:
deleted text end
deleted text begin
(1) identify and plan for general needs of the recipient population served;
deleted text end
deleted text begin
(2) identify and plan to address provider entity program needs and effectiveness;
deleted text end
deleted text begin
(3) identify and plan provider entity staff training and personnel needs and issues; and
deleted text end
deleted text begin
(4) plan, implement, and evaluate provider entity quality improvement programs.
deleted text end
Sec. 67.
Minnesota Statutes 2018, section 256B.0623, subdivision 7, is amended to read:
Subd. 7.
Personnel file.
The adult rehabilitative mental health services provider entity
must maintain a personnel file on each staffnew text begin in accordance with section 245I.13new text end . deleted text begin Each file
must contain:
deleted text end
deleted text begin
(1) an annual performance review;
deleted text end
deleted text begin
(2) a summary of on-site service observations and charting review;
deleted text end
deleted text begin
(3) a criminal background check of all direct service staff;
deleted text end
deleted text begin
(4) evidence of academic degree and qualifications;
deleted text end
deleted text begin
(5) a copy of professional license;
deleted text end
deleted text begin
(6) any job performance recognition and disciplinary actions;
deleted text end
deleted text begin
(7) any individual staff written input into own personnel file;
deleted text end
deleted text begin
(8) all clinical supervision provided; and
deleted text end
deleted text begin
(9) documentation of compliance with continuing education requirements.
deleted text end
Sec. 68.
Minnesota Statutes 2018, section 256B.0623, subdivision 8, is amended to read:
Subd. 8.
Diagnostic assessment.
Providers of adult rehabilitative mental health services
must new text begin obtain or new text end complete a diagnostic assessment deleted text begin as defined indeleted text end new text begin according tonew text end section deleted text begin 245.462,
subdivision 9, within five days after the recipient's second visit or within 30 days after
intake, whichever occurs first. In cases where a diagnostic assessment is available that
reflects the recipient's current status, and has been completed within three years preceding
admission, an adult diagnostic assessment update must be completed. An update shall include
a face-to-face interview with the recipient and a written summary by a mental health
professional of the recipient's current mental health status and service needs. If the recipient's
mental health status has changed significantly since the adult's most recent diagnostic
assessment, a new diagnostic assessment is requireddeleted text end new text begin 256B.0671, subdivisions 2 and 3new text end .
Sec. 69.
Minnesota Statutes 2018, section 256B.0623, subdivision 10, is amended to read:
Subd. 10.
Individual treatment plan.
All providers of adult rehabilitative mental health
services must develop and implement an individual treatment plan for each recipientdeleted text begin . The
provisions in clauses (1) and (2) apply:deleted text end new text begin according to section 256B.0671, subdivisions 5 and
6.
new text end
deleted text begin (1) Individual treatment plan means a plan of intervention, treatment, and services for
an individual recipient written by a mental health professional or by a mental health
practitioner under the clinical supervision of a mental health professional. The individual
treatment plan must be based on diagnostic and functional assessments. To the extent
possible, the development and implementation of a treatment plan must be a collaborative
process involving the recipient, and with the permission of the recipient, the recipient's
family and others in the recipient's support system. Providers of adult rehabilitative mental
health services must develop the individual treatment plan within 30 calendar days of intake.deleted text end
The treatment plan must be updated at least every six months thereafter, or more often when
there is significant change in the recipient's situation or functioning, or in services or service
methods to be used, or at the request of the recipient or the recipient's legal guardian.
deleted text begin
(2) The individual treatment plan must include:
deleted text end
deleted text begin
(i) a list of problems identified in the assessment;
deleted text end
deleted text begin
(ii) the recipient's strengths and resources;
deleted text end
deleted text begin
(iii) concrete, measurable goals to be achieved, including time frames for achievement;
deleted text end
deleted text begin
(iv) specific objectives directed toward the achievement of each one of the goals;
deleted text end
deleted text begin
(v) documentation of participants in the treatment planning. The recipient, if possible,
must be a participant. The recipient or the recipient's legal guardian must sign the treatment
plan, or documentation must be provided why this was not possible. A copy of the plan
must be given to the recipient or legal guardian. Referral to formal services must be arranged,
including specific providers where applicable;
deleted text end
deleted text begin
(vi) cultural considerations, resources, and needs of the recipient must be included;
deleted text end
deleted text begin
(vii) planned frequency and type of services must be initiated; and
deleted text end
deleted text begin
(viii) clear progress notes on outcome of goals.
deleted text end
deleted text begin
(3) The individual community support plan defined in section 245.462, subdivision 12,
may serve as the individual treatment plan if there is involvement of a mental health case
manager, and with the approval of the recipient. The individual community support plan
must include the criteria in clause (2).
deleted text end
Sec. 70.
Minnesota Statutes 2018, section 256B.0623, subdivision 11, is amended to read:
Subd. 11.
Recipient file.
Providers of adult rehabilitative mental health services must
maintain a file for each recipient deleted text begin that contains the following information:deleted text end new text begin according to
section 245I.32.
new text end
deleted text begin
(1) diagnostic assessment or verification of its location that is current and that was
reviewed by a mental health professional who is employed by or under contract with the
provider entity;
deleted text end
deleted text begin
(2) functional assessments;
deleted text end
deleted text begin
(3) individual treatment plans signed by the recipient and the mental health professional,
or if the recipient refused to sign the plan, the date and reason stated by the recipient as to
why the recipient would not sign the plan;
deleted text end
deleted text begin
(4) recipient history;
deleted text end
deleted text begin
(5) signed release forms;
deleted text end
deleted text begin
(6) recipient health information and current medications;
deleted text end
deleted text begin
(7) emergency contacts for the recipient;
deleted text end
deleted text begin
(8) case records which document the date of service, the place of service delivery,
signature of the person providing the service, nature, extent and units of service, and place
of service delivery;
deleted text end
deleted text begin
(9) contacts, direct or by telephone, with recipient's family or others, other providers,
or other resources for service coordination;
deleted text end
deleted text begin
(10) summary of recipient case reviews by staff; and
deleted text end
deleted text begin
(11) written information by the recipient that the recipient requests be included in the
file.
deleted text end
Sec. 71.
Minnesota Statutes 2018, section 256B.0623, subdivision 12, is amended to read:
Subd. 12.
Additional requirements.
(a) Providers of adult rehabilitative mental health
services must comply with the requirements relating to referrals for case management in
section 245.467, subdivision 4.
(b) Adult rehabilitative mental health services are provided for most recipients in the
recipient's home and community. Services may also be provided at the home of a relative
or significant other, job site, psychosocial clubhouse, drop-in center, social setting, classroom,
or other places in the community. Except for "transition to community services," the place
of service does not include a regional treatment center, nursing home, residential treatment
facility licensed under Minnesota Rules, parts 9520.0500 to 9520.0670 (Rule 36), or an
acute care hospital.
(c) Adult rehabilitative mental health services may be provided in group settings if
appropriate to each participating recipient's needs and treatment plan. A group is defined
as two to ten clients, at least one of whom is a recipient, who is concurrently receiving a
service which is identified in this section. The service and group must be specified in the
recipient's treatment plan. No more than two qualified staff may bill Medicaid for services
provided to the same group of recipients. If two adult rehabilitative mental health workers
bill for recipients in the same group session, they must each bill for different recipients.
new text begin
(d) Adult rehabilitative mental health services are appropriate if provided to enable a
recipient to retain stability and functioning, when the recipient is at risk of significant
functional decompensation or requiring more restrictive service settings without these
services.
new text end
new text begin
(e) Adult rehabilitative mental health services instruct, assist, and support the recipient
in areas including: interpersonal communication skills, community resource utilization and
integration skills, crisis planning, relapse prevention skills, health care directives, budgeting
and shopping skills, healthy lifestyle skills and practices, cooking and nutrition skills,
transportation skills, medication education and monitoring, mental illness symptom
management skills, household management skills, employment-related skills, parenting
skills, and transition to community living services.
new text end
new text begin
(f) Community intervention, including consultation with relatives, guardians, friends,
employers, treatment providers, and other significant individuals, is appropriate when
directed exclusively to the treatment of the client.
new text end
Sec. 72.
Minnesota Statutes 2018, section 256B.0624, subdivision 2, is amended to read:
Subd. 2.
Definitions.
For purposes of this section, the following terms have the meanings
given them.
(a) "Mental health crisis" is an adult behavioral, emotional, or psychiatric situation
which, but for the provision of crisis response services, would likely result in significantly
reduced levels of functioning in primary activities of daily living, or in an emergency
situation, or in the placement of the recipient in a more restrictive setting, including, but
not limited to, inpatient hospitalization.
(b) "Mental health emergency" is an adult behavioral, emotional, or psychiatric situation
which causes an immediate need for mental health services and is consistent with section
62Q.55.
A mental health crisis or emergency is determined for medical assistance service
reimbursement by a physician, a mental health professional, or deleted text begin crisis mental health
practitionerdeleted text end new text begin qualified member of a crisis teamnew text end with input from the recipient whenever
possible.
(c) "Mental health crisis assessment" means an immediate face-to-face assessment by
a physician, a mental health professional, or deleted text begin mental health practitioner under the clinical
supervision of a mental health professional,deleted text end new text begin qualified member of a crisis teamnew text end following a
screening that suggests that the adult may be experiencing a mental health crisis or mental
health emergency situation. It includes, when feasible, assessing whether the person might
be willing to voluntarily accept treatment, determining whether the person has an advance
directive, and obtaining information and history from involved family members or caretakers.
(d) "Mental health mobile crisis intervention services" means face-to-face, short-term
intensive mental health services initiated during a mental health crisis or mental health
emergency to help the recipient cope with immediate stressors, identify and utilize available
resources and strengths, engage in voluntary treatment, and begin to return to the recipient's
baseline level of functioning. The services, including screening and treatment plan
recommendations, must be culturally and linguistically appropriate.
(1) This service is provided on site by a mobile crisis intervention team outside of an
inpatient hospital setting. Mental health mobile crisis intervention services must be available
24 hours a day, seven days a week.
(2) The initial screening must consider other available services to determine which
service intervention would best address the recipient's needs and circumstances.
(3) The mobile crisis intervention team must be available to meet promptly face-to-face
with a person in mental health crisis or emergency in a community setting or hospital
emergency room.
(4) The intervention must consist of a mental health crisis assessment and a crisis
treatment plan.
(5) The team must be available to individuals who are experiencing a co-occurring
substance use disorder, who do not need the level of care provided in a detoxification facility.
(6) The treatment plan must include recommendations for any needed crisis stabilization
services for the recipient, including engagement in treatment planning and family
psychoeducation.
(e) "Mental health crisis stabilization services" means individualized mental health
services provided to a recipient following crisis intervention services which are designed
to restore the recipient to the recipient's prior functional level. Mental health crisis
stabilization services may be provided in the recipient's home, the home of a family member
or friend of the recipient, another community setting, or a short-term supervised, licensed
residential program. Mental health crisis stabilization does not include partial hospitalization
or day treatment. Mental health crisis stabilization services includes family psychoeducation.
new text begin
(f) "Clinical trainee" means a person qualified according to section 245I.16, subdivision
6.
new text end
new text begin
(g) "Mental health certified family peer specialist" means a person qualified according
to section 245I.16, subdivision 12.
new text end
new text begin
(h) "Mental health certified peer specialist" means a person qualified according to section
245I.16, subdivision 10.
new text end
new text begin
(i) "Mental health practitioner" means a person qualified according to section 245I.16,
subdivision 4.
new text end
new text begin
(j) "Mental health professional" means a person qualified according to section 245I.16,
subdivision 2.
new text end
new text begin
(k) "Mental health rehabilitation worker" means a person qualified according to section
245I.16, subdivision 14.
new text end
Sec. 73.
Minnesota Statutes 2018, section 256B.0624, subdivision 4, is amended to read:
Subd. 4.
Provider entity standards.
(a) A provider entity is an entity that meets the
standards listed in paragraph (c) and:
(1) is a county board operated entity; deleted text begin or
deleted text end
(2)new text begin is an Indian health service facility or facility owned and operated by a tribe or a tribal
organization operating under United States Code, title 25, section 450f; or
new text end
new text begin (3)new text end is a provider entity that is under contract with the county board in the county where
the potential crisis or emergency is occurring. To provide services under this section, the
provider entity must directly provide the services; or if services are subcontracted, the
provider entity must maintain responsibility for services and billing.
(b) A provider entity that provides crisis stabilization services in a residential setting
under subdivision 7 is not required to meet the requirements of paragraph (a), clauses (1)
deleted text begin and (2)deleted text end new text begin to (3), and paragraph (c), clauses (9), (20), and (21)new text end , but must meet all other
requirements of this subdivision.new text begin Upon approval by the commissioner, a residential crisis
services provider meeting relevant standards for supervision and assessment may allow a
practitioner to perform a crisis assessment to establish eligibility for admission to the
program. A provider performing an assessment under this paragraph shall not bill separately
beyond the daily rate for the residential stabilization program.
new text end
(c) The adult mental health crisis response services provider entity must have the capacity
to meet and carry outnew text begin the requirements in chapter 245I andnew text end the following standards:
(1) has the capacity to recruit, hire, and manage and train deleted text begin mental health professionals,
practitioners, and rehabilitation workersdeleted text end new text begin qualified staffnew text end ;
(2) has adequate administrative ability to ensure availability of services;
(3) is able to ensure adequate preservice and in-service training;
(4) is able to ensure that staff providing these services are skilled in the delivery of
mental health crisis response services to recipients;
(5) is able to ensure that staff are capable of implementing culturally specific treatment
identified in the individual treatment plan that is meaningful and appropriate as determined
by the recipient's culture, beliefs, values, and language;
(6) is able to ensure enough flexibility to respond to the changing intervention and care
needs of a recipient as identified by the recipient during the service partnership between
the recipient and providers;
(7) is able to ensure that deleted text begin mental health professionals and mental health practitionersdeleted text end new text begin staffnew text end
have the communication tools and procedures to communicate and consult promptly about
crisis assessment and interventions as services occur;
(8) is able to coordinate these services with county emergency services, community
hospitals, ambulance, transportation services, social services, law enforcement, and mental
health crisis services through regularly scheduled interagency meetings;
(9) is able to ensure that mental health crisis assessment and mobile crisis intervention
services are available 24 hours a day, seven days a week;
(10) is able to ensure that services are coordinated with other mental health service
providers, county mental health authorities, or federally recognized American Indian
authorities and others as necessary, with the consent of the deleted text begin adultdeleted text end new text begin recipientnew text end . Services must
also be coordinated with the recipient's case manager if the adult is receiving case
management services;
(11)new text begin is able to coordinate services with detoxification according to Minnesota Rules,
parts 9530.6605 to 9530.6655, or withdrawal management according to chapter 245F to
ensure a recipient receives care that is responsive to the recipient's chemical and mental
health needs;
new text end
new text begin (12)new text end is able to ensure that crisis intervention services are provided in a manner consistent
with sections 245.461 to 245.486;
deleted text begin (12)deleted text end new text begin (13)new text end is able to submit information as required by the statenew text begin , including the number of
people served, response times, number of face-to-face contacts, call outcomes, and protocols
for when to respond face-to-facenew text end ;
deleted text begin (13)deleted text end new text begin (14)new text end maintains staff training and personnel filesnew text begin , including documentation of staff
completion of required training modulesnew text end ;
deleted text begin (14)deleted text end new text begin (15)new text end is able to establish and maintain a quality assurance and evaluation plan to
evaluate the outcomes of services and recipient satisfactionnew text begin , including notifying recipients
of the process by which the provider, county, or tribe accepts and responds to concerns, and
the process to file a complaint with the departmentnew text end ;
deleted text begin (15)deleted text end new text begin (16)new text end is able to keep records as required by applicable laws;
deleted text begin (16)deleted text end new text begin (17)new text end is able to comply with all applicable laws and statutes;
deleted text begin (17)deleted text end new text begin (18)new text end is an enrolled medical assistance provider; deleted text begin and
deleted text end
deleted text begin (18)deleted text end new text begin (19)new text end develops and maintains written policies and procedures regarding service
provision and administration of the provider entity, including safety of staff and recipients
in high-risk situationsdeleted text begin .deleted text end new text begin ;
new text end
new text begin
(20) is able to respond to a call for crisis services in a designated service area or according
to a written agreement with the local mental health authority for an adjacent area; and
new text end
new text begin
(21) documents protocol used when delivering services by telemedicine, according to
sections 62A.67 to 62A.672, including responsibilities of the originating site, means to
promote recipient safety, timeliness for connection and response, and steps to take in the
event of a lost connection.
new text end
Sec. 74.
Minnesota Statutes 2018, section 256B.0624, subdivision 5, is amended to read:
Subd. 5.
Mobile crisis intervention staff qualifications.
deleted text begin
For provision of adult mental
health mobile crisis intervention services, a mobile crisis intervention team is comprised of
at least two mental health professionals as defined in section 245.462, subdivision 18, clauses
(1) to (6), or a combination of at least one mental health professional and one mental health
practitioner as defined in section 245.462, subdivision 17, with the required mental health
crisis training and under the clinical supervision of a mental health professional on the team.
deleted text end
new text begin
(a) Mobile crisis intervention team staff must be qualified to provide services as mental
health professionals, mental health practitioners, clinical trainees, mental health certified
family peer specialists, or mental health certified peer specialists.
new text end
new text begin
(b) A mobile crisis intervention team is comprised of at least two members, one of whom
must be qualified as a mental health professional. A second member must be qualified as
a mental health professional, clinical trainee, or mental health practitioner. A provider entity
must consider the needs of the area served when adding staff.
new text end
new text begin
(c) Mental health crisis assessment and intervention services must be led by a mental
health professional, or under the supervision of a mental health professional according to
subdivision 9, by a clinical trainee or mental health practitioner.
new text end
new text begin (d)new text end The team must have deleted text begin at least two people withdeleted text end at least one member providing on-site
crisis intervention services when needed. Team members must be experienced in mental
health assessment, crisis intervention techniques, treatment engagement strategies, working
with families, and clinical decision-making under emergency conditions and have knowledge
of local services and resources. The team must recommend and coordinate the team's services
with appropriate local resources such as the county social services agency, mental health
services, and local law enforcement when necessary.
Sec. 75.
Minnesota Statutes 2018, section 256B.0624, subdivision 6, is amended to read:
Subd. 6.
Crisis assessment and mobile intervention treatment planning.
(a) Prior to
initiating mobile crisis intervention services, a screening of the potential crisis situation
must be conducted. The screening may use the resources of crisis assistance and emergency
services as defined in sections 245.462, subdivision 6, and 245.469, subdivisions 1 and 2.
The screening must gather information, determine whether a crisis situation exists, identify
parties involved, and determine an appropriate response.new text begin Nothing in this section precludes
crisis staff from answering a call from a third party.
new text end
new text begin
(b) In conducting the screening, a provider shall:
new text end
new text begin
(1) employ evidence-based practices as identified by the commissioner in collaboration
with the commissioner of health to reduce the risk of the recipient's suicide and self-injurious
behavior;
new text end
new text begin
(2) work with the recipient to establish a plan and time frame for responding to the crisis,
including immediate needs for support by telephone or text message until a face-to-face
response arrives;
new text end
new text begin
(3) document significant factors related to the determination of a crisis, including prior
calls to the crisis team, recent presentation at an emergency department, known calls to 911
or law enforcement, or third parties with knowledge of a potential recipient's history or
current needs;
new text end
new text begin
(4) screen for the needs of a third-party caller, including a recipient who primarily
identifies as a family member or a caregiver but also presents signs of a crisis; and
new text end
new text begin
(5) provide psychoeducation, including education on the available means for reducing
self-harm, to relevant third parties, including family members or other persons living in the
home.
new text end
new text begin
(c) A provider entity shall consider the following to indicate a positive screening unless
the provider entity documents specific evidence to show why crisis response was clinically
inappropriate:
new text end
new text begin
(1) the recipient presented in an emergency department or urgent care setting, and the
health care team at that location requested crisis services; or
new text end
new text begin
(2) a peace officer requested crisis services for a recipient who may be subject to
transportation under section 253B.05 for a mental health crisis.
new text end
deleted text begin (b)deleted text end new text begin (d)new text end If a crisis exists, a crisis assessment must be completed. A crisis assessment
evaluates any immediate needs for which emergency services are needed and, as time
permits, the recipient's current life situation, new text begin health information including current medications,new text end
sources of stress, mental health problems and symptoms, strengths, cultural considerations,
support network, vulnerabilities, current functioning, and the recipient's preferences as
communicated directly by the recipient, or as communicated in a health care directive as
described in chapters 145C and 253B, the treatment plan described under paragraph (d), a
crisis prevention plan, or a wellness recovery action plan.
deleted text begin (c)deleted text end new text begin (e)new text end If the crisis assessment determines mobile crisis intervention services are needed,
the intervention services must be provided promptly. As opportunity presents during the
intervention, at least two members of the mobile crisis intervention team must confer directly
or by telephone about the assessment, treatment plan, and actions taken and needed. At least
one of the team members must be on site providing crisis intervention services. If providing
on-site crisis intervention services, a mental health practitioner must seek deleted text begin clinicaldeleted text end new text begin treatmentnew text end
supervision as required in subdivision 9.
new text begin
(f) Direct contact with the recipient is not required before initiating a crisis assessment
or intervention service. A crisis team may gather relevant information from a third party at
the scene to establish the need for services and potential safety factors. A crisis assessment
is provided face-to-face by a mobile crisis intervention team outside of an inpatient hospital
setting. A service must be provided promptly and respond to the recipient's location whenever
possible, including community or clinical settings. As clinically appropriate, a mobile crisis
intervention team must coordinate a response with other health care providers if a recipient
requires detoxification, withdrawal management, or medical stabilization services in addition
to crisis services.
new text end
deleted text begin (d)deleted text end new text begin (g)new text end The mobile crisis intervention team must develop an initial, brief crisis treatment
plan as soon as appropriate but no later than 24 hours after the initial face-to-face intervention.
The plan must address the needs and problems noted in the crisis assessment and include
measurable short-term goals, cultural considerations, and frequency and type of services to
be provided to achieve the goals and reduce or eliminate the crisis. The treatment plan must
be updated as needed to reflect current goals and services.
deleted text begin (e)deleted text end new text begin (h)new text end The team must document which short-term goals have been met and when no
further crisis intervention services are required.new text begin If after an assessment a crisis provider entity
refers a recipient to an intensive setting, including an emergency department, in-patient
hospitalization, or crisis residential treatment, one of the crisis team members who performed
or conferred on the assessment must immediately contact the provider entity and consult
with the triage nurse or other staff responsible for intake. The crisis team member must
convey key findings or concerns that led to the referral. The consultation shall occur with
the recipient's consent, the recipient's legal guardian's consent, or as allowed by section
144.293, subdivision 5. Any available written documentation, including a crisis treatment
plan, must be sent no later than the next business day.
new text end
deleted text begin (f)deleted text end new text begin (i)new text end If the recipient's crisis is stabilized, but the recipient needs a referral to other
services, the team must provide referrals to these services. If the recipient has a case manager,
planning for other services must be coordinated with the case manager. If the recipient is
unable to follow up on the referral, the team must link the recipient to the service and follow
up to ensure the recipient is receiving the service.
deleted text begin (g)deleted text end new text begin (j)new text end If the recipient's crisis is stabilized and the recipient does not have an advance
directive, the case manager or crisis team shall offer to work with the recipient to develop
one.
new text begin
(k) If an intervention service is provided without the recipient present, the provider shall
document the reasons why the service is more effective without the recipient present.
new text end
Sec. 76.
Minnesota Statutes 2018, section 256B.0624, subdivision 7, is amended to read:
Subd. 7.
Crisis stabilization services.
(a) Crisis stabilization services must be provided
by qualified staff of a crisis stabilization services provider entity and must meet the following
standards:
(1) a crisis stabilization treatment plan must be developed which meets the criteria in
subdivision 11;
(2) staff must be qualified as defined in subdivision 8; deleted text begin and
deleted text end
(3) services must be delivered according to the treatment plan and include face-to-face
contact with the recipient by qualified staff for further assessment, help with referrals,
updating of the crisis stabilization treatment plan, supportive counseling, skills training,
and collaboration with other service providers in the communitydeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(4) if a stabilization service is provided without the recipient present, the provider shall
document the reasons why the service is more effective without the recipient present.
new text end
(b) If crisis stabilization services are provided in a supervised, licensed residential setting,
the recipient must be contacted face-to-face daily by a qualified mental health practitioner
or mental health professional. The program must have 24-hour-a-day residential staffing
which may include staff who do not meet the qualifications in subdivision 8. The residential
staff must have 24-hour-a-day immediate direct or telephone access to a qualified mental
health professional or practitioner.
(c) If crisis stabilization services are provided in a supervised, licensed residential setting
that serves no more than four adult residents, and one or more individuals are present at the
setting to receive residential crisis stabilization services, the residential staff must include,
for at least eight hours per day, at least one individual who meets the qualifications in
subdivision 8, paragraph (a), clause (1) or (2).
(d) If crisis stabilization services are provided in a supervised, licensed residential setting
that serves more than four adult residents, and one or more are recipients of crisis stabilization
services, the residential staff must include, for 24 hours a day, at least one individual who
meets the qualifications in subdivision 8. new text begin When more than four residents are present at the
setting new text end during the first 48 hours that a recipient is in the residential program, the residential
program must have at least two staff working 24 hours a day. Staffing levels may be adjusted
thereafter according to the needs of the recipient as specified in the crisis stabilization
treatment plan.
Sec. 77.
Minnesota Statutes 2018, section 256B.0624, subdivision 8, is amended to read:
Subd. 8.
Adult crisis stabilization staff qualifications.
deleted text begin (a)deleted text end Adult mental health crisis
stabilization services must be provided by qualified individual staff of a qualified provider
entity. Individual provider staff must deleted text begin have the following qualificationsdeleted text end new text begin benew text end :
(1) deleted text begin bedeleted text end a mental health professional deleted text begin as defined in section 245.462, subdivision 18, clauses
(1) to (6)deleted text end ;
(2) deleted text begin bedeleted text end a mental health practitioner deleted text begin as defined in section 245.462, subdivision 17. The
mental health practitioner must work under the clinical supervision of a mental health
professionaldeleted text end ;
(3) deleted text begin bedeleted text end a new text begin mental health new text end certified peer specialist deleted text begin under section 256B.0615. The certified
peer specialist must work under the clinical supervision of a mental health professionaldeleted text end ; or
(4) deleted text begin bedeleted text end a mental health rehabilitation worker deleted text begin who meets the criteria in section 256B.0623,
subdivision 5, paragraph (a), clause (4); works under the direction of a mental health
practitioner as defined in section 245.462, subdivision 17, or under direction of a mental
health professional; and works under the clinical supervision of a mental health professionaldeleted text end .
deleted text begin
(b) Mental health practitioners and mental health rehabilitation workers must have
completed at least 30 hours of training in crisis intervention and stabilization during the
past two years.
deleted text end
Sec. 78.
Minnesota Statutes 2018, section 256B.0624, subdivision 9, is amended to read:
Subd. 9.
Supervision.
Mental health practitionersnew text begin or clinical traineesnew text end may provide crisis
assessment and mobile crisis intervention services if the following deleted text begin clinicaldeleted text end new text begin treatmentnew text end
supervision requirements are met:
(1) the mental health provider entity must accept full responsibility for the services
provided;
(2) the mental health professional of the provider entity, who is an employee or under
contract with the provider entity, must be immediately available by phone or in person for
clinical supervision;
(3) the mental health professional is consulted, in person or by phone, during the first
three hours when a mental health practitionernew text begin or clinical traineenew text end provides on-site service;
(4) the mental health professional must:
(i) review and approve of the tentative crisis assessment and crisis treatment plan;
(ii) document the consultation; and
(iii) sign the crisis assessment and treatment plan within the next business day;new text begin and
new text end
deleted text begin
(5) if the mobile crisis intervention services continue into a second calendar day, a mental
health professional must contact the recipient face-to-face on the second day to provide
services and update the crisis treatment plan; and
deleted text end
deleted text begin (6)deleted text end new text begin (5)new text end the on-site observation must be documented in the recipient's record and signed
by the mental health professional.
Sec. 79.
Minnesota Statutes 2018, section 256B.0624, subdivision 11, is amended to read:
Subd. 11.
Treatment plan.
The individual crisis stabilization treatment plan must include,
at a minimum:
(1) a list of problems identified in the assessment;
(2) a list of the recipient's strengths and resources;
(3) concrete, measurable short-term goals and tasks to be achieved, including time frames
for achievement;
(4) specific objectives directed toward the achievement of each one of the goals;
(5) documentation of the participants involved in the service planning. The recipient, if
possible, must be a participant. The recipient or the recipient's legal guardian must sign the
service plan or documentation must be provided why this was not possible. A copy of the
plan must be given to the recipient and the recipient's legal guardian. The plan should include
services arranged, including specific providers where applicable;
(6) planned frequency and type of services initiated;
(7) a crisis response action plan if a crisis should occur;
(8) clear progress notes on outcome of goals;
(9) a written plan must be completed within 24 hours of beginning services with the
recipient; and
(10) a treatment plan must be developed by a mental health professionalnew text begin , clinical trainee,new text end
or mental health practitioner deleted text begin under the clinical supervision of a mental health professionaldeleted text end .
The mental health professional must approve and sign all treatment plans.
Sec. 80.
Minnesota Statutes 2018, section 256B.0625, subdivision 3b, is amended to read:
Subd. 3b.
Telemedicine services.
(a) Medical assistance covers medically necessary
services and consultations delivered by a licensed health care provider via telemedicine in
the same manner as if the service or consultation was delivered in person. Coverage is
limited to three telemedicine services per enrollee per calendar week. Telemedicine services
shall be paid at the full allowable rate.
(b) The commissioner shall establish criteria that a health care provider must attest to
in order to demonstrate the safety or efficacy of delivering a particular service via
telemedicine. The attestation may include that the health care provider:
(1) has identified the categories or types of services the health care provider will provide
via telemedicine;
(2) has written policies and procedures specific to telemedicine services that are regularly
reviewed and updated;
(3) has policies and procedures that adequately address patient safety before, during,
and after the telemedicine service is rendered;
(4) has established protocols addressing how and when to discontinue telemedicine
services; and
(5) has an established quality assurance process related to telemedicine services.
(c) As a condition of payment, a licensed health care provider must document each
occurrence of a health service provided by telemedicine to a medical assistance enrollee.
Health care service records for services provided by telemedicine must meet the requirements
set forth in Minnesota Rules, part 9505.2175, subparts 1 and 2, and must document:
(1) the type of service provided by telemedicine;
(2) the time the service began and the time the service ended, including an a.m. and p.m.
designation;
(3) the licensed health care provider's basis for determining that telemedicine is an
appropriate and effective means for delivering the service to the enrollee;
(4) the mode of transmission of the telemedicine service and records evidencing that a
particular mode of transmission was utilized;
(5) the location of the originating site and the distant site;
(6) if the claim for payment is based on a physician's telemedicine consultation with
another physician, the written opinion from the consulting physician providing the
telemedicine consultation; and
(7) compliance with the criteria attested to by the health care provider in accordance
with paragraph (b).
(d) For purposes of this subdivision, unless otherwise covered under this chapter,
"telemedicine" is defined as the delivery of health care services or consultations while the
patient is at an originating site and the licensed health care provider is at a distant site. A
communication between licensed health care providers, or a licensed health care provider
and a patient that consists solely of a telephone conversation, e-mail, or facsimile transmission
does not constitute telemedicine consultations or services. Telemedicine may be provided
by means of real-time two-way, interactive audio and visual communications, including the
application of secure video conferencing or store-and-forward technology to provide or
support health care delivery, which facilitate the assessment, diagnosis, consultation,
treatment, education, and care management of a patient's health care.
(e) For purposes of this section, "licensed health care provider" means a licensed health
care provider under section 62A.671, subdivision 6, new text begin a clinical trainee, new text end and a mental health
practitioner defined under section 245.462, subdivision 17deleted text begin , or 245.4871, subdivision 26deleted text end ,
working under the general supervision of a mental health professional; "health care provider"
is defined under section 62A.671, subdivision 3; and "originating site" is defined under
section 62A.671, subdivision 7.
Sec. 81.
Minnesota Statutes 2018, section 256B.0625, subdivision 5, is amended to read:
Subd. 5.
Community mental health center services.
Medical assistance covers
community mental health center services provided by a community mental health center
that meets the requirements in paragraphs (a) to (j).
(a) The provider is licensed under Minnesota Rules, parts 9520.0750 to 9520.0870new text begin , and
in compliance with requirements under chapter 245I and section 256B.0671new text end .
(b) The provider provides mental health services under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision
of a mental health professional who is licensed for independent practice at the doctoral level
or by a board-certified psychiatrist or a psychiatrist who is eligible for board certification.
deleted text begin Clinical supervision has the meaning given in Minnesota Rules, part 9505.0370, subpart 6.deleted text end new text begin
Treatment supervision means the treatment supervision described under section 245I.18.
new text end
(c) The provider must be a private nonprofit corporation or a governmental agency and
have a community board of directors as specified by section 245.66.
(d) The provider must have a sliding fee scale that meets the requirements in section
245.481, and agree to serve within the limits of its capacity all individuals residing in its
service delivery area.
(e) At a minimum, the provider must provide the following outpatient mental health
services: diagnostic assessment; explanation of findings;new text begin andnew text end family, group, and individual
psychotherapy, including crisis intervention psychotherapy servicesdeleted text begin , multiple family group
psychotherapydeleted text end , psychological testing, and medication management. In addition, the provider
must provide or be capable of providing upon request of the local mental health authority
day treatment servicesnew text begin , multiple family group psychotherapy,new text end and professional home-based
mental health services. The provider must have the capacity to provide such services to
specialized populations such as the elderly, families with children, persons who are seriously
and persistently mentally ill, and children who are seriously emotionally disturbed.
(f) The provider must be capable of providing the services specified in paragraph (e) to
individuals who are new text begin dually new text end diagnosed with deleted text begin bothdeleted text end new text begin anew text end mental illness or emotional disturbancedeleted text begin ,deleted text end
and deleted text begin chemical dependencydeleted text end new text begin substance use disordernew text end , and to individuals new text begin who are new text end dually diagnosed
with a mental illness or emotional disturbance and developmental disability.
(g) The provider must provide 24-hour emergency care services or demonstrate the
capacity to assist recipients in need of such services to access such services on a 24-hour
basis.
(h) The provider must have a contract with the local mental health authority to provide
one or more of the services specified in paragraph (e).
(i) The provider must agree, upon request of the local mental health authority, to enter
into a contract with the county to provide mental health services not reimbursable under
the medical assistance program.
(j) The provider may not be enrolled with the medical assistance program as both a
hospital and a community mental health center. The community mental health center's
administrative, organizational, and financial structure must be separate and distinct from
that of the hospital.
Sec. 82.
Minnesota Statutes 2018, section 256B.0625, subdivision 5l, is amended to read:
Subd. 5l.
Intensive mental health outpatient treatment.
new text begin (a) new text end Medical assistance covers
intensive mental health outpatient treatment for dialectical behavioral therapy for adults.
The commissioner shall establish:
(1) certification procedures to ensure that providers of these services are qualifiednew text begin and
meet the standards in chapter 245Inew text end ; and
(2) treatment protocols including required service components and criteria for admission,
continued treatment, and discharge.
new text begin
(b) "Dialectical behavior therapy" means an evidence-based treatment approach provided
in an intensive outpatient treatment program using a combination of individualized
rehabilitative and psychotherapeutic interventions. A dialectical behavior therapy program
involves the following service components: individual dialectical behavior therapy, group
skills training, telephone coaching, and team consultation meetings.
new text end
new text begin
(c) To be eligible for dialectical behavior therapy a client must:
new text end
new text begin
(1) be 18 years of age or older;
new text end
new text begin
(2) have mental health needs that cannot be met with other available community-based
services or that must be provided concurrently with other community-based services;
new text end
new text begin
(3) meet one of the following criteria:
new text end
new text begin
(i) have a diagnosis of borderline personality disorder; or
new text end
new text begin
(ii) have multiple mental health diagnoses, exhibit behaviors characterized by impulsivity
or intentional self-harm, and be at significant risk of death, morbidity, disability, or severe
dysfunction across multiple life areas;
new text end
new text begin
(4) understand and be cognitively capable of participating in dialectical behavior therapy
as an intensive therapy program and be able and willing to follow program policies and
rules ensuring safety of self and others; and
new text end
new text begin
(5) be at significant risk of one or more of the following if dialectical behavior therapy
is not provided:
new text end
new text begin
(i) having a mental health crisis;
new text end
new text begin
(ii) requiring a more restrictive setting including hospitalization;
new text end
new text begin
(iii) decompensation; or
new text end
new text begin
(iv) engaging in intentional self-harm behavior.
new text end
new text begin
(d) Individual dialectical behavior therapy combines individualized rehabilitative and
psychotherapeutic interventions to treat suicidal and other dysfunctional behaviors and
reinforce the use of adaptive skillful behaviors. Individual dialectical behavior therapy must
be provided by a mental health professional or a clinical trainee. The mental health
professional or clinical trainee must:
new text end
new text begin
(1) identify, prioritize, and sequence behavioral targets;
new text end
new text begin
(2) treat behavioral targets;
new text end
new text begin
(3) generalize dialectical behavior therapy skills to the client's natural environment
through telephone coaching outside of the treatment session;
new text end
new text begin
(4) measure the client's progress toward dialectical behavior therapy targets;
new text end
new text begin
(5) help the client manage mental health crises and life-threatening behaviors; and
new text end
new text begin
(6) help the client learn and apply effective behaviors when working with other treatment
providers.
new text end
new text begin
(e) Group skills training combines individualized psychotherapeutic and psychiatric
rehabilitative interventions conducted in a group setting to reduce the client's suicidal and
other dysfunctional coping behaviors and restore function. Group skills training must teach
the client adaptive skills in the following areas:
new text end
new text begin
(1) mindfulness;
new text end
new text begin
(2) interpersonal effectiveness;
new text end
new text begin
(3) emotional regulation; and
new text end
new text begin
(4) distress tolerance.
new text end
new text begin
(f) Group skills training must be provided by two mental health professionals, or by a
mental health professional co-facilitating with a clinical trainee or a mental health practitioner
as specified in section 245I.16, subdivision 4. Individual skills training must be provided
by a mental health professional, a clinical trainee, or a mental health practitioner as specified
in section 245I.16, subdivision 4.
new text end
new text begin
(g) A program must be certified by the commissioner as a dialectical behavior therapy
provider. To qualify for certification, a provider must:
new text end
new text begin
(1) submit to the commissioner's inspection;
new text end
new text begin
(2) provide evidence that the dialectical behavior therapy program's policies, procedures,
and practices continuously meet the requirements of this subdivision;
new text end
new text begin
(3) be enrolled as a MHCP provider;
new text end
new text begin
(4) collect and report client outcomes as specified by the commissioner; and
new text end
new text begin
(5) have a manual that outlines the dialectical behavior therapy program's policies,
procedures, and practices that meet the requirements of this subdivision.
new text end
Sec. 83.
Minnesota Statutes 2018, section 256B.0625, subdivision 19c, is amended to
read:
Subd. 19c.
Personal care.
Medical assistance covers personal care assistance services
provided by an individual who is qualified to provide the services according to subdivision
19a and sections 256B.0651 to 256B.0654, provided in accordance with a plan, and
supervised by a qualified professional.
"Qualified professional" means a mental health professional deleted text begin as defined in section deleted text end deleted text begin 245.462,deleted text end
deleted text begin subdivision 18deleted text end deleted text begin , clauses (1) to (6), or deleted text end deleted text begin 245.4871, subdivision 27deleted text end deleted text begin , clauses (1) to (6)deleted text end ; a registered
nurse as defined in sections 148.171 to 148.285, a licensed social worker as defined in
sections 148E.010 and 148E.055, or a qualified designated coordinator under section
245D.081, subdivision 2. The qualified professional shall perform the duties required in
section 256B.0659.
Sec. 84.
Minnesota Statutes 2018, section 256B.0625, subdivision 23, is amended to read:
Subd. 23.
new text begin Adult new text end day treatment services.
new text begin (a) new text end Medical assistance covers new text begin adult new text end day
treatment services as specified in sections 245.462, subdivision 8, and 245.4871, subdivision
10, that are provided under contract with the county board. The commissioner may set
authorization thresholds for day treatment for adults according to subdivision 25. Medical
assistance covers day treatment services for children as specified under section 256B.0943.new text begin
Adult day treatment payment is limited to the conditions in paragraphs (b) to (e).
new text end
new text begin
(b) Adult day treatment is an intensive psychotherapeutic treatment to reduce or relieve
the effects of mental illness to enable the client to benefit from a lower level of care and to
live and function more independently in the community. Adult day treatment services must
stabilize the client's mental health status and develop and improve the client's independent
living and socialization skills. Adult day treatment must consist of at least one hour of group
psychotherapy and must include group time focused on rehabilitative interventions or other
therapeutic services that are provided by a multidisciplinary staff person. Adult day treatment
services are not a part of inpatient or residential treatment services.
new text end
new text begin
(c) To be eligible for medical assistance payment, an adult day treatment service must:
new text end
new text begin
(1) be reviewed by and approved by the commissioner;
new text end
new text begin
(2) be provided to a group of clients by a multidisciplinary staff person under the
treatment supervision of a mental health professional as described under section 245I.18;
new text end
new text begin
(3) be available to the client at least two days a week for at least three consecutive hours
per day. The adult day treatment may be longer than three hours per day, but medical
assistance must not reimburse a provider for more than 15 hours per week;
new text end
new text begin
(4) include group psychotherapy by a mental health professional or clinical trainee and
daily rehabilitative interventions by a mental health professional qualified according to
section 245I.16, subdivision 2, clinical trainee qualified according to section 245I.16,
subdivision 6, or mental health practitioner qualified according to section 245I.16, subdivision
4;
new text end
new text begin
(5) be included in the client's individual treatment plan as described under section
256B.0671, subdivisions 5 and 6, as appropriate. The individual treatment plan must include
attainable, measurable goals related to services and must be completed before the first adult
day treatment session. The vendor must review the client's progress and update the treatment
plan at least every 30 days until the client is discharged and include an available discharge
plan for the client in the treatment plan; and
new text end
new text begin
(6) document the daily interventions provided and the client's response according to
section 245I.33.
new text end
new text begin
(d) To be eligible for adult day treatment, a client must:
new text end
new text begin
(1) be 18 years of age or older;
new text end
new text begin
(2) not be residing in a nursing facility, hospital, institute of mental disease, or regional
treatment center unless the client has an active discharge plan that indicates a move to an
independent living arrangement within 180 days;
new text end
new text begin
(3) have a diagnosis of mental illness as determined by a diagnostic assessment;
new text end
new text begin
(4) have the capacity to engage in the rehabilitative nature, the structured setting, and
the therapeutic parts of psychotherapy and skills activities of an adult day treatment program
and demonstrate measurable improvements in the client's functioning related to the client's
mental illness that would result from participating in the adult day treatment program;
new text end
new text begin
(5) have at least three areas of functional impairment as determined by a functional
assessment with the domains prescribed by section 245.462, subdivision 11a;
new text end
new text begin
(6) have a level of care determination that supports the need for the level of intensity
and duration of an adult day treatment program; and
new text end
new text begin
(7) be determined to need adult day treatment services by a mental health professional
who must deem the adult day treatment services medically necessary.
new text end
new text begin
(e) The following services are not covered by medical assistance as an adult day treatment
service:
new text end
new text begin
(1) a service that is primarily recreation-oriented or that is provided in a setting that is
not medically supervised. This includes sports activities, exercise groups, craft hours, leisure
time, social hours, meal or snack time, trips to community activities, and tours;
new text end
new text begin
(2) a social or educational service that does not have or cannot reasonably be expected
to have a therapeutic outcome related to the client's mental illness;
new text end
new text begin
(3) consultation with other providers or service agency staff persons about the care or
progress of a client;
new text end
new text begin
(4) prevention or education programs provided to the community;
new text end
new text begin
(5) day treatment for clients with primary diagnoses of alcohol or other drug abuse;
new text end
new text begin
(6) day treatment provided in the client's home;
new text end
new text begin
(7) psychotherapy for more than two hours per day; and
new text end
new text begin
(8) participation in meal preparation and eating that is not part of a clinical treatment
plan to address the client's eating disorder.
new text end
Sec. 85.
Minnesota Statutes 2018, section 256B.0625, subdivision 42, is amended to read:
Subd. 42.
Mental health professional.
Notwithstanding Minnesota Rules, part
9505.0175, subpart 28, the definition of a mental health professional shall include a person
who is qualified as specified in section deleted text begin 245.462, subdivision 18deleted text end deleted text begin , clauses (1) to (6); or
deleted text end deleted text begin 245.4871, subdivision 27deleted text end deleted text begin , clauses (1) to (6),deleted text end new text begin 245I.16, subdivision 2,new text end for the purpose of this
section and Minnesota Rules, parts 9505.0170 to 9505.0475.
Sec. 86.
Minnesota Statutes 2018, section 256B.0625, subdivision 48, is amended to read:
Subd. 48.
Psychiatric consultation to primary care practitioners.
Medical assistance
covers consultation provided by a deleted text begin psychiatrist, a psychologist, an advanced practice registered
nurse certified in psychiatric mental health, a licensed independent clinical social worker,
as defined in section 245.462, subdivision 18, clause (2), or a licensed marriage and family
therapist, as defined in section 245.462, subdivision 18, clause (5),deleted text end new text begin mental health professional
except one licensed under section 148B.5301new text end via telephone, e-mail, facsimile, or other
means of communication to primary care practitioners, including pediatricians. The need
for consultation and the receipt of the consultation must be documented in the patient record
maintained by the primary care practitioner. If the patient consents, and subject to federal
limitations and data privacy provisions, the consultation may be provided without the patient
present.
Sec. 87.
Minnesota Statutes 2018, section 256B.0625, subdivision 49, is amended to read:
Subd. 49.
Community health worker.
(a) Medical assistance covers the care
coordination and patient education services provided by a community health worker if the
community health worker hasdeleted text begin : (1)deleted text end received a certificate from the Minnesota State Colleges
and Universities System approved community health worker curriculumdeleted text begin ; ordeleted text end new text begin .
new text end
deleted text begin
(2) at least five years of supervised experience with an enrolled physician, registered
nurse, advanced practice registered nurse, mental health professional as defined in section
245.462, subdivision 18, clauses (1) to (6), and section 245.4871, subdivision 27, clauses
(1) to (5), or dentist, or at least five years of supervised experience by a certified public
health nurse operating under the direct authority of an enrolled unit of government.
deleted text end
deleted text begin
Community health workers eligible for payment under clause (2) must complete the
certification program by January 1, 2010, to continue to be eligible for payment.
deleted text end
(b) Community health workers must work under the supervision of a medical assistance
enrolled physician, registered nurse, advanced practice registered nurse, mental health
professional deleted text begin as defined in section deleted text begin 245.462, subdivision 18deleted text end , clauses (1) to (6), and section
deleted text begin 245.4871, subdivision 27deleted text end , clauses (1) to (5)deleted text end , or dentist, or work under the supervision of a
certified public health nurse operating under the direct authority of an enrolled unit of
government.
(c) Care coordination and patient education services covered under this subdivision
include, but are not limited to, services relating to oral health and dental care.
Sec. 88.
Minnesota Statutes 2018, section 256B.0625, subdivision 56a, is amended to
read:
Subd. 56a.
deleted text begin Post-arrestdeleted text end new text begin Officer-involved new text end community-based deleted text begin servicedeleted text end new text begin care
new text end coordination.
(a) Medical assistance covers deleted text begin post-arrestdeleted text end new text begin officer-involved new text end community-based
deleted text begin servicedeleted text end new text begin care new text end coordination for an individual who:
(1) has deleted text begin been identified as havingdeleted text end new text begin screened positive for benefiting from treatment for new text end a
mental illness or substance use disorder using a deleted text begin screeningdeleted text end tool approved by the commissioner;
(2) does not require the security of a public detention facility and is not considered an
inmate of a public institution as defined in Code of Federal Regulations, title 42, section
435.1010;
(3) meets the eligibility requirements in section 256B.056; and
(4) has agreed to participate in deleted text begin post-arrestdeleted text end new text begin officer-involved new text end community-based deleted text begin servicedeleted text end
new text begin care new text end coordination deleted text begin through a diversion contract in lieu of incarcerationdeleted text end .
(b) deleted text begin Post-arrestdeleted text end new text begin Officer-involvednew text end community-based deleted text begin servicedeleted text end new text begin care new text end coordination means
navigating services to address a client's mental health, chemical health, social, economic,
and housing needs, or any other activity targeted at reducing the incidence of jail utilization
and connecting individuals with existing covered services available to them, including, but
not limited to, targeted case management, waiver case management, or care coordination.
(c) deleted text begin Post-arrestdeleted text end new text begin Officer-involved new text end community-based deleted text begin servicedeleted text end new text begin care new text end coordination must be
provided by an individual who is an employee of deleted text begin a countydeleted text end or is under contract with a countynew text begin ,
or is an employee of or under contract with an Indian health service facility or facility owned
and operated by a tribe or a tribal organization operating under Public Law 93-638 as a 638
facilitynew text end to provide deleted text begin post-arrestdeleted text end new text begin officer-involved new text end community-based new text begin care new text end coordination and is
qualified under one of the following criteria:
(1) a licensed mental health professional deleted text begin as defined in section 245.462, subdivision 18,
clauses (1) to (6)deleted text end ;
(2) a mental health practitioner as defined in section 245.462, subdivision 17, working
under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional; deleted text begin or
deleted text end
(3) a certified peer specialist under section 256B.0615, working under the deleted text begin clinicaldeleted text end new text begin
treatmentnew text end supervision of a mental health professionaldeleted text begin .deleted text end new text begin ;
new text end
new text begin
(4) a clinical trainee;
new text end
new text begin
(5) an individual qualified as an alcohol and drug counselor under section 245G.11,
subdivision 5; or
new text end
new text begin
(6) a recovery peer qualified under section 245G.11, subdivision 8, working under the
supervision of an individual qualified as an alcohol and drug counselor under section
245G.11, subdivision 5.
new text end
(d) Reimbursement is allowed for up to 60 days following the initial determination of
eligibility.
(e) Providers of deleted text begin post-arrestdeleted text end new text begin officer-involved new text end community-based deleted text begin servicedeleted text end new text begin care new text end coordination
shall annually report to the commissioner on the number of individuals served, and number
of the community-based services that were accessed by recipients. The commissioner shall
ensure that services and payments provided under deleted text begin post-arrestdeleted text end new text begin officer-involved
new text end community-based deleted text begin servicedeleted text end new text begin care new text end coordination do not duplicate services or payments provided
under section 256B.0625, subdivision 20, 256B.0753, 256B.0755, or 256B.0757.
(f) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of cost for
post-arrest community-based service coordination services shall be provided by the county
providing the services, from sources other than federal funds or funds used to match other
federal funds.
Sec. 89.
Minnesota Statutes 2018, section 256B.0625, subdivision 61, is amended to read:
Subd. 61.
Family psychoeducation services.
deleted text begin Effective July 1, 2013, or upon federal
approval, whichever is later,deleted text end Medical assistance covers family psychoeducation services
provided to a child up to age 21 with a diagnosed mental health condition when identified
in the child's individual treatment plan and provided by a licensed mental health professionaldeleted text begin ,
as defined in Minnesota Rules, part 9505.0371, subpart 5, item A,deleted text end or a clinical traineedeleted text begin , as
defined in Minnesota Rules, part 9505.0371, subpart 5, item C,deleted text end who has determined it
medically necessary to involve family members in the child's care. For the purposes of this
subdivision, "family psychoeducation services" means information or demonstration provided
to an individual or family as part of an individual, family, multifamily group, or peer group
session to explain, educate, and support the child and family in understanding a child's
symptoms of mental illness, the impact on the child's development, and needed components
of treatment and skill development so that the individual, family, or group can help the child
to prevent relapse, prevent the acquisition of comorbid disorders, and achieve optimal mental
health and long-term resilience.
Sec. 90.
Minnesota Statutes 2018, section 256B.0625, subdivision 62, is amended to read:
Subd. 62.
Mental health clinical care consultation.
deleted text begin Effective July 1, 2013, or upon
federal approval, whichever is later,deleted text end Medical assistance covers clinical care consultation
for a person up to age 21 who is diagnosed with a complex mental health condition or a
mental health condition that co-occurs with other complex and chronic conditions, when
described in the person's individual treatment plan and provided by a licensed mental health
professionaldeleted text begin , as defined in Minnesota Rules, part 9505.0371, subpart 5, item A,deleted text end or a clinical
traineedeleted text begin , as defined in Minnesota Rules, part 9505.0371, subpart 5, item Cdeleted text end . For the purposes
of this subdivision, "clinical care consultation" means communication from a treating mental
health professional to other providers or educators not under the clinical supervision of the
treating mental health professional who are working with the same client to inform, inquire,
and instruct regarding the client's symptoms; strategies for effective engagement, care, and
intervention needs; and treatment expectations across service settings; and to direct and
coordinate clinical service components provided to the client and family.
Sec. 91.
Minnesota Statutes 2018, section 256B.0625, subdivision 65, is amended to read:
Subd. 65.
Outpatient mental health services.
new text begin For the purposes of this section, "clinical
trainee" has the meaning given in section 245I.16, subdivision 6. new text end Medical assistance covers
diagnostic assessment, explanation of findings, and psychotherapy according to deleted text begin Minnesota
Rules, part 9505.0372,deleted text end new text begin subdivision 69 and section 256B.0671new text end when the mental health
services are performed by deleted text begin a mental health practitioner working asdeleted text end a clinical trainee deleted text begin according
to section 245.462, subdivision 17, paragraph (g)deleted text end .
Sec. 92.
Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 66. new text end
new text begin Neuropsychological assessment. new text end
new text begin
(a) "Neuropsychological assessment" means
a specialized clinical assessment of the client's underlying cognitive abilities related to
thinking, reasoning, and judgment that is conducted by a qualified neuropsychologist. A
neuropsychological assessment must include a face-to-face interview with the client,
interpretation of the test results, and preparation and completion of a report.
new text end
new text begin
(b) A client is eligible for a neuropsychological assessment if at least one of the following
criteria is met:
new text end
new text begin
(1) there is a known or strongly suspected brain disorder based on medical history or
neurological evaluation, including a history of significant head trauma, brain tumor, stroke,
seizure disorder, multiple sclerosis, neurodegenerative disorder, significant exposure to
neurotoxins, central nervous system infection, metabolic or toxic encephalopathy, fetal
alcohol syndrome, or congenital malformation of the brain; or
new text end
new text begin
(2) there are cognitive or behavioral symptoms that suggest that the client has an organic
condition that cannot be readily attributed to functional psychopathology or suspected
neuropsychological impairment in addition to functional psychopathology. This includes:
new text end
new text begin
(i) poor memory or impaired problem solving;
new text end
new text begin
(ii) change in mental status evidenced by lethargy, confusion, or disorientation;
new text end
new text begin
(iii) deterioration in level of functioning;
new text end
new text begin
(iv) marked behavioral or personality change;
new text end
new text begin
(v) in children or adolescents, significant delays in academic skill acquisition or poor
attention relative to peers;
new text end
new text begin
(vi) in children or adolescents, significant plateau in expected development of cognitive,
social, emotional, or physical function relative to peers; and
new text end
new text begin
(vii) in children or adolescents, significant inability to develop expected knowledge,
skills, or abilities as required to adapt to new or changing cognitive, social, emotional, or
physical demands.
new text end
new text begin
(c) The neuropsychological assessment must be conducted by a neuropsychologist
competent in the area of neuropsychological assessment who:
new text end
new text begin
(1) was awarded a diploma by the American Board of Clinical Neuropsychology, the
American Board of Professional Neuropsychology, or the American Board of Pediatric
Neuropsychology;
new text end
new text begin
(2) earned a doctoral degree in psychology from an accredited university training program
and:
new text end
new text begin
(i) completed an internship or its equivalent in a clinically relevant area of professional
psychology;
new text end
new text begin
(ii) completed the equivalent of two full-time years of experience and specialized training,
at least one of which is at the postdoctoral level, supervised by a clinical neuropsychologist
in the study and practice of clinical neuropsychology and related neurosciences; and
new text end
new text begin
(iii) holds a current license to practice psychology independently according to sections
144.88 to 144.98;
new text end
new text begin
(3) is licensed or credentialed by another state's board of psychology examiners in the
specialty of neuropsychology using requirements equivalent to requirements specified by
one of the boards named in clause (1); or
new text end
new text begin
(4) was approved by the commissioner as an eligible provider of neuropsychological
assessment prior to December 31, 2010.
new text end
Sec. 93.
Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 67. new text end
new text begin Neuropsychological testing. new text end
new text begin
(a) "Neuropsychological testing" means
administering standardized tests and measures designed to evaluate the client's ability to
attend to, process, interpret, comprehend, communicate, learn, and recall information and
use problem solving and judgment.
new text end
new text begin
(b) Medical assistance covers neuropsychological testing when the client:
new text end
new text begin
(1) has a significant mental status change that is not a result of a metabolic disorder and
that has failed to respond to treatment;
new text end
new text begin
(2) is a child or adolescent with a significant plateau in expected development of
cognitive, social, emotional, or physical function relative to peers;
new text end
new text begin
(3) is a child or adolescent with a significant inability to develop expected knowledge,
skills, or abilities as required to adapt to new or changing cognitive, social, physical, or
emotional demands; or
new text end
new text begin
(4) has a significant behavioral change, memory loss, or suspected neuropsychological
impairment in addition to functional psychopathology, or other organic brain injury or one
of the following:
new text end
new text begin
(i) traumatic brain injury;
new text end
new text begin
(ii) stroke;
new text end
new text begin
(iii) brain tumor;
new text end
new text begin
(iv) substance use disorder;
new text end
new text begin
(v) cerebral anoxic or hypoxic episode;
new text end
new text begin
(vi) central nervous system infection or other infectious disease;
new text end
new text begin
(vii) neoplasms or vascular injury of the central nervous system;
new text end
new text begin
(viii) neurodegenerative disorders;
new text end
new text begin
(ix) demyelinating disease;
new text end
new text begin
(x) extrapyramidal disease;
new text end
new text begin
(xi) exposure to systemic or intrathecal agents or cranial radiation known to be associated
with cerebral dysfunction;
new text end
new text begin
(xii) systemic medical conditions known to be associated with cerebral dysfunction,
including renal disease, hepatic encephalopathy, cardiac anomaly, sickle cell disease, and
related hematologic anomalies, and autoimmune disorders, including lupus, erythematosis,
or celiac disease;
new text end
new text begin
(xiii) congenital genetic or metabolic disorders known to be associated with cerebral
dysfunction, including phenylketonuria, craniofacial syndromes, or congenital hydrocephalus;
new text end
new text begin
(xiv) severe or prolonged nutrition or malabsorption syndromes; or
new text end
new text begin
(xv) a condition presenting in a manner difficult for a clinician to distinguish between
the neurocognitive effects of a neurogenic syndrome, including dementia or encephalopathy;
and a major depressive disorder when adequate treatment for major depressive disorder has
not resulted in improvement in neurocognitive function; or another disorder, including
autism, selective mutism, anxiety disorder, or reactive attachment disorder.
new text end
new text begin
(c) Neuropsychological testing must be administered or clinically supervised by a
neuropsychologist qualified as defined in subdivision 66, paragraph (c).
new text end
new text begin
(d) Neuropsychological testing is not covered when performed: (1) primarily for
educational purposes; (2) primarily for vocational counseling or training; (3) for personnel
or employment testing; (4) as a routine battery of psychological tests given at inpatient
admission or during a continued stay; or (5) for legal or forensic purposes.
new text end
Sec. 94.
Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 68. new text end
new text begin Psychological testing. new text end
new text begin
(a) "Psychological testing" means the use of tests or
other psychometric instruments to determine the status of the client's mental, intellectual,
and emotional functioning.
new text end
new text begin
(b) The psychological testing must:
new text end
new text begin
(1) be administered or clinically supervised by a licensed psychologist qualified according
to section 245I.16, subdivision 2, clause (3), competent in the area of psychological testing;
and
new text end
new text begin
(2) be validated in a face-to-face interview between the client and a licensed psychologist
or a clinical psychology trainee qualified according to section 245I.16, subdivision 6, under
the treatment supervision of a licensed psychologist according to section 245I.18.
new text end
new text begin
(c) The administration, scoring, and interpretation of the psychological tests must be
done under the treatment supervision of a licensed psychologist when performed by a clinical
psychology trainee, technician, psychometrist, or psychological assistant or as part of a
computer-assisted psychological testing program. The report resulting from the psychological
testing must be signed by the psychologist conducting the face-to-face interview, placed in
the client's record, and released to each person authorized by the client.
new text end
Sec. 95.
Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 69. new text end
new text begin Psychotherapy. new text end
new text begin
(a) "Psychotherapy" means treatment of a client with mental
illness that applies to the most appropriate psychological, psychiatric, psychosocial, or
interpersonal method that conforms to prevailing community standards of professional
practice to meet the mental health needs of the client. Medical assistance covers
psychotherapy if conducted by a mental health professional qualified according to section
245I.16, subdivision 2, or a clinical trainee qualified according to section 245I.16, subdivision
6.
new text end
new text begin
(b) Individual psychotherapy is psychotherapy designed for one client.
new text end
new text begin
(c) Family psychotherapy is designed for the client and one or more family members or
the client's primary caregiver whose participation is necessary to accomplish the client's
treatment goals. Family members or primary caregivers participating in a therapy session
do not need to be eligible for medical assistance. For purposes of this paragraph, "primary
caregiver whose participation is necessary to accomplish the client's treatment goals" excludes
shift or facility staff persons at the client's residence. Medical assistance payment for family
psychotherapy is limited to face-to-face sessions at which the client is present throughout
the family psychotherapy session unless the mental health professional believes the client's
absence from the family psychotherapy session is necessary to carry out the client's individual
treatment plan. If the client is excluded, the mental health professional must document the
reason for and the length of time of the exclusion. The mental health professional must also
document any reason a member of the client's family is excluded.
new text end
new text begin
(d) Group psychotherapy is appropriate for a client who, because of the nature of the
client's emotional, behavioral, or social dysfunctions, can derive mutual benefit from
treatment in a group setting. For a group of three to eight persons, one mental health
professional or clinical trainee is required to conduct the group. For a group of nine to 12
persons, a team of at least two mental health professionals or two clinical trainees or one
mental health professional and one clinical trainee is required to co-conduct the group.
Medical assistance payment is limited to a group of no more than 12 persons.
new text end
new text begin
(e) A multiple-family group psychotherapy session is eligible for medical assistance
payment if the psychotherapy session is designed for at least two but not more than five
families. Multiple-family group psychotherapy is clearly directed toward meeting the
identified treatment needs of each client as indicated in each client's treatment plan. If the
client is excluded, the mental health professional or clinical trainee must document the
reason for and the length of time of the exclusion. The mental health professional or clinical
trainee must document any reason a member of the client's family is excluded.
new text end
Sec. 96.
Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 70. new text end
new text begin Partial hospitalization. new text end
new text begin
"Partial hospitalization" means a provider's
time-limited, structured program of psychotherapy and other therapeutic services, as defined
in United States Code, title 42, chapter 7, subchapter XVIII, part E, section 1395x(ff), that
is provided in an outpatient hospital facility or community mental health center that meets
Medicare requirements to provide partial hospitalization services. Partial hospitalization is
a covered service when it is an appropriate alternative to inpatient hospitalization for a client
who is experiencing an acute episode of mental illness that meets the criteria for an inpatient
hospital admission under Minnesota Rules, part 9505.0520, subpart 1, and who has the
family and community resources necessary and appropriate to support the client's residence
in the community. Partial hospitalization consists of multiple intensive short-term therapeutic
services provided by a multidisciplinary staff person to treat the client's mental illness.
new text end
Sec. 97.
new text begin
[256B.0671] CLIENT ELIGIBILITY FOR MENTAL HEALTH SERVICES.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
For the purposes of this section, the definitions in section
245I.02 apply.
new text end
new text begin Subd. 1a. new text end
new text begin Generally. new text end
new text begin
(a) The provider must use a diagnostic assessment or crisis
assessment to determine a client's eligibility for mental health services, except as provided
in this section.
new text end
new text begin
(b) Prior to completion of a client's initial diagnostic assessment, a client is eligible for:
new text end
new text begin
(1) one explanation of findings;
new text end
new text begin
(2) one psychological testing;
new text end
new text begin
(3) any combination of individual psychotherapy sessions, family psychotherapy sessions,
group psychotherapy sessions, and individual or family psychoeducation sessions not to
exceed three sessions; and
new text end
new text begin
(4) crisis assessment and intervention services provided according to section 256B.0624
or 256B.0944.
new text end
new text begin
(c) Based on the needs identified in a crisis assessment as specified in section 256B.0624
or 256B.0944, a client may receive: (1) crisis stabilization services; and (2) any combination
of individual psychotherapy sessions, family psychotherapy sessions, or family
psychoeducation sessions not to exceed ten sessions within a 12-month period without prior
authorization.
new text end
new text begin
(d) Based on the needs identified in a brief diagnostic assessment, a client may receive
a combination of individual psychotherapy sessions, family psychotherapy sessions, or
family psychoeducation sessions not to exceed ten sessions within a 12-month period without
prior authorization for any new client or for an existing client who is projected to need fewer
than ten sessions in the next 12 months.
new text end
new text begin
(e) If the amount of services or intensity required by the client exceeds the coverage
limits in this section, a provider shall complete a standard diagnostic assessment.
new text end
new text begin
(f) A new standard diagnostic assessment must be completed:
new text end
new text begin
(1) when the client requires services of a greater number or intensity than those permitted
by paragraphs (b) to (d);
new text end
new text begin
(2) at least annually following the initial diagnostic assessment if additional services are
needed and the client does not meet the criteria for brief assessment.
new text end
new text begin
(3) when the client's mental health condition has changed markedly since the client's
most recent diagnostic assessment; or
new text end
new text begin
(4) when the client's current mental health condition does not meet the criteria of the
client's current diagnosis.
new text end
new text begin
(g) For an existing client, a new standard diagnostic assessment shall include a written
update of the parts where significant new or changed information exists, and documentation
where there has not been significant change, including discussion with the client about
changes in the client's life situation, functioning, presenting problems, and progress on
treatment goals since the last diagnostic assessment was completed.
new text end
new text begin Subd. 1b. new text end
new text begin Continuity of services. new text end
new text begin
(a) For any client served with a diagnostic assessment
completed under Minnesota Rules, parts 9505.0370 to 9505.0372, before the effective date,
the diagnostic assessment is valid for purposes of authorizing treatment and billing for one
calendar year after completion.
new text end
new text begin
(b) For any client served with an individual treatment plan completed under section
256B.0622, 256B.0623, 256B.0943, 256B.0946, or 256B.0947 or Minnesota Rules, parts
9505.0370 to 9505.0372, the individual treatment plan is valid for purposes of authorizing
treatment and billing until its expiration date.
new text end
new text begin
(c) This subdivision expires July 1, 2021.
new text end
new text begin Subd. 2. new text end
new text begin Diagnostic assessment. new text end
new text begin
To be eligible for medical assistance payment, a
diagnostic assessment must (1) identify at least one mental health diagnosis and recommend
mental health services to develop the client's mental health services and treatment plan, or
(2) include a finding that the client does not meet the criteria for a mental health disorder.
new text end
new text begin Subd. 3. new text end
new text begin Standard diagnostic assessment requirements. new text end
new text begin
(a) A standard diagnostic
assessment must include a face-to-face interview with the client and contain a written
evaluation of a client by a mental health professional or clinical trainee. The standard
diagnostic assessment must be completed within the cultural context of the client.
new text end
new text begin
(b) The clinician shall gather and document information related to the client's current
life situation and the client's:
new text end
new text begin
(1) age;
new text end
new text begin
(2) current living situation, including household membership and housing status;
new text end
new text begin
(3) basic needs status;
new text end
new text begin
(4) education level and employment status;
new text end
new text begin
(5) family and other significant personal relationships, including the client's evaluation
of relationship quality;
new text end
new text begin
(6) strengths and resources, including the extent and quality of social networks;
new text end
new text begin
(7) belief systems;
new text end
new text begin
(8) current medications; and
new text end
new text begin
(9) immediate risks to health and safety.
new text end
new text begin
(c) The clinician shall gather and document information related to the elements of the
assessment, including the client's:
new text end
new text begin
(1) perceptions of the client's condition;
new text end
new text begin
(2) description of symptoms, including reason for referral;
new text end
new text begin
(3) history of mental health treatment; and
new text end
new text begin
(4) cultural influences and the impact on the client.
new text end
new text begin
(d) A clinician completing a diagnostic assessment shall use professional judgment in
making inquiries under this paragraph. If information cannot be obtained without
retraumatizing the client or harming the client's willingness to engage in treatment, the
clinician shall document which topics require further attention in the course of treatment.
A clinician must, as clinically appropriate, include the following information related to a
client in a diagnostic assessment:
new text end
new text begin
(1) important developmental incidents;
new text end
new text begin
(2) maltreatment, trauma, potential brain injuries, or abuse issues;
new text end
new text begin
(3) history of alcohol and drug usage and treatment; and
new text end
new text begin
(4) health history and family health history, including physical, chemical, and mental
health history.
new text end
new text begin
(e) The clinician must perform and document the following components of the
assessment:
new text end
new text begin
(1) the client's mental status examination;
new text end
new text begin
(2) information gathered concerning the client's baseline measurements; symptoms;
behavior; skills; abilities; resources; vulnerabilities; safety needs, including client data
adequate to support findings based on the current edition of the Diagnostic and Statistical
Manual of Mental Disorders, published by the American Psychiatric Association; and any
differential diagnosis;
new text end
new text begin
(3) for a child younger than 6 years of age, a clinician may use the current edition of the
DC: 0-5 Diagnostic Classification of Mental Health and Development Disorders of Infancy
and Early Childhood instead of the Diagnostic and Statistical Manual of Mental Disorders;
new text end
new text begin
(4) the screenings used to determine the client's substance use, abuse, or dependency
and other standardized screening instruments determined by the commissioner;
new text end
new text begin
(5) use of standardized outcome measurements by the provider as determined and
periodically updated by the commissioner; and
new text end
new text begin
(6) a case conceptualization that explains: (i) the diagnostic formulation made based on
the information gathered through the interview, assessment, available psychological testing,
and collateral information; (ii) the needs of the client; (iii) risk factors; (iv) strengths; and
(v) responsivity factors.
new text end
new text begin
(f) The diagnostic assessment must include recommendations, client and family
participation in assessment and service preferences, and referrals to services required by
law.
new text end
new text begin Subd. 4. new text end
new text begin Brief diagnostic assessment requirements. new text end
new text begin
(a) A brief diagnostic assessment
must include a face-to-face interview with the client and a written evaluation of the client
by a mental health professional or a clinical trainee. The mental health professional or
clinical trainee must gather initial components of a standard diagnostic assessment, including
the client's:
new text end
new text begin
(1) age;
new text end
new text begin
(2) description of symptoms, including reason for referral;
new text end
new text begin
(3) history of mental health treatment;
new text end
new text begin
(4) cultural influences and their impact on the client; and
new text end
new text begin
(5) mental status examination.
new text end
new text begin
(b) On the basis of the initial components, the mental health professional or clinical
trainee must draw a provisional diagnostic formulation. The diagnostic formulation may be
used to address the client's immediate needs or presenting problem.
new text end
new text begin
(c) Treatment sessions conducted under authorization of a brief diagnostic assessment
may be used to gather additional information necessary to complete a standard diagnostic
assessment if coverage limits in subdivision 1 will be exceeded.
new text end
new text begin Subd. 5. new text end
new text begin Individual treatment plan. new text end
new text begin
Medical assistance payment is available only for
mental health services provided in accordance with the client's written individual treatment
plan, with the following exceptions: (1) services that do not require a standard diagnostic
assessment prior to service delivery; (2) service plan development; and (3) re-engagement
of a client as described in subdivision 6, clause (6).
new text end
new text begin Subd. 6. new text end
new text begin Individual treatment plan; required elements. new text end
new text begin
An individual treatment plan
must:
new text end
new text begin
(1) be based on the information in the client's diagnostic assessment and baselines;
new text end
new text begin
(2) identify goals and objectives of treatment, the treatment strategy, the schedule for
accomplishing treatment goals and measurable objectives, and the individuals responsible
for providing treatment services and supports;
new text end
new text begin
(3) be developed after completion of the client's diagnostic assessment, within three
visits unless otherwise specified by a service line;
new text end
new text begin
(4) for a child client, be developed through a child-centered, family-driven, culturally
appropriate planning process, including allowing parents and guardians to observe or
participate in individual and family treatment services, assessment, and treatment planning.
For an adult client, the individual treatment plan must be developed through a
person-centered, culturally appropriate planning process, including allowing identified
supports to observe or participate in treatment services, assessment, and treatment planning;
new text end
new text begin
(5) be reviewed at least every 90 days unless otherwise specified by the requirements
of a service line and revised to document treatment progress on each treatment objective
and next goals or, if progress is not documented, to document changes in treatment; and
new text end
new text begin
(6) be approved by the client, the client's parent, another person authorized by law to
consent to mental health services for the client, or a treatment plan ordered by the court
under chapter 253B. If approval cannot be obtained, a mental health professional shall make
efforts to obtain approval from an authorized person for a period of 30 days following the
date the previous individual treatment plan expired. A client shall not be denied service in
this time period solely on the basis of an unapproved individual treatment plan. A provider
entity may continue to bill for otherwise eligible services during a period of re-engagement.
new text end
Sec. 98.
Minnesota Statutes 2018, section 256B.0757, subdivision 2, is amended to read:
Subd. 2.
Eligible individual.
An individual is eligible for health home services under
this section if the individual is eligible for medical assistance under this chapter and has at
least:
(1) two chronic conditions;
(2) one chronic condition and is at risk of having a second chronic condition;
(3) one serious and persistent mental health condition; or
(4) a condition that meets the definition in section 245.462, subdivision 20, paragraph
(a), or 245.4871, subdivision 15, clause (2); and has a current diagnostic assessment as
deleted text begin defined in Minnesota Rules, part 9505.0372, subpart 1, item B or Cdeleted text end new text begin that meets the
requirements of section 256B.0671, subdivisions 2 and 3new text end , as performed or reviewed by a
mental health professional employed by or under contract with the behavioral health home.
The commissioner shall establish criteria for determining continued eligibility.
Sec. 99.
Minnesota Statutes 2018, section 256B.0941, subdivision 1, is amended to read:
Subdivision 1.
Eligibility.
(a) An individual who is eligible for mental health treatment
services in a psychiatric residential treatment facility must meet all of the following criteria:
(1) before admission, services are determined to be medically necessary by the state's
medical review agent according to Code of Federal Regulations, title 42, section 441.152;
(2) is younger than 21 years of age at the time of admission. Services may continue until
the individual meets criteria for discharge or reaches 22 years of age, whichever occurs
first;
(3) has a mental health diagnosis as defined in the most recent edition of the Diagnostic
and Statistical Manual for Mental Disorders, as well as clinical evidence of severe aggression,
or a finding that the individual is a risk to self or others;
(4) has functional impairment and a history of difficulty in functioning safely and
successfully in the community, school, home, or job; an inability to adequately care for
one's physical needs; or caregivers, guardians, or family members are unable to safely fulfill
the individual's needs;
(5) requires psychiatric residential treatment under the direction of a physician to improve
the individual's condition or prevent further regression so that services will no longer be
needed;
(6) utilized and exhausted other community-based mental health services, or clinical
evidence indicates that such services cannot provide the level of care needed; and
(7) was referred for treatment in a psychiatric residential treatment facility by a qualified
mental health professional deleted text begin licensed as defined in section deleted text end deleted text begin 245.4871, subdivision 27deleted text end deleted text begin , clauses
(1) to (6)deleted text end new text begin qualified according to section 245I.16, subdivision 2new text end .
(b) A mental health professional making a referral shall submit documentation to the
state's medical review agent containing all information necessary to determine medical
necessity, including a standard diagnostic assessment completed within 180 days of the
individual's admission. Documentation shall include evidence of family participation in the
individual's treatment planning and signed consent for services.
Sec. 100.
Minnesota Statutes 2018, section 256B.0943, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
For purposes of this section, the following terms have the
meanings given them.
(a) "Children's therapeutic services and supports" means the flexible package of mental
health services for children who require varying therapeutic and rehabilitative levels of
intervention to treat a diagnosed emotional disturbancedeleted text begin , as defined in section 245.4871,
subdivision 15,deleted text end or deleted text begin a diagnoseddeleted text end mental illnessdeleted text begin , as defined in section 245.462, subdivision
20deleted text end . The services are time-limited interventions that are delivered using various treatment
modalities and combinations of services designed to reach treatment outcomes identified
in the individual treatment plan.
deleted text begin
(b) "Clinical supervision" means the overall responsibility of the mental health
professional for the control and direction of individualized treatment planning, service
delivery, and treatment review for each client. A mental health professional who is an
enrolled Minnesota health care program provider accepts full professional responsibility
for a supervisee's actions and decisions, instructs the supervisee in the supervisee's work,
and oversees or directs the supervisee's work.
deleted text end
deleted text begin (c)deleted text end new text begin (b)new text end "Clinical trainee" deleted text begin means a mental health practitioner who meets the qualifications
specified in Minnesota Rules, part 9505.0371, subpart 5, item Cdeleted text end new text begin means a staff person
qualified according to section 245I.16, subdivision 6new text end .
deleted text begin
(d) "Crisis assistance" has the meaning given in section 245.4871, subdivision 9a. Crisis
assistance entails the development of a written plan to assist a child's family to contend with
a potential crisis and is distinct from the immediate provision of crisis intervention services.
deleted text end
new text begin
(c) "Crisis planning" means the support and planning activities described under section
245.4871, subdivision 9a.
new text end
deleted text begin (e)deleted text end new text begin (d)new text end "Culturally competent provider" means a provider who understands and can
utilize to a client's benefit the client's culture when providing services to the client. A provider
may be culturally competent because the provider is of the same cultural or ethnic group
as the client or the provider has developed the knowledge and skills through training and
experience to provide services to culturally diverse clients.
deleted text begin (f)deleted text end new text begin (e)new text end "Day treatment program" for children means a site-based structured mental health
program consisting of psychotherapy for three or more individuals and individual or group
skills training provided by a deleted text begin multidisciplinarydeleted text end new text begin treatmentnew text end team, under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end
supervision of a mental health professional.
deleted text begin (g)deleted text end new text begin (f)new text end "Diagnostic assessment" deleted text begin has the meaning given in Minnesota Rules, part
9505.0372, subpart 1deleted text end new text begin means the assessment described under section 256B.0671, subdivisions
2 and 3new text end .
deleted text begin (h)deleted text end new text begin (g)new text end "Direct service time" means the time that a mental health professional, clinical
trainee, mental health practitioner, or mental health behavioral aide spends face-to-face with
a client and the client's family or providing covered telemedicine services. Direct service
time includes time in which the provider obtains a client's history, develops a client's
treatment plan, records individual treatment outcomes, or provides service components of
children's therapeutic services and supports. Direct service time does not include time doing
work before and after providing direct services, including scheduling or maintaining clinical
records.
deleted text begin (i)deleted text end new text begin (h)new text end "Direction of mental health behavioral aide" means the activities of a mental
health professionalnew text begin , clinical trainee,new text end or mental health practitioner in guiding the mental
health behavioral aide in providing services to a client. The direction of a mental health
behavioral aide must be based on the client's individualized treatment plan and meet the
requirements in subdivision 6, paragraph (b), clause (5).
deleted text begin (j)deleted text end new text begin (i)new text end "Emotional disturbance" has the meaning given in section 245.4871, subdivision
15.
deleted text begin (k)deleted text end new text begin (j)new text end "Individual behavioral plan" means a plan of intervention, treatment, and services
for a child written by a mental health professionalnew text begin , clinical trainee,new text end or mental health
practitioner, under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional, to
guide the work of the mental health behavioral aide. The individual behavioral plan may
be incorporated into the child's individual treatment plan so long as the behavioral plan is
separately communicable to the mental health behavioral aide.
deleted text begin (l)deleted text end new text begin (k)new text end "Individual treatment plan" deleted text begin has the meaning given in Minnesota Rules, part
9505.0371, subpart 7deleted text end new text begin means the plan described under section 256B.0671, subdivisions 5
and 6new text end .
deleted text begin (m)deleted text end new text begin (l)new text end "Mental health behavioral aide services" means medically necessary deleted text begin one-on-onedeleted text end
activities performed by a trained paraprofessional deleted text begin qualified as provided in subdivision 7,
paragraph (b), clause (3),deleted text end to assist a child retain or generalize psychosocial skills as previously
trained by a mental health professionalnew text begin , clinical trainee,new text end or mental health practitioner and
as described in the child's individual treatment plan and individual behavior plan. Activities
involve working directly with the child or child's family as provided in subdivision 9,
paragraph (b), clause (4).
new text begin
(m) "Mental health certified family peer specialist" means a staff person qualified
according to section 245I.16, subdivision 12.
new text end
(n) "Mental health practitioner" deleted text begin has the meaning given indeleted text end new text begin means a staff person qualified
according tonew text end section deleted text begin 245.462, subdivision 17, except that a practitioner working in a day
treatment setting may qualify as a mental health practitioner if the practitioner holds a
bachelor's degree in one of the behavioral sciences or related fields from an accredited
college or university, and: (1) has at least 2,000 hours of clinically supervised experience
in the delivery of mental health services to clients with mental illness; (2) is fluent in the
language, other than English, of the cultural group that makes up at least 50 percent of the
practitioner's clients, completes 40 hours of training on the delivery of services to clients
with mental illness, and receives clinical supervision from a mental health professional at
least once per week until meeting the required 2,000 hours of supervised experience; or (3)
receives 40 hours of training on the delivery of services to clients with mental illness within
six months of employment, and clinical supervision from a mental health professional at
least once per week until meeting the required 2,000 hours of supervised experiencedeleted text end new text begin 245I.16,
subdivision 4new text end .
(o) "Mental health professional" means deleted text begin an individual as defined in Minnesota Rules,
part 9505.0370, subpart 18deleted text end new text begin a staff person qualified according to section 245I.16, subdivision
2new text end .
(p) "Mental health service plan development" includes:
(1) the development, review, and revision of a child's individual treatment plan, deleted text begin as
provided in Minnesota Rules, part 9505.0371, subpart 7deleted text end new text begin according to section 256B.0671,
subdivisions 5 and 6new text end , including involvement of the client or client's parents, primary
caregiver, or other person authorized to consent to mental health services for the client, and
including arrangement of treatment and support activities specified in the individual treatment
plan; and
(2) administering standardized outcome measurement instruments, determined and
updated by the commissioner, as periodically needed to evaluate the effectiveness of
treatment for children receiving clinical services and reporting outcome measures, as required
by the commissioner.
(q) "Mental illness," for persons at least age 18 but under age 21, has the meaning given
in section 245.462, subdivision 20, paragraph (a).
(r) "Psychotherapy" means the treatment of mental or emotional disorders or
maladjustment by psychological means. Psychotherapy may be provided in many modalities
deleted text begin in accordance with Minnesota Rules, part 9505.0372, subpart 6,deleted text end including patient and/or
family psychotherapy; family psychotherapy; psychotherapy for crisis; group psychotherapy;
or multiple-family psychotherapy. deleted text begin Beginning with the American Medical Association's
Current Procedural Terminology, standard edition, 2014, the procedure "individual
psychotherapy" is replaced with "patient and/or family psychotherapy," a substantive change
that permits the therapist to work with the client's family without the client present to obtain
information about the client or to explain the client's treatment plan to the family.deleted text end
Psychotherapy new text begin for crisis new text end is appropriate deleted text begin for crisis responsedeleted text end when a child has become
dysregulated or experienced new trauma since the diagnostic assessment was completed
and needs psychotherapy to address issues not currently included in the child's individual
treatment plan.
(s) "Rehabilitative services" or "psychiatric rehabilitation services" means deleted text begin a series or
multidisciplinary combination of psychiatric and psychosocialdeleted text end interventions to: (1) restore
a child or adolescent to an age-appropriate developmental trajectory that had been disrupted
by a psychiatric illness; or (2) enable the child to self-monitor, compensate for, cope with,
counteract, or replace psychosocial skills deficits or maladaptive skills acquired over the
course of a psychiatric illness. Psychiatric rehabilitation services for children combine
new text begin coordinated new text end psychotherapy to address internal psychological, emotional, and intellectual
processing deficits, and skills training to restore personal and social functioning. Psychiatric
rehabilitation services establish a progressive series of goals with each achievement building
upon a prior achievement. deleted text begin Continuing progress toward goals is expected, and rehabilitative
potential ceases when successive improvement is not observable over a period of time.
deleted text end
(t) "Skills training" means individual, family, or group training, delivered by or under
the supervision of a mental health professional, designed to facilitate the acquisition of
psychosocial skills that are medically necessary to rehabilitate the child to an age-appropriate
developmental trajectory heretofore disrupted by a psychiatric illness or to enable the child
to self-monitor, compensate for, cope with, counteract, or replace skills deficits or
maladaptive skills acquired over the course of a psychiatric illness. Skills training is subject
to the service delivery requirements under subdivision 9, paragraph (b), clause (2).
new text begin
(u) "Treatment supervision" means the supervision described under section 245I.18.
new text end
Sec. 101.
Minnesota Statutes 2018, section 256B.0943, subdivision 2, is amended to read:
Subd. 2.
Covered service components of children's therapeutic services and
supports.
(a) deleted text begin Subject to federal approval,deleted text end Medical assistance covers medically necessary
children's therapeutic services and supports as defined in this section that an eligible provider
entity certified under subdivision 4 provides to a client eligible under subdivision 3.
(b) The service components of children's therapeutic services and supports are:
(1) patient and/or family psychotherapy, family psychotherapy, psychotherapy for crisis,
and group psychotherapy;
(2) individual, family, or group skills training provided by a mental health professional
or mental health practitioner;
(3) crisis deleted text begin assistancedeleted text end new text begin planningnew text end ;
(4) mental health behavioral aide services;
(5) direction of a mental health behavioral aide;
(6) mental health service plan development; and
(7) children's day treatment.
Sec. 102.
Minnesota Statutes 2018, section 256B.0943, subdivision 3, is amended to read:
Subd. 3.
Determination of client eligibility.
A client's eligibility to receive children's
therapeutic services and supports under this section shall be determined based on a diagnostic
assessment by a mental health professional or deleted text begin a mental health practitioner who meets the
requirements ofdeleted text end a clinical trainee deleted text begin as defined in Minnesota Rules, part 9505.0371, subpart
5, item C,deleted text end that is performed within one year before the initial start of service. The diagnostic
assessment must meet the requirements for a standard deleted text begin or extendeddeleted text end diagnostic assessment
deleted text begin as defined in Minnesota Rules, part 9505.0372, subpart 1, items B and Cdeleted text end , and:
(1) deleted text begin include current diagnoses, including any differential diagnosis, in accordance with
all criteria for a complete diagnosis and diagnostic profile as specified in the current edition
of the Diagnostic and Statistical Manual of the American Psychiatric Association, or,deleted text end for
children under age deleted text begin five, asdeleted text end new text begin six, follow the requirementsnew text end specified in the current edition of
the Diagnostic Classification of Mental Health Disorders of Infancy and Early Childhood;
(2) determine whether a child under age 18 has a diagnosis of emotional disturbance or,
if the person is between the ages of 18 and 21, whether the person has a mental illness;
(3) document children's therapeutic services and supports as medically necessary to
address an identified disability, functional impairment, and the individual client's needs and
goals;new text begin and
new text end
(4) be used in the development of the individualized treatment plandeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(5) be completed annually until age 18. For individuals between age 18 and 21, unless
a client's mental health condition has changed markedly since the client's most recent
diagnostic assessment, annual updating is necessary. For the purpose of this section,
"updating" means an adult diagnostic update as defined in Minnesota Rules, part 9505.0371,
subpart 2, item E.
deleted text end
Sec. 103.
Minnesota Statutes 2018, section 256B.0943, subdivision 4, is amended to read:
Subd. 4.
Provider entity certification.
(a) The commissioner shall establish an initial
provider entity application and certification process and recertification process to determine
whether a provider entity has an administrative and clinical infrastructure that meets the
requirements in subdivisions 5 and 6. A provider entity must be certified for the three core
rehabilitation services of psychotherapy, skills training, and crisis deleted text begin assistancedeleted text end new text begin planningnew text end . The
commissioner shall recertify a provider entity at least every three years. The commissioner
shall establish a process for decertification of a provider entity and shall require corrective
action, medical assistance repayment, or decertification of a provider entity that no longer
meets the requirements in this section or that fails to meet the clinical quality standards or
administrative standards provided by the commissioner in the application and certification
process.
(b) For purposes of this section, a provider entity must new text begin meet all requirements in chapter
245I and new text end be:
(1) an Indian health services facility or a facility owned and operated by a tribe or tribal
organization operating as a 638 facility under Public Law 93-638 certified by the state;
(2) a county-operated entity certified by the state; or
(3) a noncounty entity certified by the state.
Sec. 104.
Minnesota Statutes 2018, section 256B.0943, subdivision 5, is amended to read:
Subd. 5.
Provider entity administrative infrastructure requirements.
(a) To be an
eligible provider entity under this section, a provider entity must have an administrative
infrastructure that establishes authority and accountability for decision making and oversight
of functions, including finance, personnel, system management, clinical practice, and
individual treatment outcomes measurement. An eligible provider entity shall demonstrate
the availability, by means of employment or contract, of at least one backup mental health
professional in the event of the primary mental health professional's absence. The provider
must have written policies and procedures that it reviews and updates every three years and
distributes to staff initially and upon each subsequent update.
(b) The administrative infrastructure written policies and procedures new text begin must be in
accordance with sections 245I.10 and 245I.13 and new text end must include:
(1) personnel procedures, including a process for: (i) recruiting, hiring, training, and
retention of culturally and linguistically competent providers; (ii) conducting a criminal
background check on all direct service providers and volunteers; (iii) investigating, reporting,
and acting on violations of ethical conduct standards; (iv) investigating, reporting, and acting
on violations of data privacy policies that are compliant with federal and state laws; (v)
utilizing volunteers, including screening applicants, training and supervising volunteers,
and providing liability coverage for volunteers; and (vi) documenting that each deleted text begin mental
health professional, mental health practitioner, or mental health behavioral aide meets the
applicable provider qualification criteriadeleted text end new text begin staff person meets the applicable qualifications
under section 245I.16new text end , training criteria under deleted text begin subdivision 8deleted text end new text begin section 245I.10new text end , and deleted text begin clinicaldeleted text end new text begin
treatmentnew text end supervision deleted text begin or direction of a mental health behavioral aidedeleted text end requirements under
deleted text begin subdivision 6deleted text end new text begin section 245I.18new text end ;
(2) fiscal procedures, including internal fiscal control practices and a process for collecting
revenue that is compliant with federal and state laws;
(3) a client-specific treatment outcomes measurement system, including baseline
measures, to measure a client's progress toward achieving mental health rehabilitation goals.
deleted text begin Effective July 1, 2017,deleted text end To be eligible for medical assistance payment, a provider entity must
report individual client outcomes to the commissioner, using instruments and protocols
approved by the commissioner; and
(4) a process to establish and maintain individual client recordsnew text begin in accordance with
section 245I.32new text end . deleted text begin The client's records must include:
deleted text end
deleted text begin
(i) the client's personal information;
deleted text end
deleted text begin
(ii) forms applicable to data privacy;
deleted text end
deleted text begin
(iii) the client's diagnostic assessment, updates, results of tests, individual treatment
plan, and individual behavior plan, if necessary;
deleted text end
deleted text begin
(iv) documentation of service delivery as specified under subdivision 6;
deleted text end
deleted text begin
(v) telephone contacts;
deleted text end
deleted text begin
(vi) discharge plan; and
deleted text end
deleted text begin
(vii) if applicable, insurance information.
deleted text end
(c) A provider entity that uses a restrictive procedure with a client must meet the
requirements of section 245.8261.
Sec. 105.
Minnesota Statutes 2018, section 256B.0943, subdivision 6, is amended to read:
Subd. 6.
Provider entity clinical infrastructure requirements.
(a) To be an eligible
provider entity under this section, a provider entity must have a clinical infrastructure that
utilizes diagnostic assessment, individualized treatment plans, service delivery, and individual
treatment plan review that are culturally competent, child-centered, and family-driven to
achieve maximum benefit for the client. The provider entity must review, and update as
necessary, the clinical policies and procedures every three years, must distribute the policies
and procedures to staff initially and upon each subsequent update, and must train staff
accordingly.
(b) The clinical infrastructure written policies and procedures must include policies and
procedures for:
(1) providing or obtaining a client's diagnostic assessment, including a diagnostic
assessment performed by an outside or independent clinician, that identifies acute and
chronic clinical disorders, co-occurring medical conditions, and sources of psychological
and environmental problems, including baselines, and a functional assessment. The functional
assessment component must clearly summarize the client's individual strengths and needs.
When required components of the diagnostic assessment, such as baseline measures, are
not provided in an outside or independent assessment or when baseline measures cannot be
attained in a deleted text begin one-sessiondeleted text end standard diagnostic assessment, the provider entity must determine
the missing information within 30 days and amend the child's diagnostic assessment or
incorporate the baselines into the child's individual treatment plan;
(2) developing an individual treatment plan deleted text begin that:deleted text end new text begin according to section 256B.0671,
subdivisions 5 and 6;
new text end
deleted text begin
(i) is based on the information in the client's diagnostic assessment and baselines;
deleted text end
deleted text begin
(ii) identified goals and objectives of treatment, treatment strategy, schedule for
accomplishing treatment goals and objectives, and the individuals responsible for providing
treatment services and supports;
deleted text end
deleted text begin
(iii) is developed after completion of the client's diagnostic assessment by a mental health
professional or clinical trainee and before the provision of children's therapeutic services
and supports;
deleted text end
deleted text begin
(iv) is developed through a child-centered, family-driven, culturally appropriate planning
process, including allowing parents and guardians to observe or participate in individual
and family treatment services, assessment, and treatment planning;
deleted text end
deleted text begin
(v) is reviewed at least once every 90 days and revised to document treatment progress
on each treatment objective and next goals or, if progress is not documented, to document
changes in treatment; and
deleted text end
deleted text begin
(vi) is signed by the clinical supervisor and by the client or by the client's parent or other
person authorized by statute to consent to mental health services for the client. A client's
parent may approve the client's individual treatment plan by secure electronic signature or
by documented oral approval that is later verified by written signature;
deleted text end
(3) developing an individual behavior plan that documents deleted text begin treatment strategiesdeleted text end new text begin and
describes interventionsnew text end to be provided by the mental health behavioral aide. The individual
behavior plan must include:
(i) detailed instructions on the deleted text begin treatment strategies to be provideddeleted text end new text begin psychosocial skills to
be practicednew text end ;
(ii) time allocated to each deleted text begin treatment strategydeleted text end new text begin interventionnew text end ;
(iii) methods of documenting the child's behavior;
(iv) methods of monitoring the child's progress in reaching objectives; and
(v) goals to increase or decrease targeted behavior as identified in the individual treatment
plan;
(4) providing deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision plans deleted text begin for mental health practitioners and
mental health behavioral aidesdeleted text end new text begin according to section 245I.18new text end . deleted text begin A mental health professional
must document the clinical supervision the professional provides by cosigning individual
treatment plans and making entries in the client's record on supervisory activities. The
clinical supervisor also shall document supervisee-specific supervision in the supervisee's
personnel file. Clinicaldeleted text end new text begin Treatmentnew text end supervision does not include the authority to make or
terminate court-ordered placements of the childdeleted text begin . A clinical supervisor must be available for
urgent consultation as required by the individual client's needs or the situation. Clinical
supervision may occur individually or in a small group to discuss treatment and review
progress toward goals. The focus of clinical supervision must be the client's treatment needs
and progress and the mental health practitioner's or behavioral aide's ability to provide
servicesdeleted text end ;
(4a) meeting day treatment program conditions in items (i) to (iii):
(i) the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor must be present and available on the premises more
than 50 percent of the time in a provider's standard working week during which the supervisee
is providing a mental health service;
(ii) new text begin the treatment supervisor must review and approve new text end the new text begin client's new text end diagnosis and the
client's individual treatment plan or a change in the diagnosis or individual treatment plan
deleted text begin must be made by or reviewed, approved, and signed by the clinical supervisordeleted text end ; and
(iii) every 30 days, the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor must review and sign the record
indicating the supervisor has reviewed the client's care for all activities in the preceding
30-day period;
(4b) meeting the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision standards in items (i) deleted text begin to (iv)deleted text end new text begin and (ii)new text end for
all other services provided under CTSS:
deleted text begin
(i) medical assistance shall reimburse for services provided by a mental health practitioner
who is delivering services that fall within the scope of the practitioner's practice and who
is supervised by a mental health professional who accepts full professional responsibility;
deleted text end
deleted text begin
(ii) medical assistance shall reimburse for services provided by a mental health behavioral
aide who is delivering services that fall within the scope of the aide's practice and who is
supervised by a mental health professional who accepts full professional responsibility and
has an approved plan for clinical supervision of the behavioral aide. Plans must be developed
in accordance with supervision standards defined in Minnesota Rules, part 9505.0371,
subpart 4, items A to D;
deleted text end
deleted text begin (iii)deleted text end new text begin (i)new text end the mental health professional is required to be present at the site of service
delivery for observation as clinically appropriate when the mental health practitioner or
mental health behavioral aide is providing CTSS services; and
deleted text begin (iv)deleted text end new text begin (ii)new text end when conducted, the on-site presence of the mental health professional must be
documented in the child's record and signed by the mental health professional who accepts
full professional responsibility;
(5) providing direction to a mental health behavioral aide. For entities that employ mental
health behavioral aides, the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor must be employed by the provider
entity or other provider certified to provide mental health behavioral aide services to ensure
necessary and appropriate oversight for the client's treatment and continuity of care. The
deleted text begin mental health professional or mental health practitionerdeleted text end new text begin staffnew text end giving direction must begin
with the goals on the individualized treatment plan, and instruct the mental health behavioral
aide on how to implement therapeutic activities and interventions that will lead to goal
attainment. The deleted text begin professional or practitionerdeleted text end new text begin staffnew text end giving direction must also instruct the
mental health behavioral aide about the client's diagnosis, functional status, and other
characteristics that are likely to affect service delivery. Direction must also include
determining that the mental health behavioral aide has the skills to interact with the client
and the client's family in ways that convey personal and cultural respect and that the aide
actively solicits information relevant to treatment from the family. The aide must be able
to clearly explain or demonstrate the activities the aide is doing with the client and the
activities' relationship to treatment goals. Direction is more didactic than is supervision and
requires the deleted text begin professional or practitionerdeleted text end new text begin staffnew text end providing it to continuously evaluate the mental
health behavioral aide's ability to carry out the activities of the individualized treatment
plan and the individualized behavior plan. When providing direction, the deleted text begin professional or
practitionerdeleted text end new text begin staffnew text end must:
(i) review progress notes prepared by the mental health behavioral aide for accuracy and
consistency with diagnostic assessment, treatment plan, and behavior goals and the
professional or practitioner must approve and sign the progress notes;
(ii) identify changes in treatment strategies, revise the individual behavior plan, and
communicate treatment instructions and methodologies as appropriate to ensure that treatment
is implemented correctly;
(iii) demonstrate family-friendly behaviors that support healthy collaboration among
the child, the child's family, and providers as treatment is planned and implemented;
(iv) ensure that the mental health behavioral aide is able to effectively communicate
with the child, the child's family, and the provider; and
(v) record the results of any evaluation and corrective actions taken to modify the work
of the mental health behavioral aide;
(6) providing service delivery that implements the individual treatment plan and meets
the requirements under subdivision 9; and
(7) individual treatment plan review. The review must determine the extent to which
the services have met each of the goals and objectives in the treatment plan. The review
must assess the client's progress and ensure that services and treatment goals continue to
be necessary and appropriate to the client and the client's family or foster family. deleted text begin Revision
of the individual treatment plan does not require a new diagnostic assessment unless the
client's mental health status has changed markedly. The updated treatment plan must be
signed by the clinical supervisor and by the client, if appropriate, and by the client's parent
or other person authorized by statute to give consent to the mental health services for the
child.
deleted text end
Sec. 106.
Minnesota Statutes 2018, section 256B.0943, subdivision 7, is amended to read:
Subd. 7.
Qualifications of individual and team providers.
(a) An individual or team
provider working within the scope of the provider's practice or qualifications may provide
service components of children's therapeutic services and supports that are identified as
medically necessary in a client's individual treatment plan.
(b) An individual provider must be qualified as:
(1) a mental health professional deleted text begin as defined in subdivision 1, paragraph (o)deleted text end ; deleted text begin or
deleted text end
(2) a mental health practitioner or clinical traineedeleted text begin . The mental health practitioner or
clinical trainee must work under the clinical supervision of a mental health professionaldeleted text end ; deleted text begin or
deleted text end
(3) a mental health behavioral aide deleted text begin working under the clinical supervision of a mental
health professional to implement the rehabilitative mental health services previously
introduced by a mental health professional or practitioner and identified in the client's
individual treatment plan and individual behavior plan.deleted text end new text begin ; or
new text end
new text begin
(4) a mental health certified family peer specialist.
new text end
deleted text begin
(A) A level I mental health behavioral aide must:
deleted text end
deleted text begin
(i) be at least 18 years old;
deleted text end
deleted text begin
(ii) have a high school diploma or commissioner of education-selected high school
equivalency certification or two years of experience as a primary caregiver to a child with
severe emotional disturbance within the previous ten years; and
deleted text end
deleted text begin
(iii) meet preservice and continuing education requirements under subdivision 8.
deleted text end
deleted text begin
(B) A level II mental health behavioral aide must:
deleted text end
deleted text begin
(i) be at least 18 years old;
deleted text end
deleted text begin
(ii) have an associate or bachelor's degree or 4,000 hours of experience in delivering
clinical services in the treatment of mental illness concerning children or adolescents or
complete a certificate program established under subdivision 8a; and
deleted text end
deleted text begin
(iii) meet preservice and continuing education requirements in subdivision 8.
deleted text end
deleted text begin
(c) A day treatment multidisciplinary team must include at least one mental health
professional or clinical trainee and one mental health practitioner.
deleted text end
Sec. 107.
Minnesota Statutes 2018, section 256B.0943, subdivision 8, is amended to read:
Subd. 8.
Required preservice and continuing education.
deleted text begin (a)deleted text end A provider entity shall
establish a plan to provide preservice and continuing education for staffnew text begin according to section
245I.10new text end . deleted text begin The plan must clearly describe the type of training necessary to maintain current
skills and obtain new skills and that relates to the provider entity's goals and objectives for
services offered.
deleted text end
deleted text begin
(b) A provider that employs a mental health behavioral aide under this section must
require the mental health behavioral aide to complete 30 hours of preservice training. The
preservice training must include parent team training. The preservice training must include
15 hours of in-person training of a mental health behavioral aide in mental health services
delivery and eight hours of parent team training. Curricula for parent team training must be
approved in advance by the commissioner. Components of parent team training include:
deleted text end
deleted text begin
(1) partnering with parents;
deleted text end
deleted text begin
(2) fundamentals of family support;
deleted text end
deleted text begin
(3) fundamentals of policy and decision making;
deleted text end
deleted text begin
(4) defining equal partnership;
deleted text end
deleted text begin
(5) complexities of the parent and service provider partnership in multiple service delivery
systems due to system strengths and weaknesses;
deleted text end
deleted text begin
(6) sibling impacts;
deleted text end
deleted text begin
(7) support networks; and
deleted text end
deleted text begin
(8) community resources.
deleted text end
deleted text begin
(c) A provider entity that employs a mental health practitioner and a mental health
behavioral aide to provide children's therapeutic services and supports under this section
must require the mental health practitioner and mental health behavioral aide to complete
20 hours of continuing education every two calendar years. The continuing education must
be related to serving the needs of a child with emotional disturbance in the child's home
environment and the child's family.
deleted text end
deleted text begin
(d) The provider entity must document the mental health practitioner's or mental health
behavioral aide's annual completion of the required continuing education. The documentation
must include the date, subject, and number of hours of the continuing education, and
attendance records, as verified by the staff member's signature, job title, and the instructor's
name. The provider entity must keep documentation for each employee, including records
of attendance at professional workshops and conferences, at a central location and in the
employee's personnel file.
deleted text end
Sec. 108.
Minnesota Statutes 2018, section 256B.0943, subdivision 9, is amended to read:
Subd. 9.
Service delivery criteria.
(a) In delivering services under this section, a certified
provider entity must ensure that:
(1) deleted text begin each individual provider's caseload size permits the provider to deliver services to
both clients with severe, complex needs and clients with less intensive needs.deleted text end the provider's
caseload size deleted text begin shoulddeleted text end reasonably deleted text begin enabledeleted text end new text begin enablesnew text end the provider to play an active role in service
planning, monitoring, and delivering services to meet the client's and client's family's needs,
as specified in each client's individual treatment plan;
(2) site-based programs, including day treatment programs, provide staffing and facilities
to ensure the client's health, safety, and protection of rights, and that the programs are able
to implement each client's individual treatment plan; and
(3) a day treatment program is provided to a group of clients by a deleted text begin multidisciplinarydeleted text end team
under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional. The day treatment
program must be provided in and by: (i) an outpatient hospital accredited by the Joint
Commission on Accreditation of Health Organizations and licensed under sections 144.50
to 144.55; (ii) a community mental health center under section 245.62; or (iii) an entity that
is certified under subdivision 4 to operate a program that meets the requirements of section
245.4884, subdivision 2, and Minnesota Rules, parts 9505.0170 to 9505.0475. The day
treatment program must stabilize the client's mental health status while developing and
improving the client's independent living and socialization skills. The goal of the day
treatment program must be to reduce or relieve the effects of mental illness and provide
training to enable the client to live in the community. The program must be available
year-round at least three to five days per week, two or three hours per day, unless the normal
five-day school week is shortened by a holiday, weather-related cancellation, or other
districtwide reduction in a school week. A child transitioning into or out of day treatment
must receive a minimum treatment of one day a week for a two-hour time block. The
two-hour time block must include at least one hour of patient and/or family or group
psychotherapy. The remainder of the structured treatment program may include patient
and/or family or group psychotherapy, and individual or group skills training, if included
in the client's individual treatment plan. Day treatment programs are not part of inpatient
or residential treatment services. When a day treatment group that meets the minimum group
size requirement temporarily falls below the minimum group size because of a member's
temporary absence, medical assistance covers a group session conducted for the group
members in attendance. A day treatment program may provide fewer than the minimally
required hours for a particular child during a billing period in which the child is transitioning
into, or out of, the program.
(b) To be eligible for medical assistance payment, a provider entity must deliver the
service components of children's therapeutic services and supports in compliance with the
following requirements:
(1) patient and/or family, family, and group psychotherapy must be delivered as specified
in deleted text begin Minnesota Rules, part 9505.0372, subpart 6deleted text end new text begin section 256B.0625, subdivision 69new text end .
Psychotherapy to address the child's underlying mental health disorder must be documented
as part of the child's ongoing treatment. A provider must deliver, or arrange for, medically
necessary psychotherapy, unless the child's parent or caregiver chooses not to receive it.
When a provider delivering other services to a child under this section deems it not medically
necessary to provide psychotherapy to the child for a period of 90 days or longer, the provider
entity must document the medical reasons why psychotherapy is not necessary. When a
provider determines that a child needs psychotherapy but psychotherapy cannot be delivered
due to a shortage of licensed mental health professionals in the child's community, the
provider must document the lack of access in the child's medical record;
(2) individual, family, or group skills training deleted text begin must be provided by a mental health
professional or a mental health practitioner who is delivering services that fall within the
scope of the provider's practice and is supervised by a mental health professional who
accepts full professional responsibility for the training. Skills trainingdeleted text end is subject to the
following requirements:
(i) a mental health professional, clinical trainee, or mental health practitioner shall provide
skills training;
(ii) skills training delivered to a child or the child's family must be targeted to the specific
deficits or maladaptations of the child's mental health disorder and must be prescribed in
the child's individual treatment plan;
(iii) the mental health professional delivering or supervising the delivery of skills training
must document any underlying psychiatric condition and must document how skills training
is being used in conjunction with psychotherapy to address the underlying condition;
(iv) skills training delivered to the child's family must teach skills needed by parents new text begin or
primary caregivers new text end to enhance the child's skill development, to help the child utilize daily
life skills taught by a mental health professional, clinical trainee, or mental health practitioner,
and to develop or maintain a home environment that supports the child's progressive use of
skills;
(v) group skills training may be provided to multiple recipients who, because of the
nature of their emotional, behavioral, or social dysfunction, can derive mutual benefit from
interaction in a group setting, which must be staffed as follows:
(A) one mental health professional or one clinical trainee or mental health practitioner
deleted text begin under supervision of a licensed mental health professionaldeleted text end must work with a group of three
to eight clients; or
(B) new text begin any combination of new text end two mental health professionals, deleted text begin twodeleted text end clinical traineesnew text begin ,new text end or mental
health practitioners deleted text begin under supervision of a licensed mental health professional, or one mental
health professional or clinical trainee and one mental health practitionerdeleted text end must work with a
group of nine to 12 clients;
(vi) a mental health professional, clinical trainee, or mental health practitioner must have
taught the psychosocial skill before a mental health behavioral aide may practice that skill
with the client; and
(vii) for group skills training, when a skills group that meets the minimum group size
requirement temporarily falls below the minimum group size because of a group member's
temporary absence, the provider may conduct the session for the group members in
attendance;
(3) crisis deleted text begin assistancedeleted text end new text begin planningnew text end to a child and family must include development of a written
plan that anticipates the particular factors specific to the child that may precipitate a
psychiatric crisis for the child in the near future. The written plan must document actions
that the family should be prepared to take to resolve or stabilize a crisis, such as advance
arrangements for direct intervention and support services to the child and the child's family.
Crisis deleted text begin assistancedeleted text end new text begin planningnew text end must include preparing resources designed to address abrupt or
substantial changes in the functioning of the child or the child's family when sudden change
in behavior or a loss of usual coping mechanisms is observed, or the child begins to present
a danger to self or others;
(4) mental health behavioral aide services must be medically necessary treatment services,
identified in the child's individual treatment plan and individual behavior plan, deleted text begin which are
performed minimally by a paraprofessional qualified according to subdivision 7, paragraph
(b), clause (3), anddeleted text end which are designed to improve the functioning of the child in the
progressive use of developmentally appropriate psychosocial skills. Activities involve
working directly with the child, child-peer groupings, or child-family groupings to practice,
repeat, reintroduce, and master the skills defined in subdivision 1, paragraph (t), as previously
taught by a mental health professional, clinical trainee, or mental health practitioner including:
(i) providing cues or prompts in skill-building peer-to-peer or parent-child interactions
so that the child progressively recognizes and responds to the cues independently;
(ii) performing as a practice partner or role-play partner;
(iii) reinforcing the child's accomplishments;
(iv) generalizing skill-building activities in the child's multiple natural settings;
(v) assigning further practice activities; and
(vi) intervening as necessary to redirect the child's target behavior and to de-escalate
behavior that puts the child or other person at risk of injury.
To be eligible for medical assistance payment, mental health behavioral aide services must
be delivered to a child who has been diagnosed with an emotional disturbance or a mental
illness, as provided in subdivision 1, paragraph (a). The mental health behavioral aide must
implement treatment strategies in the individual treatment plan and the individual behavior
plan as developed by the mental health professional, clinical trainee, or mental health
practitioner providing direction for the mental health behavioral aide. The mental health
behavioral aide must document the delivery of services in written progress notes. Progress
notes must reflect implementation of the treatment strategies, as performed by the mental
health behavioral aide and the child's responses to the treatment strategies;
(5) direction of a mental health behavioral aide must include deleted text begin the following:
deleted text end
deleted text begin
(i) ongoing face-to-face observation of the mental health behavioral aide delivering
services to a child by a mental health professional or mental health practitioner for at least
a total of one hour during every 40 hours of service provided to a child; and
deleted text end
deleted text begin (ii)deleted text end immediate accessibility of the mental health professional, clinical trainee, or mental
health practitioner to the mental health behavioral aide during service provision;new text begin and
new text end
(6) mental health service plan development must be performed in consultation with the
child's family and, when appropriate, with other key participants in the child's life by the
child's treating mental health professional or clinical trainee or by a mental health practitioner
and approved by the treating mental health professional. Treatment plan drafting consists
of development, review, and revision by face-to-face or electronic communication. The
provider must document events, including the time spent with the family and other key
participants in the child's life to deleted text begin review, revise, and signdeleted text end new text begin approvenew text end the individual treatment
plan. deleted text begin Notwithstanding Minnesota Rules, part 9505.0371, subpart 7, medical assistance
covers service plan development before completion of the child's individual treatment plan.deleted text end
Service plan development is covered only if a treatment plan is completed for the child. If
upon review it is determined that a treatment plan was not completed for the child, the
commissioner shall recover the payment for the service plan developmentdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(7) to be eligible for payment, a diagnostic assessment must be complete with regard to
all required components, including multiple assessment appointments required for an
extended diagnostic assessment and the written report. Dates of the multiple assessment
appointments must be noted in the client's clinical record.
deleted text end
Sec. 109.
Minnesota Statutes 2018, section 256B.0943, subdivision 11, is amended to
read:
Subd. 11.
Documentation and billing.
(a) A provider entity must document the services
it provides under this sectionnew text begin according to section 245I.33new text end . deleted text begin The provider entity must ensure
that documentation complies with Minnesota Rules, parts 9505.2175 and 9505.2197. Services
billed under this section that are not documented according to this subdivision shall be
subject to monetary recovery by the commissioner. Billing for covered service components
under subdivision 2, paragraph (b), must not include anything other than direct service time.
deleted text end
deleted text begin
(b) An individual mental health provider must promptly document the following in a
client's record after providing services to the client:
deleted text end
deleted text begin
(1) each occurrence of the client's mental health service, including the date, type, start
and stop times, scope of the service as described in the child's individual treatment plan,
and outcome of the service compared to baselines and objectives;
deleted text end
deleted text begin
(2) the name, dated signature, and credentials of the person who delivered the service;
deleted text end
deleted text begin
(3) contact made with other persons interested in the client, including representatives
of the courts, corrections systems, or schools. The provider must document the name and
date of each contact;
deleted text end
deleted text begin
(4) any contact made with the client's other mental health providers, case manager,
family members, primary caregiver, legal representative, or the reason the provider did not
contact the client's family members, primary caregiver, or legal representative, if applicable;
deleted text end
deleted text begin
(5) required clinical supervision directly related to the identified client's services and
needs, as appropriate, with co-signatures of the supervisor and supervisee; and
deleted text end
deleted text begin
(6) the date when services are discontinued and reasons for discontinuation of services.
deleted text end
Sec. 110.
Minnesota Statutes 2018, section 256B.0944, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
For purposes of this section, the following terms have the
meanings given them.
(a) "Mental health crisis" means a child's behavioral, emotional, or psychiatric situation
that, but for the provision of crisis response services to the child, would likely result in
significantly reduced levels of functioning in primary activities of daily living, an emergency
situation, or the child's placement in a more restrictive setting, including, but not limited
to, inpatient hospitalization.
(b) "Mental health emergency" means a child's behavioral, emotional, or psychiatric
situation that causes an immediate need for mental health services and is consistent with
section 62Q.55. A physician, mental health professional, or deleted text begin crisis mental health practitionerdeleted text end new text begin
qualified member of a crisis teamnew text end determines a mental health crisis or emergency for medical
assistance reimbursement with input from the client and the client's family, if possible.
(c) "Mental health crisis assessment" means an immediate face-to-face assessment by
a physician, mental health professional, or deleted text begin mental health practitioner under the clinical
deleted text end deleted text begin supervision of a mental health professionaldeleted text end new text begin qualified member of a crisis teamnew text end , following a
screening that suggests the child may be experiencing a mental health crisis or mental health
emergency situation.
(d) "Mental health mobile crisis intervention services" means face-to-face, short-term
intensive mental health services initiated during a mental health crisis or mental health
emergency. Mental health mobile crisis services must help the recipient cope with immediate
stressors, identify and utilize available resources and strengths, and begin to return to the
recipient's baseline level of functioning. Mental health mobile services deleted text begin must be provided
on site by a mobile crisis intervention team outside of an emergency room, urgent care, or
an inpatient hospital setting.deleted text end new text begin , including screening and treatment plan recommendations,
must be culturally and linguistically appropriate.
new text end
(e) "Mental health crisis stabilization services" means individualized mental health
services provided to a recipient following crisis intervention services that are designed to
restore the recipient to the recipient's prior functional level. The individual treatment plan
recommending mental health crisis stabilization must be completed by the intervention team
or by staff after an inpatient or urgent care visit. Mental health crisis stabilization services
may be provided in the recipient's home, the home of a family member or friend of the
recipient, schools, another community setting, or a short-term supervised, licensed residential
program if the service is not included in the facility's cost pool or per diem. Mental health
crisis stabilization is not reimbursable when provided as part of a partial hospitalization or
day treatment program.
new text begin
(f) "Clinical trainee" means a person qualified according to section 245I.16, subdivision
6.
new text end
new text begin
(g) "Mental health certified family peer specialist" means a person qualified according
to section 245I.16, subdivision 12.
new text end
new text begin
(h) "Mental health practitioner" means a person qualified according to section 245I.16,
subdivision 4.
new text end
new text begin
(i) "Mental health professional" means a person qualified according to section 245I.16,
subdivision 2.
new text end
Sec. 111.
Minnesota Statutes 2018, section 256B.0944, subdivision 3, is amended to read:
Subd. 3.
Eligibility.
An eligible recipient is an individual who:
(1) is eligible for medical assistance;
(2) is under age 18 or between the ages of 18 and 21;
(3) is screened as possibly experiencing a mental health crisis or mental health emergency
where a mental health crisis assessment is needed;new text begin and
new text end
(4) is assessed as experiencing a mental health crisis or mental health emergency, and
mental health mobile crisis intervention or mental health crisis stabilization services are
determined to be medically necessarydeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(5) meets the criteria for emotional disturbance or mental illness.
deleted text end
Sec. 112.
Minnesota Statutes 2018, section 256B.0944, subdivision 4, is amended to read:
Subd. 4.
Provider entity standards.
deleted text begin (a)deleted text end A crisis intervention and crisis stabilization
provider entity must meet the administrative and clinical standards specified in deleted text begin section
, subdivisions 5 and 6, meet the standards listed in paragraph (b), and be:deleted text end new text begin section
256B.0624, subdivision 4, and ensure services are developmentally appropriate and
responsive to the needs of the families.
new text end
deleted text begin
(1) an Indian health service facility or facility owned and operated by a tribe or a tribal
organization operating under Public Law 93-638 as a 638 facility;
deleted text end
deleted text begin
(2) a county board-operated entity; or
deleted text end
deleted text begin
(3) a provider entity that is under contract with the county board in the county where
the potential crisis or emergency is occurring.
deleted text end
deleted text begin
(b) The children's mental health crisis response services provider entity must:
deleted text end
deleted text begin
(1) ensure that mental health crisis assessment and mobile crisis intervention services
are available 24 hours a day, seven days a week;
deleted text end
deleted text begin
(2) directly provide the services or, if services are subcontracted, the provider entity
must maintain clinical responsibility for services and billing;
deleted text end
deleted text begin
(3) ensure that crisis intervention services are provided in a manner consistent with
sections 245.487 to 245.4889; and
deleted text end
deleted text begin
(4) develop and maintain written policies and procedures regarding service provision
that include safety of staff and recipients in high-risk situations.
deleted text end
Sec. 113.
Minnesota Statutes 2018, section 256B.0944, subdivision 5, is amended to read:
Subd. 5.
Mobile crisis intervention staff qualifications.
deleted text begin
(a) To provide children's
mental health mobile crisis intervention services, a mobile crisis intervention team must
include:
deleted text end
deleted text begin
(1) at least two mental health professionals as defined in section 256B.0943, subdivision
1, paragraph (o); or
deleted text end
deleted text begin
(2) a combination of at least one mental health professional and one mental health
practitioner as defined in section 245.4871, subdivision 26, with the required mental health
crisis training and under the clinical supervision of a mental health professional on the team.
deleted text end
new text begin
(a) Mobile crisis intervention team staff must be qualified to provide services as mental
health professionals, mental health practitioners, clinical trainees, or mental health certified
family peer specialists.
new text end
new text begin
(b) A mobile crisis intervention team is comprised of at least two members, one of whom
must be qualified as a mental health professional. A second member must be qualified as
a mental health professional, clinical trainee, or mental health practitioner. Additional staff
must be added to reflect the needs of the area served.
new text end
new text begin
(c) Mental health crisis assessment and intervention services must be led by a mental
health professional, or under the supervision of a mental health professional according to
subdivision 9, by a clinical trainee or mental health practitioner.
new text end
deleted text begin (b)deleted text end new text begin (d)new text end The team must have deleted text begin at least two people withdeleted text end at least one member providing
on-site crisis intervention services when needed. Team members must be experienced in
mental health assessment, crisis intervention techniques, and clinical decision making under
emergency conditions and have knowledge of local services and resources. The team must
recommend and coordinate the team's services with appropriate local resources, including
the county social services agency, mental health service providers, and local law enforcement,
if necessary.
Sec. 114.
Minnesota Statutes 2018, section 256B.0944, subdivision 6, is amended to read:
Subd. 6.
Initial screening and crisis assessment planning.
(a) Before initiating mobile
crisis intervention services, a screening of the potential crisis situation must be conducted.
The screening may use the resources of crisis assistance and emergency services as defined
in sections 245.4871, subdivision 14, and 245.4879, subdivisions 1 and 2. The screening
must gather information, determine whether a crisis situation exists, identify the parties
involved, and determine an appropriate response.
new text begin
(b) In conducting the screening, a provider shall:
new text end
new text begin
(1) employ evidence-based practices as identified by the commissioner in collaboration
with the commissioner of health to reduce the risk of the recipient's suicide and self-injurious
behavior;
new text end
new text begin
(2) work with the recipient to establish a plan and time frame for responding to the crisis,
including immediate needs for support by telephone or text message until a face-to-face
response arrives;
new text end
new text begin
(3) document significant factors related to the determination of a crisis, including prior
calls to the crisis team, recent presentation at an emergency department, known calls to 911
or law enforcement, or the presence of third parties with knowledge of a potential recipient's
history or current needs;
new text end
new text begin
(4) screen for the needs of a third-party caller, including a recipient who primarily
identifies as a family member or a caregiver but also presents signs of a crisis; and
new text end
new text begin
(5) provide psychoeducation, including education on the available means for reducing
self-harm, to relevant third parties, including family members or other persons living in the
home.
new text end
new text begin
(c) A provider entity shall consider the following to indicate a positive screening unless
the provider entity documents specific evidence to show why crisis response was clinically
inappropriate:
new text end
new text begin
(1) the recipient presented in an emergency department or urgent care setting, and the
health care team at that location requested crisis services;
new text end
new text begin
(2) a peace officer requested crisis services for a recipient who may be subject to
transportation under section 253B.05 for a mental health crisis.
new text end
deleted text begin (b)deleted text end new text begin (d)new text end If a crisis exists, a crisis assessment must be completed. A crisis assessment must
evaluate any immediate needs for which emergency services are needed and, as time permits,
the recipient's current life situation, new text begin health information including current medications,new text end sources
of stress, mental health problems and symptoms, strengths, cultural considerations, support
network, vulnerabilities, and current functioning.
deleted text begin (c)deleted text end new text begin (e)new text end If the crisis assessment determines mobile crisis intervention services are needed,
the intervention services must be provided promptly. As the opportunity presents itself
during the intervention, at least two members of the mobile crisis intervention team must
confer directly or by telephone about the assessment, treatment plan, and actions taken and
needed. At least one of the team members must be on site providing crisis intervention
services. If providing on-site crisis intervention services, a mental health practitioner must
seek deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision as required under subdivision 9.
new text begin
(f) Direct contact with the recipient is not required before initiating a crisis assessment
or intervention service. A crisis team may gather relevant information from a third party at
the scene to establish the need for services and potential safety factors. A crisis assessment
is provided face-to-face by a mobile crisis intervention team outside of an inpatient hospital
setting. A service must be provided promptly and respond to the recipient's location whenever
possible, including community or clinical settings. As clinically appropriate, a mobile crisis
intervention team must coordinate a response with other health care providers if a recipient
requires detoxification, withdrawal management, or medical stabilization services in addition
to crisis services.
new text end
deleted text begin (d)deleted text end new text begin (g)new text end The mobile crisis intervention team must develop an initial, brief crisis treatment
plan as soon as appropriate but no later than 24 hours after the initial face-to-face intervention.
The plan must address the needs and problems noted in the crisis assessment and include
measurable short-term goals, cultural considerations, and frequency and type of services to
be provided to achieve the goals and reduce or eliminate the crisis. The crisis treatment plan
must be updated as needed to reflect current goals and services. The team must involve the
client and the client's family in developing and implementing the plan.
deleted text begin (e)deleted text end new text begin (h)new text end The team must document in progress notes which short-term goals have been
met and when no further crisis intervention services are required.new text begin If after an assessment a
crisis provider entity refers a recipient to an intensive setting, including an emergency
department, in-patient hospitalization, or residential treatment, one of the crisis team members
who performed or conferred on the assessment must immediately contact the provider entity
and consult with the triage nurse or other staff responsible for intake. The crisis team member
must convey key findings or concerns that led to the referral. The consultation must occur
with the recipient's consent, the recipient's legal guardian's consent, or as allowed by section
144.293, subdivision 5. Any available written documentation, including a crisis treatment
plan, must be sent no later than the next business day.
new text end
deleted text begin (f)deleted text end new text begin (i)new text end If the client's crisis is stabilized, but the client needs a referral for mental health
crisis stabilization services or to other services, the team must provide a referral to these
services. If the recipient has a case manager, planning for other services must be coordinated
with the case manager.
new text begin
(j) If an intervention service is provided without the recipient present, the provider shall
document the reasons why the service is more effective without the recipient present.
new text end
Sec. 115.
Minnesota Statutes 2018, section 256B.0944, subdivision 7, is amended to read:
Subd. 7.
Crisis stabilization services.
Crisis stabilization services deleted text begin must be provided by
a mental health professional or a mental health practitioner, as defined in section 245.462,
subdivision 17, who works under the clinical supervision of a mental health professional
and for a crisis stabilization services provider entity anddeleted text end must meet the following standards:
(1) a crisis stabilization treatment plan must be developed which meets the criteria in
subdivision 8;
(2) services must be delivered according to the treatment plan and include face-to-face
contact with the recipient by qualified staff for further assessment, help with referrals,
updating the crisis stabilization treatment plan, supportive counseling, skills training, and
collaboration with other service providers in the community; and
deleted text begin
(3) mental health practitioners must have completed at least 30 hours of training in crisis
intervention and stabilization during the past two years.
deleted text end
new text begin
(3) if an intervention is provided without the recipient present, the provider shall
document the reasons why the intervention is more effective without the recipient present.
new text end
Sec. 116.
Minnesota Statutes 2018, section 256B.0944, subdivision 8, is amended to read:
Subd. 8.
Treatment plan.
(a) The individual crisis stabilization treatment plan must
include, at a minimum:
(1) a list of problems identified in the assessment;
(2) a list of the recipient's strengths and resources;
(3) concrete, measurable short-term goals and tasks to be achieved, including time frames
for achievement of the goals;
(4) specific objectives directed toward the achievement of each goal;
(5) documentation of the participants involved in the service planning;
(6) planned frequency and type of services initiated;
(7) a crisis response action plan if a crisis should occur; and
(8) clear progress notes on the outcome of goals.
(b) The client, if clinically appropriate, must be a participant in the development of the
crisis stabilization treatment plan. The client or the client's legal guardian must sign the
service plan or documentation must be provided why this was not possible. A copy of the
plan must be given to the client and the client's legal guardian. The plan should include
services arranged, including specific providers where applicable.
(c) A treatment plan must be developed by a mental health professionalnew text begin , clinical trainee,new text end
or mental health practitioner deleted text begin under the clinical supervision of a mental health professionaldeleted text end .
A written plan must be completed within 24 hours of beginning services with the client.
Sec. 117.
Minnesota Statutes 2018, section 256B.0944, subdivision 9, is amended to read:
Subd. 9.
Supervision.
deleted text begin (a)deleted text end A mental health practitioner new text begin or clinical trainee new text end may provide
crisis assessment and mobile crisis intervention services if the following deleted text begin clinicaldeleted text end new text begin treatmentnew text end
supervision requirements are met:
(1) the mental health provider entity must accept full responsibility for the services
provided;
(2) the mental health professional of the provider entity, who is an employee or under
contract with the provider entity, must be immediately available by telephone or in person
for deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision;
(3) the mental health professional is consulted, in person or by telephone, during the
first three hours when a mental health practitioner provides on-site service; and
(4) the mental health professional must review and approve the tentative crisis assessment
and crisis treatment plan, document the consultation, and sign the crisis assessment and
treatment plan within the next business day.
deleted text begin
(b) If the mobile crisis intervention services continue into a second calendar day, a mental
health professional must contact the client face-to-face on the second day to provide services
and update the crisis treatment plan. The on-site observation must be documented in the
client's record and signed by the mental health professional.
deleted text end
Sec. 118.
Minnesota Statutes 2018, section 256B.0946, subdivision 1, is amended to read:
Subdivision 1.
Required covered service components.
(a) deleted text begin Effective May 23, 2013,
and subject to federal approval,deleted text end Medical assistance covers medically necessary intensive
treatment services described under paragraph (b) that are provided by a provider entity
eligible under subdivision 3 to a client eligible under subdivision 2 who is placed in a foster
home licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, or placed in a foster
home licensed under the regulations established by a federally recognized Minnesota tribe.
(b) Intensive treatment services to children with mental illness residing in foster family
settings that comprise specific required service components provided in clauses (1) to (5)
are reimbursed by medical assistance when they meet the following standards:
(1) psychotherapy provided by a mental health professional deleted text begin as defined in Minnesota
Rules, part 9505.0371, subpart 5, item A,deleted text end or a clinical traineedeleted text begin , as defined in Minnesota
Rules, part 9505.0371, subpart 5, item Cdeleted text end ;
(2) crisis deleted text begin assistancedeleted text end new text begin planningnew text end provided according to standards for children's therapeutic
services and supports in section 256B.0943;
(3) individual, family, and group psychoeducation services, defined in subdivision 1a,
paragraph deleted text begin (q)deleted text end new text begin (o)new text end , provided by a mental health professional or a clinical trainee;
(4) clinical care consultation, as defined in subdivision 1a, and provided by a mental
health professional or a clinical trainee; and
(5) service delivery payment requirements as provided under subdivision 4.
Sec. 119.
Minnesota Statutes 2018, section 256B.0946, subdivision 1a, is amended to
read:
Subd. 1a.
Definitions.
For the purposes of this section, the following terms have the
meanings given them.
(a) "Clinical care consultation" means communication from a treating clinician to other
providers working with the same client to inform, inquire, and instruct regarding the client's
symptoms, strategies for effective engagement, care and intervention needs, and treatment
expectations across service settings, including but not limited to the client's school, social
services, day care, probation, home, primary care, medication prescribers, disabilities
services, and other mental health providers and to direct and coordinate clinical service
components provided to the client and family.
deleted text begin
(b) "Clinical supervision" means the documented time a clinical supervisor and supervisee
spend together to discuss the supervisee's work, to review individual client cases, and for
the supervisee's professional development. It includes the documented oversight and
supervision responsibility for planning, implementation, and evaluation of services for a
client's mental health treatment.
deleted text end
deleted text begin
(c) "Clinical supervisor" means the mental health professional who is responsible for
clinical supervision.
deleted text end
deleted text begin (d)deleted text end new text begin (b)new text end "Clinical trainee" deleted text begin has the meaning given in Minnesota Rules, part 9505.0371,
subpart 5, item Cdeleted text end new text begin means a staff person qualified according to section 245I.16, subdivision
6new text end ;
deleted text begin (e)deleted text end new text begin (c)new text end "Crisis deleted text begin assistancedeleted text end new text begin planningnew text end " has the meaning given in section 245.4871, subdivision
9a, including the development of a plan that addresses prevention and intervention strategies
to be used in a potential crisis, but does not include actual crisis intervention.
deleted text begin (f)deleted text end new text begin (d)new text end "Culturally appropriate" means providing mental health services in a manner that
incorporates the child's cultural influencesdeleted text begin , as defined in Minnesota Rules, part 9505.0370,
subpart 9,deleted text end into interventions as a way to maximize resiliency factors and utilize cultural
strengths and resources to promote overall wellness.
deleted text begin (g)deleted text end new text begin (e)new text end "Culture" means the distinct ways of living and understanding the world that are
used by a group of people and are transmitted from one generation to another or adopted
by an individual.
deleted text begin (h)deleted text end new text begin (f)new text end "Diagnostic assessment" deleted text begin has the meaning given in Minnesota Rules, part
9505.0370, subpart 11deleted text end new text begin means an assessment described under section 256B.0671, subdivisions
2 and 3new text end .
deleted text begin (i)deleted text end new text begin (g)new text end "Family" means a person who is identified by the client or the client's parent or
guardian as being important to the client's mental health treatment. Family may include,
but is not limited to, parents, foster parents, children, spouse, committed partners, former
spouses, persons related by blood or adoption, persons who are a part of the client's
permanency plan, or persons who are presently residing together as a family unit.
deleted text begin (j)deleted text end new text begin (h)new text end "Foster care" has the meaning given in section 260C.007, subdivision 18.
deleted text begin (k)deleted text end new text begin (i)new text end "Foster family setting" means the foster home in which the license holder resides.
deleted text begin (l)deleted text end new text begin (j)new text end "Individual treatment plan" deleted text begin has the meaning given in Minnesota Rules, part
9505.0370, subpart 15deleted text end new text begin means the plan described under section 256B.0671, subdivisions 5
and 6new text end .
deleted text begin
(m) "Mental health practitioner" has the meaning given in section 245.462, subdivision
17, and a mental health practitioner working as a clinical trainee according to Minnesota
Rules, part 9505.0371, subpart 5, item C.
deleted text end
new text begin
(k) "Mental health certified family peer specialist" means a staff person qualified
according to section 245I.16, subdivision 12.
new text end
deleted text begin (n)deleted text end new text begin (1)new text end "Mental health professional" deleted text begin has the meaning given in Minnesota Rules, part
9505.0370, subpart 18deleted text end new text begin means a staff person qualified according to section 245I.16,
subdivision 2new text end .
deleted text begin (o)deleted text end new text begin (m)new text end "Mental illness" has the meaning given in deleted text begin Minnesota Rules, part 9505.0370,
subpart 20deleted text end new text begin section 245.462, subdivision 20, paragraph (a), and includes emotional disturbance
as defined in section 245.4871, subdivision 15new text end .
deleted text begin (p)deleted text end new text begin (n)new text end "Parent" has the meaning given in section 260C.007, subdivision 25.
deleted text begin (q)deleted text end new text begin (o)new text end "Psychoeducation services" means information or demonstration provided to an
individual, family, or group to explain, educate, and support the individual, family, or group
in understanding a child's symptoms of mental illness, the impact on the child's development,
and needed components of treatment and skill development so that the individual, family,
or group can help the child to prevent relapse, prevent the acquisition of comorbid disorders,
and achieve optimal mental health and long-term resilience.
deleted text begin (r)deleted text end new text begin (p)new text end "Psychotherapy" has the meaning given in deleted text begin Minnesota Rules, part 9505.0370,
subpart 27deleted text end new text begin section 256B.0625, subdivision 69new text end .
deleted text begin (s)deleted text end new text begin (q)new text end "Team consultation and treatment planning" means the coordination of treatment
plans and consultation among providers in a group concerning the treatment needs of the
child, including disseminating the child's treatment service schedule to all members of the
service team. Team members must include all mental health professionals working with the
child, a parent, the child unless the team lead or parent deem it clinically inappropriate, and
at least two of the following: an individualized education program case manager; probation
agent; children's mental health case manager; child welfare worker, including adoption or
guardianship worker; primary care provider; foster parent; and any other member of the
child's service team.
new text begin
(r) "Trauma" has the meaning given in section 245I.02, subdivision 24.
new text end
new text begin
(s) "Treatment supervision" means the supervision described under section 245I.18.
new text end
new text begin
(t) "Treatment supervisor" means the mental health professional who is responsible for
treatment supervision.
new text end
Sec. 120.
Minnesota Statutes 2018, section 256B.0946, subdivision 2, is amended to read:
Subd. 2.
Determination of client eligibility.
new text begin (a) new text end An eligible recipient is an individual,
from birth through age 20, who is currently placed in a foster home licensed under Minnesota
Rules, parts 2960.3000 to 2960.3340, and has received a diagnostic assessment and an
evaluation of level of care needed, as defined in paragraphs deleted text begin (a)deleted text end new text begin (b)new text end and deleted text begin (b)deleted text end new text begin (c)new text end .
deleted text begin (a)deleted text end new text begin (b)new text end The diagnostic assessment must:
deleted text begin
(1) meet criteria described in Minnesota Rules, part 9505.0372, subpart 1, and be
conducted by a mental health professional or a clinical trainee;
deleted text end
deleted text begin
(2) determine whether or not a child meets the criteria for mental illness, as defined in
Minnesota Rules, part 9505.0370, subpart 20;
deleted text end
deleted text begin (3)deleted text end new text begin (1)new text end document that intensive treatment services are medically necessary within a foster
family setting to ameliorate identified symptoms and functional impairments;new text begin and
new text end
deleted text begin (4)deleted text end new text begin (2)new text end be performed within 180 days before the start of servicedeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(5) be completed as either a standard or extended diagnostic assessment annually to
determine continued eligibility for the service.
deleted text end
deleted text begin (b)deleted text end new text begin (c)new text end The evaluation of level of care must be conducted by the placing county, tribe,
or case manager in conjunction with the diagnostic assessment deleted text begin as described by Minnesota
Rules, part 9505.0372, subpart 1, item Bdeleted text end , using a validated tool approved by the
commissioner of human services and not subject to the rulemaking process, consistent with
section 245.4885, subdivision 1, paragraph (d), the result of which evaluation demonstrates
that the child requires intensive intervention without 24-hour medical monitoring. The
commissioner shall update the list of approved level of care tools annually and publish on
the department's website.
Sec. 121.
Minnesota Statutes 2018, section 256B.0946, subdivision 3, is amended to read:
Subd. 3.
Eligible mental health services providers.
(a) Eligible providers for intensive
children's mental health services in a foster family setting must be certified by the state and
have a service provision contract with a county board or a reservation tribal council and
must be able to demonstrate the ability to provide all of the services required in this sectionnew text begin
and meet the requirements under chapter 245Inew text end .
(b) For purposes of this section, a provider agency must be:
(1) a county-operated entity certified by the state;
(2) an Indian Health Services facility operated by a tribe or tribal organization under
funding authorized by United States Code, title 25, sections 450f to 450n, or title 3 of the
Indian Self-Determination Act, Public Law 93-638, section 638 (facilities or providers); or
(3) a noncounty entity.
(c) Certified providers that do not meet the service delivery standards required in this
section shall be subject to a decertification process.
(d) For the purposes of this section, all services delivered to a client must be provided
by a mental health professional deleted text begin ordeleted text end new text begin ,new text end a clinical traineenew text begin , or a mental health certified family peer
specialistnew text end .
Sec. 122.
Minnesota Statutes 2018, section 256B.0946, subdivision 4, is amended to read:
Subd. 4.
Service delivery payment requirements.
(a) To be eligible for payment under
this section, a provider must develop and practice written policies and procedures for
intensive treatment in foster care, consistent with subdivision 1, paragraph (b), and comply
with the following requirements in paragraphs (b) to deleted text begin (n)deleted text end new text begin (m)new text end .
deleted text begin
(b) A qualified clinical supervisor, as defined in and performing in compliance with
Minnesota Rules, part 9505.0371, subpart 5, item D, must supervise the treatment and
provision of services described in this section.
deleted text end
deleted text begin
(c) Each client receiving treatment services must receive an extended diagnostic
assessment, as described in Minnesota Rules, part 9505.0372, subpart 1, item C, within 30
days of enrollment in this service unless the client has a previous extended diagnostic
assessment that the client, parent, and mental health professional agree still accurately
describes the client's current mental health functioning.
deleted text end
new text begin
(b) For children under age six, each client must receive a diagnostic assessment according
to the requirements in the current edition of the Diagnostic Classification of Mental Health
Disorders of Infancy and Early Childhood.
new text end
deleted text begin (d)deleted text end new text begin (c)new text end Each previous and current mental health, school, and physical health treatment
provider must be contacted to request documentation of treatment and assessments that the
eligible client has received. This information must be reviewed and incorporated into the
diagnostic assessment and team consultation and treatment planning review process.
deleted text begin (e)deleted text end new text begin (d)new text end Each client receiving treatment must be assessed for a trauma history, and the
client's treatment plan must document how the results of the assessment will be incorporated
into treatment.
deleted text begin (f)deleted text end new text begin (e)new text end Each client receiving treatment services must have an individual treatment plan
that is reviewed, evaluated, and deleted text begin signeddeleted text end new text begin approvednew text end every 90 days using the team consultation
and treatment planning process, as defined in subdivision 1a, paragraph deleted text begin (s)deleted text end new text begin (p)new text end .
deleted text begin (g)deleted text end new text begin (f) Clinicalnew text end care consultation, as defined in subdivision 1a, paragraph (a), must be
provided in accordance with the client's individual treatment plan.
deleted text begin (h)deleted text end new text begin (g)new text end Each client must have a crisis deleted text begin assistancedeleted text end plan within ten days of initiating services
and must have access to clinical phone support 24 hours per day, seven days per week,
during the course of treatment. The crisis plan must demonstrate coordination with the local
or regional mobile crisis intervention team.
deleted text begin (i)deleted text end new text begin (h)new text end Services must be delivered and documented at least three days per week, equaling
at least six hours of treatment per week, unless reduced units of service are specified on the
treatment plan as part of transition or on a discharge plan to another service or level of care.
deleted text begin Documentation must comply with Minnesota Rules, parts 9505.2175 and 9505.2197.
deleted text end
deleted text begin (j)deleted text end new text begin (i)new text end Location of service delivery must be in the client's home, day care setting, school,
or other community-based setting that is specified on the client's individualized treatment
plan.
deleted text begin (k)deleted text end new text begin (j)new text end Treatment must be developmentally and culturally appropriate for the client.
deleted text begin (l)deleted text end new text begin (k)new text end Services must be delivered in continual collaboration and consultation with the
client's medical providers and, in particular, with prescribers of psychotropic medications,
including those prescribed on an off-label basis. Members of the service team must be aware
of the medication regimen and potential side effects.
deleted text begin (m)deleted text end new text begin (l)new text end Parents, siblings, foster parents, and members of the child's permanency plan
must be involved in treatment and service delivery unless otherwise noted in the treatment
plan.
deleted text begin (n)deleted text end new text begin (m)new text end Transition planning for the child must be conducted starting with the first
treatment plan and must be addressed throughout treatment to support the child's permanency
plan and postdischarge mental health service needs.
Sec. 123.
Minnesota Statutes 2018, section 256B.0946, subdivision 6, is amended to read:
Subd. 6.
Excluded services.
(a) Services in clauses (1) to (7) are not covered under this
section and are not eligible for medical assistance payment as components of intensive
treatment in foster care services, but may be billed separately:
(1) inpatient psychiatric hospital treatment;
(2) mental health targeted case management;
(3) partial hospitalization;
(4) medication management;
(5) children's mental health day treatment services;
(6) crisis response services under section 256B.0944; and
(7) transportation.
(b) Children receiving intensive treatment in foster care services are not eligible for
medical assistance reimbursement for the following services while receiving intensive
treatment in foster care:
(1) psychotherapy and skills training components of children's therapeutic services and
supports under section 256B.0625, subdivision 35b;
(2) mental health behavioral aide services as defined in section 256B.0943, subdivision
1, paragraph deleted text begin (m)deleted text end new text begin (l)new text end ;
(3) home and community-based waiver services;
(4) mental health residential treatment; and
(5) room and board costs as defined in section 256I.03, subdivision 6.
Sec. 124.
Minnesota Statutes 2018, section 256B.0947, subdivision 1, is amended to read:
Subdivision 1.
Scope.
deleted text begin Effective November 1, 2011, and subject to federal approval,deleted text end
Medical assistance covers medically necessary, intensive nonresidential rehabilitative mental
health services as defined in subdivision 2, for recipients as defined in subdivision 3, when
the services are provided by an entity meeting the standards in this section.
Sec. 125.
Minnesota Statutes 2018, section 256B.0947, subdivision 2, is amended to read:
Subd. 2.
Definitions.
For purposes of this section, the following terms have the meanings
given them.
(a) "Intensive nonresidential rehabilitative mental health services" means child
rehabilitative mental health services as defined in section 256B.0943, except that these
services are provided by a multidisciplinary staff using deleted text begin a total teamdeleted text end new text begin annew text end approach consistent
with assertive community treatment, as adapted for youth, and are directed to recipients
deleted text begin ages 16, 17, 18, 19, or 20 with a serious mental illness or co-occurring mental illness and
substance abuse addictiondeleted text end who require intensive services to prevent admission to an inpatient
psychiatric hospital or placement in a residential treatment facility or who require intensive
services to step down from inpatient or residential care to community-based care.
(b) "Co-occurring mental illness and substance abuse addiction" means a dual diagnosis
of at least one form of mental illness and at least one substance use disorder. Substance use
disorders include alcohol or drug abuse or dependence, excluding nicotine use.
(c) "Diagnostic assessment" deleted text begin has the meaning given to it in Minnesota Rules, part
9505.0370, subpart 11. A diagnostic assessment must be provided according to Minnesota
Rules, part 9505.0372, subpart 1,deleted text end new text begin means the assessment described under section 256B.0671,
subdivisions 2 and 3,new text end and for this section must incorporate a determination of the youth's
necessary level of care using a standardized functional assessment instrument approved and
periodically updated by the commissioner.
(d) "Education specialist" means an individual with knowledge and experience working
with youth regarding special education requirements and goals, special education plans,
and coordination of educational activities with health care activities.
(e) "Housing access support" means an ancillary activity to help an individual find,
obtain, retain, and move to safe and adequate housing. Housing access support does not
provide monetary assistance for rent, damage deposits, or application fees.
(f) "Integrated dual disorders treatment" means the integrated treatment of co-occurring
mental illness and substance use disorders by a team of cross-trained clinicians within the
same program, and is characterized by assertive outreach, stage-wise comprehensive
treatment, treatment goal setting, and flexibility to work within each stage of treatment.
(g) "Medication education services" means services provided individually or in groups,
which focus on:
(1) educating the client and client's family or significant nonfamilial supporters about
mental illness and symptoms;
(2) the role and effects of medications in treating symptoms of mental illness; and
(3) the side effects of medications.
Medication education is coordinated with medication management services and does not
duplicate it. Medication education services are provided by physicians, pharmacists, or
registered nurses with certification in psychiatric and mental health care.
(h) "Peer specialist" means an employed team member who is a mental health certified
peer specialist according to section 256B.0615 and also a former children's mental health
consumer deleted text begin who:deleted text end new text begin .
new text end
deleted text begin
(1) provides direct services to clients including social, emotional, and instrumental
support and outreach;
deleted text end
deleted text begin
(2) assists younger peers to identify and achieve specific life goals;
deleted text end
deleted text begin
(3) works directly with clients to promote the client's self-determination, personal
responsibility, and empowerment;
deleted text end
deleted text begin
(4) assists youth with mental illness to regain control over their lives and their
developmental process in order to move effectively into adulthood;
deleted text end
deleted text begin
(5) provides training and education to other team members, consumer advocacy
organizations, and clients on resiliency and peer support; and
deleted text end
deleted text begin
(6) meets the following criteria:
deleted text end
deleted text begin
(i) is at least 22 years of age;
deleted text end
deleted text begin
(ii) has had a diagnosis of mental illness, as defined in Minnesota Rules, part 9505.0370,
subpart 20, or co-occurring mental illness and substance abuse addiction;
deleted text end
deleted text begin
(iii) is a former consumer of child and adolescent mental health services, or a former or
current consumer of adult mental health services for a period of at least two years;
deleted text end
deleted text begin
(iv) has at least a high school diploma or equivalent;
deleted text end
deleted text begin
(v) has successfully completed training requirements determined and periodically updated
by the commissioner;
deleted text end
deleted text begin
(vi) is willing to disclose the individual's own mental health history to team members
and clients; and
deleted text end
deleted text begin
(vii) must be free of substance use problems for at least one year.
deleted text end
deleted text begin
(i) "Provider agency" means a for-profit or nonprofit organization established to
administer an assertive community treatment for youth team.
deleted text end
deleted text begin (j)deleted text end new text begin (i)new text end "Substance use disorders" means one or more of the disorders defined in the
Diagnostic and Statistical Manual of Mental Disorders, current edition.
deleted text begin (k)deleted text end new text begin (j)new text end "Transition services" means:
(1) activities, materials, consultation, and coordination that ensures continuity of the
client's care in advance of and in preparation for the client's move from one stage of care
or life to another by maintaining contact with the client and assisting the client to establish
provider relationships;
(2) providing the client with knowledge and skills needed posttransition;
(3) establishing communication between sending and receiving entities;
(4) supporting a client's request for service authorization and enrollment; and
(5) establishing and enforcing procedures and schedules.
A youth's transition from the children's mental health system and services to the adult
mental health system and services and return to the client's home and entry or re-entry into
community-based mental health services following discharge from an out-of-home placement
or inpatient hospital stay.
deleted text begin (l)deleted text end new text begin (k)new text end "Treatment team" means all staff who provide services to recipients under this
section.
Sec. 126.
Minnesota Statutes 2018, section 256B.0947, subdivision 3, is amended to read:
Subd. 3.
Client eligibility.
An eligible recipient is an individual who:
(1) is age 16, 17, 18, 19, or 20; and
(2) is diagnosed with a serious mental illness or co-occurring mental illness and substance
abuse addiction, for which intensive nonresidential rehabilitative mental health services are
needed;
(3) has received a level-of-care determination, using an instrument approved by the
commissioner, that indicates a need for intensive integrated intervention without 24-hour
medical monitoring and a need for extensive collaboration among multiple providers;
(4) has a functional impairment and a history of difficulty in functioning safely and
successfully in the community, school, home, or job; or who is likely to need services from
the adult mental health system within the next two years; and
(5) has had a recent diagnostic assessmentdeleted text begin , as provided in Minnesota Rules, part
9505.0372, subpart 1, by a mental health professional who is qualified under Minnesota
Rules, part 9505.0371, subpart 5, item A,deleted text end that documents that intensive nonresidential
rehabilitative mental health services are medically necessary to ameliorate identified
symptoms and functional impairments and to achieve individual transition goals.
Sec. 127.
Minnesota Statutes 2018, section 256B.0947, subdivision 3a, is amended to
read:
Subd. 3a.
Required service components.
deleted text begin
(a) Subject to federal approval, medical
assistance covers all medically necessary intensive nonresidential rehabilitative mental
health services and supports, as defined in this section, under a single daily rate per client.
Services and supports must be delivered by an eligible provider under subdivision 5 to an
eligible client under subdivision 3.
deleted text end
deleted text begin (b)deleted text end new text begin (a)new text end Intensive nonresidential rehabilitative mental health services, supports, and
ancillary activities covered by the single daily rate per client must include the following,
as needed by the individual client:
(1) individual, family, and group psychotherapy;
(2) individual, family, and group skills training, as defined in section 256B.0943,
subdivision 1, paragraph (t);
(3) crisis deleted text begin assistancedeleted text end new text begin planningnew text end as defined in section deleted text begin 245.4871, subdivision 9a, which
includes recognition of factors precipitating a mental health crisis, identification of behaviors
related to the crisis, and the development of a plan to address prevention, intervention, and
follow-up strategies to be used in the lead-up to or onset of, and conclusion of, a mental
health crisis; crisis assistance does not mean crisis response services or crisis intervention
services provided in section 256B.0944deleted text end new text begin 256B.0943, subdivision 1, paragraph (c)new text end ;
(4) medication management provided by a physician or an advanced practice registered
nurse with certification in psychiatric and mental health care;
(5) mental health case management as provided in section 256B.0625, subdivision 20;
(6) medication education services deleted text begin as defined in this sectiondeleted text end ;
(7) care coordination by a client-specific lead worker assigned by and responsible to the
treatment team;
(8) psychoeducation of and consultation and coordination with the client's biological,
adoptive, or foster family and, in the case of a youth living independently, the client's
immediate nonfamilial support network;
(9) clinical consultation to a client's employer or school or to other service agencies or
to the courts to assist in managing the mental illness or co-occurring disorder and to develop
client support systems;
(10) coordination with, or performance of, crisis intervention and stabilization services
as defined in section 256B.0944;
(11) assessment of a client's treatment progress and effectiveness of services using
standardized outcome measures published by the commissioner;
(12) transition services as defined in this section;
(13) integrated dual disorders treatment as defined in this section; and
(14) housing access support.
deleted text begin (c)deleted text end new text begin (b)new text end The provider shall ensure and document the following by means of performing
the required function or by contracting with a qualified person or entity:
(1) client access to crisis intervention services, as defined in section 256B.0944, and
available 24 hours per day and seven days per week;new text begin and
new text end
deleted text begin
(2) completion of an extended diagnostic assessment, as defined in Minnesota Rules,
part 9505.0372, subpart 1, item C; and
deleted text end
deleted text begin (3)deleted text end new text begin (2)new text end determination of the client's needed level of care using an instrument approved
and periodically updated by the commissioner.
Sec. 128.
Minnesota Statutes 2018, section 256B.0947, subdivision 5, is amended to read:
Subd. 5.
Standards for intensive nonresidential rehabilitative providers.
(a) Services
must be provided by a provider entity as provided in subdivision 4.
(b) The treatment team for intensive nonresidential rehabilitative mental health services
comprises both permanently employed core team members and client-specific team members
as follows:
(1) deleted text begin The core treatment team is an entity that operates under the direction of an
independently licensed mental health professional, who is qualified under Minnesota Rules,
part 9505.0371, subpart 5, item A, and that assumes comprehensive clinical responsibility
for clients.deleted text end Based on professional qualifications and client needs, clinically qualified core
team members are assigned on a rotating basis as the client's lead worker to coordinate a
client's care. The core team must comprise at least four full-time equivalent direct care staff
and must includedeleted text begin , but is not limited todeleted text end new text begin at a minimumnew text end :
(i) deleted text begin an independently licenseddeleted text end new text begin anew text end mental health professionaldeleted text begin , qualified under Minnesota
Rules, part 9505.0371, subpart 5, item A,deleted text end who serves as team leader to provide administrative
direction and deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision to the team;
(ii) an advanced-practice registered nurse with certification in psychiatric or mental
health care or a board-certified child and adolescent psychiatrist, either of which must be
credentialed to prescribe medications;
(iii) a licensed alcohol and drug counselor who is also trained in mental health
interventions; and
(iv) a peer specialist deleted text begin as defined in subdivision 2, paragraph (h)deleted text end .
(2) The core team may also include any of the following:
(i) additional mental health professionals;
(ii) a vocational specialist;
(iii) an educational specialist;
(iv) a child and adolescent psychiatrist who may be retained on a consultant basis;
(v) a mental health practitionerdeleted text begin , as defined indeleted text end new text begin qualified according tonew text end section deleted text begin 245.4871,
subdivision 26deleted text end new text begin 245I.16, subdivision 4new text end ;
(vi) a mental health manager, as defined in section 245.4871, subdivision 4; deleted text begin and
deleted text end
(vii) a housing access specialistdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(viii) a clinical trainee qualified according to section 245I.16, subdivision 6.
new text end
(3) A treatment team may include, in addition to those in deleted text begin clausedeleted text end new text begin clausesnew text end (1) deleted text begin ordeleted text end new text begin andnew text end (2),
ad hoc members not employed by the team who consult on a specific client and who must
accept overall clinical direction from the treatment team for the duration of the client's
placement with the treatment team and must be paid by the provider deleted text begin agency at the rate for
a typical session by that provider with that client or at a rate negotiated with the client-specific
memberdeleted text end new text begin entitynew text end . Client-specific treatment team members may include:
(i) the mental health professional treating the client prior to placement with the treatment
team;
(ii) the client's current substance abuse counselor, if applicable;
(iii) a lead member of the client's individualized education program team or school-based
mental health provider, if applicable;
(iv) a representative from the client's health care home or primary care clinic, as needed
to ensure integration of medical and behavioral health care;
(v) the client's probation officer or other juvenile justice representative, if applicable;
and
(vi) the client's current vocational or employment counselor, if applicable.
(c) The deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor shall be an active member of the treatment team
and shall function as a practicing clinician at least on a part-time basis. The treatment team
shall meet with the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor at least weekly to discuss recipients' progress
and make rapid adjustments to meet recipients' needs. The team meeting must include
client-specific case reviews and general treatment discussions among team members.
Client-specific case reviews and planning must be documented in the individual client's
treatment record.
(d) The staffing ratio must not exceed ten clients to one full-time equivalent treatment
team position.
(e) The treatment team shall serve no more than 80 clients at any one time. Should local
demand exceed the team's capacity, an additional team must be established rather than
exceed this limit.
(f) Nonclinical staff shall have prompt access in person or by telephone to a mental
health practitioner or mental health professional. The provider shall have the capacity to
promptly and appropriately respond to emergent needs and make any necessary staffing
adjustments to assure the health and safety of clients.
(g) The intensive nonresidential rehabilitative mental health services provider shall
participate in evaluation of the assertive community treatment for youth (Youth ACT) model
as conducted by the commissioner, including the collection and reporting of data and the
reporting of performance measures as specified by contract with the commissioner.
(h) A regional treatment team may serve multiple counties.
Sec. 129.
Minnesota Statutes 2018, section 256B.0947, subdivision 6, is amended to read:
Subd. 6.
Service standards.
The standards in this subdivision apply to intensive
nonresidential rehabilitative mental health services.
(a) The treatment team shall use team treatment, not an individual treatment model.
(b) Services must be available at times that meet client needs.
(c) The initial functional assessment must be completed within ten days of intake and
updated at least every three months or prior to discharge from the service, whichever comes
first.
(d) An individual treatment plan must be completed for each client, according to criteria
specified in section deleted text begin 256B.0943, subdivision 6, paragraph (b), clause (2)deleted text end new text begin 256B.0671,
subdivisions 5 and 6new text end , and, additionally, must:
(1) be completed in consultation with the client's current therapist and key providers and
provide for ongoing consultation with the client's current therapist to ensure therapeutic
continuity and to facilitate the client's return to the community;
(2) if a need for substance use disorder treatment is indicated by validated assessmentdeleted text begin :deleted text end new text begin ,
new text end
deleted text begin (i)deleted text end identify goals, objectives, and strategies of substance use disorder treatment; develop
a schedule for accomplishing treatment goals and objectives; and identify the individuals
responsible for providing treatment services and supports;new text begin and
new text end
deleted text begin
(ii) be reviewed at least once every 90 days and revised, if necessary;
deleted text end
deleted text begin
(3) be signed by the clinical supervisor and by the client and, if the client is a minor, by
the client's parent or other person authorized by statute to consent to mental health treatment
and substance use disorder treatment for the client; and
deleted text end
deleted text begin (4)deleted text end new text begin (3)new text end provide for the client's transition out of intensive nonresidential rehabilitative
mental health services by defining the team's actions to assist the client and subsequent
providers in the transition to less intensive or "stepped down" services.
(e) The treatment team shall actively and assertively engage the client's family members
and significant others by establishing communication and collaboration with the family and
significant others and educating the family and significant others about the client's mental
illness, symptom management, and the family's role in treatment, unless the team knows or
has reason to suspect that the client has suffered or faces a threat of suffering any physical
or mental injury, abuse, or neglect from a family member or significant other.
(f) For a client age 18 or older, the treatment team may disclose to a family member,
other relative, or a close personal friend of the client, or other person identified by the client,
the protected health information directly relevant to such person's involvement with the
client's care, as provided in Code of Federal Regulations, title 45, part 164.502(b). If the
client is present, the treatment team shall obtain the client's agreement, provide the client
with an opportunity to object, or reasonably infer from the circumstances, based on the
exercise of professional judgment, that the client does not object. If the client is not present
or is unable, by incapacity or emergency circumstances, to agree or object, the treatment
team may, in the exercise of professional judgment, determine whether the disclosure is in
the best interests of the client and, if so, disclose only the protected health information that
is directly relevant to the family member's, relative's, friend's, or client-identified person's
involvement with the client's health care. The client may orally agree or object to the
disclosure and may prohibit or restrict disclosure to specific individuals.
(g) The treatment team shall provide interventions to promote positive interpersonal
relationships.
Sec. 130.
Minnesota Statutes 2018, section 256B.0947, subdivision 7a, is amended to
read:
Subd. 7a.
Noncovered services.
(a) The rate for intensive rehabilitative mental health
services does not include medical assistance payment for services in clauses (1) to (7).
Services not covered under this paragraph may be billed separately:
(1) inpatient psychiatric hospital treatment;
(2) partial hospitalization;
(3) children's mental health day treatment services;
(4) physician services outside of care provided by a psychiatrist serving as a member of
the treatment team;
(5) room and board costs, as defined in section 256I.03, subdivision 6;
(6) home and community-based waiver services; and
(7) other mental health services identified in the child's individualized education program.
(b) The following services are not covered under this section and are not eligible for
medical assistance payment while youth are receiving intensive rehabilitative mental health
services:
(1) mental health residential treatment; and
(2) mental health behavioral aide services, as defined in section 256B.0943, subdivision
1, paragraph deleted text begin (m)deleted text end new text begin (l)new text end .
Sec. 131.
Minnesota Statutes 2018, section 256B.0949, subdivision 2, is amended to read:
Subd. 2.
Definitions.
(a) The terms used in this section have the meanings given in this
subdivision.
(b) "Agency" means the legal entity that is enrolled with Minnesota health care programs
as a medical assistance provider according to Minnesota Rules, part 9505.0195, to provide
EIDBI services and that has the legal responsibility to ensure that its employees or contractors
carry out the responsibilities defined in this section. Agency includes a licensed individual
professional who practices independently and acts as an agency.
(c) "Autism spectrum disorder or a related condition" or "ASD or a related condition"
means either autism spectrum disorder (ASD) as defined in the current version of the
Diagnostic and Statistical Manual of Mental Disorders (DSM) or a condition that is found
to be closely related to ASD, as identified under the current version of the DSM, and meets
all of the following criteria:
(1) is severe and chronic;
(2) results in impairment of adaptive behavior and function similar to that of a person
with ASD;
(3) requires treatment or services similar to those required for a person with ASD; and
(4) results in substantial functional limitations in three core developmental deficits of
ASD: social interaction; nonverbal or social communication; and restrictive, repetitive
behaviors or hyperreactivity or hyporeactivity to sensory input; and may include deficits or
a high level of support in one or more of the following domains:
(i) self-regulation;
(ii) self-care;
(iii) behavioral challenges;
(iv) expressive communication;
(v) receptive communication;
(vi) cognitive functioning; or
(vii) safety.
(d) "Person" means a person under 21 years of age.
(e) "Clinical supervision" means the overall responsibility for the control and direction
of EIDBI service delivery, including individual treatment planning, staff supervision,
individual treatment plan progress monitoring, and treatment review for each person. Clinical
supervision is provided by a qualified supervising professional (QSP) who takes full
professional responsibility for the service provided by each supervisee.
(f) "Commissioner" means the commissioner of human services, unless otherwise
specified.
(g) "Comprehensive multidisciplinary evaluation" or "CMDE" means a comprehensive
evaluation of a person to determine medical necessity for EIDBI services based on the
requirements in subdivision 5.
(h) "Department" means the Department of Human Services, unless otherwise specified.
(i) "Early intensive developmental and behavioral intervention benefit" or "EIDBI
benefit" means a variety of individualized, intensive treatment modalities approved by the
commissioner that are based in behavioral and developmental science consistent with best
practices on effectiveness.
(j) "Generalizable goals" means results or gains that are observed during a variety of
activities over time with different people, such as providers, family members, other adults,
and people, and in different environments including, but not limited to, clinics, homes,
schools, and the community.
(k) "Incident" means when any of the following occur:
(1) an illness, accident, or injury that requires first aid treatment;
(2) a bump or blow to the head; or
(3) an unusual or unexpected event that jeopardizes the safety of a person or staff,
including a person leaving the agency unattended.
(l) "Individual treatment plan" or "ITP" means the person-centered, individualized written
plan of care that integrates and coordinates person and family information from the CMDE
for a person who meets medical necessity for the EIDBI benefit. An individual treatment
plan must meet the standards in subdivision 6.
(m) "Legal representative" means the parent of a child who is under 18 years of age, a
court-appointed guardian, or other representative with legal authority to make decisions
about service for a person. For the purpose of this subdivision, "other representative with
legal authority to make decisions" includes a health care agent or an attorney-in-fact
authorized through a health care directive or power of attorney.
(n) "Mental health professional" has the meaning given in section 245.4871, subdivision
27deleted text begin , clauses (1) to (6)deleted text end .
(o) "Person-centered" means a service that both responds to the identified needs, interests,
values, preferences, and desired outcomes of the person or the person's legal representative
and respects the person's history, dignity, and cultural background and allows inclusion and
participation in the person's community.
(p) "Qualified EIDBI provider" means a person who is a QSP or a level I, level II, or
level III treatment provider.
Sec. 132.
Minnesota Statutes 2018, section 256B.0949, subdivision 4, is amended to read:
Subd. 4.
Diagnosis.
(a) A diagnosis of ASD or a related condition must:
(1) be based upon current DSM criteria including direct observations of the person and
information from the person's legal representative or primary caregivers;
(2) be completed by either (i) a licensed physician or advanced practice registered nurse
or (ii) a mental health professional; and
(3) meet the requirements of deleted text begin Minnesota Rules, part 9505.0372, subpart 1, items B and
Cdeleted text end new text begin section 256B.071, subdivisions 2 and 3new text end .
(b) Additional assessment information may be considered to complete a diagnostic
assessment including specialized tests administered through special education evaluations
and licensed school personnel, and from professionals licensed in the fields of medicine,
speech and language, psychology, occupational therapy, and physical therapy. A diagnostic
assessment may include treatment recommendations.
Sec. 133.
Minnesota Statutes 2018, section 256B.0949, subdivision 5a, is amended to
read:
Subd. 5a.
Comprehensive multidisciplinary evaluation provider qualification.
A
CMDE provider must:
(1) be a licensed physician, advanced practice registered nurse, a mental health
professional, or a deleted text begin mental health practitioner who meets the requirements of adeleted text end clinical trainee
deleted text begin as defined in Minnesota Rules, part 9505.0371, subpart 5, item Cdeleted text end new text begin described under section
245I.16, subdivision 6new text end ;
(2) have at least 2,000 hours of clinical experience in the evaluation and treatment of
people with ASD or a related condition or equivalent documented coursework at the graduate
level by an accredited university in the following content areas: ASD or a related condition
diagnosis, ASD or a related condition treatment strategies, and child development; and
(3) be able to diagnose, evaluate, or provide treatment within the provider's scope of
practice and professional license.
Sec. 134. new text begin DIRECTION TO COMMISSIONER; SINGLE COMPREHENSIVE
LICENSE STRUCTURE.
new text end
new text begin
The commissioner of human services, in consultation with stakeholders including but
not limited to counties, tribes, managed care organizations, provider organizations, advocacy
groups, and individuals and families served, shall develop recommendations to provide a
single comprehensive license structure for mental health service programs, including
community mental health centers according to Minnesota Rules, part 9520.0750, intensive
residential treatment services, assertive community treatment, adult rehabilitative mental
health services, children's therapeutic services and supports, intensive rehabilitative mental
health services, intensive treatment in foster care, and children's residential treatment
programs currently approved under Minnesota Rules, chapter 2960. The recommendations
must prioritize program integrity, the welfare of individuals and families served, improved
integration of mental health and substance use disorder services, and the reduction of
administrative burden on providers.
new text end
Sec. 135. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2018, sections 245.462, subdivision 4a; 256B.0615, subdivisions
2, 4, and 5; 256B.0616, subdivisions 2, 4, and 5; 256B.0624, subdivision 10; 256B.0943,
subdivision 10; 256B.0944, subdivision 10; 256B.0946, subdivision 5; and 256B.0947,
subdivision 9,
new text end
new text begin
are repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Rules, parts 9505.0370; 9505.0371; 9505.0372; 9520.0010; 9520.0020;
9520.0030; 9520.0040; 9520.0050; 9520.0060; 9520.0070; 9520.0080; 9520.0090;
9520.0100; 9520.0110; 9520.0120; 9520.0130; 9520.0140; 9520.0150; 9520.0160;
9520.0170; 9520.0180; 9520.0190; 9520.0200; 9520.0210; and 9520.0230,
new text end
new text begin
are repealed.
new text end
ARTICLE 8
HEALTH CARE
Section 1.
Minnesota Statutes 2018, section 13.69, subdivision 1, is amended to read:
Subdivision 1.
Classifications.
(a) The following government data of the Department
of Public Safety are private data:
(1) medical data on driving instructors, licensed drivers, and applicants for parking
certificates and special license plates issued to physically disabled persons;
(2) other data on holders of a disability certificate under section 169.345, except that (i)
data that are not medical data may be released to law enforcement agencies, and (ii) data
necessary for enforcement of sections 169.345 and 169.346 may be released to parking
enforcement employees or parking enforcement agents of statutory or home rule charter
cities and towns;
(3) Social Security numbers in driver's license and motor vehicle registration records,
except that Social Security numbers must be provided to the Department of Revenue for
purposes of tax administration, the Department of Labor and Industry for purposes of
workers' compensation administration and enforcement, the judicial branch for purposes of
debt collection, and the Department of Natural Resources for purposes of license application
administrationnew text begin , and except that the last four digits of the Social Security number must be
provided to the Department of Human Services for purposes of recovery of Minnesota health
care program benefits paidnew text end ; and
(4) data on persons listed as standby or temporary custodians under section 171.07,
subdivision 11, except that the data must be released to:
(i) law enforcement agencies for the purpose of verifying that an individual is a designated
caregiver; or
(ii) law enforcement agencies who state that the license holder is unable to communicate
at that time and that the information is necessary for notifying the designated caregiver of
the need to care for a child of the license holder.
The department may release the Social Security number only as provided in clause (3)
and must not sell or otherwise provide individual Social Security numbers or lists of Social
Security numbers for any other purpose.
(b) The following government data of the Department of Public Safety are confidential
data: data concerning an individual's driving ability when that data is received from a member
of the individual's family.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 2.
Minnesota Statutes 2018, section 16A.724, subdivision 2, is amended to read:
Subd. 2.
Transfers.
(a) Notwithstanding section 295.581, to the extent available resources
in the health care access fund exceed expenditures in that fund, effective for the biennium
beginning July 1, 2007, the commissioner of management and budget shall transfer the
excess funds from the health care access fund to the general fund on June 30 of each year,
provided that the amount transferred in fiscal year 2016 shall not exceed $48,000,000, the
amount in fiscal year 2017 shall not exceed $122,000,000, and the amount in any fiscal
biennium thereafter shall not exceed $244,000,000. The purpose of this transfer is to meet
the rate increase required under deleted text begin Laws 2003, First Special Session chapter 14, article 13C,
section 2, subdivision 6deleted text end new text begin section 256B.0625, subdivision 67new text end .
(b) For fiscal years 2006 to 2011, MinnesotaCare shall be a forecasted program, and, if
necessary, the commissioner shall reduce these transfers from the health care access fund
to the general fund to meet annual MinnesotaCare expenditures or, if necessary, transfer
sufficient funds from the general fund to the health care access fund to meet annual
MinnesotaCare expenditures.
Sec. 3.
Minnesota Statutes 2018, section 62A.671, subdivision 6, is amended to read:
Subd. 6.
Licensed health care provider.
"Licensed health care provider" means a health
care provider who is:
(1) licensed under chapter 147, 147A, 148, 148B, 148E, 148F, 150A, or 153; a mental
health professional as defined under section 245.462, subdivision 18, or 245.4871,
subdivision 27; new text begin a community health worker meeting the criteria specified in section
256B.0625, subdivision 49, paragraph (a); new text end or vendor of medical care defined in section
256B.02, subdivision 7; and
(2) authorized within their respective scope of practice to provide the particular service
with no supervision or under general supervision.
Sec. 4.
Minnesota Statutes 2018, section 62Q.184, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For the purposes of this section, the terms in this
subdivision have the meanings given them.
(b) "Clinical practice guideline" means a systematically developed statement to assist
health care providers and enrollees in making decisions about appropriate health care services
for specific clinical circumstances and conditions developed independently of a health plan
company, pharmaceutical manufacturer, or any entity with a conflict of interest.new text begin A clinical
practice guideline also includes a preferred drug list developed in accordance with section
256B.0625.
new text end
(c) "Clinical review criteria" means the written screening procedures, decision abstracts,
clinical protocols, and clinical practice guidelines used by a health plan company to determine
the medical necessity and appropriateness of health care services.
(d) "Health plan company" has the meaning given in section 62Q.01, subdivision 4, but
deleted text begin does not include a managed care organization ordeleted text end new text begin also includes anew text end county-based purchasing
plan participating in a public program under chapter 256B or 256Ldeleted text begin , ordeleted text end new text begin and new text end an integrated
health partnership under section 256B.0755.
(e) "Step therapy protocol" means a protocol or program that establishes the specific
sequence in which prescription drugs for a specified medical condition, including
self-administered and physician-administered drugs, are medically appropriate for a particular
enrollee and are covered under a health plan.
(f) "Step therapy override" means that the step therapy protocol is overridden in favor
of coverage of the selected prescription drug of the prescribing health care provider because
at least one of the conditions of subdivision 3, paragraph (a), exists.
Sec. 5.
Minnesota Statutes 2018, section 62Q.184, subdivision 3, is amended to read:
Subd. 3.
Step therapy override process; transparency.
(a) When coverage of a
prescription drug for the treatment of a medical condition is restricted for use by a health
plan company through the use of a step therapy protocol, enrollees and prescribing health
care providers shall have access to a clear, readily accessible, and convenient process to
request a step therapy override. The process shall be made easily accessible on the health
plan company's website. A health plan company may use its existing medical exceptions
process to satisfy this requirement. A health plan company shall grant an override to the
step therapy protocol if at least one of the following conditions exist:
(1) the prescription drug required under the step therapy protocol is contraindicated
pursuant to the pharmaceutical manufacturer's prescribing information for the drug or, due
to a documented adverse event with a previous use or a documented medical condition,
including a comorbid condition, is likely to do any of the following:
(i) cause an adverse reaction to the enrollee;
(ii) decrease the ability of the enrollee to achieve or maintain reasonable functional
ability in performing daily activities; or
(iii) cause physical or mental harm to the enrollee;
(2) the enrollee has had a trial of the required prescription drug covered by their current
or previous health plan, or another prescription drug in the same pharmacologic class or
with the same mechanism of action, and was adherent during such trial for a period of time
sufficient to allow for a positive treatment outcome, and the prescription drug was
discontinued by the enrollee's health care provider due to lack of effectiveness, or an adverse
event. This clause does not prohibit a health plan company from requiring an enrollee to
try another drug in the same pharmacologic class or with the same mechanism of action if
that therapy sequence is supported by the evidence-based and peer-reviewed clinical practice
guideline, Food and Drug Administration label, or pharmaceutical manufacturer's prescribing
information; or
(3) the enrollee is currently receiving a positive therapeutic outcome on a prescription
drug for the medical condition under consideration if, while on their current health plan or
the immediately preceding health plan, the enrollee received coverage for the prescription
drug and the enrollee's prescribing health care provider gives documentation to the health
plan company that the change in prescription drug required by the step therapy protocol is
expected to be ineffective or cause harm to the enrollee based on the known characteristics
of the specific enrollee and the known characteristics of the required prescription drug.
(b) Upon granting a step therapy override, a health plan company shall authorize coverage
for the prescription drug if the prescription drug is a covered prescription drug under the
enrollee's health plan.
(c) The enrollee, or the prescribing health care provider if designated by the enrollee,
may appeal the denial of a step therapy override by a health plan company using the
complaint procedure under sections 62Q.68 to 62Q.73new text begin or 256.045new text end .
(d) In a denial of an override request and any subsequent appeal, a health plan company's
decision must specifically state why the step therapy override request did not meet the
condition under paragraph (a) cited by the prescribing health care provider in requesting
the step therapy override and information regarding the procedure to request external review
of the denial pursuant to section 62Q.73. A denial of a request for a step therapy override
that is upheld on appeal is a final adverse determination for purposes of section 62Q.73 and
is eligible for a request for external review by an enrollee pursuant to section 62Q.73.
(e) A health plan company shall respond to a step therapy override request or an appeal
within five days of receipt of a complete request. In cases where exigent circumstances
exist, a health plan company shall respond within 72 hours of receipt of a complete request.
If a health plan company does not send a response to the enrollee or prescribing health care
provider if designated by the enrollee within the time allotted, the override request or appeal
is granted and binding on the health plan company.
(f) Step therapy override requests must be accessible to and submitted by health care
providers, and accepted by group purchasers electronically through secure electronic
transmission, as described under section 62J.497, subdivision 5.
(g) Nothing in this section prohibits a health plan company from:
(1) requesting relevant documentation from an enrollee's medical record in support of
a step therapy override request; or
(2) requiring an enrollee to try a generic equivalent drug pursuant to section 151.21, or
a biosimilar, as defined under United States Code, chapter 42, section 262(i)(2), prior to
providing coverage for the equivalent branded prescription drug.
(h) This section shall not be construed to allow the use of a pharmaceutical sample for
the primary purpose of meeting the requirements for a step therapy override.
Sec. 6.
new text begin
[214.078] PROTECTION FROM CONVERSION THERAPY.
new text end
new text begin Subdivision 1. new text end
new text begin Definition. new text end
new text begin
"Conversion therapy" means any practice by a mental health
practitioner or mental health professional as defined in section 245.462 that seeks to change
an individual's sexual orientation or gender identity, including efforts to change behaviors
or gender expressions or to eliminate or reduce sexual or romantic attractions or feelings
toward individuals of the same gender. Conversion therapy does not include counseling
that provides assistance to an individual undergoing gender transition, or counseling that
provides acceptance, support, and understanding of an individual or facilitates an individual's
coping, social support, and identity exploration and development, including
sexual-orientation-neutral interventions to prevent or address unlawful conduct or unsafe
sexual practices, as long as the counseling does not seek to change an individual's sexual
orientation or gender identity.
new text end
new text begin Subd. 2. new text end
new text begin Prohibition. new text end
new text begin
(a) No mental health practitioner or mental health professional
shall engage in conversion therapy with a client younger than 18 years of age or with a
vulnerable adult as defined in section 626.5572, subdivision 21.
new text end
new text begin
(b) Conversion therapy attempted by a mental health practitioner or mental health
professional with a client younger than 18 years of age or with vulnerable adults shall be
considered unprofessional conduct and the mental health practitioner or mental health
professional may be subject to disciplinary action by the licensing board of the mental health
practitioner or mental health professional.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 7.
Minnesota Statutes 2018, section 245A.02, subdivision 5a, is amended to read:
Subd. 5a.
Controlling individual.
(a) "Controlling individual" means an owner of a
program or service provider licensed under this chapter and the following individuals, if
applicable:
(1) each officer of the organization, including the chief executive officer and chief
financial officer;
(2) the individual designated as the authorized agent under section 245A.04, subdivision
1, paragraph (b);
(3) the individual designated as the compliance officer under section 256B.04, subdivision
21, paragraph deleted text begin (b)deleted text end new text begin (g)new text end ; and
(4) each managerial official whose responsibilities include the direction of the
management or policies of a program.
(b) Controlling individual does not include:
(1) a bank, savings bank, trust company, savings association, credit union, industrial
loan and thrift company, investment banking firm, or insurance company unless the entity
operates a program directly or through a subsidiary;
(2) an individual who is a state or federal official, or state or federal employee, or a
member or employee of the governing body of a political subdivision of the state or federal
government that operates one or more programs, unless the individual is also an officer,
owner, or managerial official of the program, receives remuneration from the program, or
owns any of the beneficial interests not excluded in this subdivision;
(3) an individual who owns less than five percent of the outstanding common shares of
a corporation:
(i) whose securities are exempt under section 80A.45, clause (6); or
(ii) whose transactions are exempt under section 80A.46, clause (2);
(4) an individual who is a member of an organization exempt from taxation under section
290.05, unless the individual is also an officer, owner, or managerial official of the program
or owns any of the beneficial interests not excluded in this subdivision. This clause does
not exclude from the definition of controlling individual an organization that is exempt from
taxation; or
(5) an employee stock ownership plan trust, or a participant or board member of an
employee stock ownership plan, unless the participant or board member is a controlling
individual according to paragraph (a).
(c) For purposes of this subdivision, "managerial official" means an individual who has
the decision-making authority related to the operation of the program, and the responsibility
for the ongoing management of or direction of the policies, services, or employees of the
program. A site director who has no ownership interest in the program is not considered to
be a managerial official for purposes of this definition.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 8.
Minnesota Statutes 2018, section 245D.081, subdivision 3, is amended to read:
Subd. 3.
Program management and oversight.
(a) The license holder must designate
a managerial staff person or persons to provide program management and oversight of the
services provided by the license holder. The designated manager is responsible for the
following:
(1) maintaining a current understanding of the licensing requirements sufficient to ensure
compliance throughout the program as identified in section 245A.04, subdivision 1, paragraph
(e), and when applicable, as identified in section 256B.04, subdivision 21, paragraph deleted text begin (b)deleted text end new text begin
(g)new text end ;
(2) ensuring the duties of the designated coordinator are fulfilled according to the
requirements in subdivision 2;
(3) ensuring the program implements corrective action identified as necessary by the
program following review of incident and emergency reports according to the requirements
in section 245D.11, subdivision 2, clause (7). An internal review of incident reports of
alleged or suspected maltreatment must be conducted according to the requirements in
section 245A.65, subdivision 1, paragraph (b);
(4) evaluation of satisfaction of persons served by the program, the person's legal
representative, if any, and the case manager, with the service delivery and progress deleted text begin towardsdeleted text end new text begin
towardnew text end accomplishing outcomes identified in sections 245D.07 and 245D.071, and ensuring
and protecting each person's rights as identified in section 245D.04;
(5) ensuring staff competency requirements are met according to the requirements in
section 245D.09, subdivision 3, and ensuring staff orientation and training is provided
according to the requirements in section 245D.09, subdivisions 4, 4a, and 5;
(6) ensuring corrective action is taken when ordered by the commissioner and that the
terms and conditions of the license and any variances are met; and
(7) evaluating the information identified in clauses (1) to (6) to develop, document, and
implement ongoing program improvements.
(b) The designated manager must be competent to perform the duties as required and
must minimally meet the education and training requirements identified in subdivision 2,
paragraph (b), and have a minimum of three years of supervisory level experience in a
program providing direct support services to persons with disabilities or persons age 65 and
older.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 9.
Minnesota Statutes 2018, section 256.962, subdivision 5, is amended to read:
Subd. 5.
Incentive program.
Beginning January 1, 2008, the commissioner shall establish
an incentive program for organizations and licensed insurance producers under chapter 60K
that directly identify and assist potential enrollees in filling out and submitting an application.
For each applicant who is successfully enrolled in MinnesotaCare or medical assistance,
the commissioner, within the available appropriation, shall pay the organization or licensed
insurance producer a deleted text begin $25deleted text end new text begin $70new text end application assistance bonus. The organization or licensed
insurance producer may provide an applicant a gift certificate or other incentive upon
enrollment.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 10.
Minnesota Statutes 2018, section 256.969, subdivision 2b, is amended to read:
Subd. 2b.
Hospital payment rates.
(a) For discharges occurring on or after November
1, 2014, hospital inpatient services for hospitals located in Minnesota shall be paid according
to the following:
(1) critical access hospitals as defined by Medicare shall be paid using a cost-based
methodology;
(2) long-term hospitals as defined by Medicare shall be paid on a per diem methodology
under subdivision 25;
(3) rehabilitation hospitals or units of hospitals that are recognized as rehabilitation
distinct parts as defined by Medicare shall be paid according to the methodology under
subdivision 12; and
(4) all other hospitals shall be paid on a diagnosis-related group (DRG) methodology.
(b) For the period beginning January 1, 2011, through October 31, 2014, rates shall not
be rebased, except that a Minnesota long-term hospital shall be rebased effective January
1, 2011, based on its most recent Medicare cost report ending on or before September 1,
2008, with the provisions under subdivisions 9 and 23, based on the rates in effect on
December 31, 2010. For rate setting periods after November 1, 2014, in which the base
years are updated, a Minnesota long-term hospital's base year shall remain within the same
period as other hospitals.
(c) Effective for discharges occurring on and after November 1, 2014, payment rates
for hospital inpatient services provided by hospitals located in Minnesota or the local trade
area, except for the hospitals paid under the methodologies described in paragraph (a),
clauses (2) and (3), shall be rebased, incorporating cost and payment methodologies in a
manner similar to Medicare. The base year for the rates effective November 1, 2014, shall
be calendar year 2012. The rebasing under this paragraph shall be budget neutral, ensuring
that the total aggregate payments under the rebased system are equal to the total aggregate
payments that were made for the same number and types of services in the base year. Separate
budget neutrality calculations shall be determined for payments made to critical access
hospitals and payments made to hospitals paid under the DRG system. Only the rate increases
or decreases under subdivision 3a or 3c that applied to the hospitals being rebased during
the entire base period shall be incorporated into the budget neutrality calculation.
(d) For discharges occurring on or after November 1, 2014, through the next rebasing
that occurs, the rebased rates under paragraph (c) that apply to hospitals under paragraph
(a), clause (4), shall include adjustments to the projected rates that result in no greater than
a five percent increase or decrease from the base year payments for any hospital. Any
adjustments to the rates made by the commissioner under this paragraph and paragraph (e)
shall maintain budget neutrality as described in paragraph (c).
(e) For discharges occurring on or after November 1, 2014, deleted text begin through the next two rebasing
periodsdeleted text end the commissioner may make additional adjustments to the rebased rates, and when
evaluating whether additional adjustments should be made, the commissioner shall consider
the impact of the rates on the following:
(1) pediatric services;
(2) behavioral health services;
(3) trauma services as defined by the National Uniform Billing Committee;
(4) transplant services;
(5) obstetric services, newborn services, and behavioral health services provided by
hospitals outside the seven-county metropolitan area;
(6) outlier admissions;
(7) low-volume providers; and
(8) services provided by small rural hospitals that are not critical access hospitals.
(f) Hospital payment rates established under paragraph (c) must incorporate the following:
(1) for hospitals paid under the DRG methodology, the base year payment rate per
admission is standardized by the applicable Medicare wage index and adjusted by the
hospital's disproportionate population adjustment;
(2) for critical access hospitals, payment rates for discharges between November 1, 2014,
and June 30, 2015, shall be set to the same rate of payment that applied for discharges on
October 31, 2014;
(3) the cost and charge data used to establish hospital payment rates must only reflect
inpatient services covered by medical assistance; and
(4) in determining hospital payment rates for discharges occurring on or after the rate
year beginning January 1, 2011, through December 31, 2012, the hospital payment rate per
discharge shall be based on the cost-finding methods and allowable costs of the Medicare
program in effect during the base year or years. In determining hospital payment rates for
discharges in subsequent base years, the per discharge rates shall be based on the cost-finding
methods and allowable costs of the Medicare program in effect during the base year or
years.
(g) The commissioner shall validate the rates effective November 1, 2014, by applying
the rates established under paragraph (c), and any adjustments made to the rates under
paragraph (d) or (e), to hospital claims paid in calendar year 2013 to determine whether the
total aggregate payments for the same number and types of services under the rebased rates
are equal to the total aggregate payments made during calendar year 2013.
(h) Effective for discharges occurring on or after July 1, 2017, and every two years
thereafter, payment rates under this section shall be rebased to reflect only those changes
in hospital costs between the existing base year and the next base year. Changes in costs
between base years shall be measured using the lower of the hospital cost index defined in
subdivision 1, paragraph (a), or the percentage change in the case mix adjusted cost per
claim. The commissioner shall establish the base year for each rebasing period considering
the most recent year for which filed Medicare cost reports are available. The estimated
change in the average payment per hospital discharge resulting from a scheduled rebasing
must be calculated and made available to the legislature by January 15 of each year in which
rebasing is scheduled to occur, and must include by hospital the differential in payment
rates compared to the individual hospital's costs.
(i) Effective for discharges occurring on or after July 1, 2015, inpatient payment rates
for critical access hospitals located in Minnesota or the local trade area shall be determined
using a new cost-based methodology. The commissioner shall establish within the
methodology tiers of payment designed to promote efficiency and cost-effectiveness.
Payment rates for hospitals under this paragraph shall be set at a level that does not exceed
the total cost for critical access hospitals as reflected in base year cost reports. Until the
next rebasing that occurs, the new methodology shall result in no greater than a five percent
decrease from the base year payments for any hospital, except a hospital that had payments
that were greater than 100 percent of the hospital's costs in the base year shall have their
rate set equal to 100 percent of costs in the base year. The rates paid for discharges on and
after July 1, 2016, covered under this paragraph shall be increased by the inflation factor
in subdivision 1, paragraph (a). The new cost-based rate shall be the final rate and shall not
be settled to actual incurred costs. Hospitals shall be assigned a payment tier based on the
following criteria:
(1) hospitals that had payments at or below 80 percent of their costs in the base year
shall have a rate set that equals 85 percent of their base year costs;
(2) hospitals that had payments that were above 80 percent, up to and including 90
percent of their costs in the base year shall have a rate set that equals 95 percent of their
base year costs; and
(3) hospitals that had payments that were above 90 percent of their costs in the base year
shall have a rate set that equals 100 percent of their base year costs.
(j) The commissioner may refine the payment tiers and criteria for critical access hospitals
to coincide with the next rebasing under paragraph (h). The factors used to develop the new
methodology may include, but are not limited to:
(1) the ratio between the hospital's costs for treating medical assistance patients and the
hospital's charges to the medical assistance program;
(2) the ratio between the hospital's costs for treating medical assistance patients and the
hospital's payments received from the medical assistance program for the care of medical
assistance patients;
(3) the ratio between the hospital's charges to the medical assistance program and the
hospital's payments received from the medical assistance program for the care of medical
assistance patients;
(4) the statewide average increases in the ratios identified in clauses (1), (2), and (3);
(5) the proportion of that hospital's costs that are administrative and trends in
administrative costs; and
(6) geographic location.
Sec. 11.
Minnesota Statutes 2018, section 256.969, subdivision 3a, is amended to read:
Subd. 3a.
Payments.
(a) Acute care hospital billings under the medical assistance program
must not be submitted until the recipient is discharged. However, the commissioner shall
establish monthly interim payments for inpatient hospitals that have individual patient
lengths of stay over 30 days regardless of diagnostic category. Except as provided in section
256.9693, medical assistance reimbursement for treatment of mental illness shall be
reimbursed based on diagnostic classifications. Individual hospital payments established
under this section and sections 256.9685, 256.9686, and 256.9695, in addition to third-party
and recipient liability, for discharges occurring during the rate year shall not exceed, deleted text begin in
aggregatedeleted text end new text begin on a per claim basisnew text end , the charges for the medical assistance covered inpatient
services paid for the same period of time to the hospital. Services that have rates established
under subdivision 12, must be limited separately from other services. After consulting with
the affected hospitals, the commissioner may consider related hospitals one entity and may
merge the payment rates while maintaining separate provider numbers. The operating and
property base rates per admission or per day shall be derived from the best Medicare and
claims data available when rates are established. The commissioner shall determine the best
Medicare and claims data, taking into consideration variables of recency of the data, audit
disposition, settlement status, and the ability to set rates in a timely manner. The
commissioner shall notify hospitals of payment rates 30 days prior to implementation. The
rate setting data must reflect the admissions data used to establish relative values. The
commissioner may adjust base year cost, relative value, and case mix index data to exclude
the costs of services that have been discontinued by October 1 of the year preceding the
rate year or that are paid separately from inpatient services. Inpatient stays that encompass
portions of two or more rate years shall have payments established based on payment rates
in effect at the time of admission unless the date of admission preceded the rate year in
effect by six months or more. In this case, operating payment rates for services rendered
during the rate year in effect and established based on the date of admission shall be adjusted
to the rate year in effect by the hospital cost index.
(b) For fee-for-service admissions occurring on or after July 1, 2002, the total payment,
before third-party liability and spenddown, made to hospitals for inpatient services is reduced
by .5 percent from the current statutory rates.
(c) In addition to the reduction in paragraph (b), the total payment for fee-for-service
admissions occurring on or after July 1, 2003, made to hospitals for inpatient services before
third-party liability and spenddown, is reduced five percent from the current statutory rates.
Mental health services within diagnosis related groups 424 to 432 or corresponding
APR-DRGs, and facilities defined under subdivision 16 are excluded from this paragraph.
(d) In addition to the reduction in paragraphs (b) and (c), the total payment for
fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for
inpatient services before third-party liability and spenddown, is reduced 6.0 percent from
the current statutory rates. Mental health services within diagnosis related groups 424 to
432 or corresponding APR-DRGs, and facilities defined under subdivision 16 are excluded
from this paragraph. Payments made to managed care plans shall be reduced for services
provided on or after January 1, 2006, to reflect this reduction.
(e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made
to hospitals for inpatient services before third-party liability and spenddown, is reduced
3.46 percent from the current statutory rates. Mental health services with diagnosis related
groups 424 to 432 or corresponding APR-DRGs, and facilities defined under subdivision
16 are excluded from this paragraph. Payments made to managed care plans shall be reduced
for services provided on or after January 1, 2009, through June 30, 2009, to reflect this
reduction.
(f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2011, made
to hospitals for inpatient services before third-party liability and spenddown, is reduced 1.9
percent from the current statutory rates. Mental health services with diagnosis related groups
424 to 432 or corresponding APR-DRGs, and facilities defined under subdivision 16 are
excluded from this paragraph. Payments made to managed care plans shall be reduced for
services provided on or after July 1, 2009, through June 30, 2011, to reflect this reduction.
(g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
fee-for-service admissions occurring on or after July 1, 2011, made to hospitals for inpatient
services before third-party liability and spenddown, is reduced 1.79 percent from the current
statutory rates. Mental health services with diagnosis related groups 424 to 432 or
corresponding APR-DRGs, and facilities defined under subdivision 16 are excluded from
this paragraph. Payments made to managed care plans shall be reduced for services provided
on or after July 1, 2011, to reflect this reduction.
(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total payment
for fee-for-service admissions occurring on or after July 1, 2009, made to hospitals for
inpatient services before third-party liability and spenddown, is reduced one percent from
the current statutory rates. Facilities defined under subdivision 16 are excluded from this
paragraph. Payments made to managed care plans shall be reduced for services provided
on or after October 1, 2009, to reflect this reduction.
(i) In addition to the reductions in paragraphs (b), (c), (d), (g), and (h), the total payment
for fee-for-service admissions occurring on or after July 1, 2011, made to hospitals for
inpatient services before third-party liability and spenddown, is reduced 1.96 percent from
the current statutory rates. Facilities defined under subdivision 16 are excluded from this
paragraph. Payments made to managed care plans shall be reduced for services provided
on or after January 1, 2011, to reflect this reduction.
(j) Effective for discharges on and after November 1, 2014, from hospitals paid under
subdivision 2b, paragraph (a), clauses (1) and (4), the rate adjustments in this subdivision
must be incorporated into the rebased rates established under subdivision 2b, paragraph (c),
and must not be applied to each claim.
(k) Effective for discharges on and after July 1, 2015, from hospitals paid under
subdivision 2b, paragraph (a), clauses (2) and (3), the rate adjustments in this subdivision
must be incorporated into the rates and must not be applied to each claim.
(l) Effective for discharges on and after July 1, 2017, from hospitals paid under
subdivision 2b, paragraph (a), clause (2), the rate adjustments in this subdivision must be
incorporated into the rates and must not be applied to each claim.
Sec. 12.
Minnesota Statutes 2018, section 256.969, subdivision 9, is amended to read:
Subd. 9.
Disproportionate numbers of low-income patients served.
(a) For admissions
occurring on or after July 1, 1993, the medical assistance disproportionate population
adjustment shall comply with federal law and shall be paid to a hospital, excluding regional
treatment centers and facilities of the federal Indian Health Service, with a medical assistance
inpatient utilization rate in excess of the arithmetic mean. The adjustment must be determined
as follows:
(1) for a hospital with a medical assistance inpatient utilization rate above the arithmetic
mean for all hospitals excluding regional treatment centers and facilities of the federal Indian
Health Service but less than or equal to one standard deviation above the mean, the
adjustment must be determined by multiplying the total of the operating and property
payment rates by the difference between the hospital's actual medical assistance inpatient
utilization rate and the arithmetic mean for all hospitals excluding regional treatment centers
and facilities of the federal Indian Health Service; and
(2) for a hospital with a medical assistance inpatient utilization rate above one standard
deviation above the mean, the adjustment must be determined by multiplying the adjustment
that would be determined under clause (1) for that hospital by 1.1. The commissioner shall
report annually on the number of hospitals likely to receive the adjustment authorized by
this paragraph. The commissioner shall specifically report on the adjustments received by
public hospitals and public hospital corporations located in cities of the first class.
(b) Certified public expenditures made by Hennepin County Medical Center shall be
considered Medicaid disproportionate share hospital payments. Hennepin County and
Hennepin County Medical Center shall report by June 15, 2007, on payments made beginning
July 1, 2005, or another date specified by the commissioner, that may qualify for
reimbursement under federal law. Based on these reports, the commissioner shall apply for
federal matching funds.
(c) Upon federal approval of the related state plan amendment, paragraph (b) is effective
retroactively from July 1, 2005, or the earliest effective date approved by the Centers for
Medicare and Medicaid Services.
(d) Effective July 1, 2015, disproportionate share hospital (DSH) payments shall be paid
in accordance with a new methodology using 2012 as the base year. Annual payments made
under this paragraph shall equal the total amount of payments made for 2012. A licensed
children's hospital shall receive only a single DSH factor for children's hospitals. Other
DSH factors may be combined to arrive at a single factor for each hospital that is eligible
for DSH payments. The new methodology shall make payments only to hospitals located
in Minnesota and include the following factors:
(1) a licensed children's hospital with at least 1,000 fee-for-service discharges in the
base year shall receive a factor of 0.868. A licensed children's hospital with less than 1,000
fee-for-service discharges in the base year shall receive a factor of 0.7880;
(2) a hospital that has in effect for the initial rate year a contract with the commissioner
to provide extended psychiatric inpatient services under section 256.9693 shall receive a
factor of 0.0160;
(3) a hospital that has received payment from the fee-for-service program for at least 20
transplant services in the base year shall receive a factor of 0.0435;
(4) a hospital that has a medical assistance utilization rate in the base year between 20
percent up to one standard deviation above the statewide mean utilization rate shall receive
a factor of 0.0468;
(5) a hospital that has a medical assistance utilization rate in the base year that is at least
one standard deviation above the statewide mean utilization rate but is less than three standard
deviations above the mean shall receive a factor of 0.2300; and
(6) a hospital that has a medical assistance utilization rate in the base year that is at least
deleted text begin threedeleted text end new text begin two and one-halfnew text end standard deviations above the statewide mean utilization rate shall
receive a factor of 0.3711.
(e) Any payments or portion of payments made to a hospital under this subdivision that
are subsequently returned to the commissioner because the payments are found to exceed
the hospital-specific DSH limit for that hospital shall be redistributed, proportionate to the
number of fee-for-service discharges, to other DSH-eligible non-children's hospitals that
have a medical assistance utilization rate that is at least one standard deviation above the
mean.
new text begin
(f) An additional payment adjustment shall be established by the commissioner under
this subdivision for a hospital that provides high levels of administering high-cost drugs to
enrollees in fee-for-service medical assistance. The commissioner shall consider factors
including fee-for-service medical assistance utilization rates and payments made for drugs
purchased through the 340B drug purchasing program and administered to fee-for-service
enrollees. If any part of this adjustment exceeds a hospital's hospital-specific disproportionate
share hospital limit, the commissioner shall make a payment to the hospital that equals the
nonfederal share of the amount that exceeds the limit. The total nonfederal share of the
amount of the payment adjustment under this paragraph shall not exceed $1,500,000.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019, except paragraph (f) is
effective for discharges on or after April 1, 2019.
new text end
Sec. 13.
Minnesota Statutes 2018, section 256.969, subdivision 17, is amended to read:
Subd. 17.
Out-of-state hospitals in local trade areas.
Out-of-state hospitals that are
located within a Minnesota local trade area and that have deleted text begin more than 20deleted text end admissions in the
base year or years shall have rates established using the same procedures and methods that
apply to Minnesota hospitals. For this subdivision and subdivision 18, local trade area means
a county contiguous to Minnesota and located in a metropolitan statistical area as determined
by Medicare for October 1 prior to the most current rebased rate year. Hospitals that are
not required by law to file information in a format necessary to establish rates shall have
rates established based on the commissioner's estimates of the information. Relative values
of the diagnostic categories shall not be redetermined under this subdivision until required
by statute. Hospitals affected by this subdivision shall then be included in determining
relative values. However, hospitals that have rates established based upon the commissioner's
estimates of information shall not be included in determining relative values. This subdivision
is effective for hospital fiscal years beginning on or after July 1, 1988. A hospital shall
provide the information necessary to establish rates under this subdivision at least 90 days
before the start of the hospital's fiscal year.
Sec. 14.
Minnesota Statutes 2018, section 256.969, subdivision 19, is amended to read:
Subd. 19.
Metabolic disorder testing of medical assistance recipients.
Medical
assistance inpatient payment rates must include the cost incurred by hospitals to pay the
Department of Health for metabolic disorder testing of newborns who are medical assistance
recipients, if the cost is not recognized by another payment source.new text begin This payment increase
remains in effect until the increase is fully recognized in the base year cost under subdivision
2b.
new text end
Sec. 15.
Minnesota Statutes 2018, section 256B.04, subdivision 14, is amended to read:
Subd. 14.
Competitive bidding.
(a) When determined to be effective, economical, and
feasible, the commissioner may utilize volume purchase through competitive bidding and
negotiation under the provisions of chapter 16C, to provide items under the medical assistance
program including but not limited to the following:
(1) eyeglasses;
(2) oxygen. The commissioner shall provide for oxygen needed in an emergency situation
on a short-term basis, until the vendor can obtain the necessary supply from the contract
dealer;
(3) hearing aids and supplies; deleted text begin and
deleted text end
(4) durable medical equipment, including but not limited to:
(i) hospital beds;
(ii) commodes;
(iii) glide-about chairs;
(iv) patient lift apparatus;
(v) wheelchairs and accessories;
(vi) oxygen administration equipment;
(vii) respiratory therapy equipment;
(viii) electronic diagnostic, therapeutic and life-support systems;new text begin and
new text end
new text begin
(ix) allergen-reducing products as described in section 256B.0625, subdivision 66,
paragraph (c);
new text end
(5) nonemergency medical transportation level of need determinations, disbursement of
public transportation passes and tokens, and volunteer and recipient mileage and parking
reimbursements; and
(6) drugs.
(b) Rate changes and recipient cost-sharing under this chapter and chapter 256L do not
affect contract payments under this subdivision unless specifically identified.
(c) The commissioner may not utilize volume purchase through competitive bidding
and negotiation for special transportation services under the provisions of chapter 16C.
Sec. 16.
Minnesota Statutes 2018, section 256B.04, subdivision 21, is amended to read:
Subd. 21.
Provider enrollment.
(a)new text begin The commissioner shall enroll providers and conduct
screening activities as required by Code of Federal Regulations, title 42, section 455, subpart
E. A provider providing services from multiple locations must enroll each location separately.
The commissioner may deny a provider's incomplete application if a provider fails to respond
to the commissioner's request for additional information within 60 days of the request. The
commissioner must conduct a background study under chapter 245C, including a review
of databases in section 245C.08, subdivision 1, paragraph (a), clauses (1) to (5), for a provider
described in this paragraph. The background study requirement may be satisfied if the
commissioner conducted a fingerprint-based background study on the provider that includes
a review of databases in section 245C.08, subdivision 1, paragraph (a), clauses (1) to (5).
new text end
new text begin
(b) The commissioner shall revalidate each: (1) provider under this subdivision at least
once every five years; and (2) personal care assistance agency under this subdivision once
every three years.
new text end
new text begin
(c) The commissioner shall conduct revalidation as follows:
new text end
new text begin
(1) provide 30-day notice of the revalidation due date including instructions for
revalidation and a list of materials the provider must submit;
new text end
new text begin
(2) if a provider fails to submit all required materials by the due date, notify the provider
of the deficiency within 30 days after the due date and allow the provider an additional 30
days from the notification date to comply; and
new text end
new text begin
(3) if a provider fails to remedy a deficiency within the 30-day time period, give 60-day
notice of termination and immediately suspend the provider's ability to bill. The provider
does not have the right to appeal suspension of ability to bill.
new text end
new text begin
(d) If a provider fails to comply with any individual provider requirement or condition
of participation, the commissioner may suspend the provider's ability to bill until the provider
comes into compliance. The commissioner's decision to suspend the provider is not subject
to an administrative appeal.
new text end
new text begin
(e) All correspondence and notifications, including notifications of termination and other
actions, must be delivered electronically to a provider's MN-ITS mailbox. For a provider
that does not have a MN-ITS account and mailbox, notice must be sent by first-class mail.
This paragraph does not apply to correspondences and notifications related to background
studies.
new text end
new text begin (f)new text end If the commissioner or the Centers for Medicare and Medicaid Services determines
that a provider is designated "high-risk," the commissioner may withhold payment from
providers within that category upon initial enrollment for a 90-day period. The withholding
for each provider must begin on the date of the first submission of a claim.
deleted text begin (b)deleted text end new text begin (g)new text end An enrolled provider that is also licensed by the commissioner under chapter
245A, or is licensed as a home care provider by the Department of Health under chapter
144A and has a home and community-based services designation on the home care license
under section 144A.484, must designate an individual as the entity's compliance officer.
The compliance officer must:
(1) develop policies and procedures to assure adherence to medical assistance laws and
regulations and to prevent inappropriate claims submissions;
(2) train the employees of the provider entity, and any agents or subcontractors of the
provider entity including billers, on the policies and procedures under clause (1);
(3) respond to allegations of improper conduct related to the provision or billing of
medical assistance services, and implement action to remediate any resulting problems;
(4) use evaluation techniques to monitor compliance with medical assistance laws and
regulations;
(5) promptly report to the commissioner any identified violations of medical assistance
laws or regulations; and
(6) within 60 days of discovery by the provider of a medical assistance reimbursement
overpayment, report the overpayment to the commissioner and make arrangements with
the commissioner for the commissioner's recovery of the overpayment.
The commissioner may require, as a condition of enrollment in medical assistance, that a
provider within a particular industry sector or category establish a compliance program that
contains the core elements established by the Centers for Medicare and Medicaid Services.
deleted text begin (c)deleted text end new text begin (h)new text end The commissioner may revoke the enrollment of an ordering or rendering provider
for a period of not more than one year, if the provider fails to maintain and, upon request
from the commissioner, provide access to documentation relating to written orders or requests
for payment for durable medical equipment, certifications for home health services, or
referrals for other items or services written or ordered by such provider, when the
commissioner has identified a pattern of a lack of documentation. A pattern means a failure
to maintain documentation or provide access to documentation on more than one occasion.
Nothing in this paragraph limits the authority of the commissioner to sanction a provider
under the provisions of section 256B.064.
deleted text begin (d)deleted text end new text begin (i)new text end The commissioner shall terminate or deny the enrollment of any individual or
entity if the individual or entity has been terminated from participation in Medicare or under
the Medicaid program or Children's Health Insurance Program of any other state.
deleted text begin (e)deleted text end new text begin (j)new text end As a condition of enrollment in medical assistance, the commissioner shall require
that a provider designated "moderate" or "high-risk" by the Centers for Medicare and
Medicaid Services or the commissioner permit the Centers for Medicare and Medicaid
Services, its agents, or its designated contractors and the state agency, its agents, or its
designated contractors to conduct unannounced on-site inspections of any provider location.
The commissioner shall publish in the Minnesota Health Care Program Provider Manual a
list of provider types designated "limited," "moderate," or "high-risk," based on the criteria
and standards used to designate Medicare providers in Code of Federal Regulations, title
42, section 424.518. The list and criteria are not subject to the requirements of chapter 14.
The commissioner's designations are not subject to administrative appeal.
deleted text begin (f)deleted text end new text begin (k)new text end As a condition of enrollment in medical assistance, the commissioner shall require
that a high-risk provider, or a person with a direct or indirect ownership interest in the
provider of five percent or higher, consent to criminal background checks, including
fingerprinting, when required to do so under state law or by a determination by the
commissioner or the Centers for Medicare and Medicaid Services that a provider is designated
high-risk for fraud, waste, or abuse.
deleted text begin (g)deleted text end new text begin (l)new text end (1) Upon initial enrollment, reenrollment, and notification of revalidation, all
durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) medical suppliers
meeting the durable medical equipment provider and supplier definition in clause (3),
operating in Minnesota and receiving Medicaid funds must purchase a surety bond that is
annually renewed and designates the Minnesota Department of Human Services as the
obligee, and must be submitted in a form approved by the commissioner. For purposes of
this clause, the following medical suppliers are not required to obtain a surety bond: a
federally qualified health center, a home health agency, the Indian Health Service, a
pharmacy, and a rural health clinic.
(2) At the time of initial enrollment or reenrollment, durable medical equipment providers
and suppliers defined in clause (3) must purchase a surety bond of $50,000. If a revalidating
provider's Medicaid revenue in the previous calendar year is up to and including $300,000,
the provider agency must purchase a surety bond of $50,000. If a revalidating provider's
Medicaid revenue in the previous calendar year is over $300,000, the provider agency must
purchase a surety bond of $100,000. The surety bond must allow for recovery of costs and
fees in pursuing a claim on the bond.
(3) "Durable medical equipment provider or supplier" means a medical supplier that can
purchase medical equipment or supplies for sale or rental to the general public and is able
to perform or arrange for necessary repairs to and maintenance of equipment offered for
sale or rental.
deleted text begin (h)deleted text end new text begin (m)new text end The Department of Human Services may require a provider to purchase a surety
bond as a condition of initial enrollment, reenrollment, reinstatement, or continued enrollment
if: (1) the provider fails to demonstrate financial viability, (2) the department determines
there is significant evidence of or potential for fraud and abuse by the provider, or (3) the
provider or category of providers is designated high-risk pursuant to paragraph deleted text begin (a)deleted text end new text begin (f)new text end and
as per Code of Federal Regulations, title 42, section 455.450. The surety bond must be in
an amount of $100,000 or ten percent of the provider's payments from Medicaid during the
immediately preceding 12 months, whichever is greater. The surety bond must name the
Department of Human Services as an obligee and must allow for recovery of costs and fees
in pursuing a claim on the bond. This paragraph does not apply if the provider currently
maintains a surety bond under the requirements in section 256B.0659 or 256B.85.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 17.
Minnesota Statutes 2018, section 256B.04, subdivision 22, is amended to read:
Subd. 22.
Application fee.
(a) The commissioner must collect and retain federally
required nonrefundable application fees to pay for provider screening activities in accordance
with Code of Federal Regulations, title 42, section 455, subpart E. The enrollment application
must be made under the procedures specified by the commissioner, in the form specified
by the commissioner, and accompanied by an application fee described in paragraph (b),
or a request for a hardship exception as described in the specified procedures. Application
fees must be deposited in the provider screening account in the special revenue fund.
Amounts in the provider screening account are appropriated to the commissioner for costs
associated with the provider screening activities required in Code of Federal Regulations,
title 42, section 455, subpart E. deleted text begin The commissioner shall conduct screening activities as
required by Code of Federal Regulations, title 42, section 455, subpart E, and as otherwise
provided by law, to include database checks, unannounced pre- and postenrollment site
visits, fingerprinting, and criminal background studies. The commissioner must revalidate
all providers under this subdivision at least once every five years.
deleted text end
(b) The application fee under this subdivision is $532 for the calendar year 2013. For
calendar year 2014 and subsequent years, the fee:
(1) is adjusted by the percentage change to the Consumer Price Index for all urban
consumers, United States city average, for the 12-month period ending with June of the
previous year. The resulting fee must be announced in the Federal Register;
(2) is effective from January 1 to December 31 of a calendar year;
(3) is required on the submission of an initial application, an application to establish a
new practice location, an application for reenrollment when the provider is not enrolled at
the time of application of reenrollment, or at revalidation when required by federal regulation;
and
(4) must be in the amount in effect for the calendar year during which the application
for enrollment, new practice location, or reenrollment is being submitted.
(c) The application fee under this subdivision cannot be charged to:
(1) providers who are enrolled in Medicare or who provide documentation of payment
of the fee to, and enrollment with, another state, unless the commissioner is required to
rescreen the provider;
(2) providers who are enrolled but are required to submit new applications for purposes
of reenrollment;
(3) a provider who enrolls as an individual; and
(4) group practices and clinics that bill on behalf of individually enrolled providers
within the practice who have reassigned their billing privileges to the group practice or
clinic.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 18.
Minnesota Statutes 2018, section 256B.055, subdivision 2, is amended to read:
Subd. 2.
Subsidized foster children.
Medical assistance may be paid for a child eligible
for or receiving foster care maintenance payments under Title IV-E of the Social Security
Act, United States Code, title 42, sections 670 to 676new text begin , and for a child who is not eligible for
Title IV-E of the Social Security Act but who is determined eligible for foster care or kinship
assistance under chapter 256Nnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 19.
Minnesota Statutes 2018, section 256B.056, subdivision 3, is amended to read:
Subd. 3.
Asset limitations for certain individuals.
(a) To be eligible for medical
assistance, a person must not individually own more than $3,000 in assets, or if a member
of a household with two family members, husband and wife, or parent and child, the
household must not own more than $6,000 in assets, plus $200 for each additional legal
dependent. In addition to these maximum amounts, an eligible individual or family may
accrue interest on these amounts, but they must be reduced to the maximum at the time of
an eligibility redetermination. The accumulation of the clothing and personal needs allowance
according to section 256B.35 must also be reduced to the maximum at the time of the
eligibility redetermination. The value of assets that are not considered in determining
eligibility for medical assistance is the value of those assets excluded under the Supplemental
Security Income program for aged, blind, and disabled persons, with the following
exceptions:
(1) household goods and personal effects are not considered;
(2) capital and operating assets of a trade or business that the local agency determines
are necessary to the person's ability to earn an income are not considered;
(3) motor vehicles are excluded to the same extent excluded by the Supplemental Security
Income program;
(4) assets designated as burial expenses are excluded to the same extent excluded by the
Supplemental Security Income program. Burial expenses funded by annuity contracts or
life insurance policies must irrevocably designate the individual's estate as contingent
beneficiary to the extent proceeds are not used for payment of selected burial expenses;
(5) for a person who no longer qualifies as an employed person with a disability due to
loss of earnings, assets allowed while eligible for medical assistance under section 256B.057,
subdivision 9, are not considered for 12 months, beginning with the first month of ineligibility
as an employed person with a disability, to the extent that the person's total assets remain
within the allowed limits of section 256B.057, subdivision 9, paragraph (d);
(6) deleted text begin when a person enrolled in medical assistance under section 256B.057, subdivision
9, is age 65 or older and has been enrolled during each of the 24 consecutive deleted text end deleted text begin months deleted text end deleted text begin before
the person's 65th birthday, the assets owned by the person and the person's spouse must be
disregarded, up to the limits of section 256B.057, subdivision 9, paragraph (d), when
determining eligibility for medical assistance under section 256B.055, subdivision 7.deleted text end new text begin a
designated employment incentives asset account is disregarded when determining eligibility
for medical assistance for a person age 65 years or older under section 256B.055, subdivision
7. An employment incentives asset account must only be designated by a person who has
been enrolled in medical assistance under section 256B.057, subdivision 9, for a
24-consecutive-month period. A designated employment incentives asset account contains
qualified assets owned by the person and the person's spouse in the last month of enrollment
in medical assistance under section 256B.057, subdivision 9. Qualified assets include
retirement and pension accounts, medical expense accounts, and up to $17,000 of the person's
other nonexcluded assets. An employment incentives asset account is no longer designated
when a person loses medical assistance eligibility for a calendar month or more before
turning age 65. A person who loses medical assistance eligibility before age 65 can establish
a new designated employment incentives asset account by establishing a new
24-consecutive-month period of enrollment under section 256B.057, subdivision 9.new text end The
income of a spouse of a person enrolled in medical assistance under section 256B.057,
subdivision 9, during each of the 24 consecutive months before the person's 65th birthday
must be disregarded when determining eligibility for medical assistance under section
256B.055, subdivision 7. Persons eligible under this clause are not subject to the provisions
in section 256B.059; and
(7) effective July 1, 2009, certain assets owned by American Indians are excluded as
required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
Law 111-5. For purposes of this clause, an American Indian is any person who meets the
definition of Indian according to Code of Federal Regulations, title 42, section 447.50.
(b) No asset limit shall apply to persons eligible under section 256B.055, subdivision
15.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 20.
Minnesota Statutes 2018, section 256B.056, subdivision 5c, is amended to read:
Subd. 5c.
Excess income standard.
(a) The excess income standard for parents and
caretaker relatives, pregnant women, infants, and children ages two through 20 is the standard
specified in subdivision 4, paragraph (b).
(b) The excess income standard for a person whose eligibility is based on blindness,
disability, or age of 65 or more years shall equalnew text begin :
new text end
new text begin (1)new text end 81 percent of the federal poverty guidelinesnew text begin ; and
new text end
new text begin (2) 83 percent of the federal poverty guidelines, effective July 1, 2021new text end .
Sec. 21.
Minnesota Statutes 2018, section 256B.0625, subdivision 3b, is amended to read:
Subd. 3b.
Telemedicine services.
(a) Medical assistance covers medically necessary
services and consultations delivered by a licensed health care provider via telemedicine in
the same manner as if the service or consultation was delivered in person. Coverage is
limited to three telemedicine services per enrollee per calendar weeknew text begin , except as provided
in paragraph (f)new text end . Telemedicine services shall be paid at the full allowable rate.
(b) The commissioner shall establish criteria that a health care provider must attest to
in order to demonstrate the safety or efficacy of delivering a particular service via
telemedicine. The attestation may include that the health care provider:
(1) has identified the categories or types of services the health care provider will provide
via telemedicine;
(2) has written policies and procedures specific to telemedicine services that are regularly
reviewed and updated;
(3) has policies and procedures that adequately address patient safety before, during,
and after the telemedicine service is rendered;
(4) has established protocols addressing how and when to discontinue telemedicine
services; and
(5) has an established quality assurance process related to telemedicine services.
(c) As a condition of payment, a licensed health care provider must document each
occurrence of a health service provided by telemedicine to a medical assistance enrollee.
Health care service records for services provided by telemedicine must meet the requirements
set forth in Minnesota Rules, part 9505.2175, subparts 1 and 2, and must document:
(1) the type of service provided by telemedicine;
(2) the time the service began and the time the service ended, including an a.m. and p.m.
designation;
(3) the licensed health care provider's basis for determining that telemedicine is an
appropriate and effective means for delivering the service to the enrollee;
(4) the mode of transmission of the telemedicine service and records evidencing that a
particular mode of transmission was utilized;
(5) the location of the originating site and the distant site;
(6) if the claim for payment is based on a physician's telemedicine consultation with
another physician, the written opinion from the consulting physician providing the
telemedicine consultation; and
(7) compliance with the criteria attested to by the health care provider in accordance
with paragraph (b).
(d) For purposes of this subdivision, unless otherwise covered under this chapter,
"telemedicine" is defined as the delivery of health care services or consultations while the
patient is at an originating site and the licensed health care provider is at a distant site. A
communication between licensed health care providers, or a licensed health care provider
and a patient that consists solely of a telephone conversation, e-mail, or facsimile transmission
does not constitute telemedicine consultations or services. Telemedicine may be provided
by means of real-time two-way, interactive audio and visual communications, including the
application of secure video conferencing or store-and-forward technology to provide or
support health care delivery, which facilitate the assessment, diagnosis, consultation,
treatment, education, and care management of a patient's health care.
(e) For purposes of this section, "licensed health care provider" means a licensed health
care provider under section 62A.671, subdivision 6, and a mental health practitioner defined
under section 245.462, subdivision 17, or 245.4871, subdivision 26, working under the
general supervision of a mental health professional; "health care provider" is defined under
section 62A.671, subdivision 3; and "originating site" is defined under section 62A.671,
subdivision 7.
new text begin
(f) The limit on coverage of three telemedicine services per enrollee per calendar week
does not apply if:
new text end
new text begin
(1) the telemedicine services provided by the licensed health care provider are for the
treatment and control of tuberculosis; and
new text end
new text begin
(2) the services are provided in a manner consistent with the recommendations and best
practices specified by the Centers for Disease Control and Prevention and the commissioner
of health.
new text end
Sec. 22.
Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 5m. new text end
new text begin Conversion therapy. new text end
new text begin
Conversion therapy, as defined in section 214.078, is
not covered.
new text end
Sec. 23.
Minnesota Statutes 2018, section 256B.0625, subdivision 9, is amended to read:
Subd. 9.
Dental services.
(a) Medical assistance covers dental services.
(b) Medical assistance dental coverage for nonpregnant adults is limited to the following
services:
(1) comprehensive exams, limited to once every five years;
(2) periodic exams, limited to one per year;
(3) limited exams;
(4) bitewing x-rays, limited to one per year;
(5) periapical x-rays;
(6) panoramic x-rays, limited to one every five years except (1) when medically necessary
for the diagnosis and follow-up of oral and maxillofacial pathology and trauma or (2) once
every two years for patients who cannot cooperate for intraoral film due to a developmental
disability or medical condition that does not allow for intraoral film placement;
(7) prophylaxis, limited to one per year;
(8) application of fluoride varnish, limited to one per year;
(9) posterior fillings, all at the amalgam rate;
(10) anterior fillings;
(11) endodontics, limited to root canals on the anterior and premolars only;
(12) removable prostheses, each dental arch limited to one every six years;
(13) oral surgery, limited to extractions, biopsies, and incision and drainage of abscesses;
(14) palliative treatment and sedative fillings for relief of pain; deleted text begin and
deleted text end
(15) full-mouth debridement, limited to one every five yearsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(16) nonsurgical treatment for periodontal disease, including scaling and root planing
once every two years for each quadrant, and routine periodontal maintenance procedures.
new text end
(c) In addition to the services specified in paragraph (b), medical assistance covers the
following services for adults, if provided in an outpatient hospital setting or freestanding
ambulatory surgical center as part of outpatient dental surgery:
(1) periodontics, limited to periodontal scaling and root planing once every two years;
(2) general anesthesia; and
(3) full-mouth survey once every five years.
(d) Medical assistance covers medically necessary dental services for children and
pregnant women. The following guidelines apply:
(1) posterior fillings are paid at the amalgam rate;
(2) application of sealants are covered once every five years per permanent molar for
children only;
(3) application of fluoride varnish is covered once every six months; and
(4) orthodontia is eligible for coverage for children only.
(e) In addition to the services specified in paragraphs (b) and (c), medical assistance
covers the following services for adults:
(1) house calls or extended care facility calls for on-site delivery of covered services;
(2) behavioral management when additional staff time is required to accommodate
behavioral challenges and sedation is not used;
(3) oral or IV sedation, if the covered dental service cannot be performed safely without
it or would otherwise require the service to be performed under general anesthesia in a
hospital or surgical center; and
(4) prophylaxis, in accordance with an appropriate individualized treatment plan, but
no more than four times per year.
(f) The commissioner shall not require prior authorization for the services included in
paragraph (e), clauses (1) to (3), and shall prohibit managed care and county-based purchasing
plans from requiring prior authorization for the services included in paragraph (e), clauses
(1) to (3), when provided under sections 256B.69, 256B.692, and 256L.12.
Sec. 24.
Minnesota Statutes 2018, section 256B.0625, subdivision 13, is amended to read:
Subd. 13.
Drugs.
(a) Medical assistance covers drugs, except for fertility drugs when
specifically used to enhance fertility, if prescribed by a licensed practitioner and dispensed
by a licensed pharmacist, by a physician enrolled in the medical assistance program as a
dispensing physician, or by a physician, physician assistant, or a nurse practitioner employed
by or under contract with a community health board as defined in section 145A.02,
subdivision 5, for the purposes of communicable disease control.
(b) The dispensed quantity of a prescription drug must not exceed a 34-day supply,
unless authorized by the commissioner.
(c) For the purpose of this subdivision and subdivision 13d, an "active pharmaceutical
ingredient" is defined as a substance that is represented for use in a drug and when used in
the manufacturing, processing, or packaging of a drug becomes an active ingredient of the
drug product. An "excipient" is defined as an inert substance used as a diluent or vehicle
for a drug. The commissioner shall establish a list of active pharmaceutical ingredients and
excipients which are included in the medical assistance formulary. Medical assistance covers
selected active pharmaceutical ingredients and excipients used in compounded prescriptions
when the compounded combination is specifically approved by the commissioner or when
a commercially available product:
(1) is not a therapeutic option for the patient;
(2) does not exist in the same combination of active ingredients in the same strengths
as the compounded prescription; and
(3) cannot be used in place of the active pharmaceutical ingredient in the compounded
prescription.
(d) Medical assistance covers the following over-the-counter drugs when prescribed by
a licensed practitioner or by a licensed pharmacist who meets standards established by the
commissioner, in consultation with the board of pharmacy: antacids, acetaminophen, family
planning products, aspirin, insulin, products for the treatment of lice, vitamins for adults
with documented vitamin deficiencies, vitamins for children under the age of seven and
pregnant or nursing women, and any other over-the-counter drug identified by the
commissioner, in consultation with the Formulary Committee, as necessary, appropriate,
and cost-effective for the treatment of certain specified chronic diseases, conditions, or
disorders, and this determination shall not be subject to the requirements of chapter 14. A
pharmacist may prescribe over-the-counter medications as provided under this paragraph
for purposes of receiving reimbursement under Medicaid. When prescribing over-the-counter
drugs under this paragraph, licensed pharmacists must consult with the recipient to determine
necessity, provide drug counseling, review drug therapy for potential adverse interactions,
and make referrals as needed to other health care professionals. deleted text begin Over-the-counter medications
must be dispensed in a quantity that is the lowest of: (1) the number of dosage units contained
in the manufacturer's original package; (2) the number of dosage units required to complete
the patient's course of therapy; or (3) if applicable, the number of dosage units dispensed
from a system using retrospective billing, as provided under subdivision 13e, paragraph
(b).
deleted text end
(e) Effective January 1, 2006, medical assistance shall not cover drugs that are coverable
under Medicare Part D as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), for individuals eligible
for drug coverage as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-1(a)(3)(A). For these
individuals, medical assistance may cover drugs from the drug classes listed in United States
Code, title 42, section 1396r-8(d)(2), subject to this subdivision and subdivisions 13a to
13g, except that drugs listed in United States Code, title 42, section 1396r-8(d)(2)(E), shall
not be covered.
(f) Medical assistance covers drugs acquired through the federal 340B Drug Pricing
Program and dispensed by 340B covered entities and ambulatory pharmacies under common
ownership of the 340B covered entity. Medical assistance does not cover drugs acquired
through the federal 340B Drug Pricing Program and dispensed by 340B contract pharmacies.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 1, 2019, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 25.
Minnesota Statutes 2018, section 256B.0625, subdivision 13d, is amended to
read:
Subd. 13d.
Drug formulary.
(a) The commissioner shall establish a drug formulary. Its
establishment and publication shall not be subject to the requirements of the Administrative
Procedure Act, but the Formulary Committee shall review and comment on the formulary
contents.
(b) The formulary shall not include:
(1) drugs, active pharmaceutical ingredients, or products for which there is no federal
funding;
(2) over-the-counter drugs, except as provided in subdivision 13;
deleted text begin
(3) drugs or active pharmaceutical ingredients used for weight loss, except that medically
necessary lipase inhibitors may be covered for a recipient with type II diabetes;
deleted text end
deleted text begin (4)deleted text end new text begin (3)new text end drugs or active pharmaceutical ingredients when used for the treatment of
impotence or erectile dysfunction;
deleted text begin (5)deleted text end new text begin (4)new text end drugs or active pharmaceutical ingredients for which medical value has not been
established;
deleted text begin (6)deleted text end new text begin (5)new text end drugs from manufacturers who have not signed a rebate agreement with the
Department of Health and Human Services pursuant to section 1927 of title XIX of the
Social Security Act; and
deleted text begin (7)deleted text end new text begin (6)new text end medical cannabis as defined in section 152.22, subdivision 6.
(c) If a single-source drug used by at least two percent of the fee-for-service medical
assistance recipients is removed from the formulary due to the failure of the manufacturer
to sign a rebate agreement with the Department of Health and Human Services, the
commissioner shall notify prescribing practitioners within 30 days of receiving notification
from the Centers for Medicare and Medicaid Services (CMS) that a rebate agreement was
not signed.
Sec. 26.
Minnesota Statutes 2018, section 256B.0625, subdivision 13e, is amended to
read:
Subd. 13e.
Payment rates.
(a) The basis for determining the amount of payment shall
be the lower of the deleted text begin actual acquisitiondeleted text end new text begin ingredientnew text end costs of the drugs deleted text begin or the maximum allowable
cost by the commissionerdeleted text end plus the deleted text begin fixeddeleted text end new text begin professionalnew text end dispensing fee; or the usual and
customary price charged to the public. new text begin The usual and customary price means the lowest
price charged by the provider to a patient who pays for the prescription by cash, check, or
charge account and includes prices the pharmacy charges to a patient enrolled in a
prescription savings club or prescription discount club administered by the pharmacy or
pharmacy chain. new text end The amount of payment basis must be reduced to reflect all discount
amounts applied to the charge by any new text begin third-party new text end provider/insurer agreement or contract for
submitted charges to medical assistance programs. The net submitted charge may not be
greater than the patient liability for the service. The deleted text begin pharmacydeleted text end new text begin professionalnew text end dispensing fee
shall be deleted text begin $3.65deleted text end new text begin $10.48new text end for deleted text begin legend prescription drugs, except thatdeleted text end new text begin prescriptions filled with
legend drugs meeting the definition of "covered outpatient drugs" according to United States
Code, title 42, section 1396r-8(k)(2).new text end The dispensing fee for intravenous solutions deleted text begin whichdeleted text end new text begin
thatnew text end must be compounded by the pharmacist shall be deleted text begin $8deleted text end new text begin $10.48new text end per bagdeleted text begin , $14 per bag for
cancer chemotherapy products, and $30 per bag for total parenteral nutritional products
dispensed in one liter quantities, or $44 per bag for total parenteral nutritional products
dispensed in quantities greater than one literdeleted text end . new text begin The professional dispensing fee for
prescriptions filled with over-the-counter drugs meeting the definition of covered outpatient
drugs shall be $10.48 for dispensed quantities equal to or greater than the number of units
contained in the manufacturer's original package. The professional dispensing fee shall be
prorated based on the percentage of the package dispensed when the pharmacy dispenses
a quantity less than the number of units contained in the manufacturer's original package.
new text end The pharmacy dispensing fee for new text begin prescribed new text end over-the-counter drugs new text begin not meeting the definition
of covered outpatient drugs new text end shall be $3.65deleted text begin , except that the fee shall be $1.31 for
retrospectively billing pharmacies when billing for quantities less than the number of units
contained in the manufacturer's original package. Actual acquisition cost includes quantity
and other special discounts except time and cash discounts. The actual acquisition cost of
a drug shall be estimated by the commissioner at wholesale acquisition cost plus four percent
for independently owned pharmacies located in a designated rural area within Minnesota,
and at wholesale acquisition cost plus two percent for all other pharmacies. A pharmacy is
"independently owned" if it is one of four or fewer pharmacies under the same ownership
nationally. A "designated rural area" means an area defined as a small rural area or isolated
rural area according to the four-category classification of the Rural Urban Commuting Area
system developed for the United States Health Resources and Services Administration.
Effective January 1, 2014, the actual acquisitiondeleted text end new text begin for quantities equal to or greater than the
number of units contained in the manufacturer's original package and shall be prorated based
on the percentage of the package dispensed when the pharmacy dispenses a quantity less
than the number of units contained in the manufacturer's original package. The National
Average Drug Acquisition Cost (NADAC) shall be used to determine the ingredient cost
of a drug. For drugs for which a NADAC is not reported, the commissioner shall estimate
the ingredient cost at the wholesale acquisition cost minus two percent. The ingredientnew text end cost
of a drug deleted text begin acquired throughdeleted text end new text begin for a provider participating innew text end the federal 340B Drug Pricing
Program shall be deleted text begin estimated by the commissioner at wholesale acquisition cost minus 40
percentdeleted text end new text begin either the 340B Drug Pricing Program ceiling price established by the Health
Resources and Services Administration or NADAC, whichever is lowernew text end . Wholesale
acquisition cost is defined as the manufacturer's list price for a drug or biological to
wholesalers or direct purchasers in the United States, not including prompt pay or other
discounts, rebates, or reductions in price, for the most recent month for which information
is available, as reported in wholesale price guides or other publications of drug or biological
pricing data. The maximum allowable cost of a multisource drug may be set by the
commissioner and it shall be comparable todeleted text begin , butdeleted text end new text begin the actual acquisition cost of the drug
product andnew text end no higher thandeleted text begin , the maximum amount paid by other third-party payors in this
state who have maximum allowable cost programsdeleted text end new text begin the NADAC of the generic productnew text end .
Establishment of the amount of payment for drugs shall not be subject to the requirements
of the Administrative Procedure Act.
(b) Pharmacies dispensing prescriptions to residents of long-term care facilities using
an automated drug distribution system meeting the requirements of section 151.58, or a
packaging system meeting the packaging standards set forth in Minnesota Rules, part
6800.2700, that govern the return of unused drugs to the pharmacy for reuse, may employ
retrospective billing for prescription drugs dispensed to long-term care facility residents. A
retrospectively billing pharmacy must submit a claim only for the quantity of medication
used by the enrolled recipient during the defined billing period. A retrospectively billing
pharmacy must use a billing period not less than one calendar month or 30 days.
(c) deleted text begin An additional dispensing fee of $.30 may be added to the dispensing fee paid to
pharmacists for legend drug prescriptions dispensed to residents of long-term care facilities
when a unit dose blister card system, approved by the department, is used. Under this type
of dispensing system, the pharmacist must dispense a 30-day supply of drug. The National
Drug Code (NDC) from the drug container used to fill the blister card must be identified
on the claim to the department. The unit dose blister card containing the drug must meet
the packaging standards set forth in Minnesota Rules, part 6800.2700, that govern the return
of unused drugs to the pharmacy for reuse.deleted text end A pharmacy provider using packaging that meets
the standards set forth in Minnesota Rules, part 6800.2700, is required to credit the
department for the actual acquisition cost of all unused drugs that are eligible for reuse,
unless the pharmacy is using retrospective billing. The commissioner may permit the drug
clozapine to be dispensed in a quantity that is less than a 30-day supply.
(d) deleted text begin Whenever a maximum allowable cost has been set fordeleted text end new text begin If a pharmacy dispensesnew text end a
multisource drug, deleted text begin payment shall be the lower of the usual and customary price charged to
the public ordeleted text end new text begin the ingredient cost shall be the NADAC of the generic product ornew text end the maximum
allowable cost established by the commissioner unless prior authorization for the brand
name product has been granted according to the criteria established by the Drug Formulary
Committee as required by subdivision 13f, paragraph (a), and the prescriber has indicated
"dispense as written" on the prescription in a manner consistent with section 151.21,
subdivision 2.
(e) The basis for determining the amount of payment for drugs administered in an
outpatient setting shall be the lower of the usual and customary cost submitted by the
provider, 106 percent of the average sales price as determined by the United States
Department of Health and Human Services pursuant to title XVIII, section 1847a of the
federal Social Security Act, the specialty pharmacy rate, or the maximum allowable cost
set by the commissioner. If average sales price is unavailable, the amount of payment must
be lower of the usual and customary cost submitted by the provider, the wholesale acquisition
cost, the specialty pharmacy rate, or the maximum allowable cost set by the commissioner.
deleted text begin Effective January 1, 2014,deleted text end The commissioner shall discount the payment rate for drugs
obtained through the federal 340B Drug Pricing Program by deleted text begin 20deleted text end new text begin 28.6new text end percent. The payment
for drugs administered in an outpatient setting shall be made to the administering facility
or practitioner. A retail or specialty pharmacy dispensing a drug for administration in an
outpatient setting is not eligible for direct reimbursement.
(f) The commissioner may deleted text begin negotiate lower reimbursementdeleted text end new text begin establish maximum allowable
costnew text end rates for specialty pharmacy products deleted text begin than the ratesdeleted text end new text begin that are lower than the ingredient
cost formulasnew text end specified in paragraph (a). The commissioner may require individuals enrolled
in the health care programs administered by the department to obtain specialty pharmacy
products from providers with whom the commissioner has negotiated lower reimbursement
rates. Specialty pharmacy products are defined as those used by a small number of recipients
or recipients with complex and chronic diseases that require expensive and challenging drug
regimens. Examples of these conditions include, but are not limited to: multiple sclerosis,
HIV/AIDS, transplantation, hepatitis C, growth hormone deficiency, Crohn's Disease,
rheumatoid arthritis, and certain forms of cancer. Specialty pharmaceutical products include
injectable and infusion therapies, biotechnology drugs, antihemophilic factor products,
high-cost therapies, and therapies that require complex care. The commissioner shall consult
with the Formulary Committee to develop a list of specialty pharmacy products subject to
deleted text begin this paragraphdeleted text end new text begin maximum allowable cost reimbursementnew text end . In consulting with the Formulary
Committee in developing this list, the commissioner shall take into consideration the
population served by specialty pharmacy products, the current delivery system and standard
of care in the state, and access to care issues. The commissioner shall have the discretion
to adjust the deleted text begin reimbursement ratedeleted text end new text begin maximum allowable costnew text end to prevent access to care issues.
(g) Home infusion therapy services provided by home infusion therapy pharmacies must
be paid at rates according to subdivision 8d.
new text begin
(h) The commissioner shall contract with a vendor to conduct a cost of dispensing survey
for all pharmacies that are physically located in the state of Minnesota that dispense outpatient
drugs under medical assistance. The commissioner shall ensure that the vendor has prior
experience in conducting cost of dispensing surveys. Each pharmacy enrolled with the
department to dispense outpatient prescription drugs to fee-for-service members must
respond to the cost of dispensing survey. The commissioner may sanction a pharmacy under
section 256B.064 for failure to respond. The commissioner shall require the vendor to
measure a single statewide cost of dispensing for all responding pharmacies to measure the
mean, mean weighted by total prescription volume, mean weighted by medical assistance
prescription volume, median, median weighted by total prescription volume, and median
weighted by total medical assistance prescription volume. The commissioner shall post a
copy of the final cost of dispensing survey report on the department's website. The initial
survey must be completed no later than January 1, 2021, and repeated every three years.
The commissioner shall provide a summary of the results of each cost of dispensing survey
and provide recommendations for any changes to the dispensing fee to the chairs and ranking
members of the legislative committees with jurisdiction over medical assistance pharmacy
reimbursement.
new text end
new text begin
(i) The commissioner shall increase the ingredient cost reimbursement calculated in
paragraphs (a) and (f) by two percent for prescription and nonprescription drugs subject to
the wholesale drug distributor tax under section 295.52.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 1, 2019, or upon federal approval,
whichever is later. Paragraph (i) expires if federal approval is denied. The commissioner
of human services shall inform the revisor of statutes when federal approval is obtained or
denied.
new text end
Sec. 27.
Minnesota Statutes 2018, section 256B.0625, subdivision 13f, is amended to read:
Subd. 13f.
Prior authorization.
(a) The Formulary Committee shall review and
recommend drugs which require prior authorization. The Formulary Committee shall
establish general criteria to be used for the prior authorization of brand-name drugs for
which generically equivalent drugs are available, but the committee is not required to review
each brand-name drug for which a generically equivalent drug is available.
(b) Prior authorization may be required by the commissioner before certain formulary
drugs are eligible for payment. The Formulary Committee may recommend drugs for prior
authorization directly to the commissioner. The commissioner may also request that the
Formulary Committee review a drug for prior authorization. Before the commissioner may
require prior authorization for a drug:
(1) the commissioner must provide information to the Formulary Committee on the
impact that placing the drug on prior authorization may have on the quality of patient care
and on program costs, information regarding whether the drug is subject to clinical abuse
or misuse, and relevant data from the state Medicaid program if such data is available;
(2) the Formulary Committee must review the drug, taking into account medical and
clinical data and the information provided by the commissioner; and
(3) the Formulary Committee must hold a public forum and receive public comment for
an additional 15 days.
The commissioner must provide a 15-day notice period before implementing the prior
authorization.
(c) Except as provided in subdivision 13j, prior authorization shall not be required or
utilized for any atypical antipsychotic drug prescribed for the treatment of mental illness
if:
(1) there is no generically equivalent drug available; and
(2) the drug was initially prescribed for the recipient prior to July 1, 2003; or
(3) the drug is part of the recipient's current course of treatment.
This paragraph applies to any multistate preferred drug list or supplemental drug rebate
program established or administered by the commissioner. Prior authorization shall
automatically be granted for 60 days for brand name drugs prescribed for treatment of mental
illness within 60 days of when a generically equivalent drug becomes available, provided
that the brand name drug was part of the recipient's course of treatment at the time the
generically equivalent drug became available.
deleted text begin
(d) Prior authorization shall not be required or utilized for any antihemophilic factor
drug prescribed for the treatment of hemophilia and blood disorders where there is no
generically equivalent drug available if the prior authorization is used in conjunction with
any supplemental drug rebate program or multistate preferred drug list established or
administered by the commissioner.
deleted text end
deleted text begin (e)deleted text end new text begin (d)new text end The commissioner may require prior authorization for brand name drugs whenever
a generically equivalent product is available, even if the prescriber specifically indicates
"dispense as written-brand necessary" on the prescription as required by section 151.21,
subdivision 2.
deleted text begin (f)deleted text end new text begin (e)new text end Notwithstanding this subdivision, the commissioner may automatically require
prior authorization, for a period not to exceed 180 days, for any drug that is approved by
the United States Food and Drug Administration on or after July 1, 2005. The 180-day
period begins no later than the first day that a drug is available for shipment to pharmacies
within the state. The Formulary Committee shall recommend to the commissioner general
criteria to be used for the prior authorization of the drugs, but the committee is not required
to review each individual drug. In order to continue prior authorizations for a drug after the
180-day period has expired, the commissioner must follow the provisions of this subdivision.
new text begin
(f) Prior authorization under this subdivision shall comply with section 62Q.184.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment, except
that paragraph (f) is effective July 1, 2019.
new text end
Sec. 28.
Minnesota Statutes 2018, section 256B.0625, subdivision 17, is amended to read:
Subd. 17.
Transportation costs.
(a) "Nonemergency medical transportation service"
means motor vehicle transportation provided by a public or private person that serves
Minnesota health care program beneficiaries who do not require emergency ambulance
service, as defined in section 144E.001, subdivision 3, to obtain covered medical services.
(b) Medical assistance covers medical transportation costs incurred solely for obtaining
emergency medical care or transportation costs incurred by eligible persons in obtaining
emergency or nonemergency medical care when paid directly to an ambulance company,
nonemergency medical transportation company, or other recognized providers of
transportation services. Medical transportation must be provided by:
(1) nonemergency medical transportation providers who meet the requirements of this
subdivision;
(2) ambulances, as defined in section 144E.001, subdivision 2;
(3) taxicabs that meet the requirements of this subdivision;
(4) public transit, as defined in section 174.22, subdivision 7; or
(5) not-for-hire vehicles, including volunteer drivers.
(c) Medical assistance covers nonemergency medical transportation provided by
nonemergency medical transportation providers enrolled in the Minnesota health care
programs. All nonemergency medical transportation providers must comply with the
operating standards for special transportation service as defined in sections 174.29 to 174.30
and Minnesota Rules, chapter 8840, and deleted text begin in consultation with the Minnesota Department of
Transportationdeleted text end new text begin all drivers must be individually enrolled with the commissioner and reported
on the claim as the individual who provided the servicenew text end . All nonemergency medical
transportation providers shall bill for nonemergency medical transportation services in
accordance with Minnesota health care programs criteria. Publicly operated transit systems,
volunteers, and not-for-hire vehicles are exempt from the requirements outlined in this
paragraph.
(d) An organization may be terminated, denied, or suspended from enrollment if:
(1) the provider has not initiated background studies on the individuals specified in
section 174.30, subdivision 10, paragraph (a), clauses (1) to (3); or
(2) the provider has initiated background studies on the individuals specified in section
174.30, subdivision 10, paragraph (a), clauses (1) to (3), and:
(i) the commissioner has sent the provider a notice that the individual has been
disqualified under section 245C.14; and
(ii) the individual has not received a disqualification set-aside specific to the special
transportation services provider under sections 245C.22 and 245C.23.
(e) The administrative agency of nonemergency medical transportation must:
(1) adhere to the policies defined by the commissioner in consultation with the
Nonemergency Medical Transportation Advisory Committee;
(2) pay nonemergency medical transportation providers for services provided to
Minnesota health care programs beneficiaries to obtain covered medical services;
(3) provide data monthly to the commissioner on appeals, complaints, no-shows, canceled
trips, and number of trips by mode; and
(4) by July 1, 2016, in accordance with subdivision 18e, utilize a web-based single
administrative structure assessment tool that meets the technical requirements established
by the commissioner, reconciles trip information with claims being submitted by providers,
and ensures prompt payment for nonemergency medical transportation services.
(f) Until the commissioner implements the single administrative structure and delivery
system under subdivision 18e, clients shall obtain their level-of-service certificate from the
commissioner or an entity approved by the commissioner that does not dispatch rides for
clients using modes of transportation under paragraph (i), clauses (4), (5), (6), and (7).
(g) The commissioner may use an order by the recipient's attending physician or a medical
or mental health professional to certify that the recipient requires nonemergency medical
transportation services. Nonemergency medical transportation providers shall perform
driver-assisted services for eligible individuals, when appropriate. Driver-assisted service
includes passenger pickup at and return to the individual's residence or place of business,
assistance with admittance of the individual to the medical facility, and assistance in
passenger securement or in securing of wheelchairs, child seats, or stretchers in the vehicle.
Nonemergency medical transportation providers must take clients to the health care
provider using the most direct route, and must not exceed 30 miles for a trip to a primary
care provider or 60 miles for a trip to a specialty care provider, unless the client receives
authorization from the local agency.
Nonemergency medical transportation providers may not bill for separate base rates for
the continuation of a trip beyond the original destination. Nonemergency medical
transportation providers must maintain trip logs, which include pickup and drop-off times,
signed by the medical provider or client, whichever is deemed most appropriate, attesting
to mileage traveled to obtain covered medical services. Clients requesting client mileage
reimbursement must sign the trip log attesting mileage traveled to obtain covered medical
services.
(h) The administrative agency shall use the level of service process established by the
commissioner in consultation with the Nonemergency Medical Transportation Advisory
Committee to determine the client's most appropriate mode of transportation. If public transit
or a certified transportation provider is not available to provide the appropriate service mode
for the client, the client may receive a onetime service upgrade.
(i) The covered modes of transportation are:
(1) client reimbursement, which includes client mileage reimbursement provided to
clients who have their own transportation, or to family or an acquaintance who provides
transportation to the client;
(2) volunteer transport, which includes transportation by volunteers using their own
vehicle;
(3) unassisted transport, which includes transportation provided to a client by a taxicab
or public transit. If a taxicab or public transit is not available, the client can receive
transportation from another nonemergency medical transportation provider;
(4) assisted transport, which includes transport provided to clients who require assistance
by a nonemergency medical transportation provider;
(5) lift-equipped/ramp transport, which includes transport provided to a client who is
dependent on a device and requires a nonemergency medical transportation provider with
a vehicle containing a lift or ramp;
(6) protected transport, which includes transport provided to a client who has received
a prescreening that has deemed other forms of transportation inappropriate and who requires
a provider: (i) with a protected vehicle that is not an ambulance or police car and has safety
locks, a video recorder, and a transparent thermoplastic partition between the passenger and
the vehicle driver; and (ii) who is certified as a protected transport provider; and
(7) stretcher transport, which includes transport for a client in a prone or supine position
and requires a nonemergency medical transportation provider with a vehicle that can transport
a client in a prone or supine position.
(j) The local agency shall be the single administrative agency and shall administer and
reimburse for modes defined in paragraph (i) according to paragraphs (m) and (n) when the
commissioner has developed, made available, and funded the web-based single administrative
structure, assessment tool, and level of need assessment under subdivision 18e. The local
agency's financial obligation is limited to funds provided by the state or federal government.
(k) The commissioner shall:
(1) in consultation with the Nonemergency Medical Transportation Advisory Committee,
verify that the mode and use of nonemergency medical transportation is appropriate;
(2) verify that the client is going to an approved medical appointment; and
(3) investigate all complaints and appeals.
(l) The administrative agency shall pay for the services provided in this subdivision and
seek reimbursement from the commissioner, if appropriate. As vendors of medical care,
local agencies are subject to the provisions in section 256B.041, the sanctions and monetary
recovery actions in section 256B.064, and Minnesota Rules, parts 9505.2160 to 9505.2245.
(m) Payments for nonemergency medical transportation must be paid based on the client's
assessed mode under paragraph (h), not the type of vehicle used to provide the service. The
medical assistance reimbursement rates for nonemergency medical transportation services
that are payable by or on behalf of the commissioner for nonemergency medical
transportation services are:
(1) $0.22 per mile for client reimbursement;
(2) up to 100 percent of the Internal Revenue Service business deduction rate for volunteer
transport;
(3) equivalent to the standard fare for unassisted transport when provided by public
transit, and $11 for the base rate and $1.30 per mile when provided by a nonemergency
medical transportation provider;
(4) $13 for the base rate and $1.30 per mile for assisted transport;
(5) $18 for the base rate and $1.55 per mile for lift-equipped/ramp transport;
(6) $75 for the base rate and $2.40 per mile for protected transport; and
(7) $60 for the base rate and $2.40 per mile for stretcher transport, and $9 per trip for
an additional attendant if deemed medically necessary.
(n) The base rate for nonemergency medical transportation services in areas defined
under RUCA to be super rural is equal to 111.3 percent of the respective base rate in
paragraph (m), clauses (1) to (7). The mileage rate for nonemergency medical transportation
services in areas defined under RUCA to be rural or super rural areas is:
(1) for a trip equal to 17 miles or less, equal to 125 percent of the respective mileage
rate in paragraph (m), clauses (1) to (7); and
(2) for a trip between 18 and 50 miles, equal to 112.5 percent of the respective mileage
rate in paragraph (m), clauses (1) to (7).
(o) For purposes of reimbursement rates for nonemergency medical transportation
services under paragraphs (m) and (n), the zip code of the recipient's place of residence
shall determine whether the urban, rural, or super rural reimbursement rate applies.
(p) For purposes of this subdivision, "rural urban commuting area" or "RUCA" means
a census-tract based classification system under which a geographical area is determined
to be urban, rural, or super rural.
(q) The commissioner, when determining reimbursement rates for nonemergency medical
transportation under paragraphs (m) and (n), shall exempt all modes of transportation listed
under paragraph (i) from Minnesota Rules, part 9505.0445, item R, subitem (2).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 29.
Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 17d. new text end
new text begin Transportation services oversight. new text end
new text begin
The commissioner shall contract with
a vendor or dedicate staff to oversee providers of nonemergency medical transportation
services pursuant to the commissioner's authority in section 256B.04 and Minnesota Rules,
parts 9505.2160 to 9505.2245.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 30.
Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 17e. new text end
new text begin Transportation provider termination. new text end
new text begin
(a) A terminated nonemergency
medical transportation provider, including all named individuals on the current enrollment
disclosure form and known or discovered affiliates of the nonemergency medical
transportation provider, is not eligible to enroll as a nonemergency medical transportation
provider for five years following the termination.
new text end
new text begin
(b) After the five-year period in paragraph (a), if a provider seeks to reenroll as a
nonemergency medical transportation provider, the provider must be placed on a one-year
probation period. During a provider's probation period the commissioner shall complete
unannounced site visits and request documentation to review compliance with program
requirements.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 31.
Minnesota Statutes 2018, section 256B.0625, subdivision 30, is amended to read:
Subd. 30.
Other clinic services.
(a) Medical assistance covers rural health clinic services,
federally qualified health center services, nonprofit community health clinic services, and
public health clinic services. Rural health clinic services and federally qualified health center
services mean services defined in United States Code, title 42, section 1396d(a)(2)(B) and
(C). Payment for rural health clinic and federally qualified health center services shall be
made according to applicable federal law and regulation.
(b) A federally qualified health center new text begin (FQHC) new text end that is beginning initial operation shall
submit an estimate of budgeted costs and visits for the initial reporting period in the form
and detail required by the commissioner. deleted text begin A federally qualified health centerdeleted text end new text begin An FQHCnew text end that
is already in operation shall submit an initial report using actual costs and visits for the
initial reporting period. Within 90 days of the end of its reporting period, deleted text begin a federally qualified
health centerdeleted text end new text begin an FQHCnew text end shall submit, in the form and detail required by the commissioner,
a report of its operations, including allowable costs actually incurred for the period and the
actual number of visits for services furnished during the period, and other information
required by the commissioner. deleted text begin Federally qualified health centersdeleted text end new text begin FQHCsnew text end that file Medicare
cost reports shall provide the commissioner with a copy of the most recent Medicare cost
report filed with the Medicare program intermediary for the reporting year which support
the costs claimed on their cost report to the state.
(c) In order to continue cost-based payment under the medical assistance program
according to paragraphs (a) and (b), deleted text begin a federally qualified health centerdeleted text end new text begin an FQHCnew text end or rural
health clinic must apply for designation as an essential community provider within six
months of final adoption of rules by the Department of Health according to section 62Q.19,
subdivision 7. For those deleted text begin federally qualified health centersdeleted text end new text begin FQHCsnew text end and rural health clinics
that have applied for essential community provider status within the six-month time
prescribed, medical assistance payments will continue to be made according to paragraphs
(a) and (b) for the first three years after application. For deleted text begin federally qualified health centersdeleted text end new text begin
FQHCsnew text end and rural health clinics that either do not apply within the time specified above or
who have had essential community provider status for three years, medical assistance
payments for health services provided by these entities shall be according to the same rates
and conditions applicable to the same service provided by health care providers that are not
deleted text begin federally qualified health centersdeleted text end new text begin FQHCsnew text end or rural health clinics.
(d) Effective July 1, 1999, the provisions of paragraph (c) requiring deleted text begin a federally qualified
health centerdeleted text end new text begin an FQHCnew text end or a rural health clinic to make application for an essential community
provider designation in order to have cost-based payments made according to paragraphs
(a) and (b) no longer apply.
(e) Effective January 1, 2000, payments made according to paragraphs (a) and (b) shall
be limited to the cost phase-out schedule of the Balanced Budget Act of 1997.
(f) Effective January 1, 2001, new text begin through December 31, 2020, new text end each deleted text begin federally qualified
health centerdeleted text end new text begin FQHCnew text end and rural health clinic may elect to be paid either under the prospective
payment system established in United States Code, title 42, section 1396a(aa), or under an
alternative payment methodology consistent with the requirements of United States Code,
title 42, section 1396a(aa), and approved by the Centers for Medicare and Medicaid Services.
The alternative payment methodology shall be 100 percent of cost as determined according
to Medicare cost principles.
(g)new text begin Effective for services provided on or after January 1, 2021, all claims for payment
of clinic services provided by FQHCs and rural health clinics shall be paid by the
commissioner, according to an annual election by the FQHC or rural health clinic, under
the current prospective payment system described in paragraph (f) or the alternative payment
methodology described in paragraph (l).
new text end
new text begin (h)new text end For purposes of this section, "nonprofit community clinic" is a clinic that:
(1) has nonprofit status as specified in chapter 317A;
(2) has tax exempt status as provided in Internal Revenue Code, section 501(c)(3);
(3) is established to provide health services to low-income population groups, uninsured,
high-risk and special needs populations, underserved and other special needs populations;
(4) employs professional staff at least one-half of which are familiar with the cultural
background of their clients;
(5) charges for services on a sliding fee scale designed to provide assistance to
low-income clients based on current poverty income guidelines and family size; and
(6) does not restrict access or services because of a client's financial limitations or public
assistance status and provides no-cost care as needed.
deleted text begin (h)deleted text end new text begin (i)new text end Effective for services provided on or after January 1, 2015, all claims for payment
of clinic services provided by deleted text begin federally qualified health centersdeleted text end new text begin FQHCsnew text end and rural health
clinics shall be paid by the commissioner. the commissioner shall determine the most feasible
method for paying claims from the following options:
(1) deleted text begin federally qualified health centersdeleted text end new text begin FQHCsnew text end and rural health clinics submit claims
directly to the commissioner for payment, and the commissioner provides claims information
for recipients enrolled in a managed care or county-based purchasing plan to the plan, on
a regular basis; or
(2) deleted text begin federally qualified health centersdeleted text end new text begin FQHCsnew text end and rural health clinics submit claims for
recipients enrolled in a managed care or county-based purchasing plan to the plan, and those
claims are submitted by the plan to the commissioner for payment to the clinic.
deleted text begin (i)deleted text end new text begin (j)new text end For clinic services provided prior to January 1, 2015, the commissioner shall
calculate and pay monthly the proposed managed care supplemental payments to clinics,
and clinics shall conduct a timely review of the payment calculation data in order to finalize
all supplemental payments in accordance with federal law. Any issues arising from a clinic's
review must be reported to the commissioner by January 1, 2017. Upon final agreement
between the commissioner and a clinic on issues identified under this subdivision, and in
accordance with United States Code, title 42, section 1396a(bb), no supplemental payments
for managed care plan or county-based purchasing plan claims for services provided prior
to January 1, 2015, shall be made after June 30, 2017. If the commissioner and clinics are
unable to resolve issues under this subdivision, the parties shall submit the dispute to the
arbitration process under section 14.57.
deleted text begin (j)deleted text end new text begin (k)new text end The commissioner shall seek a federal waiver, authorized under section 1115 of
the Social Security Act, to obtain federal financial participation at the 100 percent federal
matching percentage available to facilities of the Indian Health Service or tribal organization
in accordance with section 1905(b) of the Social Security Act for expenditures made to
organizations dually certified under Title V of the Indian Health Care Improvement Act,
Public Law 94-437, and as a federally qualified health center under paragraph (a) that
provides services to American Indian and Alaskan Native individuals eligible for services
under this subdivision.
new text begin
(l) All claims for payment of clinic services provided by FQHCs and rural health clinics,
that have elected to be paid under this paragraph, shall be paid by the commissioner according
to the following requirements:
new text end
new text begin
(1) the commissioner shall establish a single medical and single dental organization rate
for each FQHC and rural health clinic when applicable;
new text end
new text begin
(2) each FQHC and rural health clinic is eligible for same day reimbursement of one
medical and one dental organization rate if eligible medical and dental visits are provided
on the same day;
new text end
new text begin
(3) the commissioner shall reimburse FQHCs and rural health clinics, in accordance
with current applicable Medicare cost principles, their allowable costs, including direct
patient care costs and patient-related support services. Nonallowable costs include, but are
not limited to:
new text end
new text begin
(i) general social service and administrative costs;
new text end
new text begin
(ii) retail pharmacy;
new text end
new text begin
(iii) patient incentives, food, housing assistance, and utility assistance;
new text end
new text begin
(iv) external lab and x-ray;
new text end
new text begin
(v) navigation services;
new text end
new text begin
(vi) health care taxes;
new text end
new text begin
(vii) advertising, public relations, and marketing;
new text end
new text begin
(viii) office entertainment costs, food, alcohol, and gifts;
new text end
new text begin
(ix) contributions and donations;
new text end
new text begin
(x) bad debts or losses on awards or contracts;
new text end
new text begin
(xi) fines, penalties, damages, or other settlements;
new text end
new text begin
(xii) fund-raising, investment management, and associated administrative costs;
new text end
new text begin
(xiii) research and associated administrative costs;
new text end
new text begin
(xiv) nonpaid workers;
new text end
new text begin
(xv) lobbying;
new text end
new text begin
(xvi) scholarships and student aid; and
new text end
new text begin
(xvii) nonmedical assistance covered services;
new text end
new text begin
(4) the commissioner shall review the list of nonallowable costs in the years between
the rebasing process established in clause (5), in consultation with the Minnesota Association
of Community Health Centers, FQHCs, and rural health clinics. The commissioner shall
publish the list and any updates in the Minnesota health care programs provider manual;
new text end
new text begin
(5) the initial applicable base year organization rates for FQHCs and rural health clinics
shall be computed for services delivered on or after January 1, 2021, and:
new text end
new text begin
(i) must be determined using each FQHC's and rural health clinic's Medicare cost reports
from both 2017 and 2018;
new text end
new text begin
(ii) must be according to current applicable Medicare cost principles as applicable to
FQHCs and rural health clinics without the application of productivity screens and upper
payment limits or the Medicare prospective payment system FQHC aggregate mean upper
payment limit;
new text end
new text begin
(iii) must be subsequently rebased every two years thereafter using the Medicare cost
reports that are three and four years prior to the rebasing year;
new text end
new text begin
(iv) must be inflated to the base year using the inflation factor described in clause (6);
and
new text end
new text begin
(v) the commissioner must provide for a 60-day appeals process under section 14.57;
new text end
new text begin
(6) the commissioner shall annually inflate the applicable organization rates for FQHCs
and rural health clinics from the base year payment rate to the effective date by using the
CMS FQHC Market Basket inflator established under United States Code, title 42, section
1395m(o), less productivity;
new text end
new text begin
(7) FQHCs and rural health clinics that have elected the alternative payment methodology
under this paragraph shall submit all necessary documentation required by the commissioner
to compute the rebased organization rates no later than six months following the date the
applicable Medicare cost reports are due to the Centers for Medicare and Medicaid Services;
new text end
new text begin
(8) the commissioner shall reimburse FQHCs and rural health clinics an additional
amount relative to their medical and dental organization rates that is attributable to the tax
required to be paid according to section 295.52, if applicable;
new text end
new text begin
(9) FQHCs and rural health clinics may submit change of scope requests to the
commissioner if the change of scope would result in an increase or decrease of 2.5 percent
or higher in the medical or dental organization rate currently received by the FQHC or rural
health clinic;
new text end
new text begin
(10) For FQHCs and rural health clinics seeking a change in scope with the commissioner
under clause (9) that requires the approval of the scope change by the federal Health
Resources Services Administration:
new text end
new text begin
(i) FQHCs and rural health clinics shall submit the change of scope request, including
the start date of services, to the commissioner within seven business days of submission of
the scope change to the federal Health Resources Services Administration;
new text end
new text begin
(ii) the commissioner shall establish the effective date of the payment change as the
federal Health Resources Services Administration date of approval of the FQHC's or rural
health clinic's scope change request, or the effective start date of services, whichever is
later; and
new text end
new text begin
(iii) within 45 days of one year after the effective date established in item (ii), the
commissioner shall conduct a retroactive review to determine if the actual costs established
under clause (3) or encounters result in an increase or decrease of 2.5 percent or higher in
the medical or dental organization rate, and if this is the case, the commissioner shall revise
the rate accordingly and shall adjust payments retrospectively to the effective date established
in item (ii);
new text end
new text begin
(11) for change of scope requests that do not require federal Health Resources Services
Administration approval, the FQHC and rural health clinic shall submit the request to the
commissioner before implementing the change, and the effective date of the change is the
date the commissioner received the FQHC's or rural health clinic's request, or the effective
start date of the service, whichever is later. The commissioner shall provide a response to
the FQHC's or rural health clinic's request within 45 days of submission and provide a final
approval within 120 days of submission. This timeline may be waived at the mutual
agreement of the commissioner and the FQHC or rural health clinic if more information is
needed to evaluate the request;
new text end
new text begin
(12) the commissioner, when establishing organization rates for new FQHCs and rural
health clinics, shall consider the patient caseload of existing FQHCs and rural health clinics
in a 60-mile radius for organizations established outside of the seven-county metropolitan
area, and in a 30-mile radius for organizations in the seven-county metropolitan area. If this
information is not available, the commissioner may use Medicare cost reports or audited