1.1 	A bill for an act
1.2 	relating to human services; establishing a funding mechanism for a long-term care 
1.3 	access fund in the state treasury; establishing an office of addiction and recovery; 
1.4 	establishing the Minnesota board of recovery services; establishing title protection 
1.5 	for sober homes; modifying provisions governing disability services, aging services, 
1.6 	and behavioral health; modifying medical assistance eligibility requirements for 
1.7 	certain populations; making technical and conforming changes; establishing certain 
1.8 	grants; requiring reports; appropriating money;amending Minnesota Statutes 2022, 
1.9 	sections 4.046, subdivisions 6, 7, by adding a subdivision; 16A.151, subdivision 
1.10 	2; 16A.152, subdivisions 1b, 2; 151.065, subdivision 7; 179A.54, by adding a 
1.11 	subdivision; 241.021, subdivision 1; 241.31, subdivision 5; 241.415; 245.945; 
1.12 	245A.03, subdivision 7; 245A.11, subdivisions 7, 7a; 245G.01, by adding 
1.13 	subdivisions; 245G.02, subdivision 2; 245G.05, subdivision 1, by adding a 
1.14 	subdivision; 245G.06, subdivisions 1, 3, 4, by adding subdivisions; 245G.08, 
1.15 	subdivision 3; 245G.09, subdivision 3; 245G.22, subdivision 15; 245I.10, 
1.16 	subdivision 6; 246.54, subdivisions 1a, 1b; 252.27, subdivision 2a; 254B.01, 
1.17 	subdivision 8, by adding subdivisions; 254B.04, by adding a subdivision; 254B.05, 
1.18 	subdivisions 1, 5; 256.043, subdivisions 3, 3a; 256.9754; 256B.04, by adding a 
1.19 	subdivision; 256B.056, subdivision 3; 256B.057, subdivision 9; 256B.0625, 
1.20 	subdivisions 17, 17a, 22, by adding a subdivision; 256B.0638, subdivisions 2, 4, 
1.21 	5; 256B.0659, subdivisions 1, 12, 19, 24; 256B.073, subdivision 3, by adding a 
1.22 	subdivision; 256B.0759, subdivision 2; 256B.0911, subdivision 13; 256B.0913, 
1.23 	subdivisions 4, 5; 256B.0917, subdivision 1b; 256B.0922, subdivision 1; 
1.24 	256B.0949, subdivision 15; 256B.14, subdivision 2; 256B.434, by adding a 
1.25 	subdivision; 256B.49, subdivisions 11, 28; 256B.4905, subdivision 5a; 256B.4911, 
1.26 	by adding a subdivision; 256B.4912, by adding subdivisions; 256B.4914, 
1.27 	subdivisions 3, as amended, 4, 5, 5a, 5b, 5c, 5d, 5e, 8, 9, 10, 10a, 10c, 12, 14, by 
1.28 	adding a subdivision; 256B.492; 256B.5012, by adding subdivisions; 256B.766; 
1.29 	256B.85, subdivision 7, by adding a subdivision; 256B.851, subdivisions 5, 6; 
1.30 	256I.05, by adding subdivisions; 256M.42; 256R.02, subdivision 19; 256R.17, 
1.31 	subdivision 2; 256R.25; 256R.47; 256R.481; 256R.53, by adding subdivisions; 
1.32 	256S.15, subdivision 2; 256S.18, by adding a subdivision; 256S.19, subdivision 
1.33 	3; 256S.203, subdivisions 1, 2; 256S.205, subdivisions 3, 5; 256S.21; 256S.2101, 
1.34 	subdivisions 1, 2, by adding subdivisions; 256S.211, by adding subdivisions; 
1.35 	256S.212; 256S.213; 256S.214; 256S.215, subdivisions 2, 3, 4, 7, 8, 9, 10, 11, 12, 
1.36 	13, 14, 15, 16, 17; 289A.20, subdivision 4; 289A.60, subdivision 15; Laws 2019, 
1.37 	chapter 63, article 3, section 1, as amended; Laws 2021, First Special Session 
1.38 	chapter 7, article 16, section 28, as amended; article 17, sections 16; 20; proposing 
2.1 	coding for new law in Minnesota Statutes, chapters 16A; 121A; 245; 245D; 254B; 
2.2 	256; 256I; 256S; 325F; repealing Minnesota Statutes 2022, sections 245G.05, 
2.3 	subdivision 2; 246.18, subdivisions 2, 2a; 256B.0638, subdivisions 1, 2, 3, 4, 5, 
2.4 	6; 256B.0759, subdivision 6; 256B.0917, subdivisions 1a, 6, 7a, 13; 256B.4914, 
2.5 	subdivision 9a; 256S.19, subdivision 4.
2.6 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

2.7 	ARTICLE 1
2.8 	DISABILITY SERVICES

2.9 	Section 1. Minnesota Statutes 2022, section 16A.152, subdivision 1b, is amended to read:
2.10 		Subd. 1b.Budget reserve level. (a) The commissioner of management and budget shall 
2.11 	calculate the budget reserve level by multiplying the current biennium's general fund 
2.12 	nondedicated revenues and the most recent budget reserve percentage under subdivision 8.
2.13 	(b) If, on the basis of a November forecast of general fund revenues and expenditures, 
2.14 	the commissioner of management and budget determines that there will be a positive 
2.15 	unrestricted general fund balance at the close of the biennium and that the provisions of 
2.16 	subdivision 2, paragraph (a), clauses (1), (2), (3), and (4) to (5), are satisfied, the 
2.17 	commissioner shall transfer to the budget reserve account in the general fund the amount 
2.18 	necessary to increase the budget reserve to the budget reserve level determined under 
2.19 	paragraph (a). The amount of the transfer authorized in this paragraph shall not exceed 33 
2.20 	percent of the positive unrestricted general fund balance determined in the forecast.

2.21 	Sec. 2. Minnesota Statutes 2022, section 16A.152, subdivision 2, is amended to read:
2.22 		Subd. 2.Additional revenues; priority. (a) If on the basis of a forecast of general fund 
2.23 	revenues and expenditures, the commissioner of management and budget determines that 
2.24 	there will be a positive unrestricted budgetary general fund balance at the close of the 
2.25 	biennium, the commissioner of management and budget must allocate money to the following
2.26 	funds, accounts, and purposes in priority order:
2.27 	(1) the cash flow account established in subdivision 1 until that account reaches 
2.28 	$350,000,000;
2.29 	(2) the long-term care access fund established in section 16A.7241, subdivision 1, until 
2.30 	the allocated amount equals the long-term care access fund contribution amount calculated 
2.31 	in section 16A.7241, subdivision 2;
2.32 	(2) (3) the budget reserve account established in subdivision 1a until that account reaches 
2.33 	$2,377,399,000;
3.1 	(3) (4) the amount necessary to increase the aid payment schedule for school district 
3.2 	aids and credits payments in section 127A.45 to not more than 90 percent rounded to the 
3.3 	nearest tenth of a percent without exceeding the amount available and with any remaining 
3.4 	funds deposited in the budget reserve;
3.5 	(4) (5) the amount necessary to restore all or a portion of the net aid reductions under 
3.6 	section 127A.441 and to reduce the property tax revenue recognition shift under section 
3.7 	123B.75, subdivision 5, by the same amount;
3.8 	(5) (6) the amount necessary to increase the Minnesota 21st century fund by not more 
3.9 	than the difference between $5,000,000 and the sum of the amounts credited and canceled 
3.10 	to it in the previous 12 months under Laws 2020, chapter 71, article 1, section 11, until the 
3.11 	sum of all transfers under this section and all amounts credited or canceled under Laws 
3.12 	2020, chapter 71, article 1, section 11, equals $20,000,000; and
3.13 	(6) (7) for a forecast in November only, the amount remaining after the transfer under 
3.14 	clause (5) must be used to reduce the percentage of accelerated June liability sales tax 
3.15 	payments required under section 289A.20, subdivision 4, paragraph (b), until the percentage 
3.16 	equals zero, rounded to the nearest tenth of a percent. By March 15 following the November 
3.17 	forecast, the commissioner must provide the commissioner of revenue with the percentage 
3.18 	of accelerated June liability owed based on the reduction required by this clause. By April 
3.19 	15 each year, the commissioner of revenue must certify the percentage of June liability 
3.20 	owed by vendors based on the reduction required by this clause.
3.21 	(b) The amounts necessary to meet the requirements of this section are appropriated 
3.22 	from the general fund within two weeks after the forecast is released or, in the case of 
3.23 	transfers under paragraph (a), clauses (3) (4) and (4) (5), as necessary to meet the 
3.24 	appropriations schedules otherwise established in statute.
3.25 	(c) The commissioner of management and budget shall certify the total dollar amount 
3.26 	of the reductions under paragraph (a), clauses (3) (4) and (4) (5), to the commissioner of 
3.27 	education. The commissioner of education shall increase the aid payment percentage and 
3.28 	reduce the property tax shift percentage by these amounts and apply those reductions to the 
3.29 	current fiscal year and thereafter.

3.30 	Sec. 3. [16A.7241] LONG-TERM CARE ACCESS FUND.
3.31 		Subdivision 1.Long-term care access fund established. A long-term care access fund 
3.32 	is created in the state treasury. The fund is a direct appropriated special revenue fund. The 
3.33 	commissioner shall deposit to the credit of the fund money made available to the fund. 
4.1 	Notwithstanding section 11A.20, all investment income and all investment losses attributable 
4.2 	to the investment of the long-term care access fund not currently needed shall be credited 
4.3 	to the long-term care access fund.
4.4 		Subd. 2.Contribution amount determined. The commissioner of management and 
4.5 	budget must determine the long-term care access fund contribution amount when preparing 
4.6 	a forecast. The long-term care access fund contribution amount is equal to any amount 
4.7 	greater than zero resulting from subtracting the state share of the projected expenditures for 
4.8 	the long-term care facility and long-term care waiver portions of the medical assistance 
4.9 	program from the state share of the most recently enacted appropriation from the general 
4.10 	fund for these portions of the medical assistance program.
4.11 		Subd. 3.Allocation of contribution amount. If, on the basis of a forecast of general 
4.12 	fund revenues and expenditures, the commissioner of management and budget determines 
4.13 	that there will be a positive unrestricted budgetary general fund balance at the close of the 
4.14 	biennium and that there will be a long-term care access fund contribution amount at the end 
4.15 	of the biennium, the commissioner of management and budget must transfer the contribution 
4.16 	amount to the long-term care access fund in accordance with the requirements of section 
4.17 	16A.152.
4.18 		Subd. 4.Long-term services and supports funding. The commissioner of human 
4.19 	services may expend money appropriated from the long-term care access fund for publicly 
4.20 	funded long-term services and supports and for initiatives to prevent or delay the need for 
4.21 	Minnesotans to receive publicly funded long-term care services and supports. Money 
4.22 	appropriated by law must supplement traditional sources of funding for long-term care 
4.23 	services and may not be used as a substitute for forecasted spending.

4.24 	Sec. 4. Minnesota Statutes 2022, section 179A.54, is amended by adding a subdivision to 
4.25 	read:
4.26 		Subd. 11.Home Care Orientation Trust. (a) The state and an exclusive representative 
4.27 	certified pursuant to this section may establish a joint labor and management trust, referred 
4.28 	to as the Home Care Orientation Trust, for the exclusive purpose of rendering voluntary 
4.29 	orientation training to individual providers of direct support services who are represented 
4.30 	by the exclusive representative.
4.31 	(b) Financial contributions by the state to the Home Care Orientation Trust shall be made 
4.32 	by the state pursuant to a collective bargaining agreement negotiated under this section. All 
4.33 	such financial contributions by the state shall be held in trust for the purpose of paying, 
4.34 	from principal, from income, or from both, the costs associated with developing, delivering, 
5.1 	and promoting voluntary orientation training for individual providers of direct support 
5.2 	services working under a collective bargaining agreement and providing services through 
5.3 	a covered program under section 256B.0711. The Home Care Orientation Trust shall be 
5.4 	administered, managed, and otherwise controlled jointly by a board of trustees composed 
5.5 	of an equal number of trustees appointed by the state and trustees appointed by the exclusive 
5.6 	representative under this section. The trust shall not be an agent of either the state or of the 
5.7 	exclusive representative.
5.8 	(c) Trust administrative, management, legal, and financial services may be provided to 
5.9 	the board of trustees by a third-party administrator, financial management institution, other 
5.10 	appropriate entity, or any combination thereof, as designated by the board of trustees from 
5.11 	time to time, and those services shall be paid from the money held in trust and created by 
5.12 	the state's financial contributions to the Home Care Orientation Trust.
5.13 	(d) The state is authorized to purchase liability insurance for members of the board of 
5.14 	trustees appointed by the state.
5.15 	(e) Financial contributions to, participation in, or both contributions to and participation 
5.16 	in the administration, management, or both the administration and management of the Home 
5.17 	Care Orientation Trust shall not be considered an unfair labor practice under section 179A.13 
5.18 	or in violation of Minnesota law.

5.19 	Sec. 5. Minnesota Statutes 2022, section 245.945, is amended to read:
5.20 	245.945 REIMBURSEMENT TO OMBUDSMAN FOR MENTAL HEALTH AND 
5.21 	DEVELOPMENTAL DISABILITIES.
5.22 	The commissioner of human services shall obtain federal financial participation for 
5.23 	eligible medical assistance administrative activity by the ombudsman for mental health and 
5.24 	developmental disabilities Office of Ombudsman for Mental Health and Developmental 
5.25 	Disabilities and remit all such money back to the office. The ombudsman shall maintain 
5.26 	and transmit to the Department of Human Services documentation that is necessary in order 
5.27 	to obtain federal funds.

5.28 	Sec. 6. Minnesota Statutes 2022, section 245A.03, subdivision 7, is amended to read:
5.29 		Subd. 7.Licensing moratorium. (a) The commissioner shall not issue an initial license 
5.30 	for child foster care licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, or adult 
5.31 	foster care licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, under this chapter 
5.32 	for a physical location that will not be the primary residence of the license holder for the 
6.1 	entire period of licensure. If a family child foster care home or family adult foster care home 
6.2 	license is issued during this moratorium, and the license holder changes the license holder's 
6.3 	primary residence away from the physical location of the foster care license, the 
6.4 	commissioner shall revoke the license according to section 245A.07. The commissioner 
6.5 	shall not issue an initial license for a community residential setting licensed under chapter 
6.6 	245D. When approving an exception under this paragraph, the commissioner shall consider 
6.7 	the resource need determination process in paragraph (h), the availability of foster care 
6.8 	licensed beds in the geographic area in which the licensee seeks to operate, the results of a 
6.9 	person's choices during their annual assessment and service plan review, and the 
6.10 	recommendation of the local county board. The determination by the commissioner is final 
6.11 	and not subject to appeal. Exceptions to the moratorium include:
6.12 	(1) foster care settings where at least 80 percent of the residents are 55 years of age or 
6.13 	older;
6.14 	(2) foster care licenses replacing foster care licenses in existence on May 15, 2009, or 
6.15 	community residential setting licenses replacing adult foster care licenses in existence on 
6.16 	December 31, 2013, and determined to be needed by the commissioner under paragraph 
6.17 	(b);
6.18 	(3) new foster care licenses or community residential setting licenses determined to be 
6.19 	needed by the commissioner under paragraph (b) for the closure of a nursing facility, ICF/DD, 
6.20 	or regional treatment center; restructuring of state-operated services that limits the capacity 
6.21 	of state-operated facilities; or allowing movement to the community for people who no 
6.22 	longer require the level of care provided in state-operated facilities as provided under section 
6.23 	256B.092, subdivision 13, or 256B.49, subdivision 24;
6.24 	(4) new foster care licenses or community residential setting licenses determined to be 
6.25 	needed by the commissioner under paragraph (b) for persons requiring hospital-level care; 
6.26 	or
6.27 	(5) new foster care licenses or community residential setting licenses for people receiving 
6.28 	customized living or 24-hour customized living services under the brain injury or community 
6.29 	access for disability inclusion waiver plans under section 256B.49 or elderly waiver plan 
6.30 	under chapter 256S and residing in the customized living setting before July 1, 2022, for 
6.31 	which a license is required. A customized living service provider subject to this exception 
6.32 	may rebut the presumption that a license is required by seeking a reconsideration of the 
6.33 	commissioner's determination. The commissioner's disposition of a request for 
7.1 	reconsideration is final and not subject to appeal under chapter 14. The exception is available 
7.2 	until June 30 December 31, 2023. This exception is available when:
7.3 	(i) the person's customized living services are provided in a customized living service 
7.4 	setting serving four or fewer people under the brain injury or community access for disability 
7.5 	inclusion waiver plans under section 256B.49 in a single-family home operational on or 
7.6 	before June 30, 2021. Operational is defined in section 256B.49, subdivision 28;
7.7 	(ii) the person's case manager provided the person with information about the choice of 
7.8 	service, service provider, and location of service, including in the person's home, to help 
7.9 	the person make an informed choice; and
7.10 	(iii) the person's services provided in the licensed foster care or community residential 
7.11 	setting are less than or equal to the cost of the person's services delivered in the customized 
7.12 	living setting as determined by the lead agency; or
7.13 	(6) new foster care licenses or community residential setting licenses for a customized 
7.14 	living setting that is a single-family home in which customized living or 24-hour customized 
7.15 	living services were authorized and delivered on June 30, 2021, under the brain injury or 
7.16 	community access for disability inclusion waiver plans under section 256B.49 or the elderly 
7.17 	waiver under chapter 256S and for which a license is required. A customized living service 
7.18 	provider subject to this exception may rebut the presumption that a license is required by 
7.19 	seeking a reconsideration of the commissioner's determination. The commissioner's 
7.20 	disposition of a request for reconsideration is final and not subject to appeal under chapter 
7.21 	14. The exception is available for any eligible setting licensed as an assisted living facility 
7.22 	under chapter 144G on or after August 1, 2021, if the assisted living licensee applies for a 
7.23 	license under chapter 245D before December 31, 2023. The initial licensed capacity of the 
7.24 	setting under this exception must be four. This exception is available when:
7.25 	(i) the case manager of each resident of the customized living setting provided the person 
7.26 	with information about the choice of service, service provider, and location of service, 
7.27 	including in the person's home, to help the person make an informed choice about remaining 
7.28 	in the newly licensed setting; and
7.29 	(ii) the estimated average cost of services provided in the licensed foster care or 
7.30 	community residential setting is less than or equal to the estimated average cost of services 
7.31 	delivered in the customized living setting as determined by the lead agency.
7.32 	(b) The commissioner shall determine the need for newly licensed foster care homes or 
7.33 	community residential settings as defined under this subdivision. As part of the determination, 
7.34 	the commissioner shall consider the availability of foster care capacity in the area in which 
8.1 	the licensee seeks to operate, and the recommendation of the local county board. The 
8.2 	determination by the commissioner must be final. A determination of need is not required 
8.3 	for a change in ownership at the same address.
8.4 	(c) When an adult resident served by the program moves out of a foster home that is not 
8.5 	the primary residence of the license holder according to section 256B.49, subdivision 15, 
8.6 	paragraph (f), or the adult community residential setting, the county shall immediately 
8.7 	inform the Department of Human Services Licensing Division. The department may decrease 
8.8 	the statewide licensed capacity for adult foster care settings.
8.9 	(d) Residential settings that would otherwise be subject to the decreased license capacity 
8.10 	established in paragraph (c) shall be exempt if the license holder's beds are occupied by 
8.11 	residents whose primary diagnosis is mental illness and the license holder is certified under 
8.12 	the requirements in subdivision 6a or section 245D.33.
8.13 	(e) A resource need determination process, managed at the state level, using the available 
8.14 	data required by section 144A.351, and other data and information shall be used to determine 
8.15 	where the reduced capacity determined under section 256B.493 will be implemented. The 
8.16 	commissioner shall consult with the stakeholders described in section 144A.351, and employ 
8.17 	a variety of methods to improve the state's capacity to meet the informed decisions of those 
8.18 	people who want to move out of corporate foster care or community residential settings, 
8.19 	long-term service needs within budgetary limits, including seeking proposals from service 
8.20 	providers or lead agencies to change service type, capacity, or location to improve services, 
8.21 	increase the independence of residents, and better meet needs identified by the long-term 
8.22 	services and supports reports and statewide data and information.
8.23 	(f) At the time of application and reapplication for licensure, the applicant and the license 
8.24 	holder that are subject to the moratorium or an exclusion established in paragraph (a) are 
8.25 	required to inform the commissioner whether the physical location where the foster care 
8.26 	will be provided is or will be the primary residence of the license holder for the entire period 
8.27 	of licensure. If the primary residence of the applicant or license holder changes, the applicant 
8.28 	or license holder must notify the commissioner immediately. The commissioner shall print 
8.29 	on the foster care license certificate whether or not the physical location is the primary 
8.30 	residence of the license holder.
8.31 	(g) License holders of foster care homes identified under paragraph (f) that are not the 
8.32 	primary residence of the license holder and that also provide services in the foster care home 
8.33 	that are covered by a federally approved home and community-based services waiver, as 
8.34 	authorized under chapter 256S or section 256B.092 or 256B.49, must inform the human 
9.1 	services licensing division that the license holder provides or intends to provide these 
9.2 	waiver-funded services.
9.3 	(h) The commissioner may adjust capacity to address needs identified in section 
9.4 	144A.351. Under this authority, the commissioner may approve new licensed settings or 
9.5 	delicense existing settings. Delicensing of settings will be accomplished through a process 
9.6 	identified in section 256B.493.
9.7 	(i) The commissioner must notify a license holder when its corporate foster care or 
9.8 	community residential setting licensed beds are reduced under this section. The notice of 
9.9 	reduction of licensed beds must be in writing and delivered to the license holder by certified 
9.10 	mail or personal service. The notice must state why the licensed beds are reduced and must 
9.11 	inform the license holder of its right to request reconsideration by the commissioner. The 
9.12 	license holder's request for reconsideration must be in writing. If mailed, the request for 
9.13 	reconsideration must be postmarked and sent to the commissioner within 20 calendar days 
9.14 	after the license holder's receipt of the notice of reduction of licensed beds. If a request for 
9.15 	reconsideration is made by personal service, it must be received by the commissioner within 
9.16 	20 calendar days after the license holder's receipt of the notice of reduction of licensed beds.
9.17 	(j) The commissioner shall not issue an initial license for children's residential treatment 
9.18 	services licensed under Minnesota Rules, parts 2960.0580 to 2960.0700, under this chapter 
9.19 	for a program that Centers for Medicare and Medicaid Services would consider an institution 
9.20 	for mental diseases. Facilities that serve only private pay clients are exempt from the 
9.21 	moratorium described in this paragraph. The commissioner has the authority to manage 
9.22 	existing statewide capacity for children's residential treatment services subject to the 
9.23 	moratorium under this paragraph and may issue an initial license for such facilities if the 
9.24 	initial license would not increase the statewide capacity for children's residential treatment 
9.25 	services subject to the moratorium under this paragraph.

9.26 	EFFECTIVE DATE. This section is effective retroactively from July 1, 2021.

9.27 	Sec. 7. Minnesota Statutes 2022, section 245A.11, subdivision 7, is amended to read:
9.28 		Subd. 7.Adult foster care; variance for alternate overnight supervision. (a) The 
9.29 	commissioner may grant a variance under section 245A.04, subdivision 9, to rule parts 
9.30 	requiring a caregiver to be present in an adult foster care home during normal sleeping hours 
9.31 	to allow for alternative methods of overnight supervision. The commissioner may grant the 
9.32 	variance if the local county licensing agency recommends the variance and the county 
9.33 	recommendation includes documentation verifying that:
10.1 	(1) the county has approved the license holder's plan for alternative methods of providing 
10.2 	overnight supervision and determined the plan protects the residents' health, safety, and 
10.3 	rights;
10.4 	(2) the license holder has obtained written and signed informed consent from each 
10.5 	resident or each resident's legal representative documenting the resident's or legal 
10.6 	representative's agreement with the alternative method of overnight supervision; and
10.7 	(3) the alternative method of providing overnight supervision, which may include the 
10.8 	use of technology, is specified for each resident in the resident's: (i) individualized plan of 
10.9 	care; (ii) individual service plan under section 256B.092, subdivision 1b, if required; or (iii) 
10.10 	individual resident placement agreement under Minnesota Rules, part 9555.5105, subpart 
10.11 	19, if required.
10.12 	(b) To be eligible for a variance under paragraph (a), the adult foster care license holder 
10.13 	must not have had a conditional license issued under section 245A.06, or any other licensing 
10.14 	sanction issued under section 245A.07 during the prior 24 months based on failure to provide 
10.15 	adequate supervision, health care services, or resident safety in the adult foster care home.
10.16 	(c) A license holder requesting a variance under this subdivision to utilize technology 
10.17 	as a component of a plan for alternative overnight supervision may request the commissioner's 
10.18 	review in the absence of a county recommendation. Upon receipt of such a request from a 
10.19 	license holder, the commissioner shall review the variance request with the county.
10.20 	(d) A variance granted by the commissioner according to this subdivision before January 
10.21 	1, 2014, to a license holder for an adult foster care home must transfer with the license when 
10.22 	the license converts to a community residential setting license under chapter 245D. The 
10.23 	terms and conditions of the variance remain in effect as approved at the time the variance 
10.24 	was granted The variance requirements under this subdivision for alternative overnight 
10.25 	supervision do not apply to community residential settings licensed under chapter 245D.

10.26 	EFFECTIVE DATE. This section is effective January 1, 2024.

10.27 	Sec. 8. Minnesota Statutes 2022, section 245A.11, subdivision 7a, is amended to read:
10.28 		Subd. 7a.Alternate overnight supervision technology; adult foster care and 
10.29 	community residential setting licenses. (a) The commissioner may grant an applicant or 
10.30 	license holder an adult foster care or community residential setting license for a residence 
10.31 	that does not have a caregiver in the residence during normal sleeping hours as required 
10.32 	under Minnesota Rules, part 9555.5105, subpart 37, item B, or section 245D.02, subdivision 
10.33 	33b, but uses monitoring technology to alert the license holder when an incident occurs that 
11.1 	may jeopardize the health, safety, or rights of a foster care recipient. The applicant or license 
11.2 	holder must comply with all other requirements under Minnesota Rules, parts 9555.5105 
11.3 	to 9555.6265, or applicable requirements under chapter 245D, and the requirements under 
11.4 	this subdivision. The license printed by the commissioner must state in bold and large font:
11.5 	(1) that the facility is under electronic monitoring; and
11.6 	(2) the telephone number of the county's common entry point for making reports of 
11.7 	suspected maltreatment of vulnerable adults under section 626.557, subdivision 9.
11.8 	(b) Applications for a license under this section must be submitted directly to the 
11.9 	Department of Human Services licensing division. The licensing division must immediately 
11.10 	notify the county licensing agency. The licensing division must collaborate with the county 
11.11 	licensing agency in the review of the application and the licensing of the program.
11.12 	(c) Before a license is issued by the commissioner, and for the duration of the license, 
11.13 	the applicant or license holder must establish, maintain, and document the implementation 
11.14 	of written policies and procedures addressing the requirements in paragraphs (d) through 
11.15 	(f).
11.16 	(d) The applicant or license holder must have policies and procedures that:
11.17 	(1) establish characteristics of target populations that will be admitted into the home, 
11.18 	and characteristics of populations that will not be accepted into the home;
11.19 	(2) explain the discharge process when a resident served by the program requires 
11.20 	overnight supervision or other services that cannot be provided by the license holder due 
11.21 	to the limited hours that the license holder is on site;
11.22 	(3) describe the types of events to which the program will respond with a physical 
11.23 	presence when those events occur in the home during time when staff are not on site, and 
11.24 	how the license holder's response plan meets the requirements in paragraph (e), clause (1) 
11.25 	or (2);
11.26 	(4) establish a process for documenting a review of the implementation and effectiveness 
11.27 	of the response protocol for the response required under paragraph (e), clause (1) or (2). 
11.28 	The documentation must include:
11.29 	(i) a description of the triggering incident;
11.30 	(ii) the date and time of the triggering incident;
11.31 	(iii) the time of the response or responses under paragraph (e), clause (1) or (2);
11.32 	(iv) whether the response met the resident's needs;
12.1 	(v) whether the existing policies and response protocols were followed; and
12.2 	(vi) whether the existing policies and protocols are adequate or need modification.
12.3 	When no physical presence response is completed for a three-month period, the license 
12.4 	holder's written policies and procedures must require a physical presence response drill to 
12.5 	be conducted for which the effectiveness of the response protocol under paragraph (e), 
12.6 	clause (1) or (2), will be reviewed and documented as required under this clause; and
12.7 	(5) establish that emergency and nonemergency phone numbers are posted in a prominent 
12.8 	location in a common area of the home where they can be easily observed by a person 
12.9 	responding to an incident who is not otherwise affiliated with the home.
12.10 	(e) The license holder must document and include in the license application which 
12.11 	response alternative under clause (1) or (2) is in place for responding to situations that 
12.12 	present a serious risk to the health, safety, or rights of residents served by the program:
12.13 	(1) response alternative (1) requires only the technology to provide an electronic 
12.14 	notification or alert to the license holder that an event is underway that requires a response. 
12.15 	Under this alternative, no more than ten minutes will pass before the license holder will be 
12.16 	physically present on site to respond to the situation; or
12.17 	(2) response alternative (2) requires the electronic notification and alert system under 
12.18 	alternative (1), but more than ten minutes may pass before the license holder is present on 
12.19 	site to respond to the situation. Under alternative (2), all of the following conditions are 
12.20 	met:
12.21 	(i) the license holder has a written description of the interactive technological applications 
12.22 	that will assist the license holder in communicating with and assessing the needs related to 
12.23 	the care, health, and safety of the foster care recipients. This interactive technology must 
12.24 	permit the license holder to remotely assess the well being of the resident served by the 
12.25 	program without requiring the initiation of the foster care recipient. Requiring the foster 
12.26 	care recipient to initiate a telephone call does not meet this requirement;
12.27 	(ii) the license holder documents how the remote license holder is qualified and capable 
12.28 	of meeting the needs of the foster care recipients and assessing foster care recipients' needs 
12.29 	under item (i) during the absence of the license holder on site;
12.30 	(iii) the license holder maintains written procedures to dispatch emergency response 
12.31 	personnel to the site in the event of an identified emergency; and
12.32 	(iv) each resident's individualized plan of care, support plan under sections 256B.0913, 
12.33 	subdivision 8; 256B.092, subdivision 1b; 256B.49, subdivision 15; and 256S.10, if required, 
13.1 	or individual resident placement agreement under Minnesota Rules, part 9555.5105, subpart 
13.2 	19, if required, identifies the maximum response time, which may be greater than ten minutes, 
13.3 	for the license holder to be on site for that resident.
13.4 	(f) Each resident's placement agreement, individual service agreement, and plan must 
13.5 	clearly state that the adult foster care or community residential setting license category is 
13.6 	a program without the presence of a caregiver in the residence during normal sleeping hours; 
13.7 	the protocols in place for responding to situations that present a serious risk to the health, 
13.8 	safety, or rights of residents served by the program under paragraph (e), clause (1) or (2); 
13.9 	and a signed informed consent from each resident served by the program or the person's 
13.10 	legal representative documenting the person's or legal representative's agreement with 
13.11 	placement in the program. If electronic monitoring technology is used in the home, the 
13.12 	informed consent form must also explain the following:
13.13 	(1) how any electronic monitoring is incorporated into the alternative supervision system;
13.14 	(2) the backup system for any electronic monitoring in times of electrical outages or 
13.15 	other equipment malfunctions;
13.16 	(3) how the caregivers or direct support staff are trained on the use of the technology;
13.17 	(4) the event types and license holder response times established under paragraph (e);
13.18 	(5) how the license holder protects each resident's privacy related to electronic monitoring 
13.19 	and related to any electronically recorded data generated by the monitoring system. A 
13.20 	resident served by the program may not be removed from a program under this subdivision 
13.21 	for failure to consent to electronic monitoring. The consent form must explain where and 
13.22 	how the electronically recorded data is stored, with whom it will be shared, and how long 
13.23 	it is retained; and
13.24 	(6) the risks and benefits of the alternative overnight supervision system.
13.25 	The written explanations under clauses (1) to (6) may be accomplished through 
13.26 	cross-references to other policies and procedures as long as they are explained to the person 
13.27 	giving consent, and the person giving consent is offered a copy.
13.28 	(g) Nothing in this section requires the applicant or license holder to develop or maintain 
13.29 	separate or duplicative policies, procedures, documentation, consent forms, or individual 
13.30 	plans that may be required for other licensing standards, if the requirements of this section 
13.31 	are incorporated into those documents.
13.32 	(h) The commissioner may grant variances to the requirements of this section according 
13.33 	to section 245A.04, subdivision 9.
14.1 	(i) For the purposes of paragraphs (d) through (h), "license holder" has the meaning 
14.2 	under section 245A.02, subdivision 9, and additionally includes all staff, volunteers, and 
14.3 	contractors affiliated with the license holder.
14.4 	(j) For the purposes of paragraph (e), the terms "assess" and "assessing" mean to remotely 
14.5 	determine what action the license holder needs to take to protect the well-being of the foster 
14.6 	care recipient.
14.7 	(k) The commissioner shall evaluate license applications using the requirements in 
14.8 	paragraphs (d) to (f). The commissioner shall provide detailed application forms, including 
14.9 	a checklist of criteria needed for approval.
14.10 	(l) To be eligible for a license under paragraph (a), the adult foster care or community 
14.11 	residential setting license holder must not have had a conditional license issued under section 
14.12 	245A.06 or any licensing sanction under section 245A.07 during the prior 24 months based 
14.13 	on failure to provide adequate supervision, health care services, or resident safety in the 
14.14 	adult foster care home or community residential setting.
14.15 	(m) The commissioner shall review an application for an alternative overnight supervision 
14.16 	license within 60 days of receipt of the application. When the commissioner receives an 
14.17 	application that is incomplete because the applicant failed to submit required documents or 
14.18 	that is substantially deficient because the documents submitted do not meet licensing 
14.19 	requirements, the commissioner shall provide the applicant written notice that the application 
14.20 	is incomplete or substantially deficient. In the written notice to the applicant, the 
14.21 	commissioner shall identify documents that are missing or deficient and give the applicant 
14.22 	45 days to resubmit a second application that is substantially complete. An applicant's failure 
14.23 	to submit a substantially complete application after receiving notice from the commissioner 
14.24 	is a basis for license denial under section 245A.05. The commissioner shall complete 
14.25 	subsequent review within 30 days.
14.26 	(n) Once the application is considered complete under paragraph (m), the commissioner 
14.27 	will approve or deny an application for an alternative overnight supervision license within 
14.28 	60 days.
14.29 	(o) For the purposes of this subdivision, "supervision" means:
14.30 	(1) oversight by a caregiver or direct support staff as specified in the individual resident's 
14.31 	place agreement or support plan and awareness of the resident's needs and activities; and
14.32 	(2) the presence of a caregiver or direct support staff in a residence during normal sleeping 
14.33 	hours, unless a determination has been made and documented in the individual's support 
15.1 	plan that the individual does not require the presence of a caregiver or direct support staff 
15.2 	during normal sleeping hours.

15.3 	EFFECTIVE DATE. This section is effective January 1, 2024.

15.4 	Sec. 9. [245D.261] COMMUNITY RESIDENTIAL SETTINGS; REMOTE 
15.5 	OVERNIGHT SUPERVISION.
15.6 		Subdivision 1.Definitions. (a) For purposes of this section, the following terms have 
15.7 	the meanings given, unless otherwise specified.
15.8 	(b) "Resident" means an adult residing in a community residential setting.
15.9 	(c) "Technology" means:
15.10 	(1) enabling technology, which is a device capable of live two-way communication or 
15.11 	engagement between a resident and direct support staff at a remote location; or
15.12 	(2) monitoring technology, which is the use of equipment to oversee, monitor, and 
15.13 	supervise an individual who receives medical assistance waiver or alternative care services 
15.14 	under section 256B.0913, 256B.092, or chapter 256S.
15.15 		Subd. 2.Documentation of permissible remote overnight supervision. A license 
15.16 	holder providing remote overnight supervision in a community residential setting in lieu of 
15.17 	on-site direct support staff must comply with the requirements of this chapter, including 
15.18 	the requirement under section 245D.02, subdivision 33b, paragraph (a), clause (3), that the 
15.19 	absence of direct support staff from the community residential setting while services are 
15.20 	being delivered must be documented in the resident's support plan or support plan addendum.
15.21 		Subd. 3.Provider requirements for remote overnight supervision; commissioner 
15.22 	notification. (a) A license holder providing remote overnight supervision in a community 
15.23 	residential setting must:
15.24 	(1) use technology;
15.25 	(2) notify the commissioner of the community residential setting's intent to use technology 
15.26 	in lieu of on-site staff. The notification must:
15.27 	(i) indicate a start date for the use of technology; and
15.28 	(ii) attest that all requirements under this section are met and policies required under 
15.29 	subdivision 4 are available upon request;
15.30 	(3) clearly state in each person's support plan addendum that the community residential 
15.31 	setting is a program without the in-person presence of overnight direct support;
16.1 	(4) include with each person's support plan addendum the license holder's protocols for 
16.2 	responding to situations that present a serious risk to the health, safety, or rights of residents 
16.3 	served by the program; and
16.4 	(5) include in each person's support plan addendum the person's maximum permissible 
16.5 	response time as determined by the person's support team.
16.6 	(b) Upon being notified via technology that an incident has occurred that may jeopardize 
16.7 	the health, safety, or rights of a resident, the license holder must conduct an evaluation of 
16.8 	the need for the physical presence of a staff member. If a physical presence is needed, a 
16.9 	staff person, volunteer, or contractor must be on site to respond to the situation within the 
16.10 	resident's maximum permissible response time.
16.11 	(c) A license holder must notify the commissioner if remote overnight supervision 
16.12 	technology will no longer be used by the license holder.
16.13 	(d) Upon receipt of notification of use of remote overnight supervision or discontinuation 
16.14 	of use of remote overnight supervision by a license holder, the commissioner shall notify 
16.15 	the county licensing agency and update the license.
16.16 		Subd. 4.Required policies and procedures for remote overnight supervision. (a) A 
16.17 	license holder providing remote overnight supervision must have policies and procedures 
16.18 	that:
16.19 	(1) protect the residents' health, safety, and rights;
16.20 	(2) explain the discharge process if a person served by the program requires in-person 
16.21 	supervision or other services that cannot be provided by the license holder due to the limited 
16.22 	hours that direct support staff are on site;
16.23 	(3) explain the backup system for technology in times of electrical outages or other 
16.24 	equipment malfunctions;
16.25 	(4) explain how the license holder trains the direct support staff on the use of the 
16.26 	technology; and
16.27 	(5) establish a plan for dispatching emergency response personnel to the site in the event 
16.28 	of an identified emergency.
16.29 	(b) Nothing in this section requires the license holder to develop or maintain separate 
16.30 	or duplicative policies, procedures, documentation, consent forms, or individual plans that 
16.31 	may be required for other licensing standards if the requirements of this section are 
16.32 	incorporated into those documents.
17.1 	(c) When no physical presence response is completed for a three-month period, the 
17.2 	license holder must conduct a physical presence response drill. The effectiveness of the 
17.3 	response protocol must be reviewed and documented.
17.4 		Subd. 5.Consent to use of monitoring technology. If a license holder uses monitoring 
17.5 	technology in a community residential setting, the license holder must obtain a signed 
17.6 	informed consent form from each resident served by the program or the resident's legal 
17.7 	representative documenting the resident's or legal representative's agreement to use of the 
17.8 	specific monitoring technology used in the setting. The informed consent form documenting 
17.9 	this agreement must also explain:
17.10 	(1) how the license holder uses monitoring technology to provide remote supervision;
17.11 	(2) the risks and benefits of using monitoring technology;
17.12 	(3) how the license holder protects each resident's privacy while monitoring technology 
17.13 	is being used in the setting; and
17.14 	(4) how the license holder protects each resident's privacy when the monitoring 
17.15 	technology system electronically records personally identifying data.

17.16 	EFFECTIVE DATE. This section is effective January 1, 2024.

17.17 	Sec. 10. [256.4761] PROVIDER CAPACITY GRANTS FOR RURAL AND 
17.18 	UNDERSERVED COMMUNITIES.
17.19 		Subdivision 1.Establishment and authority. (a) The commissioner of human services 
17.20 	shall award grants to organizations that provide community-based services to rural or 
17.21 	underserved communities. The grants must be used to build organizational capacity to 
17.22 	provide home and community-based services in the state and to build new or expanded 
17.23 	infrastructure to access medical assistance reimbursement.
17.24 	(b) The commissioner shall conduct community engagement, provide technical assistance, 
17.25 	and establish a collaborative learning community related to the grants available under this 
17.26 	section and shall work with the commissioner of management and budget and the 
17.27 	commissioner of the Department of Administration to mitigate barriers in accessing grant 
17.28 	money.
17.29 	(c) The commissioner shall limit expenditures under this subdivision to the amount 
17.30 	appropriated for this purpose.
18.1 	(d) The commissioner shall give priority to organizations that provide culturally specific 
18.2 	and culturally responsive services or that serve historically underserved communities 
18.3 	throughout the state.
18.4 		Subd. 2.Eligibility. An eligible applicant for the capacity grants under subdivision 1 is 
18.5 	an organization or provider that serves, or will serve, rural or underserved communities 
18.6 	and:
18.7 	(1) provides, or will provide, home and community-based services in the state; or
18.8 	(2) serves, or will serve, as a connector for communities to available home and 
18.9 	community-based services.
18.10 		Subd. 3.Allowable grant activities.  Grants under this section must be used by recipients 
18.11 	for the following activities:
18.12 	(1) expanding existing services;
18.13 	(2) increasing access in rural or underserved areas;
18.14 	(3) creating new home and community-based organizations;
18.15 	(4) connecting underserved communities to benefits and available services; or
18.16 	(5) building new or expanded infrastructure to access medical assistance reimbursement.

18.17 	Sec. 11. [256.4762] LONG-TERM CARE WORKFORCE GRANTS FOR NEW 
18.18 	AMERICANS.
18.19 		Subdivision 1.Definition. For the purposes of this section, "new American" means an 
18.20 	individual born abroad and the individual's children, irrespective of immigration status.
18.21 		Subd. 2.Grant program established. The commissioner of human services shall 
18.22 	establish a grant program for organizations that support immigrants, refugees, and new 
18.23 	Americans interested in entering the long-term care workforce.
18.24 		Subd. 3.Eligibility. (a) The commissioner shall select projects for funding under this 
18.25 	section. An eligible applicant for the grant program in subdivision 1 is an:
18.26 	(1) organization or provider that is experienced in working with immigrants, refugees, 
18.27 	and people born outside of the United States and that demonstrates cultural competency; 
18.28 	or
18.29 	(2) organization or provider with the expertise and capacity to provide training, peer 
18.30 	mentoring, supportive services, and workforce development or other services to develop 
18.31 	and implement strategies for recruiting and retaining qualified employees.
19.1 	(b) The commissioner shall prioritize applications from joint labor management programs.
19.2 		Subd. 4.Allowable grant activities.  (a) Money allocated under this section must be 
19.3 	used to:
19.4 	(1) support immigrants, refugees, or new Americans to obtain or maintain employment 
19.5 	in the long-term care workforce;
19.6 	(2) develop connections to employment with long-term care employers and potential 
19.7 	employees;
19.8 	(3) provide recruitment, training, guidance, mentorship, and other support services 
19.9 	necessary to encourage employment, employee retention, and successful community 
19.10 	integration;
19.11 	(4) provide career education, wraparound support services, and job skills training in 
19.12 	high-demand health care and long-term care fields;
19.13 	(5) pay for program expenses, including but not limited to hiring instructors and 
19.14 	navigators, space rentals, and supportive services to help participants attend classes. 
19.15 	Allowable uses for supportive services include but are not limited to:
19.16 	(i) course fees;
19.17 	(ii) child care costs;
19.18 	(iii) transportation costs;
19.19 	(iv) tuition fees;
19.20 	(v) financial coaching fees;
19.21 	(vi) mental health supports; or
19.22 	(vii) uniforms costs incurred as a direct result of participating in classroom instruction 
19.23 	or training; or
19.24 	(6) repay student loan debt directly incurred as a result of pursuing a qualifying course 
19.25 	of study or training.

19.26 	Sec. 12. [256.4763] AWARENESS-BUILDING CAMPAIGN FOR THE 
19.27 	RECRUITMENT OF DIRECT CARE PROFESSIONALS.
19.28 		Subdivision 1.Grant program established. The commissioner of employment and 
19.29 	economic development shall develop and implement paid advertising as part of a 
20.1 	comprehensive awareness-building campaign aimed at recruiting direct care professionals 
20.2 	to provide long-term care services.
20.3 		Subd. 2.Definition. For purposes of this section, "direct care professionals" means 
20.4 	long-term care services employees who provide direct support or care to people using aging, 
20.5 	disability, or behavioral health services.
20.6 		Subd. 3.Request for proposals; allowable uses of grant money. (a) The commissioner 
20.7 	shall publish a request for proposals to select an outside vendor or vendors to conduct the 
20.8 	awareness-building campaign for the recruitment of direct care professionals.
20.9 	(b) Grant money received under this section may be used:
20.10 	(1) for the development of recruitment materials for the direct care workforce to be 
20.11 	featured on:
20.12 	(i) television;
20.13 	(ii) streaming services;
20.14 	(iii) radio;
20.15 	(iv) social media;
20.16 	(v) billboards; and
20.17 	(vi) other print materials;
20.18 	(2) for the development of materials and strategies to highlight and promote the positive 
20.19 	aspects of the direct care workforce;
20.20 	(3) purchase of media time or space to feature recruitment materials for the direct care 
20.21 	workforce; and
20.22 	(4) for administrative costs necessary to implement this grant program.
20.23 	(c) The Department of Employment and Economic Development may collaborate with 
20.24 	relevant state agencies for the purposes of the development and implementation of this 
20.25 	campaign and is authorized to transfer administrative money to such agencies to cover any 
20.26 	associated administrative costs.

21.1 	Sec. 13. [256.4764] HOME AND COMMUNITY-BASED WORKFORCE 
21.2 	INCENTIVE FUND GRANTS.
21.3 		Subdivision 1.Grant program established. The commissioner of human services shall 
21.4 	establish grants for disability and home and community-based providers to assist with 
21.5 	recruiting and retaining direct support and frontline workers.
21.6 		Subd. 2.Definitions. (a) For purposes of this section, the following terms have the 
21.7 	meanings given.
21.8 	(b) "Commissioner" means the commissioner of human services.
21.9 	(c) "Eligible employer" means an organization enrolled in a Minnesota health care 
21.10 	program or providing housing services and that is:
21.11 	(1) a provider of home and community-based services under chapter 245D; or
21.12 	(2) a facility certified as an intermediate care facility for persons with developmental 
21.13 	disabilities.
21.14 	(d) "Eligible worker" means a worker who earns $30 per hour or less and is currently 
21.15 	employed or recruited to be employed by an eligible employer.
21.16 		Subd. 3.Allowable uses of grant money. (a) Grantees must use grant money to provide 
21.17 	payments to eligible workers for the following purposes:
21.18 	(1) retention, recruitment, and incentive payments;
21.19 	(2) postsecondary loan and tuition payments;
21.20 	(3) child care costs;
21.21 	(4) transportation-related costs; and
21.22 	(5) other costs associated with retaining and recruiting workers, as approved by the 
21.23 	commissioner.
21.24 	(b) Eligible workers may receive payments up to $1,000 per year from the home and 
21.25 	community-based workforce incentive fund.
21.26 	(c) The commissioner must develop a grant cycle distribution plan that allows for 
21.27 	equitable distribution of money among eligible employers. The commissioner's determination 
21.28 	of the grant awards and amounts is final and is not subject to appeal.
21.29 		Subd. 4.Attestation. As a condition of obtaining grant payments under this section, an 
21.30 	eligible employer must attest and agree to the following:
22.1 	(1) the employer is an eligible employer;
22.2 	(2) the total number of eligible employees;
22.3 	(3) the employer will distribute the entire value of the grant to eligible workers, as 
22.4 	allowed under this section;
22.5 	(4) the employer will create and maintain records under subdivision 6;
22.6 	(5) the employer will not use the money appropriated under this section for any purpose 
22.7 	other than the purposes permitted under this section; and
22.8 	(6) the entire value of any grant amounts will be distributed to eligible workers identified 
22.9 	by the employer.
22.10 		Subd. 5.Audits and recoupment. (a) The commissioner may perform an audit under 
22.11 	this section up to six years after a grant is awarded to ensure:
22.12 	(1) the grantee used the money solely for allowable purposes under subdivision 3;
22.13 	(2) the grantee was truthful when making attestations under subdivision 4; and
22.14 	(3) the grantee complied with the conditions of receiving a grant under this section.
22.15 	(b) If the commissioner determines that a grantee used grant money for purposes not 
22.16 	authorized under this section, the commissioner must treat any amount used for a purpose 
22.17 	not authorized under this section as an overpayment. The commissioner must recover any 
22.18 	overpayment.
22.19 		Subd. 6.Grants not to be considered income. (a) For the purposes of this subdivision, 
22.20 	"subtraction" has the meaning given in section 290.0132, subdivision 1, paragraph (a), and 
22.21 	the rules in that subdivision apply to this subdivision. The definitions in section 290.01 
22.22 	apply to this subdivision.
22.23 	(b) The amount of a grant award received under this section is a subtraction.
22.24 	(c) Grant awards under this section are excluded from income, as defined in sections 
22.25 	290.0674, subdivision 2a, and 290A.03, subdivision 3.
22.26 	(d) Notwithstanding any law to the contrary, grant awards under this section must not 
22.27 	be considered income, assets, or personal property for purposes of determining eligibility 
22.28 	or recertifying eligibility for:
22.29 	(1) child care assistance programs under chapter 119B;
22.30 	(2) general assistance, Minnesota supplemental aid, and food support under chapter 
22.31 	256D;
23.1 	(3) housing support under chapter 256I;
23.2 	(4) the Minnesota family investment program and diversionary work program under 
23.3 	chapter 256J; and
23.4 	(5) economic assistance programs under chapter 256P.
23.5 	(e) The commissioner must not consider grant awards under this section as income or 
23.6 	assets under section 256B.056, subdivision 1a, paragraph (a), 3, or 3c, or for persons with 
23.7 	eligibility determined under section 256B.057, subdivision 3, 3a, or 3b.

23.8 	Sec. 14. [256.4771] SUPPORTED-DECISION-MAKING PROGRAMS.
23.9 		Subdivision 1.Authorization. The commissioner of human services shall award general 
23.10 	operating grants to public and private nonprofit organizations, counties, and Tribes to provide 
23.11 	and promote supported decision making.
23.12 		Subd. 2.Definitions. (a) For the purposes of this section, the terms in this section have 
23.13 	the meanings given.
23.14 	(b) "Supported decision making" has the meaning given in section 524.5-102, subdivision 
23.15 	16a.
23.16 	(c) "Supported-decision-making services" means services provided to help an individual 
23.17 	consider, access, or develop supported decision making, potentially as an alternative to 
23.18 	more restrictive forms of decision making, including guardianship and conservatorship. 
23.19 	The services may be provided to the individual, family members, or trusted support people. 
23.20 	The individual may currently be a person subject to guardianship or conservatorship, but 
23.21 	the services must not be used to help a person access a guardianship or conservatorship.
23.22 		Subd. 3.Grants. (a) The grants must be distributed as follows:
23.23 	(1) at least 75 percent of the grant money must be used to fund programs or organizations 
23.24 	that provide supported-decision-making services;
23.25 	(2) no more than 20 percent of the grant money may be used to fund county or Tribal 
23.26 	programs that provide supported-decision-making services; and
23.27 	(3) no more than five percent of the grant money may be used to fund programs or 
23.28 	organizations that do not provide supported-decision-making services but do promote the 
23.29 	use and advancement of supported decision making.
23.30 	(b) The grants must be distributed in a manner to promote racial and geographic diversity 
23.31 	in the populations receiving services as determined by the commissioner.
24.1 		Subd. 4.Evaluation and report. By December 1, 2024, the commissioner must submit 
24.2 	to the chairs and ranking minority members of the legislative committees with jurisdiction 
24.3 	over human services finance and policy an interim report on the impact and outcomes of 
24.4 	the grants, including the number of grants awarded and the organizations receiving the 
24.5 	grants. The interim report must include any available evidence of how grantees were able 
24.6 	to increase utilization of supported decision making and reduce or avoid more restrictive 
24.7 	forms of decision making such as guardianship and conservatorship. By December 1, 2025, 
24.8 	the commissioner must submit to the chairs and ranking minority members of the legislative 
24.9 	committees with jurisdiction over human services finance and policy a final report on the 
24.10 	impact and outcomes of the grants, including any updated information from the interim 
24.11 	report and the total number of people served by the grants. The final report must also detail 
24.12 	how the money was used to achieve the requirements in subdivision 3, paragraph (b).
24.13 		Subd. 5.Applications. Any public or private nonprofit agency may apply to the 
24.14 	commissioner for a grant under subdivision 3, paragraph (a), clause (1) or (3). Any county 
24.15 	or Tribal agency in Minnesota may apply to the commissioner for a grant under subdivision 
24.16 	3, paragraph (a), clause (2). The application must be submitted in a form approved by the 
24.17 	commissioner.
24.18 		Subd. 6.Duties of grantees. Every public or private nonprofit agency, county, or Tribal 
24.19 	agency that receives a grant to provide or promote supported decision making must comply 
24.20 	with rules related to the administration of the grants.

24.21 	Sec. 15. [256.4773] TECHNOLOGY FOR HOME GRANT.
24.22 		Subdivision 1.Establishment. The commissioner must establish a technology for home 
24.23 	grant program that provides assistive technology consultations and resources for people 
24.24 	with disabilities who want to stay in their own home, move to their own home, or remain 
24.25 	in a less restrictive residential setting. The grant program may be administered using a team 
24.26 	approach that allows multiple professionals to assess and meet a person's assistive technology 
24.27 	needs. The team may include but is not limited to occupational therapists, physical therapists, 
24.28 	speech therapists, nurses, and engineers.
24.29 		Subd. 2.Eligible applicants. An eligible applicant is a person who uses or is eligible 
24.30 	for home care services under section 256B.0651, home and community-based services under 
24.31 	section 256B.092 or 256B.49, personal care assistance under section 256B.0659, or 
24.32 	community first services and supports under section 256B.85, and who meets one of the 
24.33 	following conditions:
25.1 	(1) lives in the applicant's own home and may benefit from assistive technology for 
25.2 	safety, communication, community engagement, or independence;
25.3 	(2) is currently seeking to live in the applicant's own home and needs assistive technology 
25.4 	to meet that goal; or
25.5 	(3) resides in a residential setting under section 256B.4914, subdivision 3, and is seeking 
25.6 	to reduce reliance on paid staff to live more independently in the setting.
25.7 		Subd. 3.Allowable grant activities. The technology for home grant program must 
25.8 	provide at-home, in-person assistive technology consultation and technical assistance to 
25.9 	help people with disabilities live more independently. Allowable activities include but are 
25.10 	not limited to:
25.11 	(1) consultations in people's homes, workplaces, or community locations;
25.12 	(2) connecting people to resources to help them live in their own homes, transition to 
25.13 	their own homes, or live more independently in residential settings;
25.14 	(3) conduct training and set-up and installation of assistive technology; and
25.15 	(4) participate on a person's care team to develop a plan to ensure assistive technology 
25.16 	goals are met.
25.17 		Subd. 4.Data collection and outcomes. Grantees must provide data summaries to the 
25.18 	commissioner for the purpose of evaluating the effectiveness of the grant program. The 
25.19 	commissioner must identify outcome measures to evaluate program activities to assess 
25.20 	whether the grant programs help people transition to or remain in the least restrictive setting.

25.21 	Sec. 16. Minnesota Statutes 2022, section 256B.0659, subdivision 1, is amended to read:
25.22 		Subdivision 1.Definitions. (a) For the purposes of this section, the terms defined in 
25.23 	paragraphs (b) to (r) have the meanings given unless otherwise provided in text.
25.24 	(b) "Activities of daily living" means grooming, dressing, bathing, transferring, mobility, 
25.25 	positioning, eating, and toileting.
25.26 	(c) "Behavior," effective January 1, 2010, means a category to determine the home care 
25.27 	rating and is based on the criteria found in this section. "Level I behavior" means physical 
25.28 	aggression towards toward self, others, or destruction of property that requires the immediate 
25.29 	response of another person.
25.30 	(d) "Complex health-related needs," effective January 1, 2010, means a category to 
25.31 	determine the home care rating and is based on the criteria found in this section.
26.1 	(e) "Critical activities of daily living," effective January 1, 2010, means transferring, 
26.2 	mobility, eating, and toileting.
26.3 	(f) "Dependency in activities of daily living" means a person requires assistance to begin 
26.4 	and complete one or more of the activities of daily living.
26.5 	(g) "Extended personal care assistance service" means personal care assistance services 
26.6 	included in a service plan under one of the home and community-based services waivers 
26.7 	authorized under chapter 256S and sections 256B.092, subdivision 5, and 256B.49, which 
26.8 	exceed the amount, duration, and frequency of the state plan personal care assistance services 
26.9 	for participants who:
26.10 	(1) need assistance provided periodically during a week, but less than daily will not be 
26.11 	able to remain in their homes without the assistance, and other replacement services are 
26.12 	more expensive or are not available when personal care assistance services are to be reduced; 
26.13 	or
26.14 	(2) need additional personal care assistance services beyond the amount authorized by 
26.15 	the state plan personal care assistance assessment in order to ensure that their safety, health, 
26.16 	and welfare are provided for in their homes.
26.17 	(h) "Health-related procedures and tasks" means procedures and tasks that can be 
26.18 	delegated or assigned by a licensed health care professional under state law to be performed 
26.19 	by a personal care assistant.
26.20 	(i) "Instrumental activities of daily living" means activities to include meal planning and 
26.21 	preparation; basic assistance with paying bills; shopping for food, clothing, and other 
26.22 	essential items; performing household tasks integral to the personal care assistance services; 
26.23 	communication by telephone and other media; and traveling, including to medical 
26.24 	appointments and to participate in the community. For purposes of this paragraph, traveling 
26.25 	includes driving and accompanying the recipient in the recipient's chosen mode of 
26.26 	transportation and according to the recipient's personal care assistance care plan.
26.27 	(j) "Managing employee" has the same definition as Code of Federal Regulations, title 
26.28 	42, section 455.
26.29 	(k) "Qualified professional" means a professional providing supervision of personal care 
26.30 	assistance services and staff as defined in section 256B.0625, subdivision 19c.
26.31 	(l) "Personal care assistance provider agency" means a medical assistance enrolled 
26.32 	provider that provides or assists with providing personal care assistance services and includes 
27.1 	a personal care assistance provider organization, personal care assistance choice agency, 
27.2 	class A licensed nursing agency, and Medicare-certified home health agency.
27.3 	(m) "Personal care assistant" or "PCA" means an individual employed by a personal 
27.4 	care assistance agency who provides personal care assistance services.
27.5 	(n) "Personal care assistance care plan" means a written description of personal care 
27.6 	assistance services developed by the personal care assistance provider according to the 
27.7 	service plan.
27.8 	(o) "Responsible party" means an individual who is capable of providing the support 
27.9 	necessary to assist the recipient to live in the community.
27.10 	(p) "Self-administered medication" means medication taken orally, by injection, nebulizer, 
27.11 	or insertion, or applied topically without the need for assistance.
27.12 	(q) "Service plan" means a written summary of the assessment and description of the 
27.13 	services needed by the recipient.
27.14 	(r) "Wages and benefits" means wages and salaries, the employer's share of FICA taxes, 
27.15 	Medicare taxes, state and federal unemployment taxes, workers' compensation, mileage 
27.16 	reimbursement, health and dental insurance, life insurance, disability insurance, long-term 
27.17 	care insurance, uniform allowance, and contributions to employee retirement accounts.

27.18 	EFFECTIVE DATE. This section is effective 90 days following federal approval. The 
27.19 	commissioner of human services shall notify the revisor of statutes when federal approval 
27.20 	is obtained.

27.21 	Sec. 17. Minnesota Statutes 2022, section 256B.0659, subdivision 12, is amended to read:
27.22 		Subd. 12.Documentation of personal care assistance services provided. (a) Personal 
27.23 	care assistance services for a recipient must be documented daily by each personal care 
27.24 	assistant, on a time sheet form approved by the commissioner. All documentation may be 
27.25 	web-based, electronic, or paper documentation. The completed form must be submitted on 
27.26 	a monthly basis to the provider and kept in the recipient's health record.
27.27 	(b) The activity documentation must correspond to the personal care assistance care plan 
27.28 	and be reviewed by the qualified professional.
27.29 	(c) The personal care assistant time sheet must be on a form approved by the 
27.30 	commissioner documenting time the personal care assistant provides services in the home. 
27.31 	The following criteria must be included in the time sheet:
27.32 	(1) full name of personal care assistant and individual provider number;
28.1 	(2) provider name and telephone numbers;
28.2 	(3) full name of recipient and either the recipient's medical assistance identification 
28.3 	number or date of birth;
28.4 	(4) consecutive dates, including month, day, and year, and arrival and departure times 
28.5 	with a.m. or p.m. notations;
28.6 	(5) signatures of recipient or the responsible party;
28.7 	(6) personal signature of the personal care assistant;
28.8 	(7) any shared care provided, if applicable;
28.9 	(8) a statement that it is a federal crime to provide false information on personal care 
28.10 	service billings for medical assistance payments; and
28.11 	(9) dates and location of recipient stays in a hospital, care facility, or incarceration; and
28.12 	(10) any time spent traveling, as described in subdivision 1, paragraph (i), including 
28.13 	start and stop times with a.m. and p.m. designations, the origination site, and the destination 
28.14 	site.

28.15 	EFFECTIVE DATE. This section is effective 90 days following federal approval. The 
28.16 	commissioner of human services shall notify the revisor of statutes when federal approval 
28.17 	is obtained.

28.18 	Sec. 18. Minnesota Statutes 2022, section 256B.0659, subdivision 19, is amended to read:
28.19 		Subd. 19.Personal care assistance choice option; qualifications; duties. (a) Under 
28.20 	personal care assistance choice, the recipient or responsible party shall:
28.21 	(1) recruit, hire, schedule, and terminate personal care assistants according to the terms 
28.22 	of the written agreement required under subdivision 20, paragraph (a);
28.23 	(2) develop a personal care assistance care plan based on the assessed needs and 
28.24 	addressing the health and safety of the recipient with the assistance of a qualified professional 
28.25 	as needed;
28.26 	(3) orient and train the personal care assistant with assistance as needed from the qualified 
28.27 	professional;
28.28 	(4) supervise and evaluate the personal care assistant with the qualified professional, 
28.29 	who is required to visit the recipient at least every 180 days;
29.1 	(5) monitor and verify in writing and report to the personal care assistance choice agency 
29.2 	the number of hours worked by the personal care assistant and the qualified professional;
29.3 	(6) engage in an annual reassessment as required in subdivision 3a to determine 
29.4 	continuing eligibility and service authorization; and
29.5 	(7) use the same personal care assistance choice provider agency if shared personal 
29.6 	assistance care is being used.; and
29.7 	(8) ensure that a personal care assistant driving the recipient under subdivision 1, 
29.8 	paragraph (i), has a valid driver's license and the vehicle used is registered and insured 
29.9 	according to Minnesota law.
29.10 	(b) The personal care assistance choice provider agency shall:
29.11 	(1) meet all personal care assistance provider agency standards;
29.12 	(2) enter into a written agreement with the recipient, responsible party, and personal 
29.13 	care assistants;
29.14 	(3) not be related as a parent, child, sibling, or spouse to the recipient or the personal 
29.15 	care assistant; and
29.16 	(4) ensure arm's-length transactions without undue influence or coercion with the recipient 
29.17 	and personal care assistant.
29.18 	(c) The duties of the personal care assistance choice provider agency are to:
29.19 	(1) be the employer of the personal care assistant and the qualified professional for 
29.20 	employment law and related regulations including but not limited to purchasing and 
29.21 	maintaining workers' compensation, unemployment insurance, surety and fidelity bonds, 
29.22 	and liability insurance, and submit any or all necessary documentation including but not 
29.23 	limited to workers' compensation, unemployment insurance, and labor market data required 
29.24 	under section 256B.4912, subdivision 1a;
29.25 	(2) bill the medical assistance program for personal care assistance services and qualified 
29.26 	professional services;
29.27 	(3) request and complete background studies that comply with the requirements for 
29.28 	personal care assistants and qualified professionals;
29.29 	(4) pay the personal care assistant and qualified professional based on actual hours of 
29.30 	services provided;
29.31 	(5) withhold and pay all applicable federal and state taxes;
30.1 	(6) verify and keep records of hours worked by the personal care assistant and qualified 
30.2 	professional;
30.3 	(7) make the arrangements and pay taxes and other benefits, if any, and comply with 
30.4 	any legal requirements for a Minnesota employer;
30.5 	(8) enroll in the medical assistance program as a personal care assistance choice agency; 
30.6 	and
30.7 	(9) enter into a written agreement as specified in subdivision 20 before services are 
30.8 	provided.

30.9 	EFFECTIVE DATE. This section is effective 90 days following federal approval. The 
30.10 	commissioner of human services shall notify the revisor of statutes when federal approval 
30.11 	is obtained.

30.12 	Sec. 19. Minnesota Statutes 2022, section 256B.0659, subdivision 24, is amended to read:
30.13 		Subd. 24.Personal care assistance provider agency; general duties. A personal care 
30.14 	assistance provider agency shall:
30.15 	(1) enroll as a Medicaid provider meeting all provider standards, including completion 
30.16 	of the required provider training;
30.17 	(2) comply with general medical assistance coverage requirements;
30.18 	(3) demonstrate compliance with law and policies of the personal care assistance program 
30.19 	to be determined by the commissioner;
30.20 	(4) comply with background study requirements;
30.21 	(5) verify and keep records of hours worked by the personal care assistant and qualified 
30.22 	professional;
30.23 	(6) not engage in any agency-initiated direct contact or marketing in person, by phone, 
30.24 	or other electronic means to potential recipients, guardians, or family members;
30.25 	(7) pay the personal care assistant and qualified professional based on actual hours of 
30.26 	services provided;
30.27 	(8) withhold and pay all applicable federal and state taxes;
30.28 	(9) document that the agency uses a minimum of 72.5 percent of the revenue generated 
30.29 	by the medical assistance rate for personal care assistance services for employee personal 
30.30 	care assistant wages and benefits. The revenue generated by the qualified professional and 
31.1 	the reasonable costs associated with the qualified professional shall not be used in making 
31.2 	this calculation;
31.3 	(10) make the arrangements and pay unemployment insurance, taxes, workers' 
31.4 	compensation, liability insurance, and other benefits, if any;
31.5 	(11) enter into a written agreement under subdivision 20 before services are provided;
31.6 	(12) report suspected neglect and abuse to the common entry point according to section 
31.7 	256B.0651;
31.8 	(13) provide the recipient with a copy of the home care bill of rights at start of service;
31.9 	(14) request reassessments at least 60 days prior to the end of the current authorization 
31.10 	for personal care assistance services, on forms provided by the commissioner;
31.11 	(15) comply with the labor market reporting requirements described in section 256B.4912, 
31.12 	subdivision 1a; and
31.13 	(16) document that the agency uses the additional revenue due to the enhanced rate under 
31.14 	subdivision 17a for the wages and benefits of the PCAs whose services meet the requirements 
31.15 	under subdivision 11, paragraph (d); and
31.16 	(17) ensure that a personal care assistant driving a recipient under subdivision 1, 
31.17 	paragraph (i), has a valid driver's license and the vehicle used is registered and insured 
31.18 	according to Minnesota law.

31.19 	EFFECTIVE DATE. This section is effective 90 days following federal approval. The 
31.20 	commissioner of human services shall notify the revisor of statutes when federal approval 
31.21 	is obtained.

31.22 	Sec. 20. Minnesota Statutes 2022, section 256B.0911, subdivision 13, is amended to read:
31.23 		Subd. 13.MnCHOICES assessor qualifications, training, and certification. (a) The 
31.24 	commissioner shall develop and implement a curriculum and an assessor certification 
31.25 	process.
31.26 	(b) MnCHOICES certified assessors must:
31.27 	(1) either have a bachelor's degree in social work, nursing with a public health nursing 
31.28 	certificate, or other closely related field with at least one year of home and community-based 
31.29 	experience or be a registered nurse with at least two years of home and community-based 
31.30 	experience; and
32.1 	(2) have received training and certification specific to assessment and consultation for 
32.2 	long-term care services in the state.
32.3 	(c) Certified assessors shall demonstrate best practices in assessment and support 
32.4 	planning, including person-centered planning principles, and have a common set of skills 
32.5 	that ensures consistency and equitable access to services statewide.
32.6 	(d) Certified assessors must be recertified every three years.

32.7 	Sec. 21. Minnesota Statutes 2022, section 256B.0949, subdivision 15, is amended to read:
32.8 		Subd. 15.EIDBI provider qualifications. (a) A QSP must be employed by an agency 
32.9 	and be:
32.10 	(1) a licensed mental health professional who has at least 2,000 hours of supervised 
32.11 	clinical experience or training in examining or treating people with ASD or a related condition 
32.12 	or equivalent documented coursework at the graduate level by an accredited university in 
32.13 	ASD diagnostics, ASD developmental and behavioral treatment strategies, and typical child 
32.14 	development; or
32.15 	(2) a developmental or behavioral pediatrician who has at least 2,000 hours of supervised 
32.16 	clinical experience or training in examining or treating people with ASD or a related condition 
32.17 	or equivalent documented coursework at the graduate level by an accredited university in 
32.18 	the areas of ASD diagnostics, ASD developmental and behavioral treatment strategies, and 
32.19 	typical child development.
32.20 	(b) A level I treatment provider must be employed by an agency and:
32.21 	(1) have at least 2,000 hours of supervised clinical experience or training in examining 
32.22 	or treating people with ASD or a related condition or equivalent documented coursework 
32.23 	at the graduate level by an accredited university in ASD diagnostics, ASD developmental 
32.24 	and behavioral treatment strategies, and typical child development or an equivalent 
32.25 	combination of documented coursework or hours of experience; and
32.26 	(2) have or be at least one of the following:
32.27 	(i) a master's degree in behavioral health or child development or related fields including, 
32.28 	but not limited to, mental health, special education, social work, psychology, speech 
32.29 	pathology, or occupational therapy from an accredited college or university;
32.30 	(ii) a bachelor's degree in a behavioral health, child development, or related field 
32.31 	including, but not limited to, mental health, special education, social work, psychology, 
33.1 	speech pathology, or occupational therapy, from an accredited college or university, and 
33.2 	advanced certification in a treatment modality recognized by the department;
33.3 	(iii) a board-certified behavior analyst; or
33.4 	(iv) a board-certified assistant behavior analyst with 4,000 hours of supervised clinical 
33.5 	experience that meets all registration, supervision, and continuing education requirements 
33.6 	of the certification.
33.7 	(c) A level II treatment provider must be employed by an agency and must be:
33.8 	(1) a person who has a bachelor's degree from an accredited college or university in a 
33.9 	behavioral or child development science or related field including, but not limited to, mental 
33.10 	health, special education, social work, psychology, speech pathology, or occupational 
33.11 	therapy; and meets at least one of the following:
33.12 	(i) has at least 1,000 hours of supervised clinical experience or training in examining or 
33.13 	treating people with ASD or a related condition or equivalent documented coursework at 
33.14 	the graduate level by an accredited university in ASD diagnostics, ASD developmental and 
33.15 	behavioral treatment strategies, and typical child development or a combination of 
33.16 	coursework or hours of experience;
33.17 	(ii) has certification as a board-certified assistant behavior analyst from the Behavior 
33.18 	Analyst Certification Board;
33.19 	(iii) is a registered behavior technician as defined by the Behavior Analyst Certification 
33.20 	Board; or
33.21 	(iv) is certified in one of the other treatment modalities recognized by the department; 
33.22 	or
33.23 	(2) a person who has:
33.24 	(i) an associate's degree in a behavioral or child development science or related field 
33.25 	including, but not limited to, mental health, special education, social work, psychology, 
33.26 	speech pathology, or occupational therapy from an accredited college or university; and
33.27 	(ii) at least 2,000 hours of supervised clinical experience in delivering treatment to people 
33.28 	with ASD or a related condition. Hours worked as a mental health behavioral aide or level 
33.29 	III treatment provider may be included in the required hours of experience; or
33.30 	(3) a person who has at least 4,000 hours of supervised clinical experience in delivering 
33.31 	treatment to people with ASD or a related condition. Hours worked as a mental health 
34.1 	behavioral aide or level III treatment provider may be included in the required hours of 
34.2 	experience; or
34.3 	(4) a person who is a graduate student in a behavioral science, child development science, 
34.4 	or related field and is receiving clinical supervision by a QSP affiliated with an agency to 
34.5 	meet the clinical training requirements for experience and training with people with ASD 
34.6 	or a related condition; or
34.7 	(5) a person who is at least 18 years of age and who:
34.8 	(i) is fluent in a non-English language or is an individual certified by a Tribal Nation;
34.9 	(ii) completed the level III EIDBI training requirements; and
34.10 	(iii) receives observation and direction from a QSP or level I treatment provider at least 
34.11 	once a week until the person meets 1,000 hours of supervised clinical experience.
34.12 	(d) A level III treatment provider must be employed by an agency, have completed the 
34.13 	level III training requirement, be at least 18 years of age, and have at least one of the 
34.14 	following:
34.15 	(1) a high school diploma or commissioner of education-selected high school equivalency 
34.16 	certification;
34.17 	(2) fluency in a non-English language or Tribal Nation certification;
34.18 	(3) one year of experience as a primary personal care assistant, community health worker, 
34.19 	waiver service provider, or special education assistant to a person with ASD or a related 
34.20 	condition within the previous five years; or
34.21 	(4) completion of all required EIDBI training within six months of employment.

34.22 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
34.23 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
34.24 	when federal approval is obtained.

34.25 	Sec. 22. Minnesota Statutes 2022, section 256B.49, subdivision 11, is amended to read:
34.26 		Subd. 11.Authority. (a) The commissioner is authorized to apply for home and 
34.27 	community-based service waivers, as authorized under section 1915(c) of the federal Social 
34.28 	Security Act to serve persons under the age of 65 who are determined to require the level 
34.29 	of care provided in a nursing home and persons who require the level of care provided in a 
34.30 	hospital. The commissioner shall apply for the home and community-based waivers in order 
34.31 	to:
35.1 	(1) promote the support of persons with disabilities in the most integrated settings;
35.2 	(2) expand the availability of services for persons who are eligible for medical assistance;
35.3 	(3) promote cost-effective options to institutional care; and
35.4 	(4) obtain federal financial participation.
35.5 	(b) The provision of waiver services to medical assistance recipients with disabilities 
35.6 	shall comply with the requirements outlined in the federally approved applications for home 
35.7 	and community-based services and subsequent amendments, including provision of services 
35.8 	according to a service plan designed to meet the needs of the individual, except when 
35.9 	applying a size limitation to a setting, the commissioner must treat residents under 55 years 
35.10 	of age who are receiving services under the brain injury or the community access for 
35.11 	disability inclusion waiver as if the residents are 55 years of age or older if the residents 
35.12 	lived and received services in the setting on or before March 1, 2023. For purposes of this 
35.13 	section, the approved home and community-based application is considered the necessary 
35.14 	federal requirement.
35.15 	(c) The commissioner shall provide interested persons serving on agency advisory 
35.16 	committees, task forces, the Centers for Independent Living, and others who request to be 
35.17 	on a list to receive, notice of, and an opportunity to comment on, at least 30 days before 
35.18 	any effective dates, (1) any substantive changes to the state's disability services program 
35.19 	manual, or (2) changes or amendments to the federally approved applications for home and 
35.20 	community-based waivers, prior to their submission to the federal Centers for Medicare 
35.21 	and Medicaid Services.
35.22 	(d) The commissioner shall seek approval, as authorized under section 1915(c) of the 
35.23 	federal Social Security Act, to allow medical assistance eligibility under this section for 
35.24 	children under age 21 without deeming of parental income or assets.
35.25 	(e) The commissioner shall seek approval, as authorized under section 1915(c) of the 
35.26 	Social Act, to allow medical assistance eligibility under this section for individuals under 
35.27 	age 65 without deeming the spouse's income or assets.
35.28 	(f) The commissioner shall comply with the requirements in the federally approved 
35.29 	transition plan for the home and community-based services waivers authorized under this 
35.30 	section, except when applying a size limitation to a setting, the commissioner must treat 
35.31 	residents under 55 years of age who are receiving services under the brain injury or the 
35.32 	community access for disability inclusion waiver as if the residents are 55 years of age or 
35.33 	older if the residents lived and received services in the setting on or before March 1, 2023.
36.1 	(g) The commissioner shall seek federal approval to allow for the reconfiguration of the 
36.2 	1915(c) home and community-based waivers in this section, as authorized under section 
36.3 	1915(c) of the federal Social Security Act, to implement a two-waiver program structure.
36.4 	(h) The commissioner shall seek federal approval for the 1915(c) home and 
36.5 	community-based waivers in this section, as authorized under section 1915(c) of the federal 
36.6 	Social Security Act, to implement an individual resource allocation methodology.

36.7 	EFFECTIVE DATE. This section is effective retroactively from January 11, 2021.

36.8 	Sec. 23. Minnesota Statutes 2022, section 256B.49, subdivision 28, is amended to read:
36.9 		Subd. 28.Customized living moratorium for brain injury and community access 
36.10 	for disability inclusion waivers. (a) Notwithstanding section 245A.03, subdivision 2, 
36.11 	paragraph (a), clause (23), to prevent new development of customized living settings that 
36.12 	otherwise meet the residential program definition under section 245A.02, subdivision 14, 
36.13 	the commissioner shall not enroll new customized living settings serving four or fewer 
36.14 	people in a single-family home to deliver customized living services as defined under the 
36.15 	brain injury or community access for disability inclusion waiver plans under this section.
36.16 	(b) The commissioner may approve an exception to paragraph (a) when an existing 
36.17 	customized living setting changes ownership at the same address and must approve an 
36.18 	exception to paragraph (a) when the same owner relocates an existing customized living 
36.19 	setting to a new address.
36.20 	(c) Customized living settings operational on or before June 30, 2021, are considered 
36.21 	existing customized living settings.
36.22 	(d) For any new customized living settings serving four or fewer people in a single-family 
36.23 	home to deliver customized living services as defined in paragraph (a) and that was not 
36.24 	operational on or before June 30, 2021, the authorizing lead agency is financially responsible 
36.25 	for all home and community-based service payments in the setting.
36.26 	(e) For purposes of this subdivision, "operational" means customized living services are 
36.27 	authorized and delivered to a person in the customized living setting.

36.28 	EFFECTIVE DATE. This section is effective the day following final enactment.

36.29 	Sec. 24. Minnesota Statutes 2022, section 256B.4905, subdivision 5a, is amended to read:
36.30 		Subd. 5a.Employment first implementation for disability waiver services. (a) The 
36.31 	commissioner of human services shall ensure that:
37.1 	(1) the disability waivers under sections 256B.092 and 256B.49 support the presumption 
37.2 	that all working-age Minnesotans with disabilities can work and achieve competitive 
37.3 	integrated employment with appropriate services and supports, as needed; and
37.4 	(2) each waiver recipient of working age be offered, after an informed decision-making 
37.5 	process and during a person-centered planning process, the opportunity to work and earn a 
37.6 	competitive wage before being offered exclusively day services as defined in section 
37.7 	245D.03, subdivision 1, paragraph (c), clause (4), or successor provisions.
37.8 	(b) Nothing in this subdivision prohibits a waiver recipient of working age, after an 
37.9 	informed decision-making process and during a person-centered planning process, from 
37.10 	choosing employment at a special minimum wage under a 14(c) certificate as provided by 
37.11 	Code of Federal Regulations, title 29, sections 525.1 to 525.24. For any waiver recipient 
37.12 	who chooses employment at a special minimum wage, the commissioner must not impose 
37.13 	any limitations on the length of disability services provided to support the recipient's informed 
37.14 	choice or limitations on the reimbursement rates for the disability waiver services provided 
37.15 	to support the recipient's informed choice.

37.16 	Sec. 25. Minnesota Statutes 2022, section 256B.4911, is amended by adding a subdivision 
37.17 	to read:
37.18 		Subd. 6.Services provided by parents and spouses. (a) This subdivision limits medical 
37.19 	assistance payments under the consumer-directed community supports option for personal 
37.20 	assistance services provided by a parent to the parent's minor child or by a participant's 
37.21 	spouse. This subdivision applies to the consumer-directed community supports option 
37.22 	available under all of the following:
37.23 	(1) alternative care program;
37.24 	(2) brain injury waiver;
37.25 	(3) community alternative care waiver;
37.26 	(4) community access for disability inclusion waiver;
37.27 	(5) developmental disabilities waiver;
37.28 	(6) elderly waiver; and
37.29 	(7) Minnesota senior health option.
37.30 	(b) For the purposes of this subdivision, "parent" means a parent, stepparent, or legal 
37.31 	guardian of a minor.
38.1 	(c) If multiple parents are providing personal assistance services to their minor child or 
38.2 	children, each parent may provide up to 40 hours of personal assistance services in any 
38.3 	seven-day period regardless of the number of children served. The total number of hours 
38.4 	of personal assistance services provided by all of the parents must not exceed 80 hours in 
38.5 	a seven-day period regardless of the number of children served.
38.6 	(d) If only one parent is providing personal assistance services to a minor child or 
38.7 	children, the parent may provide up to 60 hours of personal assistance services in a seven-day 
38.8 	period regardless of the number of children served.
38.9 	(e) If a participant's spouse is providing personal assistance services, the spouse may 
38.10 	provide up to 60 hours of personal assistance services in a seven-day period.
38.11 	(f) This subdivision must not be construed to permit an increase in the total authorized 
38.12 	consumer-directed community supports budget for an individual.

38.13 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
38.14 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
38.15 	when federal approval is obtained.

38.16 	Sec. 26. Minnesota Statutes 2022, section 256B.4912, is amended by adding a subdivision 
38.17 	to read:
38.18 		Subd. 1b.Direct support professional annual labor market survey. (a) The 
38.19 	commissioner shall develop and administer a survey of direct care staff who work for 
38.20 	organizations that provide services under the following programs:
38.21 	(1) home and community-based services for seniors under chapter 256S and section 
38.22 	256B.0913, home and community-based services for people with developmental disabilities 
38.23 	under section 256B.092, and home and community-based services for people with disabilities 
38.24 	under section 256B.49;
38.25 	(2) personal care assistance services under section 256B.0625, subdivision 19a; 
38.26 	community first services and supports under section 256B.85; nursing services and home 
38.27 	health services under section 256B.0625, subdivision 6a; home care nursing services under 
38.28 	section 256B.0625, subdivision 7; and
38.29 	(3) financial management services for participants who directly employ direct-care staff 
38.30 	through consumer support grants under section 256.476; the personal care assistance choice 
38.31 	program under section 256B.0659, subdivisions 18 to 20; community first services and 
38.32 	supports under section 256B.85; and the consumer-directed community supports option 
38.33 	available under the alternative care program, the brain injury waiver, the community 
39.1 	alternative care waiver, the community access for disability inclusion waiver, the 
39.2 	developmental disabilities waiver, the elderly waiver, and the Minnesota senior health 
39.3 	option, except financial management services providers are not required to submit the data 
39.4 	listed in subdivision 1a, clauses (7) to (11).
39.5 	(b) The survey must collect information about the individual experience of the direct-care 
39.6 	staff and any other information necessary to assess the overall economic viability and 
39.7 	well-being of the workforce.
39.8 	(c) For purposes of this subdivision, "direct-care staff" means employees, including 
39.9 	self-employed individuals and individuals directly employed by a participant in a 
39.10 	consumer-directed service delivery option, providing direct service to participants under 
39.11 	this section. Direct-care staff does not include executive, managerial, or administrative staff.
39.12 	(d) Individually identifiable data submitted to the commissioner under this section are 
39.13 	considered private data on individuals as defined by section 13.02, subdivision 12.
39.14 	(e) The commissioner shall analyze data submitted under this section annually to assess 
39.15 	the overall economic viability and well-being of the workforce and the impact of the state 
39.16 	of workforce on access to services.

39.17 	Sec. 27. Minnesota Statutes 2022, section 256B.4912, is amended by adding a subdivision 
39.18 	to read:
39.19 		Subd. 1c.Annual labor market report. The commissioner shall publish annual reports 
39.20 	on provider and state-level labor market data, including but not limited to the data outlined 
39.21 	in subdivisions 1a and 1b.

39.22 	Sec. 28. Minnesota Statutes 2022, section 256B.4912, is amended by adding a subdivision 
39.23 	to read:
39.24 		Subd. 16.Rates established by the commissioner. For homemaker services eligible 
39.25 	for reimbursement under the developmental disabilities waiver, the brain injury waiver, the 
39.26 	community alternative care waiver, and the community access for disability inclusion waiver, 
39.27 	the commissioner must establish rates equal to the rates established under sections 256S.21 
39.28 	to 256S.215 for the corresponding homemaker services.

39.29 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
39.30 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
39.31 	when federal approval is obtained.

40.1 	Sec. 29. Minnesota Statutes 2022, section 256B.4914, subdivision 3, is amended to read:
40.2 		Subd. 3.Applicable services. Applicable services are those authorized under the state's 
40.3 	home and community-based services waivers under sections 256B.092 and 256B.49, 
40.4 	including the following, as defined in the federally approved home and community-based 
40.5 	services plan:
40.6 	(1) 24-hour customized living;
40.7 	(2) adult day services;
40.8 	(3) adult day services bath;
40.9 	(4) community residential services;
40.10 	(5) customized living;
40.11 	(6) day support services;
40.12 	(7) employment development services;
40.13 	(8) employment exploration services;
40.14 	(9) employment support services;
40.15 	(10) family residential services;
40.16 	(11) individualized home supports;
40.17 	(12) individualized home supports with family training;
40.18 	(13) individualized home supports with training;
40.19 	(14) integrated community supports;
40.20 	(15) night supervision;
40.21 	(16) positive support services;
40.22 	(17) prevocational services;
40.23 	(18) residential support services;
40.24 	(19) respite services;
40.25 	(20) transportation services; and
40.26 	(21) (20) other services as approved by the federal government in the state home and 
40.27 	community-based services waiver plan.

41.1 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
41.2 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
41.3 	when federal approval is obtained.

41.4 	Sec. 30. Minnesota Statutes 2022, section 256B.4914, subdivision 4, is amended to read:
41.5 		Subd. 4.Data collection for rate determination. (a) Rates for applicable home and 
41.6 	community-based waivered services, including customized rates under subdivision 12, are 
41.7 	set by the rates management system.
41.8 	(b) Data and information in the rates management system must be used to calculate an 
41.9 	individual's rate.
41.10 	(c) Service providers, with information from the support plan and oversight by lead 
41.11 	agencies, shall provide values and information needed to calculate an individual's rate in 
41.12 	the rates management system. The determination of service levels must be part of a discussion 
41.13 	with members of the support team as defined in section 245D.02, subdivision 34. This 
41.14 	discussion must occur prior to the final establishment of each individual's rate. The values 
41.15 	and information include:
41.16 	(1) shared staffing hours;
41.17 	(2) individual staffing hours;
41.18 	(3) direct registered nurse hours;
41.19 	(4) direct licensed practical nurse hours;
41.20 	(5) staffing ratios;
41.21 	(6) information to document variable levels of service qualification for variable levels 
41.22 	of reimbursement in each framework;
41.23 	(7) shared or individualized arrangements for unit-based services, including the staffing 
41.24 	ratio;
41.25 	(8) number of trips and miles for transportation services; and
41.26 	(9) service hours provided through monitoring technology.
41.27 	(d) Updates to individual data must include:
41.28 	(1) data for each individual that is updated annually when renewing service plans; and
41.29 	(2) requests by individuals or lead agencies to update a rate whenever there is a change 
41.30 	in an individual's service needs, with accompanying documentation.
42.1 	(e) Lead agencies shall review and approve all services reflecting each individual's needs, 
42.2 	and the values to calculate the final payment rate for services with variables under 
42.3 	subdivisions 6 to 9a 9 for each individual. Lead agencies must notify the individual and the 
42.4 	service provider of the final agreed-upon values and rate, and provide information that is 
42.5 	identical to what was entered into the rates management system. If a value used was 
42.6 	mistakenly or erroneously entered and used to calculate a rate, a provider may petition lead 
42.7 	agencies to correct it. Lead agencies must respond to these requests. When responding to 
42.8 	the request, the lead agency must consider:
42.9 	(1) meeting the health and welfare needs of the individual or individuals receiving 
42.10 	services by service site, identified in their support plan under section 245D.02, subdivision 
42.11 	4b, and any addendum under section 245D.02, subdivision 4c;
42.12 	(2) meeting the requirements for staffing under subdivision 2, paragraphs (h), (n), and 
42.13 	(o); and meeting or exceeding the licensing standards for staffing required under section 
42.14 	245D.09, subdivision 1; and
42.15 	(3) meeting the staffing ratio requirements under subdivision 2, paragraph (o), and 
42.16 	meeting or exceeding the licensing standards for staffing required under section 245D.31.

42.17 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
42.18 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
42.19 	when federal approval is obtained.

42.20 	Sec. 31. Minnesota Statutes 2022, section 256B.4914, subdivision 5, is amended to read:
42.21 		Subd. 5.Base wage index; establishment and updates. (a) The base wage index is 
42.22 	established to determine staffing costs associated with providing services to individuals 
42.23 	receiving home and community-based services. For purposes of calculating the base wage, 
42.24 	Minnesota-specific wages taken from job descriptions and standard occupational 
42.25 	classification (SOC) codes from the Bureau of Labor Statistics as defined in the Occupational 
42.26 	Handbook must be used.
42.27 	(b) The commissioner shall update the base wage index in subdivision 5a, publish these 
42.28 	updated values, and load them into the rate management system as follows:
42.29 	(1) on January 1, 2022, based on wage data by SOC from the Bureau of Labor Statistics 
42.30 	available as of December 31, 2019; and
42.31 	(2) on November 1, 2024, based on wage data by SOC from the Bureau of Labor Statistics 
42.32 	available as of December 31, 2021; and
43.1 	(3)(2) on July 1, 2026 January 1, 2024, and every two years thereafter, based on wage 
43.2 	data by SOC from the Bureau of Labor Statistics available 30 24 months and one day prior 
43.3 	to the scheduled update.

43.4 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
43.5 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
43.6 	when federal approval is obtained.

43.7 	Sec. 32. Minnesota Statutes 2022, section 256B.4914, subdivision 5a, is amended to read:
43.8 		Subd. 5a.Base wage index; calculations. The base wage index must be calculated as 
43.9 	follows:
43.10 	(1) for supervisory staff, 100 percent of the median wage for community and social 
43.11 	services specialist (SOC code 21-1099), with the exception of the supervisor of positive 
43.12 	supports professional, positive supports analyst, and positive supports specialist, which is 
43.13 	100 percent of the median wage for clinical counseling and school psychologist (SOC code 
43.14 	19-3031);
43.15 	(2) for registered nurse staff, 100 percent of the median wage for registered nurses (SOC 
43.16 	code 29-1141);
43.17 	(3) for licensed practical nurse staff, 100 percent of the median wage for licensed practical 
43.18 	nurses (SOC code 29-2061);
43.19 	(4) for residential asleep-overnight staff, the minimum wage in Minnesota for large 
43.20 	employers, with the exception of asleep-overnight staff for family residential services, which 
43.21 	is 36 percent of the minimum wage in Minnesota for large employers;
43.22 	(5) for residential direct care staff, the sum of:
43.23 	(i) 15 percent of the subtotal of 50 percent of the median wage for home health and 
43.24 	personal care aide (SOC code 31-1120); 30 percent of the median wage for nursing assistant 
43.25 	(SOC code 31-1131); and 20 percent of the median wage for social and human services 
43.26 	aide (SOC code 21-1093); and
43.27 	(ii) 85 percent of the subtotal of 40 percent of the median wage for home health and 
43.28 	personal care aide (SOC code 31-1120); 20 percent of the median wage for nursing assistant 
43.29 	(SOC code 31-1014 31-1131); 20 percent of the median wage for psychiatric technician 
43.30 	(SOC code 29-2053); and 20 percent of the median wage for social and human services 
43.31 	aide (SOC code 21-1093);
44.1 	(6) for adult day services staff, 70 percent of the median wage for nursing assistant (SOC 
44.2 	code 31-1131); and 30 percent of the median wage for home health and personal care aide 
44.3 	(SOC code 31-1120);
44.4 	(7) for day support services staff and prevocational services staff, 20 percent of the 
44.5 	median wage for nursing assistant (SOC code 31-1131); 20 percent of the median wage for 
44.6 	psychiatric technician (SOC code 29-2053); and 60 percent of the median wage for social 
44.7 	and human services aide (SOC code 21-1093);
44.8 	(8) for positive supports analyst staff, 100 percent of the median wage for substance 
44.9 	abuse, behavioral disorder, and mental health counselor clinical, counseling, and school 
44.10 	psychologists (SOC code 21-1018 19-3031);
44.11 	(9) for positive supports professional staff, 100 percent of the median wage for clinical 
44.12 	counseling and school psychologist, all other (SOC code 19-3031 19-3039);
44.13 	(10) for positive supports specialist staff, 100 percent of the median wage for psychiatric 
44.14 	technicians occupational therapist (SOC code 29-2053 29-1122);
44.15 	(11) for individualized home supports with family training staff, 20 percent of the median 
44.16 	wage for nursing aide (SOC code 31-1131); 30 percent of the median wage for community 
44.17 	social service specialist (SOC code 21-1099); 40 percent of the median wage for social and 
44.18 	human services aide (SOC code 21-1093); and ten percent of the median wage for psychiatric 
44.19 	technician (SOC code 29-2053);
44.20 	(12) for individualized home supports with training services staff, 40 percent of the 
44.21 	median wage for community social service specialist (SOC code 21-1099); 50 percent of 
44.22 	the median wage for social and human services aide (SOC code 21-1093); and ten percent 
44.23 	of the median wage for psychiatric technician (SOC code 29-2053);
44.24 	(13) for employment support services staff, 50 percent of the median wage for 
44.25 	rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for 
44.26 	community and social services specialist (SOC code 21-1099);
44.27 	(14) for employment exploration services staff, 50 percent of the median wage for 
44.28 	rehabilitation counselor (SOC code 21-1015) education, guidance, school, and vocational 
44.29 	counselor (SOC code 21-1012); and 50 percent of the median wage for community and 
44.30 	social services specialist (SOC code 21-1099);
44.31 	(15) for employment development services staff, 50 percent of the median wage for 
44.32 	education, guidance, school, and vocational counselors (SOC code 21-1012); and 50 percent 
44.33 	of the median wage for community and social services specialist (SOC code 21-1099);
45.1 	(16) for individualized home support without training staff, 50 percent of the median 
45.2 	wage for home health and personal care aide (SOC code 31-1120); and 50 percent of the 
45.3 	median wage for nursing assistant (SOC code 31-1131); and
45.4 	(17) for night supervision staff, 40 percent of the median wage for home health and 
45.5 	personal care aide (SOC code 31-1120); 20 percent of the median wage for nursing assistant 
45.6 	(SOC code 31-1131); 20 percent of the median wage for psychiatric technician (SOC code 
45.7 	29-2053); and 20 percent of the median wage for social and human services aide (SOC code 
45.8 	21-1093); and.
45.9 	(18) for respite staff, 50 percent of the median wage for home health and personal care 
45.10 	aide (SOC code 31-1131); and 50 percent of the median wage for nursing assistant (SOC 
45.11 	code 31-1014).

45.12 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
45.13 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
45.14 	when federal approval is obtained.

45.15 	Sec. 33. Minnesota Statutes 2022, section 256B.4914, subdivision 5b, is amended to read:
45.16 		Subd. 5b.Standard component value adjustments. The commissioner shall update 
45.17 	the client and programming support, transportation, and program facility cost component 
45.18 	values as required in subdivisions 6 to 9a 9 for changes in the Consumer Price Index. The 
45.19 	commissioner shall adjust these values higher or lower, publish these updated values, and 
45.20 	load them into the rate management system as follows:
45.21 	(1) on January 1, 2022, by the percentage change in the CPI-U from the date of the 
45.22 	previous update to the data available on December 31, 2019; and
45.23 	(2) on November 1, 2024, by the percentage change in the CPI-U from the date of the 
45.24 	previous update to the data available as of December 31, 2021; and
45.25 	(3) (2) on July January 1, 2026 2024, and every two years thereafter, by the percentage 
45.26 	change in the CPI-U from the date of the previous update to the data available 30 12 months 
45.27 	and one day prior to the scheduled update.

45.28 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
45.29 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
45.30 	when federal approval is obtained.

46.1 	Sec. 34. Minnesota Statutes 2022, section 256B.4914, subdivision 5c, is amended to read:
46.2 		Subd. 5c.Removal of after-framework adjustments. Any rate adjustments applied to 
46.3 	the service rates calculated under this section outside of the cost components and rate 
46.4 	methodology specified in this section shall be removed from rate calculations upon 
46.5 	implementation of the updates under subdivisions 5 and, 5b, and 5f.

46.6 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
46.7 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
46.8 	when federal approval is obtained.

46.9 	Sec. 35. Minnesota Statutes 2022, section 256B.4914, subdivision 5d, is amended to read:
46.10 		Subd. 5d.Unavailable data for updates and adjustments. If Bureau of Labor Statistics 
46.11 	occupational codes or Consumer Price Index items specified in subdivision 5 or, 5b, or 5f
46.12 	are unavailable in the future, the commissioner shall recommend to the legislature codes or 
46.13 	items to update and replace.

46.14 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
46.15 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
46.16 	when federal approval is obtained.

46.17 	Sec. 36. Minnesota Statutes 2022, section 256B.4914, subdivision 5e, is amended to read:
46.18 		Subd. 5e.Inflationary update spending requirement. (a) At least 80 percent of the 
46.19 	marginal increase in revenue from the rate adjustment applied to the service rates adjustments
46.20 	calculated under subdivisions 5 and 5b beginning on January 1, 2022, 5f for services rendered 
46.21 	between January 1, 2022, and March 31, 2024, on or after the day of implementation of the 
46.22 	adjustment must be used to increase compensation-related costs for employees directly 
46.23 	employed by the program on or after January 1, 2022.
46.24 	(b) For the purposes of this subdivision, compensation-related costs include:
46.25 	(1) wages and salaries;
46.26 	(2) the employer's share of FICA taxes, Medicare taxes, state and federal unemployment 
46.27 	taxes, workers' compensation, and mileage reimbursement;
46.28 	(3) the employer's paid share of health and dental insurance, life insurance, disability 
46.29 	insurance, long-term care insurance, uniform allowance, pensions, and contributions to 
46.30 	employee retirement accounts; and
47.1 	(4) benefits that address direct support professional workforce needs above and beyond 
47.2 	what employees were offered prior to January 1, 2022 implementation of the applicable 
47.3 	rate adjustment, including retention and recruitment bonuses and tuition reimbursement.
47.4 	(c) Compensation-related costs for persons employed in the central office of a corporation 
47.5 	or entity that has an ownership interest in the provider or exercises control over the provider, 
47.6 	or for persons paid by the provider under a management contract, do not count toward the 
47.7 	80 percent requirement under this subdivision.
47.8 	(d) A provider agency or individual provider that receives a rate subject to the 
47.9 	requirements of this subdivision shall prepare, and upon request submit to the commissioner, 
47.10 	a distribution plan that specifies the amount of money the provider expects to receive that 
47.11 	is subject to the requirements of this subdivision, including how that money was or will be 
47.12 	distributed to increase compensation-related costs for employees. Within 60 days of final 
47.13 	implementation of a rate adjustment subject to the requirements of this subdivision, the 
47.14 	provider must post the distribution plan and leave it posted for a period of at least six months 
47.15 	in an area of the provider's operation to which all direct support professionals have access.
47.16 	The posted distribution plan must include instructions regarding how to contact the 
47.17 	commissioner or commissioner's representative if an employee believes the employee has 
47.18 	not received the compensation-related increase described in the plan.
47.19 	(e) This subdivision expires June 30, 2024.

47.20 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
47.21 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
47.22 	when federal approval is obtained.

47.23 	Sec. 37. Minnesota Statutes 2022, section 256B.4914, is amended by adding a subdivision 
47.24 	to read:
47.25 		Subd. 5f.Competitive workforce factor adjustments. (a) On January 1, 2024, and 
47.26 	every two years thereafter, the commissioner shall update the competitive workforce factor 
47.27 	to equal the differential between:
47.28 	(1) the most recently available wage data by SOC code for the weighted average wage 
47.29 	for direct care staff for residential support services and direct care staff for day programs; 
47.30 	and
47.31 	(2) the most recently available wage data by SOC code of the weighted average wage 
47.32 	of comparable occupations.
48.1 	(b) For each update of the competitive workforce factor, the update must not decrease 
48.2 	the competitive workforce factor by more than 2.0. If the competitive workforce factor is 
48.3 	less than or equal to zero, then the competitive workforce factor is zero.

48.4 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
48.5 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
48.6 	when federal approval is obtained.

48.7 	Sec. 38. Minnesota Statutes 2022, section 256B.4914, subdivision 8, is amended to read:
48.8 		Subd. 8. Unit-based services with programming; component values and calculation 
48.9 	of payment rates. (a) For the purpose of this section, unit-based services with programming 
48.10 	include employment exploration services, employment development services, employment 
48.11 	support services, individualized home supports with family training, individualized home 
48.12 	supports with training, and positive support services provided to an individual outside of 
48.13 	any service plan for a day program or residential support service.
48.14 	(b) Component values for unit-based services with programming are:
48.15 	(1) competitive workforce factor: 4.7 percent;
48.16 	(2) supervisory span of control ratio: 11 percent;
48.17 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
48.18 	(4) employee-related cost ratio: 23.6 percent;
48.19 	(5) program plan support ratio: 15.5 percent;
48.20 	(6) client programming and support ratio: 4.7 percent, updated as specified in subdivision 
48.21 	5b;
48.22 	(7) general administrative support ratio: 13.25 percent;
48.23 	(8) program-related expense ratio: 6.1 percent; and
48.24 	(9) absence and utilization factor ratio: 3.9 percent.
48.25 	(c) A unit of service for unit-based services with programming is 15 minutes.
48.26 	(d) Payments for unit-based services with programming must be calculated as follows, 
48.27 	unless the services are reimbursed separately as part of a residential support services or day 
48.28 	program payment rate:
48.29 	(1) determine the number of units of service to meet a recipient's needs;
49.1 	(2) determine the appropriate hourly staff wage rates derived by the commissioner as 
49.2 	provided in subdivisions 5 and 5a;
49.3 	(3) except for subdivision 5a, clauses (1) to (4), multiply the result of clause (2) by the 
49.4 	product of one plus the competitive workforce factor;
49.5 	(4) for a recipient requiring customization for deaf and hard-of-hearing language 
49.6 	accessibility under subdivision 12, add the customization rate provided in subdivision 12 
49.7 	to the result of clause (3);
49.8 	(5) multiply the number of direct staffing hours by the appropriate staff wage;
49.9 	(6) multiply the number of direct staffing hours by the product of the supervisory span 
49.10 	of control ratio and the appropriate supervisory staff wage in subdivision 5a, clause (1);
49.11 	(7) combine the results of clauses (5) and (6), and multiply the result by one plus the 
49.12 	employee vacation, sick, and training allowance ratio. This is defined as the direct staffing 
49.13 	rate;
49.14 	(8) for program plan support, multiply the result of clause (7) by one plus the program 
49.15 	plan support ratio;
49.16 	(9) for employee-related expenses, multiply the result of clause (8) by one plus the 
49.17 	employee-related cost ratio;
49.18 	(10) for client programming and supports, multiply the result of clause (9) by one plus 
49.19 	the client programming and support ratio;
49.20 	(11) this is the subtotal rate;
49.21 	(12) sum the standard general administrative support ratio, the program-related expense 
49.22 	ratio, and the absence and utilization factor ratio;
49.23 	(13) divide the result of clause (11) by one minus the result of clause (12). This is the 
49.24 	total payment amount;
49.25 	(14) for services provided in a shared manner, divide the total payment in clause (13) 
49.26 	as follows:
49.27 	(i) for employment exploration services, divide by the number of service recipients, not 
49.28 	to exceed five;
49.29 	(ii) for employment support services, divide by the number of service recipients, not to 
49.30 	exceed six; and
50.1 	(iii) for individualized home supports with training and individualized home supports 
50.2 	with family training, divide by the number of service recipients, not to exceed two three; 
50.3 	and
50.4 	(15) adjust the result of clause (14) by a factor to be determined by the commissioner 
50.5 	to adjust for regional differences in the cost of providing services.

50.6 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
50.7 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
50.8 	when federal approval is obtained.

50.9 	Sec. 39. Minnesota Statutes 2022, section 256B.4914, subdivision 9, is amended to read:
50.10 		Subd. 9. Unit-based services without programming; component values and 
50.11 	calculation of payment rates. (a) For the purposes of this section, unit-based services 
50.12 	without programming include individualized home supports without training and night 
50.13 	supervision provided to an individual outside of any service plan for a day program or 
50.14 	residential support service. Unit-based services without programming do not include respite.
50.15 	(b) Component values for unit-based services without programming are:
50.16 	(1) competitive workforce factor: 4.7 percent;
50.17 	(2) supervisory span of control ratio: 11 percent;
50.18 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
50.19 	(4) employee-related cost ratio: 23.6 percent;
50.20 	(5) program plan support ratio: 7.0 percent;
50.21 	(6) client programming and support ratio: 2.3 percent, updated as specified in subdivision 
50.22 	5b;
50.23 	(7) general administrative support ratio: 13.25 percent;
50.24 	(8) program-related expense ratio: 2.9 percent; and
50.25 	(9) absence and utilization factor ratio: 3.9 percent.
50.26 	(c) A unit of service for unit-based services without programming is 15 minutes.
50.27 	(d) Payments for unit-based services without programming must be calculated as follows 
50.28 	unless the services are reimbursed separately as part of a residential support services or day 
50.29 	program payment rate:
50.30 	(1) determine the number of units of service to meet a recipient's needs;
51.1 	(2) determine the appropriate hourly staff wage rates derived by the commissioner as 
51.2 	provided in subdivisions 5 to 5a;
51.3 	(3) except for subdivision 5a, clauses (1) to (4), multiply the result of clause (2) by the 
51.4 	product of one plus the competitive workforce factor;
51.5 	(4) for a recipient requiring customization for deaf and hard-of-hearing language 
51.6 	accessibility under subdivision 12, add the customization rate provided in subdivision 12 
51.7 	to the result of clause (3);
51.8 	(5) multiply the number of direct staffing hours by the appropriate staff wage;
51.9 	(6) multiply the number of direct staffing hours by the product of the supervisory span 
51.10 	of control ratio and the appropriate supervisory staff wage in subdivision 5a, clause (1);
51.11 	(7) combine the results of clauses (5) and (6), and multiply the result by one plus the 
51.12 	employee vacation, sick, and training allowance ratio. This is defined as the direct staffing 
51.13 	rate;
51.14 	(8) for program plan support, multiply the result of clause (7) by one plus the program 
51.15 	plan support ratio;
51.16 	(9) for employee-related expenses, multiply the result of clause (8) by one plus the 
51.17 	employee-related cost ratio;
51.18 	(10) for client programming and supports, multiply the result of clause (9) by one plus 
51.19 	the client programming and support ratio;
51.20 	(11) this is the subtotal rate;
51.21 	(12) sum the standard general administrative support ratio, the program-related expense 
51.22 	ratio, and the absence and utilization factor ratio;
51.23 	(13) divide the result of clause (11) by one minus the result of clause (12). This is the 
51.24 	total payment amount;
51.25 	(14) for individualized home supports without training provided in a shared manner, 
51.26 	divide the total payment amount in clause (13) by the number of service recipients, not to 
51.27 	exceed two three; and
51.28 	(15) adjust the result of clause (14) by a factor to be determined by the commissioner 
51.29 	to adjust for regional differences in the cost of providing services.

52.1 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
52.2 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
52.3 	when federal approval is obtained.

52.4 	Sec. 40. Minnesota Statutes 2022, section 256B.4914, subdivision 10, is amended to read:
52.5 		Subd. 10.Evaluation of information and data. (a) The commissioner shall, within 
52.6 	available resources, conduct research and gather data and information from existing state 
52.7 	systems or other outside sources on the following items:
52.8 	(1) differences in the underlying cost to provide services and care across the state;
52.9 	(2) mileage, vehicle type, lift requirements, incidents of individual and shared rides, and 
52.10 	units of transportation for all day services, which must be collected from providers using 
52.11 	the rate management worksheet and entered into the rates management system; and
52.12 	(3) the distinct underlying costs for services provided by a license holder under sections 
52.13 	245D.05, 245D.06, 245D.07, 245D.071, 245D.081, and 245D.09, and for services provided 
52.14 	by a license holder certified under section 245D.33.
52.15 	(b) The commissioner, in consultation with stakeholders, shall review and evaluate the 
52.16 	following values already in subdivisions 6 to 9a 9, or issues that impact all services, including, 
52.17 	but not limited to:
52.18 	(1) values for transportation rates;
52.19 	(2) values for services where monitoring technology replaces staff time;
52.20 	(3) values for indirect services;
52.21 	(4) values for nursing;
52.22 	(5) values for the facility use rate in day services, and the weightings used in the day 
52.23 	service ratios and adjustments to those weightings;
52.24 	(6) values for workers' compensation as part of employee-related expenses;
52.25 	(7) values for unemployment insurance as part of employee-related expenses;
52.26 	(8) direct care workforce labor market measures;
52.27 	(9) any changes in state or federal law with a direct impact on the underlying cost of 
52.28 	providing home and community-based services;
52.29 	(10) outcome measures, determined by the commissioner, for home and community-based 
52.30 	services rates determined under this section; and
53.1 	(11) different competitive workforce factors by service, as determined under subdivision 
53.2 	10b.
53.3 	(c) The commissioner shall report to the chairs and the ranking minority members of 
53.4 	the legislative committees and divisions with jurisdiction over health and human services 
53.5 	policy and finance with the information and data gathered under paragraphs (a) and (b) on 
53.6 	January 15, 2021, with a full report, and a full report once every four years thereafter.
53.7 	(d) Beginning July 1, 2022, the commissioner shall renew analysis and implement 
53.8 	changes to the regional adjustment factors once every six years. Prior to implementation, 
53.9 	the commissioner shall consult with stakeholders on the methodology to calculate the 
53.10 	adjustment.

53.11 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
53.12 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
53.13 	when federal approval is obtained.

53.14 	Sec. 41. Minnesota Statutes 2022, section 256B.4914, subdivision 10a, is amended to 
53.15 	read:
53.16 		Subd. 10a.Reporting and analysis of cost data. (a) The commissioner must ensure 
53.17 	that wage values and component values in subdivisions 5 to 9a 9 reflect the cost to provide 
53.18 	the service. As determined by the commissioner, in consultation with stakeholders identified 
53.19 	in subdivision 17, a provider enrolled to provide services with rates determined under this 
53.20 	section must submit requested cost data to the commissioner to support research on the cost 
53.21 	of providing services that have rates determined by the disability waiver rates system. 
53.22 	Requested cost data may include, but is not limited to:
53.23 	(1) worker wage costs;
53.24 	(2) benefits paid;
53.25 	(3) supervisor wage costs;
53.26 	(4) executive wage costs;
53.27 	(5) vacation, sick, and training time paid;
53.28 	(6) taxes, workers' compensation, and unemployment insurance costs paid;
53.29 	(7) administrative costs paid;
53.30 	(8) program costs paid;
53.31 	(9) transportation costs paid;
54.1 	(10) vacancy rates; and
54.2 	(11) other data relating to costs required to provide services requested by the 
54.3 	commissioner.
54.4 	(b) At least once in any five-year period, a provider must submit cost data for a fiscal 
54.5 	year that ended not more than 18 months prior to the submission date. The commissioner 
54.6 	shall provide each provider a 90-day notice prior to its submission due date. If a provider 
54.7 	fails to submit required reporting data, the commissioner shall provide notice to providers 
54.8 	that have not provided required data 30 days after the required submission date, and a second 
54.9 	notice for providers who have not provided required data 60 days after the required 
54.10 	submission date. The commissioner shall temporarily suspend payments to the provider if 
54.11 	cost data is not received 90 days after the required submission date. Withheld payments 
54.12 	shall be made once data is received by the commissioner.
54.13 	(c) The commissioner shall conduct a random validation of data submitted under 
54.14 	paragraph (a) to ensure data accuracy.
54.15 	(d) The commissioner shall analyze cost data submitted under paragraph (a) and, in 
54.16 	consultation with stakeholders identified in subdivision 17, may submit recommendations 
54.17 	on component values and inflationary factor adjustments to the chairs and ranking minority 
54.18 	members of the legislative committees with jurisdiction over human services once every 
54.19 	four years beginning January 1, 2021. The commissioner shall make recommendations in 
54.20 	conjunction with reports submitted to the legislature according to subdivision 10, paragraph 
54.21 	(c).
54.22 	(e) The commissioner shall release cost data in an aggregate form, and cost data from 
54.23 	individual providers shall not be released except as provided for in current law.
54.24 	(f) The commissioner, in consultation with stakeholders identified in subdivision 17, 
54.25 	shall develop and implement a process for providing training and technical assistance 
54.26 	necessary to support provider submission of cost documentation required under paragraph 
54.27 	(a).

54.28 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
54.29 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
54.30 	when federal approval is obtained.

55.1 	Sec. 42. Minnesota Statutes 2022, section 256B.4914, subdivision 10c, is amended to 
55.2 	read:
55.3 		Subd. 10c.Reporting and analysis of competitive workforce factor. (a) Beginning 
55.4 	February 1, 2021 2025, and every two years thereafter, the commissioner shall report to the 
55.5 	chairs and ranking minority members of the legislative committees and divisions with 
55.6 	jurisdiction over health and human services policy and finance an analysis of the competitive 
55.7 	workforce factor.
55.8 	(b) The report must include recommendations to update the competitive workforce factor 
55.9 	using:
55.10 	(1) the most recently available wage data by SOC code for the weighted average wage 
55.11 	for direct care staff for residential services and direct care staff for day services;
55.12 	(2) the most recently available wage data by SOC code of the weighted average wage 
55.13 	of comparable occupations; and
55.14 	(3) workforce data as required under subdivision 10b.
55.15 	(c) The commissioner shall not recommend an increase or decrease of the competitive 
55.16 	workforce factor from the current value by more than two percentage points. If, after a 
55.17 	biennial analysis for the next report, the competitive workforce factor is less than or equal 
55.18 	to zero, the commissioner shall recommend a competitive workforce factor of zero. This 
55.19 	subdivision expires upon submission of the calendar year 2030 report.

55.20 	EFFECTIVE DATE. This section is effective July 1, 2023.

55.21 	Sec. 43. Minnesota Statutes 2022, section 256B.4914, subdivision 12, is amended to read:
55.22 		Subd. 12.Customization of rates for individuals.  (a) For persons determined to have 
55.23 	higher needs based on being deaf or hard-of-hearing, the direct-care costs must be increased 
55.24 	by an adjustment factor prior to calculating the rate under subdivisions 6 to 9a 9. The 
55.25 	customization rate with respect to deaf or hard-of-hearing persons shall be $2.50 per hour 
55.26 	for waiver recipients who meet the respective criteria as determined by the commissioner.
55.27 	(b) For the purposes of this section, "deaf and hard-of-hearing" means:
55.28 	(1) the person has a developmental disability and:
55.29 	(i) an assessment score which indicates a hearing impairment that is severe or that the 
55.30 	person has no useful hearing;
56.1 	(ii) an expressive communications score that indicates the person uses single signs or 
56.2 	gestures, uses an augmentative communication aid, or does not have functional 
56.3 	communication, or the person's expressive communications is unknown; and
56.4 	(iii) a communication score which indicates the person comprehends signs, gestures, 
56.5 	and modeling prompts or does not comprehend verbal, visual, or gestural communication, 
56.6 	or that the person's receptive communication score is unknown; or
56.7 	(2) the person receives long-term care services and has an assessment score that indicates 
56.8 	the person hears only very loud sounds, the person has no useful hearing, or a determination 
56.9 	cannot be made; and the person receives long-term care services and has an assessment that 
56.10 	indicates the person communicates needs with sign language, symbol board, written 
56.11 	messages, gestures, or an interpreter; communicates with inappropriate content, makes 
56.12 	garbled sounds or displays echolalia, or does not communicate needs.

56.13 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
56.14 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
56.15 	when federal approval is obtained.

56.16 	Sec. 44. Minnesota Statutes 2022, section 256B.4914, subdivision 14, is amended to read:
56.17 		Subd. 14.Exceptions. (a) In a format prescribed by the commissioner, lead agencies 
56.18 	must identify individuals with exceptional needs that cannot be met under the disability 
56.19 	waiver rate system. The commissioner shall use that information to evaluate and, if necessary, 
56.20 	approve an alternative payment rate for those individuals. Whether granted, denied, or 
56.21 	modified, the commissioner shall respond to all exception requests in writing. The 
56.22 	commissioner shall include in the written response the basis for the action and provide 
56.23 	notification of the right to appeal under paragraph (h).
56.24 	(b) Lead agencies must act on an exception request within 30 days and notify the initiator 
56.25 	of the request of their recommendation in writing. A lead agency shall submit all exception 
56.26 	requests along with its recommendation to the commissioner.
56.27 	(c) An application for a rate exception may be submitted for the following criteria:
56.28 	(1) an individual has service needs that cannot be met through additional units of service;
56.29 	(2) an individual's rate determined under subdivisions 6 to 9a 9 is so insufficient that it 
56.30 	has resulted in an individual receiving a notice of discharge from the individual's provider; 
56.31 	or
57.1 	(3) an individual's service needs, including behavioral changes, require a level of service 
57.2 	which necessitates a change in provider or which requires the current provider to propose 
57.3 	service changes beyond those currently authorized.
57.4 	(d) Exception requests must include the following information:
57.5 	(1) the service needs required by each individual that are not accounted for in subdivisions 
57.6 	6 to 9a 9;
57.7 	(2) the service rate requested and the difference from the rate determined in subdivisions 
57.8 	6 to 9a 9;
57.9 	(3) a basis for the underlying costs used for the rate exception and any accompanying 
57.10 	documentation; and
57.11 	(4) any contingencies for approval.
57.12 	(e) Approved rate exceptions shall be managed within lead agency allocations under 
57.13 	sections 256B.092 and 256B.49.
57.14 	(f) Individual disability waiver recipients, an interested party, or the license holder that 
57.15 	would receive the rate exception increase may request that a lead agency submit an exception 
57.16 	request. A lead agency that denies such a request shall notify the individual waiver recipient, 
57.17 	interested party, or license holder of its decision and the reasons for denying the request in 
57.18 	writing no later than 30 days after the request has been made and shall submit its denial to 
57.19 	the commissioner in accordance with paragraph (b). The reasons for the denial must be 
57.20 	based on the failure to meet the criteria in paragraph (c).
57.21 	(g) The commissioner shall determine whether to approve or deny an exception request 
57.22 	no more than 30 days after receiving the request. If the commissioner denies the request, 
57.23 	the commissioner shall notify the lead agency and the individual disability waiver recipient, 
57.24 	the interested party, and the license holder in writing of the reasons for the denial.
57.25 	(h) The individual disability waiver recipient may appeal any denial of an exception 
57.26 	request by either the lead agency or the commissioner, pursuant to sections 256.045 and 
57.27 	256.0451. When the denial of an exception request results in the proposed demission of a 
57.28 	waiver recipient from a residential or day habilitation program, the commissioner shall issue 
57.29 	a temporary stay of demission, when requested by the disability waiver recipient, consistent 
57.30 	with the provisions of section 256.045, subdivisions 4a and 6, paragraph (c). The temporary 
57.31 	stay shall remain in effect until the lead agency can provide an informed choice of 
57.32 	appropriate, alternative services to the disability waiver.
58.1 	(i) Providers may petition lead agencies to update values that were entered incorrectly 
58.2 	or erroneously into the rate management system, based on past service level discussions 
58.3 	and determination in subdivision 4, without applying for a rate exception.
58.4 	(j) The starting date for the rate exception will be the later of the date of the recipient's 
58.5 	change in support or the date of the request to the lead agency for an exception.
58.6 	(k) The commissioner shall track all exception requests received and their dispositions. 
58.7 	The commissioner shall issue quarterly public exceptions statistical reports, including the 
58.8 	number of exception requests received and the numbers granted, denied, withdrawn, and 
58.9 	pending. The report shall include the average amount of time required to process exceptions.
58.10 	(l) Approved rate exceptions remain in effect in all cases until an individual's needs 
58.11 	change as defined in paragraph (c).

58.12 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
58.13 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
58.14 	when federal approval is obtained.

58.15 	Sec. 45. Minnesota Statutes 2022, section 256B.492, is amended to read:
58.16 	256B.492 HOME AND COMMUNITY-BASED SETTINGS FOR PEOPLE WITH 
58.17 	DISABILITIES.
58.18 	(a) Individuals receiving services under a home and community-based waiver under 
58.19 	section 256B.092 or 256B.49 may receive services in the following settings:
58.20 	(1) home and community-based settings that comply with:
58.21 	(i) all requirements identified by the federal Centers for Medicare and Medicaid Services 
58.22 	in the Code of Federal Regulations, title 42, section 441.301(c),; and
58.23 	with (ii) the requirements of the federally approved transition plan and waiver plans for 
58.24 	each home and community-based services waiver except when applying a size limitation 
58.25 	to a setting, the commissioner must treat residents under 55 years of age who are receiving 
58.26 	services under the brain injury or the community access for disability inclusion waiver as 
58.27 	if the residents are 55 years of age or older if the residents lived and received services in 
58.28 	the setting on or before March 1, 2023; and
58.29 	(2) settings required by the Housing Opportunities for Persons with AIDS Program.
58.30 	(b) The settings in paragraph (a) must not have the qualities of an institution which 
58.31 	include, but are not limited to: regimented meal and sleep times, limitations on visitors, and 
58.32 	lack of privacy. Restrictions agreed to and documented in the person's individual service 
59.1 	plan shall not result in a residence having the qualities of an institution as long as the 
59.2 	restrictions for the person are not imposed upon others in the same residence and are the 
59.3 	least restrictive alternative, imposed for the shortest possible time to meet the person's needs.

59.4 	Sec. 46. Minnesota Statutes 2022, section 256B.5012, is amended by adding a subdivision 
59.5 	to read:
59.6 		Subd. 19.ICF/DD rate increase effective July 1, 2023. (a) Effective July 1, 2023, the 
59.7 	daily operating payment rate for a class A intermediate care facility for persons with 
59.8 	developmental disabilities is increased by $50.
59.9 	(b) Effective July 1, 2023, the daily operating payment rate for a class B intermediate 
59.10 	care facility for persons with developmental disabilities is increased by $50.

59.11 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
59.12 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
59.13 	when federal approval is obtained.

59.14 	Sec. 47. Minnesota Statutes 2022, section 256B.5012, is amended by adding a subdivision 
59.15 	to read:
59.16 		Subd. 20.ICF/DD minimum daily operating payment rates. (a) The minimum daily 
59.17 	operating payment rate for a class A intermediate care facility for persons with developmental 
59.18 	disabilities is $300.
59.19 	(b) The minimum daily operating payment rate for a class B intermediate care facility 
59.20 	for persons with developmental disabilities is $400.

59.21 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
59.22 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
59.23 	when federal approval is obtained.

59.24 	Sec. 48. Minnesota Statutes 2022, section 256B.5012, is amended by adding a subdivision 
59.25 	to read:
59.26 		Subd. 21.Spending requirements. (a) At least 80 percent of the marginal increase in 
59.27 	revenue resulting from implementation of the rate increases under subdivisions 19 and 20 
59.28 	for services rendered on or after the day of implementation of the increases must be used 
59.29 	to increase compensation-related costs for employees directly employed by the facility.
59.30 	(b) For the purposes of this subdivision, compensation-related costs include:
59.31 	(1) wages and salaries;
60.1 	(2) the employer's share of FICA taxes, Medicare taxes, state and federal unemployment 
60.2 	taxes, workers' compensation, and mileage reimbursement;
60.3 	(3) the employer's paid share of health and dental insurance, life insurance, disability 
60.4 	insurance, long-term care insurance, uniform allowance, pensions, and contributions to 
60.5 	employee retirement accounts; and
60.6 	(4) benefits that address direct support professional workforce needs above and beyond 
60.7 	what employees were offered prior to implementation of the rate increases.
60.8 	(c) Compensation-related costs for persons employed in the central office of a corporation 
60.9 	or entity that has an ownership interest in the provider or exercises control over the provider, 
60.10 	or for persons paid by the provider under a management contract, do not count toward the 
60.11 	80 percent requirement under this subdivision.
60.12 	(d) A provider agency or individual provider that receives additional revenue subject to 
60.13 	the requirements of this subdivision shall prepare, and upon request submit to the 
60.14 	commissioner, a distribution plan that specifies the amount of money the provider expects 
60.15 	to receive that is subject to the requirements of this subdivision, including how that money 
60.16 	was or will be distributed to increase compensation-related costs for employees. Within 60 
60.17 	days of final implementation of the new rate methodology or any rate adjustment subject 
60.18 	to the requirements of this subdivision, the provider must post the distribution plan and 
60.19 	leave it posted for a period of at least six months in an area of the provider's operation to 
60.20 	which all direct support professionals have access. The posted distribution plan must include 
60.21 	instructions regarding how to contact the commissioner, or the commissioner's representative, 
60.22 	if an employee has not received the compensation-related increase described in the plan.

60.23 	Sec. 49. Minnesota Statutes 2022, section 256B.85, subdivision 7, is amended to read:
60.24 		Subd. 7.Community first services and supports; covered services.  Services and 
60.25 	supports covered under CFSS include:
60.26 	(1) assistance to accomplish activities of daily living (ADLs), instrumental activities of 
60.27 	daily living (IADLs), and health-related procedures and tasks through hands-on assistance 
60.28 	to accomplish the task or constant supervision and cueing to accomplish the task;
60.29 	(2) assistance to acquire, maintain, or enhance the skills necessary for the participant to 
60.30 	accomplish activities of daily living, instrumental activities of daily living, or health-related 
60.31 	tasks;
60.32 	(3) expenditures for items, services, supports, environmental modifications, or goods, 
60.33 	including assistive technology. These expenditures must:
61.1 	(i) relate to a need identified in a participant's CFSS service delivery plan; and
61.2 	(ii) increase independence or substitute for human assistance, to the extent that 
61.3 	expenditures would otherwise be made for human assistance for the participant's assessed 
61.4 	needs;
61.5 	(4) observation and redirection for behavior or symptoms where there is a need for 
61.6 	assistance;
61.7 	(5) back-up systems or mechanisms, such as the use of pagers or other electronic devices, 
61.8 	to ensure continuity of the participant's services and supports;
61.9 	(6) services provided by a consultation services provider as defined under subdivision 
61.10 	17, that is under contract with the department and enrolled as a Minnesota health care 
61.11 	program provider;
61.12 	(7) services provided by an FMS provider as defined under subdivision 13a, that is an 
61.13 	enrolled provider with the department;
61.14 	(8) CFSS services provided by a support worker who is a parent, stepparent, or legal 
61.15 	guardian of a participant under age 18, or who is the participant's spouse. These support 
61.16 	workers shall not: Covered services under this clause are subject to the limitations described 
61.17 	in subdivision 7b; and
61.18 	(i) provide any medical assistance home and community-based services in excess of 40 
61.19 	hours per seven-day period regardless of the number of parents providing services, 
61.20 	combination of parents and spouses providing services, or number of children who receive 
61.21 	medical assistance services; and
61.22 	(ii) have a wage that exceeds the current rate for a CFSS support worker including the 
61.23 	wage, benefits, and payroll taxes; and
61.24 	(9) worker training and development services as described in subdivision 18a.

61.25 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
61.26 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
61.27 	when federal approval is obtained.

61.28 	Sec. 50. Minnesota Statutes 2022, section 256B.85, is amended by adding a subdivision 
61.29 	to read:
61.30 		Subd. 7b.Services provided by parents and spouses. (a) This subdivision applies to 
61.31 	services and supports described in subdivision 7, clause (8).
62.1 	(b) If multiple parents are support workers providing CFSS services to their minor child 
62.2 	or children, each parent may provide up to 40 hours of medical assistance home and 
62.3 	community-based services in any seven-day period regardless of the number of children 
62.4 	served. The total number of hours of medical assistance home and community-based services 
62.5 	provided by all of the parents must not exceed 80 hours in a seven-day period regardless of 
62.6 	the number of children served.
62.7 	(c) If only one parent is a support worker providing CFSS services to the parent's minor 
62.8 	child or children, the parent may provide up to 60 hours of medical assistance home and 
62.9 	community-based services in a seven-day period regardless of the number of children served.
62.10 	(d) If a participant's spouse is a support worker providing CFSS services, the spouse 
62.11 	may provide up to 60 hours of medical assistance home and community-based services in 
62.12 	a seven-day period.
62.13 	(e) Paragraphs (b) to (d) must not be construed to permit an increase in either the total 
62.14 	authorized service budget for an individual or the total number of authorized service units.
62.15 	(f) A parent or participant's spouse must not receive a wage that exceeds the current rate 
62.16 	for a CFSS support worker, including wages, benefits, and payroll taxes.

62.17 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
62.18 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
62.19 	when federal approval is obtained.

62.20 	Sec. 51. Minnesota Statutes 2022, section 256B.851, subdivision 5, is amended to read:
62.21 		Subd. 5.Payment rates; component values. (a) The commissioner must use the 
62.22 	following component values:
62.23 	(1) employee vacation, sick, and training factor, 8.71 percent;
62.24 	(2) employer taxes and workers' compensation factor, 11.56 percent;
62.25 	(3) employee benefits factor, 12.04 percent;
62.26 	(4) client programming and supports factor, 2.30 percent;
62.27 	(5) program plan support factor, 7.00 percent;
62.28 	(6) general business and administrative expenses factor, 13.25 percent;
62.29 	(7) program administration expenses factor, 2.90 percent; and
62.30 	(8) absence and utilization factor, 3.90 percent.
63.1 	(b) For purposes of implementation, the commissioner shall use the following 
63.2 	implementation components:
63.3 	(1) personal care assistance services and CFSS: 75.45 percent; 88.19 percent;
63.4 	(2) enhanced rate personal care assistance services and enhanced rate CFSS: 75.4588.19 
63.5 	percent; and
63.6 	(3) qualified professional services and CFSS worker training and development: 75.45
63.7 	88.19 percent.
63.8 	(c) Effective January 1, 2025, for purposes of implementation, the commissioner shall 
63.9 	use the following implementation components:
63.10 	(1) personal care assistance services and CFSS: 92.10 percent;
63.11 	(2) enhanced rate personal care assistance services and enhanced rate CFSS: 92.10 
63.12 	percent; and
63.13 	(3) qualified professional services and CFSS worker training and development: 92.10 
63.14 	percent.
63.15 	(d) Beginning January 1, 2025, the commissioner shall use the following worker retention 
63.16 	components:
63.17 	(1) for workers who have provided fewer than 1,001 cumulative hours in personal care 
63.18 	assistance services or CFSS, the worker retention component is zero percent;
63.19 	(2) for workers who have provided between 1,001 and 2,000 cumulative hours in personal 
63.20 	care assistance services or CFSS, the worker retention component is 2.17 percent;
63.21 	(3) for workers who have provided between 2,001 and 6,000 cumulative hours in personal 
63.22 	care assistance services or CFSS, the worker retention component is 4.36 percent;
63.23 	(4) for workers who have provided between 6,001 and 10,000 cumulative hours in 
63.24 	personal care assistance services or CFSS, the worker retention component is 7.35 percent; 
63.25 	and
63.26 	(5) for workers who have provided more than 10,000 hours in personal care assistance 
63.27 	services or CFSS, the worker retention component is 10.81 percent.
63.28 	(e) The commissioner shall define the appropriate worker retention component based 
63.29 	on the total number of units billed for services rendered by the individual provider since 
63.30 	July 1, 2017. The worker retention component must be determined by the commissioner 
63.31 	for each individual provider and is not subject to appeal.

64.1 	EFFECTIVE DATE. The amendments to paragraph (b) are effective January 1, 2024, 
64.2 	or 90 days after federal approval, whichever is later. Paragraph (b) expires January 1, 2025, 
64.3 	or 90 days after federal approval of paragraph (c), whichever is later. Paragraphs (c), (d), 
64.4 	and (e) are effective January 1, 2025, or 90 days after federal approval, whichever is later. 
64.5 	The commissioner of human services shall notify the revisor of statutes when federal approval 
64.6 	is obtained.

64.7 	Sec. 52. Minnesota Statutes 2022, section 256B.851, subdivision 6, is amended to read:
64.8 		Subd. 6.Payment rates; rate determination. (a) The commissioner must determine 
64.9 	the rate for personal care assistance services, CFSS, extended personal care assistance 
64.10 	services, extended CFSS, enhanced rate personal care assistance services, enhanced rate 
64.11 	CFSS, qualified professional services, and CFSS worker training and development as 
64.12 	follows:
64.13 	(1) multiply the appropriate total wage component value calculated in subdivision 4 by 
64.14 	one plus the employee vacation, sick, and training factor in subdivision 5;
64.15 	(2) for program plan support, multiply the result of clause (1) by one plus the program 
64.16 	plan support factor in subdivision 5;
64.17 	(3) for employee-related expenses, add the employer taxes and workers' compensation 
64.18 	factor in subdivision 5 and the employee benefits factor in subdivision 5. The sum is 
64.19 	employee-related expenses. Multiply the product of clause (2) by one plus the value for 
64.20 	employee-related expenses;
64.21 	(4) for client programming and supports, multiply the product of clause (3) by one plus 
64.22 	the client programming and supports factor in subdivision 5;
64.23 	(5) for administrative expenses, add the general business and administrative expenses 
64.24 	factor in subdivision 5, the program administration expenses factor in subdivision 5, and 
64.25 	the absence and utilization factor in subdivision 5;
64.26 	(6) divide the result of clause (4) by one minus the result of clause (5). The quotient is 
64.27 	the hourly rate;
64.28 	(7) multiply the hourly rate by the appropriate implementation component under 
64.29 	subdivision 5. This is the adjusted hourly rate; and
64.30 	(8) divide the adjusted hourly rate by four. The quotient is the total adjusted payment 
64.31 	rate.
65.1 	(b) In processing claims, the commissioner shall incorporate a staff retention component 
65.2 	as specified under subdivision 5 by multiplying the total adjusted payment rate by one plus 
65.3 	the appropriate staff retention component under subdivision 5. This is the total payment 
65.4 	rate.
65.5 	(b) (c) The commissioner must publish the total adjusted final payment rates.

65.6 	EFFECTIVE DATE. This section is effective January 1, 2025, or ninety days after 
65.7 	federal approval, whichever is later. The commissioner of human services shall notify the 
65.8 	revisor of statutes when federal approval is obtained.

65.9 	Sec. 53. Minnesota Statutes 2022, section 256S.2101, subdivision 1, is amended to read:
65.10 		Subdivision 1.Phase-in for disability waiver customized living rates. All rates and 
65.11 	rate components for community access for disability inclusion customized living and brain 
65.12 	injury customized living under section 256B.4914 shall must be the sum of ten 21.6 percent 
65.13 	of the rates calculated under sections 256S.211 to 256S.215 and 90 78.4 percent of the rates 
65.14 	calculated using the rate methodology in effect as of June 30, 2017.

65.15 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
65.16 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
65.17 	when federal approval is obtained.

65.18 	Sec. 54. Minnesota Statutes 2022, section 289A.20, subdivision 4, is amended to read:
65.19 		Subd. 4.Sales and use tax. (a) The taxes imposed by chapter 297A are due and payable 
65.20 	to the commissioner monthly on or before the 20th day of the month following the month 
65.21 	in which the taxable event occurred, or following another reporting period as the 
65.22 	commissioner prescribes or as allowed under section 289A.18, subdivision 4, paragraph (f) 
65.23 	or (g), except that use taxes due on an annual use tax return as provided under section 
65.24 	289A.11, subdivision 1, are payable by April 15 following the close of the calendar year.
65.25 	(b) A vendor having a liability of $250,000 or more during a fiscal year ending June 30, 
65.26 	except a vendor of construction materials as defined in paragraph (e), must remit the June 
65.27 	liability for the next year in the following manner:
65.28 	(1) Two business days before June 30 of calendar year 2020 and 2021, the vendor must 
65.29 	remit 87.5 percent of the estimated June liability to the commissioner. Two business days 
65.30 	before June 30 of calendar year 2022 and thereafter, the vendor must remit 84.5 percent, or 
65.31 	a reduced percentage as certified by the commissioner under section 16A.152, subdivision 
65.32 	2, paragraph (a), clause (6) (7), of the estimated June liability to the commissioner.
66.1 	(2) On or before August 20 of the year, the vendor must pay any additional amount of 
66.2 	tax not remitted in June.
66.3 	(c) A vendor having a liability of:
66.4 	(1) $10,000 or more, but less than $250,000, during a fiscal year must remit by electronic 
66.5 	means all liabilities on returns due for periods beginning in all subsequent calendar years 
66.6 	on or before the 20th day of the month following the month in which the taxable event 
66.7 	occurred, or on or before the 20th day of the month following the month in which the sale 
66.8 	is reported under section 289A.18, subdivision 4; or
66.9 	(2) $250,000 or more during a fiscal year must remit by electronic means all liabilities 
66.10 	in the manner provided in paragraph (a) on returns due for periods beginning in the 
66.11 	subsequent calendar year, except that a vendor subject to the remittance requirements of 
66.12 	paragraph (b) must remit the percentage of the estimated June liability, as provided in 
66.13 	paragraph (b), clause (1), which is due two business days before June 30. The remaining 
66.14 	amount of the June liability is due on August 20.
66.15 	(d) Notwithstanding paragraph (b) or (c), a person prohibited by the person's religious 
66.16 	beliefs from paying electronically shall be allowed to remit the payment by mail. The filer 
66.17 	must notify the commissioner of revenue of the intent to pay by mail before doing so on a 
66.18 	form prescribed by the commissioner. No extra fee may be charged to a person making 
66.19 	payment by mail under this paragraph. The payment must be postmarked at least two business 
66.20 	days before the due date for making the payment in order to be considered paid on a timely 
66.21 	basis.
66.22 	(e) For the purposes of paragraph (b), "vendor of construction materials" means a retailer 
66.23 	that sells any of the following construction materials, if 50 percent or more of the retailer's 
66.24 	sales revenue for the fiscal year ending June 30 is from the sale of those materials:
66.25 	(1) lumber, veneer, plywood, wood siding, wood roofing;
66.26 	(2) millwork, including wood trim, wood doors, wood windows, wood flooring; or
66.27 	(3) concrete, cement, and masonry.
66.28 	(f) Paragraph (b) expires after the percentage of estimated payment is reduced to zero 
66.29 	in accordance with section 16A.152, subdivision 2, paragraph (a), clause (6) (7).

66.30 	Sec. 55. Minnesota Statutes 2022, section 289A.60, subdivision 15, is amended to read:
66.31 		Subd. 15.Accelerated payment of June sales tax liability; penalty for 
66.32 	underpayment. (a) For payments made after December 31, 2019, and before December 
67.1 	31, 2021, if a vendor is required by law to submit an estimation of June sales tax liabilities 
67.2 	and 87.5 percent payment by a certain date, the vendor shall pay a penalty equal to ten 
67.3 	percent of the amount of actual June liability required to be paid in June less the amount 
67.4 	remitted in June. The penalty must not be imposed, however, if the amount remitted in June 
67.5 	equals the lesser of 87.5 percent of the preceding May's liability or 87.5 percent of the 
67.6 	average monthly liability for the previous calendar year.
67.7 	(b) For payments made after December 31, 2021, the penalty must not be imposed if 
67.8 	the amount remitted in June equals the lesser of 84.5 percent, or a reduced percentage as 
67.9 	certified by the commissioner under section 16A.152, subdivision 2, paragraph (a), clause 
67.10 	(6) (7), of the preceding May's liability or 84.5 percent of the average monthly liability for 
67.11 	the previous calendar year.
67.12 	(c) This subdivision expires after the percentage of estimated payment is reduced to zero 
67.13 	in accordance with section 16A.152, subdivision 2, paragraph (a), clause (6) (7).

67.14 	Sec. 56. Laws 2021, First Special Session chapter 7, article 17, section 16, is amended to 
67.15 	read:
67.16 	Sec. 16. RESEARCH ON ACCESS TO LONG-TERM CARE SERVICES AND 
67.17 	FINANCING.
 67.18 	(a) This act includes $400,000 in fiscal year 2022 and $300,000 in fiscal year 2023 for 
67.19 	an actuarial research study of public and private financing options for long-term services 
67.20 	and supports reform to increase access across the state. Any unexpended amount in fiscal 
67.21 	year 2023 is available through June 30, 2024. The commissioner of human services must 
67.22 	conduct the study. Of this amount, the commissioner may transfer up to $100,000 to the 
67.23 	commissioner of commerce for costs related to the requirements of the study. The general 
67.24 	fund base included in this act for this purpose is $0 in fiscal year 2024 and $0 in fiscal year 
67.25 	2025.
67.26 	(b) All activities must be completed by June 30, 2024.

67.27 	EFFECTIVE DATE. This section is effective the day following final enactment.

68.1 	Sec. 57. Laws 2021, First Special Session chapter 7, article 17, section 20, is amended to 
68.2 	read:
68.3 	Sec. 20. HCBS WORKFORCE DEVELOPMENT GRANT.
 68.4 		Subdivision 1.Appropriation. (a) This act includes $0 in fiscal year 2022 and $5,588,000
68.5 	$0 in fiscal year 2023 to address challenges related to attracting and maintaining direct care 
68.6 	workers who provide home and community-based services for people with disabilities and 
68.7 	older adults. The general fund base included in this act for this purpose is $5,588,000
68.8 	$11,176,000 in fiscal year 2024 and $0 in fiscal year 2025.
68.9 	(b) At least 90 percent of funding for this provision must be directed to workers who 
68.10 	earn 200 300 percent or less of the most current federal poverty level issued by the United 
68.11 	States Department of Health and Human Services.
68.12 	(c) The commissioner must consult with stakeholders to finalize a report detailing the 
68.13 	final plan for use of the funds. The commissioner must publish the report by March 1, 2022, 
68.14 	and notify the chairs and ranking minority members of the legislative committees with 
68.15 	jurisdiction over health and human services policy and finance.
68.16 		Subd. 2.Public assistance eligibility. Notwithstanding any law to the contrary, workforce 
68.17 	development grant money received under this section is not income, assets, or personal 
68.18 	property for purposes of determining eligibility or recertifying eligibility for:
68.19 	(1) child care assistance programs under Minnesota Statutes, chapter 119B;
68.20 	(2) general assistance, Minnesota supplemental aid, and food support under Minnesota 
68.21 	Statutes, chapter 256D;
68.22 	(3) housing support under Minnesota Statutes, chapter 256I;
68.23 	(4) the Minnesota family investment program and diversionary work program under 
68.24 	Minnesota Statutes, chapter 256J; and
68.25 	(5) economic assistance programs under Minnesota Statutes, chapter 256P.
68.26 		Subd. 3.Medical assistance eligibility. Notwithstanding any law to the contrary, 
68.27 	workforce development grant money received under this section is not income or assets for 
68.28 	the purposes of determining eligibility for medical assistance under Minnesota Statutes, 
68.29 	section 256B.056, subdivision 1a, paragraph (a), 3, or 3c; or 256B.057, subdivision 3, 3a,  
68.30 	3b, 4, or 9.

68.31 	EFFECTIVE DATE. This section is effective the day following final enactment.

69.1 	Sec. 58. MEMORANDUMS OF UNDERSTANDING.
 69.2 	The memorandums of understanding with Service Employees International Union 
69.3 	Healthcare Minnesota and Iowa, submitted by the commissioner of management and budget 
69.4 	on February 27, 2023, are ratified.

69.5 	Sec. 59. SELF-DIRECTED WORKER CONTRACT RATIFICATION.
 69.6 	The labor agreement between the state of Minnesota and the Service Employees 
69.7 	International Union Healthcare Minnesota and Iowa, submitted to the Legislative 
69.8 	Coordinating Commissioner on February 27, 2023, is ratified.

69.9 	Sec. 60. BUDGET INCREASE FOR CONSUMER-DIRECTED COMMUNITY 
69.10 	SUPPORTS.
 69.11 	(a) Effective January 1, 2024, or upon federal approval, whichever is later, 
69.12 	consumer-directed community support budgets identified in the waiver plans under Minnesota 
69.13 	Statutes, sections 256B.092 and 256B.49, and chapter 256S; and the alternative care program 
69.14 	under Minnesota Statutes, section 256B.0913, must be increased by 8.49 percent.
69.15 	(b) Effective January 1, 2025, or upon federal approval, whichever is later, 
69.16 	consumer-directed community support budgets identified in the waiver plans under Minnesota 
69.17 	Statutes, sections 256B.092 and 256B.49, and chapter 256S; and the alternative care program 
69.18 	under Minnesota Statutes, section 256B.0913, must be increased by 4.53 percent.

69.19 	Sec. 61. DIRECT CARE SERVICE CORPS PILOT PROJECT.
 69.20 		Subdivision 1.Establishment. The Metropolitan Center for Independent Living must 
69.21 	develop a pilot project establishing the Minnesota Direct Care Service Corps. The pilot 
69.22 	project must utilize financial incentives to attract postsecondary students to work as personal 
69.23 	care assistants or direct support professionals. The Metropolitan Center for Independent 
69.24 	Living must establish the financial incentives and minimum work requirements to be eligible 
69.25 	for incentive payments. The financial incentive must increase with each semester that the 
69.26 	student participates in the Minnesota Direct Care Service Corps.
69.27 		Subd. 2.Pilot sites. (a) Pilot sites must include one postsecondary institution in the 
69.28 	seven-county metropolitan area and at least one postsecondary institution outside of the 
69.29 	seven-county metropolitan area. If more than one postsecondary institution outside the 
69.30 	metropolitan area is selected, one must be located in northern Minnesota and the other must 
69.31 	be located in southern Minnesota.
70.1 	(b) After satisfactorily completing the work requirements for a semester, the pilot site 
70.2 	or its fiscal agent must pay students the financial incentive developed for the pilot project.
70.3 		Subd. 3.Evaluation and report. (a) The Metropolitan Center for Independent Living 
70.4 	must contract with a third party to evaluate the pilot project's impact on health care costs, 
70.5 	retention of personal care assistants, and patients' and providers' satisfaction of care. The 
70.6 	evaluation must include the number of participants, the hours of care provided by participants, 
70.7 	and the retention of participants from semester to semester.
70.8 	(b) By January 15, 2025, the Metropolitan Center for Independent Living must report 
70.9 	the findings under paragraph (a) to the chairs and ranking minority members of the legislative 
70.10 	committees with jurisdiction over human services policy and finance.

70.11 	Sec. 62. EMERGENCY GRANT PROGRAM FOR AUTISM SPECTRUM 
70.12 	DISORDER TREATMENT AGENCIES.
 70.13 		Subdivision 1.Definitions. (a) For purposes of this section, the following terms have 
70.14 	the meanings given.
70.15 	(b) "Autism spectrum disorder" has the meaning given to "autism spectrum disorder or 
70.16 	a related condition" in Minnesota Statutes, section 256B.0949, subdivision 2, paragraph 
70.17 	(d).
70.18 	(c) "Autism spectrum disorder treatment services" means treatment delivered under 
70.19 	Minnesota Statutes, section 256B.0949.
70.20 	(d) "Qualified early intensive developmental and behavioral intervention agency" or 
70.21 	"qualified EIDBI agency" has the meaning given in Minnesota Statutes, section 256B.0949, 
70.22 	subdivision 2, paragraph (c).
70.23 		Subd. 2.Emergency grant program for autism spectrum disorder treatment 
70.24 	agencies. The commissioner of human services shall award emergency grant money to 
70.25 	eligible qualified EIDBI agencies to support the stability of the autism spectrum disorder 
70.26 	treatment provider sector.
70.27 		Subd. 3.Eligible agencies. Qualified EIDBI agencies that have been delivering autism 
70.28 	spectrum disorder treatment services for a minimum of six months are eligible to receive 
70.29 	emergency grants under this section.
70.30 		Subd. 4.Allocation of grants.  (a) Eligible agencies must apply for a grant under this 
70.31 	section on an application in the form specified by the commissioner, which at a minimum 
70.32 	must contain:
71.1 	(1) a description of the purpose or project for which grant money will be used;
71.2 	(2) a description of the specific problem the grant money will address;
71.3 	(3) a description of achievable objectives, a work plan, and a timeline for implementation 
71.4 	and completion of processes or projects enabled by the grant; and
71.5 	(4) a process for documenting and evaluating results of the grant.
71.6 	(b) The commissioner shall review each application to determine whether the application 
71.7 	is complete and whether the applicant and the project are eligible for a grant. In evaluating 
71.8 	applications, the commissioner shall establish criteria, including but not limited to:
71.9 	(1) the eligibility of the project;
71.10 	(2) the applicant's thoroughness and clarity in describing the problem grant money is 
71.11 	intended to address;
71.12 	(3) a description of the applicant's proposed project;
71.13 	(4) a description of the population demographics and service area of the proposed project;
71.14 	(5) the manner in which the applicant will demonstrate the effectiveness of any projects 
71.15 	undertaken;
71.16 	(6) the proposed project's longevity and demonstrated financial sustainability after the 
71.17 	initial grant period; and
71.18 	(7) the evidence of efficiencies and effectiveness gained through collaborative efforts.
71.19 	(c) The commissioner may consider other relevant factors in addition to those listed in 
71.20 	paragraph (b).
71.21 	(d) In evaluating applications, the commissioner may request from the applicant additional 
71.22 	information regarding a proposed project, including information on project costs. An 
71.23 	applicant's failure to provide the information requested disqualifies an applicant.
71.24 	(e) The commissioner shall determine the number of grants awarded.
71.25 	(f) The commissioner shall award grants to eligible agencies through December 31, 
71.26 	2025.
71.27 		Subd. 5.Eligible uses of grant money. The commissioner shall develop a list of eligible 
71.28 	uses for grants awarded under this section.

72.1 	Sec. 63. RATE INCREASE FOR CERTAIN HOME CARE SERVICES.
 72.2 	(a) Effective January 1, 2024, or upon federal approval, whichever is later, the 
72.3 	commissioner of human services must increase payment rates for home health aide visits 
72.4 	by 14 percent from the rates in effect on December 31, 2023. The commissioner must apply 
72.5 	the annual rate increases under Minnesota Statutes, section 256B.0653, subdivision 8, to 
72.6 	the rates resulting from the application of the rate increases under this paragraph.
72.7 	(b) Effective January 1, 2024, or upon federal approval, whichever is later, the 
72.8 	commissioner must increase payment rates for respiratory therapy under Minnesota Rules, 
72.9 	part 9505.0295, subpart 2, item E, and for home health services and home care nursing 
72.10 	services, except home health aide visits, under Minnesota Statutes, section 256B.0651, 
72.11 	subdivision 2, clauses (1) to (3), by 55 percent from the rates in effect on December 31, 
72.12 	2023. The commissioner must apply the annual rate increases under Minnesota Statutes, 
72.13 	sections 256B.0653, subdivision 8, and 256B.0654, subdivision 5, to the rates resulting 
72.14 	from the application of the rate increase under this paragraph.

72.15 	Sec. 64. SPECIALIZED EQUIPMENT AND SUPPLIES LIMIT INCREASE.
 72.16 	Upon federal approval, the commissioner must increase the annual limit for specialized 
72.17 	equipment and supplies under Minnesota's federally approved home and community-based 
72.18 	service waiver plans, alternative care, and essential community supports to $10,000.

72.19 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
72.20 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
72.21 	when federal approval is obtained.

72.22 	Sec. 65. STUDY TO EXPAND ACCESS TO SERVICES FOR PEOPLE WITH 
72.23 	CO-OCCURRING BEHAVIORAL HEALTH CONDITIONS AND DISABILITIES.
 72.24 	The commissioner, in consultation with stakeholders, must evaluate options to expand 
72.25 	services authorized under Minnesota's federally approved home and community-based 
72.26 	waivers, including positive support, crisis respite, respite, and specialist services. The 
72.27 	evaluation may include surveying community providers as to the barriers to meeting people's 
72.28 	needs and options to authorize services under Minnesota's medical assistance state plan and 
72.29 	strategies to decrease the number of people who remain in hospitals, jails, and other acute 
72.30 	or crisis settings when they no longer meet medical or other necessity criteria.

73.1 	Sec. 66. TEMPORARY GRANT FOR SMALL CUSTOMIZED LIVING 
73.2 	PROVIDERS.
 73.3 	(a) The commissioner must establish a temporary grant for:
73.4 	(1) customized living providers that serve six or fewer people in a single-family home 
73.5 	and that are transitioning to a community residential services licensure or integrated 
73.6 	community supports licensure; and
73.7 	(2) community residential service providers and integrated community supports providers 
73.8 	who transitioned from providing customized living or 24-hour customized living on or after 
73.9 	June 30, 2021.
73.10 	(b) Allowable uses of grant money include physical plant updates required for community 
73.11 	residential services or integrated community supports licensure, technical assistance to adapt 
73.12 	business models and meet policy and regulatory guidance, and other uses approved by the 
73.13 	commissioner. Allowable uses of grant money also include reimbursement for eligible costs 
73.14 	incurred by a community residential service provider or integrated community supports 
73.15 	provider directly related to the provider's transition from providing customized living or 
73.16 	24-hour customized living. License holders of eligible settings must apply for grant money 
73.17 	using an application process determined by the commissioner. Grant money approved by 
73.18 	the commissioner is a onetime award of up to $20,000 per eligible setting. To be considered 
73.19 	for grant money, eligible license holders must submit a grant application by June 30, 2024. 
73.20 	The commissioner may approve grant applications on a rolling basis.

73.21 	Sec. 67. DIRECTION TO COMMISSIONER; SUPPORTED-DECISION-MAKING 
73.22 	REIMBURSEMENT STUDY.
 73.23 	By December 15, 2024, the commissioner shall issue a report to the governor and the 
73.24 	chairs and ranking minority members of the legislative committees with jurisdiction over 
73.25 	human services detailing how medical assistance service providers could be reimbursed for 
73.26 	providing supported-decision-making services. The report must detail recommendations 
73.27 	for all medical assistance programs, including all home and community-based programs, 
73.28 	to provide for reimbursement for supported-decision-making services. The report must 
73.29 	develop detailed provider requirements for reimbursement, including the criteria necessary 
73.30 	to provide high-quality services.  In developing provider requirements, the commissioner 
73.31 	shall consult with all relevant stakeholders, including organizations currently providing 
73.32 	supported-decision-making  services. The report must also include strategies to promote 
73.33 	equitable access to supported-decision-making services to individuals who are Black, 
73.34 	Indigenous, or People of Color; people from culturally-specific communities; people from 
74.1 	rural communities; and other people who may experience barriers to accessing medical 
74.2 	assistance home and community-based services.

74.3 	Sec. 68. DIRECTION TO COMMISSIONER; APPLICATION OF INTERMEDIATE 
74.4 	CARE FACILITIES FOR PERSONS WITH DEVELOPMENTAL DISABILITIES 
74.5 	RATE INCREASES.
 74.6 	The commissioner of human services shall apply the rate increases under Minnesota 
74.7 	Statutes, section 256B.5012, subdivisions 19 and 20, as follows:
74.8 	(1) apply Minnesota Statutes, section 256B.5012, subdivision 19; and
74.9 	(2) apply any required rate increase as required under Minnesota Statutes, section 
74.10 	256B.5012, subdivision 20, to the results of clause (1).

74.11 	Sec. 69. DIRECTION TO COMMISSIONER; SHARED SERVICES.
 74.12 	(a) By December 1, 2023, the commissioner of human services shall seek any necessary 
74.13 	changes to home and community-based services waiver plans regarding sharing services in 
74.14 	order to:
74.15 	(1) permit shared services for additional services, including chore, homemaker, and 
74.16 	night supervision;
74.17 	(2) permit existing shared services at higher ratios, including individualized home 
74.18 	supports without training, individualized home supports with training, and individualized 
74.19 	home supports with family training at a ratio of one staff person to three recipients;
74.20 	(3) ensure that individuals who are seeking to share services permitted under the waiver 
74.21 	plans in an own-home setting are not required to live in a licensed setting in order to share 
74.22 	services so long as all other requirements are met; and
74.23 	(4) issue guidance for shared services, including:
74.24 	(i) informed choice for all individuals sharing the services;
74.25 	(ii) guidance for when multiple shared services by different providers occur in one home 
74.26 	and how lead agencies and individuals shall determine that shared service is appropriate to 
74.27 	meet the needs, health, and safety of each individual for whom the lead agency provides 
74.28 	case management or care coordination; and
74.29 	(iii) guidance clarifying that an individual's decision to share services does not reduce 
74.30 	any determination of the individual's overall or assessed needs for services.
75.1 	(b) The commissioner shall develop or provide guidance outlining:
75.2 	(1) instructions for shared services support planning;
75.3 	(2) person-centered approaches and informed choice in shared services support planning; 
75.4 	and
75.5 	(3) required contents of shared services agreements.
75.6 	(c) The commissioner shall seek and utilize stakeholder input for any proposed changes 
75.7 	to waiver plans and any shared services guidance.

75.8 	Sec. 70. DIRECTION TO COMMISSIONER; DISABILITY WAIVER SHARED 
75.9 	SERVICES RATES.
 75.10 	The commissioner of human services shall establish a rate system for shared homemaker 
75.11 	services and shared chore services provided under Minnesota Statutes, sections 256B.092 
75.12 	and 256B.49. For two persons sharing services, the rate paid to a provider must not exceed 
75.13 	1-1/2 times the rate paid for serving a single individual, and for three persons sharing 
75.14 	services, the rate paid to a provider must not exceed two times the rate paid for serving a 
75.15 	single individual. These rates apply only when all of the criteria for the shared service have 
75.16 	been met.

75.17 	Sec. 71. DIRECTION TO COMMISSIONER; LIFE-SHARING SERVICES.
 75.18 		Subdivision 1.Recommendations required. The commissioner of human services shall 
75.19 	develop recommendations for establishing life sharing as a covered medical assistance 
75.20 	waiver service.
75.21 		Subd. 2.Definition. For the purposes of this section, "life sharing" means a 
75.22 	relationship-based living arrangement between an adult with a disability and an individual 
75.23 	or family in which they share their lives and experiences while the adult with a disability 
75.24 	receives support from the individual or family using person-centered practices.
75.25 		Subd. 3.Stakeholder engagement and consultation. (a) The commissioner must 
75.26 	proactively solicit participation in the development of the life-sharing medical assistance 
75.27 	service through a robust stakeholder engagement process that results in the inclusion of a 
75.28 	racially, culturally, and geographically diverse group of interested stakeholders from each 
75.29 	of the following groups:
75.30 	(1) providers currently providing or interested in providing life-sharing services;
75.31 	(2) people with disabilities accessing or interested in accessing life-sharing services;
76.1 	(3) disability advocacy organizations; and
76.2 	(4) lead agencies.
76.3 	(b) The commissioner must proactively seek input into and assistance with the 
76.4 	development of recommendations for establishing the life-sharing service from interested 
76.5 	stakeholders.
76.6 	(c) The first meeting must occur before July 31, 2023. The commissioner must meet 
76.7 	with stakeholders at least monthly through December 31, 2023. All meetings must be 
76.8 	accessible.
76.9 		Subd. 4.Required topics to be discussed during development of the 
76.10 	recommendations. The commissioner and the interested stakeholders must discuss the 
76.11 	following topics:
76.12 	(1) the distinction between life sharing, adult family foster care, family residential 
76.13 	services, and community residential services;
76.14 	(2) successful life-sharing models used in other states;
76.15 	(3) services and supports that could be included in a life-sharing service;
76.16 	(4) potential barriers to providing or accessing life-sharing services;
76.17 	(5) solutions to remove identified barriers to providing or accessing life-sharing services;
76.18 	(6) requirements of a life-sharing agency;
76.19 	(7) medical assistance payment methodologies for life-sharing providers and life-sharing 
76.20 	agencies;
76.21 	(8) expanding awareness of the life-sharing model; and
76.22 	(9) draft language for legislation necessary to further define and implement life-sharing 
76.23 	services.
76.24 		Subd. 5.Report to the legislature. By December 31, 2023, the commissioner must 
76.25 	provide to the chairs and ranking minority members of the legislative committees and 
76.26 	divisions with jurisdiction over direct care services any draft legislation necessary to 
76.27 	implement the rates and requirements for life-sharing services.

77.1 	Sec. 72. DIRECTION TO COMMISSIONER; FOSTER CARE MORATORIUM 
77.2 	EXCEPTION APPLICATIONS.
 77.3 	(a) The commissioner must expedite the processing and review of all new and pending 
77.4 	applications for an initial foster care or community residential setting license under Minnesota 
77.5 	Statutes, section 245A.03, subdivision 7, paragraph (a), clauses (5) and (6).
77.6 	(b) The commissioner must include on the application materials for an initial foster care 
77.7 	or community residential setting license under Minnesota Statutes, section 245A.03, 
77.8 	subdivision 7, paragraph (a), clauses (5) and (6), an opportunity for applicants to signify 
77.9 	that they are seeking an initial foster care or community residential setting license in order 
77.10 	to transition an existing operational customized living setting to a foster care or community 
77.11 	residential setting. Operational has the meaning given in section 256B.49, subdivision 28, 
77.12 	paragraph (e).
77.13 	(c) For any pending applications for a license under Minnesota Statutes, section 245A.03, 
77.14 	subdivision 7, paragraph (a), clause (5), the commissioner must determine if the applicant 
77.15 	is eligible for an exception under Minnesota Statutes, section 245A.03, subdivision 7, 
77.16 	paragraph (a), clause (6), and if so, act upon the application under clause (6) rather than 
77.17 	clause (5).
77.18 	(d) The commissioner must increase to four the licensed capacity of any setting for 
77.19 	which the commissioner issued a license under Minnesota Statutes, section 245A.03, 
77.20 	subdivision 7, paragraph (a), clause (5), before the final enactment of this act.
77.21 	(e) This section expires June 30, 2023.

77.22 	EFFECTIVE DATE. This section is effective the day following final enactment.

77.23 	Sec. 73. REPEALER.
 77.24 	Minnesota Statutes 2022, section 256B.4914, subdivision 9a, is repealed.

77.25 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
77.26 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
77.27 	when federal approval is obtained.

78.1 	ARTICLE 2
78.2 	AGING SERVICES

78.3 	Section 1. Minnesota Statutes 2022, section 256.9754, is amended to read:
78.4 	256.9754 COMMUNITY SERVICES DEVELOPMENT LIVE WELL AT HOME
78.5 	GRANTS PROGRAM.
78.6 		Subdivision 1.Definitions. For purposes of this section, the following terms have the 
78.7 	meanings given.
78.8 	(a) "Community" means a town, township, city, or targeted neighborhood within a city, 
78.9 	or a consortium of towns, townships, cities, or targeted neighborhoods within cities.
78.10 	(b) "Core home and community-based services provider" means a Faith in Action, Living 
78.11 	at Home/Block Nurse, congregational nurse, or similar community-based program governed 
78.12 	by a board, the majority of whose members reside within the program's service area, that 
78.13 	organizes and uses volunteers and paid staff to deliver nonmedical services intended to 
78.14 	assist older adults to identify and manage risks and to maintain their community living and 
78.15 	integration in the community.
78.16 	(c) "Long-term services and supports" means any service available under the elderly 
78.17 	waiver program or alternative care grant programs, nursing facility services, transportation 
78.18 	services, caregiver support and respite care services, and other home and community-based 
78.19 	services identified as necessary either to maintain lifestyle choices for older adults or to 
78.20 	support them to remain in their own home.
78.21 	(b) (d) "Older adult services" means any services available under the elderly waiver 
78.22 	program or alternative care grant programs; nursing facility services; transportation services; 
78.23 	respite services; and other community-based services identified as necessary either to 
78.24 	maintain lifestyle choices for older Minnesotans, or to promote independence.
78.25 	(c) (e) "Older adult" refers to individuals 65 years of age and older.
78.26 		Subd. 2.Creation; purpose. (a) The community services development live well at home
78.27 	grants program is are created under the administration of the commissioner of human 
78.28 	services.
78.29 	(b) The purpose of projects selected by the commissioner of human services under this 
78.30 	section is to make strategic changes in the long-term services and supports system for older 
78.31 	adults and people with dementia, including statewide capacity for local service development 
78.32 	and technical assistance and statewide availability of home and community-based services 
78.33 	for older adult services, caregiver support and respite care services, and other supports in 
79.1 	Minnesota. These projects are intended to create incentives for new and expanded home 
79.2 	and community-based services in Minnesota in order to:
79.3 	(1) reach older adults early in the progression of their need for long-term services and 
79.4 	supports, providing them with low-cost, high-impact services that will prevent or delay the 
79.5 	use of more costly services;
79.6 	(2) support older adults to live in the most integrated, least restrictive community setting;
79.7 	(3) support the informal caregivers of older adults;
79.8 	(4) develop and implement strategies to integrate long-term services and supports with 
79.9 	health care services, in order to improve the quality of care and enhance the quality of life 
79.10 	of older adults and their informal caregivers;
79.11 	(5) ensure cost-effective use of financial and human resources;
79.12 	(6) build community-based approaches and community commitment to delivering 
79.13 	long-term services and supports for older adults in their own homes;
79.14 	(7) achieve a broad awareness and use of lower-cost in-home services as an alternative 
79.15 	to nursing homes and other residential services;
79.16 	(8) strengthen and develop additional home and community-based services and 
79.17 	alternatives to nursing homes and other residential services; and
79.18 	(9) strengthen programs that use volunteers.
79.19 	(c) The services provided by these projects are available to older adults who are eligible 
79.20 	for medical assistance and the elderly waiver under chapter 256S, the alternative care 
79.21 	program under section 256B.0913, or the essential community supports grant under section 
79.22 	256B.0922, and to persons who have their own money to pay for services.
79.23 		Subd. 3.Provision of Community services development grants. The commissioner 
79.24 	shall make community services development grants available to communities, providers of 
79.25 	older adult services identified in subdivision 1, or to a consortium of providers of older 
79.26 	adult services, to establish older adult services. Grants may be provided for capital and other 
79.27 	costs including, but not limited to, start-up and training costs, equipment, and supplies 
79.28 	related to older adult services or other residential or service alternatives to nursing facility 
79.29 	care. Grants may also be made to renovate current buildings, provide transportation services, 
79.30 	fund programs that would allow older adults or individuals with a disability to stay in their 
79.31 	own homes by sharing a home, fund programs that coordinate and manage formal and 
79.32 	informal services to older adults in their homes to enable them to live as independently as 
80.1 	possible in their own homes as an alternative to nursing home care, or expand state-funded 
80.2 	programs in the area.
80.3 		Subd. 3a.Priority for other grants. The commissioner of health shall give priority to 
80.4 	a grantee selected under subdivision 3 when awarding technology-related grants, if the 
80.5 	grantee is using technology as part of the proposal unless that priority conflicts with existing 
80.6 	state or federal guidance related to grant awards by the Department of Health. The 
80.7 	commissioner of transportation shall give priority to a grantee under subdivision 3 when 
80.8 	distributing transportation-related funds to create transportation options for older adults 
80.9 	unless that preference conflicts with existing state or federal guidance related to grant awards 
80.10 	by the Department of Transportation.
80.11 		Subd. 3b.State waivers. The commissioner of health may waive applicable state laws 
80.12 	and rules for grantees under subdivision 3 on a time-limited basis if the commissioner of 
80.13 	health determines that a participating grantee requires a waiver in order to achieve 
80.14 	demonstration project goals.
80.15 		Subd. 3c.Caregiver support and respite care projects. (a) The commissioner shall 
80.16 	establish projects to expand the availability of caregiver support and respite care services 
80.17 	for family and other caregivers. The commissioner shall use a request for proposals to select 
80.18 	nonprofit entities to administer the projects. Projects must:
80.19 	(1) establish a local coordinated network of volunteer and paid respite workers;
80.20 	(2) coordinate assignment of respite care services to caregivers of older adults;
80.21 	(3) assure the health and safety of the older adults;
80.22 	(4) identify at-risk caregivers;
80.23 	(5) provide information, education, and training for caregivers in the designated 
80.24 	community; and
80.25 	(6) demonstrate the need in the proposed service area, particularly where nursing facility 
80.26 	closures have occurred or are occurring or areas with service needs identified by section 
80.27 	144A.351. Preference must be given for projects that reach underserved populations.
80.28 	(b) Projects must clearly describe:
80.29 	(1) how they will achieve their purpose;
80.30 	(2) the process for recruiting, training, and retraining volunteers; and
80.31 	(3) a plan to promote the project in the designated community, including outreach to 
80.32 	persons needing the services.
81.1 	(c) Money for all projects under this subdivision may be used to:
81.2 	(1) hire a coordinator to develop a coordinated network of volunteer and paid respite 
81.3 	care services and assign workers to clients;
81.4 	(2) recruit and train volunteer providers;
81.5 	(3) provide information, training, and education to caregivers;
81.6 	(4) advertise the availability of the caregiver support and respite care project; and
81.7 	(5) purchase equipment to maintain a system of assigning workers to clients.
81.8 	(d) Volunteer and caregiver training must include resources on how to support an 
81.9 	individual with dementia.
81.10 	(e) Project money may not be used to supplant existing funding sources.
81.11 		Subd. 3d.Core home and community-based services projects. The commissioner 
81.12 	shall select and contract with core home and community-based services providers for projects 
81.13 	to provide services and supports to older adults both with and without family and other 
81.14 	informal caregivers using a request for proposals process. Projects must:
81.15 	(1) have a credible public or private nonprofit sponsor providing ongoing financial 
81.16 	support;
81.17 	(2) have a specific, clearly defined geographic service area;
81.18 	(3) use a practice framework designed to identify high-risk older adults and help them 
81.19 	take action to better manage their chronic conditions and maintain their community living;
81.20 	(4) have a team approach to coordination and care, ensuring that the older adult 
81.21 	participants, their families, and the formal and informal providers are all part of planning 
81.22 	and providing services;
81.23 	(5) provide information, support services, homemaking services, counseling, and training 
81.24 	for the older adults and family caregivers;
81.25 	(6) encourage service area or neighborhood residents and local organizations to 
81.26 	collaborate in meeting the needs of older adults in their geographic service areas;
81.27 	(7) recruit, train, and direct the use of volunteers to provide informal services and other 
81.28 	appropriate support to older adults and their caregivers; and
81.29 	(8) provide coordination and management of formal and informal services to older adults 
81.30 	and their families using less expensive alternatives.
82.1 		Subd. 3e.Community service grants. The commissioner shall award contracts for 
82.2 	grants to public and private nonprofit agencies to establish services that strengthen a 
82.3 	community's ability to provide a system of home and community-based services for elderly 
82.4 	persons. The commissioner shall use a request for proposals process.
82.5 		Subd. 3f.Live well at home grants extension. (a) A community or organization that 
82.6 	has previously received a grant under subdivision 3c, 3d, or 3e that funded a project that 
82.7 	has proven to be successful and that is no longer eligible for funding under subdivision 3c, 
82.8 	3d, or 3e may apply to the commissioner to receive ongoing funding to sustain the project.
82.9 	(b) In order to be eligible for a grant under this subdivision, a grant applicant must:
82.10 	(1) have an operating budget of $300,000 or less;
82.11 	(2) provide home and community-based services that fill a service gap in a designated 
82.12 	geographic area; or
82.13 	(3) be the only provider of essential community services such as chore services, 
82.14 	homemaker services, or transportation in a designated geographic area.
82.15 	(c) The commissioner shall use a request for proposals process and may use a two-year 
82.16 	grant cycle.
82.17 		Subd. 4.Eligibility. Grants may be awarded only to communities and providers or to a 
82.18 	consortium of providers that have a local match of 50 percent of the costs for the project in 
82.19 	the form of donations, local tax dollars, in-kind donations, fundraising, or other local matches.
82.20 		Subd. 5.Grant preference. The commissioner of human services shall give preference 
82.21 	when awarding grants under this section to areas where nursing facility closures have 
82.22 	occurred or are occurring or areas with service needs identified by section 144A.351. The 
82.23 	commissioner may award grants to the extent grant funds are available and to the extent 
82.24 	applications are approved by the commissioner. Denial of approval of an application in one 
82.25 	year does not preclude submission of an application in a subsequent year. The maximum 
82.26 	grant amount is limited to $750,000.

82.27 	Sec. 2. [256.9756] CAREGIVER RESPITE SERVICES GRANTS.
82.28 		Subdivision 1.Caregiver respite grant program established. The commissioner of 
82.29 	human services must establish a caregiver respite services grant program to increase the 
82.30 	availability of respite services for family caregivers of people with dementia and older adults 
82.31 	and to provide information, education, and training to respite caregivers and volunteers 
82.32 	regarding caring for people with dementia. From the money made available for this purpose, 
83.1 	the commissioner must award grants on a competitive basis to respite service providers, 
83.2 	giving priority to areas of the state where there is a high need of respite services.
83.3 		Subd. 2.Eligible uses. Grant recipients awarded grant money under this section must 
83.4 	use a portion of the grant award as determined by the commissioner to provide free or 
83.5 	subsidized respite services for family caregivers of people with dementia and older adults.
83.6 		Subd. 3.Report. By January 15, 2026, and every other January 15 thereafter, the 
83.7 	commissioner shall submit a progress report about the caregiver respite services grants in 
83.8 	this section to the chairs and ranking minority members of the legislative committees and 
83.9 	divisions with jurisdiction over human services. The progress report must include metrics 
83.10 	of the use of grant program money.

83.11 	Sec. 3. Minnesota Statutes 2022, section 256B.0913, subdivision 4, is amended to read:
83.12 		Subd. 4.Eligibility for funding for services for nonmedical assistance recipients. (a) 
83.13 	Funding for services under the alternative care program is available to persons who meet 
83.14 	the following criteria:
83.15 	(1) the person is a citizen of the United States or a United States national;
83.16 	(2) the person has been determined by a community assessment under section 256B.0911 
83.17 	to be a person who would require the level of care provided in a nursing facility, as 
83.18 	determined under section 256B.0911, subdivision 26, but for the provision of services under 
83.19 	the alternative care program;
83.20 	(3) the person is age 65 or older;
83.21 	(4) the person would be eligible for medical assistance within 135 days of admission to 
83.22 	a nursing facility;
83.23 	(5) the person is not ineligible for the payment of long-term care services by the medical 
83.24 	assistance program due to an asset transfer penalty under section 256B.0595 or equity 
83.25 	interest in the home exceeding $500,000 as stated in section 256B.056;
83.26 	(6) the person needs long-term care services that are not funded through other state or 
83.27 	federal funding, or other health insurance or other third-party insurance such as long-term 
83.28 	care insurance;
83.29 	(7) except for individuals described in clause (8), the monthly cost of the alternative 
83.30 	care services funded by the program for this person does not exceed 75 percent of the 
83.31 	monthly limit described under section 256S.18. This monthly limit does not prohibit the 
83.32 	alternative care client from payment for additional services, but in no case may the cost of 
84.1 	additional services purchased under this section exceed the difference between the client's 
84.2 	monthly service limit defined under section 256S.04, and the alternative care program 
84.3 	monthly service limit defined in this paragraph. If care-related supplies and equipment or 
84.4 	environmental modifications and adaptations are or will be purchased for an alternative 
84.5 	care services recipient, the costs may be prorated on a monthly basis for up to 12 consecutive 
84.6 	months beginning with the month of purchase. If the monthly cost of a recipient's other 
84.7 	alternative care services exceeds the monthly limit established in this paragraph, the annual 
84.8 	cost of the alternative care services shall be determined. In this event, the annual cost of 
84.9 	alternative care services shall not exceed 12 times the monthly limit described in this 
84.10 	paragraph;
84.11 	(8) for individuals assigned a case mix classification A as described under section 
84.12 	256S.18, with (i) no dependencies in activities of daily living, or (ii) up to two dependencies 
84.13 	in bathing, dressing, grooming, walking, and eating when the dependency score in eating 
84.14 	is three or greater as determined by an assessment performed under section 256B.0911, the 
84.15 	monthly cost of alternative care services funded by the program cannot exceed $593 per 
84.16 	month for all new participants enrolled in the program on or after July 1, 2011. This monthly 
84.17 	limit shall be applied to all other participants who meet this criteria at reassessment. This 
84.18 	monthly limit shall be increased annually as described in section 256S.18. This monthly 
84.19 	limit does not prohibit the alternative care client from payment for additional services, but 
84.20 	in no case may the cost of additional services purchased exceed the difference between the 
84.21 	client's monthly service limit defined in this clause and the limit described in clause (7) for 
84.22 	case mix classification A; and
84.23 	(9) the person is making timely payments of the assessed monthly fee. A person is 
84.24 	ineligible if payment of the fee is over 60 days past due, unless the person agrees to:
84.25 	(i) the appointment of a representative payee;
84.26 	(ii) automatic payment from a financial account;
84.27 	(iii) the establishment of greater family involvement in the financial management of 
84.28 	payments; or
84.29 	(iv) another method acceptable to the lead agency to ensure prompt fee payments.; and
84.30 	(10) for a person participating in consumer-directed community supports, the person's 
84.31 	monthly service limit must be equal to the monthly service limits in clause (7), except that 
84.32 	a person assigned a case mix classification L must receive the monthly service limit for 
84.33 	case mix classification A.
85.1 	(b) The lead agency may extend the client's eligibility as necessary while making 
85.2 	arrangements to facilitate payment of past-due amounts and future premium payments. 
85.3 	Following disenrollment due to nonpayment of a monthly fee, eligibility shall not be 
85.4 	reinstated for a period of 30 days.
85.5 	(c) Alternative care funding under this subdivision is not available for a person who is 
85.6 	a medical assistance recipient or who would be eligible for medical assistance without a 
85.7 	spenddown or waiver obligation. A person whose initial application for medical assistance 
85.8 	and the elderly waiver program is being processed may be served under the alternative care 
85.9 	program for a period up to 60 days. If the individual is found to be eligible for medical 
85.10 	assistance, medical assistance must be billed for services payable under the federally 
85.11 	approved elderly waiver plan and delivered from the date the individual was found eligible 
85.12 	for the federally approved elderly waiver plan. Notwithstanding this provision, alternative 
85.13 	care funds may not be used to pay for any service the cost of which: (i) is payable by medical 
85.14 	assistance; (ii) is used by a recipient to meet a waiver obligation; or (iii) is used to pay a 
85.15 	medical assistance income spenddown for a person who is eligible to participate in the 
85.16 	federally approved elderly waiver program under the special income standard provision.
85.17 	(d) Alternative care funding is not available for a person who resides in a licensed nursing 
85.18 	home, certified boarding care home, hospital, or intermediate care facility, except for case 
85.19 	management services which are provided in support of the discharge planning process for 
85.20 	a nursing home resident or certified boarding care home resident to assist with a relocation 
85.21 	process to a community-based setting.
85.22 	(e) Alternative care funding is not available for a person whose income is greater than 
85.23 	the maintenance needs allowance under section 256S.05, but equal to or less than 120 percent 
85.24 	of the federal poverty guideline effective July 1 in the fiscal year for which alternative care 
85.25 	eligibility is determined, who would be eligible for the elderly waiver with a waiver 
85.26 	obligation.

85.27 	EFFECTIVE DATE. This section is effective January 1, 2024.

85.28 	Sec. 4. Minnesota Statutes 2022, section 256B.0913, subdivision 5, is amended to read:
85.29 		Subd. 5.Services covered under alternative care. Alternative care funding may be 
85.30 	used for payment of costs of:
85.31 	(1) adult day services and adult day services bath;
85.32 	(2) home care;
85.33 	(3) homemaker services;
86.1 	(4) personal care;
86.2 	(5) case management and conversion case management;
86.3 	(6) respite care;
86.4 	(7) specialized supplies and equipment;
86.5 	(8) home-delivered meals;
86.6 	(9) nonmedical transportation;
86.7 	(10) nursing services;
86.8 	(11) chore services;
86.9 	(12) companion services;
86.10 	(13) nutrition services;
86.11 	(14) family caregiver training and education;
86.12 	(15) coaching and counseling;
86.13 	(16) telehome care to provide services in their own homes in conjunction with in-home 
86.14 	visits;
86.15 	(17) consumer-directed community supports under the alternative care programs which 
86.16 	are available statewide and limited to the average monthly expenditures representative of 
86.17 	all alternative care program participants for the same case mix resident class assigned in 
86.18 	the most recent fiscal year for which complete expenditure data is available;
86.19 	(18) environmental accessibility and adaptations; and
86.20 	(19) discretionary services, for which lead agencies may make payment from their 
86.21 	alternative care program allocation for services not otherwise defined in this section or 
86.22 	section 256B.0625, following approval by the commissioner.
86.23 	Total annual payments for discretionary services for all clients served by a lead agency 
86.24 	must not exceed 25 percent of that lead agency's annual alternative care program base 
86.25 	allocation, except that when alternative care services receive federal financial participation 
86.26 	under the 1115 waiver demonstration, funding shall be allocated in accordance with 
86.27 	subdivision 17.

86.28 	EFFECTIVE DATE. This section is effective January 1, 2024.

87.1 	Sec. 5. Minnesota Statutes 2022, section 256B.0917, subdivision 1b, is amended to read:
87.2 		Subd. 1b.Definitions. (a) For purposes of this section, the following terms have the 
87.3 	meanings given.
87.4 	(b) "Community" means a town; township; city; or targeted neighborhood within a city; 
87.5 	or a consortium of towns, townships, cities, or specific neighborhoods within a city.
87.6 	(c) "Core home and community-based services provider" means a Faith in Action, Living 
87.7 	at Home Block Nurse, Congregational Nurse, or similar community-based program governed 
87.8 	by a board, the majority of whose members reside within the program's service area, that 
87.9 	organizes and uses volunteers and paid staff to deliver nonmedical services intended to 
87.10 	assist older adults to identify and manage risks and to maintain their community living and 
87.11 	integration in the community.
87.12 	(d) "Eldercare development partnership" means a team of representatives of county 
87.13 	social service and public health agencies, the area agency on aging, local nursing home 
87.14 	providers, local home care providers, and other appropriate home and community-based 
87.15 	providers in the area agency's planning and service area.
87.16 	(e) (c) "Long-term services and supports" means any service available under the elderly 
87.17 	waiver program or alternative care grant programs, nursing facility services, transportation 
87.18 	services, caregiver support and respite care services, and other home and community-based 
87.19 	services identified as necessary either to maintain lifestyle choices for older adults or to 
87.20 	support them to remain in their own home.
87.21 	(f) (d) "Older adult" refers to an individual who is 65 years of age or older.

87.22 	Sec. 6. Minnesota Statutes 2022, section 256B.0922, subdivision 1, is amended to read:
87.23 		Subdivision 1.Essential community supports. (a) The purpose of the essential 
87.24 	community supports program is to provide targeted services to persons age 65 and older 
87.25 	who need essential community support, but whose needs do not meet the level of care 
87.26 	required for nursing facility placement under section 144.0724, subdivision 11.
87.27 	(b) Essential community supports are available not to exceed $400 $600 per person per 
87.28 	month. Essential community supports may be used as authorized within an authorization 
87.29 	period not to exceed 12 months. Services must be available to a person who:
87.30 	(1) is age 65 or older;
87.31 	(2) is not eligible for medical assistance;
88.1 	(3) has received a community assessment under section 256B.0911, subdivisions 17 to 
88.2 	21, 23, 24, or 27, and does not require the level of care provided in a nursing facility;
88.3 	(4) meets the financial eligibility criteria for the alternative care program under section 
88.4 	256B.0913, subdivision 4;
88.5 	(5) has an assessment summary; and
88.6 	(6) has been determined by a community assessment under section 256B.0911, 
88.7 	subdivisions 17 to 21, 23, 24, or 27, to be a person who would require provision of at least 
88.8 	one of the following services, as defined in the approved elderly waiver plan, in order to 
88.9 	maintain their community residence:
88.10 	(i) adult day services;
88.11 	(ii) caregiver support, including respite care;
88.12 	(iii) homemaker support;
88.13 	(iv) adult companion services;
88.14 	(iv) (v) chores;
88.15 	(v) (vi) a personal emergency response device or system;
88.16 	(vi) (vii) home-delivered meals; or
88.17 	(vii) (viii) community living assistance as defined by the commissioner.
88.18 	(c) The person receiving any of the essential community supports in this subdivision 
88.19 	must also receive service coordination, not to exceed $600 in a 12-month authorization 
88.20 	period, as part of their assessment summary.
88.21 	(d) A person who has been determined to be eligible for essential community supports 
88.22 	must be reassessed at least annually and continue to meet the criteria in paragraph (b) to 
88.23 	remain eligible for essential community supports.
88.24 	(e) The commissioner is authorized to use federal matching funds for essential community 
88.25 	supports as necessary and to meet demand for essential community supports as outlined in 
88.26 	subdivision 2, and that amount of federal funds is appropriated to the commissioner for this 
88.27 	purpose.

89.1 	Sec. 7. Minnesota Statutes 2022, section 256B.434, is amended by adding a subdivision 
89.2 	to read:
89.3 		Subd. 4k.Property rate increase for certain nursing facilities. (a) A rate increase 
89.4 	under this subdivision ends upon the effective date of the transition of the facility's property 
89.5 	rate to a property payment rate under section 256R.26, subdivision 8.
89.6 	(b) The commissioner shall increase the property rate of a nursing facility located in the 
89.7 	city of Saint Paul at 1415 Almond Avenue in Ramsey County by $10.65 on September 1, 
89.8 	2023.
89.9 	(c) The commissioner shall increase the property rate of a nursing facility located in the 
89.10 	city of Duluth at 3111 Church Place in St. Louis County by $20.81 on September 1, 2023.
89.11 	(d) The commissioner shall increase the property rate of a nursing facility located in the 
89.12 	city of Chatfield at 1102 Liberty Street SE in Fillmore County by $21.35 on September 1, 
89.13 	2023.

89.14 	EFFECTIVE DATE. This section is effective September 1, 2023.

89.15 	Sec. 8. Minnesota Statutes 2022, section 256M.42, is amended to read:
89.16 	256M.42 ADULT PROTECTION GRANT ALLOCATIONS.
89.17 		Subdivision 1.Formula. (a) The commissioner shall allocate state money appropriated 
89.18 	under this section on an annual basis to each county board and tribal government approved 
89.19 	by the commissioner to assume county agency duties for adult protective services or as a 
89.20 	lead investigative agency protection under section 626.557on an annual basis in an amount 
89.21 	determined and to Tribal Nations that have voluntarily chosen by resolution of Tribal 
89.22 	government to participate in vulnerable adult protection programs according to the following 
89.23 	formula after the award of the amounts in paragraph (c):
89.24 	(1) 25 percent must be allocated to the responsible agency on the basis of the number 
89.25 	of reports of suspected vulnerable adult maltreatment under sections 626.557 and 626.5572, 
89.26 	when the county or tribe is responsible as determined by the most recent data of the 
89.27 	commissioner; and
89.28 	(2) 75 percent must be allocated to the responsible agency on the basis of the number 
89.29 	of screened-in reports for adult protective services or vulnerable adult maltreatment 
89.30 	investigations under sections 626.557 and 626.5572, when the county or tribe is responsible
89.31 	as determined by the most recent data of the commissioner.
90.1 	(b) The commissioner is precluded from changing the formula under this subdivision 
90.2 	or recommending a change to the legislature without public review and input.
90.3 	Notwithstanding this subdivision, no county must be awarded less than a minimum allocation 
90.4 	established by the commissioner.
90.5 	(c) To receive money under this subdivision, a participating Tribal Nation must apply 
90.6 	to the commissioner. Of the amount appropriated for purposes of this section, the 
90.7 	commissioner must award $100,000 to each federally recognized Tribal Nation with a Tribal 
90.8 	resolution establishing a vulnerable adult protection program. Money received by a Tribal 
90.9 	Nation under this section must be used for its vulnerable adult protection program.
90.10 		Subd. 2.Payment. The commissioner shall make allocations for the state fiscal year 
90.11 	starting July 1, 2019 2023, and to each county board or tribal government on or before 
90.12 	October 10, 2019 2023. The commissioner shall make allocations under subdivision 1 to 
90.13 	each county board or tribal government each year thereafter on or before July 10.
90.14 		Subd. 3.Prohibition on supplanting existing money Purpose of expenditures. Money 
90.15 	received under this section must be used for staffing for protection of vulnerable adults or 
90.16 	to meet the agency's duties under section 626.557 and to expand adult protective services
90.17 	to stop, prevent, and reduce risks of maltreatment for adults accepted for services under 
90.18 	section 626.557, or for multidisciplinary teams under section 626.5571. Money must not 
90.19 	be used to supplant current county or tribe expenditures for these purposes.
90.20 		Subd. 4.Required expenditures. State money must be used to expand, not supplant,  
90.21 	county or Tribal expenditures for the fiscal year 2023 base for adult protection programs, 
90.22 	service interventions, or multidisciplinary teams. This prohibition on county or Tribal 
90.23 	expenditures supplanting state money ends July 1, 2027.
90.24 		Subd. 5.County performance on adult protection measures. The commissioner must 
90.25 	set vulnerable adult protection measures and standards for money received under this section. 
90.26 	The commissioner must require an underperforming county to demonstrate that the county 
90.27 	designated money allocated under this section for the purpose required and implemented a 
90.28 	reasonable strategy to improve adult protection performance, including the provision of a 
90.29 	performance improvement plan and additional remedies identified by the commissioner. 
90.30 	The commissioner may redirect up to 20 percent of a county's money under this section 
90.31 	toward the performance improvement plan.
90.32 		Subd. 6.American Indian adult protection. Tribal Nations shall establish vulnerable 
90.33 	adult protection measures and standards and report annually to the commissioner on these 
90.34 	outcomes and the number of adults served.

91.1 	EFFECTIVE DATE. This section is effective July 1, 2023.

91.2 	Sec. 9. Minnesota Statutes 2022, section 256R.02, subdivision 19, is amended to read:
91.3 		Subd. 19.External fixed costs. "External fixed costs" means costs related to the nursing 
91.4 	home surcharge under section 256.9657, subdivision 1; licensure fees under section 144.122; 
91.5 	family advisory council fee under section 144A.33; scholarships under section 256R.37; 
91.6 	planned closure rate adjustments under section 256R.40; consolidation rate adjustments 
91.7 	under section 144A.071, subdivisions 4c, paragraph (a), clauses (5) and (6), and 4d; 
91.8 	single-bed room incentives under section 256R.41; property taxes, special assessments, and 
91.9 	payments in lieu of taxes; employer health insurance costs; quality improvement incentive 
91.10 	payment rate adjustments under section 256R.39; performance-based incentive payments 
91.11 	under section 256R.38; special dietary needs under section 256R.51; Public Employees 
91.12 	Retirement Association employer costs; and border city facility-specific rate adjustments
91.13 	modifications under section 256R.481.

91.14 	EFFECTIVE DATE. This section is effective July 1, 2023.

91.15 	Sec. 10. Minnesota Statutes 2022, section 256R.17, subdivision 2, is amended to read:
91.16 		Subd. 2.Case mix indices. (a) The commissioner shall assign a case mix index to each 
91.17 	case mix classification based on the Centers for Medicare and Medicaid Services staff time 
91.18 	measurement study as determined by the commissioner of health under section 144.0724.
91.19 	(b) An index maximization approach shall be used to classify residents. "Index 
91.20 	maximization" has the meaning given in section 144.0724, subdivision 2, paragraph (c).

91.21 	Sec. 11. Minnesota Statutes 2022, section 256R.25, is amended to read:
91.22 	256R.25 EXTERNAL FIXED COSTS PAYMENT RATE.
91.23 	(a) The payment rate for external fixed costs is the sum of the amounts in paragraphs 
91.24 	(b) to (o).
91.25 	(b) For a facility licensed as a nursing home, the portion related to the provider surcharge 
91.26 	under section 256.9657 is equal to $8.86 per resident day. For a facility licensed as both a 
91.27 	nursing home and a boarding care home, the portion related to the provider surcharge under 
91.28 	section 256.9657 is equal to $8.86 per resident day multiplied by the result of its number 
91.29 	of nursing home beds divided by its total number of licensed beds.
91.30 	(c) The portion related to the licensure fee under section 144.122, paragraph (d), is the 
91.31 	amount of the fee divided by the sum of the facility's resident days.
92.1 	(d) The portion related to development and education of resident and family advisory 
92.2 	councils under section 144A.33 is $5 per resident day divided by 365.
92.3 	(e) The portion related to scholarships is determined under section 256R.37.
92.4 	(f) The portion related to planned closure rate adjustments is as determined under section 
92.5 	256R.40, subdivision 5, and Minnesota Statutes 2010, section 256B.436.
92.6 	(g) The portion related to consolidation rate adjustments shall be as determined under 
92.7 	section 144A.071, subdivisions 4c, paragraph (a), clauses (5) and (6), and 4d.
92.8 	(h) The portion related to single-bed room incentives is as determined under section 
92.9 	256R.41.
92.10 	(i) The portions related to real estate taxes, special assessments, and payments made in 
92.11 	lieu of real estate taxes directly identified or allocated to the nursing facility are the allowable 
92.12 	amounts divided by the sum of the facility's resident days. Allowable costs under this 
92.13 	paragraph for payments made by a nonprofit nursing facility that are in lieu of real estate 
92.14 	taxes shall not exceed the amount which the nursing facility would have paid to a city or 
92.15 	township and county for fire, police, sanitation services, and road maintenance costs had 
92.16 	real estate taxes been levied on that property for those purposes.
92.17 	(j) The portion related to employer health insurance costs is the allowable costs divided 
92.18 	by the sum of the facility's resident days.
92.19 	(k) The portion related to the Public Employees Retirement Association is the allowable 
92.20 	costs divided by the sum of the facility's resident days.
92.21 	(l) The portion related to quality improvement incentive payment rate adjustments is 
92.22 	the amount determined under section 256R.39.
92.23 	(m) The portion related to performance-based incentive payments is the amount 
92.24 	determined under section 256R.38.
92.25 	(n) The portion related to special dietary needs is the amount determined under section 
92.26 	256R.51.
92.27 	(o) The portion related to the rate adjustments for border city facilities facility-specific 
92.28 	rate modifications is the amount determined under section 256R.481.
92.29 	(p) The portion related to the rate adjustment for critical access nursing facilities is the 
92.30 	amount determined under section 256R.47.

92.31 	EFFECTIVE DATE. This section is effective July 1, 2023.

93.1 	Sec. 12. Minnesota Statutes 2022, section 256R.47, is amended to read:
93.2 	256R.47 RATE ADJUSTMENT FOR CRITICAL ACCESS NURSING 
93.3 	FACILITIES.
93.4 	(a) The commissioner, in consultation with the commissioner of health, may designate 
93.5 	certain nursing facilities as critical access nursing facilities. The designation shall be granted 
93.6 	on a competitive basis, within the limits of funds appropriated for this purpose.
93.7 	(b) The commissioner shall request proposals from nursing facilities every two years. 
93.8 	Proposals must be submitted in the form and according to the timelines established by the 
93.9 	commissioner. In selecting applicants to designate, the commissioner, in consultation with 
93.10 	the commissioner of health, and with input from stakeholders, shall develop criteria designed 
93.11 	to preserve access to nursing facility services in isolated areas, rebalance long-term care, 
93.12 	and improve quality. To the extent practicable, the commissioner shall ensure an even 
93.13 	distribution of designations across the state.
93.14 	(c) The commissioner shall allow the benefits in clauses (1) to (5) For nursing facilities 
93.15 	designated as critical access nursing facilities:, the commissioner shall allow a supplemental 
93.16 	payment above a facility's operating payment rate as determined to be necessary by the 
93.17 	commissioner to maintain access to nursing facilities services in isolated areas identified 
93.18 	in paragraph (b). The commissioner must approve the amounts of supplemental payments 
93.19 	through a memorandum of understanding. Supplemental payments to facilities under this 
93.20 	section must be in the form of time-limited rate adjustments included in the external fixed 
93.21 	payment rate under section 256R.25.
93.22 	(1) partial rebasing, with the commissioner allowing a designated facility operating 
93.23 	payment rates being the sum of up to 60 percent of the operating payment rate determined 
93.24 	in accordance with section 256R.21, subdivision 3, and at least 40 percent, with the sum of 
93.25 	the two portions being equal to 100 percent, of the operating payment rate that would have 
93.26 	been allowed had the facility not been designated. The commissioner may adjust these 
93.27 	percentages by up to 20 percent and may approve a request for less than the amount allowed;
93.28 	(2) enhanced payments for leave days. Notwithstanding section 256R.43, upon 
93.29 	designation as a critical access nursing facility, the commissioner shall limit payment for 
93.30 	leave days to 60 percent of that nursing facility's total payment rate for the involved resident, 
93.31 	and shall allow this payment only when the occupancy of the nursing facility, inclusive of 
93.32 	bed hold days, is equal to or greater than 90 percent;
93.33 	(3) two designated critical access nursing facilities, with up to 100 beds in active service, 
93.34 	may jointly apply to the commissioner of health for a waiver of Minnesota Rules, part 
94.1 	4658.0500, subpart 2, in order to jointly employ a director of nursing. The commissioner 
94.2 	of health shall consider each waiver request independently based on the criteria under 
94.3 	Minnesota Rules, part 4658.0040;
94.4 	(4) the minimum threshold under section 256B.431, subdivision 15, paragraph (e), shall 
94.5 	be 40 percent of the amount that would otherwise apply; and
94.6 	(5) the quality-based rate limits under section 256R.23, subdivisions 5 to 7, apply to 
94.7 	designated critical access nursing facilities.
94.8 	(d) Designation of a critical access nursing facility is for a maximum period of up to 
94.9 	two years, after which the benefits benefit allowed under paragraph (c) shall be removed. 
94.10 	Designated facilities may apply for continued designation.
94.11 	(e) This section is suspended and no state or federal funding shall be appropriated or 
94.12 	allocated for the purposes of this section from January 1, 2016, to December 31, 2019.
94.13 	(e) The memorandum of understanding required by paragraph (c) must state that the 
94.14 	designation of a critical access nursing facility must be removed if the facility undergoes a 
94.15 	change of ownership as defined in section 144A.06, subdivision 2.

94.16 	EFFECTIVE DATE. This section is effective July 1, 2023.

94.17 	Sec. 13. Minnesota Statutes 2022, section 256R.481, is amended to read:
94.18 	256R.481 FACILITY-SPECIFIC RATE ADJUSTMENTS FOR BORDER CITY 
94.19 	FACILITIES MODIFICATIONS.
94.20 		Subdivision 1.Border city facilities. (a) The commissioner shall allow each nonprofit 
94.21 	nursing facility located within the boundaries of the city of Breckenridge or Moorhead prior 
94.22 	to January 1, 2015, to apply once annually for a rate add-on to the facility's external fixed 
94.23 	costs payment rate.
94.24 	(b) A facility seeking an add-on to its external fixed costs payment rate under this section 
94.25 	must apply annually to the commissioner to receive the add-on. A facility must submit the 
94.26 	application within 60 calendar days of the effective date of any add-on under this section. 
94.27 	The commissioner may waive the deadlines required by this paragraph under extraordinary 
94.28 	circumstances.
94.29 	(c) The commissioner shall provide the add-on to each eligible facility that applies by 
94.30 	the application deadline.
94.31 	(d) The add-on to the external fixed costs payment rate is the difference on January 1 
94.32 	of the median total payment rate for case mix classification PA1 of the nonprofit facilities 
95.1 	located in an adjacent city in another state and in cities contiguous to the adjacent city minus 
95.2 	the eligible nursing facility's total payment rate for case mix classification PA1 as determined 
95.3 	under section 256R.22, subdivision 4.
95.4 		Subd. 2.Nursing facility in Chisholm; temporary rate add-on. Effective July 1, 2023, 
95.5 	through December 31, 2027, the commissioner shall provide an external fixed rate add-on 
95.6 	for the nursing facility in the city of Chisholm in the amount of $11.81. If this nursing 
95.7 	facility completes a moratorium exception project that is approved after March 27, 2023, 
95.8 	this subdivision expires the day before the effective date of that moratorium rate adjustment 
95.9 	or December 31, 2027, whichever is earlier. The commissioner of human services shall 
95.10 	notify the revisor of statutes if this subdivision expires prior to December 31, 2027.

95.11 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
95.12 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
95.13 	when federal approval is obtained.

95.14 	Sec. 14. Minnesota Statutes 2022, section 256R.53, is amended by adding a subdivision 
95.15 	to read:
95.16 		Subd. 3.Nursing facility in Fergus Falls. Notwithstanding sections 256B.431, 256B.434, 
95.17 	and 256R.26, subdivision 9, a nursing facility located in the city of Fergus Falls licensed 
95.18 	for 105 beds on September 1, 2021, must have the property portion of its total payment rate 
95.19 	determined according to sections 256R.26 to 256R.267.

95.20 	EFFECTIVE DATE. This section is effective January 1, 2024.

95.21 	Sec. 15. Minnesota Statutes 2022, section 256R.53, is amended by adding a subdivision 
95.22 	to read:
95.23 		Subd. 4.Nursing facility in Red Wing. The operating payment rate for a facility located 
95.24 	in the city of Red Wing at 1412 West 4th Street is the sum of its direct care costs per 
95.25 	standardized day, its other care-related costs per resident day, and its other operating costs 
95.26 	per day.

95.27 	EFFECTIVE DATE. This section is effective July 1, 2023.

95.28 	Sec. 16. Minnesota Statutes 2022, section 256S.15, subdivision 2, is amended to read:
95.29 		Subd. 2.Foster care limit. The elderly waiver payment for the foster care service in 
95.30 	combination with the payment for all other elderly waiver services, including case 
95.31 	management, must not exceed the monthly case mix budget cap for the participant as 
96.1 	specified in sections 256S.18, subdivision 3, and 256S.19, subdivisions subdivision 3and 
96.2 	4.

96.3 	EFFECTIVE DATE. This section is effective January 1, 2024.

96.4 	Sec. 17. Minnesota Statutes 2022, section 256S.18, is amended by adding a subdivision 
96.5 	to read:
96.6 		Subd. 3a.Monthly case mix budget caps for consumer-directed community 
96.7 	supports. The monthly case mix budget caps for each case mix classification for 
96.8 	consumer-directed community supports must be equal to the monthly case mix budget caps 
96.9 	in subdivision 3.

96.10 	EFFECTIVE DATE. This section is effective January 1, 2024.

96.11 	Sec. 18. Minnesota Statutes 2022, section 256S.19, subdivision 3, is amended to read:
96.12 		Subd. 3.Calculation of monthly conversion budget cap without consumer-directed 
96.13 	community supports caps. (a) The elderly waiver monthly conversion budget cap for the 
96.14 	cost of elderly waiver services without consumer-directed community supports must be 
96.15 	based on the nursing facility case mix adjusted total payment rate of the nursing facility 
96.16 	where the elderly waiver applicant currently resides for the applicant's case mix classification 
96.17 	as determined according to section 256R.17.
96.18 	(b) The elderly waiver monthly conversion budget cap for the cost of elderly waiver 
96.19 	services without consumer-directed community supports shall must be calculated by 
96.20 	multiplying the applicable nursing facility case mix adjusted total payment rate by 365, 
96.21 	dividing by 12, and subtracting the participant's maintenance needs allowance.
96.22 	(c) A participant's initially approved monthly conversion budget cap for elderly waiver 
96.23 	services without consumer-directed community supports shall must be adjusted at least 
96.24 	annually as described in section 256S.18, subdivision 5.
96.25 	(d) Conversion budget caps for individuals participating in consumer-directed community 
96.26 	supports must be set as described in paragraphs (a) to (c).

96.27 	EFFECTIVE DATE. This section is effective January 1, 2024.

96.28 	Sec. 19. Minnesota Statutes 2022, section 256S.203, subdivision 1, is amended to read:
96.29 		Subdivision 1.Capitation payments. The commissioner must adjust the elderly waiver 
96.30 	capitation payment rates for managed care organizations paid to reflect the monthly service 
96.31 	rate limits for customized living services and 24-hour customized living services established 
97.1 	under section 256S.202and, the rate adjustments for disproportionate share facilities under 
97.2 	section 256S.205, and the assisted living facility closure payments under section 256S.206.

97.3 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
97.4 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
97.5 	when federal approval is obtained.

97.6 	Sec. 20. Minnesota Statutes 2022, section 256S.203, subdivision 2, is amended to read:
97.7 		Subd. 2.Reimbursement rates. Medical assistance rates paid to customized living 
97.8 	providers by managed care organizations under this chapter must not exceed the monthly 
97.9 	service rate limits and component rates as determined by the commissioner under sections 
97.10 	256S.15 and 256S.20 to 256S.202, plus any rate adjustment or special payment under section 
97.11 	256S.205 or 256S.206.

97.12 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
97.13 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
97.14 	when federal approval is obtained.

97.15 	Sec. 21. Minnesota Statutes 2022, section 256S.205, subdivision 3, is amended to read:
97.16 		Subd. 3.Rate adjustment eligibility criteria. Only facilities satisfying all of the 
97.17 	following conditions on September 1 of the application year are eligible for designation as 
97.18 	a disproportionate share facility:
97.19 	(1) at least 83.5 80 percent of the residents of the facility are customized living residents; 
97.20 	and
97.21 	(2) at least 70 50 percent of the customized living residents are elderly waiver participants.

97.22 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
97.23 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
97.24 	when federal approval is obtained.

97.25 	Sec. 22. Minnesota Statutes 2022, section 256S.205, subdivision 5, is amended to read:
97.26 		Subd. 5.Rate adjustment; rate floor. (a) Notwithstanding the 24-hour customized 
97.27 	living monthly service rate limits under section 256S.202, subdivision 2, and the component 
97.28 	service rates established under section 256S.201, subdivision 4, the commissioner must 
97.29 	establish a rate floor equal to $119 $139 per resident per day for 24-hour customized living 
97.30 	services provided to an elderly waiver participant in a designated disproportionate share 
97.31 	facility.
98.1 	(b) The commissioner must apply the rate floor to the services described in paragraph 
98.2 	(a) provided during the rate year.
98.3 	(c) The commissioner must adjust the rate floor by the same amount and at the same 
98.4 	time as any adjustment to the 24-hour customized living monthly service rate limits under 
98.5 	section 256S.202, subdivision 2.
98.6 	(d) The commissioner shall not implement the rate floor under this section if the 
98.7 	customized living rates established under sections 256S.21 to 256S.215 will be implemented 
98.8 	at 100 percent on January 1 of the year following an application year.

98.9 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
98.10 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
98.11 	when federal approval is obtained.

98.12 	Sec. 23. [256S.206] ASSISTED LIVING FACILITY CLOSURE PAYMENTS.
98.13 		Subdivision 1.Assisted living facility closure payments provided. The commissioner 
98.14 	of human services shall establish a special payment program to support licensed assisted 
98.15 	living facilities who serve waiver participants under section 256B.49 and chapter 256S 
98.16 	when the assisted living facility is acting to close the facility as outlined in section 144G.57. 
98.17 	The payments must support the facility to meet the health and safety needs of residents 
98.18 	during facility occupancy and revenue decline.
98.19 		Subd. 2.Definitions. (a) For the purposes of this section, the terms in this subdivision 
98.20 	have the meanings given.
98.21 	(b) "Closure period" means the number of days in the approved closure plan for the 
98.22 	eligible facility as determined by the commissioner of health under section 144G.57, not to 
98.23 	exceed 60 calendar days.
98.24 	(c) "Eligible claim" means a claim for customized living services and 24-hour customized 
98.25 	living services provided to waiver participants under section 256B.49 and chapter 256S 
98.26 	during the eligible facility's closure period.
98.27 	(d) "Eligible facility" means a licensed assisted living facility that has an approved 
98.28 	closure plan, as determined by the commissioner of health under section 144G.57, that is 
98.29 	acting to close the facility and no longer serve residents in that setting. A facility where a 
98.30 	provider is relinquishing an assisted living facility license to transition to a different license 
98.31 	type is not an eligible facility.
99.1 		Subd. 3.Application. (a) An eligible facility may apply to the commissioner of human 
99.2 	services for assisted living closure transition payments in the manner prescribed by the 
99.3 	commissioner.
99.4 	(b) The commissioner shall notify the facility within 14 calendars days of the facility's 
99.5 	application about the result of the application, including whether the facility meets the 
99.6 	definition of an eligible facility.
99.7 		Subd. 4.Issuing closure payments. (a) The commissioner must increase the payment 
99.8 	for eligible claims by 50 percent during the eligible facility's closure period.
99.9 	(b) The commissioner must direct managed care organizations to increase the payment 
99.10 	for eligible claims by 50 percent during the eligible facility's closure period for eligible 
99.11 	claims submitted to managed care organizations.
99.12 		Subd. 5.Interagency coordination. The commissioner of human services must 
99.13 	coordinate the activities under this section with any impacted state agencies and lead agencies.

99.14 	EFFECTIVE DATE. This section is effective July 1, 2024, or upon federal approval, 
99.15 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
99.16 	when federal approval is obtained.

99.17 	Sec. 24. Minnesota Statutes 2022, section 256S.21, is amended to read:
99.18 	256S.21 RATE SETTING; APPLICATION; EVALUATION.
99.19 		Subdivision 1.Application of rate setting. The paymentrate methodologies in sections 
99.20 	256S.2101 to 256S.215 apply to:
99.21 	(1) elderly waiver, elderly waiver customized living, and elderly waiver foster care under 
99.22 	this chapter;
99.23 	(2) alternative care under section 256B.0913;
99.24 	(3) essential community supports under section 256B.0922; and
99.25 	(4) community access for disability inclusion customized living and brain injury 
99.26 	customized living under section 256B.49.
99.27 		Subd. 2.Evaluation of rate setting. (a) Beginning January 1, 2024, and every two years 
99.28 	thereafter, the commissioner, in consultation with stakeholders, shall use all available data 
99.29 	and resources to evaluate the following rate setting elements:
99.30 	(1) the base wage index;
99.31 	(2) the factors and supervision wage components; and
100.1 	(3) the formulas to calculate adjusted base wages and rates.
100.2 	(b) Beginning January 15, 2026, and every two years thereafter, the commissioner shall 
100.3 	report to the chairs and ranking minority members of the legislative committees and divisions 
100.4 	with jurisdiction over health and human services finance and policy with a full report on 
100.5 	the information and data gathered under paragraph (a).
100.6 		Subd. 3.Cost reporting. (a) As determined by the commissioner, in consultation with 
100.7 	stakeholders, a provider enrolled to provide services with rates determined under this chapter 
100.8 	must submit requested cost data to the commissioner to support evaluation of the rate 
100.9 	methodologies in this chapter. Requested cost data may include but are not limited to:
100.10 	(1) worker wage costs;
100.11 	(2) benefits paid;
100.12 	(3) supervisor wage costs;
100.13 	(4) executive wage costs;
100.14 	(5) vacation, sick, and training time paid;
100.15 	(6) taxes, workers' compensation, and unemployment insurance costs paid;
100.16 	(7) administrative costs paid;
100.17 	(8) program costs paid;
100.18 	(9) transportation costs paid;
100.19 	(10) vacancy rates; and
100.20 	(11) other data relating to costs required to provide services requested by the 
100.21 	commissioner.
100.22 	(b) At least once in any five-year period, a provider must submit cost data for a fiscal 
100.23 	year that ended not more than 18 months prior to the submission date. The commissioner 
100.24 	shall provide each provider a 90-day notice prior to the provider's submission due date. If 
100.25 	by 30 days after the required submission date a provider fails to submit required reporting 
100.26 	data, the commissioner shall provide notice to the provider, and if by 60 days after the 
100.27 	required submission date a provider has not provided the required data, the commissioner 
100.28 	shall provide a second notice. The commissioner shall temporarily suspend payments to the 
100.29 	provider if cost data is not received 90 days after the required submission date. Withheld 
100.30 	payments must be made once data is received by the commissioner.
101.1 	(c) The commissioner shall coordinate the cost reporting activities required under this 
101.2 	section with the cost reporting activities directed under section 256B.4914, subdivision 10a.
101.3 	(d) The commissioner shall analyze cost documentation in paragraph (a) and, in 
101.4 	consultation with stakeholders, may submit recommendations on rate methodologies in this 
101.5 	chapter, including ways to monitor and enforce the spending requirements directed in section 
101.6 	256S.2101, subdivision 3, through the reports directed by subdivision 2.

101.7 	EFFECTIVE DATE. Subdivisions 1 and 2 are effective January 1, 2024. Subdivision 
101.8 	3 is effective January 1, 2025.

101.9 	Sec. 25. Minnesota Statutes 2022, section 256S.2101, subdivision 2, is amended to read:
101.10 		Subd. 2.Phase-in for elderly waiver rates.  Except for home-delivered meals as 
101.11 	described in section 256S.215, subdivision 15 and the services in subdivision 2a, all rates 
101.12 	and rate components for elderly waiver, elderly waiver customized living, and elderly waiver 
101.13 	foster care under this chapter; alternative care under section 256B.0913; and essential 
101.14 	community supports under section 256B.0922 shall be:
101.15 	(1) beginning January 1, 2024, the sum of 18.8 27.8 percent of the rates calculated under 
101.16 	sections 256S.211 to 256S.215, and 81.2 72.2 percent of the rates calculated using the rate 
101.17 	methodology in effect as of June 30, 2017. The rate for home-delivered meals shall be the 
101.18 	sum of the service rate in effect as of January 1, 2019, and the increases described in section 
101.19 	256S.215, subdivision 15; and
101.20 	(2) beginning January 1, 2026, the sum of 25 percent of the rates calculated under sections 
101.21 	256S.211 to 256S.215, and 75 percent of the rates calculated using the rate methodology 
101.22 	in effect as of June 30, 2017.

101.23 	Sec. 26. Minnesota Statutes 2022, section 256S.2101, is amended by adding a subdivision 
101.24 	to read:
101.25 		Subd. 2a.Service rates exempt from phase-in. Subdivision 2 does not apply to rates 
101.26 	for homemaker services described in section 256S.215, subdivisions 9 to 11.

101.27 	EFFECTIVE DATE. This section is effective January 1, 2024.

101.28 	Sec. 27. Minnesota Statutes 2022, section 256S.2101, is amended by adding a subdivision 
101.29 	to read:
101.30 		Subd. 3.Spending requirements. (a) Except for community access for disability 
101.31 	inclusion customized living and brain injury customized living under section 256B.49, at 
102.1 	least 80 percent of the marginal increase in revenue from the implementation of any 
102.2 	adjustments to the phase-in in subdivision 2, or any updates to services rates directed under 
102.3 	section 256S.211, subdivision 3, must be used to increase compensation-related costs for 
102.4 	employees directly employed by the provider.
102.5 	(b) For the purposes of this subdivision, compensation-related costs include:
102.6 	(1) wages and salaries;
102.7 	(2) the employer's share of FICA taxes, Medicare taxes, state and federal unemployment 
102.8 	taxes, workers' compensation, and mileage reimbursement;
102.9 	(3) the employer's paid share of health and dental insurance, life insurance, disability 
102.10 	insurance, long-term care insurance, uniform allowance, pensions, and contributions to 
102.11 	employee retirement accounts; and
102.12 	(4) benefits that address direct support professional workforce needs above and beyond 
102.13 	what employees were offered prior to the implementation of the adjusted phase-in in 
102.14 	subdivision 2, including any concurrent or subsequent adjustments to the base wage indices.
102.15 	(c) Compensation-related costs for persons employed in the central office of a corporation 
102.16 	or entity that has an ownership interest in the provider or exercises control over the provider, 
102.17 	or for persons paid by the provider under a management contract, do not count toward the 
102.18 	80 percent requirement under this subdivision.
102.19 	(d) A provider agency or individual provider that receives additional revenue subject to 
102.20 	the requirements of this subdivision shall prepare, and upon request submit to the 
102.21 	commissioner, a distribution plan that specifies the amount of money the provider expects 
102.22 	to receive that is subject to the requirements of this subdivision, including how that money 
102.23 	was or will be distributed to increase compensation-related costs for employees. Within 60 
102.24 	days of final implementation of the new phase-in proportion or adjustment to the base wage 
102.25 	indices subject to the requirements of this subdivision, the provider must post the distribution 
102.26 	plan and leave it posted for a period of at least six months in an area of the provider's 
102.27 	operation to which all direct support professionals have access. The posted distribution plan 
102.28 	must include instructions regarding how to contact the commissioner, or the commissioner's 
102.29 	representative, if an employee has not received the compensation-related increase described 
102.30 	in the plan.

103.1 	Sec. 28. Minnesota Statutes 2022, section 256S.211, is amended by adding a subdivision 
103.2 	to read:
103.3 		Subd. 3.Updating services rates. On January 1, 2024, and every two years thereafter, 
103.4 	the commissioner shall recalculate rates for services as directed in section 256S.215. Prior 
103.5 	to recalculating the rates, the commissioner shall:
103.6 	(1) update the base wage index for services in section 256S.212 based on the most 
103.7 	recently available Bureau of Labor Statistics Minneapolis-St. Paul-Bloomington, MN-WI 
103.8 	MetroSA data;
103.9 	(2) update the payroll taxes and benefits factor in section 256S.213, subdivision 1, based 
103.10 	on the most recently available nursing facility cost report data;
103.11 	(3) update the supervision wage components in section 256S.213, subdivisions 4 and 5, 
103.12 	based on the most recently available Bureau of Labor Statistics Minneapolis-St. 
103.13 	Paul-Bloomington, MN-WI MetroSA data; and
103.14 	(4) update the adjusted base wage for services as directed in section 256S.214.

103.15 	EFFECTIVE DATE. This section is effective January 1, 2024.

103.16 	Sec. 29. Minnesota Statutes 2022, section 256S.211, is amended by adding a subdivision 
103.17 	to read:
103.18 		Subd. 4.Updating home-delivered meals rate. On January 1 of each year, the 
103.19 	commissioner shall update the home-delivered meals rate in section 256S.215, subdivision 
103.20 	15, by the percent increase in the nursing facility dietary per diem using the two most recently 
103.21 	available nursing facility cost reports.

103.22 	EFFECTIVE DATE. This section is effective January 1, 2024.

103.23 	Sec. 30. Minnesota Statutes 2022, section 256S.212, is amended to read:
103.24 	256S.212 RATE SETTING; BASE WAGE INDEX.
103.25 		Subdivision 1.Updating SOC codes. If any of the SOC codes and positions used in 
103.26 	this section are no longer available, the commissioner shall, in consultation with stakeholders, 
103.27 	select a new SOC code and position that is the closest match to the previously used SOC 
103.28 	position.
103.29 		Subd. 2.Home management and support services base wage. For customized living,
103.30 	and foster care, and residential care component services, the home management and support 
103.31 	services base wage equals 33.33 percent of the Minneapolis-St. Paul-Bloomington, MN-WI 
104.1 	MetroSA average wage for home health and personal and home care aide (SOC code 39-9021
104.2 	31-1120); 33.33 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average 
104.3 	wage for food preparation workers (SOC code 35-2021); and 33.34 percent of the 
104.4 	Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for maids and 
104.5 	housekeeping cleaners (SOC code 37-2012).
104.6 		Subd. 3.Home care aide base wage. For customized living, and foster care, and 
104.7 	residential care component services, the home care aide base wage equals 50 75 percent of 
104.8 	the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for home health
104.9 	and personal care aides (SOC code 31-1011 31-1120); and 50 25 percent of the 
104.10 	Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants 
104.11 	(SOC code 31-1014 31-1131).
104.12 		Subd. 4.Home health aide base wage. For customized living, and foster care, and 
104.13 	residential care component services, the home health aide base wage equals 20 33.33 percent 
104.14 	of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for licensed 
104.15 	practical and licensed vocational nurses (SOC code 29-2061); and 80 33.33 percent of the 
104.16 	Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants 
104.17 	(SOC code 31-1014 31-1131); and 33.34 percent of the Minneapolis-St. Paul-Bloomington, 
104.18 	MN-WI MetroSA average wage for home health and personal care aides (SOC code 
104.19 	31-1120).
104.20 		Subd. 5.Medication setups by licensed nurse base wage. For customized living, and
104.21 	foster care, and residential care component services, the medication setups by licensed nurse 
104.22 	base wage equals ten 25 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA 
104.23 	average wage for licensed practical and licensed vocational nurses (SOC code 29-2061); 
104.24 	and 90 75 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average 
104.25 	wage for registered nurses (SOC code 29-1141).
104.26 		Subd. 6.Chore services base wage. The chore services base wage equals 100 50 percent 
104.27 	of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for landscaping 
104.28 	and groundskeeping workers (SOC code 37-3011); and 50 percent of the Minneapolis-St. 
104.29 	Paul-Bloomington, MN-WI MetroSA average wage for maids and housekeeping cleaners 
104.30 	(SOC code 37-2012).
104.31 		Subd. 7.Companion services base wage. The companion services base wage equals 
104.32 	50 80 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage 
104.33 	for home health and personal and home care aides (SOC code 39-9021 31-1120); and 50
105.1 	20 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for 
105.2 	maids and housekeeping cleaners (SOC code 37-2012).
105.3 		Subd. 8.Homemaker services and assistance with personal care base wage. The 
105.4 	homemaker services and assistance with personal care base wage equals 60 50 percent of 
105.5 	the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for home health 
105.6 	and personal and home care aide aides (SOC code 39-9021 31-1120); 20 and 50 percent of 
105.7 	the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants 
105.8 	(SOC code 31-1014 31-1131); and 20 percent of the Minneapolis-St. Paul-Bloomington, 
105.9 	MN-WI MetroSA average wage for maids and housekeeping cleaners (SOC code 37-2012).
105.10 		Subd. 9.Homemaker services and cleaning base wage. The homemaker services and
105.11 	cleaning base wage equals 60 percent of the Minneapolis-St. Paul-Bloomington, MN-WI 
105.12 	MetroSA average wage for personal and home care aide (SOC code 39-9021); 20 percent 
105.13 	of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing 
105.14 	assistants (SOC code 31-1014); and 20 100 percent of the Minneapolis-St. Paul-Bloomington, 
105.15 	MN-WI MetroSA average wage for maids and housekeeping cleaners (SOC code 37-2012).
105.16 		Subd. 10.Homemaker services and home management base wage. The homemaker 
105.17 	services and home management base wage equals 60 50 percent of the Minneapolis-St. 
105.18 	Paul-Bloomington, MN-WI MetroSA average wage for home health and personal and home
105.19 	care aide aides (SOC code 39-9021 31-1120); 20 and 50 percent of the Minneapolis-St. 
105.20 	Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants (SOC code 
105.21 	31-1014 31-1131); and 20 percent of the Minneapolis-St. Paul-Bloomington, MN-WI 
105.22 	MetroSA average wage for maids and housekeeping cleaners (SOC code 37-2012).
105.23 		Subd. 11.In-home respite care services base wage. The in-home respite care services 
105.24 	base wage equals five 15 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA 
105.25 	average wage for registered nurses (SOC code 29-1141); 75 percent of the Minneapolis-St. 
105.26 	Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants home health and 
105.27 	personal care aides (SOC code 31-1014 31-1120); and 20 ten percent of the Minneapolis-St. 
105.28 	Paul-Bloomington, MN-WI MetroSA average wage for licensed practical and licensed 
105.29 	vocational nurses (SOC code 29-2061).
105.30 		Subd. 12.Out-of-home respite care services base wage. The out-of-home respite care 
105.31 	services base wage equals five 15 percent of the Minneapolis-St. Paul-Bloomington, MN-WI 
105.32 	MetroSA average wage for registered nurses (SOC code 29-1141); 75 percent of the 
105.33 	Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants
105.34 	home health and personal care aides (SOC code 31-1014 31-1120); and 20 ten percent of 
106.1 	the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for licensed practical 
106.2 	and licensed vocational nurses (SOC code 29-2061).
106.3 		Subd. 13.Individual community living support base wage. The individual community 
106.4 	living support base wage equals 20 60 percent of the Minneapolis-St. Paul-Bloomington, 
106.5 	MN-WI MetroSA average wage for licensed practical and licensed vocational nurses social 
106.6 	and human services assistants (SOC code 29-2061 21-1093); and 80 40 percent of the 
106.7 	Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants 
106.8 	(SOC code 31-1014 31-1131).
106.9 		Subd. 14.Registered nurse base wage. The registered nurse base wage equals 100 
106.10 	percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for 
106.11 	registered nurses (SOC code 29-1141).
106.12 		Subd. 15.Social worker Unlicensed supervisor base wage. The social worker
106.13 	unlicensed supervisor base wage equals 100 percent of the Minneapolis-St. 
106.14 	Paul-Bloomington, MN-WI MetroSA average wage for medical and public health social
106.15 	first-line supervisors of personal service workers (SOC code 21-1022 39-1022).
106.16 		Subd. 16.Adult day services base wage. The adult day services base wage equals 75 
106.17 	percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for home 
106.18 	health and personal care aides (SOC code 31-1120); and 25 percent of the Minneapolis-St. 
106.19 	Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants (SOC code 
106.20 	31-1131).

106.21 	EFFECTIVE DATE. This section is effective January 1, 2024.

106.22 	Sec. 31. Minnesota Statutes 2022, section 256S.213, is amended to read:
106.23 	256S.213 RATE SETTING; FACTORS.
106.24 		Subdivision 1.Payroll taxes and benefits factor. The payroll taxes and benefits factor 
106.25 	is the sum of net payroll taxes and benefits, divided by the sum of all salaries for all nursing 
106.26 	facilities on the most recent and available cost report.
106.27 		Subd. 2.General and administrative factor. The general and administrative factor is 
106.28 	the difference of net general and administrative expenses and administrative salaries, divided 
106.29 	by total operating expenses for all nursing facilities on the most recent and available cost 
106.30 	report 14.4 percent.
106.31 		Subd. 3.Program plan support factor. (a) The program plan support factor is 12.8 ten
106.32 	percent for the following services to cover the cost of direct service staff needed to provide 
107.1 	support for home and community-based the service when not engaged in direct contact with 
107.2 	participants.:
107.3 	(1) adult day services;
107.4 	(2) customized living; and
107.5 	(3) foster care.
107.6 	(b) The program plan support factor is 15.5 percent for the following services to cover 
107.7 	the cost of direct service staff needed to provide support for the service when not engaged 
107.8 	in direct contact with participants:
107.9 	(1) chore services;
107.10 	(2) companion services;
107.11 	(3) homemaker assistance with personal care;
107.12 	(4) homemaker cleaning;
107.13 	(5) homemaker home management;
107.14 	(6) in-home respite care;
107.15 	(7) individual community living support; and
107.16 	(8) out-of-home respite care.
107.17 		Subd. 4.Registered nurse management and supervision factor wage component. The 
107.18 	registered nurse management and supervision factor wage component equals 15 percent of 
107.19 	the registered nurse adjusted base wage as defined in section 256S.214.
107.20 		Subd. 5.Social worker Unlicensed supervisor supervision factor wage 
107.21 	component. The social worker unlicensed supervisor supervision factor wage component
107.22 	equals 15 percent of the social worker unlicensed supervisor adjusted base wage as defined 
107.23 	in section 256S.214.
107.24 		Subd. 6.Facility and equipment factor. The facility and equipment factor for adult 
107.25 	day services is 16.2 percent.
107.26 		Subd. 7.Food, supplies, and transportation factor. The food, supplies, and 
107.27 	transportation factor for adult day services is 24 percent.
107.28 		Subd. 8.Supplies and transportation factor. The supplies and transportation factor 
107.29 	for the following services is 1.56 percent:
107.30 	(1) chore services;
108.1 	(2) companion services;
108.2 	(3) homemaker assistance with personal care;
108.3 	(4) homemaker cleaning;
108.4 	(5) homemaker home management;
108.5 	(6) in-home respite care;
108.6 	(7) individual community support services; and
108.7 	(8) out-of-home respite care.
108.8 		Subd. 9.Absence factor. The absence factor for the following services is 4.5 percent:
108.9 	(1) adult day services;
108.10 	(2) chore services;
108.11 	(3) companion services;
108.12 	(4) homemaker assistance with personal care;
108.13 	(5) homemaker cleaning;
108.14 	(6) homemaker home management;
108.15 	(7) in-home respite care;
108.16 	(8) individual community living support; and
108.17 	(9) out-of-home respite care.

108.18 	EFFECTIVE DATE. This section is effective January 1, 2024.

108.19 	Sec. 32. Minnesota Statutes 2022, section 256S.214, is amended to read:
108.20 	256S.214 RATE SETTING; ADJUSTED BASE WAGE.
108.21 	For the purposes of section 256S.215, the adjusted base wage for each position equals 
108.22 	the position's base wage under section 256S.212 plus:
108.23 	(1) the position's base wage multiplied by the payroll taxes and benefits factor under 
108.24 	section 256S.213, subdivision 1;
108.25 	(2) the position's base wage multiplied by the general and administrative factor under 
108.26 	section 256S.213, subdivision 2; and
108.27 	(3) (2) the position's base wage multiplied by the applicable program plan support factor 
108.28 	under section 256S.213, subdivision 3.; and
109.1 	(3) the position's base wage multiplied by the absence factor under section 256S.213, 
109.2 	subdivision 9, if applicable.

109.3 	EFFECTIVE DATE. This section is effective January 1, 2024.

109.4 	Sec. 33. Minnesota Statutes 2022, section 256S.215, subdivision 2, is amended to read:
109.5 		Subd. 2.Home management and support services component rate. The component 
109.6 	rate for home management and support services is calculated as follows:
109.7 	(1) sum the home management and support services adjusted base wage plus and the 
109.8 	registered nurse management and supervision factor. wage component;
109.9 	(2) multiply the result of clause (1) by the general and administrative factor; and
109.10 	(3) sum the results of clauses (1) and (2).

109.11 	Sec. 34. Minnesota Statutes 2022, section 256S.215, subdivision 3, is amended to read:
109.12 		Subd. 3.Home care aide services component rate. The component rate for home care 
109.13 	aide services is calculated as follows:
109.14 	(1) sum the home health aide services adjusted base wage plus and the registered nurse 
109.15 	management and supervision factor. wage component;
109.16 	(2) multiply the result of clause (1) by the general and administrative factor; and
109.17 	(3) sum the results of clauses (1) and (2).

109.18 	EFFECTIVE DATE. This section is effective January 1, 2024.

109.19 	Sec. 35. Minnesota Statutes 2022, section 256S.215, subdivision 4, is amended to read:
109.20 		Subd. 4.Home health aide services component rate. The component rate for home 
109.21 	health aide services is calculated as follows:
109.22 	(1) sum the home health aide services adjusted base wage plus and the registered nurse 
109.23 	management and supervision factor. wage component;
109.24 	(2) multiply the result of clause (1) by the general and administrative factor; and
109.25 	(3) sum the results of clauses (1) and (2).

109.26 	EFFECTIVE DATE. This section is effective January 1, 2024.

110.1 	Sec. 36. Minnesota Statutes 2022, section 256S.215, subdivision 7, is amended to read:
110.2 		Subd. 7.Chore services rate. The 15-minute unit rate for chore services is calculated 
110.3 	as follows:
110.4 	(1) sum the chore services adjusted base wage and the social worker unlicensed supervisor
110.5 	supervision factor wage component; and
110.6 	(2) multiply the result of clause (1) by the general and administrative factor;
110.7 	(3) multiply the result of clause (1) by the supplies and transportation factor; and
110.8 	(4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.

110.9 	EFFECTIVE DATE. This section is effective January 1, 2024.

110.10 	Sec. 37. Minnesota Statutes 2022, section 256S.215, subdivision 8, is amended to read:
110.11 		Subd. 8.Companion services rate. The 15-minute unit rate for companion services is 
110.12 	calculated as follows:
110.13 	(1) sum the companion services adjusted base wage and the social worker unlicensed 
110.14 	supervisor supervision factor wage component; and
110.15 	(2) multiply the result of clause (1) by the general and administrative factor;
110.16 	(3) multiply the result of clause (1) by the supplies and transportation factor; and
110.17 	(4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.

110.18 	EFFECTIVE DATE. This section is effective January 1, 2024.

110.19 	Sec. 38. Minnesota Statutes 2022, section 256S.215, subdivision 9, is amended to read:
110.20 		Subd. 9.Homemaker services and assistance with personal care rate. The 15-minute 
110.21 	unit rate for homemaker services and assistance with personal care is calculated as follows:
110.22 	(1) sum the homemaker services and assistance with personal care adjusted base wage 
110.23 	and the registered nurse management and unlicensed supervisor supervision factor wage 
110.24 	component; and
110.25 	(2) multiply the result of clause (1) by the general and administrative factor;
110.26 	(3) multiply the result of clause (1) by the supplies and transportation factor; and
110.27 	(4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.

110.28 	EFFECTIVE DATE. This section is effective January 1, 2024.

111.1 	Sec. 39. Minnesota Statutes 2022, section 256S.215, subdivision 10, is amended to read:
111.2 		Subd. 10.Homemaker services and cleaning rate. The 15-minute unit rate for 
111.3 	homemaker services and cleaning is calculated as follows:
111.4 	(1) sum the homemaker services and cleaning adjusted base wage and the registered 
111.5 	nurse management and unlicensed supervisor supervision factor wage component; and
111.6 	(2) multiply the result of clause (1) by the general and administrative factor;
111.7 	(3) multiply the result of clause (1) by the supplies and transportation factor; and
111.8 	(4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.

111.9 	EFFECTIVE DATE. This section is effective January 1, 2024.

111.10 	Sec. 40. Minnesota Statutes 2022, section 256S.215, subdivision 11, is amended to read:
111.11 		Subd. 11.Homemaker services and home management rate. The 15-minute unit rate 
111.12 	for homemaker services and home management is calculated as follows:
111.13 	(1) sum the homemaker services and home management adjusted base wage and the
111.14 	registered nurse management and unlicensed supervisor supervision factor wage component; 
111.15 	and
111.16 	(2) multiply the result of clause (1) by the general and administrative factor;
111.17 	(3) multiply the result of clause (1) by the supplies and transportation factor; and
111.18 	(4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.

111.19 	EFFECTIVE DATE. This section is effective January 1, 2024.

111.20 	Sec. 41. Minnesota Statutes 2022, section 256S.215, subdivision 12, is amended to read:
111.21 		Subd. 12.In-home respite care services rates. (a) The 15-minute unit rate for in-home 
111.22 	respite care services is calculated as follows:
111.23 	(1) sum the in-home respite care services adjusted base wage and the registered nurse 
111.24 	management and supervision factor wage component; and
111.25 	(2) multiply the result of clause (1) by the general and administrative factor;
111.26 	(3) multiply the result of clause (1) by the supplies and transportation factor; and
111.27 	(4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.
112.1 	(b) The in-home respite care services daily rate equals the in-home respite care services 
112.2 	15-minute unit rate multiplied by 18.

112.3 	EFFECTIVE DATE. This section is effective January 1, 2024.

112.4 	Sec. 42. Minnesota Statutes 2022, section 256S.215, subdivision 13, is amended to read:
112.5 		Subd. 13.Out-of-home respite care services rates. (a) The 15-minute unit rate for 
112.6 	out-of-home respite care is calculated as follows:
112.7 	(1) sum the out-of-home respite care services adjusted base wage and the registered 
112.8 	nurse management and supervision factor wage component; and
112.9 	(2) multiply the result of clause (1) by the general and administrative factor;
112.10 	(3) multiply the result of clause (1) by the supplies and transportation factor; and
112.11 	(4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.
112.12 	(b) The out-of-home respite care services daily rate equals the 15-minute unit rate for 
112.13 	out-of-home respite care services multiplied by 18.

112.14 	EFFECTIVE DATE. This section is effective January 1, 2024.

112.15 	Sec. 43. Minnesota Statutes 2022, section 256S.215, subdivision 14, is amended to read:
112.16 		Subd. 14.Individual community living support rate. The individual community living 
112.17 	support rate is calculated as follows:
112.18 	(1) sum the home care aide individual community living support adjusted base wage 
112.19 	and the social worker registered nurse management and supervision factor wage component; 
112.20 	and
112.21 	(2) multiply the result of clause (1) by the general and administrative factor;
112.22 	(3) multiply the result of clause (1) by the supplies and transportation factor; and
112.23 	(4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.

112.24 	EFFECTIVE DATE. This section is effective January 1, 2024.

112.25 	Sec. 44. Minnesota Statutes 2022, section 256S.215, subdivision 15, is amended to read:
112.26 		Subd. 15.Home-delivered meals rate. Effective January 1, 2024, the home-delivered 
112.27 	meals rate equals $9.30 is $8.17, updated as directed in section 256S.211, subdivision 4. 
112.28 	The commissioner shall increase the home delivered meals rate every July 1 by the percent 
113.1 	increase in the nursing facility dietary per diem using the two most recent and available 
113.2 	nursing facility cost reports.

113.3 	EFFECTIVE DATE. This section is effective July 1, 2023.

113.4 	Sec. 45. Minnesota Statutes 2022, section 256S.215, subdivision 16, is amended to read:
113.5 		Subd. 16.Adult day services rate. The 15-minute unit rate for adult day services, with 
113.6 	an assumed staffing ratio of one staff person to four participants, is the sum of is calculated 
113.7 	as follows:
113.8 	(1) one-sixteenth of the home care aide divide the adult day services adjusted base wage, 
113.9 	except that the general and administrative factor used to determine the home care aide 
113.10 	services adjusted base wage is 20 percent by five to reflect an assumed staffing ratio of one 
113.11 	to five;
113.12 	(2) one-fourth of the registered nurse management and supervision factor sum the result 
113.13 	of clause (1) and the registered nurse management and supervision wage component; and
113.14 	(3) $0.63 to cover the cost of meals. multiply the result of clause (2) by the general and 
113.15 	administrative factor;
113.16 	(4) multiply the result of clause (2) by the facility and equipment factor;
113.17 	(5) multiply the result of clause (2) by the food, supplies, and transportation factor; and
113.18 	(6) sum the results of clauses (2) to (5) and divide the result by four.

113.19 	EFFECTIVE DATE. This section is effective January 1, 2024.

113.20 	Sec. 46. Minnesota Statutes 2022, section 256S.215, subdivision 17, is amended to read:
113.21 		Subd. 17.Adult day services bath rate. The 15-minute unit rate for adult day services 
113.22 	bath is the sum of calculated as follows:
113.23 	(1) one-fourth of the home care aide sum the adult day services adjusted base wage, 
113.24 	except that the general and administrative factor used to determine the home care aide 
113.25 	services adjusted base wage is 20 percent and the nurse management and supervision wage 
113.26 	component;
113.27 	(2) one-fourth of the registered nurse management and supervision multiply the result 
113.28 	of clause (1) by the general and administrative factor; and
113.29 	(3) $0.63 to cover the cost of meals. multiply the result of clause (1) by the facility and 
113.30 	equipment factor;
114.1 	(4) multiply the result of clause (1) by the food, supplies, and transportation factor; and
114.2 	(5) sum the results of clauses (1) to (4) and divide the result by four.

114.3 	EFFECTIVE DATE. This section is effective January 1, 2024.

114.4 	Sec. 47. DIRECTION TO COMMISSIONER; FUTURE PACE IMPLEMENTATION 
114.5 	FUNDING.
 114.6 	The commissioner of human services must work with stakeholders to develop 
114.7 	recommendations for financing mechanisms to complete the actuarial work and cover the 
114.8 	administrative costs of a program of all-inclusive care for the elderly (PACE). The 
114.9 	commissioner must recommend a financing mechanism that could begin July 1, 2025. By 
114.10 	December 15, 2023, the commissioner shall inform the chairs and ranking minority members 
114.11 	of the legislative committees with jurisdiction over health care finance on the commissioner's 
114.12 	progress toward developing a recommended financing mechanism.

114.13 	Sec. 48. DIRECTION TO COMMISSIONER; CAREGIVER RESPITE SERVICES 
114.14 	GRANTS.
 114.15 	Beginning in fiscal year 2025, the commissioner of human services must continue the 
114.16 	respite services for older adults grant program established under Laws 2021, First Special 
114.17 	Session chapter 7, article 17, section 17, subdivision 3, under the authority granted under 
114.18 	Minnesota Statutes, section 256.9756. The commissioner may begin the grant application 
114.19 	process for awarding grants under Minnesota Statutes, section 256.9756, during fiscal year 
114.20 	2024 in order to facilitate the continuity of the grant program during the transition from a 
114.21 	temporary program to a permanent one.

114.22 	Sec. 49. NURSING FACILITY FUNDING.
 114.23 	(a) Effective July 1, 2023, through June 30, 2025, the total payment rate for all facilities 
114.24 	reimbursed under Minnesota Statutes, chapter 256R, must be increased by an amount per 
114.25 	resident day equal to a net state general fund expenditure of $37,045,000 in fiscal year 2024 
114.26 	and $37,045,000 in fiscal year 2025. Effective July 1, 2025, the total payment rate for all 
114.27 	facilities reimbursed under Minnesota Statutes, chapter 256R, must be increased by an 
114.28 	amount per resident day equal to a net state expenditure of $23,698,000 per fiscal year. The 
114.29 	rate increases under this paragraph are add-ons to the facilities' rates calculated under 
114.30 	Minnesota Statutes, chapter 256R.
114.31 	(b) To be eligible to receive a payment under this section, a nursing facility must attest 
114.32 	to the commissioner of human services that the additional revenue will be used exclusively 
115.1 	to increase compensation-related costs for employees directly employed by the facility on 
115.2 	or after July 1, 2023, excluding:
115.3 	(1) owners of the building and operation;
115.4 	(2) persons employed in the central office of an entity that has any ownership interest 
115.5 	in the nursing facility or exercises control over the nursing facility;
115.6 	(3) persons paid by the nursing facility under a management contract; and
115.7 	(4) persons providing separately billable services.
115.8 	(c) Contracted housekeeping, dietary, and laundry employees providing services on site 
115.9 	at the nursing facility are eligible for compensation-related cost increases under this section, 
115.10 	provided the agency that employs them submits to the nursing facility proof of the costs of 
115.11 	the increases provided to those employees.
115.12 	(d) For purposes of this section, compensation-related costs include:
115.13 	(1) permanent new increases to wages and salaries implemented on or after July 1, 2023, 
115.14 	and before September 1, 2023, for nursing facility employees;
115.15 	(2) permanent new increases to wages and salaries implemented on or after July 1, 2023, 
115.16 	and before September 1, 2023, for employees in the organization's shared services 
115.17 	departments of hospital-attached nursing facilities for the nursing facility allocated share 
115.18 	of wages; and
115.19 	(3) the employer's share of FICA taxes, Medicare taxes, state and federal unemployment 
115.20 	taxes, PERA, workers' compensation, and pension and employee retirement accounts directly 
115.21 	associated with the wage and salary increases in clauses (1) and (2) incurred no later than 
115.22 	December 31, 2025, and paid for no later than June 30, 2026.
115.23 	(e) A facility that receives a rate increase under this section must complete a distribution 
115.24 	plan in the form and manner determined by the commissioner. This plan must specify the 
115.25 	total amount of money the facility is estimated to receive from this rate increase and how 
115.26 	that money will be distributed to increase the allowable compensation-related costs described 
115.27 	in paragraph (d) for employees described in paragraphs (b) and (c). This estimate must be 
115.28 	computed by multiplying $28.65 by the sum of the medical assistance and private pay 
115.29 	resident days as defined in Minnesota Statutes, section 256R.02, subdivision 45, for the 
115.30 	period beginning October 1, 2021, through September 30, 2022, dividing this sum by 365 
115.31 	and multiplying the result by 915. A facility must submit its distribution plan to the 
115.32 	commissioner by October 1, 2023. The commissioner may review the distribution plan to 
115.33 	ensure that the payment rate adjustment per resident day is used in accordance with this 
116.1 	section. The commissioner may allow for a distribution plan amendment under exceptional 
116.2 	circumstances to be determined at the sole discretion of the commissioner.
116.3 	(f) By September 1, 2023, a facility must post the distribution plan summary and leave 
116.4 	it posted for a period of at least six months in an area of the facility to which all employees 
116.5 	have access. The posted distribution plan summary must be in the form and manner 
116.6 	determined by the commissioner. The distribution plan summary must include instructions 
116.7 	regarding how to contact the commissioner, or the commissioner's representative, if an 
116.8 	employee believes the employee is covered by paragraph (b) or (c) and has not received the 
116.9 	compensation-related increases described in paragraph (d). The instruction to such employees 
116.10 	must include the e-mail address and telephone number that may be used by the employee 
116.11 	to contact the commissioner's representative. The posted distribution plan summary must 
116.12 	demonstrate how the increase in paragraph (a) received by the nursing facility from July 1, 
116.13 	2023, through December 1, 2025, will be used in full to pay the compensation-related costs 
116.14 	in paragraph (d) for employees described in paragraphs (b) and (c).
116.15 	(g) If the nursing facility expends less on new compensation-related costs than the amount 
116.16 	that was made available by the rate increase in this section for that purpose, the amount of 
116.17 	this rate adjustment must be reduced to equal the amount utilized by the facility for purposes 
116.18 	authorized under this section. If the facility fails to post the distribution plan summary in 
116.19 	its facility as required, fails to submit its distribution plan to the commissioner by the due 
116.20 	date, or uses the money for unauthorized purposes, these rate increases must be treated as 
116.21 	an overpayment and subsequently recovered.
116.22 	(h) The commissioner shall not treat payments received under this section as an applicable 
116.23 	credit for purposes of setting total payment rates under Minnesota Statutes, chapter 256R.

116.24 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
116.25 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
116.26 	when federal approval is obtained.

116.27 	Sec. 50. INCREASED MEDICAL ASSISTANCE INCOME LIMIT FOR OLDER 
116.28 	ADULTS AND PERSONS WITH DISABILITIES.
 116.29 	Effective July 1, 2023, the commissioner of human services must increase the income 
116.30 	limit under Minnesota Statutes, section 256B.056, subdivision 4, paragraph (a), to a level 
116.31 	that is projected to result in a net cost to the state of $5,000,000 for the 2026-2027 biennium.

117.1 	Sec. 51. RETURN FORECASTED FUNDS TO NURSING FACILITIES.
 117.2 	(a) The commissioner shall use the estimated total annual payments for nursing facilities 
117.3 	from the Department of Human Services February 2023 forecast for fiscal years 2023, 2024, 
117.4 	2025, 2026, and 2027 for the rate add-ons as directed in paragraphs (b) to (f). The add-ons 
117.5 	described below are only implemented when they result in an increase.
117.6 	(b) For the year beginning January 1, 2024, the commissioner shall determine the amount 
117.7 	of unspent forecast funds by subtracting the actual total annual state, federal, and county 
117.8 	payments for fiscal year 2023 from the amount specified in paragraph (a) for 2023. The 
117.9 	amount shall be converted into an equal per resident day increase and applied as an add-on 
117.10 	to all nursing facilities' rates.
117.11 	(c) For the year beginning January 1, 2025, the commissioner shall determine the amount 
117.12 	of unspent forecast funds by subtracting the actual total annual state, federal, and county 
117.13 	payments for fiscal year 2024 from the amount specified in paragraph (a) for 2024. The 
117.14 	amount shall be converted into an equal per resident day increase and applied as an add-on 
117.15 	to all nursing facilities' rates.
117.16 	(d) For the year beginning January 1, 2026, the commissioner shall determine the amount 
117.17 	of unspent forecast funds by subtracting the actual total annual state, federal, and county 
117.18 	payments for fiscal year 2025 from the amount specified in paragraph (a) for 2025. The 
117.19 	amount shall be converted into an equal per resident day increase and applied as an add-on 
117.20 	to all nursing facilities' rates.
117.21 	(e) For the year beginning January 1, 2027, the commissioner shall determine the amount 
117.22 	of unspent forecast funds by subtracting the actual total annual state, federal, and county 
117.23 	payments for fiscal year 2026 from the amount specified in paragraph (a) for 2026. The 
117.24 	amount shall be converted into an equal per resident day increase and applied as an add-on 
117.25 	to all nursing facilities' rates.
117.26 	(f) For the year beginning January 1, 2028, the commissioner shall determine the amount 
117.27 	of unspent forecast funds by subtracting the actual total annual state, federal, and county 
117.28 	payments for fiscal year 2027 from the amount specified in paragraph (a) for 2027. The 
117.29 	amount shall be converted into an equal per resident day increase and applied as an add-on 
117.30 	to all nursing facilities' rates.

118.1 	Sec. 52. SENIOR HOUSING-RELATED STRESS AND MENTAL HEALTH 
118.2 	PREVENTION.
 118.3 	(a) In order to prevent inordinate mental health stress and financial distress for seniors 
118.4 	and persons with disabilities, effective for any lease agreement entered into on or after July 
118.5 	1, 2023, any properties owned by a corporation founded in 1992; domiciled in Minnesota, 
118.6 	with over 38,000 properties in 19 states as of January 1, 2023; and leasing properties in 
118.7 	Coon Rapids, Blaine, Champlin, and elsewhere in Minnesota must not increase rents by 
118.8 	over three percent per year for any resident.
118.9 	(b) Any rent increases for residents of a property described in paragraph (a) exceeding 
118.10 	three percent per year effective on or after January 1, 2022, must be credited by the 
118.11 	corporation described in paragraph (a) to the affected lessees.
118.12 	(c) Any fees charged to residents of a property described in paragraph (a) for repairs 
118.13 	occurring on or after July 1, 2023, must not exceed actual costs.
118.14 	(d) Beginning July 1, 2023, all residents of a property described in paragraph (a) must 
118.15 	be permitted to park one resident-owned vehicle per unit in an indoor garage at no cost.

118.16 	EFFECTIVE DATE. This section is effective retroactively from January 1, 2022.

118.17 	Sec. 53. REVISOR INSTRUCTION.
 118.18 	The revisor of statutes shall change the headnote in Minnesota Statutes, section 
118.19 	256B.0917, from "HOME AND COMMUNITY-BASED SERVICES FOR OLDER 
118.20 	ADULTS" to "ELDERCARE DEVELOPMENT PARTNERSHIPS."

118.21 	Sec. 54. REPEALER.
 118.22 	(a) Minnesota Statutes 2022, section 256B.0917, subdivisions 1a, 6, 7a, and 13, are 
118.23 	repealed.
118.24 	(b) Minnesota Statutes 2022, section 256S.19, subdivision 4, is repealed.

118.25 	EFFECTIVE DATE. Paragraph (a) is effective July 1, 2023. Paragraph (b) is effective 
118.26 	January 1, 2024.

119.1 	ARTICLE 3
119.2 	HEALTH CARE

119.3 	Section 1. Minnesota Statutes 2022, section 252.27, subdivision 2a, is amended to read:
119.4 		Subd. 2a.Contribution amount. (a) The natural or adoptive parents of a minor child, 
119.5 	not including a child determined eligible for medical assistance without consideration of 
119.6 	parental income under the Tax Equity and Fiscal Responsibility Act (TEFRA) option or a 
119.7 	child accessing home and community-based waiver services, must contribute to the cost of 
119.8 	services used by making monthly payments on a sliding scale based on income, unless the 
119.9 	child is married or has been married, parental rights have been terminated, or the child's 
119.10 	adoption is subsidized according to chapter 259A or through title IV-E of the Social Security 
119.11 	Act. The parental contribution is a partial or full payment for medical services provided for 
119.12 	diagnostic, therapeutic, curing, treating, mitigating, rehabilitation, maintenance, and personal 
119.13 	care services as defined in United States Code, title 26, section 213, needed by the child 
119.14 	with a chronic illness or disability.
119.15 	(b) For households with adjusted gross income equal to or greater than 275 percent of 
119.16 	federal poverty guidelines, the parental contribution shall be computed by applying the 
119.17 	following schedule of rates to the adjusted gross income of the natural or adoptive parents:
119.18 	(1) if the adjusted gross income is equal to or greater than 275 percent of federal poverty 
119.19 	guidelines and less than or equal to 545 percent of federal poverty guidelines, the parental 
119.20 	contribution shall be determined using a sliding fee scale established by the commissioner 
119.21 	of human services which begins at 1.65 percent of adjusted gross income at 275 percent of 
119.22 	federal poverty guidelines and increases to 4.5 percent of adjusted gross income for those 
119.23 	with adjusted gross income up to 545 percent of federal poverty guidelines;
119.24 	(2) if the adjusted gross income is greater than 545 percent of federal poverty guidelines 
119.25 	and less than 675 percent of federal poverty guidelines, the parental contribution shall be 
119.26 	4.5 percent of adjusted gross income;
119.27 	(3) if the adjusted gross income is equal to or greater than 675 percent of federal poverty 
119.28 	guidelines and less than 975 percent of federal poverty guidelines, the parental contribution 
119.29 	shall be determined using a sliding fee scale established by the commissioner of human 
119.30 	services which begins at 4.5 percent of adjusted gross income at 675 percent of federal 
119.31 	poverty guidelines and increases to 5.99 percent of adjusted gross income for those with 
119.32 	adjusted gross income up to 975 percent of federal poverty guidelines; and
119.33 	(4) if the adjusted gross income is equal to or greater than 975 percent of federal poverty 
119.34 	guidelines, the parental contribution shall be 7.49 percent of adjusted gross income.
120.1 	If the child lives with the parent, the annual adjusted gross income is reduced by $2,400 
120.2 	prior to calculating the parental contribution. If the child resides in an institution specified 
120.3 	in section 256B.35, the parent is responsible for the personal needs allowance specified 
120.4 	under that section in addition to the parental contribution determined under this section. 
120.5 	The parental contribution is reduced by any amount required to be paid directly to the child 
120.6 	pursuant to a court order, but only if actually paid.
120.7 	(c) The household size to be used in determining the amount of contribution under 
120.8 	paragraph (b) includes natural and adoptive parents and their dependents, including the 
120.9 	child receiving services. Adjustments in the contribution amount due to annual changes in 
120.10 	the federal poverty guidelines shall be implemented on the first day of July following 
120.11 	publication of the changes.
120.12 	(d) For purposes of paragraph (b), "income" means the adjusted gross income of the 
120.13 	natural or adoptive parents determined according to the previous year's federal tax form, 
120.14 	except, effective retroactive to July 1, 2003, taxable capital gains to the extent the funds 
120.15 	have been used to purchase a home shall not be counted as income.
120.16 	(e) The contribution shall be explained in writing to the parents at the time eligibility 
120.17 	for services is being determined. The contribution shall be made on a monthly basis effective 
120.18 	with the first month in which the child receives services. Annually upon redetermination 
120.19 	or at termination of eligibility, if the contribution exceeded the cost of services provided, 
120.20 	the local agency or the state shall reimburse that excess amount to the parents, either by 
120.21 	direct reimbursement if the parent is no longer required to pay a contribution, or by a 
120.22 	reduction in or waiver of parental fees until the excess amount is exhausted. All 
120.23 	reimbursements must include a notice that the amount reimbursed may be taxable income 
120.24 	if the parent paid for the parent's fees through an employer's health care flexible spending 
120.25 	account under the Internal Revenue Code, section 125, and that the parent is responsible 
120.26 	for paying the taxes owed on the amount reimbursed.
120.27 	(f) The monthly contribution amount must be reviewed at least every 12 months; when 
120.28 	there is a change in household size; and when there is a loss of or gain in income from one 
120.29 	month to another in excess of ten percent. The local agency shall mail a written notice 30 
120.30 	days in advance of the effective date of a change in the contribution amount. A decrease in 
120.31 	the contribution amount is effective in the month that the parent verifies a reduction in 
120.32 	income or change in household size.
120.33 	(g) Parents of a minor child who do not live with each other shall each pay the 
120.34 	contribution required under paragraph (a). An amount equal to the annual court-ordered 
121.1 	child support payment actually paid on behalf of the child receiving services shall be deducted 
121.2 	from the adjusted gross income of the parent making the payment prior to calculating the 
121.3 	parental contribution under paragraph (b).
121.4 	(h) The contribution under paragraph (b) shall be increased by an additional five percent 
121.5 	if the local agency determines that insurance coverage is available but not obtained for the 
121.6 	child. For purposes of this section, "available" means the insurance is a benefit of employment 
121.7 	for a family member at an annual cost of no more than five percent of the family's annual 
121.8 	income. For purposes of this section, "insurance" means health and accident insurance 
121.9 	coverage, enrollment in a nonprofit health service plan, health maintenance organization, 
121.10 	self-insured plan, or preferred provider organization.
121.11 	Parents who have more than one child receiving services shall not be required to pay 
121.12 	more than the amount for the child with the highest expenditures. There shall be no resource 
121.13 	contribution from the parents. The parent shall not be required to pay a contribution in 
121.14 	excess of the cost of the services provided to the child, not counting payments made to 
121.15 	school districts for education-related services. Notice of an increase in fee payment must 
121.16 	be given at least 30 days before the increased fee is due.
121.17 	(i) The contribution under paragraph (b) shall be reduced by $300 per fiscal year if, in 
121.18 	the 12 months prior to July 1:
121.19 	(1) the parent applied for insurance for the child;
121.20 	(2) the insurer denied insurance;
121.21 	(3) the parents submitted a complaint or appeal, in writing to the insurer, submitted a 
121.22 	complaint or appeal, in writing, to the commissioner of health or the commissioner of 
121.23 	commerce, or litigated the complaint or appeal; and
121.24 	(4) as a result of the dispute, the insurer reversed its decision and granted insurance.
121.25 	For purposes of this section, "insurance" has the meaning given in paragraph (h).
121.26 	A parent who has requested a reduction in the contribution amount under this paragraph 
121.27 	shall submit proof in the form and manner prescribed by the commissioner or county agency, 
121.28 	including, but not limited to, the insurer's denial of insurance, the written letter or complaint 
121.29 	of the parents, court documents, and the written response of the insurer approving insurance. 
121.30 	The determinations of the commissioner or county agency under this paragraph are not rules 
121.31 	subject to chapter 14.

122.1 	Sec. 2. Minnesota Statutes 2022, section 256B.04, is amended by adding a subdivision to 
122.2 	read:
122.3 		Subd. 26.Notice of employed persons with disabilities program. At the time of initial 
122.4 	enrollment and at least annually thereafter, the commissioner shall provide information on 
122.5 	the medical assistance program for employed persons with disabilities under section 
122.6 	256B.057, subdivision 9, to all medical assistance enrollees who indicate they have a 
122.7 	disability.

122.8 	Sec. 3. Minnesota Statutes 2022, section 256B.056, subdivision 3, is amended to read:
122.9 		Subd. 3.Asset limitations for certain individuals. (a) To be eligible for medical 
122.10 	assistance, a person must not individually own more than $3,000 in assets, or if a member 
122.11 	of a household with two family members, husband and wife, or parent and child, the 
122.12 	household must not own more than $6,000 in assets, plus $200 for each additional legal 
122.13 	dependent. In addition to these maximum amounts, an eligible individual or family may 
122.14 	accrue interest on these amounts, but they must be reduced to the maximum at the time of 
122.15 	an eligibility redetermination. The accumulation of the clothing and personal needs allowance 
122.16 	according to section 256B.35 must also be reduced to the maximum at the time of the 
122.17 	eligibility redetermination. The value of assets that are not considered in determining 
122.18 	eligibility for medical assistance is the value of those assets excluded under the Supplemental 
122.19 	Security Income program for aged, blind, and disabled persons, with the following 
122.20 	exceptions:
122.21 	(1) household goods and personal effects are not considered;
122.22 	(2) capital and operating assets of a trade or business that the local agency determines 
122.23 	are necessary to the person's ability to earn an income are not considered;
122.24 	(3) motor vehicles are excluded to the same extent excluded by the Supplemental Security 
122.25 	Income program;
122.26 	(4) assets designated as burial expenses are excluded to the same extent excluded by the 
122.27 	Supplemental Security Income program. Burial expenses funded by annuity contracts or 
122.28 	life insurance policies must irrevocably designate the individual's estate as contingent 
122.29 	beneficiary to the extent proceeds are not used for payment of selected burial expenses;
122.30 	(5) for a person who no longer qualifies as an employed person with a disability due to 
122.31 	loss of earnings, assets allowed while eligible for medical assistance under section 256B.057, 
122.32 	subdivision 9, are not considered for 12 months, beginning with the first month of ineligibility 
123.1 	as an employed person with a disability, to the extent that the person's total assets remain 
123.2 	within the allowed limits of section 256B.057, subdivision 9, paragraph (d);
123.3 	(6) a designated employment incentives asset account is disregarded when determining 
123.4 	eligibility for medical assistance for a person age 65 years or older under section 256B.055, 
123.5 	subdivision 7. An employment incentives asset account must only be designated by a person 
123.6 	who has been enrolled in medical assistance under section 256B.057, subdivision 9, for a 
123.7 	24-consecutive-month period. A designated employment incentives asset account contains 
123.8 	qualified assets owned by the person and the person's spouse in the last month of enrollment 
123.9 	in medical assistance under section 256B.057, subdivision 9. Qualified assets include 
123.10 	retirement and pension accounts, medical expense accounts, and up to $17,000 of the person's 
123.11 	other nonexcluded liquid assets. An employment incentives asset account is no longer 
123.12 	designated when a person loses medical assistance eligibility for a calendar month or more 
123.13 	before turning age 65. A person who loses medical assistance eligibility before age 65 can 
123.14 	establish a new designated employment incentives asset account by establishing a new 
123.15 	24-consecutive-month period of enrollment under section 256B.057, subdivision 9. The 
123.16 	income of a spouse of a person enrolled in medical assistance under section 256B.057, 
123.17 	subdivision 9, during each of the 24 consecutive months before the person's 65th birthday 
123.18 	must be disregarded when determining eligibility for medical assistance under section 
123.19 	256B.055, subdivision 7. Persons eligible under this clause are not subject to the provisions 
123.20 	in section 256B.059; and
123.21 	(7) effective July 1, 2009, certain assets owned by American Indians are excluded as 
123.22 	required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public 
123.23 	Law 111-5. For purposes of this clause, an American Indian is any person who meets the 
123.24 	definition of Indian according to Code of Federal Regulations, title 42, section 447.50.
123.25 	(b) No asset limit shall apply to persons eligible under section sections256B.055, 
123.26 	subdivision 15, and 256B.057, subdivision 9.

123.27 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
123.28 	whichever occurs later. The commissioner of human services shall notify the revisor of 
123.29 	statutes when federal approval is obtained.

123.30 	Sec. 4. Minnesota Statutes 2022, section 256B.057, subdivision 9, is amended to read:
123.31 		Subd. 9.Employed persons with disabilities. (a) Medical assistance may be paid for 
123.32 	a person who is employed and who:
124.1 	(1) but for excess earnings or assets, meets the definition of disabled under the 
124.2 	Supplemental Security Income program;
124.3 	(2) meets the asset limits in paragraph (d); and
124.4 	(3) pays a premium and other obligations under paragraph (e).
124.5 	(b) For purposes of eligibility, there is a $65 earned income disregard. To be eligible 
124.6 	for medical assistance under this subdivision, a person must have more than $65 of earned 
124.7 	income. Earned income must have Medicare, Social Security, and applicable state and 
124.8 	federal taxes withheld. The person must document earned income tax withholding. Any 
124.9 	spousal income or assets shall be disregarded for purposes of eligibility and premium 
124.10 	determinations.
124.11 	(c) After the month of enrollment, a person enrolled in medical assistance under this 
124.12 	subdivision who:
124.13 	(1) is temporarily unable to work and without receipt of earned income due to a medical 
124.14 	condition, as verified by a physician, advanced practice registered nurse, or physician 
124.15 	assistant; or
124.16 	(2) loses employment for reasons not attributable to the enrollee, and is without receipt 
124.17 	of earned income may retain eligibility for up to four consecutive months after the month 
124.18 	of job loss. To receive a four-month extension, enrollees must verify the medical condition 
124.19 	or provide notification of job loss. All other eligibility requirements must be met and the 
124.20 	enrollee must pay all calculated premium costs for continued eligibility.
124.21 	(d) For purposes of determining eligibility under this subdivision, a person's assets must 
124.22 	not exceed $20,000, excluding:
124.23 	(1) all assets excluded under section 256B.056;
124.24 	(2) retirement accounts, including individual accounts, 401(k) plans, 403(b) plans, Keogh 
124.25 	plans, and pension plans;
124.26 	(3) medical expense accounts set up through the person's employer; and
124.27 	(4) spousal assets, including spouse's share of jointly held assets.
124.28 	(e) All enrollees must pay a premium to be eligible for medical assistance under this 
124.29 	subdivision, except as provided under clause (5).
124.30 	(1) An enrollee must pay the greater of a $35 premium or the premium calculated based 
124.31 	on the person's gross earned and unearned income and the applicable family size using a 
124.32 	sliding fee scale established by the commissioner, which begins at one percent of income 
125.1 	at 100 percent of the federal poverty guidelines and increases to 7.5 percent of income for 
125.2 	those with incomes at or above 300 percent of the federal poverty guidelines.
125.3 	(2) Annual adjustments in the premium schedule based upon changes in the federal 
125.4 	poverty guidelines shall be effective for premiums due in July of each year.
125.5 	(3) All enrollees who receive unearned income must pay one-half of one percent of 
125.6 	unearned income in addition to the premium amount, except as provided under clause (5).
125.7 	(4) (d) Increases in benefits under title II of the Social Security Act shall not be counted 
125.8 	as income for purposes of this subdivision until July 1 of each year.
125.9 	(5) Effective July 1, 2009, American Indians are exempt from paying premiums as 
125.10 	required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public 
125.11 	Law 111-5. For purposes of this clause, an American Indian is any person who meets the 
125.12 	definition of Indian according to Code of Federal Regulations, title 42, section 447.50.
125.13 	(f) (e) A person's eligibility and premium shall be determined by the local county agency. 
125.14 	Premiums must be paid to the commissioner. All premiums are dedicated to the 
125.15 	commissioner.
125.16 	(g) Any required premium shall be determined at application and redetermined at the 
125.17 	enrollee's six-month income review or when a change in income or household size is reported.
125.18 	(f) Enrollees must report any change in income or household size within ten days of when 
125.19 	the change occurs. A decreased premium resulting from a reported change in income or 
125.20 	household size shall be effective the first day of the next available billing month after the 
125.21 	change is reported. Except for changes occurring from annual cost-of-living increases, a 
125.22 	change resulting in an increased premium shall not affect the premium amount until the 
125.23 	next six-month review.
125.24 	(h) Premium payment is due upon notification from the commissioner of the premium 
125.25 	amount required. Premiums may be paid in installments at the discretion of the commissioner.
125.26 	(i) Nonpayment of the premium shall result in denial or termination of medical assistance 
125.27 	unless the person demonstrates good cause for nonpayment. "Good cause" means an excuse 
125.28 	for the enrollee's failure to pay the required premium when due because the circumstances 
125.29 	were beyond the enrollee's control or not reasonably foreseeable. The commissioner shall 
125.30 	determine whether good cause exists based on the weight of the supporting evidence 
125.31 	submitted by the enrollee to demonstrate good cause. Except when an installment agreement 
125.32 	is accepted by the commissioner, all persons disenrolled for nonpayment of a premium must 
125.33 	pay any past due premiums as well as current premiums due prior to being reenrolled. 
126.1 	Nonpayment shall include payment with a returned, refused, or dishonored instrument. The 
126.2 	commissioner may require a guaranteed form of payment as the only means to replace a 
126.3 	returned, refused, or dishonored instrument.
126.4 	(j) (g) The commissioner is authorized to determine that a premium amount was calculated 
126.5 	or billed in error, make corrections to financial records and billing systems, and refund 
126.6 	premiums collected in error.
126.7 	(h) For enrollees whose income does not exceed 200 percent of the federal poverty 
126.8 	guidelines who are: (1) eligible under this subdivision and who are also enrolled in Medicare,;
126.9 	and (2) not eligible for medical assistance reimbursement of Medicare premiums under 
126.10 	subdivisions 3, 3a, 3b, or 4, the commissioner shall reimburse the enrollee for Medicare
126.11 	part A and Medicare part B premiums under section 256B.0625, subdivision 15, paragraph 
126.12 	(a). and part A and part B coinsurance and deductibles. Reimbursement of the Medicare 
126.13 	coinsurance and deductibles, when added to the amount paid by Medicare, must not exceed 
126.14 	the total rate the provider would have received for the same service or services if the person 
126.15 	was receiving benefits as a qualified Medicare beneficiary.
126.16 	(i) The commissioner must permit any individual who was disenrolled for nonpayment 
126.17 	of premiums previously required under this subdivision to reapply for medical assistance 
126.18 	under this subdivision and be reenrolled if eligible without paying past due premiums.

126.19 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
126.20 	whichever occurs later. The commissioner of human services shall notify the revisor of 
126.21 	statutes when federal approval is obtained.

126.22 	Sec. 5. Minnesota Statutes 2022, section 256B.0625, subdivision 17, is amended to read:
126.23 		Subd. 17.Transportation costs. (a) "Nonemergency medical transportation service" 
126.24 	means motor vehicle transportation provided by a public or private person that serves 
126.25 	Minnesota health care program beneficiaries who do not require emergency ambulance 
126.26 	service, as defined in section 144E.001, subdivision 3, to obtain covered medical services.
126.27 	(b) Medical assistance covers medical transportation costs incurred solely for obtaining 
126.28 	emergency medical care or transportation costs incurred by eligible persons in obtaining 
126.29 	emergency or nonemergency medical care when paid directly to an ambulance company, 
126.30 	nonemergency medical transportation company, or other recognized providers of 
126.31 	transportation services. Medical transportation must be provided by:
126.32 	(1) nonemergency medical transportation providers who meet the requirements of this 
126.33 	subdivision;
127.1 	(2) ambulances, as defined in section 144E.001, subdivision 2;
127.2 	(3) taxicabs that meet the requirements of this subdivision;
127.3 	(4) public transit, as defined in section 174.22, subdivision 7; or
127.4 	(5) not-for-hire vehicles, including volunteer drivers, as defined in section 65B.472, 
127.5 	subdivision 1, paragraph (h).
127.6 	(c) Medical assistance covers nonemergency medical transportation provided by 
127.7 	nonemergency medical transportation providers enrolled in the Minnesota health care 
127.8 	programs. All nonemergency medical transportation providers must comply with the 
127.9 	operating standards for special transportation service as defined in sections 174.29 to 174.30 
127.10 	and Minnesota Rules, chapter 8840, and all drivers must be individually enrolled with the 
127.11 	commissioner and reported on the claim as the individual who provided the service. All 
127.12 	nonemergency medical transportation providers shall bill for nonemergency medical 
127.13 	transportation services in accordance with Minnesota health care programs criteria. Publicly 
127.14 	operated transit systems, volunteers, and not-for-hire vehicles are exempt from the 
127.15 	requirements outlined in this paragraph.
127.16 	(d) An organization may be terminated, denied, or suspended from enrollment if:
127.17 	(1) the provider has not initiated background studies on the individuals specified in 
127.18 	section 174.30, subdivision 10, paragraph (a), clauses (1) to (3); or
127.19 	(2) the provider has initiated background studies on the individuals specified in section 
127.20 	174.30, subdivision 10, paragraph (a), clauses (1) to (3), and:
127.21 	(i) the commissioner has sent the provider a notice that the individual has been 
127.22 	disqualified under section 245C.14; and
127.23 	(ii) the individual has not received a disqualification set-aside specific to the special 
127.24 	transportation services provider under sections 245C.22 and 245C.23.
127.25 	(e) The administrative agency of nonemergency medical transportation must:
127.26 	(1) adhere to the policies defined by the commissioner;
127.27 	(2) pay nonemergency medical transportation providers for services provided to 
127.28 	Minnesota health care programs beneficiaries to obtain covered medical services;
127.29 	(3) provide data monthly to the commissioner on appeals, complaints, no-shows, canceled 
127.30 	trips, and number of trips by mode; and
128.1 	(4) by July 1, 2016, in accordance with subdivision 18e, utilize a web-based single 
128.2 	administrative structure assessment tool that meets the technical requirements established 
128.3 	by the commissioner, reconciles trip information with claims being submitted by providers, 
128.4 	and ensures prompt payment for nonemergency medical transportation services.
128.5 	(f) Until the commissioner implements the single administrative structure and delivery 
128.6 	system under subdivision 18e, clients shall obtain their level-of-service certificate from the 
128.7 	commissioner or an entity approved by the commissioner that does not dispatch rides for 
128.8 	clients using modes of transportation under paragraph (i), clauses (4), (5), (6), and (7).
128.9 	(g) The commissioner may use an order by the recipient's attending physician, advanced 
128.10 	practice registered nurse, physician assistant, or a medical or mental health professional to 
128.11 	certify that the recipient requires nonemergency medical transportation services. 
128.12 	Nonemergency medical transportation providers shall perform driver-assisted services for 
128.13 	eligible individuals, when appropriate. Driver-assisted service includes passenger pickup 
128.14 	at and return to the individual's residence or place of business, assistance with admittance 
128.15 	of the individual to the medical facility, and assistance in passenger securement or in securing 
128.16 	of wheelchairs, child seats, or stretchers in the vehicle.
128.17 	Nonemergency medical transportation providers must take clients to the health care 
128.18 	provider using the most direct route, and must not exceed 30 miles for a trip to a primary 
128.19 	care provider or 60 miles for a trip to a specialty care provider, unless the client receives 
128.20 	authorization from the local agency.
128.21 	Nonemergency medical transportation providers may not bill for separate base rates for 
128.22 	the continuation of a trip beyond the original destination. Nonemergency medical 
128.23 	transportation providers must maintain trip logs, which include pickup and drop-off times, 
128.24 	signed by the medical provider or client, whichever is deemed most appropriate, attesting 
128.25 	to mileage traveled to obtain covered medical services. Clients requesting client mileage 
128.26 	reimbursement must sign the trip log attesting mileage traveled to obtain covered medical 
128.27 	services.
128.28 	(h) The administrative agency shall use the level of service process established by the 
128.29 	commissioner to determine the client's most appropriate mode of transportation. If public 
128.30 	transit or a certified transportation provider is not available to provide the appropriate service 
128.31 	mode for the client, the client may receive a onetime service upgrade.
128.32 	(i) The covered modes of transportation are:
129.1 	(1) client reimbursement, which includes client mileage reimbursement provided to 
129.2 	clients who have their own transportation, or to family or an acquaintance who provides 
129.3 	transportation to the client;
129.4 	(2) volunteer transport, which includes transportation by volunteers using their own 
129.5 	vehicle;
129.6 	(3) unassisted transport, which includes transportation provided to a client by a taxicab 
129.7 	or public transit. If a taxicab or public transit is not available, the client can receive 
129.8 	transportation from another nonemergency medical transportation provider;
129.9 	(4) assisted transport, which includes transport provided to clients who require assistance 
129.10 	by a nonemergency medical transportation provider;
129.11 	(5) lift-equipped/ramp transport, which includes transport provided to a client who is 
129.12 	dependent on a device and requires a nonemergency medical transportation provider with 
129.13 	a vehicle containing a lift or ramp;
129.14 	(6) protected transport, which includes transport provided to a client who has received 
129.15 	a prescreening that has deemed other forms of transportation inappropriate and who requires 
129.16 	a provider: (i) with a protected vehicle that is not an ambulance or police car and has safety 
129.17 	locks, a video recorder, and a transparent thermoplastic partition between the passenger and 
129.18 	the vehicle driver; and (ii) who is certified as a protected transport provider; and
129.19 	(7) stretcher transport, which includes transport for a client in a prone or supine position 
129.20 	and requires a nonemergency medical transportation provider with a vehicle that can transport 
129.21 	a client in a prone or supine position.
129.22 	(j) The local agency shall be the single administrative agency and shall administer and 
129.23 	reimburse for modes defined in paragraph (i) according to paragraphs (m) and (n) when the 
129.24 	commissioner has developed, made available, and funded the web-based single administrative 
129.25 	structure, assessment tool, and level of need assessment under subdivision 18e. The local 
129.26 	agency's financial obligation is limited to funds provided by the state or federal government.
129.27 	(k) The commissioner shall:
129.28 	(1) verify that the mode and use of nonemergency medical transportation is appropriate;
129.29 	(2) verify that the client is going to an approved medical appointment; and
129.30 	(3) investigate all complaints and appeals.
129.31 	(l) The administrative agency shall pay for the services provided in this subdivision and 
129.32 	seek reimbursement from the commissioner, if appropriate. As vendors of medical care, 
130.1 	local agencies are subject to the provisions in section 256B.041, the sanctions and monetary 
130.2 	recovery actions in section 256B.064, and Minnesota Rules, parts 9505.2160 to 9505.2245.
130.3 	(m) Payments for nonemergency medical transportation must be paid based on the client's 
130.4 	assessed mode under paragraph (h), not the type of vehicle used to provide the service. The 
130.5 	medical assistance reimbursement rates for nonemergency medical transportation services 
130.6 	that are payable by or on behalf of the commissioner for nonemergency medical 
130.7 	transportation services are:
130.8 	(1) $0.22 per mile for client reimbursement;
130.9 	(2) up to 100 percent of the Internal Revenue Service business deduction rate for volunteer 
130.10 	transport;
130.11 	(3) equivalent to the standard fare for unassisted transport when provided by public 
130.12 	transit, and $11 $12.93 for the base rate and $1.30 $1.53 per mile when provided by a 
130.13 	nonemergency medical transportation provider;
130.14 	(4) $13 $15.28 for the base rate and $1.30 $1.53 per mile for assisted transport;
130.15 	(5) $18 $21.15 for the base rate and $1.55 $1.82 per mile for lift-equipped/ramp transport;
130.16 	(6) $75 for the base rate and $2.40 per mile for protected transport; and
130.17 	(7) $60 for the base rate and $2.40 per mile for stretcher transport, and $9 per trip for 
130.18 	an additional attendant if deemed medically necessary.
130.19 	(n) The base rate for nonemergency medical transportation services in areas defined 
130.20 	under RUCA to be super rural is equal to 111.3 percent of the respective base rate in 
130.21 	paragraph (m), clauses (1) to (7). The mileage rate for nonemergency medical transportation 
130.22 	services in areas defined under RUCA to be rural or super rural areas is:
130.23 	(1) for a trip equal to 17 miles or less, equal to 125 percent of the respective mileage 
130.24 	rate in paragraph (m), clauses (1) to (7); and
130.25 	(2) for a trip between 18 and 50 miles, equal to 112.5 percent of the respective mileage 
130.26 	rate in paragraph (m), clauses (1) to (7).
130.27 	(o) For purposes of reimbursement rates for nonemergency medical transportation 
130.28 	services under paragraphs (m) and (n), the zip code of the recipient's place of residence 
130.29 	shall determine whether the urban, rural, or super rural reimbursement rate applies.
130.30 	(p) For purposes of this subdivision, "rural urban commuting area" or "RUCA" means 
130.31 	a census-tract based classification system under which a geographical area is determined 
130.32 	to be urban, rural, or super rural.
131.1 	(q) The commissioner, when determining reimbursement rates for nonemergency medical 
131.2 	transportation under paragraphs (m) and (n), shall exempt all modes of transportation listed 
131.3 	under paragraph (i) from Minnesota Rules, part 9505.0445, item R, subitem (2).
131.4 	(r) Effective for the first day of each calendar quarter in which the price of gasoline as 
131.5 	posted publicly by the United States Energy Information Administration exceeds $3.00 per 
131.6 	gallon, the commissioner shall adjust the rate paid per mile in paragraph (m) by one percent 
131.7 	up or down for every increase or decrease of ten cents for the price of gasoline. The increase 
131.8 	or decrease must be calculated using a base gasoline price of $3.00. The percentage increase 
131.9 	or decrease must be calculated using the average of the most recently available price of all 
131.10 	grades of gasoline for Minnesota as posted publicly by the United States Energy Information 
131.11 	Administration.

131.12 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
131.13 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
131.14 	when federal approval is obtained.

131.15 	Sec. 6. Minnesota Statutes 2022, section 256B.0625, subdivision 17a, is amended to read:
131.16 		Subd. 17a.Payment for ambulance services. (a) Medical assistance covers ambulance 
131.17 	services. Providers shall bill ambulance services according to Medicare criteria. 
131.18 	Nonemergency ambulance services shall not be paid as emergencies. Effective for services 
131.19 	rendered on or after July 1, 2001, medical assistance payments for ambulance services shall 
131.20 	be paid at the Medicare reimbursement rate or at the medical assistance payment rate in 
131.21 	effect on July 1, 2000, whichever is greater.
131.22 	(b) Effective for services provided on or after July 1, 2016, medical assistance payment 
131.23 	rates for ambulance services identified in this paragraph are increased by five percent. 
131.24 	Capitation payments made to managed care plans and county-based purchasing plans for 
131.25 	ambulance services provided on or after January 1, 2017, shall be increased to reflect this 
131.26 	rate increase. The increased rate described in this paragraph applies to ambulance service 
131.27 	providers whose base of operations as defined in section 144E.10 is located:
131.28 	(1) outside the metropolitan counties listed in section 473.121, subdivision 4, and outside 
131.29 	the cities of Duluth, Mankato, Moorhead, St. Cloud, and Rochester; or
131.30 	(2) within a municipality with a population of less than 1,000.
131.31 	(c) Effective for the first day of each calendar quarter in which the price of gasoline as 
131.32 	posted publicly by the United States Energy Information Administration exceeds $3.00 per 
131.33 	gallon, the commissioner shall adjust the rate paid per mile in paragraphs (a) and (b) by one 
132.1 	percent up or down for every increase or decrease of ten cents for the price of gasoline. The 
132.2 	increase or decrease must be calculated using a base gasoline price of $3.00. The percentage 
132.3 	increase or decrease must be calculated using the average of the most recently available 
132.4 	price of all grades of gasoline for Minnesota as posted publicly by the United States Energy 
132.5 	Information Administration.

132.6 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
132.7 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
132.8 	when federal approval is obtained.

132.9 	Sec. 7. Minnesota Statutes 2022, section 256B.0625, subdivision 22, is amended to read:
132.10 		Subd. 22.Hospice care. Medical assistance covers hospice care services under Public 
132.11 	Law 99-272, section 9505, to the extent authorized by rule, except that a recipient age 21 
132.12 	or under who elects to receive hospice services does not waive coverage for services that 
132.13 	are related to the treatment of the condition for which a diagnosis of terminal illness has 
132.14 	been made. Hospice respite and end-of-life care under subdivision 22a are not hospice care 
132.15 	services under this subdivision.

132.16 	EFFECTIVE DATE. This section is effective January 1, 2024.

132.17 	Sec. 8. Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision 
132.18 	to read:
132.19 		Subd. 22a.Residential hospice facility; hospice respite and end-of-life care for 
132.20 	children. (a) Medical assistance covers hospice respite and end-of-life care if the care is 
132.21 	for recipients age 21 or under who elect to receive hospice care delivered in a facility that 
132.22 	is licensed under sections 144A.75 to 144A.755 and that is a residential hospice facility 
132.23 	under section 144A.75, subdivision 13, paragraph (a). Hospice care services under 
132.24 	subdivision 22 are not hospice respite or end-of-life care under this subdivision.
132.25 	(b) The payment rates for coverage under this subdivision must be 100 percent of the 
132.26 	Medicare rate for continuous home care hospice services as published in the Centers for 
132.27 	Medicare and Medicaid Services annual final rule updating payments and policies for hospice 
132.28 	care. Payment for hospice respite and end-of-life care under this subdivision must be made 
132.29 	from state money, though the commissioner must seek to obtain federal financial participation 
132.30 	for the payments. Payment for hospice respite and end-of-life care must be paid to the 
132.31 	residential hospice facility and are not included in any limit or cap amount applicable to 
132.32 	hospice services payments to the elected hospice services provider.
133.1 	(c) Certification of the residential hospice facility by the federal Medicare program must 
133.2 	not be a requirement of medical assistance payment for hospice respite and end-of-life care 
133.3 	under this subdivision.

133.4 	EFFECTIVE DATE. This section is effective January 1, 2024.

133.5 	Sec. 9. Minnesota Statutes 2022, section 256B.073, subdivision 3, is amended to read:
133.6 		Subd. 3.Requirements. (a) In developing implementation requirements for electronic 
133.7 	visit verification, the commissioner shall ensure that the requirements:
133.8 	(1) are minimally administratively and financially burdensome to a provider;
133.9 	(2) are minimally burdensome to the service recipient and the least disruptive to the 
133.10 	service recipient in receiving and maintaining allowed services;
133.11 	(3) consider existing best practices and use of electronic visit verification;
133.12 	(4) are conducted according to all state and federal laws;
133.13 	(5) are effective methods for preventing fraud when balanced against the requirements 
133.14 	of clauses (1) and (2); and
133.15 	(6) are consistent with the Department of Human Services' policies related to covered 
133.16 	services, flexibility of service use, and quality assurance.
133.17 	(b) The commissioner shall make training available to providers on the electronic visit 
133.18 	verification system requirements.
133.19 	(c) The commissioner shall establish baseline measurements related to preventing fraud 
133.20 	and establish measures to determine the effect of electronic visit verification requirements 
133.21 	on program integrity.
133.22 	(d) The commissioner shall make a state-selected electronic visit verification system 
133.23 	available to providers of services.
133.24 	(e) The commissioner shall make available and publish on the agency website the name 
133.25 	and contact information for the vendor of the state-selected electronic visit verification 
133.26 	system and the other vendors that offer alternative electronic visit verification systems. The 
133.27 	information provided must state that the state-selected electronic visit verification system 
133.28 	is offered at no cost to the provider of services and that the provider may choose an alternative 
133.29 	system that may be at a cost to the provider.

134.1 	Sec. 10. Minnesota Statutes 2022, section 256B.073, is amended by adding a subdivision 
134.2 	to read:
134.3 		Subd. 5.Vendor requirements. (a) The vendor of the electronic visit verification system 
134.4 	selected by the commissioner and the vendor's affiliate must comply with the requirements 
134.5 	of this subdivision.
134.6 	(b) The vendor of the state-selected electronic visit verification system and the vendor's 
134.7 	affiliate must:
134.8 	(1) notify the provider of services that the provider may choose the state-selected 
134.9 	electronic visit verification system at no cost to the provider;
134.10 	(2) offer the state-selected electronic visit verification system to the provider of services 
134.11 	prior to offering any fee-based electronic visit verification system;
134.12 	(3) notify the provider of services that the provider may choose any fee-based electronic 
134.13 	visit verification system prior to offering the vendor's or its affiliate's fee-based electronic 
134.14 	visit verification system;
134.15 	(4) when offering the state-selected electronic visit verification system, clearly 
134.16 	differentiate between the state-selected electronic visit verification system and the vendor's 
134.17 	or its affiliate's alternative fee-based system; and
134.18 	(5) allow the provider of services, at no cost to the provider, to terminate the agreement 
134.19 	after 12 months of the provider executing the agreement.
134.20 	(c) The vendor of the state-selected electronic visit verification system and the vendor's 
134.21 	affiliate must not use state data that is not available to other vendors of electronic visit 
134.22 	verification systems to develop, promote, or sell the vendor's or its affiliate's alternative 
134.23 	electronic visit verification system.
134.24 	(d) Upon request from the provider, the vendor of the state-selected electronic visit 
134.25 	verification system must provide proof of compliance with the requirements of this 
134.26 	subdivision.
134.27 	(e) An agreement between the vendor of the state-selected electronic visit verification 
134.28 	system or its affiliate and a provider of services for an electronic visit verification system 
134.29 	that is not the state-selected system entered into on or after July 1, 2023, is subject to 
134.30 	immediate termination by the provider if the vendor violates any of the requirements of this 
134.31 	subdivision.

134.32 	EFFECTIVE DATE. This section is effective July 1, 2023.

135.1 	Sec. 11. Minnesota Statutes 2022, section 256B.14, subdivision 2, is amended to read:
135.2 		Subd. 2.Actions to obtain payment. The state agency shall promulgate rules to 
135.3 	determine the ability of responsible relatives to contribute partial or complete payment or 
135.4 	repayment of medical assistance furnished to recipients for whom they are responsible. All 
135.5 	medical assistance exclusions shall be allowed, and a resource limit of $10,000 for 
135.6 	nonexcluded resources shall be implemented. Above these limits, a contribution of one-third 
135.7 	of the excess resources shall be required. These rules shall not require payment or repayment 
135.8 	when payment would cause undue hardship to the responsible relative or that relative's 
135.9 	immediate family. These rules shall be consistent with the requirements of section 252.27
135.10 	for do not apply to parents of children whose eligibility for medical assistance was determined 
135.11 	without deeming of the parents' resources and income under the Tax Equity and Fiscal 
135.12 	Responsibility Act (TEFRA) option or to parents of children accessing home and 
135.13 	community-based waiver services. The county agency shall give the responsible relative 
135.14 	notice of the amount of the payment or repayment. If the state agency or county agency 
135.15 	finds that notice of the payment obligation was given to the responsible relative, but that 
135.16 	the relative failed or refused to pay, a cause of action exists against the responsible relative 
135.17 	for that portion of medical assistance granted after notice was given to the responsible 
135.18 	relative, which the relative was determined to be able to pay.
135.19 	The action may be brought by the state agency or the county agency in the county where 
135.20 	assistance was granted, for the assistance, together with the costs of disbursements incurred 
135.21 	due to the action.
135.22 	In addition to granting the county or state agency a money judgment, the court may, 
135.23 	upon a motion or order to show cause, order continuing contributions by a responsible 
135.24 	relative found able to repay the county or state agency. The order shall be effective only 
135.25 	for the period of time during which the recipient receives medical assistance from the county 
135.26 	or state agency.

135.27 	Sec. 12. Minnesota Statutes 2022, section 256B.766, is amended to read:
135.28 	256B.766 REIMBURSEMENT FOR BASIC CARE SERVICES.
135.29 	(a) Effective for services provided on or after July 1, 2009, total payments for basic care 
135.30 	services, shall be reduced by three percent, except that for the period July 1, 2009, through 
135.31 	June 30, 2011, total payments shall be reduced by 4.5 percent for the medical assistance 
135.32 	and general assistance medical care programs, prior to third-party liability and spenddown 
135.33 	calculation. Effective July 1, 2010, the commissioner shall classify physical therapy services, 
135.34 	occupational therapy services, and speech-language pathology and related services as basic 
136.1 	care services. The reduction in this paragraph shall apply to physical therapy services, 
136.2 	occupational therapy services, and speech-language pathology and related services provided 
136.3 	on or after July 1, 2010.
136.4 	(b) Payments made to managed care plans and county-based purchasing plans shall be 
136.5 	reduced for services provided on or after October 1, 2009, to reflect the reduction effective 
136.6 	July 1, 2009, and payments made to the plans shall be reduced effective October 1, 2010, 
136.7 	to reflect the reduction effective July 1, 2010.
136.8 	(c) Effective for services provided on or after September 1, 2011, through June 30, 2013, 
136.9 	total payments for outpatient hospital facility fees shall be reduced by five percent from the 
136.10 	rates in effect on August 31, 2011.
136.11 	(d) Effective for services provided on or after September 1, 2011, through June 30, 2013, 
136.12 	total payments for ambulatory surgery centers facility fees, medical supplies and durable 
136.13 	medical equipment not subject to a volume purchase contract, prosthetics and orthotics, 
136.14 	renal dialysis services, laboratory services, public health nursing services, physical therapy 
136.15 	services, occupational therapy services, speech therapy services, eyeglasses not subject to 
136.16 	a volume purchase contract, hearing aids not subject to a volume purchase contract, and 
136.17 	anesthesia services shall be reduced by three percent from the rates in effect on August 31, 
136.18 	2011.
136.19 	(e) Effective for services provided on or after September 1, 2014, payments for 
136.20 	ambulatory surgery centers facility fees, hospice services, renal dialysis services, laboratory 
136.21 	services, public health nursing services, eyeglasses not subject to a volume purchase contract, 
136.22 	and hearing aids not subject to a volume purchase contract shall be increased by three percent 
136.23 	and payments for outpatient hospital facility fees shall be increased by three percent. 
136.24 	Payments made to managed care plans and county-based purchasing plans shall not be 
136.25 	adjusted to reflect payments under this paragraph.
136.26 	(f) Payments for medical supplies and durable medical equipment not subject to a volume 
136.27 	purchase contract, and prosthetics and orthotics, provided on or after July 1, 2014, through 
136.28 	June 30, 2015, shall be decreased by .33 percent. Payments for medical supplies and durable 
136.29 	medical equipment not subject to a volume purchase contract, and prosthetics and orthotics, 
136.30 	provided on or after July 1, 2015, shall be increased by three percent from the rates as 
136.31 	determined under paragraphs (i) and (j).
136.32 	(g) Effective for services provided on or after July 1, 2015, payments for outpatient 
136.33 	hospital facility fees, medical supplies and durable medical equipment not subject to a 
136.34 	volume purchase contract, prosthetics, and orthotics to a hospital meeting the criteria specified 
137.1 	in section 62Q.19, subdivision 1, paragraph (a), clause (4), shall be increased by 90 percent 
137.2 	from the rates in effect on June 30, 2015. Payments made to managed care plans and 
137.3 	county-based purchasing plans shall not be adjusted to reflect payments under this paragraph.
137.4 	(h) This section does not apply to physician and professional services, inpatient hospital 
137.5 	services, family planning services, mental health services, dental services, prescription 
137.6 	drugs, medical transportation, federally qualified health centers, rural health centers, Indian 
137.7 	health services, and Medicare cost-sharing.
137.8 	(i) Effective for services provided on or after July 1, 2015, the following categories of 
137.9 	medical supplies and durable medical equipment shall be individually priced items: enteral 
137.10 	nutrition and supplies, customized and other specialized tracheostomy tubes and supplies, 
137.11 	electric patient lifts, and durable medical equipment repair and service. This paragraph does 
137.12 	not apply to medical supplies and durable medical equipment subject to a volume purchase 
137.13 	contract, products subject to the preferred diabetic testing supply program, and items provided 
137.14 	to dually eligible recipients when Medicare is the primary payer for the item. The 
137.15 	commissioner shall not apply any medical assistance rate reductions to durable medical 
137.16 	equipment as a result of Medicare competitive bidding.
137.17 	(j) Effective for services provided on or after July 1, 2015, medical assistance payment 
137.18 	rates for durable medical equipment, prosthetics, orthotics, or supplies shall be increased 
137.19 	as follows:
137.20 	(1) payment rates for durable medical equipment, prosthetics, orthotics, or supplies that 
137.21 	were subject to the Medicare competitive bid that took effect in January of 2009 shall be 
137.22 	increased by 9.5 percent; and
137.23 	(2) payment rates for durable medical equipment, prosthetics, orthotics, or supplies on 
137.24 	the medical assistance fee schedule, whether or not subject to the Medicare competitive bid 
137.25 	that took effect in January of 2009, shall be increased by 2.94 percent, with this increase 
137.26 	being applied after calculation of any increased payment rate under clause (1).
137.27 	This paragraph does not apply to medical supplies and durable medical equipment subject 
137.28 	to a volume purchase contract, products subject to the preferred diabetic testing supply 
137.29 	program, items provided to dually eligible recipients when Medicare is the primary payer 
137.30 	for the item, and individually priced items identified in paragraph (i). Payments made to 
137.31 	managed care plans and county-based purchasing plans shall not be adjusted to reflect the 
137.32 	rate increases in this paragraph.
137.33 	(k) Effective for nonpressure support ventilators provided on or after January 1, 2016, 
137.34 	the rate shall be the lower of the submitted charge or the Medicare fee schedule rate. Effective 
138.1 	for pressure support ventilators provided on or after January 1, 2016, the rate shall be the 
138.2 	lower of the submitted charge or 47 percent above the Medicare fee schedule rate. For 
138.3 	payments made in accordance with this paragraph, if, and to the extent that, the commissioner 
138.4 	identifies that the state has received federal financial participation for ventilators in excess 
138.5 	of the amount allowed effective January 1, 2018, under United States Code, title 42, section 
138.6 	1396b(i)(27), the state shall repay the excess amount to the Centers for Medicare and 
138.7 	Medicaid Services with state funds and maintain the full payment rate under this paragraph.
138.8 	(l) Payment rates for durable medical equipment, prosthetics, orthotics or supplies, that 
138.9 	are subject to the upper payment limit in accordance with section 1903(i)(27) of the Social 
138.10 	Security Act, shall be paid the Medicare rate. Rate increases provided in this chapter shall 
138.11 	not be applied to the items listed in this paragraph.
138.12 	(m) For dates of service on or after July 1, 2023, through June 30, 2024, enteral nutrition 
138.13 	and supplies must be paid according to this paragraph. If sufficient data exists for a product 
138.14 	or supply, payment must be based upon the 50th percentile of the usual and customary 
138.15 	charges per product code submitted to the department, using only charges submitted per 
138.16 	unit. Increases in rates resulting from the 50th percentile payment method must not exceed 
138.17 	150 percent of the previous fiscal year's rate per code and product combination. Data are 
138.18 	sufficient if: (1) the department has at least 100 paid claim lines by at least ten different 
138.19 	providers for a given product or supply; or (2) in the absence of the data in clause (1), the 
138.20 	department has at least 20 claim lines by at least five different providers for a product or 
138.21 	supply that does not meet the requirements of clause (1). If sufficient data are not available 
138.22 	to calculate the 50th percentile for enteral products or supplies, the payment rate shall be 
138.23 	the payment rate in effect on June 30, 2023.
138.24 	(n) For dates of service on or after July 1, 2024, enteral nutrition and supplies must be 
138.25 	paid according to this paragraph and updated annually each January 1. If sufficient data 
138.26 	exists for a product or supply, payment must be based upon the 50th percentile of the usual 
138.27 	and customary charges per product code submitted to the department for the previous 
138.28 	calendar year, using only charges submitted per unit. Increases in rates resulting from the 
138.29 	50th percentile payment method must not exceed 150 percent of the previous year's rate per 
138.30 	code and product combination. Data are sufficient if: (1) the department has at least 100 
138.31 	paid claim lines by at least ten different providers for a given product or supply; or (2) in 
138.32 	the absence of the data in clause (1), the department has at least 20 claim lines by at least 
138.33 	five different providers for a product or supply that does not meet the requirements of clause 
138.34 	(1). If sufficient data is not available to calculate the 50th percentile for enteral products or 
138.35 	supplies, the payment shall be the manufacturer's suggested retail price of that product or 
139.1 	supply minus 20 percent. If the manufacturer's suggested retail price is not available, payment 
139.2 	shall be the actual acquisition cost of that product or supply plus 20 percent.

139.3 	ARTICLE 4
139.4 	BEHAVIORAL HEALTH

139.5 	Section 1. Minnesota Statutes 2022, section 4.046, subdivision 6, is amended to read:
139.6 		Subd. 6.Addiction and recovery Office of Addiction and Recovery; director. An 
139.7 	Office of Addiction and Recovery is created in the Department of Management and Budget. 
139.8 	The governor must appoint an addiction and recovery director, who shall serve as chair of 
139.9 	the subcabinet and administer the Office of Addiction and Recovery. The director shall 
139.10 	serve in the unclassified service and shall report to the governor. The director must:
139.11 	(1) make efforts to break down silos and work across agencies to better target the state's 
139.12 	role in addressing addiction, treatment, and recovery;
139.13 	(2) assist in leading the subcabinet and the advisory council toward progress on 
139.14 	measurable goals that track the state's efforts in combatting addiction; and
139.15 	(3) establish and manage external partnerships and build relationships with communities, 
139.16 	community leaders, and those who have direct experience with addiction to ensure that all 
139.17 	voices of recovery are represented in the work of the subcabinet and advisory council.

139.18 	Sec. 2. Minnesota Statutes 2022, section 4.046, subdivision 7, is amended to read:
139.19 		Subd. 7.Staff and administrative support. The commissioner of human services
139.20 	management and budget, in coordination with other state agencies and boards as applicable, 
139.21 	must provide staffing and administrative support to the addiction and recovery director, the 
139.22 	subcabinet, and the advisory council, and the Office of Addiction and Recovery established 
139.23 	in this section.

139.24 	Sec. 3. Minnesota Statutes 2022, section 4.046, is amended by adding a subdivision to 
139.25 	read:
139.26 		Subd. 8.Division of Youth Substance Use and Addiction Recovery. (a) A Division 
139.27 	of Youth Substance Use and Addiction Recovery is created in the Office of Addiction and 
139.28 	Recovery to focus on preventing adolescent substance use and addiction. The addiction and 
139.29 	recovery director shall employ a director to lead the Division of Youth Substance Use and 
139.30 	Addiction Recovery and staff necessary to fulfill its purpose.
139.31 	(b) The director of the division shall:
140.1 	(1) make efforts to bridge mental health and substance abuse treatment silos and work 
140.2 	across agencies to focus the state's role and resources in preventing youth substance use 
140.3 	and addiction;
140.4 	(2) develop and share resources on evidence-based strategies and programs for addressing 
140.5 	youth substance use and  prevention;
140.6 	(3) establish and manage external partnerships and build relationships with communities, 
140.7 	community leaders, and persons and organizations with direct experience with youth 
140.8 	substance use and addiction; and
140.9 	(4) work to achieve progress on established measurable goals that track the state's efforts 
140.10 	in preventing substance use and addiction among the state's youth population.

140.11 	Sec. 4. Minnesota Statutes 2022, section 245G.01, is amended by adding a subdivision to 
140.12 	read:
140.13 		Subd. 4a.American Society of Addiction Medicine criteria or ASAM 
140.14 	criteria. "American Society of Addiction Medicine criteria" or "ASAM criteria" has the 
140.15 	meaning provided in section 254B.01, subdivision 2a.

140.16 	EFFECTIVE DATE. This section is effective January 1, 2024.

140.17 	Sec. 5. Minnesota Statutes 2022, section 245G.01, is amended by adding a subdivision to 
140.18 	read:
140.19 		Subd. 20c.Protective factors. "Protective factors" means the actions or efforts a person 
140.20 	can take to reduce the negative impact of certain issues, such as substance use disorders, 
140.21 	mental health disorders, and risk of suicide. Protective factors include connecting to positive 
140.22 	supports in the community, a good diet, exercise, attending counseling or 12-step groups, 
140.23 	and taking medications.

140.24 	EFFECTIVE DATE. This section is effective January 1, 2024.

140.25 	Sec. 6. Minnesota Statutes 2022, section 245G.02, subdivision 2, is amended to read:
140.26 		Subd. 2.Exemption from license requirement. This chapter does not apply to a county 
140.27 	or recovery community organization that is providing a service for which the county or 
140.28 	recovery community organization is an eligible vendor under section 254B.05. This chapter 
140.29 	does not apply to an organization whose primary functions are information, referral, 
140.30 	diagnosis, case management, and assessment for the purposes of client placement, education, 
140.31 	support group services, or self-help programs. This chapter does not apply to the activities 
141.1 	of a licensed professional in private practice. A license holder providing the initial set of 
141.2 	substance use disorder services allowable under section 254A.03, subdivision 3, paragraph 
141.3 	(c), to an individual referred to a licensed nonresidential substance use disorder treatment 
141.4 	program after a positive screen for alcohol or substance misuse is exempt from sections 
141.5 	245G.05; 245G.06, subdivisions 1, 1a, 2, and 4; 245G.07, subdivisions 1, paragraph (a), 
141.6 	clauses (2) to (4), and 2, clauses (1) to (7); and 245G.17.

141.7 	EFFECTIVE DATE. This section is effective January 1, 2024.

141.8 	Sec. 7. Minnesota Statutes 2022, section 245G.05, subdivision 1, is amended to read:
141.9 		Subdivision 1.Comprehensive assessment. (a) A comprehensive assessment of the 
141.10 	client's substance use disorder must be administered face-to-face by an alcohol and drug 
141.11 	counselor within three five calendar days from the day of service initiation for a residential 
141.12 	program or within three calendar days on which a treatment session has been provided of 
141.13 	the day of service initiation for a client by the end of the fifth day on which a treatment 
141.14 	service is provided in a nonresidential program. The number of days to complete the 
141.15 	comprehensive assessment excludes the day of service initiation. If the comprehensive 
141.16 	assessment is not completed within the required time frame, the person-centered reason for 
141.17 	the delay and the planned completion date must be documented in the client's file. The 
141.18 	comprehensive assessment is complete upon a qualified staff member's dated signature. If 
141.19 	the client received a comprehensive assessment that authorized the treatment service, an 
141.20 	alcohol and drug counselor may use the comprehensive assessment for requirements of this 
141.21 	subdivision but must document a review of the comprehensive assessment and update the 
141.22 	comprehensive assessment as clinically necessary to ensure compliance with this subdivision 
141.23 	within applicable timelines. The comprehensive assessment must include sufficient 
141.24 	information to complete the assessment summary according to subdivision 2 and the 
141.25 	individual treatment plan according to section 245G.06. The comprehensive assessment 
141.26 	must include information about the client's needs that relate to substance use and personal 
141.27 	strengths that support recovery, including:
141.28 	(1) age, sex, cultural background, sexual orientation, living situation, economic status, 
141.29 	and level of education;
141.30 	(2) a description of the circumstances on the day of service initiation;
141.31 	(3) a list of previous attempts at treatment for substance misuse or substance use disorder, 
141.32 	compulsive gambling, or mental illness;
142.1 	(4) a list of substance use history including amounts and types of substances used, 
142.2 	frequency and duration of use, periods of abstinence, and circumstances of relapse, if any. 
142.3 	For each substance used within the previous 30 days, the information must include the date 
142.4 	of the most recent use and address the absence or presence of previous withdrawal symptoms;
142.5 	(5) specific problem behaviors exhibited by the client when under the influence of 
142.6 	substances;
142.7 	(6) the client's desire for family involvement in the treatment program, family history 
142.8 	of substance use and misuse, history or presence of physical or sexual abuse, and level of 
142.9 	family support;
142.10 	(7) physical and medical concerns or diagnoses, current medical treatment needed or 
142.11 	being received related to the diagnoses, and whether the concerns need to be referred to an 
142.12 	appropriate health care professional;
142.13 	(8) mental health history, including symptoms and the effect on the client's ability to 
142.14 	function; current mental health treatment; and psychotropic medication needed to maintain 
142.15 	stability. The assessment must utilize screening tools approved by the commissioner pursuant 
142.16 	to section 245.4863 to identify whether the client screens positive for co-occurring disorders;
142.17 	(9) arrests and legal interventions related to substance use;
142.18 	(10) a description of how the client's use affected the client's ability to function 
142.19 	appropriately in work and educational settings;
142.20 	(11) ability to understand written treatment materials, including rules and the client's 
142.21 	rights;
142.22 	(12) a description of any risk-taking behavior, including behavior that puts the client at 
142.23 	risk of exposure to blood-borne or sexually transmitted diseases;
142.24 	(13) social network in relation to expected support for recovery;
142.25 	(14) leisure time activities that are associated with substance use;
142.26 	(15) whether the client is pregnant and, if so, the health of the unborn child and the 
142.27 	client's current involvement in prenatal care;
142.28 	(16) whether the client recognizes needs related to substance use and is willing to follow 
142.29 	treatment recommendations; and
142.30 	(17) information from a collateral contact may be included, but is not required.
143.1 	(b) If the client is identified as having opioid use disorder or seeking treatment for opioid 
143.2 	use disorder, the program must provide educational information to the client concerning:
143.3 	(1) risks for opioid use disorder and dependence;
143.4 	(2) treatment options, including the use of a medication for opioid use disorder;
143.5 	(3) the risk of and recognizing opioid overdose; and
143.6 	(4) the use, availability, and administration of naloxone to respond to opioid overdose.
143.7 	(c) The commissioner shall develop educational materials that are supported by research 
143.8 	and updated periodically. The license holder must use the educational materials that are 
143.9 	approved by the commissioner to comply with this requirement.
143.10 	(d) If the comprehensive assessment is completed to authorize treatment service for the 
143.11 	client, at the earliest opportunity during the assessment interview the assessor shall determine 
143.12 	if:
143.13 	(1) the client is in severe withdrawal and likely to be a danger to self or others;
143.14 	(2) the client has severe medical problems that require immediate attention; or
143.15 	(3) the client has severe emotional or behavioral symptoms that place the client or others 
143.16 	at risk of harm.
143.17 	If one or more of the conditions in clauses (1) to (3) are present, the assessor must end the 
143.18 	assessment interview and follow the procedures in the program's medical services plan 
143.19 	under section 245G.08, subdivision 2, to help the client obtain the appropriate services. The 
143.20 	assessment interview may resume when the condition is resolved. An alcohol and drug 
143.21 	counselor must sign and date the comprehensive assessment review and update.

143.22 	EFFECTIVE DATE. This section is effective January 1, 2024.

143.23 	Sec. 8. Minnesota Statutes 2022, section 245G.05, is amended by adding a subdivision to 
143.24 	read:
143.25 		Subd. 3.Comprehensive assessment requirements. (a) A comprehensive assessment 
143.26 	must meet the requirements under section 245I.10, subdivision 6, paragraphs (b) and (c). 
143.27 	A comprehensive assessment must also include:
143.28 	(1) a diagnosis of a substance use disorder or a finding that the client does not meet the 
143.29 	criteria for a substance use disorder;
143.30 	(2) a determination of whether the individual screens positive for co-occurring mental 
143.31 	health disorders using a screening tool approved by the commissioner pursuant to section 
144.1 	245.4863, except when the comprehensive assessment is being completed as part of a 
144.2 	diagnostic assessment; and
144.3 	(3) a recommendation for the ASAM level of care identified in section 254B.19, 
144.4 	subdivision 1.
144.5 	(b) If the individual is assessed for opioid use disorder, the program must provide 
144.6 	educational material to the client within 24 hours of service initiation on:
144.7 	(1) risks for opioid use disorder and dependence;
144.8 	(2) treatment options, including the use of a medication for opioid use disorder;
144.9 	(3) the risk of recognizing opioid overdose; and
144.10 	(4) the use, availability, and administration of naloxone to respond to opioid overdose.
144.11 	If the client is identified as having opioid use disorder at a later point, the education must 
144.12 	be provided at that point. The license holder must use the educational materials that are 
144.13 	approved by the commissioner to comply with this requirement.

144.14 	EFFECTIVE DATE. This section is effective January 1, 2024.

144.15 	Sec. 9. Minnesota Statutes 2022, section 245G.06, subdivision 1, is amended to read:
144.16 		Subdivision 1.General. Each client must have a person-centered individual treatment 
144.17 	plan developed by an alcohol and drug counselor within ten days from the day of service 
144.18 	initiation for a residential program and within five calendar daysby the end of the tenth day 
144.19 	on which a treatment session has been provided from the day of service initiation for a client 
144.20 	in a nonresidential program, not to exceed 30 days. Opioid treatment programs must complete 
144.21 	the individual treatment plan within 21 days from the day of service initiation. The number 
144.22 	of days to complete the individual treatment plan excludes the day of service initiation. 
144.23 	The individual treatment plan must be signed by the client and the alcohol and drug counselor 
144.24 	and document the client's involvement in the development of the plan. The individual 
144.25 	treatment plan is developed upon the qualified staff member's dated signature. Treatment 
144.26 	planning must include ongoing assessment of client needs. An individual treatment plan 
144.27 	must be updated based on new information gathered about the client's condition, the client's 
144.28 	level of participation, and on whether methods identified have the intended effect. A change 
144.29 	to the plan must be signed by the client and the alcohol and drug counselor. If the client 
144.30 	chooses to have family or others involved in treatment services, the client's individual 
144.31 	treatment plan must include how the family or others will be involved in the client's treatment. 
144.32 	If a client is receiving treatment services or an assessment via telehealth and the alcohol 
145.1 	and drug counselor documents the reason the client's signature cannot be obtained, the 
145.2 	alcohol and drug counselor may document the client's verbal approval or electronic written 
145.3 	approval of the treatment plan or change to the treatment plan in lieu of the client's signature.

145.4 	EFFECTIVE DATE. This section is effective January 1, 2024.

145.5 	Sec. 10. Minnesota Statutes 2022, section 245G.06, is amended by adding a subdivision 
145.6 	to read:
145.7 		Subd. 1a.Individual treatment plan contents and process. (a) After completing a 
145.8 	client's  comprehensive assessment, the license holder must complete an individual treatment 
145.9 	plan. The license holder must:
145.10 	(1) base the client's individual treatment plan on the client's comprehensive assessment;
145.11 	(2) use a person-centered, culturally appropriate planning process that allows the client's 
145.12 	family and other natural supports to observe and participate in the client's individual treatment 
145.13 	services, assessments, and treatment planning;
145.14 	(3) identify the client's treatment goals in relation to any or all of the applicable ASAM 
145.15 	six dimensions identified in section 254B.04, subdivision 4, to ensure measurable treatment 
145.16 	objectives, a treatment strategy, and a schedule for accomplishing the client's treatment 
145.17 	goals and objectives;
145.18 	(4) document in the treatment plan the ASAM level of care identified in section 254B.19, 
145.19 	subdivision 1, that the client is receiving services under;
145.20 	(5) identify the participants involved in the client's treatment planning. The client must 
145.21 	be a participant in the client's treatment planning. If applicable, the license holder must 
145.22 	document the reasons that the license holder did not involve the client's family or other 
145.23 	natural supports in the client's treatment planning;
145.24 	(6) identify resources to refer the client to when the client's needs are to be addressed 
145.25 	concurrently by another provider; and
145.26 	(7) identify maintenance strategy goals and methods designed to address relapse 
145.27 	prevention and to strengthen the client's protective factors.

145.28 	EFFECTIVE DATE. This section is effective January 1, 2024.

145.29 	Sec. 11. Minnesota Statutes 2022, section 245G.06, subdivision 3, is amended to read:
145.30 		Subd. 3. Treatment plan review.  A treatment plan review must be entered in a client's 
145.31 	file weekly or after each treatment service, whichever is less frequent, completed by the 
146.1 	alcohol and drug counselor responsible for the client's treatment plan. The review must 
146.2 	indicate the span of time covered by the review and each of the six dimensions listed in 
146.3 	section 245G.05, subdivision 2, paragraph (c). The review must:
146.4 	(1) address each goal in the document client goals addressed since the last treatment 
146.5 	plan review and whether the identified methods to address the goals arecontinue to be 
146.6 	effective;
146.7 	(2) include document monitoring of any physical and mental health problems and include 
146.8 	toxicology results for alcohol and substance use, when available;
146.9 	(3) document the participation of others involved in the individual's treatment planning, 
146.10 	including when services are offered to the client's family or natural supports;
146.11 	(4) if changes to the treatment plan are determined to be necessary, document staff 
146.12 	recommendations for changes in the methods identified in the treatment plan and whether 
146.13 	the client agrees with the change; and
146.14 	(5) include a review and evaluation of the individual abuse prevention plan according 
146.15 	to section 245A.65.; and
146.16 	(6) document any referrals made since the previous treatment plan review.

146.17 	EFFECTIVE DATE. This section is effective January 1, 2024.

146.18 	Sec. 12. Minnesota Statutes 2022, section 245G.06, is amended by adding a subdivision 
146.19 	to read:
146.20 		Subd. 3a.Frequency of treatment plan reviews. (a) A license holder must ensure that 
146.21 	the alcohol and drug counselor responsible for a client's treatment plan completes and 
146.22 	documents a treatment plan review that meets the requirements of subdivision 3 in each 
146.23 	client's file according to the frequencies required in this subdivision. All ASAM levels 
146.24 	referred to in this chapter are those described in section 254B.19, subdivision 1.
146.25 	(b) For a client receiving residential ASAM level 3.3 or 3.5 high-intensity services or 
146.26 	residential hospital-based services, a treatment plan review must be completed once every 
146.27 	14 days.
146.28 	(c) For a client receiving residential ASAM level 3.1 low-intensity services or any other 
146.29 	residential level not listed in paragraph (b), a treatment plan review must be completed once 
146.30 	every 30 days.
146.31 	(d) For a client receiving nonresidential ASAM level 2.5 partial hospitalization services, 
146.32 	a treatment plan review must be completed once every 14 days.
147.1 	(e) For a client receiving nonresidential ASAM level 1.0 outpatient or 2.1 intensive 
147.2 	outpatient services or any other nonresidential level not included in paragraph (d), a treatment 
147.3 	plan review must be completed once every 30 days.
147.4 	(f) For a client receiving nonresidential opioid treatment program services according to 
147.5 	section 245G.22, a treatment plan review must be completed weekly for the ten weeks 
147.6 	following completion of the treatment plan and monthly thereafter. Treatment plan reviews 
147.7 	must be completed more frequently when clinical needs warrant.
147.8 	(g) Notwithstanding paragraphs (e) and (f), for a client in a nonresidential program with 
147.9 	a treatment plan that clearly indicates less than five hours of skilled treatment services will 
147.10 	be provided to the client each month, a treatment plan review must be completed once every 
147.11 	90 days.

147.12 	EFFECTIVE DATE. This section is effective January 1, 2024.

147.13 	Sec. 13. Minnesota Statutes 2022, section 245G.06, subdivision 4, is amended to read:
147.14 		Subd. 4.Service discharge summary. (a) An alcohol and drug counselor must write a 
147.15 	service discharge summary for each client. The service discharge summary must be 
147.16 	completed within five days of the client's service termination. A copy of the client's service 
147.17 	discharge summary must be provided to the client upon the client's request.
147.18 	(b) The service discharge summary must be recorded in the six dimensions listed in 
147.19 	section 245G.05, subdivision 2, paragraph (c) 254B.04, subdivision 4, and include the 
147.20 	following information:
147.21 	(1) the client's issues, strengths, and needs while participating in treatment, including 
147.22 	services provided;
147.23 	(2) the client's progress toward achieving each goal identified in the individual treatment 
147.24 	plan;
147.25 	(3) a risk description according to section 245G.05 254B.04, subdivision 4;
147.26 	(4) the reasons for and circumstances of service termination. If a program discharges a 
147.27 	client at staff request, the reason for discharge and the procedure followed for the decision 
147.28 	to discharge must be documented and comply with the requirements in section 245G.14, 
147.29 	subdivision 3, clause (3);
147.30 	(5) the client's living arrangements at service termination;
148.1 	(6) continuing care recommendations, including transitions between more or less intense 
148.2 	services, or more frequent to less frequent services, and referrals made with specific attention 
148.3 	to continuity of care for mental health, as needed; and
148.4 	(7) service termination diagnosis.

148.5 	Sec. 14. Minnesota Statutes 2022, section 245G.09, subdivision 3, is amended to read:
148.6 		Subd. 3.Contents. Client records must contain the following:
148.7 	(1) documentation that the client was given information on client rights and 
148.8 	responsibilities, grievance procedures, tuberculosis, and HIV, and that the client was provided 
148.9 	an orientation to the program abuse prevention plan required under section 245A.65, 
148.10 	subdivision 2, paragraph (a), clause (4). If the client has an opioid use disorder, the record 
148.11 	must contain documentation that the client was provided educational information according 
148.12 	to section 245G.05, subdivision 1 3, paragraph (b);
148.13 	(2) an initial services plan completed according to section 245G.04;
148.14 	(3) a comprehensive assessment completed according to section 245G.05;
148.15 	(4) an assessment summary completed according to section 245G.05, subdivision 2;
148.16 	(5) an individual abuse prevention plan according to sections 245A.65, subdivision 2, 
148.17 	and 626.557, subdivision 14, when applicable;
148.18 	(6) (5) an individual treatment plan according to section 245G.06, subdivisions 1 and 2
148.19 	1a;
148.20 	(7) (6) documentation of treatment services, significant events, appointments, concerns, 
148.21 	and treatment plan reviews according to section 245G.06, subdivisions 2a, 2b, and 3, and 
148.22 	3a; and
148.23 	(8) (7) a summary at the time of service termination according to section 245G.06, 
148.24 	subdivision 4.

148.25 	Sec. 15. Minnesota Statutes 2022, section 245G.22, subdivision 15, is amended to read:
148.26 		Subd. 15.Nonmedication treatment services; documentation. (a) The program must 
148.27 	offer at least 50 consecutive minutes of individual or group therapy treatment services as 
148.28 	defined in section 245G.07, subdivision 1, paragraph (a), clause (1), per week, for the first 
148.29 	ten weeks following the day of service initiation, and at least 50 consecutive minutes per 
148.30 	month thereafter. As clinically appropriate, the program may offer these services cumulatively 
148.31 	and not consecutively in increments of no less than 15 minutes over the required time period, 
149.1 	and for a total of 60 minutes of treatment services over the time period, and must document 
149.2 	the reason for providing services cumulatively in the client's record. The program may offer 
149.3 	additional levels of service when deemed clinically necessary meet the requirements in 
149.4 	section 245G.07, subdivision 1, paragraph (a), and must document each time the client was 
149.5 	offered an individual or group counseling service. If the individual or group counseling 
149.6 	service was offered but not provided to the client, the license holder must document the 
149.7 	reason the service was not provided. If the service was provided, the license holder must 
149.8 	ensure the service is documented according to the requirements in section 245G.06, 
149.9 	subdivision 2a.
149.10 	(b) Notwithstanding the requirements of comprehensive assessments in section 245G.05, 
149.11 	the assessment must be completed within 21 days from the day of service initiation.
149.12 	(c) Notwithstanding the requirements of individual treatment plans set forth in section 
149.13 	245G.06:
149.14 	(1) treatment plan contents for a maintenance client are not required to include goals 
149.15 	the client must reach to complete treatment and have services terminated;
149.16 	(2) treatment plans for a client in a taper or detox status must include goals the client 
149.17 	must reach to complete treatment and have services terminated; and
149.18 	(3) for the ten weeks following the day of service initiation for all new admissions, 
149.19 	readmissions, and transfers, a weekly treatment plan review must be documented once the 
149.20 	treatment plan is completed. Subsequently, the counselor must document treatment plan 
149.21 	reviews in the six dimensions at least once monthly or, when clinical need warrants, more 
149.22 	frequently.

149.23 	EFFECTIVE DATE. This section is effective January 1, 2024.

149.24 	Sec. 16. Minnesota Statutes 2022, section 245I.10, subdivision 6, is amended to read:
149.25 		Subd. 6.Standard diagnostic assessment; required elements. (a) Only a mental health 
149.26 	professional or a clinical trainee may complete a standard diagnostic assessment of a client. 
149.27 	A standard diagnostic assessment of a client must include a face-to-face interview with a 
149.28 	client and a written evaluation of the client. The assessor must complete a client's standard 
149.29 	diagnostic assessment within the client's cultural context. An alcohol and drug counselor 
149.30 	may gather and document the information in paragraphs (b) and (c) when completing a 
149.31 	comprehensive assessment according to section 245G.05.
150.1 	(b) When completing a standard diagnostic assessment of a client, the assessor must 
150.2 	gather and document information about the client's current life situation, including the 
150.3 	following information:
150.4 	(1) the client's age;
150.5 	(2) the client's current living situation, including the client's housing status and household 
150.6 	members;
150.7 	(3) the status of the client's basic needs;
150.8 	(4) the client's education level and employment status;
150.9 	(5) the client's current medications;
150.10 	(6) any immediate risks to the client's health and safety, specifically withdrawal, medical 
150.11 	conditions, and behavioral and emotional symptoms;
150.12 	(7) the client's perceptions of the client's condition;
150.13 	(8) the client's description of the client's symptoms, including the reason for the client's 
150.14 	referral;
150.15 	(9) the client's history of mental health and substance use disorder treatment; and
150.16 	(10) cultural influences on the client.; and
150.17 	(11) substance use history, if applicable, including:
150.18 	(i) amounts and types of substances, frequency and duration, route of administration, 
150.19 	periods of abstinence, and circumstances of relapse; and
150.20 	(ii) the impact to functioning when under the influence of substances, including legal 
150.21 	interventions.
150.22 	(c) If the assessor cannot obtain the information that this paragraph requires without 
150.23 	retraumatizing the client or harming the client's willingness to engage in treatment, the 
150.24 	assessor must identify which topics will require further assessment during the course of the 
150.25 	client's treatment. The assessor must gather and document information related to the following 
150.26 	topics:
150.27 	(1) the client's relationship with the client's family and other significant personal 
150.28 	relationships, including the client's evaluation of the quality of each relationship;
150.29 	(2) the client's strengths and resources, including the extent and quality of the client's 
150.30 	social networks;
151.1 	(3) important developmental incidents in the client's life;
151.2 	(4) maltreatment, trauma, potential brain injuries, and abuse that the client has suffered;
151.3 	(5) the client's history of or exposure to alcohol and drug usage and treatment; and
151.4 	(6) the client's health history and the client's family health history, including the client's 
151.5 	physical, chemical, and mental health history.
151.6 	(d) When completing a standard diagnostic assessment of a client, an assessor must use 
151.7 	a recognized diagnostic framework.
151.8 	(1) When completing a standard diagnostic assessment of a client who is five years of 
151.9 	age or younger, the assessor must use the current edition of the DC: 0-5 Diagnostic 
151.10 	Classification of Mental Health and Development Disorders of Infancy and Early Childhood 
151.11 	published by Zero to Three.
151.12 	(2) When completing a standard diagnostic assessment of a client who is six years of 
151.13 	age or older, the assessor must use the current edition of the Diagnostic and Statistical 
151.14 	Manual of Mental Disorders published by the American Psychiatric Association.
151.15 	(3) When completing a standard diagnostic assessment of a client who is five years of 
151.16 	age or younger, an assessor must administer the Early Childhood Service Intensity Instrument 
151.17 	(ECSII) to the client and include the results in the client's assessment.
151.18 	(4) When completing a standard diagnostic assessment of a client who is six to 17 years 
151.19 	of age, an assessor must administer the Child and Adolescent Service Intensity Instrument 
151.20 	(CASII) to the client and include the results in the client's assessment.
151.21 	(5) When completing a standard diagnostic assessment of a client who is 18 years of 
151.22 	age or older, an assessor must use either (i) the CAGE-AID Questionnaire or (ii) the criteria 
151.23 	in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders 
151.24 	published by the American Psychiatric Association to screen and assess the client for a 
151.25 	substance use disorder.
151.26 	(e) When completing a standard diagnostic assessment of a client, the assessor must 
151.27 	include and document the following components of the assessment:
151.28 	(1) the client's mental status examination;
151.29 	(2) the client's baseline measurements; symptoms; behavior; skills; abilities; resources; 
151.30 	vulnerabilities; safety needs, including client information that supports the assessor's findings 
151.31 	after applying a recognized diagnostic framework from paragraph (d); and any differential 
151.32 	diagnosis of the client; and
152.1 	(3) an explanation of: (i) how the assessor diagnosed the client using the information 
152.2 	from the client's interview, assessment, psychological testing, and collateral information 
152.3 	about the client; (ii) the client's needs; (iii) the client's risk factors; (iv) the client's strengths; 
152.4 	and (v) the client's responsivity factors.
152.5 	(f) When completing a standard diagnostic assessment of a client, the assessor must 
152.6 	consult the client and the client's family about which services that the client and the family 
152.7 	prefer to treat the client. The assessor must make referrals for the client as to services required 
152.8 	by law.

152.9 	Sec. 17. Minnesota Statutes 2022, section 254B.01, is amended by adding a subdivision 
152.10 	to read:
152.11 		Subd. 2a.American Society of Addiction Medicine criteria or ASAM 
152.12 	criteria. "American Society of Addiction Medicine criteria" or "ASAM" means the clinical 
152.13 	guidelines for purposes of the assessment, treatment, placement, and transfer or discharge 
152.14 	of individuals with substance use disorders. The ASAM criteria are contained in the current 
152.15 	edition of the ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and 
152.16 	Co-Occurring Conditions.

152.17 	Sec. 18. Minnesota Statutes 2022, section 254B.01, subdivision 8, is amended to read:
152.18 		Subd. 8.Recovery community organization. "Recovery community organization" 
152.19 	means an independent organization led and governed by representatives of local communities 
152.20 	of recovery. A recovery community organization mobilizes resources within and outside 
152.21 	of the recovery community to increase the prevalence and quality of long-term recovery 
152.22 	from alcohol and other drug addiction substance use disorder. Recovery community 
152.23 	organizations provide peer-based recovery support activities such as training of recovery 
152.24 	peers. Recovery community organizations provide mentorship and ongoing support to 
152.25 	individuals dealing with a substance use disorder and connect them with the resources that 
152.26 	can support each person's recovery. A recovery community organization also promotes a 
152.27 	recovery-focused orientation in community education and outreach programming, and 
152.28 	organize recovery-focused policy advocacy activities to foster healthy communities and 
152.29 	reduce the stigma of substance use disorder.

153.1 	Sec. 19. Minnesota Statutes 2022, section 254B.01, is amended by adding a subdivision 
153.2 	to read:
153.3 		Subd. 9.Skilled treatment services. "Skilled treatment services" has the meaning given 
153.4 	for the "treatment services" described in section 245G.07, subdivisions 1, paragraph (a), 
153.5 	clauses (1) to (4), and 2, clauses (1) to (6). Skilled treatment services must be provided by 
153.6 	qualified professionals as identified in section 245G.07, subdivision 3.

153.7 	Sec. 20. Minnesota Statutes 2022, section 254B.01, is amended by adding a subdivision 
153.8 	to read:
153.9 		Subd. 10.Comprehensive assessment. "Comprehensive assessment" means a 
153.10 	person-centered, trauma-informed assessment that:
153.11 	(1) is completed for a substance use disorder diagnosis, treatment planning, and 
153.12 	determination of client eligibility for substance use disorder treatment services;
153.13 	(2) meets the requirements in section 245G.05; and
153.14 	(3) is completed by an alcohol and drug counselor qualified according to section 245G.11, 
153.15 	subdivision 5.

153.16 	Sec. 21. Minnesota Statutes 2022, section 254B.04, is amended by adding a subdivision 
153.17 	to read:
153.18 		Subd. 4.Assessment criteria and risk descriptions. (a) A level of care determination 
153.19 	must use the following criteria to assess risk:
153.20 	(b) Dimension 1: Acute intoxication and withdrawal potential. A vendor must use the 
153.21 	following scoring and criteria in Dimension 1 to determine a client's acute intoxication and 
153.22 	withdrawal potential, the client's ability to cope with withdrawal symptoms, and the client's 
153.23 	current state of intoxication.
153.24 	"0" The client displays full functioning with good ability to tolerate and cope with 
153.25 	withdrawal discomfort, and the client shows no signs or symptoms of intoxication or 
153.26 	withdrawal or diminishing signs or symptoms.
153.27 	"1" The client can tolerate and cope with withdrawal discomfort. The client displays 
153.28 	mild-to-moderate intoxication or signs and symptoms interfering with daily functioning but 
153.29 	does not immediately endanger self or others. The client poses a minimal risk of severe 
153.30 	withdrawal.
154.1 	"2" The client has some difficulty tolerating and coping with withdrawal discomfort. 
154.2 	The client's intoxication may be severe, but the client responds to support and treatment 
154.3 	such that the client does not immediately endanger self or others. The client displays moderate 
154.4 	signs and symptoms of withdrawal with moderate risk of severe withdrawal.
154.5 	"3" The client tolerates and copes with withdrawal discomfort poorly. The client has 
154.6 	severe intoxication, such that the client endangers self or others, or intoxication has not 
154.7 	abated with less intensive services. The client displays severe signs and symptoms of 
154.8 	withdrawal, has a risk of severe-but-manageable withdrawal, or has worsening withdrawal 
154.9 	despite detoxification at less intensive level.
154.10 	"4" The client is incapacitated with severe signs and symptoms. The client displays 
154.11 	severe withdrawal and is a danger to self or others.
154.12 	(c) Dimension 2: biomedical conditions and complications. The vendor must use the 
154.13 	following scoring and criteria in Dimension 2 to determine a client's biomedical conditions 
154.14 	and complications, the degree to which any physical disorder of the client would interfere 
154.15 	with treatment for substance use, and the client's ability to tolerate any related discomfort. 
154.16 	If the client is pregnant, the provider must determine the impact of continued substance use 
154.17 	on the unborn child.
154.18 	"0" The client displays full functioning with good ability to cope with physical discomfort.
154.19 	"1" The client tolerates and copes with physical discomfort and is able to get the services 
154.20 	that the client needs.
154.21 	"2" The client has difficulty tolerating and coping with physical problems or has other 
154.22 	biomedical problems that interfere with recovery and treatment. The client neglects or does 
154.23 	not seek care for serious biomedical problems.
154.24 	"3" The client tolerates and copes poorly with physical problems or has poor general 
154.25 	health. The client neglects the client's medical problems without active assistance.
154.26 	"4" The client is unable to participate in substance use disorder treatment and has severe 
154.27 	medical problems, a condition that requires immediate intervention, or is incapacitated.
154.28 	(d) Dimension 3: Emotional, behavioral, and cognitive conditions and complications. 
154.29 	The vendor must use the following scoring and criteria in Dimension 3 to determine a client's 
154.30 	emotional, behavioral, and cognitive conditions and complications; the degree to which any 
154.31 	condition or complication is likely to interfere with treatment for substance use or with 
154.32 	functioning in significant life areas; and the likelihood of harm to self or others.
155.1 	"0" The client has good impulse control and coping skills and presents no risk of harm 
155.2 	to self or others. The client functions in all life areas and displays no emotional, behavioral, 
155.3 	or cognitive problems or the problems are stable.
155.4 	"1" The client has impulse control and coping skills. The client presents a mild to 
155.5 	moderate risk of harm to self or others or displays symptoms of emotional, behavioral, or 
155.6 	cognitive problems. The client has a mental health diagnosis and is stable. The client 
155.7 	functions adequately in significant life areas.
155.8 	"2" The client has difficulty with impulse control and lacks coping skills. The client has 
155.9 	thoughts of suicide or harm to others without means, however the thoughts may interfere 
155.10 	with participation in some activities. The client has difficulty functioning in significant life 
155.11 	areas. The client has moderate symptoms of emotional, behavioral, or cognitive problems. 
155.12 	The client is able to participate in most treatment activities.
155.13 	"3" The client has a severe lack of impulse control and coping skills. The client also has 
155.14 	frequent thoughts of suicide or harm to others including a plan and the means to carry out 
155.15 	the plan. In addition, the client is severely impaired in significant life areas and has severe 
155.16 	symptoms of emotional, behavioral, or cognitive problems that interfere with the client's 
155.17 	participation in treatment activities.
155.18 	"4" The client has severe emotional or behavioral symptoms that place the client or 
155.19 	others at acute risk of harm. The client also has intrusive thoughts of harming self or others. 
155.20 	The client is unable to participate in treatment activities.
155.21 	(e) Dimension 4: Readiness for change. The vendor must use the following scoring and 
155.22 	criteria in Dimension 4 to determine a client's readiness for change and the support necessary 
155.23 	to keep the client involved in treatment services.
155.24 	"0" The client is cooperative, motivated, ready to change, admits problems, committed 
155.25 	to change, and engaged in treatment as a responsible participant.
155.26 	"1" The client is motivated with active reinforcement to explore treatment and strategies 
155.27 	for change but ambivalent about illness or need for change.
155.28 	"2" The client displays verbal compliance, but lacks consistent behaviors, has low 
155.29 	motivation for change, and is passively involved in treatment.
155.30 	"3" The client displays inconsistent compliance, minimal awareness of either the client's 
155.31 	addiction or mental disorder, and is minimally cooperative.
155.32 	"4" The client is:
156.1 	(i) noncompliant with treatment and has no awareness of addiction or mental disorder 
156.2 	and does not want or is unwilling to explore change or is in total denial of the client's illness 
156.3 	and its implications; or
156.4 	(ii) the client is dangerously oppositional to the extent that the client is a threat of 
156.5 	imminent harm to self and others.
156.6 	(f) Dimension 5: Relapse, continued use, and continued problem potential. The vendor 
156.7 	must use the following scoring and criteria in Dimension 5 to determine a client's relapse, 
156.8 	continued use, and continued problem potential and the degree to which the client recognizes 
156.9 	relapse issues and has the skills to prevent relapse of either substance use or mental health 
156.10 	problems.
156.11 	"0" The client recognizes risk well and is able to manage potential problems.
156.12 	"1" The client recognizes relapse issues and prevention strategies but displays some 
156.13 	vulnerability for further substance use or mental health problems.
156.14 	"2" The client has:
156.15 	(i) minimal recognition and understanding of relapse and recidivism issues and displays 
156.16 	moderate vulnerability for further substance use or mental health problems; or
156.17 	(ii) some coping skills inconsistently applied.
156.18 	"3" The client has poor recognition and understanding of relapse and recidivism issues 
156.19 	and displays moderately high vulnerability for further substance use or mental health 
156.20 	problems. The client has few coping skills and rarely applies coping skills.
156.21 	"4" The client has no coping skills to arrest mental health or addiction illnesses or prevent 
156.22 	relapse. The client has no recognition or understanding of relapse and recidivism issues and 
156.23 	displays high vulnerability for further substance use disorder or mental health problems.
156.24 	(g) Dimension 6: Recovery environment. The vendor must use the following scoring 
156.25 	and criteria in Dimension 6 to determine a client's recovery environment, whether the areas 
156.26 	of the client's life are supportive of or antagonistic to treatment participation and recovery.
156.27 	"0" The client is engaged in structured meaningful activity and has a supportive significant 
156.28 	other, family, and living environment.
156.29 	"1" The client has passive social network support, or family and significant other are 
156.30 	not interested in the client's recovery. The client is engaged in structured meaningful activity.
157.1 	"2" The client is engaged in structured, meaningful activity, but peers, family, significant 
157.2 	other, and living environment are unsupportive, or there is criminal justice involvement by 
157.3 	the client or among the client's peers, significant other, or in the client's living environment.
157.4 	"3" The client is not engaged in structured meaningful activity, and the client's peers, 
157.5 	family, significant other, and living environment are unsupportive, or there is significant 
157.6 	criminal justice system involvement.
157.7 	"4" The client has:
157.8 	(i) a chronically antagonistic significant other, living environment, family, peer group, 
157.9 	or a long-term criminal justice involvement that is harmful to recovery or treatment progress; 
157.10 	or
157.11 	(ii) an actively antagonistic significant other, family, work, or living environment that 
157.12 	poses an immediate threat to the client's safety and well-being.

157.13 	Sec. 22. Minnesota Statutes 2022, section 254B.05, subdivision 1, is amended to read:
157.14 		Subdivision 1.Licensure requiredEligible vendors. (a) Programs licensed by the 
157.15 	commissioner are eligible vendors. Hospitals may apply for and receive licenses to be 
157.16 	eligible vendors, notwithstanding the provisions of section 245A.03. American Indian 
157.17 	programs that provide substance use disorder treatment, extended care, transitional residence, 
157.18 	or outpatient treatment services, and are licensed by tribal government are eligible vendors.
157.19 	(b) A licensed professional in private practice as defined in section 245G.01, subdivision 
157.20 	17, who meets the requirements of section 245G.11, subdivisions 1 and 4, is an eligible 
157.21 	vendor of a comprehensive assessment and assessment summary provided according to 
157.22 	section 245G.05, and treatment services provided according to sections 245G.06 and 
157.23 	245G.07, subdivision 1, paragraphs (a), clauses (1) to (5), and (b); and subdivision 2, clauses 
157.24 	(1) to (6).
157.25 	(c) A county is an eligible vendor for a comprehensive assessment and assessment 
157.26 	summary when provided by an individual who meets the staffing credentials of section 
157.27 	245G.11, subdivisions 1 and 5, and completed according to the requirements of section 
157.28 	245G.05. A county is an eligible vendor of care coordination services when provided by an 
157.29 	individual who meets the staffing credentials of section 245G.11, subdivisions 1 and 7, and 
157.30 	provided according to the requirements of section 245G.07, subdivision 1, paragraph (a), 
157.31 	clause (5). A county is an eligible vendor of peer recovery services when the services are 
157.32 	provided by an individual who meets the requirements of section 245G.11, subdivision 8.
158.1 	(d) A recovery community organization that meets certification requirements identified 
158.2 	by the commissioner certified by the Board of Recovery Services under sections 254B.20 
158.3 	to 254B.24 is an eligible vendor of peer support services.
158.4 	(e) Recovery community organizations directly approved by the commissioner of human 
158.5 	services before June 30, 2023, will retain their designation as a recovery community 
158.6 	organization.
158.7 	(e) (f) Detoxification programs licensed under Minnesota Rules, parts 9530.6510 to 
158.8 	9530.6590, are not eligible vendors. Programs that are not licensed as a residential or 
158.9 	nonresidential substance use disorder treatment or withdrawal management program by the 
158.10 	commissioner or by tribal government or do not meet the requirements of subdivisions 1a 
158.11 	and 1b are not eligible vendors.

158.12 	Sec. 23. Minnesota Statutes 2022, section 254B.05, subdivision 5, is amended to read:
158.13 		Subd. 5.Rate requirements. (a) The commissioner shall establish rates for substance 
158.14 	use disorder services and service enhancements funded under this chapter.
158.15 	(b) Eligible substance use disorder treatment services include:
158.16 	(1) outpatient treatment services that are licensed according to sections 245G.01 to 
158.17 	245G.17, or applicable tribal license; those licensed, as applicable, according to chapter 
158.18 	245G or applicable Tribal license and provided by the following ASAM levels of care:
158.19 	(i) ASAM level 0.5 early intervention services provided according to section 254B.19, 
158.20 	subdivision 1, clause (1);
158.21 	(ii) ASAM level 1.0 outpatient services provided according to section 254B.19, 
158.22 	subdivision 1, clause (2);
158.23 	(iii) ASAM level 2.1 intensive outpatient services provided according to section 254B.19, 
158.24 	subdivision 1, clause (3);
158.25 	(iv) ASAM level 2.5 partial hospitalization services provided according to section 
158.26 	254B.19, subdivision 1, clause (4);
158.27 	(v) ASAM level 3.1 clinically managed low-intensity residential services provided 
158.28 	according to section 254B.19, subdivision 1, clause (5);
158.29 	(vi) ASAM level 3.3 clinically managed population-specific high-intensity residential 
158.30 	services provided according to section 254B.19, subdivision 1, clause (6); and
159.1 	(vii) ASAM level 3.5 clinically managed high-intensity residential services provided 
159.2 	according to section 254B.19, subdivision 1, clause (7);
159.3 	(2) comprehensive assessments provided according to sections 245.4863, paragraph (a), 
159.4 	and 245G.05;
159.5 	(3) care treatment coordination services provided according to section 245G.07, 
159.6 	subdivision 1, paragraph (a), clause (5);
159.7 	(4) peer recovery support services provided according to section 245G.07, subdivision 
159.8 	2, clause (8);
159.9 	(5) on July 1, 2019, or upon federal approval, whichever is later, withdrawal management 
159.10 	services provided according to chapter 245F;
159.11 	(6) substance use disorder treatment services with medications for opioid use disorder 
159.12 	that are provided in an opioid treatment program licensed according to sections 245G.01 
159.13 	to 245G.17 and 245G.22, or applicable tribal license;
159.14 	(7) substance use disorder treatment with medications for opioid use disorder plus 
159.15 	enhanced treatment services that meet the requirements of clause (6) and provide nine hours 
159.16 	of clinical services each week;
159.17 	(8) high, medium, and low intensity residential treatment services that are licensed 
159.18 	according to sections 245G.01 to 245G.17 and 245G.21 or applicable tribal license which 
159.19 	provide, respectively, 30, 15, and five hours of clinical services each week;
159.20 	(9) (7) hospital-based treatment services that are licensed according to sections 245G.01
159.21 	to 245G.17 or applicable tribal license and licensed as a hospital under sections 144.50 to 
159.22 	144.56;
159.23 	(10) (8) adolescent treatment programs that are licensed as outpatient treatment programs 
159.24 	according to sections 245G.01 to 245G.18 or as residential treatment programs according 
159.25 	to Minnesota Rules, parts 2960.0010 to 2960.0220, and 2960.0430 to 2960.0490, or 
159.26 	applicable tribal license;
159.27 	(11) high-intensity residential treatment (9) ASAM 3.5 clinically managed high-intensity 
159.28 	residential services that are licensed according to sections 245G.01 to 245G.17 and 245G.21
159.29 	or applicable tribal license, which provide 30 hours of clinical services each week ASAM 
159.30 	level of care 3.5 according to section 254B.19, subdivision 1, clause (7), and is provided 
159.31 	by a state-operated vendor or to clients who have been civilly committed to the commissioner, 
159.32 	present the most complex and difficult care needs, and are a potential threat to the community; 
159.33 	and
160.1 	(12) (10) room and board facilities that meet the requirements of subdivision 1a.
160.2 	(c) The commissioner shall establish higher rates for programs that meet the requirements 
160.3 	of paragraph (b) and one of the following additional requirements:
160.4 	(1) programs that serve parents with their children if the program:
160.5 	(i) provides on-site child care during the hours of treatment activity that:
160.6 	(A) is licensed under chapter 245A as a child care center under Minnesota Rules, chapter 
160.7 	9503; or
160.8 	(B) meets the licensure exclusion criteria of section 245A.03, subdivision 2, paragraph 
160.9 	(a), clause (6), and meets the requirements under section 245G.19, subdivision 4; or
160.10 	(ii) arranges for off-site child care during hours of treatment activity at a facility that is 
160.11 	licensed under chapter 245A as:
160.12 	(A) a child care center under Minnesota Rules, chapter 9503; or
160.13 	(B) a family child care home under Minnesota Rules, chapter 9502;
160.14 	(2) culturally specific or culturally responsive programs as defined in section 254B.01, 
160.15 	subdivision 4a;
160.16 	(3) disability responsive programs as defined in section 254B.01, subdivision 4b;
160.17 	(4) programs that offer medical services delivered by appropriately credentialed health 
160.18 	care staff in an amount equal to two hours per client per week if the medical needs of the 
160.19 	client and the nature and provision of any medical services provided are documented in the 
160.20 	client file; or
160.21 	(5) programs that offer services to individuals with co-occurring mental health and 
160.22 	substance use disorder problems if:
160.23 	(i) the program meets the co-occurring requirements in section 245G.20;
160.24 	(ii) 25 percent of the counseling staff are licensed mental health professionals under 
160.25 	section 245I.04, subdivision 2, or are students or licensing candidates under the supervision 
160.26 	of a licensed alcohol and drug counselor supervisor and mental health professional under 
160.27 	section 245I.04, subdivision 2, except that no more than 50 percent of the mental health 
160.28 	staff may be students or licensing candidates with time documented to be directly related 
160.29 	to provisions of co-occurring services;
160.30 	(iii) clients scoring positive on a standardized mental health screen receive a mental 
160.31 	health diagnostic assessment within ten days of admission;
161.1 	(iv) the program has standards for multidisciplinary case review that include a monthly 
161.2 	review for each client that, at a minimum, includes a licensed mental health professional 
161.3 	and licensed alcohol and drug counselor, and their involvement in the review is documented;
161.4 	(v) family education is offered that addresses mental health and substance use disorder 
161.5 	and the interaction between the two; and
161.6 	(vi) co-occurring counseling staff shall receive eight hours of co-occurring disorder 
161.7 	training annually.
161.8 	(d) In order to be eligible for a higher rate under paragraph (c), clause (1), a program 
161.9 	that provides arrangements for off-site child care must maintain current documentation at 
161.10 	the substance use disorder facility of the child care provider's current licensure to provide 
161.11 	child care services. Programs that provide child care according to paragraph (c), clause (1), 
161.12 	must be deemed in compliance with the licensing requirements in section 245G.19.
161.13 	(e) Adolescent residential programs that meet the requirements of Minnesota Rules, 
161.14 	parts 2960.0430 to 2960.0490 and 2960.0580 to 2960.0690, are exempt from the requirements 
161.15 	in paragraph (c), clause (4), items (i) to (iv).
161.16 	(f) Subject to federal approval, substance use disorder services that are otherwise covered 
161.17 	as direct face-to-face services may be provided via telehealth as defined in section 256B.0625, 
161.18 	subdivision 3b. The use of telehealth to deliver services must be medically appropriate to 
161.19 	the condition and needs of the person being served. Reimbursement shall be at the same 
161.20 	rates and under the same conditions that would otherwise apply to direct face-to-face services.
161.21 	(g) For the purpose of reimbursement under this section, substance use disorder treatment 
161.22 	services provided in a group setting without a group participant maximum or maximum 
161.23 	client to staff ratio under chapter 245G shall not exceed a client to staff ratio of 48 to one. 
161.24 	At least one of the attending staff must meet the qualifications as established under this 
161.25 	chapter for the type of treatment service provided. A recovery peer may not be included as 
161.26 	part of the staff ratio.
161.27 	(h) Payment for outpatient substance use disorder services that are licensed according 
161.28 	to sections 245G.01 to 245G.17 is limited to six hours per day or 30 hours per week unless 
161.29 	prior authorization of a greater number of hours is obtained from the commissioner Payment 
161.30 	for substance use disorder services under this section must start from the day of service 
161.31 	initiation when the comprehensive assessment is completed within the required timelines.

161.32 	EFFECTIVE DATE. The amendments to paragraph (b), clause (1), items (i) to (iv), 
161.33 	are effective January 1, 2025, or upon federal approval, whichever is later. The amendments 
162.1 	to paragraph (b), clause (1), items (v) to (vii), are effective January 1, 2024, or upon federal 
162.2 	approval, whichever is later. The amendments to paragraph (b), clauses (2) to (10), are 
162.3 	effective January 1, 2024.

162.4 	Sec. 24. [254B.19] AMERICAN SOCIETY OF ADDICTION MEDICINE 
162.5 	STANDARDS OF CARE.
162.6 		Subdivision 1.Level of care requirements. For each client assigned an ASAM level 
162.7 	of care, eligible vendors must implement the standards set by the ASAM for the respective 
162.8 	level of care. Additionally, vendors must meet the following requirements.
162.9 	(1) For ASAM level 0.5 early intervention targeting individuals who are at risk of 
162.10 	developing a substance-related problem but may not have a diagnosed substance use disorder, 
162.11 	early intervention services may include individual or group counseling, treatment 
162.12 	coordination, peer recovery support, screening brief intervention, and referral to treatment 
162.13 	provided according to section 254A.03, subdivision 3, paragraph (c).
162.14 	(2) For ASAM level 1.0 outpatient clients, adults must receive up to eight hours per 
162.15 	week of skilled treatment services and adolescents must receive up to five hours per week. 
162.16 	Services must be licensed according to section 245G.20 and meet requirements under section 
162.17 	256B.0759. Peer recovery and treatment coordination may be provided beyond the hourly 
162.18 	skilled treatment service hours allowable per week.
162.19 	(3) For ASAM level 2.1 intensive outpatient clients, adults must receive nine to 19 hours 
162.20 	per week of skilled treatment services and adolescents must receive six or more hours per 
162.21 	week. Vendors must be licensed according to section 245G.20 and must meet requirements 
162.22 	under section 256B.0759. Peer recovery and treatment coordination may be provided beyond 
162.23 	the hourly skilled treatment service hours allowable per week. If clinically indicated on the 
162.24 	client's treatment plan, this service may be provided in conjunction with room and board 
162.25 	according to section 254B.05, subdivision 1a.
162.26 	(4) For ASAM level 2.5 partial hospitalization clients, adults must receive 20 hours or 
162.27 	more of skilled treatment services. Services must be licensed according to section 245G.20 
162.28 	and must meet requirements under section 256B.0759. Level 2.5 is for clients who need 
162.29 	daily monitoring in a structured setting as directed by the individual treatment plan and in 
162.30 	accordance with the limitations in section 254B.05, subdivision 5, paragraph (h). If clinically 
162.31 	indicated on the client's treatment plan, this service may be provided in conjunction with 
162.32 	room and board according to section 254B.05, subdivision 1a.
163.1 	(5) For ASAM level 3.1 clinically managed low-intensity residential clients, programs 
163.2 	must provide at least 5 hours of skilled treatment services per week according to each client's 
163.3 	specific treatment schedule as directed by the individual treatment plan. Programs must be 
163.4 	licensed according to section 245G.20 and must meet requirements under section 256B.0759.
163.5 	(6) For ASAM level 3.3 clinically managed population-specific high-intensity residential 
163.6 	clients, programs must be licensed according to section 245G.20 and must meet requirements 
163.7 	under section 256B.0759. Programs must have 24-hour-a-day staffing coverage. Programs 
163.8 	must be enrolled as a disability responsive program as described in section 254B.01, 
163.9 	subdivision 4b, and must specialize in serving persons with a traumatic brain injury or a 
163.10 	cognitive impairment so significant, and the resulting level of impairment so great, that 
163.11 	outpatient or other levels of residential care would not be feasible or effective. Programs 
163.12 	must provide, at minimum, daily skilled treatment services seven days a week according to 
163.13 	each client's specific treatment schedule as directed by the individual treatment plan.
163.14 	(7) For ASAM level 3.5 clinically managed high-intensity residential clients, services 
163.15 	must be licensed according to section 245G.20 and must meet requirements under section 
163.16 	256B.0759. Programs must have 24-hour-a-day staffing coverage and provide, at minimum, 
163.17 	daily skilled treatment services seven days a week according to each client's specific treatment 
163.18 	schedule as directed by the individual treatment plan.
163.19 	(8) For ASAM level withdrawal management 3.2 clinically managed clients, withdrawal 
163.20 	management must be provided according to chapter 245F.
163.21 	(9) For ASAM level withdrawal management 3.7 medically monitored clients, withdrawal 
163.22 	management must be provided according to chapter 245F.
163.23 		Subd. 2.Patient referral arrangement agreement. The license holder must maintain 
163.24 	documentation of a formal patient referral arrangement agreement for each of the following 
163.25 	levels of care not provided by the license holder:
163.26 	(1) level 1.0 outpatient;
163.27 	(2) level 2.1 intensive outpatient;
163.28 	(3) level 2.5 partial hospitalization;
163.29 	(4) level 3.1 clinically managed low-intensity residential;
163.30 	(5) level 3.3 clinically managed population-specific high-intensity residential;
163.31 	(6) level 3.5 clinically managed high-intensity residential;
164.1 	(7) level withdrawal management 3.2 clinically managed residential withdrawal 
164.2 	management; and
164.3 	(8) level withdrawal management 3.7 medically monitored inpatient withdrawal 
164.4 	management.
164.5 		Subd. 3.Evidence-based practices. All services delivered within the ASAM levels of 
164.6 	care referenced in subdivision 1, clauses (1) to (7), must have documentation of the 
164.7 	evidence-based practices being utilized as referenced in the most current edition of the 
164.8 	ASAM criteria.
164.9 		Subd. 4.Program outreach plan. Eligible vendors providing services under ASAM 
164.10 	levels of care referenced in subdivision 1, clauses (2) to (7), must have a program outreach 
164.11 	plan. The treatment director must document a review and update the plan annually. The 
164.12 	program outreach plan must include treatment coordination strategies and processes to 
164.13 	ensure seamless transitions across the continuum of care. The plan must include how the 
164.14 	provider will:
164.15 	(1) increase the awareness of early intervention treatment services, including but not 
164.16 	limited to the services defined in section 254A.03, subdivision 3, paragraph (c);
164.17 	(2) coordinate, as necessary, with certified community behavioral health clinics when 
164.18 	a license holder is located in a geographic region served by a certified community behavioral 
164.19 	health clinic;
164.20 	(3) establish a referral arrangement agreement with a withdrawal management program 
164.21 	licensed under chapter 245F when a license holder is located in a geographic region in which 
164.22 	a withdrawal management program is licensed under chapter 245F. If a withdrawal 
164.23 	management program licensed under chapter 245F is not geographically accessible, the 
164.24 	plan must include how the provider will address the client's need for this level of care;
164.25 	(4) coordinate with inpatient acute-care hospitals, including emergency departments, 
164.26 	hospital outpatient clinics, urgent care centers, residential crisis settings, medical 
164.27 	detoxification inpatient facilities and ambulatory detoxification providers in the area served 
164.28 	by the provider to help transition individuals from emergency department or hospital settings 
164.29 	and minimize the time between assessment and treatment;
164.30 	(5) develop and maintain collaboration with local county and Tribal human services 
164.31 	agencies; and
164.32 	(6) collaborate with primary care and mental health settings.

165.1 	Sec. 25. [254B.191] EVIDENCE-BASED TRAINING.
165.2 	The commissioner must establish ongoing training opportunities for substance use 
165.3 	disorder treatment providers under chapter 245F to increase knowledge and develop skills 
165.4 	to adopt evidence-based and promising practices in substance use disorder treatment 
165.5 	programs. Training opportunities must support the transition to ASAM standards. Training 
165.6 	formats may include self or organizational assessments, virtual modules, one-to-one coaching, 
165.7 	self-paced courses, interactive hybrid courses, and in-person courses. Foundational and 
165.8 	skill-building training topics may include:
165.9 	(1) ASAM criteria;
165.10 	(2) person-centered and culturally responsive services;
165.11 	(3) medical and clinical decision making;
165.12 	(4) conducting assessments and appropriate level of care;
165.13 	(5) treatment and service planning;
165.14 	(6) identifying and overcoming systems challenges;
165.15 	(7) conducting clinical case reviews; and
165.16 	(8) appropriate and effective transfer and discharge.

165.17 	Sec. 26. [254B.20] DEFINITIONS.
165.18 		Subdivision 1.Applicability. For the purposes of sections 254B.20 to 254B.24, the 
165.19 	following terms have the meanings given.
165.20 		Subd. 2.Board. "Board" means the Board of Recovery Services established by section 
165.21 	254B.21.
165.22 		Subd. 3.Credential or credentialing. "Credential" or "credentialing" means the 
165.23 	standardized process of formally reviewing and designating a recovery organization as 
165.24 	qualified to employ peer recovery specialists based on criteria established by the board.
165.25 		Subd. 4.Minnesota Certification Board. "Minnesota Certification Board" means the 
165.26 	nonprofit agency member board of the International Certification and Reciprocity Consortium 
165.27 	that sets the policies and procedures for alcohol and other drug professional certifications 
165.28 	in Minnesota, including peer recovery specialists.
165.29 		Subd. 5.Peer recovery specialist. "Peer recovery specialist" has the meaning given to 
165.30 	"recovery peer" in section 245F.02, subdivision 21. A peer recovery specialist must meet 
165.31 	the qualifications of a recovery peer in section 245G.11, subdivision 8.
166.1 		Subd. 6.Peer recovery services. "Peer recovery services" has the meaning given to 
166.2 	"peer recovery support services" in section 245F.02, subdivision 17.

166.3 	Sec. 27. [254B.21] MINNESOTA BOARD OF RECOVERY SERVICES.
166.4 		Subdivision 1.Creation. (a) The Minnesota Board of Recovery Services is established 
166.5 	and consists of 13 members appointed by the governor as follows:
166.6 	(1) five of the members must be certified peer recovery specialists certified under the 
166.7 	Minnesota Certification Board with an active credential;
166.8 	(2) two of the members must be certified peer recovery specialist supervisors certified 
166.9 	under the Minnesota Certification Board with an active credential;
166.10 	(3) four of the members must be currently employed by a Minnesota-based recovery 
166.11 	community organization recognized by the commissioner of human services; and
166.12 	(4) two of the members must be public members as defined in section 214.02, and be 
166.13 	either a family member of a person currently using substances or a person in recovery from 
166.14 	a substance use disorder.
166.15 	(b) At the time of their appointments, at least three members must reside outside of the 
166.16 	seven-county metropolitan area.
166.17 	(c) At the time of their appointments, at least three members must be members of:
166.18 	(1) a community of color; or
166.19 	(2) an underrepresented community, defined as a group that is not represented in the 
166.20 	majority with respect to race, ethnicity, national origin, sexual orientation, gender identity, 
166.21 	or physical ability.
166.22 		Subd. 2.Officers. The board must annually elect a chair and vice-chair from among its 
166.23 	members and may elect other officers as necessary. The board must meet at least twice a 
166.24 	year but may meet more frequently at the call of the chair.
166.25 		Subd. 3.Membership terms; compensation. Membership terms, compensation of 
166.26 	members, removal of members, the filling of membership vacancies, and fiscal year and 
166.27 	reporting requirements are as provided in section 15.058.
166.28 		Subd. 4.Expiration. The board does not expire.

166.29 	Sec. 28. [254B.22] DUTIES OF THE BOARD.
166.30 	The Minnesota Board of Recovery Services shall:
167.1 	(1) develop and define by rule criteria for credentialing recovery organizations using 
167.2 	nationally recognized best practices and standards;
167.3 	(2) determine the renewal cycle and renewal period for eligible vendors of peer recovery 
167.4 	services;
167.5 	(3) receive, review, approve, or disapprove initial applications, renewals, and 
167.6 	reinstatement requests for credentialing from recovery organizations;
167.7 	(4) establish administrative procedures for processing applications submitted under 
167.8 	clause (3) and hire or appoint such agents as are appropriate for processing applications;
167.9 	(5) retain records of board actions and proceedings in accordance with public records 
167.10 	laws; and
167.11 	(6) establish, maintain, and publish annually a register of current credentialed recovery 
167.12 	organizations.

167.13 	Sec. 29. [254B.23] REQUIREMENTS FOR CREDENTIALING.
167.14 		Subdivision 1.Application requirements. An application submitted to the board for 
167.15 	credentialing must include:
167.16 	(1) evidence that the applicant is a nonprofit organization based in Minnesota or meets 
167.17 	the eligibility criteria defined by the board;
167.18 	(2) a description of the applicant's activities and services that support recovery from 
167.19 	substance use disorder; and
167.20 	(3) any other requirements as specified by the board.
167.21 		Subd. 2.Fee. Each applicant must pay a nonrefundable application fee as established 
167.22 	by the board. The revenue from the fee must be deposited in the state government special 
167.23 	revenue fund.

167.24 	Sec. 30. [254B.24] APPEAL AND HEARING.
167.25 	A recovery organization aggrieved by the board's failure to issue, renew, or reinstate 
167.26 	credentialing under sections 254B.20 to 254B.24 may appeal by requesting a hearing under 
167.27 	the procedures of chapter 14.

167.28 	Sec. 31. [254B.30] PROJECT ECHO GRANTS.
167.29 		Subdivision 1.Establishment. The commissioner must establish a grant program to 
167.30 	support new or existing Project ECHO programs in the state.
168.1 		Subd. 2.Project ECHO at Hennepin Healthcare. The commissioner must use 
168.2 	appropriations under this subdivision to award grants to Hennepin Healthcare to establish 
168.3 	at least four substance use disorder-focused Project ECHO programs, expanding the grantee's 
168.4 	capacity to improve health and substance use disorder outcomes for diverse populations of 
168.5 	individuals enrolled in medical assistance, including but not limited to immigrants, 
168.6 	individuals who are homeless, individuals seeking maternal and perinatal care, and other 
168.7 	underserved populations. The Project ECHO programs funded under this subdivision must 
168.8 	be culturally responsive, and the grantee must contract with culturally and linguistically 
168.9 	appropriate substance use disorder service providers who have expertise in focus areas, 
168.10 	based on the populations served. Grant funds may be used for program administration, 
168.11 	equipment, provider reimbursement, and staffing hours.

168.12 	Sec. 32. Minnesota Statutes 2022, section 256B.0759, subdivision 2, is amended to read:
168.13 		Subd. 2.Provider participation. (a) Outpatient Programs licensed by the Department 
168.14 	of Human Services as nonresidential substance use disorder treatment providers may elect 
168.15 	to participate in the demonstration project and meet the requirements of subdivision 3. To 
168.16 	participate, a provider must notify the commissioner of the provider's intent to participate 
168.17 	in a format required by the commissioner and enroll as a demonstration project provider
168.18 	programs that receive payment under this chapter must enroll as demonstration project 
168.19 	providers and meet the requirements of subdivision 3 by January 1, 2025. Programs that do 
168.20 	not meet the requirements of this paragraph are ineligible for payment for services provided 
168.21 	under section 256B.0625.
168.22 	(b) Programs licensed by the Department of Human Services as residential treatment 
168.23 	programs according to section 245G.21 that receive payment under this chapter must enroll 
168.24 	as demonstration project providers and meet the requirements of subdivision 3 by January 
168.25 	1, 2024. Programs that do not meet the requirements of this paragraph are ineligible for 
168.26 	payment for services provided under section 256B.0625.
168.27 	(c) Programs licensed by the Department of Human Services as residential treatment 
168.28 	programs according to section 245G.21 that receive payment under this chapter and are 
168.29 	licensed as a hospital under sections 144.50 to 144.581 must enroll as demonstration project 
168.30 	providers and meet the requirements of subdivision 3 by January 1, 2025.
168.31 	(c) (d) Programs licensed by the Department of Human Services as withdrawal 
168.32 	management programs according to chapter 245F that receive payment under this chapter 
168.33 	must enroll as demonstration project providers and meet the requirements of subdivision 3 
169.1 	by January 1, 2024. Programs that do not meet the requirements of this paragraph are 
169.2 	ineligible for payment for services provided under section 256B.0625.
169.3 	(d) (e) Out-of-state residential substance use disorder treatment programs that receive 
169.4 	payment under this chapter must enroll as demonstration project providers and meet the 
169.5 	requirements of subdivision 3 by January 1, 2024. Programs that do not meet the requirements 
169.6 	of this paragraph are ineligible for payment for services provided under section 256B.0625.
169.7 	(e) (f) Tribally licensed programs may elect to participate in the demonstration project 
169.8 	and meet the requirements of subdivision 3. The Department of Human Services must 
169.9 	consult with Tribal nations to discuss participation in the substance use disorder 
169.10 	demonstration project.
169.11 	(f) (g) The commissioner shall allow providers enrolled in the demonstration project 
169.12 	before July 1, 2021, to receive applicable rate enhancements authorized under subdivision 
169.13 	4 for all services provided on or after the date of enrollment, except that the commissioner 
169.14 	shall allow a provider to receive applicable rate enhancements authorized under subdivision 
169.15 	4 for services provided on or after July 22, 2020, to fee-for-service enrollees, and on or after 
169.16 	January 1, 2021, to managed care enrollees, if the provider meets all of the following 
169.17 	requirements:
169.18 	(1) the provider attests that during the time period for which the provider is seeking the 
169.19 	rate enhancement, the provider took meaningful steps in their plan approved by the 
169.20 	commissioner to meet the demonstration project requirements in subdivision 3; and
169.21 	(2) the provider submits attestation and evidence, including all information requested 
169.22 	by the commissioner, of meeting the requirements of subdivision 3 to the commissioner in 
169.23 	a format required by the commissioner.
169.24 	(g) (h) The commissioner may recoup any rate enhancements paid under paragraph (f)
169.25 	(g) to a provider that does not meet the requirements of subdivision 3 by July 1, 2021.

169.26 	Sec. 33. Minnesota Statutes 2022, section 256I.05, is amended by adding a subdivision 
169.27 	to read:
169.28 		Subd. 1s.Supplemental rate; Douglas County. Notwithstanding the provisions of 
169.29 	subdivisions 1a and 1c, beginning July 1, 2023, a county agency shall negotiate a 
169.30 	supplementary rate in addition to the rate specified in subdivision 1, not to exceed $750 per 
169.31 	month, including any legislatively authorized inflationary adjustments, for a housing support 
169.32 	provider located in Douglas County that operates a long-term residential facility with a total 
170.1 	of 74 beds that serve chemically dependent men and provide 24-hour-a-day supervision 
170.2 	and other support services.

170.3 	Sec. 34. Minnesota Statutes 2022, section 256I.05, is amended by adding a subdivision 
170.4 	to read:
170.5 		Subd. 1t.Supplemental rate; Crow Wing County. Notwithstanding the provisions of 
170.6 	subdivisions 1a and 1c, beginning July 1, 2023, a county agency shall negotiate a 
170.7 	supplementary rate in addition to the rate specified in subdivision 1, not to exceed $750 per 
170.8 	month, including any legislatively authorized inflationary adjustments, for a housing support 
170.9 	provider located in Crow Wing County that operates a long-term residential facility with a 
170.10 	total of 90 beds that serve chemically dependent men and women and provides 24-hour-a-day 
170.11 	supervision and other support services.

170.12 	Sec. 35. [325F.725] SOBER HOME TITLE PROTECTION.
170.13 	No person or entity may use the phrase "sober home," whether alone or in combination 
170.14 	with other words and whether orally or in writing, to advertise, market, or otherwise describe, 
170.15 	offer, or promote itself, or any housing, service, service package, or program that it provides 
170.16 	within this state, unless the person or entity is a cooperative living residence, a room and 
170.17 	board residence, an apartment, or any other living accommodation that provides temporary 
170.18 	housing to persons with a substance use disorder, does not provide counseling or treatment 
170.19 	services to residents, promotes sustained recovery from substance use disorders, and follows 
170.20 	the sober living guidelines published by the federal Substance Abuse and Mental Health 
170.21 	Services Administration.

170.22 	Sec. 36. CULTURALLY RESPONSIVE RECOVERY COMMUNITY GRANTS.
 170.23 	The commissioner must establish start-up and capacity-building grants for prospective 
170.24 	or new recovery community organizations serving or intending to serve culturally specific 
170.25 	or population-specific recovery communities. Grants may be used for expenses that are not 
170.26 	reimbursable under Minnesota health care programs, including but not limited to:
170.27 	(1) costs associated with hiring and retaining staff;
170.28 	(2) staff training, purchasing office equipment and supplies;
170.29 	(3) purchasing software and website services;
170.30 	(4) costs associated with establishing nonprofit status;
170.31 	(5) rental and lease costs and community outreach; and
171.1 	(6) education and recovery events.

171.2 	EFFECTIVE DATE. This section is effective July 1, 2023.

171.3 	Sec. 37. WITHDRAWAL MANAGEMENT START-UP AND 
171.4 	CAPACITY-BUILDING GRANTS.
 171.5 	The commissioner must establish start-up and capacity-building grants for prospective 
171.6 	or new withdrawal management programs that will meet medically monitored or clinically 
171.7 	monitored levels of care. Grants may be used for expenses that are not reimbursable under 
171.8 	Minnesota health care programs, including but not limited to:
171.9 	(1) costs associated with hiring staff;
171.10 	(2) costs associated with staff retention;
171.11 	(3) the purchase of office equipment and supplies;
171.12 	(4) the purchase of software;
171.13 	(5) costs associated with obtaining applicable and required licenses;
171.14 	(6) business formation costs;
171.15 	(7) costs associated with staff training; and
171.16 	(8) the purchase of medical equipment and supplies necessary to meet health and safety 
171.17 	requirements.

171.18 	EFFECTIVE DATE. This section is effective July 1, 2023.

171.19 	Sec. 38. FAMILY TREATMENT START-UP AND CAPACITY-BUILDING 
171.20 	GRANTS.
 171.21 	The commissioner must establish start-up and capacity-building grants for prospective 
171.22 	or new substance use disorder treatment programs that serve parents with their children. 
171.23 	Grants must be used for expenses that are not reimbursable under Minnesota health care 
171.24 	programs, including but not limited to:
171.25 	(1) physical plant upgrades to support larger family units;
171.26 	(2) supporting the expansion or development of programs that provide holistic services, 
171.27 	including trauma supports, conflict resolution, and parenting skills;
172.1 	(3) increasing awareness, education, and outreach utilizing culturally responsive 
172.2 	approaches to develop relationships between culturally specific communities and clinical 
172.3 	treatment provider programs; and
172.4 	(4) expanding culturally specific family programs and accommodating diverse family 
172.5 	units.

172.6 	EFFECTIVE DATE. This section is effective July 1, 2023.

172.7 	Sec. 39. MEDICAL ASSISTANCE BEHAVIORAL HEALTH SYSTEM 
172.8 	TRANSFORMATION STUDY.
 172.9 	The commissioner, in consultation with stakeholders, must evaluate the feasibility, 
172.10 	potential design, and federal authorities needed to cover traditional healing, behavioral 
172.11 	health services in correctional facilities, and contingency management under the medical 
172.12 	assistance program.

172.13 	Sec. 40. REVISED PAYMENT METHODOLOGY FOR OPIOID TREATMENT 
172.14 	PROGRAMS.
 172.15 	The commissioner must revise the payment methodology for substance use services 
172.16 	with medications for opioid use disorder under Minnesota Statutes, section 254B.05, 
172.17 	subdivision 5, paragraph (b), clause (6). Payment must occur only if the provider renders 
172.18 	the service or services billed on that date of service or, in the case of drugs and drug-related 
172.19 	services, within a week as defined by the commissioner. The revised payment methodology 
172.20 	must include a weekly bundled rate that includes the costs of drugs, drug administration 
172.21 	and observation, drug packaging and preparation, and nursing time. The bundled weekly 
172.22 	rate must be based on the Medicare rate. The commissioner must seek all necessary waivers, 
172.23 	state plan amendments, and federal authorities required to implement the revised payment 
172.24 	methodology.

172.25 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
172.26 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
172.27 	when federal approval is obtained.

172.28 	Sec. 41. REVISOR INSTRUCTION.
 172.29 	The revisor of statutes shall renumber Minnesota Statutes, section 245G.01, subdivision 
172.30 	20b, as Minnesota Statutes, section 245G.01, subdivision 20d, and make any necessary 
172.31 	changes to cross-references.

173.1 	Sec. 42. REPEALER.
 173.2 	(a) Minnesota Statutes 2022, sections 245G.05, subdivision 2; and 256B.0759, subdivision 
173.3 	6, are repealed.
173.4 	(b) Minnesota Statutes 2022, section 246.18, subdivisions 2 and 2a, are repealed.

173.5 	EFFECTIVE DATE. Paragraph (a) is effective January 1, 2024. Paragraph (b) is 
173.6 	effective July 1, 2023.

173.7 	ARTICLE 5
173.8 	SUBSTANCE USE DISORDER

173.9 	Section 1. Minnesota Statutes 2022, section 16A.151, subdivision 2, is amended to read:
173.10 		Subd. 2.Exceptions. (a) If a state official litigates or settles a matter on behalf of specific 
173.11 	injured persons or entities, this section does not prohibit distribution of money to the specific 
173.12 	injured persons or entities on whose behalf the litigation or settlement efforts were initiated. 
173.13 	If money recovered on behalf of injured persons or entities cannot reasonably be distributed 
173.14 	to those persons or entities because they cannot readily be located or identified or because 
173.15 	the cost of distributing the money would outweigh the benefit to the persons or entities, the 
173.16 	money must be paid into the general fund.
173.17 	(b) Money recovered on behalf of a fund in the state treasury other than the general fund 
173.18 	may be deposited in that fund.
173.19 	(c) This section does not prohibit a state official from distributing money to a person or 
173.20 	entity other than the state in litigation or potential litigation in which the state is a defendant 
173.21 	or potential defendant.
173.22 	(d) State agencies may accept funds as directed by a federal court for any restitution or 
173.23 	monetary penalty under United States Code, title 18, section 3663(a)(3), or United States 
173.24 	Code, title 18, section 3663A(a)(3). Funds received must be deposited in a special revenue 
173.25 	account and are appropriated to the commissioner of the agency for the purpose as directed 
173.26 	by the federal court.
173.27 	(e) Tobacco settlement revenues as defined in section 16A.98, subdivision 1, paragraph 
173.28 	(t), may be deposited as provided in section 16A.98, subdivision 12.
173.29 	(f) Any money received by the state resulting from a settlement agreement or an assurance 
173.30 	of discontinuance entered into by the attorney general of the state, or a court order in litigation 
173.31 	brought by the attorney general of the state, on behalf of the state or a state agency, related 
173.32 	to alleged violations of consumer fraud laws in the marketing, sale, or distribution of opioids 
174.1 	in this state or other alleged illegal actions that contributed to the excessive use of opioids, 
174.2 	must be deposited in the settlement account established in the opiate epidemic response 
174.3 	fund under section 256.043, subdivision 1. This paragraph does not apply to attorney fees 
174.4 	and costs awarded to the state or the Attorney General's Office, to contract attorneys hired 
174.5 	by the state or Attorney General's Office, or to other state agency attorneys.
174.6 	(g) Notwithstanding paragraph (f), if money is received from a settlement agreement or 
174.7 	an assurance of discontinuance entered into by the attorney general of the state or a court 
174.8 	order in litigation brought by the attorney general of the state on behalf of the state or a state 
174.9 	agency against a consulting firm working for an opioid manufacturer or opioid wholesale 
174.10 	drug distributor, the commissioner shall deposit any money received into the settlement 
174.11 	account established within the opiate epidemic response fund under section 256.042, 
174.12 	subdivision 1. Notwithstanding section 256.043, subdivision 3a, paragraph (a), any amount 
174.13 	deposited into the settlement account in accordance with this paragraph shall be appropriated 
174.14 	to the commissioner of human services to award as grants as specified by the opiate epidemic 
174.15 	response advisory council in accordance with section 256.043, subdivision 3a, paragraph 
174.16 	(d) (e).

174.17 	Sec. 2. [121A.224] OPIATE ANTAGONISTS.
174.18 	(a) A school district or charter school must maintain a supply of opiate antagonists, as 
174.19 	defined in section 604A.04, subdivision 1, at each school site to be administered in 
174.20 	compliance with section 151.37, subdivision 12.
174.21 	(b) Each school building must have two doses of nasal naloxone available on site.
174.22 	(c) The commissioner of health must develop and disseminate to schools a short training 
174.23 	video about how and when to administer nasal naloxone. The person having control of the 
174.24 	school building must ensure that at least one staff member trained on how and when to 
174.25 	administer nasal naloxone is on site when the school building is open to students, staff, or 
174.26 	the public, including before school, after school, or weekend activities.

174.27 	EFFECTIVE DATE. This section is effective July 1, 2023.

174.28 	Sec. 3. Minnesota Statutes 2022, section 151.065, subdivision 7, is amended to read:
174.29 		Subd. 7.Deposit of fees. (a) The license fees collected under this section, with the 
174.30 	exception of the fees identified in paragraphs (b) and (c), shall be deposited in the state 
174.31 	government special revenue fund.
175.1 	(b) $5,000 of each fee collected under subdivision 1, clauses (6) to (9), and (11) to (15), 
175.2 	and subdivision 3, clauses (4) to (7), and (9) to (13), and $55,000 of each fee collected under 
175.3 	subdivision 1, clause (16), and subdivision 3, clause (14), shall be deposited in the opiate 
175.4 	epidemic response fund established in section 256.043.
175.5 	(c) If the fees collected under subdivision 1, clause (16), or subdivision 3, clause (14), 
175.6 	are reduced under section 256.043, $5,000 of the reduced fee shall be deposited in the opiate 
175.7 	epidemic response fund in section 256.043.

175.8 	Sec. 4. Minnesota Statutes 2022, section 241.021, subdivision 1, is amended to read:
175.9 		Subdivision 1.Correctional facilities; inspection; licensing. (a) Except as provided 
175.10 	in paragraph (b), the commissioner of corrections shall inspect and license all correctional 
175.11 	facilities throughout the state, whether public or private, established and operated for the 
175.12 	detention and confinement of persons confined or incarcerated therein according to law 
175.13 	except to the extent that they are inspected or licensed by other state regulating agencies. 
175.14 	The commissioner shall promulgate pursuant to chapter 14, rules establishing minimum 
175.15 	standards for these facilities with respect to their management, operation, physical condition, 
175.16 	and the security, safety, health, treatment, and discipline of persons confined or incarcerated 
175.17 	therein. These minimum standards shall include but are not limited to specific guidance 
175.18 	pertaining to:
175.19 	(1) screening, appraisal, assessment, and treatment for persons confined or incarcerated 
175.20 	in correctional facilities with mental illness or substance use disorders;
175.21 	(2) a policy on the involuntary administration of medications;
175.22 	(3) suicide prevention plans and training;
175.23 	(4) verification of medications in a timely manner;
175.24 	(5) well-being checks;
175.25 	(6) discharge planning, including providing prescribed medications to persons confined 
175.26 	or incarcerated in correctional facilities upon release;
175.27 	(7) a policy on referrals or transfers to medical or mental health care in a noncorrectional 
175.28 	institution;
175.29 	(8) use of segregation and mental health checks;
175.30 	(9) critical incident debriefings;
176.1 	(10) clinical management of substance use disorders and opioid overdose emergency 
176.2 	procedures;
176.3 	(11) a policy regarding identification of persons with special needs confined or 
176.4 	incarcerated in correctional facilities;
176.5 	(12) a policy regarding the use of telehealth;
176.6 	(13) self-auditing of compliance with minimum standards;
176.7 	(14) information sharing with medical personnel and when medical assessment must be 
176.8 	facilitated;
176.9 	(15) a code of conduct policy for facility staff and annual training;
176.10 	(16) a policy on death review of all circumstances surrounding the death of an individual 
176.11 	committed to the custody of the facility; and
176.12 	(17) dissemination of a rights statement made available to persons confined or 
176.13 	incarcerated in licensed correctional facilities.
176.14 	No individual, corporation, partnership, voluntary association, or other private 
176.15 	organization legally responsible for the operation of a correctional facility may operate the 
176.16 	facility unless it possesses a current license from the commissioner of corrections. Private 
176.17 	adult correctional facilities shall have the authority of section 624.714, subdivision 13, if 
176.18 	the Department of Corrections licenses the facility with the authority and the facility meets 
176.19 	requirements of section 243.52.
176.20 	The commissioner shall review the correctional facilities described in this subdivision 
176.21 	at least once every two years, except as otherwise provided, to determine compliance with 
176.22 	the minimum standards established according to this subdivision or other Minnesota statute 
176.23 	related to minimum standards and conditions of confinement.
176.24 	The commissioner shall grant a license to any facility found to conform to minimum 
176.25 	standards or to any facility which, in the commissioner's judgment, is making satisfactory 
176.26 	progress toward substantial conformity and the standards not being met do not impact the 
176.27 	interests and well-being of the persons confined or incarcerated in the facility. A limited 
176.28 	license under subdivision 1a may be issued for purposes of effectuating a facility closure. 
176.29 	The commissioner may grant licensure up to two years. Unless otherwise specified by 
176.30 	statute, all licenses issued under this chapter expire at 12:01 a.m. on the day after the 
176.31 	expiration date stated on the license.
177.1 	The commissioner shall have access to the buildings, grounds, books, records, staff, and 
177.2 	to persons confined or incarcerated in these facilities. The commissioner may require the 
177.3 	officers in charge of these facilities to furnish all information and statistics the commissioner 
177.4 	deems necessary, at a time and place designated by the commissioner.
177.5 	All facility administrators of correctional facilities are required to report all deaths of 
177.6 	individuals who died while committed to the custody of the facility, regardless of whether 
177.7 	the death occurred at the facility or after removal from the facility for medical care stemming 
177.8 	from an incident or need for medical care at the correctional facility, as soon as practicable, 
177.9 	but no later than 24 hours of receiving knowledge of the death, including any demographic 
177.10 	information as required by the commissioner.
177.11 	All facility administrators of correctional facilities are required to report all other 
177.12 	emergency or unusual occurrences as defined by rule, including uses of force by facility 
177.13 	staff that result in substantial bodily harm or suicide attempts, to the commissioner of 
177.14 	corrections within ten days from the occurrence, including any demographic information 
177.15 	as required by the commissioner. The commissioner of corrections shall consult with the 
177.16 	Minnesota Sheriffs' Association and a representative from the Minnesota Association of 
177.17 	Community Corrections Act Counties who is responsible for the operations of an adult 
177.18 	correctional facility to define "use of force" that results in substantial bodily harm for 
177.19 	reporting purposes.
177.20 	The commissioner may require that any or all such information be provided through the 
177.21 	Department of Corrections detention information system. The commissioner shall post each 
177.22 	inspection report publicly and on the department's website within 30 days of completing 
177.23 	the inspection. The education program offered in a correctional facility for the confinement 
177.24 	or incarceration of juvenile offenders must be approved by the commissioner of education 
177.25 	before the commissioner of corrections may grant a license to the facility.
177.26 	(b) For juvenile facilities licensed by the commissioner of human services, the 
177.27 	commissioner may inspect and certify programs based on certification standards set forth 
177.28 	in Minnesota Rules. For the purpose of this paragraph, "certification" has the meaning given 
177.29 	it in section 245A.02.
177.30 	(c) Any state agency which regulates, inspects, or licenses certain aspects of correctional 
177.31 	facilities shall, insofar as is possible, ensure that the minimum standards it requires are 
177.32 	substantially the same as those required by other state agencies which regulate, inspect, or 
177.33 	license the same aspects of similar types of correctional facilities, although at different 
177.34 	correctional facilities.
178.1 	(d) Nothing in this section shall be construed to limit the commissioner of corrections' 
178.2 	authority to promulgate rules establishing standards of eligibility for counties to receive 
178.3 	funds under sections 401.01 to 401.16, or to require counties to comply with operating 
178.4 	standards the commissioner establishes as a condition precedent for counties to receive that 
178.5 	funding.
178.6 	(e) The department's inspection unit must report directly to a division head outside of 
178.7 	the correctional institutions division.

178.8 	Sec. 5. Minnesota Statutes 2022, section 241.31, subdivision 5, is amended to read:
178.9 		Subd. 5.Minimum standards. The commissioner of corrections shall establish minimum 
178.10 	standards for the size, area to be served, qualifications of staff, ratio of staff to client 
178.11 	population, and treatment programs for community corrections programs established pursuant 
178.12 	to this section. Plans and specifications for such programs, including proposed budgets must 
178.13 	first be submitted to the commissioner for approval prior to the establishment. Community 
178.14 	corrections programs must maintain a supply of opiate antagonists, as defined in section 
178.15 	604A.04, subdivision 1, at each correctional site to be administered in compliance with 
178.16 	section 151.37, subdivision 12. Each site must have at least two doses of naloxone on site. 
178.17 	Staff must be trained on how and when to administer opiate antagonists.

178.18 	Sec. 6. Minnesota Statutes 2022, section 241.415, is amended to read:
178.19 	241.415 RELEASE PLANS; SUBSTANCE ABUSE.
178.20 	The commissioner shall cooperate with community-based corrections agencies to 
178.21 	determine how best to address the substance abuse treatment needs of offenders who are 
178.22 	being released from prison. The commissioner shall ensure that an offender's prison release 
178.23 	plan adequately addresses the offender's needs for substance abuse assessment, treatment, 
178.24 	or other services following release, within the limits of available resources. The commissioner 
178.25 	must provide individuals with known or stated histories of opioid use disorder with 
178.26 	emergency opiate antagonist rescue kits upon release.

178.27 	Sec. 7. [245.89] PUBLIC AWARENESS CAMPAIGN.
178.28 	(a) The commissioner must establish an ongoing, multitiered public awareness and 
178.29 	educational campaign on substance use disorders. The campaign must include strategies to 
178.30 	prevent substance use disorder, reduce stigma, and ensure people know how to access 
178.31 	treatment, recovery, and harm reduction services.
179.1 	(b) The commissioner must consult with communities disproportionately impacted by 
179.2 	substance use disorder to ensure the campaign centers lived experience and equity. The 
179.3 	commissioner may also consult with and establish relationships with media and 
179.4 	communication experts, behavioral health professionals, state and local agencies, and 
179.5 	community organizations to design and implement the campaign.
179.6 	(c) The campaign must include awareness-raising and educational information using 
179.7 	multichannel marketing strategies, social media, virtual events, press releases, reports, and 
179.8 	targeted outreach. The commissioner must evaluate the effectiveness of the campaign and 
179.9 	modify outreach and strategies as needed.

179.10 	Sec. 8. [245.891] OVERDOSE SURGE ALERT SYSTEM.
179.11 	The commissioner must establish a statewide overdose surge text message alert system. 
179.12 	The system may include other forms of electronic alerts. The purpose of the system is to 
179.13 	prevent opioid overdose by cautioning people to refrain from substance use or to use 
179.14 	harm-reduction strategies when there is an overdose surge in the surrounding area. The 
179.15 	commissioner may collaborate with local agencies, other state agencies, and harm-reduction 
179.16 	organizations to promote and improve the voluntary text service.

179.17 	Sec. 9. [245.892] HARM-REDUCTION AND CULTURALLY SPECIFIC GRANTS.
179.18 	(a) The commissioner must establish grants for Tribal Nations or culturally specific 
179.19 	organizations to enhance and expand capacity to address the impacts of the opioid epidemic 
179.20 	in their respective communities. Grants may be used to purchase and distribute 
179.21 	harm-reduction supplies, develop organizational capacity, and expand culturally specific 
179.22 	services.
179.23 	(b) Harm-reduction grant funds must be used to promote safer practices and reduce the 
179.24 	transmission of infectious disease. Allowable expenses include fentanyl-testing supplies, 
179.25 	disinfectants, naloxone rescue kits, sharps disposal, wound-care supplies, medication lock 
179.26 	boxes, FDA-approved home testing kits for viral hepatitis and HIV, and written educational 
179.27 	and resource materials.
179.28 	(c) Culturally specific organizational capacity grant funds must be used to develop and 
179.29 	improve organizational infrastructure to increase access to culturally specific services and 
179.30 	community building. Allowable expenses include funds for organizations to hire staff or 
179.31 	consultants who specialize in fundraising, grant writing, business development, and program 
179.32 	integrity or other identified organizational needs as approved by the commissioner.
180.1 	(d) Culturally specific service grant funds must be used to expand culturally specific 
180.2 	outreach and services. Allowable expenses include hiring or consulting with cultural advisors, 
180.3 	resources to support cultural traditions, and education to empower, develop a sense of 
180.4 	community, and develop a connection to ancestral roots.
180.5 	(e) Training grant funds may be used to provide information and training on safe storage 
180.6 	and use of opiate antagonists. Training may be conducted via multiple modalities, including 
180.7 	but not limited to in-person, virtual, written, and video recordings.

180.8 	Sec. 10. Minnesota Statutes 2022, section 245G.08, subdivision 3, is amended to read:
180.9 		Subd. 3.Standing order protocol Emergency overdose treatment. A license holder 
180.10 	that maintains must maintain a supply of naloxone opiate antagonists as defined in section 
180.11 	604A.04, subdivision 1, available for emergency treatment of opioid overdose and must 
180.12 	have a written standing order protocol by a physician who is licensed under chapter 147, 
180.13 	advanced practice registered nurse who is licensed under chapter 148, or physician assistant 
180.14 	who is licensed under chapter 147A, that permits the license holder to maintain a supply of 
180.15 	naloxone on site. A license holder must require staff to undergo training in the specific 
180.16 	mode of administration used at the program, which may include intranasal administration, 
180.17 	intramuscular injection, or both.

180.18 	Sec. 11. Minnesota Statutes 2022, section 256.043, subdivision 3, is amended to read:
180.19 		Subd. 3.Appropriations from registration and license fee account. (a) The 
180.20 	appropriations in paragraphs (b) to (h) (j) shall be made from the registration and license 
180.21 	fee account on a fiscal year basis in the order specified.
180.22 	(b) The appropriations specified in Laws 2019, chapter 63, article 3, section 1, paragraphs 
180.23 	(b), (f), (g), and (h), as amended by Laws 2020, chapter 115, article 3, section 35, shall be 
180.24 	made accordingly.
180.25 	(c) $100,000 is appropriated to the commissioner of human services for grants for 
180.26 	overdose antagonist distribution. Grantees may utilize funds for opioid overdose prevention, 
180.27 	community asset mapping, education, and overdose antagonist distribution.
180.28 	(d) $2,000,000 is appropriated to the commissioner of human services for grants to Tribal 
180.29 	Nations and five urban Indian communities for traditional healing practices for American 
180.30 	Indians and to increase the capacity of culturally specific providers in the behavioral health 
180.31 	workforce.
181.1 	(e) $400,000 is appropriated to the commissioner of human services for grants of 
181.2 	$200,000 to CHI St. Gabriel's Health Family Medical Center for the opioid-focused Project 
181.3 	ECHO program and $200,000 to Hennepin Health Care for the opioid-focused Project 
181.4 	ECHO program.
181.5 	(c) (f) $300,000 is appropriated to the commissioner of management and budget for 
181.6 	evaluation activities under section 256.042, subdivision 1, paragraph (c).
181.7 	(d) (g) $249,000 is in fiscal year 2023, $375,000 in fiscal year 2024, and $315,000 each 
181.8 	year thereafter are appropriated to the commissioner of human services for the provision 
181.9 	of administrative services to the Opiate Epidemic Response Advisory Council and for the 
181.10 	administration of the grants awarded under paragraph (h) (k).
181.11 	(e) (h) $126,000 is appropriated to the Board of Pharmacy for the collection of the 
181.12 	registration fees under section 151.066.
181.13 	(f) (i) $672,000 is appropriated to the commissioner of public safety for the Bureau of 
181.14 	Criminal Apprehension. Of this amount, $384,000 is for drug scientists and lab supplies 
181.15 	and $288,000 is for special agent positions focused on drug interdiction and drug trafficking.
181.16 	(g) (j) After the appropriations in paragraphs (b) to (f) (i) are made, 50 percent of the 
181.17 	remaining amount is appropriated to the commissioner of human services for distribution 
181.18 	to county social service agencies and Tribal social service agency initiative projects 
181.19 	authorized under section 256.01, subdivision 14b, to provide child protection services to 
181.20 	children and families who are affected by addiction. The commissioner shall distribute this 
181.21 	money proportionally to county social service agencies and Tribal social service agency 
181.22 	initiative projects based on out-of-home placement episodes where parental drug abuse is 
181.23 	the primary reason for the out-of-home placement using data from the previous calendar 
181.24 	year. County social service agencies and Tribal social service agency initiative projects 
181.25 	receiving funds from the opiate epidemic response fund must annually report to the 
181.26 	commissioner on how the funds were used to provide child protection services, including 
181.27 	measurable outcomes, as determined by the commissioner. County social service agencies 
181.28 	and Tribal social service agency initiative projects must not use funds received under this 
181.29 	paragraph to supplant current state or local funding received for child protection services 
181.30 	for children and families who are affected by addiction.
181.31 	(h) (k) After the appropriations in paragraphs (b) to (g) (j) are made, the remaining 
181.32 	amount in the account is appropriated to the commissioner of human services to award 
181.33 	grants as specified by the Opiate Epidemic Response Advisory Council in accordance with 
181.34 	section 256.042, unless otherwise appropriated by the legislature.
182.1 	(i) (l) Beginning in fiscal year 2022 and each year thereafter, funds for county social 
182.2 	service agencies and Tribal social service agency initiative projects under paragraph (g) (j)
182.3 	and grant funds specified by the Opiate Epidemic Response Advisory Council under 
182.4 	paragraph (h) (k) may be distributed on a calendar year basis.

182.5 	EFFECTIVE DATE. This section is effective the day following final enactment.

182.6 	Sec. 12. Minnesota Statutes 2022, section 256.043, subdivision 3a, is amended to read:
182.7 		Subd. 3a.Appropriations from settlement account. (a) The appropriations in paragraphs 
182.8 	(b) to (e) shall be made from the settlement account on a fiscal year basis in the order 
182.9 	specified.
182.10 	(b) If the balance in the registration and license fee account is not sufficient to fully fund 
182.11 	the appropriations specified in subdivision 3, paragraphs (b) to (f) (i), an amount necessary 
182.12 	to meet any insufficiency shall be transferred from the settlement account to the registration 
182.13 	and license fee account to fully fund the required appropriations.
182.14 	(c) $209,000 in fiscal year 2023 and $239,000 in fiscal year 2024 and subsequent fiscal 
182.15 	years are appropriated to the commissioner of human services for the administration of 
182.16 	grants awarded under paragraph (e). $276,000 in fiscal year 2023 and $151,000 in fiscal 
182.17 	year 2024 and subsequent fiscal years are appropriated to the commissioner of human 
182.18 	services to collect, collate, and report data submitted and to monitor compliance with 
182.19 	reporting and settlement expenditure requirements by grantees awarded grants under this 
182.20 	section and municipalities receiving direct payments from a statewide opioid settlement 
182.21 	agreement as defined in section 256.042, subdivision 6.
182.22 	(d) After any appropriations necessary under paragraphs (b) and (c) are made, an amount 
182.23 	equal to the calendar year allocation to Tribal social service agency initiative projects under 
182.24 	subdivision 3, paragraph (g) (j), is appropriated from the settlement account to the 
182.25 	commissioner of human services for distribution to Tribal social service agency initiative 
182.26 	projects to provide child protection services to children and families who are affected by 
182.27 	addiction. The requirements related to proportional distribution, annual reporting, and 
182.28 	maintenance of effort specified in subdivision 3, paragraph (g) (j), also apply to the 
182.29 	appropriations made under this paragraph.
182.30 	(e) After making the appropriations in paragraphs (b), (c), and (d), the remaining amount 
182.31 	in the account is appropriated to the commissioner of human services to award grants as 
182.32 	specified by the Opiate Epidemic Response Advisory Council in accordance with section 
182.33 	256.042.
183.1 	(f) Funds for Tribal social service agency initiative projects under paragraph (d) and 
183.2 	grant funds specified by the Opiate Epidemic Response Advisory Council under paragraph 
183.3 	(e) may be distributed on a calendar year basis.
183.4 	(g) Notwithstanding section 16A.28, funds appropriated in paragraphs (d) and (e) are 
183.5 	available for three years.

183.6 	EFFECTIVE DATE. This section is effective the day following final enactment.

183.7 	Sec. 13. [256I.052] OPIATE ANTAGONISTS.
183.8 	(a) Site-based or group housing support settings must maintain a supply of opiate 
183.9 	antagonists as defined in section 604A.04, subdivision 1, at each housing site to be 
183.10 	administered in compliance with section 151.37, subdivision 12.
183.11 	(b) Each site must have at least two doses of naloxone on site.
183.12 	(c) Staff on site must have training on how and when to administer opiate antagonists.

183.13 	Sec. 14. Laws 2019, chapter 63, article 3, section 1, as amended by Laws 2020, chapter 
183.14 	115, article 3, section 35, and Laws 2022, chapter 53, section 12, is amended to read:
183.15 	Section 1. APPROPRIATIONS.
 183.16 	(a) Board of Pharmacy; administration. $244,000 in fiscal year 2020 is appropriated 
183.17 	from the general fund to the Board of Pharmacy for onetime information technology and 
183.18 	operating costs for administration of licensing activities under Minnesota Statutes, section 
183.19 	151.066. This is a onetime appropriation.
183.20 	(b) Commissioner of human services; administration. $309,000 in fiscal year 2020 
183.21 	is appropriated from the general fund and $60,000 in fiscal year 2021 is appropriated from 
183.22 	the opiate epidemic response fund to the commissioner of human services for the provision 
183.23 	of administrative services to the Opiate Epidemic Response Advisory Council and for the 
183.24 	administration of the grants awarded under paragraphs (f), (g), and (h). The opiate epidemic 
183.25 	response fund base for this appropriation is $60,000 in fiscal year 2022, $60,000 in fiscal 
183.26 	year 2023, $60,000 in fiscal year 2024, and $0 in fiscal year 20252024.
183.27 	(c) Board of Pharmacy; administration. $126,000 in fiscal year 2020 is appropriated 
183.28 	from the general fund to the Board of Pharmacy for the collection of the registration fees 
183.29 	under section 151.066.
183.30 	(d) Commissioner of public safety; enforcement activities. $672,000 in fiscal year 
183.31 	2020 is appropriated from the general fund to the commissioner of public safety for the 
184.1 	Bureau of Criminal Apprehension. Of this amount, $384,000 is for drug scientists and lab 
184.2 	supplies and $288,000 is for special agent positions focused on drug interdiction and drug 
184.3 	trafficking.
184.4 	(e) Commissioner of management and budget; evaluation activities. $300,000 in 
184.5 	fiscal year 2020 is appropriated from the general fund and $300,000 in fiscal year 2021 is 
184.6 	appropriated from the opiate epidemic response fund to the commissioner of management 
184.7 	and budget for evaluation activities under Minnesota Statutes, section 256.042, subdivision 
184.8 	1, paragraph (c).
184.9 	(f) Commissioner of human services; grants for Project ECHO. $400,000 in fiscal 
184.10 	year 2020 is appropriated from the general fund and $400,000 in fiscal year 2021 is 
184.11 	appropriated from the opiate epidemic response fund to the commissioner of human services 
184.12 	for grants of $200,000 to CHI St. Gabriel's Health Family Medical Center for the 
184.13 	opioid-focused Project ECHO program and $200,000 to Hennepin Health Care for the 
184.14 	opioid-focused Project ECHO program. The opiate epidemic response fund base for this 
184.15 	appropriation is $400,000 in fiscal year 2022, $400,000 in fiscal year 2023, $400,000 in 
184.16 	fiscal year 2024, and $0 in fiscal year 2025.
184.17 	(g) Commissioner of human services; opioid overdose prevention grant. $100,000 
184.18 	in fiscal year 2020 is appropriated from the general fund and $100,000 in fiscal year 2021 
184.19 	is appropriated from the opiate epidemic response fund to the commissioner of human 
184.20 	services for a grant to a nonprofit organization that has provided overdose prevention 
184.21 	programs to the public in at least 60 counties within the state, for at least three years, has 
184.22 	received federal funding before January 1, 2019, and is dedicated to addressing the opioid 
184.23 	epidemic. The grant must be used for opioid overdose prevention, community asset mapping, 
184.24 	education, and overdose antagonist distribution. The opiate epidemic response fund base 
184.25 	for this appropriation is $100,000 in fiscal year 2022, $100,000 in fiscal year 2023, $100,000 
184.26 	in fiscal year 2024, and $0 in fiscal year 2025.
184.27 	(h) Commissioner of human services; traditional healing. $2,000,000 in fiscal year 
184.28 	2020 is appropriated from the general fund and $2,000,000 in fiscal year 2021 is appropriated 
184.29 	from the opiate epidemic response fund to the commissioner of human services to award 
184.30 	grants to Tribal nations and five urban Indian communities for traditional healing practices 
184.31 	to American Indians and to increase the capacity of culturally specific providers in the 
184.32 	behavioral health workforce. The opiate epidemic response fund base for this appropriation 
184.33 	is $2,000,000 in fiscal year 2022, $2,000,000 in fiscal year 2023, $2,000,000 in fiscal year 
184.34 	2024, and $0 in fiscal year 2025.
185.1 	(i) Board of Dentistry; continuing education. $11,000 in fiscal year 2020 is 
185.2 	appropriated from the state government special revenue fund to the Board of Dentistry to 
185.3 	implement the continuing education requirements under Minnesota Statutes, section 214.12, 
185.4 	subdivision 6.
185.5 	(j) Board of Medical Practice; continuing education. $17,000 in fiscal year 2020 is 
185.6 	appropriated from the state government special revenue fund to the Board of Medical Practice 
185.7 	to implement the continuing education requirements under Minnesota Statutes, section 
185.8 	214.12, subdivision 6.
185.9 	(k) Board of Nursing; continuing education. $17,000 in fiscal year 2020 is appropriated 
185.10 	from the state government special revenue fund to the Board of Nursing to implement the 
185.11 	continuing education requirements under Minnesota Statutes, section 214.12, subdivision 
185.12 	6.
185.13 	(l) Board of Optometry; continuing education. $5,000 in fiscal year 2020 is 
185.14 	appropriated from the state government special revenue fund to the Board of Optometry to 
185.15 	implement the continuing education requirements under Minnesota Statutes, section 214.12, 
185.16 	subdivision 6.
185.17 	(m) Board of Podiatric Medicine; continuing education. $5,000 in fiscal year 2020 
185.18 	is appropriated from the state government special revenue fund to the Board of Podiatric 
185.19 	Medicine to implement the continuing education requirements under Minnesota Statutes, 
185.20 	section 214.12, subdivision 6.
185.21 	(n) Commissioner of health; nonnarcotic pain management and wellness. $1,250,000 
185.22 	is appropriated in fiscal year 2020 from the general fund to the commissioner of health, to 
185.23 	provide funding for:
185.24 	(1) statewide mapping and assessment of community-based nonnarcotic pain management 
185.25 	and wellness resources; and
185.26 	(2) up to five demonstration projects in different geographic areas of the state to provide 
185.27 	community-based nonnarcotic pain management and wellness resources to patients and 
185.28 	consumers.
185.29 	The demonstration projects must include an evaluation component and scalability analysis. 
185.30 	The commissioner shall award the grant for the statewide mapping and assessment, and the 
185.31 	demonstration project grants, through a competitive request for proposal process. Grants 
185.32 	for statewide mapping and assessment and demonstration projects may be awarded 
185.33 	simultaneously. In awarding demonstration project grants, the commissioner shall give 
186.1 	preference to proposals that incorporate innovative community partnerships, are informed 
186.2 	and led by people in the community where the project is taking place, and are culturally 
186.3 	relevant and delivered by culturally competent providers. This is a onetime appropriation.
186.4 	(o) Commissioner of health; administration. $38,000 in fiscal year 2020 is appropriated 
186.5 	from the general fund to the commissioner of health for the administration of the grants 
186.6 	awarded in paragraph (n).

186.7 	EFFECTIVE DATE. This section is effective the day following final enactment.

186.8 	Sec. 15. OPIATE ANTAGONIST TRAINING GRANTS.
 186.9 	The commissioner must establish grants to support training on how to safely store opiate 
186.10 	antagonists, opioid overdose symptoms and identification, and how and when to administer 
186.11 	opiate antagonists. Eligible grantees include correctional facilities or programs, housing 
186.12 	programs, and substance use disorder programs.

186.13 	ARTICLE 6
186.14 	OPIOID PRESCRIBING IMPROVEMENT PROGRAM

186.15 	Section 1. Minnesota Statutes 2022, section 256B.0638, subdivision 2, is amended to read:
186.16 		Subd. 2.Definitions. (a) For purposes of this section, the terms defined in this subdivision 
186.17 	have the meanings given them.
186.18 	(b) "Commissioner" means the commissioner of human services.
186.19 	(c) "Commissioners" means the commissioner of human services and the commissioner 
186.20 	of health.
186.21 	(d) "DEA" means the United States Drug Enforcement Administration.
186.22 	(e) "Minnesota health care program" means a public health care program administered 
186.23 	by the commissioner of human services under this chapter and chapter 256L, and the 
186.24 	Minnesota restricted recipient program.
186.25 	(f) "Opioid disenrollment standards" means parameters of opioid prescribing practices 
186.26 	that fall outside community standard thresholds for prescribing to such a degree that a 
186.27 	provider must be disenrolled as a medical assistance provider.
186.28 	(g) "Opioid prescriber" means a licensed health care provider who prescribes opioids to 
186.29 	medical assistance and MinnesotaCare Minnesota health care program enrollees under the 
186.30 	fee-for-service system or under a managed care or county-based purchasing plan.
187.1 	(h) "Opioid quality improvement standard thresholds" means parameters of opioid 
187.2 	prescribing practices that fall outside community standards for prescribing to such a degree 
187.3 	that quality improvement is required.
187.4 	(i) "Program" means the statewide opioid prescribing improvement program established 
187.5 	under this section.
187.6 	(j) "Provider group" means a clinic, hospital, or primary or specialty practice group that 
187.7 	employs, contracts with, or is affiliated with an opioid prescriber. Provider group does not 
187.8 	include a professional association supported by dues-paying members.
187.9 	(k) "Sentinel measures" means measures of opioid use that identify variations in 
187.10 	prescribing practices during the prescribing intervals.

187.11 	Sec. 2. Minnesota Statutes 2022, section 256B.0638, subdivision 4, is amended to read:
187.12 		Subd. 4.Program components. (a) The working group shall recommend to the 
187.13 	commissioners the components of the statewide opioid prescribing improvement program, 
187.14 	including, but not limited to, the following:
187.15 	(1) developing criteria for opioid prescribing protocols, including:
187.16 	(i) prescribing for the interval of up to four days immediately after an acute painful 
187.17 	event;
187.18 	(ii) prescribing for the interval of up to 45 days after an acute painful event; and
187.19 	(iii) prescribing for chronic pain, which for purposes of this program means pain lasting 
187.20 	longer than 45 days after an acute painful event;
187.21 	(2) developing sentinel measures;
187.22 	(3) developing educational resources for opioid prescribers about communicating with 
187.23 	patients about pain management and the use of opioids to treat pain;
187.24 	(4) developing opioid quality improvement standard thresholds and opioid disenrollment
187.25 	standards for opioid prescribers and provider groups. In developing opioid disenrollment 
187.26 	standards, the standards may be described in terms of the length of time in which prescribing 
187.27 	practices fall outside community standards and the nature and amount of opioid prescribing 
187.28 	that fall outside community standards; and
187.29 	(5) addressing other program issues as determined by the commissioners.
187.30 	(b) The opioid prescribing protocols shall not apply to opioids prescribed for patients 
187.31 	who are experiencing pain caused by a malignant condition or who are receiving hospice 
188.1 	care or palliative care, or to opioids prescribed for substance use disorder treatment with 
188.2 	medications for opioid use disorder.
188.3 	(c) All opioid prescribers who prescribe opioids to Minnesota health care program 
188.4 	enrollees must participate in the program in accordance with subdivision 5. Any other 
188.5 	prescriber who prescribes opioids may comply with the components of this program described 
188.6 	in paragraph (a) on a voluntary basis.

188.7 	Sec. 3. Minnesota Statutes 2022, section 256B.0638, subdivision 5, is amended to read:
188.8 		Subd. 5.Program implementation. (a) The commissioner shall implement the programs 
188.9 	within the Minnesota health care quality improvement program to improve the health of 
188.10 	and quality of care provided to Minnesota health care program enrollees. The commissioner 
188.11 	shall annually collect and report to provider groups the sentinel measures of data showing 
188.12 	individual opioid prescribers' opioid prescribing patterns compared to their anonymized 
188.13 	peers. Provider groups shall distribute data to their affiliated, contracted, or employed opioid 
188.14 	prescribers.
188.15 	(b) The commissioner shall notify an opioid prescriber and all provider groups with 
188.16 	which the opioid prescriber is employed or affiliated when the opioid prescriber's prescribing 
188.17 	pattern exceeds the opioid quality improvement standard thresholds. An opioid prescriber 
188.18 	and any provider group that receives a notice under this paragraph shall submit to the 
188.19 	commissioner a quality improvement plan for review and approval by the commissioner 
188.20 	with the goal of bringing the opioid prescriber's prescribing practices into alignment with 
188.21 	community standards. A quality improvement plan must include:
188.22 	(1) components of the program described in subdivision 4, paragraph (a);
188.23 	(2) internal practice-based measures to review the prescribing practice of the opioid 
188.24 	prescriber and, where appropriate, any other opioid prescribers employed by or affiliated 
188.25 	with any of the provider groups with which the opioid prescriber is employed or affiliated; 
188.26 	and
188.27 	(3) appropriate use of the prescription monitoring program under section 152.126.
188.28 	(c) If, after a year from the commissioner's notice under paragraph (b), the opioid 
188.29 	prescriber's prescribing practices do not improve so that they are consistent with community 
188.30 	standards, the commissioner shall may take one or more of the following steps:
188.31 	(1) monitor prescribing practices more frequently than annually;
189.1 	(2) monitor more aspects of the opioid prescriber's prescribing practices than the sentinel 
189.2 	measures; or
189.3 	(3) require the opioid prescriber to participate in additional quality improvement efforts, 
189.4 	including but not limited to mandatory use of the prescription monitoring program established 
189.5 	under section 152.126.
189.6 	(d) The commissioner shall terminate from Minnesota health care programs all opioid 
189.7 	prescribers and provider groups whose prescribing practices fall within the applicable opioid 
189.8 	disenrollment standards.
189.9 	(e) No physician, advanced practice registered nurse, or physician assistant, acting in 
189.10 	good faith based on the needs of the patient, may be disenrolled by the commissioner of 
189.11 	human services solely for prescribing a dosage that equates to an upward deviation from 
189.12 	morphine milligram equivalent dosage recommendations specified in state or federal opioid 
189.13 	prescribing guidelines or policies, or quality improvement thresholds established under this 
189.14 	section.

189.15 	Sec. 4. REPEALER.
 189.16 	Minnesota Statutes 2022, section 256B.0638, subdivisions 1, 2, 3, 4, 5, and 6, are 
189.17 	repealed.

189.18 	EFFECTIVE DATE. This section is effective June 30, 2024.

189.19 	ARTICLE 7
189.20 	DEPARTMENT OF DIRECT CARE AND TREATMENT

189.21 	Section 1. Minnesota Statutes 2022, section 246.54, subdivision 1a, is amended to read:
189.22 		Subd. 1a.Anoka-Metro Regional Treatment Center. (a) A county's payment of the 
189.23 	cost of care provided at Anoka-Metro Regional Treatment Center shall be according to the 
189.24 	following schedule:
189.25 	(1) zero percent for the first 30 days;
189.26 	(2) 20 percent for days 31 and over if the stay is determined to be clinically appropriate 
189.27 	for the client; and
189.28 	(3) 100 percent for each day during the stay, including the day of admission, when the 
189.29 	facility determines that it is clinically appropriate for the client to be discharged. The county 
189.30 	is responsible for zero percent of the cost of care under this clause for a person committed 
190.1 	as a person who has a mental illness and is dangerous to the public under section 253B.18 
190.2 	and who is awaiting transfer to another state-operated facility or program.
190.3 	Notwithstanding any law to the contrary, the client is not responsible for payment of the 
190.4 	cost of care under this subdivision.
190.5 	(b) If payments received by the state under sections 246.50 to 246.53 exceed 80 percent 
190.6 	of the cost of care for days over 31 for clients who meet the criteria in paragraph (a), clause 
190.7 	(2), the county shall be responsible for paying the state only the remaining amount. The 
190.8 	county shall not be entitled to reimbursement from the client, the client's estate, or from the 
190.9 	client's relatives, except as provided in section 246.53.

190.10 	Sec. 2. Minnesota Statutes 2022, section 246.54, subdivision 1b, is amended to read:
190.11 		Subd. 1b.Community behavioral health hospitals. (a) A county's payment of the cost 
190.12 	of care provided at state-operated community-based behavioral health hospitals for adults 
190.13 	and children shall be according to the following schedule:
190.14 	(1) 100 percent for each day during the stay, including the day of admission, when the 
190.15 	facility determines that it is clinically appropriate for the client to be discharged except as 
190.16 	provided under paragraph (b); and
190.17 	(2) the county shall not be entitled to reimbursement from the client, the client's estate, 
190.18 	or from the client's relatives, except as provided in section 246.53.
190.19 	(b) The county is responsible for 50 percent of the cost of care under paragraph (a), 
190.20 	clause (1), for a person committed as a person who has a mental illness and is dangerous 
190.21 	to the public under section 253B.18 and who is awaiting transfer to another state-operated 
190.22 	facility or program.
190.23 	(c) Notwithstanding any law to the contrary, the client is not responsible for payment 
190.24 	of the cost of care under this subdivision.

190.25 	ARTICLE 8
190.26 	APPROPRIATIONS

190.27	Section 1. HEALTH AND HUMAN SERVICES APPROPRIATIONS.
 	
190.28 	The sums shown in the columns marked "Appropriations" are appropriated to the agencies 
190.29 	and for the purposes specified in this article. The appropriations are from the general fund, 
190.30 	or another named fund, and are available for the fiscal years indicated for each purpose. 
190.31 	The figures "2024" and "2025" used in this article mean that the appropriations listed under 
190.32 	them are available for the fiscal year ending June 30, 2024, or June 30, 2025, respectively. 
191.1 	"The first year" is fiscal year 2024. "The second year" is fiscal year 2025. "The biennium" 
191.2 	is fiscal years 2024 and 2025.

191.3				APPROPRIATIONS
	
191.4				Available for the Year
	
191.5				Ending June 30
	
191.6					2024
		2025

191.7
191.8	Sec. 2. COMMISSIONER OF HUMAN 
SERVICES

191.9	Subdivision 1.Total Appropriation
 	$
	6,734,962,000
	$
	7,315,857,000

191.10	Appropriations by Fund
	
191.11		2024
	2025
	
191.12	General
	6,732,703,000
	7,314,065,000
	
191.13	Health Care Access
	26,000
	59,000
	
191.14	Lottery Prize
	1,733,000
	1,733,000
	
191.15
191.16	Opiate Epidemic 
Response
	500,000
	-0-
	
191.17 	The amounts that may be spent for each 
191.18 	purpose are specified in the following 
191.19 	subdivisions.

191.20	Subd. 2.Central Office; Operations
 		15,739,000
		11,266,000
	
191.21 	Base level adjustment. The general fund base 
191.22 	is $5,165,000 in fiscal year 2026 and 
191.23 	$5,015,000 in fiscal year 2027.

191.24	Subd. 3.Central Office; Health Care
 		3,513,000
		4,302,000
	
191.25 	Base level adjustment. The general fund base 
191.26 	is $4,032,000 in fiscal year 2026 and 
191.27 	$4,032,000 in fiscal year 2027.

191.28
191.29	Subd. 4.Central Office; Aging and Disabilities 
Services
 		17,221,000
		21,454,000
	
191.30 	(a) Research on access to long-term care 
191.31 	services and financing. $700,000 in fiscal 
191.32 	year 2024 is from the general fund for 
192.1 	additional funding for the actuarial research 
192.2 	study of public and private financing options 
192.3 	for long-term services and supports reform 
192.4 	under Laws 2021, First Special Session 
192.5 	chapter 7, article 17, section 16. This is a 
192.6 	onetime appropriation.
192.7 	(b) Case management training curriculum.
192.8 	$377,000 in fiscal year 2024 and $377,000 
192.9 	fiscal year 2025 are to develop and implement 
192.10 	a curriculum and training plan to ensure all 
192.11 	lead agency assessors and case managers have 
192.12 	the knowledge and skills necessary to fulfill 
192.13 	support planning and coordination 
192.14 	responsibilities for individuals who use home 
192.15 	and community-based disability services and 
192.16 	live in own-home settings. This is a onetime 
192.17 	appropriation.
192.18 	(c) Office of ombudsman for long-term 
192.19 	care. $1,744,000 in fiscal year 2024 and 
192.20 	$2,049,000 in fiscal year 2025 are for 
192.21 	additional staff and associated direct costs in 
192.22 	the Office of Ombudsman for Long-Term 
192.23 	Care. The additional staff must include ten 
192.24 	full-time regional ombudsmen, two full-time 
192.25 	supervisors, and five additional full-time 
192.26 	support staff.
192.27 	(d) Direct care services corps pilot project.
192.28 	$500,000 in fiscal year 2024 is from the 
192.29 	general fund for a grant to the Metropolitan 
192.30 	Center for Independent Living for the direct 
192.31 	care services corps pilot project. Up to $25,000 
192.32 	may be used by the Metropolitan Center for 
192.33 	Independent Living for administrative costs. 
192.34 	This is a onetime appropriation.
193.1 	(e) Base level adjustment. The general fund 
193.2 	base is $7,468,000 in fiscal year 2026 and 
193.3 	$7,465,000 in fiscal year 2027.

193.4
193.5
193.6	Subd. 5.Central Office; Behavioral Health, 
Housing, and Deaf and Hard of Hearing 
Services
 		4,857,000
		6,539,000
	
193.7 	(a) Competency-based training funding for 
193.8 	substance use disorder provider 
193.9 	community.  $150,000 in fiscal year 2024 and 
193.10 	$150,000 in fiscal year 2025 are from the 
193.11 	general fund to provide funding for provider 
193.12 	participation in clinical training for the 
193.13 	transition to American Society of Addiction 
193.14 	Medicine standards.
193.15 	(b) Public awareness campaign. $300,000 
193.16 	in fiscal year 2024 and $300,000 in fiscal year 
193.17 	2025 are from the general fund for a public 
193.18 	awareness campaign under Minnesota Statutes, 
193.19 	section 245.89.
193.20 	(c) Bad batch overdose surge text alert 
193.21 	system. $250,000 in fiscal year 2024 and 
193.22 	$250,000 in fiscal year 2025 are from the 
193.23 	general fund for a overdose surge alert system 
193.24 	under Minnesota Statutes, section 245.891.
193.25 	(d) Base level adjustment. The general fund 
193.26 	base is $4,029,000 in fiscal year 2026 and 
193.27 	$4,029,000 in fiscal year 2027.

193.28	Subd. 6.Forecasted Programs; Housing Support
 		305,000
		666,000

193.29	Subd. 7.Forecasted Programs; MinnesotaCare
 		26,000
		59,000
	
193.30 	This appropriation is from the Health Care 
193.31 	Access Fund.

193.32
193.33	Subd. 8.Forecasted Programs; Medical 
Assistance
 		5,714,700,000
		6,360,965,000

193.34	Subd. 9.Forecasted Programs; Alternative Care
 		47,189,000
		51,046,000
	
194.1 	Any money allocated to the alternative care 
194.2 	program that is not spent for the purposes 
194.3 	indicated does not cancel but must be 
194.4 	transferred to the medical assistance account.

194.5
194.6	Subd. 10.Forecasted Programs; Behavioral 
Health Fund
 		96,387,000
		98,417,000

194.7
194.8	Subd. 11.Grant Programs; Other Long-Term 
Care Grants
 		31,073,000
		27,001,000
	
194.9 	(a) Provider capacity grant for rural and 
194.10 	underserved communities. $455,000 in fiscal 
194.11 	year 2024 and $15,492,000 in fiscal year 2025 
194.12 	are for provider capacity grants for rural and 
194.13 	underserved communities under Minnesota 
194.14 	Statutes, section 256.4761. Of this amount, 
194.15 	$13,016,000 in fiscal year 2025 is for grants, 
194.16 	and $455,000 in fiscal year 2024 and 
194.17 	$2,476,000 in fiscal year 2025 are for 
194.18 	administration. Notwithstanding Minnesota 
194.19 	Statutes, section 16A.28, this appropriation is 
194.20 	available until June 30, 2027.
194.21 	(b) Long-term care workforce grants for 
194.22 	new Americans. $10,886,000 in fiscal year 
194.23 	2024 and $10,886,000 in fiscal year 2025 are 
194.24 	for long-term care workforce grants for new 
194.25 	Americans under Minnesota Statutes, section 
194.26 	256.4762. Of this amount, $10,060,000 in 
194.27 	fiscal year 2024 and $10,060,000 in fiscal year 
194.28 	2025 are for grants to counties, and $826,000 
194.29 	in fiscal year 2024 and $826,000 in fiscal year 
194.30 	2025 are for administration. Notwithstanding 
194.31 	Minnesota Statutes, section 16A.28, this 
194.32 	appropriation is available until June 30, 2027.
194.33 	(c) Supported decision making grants.
194.34 	$2,000,000 in fiscal year 2024 and $2,000,000 
194.35 	in fiscal year 2025 are for supported decision 
195.1 	making grants under Minnesota Statutes, 
195.2 	section 256.4771.
195.3 	(d) Base level adjustment. The general fund 
195.4 	base is $1,925,000 in fiscal year 2026 and 
195.5 	$1,925,000 in fiscal year 2027.

195.6
195.7	Subd. 12.Grant Programs; Aging and Adult 
Services Grants
 		100,027,000
		105,417,000
	
195.8 	(a) Vulnerable Adult Act redesign phase 
195.9 	two. $30,101,000 in fiscal year 2024 and 
195.10 	$28,700,000 in fiscal year 2025 are for the 
195.11 	Vulnerable Adult Act redesign phase two. Of 
195.12 	this amount, $19,791,000 in fiscal year 2024 
195.13 	and $20,652,000 in fiscal year 2025 are for 
195.14 	grants to counties, and $10,310,000 in fiscal 
195.15 	year 2024 and $8,048,000 in fiscal year 2025 
195.16 	are for administration. Notwithstanding 
195.17 	Minnesota Statutes, section 16A.28, this 
195.18 	appropriation is available until June 30, 2027.
195.19 	(b) Caregiver respite services grants.
195.20 	$304,000 in fiscal year 2024 and $6,936,000 
195.21 	in fiscal year 2025 are for caregiver respite 
195.22 	services grants under Minnesota Statutes, 
195.23 	section 256.9756. $6,009,000 in fiscal year 
195.24 	2025 is for grants, and $304,000 in fiscal year 
195.25 	2024 and $927,000 in fiscal year 2025 are for 
195.26 	administration. Notwithstanding Minnesota 
195.27 	Statutes, section 16A.28, this appropriation is 
195.28 	available until June 30, 2027. This is a onetime 
195.29 	appropriation.
195.30 	(c) Live well at home grants. $30,000,000 in 
195.31 	fiscal year 2024 and $30,000,000 in fiscal year 
195.32 	2025 are for live well at home grants under 
195.33 	Minnesota Statutes, section 256.9754, 
195.34 	subdivision 3f. This is a onetime appropriation 
195.35 	and is available until June 30, 2027.
196.1 	(d) Senior nutrition program. $16,098,000 
196.2 	in fiscal year 2024 and $16,351,000 in fiscal 
196.3 	year 2025 are for the senior nutrition program. 
196.4 	$16,000,000 in fiscal year 2024 and 
196.5 	$16,000,000 in fiscal year 2025 are for grants, 
196.6 	and $307,000 in fiscal year 2024 and $351,000 
196.7 	in fiscal year 2025 are for administration. 
196.8 	Notwithstanding Minnesota Statutes, section 
196.9 	16A.28, this appropriation is available until 
196.10 	June 30, 2027. This is a onetime appropriation.
196.11 	(e) Boundary Waters Care Center. $250,000 
196.12 	in fiscal year 2024 is for a sole source grant 
196.13 	to Boundary Waters Care Center in Ely, 
196.14 	Minnesota.
196.15 	(f) Base level adjustment. The general fund 
196.16 	base is $32,995,000 in fiscal year 2026 and 
196.17 	$32,995,000 in fiscal year 2027.

196.18	Subd. 13.Deaf and Hard of Hearing Grants
 		2,886,000
		2,886,000

196.19	Subd. 14.Grant Programs; Disabilities Grants
 		152,294,000
		42,618,000
	
196.20 	(a) Direct Support Connect. The base is 
196.21 	increased by $250,000 in fiscal year 2026 for 
196.22 	Direct Support Connect. This is a onetime base 
196.23 	adjustment.
196.24 	(b) Home and community-based services 
196.25 	innovation pool. $2,000,000 in fiscal year 
196.26 	2024 and $2,000,000 in fiscal year 2025 are 
196.27 	for the home and community-based services 
196.28 	innovation pool under Minnesota Statutes, 
196.29 	section 256B.0921.
196.30 	(c) Emergency grants for autism spectrum 
196.31 	disorder treatment. $10,000,000 in fiscal 
196.32 	year 2024 and $10,000,000 in fiscal year 2025 
196.33 	are for the emergency grant program for 
196.34 	autism spectrum disorder treatment providers. 
197.1 	This is a onetime appropriation and is 
197.2 	available until June 30, 2025.
197.3 	(d) Temporary grants for small customized 
197.4 	living providers. $650,000 in fiscal year 2024 
197.5 	and $650,000 in fiscal year 2025 are for grants 
197.6 	to assist small customized living providers to 
197.7 	transition to community residential services 
197.8 	licensure or integrated community supports 
197.9 	licensure. This is a onetime appropriation.
197.10 	(e) Electronic visit verification stipends.
197.11 	$6,095,000 in fiscal year 2024 is for onetime 
197.12 	stipends of $200 to bargaining members to 
197.13 	offset the potential costs related to people 
197.14 	using individual devices to access the 
197.15 	electronic visit verification system. Of this 
197.16 	amount, $5,600,000 is for stipends and 
197.17 	$495,000 is for administration. This is a 
197.18 	onetime appropriation and is available until 
197.19 	June 30, 2025.
197.20 	(f) Self-directed collective bargaining 
197.21 	agreement; temporary rate increase 
197.22 	memorandum of understanding. $1,600,000 
197.23 	in fiscal year 2024 is for onetime stipends for 
197.24 	individual providers covered by the SEIU 
197.25 	collective bargaining agreement based on the 
197.26 	memorandum of understanding related to the 
197.27 	temporary rate increase in effect between 
197.28 	December 1, 2020, and February 7, 2021. Of 
197.29 	this amount, $1,400,000 of the appropriation 
197.30 	is for stipends and $200,000 is for 
197.31 	administration. This is a onetime 
197.32 	appropriation.
197.33 	(g) Self-directed collective bargaining 
197.34 	agreement; retention bonuses. $50,750,000 
197.35 	in fiscal year 2024 is for onetime retention 
198.1 	bonuses covered by the SEIU collective 
198.2 	bargaining agreement. Of this amount, 
198.3 	$50,000,000 is for retention bonuses and 
198.4 	$750,000 is for administration of the bonuses. 
198.5 	This is a onetime appropriation and is 
198.6 	available until June 30, 2025.
198.7 	(h) Training stipends. $2,100,000 in fiscal 
198.8 	year 2024 and $100,000 in fiscal year 2025 
198.9 	are for onetime stipends of $500 for collective 
198.10 	bargaining unit members who complete 
198.11 	designated, voluntary trainings made available 
198.12 	through or recommended by the State Provider 
198.13 	Cooperation Committee. Of this amount, 
198.14 	$2,000,000 in fiscal year 2024 is for stipends, 
198.15 	and $100,000 in fiscal year 2024 and $100,000 
198.16 	in fiscal year 2025 are for administration. This 
198.17 	is a onetime appropriation.
198.18 	(i) Orientation program. $2,000,000 in fiscal 
198.19 	year 2024 and $2,000,000 in fiscal year 2025 
198.20 	are for onetime $100 payments to collective 
198.21 	bargaining unit members who complete 
198.22 	voluntary orientation requirements. Of this 
198.23 	amount, $1,500,000 in fiscal year 2024 and 
198.24 	$1,500,000 in fiscal year 2025 are for the 
198.25 	onetime $100 payments, and $500,000 in 
198.26 	fiscal year 2024 and $500,000 in fiscal year 
198.27 	2025 are for orientation-related costs. This is 
198.28 	a onetime appropriation.
198.29 	(j) Home Care Orientation Trust.
198.30 	$1,000,000 in fiscal year 2024 is for the Home 
198.31 	Care Orientation Trust under Minnesota 
198.32 	Statutes, section 179A.54, subdivision 11. The 
198.33 	commissioner shall disburse the appropriation 
198.34 	to the board of trustees of the Home Care 
198.35 	Orientation Trust for deposit into an account 
199.1 	designated by the board of trustees outside the 
199.2 	state treasury and state's accounting system. 
199.3 	This is a onetime appropriation.
199.4 	(k) HIV/AIDS support services. $10,100,000 
199.5 	in fiscal year 2024 is for grants to 
199.6 	community-based HIV/AIDS support services 
199.7 	providers and for payment of allowed health 
199.8 	care costs as defined in Minnesota Statutes, 
199.9 	section 256.935. This is a onetime 
199.10 	appropriation.
199.11 	(l) Motion analysis advancements clinical 
199.12 	study. $400,000 is fiscal year 2024 is for a 
199.13 	grant to the Mayo Clinic Motion Analysis 
199.14 	Laboratory and Limb Lab for continued 
199.15 	research in motion analysis and patient care. 
199.16 	This is a onetime appropriation and is 
199.17 	available through June 30, 2025.
199.18 	(m) Parent-to-parent peer support grants.
199.19 	$75,000 in fiscal year 2024 and $75,000 in 
199.20 	fiscal year 2025 are for a grant under 
199.21 	Minnesota Statutes, section 256.4776.
199.22 	(n) Self-advocacy grants. $323,000 in fiscal 
199.23 	year 2024 and $323,000 in fiscal year 2025 
199.24 	are for self-advocacy grants under Minnesota 
199.25 	Statutes, section 256.477. Of these amounts, 
199.26 	$218,000 in fiscal year 2024 and $218,000 in 
199.27 	fiscal year 2025 are for the activities under 
199.28 	Minnesota Statutes, section 256.477, 
199.29 	subdivision 1, paragraph (a), clauses (5) to (7), 
199.30 	and for administrative costs, and $105,000 in 
199.31 	fiscal year 2024 and $105,000 in fiscal year 
199.32 	2025 are for the activities under Minnesota 
199.33 	Statutes, section 256.477, subdivision 2.
200.1 	(o) Home and community-based workforce 
200.2 	incentive fund grants. $35,641,000 in fiscal 
200.3 	year 2024 and $4,910,000 in fiscal year 2025 
200.4 	are for the home and community-based 
200.5 	workforce incentive fund grants under 
200.6 	Minnesota Statutes, section 256.4764. The 
200.7 	base for this appropriation is $3,151,000 in 
200.8 	fiscal year 2026 and $2,328,000 in fiscal year 
200.9 	2027.
200.10 	(p) Technology grants. $300,000 in fiscal 
200.11 	year 2024 and $....... in fiscal year 2025 are 
200.12 	for technology grants under Minnesota 
200.13 	Statutes, section .....
200.14 	(q) Base level adjustment. The general fund 
200.15 	base is $28,359,000 in fiscal year 2026 and 
200.16 	$27,286,000 in fiscal year 2027.

200.17
200.18	Subd. 15.Grant Programs; Adult Mental Health 
Grants
 		1,200,000
		3,200,000
	
200.19 	(a) Training for peer workforce. $1,000,000 
200.20 	in fiscal year 2024 and $3,000,000 in fiscal 
200.21 	year 2025 from the general fund are for peer 
200.22 	workforce training grants. This is a onetime 
200.23 	appropriation and is available until June 30, 
200.24 	2027.
200.25 	(b) Family enhancement center. $360,000 
200.26 	in fiscal year 2024 and $360,000 in fiscal year 
200.27 	2025 are for a grant to the Family 
200.28 	Enhancement Center to develop, maintain, 
200.29 	and expand community-based social 
200.30 	engagement and connection programs to help 
200.31 	families dealing with trauma and mental health 
200.32 	issues develop connections with each other 
200.33 	and their communities, including the NEST 
200.34 	parent monitoring program, the cook to 
201.1 	connect program, and the call to movement 
201.2 	initiative. This paragraph does not expire.
201.3 	(c) Base level adjustment. The general fund 
201.4 	base is $200,000 in fiscal year 2026 and 
201.5 	$200,000 in fiscal year 2027.

201.6
201.7	Subd. 16.Grant Programs; Chemical 
Dependency Treatment Support Grants

201.8	Appropriations by Fund
	
201.9	General
	24,275,000
	21,047,000
	
201.10	Lottery Prize
	1,733,000
	1,733,000
	
201.11
201.12	Opiate Epidemic 
Response
	500,000
	-0-
	
201.13 	(a) Culturally-specific recovery community 
201.14 	organization start-up grants. $1,141,000 in 
201.15 	fiscal year 2024 and $3,492,000 in fiscal year 
201.16 	2025 are for culturally-specific recovery 
201.17 	community organization start-up grants. 
201.18 	$1,000,000 in fiscal year 2024 and $3,000,000 
201.19 	in fiscal year 2025 are for grants, and 
201.20 	$141,000 in fiscal year 2024 and $492,000 in 
201.21 	fiscal year 2025 are for administration. 
201.22 	Notwithstanding Minnesota Statutes, section 
201.23 	16A.28, this appropriation is available until 
201.24 	June 30, 2027. This is a onetime appropriation.
201.25 	(b) Culturally-specific services grants. $....... 
201.26 	in fiscal year 2024 and $....... in fiscal year 
201.27 	2025 are for grants to culturally-specific 
201.28 	providers for technical assistance navigating 
201.29 	culturally-specific and responsive substance 
201.30 	use and recovery programs. Of this amount, 
201.31 	$1,000,000 in fiscal year 2024 and $3,000,000 
201.32 	in fiscal year 2025 are for grants, and $....... 
201.33 	in fiscal year 2024 and $....... in fiscal year 
201.34 	2025 are for administration. Notwithstanding 
202.1 	Minnesota Statutes, section 16A.28, this 
202.2 	appropriation is available until June 30, 2027.
202.3 	(c) Culturally-specific grant development 
202.4 	trainings. $....... in fiscal year 2024 and $....... 
202.5 	in fiscal year 2025 are for grants for up to four 
202.6 	trainings for community members and 
202.7 	culturally-specific providers for grant writing 
202.8 	training for substance use and recovery. Of 
202.9 	this amount, $200,000 in fiscal year 2024 and 
202.10 	$200,000 in fiscal year 2025 are for grants, 
202.11 	and $....... in fiscal year 2024 and $....... in 
202.12 	fiscal year 2025 are for administration. 
202.13 	Notwithstanding Minnesota Statutes, section 
202.14 	16A.28, this appropriation is available until 
202.15 	June 30, 2027. This is a onetime appropriation.
202.16 	(d) Harm reduction and culturally-specific 
202.17 	grants. $500,000 in fiscal year 2024 and 
202.18 	$500,000 in fiscal year 2025 are to provide 
202.19 	sole source grants to culturally-specific 
202.20 	communities to purchase testing supplies and 
202.21 	naloxone.
202.22 	(e) Families and family treatment 
202.23 	capacity-building and start-up grants.
202.24 	$10,000,000 in fiscal year 2024 is for start-up 
202.25 	and capacity-building grants for family 
202.26 	substance use disorder treatment programs. 
202.27 	This is a onetime appropriation and is 
202.28 	available until June 30, 2029.
202.29 	(f) Start-up and capacity building grants 
202.30 	for withdrawal management. $641,000 in 
202.31 	fiscal year 2024 and $3,492,000 in fiscal year 
202.32 	2025 are for start-up and capacity building 
202.33 	grants for withdrawal management. $500,000 
202.34 	in fiscal year 2024 and $3,000,000 in fiscal 
202.35 	year 2025 are for grants, and $141,000 in 
203.1 	fiscal year 2024 and $492,000 in fiscal year 
203.2 	2025 are for administration. Notwithstanding 
203.3 	Minnesota Statutes, section 16A.28, this 
203.4 	appropriation is available until June 30, 2027. 
203.5 	This is a onetime appropriation.
203.6 	(g) Recovery community organization 
203.7 	grants. $6,000,000 in fiscal year 2025 is for 
203.8 	grants to recovery community organizations, 
203.9 	as defined in Minnesota Statutes, section 
203.10 	254B.01, subdivision 8, to provide for costs 
203.11 	and community-based peer recovery support 
203.12 	services that are not otherwise eligible for 
203.13 	reimbursement under Minnesota Statutes, 
203.14 	section 254B.05, as part of the continuum of 
203.15 	care for substance use disorders. 
203.16 	Notwithstanding Minnesota Statutes, section 
203.17 	16A.28, this appropriation is available until 
203.18 	June 30, 2027. This is a onetime appropriation.
203.19 	(h) Naloxone grants. $1,500,000 in fiscal year 
203.20 	2024 and $1,500,000 in fiscal year 2025 are 
203.21 	for naloxone grants under Minnesota Statutes, 
203.22 	section .....
203.23 	(i) Problem gambling. $225,000 in fiscal year 
203.24 	2024 and $225,000 in fiscal year 2025 are 
203.25 	from the lottery prize fund for a grant to a state 
203.26 	affiliate recognized by the National Council 
203.27 	on Problem Gambling. The affiliate must 
203.28 	provide services to increase public awareness 
203.29 	of problem gambling, education, training for 
203.30 	individuals and organizations that provide 
203.31 	effective treatment services to problem 
203.32 	gamblers and their families, and research 
203.33 	related to problem gambling.
203.34 	(j) Project ECHO at Hennepin Health Care.
203.35 	$1,228,000 in fiscal year 2024 and $1,500,000 
204.1 	in fiscal year 2025 are for Project ECHO 
204.2 	grants under Minnesota Statutes, section 
204.3 	254B.30, subdivision 2.
204.4 	(k) White Earth Nation substance use 
204.5 	disorder digital therapy tool. $4,000,000 in 
204.6 	fiscal year 2024 is appropriated from the 
204.7 	general fund for a grant to the White Earth 
204.8 	Nation to develop an individualized 
204.9 	Native-American-centric digital therapy tool 
204.10 	with Pathfinder Solutions. The grant must be 
204.11 	used to:
204.12 	(1) develop a mobile application that is 
204.13 	culturally tailored to connecting substance use 
204.14 	disorder resources with White Earth Nation 
204.15 	members;
204.16 	(2) convene a planning circle with White Earth 
204.17 	Nation members to design the tool;
204.18 	(3) provide and expand White Earth 
204.19 	Nation-specific substance use disorder 
204.20 	services; and
204.21 	(4) partner with an academic research 
204.22 	institution to evaluate the efficacy of the 
204.23 	program.
204.24 	(l) Wellness in the Woods. $100,000 in fiscal 
204.25 	year 2024 and $100,000 in fiscal year 2025 
204.26 	are for a grant to Wellness in the Woods to 
204.27 	provide daily peer support for individuals who 
204.28 	are in recovery, are transitioning out of 
204.29 	incarceration, or have experienced trauma. 
204.30 	This paragraph does not expire.
204.31 	(m) Base level adjustment. The general fund 
204.32 	base is $5,847,000 in fiscal year 2026 and 
204.33 	$5,847,000 in fiscal year 2027.

205.1
205.2	Subd. 17.Direct Care and Treatment - Transfer 
Authority
 					
205.3 	Money appropriated under subdivisions 18 to 
205.4 	22 may be transferred between budget 
205.5 	activities and between years of the biennium 
205.6 	with the approval of the commissioner of 
205.7 	management and budget.

205.8
205.9	Subd. 18.Direct Care and Treatment - Mental 
Health and Substance Abuse
 		169,962,000
		177,152,000

205.10
205.11	Subd. 19.Direct Care and Treatment - 
Community-Based Services
 		21,223,000
		22,280,000

205.12
205.13	Subd. 20.Direct Care and Treatment - Forensic 
Services
 		141,020,000
		148,513,000

205.14
205.15	Subd. 21.Direct Care and Treatment - Sex 
Offender Program
 		115,920,000
		121,726,000

205.16
205.17	Subd. 22.Direct Care and Treatment - 
Operations
 		72,912,000
		87,570,000
	
205.18 	The general fund base is $80,222,000 in fiscal 
205.19 	year 2026 and $81,142,000 in fiscal year 2027.

205.20	Sec. 3. COUNCIL ON DISABILITY
 	$
	2,856,000
	$
	3,323,000

205.21
205.22
205.23	Sec. 4. OFFICE OF THE OMBUDSMAN FOR 
MENTAL HEALTH AND DEVELOPMENTAL 
DISABILITIES
 	$
	3,700,000
	$
	4,017,000
	
205.24 	Base level adjustment. The general fund base 
205.25 	is $3,917,000 in fiscal year 2026 and 
205.26 	$3,917,000 in fiscal year 2027.

205.27
205.28	Sec. 5. COMMISSIONER OF EMPLOYMENT 
AND ECONOMIC DEVELOPMENT
 	$
	3,924,000
	$
	76,000
	
205.29 	$3,800,000 in fiscal year 2024 is for 
205.30 	development and implementation of an 
205.31 	awareness-building campaign for the 
205.32 	recruitment of direct care professionals, and 
205.33 	$124,000 in fiscal year 2024 and $76,000 in 
205.34 	fiscal year 2025 are for administration. This 
205.35 	is a onetime appropriation and is available 
205.36 	until June 30, 2025.

206.1
206.2	Sec. 6. COMMISSIONER OF MANAGEMENT 
AND BUDGET
 	$
	900,000
	$
	900,000

206.3 	Sec. 7. Laws 2021, First Special Session chapter 7, article 16, section 28, as amended by 
206.4 	Laws 2022, chapter 40, section 1, is amended to read:
206.5 	Sec. 28. CONTINGENT APPROPRIATIONS.
 206.6 	Any appropriation in this act for a purpose included in Minnesota's initial state spending 
206.7 	plan as described in guidance issued by the Centers for Medicare and Medicaid Services 
206.8 	for implementation of section 9817 of the federal American Rescue Plan Act of 2021 is 
206.9 	contingent upon the initial approval of that purpose by the Centers for Medicare and Medicaid 
206.10 	Services, except for the rate increases specified in article 11, sections 12 and 19. This section 
206.11 	expires June 30, 2024.

206.12 	Sec. 8. DIRECT CARE AND TREATMENT FISCAL YEAR 2023 
206.13 	APPROPRIATION.
 206.14 	$4,829,000 is appropriated in fiscal year 2023 to the commissioner of human services 
206.15 	for direct care and treatment programs. This is a onetime appropriation.

206.16 	EFFECTIVE DATE. This section is effective the day following final enactment.

206.17 	Sec. 9. APPROPRIATION ENACTED MORE THAN ONCE.
 206.18 	If an appropriation is enacted more than once in the 2023 legislative session, the 
206.19 	appropriation must be given effect only once.

206.20 	Sec. 10. EXPIRATION OF UNCODIFIED LANGUAGE.
 206.21 	All uncodified language contained in this article expires on June 30, 2025, unless a 
206.22 	different expiration date is explicit.

206.23 	Sec. 11. EFFECTIVE DATE.
 206.24 	This article is effective July 1, 2023, unless a different effective date is specified.

APPENDIX 

Repealed Minnesota Statutes: S2934-1 

245G.05 COMPREHENSIVE ASSESSMENT AND ASSESSMENT SUMMARY.Subd. 2.Assessment summary. 
(a) An alcohol and drug counselor must complete an assessment summary within three calendar days from the day of service initiation for a residential program and within three calendar days on which a treatment session has been provided from the day of service initiation for a client in a nonresidential program. The comprehensive assessment summary is complete upon a qualified staff member's dated signature. If the comprehensive assessment is used to authorize the treatment service, the alcohol and drug counselor must prepare an assessment summary on the same date the comprehensive assessment is completed. If the comprehensive assessment and assessment summary are to authorize treatment services, the assessor must determine appropriate services for the client using the dimensions in Minnesota Rules, part 9530.6622, and document the recommendations. 

(b) An assessment summary must include: 

(1) a risk description according to section 245G.05 for each dimension listed in paragraph (c); 

(2) a narrative summary supporting the risk descriptions; and 

(3) a determination of whether the client has a substance use disorder. 

(c) An assessment summary must contain information relevant to treatment service planning and recorded in the dimensions in clauses (1) to (6). The license holder must consider: 

(1) Dimension 1, acute intoxication/withdrawal potential; the client's ability to cope with withdrawal symptoms and current state of intoxication; 

(2) Dimension 2, biomedical conditions and complications; the degree to which any physical disorder of the client would interfere with treatment for substance use, and the client's ability to tolerate any related discomfort. The license holder must determine the impact of continued substance use on the unborn child, if the client is pregnant; 

(3) Dimension 3, emotional, behavioral, and cognitive conditions and complications; the degree to which any condition or complication is likely to interfere with treatment for substance use or with functioning in significant life areas and the likelihood of harm to self or others; 

(4) Dimension 4, readiness for change; the support necessary to keep the client involved in treatment service; 

(5) Dimension 5, relapse, continued use, and continued problem potential; the degree to which the client recognizes relapse issues and has the skills to prevent relapse of either substance use or mental health problems; and 

(6) Dimension 6, recovery environment; whether the areas of the client's life are supportive of or antagonistic to treatment participation and recovery. 

246.18 DISPOSAL OF FUNDS.Subd. 2.Behavioral health fund. 
Money received by a substance use disorder treatment facility operated by a regional treatment center or nursing home under the jurisdiction of the commissioner of human services must be deposited in the state treasury and credited to the behavioral health fund. Money in the behavioral health fund is appropriated to the commissioner to operate substance use disorder programs. 

Subd. 2a.Disposition of interest for the behavioral health fund. 
Beginning July 1, 1991, interest earned on cash balances on deposit with the commissioner of management and budget derived from receipts from substance use disorder programs affiliated with state-operated facilities under the commissioner of human services must be deposited in the state treasury and credited to a substance use disorder account under subdivision 2. Any interest earned is appropriated to the commissioner to operate substance use disorder programs according to subdivision 2. 

256B.0638 OPIOID PRESCRIBING IMPROVEMENT PROGRAM.Subdivision 1.Program established. 
The commissioner of human services, in conjunction with the commissioner of health, shall coordinate and implement an opioid prescribing improvement program to reduce opioid dependency and substance use by Minnesotans due to the prescribing of opioid analgesics by health care providers. 

Subd. 2.Definitions. 
(a) For purposes of this section, the terms defined in this subdivision have the meanings given them. 

(b) "Commissioner" means the commissioner of human services. 

(c) "Commissioners" means the commissioner of human services and the commissioner of health. 

(d) "DEA" means the United States Drug Enforcement Administration. 

(e) "Minnesota health care program" means a public health care program administered by the commissioner of human services under this chapter and chapter 256L, and the Minnesota restricted recipient program. 

(f) "Opioid disenrollment standards" means parameters of opioid prescribing practices that fall outside community standard thresholds for prescribing to such a degree that a provider must be disenrolled as a medical assistance provider. 

(g) "Opioid prescriber" means a licensed health care provider who prescribes opioids to medical assistance and MinnesotaCare enrollees under the fee-for-service system or under a managed care or county-based purchasing plan. 

(h) "Opioid quality improvement standard thresholds" means parameters of opioid prescribing practices that fall outside community standards for prescribing to such a degree that quality improvement is required. 

(i) "Program" means the statewide opioid prescribing improvement program established under this section. 

(j) "Provider group" means a clinic, hospital, or primary or specialty practice group that employs, contracts with, or is affiliated with an opioid prescriber. Provider group does not include a professional association supported by dues-paying members. 

(k) "Sentinel measures" means measures of opioid use that identify variations in prescribing practices during the prescribing intervals. 

Subd. 3.Opioid prescribing work group. 
(a) The commissioner of human services, in consultation with the commissioner of health, shall appoint the following voting members to an opioid prescribing work group: 

(1) two consumer members who have been impacted by an opioid abuse disorder or opioid dependence disorder, either personally or with family members; 

(2) one member who is a licensed physician actively practicing in Minnesota and registered as a practitioner with the DEA; 

(3) one member who is a licensed pharmacist actively practicing in Minnesota and registered as a practitioner with the DEA; 

(4) one member who is a licensed advanced practice registered nurse actively practicing in Minnesota and registered as a practitioner with the DEA; 

(5) one member who is a licensed dentist actively practicing in Minnesota and registered as a practitioner with the DEA; 

(6) two members who are nonphysician licensed health care professionals actively engaged in the practice of their profession in Minnesota, and their practice includes treating pain; 

(7) one member who is a mental health professional who is licensed or registered in a mental health profession, who is actively engaged in the practice of that profession in Minnesota, and whose practice includes treating patients with substance use disorder or substance abuse; 

(8) one member who is a medical examiner for a Minnesota county; 

(9) one member of the Health Services Advisory Council established under section 256B.0625, subdivisions 3c to 3e; 

(10) one member who is a medical director of a health plan company doing business in Minnesota; 

(11) one member who is a pharmacy director of a health plan company doing business in Minnesota; 

(12) one member representing Minnesota law enforcement; and 

(13) two consumer members who are Minnesota residents and who have used or are using opioids to manage chronic pain. 

(b) In addition, the work group shall include the following nonvoting members: 

(1) the medical director for the medical assistance program; 

(2) a member representing the Department of Human Services pharmacy unit; 

(3) the medical director for the Department of Labor and Industry; and 

(4) a member representing the Minnesota Department of Health. 

(c) An honorarium of $200 per meeting and reimbursement for mileage and parking shall be paid to each voting member in attendance. 

Subd. 4.Program components. 
(a) The working group shall recommend to the commissioners the components of the statewide opioid prescribing improvement program, including, but not limited to, the following: 

(1) developing criteria for opioid prescribing protocols, including: 

(i) prescribing for the interval of up to four days immediately after an acute painful event; 

(ii) prescribing for the interval of up to 45 days after an acute painful event; and 

(iii) prescribing for chronic pain, which for purposes of this program means pain lasting longer than 45 days after an acute painful event; 

(2) developing sentinel measures; 

(3) developing educational resources for opioid prescribers about communicating with patients about pain management and the use of opioids to treat pain; 

(4) developing opioid quality improvement standard thresholds and opioid disenrollment standards for opioid prescribers and provider groups. In developing opioid disenrollment standards, the standards may be described in terms of the length of time in which prescribing practices fall outside community standards and the nature and amount of opioid prescribing that fall outside community standards; and 

(5) addressing other program issues as determined by the commissioners. 

(b) The opioid prescribing protocols shall not apply to opioids prescribed for patients who are experiencing pain caused by a malignant condition or who are receiving hospice care, or to opioids prescribed for substance use disorder treatment with medications for opioid use disorder. 

(c) All opioid prescribers who prescribe opioids to Minnesota health care program enrollees must participate in the program in accordance with subdivision 5. Any other prescriber who prescribes opioids may comply with the components of this program described in paragraph (a) on a voluntary basis. 

Subd. 5.Program implementation. 
(a) The commissioner shall implement the programs within the Minnesota health care program to improve the health of and quality of care provided to Minnesota health care program enrollees. The commissioner shall annually collect and report to provider groups the sentinel measures of data showing individual opioid prescribers' opioid prescribing patterns compared to their anonymized peers. Provider groups shall distribute data to their affiliated, contracted, or employed opioid prescribers. 

(b) The commissioner shall notify an opioid prescriber and all provider groups with which the opioid prescriber is employed or affiliated when the opioid prescriber's prescribing pattern exceeds the opioid quality improvement standard thresholds. An opioid prescriber and any provider group that receives a notice under this paragraph shall submit to the commissioner a quality improvement plan for review and approval by the commissioner with the goal of bringing the opioid prescriber's prescribing practices into alignment with community standards. A quality improvement plan must include: 

(1) components of the program described in subdivision 4, paragraph (a); 

(2) internal practice-based measures to review the prescribing practice of the opioid prescriber and, where appropriate, any other opioid prescribers employed by or affiliated with any of the provider groups with which the opioid prescriber is employed or affiliated; and 

(3) appropriate use of the prescription monitoring program under section 152.126. 

(c) If, after a year from the commissioner's notice under paragraph (b), the opioid prescriber's prescribing practices do not improve so that they are consistent with community standards, the commissioner shall take one or more of the following steps: 

(1) monitor prescribing practices more frequently than annually; 

(2) monitor more aspects of the opioid prescriber's prescribing practices than the sentinel measures; or 

(3) require the opioid prescriber to participate in additional quality improvement efforts, including but not limited to mandatory use of the prescription monitoring program established under section 152.126. 

(d) The commissioner shall terminate from Minnesota health care programs all opioid prescribers and provider groups whose prescribing practices fall within the applicable opioid disenrollment standards. 

(e) No physician, advanced practice registered nurse, or physician assistant, acting in good faith based on the needs of the patient, may be disenrolled by the commissioner of human services solely for prescribing a dosage that equates to an upward deviation from morphine milligram equivalent dosage recommendations specified in state or federal opioid prescribing guidelines or policies, or quality improvement thresholds established under this section. 

Subd. 6.Data practices. 
(a) Reports and data identifying an opioid prescriber are private data on individuals as defined under section 13.02, subdivision 12, until an opioid prescriber is subject to termination as a medical assistance provider under this section. Notwithstanding this data classification, the commissioner shall share with all of the provider groups with which an opioid prescriber is employed, contracted, or affiliated, the data under subdivision 5, paragraph (a), (b), or (c). 

(b) Reports and data identifying a provider group are nonpublic data as defined under section 13.02, subdivision 9, until the provider group is subject to termination as a medical assistance provider under this section. 

(c) Upon termination under this section, reports and data identifying an opioid prescriber or provider group are public, except that any identifying information of Minnesota health care program enrollees must be redacted by the commissioner. 

256B.0759 SUBSTANCE USE DISORDER DEMONSTRATION PROJECT.Subd. 6.Medium intensity residential program participation. 
Medium intensity residential programs that qualify to participate in the demonstration project shall use the specified base payment rate of $132.90 per day, and shall be eligible for the rate increases specified in subdivision 4. 

256B.0917 HOME AND COMMUNITY-BASED SERVICES FOR OLDER ADULTS.Subd. 1a.Home and community-based services for older adults. 
(a) The purpose of projects selected by the commissioner of human services under this section is to make strategic changes in the long-term services and supports system for older adults including statewide capacity for local service development and technical assistance, and statewide availability of home and community-based services for older adult services, caregiver support and respite care services, and other supports in the state of Minnesota. These projects are intended to create incentives for new and expanded home and community-based services in Minnesota in order to: 

(1) reach older adults early in the progression of their need for long-term services and supports, providing them with low-cost, high-impact services that will prevent or delay the use of more costly services; 

(2) support older adults to live in the most integrated, least restrictive community setting; 

(3) support the informal caregivers of older adults; 

(4) develop and implement strategies to integrate long-term services and supports with health care services, in order to improve the quality of care and enhance the quality of life of older adults and their informal caregivers; 

(5) ensure cost-effective use of financial and human resources; 

(6) build community-based approaches and community commitment to delivering long-term services and supports for older adults in their own homes; 

(7) achieve a broad awareness and use of lower-cost in-home services as an alternative to nursing homes and other residential services; 

(8) strengthen and develop additional home and community-based services and alternatives to nursing homes and other residential services; and 

(9) strengthen programs that use volunteers. 

(b) The services provided by these projects are available to older adults who are eligible for medical assistance and the elderly waiver under chapter 256S, the alternative care program under section 256B.0913, or essential community supports grant under section 256B.0922, and to persons who have their own funds to pay for services. 

Subd. 6.Caregiver support and respite care projects. 
(a) The commissioner shall establish projects to expand the availability of caregiver support and respite care services for family and other caregivers. The commissioner shall use a request for proposals to select nonprofit entities to administer the projects. Projects shall: 

(1) establish a local coordinated network of volunteer and paid respite workers; 

(2) coordinate assignment of respite care services to caregivers of older adults; 

(3) assure the health and safety of the older adults; 

(4) identify at-risk caregivers; 

(5) provide information, education, and training for caregivers in the designated community; and 

(6) demonstrate the need in the proposed service area particularly where nursing facility closures have occurred or are occurring or areas with service needs identified by section 144A.351. Preference must be given for projects that reach underserved populations. 

(b) Projects must clearly describe: 

(1) how they will achieve their purpose; 

(2) the process for recruiting, training, and retraining volunteers; and 

(3) a plan to promote the project in the designated community, including outreach to persons needing the services. 

(c) Funds for all projects under this subdivision may be used to: 

(1) hire a coordinator to develop a coordinated network of volunteer and paid respite care services and assign workers to clients; 

(2) recruit and train volunteer providers; 

(3) provide information, training, and education to caregivers; 

(4) advertise the availability of the caregiver support and respite care project; and 

(5) purchase equipment to maintain a system of assigning workers to clients. 

(d) Project funds may not be used to supplant existing funding sources. 

Subd. 7a.Core home and community-based services. 
The commissioner shall select and contract with core home and community-based services providers for projects to provide services and supports to older adults both with and without family and other informal caregivers using a request for proposals process. Projects must: 

(1) have a credible, public, or private nonprofit sponsor providing ongoing financial support; 

(2) have a specific, clearly defined geographic service area; 

(3) use a practice framework designed to identify high-risk older adults and help them take action to better manage their chronic conditions and maintain their community living; 

(4) have a team approach to coordination and care, ensuring that the older adult participants, their families, and the formal and informal providers are all part of planning and providing services; 

(5) provide information, support services, homemaking services, counseling, and training for the older adults and family caregivers; 

(6) encourage service area or neighborhood residents and local organizations to collaborate in meeting the needs of older adults in their geographic service areas; 

(7) recruit, train, and direct the use of volunteers to provide informal services and other appropriate support to older adults and their caregivers; and 

(8) provide coordination and management of formal and informal services to older adults and their families using less expensive alternatives. 

Subd. 13.Community service grants. 
The commissioner shall award contracts for grants to public and private nonprofit agencies to establish services that strengthen a community's ability to provide a system of home and community-based services for elderly persons. The commissioner shall use a request for proposal process. The commissioner shall give preference when awarding grants under this section to areas where nursing facility closures have occurred or are occurring or to areas with service needs identified under section 144A.351. 

256B.4914 HOME AND COMMUNITY-BASED SERVICES WAIVERS; RATE SETTING.Subd. 9a.Respite services; component values and calculation of payment rates. 
(a) For the purposes of this section, respite services include respite services provided to an individual outside of any service plan for a day program or residential support service. 

(b) Component values for respite services are: 

(1) competitive workforce factor: 4.7 percent; 

(2) supervisory span of control ratio: 11 percent; 

(3) employee vacation, sick, and training allowance ratio: 8.71 percent; 

(4) employee-related cost ratio: 23.6 percent; 

(5) general administrative support ratio: 13.25 percent; 

(6) program-related expense ratio: 2.9 percent; and 

(7) absence and utilization factor ratio: 3.9 percent. 

(c) A unit of service for respite services is 15 minutes. 

(d) Payments for respite services must be calculated as follows unless the service is reimbursed separately as part of a residential support services or day program payment rate: 

(1) determine the number of units of service to meet an individual's needs; 

(2) determine the appropriate hourly staff wage rates derived by the commissioner as provided in subdivisions 5 and 5a; 

(3) except for subdivision 5a, clauses (1) to (4), multiply the result of clause (2) by the product of one plus the competitive workforce factor; 

(4) 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 (3); 

(5) multiply the number of direct staffing hours by the appropriate staff wage; 

(6) multiply the number of direct staffing hours by the product of the supervisory span of control ratio and the appropriate supervisory staff wage in subdivision 5a, clause (1); 

(7) combine the results of clauses (5) and (6), and multiply the result by one plus the employee vacation, sick, and training allowance ratio. This is defined as the direct staffing rate; 

(8) for employee-related expenses, multiply the result of clause (7) by one plus the employee-related cost ratio; 

(9) this is the subtotal rate; 

(10) sum the standard general administrative support ratio, the program-related expense ratio, and the absence and utilization factor ratio; 

(11) divide the result of clause (9) by one minus the result of clause (10). This is the total payment amount; 

(12) for respite services provided in a shared manner, divide the total payment amount in clause (11) by the number of service recipients, not to exceed three; and 

(13) adjust the result of clause (12) by a factor to be determined by the commissioner to adjust for regional differences in the cost of providing services. 

256S.19 MONTHLY CASE MIX BUDGET CAPS; NURSING FACILITY RESIDENTS.Subd. 4.Calculation of monthly conversion budget cap with consumer-directed community supports. 
For the elderly waiver monthly conversion budget cap for the cost of elderly waiver services with consumer-directed community supports, the nursing facility case mix adjusted total payment rate used under subdivision 3 to calculate the monthly conversion budget cap for elderly waiver services without consumer-directed community supports must be reduced by a percentage equal to the percentage difference between the consumer-directed community supports budget limit that would be assigned according to the elderly waiver plan and the corresponding monthly case mix budget cap under this chapter, but not to exceed 50 percent.