SF 4476

1st Engrossment - 94th Legislature (2025 - 2026)

Posted on 05/01/2026 02:02 p.m.

A bill for an act
relating to state government; modifying provisions relating to human services
continuity of care, aging and disability services, behavioral health services,
long-term care facility regulation, and Direct Care and Treatment; requiring reports;
establishing working groups; providing for civil penalties; permitting retrieval fee
for records; providing for transfers and cancellation of money; appropriating
money; amending Minnesota Statutes 2024, sections 15.43, subdivision 3; 144.0724,
by adding a subdivision; 144.121, subdivision 9; 144.1503, subdivision 7; 144.292,
subdivision 6; 144A.04, by adding subdivisions; 144A.291, subdivision 2;
144A.471, subdivision 9; 144G.09, subdivision 2; 144G.15; 144G.16, by adding
a subdivision; 144G.195, subdivision 1; 144G.31, subdivision 7; 144G.40, by
adding a subdivision; 144G.41, subdivisions 1, 2, by adding a subdivision; 144G.45,
subdivision 3; 144G.61, subdivision 2; 144G.63, subdivisions 2, 5, by adding a
subdivision; 245A.04, subdivisions 2, 2a; 245A.042, by adding a subdivision;
246.54, subdivision 2; 254A.03, subdivision 2; 254B.17; 256.01, subdivision 21;
256B.04, subdivision 23, by adding a subdivision; 256B.0625, by adding a
subdivision; 256B.064, subdivision 2; 256B.0761, subdivision 2; 256B.0911,
subdivision 26; 256B.092, subdivision 5; 256B.49, subdivision 11; 256S.205,
subdivision 1; 297E.02, subdivision 3; Minnesota Statutes 2025 Supplement,
sections 144.0724, subdivision 2; 144.121, subdivision 1a; 144A.474, subdivision
11; 144A.4799, subdivision 1; 144G.19, subdivision 5; 145D.40, by adding a
subdivision; 145D.41, subdivisions 1, 2, by adding a subdivision; 254B.02,
subdivision 5; 254B.03, subdivision 4; 254B.0503, subdivision 1; 254B.0509,
subdivision 2; 256.4792, subdivisions 1, 7, by adding a subdivision; 256B.0625,
subdivisions 17, 18i; 256B.0911, subdivision 14; 256B.092, subdivision 3b;
256B.49, subdivision 17a; 256B.4914, subdivision 8; 256I.04, subdivision 2a;
256S.205, subdivision 2; Laws 2023, chapter 61, article 1, sections 61, subdivision
4, as amended; 67, subdivision 3, as amended; article 9, section 2, subdivision 5,
as amended; Laws 2024, chapter 125, article 1, section 47; article 8, section 2,
subdivisions 4, 14, as amended, 20; Laws 2025, First Special Session chapter 3,
article 8, section 43; article 20, section 19, subdivision 1; article 21, section 3,
subdivision 2; Laws 2025, First Special Session chapter 9, article 2, section 58,
subdivision 9; article 4, sections 2; 23; 38; 39; 40; 41; 42; 43; 44; 50; proposing
coding for new law in Minnesota Statutes, chapters 144A; 144G; 145D; 256B;
repealing Minnesota Statutes 2024, sections 144A.04, subdivision 7; 256B.055,
subdivision 14; 256B.0921; Minnesota Statutes 2025 Supplement, sections
256B.4907, subdivisions 1, 2, 3, 4, 5, 6; 256S.205, subdivision 7; Laws 2019, First
Special Session chapter 9, article 5, section 86, as amended; Laws 2021, First
Special Session chapter 7, article 13, sections 73, as amended; 75, subdivision 1,
as amended.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

ARTICLE 1

CONTINUITY OF CARE

Section 1.

new text begin [256B.045] CONTINUITY OF CARE.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For the purposes of this section, the following terms have
the meanings given.
new text end

new text begin (b) "Lead agency" means a county, Tribe, or managed care organization.
new text end

new text begin (c) "Residential services and supports" means any of the following services as defined
in the brain injury, community alternative care, community access for disability inclusion,
developmental disabilities, or elderly waiver plans:
new text end

new text begin (1) 24-hour customized living services;
new text end

new text begin (2) community residential services;
new text end

new text begin (3) customized living services;
new text end

new text begin (4) family residential services; and
new text end

new text begin (5) integrated community supports.
new text end

new text begin Subd. 2. new text end

new text begin Department of Human Services continuity of care team; establishment. new text end

new text begin To
ensure the continuity of care of older adults and people with disabilities receiving residential
services and supports following the imposition of a payment withhold under section
256B.064, subdivision 2, the commissioner must establish and maintain a continuity of care
team. The commissioner must ensure the continuity of care team always has sufficient staff
capacity and resources for timely compliance with the requirements of this section.
new text end

new text begin Subd. 3. new text end

new text begin Department of Human Services continuity of care team; duties. new text end

new text begin (a) Upon
notice from the commissioner under section 256B.064, subdivision 2, paragraph (i), that
the commissioner intends to impose a payment withhold on a provider of residential services
and supports, the continuity of care team must:
new text end

new text begin (1) identify all the provider's clients whose services might be affected by the payment
withhold the commissioner intends to impose, including but not limited to all clients paying
for services from a source other than medical assistance;
new text end

new text begin (2) for each identified client, identify the lead agency responsible for providing case
management or care coordination to the client;
new text end

new text begin (3) for each identified client, identify the client's case manager or care coordinator; and
new text end

new text begin (4) for each identified client, develop an initial profile of the client containing the team's
expectations regarding the services and supports the client is likely to require if the
commissioner's imposition of a payment withhold upon the provider puts the continuity of
care of the provider's client at risk or poses a risk that the provider's client will need to
transition to a new service provider or setting.
new text end

new text begin (b) After the team has completed the tasks identified in paragraph (a), clauses (1) to (4),
the team must inform the commissioner that the team is prepared to intervene on behalf of
each identified client immediately upon imposition of the payment withhold.
new text end

new text begin (c) Upon imposition of the payment withhold, for each identified client, the continuity
of care team must:
new text end

new text begin (1) inform the Office of the Ombudsman for Long-Term Care, the Office of the
Ombudsman for Mental Health and Developmental Disabilities, the Office of the
Ombudsperson for Public Managed Care Health Care Programs, and the lead agency that
the client's services may be disrupted by actions taken by the commissioner under section
256B.064, subdivision 2, and that the lead agency must comply with the requirements of
subdivision 4;
new text end

new text begin (2) directly inform each identified client's case manager or care coordinator that the
client's services may be disrupted by actions taken by the commissioner under section
256B.064, subdivision 2; that the continuity of care team is prepared to offer assistance to
ensure the client's continuity of care; and that the case manager must comply with the
requirements of subdivision 4; and
new text end

new text begin (3) directly inform each identified client that the client's services may be disrupted by
actions taken by the commissioner under section 256B.064, subdivision 2, and that the lead
agency, the client's case manager, and the continuity of care team are already taking steps
to develop contingency plans in the event the client's services are disrupted.
new text end

new text begin Subd. 4. new text end

new text begin Continuity of care team and lead agency shared duties. new text end

new text begin (a) This subdivision
applies to all lead agencies regardless of whether a lead agency provides case management
directly or under contract.
new text end

new text begin (b) The continuity of care team and the lead agency must cooperate and coordinate with
the client's case manager to:
new text end

new text begin (1) closely monitor services delivered to a client of a provider subject to a payment
withhold; and
new text end

new text begin (2) develop a person-centered contingency plan for alternative services or an alternative
service provider or setting in the event a client's services are disrupted.
new text end

new text begin (c) If a lead agency fails to develop or implement a person-centered contingency plan
that ensures timely transition to alternative services or to an alternative service provider or
setting, the continuity of care team must directly intervene and provide case management
directly to the client. The lead agency and the client's case manager must fully cooperate
and assist the continuity of care team in the provision of case management services. The
lead agency is responsible for the state share of case management services provided by the
continuity of care team.
new text end

new text begin (d) If the lead agency or the continuity of care team does not identify alternative services
or an alternative service provider or setting, the continuity of care team must notify the
commissioner and the commissioner of health, if applicable, and recommend:
new text end

new text begin (1) the commissioner of human services either determine there is a good cause under
Code of Federal Regulations, title 42, section 455.23(e) or (f), to not suspend payments
under section 256B.064, subdivision 2, or petition the district court of Ramsey County under
section 245A.13 to be appointed receiver to operate the residential program; or
new text end

new text begin (2) the commissioner of health bring an action under section 144G.20, subdivision 21,
against the provider subject to the withhold for violations of section 144G.52 or 144G.53.
new text end

new text begin (e) If the commissioner does not follow the recommendations of the continuity of care
team identified in paragraph (d), within 30 days of receipt of the recommendations, the
commissioner must notify the chairs and ranking minority members of the legislative
committees with jurisdiction over human services of the commissioner's decision and include
in the notice an explanation of the commissioner's rejection of the recommendations, the
number of clients who will lose services as a result of the commissioner's decision, and the
likely outcomes for the clients who will lose services.
new text end

new text begin Subd. 5. new text end

new text begin Provider duties. new text end

new text begin (a) The provider must fully cooperate with the lead agency
and the continuity of care team to effectuate a coordinated transfer or coordinated move for
each client who requires a new provider.
new text end

new text begin (b) Nothing in this section absolves a provider of its obligations under chapters 144G,
245A, and 245D with respect to service suspensions, service terminations, contract
terminations, and coordinated moves. The commissioners of health and human services
may impose any sanctions available under law for violations of a licensing requirement
even if the provider complies with paragraph (a).
new text end

Sec. 2.

Minnesota Statutes 2024, section 256B.064, subdivision 2, is amended to read:

Subd. 2.

Imposition of monetary recovery and sanctions.

(a) The commissioner shall
determine any monetary amounts to be recovered and sanctions to be imposed upon an
individual or entity under this section. Except as provided in paragraphs (b) and (d), neither
a monetary recovery nor a sanction will be imposed by the commissioner without prior
notice and an opportunity for a hearing, according to chapter 14, on the commissioner's
proposed action, provided that the commissioner may suspend or reduce payment to an
individual or entity, except a nursing home or convalescent care facility, after notice and
prior to the hearing if in the commissioner's opinion that action is necessary to protect the
public welfare and the interests of the program.

(b) Except when the commissioner finds good cause not to suspend payments under
Code of Federal Regulations, title 42, section 455.23(e) or (f), the commissioner shall
withhold or reduce payments to an individual or entity without providing advance notice
of such withholding or reduction if either of the following occurs:

(1) the individual or entity is convicted of a crime involving the conduct described in
subdivision 1a; or

(2) the commissioner determines there is a credible allegation of fraud for which an
investigation is pending under the program. Allegations are considered credible when they
have an indicium of reliability and the state agency has reviewed all allegations, facts, and
evidence carefully and acts judiciously on a case-by-case basis. A credible allegation of
fraud is an allegation which has been verified by the state, from any source, including but
not limited to:

(i) fraud hotline complaints;

(ii) claims data mining; and

(iii) patterns identified through provider audits, civil false claims cases, and law
enforcement investigations.

(c) The commissioner must send notice of the withholding or reduction of payments
under paragraph (b) within five days of taking such action unless requested in writing by a
law enforcement agency to temporarily withhold the notice. The notice must:

(1) state that payments are being withheld according to paragraph (b);

(2) set forth the general allegations as to the nature of the withholding action, but need
not disclose any specific information concerning an ongoing investigation;

(3) except in the case of a conviction for conduct described in subdivision 1a, state that
the withholding is for a temporary period and cite the circumstances under which withholding
will be terminated;

(4) identify the types of claims to which the withholding applies; and

(5) inform the individual or entity of the right to submit written evidence for consideration
by the commissioner.

(d) deleted text begin The withholding or reduction of payments will not continue after deleted text end The commissioner
deleted text begin determines deleted text end new text begin must cease the withholding or reduction of payments after determining new text end there is
insufficient evidence of fraud by the individual or entity deleted text begin , deleted text end new text begin ; after finding good cause not to
continue withholding or reducing payments under Code of Federal Regulations, title 42,
section 455.23(e) or (f); new text end or after legal proceedings relating to the alleged fraud are completed,
unless the commissioner has sent notice of intention to impose monetary recovery or
sanctions under paragraph (a). Upon conviction for a crime related to the provision,
management, or administration of a health service under medical assistance, a payment held
pursuant to this section by the commissioner or a managed care organization that contracts
with the commissioner under section 256B.035 is forfeited to the commissioner or managed
care organization, regardless of the amount charged in the criminal complaint or the amount
of criminal restitution ordered.

(e) The commissioner shall suspend or terminate an individual's or entity's participation
in the program without providing advance notice and an opportunity for a hearing when the
suspension or termination is required because of the individual's or entity's exclusion from
participation in Medicare. Within five days of taking such action, the commissioner must
send notice of the suspension or termination. The notice must:

(1) state that suspension or termination is the result of the individual's or entity's exclusion
from Medicare;

(2) identify the effective date of the suspension or termination; and

(3) inform the individual or entity of the need to be reinstated to Medicare before
reapplying for participation in the program.

(f) Upon receipt of a notice under paragraph (a) that a monetary recovery or sanction is
to be imposed, an individual or entity may request a contested case, as defined in section
14.02, subdivision 3, by filing with the commissioner a written request of appeal. The appeal
request must be received by the commissioner no later than 30 days after the date the
notification of monetary recovery or sanction was mailed to the individual or entity. The
appeal request must specify:

(1) each disputed item, the reason for the dispute, and an estimate of the dollar amount
involved for each disputed item;

(2) the computation that the individual or entity believes is correct;

(3) the authority in statute or rule upon which the individual or entity relies for each
disputed item;

(4) the name and address of the person or entity with whom contacts may be made
regarding the appeal; and

(5) other information required by the commissioner.

(g) The commissioner may order an individual or entity to forfeit a fine for failure to
fully document services according to standards in this chapter and Minnesota Rules, chapter
9505. The commissioner may assess fines if specific required components of documentation
are missing. The fine for incomplete documentation shall equal 20 percent of the amount
paid on the claims for reimbursement submitted by the individual or entity, or up to $5,000,
whichever is less. If the commissioner determines that an individual or entity repeatedly
violated this chapter, chapter 254B or 245G, or Minnesota Rules, chapter 9505, related to
the provision of services to program recipients and the submission of claims for payment,
the commissioner may order an individual or entity to forfeit a fine based on the nature,
severity, and chronicity of the violations, in an amount of up to $5,000 or 20 percent of the
value of the claims, whichever is greater.

(h) The individual or entity shall pay the fine assessed on or before the payment date
specified. If the individual or entity fails to pay the fine, the commissioner may withhold
or reduce payments and recover the amount of the fine. A timely appeal shall stay payment
of the fine until the commissioner issues a final order.

new text begin (i) Prior to suspending or withholding payments to an entity providing residential services
and supports to an older adult or person with a disability, or suspending or terminating the
entity's participation in medical assistance, the commissioner must notify the Department
of Human Services continuity of care team established under section 256B.045. The
commissioner must not suspend or withhold payments to an entity providing residential
services and supports to an older adult or person with a disability, or suspend or terminate
the entity's participation in the program, until the continuity of care team notifies the
commissioner that the team is prepared to immediately intervene and comply with its duties
under section 256B.045 upon imposition of the commissioner's sanction. For the purposes
of this paragraph, "residential services and supports" has the meaning given in section
256B.045, subdivision 1.
new text end

ARTICLE 2

AGING AND DISABILITY SERVICES

Section 1.

Minnesota Statutes 2025 Supplement, section 144.0724, subdivision 2, is
amended to read:

Subd. 2.

Definitions.

For purposes of this section, the following terms have the meanings
given.

(a) "Assessment reference date" or "ARD" means the specific end point for look-back
periods in the MDS assessment process. This look-back period is also called the observation
or assessment period.

(b) "Case mix index" means the weighting factors assigned to the case mix reimbursement
classifications determined by an assessment.

(c) "Index maximization" means classifying a resident who could be assigned to more
than one category, to the category with the highest case mix index.

(d) "Minimum Data Set" or "MDS" means a core set of screening, clinical assessment,
and functional status elements, that include common definitions and coding categories
specified by the Centers for Medicare and Medicaid Services and designated by the
Department of Health.

(e) "Representative" means a person who is the resident's guardian or conservator, the
person authorized to pay the nursing home expenses of the resident, a representative of the
Office of Ombudsman for Long-Term Care whose assistance has been requested, or any
other individual designated by the resident.

(f) "Activities of daily living" or "ADL" includes personal hygiene, dressing, bathing,
transferring, bed mobility, locomotion, eating, and toileting.

(g) "Nursing facility level of care determination" means the assessment process that
results in a determination of a resident's or prospective resident's need for nursing facility
level of care as established in subdivision 11 for purposes of medical assistance payment
of long-term care services for:

(1) nursing facility services under chapter 256R;

(2) elderly waiver services under chapter 256S;

(3) CADI and BI waiver services under section 256B.49; and

(4) state payment of alternative care services under section 256B.0913.

new text begin This paragraph expires upon the effective date of paragraph (h).
new text end

new text begin (h) Effective January 1, 2027, or upon federal approval, whichever is later, "nursing
facility level of care determination" means the assessment process that results in a
determination of a resident's or prospective resident's need for nursing facility level of care:
new text end

new text begin (1) as established in subdivision 11 for purposes of medical assistance payment of
long-term care services for:
new text end

new text begin (i) nursing facility services under chapter 256R;
new text end

new text begin (ii) elderly waiver services under chapter 256S; and
new text end

new text begin (iii) state payment of alternative care services under section 256B.0913; and
new text end

new text begin (2) as established in subdivision 11a for purposes of medical assistance payment of
long-term care services for brain injury and community access for disability and inclusion
waivers under section 256B.49.
new text end

deleted text begin (h) deleted text end new text begin (i) new text end "Patient Driven Payment Model" or "PDPM" means the case mix reimbursement
classification system for residents in nursing facilities based on the resident's condition,
diagnosis, and the care the resident received at the time of the MDS assessment with an
ARD on or after October 1, 2025.

deleted text begin (i) deleted text end new text begin (j) new text end "Resource utilization group" or "RUG" means the case mix reimbursement
classification system for residents in nursing facilities according to the resident's clinical
and functional status as reflected in data supplied by the facility's MDS with an ARD on or
before September 30, 2025.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 2.

Minnesota Statutes 2024, section 144.0724, is amended by adding a subdivision
to read:

new text begin Subd. 11a. new text end

new text begin Nursing facility level of care; BI and CADI waivers. new text end

new text begin (a) Effective January
1, 2027, or upon federal approval, whichever is later, a determination of need for nursing
facility level of care for brain injury and community access for disability and inclusion
waivers under section 256B.49 must meet one of the following criteria:
new text end

new text begin (1) the person needs the assistance of another person or constant supervision to begin
and complete at least four of the following activities of living: bathing, bed mobility, dressing,
eating, grooming, toileting, transferring, and walking;
new text end

new text begin (2) the person needs the assistance of another person or constant supervision to begin
and complete toileting, transferring, or positioning and the assistance cannot be scheduled;
or
new text end

new text begin (3) the person has significant difficulty with memory, using information, daily decision
making, or behavioral needs that require intervention.
new text end

new text begin (b) Nursing facility level of care determinations for purposes of initial and ongoing
access to brain injury and community access for disability inclusion waiver programs must
be conducted by a MnCHOICES certified assessor in a manner determined by the
commissioner.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 3.

Minnesota Statutes 2024, section 144.292, subdivision 6, is amended to read:

Subd. 6.

Cost.

(a) When a patient requests a copy of the patient's record for purposes of
reviewing current medical care, the provider must not charge a fee.

(b) When a provider or its representative makes copies of patient records upon a patient's
request under this section, the provider or its representative may charge the patient or the
patient's representative no more than the following amount, unless other law or a rule or
contract provide for a lower maximum charge:

(1) for paper copies, $1 per page, plus $10 for time spent retrieving and copying the
records;

(2) for x-rays, a total of $30 for retrieving and reproducing x-rays; and

(3) for electronic copies, a total of $20 for retrieving the records.

(c) For any copies of paper records provided under paragraph (b), clause (1), a provider
or the provider's representative may not charge more than a total of:

(1) $10 if there are no records available;

(2) $30 for copies of records of up to 25 pages;

(3) $50 for copies of records of up to 100 pages;

(4) $50, plus an additional 20 cents per page for pages 101 and above; or

(5) $500 for any request.

(d) A provider or its representative may charge a $10 retrieval fee, but must not charge
a per page fee or x-ray fee to provide copies of records requested by a patient or the patient's
authorized representative if the request for copies of records is for purposes of appealing a
denial of Social Security disability income or Social Security disability benefits under title
II or title XVI of the Social Security Act. Notwithstanding the foregoing, a provider or its
representative must not charge a fee, including a retrieval fee, to provide copies of records
requested by a patient or the patient's authorized representative if the request for copies of
records is for purposes of appealing a denial of Social Security disability income or Social
Security disability benefits under title II or title XVI of the Social Security Act when the
patient is receiving public assistance, represented by an attorney on behalf of a civil legal
services program, or represented by a volunteer attorney program based on indigency. The
patient or the patient's representative must submit one of the following to show that they
are entitled to receive records without charge under this paragraph:

(1) a public assistance statement from the county or state administering assistance;

(2) a request for records on the letterhead of the civil legal services program or volunteer
attorney program based on indigency; or

(3) a benefits statement from the Social Security Administration.

For the purpose of further appeals, a patient may receive no more than two medical record
updates without charge, but only for medical record information previously not provided.

For purposes of this paragraph, a patient's authorized representative does not include units
of state government engaged in the adjudication of Social Security disability claims.

new text begin (e) A provider or its representative may charge a $10 retrieval fee, but must not charge
a per page fee or x-ray fee to provide copies of records requested by a patient or the patient's
authorized representative if the request for copies of records is for purposes of a disability
determination by the department's state medical review team. Notwithstanding the foregoing,
a provider or its representative must not charge a fee, including a retrieval fee, to provide
copies of records requested by a patient or the patient's authorized representative if the
request for copies of records is for purposes of a disability determination by the department's
state medical review team when the patient is receiving public assistance. To show that the
patient or the patient's representative is entitled to receive records without charge under this
paragraph, the patient or the patient's representative must submit either the patient's public
assistance statement from the county or state administering assistance or the patient's benefits
statement from the Social Security Administration.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 4.

Minnesota Statutes 2024, section 245A.04, subdivision 2, is amended to read:

Subd. 2.

Notification of affected municipality.

The commissioner must not issue a
license under this chapter without giving 30 calendar days' written notice to the affected
municipality or other political subdivision unless the program is considered a permitted
single-family residential use under sections 245A.11 and 245A.14. new text begin If the program is
considered a permitted single-family residence, the commissioner must give the affected
municipality or other political subdivision written notice of the issuance no later than five
days after issuing the license, excluding weekends and holidays. The written notice must
include the prospective license holder's name and contact information, the license type and
capacity, and the proposed address of the licensed facility or program. new text end The commissioner
may provide notice through electronic communication. The notification must be given
before the first issuance of a license under this chapter and annually after that time if annual
notification is requested in writing by the affected municipality or other political subdivision.
State funds must not be made available to or be spent by an agency or department of state,
county, or municipal government for payment to a residential or nonresidential program
licensed under this chapter until the provisions of this subdivision have been complied with
in full. The provisions of this subdivision shall not apply to programs located in hospitals.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2026, and applies to licenses
issued on or after that date.
new text end

Sec. 5.

Minnesota Statutes 2024, section 245A.04, subdivision 2a, is amended to read:

Subd. 2a.

Meeting fire and safety codes.

new text begin (a) new text end An applicant or license holder under
sections 245A.01 to 245A.16 must document compliance with applicable building codes,
fire and safety codes, health rules, and zoning ordinances, or document that an appropriate
waiver has been granted.

new text begin (b) At the request of a county or local unit of government, the commissioner may delegate
to a county agency or local unit of government the commissioner's or local agency's authority
to inspect an existing residential program serving six or fewer persons for compliance with
zoning ordinances and applicable physical plant licensing requirements. If the commissioner
delegates the commissioner's or local agency's authority to a county agency or local unit of
government under this subdivision, the commissioner must execute a formal delegation of
authority that clearly specifies what authority is being delegated to the county agency or
local unit of government, that the commissioner is responsible for any costs incurred by the
county agency or local unit of government for conducting inspections under delegated
authority, and that the county agency or local unit of government must not assess any
additional fees for conducting an inspection under delegated authority. When conducting
an inspection under delegated authority, the county agency or local unit of government must
provide the subject of the inspection with a copy of the delegation of authority.
new text end

new text begin (c) When a county agency or local unit of government is conducting an inspection under
delegated authority as provided in paragraph (b), the county agency or local unit of
government and the agency responsible for licensing inspections must coordinate inspections
to minimize visits to and disruptions of the residential program. A county agency or local
unit of government conducting an inspection must notify the commissioner of any violations
or concerns within ten days of the inspection, excluding weekends and holidays. A county
agency or local unit of government that conducts inspections under this subdivision must
not inspect a residential program more frequently than annually, except a follow-up inspection
is permitted before the next annual inspection to verify correction of a violation discovered
during the most recent inspection.
new text end

new text begin (d) The commissioner must ensure that laws, rules, and codes are uniformly enforced
throughout the state by reviewing at least every four years each county agency and local
unit of government conducting inspections under this subdivision for compliance with this
subdivision and other applicable laws and rules.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2027.
new text end

Sec. 6.

Minnesota Statutes 2024, section 245A.042, is amended by adding a subdivision
to read:

new text begin Subd. 7. new text end

new text begin Colocation of certain home and community-based residential settings. new text end

new text begin (a)
Effective July 1, 2026, the commissioner must not authorize services in or issue an initial
license under this chapter or chapter 245D for any of the following residential settings or
programs unless the proposed setting meets the heightened home and community-based
setting standards described in this subdivision:
new text end

new text begin (1) a community residential setting, as defined in section 245D.02, subdivision 4a;
new text end

new text begin (2) an adult foster care home;
new text end

new text begin (3) a setting providing customized living services with a resident capacity of six or fewer;
new text end

new text begin (4) a setting providing 24-hour customized living services with a resident capacity of
six or fewer; and
new text end

new text begin (5) an assisted living facility licensed under chapter 144G with a resident capacity of
six or fewer.
new text end

new text begin (b) Newly licensed settings enumerated in paragraph (a) must not be located on the same
property or on an adjoining property of any existing community residential setting, any
existing adult foster care setting, any existing setting providing family residential services
to an adult, any existing setting providing customized living services with a resident capacity
of six or fewer, any existing setting providing 24-hour customized living services with a
resident capacity of six or fewer, or any existing assisted living facility licensed under
chapter 144G with a resident capacity of six or fewer. The requirements of this paragraph
apply regardless of who owns or controls the existing setting. The commissioner must
comply with section 245A.11, subdivision 4, when authorizing services or issuing an initial
license under this subdivision.
new text end

new text begin (c) For the purposes of this subdivision, "adjoining property" means a property that
shares a common boundary line with another property. Adjoining property also includes
properties that meet at a common corner point. The presence of a right-of-way or public
easement, including but not limited to a bicycle path, alley, or residential street, between
adjoining properties, including between properties that but for the right-of-way or public
easement would share a common corner point, are adjoining properties.
new text end

Sec. 7.

Minnesota Statutes 2024, section 256.01, subdivision 21, is amended to read:

Subd. 21.

Interagency deleted text begin agreement deleted text end new text begin agreements new text end with Department of Health.

new text begin (a) new text end The
commissioner of human services shall amend the interagency agreement with the
commissioner of health to certify nursing facilities for participation in the medical assistance
program, to require the commissioner of health, as a condition of the agreement, to comply
beginning July 1, 2005, with action plans included in the annual survey and certification
quality improvement report required under section 144A.10, subdivision 17.

new text begin (b) The commissioners of health and human services must execute an interagency
agreement to determine on behalf of the commissioner of health whether an assisted living
facility for which either an applicant is seeking a provisional license under chapter 144G
or a licensee is seeking to relocate under section 144G.195 meets the standards described
in section 245A.042, subdivision 7.
new text end

Sec. 8.

Minnesota Statutes 2025 Supplement, section 256.4792, subdivision 1, is amended
to read:

Subdivision 1.

Long-term services and supports loan program.

The commissioner
of human services shall establish a loan program to provide operating loans to eligible
long-term services and supports providers. deleted text begin The commissioner shall initiate the application
process for the loan described in this section on an ongoing basis. deleted text end new text begin The commissioner must
not issue any new loans under this program after June 30, 2026.
new text end

Sec. 9.

Minnesota Statutes 2025 Supplement, section 256.4792, subdivision 7, is amended
to read:

Subd. 7.

Loan repayment.

(a) If a borrower is more than 60 calendar days delinquent
in the timely payment of a contractual payment under this section, the provisions in
paragraphs (b) to (e) apply.

(b) The commissioner may withhold some or all of the amount of the delinquent loan
payment, together with any penalties due and owing on those amounts, from any money
the department owes to the borrower. The commissioner may, at the commissioner's
discretion, also withhold future contractual payments from any money the commissioner
owes the provider as those contractual payments become due and owing. The commissioner
may continue this withholding until the commissioner determines there is no longer any
need to do so.

(c) The commissioner shall give prior notice of the commissioner's intention to withhold
by mail, facsimile, or email at least ten business days before the date of the first payment
period for which the withholding begins. The notice must be deemed received as of the date
of mailing or receipt of the facsimile or electronic notice. The notice must state:

(1) the amount of the delinquent contractual payment;

(2) the amount of the withholding per payment period;

(3) the date on which the withholding is to begin;

(4) whether the commissioner intends to withhold future installments of the provider's
contractual payments; and

(5) other contents as the commissioner deems appropriate.

(d) The commissioner, or the commissioner's designee, may enter into written settlement
agreements with a provider to resolve disputes and other matters involving unpaid loan
contractual payments or future loan contractual payments.

(e) Notwithstanding any law to the contrary, all unpaid loans, plus any accrued penalties,
are overpayments for the purposes of section 256B.0641, subdivision 1. The current long-term
services and supports provider is liable for the overpayment amount owed by a former owner
for any provider sold, transferred, or reorganized.

new text begin (f) By January 15 each year, the commissioner must provide to the chairs and ranking
minority members of the legislative committees with jurisdiction over nursing facilities a
report of all facilities that are delinquent in their repayments. The reporting required under
this paragraph expires upon notification by the commissioner to the committees that there
are no outstanding balances from loan awards issued under this subdivision.
new text end

Sec. 10.

Minnesota Statutes 2025 Supplement, section 256.4792, is amended by adding
a subdivision to read:

new text begin Subd. 11. new text end

new text begin Loan program expiration. new text end

new text begin This section expires after the commissioner collects
all loan repayments incurred on or before June 30, 2026. The commissioner must notify the
revisor of statutes once all loan repayments under this section are collected.
new text end

Sec. 11.

Minnesota Statutes 2024, section 256B.04, is amended by adding a subdivision
to read:

new text begin Subd. 28. new text end

new text begin Interpretive guidelines for disability waiver regulation. new text end

new text begin (a) The
commissioner must develop and publish interpretive guidelines within 120 calendar days
of the effective date of any statutory changes, waiver plan amendments, state or federal
administrative rulings, or state or federal court decisions that affect policies or reimbursement
for services licensed under chapter 245D, authorized under section 256B.092 or 256B.49,
or reimbursed under section 256B.4914.
new text end

new text begin (b) Interpretive guidelines issued by the commissioner under this subdivision do not
have the force and effect of law and have no precedential effect but may be relied on by
consumers, providers of service, county agencies, the Department of Human Services, and
others concerned until revoked or modified. An interpretive guideline may be expressly
revoked or modified by the commissioner or by the issuance of another interpretive guideline
but may not be revoked or modified retroactively to the detriment of consumers, providers
of service, county agencies, the Department of Human Services, or others concerned. A
change in the law or an interpretation of the law occurring after the interpretive guidelines
are issued, whether in the form of a statute, court decision, administrative ruling, or
subsequent interpretive guideline, results in the revocation or modification of the previously
adopted guidelines to the extent that the change affects the guidelines.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment and
applies to statutory changes, waiver plan amendments, state or federal administrative rulings,
or state or federal court decisions effective or issued on or after that date.
new text end

Sec. 12.

Minnesota Statutes 2025 Supplement, section 256B.0911, subdivision 14, is
amended to read:

Subd. 14.

Use of MnCHOICES certified assessors required.

(a) Each lead agency
shall use MnCHOICES certified assessors who have completed MnCHOICES training and
the certification process determined by the commissioner in subdivision 13.

(b) Each lead agency must ensure that the lead agency has sufficient numbers of certified
assessors to provide long-term consultation assessment and support planning within the
timelines and parameters of the service.

(c) A lead agency may choose, according to departmental policies, to contract with a
qualified, certified assessor to conduct assessments and reassessments on behalf of the lead
agency.

(d) Tribes and health plans under contract with the commissioner must provide long-term
care consultation services as specified in the contract.

(e) A lead agency must provide the commissioner with an administrative contact for
communication purposes.

(f) A lead agency may contract under this subdivision with any hospital licensed under
sections 144.50 to 144.56 to conduct assessments of patients in the hospital on behalf of
the lead agency when the lead agency has failed to meet its obligations under subdivision
17. The contracted assessment must be conducted by a hospital employee who is a qualified,
certified assessor. The hospital employees who perform assessments under the contract
between the hospital and the lead agency may perform assessments in addition to other
duties assigned to the employee by the hospital, except the hospital employees who perform
the assessments under contract with the lead agency must not perform any waiver-related
tasks other than assessments. Hospitals are not eligible for reimbursement under subdivision
33. The lead agency that enters into a contract with a hospital under this paragraph is
responsible for oversight, compliance, and quality assurance for all assessments performed
under the contract.

new text begin (g) The commissioner must employ certified assessors within the department to conduct
assessments on behalf of lead agencies under conditions and circumstances determined by
the commissioner. Certified assessors employed by the department may conduct assessments
in addition to other duties as assigned, except the certified assessors employed by the
department must not perform any responsibilities of a lead agency described in this section
other than assessments. Nothing in this paragraph creates an obligation for the department
to provide the department's certified assessors to conduct assessments on behalf of a lead
agency.
new text end

Sec. 13.

Minnesota Statutes 2024, section 256B.0911, subdivision 26, is amended to read:

Subd. 26.

Determination of institutional level of care.

(a) The determination of need
for hospital and intermediate care facility levels of care must be made according to criteria
developed by the commissioner, and in section 256B.092, using forms developed by the
commissioner.

(b) The determination of need for nursing facility level of care must be made based on
criteria in section 144.0724, subdivision 11. new text begin This paragraph expires upon the effective date
of paragraph (c).
new text end

new text begin (c) Effective January 1, 2027, or upon federal approval, whichever is later, the
determination of need for nursing facility level of care must be made based on criteria in
section 144.0724, subdivision 11, or for brain injury and community access for disability
inclusion waiver services provided under section 256B.49 based on criteria in section
144.0724, subdivision 11a.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 14.

Minnesota Statutes 2025 Supplement, section 256B.092, subdivision 3b, is
amended to read:

Subd. 3b.

Service authorizations and service agreements.

(a) Recipients must be
screened and authorized for services according to the federally approved waiver application
and its subsequent amendments.

(b) The commissioner must require lead agency supervisors to review and accept all
service agreements entered by lead agency staff into the Medicaid management information
system (MMIS) prior to the commissioner's approval of the service agreement.

(c) For a service agreement with a proposed total authorized amount that exceeds the
total authorized amount in the recipient's prior service agreement by more than the value
of legislatively enacted rate increases, the commissioner must manually review and manually
approve the service agreement in the MMIS. For purposes of this paragraph, "prior service
agreement" means the service agreement that was in effect 12 months prior to the start date
of the new proposed service agreement.

(d) In a format prescribed by the commissioner, lead agencies must submit the following
information for all service agreements subject to the commissioner's approval in paragraph
(c):

(1) changes in the number of units authorized;

(2) new services authorized;

(3) changes in the values used to calculate service rates under section 256B.4914, except
for automatic adjustments required under section 256B.4914, subdivisions 5 and 5b;

(4) changes in the person's level of need that require an increase in the amount of services
authorized;

(5) documentation detailing why the previous amount of services is not sufficient to
meet the person's needs; and

(6) anticipated impact if the total service amount is not increased to the proposed amount.

(e) Except for rate increases required under section 256B.4914, subdivisions 5 and 5b,
and rate changes authorized by the 2025 legislature, the commissioner must not approve
service agreements under paragraph (c) that are not the result of either a documented change
in a person's assessed needs or documented evidence that the previous level of service was
insufficient to meet the person's assessed needs.

deleted text begin (f) This subdivision expires upon full implementation of waiver reimagine. The
commissioner must inform the revisor of statutes when waiver reimagine is fully
implemented.
deleted text end

Sec. 15.

Minnesota Statutes 2024, section 256B.092, subdivision 5, is amended to read:

Subd. 5.

Federal waivers.

(a) The commissioner shall apply for any federal waivers
necessary to secure, to the extent allowed by law, federal financial participation under United
States Code, title 42, sections 1396 et seq., as amended, for the provision of services to
persons who, in the absence of the services, would need the level of care provided in a
regional treatment center or a community intermediate care facility for persons with
developmental disabilities. The commissioner may seek amendments to the waivers or apply
for additional waivers under United States Code, title 42, sections 1396 et seq., as amended,
to contain costs. The commissioner shall ensure that payment for the cost of providing home
and community-based alternative services under the federal waiver plan shall not exceed
the cost of intermediate care services including day training and habilitation services that
would have been provided without the waivered services.

The commissioner shall seek an amendment to the 1915(c) home and community-based
waiver to allow properly licensed adult foster care homes to provide residential services to
up to five individuals with developmental disabilities. If the amendment to the waiver is
approved, adult foster care providers that can accommodate five individuals shall increase
their capacity to five beds, provided the providers continue to meet all applicable licensing
requirements.

(b) The commissioner, in administering home and community-based waivers for persons
with developmental disabilities, shall ensure that day services for eligible persons are not
provided by the person's residential service provider, unless the person or the person's legal
representative is offered a choice of providers and agrees in writing to provision of day
services by the residential service provider. The support plan for individuals who choose
to have their residential service provider provide their day services must describe how health,
safety, protection, and habilitation needs will be met, including how frequent and regular
contact with persons other than the residential service provider will occur. The support plan
must address the provision of services during the day outside the residence on weekdays.

(c) When a lead agency is evaluating denials, reductions, or terminations of home and
community-based services under section 256B.0916 for an individual, the lead agency shall
offer to meet with the individual or the individual's guardian in order to discuss the
prioritization of service needs within the support plan. The reduction in the authorized
services for an individual due to changes in funding for waivered services may not exceed
the amount needed to ensure medically necessary services to meet the individual's health,
safety, and welfare.

deleted text begin (d) The commissioner shall seek federal approval to allow for the reconfiguration of the
1915(c) home and community-based waivers in this section, as authorized under section
1915(c) of the federal Social Security Act, to implement a two-waiver program structure.
deleted text end

deleted text begin (e) The transition to two disability home and community-based services waiver programs
must align with the independent living first policy under section 256B.4905. Unless
superseded by any other state or federal law, waiver eligibility criteria shall be the same for
each waiver. The waiver program that a person uses shall be determined by the support
planning process and whether the person chooses to live in a provider-controlled setting or
in the person's own home.
deleted text end

deleted text begin (f) Prior to July 1, 2024, the commissioner shall seek federal approval for the 1915(c)
home and community-based waivers in this section, as authorized under section 1915(c) of
the federal Social Security Act, to implement an individual resource allocation methodology.
deleted text end

Sec. 16.

Minnesota Statutes 2024, section 256B.49, subdivision 11, is amended to read:

Subd. 11.

Authority.

(a) The commissioner is authorized to apply for home and
community-based service waivers, as authorized under section 1915(c) of the federal Social
Security Act to serve persons under the age of 65 who are determined to require the level
of care provided in a nursing home and persons who require the level of care provided in a
hospital. The commissioner shall apply for the home and community-based waivers in order
to:

(1) promote the support of persons with disabilities in the most integrated settings;

(2) expand the availability of services for persons who are eligible for medical assistance;

(3) promote cost-effective options to institutional care; and

(4) obtain federal financial participation.

(b) The provision of waiver services to medical assistance recipients with disabilities
shall comply with the requirements outlined in the federally approved applications for home
and community-based services and subsequent amendments, including provision of services
according to a service plan designed to meet the needs of the individual. For purposes of
this section, the approved home and community-based application is considered the necessary
federal requirement.

(c) The commissioner shall provide interested persons serving on agency advisory
committees, task forces, the Centers for Independent Living, and others who request to be
on a list to receive, notice of, and an opportunity to comment on, at least 30 days before
any effective dates, (1) any substantive changes to the state's disability services program
manual, or (2) changes or amendments to the federally approved applications for home and
community-based waivers, prior to their submission to the federal Centers for Medicare
and Medicaid Services.

(d) The commissioner shall seek approval, as authorized under section 1915(c) of the
federal Social Security Act, to allow medical assistance eligibility under this section for
children under age 21 without deeming of parental income or assets.

(e) The commissioner shall seek approval, as authorized under section 1915(c) of the
Social Act, to allow medical assistance eligibility under this section for individuals under
age 65 without deeming the spouse's income or assets.

(f) The commissioner shall comply with the requirements in the federally approved
transition plan for the home and community-based services waivers authorized under this
section.

deleted text begin (g) The commissioner shall seek federal approval to allow for the reconfiguration of the
1915(c) home and community-based waivers in this section, as authorized under section
1915(c) of the federal Social Security Act, to implement a two-waiver program structure.
deleted text end

deleted text begin (h) The commissioner shall seek federal approval for the 1915(c) home and
community-based waivers in this section, as authorized under section 1915(c) of the federal
Social Security Act, to implement an individual resource allocation methodology.
deleted text end

Sec. 17.

Minnesota Statutes 2025 Supplement, section 256B.49, subdivision 17a, is
amended to read:

Subd. 17a.

Service authorizations and service agreements.

(a) Recipients must be
screened and authorized for services according to the federally approved waiver application
and its subsequent amendments.

(b) The commissioner must require lead agency supervisors to review and accept all
service agreements entered by lead agency staff into the Medicaid management information
system (MMIS) prior to the commissioner's approval of the service agreement.

(c) For a service agreement with a proposed total authorized amount that exceeds the
total authorized amount in the recipient's prior service agreement by more than the value
of legislatively enacted rate increases, the commissioner must manually review and manually
approve the service agreement in the MMIS. For purposes of this paragraph, "prior service
agreement" means the service agreement that was in effect 12 months prior to the start date
of the new proposed service agreement.

(d) In a format prescribed by the commissioner, lead agencies must submit the following
information for all service agreements subject to the commissioner's approval in paragraph
(c):

(1) changes in the number of units authorized;

(2) new services authorized;

(3) changes in the values used to calculate service rates under section 256B.4914, except
for automatic adjustments required under section 256B.4914, subdivisions 5 and 5b;

(4) changes in the person's level of need that require an increase in the amount of services
authorized;

(5) documentation detailing why the previous amount of services is not sufficient to
meet the person's needs; and

(6) anticipated impact if the total service amount is not increased to the proposed amount.

(e) Except for rate increases required under section 256B.4914, subdivisions 5 and 5b,
and rate changes authorized by the 2025 legislature, the commissioner must not approve
service agreements under paragraph (c) that are not the result of either a documented change
in a person's assessed needs or documented evidence that the previous level of service was
insufficient to meet the person's assessed needs.

deleted text begin (f) This subdivision expires upon full implementation of waiver reimagine. The
commissioner must inform the revisor of statutes when waiver reimagine is fully
implemented.
deleted text end

Sec. 18.

Minnesota Statutes 2025 Supplement, section 256B.4914, subdivision 8, is
amended to read:

Subd. 8.

Unit-based services with programming; component values and calculation
of payment rates.

(a) For the purpose of this section, unit-based services with programming
include employment exploration services, employment development services, employment
support services, individualized home supports with family training, individualized home
supports with training, and positive support services provided to an individual outside of
any service plan for a day program or residential support service.

(b) Component values for unit-based services with programming are:

(1) competitive workforce factor: 6.7 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) program plan support ratio: 15.5 percent;

(6) client programming and support ratio: 4.7 percent, updated as specified in subdivision
5b;

(7) general administrative support ratio: 13.25 percent;

(8) program-related expense ratio: 6.1 percent; and

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

(c) A unit of service for unit-based services with programming is 15 minutes.

(d) Payments for unit-based services with programming must be calculated as follows,
unless the services are reimbursed separately as part of a residential support services or day
program payment rate:

(1) determine the number of units of service to meet a recipient'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 customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (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 program plan support, multiply the result of clause (7) by one plus the program
plan support ratio;

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

(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and support ratio;

(11) this is the subtotal rate;

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

(13) divide the result of clause (11) by one minus the result of clause (12). This is the
total payment amount;

(14) for services provided in a shared manner, divide the total payment in clause (13)
as follows:

(i) for employment exploration services, divide by the number of service recipients, not
to exceed five;

(ii) for employment support services, divide by the number of service recipients, not to
exceed six;

(iii) for individualized home supports with training and individualized home supports
with family training, divide by the number of service recipients, not to exceed three; and

(iv) for night supervision, divide by the number of service recipients, not to exceed two;
and

(15) adjust the result of clause (14) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services.

(e) Effective January 1, 2026, or upon federal approval, whichever is later, a provider
must not bill more than three consecutive hours and not more than six total hours per day
for individualized home supports with training and individualized home supports with family
training. This daily limit does not limit a person's use of other disability waiver services,
including individualized home supports, which may be provided on the same day by the
same provider providing individualized home supports with training or individualized home
supports with family training. new text begin This paragraph expires upon the effective date of paragraph
(f).
new text end

new text begin (f) Effective January 1, 2027, or upon federal approval, whichever is later, except as
provided in paragraph (g), a provider must not bill more than:
new text end

new text begin (1) for individualized home supports with training, a monthly unit of service determined
by multiplying 24 units by the total number of days in the month during which service was
provided; and
new text end

new text begin (2) for individualized home supports with family training, not more than six total hours
per day.
new text end

new text begin (g) The daily limits specified in paragraph (f) do not:
new text end

new text begin (1) limit a person's use of other disability waiver services, including individualized home
supports, which may be provided on the same day by the same provider providing
individualized home supports with training or individualized home supports with family
training; or
new text end

new text begin (2) apply to individuals who are assessed under section 256B.0911 to need a 24-hour
plan of care.
new text end

Sec. 19.

Minnesota Statutes 2024, section 256S.205, subdivision 1, is amended to read:

Subdivision 1.

Definitions.

(a) For the purposes of this section, the terms in this
subdivision have the meanings given.

(b) "Application year" means a year in which a facility submits an application for
designation as a disproportionate share facility.

(c) "Customized living resident" means a resident of a facility who is receiving either
24-hour customized living services or customized living services authorized under the
elderly waiver, the brain injury waiver, or the community access for disability inclusion
waiver. new text begin Effective August 31, 2025, a resident who experiences an interruption to waiver
benefits resulting from a temporary absence from the facility is a customized living resident
during the period of the temporary absence for purposes of this section.
new text end

(d) "Disproportionate share facility" means a facility designated by the commissioner
under subdivision 4.

(e) "Facility" means either an assisted living facility licensed under chapter 144G or a
setting that is exempt from assisted living licensure under section 144G.08, subdivision 7,
clauses (10) to (13).

(f) "Rate year" means January 1 to December 31 of the year following an application
year.

new text begin (g) "Residing in the facility" means that the facility is the resident's fixed permanent
home and the place to which the resident intends to return following a temporary absence.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective retroactively from August 1, 2025.
new text end

Sec. 20.

Minnesota Statutes 2025 Supplement, section 256S.205, subdivision 2, is amended
to read:

Subd. 2.

Rate adjustment application.

(a) Effective through September 30, 2023, a
facility may apply to the commissioner for an initial designation as a disproportionate share
facility. Applications must be submitted annually between September 1 and September 30.
The applying facility must apply in a manner determined by the commissioner. The applying
facility must document each of the following on the application:

(1) the number of customized living residents new text begin residing new text end in the facility on September 1 of
the application year, broken out by specific waiver program; and

(2) the total number of people residing in the facility on September 1 of the application
year.

(b) Effective October 1, 2023, the commissioner must not process any new initial
applications for disproportionate share facilities.

(c) A facility that received rate floor payments in rate year 2024 may submit an annual
application under this subdivision to maintain its designation as a disproportionate share
facility.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective retroactively from August 1, 2025.
new text end

Sec. 21.

Laws 2023, chapter 61, article 1, section 61, subdivision 4, as amended by Laws
2025, First Special Session chapter 9, article 2, section 57, is amended to read:

Subd. 4.

Evaluation and report.

By December 1, 2024, the commissioner must submit
to the chairs and ranking minority members of the legislative committees with jurisdiction
over human services finance and policy an interim report on the impact and outcomes of
the grants, including the number of grants awarded and the organizations receiving the
grants. The interim report must include any available evidence of how grantees were able
to increase utilization of supported decision making and reduce or avoid more restrictive
forms of decision making such as guardianship and conservatorship. By December 1, 2026,
the commissioner must submit to the chairs and ranking minority members of the legislative
committees with jurisdiction over human services finance and policy a deleted text begin final deleted text end new text begin second interim new text end
report on the impact and outcomes of the grants, including any updated information from
the interim report and the total number of people served by the grants. The deleted text begin final deleted text end new text begin second
interim new text end report must also detail how the money was used to achieve the requirements in
subdivision 3, paragraph (b). new text begin By December 1, 2028, the commissioner must submit to the
chairs and ranking minority members of the legislative committees with jurisdiction over
human services finance and policy a final report on the impact and outcomes of the grants,
including any updated information from the interim reports and the total number of people
served by the grants.
new text end

Sec. 22.

Laws 2025, First Special Session chapter 9, article 2, section 58, subdivision 9,
is amended to read:

Subd. 9.

Savings determinations.

(a) When preparing the forecast for state revenue and
expenditures under Minnesota Statutes, section 16A.103, the commissioner of management
and budget must assume deleted text begin the following reductions of deleted text end new text begin a reduction of $62,601,000 in new text end human
services general fund spending for the biennium beginning July 1, 2027, until the end of
the legislative session that enacts a budget for the commissioner of human services for the
biennium beginning July 1, 2027 deleted text begin :
deleted text end

deleted text begin (1) if a bond appropriation for the replacement of the Miller Building on the Anoka
Metro Regional Treatment Center Campus is enacted during a 2025 special session,
$177,542,000; or
deleted text end

deleted text begin (2) if a bond appropriation for the replacement of the Miller Building on the Anoka
Metro Regional Treatment Center Campus is not enacted during a 2025 special session,
$143,542,000 deleted text end .

(b) Upon enactment of a budget for the commissioner of human services for the biennium
beginning July 1, 2027, the legislature must identify enacted provisions that were
recommended by the advisory council under subdivision 7.

(c) To the extent the net savings attributable to the provisions identified by the legislature
under paragraph (b) for the biennium beginning July 1, 2027, are less than the assumed
savings in paragraph (a), the commissioner of human services must implement the contingent
spending reductions described in subdivision 10, beginning July 1, 2027, or upon federal
approval, whichever is later.

Sec. 23. new text begin WAIVER CASE MANAGEMENT QUALITY WORKING GROUP.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The commissioner of human services must convene a
waiver case management quality working group to develop recommendations related to
county provision of home and community-based waiver case management services without
the use of contractors.
new text end

new text begin Subd. 2. new text end

new text begin Membership. new text end

new text begin At a minimum, the working group must include the following
members:
new text end

new text begin (1) two individuals receiving waiver services or family members of or advocates for
individuals receiving waiver services, appointed by the commissioner, in consultation with
organizations representing individuals with lived experience of disability and waiver services;
new text end

new text begin (2) three county representatives, appointed by the Minnesota Association of County
Social Service Administrators;
new text end

new text begin (3) at least three representatives of contracted case management agencies, appointed by
the Minnesota Social Service Association, including:
new text end

new text begin (i) at least one representative of a contracted case management agency located in a
metropolitan county, as defined in Minnesota Statutes, section 473.121, subdivision 4; and
new text end

new text begin (ii) at least two representatives of contracted case management agencies located outside
of a metropolitan county;
new text end

new text begin (4) one staff member from the Minnesota Social Service Association, appointed by the
Minnesota Social Service Association;
new text end

new text begin (5) one member of a Tribal Nation, appointed by the commissioner;
new text end

new text begin (6) two representatives of disability advocacy organizations, appointed by the
commissioner; and
new text end

new text begin (7) additional nonvoting participants as determined by the commissioner, which may
include staff from the Department of Human Services and other interested parties.
new text end

new text begin Subd. 3. new text end

new text begin Duties. new text end

new text begin (a) The working group must make recommendations to ensure that
clients are receiving high-quality case management services. The working group must
consider the following proposals:
new text end

new text begin (1) requiring written documentation of visits with clients in order to receive payment;
new text end

new text begin (2) requiring initial and annual case management training conducted by the Department
of Human Services, with input from the counties related to core competencies and the
training curriculum;
new text end

new text begin (3) requiring a county to accept a client transfer and continue services at the level provided
by the previous county without the client reapplying for services;
new text end

new text begin (4) prohibiting a county from arbitrarily reducing the level and type of services a client
receives;
new text end

new text begin (5) requiring case management service providers to submit to a yearly financial audit
and random inspections of files and documentation;
new text end

new text begin (6) requiring counties that contract for case management services to utilize a competitive
process for the procurement of contracted case management services at least once every
three years;
new text end

new text begin (7) requiring case management service providers to implement a grievance process for
clients that must document all complaints and responses to and resolutions of complaints;
and
new text end

new text begin (8) requiring contracted case management service providers to annually report to the
county the provider's case load numbers and staff turnover rate.
new text end

new text begin (b) The working group must make recommendations to transition from a contract-based
case management services system to a system in which counties provide case management
services without contracting for those services. The recommendations must include but are
not limited to:
new text end

new text begin (1) ways to reduce complaints and improve quality of waiver case management services;
new text end

new text begin (2) an evaluation of the impact of current funding levels, administrative structures, and
workforce capacity on case management service delivery;
new text end

new text begin (3) an examination of alternative accountability and oversight models that protect access,
provider flexibility, and case management service quality;
new text end

new text begin (4) creation of a variance process, including county oversight and contractor site visits,
to allow a county to continue to use contracted case management services; and
new text end

new text begin (5) legislative or administrative changes to strengthen the waiver case management
services system.
new text end

new text begin Subd. 4. new text end

new text begin Compensation; expenses. new text end

new text begin Members of the working group may receive
compensation and expense reimbursement as provided in Minnesota Statutes, section 15.059,
subdivision 3.
new text end

new text begin Subd. 5. new text end

new text begin Meetings; administrative support. new text end

new text begin (a) The first meeting of the working group
must be convened no later than August 1, 2026. The working group must meet at least
monthly. Meetings are subject to Minnesota Statutes, chapter 13D. The working group may
meet by telephone or interactive technology consistent with Minnesota Statutes, section
13D.015.
new text end

new text begin (b) The Department of Human Services shall provide staff and administrative support
to convene the working group, facilitate working group meetings, and prepare the final
report.
new text end

new text begin Subd. 6. new text end

new text begin Report. new text end

new text begin By September 1, 2027, the commissioner shall submit a report of the
working group's findings and recommendations, including any legislative language necessary
to implement the recommendations, to the chairs and ranking minority members of the
legislative committees with jurisdiction over human services policy and finance.
new text end

new text begin Subd. 7. new text end

new text begin Expiration. new text end

new text begin The working group expires upon submission of the report required
under subdivision 6.
new text end

Sec. 24. new text begin DIRECTION TO COMMISSIONER; CASE MANAGEMENT AND HOME
AND COMMUNITY-BASED SERVICES RATES STUDY.
new text end

new text begin (a) The commissioner of human services shall analyze the current rate-setting
methodology for all case management and medical assistance home and community-based
services waivers and make recommendations to improve rate-setting methodologies to more
accurately reflect service costs. By January 1, 2027, the commissioner shall issue a request
for proposals to analyze the rate frameworks and current rate-setting practices. The
commissioner must consult with lead agencies and providers across the spectrum of services
and regions of the state and with culturally responsive providers when developing the request
for proposals and for the duration of the contract.
new text end

new text begin (b) By January 15, 2028, the commissioner must submit to the chairs and ranking minority
members of the legislative committees with jurisdiction over human services policy and
finance a report on the initial results of the analysis required under this section. By January
15, 2029, the commissioner must submit to the chairs and ranking minority members of the
legislative committees with jurisdiction over human services policy and finance a final
report that includes legislative language necessary to modify existing or implement new
rate methodologies and a detailed fiscal analysis.
new text end

Sec. 25. new text begin DIRECTION TO COMMISSIONER; ASSESSMENT OF
ADMINISTRATIVE ROLES.
new text end

new text begin (a) The commissioner of human services, in consultation with Tribal Nations and counties,
must conduct a study to assess and recommend improvements to the roles and responsibilities
of the state agency, counties, and Tribal Nations in administering human services programs.
new text end

new text begin (b) The study must include a comprehensive review of programs administered by the
department, including but not limited to medical assistance, MinnesotaCare, behavioral
health services, long-term services and supports, housing and homelessness programs,
Minnesota supplemental aid, general assistance, and licensing and oversight functions.
new text end

new text begin (c) The study must evaluate the:
new text end

new text begin (1) current roles and responsibilities held by the state agency, counties, and Tribal Nations
in administering human services programs, including but not limited to the challenges and
benefits of the current delegation of roles and responsibilities;
new text end

new text begin (2) lived experience of people accessing human services programs related to the
delegation of administrative duties;
new text end

new text begin (3) financing of human services program administration across the state agency, counties,
and Tribal Nations; and
new text end

new text begin (4) administration of human services programs in other states, focusing on the roles and
responsibilities of the local governments versus the state Medicaid or human services agency,
and identifying the benefits, challenges, and financing of the delegation of duties.
new text end

new text begin (d) The study must focus on the goals of transforming the human services system to
ensure a transparent, accessible, accountable, equitable, and effective human services system.
new text end

new text begin (e) The study must provide recommendations for the optimal delegation of duties between
the state agency, counties, and Tribal Nations in the delivery of human services.
Recommendations must include:
new text end

new text begin (1) how the delegation of duties will improve the experience of people accessing human
services;
new text end

new text begin (2) implementation and timing considerations to ensure continuity of services;
new text end

new text begin (3) systems technology adaptations required;
new text end

new text begin (4) workforce considerations; and
new text end

new text begin (5) financing strategies and the estimated fiscal impact to the state budget.
new text end

new text begin (f) By October 1, 2028, the commissioner must submit a report on the study and
recommendations to the chairs and ranking minority members of the legislative committees
with jurisdiction over health and human services policy and finance.
new text end

Sec. 26. new text begin MNCHOICES REDESIGN WORKING GROUP.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The commissioner of human services shall convene a
MnCHOICES redesign working group to develop recommendations related to state provision
of MnCHOICES assessments under Minnesota Statutes, section 256B.0911, subdivision
14, paragraph (g).
new text end

new text begin Subd. 2. new text end

new text begin Membership. new text end

new text begin At a minimum, the working group must include the following
members:
new text end

new text begin (1) two individuals receiving waiver services or the individuals' family members or
advocates, appointed by the commissioner in consultation with organizations representing
individuals with lived experience of disability and waiver services;
new text end

new text begin (2) three county representatives, appointed by the Minnesota Association of County
Social Service Administrators, including:
new text end

new text begin (i) at least one representative of a lead agency located in a metropolitan county, as defined
in Minnesota Statutes, section 473.121, subdivision 4; and
new text end

new text begin (ii) at least two representatives of lead agencies located outside of a metropolitan county,
as defined in Minnesota Statutes, section 473.121, subdivision 4;
new text end

new text begin (3) one staff member from the Minnesota Social Service Association, appointed by the
Minnesota Social Service Association;
new text end

new text begin (4) at least three representatives from Tribal Nations, appointed by the commissioner;
new text end

new text begin (5) two representatives of disability advocacy organizations, appointed by the
commissioner; and
new text end

new text begin (6) additional nonvoting participants as determined by the commissioner, which may
include staff from the Department of Human Services and other interested parties.
new text end

new text begin Subd. 3. new text end

new text begin Duties. new text end

new text begin The working group shall make recommendations to shift the
responsibility and administration of conducting MnCHOICES assessments to the state.
Recommendations must include:
new text end

new text begin (1) defined roles and responsibilities between county, Tribal Nation, and state functions;
new text end

new text begin (2) revised payment methodologies and financing of duties;
new text end

new text begin (3) efficient workflows between local and state functions;
new text end

new text begin (4) service continuity for people seeking and receiving long-term services and supports;
and
new text end

new text begin (5) methods for gathering public feedback and providing public awareness.
new text end

new text begin Subd. 4. new text end

new text begin Terms, compensation, and removal. new text end

new text begin The terms, compensation, and removal
of the working group members are governed by Minnesota Statutes, section 15.059.
new text end

new text begin Subd. 5. new text end

new text begin Meetings; administrative support. new text end

new text begin (a) The first meeting of the working group
must be convened no later than August 1, 2026. The working group must meet at least
monthly. The working group may meet by telephone or interactive technology consistent
with Minnesota Statutes, section 13D.015.
new text end

new text begin (b) The Department of Human Services shall provide staff and administrative support
to convene the working group, facilitate working group meetings, and prepare the final
report.
new text end

new text begin Subd. 6. new text end

new text begin Report. new text end

new text begin By September 1, 2027, the commissioner must submit a report of the
working group's findings and recommendations, including but not limited to any legislative
changes necessary to implement the recommendations, to the chairs and ranking minority
members of the legislative committees with jurisdiction over human services policy and
finance.
new text end

new text begin Subd. 7. new text end

new text begin Expiration. new text end

new text begin The working group expires upon submission of the report required
under subdivision 6.
new text end

Sec. 27. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES;
IMPLEMENTATION OF NEW NURSING FACILITY LEVEL OF CARE CRITERIA.
new text end

new text begin For existing brain injury and community access for disability inclusion waiver
participants, the effective date of the termination of waiver services based on Minnesota
Statutes, section 144.0724, subdivision 11a, must be at least 90 days after the date of the
reassessment that results in a determination that the individual no longer meets the level of
care criteria.
new text end

Sec. 28. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; INCREASE
TIERED RATES FOR FAMILY RESIDENTIAL AND LIFE SHARING SERVICES.
new text end

new text begin Effective January 1, 2027, or upon federal approval, whichever is later, the commissioner
of human services must increase payment rates for family residential services previously
established under Minnesota Statutes, section 256B.4914, subdivision 19, and amended
under Laws 2025, First Special Session chapter 9, article 2, section 68, as follows:
new text end

new text begin (1) for tier 4 and tier 5, by ten percent; and
new text end

new text begin (2) for tier 6, by 20 percent.
new text end

new text begin Rates for life sharing services must be ten percent higher than the corresponding family
residential services rate established under this section.
new text end

Sec. 29. new text begin REPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2024, section 256B.0921, new text end new text begin is repealed
new text end

new text begin (b) new text end new text begin Minnesota Statutes 2025 Supplement, sections 256B.4907, subdivisions 1, 2, 3, 4,
5, and 6; and 256S.205, subdivision 7, new text end new text begin are repealed.
new text end

new text begin (c) new text end new text begin Laws 2019, First Special Session chapter 9, article 5, section 86, as amended by
Laws 2020, First Special Session chapter 2, article 3, section 2; and Laws 2021, First Special
Session chapter 7, article 13, sections 73, as amended by Laws 2025, First Special Session
chapter 9, article 2, section 56; and 75, subdivision 1, as amended by Laws 2024, chapter
108, article 1, section 28, new text end new text begin are repealed.
new text end

ARTICLE 3

BEHAVIORAL HEALTH

Section 1.

Minnesota Statutes 2024, section 254A.03, subdivision 2, is amended to read:

Subd. 2.

American Indian programs.

There is hereby created a section of American
Indian programs, within the Alcohol and Drug Abuse Section of the Department of Human
Services, to be headed by a special assistant for American Indian programs on substance
misuse and substance use disorder and two assistants to that position. The section shall be
staffed with all personnel necessary to fully administer programming for substance misuse
and substance use disorder services for American Indians in the state. The special assistant
position shall be filled by a person with considerable practical experience in and
understanding of substance misuse and substance use disorder in the American Indian
community, who shall be responsible to the director of the Alcohol and Drug Abuse Section
created in subdivision 1 and shall be in the unclassified service. The special assistant shall
meet and consult with the American Indian Advisory Council as described in section
254A.035 and serve as a liaison to the Minnesota Indian Affairs Council and tribes to report
on the status of substance misuse and substance use disorder among American Indians in
the state of Minnesota. The special assistant with the approval of the director shall:

(1) administer new text begin direct payments using new text end funds appropriated for American Indian groups,
organizations and reservations within the state for American Indian substance misuse and
substance use disorder programs;

(2) establish policies and procedures for such American Indian programs with the
assistance of the American Indian Advisory Board; and

(3) hire and supervise staff to assist in the administration of the American Indian program
section within the Alcohol and Drug Abuse Section of the Department of Human Services.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2027.
new text end

Sec. 2.

Minnesota Statutes 2025 Supplement, section 254B.02, subdivision 5, is amended
to read:

Subd. 5.

Tribal allocation.

The commissioner may make new text begin direct new text end payments to Tribal
Nation servicing agencies from money allocated under this section to support individuals
with substance use disorders and determine eligibility for behavioral health fund payments.
The payment must not be less than 133 percent of the Tribal Nations payment for the fiscal
year ending June 30, 2009, adjusted in proportion to the statewide change in the appropriation
for this chapter.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2027.
new text end

Sec. 3.

Minnesota Statutes 2025 Supplement, section 254B.03, subdivision 4, is amended
to read:

Subd. 4.

Division of costs.

(a) Except for services provided by a county under section
254B.09, subdivision 1, or services provided under section 256B.69, the county shall, out
of local money, pay the state for 22.95 percent of the cost of substance use disorder services,
except for those services provided to persons enrolled in medical assistance under chapter
256B and room and board services under section 254B.0505, subdivision 1. Counties may
use the indigent hospitalization levy for treatment and hospital payments made under this
section.

(b) 22.95 percent of any state collections from private or third-party pay, less 15 percent
for the cost of payment and collections, must be distributed to the county that paid for a
portion of the treatment under this section.

new text begin (c) Notwithstanding paragraphs (a) and (b), a county that is classified as economically
distressed is not responsible for the county share of the cost of substance use disorder
services. The commissioner must classify a county as economically distressed if:
new text end

new text begin (1) more than 15 percent of the county's population is living in poverty, according to
the most recent data published by the United States Census Bureau; and
new text end

new text begin (2) more than 70 percent of the total acreage in the county is exempt from property
taxation under chapter 272.
new text end

new text begin The commissioner must not require any other county to pay to the state any portion of the
cost of substance use disorder services subject to the exception under this paragraph.
new text end

Sec. 4.

Minnesota Statutes 2025 Supplement, section 254B.0503, subdivision 1, is amended
to read:

Subdivision 1.

Eligible vendor requirements.

(a) Vendors of room and board are
eligible for behavioral health fund payment if the vendor:

(1) has rules prohibiting residents bringing chemicals into the facility or using chemicals
while residing in the facility and provide consequences for infractions of those rules;

(2) is determined to meet applicable health and safety requirements;

(3) is not a jail or prison;

(4) is not concurrently receiving funds under chapter 256I for the recipient;

(5) admits individuals who are 18 years of age or older;

(6) is registered as a board and lodging or lodging establishment according to section
157.17;

(7) has awake staff on site whenever a client is present;

(8) has staff who are at least 18 years of age and meet the requirements of section
245G.11, subdivision 1, paragraph (b);

(9) has emergency behavioral procedures that meet the requirements of section 245G.16;

(10) meets the requirements of section 245G.08, subdivision 5, if administering
medications to clients;

(11) meets the abuse prevention requirements of section 245A.65, including a policy on
fraternization and the mandatory reporting requirements of section 626.557;

(12) documents coordination with the treatment provider to ensure compliance with
section 254B.03, subdivision 2;

(13) protects client funds and ensures freedom from exploitation by meeting the
provisions of section 245A.04, subdivision 13;

(14) has a grievance procedure that meets the requirements of section 245G.15,
subdivision 2; and

(15) has sleeping and bathroom facilities for men and women separated by a door that
is locked, has an alarm, or is supervised by awake staff.

(b) Programs providing children's mental health crisis admissions and stabilization under
section 245.4882, subdivision 6, are eligible vendors of room and board.

(c) Programs providing children's residential services under section 245.4882, except
services for individuals who have a placement under chapter 260C or 260D, are eligible
vendors of room and board.

(d) A vendor that is not licensed as a residential treatment program must have a policy
to address staffing coverage when a client may unexpectedly need to be present at the room
and board site.

(e) No new vendors for room and board services may be approved after June 30, 2025,
to receive payments from the behavioral health fund, under the provisions of section 254B.04,
subdivision 2a. Room and board vendors that were approved and operating prior to July 1,
2025, may continue to receive payments from the behavioral health fund for services provided
until deleted text begin June 30, 2027 deleted text end new text begin December 31, 2026 new text end . Room and board vendors providing services in
accordance with section 254B.04, subdivision 2a, will no longer be eligible to claim
reimbursement for room and board services provided on or after deleted text begin July deleted text end new text begin January new text end 1, 2027.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 5.

Minnesota Statutes 2025 Supplement, section 254B.0509, subdivision 2, is amended
to read:

Subd. 2.

Annual adjustments.

Effective January 1, 2027, and annually thereafter, the
commissioner of human services must adjust the payment rates under deleted text begin subdivision 1 deleted text end new text begin section
254B.0505, subdivision 1, clauses (1) to (9), new text end according to the change from the midpoint of
the previous rate year to the midpoint of the rate year for which the rate is being determined
using the Centers for Medicare and Medicaid Services Medicare Economic Index as
forecasted in the fourth quarter of the calendar year before the rate year. new text begin Notwithstanding
this subdivision, rates must not be adjusted lower than those established on January 1, 2026.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 6.

Minnesota Statutes 2024, section 254B.17, is amended to read:

254B.17 WITHDRAWAL MANAGEMENT START-UP AND
CAPACITY-BUILDING GRANTS.

The commissioner must establish start-up and capacity-building grants for prospective deleted text begin
or deleted text end new text begin , new text end new new text begin , or existing substance use disorder treatment or new text end withdrawal management programs
deleted text begin licensed under chapter deleted text end deleted text begin 245F deleted text end that will meet new text begin ASAM criteria for new text end medically deleted text begin monitored deleted text end new text begin managed new text end
or clinically monitored levels of care new text begin by integrating withdrawal management services into
outpatient, intensive outpatient, or residential treatment services. Grants must be used to
measurably increase the client capacity or expand available services. Grants must align
services with ASAM criteria. Grants may be used to add medications for opioid use disorder
to services new text end . Grants may be used for new text begin capacity-building new text end expenses that are not reimbursable
under Minnesota health care programs, including but not limited to:

(1) costs associated with hiring staff new text begin or contracting with medical services providers new text end ;

(2) costs associated with staff retention;

(3) the purchase of office equipment and supplies;

(4) the purchase of software;

(5) costs associated with obtaining applicable and required licenses;

(6) business formation costs;

(7) costs associated with staff training; deleted text begin and
deleted text end

(8) the purchase of medical equipment and supplies necessary to meet health and safety
requirements new text begin ;
new text end

new text begin (9) costs associated with adding or improving physical space;
new text end

new text begin (10) start-up costs associated with adding a new location; and
new text end

new text begin (11) costs associated with becoming ASAM certified for medically managed levels of
care new text end .

Sec. 7.

Minnesota Statutes 2024, section 256B.04, subdivision 23, is amended to read:

Subd. 23.

Medical assistance costs for certain inmates.

new text begin (a) new text end The commissioner shall
execute an interagency agreement with the commissioner of corrections to recover the state
cost attributable to medical assistance eligibility for inmates of public institutions admitted
to a medical institution on an inpatient basis. The annual amount to be transferred from the
Department of Corrections under the agreement must include all eligible state medical
assistance costs, including administrative costs incurred by the Department of Human
Services, attributable to inmates under state and county jurisdiction admitted to medical
institutions on an inpatient basis that are related to the implementation of section 256B.055,
subdivision 14, paragraph (c). new text begin This paragraph expires upon the effective date of paragraph
(b).
new text end

new text begin (b) Effective January 1, 2028, or upon federal approval, whichever is later, the
commissioner shall execute an interagency agreement with the commissioner of corrections
to recover the state cost attributable to medical assistance eligibility for inmates of public
institutions admitted to a medical institution on an inpatient basis. The annual amount to
be transferred from the Department of Corrections under the agreement must include all
eligible state medical assistance costs, including administrative costs incurred by the
Department of Human Services, attributable to inmates under state and county jurisdiction
admitted to medical institutions on an inpatient basis that are related to the implementation
of section 256B.0618, paragraph (b).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 8.

new text begin [256B.0618] COVERAGE FOR DETAINED INDIVIDUALS.
new text end

new text begin (a) An inmate of a correctional facility who is conditionally released under section
241.26, 244.065, or 631.425 is eligible for medical assistance if the individual:
new text end

new text begin (1) does not require the security of a public detention facility and is housed:
new text end

new text begin (i) in a halfway house or community correction center; or
new text end

new text begin (ii) under house arrest and monitored by electronic surveillance in a residence approved
by the commissioner of corrections; and
new text end

new text begin (2) meets all other eligibility requirements of this chapter.
new text end

new text begin (b) An individual, regardless of age, who is considered an inmate of a public institution
as defined in Code of Federal Regulations, title 42, section 435.1010, and who meets the
eligibility requirements in section 256B.056 is not eligible for medical assistance, except
for covered medical assistance services received:
new text end

new text begin (1) while an inpatient in a medical institution as defined in Code of Federal Regulations,
title 42, section 435.1010;
new text end

new text begin (2) by an eligible juvenile in accordance with the Consolidated Appropriations Act,
2023, Public Law 117-328, part 5121; or
new text end

new text begin (3) by an eligible individual under section 256B.0761.
new text end

new text begin (c) Security logistics and costs related to the inpatient treatment of an inmate are the
responsibility of the entity with jurisdiction over the inmate.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2028.
new text end

Sec. 9.

new text begin [256B.0619] CARCERAL TARGETED CASE MANAGEMENT SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Generally. new text end

new text begin Effective January 1, 2028, or upon federal approval, whichever
is later, medical assistance covers carceral targeted case management services in accordance
with section 256B.0761 and United States Code, title 42, sections 1396a(a)(84); 1396d(a)(32);
1397bb(d); and 1397jj(b)(2) and (7).
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have the
meanings given.
new text end

new text begin (b) "Comprehensive care plan" means a person-centered plan that includes goals, tasks,
and services identified through screening and assessments and agreed upon by all parties.
Comprehensive care plan includes but is not limited to identifying resources and services
necessary to meet the individual's physical, behavioral health, and health-related social
needs prerelease and postrelease.
new text end

new text begin (c) "Consultation" means communication from a carceral targeted case manager to other
providers working with the same individual to inform, inquire, and instruct regarding the
individual's symptoms, strategies for effective engagement, care and intervention needs,
and treatment expectations across service settings, including but not limited to the education
services, social services, probation, home, primary care, medication prescribers, disabilities
services, and other mental health providers and to direct and coordinate clinical service
components provided to the justice-involved individual.
new text end

new text begin (d) "Targeted case management for justice-involved individuals" means the provision
of both county targeted case management and public or private vendor service coordination
services for the purpose of bridging prerelease and postrelease medical assistance services
to support the physical, behavioral health, and health-related social needs of justice-involved
individuals.
new text end

new text begin (e) "Targeted case management services" means services that assist medical assistance
eligible persons to gain access to needed medical, social, educational, and other services.
new text end

new text begin Subd. 3. new text end

new text begin Eligibility. new text end

new text begin The following individuals are eligible for carceral targeted case
management services:
new text end

new text begin (1) individuals eligible for medical assistance who meet all eligibility requirements under
United States Code, title 42, section 1396a(nn);
new text end

new text begin (2) individuals eligible for medical assistance who meet eligibility requirements for the
Children's Health Insurance Program under United States Code, title 42, section 1397jj(b)(7);
or
new text end

new text begin (3) individuals eligible for medical assistance who are currently incarcerated at a section
1115 reentry demonstration pilot facility and meet the participation requirements in section
256B.0761, subdivision 2.
new text end

new text begin Subd. 4. new text end

new text begin Carceral targeted case management services. new text end

new text begin (a) For individuals eligible for
services under subdivision 3, clause (1) or (2), carceral targeted case management care
coordination is available for 30 days before release and up to 180 days postrelease. For
individuals eligible for services under subdivision 3, clause (3), carceral targeted case
management care coordination is available for up to 90 days before release and up to 180
days postrelease.
new text end

new text begin (b) Carceral targeted case management care coordination includes:
new text end

new text begin (1) comprehensive assessment and periodic reassessment addressing physical, behavioral,
and health-related social needs in accordance with section 256B.0761 and United States
Code, title 42, sections 1396a(nn) and 1397jj(b)(7);
new text end

new text begin (2) comprehensive care plans, including but not limited to:
new text end

new text begin (i) the desired goals of the individual;
new text end

new text begin (ii) the individual's preferences for services and supports;
new text end

new text begin (iii) formal and informal services and supports based on areas of assessment, such as
social health, mental health, residence, family, education and vocation, safety, legal,
self-determination, financial, and chemical health; and
new text end

new text begin (iv) housing arrangements postrelease;
new text end

new text begin (3) regular review and revision of the comprehensive care plan with the individual to
ensure needs are adequately met by referrals and supports;
new text end

new text begin (4) coordination of referrals, which must contain more than just a list of resources, to
bridge prerelease to postrelease medical assistance services, including but not limited to
referrals to community-based services identified as a need on the comprehensive care plan;
new text end

new text begin (5) warm handoffs and follow-up post release through direct coordination between
providers, including timely communication, active engagement of the individual when
feasible, and facilitation of continuity of care upon release;
new text end

new text begin (6) monitoring and evaluation of services identified in the comprehensive care plan to
ensure personal outcomes are met and to ensure satisfaction with services and service
delivery;
new text end

new text begin (7) consultation with other professionals, including but not limited to community-based
mental health providers; and
new text end

new text begin (8) completion and maintenance of necessary documentation that supports and verifies
the activities in this section.
new text end

new text begin Subd. 5. new text end

new text begin Carceral targeted case management provider standards. new text end

new text begin Providers eligible
to receive medical assistance reimbursement under this section must enroll as a Minnesota
Health Care Programs provider. To qualify as a provider of carceral targeted case
management services, a provider must:
new text end

new text begin (1) have a minimum of a bachelor's degree or a license in a health or human services
field, comparable training and two years of experience in human services, or credentials
from an American Indian Tribe under section 256B.02, subdivision 7;
new text end

new text begin (2) demonstrate the capacity and experience to provide targeted case management
activities for justice-involved individuals as defined in subdivision 2;
new text end

new text begin (3) be able to coordinate and connect community resources needed by the recipient;
new text end

new text begin (4) demonstrate administrative capacity and experience to serve the justice-involved
population for which the provider will provide services and ensure quality of services under
state and federal requirements;
new text end

new text begin (5) have a financial management system that provides accurate documentation of services
and costs under state and federal requirements;
new text end

new text begin (6) demonstrate capacity to document and maintain individual case records under state
and federal requirements;
new text end

new text begin (7) demonstrate the capacity to coordinate with county administrative functions;
new text end

new text begin (8) be able to coordinate with health care providers to ensure access to necessary health
care services;
new text end

new text begin (9) have a procedure that (i) notifies the recipient of any conflict of interest if the targeted
case management service provider also provides the recipient's services and supports, (ii)
provides information on all potential conflicts of interest, (iii) obtains the recipient's informed
consent, and (iv) provides the recipient with alternatives; and
new text end

new text begin (10) demonstrate the capacity to achieve the following performance outcomes: (i) access;
(ii) quality; and (iii) consumer satisfaction.
new text end

new text begin Subd. 6. new text end

new text begin Medical assistance payment and rate setting. new text end

new text begin (a) Carceral targeted case
management rates are equal to rates authorized by the commissioner for relocation targeted
case management under section 256B.0621, subdivision 10.
new text end

new text begin (b) The carceral targeted case management rate only includes eligible services delivered
to an eligible recipient by an eligible provider.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 10.

Minnesota Statutes 2024, section 256B.0625, is amended by adding a subdivision
to read:

new text begin Subd. 77. new text end

new text begin Carceral targeted case management. new text end

new text begin Effective January 1, 2028, or upon
federal approval, whichever is later, medical assistance covers carceral targeted case
management services under section 256B.0619.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 11.

Minnesota Statutes 2024, section 256B.0761, subdivision 2, is amended to read:

Subd. 2.

Eligible individuals.

new text begin (a) new text end Notwithstanding section 256B.055, subdivision 14,
individuals are eligible to receive services under this demonstration if they are eligible under
section 256B.055, subdivision 3a, 6, 7, 7a, 9, 15, 16, or 17, as determined by the
commissioner in collaboration with correctional facilities, local governments, and Tribal
governments. new text begin This paragraph expires upon the effective date of paragraph (b).
new text end

new text begin (b) Effective January 1, 2028, or upon federal approval, whichever is later,
notwithstanding section 256B.0618, individuals are eligible to receive services under this
demonstration if they are eligible under section 256B.055, subdivision 3a, 6, 7, 7a, 9, 15,
16, or 17, as determined by the commissioner in collaboration with correctional facilities,
local governments, and Tribal governments.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 12.

Minnesota Statutes 2025 Supplement, section 256I.04, subdivision 2a, is amended
to read:

Subd. 2a.

License required; staffing qualifications.

(a) Except as provided in paragraph
(b), an agency may not enter into an agreement with an establishment to provide housing
support unless:

(1) the establishment is licensed by the Department of Health as a hotel and restaurant;
a board and lodging establishment; a boarding care home before March 1, 1985; or a
supervised living facility, and the service provider for residents of the facility is licensed
under chapter 245A. However, an establishment licensed by the Department of Health to
provide lodging need not also be licensed to provide board if meals are being supplied to
residents under a contract with a food vendor who is licensed by the Department of Health;

(2) the residence is: (i) licensed by the commissioner of human services under Minnesota
Rules, parts 9555.5050 to 9555.6265; (ii) certified by a county human services agency prior
to July 1, 1992, using the standards under Minnesota Rules, parts 9555.5050 to 9555.6265;
(iii) licensed by the commissioner under Minnesota Rules, parts 2960.0010 to 2960.0120,
with a variance under section 245A.04, subdivision 9; or (iv) licensed under section 245D.02,
subdivision 4a, as a community residential setting by the commissioner of human services;

(3) the facility is licensed under chapter 144G and provides three meals a day; or

(4) effective deleted text begin January 1, 2027 deleted text end new text begin July 1, 2026 new text end , the establishment is licensed by the Department
of Health as a board and lodging establishment and is certified by the commissioner as a
recovery residence in accordance with section 254B.215, subdivision 3, that is subject to
the requirements of section 256I.04, subdivisions 2a to 2f. The Department of Human
Services must serve as the lead agency for agreements entered into under this clause.

(b) The requirements under paragraph (a) do not apply to establishments exempt from
state licensure because they are:

(1) located on Indian reservations and subject to tribal health and safety requirements;
or

(2) supportive housing establishments where an individual has an approved habitability
inspection and an individual lease agreement.

(c) Supportive housing establishments that serve individuals who have experienced
long-term homelessness and emergency shelters must participate in the homeless management
information system and a coordinated assessment system as defined by the commissioner.

(d) Effective July 1, 2016, an agency shall not have an agreement with a provider of
housing support unless all staff members who have direct contact with recipients:

(1) have skills and knowledge acquired through one or more of the following:

(i) a course of study in a health- or human services-related field leading to a bachelor
of arts, bachelor of science, or associate's degree;

(ii) one year of experience with the target population served;

(iii) experience as a mental health certified peer specialist according to section 256B.0615;
or

(iv) meeting the requirements for unlicensed personnel under sections 144A.43 to
144A.483;

(2) hold a current driver's license appropriate to the vehicle driven if transporting
recipients;

(3) complete training on vulnerable adults mandated reporting and child maltreatment
mandated reporting, where applicable; and

(4) complete housing support orientation training offered by the commissioner.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2026.
new text end

Sec. 13.

Minnesota Statutes 2024, section 297E.02, subdivision 3, is amended to read:

Subd. 3.

Collection; disposition.

(a) Taxes imposed by this section are due and payable
to the commissioner when the gambling tax return is required to be filed. Distributors must
file their monthly sales figures with the commissioner on a form prescribed by the
commissioner. Returns covering the taxes imposed under this section must be filed with
the commissioner on or before the 20th day of the month following the close of the previous
calendar month. The commissioner shall prescribe the content, format, and manner of returns
or other documents pursuant to section 270C.30. The proceeds, along with the revenue
received from all license fees and other fees under sections 349.11 to 349.191, 349.211,
and 349.213, must be paid to the commissioner of management and budget for deposit in
the general fund.

(b) The sales tax imposed by chapter 297A on the sale of pull-tabs and tipboards by the
distributor is imposed on the retail sales price. The retail sale of pull-tabs or tipboards by
the organization is exempt from taxes imposed by chapter 297A and is exempt from all
local taxes and license fees except a fee authorized under section 349.16, subdivision 8.

(c) One-half of one percent of the revenue deposited in the general fund under paragraph
(a), is appropriated to the commissioner of human services for the compulsive gambling
treatment program established under section 245.98. One-half of one percent of the revenue
deposited in the general fund under paragraph (a), is appropriated to the commissioner of
human services for a grant to the state affiliate recognized by the National Council on
Problem Gambling to increase public awareness of problem gambling, education and training
for individuals and organizations providing effective treatment services to problem gamblers
and their families, and research relating to problem gambling. Money appropriated by this
paragraph must supplement and must not replace existing state funding for these programs. new text begin
The balance of amounts appropriated under this paragraph that are unencumbered and
unspent at the close of a fiscal year are available in the next fiscal year for the same purposes
and shall not cancel to the fund from which appropriated.
new text end

(d) The commissioner of human services must provide to the state affiliate recognized
by the National Council on Problem Gambling a monthly statement of the amounts deposited
under paragraph (c). Beginning January 1, 2022, the commissioner of human services must
provide to the chairs and ranking minority members of the legislative committees with
jurisdiction over treatment for problem gambling and to the state affiliate recognized by the
National Council on Problem Gambling an annual reconciliation of the amounts deposited
under paragraph (c). The annual reconciliation under this paragraph must include the amount
allocated to the commissioner of human services for the compulsive gambling treatment
program established under section 245.98, and the amount allocated to the state affiliate
recognized by the National Council on Problem Gambling. new text begin The annual reconciliation must
also include any rollover amounts from the previous fiscal year and the utilization of those
amounts during the current reporting period.
new text end

Sec. 14.

Laws 2025, First Special Session chapter 9, article 4, section 2, the effective date,
is amended to read:

EFFECTIVE DATE.

This section is effective deleted text begin January deleted text end new text begin July new text end 1, deleted text begin 2027 deleted text end new text begin 2026 new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 15.

Laws 2025, First Special Session chapter 9, article 4, section 23, the effective
date, is amended to read:

EFFECTIVE DATE.

This section is effective deleted text begin January deleted text end new text begin July new text end 1, deleted text begin 2027 deleted text end new text begin 2026 new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 16.

Laws 2025, First Special Session chapter 9, article 4, section 38, the effective
date, is amended to read:

EFFECTIVE DATE.

This section is effective deleted text begin January deleted text end new text begin July new text end 1, deleted text begin 2027 deleted text end new text begin 2026 new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 17.

Laws 2025, First Special Session chapter 9, article 4, section 39, the effective
date, is amended to read:

EFFECTIVE DATE.

This section is effective deleted text begin January deleted text end new text begin July new text end 1, deleted text begin 2027 deleted text end new text begin 2026 new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 18.

Laws 2025, First Special Session chapter 9, article 4, section 40, the effective
date, is amended to read:

EFFECTIVE DATE.

This section is effective deleted text begin January deleted text end new text begin July new text end 1, deleted text begin 2027 deleted text end new text begin 2026 new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 19.

Laws 2025, First Special Session chapter 9, article 4, section 41, the effective
date, is amended to read:

EFFECTIVE DATE.

This section is effective deleted text begin January deleted text end new text begin July new text end 1, deleted text begin 2027 deleted text end new text begin 2026 new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 20.

Laws 2025, First Special Session chapter 9, article 4, section 42, the effective
date, is amended to read:

EFFECTIVE DATE.

This section is effective deleted text begin January deleted text end new text begin July new text end 1, deleted text begin 2027 deleted text end new text begin 2026 new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 21.

Laws 2025, First Special Session chapter 9, article 4, section 43, the effective
date, is amended to read:

EFFECTIVE DATE.

This section is effective deleted text begin January deleted text end new text begin July new text end 1, deleted text begin 2027 deleted text end new text begin 2026 new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 22.

Laws 2025, First Special Session chapter 9, article 4, section 44, the effective
date, is amended to read:

EFFECTIVE DATE.

This section is effective deleted text begin January deleted text end new text begin July new text end 1, deleted text begin 2027 deleted text end new text begin 2026 new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 23.

Laws 2025, First Special Session chapter 9, article 4, section 50, the effective
date, is amended to read:

EFFECTIVE DATE.

This section is effective deleted text begin January deleted text end new text begin July new text end 1, deleted text begin 2027 deleted text end new text begin 2026 new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 24. new text begin DIRECTION TO COMMISSIONER; CARCERAL TARGETED CASE
MANAGEMENT SERVICES BILLING UNITS.
new text end

new text begin The commissioner of human services must establish a new billing code for carceral
targeted case management services. The commissioner must identify reimbursement rates
for the newly defined codes, as required under Minnesota Statutes, section 256B.0619,
subdivision 6. The new billing codes must correspond to a 15-minute unit. The new billing
codes must be available for 180 days postrelease.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2028, or upon federal approval,
whichever is later.
new text end

Sec. 25. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2024, section 256B.055, subdivision 14, new text end new text begin is repealed.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2028, or upon federal approval,
whichever is later.
new text end

ARTICLE 4

LONG-TERM CARE FACILITY REGULATION

Section 1.

Minnesota Statutes 2024, section 144.1503, subdivision 7, is amended to read:

Subd. 7.

Selection process.

The commissioner shall determine a maximum award for
grants and loan forgiveness, and shall make selections based on the information provided
in the grant application, including the demonstrated need for an applicant provider to enhance
the education of its workforce, the proposed employee scholarship or loan forgiveness
selection process, the applicant's proposed budget, and other criteria as determined by the
commissioner. Notwithstanding any law or rule to the contrary, amounts appropriated for
purposes of this section do not cancel and are available until expended deleted text begin , except that at the
end of each biennium, any remaining amount that is not committed by contract and not
needed to fulfill existing commitments shall cancel to the general fund deleted text end .

Sec. 2.

Minnesota Statutes 2024, section 144A.04, is amended by adding a subdivision to
read:

new text begin Subd. 7b. new text end

new text begin Onsite registered nurse. new text end

new text begin (a) Except when waived under subdivision 7f, a
nursing home must have a registered nurse onsite 24 hours per day. The registered nurse
must be available to provide direct resident care.
new text end

new text begin (b) For any periods when the onsite registered nurse requirements in paragraph (a) are
waived under subdivision 7f, a nursing home must have a registered nurse, licensed nurse
practitioner, physician assistant, or physician available to respond immediately to telephone
calls from a nursing home.
new text end

Sec. 3.

Minnesota Statutes 2024, section 144A.04, is amended by adding a subdivision to
read:

new text begin Subd. 7c. new text end

new text begin Staffing competencies. new text end

new text begin A nursing home must ensure that all nurses have the
specific competencies and skill sets necessary to care for residents' needs, as identified
through resident assessments and described in the service plan. Providing care includes but
is not limited to assessing, evaluating, planning, and implementing resident care plans and
responding to residents' needs.
new text end

Sec. 4.

Minnesota Statutes 2024, section 144A.04, is amended by adding a subdivision to
read:

new text begin Subd. 7d. new text end

new text begin Required staff ratio. new text end

new text begin (a) The minimum staffing standard for nursing personnel
in a nursing home is as specified in this subdivision.
new text end

new text begin (b) A nursing home must provide nursing care to all residents in accordance with each
resident's service plan while also providing a minimum of 3.48 hours per resident per 24
hours for total nurse staffing, including but not limited to a minimum of 0.55 hours per
resident per 24 hours for registered nurses and a minimum of 2.45 hours per resident per
24 hours for nurse aides and licensed nurse practitioners.
new text end

new text begin (c) For purposes of this subdivision, "hours of nursing personnel" means the paid, on-duty,
productive nursing hours of all nurses and nursing assistants, calculated on the basis of any
given 24-hour period. "Productive nursing hours" means all on-duty hours during which
nurses and nursing assistants are engaged in nursing duties. Examples of nursing duties may
be found in Minnesota Rules, part 4655.6400. Not included are vacations, holidays, sick
leave, in-service classroom training, or lunches. Also not included are the nonproductive
nursing hours of the in-service training director. In homes with more than 60 licensed beds,
the hours of the director of nursing are excluded.
new text end

new text begin (d) A nursing home that is issued a notice of noncompliance under section 144A.10,
subdivision 5, for a violation of this subdivision, shall be assessed a civil fine of $300 for
each day of noncompliance, subject to section 144A.10, subdivisions 7 and 8.
new text end

Sec. 5.

Minnesota Statutes 2024, section 144A.04, is amended by adding a subdivision to
read:

new text begin Subd. 7e. new text end

new text begin Nursing supervision. new text end

new text begin (a) Except when waived under subdivision 7f, a nursing
home must designate a registered nurse to serve as a charge nurse for each shift.
new text end

new text begin (b) Except when waived under subdivision 7f, a nursing home must designate a registered
nurse to serve as the director of nursing on a full-time basis. The director of nursing may
serve as a charge nurse only when a nursing home has an average daily occupancy of 60 or
fewer residents.
new text end

Sec. 6.

Minnesota Statutes 2024, section 144A.04, is amended by adding a subdivision to
read:

new text begin Subd. 7f. new text end

new text begin Exemption process. new text end

new text begin (a) The commissioner shall establish a process for
exemption to the requirements under subdivisions 7b and 7e. A nursing home shall submit
a request for exemption under this subdivision on a form developed and in a manner
established by the commissioner. A requesting nursing home shall provide in writing to the
commissioner the following information at a minimum:
new text end

new text begin (1) the specific requirement from which exemption is sought;
new text end

new text begin (2) a detailed explanation of the physical proximity of the requesting nursing home to
other nursing homes within reasonable distance providing the same services as the requesting
nursing home;
new text end

new text begin (3) the reason the nursing home is unable to comply with the requirement;
new text end

new text begin (4) the reason that compliance with the requirement will impose substantial hardship,
including but not limited to the risk of the nursing home closing and requiring residents to
move; and
new text end

new text begin (5) the reason that a waiver will not significantly harm residents.
new text end

new text begin Following the submission of an exemption request, the commissioner must provide public
notice of the requested exemption and allow a public comment period.
new text end

new text begin (b) The commissioner shall evaluate requests for exemption under this subdivision by
reviewing the application materials and all comments submitted during the public comment
period. As part of the evaluation process, the commissioner may:
new text end

new text begin (1) inspect the nursing home;
new text end

new text begin (2) confer with the nursing home manager or designee;
new text end

new text begin (3) contact residents or their representatives to determine whether they believe a waiver
is in the residents' best interest; and
new text end

new text begin (4) contact individuals who submitted public comment during the public comment period.
new text end

new text begin (c) The commissioner may grant an exemption if the commissioner determines that
compliance with the requirement from which the exemption is sought cannot be accomplished
without substantial hardship to the nursing home and granting an exemption will not
significantly harm residents. The commissioner may not grant an exemption if it will create
an imminent risk of harm to a resident.
new text end

new text begin (d) An exemption granted under this subdivision is in effect for 90 days. After 90 days,
the nursing home may request a renewal of the exemption. After one renewal, the nursing
home must submit a new request for exemption under this subdivision.
new text end

Sec. 7.

new text begin [144A.082] AUTOMATIC EXTERNAL DEFIBRILLATOR.
new text end

new text begin (a) For purposes of this section, "automatic external defibrillator" has the meaning given
in section 403.51, subdivision 1.
new text end

new text begin (b) A nursing home must:
new text end

new text begin (1) maintain an automatic external defibrillator in each building on the nursing home
campus where residents may be present;
new text end

new text begin (2) ensure each of its automatic external defibrillators is maintained and regularly tested
according to the manufacturer's recommendations; and
new text end

new text begin (3) as part of initial orientation and annually thereafter, ensure all nursing home personnel
receive training in cardiopulmonary resuscitation, the use of automatic external defibrillators,
the nursing home's process for checking a resident's code status before initiating lifesaving
measures, and requesting emergency medical assistance as soon as practicable after an
automatic external defibrillator is used.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2026.
new text end

Sec. 8.

Minnesota Statutes 2024, section 144A.291, subdivision 2, is amended to read:

Subd. 2.

Amounts.

(a) Fees may not exceed the following amounts but may be adjusted
lower by board direction and are for the exclusive use of the board as required to sustain
board operations. The maximum amounts of fees are:

(1) application for licensure, $200;

(2) for a prospective applicant for a review of education and experience advisory to the
license application, $100, to be applied to the fee for application for licensure if the latter
is submitted within one year of the request for review of education and experience;

(3) state examination, $125;

(4) initial license, $250 deleted text begin if issued between July 1 and December 31, $100 if issued between
January 1 and June 30 deleted text end ;

(5) deleted text begin acting deleted text end permit, $400;

(6) renewal license new text begin or certificate new text end , $250;

(7) duplicate license new text begin , permit, or certificate new text end , $50;

(8) reinstatement fee, $250;

deleted text begin (9) health services executive initial license, $250;
deleted text end

deleted text begin (10) health services executive renewal license, $250;
deleted text end

deleted text begin (11) deleted text end new text begin (9) new text end reciprocity verification fee, $50;

deleted text begin (12) second deleted text end new text begin (10) application for new text end shared assignment new text begin certificate new text end , $250;

deleted text begin (13) deleted text end new text begin (11) new text end continuing education fees:

(i) greater than six hours, $50; and

(ii) seven hours or more, $75;

deleted text begin (14) deleted text end new text begin (12) new text end education review, $100;

deleted text begin (15) deleted text end new text begin (13) new text end fee to a sponsor for review of individual continuing education seminars,
institutes, workshops, or home study courses:

(i) for less than seven clock hours, $30; and

(ii) for seven or more clock hours, $50;

deleted text begin (16) deleted text end new text begin (14) new text end fee to a licensee for review of continuing education seminars, institutes,
workshops, or home study courses not previously approved for a sponsor and submitted
with an application for license renewal:

(i) for less than seven clock hours total, $30; and

(ii) for seven or more clock hours total, $50;

deleted text begin (17) deleted text end new text begin (15) new text end late renewal fee, $75;

deleted text begin (18) deleted text end new text begin (16) new text end fee to a licensee for verification of licensure status and examination scores,
$30;

deleted text begin (19) deleted text end new text begin (17) new text end registration as a registered continuing education sponsor, $1,000;

deleted text begin (20) mail deleted text end new text begin (18) mailing list new text end labels, $75; and

deleted text begin (21) deleted text end new text begin (19) new text end annual assisted living program education provider fee, $2,500.

(b) The revenue generated from the fees must be deposited in an account in the state
government special revenue fund.

Sec. 9.

Minnesota Statutes 2024, section 144A.471, subdivision 9, is amended to read:

Subd. 9.

Exclusions from home care licensure.

The following are excluded from home
care licensure and are not required to provide the home care bill of rights:

(1) an individual or business entity providing only coordination of home care that includes
one or more of the following:

(i) determination of whether a client needs home care services, or assisting a client in
determining what services are needed;

(ii) referral of clients to a home care provider;

(iii) administration of payments for home care services; or

(iv) administration of a health care home established under section 62U.03;

(2) an individual who is not an employee of a licensed home care provider if the
individual:

(i) only provides services as an independent contractor to one or more licensed home
care providers;

(ii) provides no services under direct agreements or contracts with clients; and

(iii) is contractually bound to perform services in compliance with the contracting home
care provider's policies and service plans;

(3) a business that provides staff to home care providers, such as a temporary employment
agency, if the business:

(i) only provides staff under contract to licensed or exempt providers;

(ii) provides no services under direct agreements with clients; and

(iii) is contractually bound to perform services under the contracting home care provider's
direction and supervision;

(4) any home care services conducted by and for the adherents of any recognized church
or religious denomination for its members through spiritual means, or by prayer for healing;

(5) an individual who only provides home care services to a relative;

(6) an individual not connected with a home care provider that provides assistance with
basic home care needs if the assistance is provided primarily as a contribution and not as a
business;

(7) an individual not connected with a home care provider that shares housing with and
provides primarily housekeeping or homemaking services to an elderly or disabled person
in return for free or reduced-cost housing;

(8) an individual or provider providing home-delivered meal services;

(9) an individual providing senior companion services and other older American volunteer
programs (OAVP) established under the Domestic Volunteer Service Act of 1973, United
States Code, title 42, chapter 66;

(10) a member of a professional corporation organized under chapter 319B that does
not regularly offer or provide home care services as defined in section 144A.43, subdivision
3;

(11) the following organizations established to provide medical or surgical services that
do not regularly offer or provide home care services as defined in section 144A.43,
subdivision 3: a business trust organized under sections 318.01 to 318.04, a nonprofit
corporation organized under chapter 317A, a partnership organized under chapter 323, or
any other entity determined by the commissioner;

(12) an individual or agency that provides medical supplies or durable medical equipment,
except when the provision of supplies or equipment is accompanied by a home care service;

(13) a physician licensed under chapter 147;

(14) an individual who provides home care services to a person with a developmental
disability who lives in a place of residence with a family, foster family, or primary caregiver;

(15) a business that only provides services that are primarily instructional and not medical
services or health-related support services;

(16) an individual who performs basic home care services for no more than 14 hours
each calendar week to no more than one client;

(17) an individual or business licensed as hospice as defined in sections 144A.75 to
144A.755 who is not providing home care services independent of hospice service;

(18) activities conducted by the commissioner of health or a community health board
as defined in section 145A.02, subdivision 5, including communicable disease investigations
or testing; deleted text begin or
deleted text end

(19) administering or monitoring a prescribed therapy necessary to control or prevent a
communicable disease, or the monitoring of an individual's compliance with a health directive
as defined in section 144.4172, subdivision 6 new text begin ; or
new text end

new text begin (20) a federally qualified health center as defined in section 145.9269, when providing
nursing services described in United States Code, title 42, section 1395x(aa)(1)(C) new text end .

Sec. 10.

Minnesota Statutes 2025 Supplement, section 144A.474, subdivision 11, is
amended to read:

Subd. 11.

Fines.

(a) Fines and enforcement actions under this subdivision may be assessed
based on the level and scope of the violations described in paragraph (b) and imposed
immediately with no opportunity to correct the violation first as follows:

(1) Level 1, no fines or enforcement;

(2) Level 2, a fine of $500 per violation, in addition to any of the enforcement
mechanisms authorized in section 144A.475;

(3) Level 3, a fine of $1,000 per incident, in addition to any of the enforcement
mechanisms authorized in section 144A.475;

(4) Level 4, a fine of $3,000 per incident, in addition to any of the enforcement
mechanisms authorized in section 144A.475;

(5) Level 5, a fine of $5,000 per violation, in addition to any enforcement mechanism
authorized in section 144A.475; and

(6) for maltreatment violations for which the licensee was determined to be responsible
for the maltreatment under section 626.557, subdivision 9c, paragraph (c), a fine of $1,000.
A fine of $5,000 may be imposed if the commissioner determines the licensee is responsible
for maltreatment consisting of sexual assault, death, or abuse resulting in serious injury.

The fines in clauses (1) to (5) are increased and immediate fine imposition is authorized
for both surveys and investigations conducted.

When a fine is assessed against a facility for substantiated maltreatment, the commissioner
shall not also impose an immediate fine under this chapter for the same circumstance.

(b) Correction orders for violations are categorized by both level and scope and fines
shall be assessed as follows:

(1) level of violation:

(i) Level 1 is a violation that will cause only minimal impact on the client and does not
affect health or safety;

(ii) Level 2 is a violation that did not harm a client's health or safety but had the potential
to have harmed a client's health or safety, but was not likely to cause serious injury,
impairment, or death;

(iii) Level 3 is a violation that harmed a client's health or safety, or a violation that had
the potential to cause more than minimal harm to the client;

(iv) Level 4 is a violation that harmed a client's health or safety, not including serious
injury or death, or a violation that was likely to lead to serious injury or death; and

(v) Level 5 is a violation that results in serious injury or death; and

(2) scope of violation:

(i) isolated, when one or a limited number of clients are affected or one or a limited
number of staff are involved or the situation has occurred only occasionally;

(ii) pattern, when more than a limited number of clients are affected, more than a limited
number of staff are involved, or the situation has occurred repeatedly but is not found to be
pervasive; and

(iii) widespread, when problems are pervasive or represent a systemic failure that has
affected or has the potential to affect a large portion or all of the clients.

(c) If the commissioner finds that the applicant or a home care provider has not corrected
violations by the date specified in the correction order or conditional license resulting from
a survey or complaint investigation, the commissioner shall provide a notice of
noncompliance with a correction order by email to the applicant's or provider's last known
email address. The noncompliance notice must list the violations not corrected.

(d) For every violation identified by the commissioner, the commissioner shall issue an
immediate fine pursuant to paragraph (a). The license holder must still correct the violation
in the time specified. The issuance of an immediate fine can occur in addition to any
enforcement mechanism authorized under section 144A.475. The immediate fine may be
appealed as allowed under this subdivision.

(e) The license holder must pay the fines assessed on or before the payment date specified.
If the license holder fails to fully comply with the order, the commissioner may issue a
second fine or suspend the license until the license holder complies by paying the fine. A
timely appeal shall stay payment of the fine until the commissioner issues a final order.

(f) A license holder shall promptly notify the commissioner in writing when a violation
specified in the order is corrected. If upon reinspection the commissioner determines that
a violation has not been corrected as indicated by the order, the commissioner may issue a
second fine. The commissioner shall notify the license holder by mail to the last known
address in the licensing record that a second fine has been assessed. The license holder may
appeal the second fine as provided under this subdivision.

(g) A home care provider that has been assessed a fine under this subdivision has a right
to a reconsideration or a hearing under this section and chapter 14.

(h) When a fine has been assessed, the license holder may not avoid payment by closing,
selling, or otherwise transferring the licensed program to a third party. In such an event, the
license holder shall be liable for payment of the fine.

(i) In addition to any fine imposed under this section, the commissioner may assess a
penalty amount based on costs related to an investigation that results in a final order assessing
a fine or other enforcement action authorized by this chapter.

(j) Fines collected under paragraph (a) shall be deposited in a dedicated special revenue
account. deleted text begin On an annual basis, the balance in the special revenue account shall be appropriated
to the commissioner to implement the recommendations of the advisory council established
in section 144A.4799. deleted text end new text begin Money deposited in the account is appropriated to the commissioner
on an annual basis for a competitive grant program for special projects for improving home
care client quality of care and outcomes in Minnesota, with a specific focus on workforce
and clinical outcomes, including projects consistent with criteria in section 144A.4799,
subdivision 3, paragraph (c). Grants must be distributed to home care providers licensed
under this chapter or organizations with experience in or knowledge of home care operations,
compliance, client needs, or best practices. Each grant must be $1,000 at minimum. A
provider with a temporary license under this chapter is not eligible to apply for a grant. The
commissioner may retain up to ten percent of the amount available to cover costs to
administer the grant under this section. new text end The commissioner must publish on the department's
website an annual report on the fines assessed and collected, and how the appropriated
money was allocated.

Sec. 11.

Minnesota Statutes 2025 Supplement, section 144A.4799, subdivision 1, is
amended to read:

Subdivision 1.

Membership.

new text begin (a) new text end The commissioner of health shall appoint 14 persons
to a home care and assisted living advisory council consisting of the following:

(1) four public members as defined in section 214.02, one of whom must be a person
who either is receiving or has received home care services preferably within the five years
prior to initial appointment, one of whom must be a person who has or had a family member
receiving home care services preferably within the five years prior to initial appointment,
one of whom must be a person who either is or has been a resident in an assisted living
facility preferably within the five years prior to initial appointment, and one of whom must
be a person who has or had a family member residing in an assisted living facility preferably
within the five years prior to initial appointment;

(2) two Minnesota home care licensees representing basic and comprehensive levels of
licensure who may be a managerial official, an administrator, a supervising registered nurse,
or an unlicensed personnel performing home care tasks;

(3) one member representing the Minnesota Board of Nursing;

(4) one member representing the Office of Ombudsman for Long-Term Care;

(5) one member representing the Office of Ombudsman for Mental Health and
Developmental Disabilities;

(6) one member of a county health and human services or county adult protection office;

(7) two Minnesota assisted living facility licensees representing assisted living facilities
and assisted living facilities with dementia care levels of licensure who may be the facility's
assisted living director, managerial official, or clinical nurse supervisor;

(8) one organization representing long-term care providers, home care providers, and
assisted living providers in Minnesota; and

(9) one representative of a consumer advocacy organization representing individuals
receiving long-term care from licensed home care providers or assisted living facilities.

new text begin (b) When a vacancy occurs for an appointment identified in paragraph (a), the
commissioner must select an applicant for appointment within 81 calendar days of the
position being posted by the secretary of state, if the application of a qualified and, if
applicable, a licensee in good standing applicant is received within 21 days of posting. If
no qualified applications are received within the first 21 days, the commissioner must select
an applicant for appointment within 60 calendar days of receiving the application of a
qualified and, if applicable, a licensee in good standing applicant.
new text end

Sec. 12.

Minnesota Statutes 2024, section 144G.09, subdivision 2, is amended to read:

Subd. 2.

Regulatory functions.

(a) The commissioner shall:

(1) license, survey, and monitor without advance notice assisted living facilities in
accordance with this chapter and rules;

(2) survey every provisional licensee within one year of the provisional license issuance
date subject to the provisional licensee providing assisted living services to residents;

(3) survey assisted living facility licensees at least once every two years;

(4) investigate complaints of assisted living facilities;

(5) issue correction orders and assess civil penalties under sections 144G.30 and 144G.31;

(6) take action as authorized in section 144G.20; deleted text begin and
deleted text end

new text begin (7) approve or disapprove proposed increases in amounts charged for housing or assisted
living services under sections 144G.19, subdivision 5, and 144G.40, subdivision 4; and
new text end

deleted text begin (7) deleted text end new text begin (8) new text end take other action reasonably required to accomplish the purposes of this chapter.

(b) The commissioner shall review blueprints for all new facility construction and must
approve the plans before construction may be commenced.

(c) The commissioner shall provide on-site review of the construction to ensure that all
physical environment standards are met before the facility license is complete.

Sec. 13.

Minnesota Statutes 2024, section 144G.15, is amended to read:

144G.15 CONSIDERATION OF APPLICATIONS.

new text begin Subdivision 1. new text end

new text begin Consideration. new text end

(a) Before issuing a provisional license or license or
renewing a license, the commissioner shall consider an applicant's compliance history in
providing care in this state or any other state in a facility that provides care to children, the
elderly, ill individuals, or individuals with disabilities.

(b) The applicant's compliance history shall include repeat violation, rule violations, and
any license or certification involuntarily suspended or terminated during an enforcement
process.

new text begin (c) Before issuing a provisional license for an assisted living facility with a licensed
resident capacity of six or fewer, the commissioner shall also consider the population, size,
land use plan, availability of community services, and the number and size of existing
licensed assisted living facilities in the town, municipality, or county in which the applicant
seeks to operate an assisted living facility.
new text end

new text begin Subd. 2. new text end

new text begin Colocation of certain home and community-based residential settings. new text end

new text begin The
commissioner must not grant a provisional license for an assisted living facility with a
licensed resident capacity of six or fewer until the commissioner of human services
determines that the proposed location of the assisted living facility meets the standard
described in section 245A.042, subdivision 7. This paragraph applies regardless of the
services to be provided in the proposed assisted living facility and regardless of whether
any residents of the facility will receive publicly funded services.
new text end

new text begin Subd. 3. new text end

new text begin Grounds for licensing action. new text end

deleted text begin (c) deleted text end The commissioner may deny, revoke, suspend,
restrict, or refuse to renew the license or impose conditions if:

(1) the applicant fails to provide complete and accurate information on the application
and the commissioner concludes that the missing or corrected information is needed to
determine if a license shall be granted;

(2) the applicant, knowingly or with reason to know, made a false statement of a material
fact in an application for the license or any data attached to the application or in any matter
under investigation by the department;

(3) the applicant refused to allow agents of the commissioner to inspect its books, records,
and files related to the license application, or any portion of the premises;

(4) the applicant willfully prevented, interfered with, or attempted to impede in any way:
(i) the work of any authorized representative of the commissioner, the ombudsman for
long-term care, or the ombudsman for mental health and developmental disabilities; or (ii)
the duties of the commissioner, local law enforcement, city or county attorneys, adult
protection, county case managers, or other local government personnel;

(5) the applicant, owner, controlling individual, managerial official, or assisted living
director for the facility has a history of noncompliance with federal or state regulations that
were detrimental to the health, welfare, or safety of a resident or a client; or

(6) the applicant violates any requirement in this chapter.

deleted text begin (d) If a license is denied, the applicant has the reconsideration rights available under
section 144G.16, subdivision 4.
deleted text end

Sec. 14.

Minnesota Statutes 2024, section 144G.16, is amended by adding a subdivision
to read:

new text begin Subd. 8. new text end

new text begin Notice to affected municipality. new text end

new text begin (a) No later than five days, excluding weekends
and holidays, after issuing a provisional license to an assisted living facility with a licensed
resident capacity of six or fewer, the commissioner must provide the following information
about the provisional licensee and the facility to the affected municipality or other political
subdivision:
new text end

new text begin (1) business name of the provisional licensee;
new text end

new text begin (2) street address of the facility;
new text end

new text begin (3) license category;
new text end

new text begin (4) licensed resident capacity; and
new text end

new text begin (5) contact information for an authorized agent of the provisional licensee.
new text end

new text begin (b) The commissioner may provide notice through electronic communication or by
submitting a written document to the official address of the municipality or other political
subdivision.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2026, and applies to provisional
licenses issued on or after that date.
new text end

Sec. 15.

Minnesota Statutes 2025 Supplement, section 144G.19, subdivision 5, is amended
to read:

Subd. 5.

Change of ownership; existing contracts.

new text begin (a) new text end Following a change of ownership,
the new licensee must honor the terms of an assisted living contract in effect at the time of
the change of ownership until the end of the contract term. new text begin A new licensee that proposes to
increase the amount charged for housing or assisted living services in an assisted living
contract replacing a contract in effect at the time of the change of ownership must provide
the commissioner with justification for and specific documentation supporting the proposed
increase.
new text end

new text begin (b) The commissioner must review the justification and documentation provided under
paragraph (a) and approve or disapprove the proposed increase. The commissioner may
request from the new licensee additional documentation or information the commissioner
deems necessary to conduct the review. An assisted living facility must not implement a
proposed increase described in paragraph (a) unless the commissioner approves the proposed
increase.
new text end

Sec. 16.

Minnesota Statutes 2024, section 144G.195, subdivision 1, is amended to read:

Subdivision 1.

New license not required.

(a) deleted text begin Beginning March 15, 2025, deleted text end An assisted
living facility with a licensed resident capacity of five residents or fewer may operate under
the licensee's current license if the facility is relocated with the approval of the commissioner
of health during the period the current license is valid.

(b) A licensee is not required to apply for a new license solely because the licensee
receives approval to relocate a facility. The licensee's license for the relocated facility
remains valid until the expiration date specified on the existing license. The commissioner
of health must apply the licensing and survey cycle previously established for the facility's
prior location to the facility's new location.

(c) A licensee must notify the commissioner of health, on a form developed by the
commissioner, of the licensee's intent to relocate the licensee's facility and submit a
nonrefundable relocation fee of $3,905. The commissioner must deposit all relocation fees
in the state treasury to be credited to the state government special revenue fund.

(d) The licensee must obtain plan review approval for the building to which the licensee
intends to relocate the facility and a certificate of occupancy from the commissioner of labor
and industry or the commissioner of labor and industry's delegated authority for the building.
Upon issuance of a certificate of occupancy, the commissioner of health must review and
inspect the building to which the licensee intends to relocate the facility deleted text begin and approve or
deny the license relocation within 30 calendar days deleted text end new text begin and must request from the commissioner
of human services a determination of whether the location to which the licensee intends to
relocate complies with the standards described in section 245A.042, subdivision 7. The
commissioner of health must approve or deny the license relocation within 30 calendar days
after inspecting the building and receiving a determination from the commissioner of human
services new text end .

(e) A licensee deleted text begin may only relocate a facility within the geographic boundaries of the
municipality in which the facility is currently located or within the geographic boundaries
of a contiguous municipality deleted text end new text begin located in the seven-county metropolitan area may not relocate
outside of the seven-county metropolitan area. A licensee located outside of the seven-county
metropolitan area may not relocate more than two hours or 120 miles from the licensee's
previous location nor relocate within the seven-county metropolitan area new text end .

(f) A licensee may only relocate one time in any three-year period, except that the
commissioner may approve an additional relocation within a three-year period upon a
licensee's demonstration of an extenuating circumstance, including but not limited to the
criteria outlined in section 256B.49, subdivision 28a, paragraph (c).

(g) A licensee that receives approval from the commissioner to relocate a facility must
provide each resident with a new assisted living contract and comply with the coordinated
move requirements under section 144G.55.

(h) A licensee denied approval by the commissioner of health to relocate a facility may
continue to operate the facility in its current location, follow the requirements in section
144G.57 and close the facility, or notify the commissioner of health of the licensee's intent
to relocate the facility to an alternative new location. If the licensee notifies the commissioner
of the licensee's intent to relocate the facility to an alternative new location, deleted text begin paragraph (c)
applies, including deleted text end new text begin all provisions of this section apply, including paragraph (c) and new text end the
timelines for approving or denying the license relocation for the alternative new location.

new text begin (g) If the commissioner of health approves a relocation under this subdivision, the
commissioner must comply with the provisions of section 144G.16, subdivision 8.
new text end

Sec. 17.

Minnesota Statutes 2024, section 144G.31, subdivision 7, is amended to read:

Subd. 7.

Additional penalties.

In addition to any fine imposed under this section, the
commissioner may new text begin :
new text end

new text begin (1) new text end assess a penalty amount based on costs related to an investigation that results in a
final order assessing a fine or other enforcement action authorized by this chapter deleted text begin . deleted text end new text begin ; and
new text end

new text begin (2) increase a fine if the violation results in serious injury or death and the commissioner
determines the licensee's conduct was sufficiently egregious to warrant an increase,
notwithstanding the fine amount provided in subdivision 4, paragraph (a), clause (5).
new text end

Sec. 18.

Minnesota Statutes 2024, section 144G.40, is amended by adding a subdivision
to read:

new text begin Subd. 4. new text end

new text begin Increase in amount charged for housing or services. new text end

new text begin (a) If an assisted living
facility proposes to increase the amount charged for housing or assisted living services by
an amount that exceeds the change in the Consumer Price Index for All Urban Consumers
published by the federal Bureau of Labor Statistics, for the most recent 12-month period
for which data is available, the assisted living facility must provide the commissioner with
justification for and specific documentation supporting the proposed increase.
new text end

new text begin (b) The documentation required under paragraph (a) must include:
new text end

new text begin (1) data on operational costs, including but not limited to the cost of staffing, utilities,
maintenance, and other day-to-day expenses necessary to operate the facility;
new text end

new text begin (2) data on the proposed imposition of any new fees, but is not limited to a raw food
fee, community fee, pharmacy choice or coordination fee, hospice choice or coordination
fee, or activities fee;
new text end

new text begin (3) the facility's balance sheet, including projected revenues and expenses for the next
fiscal year;
new text end

new text begin (4) data on costs related to compliance with new regulatory requirements, including but
not limited to health and safety requirements;
new text end

new text begin (5) data on capital improvements to, upgrades to, or expansion of the facility, including
but not limited to building renovations or new construction;
new text end

new text begin (6) a comparison of the facility's costs and fees and the costs and fees of similar facilities
in the region where the facility is located;
new text end

new text begin (7) data on whether the facility's residents have increased needs or are requesting new
amenities; and
new text end

new text begin (8) the percentage of revenue devoted to administrative costs and the percentage of
revenue devoted to marketing costs.
new text end

new text begin (c) The commissioner must review the justification and documentation provided under
paragraph (a) and approve or disapprove the proposed increase. The commissioner may
request from the facility additional documentation or information the commissioner deems
necessary to conduct the review. An assisted living facility must not implement a proposed
increase described in paragraph (a) unless the commissioner approves the proposed increase.
new text end

new text begin (d) If the commissioner approves the proposed increase, approval must be conditioned
on the facility maintaining or improving the quality of care it provides, including but not
limited to hiring additional staff, improving staff training, updating medical equipment, or
upgrading physical environment elements of the facility.
new text end

Sec. 19.

Minnesota Statutes 2024, section 144G.41, subdivision 1, is amended to read:

Subdivision 1.

Minimum requirements.

All assisted living facilities shall:

(1) distribute to residents the assisted living bill of rights;

(2) provide services in a manner that complies with the Nurse Practice Act in sections
148.171 to 148.285;

(3) utilize a person-centered planning and service delivery process;

(4) have and maintain a system for delegation of health care activities to unlicensed
personnel by a registered nurse, including supervision and evaluation of the delegated
activities as required by the Nurse Practice Act in sections 148.171 to 148.285;

(5) provide a means for residents to request assistance for health and safety needs 24
hours per day, seven days per week;

(6) allow residents the ability to furnish and decorate the resident's unit within the terms
of the assisted living contract;

(7) permit residents access to food at any time;

(8) allow residents to choose the resident's visitors and times of visits;

(9) allow the resident the right to choose a roommate if sharing a unit;

(10) notify the resident of the resident's right to have and use a lockable door to the
resident's unit. The licensee shall provide the locks on the unit. Only a staff member with
a specific need to enter the unit shall have keys, and advance notice must be given to the
resident before entrance, when possible. An assisted living facility must not lock a resident
in the resident's unit;

(11) develop and implement a staffing plan for determining its staffing level that:

(i) includes an evaluation, to be conducted at least twice a year, of the appropriateness
of staffing levels in the facility;

(ii) ensures sufficient staffing at all times to meet the scheduled and reasonably
foreseeable unscheduled needs of each resident as required by the residents' assessments
and service plans on a 24-hour per day basis; and

(iii) ensures that the facility can respond promptly and effectively to individual resident
emergencies and to emergency, life safety, and disaster situations affecting staff or residents
in the facility;

(12) ensure that one or more persons are available 24 hours per day, seven days per
week, who are responsible for responding to the requests of residents for assistance with
health or safety needs. Such persons must be:

(i) awake;

(ii) located in the same building, in an attached building, or on a contiguous campus
with the facility in order to respond within a reasonable amount of time;

(iii) capable of communicating with residents;

(iv) capable of providing or summoning the appropriate assistance; and

(v) capable of following directions; deleted text begin and
deleted text end

(13) provide staff access to an on-call registered nurse 24 hours per day, seven days per
week deleted text begin . deleted text end new text begin ;
new text end

new text begin (14) ensure a plan to immediately attend to resident needs in a medical emergency; and
new text end

new text begin (15) ensure that a person trained in emergency medical response is on site 24 hours per
day, seven days per week.
new text end

Sec. 20.

Minnesota Statutes 2024, section 144G.41, subdivision 2, is amended to read:

Subd. 2.

Policies and procedures.

new text begin (a) new text end Each assisted living facility must have policies
and procedures in place to address the following deleted text begin and keep them current deleted text end :

(1) requirements in section 626.557, reporting of maltreatment of vulnerable adults;

(2) conducting and handling background studies on employees;

(3) orientation, training, and competency evaluations of staff, and a process for evaluating
staff performance;

(4) handling complaints regarding staff or services provided by staff;

(5) conducting initial evaluations of residents' needs and the providers' ability to provide
those services;

(6) conducting initial and ongoing resident evaluations and assessments of resident
needs, including assessments by a registered nurse or appropriate licensed health professional,
and how changes in a resident's condition are identified, managed, and communicated to
staff and other health care providers as appropriate;

(7) orientation to and implementation of the assisted living bill of rights;

(8) infection control practices;

(9) reminders for medications, treatments, or exercises, if provided;

(10) conducting appropriate screenings, or documentation of prior screenings, to show
that staff are free of tuberculosis, consistent with current United States Centers for Disease
Control and Prevention standards;

(11) ensuring that nurses and licensed health professionals have current and valid licenses
to practice;

(12) medication and treatment management;

(13) delegation of tasks by registered nurses or licensed health professionals;

(14) supervision of registered nurses and licensed health professionals; deleted text begin and
deleted text end

(15) supervision of unlicensed personnel performing delegated tasks deleted text begin . deleted text end new text begin ; and
new text end

new text begin (16) medical emergency procedures initiated when a resident is experiencing a medical
emergency, including but not limited to a resident falling, having a heart event, having
difficulty breathing, bleeding, or choking.
new text end

new text begin (b) Each assisted living facility must keep all policies and procedures current and make
them available to a resident or the resident's representative upon request. Policies and
procedures covering emergency situations must be provided to prospective residents before
admission to an assisted living facility and provided to current residents at the time of a
nursing assessment as required under section 144G.70, subdivision 2.
new text end

Sec. 21.

Minnesota Statutes 2024, section 144G.41, is amended by adding a subdivision
to read:

new text begin Subd. 9. new text end

new text begin Automatic external defibrillator. new text end

new text begin (a) For purposes of this subdivision,
"automatic external defibrillator" has the meaning given in section 403.51, subdivision 1.
new text end

new text begin (b) A facility must:
new text end

new text begin (1) maintain an automatic external defibrillator in each building on the assisted living
facility campus where residents may be present; and
new text end

new text begin (2) ensure each of its automatic external defibrillators is maintained and regularly tested
according to the manufacturer's recommendations.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2026.
new text end

Sec. 22.

Minnesota Statutes 2024, section 144G.45, subdivision 3, is amended to read:

Subd. 3.

Local laws apply new text begin ; delegating inspection authority new text end .

new text begin (a) new text end Assisted living facilities
shall comply with all applicable state and local governing laws, regulations, standards,
ordinances, and codes for fire safety, building, and zoning requirements, except a facility
with a licensed resident capacity of six or fewer is exempt from rental licensing regulations
imposed by any town, municipality, or county.

new text begin (b) At the request of a county or local unit of government, the commissioner may delegate
to a county agency or local unit of government the commissioner's authority to inspect an
existing assisted living facility with a licensed resident capacity of six or fewer that is in
the jurisdiction of the county or local unit of government for compliance with applicable
physical plant licensing requirements and zoning ordinances. If the commissioner delegates
the commissioner's authority to a county agency or local unit of government under this
subdivision, the commissioner must execute a formal delegation of authority that clearly
specifies what authority is being delegated to the county agency or local unit of government,
that the commissioner is responsible for any costs incurred by the county agency or local
unit of government for conducting inspections under delegated authority, and that the county
agency or local unit of government must not assess any additional fees for conducting an
inspection under delegated authority. When conducting an inspection under delegated
authority, the county agency or local unit of government must provide the subject of the
inspection with a copy of the delegation of authority.
new text end

new text begin (c) When a county agency or local unit of government is conducting an inspection under
delegated authority as provided in paragraph (b), the county agency or local unit of
government and the commissioner must coordinate their inspections to minimize visits to
and disruptions of the facility. A county agency or local unit of government conducting an
inspection must notify the commissioner of any violations or concerns within ten working
days of the inspection. A county agency or local unit of government that conducts inspections
under this subdivision must not inspect an assisted living facility more frequently than
annually, except a follow-up inspection is permitted before the next annual inspection to
verify correction of a violation discovered during the most recent inspection.
new text end

new text begin (d) The commissioner must ensure that laws, rules, and codes are uniformly enforced
throughout the state by reviewing at least every four years each county agency and local
unit of government conducting inspections under this subdivision for compliance with this
subdivision and other applicable laws and rules. The commissioner must ensure that a county
agency or local unit of government to which the commissioner has delegated the
commissioner's authority under this subdivision has at all times sufficient expertise to
conduct delegated inspections competently, and if the county agency or local unit of
government does not, the commissioner must immediately revoke the delegation of authority.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2027.
new text end

Sec. 23.

Minnesota Statutes 2024, section 144G.61, subdivision 2, is amended to read:

Subd. 2.

Training and evaluation of unlicensed personnel.

(a) Training and competency
evaluations for all unlicensed personnel must include the following:

(1) documentation requirements for all services provided;

(2) reports of changes in the resident's condition to the supervisor designated by the
facility;

(3) basic infection control, including blood-borne pathogens;

(4) maintenance of a clean and safe environment;

(5) appropriate and safe techniques in personal hygiene and grooming, including:

(i) hair care and bathing;

(ii) care of teeth, gums, and oral prosthetic devices;

(iii) care and use of hearing aids; and

(iv) dressing and assisting with toileting;

(6) training on the prevention of falls;

(7) standby assistance techniques and how to perform them;

(8) medication, exercise, and treatment reminders;

(9) basic nutrition, meal preparation, food safety, and assistance with eating;

(10) preparation of modified diets as ordered by a licensed health professional;

(11) communication skills that include preserving the dignity of the resident and showing
respect for the resident and the resident's preferences, cultural background, and family;

(12) awareness of confidentiality and privacy;

(13) understanding appropriate boundaries between staff and residents and the resident's
family;

(14) procedures to use in handling various emergency situations; deleted text begin and
deleted text end

(15) awareness of commonly used health technology equipment and assistive devices new text begin ;
and
new text end

new text begin (16) procedures to use when handling various emergency medical situations, including
but not limited to a resident falling, having a heart event, having difficulty breathing,
bleeding, or choking new text end .

(b) In addition to paragraph (a), training and competency evaluation for unlicensed
personnel providing assisted living services must include:

(1) observing, reporting, and documenting resident status;

(2) basic knowledge of body functioning and changes in body functioning, injuries, or
other observed changes that must be reported to appropriate personnel;

(3) reading and recording temperature, pulse, and respirations of the resident;

(4) recognizing physical, emotional, cognitive, and developmental needs of the resident;

(5) safe transfer techniques and ambulation;

(6) range of motioning and positioning; and

(7) administering medications or treatments as required.

Sec. 24.

Minnesota Statutes 2024, section 144G.63, subdivision 2, is amended to read:

Subd. 2.

Content of required orientation.

(a) The orientation must contain the following
topics:

(1) an overview of this chapter;

(2) an introduction and review of the facility's policies and procedures related to the
provision of assisted living services by the individual staff person;

(3) handling of emergencies and use of emergency services;

(4) compliance with and reporting of the maltreatment of vulnerable adults under section
626.557 to the Minnesota Adult Abuse Reporting Center (MAARC);

(5) the assisted living bill of rights and staff responsibilities related to ensuring the
exercise and protection of those rights;

(6) the principles of person-centered planning and service delivery and how they apply
to direct support services provided by the staff person;

(7) handling of residents' complaints, reporting of complaints, and where to report
complaints, including information on the Office of Health Facility Complaints;

(8) consumer advocacy services of the Office of Ombudsman for Long-Term Care,
Office of Ombudsman for Mental Health and Developmental Disabilities, Managed Care
Ombudsman at the Department of Human Services, county-managed care advocates, or
other relevant advocacy services; deleted text begin and
deleted text end

(9) a review of the types of assisted living services the staff member will be providing
and the facility's category of licensure deleted text begin . deleted text end new text begin ; and
new text end

new text begin (10) cardiopulmonary resuscitation, the use of automatic external defibrillators, the
facility's process for checking a resident's code status before initiating lifesaving measures,
and requesting emergency medical assistance as soon as practicable after an automatic
external defibrillator is used.
new text end

(b) In addition to the topics in paragraph (a), orientation may also contain training on
providing services to residents with hearing loss. Any training on hearing loss provided
under this subdivision must be high quality and research based, may include online training,
and must include training on one or more of the following topics:

(1) an explanation of age-related hearing loss and how it manifests itself, its prevalence,
and the challenges it poses to communication;

(2) health impacts related to untreated age-related hearing loss, such as increased
incidence of dementia, falls, hospitalizations, isolation, and depression; or

(3) information about strategies and technology that may enhance communication and
involvement, including communication strategies, assistive listening devices, hearing aids,
visual and tactile alerting devices, communication access in real time, and closed captions.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2026.
new text end

Sec. 25.

Minnesota Statutes 2024, section 144G.63, subdivision 5, is amended to read:

Subd. 5.

Required annual training.

(a) All staff that perform direct services must
complete at least eight hours of annual training for each 12 months of employment. The
training may be obtained from the facility or another source and must include topics relevant
to the provision of assisted living services. The annual training must include:

(1) training on reporting of maltreatment of vulnerable adults under section 626.557;

(2) review of the assisted living bill of rights and staff responsibilities related to ensuring
the exercise and protection of those rights;

(3) review of infection control techniques used in the home and implementation of
infection control standards including a review of hand washing techniques; the need for and
use of protective gloves, gowns, and masks; appropriate disposal of contaminated materials
and equipment, such as dressings, needles, syringes, and razor blades; disinfecting reusable
equipment; disinfecting environmental surfaces; and reporting communicable diseases;

(4) effective approaches to use to problem solve when working with a resident's
challenging behaviors, and how to communicate with residents who have dementia,
Alzheimer's disease, or related disorders;

(5) review of the facility's policies and procedures relating to the provision of assisted
living services and how to implement those policies and procedures; deleted text begin and
deleted text end

(6) the principles of person-centered planning and service delivery and how they apply
to direct support services provided by the staff person deleted text begin . deleted text end new text begin ; and
new text end

new text begin (7) cardiopulmonary resuscitation, the use of automatic external defibrillators, the
facility's process for checking a resident's code status before initiating lifesaving measures,
and requesting emergency medical assistance as soon as practicable after an automatic
external defibrillator is used.
new text end

(b) In addition to the topics in paragraph (a), annual training may also contain training
on providing services to residents with hearing loss. Any training on hearing loss provided
under this subdivision must be high quality and research based, may include online training,
and must include training on one or more of the following topics:

(1) an explanation of age-related hearing loss and how it manifests itself, its prevalence,
and challenges it poses to communication;

(2) the health impacts related to untreated age-related hearing loss, such as increased
incidence of dementia, falls, hospitalizations, isolation, and depression; or

(3) information about strategies and technology that may enhance communication and
involvement, including communication strategies, assistive listening devices, hearing aids,
visual and tactile alerting devices, communication access in real time, and closed captions.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2026.
new text end

Sec. 26.

Minnesota Statutes 2024, section 144G.63, is amended by adding a subdivision
to read:

new text begin Subd. 5a. new text end

new text begin Orientation and annual training; other staff. new text end

new text begin (a) All staff who are not subject
to the orientation requirements in subdivisions 1 and 2 must complete an orientation on the
topics specified under paragraph (b) within 160 hours of the employment start date. All
staff who are not subject to the annual training requirements in subdivision 5 must complete
annual training on the topics specified under paragraph (b).
new text end

new text begin (b) The orientation and annual training must include training on cardiopulmonary
resuscitation, the use of automatic external defibrillators, the facility's process for checking
a resident's code status before initiating lifesaving measures, and requesting emergency
medical assistance as soon as practicable after an automatic external defibrillator is used.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2026.
new text end

Sec. 27.

new text begin [144G.65] NURSING STAFF REQUIREMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Onsite registered nurse. new text end

new text begin (a) Except when waived under subdivision 5,
the facility must have a registered nurse onsite 24 hours per day. The registered nurse must
be available to provide direct resident care.
new text end

new text begin (b) For any periods when the onsite registered nurse requirements in paragraph (a) are
waived under subdivision 5, a facility must have a registered nurse, licensed nurse
practitioner, physician assistant, or physician available to respond immediately to telephone
calls from the facility.
new text end

new text begin Subd. 2. new text end

new text begin Staffing competencies. new text end

new text begin The facility must ensure that all nurses have the specific
competencies and skill sets necessary to care for residents' needs, as identified through
resident assessments, and described in the service plan. Providing care includes but is not
limited to assessing, evaluating, planning, and implementing resident care plans and
responding to residents' needs.
new text end

new text begin Subd. 3. new text end

new text begin Required staff ratio. new text end

new text begin (a) The minimum staffing standard for personnel in
assisted living facilities is as specified in this subdivision.
new text end

new text begin (b) A facility must provide nursing care to all residents in accordance with each resident's
service plan while also providing a minimum of 3.48 hours per resident per 24 hours for
total nurse staffing, including but not limited to a minimum of 0.55 hours per resident per
24 hours for registered nurses and a minimum of 2.45 hours per resident per 24 hours for
nurse aides and licensed nurse practitioners per resident per 24 hours.
new text end

new text begin (c) For purposes of this subdivision, "hours of nursing personnel" means the paid, on-duty,
productive nursing hours of all nurses and nursing assistants, calculated on the basis of any
given 24-hour period. "Productive nursing hours" means all on-duty hours during which
nurses and nursing assistants are engaged in nursing duties. Not included are vacations,
holidays, sick leave, in-service classroom training, or lunches. Also not included are the
nonproductive nursing hours of the in-service training director. In a facility with more than
60 licensed beds, the hours of the director of nursing are excluded.
new text end

new text begin (d) An assisted living facility that is issued a notice of noncompliance for a violation of
this subdivision shall be assessed a civil fine of $300 for each day of noncompliance.
new text end

new text begin Subd. 4. new text end

new text begin Nursing supervision. new text end

new text begin (a) Except when waived under subdivision 5, the facility
must designate a registered nurse to serve as a charge nurse for each shift.
new text end

new text begin (b) Except when waived under subdivision 5, the facility must designate a registered
nurse to serve as the director of nursing on a full-time basis. The director of nursing may
serve as a charge nurse only when the facility has an average daily occupancy of 60 or fewer
residents.
new text end

new text begin Subd. 5. new text end

new text begin Exemption process. new text end

new text begin (a) The commissioner shall establish a process for
exemption to the requirements under subdivisions 1 and 4. A facility shall submit a request
for exemption under this subdivision on a form developed and in a manner established by
the commissioner. A requesting facility shall provide in writing to the commissioner the
following information at a minimum:
new text end

new text begin (1) the specific requirement from which exemption is sought;
new text end

new text begin (2) a detailed explanation of the physical proximity of the requesting facility to other
facilities within reasonable distance providing the same services as the requesting facility;
new text end

new text begin (3) the reason the facility is unable to comply with the requirement;
new text end

new text begin (4) the reason that compliance with the requirement will impose substantial hardship,
including but not limited to the risk of the facility closing and requiring residents to move;
and
new text end

new text begin (5) the reason that a waiver will not significantly harm residents.
new text end

new text begin Following the submission of an exemption request, the commissioner must provide public
notice of the requested exemption and allow a public comment period.
new text end

new text begin (b) The commissioner shall evaluate requests for exemption under this subdivision by
reviewing the application materials and all comments submitted during the public comment
period. As part of the evaluation process, the commissioner may:
new text end

new text begin (1) inspect the facility;
new text end

new text begin (2) confer with the facility manager or designee;
new text end

new text begin (3) contact residents or their representatives to determine whether they believe a waiver
is in the residents' best interest; and
new text end

new text begin (4) contact individuals who submitted public comment during the public comment period.
new text end

new text begin (c) The commissioner may grant an exemption if the commissioner determines that
compliance with the requirement from which the exemption is sought cannot be accomplished
without substantial hardship to the facility and granting an exemption will not significantly
harm residents. The commissioner may not grant an exemption if it will create an imminent
risk of harm to a resident.
new text end

new text begin (d) An exemption granted under this subdivision is in effect for 90 days. After 90 days,
the facility may request a renewal of the exemption. After one renewal, the facility must
submit a new request for exemption under this subdivision.
new text end

Sec. 28.

Minnesota Statutes 2025 Supplement, section 145D.40, is amended by adding a
subdivision to read:

new text begin Subd. 5. new text end

new text begin Health care professional. new text end

new text begin "Health care professional" means an individual who
is licensed or registered by the state to provide health care services within the professional's
scope of practice and in accordance with state law.
new text end

Sec. 29.

Minnesota Statutes 2025 Supplement, section 145D.41, subdivision 1, is amended
to read:

Subdivision 1.

Notice.

At least 120 days prior to the transfer of ownership or control of
a nonprofit nursing home or nonprofit assisted living facility to a for-profit entity, the nursing
home or assisted living facility must provide written notice to new text begin the attorney general, new text end the
commissioner of health new text begin , new text end and the commissioner of human services of its intent to transfer
ownership or control to a for-profit entity.

Sec. 30.

Minnesota Statutes 2025 Supplement, section 145D.41, subdivision 2, is amended
to read:

Subd. 2.

Information.

Together with the notice, the for-profit entity seeking to acquire
ownership or control of the nonprofit nursing home or nonprofit assisted living facility must
provide to the attorney general, commissioner of health, and commissioner of human services new text begin :
new text end

new text begin (1) new text end the names of each individual with an interest in the for-profit entity and the percentage
of interest each individual holds in the for-profit entity new text begin ;
new text end

new text begin (2) a complete and detailed description of the for-profit entity's corporate structure;
new text end

new text begin (3) the names of each individual holding an interest in, and the percentage of interest
held in, any affiliate, subsidiary, or otherwise related entity that the for-profit entity has a
contract to provide goods or services for the operation or maintenance of the nursing home
or assisted living facility or has a contract for goods and services to be provided to residents,
including any real estate investment trusts if permitted under section 145D.42;
new text end

new text begin (4) for the previous five years, any filings required to be made to any federal or state
agency;
new text end

new text begin (5) the for-profit entity's current balance sheet;
new text end

new text begin (6) all application materials required under section 144A.03 or 144G.12, as applicable;
new text end

new text begin (7) a description of the condition of the buildings the for-profit entity seeks to acquire
or manage, identifying any cooling problems, electric medical devices present, recent exterior
additions and replacements, external building conditions, recent flush toilet breakdowns,
foreclosure status in the previous 12 months, heat risk, heating problems, indoor air quality,
recent interior additions and replacements, and mold, as those terms are defined and described
in Appendix A of the American Housing Survey for the United States: 2023;
new text end

new text begin (8) an affidavit and evidence; and
new text end

new text begin (9) other information required by the attorney general, commissioner of health, and
commissioner of human services new text end .

Sec. 31.

Minnesota Statutes 2025 Supplement, section 145D.41, is amended by adding a
subdivision to read:

new text begin Subd. 3. new text end

new text begin Affidavit and evidence. new text end

new text begin In addition to the notice required under subdivision
1, a for-profit entity seeking to acquire ownership or control of a nonprofit nursing home
or nonprofit assisted living facility must submit to the attorney general an affidavit and
evidence sufficient to demonstrate that:
new text end

new text begin (1) the for-profit entity has the financial, managerial, and operational ability to operate
or manage the nursing home or assisted living facility consistent with the requirements of:
(i) for a nursing home, sections 144A.01 to 144A.1888, chapter 256R, and Minnesota Rules,
chapter 4658; or (ii) for an assisted living facility, chapter 144G and Minnesota Rules,
chapter 4659;
new text end

new text begin (2) neither the for-profit entity nor any of its owners, managerial officials, or managers
have committed a crime listed in, or been found civilly liable for an offense listed in, section
144A.03, subdivision 1, paragraph (b), clause (13), or 144G.12, subdivision 1, clause (13),
as applicable;
new text end

new text begin (3) in the preceding ten years, there have been no judgments and no filed, pending, or
completed public or private litigations, tax liens, written complaints, administrative actions,
or investigations by a government agency against the for-profit entity or any of its owners,
managerial officials, or managers;
new text end

new text begin (4) in the preceding ten years, the for-profit entity has not defaulted in the payment of
money collected for others and has not discharged debts through bankruptcy proceedings;
new text end

new text begin (5) the for-profit entity will invest sufficient capital in the nursing home or assisted living
facility to maintain or improve the facility's infrastructure and staffing;
new text end

new text begin (6)(i) housing costs or costs for services in a nursing home or assisted living facility in
the United States over which the for-profit entity acquired ownership or control have not
increased by more than the increase in the Consumer Price Index for all urban consumers
published by the federal Bureau of Labor Statistics for the 12 months preceding the month
in which the increase became effective; or (ii) if housing costs or costs for services in the
nursing home or assisted living facility increased by more than the increase in the Consumer
Price Index as described in item (i), the increase was justified;
new text end

new text begin (7) within five years after acquiring ownership or control of any other nursing home or
assisted living facility in the United States, the for-profit entity did not sell or otherwise
transfer ownership or control of the nursing home or assisted living facility to another person;
and
new text end

new text begin (8) after acquiring ownership or control of another nursing home in the United States,
that nursing home, with respect to the Centers for Medicare and Medicaid Services rating
system:
new text end

new text begin (i) maintained or improved the nursing home's rating if upon acquisition of ownership
or control the rating was three or more stars; or
new text end

new text begin (ii) improved the nursing home's rating to at least three stars if upon acquisition of
ownership or control the rating was one or two stars.
new text end

Sec. 32.

new text begin [145D.42] PROHIBITED PRACTICES.
new text end

new text begin A for-profit entity that acquires ownership or control of a nonprofit nursing home or
nonprofit assisted living facility is prohibited from:
new text end

new text begin (1) interfering with the professional judgment of a health care professional providing
care in the nursing home or assisted living facility or with a health care professional's
diagnosis or treatment of residents in the nursing home or assisted living facility;
new text end

new text begin (2) providing unequal treatment with regard to charges for housing or services based on
whether the resident pays for housing or services with private funds or through a public
program;
new text end

new text begin (3) engaging in any act, practice, or course of business that would strip an asset from an
acquired nursing home or assisted living facility or that would otherwise undermine the
quality of, safety of, or access to care and services provided by the nursing home or assisted
living facility;
new text end

new text begin (4) engaging in self-dealing;
new text end

new text begin (5) engaging in any acts, practices, or courses of business that result in an adverse impact
on the health, safety, and well-being and quality of care of the residents of the nursing home
or assisted living facility;
new text end

new text begin (6) spending less than 75 percent of the funds received by the nursing home or assisted
living facility from public programs and state appropriations on the direct care of residents;
new text end

new text begin (7) raising resident housing costs beyond the Consumer Price Index for all urban
consumers published by the federal Bureau of Labor Statistics for the 12 months preceding
the month in which the increase became effective unless the for-profit entity can demonstrate
that the increase was justified by legitimate business expenses;
new text end

new text begin (8) allowing a diminution of maintenance or a deterioration in the operations and
infrastructure of the nursing home or assisted living facility that results in unsafe conditions
or violations of building and other relevant codes, diminishes the property value of the
facility, or jeopardizes the health and well-being of the residents; or
new text end

new text begin (9) for a nursing home:
new text end

new text begin (i) failing to improve in the Centers for Medicare and Medicaid Services rating if the
nursing home's current rating is one or two stars; or
new text end

new text begin (ii) allowing a decline in the Centers for Medicare and Medicaid Services rating if the
nursing home's current rating is at least three stars.
new text end

Sec. 33.

new text begin [145D.43] ENFORCEMENT AND REMEDIES; NURSING HOMES AND
ASSISTED LIVING FACILITIES.
new text end

new text begin Subdivision 1. new text end

new text begin Equitable remedies. new text end

new text begin (a) In addition to other remedies provided by law,
the attorney general may bring an action in district court to enjoin or unwind a transaction
or seek other equitable relief if a nonprofit assisted living facility, nonprofit nursing home,
or for-profit entity violates sections 145D.41 and 145D.42.
new text end

new text begin (b) In seeking injunctive relief under this section, the attorney general is not required to
establish irreparable harm but must instead establish that a violation of sections 145D.41
and 145D.42 occurred.
new text end

new text begin Subd. 2. new text end

new text begin Failure to provide information. new text end

new text begin Failure of the entities involved in a transaction
subject to sections 145D.41 and 145D.42 to provide timely information as required by the
attorney general, the commissioner of health, or the commissioner of human services is an
independent and sufficient ground for a court to enjoin or unwind the transaction or provide
other equitable relief, provided the attorney general notifies the entities of the inadequacy
of the information provided and provides the entities with a reasonable opportunity to remedy
the inadequacy.
new text end

new text begin Subd. 3. new text end

new text begin Enforcement. new text end

new text begin In addition to the remedies provided under this section or other
law, the attorney general may enforce sections 145D.41 and 145D.42 pursuant to section
8.31.
new text end

new text begin Subd. 4. new text end

new text begin Civil penalties; attorney fees. new text end

new text begin (a) An officer, director, or other executive found
to have violated sections 145D.41 and 145D.42 shall be subject to a civil penalty of up to
$50,000 for each violation. A nonprofit assisted living facility, nonprofit nursing home, or
for-profit entity that is a party to or materially participated in a transaction found to have
violated sections 145D.41 and 145D.42 shall be subject to a civil penalty of up to $500,000.
new text end

new text begin (b) A court may also award reasonable attorney fees and costs of investigation and
litigation for an action brought under this section.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2026, and applies to violations
occurring on or after that date.
new text end

Sec. 34. new text begin DIRECTION TO COMMISSIONER OF HEALTH; SMALL ASSISTED
LIVING FACILITY LICENSURE.
new text end

new text begin (a) The commissioner of health must convene a group of interested parties to examine
the licensing requirements under Minnesota Statutes, chapter 144G, for assisted living
facilities with a licensed resident capacity of five residents or fewer. The group must develop
a new licensing category applicable to such facilities to account for health and safety
requirements and practical realities of operating small assisted living facilities that
predominantly serve individuals receiving customized living services under the federally
approved brain injury, community access for disability inclusion, and elderly waiver plans.
new text end

new text begin (b) The commissioner must develop draft legislative language to establish a new assisted
living license category for facilities with a licensed resident capacity of five residents or
fewer.
new text end

new text begin (c) The commissioner must submit the draft legislation to the chairs and ranking minority
members of the legislative committees with jurisdiction over health and human services
policy and finance by January 1, 2028.
new text end

Sec. 35. new text begin SPECIAL PROJECTS GRANT PROGRAM FOR HOME CARE
PROVIDERS.
new text end

new text begin By December 31, 2028, the commissioner of health must distribute the balance as of
January 1, 2027, in the special revenue account under Minnesota Statutes, section 144A.474,
subdivision 11, paragraph (j), under a competitive grant program for special projects for
improving home care client quality of care and outcomes in Minnesota, with a specific focus
on workforce and clinical outcomes, including projects consistent with criteria in Minnesota
Statutes, section 144A.4799, subdivision 3, paragraph (c). Grants must be distributed to
home care providers licensed under Minnesota Statutes, chapter 144A, or organizations
with experience in or knowledge of home care operations, compliance, client needs, or best
practices. Each grant must be $1,000 at minimum. A provider with a temporary license
under Minnesota Statutes, chapter 144A, is not eligible to apply for a grant. Any amount
that has not been awarded as a grant by December 31, 2028, must be used for the annual
distributions under Minnesota Statutes, section 144A.474, subdivision 11, paragraph (j),
beginning January 1, 2029.
new text end

Sec. 36. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2024, section 144A.04, subdivision 7, new text end new text begin is repealed.
new text end

ARTICLE 5

DIRECT CARE AND TREATMENT

Section 1.

Minnesota Statutes 2024, section 15.43, subdivision 3, is amended to read:

Subd. 3.

Other exemptions.

The deleted text begin commissioners deleted text end new text begin commissioner new text end of deleted text begin human services and deleted text end
corrections new text begin and Direct Care and Treatment executive board new text end may by rule prescribe procedures
for the acceptance of gifts from any person or organization, provided that such gifts are
accepted by the commissioner new text begin or executive board new text end , or a designated representative of the
commissioner new text begin or executive board new text end , and that such gifts are used solely for the direct benefit
of patients new text begin , clients, new text end or inmates under the jurisdiction of the accepting state officer.

Sec. 2.

Minnesota Statutes 2025 Supplement, section 144.121, subdivision 1a, is amended
to read:

Subd. 1a.

Fees for ionizing radiation-producing equipment.

(a) A facility with ionizing
radiation-producing equipment and other sources of ionizing radiation must pay an initial
or annual renewal registration fee consisting of a base facility fee of $155 and an additional
fee for each x-ray tube, as follows:

(1)	medical or veterinary equipment	$	130
(2)	dental x-ray equipment	$	60
(3)	x-ray equipment not used on humans or animals	$	130
(4)	devices with sources of ionizing radiation not used on humans or animals	$	130
(5)	security screening system	$	160
(6)	radiation therapy and accelerator x-ray equipment	$	1,000
(7)	industrial accelerator x-ray equipment	$	300

(b) Electron microscopy equipment is exempt from the registration fee requirements of
this section.

(c) For purposes of this section, a security screening system means ionizing
radiation-producing equipment designed and used for security screening of humans who
are in the custody of a correctional or detention facility new text begin or who are civilly committed in a
secure treatment facility new text end , and used by the facility to image and identify contraband items
concealed within or on all sides of a human body.

new text begin (d) new text end For purposes of this section, a correctional or detention facility is a facility licensed
under section 241.021 and operated by a state agency or political subdivision charged with
detection, enforcement, or incarceration in respect to state criminal and traffic laws.

new text begin (e) For purposes of this section, a secure treatment facility includes the facilities listed
in sections 253B.02, subdivision 18a, and 253D.02, subdivision 13.
new text end

new text begin (f) new text end The commissioner shall adopt rules to establish requirements for the use of security
screening systems. Notwithstanding section 14.125, the authority to adopt these rules does
not expire.

Sec. 3.

Minnesota Statutes 2024, section 144.121, subdivision 9, is amended to read:

Subd. 9.

Exemption from examination requirements; operators of security screening
systems.

(a) An employee of a correctional deleted text begin or deleted text end new text begin , new text end detention new text begin , or secure treatment new text end facility who
operates a security screening system and the facility in which the system is being operated
are exempt from the requirements of subdivisions 5 and 6.

(b) An employee of a correctional or detention facility who operates a security screening
system and the facility in which the system is being operated must meet the requirements
of a variance to Minnesota Rules, parts 4732.0305 and 4732.0565, issued under Minnesota
Rules, parts 4717.7000 to 4717.7050. This paragraph expires on December 31 of the year
that the permanent rules adopted by the commissioner governing security screening systems
are published in the State Register.

new text begin (c) An employee of a secure treatment facility who operates a security screening system
and the facility in which the system is being operated must meet the requirements of a
variance to Minnesota Rules, parts 4732.0305 and 4732.0565, issued under Minnesota
Rules, parts 4717.7000 to 4717.7050.
new text end

Sec. 4.

Minnesota Statutes 2024, section 246.54, subdivision 2, is amended to read:

Subd. 2.

Exceptions.

new text begin (a) new text end Regardless of the facility to which the client is committed,
subdivisions 1, 1a, 1b, and 1c, do not apply to the following individuals:

(1) clients who are committed as sexual psychopathic personalities under section 253D.02,
subdivision 15; and

(2) clients who are committed as sexually dangerous persons under section 253D.02,
subdivision 16.

new text begin (b) A county that is classified as economically distressed is not responsible for the costs
of care under this section. The executive board must classify a county as economically
distressed if:
new text end

new text begin (1) more than 15 percent of the county's population is living in poverty, according to
the most recent data published by the United States Census Bureau; and
new text end

new text begin (2) more than 70 percent of the total acreage in the county is exempt from property
taxation under chapter 272.
new text end

new text begin The executive board must not require any other county to pay to the state of Minnesota any
portion of the cost of care subject to the exception under this paragraph.
new text end

ARTICLE 6

MISCELLANEOUS

Section 1.

Minnesota Statutes 2025 Supplement, section 256B.0625, subdivision 17, is
amended to read:

Subd. 17.

Transportation costs.

(a) "Nonemergency medical transportation service"
means motor vehicle transportation provided by a public or private person that serves
Minnesota health care program beneficiaries who do not require emergency ambulance
service, as defined in section 144E.001, subdivision 3, to obtain covered medical services.

(b) For purposes of this subdivision, "rural urban commuting area" or "RUCA" means
a census-tract based classification system under which a geographical area is determined
to be urban, rural, or super rural. This paragraph expires July 1, deleted text begin 2026 deleted text end new text begin 2027 new text end , for medical
assistance fee-for-service and January 1, deleted text begin 2027 deleted text end new text begin 2028 new text end , for prepaid medical assistance.

(c) Medical assistance covers medical transportation costs incurred solely for obtaining
emergency medical care or transportation costs incurred by eligible persons in obtaining
emergency or nonemergency medical care when paid directly to an ambulance company,
nonemergency medical transportation company, or other recognized providers of
transportation services. Medical transportation must be provided by:

(1) nonemergency medical transportation providers who meet the requirements of this
subdivision;

(2) ambulances, as defined in section 144E.001, subdivision 2;

(3) taxicabs that meet the requirements of this subdivision;

(4) public transportation, within the meaning of "public transportation" as defined in
section 174.22, subdivision 7; or

(5) not-for-hire vehicles, including volunteer drivers, as defined in section 65B.472,
subdivision 1, paragraph (p).

(d) Medical assistance covers nonemergency medical transportation provided by
nonemergency medical transportation providers enrolled in the Minnesota health care
programs. All nonemergency medical transportation providers must comply with the
operating standards for special transportation service as defined in sections 174.29 to 174.30
and Minnesota Rules, chapter 8840, and all drivers must be individually enrolled with the
commissioner and reported on the claim as the individual who provided the service. All
nonemergency medical transportation providers shall bill for nonemergency medical
transportation services in accordance with Minnesota health care programs criteria. Publicly
operated transit systems, volunteers, and not-for-hire vehicles are exempt from the
requirements outlined in this paragraph.

(e) An organization may be terminated, denied, or suspended from enrollment if:

(1) the provider has not initiated background studies on the individuals specified in
section 174.30, subdivision 10, paragraph (a), clauses (1) to (3); or

(2) the provider has initiated background studies on the individuals specified in section
174.30, subdivision 10, paragraph (a), clauses (1) to (3), and:

(i) the commissioner has sent the provider a notice that the individual has been
disqualified under section 245C.14; and

(ii) the individual has not received a disqualification set-aside specific to the special
transportation services provider under sections 245C.22 and 245C.23.

(f) The administrative agency of nonemergency medical transportation must:

(1) adhere to the policies defined by the commissioner;

(2) pay nonemergency medical transportation providers for services provided to
Minnesota health care programs beneficiaries to obtain covered medical services;

(3) provide data monthly to the commissioner on appeals, complaints, no-shows, canceled
trips, and number of trips by mode; and

(4) by July 1, 2016, in accordance with subdivision 18e, utilize a web-based single
administrative structure assessment tool that meets the technical requirements established
by the commissioner, reconciles trip information with claims being submitted by providers,
and ensures prompt payment for nonemergency medical transportation services. This
paragraph expires July 1, deleted text begin 2026 deleted text end new text begin 2027 new text end , for medical assistance fee-for-service and January 1,
deleted text begin 2027 deleted text end new text begin 2028 new text end , for prepaid medical assistance.

(g) Effective July 1, deleted text begin 2026 deleted text end new text begin 2027 new text end , for medical fee-for-service and January 1, deleted text begin 2027 deleted text end new text begin 2028 new text end ,
for prepaid medical assistance, the administrative agency of nonemergency medical
transportation must:

(1) adhere to the policies defined by the commissioner;

(2) pay nonemergency medical transportation providers for services provided to
Minnesota health care program beneficiaries to obtain covered medical services; and

(3) provide data monthly to the commissioner on appeals, complaints, no-shows, canceled
trips, and number of trips by mode.

(h) Until the commissioner implements the single administrative structure and delivery
system under subdivision 18e, clients shall obtain their level-of-service certificate from the
commissioner or an entity approved by the commissioner that does not dispatch rides for
clients using modes of transportation under paragraph (n), clauses (4), (5), (6), and (7). This
paragraph expires July 1, deleted text begin 2026 deleted text end new text begin 2027 new text end , for medical assistance fee-for-service and January 1,
deleted text begin 2027 deleted text end new text begin 2028 new text end , for prepaid medical assistance.

(i) The commissioner may use an order by the recipient's attending physician, advanced
practice registered nurse, physician assistant, or a medical or mental health professional to
certify that the recipient requires nonemergency medical transportation services.
Nonemergency medical transportation providers shall perform driver-assisted services for
eligible individuals, when appropriate. Driver-assisted service includes passenger pickup
at and return to the individual's residence or place of business, assistance with admittance
of the individual to the medical facility, and assistance in passenger securement or in securing
of wheelchairs, child seats, or stretchers in the vehicle.

(j) Nonemergency medical transportation providers must take clients to the health care
provider using the most direct route, and must not exceed 30 miles for a trip to a primary
care provider or 60 miles for a trip to a specialty care provider, unless the client receives
authorization from the local agency. This paragraph expires July 1, deleted text begin 2026 deleted text end new text begin 2027 new text end , for medical
assistance fee-for-service and January 1, deleted text begin 2027 deleted text end new text begin 2028 new text end , for prepaid medical assistance.

(k) Effective July 1, deleted text begin 2026 deleted text end new text begin 2027 new text end , for medical assistance fee-for-service and January 1,
deleted text begin 2027 deleted text end new text begin 2028 new text end , for prepaid medical assistance, nonemergency medical transportation providers
must take clients to the health care provider using the most direct route and must not exceed
30 miles for a trip to a primary care provider or 60 miles for a trip to a specialty care provider,
unless the client receives authorization from the administrator.

(l) Nonemergency medical transportation providers may not bill for separate base rates
for the continuation of a trip beyond the original destination. Nonemergency medical
transportation providers must maintain trip logs, which include pickup and drop-off times,
signed by the medical provider or client, whichever is deemed most appropriate, attesting
to mileage traveled to obtain covered medical services. Clients requesting client mileage
reimbursement must sign the trip log attesting mileage traveled to obtain covered medical
services.

(m) The administrative agency shall use the level of service process established by the
commissioner to determine the client's most appropriate mode of transportation. If public
transit or a certified transportation provider is not available to provide the appropriate service
mode for the client, the client may receive a onetime service upgrade.

(n) The covered modes of transportation are:

(1) client reimbursement, which includes client mileage reimbursement provided to
clients who have their own transportation, or to family or an acquaintance who provides
transportation to the client;

(2) volunteer transport, which includes transportation by volunteers using their own
vehicle;

(3) unassisted transport, which includes transportation provided to a client by a taxicab
or public transit. If a taxicab or public transit is not available, the client can receive
transportation from another nonemergency medical transportation provider;

(4) assisted transport, which includes transport provided to clients who require assistance
by a nonemergency medical transportation provider;

(5) lift-equipped/ramp transport, which includes transport provided to a client who is
dependent on a device and requires a nonemergency medical transportation provider with
a vehicle containing a lift or ramp;

(6) protected transport, which includes transport provided to a client who has received
a prescreening that has deemed other forms of transportation inappropriate and who requires
a provider: (i) with a protected vehicle that is not an ambulance or police car and has safety
locks, a video recorder, and a transparent thermoplastic partition between the passenger and
the vehicle driver; and (ii) who is certified as a protected transport provider; and

(7) stretcher transport, which includes transport for a client in a prone or supine position
and requires a nonemergency medical transportation provider with a vehicle that can transport
a client in a prone or supine position.

(o) The local agency shall be the single administrative agency and shall administer and
reimburse for modes defined in paragraph (n) according to paragraphs (r) to (t) when the
commissioner has developed, made available, and funded the web-based single administrative
structure, assessment tool, and level of need assessment under subdivision 18e. The local
agency's financial obligation is limited to funds provided by the state or federal government.
This paragraph expires July 1, deleted text begin 2026 deleted text end new text begin 2027 new text end , for medical assistance fee-for-service and January
1, deleted text begin 2027 deleted text end new text begin 2028 new text end , for prepaid medical assistance.

(p) The commissioner shall:

(1) verify that the mode and use of nonemergency medical transportation is appropriate;

(2) verify that the client is going to an approved medical appointment; and

(3) investigate all complaints and appeals.

(q) The administrative agency shall pay for the services provided in this subdivision and
seek reimbursement from the commissioner, if appropriate. As vendors of medical care,
local agencies are subject to the provisions in section 256B.041, the sanctions and monetary
recovery actions in section 256B.064, and Minnesota Rules, parts 9505.2160 to 9505.2245.
This paragraph expires July 1, 2026, for medical assistance fee-for-service and January 1,
2027, for prepaid medical assistance.

(r) Payments for nonemergency medical transportation must be paid based on the client's
assessed mode under paragraph (m), not the type of vehicle used to provide the service. The
medical assistance reimbursement rates for nonemergency medical transportation services
that are payable by or on behalf of the commissioner for nonemergency medical
transportation services are:

(1) $0.22 per mile for client reimbursement;

(2) up to 100 percent of the Internal Revenue Service business deduction rate for volunteer
transport;

(3) equivalent to the standard fare for unassisted transport when provided by public
transit, and $12.10 for the base rate and $1.43 per mile when provided by a nonemergency
medical transportation provider;

(4) $14.30 for the base rate and $1.43 per mile for assisted transport;

(5) $19.80 for the base rate and $1.70 per mile for lift-equipped/ramp transport;

(6) $75 for the base rate and $2.40 per mile for protected transport; and

(7) $60 for the base rate and $2.40 per mile for stretcher transport, and $9 per trip for
an additional attendant if deemed medically necessary. This paragraph expires July 1, deleted text begin 2026 deleted text end new text begin
2027 new text end , for medical assistance fee-for-service and January 1, deleted text begin 2027 deleted text end new text begin 2028 new text end , for prepaid medical
assistance.

(s) Effective July 1, deleted text begin 2026 deleted text end new text begin 2027 new text end , for medical assistance fee-for-service and January 1,
deleted text begin 2027 deleted text end new text begin 2028 new text end , for prepaid medical assistance, payments for nonemergency medical
transportation must be paid based on the client's assessed mode under paragraph (m), not
the type of vehicle used to provide the service.

(t) The base rate for nonemergency medical transportation services in areas defined
under RUCA to be super rural is equal to 111.3 percent of the respective base rate in
paragraph (r), clauses (1) to (7). The mileage rate for nonemergency medical transportation
services in areas defined under RUCA to be rural or super rural areas is:

(1) for a trip equal to 17 miles or less, equal to 125 percent of the respective mileage
rate in paragraph (r), clauses (1) to (7); and

(2) for a trip between 18 and 50 miles, equal to 112.5 percent of the respective mileage
rate in paragraph (r), clauses (1) to (7). This paragraph expires July 1, deleted text begin 2026 deleted text end new text begin 2027 new text end , for medical
assistance fee-for-service and January 1, deleted text begin 2027 deleted text end new text begin 2028 new text end , for prepaid medical assistance.

(u) For purposes of reimbursement rates for nonemergency medical transportation
services under paragraphs (r) to (t), the zip code of the recipient's place of residence shall
determine whether the urban, rural, or super rural reimbursement rate applies. This paragraph
expires July 1, deleted text begin 2026 deleted text end new text begin 2027 new text end , for medical assistance fee-for-service and January 1, deleted text begin 2027 deleted text end new text begin 2028 new text end ,
for prepaid medical assistance.

(v) The commissioner, when determining reimbursement rates for nonemergency medical
transportation, shall exempt all modes of transportation listed under paragraph (n) from
Minnesota Rules, part 9505.0445, item R, subitem (2).

(w) Effective for the first day of each calendar quarter in which the price of gasoline as
posted publicly by the United States Energy Information Administration exceeds $3.00 per
gallon, the commissioner shall adjust the rate paid per mile in paragraph (r) by one percent
up or down for every increase or decrease of ten cents for the price of gasoline. The increase
or decrease must be calculated using a base gasoline price of $3.00. The percentage increase
or decrease must be calculated using the average of the most recently available price of all
grades of gasoline for Minnesota as posted publicly by the United States Energy Information
Administration. This paragraph expires July 1, deleted text begin 2026 deleted text end new text begin 2027 new text end , for medical assistance
fee-for-service and January 1, deleted text begin 2027 deleted text end new text begin 2028 new text end , for prepaid medical assistance.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 2.

Minnesota Statutes 2025 Supplement, section 256B.0625, subdivision 18i, is
amended to read:

Subd. 18i.

Administration of nonemergency medical transportation.

Effective July
1, deleted text begin 2026 deleted text end new text begin 2027 new text end , for medical assistance fee-for-service and January 1, deleted text begin 2027 deleted text end new text begin 2028 new text end , for prepaid
medical assistance, the commissioner must contract either statewide or regionally for the
administration of the nonemergency medical transportation program in compliance with
the provisions of this chapter. The contract must include the administration of the
nonemergency medical transportation benefit for those enrolled in managed care as described
in section 256B.69.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 3.

Laws 2025, First Special Session chapter 3, article 8, section 43, the effective date,
is amended to read:

EFFECTIVE DATE.

Paragraph (b) is effective July 1, deleted text begin 2026 deleted text end new text begin 2027 new text end , for medical assistance
fee-for-service and January 1, deleted text begin 2027 deleted text end new text begin 2028 new text end , for prepaid medical assistance. Paragraph (c) is
effective on the latest of the following: (1) January 1, 2026; (2) federal approval of the
medical assistance program changes in this section; (3) federal approval of the amendments
in this act to Minnesota Statutes, section 256B.76, subdivision 6; (4) federal approval of
the amendments in this act to Minnesota Statutes, section 256B.761; or (5) federal approval
of all necessary federal waivers to implement the managed care organization assessment in
Minnesota Statutes, section 295.525. The commissioner of human services shall notify the
revisor of statutes when federal approval is obtained.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

ARTICLE 7

DEPARTMENT OF HUMAN SERVICES APPROPRIATIONS

Section 1. new text begin HUMAN SERVICES APPROPRIATIONS. new text end

new text begin The sums shown in the columns marked "Appropriations" are added to or, if shown in
parentheses, are subtracted from the appropriations in Laws 2025, First Special Session
chapter 9, article 12, to the agency and for the purposes specified in this article. The
appropriations are from the general fund or other named fund and are available for the fiscal
years indicated for each purpose. The figures "2026" and "2027" used in this article mean
that the addition to or subtraction from the appropriation listed under them is available for
the fiscal year ending June 30, 2026, or June 30, 2027, respectively. Base adjustments mean
the addition to or subtraction from the base level adjustment set in Laws 2025, First Special
Session chapter 9, article 12. Appropriations and reductions to appropriations for the fiscal
year ending June 30, 2026, are effective the day following final enactment unless a different
effective date is explicit.
new text end

			new text begin APPROPRIATIONS new text end
			new text begin Available for the Year new text end
			new text begin Ending June 30 new text end
				new text begin 2026 new text end		new text begin 2027 new text end

Sec. 2. new text begin TOTAL APPROPRIATION new text end

new text begin $ new text end

new text begin (822,000) new text end

new text begin $ new text end

new text begin 19,672,000 new text end

new text begin The amounts that may be spent for each
purpose are specified in the following sections
and subdivisions.
new text end

Sec. 3. new text begin CENTRAL OFFICE; OPERATIONS new text end

new text begin $ new text end

new text begin -0- new text end

new text begin $ new text end

new text begin 5,455,000 new text end

new text begin Subdivision 1. new text end new text begin Assessment of Administrative Roles new text end

new text begin $3,000,000 in fiscal year 2027 is for an
assessment of the administrative roles and
responsibilities of the state agency, counties,
and Tribal Nations in administering human
services programs. This is a onetime
appropriation and is available until June 30,
2029.
new text end

new text begin Subd. 2. new text end new text begin Base Level Adjustment new text end

new text begin The general fund base is increased by
$1,542,000 in fiscal year 2028 and increased
by $1,580,000 in fiscal year 2029.
new text end

Sec. 4. new text begin CENTRAL OFFICE; HEALTH CARE new text end

new text begin $ new text end

new text begin -0- new text end

new text begin $ new text end

new text begin 482,000 new text end

new text begin new text begin Base Level Adjustment. new text end The general fund
base is increased by $953,000 in fiscal year
2028 and increased by $918,000 in fiscal year
2029.
new text end

Sec. 5. new text begin CENTRAL OFFICE; AGING AND DISABILITY SERVICES new text end

new text begin $ new text end

new text begin -0- new text end

new text begin $ new text end

new text begin 11,306,000 new text end

new text begin Subdivision 1. new text end new text begin MnCHOICES Redesign Working Group new text end

new text begin $550,000 in fiscal year 2027 is for a contract
related to the MnCHOICES redesign working
group. The base for this appropriation is
$500,000 in fiscal year 2028, $250,000 in
fiscal year 2029, $0 in fiscal year 2030, and
$0 in fiscal year 2031.
new text end

new text begin Subd. 2. new text end new text begin Waiver Case Management Quality Working Group new text end

new text begin $350,000 in fiscal year 2027 is for a contract
related to the waiver case management quality
working group. The base for this appropriation
is $150,000 in fiscal year 2028 and $0 in fiscal
year 2029.
new text end

new text begin Subd. 3. new text end new text begin Case Management and Home and Community-Based Services Rates Study new text end

new text begin $200,000 in fiscal year 2027 is for a rates
study for case management and home and
community-based services. This is a onetime
appropriation and is available until June 30,
2028. The base for this appropriation is
$400,000 in fiscal year 2028, $200,000 in
fiscal year 2029, $0 in fiscal year 2030, and
$0 in fiscal year 2031.
new text end

new text begin Subd. 4. new text end new text begin Base Level Adjustment new text end

new text begin The general fund base is increased by
$21,386,000 in fiscal year 2028 and increased
by $23,413,000 in fiscal year 2029.
new text end

Sec. 6. new text begin CENTRAL OFFICE; BEHAVIORAL HEALTH new text end

new text begin $ new text end

new text begin -0- new text end

new text begin $ new text end

new text begin 150,000 new text end

new text begin Subdivision 1. new text end new text begin Access to Services for Incarcerated Individuals Evaluation new text end

new text begin $150,000 in fiscal year 2027 is for community
engagement and evaluation related reentry
services.
new text end

new text begin Subd. 2. new text end new text begin Base Level Adjustment new text end

new text begin The general fund base is increased by
$353,000 in fiscal year 2028 and increased by
$336,000 in fiscal year 2029.
new text end

Sec. 7. new text begin CENTRAL OFFICE; OFFICE OF INSPECTOR GENERAL new text end

new text begin $ new text end

new text begin -0- new text end

new text begin $ new text end

new text begin 1,284,000 new text end

new text begin new text begin Base Level Adjustment. new text end The general fund
base is increased by $1,500,000 in fiscal year
2028 and increased by $1,500,000 in fiscal
year 2029.
new text end

Sec. 8. new text begin FORECASTED PROGRAMS; HOUSING SUPPORT new text end

new text begin $ new text end

new text begin -0- new text end

new text begin $ new text end

new text begin 10,057,000 new text end

Sec. 9. new text begin FORECASTED PROGRAMS; MEDICAL ASSISTANCE new text end

new text begin $ new text end

new text begin -0- new text end

new text begin $ new text end

new text begin (422,000) new text end

Sec. 10. new text begin FORECASTED PROGRAMS; BEHAVIORAL HEALTH FUND new text end

new text begin $ new text end

new text begin -0- new text end

new text begin $ new text end

new text begin (19,220,000) new text end

Sec. 11. new text begin GRANT PROGRAMS; REFUGEE SERVICE GRANTS new text end

new text begin $ new text end

new text begin -0- new text end

new text begin $ new text end

new text begin 10,000,000 new text end

new text begin Human Services Response Contingency
Account. $10,000,000 in fiscal year 2026 is
for the human services response contingency
account established under Minnesota Statutes,
section 256.044. This is a onetime
appropriation.
new text end

Sec. 12. new text begin GRANT PROGRAMS; OTHER LONG-TERM CARE GRANTS new text end

new text begin $ new text end

new text begin (822,000) new text end

new text begin $ new text end

new text begin 75,000 new text end

new text begin new text begin Supported-decision-making programs. new text end
$2,000,000 in fiscal year 2027 is for
supported-decision-making grants under Laws
2023, chapter 61, article 1, section 61. This is
a onetime appropriation and is available until
June 30, 2028.
new text end

Sec. 13. new text begin GRANT PROGRAMS; DISABILITY GRANTS new text end

new text begin $ new text end

new text begin -0- new text end

new text begin $ new text end

new text begin (145,000) new text end

new text begin Base Level Adjustment. The general fund
base is decreased by $956,000 in fiscal year
2028 and decreased by $956,000 in fiscal year
2029.
new text end

Sec. 14. new text begin GRANT PROGRAMS; SUBSTANCE USE DISORDER GRANTS new text end

new text begin $ new text end

new text begin -0- new text end

new text begin $ new text end

new text begin 300,000 new text end

new text begin Todd County; Peer Recovery Support.
$300,000 in fiscal year 2027 is for a grant to
Todd County for a contract with an
organization operating in Todd County to
provide daily peer recovery support services
and special sessions for individuals who are
in substance use recovery, are transitioning
out of incarceration, or have experienced
trauma.
new text end

Sec. 15. new text begin GRANT PROGRAMS; SUBSTANCE USE DISORDER GRANTS new text end

new text begin $ new text end

new text begin -0- new text end

new text begin $ new text end

new text begin 350,000 new text end

new text begin Thrive Family Recovery Resources.
$350,000 in fiscal year 2027 is for a grant to
Thrive Family Recovery Resources for a pilot
program that provides family peer services,
education, resource navigation, and general
support for families impacted by substance
use disorder. By January 20, 2027, the
commissioner must submit a report to the
chairs and ranking minority members of the
legislative committees with jurisdiction over
human services that evaluates the results of
the pilot program and makes recommendations
for developing an ongoing grant program to
provide supportive services and education for
families impacted by substance use disorder.
This is a onetime appropriation.
new text end

Sec. 16.

Laws 2023, chapter 61, article 1, section 67, subdivision 3, as amended by Laws
2024, chapter 125, article 8, section 10, is amended to read:

Subd. 3.

Evaluation and report.

(a) The Metropolitan Center for Independent Living
must contract with a third party to evaluate the pilot project's impact on health care costs,
retention of personal care assistants, and patients' and providers' satisfaction of care. The
evaluation must include the number of participants, the hours of care provided by participants,
and the retention of participants from semester to semester.

(b) By January 15, deleted text begin 2026 deleted text end new text begin 2028 new text end , the Metropolitan Center for Independent Living must
report the findings under paragraph (a) to the chairs and ranking minority members of the
legislative committees with jurisdiction over human services finance and policy.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 17.

Laws 2023, chapter 61, article 9, section 2, subdivision 5, as amended by Laws
2024, chapter 125, article 8, section 12, is amended to read:

Subd. 5. Central Office; Aging and Disability Services

40,115,000

11,995,000

(a) Employment Supports Alignment Study.
$50,000 in fiscal year 2024 and $200,000 in
fiscal year 2025 are to conduct an interagency
employment supports alignment study. The
base for this appropriation is $150,000 in fiscal
year 2026 and $100,000 in fiscal year 2027.

(b) Case Management Training
Curriculum. $377,000 in fiscal year 2024 and
$377,000 in fiscal year 2025 are to develop
and implement a curriculum and training plan
to ensure all lead agency assessors and case
managers have the knowledge and skills
necessary to fulfill support planning and
coordination responsibilities for individuals
who use home and community-based disability
services and live in own-home settings. This
is a onetime appropriation.

(c) Office of Ombudsperson for Long-Term
Care. $875,000 in fiscal year 2024 and
$875,000 in fiscal year 2025 are for additional
staff and associated direct costs in the Office
of Ombudsperson for Long-Term Care.

(d) Direct Care Services Corps Pilot Project.
$500,000 in fiscal year 2024 is from the
general fund for a grant to the Metropolitan
Center for Independent Living for the direct
care services corps pilot project. Up to $25,000
may be used by the Metropolitan Center for
Independent Living for administrative costs.
This is a onetime appropriation and is
available until June 30, deleted text begin 2026 deleted text end new text begin 2027 new text end .

(e) Research on Access to Long-Term Care
Services and Financing. Any unexpended
amount of the fiscal year 2023 appropriation
referenced in Laws 2021, First Special Session
chapter 7, article 17, section 16, estimated to
be $300,000, is canceled. The amount canceled
is appropriated in fiscal year 2024 for the same
purpose.

(f) Native American Elder Coordinator.
$441,000 in fiscal year 2024 and $441,000 in
fiscal year 2025 are for the Native American
elder coordinator position under Minnesota
Statutes, section 256.975, subdivision 6.

(g) Grant Administration Carryforward.

(1) Of this amount, $8,154,000 in fiscal year
2024 is available until June 30, 2027.

(2) Of this amount, $1,071,000 in fiscal year
2025 is available until June 30, 2027.

(3) Of this amount, $19,000,000 in fiscal year
2024 is available until June 30, 2029.

(h) Base Level Adjustment. The general fund
base is increased by $8,189,000 in fiscal year
2026 and increased by $8,093,000 in fiscal
year 2027.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 18.

Laws 2024, chapter 125, article 1, section 47, is amended to read:

Sec. 47. DIRECTION TO COMMISSIONER; PEDIATRIC HOSPITAL-TO-HOME
TRANSITION PILOT PROGRAM.

(a) The commissioner of human services must award a single competitive grant to a
home care nursing provider to develop and implement, in coordination with the commissioner
of health, Fairview Masonic Children's Hospital, Gillette Children's Specialty Healthcare,
and Children's Minnesota of St. Paul and Minneapolis, a pilot program to expedite and
facilitate pediatric hospital-to-home discharges for patients receiving services in this state
under medical assistance, including under the community alternative care waiver, community
access for disability inclusion waiver, and developmental disabilities waiver.

(b) Grant money awarded under this section must be used only to support the
administrative, training, and auxiliary services necessary to reduce:

(1) delayed discharge days due to unavailability of home care nursing staffing to
accommodate complex pediatric patients;

(2) avoidable rehospitalization days for pediatric patients;

(3) unnecessary emergency department utilization by pediatric patients following
discharge;

(4) long-term nursing needs for pediatric patients; and

(5) the number of school days missed by pediatric patients.

(c) Grant money must not be used to supplant payment rates for services covered under
Minnesota Statutes, chapter 256B.

(d) No later than December 15, deleted text begin 2026 deleted text end new text begin 2027 new text end , the commissioner must prepare a report
summarizing the impact of the pilot program that includes but is not limited to: (1) the
number of delayed discharge days eliminated; (2) the number of rehospitalization days
eliminated; (3) the number of unnecessary emergency department admissions eliminated;
(4) the number of missed school days eliminated; and (5) an estimate of the return on
investment of the pilot program.

(e) The commissioner must submit the report under paragraph (d) to the chairs and
ranking minority members of the legislative committees with jurisdiction over health and
human services finance and policy.

Sec. 19.

Laws 2024, chapter 125, article 8, section 2, subdivision 4, is amended to read:

Subd. 4. Central Office; Aging and Disability Services

(2,664,000)

4,164,000

(a) Tribal Vulnerable Adult and
Developmental Disabilities Targeted Case
Management Medical Assistance Benefit.
$200,000 in fiscal year 2025 is for a contract
to develop a Tribal vulnerable adult and
developmental disabilities targeted case
management medical assistance benefit under
Minnesota Statutes, section 256B.0924. This
is a onetime appropriation. Notwithstanding
Minnesota Statutes, section 16A.28,
subdivision 3, this appropriation is available
until June 30, 2027.

(b) Disability Services Person-Centered
Engagement and Navigation Study.
$600,000 in fiscal year 2025 is for the
disability services person-centered engagement
and navigation study. This is a onetime
appropriation. Notwithstanding Minnesota
Statutes, section 16A.28, subdivision 3, this
appropriation is available until June 30, 2026.

(c) Pediatric Hospital-to-Home Transition
Pilot Program Administration. $300,000 in
fiscal year 2025 is for a contract related to the
pediatric hospital-to-home transition pilot
program. This is a onetime appropriation.
Notwithstanding Minnesota Statutes, section
16A.28, subdivision 3, this appropriation is
available until June 30, deleted text begin 2027 deleted text end new text begin 2028 new text end .

(d) Reimbursement for Community-First
Services and Supports Workers Report.
$250,000 in fiscal year 2025 is for a contract
related to the reimbursement for
community-first services and supports workers
report. This is a onetime appropriation.
Notwithstanding Minnesota Statutes, section
16A.28, subdivision 3, this appropriation is
available until June 30, 2026.

(e) Carryforward Authority.
Notwithstanding Minnesota Statutes, section
16A.28, subdivision 3, $758,000 in fiscal year
2025 is available until June 30, 2026, and
$2,687,000 in fiscal year 2025 is available
until June 30, 2027.

(f) Base Level Adjustment. The general fund
base is increased by $340,000 in fiscal year
2026 and increased by $340,000 in fiscal year
2027.

Sec. 20.

Laws 2024, chapter 125, article 8, section 2, subdivision 14, as amended by Laws
2025, First Special Session chapter 9, article 12, section 29, is amended to read:

Subd. 14. Grant Programs; Disabilities Grants

1,650,000

9,574,000

(a) Capital Improvement for Accessibility.
$400,000 in fiscal year 2025 is for a payment
to Anoka County to make capital
improvements to existing space in the Anoka
County Human Services building in the city
of Blaine, including making bathrooms fully
compliant with the Americans with Disabilities
Act with adult changing tables and ensuring
barrier-free access for the purposes of
improving and expanding the services an
existing building tenant can provide to adults
with developmental disabilities. This is a
onetime appropriation.

(b) Dakota County Disability Services
Workforce Shortage Pilot Project. $500,000
in fiscal year 2025 is for a grant to Dakota
County for innovative solutions to the
disability services workforce shortage. Up to
$250,000 of this amount must be used to
develop and test an online application for
matching requests for services from people
with disabilities to available staff, and up to
$250,000 of this amount must be used to
develop a communities-for-all program that
engages businesses, community organizations,
neighbors, and informal support systems to
promote community inclusion of people with
disabilities. By October 1, 2026, the
commissioner shall report the outcomes and
recommendations of these pilot projects to the
chairs and ranking minority members of the
legislative committees with jurisdiction over
human services finance and policy. This is a
onetime appropriation. Notwithstanding
Minnesota Statutes, section 16A.28,
subdivision 3, this appropriation is available
until June 30, 2027.

(c) Pediatric Hospital-to-Home Transition
Pilot Program. $1,040,000 in fiscal year 2025
is for the pediatric hospital-to-home pilot
program. This is a onetime appropriation.
Notwithstanding Minnesota Statutes, section
16A.28, subdivision 3, this appropriation is
available until June 30, deleted text begin 2027 deleted text end new text begin 2028 new text end .

(d) Artists With Disabilities Support.
$690,000 in fiscal year 2025 is for a payment
to a nonprofit organization licensed under
Minnesota Statutes, chapter 245D, located on
Minnehaha Avenue West in Saint Paul, and
that supports artists with disabilities in creating
visual and performing art that challenges
society's views of persons with disabilities.
This is a onetime appropriation.
Notwithstanding Minnesota Statutes, section
16A.28, subdivision 3, this appropriation is
available until June 30, 2027.

(e) Emergency Relief Grants for Rural
EIDBI Providers. $600,000 in fiscal year
2025 is for emergency relief grants for EIDBI
providers. This is a onetime appropriation.
Notwithstanding Minnesota Statutes, section
16A.28, subdivision 3, this appropriation is
available until June 30, 2027.

(f) Self-Advocacy Grants for Persons with
Intellectual and Developmental Disabilities.
$250,000 in fiscal year 2025 is for
self-advocacy grants under Minnesota Statutes,
section 256.477, subdivision 1, paragraph (a),
clauses (5) to (7), and for administrative costs.
This is a onetime appropriation and is
available until June 30, 2027.

(g) Electronic Visit Verification
Implementation Grants. $864,000 in fiscal
year 2025 is for electronic visit verification
implementation grants. This is a onetime
appropriation. Notwithstanding Minnesota
Statutes, section 16A.28, subdivision 3, this
appropriation is available until June 30, 2027.

(h) Aging and Disability Services for
Immigrant and Refugee Communities.
$250,000 in fiscal year 2025 is for a payment
to SEWA-AIFW to address aging, disability,
and mental health needs for immigrant and
refugee communities. This is a onetime
appropriation and is available until June 30,
2027.

(i) License Transition Support for Small
Disability Waiver Providers. $3,150,000 in
fiscal year 2025 is for license transition
payments to small disability waiver providers.
This is a onetime appropriation.
Notwithstanding Minnesota Statutes, section
16A.28, subdivision 3, this appropriation is
available until June 30, 2027.

(j) Own home services provider
capacity-building grants. $1,519,000 in fiscal
year 2025 is for the own home services
provider capacity-building grant program.
Notwithstanding Minnesota Statutes, section
16A.28, subdivision 3, this appropriation is
available until June 30, 2027. This is a onetime
appropriation.

(k) Continuation of Centers for
Independent Living HCBS Access Grants.
$311,000 in fiscal year 2024 is for continued
funding of grants awarded under Laws 2021,
First Special Session chapter 7, article 17,
section 19, as amended by Laws 2022, chapter
98, article 15, section 15. This is a onetime
appropriation and is available until June 30,
2025.

(l) Base Level Adjustment. The general fund
base is increased by $811,000 in fiscal year
2026 and increased by $811,000 in fiscal year
2027.

Sec. 21.

Laws 2025, First Special Session chapter 3, article 20, section 19, subdivision 1,
is amended to read:

Subdivision 1. deleted text begin Intensive Residential Treatment Services deleted text end new text begin Community Health Unit new text end ; Hennepin County

$563,000 in fiscal year 2026 is for a grant to
the city of Brooklyn Park deleted text begin as start-up funding
for an intensive residential treatment services
and residential crisis stabilization services
facility deleted text end new text begin for the city of Brooklyn Park's
Community Health Unit, operating out of the
Brooklyn Park Police Department new text end . This is a
onetime appropriation and is available until
June 30, deleted text begin 2027 deleted text end new text begin 2028 new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 22. new text begin TRANSFERS AND CANCELLATIONS.
new text end

new text begin Subdivision 1. new text end

new text begin MnCHOICES modification grants. new text end

new text begin The fiscal year 2027 general fund
base appropriation for MnCHOICES modifications first established under Laws 2023,
chapter 61, article 9, section 2, subdivision 16, is reduced from $125,000 to $0. The general
fund base for this purpose is $0 in fiscal year 2028 and $0 in fiscal year 2029.
new text end

new text begin Subd. 2. new text end

new text begin Day training and habilitation facility grants. new text end

new text begin The fiscal year 2028 and fiscal
year 2029 general fund base appropriations for grant allocations to counties for day training
and habilitation services for adults with developmental disabilities when provided as a social
service under Minnesota Statutes, sections 252.41 to 252.46, are reduced from $811,000 to
$0. The general fund base for this purpose is $0 in fiscal year 2028 and $0 in fiscal year
2029.
new text end

new text begin Subd. 3. new text end

new text begin Innovation grants. new text end

new text begin The fiscal year 2027 general fund base appropriation for
the innovation grants program under Minnesota Statutes, section 256B.0921, is reduced
from $1,925,000 to $0. The general fund base for this purpose is $0 in fiscal year 2028 and
$0 in fiscal year 2029.
new text end

new text begin Subd. 4. new text end

new text begin Preadmission screening grant program. new text end

new text begin The fiscal year 2027 general fund
base appropriation for the preadmission screening grant program under Minnesota Statutes,
section 256.975, subdivision 7d, paragraph (b), is reduced from $20,000 to $0. The general
fund base for this purpose is $0 in fiscal year 2028 and $0 in fiscal year 2029.
new text end

new text begin Subd. 5. new text end

new text begin 2023 long-term services and supports loan program. new text end

new text begin Any unencumbered
and unexpended amount of the long-term services and supports program under Minnesota
Statutes, section 256.4792, subdivision 8a, estimated to be $70,854,000, is transferred from
the special revenue fund to the general fund and is canceled.
new text end

new text begin Subd. 6. new text end

new text begin 2024 long-term services and supports loan program. new text end

new text begin Any unencumbered
and unexpended amount of the fiscal year 2026 general fund base appropriation for the
long-term services and supports loan program first established under Laws 2024, chapter
125, article 8, section 2, subdivision 12, paragraph (e), estimated to be $822,000, is canceled.
new text end

new text begin Subd. 7. new text end

new text begin Human services response contingency account transfer. new text end

new text begin The commissioner
of management and budget must transfer $10,000,000 in fiscal year 2026 from the general
fund to the human services response contingency account established under Minnesota
Statutes, section 256.044. This is a onetime transfer.
new text end

Sec. 23. new text begin APPROPRIATIONS GIVEN EFFECT ONCE.
new text end

new text begin If an appropriation or transfer in this article is enacted more than once during the 2026
regular session, the appropriation or transfer must be given effect once.
new text end

Sec. 24. new text begin EXPIRATION OF UNCODIFIED LANGUAGE.
new text end

new text begin All uncodified language contained in this article expires on June 30, 2027, unless a
different expiration date is explicit.
new text end

ARTICLE 8

OTHER AGENCY APPROPRIATIONS

Section 1. new text begin OTHER AGENCY APPROPRIATIONS. new text end

new text begin The sums shown in the columns marked "Appropriations" are added to or, if shown in
parentheses, are subtracted from the appropriations in Laws 2025, First Special Session
chapter 9, article 14, to the agencies and for the purposes specified in this article. The
appropriations are from the general fund or other named fund and are available for the fiscal
years indicated for each purpose. The figures "2026" and "2027" used in this article mean
that the addition or subtraction from the appropriation listed under them is available for the
fiscal year ending June 30, 2026, or June 30, 2027, respectively. Base adjustments mean
the addition to or subtraction from the base level adjustment set in Laws 2025, First Special
Session chapter 9, article 14. Supplemental appropriations and reductions to appropriations
for the fiscal year ending June 30, 2026, are effective the day following final enactment
unless a different effective date is explicit.
new text end

			new text begin APPROPRIATIONS new text end
			new text begin Available for the Year new text end
			new text begin Ending June 30 new text end
				new text begin 2026 new text end		new text begin 2027 new text end

Sec. 2. new text begin COMMISSIONER OF HEALTH; TOTAL APPROPRIATION new text end

new text begin $ new text end

new text begin -0- new text end

new text begin $ new text end

new text begin 4,871,000 new text end

new text begin The amounts that may be spent for each
purpose are specified in the following sections.
new text end

Sec. 3. new text begin HEALTH PROTECTION new text end

new text begin $ new text end

new text begin -0- new text end

new text begin $ new text end

new text begin 4,871,000 new text end

new text begin Subdivision 1. new text end new text begin Small Assisted Living Facility Licensure new text end

new text begin $150,000 in fiscal year 2027 is appropriated
from the general fund to the commissioner of
health to develop small assisted living facility
licensure draft legislation. This is a onetime
appropriation and is available until June 30,
2028.
new text end

new text begin Subd. 2. new text end new text begin Base Level Adjustment new text end

new text begin The general fund base is increased by
$17,566,000 in fiscal year 2028 and increased
by $17,347,000 in fiscal year 2029.
new text end

Sec. 4. new text begin ATTORNEY GENERAL; OVERSIGHT AND ENFORCEMENT OF
MINNESOTA STATUTES, SECTIONS 145D.41 TO 145D.43.
new text end

new text begin $112,000 in fiscal year 2027 is appropriated from the general fund to the attorney general
for oversight and enforcement of Minnesota Statutes, sections 145D.41 to 145D.43.
new text end

Sec. 5.

Laws 2024, chapter 125, article 8, section 2, subdivision 20, is amended to read:

Subd. 20. Direct Care and Treatment - Operations

-0-

6,094,000

(a) Free Communication Services for
Patients and Clients. $1,368,000 in fiscal
year 2025 is for free communication services
under article 6, section 1. This is a onetime
appropriation. Notwithstanding Minnesota
Statutes, section 16A.28, subdivision 3, this
appropriation is available until June 30, 2026.

(b) Direct Care and Treatment Capacity;
Miller Building. $1,796,000 in fiscal year
2025 is to design a replacement facility for the
Miller Building on the Anoka Metro Regional
Treatment Center campus. This is a onetime
appropriation. Notwithstanding Minnesota
Statutes, section 16A.28, subdivision 3, this
appropriation is available until June 30, 2027.

(c) Direct Care and Treatment County
Correctional Facility Support Pilot
Program. $2,387,000 in fiscal year 2025 is
to establish a two-year county correctional
facility support pilot program. The pilot
program must: (1) provide education and
support to counties and county correctional
facilities on protocols and best practices for
the provision of involuntary medications for
mental health treatment; (2) provide technical
assistance to expand access to injectable
psychotropic medications in county
correctional facilities; and (3) survey county
correctional facilities and their contracted
medical providers on their capacity to provide
injectable psychotropic medications, including
involuntary administration of medications,
and barriers to providing these services. This
is a onetime appropriation. Notwithstanding
Minnesota Statutes, section 16A.28,
subdivision 3, this appropriation is available
until June 30, deleted text begin 2026 deleted text end new text begin 2027 new text end .

(d) Advisory Committee for Direct Care
and Treatment. $482,000 in fiscal year 2025
is for the administration of the advisory
committee for the operation of Direct Care
and Treatment. This is a onetime
appropriation. Notwithstanding Minnesota
Statutes, section 16A.28, subdivision 3, this
appropriation is available until June 30, 2027.

(e) Base Level Adjustment. The general fund
base is increased by $31,000 in fiscal year
2026 and increased by $0 in fiscal year 2027.

Sec. 6.

Laws 2025, First Special Session chapter 3, article 21, section 3, subdivision 2, is
amended to read:

Subd. 2. Substance Use Treatment, Recovery, and Prevention Grants

$3,000,000 in fiscal year 2026 and $3,000,000
in fiscal year 2027 are from the general fund
for substance use treatment, recovery, and
prevention grants under Minnesota Statutes,
section 342.72. new text begin The commissioner may use
up to $300,000 of this appropriation for
administration.
new text end

Sec. 7. new text begin APPROPRIATIONS GIVEN EFFECT ONCE.
new text end

new text begin If an appropriation or transfer in this article is enacted more than once during the 2026
regular session, the appropriation or transfer must be given effect once.
new text end

Sec. 8. new text begin EXPIRATION OF UNCODIFIED LANGUAGE.
new text end

new text begin All uncodified language contained in this article expires on June 30, 2027, unless a
different expiration date is explicit.
new text end

APPENDIX

Repealed Minnesota Statutes: S4476-1

144A.04 QUALIFICATIONS FOR LICENSE.

Subd. 7.

Minimum nursing staff requirement.

The minimum staffing standard for nursing personnel in certified nursing homes is as specified in this subdivision.

(a) The minimum number of hours of nursing personnel to be provided in a nursing home is the greater of two hours per resident per 24 hours or 0.95 hours per standardized resident day. Upon transition to the 34 group, RUG-III resident classification system, the 0.95 hours per standardized resident day shall no longer apply.

(b) For purposes of this subdivision, "hours of nursing personnel" means the paid, on-duty, productive nursing hours of all nurses and nursing assistants, calculated on the basis of any given 24-hour period. "Productive nursing hours" means all on-duty hours during which nurses and nursing assistants are engaged in nursing duties. Examples of nursing duties may be found in Minnesota Rules, part 4655.6400. Not included are vacations, holidays, sick leave, in-service classroom training, or lunches. Also not included are the nonproductive nursing hours of the in-service training director. In homes with more than 60 licensed beds, the hours of the director of nursing are excluded. "Standardized resident day" means the sum of the number of residents in each case mix class multiplied by the case mix weight for that resident class, as found in Minnesota Rules, part 9549.0059, subpart 2, calculated on the basis of a facility's census for any given day. For the purpose of determining a facility's census, the commissioner of health shall exclude the resident days claimed by the facility for resident therapeutic leave or bed hold days.

(c) Calculation of nursing hours per standardized resident day is performed by dividing total hours of nursing personnel for a given period by the total of standardized resident days for that same period.

(d) A nursing home that is issued a notice of noncompliance under section 144A.10, subdivision 5, for a violation of this subdivision, shall be assessed a civil fine of $300 for each day of noncompliance, subject to section 144A.10, subdivisions 7 and 8.

256B.055 ELIGIBILITY CATEGORIES.

Subd. 14.

Persons detained by law.

(a) Medical assistance may be paid for an inmate of a correctional facility who is conditionally released as authorized under section 241.26, 244.065, or 631.425, if the individual does not require the security of a public detention facility and is housed in a halfway house or community correction center, or under house arrest and monitored by electronic surveillance in a residence approved by the commissioner of corrections, and if the individual meets the other eligibility requirements of this chapter.

(b) An individual who is enrolled in medical assistance, and who is charged with a crime and incarcerated for less than 12 months shall be suspended from eligibility at the time of incarceration until the individual is released. Upon release, medical assistance eligibility is reinstated without reapplication using a reinstatement process and form, if the individual is otherwise eligible.

(c) An individual, regardless of age, who is considered an inmate of a public institution as defined in Code of Federal Regulations, title 42, section 435.1010, and who meets the eligibility requirements in section 256B.056, is not eligible for medical assistance, except for covered services received while an inpatient in a medical institution as defined in Code of Federal Regulations, title 42, section 435.1010. Security issues, including costs, related to the inpatient treatment of an inmate are the responsibility of the entity with jurisdiction over the inmate.

256B.0921 HOME AND COMMUNITY-BASED SERVICES INNOVATION POOL.

The commissioner of human services shall develop an initiative to provide incentives for innovation in: (1) achieving integrated competitive employment; (2) achieving integrated competitive employment for youth under age 25 upon their graduation from school; (3) living in the most integrated setting; and (4) other outcomes determined by the commissioner. The commissioner shall seek requests for proposals and shall contract with one or more entities to provide incentive payments for meeting identified outcomes.

256B.4907 ADVISORY TASK FORCE ON WAIVER REIMAGINE.

Subdivision 1.

Membership; co-chairs.

(a) The Advisory Task Force on Waiver Reimagine consists of the following members:

(1) one member of the house of representatives, appointed by the speaker of the house;

(2) one member of the house of representatives, appointed by the leader of the house of representatives Democratic-Farmer-Labor caucus;

(3) one member of the senate, appointed by the senate majority leader;

(4) one member of the senate, appointed by the senate minority leader;

(5) four individuals currently receiving disability waiver services who are under the age of 65, appointed by the governor;

(6) one county employee who conducts long-term care consultation services assessments for persons under the age of 65, appointed by the Minnesota Association of County Social Services Administrators;

(7) one representative of the Department of Human Services with knowledge of the requirements for a provider to participate in disability waiver service programs and of the administration of benefits, appointed by the commissioner of human services;

(8) one employee of the Minnesota Council on Disability, appointed by the Minnesota Council on Disability;

(9) two representatives of disability advocacy organizations, appointed by the governor;

(10) two family members of individuals who are receiving disability waiver services, appointed by the governor;

(11) two providers of disability waiver services for persons who are under the age of 65, appointed by the governor;

(12) one employee from the Office of Ombudsman for Mental Health and Developmental Disabilities, appointed by the ombudsman;

(13) one employee from the Olmstead Implementation Office, appointed by the director of the office;

(14) the assistant commissioner of the Department of Human Services administration that oversees disability services; and

(15) a member of the Minnesota Disability Law Center, appointed by the executive director of Mid-Minnesota Legal Aid.

(b) Each appointing authority must make appointments by September 30, 2025. Appointments made by an agency or commissioner may also be made by a designee.

(c) In making task force appointments, the governor must ensure representation from greater Minnesota.

(d) The Office of Collaboration and Dispute Resolution must convene the task force.

(e) The task force members must elect co-chairs from the membership of the task force at the first task force meeting.

Subd. 2.

Meetings; administrative support.

(a) The first meeting of the task force must be convened no later than November 30, 2025. The task force must meet at least quarterly. Meetings are subject to chapter 13D. The task force may meet by telephone or interactive technology consistent with section 13D.015.

(b) The Department of Human Services shall provide meeting space and administrative and research support to the task force.

Subd. 3.

Duties.

(a) The task force must make findings and recommendations related to waiver reimagine in Minnesota, including but not limited to the following:

(1) consolidation of the existing four disability home and community-based waiver service programs into two waiver programs;

(2) budgets based on the needs of the individual that are not tied to location of services, including resources beyond those required to meet assessed needs that may be necessary for the individual to live in the least restrictive environment;

(3) criteria and processes for provider rate exceptions and individualized budget exceptions;

(4) appropriate assessments, including the MnCHOICES 2.0 assessment tool, in determining service needs and individualized budgets;

(5) covered services under each disability waiver program, including any proposed adjustments to the menu of services;

(6) service planning and authorization processes for disability waiver services;

(7) a plan of support, financial and otherwise, to live in the person's own home and in the most integrated setting as defined under Title 2 of the Americans with Disabilities Act Integration Mandate and in Minnesota's Olmstead Plan;

(8) intended and unintended outcomes of waiver reimagine; and

(9) other items related to waiver reimagine as necessary.

(b) The task force must seek input from the public, counties, persons receiving disability waiver services, families of persons receiving disability waiver services, providers, state agencies, and advocacy groups.

(c) The task force must hold public meetings to gather information to fulfill the purpose of the task force. The meetings must be accessible by remote participants.

(d) The Department of Human Services shall provide relevant data and research to the task force to facilitate the task force's work.

Subd. 4.

Compensation; expenses.

Members of the task force may receive compensation and expense reimbursement as provided in section 15.059, subdivision 3.

Subd. 5.

Report.

(a) The task force shall submit a report to the chairs and ranking minority members of the legislative committees with jurisdiction over disability waiver services no later than January 15, 2027, that describes any concerns or recommendations related to waiver reimagine as identified by the task force.

(b) The report required under Laws 2021, First Special Session chapter 7, article 13, section 75, subdivision 4, as amended by Laws 2024, chapter 108, article 1, section 28, must be presented to the task force prior to December 15, 2026.

Subd. 6.

Task force does not expire.

Notwithstanding section 15.059, subdivision 6, the task force under this section does not expire.

256S.205 CUSTOMIZED LIVING SERVICES; DISPROPORTIONATE SHARE RATE ADJUSTMENTS.

Subd. 7.

Expiration.

This section expires May 31, 2028.

Repealed Minnesota Session Laws: S4476-1

Laws 2019, First Special Session chapter 9, article 5, section 86, as amended by Laws 2020, First Special Session chapter 2, article 3, section 2

Sec. 2.

Laws 2019, First Special Session chapter 9, article 5, section 86, is amended to read:

Sec. 86. DISABILITY WAIVER RECONFIGURATION.

Subdivision 1.

Intent.

It is the intent of the legislature to reform the medical assistance waiver programs for people with disabilities to simplify administration of the programs. Disability waiver reconfiguration must incentivize inclusive, person-centered, individualized supports and services; enhance each person's self-determination and personal authority over the person's service choice; align benefits across waivers; ensure equity across programs and populations; promote long-term sustainability of waiver services; and maintain service stability and continuity of care while prioritizing, promoting, and creating incentives for independent, integrated, and individualized supports and services chosen by each person through an informed decision-making process and person-centered planning.

Subd. 2.

Report.

By January 15, 2021, the commissioner of human services shall submit a report to the members of the legislative committees with jurisdiction over human services on any necessary waivers, state plan amendments, requests for new funding or realignment of existing funds, any changes to state statute or rule, and any other federal authority necessary to implement this section. The report must include information about the commissioner's work to collect feedback and input from providers, persons accessing home and community-based services waivers and their families, and client advocacy organizations.

Subd. 3.

Proposal.

By January 15, 2021, the commissioner shall develop a proposal to reconfigure the medical assistance waivers provided in sections 256B.092 and 256B.49. The proposal shall include all necessary plans for implementing two home and community-based services waiver programs, as authorized under section 1915(c) of the Social Security Act that serve persons who are determined to require the levels of care provided in a nursing home, a hospital, a neurobehavioral hospital, or an intermediate care facility for persons with developmental disabilities. The proposal must include in each home and community-based waiver program options to self-direct services. Before submitting the final report to the legislature, the commissioner shall publish a draft report with sufficient time for interested persons to offer additional feedback.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Laws 2021, First Special Session chapter 7, article 13, section 73, as amended by Laws 2025, First Special Session chapter 9, article 2, section 56

Sec. 56.

Laws 2021, First Special Session chapter 7, article 13, section 73, is amended to read:

Sec. 73. WAIVER REIMAGINE PHASE II.

(a) Effective January 1, 2027, or upon federal approval, whichever is later, the commissioner of human services must implement a two-home and community-based services waiver program structure, as authorized under section 1915(c) of the federal Social Security Act, that serves persons who are determined by a certified assessor to require the levels of care provided in a nursing home, a hospital, a neurobehavioral hospital, or an intermediate care facility for persons with developmental disabilities.

(b) The commissioner of human services must implement an individualized budget methodology, as authorized under section 1915(c) of the federal Social Security Act, that serves persons who are determined by a certified assessor to require the levels of care provided in a nursing home, a hospital, a neurobehavioral hospital, or an intermediate care facility for persons with developmental disabilities.

(c) The commissioner must develop an individualized budget methodology exception to support access to self-directed home care nursing services. Lead agencies must submit budget exception requests to the commissioner in a manner identified by the commissioner. Eligibility for the budget exception in this paragraph is limited to persons meeting all of the following criteria in the person's most recent assessment:

(1) the person is assessed to need the level of care delivered in a hospital setting as evidenced by the submission of the Department of Human Services form 7096, primary medical provider's documentation of medical monitoring and treatment needs;

(2) the person is assessed to receive a support range budget of E or H; and

(3) the person does not receive community residential services, family residential services, integrated community supports services, or customized living services.

(d) Home care nursing services funded through the budget exception developed under paragraph (c) must be ordered by a physician, physician assistant, or advanced practice registered nurse. If the participant chooses home care nursing, the home care nursing services must be performed by a registered nurse or licensed practical nurse practicing within the registered nurse's or licensed practical nurse's scope of practice as defined under Minnesota Statutes, sections 148.171 to 148.285. If after a person's annual reassessment under Minnesota Statutes, section 256B.0911, any requirements of this paragraph or paragraph (c) are no longer met, the commissioner must terminate the budget exception.

(e) The commissioner of human services may seek all federal authority necessary to implement this section.

(f) The commissioner must ensure that the new waiver service menu and individual budgets allow people to live in their own home, family home, or any home and community-based setting of their choice. The commissioner must ensure, within available resources and subject to state and federal regulations and law, that waiver reimagine does not result in unintended service disruptions.

(g) No later than July 1, 2026, the commissioner must:

(1) develop and implement an online support planning and tracking tool to provide information in an accessible format to support informed choice for people using disability waiver services that allows access to the total budget available to a person, the services for which they are eligible, and the services they have chosen and used;

(2) explore operability options that facilitate real-time tracking of a person's remaining available budget throughout the service year; and

(3) seek input from people with disabilities about the online support planning and tracking tool prior to the tool's implementation.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Laws 2021, First Special Session chapter 7, article 13, section 75, subdivision 1, as amended by Laws 2024, chapter 108, article 1, section 28;

Sec. 75. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; WAIVER REIMAGINE AND INFORMED CHOICE STAKEHOLDER CONSULTATION. new text end

Subdivision 1.

Stakeholder consultation; generally.

(a) The commissioner of human services must consult with and seek input and assistance from stakeholders concerning potential adjustments to the streamlined service menu from waiver reimagine phase I and to the existing rate exemption criteria and process.

(b) The commissioner of human services must consult with deleted text begin and deleted text end new text begin , new text end seek input and assistance from new text begin , and collaborate with new text end stakeholders concerning the development and implementation of waiver reimagine phase II, including criteria and a process for individualized budget exemptions, and how waiver reimagine phase II can support and expand informed choice and informed decision making, including integrated employment, independent living, and self-direction, consistent with Minnesota Statutes, section 256B.4905.

new text begin (c) The commissioner of human services must consult with, seek input and assistance from, and collaborate with stakeholders concerning the implementation and revisions of the MnCHOICES 2.0 assessment tool. new text end