2nd Engrossment - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am
1.1 A bill for an act 1.2 relating to the operation of state government; making 1.3 changes to health and human services programs; 1.4 changing licensing and state-operated services 1.5 provisions; changing provisions in state health care 1.6 programs, changing MinnesotaCare to a forecasted 1.7 program and changing eligibility requirements and 1.8 payments, allowing transfer of excess health care 1.9 access funds to the general fund, allowing the 1.10 commissioner to withhold for delinquent nursing home 1.11 provider surcharges, allowing reduction of excess 1.12 assets for MA and changing other MA provisions, 1.13 reducing payments to managed care plans, establishing 1.14 medical necessity standards for state health care 1.15 programs, allowing the state to recover payment for 1.16 long-term care from trusts and life estates or joint 1.17 tenancy interests, and establishing a health services 1.18 policy committee and medication therapy management; 1.19 establishing a value-based nursing facility 1.20 reimbursement system and changing other provisions for 1.21 nursing facilities; changing continuing care for the 1.22 elderly and disabled provisions and establishing the 1.23 Minnesota partnership for long-term care programs, 1.24 increasing rate reimbursement for ICF/MR facilities, 1.25 health care services, and provider rate increases, 1.26 requiring a study for dental access, establishing an 1.27 interagency work group on disability services; 1.28 changing provisions for mental health services, 1.29 allowing payment for mental health telemedicine, 1.30 providing treatment foster care services and 1.31 transitional youth intensive rehabilitative mental 1.32 health services; modifying health policy, establishing 1.33 a Health Information Technology and Infrastructure 1.34 Advisory Committee, establishing a rural pharmacy 1.35 planning and transition grant program, requiring a 1.36 report from physicians and facilities performing 1.37 abortions, classifying data in abortion notification 1.38 reports, providing education on shaking infants and 1.39 children, establishing a voluntary trauma system, 1.40 trauma registry, and trauma advisory council, 1.41 establishing a cancer drug repository program, 1.42 prohibiting family grant funds to subsidize abortion 1.43 services, promoting positive abortion alternatives, 1.44 establishing the unborn child pain prevention act, 1.45 providing education on postpartum depression, 1.46 adjusting certain fees, providing civil and criminal 2.1 penalties; making forecast adjustments; appropriating 2.2 money; and providing for alternative funding; amending 2.3 Minnesota Statutes 2004, sections 13.3806, by adding a 2.4 subdivision; 16A.724; 103I.101, subdivision 6; 2.5 103I.208, subdivisions 1, 2; 103I.235, subdivision 1; 2.6 103I.601, subdivision 2; 144.122; 144.147, 2.7 subdivisions 1, 2; 144.148, subdivision 1; 144.1483; 2.8 144.1501, subdivisions 1, 2, 3, 4; 144.226, 2.9 subdivisions 1, 4, by adding subdivisions; 144.3831, 2.10 subdivision 1; 144.551, subdivision 1; 144.562, 2.11 subdivision 2; 144.9504, subdivision 2; 144.98, 2.12 subdivision 3; 144A.071, subdivision 4a; 144A.073, by 2.13 adding a subdivision; 144E.101, by adding a 2.14 subdivision; 145.56, subdivisions 2, 5; 145.924; 2.15 145.9268; 146A.11, subdivision 1; 147A.08; 150A.22; 2.16 157.15, by adding a subdivision; 157.16, subdivisions 2.17 2, 3, by adding subdivisions; 157.20, subdivisions 2, 2.18 2a; 214.01, subdivision 2; 214.06, subdivision 1, by 2.19 adding a subdivision; 245.4661, subdivisions 2, 6; 2.20 245.4885, subdivisions 1, 2, by adding a subdivision; 2.21 245A.10, subdivision 5; 245C.10, subdivisions 2, 3; 2.22 245C.32, subdivision 2; 246.0136, subdivision 1; 2.23 252.27, subdivision 2a; 253.20; 253B.02, subdivision 2.24 7; 256.01, subdivision 2, by adding subdivisions; 2.25 256.019, subdivision 1; 256.045, subdivisions 3, 3a; 2.26 256.046, subdivision 1; 256.9657, by adding a 2.27 subdivision; 256.969, subdivisions 3a, 26; 256B.02, 2.28 subdivision 12; 256B.04, by adding a subdivision; 2.29 256B.056, subdivisions 5, 5a, 5b, 7, by adding 2.30 subdivisions; 256B.057, subdivision 9; 256B.0575; 2.31 256B.0595, subdivision 2; 256B.06, subdivision 4; 2.32 256B.0621, subdivisions 2, 3, 4, 5, 6, 7, by adding a 2.33 subdivision; 256B.0625, subdivisions 2, 3a, 13, 13a, 2.34 13c, 13e, 13f, 17, by adding subdivisions; 256B.0644; 2.35 256B.075, subdivision 2; 256B.0913, subdivisions 2, 4; 2.36 256B.0916, by adding a subdivision; 256B.095; 2.37 256B.0951, subdivision 1; 256B.0952, subdivision 5; 2.38 256B.0953, subdivision 1; 256B.15, subdivision 1; 2.39 256B.19, subdivision 1; 256B.195, subdivision 3; 2.40 256B.32, subdivision 1; 256B.431, subdivisions 28, 29, 2.41 35, by adding subdivisions; 256B.432, subdivisions 1, 2.42 2, 5, by adding subdivisions; 256B.434, subdivisions 2.43 3, 4, 4a, 4b, 4c, 4d, by adding subdivisions; 2.44 256B.438, subdivision 3; 256B.47, subdivision 2; 2.45 256B.49, subdivision 16; 256B.5012, by adding a 2.46 subdivision; 256B.69, subdivisions 4, 23, by adding a 2.47 subdivision; 256B.75; 256B.765; 256D.03, subdivisions 2.48 3, 4, by adding subdivisions; 256D.045; 256L.01, 2.49 subdivisions 1a, 4, 5; 256L.03, subdivisions 1, 3, 5, 2.50 by adding a subdivision; 256L.04, subdivisions 1, 2, 2.51 8, by adding subdivisions; 256L.05, subdivisions 2, 3, 2.52 3a, 5; 256L.06, subdivision 3; 256L.07, subdivisions 2.53 1, 3, by adding a subdivision; 256L.09, subdivision 2; 2.54 256L.11, subdivision 6; 256L.12, subdivision 6, by 2.55 adding a subdivision; 256L.15, subdivisions 2, 3; 2.56 326.42, subdivision 2; 471.61, by adding a 2.57 subdivision; 514.981, subdivision 6; Laws 2003, First 2.58 Special Session chapter 14, article 12, section 93; 2.59 proposing coding for new law in Minnesota Statutes, 2.60 chapters 62J; 144; 145; 245A; 256B; 501B; repealing 2.61 Minnesota Statutes 2004, sections 13.383, subdivision 2.62 3; 13.411, subdivision 3; 144.1486; 144.1502; 145.925; 2.63 146A.01, subdivisions 2, 5; 146A.02; 146A.03; 146A.04; 2.64 146A.05; 146A.06; 146A.07; 146A.08; 146A.09; 146A.10; 2.65 157.215; 256.955; 256B.075, subdivision 5; 256L.035; 2.66 256L.04, subdivisions 7, 11; 256L.09, subdivisions 1, 2.67 4, 5, 6, 7; 295.581; Minnesota Rules, parts 4700.1900; 2.68 4700.2000; 4700.2100; 4700.2200; 4700.2210; 4700.2300; 2.69 4700.2400; 4700.2410; 4700.2420; 4700.2500. 2.70 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 3.1 ARTICLE 1 3.2 LICENSING 3.3 Section 1. Minnesota Statutes 2004, section 245A.10, 3.4 subdivision 5, is amended to read: 3.5 Subd. 5. [ANNUAL LICENSE OR CERTIFICATION FEE FOR PROGRAMS 3.6 WITHOUT A LICENSED CAPACITY.] (a) Except as provided 3.7 inparagraphparagraphs (b) and (c), a program without a stated 3.8 licensed capacity shall pay a license or certification fee of 3.9 $400. 3.10 (b) A mental health center or mental health clinic 3.11 requesting certification for purposes of insurance and 3.12 subscriber contract reimbursement under Minnesota Rules, parts 3.13 9520.0750 to 9520.0870, shall pay a certification fee of $1,000 3.14 per year. If the mental health center or mental health clinic 3.15 provides services at a primary location with satellite 3.16 facilities, the satellite facilities shall be certified with the 3.17 primary location without an additional charge. 3.18 (c) A program licensed to provide residential-based 3.19 habilitation services under the home and community-based waiver 3.20 for persons with developmental disabilities shall pay an annual 3.21 license fee that includes a base rate of $250 plus $38 times the 3.22 number of clients served on the first day of August of the 3.23 current license year. State-operated programs are exempt from 3.24 the license fee under this paragraph. 3.25 Sec. 2. Minnesota Statutes 2004, section 245C.10, 3.26 subdivision 2, is amended to read: 3.27 Subd. 2. [SUPPLEMENTAL NURSING SERVICES AGENCIES.] The 3.28 commissioner shall recover the cost of the background studies 3.29 initiated by supplemental nursing services agencies registered 3.30 under section 144A.71, subdivision 1, through a fee of no more 3.31 than$8$20 per study charged to the agency. The fees collected 3.32 under this subdivision are appropriated to the commissioner for 3.33 the purpose of conducting background studies. 3.34 Sec. 3. Minnesota Statutes 2004, section 245C.10, 3.35 subdivision 3, is amended to read: 3.36 Subd. 3. [PERSONAL CARE PROVIDER ORGANIZATIONS.] The 4.1 commissioner shall recover the cost of background studies 4.2 initiated by a personal care provider organization under section 4.3 256B.0627 through a fee of no more than$12$20 per study 4.4 charged to the organization responsible for submitting the 4.5 background study form. The fees collected under this 4.6 subdivision are appropriated to the commissioner for the purpose 4.7 of conducting background studies. 4.8 Sec. 4. Minnesota Statutes 2004, section 245C.32, 4.9 subdivision 2, is amended to read: 4.10 Subd. 2. [USE.] (a) The commissioner may also use these 4.11 systems and records to obtain and provide criminal history data 4.12 from the Bureau of Criminal Apprehension, criminal history data 4.13 held by the commissioner, and data about substantiated 4.14 maltreatment under section 626.556 or 626.557, for other 4.15 purposes, provided that: 4.16 (1) the background study is specifically authorized in 4.17 statute; or 4.18 (2) the request is made with the informed consent of the 4.19 subject of the study as provided in section 13.05, subdivision 4. 4.20 (b) An individual making a request under paragraph (a), 4.21 clause (2), must agree in writing not to disclose the data to 4.22 any other individual without the consent of the subject of the 4.23 data. 4.24 (c) The commissioner may recover the cost of obtaining and 4.25 providing background study data by charging the individual or 4.26 entity requesting the study a fee of no more than$12$20 per 4.27 study. The fees collected under this paragraph are appropriated 4.28 to the commissioner for the purpose of conducting background 4.29 studies. 4.30 ARTICLE 2 4.31 STATE-OPERATED SERVICES 4.32 Section 1. Minnesota Statutes 2004, section 245.4661, 4.33 subdivision 2, is amended to read: 4.34 Subd. 2. [PROGRAM DESIGN AND IMPLEMENTATION.] (a) The 4.35 pilot projects shall be established to design, plan, and improve 4.36 the mental health service delivery system for adults with 5.1 serious and persistent mental illness that would: 5.2 (1) provide an expanded array of services from which 5.3 clients can choose services appropriate to their needs; 5.4 (2) be based on purchasing strategies that improve access 5.5 and coordinate services without cost shifting; 5.6 (3) incorporate existing state facilities and resources 5.7 into the community mental health infrastructure through creative 5.8 partnerships with local vendors; and 5.9 (4) utilize existing categorical funding streams and 5.10 reimbursement sources in combined and creative ways, except 5.11 appropriations to regional treatment centers and all funds that 5.12 are attributable to the operation of state-operated services are 5.13 excluded unless appropriated specifically by the legislature for 5.14 a purpose consistent with this section or section 246.0136, 5.15 subdivision 1. 5.16 (b) All projects funded by January 1, 1997, must complete 5.17 the planning phase and be operational by June 30, 1997; all 5.18 projects funded by January 1, 1998, must be operational by June 5.19 30, 1998. 5.20 Sec. 2. Minnesota Statutes 2004, section 245.4661, 5.21 subdivision 6, is amended to read: 5.22 Subd. 6. [DUTIES OF COMMISSIONER.] (a) For purposes of the 5.23 pilot projects, the commissioner shall facilitate integration of 5.24 funds or other resources as needed and requested by each 5.25 project. These resources may include: 5.26 (1) residential services funds administered under Minnesota 5.27 Rules, parts 9535.2000 to 9535.3000, in an amount to be 5.28 determined by mutual agreement between the project's managing 5.29 entity and the commissioner of human services after an 5.30 examination of the county's historical utilization of facilities 5.31 located both within and outside of the county and licensed under 5.32 Minnesota Rules, parts 9520.0500 to 9520.0690; 5.33 (2) community support services funds administered under 5.34 Minnesota Rules, parts 9535.1700 to 9535.1760; 5.35 (3) other mental health special project funds; 5.36 (4) medical assistance, general assistance medical care, 6.1 MinnesotaCare and group residential housing if requested by the 6.2 project's managing entity, and if the commissioner determines 6.3 this would be consistent with the state's overall health care 6.4 reform efforts; and 6.5 (5) regional treatment centernonfiscalresourcesto the6.6extent agreed to by the project's managing entity and the6.7regional treatment centerconsistent with section 246.0136, 6.8 subdivision 1. 6.9 (b) The commissioner shall consider the following criteria 6.10 in awarding start-up and implementation grants for the pilot 6.11 projects: 6.12 (1) the ability of the proposed projects to accomplish the 6.13 objectives described in subdivision 2; 6.14 (2) the size of the target population to be served; and 6.15 (3) geographical distribution. 6.16 (c) The commissioner shall review overall status of the 6.17 projects initiatives at least every two years and recommend any 6.18 legislative changes needed by January 15 of each odd-numbered 6.19 year. 6.20 (d) The commissioner may waive administrative rule 6.21 requirements which are incompatible with the implementation of 6.22 the pilot project. 6.23 (e) The commissioner may exempt the participating counties 6.24 from fiscal sanctions for noncompliance with requirements in 6.25 laws and rules which are incompatible with the implementation of 6.26 the pilot project. 6.27 (f) The commissioner may award grants to an entity 6.28 designated by a county board or group of county boards to pay 6.29 for start-up and implementation costs of the pilot project. 6.30 Sec. 3. Minnesota Statutes 2004, section 246.0136, 6.31 subdivision 1, is amended to read: 6.32 Subdivision 1. [PLANNING FOR ENTERPRISE ACTIVITIES.] The 6.33 commissioner of human services is directed to study and make 6.34 recommendations to the legislature on establishing enterprise 6.35 activities within state-operated services. Before implementing 6.36 an enterprise activity, the commissioner must obtain statutory 7.1 authorization for its implementation, except that the 7.2 commissioner has authority to implement enterprise activities 7.3 for adult mental health, adolescent services, and to establish a 7.4 public group practice without statutory authorization. 7.5 Enterprise activities are defined as the range of services, 7.6 which are delivered by state employees, needed by people with 7.7 disabilities and are fully funded by public or private 7.8 third-party health insurance or other revenue sources available 7.9 to clients that provide reimbursement for the services 7.10 provided. Enterprise activities within state-operated services 7.11 shall specialize in caring for vulnerable people for whom no 7.12 other providers are available or for whom state-operated 7.13 services may be the provider selected by the payer. In 7.14 subsequent biennia after an enterprise activity is established 7.15 within a state-operated service, the base state appropriation 7.16 for that state-operated service shall be reduced proportionate 7.17 to the size of the enterprise activity. 7.18 Sec. 4. Minnesota Statutes 2004, section 253.20, is 7.19 amended to read: 7.20 253.20 [MINNESOTA SECURITY HOSPITAL.] 7.21 The commissioner of human services shall erect, equip, and 7.22 maintain in St. Peteraand other geographic locations under the 7.23 control of the commissioner of human services suitable 7.24buildingbuildings to be known as the Minnesota Security 7.25 Hospital, for the purpose of providing a secure treatment 7.26 facility as defined in section 253B.02, subdivision 18a, for 7.27 persons who may be committed there by courts, or otherwise, or 7.28 transferred there by the commissioner of human services, and for 7.29 persons who are found to be mentally ill while confined in any 7.30 correctional facility, or who may be found to be mentally ill 7.31 and dangerous, and the commissioner shall supervise and manage 7.32 the same as in the case of other state hospitals. 7.33 ARTICLE 3 7.34 HEALTH CARE 7.35 Section 1. Minnesota Statutes 2004, section 16A.724, is 7.36 amended to read: 8.1 16A.724 [HEALTH CARE ACCESS FUND.] 8.2 Subdivision 1. [CREATION OF FUND.] (a) A health care 8.3 access fund is created in the state treasury. The fund is a 8.4 direct appropriated special revenue fund. The commissioner 8.5 shall deposit to the credit of the fund money made available to 8.6 the fund. Notwithstanding section 11A.20, after June 30, 1997, 8.7 all investment income and all investment losses attributable to 8.8 the investment of the health care access fund not currently 8.9 needed shall be credited to the health care access fund. 8.10 (b) Effective July 1, 2006, the commissioner of finance 8.11 shall deposit revenues collected from section 256.9657, 8.12 subdivisions 2 and 3, into the health care access fund. 8.13 Subd. 2. [TRANSFERS.] To the extent available resources in 8.14 the health care access fund exceed expenditures in that fund, 8.15 starting in fiscal year 2005, the commissioner of finance shall 8.16 transfer the excess funds from the health care access fund to 8.17 the general fund on June 30 of each year. 8.18 (a) In fiscal year 2005, transfers may not exceed 8.19 $192,442,000. For fiscal year 2008 and thereafter, the transfer 8.20 may not exceed $50,000,000. 8.21 (b) For fiscal years 2005 to 2007, MinnesotaCare shall be a 8.22 forecasted program and, if necessary, the commissioner shall 8.23 reduce transfers to meet expenditures and shall transfer 8.24 sufficient funds from the general fund to the health care access 8.25 fund to meet annual expenditures. 8.26 [EFFECTIVE DATE.] This section is effective the day 8.27 following final enactment. 8.28 Sec. 2. Minnesota Statutes 2004, section 256.01, 8.29 subdivision 2, is amended to read: 8.30 Subd. 2. [SPECIFIC POWERS.] Subject to the provisions of 8.31 section 241.021, subdivision 2, the commissioner of human 8.32 services shall carry out the specific duties in paragraphs (a) 8.33 through(aa)(cc): 8.34 (a) Administer and supervise all forms of public assistance 8.35 provided for by state law and other welfare activities or 8.36 services as are vested in the commissioner. Administration and 9.1 supervision of human services activities or services includes, 9.2 but is not limited to, assuring timely and accurate distribution 9.3 of benefits, completeness of service, and quality program 9.4 management. In addition to administering and supervising human 9.5 services activities vested by law in the department, the 9.6 commissioner shall have the authority to: 9.7 (1) require county agency participation in training and 9.8 technical assistance programs to promote compliance with 9.9 statutes, rules, federal laws, regulations, and policies 9.10 governing human services; 9.11 (2) monitor, on an ongoing basis, the performance of county 9.12 agencies in the operation and administration of human services, 9.13 enforce compliance with statutes, rules, federal laws, 9.14 regulations, and policies governing welfare services and promote 9.15 excellence of administration and program operation; 9.16 (3) develop a quality control program or other monitoring 9.17 program to review county performance and accuracy of benefit 9.18 determinations; 9.19 (4) require county agencies to make an adjustment to the 9.20 public assistance benefits issued to any individual consistent 9.21 with federal law and regulation and state law and rule and to 9.22 issue or recover benefits as appropriate; 9.23 (5) delay or deny payment of all or part of the state and 9.24 federal share of benefits and administrative reimbursement 9.25 according to the procedures set forth in section 256.017; 9.26 (6) make contracts with and grants to public and private 9.27 agencies and organizations, both profit and nonprofit, and 9.28 individuals, using appropriated funds; and 9.29 (7) enter into contractual agreements with federally 9.30 recognized Indian tribes with a reservation in Minnesota to the 9.31 extent necessary for the tribe to operate a federally approved 9.32 family assistance program or any other program under the 9.33 supervision of the commissioner. The commissioner shall consult 9.34 with the affected county or counties in the contractual 9.35 agreement negotiations, if the county or counties wish to be 9.36 included, in order to avoid the duplication of county and tribal 10.1 assistance program services. The commissioner may establish 10.2 necessary accounts for the purposes of receiving and disbursing 10.3 funds as necessary for the operation of the programs. 10.4 (b) Inform county agencies, on a timely basis, of changes 10.5 in statute, rule, federal law, regulation, and policy necessary 10.6 to county agency administration of the programs. 10.7 (c) Administer and supervise all child welfare activities; 10.8 promote the enforcement of laws protecting handicapped, 10.9 dependent, neglected and delinquent children, and children born 10.10 to mothers who were not married to the children's fathers at the 10.11 times of the conception nor at the births of the children; 10.12 license and supervise child-caring and child-placing agencies 10.13 and institutions; supervise the care of children in boarding and 10.14 foster homes or in private institutions; and generally perform 10.15 all functions relating to the field of child welfare now vested 10.16 in the State Board of Control. 10.17 (d) Administer and supervise all noninstitutional service 10.18 to handicapped persons, including those who are visually 10.19 impaired, hearing impaired, or physically impaired or otherwise 10.20 handicapped. The commissioner may provide and contract for the 10.21 care and treatment of qualified indigent children in facilities 10.22 other than those located and available at state hospitals when 10.23 it is not feasible to provide the service in state hospitals. 10.24 (e) Assist and actively cooperate with other departments, 10.25 agencies and institutions, local, state, and federal, by 10.26 performing services in conformity with the purposes of Laws 10.27 1939, chapter 431. 10.28 (f) Act as the agent of and cooperate with the federal 10.29 government in matters of mutual concern relative to and in 10.30 conformity with the provisions of Laws 1939, chapter 431, 10.31 including the administration of any federal funds granted to the 10.32 state to aid in the performance of any functions of the 10.33 commissioner as specified in Laws 1939, chapter 431, and 10.34 including the promulgation of rules making uniformly available 10.35 medical care benefits to all recipients of public assistance, at 10.36 such times as the federal government increases its participation 11.1 in assistance expenditures for medical care to recipients of 11.2 public assistance, the cost thereof to be borne in the same 11.3 proportion as are grants of aid to said recipients. 11.4 (g) Establish and maintain any administrative units 11.5 reasonably necessary for the performance of administrative 11.6 functions common to all divisions of the department. 11.7 (h) Act as designated guardian of both the estate and the 11.8 person of all the wards of the state of Minnesota, whether by 11.9 operation of law or by an order of court, without any further 11.10 act or proceeding whatever, except as to persons committed as 11.11 mentally retarded. For children under the guardianship of the 11.12 commissioner whose interests would be best served by adoptive 11.13 placement, the commissioner may contract with a licensed 11.14 child-placing agency or a Minnesota tribal social services 11.15 agency to provide adoption services. A contract with a licensed 11.16 child-placing agency must be designed to supplement existing 11.17 county efforts and may not replace existing county programs, 11.18 unless the replacement is agreed to by the county board and the 11.19 appropriate exclusive bargaining representative or the 11.20 commissioner has evidence that child placements of the county 11.21 continue to be substantially below that of other counties. 11.22 Funds encumbered and obligated under an agreement for a specific 11.23 child shall remain available until the terms of the agreement 11.24 are fulfilled or the agreement is terminated. 11.25 (i) Act as coordinating referral and informational center 11.26 on requests for service for newly arrived immigrants coming to 11.27 Minnesota. 11.28 (j) The specific enumeration of powers and duties as 11.29 hereinabove set forth shall in no way be construed to be a 11.30 limitation upon the general transfer of powers herein contained. 11.31 (k) Establish county, regional, or statewide schedules of 11.32 maximum fees and charges which may be paid by county agencies 11.33 for medical, dental, surgical, hospital, nursing and nursing 11.34 home care and medicine and medical supplies under all programs 11.35 of medical care provided by the state and for congregate living 11.36 care under the income maintenance programs. 12.1 (l) Have the authority to conduct and administer 12.2 experimental projects to test methods and procedures of 12.3 administering assistance and services to recipients or potential 12.4 recipients of public welfare. To carry out such experimental 12.5 projects, it is further provided that the commissioner of human 12.6 services is authorized to waive the enforcement of existing 12.7 specific statutory program requirements, rules, and standards in 12.8 one or more counties. The order establishing the waiver shall 12.9 provide alternative methods and procedures of administration, 12.10 shall not be in conflict with the basic purposes, coverage, or 12.11 benefits provided by law, and in no event shall the duration of 12.12 a project exceed four years. It is further provided that no 12.13 order establishing an experimental project as authorized by the 12.14 provisions of this section shall become effective until the 12.15 following conditions have been met: 12.16 (1) the secretary of health and human services of the 12.17 United States has agreed, for the same project, to waive state 12.18 plan requirements relative to statewide uniformity; and 12.19 (2) a comprehensive plan, including estimated project 12.20 costs, shall be approved by the Legislative Advisory Commission 12.21 and filed with the commissioner of administration. 12.22 (m) According to federal requirements, establish procedures 12.23 to be followed by local welfare boards in creating citizen 12.24 advisory committees, including procedures for selection of 12.25 committee members. 12.26 (n) Allocate federal fiscal disallowances or sanctions 12.27 which are based on quality control error rates for the aid to 12.28 families with dependent children program formerly codified in 12.29 sections 256.72 to 256.87, medical assistance, or food stamp 12.30 program in the following manner: 12.31 (1) one-half of the total amount of the disallowance shall 12.32 be borne by the county boards responsible for administering the 12.33 programs. For the medical assistance and the AFDC program 12.34 formerly codified in sections 256.72 to 256.87, disallowances 12.35 shall be shared by each county board in the same proportion as 12.36 that county's expenditures for the sanctioned program are to the 13.1 total of all counties' expenditures for the AFDC program 13.2 formerly codified in sections 256.72 to 256.87, and medical 13.3 assistance programs. For the food stamp program, sanctions 13.4 shall be shared by each county board, with 50 percent of the 13.5 sanction being distributed to each county in the same proportion 13.6 as that county's administrative costs for food stamps are to the 13.7 total of all food stamp administrative costs for all counties, 13.8 and 50 percent of the sanctions being distributed to each county 13.9 in the same proportion as that county's value of food stamp 13.10 benefits issued are to the total of all benefits issued for all 13.11 counties. Each county shall pay its share of the disallowance 13.12 to the state of Minnesota. When a county fails to pay the 13.13 amount due hereunder, the commissioner may deduct the amount 13.14 from reimbursement otherwise due the county, or the attorney 13.15 general, upon the request of the commissioner, may institute 13.16 civil action to recover the amount due; and 13.17 (2) notwithstanding the provisions of clause (1), if the 13.18 disallowance results from knowing noncompliance by one or more 13.19 counties with a specific program instruction, and that knowing 13.20 noncompliance is a matter of official county board record, the 13.21 commissioner may require payment or recover from the county or 13.22 counties, in the manner prescribed in clause (1), an amount 13.23 equal to the portion of the total disallowance which resulted 13.24 from the noncompliance, and may distribute the balance of the 13.25 disallowance according to clause (1). 13.26 (o) Develop and implement special projects that maximize 13.27 reimbursements and result in the recovery of money to the 13.28 state. For the purpose of recovering state money, the 13.29 commissioner may enter into contracts with third parties. Any 13.30 recoveries that result from projects or contracts entered into 13.31 under this paragraph shall be deposited in the state treasury 13.32 and credited to a special account until the balance in the 13.33 account reaches $1,000,000. When the balance in the account 13.34 exceeds $1,000,000, the excess shall be transferred and credited 13.35 to the general fund. All money in the account is appropriated 13.36 to the commissioner for the purposes of this paragraph. 14.1 (p) Have the authority to make direct payments to 14.2 facilities providing shelter to women and their children 14.3 according to section 256D.05, subdivision 3. Upon the written 14.4 request of a shelter facility that has been denied payments 14.5 under section 256D.05, subdivision 3, the commissioner shall 14.6 review all relevant evidence and make a determination within 30 14.7 days of the request for review regarding issuance of direct 14.8 payments to the shelter facility. Failure to act within 30 days 14.9 shall be considered a determination not to issue direct payments. 14.10 (q) Have the authority to establish and enforce the 14.11 following county reporting requirements: 14.12 (1) the commissioner shall establish fiscal and statistical 14.13 reporting requirements necessary to account for the expenditure 14.14 of funds allocated to counties for human services programs. 14.15 When establishing financial and statistical reporting 14.16 requirements, the commissioner shall evaluate all reports, in 14.17 consultation with the counties, to determine if the reports can 14.18 be simplified or the number of reports can be reduced; 14.19 (2) the county board shall submit monthly or quarterly 14.20 reports to the department as required by the commissioner. 14.21 Monthly reports are due no later than 15 working days after the 14.22 end of the month. Quarterly reports are due no later than 30 14.23 calendar days after the end of the quarter, unless the 14.24 commissioner determines that the deadline must be shortened to 14.25 20 calendar days to avoid jeopardizing compliance with federal 14.26 deadlines or risking a loss of federal funding. Only reports 14.27 that are complete, legible, and in the required format shall be 14.28 accepted by the commissioner; 14.29 (3) if the required reports are not received by the 14.30 deadlines established in clause (2), the commissioner may delay 14.31 payments and withhold funds from the county board until the next 14.32 reporting period. When the report is needed to account for the 14.33 use of federal funds and the late report results in a reduction 14.34 in federal funding, the commissioner shall withhold from the 14.35 county boards with late reports an amount equal to the reduction 14.36 in federal funding until full federal funding is received; 15.1 (4) a county board that submits reports that are late, 15.2 illegible, incomplete, or not in the required format for two out 15.3 of three consecutive reporting periods is considered 15.4 noncompliant. When a county board is found to be noncompliant, 15.5 the commissioner shall notify the county board of the reason the 15.6 county board is considered noncompliant and request that the 15.7 county board develop a corrective action plan stating how the 15.8 county board plans to correct the problem. The corrective 15.9 action plan must be submitted to the commissioner within 45 days 15.10 after the date the county board received notice of 15.11 noncompliance; 15.12 (5) the final deadline for fiscal reports or amendments to 15.13 fiscal reports is one year after the date the report was 15.14 originally due. If the commissioner does not receive a report 15.15 by the final deadline, the county board forfeits the funding 15.16 associated with the report for that reporting period and the 15.17 county board must repay any funds associated with the report 15.18 received for that reporting period; 15.19 (6) the commissioner may not delay payments, withhold 15.20 funds, or require repayment under clause (3) or (5) if the 15.21 county demonstrates that the commissioner failed to provide 15.22 appropriate forms, guidelines, and technical assistance to 15.23 enable the county to comply with the requirements. If the 15.24 county board disagrees with an action taken by the commissioner 15.25 under clause (3) or (5), the county board may appeal the action 15.26 according to sections 14.57 to 14.69; and 15.27 (7) counties subject to withholding of funds under clause 15.28 (3) or forfeiture or repayment of funds under clause (5) shall 15.29 not reduce or withhold benefits or services to clients to cover 15.30 costs incurred due to actions taken by the commissioner under 15.31 clause (3) or (5). 15.32 (r) Allocate federal fiscal disallowances or sanctions for 15.33 audit exceptions when federal fiscal disallowances or sanctions 15.34 are based on a statewide random sample for the foster care 15.35 program under title IV-E of the Social Security Act, United 15.36 States Code, title 42, in direct proportion to each county's 16.1 title IV-E foster care maintenance claim for that period. 16.2 (s) Be responsible for ensuring the detection, prevention, 16.3 investigation, and resolution of fraudulent activities or 16.4 behavior by applicants, recipients, and other participants in 16.5 the human services programs administered by the department. 16.6 (t) Require county agencies to identify overpayments, 16.7 establish claims, and utilize all available and cost-beneficial 16.8 methodologies to collect and recover these overpayments in the 16.9 human services programs administered by the department. 16.10 (u) Have the authority to administer a drug rebate program 16.11 for drugs purchased pursuant to the prescription drug program 16.12 established under section 256.955 after the beneficiary's 16.13 satisfaction of any deductible established in the program. The 16.14 commissioner shall require a rebate agreement from all 16.15 manufacturers of covered drugs as defined in section 256B.0625, 16.16 subdivision 13. Rebate agreements for prescription drugs 16.17 delivered on or after July 1, 2002, must include rebates for 16.18 individuals covered under the prescription drug program who are 16.19 under 65 years of age. For each drug, the amount of the rebate 16.20 shall be equal to the rebate as defined for purposes of the 16.21 federal rebate program in United States Code, title 42, section 16.22 1396r-8. The manufacturers must provide full payment within 30 16.23 days of receipt of the state invoice for the rebate within the 16.24 terms and conditions used for the federal rebate program 16.25 established pursuant to section 1927 of title XIX of the Social 16.26 Security Act. The manufacturers must provide the commissioner 16.27 with any information necessary to verify the rebate determined 16.28 per drug. The rebate program shall utilize the terms and 16.29 conditions used for the federal rebate program established 16.30 pursuant to section 1927 of title XIX of the Social Security Act. 16.31 (v) Have the authority to administer the federal drug 16.32 rebate program for drugs purchased under the medical assistance 16.33 program as allowed by section 1927 of title XIX of the Social 16.34 Security Act and according to the terms and conditions of 16.35 section 1927. Rebates shall be collected for all drugs that 16.36 have been dispensed or administered in an outpatient setting and 17.1 that are from manufacturers who have signed a rebate agreement 17.2 with the United States Department of Health and Human Services. 17.3 (w) Have the authority to administer a supplemental drug 17.4 rebate program for drugs purchased under the medical assistance 17.5 program. The commissioner may enter into supplemental rebate 17.6 contracts with pharmaceutical manufacturers and may require 17.7 prior authorization for drugs that are from manufacturers that 17.8 have not signed a supplemental rebate contract. Prior 17.9 authorization of drugs shall be subject to the provisions of 17.10 section 256B.0625, subdivision 13. 17.11 (x) Operate the department's communication systems account 17.12 established in Laws 1993, First Special Session chapter 1, 17.13 article 1, section 2, subdivision 2, to manage shared 17.14 communication costs necessary for the operation of the programs 17.15 the commissioner supervises. A communications account may also 17.16 be established for each regional treatment center which operates 17.17 communications systems. Each account must be used to manage 17.18 shared communication costs necessary for the operations of the 17.19 programs the commissioner supervises. The commissioner may 17.20 distribute the costs of operating and maintaining communication 17.21 systems to participants in a manner that reflects actual usage. 17.22 Costs may include acquisition, licensing, insurance, 17.23 maintenance, repair, staff time and other costs as determined by 17.24 the commissioner. Nonprofit organizations and state, county, 17.25 and local government agencies involved in the operation of 17.26 programs the commissioner supervises may participate in the use 17.27 of the department's communications technology and share in the 17.28 cost of operation. The commissioner may accept on behalf of the 17.29 state any gift, bequest, devise or personal property of any 17.30 kind, or money tendered to the state for any lawful purpose 17.31 pertaining to the communication activities of the department. 17.32 Any money received for this purpose must be deposited in the 17.33 department's communication systems accounts. Money collected by 17.34 the commissioner for the use of communication systems must be 17.35 deposited in the state communication systems account and is 17.36 appropriated to the commissioner for purposes of this section. 18.1 (y) Receive any federal matching money that is made 18.2 available through the medical assistance program for the 18.3 consumer satisfaction survey. Any federal money received for 18.4 the survey is appropriated to the commissioner for this 18.5 purpose. The commissioner may expend the federal money received 18.6 for the consumer satisfaction survey in either year of the 18.7 biennium. 18.8 (z) Designate community information and referral call 18.9 centers and incorporate cost reimbursement claims from the 18.10 designated community information and referral call centers into 18.11 the federal cost reimbursement claiming processes of the 18.12 department according to federal law, rule, and regulations. 18.13 Existing information and referral centers provided by Greater 18.14 Twin Cities United Way or existing call centers for which 18.15 Greater Twin Cities United Way has legal authority to represent, 18.16 shall be included in these designations upon review by the 18.17 commissioner and assurance that these services are accredited 18.18 and in compliance with national standards. Any reimbursement is 18.19 appropriated to the commissioner and all designated information 18.20 and referral centers shall receive payments according to normal 18.21 department schedules established by the commissioner upon final 18.22 approval of allocation methodologies from the United States 18.23 Department of Health and Human Services Division of Cost 18.24 Allocation or other appropriate authorities. 18.25 (aa) Develop recommended standards for foster care homes 18.26 that address the components of specialized therapeutic services 18.27 to be provided by foster care homes with those services. 18.28 (bb) Have the authority to administer a drug rebate program 18.29 for drugs purchased for persons eligible for general assistance 18.30 medical care under section 256D.03, subdivision 3. The 18.31 commissioner shall require a rebate agreement from all 18.32 manufacturers of covered drugs as defined in section 256B.0625, 18.33 subdivisions 13 and 13d. For each drug, the amount of the 18.34 rebate shall be equal to the rebate as defined for purposes of 18.35 the federal rebate program in United States Code, title 42, 18.36 section 1396r-8. The manufacturers must provide payment within 19.1 the terms and conditions used for the federal rebate program 19.2 established under section 1927 of title XIX of the Social 19.3 Security Act. The manufacturers must provide the commissioner 19.4 with any information necessary to verify the rebate determined 19.5 per drug. The rebate program shall utilize the terms and 19.6 conditions used for the federal rebate program established under 19.7 section 1927 of title XIX of the Social Security Act. 19.8 Effective January 1, 2006, drug coverage under general 19.9 assistance medical care shall be limited to those prescription 19.10 drugs that: 19.11 (1) are covered under the medical assistance program as 19.12 described in section 256B.0625, subdivisions 13 and 13d; and 19.13 (2) are provided by manufacturers that have fully executed 19.14 general assistance medical care rebate agreements with the 19.15 commissioner and comply with such agreements. Prescription drug 19.16 coverage under general assistance medical care shall conform to 19.17 coverage under the medical assistance program according to 19.18 section 256B.0625, subdivisions 13 to 13g. 19.19 The rebate revenues collected under the drug rebate program 19.20 are dedicated to funding the pharmaceutical assistance program 19.21 established under paragraph (cc). 19.22 (cc) Have the authority to administer a pharmaceutical 19.23 assistance program. The pharmaceutical assistance program may 19.24 include: 19.25 (1) a drug discount card; 19.26 (2) assistance to the program administered by the Minnesota 19.27 Board on Aging under section 256.975, subdivision 9; and 19.28 (3) other efforts designed to assist citizens of the state 19.29 who are not eligible for prescription drug coverage to obtain 19.30 free or discounted prescription drugs. 19.31 The commissioner shall have authority to administer a drug 19.32 rebate program for any discount card program established under 19.33 this paragraph. The rebates collected under this paragraph 19.34 shall be used to provide a discount on the prescription drugs 19.35 dispensed to enrollees of the discount card program. 19.36 Sec. 3. Minnesota Statutes 2004, section 256.01, is 20.1 amended by adding a subdivision to read: 20.2 Subd. 2a. [AUTHORIZATION FOR TEST SITES FOR HEALTH CARE 20.3 PROGRAMS.] In coordination with the development and 20.4 implementation of HealthMatch, an automated eligibility system 20.5 for medical assistance, general assistance medical care, and 20.6 MinnesotaCare, the commissioner, in cooperation with county 20.7 agencies, is authorized to test and compare a variety of 20.8 administrative models to demonstrate and evaluate outcomes of 20.9 integrating health care program business processes and points of 20.10 access. The models will be evaluated for ease of enrollment for 20.11 health care program applicants and recipients and administrative 20.12 efficiencies. Test sites will combine the administration of all 20.13 three programs and will include both local county and 20.14 centralized statewide customer assistance. The duration of each 20.15 approved test site shall be no more than one year. Based on the 20.16 evaluation, the commissioner shall recommend the most efficient 20.17 and effective administrative model for statewide implementation. 20.18 Sec. 4. Minnesota Statutes 2004, section 256.019, 20.19 subdivision 1, is amended to read: 20.20 Subdivision 1. [RETENTION RATES.] When an assistance 20.21 recovery amount is collected and posted by a county agency under 20.22 the provisions governing public assistance programs including 20.23 general assistance medical care, general assistance, and 20.24 Minnesota supplemental aid, the county may keep one-half of the 20.25 recovery made by the county agency using any method other than 20.26 recoupment. For medical assistance, if the recovery is made by 20.27 a county agency using any method other than recoupment, the 20.28 county may keep one-half of the nonfederal share of the recovery. 20.29 For MinnesotaCare, if the recovery is collected and posted by 20.30 the county agency, the county may keep one-half of the 20.31 nonfederal share of the recovery. 20.32 This does not apply to recoveries from medical providers or 20.33 to recoveries begun by the Department of Human Services' 20.34 Surveillance and Utilization Review Division, State Hospital 20.35 Collections Unit, and the Benefit Recoveries Division or, by the 20.36 attorney general's office, or child support collections. In the 21.1 food stamp or food support program, the nonfederal share of 21.2 recoveries in the federal tax offset program only will be 21.3 divided equally between the state agency and the involved county 21.4 agency. 21.5 Sec. 5. Minnesota Statutes 2004, section 256.045, 21.6 subdivision 3, is amended to read: 21.7 Subd. 3. [STATE AGENCY HEARINGS.] (a) State agency 21.8 hearings are available for the following: (1) any person 21.9 applying for, receiving or having received public assistance, 21.10 medical care, or a program of social services granted by the 21.11 state agency or a county agency or the federal Food Stamp Act 21.12 whose application for assistance is denied, not acted upon with 21.13 reasonable promptness, or whose assistance is suspended, 21.14 reduced, terminated, or claimed to have been incorrectly paid; 21.15 (2) any patient or relative aggrieved by an order of the 21.16 commissioner under section 252.27; (3) a party aggrieved by a 21.17 ruling of a prepaid health plan; (4) except as provided under 21.18 chapter 245C, any individual or facility determined by a lead 21.19 agency to have maltreated a vulnerable adult under section 21.20 626.557 after they have exercised their right to administrative 21.21 reconsideration under section 626.557; (5) any person whose 21.22 claim for foster care payment according to a placement of the 21.23 child resulting from a child protection assessment under section 21.24 626.556 is denied or not acted upon with reasonable promptness, 21.25 regardless of funding source; (6) any person to whom a right of 21.26 appeal according to this section is given by other provision of 21.27 law; (7) an applicant aggrieved by an adverse decision to an 21.28 application for a hardship waiver under section 256B.15; (8) an 21.29 applicant aggrieved by an adverse decision to an application or 21.30 redetermination for a Medicare Part D prescription drug subsidy 21.31 under section 256B.04, subdivision 4a; (9) except as provided 21.32 under chapter 245A, an individual or facility determined to have 21.33 maltreated a minor under section 626.556, after the individual 21.34 or facility has exercised the right to administrative 21.35 reconsideration under section 626.556; or(9)(10) except as 21.36 provided under chapter 245C, an individual disqualified under 22.1 sections 245C.14 and 245C.15, on the basis of serious or 22.2 recurring maltreatment; a preponderance of the evidence that the 22.3 individual has committed an act or acts that meet the definition 22.4 of any of the crimes listed in section 245C.15, subdivisions 1 22.5 to 4; or for failing to make reports required under section 22.6 626.556, subdivision 3, or 626.557, subdivision 3. Hearings 22.7 regarding a maltreatment determination under clause (4) 22.8 or(8)(9) and a disqualification under this clause in which the 22.9 basis for a disqualification is serious or recurring 22.10 maltreatment, which has not been set aside under sections 22.11 245C.22 and 245C.23, shall be consolidated into a single fair 22.12 hearing. In such cases, the scope of review by the human 22.13 services referee shall include both the maltreatment 22.14 determination and the disqualification. The failure to exercise 22.15 the right to an administrative reconsideration shall not be a 22.16 bar to a hearing under this section if federal law provides an 22.17 individual the right to a hearing to dispute a finding of 22.18 maltreatment. Individuals and organizations specified in this 22.19 section may contest the specified action, decision, or final 22.20 disposition before the state agency by submitting a written 22.21 request for a hearing to the state agency within 30 days after 22.22 receiving written notice of the action, decision, or final 22.23 disposition, or within 90 days of such written notice if the 22.24 applicant, recipient, patient, or relative shows good cause why 22.25 the request was not submitted within the 30-day time limit. 22.26 The hearing for an individual or facility under clause (4), 22.27(8)(9), or(9)(10) is the only administrative appeal to the 22.28 final agency determination specifically, including a challenge 22.29 to the accuracy and completeness of data under section 13.04. 22.30 Hearings requested under clause (4) apply only to incidents of 22.31 maltreatment that occur on or after October 1, 1995. Hearings 22.32 requested by nursing assistants in nursing homes alleged to have 22.33 maltreated a resident prior to October 1, 1995, shall be held as 22.34 a contested case proceeding under the provisions of chapter 14. 22.35 Hearings requested under clause(8)(9) apply only to incidents 22.36 of maltreatment that occur on or after July 1, 1997. A hearing 23.1 for an individual or facility under clause(8)(9) is only 23.2 available when there is no juvenile court or adult criminal 23.3 action pending. If such action is filed in either court while 23.4 an administrative review is pending, the administrative review 23.5 must be suspended until the judicial actions are completed. If 23.6 the juvenile court action or criminal charge is dismissed or the 23.7 criminal action overturned, the matter may be considered in an 23.8 administrative hearing. 23.9 For purposes of this section, bargaining unit grievance 23.10 procedures are not an administrative appeal. 23.11 The scope of hearings involving claims to foster care 23.12 payments under clause (5) shall be limited to the issue of 23.13 whether the county is legally responsible for a child's 23.14 placement under court order or voluntary placement agreement 23.15 and, if so, the correct amount of foster care payment to be made 23.16 on the child's behalf and shall not include review of the 23.17 propriety of the county's child protection determination or 23.18 child placement decision. 23.19 (b) A vendor of medical care as defined in section 256B.02, 23.20 subdivision 7, or a vendor under contract with a county agency 23.21 to provide social services is not a party and may not request a 23.22 hearing under this section, except if assisting a recipient as 23.23 provided in subdivision 4. 23.24 (c) An applicant or recipient is not entitled to receive 23.25 social services beyond the services included in the amended 23.26 community social services plan. 23.27 (d) The commissioner may summarily affirm the county or 23.28 state agency's proposed action without a hearing when the sole 23.29 issue is an automatic change due to a change in state or federal 23.30 law. 23.31 Sec. 6. Minnesota Statutes 2004, section 256.045, 23.32 subdivision 3a, is amended to read: 23.33 Subd. 3a. [PREPAID HEALTH PLAN APPEALS.] (a) All prepaid 23.34 health plans under contract to the commissioner under chapter 23.35 256B or 256D must provide for a complaint system according to 23.36 section 62D.11. When a prepaid health plan denies, reduces, or 24.1 terminates a health service or denies a request to authorize a 24.2 previously authorized health service, the prepaid health plan 24.3 must notify the recipient of the right to file a complaint or an 24.4 appeal. The notice must include the name and telephone number 24.5 of the ombudsman and notice of the recipient's right to request 24.6 a hearing under paragraph (b).When a complaint is filed, the24.7prepaid health plan must notify the ombudsman within three24.8working days.Recipients may request the assistance of the 24.9 ombudsman in the complaint system process. The prepaid health 24.10 plan must issue a written resolution of the complaint to the 24.11 recipient within 30 days after the complaint is filed with the 24.12 prepaid health plan. A recipient is not required to exhaust the 24.13 complaint system procedures in order to request a hearing under 24.14 paragraph (b). 24.15 (b) Recipients enrolled in a prepaid health plan under 24.16 chapter 256B or 256D may contest a prepaid health plan's denial, 24.17 reduction, or termination of health services, a prepaid health 24.18 plan's denial of a request to authorize a previously authorized 24.19 health service, or the prepaid health plan's written resolution 24.20 of a complaint by submitting a written request for a hearing 24.21 according to subdivision 3. A state human services referee 24.22 shall conduct a hearing on the matter and shall recommend an 24.23 order to the commissioner of human services. The commissioner 24.24 need not grant a hearing if the sole issue raised by a recipient 24.25 is the commissioner's authority to require mandatory enrollment 24.26 in a prepaid health plan in a county where prepaid health plans 24.27 are under contract with the commissioner. The state human 24.28 services referee may order a second medical opinion from the 24.29 prepaid health plan or may order a second medical opinion from a 24.30 nonprepaid health plan provider at the expense of the prepaid 24.31 health plan. Recipients may request the assistance of the 24.32 ombudsman in the appeal process. 24.33 (c) In the written request for a hearing to appeal from a 24.34 prepaid health plan's denial, reduction, or termination of a 24.35 health service, a prepaid health plan's denial of a request to 24.36 authorize a previously authorized service, or the prepaid health 25.1 plan's written resolution to a complaint, a recipient may 25.2 request an expedited hearing. If an expedited appeal is 25.3 warranted, the state human services referee shall hear the 25.4 appeal and render a decision within a time commensurate with the 25.5 level of urgency involved, based on the individual circumstances 25.6 of the case. 25.7 Sec. 7. Minnesota Statutes 2004, section 256.046, 25.8 subdivision 1, is amended to read: 25.9 Subdivision 1. [HEARING AUTHORITY.] A local agency must 25.10 initiate an administrative fraud disqualification hearing for 25.11 individuals, including child care providers caring for children 25.12 receiving child care assistance, accused of wrongfully obtaining 25.13 assistance or intentional program violations, in lieu of a 25.14 criminal action when it has not been pursued, in the aid to 25.15 families with dependent children program formerly codified in 25.16 sections 256.72 to 256.87, MFIP, the diversionary work program, 25.17 child care assistance programs, general assistance, family 25.18 general assistance program formerly codified in section 256D.05, 25.19 subdivision 1, clause (15), Minnesota supplemental aid, food 25.20 stamp programs, general assistance medical care, MinnesotaCare 25.21 for adults without children, and upon federal approval, all 25.22 categories of medical assistance and remaining categories of 25.23 MinnesotaCare except for children through age 18. The 25.24 Department of Human Services, in lieu of a local agency, may 25.25 initiate an administrative fraud disqualification hearing when 25.26 the state agency is directly responsible for administration of 25.27 the health care program for which benefits were wrongfully 25.28 obtained. The hearing is subject to the requirements of section 25.29 256.045 and the requirements in Code of Federal Regulations, 25.30 title 7, section 273.16, for the food stamp program and title 25.31 45, section 235.112, as of September 30, 1995, for the cash 25.32 grant, medical care programs, and child care assistance under 25.33 chapter 119B. 25.34 Sec. 8. Minnesota Statutes 2004, section 256.9657, is 25.35 amended by adding a subdivision to read: 25.36 Subd. 7a. [WITHHOLDING.] If any provider obligated to pay 26.1 an annual surcharge under this section is more than two months 26.2 delinquent in the timely payment of a monthly surcharge 26.3 installment payment, the provisions in paragraphs (a) to (f) 26.4 apply. 26.5 (a) The department may withhold some or all of the amount 26.6 of the delinquent surcharge, together with any interest and 26.7 penalties due and owing on those amounts, from any money the 26.8 department owes to the provider. The department may, at its 26.9 discretion, also withhold future surcharge installment payments 26.10 from any money the department owes the provider as those 26.11 installments become due and owing. The department may continue 26.12 this withholding until the department determines there in no 26.13 longer any need to do so. 26.14 (b) The department shall give prior notice of the 26.15 department's intention to withhold by mailing a written notice 26.16 to the provider at the address to which remittance advices are 26.17 mailed or faxing a copy of the notice to the provider at least 26.18 ten business days before the date of the first payment period 26.19 for which the withholding begins. The notice may be sent by 26.20 ordinary or certified mail, or facsimile, and shall be deemed 26.21 received as of the date of mailing or receipt of the facsimile. 26.22 The notice shall: 26.23 (i) state the amount of the delinquent surcharge; 26.24 (ii) state the amount of the withholding per payment 26.25 period; 26.26 (iii) state the date on which the withholding is to begin; 26.27 (iv) state whether the department intends to withhold 26.28 future installments of the provider's surcharge payments; 26.29 (v) inform the provider of their rights to informally 26.30 object to the proposed withholding and to appeal the withholding 26.31 as provided for in this subdivision; 26.32 (vi) state that the provider may prevent the withholding 26.33 during the pendancy of their appeal by posting a bond; and 26.34 (vii) state other contents as the department deems 26.35 appropriate. 26.36 (c) The provider may informally object to the withholding 27.1 in writing anytime before the withholding begins. An informal 27.2 objection shall not stay or delay the commencement of the 27.3 withholding. The department may postpone the commencement of 27.4 the withholding as deemed appropriate and shall not be required 27.5 to give another notice at the end of the postponement and before 27.6 commencing the withholding. The provider shall have the right 27.7 to appeal any withholding from remittances by filing an appeal 27.8 with Ramsey County District Court and serving notice of the 27.9 appeal on the department within 30 days of the date of the 27.10 written notice of the withholding. Notice shall be given and 27.11 the appeal shall be heard no later than 45 days after the appeal 27.12 is filed. In a hearing of the appeal, the department's action 27.13 shall be sustained if the department proves the amount of the 27.14 delinquent surcharges or overpayment the provider owes, plus any 27.15 accrued interest and penalties, has not been repaid. The 27.16 department may continue withholding for delinquent and current 27.17 surcharge installment payments during the pendancy of an appeal 27.18 unless the provider posts a bond from a surety company licensed 27.19 to do business in Minnesota in favor of the department in an 27.20 amount equal to two times the provider's total annual surcharge 27.21 payment for the fiscal year in which the appeal is filed with 27.22 the department. 27.23 (d) The department shall refund any amounts due to the 27.24 provider under any final administrative or judicial order or 27.25 decree which fully and finally resolves the appeal together with 27.26 interest on those amounts at the rate of three percent per annum 27.27 simple interest computed from the date of each withholding, as 27.28 soon as practical after entry of the order or decree. 27.29 (e) The commissioner, or the commissioner's designee, may 27.30 enter into written settlement agreements with a provider to 27.31 resolve disputes and other matters involving unpaid surcharge 27.32 installment payments or future surcharge installment payments. 27.33 (f) Notwithstanding any law to the contrary, all unpaid 27.34 surcharges, plus any accrued interest and penalties, shall be 27.35 overpayments for purposes of section 256B.0641. 27.36 Sec. 9. Minnesota Statutes 2004, section 256.969, 28.1 subdivision 3a, is amended to read: 28.2 Subd. 3a. [PAYMENTS.] (a) Acute care hospital billings 28.3 under the medical assistance program must not be submitted until 28.4 the recipient is discharged. However, the commissioner shall 28.5 establish monthly interim payments for inpatient hospitals that 28.6 have individual patient lengths of stay over 30 days regardless 28.7 of diagnostic category. Except as provided in section 256.9693, 28.8 medical assistance reimbursement for treatment of mental illness 28.9 shall be reimbursed based on diagnostic classifications. 28.10 Individual hospital payments established under this section and 28.11 sections 256.9685, 256.9686, and 256.9695, in addition to third 28.12 party and recipient liability, for discharges occurring during 28.13 the rate year shall not exceed, in aggregate, the charges for 28.14 the medical assistance covered inpatient services paid for the 28.15 same period of time to the hospital. This payment limitation 28.16 shall be calculated separately for medical assistance and 28.17 general assistance medical care services. The limitation on 28.18 general assistance medical care shall be effective for 28.19 admissions occurring on or after July 1, 1991. Services that 28.20 have rates established under subdivision 11 or 12, must be 28.21 limited separately from other services. After consulting with 28.22 the affected hospitals, the commissioner may consider related 28.23 hospitals one entity and may merge the payment rates while 28.24 maintaining separate provider numbers. The operating and 28.25 property base rates per admission or per day shall be derived 28.26 from the best Medicare and claims data available when rates are 28.27 established. The commissioner shall determine the best Medicare 28.28 and claims data, taking into consideration variables of recency 28.29 of the data, audit disposition, settlement status, and the 28.30 ability to set rates in a timely manner. The commissioner shall 28.31 notify hospitals of payment rates by December 1 of the year 28.32 preceding the rate year. The rate setting data must reflect the 28.33 admissions data used to establish relative values. Base year 28.34 changes from 1981 to the base year established for the rate year 28.35 beginning January 1, 1991, and for subsequent rate years, shall 28.36 not be limited to the limits ending June 30, 1987, on the 29.1 maximum rate of increase under subdivision 1. The commissioner 29.2 may adjust base year cost, relative value, and case mix index 29.3 data to exclude the costs of services that have been 29.4 discontinued by the October 1 of the year preceding the rate 29.5 year or that are paid separately from inpatient services. 29.6 Inpatient stays that encompass portions of two or more rate 29.7 years shall have payments established based on payment rates in 29.8 effect at the time of admission unless the date of admission 29.9 preceded the rate year in effect by six months or more. In this 29.10 case, operating payment rates for services rendered during the 29.11 rate year in effect and established based on the date of 29.12 admission shall be adjusted to the rate year in effect by the 29.13 hospital cost index. 29.14 (b) For fee-for-service admissions occurring on or after 29.15 July 1, 2002, the total payment, before third-party liability 29.16 and spenddown, made to hospitals for inpatient services is 29.17 reduced by .5 percent from the current statutory rates. 29.18 (c) In addition to the reduction in paragraph (b), the 29.19 total payment for fee-for-service admissions occurring on or 29.20 after July 1, 2003, made to hospitals for inpatient services 29.21 before third-party liability and spenddown, is reduced five 29.22 percent from the current statutory rates. Mental health 29.23 services within diagnosis related groups 424 to 432, and 29.24 facilities defined under subdivision 16 are excluded from this 29.25 paragraph. 29.26 (d) In addition to the reduction in paragraphs (b) and (c) 29.27 and section 256D.03, subdivision 4, paragraph (k), the total 29.28 payment for fee-for-service admissions occurring on or after 29.29 July 1, 2005, made to hospitals for inpatient services before 29.30 third-party liability and spenddown, is reduced five percent 29.31 from the current statutory rates. Mental health services within 29.32 diagnosis related groups 424 to 432 and facilities defined under 29.33 subdivision 16 are excluded from this paragraph. 29.34 Sec. 10. Minnesota Statutes 2004, section 256.969, 29.35 subdivision 26, is amended to read: 29.36 Subd. 26. [GREATER MINNESOTA PAYMENT ADJUSTMENT AFTER JUNE 30.1 30, 2001.] (a) For admissions occurring after June 30, 2001, the 30.2 commissioner shall pay fee-for-service inpatient admissions for 30.3 the diagnosis-related groups specified in paragraph (b) at 30.4 hospitals located outside of the seven-county metropolitan area 30.5 at the higher of: 30.6 (1) the hospital's current payment rate for the diagnostic 30.7 category to which the diagnosis-related group belongs, exclusive 30.8 of disproportionate population adjustments received under 30.9 subdivision 9 and hospital payment adjustments received under 30.10 subdivision 23; or 30.11 (2) 90 percent of the average payment rate for that 30.12 diagnostic category for hospitals located within the 30.13 seven-county metropolitan area, exclusive of disproportionate 30.14 population adjustments received under subdivision 9 and hospital 30.15 payment adjustments received under subdivisions 20 and 23.The30.16commissioner may adjust this percentage each year so that the30.17estimated payment increases under this paragraph are equal to30.18the funding provided under section 256B.195 for this purpose.30.19 (b) The payment increases provided in paragraph (a) apply 30.20 to the following diagnosis-related groups, as they fall within 30.21 the diagnostic categories: 30.22 (1) 370 cesarean section with complicating diagnosis; 30.23 (2) 371 cesarean section without complicating diagnosis; 30.24 (3) 372 vaginal delivery with complicating diagnosis; 30.25 (4) 373 vaginal delivery without complicating diagnosis; 30.26 (5) 386 extreme immaturity and respiratory distress 30.27 syndrome, neonate; 30.28 (6) 388 full-term neonates with other problems; 30.29 (7) 390 prematurity without major problems; 30.30 (8) 391 normal newborn; 30.31 (9) 385 neonate, died or transferred to another acute care 30.32 facility; 30.33 (10) 425 acute adjustment reaction and psychosocial 30.34 dysfunction; 30.35 (11) 430 psychoses; 30.36 (12) 431 childhood mental disorders; and 31.1 (13) 164-167 appendectomy. 31.2 Sec. 11. Minnesota Statutes 2004, section 256B.02, 31.3 subdivision 12, is amended to read: 31.4 Subd. 12. [THIRD-PARTY PAYER.] "Third-party payer" means a 31.5 person, entity, or agency or government program that has a 31.6 probable obligation to pay all or part of the costs of a medical 31.7 assistance recipient's health services. Third-party payer 31.8 includes an entity under contract with the recipient to cover 31.9 all or part of the recipient's medical costs. 31.10 Sec. 12. Minnesota Statutes 2004, section 256B.04, is 31.11 amended by adding a subdivision to read: 31.12 Subd. 4a. [MEDICARE PRESCRIPTION DRUG SUBSIDY.] The 31.13 commissioner shall perform all duties necessary to administer 31.14 eligibility determinations for the Medicare Part D prescription 31.15 drug subsidy and facilitate the enrollment of eligible medical 31.16 assistance recipients into Medicare prescription drug plans as 31.17 required by the Medicare Prescription Drug, Improvement and 31.18 Modernization Act of 2003 (MMA), Public Law 108-173, and Code of 31.19 Federal Regulations, title 42, sections 423.30 through 423.56 31.20 and 423.771 through 423.800. 31.21 Sec. 13. Minnesota Statutes 2004, section 256B.056, is 31.22 amended by adding a subdivision to read: 31.23 Subd. 3d. [REDUCTION OF EXCESS ASSETS.] Assets in excess 31.24 of the limits set forth in subdivisions 3 to 3c may be reduced 31.25 to allowable limits as follows: 31.26 (a) Assets may be reduced in any of the three calendar 31.27 months before the month of application in which the applicant 31.28 seeks coverage by: 31.29 (1) designating burial funds up to $1500 for each 31.30 applicant, spouse, and MA-eligible dependent child; and 31.31 (2) paying health service bills incurred in the retroactive 31.32 period for which the applicant seeks eligibility, starting with 31.33 the oldest bill. After assets are reduced to allowable limits, 31.34 eligibility begins with the next dollar of MA-covered health 31.35 services incurred in the retroactive period. Applicants 31.36 reducing assets under this subdivision who also have excess 32.1 income shall first spend excess assets to pay health service 32.2 bills and may meet the income spenddown on remaining bills. 32.3 (b) Assets may be reduced beginning the month of 32.4 application by: 32.5 (1) paying bills for health services that would otherwise 32.6 be paid by medical assistance; and 32.7 (2) using any means other than a transfer of assets for 32.8 less than fair market value as defined in section 256B.0595, 32.9 subdivision 1, paragraph (b). 32.10 Sec. 14. Minnesota Statutes 2004, section 256B.056, 32.11 subdivision 5, is amended to read: 32.12 Subd. 5. [EXCESS INCOME.] A person who has excess income 32.13 is eligible for medical assistance if the person has expenses 32.14 for medical care that are more than the amount of the person's 32.15 excess income, computed by deducting incurred medical expenses 32.16 from the excess income to reduce the excess to the income 32.17 standard specified in subdivision 5c. The person shall elect to 32.18 have the medical expenses deducted at the beginning of a 32.19 one-month budget period or at the beginning of a six-month 32.20 budget period. The commissioner shall allow persons eligible 32.21 for assistance on a one-month spenddown basis under this 32.22 subdivision to elect to pay the monthly spenddown amount in 32.23 advance of the month of eligibility to the state agency in order 32.24 to maintain eligibility on a continuous basis. If the recipient 32.25 does not pay the spenddown amount on or before the20thlast 32.26 business day of the month, the recipient is ineligible for this 32.27 option for the following month. The local agency shall code the 32.28 Medicaid Management Information System (MMIS) to indicate that 32.29 the recipient has elected this option. The state agency shall 32.30 convey recipient eligibility information relative to the 32.31 collection of the spenddown to providers through the Electronic 32.32 Verification System (EVS). A recipient electing advance payment 32.33 must pay the state agency the monthly spenddown amount on or 32.34 before noon on the20thlast business day of the month in order 32.35 to be eligible for this option in the following month. 32.36 [EFFECTIVE DATE.] This section is effective March 1, 2006, 33.1 or upon HealthMatch implementation, whichever is later. 33.2 Sec. 15. Minnesota Statutes 2004, section 256B.056, 33.3 subdivision 5a, is amended to read: 33.4 Subd. 5a. [INDIVIDUALS ON FIXED OR EXCLUDED INCOME.] 33.5 Recipients of medical assistance who receive only fixed unearned 33.6 or excluded income, when that income is excluded from 33.7 consideration as income or unvarying in amount and timing of 33.8 receipt throughout the year, shall report and verify their 33.9 incomeannuallyevery 12 months. The 12-month period begins 33.10 with the month of application. 33.11 [EFFECTIVE DATE.] This section is effective March 1, 2006, 33.12 or upon HealthMatch implementation, whichever is later. 33.13 Sec. 16. Minnesota Statutes 2004, section 256B.056, 33.14 subdivision 5b, is amended to read: 33.15 Subd. 5b. [INDIVIDUALS WITH LOW INCOME.] Recipients of 33.16 medical assistance not residing in a long-term care facility who 33.17 have slightly fluctuating income which is below the medical 33.18 assistance income limit shall report and verify their incomeon33.19a semiannual basisevery six months. The six-month period 33.20 begins the month of application. 33.21 [EFFECTIVE DATE.] This section is effective March 1, 2006, 33.22 or upon HealthMatch implementation, whichever is later. 33.23 Sec. 17. Minnesota Statutes 2004, section 256B.056, 33.24 subdivision 7, is amended to read: 33.25 Subd. 7. [PERIOD OF ELIGIBILITY.] Eligibility is available 33.26 for the month of application and for three months prior to 33.27 application if the person was eligible in those prior 33.28 months. Eligibility for months prior to application is 33.29 determined independently from eligibility for the month of 33.30 application and future months. A redetermination of eligibility 33.31 must occur every 12 months. The 12-month period begins with the 33.32 month of application. 33.33 [EFFECTIVE DATE.] This section is effective March 1, 2006, 33.34 or upon HealthMatch implementation, whichever is later. 33.35 Sec. 18. Minnesota Statutes 2004, section 256B.056, is 33.36 amended by adding a subdivision to read: 34.1 Subd. 9. [NOTICE.] The state agency must be given notice 34.2 of monetary claims against a person, entity, or corporation that 34.3 may be liable to pay all or part of the cost of medical care 34.4 when the state agency has paid or becomes liable for the cost of 34.5 that care. Notice must be given according to paragraphs (a) to 34.6 (d). 34.7 (a) An applicant for medical assistance shall notify the 34.8 state or local agency of any possible claims when the applicant 34.9 submits the application. A recipient of medical assistance 34.10 shall notify the state or local agency of any possible claims 34.11 when those claims arise. 34.12 (b) A person providing medical care services to a recipient 34.13 of medical assistance shall notify the state agency when the 34.14 person has reason to believe that a third party may be liable 34.15 for payment of the cost of medical care. 34.16 (c) A party to a claim that may be assigned to the state 34.17 agency under this section shall notify the state agency of its 34.18 potential assignment claim in writing at each of the following 34.19 stages of a claim: 34.20 (1) when a claim is filed; 34.21 (2) when an action is commenced; and 34.22 (3) when a claim is concluded by payment, award, judgment, 34.23 settlement, or otherwise. 34.24 (d) Every party involved in any stage of a claim under this 34.25 subdivision is required to provide notice to the state agency at 34.26 that stage of the claim. However, when one of the parties to 34.27 the claim provides notice at that stage, every other party to 34.28 the claim is deemed to have provided the required notice for 34.29 that stage of the claim. If the required notice under this 34.30 paragraph is not provided to the state agency, all parties to 34.31 the claim are deemed to have failed to provide the required 34.32 notice. A party to the claim includes the injured person or the 34.33 person's legal representative, the plaintiff, the defendants, or 34.34 persons alleged to be responsible for compensating the injured 34.35 person or plaintiff, and any other party to the cause of action 34.36 or claim, regardless of whether the party knows the state agency 35.1 has a potential or actual assignment claim. 35.2 Sec. 19. Minnesota Statutes 2004, section 256B.056, is 35.3 amended by adding a subdivision to read: 35.4 Subd. 10. [ELIGIBILITY VERIFICATION.] (a) The commissioner 35.5 shall require women who are applying for the continuation of 35.6 medical assistance coverage following the end of the 60-day 35.7 postpartum period to complete a renewal form and verify assets. 35.8 (b) The commissioner shall determine the eligibility of 35.9 private-sector health care coverage for infants less than one 35.10 year of age eligible under section 256B.055, subdivision 10, or 35.11 256B.057, subdivision 1, paragraph (d), and shall pay for 35.12 private-sector coverage if this is determined to be 35.13 cost-effective. 35.14 (c) The commissioner shall modify the application for 35.15 Minnesota health care programs to require more detailed 35.16 information related to verification of assets and income, and 35.17 shall verify assets and income for all applicants, and for all 35.18 recipients upon renewal. 35.19 (d) The commissioner shall require recipients to report and 35.20 verify new employment income within ten days of the change, and 35.21 shall disenroll recipients who fail to provide verification. 35.22 [EFFECTIVE DATE.] This section is effective July 1, 2005. 35.23 Prior to the implementation of HealthMatch, the commissioner 35.24 shall implement this section to the fullest extent possible, 35.25 including the use of manual processing. Upon implementation of 35.26 HealthMatch, the commissioner shall implement this section in a 35.27 manner consistent with the procedures and requirements of 35.28 HealthMatch. 35.29 Sec. 20. Minnesota Statutes 2004, section 256B.0575, is 35.30 amended to read: 35.31 256B.0575 [AVAILABILITY OF INCOME FOR INSTITUTIONALIZED 35.32 PERSONS.] 35.33 When an institutionalized person is determined eligible for 35.34 medical assistance, the income that exceeds the deductions in 35.35 paragraphs (a) and (b) must be applied to the cost of 35.36 institutional care. 36.1 (a) The following amounts must be deducted from the 36.2 institutionalized person's income in the following order: 36.3 (1) the personal needs allowance under section 256B.35 or, 36.4 for a veteran who does not have a spouse or child, or a 36.5 surviving spouse of a veteran having no child, the amount of an 36.6 improved pension received from the veteran's administration not 36.7 exceeding $90 per month; 36.8 (2) the personal allowance for disabled individuals under 36.9 section 256B.36; 36.10 (3) if the institutionalized person has a legally appointed 36.11 guardian or conservator, five percent of the recipient's gross 36.12 monthly income up to $100 as reimbursement for guardianship or 36.13 conservatorship services; 36.14 (4) a monthly income allowance determined under section 36.15 256B.058, subdivision 2, but only to the extent income of the 36.16 institutionalized spouse is made available to the community 36.17 spouse; 36.18 (5) a monthly allowance for children under age 18 which, 36.19 together with the net income of the children, would provide 36.20 income equal to the medical assistance standard for families and 36.21 children according to section 256B.056, subdivision 4, for a 36.22 family size that includes only the minor children. This 36.23 deduction applies only if the children do not live with the 36.24 community spouse and only to the extent that the deduction is 36.25 not included in the personal needs allowance under section 36.26 256B.35, subdivision 1, as child support garnished under a court 36.27 order; 36.28 (6) a monthly family allowance for other family members, 36.29 equal to one-third of the difference between 122 percent of the 36.30 federal poverty guidelines and the monthly income for that 36.31 family member; 36.32 (7) reparations payments made by the Federal Republic of 36.33 Germany and reparations payments made by the Netherlands for 36.34 victims of Nazi persecution between 1940 and 1945; 36.35 (8) all other exclusions from income for institutionalized 36.36 persons as mandated by federal law; and 37.1 (9) amounts for reasonable expenses incurred for necessary 37.2 medical or remedial care for the institutionalized person that 37.3 are not medical assistance covered expenses and that are not 37.4 subject to payment by a third party. 37.5 Reasonable expenses are limited to expenses that have not 37.6 been previously used as a deduction from income and are incurred 37.7 during the enrollee's current period of eligibility, including 37.8 retroactive months associated with the current period of 37.9 eligibility, for medical assistance payment of long-term care 37.10 services. 37.11 For purposes of clause (6), "other family member" means a 37.12 person who resides with the community spouse and who is a minor 37.13 or dependent child, dependent parent, or dependent sibling of 37.14 either spouse. "Dependent" means a person who could be claimed 37.15 as a dependent for federal income tax purposes under the 37.16 Internal Revenue Code. 37.17 (b) Income shall be allocated to an institutionalized 37.18 person for a period of up to three calendar months, in an amount 37.19 equal to the medical assistance standard for a family size of 37.20 one if: 37.21 (1) a physician certifies that the person is expected to 37.22 reside in the long-term care facility for three calendar months 37.23 or less; 37.24 (2) if the person has expenses of maintaining a residence 37.25 in the community; and 37.26 (3) if one of the following circumstances apply: 37.27 (i) the person was not living together with a spouse or a 37.28 family member as defined in paragraph (a) when the person 37.29 entered a long-term care facility; or 37.30 (ii) the person and the person's spouse become 37.31 institutionalized on the same date, in which case the allocation 37.32 shall be applied to the income of one of the spouses. 37.33 For purposes of this paragraph, a person is determined to be 37.34 residing in a licensed nursing home, regional treatment center, 37.35 or medical institution if the person is expected to remain for a 37.36 period of one full calendar month or more. 38.1 Sec. 21. Minnesota Statutes 2004, section 256B.0595, 38.2 subdivision 2, is amended to read: 38.3 Subd. 2. [PERIOD OF INELIGIBILITY.] (a) For any 38.4 uncompensated transfer occurring on or before August 10, 1993, 38.5 the number of months of ineligibility for long-term care 38.6 services shall be the lesser of 30 months, or the uncompensated 38.7 transfer amount divided by the average medical assistance rate 38.8 for nursing facility services in the state in effect on the date 38.9 of application. The amount used to calculate the average 38.10 medical assistance payment rate shall be adjusted each July 1 to 38.11 reflect payment rates for the previous calendar year. The 38.12 period of ineligibility begins with the month in which the 38.13 assets were transferred. If the transfer was not reported to 38.14 the local agency at the time of application, and the applicant 38.15 received long-term care services during what would have been the 38.16 period of ineligibility if the transfer had been reported, a 38.17 cause of action exists against the transferee for the cost of 38.18 long-term care services provided during the period of 38.19 ineligibility, or for the uncompensated amount of the transfer, 38.20 whichever is less. The action may be brought by the state or 38.21 the local agency responsible for providing medical assistance 38.22 under chapter 256G. The uncompensated transfer amount is the 38.23 fair market value of the asset at the time it was given away, 38.24 sold, or disposed of, less the amount of compensation received. 38.25 (b) For uncompensated transfers made after August 10, 1993, 38.26 the number of months of ineligibility for long-term care 38.27 services shall be the total uncompensated value of the resources 38.28 transferred divided by the average medical assistance rate for 38.29 nursing facility services in the state in effect on the date of 38.30 application. The amount used to calculate the average medical 38.31 assistance payment rate shall be adjusted each July 1 to reflect 38.32 payment rates for the previous calendar year. The period of 38.33 ineligibility begins with the first day of the month after the 38.34 month in which the assets were transferred except that if one or 38.35 more uncompensated transfers are made during a period of 38.36 ineligibility, the total assets transferred during the 39.1 ineligibility period shall be combined and a penalty period 39.2 calculated to begin on the first day of the month after the 39.3 month in which the first uncompensated transfer was made. If 39.4 the transfer was reported to the local agency after the date 39.5 that advance notice of a period of ineligibility that affects 39.6 the next month could be provided to the recipient and the 39.7 recipient received medical assistance services or the transfer 39.8 was not reported to the local agency, and the applicant or 39.9 recipient received medical assistance services during what would 39.10 have been the period of ineligibility if the transfer had been 39.11 reported, a cause of action exists against the transferee for 39.12 the cost of medical assistance services provided during the 39.13 period of ineligibility, or for the uncompensated amount of the 39.14 transfer, whichever is less. The action may be brought by the 39.15 state or the local agency responsible for providing medical 39.16 assistance under chapter 256G. The uncompensated transfer 39.17 amount is the fair market value of the asset at the time it was 39.18 given away, sold, or disposed of, less the amount of 39.19 compensation received. Effective for transfers made on or after 39.20 March 1, 1996, involving persons who apply for medical 39.21 assistance on or after April 13, 1996, no cause of action exists 39.22 for a transfer unless: 39.23 (1) the transferee knew or should have known that the 39.24 transfer was being made by a person who was a resident of a 39.25 long-term care facility or was receiving that level of care in 39.26 the community at the time of the transfer; 39.27 (2) the transferee knew or should have known that the 39.28 transfer was being made to assist the person to qualify for or 39.29 retain medical assistance eligibility; or 39.30 (3) the transferee actively solicited the transfer with 39.31 intent to assist the person to qualify for or retain eligibility 39.32 for medical assistance. 39.33 (c) If a calculation of a penalty period results in a 39.34 partial month, payments for long-term care services shall be 39.35 reduced in an amount equal to the fraction, except that in 39.36 calculating the value of uncompensated transfers, if the total 40.1 value of all uncompensated transfers made in a month not 40.2 included in an existing penalty period does not exceed $200, 40.3 then such transfers shall be disregarded for each month prior to 40.4 the month of application for or during receipt of medical 40.5 assistance. 40.6 [EFFECTIVE DATE.] This section is effective for transfers 40.7 occurring on or after July 1, 2005. 40.8 Sec. 22. Minnesota Statutes 2004, section 256B.06, 40.9 subdivision 4, is amended to read: 40.10 Subd. 4. [CITIZENSHIP REQUIREMENTS.] (a) Eligibility for 40.11 medical assistance is limited to citizens of the United States, 40.12 qualified noncitizens as defined in this subdivision, and other 40.13 persons residing lawfully in the United States. 40.14 (b) "Qualified noncitizen" means a person who meets one of 40.15 the following immigration criteria: 40.16 (1) admitted for lawful permanent residence according to 40.17 United States Code, title 8; 40.18 (2) admitted to the United States as a refugee according to 40.19 United States Code, title 8, section 1157; 40.20 (3) granted asylum according to United States Code, title 40.21 8, section 1158; 40.22 (4) granted withholding of deportation according to United 40.23 States Code, title 8, section 1253(h); 40.24 (5) paroled for a period of at least one year according to 40.25 United States Code, title 8, section 1182(d)(5); 40.26 (6) granted conditional entrant status according to United 40.27 States Code, title 8, section 1153(a)(7); 40.28 (7) determined to be a battered noncitizen by the United 40.29 States Attorney General according to the Illegal Immigration 40.30 Reform and Immigrant Responsibility Act of 1996, title V of the 40.31 Omnibus Consolidated Appropriations Bill, Public Law 104-200; 40.32 (8) is a child of a noncitizen determined to be a battered 40.33 noncitizen by the United States Attorney General according to 40.34 the Illegal Immigration Reform and Immigrant Responsibility Act 40.35 of 1996, title V, of the Omnibus Consolidated Appropriations 40.36 Bill, Public Law 104-200; or 41.1 (9) determined to be a Cuban or Haitian entrant as defined 41.2 in section 501(e) of Public Law 96-422, the Refugee Education 41.3 Assistance Act of 1980. 41.4 (c) All qualified noncitizens who were residing in the 41.5 United States before August 22, 1996, who otherwise meet the 41.6 eligibility requirements of this chapter, are eligible for 41.7 medical assistance with federal financial participation. 41.8 (d) All qualified noncitizens who entered the United States 41.9 on or after August 22, 1996, and who otherwise meet the 41.10 eligibility requirements of this chapter, are eligible for 41.11 medical assistance with federal financial participation through 41.12 November 30, 1996. 41.13 Beginning December 1, 1996, qualified noncitizens who 41.14 entered the United States on or after August 22, 1996, and who 41.15 otherwise meet the eligibility requirements of this chapter are 41.16 eligible for medical assistance with federal participation for 41.17 five years if they meet one of the following criteria: 41.18 (i) refugees admitted to the United States according to 41.19 United States Code, title 8, section 1157; 41.20 (ii) persons granted asylum according to United States 41.21 Code, title 8, section 1158; 41.22 (iii) persons granted withholding of deportation according 41.23 to United States Code, title 8, section 1253(h); 41.24 (iv) veterans of the United States armed forces with an 41.25 honorable discharge for a reason other than noncitizen status, 41.26 their spouses and unmarried minor dependent children; or 41.27 (v) persons on active duty in the United States armed 41.28 forces, other than for training, their spouses and unmarried 41.29 minor dependent children. 41.30 Beginning December 1, 1996, qualified noncitizens who do 41.31 not meet one of the criteria in items (i) to (v) are eligible 41.32 for medical assistance without federal financial participation 41.33 as described in paragraph (j). 41.34 (e) Noncitizens who are not qualified noncitizens as 41.35 defined in paragraph (b), who are lawfully residing in the 41.36 United States and who otherwise meet the eligibility 42.1 requirements of this chapter, are eligible for medical 42.2 assistance under clauses (1) to (3). These individuals must 42.3 cooperate with the Immigration and Naturalization Service to 42.4 pursue any applicable immigration status, including citizenship, 42.5 that would qualify them for medical assistance with federal 42.6 financial participation. 42.7 (1) Persons who were medical assistance recipients on 42.8 August 22, 1996, are eligible for medical assistance with 42.9 federal financial participation through December 31, 1996. 42.10 (2) Beginning January 1, 1997, persons described in clause 42.11 (1) are eligible for medical assistance without federal 42.12 financial participation as described in paragraph (j). 42.13 (3) Beginning December 1, 1996, persons residing in the 42.14 United States prior to August 22, 1996, who were not receiving 42.15 medical assistance and persons who arrived on or after August 42.16 22, 1996, are eligible for medical assistance without federal 42.17 financial participation as described in paragraph (j). 42.18 (f) Nonimmigrants who otherwise meet the eligibility 42.19 requirements of this chapter are eligible for the benefits as 42.20 provided in paragraphs (g) to (i). For purposes of this 42.21 subdivision, a "nonimmigrant" is a person in one of the classes 42.22 listed in United States Code, title 8, section 1101(a)(15). 42.23 (g) Payment shall also be made for care and services that 42.24 are furnished to noncitizens, regardless of immigration status, 42.25 who otherwise meet the eligibility requirements of this chapter, 42.26 if such care and services are necessary for the treatment of an 42.27 emergency medical condition, except for organ transplants and 42.28 related care and services and routine prenatal care. 42.29 (h) For purposes of this subdivision, the term "emergency 42.30 medical condition" means a medical condition that meets the 42.31 requirements of United States Code, title 42, section 1396b(v). 42.32 (i) Pregnant noncitizens who are undocumentedor, 42.33 nonimmigrants, or eligible for medical assistance as described 42.34 in paragraph (j), and who are not covered by a group health plan 42.35 or health insurance coverage according to Code of Federal 42.36 Regulations, title 42, section 457.310, and who otherwise meet 43.1 the eligibility requirements of this chapter, are eligible for 43.2 medical assistancepayment without federal financial43.3participation for care and servicesthrough the period of 43.4 pregnancy,andincluding labor and delivery, to the extent 43.5 federal funds are available under Title XXI of the Social 43.6 Security Act, and the state children's health insurance program, 43.7 followed by 60 days postpartum, except for labor and43.8deliverywithout federal financial participation. 43.9 (j) Qualified noncitizens as described in paragraph (d), 43.10 and all other noncitizens lawfully residing in the United States 43.11 as described in paragraph (e), who are ineligible for medical 43.12 assistance with federal financial participation and who 43.13 otherwise meet the eligibility requirements of chapter 256B and 43.14 of this paragraph, are eligible for medical assistance without 43.15 federal financial participation. Qualified noncitizens as 43.16 described in paragraph (d) are only eligible for medical 43.17 assistance without federal financial participation for five 43.18 years from their date of entry into the United States. 43.19 (k) Beginning October 1, 2003, persons who are receiving 43.20 care and rehabilitation services from a nonprofit center 43.21 established to serve victims of torture and are otherwise 43.22 ineligible for medical assistance under this chapter are 43.23 eligible for medical assistance without federal financial 43.24 participation. These individuals are eligible only for the 43.25 period during which they are receiving services from the 43.26 center. Individuals eligible under this paragraph shall not be 43.27 required to participate in prepaid medical assistance. 43.28 Sec. 23. Minnesota Statutes 2004, section 256B.0625, is 43.29 amended by adding a subdivision to read: 43.30 Subd. 1a. [SERVICES PROVIDED IN A HOSPITAL EMERGENCY 43.31 ROOM.] Medical assistance does not cover visits to a hospital 43.32 emergency room that are not for emergency and emergency 43.33 poststabilization care or urgent care, and does not pay for any 43.34 services provided in a hospital emergency room that are not for 43.35 emergency and emergency poststabilization care or urgent care. 43.36 Sec. 24. Minnesota Statutes 2004, section 256B.0625, 44.1 subdivision 3a, is amended to read: 44.2 Subd. 3a. [GENDERSEX REASSIGNMENT SURGERY.]GenderSex 44.3 reassignment surgeryand other gender reassignment medical44.4procedures including drug therapy for gender reassignment areis 44.5 not coveredunless the individual began receiving gender44.6reassignment services prior to July 1, 1998. 44.7 Sec. 25. Minnesota Statutes 2004, section 256B.0625, is 44.8 amended by adding a subdivision to read: 44.9 Subd. 3c. [CIRCUMCISION FOR NEWBORNS.] Newborn 44.10 circumcision is not covered, unless the procedure is medically 44.11 necessary or required because of a well-established religious 44.12 practice. 44.13 [EFFECTIVE DATE.] This section is effective July 1, 2005, 44.14 and applies to services provided on or after that date. 44.15 Sec. 26. Minnesota Statutes 2004, section 256B.0625, is 44.16 amended by adding a subdivision to read: 44.17 Subd. 3d. [HEALTH SERVICES POLICY COMMITTEE.] The 44.18 commissioner, after receiving recommendations from professional 44.19 physician associations, professional associations representing 44.20 licensed nonphysician health care professionals, and consumer 44.21 groups, shall establish an 11-member Health Services Policy 44.22 Committee which will consist of ten voting members and one 44.23 nonvoting member. The Health Services Policy Committee will 44.24 advise the commissioner regarding health services issues 44.25 pertaining to the administration of health care benefits covered 44.26 under the medical assistance, general assistance medical care, 44.27 and MinnesotaCare programs. The Health Services Policy 44.28 Committee shall meet at least quarterly. The Health Services 44.29 Policy Committee shall annually elect a physician chair from 44.30 among its members, who will work directly with the 44.31 commissioner's medical director, to establish the agenda for 44.32 each meeting. 44.33 Sec. 27. Minnesota Statutes 2004, section 256B.0625, is 44.34 amended by adding a subdivision to read: 44.35 Subd. 3e. [HEALTH SERVICES POLICY COMMITTEE MEMBERS.] The 44.36 Health Services Policy Committee shall be comprised of: 45.1 (1) six voting members who are licensed physicians actively 45.2 engaged in the practice of medicine in Minnesota, one of whom 45.3 must be actively engaged in the treatment of persons with mental 45.4 illness and three of whom must represent health plans currently 45.5 under contract to serve medical assistance recipients; 45.6 (2) three voting members who are nonphysician health care 45.7 professionals licensed in their profession and actively engaged 45.8 in the practice of their profession in Minnesota; 45.9 (3) the commissioner's medical director who will serve as a 45.10 nonvoting member; and 45.11 (4) one consumer who shall serve as a voting member. 45.12 Members of the Health Services Policy Committee shall not 45.13 be employed by the Department of Human Services, except for the 45.14 medical director. 45.15 Sec. 28. Minnesota Statutes 2004, section 256B.0625, is 45.16 amended by adding a subdivision to read: 45.17 Subd. 3f. [HEALTH SERVICES POLICY COMMITTEE TERMS AND 45.18 COMPENSATION.] Committee members shall serve staggered 45.19 three-year terms, with one-third of the voting members' terms 45.20 expiring annually. Members may be reappointed by the 45.21 commissioner. The commissioner may require more frequent Health 45.22 Services Policy Committee meetings as needed. An honorarium of 45.23 $200 per meeting and reimbursement for mileage and parking shall 45.24 be paid to each committee member in attendance except the 45.25 medical director. The Health Services Policy Committee does not 45.26 expire as provided in section 15.059, subdivision 6. 45.27 Sec. 29. Minnesota Statutes 2004, section 256B.0625, 45.28 subdivision 13, is amended to read: 45.29 Subd. 13. [DRUGS.] (a) Medical assistance covers drugs, 45.30 except for fertility drugs when specifically used to enhance 45.31 fertility, if prescribed by a licensed practitioner and 45.32 dispensed by a licensed pharmacist, by a physician enrolled in 45.33 the medical assistance program as a dispensing physician, or by 45.34 a physician or a nurse practitioner employed by or under 45.35 contract with a community health board as defined in section 45.36 145A.02, subdivision 5, for the purposes of communicable disease 46.1 control. 46.2 (b) The dispensed quantity of a prescription drug must not 46.3 exceed a 34-day supply, unless authorized by the commissioner. 46.4 (c) Medical assistance covers the following 46.5 over-the-counter drugs when prescribed by a licensed 46.6 practitioner or by a licensed pharmacist who meets standards 46.7 established by the commissioner, in consultation with the board 46.8 of pharmacy: antacids, acetaminophen, family planning products, 46.9 aspirin, insulin, products for the treatment of lice, vitamins 46.10 for adults with documented vitamin deficiencies, vitamins for 46.11 children under the age of seven and pregnant or nursing women, 46.12 and any other over-the-counter drug identified by the 46.13 commissioner, in consultation with the formulary committee, as 46.14 necessary, appropriate, and cost-effective for the treatment of 46.15 certain specified chronic diseases, conditions, or disorders, 46.16 and this determination shall not be subject to the requirements 46.17 of chapter 14. A pharmacist may prescribe over-the-counter 46.18 medications as provided under this paragraph for purposes of 46.19 receiving reimbursement under Medicaid. When prescribing 46.20 over-the-counter drugs under this paragraph, licensed 46.21 pharmacists must consult with the recipient to determine 46.22 necessity, provide drug counseling, review drug therapy for 46.23 potential adverse interactions, and make referrals as needed to 46.24 other health care professionals. 46.25 (d) Effective January 1, 2006, medical assistance shall not 46.26 cover drugs that are coverable under Medicare Part D as defined 46.27 in the Medicare Prescription Drug, Improvement, and 46.28 Modernization Act of 2003, Public Law 108-173, section 46.29 1860D-2(e), for individuals eligible for drug coverage as 46.30 defined in the Medicare Prescription Drug, Improvement, and 46.31 Modernization Act of 2003, Public Law 108-173, section 46.32 1860D-1(a)(3)(A). For such individuals, medical assistance may 46.33 cover drugs from the drug classes listed in United States Code, 46.34 title 42, section 1396r-8(d)(2), subject to the provisions of 46.35 this subdivision and subdivisions 13a to 13g, except that drugs 46.36 listed in United States Code, title 42, section 47.1 1396r-8(d)(2)(E), shall not be covered. 47.2 Sec. 30. Minnesota Statutes 2004, section 256B.0625, 47.3 subdivision 13a, is amended to read: 47.4 Subd. 13a. [DRUG UTILIZATION REVIEW BOARD.] The 47.5 commissioner, after receiving recommendations from professional 47.6 medical associations, professional pharmacy associations, and 47.7 consumer groups shall designate a nine-member Drug Utilization 47.8 Review Boardis established. The boardisshall be comprised of 47.9 at least three but no more than four licensed physicians 47.10 actively engaged in the practice of medicine in Minnesota; at 47.11 least three licensed pharmacists actively engaged in the 47.12 practice of pharmacy in Minnesota; and one consumer 47.13 representative; the remainder to be made up of health care 47.14 professionals who are licensed in their field and have 47.15 recognized knowledge in the clinically appropriate prescribing, 47.16 dispensing, and monitoring of covered outpatient drugs. The 47.17 board shall be staffed by an employee of the department who 47.18 shall serve as an ex officio nonvoting member of the board. The 47.19 department's medical director shall also serve as an ex officio, 47.20 nonvoting member of the board. The members of the board shall 47.21 be appointed by the commissioner and shall serve three-year 47.22 terms.The members shall be selected from lists submitted by47.23professional associations.The commissioner shall appoint the 47.24 initial members of the board for terms expiring as follows: 47.25 three members for terms expiring June 30, 1996; three members 47.26 for terms expiring June 30, 1997; and three members for terms 47.27 expiring June 30, 1998. Members may be reappointedonceby the 47.28 commissioner. The board shall annually elect a chair from among 47.29 the members. 47.30 The commissioner shall, with the advice of the board: 47.31 (1) implement a medical assistance retrospective and 47.32 prospective drug utilization review program as required by 47.33 United States Code, title 42, section 1396r-8(g)(3); 47.34 (2) develop and implement the predetermined criteria and 47.35 practice parameters for appropriate prescribing to be used in 47.36 retrospective and prospective drug utilization review; 48.1 (3) develop, select, implement, and assess interventions 48.2 for physicians, pharmacists, and patients that are educational 48.3 and not punitive in nature; 48.4 (4) establish a grievance and appeals process for 48.5 physicians and pharmacists under this section; 48.6 (5) publish and disseminate educational information to 48.7 physicians and pharmacists regarding the board and the review 48.8 program; 48.9 (6) adopt and implement procedures designed to ensure the 48.10 confidentiality of any information collected, stored, retrieved, 48.11 assessed, or analyzed by the board, staff to the board, or 48.12 contractors to the review program that identifies individual 48.13 physicians, pharmacists, or recipients; 48.14 (7) establish and implement an ongoing process to (i) 48.15 receive public comment regarding drug utilization review 48.16 criteria and standards, and (ii) consider the comments along 48.17 with other scientific and clinical information in order to 48.18 revise criteria and standards on a timely basis; and 48.19 (8) adopt any rules necessary to carry out this section. 48.20 The board may establish advisory committees. The 48.21 commissioner may contract with appropriate organizations to 48.22 assist the board in carrying out the board's duties. The 48.23 commissioner may enter into contracts for services to develop 48.24 and implement a retrospective and prospective review program. 48.25 The board shall report to the commissioner annually on the 48.26 date the Drug Utilization Review Annual Report is due to the 48.27 Centers for Medicare and Medicaid Services. This report is to 48.28 cover the preceding federal fiscal year. The commissioner shall 48.29 make the report available to the public upon request. The 48.30 report must include information on the activities of the board 48.31 and the program; the effectiveness of implemented interventions; 48.32 administrative costs; and any fiscal impact resulting from the 48.33 program. An honorarium of $100 per meeting and reimbursement 48.34 for mileage shall be paid to each board member in attendance. 48.35 Sec. 31. Minnesota Statutes 2004, section 256B.0625, 48.36 subdivision 13c, is amended to read: 49.1 Subd. 13c. [FORMULARY COMMITTEE.] The commissioner, after 49.2 receiving recommendations from professional medical associations 49.3 and professional pharmacy associations, and consumer groups 49.4 shall designate a Formulary Committee to carry out duties as 49.5 described in subdivisions 13 to 13g. The Formulary Committee 49.6 shall be comprised of four licensed physicians actively engaged 49.7 in the practice of medicine in Minnesota one of whom must be 49.8 actively engaged in the treatment of persons with mental 49.9 illness; at least three licensed pharmacists actively engaged in 49.10 the practice of pharmacy in Minnesota; and one consumer 49.11 representative; the remainder to be made up of health care 49.12 professionals who are licensed in their field and have 49.13 recognized knowledge in the clinically appropriate prescribing, 49.14 dispensing, and monitoring of covered outpatient drugs. Members 49.15 of the Formulary Committee shall not be employed by the 49.16 Department of Human Services, but the committee shall be staffed 49.17 by an employee of the department who shall serve as an ex 49.18 officio, nonvoting member of the board. The department's 49.19 medical director shall also serve as an ex officio, nonvoting 49.20 member for the committee. Committee members shall serve 49.21 three-year terms and may be reappointed by the commissioner. 49.22 The Formulary Committee shall meet at least quarterly. The 49.23 commissioner may require more frequent Formulary Committee 49.24 meetings as needed. An honorarium of $100 per meeting and 49.25 reimbursement for mileage shall be paid to each committee member 49.26 in attendance. 49.27 Sec. 32. Minnesota Statutes 2004, section 256B.0625, 49.28 subdivision 13e, is amended to read: 49.29 Subd. 13e. [PAYMENT RATES.] (a) The basis for determining 49.30 the amount of payment shall be the lower of the actual 49.31 acquisition costs of the drugs plus a fixed dispensing fee; the 49.32 maximum allowable cost set by the federal government or by the 49.33 commissioner plus the fixed dispensing fee; or the usual and 49.34 customary price charged to the public. The amount of payment 49.35 basis must be reduced to reflect all discount amounts applied to 49.36 the charge by any provider/insurer agreement or contract for 50.1 submitted charges to medical assistance programs. The net 50.2 submitted charge may not be greater than the patient liability 50.3 for the service. The pharmacy dispensing fee shall be $3.65, 50.4 except that the dispensing fee for intravenous solutions which 50.5 must be compounded by the pharmacist shall be $8 per bag, $14 50.6 per bag for cancer chemotherapy products, and $30 per bag for 50.7 total parenteral nutritional products dispensed in one liter 50.8 quantities, or $44 per bag for total parenteral nutritional 50.9 products dispensed in quantities greater than one liter. Actual 50.10 acquisition cost includes quantity and other special discounts 50.11 except time and cash discounts. The actual acquisition cost of 50.12 a drug shall be estimated by the commissioner, at average 50.13 wholesale price minus11.512 percent, except that where a drug50.14has had its wholesale price reduced as a result of the actions50.15of the National Association of Medicaid Fraud Control Units, the50.16estimated actual acquisition cost shall be the reduced average50.17wholesale price, without the 11.5 percent deduction. The 50.18 maximum allowable cost of a multisource drug may be set by the 50.19 commissioner and it shall be comparable to, but no higher than, 50.20 the maximum amount paid by other third-party payors in this 50.21 state who have maximum allowable cost programs. Establishment 50.22 of the amount of payment for drugs shall not be subject to the 50.23 requirements of the Administrative Procedure Act. 50.24 (b) An additional dispensing fee of $.30 may be added to 50.25 the dispensing fee paid to pharmacists for legend drug 50.26 prescriptions dispensed to residents of long-term care 50.27 facilities when a unit dose blister card system, approved by the 50.28 department, is used. Under this type of dispensing system, the 50.29 pharmacist must dispense a 30-day supply of drug. The National 50.30 Drug Code (NDC) from the drug container used to fill the blister 50.31 card must be identified on the claim to the department. The 50.32 unit dose blister card containing the drug must meet the 50.33 packaging standards set forth in Minnesota Rules, part 50.34 6800.2700, that govern the return of unused drugs to the 50.35 pharmacy for reuse. The pharmacy provider will be required to 50.36 credit the department for the actual acquisition cost of all 51.1 unused drugs that are eligible for reuse. Over-the-counter 51.2 medications must be dispensed in the manufacturer's unopened 51.3 package. The commissioner may permit the drug clozapine to be 51.4 dispensed in a quantity that is less than a 30-day supply. 51.5 (c) Whenever a generically equivalent product is available, 51.6 payment shall be on the basis of the actual acquisition cost of 51.7 the generic drug, or on the maximum allowable cost established 51.8 by the commissioner. 51.9 (d) The basis for determining the amount of payment for 51.10 drugs administered in an outpatient setting shall be the lower 51.11 of the usual and customary cost submitted by the provider, the51.12average wholesale price minus five percent, or the maximum51.13allowable cost set by the federal government under United States51.14Code, title 42, chapter 7, section 1396r-8(e), and Code of51.15Federal Regulations, title 42, section 447.332, or by the51.16commissioner under paragraphs (a) to (c)or the amount 51.17 established for Medicare by the United States Department of 51.18 Health and Human Services pursuant to the Social Security Act, 51.19 title XVIII, section 1847a. 51.20 (e) The commissioner may negotiate lower reimbursement 51.21 rates for specialty pharmacy products than the rates specified 51.22 in paragraph (a). The commissioner may require individuals 51.23 enrolled in the health care programs administered by the 51.24 department to obtain specialty pharmacy products from providers 51.25 with whom the commissioner has negotiated lower reimbursement 51.26 rates. Specialty pharmacy products are defined as those used by 51.27 a small number of recipients or recipients with complex and 51.28 chronic diseases that require expensive and challenging drug 51.29 regimens. Examples of such conditions include, but are not 51.30 limited to: multiple sclerosis, HIV/AIDS, transplantation, 51.31 hepatitis C, growth hormone deficiency, Crohn's Disease, 51.32 rheumatoid arthritis, and certain forms of cancer. Specialty 51.33 pharmaceutical products commonly include injectable and infusion 51.34 therapies, biotechnology drugs, high-cost therapies, and 51.35 therapies that require complex care. The commissioner shall 51.36 consult with the formulary committee to develop a list of 52.1 specialty pharmacy products subject to this paragraph. 52.2 (f) The commissioner may require individuals enrolled in 52.3 the health care programs administered by the department to 52.4 obtain drugs used to treat hemophilia from a comprehensive 52.5 hemophilia diagnostic treatment center as defined in United 52.6 States Code, title 42, section 256b(a)(4)(G); provided that the 52.7 hemophilia treatment center is enrolled as a covered entity in 52.8 the drug pricing program, commonly known as the 340B program, 52.9 that is established under that section. 52.10 Sec. 33. Minnesota Statutes 2004, section 256B.0625, 52.11 subdivision 13f, is amended to read: 52.12 Subd. 13f. [PRIOR AUTHORIZATION.] (a) The Formulary 52.13 Committee shall review and recommend drugs which require prior 52.14 authorization. The Formulary Committee shall establish general 52.15 criteria to be used for the prior authorization of brand-name 52.16 drugs for which generically equivalent drugs are available, but 52.17 the committee is not required to review each brand-name drug for 52.18 which a generically equivalent drug is available. 52.19 (b) Prior authorization may be required by the commissioner 52.20 before certain formulary drugs are eligible for payment. The 52.21 Formulary Committee may recommend drugs for prior authorization 52.22 directly to the commissioner. The commissioner may also request 52.23 that the Formulary Committee review a drug for prior 52.24 authorization. Before the commissioner may require prior 52.25 authorization for a drug: 52.26 (1) the commissioner must provide information to the 52.27 Formulary Committee on the impact that placing the drug on prior 52.28 authorization may have on the quality of patient care and on 52.29 program costs, information regarding whether the drug is subject 52.30 to clinical abuse or misuse, and relevant data from the state 52.31 Medicaid program if such data is available; 52.32 (2) the Formulary Committee must review the drug, taking 52.33 into account medical and clinical data and the information 52.34 provided by the commissioner; and 52.35 (3) the Formulary Committee must hold a public forum and 52.36 receive public comment for an additional 15 days. 53.1 The commissioner must provide a 15-day notice period before 53.2 implementing the prior authorization. 53.3 (c) Prior authorization shall not be required or utilized 53.4 for any atypical antipsychotic drug prescribed for the treatment 53.5 of mental illness if: 53.6 (1) there is no generically equivalent drug available; and 53.7 (2) the drug was initially prescribed for the recipient 53.8 prior to July 1, 2003; or 53.9 (3) the drug is part of the recipient's current course of 53.10 treatment. 53.11 This paragraph applies to any multistate preferred drug list or 53.12 supplemental drug rebate program established or administered by 53.13 the commissioner. Prior authorization shall automatically be 53.14 granted for 60 days for brand name drugs prescribed for 53.15 treatment of mental illness within 60 days of when a generically 53.16 equivalent drug becomes available. 53.17 (d) Prior authorization shall not be required or utilized 53.18 for any antihemophilic factor drug prescribed for the treatment 53.19 of hemophilia and blood disorders where there is no generically 53.20 equivalent drug available if the prior authorization is used in 53.21 conjunction with any supplemental drug rebate program or 53.22 multistate preferred drug list established or administered by 53.23 the commissioner.This paragraph expires July 1, 2005.53.24 (e) The commissioner may require prior authorization for 53.25 brand name drugs whenever a generically equivalent product is 53.26 available, even if the prescriber specifically indicates 53.27 "dispense as written-brand necessary" on the prescription as 53.28 required by section 151.21, subdivision 2. 53.29 (f) Notwithstanding the provisions of this subdivision, the 53.30 commissioner may automatically require prior authorization, for 53.31 a period not to exceed 180 days, for any drug that is approved 53.32 by the United States Food and Drug Administration on or after 53.33 July 1, 2005. The 180-day period shall begin no later than the 53.34 first day that a drug is available for shipment to pharmacies 53.35 within the state. The Formulary Committee shall recommend to 53.36 the commissioner general criteria to be used for the prior 54.1 authorization of such drugs, but the committee is not required 54.2 to review each individual drug. In order to continue prior 54.3 authorizations for a drug after the 180-day period has expired, 54.4 the commissioner must follow the provisions of this subdivision. 54.5 [EFFECTIVE DATE.] The amendment to paragraph (d) is 54.6 effective June 30, 2005. 54.7 Sec. 34. Minnesota Statutes 2004, section 256B.0625, is 54.8 amended by adding a subdivision to read: 54.9 Subd. 13h. [MEDICATION THERAPY MANAGEMENT CARE.] (a) 54.10 Medical assistance and general assistance medical care cover 54.11 medication therapy management services for a recipient taking 54.12 four or more prescriptions to treat or prevent two or more 54.13 chronic medical conditions, or a recipient with a drug therapy 54.14 problem that is identified or prior authorized by the 54.15 commissioner that has resulted or is likely to result in 54.16 significant nondrug program costs. The commissioner may cover 54.17 medical therapy management services under MinnesotaCare if the 54.18 commissioner determines this is cost-effective. For purposes of 54.19 this subdivision, "medication therapy management" means the 54.20 provision of the following pharmaceutical care services by a 54.21 licensed pharmacist to optimize the therapeutic outcomes of the 54.22 patient's medications: 54.23 (1) performing or obtaining necessary assessments of the 54.24 patient's health status; 54.25 (2) formulating a medication treatment plan; 54.26 (3) monitoring and evaluating the patient's response to 54.27 therapy, including safety and effectiveness; 54.28 (4) performing a comprehensive medication review to 54.29 identify, resolve, and prevent medication-related problems, 54.30 including adverse drug events; 54.31 (5) documenting the care delivered and communicating 54.32 essential information to the patient's other primary care 54.33 providers; 54.34 (6) providing verbal education and training designed to 54.35 enhance patient understanding and appropriate use of the 54.36 patient's medications; 55.1 (7) providing information, support services, and resources 55.2 designed to enhance patient adherence with the patient's 55.3 therapeutic regimens; and 55.4 (8) coordinating and integrating medication therapy 55.5 management services within the broader health care management 55.6 services being provided to the patient. 55.7 Nothing in this subdivision shall be construed to expand or 55.8 modify the scope of practice of the pharmacist as defined in 55.9 section 151.01, subdivision 27. 55.10 (b) To be eligible for reimbursement for services under 55.11 this subdivision, a pharmacist must meet the following 55.12 requirements: 55.13 (1) have a valid license issued under chapter 151; 55.14 (2) have graduated from an accredited college of pharmacy 55.15 on or after May 1996, or completed a structured and 55.16 comprehensive education program approved by the Board of 55.17 Pharmacy and the American Council of Pharmaceutical Education 55.18 for the provision and documentation of pharmaceutical care 55.19 management services that has both clinical and didactic 55.20 elements; 55.21 (3) be practicing in an ambulatory care setting as part of 55.22 a multidisciplinary team or have developed a structured patient 55.23 care process that is offered in a private or semiprivate patient 55.24 care area that is separate from the commercial business that 55.25 also occurs in the setting; and 55.26 (4) make use of an electronic patient record system that 55.27 meets state standards. 55.28 (c) For purposes of reimbursement for medication therapy 55.29 management services, the commissioner may enroll individual 55.30 pharmacists as medical assistance and general assistance medical 55.31 care providers. The commissioner may also establish contact 55.32 requirements between the pharmacist and recipient, including 55.33 limiting the number of reimbursable consultations per recipient. 55.34 (d) The commissioner, after receiving recommendations from 55.35 professional medical associations, professional pharmacy 55.36 associations, and consumer groups, shall convene an 11-member 56.1 Medication Therapy Management Advisory Committee to advise the 56.2 commissioner on the implementation and administration of 56.3 medication therapy management services. The committee shall be 56.4 comprised of: two licensed physicians; two licensed 56.5 pharmacists; two consumer representatives; two health plan 56.6 company representatives; and three members with expertise in the 56.7 area of medication therapy management, who may be licensed 56.8 physicians or licensed pharmacists. The committee is governed 56.9 by section 15.059, except that committee members do not receive 56.10 compensation or reimbursement for expenses. The advisory 56.11 committee expires on June 30, 2007. 56.12 (e) The commissioner shall evaluate the effect of 56.13 medication therapy management on quality of care, patient 56.14 outcomes, and program costs, and shall include a description of 56.15 any savings generated in the medical assistance and general 56.16 assistance medical care programs that can be attributable to 56.17 this coverage. The evaluation shall be submitted to the 56.18 legislature by December 15, 2007. The commissioner may contract 56.19 with a vendor or an academic institution that has expertise in 56.20 evaluating health care outcomes for the purpose of completing 56.21 the evaluation. 56.22 Sec. 35. Minnesota Statutes 2004, section 256B.0625, 56.23 subdivision 17, is amended to read: 56.24 Subd. 17. [TRANSPORTATION COSTS.] (a) Medical assistance 56.25 covers transportation costs incurred solely for obtaining 56.26 emergency medical care or transportation costs incurred by 56.27 eligible persons in obtaining emergency or nonemergency medical 56.28 care when paid directly to an ambulance company, common carrier, 56.29 or other recognized providers of transportation services. 56.30 (b) Medical assistance covers special transportation, as 56.31 defined in Minnesota Rules, part 9505.0315, subpart 1, item F, 56.32 if the recipient has a physical or mental impairment that would 56.33 prohibit the recipient from safely accessing and using a bus, 56.34 taxi, other commercial transportation, or private automobile. 56.35 The commissioner may use an order by the recipient's attending 56.36 physician to certify that the recipient requires special 57.1 transportation services. Special transportation includes 57.2 driver-assisted service to eligible individuals. 57.3 Driver-assisted service includes passenger pickup at and return 57.4 to the individual's residence or place of business, assistance 57.5 with admittance of the individual to the medical facility, and 57.6 assistance in passenger securement or in securing of wheelchairs 57.7 or stretchers in the vehicle. Special transportation providers 57.8 must obtain written documentation from the health care service 57.9 provider who is serving the recipient being transported, 57.10 identifying the time that the recipient arrived. Special 57.11 transportation providers may not bill for separate base rates 57.12 for the continuation of a trip beyond the original destination. 57.13 Special transportation providers must take recipients to the 57.14 nearest appropriate health care provider, using the most direct 57.15 route available. The maximum medical assistance reimbursement 57.16 rates for special transportation services are: 57.17 (1) $18 for the base rate and $1.40 per mile for services 57.18 to eligible persons who need a wheelchair-accessible van; 57.19 (2) $12 for the base rate and $1.35 per mile for services 57.20 to eligible persons who do not need a wheelchair-accessible van; 57.21 and 57.22 (3)$36$60 for the base rate and$1.40$2.40 per mile, and 57.23 an attendant rate of $9 per trip, for services to eligible 57.24 persons who need a stretcher-accessible vehicle. 57.25 Sec. 36. [256B.0632] [MEDICALLY NECESSARY ITEMS AND 57.26 SERVICES.] 57.27 Subdivision 1. [GENERAL REQUIREMENT FOR 57.28 COVERAGE.] Enrollees under the medical assistance program are 57.29 eligible to receive, and medical assistance shall provide 57.30 payment for, only those medical items and services that are: 57.31 (1) within the scope of defined benefits for which the 57.32 enrollee is eligible under the medical assistance program; and 57.33 (2) determined by the medical assistance program to be 57.34 medically necessary. 57.35 Subd. 2. [MEDICAL NECESSITY.] (a) To be determined to be 57.36 medically necessary, a medical item or service must be 58.1 recommended by a physician who is treating the enrollee or other 58.2 licensed health care provider practicing within the scope of the 58.3 physician's license who is treating the enrollee and must 58.4 satisfy each of the criteria in this section. 58.5 (b) It must be required in order to diagnose or treat an 58.6 enrollee's medical condition. The convenience of an enrollee, 58.7 the enrollee's family, or a provider, shall not be a factor or 58.8 justification in determining that a medical item or service is 58.9 medically necessary. 58.10 (c) It must be safe and effective. To qualify as safe and 58.11 effective, the type and level of medical item or service must be 58.12 consistent with the symptoms or diagnosis and treatment of the 58.13 particular medical condition, and the reasonably anticipated 58.14 medical benefits of the item or service must outweigh the 58.15 reasonably anticipated medical risks based on the enrollee's 58.16 condition and scientifically supported evidence. 58.17 (d) It must be the least costly alternative course of 58.18 diagnosis or treatment that is adequate for the medical 58.19 condition of the enrollee. When applied to medical items or 58.20 services delivered in an inpatient setting, it further means 58.21 that the medical item or service cannot be safely provided for 58.22 the same or lesser cost to the person in an outpatient setting. 58.23 Where there are less costly alternative courses of diagnosis or 58.24 treatment, including less costly alternative settings, that are 58.25 adequate for the medical condition of the enrollee, more costly 58.26 alternative courses of diagnosis or treatment are not medically 58.27 necessary. An alternative course of diagnosis or treatment may 58.28 include observation, lifestyle or behavioral changes, or where 58.29 appropriate, no treatment at all. 58.30 Subd. 3. [DETERMINATION OF COMMISSIONER.] It is the 58.31 responsibility of the commissioner ultimately to determine what 58.32 medical items and services are medically necessary for the 58.33 medical assistance program. The fact that a provider has 58.34 prescribed, recommended, or approved a medical item or service 58.35 does not, in itself, make such item or service medically 58.36 necessary. 59.1 Subd. 4. [APPLICABILITY.] The medical necessity standard 59.2 in this section shall govern the delivery of all services and 59.3 items to all enrollees or classes of beneficiaries in the 59.4 medical assistance program. The commissioner is authorized to 59.5 make limited special provisions for particular items or 59.6 services, such as long-term care, or such as may be required for 59.7 compliance with federal law. 59.8 Subd. 5. [MEDICAL PROTOCOLS.] Medical protocols developed 59.9 using evidence-based medicine that are authorized by the 59.10 commissioner shall satisfy the standard of medical necessity. 59.11 Such protocols shall be appropriately published to all medical 59.12 assistance providers and managed care organizations. 59.13 Subd. 6. [RULEMAKING.] The commissioner is authorized to 59.14 adopt any rules necessary to implement this section. 59.15 Subd. 7. [APPLICATION.] This section does not apply if the 59.16 medical necessity standard, or medical protocols authorized 59.17 under subdivision 5, authorize or recommend denial of treatment, 59.18 food, or fluids necessary to sustain life on the basis of the 59.19 patient's age or expected length of life, or the patient's 59.20 present or predicted disability, degree of medical dependency, 59.21 or quality of life. 59.22 Sec. 37. [256B.0633] [LIMITING COVERAGE OF HEALTH CARE 59.23 SERVICES FOR PUBLIC PROGRAMS.] 59.24 Subdivision 1. [PRIOR AUTHORIZATION OF SERVICES.] (a) 59.25 Effective July 1, 2005, prior authorization is required for the 59.26 services described in subdivision 2 for reimbursement under 59.27 chapters 256B, 256D, and 256L. Effective July 1, 2005, prepaid 59.28 health plans shall use prior authorization for the services 59.29 described in subdivision 2 unless the prepaid health plan is 59.30 otherwise using evidence-based practices to address these 59.31 services. 59.32 (b) Prior authorization shall be conducted by the medical 59.33 director of the Department of Human Services in conjunction with 59.34 the Health Services Policy Committee. To the extent available, 59.35 the medical director shall use publicly available evidence-based 59.36 guidelines developed by an independent, nonprofit organization 60.1 or by the professional association of the specialty that 60.2 typically provides the service or by a multistate Medicaid 60.3 evidence-based practice center. If the commissioner does not 60.4 have a medical director and medical policy in place, the 60.5 commissioner shall contract prior authorization to a 60.6 Minnesota-licensed utilization review organization. 60.7 Subd. 2. [SERVICES REQUIRING PRIOR AUTHORIZATION.] The 60.8 following services require prior authorization: 60.9 (1) elective outpatient high technology imaging to include 60.10 positive emission tomography (PET) scans, magnetic resonance 60.11 imaging (MRI), computed tomography (CT), and nuclear cardiology; 60.12 (2) spinal fusion, unless in an emergency situation related 60.13 to trauma; 60.14 (3) bariatric surgery; 60.15 (4) orthodontia; 60.16 (5) cesarean section or insertion of tympanostomy tubes 60.17 except in an emergency situation; and 60.18 (6) hysterectomy. 60.19 Sec. 38. Minnesota Statutes 2004, section 256B.0644, is 60.20 amended to read: 60.21 256B.0644 [PARTICIPATION REQUIRED FOR REIMBURSEMENT UNDER 60.22 OTHER STATE HEALTH CARE PROGRAMS.] 60.23 A vendor of medical care, as defined in section 256B.02, 60.24 subdivision 7, and a health maintenance organization, as defined 60.25 in chapter 62D, must participate as a provider or contractor in 60.26 the medical assistance program, general assistance medical care 60.27 program, and MinnesotaCare as a condition of participating as a 60.28 provider in health insurance plans and programs or contractor 60.29 for state employees established under section 43A.18, the public 60.30 employees insurance program under section 43A.316, for health 60.31 insurance plans offered to local statutory or home rule charter 60.32 city, county, and school district employees, the workers' 60.33 compensation system under section 176.135, and insurance plans 60.34 provided through the Minnesota Comprehensive Health Association 60.35 under sections 62E.01 to 62E.19. This section does not apply to 60.36 any person providing dental services. The limitations on 61.1 insurance plans offered to local government employees shall not 61.2 be applicable in geographic areas where provider participation 61.3 is limited by managed care contracts with the Department of 61.4 Human Services. For providers other than health maintenance 61.5 organizations, participation in the medical assistance program 61.6 means that(1)the provider accepts new medical assistance, 61.7 general assistance medical care, and MinnesotaCare patientsor61.8(2) for providers other than dental service providers, and at 61.9 least 20 percent of the provider's patients are covered by 61.10 medical assistance, general assistance medical care, and 61.11 MinnesotaCare as their primary source of coverage, or (3) for61.12dental service providers, at least ten percent of the provider's61.13patients are covered by medical assistance, general assistance61.14medical care, and MinnesotaCare as their primary source of61.15coverage. Patients seen on a volunteer basis by the provider at 61.16 a location other than the provider's usual place of practice may 61.17 be considered in meeting this participation requirement. The 61.18 commissioner shall establish participation requirements for 61.19 health maintenance organizations. The commissioner shall 61.20 provide lists of participating medical assistance providers on a 61.21 quarterly basis to the commissioner of employee relations, the 61.22 commissioner of labor and industry, and the commissioner of 61.23 commerce. Each of the commissioners shall develop and implement 61.24 procedures to exclude as participating providers in the program 61.25 or programs under their jurisdiction those providers who do not 61.26 participate in the medical assistance program. The commissioner 61.27 of employee relations shall implement this section through 61.28 contracts with participating healthand dentalcarriers. 61.29 Sec. 39. Minnesota Statutes 2004, section 256B.075, 61.30 subdivision 2, is amended to read: 61.31 Subd. 2. [FEE-FOR-SERVICE.] (a) The commissioner shall 61.32 develop and implement a disease management program for medical 61.33 assistance and general assistance medical care recipients who 61.34 are not enrolled in the prepaid medical assistance or prepaid 61.35 general assistance medical care programs and who are receiving 61.36 services on a fee-for-service basis. The commissioner may 62.1 contract with an outside organization to provide these services. 62.2 (b) The commissioner shall seek any federal approval 62.3 necessary to implement this section and to obtain federal 62.4 matching funds. 62.5 (c) The commissioner shall develop and implement a pilot 62.6 intensive care management program for medical assistance 62.7 children with complex and chronic medical issues who are not 62.8 able to participate in the metro-based U Special Kids program 62.9 due to geographic distance. 62.10 Sec. 40. Minnesota Statutes 2004, section 256B.15, 62.11 subdivision 1, is amended to read: 62.12 Subdivision 1. [POLICY, APPLICABILITY, PURPOSE, AND 62.13 CONSTRUCTION; DEFINITION.] (a) It is the policy of this state 62.14 that individuals or couples, either or both of whom participate 62.15 in the medical assistance program, use their own assets to pay 62.16 their share of the total cost of their care during or after 62.17 their enrollment in the program according to applicable federal 62.18 law and the laws of this state. The following provisions apply: 62.19 (1) subdivisions 1c to 1k shall not apply to claims arising 62.20 under this section which are presented under section 525.313; 62.21 (2) the provisions of subdivisions 1c to 1k expanding the 62.22 interests included in an estate for purposes of recovery under 62.23 this section give effect to the provisions of United States 62.24 Code, title 42, section 1396p, governing recoveries, but do not 62.25 give rise to any express or implied liens in favor of any other 62.26 parties not named in these provisions; 62.27 (3) the continuation of a recipient's life estate or joint 62.28 tenancy interest in real property after the recipient's death 62.29 for the purpose of recovering medical assistance under this 62.30 section modifies common law principles holding that these 62.31 interests terminate on the death of the holder; 62.32 (4) all laws, rules, and regulations governing or involved 62.33 with a recovery of medical assistance shall be liberally 62.34 construed to accomplish their intended purposes; 62.35 (5) a deceased recipient's life estate and joint tenancy 62.36 interests continued under this section shall be owned by the 63.1 remaindermen or surviving joint tenants as their interests may 63.2 appear on the date of the recipient's death. They shall not be 63.3 merged into the remainder interest or the interests of the 63.4 surviving joint tenants by reason of ownership. They shall be 63.5 subject to the provisions of this section. Any conveyance, 63.6 transfer, sale, assignment, or encumbrance by a remainderman, a 63.7 surviving joint tenant, or their heirs, successors, and assigns 63.8 shall be deemed to include all of their interest in the deceased 63.9 recipient's life estate or joint tenancy interest continued 63.10 under this section; and 63.11 (6) the provisions of subdivisions 1c to 1k continuing a 63.12 recipient's joint tenancy interests in real property after the 63.13 recipient's death do not apply to a homestead owned of record, 63.14 on the date the recipient dies, by the recipient and the 63.15 recipient's spouse as joint tenants with a right of 63.16 survivorship. Homestead means the real property occupied by the 63.17 surviving joint tenant spouse as their sole residence on the 63.18 date the recipient dies and classified and taxed to the 63.19 recipient and surviving joint tenant spouse as homestead 63.20 property for property tax purposes in the calendar year in which 63.21 the recipient dies. For purposes of this exemption, real 63.22 property the recipient and their surviving joint tenant spouse 63.23 purchase solely with the proceeds from the sale of their prior 63.24 homestead, own of record as joint tenants, and qualify as 63.25 homestead property under section 273.124 in the calendar year in 63.26 which the recipient dies and prior to the recipient's death 63.27 shall be deemed to be real property classified and taxed to the 63.28 recipient and their surviving joint tenant spouse as homestead 63.29 property in the calendar year in which the recipient dies. The 63.30 surviving spouse, or any person with personal knowledge of the 63.31 facts, may provide an affidavit describing the homestead 63.32 property affected by this clause and stating facts showing 63.33 compliance with this clause. The affidavit shall be prima facie 63.34 evidence of the facts it states. 63.35 (b) For purposes of this section, "medical assistance" 63.36 includes the medical assistance program under this chapter and 64.1 the general assistance medical care program under chapter 256D 64.2 and alternative care for nonmedical assistance recipients under 64.3 section 256B.0913. 64.4 (c) All provisions in this subdivision, and subdivisions 64.5 1d, 1f, 1g, 1h, 1i, and 1j, related to the continuation of a 64.6 recipient's life estate or joint tenancy interests in real 64.7 property after the recipient's death for the purpose of 64.8 recovering medical assistance, are effective only for life 64.9 estates and joint tenancy interests established on or after 64.10 August 1, 2003. 64.11 [EFFECTIVE DATE.] This section is effective retroactively 64.12 from August 1, 2003. 64.13 Sec. 41. Minnesota Statutes 2004, section 256B.195, 64.14 subdivision 3, is amended to read: 64.15 Subd. 3. [PAYMENTS TO CERTAIN SAFETY NET PROVIDERS.] (a) 64.16 Effective July 15, 2001, the commissioner shall make the 64.17 following payments to the hospitals indicated after noon on the 64.18 15th of each month: 64.19 (1) to Hennepin County Medical Center, any federal matching 64.20 funds available to match the payments received by the medical 64.21 center under subdivision 2, to increase payments for medical 64.22 assistance admissions and to recognize higher medical assistance 64.23 costs in institutions that provide high levels of charity care; 64.24 and 64.25 (2) to Regions Hospital, any federal matching funds 64.26 available to match the payments received by the hospital under 64.27 subdivision 2, to increase payments for medical assistance 64.28 admissions and to recognize higher medical assistance costs in 64.29 institutions that provide high levels of charity care. 64.30 (b) Effective July 15, 2001, the following percentages of 64.31 the transfers under subdivision 2 shall be retained by the 64.32 commissioner for deposit each month into the general fund: 64.33 (1) 18 percent, plus any federal matching funds, shall be 64.34 allocated for the following purposes: 64.35 (i) during the fiscal year beginning July 1, 2001, of the 64.36 amount available under this clause, 39.7 percent shall be 65.1 allocated to make increased hospital payments under section 65.2 256.969, subdivision 26; 34.2 percent shall be allocated to fund 65.3 the amounts due from small rural hospitals, as defined in 65.4 section 144.148, for overpayments under section 256.969, 65.5 subdivision 5a, resulting from a determination that medical 65.6 assistance and general assistance payments exceeded the charge 65.7 limit during the period from 1994 to 1997; and 26.1 percent 65.8 shall be allocated to the commissioner of health for rural 65.9 hospital capital improvement grants under section 144.148; and 65.10 (ii) during fiscal years beginning on or after July 1, 65.11 2002, of the amount available under this clause, 55 percent 65.12 shall be allocated to make increased hospital payments under 65.13 section 256.969, subdivision 26, and 45 percent shall be 65.14 allocated to the commissioner of health for rural hospital 65.15 capital improvement grants under section 144.148; and 65.16 (2) 11 percent shall be allocated to the commissioner of 65.17 health to fund community clinic grants under section 145.9268. 65.18 (c) This subdivision shall apply to fee-for-service 65.19 payments only and shall not increase capitation payments or 65.20 payments made based on average rates. The allocation in 65.21 paragraph (b), clause (1), item (ii), to increase hospital 65.22 payments under section 256.969, subdivision 26, shall not limit 65.23 payments under that section. 65.24 (d) Medical assistance rate or payment changes, including 65.25 those required to obtain federal financial participation under 65.26 section 62J.692, subdivision 8, shall precede the determination 65.27 of intergovernmental transfer amounts determined in this 65.28 subdivision. Participation in the intergovernmental transfer 65.29 program shall not result in the offset of any health care 65.30 provider's receipt of medical assistance payment increases other 65.31 than limits resulting from hospital-specific charge limits and 65.32 limits on disproportionate share hospital payments. 65.33 (e) Effective July 1, 2003, if the amount available for 65.34 allocation under paragraph (b) is greater than the amounts 65.35 available during March 2003, after any increase in 65.36 intergovernmental transfers and payments that result from 66.1 section 256.969, subdivision 3a, paragraph (c), are paid to the 66.2 general fund, any additional amounts available under this 66.3 subdivision after reimbursement of the transfers under 66.4 subdivision 2 shall be allocated to increase medical assistance 66.5 payments, subject to hospital-specific charge limits and limits 66.6 on disproportionate share hospital payments, as follows: 66.7 (1) if the payments under subdivision 5 are approved, the 66.8 amount shall be paid to the largest ten percent of hospitals as 66.9 measured by 2001 payments for medical assistance, general 66.10 assistance medical care, and MinnesotaCare in the nonstate 66.11 government hospital category. Payments shall be allocated 66.12 according to each hospital's proportionate share of the 2001 66.13 payments; or 66.14 (2) if the payments under subdivision 5 are not approved, 66.15 the amount shall be paid to the largest ten percent of hospitals 66.16 as measured by 2001 payments for medical assistance, general 66.17 assistance medical care, and MinnesotaCare in the nonstate 66.18 government category and to the largest ten percent of hospitals 66.19 as measured by payments for medical assistance, general 66.20 assistance medical care, and MinnesotaCare in the nongovernment 66.21 hospital category. Payments shall be allocated according to 66.22 each hospital's proportionate share of the 2001 payments in 66.23 their respective category of nonstate government and 66.24 nongovernment. The commissioner shall determine which hospitals 66.25 are in the nonstate government and nongovernment hospital 66.26 categories. 66.27 Sec. 42. Minnesota Statutes 2004, section 256B.32, 66.28 subdivision 1, is amended to read: 66.29 Subdivision 1. [FACILITY FEE PAYMENT.] (a) The 66.30 commissioner shall establish a facility fee payment mechanism 66.31 that will pay a facility fee to all enrolled outpatient 66.32 hospitals for each emergency room or outpatient clinic visit 66.33 provided on or after July 1, 1989. This payment mechanism may 66.34 not result in an overall increase in outpatient payment rates. 66.35 This section does not apply to federally mandated maximum 66.36 payment limits, department-approved program packages, or 67.1 services billed using a nonoutpatient hospital provider number. 67.2 (b) For fee-for-service services provided on or after July 67.3 1, 2002, the total payment, before third-party liability and 67.4 spenddown, made to hospitals for outpatient hospital facility 67.5 services is reduced by .5 percent from the current statutory 67.6 rates. 67.7 (c) In addition to the reduction in paragraph (b), the 67.8 total payment for fee-for-service services provided on or after 67.9 July 1, 2003, made to hospitals for outpatient hospital facility 67.10 services before third-party liability and spenddown, is reduced 67.11 five percent from the current statutory rates. Facilities 67.12 defined under section 256.969, subdivision 16, are excluded from 67.13 this paragraph. 67.14 (d) In addition to the reduction in paragraphs (b) and (c) 67.15 and section 256D.03, subdivision 4, paragraph (k), the total 67.16 payment for fee-for-service services provided on or after July 67.17 1, 2005, made to hospitals for outpatient hospital facility 67.18 services before third-party liability and spenddown, is reduced 67.19 five percent from the current statutory rates. Facilities 67.20 defined under section 256.969, subdivision 16, are excluded from 67.21 this paragraph. 67.22 Sec. 43. Minnesota Statutes 2004, section 256B.69, 67.23 subdivision 4, is amended to read: 67.24 Subd. 4. [LIMITATION OF CHOICE.] (a) The commissioner 67.25 shall develop criteria to determine when limitation of choice 67.26 may be implemented in the experimental counties. The criteria 67.27 shall ensure that all eligible individuals in the county have 67.28 continuing access to the full range of medical assistance 67.29 services as specified in subdivision 6. 67.30 (b) The commissioner shall exempt the following persons 67.31 from participation in the project, in addition to those who do 67.32 not meet the criteria for limitation of choice: 67.33 (1) persons eligible for medical assistance according to 67.34 section 256B.055, subdivision 1; 67.35 (2) persons eligible for medical assistance due to 67.36 blindness or disability as determined by the Social Security 68.1 Administration or the state medical review team, unless: 68.2 (i) they are 65 years of age or older; or 68.3 (ii) they reside in Itasca County or they reside in a 68.4 county in which the commissioner conducts a pilot project under 68.5 a waiver granted pursuant to section 1115 of the Social Security 68.6 Act; 68.7 (3) recipients who currently have private coverage through 68.8 a health maintenance organization; 68.9 (4) recipients who are eligible for medical assistance by 68.10 spending down excess income for medical expenses other than the 68.11 nursing facility per diem expense; 68.12 (5) recipients who receive benefits under the Refugee 68.13 Assistance Program, established under United States Code, title 68.14 8, section 1522(e); 68.15 (6) children who are both determined to be severely 68.16 emotionally disturbed and receiving case management services 68.17 according to section 256B.0625, subdivision 20; 68.18 (7) adults who are both determined to be seriously and 68.19 persistently mentally ill and received case management services 68.20 according to section 256B.0625, subdivision 20; 68.21 (8) persons eligible for medical assistance according to 68.22 section 256B.057, subdivision 10; and 68.23 (9) persons with access to cost-effective 68.24 employer-sponsored private health insurance or persons enrolled 68.25 inana non-Medicare individual health plan determined to be 68.26 cost-effective according to section 256B.0625, subdivision 15. 68.27 Children under age 21 who are in foster placement may enroll in 68.28 the project on an elective basis. Individuals excluded under 68.29 clauses (1), (6), and (7) may choose to enroll on an elective 68.30 basis. The commissioner may enroll recipients in the prepaid 68.31 medical assistance program for seniors who are (1) age 65 and 68.32 over, and (2) eligible for medical assistance by spending down 68.33 excess income. 68.34 (c) The commissioner may allow persons with a one-month 68.35 spenddown who are otherwise eligible to enroll to voluntarily 68.36 enroll or remain enrolled, if they elect to prepay their monthly 69.1 spenddown to the state. 69.2 (d) The commissioner may require those individuals to 69.3 enroll in the prepaid medical assistance program who otherwise 69.4 would have been excluded under paragraph (b), clauses (1), (3), 69.5 and (8), and under Minnesota Rules, part 9500.1452, subpart 2, 69.6 items H, K, and L. 69.7 (e) Before limitation of choice is implemented, eligible 69.8 individuals shall be notified and after notification, shall be 69.9 allowed to choose only among demonstration providers. The 69.10 commissioner may assign an individual with private coverage 69.11 through a health maintenance organization, to the same health 69.12 maintenance organization for medical assistance coverage, if the 69.13 health maintenance organization is under contract for medical 69.14 assistance in the individual's county of residence. After 69.15 initially choosing a provider, the recipient is allowed to 69.16 change that choice only at specified times as allowed by the 69.17 commissioner. If a demonstration provider ends participation in 69.18 the project for any reason, a recipient enrolled with that 69.19 provider must select a new provider but may change providers 69.20 without cause once more within the first 60 days after 69.21 enrollment with the second provider. 69.22 (f) An infant born to a woman who is eligible for and 69.23 receiving medical assistance and who is enrolled in the prepaid 69.24 medical assistance program shall be retroactively enrolled to 69.25 the month of birth in the same managed care plan as the mother 69.26 once the child is enrolled in medical assistance unless the 69.27 child is determined to be excluded from enrollment in a prepaid 69.28 plan under this section. 69.29 Sec. 44. Minnesota Statutes 2004, section 256B.69, is 69.30 amended by adding a subdivision to read: 69.31 Subd. 5i. [PAYMENT REDUCTION.] In addition to the 69.32 reduction in subdivisions 5g and 5h and section 256D.03, 69.33 subdivision 4, paragraph (m), the total payment made to managed 69.34 care plans is reduced 2.01 percent under the medical assistance 69.35 program and 2.20 percent under the general assistance medical 69.36 care program for services provided on or after January 1, 2006. 70.1 This provision excludes payments for nursing home services, home 70.2 and community-based waivers, and payments to demonstration 70.3 projects for persons with disabilities. 70.4 Sec. 45. Minnesota Statutes 2004, section 256B.75, is 70.5 amended to read: 70.6 256B.75 [HOSPITAL OUTPATIENT REIMBURSEMENT.] 70.7 (a) For outpatient hospital facility fee payments for 70.8 services rendered on or after October 1, 1992, the commissioner 70.9 of human services shall pay the lower of (1) submitted charge, 70.10 or (2) 32 percent above the rate in effect on June 30, 1992, 70.11 except for those services for which there is a federal maximum 70.12 allowable payment. Effective for services rendered on or after 70.13 January 1, 2000, payment rates for nonsurgical outpatient 70.14 hospital facility fees and emergency room facility fees shall be 70.15 increased by eight percent over the rates in effect on December 70.16 31, 1999, except for those services for which there is a federal 70.17 maximum allowable payment. Services for which there is a 70.18 federal maximum allowable payment shall be paid at the lower of 70.19 (1) submitted charge, or (2) the federal maximum allowable 70.20 payment. Total aggregate payment for outpatient hospital 70.21 facility fee services shall not exceed the Medicare upper 70.22 limit. If it is determined that a provision of this section 70.23 conflicts with existing or future requirements of the United 70.24 States government with respect to federal financial 70.25 participation in medical assistance, the federal requirements 70.26 prevail. The commissioner may, in the aggregate, prospectively 70.27 reduce payment rates to avoid reduced federal financial 70.28 participation resulting from rates that are in excess of the 70.29 Medicare upper limitations. 70.30 (b) Notwithstanding paragraph (a), payment for outpatient, 70.31 emergency, and ambulatory surgery hospital facility fee services 70.32 for critical access hospitals designated under section 144.1483, 70.33 clause (11), shall be paid on a cost-based payment system that 70.34 is based on the cost-finding methods and allowable costs of the 70.35 Medicare program. 70.36 (c) Effective for services provided on or after July 1, 71.1 2003, rates that are based on the Medicare outpatient 71.2 prospective payment system shall be replaced by a budget neutral 71.3 prospective payment system that is derived using medical 71.4 assistance data. The commissioner shall provide a proposal to 71.5 the 2003 legislature to define and implement this provision. 71.6 (d) For fee-for-service services provided on or after July 71.7 1, 2002, the total payment, before third-party liability and 71.8 spenddown, made to hospitals for outpatient hospital facility 71.9 services is reduced by .5 percent from the current statutory 71.10 rate. 71.11 (e) In addition to the reduction in paragraph (d), the 71.12 total payment for fee-for-service services provided on or after 71.13 July 1, 2003, made to hospitals for outpatient hospital facility 71.14 services before third-party liability and spenddown, is reduced 71.15 five percent from the current statutory rates. Facilities 71.16 defined under section 256.969, subdivision 16, are excluded from 71.17 this paragraph. 71.18 (f) In addition to the reduction in paragraphs (d) and (e) 71.19 and section 256D.03, subdivision 4, paragraph (k), the total 71.20 payment for fee-for-service services provided on or after July 71.21 1, 2005, made to hospitals for outpatient hospital facility 71.22 services before third-party liability and spenddown, is reduced 71.23 five percent from the current statutory rates. Facilities 71.24 defined under section 256.969, subdivision 16, are excluded from 71.25 this paragraph. 71.26 Sec. 46. Minnesota Statutes 2004, section 256D.03, 71.27 subdivision 3, is amended to read: 71.28 Subd. 3. [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.] 71.29 (a) General assistance medical care may be paid for any person 71.30 who is not eligible for medical assistance under chapter 256B, 71.31 including eligibility for medical assistance based on a 71.32 spenddown of excess income according to section 256B.056, 71.33 subdivision 5, or MinnesotaCare as defined in paragraph (b), 71.34 except as provided in paragraph (c), and: 71.35 (1) who is receiving assistance under section 256D.05, 71.36 except for families with children who are eligible under 72.1 Minnesota family investment program (MFIP),orwho is having a 72.2 payment made on the person's behalf under sections 256I.01 to 72.3 256I.06, or who resides in group residential housing as defined 72.4 in chapter 256I and can meet a spenddown using the cost of 72.5 remedial services received through group residential housing; or 72.6 (2)(i) who is a resident of Minnesota;and 72.7(i) who has gross countable income not in excess of 7572.8percent of the federal poverty guidelines for the family size,72.9using a six-month budget period andwhose equity in assets is 72.10 not in excess of $1,000 per assistance unit. Exempt assets, the 72.11 reduction of excess assets, and the waiver of excess assets must 72.12 conform to the medical assistance program in section 256B.056, 72.13 subdivision 3, with the following exception: the maximum amount 72.14 of undistributed funds in a trust that could be distributed to 72.15 or on behalf of the beneficiary by the trustee, assuming the 72.16 full exercise of the trustee's discretion under the terms of the 72.17 trust, must be applied toward the asset maximum;orand 72.18 (ii) who has gross countable incomeabove 75 percentnot in 72.19 excess of 75 percent of the federal poverty guidelinesbut not72.20in excess of 175 percent of the federal poverty guidelinesfor 72.21 the family size, using a six-month budget period, or whose 72.22equity in assets is not in excess of the limits in section72.23256B.056, subdivision 3c, and who applies during an inpatient72.24hospitalizationexcess income is spent down to 50 percent of the 72.25 federal poverty guidelines using a six-month budget period. 72.26 (b) General assistance medical care may not be paid for 72.27 applicants or recipients who meet all eligibility requirements 72.28 of MinnesotaCare as defined in sections 256L.01 to 256L.16, and 72.29 are adults with dependent children under 21 whose gross family 72.30 income is equal to or less than275175 percent of the federal 72.31 poverty guidelines. 72.32 (c)For applications received on or after October 1, 2003,72.33 Eligibility may begin no earlier than the date of application. 72.34 For individuals eligible under paragraph (a), clause (2),item72.35(i),a redetermination of eligibility must occur every 12 72.36 months.Individuals are eligible under paragraph (a), clause73.1(2), item (ii), only during inpatient hospitalization but may73.2reapply if there is a subsequent period of inpatient73.3hospitalization.Beginning January 1, 2000, Minnesota health 73.4 care program applications completed by recipients and applicants 73.5 who are persons described in paragraph (b), may be returned to 73.6 the county agency to be forwarded to the Department of Human 73.7 Services or sent directly to the Department of Human Services 73.8 for enrollment in MinnesotaCare. If all other eligibility 73.9 requirements of this subdivision are met, eligibility for 73.10 general assistance medical care shall be available in any month 73.11 during which a MinnesotaCare eligibility determination and 73.12 enrollment are pending. Upon notification of eligibility for 73.13 MinnesotaCare, notice of termination for eligibility for general 73.14 assistance medical care shall be sent to an applicant or 73.15 recipient. If all other eligibility requirements of this 73.16 subdivision are met, eligibility for general assistance medical 73.17 care shall be available until enrollment in MinnesotaCare 73.18 subject to the provisions of paragraph (e). 73.19 (d) The date of an initial Minnesota health care program 73.20 application necessary to begin a determination of eligibility 73.21 shall be the date the applicant has provided a name, address, 73.22 and Social Security number, signed and dated, to the county 73.23 agency or the Department of Human Services. If the applicant is 73.24 unable to provide a name, address, Social Security number, and 73.25 signature when health care is delivered due to a medical 73.26 condition or disability, a health care provider may act on an 73.27 applicant's behalf to establish the date of an initial Minnesota 73.28 health care program application by providing the county agency 73.29 or Department of Human Services with provider identification and 73.30 a temporary unique identifier for the applicant. The applicant 73.31 must complete the remainder of the application and provide 73.32 necessary verification before eligibility can be determined. 73.33 The county agency must assist the applicant in obtaining 73.34 verification if necessary. 73.35 (e) County agencies are authorized to use all automated 73.36 databases containing information regarding recipients' or 74.1 applicants' income in order to determine eligibility for general 74.2 assistance medical care or MinnesotaCare. Such use shall be 74.3 considered sufficient in order to determine eligibility and 74.4 premium payments by the county agency. 74.5 (f) General assistance medical care is not available for a 74.6 person in a correctional facility unless the person is detained 74.7 by law for less than one year in a county correctional or 74.8 detention facility as a person accused or convicted of a crime, 74.9 or admitted as an inpatient to a hospital on a criminal hold 74.10 order, and the person is a recipient of general assistance 74.11 medical care at the time the person is detained by law or 74.12 admitted on a criminal hold order and as long as the person 74.13 continues to meet other eligibility requirements of this 74.14 subdivision. 74.15 (g) General assistance medical care is not available for 74.16 applicants or recipients who do not cooperate with the county 74.17 agency to meet the requirements of medical assistance. 74.18 (h) In determining the amount of assets of an individual 74.19 eligible under paragraph (a), clause (2),item (i),there shall 74.20 be included any asset or interest in an asset, including an 74.21 asset excluded under paragraph (a), that was given away, sold, 74.22 or disposed of for less than fair market value within the 60 74.23 months preceding application for general assistance medical care 74.24 or during the period of eligibility. Any transfer described in 74.25 this paragraph shall be presumed to have been for the purpose of 74.26 establishing eligibility for general assistance medical care, 74.27 unless the individual furnishes convincing evidence to establish 74.28 that the transaction was exclusively for another purpose. For 74.29 purposes of this paragraph, the value of the asset or interest 74.30 shall be the fair market value at the time it was given away, 74.31 sold, or disposed of, less the amount of compensation received. 74.32 For any uncompensated transfer, the number of months of 74.33 ineligibility, including partial months, shall be calculated by 74.34 dividing the uncompensated transfer amount by the average 74.35 monthly per person payment made by the medical assistance 74.36 program to skilled nursing facilities for the previous calendar 75.1 year. The individual shall remain ineligible until this fixed 75.2 period has expired. The period of ineligibility may exceed 30 75.3 months, and a reapplication for benefits after 30 months from 75.4 the date of the transfer shall not result in eligibility unless 75.5 and until the period of ineligibility has expired. The period 75.6 of ineligibility begins in the month the transfer was reported 75.7 to the county agency, or if the transfer was not reported, the 75.8 month in which the county agency discovered the transfer, 75.9 whichever comes first. For applicants, the period of 75.10 ineligibility begins on the date of the first approved 75.11 application. 75.12 (i) When determining eligibility for any state benefits 75.13 under this subdivision, the income and resources of all 75.14 noncitizens shall be deemed to include their sponsor's income 75.15 and resources as defined in the Personal Responsibility and Work 75.16 Opportunity Reconciliation Act of 1996, title IV, Public Law 75.17 104-193, sections 421 and 422, and subsequently set out in 75.18 federal rules. 75.19 (j) Undocumented noncitizens and nonimmigrants are 75.20 ineligible for general assistance medical care. For purposes of 75.21 this subdivision, a nonimmigrant is an individual in one or more 75.22 of the classes listed in United States Code, title 8, section 75.23 1101(a)(15), and an undocumented noncitizen is an individual who 75.24 resides in the United States without the approval or 75.25 acquiescence of the Immigration and Naturalization Service. 75.26 (k) Notwithstanding any other provision of law, a 75.27 noncitizen who is ineligible for medical assistance due to the 75.28 deeming of a sponsor's income and resources, is ineligible for 75.29 general assistance medical care. 75.30 (l) Effective July 1, 2003, general assistance medical care 75.31 emergency services end. 75.32 [EFFECTIVE DATE.] This section is effective October 1, 2005. 75.33 Sec. 47. Minnesota Statutes 2004, section 256D.03, 75.34 subdivision 4, is amended to read: 75.35 Subd. 4. [GENERAL ASSISTANCE MEDICAL CARE; SERVICES.] 75.36 (a)(i)For a person who is eligible under subdivision 3, 76.1 paragraph (a),clause (2), item (i),general assistance medical 76.2 care covers, except as provided in paragraph (c): 76.3 (1) inpatient hospital services; 76.4 (2) outpatient hospital services; 76.5 (3) services provided by Medicare certified rehabilitation 76.6 agencies; 76.7 (4) prescription drugs and other products recommended 76.8 through the process established in section 256B.0625, 76.9 subdivision 13; 76.10 (5) equipment necessary to administer insulin and 76.11 diagnostic supplies and equipment for diabetics to monitor blood 76.12 sugar level; 76.13 (6) eyeglasses and eye examinations provided by a physician 76.14 or optometrist; 76.15 (7) hearing aids; 76.16 (8) prosthetic devices; 76.17 (9) laboratory and X-ray services; 76.18 (10) physician's services; 76.19 (11) medical transportation except special transportation; 76.20 (12) chiropractic services as covered under the medical 76.21 assistance program; 76.22 (13) podiatric services; 76.23 (14) dental services and dentures, subject to the 76.24 limitations specified in section 256B.0625, subdivision 9; 76.25 (15) outpatient services provided by a mental health center 76.26 or clinic that is under contract with the county board and is 76.27 established under section 245.62; 76.28 (16) day treatment services for mental illness provided 76.29 under contract with the county board; 76.30 (17) prescribed medications for persons who have been 76.31 diagnosed as mentally ill as necessary to prevent more 76.32 restrictive institutionalization; 76.33 (18) psychological services, medical supplies and 76.34 equipment, and Medicare premiums, coinsurance and deductible 76.35 payments; 76.36 (19) medical equipment not specifically listed in this 77.1 paragraph when the use of the equipment will prevent the need 77.2 for costlier services that are reimbursable under this 77.3 subdivision; 77.4 (20) services performed by a certified pediatric nurse 77.5 practitioner, a certified family nurse practitioner, a certified 77.6 adult nurse practitioner, a certified obstetric/gynecological 77.7 nurse practitioner, a certified neonatal nurse practitioner, or 77.8 a certified geriatric nurse practitioner in independent 77.9 practice, if (1) the service is otherwise covered under this 77.10 chapter as a physician service, (2) the service provided on an 77.11 inpatient basis is not included as part of the cost for 77.12 inpatient services included in the operating payment rate, and 77.13 (3) the service is within the scope of practice of the nurse 77.14 practitioner's license as a registered nurse, as defined in 77.15 section 148.171; 77.16 (21) services of a certified public health nurse or a 77.17 registered nurse practicing in a public health nursing clinic 77.18 that is a department of, or that operates under the direct 77.19 authority of, a unit of government, if the service is within the 77.20 scope of practice of the public health nurse's license as a 77.21 registered nurse, as defined in section 148.171; and 77.22 (22) telemedicine consultations, to the extent they are 77.23 covered under section 256B.0625, subdivision 3b. 77.24(ii) Effective October 1, 2003, for a person who is77.25eligible under subdivision 3, paragraph (a), clause (2), item77.26(ii), general assistance medical care coverage is limited to77.27inpatient hospital services, including physician services77.28provided during the inpatient hospital stay. A $1,00077.29deductible is required for each inpatient hospitalization.77.30 (b)GenderSex reassignment surgeryand related services77.31areis not coveredservicesunder this subdivisionunless the77.32individual began receiving gender reassignment services prior to77.33July 1, 1995. 77.34 (c) In order to contain costs, the commissioner of human 77.35 services shall select vendors of medical care who can provide 77.36 the most economical care consistent with high medical standards 78.1 and shall where possible contract with organizations on a 78.2 prepaid capitation basis to provide these services. The 78.3 commissioner shall consider proposals by counties and vendors 78.4 for prepaid health plans, competitive bidding programs, block 78.5 grants, or other vendor payment mechanisms designed to provide 78.6 services in an economical manner or to control utilization, with 78.7 safeguards to ensure that necessary services are provided. 78.8 Before implementing prepaid programs in counties with a county 78.9 operated or affiliated public teaching hospital or a hospital or 78.10 clinic operated by the University of Minnesota, the commissioner 78.11 shall consider the risks the prepaid program creates for the 78.12 hospital and allow the county or hospital the opportunity to 78.13 participate in the program in a manner that reflects the risk of 78.14 adverse selection and the nature of the patients served by the 78.15 hospital, provided the terms of participation in the program are 78.16 competitive with the terms of other participants considering the 78.17 nature of the population served. Payment for services provided 78.18 pursuant to this subdivision shall be as provided to medical 78.19 assistance vendors of these services under sections 256B.02, 78.20 subdivision 8, and 256B.0625. For payments made during fiscal 78.21 year 1990 and later years, the commissioner shall consult with 78.22 an independent actuary in establishing prepayment rates, but 78.23 shall retain final control over the rate methodology. 78.24 (d) Recipients eligible under subdivision 3, paragraph (a), 78.25clause (2), item (i),shall pay the following co-payments for 78.26 services provided on or after October 1, 2003: 78.27 (1) $3 per nonpreventive visit. For purposes of this 78.28 subdivision, a visit means an episode of service which is 78.29 required because of a recipient's symptoms, diagnosis, or 78.30 established illness, and which is delivered in an ambulatory 78.31 setting by a physician or physician ancillary, chiropractor, 78.32 podiatrist, nurse midwife, advanced practice nurse, audiologist, 78.33 optician, or optometrist; 78.34 (2) $25 for eyeglasses; 78.35 (3) $25 for nonemergency visits to a hospital-based 78.36 emergency room; 79.1 (4) $3 per brand-name drug prescription and $1 per generic 79.2 drug prescription, subject to a $20 per month maximum for 79.3 prescription drug co-payments. No co-payments shall apply to 79.4 antipsychotic drugs when used for the treatment of mental 79.5 illness; and 79.6 (5) 50 percent coinsurance on restorative dental services. 79.7 (e) Co-payments shall be limited to one per day per 79.8 provider for nonpreventive visits, eyeglasses, and nonemergency 79.9 visits to a hospital-based emergency room. Recipients of 79.10 general assistance medical care are responsible for all 79.11 co-payments in this subdivision. The general assistance medical 79.12 care reimbursement to the provider shall be reduced by the 79.13 amount of the co-payment, except that reimbursement for 79.14 prescription drugs shall not be reduced once a recipient has 79.15 reached the $20 per month maximum for prescription drug 79.16 co-payments. The provider collects the co-payment from the 79.17 recipient. Providers may not deny services to recipients who 79.18 are unable to pay the co-payment, except as provided in 79.19 paragraph (f). 79.20 (f) If it is the routine business practice of a provider to 79.21 refuse service to an individual with uncollected debt, the 79.22 provider may include uncollected co-payments under this 79.23 section. A provider must give advance notice to a recipient 79.24 with uncollected debt before services can be denied. 79.25 (g) Any county may, from its own resources, provide medical 79.26 payments for which state payments are not made. 79.27 (h) Chemical dependency services that are reimbursed under 79.28 chapter 254B must not be reimbursed under general assistance 79.29 medical care. 79.30 (i) The maximum payment for new vendors enrolled in the 79.31 general assistance medical care program after the base year 79.32 shall be determined from the average usual and customary charge 79.33 of the same vendor type enrolled in the base year. 79.34 (j) The conditions of payment for services under this 79.35 subdivision are the same as the conditions specified in rules 79.36 adopted under chapter 256B governing the medical assistance 80.1 program, unless otherwise provided by statute or rule. 80.2 (k) Inpatient and outpatient payments shall be reduced by 80.3 five percent, effective July 1, 2003. This reduction is in 80.4 addition to the five percent reduction effective July 1, 2003, 80.5 and incorporated by reference in paragraph (i). 80.6 (l) Payments for all other health services except 80.7 inpatient, outpatient, and pharmacy services shall be reduced by 80.8 five percent, effective July 1, 2003. 80.9 (m) Payments to managed care plans shall be reduced by five 80.10 percent for services provided on or after October 1, 2003. 80.11 (n) A hospital receiving a reduced payment as a result of 80.12 this section may apply the unpaid balance toward satisfaction of 80.13 the hospital's bad debts. 80.14 [EFFECTIVE DATE.] This section is effective July 1, 2005, 80.15 except the amendment to paragraph (a), item (ii), is effective 80.16 October 1, 2005. 80.17 Sec. 48. Minnesota Statutes 2004, section 256D.03, is 80.18 amended by adding a subdivision to read: 80.19 Subd. 4a. [GENERAL ASSISTANCE MEDICAL CARE; MEDICAL 80.20 NECESSITY.] In order to be covered under general assistance 80.21 medical care, a medical item or service must meet the medical 80.22 necessity standards in section 256B.0632. 80.23 Sec. 49. Minnesota Statutes 2004, section 256D.03, is 80.24 amended by adding a subdivision to read: 80.25 Subd. 10. [PAYMENTS AFTER OCTOBER 1, 2005.] General 80.26 assistance medical care payments made on or after October 1, 80.27 2005, shall be made from the health care access fund. 80.28 Sec. 50. Minnesota Statutes 2004, section 256D.045, is 80.29 amended to read: 80.30 256D.045 [SOCIAL SECURITY NUMBER REQUIRED.] 80.31 To be eligible for general assistance under sections 80.32 256D.01 to 256D.21, an individual must provide the individual's 80.33 Social Security number to the county agency or submit proof that 80.34 an application has been made. An individual who refuses to 80.35 provide a Social Security number because of a well-established 80.36 religious objection as described in Code of Federal Regulations, 81.1 title 42, section 435.910, may be eligible for general 81.2 assistance medical care under section 256D.03. The provisions 81.3 of this section do not apply to the determination of eligibility 81.4 for emergency general assistance under section 256D.06, 81.5 subdivision 2. This provision applies to eligible children 81.6 under the age of 18 effective July 1, 1997. 81.7 [EFFECTIVE DATE.] This section is effective March 1, 2006, 81.8 or upon HealthMatch implementation, whichever is later. 81.9 Sec. 51. Minnesota Statutes 2004, section 256L.01, 81.10 subdivision 1a, is amended to read: 81.11 Subd. 1a. [CHILD.] (a) "Child" means an individual under 81.12 21 years of age who is not enrolled in a program of study at a 81.13 postsecondary education institution, including the unborn child 81.14 of a pregnant woman, an emancipated minor, and an emancipated 81.15 minor's spouse. 81.16 (b) For an individual enrolled in a program of study at a 81.17 postsecondary education institution, child means an individual 81.18 under 19 years of age, including an emancipated minor, and an 81.19 emancipated minor's spouse, except that an individual with 81.20 access to health coverage through the postsecondary education 81.21 institution or the individual's parent does not qualify as a 81.22 child under this paragraph. 81.23 [EFFECTIVE DATE.] This section is effective July 1, 2005, 81.24 or upon federal approval, whichever is later. Prior to the 81.25 implementation of HealthMatch, the commissioner shall implement 81.26 this section to the fullest extent possible, including the use 81.27 of manual processing. Upon implementation of HealthMatch, the 81.28 commissioner shall implement this section in a manner consistent 81.29 with the procedures and requirements of HealthMatch. 81.30 Sec. 52. Minnesota Statutes 2004, section 256L.01, 81.31 subdivision 4, is amended to read: 81.32 Subd. 4. [GROSS INDIVIDUAL OR GROSS FAMILY INCOME.] (a) 81.33 "Gross individual or gross family income" for nonfarm 81.34 self-employed means income calculated for the six-month period 81.35 of eligibility using as the baseline the adjusted gross income 81.36 reported on the applicant's federal income tax form for the 82.1 previous year andadding back in reported depreciation,82.2carryover loss, and net operating loss amounts that apply to the82.3business in which the family is currently engagedusing medical 82.4 assistance methodology for determining allowable and 82.5 nonallowable expenses and countable income. 82.6 (b) "Gross individual or gross family income" for farm 82.7 self-employed means income calculated for the six-month period 82.8 of eligibility using as the baseline the adjusted gross income 82.9 reported on the applicant's federal income tax form for the 82.10 previous year and adding back in reported depreciation amounts 82.11 that apply to the business in which the family is currently 82.12 engaged. 82.13 (c)Applicants shall report the most recent financial82.14situation of the family if it has changed from the period of82.15time covered by the federal income tax form. The report may be82.16in the form of percentage increase or decrease"Gross individual 82.17 or gross family income" means the total income for all family 82.18 members, calculated for the six-month period of eligibility. 82.19 [EFFECTIVE DATE.] This section is effective March 1, 2006, 82.20 or upon HealthMatch implementation, whichever is later. 82.21 Sec. 53. Minnesota Statutes 2004, section 256L.01, 82.22 subdivision 5, is amended to read: 82.23 Subd. 5. [INCOME.] (a) "Income" has the meaning given for 82.24 earned and unearned income for families and children in the 82.25 medical assistance program, according to the state's aid to 82.26 families with dependent children plan in effect as of July 16, 82.27 1996. The definition does not include medical assistance income 82.28 methodologies and deeming requirements. The earned income of 82.29 full-time and part-time students under age 19 is not counted as 82.30 income. Public assistance payments and supplemental security 82.31 income are not excluded income. 82.32 (b) For purposes of this subdivision, and unless otherwise 82.33 specified in this section, the commissioner shall use reasonable 82.34 methods to calculate gross earned and unearned income including, 82.35 but not limited to, projecting income based on income received 82.36 within the past 30 days, the last 90 days, or the last 12 months. 83.1 [EFFECTIVE DATE.] This section is effective July 1, 2005. 83.2 Sec. 54. Minnesota Statutes 2004, section 256L.03, 83.3 subdivision 1, is amended to read: 83.4 Subdivision 1. [COVERED HEALTH SERVICES.]For individuals83.5under section 256L.04, subdivision 7, with income no greater83.6than 75 percent of the federal poverty guidelines orFor 83.7 families with children under section 256L.04, subdivision 1, all 83.8 subdivisions of this section apply. "Covered health services" 83.9 means the health services reimbursed under chapter 256B, with 83.10 the exception of inpatient hospital services, special education 83.11 services, private duty nursing services, adult dental care 83.12 services other than services covered under section 256B.0625, 83.13 subdivision 9, paragraph (b), orthodontic services, nonemergency 83.14 medical transportation services, personal care assistant and 83.15 case management services, nursing home or intermediate care 83.16 facilities services, inpatient mental health services, and 83.17 chemical dependency services. Outpatient mental health services 83.18 covered under the MinnesotaCare program are limited to 83.19 diagnostic assessments, psychological testing, explanation of 83.20 findings, medication management by a physician, day treatment, 83.21 partial hospitalization, and individual, family, and group 83.22 psychotherapy. 83.23 No public funds shall be used for coverage of abortion 83.24 under MinnesotaCare except where the life of the female would be 83.25 endangered or substantial and irreversible impairment of a major 83.26 bodily function would result if the fetus were carried to term; 83.27 or where the pregnancy is the result of rape or incest. 83.28 Covered health services shall be expanded as provided in 83.29 this section. 83.30 [EFFECTIVE DATE.] This section is effective October 1, 2005. 83.31 Sec. 55. Minnesota Statutes 2004, section 256L.03, 83.32 subdivision 3, is amended to read: 83.33 Subd. 3. [INPATIENT HOSPITAL SERVICES.] (a) Covered health 83.34 services shall include inpatient hospital services, including 83.35 inpatient hospital mental health services and inpatient hospital 83.36 and residential chemical dependency treatment, subject to those 84.1 limitations necessary to coordinate the provision of these 84.2 services with eligibility under the medical assistance 84.3 spenddown.Prior to July 1, 1997, the inpatient hospital84.4benefit for adult enrollees is subject to an annual benefit84.5limit of $10,000. The inpatient hospital benefit for adult84.6enrollees who qualify under section 256L.04, subdivision 7, or84.7who qualify under section 256L.04, subdivisions 1 and 2, with84.8family gross income that exceeds 175 percent of the federal84.9poverty guidelines and who are not pregnant, is subject to an84.10annual limit of $10,000.84.11 (b) Admissions for inpatient hospital services paid for 84.12 under section 256L.11, subdivision 3, must be certified as 84.13 medically necessary in accordance with Minnesota Rules, parts 84.14 9505.0500 to 9505.0540, except as provided in clauses (1) and 84.15 (2): 84.16 (1) all admissions must be certified, except those 84.17 authorized under rules established under section 254A.03, 84.18 subdivision 3, or approved under Medicare; and 84.19 (2) payment under section 256L.11, subdivision 3, shall be 84.20 reduced by five percent for admissions for which certification 84.21 is requested more than 30 days after the day of admission. The 84.22 hospital may not seek payment from the enrollee for the amount 84.23 of the payment reduction under this clause. 84.24 [EFFECTIVE DATE.] This section is effective October 1, 2005. 84.25 Sec. 56. Minnesota Statutes 2004, section 256L.03, 84.26 subdivision 5, is amended to read: 84.27 Subd. 5. [CO-PAYMENTS AND COINSURANCE.] (a) Except as 84.28 provided in paragraphs (b) and (c), the MinnesotaCare benefit 84.29 plan shall include the following co-payments and coinsurance 84.30 requirements for all enrollees: 84.31 (1) ten percent of the paid charges for inpatient hospital 84.32 services for adult enrollees, subject to an annual inpatient 84.33 out-of-pocket maximum of $1,000 per individual and $3,000 per 84.34 family; 84.35 (2) $3 per prescription for adult enrollees; 84.36 (3) $25 for eyeglasses for adult enrollees;and85.1 (4) $3 per nonpreventive visit. For purposes of this 85.2 subdivision, a visit means an episode of service which is 85.3 required because of an enrollee's symptoms, diagnosis, or 85.4 established illness, and which is delivered in an ambulatory 85.5 setting by a physician or physician ancillary, chiropractor, 85.6 podiatrist, advanced practice nurse, audiologist, optician, or 85.7 optometrist; 85.8 (5) $6 for nonemergency visits to a hospital-based 85.9 emergency room; and 85.10 (6) 50 percent of the fee-for-service rate for adult dental 85.11 care services other than preventive care services for persons 85.12 eligible under section 256L.04, subdivisions 1 to 7, with income 85.13 equal to or less than 175 percent of the federal poverty 85.14 guidelines. 85.15 (b) Paragraph (a), clause (1), does not apply to parents 85.16 and relative caretakers of children under the age of 21 in 85.17 households with family income equal to or less than 175 percent 85.18 of the federal poverty guidelines.Paragraph (a), clause (1),85.19does not apply to parents and relative caretakers of children85.20under the age of 21 in households with family income greater85.21than 175 percent of the federal poverty guidelines for inpatient85.22hospital admissions occurring on or after January 1, 2001.85.23 (c) Paragraph (a), clauses (1) to(4)(6), do not apply to 85.24 pregnant women and children under the age of 21. 85.25 (d) Adult enrollees with family gross income that exceeds 85.26 175 percent of the federal poverty guidelines and who are not 85.27 pregnant shall be financially responsible for the coinsurance 85.28 amount, if applicable, and amounts which exceed the $10,000 85.29 inpatient hospital benefit limit. 85.30 (e) When a MinnesotaCare enrollee becomes a member of a 85.31 prepaid health plan, or changes from one prepaid health plan to 85.32 another during a calendar year, any charges submitted towards 85.33 the $10,000 annual inpatient benefit limit, and any 85.34 out-of-pocket expenses incurred by the enrollee for inpatient 85.35 services, that were submitted or incurred prior to enrollment, 85.36 or prior to the change in health plans, shall be disregarded. 86.1 (f) Paragraph (a), clauses (4) and (5), are limited to one 86.2 co-payment per day per provider. 86.3 [EFFECTIVE DATE.] This section is effective January 1, 86.4 2006, except the amendment to paragraph (b) is effective October 86.5 1, 2005. 86.6 Sec. 57. Minnesota Statutes 2004, section 256L.03, is 86.7 amended by adding a subdivision to read: 86.8 Subd. 7. [MEDICAL NECESSITY.] In order to be covered under 86.9 MinnesotaCare, a medical item or service must meet the medical 86.10 necessity standards in section 256B.0632. 86.11 Sec. 58. Minnesota Statutes 2004, section 256L.04, 86.12 subdivision 1, is amended to read: 86.13 Subdivision 1. [FAMILIES WITH CHILDREN.] (a) Through 86.14 September 30, 2005, families with children with family income 86.15 equal to or less than 275 percent of the federal poverty 86.16 guidelines for the applicable family size shall be eligible for 86.17 MinnesotaCare according to this section. Beginning October 1, 86.18 2005, children and pregnant women with family income equal to or 86.19 less than 275 percent of the federal poverty guidelines for the 86.20 applicable family size shall be eligible for MinnesotaCare 86.21 according to this section. Beginning October 1, 2005, parents, 86.22 grandparents, foster parents, relative caretakers, and legal 86.23 guardians ages 21 and over are not eligible for MinnesotaCare if 86.24 their gross income exceeds 175 percent of the federal poverty 86.25 guidelines for the applicable family size. All other provisions 86.26 of sections 256L.01 to 256L.18, including the insurance-related 86.27 barriers to enrollment under section 256L.07, shall apply unless 86.28 otherwise specified. 86.29 (b) Parents who enroll in the MinnesotaCare program must 86.30 also enroll their children, if the children are eligible. 86.31 Children may be enrolled separately without enrollment by 86.32 parents. However, if one parent in the household enrolls, both 86.33 parents must enroll, unless other insurance is available. If 86.34 one child from a family is enrolled, all children must be 86.35 enrolled, unless other insurance is available. If one spouse in 86.36 a household enrolls, the other spouse in the household must also 87.1 enroll, unless other insurance is available. Families cannot 87.2 choose to enroll only certain uninsured members. 87.3 (c)Beginning October 1, 2003, the dependent sibling87.4definition no longer applies to the MinnesotaCare program.87.5These persons are no longer counted in the parental household87.6and may apply as a separate household.87.7(d)Beginning July 1, 2003, or upon federal approval, 87.8 whichever is later, parents are not eligible for MinnesotaCare 87.9 if their gross income exceeds $50,000. 87.10 Sec. 59. Minnesota Statutes 2004, section 256L.04, is 87.11 amended by adding a subdivision to read: 87.12 Subd. 1a. [SOCIAL SECURITY NUMBER REQUIRED.] (a) 87.13 Individuals and families applying for MinnesotaCare coverage 87.14 must provide a Social Security number. 87.15 (b) The commissioner shall not deny eligibility to an 87.16 otherwise eligible applicant who has applied for a Social 87.17 Security number and is awaiting issuance of that Social Security 87.18 number. 87.19 (c) Newborns enrolled under section 256L.05, subdivision 3, 87.20 are exempt from the requirements of this subdivision. 87.21 (d) Individuals who refuse to provide a Social Security 87.22 number because of well-established religious objections are 87.23 exempt from the requirements of this subdivision. The term 87.24 "well-established religious objections" has the meaning given in 87.25 Code of Federal Regulations, title 42, section 435.910. 87.26 [EFFECTIVE DATE.] This section is effective March 1, 2006, 87.27 or upon HealthMatch implementation, whichever is later. 87.28 Sec. 60. Minnesota Statutes 2004, section 256L.04, 87.29 subdivision 2, is amended to read: 87.30 Subd. 2. [COOPERATION IN ESTABLISHING THIRD-PARTY 87.31 LIABILITY, PATERNITY, AND OTHER MEDICAL SUPPORT.] (a) To be 87.32 eligible for MinnesotaCare, individuals and families must 87.33 cooperate with the state agency to identify potentially liable 87.34 third-party payers and assist the state in obtaining third-party 87.35 payments. "Cooperation" includes, but is not limited 87.36 to, complying with the notice requirements in section 256B.056, 88.1 subdivision 9, identifying any third party who may be liable for 88.2 care and services provided under MinnesotaCare to the enrollee, 88.3 providing relevant information to assist the state in pursuing a 88.4 potentially liable third party, and completing forms necessary 88.5 to recover third-party payments. 88.6 (b) A parent, guardian, relative caretaker, or child 88.7 enrolled in the MinnesotaCare program must cooperate with the 88.8 Department of Human Services and the local agency in 88.9 establishing the paternity of an enrolled child and in obtaining 88.10 medical care support and payments for the child and any other 88.11 person for whom the person can legally assign rights, in 88.12 accordance with applicable laws and rules governing the medical 88.13 assistance program. A child shall not be ineligible for or 88.14 disenrolled from the MinnesotaCare program solely because the 88.15 child's parent, relative caretaker, or guardian fails to 88.16 cooperate in establishing paternity or obtaining medical support. 88.17 Sec. 61. Minnesota Statutes 2004, section 256L.04, is 88.18 amended by adding a subdivision to read: 88.19 Subd. 2a. [APPLICATIONS FOR OTHER BENEFITS.] To be 88.20 eligible for MinnesotaCare, individuals and families must take 88.21 all necessary steps to obtain other benefits as described in 88.22 Code of Federal Regulations, title 42, section 435.608. 88.23 Applicants and enrollees must apply for other benefits within 30 88.24 days. 88.25 [EFFECTIVE DATE.] This section is effective March 1, 2006, 88.26 or upon HealthMatch implementation, whichever is later. 88.27 Sec. 62. Minnesota Statutes 2004, section 256L.04, 88.28 subdivision 8, is amended to read: 88.29 Subd. 8. [APPLICANTS POTENTIALLY ELIGIBLE FOR MEDICAL 88.30 ASSISTANCE.](a) Individuals who receive supplemental security88.31income or retirement, survivors, or disability benefits due to a88.32disability, or other disability-based pension, who qualify under88.33subdivision 7, but who are potentially eligible for medical88.34assistance without a spenddown shall be allowed to enroll in88.35MinnesotaCare for a period of 60 days, so long as the applicant88.36meets all other conditions of eligibility. The commissioner89.1shall identify and refer the applications of such individuals to89.2their county social service agency. The county and the89.3commissioner shall cooperate to ensure that the individuals89.4obtain medical assistance coverage for any months for which they89.5are eligible.89.6(b) The enrollee must cooperate with the county social89.7service agency in determining medical assistance eligibility89.8within the 60-day enrollment period. Enrollees who do not89.9cooperate with medical assistance within the 60-day enrollment89.10period shall be disenrolled from the plan within one calendar89.11month. Persons disenrolled for nonapplication for medical89.12assistance may not reenroll until they have obtained a medical89.13assistance eligibility determination. Persons disenrolled for89.14noncooperation with medical assistance may not reenroll until89.15they have cooperated with the county agency and have obtained a89.16medical assistance eligibility determination.89.17(c)Beginning January 1, 2000, counties that choose to 89.18 become MinnesotaCare enrollment sites shall consider 89.19 MinnesotaCare applications to also be applications for medical 89.20 assistance. Applicants who are potentially eligible for medical 89.21 assistance, except for those described in paragraph (a),may 89.22 choose to enroll in either MinnesotaCare or medical assistance. 89.23(d) The commissioner shall redetermine provider payments89.24made under MinnesotaCare to the appropriate medical assistance89.25payments for those enrollees who subsequently become eligible89.26for medical assistance.89.27 [EFFECTIVE DATE.] This section is effective October 1, 2005. 89.28 Sec. 63. Minnesota Statutes 2004, section 256L.05, 89.29 subdivision 2, is amended to read: 89.30 Subd. 2. [COMMISSIONER'S DUTIES.] (a) The commissioner or 89.31 county agency shall use electronic verification as the primary 89.32 method of income verification. If there is a discrepancy 89.33 between reported income and electronically verified income, an 89.34 individual may be required to submit additional verification. 89.35 In addition, the commissioner shall perform random audits to 89.36 verify reported income and eligibility. The commissioner may 90.1 execute data sharing arrangements with the Department of Revenue 90.2 and any other governmental agency in order to perform income 90.3 verification related to eligibility and premium payment under 90.4 the MinnesotaCare program. 90.5 (b) In determining eligibility for MinnesotaCare, the 90.6 commissioner shall require applicants and enrollees seeking 90.7 renewal of eligibility to verify both earned and unearned 90.8 income. The commissioner shall also require applicants and 90.9 enrollees to submit to their employers, if employed, a form to 90.10 verify whether the applicant or enrollee, and any dependents, 90.11 are eligible for employer subsidized coverage. 90.12 [EFFECTIVE DATE.] This section is effective July 1, 2005. 90.13 Prior to the implementation of HealthMatch, the commissioner 90.14 shall implement this section to the fullest extent possible, 90.15 including the use of manual processing. Upon implementation of 90.16 HealthMatch, the commissioner shall implement this section in a 90.17 manner consistent with the procedures and requirements of 90.18 HealthMatch. 90.19 Sec. 64. Minnesota Statutes 2004, section 256L.05, 90.20 subdivision 3, is amended to read: 90.21 Subd. 3. [EFFECTIVE DATE OF COVERAGE.] (a) The effective 90.22 date of coverage is the first day of the month following the 90.23 month in which eligibility is approved and the first premium 90.24 payment has been received. As provided in section 256B.057, 90.25 coverage for newborns is automatic from the date of birth and 90.26 must be coordinated with other health coverage. The effective 90.27 date of coverage for eligible newly adoptive children added to a 90.28 family receiving covered health services is thedate of entry90.29into the familymonth of placement or the month placement is 90.30 reported, whichever is later. The effective date of coverage 90.31 for other newrecipientsmembers added to the familyreceiving90.32covered health servicesis the first day of the month following 90.33 the month in whicheligibility is approved or at renewal,90.34whichever the family receiving covered health services90.35prefersthe change is reported. All eligibility criteria must 90.36 be met by the family at the time the new family member is 91.1 added. The income of the new family member is included with the 91.2 family's gross income and the adjusted premium begins in the 91.3 month the new family member is added. 91.4 (b) The initial premium must be received by the last 91.5 working day of the month for coverage to begin the first day of 91.6 the following month. 91.7 (c) Benefits are not available until the day following 91.8 discharge if an enrollee is hospitalized on the first day of 91.9 coverage. 91.10 (d) Notwithstanding any other law to the contrary, benefits 91.11 under sections 256L.01 to 256L.18 are secondary to a plan of 91.12 insurance or benefit program under which an eligible person may 91.13 have coverage and the commissioner shall use cost avoidance 91.14 techniques to ensure coordination of any other health coverage 91.15 for eligible persons. The commissioner shall identify eligible 91.16 persons who may have coverage or benefits under other plans of 91.17 insurance or who become eligible for medical assistance. 91.18 [EFFECTIVE DATE.] This section is effective March 1, 2006, 91.19 or upon HealthMatch implementation, whichever is later. 91.20 Sec. 65. Minnesota Statutes 2004, section 256L.05, 91.21 subdivision 3a, is amended to read: 91.22 Subd. 3a. [RENEWAL OF ELIGIBILITY.] (a) Beginning January 91.23 1, 1999, an enrollee's eligibility must be renewed every 12 91.24 months. The 12-month period begins in the month after the month 91.25 the application is approved. 91.26 (b) Beginning October 1, 2004, an enrollee's eligibility 91.27 must be renewed every six months. The first six-month period of 91.28 eligibility beginsin the month afterthe month the application 91.29 isapprovedreceived by the commissioner. The effective date of 91.30 coverage within the first six-month period of eligibility is as 91.31 provided in section 256L.05, subdivision 3. Each new period of 91.32 eligibility must take into account any changes in circumstances 91.33 that impact eligibility and premium amount. An enrollee must 91.34 provide all the information needed to redetermine eligibility by 91.35 the first day of the month that ends the eligibility period. 91.36 The premium for the new period of eligibility must be received 92.1 as provided in section 256L.06 in order for eligibility to 92.2 continue. 92.3 [EFFECTIVE DATE.] This section is effective March 1, 2006, 92.4 or upon HealthMatch implementation, whichever is later. 92.5 Sec. 66. Minnesota Statutes 2004, section 256L.05, 92.6 subdivision 5, is amended to read: 92.7 Subd. 5. [AVAILABILITY OF PRIVATE INSURANCE.] The 92.8 commissioner, in consultation with the commissioners of health 92.9 and commerce, shall provide information regarding the 92.10 availability of private health insurance coverage and the 92.11 possibility of disenrollment under section 256L.07, subdivision 92.12 1,paragraphs (b) and (c), to all: (1)to families enrolled in 92.13 the MinnesotaCare program whose gross family income is equal to 92.14 or more than 225 percent of the federal poverty guidelines; and92.15(2) single adults and households without children enrolled in92.16the MinnesotaCare program whose gross family income is equal to92.17or more than 165 percent of the federal poverty guidelines. 92.18 This information must be provided upon initial enrollment and 92.19 annually thereafter. The commissioner shall also include 92.20 information regarding the availability of private health 92.21 insurance coverage in the notice of ineligibility provided to 92.22 persons subject to disenrollment under section 256L.07, 92.23 subdivision 1, paragraphs (b) and (c). 92.24 [EFFECTIVE DATE.] This section is effective October 1, 2005. 92.25 Sec. 67. Minnesota Statutes 2004, section 256L.06, 92.26 subdivision 3, is amended to read: 92.27 Subd. 3. [COMMISSIONER'S DUTIES AND PAYMENT.] (a) Premiums 92.28 are dedicated to the commissioner for MinnesotaCare. 92.29 (b) The commissioner shall develop and implement procedures 92.30 to: (1) require enrollees to report changes in income; (2) 92.31 adjust sliding scale premium payments, based uponchangesboth 92.32 increases and decreases in enrollee income, at the time the 92.33 change in income is reported; and (3) disenroll enrollees from 92.34 MinnesotaCare for failure to pay required premiums. Failure to 92.35 pay includes payment with a dishonored check, a returned 92.36 automatic bank withdrawal, or a refused credit card or debit 93.1 card payment. The commissioner may demand a guaranteed form of 93.2 payment, including a cashier's check or a money order, as the 93.3 only means to replace a dishonored, returned, or refused payment. 93.4 (c) Premiums are calculated on a calendar month basis and 93.5 may be paid on a monthly, quarterly, or semiannual basis, with 93.6 the first payment due upon notice from the commissioner of the 93.7 premium amount required. The commissioner shall inform 93.8 applicants and enrollees of these premium payment options. 93.9 Premium payment is required before enrollment is complete and to 93.10 maintain eligibility in MinnesotaCare. Premium payments 93.11 received before noon are credited the same day. Premium 93.12 payments received after noon are credited on the next working 93.13 day. 93.14 (d) Nonpayment of the premium will result in disenrollment 93.15 from the plan effective for the calendar month for which the 93.16 premium was due. Persons disenrolled for nonpayment or who 93.17 voluntarily terminate coverage from the program may not reenroll 93.18 until four calendar months have elapsed. Persons disenrolled 93.19 for nonpayment who pay all past due premiums as well as current 93.20 premiums due, including premiums due for the period of 93.21 disenrollment, within 20 days of disenrollment, shall be 93.22 reenrolled retroactively to the first day of disenrollment. 93.23 Persons disenrolled for nonpayment or who voluntarily terminate 93.24 coverage from the program may not reenroll for four calendar 93.25 months unless the person demonstrates good cause for 93.26 nonpayment. Good cause does not exist if a person chooses to 93.27 pay other family expenses instead of the premium. The 93.28 commissioner shall define good cause in rule. 93.29 [EFFECTIVE DATE.] This section is effective July 1, 2005. 93.30 Prior to the implementation of HealthMatch, the commissioner 93.31 shall implement this section to the fullest extent possible, 93.32 including the use of manual processing. Upon implementation of 93.33 HealthMatch, the commissioner shall implement this section in a 93.34 manner consistent with the procedures and requirements of 93.35 HealthMatch. 93.36 Sec. 68. Minnesota Statutes 2004, section 256L.07, 94.1 subdivision 1, is amended to read: 94.2 Subdivision 1. [GENERAL REQUIREMENTS.] (a) Children 94.3 enrolled in the original children's health plan as of September 94.4 30, 1992, children who enrolled in the MinnesotaCare program 94.5 after September 30, 1992, pursuant to Laws 1992, chapter 549, 94.6 article 4, section 17, and children who have family gross 94.7 incomes that are equal to or less than 150 percent of the 94.8 federal poverty guidelines are eligible without meeting the 94.9 requirements of subdivision 2 and the four-month requirement in 94.10 subdivision 3, as long as they maintain continuous coverage in 94.11 the MinnesotaCare program or medical assistance. Children who 94.12 apply for MinnesotaCare on or after the implementation date of 94.13 the employer-subsidized health coverage program as described in 94.14 Laws 1998, chapter 407, article 5, section 45, who have family 94.15 gross incomes that are equal to or less than 150 percent of the 94.16 federal poverty guidelines, must meet the requirements of 94.17 subdivision 2 to be eligible for MinnesotaCare. 94.18 (b) Through September 30, 2005, families enrolled in 94.19 MinnesotaCare under section 256L.04, subdivision 1, whose income 94.20 increases above 275 percent of the federal poverty guidelines, 94.21 are no longer eligible for the program and shall be disenrolled 94.22 by the commissioner.IndividualsBeginning October 1, 2005, 94.23 children enrolled in MinnesotaCare under section 256L.04, 94.24 subdivision71, whose income increases above175275 percent of 94.25 the federal poverty guidelines, are no longer eligible for the 94.26 program and shall be disenrolled by the commissioner. Pregnant 94.27 women enrolled in MinnesotaCare whose income increases above 275 94.28 percent of the federal poverty guidelines remain eligible 94.29 through the end of the 60-day postpartum period. Beginning 94.30 October 1, 2005, parents, grandparents, foster parents, relative 94.31 caretakers, and legal guardians ages 21 and over are no longer 94.32 eligible for MinnesotaCare if their gross income exceeds 175 94.33 percent of the federal poverty guidelines for the applicable 94.34 family size. For persons disenrolled under this subdivision, 94.35 MinnesotaCare coverage terminates the last day of the calendar 94.36 month following the month in which the commissioner determines 95.1 that the income of a family or individual exceeds program income 95.2 limits. 95.3 (c)(1) Notwithstanding paragraph (b), families enrolled in95.4MinnesotaCare under section 256L.04, subdivision 1, may remain95.5enrolled in MinnesotaCare if ten percent of their annual income95.6is less than the annual premium for a policy with a $50095.7deductible available through the Minnesota Comprehensive Health95.8Association. Families who are no longer eligible for95.9MinnesotaCare under this subdivision shall be given an 18-month95.10notice period from the date that ineligibility is determined95.11before disenrollment. This clause expires February 1, 2004.95.12(2)Effective February 1, 2004, notwithstanding paragraph 95.13 (b), children may remain enrolled in MinnesotaCare if ten 95.14 percent of theirannualgross individual or gross family income 95.15 as defined in section 256L.01, subdivision 4, is less than the 95.16annualpremium for a six-month policy with a $500 deductible 95.17 available through the Minnesota Comprehensive Health 95.18 Association. Children who are no longer eligible for 95.19 MinnesotaCare under this clause shall be given a12-month95.20 six-month notice period from the date that ineligibility is 95.21 determined before disenrollment. The premium for children 95.22 remaining eligible under this clause shall be the maximum 95.23 premium determined under section 256L.15, subdivision 2, 95.24 paragraph (b). 95.25 (d) Effective July 1, 2003, notwithstanding paragraphs (b) 95.26 and (c), parents are no longer eligible for MinnesotaCare if 95.27 gross household income exceeds$50,000$25,000 for the six-month 95.28 period of eligibility. 95.29 [EFFECTIVE DATE.] This section is effective March 1, 2006, 95.30 or upon HealthMatch implementation, whichever is later. 95.31 Sec. 69. Minnesota Statutes 2004, section 256L.07, 95.32 subdivision 3, is amended to read: 95.33 Subd. 3. [OTHER HEALTH COVERAGE.] (a) Families and 95.34 individuals enrolled in the MinnesotaCare program must have no 95.35 health coverage while enrolled or for at least four months prior 95.36 to application and renewal. Children enrolled in the original 96.1 children's health plan and children in families with income 96.2 equal to or less than 150 percent of the federal poverty 96.3 guidelines, who have other health insurance, are eligible if the 96.4 coverage: 96.5 (1) lacks two or more of the following: 96.6 (i) basic hospital insurance; 96.7 (ii) medical-surgical insurance; 96.8 (iii) prescription drug coverage; 96.9 (iv) dental coverage; or 96.10 (v) vision coverage; 96.11 (2) requires a deductible of $100 or more per person per 96.12 year; or 96.13 (3) lacks coverage because the child has exceeded the 96.14 maximum coverage for a particular diagnosis or the policy 96.15 excludes a particular diagnosis. 96.16 The commissioner may change this eligibility criterion for 96.17 sliding scale premiums in order to remain within the limits of 96.18 available appropriations. The requirement of no health coverage 96.19 does not apply to newborns. 96.20 (b) Medical assistance, general assistance medical care, 96.21 and the Civilian Health and Medical Program of the Uniformed 96.22 Service, CHAMPUS, or other coverage provided under United States 96.23 Code, title 10, subtitle A, part II, chapter 55, are not 96.24 considered insurance or health coverage for purposes of the 96.25 four-month requirement described in this subdivision. 96.26 (c) For purposes of this subdivision, an applicant or 96.27 enrollee who is entitled to Medicare Part A or enrolled in 96.28 Medicare Part B coverage under title XVIII of the Social 96.29 Security Act, United States Code, title 42, sections 1395c 96.30 to1395w-41395w-152, is considered to have health coverage. An 96.31 applicant or enrollee who is entitled to premium free Medicare 96.32 Part A may not refuse to apply for or enroll in Medicare 96.33 coverage to establish eligibility for MinnesotaCare. 96.34 (d) Applicants who were recipients of medical assistance or 96.35 general assistance medical care within one month of application 96.36 must meet the provisions of this subdivision and subdivision 2. 97.1 (e)Effective October 1, 2003, applicants who were97.2recipients of medical assistance and hadCost-effective health 97.3 insurancewhichthat was paid for by medical assistanceare97.4exempt fromis not considered health coverage for purposes of 97.5 the four-month requirement under this section, except if the 97.6 insurance continued after medical assistance no longer 97.7 considered it cost-effective or after medical assistance closed. 97.8 Sec. 70. Minnesota Statutes 2004, section 256L.07, is 97.9 amended by adding a subdivision to read: 97.10 Subd. 5. [VOLUNTARY DISENROLLMENT FOR MEMBERS OF 97.11 MILITARY.] Notwithstanding section 256L.05, subdivision 3b, 97.12 MinnesotaCare enrollees who are members of the military and 97.13 their families, who choose to voluntarily disenroll from the 97.14 program when one or more family members are called to active 97.15 duty, may reenroll during or following that member's tour of 97.16 active duty. Those individuals and families shall be considered 97.17 to have good cause for voluntary termination under section 97.18 256L.06, subdivision 3, paragraph (d). Income and asset 97.19 increases reported at the time of reenrollment shall be 97.20 disregarded. All provisions of sections 256L.01 to 256L.18, 97.21 shall apply to individuals and families enrolled under this 97.22 subdivision upon six-month renewal. 97.23 [EFFECTIVE DATE.] This section is effective July 1, 2005. 97.24 Sec. 71. Minnesota Statutes 2004, section 256L.09, 97.25 subdivision 2, is amended to read: 97.26 Subd. 2. [RESIDENCY REQUIREMENT.](a) To be eligible for97.27health coverage under the MinnesotaCare program, adults without97.28children must be permanent residents of Minnesota.97.29(b)To be eligible for health coverage under the 97.30 MinnesotaCare program, pregnant women, families, and children 97.31 must meet the residency requirements as provided by Code of 97.32 Federal Regulations, title 42, section 435.403, except that the97.33provisions of section 256B.056, subdivision 1, shall apply upon97.34receipt of federal approval. 97.35 [EFFECTIVE DATE.] This section is effective October 1, 2005. 97.36 Sec. 72. Minnesota Statutes 2004, section 256L.11, 98.1 subdivision 6, is amended to read: 98.2 Subd. 6. [ENROLLEES 18 OR OLDER.]Payment by the98.3MinnesotaCare program for inpatient hospital services provided98.4to MinnesotaCare enrollees eligible under section 256L.04,98.5subdivision 7, or who qualify under section 256L.04,98.6subdivisions 1 and 2, with family gross income that exceeds 17598.7percent of the federal poverty guidelines and who are not98.8pregnant, who are 18 years old or older on the date of admission98.9to the inpatient hospital must be in accordance with paragraphs98.10(a) and (b).Payment for adults who are not pregnant and are 98.11 eligible under section 256L.04, subdivisions 1 and 2, and whose 98.12 incomes are equal to or less than 175 percent of the federal 98.13 poverty guidelines, shall be as provided for underparagraph (c)98.14 this subdivision. 98.15(a) If the medical assistance rate minus any co-payment98.16required under section 256L.03, subdivision 4, is less than or98.17equal to the amount remaining in the enrollee's benefit limit98.18under section 256L.03, subdivision 3, payment must be the98.19medical assistance rate minus any co-payment required under98.20section 256L.03, subdivision 4. The hospital must not seek98.21payment from the enrollee in addition to the co-payment. The98.22MinnesotaCare payment plus the co-payment must be treated as98.23payment in full.98.24(b) If the medical assistance rate minus any co-payment98.25required under section 256L.03, subdivision 4, is greater than98.26the amount remaining in the enrollee's benefit limit under98.27section 256L.03, subdivision 3, payment must be the lesser of:98.28(1) the amount remaining in the enrollee's benefit limit;98.29or98.30(2) charges submitted for the inpatient hospital services98.31less any co-payment established under section 256L.03,98.32subdivision 4.98.33The hospital may seek payment from the enrollee for the98.34amount by which usual and customary charges exceed the payment98.35under this paragraph. If payment is reduced under section98.36256L.03, subdivision 3, paragraph (b), the hospital may not seek99.1payment from the enrollee for the amount of the reduction.99.2(c)For admissions occurring during the period of July 1, 99.3 1997, through June 30, 1998, for adults who are not pregnant and 99.4 are eligible under section 256L.04, subdivisions 1 and 2, and 99.5 whose incomes are equal to or less than 175 percent of the 99.6 federal poverty guidelines, the commissioner shall pay hospitals 99.7 directly, up to the medical assistance payment rate, for 99.8 inpatient hospital benefits in excess of the $10,000 annual 99.9 inpatient benefit limit. 99.10 [EFFECTIVE DATE.] This section is effective October 1, 2005. 99.11 Sec. 73. Minnesota Statutes 2004, section 256L.12, 99.12 subdivision 6, is amended to read: 99.13 Subd. 6. [CO-PAYMENTS AND BENEFIT LIMITS.] Enrollees are 99.14 responsible for all co-payments insectionssection 256L.03, 99.15 subdivision 5,and 256L.035,and shall pay co-payments to the 99.16 managed care plan or to its participating providers. The 99.17 enrollee is also responsible for payment of inpatient hospital 99.18 charges which exceed the MinnesotaCare benefit limit. 99.19 [EFFECTIVE DATE.] This section is effective October 1, 2005. 99.20 Sec. 74. Minnesota Statutes 2004, section 256L.12, is 99.21 amended by adding a subdivision to read: 99.22 Subd. 9b. [RATE SETTING; RATABLE REDUCTION.] In addition 99.23 to the reduction in subdivision 9a, the total payment made to 99.24 managed care plans under the MinnesotaCare program is reduced 99.25 1.83 percent for services provided on or after January 1, 2006. 99.26 Sec. 75. Minnesota Statutes 2004, section 256L.15, 99.27 subdivision 2, is amended to read: 99.28 Subd. 2. [SLIDING FEE SCALE TO DETERMINE PERCENTAGE OF 99.29 MONTHLY GROSS INDIVIDUAL OR FAMILY INCOME.] (a) The commissioner 99.30 shall establish a sliding fee scale to determine the percentage 99.31 of monthly gross individual or family income that households at 99.32 different income levels must pay to obtain coverage through the 99.33 MinnesotaCare program. The sliding fee scale must be based on 99.34 the enrollee's monthly gross individual or family income. The 99.35 sliding fee scale must contain separate tables based on 99.36 enrollment of one, two, or three or more persons. The sliding 100.1 fee scale begins with a premium of 1.5 percent of monthly gross 100.2 individual or family income for individuals or families with 100.3 incomes below the limits for the medical assistance program for 100.4 families and children in effect on January 1, 1999, and proceeds 100.5 through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 100.6 4.8, 5.9, 7.4, and 8.8 percent. These percentages are matched 100.7 to evenly spaced income steps ranging from the medical 100.8 assistance income limit for families and children in effect on 100.9 January 1, 1999, to 275 percent of the federal poverty 100.10 guidelines for the applicable family size, up to a family size 100.11 of five. The sliding fee scale for a family of five must be 100.12 used for families of more than five. Effective October 1, 2003, 100.13 the commissioner shall increase each percentage by 0.5 100.14 percentage points for enrollees with income greater than 100 100.15 percent but not exceeding 200 percent of the federal poverty 100.16 guidelines and shall increase each percentage by 1.0 percentage 100.17 points for families and children with incomes greater than 200 100.18 percent of the federal poverty guidelines. The sliding fee 100.19 scale and percentages are not subject to the provisions of 100.20 chapter 14. If a family or individual reports increased income 100.21 after enrollment, premiums shallnotbe adjusteduntil100.22eligibility renewalat the time the change in income is reported. 100.23 (b)(1) Enrolled families whose gross annual income 100.24 increases above 275 percent of the federal poverty guideline 100.25 shall pay the maximum premium. This clause expires effective 100.26 February 1, 2004. 100.27 (2) Effective February 1, 2004, children in families whose 100.28 gross income is above 275 percent of the federal poverty 100.29 guidelines shall pay the maximum premium. 100.30 (3) The maximum premium is defined as a base charge for 100.31 one, two, or three or more enrollees so that if all 100.32 MinnesotaCare cases paid the maximum premium, the total revenue 100.33 would equal the total cost of MinnesotaCare medical coverage and 100.34 administration. In this calculation, administrative costs shall 100.35 be assumed to equal ten percent of the total. The costs of 100.36 medical coverage for pregnant women and children under age two 101.1 and the enrollees in these groups shall be excluded from the 101.2 total. The maximum premium for two enrollees shall be twice the 101.3 maximum premium for one, and the maximum premium for three or 101.4 more enrollees shall be three times the maximum premium for one. 101.5 (c) After calculating the percentage of premium each 101.6 enrollee shall pay under paragraph (a), ten percent shall be 101.7 added to the premium effective July 1, 2005. 101.8 [EFFECTIVE DATE.] The amendment to paragraph (a) changing 101.9 gross family or individual income to monthly gross family or 101.10 individual income is effective March 1, 2006, or upon 101.11 implementation of HealthMatch, whichever is later. The 101.12 amendment to paragraph (a) related to premium adjustments and 101.13 changes of income is effective July 1, 2005. Prior to the 101.14 implementation of HealthMatch, the commissioner shall implement 101.15 this section to the fullest extent possible, including the use 101.16 of manual processing. Upon implementation of HealthMatch, the 101.17 commissioner shall implement this section in a manner consistent 101.18 with the procedures and requirements of HealthMatch. 101.19 Sec. 76. Minnesota Statutes 2004, section 256L.15, 101.20 subdivision 3, is amended to read: 101.21 Subd. 3. [EXCEPTIONS TO SLIDING SCALE.]An annual premium101.22of $48 is required for allChildren in families with income at 101.23 orless thanbelow 150 percent of the federal poverty guidelines 101.24 pay a monthly premium of $5. 101.25 [EFFECTIVE DATE.] This section is effective March 1, 2006, 101.26 or upon implementation of HealthMatch, whichever is later, 101.27 except that the increase in the monthly premium shall be 101.28 effective July 1, 2005. 101.29 Sec. 77. [501B.895] [PUBLIC HEALTH CARE PROGRAMS AND 101.30 CERTAIN TRUSTS.] 101.31 (a) It is the public policy of this state that individuals 101.32 use all available resources to pay for the cost of long-term 101.33 care services, as defined in section 256B.0595, before turning 101.34 to Minnesota health care program funds, and that trust 101.35 instruments should not be permitted to shield available 101.36 resources of an individual or an individual's spouse from such 102.1 use. Any irrevocable inter-vivos trust or any legal instrument, 102.2 device, or arrangement similar to an irrevocable inter-vivos 102.3 trust created on or after July 1, 2005, containing assets or 102.4 income of an individual or an individual's spouse, including 102.5 those created by a person, court, or administrative body with 102.6 legal authority to act in place of, at the direction of, upon 102.7 the request of, or on behalf of the individual or individual's 102.8 spouse, becomes revocable by operation of law for the sole 102.9 purpose of a state or local human services agency determination 102.10 on an application by the individual or the individual's spouse 102.11 for payment of long-term care services through a Minnesota 102.12 public health care program pursuant to chapter 256B. For 102.13 purposes of this section, any inter-vivos trust and any legal 102.14 instrument, device, or arrangement similar to an inter-vivos 102.15 trust: 102.16 (1) shall be deemed to be located in and subject to the 102.17 laws of this state; and 102.18 (2) is created as of the date it is fully executed by or on 102.19 behalf of all of the settlors or others. 102.20 (b) For purposes of this section, a legal instrument, 102.21 device, or arrangement similar to an irrevocable inter-vivos 102.22 trust means any instrument, device, or arrangement which 102.23 involves a grantor who transfers or whose property is 102.24 transferred by another including, but not limited to, any court, 102.25 administrative body, or anyone else with authority to act on 102.26 their behalf or at their direction, to an individual or entity 102.27 with fiduciary, contractual, or legal obligations to the grantor 102.28 or others to be held, managed, or administered by the individual 102.29 or entity for the benefit of the grantor or others. These legal 102.30 instruments, devices, or other arrangements are irrevocable 102.31 inter-vivos trusts for purposes of this section. 102.32 (c) In the event of a conflict between this section and the 102.33 provisions of an irrevocable trust created on or after July 1, 102.34 2005, this section shall control. 102.35 (d) This section does not apply to trusts that qualify as 102.36 supplemental needs trusts under section 501B.89 or to trusts 103.1 meeting the criteria of United States Code, title 42, section 103.2 1396p (d)(4)(a) and (c) for purposes of eligibility for medical 103.3 assistance. 103.4 (e) This section applies to all trusts first created on or 103.5 after July 1, 2005, and to all interests in real or personal 103.6 property regardless of the date on which the interest was 103.7 created, reserved, or acquired. 103.8 Sec. 78. Minnesota Statutes 2004, section 514.981, 103.9 subdivision 6, is amended to read: 103.10 Subd. 6. [TIME LIMITS; CLAIM LIMITS; LIENS ON LIFE ESTATES 103.11 AND JOINT TENANCIES.] (a) A medical assistance lien is a lien on 103.12 the real property it describes for a period of ten years from 103.13 the date it attaches according to section 514.981, subdivision 103.14 2, paragraph (a), except as otherwise provided for in sections 103.15 514.980 to 514.985. The agency may renew a medical assistance 103.16 lien for an additional ten years from the date it would 103.17 otherwise expire by recording or filing a certificate of renewal 103.18 before the lien expires. The certificate shall be recorded or 103.19 filed in the office of the county recorder or registrar of 103.20 titles for the county in which the lien is recorded or filed. 103.21 The certificate must refer to the recording or filing data for 103.22 the medical assistance lien it renews. The certificate need not 103.23 be attested, certified, or acknowledged as a condition for 103.24 recording or filing. The registrar of titles or the recorder 103.25 shall file, record, index, and return the certificate of renewal 103.26 in the same manner as provided for medical assistance liens in 103.27 section 514.982, subdivision 2. 103.28 (b) A medical assistance lien is not enforceable against 103.29 the real property of an estate to the extent there is a 103.30 determination by a court of competent jurisdiction, or by an 103.31 officer of the court designated for that purpose, that there are 103.32 insufficient assets in the estate to satisfy the agency's 103.33 medical assistance lien in whole or in part because of the 103.34 homestead exemption under section 256B.15, subdivision 4, the 103.35 rights of the surviving spouse or minor children under section 103.36 524.2-403, paragraphs (a) and (b), or claims with a priority 104.1 under section 524.3-805, paragraph (a), clauses (1) to (4). For 104.2 purposes of this section, the rights of the decedent's adult 104.3 children to exempt property under section 524.2-403, paragraph 104.4 (b), shall not be considered costs of administration under 104.5 section 524.3-805, paragraph (a), clause (1). 104.6 (c) Notwithstanding any law or rule to the contrary, the 104.7 provisions in clauses (1) to (7) apply if a life estate subject 104.8 to a medical assistance lien ends according to its terms, or if 104.9 a medical assistance recipient who owns a life estate or any 104.10 interest in real property as a joint tenant that is subject to a 104.11 medical assistance lien dies. 104.12 (1) The medical assistance recipient's life estate or joint 104.13 tenancy interest in the real property shall not end upon the 104.14 recipient's death but shall merge into the remainder interest or 104.15 other interest in real property the medical assistance recipient 104.16 owned in joint tenancy with others. The medical assistance lien 104.17 shall attach to and run with the remainder or other interest in 104.18 the real property to the extent of the medical assistance 104.19 recipient's interest in the property at the time of the 104.20 recipient's death as determined under this section. 104.21 (2) If the medical assistance recipient's interest was a 104.22 life estate in real property, the lien shall be a lien against 104.23 the portion of the remainder equal to the percentage factor for 104.24 the life estate of a person the medical assistance recipient's 104.25 age on the date the life estate ended according to its terms or 104.26 the date of the medical assistance recipient's death as listed 104.27 in the Life Estate Mortality Table in the health care program's 104.28 manual. 104.29 (3) If the medical assistance recipient owned the interest 104.30 in real property in joint tenancy with others, the lien shall be 104.31 a lien against the portion of that interest equal to the 104.32 fractional interest the medical assistance recipient would have 104.33 owned in the jointly owned interest had the medical assistance 104.34 recipient and the other owners held title to that interest as 104.35 tenants in common on the date the medical assistance recipient 104.36 died. 105.1 (4) The medical assistance lien shall remain a lien against 105.2 the remainder or other jointly owned interest for the length of 105.3 time and be renewable as provided in paragraph (a). 105.4 (5) Subdivision 5, paragraph (a), clause (4), paragraph 105.5 (b), clauses (1) and (2); and subdivision 6, paragraph (b), do 105.6 not apply to medical assistance liens which attach to interests 105.7 in real property as provided under this subdivision. 105.8 (6) The continuation of a medical assistance recipient's 105.9 life estate or joint tenancy interest in real property after the 105.10 medical assistance recipient's death for the purpose of 105.11 recovering medical assistance provided for in sections 514.980 105.12 to 514.985 modifies common law principles holding that these 105.13 interests terminate on the death of the holder. 105.14 (7) Notwithstanding any law or rule to the contrary, no 105.15 release, satisfaction, discharge, or affidavit under section 105.16 256B.15 shall extinguish or terminate the life estate or joint 105.17 tenancy interest of a medical assistance recipient subject to a 105.18 lien under sections 514.980 to 514.985 on the date the recipient 105.19 dies. 105.20 (8) The provisions of clauses (1) to (7) do not apply to a 105.21 homestead owned of record, on the date the recipient dies, by 105.22 the recipient and the recipient's spouse as joint tenants with a 105.23 right of survivorship. Homestead means the real property 105.24 occupied by the surviving joint tenant spouse as their sole 105.25 residence on the date the recipient dies and classified and 105.26 taxed to the recipient and surviving joint tenant spouse as 105.27 homestead property for property tax purposes in the calendar 105.28 year in which the recipient dies. For purposes of this 105.29 exemption, real property the recipient and their surviving joint 105.30 tenant spouse purchase solely with the proceeds from the sale of 105.31 their prior homestead, own of record as joint tenants, and 105.32 qualify as homestead property under section 273.124 in the 105.33 calendar year in which the recipient dies and prior to the 105.34 recipient's death shall be deemed to be real property classified 105.35 and taxed to the recipient and their surviving joint tenant 105.36 spouse as homestead property in the calendar year in which the 106.1 recipient dies. The surviving spouse, or any person with 106.2 personal knowledge of the facts, may provide an affidavit 106.3 describing the homestead property affected by this clause and 106.4 stating facts showing compliance with this clause. The 106.5 affidavit shall be prima facie evidence of the facts it states. 106.6 All provisions in this paragraph related to the continuation of 106.7 a recipient's life estate or joint tenancy interests in real 106.8 property after the recipient's death, for the purpose of 106.9 recovering medical assistance, are effective only for life 106.10 estates and joint tenancy interests established on or after 106.11 August 1, 2003. 106.12 [EFFECTIVE DATE.] This section is effective retroactively 106.13 from August 1, 2003. 106.14 Sec. 79. Laws 2003, First Special Session chapter 14, 106.15 article 12, section 93, is amended to read: 106.16 Sec. 93. [REVIEW OF SPECIAL TRANSPORTATION ELIGIBILITY106.17CRITERIA AND POTENTIAL COST SAVINGSUSE OF A BROKER TO MANAGE 106.18 SPECIAL TRANSPORTATION SERVICES.] 106.19The commissioner of human services, in consultation with106.20the commissioner of transportation and special transportation106.21service providers, shall review eligibility criteria for medical106.22assistance special transportation services and shall evaluate106.23whether the level of special transportation services provided106.24should be based on the degree of impairment of the client, as106.25well as the medical diagnosis. The commissioner shall also106.26evaluate methods for reducing the cost of special transportation106.27services, including, but not limited to:106.28(1) requiring providers to maintain a daily log book106.29confirming delivery of clients to medical facilities;106.30(2) requiring providers to implement commercially available106.31computer mapping programs to calculate mileage for purposes of106.32reimbursement;106.33(3) restricting special transportation service from being106.34provided solely for trips to pharmacies;106.35(4) modifying eligibility for special transportation;106.36(5) expanding alternatives to the use of special107.1transportation services;107.2(6) improving the process of certifying persons as eligible107.3for special transportation services; and107.4(7) examining the feasibility and benefits of licensing107.5special transportation providers.107.6The commissioner shall present recommendations for changes107.7in the eligibility criteria and potential cost-savings for107.8special transportation services to the chairs and ranking107.9minority members of the house and senate committees having107.10jurisdiction over health and human services spending by January107.1115, 2004.The commissioner is prohibited from using a broker or 107.12 coordinator to manage special transportation services for 107.13 fee-for-service enrollees residing in a nursing home licensed 107.14 under Minnesota Statutes, chapter 144A, until July 1, 2006, and 107.15 for all other fee-for-service enrollees until July 1, 2005, 107.16 except for the purposes of checking for recipient eligibility, 107.17 authorizing recipients for appropriate level of transportation, 107.18 and monitoring provider compliance with Minnesota Statutes, 107.19 section 256B.0625, subdivision 17. This prohibition does not 107.20 apply to the purchase or management of common carrier 107.21 transportation. 107.22 Sec. 80. [ADVISORY COMMITTEE ON NONEMERGENCY 107.23 TRANSPORTATION SERVICES.] 107.24 The commissioner of human services shall establish a 107.25 seven-member advisory committee on medical assistance 107.26 nonemergency transportation services. The committee shall 107.27 consist of: a representative of the commissioner of human 107.28 services, who shall serve as chair; two special transportation 107.29 service providers, appointed by the trade associations 107.30 representing special transportation service providers; one 107.31 representative of nursing facilities; one representative of the 107.32 disability community; and one house and one senate member, 107.33 appointed respectively by the chairs of the house and senate 107.34 committees with jurisdiction over medical assistance funding. 107.35 The advisory committee shall monitor and evaluate the provision 107.36 of medical assistance nonemergency medical transportation 108.1 services, and present recommendations for any necessary changes 108.2 to the commissioner. 108.3 Sec. 81. [PLANNING PROCESS FOR MANAGED CARE.] 108.4 The commissioner of human services shall develop a planning 108.5 process for the purposes of implementing at least one additional 108.6 managed care arrangement to provide medical assistance services, 108.7 excluding continuing care services, to recipients enrolled in 108.8 the medical assistance fee-for-service program, effective 108.9 January 1, 2007. This planning process shall include an 108.10 advisory committee composed of current fee-for-service 108.11 consumers, consumer advocates, and providers, as well as 108.12 representatives of health plans and other provider organizations 108.13 qualified to provide basic health care services to persons with 108.14 disabilities. The department shall seek any additional federal 108.15 authority necessary to provide basic health care services 108.16 through contracted managed care arrangements. 108.17 Sec. 82. [FEDERAL APPROVAL RELATED TO MEDICAL ASSISTANCE 108.18 INCOME LIMIT FOR PREGNANT WOMEN AND SPECIAL WORK EXPENSE 108.19 DEDUCTION.] 108.20 The commissioner of human services, by July 1, 2005, shall 108.21 apply for any federal waivers and approvals necessary to retain 108.22 the medical assistance income limit for pregnant women at 200 108.23 percent of the federal poverty guidelines, and to not apply the 108.24 special work expense deductions for infants and pregnant women, 108.25 while continuing to receive federal funding under the state 108.26 children's health insurance program (SCHIP). The commissioner 108.27 shall update the chairs and ranking minority members of the 108.28 house and senate committees with jurisdiction over the medical 108.29 assistance program of the status of the request for federal 108.30 waivers and approvals. 108.31 Sec. 83. [FEDERAL APPROVAL.] 108.32 (a) The commissioner of human services shall seek federal 108.33 waivers and approvals necessary to allow the commissioner to 108.34 charge medical assistance recipients sliding scale premiums, 108.35 based on the sliding scale used for the MinnesotaCare program 108.36 under Minnesota Statutes, section 256L.15. 109.1 (b) The commissioner of human services shall seek federal 109.2 waivers and approvals necessary to modify the definition of 109.3 household and family income under MinnesotaCare, to include the 109.4 earned and unearned income of all persons residing in the 109.5 household or family, including unrelated persons. 109.6 Sec. 84. [HEALTH CARE FINANCING REPORT.] 109.7 The commissioner of human services shall develop 109.8 recommendations on simplifying publicly funded health care 109.9 program financing. The commissioner shall report the 109.10 recommendations to the chairs of the house and senate committees 109.11 with jurisdiction over health care financing during the 2007 109.12 legislative session. 109.13 Sec. 85. [GENERAL PROVISIONS GOVERNING CHANGE IN EFFECTIVE 109.14 DATE FOR LIFE ESTATE AND JOINT TENANCY INTEREST PROVISIONS.] 109.15 Subdivision 1. [ESTABLISHMENT OF LIFE ESTATE OR JOINT 109.16 TENANCY INTEREST.] For purposes of the amendments to Minnesota 109.17 Statutes, sections 256B.15, subdivision 1, and 514.981, 109.18 subdivision 6, a life estate or joint tenancy interest is 109.19 established upon the earlier of: 109.20 (1) the date the instrument creating the interest is 109.21 recorded or filed in the office of the county recorder or 109.22 registrar of titles where the real estate interest it describes 109.23 is located; 109.24 (2) the date of delivery by the grantor to the grantee of 109.25 the signed instrument as stated in an affidavit made by a person 109.26 with knowledge of the facts; 109.27 (3) the date on which the judicial order creating the 109.28 interest was issued by the court; or 109.29 (4) the date upon which the interest devolves under 109.30 Minnesota Statutes, section 524.3-101. 109.31 Subd. 2. [MEDICAL ASSISTANCE.] For purposes of the 109.32 amendments to Minnesota Statutes, sections 256B.15, subdivision 109.33 1, and 514.981, subdivision 6, the term medical assistance means 109.34 medical assistance as defined in Minnesota Statutes 2004, 109.35 section 256B.15, subdivision 1. 109.36 Subd. 3. [LIEN NOTICES.] Medical assistance liens and 110.1 liens under notices of potential claims that are of record 110.2 against life estate or joint tenancy interests established prior 110.3 to August 1, 2003, shall end and become unenforceable upon the 110.4 death of the person named in the lien, or a notice of potential 110.5 claim shall be disregarded by examiners of title after the death 110.6 of the life tenant or joint tenant, and shall not be carried 110.7 forward to a subsequent certificate of title. This subdivision 110.8 shall not apply to life estates that continue to exist after the 110.9 death of the person named in the lien or notice of potential 110.10 claim under the terms of the instrument creating or reserving 110.11 the life estate until the life estate ends as provided for in 110.12 the instrument. 110.13 [EFFECTIVE DATE.] This section is effective retroactively 110.14 from August 1, 2003. 110.15 Sec. 86. [COMMISSIONER'S DUTIES RELATED TO CHANGE IN 110.16 EFFECTIVE DATE FOR LIFE ESTATE AND JOINT TENANCY INTEREST 110.17 PROVISIONS.] 110.18 (a) The commissioner of human services or a county agency 110.19 that has recovered medical assistance or alternative care 110.20 payments for recipients after they die from their life estates 110.21 or jointly owned interests in real property that were 110.22 established prior to August 1, 2003, and that were continued in 110.23 existence or merged into another interest in real property after 110.24 their death due solely to the provisions of section 256B.15 or 110.25 514.981, subdivision 6, paragraph (c), as those provisions 110.26 existed prior to the amendments in this act, shall refund those 110.27 recoveries, without interest. The refunds shall be paid to the 110.28 surviving record owners of the real property in which the 110.29 recipient had a life estate or a jointly owned interest on the 110.30 date of the recipient's death in proportion to their record 110.31 interests on that date. The commissioner and a county agency 110.32 are not required to refund any other recoveries attributable to 110.33 any other interests or assets of the deceased recipient. 110.34 (b) If the commissioner of human services or a county 110.35 agency determines a person entitled to any refund under this act 110.36 is dead, they may pay the refund due that person to their estate 111.1 if it is still open. If the person's estate is closed or if a 111.2 court has entered a decree of distribution for that person under 111.3 section 525.312 that is a final decree, the commissioner or the 111.4 county agency may, in their absolute discretion, pay the 111.5 person's refund to their heirs or devisees as finally determined 111.6 in any completed probate or under any final decree of 111.7 distribution. In all other cases including, but not limited to, 111.8 those in which the commissioner or a county agency determines 111.9 they cannot identify or locate a person entitled to a refund 111.10 under this section, they may, at their discretion, declare such 111.11 person's refund to be abandoned property and pay and deliver it 111.12 to the commissioner of commerce. The commissioner of commerce 111.13 shall administer and dispose of the refunds according to 111.14 sections 345.31 to 345.60. Neither the commissioner of human 111.15 services, the Department of Human Services, a county agency, or 111.16 the employees of the department or agency, shall be liable to 111.17 anyone with respect to the refund after paying or delivering the 111.18 refund as provided for in this section. 111.19 [EFFECTIVE DATE.] This section is effective retroactively 111.20 from August 1, 2003. 111.21 Sec. 87. [IMMUNITY.] 111.22 The commissioner of human services, county agencies, and 111.23 elected officials and their employees are immune from all 111.24 liability for any action taken implementing Laws 2003, First 111.25 Special Session chapter 14, article 12, sections 40 to 52 and 111.26 90, as those laws existed at the time the action was taken, and 111.27 sections 1 to 4 of this act. 111.28 [EFFECTIVE DATE.] This section is effective retroactively 111.29 from August 1, 2003. 111.30 Sec. 88. [REPEALER.] 111.31 (a) Minnesota Statutes 2004, sections 256L.035; 256L.04, 111.32 subdivision 7; and 256L.09, subdivisions 1, 4, 5, 6, and 7, are 111.33 repealed effective October 1, 2005. 111.34 (b) Minnesota Statutes 2004, section 256.955, is repealed 111.35 effective January 1, 2006. 111.36 (c) Minnesota Statutes 2004, sections 256B.075, subdivision 112.1 5, and 295.581, are repealed the day following final enactment. 112.2 (d) Minnesota Statutes 2004, section 256L.04, subdivision 112.3 11, MinnesotaCare outreach grants, is repealed effective July 1, 112.4 2005. 112.5 ARTICLE 4 112.6 NURSING FACILITY REIMBURSEMENT SYSTEM 112.7 AND OTHER PROVISIONS 112.8 Section 1. Minnesota Statutes 2004, section 144A.071, 112.9 subdivision 4a, is amended to read: 112.10 Subd. 4a. [EXCEPTIONS FOR REPLACEMENT BEDS.] It is in the 112.11 best interest of the state to ensure that nursing homes and 112.12 boarding care homes continue to meet the physical plant 112.13 licensing and certification requirements by permitting certain 112.14 construction projects. Facilities should be maintained in 112.15 condition to satisfy the physical and emotional needs of 112.16 residents while allowing the state to maintain control over 112.17 nursing home expenditure growth. 112.18 The commissioner of health in coordination with the 112.19 commissioner of human services, may approve the renovation, 112.20 replacement, upgrading, or relocation of a nursing home or 112.21 boarding care home, under the following conditions: 112.22 (a) to license or certify beds in a new facility 112.23 constructed to replace a facility or to make repairs in an 112.24 existing facility that was destroyed or damaged after June 30, 112.25 1987, by fire, lightning, or other hazard provided: 112.26 (i) destruction was not caused by the intentional act of or 112.27 at the direction of a controlling person of the facility; 112.28 (ii) at the time the facility was destroyed or damaged the 112.29 controlling persons of the facility maintained insurance 112.30 coverage for the type of hazard that occurred in an amount that 112.31 a reasonable person would conclude was adequate; 112.32 (iii) the net proceeds from an insurance settlement for the 112.33 damages caused by the hazard are applied to the cost of the new 112.34 facility or repairs; 112.35 (iv) the new facility is constructed on the same site as 112.36 the destroyed facility or on another site subject to the 113.1 restrictions in section 144A.073, subdivision 5; 113.2 (v) the number of licensed and certified beds in the new 113.3 facility does not exceed the number of licensed and certified 113.4 beds in the destroyed facility; and 113.5 (vi) the commissioner determines that the replacement beds 113.6 are needed to prevent an inadequate supply of beds. 113.7 Project construction costs incurred for repairs authorized under 113.8 this clause shall not be considered in the dollar threshold 113.9 amount defined in subdivision 2; 113.10 (b) to license or certify beds that are moved from one 113.11 location to another within a nursing home facility, provided the 113.12 total costs of remodeling performed in conjunction with the 113.13 relocation of beds does not exceed $1,000,000; 113.14 (c) to license or certify beds in a project recommended for 113.15 approval under section 144A.073; 113.16 (d) to license or certify beds that are moved from an 113.17 existing state nursing home to a different state facility, 113.18 provided there is no net increase in the number of state nursing 113.19 home beds; 113.20 (e) to certify and license as nursing home beds boarding 113.21 care beds in a certified boarding care facility if the beds meet 113.22 the standards for nursing home licensure, or in a facility that 113.23 was granted an exception to the moratorium under section 113.24 144A.073, and if the cost of any remodeling of the facility does 113.25 not exceed $1,000,000. If boarding care beds are licensed as 113.26 nursing home beds, the number of boarding care beds in the 113.27 facility must not increase beyond the number remaining at the 113.28 time of the upgrade in licensure. The provisions contained in 113.29 section 144A.073 regarding the upgrading of the facilities do 113.30 not apply to facilities that satisfy these requirements; 113.31 (f) to license and certify up to 40 beds transferred from 113.32 an existing facility owned and operated by the Amherst H. Wilder 113.33 Foundation in the city of St. Paul to a new unit at the same 113.34 location as the existing facility that will serve persons with 113.35 Alzheimer's disease and other related disorders. The transfer 113.36 of beds may occur gradually or in stages, provided the total 114.1 number of beds transferred does not exceed 40. At the time of 114.2 licensure and certification of a bed or beds in the new unit, 114.3 the commissioner of health shall delicense and decertify the 114.4 same number of beds in the existing facility. As a condition of 114.5 receiving a license or certification under this clause, the 114.6 facility must make a written commitment to the commissioner of 114.7 human services that it will not seek to receive an increase in 114.8 its property-related payment rate as a result of the transfers 114.9 allowed under this paragraph; 114.10 (g) to license and certify nursing home beds to replace 114.11 currently licensed and certified boarding care beds which may be 114.12 located either in a remodeled or renovated boarding care or 114.13 nursing home facility or in a remodeled, renovated, newly 114.14 constructed, or replacement nursing home facility within the 114.15 identifiable complex of health care facilities in which the 114.16 currently licensed boarding care beds are presently located, 114.17 provided that the number of boarding care beds in the facility 114.18 or complex are decreased by the number to be licensed as nursing 114.19 home beds and further provided that, if the total costs of new 114.20 construction, replacement, remodeling, or renovation exceed ten 114.21 percent of the appraised value of the facility or $200,000, 114.22 whichever is less, the facility makes a written commitment to 114.23 the commissioner of human services that it will not seek to 114.24 receive an increase in its property-related payment rate by 114.25 reason of the new construction, replacement, remodeling, or 114.26 renovation. The provisions contained in section 144A.073 114.27 regarding the upgrading of facilities do not apply to facilities 114.28 that satisfy these requirements; 114.29 (h) to license as a nursing home and certify as a nursing 114.30 facility a facility that is licensed as a boarding care facility 114.31 but not certified under the medical assistance program, but only 114.32 if the commissioner of human services certifies to the 114.33 commissioner of health that licensing the facility as a nursing 114.34 home and certifying the facility as a nursing facility will 114.35 result in a net annual savings to the state general fund of 114.36 $200,000 or more; 115.1 (i) to certify, after September 30, 1992, and prior to July 115.2 1, 1993, existing nursing home beds in a facility that was 115.3 licensed and in operation prior to January 1, 1992; 115.4 (j) to license and certify new nursing home beds to replace 115.5 beds in a facility acquired by the Minneapolis Community 115.6 Development Agency as part of redevelopment activities in a city 115.7 of the first class, provided the new facility is located within 115.8 three miles of the site of the old facility. Operating and 115.9 property costs for the new facility must be determined and 115.10 allowed under section 256B.431 or 256B.434; 115.11 (k) to license and certify up to 20 new nursing home beds 115.12 in a community-operated hospital and attached convalescent and 115.13 nursing care facility with 40 beds on April 21, 1991, that 115.14 suspended operation of the hospital in April 1986. The 115.15 commissioner of human services shall provide the facility with 115.16 the same per diem property-related payment rate for each 115.17 additional licensed and certified bed as it will receive for its 115.18 existing 40 beds; 115.19 (l) to license or certify beds in renovation, replacement, 115.20 or upgrading projects as defined in section 144A.073, 115.21 subdivision 1, so long as the cumulative total costs of the 115.22 facility's remodeling projects do not exceed $1,000,000; 115.23 (m) to license and certify beds that are moved from one 115.24 location to another for the purposes of converting up to five 115.25 four-bed wards to single or double occupancy rooms in a nursing 115.26 home that, as of January 1, 1993, was county-owned and had a 115.27 licensed capacity of 115 beds; 115.28 (n) to allow a facility that on April 16, 1993, was a 115.29 106-bed licensed and certified nursing facility located in 115.30 Minneapolis to layaway all of its licensed and certified nursing 115.31 home beds. These beds may be relicensed and recertified in a 115.32 newly constructed teaching nursing home facility affiliated with 115.33 a teaching hospital upon approval by the legislature. The 115.34 proposal must be developed in consultation with the interagency 115.35 committee on long-term care planning. The beds on layaway 115.36 status shall have the same status as voluntarily delicensed and 116.1 decertified beds, except that beds on layaway status remain 116.2 subject to the surcharge in section 256.9657. This layaway 116.3 provision expires July 1, 1998; 116.4 (o) to allow a project which will be completed in 116.5 conjunction with an approved moratorium exception project for a 116.6 nursing home in southern Cass County and which is directly 116.7 related to that portion of the facility that must be repaired, 116.8 renovated, or replaced, to correct an emergency plumbing problem 116.9 for which a state correction order has been issued and which 116.10 must be corrected by August 31, 1993; 116.11 (p) to allow a facility that on April 16, 1993, was a 116.12 368-bed licensed and certified nursing facility located in 116.13 Minneapolis to layaway, upon 30 days prior written notice to the 116.14 commissioner, up to 30 of the facility's licensed and certified 116.15 beds by converting three-bed wards to single or double 116.16 occupancy. Beds on layaway status shall have the same status as 116.17 voluntarily delicensed and decertified beds except that beds on 116.18 layaway status remain subject to the surcharge in section 116.19 256.9657, remain subject to the license application and renewal 116.20 fees under section 144A.07 and shall be subject to a $100 per 116.21 bed reactivation fee. In addition, at any time within three 116.22 years of the effective date of the layaway, the beds on layaway 116.23 status may be: 116.24 (1) relicensed and recertified upon relocation and 116.25 reactivation of some or all of the beds to an existing licensed 116.26 and certified facility or facilities located in Pine River, 116.27 Brainerd, or International Falls; provided that the total 116.28 project construction costs related to the relocation of beds 116.29 from layaway status for any facility receiving relocated beds 116.30 may not exceed the dollar threshold provided in subdivision 2 116.31 unless the construction project has been approved through the 116.32 moratorium exception process under section 144A.073; 116.33 (2) relicensed and recertified, upon reactivation of some 116.34 or all of the beds within the facility which placed the beds in 116.35 layaway status, if the commissioner has determined a need for 116.36 the reactivation of the beds on layaway status. 117.1 The property-related payment rate of a facility placing 117.2 beds on layaway status must be adjusted by the incremental 117.3 change in its rental per diem after recalculating the rental per 117.4 diem as provided in section 256B.431, subdivision 3a, paragraph 117.5 (c). The property-related payment rate for a facility 117.6 relicensing and recertifying beds from layaway status must be 117.7 adjusted by the incremental change in its rental per diem after 117.8 recalculating its rental per diem using the number of beds after 117.9 the relicensing to establish the facility's capacity day 117.10 divisor, which shall be effective the first day of the month 117.11 following the month in which the relicensing and recertification 117.12 became effective. Any beds remaining on layaway status more 117.13 than three years after the date the layaway status became 117.14 effective must be removed from layaway status and immediately 117.15 delicensed and decertified; 117.16 (q) to license and certify beds in a renovation and 117.17 remodeling project to convert 12 four-bed wards into 24 two-bed 117.18 rooms, expand space, and add improvements in a nursing home 117.19 that, as of January 1, 1994, met the following conditions: the 117.20 nursing home was located in Ramsey County; had a licensed 117.21 capacity of 154 beds; and had been ranked among the top 15 117.22 applicants by the 1993 moratorium exceptions advisory review 117.23 panel. The total project construction cost estimate for this 117.24 project must not exceed the cost estimate submitted in 117.25 connection with the 1993 moratorium exception process; 117.26 (r) to license and certify up to 117 beds that are 117.27 relocated from a licensed and certified 138-bed nursing facility 117.28 located in St. Paul to a hospital with 130 licensed hospital 117.29 beds located in South St. Paul, provided that the nursing 117.30 facility and hospital are owned by the same or a related 117.31 organization and that prior to the date the relocation is 117.32 completed the hospital ceases operation of its inpatient 117.33 hospital services at that hospital. After relocation, the 117.34 nursing facility's status under section 256B.431, subdivision 117.35 2j, shall be the same as it was prior to relocation. The 117.36 nursing facility's property-related payment rate resulting from 118.1 the project authorized in this paragraph shall become effective 118.2 no earlier than April 1, 1996. For purposes of calculating the 118.3 incremental change in the facility's rental per diem resulting 118.4 from this project, the allowable appraised value of the nursing 118.5 facility portion of the existing health care facility physical 118.6 plant prior to the renovation and relocation may not exceed 118.7 $2,490,000; 118.8 (s) to license and certify two beds in a facility to 118.9 replace beds that were voluntarily delicensed and decertified on 118.10 June 28, 1991; 118.11 (t) to allow 16 licensed and certified beds located on July 118.12 1, 1994, in a 142-bed nursing home and 21-bed boarding care home 118.13 facility in Minneapolis, notwithstanding the licensure and 118.14 certification after July 1, 1995, of the Minneapolis facility as 118.15 a 147-bed nursing home facility after completion of a 118.16 construction project approved in 1993 under section 144A.073, to 118.17 be laid away upon 30 days' prior written notice to the 118.18 commissioner. Beds on layaway status shall have the same status 118.19 as voluntarily delicensed or decertified beds except that they 118.20 shall remain subject to the surcharge in section 256.9657. The 118.21 16 beds on layaway status may be relicensed as nursing home beds 118.22 and recertified at any time within five years of the effective 118.23 date of the layaway upon relocation of some or all of the beds 118.24 to a licensed and certified facility located in Watertown, 118.25 provided that the total project construction costs related to 118.26 the relocation of beds from layaway status for the Watertown 118.27 facility may not exceed the dollar threshold provided in 118.28 subdivision 2 unless the construction project has been approved 118.29 through the moratorium exception process under section 144A.073. 118.30 The property-related payment rate of the facility placing 118.31 beds on layaway status must be adjusted by the incremental 118.32 change in its rental per diem after recalculating the rental per 118.33 diem as provided in section 256B.431, subdivision 3a, paragraph 118.34 (c). The property-related payment rate for the facility 118.35 relicensing and recertifying beds from layaway status must be 118.36 adjusted by the incremental change in its rental per diem after 119.1 recalculating its rental per diem using the number of beds after 119.2 the relicensing to establish the facility's capacity day 119.3 divisor, which shall be effective the first day of the month 119.4 following the month in which the relicensing and recertification 119.5 became effective. Any beds remaining on layaway status more 119.6 than five years after the date the layaway status became 119.7 effective must be removed from layaway status and immediately 119.8 delicensed and decertified; 119.9 (u) to license and certify beds that are moved within an 119.10 existing area of a facility or to a newly constructed addition 119.11 which is built for the purpose of eliminating three- and 119.12 four-bed rooms and adding space for dining, lounge areas, 119.13 bathing rooms, and ancillary service areas in a nursing home 119.14 that, as of January 1, 1995, was located in Fridley and had a 119.15 licensed capacity of 129 beds; 119.16 (v) to relocate 36 beds in Crow Wing County and four beds 119.17 from Hennepin County to a 160-bed facility in Crow Wing County, 119.18 provided all the affected beds are under common ownership; 119.19 (w) to license and certify a total replacement project of 119.20 up to 49 beds located in Norman County that are relocated from a 119.21 nursing home destroyed by flood and whose residents were 119.22 relocated to other nursing homes. The operating cost payment 119.23 rates for the new nursing facility shall be determined based on 119.24 the interim and settle-up payment provisions of Minnesota Rules, 119.25 part 9549.0057, and the reimbursement provisions of section 119.26 256B.431, except that subdivision 26, paragraphs (a) and (b), 119.27 shall not apply until the second rate year after the settle-up 119.28 cost report is filed. Property-related reimbursement rates 119.29 shall be determined under section 256B.431, taking into account 119.30 any federal or state flood-related loans or grants provided to 119.31 the facility; 119.32 (x) to license and certify a total replacement project of 119.33 up to 129 beds located in Polk County that are relocated from a 119.34 nursing home destroyed by flood and whose residents were 119.35 relocated to other nursing homes. The operating cost payment 119.36 rates for the new nursing facility shall be determined based on 120.1 the interim and settle-up payment provisions of Minnesota Rules, 120.2 part 9549.0057, and the reimbursement provisions of section 120.3 256B.431, except that subdivision 26, paragraphs (a) and (b), 120.4 shall not apply until the second rate year after the settle-up 120.5 cost report is filed. Property-related reimbursement rates 120.6 shall be determined under section 256B.431, taking into account 120.7 any federal or state flood-related loans or grants provided to 120.8 the facility; 120.9 (y) to license and certify beds in a renovation and 120.10 remodeling project to convert 13 three-bed wards into 13 two-bed 120.11 rooms and 13 single-bed rooms, expand space, and add 120.12 improvements in a nursing home that, as of January 1, 1994, met 120.13 the following conditions: the nursing home was located in 120.14 Ramsey County, was not owned by a hospital corporation, had a 120.15 licensed capacity of 64 beds, and had been ranked among the top 120.16 15 applicants by the 1993 moratorium exceptions advisory review 120.17 panel. The total project construction cost estimate for this 120.18 project must not exceed the cost estimate submitted in 120.19 connection with the 1993 moratorium exception process; 120.20 (z) to license and certify up to 150 nursing home beds to 120.21 replace an existing 285 bed nursing facility located in St. 120.22 Paul. The replacement project shall include both the renovation 120.23 of existing buildings and the construction of new facilities at 120.24 the existing site. The reduction in the licensed capacity of 120.25 the existing facility shall occur during the construction 120.26 project as beds are taken out of service due to the construction 120.27 process. Prior to the start of the construction process, the 120.28 facility shall provide written information to the commissioner 120.29 of health describing the process for bed reduction, plans for 120.30 the relocation of residents, and the estimated construction 120.31 schedule. The relocation of residents shall be in accordance 120.32 with the provisions of law and rule; 120.33 (aa) to allow the commissioner of human services to license 120.34 an additional 36 beds to provide residential services for the 120.35 physically handicapped under Minnesota Rules, parts 9570.2000 to 120.36 9570.3400, in a 198-bed nursing home located in Red Wing, 121.1 provided that the total number of licensed and certified beds at 121.2 the facility does not increase; 121.3 (bb) to license and certify a new facility in St. Louis 121.4 county with 44 beds constructed to replace an existing facility 121.5 in St. Louis County with 31 beds, which has resident rooms on 121.6 two separate floors and an antiquated elevator that creates 121.7 safety concerns for residents and prevents nonambulatory 121.8 residents from residing on the second floor. The project shall 121.9 include the elimination of three- and four-bed rooms; 121.10 (cc) to license and certify four beds in a 16-bed certified 121.11 boarding care home in Minneapolis to replace beds that were 121.12 voluntarily delicensed and decertified on or before March 31, 121.13 1992. The licensure and certification is conditional upon the 121.14 facility periodically assessing and adjusting its resident mix 121.15 and other factors which may contribute to a potential 121.16 institution for mental disease declaration. The commissioner of 121.17 human services shall retain the authority to audit the facility 121.18 at any time and shall require the facility to comply with any 121.19 requirements necessary to prevent an institution for mental 121.20 disease declaration, including delicensure and decertification 121.21 of beds, if necessary; 121.22 (dd) to license and certify 72 beds in an existing facility 121.23 in Mille Lacs County with 80 beds as part of a renovation 121.24 project. The renovation must include construction of an 121.25 addition to accommodate ten residents with beginning and 121.26 midstage dementia in a self-contained living unit; creation of 121.27 three resident households where dining, activities, and support 121.28 spaces are located near resident living quarters; designation of 121.29 four beds for rehabilitation in a self-contained area; 121.30 designation of 30 private rooms; and other improvements; 121.31 (ee) to license and certify beds in a facility that has 121.32 undergone replacement or remodeling as part of a planned closure 121.33 under section 256B.437; 121.34 (ff) to license and certify a total replacement project of 121.35 up to 124 beds located in Wilkin County that are in need of 121.36 relocation from a nursing home significantly damaged by flood. 122.1 The operating cost payment rates for the new nursing facility 122.2 shall be determined based on the interim and settle-up payment 122.3 provisions of Minnesota Rules, part 9549.0057, and the 122.4 reimbursement provisions of section 256B.431, except that 122.5 section 256B.431, subdivision 26, paragraphs (a) and (b), shall 122.6 not apply until the second rate year after the settle-up cost 122.7 report is filed. Property-related reimbursement rates shall be 122.8 determined under section 256B.431, taking into account any 122.9 federal or state flood-related loans or grants provided to the 122.10 facility; 122.11 (gg) to allow the commissioner of human services to license 122.12 an additional nine beds to provide residential services for the 122.13 physically handicapped under Minnesota Rules, parts 9570.2000 to 122.14 9570.3400, in a 240-bed nursing home located in Duluth, provided 122.15 that the total number of licensed and certified beds at the 122.16 facility does not increase; 122.17 (hh) to license and certify up to 120 new nursing facility 122.18 beds to replace beds in a facility in Anoka County, which was 122.19 licensed for 98 beds as of July 1, 2000, provided the new 122.20 facility is located within four miles of the existing facility 122.21 and is in Anoka County. Operating and property rates shall be 122.22 determined and allowed under section 256B.431 and Minnesota 122.23 Rules, parts 9549.0010 to 9549.0080, or section 256B.434 or 122.24 256B.435. The provisions of section 256B.431, subdivision 26, 122.25 paragraphs (a) and (b), do not apply until the second rate year 122.26 following settle-up; or 122.27 (ii) to transfer up to 98 beds of a 129-licensed bed 122.28 facility located in Anoka County that, as of March 25, 2001, is 122.29 in the active process of closing, to a 122-licensed bed 122.30 nonprofit nursing facility located in the city of Columbia 122.31 Heights or its affiliate. The transfer is effective when the 122.32 receiving facility notifies the commissioner in writing of the 122.33 number of beds accepted. The commissioner shall place all 122.34 transferred beds on layaway status held in the name of the 122.35 receiving facility. The layaway adjustment provisions of 122.36 section 256B.431, subdivision 30, do not apply to this layaway. 123.1 The receiving facility may only remove the beds from layaway for 123.2 recertification and relicensure at the receiving facility's 123.3 current site, or at a newly constructed facility located in 123.4 Anoka County. The receiving facility must receive statutory 123.5 authorization before removing these beds from layaway status. 123.6 (jj)(1) A facility in Columbia Heights with 122 beds on 123.7 January 1, 2005, may remove from layaway status up to 35 of 98 123.8 beds placed in layaway status in paragraph (ii), and relicense 123.9 and recertify these beds in stages in a newly constructed 123.10 nursing facility in Ramsey located on a long-term care campus 123.11 that provides a continuum of housing and health care options and 123.12 services, ranging from independent living to skilled nursing 123.13 services. The beds may be relicensed and recertified in two 123.14 stages. 123.15 (2) A facility in Anoka with 57 beds on January 1, 2005, 123.16 may remove from layaway status an additional 33 of the 98 beds 123.17 placed in layaway status in paragraph (ii) and relicense and 123.18 recertify these beds in a newly constructed nursing facility 123.19 located in Anoka County, north of State Highway 242 and at a 123.20 site not closer than five miles from any other licensed and 123.21 certified nursing facility, along with up to 57 beds that may be 123.22 relocated from the facility in Anoka. 123.23 (3) Notwithstanding the five-year duration after which beds 123.24 may no longer remain in layaway and still be placed in active 123.25 service, as specified in subdivision 4b, the beds must be 123.26 relicensed and recertified prior to June 30, 2009. 123.27 (4) For the facility in clause (1), the total payment rates 123.28 shall be equal to those of the 122-bed facility in Columbia 123.29 Heights. For the facility in clause (2), the total payment 123.30 rates shall be equal to those of the 57-bed facility in Anoka. 123.31 (5) The facilities in clauses (1) and (2) may annually 123.32 certify to the commissioner of human services, on a form and in 123.33 a manner specified by the commissioner, beginning no later than 123.34 one year after they are licensed and certified, that they are 123.35 discharging eight or more individuals per year for each newly 123.36 licensed bed. If, in the certification, the facility reports 124.1 that they are discharging fewer than eight individuals per year 124.2 for each newly licensed bed, the commissioner shall reduce the 124.3 facility's payment rates under medical assistance by three 124.4 percent for each one discharge per year for each newly licensed 124.5 bed, or portion thereof, less than eight, times the portion of 124.6 the facility's licensed and certified beds that are newly 124.7 licensed and certified. If the facility fails to provide this 124.8 annual certification, the commissioner shall assume two 124.9 discharges per year for each newly licensed bed and reduce the 124.10 facility's payment rates under medical assistance by three 124.11 percent for each one discharge per year for each newly licensed 124.12 bed, less than eight. 124.13 Sec. 2. Minnesota Statutes 2004, section 144A.073, is 124.14 amended by adding a subdivision to read: 124.15 Subd. 10a. [EXTENSION OF APPROVAL FOR A FACILITY IN OTTER 124.16 TAIL COUNTY.] Notwithstanding subdivisions 3 and 10, the 124.17 commissioner of health shall extend project approval for an 124.18 additional 24 months for an exception to the nursing home 124.19 licensure and certification moratorium proposed by a nursing 124.20 facility in Otter Tail County and originally approved by the 124.21 commissioner on December 20, 2002. 124.22 Sec. 3. Minnesota Statutes 2004, section 256B.431, 124.23 subdivision 28, is amended to read: 124.24 Subd. 28. [NURSING FACILITY RATE INCREASES BEGINNING JULY 124.25 1, 1999, AND JULY 1, 2000.] (a) For the rate years beginning 124.26 July 1, 1999, and July 1, 2000, the commissioner shall make 124.27 available to each nursing facility reimbursed under this section 124.28 or section 256B.434 an adjustment to the total operating payment 124.29 rate. For nursing facilities reimbursed under this section or 124.30 section 256B.434, the July 1, 2000, operating payment rate 124.31 increases provided in this subdivision shall be applied to each 124.32 facility's June 30, 2000, operating payment rate. For each 124.33 facility, total operating costs shall be separated into costs 124.34 that are compensation related and all other costs. 124.35 Compensation-related costs include salaries, payroll taxes, and 124.36 fringe benefits for all employees except management fees, the 125.1 administrator, and central office staff. 125.2 (b) For the rate year beginning July 1, 1999, the 125.3 commissioner shall make available a rate increase for 125.4 compensation-related costs of 4.843 percent and a rate increase 125.5 for all other operating costs of 3.446 percent. 125.6 (c) For the rate year beginning July 1, 2000, the 125.7 commissioner shall make available: 125.8 (1) a rate increase for compensation-related costs of 3.632 125.9 percent; 125.10 (2) an additional rate increase for each case mix payment 125.11 rate which must be used to increase the per-hour pay rate of all 125.12 employees except management fees, the administrator, and central 125.13 office staff by an equal dollar amount and to pay associated 125.14 costs for FICA, the Medicare tax, workers' compensation 125.15 premiums, and federal and state unemployment insurance, to be 125.16 calculated according to clauses (i) to (iii): 125.17 (i) the commissioner shall calculate the arithmetic mean of 125.18 the 11 June 30, 2000, operating rates for each facility; 125.19 (ii) the commissioner shall construct an array of nursing 125.20 facilities from highest to lowest, according to the arithmetic 125.21 mean calculated in clause (i). A numerical rank shall be 125.22 assigned to each facility in the array. The facility with the 125.23 highest mean shall be assigned a numerical rank of one. The 125.24 facility with the lowest mean shall be assigned a numerical rank 125.25 equal to the total number of nursing facilities in the array. 125.26 All other facilities shall be assigned a numerical rank in 125.27 accordance with their position in the array; 125.28 (iii) the amount of the additional rate increase shall be 125.29 $1 plus an amount equal to $3.13 multiplied by the ratio of the 125.30 facility's numeric rank divided by the number of facilities in 125.31 the array; and 125.32 (3) a rate increase for all other operating costs of 2.585 125.33 percent. 125.34 Money received by a facility as a result of the additional 125.35 rate increase provided under clause (2) shall be used only for 125.36 wage increases implemented on or after July 1, 2000, and shall 126.1 not be used for wage increases implemented prior to that date. 126.2 (d) The payment rate adjustment for each nursing facility 126.3 must be determined under clause (1) or (2): 126.4 (1) for each nursing facility that reports salaries for 126.5 registered nurses, licensed practical nurses, aides, orderlies, 126.6 and attendants separately, the commissioner shall determine the 126.7 payment rate adjustment using the categories specified in 126.8 paragraph (a) multiplied by the rate increases specified in 126.9 paragraph (b) or (c), and then dividing the resulting amount by 126.10 the nursing facility's actual resident days. In determining the 126.11 amount of a payment rate adjustment for a nursing facility 126.12 reimbursed under section 256B.434, the commissioner shall 126.13 determine the proportions of the facility's rates that are 126.14 compensation-related costs and all other operating costs based 126.15 on the facility's most recent cost report; and 126.16 (2) for each nursing facility that does not report salaries 126.17 for registered nurses, licensed practical nurses, aides, 126.18 orderlies, and attendants separately, the payment rate 126.19 adjustment shall be computed using the facility's total 126.20 operating costs, separated into the categories specified in 126.21 paragraph (a) in proportion to the weighted average of all 126.22 facilities determined under clause (1), multiplied by the rate 126.23 increases specified in paragraph (b) or (c), and then dividing 126.24 the resulting amount by the nursing facility's actual resident 126.25 days. 126.26 (e) A nursing facility may apply for the 126.27 compensation-related payment rate adjustment calculated under 126.28 this subdivision. The application must be made to the 126.29 commissioner and contain a plan by which the nursing facility 126.30 will distribute the compensation-related portion of the payment 126.31 rate adjustment to employees of the nursing facility. For 126.32 nursing facilities in which the employees are represented by an 126.33 exclusive bargaining representative, an agreement negotiated and 126.34 agreed to by the employer and the exclusive bargaining 126.35 representative constitutes the plan. For the second rate year, 126.36 a negotiated agreement constitutes the plan only if the 127.1 agreement is finalized after the date of enactment of all rate 127.2 increases for the second rate year. The commissioner shall 127.3 review the plan to ensure that the payment rate adjustment per 127.4 diem is used as provided in paragraphs (a) to (c). To be 127.5 eligible, a facility must submit its plan for the compensation 127.6 distribution by December 31 each year. A facility may amend its 127.7 plan for the second rate year by submitting a revised plan by 127.8 December 31, 2000. If a facility's plan for compensation 127.9 distribution is effective for its employees after July 1 of the 127.10 year that the funds are available, the payment rate adjustment 127.11 per diem shall be effective the same date as its plan. 127.12 (f) A copy of the approved distribution plan must be made 127.13 available to all employees. This must be done by giving each 127.14 employee a copy or by posting it in an area of the nursing 127.15 facility to which all employees have access. If an employee 127.16 does not receive the compensation adjustment described in their 127.17 facility's approved plan and is unable to resolve the problem 127.18 with the facility's management or through the employee's union 127.19 representative, the employee may contact the commissioner at an 127.20 address or phone number provided by the commissioner and 127.21 included in the approved plan. 127.22 (g) If the reimbursement system under section 256B.435 is 127.23 not implemented until July 1, 2001, the salary adjustment per 127.24 diem authorized in subdivision 2i, paragraph (c), shall continue 127.25 until June 30, 2001. 127.26 (h) For the rate year beginning July 1, 1999, the following 127.27 nursing facilities shall be allowed a rate increase equal to 67 127.28 percent of the rate increase that would be allowed if 127.29 subdivision 26, paragraph (a), was not applied: 127.30 (1) a nursing facility in Carver County licensed for 33 127.31 nursing home beds and four boarding care beds; 127.32 (2) a nursing facility in Faribault County licensed for 159 127.33 nursing home beds on September 30, 1998; and 127.34 (3) a nursing facility in Houston County licensed for 68 127.35 nursing home beds on September 30, 1998. 127.36 (i) For the rate year beginning July 1, 1999, the following 128.1 nursing facilities shall be allowed a rate increase equal to 67 128.2 percent of the rate increase that would be allowed if 128.3 subdivision 26, paragraphs (a) and (b), were not applied: 128.4 (1) a nursing facility in Chisago County licensed for 135 128.5 nursing home beds on September 30, 1998; and 128.6 (2) a nursing facility in Murray County licensed for 62 128.7 nursing home beds on September 30, 1998. 128.8 (j) For the rate year beginning July 1, 1999, a nursing 128.9 facility in Hennepin County licensed for 134 beds on September 128.10 30, 1998, shall: 128.11 (1) have the prior year's allowable care-related per diem 128.12 increased by $3.93 and the prior year's other operating cost per 128.13 diem increased by $1.69 before adding the inflation in 128.14 subdivision 26, paragraph (d), clause (2); and 128.15 (2) be allowed a rate increase equal to 67 percent of the 128.16 rate increase that would be allowed if subdivision 26, 128.17 paragraphs (a) and (b), were not applied. 128.18 The increases provided in paragraphs (h), (i), and (j) 128.19 shall be included in the facility's total payment rates for the 128.20 purposes of determining future rates under this sectionor any128.21other section. 128.22 (k) For the rate years beginning on or after July 1, 2000, 128.23 a nursing home facility in Goodhue County that was licensed for 128.24 104 beds on February 1, 2000, shall have its employee pension 128.25 benefit costs reported on its Rule 50 cost report treated as 128.26 PERA contributions for the purpose of computing its payment 128.27 rates. 128.28 Sec. 4. Minnesota Statutes 2004, section 256B.431, 128.29 subdivision 29, is amended to read: 128.30 Subd. 29. [FACILITY RATE INCREASES EFFECTIVE JULY 1, 128.31 2000.] Following the determination under subdivision 28 of the 128.32 payment rate for the rate year beginning July 1, 2000, for a 128.33 facility in Roseau County licensed for 49 beds, the facility's 128.34 operating cost per diem shall be increased by the following 128.35 amounts: 128.36 (1) case mix class A, $1.97; 129.1 (2) case mix class B, $2.11; 129.2 (3) case mix class C, $2.26; 129.3 (4) case mix class D, $2.39; 129.4 (5) case mix class E, $2.54; 129.5 (6) case mix class F, $2.55; 129.6 (7) case mix class G, $2.66; 129.7 (8) case mix class H, $2.90; 129.8 (9) case mix class I, $2.97; 129.9 (10) case mix class J, $3.10; and 129.10 (11) case mix class K, $3.36. 129.11 These increases shall be included in the facility's total 129.12 payment rates for the purpose of determining future rates under 129.13 this sectionor any other section. 129.14 Sec. 5. Minnesota Statutes 2004, section 256B.431, 129.15 subdivision 35, is amended to read: 129.16 Subd. 35. [EXCLUSION OF RAW FOOD COST ADJUSTMENT.] For 129.17 rate years beginning on or after July 1, 2001, in calculating a 129.18 nursing facility's operating cost per diem for the purposes of 129.19 constructing an array, determining a median, or otherwise 129.20 performing a statistical measure of nursing facility payment 129.21 rates to be used to determine future rate increases under this 129.22 section, section 256B.434, or any other section, the 129.23 commissioner shall exclude adjustments for raw food costs under 129.24 subdivision 2b, paragraph (h), that are related to providing 129.25 special diets based on religious beliefs. For rates determined 129.26 under section 256B.441, the amount determined under subdivision 129.27 2b, paragraph (h), shall not be included in the support services 129.28 per diem cost determined in section 256B.441, subdivision 45, 129.29 and shall be added to the external fixed cost costs payment rate 129.30 determined in section 256B.441, subdivision 52, paragraph (i). 129.31 Sec. 6. Minnesota Statutes 2004, section 256B.431, is 129.32 amended by adding a subdivision to read: 129.33 Subd. 41. [NURSING FACILITY RATE INCREASES BEGINNING 129.34 OCTOBER 1, 2005, AND OCTOBER 1, 2006.] (a) For the rate year 129.35 beginning October 1, 2005, the commissioner shall provide 129.36 nursing facilities reimbursed under this section or section 130.1 256B.434 and for rates determined under section 256B.441 with an 130.2 adjustment to the total operating payment rate of 2.2 percent. 130.3 For the rate year beginning October 1, 2006, the commissioner 130.4 shall provide nursing facilities reimbursed under this section 130.5 or section 256B.434, and for rates determined under section 130.6 256B.431, with an adjustment to the total operating payment rate 130.7 of one percent. At least two-thirds of each year's adjustment 130.8 must be used for increased costs of employee salaries and 130.9 benefits and associated costs for FICA, the Medicare tax, 130.10 workers' compensation premiums, and federal and state 130.11 unemployment insurance. Each facility receiving an adjustment 130.12 shall report to the commissioner, in the form and manner 130.13 specified by the commissioner, on how the additional funding was 130.14 used. 130.15 (b) Costs for salary and employee benefits increases 130.16 incurred by nursing facilities since July 1, 2003, can be 130.17 counted towards the amount required to be spent on salaries and 130.18 benefits under paragraph (a). These costs should be reported in 130.19 the form and manner specified by the commissioner along with the 130.20 information required under paragraph (a). 130.21 Sec. 7. Minnesota Statutes 2004, section 256B.431, is 130.22 amended by adding a subdivision to read: 130.23 Subd. 42. [RATE INCREASE FOR FACILITIES IN STEARNS, 130.24 SHERBURNE, AND BENTON COUNTIES.] Effective October 1, 2005, 130.25 before determining any other rate adjustment effective on that 130.26 date, operating payment rates of nursing facilities in Stearns 130.27 County, Sherburne County, and Benton County, reimbursed under 130.28 this section or section 256B.434, shall be increased to be 130.29 equal, for a RUGs rate with a weight of 1.00, to the 30th 130.30 percentile of the geographic group III rate for the same RUGs 130.31 weight. The percentage of the operating payment rate for each 130.32 facility to be case-mix adjusted shall be equal to the 130.33 percentage that is case-mix adjusted in that facility's 130.34 September 30, 2005, operating payment rate. This subdivision 130.35 shall apply only if it results in a rate increase. Increases 130.36 provided by this subdivision shall be added to the rate 131.1 determined under any new reimbursement system established under 131.2 section 256B.440. 131.3 Sec. 8. Minnesota Statutes 2004, section 256B.432, 131.4 subdivision 1, is amended to read: 131.5 Subdivision 1. [DEFINITIONS.] For purposes of this 131.6 section, the following terms have the meanings given them. 131.7 (a) "Management agreement" means an agreement in which one 131.8 or more of the following criteria exist: 131.9 (1) the central, affiliated, or corporate office has or is 131.10 authorized to assume day-to-day operational control of the 131.11 nursing facility for any six-month period within a 24-month 131.12 period. "Day-to-day operational control" means that the 131.13 central, affiliated, or corporate office has the authority to 131.14 require, mandate, direct, or compel the employees of the nursing 131.15 facility to perform or refrain from performing certain acts, or 131.16 to supplant or take the place of the top management of the 131.17 nursing facility. "Day-to-day operational control" includes the 131.18 authority to hire or terminate employees or to provide an 131.19 employee of the central, affiliated, or corporate office to 131.20 serve as administrator of the nursing facility; 131.21 (2) the central, affiliated, or corporate office performs 131.22 or is authorized to perform two or more of the following: the 131.23 execution of contracts; authorization of purchase orders; 131.24 signature authority for checks, notes, or other financial 131.25 instruments; requiring the nursing facility to use the group or 131.26 volume purchasing services of the central, affiliated, or 131.27 corporate office; or the authority to make annual capital 131.28 expenditures for the nursing facility exceeding $50,000, or $500 131.29 per licensed bed, whichever is less, without first securing the 131.30 approval of the nursing facility board of directors; 131.31 (3) the central, affiliated, or corporate office becomes or 131.32 is required to become the licensee under applicable state law; 131.33 (4) the agreement provides that the compensation for 131.34 services provided under the agreement is directly related to any 131.35 profits made by the nursing facility; or 131.36 (5) the nursing facility entering into the agreement is 132.1 governed by a governing body that meets fewer than four times a 132.2 year, that does not publish notice of its meetings, or that does 132.3 not keep formal records of its proceedings. 132.4 (b) "Consulting agreement" means any agreement the purpose 132.5 of which is for a central, affiliated, or corporate office to 132.6 advise, counsel, recommend, or suggest to the owner or operator 132.7 of the nonrelated nursing facility measures and methods for 132.8 improving the operations of the nursing facility. 132.9 (c) "Nursing facility" means anursingfacilitywhose132.10medical assistance rates are determined according to section132.11256B.431with a medical assistance provider agreement that is 132.12 licensed as a nursing home under chapter 144A or as a boarding 132.13 care home under sections 144.50 to 144.56. 132.14 Sec. 9. Minnesota Statutes 2004, section 256B.432, 132.15 subdivision 2, is amended to read: 132.16 Subd. 2. [EFFECTIVE DATE.] For rate years beginning on or 132.17 after July 1, 1990, the central, affiliated, or corporate office 132.18 cost allocations in subdivisions 3 to 6 must be used when 132.19 determining medical assistance rates under section 256B.431, 132.20 256B.434, or 256B.441. 132.21 Sec. 10. Minnesota Statutes 2004, section 256B.432, is 132.22 amended by adding a subdivision to read: 132.23 Subd. 4a. [ALLOCATION; COSTS ALLOCABLE ON A FUNCTIONAL 132.24 BASIS.] (a) Costs that have not been directly identified must be 132.25 allocated to nursing facilities on a basis designed to equitably 132.26 allocate the costs to the nursing facilities or activities 132.27 receiving the benefits of the costs. This allocation must be 132.28 made in a manner reasonably related to the services received by 132.29 the nursing facilities. Where practical and the amounts are 132.30 material, these costs must be allocated on a functional basis. 132.31 The functions, or cost centers used to allocate central office 132.32 costs, and the unit bases used to allocate the costs, including 132.33 those central office costs allocated according to subdivision 5, 132.34 must be used consistently from one central office accounting 132.35 period to another. 132.36 (b) If the central office wishes to change its allocation 133.1 bases and believes the change will result in more appropriate 133.2 and more accurate allocations, the central office must make a 133.3 written request, with its justification, to the commissioner for 133.4 approval of the change no later than 120 days after the 133.5 beginning of the central office accounting period to which the 133.6 change is to apply. The commissioner's approval of a central 133.7 office request will be furnished to the central office in 133.8 writing. Where the commissioner approves the central office 133.9 request, the change must be applied to the accounting period for 133.10 which the request was made, and to all subsequent central office 133.11 accounting periods unless the commissioner approves a subsequent 133.12 request for change by the central office. The effective date of 133.13 the change will be the beginning of the accounting period for 133.14 which the request was made. 133.15 Sec. 11. Minnesota Statutes 2004, section 256B.432, 133.16 subdivision 5, is amended to read: 133.17 Subd. 5. [ALLOCATION OF REMAINING COSTS; ALLOCATION 133.18 RATIO.] (a) After the costs that can be directly identified 133.19 according to subdivisions 3 and 4 have been allocated, the 133.20 remaining central, affiliated, or corporate office costs must be 133.21 allocated between the nursing facility operations and the other 133.22 activities or facilities unrelated to the nursing facility 133.23 operations based on the ratio of total operating 133.24 costs. However, in the event that these remaining costs are 133.25 partially attributable to the start-up of home and 133.26 community-based services intended to fill a gap identified by 133.27 the local agency, the facility may assign these remaining costs 133.28 to the appropriate cost category of the facility for a period 133.29 not to exceed two years. 133.30 (b) For purposes of allocating these remaining central, 133.31 affiliated, or corporate office costs, the numerator for the 133.32 allocation ratio shall be determined as follows: 133.33 (1) for nursing facilities that are related organizations 133.34 or are controlled by a central, affiliated, or corporate office 133.35 under a management agreement, the numerator of the allocation 133.36 ratio shall be equal to the sum of the total operating costs 134.1 incurred by each related organization or controlled nursing 134.2 facility; 134.3 (2) for a central, affiliated, or corporate office 134.4 providing goods or services to related organizations that are 134.5 not nursing facilities, the numerator of the allocation ratio 134.6 shall be equal to the sum of the total operating costs incurred 134.7 by the nonnursing facility related organizations; 134.8 (3) for a central, affiliated, or corporate office 134.9 providing goods or services to unrelated nursing facilities 134.10 under a consulting agreement, the numerator of the allocation 134.11 ratio shall be equal to the greater of directly identified 134.12 central, affiliated, or corporate costs or the contracted 134.13 amount; or 134.14 (4) for business activities that involve the providing of 134.15 goods or services to unrelated parties which are not nursing 134.16 facilities, the numerator of the allocation ratio shall be equal 134.17 to the greater of directly identified costs or revenues 134.18 generated by the activity or function. 134.19 (c) The denominator for the allocation ratio is the sum of 134.20 the numerators in paragraph (b), clauses (1) to (4). 134.21 Sec. 12. Minnesota Statutes 2004, section 256B.432, is 134.22 amended by adding a subdivision to read: 134.23 Subd. 6a. [RELATED ORGANIZATION COSTS.] (a) Costs 134.24 applicable to services, capital assets, and supplies directly or 134.25 indirectly furnished to the nursing facility by any related 134.26 organization are includable in the allowable cost of the nursing 134.27 facility at the purchase price paid by the related organization 134.28 for capital assets or supplies and at the cost incurred by the 134.29 related organization for the provision of services to the 134.30 nursing facility if these prices or costs do not exceed the 134.31 price of comparable services, capital assets, or supplies that 134.32 could be purchased elsewhere. For this purpose, the related 134.33 organization's costs must not include an amount for markup or 134.34 profit. 134.35 (b) If the related organization in the normal course of 134.36 business sells services, capital assets, or supplies to 135.1 nonrelated organizations, the cost to the nursing facility shall 135.2 be the nonrelated organization's price provided that sales to 135.3 nonrelated organizations constitute at least 50 percent of total 135.4 annual sales of similar services, capital assets, or supplies. 135.5 Sec. 13. Minnesota Statutes 2004, section 256B.434, 135.6 subdivision 3, is amended to read: 135.7 Subd. 3. [DURATION AND TERMINATION OF CONTRACTS.] (a) 135.8 Subject to available resources, the commissioner may begin to 135.9 execute contracts with nursing facilities November 1, 1995. 135.10 (b) All contracts entered into under this section are for a 135.11 termof one yearnot to exceed four years. Either party may 135.12 terminate a contract at any time without cause by providing 90 135.13 calendar days advance written notice to the other party. The 135.14 decision to terminate a contract is not appealable. 135.15 Notwithstanding section 16C.05, subdivision 2, paragraph (a), 135.16 clause (5), the contract shall be renegotiated for 135.17 additionalone-yearfour-year terms, unless either party 135.18 provides written notice of termination. The provisions of the 135.19 contract shall be renegotiatedannuallyat a minimum of every 135.20 four years by the parties prior to the expiration date of the 135.21 contract. The parties may voluntarily renegotiate the terms of 135.22 the contract at any time by mutual agreement. 135.23 (c) If a nursing facility fails to comply with the terms of 135.24 a contract, the commissioner shall provide reasonable notice 135.25 regarding the breach of contract and a reasonable opportunity 135.26 for the facility to come into compliance. If the facility fails 135.27 to come into compliance or to remain in compliance, the 135.28 commissioner may terminate the contract. If a contract is 135.29 terminated, the contract payment remains in effect for the 135.30 remainder of the rate year in which the contract was terminated, 135.31 but in all other respects the provisions of this section do not 135.32 apply to that facility effective the date the contract is 135.33 terminated. The contract shall contain a provision governing 135.34 the transition back to the cost-based reimbursement system 135.35 established under section 256B.431 and Minnesota Rules, parts 135.36 9549.0010 to 9549.0080. A contract entered into under this 136.1 section may be amended by mutual agreement of the parties. 136.2 Sec. 14. Minnesota Statutes 2004, section 256B.434, 136.3 subdivision 4, is amended to read: 136.4 Subd. 4. [ALTERNATE RATES FOR NURSING FACILITIES.] (a) For 136.5 nursing facilities which have their payment rates determined 136.6 under this section rather than section 256B.431, the 136.7 commissioner shall establish a rate under this subdivision. The 136.8 nursing facility must enter into a written contract with the 136.9 commissioner. 136.10 (b) A nursing facility's case mix payment rate for the 136.11 first rate year of a facility's contract under this section is 136.12 the payment rate the facility would have received under section 136.13 256B.431. 136.14 (c) A nursing facility's case mix payment rates for the 136.15 second and subsequent years of a facility's contract under this 136.16 section are the previous rate year's contract payment rates plus 136.17 an inflation adjustment and, for facilities reimbursed under 136.18 this section or section 256B.431, an adjustment to include the 136.19 cost of any increase in Health Department licensing fees for the 136.20 facility taking effect on or after July 1, 2001. The index for 136.21 the inflation adjustment must be based on the change in the 136.22 Consumer Price Index-All Items (United States City average) 136.23 (CPI-U) forecasted by the commissioner of finance's national 136.24 economic consultant, as forecasted in the fourth quarter of the 136.25 calendar year preceding the rate year. The inflation adjustment 136.26 must be based on the 12-month period from the midpoint of the 136.27 previous rate year to the midpoint of the rate year for which 136.28 the rate is being determined. For the rate years beginning on 136.29 July 1, 1999, July 1, 2000, July 1, 2001, July 1, 2002, July 1, 136.30 2003,andJuly 1, 2004, July 1, 2005, July 1, 2006, July 1, 136.31 2007, July 1, 2008, and July 1, 2009, this paragraph shall apply 136.32 only to the property-related payment rate, except that 136.33 adjustments to include the cost of any increase in Health 136.34 Department licensing fees taking effect on or after July 1, 136.35 2001, shall be provided. Beginning in 2005, adjustment to the 136.36 property payment rate under this section and section 256B.431 137.1 shall be effective on October 1. In determining the amount of 137.2 the property-related payment rate adjustment under this 137.3 paragraph, the commissioner shall determine the proportion of 137.4 the facility's rates that are property-related based on the 137.5 facility's most recent cost report. Facilities reimbursed under 137.6 this section shall be allowed to receive a property rate 137.7 adjustment for building projects under section 144A.071, 137.8 subdivision 2. 137.9 (d) The commissioner shall develop additional 137.10 incentive-based payments of up to five percent above the 137.11 standard contract rate for achieving outcomes specified in each 137.12 contract. The specified facility-specific outcomes must be 137.13 measurable and approved by the commissioner. The commissioner 137.14 may establish, for each contract, various levels of achievement 137.15 within an outcome. After the outcomes have been specified the 137.16 commissioner shall assign various levels of payment associated 137.17 with achieving the outcome. Any incentive-based payment cancels 137.18 if there is a termination of the contract. In establishing the 137.19 specified outcomes and related criteria the commissioner shall 137.20 consider the following state policy objectives: 137.21 (1) improved cost effectiveness and quality of life as 137.22 measured by improved clinical outcomes; 137.23 (2) successful diversion or discharge to community 137.24 alternatives; 137.25 (3) decreased acute care costs; 137.26 (4) improved consumer satisfaction; 137.27 (5) the achievement of quality; or 137.28 (6) any additional outcomes proposed by a nursing facility 137.29 that the commissioner finds desirable. 137.30 Sec. 15. Minnesota Statutes 2004, section 256B.434, 137.31 subdivision 4a, is amended to read: 137.32 Subd. 4a. [FACILITY RATE INCREASES.] For the rate year 137.33 beginning July 1, 1999, the nursing facilities described in 137.34 clauses (1) to (5) shall receive the rate increases indicated. 137.35 The increases provided under this subdivision shall be included 137.36 in the facility's total payment rates for the purpose of 138.1 determining future rates under this sectionor any other section: 138.2 (1) a nursing facility in Becker County licensed for 102 138.3 nursing home beds on September 30, 1998, shall receive an 138.4 increase of $1.30 in its case mix class A payment rate; an 138.5 increase of $1.33 in its case mix class B payment rate; an 138.6 increase of $1.36 in its case mix class C payment rate; an 138.7 increase of $1.39 in its case mix class D payment rate; an 138.8 increase of $1.42 in its case mix class E payment rate; an 138.9 increase of $1.42 in its case mix class F payment rate; an 138.10 increase of $1.45 in its case mix class G payment rate; an 138.11 increase of $1.49 in its case mix class H payment rate; an 138.12 increase of $1.51 in its case mix class I payment rate; an 138.13 increase of $1.54 in its case mix class J payment rate; and an 138.14 increase of $1.59 in its case mix class K payment rate; 138.15 (2) a nursing facility in Chisago County licensed for 101 138.16 nursing home beds on September 30, 1998, shall receive an 138.17 increase of $3.67 in each case mix payment rate; 138.18 (3) a nursing facility in Canby, licensed for 75 beds shall 138.19 have its property-related per diem rate increased by $1.21. 138.20 This increase shall be recognized in the facility's contract 138.21 payment rate under this section; 138.22 (4) a nursing facility in Golden Valley with all its beds 138.23 licensed to provide residential rehabilitative services to young 138.24 adults under Minnesota Rules, parts 9570.2000 to 9570.3400, 138.25 shall have the payment rate computed according to this section 138.26 increased by $14.83; and 138.27 (5) a county-owned 130-bed nursing facility in Park Rapids 138.28 shall have its per diem contract payment rate increased by $1.02 138.29 for costs related to compliance with comparable worth 138.30 requirements. 138.31 Sec. 16. Minnesota Statutes 2004, section 256B.434, 138.32 subdivision 4b, is amended to read: 138.33 Subd. 4b. [FACILITY RATE INCREASES EFFECTIVE JULY 1, 138.34 2000.] For the rate year beginning July 1, 2000, the nursing 138.35 facilities described in clauses (1) to (6) shall receive the 138.36 rate increases indicated. The increases under this subdivision 139.1 shall be added following the determination under section 139.2 256B.431, subdivision 28, of the payment rate for the rate year 139.3 beginning July 1, 2000, and shall be included in the facility's 139.4 total payment rates for the purposes of determining future rates 139.5 under this sectionor any other section: 139.6 (1) a nursing facility in Hennepin County licensed for 290 139.7 beds shall receive an operating cost per diem increase of 5.9 139.8 percent, provided that the facility delicenses, decertifies, or 139.9 places on layaway status, if that status is otherwise permitted 139.10 by law, 70 beds; 139.11 (2) a nursing facility in Goodhue County licensed for 84 139.12 beds shall receive an increase of $1.54 in each case mix payment 139.13 rate; 139.14 (3) a nursing facility located in Rochester and licensed 139.15 for 103 beds on January 1, 2000, shall receive an increase in 139.16 its case mix resident class A payment of $3.78, and an increase 139.17 in the payment rate for all other case mix classes of that 139.18 amount multiplied by the class weight for that case mix class 139.19 established in Minnesota Rules, part 9549.0058, subpart 3; 139.20 (4) a nursing facility in Wright County licensed for 154 139.21 beds shall receive an increase of $2.03 in each case mix payment 139.22 rate to be used for employee wage and benefit enhancements; 139.23 (5) a facility in Todd County licensed for 78 beds, shall 139.24 have its operating cost per diem increased by the following 139.25 amounts: 139.26 (i) case mix class A, $1.16; 139.27 (ii) case mix class B, $1.50; 139.28 (iii) case mix class C, $1.89; 139.29 (iv) case mix class D, $2.26; 139.30 (v) case mix class E, $2.63; 139.31 (vi) case mix class F, $2.65; 139.32 (vii) case mix class G, $2.96; 139.33 (viii) case mix class H, $3.55; 139.34 (ix) case mix class I, $3.76; 139.35 (x) case mix class J, $4.08; and 139.36 (xi) case mix class K, $4.76; and 140.1 (6) a nursing facility in Pine City that decertified 22 140.2 beds in calendar year 1999 shall have its property-related per 140.3 diem payment rate increased by $1.59. 140.4 Sec. 17. Minnesota Statutes 2004, section 256B.434, 140.5 subdivision 4c, is amended to read: 140.6 Subd. 4c. [FACILITY RATE INCREASES EFFECTIVE JANUARY 1, 140.7 2002.] For the rate period beginning January 1, 2002, and for 140.8 the rate year beginning July 1, 2002, a nursing facility in 140.9 Morrison County licensed for 83 beds as of March 1, 2001, shall 140.10 receive an increase of $2.54 in each case mix payment rate to 140.11 offset property tax payments due as a result of the facility's 140.12 conversion from nonprofit to for-profit status. The increase 140.13 under this subdivision shall be added following the 140.14 determination under this chapter of the payment rate for the 140.15 rate year beginning July 1, 2001, and shall be included in the 140.16 facility's total payment rates for the purposes of determining 140.17 future rates under this sectionor any other section. 140.18 Sec. 18. Minnesota Statutes 2004, section 256B.434, 140.19 subdivision 4d, is amended to read: 140.20 Subd. 4d. [FACILITY RATE INCREASES EFFECTIVE JULY 1, 140.21 2001.] For the rate year beginning July 1, 2001, a nursing 140.22 facility in Hennepin County licensed for 302 beds shall receive 140.23 an increase of 29 cents in each case mix payment rate to correct 140.24 an error in the cost-reporting system that occurred prior to the 140.25 date that the facility entered the alternative payment 140.26 demonstration project. The increase under this subdivision 140.27 shall be added following the determination under this chapter of 140.28 the payment rate for the rate year beginning July 1, 2001, and 140.29 shall be included in the facility's total payment rates for the 140.30 purposes of determining future rates under this sectionor any140.31other section. 140.32 Sec. 19. Minnesota Statutes 2004, section 256B.434, is 140.33 amended by adding a subdivision to read: 140.34 Subd. 18. [PHASE-OUT OF ALTERNATIVE PAYMENT SYSTEM 140.35 CONTRACTS.] Nursing facilities that have entered into a contract 140.36 with the commissioner under the provisions of this section will 141.1 cease their contractual agreement with the commissioner 141.2 effective October 1, 2009. Nursing facilities with a contract 141.3 in effect on September 30, 2006, shall be paid the contract 141.4 payment rate for the remainder of the phase-in period according 141.5 to the provisions of section 256B.441, subdivision 53. 141.6 Sec. 20. Minnesota Statutes 2004, section 256B.434, is 141.7 amended by adding a subdivision to read: 141.8 Subd. 19. [PHASE-OUT OF RULE 50 PROPERTY RATES.] Effective 141.9 October 1, 2006, payment rates for property shall no longer be 141.10 determined under section 256B.431. A facility that does not 141.11 have a contract with the commissioner under this section shall 141.12 be construed as being reimbursed under neither section 256B.431 141.13 nor this section. 141.14 Sec. 21. Minnesota Statutes 2004, section 256B.438, 141.15 subdivision 3, is amended to read: 141.16 Subd. 3. [CASE MIX INDICES.] (a) The commissioner of human 141.17 services shall assign a case mix index to each resident class 141.18 based on the Centers for Medicare and Medicaid Services staff 141.19 time measurement study and adjusted for Minnesota-specific wage 141.20 indices. The case mix indices assigned to each resident class 141.21 shall be published in the Minnesota State Register at least 120 141.22 days prior to the implementation of the 34 group, RUG-III 141.23 resident classification system. 141.24 (b) An index maximization approach shall be used to 141.25 classify residents. 141.26 (c) After implementation of the revised case mix system, 141.27 the commissioner of human services may annually rebase case mix 141.28 indices and base rates using more current data on average wage 141.29 rates and staff time measurement studies. This rebasing shall 141.30 be calculated under subdivision 7, paragraph (b). The 141.31 commissioner shall publish in the Minnesota State Register 141.32 adjusted case mix indices at least 45 days prior to the 141.33 effective date of the adjusted case mix indices. In the event 141.34 that new case mix indices are implemented together with a new 141.35 payment system, rebasing of rates under subdivision 7, paragraph 141.36 (b), shall not apply. 142.1 Sec. 22. [256B.441] [NURSING FACILITY REIMBURSEMENT SYSTEM 142.2 EFFECTIVE OCTOBER 1, 2005.] 142.3 Subdivision 1. [IN GENERAL.] (a) The commissioner shall 142.4 establish a value-based nursing facility reimbursement system 142.5 which will provide facility-specific, prospective rates for 142.6 nursing facilities participating in the medical assistance 142.7 program. The rates shall be determined using an annual 142.8 statistical and cost report filed by each nursing facility. The 142.9 total payment rate shall be composed of four rate components: 142.10 direct care services, support services, external fixed, and 142.11 property-related rate components. The payment rate shall be 142.12 derived from statistical measures of actual costs incurred in 142.13 facility operation of nursing facilities. From this cost basis, 142.14 the components of the total payment rate shall be adjusted for 142.15 quality of services provided, recognition of staffing levels, 142.16 geographic variation in labor costs, and resident acuity. 142.17 (b) Rates shall be rebased annually. Each cost reporting 142.18 year shall begin on October 1 and end on the following September 142.19 30. Beginning in 2006, a statistical and cost report shall be 142.20 filed by each nursing facility by January 15. Notice of rates 142.21 shall be distributed by August 15 and the rates shall go into 142.22 effect on October 1 for one year. 142.23 (c) The commissioner shall begin to phase in the new 142.24 reimbursement system beginning October 1, 2006. Full phase-in 142.25 shall be completed by October 1, 2010. 142.26 Subd. 2. [DEFINITIONS.] For purposes of this section, the 142.27 terms in subdivisions 3 to 42 have the meanings given unless 142.28 otherwise provided for in this section. 142.29 Subd. 3. [ACTIVE BEDS.] "Active beds" means licensed beds 142.30 that are not currently in layaway status. 142.31 Subd. 4. [ACTIVITIES COSTS.] "Activities costs" means the 142.32 costs for the salaries and wages of the supervisor and other 142.33 activities workers, associated fringe benefits and payroll 142.34 taxes, supplies, services, and consultants. 142.35 Subd. 5. [ADMINISTRATIVE COSTS.] "Administrative costs" 142.36 means the direct costs for administering the overall activities 143.1 of the nursing home. These costs include salaries and wages of 143.2 the administrator, assistant administrator, business office 143.3 employees, security guards, and associated fringe benefits and 143.4 payroll taxes, fees, contracts, or purchases related to business 143.5 office functions, licenses, and permits except as provided in 143.6 the external fixed costs category, employee recognition, travel 143.7 including meals and lodging, training, voice and data 143.8 communication or transmission, office supplies, liability 143.9 insurance and other forms of insurance not designated to other 143.10 areas, personnel recruitment, legal services, accounting 143.11 services, management or business consultants, data processing, 143.12 central or home office costs, business meetings and seminars, 143.13 postage, fees for professional organizations, subscriptions, 143.14 security services, advertising, board of director's fees, 143.15 working capital interest expense, and bad debts and bad debt 143.16 collection fees. 143.17 Subd. 6. [ALLOWED COSTS.] "Allowed costs" means the 143.18 amounts reported by the facility which are necessary for the 143.19 operation of the facility and the care of residents and which 143.20 are reviewed by the department for accuracy, reasonableness, and 143.21 compliance with this section and generally accepted accounting 143.22 principles. 143.23 Subd. 7. [CENTER FOR MEDICARE AND MEDICAID 143.24 SERVICES.] "Center for Medicare and Medicaid services" means the 143.25 federal agency, in the United States Department of Health and 143.26 Human Services that administers Medicaid, also referred to as 143.27 "CMS." 143.28 Subd. 8. [COMMISSIONER.] "Commissioner" means the 143.29 commissioner of human services unless specified otherwise. 143.30 Subd. 9. [DESK AUDIT.] "Desk audit" means the 143.31 establishment of the payment rate based on the commissioner's 143.32 review and analysis of required reports, supporting 143.33 documentation, and work sheets submitted by the nursing facility. 143.34 Subd. 10. [DIETARY COSTS.] "Dietary costs" means the costs 143.35 for the salaries and wages of the dietary supervisor, 143.36 dietitians, chefs, cooks, dishwashers, and other employees 144.1 assigned to the kitchen and dining room, and associated fringe 144.2 benefits and payroll taxes. Dietary costs also includes the 144.3 salaries or fees of dietary consultants, direct costs of raw 144.4 food (both normal and special diet food), dietary supplies, and 144.5 food preparation and serving. Also included are special dietary 144.6 supplements used for tube feeding or oral feeding, such as 144.7 elemental high nitrogen diet, even if written as a prescription 144.8 item by a physician. 144.9 Subd. 11. [DIRECT CARE COSTS CATEGORY.] "Direct care costs 144.10 category" means costs for nursing services, activities, and 144.11 social services. 144.12 Subd. 12. [ECONOMIC DEVELOPMENT REGIONS.] "Economic 144.13 development regions" are as defined in section 462.385, 144.14 subdivision 1. 144.15 Subd. 13. [EXTERNAL FIXED COSTS CATEGORY.] "External fixed 144.16 costs category" means costs related to the nursing home 144.17 surcharge under section 256.9657, subdivision 1; licensure fees 144.18 under section 144.122; long-term care consultation fees under 144.19 section 256B.0911, subdivision 6; family advisory council fee 144.20 under section 144A.35; scholarships under section 256B.431, 144.21 subdivision 36; planned closure rate adjustments under section 144.22 256B.437; property taxes and property insurance; and PERA. 144.23 Subd. 14. [FACILITY AVERAGE CASE MIX INDEX 144.24 (CMI).] "Facility average case mix index" or "CMI" means a 144.25 numerical value score that describes the relative resource use 144.26 for all residents within the groups under the resource 144.27 utilization group (RUG-III) classification system prescribed by 144.28 the commissioner based on an assessment of each resident. The 144.29 facility average CMI shall be computed as the standardized days 144.30 divided by total days for all residents in the facility. 144.31 Subd. 15. [FIELD AUDIT.] "Field audit" means the 144.32 examination, verification, and review of the financial records, 144.33 statistical records, and related supporting documentation on the 144.34 nursing home and any related organization. 144.35 Subd. 16. [FINAL RATE.] "Final rate" means the rate 144.36 established after any adjustment by the commissioner, including, 145.1 but not limited to, adjustments resulting from audits. 145.2 Subd. 17. [FRINGE BENEFIT COSTS.] "Fringe benefit costs" 145.3 means the costs for group life, health, dental, workers' 145.4 compensation, and other employee insurances and pension, 145.5 profit-sharing, and retirement plans for which the employer pays 145.6 all or a portion of the costs and that are available to at least 145.7 all employees who work at least 20 hours per week. 145.8 Subd. 18. [GENERALLY ACCEPTED ACCOUNTING PRINCIPLES.] 145.9 "Generally Accepted Accounting Principles" means the body of 145.10 pronouncements adopted by the American Institute of Certified 145.11 Public Accountants regarding proper accounting procedures, 145.12 guidelines, and rules. 145.13 Subd. 19. [HOSPITAL-ATTACHED NURSING FACILITY STATUS.] (a) 145.14 For the purpose of setting rates under this section, for rate 145.15 years beginning after September 30, 2006, "hospital-attached 145.16 nursing facility" means a nursing facility which meets the 145.17 requirements of clauses (1) and (2); or (3); or (4), or had 145.18 hospital-attached status prior to January 1, 1995, and has been 145.19 recognized as having hospital-attached status by CMS 145.20 continuously since that date: 145.21 (1) the nursing facility is recognized by the federal 145.22 Medicare program to be a hospital-based nursing facility; 145.23 (2) the hospital and nursing facility are physically 145.24 attached or connected by a corridor; 145.25 (3) a nursing facility and hospital, which have applied for 145.26 hospital-based nursing facility status under the federal 145.27 Medicare program during the reporting year, shall be considered 145.28 a hospital-attached nursing facility for purposes of setting 145.29 payment rates under this section. The nursing facility must 145.30 file its cost report for that reporting year using Medicare 145.31 principles and Medicare's recommended cost allocation methods 145.32 had the Medicare program's hospital-based nursing facility 145.33 status been granted to the nursing facility. For each 145.34 subsequent rate year, the nursing facility must meet the 145.35 definition requirements in clauses (1) and (2). If the nursing 145.36 facility is denied hospital-based nursing facility status under 146.1 the Medicare program, the nursing facility's payment rates for 146.2 the rate years the nursing facility was considered to be a 146.3 hospital-attached nursing facility according to this paragraph 146.4 shall be recalculated treating the nursing facility as a 146.5 non-hospital-attached nursing facility; 146.6 (4) if a nonprofit or community-operated hospital and 146.7 attached nursing facility suspend operation of the hospital, the 146.8 remaining nursing facility must be allowed to continue its 146.9 status as hospital-attached for rate calculations in the three 146.10 rate years subsequent to the one in which the hospital ceased 146.11 operations. 146.12 (b) The nursing facility's cost report filed as 146.13 hospital-attached facility shall use the same cost allocation 146.14 principles and methods used in the reports filed for the 146.15 Medicare program. Direct identification of costs to the nursing 146.16 facility cost center will be permitted only when the comparable 146.17 hospital costs have also been directly identified to a cost 146.18 center which is not allocated to the nursing facility. 146.19 Subd. 20. [HOUSEKEEPING COSTS.] "Housekeeping costs" means 146.20 the costs for the salaries and wages of the housekeeping 146.21 supervisor, housekeepers, and other cleaning employees and 146.22 associated fringe benefits and payroll taxes. It also includes 146.23 the cost of housekeeping supplies, including cleaning and 146.24 lavatory supplies and contract services. 146.25 Subd. 21. [LABOR-RELATED PORTION.] The "labor-related 146.26 portion" of direct care costs and of support service costs shall 146.27 be that portion of costs that is attributable to wages for all 146.28 compensated hours, payroll taxes, and fringe benefits. 146.29 Subd. 22. [LAUNDRY COSTS.] "Laundry costs" means the costs 146.30 for the salaries and wages of the laundry supervisor and other 146.31 laundry employees, associated fringe benefits, and payroll 146.32 taxes. It also includes the costs of linen and bedding, the 146.33 laundering of resident clothing, laundry supplies, and contract 146.34 services. 146.35 Subd. 23. [LICENSEE.] "Licensee" means the individual or 146.36 organization listed on the form issued by the Minnesota 147.1 Department of Health under chapter 144A or sections 144.50 to 147.2 144.56. 147.3 Subd. 24. [MAINTENANCE AND PLANT OPERATIONS 147.4 COSTS.] "Maintenance and plant operations costs" means the costs 147.5 for the salaries and wages of the maintenance supervisor, 147.6 engineers, heating-plant employees, and other maintenance 147.7 employees and associated fringe benefits and payroll taxes. It 147.8 also includes direct costs for maintenance and operation of the 147.9 building and grounds, including fuel, electricity, medical waste 147.10 and garbage removal, water, sewer, supplies, tools, and repairs. 147.11 Subd. 25. [NORMALIZED DIRECT CARE COSTS PER 147.12 DAY.] "Normalized direct care costs per day" means direct care 147.13 costs divided by standardized days. It is the costs per day for 147.14 direct care services associated with a RUG's index of 1.00. 147.15 Subd. 26. [NURSING COSTS.] "Nursing costs" means the costs 147.16 for the wages of nursing administration, staff education, and 147.17 direct care registered nurses, licensed practical nurses, 147.18 certified nursing assistants, and trained medication aides; 147.19 mental health workers and other direct care employees, and 147.20 associated fringe benefits and payroll taxes; services from a 147.21 supplemental nursing services agency and supplies that are 147.22 stocked at nursing stations or on the floor and distributed or 147.23 used individually, including: alcohol, applicators, cotton 147.24 balls, incontinence pads, disposable ice bags, dressings, 147.25 bandages, water pitchers, tongue depressors, disposable gloves, 147.26 enemas, enema equipment, soap, medication cups, diapers, plastic 147.27 waste bags, sanitary products, thermometers, hypodermic needles 147.28 and syringes, and clinical reagents or similar diagnostic 147.29 agents, and drugs which are not paid on a separate fee schedule 147.30 by the medical assistance program or any other payer. 147.31 Subd. 27. [NURSING FACILITY.] "Nursing facility" means a 147.32 facility with a medical assistance provider agreement that is 147.33 licensed as a nursing home under chapter 144A or as a boarding 147.34 care home under sections 144.50 to 144.56. 147.35 Subd. 28. [OPERATING COSTS.] "Operating costs" means costs 147.36 associated with the direct care costs category and the support 148.1 services costs category. 148.2 Subd. 29. [PAYROLL TAXES.] "Payroll taxes" means the costs 148.3 for the employer's share of the FICA and Medicare withholding 148.4 tax, and state and federal unemployment compensation taxes. 148.5 Subd. 30. [PEER GROUPS.] Facilities shall be classified 148.6 into three groups, called "peer groups," which shall consist of: 148.7 (1) C&NC/Short Stay/R80 - facilities that have three or 148.8 more admissions per bed per year, are hospital-attached, or are 148.9 licensed under Minnesota Rules, parts 9570.2000 to 9570.3600; 148.10 (2) boarding care homes - facilities that have more than 50 148.11 percent of their beds licensed as boarding care homes; and 148.12 (3) standard - all other facilities. 148.13 Subd. 31. [PRIOR RATE-SETTING METHOD.] "Prior rate-setting 148.14 method" means the rate determination process in effect prior to 148.15 October 1, 2006, under Minnesota Rules and Minnesota Statutes. 148.16 Subd. 32. [PRIVATE PAYING RESIDENT.] "Private paying 148.17 resident" means a nursing facility resident who is not a medical 148.18 assistance recipient and whose payment rate is not established 148.19 by another third party, including the veterans administration or 148.20 Medicare. 148.21 Subd. 33. [RATE YEAR.] "Rate year" means the 12-month 148.22 period beginning on October 1 following the second most recent 148.23 reporting year. 148.24 Subd. 34. [RELATED ORGANIZATION.] "Related organization" 148.25 means a person that furnishes goods or services to a nursing 148.26 facility and that is a close relative of a nursing facility, an 148.27 affiliate of a nursing facility, a close relative of an 148.28 affiliate of a nursing facility, or an affiliate of a close 148.29 relative of an affiliate of a nursing facility. As used in this 148.30 subdivision, paragraphs (a) to (d) apply: 148.31 (a) "Affiliate" means a person that directly, or indirectly 148.32 through one or more intermediaries, controls or is controlled 148.33 by, or is under common control with another person. 148.34 (b) "Person" means an individual, a corporation, a 148.35 partnership, an association, a trust, an unincorporated 148.36 organization, or a government or political subdivision. 149.1 (c) "Close relative of an affiliate of a nursing facility" 149.2 means an individual whose relationship by blood, marriage, or 149.3 adoption to an individual who is an affiliate of a nursing 149.4 facility is no more remote than first cousin. 149.5 (d) "Control" including the terms "controlling," 149.6 "controlled by," and "under common control with" means the 149.7 possession, direct or indirect, of the power to direct or cause 149.8 the direction of the management, operations, or policies of a 149.9 person, whether through the ownership of voting securities, by 149.10 contract, or otherwise, or to influence in any manner other than 149.11 through an arms length, legal transaction. 149.12 Subd. 35. [REPORTING PERIOD.] "Reporting period" means the 149.13 one-year period beginning on October 1 and ending on the 149.14 following September 30 during which incurred costs are 149.15 accumulated and then reported on the statistical and cost report. 149.16 Subd. 36. [RESIDENT DAY OR ACTUAL RESIDENT DAY.] "Resident 149.17 day" or "actual resident day" means a day for which nursing 149.18 services are rendered and billable, or a day for which a bed is 149.19 held and billed. The day of admission is considered a resident 149.20 day, regardless of the time of admission. The day of discharge 149.21 is not considered a resident day, regardless of the time of 149.22 discharge. 149.23 Subd. 37. [SALARIES AND WAGES.] "Salaries and wages" means 149.24 amounts earned by and paid to employees or on behalf of 149.25 employees to compensate for necessary services provided. 149.26 Salaries and wages include accrued vested vacation and accrued 149.27 vested sick leave pay. Salaries and wages must be paid within 149.28 30 days of the end of the reporting period in order to be 149.29 allowable costs of the reporting period. 149.30 Subd. 38. [SOCIAL SERVICES COSTS.] "Social services costs" 149.31 means the costs for the salaries and wages of the supervisor and 149.32 other social work employees, associated fringe benefits and 149.33 payroll taxes, supplies, services, and consultants. 149.34 Subd. 39. [STAKEHOLDERS.] "Stakeholders" means individuals 149.35 and representatives of organizations interested in long-term 149.36 care, including nursing homes, consumers, and labor unions. 150.1 Subd. 40. [STANDARDIZED DAYS.] "Standardized days" means 150.2 the sum of resident days by case mix category multiplied by the 150.3 RUG index for each category. 150.4 Subd. 41. [STATISTICAL AND COST REPORT.] "Statistical and 150.5 cost report" means the forms supplied by the commissioner for 150.6 annual reporting of nursing facility expenses and statistics, 150.7 including instructions and definitions of items in the report. 150.8 Subd. 42. [SUPPORT SERVICES COSTS CATEGORY.] "Support 150.9 services costs category" means the costs for dietary, 150.10 housekeeping, laundry, maintenance, and administration. 150.11 Subd. 43. [REPORTING OF STATISTICAL AND COST 150.12 INFORMATION.] (a) Beginning in 2006, all nursing facilities 150.13 shall provide information annually to the commissioner on a form 150.14 and in a manner determined by the commissioner. The 150.15 commissioner may also require nursing facilities to provide 150.16 statistical and cost information for a subset of the items in 150.17 the annual report on a semiannual basis. Nursing facilities 150.18 shall report only costs directly related to the operation of the 150.19 nursing facility. The facility shall not include costs which 150.20 are separately reimbursed by residents, medical assistance, or 150.21 other payors. Allocations of costs from central, affiliated, or 150.22 corporate office and related organization transactions shall be 150.23 reported according to section 256B.432. The commissioner may 150.24 grant to facilities one extension of up to 15 days for the 150.25 filing of this report if the extension is requested by December 150.26 15 and the commissioner determines that the extension will not 150.27 prevent the commissioner from establishing rates in a timely 150.28 manner required by law. The commissioner may separately require 150.29 facilities to submit in a manner specified by the commissioner 150.30 documentation of statistical and cost information included in 150.31 the report to ensure accuracy in establishing payment rates and 150.32 to perform audit and appeal review functions under this section. 150.33 Facilities shall retain all records necessary to document 150.34 statistical and cost information on the report for a period of 150.35 no less than seven years. The commissioner may amend 150.36 information in the report according to subdivision 54. The 151.1 commissioner may reject a report filed by a nursing facility 151.2 under this section if the commissioner determines that the 151.3 report has been filed in a form that is incomplete or inaccurate 151.4 and the information is insufficient to establish accurate 151.5 payment rates. In the event that a complete report is not 151.6 submitted in a timely manner, the commissioner shall reduce the 151.7 reimbursement payments to a nursing facility to 85 percent of 151.8 amounts due until the information is filed. The release of 151.9 withheld payments shall be retroactive for no more than 90 151.10 days. A nursing facility that does not submit a report or whose 151.11 report is filed in a timely manner but determined to be 151.12 incomplete shall be given written notice that a payment 151.13 reduction is to be implemented and allowed ten days to complete 151.14 the report prior to any payment reduction. The commissioner may 151.15 delay the payment withhold under exceptional circumstances to be 151.16 determined at the sole discretion of the commissioner. 151.17 (b) Nursing facilities may, within 12 months of the due 151.18 date of a statistical and cost report, file an amendment when 151.19 errors or omissions in the annual statistical and cost report 151.20 are discovered and an amendment would result in a rate increase 151.21 of at least 0.15 percent of the statewide weighted average 151.22 operating payment rate and shall, at any time, file an amendment 151.23 which would result in a rate reduction of at least 0.15 percent 151.24 of the statewide weighted average operating payment rate. The 151.25 commissioner shall make retroactive adjustments to the total 151.26 payment rate of a nursing facility if an amendment is accepted. 151.27 Where a retroactive adjustment is to be made as a result of an 151.28 amended report, audit findings, or other determination of an 151.29 incorrect payment rate, the commissioner may settle the payment 151.30 error through a negotiated agreement with the facility and a 151.31 gross adjustment of the payments to the facility. Retroactive 151.32 adjustments shall not be applied to private pay residents. An 151.33 error or omission for purposes of this item does not include a 151.34 nursing facility's determination that an election between 151.35 permissible alternatives was not advantageous and should be 151.36 changed. 152.1 (c) If the commissioner determines that a nursing facility 152.2 knowingly supplied inaccurate or false information or failed to 152.3 file an amendment to a statistical and cost report that resulted 152.4 in or would result in an overpayment, the commissioner shall 152.5 immediately adjust the nursing facility's payment rate and 152.6 recover the entire overpayment. The commissioner may also 152.7 terminate the commissioner's agreement with the nursing facility 152.8 and prosecute under applicable state or federal law. 152.9 Subd. 44. [CALCULATION OF DIRECT CARE PER DIEM COSTS.] The 152.10 commissioner shall calculate, for each nursing facility, the 152.11 normalized per diem cost for direct care services by dividing 152.12 the total allowable reported costs for direct care services by 152.13 the number of standardized days for the same reporting period. 152.14 Subd. 45. [CALCULATION OF SUPPORT SERVICES PER DIEM 152.15 COSTS.] The commissioner shall calculate, for each nursing 152.16 facility, the per diem cost for support services by dividing the 152.17 total allowable reported costs for support services by the 152.18 number of resident days for the same reporting period. 152.19 Subd. 46. [CALCULATION OF A QUALITY SCORE.] (a) The 152.20 commissioner shall determine a quality score for each nursing 152.21 facility using quality measures established in section 256B.439, 152.22 according to methods determined by the commissioner in 152.23 consultation with stakeholders and experts. These methods shall 152.24 be exempt from the rulemaking requirements under chapter 14. 152.25 (b) For each quality measure, a score shall be determined 152.26 with a maximum number of points available and number of points 152.27 assigned as determined by the commissioner using the methodology 152.28 established according to this subdivision. The scores 152.29 determined for all quality measures shall be totaled. The 152.30 determination of the quality measures to be used and the methods 152.31 of calculating scores may be revised annually by the 152.32 commissioner. 152.33 (c) For the initial rate year under the new payment system, 152.34 the quality measures shall include: 152.35 (1) staff turnover; 152.36 (2) staff retention; 153.1 (3) use of pool staff; 153.2 (4) quality indicators from the minimum data set; and 153.3 (5) survey deficiencies. 153.4 (d) For rate years beginning after October 1, 2006, when 153.5 making revisions to the quality measures or method for 153.6 calculating scores, the commissioner shall publish the 153.7 methodology in the State Register at least 15 months prior to 153.8 the start of the rate year for which the revised methodology is 153.9 to be used for rate-setting purposes. The quality score used to 153.10 determine payment rates shall be established for a rate year 153.11 using data submitted in the statistical and cost report from the 153.12 associated reporting year, and using data from other sources 153.13 related to a period beginning no more than six months prior to 153.14 the associated reporting year. 153.15 Subd. 47. [CALCULATION OF PAYMENT RATE FOR DIRECT CARE 153.16 SERVICES.] The commissioner shall provide recommendations to the 153.17 legislature by February 15, 2006, on specific methodology for 153.18 the establishment of the payment rate for direct care services 153.19 under the new system. The recommendations must not increase 153.20 expenditures for the new payment system beyond the limits of the 153.21 appropriation. The commissioner shall include recommendations 153.22 on options for recognizing changes in direct care staff hours 153.23 that may require a supplemental appropriation in the future. 153.24 Subd. 48. [CALCULATION OF PAYMENT RATE FOR SUPPORT 153.25 SERVICES.] The payment rate for support services shall be a 153.26 fixed amount adjusted for the facility's peer group and 153.27 geography. 153.28 (a) For each facility, determine the geographic normalized 153.29 support services costs per standardized day according to clauses 153.30 (1) to (7): 153.31 (1) for the costs determined in subdivision 45, for each 153.32 facility, determine the portion, as a percent, that is 153.33 labor-related; 153.34 (2) array the values in clause (1) by peer group and select 153.35 the median for each peer group; 153.36 (3) for each facility, multiply the costs determined in 154.1 subdivision 45 by the value determined in clause (2) for its 154.2 peer group; 154.3 (4) divide the value determined in clause (3) by the 154.4 geographic adjuster determined in subdivision 50; 154.5 (5) for each facility, multiply the costs determined in 154.6 subdivision 45 by the value of one minus the value determined in 154.7 clause (2) for its peer group; 154.8 (6) add the value determined in clause (4) to the value 154.9 determined in clause (5); 154.10 (7) array the values determined in clause (6) for each peer 154.11 group, and select the 40th percentile; and 154.12 (8) the commissioner is authorized to apply multipliers to 154.13 the values determined in clause (7) to assure that expenditures 154.14 are within the limits of the appropriation and that funds are 154.15 not shifted between peer groups. These values shall be the 154.16 unadjusted support services payment rate for the three peer 154.17 groups. 154.18 (b) The support services price for each facility shall be 154.19 the value determined in paragraph (a), clause (8), adjusted by 154.20 the geographic adjuster of the facility according to clauses (1) 154.21 to (4): 154.22 (1) the value determined in paragraph (a), clause (8), 154.23 shall be multiplied by the value determined in paragraph (a), 154.24 clause (2), for the facility's peer group; 154.25 (2) multiply the value determined in clause (1) by the 154.26 geographic adjuster determined in subdivision 50; 154.27 (3) for each facility, multiply the value determined in 154.28 paragraph (a), clause (8), by the value of one minus the value 154.29 determined in paragraph (a), clause (2), for the facility's peer 154.30 group; 154.31 (4) add the value determined in clause (2) to the value 154.32 determined in clause (3). This value shall be the support 154.33 services payment rate for each facility; and 154.34 (c) For rate years beginning on or after October 1, 2007, 154.35 the value determined in paragraph (b), clause (4), shall not be 154.36 less than the value used for the rate year beginning October 1, 155.1 2006. 155.2 Subd. 49. [CALCULATION OF QUALITY ADD-ON.] The payment 155.3 rate for the quality add-on shall be a variable amount based on 155.4 each facility's quality score. 155.5 (a) For the rate year beginning October 1, 2006, the 155.6 maximum quality add-on percent shall be three percent and this 155.7 add-on shall not be subject to the phase-in under subdivision 155.8 53. When new quality measures are incorporated into the quality 155.9 score methodology and when existing quality measures are updated 155.10 or improved, the commissioner may increase the maximum quality 155.11 add-on percent. 155.12 (b) For each facility, determine the sum of the values 155.13 determined in subdivisions 47 and 48. 155.14 (c) For each facility determine a ratio of the quality 155.15 score of the facility determined in subdivision 46, less 40 and 155.16 then divided by 60. If this value is less than zero, use the 155.17 value zero. 155.18 (d) For each facility, the quality add-on shall be the 155.19 value determined in paragraph (b) times the value determined in 155.20 paragraph (c) times the maximum quality add-on percent. 155.21 Subd. 50. [GEOGRAPHIC ADJUSTMENTS OF LABOR-RELATED COSTS.] 155.22 The commissioner shall determine adjusters for the labor-related 155.23 share of the operating rate which shall be the ratio calculated 155.24 in paragraphs (a) to (c), using data reported under subdivision 155.25 43. In paragraphs (a) and (b), use direct care costs and direct 155.26 care compensated hours and use only facilities that have 155.27 reported both. 155.28 (a) Calculate the sum of compensation for all facilities in 155.29 each economic development region divided by the facilities total 155.30 compensated hours. 155.31 (b) Calculate the sum of compensation for all facilities in 155.32 the state divided by total reported compensated hours of all 155.33 facilities in the state. 155.34 (c) For each economic development region, divide the value 155.35 in paragraph (a) by the value in paragraph (b). These ratios 155.36 shall be the geographic adjusters for the economic development 156.1 regions. 156.2 Subd. 51. [ADJUSTER FOR OPERATING PAYMENT RATES.] (a) The 156.3 commissioner shall provide information to the appropriate 156.4 committee chairs of the legislature by January 15 of each year 156.5 specifying adjusters that may be multiplied by the uninflated 156.6 payment rates, or by any other factor the commissioner deems 156.7 appropriate, for direct care and support service costs 156.8 determined in subdivisions 47 and 48. The information shall 156.9 include: 156.10 (1) the projected change in the CPI-U, between the midpoint 156.11 of the reporting year and the midpoint of the rate year, as 156.12 determined by the national economic consultant used by the 156.13 commissioner of finance, for the next rate year; and 156.14 (2) the costs or savings to the state of adjusting payment 156.15 rates according to clause (1). 156.16 (b) The commissioner may also describe other factors or 156.17 methods that may be considered in adjusting rates. 156.18 Subd. 52. [CALCULATION OF PAYMENT RATE FOR EXTERNAL FIXED 156.19 COSTS.] The commissioner shall calculate a payment rate for 156.20 external fixed costs. 156.21 (a) For facilities licensed as nursing homes, the portion 156.22 related to section 256.9657 shall be equal to $8.86. For 156.23 facilities licensed as both nursing homes and boarding care 156.24 homes, the portion related to section 256.9657 shall be equal to 156.25 $8.86 multiplied by the ratio of their number of nursing home 156.26 beds divided by their total number of active licensed and 156.27 certified nursing home and boarding care beds. 156.28 (b) The portion related to the licensure fee under section 156.29 144.122, paragraph (d), shall be the amount of the fee divided 156.30 by actual resident days. 156.31 (c) The portion related to scholarships shall be determined 156.32 under section 256B.431, subdivision 36. 156.33 (d) The portion related to long-term care consultation 156.34 shall be determined according to section 256B.0911, subdivision 156.35 6. 156.36 (e) The portion related to development and education of 157.1 resident and family advisory councils under section 144A.33 157.2 shall be $5 divided by 365. 157.3 (f) The portion related to planned closure rate adjustments 157.4 shall be as determined under section 256B.437. 157.5 (g) The portions related to property insurance, real estate 157.6 taxes, special assessments, and payments made in lieu of real 157.7 estate taxes directly identified or allocated to the nursing 157.8 facility shall be the actual amounts divided by actual resident 157.9 days. 157.10 (h) The portion related to PERA shall be actual costs 157.11 divided by actual resident days. 157.12 (i) The payment rate for external fixed costs shall be the 157.13 sum of the amounts in paragraphs (a) to (h). 157.14 Subd. 53. [PHASE-IN.] The commissioner shall implement the 157.15 operating payment rate-setting methods in this section according 157.16 to paragraphs (a) to (j). 157.17 (a) Total payment rates effective on June 30, 2006, shall 157.18 remain in effect through September 30, 2006. 157.19 (b) By August 15 of 2006, 2007, and 2008, the commissioner 157.20 shall notify nursing facilities of the operating payment rates 157.21 they will receive under both this section and under the prior 157.22 rate-setting method, of the blended operating payment rates that 157.23 will apply based on paragraphs (c) to (i), and the actual 157.24 operating payment rate that will result from application of 157.25 paragraph (j). For purposes of determining payment rates under 157.26 the prior rate-setting method, the RUG's indices determined 157.27 under section 256B.438, subdivision 3, paragraph (a), shall be 157.28 used. For purposes of determining payment rates under the new 157.29 rate-setting method, the RUG's indices determined under section 157.30 256B.438, subdivision 3, paragraph (c), shall be used. 157.31 (c) For facilities reimbursed under section 256B.434 on 157.32 September 30, 2006, for purposes of determining payment rates 157.33 under the prior rate-setting method, and under this section for 157.34 rate years beginning after June 30, 2006, the rate adjustment 157.35 under section 256B.434, subdivision 4, paragraph (c), shall 157.36 apply only to the property-related payment rate. For facilities 158.1 reimbursed under section 256B.431 on September 30, 2006, for 158.2 rate years beginning on and after October 1, 2006, property 158.3 rates shall continue to be determined under Minnesota Rules, 158.4 parts 9549.0010 to 9549.0080. 158.5 (d) For the rate year beginning October 1, 2006, for the 158.6 operating rate components under the prior rate-setting method, 158.7 the commissioner shall use the amounts in effect on June 30, 158.8 2006. For the rate years beginning on October 1, 2007, and 158.9 October 1, 2008, the commissioner shall use the amounts in 158.10 effect on the prior September 30. 158.11 (e) For RUG's classifications with an effective date prior 158.12 to October 1, 2007, the commissioner of health shall apply index 158.13 maximization using the indices determined under section 158.14 256B.438, subdivision 3, paragraph (a). For RUG's 158.15 classifications with an effective date on or after October 1, 158.16 2007, the commissioner of health shall apply index maximization 158.17 using the indices determined under section 256B.438, subdivision 158.18 3, paragraph (c). 158.19 (f) The blended total payment rate that will apply on 158.20 October 1, 2006, shall consist of ten percent of the amount 158.21 determined under this section and 90 percent of the amount 158.22 determined under the prior rate-setting method. 158.23 (g) The blended total payment rate that will apply on 158.24 October 1, 2007, shall consist of 40 percent of the amount 158.25 determined under this section and 60 percent of the amount 158.26 determined under the prior rate-setting method. 158.27 (h) The blended total payment rate that will apply on 158.28 October 1, 2008, shall consist of 70 percent of the amount 158.29 determined under this section and 30 percent of the amount 158.30 determined under the prior rate-setting method. 158.31 (i) The blended total payment rate that will apply on 158.32 October 1, 2009, shall be the amount determined under this 158.33 section. 158.34 (j) For rate years beginning October 1 of 2006, 2007, and 158.35 2008, for facilities for which the rate determined under this 158.36 subdivision as adjusted according to section 256B.431, 159.1 subdivision 41, is less than the rate that was in effect on 159.2 September 30, 2006, the actual operating payment rate shall be 159.3 the rate that was in effect on September 30, 2006. For the rate 159.4 year beginning October 1, 2009, for facilities for which the 159.5 rate determined under this section is less than the rate 159.6 determined under the prior rate-setting method, the actual 159.7 operating payment rate shall be the rate determined under this 159.8 section but shall be no more than $10 less than the rate that 159.9 was in effect on September 30, 2006. For rate years beginning 159.10 on or after October 1, 2010, for facilities for which the rate 159.11 determined under this section is less than the rate that was in 159.12 effect on September 30, 2010, the actual operating payment rate 159.13 shall be the rate determined under this section. 159.14 Subd. 54. [AUDIT AUTHORITY.] (a) The commissioner may 159.15 subject reports and supporting documentation to desk and field 159.16 audits to determine compliance with this section. Retroactive 159.17 adjustments shall be made as a result of desk or field audit 159.18 findings if the cumulative impact of the finding would result in 159.19 a rate adjustment of at least 0.15 percent of the statewide 159.20 weighted average operating payment rate. If a field audit 159.21 reveals inadequacies in a nursing facility's record keeping or 159.22 accounting practices, the commissioner may require the nursing 159.23 facility to engage competent professional assistance to correct 159.24 those inadequacies within 90 days so that the field audit may 159.25 proceed. 159.26 (b) Field audits may cover the four most recent annual 159.27 statistical and cost reports for which desk audits have been 159.28 completed and payment rates have been established. The field 159.29 audit must be an independent review of the nursing facility's 159.30 statistical and cost report. All transactions, invoices, or 159.31 other documentation that support or relate to the statistics and 159.32 costs claimed on the annual statistical and cost reports are 159.33 subject to review by the field auditor. If the provider fails 159.34 to provide the field auditor access to supporting documentation 159.35 related to the information reported on the statistical and cost 159.36 report within the time period specified by the commissioner, the 160.1 commissioner shall calculate the total payment rate by 160.2 disallowing the cost of the items for which access to the 160.3 supporting documentation is not provided. 160.4 (c) Changes in the total payment rate which result from 160.5 desk or field audit adjustments to statistical and cost reports 160.6 for reporting years earlier than the four most recent annual 160.7 cost reports must be made to the four most recent annual 160.8 statistical and cost reports, the current statistical and cost 160.9 report, and future statistical and cost reports to the extent 160.10 that those adjustments affect the total payment rate established 160.11 by those reporting years. 160.12 (d) The commissioner shall extend the period for retention 160.13 of records under subdivision 43 for purposes of performing field 160.14 audits as necessary to enforce section 256B.48 with written 160.15 notice to the facility postmarked no later than 90 days prior to 160.16 the expiration of the record retention requirement. 160.17 Subd. 55. [REMEDIES FOR DISPUTES.] The commissioner shall 160.18 provide remedies for disputes under this section. 160.19 (a) A provider may appeal a determination of a payment rate 160.20 established under this section if the appeal, if successful, 160.21 would result in a change to the provider's payment rate of at 160.22 least 0.15 percent of the statewide weighted average operating 160.23 payment rate. Appeals must be filed according to procedures in 160.24 this subdivision. 160.25 (b) To appeal, the provider shall file with the 160.26 commissioner a written notice of appeal and the appeal must be 160.27 postmarked or received by the commissioner within 60 days of the 160.28 date the determination of the payment rate was mailed or 160.29 personally received by a provider, whichever is earlier. 160.30 (c) The notice of appeal must specify: 160.31 (1) each disputed item; 160.32 (2) the reason for the dispute; 160.33 (3) the computation that the provider believes is correct; 160.34 (4) the impact upon the facility's payment rate if the 160.35 appeal is successful; 160.36 (5) the authority in statute or rule upon which the 161.1 provider relies for each disputed item; 161.2 (6) the name and address of the person or firm with whom 161.3 contacts may be made regarding the appeal; and 161.4 (7) additional information the provider wishes to offer 161.5 with the appeal to support the provider's position. The 161.6 commissioner may request additional information to clarify the 161.7 provider's position. 161.8 (d) The commissioner shall review appeals and issue a 161.9 written appeal determination on each appealed item within 180 161.10 days of the due date of the appeal. Upon mutual agreement, the 161.11 commissioner and the provider may extend the time for issuing a 161.12 determination for a specified period. The appeal determination 161.13 takes effect 30 days following the date of issuance specified in 161.14 the determination. 161.15 (e) For an appeal item on which the provider disagrees with 161.16 the appeal determination, the provider may request 161.17 reconsideration. A request for reconsideration must be 161.18 postmarked or received by the commissioner within 30 days of the 161.19 date of issuance of the determination. A request for 161.20 reconsideration delays the date on which the determination takes 161.21 effect. The appeal determination and any changes resulting from 161.22 reconsideration shall be implemented 30 days following the 161.23 issuance of the reconsideration response. 161.24 (f) For an appeal item on which the provider disagrees with 161.25 the appeal determination and the reconsideration response, if 161.26 any, the provider may file with the commissioner a written 161.27 demand for a contested case hearing to determine the proper 161.28 resolution of specified appeal items. The demand must be 161.29 postmarked or received by the commissioner within 30 days of the 161.30 date of issuance specified in the determination or within 30 161.31 days of the issuance of the reconsideration response, if 161.32 reconsideration was requested. A demand for a contested case 161.33 hearing for an appeal item nullifies the written appeal 161.34 determination issued by the commissioner for that appeal item. 161.35 The commissioner shall refer any demand for a contested case 161.36 hearing to the Office of the Attorney General. 162.1 (g) A contested case hearing shall be heard by an 162.2 administrative law judge according to sections 14.48 to 14.56. 162.3 In any proceeding under this section, the appealing party must 162.4 demonstrate by a preponderance of the evidence that the 162.5 determination of a payment rate is incorrect. 162.6 (h) Regardless of any rate appeal, the rate established 162.7 must be the rate paid and must remain in effect until final 162.8 resolution of the appeal or a subsequent rate determination. 162.9 (i) A provider shall not use this process to challenge the 162.10 method of determining a quality score under subdivision 46; or 162.11 the commissioner's determination under subdivision 56 to 162.12 negotiate rates. This process does not apply to a request from 162.13 a resident or nursing facility for reconsideration of the 162.14 classification of a resident under section 144.0722 or 144.0724. 162.15 Subd. 56. [INTERIM RATES.] (a) The commissioner shall 162.16 determine interim payment rates for nursing facilities that have 162.17 no cost history. The facilities shall provide statistical and 162.18 cost information, according to subdivision 43, on a prospective 162.19 basis. The commissioner shall establish an interim rate using 162.20 the quality score of the nursing facility at the 60th 162.21 percentile, direct care costs according to a budget negotiated 162.22 with the provider and the methods provided in subdivision 47. 162.23 The interim rate shall apply until a rate can be established 162.24 under this section. Upon providing final information under 162.25 subdivision 43 for the interim rate period, the commissioner 162.26 shall determine that an overpayment has occurred if the interim 162.27 payment rate for direct care costs exceeded the final rate for 162.28 direct care costs by an amount greater than four percent, and 162.29 shall recover any overpayment. 162.30 In the event of an overpayment, the commissioner may allow 162.31 up to six months for complete repayment if the provider 162.32 demonstrates that immediate repayment of the overpayment would 162.33 result in an undue hardship to the operation of the facility. 162.34 (b) The commissioner may negotiate an interim rate with a 162.35 nursing facility, according to the process in paragraph (a), 162.36 when that facility has been purchased by an unrelated party 163.1 within the last six months. In determining if negotiations 163.2 shall be initiated, the commissioner shall consider: 163.3 (1) the potential inadequacy of current rates as evidenced 163.4 by the position in the arrays of operating costs of the rates of 163.5 the requesting facility; 163.6 (2) preventing closure of facilities in under-bedded areas 163.7 of the state, as measured by the number of beds per 1,000 163.8 elderly in the county or in contiguous counties in which the 163.9 facility is located; 163.10 (3) the ability of the purchaser to provide high quality 163.11 services as evidenced by high quality scores of any other 163.12 facility under the control of the purchaser operating in 163.13 Minnesota; 163.14 (4) the ability of the purchasing entity to operate 163.15 efficiently as evidenced by the difference between the operating 163.16 costs and target prices of the other facility or facilities 163.17 under the control of the purchaser operating in Minnesota; 163.18 (5) previous success of the purchaser with negotiated 163.19 interim rates; 163.20 (6) the financial soundness of the purchaser; 163.21 (7) avoiding negotiating interim rates with purchasers who 163.22 have sold facilities that then requested interim rate 163.23 negotiation; and 163.24 (8) avoiding too much consolidation of the nursing facility 163.25 industry within any small number of providers. 163.26 Sec. 23. Minnesota Statutes 2004, section 256B.47, 163.27 subdivision 2, is amended to read: 163.28 Subd. 2. [NOTICE TO RESIDENTS.] (a) No increase in nursing 163.29 facility rates for private paying residents shall be effective 163.30 unless the nursing facility notifies the resident or person 163.31 responsible for payment of the increase in writing 30 days 163.32 before the increase takes effect. 163.33 A nursing facility may adjust its rates without giving the 163.34 notice required by this subdivision when the purpose of the rate 163.35 adjustment is to reflect a change in the case-mix classification 163.36 of the resident. If the state fails to set rates as required by 164.1 section256B.431256B.441,subdivision 1,the time required for 164.2 giving notice is decreased by the number of days by which the 164.3 state was late in setting the rates. 164.4 (b) If the state does not set rates by the date required in 164.5 section256B.431256B.441,subdivision 1,nursing facilities 164.6 shall meet the requirement for advance notice by informing the 164.7 resident or person responsible for payments, on or before the 164.8 effective date of the increase, that a rate increase will be 164.9 effective on that date. If the exact amount has not yet been 164.10 determined, the nursing facility may raise the rates by the 164.11 amount anticipated to be allowed. Any amounts collected from 164.12 private pay residents in excess of the allowable rate must be 164.13 repaid to private pay residents with interest at the rate used 164.14 by the commissioner of revenue for the late payment of taxes and 164.15 in effect on the date the rate increase is effective. 164.16 Sec. 24. [MORATORIUM PROJECT DEADLINE EXTENSION IN AITKIN 164.17 COUNTY.] 164.18 Notwithstanding Minnesota Statutes, section 144A.073, 164.19 subdivisions 3 and 10, the commissioner of health shall extend 164.20 the project approval until December 31, 2006, for a nursing home 164.21 moratorium exception project that was approved under Minnesota 164.22 Statutes, section 144A.073, in 2002 to remodel a 48-bed facility 164.23 in Aitkin County. 164.24 Sec. 25. [MORATORIUM PROJECT DEADLINE EXTENSION IN 164.25 RENVILLE COUNTY.] 164.26 Notwithstanding Minnesota Statutes, section 144A.073, 164.27 subdivisions 3 and 10, the commissioner of health shall extend 164.28 the project approval until December 31, 2006, for a nursing home 164.29 moratorium exception project that was approved under Minnesota 164.30 Statutes, section 144A.073, in 2002 to remodel a 60-bed facility 164.31 in Renville County. 164.32 Sec. 26. [RECOMMENDATIONS ON CRITERIA AND RATE 164.33 NEGOTIATIONS FOR NURSING FACILITIES.] 164.34 The commissioner of human services shall provide 164.35 recommendations to the legislature by December 15, 2006, 164.36 defining criteria and rate negotiations for nursing facilities 165.1 that provide specialized care or that have extenuating 165.2 circumstances requiring a negotiated rate. The commissioner 165.3 shall also provide recommendations to the legislature on changes 165.4 to the current nursing facility property system by December 15, 165.5 2006. 165.6 ARTICLE 5 165.7 CONTINUING CARE FOR THE ELDERLY AND DISABLED 165.8 Section 1. Minnesota Statutes 2004, section 252.27, 165.9 subdivision 2a, is amended to read: 165.10 Subd. 2a. [CONTRIBUTION AMOUNT.] (a) The natural or 165.11 adoptive parents of a minor child, including a child determined 165.12 eligible for medical assistance without consideration of 165.13 parental income, must contribute to the cost of services used by 165.14 making monthly payments on a sliding scale based on income, 165.15 unless the child is married or has been married, parental rights 165.16 have been terminated, or the child's adoption is subsidized 165.17 according to section 259.67 or through title IV-E of the Social 165.18 Security Act. 165.19 (b) For households with adjusted gross income equal to or 165.20 greater than 100 percent of federal poverty guidelines, the 165.21 parental contribution shall be computed by applying the 165.22 following schedule of rates to the adjusted gross income of the 165.23 natural or adoptive parents: 165.24 (1) if the adjusted gross income is equal to or greater 165.25 than 100 percent of federal poverty guidelines and less than 175 165.26 percent of federal poverty guidelines, the parental contribution 165.27 is $4 per month; 165.28 (2) if the adjusted gross income is equal to or greater 165.29 than 175 percent of federal poverty guidelines and less than or 165.30 equal to375545 percent of federal poverty guidelines, the 165.31 parental contribution shall be determined using a sliding fee 165.32 scale established by the commissioner of human services which 165.33 begins at one percent of adjusted gross income at 175 percent of 165.34 federal poverty guidelines and increases to 7.5 percent of 165.35 adjusted gross income for those with adjusted gross income up to 165.36375545 percent of federal poverty guidelines; 166.1 (3) if the adjusted gross income is greater than375545 166.2 percent of federal poverty guidelines and less than 675 percent 166.3 of federal poverty guidelines, the parental contribution shall 166.4 be 7.5 percent of adjusted gross income; 166.5 (4) if the adjusted gross income is equal to or greater 166.6 than 675 percent of federal poverty guidelines and less than 975 166.7 percent of federal poverty guidelines, the parental contribution 166.8 shall be determined using a sliding fee scale established by the 166.9 commissioner of human services which begins at 7.5 percent of 166.10 adjusted gross income at 675 percent of federal poverty 166.11 guidelines and increases to ten percent of adjusted gross income 166.12 for those with adjusted gross income up to 975 percent of 166.13 federal poverty guidelines; and 166.14 (5) if the adjusted gross income is equal to or greater 166.15 than 975 percent of federal poverty guidelines, the parental 166.16 contribution shall be 12.5 percent of adjusted gross income. 166.17 If the child lives with the parent, the annual adjusted 166.18 gross income is reduced by $2,400 prior to calculating the 166.19 parental contribution. If the child resides in an institution 166.20 specified in section 256B.35, the parent is responsible for the 166.21 personal needs allowance specified under that section in 166.22 addition to the parental contribution determined under this 166.23 section. The parental contribution is reduced by any amount 166.24 required to be paid directly to the child pursuant to a court 166.25 order, but only if actually paid. 166.26 (c) The household size to be used in determining the amount 166.27 of contribution under paragraph (b) includes natural and 166.28 adoptive parents and their dependents, including the child 166.29 receiving services. Adjustments in the contribution amount due 166.30 to annual changes in the federal poverty guidelines shall be 166.31 implemented on the first day of July following publication of 166.32 the changes. 166.33 (d) For purposes of paragraph (b), "income" means the 166.34 adjusted gross income of the natural or adoptive parents 166.35 determined according to the previous year's federal tax form, 166.36 except, effective retroactive to July 1, 2003, taxable capital 167.1 gains to the extent the funds have been used to purchase a home 167.2 shall not be counted as income. 167.3 (e) The contribution shall be explained in writing to the 167.4 parents at the time eligibility for services is being 167.5 determined. The contribution shall be made on a monthly basis 167.6 effective with the first month in which the child receives 167.7 services. Annually upon redetermination or at termination of 167.8 eligibility, if the contribution exceeded the cost of services 167.9 provided, the local agency or the state shall reimburse that 167.10 excess amount to the parents, either by direct reimbursement if 167.11 the parent is no longer required to pay a contribution, or by a 167.12 reduction in or waiver of parental fees until the excess amount 167.13 is exhausted. 167.14 (f) The monthly contribution amount must be reviewed at 167.15 least every 12 months; when there is a change in household size; 167.16 and when there is a loss of or gain in income from one month to 167.17 another in excess of ten percent. The local agency shall mail a 167.18 written notice 30 days in advance of the effective date of a 167.19 change in the contribution amount. A decrease in the 167.20 contribution amount is effective in the month that the parent 167.21 verifies a reduction in income or change in household size. 167.22 (g) Parents of a minor child who do not live with each 167.23 other shall each pay the contribution required under paragraph 167.24 (a). An amount equal to the annual court-ordered child support 167.25 payment actually paid on behalf of the child receiving services 167.26 shall be deducted from the adjusted gross income of the parent 167.27 making the payment prior to calculating the parental 167.28 contribution under paragraph (b). 167.29 (h) The contribution under paragraph (b) shall be increased 167.30 by an additional five percent if the local agency determines 167.31 that insurance coverage is available but not obtained for the 167.32 child. For purposes of this section, "available" means the 167.33 insurance is a benefit of employment for a family member at an 167.34 annual cost of no more than five percent of the family's annual 167.35 income. For purposes of this section, "insurance" means health 167.36 and accident insurance coverage, enrollment in a nonprofit 168.1 health service plan, health maintenance organization, 168.2 self-insured plan, or preferred provider organization. 168.3 Parents who have more than one child receiving services 168.4 shall not be required to pay more than the amount for the child 168.5 with the highest expenditures. There shall be no resource 168.6 contribution from the parents. The parent shall not be required 168.7 to pay a contribution in excess of the cost of the services 168.8 provided to the child, not counting payments made to school 168.9 districts for education-related services. Notice of an increase 168.10 in fee payment must be given at least 30 days before the 168.11 increased fee is due. 168.12 (i) The contribution under paragraph (b) shall be reduced 168.13 by $300 per fiscal year if, in the 12 months prior to July 1: 168.14 (1) the parent applied for insurance for the child; 168.15 (2) the insurer denied insurance; 168.16 (3) the parents submitted a complaint or appeal, in writing 168.17 to the insurer, submitted a complaint or appeal, in writing, to 168.18 the commissioner of health or the commissioner of commerce, or 168.19 litigated the complaint or appeal; and 168.20 (4) as a result of the dispute, the insurer reversed its 168.21 decision and granted insurance. 168.22 For purposes of this section, "insurance" has the meaning 168.23 given in paragraph (h). 168.24 A parent who has requested a reduction in the contribution 168.25 amount under this paragraph shall submit proof in the form and 168.26 manner prescribed by the commissioner or county agency, 168.27 including, but not limited to, the insurer's denial of 168.28 insurance, the written letter or complaint of the parents, court 168.29 documents, and the written response of the insurer approving 168.30 insurance. The determinations of the commissioner or county 168.31 agency under this paragraph are not rules subject to chapter 14. 168.32 Sec. 2. [256B.0185] [REQUIRED REPORT.] 168.33 Subdivision 1. [PENDING APPLICATION.] By December 15 of 168.34 both 2005 and 2006, the commissioner must deliver to the 168.35 legislature a report that identifies: 168.36 (1) each county in which an application for medical 169.1 assistance from a person identified as residing in a long-term 169.2 care facility is or was pending, at any time between January 1 169.3 and December 1 of the calendar year to which the report relates, 169.4 for more than 60 days in the case of a person who is disabled, 169.5 or for more than 45 days in the case of a person who is age 65 169.6 or older; and 169.7 (2) for each of the identified counties: the number of 169.8 applications described in clause (1), the average number of days 169.9 the applications were pending, the distribution of days for 169.10 applications that were pending, and what percentage of the 169.11 applications, respectively, the county approved and denied. 169.12 Subd. 2. [TIME TO PROCESS APPLICATION.] The report must 169.13 include specific recommendations for how counties, as a group, 169.14 could shorten the time it takes to act on the applications 169.15 described in subdivision 1, clause (1). 169.16 Sec. 3. Minnesota Statutes 2004, section 256B.057, 169.17 subdivision 9, is amended to read: 169.18 Subd. 9. [EMPLOYED PERSONS WITH DISABILITIES.] (a) Medical 169.19 assistance may be paid for a person who is employed and who: 169.20 (1) meets the definition of disabled under the supplemental 169.21 security income program; 169.22 (2) is at least 16 but less than 65 years of age; 169.23 (3) meets the asset limits in paragraph (b); and 169.24 (4) effective November 1, 2003, pays a premium and other 169.25 obligations under paragraph (d). 169.26 Any spousal income or assets shall be disregarded for purposes 169.27 of eligibility and premium determinations. 169.28 After the month of enrollment, a person enrolled in medical 169.29 assistance under this subdivision who: 169.30 (1) is temporarily unable to work and without receipt of 169.31 earned income due to a medical condition, as verified by a 169.32 physician, may retain eligibility for up to four calendar 169.33 months; or 169.34 (2) effective January 1, 2004, loses employment for reasons 169.35 not attributable to the enrollee, may retain eligibility for up 169.36 to four consecutive months after the month of job loss. To 170.1 receive a four-month extension, enrollees must verify the 170.2 medical condition or provide notification of job loss. All 170.3 other eligibility requirements must be met and the enrollee must 170.4 pay all calculated premium costs for continued eligibility. 170.5 (b) For purposes of determining eligibility under this 170.6 subdivision, a person's assets must not exceed $20,000, 170.7 excluding: 170.8 (1) all assets excluded under section 256B.056; 170.9 (2) retirement accounts, including individual accounts, 170.10 401(k) plans, 403(b) plans, Keogh plans, and pension plans; and 170.11 (3) medical expense accounts set up through the person's 170.12 employer. 170.13 (c)(1) Effective January 1, 2004, for purposes of 170.14 eligibility, there will be a $65 earned income disregard. To be 170.15 eligible, a person applying for medical assistance under this 170.16 subdivision must have earned income above the disregard level. 170.17 (2) Effective January 1, 2004, to be considered earned 170.18 income, Medicare, Social Security, and applicable state and 170.19 federal income taxes must be withheld. To be eligible, a person 170.20 must document earned income tax withholding. 170.21 (d)(1) A person whose earned and unearned income is equal 170.22 to or greater than 100 percent of federal poverty guidelines for 170.23 the applicable family size must pay a premium to be eligible for 170.24 medical assistance under this subdivision. The premium shall be 170.25 based on the person's gross earned and unearned income and the 170.26 applicable family size using a sliding fee scale established by 170.27 the commissioner, which begins at one percent of income at 100 170.28 percent of the federal poverty guidelines and increases to 7.5 170.29 percent of income for those with incomes at or above 300 percent 170.30 of the federal poverty guidelines. Annual adjustments in the 170.31 premium schedule based upon changes in the federal poverty 170.32 guidelines shall be effective for premiums due in July of each 170.33 year. 170.34 (2) Effective January 1, 2004, all enrollees must pay a 170.35 premium to be eligible for medical assistance under this 170.36 subdivision. An enrollee shall pay the greater of a $35 premium 171.1 or the premium calculated in clause (1). 171.2 (3) Effective November 1, 2003, all enrollees who receive 171.3 unearned income must pay one-half of one percent of unearned 171.4 income in addition to the premium amount. 171.5 (4) EffectiveNovember 1, 2003July 1, 2005, for 171.6 enrolleeswhose income does not exceed 200 percent of the171.7federal poverty guidelines andwho are also enrolled in 171.8 Medicare, the commissioner must reimburse the enrollee for 171.9 Medicare Part B premiums under section 256B.0625, subdivision 171.10 15, paragraph (a). 171.11 (5) Increases in benefits under title II of the Social 171.12 Security Act shall not be counted as income for purposes of this 171.13 subdivision until July 1 of each year. 171.14 (e) A person's eligibility and premium shall be determined 171.15 by the local county agency. Premiums must be paid to the 171.16 commissioner. All premiums are dedicated to the commissioner. 171.17 (f) Any required premium shall be determined at application 171.18 and redetermined at the enrollee's six-month income review or 171.19 when a change in income or household size is reported. 171.20 Enrollees must report any change in income or household size 171.21 within ten days of when the change occurs. A decreased premium 171.22 resulting from a reported change in income or household size 171.23 shall be effective the first day of the next available billing 171.24 month after the change is reported. Except for changes 171.25 occurring from annual cost-of-living increases, a change 171.26 resulting in an increased premium shall not affect the premium 171.27 amount until the next six-month review. 171.28 (g) Premium payment is due upon notification from the 171.29 commissioner of the premium amount required. Premiums may be 171.30 paid in installments at the discretion of the commissioner. 171.31 (h) Nonpayment of the premium shall result in denial or 171.32 termination of medical assistance unless the person demonstrates 171.33 good cause for nonpayment. Good cause exists if the 171.34 requirements specified in Minnesota Rules, part 9506.0040, 171.35 subpart 7, items B to D, are met. Except when an installment 171.36 agreement is accepted by the commissioner, all persons 172.1 disenrolled for nonpayment of a premium must pay any past due 172.2 premiums as well as current premiums due prior to being 172.3 reenrolled. Nonpayment shall include payment with a returned, 172.4 refused, or dishonored instrument. The commissioner may require 172.5 a guaranteed form of payment as the only means to replace a 172.6 returned, refused, or dishonored instrument. 172.7 Sec. 4. [256B.0571] [LONG-TERM CARE PARTNERSHIP.] 172.8 Subdivision 1. [DEFINITIONS.] For purposes of this 172.9 section, the following terms have the meanings given them. 172.10 Subd. 2. [HOME CARE SERVICE.] "Home care service" means 172.11 care described in section 144A.43. 172.12 Subd. 3. [LONG-TERM CARE INSURANCE.] "Long-term care 172.13 insurance" means a policy described in section 62S.01. 172.14 Subd. 4. [MEDICAL ASSISTANCE.] "Medical assistance" means 172.15 the program of medical assistance established under section 172.16 256B.01. 172.17 Subd. 5. [NURSING HOME.] "Nursing home" means a nursing 172.18 home as described in section 144A.01. 172.19 Subd. 6. [PARTNERSHIP POLICY.] "Partnership policy" means 172.20 a long-term care insurance policy that meets the requirements 172.21 under subdivision 10. 172.22 Subd. 7. [PARTNERSHIP PROGRAM.] "Partnership program" 172.23 means the Minnesota partnership for long-term care program 172.24 established under this section. 172.25 Subd. 8. [PROGRAM ESTABLISHED.] (a) The commissioner, in 172.26 cooperation with the commissioner of commerce, shall establish 172.27 the Minnesota partnership for long-term care program to provide 172.28 for the financing of long-term care through a combination of 172.29 private insurance and medical assistance. 172.30 (b) An individual who meets the requirements in this 172.31 paragraph is eligible to participate in the partnership 172.32 program. The individual must: 172.33 (1) be a Minnesota resident; 172.34 (2) purchase a partnership policy that is delivered, issued 172.35 for delivery, or renewed on or after the effective date of this 172.36 section, and maintain the partnership policy in effect 173.1 throughout the period of participation in the partnership 173.2 program; and 173.3 (3) exhaust the minimum benefits under the partnership 173.4 policy as described in this section. Benefits received under a 173.5 long-term care insurance policy before the effective date of 173.6 this section do not count toward the exhaustion of benefits 173.7 required in this subdivision. 173.8 Subd. 9. [MEDICAL ASSISTANCE ELIGIBILITY.] (a) Upon 173.9 application of an individual who meets the requirements 173.10 described in subdivision 8, the commissioner shall determine the 173.11 individual's eligibility for medical assistance according to 173.12 paragraphs (b) and (c). 173.13 (b) After disregarding financial assets exempted under 173.14 medical assistance eligibility requirements, the commissioner 173.15 shall disregard an additional amount of financial assets equal 173.16 to the dollar amount of coverage utilized under the partnership 173.17 policy. 173.18 (c) The commissioner shall consider the individual's income 173.19 according to medical assistance eligibility requirements. 173.20 Subd. 10. [APPROVED POLICIES.] (a) A partnership policy 173.21 must meet all of the requirements in paragraphs (b) to (h). 173.22 (b) Minimum coverage shall be for a period of not less than 173.23 three years and for a dollar amount equal to 36 months of 173.24 nursing home care at the minimum daily benefit rate determined 173.25 and adjusted under paragraph (c). The policy shall provide for 173.26 home health care benefits to be substituted for nursing home 173.27 care benefits on the basis of two home health care days for one 173.28 nursing home care day. 173.29 (c) Minimum daily benefits shall be $150 for nursing home 173.30 care or $75 for home care, with inflation protection provided in 173.31 the policy as described in section 62S.23, subdivision 1, clause 173.32 (1). These minimum daily benefit amounts shall also be adjusted 173.33 by the commissioner on October 1 of each year by a percentage 173.34 equal to the inflation protection feature described in section 173.35 62S.23, subdivision 1, clause (1), for purposes of setting 173.36 minimum requirements that a policy must meet in future years in 174.1 order to initially qualify as an approved policy under this 174.2 subdivision. Adjusted minimum daily benefit amounts shall be 174.3 rounded to the nearest whole dollar. 174.4 (d) A third party designated by the insured shall be 174.5 entitled to receive notice if the policy is about to lapse for 174.6 nonpayment of premium, and an additional 30-day grace period for 174.7 payment of premium shall be granted following notification to 174.8 that person. 174.9 (e) The policy must cover all of the following services: 174.10 (1) nursing home stay; 174.11 (2) home care service; 174.12 (3) care management; and 174.13 (4) up to 14 days of nursing care in a hospital while the 174.14 individual is waiting for long-term care placement. 174.15 (f) Payment for service under paragraph (e), clause (4), 174.16 must not exceed the daily benefit amount for nursing home care. 174.17 (g) A partnership policy must offer, as an option for an 174.18 adjusted premium, an elimination period of not more than 180 174.19 days. 174.20 (h) An issuer of a partnership policy must comply with any 174.21 federal law authorizing partnership policies in Minnesota, 174.22 including any federal regulations, as amended, adopted under 174.23 that law. This paragraph does not require compliance with any 174.24 provision of this federal law until the date upon which the law 174.25 requires compliance with the provision. The commissioner has 174.26 authority to enforce this paragraph. 174.27 Subd. 11. [LIMITATIONS ON ESTATE RECOVERY.] For an 174.28 individual determined eligible for medical assistance under 174.29 subdivision 9, the state shall not seek recovery under the 174.30 provisions of section 256B.15 against the estate of the 174.31 individual or individual's spouse for medical assistance 174.32 benefits received by that individual. 174.33 Subd. 12. [EFFECTIVE DATE.] (a) If any provision of this 174.34 section is prohibited by federal law, no provision shall become 174.35 effective until federal law is changed to permit its full 174.36 implementation. The commissioner of human services shall notify 175.1 the revisor of statutes when federal law is enacted or other 175.2 federal approval is received and publish a notice in the State 175.3 Register. The commissioner must include the notice in the first 175.4 State Register published after the effective date of the federal 175.5 changes. 175.6 (b) If federal law is changed to permit a waiver of any 175.7 provisions prohibited by federal law, the commissioner of human 175.8 services shall apply to the federal government for a waiver of 175.9 those prohibitions or other federal authority, and that 175.10 provision shall become effective upon receipt of a federal 175.11 waiver or other federal approval, notification to the revisor of 175.12 statutes, and publication of a notice in the State Register to 175.13 that effect. 175.14 Sec. 5. Minnesota Statutes 2004, section 256B.0621, 175.15 subdivision 2, is amended to read: 175.16 Subd. 2. [TARGETED CASE MANAGEMENT; DEFINITIONS.] For 175.17 purposes of subdivisions 3 to 10, the following terms have the 175.18 meanings given them: 175.19 (1) "home care service recipients" means those individuals 175.20 receiving the following services under section 256B.0627: 175.21 skilled nursing visits, home health aide visits, private duty 175.22 nursing, personal care assistants, or therapies provided through 175.23 a home health agency; 175.24 (2) "home care targeted case management" means the 175.25 provision of targeted case management services for the purpose 175.26 of assisting home care service recipients to gain access to 175.27 needed services and supports so that they may remain in the 175.28 community; 175.29 (3) "institutions" means hospitals, consistent with Code of 175.30 Federal Regulations, title 42, section 440.10; regional 175.31 treatment center inpatient services, consistent with section 175.32 245.474; nursing facilities; and intermediate care facilities 175.33 for persons with mental retardation; 175.34 (4) "relocation targeted case management"meansincludes 175.35 the provision of both county targeted case management and public 175.36 or private vendor service coordination services for the purpose 176.1 of assisting recipients to gain access to needed services and 176.2 supports if they choose to move from an institution to the 176.3 community. Relocation targeted case management may be provided 176.4 during the last 180 consecutive days of an eligible recipient's 176.5 institutional stay; and 176.6 (5) "targeted case management" means case management 176.7 services provided to help recipients gain access to needed 176.8 medical, social, educational, and other services and supports. 176.9 Sec. 6. Minnesota Statutes 2004, section 256B.0621, 176.10 subdivision 3, is amended to read: 176.11 Subd. 3. [ELIGIBILITY.] The following persons are eligible 176.12 for relocation targeted case management or homecare-targeted176.13 care targeted case management: 176.14 (1) medical assistance eligible persons residing in 176.15 institutions who choose to move into the community are eligible 176.16 for relocation targeted case management services; and 176.17 (2) medical assistance eligible persons receiving home care 176.18 services, who are not eligible for any other medical assistance 176.19 reimbursable case management service, are eligible for home 176.20care-targetedcare targeted case management services beginning 176.21January 1, 2003July 1, 2005. 176.22 Sec. 7. Minnesota Statutes 2004, section 256B.0621, 176.23 subdivision 4, is amended to read: 176.24 Subd. 4. [RELOCATION TARGETED COUNTY CASE MANAGEMENT 176.25 PROVIDER QUALIFICATIONS.] (a) A relocation targeted county case 176.26 management provider is an enrolled medical assistance provider 176.27 who is determined by the commissioner to have all of the 176.28 following characteristics: 176.29 (1) the legal authority to provide public welfare under 176.30 sections 393.01, subdivision 7; and 393.07; or a federally 176.31 recognized Indian tribe; 176.32 (2) the demonstrated capacity and experience to provide the 176.33 components of case management to coordinate and link community 176.34 resources needed by the eligible population; 176.35 (3) the administrative capacity and experience to serve the 176.36 target population for whom it will provide services and ensure 177.1 quality of services under state and federal requirements; 177.2 (4) the legal authority to provide complete investigative 177.3 and protective services under section 626.556, subdivision 10; 177.4 and child welfare and foster care services under section 393.07, 177.5 subdivisions 1 and 2; or a federally recognized Indian tribe; 177.6 (5) a financial management system that provides accurate 177.7 documentation of services and costs under state and federal 177.8 requirements; and 177.9 (6) the capacity to document and maintain individual case 177.10 records under state and federal requirements. 177.11 (b) A provider of targeted case management under section 177.12 256B.0625, subdivision 20, may be deemed a certified provider of 177.13 relocation targeted case management. 177.14 (c) A relocation targeted county case management provider 177.15 may subcontract with another provider to deliver relocation 177.16 targeted case management services. Subcontracted providers must 177.17 demonstrate the ability to provide the services outlined in 177.18 subdivision 6, and have a procedure in place that notifies the 177.19 recipient and the recipient's legal representative of any 177.20 conflict of interest if the contracted targeted case management 177.21 provider also provides, or will provide, the recipient's 177.22 services and supports. Counties must require that contracted 177.23 providers must provide information on all conflicts of interest 177.24 and obtain the recipient's informed consent or provide the 177.25 recipient with alternatives. 177.26 Sec. 8. Minnesota Statutes 2004, section 256B.0621, 177.27 subdivision 5, is amended to read: 177.28 Subd. 5. [HOME CARE TARGETED CASE MANAGEMENT AND 177.29 RELOCATION SERVICE COORDINATION PROVIDER QUALIFICATIONS.]The177.30following qualifications and certification standards must be met177.31byProviders of home care targeted case management and 177.32 relocation service coordination must meet the qualifications 177.33 under subdivision 4 for county vendors or the qualifications and 177.34 certification standards under paragraphs (a) and (b) for private 177.35 vendors. 177.36 (a) The commissioner must certify each provider of home 178.1 care targeted case management and relocation service 178.2 coordination before enrollment. The certification process shall 178.3 examine the provider's ability to meet the requirements in this 178.4 subdivision and other state and federal requirements of this 178.5 service. 178.6 (b)ABoth home care targeted case managementprovider is178.7anproviders and relocation service coordination providers are 178.8 enrolled medical assistanceproviderproviders whohashave a 178.9 minimum of a bachelor's degree or a license in a health or human 178.10 services field, or comparable training and two years of 178.11 experience in human services, andishave been determined by the 178.12 commissioner to have all of the following characteristics: 178.13 (1) the demonstrated capacity and experience to provide the 178.14 components of case management to coordinate and link community 178.15 resources needed by the eligible population; 178.16 (2) the administrative capacity and experience to serve the 178.17 target population for whom it will provide services and ensure 178.18 quality of services under state and federal requirements; 178.19 (3) a financial management system that provides accurate 178.20 documentation of services and costs under state and federal 178.21 requirements; 178.22 (4) the capacity to document and maintain individual case 178.23 records under state and federal requirements;and178.24 (5) the capacity to coordinate with county administrative 178.25 functions; 178.26 (6) have no financial interest in the provision of 178.27 out-of-home residential services to persons for whom home care 178.28 targeted case management or relocation service coordination is 178.29 provided; and 178.30 (7) if a provider has a financial interest in services 178.31 other than out-of-home residential services provided to persons 178.32 for whom home care targeted case management or relocation 178.33 service coordination is also provided, the county must determine 178.34 each year that: 178.35 (i) any possible conflict of interest is explained annually 178.36 at a face-to-face meeting and in writing and the person provides 179.1 written informed consent consistent with section 256B.77, 179.2 subdivision 2, paragraph (p); and 179.3 (ii) information on a range of other feasible service 179.4 provider options has been provided. 179.5 Sec. 9. Minnesota Statutes 2004, section 256B.0621, 179.6 subdivision 6, is amended to read: 179.7 Subd. 6. [ELIGIBLE SERVICES.] (a) Services eligible for 179.8 medical assistance reimbursement as targeted case management 179.9 include: 179.10 (1) assessment of the recipient's need for targeted case 179.11 management services and for persons choosing to relocate, the 179.12 county must provide service coordination provider options at the 179.13 first contact and upon request; 179.14 (2) development, completion, and regular review of a 179.15 written individual service plan, which is based upon the 179.16 assessment of the recipient's needs and choices, and which will 179.17 ensure access to medical, social, educational, and other related 179.18 services and supports; 179.19 (3) routine contact or communication with the recipient, 179.20 recipient's family, primary caregiver, legal representative, 179.21 substitute care provider, service providers, or other relevant 179.22 persons identified as necessary to the development or 179.23 implementation of the goals of the individual service plan; 179.24 (4) coordinating referrals for, and the provision of, case 179.25 management services for the recipient with appropriate service 179.26 providers, consistent with section 1902(a)(23) of the Social 179.27 Security Act; 179.28 (5) coordinating and monitoring the overall service 179.29 delivery and engaging in advocacy as needed to ensure quality of 179.30 services, appropriateness, and continued need; 179.31 (6) completing and maintaining necessary documentation that 179.32 supports and verifies the activities in this subdivision; 179.33 (7)travelingassisting individuals in order to access 179.34 needed services, including travel to conduct a visit with the 179.35 recipient or other relevant person necessary to develop or 179.36 implement the goals of the individual service plan; and 180.1 (8) coordinating with the institution discharge planner in 180.2 the 180-day period before the recipient's discharge. 180.3 (b) Relocation targeted county case management includes 180.4 services under paragraph (a), clauses (1), (2), and (4). 180.5 Relocation service coordination includes services under 180.6 paragraph (a), clauses (3) and (5) to (8). Home care targeted 180.7 case management includes services under paragraph (a), clauses 180.8 (1) to (8). 180.9 Sec. 10. Minnesota Statutes 2004, section 256B.0621, 180.10 subdivision 7, is amended to read: 180.11 Subd. 7. [TIME LINES.] The following time lines must be 180.12 met for assigning a case manager: 180.13 (a) For relocation targeted case management, an eligible 180.14 recipient must be assigned a county case manager who visits the 180.15 person within 20 working days of requesting a case manager from 180.16 their county of financial responsibility as determined under 180.17 chapter 256G. 180.18 (1) If a county agency, its contractor, or federally 180.19 recognized tribe does not provide case management services as 180.20 required, the recipient may obtaintargeted relocation case180.21management servicesrelocation service coordination froman180.22alternativea providerof targeted case management services180.23enrolled by the commissionerqualified under subdivision 5. 180.24 (2) The commissioner may waive the provider requirements in 180.25 subdivision 4, paragraph (a), clauses (1) and (4), to ensure 180.26 recipient access to the assistance necessary to move from an 180.27 institution to the community. The recipient or the recipient's 180.28 legal guardian shall provide written notice to the county or 180.29 tribe of the decision to obtain services from an alternative 180.30 provider. 180.31 (3) Providers of relocation targeted case management 180.32 enrolled under this subdivision shall: 180.33 (i) meet the provider requirements under subdivision 4 that 180.34 are not waived by the commissioner; 180.35 (ii) be qualified to provide the services specified in 180.36 subdivision 6; 181.1 (iii) coordinate efforts with local social service agencies 181.2 and tribes; and 181.3 (iv) comply with the conflict of interest provisions 181.4 established under subdivision 4, paragraph (c). 181.5 (4) Local social service agencies and federally recognized 181.6 tribes shall cooperate with providers certified by the 181.7 commissioner under this subdivision to facilitate the 181.8 recipient's successful relocation from an institution to the 181.9 community. 181.10 (b) For home care targeted case management, an eligible 181.11 recipient must be assigned a case manager within 20 working days 181.12 of requesting a case manager from a home care targeted case 181.13 management provider, as defined in subdivision 5. 181.14 Sec. 11. Minnesota Statutes 2004, section 256B.0621, is 181.15 amended by adding a subdivision to read: 181.16 Subd. 11. [DATA USE AGREEMENT AND NOTICE OF RELOCATION 181.17 TARGETED CASE MANAGEMENT AVAILABILITY.] The commissioner shall 181.18 execute a data use agreement with the Centers for Medicare and 181.19 Medicaid Services to obtain the long-term care minimum data set 181.20 data to assist residents of nursing facilities who have 181.21 indicated a desire to live in the community. The commissioner 181.22 shall in turn enter into agreements with the Centers for 181.23 Independent Living to provide information about assistance for 181.24 persons who want to move to the community. 181.25 Sec. 12. Minnesota Statutes 2004, section 256B.0625, 181.26 subdivision 2, is amended to read: 181.27 Subd. 2. [SKILLED AND INTERMEDIATE NURSING CARE.] Medical 181.28 assistance covers skilled nursing home services and services of 181.29 intermediate care facilities, including training and 181.30 habilitation services, as defined in section 252.41, subdivision 181.31 3, for persons with mental retardation or related conditions who 181.32 are residing in intermediate care facilities for persons with 181.33 mental retardation or related conditions. Medical assistance 181.34 must not be used to pay the costs of nursing care provided to a 181.35 patient in a swing bed as defined in section 144.562, unless (a) 181.36 the facility in which the swing bed is located is eligible as a 182.1 sole community provider, as defined in Code of Federal 182.2 Regulations, title 42, section 412.92, or the facility is a 182.3 public hospital owned by a governmental entity with 15 or fewer 182.4 licensed acute care beds; (b) the Centers for Medicare and 182.5 Medicaid Services approves the necessary state plan amendments; 182.6 (c) the patient was screened as provided by law; (d) the patient 182.7 no longer requires acute care services; and (e) no nursing home 182.8 beds are available within 25 miles of the facility. The 182.9 commissioner shall exempt a facility from compliance with the 182.10 sole community provider requirement in clause (a) if, as of 182.11 January 1, 2004, the facility had an agreement with the 182.12 commissioner to provide medical assistance swing bed services. 182.13 Medical assistance also covers up to ten days of nursing care 182.14 provided to a patient in a swing bed if: (1) the patient's 182.15 physician certifies that the patient has a terminal illness or 182.16 condition that is likely to result in death within 30 days and 182.17 that moving the patient would not be in the best interests of 182.18 the patient and patient's family; (2) no open nursing home beds 182.19 are available within 25 miles of the facility; and (3) no open 182.20 beds are available in any Medicare hospice program within 50 182.21 miles of the facility. The daily medical assistance payment for 182.22 nursing care for the patient in the swing bed is the statewide 182.23 average medical assistance skilled nursing care per diem as 182.24 computed annually by the commissioner on July 1 of each year. 182.25 [EFFECTIVE DATE.] This section is effective the day 182.26 following final enactment and applies to medical assistance 182.27 payments for swing bed services provided on or after March 5, 182.28 2005. 182.29 Sec. 13. Minnesota Statutes 2004, section 256B.0913, 182.30 subdivision 2, is amended to read: 182.31 Subd. 2. [ELIGIBILITY FOR SERVICES.] Alternative care 182.32 services are available to Minnesotans age 65 or older who would 182.33 be eligible for medical assistance within180120 days of 182.34 admission to a nursing facility and subject to subdivisions 4 to 182.35 13. 182.36 Sec. 14. Minnesota Statutes 2004, section 256B.0913, 183.1 subdivision 4, is amended to read: 183.2 Subd. 4. [ELIGIBILITY FOR FUNDING FOR SERVICES FOR 183.3 NONMEDICAL ASSISTANCE RECIPIENTS.] (a) Funding for services 183.4 under the alternative care program is available to persons who 183.5 meet the following criteria: 183.6 (1) the person has been determined by a community 183.7 assessment under section 256B.0911 to be a person who would 183.8 require the level of care provided in a nursing facility, but 183.9 for the provision of services under the alternative care 183.10 program; 183.11 (2) the person is age 65 or older; 183.12 (3) the person would be eligible for medical assistance 183.13 within180120 days of admission to a nursing facility; 183.14 (4) the person is not ineligible for the medical assistance 183.15 program due to an asset transfer penalty; 183.16 (5) the person needs services that are not funded through 183.17 other state or federal funding; 183.18 (6) the monthly cost of the alternative care services 183.19 funded by the program for this person does not exceed 75 percent 183.20 of the monthly limit described under section 256B.0915, 183.21 subdivision 3a. This monthly limit does not prohibit the 183.22 alternative care client from payment for additional services, 183.23 but in no case may the cost of additional services purchased 183.24 under this section exceed the difference between the client's 183.25 monthly service limit defined under section 256B.0915, 183.26 subdivision 3, and the alternative care program monthly service 183.27 limit defined in this paragraph. If medical supplies and 183.28 equipment or environmental modifications are or will be 183.29 purchased for an alternative care services recipient, the costs 183.30 may be prorated on a monthly basis for up to 12 consecutive 183.31 months beginning with the month of purchase. If the monthly 183.32 cost of a recipient's other alternative care services exceeds 183.33 the monthly limit established in this paragraph, the annual cost 183.34 of the alternative care services shall be determined. In this 183.35 event, the annual cost of alternative care services shall not 183.36 exceed 12 times the monthly limit described in this paragraph; 184.1 and 184.2 (7) the person is making timely payments of the assessed 184.3 monthly fee. 184.4 A person is ineligible if payment of the fee is over 60 days 184.5 past due, unless the person agrees to: 184.6 (i) the appointment of a representative payee; 184.7 (ii) automatic payment from a financial account; 184.8 (iii) the establishment of greater family involvement in 184.9 the financial management of payments; or 184.10 (iv) another method acceptable to the county to ensure 184.11 prompt fee payments. 184.12 The county shall extend the client's eligibility as 184.13 necessary while making arrangements to facilitate payment of 184.14 past-due amounts and future premium payments. Following 184.15 disenrollment due to nonpayment of a monthly fee, eligibility 184.16 shall not be reinstated for a period of 30 days. 184.17 (b) Alternative care funding under this subdivision is not 184.18 available for a person who is a medical assistance recipient or 184.19 who would be eligible for medical assistance without a spenddown 184.20 or waiver obligation. A person whose initial application for 184.21 medical assistance and the elderly waiver program is being 184.22 processed may be served under the alternative care program for a 184.23 period up to 60 days. If the individual is found to be eligible 184.24 for medical assistance, medical assistance must be billed for 184.25 services payable under the federally approved elderly waiver 184.26 plan and delivered from the date the individual was found 184.27 eligible for the federally approved elderly waiver plan. 184.28 Notwithstanding this provision, alternative care funds may not 184.29 be used to pay for any service the cost of which: (i) is 184.30 payable by medical assistance; (ii) is used by a recipient to 184.31 meet a waiver obligation; or (iii) is used to pay a medical 184.32 assistance income spenddown for a person who is eligible to 184.33 participate in the federally approved elderly waiver program 184.34 under the special income standard provision. 184.35 (c) Alternative care funding is not available for a person 184.36 who resides in a licensed nursing home, certified boarding care 185.1 home, hospital, or intermediate care facility, except for case 185.2 management services which are provided in support of the 185.3 discharge planning process for a nursing home resident or 185.4 certified boarding care home resident to assist with a 185.5 relocation process to a community-based setting. 185.6 (d) Alternative care funding is not available for a person 185.7 whose income is greater than the maintenance needs allowance 185.8 under section 256B.0915, subdivision 1d, but equal to or less 185.9 than 120 percent of the federal poverty guideline effective July 185.10 1 in the year for which alternative care eligibility is 185.11 determined, who would be eligible for the elderly waiver with a 185.12 waiver obligation. 185.13 Sec. 15. Minnesota Statutes 2004, section 256B.0916, is 185.14 amended by adding a subdivision to read: 185.15 Subd. 10. [TRANSITIONAL SUPPORTS ALLOWANCE.] A 185.16 transitional supports allowance shall be available to all 185.17 persons under a home and community-based waiver who are moving 185.18 from a licensed setting to a community setting. "Transitional 185.19 supports allowance" means a onetime payment of up to $3,000, to 185.20 cover the costs, not covered by other sources, associated with 185.21 moving from a licensed setting to a community setting. Covered 185.22 costs include: 185.23 (1) lease or rent deposits; 185.24 (2) security deposits; 185.25 (3) utilities set-up costs, including telephone; 185.26 (4) essential furnishings and supplies; and 185.27 (5) personal supports and transports needed to locate and 185.28 transition to community settings. 185.29 [EFFECTIVE DATE.] This section is effective upon federal 185.30 approval and to the extent approved as a federal waiver 185.31 amendment. 185.32 Sec. 16. Minnesota Statutes 2004, section 256B.095, is 185.33 amended to read: 185.34 256B.095 [QUALITY ASSURANCE SYSTEM ESTABLISHED.] 185.35 (a) Effective July 1, 1998, a quality assurance system for 185.36 persons with developmental disabilities, which includes an 186.1 alternative quality assurance licensing system for programs, is 186.2 established in Dodge, Fillmore, Freeborn, Goodhue, Houston, 186.3 Mower, Olmsted, Rice, Steele, Wabasha, and Winona Counties for 186.4 the purpose of improving the quality of services provided to 186.5 persons with developmental disabilities. A county, at its 186.6 option, may choose to have all programs for persons with 186.7 developmental disabilities located within the county licensed 186.8 under chapter 245A using standards determined under the 186.9 alternative quality assurance licensing system or may continue 186.10 regulation of these programs under the licensing system operated 186.11 by the commissioner. The project expires on June 30,20072009. 186.12 (b) Effective July 1, 2003, a county not listed in 186.13 paragraph (a) may apply to participate in the quality assurance 186.14 system established under paragraph (a). The commission 186.15 established under section 256B.0951 may, at its option, allow 186.16 additional counties to participate in the system. 186.17 (c) Effective July 1, 2003, any county or group of counties 186.18 not listed in paragraph (a) may establish a quality assurance 186.19 system under this section. A new system established under this 186.20 section shall have the same rights and duties as the system 186.21 established under paragraph (a). A new system shall be governed 186.22 by a commission under section 256B.0951. The commissioner shall 186.23 appoint the initial commission members based on recommendations 186.24 from advocates, families, service providers, and counties in the 186.25 geographic area included in the new system. Counties that 186.26 choose to participate in a new system shall have the duties 186.27 assigned under section 256B.0952. The new system shall 186.28 establish a quality assurance process under section 256B.0953. 186.29 The provisions of section 256B.0954 shall apply to a new system 186.30 established under this paragraph. The commissioner shall 186.31 delegate authority to a new system established under this 186.32 paragraph according to section 256B.0955. 186.33 Sec. 17. Minnesota Statutes 2004, section 256B.0951, 186.34 subdivision 1, is amended to read: 186.35 Subdivision 1. [MEMBERSHIP.] The Quality Assurance 186.36 Commission is established. The commission consists of at least 187.1 14 but not more than 21 members as follows: at least three but 187.2 not more than five members representing advocacy organizations; 187.3 at least three but not more than five members representing 187.4 consumers, families, and their legal representatives; at least 187.5 three but not more than five members representing service 187.6 providers; at least three but not more than five members 187.7 representing counties; and the commissioner of human services or 187.8 the commissioner's designee. The first commission shall 187.9 establish membership guidelines for the transition and 187.10 recruitment of membership for the commission's ongoing 187.11 existence. Members of the commission who do not receive a 187.12 salary or wages from an employer for time spent on commission 187.13 duties may receive a per diem payment when performing commission 187.14 duties and functions. All members may be reimbursed for 187.15 expenses related to commission activities. Notwithstanding the 187.16 provisions of section 15.059, subdivision 5, the commission 187.17 expires on June 30,20072009. 187.18 Sec. 18. Minnesota Statutes 2004, section 256B.0952, 187.19 subdivision 5, is amended to read: 187.20 Subd. 5. [QUALITY ASSURANCE TEAMS.] Quality assurance 187.21 teams shall be comprised of county staff; providers; consumers, 187.22 families, and their legal representatives; members of advocacy 187.23 organizations; and other involved community members. Team 187.24 members must satisfactorily complete the training program 187.25 approved by the commission and must demonstrate 187.26 performance-based competency. Team members are not considered 187.27 to be county employees for purposes of workers' compensation, 187.28 unemployment insurance, or state retirement laws solely on the 187.29 basis of participation on a quality assurance team. The county 187.30 may pay a per diem to team memberswho do not receive a salary187.31or wages from an employerfor time spent on alternative quality 187.32 assurance process matters. All team members may be reimbursed 187.33 for expenses related to their participation in the alternative 187.34 process. 187.35 Sec. 19. Minnesota Statutes 2004, section 256B.0953, 187.36 subdivision 1, is amended to read: 188.1 Subdivision 1. [PROCESS COMPONENTS.] (a) The quality 188.2 assurance licensing process consists of an evaluation by a 188.3 quality assurance team of the facility, program, or service 188.4 according to outcome-based measurements. The process must 188.5 include an evaluation of a random sample of program consumers. 188.6 The sample must be representative of each service provided. The 188.7 sample size must be at least five percent of consumers but not 188.8 less thanthreetwo consumers. 188.9 (b) All consumers must be given the opportunity to be 188.10 included in the quality assurance process in addition to those 188.11 chosen for the random sample. 188.12 Sec. 20. Minnesota Statutes 2004, section 256B.19, 188.13 subdivision 1, is amended to read: 188.14 Subdivision 1. [DIVISION OF COST.] The state and county 188.15 share of medical assistance costs not paid by federal funds 188.16 shall be as follows: 188.17 (1) beginning January 1, 1992, 50 percent state funds and 188.18 50 percent county funds for the cost of placement of severely 188.19 emotionally disturbed children in regional treatment centers; 188.20 (2) beginning January 1, 2003, 80 percent state funds and 188.21 20 percent county funds for the costs of nursing facility 188.22 placements of persons with disabilities under the age of 65 that 188.23 have exceeded 90 days. This clause shall be subject to chapter 188.24 256G and shall not apply to placements in facilities not 188.25 certified to participate in medical assistance; 188.26 (3) beginning July 1, 2004,8095 percent state funds and 188.2720five percent county funds for the costs of placements that 188.28 have exceeded 90 days in intermediate care facilities for 188.29 persons with mental retardation or a related condition that have 188.30 seven or more beds. This provision includes pass-through 188.31 payments made under section 256B.5015; and 188.32 (4) beginning July 1, 2004, when state funds are used to 188.33 pay for a nursing facility placement due to the facility's 188.34 status as an institution for mental diseases (IMD), the county 188.35 shall pay 20 percent of the nonfederal share of costs that have 188.36 exceeded 90 days. This clause is subject to chapter 256G. 189.1 For counties that participate in a Medicaid demonstration 189.2 project under sections 256B.69 and 256B.71, the division of the 189.3 nonfederal share of medical assistance expenses for payments 189.4 made to prepaid health plans or for payments made to health 189.5 maintenance organizations in the form of prepaid capitation 189.6 payments, this division of medical assistance expenses shall be 189.7 95 percent by the state and five percent by the county of 189.8 financial responsibility. 189.9 In counties where prepaid health plans are under contract 189.10 to the commissioner to provide services to medical assistance 189.11 recipients, the cost of court ordered treatment ordered without 189.12 consulting the prepaid health plan that does not include 189.13 diagnostic evaluation, recommendation, and referral for 189.14 treatment by the prepaid health plan is the responsibility of 189.15 the county of financial responsibility. 189.16 [EFFECTIVE DATE.] This section is effective the day 189.17 following final enactment. 189.18 Sec. 21. Minnesota Statutes 2004, section 256B.49, 189.19 subdivision 16, is amended to read: 189.20 Subd. 16. [SERVICES AND SUPPORTS.] (a) Services and 189.21 supports included in the home and community-based waivers for 189.22 persons with disabilities shall meet the requirements set out in 189.23 United States Code, title 42, section 1396n. The services and 189.24 supports, which are offered as alternatives to institutional 189.25 care, shall promote consumer choice, community inclusion, 189.26 self-sufficiency, and self-determination. 189.27 (b) Beginning January 1, 2003, the commissioner shall 189.28 simplify and improve access to home and community-based waivered 189.29 services, to the extent possible, through the establishment of a 189.30 common service menu that is available to eligible recipients 189.31 regardless of age, disability type, or waiver program. 189.32 (c) Consumer directed community support services shall be 189.33 offered as an option to all persons eligible for services under 189.34 subdivision 11, by January 1, 2002. 189.35 (d) Services and supports shall be arranged and provided 189.36 consistent with individualized written plans of care for 190.1 eligible waiver recipients. 190.2 (e) A transitional supports allowance shall be available to 190.3 all persons under a home and community-based waiver who are 190.4 moving from a licensed setting to a community setting. 190.5 "Transitional supports allowance" means a onetime payment of up 190.6 to $3,000, to cover the costs, not covered by other sources, 190.7 associated with moving from a licensed setting to a community 190.8 setting. Covered costs include: 190.9 (1) lease or rent deposits; 190.10 (2) security deposits; 190.11 (3) utilities set-up costs, including telephone; 190.12 (4) essential furnishings and supplies; and 190.13 (5) personal supports and transports needed to locate and 190.14 transition to community settings. 190.15 (f) The state of Minnesota and county agencies that 190.16 administer home and community-based waivered services for 190.17 persons with disabilities, shall not be liable for damages, 190.18 injuries, or liabilities sustained through the purchase of 190.19 supports by the individual, the individual's family, legal 190.20 representative, or the authorized representative with funds 190.21 received through the consumer-directed community support service 190.22 under this section. Liabilities include but are not limited 190.23 to: workers' compensation liability, the Federal Insurance 190.24 Contributions Act (FICA), or the Federal Unemployment Tax Act 190.25 (FUTA). 190.26 [EFFECTIVE DATE.] This section is effective upon federal 190.27 approval and to the extent approved as a federal waiver 190.28 amendment. 190.29 Sec. 22. Minnesota Statutes 2004, section 256B.5012, is 190.30 amended by adding a subdivision to read: 190.31 Subd. 6. [ICF/MR RATE INCREASES BEGINNING OCTOBER 1, 2005, 190.32 AND OCTOBER 1, 2006.] For the rate years beginning October 1, 190.33 2005, and October 1, 2006, the commissioner shall provide 190.34 facilities reimbursed under this section an adjustment to the 190.35 total operating payment rate of two percent. At least 190.36 two-thirds of each year's adjustment must be used for increased 191.1 costs of employee salaries and benefits and associated costs for 191.2 FICA, the Medicare tax, workers' compensation premiums, and 191.3 federal and state unemployment insurance. Each facility 191.4 receiving an adjustment shall report to the commissioner, in the 191.5 form and manner specified by the commissioner, on how the 191.6 additional funding was used. 191.7 Sec. 23. Minnesota Statutes 2004, section 256B.69, 191.8 subdivision 23, is amended to read: 191.9 Subd. 23. [ALTERNATIVE INTEGRATED LONG-TERM CARE SERVICES; 191.10 ELDERLY AND DISABLED PERSONS.] (a) The commissioner may 191.11 implement demonstration projects to create alternative 191.12 integrated delivery systems for acute and long-term care 191.13 services to elderly persons and persons with disabilities as 191.14 defined in section 256B.77, subdivision 7a, that provide 191.15 increased coordination, improve access to quality services, and 191.16 mitigate future cost increases. The commissioner may seek 191.17 federal authority to combine Medicare and Medicaid capitation 191.18 payments for the purpose of such demonstrations. Medicare funds 191.19 and services shall be administered according to the terms and 191.20 conditions of the federal waiver and demonstration provisions. 191.21 For the purpose of administering medical assistance funds, 191.22 demonstrations under this subdivision are subject to 191.23 subdivisions 1 to 22. The provisions of Minnesota Rules, parts 191.24 9500.1450 to 9500.1464, apply to these demonstrations, with the 191.25 exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457, 191.26 subpart 1, items B and C, which do not apply to persons 191.27 enrolling in demonstrations under this section. An initial open 191.28 enrollment period may be provided. Persons who disenroll from 191.29 demonstrations under this subdivision remain subject to 191.30 Minnesota Rules, parts 9500.1450 to 9500.1464. When a person is 191.31 enrolled in a health plan under these demonstrations and the 191.32 health plan's participation is subsequently terminated for any 191.33 reason, the person shall be provided an opportunity to select a 191.34 new health plan and shall have the right to change health plans 191.35 within the first 60 days of enrollment in the second health 191.36 plan. Persons required to participate in health plans under 192.1 this section who fail to make a choice of health plan shall not 192.2 be randomly assigned to health plans under these demonstrations. 192.3 Notwithstanding section 256L.12, subdivision 5, and Minnesota 192.4 Rules, part 9505.5220, subpart 1, item A, if adopted, for the 192.5 purpose of demonstrations under this subdivision, the 192.6 commissioner may contract with managed care organizations, 192.7 including counties, to serve only elderly persons eligible for 192.8 medical assistance, elderly and disabled persons, or disabled 192.9 persons only. For persons with primary diagnoses of mental 192.10 retardation or a related condition, serious and persistent 192.11 mental illness, or serious emotional disturbance, the 192.12 commissioner must ensure that the county authority has approved 192.13 the demonstration and contracting design. Enrollment in these 192.14 projects for persons with disabilities shall be voluntary. The 192.15 commissioner shall not implement any demonstration project under 192.16 this subdivision for persons with primary diagnoses of mental 192.17 retardation or a related condition, serious and persistent 192.18 mental illness, or serious emotional disturbance, without 192.19 approval of the county board of the county in which the 192.20 demonstration is being implemented. 192.21 (b) Notwithstanding chapter 245B, sections 252.40 to 192.22 252.46, 256B.092, 256B.501 to 256B.5015, and Minnesota Rules, 192.23 parts 9525.0004 to 9525.0036, 9525.1200 to 9525.1330, 9525.1580, 192.24 and 9525.1800 to 9525.1930, the commissioner may implement under 192.25 this section projects for persons with developmental 192.26 disabilities. The commissioner may capitate payments for ICF/MR 192.27 services, waivered services for mental retardation or related 192.28 conditions, including case management services, day training and 192.29 habilitation and alternative active treatment services, and 192.30 other services as approved by the state and by the federal 192.31 government. Case management and active treatment must be 192.32 individualized and developed in accordance with a 192.33 person-centered plan. Costs under these projects may not exceed 192.34 costs that would have been incurred under fee-for-service. 192.35 Beginning July 1, 2003, and until two years after the pilot 192.36 project implementation date, subcontractor participation in the 193.1 long-term care developmental disability pilot is limited to a 193.2 nonprofit long-term care system providing ICF/MR services, home 193.3 and community-based waiver services, and in-home services to no 193.4 more than 120 consumers with developmental disabilities in 193.5 Carver, Hennepin, and Scott Counties. The commissioner shall 193.6 report to the legislature prior to expansion of the 193.7 developmental disability pilot project. This paragraph expires 193.8 two years after the implementation date of the pilot project. 193.9 (c) Before implementation of a demonstration project for 193.10 disabled persons, the commissioner must provide information to 193.11 appropriate committees of the house of representatives and 193.12 senate and must involve representatives of affected disability 193.13 groups in the design of the demonstration projects. 193.14 (d) A nursing facility reimbursed under the alternative 193.15 reimbursement methodology in section 256B.434 may, in 193.16 collaboration with a hospital, clinic, or other health care 193.17 entity provide services under paragraph (a). The commissioner 193.18 shall amend the state plan and seek any federal waivers 193.19 necessary to implement this paragraph. 193.20 (e) The commissioner, in consultation with the 193.21 commissioners of commerce and health, may approve and implement 193.22 programs for all-inclusive care for the elderly (PACE) according 193.23 to federal laws and regulations governing that program and state 193.24 laws or rules applicable to participating providers. The 193.25 process for approval of these programs shall begin only after 193.26 the commissioner receives grant money in an amount sufficient to 193.27 cover the state share of the administrative and actuarial costs 193.28 to implement the programs during state fiscal years 2006 through 193.29 2009. Grants for this purpose shall be deposited in an account 193.30 in the special revenue fund and are appropriated to the 193.31 commissioner to be used solely for the purpose of PACE 193.32 administrative and actuarial costs. A PACE provider is not 193.33 required to be licensed or certified as a health plan company as 193.34 defined in section 62Q.01, subdivision 4. Persons age 55 and 193.35 older who have been screened by the county and found to be 193.36 eligible for services under the elderly waiver or community 194.1 alternatives for disabled individuals or who are already 194.2 eligible for Medicaid but meet level of care criteria for 194.3 receipt of waiver services may choose to enroll in the PACE 194.4 program. Medicare and Medicaid services will be provided 194.5 according to this subdivision and federal Medicare and Medicaid 194.6 requirements governing PACE providers and programs. PACE 194.7 enrollees will receive Medicaid home and community-based 194.8 services through the PACE provider as an alternative to services 194.9 for which they would otherwise be eligible through home and 194.10 community-based waiver programs and Medicaid State Plan 194.11 Services. The commissioner shall establish Medicaid rates for 194.12 PACE providers that do not exceed costs that would have been 194.13 incurred under fee-for-service or other relevant managed care 194.14 programs operated by the state. 194.15 (f) The commissioner shall seek federal approval to expand 194.16 the Minnesota disability health options (MnDHO) program 194.17 established under this subdivision in stages, first to regional 194.18 population centers outside the seven-county metro area and then 194.19 to all areas of the state. 194.20 (g) Notwithstanding section 256B.0261, health plans 194.21 providing services under this section are responsible for home 194.22 care targeted case management and relocation targeted case 194.23 management. Services must be provided according to the terms of 194.24 the waivers and contracts approved by the federal government. 194.25 Sec. 24. [256B.762] [REIMBURSEMENT FOR HEALTH CARE 194.26 SERVICES.] 194.27 Effective for services provided on or after October 1, 194.28 2005, payment rates for the following services shall be 194.29 increased by five percent over the rates in effect on September 194.30 30, 2005, when these services are provided as home health 194.31 services under section 256B.0625, subdivision 6a: 194.32 (1) skilled nursing visit; 194.33 (2) physical therapy visit; 194.34 (3) occupational therapy visit; 194.35 (4) speech therapy visit; and 194.36 (5) home health aide visit. 195.1 Sec. 25. Minnesota Statutes 2004, section 256B.765, is 195.2 amended to read: 195.3 256B.765 [PROVIDER RATE INCREASES.] 195.4 Subdivision 1. [ANNUAL INFLATION ADJUSTMENTS.] (a) 195.5 Effective July 1, 2001, within the limits of appropriations 195.6 specifically for this purpose, the commissioner shall provide an 195.7 annual inflation adjustment for the providers listed 195.8 inparagraph (c)subdivision 2. The index for the inflation 195.9 adjustment must be based on the change in the Employment Cost 195.10 Index for Private Industry Workers - Total Compensation 195.11 forecasted by Data Resources, Inc., as forecasted in the fourth 195.12 quarter of the calendar year preceding the fiscal year. The 195.13 commissioner shall increase reimbursement or allocation rates by 195.14 the percentage of this adjustment, and county boards shall 195.15 adjust provider contracts as needed. 195.16 (b) The commissioner of finance shall include an annual 195.17 inflationary adjustment in reimbursement rates for the providers 195.18 listed inparagraph (c)subdivision 2 using the inflation factor 195.19 specified in paragraph (a) as a budget change request in each 195.20 biennial detailed expenditure budget submitted to the 195.21 legislature under section 16A.11. 195.22(c)Subd. 2. [ELIGIBLE PROVIDERS.] The annual adjustment 195.23 under subdivision 1, paragraph (a), shall be provided for home 195.24 and community-based waiver services for persons with mental 195.25 retardation or related conditions under section 256B.501; home 195.26 and community-based waiver services for the elderly under 195.27 section 256B.0915; waivered services under community 195.28 alternatives for disabled individuals under section 256B.49; 195.29 community alternative care waivered services under section 195.30 256B.49; traumatic brain injury waivered services under section 195.31 256B.49; nursing services and home health services under section 195.32 256B.0625, subdivision 6a; personal care services and nursing 195.33 supervision of personal care services under section 256B.0625, 195.34 subdivision 19a; private duty nursing services under section 195.35 256B.0625, subdivision 7; day training and habilitation services 195.36 for adults with mental retardation or related conditions under 196.1 sections 252.40 to 252.46; physical therapy services under 196.2 sections 256B.0625, subdivision 8, and 256D.03, subdivision 4; 196.3 occupational therapy services under sections 256B.0625, 196.4 subdivision 8a, and 256D.03, subdivision 4; speech-language 196.5 therapy services under section 256D.03, subdivision 4, and 196.6 Minnesota Rules, part 9505.0390; respiratory therapy services 196.7 under section 256D.03, subdivision 4, and Minnesota Rules, part 196.8 9505.0295; alternative care services under section 256B.0913; 196.9 adult residential program grants under Minnesota Rules, parts 196.10 9535.2000 to 9535.3000; adult and family community support 196.11 grants under Minnesota Rules, parts 9535.1700 to 9535.1760; 196.12 semi-independent living services under section 252.275 including 196.13 SILS funding under county social services grants formerly funded 196.14 under chapter 256I; and community support services for deaf and 196.15 hard-of-hearing adults with mental illness who use or wish to 196.16 use sign language as their primary means of communication. 196.17 Subd. 3. [RATE INCREASE FOR RATE PERIODS BEGINNING OCTOBER 196.18 1, 2005.] For the rate periods beginning October 1, 2005, and 196.19 October 1, 2006, the commissioner shall increase reimbursement 196.20 rates for the providers listed in subdivision 2 by two percent. 196.21 At least two-thirds of each year's adjustment must be used for 196.22 increased costs of employee salaries and benefits and associated 196.23 costs for FICA, the Medicare tax, workers' compensation 196.24 premiums, and federal and state unemployment insurance. Each 196.25 provider receiving an adjustment shall report to the 196.26 commissioner, in the form and manner specified by the 196.27 commissioner, on how the additional funding was used. 196.28 Sec. 26. [ICF/MR PLAN.] 196.29 The commissioner of human services shall consult with 196.30 ICF/MR providers, advocates, counties, and consumer families to 196.31 develop recommendations and legislation concerning the future 196.32 services provided to people now served in ICFs/MR. The 196.33 recommendations shall be reported to the house and senate 196.34 committees with jurisdiction over health and human services 196.35 policy and finance issues by January 15, 2006. In preparing the 196.36 recommendations, the commissioner shall consider: 197.1 (1) consumer choice of services; 197.2 (2) consumers' service needs, including, but not limited 197.3 to, active treatment; 197.4 (3) the total cost of providing services in ICFs/MR and 197.5 alternative delivery systems for individuals currently residing 197.6 in ICFs/MR; 197.7 (4) whether it is the policy of the state to maintain an 197.8 ICF/MR system and, if so, the recommendations shall: 197.9 (i) define the purpose, types of services, and intended 197.10 recipients of ICF/MR services; 197.11 (ii) define the capacity needed to maintain ICF/MR services 197.12 for designated populations; and 197.13 (iii) assure that mechanisms are provided to adequately 197.14 fund the transition to the defined services, maintain the 197.15 designated capacity, and are adjustable to meet increased 197.16 service demands; and 197.17 (5) if alternative services are recommended to support the 197.18 people now receiving services in an ICF/MR, the recommendations 197.19 shall provide for transition planning and ensure adequate state 197.20 and federal financial resources are available to meet the needs 197.21 of ICF/MR recipients. 197.22 [EFFECTIVE DATE.] This section is effective the day 197.23 following final enactment. 197.24 Sec. 27. [DIRECTION TO THE COMMISSIONER; LICENSING AND 197.25 ALTERNATIVE QUALITY ASSURANCE STUDY.] 197.26 The commissioner of human services shall arrange for a 197.27 study, including recommendations for statewide development and 197.28 implementation of regional or local quality assurance models for 197.29 disability services. The study shall include a review of 197.30 current projects or models; make findings regarding the best 197.31 components, role, and function of such models within a statewide 197.32 quality assurance system; and shall estimate the cost and 197.33 sources of funding for regional and local quality assurance 197.34 models on a statewide basis. The study shall be done in 197.35 consultation with counties, consumers of service, providers, and 197.36 representatives of the Quality Assurance Commission under 198.1 Minnesota Statutes, section 256B.0951, subdivision 1. 198.2 The study shall be submitted to the chairs of the 198.3 legislative committees with jurisdiction over health and human 198.4 services with recommendations on implementation of a statewide 198.5 system of quality assurance and licensing by July 1, 2006. The 198.6 commissioner shall submit proposed legislation for 198.7 implementation of a statewide system of quality assurance to the 198.8 chairs of the legislative committees with jurisdiction over 198.9 health and human services by December 15, 2006. 198.10 Sec. 28. [CONSUMER-DIRECTED COMMUNITY SUPPORTS EXCEPTION.] 198.11 (a) Effective upon federal approval, for persons using the 198.12 home and community-based waiver for persons with developmental 198.13 disabilities consumer-directed community supports option whose 198.14 budgets were reduced by the October 2004 state set budget 198.15 methodology, the commissioner must allow exceptions to exceed 198.16 the state set budget formula amount up to the daily average cost 198.17 during calendar year 2004 or for persons who graduated from 198.18 school during 2004, the average daily cost during July through 198.19 December 2004, less one-half case management and home 198.20 modifications over $5,000, when the person's county of financial 198.21 responsibility determines that: (1) necessary alternative 198.22 services will cost the same or more than the person's current 198.23 budget, and (2) administrative expenses or provider rates will 198.24 result in fewer hours of needed staffing for the person than 198.25 under the consumer-directed community supports option. Any 198.26 exceptions the county grants must be within the county's 198.27 allowable aggregate amount for the home and community-based 198.28 waiver for persons with developmental disabilities. 198.29 (b) This section expires on the date the Department of 198.30 Human Services implements a new consumer-directed community 198.31 supports budget methodology that is based on reliable and 198.32 accurate information about the services and supports intensity 198.33 needs of persons using the option which adequately accounts for 198.34 the increased costs of adults who graduate from school and need 198.35 services funded by the waiver during the day. 198.36 Sec. 29. [COSTS ASSOCIATED WITH PHYSICAL ACTIVITIES.] 199.1 Effective upon federal approval, the expenses allowed for 199.2 adults under the consumer-directed community supports option 199.3 shall include the costs at the lowest rate available considering 199.4 daily, monthly, semi-annual, annual, or membership rates, 199.5 including transportation, associated with physical exercise or 199.6 other physical activities to maintain or improve the person's 199.7 health and functioning. 199.8 Sec. 30. [WAIVER AMENDMENT.] 199.9 The commissioner of human services shall submit an 199.10 amendment to the Centers for Medicare and Medicaid Services 199.11 consistent with sections 28 and 29 by August 1, 2005. 199.12 [EFFECTIVE DATE.] This section is effective the day 199.13 following final enactment. 199.14 Sec. 31. [INDEPENDENT EVALUATION AND REVIEW OF UNALLOWABLE 199.15 ITEMS.] 199.16 The commissioner of human services shall include in the 199.17 independent evaluation of the consumer-directed community 199.18 supports option provided through the home and community-based 199.19 services waivers for persons with disabilities under 65 years of 199.20 age: (1) provisions for ongoing, regular stakeholder 199.21 representatives participation through June 30, 2007; (2) 199.22 recommendations to the legislative committees with jurisdiction 199.23 over human services policy and finance issues by January 15, 199.24 2006, on whether changes to the unallowable items should be made 199.25 to meet the health, safety, or welfare needs of participants in 199.26 the consumer-directed community supports option within the 199.27 allowed budget amounts; and (3) a review of the statewide 199.28 caseload changes for the disability waiver programs for persons 199.29 under 65 years of age, which occurred after the state set budget 199.30 methodology implementation on October 1, 2004, and 199.31 recommendations on the fiscal impact of the budget methodology 199.32 on use of the consumer-directed community supports option. 199.33 [EFFECTIVE DATE.] This section is effective the day 199.34 following final enactment. 199.35 Sec. 32. [FEDERAL APPROVAL.] 199.36 By August 1, 2005, the commissioner of human services shall 200.1 request any federal approval and plan amendments necessary to 200.2 implement (1) the transitional supports allowance under 200.3 Minnesota Statutes, sections 256B.0916, subdivision 10, and 200.4 256B.49, subdivision 16; and (2) the choice of case management 200.5 service coordination provisions under Minnesota Statutes, 200.6 section 256B.0621, subdivisions 4, 5, 6, and 7. 200.7 Sec. 33. [DENTAL ACCESS FOR PERSONS WITH DISABILITIES.] 200.8 The commissioner of human services shall study access to 200.9 dental services for persons with disabilities and shall present 200.10 recommendations for improving access to dental services to the 200.11 legislature by January 15, 2006. The study must examine 200.12 physical and geographic access, the willingness of dentists to 200.13 serve persons with disabilities enrolled in state health care 200.14 programs, reimbursement rates for dental service providers, and 200.15 other factors identified by the commissioner as potential 200.16 barriers to accessing dental services. The commissioner shall 200.17 direct the Dental Access Advisory Committee, established under 200.18 Minnesota Statutes, section 256B.55, to assist in this study. 200.19 Sec. 34. [DISABILITY SERVICES INTERAGENCY WORK GROUP.] 200.20 Subdivision 1. [MEMBERSHIP.] The Department of Human 200.21 Services, the Minnesota Housing Finance Agency, and the 200.22 Minnesota State Council on Disability shall convene an 200.23 interagency work group which includes interested stakeholders 200.24 including other state agencies, counties, public housing 200.25 authorities, the Metropolitan Council, disability service 200.26 providers, and representatives from disability advocacy 200.27 organizations to identify barriers, strengthen coordination, 200.28 recommend policy and funding changes, and pursue federal 200.29 financing that will assist Minnesotans with disabilities who are 200.30 attempting to relocate from or avoid placement in institutional 200.31 settings. 200.32 Subd. 2. [WORK GROUP ACTIVITIES.] The work group shall 200.33 make recommendations to the state agencies and the legislature 200.34 related to: 200.35 (1) coordinating the availability of housing, 200.36 transportation, and support services needed to discharge persons 201.1 with disabilities from institutions; 201.2 (2) improving information and assistance needed to make an 201.3 informed choice about relocating from an institutional placement 201.4 to community-based services; 201.5 (3) identifying gaps in human services, transportation, or 201.6 housing access which are barriers to moving to community 201.7 services; 201.8 (4) identifying strategies which would result in earlier 201.9 identification of persons most at risk of institutional 201.10 placement in order to promote diversion to community service or 201.11 reduce length of stay in an institutional facility; 201.12 (5) identifying funding mechanisms and financial strategies 201.13 to assure a financially sustainable community support system 201.14 that diverts and relocates individuals from institutional 201.15 placement; and 201.16 (6) identifying state changes needed to address any federal 201.17 changes affecting policies, benefits, or funding used to support 201.18 persons with disabilities to avoid institutional placement. 201.19 Subd. 3. [RECOMMENDATIONS.] Recommendations of the work 201.20 group will be submitted to each participating state agency and 201.21 to the chairs of the health and human services policy and 201.22 finance committees of the senate and house of representatives by 201.23 October 15, 2006. This section expires October 15, 2006. 201.24 Sec. 35. [REPORT TO LEGISLATURE.] 201.25 The commissioner shall report to the legislature on the 201.26 redesign of case management services. In preparing the report, 201.27 the commissioner shall consult with representatives for 201.28 consumers, consumer advocates, counties, and service providers. 201.29 The report shall include draft legislation for case management 201.30 changes that will: 201.31 (1) streamline administration; 201.32 (2) improve consumer access to case management services; 201.33 (3) address the use of a comprehensive universal assessment 201.34 protocol for persons seeking community supports; 201.35 (4) establish case management performance measures; 201.36 (5) provide for consumer choice of the case management 202.1 service vendor; and 202.2 (6) provide a method of payment for case management 202.3 services that is cost-effective and best supports the draft 202.4 legislation in clauses (1) to (5). 202.5 ARTICLE 6 202.6 MISCELLANEOUS 202.7 Section 1. Minnesota Statutes 2004, section 256.01, 202.8 subdivision 2, is amended to read: 202.9 Subd. 2. [SPECIFIC POWERS.] Subject to the provisions of 202.10 section 241.021, subdivision 2, the commissioner of human 202.11 services shall carry out the specific duties in paragraphs (a) 202.12 through(aa)(bb): 202.13 (a) Administer and supervise all forms of public assistance 202.14 provided for by state law and other welfare activities or 202.15 services as are vested in the commissioner. Administration and 202.16 supervision of human services activities or services includes, 202.17 but is not limited to, assuring timely and accurate distribution 202.18 of benefits, completeness of service, and quality program 202.19 management. In addition to administering and supervising human 202.20 services activities vested by law in the department, the 202.21 commissioner shall have the authority to: 202.22 (1) require county agency participation in training and 202.23 technical assistance programs to promote compliance with 202.24 statutes, rules, federal laws, regulations, and policies 202.25 governing human services; 202.26 (2) monitor, on an ongoing basis, the performance of county 202.27 agencies in the operation and administration of human services, 202.28 enforce compliance with statutes, rules, federal laws, 202.29 regulations, and policies governing welfare services and promote 202.30 excellence of administration and program operation; 202.31 (3) develop a quality control program or other monitoring 202.32 program to review county performance and accuracy of benefit 202.33 determinations; 202.34 (4) require county agencies to make an adjustment to the 202.35 public assistance benefits issued to any individual consistent 202.36 with federal law and regulation and state law and rule and to 203.1 issue or recover benefits as appropriate; 203.2 (5) delay or deny payment of all or part of the state and 203.3 federal share of benefits and administrative reimbursement 203.4 according to the procedures set forth in section 256.017; 203.5 (6) make contracts with and grants to public and private 203.6 agencies and organizations, both profit and nonprofit, and 203.7 individuals, using appropriated funds; and 203.8 (7) enter into contractual agreements with federally 203.9 recognized Indian tribes with a reservation in Minnesota to the 203.10 extent necessary for the tribe to operate a federally approved 203.11 family assistance program or any other program under the 203.12 supervision of the commissioner. The commissioner shall consult 203.13 with the affected county or counties in the contractual 203.14 agreement negotiations, if the county or counties wish to be 203.15 included, in order to avoid the duplication of county and tribal 203.16 assistance program services. The commissioner may establish 203.17 necessary accounts for the purposes of receiving and disbursing 203.18 funds as necessary for the operation of the programs. 203.19 (b) Inform county agencies, on a timely basis, of changes 203.20 in statute, rule, federal law, regulation, and policy necessary 203.21 to county agency administration of the programs. 203.22 (c) Administer and supervise all child welfare activities; 203.23 promote the enforcement of laws protecting handicapped, 203.24 dependent, neglected and delinquent children, and children born 203.25 to mothers who were not married to the children's fathers at the 203.26 times of the conception nor at the births of the children; 203.27 license and supervise child-caring and child-placing agencies 203.28 and institutions; supervise the care of children in boarding and 203.29 foster homes or in private institutions; and generally perform 203.30 all functions relating to the field of child welfare now vested 203.31 in the State Board of Control. 203.32 (d) Administer and supervise all noninstitutional service 203.33 to handicapped persons, including those who are visually 203.34 impaired, hearing impaired, or physically impaired or otherwise 203.35 handicapped. The commissioner may provide and contract for the 203.36 care and treatment of qualified indigent children in facilities 204.1 other than those located and available at state hospitals when 204.2 it is not feasible to provide the service in state hospitals. 204.3 (e) Assist and actively cooperate with other departments, 204.4 agencies and institutions, local, state, and federal, by 204.5 performing services in conformity with the purposes of Laws 204.6 1939, chapter 431. 204.7 (f) Act as the agent of and cooperate with the federal 204.8 government in matters of mutual concern relative to and in 204.9 conformity with the provisions of Laws 1939, chapter 431, 204.10 including the administration of any federal funds granted to the 204.11 state to aid in the performance of any functions of the 204.12 commissioner as specified in Laws 1939, chapter 431, and 204.13 including the promulgation of rules making uniformly available 204.14 medical care benefits to all recipients of public assistance, at 204.15 such times as the federal government increases its participation 204.16 in assistance expenditures for medical care to recipients of 204.17 public assistance, the cost thereof to be borne in the same 204.18 proportion as are grants of aid to said recipients. 204.19 (g) Establish and maintain any administrative units 204.20 reasonably necessary for the performance of administrative 204.21 functions common to all divisions of the department. 204.22 (h) Act as designated guardian of both the estate and the 204.23 person of all the wards of the state of Minnesota, whether by 204.24 operation of law or by an order of court, without any further 204.25 act or proceeding whatever, except as to persons committed as 204.26 mentally retarded. For children under the guardianship of the 204.27 commissioner whose interests would be best served by adoptive 204.28 placement, the commissioner may contract with a licensed 204.29 child-placing agency or a Minnesota tribal social services 204.30 agency to provide adoption services. A contract with a licensed 204.31 child-placing agency must be designed to supplement existing 204.32 county efforts and may not replace existing county programs, 204.33 unless the replacement is agreed to by the county board and the 204.34 appropriate exclusive bargaining representative or the 204.35 commissioner has evidence that child placements of the county 204.36 continue to be substantially below that of other counties. 205.1 Funds encumbered and obligated under an agreement for a specific 205.2 child shall remain available until the terms of the agreement 205.3 are fulfilled or the agreement is terminated. 205.4 (i) Act as coordinating referral and informational center 205.5 on requests for service for newly arrived immigrants coming to 205.6 Minnesota. 205.7 (j) The specific enumeration of powers and duties as 205.8 hereinabove set forth shall in no way be construed to be a 205.9 limitation upon the general transfer of powers herein contained. 205.10 (k) Establish county, regional, or statewide schedules of 205.11 maximum fees and charges which may be paid by county agencies 205.12 for medical, dental, surgical, hospital, nursing and nursing 205.13 home care and medicine and medical supplies under all programs 205.14 of medical care provided by the state and for congregate living 205.15 care under the income maintenance programs. 205.16 (l) Have the authority to conduct and administer 205.17 experimental projects to test methods and procedures of 205.18 administering assistance and services to recipients or potential 205.19 recipients of public welfare. To carry out such experimental 205.20 projects, it is further provided that the commissioner of human 205.21 services is authorized to waive the enforcement of existing 205.22 specific statutory program requirements, rules, and standards in 205.23 one or more counties. The order establishing the waiver shall 205.24 provide alternative methods and procedures of administration, 205.25 shall not be in conflict with the basic purposes, coverage, or 205.26 benefits provided by law, and in no event shall the duration of 205.27 a project exceed four years. It is further provided that no 205.28 order establishing an experimental project as authorized by the 205.29 provisions of this section shall become effective until the 205.30 following conditions have been met: 205.31 (1) the secretary of health and human services of the 205.32 United States has agreed, for the same project, to waive state 205.33 plan requirements relative to statewide uniformity; and 205.34 (2) a comprehensive plan, including estimated project 205.35 costs, shall be approved by the Legislative Advisory Commission 205.36 and filed with the commissioner of administration. 206.1 (m) According to federal requirements, establish procedures 206.2 to be followed by local welfare boards in creating citizen 206.3 advisory committees, including procedures for selection of 206.4 committee members. 206.5 (n) Allocate federal fiscal disallowances or sanctions 206.6 which are based on quality control error rates for the aid to 206.7 families with dependent children program formerly codified in 206.8 sections 256.72 to 256.87, medical assistance, or food stamp 206.9 program in the following manner: 206.10 (1) one-half of the total amount of the disallowance shall 206.11 be borne by the county boards responsible for administering the 206.12 programs. For the medical assistance and the AFDC program 206.13 formerly codified in sections 256.72 to 256.87, disallowances 206.14 shall be shared by each county board in the same proportion as 206.15 that county's expenditures for the sanctioned program are to the 206.16 total of all counties' expenditures for the AFDC program 206.17 formerly codified in sections 256.72 to 256.87, and medical 206.18 assistance programs. For the food stamp program, sanctions 206.19 shall be shared by each county board, with 50 percent of the 206.20 sanction being distributed to each county in the same proportion 206.21 as that county's administrative costs for food stamps are to the 206.22 total of all food stamp administrative costs for all counties, 206.23 and 50 percent of the sanctions being distributed to each county 206.24 in the same proportion as that county's value of food stamp 206.25 benefits issued are to the total of all benefits issued for all 206.26 counties. Each county shall pay its share of the disallowance 206.27 to the state of Minnesota. When a county fails to pay the 206.28 amount due hereunder, the commissioner may deduct the amount 206.29 from reimbursement otherwise due the county, or the attorney 206.30 general, upon the request of the commissioner, may institute 206.31 civil action to recover the amount due; and 206.32 (2) notwithstanding the provisions of clause (1), if the 206.33 disallowance results from knowing noncompliance by one or more 206.34 counties with a specific program instruction, and that knowing 206.35 noncompliance is a matter of official county board record, the 206.36 commissioner may require payment or recover from the county or 207.1 counties, in the manner prescribed in clause (1), an amount 207.2 equal to the portion of the total disallowance which resulted 207.3 from the noncompliance, and may distribute the balance of the 207.4 disallowance according to clause (1). 207.5 (o) Develop and implement special projects that maximize 207.6 reimbursements and result in the recovery of money to the 207.7 state. For the purpose of recovering state money, the 207.8 commissioner may enter into contracts with third parties. Any 207.9 recoveries that result from projects or contracts entered into 207.10 under this paragraph shall be deposited in the state treasury 207.11 and credited to a special account until the balance in the 207.12 account reaches $1,000,000. When the balance in the account 207.13 exceeds $1,000,000, the excess shall be transferred and credited 207.14 to the general fund. All money in the account is appropriated 207.15 to the commissioner for the purposes of this paragraph. 207.16 (p) Have the authority to make direct payments to 207.17 facilities providing shelter to women and their children 207.18 according to section 256D.05, subdivision 3. Upon the written 207.19 request of a shelter facility that has been denied payments 207.20 under section 256D.05, subdivision 3, the commissioner shall 207.21 review all relevant evidence and make a determination within 30 207.22 days of the request for review regarding issuance of direct 207.23 payments to the shelter facility. Failure to act within 30 days 207.24 shall be considered a determination not to issue direct payments. 207.25 (q) Have the authority to establish and enforce the 207.26 following county reporting requirements: 207.27 (1) the commissioner shall establish fiscal and statistical 207.28 reporting requirements necessary to account for the expenditure 207.29 of funds allocated to counties for human services programs. 207.30 When establishing financial and statistical reporting 207.31 requirements, the commissioner shall evaluate all reports, in 207.32 consultation with the counties, to determine if the reports can 207.33 be simplified or the number of reports can be reduced; 207.34 (2) the county board shall submit monthly or quarterly 207.35 reports to the department as required by the commissioner. 207.36 Monthly reports are due no later than 15 working days after the 208.1 end of the month. Quarterly reports are due no later than 30 208.2 calendar days after the end of the quarter, unless the 208.3 commissioner determines that the deadline must be shortened to 208.4 20 calendar days to avoid jeopardizing compliance with federal 208.5 deadlines or risking a loss of federal funding. Only reports 208.6 that are complete, legible, and in the required format shall be 208.7 accepted by the commissioner; 208.8 (3) if the required reports are not received by the 208.9 deadlines established in clause (2), the commissioner may delay 208.10 payments and withhold funds from the county board until the next 208.11 reporting period. When the report is needed to account for the 208.12 use of federal funds and the late report results in a reduction 208.13 in federal funding, the commissioner shall withhold from the 208.14 county boards with late reports an amount equal to the reduction 208.15 in federal funding until full federal funding is received; 208.16 (4) a county board that submits reports that are late, 208.17 illegible, incomplete, or not in the required format for two out 208.18 of three consecutive reporting periods is considered 208.19 noncompliant. When a county board is found to be noncompliant, 208.20 the commissioner shall notify the county board of the reason the 208.21 county board is considered noncompliant and request that the 208.22 county board develop a corrective action plan stating how the 208.23 county board plans to correct the problem. The corrective 208.24 action plan must be submitted to the commissioner within 45 days 208.25 after the date the county board received notice of 208.26 noncompliance; 208.27 (5) the final deadline for fiscal reports or amendments to 208.28 fiscal reports is one year after the date the report was 208.29 originally due. If the commissioner does not receive a report 208.30 by the final deadline, the county board forfeits the funding 208.31 associated with the report for that reporting period and the 208.32 county board must repay any funds associated with the report 208.33 received for that reporting period; 208.34 (6) the commissioner may not delay payments, withhold 208.35 funds, or require repayment under clause (3) or (5) if the 208.36 county demonstrates that the commissioner failed to provide 209.1 appropriate forms, guidelines, and technical assistance to 209.2 enable the county to comply with the requirements. If the 209.3 county board disagrees with an action taken by the commissioner 209.4 under clause (3) or (5), the county board may appeal the action 209.5 according to sections 14.57 to 14.69; and 209.6 (7) counties subject to withholding of funds under clause 209.7 (3) or forfeiture or repayment of funds under clause (5) shall 209.8 not reduce or withhold benefits or services to clients to cover 209.9 costs incurred due to actions taken by the commissioner under 209.10 clause (3) or (5). 209.11 (r) Allocate federal fiscal disallowances or sanctions for 209.12 audit exceptions when federal fiscal disallowances or sanctions 209.13 are based on a statewide random sample for the foster care 209.14 program under title IV-E of the Social Security Act, United 209.15 States Code, title 42, in direct proportion to each county's 209.16 title IV-E foster care maintenance claim for that period. 209.17 (s) Be responsible for ensuring the detection, prevention, 209.18 investigation, and resolution of fraudulent activities or 209.19 behavior by applicants, recipients, and other participants in 209.20 the human services programs administered by the department. 209.21 (t) Require county agencies to identify overpayments, 209.22 establish claims, and utilize all available and cost-beneficial 209.23 methodologies to collect and recover these overpayments in the 209.24 human services programs administered by the department. 209.25 (u) Have the authority to administer a drug rebate program 209.26 for drugs purchased pursuant to the prescription drug program 209.27 established under section 256.955 after the beneficiary's 209.28 satisfaction of any deductible established in the program. The 209.29 commissioner shall require a rebate agreement from all 209.30 manufacturers of covered drugs as defined in section 256B.0625, 209.31 subdivision 13. Rebate agreements for prescription drugs 209.32 delivered on or after July 1, 2002, must include rebates for 209.33 individuals covered under the prescription drug program who are 209.34 under 65 years of age. For each drug, the amount of the rebate 209.35 shall be equal to the rebate as defined for purposes of the 209.36 federal rebate program in United States Code, title 42, section 210.1 1396r-8. The manufacturers must provide full payment within 30 210.2 days of receipt of the state invoice for the rebate within the 210.3 terms and conditions used for the federal rebate program 210.4 established pursuant to section 1927 of title XIX of the Social 210.5 Security Act. The manufacturers must provide the commissioner 210.6 with any information necessary to verify the rebate determined 210.7 per drug. The rebate program shall utilize the terms and 210.8 conditions used for the federal rebate program established 210.9 pursuant to section 1927 of title XIX of the Social Security Act. 210.10 (v) Have the authority to administer the federal drug 210.11 rebate program for drugs purchased under the medical assistance 210.12 program as allowed by section 1927 of title XIX of the Social 210.13 Security Act and according to the terms and conditions of 210.14 section 1927. Rebates shall be collected for all drugs that 210.15 have been dispensed or administered in an outpatient setting and 210.16 that are from manufacturers who have signed a rebate agreement 210.17 with the United States Department of Health and Human Services. 210.18 (w) Have the authority to administer a supplemental drug 210.19 rebate program for drugs purchased under the medical assistance 210.20 program. The commissioner may enter into supplemental rebate 210.21 contracts with pharmaceutical manufacturers and may require 210.22 prior authorization for drugs that are from manufacturers that 210.23 have not signed a supplemental rebate contract. Prior 210.24 authorization of drugs shall be subject to the provisions of 210.25 section 256B.0625, subdivision 13. 210.26 (x) Operate the department's communication systems account 210.27 established in Laws 1993, First Special Session chapter 1, 210.28 article 1, section 2, subdivision 2, to manage shared 210.29 communication costs necessary for the operation of the programs 210.30 the commissioner supervises. A communications account may also 210.31 be established for each regional treatment center which operates 210.32 communications systems. Each account must be used to manage 210.33 shared communication costs necessary for the operations of the 210.34 programs the commissioner supervises. The commissioner may 210.35 distribute the costs of operating and maintaining communication 210.36 systems to participants in a manner that reflects actual usage. 211.1 Costs may include acquisition, licensing, insurance, 211.2 maintenance, repair, staff time and other costs as determined by 211.3 the commissioner. Nonprofit organizations and state, county, 211.4 and local government agencies involved in the operation of 211.5 programs the commissioner supervises may participate in the use 211.6 of the department's communications technology and share in the 211.7 cost of operation. The commissioner may accept on behalf of the 211.8 state any gift, bequest, devise or personal property of any 211.9 kind, or money tendered to the state for any lawful purpose 211.10 pertaining to the communication activities of the department. 211.11 Any money received for this purpose must be deposited in the 211.12 department's communication systems accounts. Money collected by 211.13 the commissioner for the use of communication systems must be 211.14 deposited in the state communication systems account and is 211.15 appropriated to the commissioner for purposes of this section. 211.16 (y) Receive any federal matching money that is made 211.17 available through the medical assistance program for the 211.18 consumer satisfaction survey. Any federal money received for 211.19 the survey is appropriated to the commissioner for this 211.20 purpose. The commissioner may expend the federal money received 211.21 for the consumer satisfaction survey in either year of the 211.22 biennium. 211.23 (z) Designate community information and referral call 211.24 centers and incorporate cost reimbursement claims from the 211.25 designated community information and referral call centers into 211.26 the federal cost reimbursement claiming processes of the 211.27 department according to federal law, rule, and regulations. 211.28 Existing information and referral centers provided by Greater 211.29 Twin Cities United Way or existing call centers for which 211.30 Greater Twin Cities United Way has legal authority to represent, 211.31 shall be included in these designations upon review by the 211.32 commissioner and assurance that these services are accredited 211.33 and in compliance with national standards. Any reimbursement is 211.34 appropriated to the commissioner and all designated information 211.35 and referral centers shall receive payments according to normal 211.36 department schedules established by the commissioner upon final 212.1 approval of allocation methodologies from the United States 212.2 Department of Health and Human Services Division of Cost 212.3 Allocation or other appropriate authorities. 212.4 (aa) Develop recommended standards for foster care homes 212.5 that address the components of specialized therapeutic services 212.6 to be provided by foster care homes with those services. 212.7 (bb) Authorize the method of payment to or from the 212.8 department as part of the human services programs administered 212.9 by the department. This authorization includes the receipt or 212.10 disbursement of funds held by the department in a fiduciary 212.11 capacity as part of the human services programs administered by 212.12 the department. 212.13 Sec. 2. Minnesota Statutes 2004, section 256.01, is 212.14 amended by adding a subdivision to read: 212.15 Subd. 23. [ANNUAL REPORT.] Effective August 1, 2006, or on 212.16 the date HealthMatch is fully implemented, whichever is later, 212.17 the commissioner shall prepare an annual report of the number of 212.18 eligible applicants who applied in the prior calendar year for 212.19 Minnesota health care programs under chapters 256B, 256D, and 212.20 256L, and had not lived in Minnesota for the 12 months prior to 212.21 the application month. The report shall indicate the number of 212.22 applicants by state of prior residence or by the general 212.23 category of foreign country. 212.24 Sec. 3. [DIRECTION TO COMMISSIONER; STUDY ON DEEMED INCOME 212.25 OF SPONSORS OF NONCITIZENS.] 212.26 The commissioner of human services shall assess county 212.27 compliance with deeming the income and assets of sponsors of 212.28 noncitizens under Minnesota Statutes, sections 256B.06, 212.29 subdivision 5; 256D.03, subdivision 3, paragraph (i); 256D.05, 212.30 subdivision 3; 256J.37, subdivision 2; and 256L.04, subdivision 212.31 10a. The commissioner shall report findings on county 212.32 compliance with these provisions and make recommendations to 212.33 ensure compliance to the legislative committees with 212.34 jurisdiction over human services by January 15, 2006. 212.35 ARTICLE 7 212.36 MENTAL HEALTH SERVICES 213.1 Section 1. Minnesota Statutes 2004, section 245.4885, 213.2 subdivision 1, is amended to read: 213.3 Subdivision 1. [SCREENING REQUIREDADMISSION CRITERIA.] 213.4 The county board shall, prior to admission, except in the case 213.5 of emergency admission,screendetermine the needed level of 213.6 care for all children referred for treatment of severe emotional 213.7 disturbancetoin a treatment foster care setting, residential 213.8 treatment facility, or informally admitted to a regional 213.9 treatment center if public funds are used to pay for the 213.10 services. The county board shall alsoscreendetermine the 213.11 needed level of care for all children admitted to an acute care 213.12 hospital for treatment of severe emotional disturbance if public 213.13 funds other than reimbursement under chapters 256B and 256D are 213.14 used to pay for the services.If a child is admitted to a213.15residential treatment facility or acute care hospital for213.16emergency treatment or held for emergency care by a regional213.17treatment center under section 253B.05, subdivision 1, screening213.18must occur within three working days of admission.213.19ScreeningThe level of care determination shall determine 213.20 whether the proposed treatment: 213.21 (1) is necessary; 213.22 (2) is appropriate to the child's individual treatment 213.23 needs; 213.24 (3) cannot be effectively provided in the child's home; and 213.25 (4) provides a length of stay as short as possible 213.26 consistent with the individual child's need. 213.27 When ascreeninglevel of care determination is conducted, 213.28 the county board may not determine that referral or admission to 213.29 a treatment foster care setting, residential treatment facility, 213.30 or acute care hospital is not appropriate solely because 213.31 services were not first provided to the child in a less 213.32 restrictive setting and the child failed to make progress toward 213.33 or meet treatment goals in the less restrictive 213.34 setting.Screening shall include bothThe level of care 213.35 determination must be based on a diagnostic assessmentandthat 213.36 includes a functional assessment which evaluates family, school, 214.1 and community living situations; and an assessment of the 214.2 child's need for care out of the home using a validated tool 214.3 which assesses a child's functional status and assigns an 214.4 appropriate level of care. The validated tool must be approved 214.5 by the commissioner of human services. If a diagnostic 214.6 assessmentorincluding a functional assessment has been 214.7 completed by a mental health professional within the past 180 214.8 days, a new diagnosticor functionalassessment need not be 214.9 completed unless in the opinion of the current treating mental 214.10 health professional the child's mental health status has changed 214.11 markedly since the assessment was completed. The child's parent 214.12 shall be notified if an assessment will not be completed and of 214.13 the reasons. A copy of the notice shall be placed in the 214.14 child's file. Recommendations developed as part of 214.15 thescreeninglevel of care determination process shall include 214.16 specific community services needed by the child and, if 214.17 appropriate, the child's family, and shall indicate whether or 214.18 not these services are available and accessible to the child and 214.19 family. 214.20 During thescreeninglevel of care determination process, 214.21 the child, child's family, or child's legal representative, as 214.22 appropriate, must be informed of the child's eligibility for 214.23 case management services and family community support services 214.24 and that an individual family community support plan is being 214.25 developed by the case manager, if assigned. 214.26ScreeningThe level of care determination shallbe in214.27compliancecomply with section 260C.212. Wherever possible, the 214.28 parent shall be consulted in thescreeningprocess, unless 214.29 clinically inappropriate. 214.30 Thescreening processlevel of care determination, and 214.31 placement decision, and recommendations for mental health 214.32 services must be documented in the child's record. 214.33 An alternate review process may be approved by the 214.34 commissioner if the county board demonstrates that an alternate 214.35 review process has been established by the county board and the 214.36 times of review, persons responsible for the review, and review 215.1 criteria are comparable to the standards in clauses (1) to (4). 215.2 [EFFECTIVE DATE.] This section is effective July 1, 2006. 215.3 Sec. 2. Minnesota Statutes 2004, section 245.4885, is 215.4 amended by adding a subdivision to read: 215.5 Subd. 1a. [EMERGENCY ADMISSION.] Effective July 1, 2006, 215.6 if a child is admitted to a treatment foster care setting, 215.7 residential treatment facility, or acute care hospital for 215.8 emergency treatment or held for emergency care by a regional 215.9 treatment center under section 253B.05, subdivision 1, the level 215.10 of care determination must occur within three working days of 215.11 admission. 215.12 Sec. 3. Minnesota Statutes 2004, section 245.4885, 215.13 subdivision 2, is amended to read: 215.14 Subd. 2. [QUALIFICATIONS.]No later than July 1, 1991,215.15ScreeningLevel of care determination of children for treatment 215.16 foster care, residential, and inpatient services must be 215.17 conducted by a mental health professional. Where appropriate 215.18 and available, culturally informed mental health consultants 215.19 must participate in thescreeninglevel of care determination. 215.20 Mental health professionals providingscreeninglevel of care 215.21 determination for treatment foster care, inpatient, and 215.22 residential services must not be financially affiliated with any 215.23acute care inpatient hospital, residential treatment facility,215.24or regional treatment centernongovernment entity which may be 215.25 providing those services.The commissioner may waive this215.26requirement for mental health professional participation after215.27July 1, 1991, if the county documents that:215.28(1) mental health professionals or mental health215.29practitioners are unavailable to provide this service; and215.30(2) services are provided by a designated person with215.31training in human services who receives clinical supervision215.32from a mental health professional.215.33 [EFFECTIVE DATE.] This section is effective July 1, 2006. 215.34 Sec. 4. Minnesota Statutes 2004, section 253B.02, 215.35 subdivision 7, is amended to read: 215.36 Subd. 7. [EXAMINER.] "Examiner" means a person who is 216.1 knowledgeable, trained, and practicing in the diagnosis and 216.2 assessment or in the treatment of the alleged impairment, and 216.3 who is: 216.4 (1) a licensed physician;or216.5 (2) a licensed psychologist who has a doctoral degree in 216.6 psychology or who became a licensed consulting psychologist 216.7 before July 2, 1975; or 216.8 (3) an advanced practice registered nurse certified in 216.9 mental health, except that only a physician or psychologist 216.10 meeting these requirements may be appointed by the court to 216.11 conduct an evaluation. 216.12 Sec. 5. Minnesota Statutes 2004, section 256B.0625, is 216.13 amended by adding a subdivision to read: 216.14 Subd. 46. [MENTAL HEALTH TELEMEDICINE.] Effective January 216.15 1, 2006, and subject to federal approval, mental health services 216.16 that are otherwise covered by medical assistance as direct 216.17 face-to-face services may be provided via two-way interactive 216.18 video. Use of two-way interactive video must be medically 216.19 appropriate to the condition and needs of the person being 216.20 served. Reimbursement is at the same rates and under the same 216.21 conditions that would otherwise apply to the service. The 216.22 interactive video equipment and connection must comply with 216.23 Medicare standards in effect at the time the service is provided. 216.24 Sec. 6. Minnesota Statutes 2004, section 256B.0625, is 216.25 amended by adding a subdivision to read: 216.26 Subd. 47. [TREATMENT FOSTER CARE SERVICES.] Effective July 216.27 1, 2006, and subject to federal approval, medical assistance 216.28 covers treatment foster care services according to section 216.29 256B.0946. 216.30 Sec. 7. Minnesota Statutes 2004, section 256B.0625, is 216.31 amended by adding a subdivision to read: 216.32 Subd. 48. [PSYCHIATRIC CONSULTATION TO PRIMARY CARE 216.33 PRACTITIONERS.] Effective January 1, 2006, medical assistance 216.34 covers consultation provided by a psychiatrist via telephone, 216.35 e-mail, facsimile, or other means of communication to primary 216.36 care practitioners, including pediatricians. The need for 217.1 consultation and the receipt of the consultation must be 217.2 documented in the patient record maintained by the primary care 217.3 practitioner. If the patient consents, and subject to federal 217.4 limitations and data privacy provisions, the consultation may be 217.5 provided without the patient present. 217.6 Sec. 8. [256B.0946] [TREATMENT FOSTER CARE.] 217.7 Subdivision 1. [COVERED SERVICE.] (a) Effective July 1, 217.8 2006, and subject to federal approval, medical assistance covers 217.9 medically necessary services described under paragraph (b) that 217.10 are provided by a provider entity eligible under subdivision 3 217.11 to a client eligible under subdivision 2 who is placed in a 217.12 treatment foster home licensed under Minnesota Rules, parts 217.13 2960.3000 to 2960.3340. 217.14 (b) Services to children with severe emotional disturbance 217.15 residing in treatment foster care settings must meet the 217.16 relevant standards for mental health services under sections 217.17 245.487 to 245.4887. In addition, specific service components 217.18 reimbursed by medical assistance must meet the following 217.19 standards: 217.20 (1) case management service component must meet the 217.21 standards in Minnesota Rules, parts 9520.0900 to 9520.0926 and 217.22 9505.0322, excluding subparts 6 and 10; 217.23 (2) psychotherapy and skills training components must meet 217.24 the standards for children's therapeutic services and supports 217.25 in section 256B.0943; and 217.26 (3) family psychoeducation services under supervision of a 217.27 mental health professional. 217.28 Subd. 2. [DETERMINATION OF CLIENT ELIGIBILITY.] A client's 217.29 eligibility to receive treatment foster care under this section 217.30 shall be determined by a diagnostic assessment, an evaluation of 217.31 level of care needed, and development of an individual treatment 217.32 plan, as defined in paragraphs (a) to (c). 217.33 (a) The diagnostic assessment must: 217.34 (1) be conducted by a psychiatrist, licensed psychologist, 217.35 or licensed independent clinical social worker that is performed 217.36 within 180 days prior to the start of service; 218.1 (2) include current diagnoses on all five axes of the 218.2 client's current mental health status; 218.3 (3) determine whether or not a child meets the criteria for 218.4 severe emotional disturbance in section 245.4871, subdivision 6, 218.5 or for serious and persistent mental illness in section 245.462, 218.6 subdivision 20; and 218.7 (4) be completed annually until age 18. For individuals 218.8 between age 18 and 21, unless a client's mental health condition 218.9 has changed markedly since the client's most recent diagnostic 218.10 assessment, annual updating is necessary. For the purpose of 218.11 this section, "updating" means a written summary, including 218.12 current diagnoses on all five axes, by a mental health 218.13 professional of the client's current mental status and service 218.14 needs. 218.15 (b) The evaluation of level of care must be conducted by 218.16 the placing county with an instrument approved by the 218.17 commissioner of human services. The commissioner shall update 218.18 the list of approved level of care instruments annually. 218.19 (c) The individual treatment plan must be: 218.20 (1) based on the information in the client's diagnostic 218.21 assessment; 218.22 (2) developed through a child-centered, family driven 218.23 planning process that identifies service needs and 218.24 individualized, planned, and culturally appropriate 218.25 interventions that contain specific measurable treatment goals 218.26 and objectives for the client and treatment strategies for the 218.27 client's family and foster family; 218.28 (3) reviewed at least once every 90 days and revised; and 218.29 (4) signed by the client or, if appropriate, by the 218.30 client's parent or other person authorized by statute to consent 218.31 to mental health services for the client. 218.32 Subd. 3. [ELIGIBLE PROVIDERS.] For purposes of this 218.33 section, a provider agency must have an individual placement 218.34 agreement for each recipient and must be a licensed child 218.35 placing agency, under Minnesota Rules, parts 9543.0010 to 218.36 9543.0150, and either: 219.1 (1) a county; 219.2 (2) an Indian Health Services facility operated by a tribe 219.3 or tribal organization under funding authorized by United States 219.4 Code, title 25, sections 450f to 450n, or title 3 of the Indian 219.5 Self-Determination Act, Public Law 93-638, section 638 219.6 (facilities or providers); or 219.7 (3) a noncounty entity under contract with a county board. 219.8 Subd. 4. [ELIGIBLE PROVIDER RESPONSIBILITIES.] (a) To be 219.9 an eligible provider under this section, a provider must develop 219.10 written policies and procedures for treatment foster care 219.11 services consistent with subdivision 1, paragraph (b), clauses 219.12 (1), (2), and (3). 219.13 (b) In delivering services under this section, a treatment 219.14 foster care provider must ensure that staff caseload size 219.15 reasonably enables the provider to play an active role in 219.16 service planning, monitoring, delivering, and reviewing for 219.17 discharge planning to meet the needs of the client, the client's 219.18 foster family, and the birth family, as specified in each 219.19 client's individual treatment plan. 219.20 Subd. 5. [SERVICE AUTHORIZATION.] The commissioner will 219.21 administer authorizations for services under this section in 219.22 compliance with section 256B.0625, subdivision 25. 219.23 Subd. 6. [EXCLUDED SERVICES.] (a) Services in clauses (1) 219.24 to (4) are not eligible as components of treatment foster care 219.25 services: 219.26 (1) treatment foster care services provided in violation of 219.27 medical assistance policy in Minnesota Rules, part 9505.0220; 219.28 (2) service components of children's therapeutic services 219.29 and supports simultaneously provided by more than one treatment 219.30 foster care provider; 219.31 (3) home and community-based waiver services; and 219.32 (4) treatment foster care services provided to a child 219.33 without a level of care determination according to section 219.34 245.4885, subdivision 1. 219.35 (b) Children receiving treatment foster care services are 219.36 not eligible for medical assistance reimbursement for the 220.1 following services while receiving treatment foster care: 220.2 (1) mental health case management services under section 220.3 256B.0625, subdivision 20; and 220.4 (2) psychotherapy and skill training components of 220.5 children's therapeutic services and supports under section 220.6 256B.0625, subdivision 35b. 220.7 Sec. 9. [256B.0947] [TRANSITIONAL YOUTH INTENSIVE 220.8 REHABILITATIVE MENTAL HEALTH SERVICES.] 220.9 Subdivision 1. [SCOPE.] Subject to federal approval, 220.10 medical assistance covers medically necessary, intensive 220.11 nonresidential rehabilitative mental health services as defined 220.12 in subdivision 2, for recipients as defined in subdivision 3, 220.13 when the services are provided by an entity meeting the 220.14 standards in this section. 220.15 Subd. 2. [DEFINITIONS.] For purposes of this section, the 220.16 following terms have the meanings given them. 220.17 (a) "Intensive nonresidential rehabilitative mental health 220.18 services" means child rehabilitative mental health services as 220.19 defined in section 256B.0943, except that these services are 220.20 provided by a multidisciplinary staff using a total team 220.21 approach consistent with assertive community treatment, or other 220.22 evidence-based practices, and directed to recipients with a 220.23 serious mental illness who require intensive services. 220.24 (b) "Evidence-based practices" are nationally recognized 220.25 mental health services that are proven by substantial research 220.26 to be effective in helping individuals with serious mental 220.27 illness obtain specific treatment goals. 220.28 (c) "Treatment team" means all staff who provide services 220.29 to recipients under this section. At a minimum, this includes 220.30 the clinical supervisor, mental health professionals, mental 220.31 health practitioners, mental health behavioral aides, and a 220.32 school representative familiar with the recipient's individual 220.33 education plan (IEP) if applicable. 220.34 Subd. 3. [ELIGIBILITY FOR TRANSITIONAL YOUTH.] An eligible 220.35 recipient under the age of 18 is an individual who: 220.36 (1) is age 16 or 17; 221.1 (2) is diagnosed with a medical condition, such as an 221.2 emotional disturbance or traumatic brain injury, for which 221.3 intensive nonresidential rehabilitative mental health services 221.4 are needed; 221.5 (3) has substantial disability and functional impairment in 221.6 three or more of the areas listed in section 245.462, 221.7 subdivision 11a, so that self-sufficiency upon adulthood or 221.8 emancipation is unlikely; and 221.9 (4) has had a recent diagnostic assessment by a qualified 221.10 professional that documents that intensive nonresidential 221.11 rehabilitative mental health services are medically necessary to 221.12 address identified disability and functional impairments and 221.13 individual recipient goals. 221.14 Subd. 4. [PROVIDER CERTIFICATION AND CONTRACT 221.15 REQUIREMENTS.] (a) The intensive nonresidential rehabilitative 221.16 mental health services provider must: 221.17 (1) have a contract with the host county to provide 221.18 intensive transition youth rehabilitative mental health 221.19 services; and 221.20 (2) be certified by the commissioner as being in compliance 221.21 with this section and section 256B.0943. 221.22 (b) The commissioner shall develop procedures for counties 221.23 and providers to submit contracts and other documentation as 221.24 needed to allow the commissioner to determine whether the 221.25 standards in this section are met. 221.26 Subd. 5. [STANDARDS APPLICABLE TO NONRESIDENTIAL 221.27 PROVIDERS.] (a) Services must be provided by a certified 221.28 provider entity as defined in section 256B.0943, subdivision 4 221.29 that meets the requirements in section 245B.0943, subdivisions 5 221.30 and 6. 221.31 (b) The clinical supervisor must be an active member of the 221.32 treatment team. The treatment team must meet with the clinical 221.33 supervisor at least weekly to discuss recipients' progress and 221.34 make rapid adjustments to meet recipients' needs. The team 221.35 meeting shall include recipient-specific case reviews and 221.36 general treatment discussions among team members. 222.1 Recipient-specific case reviews and planning must be documented 222.2 in the individual recipient's treatment record. 222.3 (c) Treatment staff must have prompt access in person or by 222.4 telephone to a mental health practitioner or mental health 222.5 professional. The provider must have the capacity to promptly 222.6 and appropriately respond to emergent needs and make any 222.7 necessary staffing adjustments to assure the health and safety 222.8 of recipients. 222.9 (d) The initial functional assessment must be completed 222.10 within ten days of intake and updated at least every three 222.11 months or prior to discharge from the service, whichever comes 222.12 first. 222.13 (e) The initial individual treatment plan must be completed 222.14 within ten days of intake and reviewed and updated at least 222.15 monthly with the recipient. 222.16 Subd. 6. [ADDITIONAL STANDARDS FOR NONRESIDENTIAL 222.17 SERVICES.] The standards in this subdivision apply to intensive 222.18 nonresidential rehabilitative mental health services. 222.19 (1) The treatment team must use team treatment, not an 222.20 individual treatment model. 222.21 (2) The clinical supervisor must function as a practicing 222.22 clinician at least on a part-time basis. 222.23 (3) The staffing ratio must not exceed ten recipients to 222.24 one full-time equivalent treatment team position. 222.25 (4) Services must be available at times that meet client 222.26 needs. 222.27 (5) The treatment team must actively and assertively engage 222.28 and reach out to the recipient's family members and significant 222.29 others, after obtaining the recipient's permission. 222.30 (6) The treatment team must establish ongoing communication 222.31 and collaboration between the team, family, and significant 222.32 others and educate the family and significant others about 222.33 mental illness, symptom management, and the family's role in 222.34 treatment. 222.35 (7) The treatment team must provide interventions to 222.36 promote positive interpersonal relationships. 223.1 Subd. 7. [MEDICAL ASSISTANCE PAYMENT FOR INTENSIVE 223.2 REHABILITATIVE MENTAL HEALTH SERVICES.] (a) Payment for 223.3 nonresidential services in this section shall be based on one 223.4 daily rate per provider inclusive of the following services 223.5 received by an eligible recipient in a given calendar day: all 223.6 rehabilitative services under this section, staff travel time to 223.7 provide rehabilitative services under this section, and 223.8 nonresidential crisis stabilization services under section 223.9 256B.0944. 223.10 (b) Except as indicated in paragraph (c), payment will not 223.11 be made to more than one entity for each recipient for services 223.12 provided under this section on a given day. If services under 223.13 this section are provided by a team that includes staff from 223.14 more than one entity, the team must determine how to distribute 223.15 the payment among the members. 223.16 (c) The host county shall recommend to the commissioner one 223.17 rate for each entity that will bill medical assistance for 223.18 nonresidential intensive rehabilitative mental health services. 223.19 In developing these rates, the host county shall consider and 223.20 document: 223.21 (1) the cost for similar services in the local trade area; 223.22 (2) actual costs incurred by entities providing the 223.23 services; 223.24 (3) the intensity and frequency of services to be provided 223.25 to each recipient; 223.26 (4) the degree to which recipients will receive services 223.27 other than services under this section; and 223.28 (5) the costs of other services that will be separately 223.29 reimbursed. 223.30 (d) The rate for intensive rehabilitative mental health 223.31 services must exclude medical assistance room and board rate, as 223.32 defined in section 256I.03, subdivision 6, and services not 223.33 covered under this section, such as partial hospitalization and 223.34 inpatient services. Physician services are not a component of 223.35 the treatment team and may be billed separately. The county's 223.36 recommendation shall specify the period for which the rate will 224.1 be applicable, not to exceed two years. 224.2 (e) When services under this section are provided by an 224.3 assertive community team, case management functions must be an 224.4 integral part of the team. 224.5 (f) The rate for a provider must not exceed the rate 224.6 charged by that provider for the same service to other payors. 224.7 (g) The commissioner shall approve or reject the county's 224.8 rate recommendation, based on the commissioner's own analysis of 224.9 the criteria in paragraph (c). 224.10 Subd. 8. [PROVIDER ENROLLMENT; RATE SETTING FOR 224.11 COUNTY-OPERATED ENTITIES.] Effective July 1, 2006, counties that 224.12 employ their own staff to provide services under this section 224.13 shall apply directly to the commissioner for enrollment and rate 224.14 setting. In this case, a county contract is not required and 224.15 the commissioner shall perform the program review and rate 224.16 setting duties which would otherwise be required of counties 224.17 under this section. 224.18 Sec. 10. Minnesota Statutes 2004, section 256D.03, 224.19 subdivision 4, is amended to read: 224.20 Subd. 4. [GENERAL ASSISTANCE MEDICAL CARE; SERVICES.] 224.21 (a)(i) For a person who is eligible under subdivision 3, 224.22 paragraph (a), clause (2), item (i), general assistance medical 224.23 care covers, except as provided in paragraph (c): 224.24 (1) inpatient hospital services; 224.25 (2) outpatient hospital services; 224.26 (3) services provided by Medicare certified rehabilitation 224.27 agencies; 224.28 (4) prescription drugs and other products recommended 224.29 through the process established in section 256B.0625, 224.30 subdivision 13; 224.31 (5) equipment necessary to administer insulin and 224.32 diagnostic supplies and equipment for diabetics to monitor blood 224.33 sugar level; 224.34 (6) eyeglasses and eye examinations provided by a physician 224.35 or optometrist; 224.36 (7) hearing aids; 225.1 (8) prosthetic devices; 225.2 (9) laboratory and X-ray services; 225.3 (10) physician's services; 225.4 (11) medical transportation except special transportation; 225.5 (12) chiropractic services as covered under the medical 225.6 assistance program; 225.7 (13) podiatric services; 225.8 (14) dental services and dentures, subject to the 225.9 limitations specified in section 256B.0625, subdivision 9; 225.10 (15) outpatient services provided by a mental health center 225.11 or clinic that is under contract with the county board and is 225.12 established under section 245.62; 225.13 (16) day treatment services for mental illness provided 225.14 under contract with the county board; 225.15 (17) prescribed medications for persons who have been 225.16 diagnosed as mentally ill as necessary to prevent more 225.17 restrictive institutionalization; 225.18 (18) psychological services, medical supplies and 225.19 equipment, and Medicare premiums, coinsurance and deductible 225.20 payments; 225.21 (19) medical equipment not specifically listed in this 225.22 paragraph when the use of the equipment will prevent the need 225.23 for costlier services that are reimbursable under this 225.24 subdivision; 225.25 (20) services performed by a certified pediatric nurse 225.26 practitioner, a certified family nurse practitioner, a certified 225.27 adult nurse practitioner, a certified obstetric/gynecological 225.28 nurse practitioner, a certified neonatal nurse practitioner, or 225.29 a certified geriatric nurse practitioner in independent 225.30 practice, if (1) the service is otherwise covered under this 225.31 chapter as a physician service, (2) the service provided on an 225.32 inpatient basis is not included as part of the cost for 225.33 inpatient services included in the operating payment rate, and 225.34 (3) the service is within the scope of practice of the nurse 225.35 practitioner's license as a registered nurse, as defined in 225.36 section 148.171; 226.1 (21) services of a certified public health nurse or a 226.2 registered nurse practicing in a public health nursing clinic 226.3 that is a department of, or that operates under the direct 226.4 authority of, a unit of government, if the service is within the 226.5 scope of practice of the public health nurse's license as a 226.6 registered nurse, as defined in section 148.171;and226.7 (22) telemedicine consultations, to the extent they are 226.8 covered under section 256B.0625, subdivision 3b; and 226.9 (23) mental health telemedicine and psychiatric 226.10 consultation as covered under section 256B.0625, subdivisions 46 226.11 and 48. 226.12 (ii) Effective October 1, 2003, for a person who is 226.13 eligible under subdivision 3, paragraph (a), clause (2), item 226.14 (ii), general assistance medical care coverage is limited to 226.15 inpatient hospital services, including physician services 226.16 provided during the inpatient hospital stay. A $1,000 226.17 deductible is required for each inpatient hospitalization. 226.18 (b) Gender reassignment surgery and related services are 226.19 not covered services under this subdivision unless the 226.20 individual began receiving gender reassignment services prior to 226.21 July 1, 1995. 226.22 (c) In order to contain costs, the commissioner of human 226.23 services shall select vendors of medical care who can provide 226.24 the most economical care consistent with high medical standards 226.25 and shall where possible contract with organizations on a 226.26 prepaid capitation basis to provide these services. The 226.27 commissioner shall consider proposals by counties and vendors 226.28 for prepaid health plans, competitive bidding programs, block 226.29 grants, or other vendor payment mechanisms designed to provide 226.30 services in an economical manner or to control utilization, with 226.31 safeguards to ensure that necessary services are provided. 226.32 Before implementing prepaid programs in counties with a county 226.33 operated or affiliated public teaching hospital or a hospital or 226.34 clinic operated by the University of Minnesota, the commissioner 226.35 shall consider the risks the prepaid program creates for the 226.36 hospital and allow the county or hospital the opportunity to 227.1 participate in the program in a manner that reflects the risk of 227.2 adverse selection and the nature of the patients served by the 227.3 hospital, provided the terms of participation in the program are 227.4 competitive with the terms of other participants considering the 227.5 nature of the population served. Payment for services provided 227.6 pursuant to this subdivision shall be as provided to medical 227.7 assistance vendors of these services under sections 256B.02, 227.8 subdivision 8, and 256B.0625. For payments made during fiscal 227.9 year 1990 and later years, the commissioner shall consult with 227.10 an independent actuary in establishing prepayment rates, but 227.11 shall retain final control over the rate methodology. 227.12 (d) Recipients eligible under subdivision 3, paragraph (a), 227.13 clause (2), item (i), shall pay the following co-payments for 227.14 services provided on or after October 1, 2003: 227.15 (1) $3 per nonpreventive visit. For purposes of this 227.16 subdivision, a visit means an episode of service which is 227.17 required because of a recipient's symptoms, diagnosis, or 227.18 established illness, and which is delivered in an ambulatory 227.19 setting by a physician or physician ancillary, chiropractor, 227.20 podiatrist, nurse midwife, advanced practice nurse, audiologist, 227.21 optician, or optometrist; 227.22 (2) $25 for eyeglasses; 227.23 (3) $25 for nonemergency visits to a hospital-based 227.24 emergency room; 227.25 (4) $3 per brand-name drug prescription and $1 per generic 227.26 drug prescription, subject to a $20 per month maximum for 227.27 prescription drug co-payments. No co-payments shall apply to 227.28 antipsychotic drugs when used for the treatment of mental 227.29 illness; and 227.30 (5) 50 percent coinsurance on restorative dental services. 227.31 (e) Co-payments shall be limited to one per day per 227.32 provider for nonpreventive visits, eyeglasses, and nonemergency 227.33 visits to a hospital-based emergency room. Recipients of 227.34 general assistance medical care are responsible for all 227.35 co-payments in this subdivision. The general assistance medical 227.36 care reimbursement to the provider shall be reduced by the 228.1 amount of the co-payment, except that reimbursement for 228.2 prescription drugs shall not be reduced once a recipient has 228.3 reached the $20 per month maximum for prescription drug 228.4 co-payments. The provider collects the co-payment from the 228.5 recipient. Providers may not deny services to recipients who 228.6 are unable to pay the co-payment, except as provided in 228.7 paragraph (f). 228.8 (f) If it is the routine business practice of a provider to 228.9 refuse service to an individual with uncollected debt, the 228.10 provider may include uncollected co-payments under this 228.11 section. A provider must give advance notice to a recipient 228.12 with uncollected debt before services can be denied. 228.13 (g) Any county may, from its own resources, provide medical 228.14 payments for which state payments are not made. 228.15 (h) Chemical dependency services that are reimbursed under 228.16 chapter 254B must not be reimbursed under general assistance 228.17 medical care. 228.18 (i) The maximum payment for new vendors enrolled in the 228.19 general assistance medical care program after the base year 228.20 shall be determined from the average usual and customary charge 228.21 of the same vendor type enrolled in the base year. 228.22 (j) The conditions of payment for services under this 228.23 subdivision are the same as the conditions specified in rules 228.24 adopted under chapter 256B governing the medical assistance 228.25 program, unless otherwise provided by statute or rule. 228.26 (k) Inpatient and outpatient payments shall be reduced by 228.27 five percent, effective July 1, 2003. This reduction is in 228.28 addition to the five percent reduction effective July 1, 2003, 228.29 and incorporated by reference in paragraph (i). 228.30 (l) Payments for all other health services except 228.31 inpatient, outpatient, and pharmacy services shall be reduced by 228.32 five percent, effective July 1, 2003. 228.33 (m) Payments to managed care plans shall be reduced by five 228.34 percent for services provided on or after October 1, 2003. 228.35 (n) A hospital receiving a reduced payment as a result of 228.36 this section may apply the unpaid balance toward satisfaction of 229.1 the hospital's bad debts. 229.2 [EFFECTIVE DATE.] This section is effective January 1, 2006. 229.3 Sec. 11. Minnesota Statutes 2004, section 256L.03, 229.4 subdivision 1, is amended to read: 229.5 Subdivision 1. [COVERED HEALTH SERVICES.] For individuals 229.6 under section 256L.04, subdivision 7, with income no greater 229.7 than 75 percent of the federal poverty guidelines or for 229.8 families with children under section 256L.04, subdivision 1, all 229.9 subdivisions of this section apply. "Covered health services" 229.10 means the health services reimbursed under chapter 256B, with 229.11 the exception of inpatient hospital services, special education 229.12 services, private duty nursing services, adult dental care 229.13 services other than services covered under section 256B.0625, 229.14 subdivision 9, paragraph (b), orthodontic services, nonemergency 229.15 medical transportation services, personal care assistant and 229.16 case management services, nursing home or intermediate care 229.17 facilities services, inpatient mental health services, and 229.18 chemical dependency services. Outpatient mental health services 229.19 covered under the MinnesotaCare program are limited to 229.20 diagnostic assessments, psychological testing, explanation of 229.21 findings, mental health telemedicine, psychiatric consultation, 229.22 medication management by a physician, day treatment, partial 229.23 hospitalization, and individual, family, and group psychotherapy. 229.24 No public funds shall be used for coverage of abortion 229.25 under MinnesotaCare except where the life of the female would be 229.26 endangered or substantial and irreversible impairment of a major 229.27 bodily function would result if the fetus were carried to term; 229.28 or where the pregnancy is the result of rape or incest. 229.29 Covered health services shall be expanded as provided in 229.30 this section. 229.31 [EFFECTIVE DATE.] This section is effective January 1, 2006. 229.32 ARTICLE 8 229.33 HEALTH POLICY 229.34 Section 1. Minnesota Statutes 2004, section 13.3806, is 229.35 amended by adding a subdivision to read: 229.36 Subd. 21. [ABORTION NOTIFICATION DATA.] Classification of 230.1 data in abortion notification reports is governed by section 230.2 144.3431. 230.3 Sec. 2. [62J.495] [HEALTH INFORMATION TECHNOLOGY AND 230.4 INFRASTRUCTURE ADVISORY COMMITTEE.] 230.5 Subdivision 1. [LEGISLATIVE FINDINGS AND PURPOSE.] There 230.6 is a need for coordination and collaboration among health care 230.7 payers, providers, consumers, and government in designing and 230.8 implementing a statewide interoperable health information 230.9 infrastructure that includes standards for administrative data 230.10 exchange, clinical support programs, quality performance 230.11 measures, and maintenance of the security and confidentiality of 230.12 individual patient data. 230.13 Subd. 2. [ESTABLISHMENT; MEMBERS; DUTIES.] (a) The 230.14 commissioner shall establish a Health Information Technology and 230.15 Infrastructure Advisory Committee governed by section 15.059 to 230.16 advise the commissioner on the following matters: 230.17 (1) assessment of the use of health information technology 230.18 by the state, licensed health care providers and facilities, and 230.19 local public health agencies; 230.20 (2) recommendations for implementing a statewide 230.21 interoperable health information infrastructure, to include 230.22 estimates of necessary resources, and for determining standards 230.23 for administrative data exchange, clinical support programs, and 230.24 maintenance of the security and confidentiality of individual 230.25 patient data; and 230.26 (3) other related issues as requested by the commissioner. 230.27 (b) The members of the Health Information Technology and 230.28 Infrastructure Advisory Committee shall include the 230.29 commissioners, or commissioners' designees, of health, human 230.30 services, and commerce and additional members to be appointed by 230.31 the commissioner to include persons representing Minnesota's 230.32 local public health agencies, licensed hospitals and other 230.33 licensed facilities and providers, private purchasers, the 230.34 medical and nursing professions, health insurers and health 230.35 plans, the state quality improvement organization, academic and 230.36 research institutions, consumer advisory organizations with an 231.1 interest and expertise in health information technology, and 231.2 other stakeholders as identified by the Health Information 231.3 Technology and Infrastructure Advisory Committee. 231.4 Subd. 3. [ANNUAL REPORT.] The commissioner shall prepare 231.5 and issue an annual report not later than January 30 of each 231.6 year outlining progress to date in implementing a statewide 231.7 health information infrastructure and recommending future 231.8 projects. 231.9 Subd. 4. [EXPIRATION.] Notwithstanding section 15.059, 231.10 this section expires June 30, 2009. 231.11 Sec. 3. Minnesota Statutes 2004, section 103I.101, 231.12 subdivision 6, is amended to read: 231.13 Subd. 6. [FEES FOR VARIANCES.] The commissioner shall 231.14 charge a nonrefundable application fee of$150$175 to cover the 231.15 administrative cost of processing a request for a variance or 231.16 modification of rules adopted by the commissioner under this 231.17 chapter. 231.18 [EFFECTIVE DATE.] This section is effective July 1, 2006. 231.19 Sec. 4. Minnesota Statutes 2004, section 103I.208, 231.20 subdivision 1, is amended to read: 231.21 Subdivision 1. [WELL NOTIFICATION FEE.] The well 231.22 notification fee to be paid by a property owner is: 231.23 (1) for a new well,$150$175, which includes the state 231.24 core function fee; 231.25 (2) for a well sealing,$30$35 for each well, which 231.26 includes the state core function fee, except that for monitoring 231.27 wells constructed on a single property, having depths within a 231.28 25 foot range, and sealed within 48 hours of start of 231.29 construction, a single fee of$30$35; and 231.30 (3) for construction of a dewatering well,$150$175, which 231.31 includes the state core function fee, for each well except a 231.32 dewatering project comprising five or more wells shall be 231.33 assessed a single fee of$750$875 for the wells recorded on the 231.34 notification. 231.35 [EFFECTIVE DATE.] This section is effective July 1, 2006. 231.36 Sec. 5. Minnesota Statutes 2004, section 103I.208, 232.1 subdivision 2, is amended to read: 232.2 Subd. 2. [PERMIT FEE.] The permit fee to be paid by a 232.3 property owner is: 232.4 (1) for a well that is not in use under a maintenance 232.5 permit,$125$150 annually; 232.6 (2) for construction of a monitoring well,$150$175, which 232.7 includes the state core function fee; 232.8 (3) for a monitoring well that is unsealed under a 232.9 maintenance permit,$125$150 annually; 232.10 (4) for monitoring wells used as a leak detection device at 232.11 a single motor fuel retail outlet, a single petroleum bulk 232.12 storage site excluding tank farms, or a single agricultural 232.13 chemical facility site, the construction permit fee 232.14 is$150$175, which includes the state core function fee, per 232.15 site regardless of the number of wells constructed on the site, 232.16 and the annual fee for a maintenance permit for unsealed 232.17 monitoring wells is$125$150 per site regardless of the number 232.18 of monitoring wells located on site; 232.19 (5) for a groundwater thermal exchange device, in addition 232.20 to the notification fee for wells,$150$175, which includes the 232.21 state core function fee; 232.22 (6) for a vertical heat exchanger,$150$175; 232.23 (7) for a dewatering well that is unsealed under a 232.24 maintenance permit,$125$150 annually for each well, except a 232.25 dewatering project comprising more than five wells shall be 232.26 issued a single permit for$625$750 annually for wells recorded 232.27 on the permit; and 232.28 (8) for excavating holes for the purpose of installing 232.29 elevator shafts,$150$175 for each hole. 232.30 [EFFECTIVE DATE.] This section is effective July 1, 2006. 232.31 Sec. 6. Minnesota Statutes 2004, section 103I.235, 232.32 subdivision 1, is amended to read: 232.33 Subdivision 1. [DISCLOSURE OF WELLS TO BUYER.] (a) Before 232.34 signing an agreement to sell or transfer real property, the 232.35 seller must disclose in writing to the buyer information about 232.36 the status and location of all known wells on the property, by 233.1 delivering to the buyer either a statement by the seller that 233.2 the seller does not know of any wells on the property, or a 233.3 disclosure statement indicating the legal description and 233.4 county, and a map drawn from available information showing the 233.5 location of each well to the extent practicable. In the 233.6 disclosure statement, the seller must indicate, for each well, 233.7 whether the well is in use, not in use, or sealed. 233.8 (b) At the time of closing of the sale, the disclosure 233.9 statement information, name and mailing address of the buyer, 233.10 and the quartile, section, township, and range in which each 233.11 well is located must be provided on a well disclosure 233.12 certificate signed by the seller or a person authorized to act 233.13 on behalf of the seller. 233.14 (c) A well disclosure certificate need not be provided if 233.15 the seller does not know of any wells on the property and the 233.16 deed or other instrument of conveyance contains the statement: 233.17 "The Seller certifies that the Seller does not know of any wells 233.18 on the described real property." 233.19 (d) If a deed is given pursuant to a contract for deed, the 233.20 well disclosure certificate required by this subdivision shall 233.21 be signed by the buyer or a person authorized to act on behalf 233.22 of the buyer. If the buyer knows of no wells on the property, a 233.23 well disclosure certificate is not required if the following 233.24 statement appears on the deed followed by the signature of the 233.25 grantee or, if there is more than one grantee, the signature of 233.26 at least one of the grantees: "The Grantee certifies that the 233.27 Grantee does not know of any wells on the described real 233.28 property." The statement and signature of the grantee may be on 233.29 the front or back of the deed or on an attached sheet and an 233.30 acknowledgment of the statement by the grantee is not required 233.31 for the deed to be recordable. 233.32 (e) This subdivision does not apply to the sale, exchange, 233.33 or transfer of real property: 233.34 (1) that consists solely of a sale or transfer of severed 233.35 mineral interests; or 233.36 (2) that consists of an individual condominium unit as 234.1 described in chapters 515 and 515B. 234.2 (f) For an area owned in common under chapter 515 or 515B 234.3 the association or other responsible person must report to the 234.4 commissioner by July 1, 1992, the location and status of all 234.5 wells in the common area. The association or other responsible 234.6 person must notify the commissioner within 30 days of any change 234.7 in the reported status of wells. 234.8 (g) For real property sold by the state under section 234.9 92.67, the lessee at the time of the sale is responsible for 234.10 compliance with this subdivision. 234.11 (h) If the seller fails to provide a required well 234.12 disclosure certificate, the buyer, or a person authorized to act 234.13 on behalf of the buyer, may sign a well disclosure certificate 234.14 based on the information provided on the disclosure statement 234.15 required by this section or based on other available information. 234.16 (i) A county recorder or registrar of titles may not record 234.17 a deed or other instrument of conveyance dated after October 31, 234.18 1990, for which a certificate of value is required under section 234.19 272.115, or any deed or other instrument of conveyance dated 234.20 after October 31, 1990, from a governmental body exempt from the 234.21 payment of state deed tax, unless the deed or other instrument 234.22 of conveyance contains the statement made in accordance with 234.23 paragraph (c) or (d) or is accompanied by the well disclosure 234.24 certificate containing all the information required by paragraph 234.25 (b) or (d). The county recorder or registrar of titles must not 234.26 accept a certificate unless it contains all the required 234.27 information. The county recorder or registrar of titles shall 234.28 note on each deed or other instrument of conveyance accompanied 234.29 by a well disclosure certificate that the well disclosure 234.30 certificate was received. The notation must include the 234.31 statement "No wells on property" if the disclosure certificate 234.32 states there are no wells on the property. The well disclosure 234.33 certificate shall not be filed or recorded in the records 234.34 maintained by the county recorder or registrar of titles. After 234.35 noting "No wells on property" on the deed or other instrument of 234.36 conveyance, the county recorder or registrar of titles shall 235.1 destroy or return to the buyer the well disclosure certificate. 235.2 The county recorder or registrar of titles shall collect from 235.3 the buyer or the person seeking to record a deed or other 235.4 instrument of conveyance, a fee of$30$40 for receipt of a 235.5 completed well disclosure certificate. By the tenth day of each 235.6 month, the county recorder or registrar of titles shall transmit 235.7 the well disclosure certificates to the commissioner of health. 235.8 By the tenth day after the end of each calendar quarter, the 235.9 county recorder or registrar of titles shall transmit to the 235.10 commissioner of health$27.50$32.50 of the fee for each well 235.11 disclosure certificate received during the quarter. The 235.12 commissioner shall maintain the well disclosure certificate for 235.13 at least six years. The commissioner may store the certificate 235.14 as an electronic image. A copy of that image shall be as valid 235.15 as the original. 235.16 (j) No new well disclosure certificate is required under 235.17 this subdivision if the buyer or seller, or a person authorized 235.18 to act on behalf of the buyer or seller, certifies on the deed 235.19 or other instrument of conveyance that the status and number of 235.20 wells on the property have not changed since the last previously 235.21 filed well disclosure certificate. The following statement, if 235.22 followed by the signature of the person making the statement, is 235.23 sufficient to comply with the certification requirement of this 235.24 paragraph: "I am familiar with the property described in this 235.25 instrument and I certify that the status and number of wells on 235.26 the described real property have not changed since the last 235.27 previously filed well disclosure certificate." The 235.28 certification and signature may be on the front or back of the 235.29 deed or on an attached sheet and an acknowledgment of the 235.30 statement is not required for the deed or other instrument of 235.31 conveyance to be recordable. 235.32 (k) The commissioner in consultation with county recorders 235.33 shall prescribe the form for a well disclosure certificate and 235.34 provide well disclosure certificate forms to county recorders 235.35 and registrars of titles and other interested persons. 235.36 (l) Failure to comply with a requirement of this 236.1 subdivision does not impair: 236.2 (1) the validity of a deed or other instrument of 236.3 conveyance as between the parties to the deed or instrument or 236.4 as to any other person who otherwise would be bound by the deed 236.5 or instrument; or 236.6 (2) the record, as notice, of any deed or other instrument 236.7 of conveyance accepted for filing or recording contrary to the 236.8 provisions of this subdivision. 236.9 [EFFECTIVE DATE.] This section is effective July 1, 2006. 236.10 Sec. 7. Minnesota Statutes 2004, section 103I.601, 236.11 subdivision 2, is amended to read: 236.12 Subd. 2. [LICENSE REQUIRED TO MAKE BORINGS.] (a) Except as 236.13 provided in paragraph(b)(d), a personmaymust not make an 236.14 exploratory boring without anexploratory borer'sexplorer's 236.15 license. The fee for an explorer's license is $75. The 236.16 explorer's license is valid until the date prescribed in the 236.17 license by the commissioner. 236.18 (b) A person must file an application and renewal 236.19 application fee to renew the explorer's license by the date 236.20 stated in the license. The renewal application fee is $75. 236.21 (c) If the licensee submits an application fee after the 236.22 required renewal date, the licensee: 236.23 (1) must include a late fee of $75; and 236.24 (2) may not conduct activities authorized by an explorer's 236.25 license until the renewal application, renewal application fee, 236.26 late fee, and sealing reports required in subdivision 9 are 236.27 submitted. 236.28 (d) An explorermaymust designate a responsible individual 236.29 to supervise and oversee the making of exploratory borings. 236.30 Before an individual supervises or oversees an exploratory 236.31 boring, the individual must file an application and application 236.32 fee of $75 to qualify as a responsible individual. The 236.33 individual must take and pass an examination relating to 236.34 construction, location, and sealing of exploratory borings. A 236.35 professional engineerregisteredor geoscientist licensed under 236.36 sections 326.02 to 326.15 or acertifiedprofessional geologist 237.1 certified by the American Institute of Professional Geologists 237.2 is not required to take the examination required in this 237.3 subdivision, but must belicensedcertified as a responsible 237.4 individual tomakesupervise an exploratory boring. 237.5 Sec. 8. Minnesota Statutes 2004, section 144.122, is 237.6 amended to read: 237.7 144.122 [LICENSE, PERMIT, AND SURVEY FEES.] 237.8 (a) The state commissioner of health, by rule, may 237.9 prescribe reasonable procedures and fees for filing with the 237.10 commissioner as prescribed by statute and for the issuance of 237.11 original and renewal permits, licenses, registrations, and 237.12 certifications issued under authority of the commissioner. The 237.13 expiration dates of the various licenses, permits, 237.14 registrations, and certifications as prescribed by the rules 237.15 shall be plainly marked thereon. Fees may include application 237.16 and examination fees and a penalty fee for renewal applications 237.17 submitted after the expiration date of the previously issued 237.18 permit, license, registration, and certification. The 237.19 commissioner may also prescribe, by rule, reduced fees for 237.20 permits, licenses, registrations, and certifications when the 237.21 application therefor is submitted during the last three months 237.22 of the permit, license, registration, or certification period. 237.23 Fees proposed to be prescribed in the rules shall be first 237.24 approved by the Department of Finance. All fees proposed to be 237.25 prescribed in rules shall be reasonable. The fees shall be in 237.26 an amount so that the total fees collected by the commissioner 237.27 will, where practical, approximate the cost to the commissioner 237.28 in administering the program. All fees collected shall be 237.29 deposited in the state treasury and credited to the state 237.30 government special revenue fund unless otherwise specifically 237.31 appropriated by law for specific purposes. 237.32 (b) The commissioner may charge a fee for voluntary 237.33 certification of medical laboratories and environmental 237.34 laboratories, and for environmental and medical laboratory 237.35 services provided by the department, without complying with 237.36 paragraph (a) or chapter 14. Fees charged for environment and 238.1 medical laboratory services provided by the department must be 238.2 approximately equal to the costs of providing the services. 238.3 (c) The commissioner may develop a schedule of fees for 238.4 diagnostic evaluations conducted at clinics held by the services 238.5 for children with handicaps program. All receipts generated by 238.6 the program are annually appropriated to the commissioner for 238.7 use in the maternal and child health program. 238.8 (d) The commissioner shall set license fees for hospitals 238.9 and nursing homes that are not boarding care homes at the 238.10 following levels: 238.11 Joint Commission on Accreditation of Healthcare 238.12 Organizations (JCAHO hospitals)$7,055$7,555 plus $13 per bed 238.13 Non-JCAHO hospitals$4,680$5,180 plus$234238.14 $247 per bed 238.15 Nursing home $183 plus $91 per bed 238.16 The commissioner shall set license fees for outpatient 238.17 surgical centers, boarding care homes, and supervised living 238.18 facilities at the following levels: 238.19 Outpatient surgical centers$1,512$3,349 238.20 Boarding care homes $183 plus $91 per bed 238.21 Supervised living facilities $183 plus $91 per bed. 238.22 (e) Unless prohibited by federal law, the commissioner of 238.23 health shall charge applicants the following fees to cover the 238.24 cost of any initial certification surveys required to determine 238.25 a provider's eligibility to participate in the Medicare or 238.26 Medicaid program: 238.27 Prospective payment surveys for $ 900 238.28 hospitals 238.30 Swing bed surveys for nursing homes $1,200 238.32 Psychiatric hospitals $1,400 238.34 Rural health facilities $1,100 238.36 Portable x-ray providers $ 500 238.38 Home health agencies $1,800 238.40 Outpatient therapy agencies $ 800 238.42 End stage renal dialysis providers $2,100 238.44 Independent therapists $ 800 239.1 Comprehensive rehabilitation $1,200 239.2 outpatient facilities 239.4 Hospice providers $1,700 239.6 Ambulatory surgical providers $1,800 239.8 Hospitals $4,200 239.10 Other provider categories or Actual surveyor costs: 239.11 additional resurveys required average surveyor cost x 239.12 to complete initial certification number of hours for the 239.13 survey process. 239.14 These fees shall be submitted at the time of the 239.15 application for federal certification and shall not be 239.16 refunded. All fees collected after the date that the imposition 239.17 of fees is not prohibited by federal law shall be deposited in 239.18 the state treasury and credited to the state government special 239.19 revenue fund. 239.20 Sec. 9. Minnesota Statutes 2004, section 144.147, 239.21 subdivision 1, is amended to read: 239.22 Subdivision 1. [DEFINITION.] "Eligible rural hospital" 239.23 means any nonfederal, general acute care hospital that: 239.24 (1) is either located in a rural area, as defined in the 239.25 federal Medicare regulations, Code of Federal Regulations, title 239.26 42, section 405.1041, or located in a community with a 239.27 population of less than10,00015,000, according to United 239.28 States Census Bureau statistics, outside the seven-county 239.29 metropolitan area; 239.30 (2) has 50 or fewer beds; and 239.31 (3) is not for profit. 239.32 Sec. 10. Minnesota Statutes 2004, section 144.147, 239.33 subdivision 2, is amended to read: 239.34 Subd. 2. [GRANTS AUTHORIZED.] The commissioner shall 239.35 establish a program of grants to assist eligible rural 239.36 hospitals. The commissioner shall award grants to hospitals and 239.37 communities for the purposes set forth in paragraphs (a) and (b). 239.38 (a) Grants may be used by hospitals and their communities 239.39 to develop strategic plans for preserving or enhancing access to 239.40 health services. At a minimum, a strategic plan must consist of: 239.41 (1) a needs assessment to determine what health services 239.42 are needed and desired by the community. The assessment must 240.1 include interviews with or surveys of area health professionals, 240.2 local community leaders, and public hearings; 240.3 (2) an assessment of the feasibility of providing needed 240.4 health services that identifies priorities and timeliness for 240.5 potential changes; and 240.6 (3) an implementation plan. 240.7 The strategic plan must be developed by a committee that 240.8 includes representatives from the hospital, local public health 240.9 agencies, other health providers, and consumers from the 240.10 community. 240.11 (b) The grants may also be used by eligible rural hospitals 240.12 that have developed strategic plans to implement transition 240.13 projects to modify the type and extent of services provided, in 240.14 order to reflect the needs of that plan. Grants may be used by 240.15 hospitals under this paragraph to develop hospital-based 240.16 physician practices that integrate hospital and existing medical 240.17 practice facilities that agree to transfer their practices, 240.18 equipment, staffing, and administration to the hospital. The 240.19 grants may also be used by the hospital to establish a health 240.20 provider cooperative, a telemedicine system, an electronic 240.21 health records system, or a rural health care system or to cover 240.22 expenses associated with being designated as a critical access 240.23 hospital for the Medicare rural hospital flexibility program. 240.24 Not more than one-third of any grant shall be used to offset 240.25 losses incurred by physicians agreeing to transfer their 240.26 practices to hospitals. 240.27 Sec. 11. [144.1476] [RURAL PHARMACY PLANNING AND 240.28 TRANSITION GRANT PROGRAM.] 240.29 Subdivision 1. [DEFINITIONS.] (a) For the purposes of this 240.30 section, the following definitions apply. 240.31 (b) "Eligible rural community" means: 240.32 (1) a Minnesota community that is located in a rural area, 240.33 as defined in the federal Medicare regulations, Code of Federal 240.34 Regulations, title 42, section 405.1041; or 240.35 (2) a Minnesota community that has a population of less 240.36 than 10,000, according to the United States Bureau of 241.1 Statistics, and that is outside the seven-county metropolitan 241.2 area, excluding the cities of Duluth, Mankato, Moorhead, 241.3 Rochester, and St. Cloud. 241.4 (c) "Health care provider" means a hospital, clinic, 241.5 pharmacy, long-term care institution, or other health care 241.6 facility that is licensed, certified, or otherwise authorized by 241.7 the laws of this state to provide health care. 241.8 (d) "Pharmacist" means an individual with a valid license 241.9 issued under chapter 151 to practice pharmacy. 241.10 (e) "Pharmacy" has the meaning given under section 151.01, 241.11 subdivision 2. 241.12 Subd. 2. [GRANTS AUTHORIZED; ELIGIBILITY.] (a) The 241.13 commissioner of health shall establish a program to award grants 241.14 to eligible rural communities or health care providers in 241.15 eligible rural communities for planning, establishing, keeping 241.16 in operation, or providing health care services that preserve 241.17 access to prescription medications and the skills of a 241.18 pharmacist according to sections 151.01 to 151.40. 241.19 (b) To be eligible for a grant, an applicant must develop a 241.20 strategic plan for preserving or enhancing access to 241.21 prescription medications and the skills of a pharmacist. At a 241.22 minimum, a strategic plan must consist of: 241.23 (1) a needs assessment to determine what pharmacy services 241.24 are needed and desired by the community. The assessment must 241.25 include interviews with or surveys of area and local health 241.26 professionals, local community leaders, and public officials; 241.27 (2) an assessment of the feasibility of providing needed 241.28 pharmacy services that identifies priorities and timelines for 241.29 potential changes; and 241.30 (3) an implementation plan. 241.31 (c) A grant may be used by a recipient that has developed a 241.32 strategic plan to implement transition projects to modify the 241.33 type and extent of pharmacy services provided, in order to 241.34 reflect the needs of the community. Grants may also be used by 241.35 recipients: 241.36 (1) to develop pharmacy practices that integrate pharmacy 242.1 and existing health care provider facilities; or 242.2 (2) to establish a pharmacy provider cooperative or 242.3 initiatives that maintain local access to prescription 242.4 medications and the skills of a pharmacist. 242.5 Subd. 3. [FUNDING.] In accordance with section 214.06, fee 242.6 revenues collected by the Board of Pharmacy shall pay for: 242.7 (1) anticipated operating expenditures during the fiscal 242.8 biennium; and 242.9 (2) appropriations for the rural pharmacy grant program 242.10 administered by the Department of Health. 242.11 The commissioner of finance shall make available money in the 242.12 state government special revenue fund for the operation and 242.13 administration of the rural pharmacy grant program. No more 242.14 than ten percent of the money appropriated for the rural 242.15 pharmacy grant program may be used for administrative expenses. 242.16 Subd. 4. [CONSIDERATION OF GRANTS.] In determining which 242.17 applicants shall receive grants under this section, the 242.18 commissioner of health shall appoint a committee comprised of 242.19 members with experience and knowledge about rural pharmacy 242.20 issues including but not limited to two rural pharmacists with a 242.21 community pharmacy background, two health care providers from 242.22 rural communities, one representative from a statewide 242.23 pharmacist organization, and one representative of the Board of 242.24 Pharmacy. A representative of the commissioner may serve on the 242.25 committee in an ex officio status. In determining who shall 242.26 receive a grant, the committee shall take into account: 242.27 (1) improving or maintaining access to prescription 242.28 medications and the skills of a pharmacist; 242.29 (2) changes in service populations; 242.30 (3) the extent community pharmacy needs are not currently 242.31 met by other providers in the area; 242.32 (4) the financial condition of the applicant; 242.33 (5) the integration of pharmacy services into existing 242.34 health care services; and 242.35 (6) community support. 242.36 The commissioner may also take into account other relevant 243.1 factors. 243.2 Subd. 5. [ALLOCATION OF GRANTS.] (a) The commissioner 243.3 shall establish a deadline for receiving applications and must 243.4 make a final decision on the funding of each application within 243.5 60 days of the deadline. An applicant must apply no later than 243.6 March 1 of each fiscal year for grants awarded for that fiscal 243.7 year. 243.8 (b) Any grant awarded must not exceed $50,000 a year and 243.9 may not exceed a one-year term. 243.10 (c) Applicants may apply to the program each year they are 243.11 eligible. 243.12 (d) Project grants may not be used to retire debt incurred 243.13 with respect to any capital expenditure made prior to the date 243.14 on which the project is initiated. 243.15 Subd. 6. [EVALUATION.] The commissioner shall evaluate the 243.16 overall effectiveness of the grant program and may collect 243.17 progress reports and other information from grantees needed for 243.18 program evaluation. An academic institution that has the 243.19 expertise in evaluating rural pharmacy outcomes may participate 243.20 in the program evaluation if asked by a grantee or the 243.21 commissioner. The commissioner shall compile summaries of 243.22 successful grant projects and other model community efforts to 243.23 preserve access to prescription medications and the skills of a 243.24 pharmacist, and make this information available to Minnesota 243.25 communities seeking to address local pharmacy issues. 243.26 Sec. 12. Minnesota Statutes 2004, section 144.148, 243.27 subdivision 1, is amended to read: 243.28 Subdivision 1. [DEFINITION.] (a) For purposes of this 243.29 section, the following definitions apply. 243.30 (b) "Eligible rural hospital" means any nonfederal, general 243.31 acute care hospital that: 243.32 (1) is either located in a rural area, as defined in the 243.33 federal Medicare regulations, Code of Federal Regulations, title 243.34 42, section 405.1041, or located in a community with a 243.35 population of less than10,00015,000, according to United 243.36 States Census Bureau statistics, outside the seven-county 244.1 metropolitan area; 244.2 (2) has 50 or fewer beds; and 244.3 (3) is not for profit. 244.4 (c) "Eligible project" means a modernization project to 244.5 update, remodel, or replace aging hospital facilities and 244.6 equipment necessary to maintain the operations of a hospital, 244.7 including establishing an electronic health records system. 244.8 Sec. 13. Minnesota Statutes 2004, section 144.1483, is 244.9 amended to read: 244.10 144.1483 [RURAL HEALTH INITIATIVES.] 244.11 The commissioner of health, through the Office of Rural 244.12 Health, and consulting as necessary with the commissioner of 244.13 human services, the commissioner of commerce, the Higher 244.14 Education Services Office, and other state agencies, shall: 244.15 (1) develop a detailed plan regarding the feasibility of 244.16 coordinating rural health care services by organizing individual 244.17 medical providers and smaller hospitals and clinics into 244.18 referral networks with larger rural hospitals and clinics that 244.19 provide a broader array of services; 244.20 (2)develop and implement a program to assist rural244.21communities in establishing community health centers, as244.22required by section 144.1486;244.23(3)develop recommendations regarding health education and 244.24 training programs in rural areas, including but not limited to a 244.25 physician assistants' training program, continuing education 244.26 programs for rural health care providers, and rural outreach 244.27 programs for nurse practitioners within existing training 244.28 programs; 244.29(4)(3) develop a statewide, coordinated recruitment 244.30 strategy for health care personnel and maintain a database on 244.31 health care personnel as required under section 144.1485; 244.32(5)(4) develop and administer technical assistance 244.33 programs to assist rural communities in: (i) planning and 244.34 coordinating the delivery of local health care services; and 244.35 (ii) hiring physicians, nurse practitioners, public health 244.36 nurses, physician assistants, and other health personnel; 245.1(6)(5) study and recommend changes in the regulation of 245.2 health care personnel, such as nurse practitioners and physician 245.3 assistants, related to scope of practice, the amount of on-site 245.4 physician supervision, and dispensing of medication, to address 245.5 rural health personnel shortages; 245.6(7)(6) support efforts to ensure continued funding for 245.7 medical and nursing education programs that will increase the 245.8 number of health professionals serving in rural areas; 245.9(8)(7) support efforts to secure higher reimbursement for 245.10 rural health care providers from the Medicare and medical 245.11 assistance programs; 245.12(9)(8) coordinate the development of a statewide plan for 245.13 emergency medical services, in cooperation with the Emergency 245.14 Medical Services Advisory Council; 245.15(10)(9) establish a Medicare rural hospital flexibility 245.16 program pursuant to section 1820 of the federal Social Security 245.17 Act, United States Code, title 42, section 1395i-4, by 245.18 developing a state rural health plan and designating, consistent 245.19 with the rural health plan, rural nonprofit or public hospitals 245.20 in the state as critical access hospitals. Critical access 245.21 hospitals shall include facilities that are certified by the 245.22 state as necessary providers of health care services to 245.23 residents in the area. Necessary providers of health care 245.24 services are designated as critical access hospitals on the 245.25 basis of being more than 20 miles, defined as official mileage 245.26 as reported by the Minnesota Department of Transportation, from 245.27 the next nearest hospital, being the sole hospital in the 245.28 county, being a hospital located in a county with a designated 245.29 medically underserved area or health professional shortage area, 245.30 or being a hospital located in a county contiguous to a county 245.31 with a medically underserved area or health professional 245.32 shortage area. A critical access hospital located in a county 245.33 with a designated medically underserved area or a health 245.34 professional shortage area or in a county contiguous to a county 245.35 with a medically underserved area or health professional 245.36 shortage area shall continue to be recognized as a critical 246.1 access hospital in the event the medically underserved area or 246.2 health professional shortage area designation is subsequently 246.3 withdrawn; and 246.4(11)(10) carry out other activities necessary to address 246.5 rural health problems. 246.6 Sec. 14. Minnesota Statutes 2004, section 144.1501, 246.7 subdivision 1, is amended to read: 246.8 Subdivision 1. [DEFINITIONS.] (a) For purposes of this 246.9 section, the following definitions apply. 246.10 (b) "Dentist" means an individual who is licensed to 246.11 practice dentistry. 246.12 (c) "Designated rural area" means: 246.13 (1) an area in Minnesota outside the counties of Anoka, 246.14 Carver, Dakota, Hennepin, Ramsey, Scott, and Washington, 246.15 excluding the cities of Duluth, Mankato, Moorhead, Rochester, 246.16 and St. Cloud; or 246.17 (2) a municipal corporation, as defined under section 246.18 471.634, that is physically located, in whole or in part, in an 246.19 area defined as a designated rural area under clause (1). 246.20(c)(d) "Emergency circumstances" means those conditions 246.21 that make it impossible for the participant to fulfill the 246.22 service commitment, including death, total and permanent 246.23 disability, or temporary disability lasting more than two years. 246.24(d)(e) "Medical resident" means an individual 246.25 participating in a medical residency in family practice, 246.26 internal medicine, obstetrics and gynecology, pediatrics, or 246.27 psychiatry. 246.28(e)(f) "Midlevel practitioner" means a nurse practitioner, 246.29 nurse-midwife, nurse anesthetist, advanced clinical nurse 246.30 specialist, or physician assistant. 246.31(f)(g) "Nurse" means an individual who has completed 246.32 training and received all licensing or certification necessary 246.33 to perform duties as a licensed practical nurse or registered 246.34 nurse. 246.35(g)(h) "Nurse-midwife" means a registered nurse who has 246.36 graduated from a program of study designed to prepare registered 247.1 nurses for advanced practice as nurse-midwives. 247.2(h)(i) "Nurse practitioner" means a registered nurse who 247.3 has graduated from a program of study designed to prepare 247.4 registered nurses for advanced practice as nurse practitioners. 247.5(i)(j) "Pharmacist" means an individual with a valid 247.6 license to practice pharmacy issued under chapter 151. 247.7 (k) "Physician" means an individual who is licensed to 247.8 practice medicine in the areas of family practice, internal 247.9 medicine, obstetrics and gynecology, pediatrics, or psychiatry. 247.10(j)(l) "Physician assistant" means a person registered 247.11 under chapter 147A. 247.12(k)(m) "Qualified educational loan" means a government, 247.13 commercial, or foundation loan for actual costs paid for 247.14 tuition, reasonable education expenses, and reasonable living 247.15 expenses related to the graduate or undergraduate education of a 247.16 health care professional. 247.17(l)(n) "Underserved urban community" means a Minnesota 247.18 urban area or population included in the list of designated 247.19 primary medical care health professional shortage areas (HPSAs), 247.20 medically underserved areas (MUAs), or medically underserved 247.21 populations (MUPs) maintained and updated by the United States 247.22 Department of Health and Human Services. 247.23 Sec. 15. Minnesota Statutes 2004, section 144.1501, 247.24 subdivision 2, is amended to read: 247.25 Subd. 2. [CREATION OF ACCOUNT.] A health professional 247.26 education loan forgiveness program account is established. The 247.27 commissioner of health shall use money from the account to 247.28 establish a loan forgiveness program for medical residents 247.29 agreeing to practice in designated rural areas or underserved 247.30 urban communities,; for dentists agreeing to deliver at least 25 247.31 percent of the dentist's yearly patient encounters to state 247.32 public program enrollees or patients receiving sliding fee 247.33 schedule discounts through a formal sliding fee schedule meeting 247.34 the standards established by the United States Department of 247.35 Health and Human Services under Code of Federal Regulations, 247.36 title 42, section 51, chapter 303; for midlevel practitioners 248.1 agreeing to practice in designated rural areas, andfor nurses 248.2 who agree to practice in a Minnesota nursing home or 248.3 intermediate care facility for persons with mental retardation 248.4 or related conditions, and for pharmacists who agree to practice 248.5 in designated rural areas. Appropriations made to the account 248.6 do not cancel and are available until expended, except that at 248.7 the end of each biennium, any remaining balance in the account 248.8 that is not committed by contract and not needed to fulfill 248.9 existing commitments shall cancel to the fund. 248.10 Sec. 16. Minnesota Statutes 2004, section 144.1501, 248.11 subdivision 3, is amended to read: 248.12 Subd. 3. [ELIGIBILITY.] (a) To be eligible to participate 248.13 in the loan forgiveness program, an individual must: 248.14 (1) be a medical or dental resident or a licensed 248.15 pharmacist or be enrolled in a dentist, midlevel practitioner, 248.16 registered nurse, or a licensed practical nurse training 248.17 program; and 248.18 (2) submit an application to the commissioner of 248.19 health. If fewer applications are submitted by dental students 248.20 or residents than there are dentist participant slots available, 248.21 the commissioner may consider applications submitted by dental 248.22 program graduates who are licensed dentists. 248.23 (b) An applicant selected to participate must sign a 248.24 contract to agree to serve a minimum three-year full-time 248.25 service obligation according to subdivision 2, which shall begin 248.26 no later than March 31 following completion of required training. 248.27 Sec. 17. Minnesota Statutes 2004, section 144.1501, 248.28 subdivision 4, is amended to read: 248.29 Subd. 4. [LOAN FORGIVENESS.] The commissioner of health 248.30 may select applicants each year for participation in the loan 248.31 forgiveness program, within the limits of available funding. The 248.32 commissioner shall distribute available funds for loan 248.33 forgiveness proportionally among the eligible professions 248.34 according to the vacancy rate for each profession in the 248.35 required geographic area, patient group, or facility type 248.36 specified in subdivision 2. The commissioner shall allocate 249.1 funds for physician loan forgiveness so that 75 percent of the 249.2 funds available are used for rural physician loan forgiveness 249.3 and 25 percent of the funds available are used for underserved 249.4 urban communities loan forgiveness. If the commissioner does 249.5 not receive enough qualified applicants each year to use the 249.6 entire allocation of funds forurban underserved communitiesany 249.7 eligible profession, the remaining funds may be allocatedfor249.8rural physician loan forgivenessproportionally among the other 249.9 eligible professions according to the vacancy rate for each 249.10 profession in the required geographic area, patient group, or 249.11 facility type specified in subdivision 2. Applicants are 249.12 responsible for securing their own qualified educational loans. 249.13 The commissioner shall select participants based on their 249.14 suitability for practice serving the required geographic area or 249.15 facility type specified in subdivision 2, as indicated by 249.16 experience or training. The commissioner shall give preference 249.17 to applicants closest to completing their training. For each 249.18 year that a participant meets the service obligation required 249.19 under subdivision 3, up to a maximum of four years, the 249.20 commissioner shall make annual disbursements directly to the 249.21 participant equivalent to 15 percent of the average educational 249.22 debt for indebted graduates in their profession in the year 249.23 closest to the applicant's selection for which information is 249.24 available, not to exceed the balance of the participant's 249.25 qualifying educational loans. Before receiving loan repayment 249.26 disbursements and as requested, the participant must complete 249.27 and return to the commissioner an affidavit of practice form 249.28 provided by the commissioner verifying that the participant is 249.29 practicing as required under subdivisions 2 and 3. The 249.30 participant must provide the commissioner with verification that 249.31 the full amount of loan repayment disbursement received by the 249.32 participant has been applied toward the designated loans. After 249.33 each disbursement, verification must be received by the 249.34 commissioner and approved before the next loan repayment 249.35 disbursement is made. Participants who move their practice 249.36 remain eligible for loan repayment as long as they practice as 250.1 required under subdivision 2. 250.2 Sec. 18. Minnesota Statutes 2004, section 144.226, 250.3 subdivision 1, is amended to read: 250.4 Subdivision 1. [WHICH SERVICES ARE FOR FEE.] The fees for 250.5 the following services shall be the following or an amount 250.6 prescribed by rule of the commissioner: 250.7 (a) The fee for the issuance of a certified vital record or 250.8 a certification that the vital record cannot be found is$8$9. 250.9 No fee shall be charged for a certified birth or death record 250.10 that is reissued within one year of the original issue, if an 250.11 amendment is made to the vital record and if the previously 250.12 issued vital record is surrendered. The fee is nonrefundable. 250.13 (b) The fee for processing a request for the replacement of 250.14 a birth record for all events, except when filing a recognition 250.15 of parentage pursuant to section 257.73, subdivision 1, 250.16 is$20$40. The fee is payable at the time of application and 250.17 is nonrefundable. 250.18 (c) The fee for processing a request for the filing of a 250.19 delayed registration of birth or death is$20$40. The fee is 250.20 payable at the time of application and is nonrefundable. This 250.21 fee includes one subsequent review of the request if the request 250.22 is not acceptable upon the initial receipt. 250.23 (d) The fee for processing a request for the amendment of 250.24 any vital record when requested more than 45 days after the 250.25 filing of the vital record is$20$40. No fee shall be charged 250.26 for an amendment requested within 45 days after the filing of 250.27 the vital record. The fee is payable at the time of application 250.28 and is nonrefundable. This fee includes one subsequent review 250.29 of the request if the request is not acceptable upon the initial 250.30 receipt. 250.31 (e) The fee for processing a request for the verification 250.32 of information from vital records is$8$9 when the applicant 250.33 furnishes the specific information to locate the vital record. 250.34 When the applicant does not furnish specific information, the 250.35 fee is $20 per hour for staff time expended. Specific 250.36 information includes the correct date of the event and the 251.1 correct name of the registrant. Fees charged shall approximate 251.2 the costs incurred in searching and copying the vital records. 251.3 The feeshall beis payable at the time of application and is 251.4 nonrefundable. 251.5 (f) The fee for processing a request for the issuance of a 251.6 copy of any document on file pertaining to a vital record or 251.7 statement that a related document cannot be found is$8$9. The 251.8 fee is payable at the time of application and is nonrefundable. 251.9 Sec. 19. Minnesota Statutes 2004, section 144.226, 251.10 subdivision 4, is amended to read: 251.11 Subd. 4. [VITAL RECORDS SURCHARGE.] In addition to any fee 251.12 prescribed under subdivision 1, there is a nonrefundable 251.13 surcharge of$2$4 for each certified and noncertified birth or 251.14 death record, and for a certification that the record cannot be 251.15 found. The local or state registrar shall forward this amount 251.16 to the commissioner of finance to be deposited into the state 251.17 government special revenue fund. This surcharge shall not be 251.18 charged under those circumstances in which no fee for a birth or 251.19 death record is permitted under subdivision 1, paragraph (a). 251.20 Sec. 20. Minnesota Statutes 2004, section 144.226, is 251.21 amended by adding a subdivision to read: 251.22 Subd. 5. [ELECTRONIC VERIFICATION.] A fee for the 251.23 electronic verification of a vital event, when the information 251.24 being verified is obtained from a certified birth or death 251.25 record, shall be established through contractual or interagency 251.26 agreements with interested local, state, or federal government 251.27 agencies. 251.28 Sec. 21. Minnesota Statutes 2004, section 144.226, is 251.29 amended by adding a subdivision to read: 251.30 Subd. 6. [ALTERNATIVE PAYMENT METHODS.] Notwithstanding 251.31 subdivision 1, alternative payment methods may be approved and 251.32 implemented by the state registrar or a local registrar. 251.33 Sec. 22. [144.3431] [ABORTION NOTIFICATION DATA.] 251.34 Subdivision 1. [REPORTING FORM.] (a) Within 90 days of the 251.35 effective date of this section, the commissioner of health shall 251.36 prepare a reporting form for use by physicians and facilities 252.1 performing abortions. 252.2 (b) The form shall require the following information: 252.3 (1) the number of minors or women for whom a guardian has 252.4 been appointed under sections 524.5-301 to 524.5-317 because of 252.5 a finding of incompetency for whom the physician or an agent of 252.6 the physician provided the notice described in section 144.343, 252.7 subdivision 2; of that number, the number of notices provided 252.8 personally as described in section 144.343, subdivision 2, 252.9 paragraph (a), and the number of notices provided by mail as 252.10 described in section 144.343, subdivision 2, paragraph (b); and 252.11 of each of those numbers, the number who, to the best of the 252.12 reporting physician's or reporting facility's information and 252.13 belief, went on to obtain the abortion from the reporting 252.14 physician or reporting physician's facility, or from the 252.15 reporting facility; 252.16 (2) the number of minors or women for whom a guardian has 252.17 been appointed under sections 524.5-301 to 524.5-317 because of 252.18 a finding of incompetency upon whom the physician performed an 252.19 abortion without providing the notice described in section 252.20 144.343, subdivision 2; and of that number, the number who were 252.21 emancipated minors, and the number for whom section 144.343, 252.22 subdivision 4, was applicable, itemized by each of the 252.23 limitations identified in paragraphs (a), (b), and (c) of that 252.24 subdivision; 252.25 (3) the number of abortions performed by the physician for 252.26 which judicial authorization was received and for which the 252.27 notification described in section 144.343, subdivision 2, was 252.28 not provided; 252.29 (4) the county the female resides in; the county where the 252.30 abortion was performed, if different from the female's 252.31 residence; and, if a judicial bypass was obtained, the county it 252.32 was obtained in, if different from the female's residence; 252.33 (5) the age of the female; 252.34 (6) the race of the female; 252.35 (7) the process the physician or the physician's agent used 252.36 to inform the female of the judicial bypass; whether court forms 253.1 were provided to her; and whether the physician or the 253.2 physician's agent made the court arrangement for the female; and 253.3 (8) how soon after visiting the abortion facility the 253.4 female went to court to obtain a judicial bypass. 253.5 Subd. 2. [FORMS TO PHYSICIANS AND FACILITIES.] Physicians 253.6 and facilities required to report under subdivision 3 shall 253.7 obtain reporting forms from the commissioner. 253.8 Subd. 3. [SUBMISSION.] (a) The following physicians or 253.9 facilities must submit the forms to the commissioner no later 253.10 than April 1 for abortions performed in the previous calendar 253.11 year: 253.12 (1) a physician who provides, or whose agent provides, the 253.13 notice described in section 144.343, subdivision 2, or the 253.14 facility at which such notice is provided; and 253.15 (2) a physician who knowingly performs an abortion upon a 253.16 minor or a woman for whom a guardian has been appointed 253.17 according to sections 524.5-301 to 524.5-317 because of a 253.18 finding of incompetency, or a facility at which such an abortion 253.19 is performed. 253.20 (b) The commissioner shall maintain as confidential data 253.21 which alone or in combination may constitute information that 253.22 would reasonably lead, using epidemiologic principles, to the 253.23 identification of: 253.24 (1) an individual who has had an abortion, who has received 253.25 judicial authorization for an abortion, or to whom the notice 253.26 described in section 144.343, subdivision 2, has been provided; 253.27 or 253.28 (2) a physician or facility required to report under 253.29 paragraph (a). 253.30 Subd. 4. [FAILURE TO REPORT AS REQUIRED.] (a) Reports that 253.31 are not submitted more than 30 days following the due date shall 253.32 be subject to a late fee of $500 for each additional 30-day 253.33 period or portion of a 30-day period overdue. If a physician or 253.34 facility required to report under this section has not submitted 253.35 a report, or has submitted only an incomplete report, more than 253.36 one year following the due date, the commissioner of health 254.1 shall bring an action in a court of competent jurisdiction for 254.2 an order directing the physician or facility to submit a 254.3 complete report within a period stated by court order or be 254.4 subject to sanctions. If the commissioner brings such an action 254.5 for an order directing a physician or facility to submit a 254.6 complete report, the court may assess reasonable attorney fees 254.7 and costs against the noncomplying party. 254.8 (b) Notwithstanding section 13.39, data related to actions 254.9 taken by the commissioner to enforce any provision of this 254.10 section is private data if the data, alone or in combination, 254.11 may constitute information that would reasonably lead, using 254.12 epidemiologic principles, to the identification of: 254.13 (1) an individual who has had an abortion, who has received 254.14 judicial authorization for an abortion, or to whom the notice 254.15 described in section 144.343, subdivision 2, has been provided; 254.16 or 254.17 (2) a physician or facility required to report under 254.18 subdivision 3. 254.19 Subd. 5. [PUBLIC RECORDS.] (a) By September 30 of each 254.20 year, the commissioner of health shall issue a public report 254.21 providing statistics for each item listed in subdivision 1 for 254.22 the previous calendar year compiled from reports submitted 254.23 according to this section. The report shall also include 254.24 statistics, which shall be obtained from court administrators, 254.25 that include: 254.26 (1) the total number of petitions or motions filed under 254.27 section 144.343, subdivision 6, paragraph (c), clause (i); 254.28 (2) the number of cases in which the court appointed a 254.29 guardian ad litem; 254.30 (3) the number of cases in which the court appointed 254.31 counsel; 254.32 (4) the number of cases in which the judge issued an order 254.33 authorizing an abortion without notification, including: 254.34 (i) the number of petitions or motions granted by the court 254.35 because of a finding of maturity and the basis for that finding; 254.36 and 255.1 (ii) the number of petitions or motions granted because of 255.2 a finding that the abortion would be in the best interest of the 255.3 minor and the basis for that finding; 255.4 (5) the number of denials from which an appeal was filed; 255.5 (6) the number of appeals that resulted in a denial being 255.6 affirmed; and 255.7 (7) the number of appeals that resulted in reversal of a 255.8 denial. 255.9 (b) The report shall provide the statistics for all 255.10 previous calendar years for which a public report was required 255.11 to be issued, adjusted to reflect any additional information 255.12 from late or corrected reports. 255.13 (c) The commissioner shall ensure that all statistical 255.14 information included in the public reports are presented so that 255.15 the data cannot reasonably lead, using epidemiologic principles, 255.16 to the identification of: 255.17 (1) an individual who has had an abortion, who has received 255.18 judicial authorization for an abortion, or to whom the notice 255.19 described in section 144.343, subdivision 2, has been provided; 255.20 or 255.21 (2) a physician or facility who has submitted a form to the 255.22 commissioner under subdivision 3. 255.23 Subd. 6. [MODIFICATION OF REQUIREMENTS.] The commissioner 255.24 of health may, by administrative rule, alter the dates 255.25 established in subdivisions 3 and 5, consolidate the forms 255.26 created according to subdivision 1 with the reporting form 255.27 created according to section 145.4131, or consolidate reports to 255.28 achieve administrative convenience or fiscal savings, to allow 255.29 physicians and facilities to submit all information collected by 255.30 the commissioner regarding abortions at one time, or to reduce 255.31 the burden of the data collection, so long as the report 255.32 described in subdivision 5 is issued at least once a year. 255.33 Subd. 7. [SUIT TO COMPEL STATISTICAL REPORT.] If the 255.34 commissioner of health fails to issue the public report required 255.35 under subdivision 5, any group of ten or more citizens of the 255.36 state may seek an injunction in a court of competent 256.1 jurisdiction against the commissioner, requiring that a complete 256.2 report be issued within a period stated by court order. Failure 256.3 to abide by the injunction shall subject the commissioner to 256.4 sanctions for civil contempt. 256.5 Subd. 8. [ATTORNEY FEES.] If judgment is rendered in favor 256.6 of the plaintiff in any action described in this section, the 256.7 court shall also render judgment for a reasonable attorney fee 256.8 in favor of the plaintiff against the defendant. If the 256.9 judgment is rendered in favor of the defendant and the court 256.10 finds that plaintiff's suit was frivolous and brought in bad 256.11 faith, the court shall render judgment for a reasonable attorney 256.12 fee in favor of the defendant against the plaintiff. 256.13 Subd. 9. [SEVERABILITY.] If any one or more provision, 256.14 section, subdivision, sentence, clause, phrase, or word of this 256.15 section or the application thereof to any person or circumstance 256.16 is found to be unconstitutional, the same is hereby declared to 256.17 be severable and the balance of this section shall remain 256.18 effective notwithstanding such unconstitutionality. The 256.19 legislature hereby declares that it would have passed this 256.20 section, and each provision, section, subdivision, sentence, 256.21 clause, phrase, or word thereof irrespective of the fact that 256.22 any one provision, section, subdivision, sentence, clause, 256.23 phrase, or word be declared unconstitutional. 256.24 Sec. 23. Minnesota Statutes 2004, section 144.3831, 256.25 subdivision 1, is amended to read: 256.26 Subdivision 1. [FEE SETTING.] The commissioner of health 256.27 may assess an annual fee of$5.21$6.36 for every service 256.28 connection to a public water supply that is owned or operated by 256.29 a home rule charter city, a statutory city, a city of the first 256.30 class, or a town. The commissioner of health may also assess an 256.31 annual fee for every service connection served by a water user 256.32 district defined in section 110A.02. 256.33 [EFFECTIVE DATE.] This section is effective July 1, 2006. 256.34 Sec. 24. Minnesota Statutes 2004, section 144.551, 256.35 subdivision 1, is amended to read: 256.36 Subdivision 1. [RESTRICTED CONSTRUCTION OR MODIFICATION.] 257.1 (a) The following construction or modification may not be 257.2 commenced: 257.3 (1) any erection, building, alteration, reconstruction, 257.4 modernization, improvement, extension, lease, or other 257.5 acquisition by or on behalf of a hospital that increases the bed 257.6 capacity of a hospital, relocates hospital beds from one 257.7 physical facility, complex, or site to another, or otherwise 257.8 results in an increase or redistribution of hospital beds within 257.9 the state; and 257.10 (2) the establishment of a new hospital. 257.11 (b) This section does not apply to: 257.12 (1) construction or relocation within a county by a 257.13 hospital, clinic, or other health care facility that is a 257.14 national referral center engaged in substantial programs of 257.15 patient care, medical research, and medical education meeting 257.16 state and national needs that receives more than 40 percent of 257.17 its patients from outside the state of Minnesota; 257.18 (2) a project for construction or modification for which a 257.19 health care facility held an approved certificate of need on May 257.20 1, 1984, regardless of the date of expiration of the 257.21 certificate; 257.22 (3) a project for which a certificate of need was denied 257.23 before July 1, 1990, if a timely appeal results in an order 257.24 reversing the denial; 257.25 (4) a project exempted from certificate of need 257.26 requirements by Laws 1981, chapter 200, section 2; 257.27 (5) a project involving consolidation of pediatric 257.28 specialty hospital services within the Minneapolis-St. Paul 257.29 metropolitan area that would not result in a net increase in the 257.30 number of pediatric specialty hospital beds among the hospitals 257.31 being consolidated; 257.32 (6) a project involving the temporary relocation of 257.33 pediatric-orthopedic hospital beds to an existing licensed 257.34 hospital that will allow for the reconstruction of a new 257.35 philanthropic, pediatric-orthopedic hospital on an existing site 257.36 and that will not result in a net increase in the number of 258.1 hospital beds. Upon completion of the reconstruction, the 258.2 licenses of both hospitals must be reinstated at the capacity 258.3 that existed on each site before the relocation; 258.4 (7) the relocation or redistribution of hospital beds 258.5 within a hospital building or identifiable complex of buildings 258.6 provided the relocation or redistribution does not result in: 258.7 (i) an increase in the overall bed capacity at that site; (ii) 258.8 relocation of hospital beds from one physical site or complex to 258.9 another; or (iii) redistribution of hospital beds within the 258.10 state or a region of the state; 258.11 (8) relocation or redistribution of hospital beds within a 258.12 hospital corporate system that involves the transfer of beds 258.13 from a closed facility site or complex to an existing site or 258.14 complex provided that: (i) no more than 50 percent of the 258.15 capacity of the closed facility is transferred; (ii) the 258.16 capacity of the site or complex to which the beds are 258.17 transferred does not increase by more than 50 percent; (iii) the 258.18 beds are not transferred outside of a federal health systems 258.19 agency boundary in place on July 1, 1983; and (iv) the 258.20 relocation or redistribution does not involve the construction 258.21 of a new hospital building; 258.22 (9) a construction project involving up to 35 new beds in a 258.23 psychiatric hospital in Rice County that primarily serves 258.24 adolescents and that receives more than 70 percent of its 258.25 patients from outside the state of Minnesota; 258.26 (10) a project to replace a hospital or hospitals with a 258.27 combined licensed capacity of 130 beds or less if: (i) the new 258.28 hospital site is located within five miles of the current site; 258.29 and (ii) the total licensed capacity of the replacement 258.30 hospital, either at the time of construction of the initial 258.31 building or as the result of future expansion, will not exceed 258.32 70 licensed hospital beds, or the combined licensed capacity of 258.33 the hospitals, whichever is less; 258.34 (11) the relocation of licensed hospital beds from an 258.35 existing state facility operated by the commissioner of human 258.36 services to a new or existing facility, building, or complex 259.1 operated by the commissioner of human services; from one 259.2 regional treatment center site to another; or from one building 259.3 or site to a new or existing building or site on the same 259.4 campus; 259.5 (12) the construction or relocation of hospital beds 259.6 operated by a hospital having a statutory obligation to provide 259.7 hospital and medical services for the indigent that does not 259.8 result in a net increase in the number of hospital beds; 259.9 (13) a construction project involving the addition of up to 259.10 31 new beds in an existing nonfederal hospital in Beltrami 259.11 County; 259.12 (14) a construction project involving the addition of up to 259.13 eight new beds in an existing nonfederal hospital in Otter Tail 259.14 County with 100 licensed acute care beds; 259.15 (15) a construction project involving the addition of 20 259.16 new hospital beds used for rehabilitation services in an 259.17 existing hospital in Carver County serving the southwest 259.18 suburban metropolitan area. Beds constructed under this clause 259.19 shall not be eligible for reimbursement under medical 259.20 assistance, general assistance medical care, or MinnesotaCare; 259.21 (16) a project for the construction or relocation of up to 259.22 20 hospital beds for the operation of up to two psychiatric 259.23 facilities or units for children provided that the operation of 259.24 the facilities or units have received the approval of the 259.25 commissioner of human services; 259.26 (17) a project involving the addition of 14 new hospital 259.27 beds to be used for rehabilitation services in an existing 259.28 hospital in Itasca County;or259.29 (18) a project to add 20 licensed beds in existing space at 259.30 a hospital in Hennepin County that closed 20 rehabilitation beds 259.31 in 2002, provided that the beds are used only for rehabilitation 259.32 in the hospital's current rehabilitation building. If the beds 259.33 are used for another purpose or moved to another location, the 259.34 hospital's licensed capacity is reduced by 20 beds; or 259.35 (19) a critical access hospital established under section 259.36 144.1483, clause (10), and section 1820 of the federal Social 260.1 Security Act, United States Code, title 42, section 1395i-4, 260.2 that delicensed beds since enactment of the Balanced Budget Act 260.3 of 1997, Public Law 105-33, to the extent that the critical 260.4 access hospital does not seek to exceed the maximum number of 260.5 beds permitted such hospital under federal law. 260.6 Sec. 25. Minnesota Statutes 2004, section 144.562, 260.7 subdivision 2, is amended to read: 260.8 Subd. 2. [ELIGIBILITY FOR LICENSE CONDITION.] (a) A 260.9 hospital is not eligible to receive a license condition for 260.10 swing beds unless (1) it either has a licensed bed capacity of 260.11 less than 50 beds defined in the federal Medicare regulations, 260.12 Code of Federal Regulations, title 42, section 482.66, or it has 260.13 a licensed bed capacity of 50 beds or more and has swing beds 260.14 that were approved for Medicare reimbursement before May 1, 260.15 1985, or it has a licensed bed capacity of less than 65 beds and 260.16 the available nursing homes within 50 miles have had, in the 260.17 aggregate, an average occupancy rate of 96 percent or higher in 260.18 the most recent two years as documented on the statistical 260.19 reports to the Department of Health; and (2) it is located in a 260.20 rural area as defined in the federal Medicare regulations, Code 260.21 of Federal Regulations, title 42, section 482.66. 260.22 (b) Except for those critical access hospitals established 260.23 under section 144.1483, clause (10), and section 1820 of the 260.24 federal Social Security Act, United States Code, title 42, 260.25 section 1395i-4, that have an attached nursing home, eligible 260.26 hospitals are allowed a total of1,4602,000 days of swing bed 260.27 use per year, provided that no more than ten hospital beds are260.28used as swing beds at any one time. Critical access hospitals 260.29 that have an attached nursing home are allowed swing bed use as 260.30 provided in federal law. 260.31 (c) Except for critical access hospitals that have an 260.32 attached nursing home, the commissioner of healthmustmay 260.33 approve swing bed use beyond1,4602,000 days as long as there 260.34 are no Medicare certified skilled nursing facility beds 260.35 available within 25 miles of that hospital that are willing to 260.36 admit the patient. Critical access hospitals exceeding 2,000 261.1 swing bed days must maintain documentation that they have 261.2 contacted skilled nursing facilities within 25 miles to 261.3 determine if any skilled nursing facility beds are available 261.4 that are willing to admit the patient. 261.5 (d) After reaching 2,000 days of swing bed use in a year, 261.6 an eligible hospital to which this limit applies may admit six 261.7 additional patients to swing beds each year without seeking 261.8 approval from the commissioner or being in violation of this 261.9 subdivision. These six swing bed admissions are exempt from the 261.10 limit of 2,000 annual swing bed days for hospitals subject to 261.11 this limit. 261.12 (e) A health care system that is in full compliance with 261.13 this subdivision may allocate its total limit of swing bed days 261.14 among the hospitals within the system, provided that no hospital 261.15 in the system without an attached nursing home may exceed 2,000 261.16 swing bed days per year. 261.17 Sec. 26. [144.574] [EDUCATION ABOUT THE DANGERS OF SHAKING 261.18 INFANTS AND YOUNG CHILDREN.] 261.19 Subdivision 1. [EDUCATION BY HOSPITALS.] (a) A hospital 261.20 licensed under sections 144.50 to 144.56 shall make available 261.21 for viewing by the parents of each newborn baby delivered in the 261.22 hospital a video presentation on the dangers associated with 261.23 shaking infants and young children. 261.24 (b) A hospital shall use a video obtained from the 261.25 commissioner or approved by the commissioner. The commissioner 261.26 shall provide to a hospital at cost copies of an approved 261.27 video. The commissioner shall review other video presentations 261.28 for possible approval upon the request of a hospital. The 261.29 commissioner shall not require a hospital to use videos that 261.30 would require the hospital to pay royalties for use of the 261.31 video, restrict viewing in order to comply with public viewing 261.32 or other restrictions, or be subject to other costs or 261.33 restrictions associated with copyrights. 261.34 (c) A hospital shall, whenever possible, request both 261.35 parents to view the video. 261.36 (d) The showing or distribution of the video shall not 262.1 subject any person or facility to any action for damages or 262.2 other relief provided the person or facility acted in good faith. 262.3 Subd. 2. [EDUCATION BY HEALTH CARE PROVIDERS.] The 262.4 commissioner shall establish a protocol for health care 262.5 providers to educate parents and primary caregivers about the 262.6 dangers associated with shaking infants and young children. The 262.7 commissioner shall request family practice physicians, 262.8 pediatricians, and other pediatric health care providers to 262.9 review these dangers with the parents and primary caregivers of 262.10 infants and young children up to the age of three at each 262.11 well-baby visit. 262.12 Sec. 27. [144.601] [ESTABLISHING A VOLUNTARY TRAUMA 262.13 SYSTEM.] 262.14 The legislature finds that death and disability from major 262.15 trauma among Minnesotans can be reduced by implementing a 262.16 statewide trauma system designed to provide that each severely 262.17 injured person is promptly transported and treated at facilities 262.18 appropriate to the severity of injury. The legislature further 262.19 finds that the most effective way to ensure this outcome is 262.20 through a system of voluntary participation, based on criteria 262.21 issued by the commissioner of health. 262.22 Sec. 28. [144.602] [DEFINITIONS.] 262.23 Subdivision 1. [APPLICABILITY.] For purposes of sections 262.24 144.601 to 144.608, the terms defined in this section have the 262.25 meanings given them. 262.26 Subd. 2. [COMMISSIONER.] "Commissioner" means the 262.27 commissioner of health. 262.28 Subd. 3. [MAJOR TRAUMA.] "Major trauma" means a sudden 262.29 severe injury or damage to the body caused by an external force 262.30 that results in potentially life-threatening injuries or that 262.31 could result in the following disabilities: 262.32 (1) impairment of cognitive or mental abilities; 262.33 (2) impairment of physical functioning; or 262.34 (3) disturbance of behavioral or emotional functioning. 262.35 Subd. 4. [TRAUMA HOSPITAL.] "Trauma hospital" means a 262.36 hospital that voluntarily meets the commissioner's criteria 263.1 under section 144.603 and that has been designated as a trauma 263.2 hospital under section 144.605. 263.3 Sec. 29. [144.603] [STATEWIDE TRAUMA SYSTEM CRITERIA.] 263.4 Subdivision 1. [CRITERIA ESTABLISHED.] The commissioner 263.5 shall adopt criteria to ensure that severely injured people are 263.6 promptly transported and treated at trauma hospitals appropriate 263.7 to the severity of injury. Minimum criteria shall address 263.8 emergency medical service trauma triage and transportation 263.9 guidelines as approved under section 144E.102, subdivision 14, 263.10 designation of hospitals as trauma hospitals, interhospital 263.11 transfers, a trauma registry, and a trauma system governance 263.12 structure. 263.13 Subd. 2. [BASIS; VERIFICATION.] The commissioner shall 263.14 base the establishment, implementation, and modifications to the 263.15 criteria under subdivision 1 on the department-published 263.16 Minnesota comprehensive statewide trauma system plan. The 263.17 commissioner shall seek the advice of the Trauma Advisory 263.18 Council in implementing and updating the criteria, using 263.19 accepted and prevailing trauma transport, treatment, and 263.20 referral standards of the American College of Surgeons, the 263.21 American College of Emergency Physicians, the Minnesota 263.22 Emergency Medical Services Regulatory Board, the national Trauma 263.23 Resources Network, and other widely recognized trauma experts. 263.24 The commissioner shall adapt and modify the standards as 263.25 appropriate to accommodate Minnesota's unique geography and the 263.26 state's hospital and health professional distribution and shall 263.27 verify that the criteria are met by each hospital voluntarily 263.28 participating in the statewide trauma system. 263.29 Subd. 3. [RULE EXEMPTION AND REPORT TO THE 263.30 LEGISLATURE.] In developing and adopting the criteria under this 263.31 section, the commissioner of health is exempt from chapter 14, 263.32 including section 14.386. By September 1, 2009, the 263.33 commissioner must report to the legislature on implementation of 263.34 the voluntary trauma system, including recommendations on the 263.35 need for including the trauma system criteria in rule. 263.36 Sec. 30. [144.604] [TRAUMA TRIAGE AND TRANSPORTATION.] 264.1 Subdivision 1. [TRANSPORT REQUIREMENT.] Unless the 264.2 Emergency Medical Services Regulatory Board has approved a 264.3 licensed ambulance service's deviation from the guidelines under 264.4 section 144E.101, subdivision 14, the ambulance service must 264.5 transport major trauma patients from the scene to the highest 264.6 state-designated trauma hospital within 30 minutes' transport 264.7 time. 264.8 Subd. 2. [GROUND AMBULANCE EXCEPTIONS.] Notwithstanding 264.9 subdivision 1, ground ambulances must comply with the following: 264.10 (1) patients with compromised airways must be transported 264.11 immediately to the nearest designated trauma hospital; and 264.12 (2) level II trauma hospitals capable of providing 264.13 definitive trauma care must not be bypassed to reach a level I 264.14 trauma hospital. 264.15 Subd. 3. [UNDESIGNATED HOSPITALS.] No major trauma patient 264.16 shall be transported to a hospital not participating in the 264.17 statewide trauma system unless no trauma hospital is available 264.18 within 30 minutes' transport time. 264.19 [EFFECTIVE DATE.] This section is effective July 1, 2009. 264.20 Sec. 31. [144.605] [DESIGNATING TRAUMA HOSPITALS.] 264.21 Subdivision 1. [NAMING PRIVILEGES.] Unless it has been 264.22 designated a trauma hospital by the commissioner, no hospital 264.23 shall use the term trauma center or trauma hospital in its name 264.24 or its advertising or shall otherwise indicate it has trauma 264.25 treatment capabilities. 264.26 Subd. 2. [DESIGNATION; REVERIFICATION.] The commissioner 264.27 shall designate four levels of trauma hospitals. A hospital 264.28 that voluntarily meets the criteria for a particular level of 264.29 trauma hospital shall apply to the commissioner for designation 264.30 and, upon the commissioner's verifying the hospital meets the 264.31 criteria, be designated a trauma hospital at the appropriate 264.32 level for a three-year period. Prior to the expiration of the 264.33 three-year designation, a hospital seeking to remain part of the 264.34 voluntary system must apply for and successfully complete a 264.35 reverification process, be awaiting the site visit for the 264.36 reverification, or be awaiting the results of the site visit. 265.1 The commissioner may extend a hospital's existing designation 265.2 for up to 18 months on a provisional basis if the hospital has 265.3 applied for reverification in a timely manner but has not yet 265.4 completed the reverification process within the expiration of 265.5 the three-year designation and the extension is in the best 265.6 interest of trauma system patient safety. To be granted a 265.7 provisional extension, the hospital must be: 265.8 (1) scheduled and awaiting the site visit for 265.9 reverification; 265.10 (2) awaiting the results of the site visit; or 265.11 (3) responding to and correcting identified deficiencies 265.12 identified in the site visit. 265.13 Subd. 3. [ACS VERIFICATION.] The commissioner shall grant 265.14 the appropriate level I, II, or III trauma hospital designation 265.15 to a hospital that successfully completes and passes the 265.16 American College of Surgeons (ACS) verification standards at the 265.17 hospital's cost, submits verification documentation to the 265.18 Trauma Advisory Council, and formally notifies the Trauma 265.19 Advisory Council of ACS verification. 265.20 Subd. 4. [LEVEL III DESIGNATION; NOT ACS VERIFIED.] (a) 265.21 The commissioner shall grant the appropriate level III trauma 265.22 hospital designation to a hospital that is not ACS verified but 265.23 that successfully completes the designation process under 265.24 paragraph (b). 265.25 (b) The hospital must complete and submit a self-reported 265.26 survey and application to the Trauma Advisory Council for 265.27 review, verifying that the hospital meets the criteria as a 265.28 level III trauma hospital. When the Trauma Advisory Council is 265.29 satisfied the application is complete, the commissioner shall 265.30 arrange a site review visit. Upon successful completion of the 265.31 site review, the review team shall make written recommendations 265.32 to the Trauma Advisory Council. If approved by the Trauma 265.33 Advisory Council, a letter of recommendation shall be sent to 265.34 the commissioner for final approval and designation. 265.35 Subd. 5. [LEVEL IV DESIGNATION.] (a) The commissioner 265.36 shall grant the appropriate level IV trauma hospital designation 266.1 to a hospital that successfully completes the designation 266.2 process under paragraph (b). 266.3 (b) The hospital must complete and submit a self-reported 266.4 survey and application to the Trauma Advisory Council for 266.5 review, verifying that the hospital meets the criteria as a 266.6 level IV trauma hospital. When the Trauma Advisory Council is 266.7 satisfied the application is complete, the council shall review 266.8 the application and, if the council approves the application, 266.9 send a letter of recommendation to the commissioner for final 266.10 approval and designation. The commissioner shall grant a level 266.11 IV designation and shall arrange a site review visit within 266.12 three years of the designation and every three years thereafter, 266.13 to coincide with the three-year reverification process. 266.14 Subd. 6. [CHANGES IN DESIGNATION.] Changes in a trauma 266.15 hospital's ability to meet the criteria for the hospital's level 266.16 of designation must be self-reported to the Trauma Advisory 266.17 Council and to other regional hospitals and local emergency 266.18 medical services providers and authorities. If the hospital 266.19 cannot correct its ability to meet the criteria for its level 266.20 within six months, the hospital may apply for redesignation at a 266.21 different level. 266.22 Subd. 7. [HIGHER DESIGNATION.] A trauma hospital may apply 266.23 for a higher trauma hospital designation one time during the 266.24 hospital's three-year designation by completing the designation 266.25 process for that level of trauma hospital. 266.26 Subd. 8. [LOSS OF DESIGNATION.] The commissioner may 266.27 refuse to designate or redesignate or may revoke a previously 266.28 issued trauma hospital designation if a hospital does not meet 266.29 the criteria of the statewide trauma plan, in the interests of 266.30 patient safety, or if a hospital denies or refuses a reasonable 266.31 request by the commissioner or the commissioner's designee to 266.32 verify information by correspondence or an on-site visit. 266.33 Sec. 32. [144.606] [INTERHOSPITAL TRANSFERS.] 266.34 Subdivision 1. [WRITTEN PROCEDURES REQUIRED.] A level III 266.35 or IV trauma hospital must have predetermined, written 266.36 procedures that direct the internal process for rapidly and 267.1 efficiently transferring a major trauma patient to definitive 267.2 care, including: 267.3 (1) clearly identified anatomic and physiologic criteria 267.4 that, if met, will immediately initiate transfer to definitive 267.5 care; 267.6 (2) a listing of appropriate ground and air transport 267.7 services, including primary and secondary telephone contact 267.8 numbers; and 267.9 (3) immediately available supplies, records, or other 267.10 necessary resources that will accompany a patient. 267.11 Subd. 2. [TRANSFER AGREEMENTS.] (a) A level III or IV 267.12 trauma hospital may transfer patients to a hospital with which 267.13 the trauma hospital has a written transfer agreement. 267.14 (b) Each agreement must be current and with a trauma 267.15 hospital or trauma hospitals capable of caring for major trauma 267.16 injuries. 267.17 (c) A level III or IV trauma hospital must have a current 267.18 transfer agreement with a hospital that has special capabilities 267.19 in the treatment of burn injuries and a transfer agreement with 267.20 a second hospital that has special capabilities in the treatment 267.21 of burn injuries, should the primary transfer hospital be unable 267.22 to accept a burn patient. 267.23 Sec. 33. [144.607] [TRAUMA REGISTRY.] 267.24 Subdivision 1. [REGISTRY PARTICIPATION REQUIRED.] A trauma 267.25 hospital must participate in the statewide trauma registry. 267.26 Subd. 2. [TRAUMA REPORTING.] A trauma hospital must report 267.27 major trauma injuries as part of the reporting for the traumatic 267.28 brain injury and spinal cord injury registry required in 267.29 sections 144.661 to 144.665. 267.30 Subd. 3. [APPLICATION OF OTHER LAW.] Sections 144.661 to 267.31 144.665 apply to a major trauma reported to the statewide trauma 267.32 registry, with the exception of sections 144.662, clause (2), 267.33 and 144.664, subdivision 3. 267.34 Sec. 34. [144.608] [TRAUMA ADVISORY COUNCIL.] 267.35 Subdivision 1. [TRAUMA ADVISORY COUNCIL ESTABLISHED.] (a) 267.36 A Trauma Advisory Council is established to advise, consult 268.1 with, and make recommendations to the commissioner on the 268.2 development, maintenance, and improvement of a statewide trauma 268.3 system. 268.4 (b) The council shall consist of the following members: 268.5 (1) a trauma surgeon certified by the American College of 268.6 Surgeons who practices in a level I or II trauma hospital; 268.7 (2) a general surgeon certified by the American College of 268.8 Surgeons whose practice includes trauma and who practices in a 268.9 designated rural area as defined under section 144.1501, 268.10 subdivision 1, paragraph (b); 268.11 (3) a neurosurgeon certified by the American Board of 268.12 Neurological Surgery who practices in a level I or II trauma 268.13 hospital; 268.14 (4) a trauma program nurse manager or coordinator 268.15 practicing in a level I or II trauma hospital; 268.16 (5) an emergency physician certified by the American 268.17 College of Emergency Physicians whose practice includes 268.18 emergency room care in a level I, II, III, or IV trauma 268.19 hospital; 268.20 (6) an emergency room nurse manager who practices in a 268.21 level III or IV trauma hospital; 268.22 (7) a family practice physician whose practice includes 268.23 emergency room care in a level III or IV trauma hospital located 268.24 in a designated rural area as defined under section 144.1501, 268.25 subdivision 1, paragraph (b); 268.26 (8) a nurse practitioner, as defined under section 268.27 144.1501, subdivision 1, paragraph (h), or a physician 268.28 assistant, as defined under section 144.1501, subdivision 1, 268.29 paragraph (j), whose practice includes emergency room care in a 268.30 level IV trauma hospital located in a designated rural area as 268.31 defined under section 144.1501, subdivision 1, paragraph (b); 268.32 (9) a pediatrician certified by the American Academy of 268.33 Pediatrics whose practice includes emergency room care in a 268.34 level I, II, III, or IV trauma hospital; 268.35 (10) an orthopedic surgeon certified by the American Board 268.36 of Orthopaedic Surgery whose practice includes trauma and who 269.1 practices in a level I, II, or III trauma hospital; 269.2 (11) the state emergency medical services medical director 269.3 appointed by the Emergency Medical Services Regulatory Board; 269.4 (12) a hospital administrator of a level III or IV trauma 269.5 hospital located in a designated rural area as defined under 269.6 section 144.1501, subdivision 1, paragraph (b); 269.7 (13) a rehabilitation specialist whose practice includes 269.8 rehabilitation of patients with major trauma injuries or 269.9 traumatic brain injuries and spinal cord injuries as defined 269.10 under section 144.661; 269.11 (14) an attendant or ambulance director who is an EMT, 269.12 EMT-I, or EMT-P within the meaning of section 144E.001 and who 269.13 actively practices with a licensed ambulance service in a 269.14 primary service area located in a designated rural area as 269.15 defined under section 144.1501, subdivision 1, paragraph (b); 269.16 and 269.17 (15) the commissioner of public safety or the 269.18 commissioner's designee. 269.19 (c) Council members whose appointment is dependent on 269.20 practice in a level III or IV trauma hospital may be appointed 269.21 to an initial term based upon their statements that the hospital 269.22 intends to become a level III or IV facility by July 1, 2009. 269.23 Subd. 2. [COUNCIL ADMINISTRATION.] (a) The council must 269.24 meet at least twice a year but may meet more frequently at the 269.25 call of the chair, a majority of the council members, or the 269.26 commissioner. 269.27 (b) The terms, compensation, and removal of members of the 269.28 council are governed by section 15.059, except that the council 269.29 expires June 30, 2015. 269.30 (c) The council may appoint subcommittees and workgroups. 269.31 Subcommittees shall consist of council members. Workgroups may 269.32 include noncouncil members. Noncouncil members shall be 269.33 compensated for workgroup activities under section 15.059, 269.34 subdivision 3, but shall receive expenses only. 269.35 Subd. 3. [REGIONAL TRAUMA ADVISORY COUNCILS.] (a) Up to 269.36 eight regional trauma advisory councils may be formed as needed. 270.1 (b) Regional trauma advisory councils shall advise, consult 270.2 with, and make recommendation to the state Trauma Advisory 270.3 Council on suggested regional modifications to the statewide 270.4 trauma criteria that will improve patient care and accommodate 270.5 specific regional needs. 270.6 (c) Each regional advisory council must have no more than 270.7 15 members. The commissioner, in consultation with the 270.8 Emergency Medical Services Regulatory Board, shall name the 270.9 council members. 270.10 (d) Regional council members may receive expenses in the 270.11 same manner and amount as authorized by the plan adopted under 270.12 section 43A.18, subdivision 2. 270.13 Sec. 35. [144.707] [CANCER DRUG REPOSITORY PROGRAM.] 270.14 Subdivision 1. [DEFINITIONS.] (a) For the purposes of this 270.15 section, the terms defined in this subdivision have the meanings 270.16 given. 270.17 (b) "Cancer drug" means a prescription drug that is used to 270.18 treat: 270.19 (1) cancer or the side effects of cancer; or 270.20 (2) the side effects of any prescription drug that is used 270.21 to treat cancer or the side effects of cancer. 270.22 (c) "Cancer drug repository" means a medical facility or 270.23 pharmacy that has notified the Board of Pharmacy of its election 270.24 to participate in the cancer drug repository program. 270.25 (d) "Cancer supply" or "cancer supplies" means prescription 270.26 and nonprescription cancer supplies needed to administer a 270.27 cancer drug. 270.28 (e) "Board of Pharmacy" means the Minnesota State Board of 270.29 Pharmacy. 270.30 (f) "Dispense" has the meaning given in section 151.01, 270.31 subdivision 30. 270.32 (g) "Distribute" means to deliver, other than by 270.33 administering or dispensing. 270.34 (h) "Donor" means an individual and not a manufacturer or 270.35 wholesale drug distributor. 270.36 (i) "Medical facility" means an institution defined in 271.1 section 144.50, subdivision 2. 271.2 (j) "Medical supplies" means any prescription and 271.3 nonprescription medical supply needed to administer a cancer 271.4 drug. 271.5 (k) "Pharmacist" has the meaning given in section 151.01, 271.6 subdivision 3. 271.7 (l) "Pharmacy" means any pharmacy registered with the Board 271.8 of Pharmacy according to section 151.19, subdivision 1. 271.9 (m) "Practitioner" has the meaning given in section 151.01, 271.10 subdivision 23. 271.11 (n) "Prescription drug" means a legend drug as defined in 271.12 section 151.01, subdivision 17. 271.13 (o) "Side effects of cancer" means symptoms of cancer. 271.14 (p) "Single-unit-dose packaging" means a single-unit 271.15 container for articles intended for administration as a single 271.16 dose, direct from the container. 271.17 (q) "Tamper-evident unit dose packaging" means a container 271.18 within which a drug is sealed so that the contents cannot be 271.19 opened without obvious destruction of the seal. 271.20 Subd. 2. [ESTABLISHMENT.] The Board of Pharmacy shall 271.21 establish and maintain a cancer drug repository program under 271.22 which any person may donate a cancer drug or supply for use by 271.23 an individual who meets the eligibility criteria specified under 271.24 subdivision 4. Under the program, donations may be made on the 271.25 premises of a medical facility or pharmacy that elects to 271.26 participate in the program and meets the requirements specified 271.27 under subdivision 3. 271.28 Subd. 3. [REQUIREMENTS FOR PARTICIPATION BY PHARMACIES AND 271.29 MEDICAL FACILITIES.] (a) To be eligible for participation in the 271.30 cancer drug repository program, a pharmacy or medical facility 271.31 must be licensed and in compliance with all applicable federal 271.32 and state laws and administrative rules. 271.33 (b) Participation in the cancer drug repository program is 271.34 voluntary. A pharmacy or medical facility may elect to 271.35 participate in the cancer drug repository program by submitting 271.36 the following information to the Board of Pharmacy, in a form 272.1 provided by the Board of Pharmacy: 272.2 (1) the name, street address, and telephone number of the 272.3 pharmacy or medical facility; 272.4 (2) the name and telephone number of a pharmacist who is 272.5 employed by or under contract with the pharmacy or medical 272.6 facility, or other contact person who is familiar with the 272.7 pharmacy's or medical facility's participation in the cancer 272.8 drug repository program; and 272.9 (3) a statement indicating that the pharmacy or medical 272.10 facility meets the eligibility requirements under paragraph (a) 272.11 and the chosen level of participation under paragraph (c). 272.12 (c) A pharmacy or medical facility may fully participate in 272.13 the cancer drug repository program by accepting, storing, and 272.14 dispensing donated drugs and supplies, or may limit its 272.15 participation to only accepting and storing donated drugs and 272.16 supplies. If a pharmacy or facility chooses to limit its 272.17 participation, the pharmacy or facility shall distribute any 272.18 donated drugs to a fully participating cancer drug repository 272.19 according to subdivision 8. 272.20 (d) A pharmacy or medical facility may withdraw from 272.21 participation in the cancer drug repository program at any time 272.22 upon notification to the Board of Pharmacy. A notice to 272.23 withdraw from participation may be given by telephone or U.S. 272.24 mail. 272.25 Subd. 4. [INDIVIDUAL ELIGIBILITY REQUIREMENTS.] Any 272.26 Minnesota resident who is diagnosed with cancer is eligible to 272.27 receive drugs or supplies under the cancer drug repository 272.28 program. Drugs and supplies shall be dispensed according to the 272.29 priority given under subdivision 6. 272.30 Subd. 5. [DONATIONS OF CANCER DRUGS AND SUPPLIES.] (a) Any 272.31 one of the following persons may donate legally obtained cancer 272.32 drugs or supplies to a cancer drug repository if the drugs or 272.33 supplies meet the requirements under paragraph (b) or (c) as 272.34 determined by a pharmacist who is employed by or under contract 272.35 with a cancer drug repository: 272.36 (1) an individual who is 18 years of age or older; or 273.1 (2) a pharmacy, medical facility, drug manufacturer, or 273.2 wholesale drug distributor, if the donated drugs have not been 273.3 previously dispensed. 273.4 (b) A cancer drug is eligible for donation under the cancer 273.5 drug repository program only if the following requirements are 273.6 met: 273.7 (1) the donation is accompanied by a cancer drug repository 273.8 donor form described under paragraph (d) that is signed by the 273.9 person making the donation or that person's authorized 273.10 representative; 273.11 (2) the drug's expiration date is at least six months later 273.12 than the date that the drug was donated; 273.13 (3) the drug is in its original, unopened, tamper-evident 273.14 unit dose packaging that includes the drug's lot number and 273.15 expiration date. Single-unit dose drugs may be accepted if the 273.16 single-unit-dose packaging is unopened; and 273.17 (4) the drug is not adulterated or misbranded. 273.18 (c) Cancer supplies are eligible for donation under the 273.19 cancer drug repository program only if the following 273.20 requirements are met: 273.21 (1) the supplies are not adulterated or misbranded; 273.22 (2) the supplies are in their original, unopened, sealed 273.23 packaging; and 273.24 (3) the donation is accompanied by a cancer drug repository 273.25 donor form described under paragraph (d) that is signed by the 273.26 person making the donation or that person's authorized 273.27 representative. 273.28 (d) The cancer drug repository donor form must be provided 273.29 by the Board of Pharmacy and shall state that to the best of the 273.30 donor's knowledge the donated drug or supply has been properly 273.31 stored and that the drug or supply has never been opened, used, 273.32 tampered with, adulterated, or misbranded. The Board of 273.33 Pharmacy shall make the cancer drug repository donor form 273.34 available on the Board of Pharmacy's Web site. 273.35 (e) Controlled substances and drugs and supplies that do 273.36 not meet the criteria under this subdivision are not eligible 274.1 for donation or acceptance under the cancer drug repository 274.2 program. 274.3 (f) Drugs and supplies may be donated on the premises of a 274.4 cancer drug repository to a pharmacist designated by the 274.5 repository. A drop box may not be used to deliver or accept 274.6 donations. 274.7 (g) Cancer drugs and supplies donated under the cancer drug 274.8 repository program must be stored in a secure storage area under 274.9 environmental conditions appropriate for the drugs or supplies 274.10 being stored. Donated drugs and supplies may not be stored with 274.11 nondonated inventory. 274.12 Subd. 6. [DISPENSING REQUIREMENTS.] (a) Drugs and supplies 274.13 must be dispensed by a licensed pharmacist pursuant to a 274.14 prescription by a practitioner and according to the requirements 274.15 of chapter 151. 274.16 (b) Before being dispensed, cancer drugs and supplies shall 274.17 be visually inspected by the pharmacist for adulteration, 274.18 misbranding, and date of expiration. Drugs or supplies that 274.19 have expired or appear upon visual inspection to be adulterated, 274.20 misbranded, or tampered with in any way may not be dispensed. 274.21 (c) Before a cancer drug or supply may be dispensed to an 274.22 individual, the individual must sign a cancer drug repository 274.23 recipient form provided by the Board of Pharmacy acknowledging 274.24 that the individual understands the information stated on the 274.25 form. The form shall include the following information: 274.26 (1) that the drug or supply being dispensed has been 274.27 donated and may have been previously dispensed; 274.28 (2) that a visual inspection has been conducted by the 274.29 pharmacist to ensure that the drug has not expired, has not been 274.30 adulterated or misbranded, and is in its original, unopened 274.31 packaging; and 274.32 (3) that the dispensing pharmacist, the cancer drug 274.33 repository, the Board of Pharmacy, and any other participant in 274.34 the cancer drug repository program cannot guarantee the safety 274.35 of the drug or supply being dispensed and that the pharmacist 274.36 has determined that the drug or supply is safe to dispense based 275.1 on the accuracy of the donor's form submitted with the donated 275.2 drug or supply and the visual inspection required to be 275.3 performed by the pharmacist before dispensing. 275.4 The Board of Pharmacy shall make the cancer drug repository form 275.5 available on the Board of Pharmacy's Web site. 275.6 (d) Drugs and supplies shall only be dispensed to 275.7 individuals who meet the eligibility requirements in subdivision 275.8 4 and in the following order of priority: 275.9 (1) individuals who are uninsured; 275.10 (2) individuals who are enrolled in medical assistance, 275.11 general assistance medical care, MinnesotaCare, Medicare, or 275.12 other public assistance health care; and 275.13 (3) all other individuals who are otherwise eligible under 275.14 subdivision 4 to receive drugs or supplies from a cancer drug 275.15 repository. 275.16 Subd. 7. [HANDLING FEES.] A cancer drug repository may 275.17 charge the individual receiving a drug or supply a handling fee 275.18 of no more than 250 percent of the medical assistance program 275.19 dispensing fee for each cancer drug or supply dispensed. 275.20 Subd. 8. [DISTRIBUTION OF DONATED CANCER DRUGS AND 275.21 SUPPLIES.] (a) Cancer drug repositories may distribute drugs and 275.22 supplies donated under the cancer drug repository program to 275.23 other repositories if requested by a participating repository. 275.24 (b) A cancer drug repository that has elected not to 275.25 dispense donated drugs or supplies shall distribute any donated 275.26 drugs and supplies to a participating repository upon request of 275.27 the repository. 275.28 (c) If a cancer drug repository distributes drugs or 275.29 supplies under paragraph (a) or (b), the repository shall 275.30 complete a cancer drug repository donor form provided by the 275.31 Board of Pharmacy. The completed form and a copy of the donor 275.32 form that was completed by the original donor under subdivision 275.33 5 shall be provided to the fully participating cancer drug 275.34 repository at the time of distribution. 275.35 Subd. 9. [RESALE OF DONATED DRUGS AND SUPPLIES.] Donated 275.36 drugs and supplies may not be resold. 276.1 Subd. 10. [RECORD KEEPING REQUIREMENTS.] (a) Cancer drug 276.2 repository donor and recipient forms shall be maintained for at 276.3 least five years. 276.4 (b) A record of destruction of donated drugs and supplies 276.5 that are not dispensed under subdivision 6 shall be maintained 276.6 by the dispensing repository for at least five years. For each 276.7 drug or supply destroyed, the record shall include the following 276.8 information: 276.9 (1) the date of destruction; 276.10 (2) the name, strength, and quantity of the cancer drug 276.11 destroyed; 276.12 (3) the name of the person or firm that destroyed the drug; 276.13 and 276.14 (4) the source of the drugs or supplies destroyed. 276.15 Subd. 11. [LIABILITY.] (a) The manufacturer of a drug or 276.16 supply is not subject to criminal or civil liability for injury, 276.17 death, or loss to a person or to property due to participation 276.18 in the cancer drug repository program. Manufacturers are not 276.19 liable for: 276.20 (1) the intentional or unintentional alteration of the drug 276.21 or supply by a party not under the control of the manufacturer; 276.22 or 276.23 (2) failure of a party not under the control of the 276.24 manufacturer to transfer or communicate product or consumer 276.25 information or the expiration date of the donated drug or supply. 276.26 (b) A medical facility or pharmacy participating in the 276.27 program, a pharmacist dispensing a drug or supply pursuant to 276.28 the program, a practitioner administering a drug or supply 276.29 pursuant to the program, or the donor of a cancer drug or supply 276.30 is immune from civil liability for an act or omission that 276.31 causes injury to or the death of an individual to whom the 276.32 cancer drug or supply is dispensed and no disciplinary action 276.33 shall be taken against a pharmacist or practitioner so long as 276.34 the drug or supply is donated, accepted, distributed, and 276.35 dispensed according to the requirements of this section. This 276.36 immunity does not apply if the act or omission involves 277.1 reckless, wanton, or intentional misconduct, or malpractice 277.2 unrelated to the quality of the cancer drug or supply. 277.3 Sec. 36. Minnesota Statutes 2004, section 144.9504, 277.4 subdivision 2, is amended to read: 277.5 Subd. 2. [LEAD RISK ASSESSMENT.] (a) An assessing agency 277.6 shall conduct a lead risk assessment of a residence according to 277.7 the venous blood lead level and time frame set forth in clauses 277.8 (1) to(5)(4) for purposes of secondary prevention: 277.9 (1) within 48 hours of a child or pregnant female in the 277.10 residence being identified to the agency as having a venous 277.11 blood lead level equal to or greater than7060 micrograms of 277.12 lead per deciliter of whole blood; 277.13 (2) within five working days of a child or pregnant female 277.14 in the residence being identified to the agency as having a 277.15 venous blood lead level equal to or greater than 45 micrograms 277.16 of lead per deciliter of whole blood; 277.17 (3) within ten working days of a child in the residence 277.18 being identified to the agency as having a venous blood lead 277.19 level equal to or greater than2015 micrograms of lead per 277.20 deciliter of whole blood; 277.21 (4)within ten working days of a child in the residence277.22being identified to the agency as having a venous blood lead277.23level that persists in the range of 15 to 19 micrograms of lead277.24per deciliter of whole blood for 90 days after initial277.25identification; or277.26(5)within ten working days of a pregnant female in the 277.27 residence being identified to the agency as having a venous 277.28 blood lead level equal to or greater than ten micrograms of lead 277.29 per deciliter of whole blood. 277.30 (b) Within the limits of available local, state, and 277.31 federal appropriations, an assessing agency may also conduct a 277.32 lead risk assessment for children with any elevated blood lead 277.33 level. 277.34 (c) In a building with two or more dwelling units, an 277.35 assessing agency shall assess the individual unit in which the 277.36 conditions of this section are met and shall inspect all common 278.1 areas accessible to a child. If a child visits one or more 278.2 other sites such as another residence, or a residential or 278.3 commercial child care facility, playground, or school, the 278.4 assessing agency shall also inspect the other sites. The 278.5 assessing agency shall have one additional day added to the time 278.6 frame set forth in this subdivision to complete the lead risk 278.7 assessment for each additional site. 278.8 (d) Within the limits of appropriations, the assessing 278.9 agency shall identify the known addresses for the previous 12 278.10 months of the child or pregnant female with venous blood lead 278.11 levels of at least2015 micrograms per deciliter for the child 278.12 or at least ten micrograms per deciliter for the pregnant 278.13 female; notify the property owners, landlords, and tenants at 278.14 those addresses that an elevated blood lead level was found in a 278.15 person who resided at the property; and give them primary 278.16 prevention information. Within the limits of appropriations, 278.17 the assessing agency may perform a risk assessment and issue 278.18 corrective orders in the properties, if it is likely that the 278.19 previous address contributed to the child's or pregnant female's 278.20 blood lead level. The assessing agency shall provide the notice 278.21 required by this subdivision without identifying the child or 278.22 pregnant female with the elevated blood lead level. The 278.23 assessing agency is not required to obtain the consent of the 278.24 child's parent or guardian or the consent of the pregnant female 278.25 for purposes of this subdivision. This information shall be 278.26 classified as private data on individuals as defined under 278.27 section 13.02, subdivision 12. 278.28 (e) The assessing agency shall conduct the lead risk 278.29 assessment according to rules adopted by the commissioner under 278.30 section 144.9508. An assessing agency shall have lead risk 278.31 assessments performed by lead risk assessors licensed by the 278.32 commissioner according to rules adopted under section 144.9508. 278.33 If a property owner refuses to allow a lead risk assessment, the 278.34 assessing agency shall begin legal proceedings to gain entry to 278.35 the property and the time frame for conducting a lead risk 278.36 assessment set forth in this subdivision no longer applies. A 279.1 lead risk assessor or assessing agency may observe the 279.2 performance of lead hazard reduction in progress and shall 279.3 enforce the provisions of this section under section 144.9509. 279.4 Deteriorated painted surfaces, bare soil, and dust must be 279.5 tested with appropriate analytical equipment to determine the 279.6 lead content, except that deteriorated painted surfaces or bare 279.7 soil need not be tested if the property owner agrees to engage 279.8 in lead hazard reduction on those surfaces. The lead content of 279.9 drinking water must be measured if another probable source of 279.10 lead exposure is not identified. Within a standard metropolitan 279.11 statistical area, an assessing agency may order lead hazard 279.12 reduction of bare soil without measuring the lead content of the 279.13 bare soil if the property is in a census tract in which soil 279.14 sampling has been performed according to rules established by 279.15 the commissioner and at least 25 percent of the soil samples 279.16 contain lead concentrations above the standard in section 279.17 144.9508. 279.18 (f) Each assessing agency shall establish an administrative 279.19 appeal procedure which allows a property owner to contest the 279.20 nature and conditions of any lead order issued by the assessing 279.21 agency. Assessing agencies must consider appeals that propose 279.22 lower cost methods that make the residence lead safe. The 279.23 commissioner shall use the authority and appeal procedure 279.24 granted under sections 144.989 to 144.993. 279.25 (g) Sections 144.9501 to 144.9509 neither authorize nor 279.26 prohibit an assessing agency from charging a property owner for 279.27 the cost of a lead risk assessment. 279.28 Sec. 37. Minnesota Statutes 2004, section 144.98, 279.29 subdivision 3, is amended to read: 279.30 Subd. 3. [FEES.] (a) An application for certification 279.31 under subdivision 1 must be accompanied by the biennial fee 279.32 specified in this subdivision. The fees are for: 279.33 (1)nonrefundablebase certification fee,$1,200279.34 $1,600;and279.35 (2) sample preparation techniques fees, $100 per technique; 279.36 and 280.1 (3) test category certification fees: 280.2 Test Category Certification Fee 280.3 Clean water program bacteriology$600$800 280.4 Safe drinking water program bacteriology$600$800 280.5 Clean water program inorganic chemistry$600$800 280.6 Safe drinking water program inorganic chemistry$600$800 280.7 Clean water program chemistry metals$800$1,200 280.8 Safe drinking water program chemistry metals$800$1,200 280.9 Resource conservation and recovery program 280.10 chemistry metals$800$1,200 280.11 Clean water program volatile organic compounds$1,200$1,500 280.12 Safe drinking water program 280.13 volatile organic compounds$1,200$1,500 280.14 Resource conservation and recovery program 280.15 volatile organic compounds$1,200$1,500 280.16 Underground storage tank program 280.17 volatile organic compounds$1,200$1,500 280.18 Clean water program other organic compounds$1,200$1,500 280.19 Safe drinking water program other organic compounds$1,200$1,500 280.20 Resource conservation and recovery program 280.21 other organic compounds$1,200$1,500 280.22 Clean water program radiochemistry $2,500 280.23 Safe drinking water program radiochemistry $2,500 280.24 Resource conservation and recovery program 280.25 agricultural contaminants $2,500 280.26 Resource conservation and recovery program 280.27 emerging contaminants $2,500 280.28 (b)The total biennial certification fee is the base fee280.29plus the applicable test category fees.280.30(c)Laboratories located outside of this state that require 280.31 an on-sitesurvey willinspection shall be assessed an 280.32 additional$2,500$3,750 fee. 280.33 (c) The total biennial certification fee includes the base 280.34 fee, the sample preparation techniques fees, the test category 280.35 fees, and, when applicable, the on-site inspection fee. 280.36 (d) Fees must be set so that the total fees support the 281.1 laboratory certification program. Direct costs of the 281.2 certification service include program administration, 281.3 inspections, the agency's general support costs, and attorney 281.4 general costs attributable to the fee function. 281.5 (e) A change fee shall be assessed if a laboratory requests 281.6 additional analytes or methods at any time other than when 281.7 applying for or renewing its certification. The change fee is 281.8 equal to the test category certification fee for the analyte. 281.9 (f) A variance fee shall be assessed if a laboratory 281.10 requests and is granted a variance from a rule adopted under 281.11 this section. The variance fee is $500 per variance. 281.12 (g) Refunds or credits shall not be made for analytes or 281.13 methods requested but not approved. 281.14 (h) Certification of a laboratory shall not be awarded 281.15 until all fees are paid. 281.16 Sec. 38. Minnesota Statutes 2004, section 144E.101, is 281.17 amended by adding a subdivision to read: 281.18 Subd. 14. [TRAUMA TRIAGE AND TRANSPORT GUIDELINES.] By 281.19 July 1, 2009, a licensee shall have written age appropriate 281.20 trauma triage and transport guidelines consistent with the 281.21 criteria issued by the Trauma Advisory Council and approved by 281.22 the board. The board may approve a licensee's requested 281.23 deviations to the guidelines due to the availability of local or 281.24 regional trauma resources if the changes are in the best 281.25 interest of the patient's health. 281.26 Sec. 39. [145.417] [FAMILY PLANNING GRANT FUNDS NOT USED 281.27 TO SUBSIDIZE ABORTION SERVICES.] 281.28 Subdivision 1. [DEFINITIONS.] (a) For purposes of this 281.29 section, the following definitions apply. 281.30 (b) "Abortion" means the use or prescription of any 281.31 instrument, medicine, drug, or any other substance or device to 281.32 intentionally terminate the pregnancy of a female known to be 281.33 pregnant, with an intention other than to prevent the death of 281.34 the female, increase the probability of a live birth, preserve 281.35 the life or health of the child after live birth, or remove a 281.36 dead fetus. 282.1 (c) "Family planning grant funds" means funds distributed 282.2 through the family planning special projects grant program under 282.3 section 145.925, or any other state grant program whose funds 282.4 are or may be used to fund family planning services. Family 282.5 planning grant funds shall not mean medical education funds 282.6 awarded under section 62J.692 to the University of Minnesota, 282.7 Mayo Clinic, or any other clinical medical education program in 282.8 the state. 282.9 (d) "Family planning services" means preconception services 282.10 that limit or enhance fertility, including methods of 282.11 contraception, the management of infertility, preconception 282.12 counseling, education, and general reproductive health care. 282.13 (e) "Nondirective counseling" means providing patients with: 282.14 (1) a list of health care providers and social service 282.15 providers that provide prenatal care, childbirth care, infant 282.16 care, foster care, adoption services, alternatives to abortion, 282.17 or abortion services; and 282.18 (2) nondirective, nonmarketing information regarding such 282.19 providers. 282.20 (f) "Public advocacy" means engaging in one or more of the 282.21 following: 282.22 (1) regularly engaging in efforts to encourage the passage 282.23 or defeat of legislation pertaining to the continued or expanded 282.24 availability of abortion; 282.25 (2) publicly endorsing or recommending the election or 282.26 defeat of a candidate for public office based on the candidate's 282.27 position on the legality of abortion; or 282.28 (3) engaging in civil litigation against a unit of 282.29 government as a plaintiff seeking to enjoin or otherwise 282.30 prohibit enforcement of a statute, ordinance, rule, or 282.31 regulation pertaining to abortion. 282.32 Subd. 2. [USES OF FAMILY PLANNING GRANT FUNDS.] No family 282.33 planning grant funds may be: 282.34 (1) expended to directly or indirectly subsidize abortion 282.35 services or administrative expenses; 282.36 (2) paid or granted to an organization or an affiliate of 283.1 an organization that provides abortion services, unless the 283.2 affiliate is independent as provided in subdivision 4; or 283.3 (3) paid or granted to an organization that has adopted or 283.4 maintains a policy in writing or through oral public statements 283.5 that abortion is considered part of a continuum of family 283.6 planning services, reproductive health services, or both. 283.7 Subd. 3. [ORGANIZATIONS RECEIVING FAMILY PLANNING GRANT 283.8 FUNDS.] An organization that receives family planning grant 283.9 funds: 283.10 (1) may provide nondirective counseling relating to 283.11 pregnancy but may not directly refer patients who seek abortion 283.12 services to any organization that provides abortion services, 283.13 including an independent affiliate of the organization receiving 283.14 family planning grant funds. For purposes of this clause, an 283.15 affiliate is independent if it satisfies the criteria in 283.16 subdivision 4, paragraph (a); 283.17 (2) may not display or distribute marketing materials about 283.18 abortion services to patients; 283.19 (3) may not engage in public advocacy promoting the 283.20 legality or accessibility of abortion; and 283.21 (4) must be separately incorporated from any affiliated 283.22 organization that provides abortion services. 283.23 Subd. 4. [INDEPENDENT AFFILIATES THAT PROVIDE ABORTION 283.24 SERVICES.] (a) To ensure that the state does not lend its 283.25 imprimatur to abortion services and to ensure that an 283.26 organization that provides abortion services does not receive a 283.27 direct or indirect economic or marketing benefit from family 283.28 planning grant funds, an organization that receives family 283.29 planning grant funds may not be affiliated with an organization 283.30 that provides abortion services unless the organizations are 283.31 independent from each other. To be independent, the 283.32 organizations may not share any of the following: 283.33 (1) the same or a similar name; 283.34 (2) medical facilities or nonmedical facilities, including 283.35 but not limited to, business offices, treatment rooms, 283.36 consultation rooms, examination rooms, and waiting rooms; 284.1 (3) expenses; 284.2 (4) employee wages or salaries; or 284.3 (5) equipment or supplies, including but not limited to, 284.4 computers, telephone systems, telecommunications equipment, and 284.5 office supplies. 284.6 (b) An organization that receives family planning grant 284.7 funds and that is affiliated with an organization that provides 284.8 abortion services must maintain financial records that 284.9 demonstrate strict compliance with this subdivision and that 284.10 demonstrate that its independent affiliate that provides 284.11 abortion services receives no direct or indirect economic or 284.12 marketing benefit from the family planning grant funds. 284.13 Subd. 5. [INDEPENDENT AUDIT.] When an organization applies 284.14 for family planning grant funds, the organization must submit 284.15 with the grant application a copy of the organization's most 284.16 recent independent audit to ensure the organization is in 284.17 compliance with this section. The independent audit must have 284.18 been conducted no more than two years before the organization 284.19 submits its grant application. 284.20 Subd. 6. [ORGANIZATIONS RECEIVING TITLE X FUNDS.] Nothing 284.21 in this section requires an organization that receives federal 284.22 funds under title X of the Public Health Service Act to refrain 284.23 from performing any service that is required to be provided as a 284.24 condition of receiving title X funds, as specified by the 284.25 provisions of title X or the title X program guidelines for 284.26 project grants for family planning services published by the 284.27 United States Department of Health and Human Services. 284.28 Subd. 7. [SEVERABILITY.] If any one or more provision, 284.29 word, phrase, clause, sentence, or subdivision of this section, 284.30 or the application to any person or circumstance, is found to be 284.31 unconstitutional, it is declared to be severable and the balance 284.32 of this section shall remain effective notwithstanding such 284.33 unconstitutionality. The legislature hereby declares that it 284.34 would have passed this section, and each provision, word, 284.35 phrase, clause, sentence, or subdivision of it, regardless of 284.36 the fact that any one or more provision, word, phrase, clause, 285.1 sentence, or subdivision be declared unconstitutional. 285.2 Sec. 40. [145.4231] [POSITIVE ABORTION ALTERNATIVES.] 285.3 Subdivision 1. [DEFINITIONS.] For purposes of this 285.4 section, the following terms have the meanings given: 285.5 (1) "abortion" means the use of any means to terminate the 285.6 pregnancy of a woman known to be pregnant with knowledge that 285.7 the termination with those means will, with reasonable 285.8 likelihood, cause the death of the unborn child. For purposes 285.9 of this section, abortion does not include an abortion necessary 285.10 to prevent the death of the mother; and 285.11 (2) "unborn child" means an individual organism of the 285.12 species Homo sapiens from fertilization until birth. 285.13 Subd. 2. [ELIGIBILITY FOR GRANTS.] (a) The commissioner of 285.14 health shall award grants to eligible applicants under paragraph 285.15 (c) for the reasonable expenses of programs to support, 285.16 encourage, and assist women in carrying their pregnancies to 285.17 term by providing information on, referral to, and assistance 285.18 with securing necessary services that enable women to carry 285.19 their pregnancies to term. Necessary services include, but are 285.20 not limited to: 285.21 (1) medical care; 285.22 (2) nutritional services; 285.23 (3) housing assistance; 285.24 (4) adoption services; 285.25 (5) education and employment assistance; 285.26 (6) parenting education and support services; and 285.27 (7) child care assistance. 285.28 (b) In addition to providing information and referral under 285.29 paragraph (a), an eligible program may provide one or more of 285.30 the necessary services under paragraph (a) that assists women in 285.31 carrying their pregnancies to term. To avoid duplication of 285.32 efforts, grantees may refer to other public or private programs, 285.33 rather than provide the care directly, if a woman meets 285.34 eligibility criteria for the other programs. 285.35 (c) To be eligible for a grant, an agency or organization 285.36 must: 286.1 (1) be a private, nonprofit organization; 286.2 (2) demonstrate that the program is conducted under 286.3 appropriate supervision; 286.4 (3) not charge women for services provided under the 286.5 program; 286.6 (4) provide each pregnant woman counseled with accurate 286.7 information on the developmental characteristics of unborn 286.8 children, including offering the printed information described 286.9 in section 145.4243; 286.10 (5) ensure that the alternatives to abortion program's sole 286.11 purposes are to assist and encourage women in carrying their 286.12 pregnancies to term and to maximize their potentials thereafter; 286.13 (6) ensure that none of the funds provided are used to 286.14 encourage or counsel a woman to have an abortion not necessary 286.15 to prevent her death, to provide her such an abortion, or to 286.16 refer her for such an abortion; and 286.17 (7) have had the alternatives to abortion program in 286.18 existence for at least one year as of July 1, 2005. 286.19 (d) The provisions, words, phrases, and clauses of 286.20 paragraph (c) are inseverable from this subdivision, and if any 286.21 provision, word, phrase, or clause of paragraph (c) or the 286.22 application thereof to any person or circumstance is held 286.23 invalid, such invalidity shall apply to all of this subdivision. 286.24 (e) An organization that provides abortions, promotes 286.25 abortions, or directly refers for abortions is ineligible to 286.26 receive a grant under this program. An affiliate of an 286.27 organization that provides abortions, promotes abortions, or 286.28 directly refers for abortions is ineligible to receive a grant 286.29 under this section unless the organizations are separately 286.30 incorporated and independent from each other. To be 286.31 independent, the organizations may not share any of the 286.32 following: 286.33 (1) the same or a similar name; 286.34 (2) medical facilities or nonmedical facilities, including, 286.35 but not limited to, business offices, treatment rooms, 286.36 consultation rooms, examination rooms, and waiting rooms; 287.1 (3) expenses; 287.2 (4) employee wages or salaries; or 287.3 (5) equipment or supplies, including, but not limited to, 287.4 computers, telephone systems, telecommunications equipment, and 287.5 office supplies. 287.6 (f) An organization that receives a grant under this 287.7 section and that is affiliated with an organization that 287.8 provides abortion services must maintain financial records that 287.9 demonstrate strict compliance with this subdivision and that 287.10 demonstrate that its independent affiliate that provides 287.11 abortion services receives no direct or indirect economic or 287.12 marketing benefit from the grant under this section. 287.13 (g) The following data on participants is private data on 287.14 individuals under section 13.02, subdivision 12: all data 287.15 collected, received, maintained, or disseminated by the grantee 287.16 using grant funds awarded by the commissioner under this section. 287.17 Subd. 3. [DUTIES OF COMMISSIONER.] The commissioner of 287.18 health shall make grants under subdivision 2 beginning no later 287.19 than July 1, 2006. The commissioner shall monitor and review 287.20 the programs of each grantee to ensure that the grantee 287.21 carefully adheres to the purposes and requirements of 287.22 subdivision 2 and shall cease funding a grantee that fails to do 287.23 so. 287.24 Subd. 4. [SEVERABILITY.] Except as provided in subdivision 287.25 2, paragraph (d), if any provision, word, phrase, or clause of 287.26 this section or the application thereof to any person or 287.27 circumstance is held invalid, such invalidity shall not affect 287.28 the provisions, words, phrases, clauses, or applications of this 287.29 section that can be given effect without the invalid provision, 287.30 word, phrase, clause, or application and to this end, the 287.31 provisions, words, phrases, and clauses of this section are 287.32 declared to be severable. 287.33 Subd. 5. [SUPREME COURT JURISDICTION.] The Minnesota 287.34 Supreme Court has original jurisdiction over an action 287.35 challenging the constitutionality of this section and shall 287.36 expedite the resolution of the action. 288.1 Sec. 41. [145.4232] [UNBORN CHILD PAIN PREVENTION.] 288.2 Subdivision 1. [SHORT TITLE.] This act shall be known and 288.3 may be cited as the "Unborn Child Pain Prevention Act." 288.4 Subd. 2. [DEFINITIONS.] For purposes of this section, the 288.5 terms used have the meanings given: 288.6 (1) "abortion" means the use of any means to terminate the 288.7 pregnancy of a female known to be pregnant with knowledge that 288.8 the termination with those means will, with reasonable 288.9 likelihood, cause the death of the unborn child; 288.10 (2) "attempt to perform an abortion" means an act, or an 288.11 omission of a statutorily required act, that, under the 288.12 circumstances as the actor believes them to be, constitutes a 288.13 substantial step in a course of conduct planned to culminate in 288.14 the performance of an abortion in violation of this section; 288.15 (3) "unborn child" means a member of the species Homo 288.16 sapiens from fertilization until birth; 288.17 (4) "medical emergency" means any condition that, on the 288.18 basis of the physician's good faith clinical judgment, so 288.19 complicates the medical condition of a pregnant female as to 288.20 necessitate the immediate abortion of her pregnancy to avert her 288.21 death or for which a delay will create serious risk of 288.22 substantial and irreversible impairment of a major bodily 288.23 function; and 288.24 (5) "physician" means a person licensed as a physician or 288.25 osteopath under chapter 147. 288.26 Subd. 3. [UNBORN CHILD PAIN PREVENTION.] Except in the 288.27 case of a medical emergency, before an abortion is performed on 288.28 an unborn child who is 20 weeks gestational age or more, the 288.29 physician performing the abortion or the physician's agent shall 288.30 inform the female if an anesthetic or analgesic would eliminate 288.31 or alleviate organic pain to the unborn child caused by the 288.32 particular method of abortion to be employed and inform her of 288.33 the particular medical risks associated with the particular 288.34 anesthetic or analgesic. With her consent, the physician shall 288.35 administer such anesthetic or analgesic. 288.36 Subd. 4. [CRIMINAL PENALTIES.] Any person who knowingly or 289.1 recklessly performs or attempts to perform an abortion in 289.2 violation of this section is guilty of a felony. No penalty may 289.3 be assessed against the female upon whom the abortion is 289.4 performed or attempted to be performed. 289.5 Subd. 5. [CIVIL REMEDIES.] (a) Any person upon whom an 289.6 abortion has been performed in violation of this section or the 289.7 father or a grandparent of the unborn child who was the subject 289.8 of such an abortion may maintain an action against the person 289.9 who performed the abortion in knowing or reckless violation of 289.10 this section for actual and punitive damages. Any person upon 289.11 whom an abortion has been attempted in violation of this section 289.12 may maintain an action against the person who attempted to 289.13 perform the abortion in knowing or reckless violation of this 289.14 section for actual and punitive damages. 289.15 (b) If judgment is rendered in favor of the plaintiff in 289.16 any action described in this subdivision, the court shall render 289.17 judgment for a reasonable attorney's fee in favor of the 289.18 plaintiff against the defendant. If judgment is rendered in 289.19 favor of the defendant and the court finds that the plaintiff's 289.20 suit was frivolous and brought in bad faith, the court shall 289.21 render judgment for a reasonable attorney's fee in favor of the 289.22 defendant against the plaintiff. 289.23 Subd. 6. [PROTECTION OF PRIVACY.] In every civil or 289.24 criminal proceeding or action brought under this section, the 289.25 court shall rule whether the anonymity of any female upon whom 289.26 an abortion has been performed or attempted shall be preserved 289.27 from public disclosure if she does not give her consent to such 289.28 disclosure. The court, upon motion or sua sponte, shall make 289.29 such a ruling and, upon determining that her anonymity should be 289.30 preserved, shall issue orders to the parties, witnesses, and 289.31 counsel and shall direct the sealing of the record and exclusion 289.32 of individuals from courtrooms or hearing rooms to the extent 289.33 necessary to safeguard her identity from public disclosure. The 289.34 order shall be accompanied by specific written findings 289.35 explaining why the anonymity of the female should be preserved 289.36 from public disclosure, why the order is essential to that end, 290.1 how the order is narrowly tailored to serve that interest, and 290.2 why no reasonable, less restrictive alternative exists. In the 290.3 absence of written consent of the female upon whom an abortion 290.4 has been performed or attempted, anyone, other than a public 290.5 official, who brings an action under subdivision 4, paragraph 290.6 (a), shall do so under a pseudonym. This subdivision may not be 290.7 construed to conceal the identity of the plaintiff or of 290.8 witnesses from the defendant. 290.9 Subd. 7. [SEVERABILITY.] If any one or more provision, 290.10 section, subsection, sentence, clause, phrase, or word of this 290.11 section or the application thereof to any person or circumstance 290.12 is found to be unconstitutional, the same is hereby declared to 290.13 be severable and the balance of this section shall remain 290.14 effective notwithstanding such unconstitutionality. The 290.15 legislature hereby declares that it would have passed this 290.16 section, and each provision, section, subsection, sentence, 290.17 clause, phrase, or word thereof, irrespective of the fact that 290.18 any one or more provision, section, subsection, sentence, 290.19 clause, phrase, or word be declared unconstitutional. 290.20 Sec. 42. Minnesota Statutes 2004, section 145.56, 290.21 subdivision 2, is amended to read: 290.22 Subd. 2. [COMMUNITY-BASED PROGRAMS.] (a) To the extent 290.23 funds are appropriated for the purposes of this subdivision, the 290.24 commissioner shall establish a grant program to fund: 290.25 (1) community-based programs to provide education, 290.26 outreach, and advocacy services to populations who may be at 290.27 risk for suicide; 290.28 (2) community-based programs that educate community helpers 290.29 and gatekeepers, such as family members, spiritual leaders, 290.30 coaches, and business owners, employers, and coworkers on how to 290.31 prevent suicide by encouraging help-seeking behaviors; 290.32 (3) community-based programs that educate populations at 290.33 risk for suicide and community helpers and gatekeepers that must 290.34 include information on the symptoms of depression and other 290.35 psychiatric illnesses, the warning signs of suicide, skills for 290.36 preventing suicides, and making or seeking effective referrals 291.1 to intervention and community resources; and 291.2 (4) community-based programs to provide evidence-based 291.3 suicide prevention and intervention education to school staff, 291.4 parents, and students in grades kindergarten through 12. 291.5 Sec. 43. Minnesota Statutes 2004, section 145.56, 291.6 subdivision 5, is amended to read: 291.7 Subd. 5. [PERIODIC EVALUATIONS; BIENNIAL REPORTS.] To the 291.8 extent funds are appropriated for the purposes of this 291.9 subdivision, the commissioner shall conduct periodic evaluations 291.10 of the impact of and outcomes from implementation of the state's 291.11 suicide prevention plan and each of the activities specified in 291.12 this section. By July 1, 2002, and July 1 of each even-numbered 291.13 year thereafter, the commissioner shall report the results of 291.14 these evaluations to the chairs of the policy and finance 291.15 committees in the house and senate with jurisdiction over health 291.16 and human services issues. 291.17 Sec. 44. [145.906] [POSTPARTUM DEPRESSION EDUCATION AND 291.18 INFORMATION.] 291.19 (a) The commissioner of health shall work with health care 291.20 facilities, licensed health and mental health care 291.21 professionals, mental health advocates, consumers, and families 291.22 in the state to develop materials and information about 291.23 postpartum depression including treatment resources and develop 291.24 policies and procedures to comply with this section. 291.25 (b) Physicians, traditional midwives, and other licensed 291.26 health care professionals providing prenatal care to women must 291.27 make available to women and their families information about 291.28 postpartum depression. 291.29 (c) Hospitals and other health care facilities in the state 291.30 must provide departing new mothers and fathers and other family 291.31 members, as appropriate, with written information about 291.32 postpartum depression, including its symptoms, methods of coping 291.33 with the illness, and treatment resources. 291.34 Sec. 45. Minnesota Statutes 2004, section 145.924, is 291.35 amended to read: 291.36 145.924 [AIDS PREVENTION GRANTS.] 292.1 (a) The commissioner may award grants to boards of health 292.2 as defined in section 145A.02, subdivision 2, state agencies, 292.3 state councils, or nonprofit corporations to provide evaluation 292.4 and counseling services to populations at risk for acquiring 292.5 human immunodeficiency virus infection, including, but not 292.6 limited to, minorities, adolescents, intravenous drug users, and 292.7 homosexual men. 292.8 (b) The commissioner may award grants to agencies 292.9 experienced in providing services to communities of color, for 292.10 the design of innovative outreach and education programs for 292.11 targeted groups within the community who may be at risk of 292.12 acquiring the human immunodeficiency virus infection, including 292.13 intravenous drug users and their partners, adolescents, gay and 292.14 bisexual individuals and women. Grants shall be awarded on a 292.15 request for proposal basis and shall include funds for 292.16 administrative costs. Priority for grants shall be given to 292.17 agencies or organizations that have experience in providing 292.18 service to the particular community which the grantee proposes 292.19 to serve; that have policy makers representative of the targeted 292.20 population; that have experience in dealing with issues relating 292.21 to HIV/AIDS; and that have the capacity to deal effectively with 292.22 persons of differing sexual orientations. For purposes of this 292.23 paragraph, the "communities of color" are: the American-Indian 292.24 community; the Hispanic community; the African-American 292.25 community; and the Asian-Pacific community. 292.26 (c) All state grants awarded under this section for 292.27 programs targeted to adolescents shall include the promotion of 292.28 abstinence from sexual activity and drug use. 292.29 (d) No state grant monies awarded under this section shall 292.30 be used for web sites, pamphlets, or other communications that 292.31 contain sexually explicit images or language. 292.32 Sec. 46. Minnesota Statutes 2004, section 145.9268, is 292.33 amended to read: 292.34 145.9268 [COMMUNITY CLINIC GRANTS.] 292.35 Subdivision 1. [DEFINITION.] For purposes of this section, 292.36 "eligible community clinic" means: 293.1 (1) a nonprofit clinic thatprovidesis established to 293.2 provide health servicesunder conditions as defined in Minnesota293.3Rules, part 9505.0255,to low income or rural population groups; 293.4 provides medical, preventive, dental, or mental health primary 293.5 care services; and utilizes a sliding fee scale or other 293.6 procedure to determine eligibility for charity care or to ensure 293.7 that no person will be denied services because of inability to 293.8 pay; 293.9 (2) a governmental entity or an Indian tribal government or 293.10 Indian health service unit that provides services and utilizes a 293.11 sliding fee scale or other procedure as described under clause 293.12 (1);or293.13 (3) a consortium of clinics comprised of entities under 293.14 clause (1) or (2); or 293.15 (4) a nonprofit, tribal, or governmental entity proposing 293.16 the establishment of a clinic that will provide services and 293.17 utilize a sliding fee scale or other procedure as described 293.18 under clause (1). 293.19 Subd. 2. [GRANTS AUTHORIZED.] The commissioner of health 293.20 shall award grants to eligible community clinics to plan, 293.21 establish, or operate services to improve the ongoing viability 293.22 of Minnesota's clinic-based safety net providers. Grants shall 293.23 be awarded to support the capacity of eligible community clinics 293.24 to serve low-income populations, reduce current or future 293.25 uncompensated care burdens, or provide for improved care 293.26 delivery infrastructure. The commissioner shall award grants to 293.27 community clinics in metropolitan and rural areas of the state, 293.28 and shall ensure geographic representation in grant awards among 293.29 all regions of the state. 293.30 Subd. 3. [ALLOCATION OF GRANTS.] (a) To receive a grant 293.31 under this section, an eligible community clinic must submit an 293.32 application to the commissioner of health by the deadline 293.33 established by the commissioner. A grant may be awarded upon 293.34 the signing of a grant contract. Community clinics may apply 293.35 for and the commissioner may award grants for one-year or 293.36 two-year periods. 294.1 (b) An application must be on a form and contain 294.2 information as specified by the commissioner but at a minimum 294.3 must contain: 294.4 (1) a description of the purpose or project for which grant 294.5 funds will be used; 294.6 (2) a description of the problem or problems the grant 294.7 funds will be used to address;and294.8 (3) a description of achievable objectives, a workplan, and 294.9 a timeline for implementation and completion of processes or 294.10 projects enabled by the grant; and 294.11 (4) a process for documenting and evaluating results of the 294.12 grant. 294.13 (c) The commissioner shall review each application to 294.14 determine whether the application is complete and whether the 294.15 applicant and the project are eligible for a grant. In 294.16 evaluating applications according to paragraph (d), the 294.17 commissioner shall establish criteria including, but not limited 294.18 to: thepriority leveleligibility of the project; the 294.19 applicant's thoroughness and clarity in describing the problem 294.20 grant funds are intended to address; a description of the 294.21 applicant's proposed project; a description of the population 294.22 demographics and service area of the proposed project; the 294.23 manner in which the applicant will demonstrate the effectiveness 294.24 of any projects undertaken; and evidence of efficiencies and 294.25 effectiveness gained through collaborative efforts. The 294.26 commissioner may also take into account other relevant factors, 294.27 including, but not limited to, the percentage for which 294.28 uninsured patients represent the applicant's patient base and 294.29 the degree to which grant funds will be used to support services 294.30 increasing or maintaining access to health care services. 294.31 During application review, the commissioner may request 294.32 additional information about a proposed project, including 294.33 information on project cost. Failure to provide the information 294.34 requested disqualifies an applicant. The commissioner has 294.35 discretion over the number of grants awarded. 294.36 (d) In determining which eligible community clinics will 295.1 receive grants under this section, the commissioner shall give 295.2 preference to those grant applications that show evidence of 295.3 collaboration with other eligible community clinics, hospitals, 295.4 health care providers, or community organizations.In addition,295.5the commissioner shall give priority, in declining order, to295.6grant applications for projects that:295.7 Subd. 3a. [AWARDING GRANTS.] (a) The commissioner may 295.8 award grants for activities to: 295.9 (1) provide a direct offset to expenses incurred for 295.10 services provided to the clinic's target population; 295.11 (2) establish, update, or improve information, data 295.12 collection, or billing systems, including electronic health 295.13 records systems; 295.14 (3) procure, modernize, remodel, or replace equipment used 295.15 in the delivery of direct patient care at a clinic; 295.16 (4) provide improvements for care delivery, such as 295.17 increased translation and interpretation services;or295.18 (5) build a new clinic or expand an existing facility; or 295.19 (6) other projects determined by the commissioner to 295.20 improve the ability of applicants to provide care to the 295.21 vulnerable populations they serve. 295.22(e)(b) A grant awarded to an eligible community clinic may 295.23 not exceed $300,000 per eligible community clinic. For an 295.24 applicant applying as a consortium of clinics, a grant may not 295.25 exceed $300,000 per clinic included in the consortium. The 295.26 commissioner has discretion over the number of grants awarded. 295.27 Subd. 4. [EVALUATION AND REPORT.] The commissioner of 295.28 health shall evaluate the overall effectiveness of the grant 295.29 program. The commissioner shall collect progress reports to 295.30 evaluate the grant program from the eligible community clinics 295.31 receiving grants. Every two years, as part of this evaluation, 295.32 the commissioner shall report to the legislature onpriority295.33areas for grants set under subdivision 3the needs of community 295.34 clinics and provide any recommendations for adding or 295.35 changingpriority areaseligible activities. 295.36 Sec. 47. Minnesota Statutes 2004, section 146A.11, 296.1 subdivision 1, is amended to read: 296.2 Subdivision 1. [SCOPE.] All unlicensed complementary and 296.3 alternative health care practitioners shall provide to each 296.4 complementary and alternative health care client prior to 296.5 providing treatment a written copy of the complementary and 296.6 alternative health care client bill of rights. A copy must also 296.7 be posted in a prominent location in the office of the 296.8 unlicensed complementary and alternative health care 296.9 practitioner. Reasonable accommodations shall be made for those 296.10 clients who cannot read or who have communication impairments 296.11 and those who do not read or speak English. The complementary 296.12 and alternative health care client bill of rights shall include 296.13 the following: 296.14 (1) the name, complementary and alternative health care 296.15 title, business address, and telephone number of the unlicensed 296.16 complementary and alternative health care practitioner; 296.17 (2) the degrees, training, experience, or other 296.18 qualifications of the practitioner regarding the complimentary 296.19 and alternative health care being provided, followed by the 296.20 following statement in bold print: 296.21 "THE STATE OF MINNESOTA HAS NOT ADOPTED ANY EDUCATIONAL AND 296.22 TRAINING STANDARDS FOR UNLICENSED COMPLEMENTARY AND ALTERNATIVE 296.23 HEALTH CARE PRACTITIONERS. THIS STATEMENT OF CREDENTIALS IS FOR 296.24 INFORMATION PURPOSES ONLY. 296.25 Under Minnesota law, an unlicensed complementary and 296.26 alternative health care practitioner may not provide a medical 296.27 diagnosis or recommend discontinuance of medically prescribed 296.28 treatments. If a client desires a diagnosis from a licensed 296.29 physician, chiropractor, or acupuncture practitioner, or 296.30 services from a physician, chiropractor, nurse, osteopath, 296.31 physical therapist, dietitian, nutritionist, acupuncture 296.32 practitioner, athletic trainer, or any other type of health care 296.33 provider, the client may seek such services at any time."; 296.34 (3) the name, business address, and telephone number of the 296.35 practitioner's supervisor, if any; 296.36 (4) notice that a complementary and alternative health care 297.1 client has the right to file a complaint with the practitioner's 297.2 supervisor, if any, and the procedure for filing complaints; 297.3 (5) the name, address, and telephone number of the office 297.4 ofunlicensed complementary and alternative health care practice297.5 the attorney general and notice thatathe office of the 297.6 attorney general is the point of contact for purposes of 297.7 referring clientmay filecomplaintswith the officeto the 297.8 proper health care board, agency, or law enforcement; 297.9 (6) the practitioner's fees per unit of service, the 297.10 practitioner's method of billing for such fees, the names of any 297.11 insurance companies that have agreed to reimburse the 297.12 practitioner, or health maintenance organizations with whom the 297.13 practitioner contracts to provide service, whether the 297.14 practitioner accepts Medicare, medical assistance, or general 297.15 assistance medical care, and whether the practitioner is willing 297.16 to accept partial payment, or to waive payment, and in what 297.17 circumstances; 297.18 (7) a statement that the client has a right to reasonable 297.19 notice of changes in services or charges; 297.20 (8) a brief summary, in plain language, of the theoretical 297.21 approach used by the practitioner in providing services to 297.22 clients; 297.23 (9) notice that the client has a right to complete and 297.24 current information concerning the practitioner's assessment and 297.25 recommended service that is to be provided, including the 297.26 expected duration of the service to be provided; 297.27 (10) a statement that clients may expect courteous 297.28 treatment and to be free from verbal, physical, or sexual abuse 297.29 by the practitioner; 297.30 (11) a statement that client records and transactions with 297.31 the practitioner are confidential, unless release of these 297.32 records is authorized in writing by the client, or otherwise 297.33 provided by law; 297.34 (12) a statement of the client's right to be allowed access 297.35 to records and written information from records in accordance 297.36 with section 144.335; 298.1 (13) a statement that other services may be available in 298.2 the community, including where information concerning services 298.3 is available; 298.4 (14) a statement that the client has the right to choose 298.5 freely among available practitioners and to change practitioners 298.6 after services have begun, within the limits of health 298.7 insurance, medical assistance, or other health programs; 298.8 (15) a statement that the client has a right to coordinated 298.9 transfer when there will be a change in the provider of 298.10 services; 298.11 (16) a statement that the client may refuse services or 298.12 treatment, unless otherwise provided by law; and 298.13 (17) a statement that the client may assert the client's 298.14 rights without retaliation. 298.15 Sec. 48. Minnesota Statutes 2004, section 147A.08, is 298.16 amended to read: 298.17 147A.08 [EXEMPTIONS.] 298.18 (a) This chapter does not apply to, control, prevent, or 298.19 restrict the practice, service, or activities of persons listed 298.20 in section 147.09, clauses (1) to (6) and (8) to (13), persons 298.21 regulated under section 214.01, subdivision 2, or persons 298.22 defined in section 144.1501, subdivision 1, paragraphs 298.23(e)(f),(g)(h), and(h)(i). 298.24 (b) Nothing in this chapter shall be construed to require 298.25 registration of: 298.26 (1) a physician assistant student enrolled in a physician 298.27 assistant or surgeon assistant educational program accredited by 298.28 the Committee on Allied Health Education and Accreditation or by 298.29 its successor agency approved by the board; 298.30 (2) a physician assistant employed in the service of the 298.31 federal government while performing duties incident to that 298.32 employment; or 298.33 (3) technicians, other assistants, or employees of 298.34 physicians who perform delegated tasks in the office of a 298.35 physician but who do not identify themselves as a physician 298.36 assistant. 299.1 Sec. 49. Minnesota Statutes 2004, section 150A.22, is 299.2 amended to read: 299.3 150A.22 [DONATED DENTAL SERVICES.] 299.4 (a) TheBoard of Dentistrycommissioner of health shall 299.5 contract with the Minnesota Dental Association, or another 299.6 appropriate and qualified organization to develop and operate a 299.7 donated dental services program to provide dental care to public 299.8 program recipients and the uninsured through dentists who 299.9 volunteer their services without compensation. As part of the 299.10 contract, theboardcommissioner shall include specific 299.11 performance and outcome measures that the contracting 299.12 organization must meet. The donated dental services program 299.13 shall: 299.14 (1) establish a network of volunteer dentists, including 299.15 dental specialties, to donate dental services to eligible 299.16 individuals; 299.17 (2) establish a system to refer eligible individuals to the 299.18 appropriate volunteer dentists; and 299.19 (3) develop and implement a public awareness campaign to 299.20 educate eligible individuals about the availability of the 299.21 program. 299.22 (b) Funding for the program may be used for administrative 299.23 or technical support. The organization contracting with the 299.24boardcommissioner shall provide an annual report that accounts 299.25 for funding appropriated to the program by the state, documents 299.26 the number of individuals served by the program and the number 299.27 of dentists participating as program providers, and provides 299.28 data on meeting the specific performance and outcome measures 299.29 identified by theboardcommissioner. 299.30 Sec. 50. Minnesota Statutes 2004, section 157.15, is 299.31 amended by adding a subdivision to read: 299.32 Subd. 19. [STATEWIDE HOSPITALITY FEE.] "Statewide 299.33 hospitality fee" means a fee to fund statewide food, beverage, 299.34 and lodging program development activities, including training 299.35 for inspection staff, technical assistance, maintenance of a 299.36 statewide integrated food safety and security information 300.1 system, and other related statewide activities that support the 300.2 food, beverage, and lodging program activities. 300.3 Sec. 51. Minnesota Statutes 2004, section 157.16, 300.4 subdivision 2, is amended to read: 300.5 Subd. 2. [LICENSE RENEWAL.] Initial and renewal licenses 300.6 for all food and beverage service establishments, hotels, 300.7 motels, lodging establishments, and resorts shall be issued for 300.8 the calendar year for which application is made and shall expire 300.9 on December 31 of such year. Any person who operates a place of 300.10 business after the expiration date of a license or without 300.11 having submitted an application and paid the fee shall be deemed 300.12 to have violated the provisions of this chapter and shall be 300.13 subject to enforcement action, as provided in the Health 300.14 Enforcement Consolidation Act, sections 144.989 to 144.993. In 300.15 addition, a penalty of$25$50 shall be added to the total of 300.16 the license fee for any food and beverage service establishment 300.17 operating without a license as a mobile food unit, a seasonal 300.18 temporary or seasonal permanent food stand, or a special event 300.19 food stand, and a penalty of$50$100 shall be added to the 300.20 total of the license fee for all restaurants, food carts, 300.21 hotels, motels, lodging establishments, and resorts operating 300.22 without a license for a period of up to 30 days. A late fee of 300.23 $300 shall be added to the license fee for establishments 300.24 operating more than 30 days without a license. 300.25 Sec. 52. Minnesota Statutes 2004, section 157.16, is 300.26 amended by adding a subdivision to read: 300.27 Subd. 2a. [FOOD MANAGER CERTIFICATION.] An applicant for 300.28 certification or certification renewal as a food manager must 300.29 submit to the commissioner a $28 nonrefundable certification fee 300.30 payable to the Department of Health. 300.31 Sec. 53. Minnesota Statutes 2004, section 157.16, 300.32 subdivision 3, is amended to read: 300.33 Subd. 3. [ESTABLISHMENT FEES; DEFINITIONS.] (a) The 300.34 following fees are required for food and beverage service 300.35 establishments, hotels, motels, lodging establishments, and 300.36 resorts licensed under this chapter. Food and beverage service 301.1 establishments must pay the highest applicable fee under 301.2 paragraph(e)(d), clause (1), (2), (3), or (4), and 301.3 establishments serving alcohol must pay the highest applicable 301.4 fee under paragraph(e)(d), clause (6) or (7). The license fee 301.5 for new operators previously licensed under this chapter for the 301.6 same calendar year is one-half of the appropriate annual license 301.7 fee, plus any penalty that may be required. The license fee for 301.8 operators opening on or after October 1 is one-half of the 301.9 appropriate annual license fee, plus any penalty that may be 301.10 required. 301.11 (b) All food and beverage service establishments, except 301.12 special event food stands, and all hotels, motels, lodging 301.13 establishments, and resorts shall pay an annual base fee of 301.14$145$150. 301.15 (c) A special event food stand shall pay a flat fee 301.16 of$35$40 annually. "Special event food stand" means a fee 301.17 category where food is prepared or served in conjunction with 301.18 celebrations, county fairs, or special events from a special 301.19 event food stand as defined in section 157.15. 301.20 (d) In addition to the base fee in paragraph (b), each food 301.21 and beverage service establishment, other than a special event 301.22 food stand, and each hotel, motel, lodging establishment, and 301.23 resort shall pay an additional annual fee for each fee category 301.24as, additional food service, or required additional inspection 301.25 specified in this paragraph: 301.26 (1) Limited food menu selection,$40$50. "Limited food 301.27 menu selection" means a fee category that provides one or more 301.28 of the following: 301.29 (i) prepackaged food that receives heat treatment and is 301.30 served in the package; 301.31 (ii) frozen pizza that is heated and served; 301.32 (iii) a continental breakfast such as rolls, coffee, juice, 301.33 milk, and cold cereal; 301.34 (iv) soft drinks, coffee, or nonalcoholic beverages; or 301.35 (v) cleaning for eating, drinking, or cooking utensils, 301.36 when the only food served is prepared off site. 302.1 (2) Small establishment, including boarding establishments, 302.2$75$100. "Small establishment" means a fee category that has 302.3 no salad bar and meets one or more of the following: 302.4 (i) possesses food service equipment that consists of no 302.5 more than a deep fat fryer, a grill, two hot holding containers, 302.6 and one or more microwave ovens; 302.7 (ii) serves dipped ice cream or soft serve frozen desserts; 302.8 (iii) serves breakfast in an owner-occupied bed and 302.9 breakfast establishment; 302.10 (iv) is a boarding establishment; or 302.11 (v) meets the equipment criteria in clause (3), item (i) or 302.12 (ii), and has a maximum patron seating capacity of not more than 302.13 50. 302.14 (3) Medium establishment,$210$260. "Medium establishment" 302.15 means a fee category that meets one or more of the following: 302.16 (i) possesses food service equipment that includes a range, 302.17 oven, steam table, salad bar, or salad preparation area; 302.18 (ii) possesses food service equipment that includes more 302.19 than one deep fat fryer, one grill, or two hot holding 302.20 containers; or 302.21 (iii) is an establishment where food is prepared at one 302.22 location and served at one or more separate locations. 302.23 Establishments meeting criteria in clause (2), item (v), 302.24 are not included in this fee category. 302.25 (4) Large establishment,$350$460. "Large establishment" 302.26 means either: 302.27 (i) a fee category that (A) meets the criteria in clause 302.28 (3), items (i) or (ii), for a medium establishment, (B) seats 302.29 more than 175 people, and (C) offers the full menu selection an 302.30 average of five or more days a week during the weeks of 302.31 operation; or 302.32 (ii) a fee category that (A) meets the criteria in clause 302.33 (3), item (iii), for a medium establishment, and (B) prepares 302.34 and serves 500 or more meals per day. 302.35 (5) Other food and beverage service, including food carts, 302.36 mobile food units, seasonal temporary food stands, and seasonal 303.1 permanent food stands,$40$50. 303.2 (6) Beer or wine table service,$40$50. "Beer or wine 303.3 table service" means a fee category where the only alcoholic 303.4 beverage service is beer or wine, served to customers seated at 303.5 tables. 303.6 (7) Alcoholic beverage service, other than beer or wine 303.7 table service,$105$135. 303.8 "Alcohol beverage service, other than beer or wine table 303.9 service" means a fee category where alcoholic mixed drinks are 303.10 served or where beer or wine are served from a bar. 303.11 (8) Lodging per sleeping accommodation unit,$6$8, 303.12 including hotels, motels, lodging establishments, and resorts, 303.13 up to a maximum of$600$800. "Lodging per sleeping 303.14 accommodation unit" means a fee category including the number of 303.15 guest rooms, cottages, or other rental units of a hotel, motel, 303.16 lodging establishment, or resort; or the number of beds in a 303.17 dormitory. 303.18 (9) First public swimming pool,$140$180; each additional 303.19 public swimming pool,$80$100. "Public swimming pool" means a 303.20 fee category that has the meaning given in Minnesota Rules, part 303.21 4717.0250, subpart 8. 303.22 (10) First spa,$80$110; each additional spa,$40$50. 303.23 "Spa pool" means a fee category that has the meaning given in 303.24 Minnesota Rules, part 4717.0250, subpart 9. 303.25 (11) Private sewer or water,$40$50. "Individual private 303.26 water" means a fee category with a water supply other than a 303.27 community public water supply as defined in Minnesota Rules, 303.28 chapter 4720. "Individual private sewer" means a fee category 303.29 with an individual sewage treatment system which uses subsurface 303.30 treatment and disposal. 303.31 (12) Additional food service, $130. "Additional food 303.32 service" means a location at a food service establishment, other 303.33 than the primary food preparation and service area, used to 303.34 prepare or serve food to the public. 303.35 (13) Additional inspection fee, $300. "Additional 303.36 inspection fee" means a fee to conduct the second inspection 304.1 each year for elementary and secondary education facility school 304.2 lunch programs when required by the Richard B. Russell National 304.3 School Lunch Act. 304.4 (e) A fee of$150$350 for review of the construction plans 304.5 must accompany the initial license application forfood and304.6beverage service establishmentsrestaurants, hotels, motels, 304.7 lodging establishments, or resorts with five or more sleeping 304.8 units. 304.9 (f) When existing food and beverage service establishments, 304.10 hotels, motels, lodging establishments, or resorts are 304.11 extensively remodeled, a fee of$150$250 must be submitted with 304.12 the remodeling plans. A fee of $250 must be submitted for new 304.13 construction or remodeling for a restaurant with a limited food 304.14 menu selection, a seasonal permanent food stand, a mobile food 304.15 unit, or a food cart, or for a hotel, motel, resort, or lodging 304.16 establishment addition of less than five sleeping units. 304.17 (g) Seasonal temporary food stands and special event food 304.18 stands are not required to submit construction or remodeling 304.19 plans for review. 304.20 Sec. 54. Minnesota Statutes 2004, section 157.16, is 304.21 amended by adding a subdivision to read: 304.22 Subd. 3a. [STATEWIDE HOSPITALITY FEE.] Every person, firm, 304.23 or corporation that operates a licensed boarding establishment, 304.24 food and beverage service establishment, seasonal temporary or 304.25 permanent food stand, special event food stand, mobile food 304.26 unit, food cart, resort, hotel, motel, or lodging establishment 304.27 in Minnesota must submit to the commissioner a $35 annual 304.28 statewide hospitality fee for each licensed activity. The fee 304.29 for establishments licensed by the Department of Health is 304.30 required at the same time the licensure fee is due. For 304.31 establishments licensed by local governments, the fee is due by 304.32 July 1 of each year. 304.33 Sec. 55. Minnesota Statutes 2004, section 157.20, 304.34 subdivision 2, is amended to read: 304.35 Subd. 2. [INSPECTION FREQUENCY.] The frequency of 304.36 inspections of the establishments shall be based on the degree 305.1 of health risk. 305.2 (a) High-risk establishments must be inspected at least 305.3 oncea yearevery 12 months. 305.4 (b) Medium-risk establishments must be inspected at least 305.5 once every 18 months. 305.6 (c) Low-risk establishments must be inspected at least once 305.7 everytwo years24 months. 305.8 Sec. 56. Minnesota Statutes 2004, section 157.20, 305.9 subdivision 2a, is amended to read: 305.10 Subd. 2a. [RISK CATEGORIES.] (a) [HIGH-RISK 305.11 ESTABLISHMENT.] "High-risk establishment" means any food and 305.12 beverage service establishment, hotel, motel, lodging 305.13 establishment, or resort that: 305.14 (1) serves potentially hazardous foods that require 305.15 extensive processing on the premises, including manual handling, 305.16 cooling, reheating, or holding for service; 305.17 (2) prepares foods several hours or days before service; 305.18 (3) serves menu items that epidemiologic experience has 305.19 demonstrated to be common vehicles of food-borne illness; 305.20 (4) has a public swimming pool; or 305.21 (5) draws its drinking water from a surface water supply. 305.22 (b) [MEDIUM-RISK ESTABLISHMENT.] "Medium-risk 305.23 establishment" means a food and beverage service establishment, 305.24 hotel, motel, lodging establishment, or resort that: 305.25 (1) serves potentially hazardous foods but with minimal 305.26 holding between preparation and service; or 305.27 (2) serves foods, such as pizza, that require extensive 305.28 handling followed by heat treatment. 305.29 (c) [LOW-RISK ESTABLISHMENT.] "Low-risk establishment" 305.30 means a food and beverage service establishment, hotel, motel, 305.31 lodging establishment, or resort that is not a high-risk or 305.32 medium-risk establishment. 305.33 (d) [RISK EXCEPTIONS.] Mobile food units, seasonal 305.34 permanent and seasonal temporary food stands, food carts, and 305.35 special event food stands are not inspected on an established 305.36 schedule and therefore are not defined as high-risk, 306.1 medium-risk, or low-risk establishments. 306.2 (e) [SCHOOL INSPECTION FREQUENCY.] Elementary and 306.3 secondary school food service establishments must be inspected 306.4 according to the assigned risk category or by the frequency 306.5 required in the Richard B. Russell National School Lunch Act, 306.6 whichever frequency is more restrictive. 306.7 Sec. 57. Minnesota Statutes 2004, section 214.01, 306.8 subdivision 2, is amended to read: 306.9 Subd. 2. [HEALTH-RELATED LICENSING BOARD.] "Health-related 306.10 licensing board" means the Board of Examiners of Nursing Home 306.11 Administrators established pursuant to section 144A.19,the306.12Office of Unlicensed Complementary and Alternative Health Care306.13Practice established pursuant to section 146A.02,the Board of 306.14 Medical Practice created pursuant to section 147.01, the Board 306.15 of Nursing created pursuant to section 148.181, the Board of 306.16 Chiropractic Examiners established pursuant to section 148.02, 306.17 the Board of Optometry established pursuant to section 148.52, 306.18 the Board of Physical Therapy established pursuant to section 306.19 148.67, the Board of Psychology established pursuant to section 306.20 148.90, the Board of Social Work pursuant to section 148B.19, 306.21 the Board of Marriage and Family Therapy pursuant to section 306.22 148B.30, the Office of Mental Health Practice established 306.23 pursuant to section 148B.61, the Board of Behavioral Health and 306.24 Therapy established by section 148B.51, the Alcohol and Drug 306.25 Counselors Licensing Advisory Council established pursuant to 306.26 section 148C.02, the Board of Dietetics and Nutrition Practice 306.27 established under section 148.622, the Board of Dentistry 306.28 established pursuant to section 150A.02, the Board of Pharmacy 306.29 established pursuant to section 151.02, the Board of Podiatric 306.30 Medicine established pursuant to section 153.02, and the Board 306.31 of Veterinary Medicine, established pursuant to section 156.01. 306.32 Sec. 58. Minnesota Statutes 2004, section 214.06, 306.33 subdivision 1, is amended to read: 306.34 Subdivision 1. [FEE ADJUSTMENT.] Notwithstanding any law 306.35 to the contrary, the commissioner of health as authorized by 306.36 section 214.13, all health-related licensing boards and all 307.1 non-health-related licensing boards shall by rule, with the 307.2 approval of the commissioner of finance, adjust, as needed, any 307.3 fee which the commissioner of health or the board is empowered 307.4 to assess. As provided in section 16A.1285, the adjustment 307.5 shall be an amount sufficient so that the total fees collected 307.6 by each board willas closely as possible equalbe based on 307.7 anticipated expenditures during the fiscal biennium, including 307.8 expenditures for the programs authorized by sections214.17 to307.9214.25 and 214.31 to 214.37.144.1476, 214.10, 214.103, 214.11, 307.10 214.17 to 214.24, 214.28 to 214.37, and 214.40, except that a 307.11 health-related licensing board may have anticipated expenditures 307.12 in excess of anticipated revenues in a biennium by using 307.13 accumulated surplus revenues from fees collected by that board 307.14 in previous bienniums. A health-related licensing board shall 307.15 not spend more money than the amount appropriated by the 307.16 legislature for a biennium. For members of an occupation 307.17 registered after July 1, 1984, by the commissioner of health 307.18 under the provisions of section 214.13, the fee established must 307.19 include an amount necessary to recover, over a five-year period, 307.20 the commissioner's direct expenditures for adoption of the rules 307.21 providing for registration of members of the occupation. All 307.22 fees received shall be deposited in the state treasury.Fees307.23received by the commissioner of health or health-related307.24licensing boards must be credited to the health occupations307.25licensing account in the state government special revenue fund.307.26 Sec. 59. Minnesota Statutes 2004, section 214.06, is 307.27 amended by adding a subdivision to read: 307.28 Subd. 1a. [HEALTH OCCUPATIONS LICENSING ACCOUNT.] Fees 307.29 received by the commissioner of health or health-related 307.30 licensing boards must be credited to the health occupations 307.31 licensing account in the state government special revenue fund. 307.32 The commissioner of finance shall ensure that the revenues and 307.33 expenditures of each health-related licensing board are tracked 307.34 separately in the health occupations licensing account. 307.35 Sec. 60. [245A.034] [CHILD CARE PROVIDER TRAINING; DANGERS 307.36 OF SHAKING INFANTS AND YOUNG CHILDREN.] 308.1 The commissioner shall make available for viewing by all 308.2 licensed and legal nonlicensed child care providers a video 308.3 presentation on the dangers associated with shaking infants and 308.4 young children. The video presentation shall be part of the 308.5 initial and ongoing training of licensed child care providers. 308.6 Legal nonlicensed child care providers may participate at their 308.7 option in a video presentation session offered under this 308.8 section. The commissioner shall provide to child care providers 308.9 at cost copies of a video approved by the commissioner of health 308.10 under section 144.574 on the dangers associated with shaking 308.11 infants and young children. 308.12 Sec. 61. Minnesota Statutes 2004, section 326.42, 308.13 subdivision 2, is amended to read: 308.14 Subd. 2. [FEES.] Plumbing system plans and specifications 308.15 that are submitted to the commissioner for review shall be 308.16 accompanied by the appropriate plan examination fees. If the 308.17 commissioner determines, upon review of the plans, that 308.18 inadequate fees were paid, the necessary additional fees shall 308.19 be paid prior to plan approval. The commissioner shall charge 308.20 the following fees for plan reviews and audits of plumbing 308.21 installations for public, commercial, and industrial buildings: 308.22 (1) systems with both water distribution and drain, waste, 308.23 and vent systems and having: 308.24 (i) 25 or fewer drainage fixture units, $150; 308.25 (ii) 26 to 50 drainage fixture units, $250; 308.26 (iii) 51 to 150 drainage fixture units, $350; 308.27 (iv) 151 to 249 drainage fixture units, $500; 308.28 (v) 250 or more drainage fixture units, $3 per drainage 308.29 fixture unit to a maximum of $4,000; and 308.30 (vi) interceptors, separators, or catch basins, $70 per 308.31 interceptor, separator, or catch basin design; 308.32 (2) building sewer service only, $150; 308.33 (3) building water service only, $150; 308.34 (4) building water distribution system only, no drainage 308.35 system, $5 per supply fixture unit or $150, whichever is 308.36 greater; 309.1 (5) storm drainage system, a minimum fee of $150 or: 309.2 (i) $50 per drain opening, up to a maximum of $500; and 309.3 (ii) $70 per interceptor, separator, or catch basin design; 309.4 (6) manufactured home park or campground, one to 25 sites, 309.5 $300; 309.6 (7) manufactured home park or campground, 26 to 50 sites, 309.7 $350; 309.8 (8) manufactured home park or campground, 51 to 125 sites, 309.9 $400; 309.10 (9) manufactured home park or campground, more than 125 309.11 sites, $500; 309.12 (10) accelerated review, double the regular fee, one-half 309.13 to be refunded if no response from the commissioner within 15 309.14 business days; and 309.15 (11) revision to previously reviewed or incomplete plans: 309.16 (i) review of plans for which commissioner has issued two 309.17 or more requests for additional information, per review, $100 or 309.18 ten percent of the original fee, whichever is greater; 309.19 (ii) proposer-requested revision with no increase in 309.20 project scope, $50 or ten percent of original fee, whichever is 309.21 greater; and 309.22 (iii) proposer-requested revision with an increase in 309.23 project scope, $50 plus the difference between the original 309.24 project fee and the revised project fee. 309.25 Sec. 62. Minnesota Statutes 2004, section 471.61, is 309.26 amended by adding a subdivision to read: 309.27 Subd. 5. [PROVISION OF LONG-TERM CARE INSURANCE.] Any 309.28 political subdivision, or any two or more political subdivisions 309.29 acting jointly, may contract with an insurance company licensed 309.30 to do business in this state for the voluntary purchase of 309.31 long-term care insurance by the employees and their dependents 309.32 of the political subdivision or subdivisions. The coverage may 309.33 be through a group policy or through individual coverage. 309.34 Sec. 63. [RULE AMENDMENT.] 309.35 The commissioner of health shall amend Minnesota Rules, 309.36 part 4626.2015, subparts 3, item C; and 6, item B, to conform 310.1 with section 52. The commissioner may use the good cause 310.2 exemption under Minnesota Statutes, section 14.388, subdivision 310.3 1, clause (3). Minnesota Statutes, section 14.386, does not 310.4 apply, except to the extent provided under Minnesota Statutes, 310.5 section 14.388. 310.6 Sec. 64. [DIRECTION TO COMMISSIONER; DENTAL REVIEW.] 310.7 The commissioner of health, in consultation with the 310.8 relevant dental associations, licensed dental and public health 310.9 professionals, and others, shall review the leadership and 310.10 advisory role of the Department of Health relative to dental 310.11 health including the usefulness of utilizing a dental director. 310.12 The review shall include prevention, health disparities, and 310.13 critical access issues and shall be reported to the legislative 310.14 committees with jurisdiction over health policy by January 15, 310.15 2006. 310.16 Sec. 65. [REPEALER.] 310.17 (a) Minnesota Statutes 2004, sections 13.383, subdivision 310.18 3; 13.411, subdivision 3; 144.1486; 144.1502; 146A.01, 310.19 subdivisions 2 and 5; 146A.02; 146A.03; 146A.04; 146A.05; 310.20 146A.06; 146A.07; 146A.08; 146A.09; 146A.10; and 157.215, are 310.21 repealed. 310.22 (b) Minnesota Statutes 2004, section 145.925, and Minnesota 310.23 Rules, parts 4700.1900, 4700.2000, 4700.2100, 4700.2200, 310.24 4700.2210, 4700.2300, 4700.2400, 4700.2410, 4700.2420, and 310.25 4700.2500, are repealed. 310.26 [EFFECTIVE DATE.] Paragraph (b) of this section is 310.27 effective July 1, 2006, or upon implementation of the Family 310.28 Planning Project section 1115 waiver, whichever is later. 310.29 ARTICLE 9 310.30 DEPARTMENT OF HUMAN SERVICES FORECAST ADJUSTMENT 310.31 Section 1. [ADJUSTMENT.] 310.32 The dollar amounts shown are added to or, if shown in 310.33 parentheses, are subtracted from the appropriations in Laws 310.34 2003, First Special Session chapter 14, as amended by Laws 2004, 310.35 chapter 272, or other law, and are appropriated from the general 310.36 fund, or any other fund named, to the Department of Human 311.1 Services for the purposes specified in this article, to be 311.2 available for the fiscal year indicated for each purpose. The 311.3 figure "2005" used in this article means that the appropriation 311.4 or appropriations listed are available for the fiscal year 311.5 ending June 30, 2005. 311.6 SUMMARY BY FUND 311.7 2005 311.8 General Fund 25,517,000 311.9 Health Care Access (33,947,000) 311.10 TANF (814,000) 311.11 TOTAL (9,244,000) 311.12 Sec. 2. COMMISSIONER OF HUMAN SERVICES 311.13 Subdivision 1. Total 311.14 Appropriation (9,244,000) 311.15 Summary by Fund 311.16 General 25,517,000 311.17 Health Care Access (33,947,000) 311.18 TANF (814,000) 311.19 Subd. 2. Revenue and Pass-Through 311.20 TANF (814,000) 311.21 Subd. 3. Basic Health Care Grants 311.22 General 44,502,000 311.23 Health Care Access (33,947,000) 311.24 The amount that may be spent from this 311.25 appropriation for each purpose is as 311.26 follows: 311.27 (a) MinnesotaCare 311.28 Health Care Access (33,947,000) 311.29 (b) MA Basic Health Care - Families and Children 311.30 General 39,343,000 311.31 (c) MA Basic Health Care - Elderly and Disabled 311.32 General (20,641,000) 311.33 (d) General Assistance Medical Care 311.34 General 25,800,000 311.35 Subd. 4. Continuing Care Grants 311.36 General (18,985,000) 311.37 The amount that may be spent from this 311.38 appropriation for each purpose is as 312.1 follows: 312.2 (a) MA Long-Term Care Waivers 312.3 General (6,218,000) 312.4 (b) MA Long-Term Care Facilities 312.5 General (15,645,000) 312.6 (c) Chemical Dependency Entitlement Grants 312.7 General (2,878,000) 312.8 ARTICLE 10 312.9 APPROPRIATIONS 312.10 Section 1. [HEALTH AND HUMAN SERVICES APPROPRIATIONS.] 312.11 The sums shown in the columns marked "APPROPRIATIONS" are 312.12 appropriated from the general fund, or any other fund named, to 312.13 the agencies and for the purposes specified in the sections of 312.14 this article, to be available for the fiscal years indicated for 312.15 each purpose. The figures "2006" and "2007" where used in this 312.16 article, mean that the appropriation or appropriations listed 312.17 under them are available for the fiscal year ending June 30, 312.18 2006, or June 30, 2007, respectively. 312.19 SUMMARY BY FUND 312.20 BIENNIAL 312.21 2006 2007 TOTAL 312.22 General $3,494,261,000 $3,635,190,000 $7,129,451,000 312.23 State Government 312.24 Special Revenue 49,893,000 50,297,000 100,190,000 312.25 Health Care 312.26 Access 464,068,000 552,640,000 1,016,708,000 312.27 Federal TANF 66,989,000 64,446,000 131,435,000 312.28 Lottery Prize 312.29 Fund 1,456,000 1,456,000 2,912,000 312.30 TOTAL $4,076,667,000 $4,304,038,000 $8,380,705,000 312.31 APPROPRIATIONS 312.32 Available for the Year 312.33 Ending June 30 312.34 2006 2007 312.35 Sec. 2. COMMISSIONER OF 312.36 HUMAN SERVICES 312.37 Subdivision 1. Total 312.38 Appropriation $3,915,840,000 $4,142,334,000 312.39 Summary by Fund 312.40 General 3,395,066,000 3,535,538,000 313.1 State Government 313.2 Special Revenue 534,000 534,000 313.3 Health Care 313.4 Access 457,795,000 546,361,000 313.5 Federal TANF 60,989,000 58,446,000 313.6 Lottery Cash 313.7 Flow 1,456,000 1,456,000 313.8 [RECEIPTS FOR SYSTEMS PROJECTS.] 313.9 Appropriations and federal receipts for 313.10 information system projects for MAXIS, 313.11 PRISM, MMIS, AND SSIS must be deposited 313.12 in the state system account authorized 313.13 in Minnesota Statutes, section 313.14 256.014. Money appropriated for 313.15 computer projects approved by the 313.16 Minnesota Office of Technology, funded 313.17 by the legislature, and approved by the 313.18 commissioner of finance, may be 313.19 transferred from one project to another 313.20 and from development to operations as 313.21 the commissioner of human services 313.22 considers necessary. Any unexpended 313.23 balance in the appropriation for these 313.24 projects does not cancel but is 313.25 available for ongoing development and 313.26 operations. 313.27 [SYSTEMS CONTINUITY.] In the event of 313.28 disruption of technical systems or 313.29 computer operations, the commissioner 313.30 may use available grant appropriations 313.31 to ensure continuity of payments for 313.32 maintaining the health, safety, and 313.33 well-being of clients served by 313.34 programs administered by the Department 313.35 of Human Services. Grant funds must be 313.36 used in a manner consistent with the 313.37 original intent of the appropriation. 313.38 [NONFEDERAL SHARE TRANSFERS.] The 313.39 nonfederal share of activities for 313.40 which federal administrative 313.41 reimbursement is appropriated to the 313.42 commissioner may be transferred to the 313.43 special revenue fund. 313.44 [GIFTS.] Notwithstanding Minnesota 313.45 Statutes, chapter 7, the commissioner 313.46 may accept, on behalf of the state, 313.47 additional funding from sources other 313.48 than state funds for the purpose of 313.49 financing the cost of assistance 313.50 program grants or nongrant 313.51 administration. All additional funding 313.52 is appropriated to the commissioner for 313.53 use as designated by the grantor of 313.54 funding. 313.55 [TANF FUNDS APPROPRIATED TO OTHER 313.56 ENTITIES.] Any expenditures from the 313.57 TANF block grant shall be expended in 313.58 accordance with the requirements and 313.59 limitations of part A of title IV of 313.60 the Social Security Act, as amended, 313.61 and any other applicable federal 313.62 requirement or limitation. Prior to 313.63 any expenditure of these funds, the 314.1 commissioner shall assure that funds 314.2 are expended in compliance with the 314.3 requirements and limitations of federal 314.4 law and that any reporting requirements 314.5 of federal law are met. It shall be 314.6 the responsibility of any entity to 314.7 which these funds are appropriated to 314.8 implement a memorandum of understanding 314.9 with the commissioner that provides the 314.10 necessary assurance of compliance prior 314.11 to any expenditure of funds. The 314.12 commissioner shall receipt TANF funds 314.13 appropriated to other state agencies 314.14 and coordinate all related interagency 314.15 accounting transactions necessary to 314.16 implement these appropriations. 314.17 Unexpended TANF funds appropriated to 314.18 any state, local, or nonprofit entity 314.19 cancel at the end of the state fiscal 314.20 year unless appropriating language 314.21 permits otherwise. 314.22 [CAPITATION RATE INCREASE.] Of the 314.23 health care access fund appropriations 314.24 to the University of Minnesota in the 314.25 higher education omnibus appropriation 314.26 bill, $2,157,000 in fiscal year 2006 314.27 and $2,157,000 in fiscal year 2007 are 314.28 to be used to increase the capitation 314.29 payments under Minnesota Statutes, 314.30 section 256B.69. Notwithstanding 314.31 section 12, this provision shall not 314.32 expire. 314.33 Subd. 2. Agency Management 314.34 Summary by Fund 314.35 General 46,899,000 46,782,000 314.36 State Government 314.37 Special Revenue 415,000 415,000 314.38 Health Care Access 5,565,000 5,200,000 314.39 Federal TANF 222,000 222,000 314.40 The amounts that may be spent from the 314.41 appropriation for each purpose are as 314.42 follows: 314.43 (a) Financial Operations 314.44 General 10,473,000 10,473,000 314.45 Health Care Access 813,000 837,000 314.46 Federal TANF 122,000 122,000 314.47 [ADMINISTRATIVE BASE ADJUSTMENT - WEB 314.48 PAYMENT.] The health care access fund 314.49 base is increased by $28,000 in fiscal 314.50 year 2008 and $61,000 in fiscal year 314.51 2009 for fees associated with web-based 314.52 payment collections. 314.53 (b) Legal and 314.54 Regulation Operations 314.55 General 9,983,000 9,636,000 315.1 State Government 315.2 Special Revenue 415,000 415,000 315.3 Health Care Access 755,000 319,000 315.4 Federal TANF 100,000 100,000 315.5 (c) Management Operations 315.6 General 3,281,000 3,281,000 315.7 Health Care Access 68,000 68,000 315.8 (d) Information Technology 315.9 Operations 315.10 General 23,162,000 23,392,000 315.11 Health Care Access 3,929,000 3,976,000 315.12 Subd. 3. Revenue and Pass-Through Expenditures 315.13 Summary by Fund 315.14 Federal TANF 60,767,000 58,224,000 315.15 Subd. 4. Children and Economic 315.16 Assistance Grants 315.17 Summary by Fund 315.18 General 37,000 177,000 315.19 (a) Children's Services Grants 315.20 General 34,000 166,000 315.21 [CHILDREN'S MENTAL HEALTH GRANTS BASE 315.22 ADJUSTMENT.] The general fund base is 315.23 increased by $41,000 in fiscal year 315.24 2008 and fiscal year 2009 for costs 315.25 associated with the long-term care 315.26 provider cost-of-living adjustment. 315.27 (b) Children and Community 315.28 Services Grants 315.29 General 3,000 11,000 315.30 [CHILDREN'S COMMUNITY SERVICE GRANTS 315.31 BASE ADJUSTMENT.] The general fund base 315.32 is increased by $2,000 in fiscal year 315.33 2008 and fiscal year 2009 for costs 315.34 associated with the long-term care 315.35 provider cost-of-living adjustment. 315.36 Subd. 5. Basic Health Care Grants 315.37 Summary by Fund 315.38 General 1,525,139,000 1,602,701,000 315.39 Health Care Access 429,897,000 523,265,000 315.40 [UPDATING FEDERAL POVERTY GUIDELINES.] 315.41 Annual updates to the federal poverty 315.42 guidelines are effective each July 1, 315.43 following publication by the United 315.44 States Department of Health and Human 315.45 Services for health care programs under 315.46 Minnesota Statutes, chapters 256, 256B, 316.1 256D, and 256L. 316.2 [HEALTH CARE ACCESS FUND SPENDING 316.3 AUTHORITY.] The commissioner of human 316.4 services, with the approval of the 316.5 commissioner of finance, and after 316.6 notification of the chairs of the 316.7 relevant house finance committee and 316.8 senate budget division, may expend 316.9 money appropriated from the health care 316.10 access fund for MinnesotaCare and 316.11 general assistance medical care in 316.12 either fiscal year of the biennium and 316.13 transfer unencumbered appropriation 316.14 balances between these two programs 316.15 within or between fiscal years for the 316.16 biennium ending June 30, 2007. 316.17 [FULL FUNDING FOR DIAGNOSIS RELATED 316.18 GROUPS PAYMENT ADJUSTMENT.] In order to 316.19 provide full funding for the 316.20 diagnosis-related groups for hospitals 316.21 located in Greater Minnesota under 316.22 Minnesota Statutes, section 256.969, 316.23 subdivision 26, the following increases 316.24 are hereby appropriated: 316.25 $722,000 in fiscal year 2006 and 316.26 $1,076,000 in fiscal year 2007 for MA 316.27 Basic Care-Families and Children; 316.28 $903,000 in fiscal year 2006 and 316.29 $1,345,000 in fiscal year 2007 for MA 316.30 Basic Care-Elderly and Disabled; and 316.31 $361,000 in fiscal year 2006 and 316.32 $538,000 in fiscal year 2007 for 316.33 General Assistance Medical Care. 316.34 The amounts that may be spent from the 316.35 appropriation for each purpose are as 316.36 follows: 316.37 (a) MinnesotaCare Grants 316.38 Health Care Access 196,222,000 124,046,000 316.39 [MINNESOTACARE FEDERAL RECEIPTS.] 316.40 Receipts received as a result of 316.41 federal participation pertaining to 316.42 administrative costs of the Minnesota 316.43 health care reform waiver shall be 316.44 deposited as nondedicated revenue in 316.45 the health care access fund. Receipts 316.46 received as a result of federal 316.47 participation pertaining to grants 316.48 shall be deposited in the federal fund 316.49 and shall offset health care access 316.50 funds for payments to providers. 316.51 (b) MA Basic Health Care - 316.52 Families and Children 316.53 General 619,076,000 735,721,000 316.54 (c) MA Basic Health Care - 316.55 Elderly and Disabled 316.56 General 808,501,000 863,921,000 316.57 (d) General Assistance Medical Care 317.1 Grants 317.2 General 87,777,000 -0- 317.3 Health Care Access 235,585,000 399,465,000 317.4 [GAMC DRUG REBATE REVENUES.] 317.5 Notwithstanding Minnesota Statutes, 317.6 section 256.01, subdivision 2, drug 317.7 rebate revenues collected for general 317.8 assistance medical care claims with a 317.9 warrant date prior to June 30, 2007, 317.10 shall be deposited in the general fund 317.11 and the pharmaceutical discount program 317.12 implementation is delayed until July 1, 317.13 2007. Notwithstanding section 12, this 317.14 provision will not expire. 317.15 Health Care Access 235,585,000 398,610,000 317.16 (e) Prescription Drug Program Grants 317.17 General 4,318,000 -0- 317.18 [PDP TO MEDICARE PART D TRANSITION.] 317.19 The commissioner of human services, 317.20 with the approval of the commissioner 317.21 of finance, and after notification of 317.22 the chair of the senate Health and 317.23 Human Services Budget Division and the 317.24 chair of the house Health Policy and 317.25 Finance Committee, may transfer fiscal 317.26 year 2006 appropriations between the 317.27 medical assistance program and the 317.28 prescription drug program. 317.29 (f) Health Care Grants - 317.30 Other Assistance 317.31 General 5,467,000 3,059,000 317.32 Subd. 6. Health Care Management 317.33 Summary by Fund 317.34 General 25,613,000 26,371,000 317.35 Health Care Access 20,423,000 17,650,000 317.36 The amounts that may be spent from the 317.37 appropriation for each purpose are as 317.38 follows: 317.39 (a) Health Care Policy Administration 317.40 General 8,976,000 9,176,000 317.41 Health Care Access 3,482,000 2,630,000 317.42 [HEALTH CARE ACCESS FUND TRANSFERS 317.43 EXPIRATION.] Notwithstanding Laws 2003, 317.44 First Special Session chapter 14, 317.45 article 13C, section 2, subdivision 6, 317.46 paragraph (b), designating funds 317.47 available for transfer to the general 317.48 fund, the commissioner of finance's 317.49 authorization to transfer those 317.50 designated funds from the health care 317.51 access fund shall expire July 1, 2005. 317.52 [HEALTH CARE ACCESS FUND TRANSFERS.] 318.1 Transfers of funds between the health 318.2 care access fund and the general fund 318.3 authorized under Minnesota Statutes, 318.4 section 16A.724, supersede the 318.5 transfers authorized in Laws 2003, 318.6 First Special Session chapter 14, 318.7 article 13C, section 2, subdivision 7, 318.8 paragraph (a). This provision is 318.9 effective the day following final 318.10 enactment. 318.11 [ADMINISTRATIVE BASE ADJUSTMENT.] The 318.12 health care access fund base is 318.13 increased by $1,868,000 in fiscal year 318.14 2008 and $1,874,000 in fiscal year 318.15 2009, for implementation of business 318.16 process redesign in health care. 318.17 [MINNESOTA SENIOR HEALTH OPTIONS 318.18 REIMBURSEMENT.] Federal administrative 318.19 reimbursement resulting from the 318.20 Minnesota senior health options project 318.21 is appropriated to the commissioner for 318.22 this activity. 318.23 [UTILIZATION REVIEW.] Federal 318.24 administrative reimbursement resulting 318.25 from prior authorization and inpatient 318.26 admission certification by a 318.27 professional review organization shall 318.28 be dedicated to the commissioner for 318.29 these purposes. A portion of these 318.30 funds must be used for activities to 318.31 decrease unnecessary pharmaceutical 318.32 costs in medical assistance. 318.33 (b) Health Care Operations 318.34 General 16,637,000 17,195,000 318.35 Health Care Access 16,941,000 15,020,000 318.36 Subd. 7. Continuing Care Grants 318.37 Summary by Fund 318.38 General 1,558,757,000 1,643,957,000 318.39 Lottery Prize 1,308,000 1,308,000 318.40 The amounts that may be spent from the 318.41 appropriation for each purpose are as 318.42 follows: 318.43 (a) Aging and Adult Services Grant 318.44 General 15,375,000 14,323,000 318.45 [MEDICARE PART D.] Of the general fund 318.46 appropriation for the biennium, 318.47 $4,697,000 shall be used for grants to 318.48 the Board on Aging for information and 318.49 assistance for Medicare Part D 318.50 implementation. This money can be used 318.51 in either year of the biennium. 318.52 Beginning in fiscal 2008, base level 318.53 funding is $3,417,000 per year. 318.54 (b) Alternative Care Grants 319.1 General 58,073,000 49,706,000 319.2 [ALTERNATIVE CARE TRANSFER.] Any money 319.3 allocated to the alternative care 319.4 program that is not spent for the 319.5 purposes indicated does not cancel but 319.6 shall be transferred to the medical 319.7 assistance account. 319.8 [ALTERNATIVE CARE BASE.] Base level 319.9 funding for alternative care grants is 319.10 increased by $563,000 in fiscal year 319.11 2008 and by $575,000 in fiscal year 319.12 2009. 319.13 [ALTERNATIVE CARE IMPLEMENTATION OF 319.14 CHANGES TO ELIGIBILITY.] Changes to 319.15 Minnesota Statutes, section 256B.0913, 319.16 subdivisions 2 and 4, paragraph (a), 319.17 are effective July 1, 2005, for all 319.18 persons found eligible for the 319.19 alternative care program on and after 319.20 July 1, 2005. All persons who are 319.21 alternative care clients as of June 30, 319.22 2005, must be subject to Minnesota 319.23 Statutes, section 256B.0913, 319.24 subdivisions 2 and 4, paragraph (a), on 319.25 the annual redetermination of program 319.26 eligibility due after June 30, 2005, 319.27 but no later than January 1, 2006. 319.28 (c) Medical Assistance Grants - 319.29 Long-term Care Facilities 319.30 General 522,953,000 524,765,000 319.31 (d) Medical Assistance Grants - 319.32 Long-Term Care Waivers and 319.33 Home Care Grants 319.34 General 835,332,000 921,347,000 319.35 [LONG-TERM CARE PROVIDER RATE 319.36 INCREASE.] The long-term care provider 319.37 rate increase in Minnesota Statutes, 319.38 sections 256B.431, subdivision 41; 319.39 256B.5012, subdivision 6; and 256B.765, 319.40 subdivision 3, shall be adjusted to 319.41 reflect an additional 2.2553 percent 319.42 increase effective October 1, 2006, and 319.43 a 2.2553 percent increase effective 319.44 October 1, 2007. This new percentage 319.45 rate shall become part of base-level 319.46 funding for fiscal years 2008 and 2009. 319.47 [LIMITING GROWTH IN COMMUNITY 319.48 ALTERNATIVES FOR DISABLED INDIVIDUALS 319.49 WAIVER.] For each year of the biennium 319.50 ending June 30, 2007, the commissioner 319.51 shall make available additional 319.52 allocations for home and 319.53 community-based services covered under 319.54 Minnesota Statutes, section 256B.49, at 319.55 a rate of 95 per month or 1,140 per 319.56 year, plus any additional legislatively 319.57 authorized growth. Priorities for the 319.58 allocation of funds shall be for 319.59 individuals anticipated to be 319.60 discharged from institutional settings 319.61 or who are at imminent risk of a 319.62 placement in an institutional setting. 320.1 [LIMITING GROWTH IN TBI WAIVER.] For 320.2 each year of the biennium ending June 320.3 30, 2007, the commissioner shall make 320.4 available additional allocations for 320.5 home and community-based services 320.6 covered under Minnesota Statutes, 320.7 section 256B.49, at a rate of 150 per 320.8 year. Priorities for the allocation of 320.9 funds shall be for individuals 320.10 anticipated to be discharged from 320.11 institutional settings or who are at 320.12 imminent risk of a placement in an 320.13 institutional setting. 320.14 [LIMITING GROWTH IN MR/RC WAIVER.] For 320.15 each year of the biennium ending June 320.16 30, 2007, the commissioner shall limit 320.17 the new diversion caseload growth in 320.18 the MR/RC waiver to 50 additional 320.19 allocations. Notwithstanding Minnesota 320.20 Statutes, section 256B.0916, 320.21 subdivision 5, paragraph (b), the 320.22 available diversion allocations shall 320.23 be awarded to support individuals whose 320.24 health and safety needs result in an 320.25 imminent risk of an institutional 320.26 placement at any time during the fiscal 320.27 year. 320.28 [QUALITY ASSURANCE COMMISSION.] Of the 320.29 general fund appropriation, $299,000 in 320.30 fiscal year 2006 and $450,000 in fiscal 320.31 year 2007 is for the Quality Assurance 320.32 Commission under Minnesota Statutes, 320.33 section 256B.0951. 320.34 (e) Mental Health Grants 320.35 General 46,731,000 47,516,000 320.36 Lottery Prize 1,308,000 1,308,000 320.37 [MENTAL HEALTH GRANT BASE.] Base level 320.38 funding for mental health grants is 320.39 increased by $388,000 in fiscal year 320.40 2008 and by $395,000 in fiscal year 320.41 2009. 320.42 [RESTRUCTURING OF ADULT MENTAL HEALTH 320.43 SERVICES.] The commissioner may make 320.44 transfers that do not increase the 320.45 state share of costs to effectively 320.46 implement the restructuring of adult 320.47 mental health services. 320.48 [COMPULSIVE GAMBLING PREVENTION AND 320.49 EDUCATION.] $150,000 is appropriated 320.50 from the lottery prize fund for the 320.51 fiscal year ending June 30, 2006, and 320.52 $150,000 is appropriated from the 320.53 lottery prize fund for the fiscal year 320.54 ending June 30, 2007, to the 320.55 commissioner of human services for a 320.56 grant to the Northstar Problem Gambling 320.57 Alliance in Arlington, Minnesota. Of 320.58 this appropriation, $75,000 in the 320.59 fiscal year ending June 30, 2006, and 320.60 $75,000 in the fiscal year ending June 320.61 30, 2007, is contingent on 320.62 demonstration of nonstate matching 320.63 funds. The commissioner of finance may 321.1 disburse the state portion of the 321.2 matching funds in increments of $37,500 321.3 upon receipt of a commitment for an 321.4 equal amount of matching nonstate 321.5 funds. These funds shall be used to 321.6 increase public awareness of problem 321.7 gambling, education, training, and 321.8 research. 321.9 (f) Deaf and Hard-of-Hearing 321.10 Grants 321.11 General 1,454,000 1,475,000 321.12 [DEAF AND HARD-OF-HEARING BASE 321.13 FUNDING.] Base level funding for the 321.14 deaf and hard-of-hearing grants is 321.15 increased by $4,000 in fiscal year 2008 321.16 and $4,000 in fiscal year 2009. 321.17 (g) Chemical Dependency 321.18 Entitlement Grants 321.19 General 63,183,000 68,744,000 321.20 (h) Chemical Dependency Nonentitlement 321.21 Grants 321.22 General 1,055,000 1,055,000 321.23 (i) Other Continuing Care Grants 321.24 General 14,601,000 15,027,000 321.25 [OTHER CONTINUING CARE GRANTS BASE 321.26 FUNDING.] Base level funding for other 321.27 continuing care grants is increased by 321.28 $45,000 in fiscal year 2008 and $94,000 321.29 in fiscal year 2009. 321.30 Subd. 8. Continuing Care Management 321.31 Summary by Fund 321.32 General 15,034,000 15,122,000 321.33 State Government 321.34 Special Revenue 119,000 119,000 321.35 Lottery Prize 148,000 148,000 321.36 [QUALITY ASSURANCE COMMISSION.] 321.37 $151,000 in fiscal year 2007 is 321.38 appropriated from the general fund to 321.39 the commissioner of human services for 321.40 the Quality Assurance Commission under 321.41 Minnesota Statutes, section 256B.0951. 321.42 This funding is added to the base 321.43 appropriation for the quality assurance 321.44 commission program for the fiscal year 321.45 beginning July 1, 2006. 321.46 Subd. 9. State-Operated Services 321.47 Summary by Fund 321.48 General 223,581,000 200,448,000 321.49 [EVIDENCE-BASED PRACTICE FOR 321.50 METHAMPHETAMINE TREATMENT.] $300,000 is 321.51 appropriated from the general fund for 322.1 the fiscal year ending June 30, 2006, 322.2 and $300,000 is appropriated from the 322.3 general fund for the fiscal year ending 322.4 June 30, 2007, to the commissioner of 322.5 human services to support development 322.6 of evidence-based practices for the 322.7 treatment of methamphetamine abuse at 322.8 the state-operated services chemical 322.9 dependency program in Willmar. These 322.10 funds shall be used to support research 322.11 on evidence-based practices for the 322.12 treatment of methamphetamine abuse, to 322.13 disseminate the results of the 322.14 evidence-based practice research 322.15 statewide, and to create training for 322.16 addiction counselors specializing in 322.17 the treatment of methamphetamine abuse. 322.18 [TRANSFER AUTHORITY RELATED TO 322.19 STATE-OPERATED SERVICES.] Money 322.20 appropriated to finance state-operated 322.21 services programs and administrative 322.22 services may be transferred between 322.23 fiscal years of the biennium with the 322.24 approval of the commissioner of finance. 322.25 [BASE ADJUSTMENT FOR STATE-OPERATED 322.26 SERVICES UTILIZATION.] The general fund 322.27 base is increased by $3,174,000 in 322.28 fiscal year 2008 and $6,472,000 in 322.29 fiscal year 2009 for state-operated 322.30 services forensic operations, with 322.31 corresponding adjustments to 322.32 nondedicated revenue estimates. 322.33 Sec. 3. COMMISSIONER OF HEALTH 322.34 Subdivision 1. Total 322.35 Appropriation 113,245,000 114,094,000 322.36 Summary by Fund 322.37 General 64,452,000 64,909,000 322.38 State Government 322.39 Special Revenue 36,520,000 36,906,000 322.40 Health Care Access 6,273,000 6,279,000 322.41 Federal TANF 6,000,000 6,000,000 322.42 [TANF APPROPRIATIONS.] (a) $4,000,000 322.43 of TANF funds is appropriated each year 322.44 to the commissioner for home visiting 322.45 and nutritional services listed under 322.46 Minnesota Statutes, section 145.882, 322.47 subdivision 7, clauses (6) and (7). 322.48 Funding shall be distributed to 322.49 community health boards based on 322.50 Minnesota Statutes, section 145A.131, 322.51 subdivision 1, and tribal governments 322.52 based on Minnesota Statutes, section 322.53 145A.14, subdivision 2, paragraph (b). 322.54 (b) $2,000,000 of TANF funds is 322.55 appropriated each year to the 322.56 commissioner for decreasing racial and 322.57 ethnic disparities in infant mortality 322.58 rates under Minnesota Statutes, section 322.59 145.928, subdivision 7. 323.1 [TANF CARRYFORWARD.] Any unexpended 323.2 balance of the TANF appropriation in 323.3 the first year of the biennium does not 323.4 cancel but is available for the second 323.5 year. 323.6 [MN AIDS PROJECT.] Notwithstanding any 323.7 law to the contrary, the Minnesota AIDS 323.8 Project is not eligible for any grants 323.9 from the commissioner of health or 323.10 Department of Health. 323.11 Subd. 2. Community and Family 323.12 Health Promotion 323.13 Summary by Fund 323.14 General 40,074,000 38,670,000 323.15 State Government 323.16 Special Revenue 341,000 328,000 323.17 Health Care Access 3,510,000 3,516,000 323.18 Federal TANF 3,580,000 3,580,000 323.19 [HEALTH OCCUPATIONS LICENSING.] 323.20 $200,000 of the appropriation in fiscal 323.21 year 2006 and $200,000 of the 323.22 appropriation in fiscal year 2007 from 323.23 the health occupations licensing 323.24 account in the state government special 323.25 revenue fund are for the rural pharmacy 323.26 planning and transition grant program. 323.27 [SHAKEN BABY VIDEO.] Of the state 323.28 government special revenue fund 323.29 appropriation, $13,000 in 2006 is 323.30 appropriated to the commissioner of 323.31 health to provide a video to hospitals 323.32 on shaken baby syndrome. The 323.33 commissioner of health shall assess a 323.34 fee to hospitals to cover the cost of 323.35 the approved shaken baby video and the 323.36 revenue received is to be deposited in 323.37 the state government special revenue 323.38 fund. 323.39 [POSITIVE ABORTION ALTERNATIVES.] 323.40 $50,000 in fiscal year 2006 is for 323.41 administrative costs of the positive 323.42 abortion alternatives program 323.43 implementation. 323.44 $2,500,000 in fiscal year 2007 is for 323.45 positive abortion alternatives under 323.46 Minnesota Statutes, section 145.4231. 323.47 Of this amount, $100,000 may be used 323.48 for administrative costs of 323.49 implementing the grant program. 323.50 Subd. 3. Policy Quality and 323.51 Compliance 323.52 Summary by Fund 323.53 General 3,668,000 3,668,000 323.54 State Government 323.55 Special Revenue 11,528,000 11,428,000 324.1 Health Care Access 2,763,000 2,763,000 324.2 [OCCUPATIONAL THERAPY FEE HOLIDAY.] The 324.3 commissioner's authority to collect the 324.4 license renewal fee from occupational 324.5 therapy practitioners under Minnesota 324.6 Statutes, section 148.6445, subdivision 324.7 2, is suspended for fiscal years 2006 324.8 and 2007. 324.9 Subd. 4. Health Protection 324.10 Summary by Fund 324.11 General 9,118,000 9,118,000 324.12 State Government 324.13 Special Revenue 24,316,000 24,815,000 324.14 Subd. 5. Minority and 324.15 Multicultural Health 324.16 Summary by Fund 324.17 General 6,190,000 8,051,000 324.18 Federal TANF 2,420,000 2,420,000 324.19 Subd. 6. Administrative 324.20 Support Services 324.21 Summary by Fund 324.22 General 5,402,000 5,402,000 324.23 State Government 324.24 Special Revenue 335,000 335,000 324.25 Sec. 4. VETERANS NURSING HOMES BOARD 324.26 General 30,030,000 30,030,000 324.27 [VETERANS HOMES SPECIAL REVENUE 324.28 ACCOUNT.] The general fund 324.29 appropriations made to the board may be 324.30 transferred to a veterans homes special 324.31 revenue account in the special revenue 324.32 fund in the same manner as other 324.33 receipts are deposited according to 324.34 Minnesota Statutes, section 198.34, and 324.35 are appropriated to the board for the 324.36 operation of board facilities and 324.37 programs. 324.38 Sec. 5. HEALTH-RELATED BOARDS 324.39 Subdivision 1. Total 324.40 Appropriation 12,268,000 12,286,000 324.41 Summary by Fund 324.42 General 25,000 25,000 324.43 State Government 324.44 Special Revenue 12,243,000 12,261,000 324.45 [STATE GOVERNMENT SPECIAL REVENUE 324.46 FUND.] The appropriations in this 324.47 section are from the state government 324.48 special revenue fund, except where 324.49 noted. 325.1 [NO SPENDING IN EXCESS OF REVENUES.] 325.2 The commissioner of finance shall not 325.3 permit the allotment, encumbrance, or 325.4 expenditure of money appropriated in 325.5 this section in excess of the 325.6 anticipated biennial revenues or 325.7 accumulated surplus revenues from fees 325.8 collected by the boards. Neither this 325.9 provision nor Minnesota Statutes, 325.10 section 214.06, applies to transfers 325.11 from the general contingent account. 325.12 Subd. 2. Board of Behavioral 325.13 Health and Therapy 673,000 673,000 325.14 Subd. 3. Board of Chiropractic 325.15 Examiners 414,000 414,000 325.16 Subd. 4. Board of Dentistry 888,000 888,000 325.17 Subd. 5. Board of Dietetic and 325.18 Nutrition Practice 101,000 101,000 325.19 The Board of Dietetic and Nutrition 325.20 Practice may lower its fees by an 325.21 amount not to exceed $36,000 in fiscal 325.22 years 2006, 2007, 2008, and 2009. 325.23 Subd. 6. Board of Marriage and 325.24 Family Therapy 127,000 131,000 325.25 Subd. 7. Board of Medical 325.26 Practice 3,529,000 3,569,000 325.27 Subd. 8. Board of Nursing 2,561,000 2,567,000 325.28 The Board of Nursing may lower its fees 325.29 by an amount not to exceed $467,000 in 325.30 fiscal year 2006 and $442,000 in fiscal 325.31 years 2007, 2008, and 2009. 325.32 Subd. 9. Board of Nursing 325.33 Home Administrators 616,000 619,000 325.34 [ADMINISTRATIVE SERVICES UNIT.] Of this 325.35 appropriation, $418,000 the first year 325.36 and $421,000 the second year are for 325.37 the health boards administrative 325.38 services unit. The administrative 325.39 services unit may receive and expend 325.40 reimbursements for services performed 325.41 for other agencies. 325.42 Subd. 10. Board of Optometry 96,000 96,000 325.43 Subd. 11. Board of Pharmacy 1,289,000 1,244,000 325.44 General Fund 25,000 25,000 325.45 State Government 325.46 Special Revenue 1,264,000 1,219,000 325.47 [CANCER DRUG REPOSITORY.] $25,000 each 325.48 year from the general fund is for the 325.49 Board of Pharmacy to operate the cancer 325.50 drug repository program in Minnesota 325.51 Statutes, section 144.707. 325.52 Subd. 12. Board of Physical 325.53 Therapy 201,000 207,000 326.1 Subd. 13. Board of Podiatry 49,000 53,000 326.2 Subd. 14. Board of Psychology 680,000 680,000 326.3 Subd. 15. Board of Social 326.4 Work 873,000 873,000 326.5 [TEMPORARY FEE REDUCTION.] Beginning 326.6 January 1, 2006, for fiscal year 2006 326.7 and for fiscal years 2007, 2008, and 326.8 2009, the following fee changes for 326.9 fees specified in Minnesota Statutes, 326.10 section 148D.175, are effective: 326.11 (1) in subdivision 1, the application 326.12 fee for a licensed independent social 326.13 worker is reduced to $45; 326.14 (2) in subdivision 1, the application 326.15 fee for a licensed independent clinical 326.16 social worker is reduced to $45; 326.17 (3) in subdivision 1, the application 326.18 fee for a licensure by endorsement is 326.19 reduced to $85; 326.20 (4) in subdivision 2, the license fee 326.21 for a licensed social worker is reduced 326.22 to $90; 326.23 (5) in subdivision 2, the license fee 326.24 for a licensed graduate social worker 326.25 is reduced to $160; 326.26 (6) in subdivision 2, the license fee 326.27 for a licensed independent social 326.28 worker is reduced to $240; 326.29 (7) in subdivision 2, the license fee 326.30 for a licensed independent clinical 326.31 social worker is reduced to $265; 326.32 (8) in subdivision 3, the renewal fee 326.33 for a licensed social worker is reduced 326.34 to $90; 326.35 (9) in subdivision 3, the renewal fee 326.36 for a licensed graduate social worker 326.37 is reduced to $160; 326.38 (10) in subdivision 3, the renewal fee 326.39 for a licensed independent social 326.40 worker is reduced to $240; 326.41 (11) in subdivision 3, the renewal fee 326.42 for a licensed independent clinical 326.43 social worker is reduced to $265; and 326.44 (12) in subdivision 5, the renewal late 326.45 fee is reduced to one-third of the 326.46 renewal fee specified in subdivision 3. 326.47 These fee reductions expire on June 30, 326.48 2009. 326.49 Subd. 16. Board of Veterinary 326.50 Medicine 171,000 171,000 326.51 Sec. 6. EMERGENCY MEDICAL SERVICES BOARD 326.52 Subdivision 1. Total 327.1 Appropriation 3,077,000 3,077,000 327.2 Summary by Fund 327.3 General 2,481,000 2,481,000 327.4 State Government 327.5 Special Revenue 596,000 596,000 327.6 [HEALTH PROFESSIONAL SERVICES 327.7 ACTIVITY.] $596,000 each year from the 327.8 state government special revenue fund 327.9 is for the health professional services 327.10 activity. 327.11 Sec. 7. COUNCIL ON DISABILITY 327.12 General 500,000 500,000 327.13 Sec. 8. OMBUDSMAN FOR MENTAL HEALTH 327.14 AND MENTAL RETARDATION 327.15 General 1,462,000 1,462,000 327.16 Sec. 9. OMBUDSMAN FOR FAMILIES 327.17 General 245,000 245,000 327.18 Sec. 10. [TRANSFERS.] 327.19 Subdivision 1. [GRANTS.] The commissioner of human 327.20 services, with the approval of the commissioner of finance, and 327.21 after notification of the chairs of the relevant senate budget 327.22 division and house finance committee, may transfer unencumbered 327.23 appropriation balances for the biennium ending June 30, 2007, 327.24 within fiscal years among the MFIP, general assistance, medical 327.25 assistance, MFIP child care assistance under Minnesota Statutes, 327.26 section 119B.05, Minnesota supplemental aid, and group 327.27 residential housing programs, and the entitlement portion of the 327.28 chemical dependency consolidated treatment fund, and between 327.29 fiscal years of the biennium. 327.30 Subd. 2. [ADMINISTRATION.] Positions, salary money, and 327.31 nonsalary administrative money may be transferred within the 327.32 departments of human services and health and within the programs 327.33 operated by the veterans nursing homes board as the 327.34 commissioners and the board consider necessary, with the advance 327.35 approval of the commissioner of finance. The commissioner or 327.36 the board shall inform the chairs of the relevant house and 327.37 senate health committees quarterly about transfers made under 327.38 this provision. 327.39 Subd. 3. [PROHIBITED TRANSFERS.] Grant money shall not be 328.1 transferred to operations within the departments of human 328.2 services and health and within the programs operated by the 328.3 veterans nursing homes board without the approval of the 328.4 legislature. 328.5 Sec. 11. [INDIRECT COSTS NOT TO FUND PROGRAMS.] 328.6 The commissioners of health and of human services shall not 328.7 use indirect cost allocations to pay for the operational costs 328.8 of any program for which they are responsible. 328.9 Sec. 12. [SUNSET OF UNCODIFIED LANGUAGE.] 328.10 All uncodified language contained in this article expires 328.11 on June 30, 2007, unless a different expiration date is explicit. 328.12 Sec. 13. [EFFECTIVE DATE.] 328.13 The provisions in this article are effective July 1, 2005, 328.14 unless a different effective date is specified. 328.15 ARTICLE 11 328.16 OPTION B SPENDING 328.17 Section 1. [CONDITIONAL EFFECTIVE DATE.] 328.18 The policies and the appropriations in this article are 328.19 effective only if H.F. 1664 is passed by the house of 328.20 representatives. The amounts indicated in this article are 328.21 appropriated to the commissioner of human services for the 328.22 purposes indicated in the fiscal years indicated. 328.23 Sec. 2. Minnesota Statutes 2004, section 256D.03, 328.24 subdivision 3, is amended to read: 328.25 Subd. 3. [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.] 328.26 (a) General assistance medical care may be paid for any person 328.27 who is not eligible for medical assistance under chapter 256B, 328.28 including eligibility for medical assistance based on a 328.29 spenddown of excess income according to section 256B.056, 328.30 subdivision 5, or MinnesotaCare as defined in paragraph (b), 328.31 except as provided in paragraph (c), and: 328.32 (1) who is receiving assistance under section 256D.05, 328.33 except for families with children who are eligible under 328.34 Minnesota family investment program (MFIP),orwho is having a 328.35 payment made on the person's behalf under sections 256I.01 to 328.36 256I.06, or who resides in group residential housing as defined 329.1 in chapter 256I and can meet a spenddown using the cost of 329.2 remedial services received through group residential housing; or 329.3 (2)(i) who is a resident of Minnesota;and 329.4(i) who has gross countable income not in excess of 75329.5percent of the federal poverty guidelines for the family size,329.6using a six-month budget period andwhose equity in assets is 329.7 not in excess of $1,000 per assistance unit. Exempt assets, the 329.8 reduction of excess assets, and the waiver of excess assets must 329.9 conform to the medical assistance program in section 256B.056, 329.10 subdivision 3, with the following exception: the maximum amount 329.11 of undistributed funds in a trust that could be distributed to 329.12 or on behalf of the beneficiary by the trustee, assuming the 329.13 full exercise of the trustee's discretion under the terms of the 329.14 trust, must be applied toward the asset maximum;orand 329.15 (ii) who has gross countable incomeabove 75 percentnot in 329.16 excess of 75 percent of the federal poverty guidelinesbut not329.17in excess of 175 percent of the federal poverty guidelinesfor 329.18 the family size, using a six-month budget period, or whose 329.19equity in assets is not in excess of the limits in section329.20256B.056, subdivision 3c, and who applies during an inpatient329.21hospitalizationexcess income is spent down to 75 percent of the 329.22 federal poverty guidelines using a six-month budget period. 329.23 (b) General assistance medical care may not be paid for 329.24 applicants or recipients who meet all eligibility requirements 329.25 of MinnesotaCare as defined in sections 256L.01 to 256L.16, and 329.26 are adults with dependent children under 21 whose gross family 329.27 income is equal to or less than275175 percent of the federal 329.28 poverty guidelines. 329.29 (c)For applications received on or after October 1, 2003,329.30 Eligibility may begin no earlier than the date of application. 329.31 For individuals eligible under paragraph (a), clause (2),item329.32(i),a redetermination of eligibility must occur every 12 329.33 months.Individuals are eligible under paragraph (a), clause329.34(2), item (ii), only during inpatient hospitalization but may329.35reapply if there is a subsequent period of inpatient329.36hospitalization.Beginning January 1, 2000, Minnesota health 330.1 care program applications completed by recipients and applicants 330.2 who are persons described in paragraph (b), may be returned to 330.3 the county agency to be forwarded to the Department of Human 330.4 Services or sent directly to the Department of Human Services 330.5 for enrollment in MinnesotaCare. If all other eligibility 330.6 requirements of this subdivision are met, eligibility for 330.7 general assistance medical care shall be available in any month 330.8 during which a MinnesotaCare eligibility determination and 330.9 enrollment are pending. Upon notification of eligibility for 330.10 MinnesotaCare, notice of termination for eligibility for general 330.11 assistance medical care shall be sent to an applicant or 330.12 recipient. If all other eligibility requirements of this 330.13 subdivision are met, eligibility for general assistance medical 330.14 care shall be available until enrollment in MinnesotaCare 330.15 subject to the provisions of paragraph (e). 330.16 (d) The date of an initial Minnesota health care program 330.17 application necessary to begin a determination of eligibility 330.18 shall be the date the applicant has provided a name, address, 330.19 and Social Security number, signed and dated, to the county 330.20 agency or the Department of Human Services. If the applicant is 330.21 unable to provide a name, address, Social Security number, and 330.22 signature when health care is delivered due to a medical 330.23 condition or disability, a health care provider may act on an 330.24 applicant's behalf to establish the date of an initial Minnesota 330.25 health care program application by providing the county agency 330.26 or Department of Human Services with provider identification and 330.27 a temporary unique identifier for the applicant. The applicant 330.28 must complete the remainder of the application and provide 330.29 necessary verification before eligibility can be determined. 330.30 The county agency must assist the applicant in obtaining 330.31 verification if necessary. 330.32 (e) County agencies are authorized to use all automated 330.33 databases containing information regarding recipients' or 330.34 applicants' income in order to determine eligibility for general 330.35 assistance medical care or MinnesotaCare. Such use shall be 330.36 considered sufficient in order to determine eligibility and 331.1 premium payments by the county agency. 331.2 (f) General assistance medical care is not available for a 331.3 person in a correctional facility unless the person is detained 331.4 by law for less than one year in a county correctional or 331.5 detention facility as a person accused or convicted of a crime, 331.6 or admitted as an inpatient to a hospital on a criminal hold 331.7 order, and the person is a recipient of general assistance 331.8 medical care at the time the person is detained by law or 331.9 admitted on a criminal hold order and as long as the person 331.10 continues to meet other eligibility requirements of this 331.11 subdivision. 331.12 (g) General assistance medical care is not available for 331.13 applicants or recipients who do not cooperate with the county 331.14 agency to meet the requirements of medical assistance. 331.15 (h) In determining the amount of assets of an individual 331.16 eligible under paragraph (a), clause (2),item (i),there shall 331.17 be included any asset or interest in an asset, including an 331.18 asset excluded under paragraph (a), that was given away, sold, 331.19 or disposed of for less than fair market value within the 60 331.20 months preceding application for general assistance medical care 331.21 or during the period of eligibility. Any transfer described in 331.22 this paragraph shall be presumed to have been for the purpose of 331.23 establishing eligibility for general assistance medical care, 331.24 unless the individual furnishes convincing evidence to establish 331.25 that the transaction was exclusively for another purpose. For 331.26 purposes of this paragraph, the value of the asset or interest 331.27 shall be the fair market value at the time it was given away, 331.28 sold, or disposed of, less the amount of compensation received. 331.29 For any uncompensated transfer, the number of months of 331.30 ineligibility, including partial months, shall be calculated by 331.31 dividing the uncompensated transfer amount by the average 331.32 monthly per person payment made by the medical assistance 331.33 program to skilled nursing facilities for the previous calendar 331.34 year. The individual shall remain ineligible until this fixed 331.35 period has expired. The period of ineligibility may exceed 30 331.36 months, and a reapplication for benefits after 30 months from 332.1 the date of the transfer shall not result in eligibility unless 332.2 and until the period of ineligibility has expired. The period 332.3 of ineligibility begins in the month the transfer was reported 332.4 to the county agency, or if the transfer was not reported, the 332.5 month in which the county agency discovered the transfer, 332.6 whichever comes first. For applicants, the period of 332.7 ineligibility begins on the date of the first approved 332.8 application. 332.9 (i) When determining eligibility for any state benefits 332.10 under this subdivision, the income and resources of all 332.11 noncitizens shall be deemed to include their sponsor's income 332.12 and resources as defined in the Personal Responsibility and Work 332.13 Opportunity Reconciliation Act of 1996, title IV, Public Law 332.14 104-193, sections 421 and 422, and subsequently set out in 332.15 federal rules. 332.16 (j) Undocumented noncitizens and nonimmigrants are 332.17 ineligible for general assistance medical care. For purposes of 332.18 this subdivision, a nonimmigrant is an individual in one or more 332.19 of the classes listed in United States Code, title 8, section 332.20 1101(a)(15), and an undocumented noncitizen is an individual who 332.21 resides in the United States without the approval or 332.22 acquiescence of the Immigration and Naturalization Service. 332.23 (k) Notwithstanding any other provision of law, a 332.24 noncitizen who is ineligible for medical assistance due to the 332.25 deeming of a sponsor's income and resources, is ineligible for 332.26 general assistance medical care. 332.27 (l) Effective July 1, 2003, general assistance medical care 332.28 emergency services end. 332.29 [EFFECTIVE DATE.] This section is effective October 1, 2005. 332.30 Sec. 3. Minnesota Statutes 2004, section 256L.03, 332.31 subdivision 3, is amended to read: 332.32 Subd. 3. [INPATIENT HOSPITAL SERVICES.] (a) Covered health 332.33 services shall include inpatient hospital services, including 332.34 inpatient hospital mental health services and inpatient hospital 332.35 and residential chemical dependency treatment, subject to those 332.36 limitations necessary to coordinate the provision of these 333.1 services with eligibility under the medical assistance 333.2 spenddown. Prior to July 1, 1997, the inpatient hospital 333.3 benefit for adult enrollees is subject to an annual benefit 333.4 limit of $10,000. The inpatient hospital benefit for adult 333.5 enrolleeswho qualify under section 256L.04, subdivision 7, or333.6 who qualify under section 256L.04, subdivisions 1 and 2, with 333.7 family gross income that exceeds 175 percent of the federal 333.8 poverty guidelines and who are not pregnant, is subject to an 333.9 annual limit of $10,000. 333.10 (b) Admissions for inpatient hospital services paid for 333.11 under section 256L.11, subdivision 3, must be certified as 333.12 medically necessary in accordance with Minnesota Rules, parts 333.13 9505.0500 to 9505.0540, except as provided in clauses (1) and 333.14 (2): 333.15 (1) all admissions must be certified, except those 333.16 authorized under rules established under section 254A.03, 333.17 subdivision 3, or approved under Medicare; and 333.18 (2) payment under section 256L.11, subdivision 3, shall be 333.19 reduced by five percent for admissions for which certification 333.20 is requested more than 30 days after the day of admission. The 333.21 hospital may not seek payment from the enrollee for the amount 333.22 of the payment reduction under this clause. 333.23 [EFFECTIVE DATE.] This section is effective October 1, 2005. 333.24 Sec. 4. Minnesota Statutes 2004, section 256L.03, 333.25 subdivision 5, is amended to read: 333.26 Subd. 5. [CO-PAYMENTS AND COINSURANCE.] (a) Except as 333.27 provided in paragraphs (b) and (c), the MinnesotaCare benefit 333.28 plan shall include the following co-payments and coinsurance 333.29 requirements for all enrollees: 333.30 (1) ten percent of the paid charges for inpatient hospital 333.31 services for adult enrollees, subject to an annual inpatient 333.32 out-of-pocket maximum of $1,000 per individual and $3,000 per 333.33 family; 333.34 (2) $3 per prescription for adult enrollees; 333.35 (3) $25 for eyeglasses for adult enrollees;and333.36 (4) $3 per nonpreventive visit. For purposes of this 334.1 subdivision, a visit means an episode of service which is 334.2 required because of an enrollee's symptoms, diagnosis, or 334.3 established illness, and which is delivered in an ambulatory 334.4 setting by a physician or physician ancillary, chiropractor, 334.5 podiatrist, advanced practice nurse, audiologist, optician, or 334.6 optometrist; 334.7 (5) $6 for nonemergency visits to a hospital-based 334.8 emergency room; and 334.9 (6) 50 percent of the fee-for-service rate for adult dental 334.10 care services other than preventive care services for persons 334.11 eligible under section 256L.04, subdivisions 1 to 7, with income 334.12 equal to or less than 175 percent of the federal poverty 334.13 guidelines. 334.14 (b) Paragraph (a), clause (1), does not apply to parents 334.15 and relative caretakers of children under the age of 21 in 334.16 households with family income equal to or less than 175 percent 334.17 of the federal poverty guidelines. Paragraph (a), clause (1), 334.18 does not apply to parents and relative caretakers of children 334.19 under the age of 21 in households with family income greater 334.20 than 175 percent of the federal poverty guidelines for inpatient 334.21 hospital admissions occurring on or after January 1, 2001. 334.22 (c) Paragraph (a), clauses (1) to(4)(6), do not apply to 334.23 pregnant women and children under the age of 21. 334.24 (d) Adult enrollees with family gross income that exceeds 334.25 175 percent of the federal poverty guidelines and who are not 334.26 pregnant shall be financially responsible for the coinsurance 334.27 amount, if applicable, and amounts which exceed the $10,000 334.28 inpatient hospital benefit limit. 334.29 (e) When a MinnesotaCare enrollee becomes a member of a 334.30 prepaid health plan, or changes from one prepaid health plan to 334.31 another during a calendar year, any charges submitted towards 334.32 the $10,000 annual inpatient benefit limit, and any 334.33 out-of-pocket expenses incurred by the enrollee for inpatient 334.34 services, that were submitted or incurred prior to enrollment, 334.35 or prior to the change in health plans, shall be disregarded. 334.36 (f) Paragraph (a), clauses (4) and (5), are limited to one 335.1 co-payment per day per provider. 335.2 [EFFECTIVE DATE.] This section is effective January 1, 2006. 335.3 Sec. 5. Minnesota Statutes 2004, section 256L.04, 335.4 subdivision 1, is amended to read: 335.5 Subdivision 1. [FAMILIES WITH CHILDREN.] (a) Through 335.6 September 30, 2005, families with children with family income 335.7 equal to or less than 275 percent of the federal poverty 335.8 guidelines for the applicable family size shall be eligible for 335.9 MinnesotaCare according to this section. Beginning October 1, 335.10 2005, children and pregnant women with family income equal to or 335.11 less than 275 percent of the federal poverty guidelines for the 335.12 applicable family size shall be eligible for MinnesotaCare 335.13 according to this section. Beginning October 1, 2005, parents, 335.14 grandparents, foster parents, relative caretakers, and legal 335.15 guardians ages 21 and over are not eligible for MinnesotaCare if 335.16 their gross income exceeds 190 percent of the federal poverty 335.17 guidelines for the applicable family size. All other provisions 335.18 of sections 256L.01 to 256L.18, including the insurance-related 335.19 barriers to enrollment under section 256L.07, shall apply unless 335.20 otherwise specified. 335.21 (b) Parents who enroll in the MinnesotaCare program must 335.22 also enroll their children, if the children are eligible. 335.23 Children may be enrolled separately without enrollment by 335.24 parents. However, if one parent in the household enrolls, both 335.25 parents must enroll, unless other insurance is available. If 335.26 one child from a family is enrolled, all children must be 335.27 enrolled, unless other insurance is available. If one spouse in 335.28 a household enrolls, the other spouse in the household must also 335.29 enroll, unless other insurance is available. Families cannot 335.30 choose to enroll only certain uninsured members. 335.31 (c)Beginning October 1, 2003, the dependent sibling335.32definition no longer applies to the MinnesotaCare program.335.33These persons are no longer counted in the parental household335.34and may apply as a separate household.335.35(d)Beginning July 1, 2003, or upon federal approval, 335.36 whichever is later, parents are not eligible for MinnesotaCare 336.1 if their gross income exceeds $50,000. 336.2 Sec. 6. Minnesota Statutes 2004, section 256L.11, 336.3 subdivision 6, is amended to read: 336.4 Subd. 6. [ENROLLEES 18 OR OLDER.] Payment by the 336.5 MinnesotaCare program for inpatient hospital services provided 336.6 to MinnesotaCare enrollees eligible undersection 256L.04,336.7subdivision 7, or who qualify undersection 256L.04, 336.8 subdivisions 1 and 2, with family gross income that exceeds 175 336.9 percent of the federal poverty guidelines and who are not 336.10 pregnant, who are 18 years old or older on the date of admission 336.11 to the inpatient hospital must be in accordance with paragraphs 336.12 (a) and (b). Payment for adults who are not pregnant and are 336.13 eligible under section 256L.04, subdivisions 1 and 2, and whose 336.14 incomes are equal to or less than 175 percent of the federal 336.15 poverty guidelines, shall be as provided for under paragraph (c). 336.16 (a) If the medical assistance rate minus any co-payment 336.17 required under section 256L.03, subdivision45, is less than or 336.18 equal to the amount remaining in the enrollee's benefit limit 336.19 under section 256L.03, subdivision 3, payment must be the 336.20 medical assistance rate minus any co-payment required under 336.21 section 256L.03, subdivision45. The hospital must not seek 336.22 payment from the enrollee in addition to the co-payment. The 336.23 MinnesotaCare payment plus the co-payment must be treated as 336.24 payment in full. 336.25 (b) If the medical assistance rate minus any co-payment 336.26 required under section 256L.03, subdivision45, is greater than 336.27 the amount remaining in the enrollee's benefit limit under 336.28 section 256L.03, subdivision 3, payment must be the lesser of: 336.29 (1) the amount remaining in the enrollee's benefit limit; 336.30 or 336.31 (2) charges submitted for the inpatient hospital services 336.32 less any co-payment established under section 256L.03, 336.33 subdivision45. 336.34 The hospital may seek payment from the enrollee for the 336.35 amount by which usual and customary charges exceed the payment 336.36 under this paragraph. If payment is reduced under section 337.1 256L.03, subdivision 3, paragraph (b), the hospital may not seek 337.2 payment from the enrollee for the amount of the reduction. 337.3 (c) For admissions occurring during the period of July 1, 337.4 1997, through June 30, 1998, for adults who are not pregnant and 337.5 are eligible under section 256L.04, subdivisions 1 and 2, and 337.6 whose incomes are equal to or less than 175 percent of the 337.7 federal poverty guidelines, the commissioner shall pay hospitals 337.8 directly, up to the medical assistance payment rate, for 337.9 inpatient hospital benefits in excess of the $10,000 annual 337.10 inpatient benefit limit. 337.11 [EFFECTIVE DATE.] This section is effective October 1, 2005. 337.12 Sec. 7. [INCREASE IN GAMC FUNDING RELATED TO SPENDDOWN 337.13 STANDARD.] 337.14 $3,062,000 in fiscal year 2006 and $3,964,000 in fiscal 337.15 year 2007 are added to the appropriations in article 10, section 337.16 2, subdivision 5, paragraph (d), to increase the general 337.17 assistance medical care spenddown standard from 50 percent to 75 337.18 percent of the federal poverty guidelines as provided in section 337.19 2. 337.20 Sec. 8. [INCREASE IN MINNESOTACARE FUNDING RELATED TO 337.21 INCOME STANDARD FOR PARENTS.] 337.22 $2,191,000 in fiscal year 2006 and $6,048,000 in fiscal 337.23 year 2007 are added to the appropriations in article 10, section 337.24 2, subdivision 5, paragraph (a), for the purpose of sections 3 337.25 to 6. 337.26 Sec. 9. [MINNESOTACARE OUTREACH GRANTS.] 337.27 The repeal in article 3 of Minnesota Statutes 2004, section 337.28 256L.04, subdivision 11, shall not take effect. 337.29 Sec. 10. [FUNDING FOR MINNESOTACARE OUTREACH GRANTS.] 337.30 $750,000 in fiscal year 2006 and $750,000 in fiscal year 337.31 2007 are added to the appropriations in article 10, section 2, 337.32 subdivision 5, paragraph (f), to fund MinnesotaCare outreach 337.33 grants under Minnesota Statutes, section 256L.04, subdivision 337.34 11. Federal administrative reimbursement resulting from 337.35 MinnesotaCare outreach is appropriated to the commissioner for 337.36 this purpose. 338.1 Sec. 11. [HOME CARE SERVICES REIMBURSEMENT RATES.] 338.2 $1,261,000 in fiscal year 2006 and $1,973,000 in fiscal 338.3 year 2007 are added to the appropriations in article 10, section 338.4 2, subdivision 7, paragraph (d), to provide additional increases 338.5 in reimbursement rates for home health services under Minnesota 338.6 Statutes, section 256B.763. The commissioner must recalculate 338.7 the rates in Minnesota Statutes, section 256B.763, to reflect 338.8 these additional appropriations. 338.9 Sec. 12. [OTHER PROVISIONS.] 338.10 The amendments in this article to sections of law supersede 338.11 and shall be implemented in place of the amendments or repealers 338.12 to those sections in article 3.