HF 1426

as introduced - 81st Legislature (1999 - 2000) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to health; modifying well notification fees; 
  1.3             modifying definitions; modifying terms of the advisory 
  1.4             council on water supply systems and wastewater 
  1.5             treatment facilities; modifying provisions for grants 
  1.6             to rural hospitals and community health centers; 
  1.7             modifying student loan repayment provisions for health 
  1.8             professionals; amending Minnesota Statutes 1998, 
  1.9             sections 103I.208, subdivision 1; 115.71, subdivisions 
  1.10            9a and 10; 115.741, subdivisions 1 and 2; 144.147, 
  1.11            subdivisions 2, 3, 4, and 5; 144.1484, subdivision 1; 
  1.12            144.1486, subdivisions 3, 4, and 8; 144.1488, 
  1.13            subdivisions 1, 3, and 4; 144.1489, subdivisions 2 and 
  1.14            4; 144.1490, subdivision 2; 144.1494, subdivisions 2, 
  1.15            3, 5, and by adding a subdivision; 144.1495, 
  1.16            subdivisions 3, 4, and by adding a subdivision; 
  1.17            144.1496, subdivisions 2 and 5; and 144.382, 
  1.18            subdivision 4. 
  1.19  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.20     Section 1.  Minnesota Statutes 1998, section 103I.208, 
  1.21  subdivision 1, is amended to read: 
  1.22     Subdivision 1.  [WELL NOTIFICATION FEE.] The well 
  1.23  notification fee to be paid by a property owner is:  
  1.24     (1) for a new well, $120, which includes the state core 
  1.25  function fee; 
  1.26     (2) for a well sealing, $20 for each well, which includes 
  1.27  the state core function fee, except that for monitoring wells 
  1.28  constructed on a single property, having depths within a 25 foot 
  1.29  range, and sealed within 48 hours of start of construction, a 
  1.30  single fee of $20; and 
  1.31     (3) for construction of a dewatering well, $120, which 
  1.32  includes the state core function fee, for each well except a 
  2.1   dewatering project comprising five or more wells shall be 
  2.2   assessed a single fee of $600 for the wells recorded on the 
  2.3   notification. 
  2.4      Sec. 2.  Minnesota Statutes 1998, section 115.71, 
  2.5   subdivision 9a, is amended to read: 
  2.6      Subd. 9a.  [WATER SUPPLY SYSTEM.] "Water supply system" 
  2.7   means a community or nontransient noncommunity public system 
  2.8   providing pumped water for human consumption, if the system has 
  2.9   at least 15 service connections or regularly serves at least 25 
  2.10  of the same persons over six months per year water supply, as 
  2.11  defined in Code of Federal Regulations, title 40, section 141.2. 
  2.12     Sec. 3.  Minnesota Statutes 1998, section 115.71, 
  2.13  subdivision 10, is amended to read: 
  2.14     Subd. 10.  [WATER SUPPLY SYSTEM OPERATOR.] "Water supply 
  2.15  system operator" means a person who has direct responsibility 
  2.16  for the operation of or operates a community water supply system 
  2.17  or such parts of the system as would affect the quality and 
  2.18  safety of the water. 
  2.19     Sec. 4.  Minnesota Statutes 1998, section 115.741, 
  2.20  subdivision 1, is amended to read: 
  2.21     Subdivision 1.  [PURPOSE; MEMBERSHIP.] The advisory council 
  2.22  on water supply systems and wastewater treatment facilities 
  2.23  shall advise the commissioners of health and the pollution 
  2.24  control agency regarding classification of water supply systems 
  2.25  and wastewater treatment facilities, qualifications and 
  2.26  competency evaluation of water supply system operators and 
  2.27  wastewater treatment facility operators, and additional laws, 
  2.28  rules, and procedures that may be desirable for regulating the 
  2.29  operation of water supply systems and of wastewater treatment 
  2.30  facilities.  The advisory council is composed of 11 voting 
  2.31  members, of whom: 
  2.32     (1) one member must be from the department of health, 
  2.33  division of environmental health, appointed by the commissioner 
  2.34  of health; 
  2.35     (2) one member must be from the pollution control agency, 
  2.36  water quality division, appointed by the commissioner of the 
  3.1   pollution control agency; 
  3.2      (3) three members must be certified water supply system 
  3.3   operators, appointed by the commissioner of health, one of which 
  3.4   must represent a nonmunicipal community or nontransient 
  3.5   noncommunity water supply system; 
  3.6      (4) three members must be certified wastewater treatment 
  3.7   facility operators, appointed by the commissioner of the 
  3.8   pollution control agency; 
  3.9      (5) one member must be a representative from an 
  3.10  organization representing municipalities, appointed by the 
  3.11  commissioner of health with the concurrence of the commissioner 
  3.12  of the pollution control agency; and 
  3.13     (6) two members must be members of the public who are not 
  3.14  associated with water supply systems or wastewater treatment 
  3.15  facilities.  One must be appointed by the commissioner of health 
  3.16  and the other by the commissioner of the pollution control 
  3.17  agency.  Consideration should be given to one of these members 
  3.18  being a representative of academia in a water-  or 
  3.19  wastewater-related field. 
  3.20     Sec. 5.  Minnesota Statutes 1998, section 115.741, 
  3.21  subdivision 2, is amended to read: 
  3.22     Subd. 2.  [GEOGRAPHIC REPRESENTATION.] At least one of the 
  3.23  water supply system operators and at least one of the wastewater 
  3.24  treatment facility operators must be from outside the 
  3.25  seven-county metropolitan area and one wastewater operator must 
  3.26  come from the metropolitan council wastewater services. 
  3.27     Sec. 6.  Minnesota Statutes 1998, section 144.147, 
  3.28  subdivision 2, is amended to read: 
  3.29     Subd. 2.  [GRANTS AUTHORIZED.] The commissioner shall 
  3.30  establish a program of grants to assist eligible rural 
  3.31  hospitals.  The commissioner shall award grants to hospitals and 
  3.32  communities for the purposes set forth in paragraphs (a) and (b).
  3.33     (a) Grants may be used by hospitals and their communities 
  3.34  to develop strategic plans for preserving or enhancing access to 
  3.35  health services.  At a minimum, a strategic plan must consist of:
  3.36     (1) a needs assessment to determine what health services 
  4.1   are needed and desired by the community.  The assessment must 
  4.2   include interviews with or surveys of area health professionals, 
  4.3   local community leaders, and public hearings; 
  4.4      (2) an assessment of the feasibility of providing needed 
  4.5   health services that identifies priorities and timeliness for 
  4.6   potential changes; and 
  4.7      (3) an implementation plan.  
  4.8      The strategic plan must be developed by a committee that 
  4.9   includes representatives from the hospital, local public health 
  4.10  agencies, other health providers, and consumers from the 
  4.11  community.  
  4.12     (b) The grants may also be used by eligible rural hospitals 
  4.13  that have developed strategic plans to implement transition 
  4.14  projects to modify the type and extent of services provided, in 
  4.15  order to reflect the needs of that plan.  Grants may be used by 
  4.16  hospitals under this paragraph to develop hospital-based 
  4.17  physician practices that integrate hospital and existing medical 
  4.18  practice facilities that agree to transfer their practices, 
  4.19  equipment, staffing, and administration to the hospital.  The 
  4.20  grants may also be used by the hospital to establish a health 
  4.21  provider cooperative, a telemedicine system, or a rural health 
  4.22  care system or to cover expenses associated with being 
  4.23  designated as a critical access hospital for the Medicare rural 
  4.24  hospital flexibility program.  Not more than one-third of any 
  4.25  grant shall be used to offset losses incurred by physicians 
  4.26  agreeing to transfer their practices to hospitals.  
  4.27     Sec. 7.  Minnesota Statutes 1998, section 144.147, 
  4.28  subdivision 3, is amended to read: 
  4.29     Subd. 3.  [CONSIDERATION OF GRANTS.] In determining which 
  4.30  hospitals will receive grants under this section, the 
  4.31  commissioner shall take into account:  
  4.32     (1) improving community access to hospital or health 
  4.33  services; 
  4.34     (2) changes in service populations; 
  4.35     (3) demand for availability and upgrading of ambulatory and 
  4.36  emergency services; 
  5.1      (4) the extent that the health needs of the community are 
  5.2   not currently being met by other providers in the service area; 
  5.3      (5) the need to recruit and retain health professionals; 
  5.4      (6) the extent of community support; 
  5.5      (7) the integration of health care services and the 
  5.6   coordination with local community organizations, such as 
  5.7   community development and public health agencies; and 
  5.8      (8) the financial condition of the hospital. 
  5.9      Sec. 8.  Minnesota Statutes 1998, section 144.147, 
  5.10  subdivision 4, is amended to read: 
  5.11     Subd. 4.  [ALLOCATION OF GRANTS.] (a) Eligible hospitals 
  5.12  must apply to the commissioner no later than September 1 of each 
  5.13  fiscal year for grants awarded for that fiscal year.  A grant 
  5.14  may be awarded upon signing of a grant contract. 
  5.15     (b) The commissioner must make a final decision on the 
  5.16  funding of each application within 60 days of the deadline for 
  5.17  receiving applications. 
  5.18     (c) Each relevant community health board has 30 days in 
  5.19  which to review and comment to the commissioner on grant 
  5.20  applications from hospitals in their community health service 
  5.21  area. 
  5.22     (d) In determining which hospitals will receive grants 
  5.23  under this section, the commissioner shall consider the 
  5.24  following factors: 
  5.25     (1) Description of the problem, description of the project, 
  5.26  and the likelihood of successful outcome of the project.  The 
  5.27  applicant must explain clearly the nature of the health services 
  5.28  problems in their service area, how the grant funds will be 
  5.29  used, what will be accomplished, and the results expected.  The 
  5.30  applicant should describe achievable objectives, a timetable, 
  5.31  and roles and capabilities of responsible individuals and 
  5.32  organizations. 
  5.33     (2) The extent of community support for the hospital and 
  5.34  this proposed project.  The applicant should demonstrate support 
  5.35  for the hospital and for the proposed project from other local 
  5.36  health service providers and from local community and government 
  6.1   leaders.  Evidence of such support may include past commitments 
  6.2   of financial support from local individuals, organizations, or 
  6.3   government entities; and commitment of financial support, 
  6.4   in-kind services or cash, for this project. 
  6.5      (3) The comments, if any, resulting from a review of the 
  6.6   application by the community health board in whose community 
  6.7   health service area the hospital is located. 
  6.8      (e) In evaluating applications, the commissioner shall 
  6.9   score each application on a 100 point scale, assigning the 
  6.10  maximum of 70 points for an applicant's understanding of the 
  6.11  problem, description of the project, and likelihood of 
  6.12  successful outcome of the project; and a maximum of 30 points 
  6.13  for the extent of community support for the hospital and this 
  6.14  project.  The commissioner may also take into account other 
  6.15  relevant factors. 
  6.16     (f) A Any single grant to a hospital, including hospitals 
  6.17  that submit applications as consortia, may not exceed $50,000 a 
  6.18  year and may not exceed a term of two years.  Prior to the 
  6.19  receipt of any grant, the hospital must certify to the 
  6.20  commissioner that at least one-half of the amount of the total 
  6.21  cost of the planning or transition project, which may include 
  6.22  in-kind services, is available for the same purposes from 
  6.23  nonstate sources.  A hospital receiving a grant under this 
  6.24  section may use the grant for any expenses incurred in the 
  6.25  development of strategic plans or the implementation of 
  6.26  transition projects with respect to which the grant is made.  
  6.27  Project grants may not be used to retire debt incurred with 
  6.28  respect to any capital expenditure made prior to the date on 
  6.29  which the project is initiated.  Hospitals may apply to the 
  6.30  program each year they are eligible. 
  6.31     (g) The commissioner may adopt rules to implement this 
  6.32  section. 
  6.33     Sec. 9.  Minnesota Statutes 1998, section 144.147, 
  6.34  subdivision 5, is amended to read: 
  6.35     Subd. 5.  [EVALUATION.] The commissioner shall evaluate the 
  6.36  overall effectiveness of the grant program.  The commissioner 
  7.1   may collect, from the hospital, and communities receiving 
  7.2   grants, the information necessary quarterly progress reports to 
  7.3   evaluate the grant program.  Information related to the 
  7.4   financial condition of individual hospitals shall be classified 
  7.5   as nonpublic data. 
  7.6      Sec. 10.  Minnesota Statutes 1998, section 144.1484, 
  7.7   subdivision 1, is amended to read: 
  7.8      Subdivision 1.  [SOLE COMMUNITY HOSPITAL FINANCIAL 
  7.9   ASSISTANCE GRANTS.] (a) The commissioner of health shall award 
  7.10  financial assistance grants to rural hospitals in isolated areas 
  7.11  of the state.  To qualify for a grant, a hospital must:  (1) be 
  7.12  eligible to be classified as a sole community hospital according 
  7.13  to the criteria in Code of Federal Regulations, title 42, 
  7.14  section 412.92 or be located in a community with a population of 
  7.15  less than 5,000 and located more than 25 miles from a like 
  7.16  hospital currently providing acute short-term services; (2) have 
  7.17  experienced net operating income losses in two of the previous 
  7.18  three most recent consecutive hospital fiscal years for which 
  7.19  audited financial information is available; (3) consist of 40 or 
  7.20  fewer licensed beds; and (4) demonstrate to the commissioner 
  7.21  that it has obtained local support for the hospital and that any 
  7.22  state support awarded under this program will not be used to 
  7.23  supplant local support for the hospital.  
  7.24     (b) The commissioner shall review audited financial 
  7.25  statements of the hospital to assess the extent of local 
  7.26  support.  Evidence of local support may include bonds issued by 
  7.27  a local government entity such as a city, county, or hospital 
  7.28  district for the purpose of financing hospital projects; and 
  7.29  loans, grants, or donations to the hospital from local 
  7.30  government entities, private organizations, or individuals.  
  7.31     (c) The commissioner shall determine the amount of the 
  7.32  award to be given to each eligible hospital based on the 
  7.33  hospital's operating loss margin (total operating losses as a 
  7.34  percentage of total operating revenue) for two of the previous 
  7.35  three most recent consecutive fiscal years for which audited 
  7.36  financial information is available and the total amount of 
  8.1   funding available.  For purposes of calculating a hospital's 
  8.2   operating loss margin, total operating revenue does not include 
  8.3   grant funding provided under this subdivision.  One hundred 
  8.4   percent of the available funds will be disbursed proportionately 
  8.5   based on the operating loss margins of the eligible hospitals.  
  8.6      (d) Before awarding a grant contract to an eligible 
  8.7   hospital, the commissioner shall require the eligible hospital 
  8.8   to submit a budget for the use of grant funds.  For grants above 
  8.9   $30,000, the commissioner shall also require the eligible 
  8.10  hospital to submit a brief annual work plan that includes 
  8.11  objectives and activities intended to improve the hospital's 
  8.12  financial viability and maintain the quality of the hospital's 
  8.13  services.  
  8.14     (e) Hospitals receiving a grant under this section shall 
  8.15  submit brief semiannual reports to the commissioner reporting 
  8.16  progress toward meeting annual plan objectives. 
  8.17     Sec. 11.  Minnesota Statutes 1998, section 144.1486, 
  8.18  subdivision 3, is amended to read: 
  8.19     Subd. 3.  [GRANTS.] (a) The commissioner shall provide 
  8.20  grants to communities for planning and, establishing, and 
  8.21  operating community health centers through the Minnesota 
  8.22  community health center program.  Grant recipients shall develop 
  8.23  and implement a strategy that allows them to become 
  8.24  self-sufficient and qualify for other supplemental funding and 
  8.25  enhanced reimbursement.  The commissioner shall coordinate the 
  8.26  grant program with the federal rural health clinic, federally 
  8.27  qualified health center, and migrant and community health center 
  8.28  programs to encourage federal certification.  The commissioner 
  8.29  may award planning, project, and initial operating expense 
  8.30  grants, as provided in paragraphs (b) to (d). 
  8.31     (b) Planning grants may be awarded to communities to plan 
  8.32  and develop state funded community health centers, federally 
  8.33  qualified health centers, or migrant and community health 
  8.34  centers. 
  8.35     (c) Project grants may be awarded to communities for 
  8.36  community health center start-up or expansion, and the 
  9.1   conversion of existing practices to community health centers.  
  9.2   Start-up grants may be used for facilities, capital equipment, 
  9.3   moving expenses, initial staffing, and setup.  Communities must 
  9.4   provide reasonable assurance of their ability to obtain health 
  9.5   care providers and effectively utilize existing health care 
  9.6   provider resources.  Funded community health center projects 
  9.7   must become operational before funding expires.  Communities may 
  9.8   obtain funding for conversion of existing health care practices 
  9.9   to community health centers.  Communities with existing 
  9.10  community health centers may apply for grants to add sites in 
  9.11  underserved areas.  Governing boards must include 
  9.12  representatives of new service areas. 
  9.13     (d) Centers may apply for grants for up to two years to 
  9.14  subsidize initial operating expenses.  Applicants for initial 
  9.15  operating expense grants must demonstrate that expenses exceed 
  9.16  revenues by a minimum of ten percent or demonstrate other 
  9.17  extreme need that cannot be met using organizational reserves. 
  9.18     Sec. 12.  Minnesota Statutes 1998, section 144.1486, 
  9.19  subdivision 4, is amended to read: 
  9.20     Subd. 4.  [ELIGIBILITY REQUIREMENTS.] In order to qualify 
  9.21  for community health center program funding, a project must: 
  9.22     (1) be located in a rural shortage area that is a medically 
  9.23  underserved, federal health professional shortage, or governor 
  9.24  designated shortage area.  "Rural" means an area of the state 
  9.25  outside the seven-county Twin Cities metropolitan area and 
  9.26  outside of the Duluth, St. Cloud, East Grand Forks, Moorhead, 
  9.27  Rochester, and LaCrosse census defined urbanized areas; 
  9.28     (2) represent or propose the formation of a nonprofit 
  9.29  corporation with local resident governance, or be a governmental 
  9.30  or tribal entity.  Applicants in the process of forming a 
  9.31  nonprofit corporation may have a nonprofit coapplicant serve as 
  9.32  financial agent through the remainder of the formation period.  
  9.33  With the exception of governmental or tribal entities, all 
  9.34  applicants must submit application for nonprofit incorporation 
  9.35  and 501(c)(3) tax-exempt status within six months of accepting 
  9.36  community health center grant funds; and 
 10.1      (3) result in a locally owned and operated community health 
 10.2   center that provides primary and preventive health care 
 10.3   services, and incorporates quality assurance, regular reviews of 
 10.4   clinical performance, and peer review; for an application for an 
 10.5   operating expense grant, demonstrate that expenses exceed 
 10.6   revenues or demonstrate other extreme need that cannot be met 
 10.7   from other sources. 
 10.8      (4) seek to employ midlevel professionals, where 
 10.9   appropriate; 
 10.10     (5) demonstrate community and popular support and provide a 
 10.11  20 percent local match of state funding; and 
 10.12     (6) propose to serve an area that is not currently served 
 10.13  or was not served prior to establishment of a state-funded 
 10.14  community health center by a federally certified medical 
 10.15  organization. 
 10.16     Sec. 13.  Minnesota Statutes 1998, section 144.1486, 
 10.17  subdivision 8, is amended to read: 
 10.18     Subd. 8.  [REQUIREMENTS.] The commissioner shall develop a 
 10.19  list of requirements for community health centers and a tracking 
 10.20  and reporting system to assess benefits realized from the 
 10.21  program to ensure that projects are on schedule and effectively 
 10.22  utilizing state funds. 
 10.23     The commissioner shall require community health centers 
 10.24  established or supported through the grant program to: 
 10.25     (1) abide by all federal and state laws, rules, 
 10.26  regulations, and executive orders; 
 10.27     (2) establish policies, procedures, and services equivalent 
 10.28  to those required for federally certified rural health clinics 
 10.29  or federally qualified health centers.  Written policies are 
 10.30  required for description of services, medical management, drugs, 
 10.31  biologicals, and review of policies; 
 10.32     (3) become a Minnesota nonprofit corporation and apply for 
 10.33  501(c)(3) tax-exempt status within six months of accepting state 
 10.34  funding.  Local governmental or tribal entities are exempt from 
 10.35  this requirement; 
 10.36     (4) establish a governing board composed of nine to 25 
 11.1   members who are residents of the area served and representative 
 11.2   of the social, economic, linguistic, ethnic, and racial target 
 11.3   population.  At least 35 percent of the board must represent 
 11.4   consumers; 
 11.5      (5) establish corporate bylaws that reflect all functions 
 11.6   and responsibilities of the board; 
 11.7      (6) develop an appropriate management and organizational 
 11.8   structure with clear lines of authority and responsibility to 
 11.9   the board; 
 11.10     (7) provide for adequate patient management and continuity 
 11.11  of care on site and from referral sources; 
 11.12     (8) establish quality assurance and risk management 
 11.13  programs, policies, and procedures; 
 11.14     (9) develop a strategic staffing plan to acquire an 
 11.15  appropriate mix of primary care providers and clinical support 
 11.16  staff; 
 11.17     (10) establish billing policies and procedures to maximize 
 11.18  patient collections, except where federal regulations or 
 11.19  contractual obligations prohibit the use of these measures; 
 11.20     (11) develop and implement policies and procedures, 
 11.21  including a sliding scale fee schedule, that assure that no 
 11.22  person will be denied services because of inability to pay; 
 11.23     (12) establish an accounting and internal control system in 
 11.24  accordance with sound financial management principles; 
 11.25     (13) provide a local match equal to 20 percent of the grant 
 11.26  amount; 
 11.27     (14) work cooperatively with the local community and other 
 11.28  health care organizations, other grant recipients, and the 
 11.29  office of rural health; 
 11.30     (15) obtain an independent annual audit and submit audit 
 11.31  results to the office of rural health; 
 11.32     (16) maintain detailed records and, upon request, make 
 11.33  these records available to the commissioner for examination; and 
 11.34     (17) pursue supplemental funding sources, when practical, 
 11.35  for implementation and initial operating expenses. 
 11.36     (1) provide ongoing active local governance to the 
 12.1   community health center and pursue community support, 
 12.2   integration, collaboration, and resources; 
 12.3      (2) offer primary care services responsive to community 
 12.4   needs and maintain compliance with requirements of all cognizant 
 12.5   regulatory authorities, health center funders, or health care 
 12.6   payers; 
 12.7      (3) maintain policies and procedures that ensure that no 
 12.8   person will be denied services because of inability to pay; and 
 12.9      (4) submit brief quarterly activity reports and utilization 
 12.10  data to the commissioner. 
 12.11     Sec. 14.  Minnesota Statutes 1998, section 144.1488, 
 12.12  subdivision 1, is amended to read: 
 12.13     Subdivision 1.  [DUTIES OF COMMISSIONER OF HEALTH.] The 
 12.14  commissioner shall administer the state loan repayment program.  
 12.15  The commissioner shall: 
 12.16     (1) ensure that federal funds are used in accordance with 
 12.17  program requirements established by the federal National Health 
 12.18  Services Corps; 
 12.19     (2) notify potentially eligible loan repayment sites about 
 12.20  the program; 
 12.21     (3) develop and disseminate application materials to sites; 
 12.22     (4) review and rank applications using the scoring criteria 
 12.23  approved by the federal Department of Health and Human Services 
 12.24  as part of the Minnesota department of health's National Health 
 12.25  Services Corps state loan repayment program application; 
 12.26     (5) select sites that qualify for loan repayment based upon 
 12.27  the availability of federal and state funding; 
 12.28     (6) carry out other activities necessary to implement and 
 12.29  administer sections 144.1487 to 144.1492; 
 12.30     (7) verify the eligibility of program participants; 
 12.31     (8) sign a contract with each participant that specifies 
 12.32  the obligations of the participant and the state; 
 12.33     (9) arrange for the payment loan repayment of qualifying 
 12.34  educational loans for program participants; 
 12.35     (10) monitor the obligated service of program participants; 
 12.36     (11) waive or suspend service or payment obligations of 
 13.1   participants in appropriate situations; 
 13.2      (12) place participants who fail to meet their obligations 
 13.3   in default; and 
 13.4      (13) enforce penalties for default. 
 13.5      Sec. 15.  Minnesota Statutes 1998, section 144.1488, 
 13.6   subdivision 3, is amended to read: 
 13.7      Subd. 3.  [ELIGIBLE LOAN REPAYMENT SITES.] Private, 
 13.8   nonprofit, Nonprofit private and public entities located in and 
 13.9   providing health care services in federally designated primary 
 13.10  care health professional shortage areas are eligible to apply 
 13.11  for the program.  The commissioner shall develop a list of 
 13.12  Minnesota health professional shortage areas in greatest need of 
 13.13  health care professionals and shall select loan repayment sites 
 13.14  from that list.  The commissioner shall ensure, to the greatest 
 13.15  extent possible, that the geographic distribution of sites 
 13.16  within the state reflects the percentage of the population 
 13.17  living in rural and urban health professional shortage areas. 
 13.18     Sec. 16.  Minnesota Statutes 1998, section 144.1488, 
 13.19  subdivision 4, is amended to read: 
 13.20     Subd. 4.  [ELIGIBLE HEALTH PROFESSIONALS.] (a) To be 
 13.21  eligible to apply to the commissioner for the loan repayment 
 13.22  program, health professionals must be citizens or nationals of 
 13.23  the United States, must not have any unserved obligations for 
 13.24  service to a federal, state, or local government, or other 
 13.25  entity, must have a current and unrestricted Minnesota license 
 13.26  to practice, and must be ready to begin full-time clinical 
 13.27  practice upon signing a contract for obligated service. 
 13.28     (b) In selecting physicians for participation, the 
 13.29  commissioner shall give priority to physicians who are board 
 13.30  certified or have completed a residency in family practice, 
 13.31  osteopathic general practice, obstetrics and gynecology, 
 13.32  internal medicine, or pediatrics.  Eligible providers are those 
 13.33  specified by the federal Bureau of Primary Health Care in the 
 13.34  policy information notice for the state's current federal grant 
 13.35  application.  A physician health professional selected for 
 13.36  participation is not eligible for loan repayment until the 
 14.1   physician health professional has an employment agreement or 
 14.2   contract with an eligible loan repayment site and has signed a 
 14.3   contract for obligated service with the commissioner. 
 14.4      Sec. 17.  Minnesota Statutes 1998, section 144.1489, 
 14.5   subdivision 2, is amended to read: 
 14.6      Subd. 2.  [OBLIGATED SERVICE.] A participant shall agree in 
 14.7   the contract to fulfill the period of obligated service by 
 14.8   providing primary health care services in full-time clinical 
 14.9   practice.  The service must be provided in a private, nonprofit, 
 14.10  nonprofit private or public entity that is located in and 
 14.11  providing services to a federally designated health professional 
 14.12  shortage area and that has been designated as an eligible site 
 14.13  by the commissioner under the state loan repayment program. 
 14.14     Sec. 18.  Minnesota Statutes 1998, section 144.1489, 
 14.15  subdivision 4, is amended to read: 
 14.16     Subd. 4.  [AFFIDAVIT OF SERVICE REQUIRED.] Within 30 days 
 14.17  of the start of obligated service, and by February 1 of each 
 14.18  succeeding calendar year Before receiving loan repayment, 
 14.19  annually thereafter, and as requested by the commissioner, a 
 14.20  participant shall submit an affidavit to the commissioner 
 14.21  stating that the participant is providing the obligated service 
 14.22  and which is signed by a representative of the organizational 
 14.23  entity in which the service is provided.  Participants must 
 14.24  provide written notice to the commissioner within 30 days of:  a 
 14.25  change in name or address, a decision not to fulfill a service 
 14.26  obligation, or cessation of clinical practice. 
 14.27     Sec. 19.  Minnesota Statutes 1998, section 144.1490, 
 14.28  subdivision 2, is amended to read: 
 14.29     Subd. 2.  [PROCEDURE FOR LOAN REPAYMENT.] Program 
 14.30  participants, at the time of signing a contract, shall designate 
 14.31  the qualifying loan or loans for which the commissioner is to 
 14.32  make payments.  The participant shall submit to the commissioner 
 14.33  all payment books for the designated loan or loans or all 
 14.34  monthly billings for the designated loan or loans within five 
 14.35  days of receipt proof that all payments made by the commissioner 
 14.36  have been applied toward the designated qualifying loans.  The 
 15.1   commissioner shall make payments in accordance with the terms 
 15.2   and conditions of the designated loans state loan repayment 
 15.3   grant agreement or contract, in an amount not to exceed $20,000 
 15.4   when annualized.  If the amount paid by the commissioner is less 
 15.5   than $20,000 during a 12-month period, the commissioner shall 
 15.6   pay during the 12th month an additional amount towards a loan or 
 15.7   loans designated by the participant, to bring the total paid to 
 15.8   $20,000.  The total amount paid by the commissioner must not 
 15.9   exceed the amount of principal and accrued interest of the 
 15.10  designated loans. 
 15.11     Sec. 20.  Minnesota Statutes 1998, section 144.1494, 
 15.12  subdivision 2, is amended to read: 
 15.13     Subd. 2.  [ELIGIBILITY.] To be eligible to participate in 
 15.14  the program, a prospective physician medical resident must 
 15.15  submit a letter of interest an application to the commissioner.  
 15.16  A resident who is accepted must sign a contract to agree to 
 15.17  serve at least three of the first five years following residency 
 15.18  in a minimum three-year service obligation within a designated 
 15.19  rural area, which shall begin no later than March following 
 15.20  completion of residency. 
 15.21     Sec. 21.  Minnesota Statutes 1998, section 144.1494, 
 15.22  subdivision 3, is amended to read: 
 15.23     Subd. 3.  [LOAN FORGIVENESS.] For each fiscal year after 
 15.24  1995, the commissioner may accept up to 12 applicants who are 
 15.25  medical residents, including four applicants who are pediatric 
 15.26  residents, six applicants who are family practice residents, and 
 15.27  two applicants who are internal medicine residents, for 
 15.28  participation in the loan forgiveness program.  If the 
 15.29  commissioner does not receive enough applicants per fiscal year 
 15.30  to fill the number of residents in the specific areas of 
 15.31  practice, the resident applicants may be from any area of 
 15.32  practice.  The 12 resident applicants may be in any year of 
 15.33  residency training; however, priority must be given to the 
 15.34  following categories of residents in descending order:  third 
 15.35  year residents, second year residents, and first year residents. 
 15.36  Applicants are responsible for securing their own loans.  
 16.1   Applicants chosen to participate in the loan forgiveness program 
 16.2   may designate for each year of medical school, up to a maximum 
 16.3   of four years, an agreed amount, not to exceed $10,000, as a 
 16.4   qualified loan.  For each year that a participant serves as a 
 16.5   physician in a designated rural area, up to a maximum of four 
 16.6   years, the commissioner shall annually pay an amount equal to 
 16.7   one year of qualified loans.  Participants who move their 
 16.8   practice from one designated rural area to another remain 
 16.9   eligible for loan repayment.  In addition, in any year that a 
 16.10  resident participating in the loan forgiveness program serves at 
 16.11  least four weeks during a year of residency substituting for a 
 16.12  rural physician to temporarily relieve the rural physician of 
 16.13  rural practice commitments to enable the rural physician to take 
 16.14  a vacation, engage in activities outside the practice area, or 
 16.15  otherwise be relieved of rural practice commitments, the 
 16.16  participating resident may designate up to an additional $2,000, 
 16.17  above the $10,000 yearly maximum.  
 16.18     Sec. 22.  Minnesota Statutes 1998, section 144.1494, 
 16.19  subdivision 5, is amended to read: 
 16.20     Subd. 5.  [LOAN FORGIVENESS; UNDERSERVED URBAN 
 16.21  COMMUNITIES.] For each fiscal year beginning on and after 1995, 
 16.22  the commissioner may accept up to four applicants who are 
 16.23  medical residents in family practice, pediatrics, or internal 
 16.24  medicine per fiscal year for participation in the urban primary 
 16.25  care physician loan forgiveness program.  The resident 
 16.26  applicants may be in any year of residency training; however, 
 16.27  priority will be given to the following categories of residents 
 16.28  in descending order:  third year residents, second year 
 16.29  residents, and first year residents.  If the commissioner does 
 16.30  not receive enough qualified applicants per fiscal year to fill 
 16.31  the number of slots for urban underserved communities, the slots 
 16.32  may be allocated to residents who have applied for the rural 
 16.33  physician loan forgiveness program in subdivision 1.  Applicants 
 16.34  are responsible for securing their own loans.  For purposes of 
 16.35  this provision, "qualifying educational loans" are government 
 16.36  and commercial loans for actual costs paid for tuition, 
 17.1   reasonable education expenses, and reasonable living expenses 
 17.2   related to the graduate or undergraduate education of a health 
 17.3   care professional.  Applicants chosen to participate in the loan 
 17.4   forgiveness program may designate for each year of medical 
 17.5   school, up to a maximum of four years, an agreed amount, not to 
 17.6   exceed $10,000, as a qualified loan.  For each year that a 
 17.7   participant serves as a physician in a designated underserved 
 17.8   urban area, up to a maximum of four years, the commissioner 
 17.9   shall annually pay an amount equal to one year of qualified 
 17.10  loans.  Participants who move their practice from one designated 
 17.11  underserved urban community to another remain eligible for loan 
 17.12  repayment. 
 17.13     Sec. 23.  Minnesota Statutes 1998, section 144.1494, is 
 17.14  amended by adding a subdivision to read: 
 17.15     Subd. 6.  [RULES.] The commissioner may adopt rules to 
 17.16  implement this section. 
 17.17     Sec. 24.  Minnesota Statutes 1998, section 144.1495, 
 17.18  subdivision 3, is amended to read: 
 17.19     Subd. 3.  [ELIGIBILITY.] To be eligible to participate in 
 17.20  the program, a prospective midlevel practitioner student must 
 17.21  submit a letter of interest an application to the commissioner 
 17.22  prior to or while attending a program of study designed to 
 17.23  prepare the individual for service as a midlevel practitioner.  
 17.24  A midlevel practitioner student who is accepted into this 
 17.25  program must sign a contract to agree to serve at least two of 
 17.26  the first four years following graduation from the program in a 
 17.27  designated rural area a minimum two-year service obligation 
 17.28  within a designated rural area, which shall begin no later than 
 17.29  March following completion of training. 
 17.30     Sec. 25.  Minnesota Statutes 1998, section 144.1495, 
 17.31  subdivision 4, is amended to read: 
 17.32     Subd. 4.  [LOAN FORGIVENESS.] The commissioner may accept 
 17.33  up to eight applicants per year for participation in the loan 
 17.34  forgiveness program.  Applicants are responsible for securing 
 17.35  their own loans.  Applicants chosen to participate in the loan 
 17.36  forgiveness program may designate for each year of midlevel 
 18.1   practitioner study, up to a maximum of two years, an agreed 
 18.2   amount, not to exceed $7,000, as a qualified loan.  For purposes 
 18.3   of this provision, "qualifying educational loans" are government 
 18.4   and commercial loans for actual costs paid for tuition, 
 18.5   reasonable education expenses, and reasonable living expenses 
 18.6   related to the graduate or undergraduate education of a health 
 18.7   care professional.  For each year that a participant serves as a 
 18.8   midlevel practitioner in a designated rural area, up to a 
 18.9   maximum of four years, the commissioner shall annually repay an 
 18.10  amount equal to one-half a qualified loan.  Participants who 
 18.11  move their practice from one designated rural area to another 
 18.12  remain eligible for loan repayment.  
 18.13     Sec. 26.  Minnesota Statutes 1998, section 144.1495, is 
 18.14  amended by adding a subdivision to read: 
 18.15     Subd. 6.  [RULES.] The commissioner may adopt rules to 
 18.16  implement this section. 
 18.17     Sec. 27.  Minnesota Statutes 1998, section 144.1496, 
 18.18  subdivision 2, is amended to read: 
 18.19     Subd. 2.  [ELIGIBILITY.] To be eligible to participate in 
 18.20  the loan forgiveness program, a person planning to enroll or 
 18.21  enrolled in a program of study designed to prepare the person to 
 18.22  become a registered nurse or licensed practical nurse must 
 18.23  submit a letter of interest an application to the commissioner 
 18.24  before completion of a nursing education program.  Before 
 18.25  completion of the program, the applicant must sign a contract in 
 18.26  which the applicant agrees to practice nursing for at least one 
 18.27  of the first two years following completion of the nursing 
 18.28  education program providing nursing services in a licensed 
 18.29  nursing home or intermediate care facility for persons with 
 18.30  mental retardation or related conditions.  A nurse who is 
 18.31  selected to participate must sign a contract to agree to serve a 
 18.32  minimum one-year service obligation providing nursing services 
 18.33  in a licensed nursing home or intermediate care facility for 
 18.34  persons with mental retardation or related conditions, which 
 18.35  shall begin no later than March following completion of a 
 18.36  nursing program or loan forgiveness program selection.  
 19.1      Sec. 28.  Minnesota Statutes 1998, section 144.1496, 
 19.2   subdivision 5, is amended to read: 
 19.3      Subd. 5.  [RULES.] The commissioner shall may adopt rules 
 19.4   to implement this section. 
 19.5      Sec. 29.  Minnesota Statutes 1998, section 144.382, 
 19.6   subdivision 4, is amended to read: 
 19.7      Subd. 4.  [PUBLIC WATER SUPPLY.] "Public water supply" 
 19.8   means a system providing piped water for human consumption, and 
 19.9   either containing a minimum of 15 service connections or 15 
 19.10  living units, or serving an average of 25 persons daily for 60 
 19.11  days of the year.  "Public water supply" includes a collection, 
 19.12  treatment, storage, and distribution facility under control of 
 19.13  an operator and used primarily in connection with the system, 
 19.14  and a collection or pretreatment storage facility used primarily 
 19.15  in connection with the system but not under control of an 
 19.16  operator has the meaning given to "public water system" in the 
 19.17  Safe Drinking Water Act, United States Code, title 42, section 
 19.18  300f, clause (4).