HF 1638

2nd Engrossment - 89th Legislature (2015 - 2016) Posted on 04/25/2015 11:07am

A bill for an act
relating to state government; establishing the health and human services
budget; modifying provisions governing health care, MinnesotaCare, MNsure,
continuing care, nursing facility payments and workforce development, public
health and health care delivery, children and family services, chemical and
mental health, direct care and treatment, withdrawal management programs,
and health-related licensing boards; establishing uniform requirements for
public assistance programs related to income calculation, reporting income,
and correcting overpayments and underpayments; making changes to medical
assistance, home and community-based services, Northstar Care for Children,
child protection, group residential housing, child support, and civil commitment;
making changes to and eliminating MinnesotaCare; establishing a federally
facilitated marketplace; providing for certain provider rate and grant increases;
establishing the Minnesota ABLE plan and accounts; modifying requirements
for administrative expenses and audits of certain public health care programs;
providing for protection of born alive infants; establishing standards for
withdrawal management programs; requiring reports and studies; authorizing
rulemaking; making technical changes; modifying certain fees for health-related
licensing boards; making human services forecast adjustments; appropriating
money; amending Minnesota Statutes 2014, sections 13.46, subdivisions 2, 7;
13.461, by adding a subdivision; 15A.0815, subdivision 3; 43A.241; 62A.02,
subdivision 2; 62A.045; 62Q.55, subdivision 3; 62V.02, by adding a subdivision;
62V.03, subdivision 2; 62V.04, subdivisions 1, 2, 4; 62V.05, subdivisions 1,
5, 6, by adding subdivisions; 62V.11, subdivision 2, by adding a subdivision;
103I.205, subdivision 4; 119B.011, subdivision 15; 119B.025, subdivision 1;
119B.035, subdivision 4; 119B.09, subdivision 4; 144.293, subdivision 5;
144A.071, subdivision 4a; 144A.75, subdivision 13; 144E.001, by adding a
subdivision; 144E.275, subdivision 1, by adding a subdivision; 145.4131,
subdivision 1; 145.423; 145.56, subdivisions 2, 4; 145.928, subdivision 13;
146B.01, subdivision 28; 146B.03, subdivisions 4, 6, by adding a subdivision;
146B.07, subdivisions 1, 2; 147.091, subdivision 1; 148.271; 148.52; 148.54;
148.57, subdivisions 1, 2, by adding a subdivision; 148.574; 148.575, subdivision
2; 148.577; 148.59; 148.603; 148E.075; 148E.080, subdivisions 1, 2; 148E.180,
subdivisions 2, 5; 150A.06, subdivision 1b; 150A.091, subdivisions 4, 5,
11, by adding subdivisions; 150A.31; 151.01, subdivisions 15a, 27; 151.02;
151.065, subdivisions 1, 2, 3, 4; 151.102; 151.58, subdivisions 2, 5; 152.34;
157.15, subdivision 8; 214.077; 214.10, subdivisions 2, 2a; 214.32, subdivision
6; 245.467, subdivision 6; 245.4876, subdivision 7; 245A.06, by adding a
subdivision; 245A.155, subdivisions 1, 2; 245A.65, subdivision 2; 245C.03, by
adding a subdivision; 245C.10, by adding a subdivision; 245D.02, by adding a
subdivision; 245D.05, subdivisions 1, 2; 245D.06, subdivisions 1, 2, 7; 245D.07,
subdivision 2; 245D.071, subdivision 5; 245D.09, subdivisions 3, 5; 245D.22,
subdivision 4; 245D.31, subdivisions 3, 4, 5; 252.27, subdivision 2a; 253B.18,
subdivisions 4c, 5; 256.01, by adding subdivisions; 256.017, subdivision 1;
256.478; 256.741, subdivisions 1, 2; 256.962, by adding a subdivision; 256.969,
subdivisions 2b, 9; 256.975, subdivision 2, by adding a subdivision; 256.98,
subdivision 1; 256B.021, subdivision 4; 256B.056, subdivision 5c; 256B.057,
subdivision 9; 256B.0625, subdivisions 3b, 13, 13e, 13h, 17, 28a, 31, 58,
by adding subdivisions; 256B.0631; 256B.0644; 256B.0913, subdivision 4;
256B.0915, subdivisions 3a, 3e, 3h; 256B.0916, subdivisions 2, 11, by adding
a subdivision; 256B.097, subdivisions 3, 4; 256B.431, subdivisions 2b, 36;
256B.434, subdivision 4, by adding a subdivision; 256B.441, subdivisions
1, 5, 6, 13, 14, 17, 30, 31, 33, 35, 40, 44, 46c, 48, 50, 51, 51a, 53, 54,
55a, 56, 63, by adding subdivisions; 256B.49, subdivision 26, by adding a
subdivision; 256B.4913, subdivisions 4a, 5; 256B.4914, subdivisions 2, 6,
8, 10, 14, 15; 256B.492; 256B.50, subdivision 1; 256B.5012, by adding a
subdivision; 256B.69, subdivisions 5a, 5i, 9c, 9d, by adding a subdivision;
256B.75; 256B.76, subdivisions 1, 2; 256B.762; 256B.766; 256B.767; 256D.01,
subdivision 1a; 256D.02, subdivision 8, by adding subdivisions; 256D.06,
subdivision 1; 256D.405, subdivision 3; 256E.35, subdivision 2, by adding a
subdivision; 256I.03, subdivisions 3, 7, by adding subdivisions; 256I.04; 256I.05,
subdivisions 1c, 1g, 2; 256I.06, subdivisions 2, 6, 7, 8; 256J.08, subdivisions
26, 86; 256J.30, subdivisions 1, 9; 256J.35; 256J.40; 256J.95, subdivision 19;
256K.45, subdivision 1a; 256L.01, subdivisions 3a, 5; 256L.03, subdivision 5;
256L.04, subdivisions 1c, 7b, 10; 256L.05, subdivisions 3, 3a, 4, by adding
a subdivision; 256L.06, subdivision 3; 256L.121, subdivision 1; 256N.22,
subdivisions 9, 10; 256N.24, subdivision 4; 256N.25, subdivision 1; 256N.27,
subdivision 2; 256P.001; 256P.01, subdivision 3, by adding subdivisions;
256P.02, by adding a subdivision; 256P.03, subdivision 1; 256P.04, subdivisions
1, 4; 256P.05, subdivision 1; 257.75, subdivisions 3, 5; 259A.75; 260C.007,
subdivisions 27, 32; 260C.203; 260C.212, subdivision 1, by adding subdivisions;
260C.331, subdivision 1; 260C.451, subdivisions 2, 6; 260C.515, subdivision
5; 260C.521, subdivisions 1, 2; 260C.607, subdivision 4; 270A.03, subdivision
5; 270B.14, subdivision 1; 518A.26, subdivision 14; 518A.32, subdivision 2;
518A.39, subdivision 1, by adding a subdivision; 518A.41, subdivisions 1, 3, 4,
14, 15; 518A.43, by adding a subdivision; 518A.46, subdivision 3, by adding a
subdivision; 518A.51; 518A.53, subdivision 4; 518C.802; 626.556, subdivisions
1, as amended, 2, 3, 6a, 7, as amended, 10, 10e, 11c, by adding subdivisions;
Laws 2008, chapter 363, article 18, section 3, subdivision 5; Laws 2012, chapter
247, article 4, section 47, as amended; Laws 2014, chapter 189, sections 5; 10;
11; 16; 17; 18; 19; 23; 24; 27; 28; 29; 31; 43; 50; 51; 73; proposing coding
for new law in Minnesota Statutes, chapters 62A; 62V; 144; 145; 148; 245;
245A; 256B; 256E; 256M; 256P; 518A; proposing coding for new law as
Minnesota Statutes, chapters 245F; 256Q; repealing Minnesota Statutes 2014,
sections 13.461, subdivision 26; 13D.08, subdivision 5a; 16A.724, subdivision
3; 62A.046, subdivision 5; 62V.01; 62V.02; 62V.03; 62V.04; 62V.05; 62V.06;
62V.07; 62V.08; 62V.09; 62V.10; 62V.11; 148.57, subdivisions 3, 4; 148.571;
148.572; 148.573, subdivision 1; 148.575, subdivisions 1, 3, 5, 6; 148.576;
148E.060, subdivision 12; 148E.075, subdivisions 4, 5, 6, 7; 214.105; 256.01,
subdivision 35; 256B.434, subdivision 19b; 256B.441, subdivisions 14a, 19, 50a,
52, 55, 58, 62; 256D.0513; 256D.06, subdivision 8; 256D.09, subdivision 6;
256D.49; 256J.38; 256L.01, subdivisions 1, 1a, 1b, 2, 3, 3a, 5, 6, 7; 256L.02,
subdivisions 1, 2, 3, 5, 6; 256L.03, subdivisions 1, 1a, 1b, 2, 3, 3a, 3b, 4, 4a, 5,
6; 256L.04, subdivisions 1, 1a, 1c, 2, 2a, 7, 7a, 7b, 8, 10, 12, 13, 14; 256L.05,
subdivisions 1, 1a, 1b, 1c, 2, 3, 3a, 3c, 4, 5, 6; 256L.06, subdivision 3; 256L.07,
subdivisions 1, 2, 3, 4; 256L.09, subdivisions 1, 2, 4, 5, 6, 7; 256L.10; 256L.11,
subdivisions 1, 2, 2a, 3, 4, 7; 256L.12; 256L.121; 256L.15, subdivisions 1, 1a,
1b, 2; 256L.18; 256L.22; 256L.24; 256L.26; 256L.28; Minnesota Rules, part
3400.0170, subparts 5, 6, 12, 13.

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

ARTICLE 1

HEALTH CARE

Section 1.

Minnesota Statutes 2014, section 62A.045, is amended to read:

62A.045 PAYMENTS ON BEHALF OF ENROLLEES IN GOVERNMENT
HEALTH PROGRAMS.

(a) As a condition of doing business in Minnesota or providing coverage to
residents of Minnesota covered by this section, each health insurer shall comply with the
requirements of the federal Deficit Reduction Act of 2005, Public Law 109-171, including
any federal regulations adopted under that act, to the extent that it imposes a requirement
that applies in this state and that is not also required by the laws of this state. This section
does not require compliance with any provision of the federal act prior to the effective date
provided for that provision in the federal act. The commissioner shall enforce this section.

For the purpose of this section, "health insurer" includes self-insured plans, group
health plans (as defined in section 607(1) of the Employee Retirement Income Security
Act of 1974), service benefit plans, managed care organizations, pharmacy benefit
managers, or other parties that are by contract legally responsible to pay a claim for a
health-care item or service for an individual receiving benefits under paragraph (b).

(b) No plan offered by a health insurer issued or renewed to provide coverage to
a Minnesota resident shall contain any provision denying or reducing benefits because
services are rendered to a person who is eligible for or receiving medical benefits pursuant
to title XIX of the Social Security Act (Medicaid) in this or any other state; chapter 256;
256B; or 256D or services pursuant to section 252.27; 256L.01 to 256L.10; 260B.331,
subdivision 2; 260C.331, subdivision 2; or 393.07, subdivision 1 or 2. No health insurer
providing benefits under plans covered by this section shall use eligibility for medical
programs named in this section as an underwriting guideline or reason for nonacceptance
of the risk.

(c) If payment for covered expenses has been made under state medical programs for
health care items or services provided to an individual, and a third party has a legal liability
to make payments, the rights of payment and appeal of an adverse coverage decision for the
individual, or in the case of a child their responsible relative or caretaker, will be subrogated
to the state agency. The state agency may assert its rights under this section within three
years of the date the service was rendered. For purposes of this section, "state agency"
includes prepaid health plans under contract with the commissioner according to sections
256B.69, 256D.03, subdivision 4, paragraph (c), and 256L.12; children's mental health
collaboratives under section 245.493; demonstration projects for persons with disabilities
under section 256B.77; nursing homes under the alternative payment demonstration project
under section 256B.434; and county-based purchasing entities under section 256B.692.

(d) Notwithstanding any law to the contrary, when a person covered by a plan
offered by a health insurer receives medical benefits according to any statute listed in this
section, payment for covered services or notice of denial for services billed by the provider
must be issued directly to the provider. If a person was receiving medical benefits through
the Department of Human Services at the time a service was provided, the provider must
indicate this benefit coverage on any claim forms submitted by the provider to the health
insurer for those services. If the commissioner of human services notifies the health
insurer that the commissioner has made payments to the provider, payment for benefits or
notices of denials issued by the health insurer must be issued directly to the commissioner.
Submission by the department to the health insurer of the claim on a Department of
Human Services claim form is proper notice and shall be considered proof of payment of
the claim to the provider and supersedes any contract requirements of the health insurer
relating to the form of submission. Liability to the insured for coverage is satisfied to the
extent that payments for those benefits are made by the health insurer to the provider or
the commissioner as required by this section.

(e) When a state agency has acquired the rights of an individual eligible for medical
programs named in this section and has health benefits coverage through a health insurer,
the health insurer shall not impose requirements that are different from requirements
applicable to an agent or assignee of any other individual covered.

new text begin (f) A health insurer must process a claim made by a state agency for covered
expenses paid under state medical programs within 90 business days of the claim's
submission. If the health insurer needs additional information to process the claim,
the health insurer may be granted an additional 30 business days to process the claim,
provided the health insurer submits the request for additional information to the state
agency within 30 business days after the health insurer received the claim.
new text end

new text begin (g) A health insurer may request a refund of a claim paid in error to the Department
of Human Services within two years of the date the payment was made to the department.
A request for a refund shall not be honored by the department if the health insurer makes
the request after the time period has lapsed.
new text end

Sec. 2.

Minnesota Statutes 2014, section 150A.06, subdivision 1b, is amended to read:

Subd. 1b.

Resident dentists.

A person who is a graduate of a dental school and
is an enrolled graduate student or student of an accredited advanced dental education
program and who is not licensed to practice dentistry in the state shall obtain from the
board a license to practice dentistry as a resident dentist. The license must be designated
"resident dentist license" and authorizes the licensee to practice dentistry only under the
supervision of a licensed dentist. new text beginA University of Minnesota School of Dentistry dental
resident holding a resident dentist license is eligible for enrollment in medical assistance,
as provided under section 256B.0625, subdivision 9b. new text endA resident dentist license must be
renewed annually pursuant to the board's rules. An applicant for a resident dentist license
shall pay a nonrefundable fee set by the board for issuing and renewing the license. The
requirements of sections 150A.01 to 150A.21 apply to resident dentists except as specified
in rules adopted by the board. A resident dentist license does not qualify a person for
licensure under subdivision 1.

Sec. 3.

Minnesota Statutes 2014, section 151.58, subdivision 2, is amended to read:

Subd. 2.

Definitions.

For purposes of this section only, the terms defined in this
subdivision have the meanings given.

(a) "Automated drug distribution system" or "system" means a mechanical system
approved by the board that performs operations or activities, other than compounding or
administration, related to the storage, packaging, or dispensing of drugs, and collects,
controls, and maintains all required transaction information and records.

(b) "Health care facility" means a nursing home licensed under section 144A.02;
a housing with services establishment registered under section 144D.01, subdivision 4,
in which a home provider licensed under chapter 144A is providing centralized storage
of medications; new text begina boarding care home licensed under sections 144.50 to 144.58 that is
providing centralized storage of medications; new text endor a Minnesota sex offender program facility
operated by the Department of Human Services.

(c) "Managing pharmacy" means a pharmacy licensed by the board that controls and
is responsible for the operation of an automated drug distribution system.

Sec. 4.

Minnesota Statutes 2014, section 151.58, subdivision 5, is amended to read:

Subd. 5.

Operation of automated drug distribution systems.

(a) The managing
pharmacy and the pharmacist in charge are responsible for the operation of an automated
drug distribution system.

(b) Access to an automated drug distribution system must be limited to pharmacy
and nonpharmacy personnel authorized to procure drugs from the system, except that field
service technicians may access a system located in a health care facility for the purposes of
servicing and maintaining it while being monitored either by the managing pharmacy, or a
licensed nurse within the health care facility. In the case of an automated drug distribution
system that is not physically located within a licensed pharmacy, access for the purpose
of procuring drugs shall be limited to licensed nurses. Each person authorized to access
the system must be assigned an individual specific access code. Alternatively, access to
the system may be controlled through the use of biometric identification procedures. A
policy specifying time access parameters, including time-outs, logoffs, and lockouts,
must be in place.

(c) For the purposes of this section only, the requirements of section 151.215 are met
if the following clauses are met:

(1) a pharmacist employed by and working at the managing pharmacy, or at a
pharmacy that is acting as a central services pharmacy for the managing pharmacy,
pursuant to Minnesota Rules, part 6800.4075, must review, interpret, and approve all
prescription drug orders before any drug is distributed from the system to be administered
to a patient. A pharmacy technician may perform data entry of prescription drug orders
provided that a pharmacist certifies the accuracy of the data entry before the drug can
be released from the automated drug distribution system. A pharmacist employed by
and working at the managing pharmacy must certify the accuracy of the filling of any
cassettes, canisters, or other containers that contain drugs that will be loaded into the
automated drug distribution system new text begin, unless the filled cassettes, canisters, or containers
have been provided by a repackager registered with the United States Food and Drug
Administration and licensed by the board as a manufacturer new text end; and

(2) when the automated drug dispensing system is located and used within the
managing pharmacy, a pharmacist must personally supervise and take responsibility for all
packaging and labeling associated with the use of an automated drug distribution system.

(d) Access to drugs when a pharmacist has not reviewed and approved the
prescription drug order is permitted only when a formal and written decision to allow such
access is issued by the pharmacy and the therapeutics committee or its equivalent. The
committee must specify the patient care circumstances in which such access is allowed,
the drugs that can be accessed, and the staff that are allowed to access the drugs.

(e) In the case of an automated drug distribution system that does not utilize bar
coding in the loading process, the loading of a system located in a health care facility may
be performed by a pharmacy technician, so long as the activity is continuously supervised,
through a two-way audiovisual system by a pharmacist on duty within the managing
pharmacy. In the case of an automated drug distribution system that utilizes bar coding
in the loading process, the loading of a system located in a health care facility may be
performed by a pharmacy technician or a licensed nurse, provided that the managing
pharmacy retains an electronic record of loading activities.

(f) The automated drug distribution system must be under the supervision of a
pharmacist. The pharmacist is not required to be physically present at the site of the
automated drug distribution system if the system is continuously monitored electronically
by the managing pharmacy. A pharmacist on duty within a pharmacy licensed by the
board must be continuously available to address any problems detected by the monitoring
or to answer questions from the staff of the health care facility. The licensed pharmacy
may be the managing pharmacy or a pharmacy which is acting as a central services
pharmacy, pursuant to Minnesota Rules, part 6800.4075, for the managing pharmacy.

Sec. 5.

Minnesota Statutes 2014, section 256.969, subdivision 2b, is amended to read:

Subd. 2b.

Hospital payment rates.

(a) For discharges occurring on or after
November 1, 2014, hospital inpatient services for hospitals located in Minnesota shall be
paid according to the following:

(1) critical access hospitals as defined by Medicare shall be paid using a cost-based
methodology;

(2) long-term hospitals as defined by Medicare shall be paid on a per diem
methodology under subdivision 25;

(3) rehabilitation hospitals or units of hospitals that are recognized as rehabilitation
distinct parts as defined by Medicare shall be paid according to the methodology under
subdivision 12; and

(4) all other hospitals shall be paid on a diagnosis-related group (DRG) methodology.

(b) For the period beginning January 1, 2011, through October 31, 2014, rates shall
not be rebased, except that a Minnesota long-term hospital shall be rebased effective
January 1, 2011, based on its most recent Medicare cost report ending on or before
September 1, 2008, with the provisions under subdivisions 9 and 23, based on the rates
in effect on December 31, 2010. For rate setting periods after November 1, 2014, in
which the base years are updated, a Minnesota long-term hospital's base year shall remain
within the same period as other hospitals.

(c) Effective for discharges occurring on and after November 1, 2014, payment rates
for hospital inpatient services provided by hospitals located in Minnesota or the local trade
area, except for the hospitals paid under the methodologies described in paragraph (a),
clauses (2) and (3), shall be rebased, incorporating cost and payment methodologies in a
manner similar to Medicare. The base year for the rates effective November 1, 2014, shall
be calendar year 2012. The rebasing under this paragraph shall be budget neutral, ensuring
that the total aggregate payments under the rebased system are equal to the total aggregate
payments that were made for the same number and types of services in the base year.
Separate budget neutrality calculations shall be determined for payments made to critical
access hospitals and payments made to hospitals paid under the DRG system. Only the rate
increases or decreases under subdivision 3a or 3c that applied to the hospitals being rebased
during the entire base period shall be incorporated into the budget neutrality calculation.

(d) For discharges occurring on or after November 1, 2014, through June 30, 2016,
the rebased rates under paragraph (c) shall include adjustments to the projected rates that
result in no greater than a five percent increase or decrease from the base year payments
for any hospital. Any adjustments to the rates made by the commissioner under this
paragraph and paragraph (e) shall maintain budget neutrality as described in paragraph (c).

(e) For discharges occurring on or after November 1, 2014, through June 30, 2016,
the commissioner may make additional adjustments to the rebased rates, and when
evaluating whether additional adjustments should be made, the commissioner shall
consider the impact of the rates on the following:

(1) pediatric services;

(2) behavioral health services;

(3) trauma services as defined by the National Uniform Billing Committee;

(4) transplant services;

(5) obstetric services, newborn services, and behavioral health services provided
by hospitals outside the seven-county metropolitan area;

(6) outlier admissions;

(7) low-volume providers; and

(8) services provided by small rural hospitals that are not critical access hospitals.

(f) Hospital payment rates established under paragraph (c) must incorporate the
following:

(1) for hospitals paid under the DRG methodology, the base year payment rate per
admission is standardized by the applicable Medicare wage index and adjusted by the
hospital's disproportionate population adjustment;

(2) for critical access hospitals, interim per diem payment rates shall be based on the
ratio of cost and charges reported on the base year Medicare cost report or reports and
applied to medical assistance utilization data. Final settlement payments for a state fiscal
year must be determined based on a review of the medical assistance cost report required
under subdivision 4b for the applicable state fiscal year;

(3) the cost and charge data used to establish hospital payment rates must only
reflect inpatient services covered by medical assistance; and

(4) in determining hospital payment rates for discharges occurring on or after the
rate year beginning January 1, 2011, through December 31, 2012, the hospital payment
rate per discharge shall be based on the cost-finding methods and allowable costs of the
Medicare program in effect during the base year or years.

(g) The commissioner shall validate the rates effective November 1, 2014, by
applying the rates established under paragraph (c), and any adjustments made to the rates
under paragraph (d) or (e), to hospital claims paid in calendar year 2013 to determine
whether the total aggregate payments for the same number and types of services under the
rebased rates are equal to the total aggregate payments made during calendar year 2013.

(h) Effective for discharges occurring on or after July 1, 2017, and every two
years thereafter, payment rates under this section shall be rebased to reflect only those
changes in hospital costs between the existing base year and the next base year. The
commissioner shall establish the base year for each rebasing period considering the most
recent year for which filed Medicare cost reports are available. The estimated change in
the average payment per hospital discharge resulting from a scheduled rebasing must be
calculated and made available to the legislature by January 15 of each year in which
rebasing is scheduled to occur, and must include by hospital the differential in payment
rates compared to the individual hospital's costs.

new text begin (i) Effective for discharges occurring on or after July 1, 2015, payment rates for
critical access hospitals located in Minnesota or the local trade area shall be determined
using a new cost-based methodology. The commissioner shall establish within the
methodology tiers of payment designed to promote efficiency and cost-effectiveness.
Annual payments to hospitals under this paragraph shall equal the total cost for critical
access hospitals as reflected in base year cost reports. The new cost-based rate shall be
the final rate and shall not be settled to actual incurred costs. The factors used to develop
the new methodology may include but are not limited to:
new text end

new text begin (1) the ratio between the hospital's costs for treating medical assistance patients and
the hospital's charges to the medical assistance program;
new text end

new text begin (2) the ratio between the hospital's costs for treating medical assistance patients and
the hospital's payments received from the medical assistance program for the care of
medical assistance patients;
new text end

new text begin (3) the ratio between the hospital's charges to the medical assistance program and
the hospital's payments received from the medical assistance program for the care of
medical assistance patients;
new text end

new text begin (4) the statewide average increases in the ratios identified in clauses (1), (2), and (3);
new text end

new text begin (5) the proportion of that hospital's costs that are administrative and trends in
administrative costs; and
new text end

new text begin (6) geographic location.
new text end

Sec. 6.

Minnesota Statutes 2014, section 256.969, subdivision 9, is amended to read:

Subd. 9.

Disproportionate numbers of low-income patients served.

(a) For
admissions occurring on or after July 1, 1993, the medical assistance disproportionate
population adjustment shall comply with federal law and shall be paid to a hospital,
excluding regional treatment centers and facilities of the federal Indian Health Service,
with a medical assistance inpatient utilization rate in excess of the arithmetic mean. The
adjustment must be determined as follows:

(1) for a hospital with a medical assistance inpatient utilization rate above the
arithmetic mean for all hospitals excluding regional treatment centers and facilities of the
federal Indian Health Service but less than or equal to one standard deviation above the
mean, the adjustment must be determined by multiplying the total of the operating and
property payment rates by the difference between the hospital's actual medical assistance
inpatient utilization rate and the arithmetic mean for all hospitals excluding regional
treatment centers and facilities of the federal Indian Health Service; and

(2) for a hospital with a medical assistance inpatient utilization rate above one
standard deviation above the mean, the adjustment must be determined by multiplying
the adjustment that would be determined under clause (1) for that hospital by 1.1.
The commissioner may establish a separate disproportionate population payment rate
adjustment for critical access hospitals. The commissioner shall report annually on the
number of hospitals likely to receive the adjustment authorized by this paragraph. The
commissioner shall specifically report on the adjustments received by public hospitals and
public hospital corporations located in cities of the first class.

(b) Certified public expenditures made by Hennepin County Medical Center shall
be considered Medicaid disproportionate share hospital payments. Hennepin County
and Hennepin County Medical Center shall report by June 15, 2007, on payments made
beginning July 1, 2005, or another date specified by the commissioner, that may qualify
for reimbursement under federal law. Based on these reports, the commissioner shall
apply for federal matching funds.

(c) Upon federal approval of the related state plan amendment, paragraph (b) is
effective retroactively from July 1, 2005, or the earliest effective date approved by the
Centers for Medicare and Medicaid Services.

new text begin (d) Effective July 1, 2015, disproportionate share hospital (DSH) payments shall
be paid in accordance with a new methodology. Annual DSH payments made under
this paragraph shall equal the total amount of DSH payments made for 2012. The new
methodology shall take into account a variety of factors, including but not limited to:
new text end

new text begin (1) the medical assistance utilization rate of the hospitals that receive payments
under this subdivision;
new text end

new text begin (2) whether the hospital is located within Minnesota;
new text end

new text begin (3) the difference between a hospital's costs for treating medical assistance patients
and the total amount of payments received from medical assistance;
new text end

new text begin (4) the percentage of uninsured patient days at each qualifying hospital in relation
to the total number of uninsured patient days statewide;
new text end

new text begin (5) the hospital's status as a hospital authorized to make presumptive eligibility
determinations for medical assistance in accordance with section 256B.057, subdivision 12;
new text end

new text begin (6) the hospital's status as a safety net, critical access, children's, rehabilitation, or
long-term hospital;
new text end

new text begin (7) whether the hospital's administrative cost of compiling the necessary DSH
reports exceeds the anticipated value of any calculated DSH payment; and
new text end

new text begin (8) whether the hospital provides specific services designated by the commissioner
to be of particular importance to the medical assistance program.
new text end

new text begin (e) Any payments or portion of payments made to a hospital under this subdivision
that are subsequently returned to the commissioner because the payments are found to
exceed the hospital-specific DSH limit for that hospital shall be redistributed to other
DSH-eligible hospitals in a manner established by the commissioner.
new text end

Sec. 7.

Minnesota Statutes 2014, section 256B.056, subdivision 5c, is amended to read:

Subd. 5c.

Excess income standard.

(a) The excess income standard for parents
and caretaker relatives, pregnant women, infants, and children ages two through 20 is the
standard specified in subdivision 4, paragraph (b).

(b) The excess income standard for a person whose eligibility is based on blindness,
disability, or age of 65 or more years shall equal deleted text begin75 deleted text end new text begin 80 new text end percent of the federal poverty
guidelines.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2016.
new text end

Sec. 8.

Minnesota Statutes 2014, section 256B.0625, is amended by adding a
subdivision to read:

new text begin Subd. 9b. new text end

new text begin Dental services provided by faculty members and resident dentists
at a dental school. new text end

new text begin (a) A dentist who is not enrolled as a medical assistance provider,
is a faculty or adjunct member at the University of Minnesota or a resident dentist
licensed under section 150A.06, subdivision 1b, and is providing dental services at a
dental clinic owned or operated by the University of Minnesota, may be enrolled as a
medical assistance provider if the provider completes and submits to the commissioner an
agreement form developed by the commissioner. The agreement must specify that the
faculty or adjunct member or resident dentist:
new text end

new text begin (1) will not receive payment for the services provided to medical assistance or
MinnesotaCare enrollees performed at the dental clinics owned or operated by the
University of Minnesota;
new text end

new text begin (2) will not be listed in the medical assistance or MinnesotaCare provider directory;
and
new text end

new text begin (3) is not required to serve medical assistance and MinnesotaCare enrollees when
providing nonvolunteer services in a private practice.
new text end

new text begin (b) A dentist or resident dentist enrolled under this subdivision as a fee-for-service
provider shall not otherwise be enrolled in or receive payments from medical assistance or
MinnesotaCare as a fee-for-service provider.
new text end

Sec. 9.

Minnesota Statutes 2014, section 256B.0625, subdivision 13, is amended to read:

Subd. 13.

Drugs.

(a) Medical assistance covers drugs, except for fertility drugs
when specifically used to enhance fertility, if prescribed by a licensed practitioner and
dispensed by a licensed pharmacist, by a physician enrolled in the medical assistance
program as a dispensing physician, or by a physician, physician assistant, or a nurse
practitioner employed by or under contract with a community health board as defined in
section 145A.02, subdivision 5, for the purposes of communicable disease control.

(b) The dispensed quantity of a prescription drug must not exceed a 34-day supply,
unless authorized by the commissioner.

(c) For the purpose of this subdivision and subdivision 13d, an "active
pharmaceutical ingredient" is defined as a substance that is represented for use in a drug
and when used in the manufacturing, processing, or packaging of a drug becomes an
active ingredient of the drug product. An "excipient" is defined as an inert substance
used as a diluent or vehicle for a drug. The commissioner shall establish a list of active
pharmaceutical ingredients and excipients which are included in the medical assistance
formulary. Medical assistance covers selected active pharmaceutical ingredients and
excipients used in compounded prescriptions when the compounded combination is
specifically approved by the commissioner or when a commercially available product:

(1) is not a therapeutic option for the patient;

(2) does not exist in the same combination of active ingredients in the same strengths
as the compounded prescription; and

(3) cannot be used in place of the active pharmaceutical ingredient in the
compounded prescription.

(d) Medical assistance covers the following over-the-counter drugs when prescribed
by a licensed practitioner or by a licensed pharmacist who meets standards established by
the commissioner, in consultation with the board of pharmacy: antacids, acetaminophen,
family planning products, aspirin, insulin, products for the treatment of lice, vitamins for
adults with documented vitamin deficiencies, vitamins for children under the age of seven
and pregnant or nursing women, and any other over-the-counter drug identified by the
commissioner, in consultation with the formulary committee, as necessary, appropriate,
and cost-effective for the treatment of certain specified chronic diseases, conditions,
or disorders, and this determination shall not be subject to the requirements of chapter
14. A pharmacist may prescribe over-the-counter medications as provided under this
paragraph for purposes of receiving reimbursement under Medicaid. When prescribing
over-the-counter drugs under this paragraph, licensed pharmacists must consult with the
recipient to determine necessity, provide drug counseling, review drug therapy for potential
adverse interactions, and make referrals as needed to other health care professionals.
Over-the-counter medications must be dispensed in a quantity that is the deleted text beginlower deleted text end new text begin lowest new text end of:

(1) the number of dosage units contained in the manufacturer's original package; deleted text beginand deleted text end

(2) the number of dosage units required to complete the patient's course of therapy new text begin; or
new text end

new text begin (3) if applicable, the number of dosage units dispensed from a system using
retrospective billing, as provided under subdivision 13e, paragraph (b) new text end.

(e) Effective January 1, 2006, medical assistance shall not cover drugs that
are coverable under Medicare Part D as defined in the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003, Public Law 108-173, section 1860D-2(e),
for individuals eligible for drug coverage as defined in the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003, Public Law 108-173, section
1860D-1(a)(3)(A). For these individuals, medical assistance may cover drugs from the
drug classes listed in United States Code, title 42, section 1396r-8(d)(2), subject to this
subdivision and subdivisions 13a to 13g, except that drugs listed in United States Code,
title 42, section 1396r-8(d)(2)(E), shall not be covered.

(f) Medical assistance covers drugs acquired through the federal 340B Drug Pricing
Program and dispensed by 340B covered entities and ambulatory pharmacies under
common ownership of the 340B covered entity. Medical assistance does not cover drugs
acquired through the federal 340B Drug Pricing Program and dispensed by 340B contract
pharmacies.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2016, or upon federal
approval, whichever is later.
new text end

Sec. 10.

Minnesota Statutes 2014, section 256B.0625, subdivision 13e, is amended to
read:

Subd. 13e.

Payment rates.

(a) The basis for determining the amount of payment
shall be the lower of the actual acquisition costs of the drugs or the maximum allowable
cost by the commissioner plus the fixed dispensing fee; or the usual and customary price
charged to the public. The amount of payment basis must be reduced to reflect all discount
amounts applied to the charge by any provider/insurer agreement or contract for submitted
charges to medical assistance programs. The net submitted charge may not be greater
than the patient liability for the service. The pharmacy dispensing fee shall be $3.65
new text beginfor legend prescription drugs new text end, except that the dispensing fee for intravenous solutions
which must be compounded by the pharmacist shall be $8 per bag, $14 per bag for cancer
chemotherapy products, and $30 per bag for total parenteral nutritional products dispensed
in one liter quantities, or $44 per bag for total parenteral nutritional products dispensed in
quantities greater than one liter. new text beginThe pharmacy dispensing fee for over-the-counter drugs
shall be $3.65, except that the fee shall be $1.31 for retrospectively billing pharmacies
when billing for quantities less than the number of units contained in the manufacturer's
original package. new text endActual acquisition cost includes quantity and other special discounts
except time and cash discounts. The actual acquisition cost of a drug shall be estimated
by the commissioner at wholesale acquisition cost plus four percent for independently
owned pharmacies located in a designated rural area within Minnesota, and at wholesale
acquisition cost plus two percent for all other pharmacies. A pharmacy is "independently
owned" if it is one of four or fewer pharmacies under the same ownership nationally. A
"designated rural area" means an area defined as a small rural area or isolated rural area
according to the four-category classification of the Rural Urban Commuting Area system
developed for the United States Health Resources and Services Administration. Effective
January 1, 2014, the actual acquisition cost of a drug acquired through the federal 340B
Drug Pricing Program shall be estimated by the commissioner at wholesale acquisition
cost minus 40 percent. Wholesale acquisition cost is defined as the manufacturer's list
price for a drug or biological to wholesalers or direct purchasers in the United States, not
including prompt pay or other discounts, rebates, or reductions in price, for the most
recent month for which information is available, as reported in wholesale price guides or
other publications of drug or biological pricing data. The maximum allowable cost of a
multisource drug may be set by the commissioner and it shall be comparable to, but no
higher than, the maximum amount paid by other third-party payors in this state who have
maximum allowable cost programs. Establishment of the amount of payment for drugs
shall not be subject to the requirements of the Administrative Procedure Act.

(b) new text beginPharmacies dispensing prescriptions to residents of long-term care facilities
using an automated drug distribution system meeting the requirements of section 151.58,
or a packaging system meeting the packaging standards set forth in Minnesota Rules, part
6800.2700, that govern the return of unused drugs to the pharmacy for reuse, may employ
retrospective billing for prescriptions dispensed to long-term care facility residents. A
retrospectively billing pharmacy must submit a claim only for the quantity of medication
used by the enrolled recipient during the defined billing period. A retrospectively billing
pharmacy must use a billing period of not less than one calendar month or 30 days.
new text end

new text begin (c) new text endAn additional dispensing fee of $.30 may be added to the dispensing fee paid to
pharmacists for legend drug prescriptions dispensed to residents of long-term care facilities
when a unit dose blister card system, approved by the department, is used. Under this type
of dispensing system, the pharmacist must dispense a 30-day supply of drug. The National
Drug Code (NDC) from the drug container used to fill the blister card must be identified on
the claim to the department. The unit dose blister card containing the drug must meet the
packaging standards set forth in Minnesota Rules, part 6800.2700, that govern the return
of unused drugs to the pharmacy for reuse. deleted text beginThe deleted text end new text begin A new text end pharmacy provider new text beginusing packaging
that meets the standards set forth in Minnesota Rules, part 6800.2700, subpart 2, new text endwill be
required to credit the department for the actual acquisition cost of all unused drugs that are
eligible for reuse new text begin, unless the pharmacy is using retrospective billing new text end. The commissioner
may permit the drug clozapine to be dispensed in a quantity that is less than a 30-day supply.

deleted text begin (c) deleted text end new text begin (d) new text end Whenever a maximum allowable cost has been set for a multisource drug,
payment shall be the lower of the usual and customary price charged to the public or the
maximum allowable cost established by the commissioner unless prior authorization
for the brand name product has been granted according to the criteria established by
the Drug Formulary Committee as required by subdivision 13f, paragraph (a), and the
prescriber has indicated "dispense as written" on the prescription in a manner consistent
with section 151.21, subdivision 2.

deleted text begin (d) deleted text end new text begin (e) new text end The basis for determining the amount of payment for drugs administered in
an outpatient setting shall be the lower of the usual and customary cost submitted by
the provider, 106 percent of the average sales price as determined by the United States
Department of Health and Human Services pursuant to title XVIII, section 1847a of the
federal Social Security Act, the specialty pharmacy rate, or the maximum allowable cost
set by the commissioner. If average sales price is unavailable, the amount of payment
must be lower of the usual and customary cost submitted by the provider, the wholesale
acquisition cost, the specialty pharmacy rate, or the maximum allowable cost set by the
commissioner. Effective January 1, 2014, the commissioner shall discount the payment
rate for drugs obtained through the federal 340B Drug Pricing Program by 20 percent. The
payment for drugs administered in an outpatient setting shall be made to the administering
facility or practitioner. A retail or specialty pharmacy dispensing a drug for administration
in an outpatient setting is not eligible for direct reimbursement.

deleted text begin (e) deleted text end new text begin (f) new text end The commissioner may negotiate lower reimbursement rates for specialty
pharmacy products than the rates specified in paragraph (a). The commissioner may
require individuals enrolled in the health care programs administered by the department
to obtain specialty pharmacy products from providers with whom the commissioner has
negotiated lower reimbursement rates. Specialty pharmacy products are defined as those
used by a small number of recipients or recipients with complex and chronic diseases
that require expensive and challenging drug regimens. Examples of these conditions
include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis
C, growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms
of cancer. Specialty pharmaceutical products include injectable and infusion therapies,
biotechnology drugs, antihemophilic factor products, high-cost therapies, and therapies
that require complex care. The commissioner shall consult with the formulary committee
to develop a list of specialty pharmacy products subject to this paragraph. In consulting
with the formulary committee in developing this list, the commissioner shall take into
consideration the population served by specialty pharmacy products, the current delivery
system and standard of care in the state, and access to care issues. The commissioner shall
have the discretion to adjust the reimbursement rate to prevent access to care issues.

deleted text begin (f) deleted text end new text begin (g) new text end Home infusion therapy services provided by home infusion therapy
pharmacies must be paid at rates according to subdivision 8d.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2016, or upon federal
approval, whichever is later.
new text end

Sec. 11.

Minnesota Statutes 2014, section 256B.0625, subdivision 13h, is amended to
read:

Subd. 13h.

Medication therapy management services.

(a) Medical assistance deleted text beginand
deleted text end deleted text begingeneral assistance medical care cover deleted text end new text begin covers new text end medication therapy management services
for a recipient taking deleted text beginthree or more deleted text end prescriptions to treat or prevent one or more chronic
medical conditions deleted text begin; a recipient with a drug therapy problem that is identified by the
commissioner or identified by a pharmacist and approved by the commissioner; or prior
authorized by the commissioner that has resulted or is likely to result in significant
nondrug program costs. The commissioner may cover medical therapy management
services under MinnesotaCare if the commissioner determines this is cost-effective deleted text end. For
purposes of this subdivision, "medication therapy management" means the provision
of the following pharmaceutical care services by a licensed pharmacist to optimize the
therapeutic outcomes of the patient's medications:

(1) performing or obtaining necessary assessments of the patient's health status;

(2) formulating a medication treatment plan;

(3) monitoring and evaluating the patient's response to therapy, including safety
and effectiveness;

(4) performing a comprehensive medication review to identify, resolve, and prevent
medication-related problems, including adverse drug events;

(5) documenting the care delivered and communicating essential information to
the patient's other primary care providers;

(6) providing verbal education and training designed to enhance patient
understanding and appropriate use of the patient's medications;

(7) providing information, support services, and resources designed to enhance
patient adherence with the patient's therapeutic regimens; and

(8) coordinating and integrating medication therapy management services within the
broader health care management services being provided to the patient.

Nothing in this subdivision shall be construed to expand or modify the scope of practice of
the pharmacist as defined in section 151.01, subdivision 27.

(b) To be eligible for reimbursement for services under this subdivision, a pharmacist
must meet the following requirements:

(1) have a valid license issued by the Board of Pharmacy of the state in which the
medication therapy management service is being performed;

(2) have graduated from an accredited college of pharmacy on or after May 1996, or
completed a structured and comprehensive education program approved by the Board of
Pharmacy and the American Council of Pharmaceutical Education for the provision and
documentation of pharmaceutical care management services that has both clinical and
didactic elements;

(3) be practicing in an ambulatory care setting as part of a multidisciplinary team or
have developed a structured patient care process that is offered in a private or semiprivate
patient care area that is separate from the commercial business that also occurs in the
setting, or in home settings, including long-term care settings, group homes, and facilities
providing assisted living services, but excluding skilled nursing facilities; and

(4) make use of an electronic patient record system that meets state standards.

(c) For purposes of reimbursement for medication therapy management services,
the commissioner may enroll individual pharmacists as medical assistance deleted text beginand general
assistance medical care deleted text end providers. The commissioner may also establish contact
requirements between the pharmacist and recipient, including limiting the number of
reimbursable consultations per recipient.

(d) If there are no pharmacists who meet the requirements of paragraph (b) practicing
within a reasonable geographic distance of the patient, a pharmacist who meets the
requirements may provide the services via two-way interactive video. Reimbursement
shall be at the same rates and under the same conditions that would otherwise apply to
the services provided. To qualify for reimbursement under this paragraph, the pharmacist
providing the services must meet the requirements of paragraph (b), and must be
located within an ambulatory care setting deleted text beginapproved by the commissioner deleted text end new text begin that meets the
requirements of paragraph (b), clause (3) new text end. The patient must also be located within an
ambulatory care setting deleted text beginapproved by the commissioner deleted text end new text begin that meets the requirements of
paragraph (b), clause (3) new text end. Services provided under this paragraph may not be transmitted
into the patient's residence.

deleted text begin (e) The commissioner shall establish a pilot project for an intensive medication
therapy management program for patients identified by the commissioner with multiple
chronic conditions and a high number of medications who are at high risk of preventable
hospitalizations, emergency room use, medication complications, and suboptimal
treatment outcomes due to medication-related problems. For purposes of the pilot
project, medication therapy management services may be provided in a patient's home
or community setting, in addition to other authorized settings. The commissioner may
waive existing payment policies and establish special payment rates for the pilot project.
The pilot project must be designed to produce a net savings to the state compared to the
estimated costs that would otherwise be incurred for similar patients without the program.
The pilot project must begin by January 1, 2010, and end June 30, 2012.
deleted text end

new text begin (e) Medication therapy management services may be delivered into a patient's
residence via secure interactive video if the medication therapy management services
are performed electronically during a covered home care visit by an enrolled provider.
Reimbursement shall be at the same rates and under the same conditions that would
otherwise apply to the services provided. To qualify for reimbursement under this
paragraph, the pharmacist providing the services must meet the requirements of paragraph
(b) and must be located within an ambulatory care setting that meets the requirements of
paragraph (b), clause (3).
new text end

Sec. 12.

Minnesota Statutes 2014, section 256B.0625, subdivision 17, is amended to
read:

Subd. 17.

Transportation costs.

(a) "Nonemergency medical transportation
service" means motor vehicle transportation provided by a public or private person
that serves Minnesota health care program beneficiaries who do not require emergency
ambulance service, as defined in section 144E.001, subdivision 3, to obtain covered
medical services. Nonemergency medical transportation service includes, but is not
limited to, special transportation service, defined in section 174.29, subdivision 1.

(b) Medical assistance covers medical transportation costs incurred solely for
obtaining emergency medical care or transportation costs incurred by eligible persons in
obtaining emergency or nonemergency medical care when paid directly to an ambulance
company, common carrier, or other recognized providers of transportation services.
Medical transportation must be provided by:

(1) nonemergency medical transportation providers who meet the requirements
of this subdivision;

(2) ambulances, as defined in section 144E.001, subdivision 2;

(3) taxicabs and public transit, as defined in section 174.22, subdivision 7; or

(4) not-for-hire vehicles, including volunteer drivers.

(c) Medical assistance covers nonemergency medical transportation provided by
nonemergency medical transportation providers enrolled in the Minnesota health care
programs. All nonemergency medical transportation providers must comply with the
operating standards for special transportation service as defined in sections 174.29 to
174.30 and Minnesota Rules, chapter 8840, and in consultation with the Minnesota
Department of Transportation. All nonemergency medical transportation providers shall
bill for nonemergency medical transportation services in accordance with Minnesota
health care programs criteria. Publicly operated transit systems, volunteers, and
not-for-hire vehicles are exempt from the requirements outlined in this paragraph.

(d) The administrative agency of nonemergency medical transportation must:

(1) adhere to the policies defined by the commissioner in consultation with the
Nonemergency Medical Transportation Advisory Committee;

(2) pay nonemergency medical transportation providers for services provided to
Minnesota health care programs beneficiaries to obtain covered medical services;

(3) provide data monthly to the commissioner on appeals, complaints, no-shows,
canceled trips, and number of trips by mode; and

(4) by July 1, 2016, in accordance with subdivision 18e, utilize a Web-based single
administrative structure assessment tool that meets the technical requirements established
by the commissioner, reconciles trip information with claims being submitted by
providers, and ensures prompt payment for nonemergency medical transportation services.

(e) Until the commissioner implements the single administrative structure and
delivery system under subdivision 18e, clients shall obtain their level-of-service certificate
from the commissioner or an entity approved by the commissioner that does not dispatch
rides for clients using modes under paragraph (h), clauses (4), (5), (6), and (7).

(f) The commissioner may use an order by the recipient's attending physician or a
medical or mental health professional to certify that the recipient requires nonemergency
medical transportation services. Nonemergency medical transportation providers shall
perform driver-assisted services for eligible individuals, when appropriate. Driver-assisted
service includes passenger pickup at and return to the individual's residence or place of
business, assistance with admittance of the individual to the medical facility, and assistance
in passenger securement or in securing of wheelchairs or stretchers in the vehicle.
Nonemergency medical transportation providers must have trip logs, which include pickup
and drop-off times, signed by the medical provider or client attesting mileage traveled to
obtain covered medical services, whichever is deemed most appropriate. Nonemergency
medical transportation providers may not bill for separate base rates for the continuation
of a trip beyond the original destination. Nonemergency medical transportation providers
must take clients to the health care provider, using the most direct route, and must not
exceed 30 miles for a trip to a primary care provider or 60 miles for a trip to a specialty
care provider, unless the client receives authorization from the local agency. The minimum
medical assistance reimbursement rates for special transportation services are:

(1)(i) $17 for the base rate and $1.35 per mile for special transportation services to
eligible persons who need a wheelchair-accessible van;

(ii) $11.50 for the base rate and $1.30 per mile for special transportation services to
eligible persons who do not need a wheelchair-accessible van; and

(iii) $60 for the base rate and $2.40 per mile, and an attendant rate of $9 per trip,
for special transportation services to eligible persons who need a stretcher-accessible
vehicle; and

(2) clients requesting client mileage reimbursement must sign the trip log attesting
mileage traveled to obtain covered medical services.

(g) The covered modes of nonemergency medical transportation include
transportation provided directly by clients or family members of clients with their own
transportation, volunteers using their own vehicles, taxicabs, and public transit, or
provided to a client who needs a stretcher-accessible vehicle, a lift/ramp equipped vehicle,
or a vehicle that is not stretcher-accessible or lift/ramp equipped designed to transport ten
or fewer persons. Upon implementation of a new rate structure, a new covered mode of
nonemergency medical transportation shall include transportation provided to a client who
needs a protected vehicle that is not an ambulance or police car and has safety locks, a
video recorder, and a transparent thermoplastic partition between the passenger and the
vehicle driver.

(h) The administrative agency shall use the level of service process established by the
commissioner in consultation with the Nonemergency Medical Transportation Advisory
Committee to determine the client's most appropriate mode of transportation. If public
transit or a certified transportation provider is not available to provide the appropriate
service mode for the client, the client may receive a onetime service upgrade. The new
modes of transportation, which may not be implemented without a new rate structure, are:

(1) client reimbursement, which includes client mileage reimbursement provided
to clients who have their own transportation or family who provides transportation to
the client;

(2) volunteer transport, which includes transportation by volunteers using their
own vehicle;

(3) unassisted transport, which includes transportation provided to a client by a
taxicab or public transit. If a taxicab or publicly operated transit system is not available,
the client can receive transportation from another nonemergency medical transportation
provider;

(4) assisted transport, which includes transport provided to clients who require
assistance by a nonemergency medical transportation provider;

(5) lift-equipped/ramp transport, which includes transport provided to a client who
is dependent on a device and requires a nonemergency medical transportation provider
with a vehicle containing a lift or ramp;

(6) protected transport, which includes transport to a client who has received a
prescreening that has deemed other forms of transportation inappropriate and who requires
a provider certified as a protected transport provider; and

(7) stretcher transport, which includes transport for a client in a prone or supine
position and requires a nonemergency medical transportation provider with a vehicle that
can transport a client in a prone or supine position.

(i) deleted text beginIn accordance with subdivision 18e, by July 1, 2016, deleted text end The local agency shall be
the single administrative agency and shall administer and reimburse for modes defined in
paragraph (h) according to a new rate structure, deleted text beginonce this is adopted deleted text end new text begin when the commissioner
has developed, made available, and funded the Web-based single administrative structure,
assessment tool, and level of need assessment under subdivision 18e new text end. new text begin The local agency's
financial obligation is limited to funds provided by the state or the federal government.
new text end

(j) The commissioner shall:

(1) in consultation with the Nonemergency Medical Transportation Advisory
Committee, verify that the mode and use of nonemergency medical transportation is
appropriate;

(2) verify that the client is going to an approved medical appointment; and

(3) investigate all complaints and appeals.

(k) The administrative agency shall pay for the services provided in this subdivision
and seek reimbursement from the commissioner, if appropriate. As vendors of medical
care, local agencies are subject to the provisions in section 256B.041, the sanctions and
monetary recovery actions in section 256B.064, and Minnesota Rules, parts 9505.2160
to 9505.2245.

(l) The base rates for special transportation services in areas defined under RUCA to
be super rural shall be equal to the reimbursement rate established in paragraph (f), clause
(1), plus 11.3 percent, and for special transportation services in areas defined under RUCA
to be rural or super rural areas:

(1) for a trip equal to 17 miles or less, mileage reimbursement shall be equal to 125
percent of the respective mileage rate in paragraph (f), clause (1); and

(2) for a trip between 18 and 50 miles, mileage reimbursement shall be equal to
112.5 percent of the respective mileage rate in paragraph (f), clause (1).

(m) For purposes of reimbursement rates for special transportation services under
paragraph (c), the zip code of the recipient's place of residence shall determine whether
the urban, rural, or super rural reimbursement rate applies.

(n) For purposes of this subdivision, "rural urban commuting area" or "RUCA"
means a census-tract based classification system under which a geographical area is
determined to be urban, rural, or super rural.

(o) Effective for services provided on or after September 1, 2011, nonemergency
transportation rates, including special transportation, taxi, and other commercial carriers,
are reduced 4.5 percent. Payments made to managed care plans and county-based
purchasing plans must be reduced for services provided on or after January 1, 2012,
to reflect this reduction.

Sec. 13.

Minnesota Statutes 2014, section 256B.0625, subdivision 28a, is amended to
read:

Subd. 28a.

Licensed physician assistant services.

(a) Medical assistance covers
services performed by a licensed physician assistant if the service is otherwise covered
under this chapter as a physician service and if the service is within the scope of practice
of a licensed physician assistant as defined in section 147A.09.

(b) Licensed physician assistants, who are supervised by a physician certified by
the American Board of Psychiatry and Neurology or eligible for board certification in
psychiatry, may bill for medication management and evaluation and management services
provided to medical assistance enrollees in inpatient hospital settings new text begin, and in outpatient
settings after the licensed physician assistant completes 2,000 hours of clinical experience
in the evaluation and treatment of mental health new text end, consistent with their authorized scope of
practice, as defined in section 147A.09, with the exception of performing psychotherapy
or diagnostic assessments or providing clinical supervision.

Sec. 14.

Minnesota Statutes 2014, section 256B.0625, subdivision 31, is amended to
read:

Subd. 31.

Medical supplies and equipment.

(a) Medical assistance covers medical
supplies and equipment. Separate payment outside of the facility's payment rate shall
be made for wheelchairs and wheelchair accessories for recipients who are residents
of intermediate care facilities for the developmentally disabled. Reimbursement for
wheelchairs and wheelchair accessories for ICF/DD recipients shall be subject to the same
conditions and limitations as coverage for recipients who do not reside in institutions. A
wheelchair purchased outside of the facility's payment rate is the property of the recipient.
deleted text beginThe commissioner may set reimbursement rates for specified categories of medical
supplies at levels below the Medicare payment rate.
deleted text end

(b) Vendors of durable medical equipment, prosthetics, orthotics, or medical supplies
must enroll as a Medicare provider.

(c) When necessary to ensure access to durable medical equipment, prosthetics,
orthotics, or medical supplies, the commissioner may exempt a vendor from the Medicare
enrollment requirement if:

(1) the vendor supplies only one type of durable medical equipment, prosthetic,
orthotic, or medical supply;

(2) the vendor serves ten or fewer medical assistance recipients per year;

(3) the commissioner finds that other vendors are not available to provide same or
similar durable medical equipment, prosthetics, orthotics, or medical supplies; and

(4) the vendor complies with all screening requirements in this chapter and Code of
Federal Regulations, title 42, part 455. The commissioner may also exempt a vendor from
the Medicare enrollment requirement if the vendor is accredited by a Centers for Medicare
and Medicaid Services approved national accreditation organization as complying with
the Medicare program's supplier and quality standards and the vendor serves primarily
pediatric patients.

(d) Durable medical equipment means a device or equipment that:

(1) can withstand repeated use;

(2) is generally not useful in the absence of an illness, injury, or disability; and

(3) is provided to correct or accommodate a physiological disorder or physical
condition or is generally used primarily for a medical purpose.

(e) Electronic tablets may be considered durable medical equipment if the electronic
tablet will be used as an augmentative and alternative communication system as defined
under subdivision 31a, paragraph (a). To be covered by medical assistance, the device
must be locked in order to prevent use not related to communication.

Sec. 15.

Minnesota Statutes 2014, section 256B.0625, subdivision 58, is amended to
read:

Subd. 58.

Early and periodic screening, diagnosis, and treatment services.

Medical assistance covers early and periodic screening, diagnosis, and treatment services
(EPSDT). The payment amount for a complete EPSDT screening shall not include charges
for deleted text beginvaccines deleted text end new text begin health care services and products new text end that are available at no cost to the provider
and shall not exceed the rate established per Minnesota Rules, part 9505.0445, item M,
effective October 1, 2010.

Sec. 16.

Minnesota Statutes 2014, section 256B.0631, is amended to read:

256B.0631 MEDICAL ASSISTANCE CO-PAYMENTS.

Subdivision 1.

Cost-sharing.

(a) Except as provided in subdivision 2, the medical
assistance benefit plan shall include the following cost-sharing for all recipients, effective
for services provided on or after September 1, 2011:

(1) $3 per nonpreventive visit, except as provided in paragraph (b). For purposes
of this subdivision, a visit means an episode of service which is required because of
a recipient's symptoms, diagnosis, or established illness, and which is delivered in an
ambulatory setting by a physician or physician ancillary, chiropractor, podiatrist, nurse
midwife, advanced practice nurse, audiologist, optician, or optometrist;

(2) $3.50 for nonemergency visits to a hospital-based emergency room, except that
this co-payment shall be increased to $20 upon federal approval;

(3) $3 per brand-name drug prescription and $1 per generic drug prescription,
subject to a $12 per month maximum for prescription drug co-payments. No co-payments
shall apply to antipsychotic drugs when used for the treatment of mental illness;

(4) deleted text begineffective January 1, 2012, deleted text end a family deductible equal to deleted text beginthe maximum amount
allowed under Code of Federal Regulations, title 42, part 447.54 deleted text end new text begin $2.75 per month per
family and adjusted annually by the percentage increase in the medical care component
of the CPI-U for the period of September to September of the preceding calendar year,
rounded to the next higher five-cent increment new text end; and

(5) deleted text beginfor individuals identified by the commissioner with income at or below 100
percent of the federal poverty guidelines, deleted text end total monthly cost-sharing must not exceed five
percent of family income. For purposes of this paragraph, family income is the total
earned and unearned income of the individual and the individual's spouse, if the spouse is
enrolled in medical assistance and also subject to the five percent limit on cost-sharing.
new text beginThis paragraph does not apply to premiums charged to individuals described under section
256B.057, subdivision 9.
new text end

(b) Recipients of medical assistance are responsible for all co-payments and
deductibles in this subdivision.

(c) Notwithstanding paragraph (b), the commissioner, through the contracting
process under sections 256B.69 and 256B.692, may allow managed care plans and
county-based purchasing plans to waive the family deductible under paragraph (a),
clause (4). The value of the family deductible shall not be included in the capitation
payment to managed care plans and county-based purchasing plans. Managed care plans
and county-based purchasing plans shall certify annually to the commissioner the dollar
value of the family deductible.

(d) Notwithstanding paragraph (b), the commissioner may waive the collection of
the family deductible described under paragraph (a), clause (4), from individuals and
allow long-term care and waivered service providers to assume responsibility for payment.

(e) Notwithstanding paragraph (b), the commissioner, through the contracting
process under section 256B.0756 shall allow the pilot program in Hennepin County to
waive co-payments. The value of the co-payments shall not be included in the capitation
payment amount to the integrated health care delivery networks under the pilot program.

Subd. 2.

Exceptions.

Co-payments and deductibles shall be subject to the following
exceptions:

(1) children under the age of 21;

(2) pregnant women for services that relate to the pregnancy or any other medical
condition that may complicate the pregnancy;

(3) recipients expected to reside for at least 30 days in a hospital, nursing home, or
intermediate care facility for the developmentally disabled;

(4) recipients receiving hospice care;

(5) 100 percent federally funded services provided by an Indian health service;

(6) emergency services;

(7) family planning services;

(8) services that are paid by Medicare, resulting in the medical assistance program
paying for the coinsurance and deductible;

(9) co-payments that exceed one per day per provider for nonpreventive visits,
eyeglasses, and nonemergency visits to a hospital-based emergency room; deleted text beginand
deleted text end

(10) services, fee-for-service payments subject to volume purchase through
competitive bidding deleted text begin. deleted text end new text begin;
new text end

new text begin (11) American Indians who meet the requirements in Code of Federal Regulations,
title 42, section 447.51;
new text end

new text begin (12) persons needing treatment for breast or cervical cancer as described under
section 256B.057, subdivision 10; and
new text end

new text begin (13) services that currently have a rating of A or B from the United States Preventive
Services Task Force (USPSTF), immunizations recommended by the Advisory Committee
on Immunization Practices of the Centers for Disease Control and Prevention, and
preventive services and screenings provided to women as described in Code of Federal
Regulations, title 45, section 147.130.
new text end

Subd. 3.

Collection.

(a) The medical assistance reimbursement to the provider shall
be reduced by the amount of the co-payment or deductible, except that reimbursements
shall not be reduced:

(1) once a recipient has reached the $12 per month maximum for prescription drug
co-payments; or

(2) for a recipient deleted text beginidentified by the commissioner under 100 percent of the federal
poverty guidelines deleted text end who has met their monthly five percent cost-sharing limit.

(b) The provider collects the co-payment or deductible from the recipient. Providers
may not deny services to recipients who are unable to pay the co-payment or deductible.

(c) Medical assistance reimbursement to fee-for-service providers and payments to
managed care plans shall not be increased as a result of the removal of co-payments or
deductibles effective on or after January 1, 2009.

new text begin EFFECTIVE DATE. new text end

new text begin The amendment to subdivision 1, paragraph (a), clause (4), is
effective retroactively from January 1, 2014.
new text end

Sec. 17.

Minnesota Statutes 2014, section 256B.0644, is amended to read:

256B.0644 REIMBURSEMENT UNDER OTHER STATE HEALTH CARE
PROGRAMS.

(a) A vendor of medical care, as defined in section 256B.02, subdivision 7, and a
health maintenance organization, as defined in chapter 62D, must participate as a provider
or contractor in the medical assistance program and MinnesotaCare as a condition of
participating as a provider in health insurance plans and programs or contractor for state
employees established under section 43A.18, the public employees insurance program
under section 43A.316, for health insurance plans offered to local statutory or home
rule charter city, county, and school district employees, the workers' compensation
system under section 176.135, and insurance plans provided through the Minnesota
Comprehensive Health Association under sections 62E.01 to 62E.19. The limitations
on insurance plans offered to local government employees shall not be applicable in
geographic areas where provider participation is limited by managed care contracts
with the Department of Human Services. new text begin This section does not apply to dental service
providers providing dental services outside the seven-county metropolitan area.
new text end

(b) For providers other than health maintenance organizations, participation in the
medical assistance program means that:

(1) the provider accepts new medical assistance and MinnesotaCare patients;

(2) for providers other than dental service providers, at least 20 percent of the
provider's patients are covered by medical assistance and MinnesotaCare as their primary
source of coverage; or

(3) for dental service providers new text begin providing dental services in the seven-county
metropolitan area new text end, at least ten percent of the provider's patients are covered by medical
assistance and MinnesotaCare as their primary source of coverage, or the provider accepts
new medical assistance and MinnesotaCare patients who are children with special health
care needs. For purposes of this section, "children with special health care needs" means
children up to age 18 who: (i) require health and related services beyond that required
by children generally; and (ii) have or are at risk for a chronic physical, developmental,
behavioral, or emotional condition, including: bleeding and coagulation disorders;
immunodeficiency disorders; cancer; endocrinopathy; developmental disabilities;
epilepsy, cerebral palsy, and other neurological diseases; visual impairment or deafness;
Down syndrome and other genetic disorders; autism; fetal alcohol syndrome; and other
conditions designated by the commissioner after consultation with representatives of
pediatric dental providers and consumers.

(c) Patients seen on a volunteer basis by the provider at a location other than
the provider's usual place of practice may be considered in meeting the participation
requirement in this section. The commissioner shall establish participation requirements
for health maintenance organizations. The commissioner shall provide lists of participating
medical assistance providers on a quarterly basis to the commissioner of management and
budget, the commissioner of labor and industry, and the commissioner of commerce. Each
of the commissioners shall develop and implement procedures to exclude as participating
providers in the program or programs under their jurisdiction those providers who do
not participate in the medical assistance program. The commissioner of management
and budget shall implement this section through contracts with participating health and
dental carriers.

(d) A volunteer dentist who has signed a volunteer agreement under section
256B.0625, subdivision 9a, shall not be considered to be participating in medical
assistance or MinnesotaCare for the purpose of this section.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon receipt of any necessary federal
waiver or approval. The commissioner of human services shall notify the revisor of
statutes if a federal waiver or approval is sought and, if sought, when a federal waiver
or approval is obtained.
new text end

Sec. 18.

new text begin [256B.0758] HEALTH CARE DELIVERY PILOT PROGRAM.
new text end

new text begin (a) The commissioner may establish a health care delivery pilot program to test
alternative and innovative integrated health care delivery networks, including accountable
care organizations or a community-based collaborative care network created by or
including North Memorial Health Care. If required, the commissioner shall seek federal
approval of a new waiver request or amend an existing demonstration pilot project waiver.
new text end

new text begin (b) Individuals eligible for the pilot program shall be individuals who are eligible for
medical assistance under section 256B.055. The commissioner may identify individuals
to be enrolled in the pilot program based on zip code or whether the individuals would
benefit from an integrated health care delivery network.
new text end

new text begin (c) In developing a payment system for the pilot programs, the commissioner shall
establish a total cost of care for the individuals enrolled in the pilot program that equals
the cost of care that would otherwise be spent for these enrollees in the prepaid medical
assistance program.
new text end

Sec. 19.

Minnesota Statutes 2014, section 256B.69, subdivision 5a, is amended to read:

Subd. 5a.

Managed care contracts.

(a) Managed care contracts under this section
and section 256L.12 shall be entered into or renewed on a calendar year basis. The
commissioner may issue separate contracts with requirements specific to services to
medical assistance recipients age 65 and older.

(b) A prepaid health plan providing covered health services for eligible persons
pursuant to chapters 256B and 256L is responsible for complying with the terms of its
contract with the commissioner. Requirements applicable to managed care programs
under chapters 256B and 256L established after the effective date of a contract with the
commissioner take effect when the contract is next issued or renewed.

(c) The commissioner shall withhold five percent of managed care plan payments
under this section and county-based purchasing plan payments under section 256B.692
for the prepaid medical assistance program pending completion of performance targets.
Each performance target must be quantifiable, objective, measurable, and reasonably
attainable, except in the case of a performance target based on a federal or state law
or rule. Criteria for assessment of each performance target must be outlined in writing
prior to the contract effective date. Clinical or utilization performance targets and their
related criteria must consider evidence-based research and reasonable interventions when
available or applicable to the populations served, and must be developed with input from
external clinical experts and stakeholders, including managed care plans, county-based
purchasing plans, and providers. The managed care or county-based purchasing plan
must demonstrate, to the commissioner's satisfaction, that the data submitted regarding
attainment of the performance target is accurate. The commissioner shall periodically
change the administrative measures used as performance targets in order to improve plan
performance across a broader range of administrative services. The performance targets
must include measurement of plan efforts to contain spending on health care services and
administrative activities. The commissioner may adopt plan-specific performance targets
that take into account factors affecting only one plan, including characteristics of the
plan's enrollee population. The withheld funds must be returned no sooner than July of the
following year if performance targets in the contract are achieved. The commissioner may
exclude special demonstration projects under subdivision 23.

(d) The commissioner shall require that managed care plans use the assessment and
authorization processes, forms, timelines, standards, documentation, and data reporting
requirements, protocols, billing processes, and policies consistent with medical assistance
fee-for-service or the Department of Human Services contract requirements consistent
with medical assistance fee-for-service or the Department of Human Services contract
requirements for all personal care assistance services under section 256B.0659.

(e) Effective for services rendered on or after January 1, 2012, the commissioner
shall include as part of the performance targets described in paragraph (c) a reduction
in the health plan's emergency department utilization rate for medical assistance and
MinnesotaCare enrollees, as determined by the commissioner. For 2012, the reduction
shall be based on the health plan's utilization in 2009. To earn the return of the withhold
each subsequent year, the managed care plan or county-based purchasing plan must
achieve a qualifying reduction of no less than ten percent of the plan's emergency
department utilization rate for medical assistance and MinnesotaCare enrollees, excluding
enrollees in programs described in subdivisions 23 and 28, compared to the previous
measurement year until the final performance target is reached. When measuring
performance, the commissioner must consider the difference in health risk in a managed
care or county-based purchasing plan's membership in the baseline year compared to the
measurement year, and work with the managed care or county-based purchasing plan to
account for differences that they agree are significant.

The withheld funds must be returned no sooner than July 1 and no later than July 31
of the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a reduction in the utilization rate
was achieved. The commissioner shall structure the withhold so that the commissioner
returns a portion of the withheld funds in amounts commensurate with achieved reductions
in utilization less than the targeted amount.

The withhold described in this paragraph shall continue for each consecutive contract
period until the plan's emergency room utilization rate for state health care program
enrollees is reduced by 25 percent of the plan's emergency room utilization rate for medical
assistance and MinnesotaCare enrollees for calendar year 2009. Hospitals shall cooperate
with the health plans in meeting this performance target and shall accept payment
withholds that may be returned to the hospitals if the performance target is achieved.

(f) Effective for services rendered on or after January 1, 2012, the commissioner
shall include as part of the performance targets described in paragraph (c) a reduction
in the plan's hospitalization admission rate for medical assistance and MinnesotaCare
enrollees, as determined by the commissioner. To earn the return of the withhold each
year, the managed care plan or county-based purchasing plan must achieve a qualifying
reduction of no less than five percent of the plan's hospital admission rate for medical
assistance and MinnesotaCare enrollees, excluding enrollees in programs described in
subdivisions 23 and 28, compared to the previous calendar year until the final performance
target is reached. When measuring performance, the commissioner must consider the
difference in health risk in a managed care or county-based purchasing plan's membership
in the baseline year compared to the measurement year, and work with the managed care
or county-based purchasing plan to account for differences that they agree are significant.

The withheld funds must be returned no sooner than July 1 and no later than July
31 of the following calendar year if the managed care plan or county-based purchasing
plan demonstrates to the satisfaction of the commissioner that this reduction in the
hospitalization rate was achieved. The commissioner shall structure the withhold so that
the commissioner returns a portion of the withheld funds in amounts commensurate with
achieved reductions in utilization less than the targeted amount.

The withhold described in this paragraph shall continue until there is a 25 percent
reduction in the hospital admission rate compared to the hospital admission rates in
calendar year 2011, as determined by the commissioner. The hospital admissions in this
performance target do not include the admissions applicable to the subsequent hospital
admission performance target under paragraph (g). Hospitals shall cooperate with the
plans in meeting this performance target and shall accept payment withholds that may be
returned to the hospitals if the performance target is achieved.

(g) Effective for services rendered on or after January 1, 2012, the commissioner
shall include as part of the performance targets described in paragraph (c) a reduction in
the plan's hospitalization admission rates for subsequent hospitalizations within 30 days of
a previous hospitalization of a patient regardless of the reason, for medical assistance and
MinnesotaCare enrollees, as determined by the commissioner. To earn the return of the
withhold each year, the managed care plan or county-based purchasing plan must achieve
a qualifying reduction of the subsequent hospitalization rate for medical assistance and
MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23
and 28, of no less than five percent compared to the previous calendar year until the
final performance target is reached.

The withheld funds must be returned no sooner than July 1 and no later than July
31 of the following calendar year if the managed care plan or county-based purchasing
plan demonstrates to the satisfaction of the commissioner that a qualifying reduction in
the subsequent hospitalization rate was achieved. The commissioner shall structure the
withhold so that the commissioner returns a portion of the withheld funds in amounts
commensurate with achieved reductions in utilization less than the targeted amount.

The withhold described in this paragraph must continue for each consecutive
contract period until the plan's subsequent hospitalization rate for medical assistance and
MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23
and 28, is reduced by 25 percent of the plan's subsequent hospitalization rate for calendar
year 2011. Hospitals shall cooperate with the plans in meeting this performance target and
shall accept payment withholds that must be returned to the hospitals if the performance
target is achieved.

(h) Effective for services rendered on or after January 1, 2013, through December
31, 2013, the commissioner shall withhold 4.5 percent of managed care plan payments
under this section and county-based purchasing plan payments under section 256B.692
for the prepaid medical assistance program. The withheld funds must be returned no
sooner than July 1 and no later than July 31 of the following year. The commissioner may
exclude special demonstration projects under subdivision 23.

(i) Effective for services rendered on or after January 1, 2014, the commissioner
shall withhold three percent of managed care plan payments under this section and
county-based purchasing plan payments under section 256B.692 for the prepaid medical
assistance program. The withheld funds must be returned no sooner than July 1 and
no later than July 31 of the following year. The commissioner may exclude special
demonstration projects under subdivision 23.

(j) A managed care plan or a county-based purchasing plan under section 256B.692
may include as admitted assets under section 62D.044 any amount withheld under this
section that is reasonably expected to be returned.

(k) Contracts between the commissioner and a prepaid health plan are exempt from
the set-aside and preference provisions of section 16C.16, subdivisions 6, paragraph
(a), and 7.

(l) The return of the withhold under paragraphs (h) and (i) is not subject to the
requirements of paragraph (c).

new text begin (m) Managed care plans and county-based purchasing plans shall maintain current
and fully executed agreements for all subcontractors, including bargaining groups, for
administrative services that are expensed to the state's public programs. Subcontractor
agreements of over $200,000 in annual payments must be in the form of a written
instrument or electronic document containing the elements of offer, acceptance, and
consideration, and must clearly indicate how the agreements relate to state public
programs. Upon request, the commissioner shall have access to all subcontractor
documentation under this paragraph. Nothing in this paragraph shall allow release of
information that is nonpublic data pursuant to section 13.02.
new text end

Sec. 20.

Minnesota Statutes 2014, section 256B.69, subdivision 5i, is amended to read:

Subd. 5i.

Administrative expenses.

(a) deleted text beginManaged care plan and county-based
purchasing plan deleted text end Administrative costs deleted text beginfor a prepaid health plan provided deleted text end new text begin paid to managed
care plans and county-based purchasing plans new text end under this section deleted text beginor deleted text end new text begin, new text end section 256B.692 new text begin, and
section 256L.12 new text end must not exceed deleted text beginby more than five deleted text end new text begin 6.6 new text end percent deleted text beginthat prepaid health plan's or
county-based purchasing plan's actual calculated administrative spending for the previous
calendar year as a percentage of total revenue deleted text end new text begin of total payments expected to be made to
all managed care plans and county-based purchasing plans in aggregate across all state
public programs at the beginning of each calendar year new text end. deleted text beginThe penalty for exceeding this
limit must be the amount of administrative spending in excess of 105 percent of the actual
calculated amount. The commissioner may waive this penalty if the excess administrative
spending is the result of unexpected shifts in enrollment or member needs or new program
requirements. deleted text end new text begin The commissioner may reduce or eliminate administrative requirements to
meet the administrative cost limit. For purposes of this paragraph, administrative costs do
not include any state or federal taxes, surcharges, or assessments.
new text end

(b) The following expenses are not allowable administrative expenses for rate-setting
purposes under this section:

(1) charitable contributions made by the managed care plan or the county-based
purchasing plan;

(2) deleted text beginany portion of an individual's compensation in excess of $200,000 paid by the
managed care plan or county-based purchasing plan deleted text end new text begin compensation of individuals within
the organization, other than the medical director, in excess of $200,000 such that the
allocation of compensation for an individual across all state public programs in total
cannot exceed $200,000 new text end;

(3) any penalties or fines assessed against the managed care plan or county-based
purchasing plan; deleted text beginand
deleted text end

(4) any indirect marketing or advertising expenses of the managed care plan or
county-based purchasing plan deleted text begin. deleted text end new text begin for marketing that does not specifically target state public
programs beneficiaries and that has not been approved by the commissioner;
new text end

new text begin (5) any lobbying and political activities, events, or contributions;
new text end

new text begin (6) administrative expenses related to the provision of services not covered under
the state plan or waiver;
new text end

new text begin (7) alcoholic beverages and related costs;
new text end

new text begin (8) membership in any social, dining, or country club or organization; and
new text end

new text begin (9) entertainment, including amusement, diversion, and social activities, and any
costs directly associated with these costs, including but not limited to tickets to shows or
sporting events, meals, lodging, rentals, transportation, and gratuities.
new text end

For the purposes of this subdivision, compensation includes salaries, bonuses and
incentives, other reportable compensation on an IRS 990 form, retirement and other
deferred compensation, and nontaxable benefits. new text begin Contributions include payments for
or to any organization or entity selected by the health maintenance organization that
is operated for charitable, educational, political, religious, or scientific purposes and
not related to the provision of medical and administrative services covered under the
state public programs, except to the extent that they improve access to or the quality of
covered services for state public programs beneficiaries, or improve the health status of
state public programs beneficiaries.
new text end

new text begin (c) Administrative expenses must be reported using the formats designated by the
commissioner as part of the rate-setting process and must include, at a minimum, the
following categories:
new text end

new text begin (1) employee benefit expenses;
new text end

new text begin (2) sales expenses;
new text end

new text begin (3) general business and office expenses;
new text end

new text begin (4) taxes and assessments;
new text end

new text begin (5) consulting and professional fees; and
new text end

new text begin (6) outsourced services.
new text end

new text begin Definitions of items to be included in each category shall be provided by the commissioner
with quarterly financial filing requirements and shall be aligned with definitions used
by the Departments of Commerce and Health in financial reporting for commercial
carriers. Where reasonably possible, expenses for an administrative item shall be directly
allocated so as to assign costs for an item to an individual state public program when the
cost can be specifically identified with and benefits the individual state public program.
For administrative services expensed to the state's public programs, managed care plans
and county-based purchasing plans must clearly identify and separately record expense
items listed under paragraph (b) in their accounting systems in a manner that allows for
independent verification of unallowable expenses for purposes of determining payment
rates for state public programs.
new text end

new text begin (d) The administrative expenses requirement of this subdivision also apply to
demonstration providers under section 256B.0755.
new text end

Sec. 21.

Minnesota Statutes 2014, section 256B.69, subdivision 9c, is amended to read:

Subd. 9c.

Managed care financial reporting.

(a) The commissioner shall collect
detailed data regarding financials, provider payments, provider rate methodologies, and
other data as determined by the commissioner. The commissioner, in consultation with the
commissioners of health and commerce, and in consultation with managed care plans and
county-based purchasing plans, shall set uniform criteria, definitions, and standards for the
data to be submitted, and shall require managed care and county-based purchasing plans
to comply with these criteria, definitions, and standards when submitting data under this
section. In carrying out the responsibilities of this subdivision, the commissioner shall
ensure that the data collection is implemented in an integrated and coordinated manner
that avoids unnecessary duplication of effort. To the extent possible, the commissioner
shall use existing data sources and streamline data collection in order to reduce public
and private sector administrative costs. Nothing in this subdivision shall allow release of
information that is nonpublic data pursuant to section 13.02.

(b) Effective January 1, 2014, each managed care and county-based purchasing plan
must quarterly provide to the commissioner the following information on state public
programs, in the form and manner specified by the commissioner, according to guidelines
developed by the commissioner in consultation with managed care plans and county-based
purchasing plans under contract:

(1) an income statement by program;

(2) financial statement footnotes;

(3) quarterly profitability by program and population group;

(4) a medical liability summary by program and population group;

(5) received but unpaid claims report by program;

(6) services versus payment lags by program for hospital services, outpatient
services, physician services, other medical services, and pharmaceutical benefits;

(7) utilization reports that summarize utilization and unit cost information by
program for hospitalization services, outpatient services, physician services, and other
medical services;

(8) pharmaceutical statistics by program and population group for measures of price
and utilization of pharmaceutical services;

(9) subcapitation expenses by population group;

(10) third-party payments by program;

(11) all new, active, and closed subrogation cases by program;

(12) all new, active, and closed fraud and abuse cases by program;

(13) medical loss ratios by program;

(14) administrative expenses by category and subcategory by program that reconcile
to other state and federal regulatory agencies;

(15) revenues by program, including investment income;

(16) nonadministrative service payments, provider payments, and reimbursement
rates by provider type or service category, by program, paid by the managed care plan
under this section or the county-based purchasing plan under section 256B.692 to
providers and vendors for administrative services under contract with the plan, including
but not limited to:

(i) individual-level provider payment and reimbursement rate data;

(ii) provider reimbursement rate methodologies by provider type, by program,
including a description of alternative payment arrangements and payments outside the
claims process;

(iii) data on implementation of legislatively mandated provider rate changes; and

(iv) individual-level provider payment and reimbursement rate data and plan-specific
provider reimbursement rate methodologies by provider type, by program, including
alternative payment arrangements and payments outside the claims process, provided to
the commissioner under this subdivision are nonpublic data as defined in section 13.02;

(17) data on the amount of reinsurance or transfer of risk by program; and

(18) contribution to reserve, by program.

(c) In the event a report is published or released based on data provided under
this subdivision, the commissioner shall provide the report to managed care plans and
county-based purchasing plans 15 days prior to the publication or release of the report.
Managed care plans and county-based purchasing plans shall have 15 days to review the
report and provide comment to the commissioner.

The quarterly reports shall be submitted to the commissioner no later than 60 days after the
end of the previous quarter, except the fourth-quarter report, which shall be submitted by
April 1 of each year. The fourth-quarter report shall include audited financial statements,
parent company audited financial statements, an income statement reconciliation report,
and any other documentation necessary to reconcile the detailed reports to the audited
financial statements.

new text begin (d) Managed care plans and county-based purchasing plans shall certify to the
commissioner, for the purpose of managed care financial reporting for state public
health care programs under this subdivision, that costs related to state public health care
programs include only services covered under the state plan and waivers, and related
allowable administrative expenses. Managed care plans and county-based purchasing
plans shall certify and report to the commissioner the dollar value of any unallowable and
nonstate plan services, including both medical and administrative expenditures, for the
purposes of managed care financial reporting under this subdivision.
new text end

new text begin (e) The financial reporting requirements of this subdivision also apply to
demonstration providers under section 256B.0755.
new text end

Sec. 22.

Minnesota Statutes 2014, section 256B.69, subdivision 9d, is amended to read:

Subd. 9d.

Financial deleted text beginaudit deleted text end new text begin and quality assurance audits new text end.

deleted text begin (a) The legislative
auditor shall contract with an audit firm to conduct a biennial independent third-party
financial audit of the information required to be provided by managed care plans and
county-based purchasing plans under subdivision 9c, paragraph (b). The audit shall be
conducted in accordance with generally accepted government auditing standards issued
by the United States Government Accountability Office. The contract with the audit
firm shall be designed and administered so as to render the independent third-party audit
eligible for a federal subsidy, if available. The contract shall require the audit to include
a determination of compliance with the federal Medicaid rate certification process. The
contract shall require the audit to determine if the administrative expenses and investment
income reported by the managed care plans and county-based purchasing plans are
compliant with state and federal law.
deleted text end

deleted text begin (b) For purposes of this subdivision, "independent third party" means an audit firm
that is independent in accordance with government auditing standards issued by the United
States Government Accountability Office and licensed in accordance with chapter 326A.
An audit firm under contract to provide services in accordance with this subdivision must
not have provided services to a managed care plan or county-based purchasing plan during
the period for which the audit is being conducted.
deleted text end

deleted text begin (c) deleted text end new text begin(a) new text endThe commissioner shall require, in the request for bids and resulting contracts
with managed care plans and county-based purchasing plans under this section and
section 256B.692, that each managed care plan and county-based purchasing plan submit
to and fully cooperate with the independent third-party financial deleted text beginaudit deleted text end new text begin audits by the
legislative auditor under subdivision 9e new text end of the information required under subdivision 9c,
paragraph (b). Each contract with a managed care plan or county-based purchasing plan
under this section or section 256B.692 must provide the commissioner and the deleted text beginaudit firm
deleted text end new text beginvendors new text endcontracting with the legislative auditor access to all data required to complete
deleted text beginthe audit. For purposes of this subdivision, the contracting audit firm shall have the same
investigative power as the legislative auditor under section 3.978, subdivision 2 deleted text end new text begin audits
under subdivision 9e new text end.

deleted text begin (d) deleted text end new text begin(b) new text endEach managed care plan and county-based purchasing plan providing services
under this section shall provide to the commissioner biweekly encounter data and claims
data for state public health care programs and shall participate in a quality assurance
program that verifies the timeliness, completeness, accuracy, and consistency of the data
provided. The commissioner shall develop written protocols for the quality assurance
program and shall make the protocols publicly available. The commissioner shall contract
for an independent third-party audit to evaluate the quality assurance protocols as to
the capacity of the protocols to ensure complete and accurate data and to evaluate the
commissioner's implementation of the protocols. deleted text beginThe audit firm under contract to provide
this evaluation must meet the requirements in paragraph (b).
deleted text end

deleted text begin (e) Upon completion of the audit under paragraph (a) and receipt by the legislative
auditor, the legislative auditor shall provide copies of the audit report to the commissioner,
the state auditor, the attorney general, and the chairs and ranking minority members of the
health and human services finance committees of the legislature. deleted text end new text begin (c) new text end Upon completion
of the evaluation under paragraph deleted text begin(d) deleted text end new text begin (b) new text end, the commissioner shall provide copies of the
report to the legislative auditor and the chairs and ranking minority members of the deleted text beginhealth
finance committees of the legislature deleted text end new text begin legislative committees with jurisdiction over health
care policy and financing new text end.

deleted text begin (f) deleted text end new text begin(d) new text endAny actuary under contract with the commissioner to provide actuarial
services must meet the independence requirements under the professional code for fellows
in the Society of Actuaries and must not have provided actuarial services to a managed
care plan or county-based purchasing plan that is under contract with the commissioner
pursuant to this section and section 256B.692 during the period in which the actuarial
services are being provided. An actuary or actuarial firm meeting the requirements
of this paragraph must certify and attest to the rates paid to the managed care plans
and county-based purchasing plans under this section and section 256B.692, and the
certification and attestation must be auditable.

new text begin (e) The commissioner may conduct ad hoc audits of the state public programs
administrative and medical expenses of managed care organizations and county-based
purchasing plans. This includes: financial and encounter data reported to the commissioner
under subdivision 9c, including payments to providers and subcontractors; supporting
documentation for expenditures; categorization of administrative and medical expenses;
and allocation methods used to attribute administrative expenses to state public programs.
These audits also must monitor compliance with data and financial certifications provided
to the commissioner for the purposes of managed care capitation payment rate-setting.
The managed care plans and county-based purchasing plans shall fully cooperate with the
audits in this subdivision.
new text end

deleted text begin (g) deleted text end new text begin(f) new text endNothing in this subdivision shall allow the release of information that is
nonpublic data pursuant to section 13.02.

new text begin (g) The audit requirements of this subdivision also apply to demonstration providers
under section 256B.0755.
new text end

Sec. 23.

Minnesota Statutes 2014, section 256B.69, is amended by adding a
subdivision to read:

new text begin Subd. 9e. new text end

new text begin Financial audits. new text end

new text begin (a) The legislative auditor shall contract with vendors
to conduct independent third-party financial audits of the Department of Human Services'
use of the information required to be provided by managed care plans and county-based
purchasing plans under subdivision 9c, paragraph (b). The audits by the vendors shall
be conducted as vendor resources permit and in accordance with generally accepted
government auditing standards issued by the United States Government Accountability
Office. The contract with the vendors shall be designed and administered so as to render
the independent third-party audits eligible for a federal subsidy, if available. The contract
shall require the audits to include a determination of compliance by the Department of
Human Services with the federal Medicaid rate certification process.
new text end

new text begin (b) For purposes of this subdivision, "independent third-party" means a vendor that
is independent in accordance with government auditing standards issued by the United
States Government Accountability Office.
new text end

Sec. 24.

Minnesota Statutes 2014, section 256B.75, is amended to read:

256B.75 HOSPITAL OUTPATIENT REIMBURSEMENT.

(a) For outpatient hospital facility fee payments for services rendered on or after
October 1, 1992, the commissioner of human services shall pay the lower of (1) submitted
charge, or (2) 32 percent above the rate in effect on June 30, 1992, except for those
services for which there is a federal maximum allowable payment. Effective for services
rendered on or after January 1, 2000, payment rates for nonsurgical outpatient hospital
facility fees and emergency room facility fees shall be increased by eight percent over the
rates in effect on December 31, 1999, except for those services for which there is a federal
maximum allowable payment. Services for which there is a federal maximum allowable
payment shall be paid at the lower of (1) submitted charge, or (2) the federal maximum
allowable payment. Total aggregate payment for outpatient hospital facility fee services
shall not exceed the Medicare upper limit. If it is determined that a provision of this
section conflicts with existing or future requirements of the United States government with
respect to federal financial participation in medical assistance, the federal requirements
prevail. The commissioner may, in the aggregate, prospectively reduce payment rates to
avoid reduced federal financial participation resulting from rates that are in excess of
the Medicare upper limitations.

(b) Notwithstanding paragraph (a), payment for outpatient, emergency, and
ambulatory surgery hospital facility fee services for critical access hospitals designated
under section 144.1483, clause (9), shall be paid on a cost-based payment system that is
based on the cost-finding methods and allowable costs of the Medicare program.

(c) Effective for services provided on or after July 1, 2003, rates that are based
on the Medicare outpatient prospective payment system shall be replaced by a budget
neutral prospective payment system that is derived using medical assistance data. The
commissioner shall provide a proposal to the 2003 legislature to define and implement
this provision.

(d) For fee-for-service services provided on or after July 1, 2002, the total payment,
before third-party liability and spenddown, made to hospitals for outpatient hospital
facility services is reduced by .5 percent from the current statutory rate.

(e) In addition to the reduction in paragraph (d), the total payment for fee-for-service
services provided on or after July 1, 2003, made to hospitals for outpatient hospital
facility services before third-party liability and spenddown, is reduced five percent from
the current statutory rates. Facilities defined under section 256.969, subdivision 16, are
excluded from this paragraph.

(f) In addition to the reductions in paragraphs (d) and (e), the total payment for
fee-for-service services provided on or after July 1, 2008, made to hospitals for outpatient
hospital facility services before third-party liability and spenddown, is reduced three
percent from the current statutory rates. Mental health services and facilities defined under
section 256.969, subdivision 16, are excluded from this paragraph.

new text begin (g) Effective for services provided on or after July 1, 2015, rates established for
critical access hospitals under paragraph (b) for the applicable payment year shall be the
final payment and shall not be settled to actual costs.
new text end

Sec. 25.

Minnesota Statutes 2014, section 256B.76, subdivision 1, is amended to read:

Subdivision 1.

Physician reimbursement.

(a) Effective for services rendered on
or after October 1, 1992, the commissioner shall make payments for physician services
as follows:

(1) payment for level one Centers for Medicare and Medicaid Services' common
procedural coding system codes titled "office and other outpatient services," "preventive
medicine new and established patient," "delivery, antepartum, and postpartum care,"
"critical care," cesarean delivery and pharmacologic management provided to psychiatric
patients, and level three codes for enhanced services for prenatal high risk, shall be paid
at the lower of (i) submitted charges, or (ii) 25 percent above the rate in effect on June
30, 1992. If the rate on any procedure code within these categories is different than the
rate that would have been paid under the methodology in section 256B.74, subdivision 2,
then the larger rate shall be paid;

(2) payments for all other services shall be paid at the lower of (i) submitted charges,
or (ii) 15.4 percent above the rate in effect on June 30, 1992; and

(3) all physician rates shall be converted from the 50th percentile of 1982 to the 50th
percentile of 1989, less the percent in aggregate necessary to equal the above increases
except that payment rates for home health agency services shall be the rates in effect
on September 30, 1992.

(b) Effective for services rendered on or after January 1, 2000, payment rates for
physician and professional services shall be increased by three percent over the rates
in effect on December 31, 1999, except for home health agency and family planning
agency services. The increases in this paragraph shall be implemented January 1, 2000,
for managed care.

(c) Effective for services rendered on or after July 1, 2009, payment rates for
physician and professional services shall be reduced by five percent, except that for the
period July 1, 2009, through June 30, 2010, payment rates shall be reduced by 6.5 percent
for the medical assistance and general assistance medical care programs, over the rates in
effect on June 30, 2009. This reduction and the reductions in paragraph (d) do not apply
to office or other outpatient visits, preventive medicine visits and family planning visits
billed by physicians, advanced practice nurses, or physician assistants in a family planning
agency or in one of the following primary care practices: general practice, general internal
medicine, general pediatrics, general geriatrics, and family medicine. This reduction
and the reductions in paragraph (d) do not apply to federally qualified health centers,
rural health centers, and Indian health services. Effective October 1, 2009, payments
made to managed care plans and county-based purchasing plans under sections 256B.69,
256B.692, and 256L.12 shall reflect the payment reduction described in this paragraph.

(d) Effective for services rendered on or after July 1, 2010, payment rates for
physician and professional services shall be reduced an additional seven percent over
the five percent reduction in rates described in paragraph (c). This additional reduction
does not apply to physical therapy services, occupational therapy services, and speech
pathology and related services provided on or after July 1, 2010. This additional reduction
does not apply to physician services billed by a psychiatrist or an advanced practice nurse
with a specialty in mental health. Effective October 1, 2010, payments made to managed
care plans and county-based purchasing plans under sections 256B.69, 256B.692, and
256L.12 shall reflect the payment reduction described in this paragraph.

(e) Effective for services rendered on or after September 1, 2011, through June 30,
2013, payment rates for physician and professional services shall be reduced three percent
from the rates in effect on August 31, 2011. This reduction does not apply to physical
therapy services, occupational therapy services, and speech pathology and related services.

(f) Effective for services rendered on or after September 1, 2014, payment rates for
physician and professional services, including physical therapy, occupational therapy,
speech pathology, and mental health services shall be increased by five percent from the
rates in effect on August 31, 2014. In calculating this rate increase, the commissioner
shall not include in the base rate for August 31, 2014, the rate increase provided under
section 256B.76, subdivision 7. This increase does not apply to federally qualified health
centers, rural health centers, and Indian health services. Payments made to managed
care plans and county-based purchasing plans shall not be adjusted to reflect payments
under this paragraph.

new text begin (g) Effective for services rendered on or after July 1, 2015, payment rates for
physical therapy, occupational therapy, and speech pathology and related services provided
by a hospital meeting the criteria specified in section 62Q.19, subdivision 1, paragraph
(a), clause (4), shall be increased by 90 percent from the rates in effect on June 30, 2015.
Payments made to managed care plans and county-based purchasing plans shall not be
adjusted to reflect payments under this paragraph.
new text end

Sec. 26.

Minnesota Statutes 2014, section 256B.76, subdivision 2, is amended to read:

Subd. 2.

Dental reimbursement.

(a) Effective for services rendered on or after
October 1, 1992, the commissioner shall make payments for dental services as follows:

(1) dental services shall be paid at the lower of (i) submitted charges, or (ii) 25
percent above the rate in effect on June 30, 1992; and

(2) dental rates shall be converted from the 50th percentile of 1982 to the 50th
percentile of 1989, less the percent in aggregate necessary to equal the above increases.

(b) Beginning October 1, 1999, the payment for tooth sealants and fluoride treatments
shall be the lower of (1) submitted charge, or (2) 80 percent of median 1997 charges.

(c) Effective for services rendered on or after January 1, 2000, payment rates for
dental services shall be increased by three percent over the rates in effect on December
31, 1999.

(d) Effective for services provided on or after January 1, 2002, payment for
diagnostic examinations and dental x-rays provided to children under age 21 shall be the
lower of (1) the submitted charge, or (2) 85 percent of median 1999 charges.

(e) The increases listed in paragraphs (b) and (c) shall be implemented January 1,
2000, for managed care.

(f) Effective for dental services rendered on or after October 1, 2010, by a
state-operated dental clinic, payment shall be paid on a reasonable cost basis that is based
on the Medicare principles of reimbursement. This payment shall be effective for services
rendered on or after January 1, 2011, to recipients enrolled in managed care plans or
county-based purchasing plans.

(g) Beginning in fiscal year 2011, if the payments to state-operated dental clinics
in paragraph (f), including state and federal shares, are less than $1,850,000 per fiscal
year, a supplemental state payment equal to the difference between the total payments
in paragraph (f) and $1,850,000 shall be paid from the general fund to state-operated
services for the operation of the dental clinics.

(h) If the cost-based payment system for state-operated dental clinics described in
paragraph (f) does not receive federal approval, then state-operated dental clinics shall be
designated as critical access dental providers under subdivision 4, paragraph (b), and shall
receive the critical access dental reimbursement rate as described under subdivision 4,
paragraph (a).

(i) Effective for services rendered on or after September 1, 2011, through June 30,
2013, payment rates for dental services shall be reduced by three percent. This reduction
does not apply to state-operated dental clinics in paragraph (f).

(j) Effective for services rendered on or after January 1, 2014, payment rates for
dental services shall be increased by five percent from the rates in effect on December
31, 2013. This increase does not apply to state-operated dental clinics in paragraph (f),
federally qualified health centers, rural health centers, and Indian health services. Effective
January 1, 2014, payments made to managed care plans and county-based purchasing
plans under sections 256B.69, 256B.692, and 256L.12 shall reflect the payment increase
described in this paragraph.

new text begin (k) Effective for services rendered on or after July 1, 2015, payment rates for dental
services shall be increased by five percent from the rates in effect on June 30, 2015. This
increase does not apply to state-operated dental clinics in paragraph (f), federally qualified
health centers, rural health centers, and Indian health services. Effective January 1, 2016,
payments to managed care plans and county-based purchasing plans under sections
256B.69 and 256B.692 shall reflect the payment increase described in this paragraph.
new text end

Sec. 27.

Minnesota Statutes 2014, section 256B.762, is amended to read:

256B.762 REIMBURSEMENT FOR HEALTH CARE SERVICES.

new text begin (a) new text endEffective for services provided on or after October 1, 2005, payment rates
for the following services shall be increased by five percent over the rates in effect on
September 30, 2005, when these services are provided as home health services under
section 256B.0625, subdivision 6a:

(1) skilled nursing visit;

(2) physical therapy visit;

(3) occupational therapy visit;

(4) speech therapy visit; and

(5) home health aide visit.

new text begin (b) Effective for services provided on or after July 1, 2015, payment rates for
managed care and fee-for-service visits for the following services shall be increased by
ten percent over the rates in effect on June 30, 2015, when these services are provided as
home health services under section 256B.0625, subdivision 6a:
new text end

new text begin (1) physical therapy;
new text end

new text begin (2) occupational therapy; and
new text end

new text begin (3) speech therapy.
new text end

new text begin The commissioner shall adjust managed care and county-based purchasing plan capitation
rates to reflect the payment rates under this paragraph.
new text end

Sec. 28.

Minnesota Statutes 2014, section 256B.766, is amended to read:

256B.766 REIMBURSEMENT FOR BASIC CARE SERVICES.

(a) Effective for services provided on or after July 1, 2009, total payments for basic
care services, shall be reduced by three percent, except that for the period July 1, 2009,
through June 30, 2011, total payments shall be reduced by 4.5 percent for the medical
assistance and general assistance medical care programs, prior to third-party liability and
spenddown calculation. Effective July 1, 2010, the commissioner shall classify physical
therapy services, occupational therapy services, and speech-language pathology and
related services as basic care services. The reduction in this paragraph shall apply to
physical therapy services, occupational therapy services, and speech-language pathology
and related services provided on or after July 1, 2010.

(b) Payments made to managed care plans and county-based purchasing plans shall
be reduced for services provided on or after October 1, 2009, to reflect the reduction
effective July 1, 2009, and payments made to the plans shall be reduced effective October
1, 2010, to reflect the reduction effective July 1, 2010.

(c) Effective for services provided on or after September 1, 2011, through June 30,
2013, total payments for outpatient hospital facility fees shall be reduced by five percent
from the rates in effect on August 31, 2011.

(d) Effective for services provided on or after September 1, 2011, through June
30, 2013, total payments for ambulatory surgery centers facility fees, medical supplies
and durable medical equipment not subject to a volume purchase contract, prosthetics
and orthotics, renal dialysis services, laboratory services, public health nursing services,
physical therapy services, occupational therapy services, speech therapy services,
eyeglasses not subject to a volume purchase contract, hearing aids not subject to a volume
purchase contract, and anesthesia services shall be reduced by three percent from the
rates in effect on August 31, 2011.

(e) Effective for services provided on or after September 1, 2014, payments
for ambulatory surgery centers facility fees, hospice services, renal dialysis services,
laboratory services, public health nursing services, eyeglasses not subject to a volume
purchase contract, and hearing aids not subject to a volume purchase contract shall be
increased by three percent and payments for outpatient hospital facility fees shall be
increased by three percent. Payments made to managed care plans and county-based
purchasing plans shall not be adjusted to reflect payments under this paragraph.

(f) Payments for medical supplies and durable medical equipment not subject to a
volume purchase contract, and prosthetics and orthotics, provided on or after July 1, 2014,
through June 30, 2015, shall be decreased by .33 percent. Payments for medical supplies
and durable medical equipment not subject to a volume purchase contract, and prosthetics
and orthotics, provided on or after July 1, 2015, shall be increased by three percent from
the rates deleted text beginin effect on June 30, 2014 deleted text end new text begin as determined under paragraph (i) new text end.

(g) new text begin Effective for services provided on or after July 1, 2015, payments for outpatient
hospital facility fees, medical supplies and durable medical equipment not subject to a
volume purchase contract, prosthetics and orthotics, and laboratory services to a hospital
meeting the criteria specified in section 62Q.19, subdivision 1, paragraph (a), clause (4),
shall be increased by 90 percent from the rates in effect on June 30, 2015. Payments made
to managed care plans and county-based purchasing plans shall not be adjusted to reflect
payments under this paragraph.
new text end

new text begin (h) new text end This section does not apply to physician and professional services, inpatient
hospital services, family planning services, mental health services, dental services,
prescription drugs, medical transportation, federally qualified health centers, rural health
centers, Indian health services, and Medicare cost-sharing.

new text begin (i) Effective July 1, 2015, the medical assistance payment rate for durable medical
equipment, prosthetics, orthotics, or supplies shall be restored to the January 1, 2008,
medical assistance fee schedule, updated to include subsequent rate increases in the
Medicare and medical assistance fee schedules, and including individually priced
items for the following categories: enteral nutrition and supplies, customized and other
specialized tracheostomy tubes and supplies, electric patient lifts, and durable medical
equipment repair and service. This paragraph does not apply to medical supplies and
durable medical equipment subject to a volume purchase contract, products subject to the
preferred diabetic testing supply program, and items provided to dually eligible recipients
when Medicare is the primary payer for the item.
new text end

Sec. 29.

Minnesota Statutes 2014, section 256B.767, is amended to read:

256B.767 MEDICARE PAYMENT LIMIT.

(a) Effective for services rendered on or after July 1, 2010, fee-for-service payment
rates for physician and professional services under section 256B.76, subdivision 1, and
basic care services subject to the rate reduction specified in section 256B.766, shall not
exceed the Medicare payment rate for the applicable service, as adjusted for any changes
in Medicare payment rates after July 1, 2010. The commissioner shall implement this
section after any other rate adjustment that is effective July 1, 2010, and shall reduce rates
under this section by first reducing or eliminating provider rate add-ons.

(b) This section does not apply to services provided by advanced practice certified
nurse midwives licensed under chapter 148 or traditional midwives licensed under chapter
147D. Notwithstanding this exemption, medical assistance fee-for-service payment rates
for advanced practice certified nurse midwives and licensed traditional midwives shall
equal and shall not exceed the medical assistance payment rate to physicians for the
applicable service.

(c) This section does not apply to mental health services or physician services billed
by a psychiatrist or an advanced practice registered nurse with a specialty in mental health.

deleted text begin (d) Effective for durable medical equipment, prosthetics, orthotics, or supplies
provided on or after July 1, 2013, through June 30, 2015, the payment rate for items
that are subject to the rates established under Medicare's National Competitive Bidding
Program shall be equal to the rate that applies to the same item when not subject to the
rate established under Medicare's National Competitive Bidding Program. This paragraph
does not apply to mail-order diabetic supplies and does not apply to items provided to
dually eligible recipients when Medicare is the primary payer of the item.
deleted text end

new text begin (d) Effective July 1, 2015, this section shall not apply to durable medical equipment,
prosthetics, orthotics, or supplies.
new text end

new text begin (e) This section does not apply to physical therapy, occupational therapy, speech
pathology and related services, and basic care services provided by a hospital meeting the
criteria specified in section 62Q.19, subdivision 1, paragraph (a), clause (4).
new text end

Sec. 30.

Laws 2008, chapter 363, article 18, section 3, subdivision 5, is amended to read:

Subd. 5. Basic Health Care Grants

(a) MinnesotaCare Grants

Health Care Access

-0-

(770,000)

Incentive Program and Outreach Grants.
Of the appropriation for the Minnesota health
care outreach program in Laws 2007, chapter
147, article 19, section 3, subdivision 7,
paragraph (b):

(1) $400,000 in fiscal year 2009 from the
general fund and $200,000 in fiscal year 2009
from the health care access fund are for the
incentive program under Minnesota Statutes,
section 256.962, subdivision 5. For the
biennium beginning July 1, 2009, base level
funding for this activity shall be $360,000
from the general fund and $160,000 from the
health care access fund; and

(2) $100,000 in fiscal year 2009 from the
general fund and $50,000 in fiscal year 2009
from the health care access fund are for the
outreach grants under Minnesota Statutes,
section 256.962, subdivision 2. For the
biennium beginning July 1, 2009, base level
funding for this activity shall be $90,000
from the general fund and $40,000 from the
health care access fund.

(b) MA Basic Health Care Grants - Families and Children

-0-

(17,280,000)

Third-Party Liability. (a) During
fiscal year 2009, the commissioner shall
employ a contractor paid on a percentage
basis to improve third-party collections.
Improvement initiatives may include, but not
be limited to, efforts to improve postpayment
collection from nonresponsive claims and
efforts to uncover third-party payers the
commissioner has been unable to identify.

(b) In fiscal year 2009, the first $1,098,000
of recoveries, after contract payments and
federal repayments, is appropriated to
the commissioner for technology-related
expenses.

deleted text begin Administrative Costs. (a) For contracts
effective on or after January 1, 2009,
the commissioner shall limit aggregate
administrative costs paid to managed care
plans under Minnesota Statutes, section
256B.69, and to county-based purchasing
plans under Minnesota Statutes, section
256B.692, to an overall average of 6.6 percent
of total contract payments under Minnesota
Statutes, sections 256B.69 and 256B.692,
for each calendar year. For purposes of
this paragraph, administrative costs do not
include premium taxes paid under Minnesota
Statutes, section 297I.05, subdivision 5, and
provider surcharges paid under Minnesota
Statutes, section 256.9657, subdivision 3.
deleted text end

deleted text begin (b) Notwithstanding any law to the contrary,
the commissioner may reduce or eliminate
administrative requirements to meet the
administrative target under paragraph (a).
deleted text end

deleted text begin (c) Notwithstanding any contrary provision
of this article, this rider shall not expire.
deleted text end

Hospital Payment Delay. Notwithstanding
Laws 2005, First Special Session chapter 4,
article 9, section 2, subdivision 6, payments
from the Medicaid Management Information
System that would otherwise have been made
for inpatient hospital services for medical
assistance enrollees are delayed as follows:
(1) for fiscal year 2008, June payments must
be included in the first payments in fiscal
year 2009; and (2) for fiscal year 2009,
June payments must be included in the first
payment of fiscal year 2010. The provisions
of Minnesota Statutes, section 16A.124,
do not apply to these delayed payments.
Notwithstanding any contrary provision in
this article, this paragraph expires on June
30, 2010.

(c) MA Basic Health Care Grants - Elderly and Disabled

(14,028,000)

(9,368,000)

Minnesota Disability Health Options Rate
Setting Methodology. The commissioner
shall develop and implement a methodology
for risk adjusting payments for community
alternatives for disabled individuals (CADI)
and traumatic brain injury (TBI) home
and community-based waiver services
delivered under the Minnesota disability
health options program (MnDHO) effective
January 1, 2009. The commissioner shall
take into account the weighting system used
to determine county waiver allocations in
developing the new payment methodology.
Growth in the number of enrollees receiving
CADI or TBI waiver payments through
MnDHO is limited to an increase of 200
enrollees in each calendar year from January
2009 through December 2011. If those limits
are reached, additional members may be
enrolled in MnDHO for basic care services
only as defined under Minnesota Statutes,
section 256B.69, subdivision 28, and the
commissioner may establish a waiting list for
future access of MnDHO members to those
waiver services.

MA Basic Elderly and Disabled
Adjustments. For the fiscal year ending June
30, 2009, the commissioner may adjust the
rates for each service affected by rate changes
under this section in such a manner across
the fiscal year to achieve the necessary cost
savings and minimize disruption to service
providers, notwithstanding the requirements
of Laws 2007, chapter 147, article 7, section
71.

(d) General Assistance Medical Care Grants

-0-

(6,971,000)

(e) Other Health Care Grants

-0-

(17,000)

MinnesotaCare Outreach Grants Special
Revenue Account. The balance in the
MinnesotaCare outreach grants special
revenue account on July 1, 2009, estimated
to be $900,000, must be transferred to the
general fund.

Grants Reduction. Effective July 1, 2008,
base level funding for nonforecast, general
fund health care grants issued under this
paragraph shall be reduced by 1.8 percent at
the allotment level.

Sec. 31.

new text begin REDUCTION IN ADMINISTRATIVE COSTS.
new text end

new text begin The commissioner of human services, when contracting with managed care and
county-based purchasing plans for the provision of services under Minnesota Statutes,
sections 256B.69 and 256B.692, for calendar years 2016 and 2017, shall negotiate
reductions in managed care and county-based purchasing plan administrative costs,
sufficient to achieve a state medical assistance savings of $100,000,000 for the biennium
ending June 30, 2017.
new text end

Sec. 32. new text beginADVISORY GROUP ON ADMINISTRATIVE EXPENSES.
new text end

new text begin Subdivision 1. new text end

new text begin Duties. new text end

new text begin The commissioner of health shall reconvene the Advisory
Group on Administrative Expenses, established under Laws 2010, First Special Session
chapter 1, article 20, section 3, to develop detailed standards and procedures for examining
the reasonableness of administrative expenses by individual state public programs.
The advisory group shall develop consistent guidelines, definitions, and reporting
requirements, including a common standardized public reporting template for health
maintenance organizations and county-based purchasing plans that participate in state
public programs. The advisory group shall take into consideration relevant reporting
standards of the National Association of Insurance Commissioners and the Centers for
Medicare and Medicaid Services. The advisory group shall expire on January 1, 2016.
new text end

new text begin Subd. 2. new text end

new text begin Membership. new text end

new text begin The advisory group shall be composed of the following
members, who serve at the pleasure of their appointing authority:
new text end

new text begin (1) the commissioner of health or the commissioner's designee;
new text end

new text begin (2) the commissioner of human services or the commissioner's designee;
new text end

new text begin (3) the commissioner of commerce or the commissioner's designee; and
new text end

new text begin (4) representatives of health maintenance organizations and county-based purchasing
plans appointed by the commissioner of health.
new text end

Sec. 33. new text beginCAPITATION PAYMENT DELAY.
new text end

new text begin (a) The commissioner of human services shall delay $135,000,000 of the medical
assistance capitation payment to managed care plans and county-based purchasing plans
due in May 2017 and the payment due in April 2017 for special needs basic care until
July 1, 2017. The payment shall be made no earlier than July 1, 2017, and no later than
July 31, 2017.
new text end

new text begin (b) The commissioner of human services shall delay $135,000,000 of the medical
assistance capitation payment to managed care plans and county-based purchasing plans
due in the second quarter of calendar year 2019 and the April 2019 payment for special
needs basic care until July 1, 2019. The payment shall be made no earlier than July 1,
2019, and no later than July 31, 2019.
new text end

Sec. 34. new text beginHEALTH AND ECONOMIC ASSISTANCE PROGRAM ELIGIBILITY
VERIFICATION AUDIT SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Request for proposals. new text end

new text begin By October 1, 2015, the commissioner of
human services shall issue a request for proposals for a contract to provide eligibility
verification audit services for benefits provided through health and economic assistance
programs. The request for proposals must require that the vendor:
new text end

new text begin (1) conduct an eligibility verification audit of all health and economic assistance
program recipients that includes, but is not limited to, appropriate data matching against
relevant state and federal databases;
new text end

new text begin (2) identify any ineligible recipients in these programs and report those findings
to the commissioner; and
new text end

new text begin (3) identify a process for ongoing eligibility verification of health and economic
assistance program recipients and applicants, following the conclusion of the eligibility
verification audit required by this section.
new text end

new text begin Subd. 2. new text end

new text begin Additional vendor criteria. new text end

new text begin The request for proposals must require the
vendor to provide the following minimum capabilities and experience in performing the
services described in subdivision 1:
new text end

new text begin (1) a rules-based process for making objective eligibility determinations;
new text end

new text begin (2) assigned eligibility advocates to assist recipients through the verification process;
new text end

new text begin (3) a formal claims and appeals process; and
new text end

new text begin (4) experience in the performance of eligibility verification audits.
new text end

new text begin Subd. 3. new text end

new text begin Contract required. new text end

new text begin (a) By January 1, 2016, the commissioner must enter
into a contract for the services specified in subdivision 1. The contract must:
new text end

new text begin (1) incorporate performance-based vendor financing that compensates the vendor
based on the amount of savings generated by the work performed under the contract;
new text end

new text begin (2) require the vendor to reimburse the commissioner and county agencies for all
reasonable costs incurred in implementing this section, out of savings generated by the
work performed under the contract;
new text end

new text begin (3) require the vendor to comply with enrollee data privacy requirements and to use
encryption to safeguard enrollee identity; and
new text end

new text begin (4) provide penalties for vendor noncompliance.
new text end

new text begin (b) The commissioner may renew the contract for up to three additional one-year
periods. The commissioner may require additional eligibility verification audits, if
the commissioner or the legislative auditor determines that the MNsure information
technology system and agency eligibility determination systems cannot effectively verify
the eligibility of health and economic assistance program recipients.
new text end

new text begin Subd. 4. new text end

new text begin Health and economic assistance program. new text end

new text begin For purposes of this section,
"health and economic assistance program" means the medical assistance program under
Minnesota Statutes, chapter 256B, Minnesota family investment and diversionary
work programs under Minnesota Statutes, chapter 256J, child care assistance programs
under Minnesota Statutes, chapter 119B, general assistance under Minnesota Statutes,
sections 256D.01 to 256D.23, alternative care program under Minnesota Statutes, section
256B.0913, and chemical dependency programs funded under Minnesota Statutes, chapter
254B.
new text end

Sec. 35. new text beginREQUEST FOR PROPOSALS.
new text end

new text begin (a) The commissioner of human services shall issue a request for proposals
for a contract to use technologically advanced software and services to improve the
identification and rejection or elimination of:
new text end

new text begin (1) improper Medicaid payments before payment is made to the provider; and
new text end

new text begin (2) improper provision of benefits by a health and economic assistance program
to ineligible individuals.
new text end

new text begin (b) The request for proposals must ensure that a system recommended and
implemented by the contractor will:
new text end

new text begin (1) implement a more comprehensive, robust, and technologically advanced
improper payments and benefits identification program;
new text end

new text begin (2) utilize state of the art fraud detection methods and technologies such as predictive
modeling, link analysis, and anomaly and outlier detection;
new text end

new text begin (3) have the ability to identify and report improper claims before the claims are paid;
new text end

new text begin (4) have the ability to identify and report the improper provision of benefits under a
health and economic assistance program;
new text end

new text begin (5) include a mechanism so that the system improves its detection capabilities over
time;
new text end

new text begin (6) leverage technology to make the Medicaid claims evaluation process more
transparent and cost-efficient; and
new text end

new text begin (7) result in increased state savings by reducing or eliminating payouts of wrongful
Medicaid claims and the improper provision of health and economic assistance program
benefits.
new text end

new text begin (c) Based on responses to the request for proposals, the commissioner must enter
into a contract for the services specified in paragraphs (a) and (b) by October 1, 2015. The
contract shall incorporate a performance-based vendor financing option whereby the
vendor shares in the risk of the project's success.
new text end

new text begin (d) For purposes of this section, "health and economic assistance program" means
the medical assistance program under Minnesota Statutes, chapter 256B, Minnesota family
investment and diversionary work programs under Minnesota Statutes, chapter 256J, child
care assistance programs under Minnesota Statutes, chapter 119B, general assistance
under Minnesota Statutes, sections 256D.01 to 256D.23, alternative care program under
Minnesota Statutes, section 256B.0913, and chemical dependency programs funded under
Minnesota Statutes, chapter 254B.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 36. new text beginFEDERAL WAIVER OR APPROVAL.
new text end

new text begin The commissioner of human services shall seek any federal waiver or approval
necessary to implement the amendments to Minnesota Statutes, section 256B.0644.
new text end

ARTICLE 2

MINNESOTACARE

Section 1.

Minnesota Statutes 2014, section 256.98, subdivision 1, is amended to read:

Subdivision 1.

Wrongfully obtaining assistance.

A person who commits any of
the following acts or omissions with intent to defeat the purposes of sections 145.891
to 145.897, the MFIP program formerly codified in sections 256.031 to 256.0361, the
AFDC program formerly codified in sections 256.72 to 256.871, chapters 256B, 256D,
256J, 256K, or 256L, and child care assistance programs, is guilty of theft and shall be
sentenced under section 609.52, subdivision 3, clauses (1) to (5):

(1) obtains or attempts to obtain, or aids or abets any person to obtain by means of
a willfully false statement or representation, by intentional concealment of any material
fact, or by impersonation or other fraudulent device, assistance or the continued receipt of
assistance, to include child care assistance or vouchers produced according to sections
145.891 to 145.897 and deleted text beginMinnesotaCare services according to sections deleted text end new text begin premium assistance
under section new text end 256.9365 deleted text begin, 256.94, and 256L.01 to 256L.15 deleted text end, to which the person is not
entitled or assistance greater than that to which the person is entitled;

(2) knowingly aids or abets in buying or in any way disposing of the property of a
recipient or applicant of assistance without the consent of the county agency; or

(3) obtains or attempts to obtain, alone or in collusion with others, the receipt of
payments to which the individual is not entitled as a provider of subsidized child care, or
by furnishing or concurring in a willfully false claim for child care assistance.

The continued receipt of assistance to which the person is not entitled or greater
than that to which the person is entitled as a result of any of the acts, failure to act, or
concealment described in this subdivision shall be deemed to be continuing offenses from
the date that the first act or failure to act occurred.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2016.
new text end

Sec. 2.

Minnesota Statutes 2014, section 256B.021, subdivision 4, is amended to read:

Subd. 4.

Projects.

The commissioner shall request permission and funding to
further the following initiatives.

(a) Health care delivery demonstration projects. This project involves testing
alternative payment and service delivery models in accordance with sections 256B.0755
and 256B.0756. These demonstrations will allow the Minnesota Department of Human
Services to engage in alternative payment arrangements with provider organizations that
provide services to a specified patient population for an agreed upon total cost of care or
risk/gain sharing payment arrangement, but are not limited to these models of care delivery
or payment. Quality of care and patient experience will be measured and incorporated into
payment models alongside the cost of care. Demonstration sites should include Minnesota
health care programs fee-for-services recipients and managed care enrollees and support a
robust primary care model and improved care coordination for recipients.

(b) Promote personal responsibility and encourage and reward healthy outcomes.
This project provides Medicaid funding to provide individual and group incentives to
encourage healthy behavior, prevent the onset of chronic disease, and reward healthy
outcomes. Focus areas may include diabetes prevention and management, tobacco
cessation, reducing weight, lowering cholesterol, and lowering blood pressure.

(c) Encourage utilization of high quality, cost-effective care. This project creates
incentives through Medicaid and MinnesotaCare enrollee cost-sharing and other means to
encourage the utilization of high-quality, low-cost, high-value providers, as determined by
the state's provider peer grouping initiative under section 62U.04.

(d) Adults without children. This proposal includes requesting federal authority to
impose a limit on assets for adults without children in medical assistance, as defined in
section 256B.055, subdivision 15, who have a household income equal to or less than
75 percent of the federal poverty limit deleted text begin, and to impose a 180-day durational residency
deleted text end deleted text beginrequirement in MinnesotaCare, consistent with section 256L.09, subdivision 4, for adults
without children, regardless of income deleted text end.

(e) Empower and encourage work, housing, and independence. This project provides
services and supports for individuals who have an identified health or disabling condition
but are not yet certified as disabled, in order to delay or prevent permanent disability,
reduce the need for intensive health care and long-term care services and supports, and to
help maintain or obtain employment or assist in return to work. Benefits may include:

(1) coordination with health care homes or health care coordinators;

(2) assessment for wellness, housing needs, employment, planning, and goal setting;

(3) training services;

(4) job placement services;

(5) career counseling;

(6) benefit counseling;

(7) worker supports and coaching;

(8) assessment of workplace accommodations;

(9) transitional housing services; and

(10) assistance in maintaining housing.

(f) Redesign home and community-based services. This project realigns existing
funding, services, and supports for people with disabilities and older Minnesotans to
ensure community integration and a more sustainable service system. This may involve
changes that promote a range of services to flexibly respond to the following needs:

(1) provide people less expensive alternatives to medical assistance services;

(2) offer more flexible and updated community support services under the Medicaid
state plan;

(3) provide an individual budget and increased opportunity for self-direction;

(4) strengthen family and caregiver support services;

(5) allow persons to pool resources or save funds beyond a fiscal year to cover
unexpected needs or foster development of needed services;

(6) use of home and community-based waiver programs for people whose needs
cannot be met with the expanded Medicaid state plan community support service options;

(7) target access to residential care for those with higher needs;

(8) develop capacity within the community for crisis intervention and prevention;

(9) redesign case management;

(10) offer life planning services for families to plan for the future of their child
with a disability;

(11) enhance self-advocacy and life planning for people with disabilities;

(12) improve information and assistance to inform long-term care decisions; and

(13) increase quality assurance, performance measurement, and outcome-based
reimbursement.

This project may include different levels of long-term supports that allow seniors to
remain in their homes and communities, and expand care transitions from acute care to
community care to prevent hospitalizations and nursing home placement. The levels
of support for seniors may range from basic community services for those with lower
needs, access to residential services if a person has higher needs, and targets access to
nursing home care to those with rehabilitation or high medical needs. This may involve
the establishment of medical need thresholds to accommodate the level of support
needed; provision of a long-term care consultation to persons seeking residential services,
regardless of payer source; adjustment of incentives to providers and care coordination
organizations to achieve desired outcomes; and a required coordination with medical
assistance basic care benefit and Medicare/Medigap benefit. This proposal will improve
access to housing and improve capacity to maintain individuals in their existing home;
adjust screening and assessment tools, as needed; improve transition and relocation
efforts; seek federal financial participation for alternative care and essential community
supports; and provide Medigap coverage for people having lower needs.

(g) Coordinate and streamline services for people with complex needs, including
those with multiple diagnoses of physical, mental, and developmental conditions. This
project will coordinate and streamline medical assistance benefits for people with complex
needs and multiple diagnoses. It would include changes that:

(1) develop community-based service provider capacity to serve the needs of this
group;

(2) build assessment and care coordination expertise specific to people with multiple
diagnoses;

(3) adopt service delivery models that allow coordinated access to a range of services
for people with complex needs;

(4) reduce administrative complexity;

(5) measure the improvements in the state's ability to respond to the needs of this
population; and

(6) increase the cost-effectiveness for the state budget.

(h) Implement nursing home level of care criteria. This project involves obtaining
any necessary federal approval in order to implement the changes to the level of care
criteria in section 144.0724, subdivision 11, and implement further changes necessary to
achieve reform of the home and community-based service system.

(i) Improve integration of Medicare and Medicaid. This project involves reducing
fragmentation in the health care delivery system to improve care for people eligible for
both Medicare and Medicaid, and to align fiscal incentives between primary, acute, and
long-term care. The proposal may include:

(1) requesting an exception to the new Medicare methodology for payment
adjustment for fully integrated special needs plans for dual eligible individuals;

(2) testing risk adjustment models that may be more favorable to capturing the
needs of frail dually eligible individuals;

(3) requesting an exemption from the Medicare bidding process for fully integrated
special needs plans for the dually eligible;

(4) modifying the Medicare bid process to recognize additional costs of health
home services; and

(5) requesting permission for risk-sharing and gain-sharing.

(j) Intensive residential treatment services. This project would involve providing
intensive residential treatment services for individuals who have serious mental illness
and who have other complex needs. This proposal would allow such individuals to remain
in these settings after mental health symptoms have stabilized, in order to maintain their
mental health and avoid more costly or unnecessary hospital or other residential care due
to their other complex conditions. The commissioner may pursue a specialized rate for
projects created under this section.

(k) Seek federal Medicaid matching funds for Anoka Metro Regional Treatment
Center (AMRTC). This project involves seeking Medicaid reimbursement for medical
services provided to patients to AMRTC, including requesting a waiver of United States
Code, title 42, section 1396d, which prohibits Medicaid reimbursement for expenditures
for services provided by hospitals with more than 16 beds that are primarily focused on
the treatment of mental illness. This waiver would allow AMRTC to serve as a statewide
resource to provide diagnostics and treatment for people with the most complex conditions.

(l) Waivers to allow Medicaid eligibility for children under age 21 receiving care
in residential facilities. This proposal would seek Medicaid reimbursement for any
Medicaid-covered service for children who are placed in residential settings that are
determined to be "institutions for mental diseases," under United States Code, title 42,
section 1396d.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2016.
new text end

Sec. 3.

Minnesota Statutes 2014, section 256L.01, subdivision 3a, is amended to read:

Subd. 3a.

Family.

(a) new text beginExcept as provided in paragraphs (c) and (d), new text end"family" has
the meaning given for family and family size as defined in Code of Federal Regulations,
title 26, section 1.36B-1.

(b) The term includes children who are temporarily absent from the household in
settings such as schools, camps, or parenting time with noncustodial parents.

new text begin (c) For an individual who does not expect to file a federal tax return and does not
expect to be claimed as a dependent for the applicable tax year, "family" has the meaning
given in Code of Federal Regulations, title 42, section 435.603(f)(3).
new text end

new text begin (d) For a married couple, "family" has the meaning given in Code of Federal
Regulations, title 42, section 435.603(f)(4).
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 4.

Minnesota Statutes 2014, section 256L.01, subdivision 5, is amended to read:

Subd. 5.

Income.

"Income" has the meaning given for modified adjusted gross
income, as defined in Code of Federal Regulations, title 26, section 1.36B-1 deleted text begin. deleted text end new text begin, and means a
household's projected annual income for the applicable tax year.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 5.

Minnesota Statutes 2014, section 256L.03, subdivision 5, is amended to read:

Subd. 5.

Cost-sharing.

(a) Except as otherwise provided in this subdivision, the
MinnesotaCare benefit plan shall include the following cost-sharing requirements for all
enrollees:

(1) $3 per prescription for adult enrollees;

(2) $25 for eyeglasses for adult enrollees;

(3) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an
episode of service which is required because of a recipient's symptoms, diagnosis, or
established illness, and which is delivered in an ambulatory setting by a physician or
physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
audiologist, optician, or optometrist;

(4) $6 for nonemergency visits to a hospital-based emergency room for services
provided through December 31, 2010, and $3.50 effective January 1, 2011; and

(5) a family deductible equal to deleted text beginthe maximum amount allowed under Code of
Federal Regulations, title 42, part 447.54 deleted text end deleted text begin. deleted text end new text begin $2.75 per month per family and adjusted
annually by the percentage increase in the medical care component of the CPI-U for
the period of September to September of the preceding calendar year, rounded to the
next-higher five-cent increment.
new text end

(b) Paragraph (a) does not apply to children under the age of 21 new text begin and to American
Indians as defined in Code of Federal Regulations, title 42, section 447.51 new text end.

(c) Paragraph (a), clause (3), does not apply to mental health services.

(d) MinnesotaCare reimbursements to fee-for-service providers and payments to
managed care plans or county-based purchasing plans shall not be increased as a result of
the reduction of the co-payments in paragraph (a), clause (4), effective January 1, 2011.

(e) The commissioner, through the contracting process under section 256L.12,
may allow managed care plans and county-based purchasing plans to waive the family
deductible under paragraph (a), clause (5). The value of the family deductible shall not be
included in the capitation payment to managed care plans and county-based purchasing
plans. Managed care plans and county-based purchasing plans shall certify annually to the
commissioner the dollar value of the family deductible.

new text begin EFFECTIVE DATE. new text end

new text begin The amendment to paragraph (a), clause (5), is effective
retroactively from January 1, 2014. The amendment to paragraph (b) is effective the
day following final enactment.
new text end

Sec. 6.

Minnesota Statutes 2014, section 256L.04, subdivision 1c, is amended to read:

Subd. 1c.

General requirements.

To be eligible for deleted text begincoverage under deleted text end MinnesotaCare,
a person must meet the eligibility requirements of this section. A person eligible for
MinnesotaCare shall not be considered a qualified individual under section 1312 of the
Affordable Care Act, and is not eligible for enrollment in a qualified health plan offered
through MNsure under chapter 62V.

new text begin EFFECTIVE DATE. new text end

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

Sec. 7.

Minnesota Statutes 2014, section 256L.04, subdivision 7b, is amended to read:

Subd. 7b.

Annual income limits adjustment.

The commissioner shall adjust the
income limits under this section deleted text begineach July 1 by the annual update of the federal poverty
guidelines following publication by the United States Department of Health and Human
Services except that the income standards shall not go below those in effect on July 1,
2009 deleted text end new text begin annually on January 1 as provided in Code of Federal Regulations, title 26, section
1.36B-1(h) new text end.

new text begin EFFECTIVE DATE. new text end

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

Sec. 8.

Minnesota Statutes 2014, section 256L.04, subdivision 10, is amended to read:

Subd. 10.

Citizenship requirements.

(a) Eligibility for MinnesotaCare is limited
to citizens or nationals of the United States and lawfully present noncitizens as defined
in Code of Federal Regulations, title deleted text begin8 deleted text end new text begin 45 new text end, section deleted text begin103.12 deleted text end new text begin 152.2 new text end. Undocumented
noncitizens are ineligible for MinnesotaCare. For purposes of this subdivision, an
undocumented noncitizen is an individual who resides in the United States without the
approval or acquiescence of the United States Citizenship and Immigration Services.
Families with children who are citizens or nationals of the United States must cooperate in
obtaining satisfactory documentary evidence of citizenship or nationality according to the
requirements of the federal Deficit Reduction Act of 2005, Public Law 109-171.

(b) Notwithstanding subdivisions 1 and 7, eligible persons include families and
individuals who are lawfully present and ineligible for medical assistance by reason of
immigration status and who have incomes equal to or less than 200 percent of federal
poverty guidelines.

Sec. 9.

Minnesota Statutes 2014, section 256L.05, is amended by adding a subdivision
to read:

new text begin Subd. 2a. new text end

new text begin Eligibility and coverage. new text end

new text begin For purposes of this chapter, an individual
is eligible for MinnesotaCare following a determination by the commissioner that the
individual meets the eligibility criteria for the applicable period of eligibility. For an
individual required to pay a premium, coverage is only available in each month of the
applicable period of eligibility for which a premium is paid.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 10.

Minnesota Statutes 2014, section 256L.05, subdivision 3, is amended to read:

Subd. 3.

Effective date of coverage.

(a) The effective date of coverage is the first
day of the month following the month in which eligibility is approved and the first premium
payment has been received. The effective date of coverage for new members added to the
family is the first day of the month following the month in which the change is reported. All
eligibility criteria must be met by the family at the time the new family member is added.
The income of the new family member is included with the family's modified adjusted gross
income and the adjusted premium begins in the month the new family member is added.

(b) The initial premium must be received by the last working day of the month for
coverage to begin the first day of the following month.

(c) Notwithstanding any other law to the contrary, benefits under sections 256L.01 to
256L.18 are secondary to a plan of insurance or benefit program under which an eligible
person may have coverage and the commissioner shall use cost avoidance techniques to
ensure coordination of any other health coverage for eligible persons. The commissioner
shall identify eligible persons who may have coverage or benefits under other plans of
insurance or who become eligible for medical assistance.

(d) The effective date of coverage for individuals or families who are exempt from
paying premiums under section 256L.15, subdivision 1, paragraph (c), is the first day of
the month following the month in which deleted text beginverification of American Indian status is received
or deleted text end eligibility is approved deleted text begin, whichever is later deleted text end.

Sec. 11.

Minnesota Statutes 2014, section 256L.05, subdivision 3a, is amended to read:

Subd. 3a.

deleted text beginRenewal deleted text end new text begin Redetermination new text end of eligibility.

(a) deleted text beginBeginning July 1, 2007, deleted text end An
enrollee's eligibility must be deleted text beginrenewed every 12 months deleted text end new text begin redetermined on an annual basis new text end.
deleted text beginThe 12-month period begins in the month after the month the application is approved. deleted text end new text begin The
period of eligibility is the entire calendar year following the year in which eligibility is
redetermined. Beginning in calendar year 2015, eligibility redeterminations shall occur
during the open enrollment period for qualified health plans as specified in Code of
Federal Regulations, title 45, section 155.410.
new text end

(b) Each new period of eligibility must take into account any changes in
circumstances that impact eligibility and premium amount. deleted text beginAn enrollee must provide all
the information needed to redetermine eligibility by the first day of the month that ends
the eligibility period. The premium for the new period of eligibility must be received
deleted text end new text beginCoverage begins new text end as provided in section 256L.06 deleted text beginin order for eligibility to continue deleted text end.

deleted text begin (c) For children enrolled in MinnesotaCare, the first period of renewal begins the
month the enrollee turns 21 years of age.
deleted text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 12.

Minnesota Statutes 2014, section 256L.05, subdivision 4, is amended to read:

Subd. 4.

Application processing.

The commissioner of human services shall
determine an applicant's eligibility for MinnesotaCare no more than deleted text begin30 deleted text end new text begin 45 new text end days from the
date that the application is received by the Department of Human Services new text begin as set forth in
Code of Federal Regulations, title 42, section 435.911 new text end. deleted text beginBeginning January 1, 2000, this
requirement also applies to local county human services agencies that determine eligibility
for MinnesotaCare.
deleted text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 13.

Minnesota Statutes 2014, section 256L.06, subdivision 3, is amended to read:

Subd. 3.

Commissioner's duties and payment.

(a) Premiums are dedicated to the
commissioner for MinnesotaCare.

(b) The commissioner shall develop and implement procedures to: (1) require
enrollees to report changes in income; (2) adjust sliding scale premium payments, based
upon both increases and decreases in enrollee income, at the time the change in income
is reported; and (3) disenroll enrollees from MinnesotaCare for failure to pay required
premiums. Failure to pay includes payment with a dishonored check, a returned automatic
bank withdrawal, or a refused credit card or debit card payment. The commissioner may
demand a guaranteed form of payment, including a cashier's check or a money order, as
the only means to replace a dishonored, returned, or refused payment.

(c) Premiums are calculated on a calendar month basis and may be paid on a
monthly, quarterly, or semiannual basis, with the first payment due upon notice from the
commissioner of the premium amount required. The commissioner shall inform applicants
and enrollees of these premium payment options. Premium payment is required before
enrollment is complete and to maintain eligibility in MinnesotaCare. Premium payments
received before noon are credited the same day. Premium payments received after noon
are credited on the next working day.

(d) Nonpayment of the premium will result in disenrollment from the plan
effective for the calendar month new text beginfollowing the month new text endfor which the premium was due.
Persons disenrolled for nonpayment deleted text beginwho pay all past due premiums as well as current
premiums due, including premiums due for the period of disenrollment, within 20 days of
disenrollment, shall be reenrolled retroactively to the first day of disenrollment deleted text end new text begin may not
reenroll prior to the first day of the month following the payment of an amount equal to
two months' premiums new text end.

new text begin EFFECTIVE DATE. new text end

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

Sec. 14.

Minnesota Statutes 2014, section 256L.121, subdivision 1, is amended to read:

Subdivision 1.

Competitive process.

The commissioner of human services shall
establish a competitive process for entering into contracts with participating entities for
the offering of standard health plans through MinnesotaCare. Coverage through standard
health plans must be available to enrollees beginning January 1, 2015. Each standard
health plan must cover the health services listed in and meet the requirements of section
256L.03. The competitive process must meet the requirements of section 1331 of the
Affordable Care Act and be designed to ensure enrollee access to high-quality health care
coverage options. The commissioner, to the extent feasible, shall seek to ensure that
enrollees have a choice of coverage from more than one participating entity within a
geographic area. In counties that were part of a county-based purchasing plan on January
1, 2013, the commissioner shall use the medical assistance competitive procurement
process under section 256B.69, deleted text beginsubdivisions 1 deleted text end deleted text begin to 32, deleted text end under which selection of entities is
based on criteria related to provider network access, coordination of health care with other
local services, alignment with local public health goals, and other factors.

Sec. 15.

Minnesota Statutes 2014, section 270A.03, subdivision 5, is amended to read:

Subd. 5.

Debt.

(a) "Debt" means a legal obligation of a natural person to pay a fixed
and certain amount of money, which equals or exceeds $25 and which is due and payable
to a claimant agency. The term includes criminal fines imposed under section 609.10 or
609.125, fines imposed for petty misdemeanors as defined in section 609.02, subdivision
4a, and restitution. A debt may arise under a contractual or statutory obligation, a court
order, or other legal obligation, but need not have been reduced to judgment.

A debt includes any legal obligation of a current recipient of assistance which is
based on overpayment of an assistance grant where that payment is based on a client
waiver or an administrative or judicial finding of an intentional program violation;
or where the debt is owed to a program wherein the debtor is not a client at the time
notification is provided to initiate recovery under this chapter and the debtor is not a
current recipient of food support, transitional child care, or transitional medical assistance.

(b) A debt does not include any legal obligation to pay a claimant agency for medical
care, including hospitalization if the income of the debtor at the time when the medical
care was rendered does not exceed the following amount:

(1) for an unmarried debtor, an income of $8,800 or less;

(2) for a debtor with one dependent, an income of $11,270 or less;

(3) for a debtor with two dependents, an income of $13,330 or less;

(4) for a debtor with three dependents, an income of $15,120 or less;

(5) for a debtor with four dependents, an income of $15,950 or less; and

(6) for a debtor with five or more dependents, an income of $16,630 or less.

(c) The commissioner shall adjust the income amounts in paragraph (b) by the
percentage determined pursuant to the provisions of section 1(f) of the Internal Revenue
Code, except that in section 1(f)(3)(B) the word "1999" shall be substituted for the word
"1992." For 2001, the commissioner shall then determine the percent change from the 12
months ending on August 31, 1999, to the 12 months ending on August 31, 2000, and in
each subsequent year, from the 12 months ending on August 31, 1999, to the 12 months
ending on August 31 of the year preceding the taxable year. The determination of the
commissioner pursuant to this subdivision shall not be considered a "rule" and shall not
be subject to the Administrative Procedure Act contained in chapter 14. The income
amount as adjusted must be rounded to the nearest $10 amount. If the amount ends in
$5, the amount is rounded up to the nearest $10 amount.

(d) Debt also includes an agreement to pay a MinnesotaCare premium, regardless
of the dollar amount of the premium authorized under new text begin Minnesota Statutes 2014, new text end section
256L.15, subdivision 1a.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2016.
new text end

Sec. 16.

Minnesota Statutes 2014, section 270B.14, subdivision 1, is amended to read:

Subdivision 1.

Disclosure to commissioner of human services.

(a) On the request
of the commissioner of human services, the commissioner shall disclose return information
regarding taxes imposed by chapter 290, and claims for refunds under chapter 290A, to
the extent provided in paragraph (b) and for the purposes set forth in paragraph (c).

(b) Data that may be disclosed are limited to data relating to the identity,
whereabouts, employment, income, and property of a person owing or alleged to be owing
an obligation of child support.

(c) The commissioner of human services may request data only for the purposes of
carrying out the child support enforcement program and to assist in the location of parents
who have, or appear to have, deserted their children. Data received may be used only
as set forth in section 256.978.

(d) The commissioner shall provide the records and information necessary to
administer the supplemental housing allowance to the commissioner of human services.

(e) At the request of the commissioner of human services, the commissioner of
revenue shall electronically match the Social Security numbers and names of participants
in the telephone assistance plan operated under sections 237.69 to 237.71, with those of
property tax refund filers, and determine whether each participant's household income is
within the eligibility standards for the telephone assistance plan.

(f) The commissioner may provide records and information collected under sections
295.50 to 295.59 to the commissioner of human services for purposes of the Medicaid
Voluntary Contribution and Provider-Specific Tax Amendments of 1991, Public Law
102-234. Upon the written agreement by the United States Department of Health and
Human Services to maintain the confidentiality of the data, the commissioner may provide
records and information collected under sections 295.50 to 295.59 to the Centers for
Medicare and Medicaid Services section of the United States Department of Health and
Human Services for purposes of meeting federal reporting requirements.

(g) The commissioner may provide records and information to the commissioner of
human services as necessary to administer the early refund of refundable tax credits.

deleted text begin (h) The commissioner may disclose information to the commissioner of human
services necessary to verify income for eligibility and premium payment under the
MinnesotaCare program, under section 256L.05, subdivision 2.
deleted text end

deleted text begin (i) deleted text end new text begin (h) new text end The commissioner may disclose information to the commissioner of human
services necessary to verify whether applicants or recipients for the Minnesota family
investment program, general assistance, food support, Minnesota supplemental aid
program, and child care assistance have claimed refundable tax credits under chapter 290
and the property tax refund under chapter 290A, and the amounts of the credits.

deleted text begin (j) deleted text end new text begin (i) new text end The commissioner may disclose information to the commissioner of human
services necessary to verify income for purposes of calculating parental contribution
amounts under section 252.27, subdivision 2a.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2016.
new text end

Sec. 17. new text beginREVISOR INSTRUCTION.
new text end

new text begin In Minnesota Statutes and Minnesota Rules, the revisor of statutes shall strike
references to Minnesota Statutes, chapter 256L, and to statutory sections within that
chapter, and shall make all necessary grammatical and conforming changes.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2016.
new text end

Sec. 18. new text begin REPEALER.
new text end

new text begin Subdivision 1. new text end

new text begin MinnesotaCare program. new text end

new text begin Minnesota Statutes 2014, sections
256L.01, subdivisions 1, 1a, 1b, 2, 3, 3a, 5, 6, and 7; 256L.02, subdivisions 1, 2, 3, 5, and
6; 256L.03, subdivisions 1, 1a, 1b, 2, 3, 3a, 3b, 4, 4a, 5, and 6; 256L.04, subdivisions 1,
1a, 1c, 2, 2a, 7, 7a, 7b, 8, 10, 12, 13, and 14; 256L.05, subdivisions 1, 1a, 1b, 1c, 2, 3, 3a,
3c, 4, 5, and 6; 256L.06, subdivision 3; 256L.07, subdivisions 1, 2, 3, and 4; 256L.09,
subdivisions 1, 2, 4, 5, 6, and 7; 256L.10; 256L.11, subdivisions 1, 2, 2a, 3, 4, and 7;
256L.12; 256L.121; 256L.15, subdivisions 1, 1a, 1b, and 2; 256L.18; 256L.22; 256L.24;
256L.26; and 256L.28, new text end new text begin are repealed.
new text end

new text begin Subd. 2. new text end

new text begin Conforming repealers. new text end

new text begin Minnesota Statutes 2014, sections 13.461,
subdivision 26; 16A.724, subdivision 3; 62A.046, subdivision 5; and 256.01, subdivision
35, new text end new text begin are repealed.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2016.
new text end

ARTICLE 3

MNSURE

Section 1. new text beginEXPANDED ACCESS TO QUALIFIED HEALTH PLANS AND
SUBSIDIES.
new text end

new text begin The commissioner of commerce, in consultation with the Board of Directors of
MNsure and the MNsure Legislative Oversight Committee, shall develop a proposal to
allow individuals to purchase qualified health plans outside of MNsure directly from
health plan companies and to allow eligible individuals to receive advanced premium tax
credits and cost-sharing reductions when purchasing these health plans. The commissioner
shall seek all federal waivers and approvals necessary to implement this proposal.
The commissioner shall submit a draft proposal to the MNsure board and the MNsure
Legislative Oversight Committee at least 30 days before submitting a final proposal to the
federal government and shall notify the board and legislative oversight committee of any
federal decision or action related to the proposal.
new text end

Sec. 2.

Minnesota Statutes 2014, section 15A.0815, subdivision 3, is amended to read:

Subd. 3.

Group II salary limits.

The salary for a position listed in this subdivision
shall not exceed 120 percent of the salary of the governor. This limit must be adjusted
annually on January 1. The new limit must equal the limit for the prior year increased
by the percentage increase, if any, in the Consumer Price Index for all urban consumers
from October of the second prior year to October of the immediately prior year. The
commissioner of management and budget must publish the limit on the department's Web
site. This subdivision applies to the following positions:

Executive director of Gambling Control Board;

Commissioner, Iron Range Resources and Rehabilitation Board;

Commissioner, Bureau of Mediation Services;

Ombudsman for Mental Health and Developmental Disabilities;

Chair, Metropolitan Council;

new text begin Executive Director, MNsure;
new text end

School trust lands director;

Executive director of pari-mutuel racing; and

Commissioner, Public Utilities Commission.

Sec. 3.

Minnesota Statutes 2014, section 62A.02, subdivision 2, is amended to read:

Subd. 2.

Approval.

(a) The health plan form shall not be issued, nor shall any
application, rider, endorsement, or rate be used in connection with it, until the expiration
of 60 days after it has been filed unless the commissioner approves it before that time.

(b) Notwithstanding paragraph (a), a rate filed with respect to a policy of accident and
sickness insurance as defined in section 62A.01 by an insurer licensed under chapter 60A,
may be used on or after the date of filing with the commissioner. Rates that are not approved
or disapproved within the 60-day time period are deemed approved. This paragraph does
not apply to Medicare-related coverage as defined in section 62A.3099, subdivision 17.

new text begin (c) For coverage to begin on or after January 1, 2016, and each January 1 thereafter,
health plans in the individual and small group markets that are not grandfathered plans to
be offered outside MNsure and qualified health plans to be offered inside MNsure must
receive rate approval from the commissioner no later than 30 days prior to the beginning
of the annual open enrollment period for MNsure. Premium rates for all carriers in the
applicable market for the next calendar year must be made available to the public by the
commissioner only after all rates for the applicable market are final and approved. Final
and approved rates must be publicly released at a uniform time for all individual and small
group health plans that are not grandfathered plans to be offered outside MNsure and
qualified health plans to be offered inside MNsure, and no later than 30 days prior to the
beginning of the annual open enrollment period for MNsure.
new text end

Sec. 4.

Minnesota Statutes 2014, section 62V.02, is amended by adding a subdivision
to read:

new text begin Subd. 2a. new text end

new text begin Consumer assistance partner. new text end

new text begin "Consumer assistance partner" means
individuals and entities certified by MNsure to serve as a navigator, in-person assister, or
certified application counselor.
new text end

Sec. 5.

Minnesota Statutes 2014, section 62V.03, subdivision 2, is amended to read:

Subd. 2.

Application of other law.

(a) MNsure must be reviewed by the legislative
auditor under section 3.971. The legislative auditor shall audit the books, accounts, and
affairs of MNsure once each year or less frequently as the legislative auditor's funds and
personnel permit. Upon the audit of the financial accounts and affairs of MNsure, MNsure
is liable to the state for the total cost and expenses of the audit, including the salaries paid
to the examiners while actually engaged in making the examination. The legislative
auditor may bill MNsure either monthly or at the completion of the audit. All collections
received for the audits must be deposited in the general fund and are appropriated to
the legislative auditor. Pursuant to section 3.97, subdivision 3a, the Legislative Audit
Commission is requested to direct the legislative auditor to report by March 1, 2014, to
the legislature on any duplication of services that occurs within state government as a
result of the creation of MNsure. The legislative auditor may make recommendations on
consolidating or eliminating any services deemed duplicative. The board shall reimburse
the legislative auditor for any costs incurred in the creation of this report.

(b) Board members of MNsure are subject to sections 10A.07 and 10A.09. Board
members and the personnel of MNsure are subject to section 10A.071.

(c) All meetings of the board shall comply with the open meeting law in chapter
13D deleted text begin, except that: deleted text end new text begin.
new text end

deleted text begin (1) meetings, or portions of meetings, regarding compensation negotiations with the
director or managerial staff may be closed in the same manner and according to the same
procedures identified in section 13D.03;
deleted text end

deleted text begin (2) meetings regarding contract negotiation strategy may be closed in the same
manner and according to the same procedures identified in section 13D.05, subdivision 3,
paragraph (c); and
deleted text end

deleted text begin (3) meetings, or portions of meetings, regarding not public data described in section
62V.06, subdivision 3, and regarding trade secret information as defined in section 13.37,
subdivision 1, paragraph (b), are closed to the public, but must otherwise comply with
the procedures identified in chapter 13D.
deleted text end

(d) MNsure and provisions specified under this chapter are exempt from deleted text begin:
deleted text end

deleted text begin (1) deleted text end chapter 14, including section 14.386, except as specified in section 62V.05 deleted text begin; and deleted text end new text begin.
new text end

deleted text begin (2) chapters 16B and 16C, with the exception of sections 16C.08, subdivision 2,
paragraph (b), clauses (1) to (8); 16C.086; 16C.09, paragraph (a), clauses (1) and (3),
paragraph (b), and paragraph (c); and section 16C.16. However, MNsure, in consultation
with the commissioner of administration, shall implement policies and procedures to
establish an open and competitive procurement process for MNsure that, to the extent
practicable, conforms to the principles and procedures contained in chapters 16B and 16C.
In addition, MNsure may enter into an agreement with the commissioner of administration
for other services.
deleted text end

(e) The board and the Web site are exempt from chapter 60K. Any employee of
MNsure who sells, solicits, or negotiates insurance to individuals or small employers must
be licensed as an insurance producer under chapter 60K.

(f) Section 3.3005 applies to any federal funds received by MNsure.

deleted text begin (g) MNsure is exempt from the following sections in chapter 16E: 16E.01,
subdivision 3, paragraph (b); 16E.03, subdivisions 3 and 4; 16E.04, subdivision 1,
subdivision 2, paragraph (c), and subdivision 3, paragraph (b); 16E.0465; 16E.055;
16E.145; 16E.15; 16E.16; 16E.17; 16E.18; and 16E.22.
deleted text end

deleted text begin (h) deleted text end new text begin (g) new text end A MNsure decision that requires a vote of the board, other than a decision
that applies only to hiring of employees or other internal management of MNsure, is an
"administrative action" under section 10A.01, subdivision 2.

Sec. 6.

Minnesota Statutes 2014, section 62V.04, subdivision 1, is amended to read:

Subdivision 1.

Board.

MNsure is governed by a board of directors with deleted text beginseven deleted text end new text begin 11
new text endmembers.

Sec. 7.

Minnesota Statutes 2014, section 62V.04, subdivision 2, is amended to read:

Subd. 2.

Appointment.

(a) Board membership of MNsure consists of the following:

(1) deleted text beginthree deleted text end new text begin six new text end members appointed by the governor with the advice and consent of
deleted text beginboth deleted text end the senate deleted text beginand the house of representatives acting separately in accordance with
paragraph (d) deleted text end, with one member representing the interests of individual consumers eligible
for individual market coverage, one member representing individual consumers eligible
for public health care program coverage, deleted text beginand deleted text end one member representing small employers new text begin,
one member who is an insurance producer, and two members who are county employees
involved in the administration of public health care programs new text end. Members are appointed to
serve four-year terms following the initial staggered-term lot determination;

(2) three members appointed by the governor with the advice and consent of deleted text beginboth deleted text end the
senate deleted text beginand the house of representatives acting separately in accordance with paragraph (d)
deleted text endwho have demonstrated expertise, leadership, and innovation in the following areas: one
member representing the areas of health administration, health care finance, health plan
purchasing, and health care delivery systems; one member representing the areas of public
health, health disparities, public health care programs, and the uninsured; and one member
representing health policy issues related to the small group and individual markets.
Members are appointed to serve four-year terms following the initial staggered-term lot
determination; deleted text beginand
deleted text end

(3) the commissioner of human services or a designee new text begin; and
new text end

new text begin (4) the chief information officer of MN.IT Services or a designee new text end.

(b) Section 15.0597 shall apply to all appointments, except for the commissioner.

(c) The governor shall make appointments to the board that are consistent with
federal law and regulations regarding its composition and structure. All board members
appointed by the governor must be legal residents of Minnesota.

deleted text begin (d) Upon appointment by the governor, a board member shall exercise duties of
deleted text end deleted text begin office immediately. If both the house of representatives and the senate vote not to confirm
deleted text end deleted text begin an appointment, the appointment terminates on the day following the vote not to confirm
deleted text end deleted text begin in the second body to vote.
deleted text end

deleted text begin (e) deleted text end deleted text beginInitial appointments shall be made by April 30, 2013.
deleted text end

deleted text begin (f) deleted text end new text begin(d) new text end One of the deleted text beginsix deleted text end new text begin nine new text end members appointed under paragraph (a), clause (1) or (2),
must have experience in representing the needs of vulnerable populations and persons
with disabilities.

deleted text begin (g) deleted text end new text begin (e) new text end Membership on the board must include representation from outside the
seven-county metropolitan area, as defined in section 473.121, subdivision 2.

Sec. 8.

Minnesota Statutes 2014, section 62V.04, subdivision 4, is amended to read:

Subd. 4.

Conflicts of interest.

(a) Within one year prior to or at any time during
their appointed term, board members appointed under subdivision 2, paragraph (a),
clauses (1) and (2), shall not be employed by, be a member of the board of directors of, or
otherwise be a representative of a health carrier, institutional health care provider or other
entity providing health care, navigator, deleted text begininsurance producer, deleted text end or other entity in the business
of selling items or services of significant value to or through MNsure. For purposes of this
paragraph, "health care provider or entity" does not include an academic institution.

(b) Board members must recuse themselves from discussion of and voting on
an official matter if the board member has a conflict of interest. new text beginFor board members
other than an insurance producer or a county employee, new text enda conflict of interest means an
association including a financial or personal association that has the potential to bias or
have the appearance of biasing a board member's decisions in matters related to MNsure
or the conduct of activities under this chapter. new text begin The board member who is an insurance
producer and the board members who are county employees are subject to section 10A.07.
new text end

(c) No board member shall have a spouse who is an executive of a health carrier.

(d) No member of the board may currently serve as a lobbyist, as defined under
section 10A.01, subdivision 21.

Sec. 9.

new text begin [62V.045] EXECUTIVE DIRECTOR.
new text end

new text begin The governor shall appoint the executive director of MNsure. The executive director
serves in the unclassified service at the pleasure of the governor.
new text end

Sec. 10.

Minnesota Statutes 2014, section 62V.05, subdivision 1, is amended to read:

Subdivision 1.

General.

(a) The board shall operate MNsure according to this
chapter and applicable state and federal law.

(b) The board has the power to:

(1) employ personnel new text begin, subject to the power of the governor to appoint the executive
director, new text end and delegate administrative, operational, and other responsibilities to the director
and other personnel as deemed appropriate by the board. This authority is subject to
chapters 43A and 179A. The director and managerial staff of MNsure shall serve in the
unclassified service deleted text beginand shall be governed by a compensation plan prepared by the board,
submitted to the commissioner of management and budget for review and comment within
14 days of its receipt, and approved by the Legislative Coordinating Commission and the
legislature under section 3.855, except that section 15A.0815, subdivision 5, paragraph
(e), shall not apply deleted text end new text begin. The director of MNsure shall not receive a salary increase on or
after July 1, 2015, unless the increase is approved under the process specified in section
15A.0815, subdivision 5 new text end;

(2) establish the budget of MNsure;

(3) seek and accept money, grants, loans, donations, materials, services, or
advertising revenue from government agencies, philanthropic organizations, and public
and private sources to fund the operation of MNsure. No health carrier or insurance
producer shall advertise on MNsure;

(4) contract for the receipt and provision of goods and services;

(5) enter into information-sharing agreements with federal and state agencies and
other entities, provided the agreements include adequate protections with respect to
the confidentiality and integrity of the information to be shared, and comply with all
applicable state and federal laws, regulations, and rules, including the requirements of
section 62V.06; and

(6) exercise all powers reasonably necessary to implement and administer the
requirements of this chapter and the Affordable Care Act, Public Law 111-148.

(c) The board shall establish policies and procedures to gather public comment and
provide public notice in the State Register.

(d) Within 180 days of enactment, the board shall establish bylaws, policies, and
procedures governing the operations of MNsure in accordance with this chapter.

Sec. 11.

Minnesota Statutes 2014, section 62V.05, subdivision 5, is amended to read:

Subd. 5.

Health carrier and health plan requirements; new text beginMNsure new text endparticipation.

deleted text begin (a) Beginning January 1, 2015, the board may establish certification requirements
for health carriers and health plans to be offered through MNsure that satisfy federal
requirements under section 1311(c)(1) of the Affordable Care Act, Public Law 111-148.
deleted text end

deleted text begin (b) Paragraph (a) does not apply if by June 1, 2013, the legislature enacts regulatory
requirements that:
deleted text end

deleted text begin (1) apply uniformly to all health carriers and health plans in the individual market;
deleted text end

deleted text begin (2) apply uniformly to all health carriers and health plans in the small group market;
and
deleted text end

deleted text begin (3) satisfy minimum federal certification requirements under section 1311(c)(1) of
the Affordable Care Act, Public Law 111-148.
deleted text end

deleted text begin (c) In accordance with section 1311(e) of the Affordable Care Act, Public Law
111-148, the board shall establish policies and procedures for certification and selection
of health plans to be offered as qualified health plans through MNsure. The board shall
certify and select a health plan as a qualified health plan to be offered through MNsure, if:
deleted text end

deleted text begin (1) the health plan meets the minimum certification requirements established in
paragraph (a) or the market regulatory requirements in paragraph (b);
deleted text end

deleted text begin (2) the board determines that making the health plan available through MNsure is in
the interest of qualified individuals and qualified employers;
deleted text end

deleted text begin (3) the health carrier applying to offer the health plan through MNsure also applies
to offer health plans at each actuarial value level and service area that the health carrier
currently offers in the individual and small group markets; and
deleted text end

deleted text begin (4) the health carrier does not apply to offer health plans in the individual and
small group markets through MNsure under a separate license of a parent organization
or holding company under section 60D.15, that is different from what the health carrier
offers in the individual and small group markets outside MNsure.
deleted text end

deleted text begin (d) In determining the interests of qualified individuals and employers under
paragraph (c), clause (2), the board may not exclude a health plan for any reason specified
under section 1311(e)(1)(B) of the Affordable Care Act, Public Law 111-148. The board
may consider:
deleted text end

deleted text begin (1) affordability;
deleted text end

deleted text begin (2) quality and value of health plans;
deleted text end

deleted text begin (3) promotion of prevention and wellness;
deleted text end

deleted text begin (4) promotion of initiatives to reduce health disparities;
deleted text end

deleted text begin (5) market stability and adverse selection;
deleted text end

deleted text begin (6) meaningful choices and access;
deleted text end

deleted text begin (7) alignment and coordination with state agency and private sector purchasing
strategies and payment reform efforts; and
deleted text end

deleted text begin (8) other criteria that the board determines appropriate.
deleted text end

deleted text begin (e) For qualified health plans offered through MNsure on or after January 1, 2015,
the board shall establish policies and procedures under paragraphs (c) and (d) for selection
of health plans to be offered as qualified health plans through MNsure by February 1
of each year, beginning February 1, 2014. The board shall consistently and uniformly
apply all policies and procedures and any requirements, standards, or criteria to all health
carriers and health plans. For any policies, procedures, requirements, standards, or criteria
that are defined as rules under section 14.02, subdivision 4, the board may use the process
described in subdivision 9.
deleted text end

deleted text begin (f) For 2014, the board shall not have the power to select health carriers and health
plans for participation in MNsure. The board shall permit all health plans that meet the
certification requirements under section 1311(c)(1) of the Affordable Care Act, Public
Law 111-148, to be offered through MNsure.
deleted text end

new text begin (a) The board shall permit all health plans that meet the applicable certification
requirements to be offered through MNsure.
new text end

deleted text begin (g) deleted text end new text begin (b) new text end Under this subdivision, the board shall have the power to verify that health
carriers and health plans are properly certified to be eligible for participation in MNsure.

deleted text begin (h) deleted text end new text begin (c) new text end The board has the authority to decertify health carriers and health plans that
fail to maintain compliance with section 1311(c)(1) of the Affordable Care Act, Public
Law 111-148.

deleted text begin (i) deleted text end new text begin (d) new text end For qualified health plans offered through MNsure beginning January 1,
2015, health carriers must use the most current addendum for Indian health care providers
approved by the Centers for Medicare and Medicaid Services and the tribes as part of their
contracts with Indian health care providers. MNsure shall comply with all future changes
in federal law with regard to health coverage for the tribes.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2015.
new text end

Sec. 12.

Minnesota Statutes 2014, section 62V.05, subdivision 6, is amended to read:

Subd. 6.

Appeals.

(a) The board may conduct hearings, appoint hearing officers,
and recommend final orders related to appeals of any MNsure determinations, except for
those determinations identified in paragraph (d). An appeal by a health carrier regarding
a specific certification deleted text beginor selection deleted text end determination made by MNsure under subdivision 5
must be conducted as a contested case proceeding under chapter 14, with the report or
order of the administrative law judge constituting the final decision in the case, subject to
judicial review under sections 14.63 to 14.69. For other appeals, the board shall establish
hearing processes which provide for a reasonable opportunity to be heard and timely
resolution of the appeal and which are consistent with the requirements of federal law and
guidance. An appealing party may be represented by legal counsel at these hearings, but
this is not a requirement.

(b) MNsure may establish service-level agreements with state agencies to conduct
hearings for appeals. Notwithstanding section 471.59, subdivision 1, a state agency is
authorized to enter into service-level agreements for this purpose with MNsure.

(c) For proceedings under this subdivision, MNsure may be represented by an
attorney who is an employee of MNsure.

(d) This subdivision does not apply to appeals of determinations where a state
agency hearing is available under section 256.045.

Sec. 13.

Minnesota Statutes 2014, section 62V.05, is amended by adding a subdivision
to read:

new text begin Subd. 11. new text end

new text begin Health carrier notification. new text end

new text begin MNsure shall provide a health carrier with
enrollment information for MNsure enrollees who have selected a qualified health plan
that is offered by that health carrier and who have been determined by MNsure to be
eligible for qualified health plan coverage. The enrollment information must be sufficient
for the health carrier to issue coverage and must be provided within 48 hours of the
determination of eligibility by MNsure.
new text end

Sec. 14.

Minnesota Statutes 2014, section 62V.05, is amended by adding a subdivision
to read:

new text begin Subd. 12. new text end

new text begin Purchase of individual health coverage. new text end

new text begin For coverage taking effect on
or after January 1, 2016, the MNsure board shall provide members of a household with the
option of purchasing individual health coverage through MNsure and shall apportion any
advanced premium tax credit available to a household choosing this option between the
separate health plans providing coverage to the household members.
new text end

Sec. 15.

Minnesota Statutes 2014, section 62V.05, is amended by adding a subdivision
to read:

new text begin Subd. 13. new text end

new text begin Prohibition on other product lines. new text end

new text begin MNsure is prohibited from
certifying, selecting, or offering products and policies of coverage that do not meet the
definition of health plan or dental plan as provided in section 62V.02.
new text end

Sec. 16.

Minnesota Statutes 2014, section 62V.11, subdivision 2, is amended to read:

Subd. 2.

Membership; meetings; compensation.

(a) The Legislative Oversight
Committee shall consist of five members of the senate, three members appointed by
the majority leader of the senate, and two members appointed by the minority leader of
the senate; and five members of the house of representatives, three members appointed
by the speaker of the house, and two members appointed by the minority leader of the
house of representatives.

(b) Appointed legislative members serve at the pleasure of the appointing authority
and shall continue to serve until their successors are appointed.

(c) The first meeting of the committee shall be convened by the chair of the
Legislative Coordinating Commission. Members shall elect a chair at the first meeting.
The chair must convene at least one meeting deleted text beginannually deleted text end new text begin each quarter of the year new text end, and may
convene other meetings as deemed necessary.

Sec. 17.

Minnesota Statutes 2014, section 62V.11, is amended by adding a subdivision
to read:

new text begin Subd. 5. new text end

new text begin Reports to the committee. new text end

new text begin (a) The board shall submit an enrollment report
to the Legislative Oversight Committee on a monthly basis. The report must include:
new text end

new text begin (1) total enrollment numbers;
new text end

new text begin (2) the number of commercial plans selected;
new text end

new text begin (3) the percentage of the commercial plans for which the first month's premium
has been paid; and
new text end

new text begin (4) the average number of days between a consumer's submission of an application
and transmittal to the health carrier chosen.
new text end

new text begin (b) At each of the committee's quarterly meetings, the board shall present the
following information:
new text end

new text begin (1) at the first quarterly meeting, a progress report on the most recent MNsure
open enrollment period and a progress report on technology upgrades and any proposed
schedule for future technology upgrades;
new text end

new text begin (2) at the second quarterly meeting, the annual budget for MNsure, as required by
subdivision 4;
new text end

new text begin (3) at the third quarterly meeting, a hearing in conjunction with the Department of
Human Services regarding any backlog created by qualifying life events for enrollees in
public or private health plans through MNsure; and
new text end

new text begin (4) at the fourth quarterly meeting, a hearing in conjunction with the Department of
Commerce on the release of premium rates and in conjunction with the Department of
Human Services on reimbursement of MNsure for public program enrollment.
new text end

Sec. 18.

Minnesota Statutes 2014, section 245C.03, is amended by adding a
subdivision to read:

new text begin Subd. 10. new text end

new text begin MNsure consumer assistance partners. new text end

new text begin Effective January 1, 2016, the
commissioner shall conduct background studies on any individual required under section
256.962, subdivision 9, to have a background study completed under this chapter.
new text end

Sec. 19.

Minnesota Statutes 2014, section 245C.10, is amended by adding a
subdivision to read:

new text begin Subd. 11. new text end

new text begin MNsure consumer assistance partners. new text end

new text begin The commissioner shall recover
the cost of background studies required under section 256.962, subdivision 9, through
a fee of no more than $20 per study. The fees collected under this subdivision are
appropriated to the commissioner for the purpose of conducting background studies.
new text end

Sec. 20.

Minnesota Statutes 2014, section 256.962, is amended by adding a subdivision
to read:

new text begin Subd. 9. new text end

new text begin Background studies for consumer assistance partners. new text end

new text begin Effective January
1, 2016, all consumer assistance partners, as defined in section 62V.02, subdivision 2a, are
required to undergo a background study according to the requirements of chapter 245C.
new text end

Sec. 21. new text beginTRANSITION.
new text end

new text begin (a) The commissioner of management and budget must assign the positions of
managerial employees of MNsure, other than the director, to salary ranges and salaries in
the managerial plan, effective the first payroll period beginning on or after July 1, 2015.
new text end

new text begin (b) Of the four additional members of the board appointed under the amendments
to Minnesota Statutes, section 62V.04, one shall have an initial term of two years, two
shall have an initial term of three years, and one shall have an initial term of four years,
determined by lot by the secretary of state.
new text end

new text begin (c) Board members must be appointed by the governor within 30 days of final
enactment of these sections.
new text end

Sec. 22. new text beginEXPANDED ACCESS TO THE SMALL BUSINESS HEALTH CARE
TAX CREDIT.
new text end

new text begin (a) The commissioner of human services, in consultation with the Board of Directors
of MNsure and the MNsure Legislative Oversight Committee, shall develop a proposal
to allow small employers the ability to receive the small business health care tax credit
when the small employer pays the premiums on behalf of employees enrolled in either a
qualified health plan offered through a small business health options program (SHOP)
marketplace or a small group health plan offered outside of the SHOP marketplace within
MNsure. To be eligible for the tax credit, the small employer must meet the requirements
under the Affordable Care Act, except that employees may be enrolled in a small group
health plan product offered outside of MNsure.
new text end

new text begin (b) The commissioner shall seek all federal waivers and approvals necessary to
implement the proposal in paragraph (a). The commissioner shall submit a draft proposal
to the MNsure board and the MNsure Legislative Oversight Committee at least 30 days
before submitting a final proposal to the federal government, and shall notify the board
and Legislative Oversight Committee of any federal decision or action received regarding
the proposal and submitted waiver.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 23. new text beginCONFIRMATION DEADLINE.
new text end

new text begin Members of the MNsure Board on the effective date of this section and new
members appointed as required by the amendments to Minnesota Statutes, section 62V.04,
are subject to confirmation by the senate. If any of these members is not confirmed by the
senate before adjournment sine die of the 2016 regular session, the appointment of that
member to the board terminates on the day following adjournment sine die.
new text end

Sec. 24.

new text begin ESTABLISHMENT OF FEDERALLY FACILITATED
MARKETPLACE.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The commissioner of commerce, in cooperation
with the secretary of Health and Human Services, shall establish a federally facilitated
marketplace for Minnesota, for coverage beginning January 1, 2017. The federally
facilitated marketplace shall take the place of MNsure, established under Minnesota
Statutes, chapter 62V. In working with the secretary of Health and Human Services to
develop the federally facilitated marketplace, the commissioner of commerce shall:
new text end

new text begin (1) seek to incorporate, where appropriate and cost-effective, elements of the
MNsure eligibility determination system;
new text end

new text begin (2) regularly consult with stakeholder groups, including but not limited to
representatives of state agencies, health care providers, health plan companies, brokers,
and consumers; and
new text end

new text begin (3) seek all available federal grants and funds for state planning and development
costs.
new text end

new text begin Subd. 2. new text end

new text begin Implementation plan; draft legislation. new text end

new text begin The commissioner of commerce,
in consultation with the commissioner of human services, the chief information officer
of MN.IT, and the MNsure Board, shall develop and present to the 2016 legislature an
implementation plan for conversion to a federally facilitated marketplace. The plan must
include draft legislation for any changes in state law necessary to implement a federally
facilitated marketplace, including but not limited to necessary changes to Laws 2013,
chapter 84, and technical and conforming changes related to the repeal of Minnesota
Statutes, chapter 62V.
new text end

new text begin Subd. 3. new text end

new text begin Vendor contract. new text end

new text begin The commissioner of commerce, in consultation with
the commissioner of human services, the chief information officer of MN.IT, and the
MNsure Board, shall contract with a vendor to provide technical assistance in developing
and implementing the plan for conversion to a federally facilitated marketplace.
new text end

new text begin Subd. 4. new text end

new text begin Contingent implementation. new text end

new text begin The commissioner shall not implement
this section if the United States Supreme Court rules in King v. Burwell (No. 14-114)
that persons obtaining qualified health plan coverage through a federally facilitated
marketplace are not eligible for advanced premium tax credits.
new text end

Sec. 25. new text beginREQUIREMENTS FOR STATE MATCH FOR FEDERAL GRANTS.
new text end

new text begin (a) The legislature shall not appropriate or authorize the use of state funds, and the
MNsure Board and the commissioner of human services shall not allocate, authorize the
use of, or expend board or agency funds, as a state match to obtain federal grant funding
for MNsure, including, but not limited to, grants to support the development and operation
of the MNsure eligibility determination system, unless the following conditions are met:
new text end

new text begin (1) 20 percent of the state match and 20 percent of federal grant funds received are
deposited into a premium reimbursement account established by the MNsure Board, for
use as provided in paragraph (b);
new text end

new text begin (2) the commissioner of human services and the legislative auditor have verified
that all persons currently enrolled in medical assistance and MinnesotaCare, who were
enrolled in medical assistance or MinnesotaCare as of September 30, 2013, have had their
eligibility for the program redetermined at least once since September 30, 2013;
new text end

new text begin (3) the administrative costs of MNsure are less than five percent of MNsure's total
operating budget in each year; and
new text end

new text begin (4) verification from the Office of the Legislative Auditor that:
new text end

new text begin (i) all life events or changes in circumstances are being processed in a timely manner
by MNsure and the Department of Human Services; and
new text end

new text begin (ii) MNsure is transmitting electronic enrollment files in a format that conforms with
standards under the federal Health Insurance Portability and Accountability Act of 1996.
new text end

new text begin (b) Funds deposited into the premium reimbursement account shall be used only to
reimburse the first month's premium for health coverage for any individual who submitted
a complete application for qualified health plan coverage through MNsure, but did not
receive their policy card or other appropriate verification of coverage within 20 days of
submittal of the completed application to MNsure. The MNsure Board shall provide this
reimbursement on a first-come, first-served basis, subject to the limits of available funding.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 26. new text beginREPEALER.
new text end

new text begin (a) Minnesota Statutes 2014, sections 62V.01; 62V.02; 62V.03; 62V.04; 62V.05;
62V.06; 62V.07; 62V.08; 62V.09; 62V.10; and 62V.11, new text end new text begin are repealed, effective January 1,
2017. This repealer shall not take effect if the United States Supreme Court rules in King
v. Burwell (No. 14-114) that persons obtaining qualified health plan coverage through a
federally facilitated marketplace are not eligible for advanced premium tax credits.
new text end

new text begin (b) new text end new text begin Minnesota Statutes 2014, section 13D.08, subdivision 5a, new text end new text begin is repealed.
new text end

ARTICLE 4

CONTINUING CARE

Section 1.

Minnesota Statutes 2014, section 13.461, is amended by adding a
subdivision to read:

new text begin Subd. 32. new text end

new text begin ABLE accounts and designated beneficiaries. new text end

new text begin Data on ABLE accounts
and designated beneficiaries of ABLE accounts are classified under section 256Q.05,
subdivision 7.
new text end

Sec. 2.

Minnesota Statutes 2014, section 245A.06, is amended by adding a subdivision
to read:

new text begin Subd. 1a. new text end

new text begin Correction orders and conditional licenses for programs licensed as
home and community-based services. new text end

new text begin (a) For programs licensed under both this chapter
and chapter 245D, if the license holder operates more than one service site under a single
license governed by chapter 245D, the order issued under this section shall be specific to
the service site or sites at which the violations of applicable law or rules occurred. The
order shall not apply to other service sites governed by chapter 245D and operated by the
same license holder unless the commissioner has included in the order the articulable basis
for applying the order to another service site.
new text end

new text begin (b) If the commissioner has issued more than one license to the license holder under
this chapter, the conditions imposed under this section shall be specific to the license for
the program at which the violations of applicable law or rules occurred and shall not apply
to other licenses held by the same license holder if those programs are being operated in
substantial compliance with applicable law and rules.
new text end

Sec. 3.

new text begin [245A.081] SETTLEMENT AGREEMENT.
new text end

new text begin (a) A license holder who has made a timely appeal pursuant to section 245A.06,
subdivision 4, or 245A.07, subdivision 3, or the commissioner may initiate a discussion
about a possible settlement agreement related to the licensing sanction. For the purposes
of this section, the following conditions apply to a settlement agreement reached by the
parties:
new text end

new text begin (1) if the parties enter into a settlement agreement, the effect of the agreement shall
be that the appeal is withdrawn and the agreement shall constitute the full agreement
between the commissioner and the party who filed the appeal; and
new text end

new text begin (2) the settlement agreement must identify the agreed upon actions the license holder
has taken and will take in order to achieve and maintain compliance with the licensing
requirements that the commissioner determined the license holder had violated.
new text end

new text begin (b) Neither the license holder nor the commissioner is required to initiate a
settlement discussion under this section.
new text end

new text begin (c) If a settlement discussion is initiated by the license holder, the commissioner
shall respond to the license holder within 14 calendar days of receipt of the license
holder's submission.
new text end

new text begin (d) If the commissioner agrees to engage in settlement discussions, the commissioner
may decide at any time not to continue settlement discussions with a license holder.
new text end

Sec. 4.

Minnesota Statutes 2014, section 245A.155, subdivision 1, is amended to read:

Subdivision 1.

Licensed foster care and respite care.

This section applies to
foster care agencies and licensed foster care providers who place, supervise, or care for
individuals who rely on medical monitoring equipment to sustain life or monitor a medical
condition new text begin that could become life-threatening without proper use of the medical equipment
new text endin respite care or foster care.

Sec. 5.

Minnesota Statutes 2014, section 245A.155, subdivision 2, is amended to read:

Subd. 2.

Foster care agency requirements.

In order for an agency to place an
individual who relies on medical equipment to sustain life or monitor a medical condition
new text beginthat could become life-threatening without proper use of the medical equipment new text end with a
foster care provider, the agency must ensure that the foster care provider has received the
training to operate such equipment as observed and confirmed by a qualified source,
and that the provider:

(1) is currently caring for an individual who is using the same equipment in the
foster home; or

(2) has written documentation that the foster care provider has cared for an
individual who relied on such equipment within the past six months; or

(3) has successfully completed training with the individual being placed with the
provider.

Sec. 6.

Minnesota Statutes 2014, section 245A.65, subdivision 2, is amended to read:

Subd. 2.

Abuse prevention plans.

All license holders shall establish and enforce
ongoing written program abuse prevention plans and individual abuse prevention plans as
required under section 626.557, subdivision 14.

(a) The scope of the program abuse prevention plan is limited to the population,
physical plant, and environment within the control of the license holder and the location
where licensed services are provided. In addition to the requirements in section 626.557,
subdivision 14, the program abuse prevention plan shall meet the requirements in clauses
(1) to (5).

(1) The assessment of the population shall include an evaluation of the following
factors: age, gender, mental functioning, physical and emotional health or behavior of the
client; the need for specialized programs of care for clients; the need for training of staff to
meet identified individual needs; and the knowledge a license holder may have regarding
previous abuse that is relevant to minimizing risk of abuse for clients.

(2) The assessment of the physical plant where the licensed services are provided
shall include an evaluation of the following factors: the condition and design of the
building as it relates to the safety of the clients; and the existence of areas in the building
which are difficult to supervise.

(3) The assessment of the environment for each facility and for each site when living
arrangements are provided by the agency shall include an evaluation of the following
factors: the location of the program in a particular neighborhood or community; the type
of grounds and terrain surrounding the building; the type of internal programming; and
the program's staffing patterns.

(4) The license holder shall provide an orientation to the program abuse prevention
plan for clients receiving services. If applicable, the client's legal representative must be
notified of the orientation. The license holder shall provide this orientation for each new
person within 24 hours of admission, or for persons who would benefit more from a later
orientation, the orientation may take place within 72 hours.

(5) The license holder's governing body new text begin or the governing body's delegated
representative new text end shall review the plan at least annually using the assessment factors in the
plan and any substantiated maltreatment findings that occurred since the last review. The
governing body new text begin or the governing body's delegated representative new text end shall revise the plan,
if necessary, to reflect the review results.

(6) A copy of the program abuse prevention plan shall be posted in a prominent
location in the program and be available upon request to mandated reporters, persons
receiving services, and legal representatives.

(b) In addition to the requirements in section 626.557, subdivision 14, the individual
abuse prevention plan shall meet the requirements in clauses (1) and (2).

(1) The plan shall include a statement of measures that will be taken to minimize the
risk of abuse to the vulnerable adult when the individual assessment required in section
626.557, subdivision 14, paragraph (b), indicates the need for measures in addition to the
specific measures identified in the program abuse prevention plan. The measures shall
include the specific actions the program will take to minimize the risk of abuse within
the scope of the licensed services, and will identify referrals made when the vulnerable
adult is susceptible to abuse outside the scope or control of the licensed services. When
the assessment indicates that the vulnerable adult does not need specific risk reduction
measures in addition to those identified in the program abuse prevention plan, the
individual abuse prevention plan shall document this determination.

(2) An individual abuse prevention plan shall be developed for each new person as
part of the initial individual program plan or service plan required under the applicable
licensing rule. The review and evaluation of the individual abuse prevention plan shall
be done as part of the review of the program plan or service plan. The person receiving
services shall participate in the development of the individual abuse prevention plan to the
full extent of the person's abilities. If applicable, the person's legal representative shall be
given the opportunity to participate with or for the person in the development of the plan.
The interdisciplinary team shall document the review of all abuse prevention plans at least
annually, using the individual assessment and any reports of abuse relating to the person.
The plan shall be revised to reflect the results of this review.

Sec. 7.

Minnesota Statutes 2014, section 245D.02, is amended by adding a subdivision
to read:

new text begin Subd. 37. new text end

new text begin Working day. new text end

new text begin "Working day" means Monday, Tuesday, Wednesday,
Thursday, or Friday, excluding any legal holiday.
new text end

Sec. 8.

Minnesota Statutes 2014, section 245D.05, subdivision 1, is amended to read:

Subdivision 1.

Health needs.

(a) The license holder is responsible for meeting
health service needs assigned in the coordinated service and support plan or the
coordinated service and support plan addendum, consistent with the person's health needs.
new text beginUnless directed otherwise in the coordinated service and support plan or the coordinated
service and support plan addendum, new text end the license holder is responsible for promptly
notifying the person's legal representative, if any, and the case manager of changes in a
person's physical and mental health needs affecting health service needs assigned to the
license holder in the coordinated service and support plan or the coordinated service
and support plan addendum, when discovered by the license holder, unless the license
holder has reason to know the change has already been reported. The license holder
must document when the notice is provided.

(b) If responsibility for meeting the person's health service needs has been assigned
to the license holder in the coordinated service and support plan or the coordinated service
and support plan addendum, the license holder must maintain documentation on how the
person's health needs will be met, including a description of the procedures the license
holder will follow in order to:

(1) provide medication setup, assistance, or administration according to this chapter.
Unlicensed staff responsible for medication setup or medication administration under this
section must complete training according to section 245D.09, subdivision 4a, paragraph (d);

(2) monitor health conditions according to written instructions from a licensed
health professional;

(3) assist with or coordinate medical, dental, and other health service appointments; or

(4) use medical equipment, devices, or adaptive aides or technology safely and
correctly according to written instructions from a licensed health professional.

Sec. 9.

Minnesota Statutes 2014, section 245D.05, subdivision 2, is amended to read:

Subd. 2.

Medication administration.

(a) For purposes of this subdivision,
"medication administration" means:

(1) checking the person's medication record;

(2) preparing the medication as necessary;

(3) administering the medication or treatment to the person;

(4) documenting the administration of the medication or treatment or the reason for
not administering the medication or treatment; and

(5) reporting to the prescriber or a nurse any concerns about the medication or
treatment, including side effects, effectiveness, or a pattern of the person refusing to
take the medication or treatment as prescribed. Adverse reactions must be immediately
reported to the prescriber or a nurse.

(b)(1) If responsibility for medication administration is assigned to the license holder
in the coordinated service and support plan or the coordinated service and support plan
addendum, the license holder must implement medication administration procedures to
ensure a person takes medications and treatments as prescribed. The license holder must
ensure that the requirements in clauses (2) and (3) have been met before administering
medication or treatment.

(2) The license holder must obtain written authorization from the person or the
person's legal representative to administer medication or treatment deleted text beginand must obtain
reauthorization annually as needed deleted text end. This authorization shall remain in effect unless it is
withdrawn in writing and may be withdrawn at any time. If the person or the person's
legal representative refuses to authorize the license holder to administer medication, the
medication must not be administered. The refusal to authorize medication administration
must be reported to the prescriber as expediently as possible.

(3) For a license holder providing intensive support services, the medication or
treatment must be administered according to the license holder's medication administration
policy and procedures as required under section 245D.11, subdivision 2, clause (3).

(c) The license holder must ensure the following information is documented in the
person's medication administration record:

(1) the information on the current prescription label or the prescriber's current
written or electronically recorded order or prescription that includes the person's name,
description of the medication or treatment to be provided, and the frequency and other
information needed to safely and correctly administer the medication or treatment to
ensure effectiveness;

(2) information on any risks or other side effects that are reasonable to expect, and
any contraindications to its use. This information must be readily available to all staff
administering the medication;

(3) the possible consequences if the medication or treatment is not taken or
administered as directed;

(4) instruction on when and to whom to report the following:

(i) if a dose of medication is not administered or treatment is not performed as
prescribed, whether by error by the staff or the person or by refusal by the person; and

(ii) the occurrence of possible adverse reactions to the medication or treatment;

(5) notation of any occurrence of a dose of medication not being administered or
treatment not performed as prescribed, whether by error by the staff or the person or by
refusal by the person, or of adverse reactions, and when and to whom the report was
made; and

(6) notation of when a medication or treatment is started, administered, changed, or
discontinued.

Sec. 10.

Minnesota Statutes 2014, section 245D.06, subdivision 1, is amended to read:

Subdivision 1.

Incident response and reporting.

(a) The license holder must
respond to incidents under section 245D.02, subdivision 11, that occur while providing
services to protect the health and safety of and minimize risk of harm to the person.

(b) The license holder must maintain information about and report incidents to the
person's legal representative or designated emergency contact and case manager within
24 hours of an incident occurring while services are being provided, within 24 hours of
discovery or receipt of information that an incident occurred, unless the license holder
has reason to know that the incident has already been reported, or as otherwise directed
in a person's coordinated service and support plan or coordinated service and support
plan addendum. An incident of suspected or alleged maltreatment must be reported as
required under paragraph (d), and an incident of serious injury or death must be reported
as required under paragraph (e).

(c) When the incident involves more than one person, the license holder must not
disclose personally identifiable information about any other person when making the report
to each person and case manager unless the license holder has the consent of the person.

(d) Within 24 hours of reporting maltreatment as required under section 626.556
or 626.557, the license holder must inform the case manager of the report unless there is
reason to believe that the case manager is involved in the suspected maltreatment. The
license holder must disclose the nature of the activity or occurrence reported and the
agency that received the report.

(e) The license holder must report the death or serious injury of the person as
required in paragraph (b) and to the Department of Human Services Licensing Division,
and the Office of Ombudsman for Mental Health and Developmental Disabilities as
required under section 245.94, subdivision 2a, within 24 hours of the death new text begin or serious
injury new text end, or receipt of information that the death new text begin or serious injury new text end occurred, unless the license
holder has reason to know that the death new text begin or serious injury new text end has already been reported.

(f) When a death or serious injury occurs in a facility certified as an intermediate
care facility for persons with developmental disabilities, the death or serious injury must
be reported to the Department of Health, Office of Health Facility Complaints, and the
Office of Ombudsman for Mental Health and Developmental Disabilities, as required
under sections 245.91 and 245.94, subdivision 2a, unless the license holder has reason to
know that the death new text begin or serious injury new text end has already been reported.

(g) The license holder must conduct an internal review of incident reports of deaths
and serious injuries that occurred while services were being provided and that were not
reported by the program as alleged or suspected maltreatment, for identification of incident
patterns, and implementation of corrective action as necessary to reduce occurrences.
The review must include an evaluation of whether related policies and procedures were
followed, whether the policies and procedures were adequate, whether there is a need for
additional staff training, whether the reported event is similar to past events with the
persons or the services involved, and whether there is a need for corrective action by the
license holder to protect the health and safety of persons receiving services. Based on
the results of this review, the license holder must develop, document, and implement a
corrective action plan designed to correct current lapses and prevent future lapses in
performance by staff or the license holder, if any.

(h) The license holder must verbally report the emergency use of manual restraint
of a person as required in paragraph (b) within 24 hours of the occurrence. The license
holder must ensure the written report and internal review of all incident reports of the
emergency use of manual restraints are completed according to the requirements in section
245D.061 or successor provisions.

Sec. 11.

Minnesota Statutes 2014, section 245D.06, subdivision 2, is amended to read:

Subd. 2.

Environment and safety.

The license holder must:

(1) ensure the following when the license holder is the owner, lessor, or tenant
of the service site:

(i) the service site is a safe and hazard-free environment;

(ii) that toxic substances or dangerous items are inaccessible to persons served by
the program only to protect the safety of a person receiving services when a known safety
threat exists and not as a substitute for staff supervision or interactions with a person who
is receiving services. If toxic substances or dangerous items are made inaccessible, the
license holder must document an assessment of the physical plant, its environment, and its
population identifying the risk factors which require toxic substances or dangerous items
to be inaccessible and a statement of specific measures to be taken to minimize the safety
risk to persons receiving services and to restore accessibility to all persons receiving
services at the service site;

(iii) doors are locked from the inside to prevent a person from exiting only when
necessary to protect the safety of a person receiving services and not as a substitute for
staff supervision or interactions with the person. If doors are locked from the inside, the
license holder must document an assessment of the physical plant, the environment and
the population served, identifying the risk factors which require the use of locked doors,
and a statement of specific measures to be taken to minimize the safety risk to persons
receiving services at the service site; and

(iv) a staff person is available at the service site who is trained in basic first aid and,
when required in a person's coordinated service and support plan or coordinated service
and support plan addendum, cardiopulmonary resuscitation (CPR) whenever persons are
present and staff are required to be at the site to provide direct support service. The CPR
training must include deleted text beginin-person deleted text end instruction, hands-on practice, and an observed skills
assessment under the direct supervision of a CPR instructor;

(2) maintain equipment, vehicles, supplies, and materials owned or leased by the
license holder in good condition when used to provide services;

(3) follow procedures to ensure safe transportation, handling, and transfers of the
person and any equipment used by the person, when the license holder is responsible for
transportation of a person or a person's equipment;

(4) be prepared for emergencies and follow emergency response procedures to
ensure the person's safety in an emergency; and

(5) follow universal precautions and sanitary practices, including hand washing, for
infection prevention and control, and to prevent communicable diseases.

Sec. 12.

Minnesota Statutes 2014, section 245D.06, subdivision 7, is amended to read:

Subd. 7.

Permitted actions and procedures.

(a) Use of the instructional techniques
and intervention procedures as identified in paragraphs (b) and (c) is permitted when used
on an intermittent or continuous basis. When used on a continuous basis, it must be
addressed in a person's coordinated service and support plan addendum as identified in
sections 245D.07 and 245D.071. For purposes of this chapter, the requirements of this
subdivision supersede the requirements identified in Minnesota Rules, part 9525.2720.

(b) Physical contact or instructional techniques must use the least restrictive
alternative possible to meet the needs of the person and may be used:

(1) to calm or comfort a person by holding that person with no resistance from
that person;

(2) to protect a person known to be at risk of injury due to frequent falls as a result
of a medical condition;

(3) to facilitate the person's completion of a task or response when the person does
not resist or the person's resistance is minimal in intensity and duration;

(4) to block or redirect a person's limbs or body without holding the person or
limiting the person's movement to interrupt the person's behavior that may result in injury
to self or others with less than 60 seconds of physical contact by staff; or

(5) to redirect a person's behavior when the behavior does not pose a serious threat
to the person or others and the behavior is effectively redirected with less than 60 seconds
of physical contact by staff.

(c) Restraint may be used as an intervention procedure to:

(1) allow a licensed health care professional to safely conduct a medical examination
or to provide medical treatment ordered by a licensed health care professional deleted text beginto a person
necessary to promote healing or recovery from an acute, meaning short-term, medical
condition deleted text end;

(2) assist in the safe evacuation or redirection of a person in the event of an
emergency and the person is at imminent risk of harm; or

(3) position a person with physical disabilities in a manner specified in the person's
coordinated service and support plan addendum.

Any use of manual restraint as allowed in this paragraph must comply with the restrictions
identified in subdivision 6, paragraph (b).

(d) Use of adaptive aids or equipment, orthotic devices, or other medical equipment
ordered by a licensed health professional to treat a diagnosed medical condition do not in
and of themselves constitute the use of mechanical restraint.

Sec. 13.

Minnesota Statutes 2014, section 245D.07, subdivision 2, is amended to read:

Subd. 2.

Service planning requirements for basic support services.

(a) License
holders providing basic support services must meet the requirements of this subdivision.

(b) Within 15 new text begin calendar new text end days of service initiation the license holder must complete
a preliminary coordinated service and support plan addendum based on the coordinated
service and support plan.

(c) Within 60 new text begin calendar new text end days of service initiation the license holder must review
and revise as needed the preliminary coordinated service and support plan addendum to
document the services that will be provided including how, when, and by whom services
will be provided, and the person responsible for overseeing the delivery and coordination
of services.

(d) The license holder must participate in service planning and support team
meetings for the person following stated timelines established in the person's coordinated
service and support plan or as requested by the person or the person's legal representative,
the support team or the expanded support team.

Sec. 14.

Minnesota Statutes 2014, section 245D.071, subdivision 5, is amended to read:

Subd. 5.

Service plan review and evaluation.

(a) The license holder must give the
person or the person's legal representative and case manager an opportunity to participate
in the ongoing review and development of the service plan and the methods used to support
the person and accomplish outcomes identified in subdivisions 3 and 4. The license holder,
in coordination with the person's support team or expanded support team, must meet
with the person, the person's legal representative, and the case manager, and participate
in service plan review meetings following stated timelines established in the person's
coordinated service and support plan or coordinated service and support plan addendum or
within 30 days of a written request by the person, the person's legal representative, or the
case manager, at a minimum of once per year. The purpose of the service plan review
is to determine whether changes are needed to the service plan based on the assessment
information, the license holder's evaluation of progress towards accomplishing outcomes,
or other information provided by the support team or expanded support team.

(b) The license holder must summarize the person's status and progress toward
achieving the identified outcomes and make recommendations and identify the rationale
for changing, continuing, or discontinuing implementation of supports and methods
identified in subdivision 4 in a deleted text beginwritten deleted text end report deleted text beginsent to the person or the person's legal
representative and case manager five working days prior to the review meeting, unless the
person, the person's legal representative, or the case manager requests to receive the report
deleted text end new text beginavailable new text end at the time of the new text begin progress review new text end meeting. new text begin The report must be sent at least
five working days prior to the progress review meeting if requested by the team in the
coordinated service and support plan or coordinated service and support plan addendum.
new text end

(c) new text beginThe license holder must send the coordinated service and support plan addendum
to the person, the person's legal representative, and the case manager by mail within ten
working days of the progress review meeting. new text end Within ten working days of the deleted text beginprogress
review meeting deleted text end new text beginmailing of the coordinated service and support plan addendum new text end, the license
holder must obtain dated signatures from the person or the person's legal representative
and the case manager to document approval of any changes to the coordinated service and
support plan addendum.

new text begin (d) If, within ten working days of submitting changes to the coordinated service
and support plan and coordinated service and support plan addendum, the person or the
person's legal representative or case manager has not signed and returned to the license
holder the coordinated service and support plan or coordinated service and support plan
addendum or has not proposed written modifications to the license holder's submission, the
submission is deemed approved and the coordinated service and support plan addendum
becomes effective and remains in effect until the legal representative or case manager
submits a written request to revise the coordinated service and support plan addendum.
new text end

Sec. 15.

Minnesota Statutes 2014, section 245D.09, subdivision 3, is amended to read:

Subd. 3.

Staff qualifications.

(a) The license holder must ensure that staff providing
direct support, or staff who have responsibilities related to supervising or managing the
provision of direct support service, are competent as demonstrated through skills and
knowledge training, experience, and education relevant to the primary disability of the
person and to meet the person's needs and additional requirements as written in the
coordinated service and support plan or coordinated service and support plan addendum,
or when otherwise required by the case manager or the federal waiver plan. The license
holder must verify and maintain evidence of staff competency, including documentation of:

(1) education and experience qualifications relevant to the job responsibilities
assigned to the staff and to the primary disability of persons served by the program,
including a valid degree and transcript, or a current license, registration, or certification,
when a degree or licensure, registration, or certification is required by this chapter or in the
coordinated service and support plan or coordinated service and support plan addendum;

(2) demonstrated competency in the orientation and training areas required under
this chapter, and when applicable, completion of continuing education required to
maintain professional licensure, registration, or certification requirements. Competency in
these areas is determined by the license holder through knowledge testing or observed
skill assessment conducted by the trainer or instructor new text begin or by an individual who has been
previously deemed competent by the trainer or instructor in the area being assessed new text end; and

(3) except for a license holder who is the sole direct support staff, periodic
performance evaluations completed by the license holder of the direct support staff
person's ability to perform the job functions based on direct observation.

(b) Staff under 18 years of age may not perform overnight duties or administer
medication.

Sec. 16.

Minnesota Statutes 2014, section 245D.09, subdivision 5, is amended to read:

Subd. 5.

Annual training.

A license holder must provide annual training to direct
support staff on the topics identified in subdivision 4, clauses (3) to (10). new text beginIf the direct
support staff has a first aid certification, annual training under subdivision 4, clause (9), is
not required as long as the certification remains current. new text endA license holder must provide a
minimum of 24 hours of annual training to direct service staff providing intensive services
and having fewer than five years of documented experience and 12 hours of annual
training to direct service staff providing intensive services and having five or more years
of documented experience in topics described in subdivisions 4 and 4a, paragraphs (a) to
(f). Training on relevant topics received from sources other than the license holder may
count toward training requirements. A license holder must provide a minimum of 12 hours
of annual training to direct service staff providing basic services and having fewer than
five years of documented experience and six hours of annual training to direct service staff
providing basic services and having five or more years of documented experience.

Sec. 17.

Minnesota Statutes 2014, section 245D.22, subdivision 4, is amended to read:

Subd. 4.

First aid must be available on site.

(a) A staff person trained in first
aid must be available on site and, when required in a person's coordinated service and
support plan or coordinated service and support plan addendum, be able to provide
cardiopulmonary resuscitation, whenever persons are present and staff are required to be
at the site to provide direct service. The CPR training must include deleted text beginin-person deleted text end instruction,
hands-on practice, and an observed skills assessment under the direct supervision of a
CPR instructor.

(b) A facility must have first aid kits readily available for use by, and that meet
the needs of, persons receiving services and staff. At a minimum, the first aid kit must
be equipped with accessible first aid supplies including bandages, sterile compresses,
scissors, an ice bag or cold pack, an oral or surface thermometer, mild liquid soap,
adhesive tape, and first aid manual.

Sec. 18.

Minnesota Statutes 2014, section 245D.31, subdivision 3, is amended to read:

Subd. 3.

Staff ratio requirement for each person receiving services.

The case
manager, in consultation with the interdisciplinary team, must determine at least once each
year which of the ratios in subdivisions 4, 5, and 6 is appropriate for each person receiving
services on the basis of the characteristics described in subdivisions 4, 5, and 6. The ratio
assigned each person and the documentation of how the ratio was arrived at must be kept
in each person's individual service plan. Documentation must include an assessment of the
person with respect to the characteristics in subdivisions 4, 5, and 6 deleted text beginrecorded on a standard
assessment form required by the commissioner deleted text end.

Sec. 19.

Minnesota Statutes 2014, section 245D.31, subdivision 4, is amended to read:

Subd. 4.

Person requiring staff ratio of one to four.

A person must be assigned a
staff ratio requirement of one to four if:

(1) on a daily basis the person requires total care and monitoring or constant
hand-over-hand physical guidance to successfully complete at least three of the following
activities: toileting, communicating basic needs, eating, new text begin or new text end ambulating; deleted text beginor is not capable
of taking appropriate action for self-preservation under emergency conditions; deleted text end or

(2) the person engages in conduct that poses an imminent risk of physical harm to
self or others at a documented level of frequency, intensity, or duration requiring frequent
daily ongoing intervention and monitoring as established in the person's coordinated
service and support plan or coordinated service and support plan addendum.

Sec. 20.

Minnesota Statutes 2014, section 245D.31, subdivision 5, is amended to read:

Subd. 5.

Person requiring staff ratio of one to eight.

A person must be assigned a
staff ratio requirement of one to eight if:

(1) the person does not meet the requirements in subdivision 4; and

(2) on a daily basis the person requires verbal prompts or spot checks and minimal
or no physical assistance to successfully complete at least deleted text beginfour deleted text end new text begin three new text end of the following
activities: toileting, communicating basic needs, eating, new text beginor new text endambulating deleted text begin, or taking