2nd Engrossment - 82nd Legislature (2001 - 2002) Posted on 12/15/2009 12:00am
Engrossments | ||
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Introduction | Posted on 03/12/2001 | |
1st Engrossment | Posted on 03/21/2001 | |
2nd Engrossment | Posted on 03/26/2001 |
1.1 A bill for an act 1.2 relating to human services; amending and initiating 1.3 provisions for long-term care; requiring certain 1.4 studies; establishing a pilot project for senior 1.5 services; establishing a long-term care revolving 1.6 fund; establishing a loan forgiveness program; 1.7 requiring nursing services agency registration; 1.8 initiating provisions relating to long-term care 1.9 insurance; appropriating money; amending Minnesota 1.10 Statutes 2000, sections 62A.48, subdivision 4, by 1.11 adding subdivisions; 62S.01, by adding subdivisions; 1.12 62S.26; 116L.11, subdivision 4; 116L.12, subdivisions 1.13 4, 5; 116L.13, subdivision 1; 144.057; 144.1464; 1.14 144.1496, subdivision 3; 144A.071, subdivisions 1, 1a, 1.15 2, 4a; 144A.073, subdivisions 2, 4, by adding a 1.16 subdivision; 144A.16; 144A.62, subdivisions 1, 2, 3, 1.17 4; 245A.04, subdivisions 3, 3a, 3b, 3d; 256.975, by 1.18 adding subdivisions; 256B.056, subdivision 4; 1.19 256B.0911, subdivisions 1, 3, 5, 6, 7, by adding 1.20 subdivisions; 256B.0913, subdivisions 1, 2, 4, 5, 6, 1.21 7, 8, 9, 10, 11, 12, 13, 14; 256B.0915, subdivisions 1.22 1d, 3, 5; 256B.431, subdivisions 2e, 17, by adding 1.23 subdivisions; 256B.434, subdivisions 4, 10; 256B.48, 1.24 subdivision 1; 256B.501, by adding a subdivision; 1.25 256D.35, by adding subdivisions; 256D.44, subdivision 1.26 5; Laws 1999, chapter 245, article 3, section 45, as 1.27 amended; proposing coding for new law in Minnesota 1.28 Statutes, chapters 16A; 62S; 116L; 144; 144A; 256; 1.29 256B; repealing Minnesota Statutes 2000, sections 1.30 116L.10; 116L.12, subdivisions 2, 7; 256B.0911, 1.31 subdivisions 2, 2a, 4, 8, 9; 256B.0913, subdivisions 1.32 3, 15a, 15b, 15c, 16; 256B.0915, subdivisions 3a, 3b, 1.33 3c; Minnesota Rules, parts 9505.2390, 9505.2395, 1.34 9505.2396, 9505.2400, 9505.2405, 9505.2410, 9505.2413, 1.35 9505.2415, 9505.2420, 9505.2425, 9505,2426, 9505.2430, 1.36 9505.2435, 9505.2440, 9505.2445, 9505.2450, 9505.2455, 1.37 9505.2458, 9505.2460, 9505.2465, 9505.2470, 9505.2473, 1.38 9505.2475, 9505.2480, 9505.2485, 9505.2486, 9505.2490, 1.39 9505.2495, 9505.2496; 9505.2500. 1.40 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 1.41 ARTICLE 1 1.42 CONSUMER INFORMATION AND ASSISTANCE 2.1 AND COMMUNITY-BASED CARE 2.2 Section 1. [144A.35] [EXPANSION OF BED DISTRIBUTION STUDY 2.3 AND CREATION OF CRITICAL ACCESS SITES.] 2.4 Subdivision 1. [OLDER ADULT SERVICES DISTRIBUTION 2.5 STUDY.] The commissioner of health, in coordination with the 2.6 commissioner of human services, shall monitor and analyze the 2.7 distribution of older adult services, including, but not limited 2.8 to, nursing home beds, senior housing, housing with services 2.9 units, and home and community-based services in the different 2.10 geographic areas of the state. The study shall include an 2.11 analysis of the impact of amendments to the nursing home 2.12 moratorium law which would allow for transfers of nursing home 2.13 beds within the state. The commissioner of health shall submit 2.14 to the legislature, beginning January 15, 2002, and each January 2.15 15 thereafter, an assessment of the distribution of long-term 2.16 health care services by geographic area, with particular 2.17 attention to service deficits or problems, the designation of 2.18 critical access service sites, and corrective action plans. 2.19 Subd. 2. [CRITICAL ACCESS SERVICE SITE.] "Critical access 2.20 service site" shall include nursing homes, senior housing, 2.21 housing with services, and home and community-based services 2.22 that are certified by the state as necessary providers of health 2.23 care services to a specific geographic area. For purposes of 2.24 this requirement, a "necessary provider of health care services" 2.25 is a provider that is: 2.26 (1) located more than 20 miles, defined as official mileage 2.27 as reported by the Minnesota department of transportation, from 2.28 the next nearest long-term health care provider; 2.29 (2) the sole long-term health care provider in the county; 2.30 or 2.31 (3) a long-term health care provider located in a medically 2.32 underserved area or health professional shortage area. 2.33 Subd. 3. [IDENTIFICATION OF CRITICAL ACCESS SERVICE 2.34 SITES.] Based on the results of the analysis completed in 2.35 subdivision 1, the commissioners of health and human services 2.36 shall identify and designate long-term health care providers as 3.1 critical access service sites. 3.2 Subd. 4. [CRITICAL ACCESS SERVICE SITES.] The commissioner 3.3 of health, in consultation with the commissioner of human 3.4 services, shall: 3.5 (1) develop and implement specific waivers to regulations 3.6 governing health care personnel scope of duties, physical plant 3.7 requirements, and location of community-based services, to 3.8 address critical access service site older adult service needs; 3.9 (2) identify payment barriers to the continued operation of 3.10 older adult services in critical access service sites, and 3.11 provide recommendations on changes to reimbursement rates to 3.12 facilitate the continued operation of these services. 3.13 Sec. 2. Minnesota Statutes 2000, section 256.975, is 3.14 amended by adding a subdivision to read: 3.15 Subd. 7. [CONSUMER INFORMATION AND ASSISTANCE; SENIOR 3.16 LINKAGE.] (a) The Minnesota board on aging shall operate a 3.17 statewide information and assistance service to aid older 3.18 Minnesotans and their families in making informed choices about 3.19 long-term care options and health care benefits. Language 3.20 services to persons with limited English language skills must be 3.21 made available. The service, known as Senior LinkAge Line, must 3.22 be available during business hours through a statewide toll-free 3.23 number and must also be available through the Internet. 3.24 (b) The service must assist older adults, caregivers, and 3.25 providers in accessing information about choices in long-term 3.26 care services that are purchased through private providers or 3.27 available through public options. The service must: 3.28 (1) develop a comprehensive database that includes detailed 3.29 listings in both consumer- and provider-oriented formats; 3.30 (2) make the database accessible on the Internet and 3.31 through other telecommunication and media-related tools; 3.32 (3) link callers to interactive long-term care screening 3.33 tools and make these tools available through the Internet by 3.34 integrating the tools with the database; 3.35 (4) develop community education materials with a focus on 3.36 planning for long-term care and evaluating independent living, 4.1 housing, and service options; 4.2 (5) conduct an outreach campaign to assist older adults and 4.3 their caregivers in finding information on the Internet and 4.4 through other means of communication; 4.5 (6) implement a messaging system for overflow callers and 4.6 respond to these callers by the next business day; 4.7 (7) link callers with county human services and other 4.8 providers to receive more in-depth assistance and consultation 4.9 related to long-term care options; and 4.10 (8) link callers with quality profiles for nursing 4.11 facilities and other providers developed by the commissioner of 4.12 health. 4.13 (c) The Minnesota board on aging shall conduct an 4.14 evaluation of the effectiveness of the statewide information and 4.15 assistance, and submit this evaluation to the legislature by 4.16 December 1, 2002. The evaluation must include an analysis of 4.17 funding adequacy, gaps in service delivery, continuity in 4.18 information between the service and identified linkages, and 4.19 potential use of private funding to enhance the service. 4.20 Sec. 3. [256.9754] [COMMUNITY SERVICES DEVELOPMENT GRANTS 4.21 PROGRAM.] 4.22 Subdivision 1. [DEFINITIONS.] For purposes of this 4.23 section, the following terms have the meanings given. 4.24 (a) "Community" means a town, township, city, or targeted 4.25 neighborhood within a city, or a consortium of towns, townships, 4.26 cities, or targeted neighborhoods within cities. 4.27 (b) "Older adult services" means any services available 4.28 under the elderly waiver program or alternative care grant 4.29 programs; nursing facility services; transportation services; 4.30 respite services; and other community-based services identified 4.31 as necessary either to maintain lifestyle choices for older 4.32 Minnesotans, or to promote independence. 4.33 (c) "Older adult" refers to individuals 65 years of age and 4.34 older. 4.35 Subd. 2. [CREATION.] The community services development 4.36 grants program is created under the administration of the 5.1 commissioner of human services. 5.2 Subd. 3. [PROVISION OF GRANTS.] The commissioner shall 5.3 make grants available to communities, providers of older adult 5.4 services identified in subdivision 1, or to a consortium of 5.5 providers of older adult services, to establish new older adult 5.6 services. Grants may be provided for capital and other costs 5.7 including, but not limited to, start-up and training costs, 5.8 equipment, and supplies related to the establishment of new 5.9 older adult services or other residential or service 5.10 alternatives to nursing facility care. Grants may also be made 5.11 to renovate current buildings, provide transportation services, 5.12 or expand state-funded programs in the area. 5.13 Subd. 4. [ELIGIBILITY.] Grants may be awarded only to 5.14 communities and providers or to a consortium of providers that 5.15 have a local match of 50 percent of the costs for the project in 5.16 the form of donations, local tax dollars, in-kind donations, 5.17 fundraising, or other local matches. 5.18 Subd. 5. [GRANT PREFERENCE.] The commissioner of human 5.19 services may award grants to the extent grant funds are 5.20 available and to the extent applications are approved by the 5.21 commissioner. Denial of approval of an application in one year 5.22 does not preclude submission of an application in a subsequent 5.23 year. The maximum grant amount is limited to $750,000. 5.24 Sec. 4. Minnesota Statutes 2000, section 256B.056, 5.25 subdivision 4, is amended to read: 5.26 Subd. 4. [INCOME.] To be eligible for medical assistance, 5.27 a person eligible under section 256B.055, subdivision 7, not 5.28 receiving supplemental security income program payments, may 5.29 have an income up to 100 percent of the federal poverty 5.30 guidelines, and families and children may have an income up to 5.31 133-1/3 percent of the AFDC income standard in effect under the 5.32 July 16, 1996, AFDC state plan. Effective July 1, 2000, the 5.33 base AFDC standard in effect on July 16, 1996, shall be 5.34 increased by three percent. Effective January 1, 2000, and each 5.35 successive January, recipients of supplemental security income 5.36 may have an income up to the supplemental security income 6.1 standard in effect on that date. In computing income to 6.2 determine eligibility of persons who are not residents of 6.3 long-term care facilities, the commissioner shall disregard 6.4 increases in income as required by Public Law Numbers 94-566, 6.5 section 503; 99-272; and 99-509. Veterans aid and attendance 6.6 benefits and Veterans Administration unusual medical expense 6.7 payments are considered income to the recipient. 6.8 Sec. 5. Minnesota Statutes 2000, section 256B.0911, 6.9 subdivision 1, is amended to read: 6.10 Subdivision 1. [PURPOSE AND GOAL.] (a) The purpose ofthe6.11preadmission screening programlong-term care consultation 6.12 services is to assist persons with long-term or chronic care 6.13 needs in making long-term care decisions and selecting options 6.14 that meet their needs and reflect their preferences. The 6.15 availability of, and access to, information and other types of 6.16 assistance is also intended to prevent or delay certified 6.17 nursing facility placementsby assessing applicants and6.18residents and offering cost-effective alternatives appropriate6.19for the person's needsand to provide transition assistance 6.20 after admission. Further, the goal ofthe programthese 6.21 services is to contain costs associated with unnecessary 6.22 certified nursing facility admissions. The commissioners of 6.23 human services and health shall seek to maximize use of 6.24 available federal and state funds and establish the broadest 6.25 program possible within the funding available. 6.26 (b) These services must be coordinated with services 6.27 provided under sections 256.975, subdivision 7, and 256.9772, 6.28 and with services provided by other public and private agencies 6.29 in the community to offer a variety of cost-effective 6.30 alternatives to persons with disabilities and elderly persons. 6.31 The county agency providing long-term care consultation services 6.32 shall encourage the use of volunteers from families, religious 6.33 organizations, social clubs, and similar civic and service 6.34 organizations to provide community-based services. 6.35 Sec. 6. Minnesota Statutes 2000, section 256B.0911, is 6.36 amended by adding a subdivision to read: 7.1 Subd. 1a. [DEFINITIONS.] For purposes of this section, the 7.2 following definitions apply: 7.3 (a) "Long-term care consultation services" means: 7.4 (1) providing information and education to the general 7.5 public regarding availability of the services authorized under 7.6 this section; 7.7 (2) an intake process that provides access to the services 7.8 described in this section; 7.9 (3) assessment of the health, psychological, and social 7.10 needs of referred individuals; 7.11 (4) assistance in identifying services needed to maintain 7.12 an individual in the least restrictive environment; 7.13 (5) providing recommendations on cost-effective community 7.14 services that are available to the individual; 7.15 (6) development of an individual's community support plan; 7.16 (7) providing information regarding eligibility for 7.17 Minnesota health care programs; 7.18 (8) preadmission screening to determine the need for a 7.19 nursing facility level of care; 7.20 (9) preliminary determination of Minnesota health care 7.21 programs eligibility for individuals who need a nursing facility 7.22 level of care, with appropriate referrals for final 7.23 determination; 7.24 (10) providing recommendations for nursing facility 7.25 placement when there are no cost-effective community services 7.26 available; and 7.27 (11) assistance to transition people back to community 7.28 settings after facility admission. 7.29 (b) "Minnesota health care programs" means the medical 7.30 assistance program under chapter 256B, the alternative care 7.31 program under section 256B.0913, and the prescription drug 7.32 program under section 256.955. 7.33 Sec. 7. Minnesota Statutes 2000, section 256B.0911, 7.34 subdivision 3, is amended to read: 7.35 Subd. 3. [PERSONS RESPONSIBLE FOR CONDUCTING THE7.36PREADMISSION SCREENINGLONG-TERM CARE CONSULTATION TEAM.] (a) A 8.1local screeninglong-term care consultation team shall be 8.2 established by the county board of commissioners. Each local 8.3screeningconsultation team shall consist ofscreeners who are a8.4 at least one social worker andaat least one public health 8.5 nurse from their respective county agencies. The board may 8.6 designate public health or social services as the lead agency 8.7 for long-term care consultation services. If a county does not 8.8 have a public health nurse available, it may request approval 8.9 from the commissioner to assign a county registered nurse with 8.10 at least one year experience in home care to participate on the 8.11 team.The screening team members must confer regarding the most8.12appropriate care for each individual screened.Two or more 8.13 counties may collaborate to establish a joint localscreening8.14 consultation team or teams. 8.15 (b)In assessing a person's needs, screeners shall have a8.16physician available for consultation and shall consider the8.17assessment of the individual's attending physician, if any. The8.18individual's physician shall be included if the physician8.19chooses to participate. Other personnel may be included on the8.20team as deemed appropriate by the county agencies.The team is 8.21 responsible for providing long-term care consultation services 8.22 to all persons located in the county who request the services, 8.23 regardless of eligibility for Minnesota health care programs. 8.24 Sec. 8. Minnesota Statutes 2000, section 256B.0911, is 8.25 amended by adding a subdivision to read: 8.26 Subd. 3a. [ASSESSMENT AND SUPPORT PLANNING.] (a) Persons 8.27 requesting assessment, services planning, or other assistance 8.28 intended to support community-based living must be visited by a 8.29 long-term care consultation team within ten working days after 8.30 the date on which an assessment was requested or recommended. 8.31 Assessments must be conducted according to paragraphs (b) to (g). 8.32 (b) The county may utilize a team of either the social 8.33 worker or public health nurse, or both, to conduct the 8.34 assessment in a face-to-face interview. The screening 8.35 consultation team members must confer regarding the most 8.36 appropriate care for each individual screened or assessed. 9.1 (c) The long-term care consultation team must assess the 9.2 health and social needs of the person, using an assessment form 9.3 provided by the commissioner of human services. 9.4 (d) The team must conduct the assessment in a face-to-face 9.5 interview with the person being assessed and the person's legal 9.6 representative, if applicable. 9.7 (e) The team must provide the person, or the person's legal 9.8 representative, with written recommendations for facility- or 9.9 community-based services. The team must document that the most 9.10 cost-effective alternatives available were offered to the 9.11 individual. For purposes of this requirement, "cost-effective 9.12 alternatives" means community services and living arrangements 9.13 that cost the same as or less than nursing facility care. 9.14 (f) If the person chooses to use community-based services, 9.15 the team must provide the person or the person's legal 9.16 representative with a written community support plan, regardless 9.17 of whether the individual is eligible for Minnesota health care 9.18 programs. The person may request assistance in developing a 9.19 community support plan without participating in a complete 9.20 assessment. 9.21 (g) The team must give the person receiving assessment or 9.22 support planning, or the person's legal representative, 9.23 materials supplied by the commissioner of human services 9.24 containing the following information: 9.25 (1) the purpose of preadmission screening and assessment; 9.26 (2) information about Minnesota health care programs; 9.27 (3) the person's freedom to accept or reject the 9.28 recommendations of the team; 9.29 (4) the person's right to confidentiality under the 9.30 Minnesota Government Data Practices Act, chapter 13; and 9.31 (5) the person's right to appeal the decision regarding the 9.32 need for nursing facility level of care or the county's final 9.33 decisions regarding public programs eligibility according to 9.34 section 256.045, subdivision 3. 9.35 Sec. 9. Minnesota Statutes 2000, section 256B.0911, is 9.36 amended by adding a subdivision to read: 10.1 Subd. 3b. [TRANSITION ASSISTANCE.] (a) A long-term care 10.2 consultation team shall provide assistance to persons residing 10.3 in a nursing facility, hospital, regional treatment center, or 10.4 intermediate care facility for persons with mental retardation 10.5 who request or are referred for such assistance. Transition 10.6 assistance must include assessment, community support plan 10.7 development, referrals to Minnesota health care programs, and 10.8 referrals to programs that provide assistance with housing. 10.9 (b) The county shall develop transition processes with 10.10 institutional social workers and discharge planners to ensure 10.11 that: 10.12 (1) persons admitted to facilities receive information 10.13 about transition assistance that is available; 10.14 (2) the assessment is completed for persons within ten 10.15 working days of the date of request or recommendation for 10.16 assessment; and 10.17 (3) there is a plan for transition and follow-up for the 10.18 individual's return to the community. The plan must require 10.19 notification of other local agencies when a person who may 10.20 require assistance is screened by one county for admission to a 10.21 facility located in another county. 10.22 (c) If a person who is eligible for a Minnesota health care 10.23 program is admitted to a nursing facility, the nursing facility 10.24 must include a consultation team member or the case manager in 10.25 the discharge planning process. 10.26 Sec. 10. Minnesota Statutes 2000, section 256B.0911, is 10.27 amended by adding a subdivision to read: 10.28 Subd. 4a. [PREADMISSION SCREENING ACTIVITIES RELATED TO 10.29 NURSING FACILITY ADMISSIONS.] (a) All applicants to Medicaid 10.30 certified nursing facilities, including certified boarding care 10.31 facilities, must be screened prior to admission regardless of 10.32 income, assets, or funding sources for nursing facility care, 10.33 except as described in subdivision 4b. The purpose of the 10.34 screening is to determine the need for nursing facility level of 10.35 care as described in paragraph (d) and to complete activities 10.36 required under federal law related to mental illness and mental 11.1 retardation as outlined in paragraph (b). 11.2 (b) A person who has a diagnosis or possible diagnosis of 11.3 mental illness, mental retardation, or a related condition must 11.4 receive a preadmission screening before admission regardless of 11.5 the exemptions outlined in subdivision 4b, paragraph (b), to 11.6 identify the need for further evaluation and specialized 11.7 services, unless the admission prior to screening is authorized 11.8 by the local mental health authority or the local developmental 11.9 disabilities case manager, or unless authorized by the county 11.10 agency according to Public Law Number 100-508. 11.11 The following criteria apply to the preadmission screening: 11.12 (1) the county must use forms and criteria developed by the 11.13 commissioner of human services to identify persons who require 11.14 referral for further evaluation and determination of the need 11.15 for specialized services; and 11.16 (2) the evaluation and determination of the need for 11.17 specialized services must be done by: 11.18 (i) a qualified independent mental health professional, for 11.19 persons with a primary or secondary diagnosis of a serious 11.20 mental illness; or 11.21 (ii) a qualified mental retardation professional, for 11.22 persons with a primary or secondary diagnosis of mental 11.23 retardation or related conditions. For purposes of this 11.24 requirement, a qualified mental retardation professional must 11.25 meet the standards for a qualified mental retardation 11.26 professional under Code of Federal Regulations, title 42, 11.27 section 483.430. 11.28 (c) The local county mental health authority or the state 11.29 mental retardation authority under Public Laws Numbers 100-203 11.30 and 101-508 may prohibit admission to a nursing facility if the 11.31 individual does not meet the nursing facility level of care 11.32 criteria or needs specialized services as defined in Public Laws 11.33 Numbers 100-203 and 101-508. For purposes of this section, 11.34 "specialized services" for a person with mental retardation or a 11.35 related condition means active treatment as that term is defined 11.36 under Code of Federal Regulations, title 42, section 483.440, 12.1 paragraph (a), clause (1). 12.2 (d) The determination of the need for nursing facility 12.3 level of care must be made according to criteria developed by 12.4 the commissioner of human services. In assessing a person's 12.5 needs, consultation team members shall have a physician 12.6 available for consultation and shall consider the assessment of 12.7 the individual's attending physician, if any. The individual's 12.8 physician must be included if the physician chooses to 12.9 participate. Other personnel may be included on the team as 12.10 deemed appropriate by the county. 12.11 Sec. 11. Minnesota Statutes 2000, section 256B.0911, is 12.12 amended by adding a subdivision to read: 12.13 Subd. 4b. [EXEMPTIONS AND EMERGENCY ADMISSIONS.] (a) 12.14 Exemptions from the federal screening requirements outlined in 12.15 subdivision 4a, paragraphs (b) and (c), are limited to: 12.16 (1) a person who, having entered an acute care facility 12.17 from a certified nursing facility, is returning to a certified 12.18 nursing facility; and 12.19 (2) a person transferring from one certified nursing 12.20 facility in Minnesota to another certified nursing facility in 12.21 Minnesota. 12.22 (b) Persons who are exempt from preadmission screening for 12.23 purposes of level of care determination include: 12.24 (1) persons described in paragraph (a); 12.25 (2) an individual who has a contractual right to have 12.26 nursing facility care paid for indefinitely by the veterans' 12.27 administration; 12.28 (3) an individual enrolled in a demonstration project under 12.29 section 256B.69, subdivision 8, at the time of application to a 12.30 nursing facility; 12.31 (4) an individual currently being served under the 12.32 alternative care program or under a home and community-based 12.33 services waiver authorized under section 1915(c) of the federal 12.34 Social Security Act; and 12.35 (5) individuals admitted to a certified nursing facility 12.36 for a short-term stay, which is expected to be 14 days or less 13.1 in duration based upon a physician's certification, and who have 13.2 been assessed and approved for nursing facility admission within 13.3 the previous six months. This exemption applies only if the 13.4 consultation team member determines at the time of the initial 13.5 assessment of the six-month period that it is appropriate to use 13.6 the nursing facility for short-term stays and that there is an 13.7 adequate plan of care for return to the home or community-based 13.8 setting. If a stay exceeds 14 days, the individual must be 13.9 referred no later than the first county working day following 13.10 the 14th resident day for a screening, which must be completed 13.11 within five working days of the referral. The payment 13.12 limitations in subdivision 7 apply to an individual found at 13.13 screening to not meet the level of care criteria for admission 13.14 to a certified nursing facility. 13.15 (c) Persons admitted to a Medicaid-certified nursing 13.16 facility from the community on an emergency basis as described 13.17 in paragraph (d) or from an acute care facility on a nonworking 13.18 day must be screened the first working day after admission. 13.19 (d) Emergency admission to a nursing facility prior to 13.20 screening is permitted when all of the following conditions are 13.21 met: 13.22 (1) a person is admitted from the community to a certified 13.23 nursing or certified boarding care facility during county 13.24 nonworking hours; 13.25 (2) a physician has determined that delaying admission 13.26 until preadmission screening is completed would adversely affect 13.27 the person's health and safety; 13.28 (3) there is a recent precipitating event that precludes 13.29 the client from living safely in the community, such as 13.30 sustaining an injury, sudden onset of acute illness, or a 13.31 caregiver's inability to continue to provide care; 13.32 (4) the attending physician has authorized the emergency 13.33 placement and has documented the reason that the emergency 13.34 placement is recommended; and 13.35 (5) the county is contacted on the first working day 13.36 following the emergency admission. 14.1 Transfer of a patient from an acute care hospital to a nursing 14.2 facility is not considered an emergency except for a person who 14.3 has received hospital services in the following situations: 14.4 hospital admission for observation, care in an emergency room 14.5 without hospital admission, or following hospital 24-hour bed 14.6 care. 14.7 Sec. 12. Minnesota Statutes 2000, section 256B.0911, is 14.8 amended by adding a subdivision to read: 14.9 Subd. 4c. [SCREENING REQUIREMENTS.] (a) A person may be 14.10 screened for nursing facility admission by telephone or in a 14.11 face-to-face screening interview. Consultation team members 14.12 shall identify each individual's needs using the following 14.13 categories: 14.14 (1) the person needs no face-to-face screening interview to 14.15 determine the need for nursing facility level of care based on 14.16 information obtained from other health care professionals; 14.17 (2) the person needs an immediate face-to-face screening 14.18 interview to determine the need for nursing facility level of 14.19 care and complete activities required under subdivision 4a; or 14.20 (3) the person may be exempt from screening requirements as 14.21 outlined in subdivision 4b, but will need transitional 14.22 assistance after admission or in-person follow-along after a 14.23 return home. 14.24 (b) Persons admitted on a nonemergency basis to a 14.25 Medicaid-certified nursing facility must be screened prior to 14.26 admission. 14.27 (c) The long-term care consultation team shall recommend a 14.28 case mix classification for persons admitted to a certified 14.29 nursing facility when sufficient information is received to make 14.30 that classification. The nursing facility is authorized to 14.31 conduct all case mix assessments for persons who have been 14.32 screened prior to admission for whom the county did not 14.33 recommend a case mix classification. The nursing facility is 14.34 authorized to conduct all case mix assessments for persons 14.35 admitted to the facility prior to a preadmission screening. The 14.36 county retains the responsibility of distributing appropriate 15.1 case mix forms to the nursing facility. 15.2 (d) The county screening or intake activity must include 15.3 processes to identify persons who may require transition 15.4 assistance as described in subdivision 3b. 15.5 Sec. 13. Minnesota Statutes 2000, section 256B.0911, 15.6 subdivision 5, is amended to read: 15.7 Subd. 5. [SIMPLIFICATION OF FORMSADMINISTRATIVE 15.8 ACTIVITY.] The commissioner shall minimize the number of forms 15.9 required in thepreadmission screening processprovision of 15.10 long-term care consultation services and shall limit the 15.11 screening document to items necessary forcarecommunity support 15.12 plan approval, reimbursement, program planning, evaluation, and 15.13 policy development. 15.14 Sec. 14. Minnesota Statutes 2000, section 256B.0911, 15.15 subdivision 6, is amended to read: 15.16 Subd. 6. [PAYMENT FORPREADMISSION SCREENINGLONG-TERM 15.17 CARE CONSULTATION SERVICES.] (a) The totalscreeningpayment for 15.18 each county must be paid monthly by certified nursing facilities 15.19 in the county. The monthly amount to be paid by each nursing 15.20 facility for each fiscal year must be determined by dividing the 15.21 county's annual allocation forscreeningslong-term care 15.22 consultation services by 12 to determine the monthly payment and 15.23 allocating the monthly payment to each nursing facility based on 15.24 the number of licensed beds in the nursing facility. Payments 15.25 to counties in which there is no certified nursing facility must 15.26 be made by increasing the payment rate of the two facilities 15.27 located nearest to the county seat. 15.28 (b) The commissioner shall include the total annual payment 15.29for screeningdetermined under paragraph (a) for each nursing 15.30 facility according to section 256B.431, subdivision 2b, 15.31 paragraph (g), or 256B.435. 15.32 (c) Payments forscreening activitieslong-term care 15.33 consultation services are available to the county or counties to 15.34 cover staff salaries and expenses to provide thescreening15.35functionservices described in subdivision 1a. Thelead agency15.36 county shall employ, or contract with other agencies to employ, 16.1 within the limits of available funding, sufficient personnel 16.2 toconduct the preadmission screening activityprovide long-term 16.3 care consultation services while meeting the state's long-term 16.4 care outcomes and objectives as defined in section 256B.0917, 16.5 subdivision 1. Thelocal agencycounty shall be accountable for 16.6 meeting local objectives as approved by the commissioner in the 16.7 CSSA biennial plan. 16.8 (d) Notwithstanding section 256B.0641, overpayments 16.9 attributable to payment of the screening costs under the medical 16.10 assistance program may not be recovered from a facility. 16.11 (e) The commissioner of human services shall amend the 16.12 Minnesota medical assistance plan to include reimbursement for 16.13 the localscreeningconsultation teams. 16.14 (f) The county may bill, as case management services, 16.15 assessments, support planning, and follow-along provided to 16.16 persons determined to be eligible for case management under 16.17 Minnesota health care programs. No individual or family member 16.18 shall be charged for an initial assessment or initial support 16.19 plan development provided under subdivision 3a or 3b. 16.20 Sec. 15. Minnesota Statutes 2000, section 256B.0911, 16.21 subdivision 7, is amended to read: 16.22 Subd. 7. [REIMBURSEMENT FOR CERTIFIED NURSING FACILITIES.] 16.23 (a) Medical assistance reimbursement for nursing facilities 16.24 shall be authorized for a medical assistance recipient only if a 16.25 preadmission screening has been conducted prior to admission or 16.26 thelocalcountyagencyhas authorized an exemption. Medical 16.27 assistance reimbursement for nursing facilities shall not be 16.28 provided for any recipient who the local screener has determined 16.29 does not meet the level of care criteria for nursing facility 16.30 placement or, if indicated, has not had a level IIPASARROBRA 16.31 evaluation as required under the federal Omnibus Reconciliation 16.32 Act of 1987 completed unless an admission for a recipient with 16.33 mental illness is approved by the local mental health authority 16.34 or an admission for a recipient with mental retardation or 16.35 related condition is approved by the state mental retardation 16.36 authority. 17.1 (b) The nursing facility must not bill a person who is not 17.2 a medical assistance recipient for resident days that preceded 17.3 the date of completion of screening activities as required under 17.4 subdivisions 4a, 4b, and 4c. The nursing facility must include 17.5 unreimbursed resident days in the nursing facility resident day 17.6 totals reported to the commissioner. 17.7 (c) The commissioner shall make a request to the health 17.8 care financing administration for a waiver allowing screening 17.9 team approval of Medicaid payments for certified nursing 17.10 facility care. An individual has a choice and makes the final 17.11 decision between nursing facility placement and community 17.12 placement after the screening team's recommendation, except as 17.13 provided inparagraphs (b) and (c)subdivision 4a, paragraph (c). 17.14(c) The local county mental health authority or the state17.15mental retardation authority under Public Law Numbers 100-20317.16and 101-508 may prohibit admission to a nursing facility, if the17.17individual does not meet the nursing facility level of care17.18criteria or needs specialized services as defined in Public Law17.19Numbers 100-203 and 101-508. For purposes of this section,17.20"specialized services" for a person with mental retardation or a17.21related condition means "active treatment" as that term is17.22defined in Code of Federal Regulations, title 42, section17.23483.440(a)(1).17.24(e) Appeals from the screening team's recommendation or the17.25county agency's final decision shall be made according to17.26section 256.045, subdivision 3.17.27 Sec. 16. Minnesota Statutes 2000, section 256B.0913, 17.28 subdivision 1, is amended to read: 17.29 Subdivision 1. [PURPOSE AND GOALS.] The purpose of the 17.30 alternative care program is to provide funding foror access to17.31 home and community-based services forfrailelderly persons, in 17.32 order to limit nursing facility placements. The program is 17.33 designed to supportfrailelderly persons in their desire to 17.34 remain in the community as independently and as long as possible 17.35 and to support informal caregivers in their efforts to provide 17.36 care forfrailelderly people. Further, the goals of the 18.1 program are: 18.2 (1) to contain medical assistance expenditures byproviding18.3 funding care in the communityat a cost the same or less than18.4nursing facility costs; and 18.5 (2) to maintain the moratorium on new construction of 18.6 nursing home beds. 18.7 Sec. 17. Minnesota Statutes 2000, section 256B.0913, 18.8 subdivision 2, is amended to read: 18.9 Subd. 2. [ELIGIBILITY FOR SERVICES.] Alternative care 18.10 services are available toall frail olderMinnesotans. This18.11includes:18.12(1) persons who are receiving medical assistance and served18.13under the medical assistance program or the Medicaid waiver18.14program;18.15(2) personsage 65 or older who are not eligible for 18.16 medical assistance without a spenddown or waiver obligation but 18.17 who would be eligible for medical assistance within 180 days of 18.18 admission to a nursing facility andserved undersubject to 18.19 subdivisions 4 to 13; and18.20(3) persons who are paying for their services out-of-pocket. 18.21 Sec. 18. Minnesota Statutes 2000, section 256B.0913, 18.22 subdivision 4, is amended to read: 18.23 Subd. 4. [ELIGIBILITY FOR FUNDING FOR SERVICES FOR 18.24 NONMEDICAL ASSISTANCE RECIPIENTS.] (a) Funding for services 18.25 under the alternative care program is available to persons who 18.26 meet the following criteria: 18.27 (1) the person has beenscreened by the county screening18.28team or, if previously screened and served under the alternative18.29care program, assessed by the local county social worker or18.30public health nursedetermined by a community assessment under 18.31 section 256B.0911, to be a person who would require the level of 18.32 care provided in a nursing facility, but for the provision of 18.33 services under the alternative care program; 18.34 (2) the person is age 65 or older; 18.35 (3) the person would befinanciallyeligible for medical 18.36 assistance within 180 days of admission to a nursing facility; 19.1 (4) the personmeets the asset transfer requirements ofis 19.2 not ineligible for the medical assistance program due to an 19.3 asset transfer penalty; 19.4 (5)the screening team would recommend nursing facility19.5admission or continued stay for the person if alternative care19.6services were not available;19.7(6)the person needs services that are notavailable at19.8that time in the countyfunded through othercounty,state,or 19.9 federal fundingsources; and 19.10(7)(6) the monthly cost of the alternative care services 19.11 funded by the program for this person does not exceed 75 percent 19.12 of the statewideaverage monthly medical assistance payment for19.13nursing facility care at the individual's case mix19.14classificationweighted average monthly nursing facility rate of 19.15 the case mix resident class to which the individual alternative 19.16 care client would be assigned under Minnesota Rules, parts 19.17 9549.0050 to 9549.0059, less the recipient's maintenance needs 19.18 allowance as described in section 256B.0915, subdivision 1d, 19.19 paragraph (a), until the first day of the state fiscal year in 19.20 which the resident assessment system, under section 256B.437, 19.21 for nursing home rate determination is implemented. Effective 19.22 on the first day of the state fiscal year in which a resident 19.23 assessment system, under section 256B.437, for nursing home rate 19.24 determination is implemented and the first day of each 19.25 subsequent state fiscal year, the monthly cost of alternative 19.26 care services for this person shall not exceed the alternative 19.27 care monthly cap for the case mix resident class to which the 19.28 alternative care client would be assigned under Minnesota Rules, 19.29 parts 9549.0050 to 9549.0059, which was in effect on the last 19.30 day of the previous state fiscal year, and adjusted by the 19.31 greater of any legislatively adopted home and community-based 19.32 services cost-of-living percentage increase or any legislatively 19.33 adopted statewide percent rate increase for nursing facilities. 19.34 This monthly limit does not prohibit the alternative care client 19.35 from payment for additional services, but in no case may the 19.36 cost of additional services purchased under this section exceed 20.1 the difference between the client's monthly service limit 20.2 defined under section 256B.0915, subdivision 3, and the 20.3 alternative care program monthly service limit defined in this 20.4 paragraph. If medical supplies and equipment oradaptations20.5 environmental modifications are or will be purchased for an 20.6 alternative care services recipient, the costs may be prorated 20.7 on a monthly basisthroughout the year in which they are20.8purchasedfor up to 12 consecutive months beginning with the 20.9 month of purchase. If the monthly cost of a recipient's other 20.10 alternative care services exceeds the monthly limit established 20.11 in this paragraph, the annual cost of the alternative care 20.12 services shall be determined. In this event, the annual cost of 20.13 alternative care services shall not exceed 12 times the monthly 20.14 limitcalculateddescribed in this paragraph. 20.15 (b)Individuals who meet the criteria in paragraph (a) and20.16who have been approved for alternative care funding are called20.17180-day eligible clients.20.18(c) The statewide average payment for nursing facility care20.19is the statewide average monthly nursing facility rate in effect20.20on July 1 of the fiscal year in which the cost is incurred, less20.21the statewide average monthly income of nursing facility20.22residents who are age 65 or older and who are medical assistance20.23recipients in the month of March of the previous fiscal year.20.24This monthly limit does not prohibit the 180-day eligible client20.25from paying for additional services needed or desired.20.26(d) In determining the total costs of alternative care20.27services for one month, the costs of all services funded by the20.28alternative care program, including supplies and equipment, must20.29be included.20.30(e)Alternative care funding under this subdivision is not 20.31 available for a person who is a medical assistance recipient or 20.32 who would be eligible for medical assistance without a 20.33 spenddown, unless authorized by the commissioneror waiver 20.34 obligation. A person whose initial application for medical 20.35 assistance is being processed may be served under the 20.36 alternative care program for a period up to 60 days. If the 21.1 individual is found to be eligible for medical assistance,the21.2county must billmedical assistance must be billed for services 21.3 payable under the federally approved elderly waiver plan and 21.4 delivered from the date the individual was found eligible 21.5 forservices reimbursable underthe federally approved elderly 21.6 waiverprogramplan. Notwithstanding this provision, 21.7 alternative care funds may not be used to pay for any service 21.8 the cost of which is payable by medical assistance or which is 21.9 used by a recipient to meet a medical assistance income 21.10 spenddown or waiver obligation. 21.11(f)(c) Alternative care funding is not available for a 21.12 person who resides in a licensed nursing homeor, certified 21.13 boarding care home, hospital, or intermediate care facility, 21.14 except for case management services which arebeingprovided in 21.15 support of the discharge planning process to a nursing home 21.16 resident or certified boarding care home resident who is 21.17 ineligible for case management funded by medical assistance. 21.18 Sec. 19. Minnesota Statutes 2000, section 256B.0913, 21.19 subdivision 5, is amended to read: 21.20 Subd. 5. [SERVICES COVERED UNDER ALTERNATIVE CARE.] (a) 21.21 Alternative care funding may be used for payment of costs of: 21.22 (1) adult foster care; 21.23 (2) adult day care; 21.24 (3) home health aide; 21.25 (4) homemaker services; 21.26 (5) personal care; 21.27 (6) case management; 21.28 (7) respite care; 21.29 (8) assisted living; 21.30 (9) residential care services; 21.31 (10) care-related supplies and equipment; 21.32 (11) meals delivered to the home; 21.33 (12) transportation; 21.34 (13) skilled nursing; 21.35 (14) chore services; 21.36 (15) companion services; 22.1 (16) nutrition services; 22.2 (17) training for direct informal caregivers; 22.3 (18) telemedicine devices to monitor recipients in their 22.4 own homes as an alternative to hospital care, nursing home care, 22.5 or home visits;and22.6 (19) other servicesincludingwhich includes discretionary 22.7 funds and direct cash payments to clients,approved by the22.8county agencyfollowing approval by the commissioner, subject to 22.9 the provisions of paragraph(m)(j). Total annual payments for " 22.10 other services" for all clients within a county may not exceed 22.11 either ten percent of that county's annual alternative care 22.12 program base allocation or $5,000, whichever is greater. In no 22.13 case shall this amount exceed the county's total annual 22.14 alternative care program base allocation; and 22.15 (20) environmental modifications. 22.16 (b) The county agency must ensure that the funds are not 22.17 usedonly to supplement and notto supplant services available 22.18 through other public assistance or services programs. 22.19 (c) Unless specified in statute, the service definitions 22.20 and standards for alternative care services shall be the same as 22.21 the service definitions and standardsdefinedspecified in the 22.22 federally approved elderly waiver plan. Except for the county 22.23 agencies' approval of direct cash payments to clients as 22.24 described in paragraph (j) or for a provider of supplies and 22.25 equipment when the monthly cost of the supplies and equipment is 22.26 less than $250, persons or agencies must be employed by or under 22.27 a contract with the county agency or the public health nursing 22.28 agency of the local board of health in order to receive funding 22.29 under the alternative care program. Supplies and equipment may 22.30 be purchased from a non-Medicaid certified vendor if the cost 22.31 for the item is less than that of a Medicaid vendor. 22.32 (d) The adult foster care rate shall be considered a 22.33 difficulty of care payment and shall not include room and 22.34 board. The adult foster caredailyrate shall be negotiated 22.35 between the county agency and the foster care provider.The22.36rate established under this section shall not exceed 75 percent23.1of the state average monthly nursing home payment for the case23.2mix classification to which the individual receiving foster care23.3is assigned, and it must allow for other alternative care23.4services to be authorized by the case manager.The alternative 23.5 care payment for the foster care service in combination with the 23.6 payment for other alternative care services, including case 23.7 management, must not exceed the limit specified in subdivision 23.8 4, paragraph (a), clause (6). 23.9 (e) Personal care servicesmay be provided by a personal23.10care provider organization.must meet the service standards 23.11 defined in the federally approved elderly waiver plan, except 23.12 that a county agency may contract with a client's relativeof23.13the clientwho meets the relative hardship waiver requirement as 23.14 defined in section 256B.0627, subdivision 4, paragraph (b), 23.15 clause (10), to provide personal care services, but must ensure23.16nursingif the county agency ensures supervision of this service 23.17 by a registered nurse or mental health practitioner.Covered23.18personal care services defined in section 256B.0627, subdivision23.194, must meet applicable standards in Minnesota Rules, part23.209505.0335.23.21 (f)A county may use alternative care funds to purchase23.22medical supplies and equipment without prior approval from the23.23commissioner when: (1) there is no other funding source; (2)23.24the supplies and equipment are specified in the individual's23.25care plan as medically necessary to enable the individual to23.26remain in the community according to the criteria in Minnesota23.27Rules, part 9505.0210, item A; and (3) the supplies and23.28equipment represent an effective and appropriate use of23.29alternative care funds. A county may use alternative care funds23.30to purchase supplies and equipment from a non-Medicaid certified23.31vendor if the cost for the items is less than that of a Medicaid23.32vendor. A county is not required to contract with a provider of23.33supplies and equipment if the monthly cost of the supplies and23.34equipment is less than $250.23.35(g)For purposes of this section, residential care services 23.36 are services which are provided to individuals living in 24.1 residential care homes. Residential care homes are currently 24.2 licensed as board and lodging establishments and are registered 24.3 with the department of health as providing special 24.4 services under section 157.17 and are not subject to 24.5 registration under chapter 144D. Residential care services are 24.6 defined as "supportive services" and "health-related services." 24.7 "Supportive services" means the provision of up to 24-hour 24.8 supervision and oversight. Supportive services includes: (1) 24.9 transportation, when provided by the residential carecenter24.10 home only; (2) socialization, when socialization is part of the 24.11 plan of care, has specific goals and outcomes established, and 24.12 is not diversional or recreational in nature; (3) assisting 24.13 clients in setting up meetings and appointments; (4) assisting 24.14 clients in setting up medical and social services; (5) providing 24.15 assistance with personal laundry, such as carrying the client's 24.16 laundry to the laundry room. Assistance with personal laundry 24.17 does not include any laundry, such as bed linen, that is 24.18 included in the room and board rate. "Health-related services" 24.19 are limited to minimal assistance with dressing, grooming, and 24.20 bathing and providing reminders to residents to take medications 24.21 that are self-administered or providing storage for medications, 24.22 if requested. Individuals receiving residential care services 24.23 cannot receive homemaking services funded under this section. 24.24(h)(g) For the purposes of this section, "assisted living" 24.25 refers to supportive services provided by a single vendor to 24.26 clients who reside in the same apartment building of three or 24.27 more units which are not subject to registration under chapter 24.28 144D and are licensed by the department of health as a class A 24.29 home care provider or a class E home care provider. Assisted 24.30 living services are defined as up to 24-hour supervision, and 24.31 oversight, supportive services as defined in clause (1), 24.32 individualized home care aide tasks as defined in clause (2), 24.33 and individualized home management tasks as defined in clause 24.34 (3) provided to residents of a residential center living in 24.35 their units or apartments with a full kitchen and bathroom. A 24.36 full kitchen includes a stove, oven, refrigerator, food 25.1 preparation counter space, and a kitchen utensil storage 25.2 compartment. Assisted living services must be provided by the 25.3 management of the residential center or by providers under 25.4 contract with the management or with the county. 25.5 (1) Supportive services include: 25.6 (i) socialization, when socialization is part of the plan 25.7 of care, has specific goals and outcomes established, and is not 25.8 diversional or recreational in nature; 25.9 (ii) assisting clients in setting up meetings and 25.10 appointments; and 25.11 (iii) providing transportation, when provided by the 25.12 residential center only. 25.13Individuals receiving assisted living services will not25.14receive both assisted living services and homemaking services.25.15Individualized means services are chosen and designed25.16specifically for each resident's needs, rather than provided or25.17offered to all residents regardless of their illnesses,25.18disabilities, or physical conditions.25.19 (2) Home care aide tasks means: 25.20 (i) preparing modified diets, such as diabetic or low 25.21 sodium diets; 25.22 (ii) reminding residents to take regularly scheduled 25.23 medications or to perform exercises; 25.24 (iii) household chores in the presence of technically 25.25 sophisticated medical equipment or episodes of acute illness or 25.26 infectious disease; 25.27 (iv) household chores when the resident's care requires the 25.28 prevention of exposure to infectious disease or containment of 25.29 infectious disease; and 25.30 (v) assisting with dressing, oral hygiene, hair care, 25.31 grooming, and bathing, if the resident is ambulatory, and if the 25.32 resident has no serious acute illness or infectious disease. 25.33 Oral hygiene means care of teeth, gums, and oral prosthetic 25.34 devices. 25.35 (3) Home management tasks means: 25.36 (i) housekeeping; 26.1 (ii) laundry; 26.2 (iii) preparation of regular snacks and meals; and 26.3 (iv) shopping. 26.4 Individuals receiving assisted living services shall not 26.5 receive both assisted living services and homemaking services. 26.6 Individualized means services are chosen and designed 26.7 specifically for each resident's needs, rather than provided or 26.8 offered to all residents regardless of their illnesses, 26.9 disabilities, or physical conditions. Assisted living services 26.10 as defined in this section shall not be authorized in boarding 26.11 and lodging establishments licensed according to sections 26.12 157.011 and 157.15 to 157.22. 26.13(i)(h) For establishments registered under chapter 144D, 26.14 assisted living services under this section means either the 26.15 services describedand licensedin paragraph (g) and delivered 26.16 by a class E home care provider licensed by the department of 26.17 health or the services described under section 144A.4605 and 26.18 delivered by an assisted living home care provider or a class A 26.19 home care provider licensed by the commissioner of health. 26.20(j) For the purposes of this section, reimbursement(i) 26.21 Payment for assisted living services and residential care 26.22 services shall be a monthly rate negotiated and authorized by 26.23 the county agency based on an individualized service plan for 26.24 each resident and may not cover direct rent or food costs.The26.25rate26.26 (1) The individualized monthly negotiated payment for 26.27 assisted living services as described in subdivision 5, 26.28 paragraph (g) or (h), and residential care services as described 26.29 in subdivision 5, paragraph (f), shall not exceed the nonfederal 26.30 share in effect on July 1 of the state fiscal year for which the 26.31 rate limit is being calculated of the greater of either the 26.32 statewide or any of the geographic groups' weighted average 26.33 monthlymedical assistancenursing facility payment rate of the 26.34 case mix resident class to which the180-dayalternative care 26.35 eligible client would be assigned under Minnesota Rules, parts 26.36 9549.0050 to 9549.0059,unless theless the maintenance needs 27.1 allowance as described in subdivision 1d, paragraph (a), until 27.2 the first day of the state fiscal year in which a resident 27.3 assessment system, under section 256B.437, of nursing home rate 27.4 determination is implemented. Effective on the first day of the 27.5 state fiscal year in which a resident assessment system, under 27.6 section 256B.437, of nursing home rate determination is 27.7 implemented and the first day of each subsequent state fiscal 27.8 year, the individualized monthly negotiated payment for the 27.9 services described in this clause shall not exceed the limit 27.10 described in this clause which was in effect on the last day of 27.11 the previous state fiscal year and which has been adjusted by 27.12 the greater of any legislatively adopted home and 27.13 community-based services cost-of-living percentage increase or 27.14 any legislatively adopted statewide percent rate increase for 27.15 nursing facilities. 27.16 (2) The individualized monthly negotiated payment for 27.17 assisted living servicesare provided by a home caredescribed 27.18 under section 144A.4605 and delivered by a provider licensed by 27.19 the department of health as a class A home care provider or an 27.20 assisted living home care provider andareprovided in a 27.21 building that is registered as a housing with services 27.22 establishment under chapter 144D and that provides 24-hour 27.23 supervision in combination with the payment for other 27.24 alternative care services, including case management, must not 27.25 exceed the limit specified in subdivision 4, paragraph (a), 27.26 clause (6). 27.27(k) For purposes of this section, companion services are27.28defined as nonmedical care, supervision and oversight, provided27.29to a functionally impaired adult. Companions may assist the27.30individual with such tasks as meal preparation, laundry and27.31shopping, but do not perform these activities as discrete27.32services. The provision of companion services does not entail27.33hands-on medical care. Providers may also perform light27.34housekeeping tasks which are incidental to the care and27.35supervision of the recipient. This service must be approved by27.36the case manager as part of the care plan. Companion services28.1must be provided by individuals or organizations who are under28.2contract with the local agency to provide the service. Any28.3person related to the waiver recipient by blood, marriage or28.4adoption cannot be reimbursed under this service. Persons28.5providing companion services will be monitored by the case28.6manager.28.7(l) For purposes of this section, training for direct28.8informal caregivers is defined as a classroom or home course of28.9instruction which may include: transfer and lifting skills,28.10nutrition, personal and physical cares, home safety in a home28.11environment, stress reduction and management, behavioral28.12management, long-term care decision making, care coordination28.13and family dynamics. The training is provided to an informal28.14unpaid caregiver of a 180-day eligible client which enables the28.15caregiver to deliver care in a home setting with high levels of28.16quality. The training must be approved by the case manager as28.17part of the individual care plan. Individuals, agencies, and28.18educational facilities which provide caregiver training and28.19education will be monitored by the case manager.28.20(m)(j) A county agency may make payment from their 28.21 alternative care program allocation for "other services" 28.22provided to an alternative care program recipient if those28.23services prevent, shorten, or delay institutionalization. These28.24services maywhich include use of "discretionary funds" for 28.25 services that are not otherwise defined in this section and 28.26 direct cash payments to therecipientclient for the purpose of 28.27 purchasing therecipient'sservices. The following provisions 28.28 apply to payments under this paragraph: 28.29 (1) a cash payment to a client under this provision cannot 28.30 exceed 80 percent of the monthly payment limit for that client 28.31 as specified in subdivision 4, paragraph (a), clause(7)(6); 28.32 (2) a county may not approve any cash payment for a client 28.33 who meets either of the following: 28.34 (i) has been assessed as having a dependency in 28.35 orientation, unless the client has an authorized 28.36 representativeunder section 256.476, subdivision 2, paragraph29.1(g), or for a client who. An "authorized representative" means 29.2 an individual who is at least 18 years of age and is designated 29.3 by the person or the person's legal representative to act on the 29.4 person's behalf. This individual may be a family member, 29.5 guardian, representative payee, or other individual designated 29.6 by the person or the person's legal representative, if any, to 29.7 assist in purchasing and arranging for supports; or 29.8 (ii) is concurrently receiving adult foster care, 29.9 residential care, or assisted living services; 29.10 (3)any service approved under this section must be a29.11service which meets the purpose and goals of the program as29.12listed in subdivision 1;29.13(4) cash payments must also meet the criteria of and are29.14governed by the procedures and liability protection established29.15in section 256.476, subdivision 4, paragraphs (b) through (h),29.16and recipients of cash grants must meet the requirements in29.17section 256.476, subdivision 10; andcash payments to a person 29.18 or a person's family will be provided through a monthly payment 29.19 and be in the form of cash, voucher, or direct county payment to 29.20 vendor. Fees or premiums assessed to the person for eligibility 29.21 for health and human services are not reimbursable through this 29.22 service option. Services and goods purchased through cash 29.23 payments must be identified in the person's individualized care 29.24 plan and must meet all of the following criteria: 29.25 (i) they must be over and above the normal cost of caring 29.26 for the person if the person did not have functional 29.27 limitations; 29.28 (ii) they must be directly attributable to the person's 29.29 functional limitations; 29.30 (iii) they must have the potential to be effective at 29.31 meeting the goals of the program; 29.32 (iv) they must be consistent with the needs identified in 29.33 the individualized service plan. The service plan shall specify 29.34 the needs of the person and family, the form and amount of 29.35 payment, the items and services to be reimbursed, and the 29.36 arrangements for management of the individual grant; and 30.1 (v) the person, the person's family, or the legal 30.2 representative shall be provided sufficient information to 30.3 ensure an informed choice of alternatives. The local agency 30.4 shall document this information in the person's care plan, 30.5 including the type and level of expenditures to be reimbursed; 30.6 (4) the county, lead agency under contract, or tribal 30.7 government under contract to administer the alternative care 30.8 program shall not be liable for damages, injuries, or 30.9 liabilities sustained through the purchase of direct supports or 30.10 goods by the person, the person's family, or the authorized 30.11 representative with funds received through the cash payments 30.12 under this section. Liabilities include, but are not limited 30.13 to, workers' compensation, the Federal Insurance Contributions 30.14 Act (FICA), or the Federal Unemployment Tax Act (FUTA); 30.15 (5) persons receiving grants under this section shall have 30.16 the following responsibilities: 30.17 (i) spend the grant money in a manner consistent with their 30.18 individualized service plan with the local agency; 30.19 (ii) notify the local agency of any necessary changes in 30.20 the grant-expenditures; 30.21 (iii) arrange and pay for supports; and 30.22 (iv) inform the local agency of areas where they have 30.23 experienced difficulty securing or maintaining supports; and 30.24(5)(6) the county shall report client outcomes, services, 30.25 and costs under this paragraph in a manner prescribed by the 30.26 commissioner. 30.27 (k) Upon implementation of direct cash payments to clients 30.28 under this section, any person determined eligible for the 30.29 alternative care program who chooses a cash payment approved by 30.30 the county agency shall receive the cash payment under this 30.31 section and not under section 256.476 unless the person was 30.32 receiving a consumer support grant under section 256.476 before 30.33 implementation of direct cash payments under this section. 30.34 Sec. 20. Minnesota Statutes 2000, section 256B.0913, 30.35 subdivision 6, is amended to read: 30.36 Subd. 6. [ALTERNATIVE CARE PROGRAM ADMINISTRATION.] The 31.1 alternative care program is administered by the county agency. 31.2 This agency is the lead agency responsible for the local 31.3 administration of the alternative care program as described in 31.4 this section. However, it may contract with the public health 31.5 nursing service to be the lead agency. The commissioner may 31.6 contract with federally recognized Indian tribes with a 31.7 reservation in Minnesota to serve as the lead agency responsible 31.8 for the local administration of the alternative care program as 31.9 described in the contract. 31.10 Sec. 21. Minnesota Statutes 2000, section 256B.0913, 31.11 subdivision 7, is amended to read: 31.12 Subd. 7. [CASE MANAGEMENT.] Providers of case management 31.13 services for persons receiving services funded by the 31.14 alternative care program must meet the qualification 31.15 requirements and standards specified in section 256B.0915, 31.16 subdivision 1b. The case manager must ensure the health and 31.17 safety of the individual client and must not approve alternative 31.18 care funding for a client in any setting in which the case 31.19 manager cannot reasonably ensure the client's health and 31.20 safety. The case manager is responsible for the 31.21 cost-effectiveness of the alternative care individual care 31.22 plan and must not approve any care plan in which the cost of 31.23 services funded by alternative care and client contributions 31.24 exceeds the limit specified in section 256B.0915, subdivision 3, 31.25 paragraph (b). The county may allow a case manager employed by 31.26 the county to delegate certain aspects of the case management 31.27 activity to another individual employed by the county provided 31.28 there is oversight of the individual by the case manager. The 31.29 case manager may not delegate those aspects which require 31.30 professional judgment including assessments, reassessments, and 31.31 care plan development. 31.32 Sec. 22. Minnesota Statutes 2000, section 256B.0913, 31.33 subdivision 8, is amended to read: 31.34 Subd. 8. [REQUIREMENTS FOR INDIVIDUAL CARE PLAN.] (a) The 31.35 case manager shall implement the plan of care for each180-day31.36eligiblealternative care client and ensure that a client's 32.1 service needs and eligibility are reassessed at least every 12 32.2 months. The plan shall include any services prescribed by the 32.3 individual's attending physician as necessary to allow the 32.4 individual to remain in a community setting. In developing the 32.5 individual's care plan, the case manager should include the use 32.6 of volunteers from families and neighbors, religious 32.7 organizations, social clubs, and civic and service organizations 32.8 to support the formal home care services. The county shall be 32.9 held harmless for damages or injuries sustained through the use 32.10 of volunteers under this subdivision including workers' 32.11 compensation liability.The lead agency shall provide32.12documentation to the commissioner verifying that the32.13individual's alternative care is not available at that time32.14through any other public assistance or service program.The 32.15 lead agency shall provide documentation in each individual's 32.16 plan of care and, if requested, to the commissioner that the 32.17 most cost-effective alternatives available have been offered to 32.18 the individual and that the individual was free to choose among 32.19 available qualified providers, both public and private. The 32.20 case manager must give the individual a ten-day written notice 32.21 of any decrease in or termination of alternative care services. 32.22 (b) If the county administering alternative care services 32.23 is different than the county of financial responsibility, the 32.24 care plan may be implemented without the approval of the county 32.25 of financial responsibility. 32.26 Sec. 23. Minnesota Statutes 2000, section 256B.0913, 32.27 subdivision 9, is amended to read: 32.28 Subd. 9. [CONTRACTING PROVISIONS FOR PROVIDERS.]The lead32.29agency shall document to the commissioner that the agency made32.30reasonable efforts to inform potential providers of the32.31anticipated need for services under the alternative care program32.32or waiver programs under sections 256B.0915 and 256B.49,32.33including a minimum of 14 days' written advance notice of the32.34opportunity to be selected as a service provider and an annual32.35public meeting with providers to explain and review the criteria32.36for selection. The lead agency shall also document to the33.1commissioner that the agency allowed potential providers an33.2opportunity to be selected to contract with the county agency.33.3Funds reimbursed to counties under this subdivisionAlternative 33.4 care funds paid to service providers are subject to audit by the 33.5 commissioner for fiscal and utilization control. 33.6 The lead agency must select providers for contracts or 33.7 agreements using the following criteria and other criteria 33.8 established by the county: 33.9 (1) the need for the particular services offered by the 33.10 provider; 33.11 (2) the population to be served, including the number of 33.12 clients, the length of time services will be provided, and the 33.13 medical condition of clients; 33.14 (3) the geographic area to be served; 33.15 (4) quality assurance methods, including appropriate 33.16 licensure, certification, or standards, and supervision of 33.17 employees when needed; 33.18 (5) rates for each service and unit of service exclusive of 33.19 county administrative costs; 33.20 (6) evaluation of services previously delivered by the 33.21 provider; and 33.22 (7) contract or agreement conditions, including billing 33.23 requirements, cancellation, and indemnification. 33.24 The county must evaluate its own agency services under the 33.25 criteria established for other providers.The county shall33.26provide a written statement of the reasons for not selecting33.27providers.33.28 Sec. 24. Minnesota Statutes 2000, section 256B.0913, 33.29 subdivision 10, is amended to read: 33.30 Subd. 10. [ALLOCATION FORMULA.] (a) The alternative care 33.31 appropriation for fiscal years 1992 and beyond shall cover 33.32 only180-dayalternative care eligible clients. Prior to July 1 33.33 of each year, the commissioner shall allocate to county agencies 33.34 the state funds available for alternative care for persons 33.35 eligible under subdivision 2. 33.36 (b)Prior to July 1 of each year, the commissioner shall34.1allocate to county agencies the state funds available for34.2alternative care for persons eligible under subdivision 2. The34.3allocation for fiscal year 1992 shall be calculated using a base34.4that is adjusted to exclude the medical assistance share of34.5alternative care expenditures. The adjusted base is calculated34.6by multiplying each county's allocation for fiscal year 1991 by34.7the percentage of county alternative care expenditures for34.8180-day eligible clients. The percentage is determined based on34.9expenditures for services rendered in fiscal year 1989 or34.10calendar year 1989, whichever is greater.The adjusted base for 34.11 each county is the county's current fiscal year base allocation 34.12 plus any targeted funds approved during the current fiscal 34.13 year. Calculations for paragraphs (c) and (d) are to be made as 34.14 follows: for each county, the determination of alternative care 34.15 program expenditures shall be based on payments for services 34.16 rendered from April 1 through March 31 in the base year, to the 34.17 extent that claims have been submitted and paid by June 1 of 34.18 that year. 34.19 (c) If thecountyalternative care program expendituresfor34.20180-day eligible clientsas defined in paragraph (b) are 95 34.21 percent or more ofitsthe county's adjusted base allocation, 34.22 the allocation for the next fiscal year is 100 percent of the 34.23 adjusted base, plus inflation to the extent that inflation is 34.24 included in the state budget. 34.25 (d) If thecountyalternative care program expendituresfor34.26180-day eligible clientsas defined in paragraph (b) are less 34.27 than 95 percent ofitsthe county's adjusted base allocation, 34.28 the allocation for the next fiscal year is the adjusted base 34.29 allocation less the amount of unspent funds below the 95 percent 34.30 level. 34.31 (e)For fiscal year 1992 only, a county may receive an34.32increased allocation if annualized service costs for the month34.33of May 1991 for 180-day eligible clients are greater than the34.34allocation otherwise determined. A county may apply for this34.35increase by reporting projected expenditures for May to the34.36commissioner by June 1, 1991. The amount of the allocation may35.1exceed the amount calculated in paragraph (b). The projected35.2expenditures for May must be based on actual 180-day eligible35.3client caseload and the individual cost of clients' care plans.35.4If a county does not report its expenditures for May, the amount35.5in paragraph (c) or (d) shall be used.35.6(f) Calculations for paragraphs (c) and (d) are to be made35.7as follows: for each county, the determination of expenditures35.8shall be based on payments for services rendered from April 135.9through March 31 in the base year, to the extent that claims35.10have been submitted by June 1 of that year. Calculations for35.11paragraphs (c) and (d) must also include the funds transferred35.12to the consumer support grant program for clients who have35.13transferred to that program from April 1 through March 31 in the35.14base year.35.15(g) For the biennium ending June 30, 2001, the allocation35.16of state funds to county agencies shall be calculated as35.17described in paragraphs (c) and (d).If the annual legislative 35.18 appropriation for the alternative care program is inadequate to 35.19 fund the combined county allocations forfiscal year 2000 or35.202001a biennium, the commissioner shall distribute to each 35.21 county the entire annual appropriation as that county's 35.22 percentage of the computed base as calculated inparagraph35.23(f)paragraphs (c) and (d). 35.24 Sec. 25. Minnesota Statutes 2000, section 256B.0913, 35.25 subdivision 11, is amended to read: 35.26 Subd. 11. [TARGETED FUNDING.] (a) The purpose of targeted 35.27 funding is to make additional money available to counties with 35.28 the greatest need. Targeted funds are not intended to be 35.29 distributed equitably among all counties, but rather, allocated 35.30 to those with long-term care strategies that meet state goals. 35.31 (b) The funds available for targeted funding shall be the 35.32 total appropriation for each fiscal year minus county 35.33 allocations determined under subdivision 10 as adjusted for any 35.34 inflation increases provided in appropriations for the biennium. 35.35 (c) The commissioner shall allocate targeted funds to 35.36 counties that demonstrate to the satisfaction of the 36.1 commissioner that they have developed feasible plans to increase 36.2 alternative care spending. In making targeted funding 36.3 allocations, the commissioner shall use the following priorities: 36.4 (1) counties that received a lower allocation in fiscal 36.5 year 1991 than in fiscal year 1990. Counties remain in this 36.6 priority until they have been restored to their fiscal year 1990 36.7 level plus inflation; 36.8 (2) counties that sustain a base allocation reduction for 36.9 failure to spend 95 percent of the allocation if they 36.10 demonstrate that the base reduction should be restored; 36.11 (3) counties that propose projects to divert community 36.12 residents from nursing home placement or convert nursing home 36.13 residents to community living; and 36.14 (4) counties that can otherwise justify program growth by 36.15 demonstrating the existence of waiting lists, demographically 36.16 justified needs, or other unmet needs. 36.17 (d) Counties that would receive targeted funds according to 36.18 paragraph (c) must demonstrate to the commissioner's 36.19 satisfaction that the funds would be appropriately spent by 36.20 showing how the funds would be used to further the state's 36.21 alternative care goals as described in subdivision 1, and that 36.22 the county has the administrative and service delivery 36.23 capability to use them. 36.24 (e) The commissioner shall request applicationsby June 136.25each year, for county agencies to applyfor targeted funds by 36.26 November 1 of each year. The counties selected for targeted 36.27 funds shall be notified of the amount of their additional 36.28 fundingby August 1 of each year. Targeted funds allocated to a 36.29 county agency in one year shall be treated as part of the 36.30 county's base allocation for that year in determining 36.31 allocations for subsequent years. No reallocations between 36.32 counties shall be made. 36.33(f) The allocation for each year after fiscal year 199236.34shall be determined using the previous fiscal year's allocation,36.35including any targeted funds, as the base and then applying the36.36criteria under subdivision 10, paragraphs (c), (d), and (f), to37.1the current year's expenditures.37.2 Sec. 26. Minnesota Statutes 2000, section 256B.0913, 37.3 subdivision 12, is amended to read: 37.4 Subd. 12. [CLIENT PREMIUMS.] (a) A premium is required for 37.5 all180-dayalternative care eligible clients to help pay for 37.6 the cost of participating in the program. The amount of the 37.7 premium for the alternative care client shall be determined as 37.8 follows: 37.9 (1) when the alternative care client's income less 37.10 recurring and predictable medical expenses is greater than the 37.11medical assistance income standardrecipient's maintenance needs 37.12 allowance as defined in section 256B.0915, subdivision 1d, 37.13 paragraph (a), but less than 150 percent of the federal poverty 37.14 guideline effective on July 1 of the state fiscal year in which 37.15 the premium is being computed, and total assets are less than 37.16 $10,000, the fee is zero; 37.17 (2) when the alternative care client's income less 37.18 recurring and predictable medical expenses is greater than 150 37.19 percent of the federal poverty guideline effective on July 1 of 37.20 the state fiscal year in which the premium is being computed, 37.21 and total assets are less than $10,000, the fee is 25 percent of 37.22 the cost of alternative care services or the difference between 37.23 150 percent of the federal poverty guideline effective on July 1 37.24 of the state fiscal year in which the premium is being computed 37.25 and the client's income less recurring and predictable medical 37.26 expenses, whichever is less; and 37.27 (3) when the alternative care client's total assets are 37.28 greater than $10,000, the fee is 25 percent of the cost of 37.29 alternative care services. 37.30 For married persons, total assets are defined as the total 37.31 marital assets less the estimated community spouse asset 37.32 allowance, under section 256B.059, if applicable. For married 37.33 persons, total income is defined as the client's income less the 37.34 monthly spousal allotment, under section 256B.058. 37.35 All alternative care services except case management shall 37.36 be included in the estimated costs for the purpose of 38.1 determining 25 percent of the costs. 38.2 The monthly premium shall be calculated based on the cost 38.3 of the first full month of alternative care services and shall 38.4 continue unaltered until the next reassessment is completed or 38.5 at the end of 12 months, whichever comes first. Premiums are 38.6 due and payable each month alternative care services are 38.7 received unless the actual cost of the services is less than the 38.8 premium. 38.9 (b) The fee shall be waived by the commissioner when: 38.10 (1) a person who is residing in a nursing facility is 38.11 receiving case management only; 38.12 (2) a person is applying for medical assistance; 38.13 (3) a married couple is requesting an asset assessment 38.14 under the spousal impoverishment provisions; 38.15 (4)a person is a medical assistance recipient, but has38.16been approved for alternative care-funded assisted living38.17services;38.18(5)a person is found eligible for alternative care, but is 38.19 not yet receiving alternative care services; or 38.20(6)(5) a person's fee under paragraph (a) is less than $25. 38.21 (c) The county agency must collect the premium from the 38.22 client and forward the amounts collected to the commissioner in 38.23 the manner and at the times prescribed by the commissioner. 38.24 Money collected must be deposited in the general fund and is 38.25 appropriated to the commissioner for the alternative care 38.26 program. The client must supply the county with the client's 38.27 social security number at the time of application. If a client 38.28 fails or refuses to pay the premium due, the county shall supply 38.29 the commissioner with the client's social security number and 38.30 other information the commissioner requires to collect the 38.31 premium from the client. The commissioner shall collect unpaid 38.32 premiums using the Revenue Recapture Act in chapter 270A and 38.33 other methods available to the commissioner. The commissioner 38.34 may require counties to inform clients of the collection 38.35 procedures that may be used by the state if a premium is not 38.36 paid. 39.1 (d) The commissioner shall begin to adopt emergency or 39.2 permanent rules governing client premiums within 30 days after 39.3 July 1, 1991, including criteria for determining when services 39.4 to a client must be terminated due to failure to pay a premium. 39.5 Sec. 27. Minnesota Statutes 2000, section 256B.0913, 39.6 subdivision 13, is amended to read: 39.7 Subd. 13. [COUNTY BIENNIAL PLAN.] The county biennial plan 39.8 forthe preadmission screening programlong-term care 39.9 consultation under section 256B.0911, the alternative care 39.10 program under this section, and waivers for the elderly under 39.11 section 256B.0915,and waivers for the disabled under section39.12256B.49,shall be incorporated into the biennial Community 39.13 Social Services Act plan and shall meet the regulations and 39.14 timelines of that plan.This county biennial plan shall include:39.15(1) information on the administration of the preadmission39.16screening program;39.17(2) information on the administration of the home and39.18community-based services waivers for the elderly under section39.19256B.0915, and for the disabled under section 256B.49; and39.20(3) information on the administration of the alternative39.21care program.39.22 Sec. 28. Minnesota Statutes 2000, section 256B.0913, 39.23 subdivision 14, is amended to read: 39.24 Subd. 14. [REIMBURSEMENTPAYMENT AND RATE ADJUSTMENTS.] (a) 39.25ReimbursementPayment forexpenditures for theprovided 39.26 alternative care services as approved by the client's case 39.27 manager shall be through the invoice processing procedures of 39.28 the department's Medicaid Management Information System (MMIS). 39.29 To receivereimbursementpayment, the county or vendor must 39.30 submit invoices within 12 months following the date of service. 39.31 The county agency and its vendors under contract shall not be 39.32 reimbursed for services which exceed the county allocation. 39.33 (b) If a county collects less than 50 percent of the client 39.34 premiums due under subdivision 12, the commissioner may withhold 39.35 up to three percent of the county's final alternative care 39.36 program allocation determined under subdivisions 10 and 11. 40.1 (c) The county shall negotiate individual rates with 40.2 vendors and maybe reimbursedauthorize service payment for 40.3 actual costs up tothe greater ofthe county's current approved 40.4 rateor 60 percent of the maximum rate in fiscal year 1994 and40.565 percent of the maximum rate in fiscal year 1995 for each40.6alternative care service. Notwithstanding any other rule or 40.7 statutory provision to the contrary, the commissioner shall not 40.8 be authorized to increase rates by an annual inflation factor, 40.9 unless so authorized by the legislature. 40.10 (d)On July 1, 1993, the commissioner shall increase the40.11maximum rate for home delivered meals to $4.50 per meal.To 40.12 improve access to community services and eliminate payment 40.13 disparities between the alternative care program and the elderly 40.14 waiver program, the commissioner shall establish statewide 40.15 maximum service rate limits and eliminate county-specific 40.16 service rate limits. 40.17 (1) Effective July 1, 2001, for service rate limits, except 40.18 those in subdivision 5, paragraphs (d) and (j), the rate limit 40.19 for each service shall be the greater of the alternative care 40.20 statewide maximum rate or the elderly waiver statewide maximum 40.21 rate. 40.22 (2) Counties may negotiate individual service rates with 40.23 vendors for actual costs up to the statewide maximum service 40.24 rate limit. 40.25 Sec. 29. Minnesota Statutes 2000, section 256B.0915, 40.26 subdivision 1d, is amended to read: 40.27 Subd. 1d. [POSTELIGIBILITY TREATMENT OF INCOME AND 40.28 RESOURCES FOR ELDERLY WAIVER.](a)Notwithstanding the 40.29 provisions of section 256B.056, the commissioner shall make the 40.30 following amendment to the medical assistance elderly waiver 40.31 program effective July 1, 1999, or upon federal approval, 40.32 whichever is later. 40.33 A recipient's maintenance needs will be an amount equal to 40.34 the Minnesota supplemental aid equivalent rate as defined in 40.35 section 256I.03, subdivision 5, plus the medical assistance 40.36 personal needs allowance as defined in section 256B.35, 41.1 subdivision 1, paragraph (a), when applying posteligibility 41.2 treatment of income rules to the gross income of elderly waiver 41.3 recipients, except for individuals whose income is in excess of 41.4 the special income standard according to Code of Federal 41.5 Regulations, title 42, section 435.236. Recipient maintenance 41.6 needs shall be adjusted under this provision each July 1. 41.7(b) The commissioner of human services shall secure41.8approval of additional elderly waiver slots sufficient to serve41.9persons who will qualify under the revised income standard41.10described in paragraph (a) before implementing section41.11256B.0913, subdivision 16.41.12(c) In implementing this subdivision, the commissioner41.13shall consider allowing persons who would otherwise be eligible41.14for the alternative care program but would qualify for the41.15elderly waiver with a spenddown to remain on the alternative41.16care program.41.17 Sec. 30. Minnesota Statutes 2000, section 256B.0915, 41.18 subdivision 3, is amended to read: 41.19 Subd. 3. [LIMITS OF CASES, RATES,REIMBURSEMENTPAYMENTS, 41.20 AND FORECASTING.] (a) The number of medical assistance waiver 41.21 recipients that a county may serve must be allocated according 41.22 to the number of medical assistance waiver cases open on July 1 41.23 of each fiscal year. Additional recipients may be served with 41.24 the approval of the commissioner. 41.25 (b) The monthly limit for the cost of waivered services to 41.26 an individual elderly waiver client shall be thestatewide41.27average paymentweighted average monthly nursing facility rate 41.28 of the case mix resident class to which the elderly waiver 41.29 client would be assigned underthe medical assistance case mix41.30reimbursement system.Minnesota Rules, parts 9549.0050 to 41.31 9549.0059, less the recipient's maintenance needs allowance as 41.32 described in subdivision 1d, paragraph (a), until the first day 41.33 of the state fiscal year in which the resident assessment system 41.34 as described in section 256B.437 for nursing home rate 41.35 determination is implemented. Effective on the first day of the 41.36 state fiscal year in which the resident assessment system as 42.1 described in section 256B.437 for nursing home rate 42.2 determination is implemented and the first day of each 42.3 subsequent state fiscal year, the monthly limit for the cost of 42.4 waivered services to an individual elderly waiver client shall 42.5 be the rate of the case mix resident class to which the waiver 42.6 client would be assigned under Minnesota Rules, parts 9549.0050 42.7 to 9549.0059, in effect on the last day of the previous state 42.8 fiscal year, adjusted by the greater of any legislatively 42.9 adopted home and community-based services cost-of-living 42.10 percentage increase or any legislatively adopted statewide 42.11 percent rate increase for nursing facilities. 42.12 (c) If extended medical supplies and equipment or 42.13adaptationsenvironmental modifications are or will be purchased 42.14 for an elderly waiverservices recipientclient, the costs may 42.15 be proratedon a monthly basis throughout the year in which they42.16are purchasedfor up to 12 consecutive months beginning with the 42.17 month of purchase. If the monthly cost of a recipient'sother42.18 waivered services exceeds the monthly limit established inthis42.19 paragraph (b), the annual cost oftheall waivered services 42.20 shall be determined. In this event, the annual cost of all 42.21 waivered services shall not exceed 12 times the monthly 42.22 limitcalculated in this paragraph. The statewide average42.23payment rate is calculated by determining the statewide average42.24monthly nursing home rate, effective July 1 of the fiscal year42.25in which the cost is incurred, less the statewide average42.26monthly income of nursing home residents who are age 65 or42.27older, and who are medical assistance recipients in the month of42.28March of the previous state fiscal year. The annual cost42.29divided by 12 of elderly or disabled waivered servicesof 42.30 waivered services as described in paragraph (b). 42.31 (d) For a person who is a nursing facility resident at the 42.32 time of requesting a determination of eligibility for elderlyor42.33disabledwaivered servicesshall be the greater of the monthly42.34payment for: (i), a monthly conversion limit for the cost of 42.35 elderly waivered services may be requested. The monthly 42.36 conversion limit for the cost of elderly waiver services shall 43.1 be the resident class assigned under Minnesota Rules, parts 43.2 9549.0050 to 9549.0059, for that resident in the nursing 43.3 facility where the resident currently resides; or (ii) the43.4statewide average payment of the case mix resident class to43.5which the resident would be assigned under the medical43.6assistance case mix reimbursement system, provided thatuntil 43.7 July 1 of the state fiscal year in which the resident assessment 43.8 system as described in section 256B.437 for nursing home rate 43.9 determination is implemented. Effective on July 1 of the state 43.10 fiscal year in which the resident assessment system as described 43.11 in section 256B.437 for nursing home rate determination is 43.12 implemented, the monthly conversion limit for the cost of 43.13 elderly waiver services shall be the per diem nursing facility 43.14 rate as determined by the resident assessment system as 43.15 described in section 256B.437 for that resident in the nursing 43.16 facility where the resident currently resides multiplied by 365 43.17 and divided by 12, less the recipient's maintenance needs 43.18 allowance as described in subdivision 1d. The limit under this 43.19 clause only applies to persons discharged from a nursing 43.20 facility after a minimum 30-day stay and found eligible for 43.21 waivered services on or after July 1, 1997. The following costs 43.22 must be included in determining the total monthly costs for the 43.23 waiver client: 43.24 (1) cost of all waivered services, including extended 43.25 medical supplies and equipment and environmental modifications; 43.26 and 43.27 (2) cost of skilled nursing, home health aide, and personal 43.28 care services reimbursable by medical assistance. 43.29(c)(e) Medical assistance funding for skilled nursing 43.30 services, private duty nursing, home health aide, and personal 43.31 care services for waiver recipients must be approved by the case 43.32 manager and included in the individual care plan. 43.33(d) For both the elderly waiver and the nursing facility43.34disabled waiver, a county may purchase extended supplies and43.35equipment without prior approval from the commissioner when43.36there is no other funding source and the supplies and equipment44.1are specified in the individual's care plan as medically44.2necessary to enable the individual to remain in the community44.3according to the criteria in Minnesota Rules, part 9505.0210,44.4items A and B.(f) A county is not required to contract with a 44.5 provider of supplies and equipment if the monthly cost of the 44.6 supplies and equipment is less than $250. 44.7(e)(g) The adult foster caredailyratefor the elderly44.8and disabled waiversshall be considered a difficulty of care 44.9 payment and shall not include room and board. The adult foster 44.10 care service rate shall be negotiated between the county agency 44.11 and the foster care provider.The rate established under this44.12section shall not exceed the state average monthly nursing home44.13payment for the case mix classification to which the individual44.14receiving foster care is assigned; the rate must allow for other44.15waiver and medical assistance home care services to be44.16authorized by the case manager.The elderly waiver payment for 44.17 the foster care service in combination with the payment for all 44.18 other elderly waiver services, including case management, must 44.19 not exceed the limit specified in paragraph (b). 44.20(f) The assisted living and residential care service rates44.21for elderly and community alternatives for disabled individuals44.22(CADI) waivers shall be made to the vendor as a monthly rate44.23negotiated with the county agency based on an individualized44.24service plan for each resident. The rate shall not exceed the44.25nonfederal share of the greater of either the statewide or any44.26of the geographic groups' weighted average monthly medical44.27assistance nursing facility payment rate of the case mix44.28resident class to which the elderly or disabled client would be44.29assigned under Minnesota Rules, parts 9549.0050 to 9549.0059,44.30unless the services are provided by a home care provider44.31licensed by the department of health and are provided in a44.32building that is registered as a housing with services44.33establishment under chapter 144D and that provides 24-hour44.34supervision. For alternative care assisted living projects44.35established under Laws 1988, chapter 689, article 2, section44.36256, monthly rates may not exceed 65 percent of the greater of45.1either the statewide or any of the geographic groups' weighted45.2average monthly medical assistance nursing facility payment rate45.3for the case mix resident class to which the elderly or disabled45.4client would be assigned under Minnesota Rules, parts 9549.005045.5to 9549.0059. The rate may not cover direct rent or food costs.45.6 (h) Payment for assisted living service shall be a monthly 45.7 rate negotiated and authorized by the county agency based on an 45.8 individualized service plan for each resident and may not cover 45.9 direct rent or food costs. 45.10 (1) The individualized monthly negotiated payment for 45.11 assisted living services as described in section 256B.0913, 45.12 subdivision 5, paragraph (g) or (h), and residential care 45.13 services as described in section 256B.0913, subdivision 5, 45.14 paragraph (f), shall not exceed the nonfederal share, in effect 45.15 on July 1 of the state fiscal year for which the rate limit is 45.16 being calculated, of the greater of either the statewide or any 45.17 of the geographic groups' weighted average monthly nursing 45.18 facility rate of the case mix resident class to which the 45.19 elderly waiver eligible client would be assigned under Minnesota 45.20 Rules, parts 9549.0050 to 9549.0059, less the maintenance needs 45.21 allowance as described in subdivision 1d, paragraph (a), until 45.22 the July 1 of the state fiscal year in which the resident 45.23 assessment system as described in section 256B.437 for nursing 45.24 home rate determination is implemented. Effective on July 1 of 45.25 the state fiscal year in which the resident assessment system as 45.26 described in section 256B.437 for nursing home rate 45.27 determination is implemented and July 1 of each subsequent state 45.28 fiscal year, the individualized monthly negotiated payment for 45.29 the services described in this clause shall not exceed the limit 45.30 described in this clause which was in effect on June 30 of the 45.31 previous state fiscal year and which has been adjusted by the 45.32 greater of any legislatively adopted home and community-based 45.33 services cost-of-living percentage increase or any legislatively 45.34 adopted statewide percent rate increase for nursing facilities. 45.35 (2) The individualized monthly negotiated payment for 45.36 assisted living services described in section 144A.4605 and 46.1 delivered by a provider licensed by the department of health as 46.2 a class A home care provider or an assisted living home care 46.3 provider and provided in a building that is registered as a 46.4 housing with services establishment under chapter 144D and that 46.5 provides 24-hour supervision in combination with the payment for 46.6 other elderly waiver services, including case management, must 46.7 not exceed the limit specified in paragraph (b). 46.8(g)(i) The county shall negotiate individual service rates 46.9 with vendors and maybe reimbursedauthorize payment for actual 46.10 costs up to thegreater of thecounty's current approved rateor46.1160 percent of the maximum rate in fiscal year 1994 and 6546.12percent of the maximum rate in fiscal year 1995 for each service46.13within each program. Persons or agencies must be employed by or 46.14 under a contract with the county agency or the public health 46.15 nursing agency of the local board of health in order to receive 46.16 funding under the elderly waiver program, except as a provider 46.17 of supplies and equipment when the monthly cost of the supplies 46.18 and equipment is less than $250. 46.19(h) On July 1, 1993, the commissioner shall increase the46.20maximum rate for home-delivered meals to $4.50 per meal.46.21(i)(j) Reimbursement for the medical assistance recipients 46.22 under the approved waiver shall be made from the medical 46.23 assistance account through the invoice processing procedures of 46.24 the department's Medicaid Management Information System (MMIS), 46.25 only with the approval of the client's case manager. The budget 46.26 for the state share of the Medicaid expenditures shall be 46.27 forecasted with the medical assistance budget, and shall be 46.28 consistent with the approved waiver. 46.29 (k) To improve access to community services and eliminate 46.30 payment disparities between the alternative care program and the 46.31 elderly waiver, the commissioner shall establish statewide 46.32 maximum service rate limits and eliminate county-specific 46.33 service rate limits. 46.34 (1) Effective July 1, 2001, for service rate limits, except 46.35 those described or defined in paragraphs (g) and (h), the rate 46.36 limit for each service shall be the greater of the alternative 47.1 care statewide maximum rate or the elderly waiver statewide 47.2 maximum rate. 47.3 (2) Counties may negotiate individual service rates with 47.4 vendors for actual costs up to the statewide maximum service 47.5 rate limit. 47.6(j)(l) Beginning July 1, 1991, the state shall reimburse 47.7 counties according to the payment schedule in section 256.025 47.8 for the county share of costs incurred under this subdivision on 47.9 or after January 1, 1991, for individuals who are receiving 47.10 medical assistance. 47.11(k) For the community alternatives for disabled individuals47.12waiver, and nursing facility disabled waivers, county may use47.13waiver funds for the cost of minor adaptations to a client's47.14residence or vehicle without prior approval from the47.15commissioner if there is no other source of funding and the47.16adaptation:47.17(1) is necessary to avoid institutionalization;47.18(2) has no utility apart from the needs of the client; and47.19(3) meets the criteria in Minnesota Rules, part 9505.0210,47.20items A and B.47.21For purposes of this subdivision, "residence" means the client's47.22own home, the client's family residence, or a family foster47.23home. For purposes of this subdivision, "vehicle" means the47.24client's vehicle, the client's family vehicle, or the client's47.25family foster home vehicle.47.26(l) The commissioner shall establish a maximum rate unit47.27for baths provided by an adult day care provider that are not47.28included in the provider's contractual daily or hourly rate.47.29This maximum rate must equal the home health aide extended rate47.30and shall be paid for baths provided to clients served under the47.31elderly and disabled waivers.47.32 Sec. 31. Minnesota Statutes 2000, section 256B.0915, 47.33 subdivision 5, is amended to read: 47.34 Subd. 5. [REASSESSMENTS FOR WAIVER CLIENTS.] A 47.35 reassessment of a client served under the elderlyor disabled47.36 waiver must be conducted at least every 12 months and at other 48.1 times when the case manager determines that there has been 48.2 significant change in the client's functioning. This may 48.3 include instances where the client is discharged from the 48.4 hospital. 48.5 Sec. 32. [256B.0918] [ESTABLISHMENT AND PURPOSE OF MEDICAL 48.6 ASSISTANCE PILOT PROJECT ON SENIOR SERVICES.] 48.7 Subdivision 1. [ESTABLISHMENT AND PURPOSE.] The 48.8 commissioner of human services shall establish a medical 48.9 assistance pilot project on senior services to determine how 48.10 converting the delivery of housing, supportive services, and 48.11 health care for seniors into a flexible voucher program will 48.12 impact public expenditures for older adult service care and 48.13 provide an alternative way to purchase services based on 48.14 consumer choice. 48.15 Subd. 2. [FEDERAL WAIVER AUTHORITY.] The commissioner 48.16 shall apply for any necessary federal waivers or approvals to 48.17 implement this pilot project. The commissioner shall submit the 48.18 waiver request no later than April 15, 2002. The medical 48.19 assistance pilot project on senior services shall be implemented 48.20 January 1, 2003, or upon federal approval, whichever is later. 48.21 Subd. 3. [REPORT.] Participating communities and the 48.22 commissioner of human services shall collaborate to prepare and 48.23 issue an annual report December 1, 2003, and each December 1 48.24 thereafter, to the appropriate committee chairs in the senate 48.25 and house on: (1) the use of state resources, including other 48.26 funds leveraged for this initiative; (2) the status of 48.27 individuals being served in the pilot project; and (3) the 48.28 cost-effectiveness of the pilot project. The commissioner shall 48.29 provide data that may be needed to evaluate the pilot project to 48.30 communities that request the data. 48.31 Subd. 4. [SUNSET.] This section sunsets June 30, 2008. 48.32 Sec. 33. Minnesota Statutes 2000, section 256D.35, is 48.33 amended by adding a subdivision to read: 48.34 Subd. 18a. [SHELTER COSTS.] "Shelter costs" means rent; 48.35 manufactured home lot rentals; monthly principal, interest, 48.36 insurance premiums, and property taxes due for mortgages or 49.1 contracts for deed costs; costs for utilities, including 49.2 heating, cooling, electricity, water, and sewage; garbage 49.3 collection fees; and the basic service fee for one telephone. 49.4 Sec. 34. Minnesota Statutes 2000, section 256D.35, is 49.5 amended by adding a subdivision to read: 49.6 Subd. 18b. [SHELTER NEEDY.] "Shelter needy" means that the 49.7 assistance unit incurs monthly shelter costs that exceed 40 49.8 percent of the assistance unit's gross income. 49.9 Sec. 35. Minnesota Statutes 2000, section 256D.44, 49.10 subdivision 5, is amended to read: 49.11 Subd. 5. [SPECIAL NEEDS.] In addition to the state 49.12 standards of assistance established in subdivisions 1 to 4, 49.13 payments are allowed for the following special needs of 49.14 recipients of Minnesota supplemental aid who are not residents 49.15 of a nursing home, a regional treatment center, or a group 49.16 residential housing facility. 49.17 (a) The county agency shall pay a monthly allowance for 49.18 medically prescribed diets payable under the Minnesota family 49.19 investment program if the cost of those additional dietary needs 49.20 cannot be met through some other maintenance benefit. 49.21 (b) Payment for nonrecurring special needs must be allowed 49.22 for necessary home repairs or necessary repairs or replacement 49.23 of household furniture and appliances using the payment standard 49.24 of the AFDC program in effect on July 16, 1996, for these 49.25 expenses, as long as other funding sources are not available. 49.26 (c) A fee for guardian or conservator service is allowed at 49.27 a reasonable rate negotiated by the county or approved by the 49.28 court. This rate shall not exceed five percent of the 49.29 assistance unit's gross monthly income up to a maximum of $100 49.30 per month. If the guardian or conservator is a member of the 49.31 county agency staff, no fee is allowed. 49.32 (d) The county agency shall continue to pay a monthly 49.33 allowance of $68 for restaurant meals for a person who was 49.34 receiving a restaurant meal allowance on June 1, 1990, and who 49.35 eats two or more meals in a restaurant daily. The allowance 49.36 must continue until the person has not received Minnesota 50.1 supplemental aid for one full calendar month or until the 50.2 person's living arrangement changes and the person no longer 50.3 meets the criteria for the restaurant meal allowance, whichever 50.4 occurs first. 50.5 (e) A fee of ten percent of the recipient's gross income or 50.6 $25, whichever is less, is allowed for representative payee 50.7 services provided by an agency that meets the requirements under 50.8 SSI regulations to charge a fee for representative payee 50.9 services. This special need is available to all recipients of 50.10 Minnesota supplemental aid regardless of their living 50.11 arrangement. 50.12 (f) Notwithstanding the language in this subdivision, an 50.13 amount equal to the maximum allotment authorized by the federal 50.14 Food Stamp Program for a single individual which is in effect on 50.15 the first day of January of the previous state fiscal year will 50.16 be added to the standard of assistance established in 50.17 subdivisions 1 to 4 for recipients of the elderly waiver program 50.18 under section 256B.0915, who are shelter needy. A recipient of 50.19 a federal or state housing subsidy that limits shelter costs to 50.20 a percentage of gross income shall not be considered shelter 50.21 needy for purposes of this provision. 50.22 Sec. 36. [INTEGRATED SERVICE ACCESS STUDY.] 50.23 By February 15, 2002, the commissioner of human services 50.24 shall submit to the legislature recommendations for creating 50.25 integrated service access at the county agency level for both 50.26 publicly subsidized and nonsubsidized long-term care services 50.27 and housing options. The report must: 50.28 (1) include a plan to integrate public funding streams to 50.29 allow low-income, privately paying consumers to purchase 50.30 services through a sliding fee scale; and 50.31 (2) evaluate the feasibility of statewide implementation, 50.32 based upon an evaluation of public cost, consumer preferences 50.33 and satisfaction, and other relevant factors. 50.34 Sec. 37. [RESPITE CARE.] 50.35 The Minnesota board on aging shall report to the 50.36 legislature by February 1, 2002, on the provision of in-home and 51.1 out-of-home respite care services on a sliding scale basis under 51.2 the federal Older Americans Act. 51.3 Sec. 38. [APPROPRIATION.] 51.4 Subdivision 1. [SENIOR LINKAGE.] $....... is appropriated 51.5 from the general fund to the commissioner of human services for 51.6 the biennium ending June 30, 2003, for the board on aging to 51.7 expand services provided through Senior LinkAge. 51.8 Subd. 2. [LONG-TERM CARE CONSULTATION SERVICES.] $....... 51.9 is appropriated from the general fund to the commissioner of 51.10 human services for the biennium ending June 30, 2003, to 51.11 increase county allocations for long-term care consultation 51.12 services. 51.13 Subd. 3. [ALTERNATIVE CARE AND ELDERLY WAIVER 51.14 PROGRAMS.] $....... is appropriated from the general fund to the 51.15 commissioner of human services for the biennium ending June 30, 51.16 2003, to eliminate county-specific rates and serve additional 51.17 individuals under the alternative care and elderly waiver 51.18 programs. 51.19 Subd. 4. [MEDICAL ASSISTANCE PILOT PROJECT.] $....... is 51.20 appropriated from the general fund to the commissioner of human 51.21 services for the biennium ending June 30, 2003, to administer 51.22 the medical assistance pilot project under section 32. 51.23 Subd. 5. [IDENTIFICATION OF CRITICAL ACCESS SERVICE 51.24 SITES.] $....... is appropriated from the general fund to the 51.25 commissioner of health for the biennium ending June 30, 2003, to 51.26 implement section 1. 51.27 Sec. 39. [REPEALER.] 51.28 Minnesota Statutes 2000, sections 256B.0911, subdivisions 51.29 2, 2a, 4, 8, and 9; 256B.0913, subdivisions 3, 15a, 15b, 15c, 51.30 and 16; and 256B.0915, subdivisions 3a, 3b, and 3c, and 51.31 Minnesota Rules, parts 9505.2390, 9505.2395, 9505.2396, 51.32 9505.2400, 9505.2405, 9505.2410, 9505.2413, 9505.2415, 51.33 9505.2420, 9505.2425, 9505,2426, 9505.2430, 9505.2435, 51.34 9505.2440, 9505.2445, 9505.2450, 9505.2455, 9505.2458, 51.35 9505.2460, 9505.2465, 9505.2470, 9505.2473, 9505.2475, 51.36 9505.2480, 9505.2485, 9505.2486, 9505.2490, 9505.2495, 52.1 9505.2496, and 9505.2500, are repealed. 52.2 ARTICLE 2 52.3 LONG-TERM CARE SYSTEM REFORM AND REIMBURSEMENT 52.4 Section 1. [16A.88] [ESTABLISHMENT OF LONG-TERM CARE 52.5 REVOLVING FUND.] 52.6 At the end of each state fiscal year, any unspent and 52.7 unencumbered state general fund appropriations for long-term 52.8 care for the elderly, including nursing facility, elderly 52.9 waiver, alternative care, and home care services, must be 52.10 deposited by the commissioner of finance in the long-term care 52.11 enhancement fund, which is established. Money in the long-term 52.12 care enhancement fund may be used only to enhance long-term care 52.13 services in the state through capital or other one-time 52.14 investment projects or through provider rate increases that are 52.15 greater than the rate of inflation, measured by the Data 52.16 Resources, Inc. forecast of the nursing home market basket index 52.17 in the fourth quarter of the calendar year preceding the rate 52.18 year, based on the 12-month period from the midpoint of the last 52.19 rate year to the midpoint of the rate year for which funds are 52.20 being appropriated. Each year that the long-term care 52.21 enhancement fund is forecast to have a balance, the legislature 52.22 shall designate the use of the funds. 52.23 Sec. 2. Minnesota Statutes 2000, section 144A.071, 52.24 subdivision 1, is amended to read: 52.25 Subdivision 1. [FINDINGS.] The legislature declares that a 52.26 moratorium on the licensure and medical assistance certification 52.27 of new nursing home beds and construction projects that 52.28 exceed$750,000$1,000,000 is necessary to control nursing home 52.29 expenditure growth and enable the state to meet the needs of its 52.30 elderly by providing high quality services in the most 52.31 appropriate manner along a continuum of care. 52.32 Sec. 3. Minnesota Statutes 2000, section 144A.071, 52.33 subdivision 1a, is amended to read: 52.34 Subd. 1a. [DEFINITIONS.] For purposes of sections 144A.071 52.35 to 144A.073, the following terms have the meanings given them: 52.36 (a) "attached fixtures" has the meaning given in Minnesota 53.1 Rules, part 9549.0020, subpart 6. 53.2 (b) "buildings" has the meaning given in Minnesota Rules, 53.3 part 9549.0020, subpart 7. 53.4 (c) "capital assets" has the meaning given in section 53.5 256B.421, subdivision 16. 53.6 (d) "commenced construction" means that all of the 53.7 following conditions were met: the final working drawings and 53.8 specifications were approved by the commissioner of health; the 53.9 construction contracts were let; a timely construction schedule 53.10 was developed, stipulating dates for beginning, achieving 53.11 various stages, and completing construction; and all zoning and 53.12 building permits were applied for. 53.13 (e) "completion date" means the date on which a certificate 53.14 of occupancy is issued for a construction project, or if a 53.15 certificate of occupancy is not required, the date on which the 53.16 construction project is available for facility use. 53.17 (f) "construction" means any erection, building, 53.18 alteration, reconstruction, modernization, or improvement 53.19 necessary to comply with the nursing home licensure rules. 53.20 (g) "construction project" means: 53.21 (1) a capital asset addition to, or replacement of a 53.22 nursing home or certified boarding care home that results in new 53.23 space or the remodeling of or renovations to existing facility 53.24 space; 53.25 (2) the remodeling or renovation of existing facility space 53.26 the use of which is modified as a result of the project 53.27 described in clause (1). This existing space and the project 53.28 described in clause (1) must be used for the functions as 53.29 designated on the construction plans on completion of the 53.30 project described in clause (1) for a period of not less than 24 53.31 months; or 53.32 (3) capital asset additions or replacements that are 53.33 completed within 12 months before or after the completion date 53.34 of the project described in clause (1). 53.35 (h) "new licensed" or "new certified beds" means: 53.36 (1) newly constructed beds in a facility or the 54.1 construction of a new facility that would increase the total 54.2 number of licensed nursing home beds or certified boarding care 54.3 or nursing home beds in the state; or 54.4 (2) newly licensed nursing home beds or newly certified 54.5 boarding care or nursing home beds that result from remodeling 54.6 of the facility that involves relocation of beds but does not 54.7 result in an increase in the total number of beds, except when 54.8 the project involves the upgrade of boarding care beds to 54.9 nursing home beds, as defined in section 144A.073, subdivision 54.10 1. "Remodeling" includes any of the type of conversion, 54.11 renovation, replacement, or upgrading projects as defined in 54.12 section 144A.073, subdivision 1. 54.13 (i) "project construction costs" means the cost of the 54.14 facility capital asset additions, replacements, renovations, or 54.15 remodeling projects, construction site preparation costs, and 54.16 related soft costs. Project construction costsalsoinclude the 54.17 cost of any remodeling or renovation of existing facility space 54.18 which is modified as a result of the construction 54.19 project. Project construction costs also includes the cost of 54.20 new technology implemented as part of the construction project. 54.21 (j) "technology" means information systems or devices that 54.22 make documentation, charting, and staff time more efficient or 54.23 encourage and allow for care through alternative settings 54.24 including, but not limited to, touch screens, monitors, 54.25 hand-helds, swipe cards, motion detectors, pagers, telemedicine, 54.26 medication dispensers, and equipment to monitor vital signs and 54.27 self-injections, and to observe skin and other conditions. 54.28 Sec. 4. Minnesota Statutes 2000, section 144A.071, 54.29 subdivision 2, is amended to read: 54.30 Subd. 2. [MORATORIUM.] The commissioner of health, in 54.31 coordination with the commissioner of human services, shall deny 54.32 each request for new licensed or certified nursing home or 54.33 certified boarding care beds except as provided in subdivision 3 54.34 or 4a, or section 144A.073. "Certified bed" means a nursing 54.35 home bed or a boarding care bed certified by the commissioner of 54.36 health for the purposes of the medical assistance program, under 55.1 United States Code, title 42, sections 1396 et seq. 55.2 The commissioner of human services, in coordination with 55.3 the commissioner of health, shall deny any request to issue a 55.4 license under section 252.28 and chapter 245A to a nursing home 55.5 or boarding care home, if that license would result in an 55.6 increase in the medical assistance reimbursement amount. 55.7 In addition, the commissioner of health must not approve 55.8 any construction project whose cost exceeds$750,000$1,000,000 55.9 unless: 55.10 (a) any construction costs exceeding$750,000$1,000,000 55.11 are not added to the facility's appraised value and are not 55.12 included in the facility's payment rate for reimbursement under 55.13 the medical assistance program; or 55.14 (b) the project: 55.15 (1) has been approved through the process described in 55.16 section 144A.073; 55.17 (2) meets an exception in subdivision 3 or 4a; 55.18 (3) is necessary to correct violations of state or federal 55.19 law issued by the commissioner of health; 55.20 (4) is necessary to repair or replace a portion of the 55.21 facility that was damaged by fire, lightning, groundshifts, or 55.22 other such hazards, including environmental hazards, provided 55.23 that the provisions of subdivision 4a, clause (a), are met; 55.24 (5) as of May 1, 1992, the facility has submitted to the 55.25 commissioner of health written documentation evidencing that the 55.26 facility meets the "commenced construction" definition as 55.27 specified in subdivision 1a, clause (d), or that substantial 55.28 steps have been taken prior to April 1, 1992, relating to the 55.29 construction project. "Substantial steps" require that the 55.30 facility has made arrangements with outside parties relating to 55.31 the construction project and include the hiring of an architect 55.32 or construction firm, submission of preliminary plans to the 55.33 department of health or documentation from a financial 55.34 institution that financing arrangements for the construction 55.35 project have been made; or 55.36 (6) is being proposed by a licensed nursing facility that 56.1 is not certified to participate in the medical assistance 56.2 program and will not result in new licensed or certified beds. 56.3 Prior to the final plan approval of any construction 56.4 project, the commissioner of health shall be provided with an 56.5 itemized cost estimate for the project construction costs. If a 56.6 construction project is anticipated to be completed in phases, 56.7 the total estimated cost of all phases of the project shall be 56.8 submitted to the commissioner and shall be considered as one 56.9 construction project. Once the construction project is 56.10 completed and prior to the final clearance by the commissioner, 56.11 the total project construction costs for the construction 56.12 project shall be submitted to the commissioner. If the final 56.13 project construction cost exceeds the dollar threshold in this 56.14 subdivision, the commissioner of human services shall not 56.15 recognize any of the project construction costs or the related 56.16 financing costs in excess of this threshold in establishing the 56.17 facility's property-related payment rate. 56.18 The dollar thresholds for construction projects are as 56.19 follows: for construction projects other than those authorized 56.20 in clauses (1) to (6), the dollar threshold 56.21 is$750,000$1,000,000. For projects authorized after July 1, 56.22 1993, under clause (1), the dollar threshold is the cost 56.23 estimate submitted with a proposal for an exception under 56.24 section 144A.073, plus inflation as calculated according to 56.25 section 256B.431, subdivision 3f, paragraph (a). For projects 56.26 authorized under clauses (2) to (4), the dollar threshold is the 56.27 itemized estimate project construction costs submitted to the 56.28 commissioner of health at the time of final plan approval, plus 56.29 inflation as calculated according to section 256B.431, 56.30 subdivision 3f, paragraph (a). 56.31 The commissioner of health shall adopt rules to implement 56.32 this section or to amend the emergency rules for granting 56.33 exceptions to the moratorium on nursing homes under section 56.34 144A.073. 56.35 Sec. 5. Minnesota Statutes 2000, section 144A.071, 56.36 subdivision 4a, is amended to read: 57.1 Subd. 4a. [EXCEPTIONS FOR REPLACEMENT BEDS.] It is in the 57.2 best interest of the state to ensure that nursing homes and 57.3 boarding care homes continue to meet the physical plant 57.4 licensing and certification requirements by permitting certain 57.5 construction projects. Facilities should be maintained in 57.6 condition to satisfy the physical and emotional needs of 57.7 residents while allowing the state to maintain control over 57.8 nursing home expenditure growth. 57.9 The commissioner of health in coordination with the 57.10 commissioner of human services, may approve the renovation, 57.11 replacement, upgrading, or relocation of a nursing home or 57.12 boarding care home, under the following conditions: 57.13 (a) to license or certify beds in a new facility 57.14 constructed to replace a facility or to make repairs in an 57.15 existing facility that was destroyed or damaged after June 30, 57.16 1987, by fire, lightning, or other hazard provided: 57.17 (i) destruction was not caused by the intentional act of or 57.18 at the direction of a controlling person of the facility; 57.19 (ii) at the time the facility was destroyed or damaged the 57.20 controlling persons of the facility maintained insurance 57.21 coverage for the type of hazard that occurred in an amount that 57.22 a reasonable person would conclude was adequate; 57.23 (iii) the net proceeds from an insurance settlement for the 57.24 damages caused by the hazard are applied to the cost of the new 57.25 facility or repairs; 57.26 (iv) the new facility is constructed on the same site as 57.27 the destroyed facility or on another site subject to the 57.28 restrictions in section 144A.073, subdivision 5; 57.29 (v) the number of licensed and certified beds in the new 57.30 facility does not exceed the number of licensed and certified 57.31 beds in the destroyed facility; and 57.32 (vi) the commissioner determines that the replacement beds 57.33 are needed to prevent an inadequate supply of beds. 57.34 Project construction costs incurred for repairs authorized under 57.35 this clause shall not be considered in the dollar threshold 57.36 amount defined in subdivision 2; 58.1 (b) to license or certify beds that are moved from one 58.2 location to another within a nursing home facility, provided the 58.3 total costs of remodeling performed in conjunction with the 58.4 relocation of beds does not exceed$750,000$1,000,000; 58.5 (c) to license or certify beds in a project recommended for 58.6 approval under section 144A.073; 58.7 (d) to license or certify beds that are moved from an 58.8 existing state nursing home to a different state facility, 58.9 provided there is no net increase in the number of state nursing 58.10 home beds; 58.11 (e) to certify and license as nursing home beds boarding 58.12 care beds in a certified boarding care facility if the beds meet 58.13 the standards for nursing home licensure, or in a facility that 58.14 was granted an exception to the moratorium under section 58.15 144A.073, and if the cost of any remodeling of the facility does 58.16 not exceed$750,000$1,000,000. If boarding care beds are 58.17 licensed as nursing home beds, the number of boarding care beds 58.18 in the facility must not increase beyond the number remaining at 58.19 the time of the upgrade in licensure. The provisions contained 58.20 in section 144A.073 regarding the upgrading of the facilities do 58.21 not apply to facilities that satisfy these requirements; 58.22 (f) to license and certify up to 40 beds transferred from 58.23 an existing facility owned and operated by the Amherst H. Wilder 58.24 Foundation in the city of St. Paul to a new unit at the same 58.25 location as the existing facility that will serve persons with 58.26 Alzheimer's disease and other related disorders. The transfer 58.27 of beds may occur gradually or in stages, provided the total 58.28 number of beds transferred does not exceed 40. At the time of 58.29 licensure and certification of a bed or beds in the new unit, 58.30 the commissioner of health shall delicense and decertify the 58.31 same number of beds in the existing facility. As a condition of 58.32 receiving a license or certification under this clause, the 58.33 facility must make a written commitment to the commissioner of 58.34 human services that it will not seek to receive an increase in 58.35 its property-related payment rate as a result of the transfers 58.36 allowed under this paragraph; 59.1 (g) to license and certify nursing home beds to replace 59.2 currently licensed and certified boarding care beds which may be 59.3 located either in a remodeled or renovated boarding care or 59.4 nursing home facility or in a remodeled, renovated, newly 59.5 constructed, or replacement nursing home facility within the 59.6 identifiable complex of health care facilities in which the 59.7 currently licensed boarding care beds are presently located, 59.8 provided that the number of boarding care beds in the facility 59.9 or complex are decreased by the number to be licensed as nursing 59.10 home beds and further provided that, if the total costs of new 59.11 construction, replacement, remodeling, or renovation exceed ten 59.12 percent of the appraised value of the facility or $200,000, 59.13 whichever is less, the facility makes a written commitment to 59.14 the commissioner of human services that it will not seek to 59.15 receive an increase in its property-related payment rate by 59.16 reason of the new construction, replacement, remodeling, or 59.17 renovation. The provisions contained in section 144A.073 59.18 regarding the upgrading of facilities do not apply to facilities 59.19 that satisfy these requirements; 59.20 (h) to license as a nursing home and certify as a nursing 59.21 facility a facility that is licensed as a boarding care facility 59.22 but not certified under the medical assistance program, but only 59.23 if the commissioner of human services certifies to the 59.24 commissioner of health that licensing the facility as a nursing 59.25 home and certifying the facility as a nursing facility will 59.26 result in a net annual savings to the state general fund of 59.27 $200,000 or more; 59.28 (i) to certify, after September 30, 1992, and prior to July 59.29 1, 1993, existing nursing home beds in a facility that was 59.30 licensed and in operation prior to January 1, 1992; 59.31 (j) to license and certify new nursing home beds to replace 59.32 beds in a facility acquired by the Minneapolis community 59.33 development agency as part of redevelopment activities in a city 59.34 of the first class, provided the new facility is located within 59.35 three miles of the site of the old facility. Operating and 59.36 property costs for the new facility must be determined and 60.1 allowed under section 256B.431 or 256B.434; 60.2 (k) to license and certify up to 20 new nursing home beds 60.3 in a community-operated hospital and attached convalescent and 60.4 nursing care facility with 40 beds on April 21, 1991, that 60.5 suspended operation of the hospital in April 1986. The 60.6 commissioner of human services shall provide the facility with 60.7 the same per diem property-related payment rate for each 60.8 additional licensed and certified bed as it will receive for its 60.9 existing 40 beds; 60.10 (l) to license or certify beds in renovation, replacement, 60.11 or upgrading projects as defined in section 144A.073, 60.12 subdivision 1, so long as the cumulative total costs of the 60.13 facility's remodeling projects do not 60.14 exceed$750,000$1,000,000; 60.15 (m) to license and certify beds that are moved from one 60.16 location to another for the purposes of converting up to five 60.17 four-bed wards to single or double occupancy rooms in a nursing 60.18 home that, as of January 1, 1993, was county-owned and had a 60.19 licensed capacity of 115 beds; 60.20 (n) to allow a facility that on April 16, 1993, was a 60.21 106-bed licensed and certified nursing facility located in 60.22 Minneapolis to layaway all of its licensed and certified nursing 60.23 home beds. These beds may be relicensed and recertified in a 60.24 newly-constructed teaching nursing home facility affiliated with 60.25 a teaching hospital upon approval by the legislature. The 60.26 proposal must be developed in consultation with the interagency 60.27 committee on long-term care planning. The beds on layaway 60.28 status shall have the same status as voluntarily delicensed and 60.29 decertified beds, except that beds on layaway status remain 60.30 subject to the surcharge in section 256.9657. This layaway 60.31 provision expires July 1, 1998; 60.32 (o) to allow a project which will be completed in 60.33 conjunction with an approved moratorium exception project for a 60.34 nursing home in southern Cass county and which is directly 60.35 related to that portion of the facility that must be repaired, 60.36 renovated, or replaced, to correct an emergency plumbing problem 61.1 for which a state correction order has been issued and which 61.2 must be corrected by August 31, 1993; 61.3 (p) to allow a facility that on April 16, 1993, was a 61.4 368-bed licensed and certified nursing facility located in 61.5 Minneapolis to layaway, upon 30 days prior written notice to the 61.6 commissioner, up to 30 of the facility's licensed and certified 61.7 beds by converting three-bed wards to single or double 61.8 occupancy. Beds on layaway status shall have the same status as 61.9 voluntarily delicensed and decertified beds except that beds on 61.10 layaway status remain subject to the surcharge in section 61.11 256.9657, remain subject to the license application and renewal 61.12 fees under section 144A.07 and shall be subject to a $100 per 61.13 bed reactivation fee. In addition, at any time within three 61.14 years of the effective date of the layaway, the beds on layaway 61.15 status may be: 61.16 (1) relicensed and recertified upon relocation and 61.17 reactivation of some or all of the beds to an existing licensed 61.18 and certified facility or facilities located in Pine River, 61.19 Brainerd, or International Falls; provided that the total 61.20 project construction costs related to the relocation of beds 61.21 from layaway status for any facility receiving relocated beds 61.22 may not exceed the dollar threshold provided in subdivision 2 61.23 unless the construction project has been approved through the 61.24 moratorium exception process under section 144A.073; 61.25 (2) relicensed and recertified, upon reactivation of some 61.26 or all of the beds within the facility which placed the beds in 61.27 layaway status, if the commissioner has determined a need for 61.28 the reactivation of the beds on layaway status. 61.29 The property-related payment rate of a facility placing 61.30 beds on layaway status must be adjusted by the incremental 61.31 change in its rental per diem after recalculating the rental per 61.32 diem as provided in section 256B.431, subdivision 3a, paragraph 61.33 (c). The property-related payment rate for a facility 61.34 relicensing and recertifying beds from layaway status must be 61.35 adjusted by the incremental change in its rental per diem after 61.36 recalculating its rental per diem using the number of beds after 62.1 the relicensing to establish the facility's capacity day 62.2 divisor, which shall be effective the first day of the month 62.3 following the month in which the relicensing and recertification 62.4 became effective. Any beds remaining on layaway status more 62.5 than three years after the date the layaway status became 62.6 effective must be removed from layaway status and immediately 62.7 delicensed and decertified; 62.8 (q) to license and certify beds in a renovation and 62.9 remodeling project to convert 12 four-bed wards into 24 two-bed 62.10 rooms, expand space, and add improvements in a nursing home 62.11 that, as of January 1, 1994, met the following conditions: the 62.12 nursing home was located in Ramsey county; had a licensed 62.13 capacity of 154 beds; and had been ranked among the top 15 62.14 applicants by the 1993 moratorium exceptions advisory review 62.15 panel. The total project construction cost estimate for this 62.16 project must not exceed the cost estimate submitted in 62.17 connection with the 1993 moratorium exception process; 62.18 (r) to license and certify up to 117 beds that are 62.19 relocated from a licensed and certified 138-bed nursing facility 62.20 located in St. Paul to a hospital with 130 licensed hospital 62.21 beds located in South St. Paul, provided that the nursing 62.22 facility and hospital are owned by the same or a related 62.23 organization and that prior to the date the relocation is 62.24 completed the hospital ceases operation of its inpatient 62.25 hospital services at that hospital. After relocation, the 62.26 nursing facility's status under section 256B.431, subdivision 62.27 2j, shall be the same as it was prior to relocation. The 62.28 nursing facility's property-related payment rate resulting from 62.29 the project authorized in this paragraph shall become effective 62.30 no earlier than April 1, 1996. For purposes of calculating the 62.31 incremental change in the facility's rental per diem resulting 62.32 from this project, the allowable appraised value of the nursing 62.33 facility portion of the existing health care facility physical 62.34 plant prior to the renovation and relocation may not exceed 62.35 $2,490,000; 62.36 (s) to license and certify two beds in a facility to 63.1 replace beds that were voluntarily delicensed and decertified on 63.2 June 28, 1991; 63.3 (t) to allow 16 licensed and certified beds located on July 63.4 1, 1994, in a 142-bed nursing home and 21-bed boarding care home 63.5 facility in Minneapolis, notwithstanding the licensure and 63.6 certification after July 1, 1995, of the Minneapolis facility as 63.7 a 147-bed nursing home facility after completion of a 63.8 construction project approved in 1993 under section 144A.073, to 63.9 be laid away upon 30 days' prior written notice to the 63.10 commissioner. Beds on layaway status shall have the same status 63.11 as voluntarily delicensed or decertified beds except that they 63.12 shall remain subject to the surcharge in section 256.9657. The 63.13 16 beds on layaway status may be relicensed as nursing home beds 63.14 and recertified at any time within five years of the effective 63.15 date of the layaway upon relocation of some or all of the beds 63.16 to a licensed and certified facility located in Watertown, 63.17 provided that the total project construction costs related to 63.18 the relocation of beds from layaway status for the Watertown 63.19 facility may not exceed the dollar threshold provided in 63.20 subdivision 2 unless the construction project has been approved 63.21 through the moratorium exception process under section 144A.073. 63.22 The property-related payment rate of the facility placing 63.23 beds on layaway status must be adjusted by the incremental 63.24 change in its rental per diem after recalculating the rental per 63.25 diem as provided in section 256B.431, subdivision 3a, paragraph 63.26 (c). The property-related payment rate for the facility 63.27 relicensing and recertifying beds from layaway status must be 63.28 adjusted by the incremental change in its rental per diem after 63.29 recalculating its rental per diem using the number of beds after 63.30 the relicensing to establish the facility's capacity day 63.31 divisor, which shall be effective the first day of the month 63.32 following the month in which the relicensing and recertification 63.33 became effective. Any beds remaining on layaway status more 63.34 than five years after the date the layaway status became 63.35 effective must be removed from layaway status and immediately 63.36 delicensed and decertified; 64.1 (u) to license and certify beds that are moved within an 64.2 existing area of a facility or to a newly constructed addition 64.3 which is built for the purpose of eliminating three- and 64.4 four-bed rooms and adding space for dining, lounge areas, 64.5 bathing rooms, and ancillary service areas in a nursing home 64.6 that, as of January 1, 1995, was located in Fridley and had a 64.7 licensed capacity of 129 beds; 64.8 (v) to relocate 36 beds in Crow Wing county and four beds 64.9 from Hennepin county to a 160-bed facility in Crow Wing county, 64.10 provided all the affected beds are under common ownership; 64.11 (w) to license and certify a total replacement project of 64.12 up to 49 beds located in Norman county that are relocated from a 64.13 nursing home destroyed by flood and whose residents were 64.14 relocated to other nursing homes. The operating cost payment 64.15 rates for the new nursing facility shall be determined based on 64.16 the interim and settle-up payment provisions of Minnesota Rules, 64.17 part 9549.0057, and the reimbursement provisions of section 64.18 256B.431, except that subdivision 26, paragraphs (a) and (b), 64.19 shall not apply until the second rate year after the settle-up 64.20 cost report is filed. Property-related reimbursement rates 64.21 shall be determined under section 256B.431, taking into account 64.22 any federal or state flood-related loans or grants provided to 64.23 the facility; 64.24 (x) to license and certify a total replacement project of 64.25 up to 129 beds located in Polk county that are relocated from a 64.26 nursing home destroyed by flood and whose residents were 64.27 relocated to other nursing homes. The operating cost payment 64.28 rates for the new nursing facility shall be determined based on 64.29 the interim and settle-up payment provisions of Minnesota Rules, 64.30 part 9549.0057, and the reimbursement provisions of section 64.31 256B.431, except that subdivision 26, paragraphs (a) and (b), 64.32 shall not apply until the second rate year after the settle-up 64.33 cost report is filed. Property-related reimbursement rates 64.34 shall be determined under section 256B.431, taking into account 64.35 any federal or state flood-related loans or grants provided to 64.36 the facility; 65.1 (y) to license and certify beds in a renovation and 65.2 remodeling project to convert 13 three-bed wards into 13 two-bed 65.3 rooms and 13 single-bed rooms, expand space, and add 65.4 improvements in a nursing home that, as of January 1, 1994, met 65.5 the following conditions: the nursing home was located in 65.6 Ramsey county, was not owned by a hospital corporation, had a 65.7 licensed capacity of 64 beds, and had been ranked among the top 65.8 15 applicants by the 1993 moratorium exceptions advisory review 65.9 panel. The total project construction cost estimate for this 65.10 project must not exceed the cost estimate submitted in 65.11 connection with the 1993 moratorium exception process; 65.12 (z) to license and certify up to 150 nursing home beds to 65.13 replace an existing 285 bed nursing facility located in St. 65.14 Paul. The replacement project shall include both the renovation 65.15 of existing buildings and the construction of new facilities at 65.16 the existing site. The reduction in the licensed capacity of 65.17 the existing facility shall occur during the construction 65.18 project as beds are taken out of service due to the construction 65.19 process. Prior to the start of the construction process, the 65.20 facility shall provide written information to the commissioner 65.21 of health describing the process for bed reduction, plans for 65.22 the relocation of residents, and the estimated construction 65.23 schedule. The relocation of residents shall be in accordance 65.24 with the provisions of law and rule; 65.25 (aa) to allow the commissioner of human services to license 65.26 an additional 36 beds to provide residential services for the 65.27 physically handicapped under Minnesota Rules, parts 9570.2000 to 65.28 9570.3400, in a 198-bed nursing home located in Red Wing, 65.29 provided that the total number of licensed and certified beds at 65.30 the facility does not increase; 65.31 (bb) to license and certify a new facility in St. Louis 65.32 county with 44 beds constructed to replace an existing facility 65.33 in St. Louis county with 31 beds, which has resident rooms on 65.34 two separate floors and an antiquated elevator that creates 65.35 safety concerns for residents and prevents nonambulatory 65.36 residents from residing on the second floor. The project shall 66.1 include the elimination of three- and four-bed rooms; 66.2 (cc) to license and certify four beds in a 16-bed certified 66.3 boarding care home in Minneapolis to replace beds that were 66.4 voluntarily delicensed and decertified on or before March 31, 66.5 1992. The licensure and certification is conditional upon the 66.6 facility periodically assessing and adjusting its resident mix 66.7 and other factors which may contribute to a potential 66.8 institution for mental disease declaration. The commissioner of 66.9 human services shall retain the authority to audit the facility 66.10 at any time and shall require the facility to comply with any 66.11 requirements necessary to prevent an institution for mental 66.12 disease declaration, including delicensure and decertification 66.13 of beds, if necessary;or66.14 (dd) to license and certify 72 beds in an existing facility 66.15 in Mille Lacs county with 80 beds as part of a renovation 66.16 project. The renovation must include construction of an 66.17 addition to accommodate ten residents with beginning and 66.18 midstage dementia in a self-contained living unit; creation of 66.19 three resident households where dining, activities, and support 66.20 spaces are located near resident living quarters; designation of 66.21 four beds for rehabilitation in a self-contained area; 66.22 designation of 30 private rooms; and other improvements; or 66.23 (ee) to license and certify beds in a facility that has 66.24 undergone remodeling as part of a planned closure under section 66.25 256B.437. 66.26 Sec. 6. Minnesota Statutes 2000, section 144A.073, 66.27 subdivision 2, is amended to read: 66.28 Subd. 2. [REQUEST FOR PROPOSALS.] At the authorization by 66.29 the legislature of additional medical assistance expenditures 66.30 for exceptions to the moratorium on nursing homes, the 66.31 interagency committee shall publish in the State Register a 66.32 request for proposals for nursing home projects to be licensed 66.33 or certified under section 144A.071, subdivision 4a, clause 66.34 (c). The public notice of this funding and the request for 66.35 proposals must specify how the approval criteria will be 66.36 prioritized by the advisory review panel, the interagency 67.1 long-term care planning committee, and the commissioner. The 67.2 notice must describe the information that must accompany a 67.3 request and state that proposals must be submitted to the 67.4 interagency committee within 90 days of the date of 67.5 publication. The notice must include the amount of the 67.6 legislative appropriation available for the additional costs to 67.7 the medical assistance program of projects approved under this 67.8 section. If no money is appropriated for a year, the 67.9 interagency committee shall publish a notice to that effect, and 67.10 no proposals shall be requested. If money is appropriated, the 67.11 interagency committee shall initiate the application and review 67.12 process described in this section at least twice each biennium 67.13 and up to four times each biennium, according to dates 67.14 established by rule. Authorized funds shall be allocated 67.15 proportionally to the number of processes. Funds not encumbered 67.16 by an earlier process within a biennium shall carry forward to 67.17 subsequent iterations of the process.Authorization for67.18expenditures does not carry forward into the following67.19biennium.To be considered for approval, a proposal must 67.20 include the following information: 67.21 (1) whether the request is for renovation, replacement, 67.22 upgrading, conversion, or relocation; 67.23 (2) a description of the problem the project is designed to 67.24 address; 67.25 (3) a description of the proposed project; 67.26 (4) an analysis of projected costs of the nursing facility 67.27 proposal, which are not required to exceed the cost threshold 67.28 referred to in section 144A.071, subdivision 1, to be considered 67.29 under this section, including initial construction and 67.30 remodeling costs; site preparation costs; technology costs; 67.31 financing costs, including the current estimated long-term 67.32 financing costs of the proposal, which consists of estimates of 67.33 the amount and sources of money, reserves if required under the 67.34 proposed funding mechanism, annual payments schedule, interest 67.35 rates, length of term, closing costs and fees, insurance costs, 67.36 and any completed marketing study or underwriting review; and 68.1 estimated operating costs during the first two years after 68.2 completion of the project; 68.3 (5) for proposals involving replacement of all or part of a 68.4 facility, the proposed location of the replacement facility and 68.5 an estimate of the cost of addressing the problem through 68.6 renovation; 68.7 (6) for proposals involving renovation, an estimate of the 68.8 cost of addressing the problem through replacement; 68.9 (7) the proposed timetable for commencing construction and 68.10 completing the project; 68.11 (8) a statement of any licensure or certification issues, 68.12 such as certification survey deficiencies; 68.13 (9) the proposed relocation plan for current residents if 68.14 beds are to be closed so that the department of human services 68.15 can estimate the total costs of a proposal; and 68.16 (10) other information required by permanent rule of the 68.17 commissioner of health in accordance with subdivisions 4 and 8. 68.18 Sec. 7. Minnesota Statutes 2000, section 144A.073, 68.19 subdivision 4, is amended to read: 68.20 Subd. 4. [CRITERIA FOR REVIEW.] The following criteria 68.21 shall be used in a consistent manner to compare, evaluate, and 68.22 rank all proposals submitted. Except for the criteria specified 68.23 in clause (3), the application of criteria listed under this 68.24 subdivision shall not reflect any distinction based on the 68.25 geographic location of the proposed project: 68.26 (1) the extent to which the proposal furthers state 68.27 long-term care goals,including the goals stated in section68.28144A.31, andincluding the goal of enhancing the availability 68.29 and use of alternative care services and the goal of reducing 68.30 the number of long-term care resident rooms with more than two 68.31 beds; 68.32 (2) the proposal's long-term effects on state costs 68.33 including the cost estimate of the project according to section 68.34 144A.071, subdivision 5a; 68.35 (3) the extent to which the proposal promotes equitable 68.36 access to long-term care services in nursing homes through 69.1 redistribution of the nursing home bed supply, as measured by 69.2 the number of beds relative to the population 85 or older, 69.3 projected to the year 2000 by the state demographer, and 69.4 according to items (i) to (iv): 69.5 (i) reduce beds in counties where the supply is high, 69.6 relative to the statewide mean, and increase beds in counties 69.7 where the supply is low, relative to the statewide mean; 69.8 (ii) adjust the bed supply so as to create the greatest 69.9 benefits in improving the distribution of beds; 69.10 (iii) adjust the existing bed supply in counties so that 69.11 the bed supply in a county moves toward the statewide mean; and 69.12 (iv) adjust the existing bed supply so that the 69.13 distribution of beds as projected for the year 2020 would be 69.14 consistent with projected need, based on the methodology 69.15 outlined in the interagency long-term care committee's199369.16 nursing home bed distribution study; 69.17 (4) the extent to which the project improves conditions 69.18 that affect the health or safety of residents, such as narrow 69.19 corridors, narrow door frames, unenclosed fire exits, and wood 69.20 frame construction, and similar provisions contained in fire and 69.21 life safety codes and licensure and certification rules; 69.22 (5) the extent to which the project improves conditions 69.23 that affect the comfort or quality of life of residents in a 69.24 facility or the ability of the facility to provide efficient 69.25 care, such as a relatively high number of residents in a room; 69.26 inadequate lighting or ventilation; poor access to bathing or 69.27 toilet facilities; a lack of available ancillary space for 69.28 dining rooms, day rooms, or rooms used for other activities; 69.29 problems relating to heating, cooling, or energy efficiency; 69.30 inefficient location of nursing stations; narrow corridors; or 69.31 other provisions contained in the licensure and certification 69.32 rules; 69.33 (6) the extent to which the applicant demonstrates the 69.34 delivery of quality care, as defined in state and federal 69.35 statutes and rules, to residents as evidenced by the two most 69.36 recent state agency certification surveys and the applicants' 70.1 response to those surveys; 70.2 (7) the extent to which the project removes the need for 70.3 waivers or variances previously granted by either the licensing 70.4 agency, certifying agency, fire marshal, or local government 70.5 entity;and70.6 (8) the extent to which the project increases the number of 70.7 private or single bed rooms; and 70.8 (9) other factors that may be developed in permanent rule 70.9 by the commissioner of health that evaluate and assess how the 70.10 proposed project will further promote or protect the health, 70.11 safety, comfort, treatment, or well-being of the facility's 70.12 residents. 70.13 Sec. 8. Minnesota Statutes 2000, section 144A.073, is 70.14 amended by adding a subdivision to read: 70.15 Subd. 9a. [CARRYFORWARD.] Funds appropriated for the 70.16 nursing home moratorium exception process that are not 70.17 authorized or have expired or are unused by the end of the 70.18 biennium are carried forward to the next biennium. 70.19 Sec. 9. Minnesota Statutes 2000, section 144A.16, is 70.20 amended to read: 70.21 144A.16 [CESSATION OF OPERATIONS.] 70.22 If a nursing home voluntarily plans to cease operations or 70.23 to curtail operations to the extent that relocation of residents 70.24 is necessary, the controlling persons of the facility shall 70.25 notify the commissioner of health at least 90 days prior to the 70.26 scheduled cessation or curtailment.The commissioner of health70.27shall cooperate with and advise the controlling persons of the70.28nursing home in the resettlement of residents.The commissioner 70.29 of health shall notify the commissioner of human services of a 70.30 nursing home's intention to cease or curtail operations. 70.31 Failure to comply with this section shall be a violation of 70.32 section 144A.10. 70.33 Sec. 10. [144A.185] [DEFINITIONS.] 70.34 Subdivision 1. [APPLICABILITY.] For purposes of sections 70.35 144A.185 to 144A.1889, the terms defined in this section have 70.36 the meanings given them. 71.1 Subd. 2. [CLOSURE.] "Closure" means the cessation of 71.2 operations of a nursing home and the delicensure or 71.3 decertification of all beds within the facility. 71.4 Subd. 3. [CURTAILMENT, REDUCTION, OR CHANGE IN 71.5 OPERATIONS.] "Curtailment, reduction, or change in operations" 71.6 means any change in operations or services that would result in 71.7 or encourage the relocation of residents. 71.8 Subd. 4. [FACILITY.] "Facility" means a licensed nursing 71.9 home or a certified boarding care home licensed according to 71.10 sections 144.50 to 144.56. 71.11 Subd. 5. [LICENSEE.] "Licensee" means the owner of the 71.12 facility or the owner's designee or the commissioner of health 71.13 for a facility in receivership. 71.14 Subd. 6. [LOCAL AGENCY.] "Local agency" means a county or 71.15 a multicounty social service agency authorized under section 71.16 393.01 as the agency responsible for providing social services. 71.17 Subd. 7. [PLAN.] "Plan" means a process that has been 71.18 agreed upon by the parties identified in section 144A.1855, 71.19 subdivision 1, for the closure or curtailment, reduction, or 71.20 change in operations of a facility and for the subsequent 71.21 discharge or transfer of residents. 71.22 Subd. 8. [RELOCATION.] "Relocation" means the discharge of 71.23 a resident and movement of the resident to another facility or 71.24 living arrangement as a result of a closure or curtailment, 71.25 reduction, or change in operations of a facility. 71.26 Subd. 9. [TRANSFER.] "Transfer" means the movement of a 71.27 resident within a nursing facility from one assigned room to 71.28 another. 71.29 Sec. 11. [144A.1852] [APPLICABILITY.] 71.30 Subdivision 1. [FUNDING MUST BE AVAILABLE.] Sections 71.31 144A.185 to 144A.1889 apply only when funding is made available 71.32 by an appropriation of the legislature. 71.33 Subd. 2. [COORDINATION WITH OTHER LAW.] The relocation 71.34 plan required under section 144A.186, subdivision 2, must be 71.35 completed before a nursing home gives notice to the commissioner 71.36 of health under section 144A.16. 72.1 Sec. 12. [144A.1855] [INITIAL NOTICE.] 72.2 Subdivision 1. [NOTIFICATION; PARTIES.] A licensee shall 72.3 notify the following parties in writing when there is an intent 72.4 to close or curtail, reduce, or change operations: 72.5 (1) the commissioner of health; 72.6 (2) the commissioner of human services; 72.7 (3) the local agency; 72.8 (4) the office of the ombudsman for older Minnesotans; and 72.9 (5) the office of the ombudsman for mental health and 72.10 mental retardation. 72.11 Subd. 2. [NOTICE REQUIREMENTS.] The written notice shall 72.12 include the names, telephone numbers, fax numbers, and e-mail 72.13 addresses of the persons in the facility who are responsible for 72.14 coordinating the facility's efforts in the planning process and 72.15 the number of residents potentially affected by the closure or 72.16 curtailment, reduction, or change in operations. 72.17 Sec. 13. [144A.186] [PLANNING PROCESS.] 72.18 Subdivision 1. [LOCAL AGENCY REQUIREMENTS.] (a) A local 72.19 agency, within five working days of receiving an initial notice 72.20 from a licensee according to section 144A.1855, shall provide 72.21 all parties identified in section 144A.1855, subdivision 1, with 72.22 the names, telephone numbers, fax numbers, and e-mail addresses 72.23 of those persons who are responsible for coordinating local 72.24 agency efforts in the planning process. 72.25 (b) Within ten working days of receipt of the notice under 72.26 paragraph (a), the local agency and licensee shall convene a 72.27 meeting with representatives from the departments of health and 72.28 human services, the office of the ombudsman for older 72.29 Minnesotans, and the office of the ombudsman for mental health 72.30 and mental retardation to develop the relocation plan under 72.31 subdivision 2. The relocation plan must be completed within 45 72.32 days. 72.33 Subd. 2. [RELOCATION PLAN.] (a) The plan shall: 72.34 (1) identify the expected date of closure or curtailment, 72.35 reduction, or change in operations; 72.36 (2) outline the process for public notification of the 73.1 closure or curtailment, reduction, or change in operations; 73.2 (3) outline the process to ensure 60-day advance written 73.3 notice to residents, family members, and designated 73.4 representatives of residents; 73.5 (4) present an aggregate description of the resident 73.6 population remaining to be transferred or relocated and the 73.7 population's needs; 73.8 (5) outline the individual resident assessment process to 73.9 be used; 73.10 (6) identify an inventory of available transfer or 73.11 relocation options, including home and community-based services; 73.12 (7) identify a timeline for submission of the list required 73.13 under section 144A.1865, subdivision 3; 73.14 (8) identify a schedule for each element of the plan; and 73.15 (9) estimate the relocation costs to the local agency and 73.16 the licensee. 73.17 (b) All parties to the plan shall refrain from any public 73.18 notification of the intent to close or curtail, reduce, or 73.19 change operations until a relocation plan has been established. 73.20 Sec. 14. [144A.1865] [REQUIREMENTS OF LICENSEE.] 73.21 Subdivision 1. [TRANSFER AND RELOCATION.] The licensee 73.22 shall provide for the safe, orderly, and appropriate transfer 73.23 and relocation of residents. The licensee and facility staff 73.24 shall cooperate with representatives from the local agency, the 73.25 departments of health and human services, the office of the 73.26 ombudsman for older Minnesotans, and the office of the ombudsman 73.27 for mental health and mental retardation in planning for and 73.28 implementing the transfer or relocation of residents. 73.29 Subd. 2. [INTERDISCIPLINARY TEAM.] The licensee shall 73.30 establish an interdisciplinary team responsible for coordinating 73.31 and implementing the plan under section 144A.186, subdivision 73.32 2. The interdisciplinary team shall include representatives 73.33 from the local agency, the office of the ombudsman for older 73.34 Minnesotans, facility staff who provide direct care services to 73.35 the residents, and the facility administration. 73.36 Subd. 3. [RESIDENT LISTS.] The licensee shall provide a 74.1 list to the local agency that includes the following information 74.2 on each resident to be transferred or relocated: 74.3 (1) name; 74.4 (2) date of birth; 74.5 (3) social security number; 74.6 (4) medical assistance ID number; 74.7 (5) all diagnoses; and 74.8 (6) name of and contact information for the resident's 74.9 family or other designated representative. 74.10 Subd. 4. [CONSULTATION WITH LOCAL AGENCY.] The licensee 74.11 shall consult with the local agency on the availability and 74.12 development of resources and in the resident transfer or 74.13 relocation process. 74.14 [EFFECTIVE DATE.] This section is effective the day 74.15 following final enactment. 74.16 Sec. 15. [144A.187] [RESIDENT AND PHYSICIAN NOTICE.] 74.17 Subdivision 1. [RESIDENT NOTICE REQUIRED.] (a) At least 60 74.18 days before the proposed date of closure or curtailment, 74.19 reduction, or change in operations as agreed to in the plan 74.20 under section 144A.186, the licensee shall send a written notice 74.21 of closure or curtailment, reduction, or change in operations to 74.22 each resident being transferred or relocated, the resident's 74.23 family member or designated representative, and the resident's 74.24 attending physician. 74.25 (b) The notice must include: 74.26 (1) the date of the proposed closure or curtailment, 74.27 reduction, or change in operations; 74.28 (2) the name, address, telephone number, fax number, and 74.29 e-mail address of the individuals in the facility responsible 74.30 for providing assistance and information; 74.31 (3) a notice of upcoming meetings for residents, families, 74.32 designated representatives, and resident councils to discuss the 74.33 transfer or relocation of residents; 74.34 (4) the name, address, and telephone number of the local 74.35 agency contact person; 74.36 (5) the name, address, and telephone number of the office 75.1 of the ombudsman for older Minnesotans and the office of the 75.2 ombudsman for mental health and mental retardation; and 75.3 (6) a notice of resident rights during transfer and 75.4 relocation. 75.5 (c) The notice to residents must comply with all applicable 75.6 state and federal requirements for notice of transfer or 75.7 discharge of nursing home residents. 75.8 Subd. 2. [MEDICAL INFORMATION REQUEST.] The licensee shall 75.9 request the attending physician to furnish the licensee with, or 75.10 arrange for the release of, any medical information needed to 75.11 update a resident's medical records and to prepare transfer 75.12 forms and discharge summaries. 75.13 Sec. 16. [144A.1875] [RELOCATION OF RESIDENTS.] 75.14 Subdivision 1. [PREPARATION; PLACEMENT INFORMATION.] A 75.15 licensee shall provide sufficient preparation to residents to 75.16 ensure safe, orderly, and appropriate discharge and relocation. 75.17 The facility is responsible for assisting residents in finding 75.18 placement within the resident's desired geographic location 75.19 using the Senior LinkAge database of the department of human 75.20 services. The list from Senior LinkAge must contain the name, 75.21 address, and telephone and fax numbers of each facility with 75.22 available beds, the certification level of the available beds, 75.23 the types of services available, and the number of beds that are 75.24 available. The list must include home and community-based 75.25 placements, services and settings, and other options for 75.26 individuals with special needs. The list must be made available 75.27 to residents, their families or designated representatives, the 75.28 office of the ombudsman for older Minnesotans, the office of the 75.29 ombudsman for mental health and mental retardation, and the 75.30 local agency. 75.31 Subd. 2. [RESIDENT AND FAMILY MEETINGS.] After preparing 75.32 the plan according to section 144A.186, the licensee shall 75.33 conduct meetings with residents, families, designated 75.34 representatives, and resident and family councils to notify them 75.35 of the process for resident transfer or relocation. 75.36 Representatives from the local agency, the office of the 76.1 ombudsman for older Minnesotans, and the office of the ombudsman 76.2 for mental health and mental retardation shall receive advance 76.3 notice of these meetings. 76.4 Subd. 3. [PERSONAL PROPERTY.] (a) The licensee shall 76.5 update the inventory of residents' personal possessions and 76.6 provide a copy of the final inventory to each resident and the 76.7 resident's family or designated representative prior to the 76.8 relocation of the resident. The licensee is responsible for the 76.9 timely transfer of a resident's possessions for all relocations 76.10 within the state and within a 50-mile radius of the facility for 76.11 relocations outside the state. 76.12 (b) The licensee shall complete a final accounting of 76.13 personal funds held in trust by the licensee and provide a copy 76.14 of the accounting to each resident and the resident's family or 76.15 designated representative. The licensee is responsible for the 76.16 timely transfer of all personal funds held in trust by the 76.17 licensee. 76.18 Subd. 4. [SITE VISITS.] The licensee is responsible for 76.19 assisting residents in making site visits to facilities or other 76.20 placements to which the resident may be relocated, unless it is 76.21 medically inadvisable, as documented by the attending physician 76.22 in the resident's care record. The licensee shall provide 76.23 transportation for site visits to facilities or other placements 76.24 within a 50-mile radius. 76.25 Subd. 5. [FINAL NOTICE OF RELOCATION.] (a) Before 76.26 relocating a resident, the licensee shall provide a final 76.27 written notice to the resident, the resident's family or 76.28 designated representative, and the resident's attending 76.29 physician. 76.30 (b) The final written notice shall: 76.31 (1) be provided seven days before the relocation of a 76.32 resident, unless the resident agrees to waive the resident's 76.33 right to advance notice; and 76.34 (2) identify the date of the anticipated relocation and the 76.35 location to which the resident is being transferred. 76.36 Subd. 6. [ADMINISTRATIVE DUTIES.] (a) All administrative 77.1 duties of the licensee under subdivisions 1, 2, 4, and 5 must be 77.2 completed before relocation of a resident. 77.3 (b) The licensee is responsible for providing the receiving 77.4 facility or other health, housing, or care entity with a 77.5 complete and accurate resident record, including information on 77.6 family members, designated representatives, guardians, social 77.7 service caseworkers, and other contact information. The record 77.8 must also include all information necessary to provide 77.9 appropriate medical care and social services, including, but not 77.10 limited to, information on preadmission screening, Level I and 77.11 Level II screening, minimum data set and all other assessments, 77.12 resident diagnosis, behavior, and medication. 77.13 (c) For residents with special care needs, the licensee 77.14 shall consult with the receiving facility or other placement 77.15 entity and provide staff training or other preparation as needed 77.16 to assist in providing for the special needs. 77.17 (d) The licensee shall assist residents with the transfer 77.18 or reconnection of telephone service. The licensee shall bear 77.19 all costs associated with reestablishing telephone service. 77.20 Subd. 7. [TRANSPORTATION; CONTINUITY OF CARE.] The 77.21 licensee shall make arrangements or provide for the 77.22 transportation of residents to the new facility or placement 77.23 within the state or within a 50-mile radius for relocations 77.24 outside the state. The licensee shall provide a staff person to 77.25 accompany the resident during transportation, upon request of 77.26 the resident, the resident's family, or designated 77.27 representative. The discharge and relocation of residents must 77.28 comply with all applicable state and federal requirements and 77.29 must be conducted in a safe, orderly, and appropriate manner. 77.30 The licensee must ensure that there is no disruption in 77.31 providing meals, medications, or treatments of a resident during 77.32 the relocation process. 77.33 Sec. 17. [144A.188] [TRANSFER OF RESIDENTS.] 77.34 (a) The licensee shall provide for the safe, orderly, and 77.35 appropriate transfer of residents. The licensee and facility 77.36 staff shall cooperate with representatives from the local 78.1 agency, the departments of health and human services, the office 78.2 of the ombudsman for older Minnesotans, and the office of the 78.3 ombudsman for mental health and mental retardation in planning 78.4 for and implementing the transfer of residents when a change in 78.5 facility operation could result in or encourage multiple 78.6 intrafacility transfers of individual residents. 78.7 (b) The licensee shall comply with all provisions of 78.8 sections 144A.1865; 144A.187, subdivision 1; and 144A.1875, 78.9 subdivision 2, applicable to residents being transferred. 78.10 Sec. 18. [144A.1885] [RELOCATION REPORTS.] 78.11 (a) Beginning the week following development of the initial 78.12 relocation plan under section 144A.186, the licensee shall 78.13 submit weekly status reports to the commissioners of health and 78.14 human services and to the local agency. 78.15 (b) The first status report must identify the relocation 78.16 plan developed under section 144A.186, the interdisciplinary 78.17 team members, and the number of residents to be relocated. 78.18 (c) Subsequent status reports must note any modifications 78.19 to the relocation plan, any change of interdisciplinary team 78.20 members or number of residents relocated, the placement 78.21 destination to which residents have been relocated, and the 78.22 number of residents remaining to be relocated. Subsequent 78.23 status reports must also identify issues or problems encountered 78.24 during the relocation process and the resolution of these issues. 78.25 Sec. 19. [144A.1886] [REQUIREMENTS OF LOCAL AGENCY.] 78.26 Subdivision 1. [MEETING; REPRESENTATION.] (a) The local 78.27 agency with the licensee shall convene a meeting to develop a 78.28 plan according to section 144A.186, subdivision 1, paragraph (b). 78.29 (b) The local agency shall designate a representative to 78.30 the interdisciplinary team established by the licensee 78.31 responsible for coordinating the relocation efforts. 78.32 Subd. 2. [RESOURCE.] (a) The local agency shall serve as a 78.33 resource in the transfer or relocation process. 78.34 (b) Concurrent with the notice sent to residents from the 78.35 licensee according to section 144A.187, subdivision 1, the local 78.36 agency shall provide written notice to residents, family 79.1 members, and designated representatives describing: 79.2 (1) the local agency's role in the transfer or relocation 79.3 process and in the follow-up to relocation; 79.4 (2) a local agency contact name, address, and telephone 79.5 number; and 79.6 (3) the name, address, and telephone number of the office 79.7 of the ombudsman for older Minnesotans and the office of the 79.8 ombudsman for mental health and mental retardation. 79.9 (c) The local agency is responsible for the safe and 79.10 orderly relocation of residents in cases where an emergent need 79.11 arises or when the licensee has abrogated the licensee's 79.12 responsibilities under the relocation plan. 79.13 Subd. 3. [COORDINATION; OVERSIGHT.] (a) The local agency 79.14 shall meet with appropriate facility staff to coordinate any 79.15 assistance. Coordination shall include participating in group 79.16 meetings with residents, family members, and designated 79.17 representatives to explain the transfer or relocation process. 79.18 (b) The local agency shall monitor compliance with all 79.19 components of the relocation plan. When the licensee is not in 79.20 compliance, the local agency shall notify the commissioners of 79.21 health and human services. 79.22 (c) Except as requested by the resident, family member, or 79.23 designated representative and within the parameters of the 79.24 Vulnerable Adults Act, the local agency may halt a relocation 79.25 that it deems inappropriate or dangerous to the health or safety 79.26 of a resident. 79.27 Subd. 4. [FOLLOW-UP REVIEW.] (a) A member of the local 79.28 agency staff shall visit residents within 30 days after a 79.29 transfer or relocation. Local agency staff shall interview the 79.30 resident and family member or designated representative or shall 79.31 observe the resident on-site, or both, and review and discuss 79.32 pertinent medical or social records with appropriate facility 79.33 staff to assess the adjustment of the resident to the new 79.34 placement, recommend services or methods to meet any special 79.35 needs of the resident, and identify residents at risk. 79.36 (b) The local agency may conduct subsequent follow-up 80.1 visits in cases where the adjustment of the resident to the new 80.2 placement is in question. 80.3 (c) Within 60 days of the completion of the follow-up 80.4 visits, the local agency shall submit a written summary of the 80.5 follow-up work to the commissioners of health and human 80.6 services, in a manner approved by the commissioners. 80.7 (d) The local agency shall submit a report of any issues 80.8 that may require further review or monitoring to the 80.9 commissioner of health. 80.10 Sec. 20. [144A.1887] [FUNDING.] 80.11 (a) Within 60 days of a nursing home ceasing operations, 80.12 the commissioner of human services shall reimburse nursing homes 80.13 that are reimbursed under sections 256B.431, 256B.434, and 80.14 256B.435 for operating costs incurred by the nursing home during 80.15 the closure process. The amount to be reimbursed to the nursing 80.16 home shall be determined by applying paragraphs (b) to (f). 80.17 (b) The facility shall provide the commissioner of human 80.18 services with the nursing home's operating costs for the time 80.19 period of 30 days prior to the notice specified under section 80.20 144A.16, to 30 days after the nursing home's closure. 80.21 (c) The nursing home shall provide the commissioner of 80.22 human services with the number of medical assistance, Medicare, 80.23 private pay, and other resident days for the period referenced 80.24 in paragraph (b) by the 11 case mix categories. 80.25 (d) The commissioner of human services shall calculate a 80.26 nursing home closure rate by dividing the facility operating 80.27 costs in paragraph (b) by the total resident days in paragraph 80.28 (c). 80.29 (e) The total closure costs attributable to medical 80.30 assistance shall be determined by multiplying the nursing home 80.31 closure rate in paragraph (d) by the medical assistance days 80.32 provided by the nursing facility in paragraph (c). 80.33 (f) The amount to be reimbursed to the nursing home is 80.34 equal to the total closure costs in paragraph (e) minus the sum 80.35 of the nursing facility's 11 operating rates times their 80.36 respective number of medical assistance days by case mix as 81.1 referenced in paragraph (c). 81.2 Sec. 21. [144A.36] [TRANSITION PLANNING GRANTS.] 81.3 Subdivision 1. [DEFINITIONS.] "Eligible nursing home" 81.4 means any nursing home licensed under sections 144A.01 to 81.5 144A.16 and certified by the appropriate authority under United 81.6 States Code, title 42, sections 1396-1396p, to participate as a 81.7 vendor in the medical assistance program established under 81.8 chapter 256B. 81.9 Subd. 2. [GRANTS AUTHORIZED.] (a) The commissioner shall 81.10 establish a program of transition planning grants to assist 81.11 eligible nursing homes in implementing the provisions in 81.12 paragraphs (b) to (d). 81.13 (b) Transition planning grants may be used by nursing homes 81.14 to develop strategic plans which identify the appropriate 81.15 institutional and noninstitutional settings necessary to meet 81.16 the older adult service needs of the community. 81.17 (c) At a minimum, a strategic plan must consist of: 81.18 (1) a needs assessment to determine what older adult 81.19 services are needed and desired by the community; 81.20 (2) an assessment of the appropriate settings in which to 81.21 provide needed older adult services; 81.22 (3) an assessment identifying currently available services 81.23 and their settings in the community; and 81.24 (4) a transition plan to achieve the needed outcome 81.25 identified by the assessment. 81.26 Subd. 3. [ALLOCATION OF GRANTS.] (a) Eligible nursing 81.27 homes must apply to the commissioner no later than September 1 81.28 of each fiscal year for grants awarded in that fiscal year. A 81.29 grant shall be awarded upon signing of a grant contract. 81.30 (b) The commissioner must make a final decision on the 81.31 funding of each application within 60 days of the deadline for 81.32 receiving applications. 81.33 Subd. 4. [EVALUATION.] The commissioner shall evaluate the 81.34 overall effectiveness of the grant program. The commissioner 81.35 may collect, from the nursing homes receiving grants, the 81.36 information necessary to evaluate the grant program. 82.1 Information related to the financial condition of individual 82.2 nursing homes shall be classified as nonpublic data. 82.3 Sec. 22. [144A.37] [ALTERNATIVE NURSING HOME SURVEY 82.4 PROCESS.] 82.5 Subdivision 1. [ALTERNATIVE NURSING HOME SURVEY 82.6 SCHEDULES.] (a) The commissioner of health shall implement 82.7 alternative procedures for the nursing home survey process as 82.8 authorized under this section. 82.9 (b) These alternative survey process procedures seek to: 82.10 (1) use department resources more effectively and efficiently to 82.11 target problem areas; (2) use other existing or new mechanisms 82.12 to provide objective assessments of quality and to measure 82.13 quality improvement; (3) provide for frequent collaborative 82.14 interaction of facility staff and surveyors rather than a 82.15 punitive approach; and (4) reward a nursing home that has 82.16 performed very well by extending intervals between full surveys. 82.17 (c) The commissioner shall pursue changes in federal law 82.18 necessary to accomplish this process and shall apply for any 82.19 necessary federal waivers or approval. If a federal waiver is 82.20 required, the commissioner shall submit a formal waiver request 82.21 no later than June 15, 2001. The commissioner shall also pursue 82.22 any necessary federal law changes during the 107th Congress. 82.23 (d) The alternative nursing home survey schedule shall be 82.24 implemented January 1, 2002, or upon federal approval. 82.25 Subd. 2. [SURVEY INTERVALS.] The commissioner of health 82.26 must extend the time period between standard surveys up to 30 82.27 months based on the criteria established in subdivision 4. In 82.28 using the alternative survey schedule, the requirement for the 82.29 statewide average to not exceed 12 months does not apply. 82.30 Subd. 3. [COMPLIANCE HISTORY.] The commissioner shall 82.31 develop a process for identifying the survey cycles for skilled 82.32 nursing facilities based upon the compliance history of the 82.33 facility. This process can use a range of months for survey 82.34 intervals. At a minimum, the process must be based on 82.35 information from the last two survey cycles and shall take into 82.36 consideration any deficiencies issued as the result of a survey 83.1 or a complaint investigation during the interval. A skilled 83.2 nursing facility with a finding of substandard quality of care 83.3 or a finding of immediate jeopardy is not entitled to a survey 83.4 interval greater than 12 months. The commissioner shall alter 83.5 the survey cycle for a specific skilled nursing facility based 83.6 on findings identified through the completion of a survey, a 83.7 monitoring visit, or a complaint investigation. The 83.8 commissioner must also take into consideration information other 83.9 than the facility's compliance history. 83.10 Subd. 4. [CRITERIA FOR SURVEY INTERVAL 83.11 CLASSIFICATION.] (a) The commissioner shall provide public 83.12 notice of the classification process and shall identify the 83.13 selected survey cycles for each skilled nursing facility. The 83.14 classification system must be based on an analysis of the 83.15 findings made during the past two standard survey intervals, but 83.16 it only takes one survey or complaint finding to modify the 83.17 interval. 83.18 (b) The commissioner shall also take into consideration 83.19 information obtained from residents and family members in each 83.20 skilled nursing facility and from other sources such as 83.21 employees and ombudsmen in determining the appropriate survey 83.22 intervals for facilities. 83.23 Subd. 5. [REQUIRED MONITORING.] (a) The commissioner shall 83.24 conduct at least one monitoring visit on an annual basis for 83.25 every skilled nursing facility which has been selected for a 83.26 survey cycle greater than 12 months. The commissioner shall 83.27 develop protocols for the monitoring visits which shall be less 83.28 extensive than the requirements for a standard survey. The 83.29 commissioner shall use the criteria in paragraph (b) to 83.30 determine whether additional monitoring visits to a facility 83.31 will be required. 83.32 (b) The criteria shall include, but not be limited to, the 83.33 following: 83.34 (1) changes in ownership, administration of the facility, 83.35 or direction of the facility's nursing service; 83.36 (2) changes in the facility's quality indicators which 84.1 might evidence a decline in the facility's quality of care; 84.2 (3) reductions in staffing or an increase in the 84.3 utilization of temporary nursing personnel; and 84.4 (4) complaint information or other information that 84.5 identifies potential concerns for the quality of the care and 84.6 services provided in the skilled nursing facility. 84.7 Subd. 6. [SURVEY REQUIREMENTS FOR FACILITIES NOT APPROVED 84.8 FOR EXTENDED SURVEY INTERVALS.] The commissioner shall establish 84.9 a process for surveying and monitoring of facilities which 84.10 require a survey interval of less than 15 months. This 84.11 information shall identify the steps that the commissioner must 84.12 take to monitor the facility in addition to the standard survey. 84.13 Subd. 7. [IMPACT ON SURVEY AGENCY'S BUDGET.] The 84.14 implementation of an alternative survey process for the state 84.15 must not result in any reduction of funding that would have been 84.16 provided to the state survey agency for survey and enforcement 84.17 activity based upon the completion of full standard surveys for 84.18 each skilled nursing facility in the state. 84.19 Subd. 8. [EDUCATIONAL ACTIVITIES.] The commissioner shall 84.20 expand the state survey agency's ability to conduct training and 84.21 educational efforts for skilled nursing facilities, residents 84.22 and family members, residents and family councils, long-term 84.23 care ombudsman programs, and the general public. 84.24 Subd. 9. [EVALUATION.] The commissioner shall develop a 84.25 process for the evaluation of the effectiveness of an 84.26 alternative survey process conducted under this section. 84.27 [EFFECTIVE DATE.] This section is effective the day 84.28 following final enactment. 84.29 Sec. 23. [144A.38] [INNOVATIONS IN QUALITY DEMONSTRATION 84.30 GRANTS.] 84.31 Subdivision 1. [PROGRAM ESTABLISHED.] The commissioner of 84.32 health and the commissioner of human services shall establish a 84.33 long-term care grant program that demonstrates best practices 84.34 and innovation for long-term care service delivery and housing. 84.35 The grants must fund demonstrations that create new means and 84.36 models for serving the elderly or demonstrate creativity in 85.1 service provision through the scope of their program or service. 85.2 Subd. 2. [ELIGIBILITY.] Grants may only be made to those 85.3 who provide direct service or housing to the elderly within the 85.4 state. Grants may only be made for projects that show 85.5 innovations and measurable improvement in resident care, quality 85.6 of life, use of technology, or customer satisfaction. 85.7 Subd. 3. [AWARDING OF GRANTS.] (a) Applications for grants 85.8 must be made to the commissioner on forms prescribed by the 85.9 commissioner. 85.10 (b) The commissioner shall review applications and award 85.11 grants based on the following criteria: 85.12 (1) improvement in direct care to residents; 85.13 (2) increase in efficiency through the use of technology; 85.14 (3) increase in quality of care through the use of 85.15 technology; 85.16 (4) increase in the access and delivery of service; 85.17 (5) enhancement of nursing staff training; 85.18 (6) the effectiveness of the project as a demonstration; 85.19 and 85.20 (7) the immediate transferability of the project to scale. 85.21 (c) In reviewing applications and awarding grants, the 85.22 commissioner shall consult with long-term care providers, 85.23 consumers of long-term care, long-term care researchers, and 85.24 staff of other state agencies. 85.25 (d) Grants for eligible projects may not exceed $100,000. 85.26 Sec. 24. [144A.39] [LONG-TERM CARE QUALITY PROFILES.] 85.27 Subdivision l. [DEVELOPMENT AND IMPLEMENTATION OF QUALITY 85.28 PROFILES.] (a) The commissioner of health and the commissioner 85.29 of human services shall develop and implement a quality profile 85.30 system for nursing facilities and, beginning not later than July 85.31 1, 2003, other providers of long-term care services, except when 85.32 the quality profile system would duplicate requirements under 85.33 sections 256B.5011 and 256B.5013. The system must be developed 85.34 and implemented to the extent possible without the collection of 85.35 significant amounts of new data. The system must be designed to 85.36 provide information on quality: 86.1 (1) to consumers and their families to facilitate informed 86.2 choices of service providers; 86.3 (2) to providers to enable them to measure the results of 86.4 their quality improvement efforts and compare quality 86.5 achievements with other service providers; and 86.6 (3) to public and private purchasers of long-term care 86.7 services to enable them to purchase high-quality care. 86.8 (b) The system must be developed in consultation with the 86.9 long-term care task force and representatives of consumers, 86.10 providers, and labor unions. Within the limits of available 86.11 appropriations, the commissioner may employ consultants to 86.12 assist with this project. 86.13 Subd. 2. [QUALITY MEASUREMENT TOOLS.] The commissioners 86.14 shall identify and apply existing quality measurement tools to: 86.15 (1) emphasize quality of care and its relationship to 86.16 quality of life; and 86.17 (2) address the needs of various users of long-term care 86.18 services, including, but not limited to, short-stay residents, 86.19 persons with behavioral problems, persons with dementia, and 86.20 persons who are members of minority groups. 86.21 The tools must be identified and applied, to the extent 86.22 possible, without requiring providers to supply information 86.23 beyond current state and federal requirements. 86.24 Subd. 3. [CONSUMER SURVEYS.] Following identification of 86.25 the quality measurement tool, the commissioners shall conduct 86.26 surveys of long-term care service consumers to develop quality 86.27 profiles of providers. To the extent possible, surveys must be 86.28 conducted face-to-face by state employees or contractors. At 86.29 the discretion of the commissioners, surveys may be conducted by 86.30 telephone or by provider staff. Surveys must be conducted 86.31 periodically to update quality profiles of individual service 86.32 providers. 86.33 Subd. 4. [DISSEMINATION OF QUALITY PROFILES.] By July 1, 86.34 2002, the commissioners shall implement a system to disseminate 86.35 the quality profiles developed from consumer surveys using the 86.36 quality measurement tool. Profiles must be disseminated to the 87.1 Senior LinkAge line and to consumers, providers, and purchasers 87.2 of long-term care services through all feasible printed and 87.3 electronic outlets. The commissioners shall conduct a public 87.4 awareness campaign to inform potential users regarding profile 87.5 contents and potential uses. 87.6 Sec. 25. Minnesota Statutes 2000, section 256B.431, 87.7 subdivision 2e, is amended to read: 87.8 Subd. 2e. [CONTRACTS FOR SERVICES FOR VENTILATOR DEPENDENT 87.9 PERSONS.] The commissioner may contract with a nursing facility 87.10 eligible to receive medical assistance payments to provide 87.11 services to a ventilator-dependent person identified by the 87.12 commissioner according to criteria developed by the 87.13 commissioner, including: 87.14 (1) nursing facility care has been recommended for the 87.15 person by a preadmission screening team; 87.16 (2)the person has been assessed at case mix classification87.17K;87.18(3)the person has been hospitalizedfor at least six87.19monthsand no longer requires inpatient acute care hospital 87.20 services; and 87.21(4)(3) the commissioner has determined that necessary 87.22 services for the person cannot be provided under existing 87.23 nursing facility rates. 87.24 The commissioner may issue a request for proposals to 87.25 provide services to a ventilator-dependent person to nursing 87.26 facilities eligible to receive medical assistance payments and 87.27 shall select nursing facilities from among respondents according 87.28 to criteria developed by the commissioner, including: 87.29 (1) the cost-effectiveness and appropriateness of services; 87.30 (2) the nursing facility's compliance with federal and 87.31 state licensing and certification standards; and 87.32 (3) the proximity of the nursing facility to a 87.33 ventilator-dependent person identified by the commissioner who 87.34 requires nursing facility placement. 87.35 The commissioner may negotiate an adjustment to the 87.36 operating cost payment rate for a nursing facility selected by 88.1 the commissioner from among respondents to the request for 88.2 proposals. The negotiated adjustment must reflect only the 88.3 actual additional cost of meeting the specialized care needs of 88.4 a ventilator-dependent person identified by the commissioner for 88.5 whom necessary services cannot be provided under existing 88.6 nursing facility rates and which are not otherwise covered under 88.7 Minnesota Rules, parts 9549.0010 to 9549.0080 or 9505.0170 to 88.8 9505.0475. For persons initially admitted to a nursing facility 88.9 before July 1, 2001, the negotiated payment rate must not exceed 88.10 200 percent of the highest multiple bedroom payment rate fora88.11Minnesota nursingthe facility, as initially established by the 88.12 commissioner for the rate year for case mix classification K. 88.13 For persons initially admitted to a nursing facility on or after 88.14 July 1, 2001, the negotiated payment rate must not exceed 300 88.15 percent of the facility's multiple bedroom payment rate for case 88.16 mix classification K. The negotiated adjustment shall not 88.17 affect the payment rate charged to private paying residents 88.18 under the provisions of section 256B.48, subdivision 1. 88.19 Sec. 26. Minnesota Statutes 2000, section 256B.431, 88.20 subdivision 17, is amended to read: 88.21 Subd. 17. [SPECIAL PROVISIONS FOR MORATORIUM EXCEPTIONS.] 88.22 (a) Notwithstanding Minnesota Rules, part 9549.0060, subpart 3, 88.23 for rate periods beginning on October 1, 1992, and for rate 88.24 years beginning after June 30, 1993, a nursing facility that (1) 88.25 has completed a construction project approved under section 88.26 144A.071, subdivision 4a, clause (m); (2) has completed a 88.27 construction project approved under section 144A.071, 88.28 subdivision 4a, and effective after June 30, 1995; or (3) has 88.29 completed a renovation, replacement, or upgrading project 88.30 approved under the moratorium exception process in section 88.31 144A.073 shall be reimbursed for costs directly identified to 88.32 that project as provided in subdivision 16 and this subdivision. 88.33 (b) Notwithstanding Minnesota Rules, part 9549.0060, 88.34 subparts 5, item A, subitems (1) and (3), and 7, item D, 88.35 allowable interest expense on debt shall include: 88.36 (1) interest expense on debt related to the cost of 89.1 purchasing or replacing depreciable equipment, excluding 89.2 vehicles, not to exceed six percent of the total historical cost 89.3 of the project; and 89.4 (2) interest expense on debt related to financing or 89.5 refinancing costs, including costs related to points, loan 89.6 origination fees, financing charges, legal fees, and title 89.7 searches; and issuance costs including bond discounts, bond 89.8 counsel, underwriter's counsel, corporate counsel, printing, and 89.9 financial forecasts. Allowable debt related to items in this 89.10 clause shall not exceed seven percent of the total historical 89.11 cost of the project. To the extent these costs are financed, 89.12 the straight-line amortization of the costs in this clause is 89.13 not an allowable cost; and 89.14 (3) interest on debt incurred for the establishment of a 89.15 debt reserve fund, net of the interest earned on the debt 89.16 reserve fund. 89.17 (c) Debt incurred for costs under paragraph (b) is not 89.18 subject to Minnesota Rules, part 9549.0060, subpart 5, item A, 89.19 subitem (5) or (6). 89.20 (d) The incremental increase in a nursing facility's rental 89.21 rate, determined under Minnesota Rules, parts 9549.0010 to 89.22 9549.0080, and this section, resulting from the acquisition of 89.23 allowable capital assets, and allowable debt and interest 89.24 expense under this subdivision shall be added to its 89.25 property-related payment rate and shall be effective on the 89.26 first day of the month following the month in which the 89.27 moratorium project was completed. 89.28 (e) Notwithstanding subdivision 3f, paragraph (a), for rate 89.29 periods beginning on October 1, 1992, and for rate years 89.30 beginning after June 30, 1993, the replacement-costs-new per bed 89.31 limit to be used in Minnesota Rules, part 9549.0060, subpart 4, 89.32 item B, for a nursing facility that has completed a renovation, 89.33 replacement, or upgrading project that has been approved under 89.34 the moratorium exception process in section 144A.073, or that 89.35 has completed an addition to or replacement of buildings, 89.36 attached fixtures, or land improvements for which the total 90.1 historical cost exceeds the lesser of $150,000 or ten percent of 90.2 the most recent appraised value, must be $47,500 per licensed 90.3 bed in multiple-bed rooms and $71,250 per licensed bed in a 90.4 single-bed room. These amounts must be adjusted annually as 90.5 specified in subdivision 3f, paragraph (a), beginning January 1, 90.6 1993. 90.7 (f) For purposes of this paragraph, a total replacement 90.8 means the complete replacement of the nursing facility's 90.9 physical plant through the construction of a new physical plant, 90.10 the transfer of the nursing facility's license from one physical 90.11 plant location to another, or a new building addition to 90.12 relocate beds from three- and four-bed wards. For total 90.13 replacement projects completed on or after July 1, 1992, the 90.14 commissioner shall compute the incremental change in the nursing 90.15 facility's rental per diem, for rate years beginning on or after 90.16 July 1, 1995, by replacing its appraised value, including the 90.17 historical capital asset costs, and the capital debt and 90.18 interest costs with the new nursing facility's allowable capital 90.19 asset costs and the related allowable capital debt and interest 90.20 costs. If the new nursing facility has decreased its licensed 90.21 capacity, the aggregate investment per bed limit in subdivision 90.22 3a, paragraph (c), shall apply. If the new nursing facility has 90.23 retained a portion of the original physical plant for nursing 90.24 facility usage, then a portion of the appraised value prior to 90.25 the replacement must be retained and included in the calculation 90.26 of the incremental change in the nursing facility's rental per 90.27 diem. For purposes of this part, the original nursing facility 90.28 means the nursing facility prior to the total replacement 90.29 project. The portion of the appraised value to be retained 90.30 shall be calculated according to clauses (1) to (3): 90.31 (1) The numerator of the allocation ratio shall be the 90.32 square footage of the area in the original physical plant which 90.33 is being retained for nursing facility usage. 90.34 (2) The denominator of the allocation ratio shall be the 90.35 total square footage of the original nursing facility physical 90.36 plant. 91.1 (3) Each component of the nursing facility's allowable 91.2 appraised value prior to the total replacement project shall be 91.3 multiplied by the allocation ratio developed by dividing clause 91.4 (1) by clause (2). 91.5 In the case of either type of total replacement as 91.6 authorized under section 144A.071 or 144A.073, the provisions of 91.7 this subdivision shall also apply. For purposes of the 91.8 moratorium exception authorized under section 144A.071, 91.9 subdivision 4a, paragraph (s), if the total replacement involves 91.10 the renovation and use of an existing health care facility 91.11 physical plant, the new allowable capital asset costs and 91.12 related debt and interest costs shall include first the 91.13 allowable capital asset costs and related debt and interest 91.14 costs of the renovation, to which shall be added the allowable 91.15 capital asset costs of the existing physical plant prior to the 91.16 renovation, and if reported by the facility, the related 91.17 allowable capital debt and interest costs. 91.18 (g) Notwithstanding Minnesota Rules, part 9549.0060, 91.19 subpart 11, item C, subitem (2), for a total replacement, as 91.20 defined in paragraph (f), authorized under section 144A.071 or 91.21 144A.073 after July 1, 1999, or any building project that is a 91.22 relocation, renovation, upgrading, or conversionauthorized91.23under section 144A.073,complete on or after July 1, 2001, the 91.24 replacement-costs-new per bed limit shall be $74,280 per 91.25 licensed bed in multiple-bed rooms, $92,850 per licensed bed in 91.26 semiprivate rooms with a fixed partition separating the resident 91.27 beds, and $111,420 per licensed bed in single rooms. Minnesota 91.28 Rules, part 9549.0060, subpart 11, item C, subitem (2), does not 91.29 apply. These amounts must be adjusted annually as specified in 91.30 subdivision 3f, paragraph (a), beginning January 1, 2000. 91.31 (h) For a total replacement, as defined in paragraph (f), 91.32 authorized under section 144A.073 for a 96-bed nursing home in 91.33 Carlton county, the replacement-costs-new per bed limit shall be 91.34 $74,280 per licensed bed in multiple-bed rooms, $92,850 per 91.35 licensed bed in semiprivate rooms with a fixed partition 91.36 separating the resident's beds, and $111,420 per licensed bed in 92.1 a single room. Minnesota Rules, part 9549.0060, subpart 11, 92.2 item C, subitem (2), does not apply. The resulting maximum 92.3 allowable replacement-costs-new multiplied by 1.25 shall 92.4 constitute the project's dollar threshold for purposes of 92.5 application of the limit set forth in section 144A.071, 92.6 subdivision 2. The commissioner of health may waive the 92.7 requirements of section 144A.073, subdivision 3b, paragraph (b), 92.8 clause (2), on the condition that the other requirements of that 92.9 paragraph are met. 92.10 (i) For a renovation authorized under section 144A.073 for 92.11 a 65-bed nursing home in St. Louis county, the incremental 92.12 increase in rental rate for purposes of paragraph (d) shall be 92.13 $8.16, and the total replacement cost, allowable appraised 92.14 value, allowable debt, and allowable interest shall be increased 92.15 according to the incremental increase. 92.16 (j) For a total replacement, as defined in paragraph (f), 92.17 authorized under section 144A.073 involving a new building 92.18 addition that relocates beds from three-bed wards for an 80-bed 92.19 nursing home in Redwood county, the replacement-costs-new per 92.20 bed limit shall be $74,280 per licensed bed for multiple-bed 92.21 rooms; $92,850 per licensed bed for semiprivate rooms with a 92.22 fixed partition separating the beds; and $111,420 per licensed 92.23 bed for single rooms. These amounts shall be adjusted annually, 92.24 beginning January 1, 2001. Minnesota Rules, part 9549.0060, 92.25 subpart 11, item C, subitem (2), does not apply. The resulting 92.26 maximum allowable replacement-costs-new multiplied by 1.25 shall 92.27 constitute the project's dollar threshold for purposes of 92.28 application of the limit set forth in section 144A.071, 92.29 subdivision 2. The commissioner of health may waive the 92.30 requirements of section 144A.073, subdivision 3b, paragraph (b), 92.31 clause (2), on the condition that the other requirements of that 92.32 paragraph are met. 92.33 Sec. 27. Minnesota Statutes 2000, section 256B.431, is 92.34 amended by adding a subdivision to read: 92.35 Subd. 31. [NURSING FACILITY RATE INCREASES BEGINNING JULY 92.36 1, 2001, AND JULY 1, 2002.] (a) For the rate years beginning 93.1 July 1, 2001, and July 1, 2002, the commissioner shall provide 93.2 each nursing facility reimbursed under this section or section 93.3 256B.434 with an adjustment to the total operating payment rates 93.4 in effect on June 30, 2001, and June 30, 2002, respectively, 93.5 after any increases required by section 256B.434, subdivision 93.6 4. The operating payment rate in effect on June 30, 2001, must 93.7 include the adjustment in subdivision 2i, paragraph (c). 93.8 (b) The adjustment is calculated according to clauses (1) 93.9 to (4): 93.10 (1) the commissioner shall calculate the arithmetic mean of 93.11 all June 30, 2001, and June 30, 2002, operating rates for each 93.12 facility; 93.13 (2) the commissioner shall construct an array of nursing 93.14 facilities from highest to lowest according to the arithmetic 93.15 mean calculated in clause (1). A numerical rank must be 93.16 assigned to each facility in the array. The facility with the 93.17 highest mean must be assigned a numerical rank of one. The 93.18 facility with the lowest mean must be assigned a numerical rank 93.19 equal to the total number of nursing facilities in the array. 93.20 All other facilities must be assigned a numerical rank according 93.21 to their position in the array; 93.22 (3) the amount of this rate increase for the rate year 93.23 beginning July 1, 2001, is $1 plus an amount equal to $6.11 93.24 multiplied by the ratio of the facility's numerical rank divided 93.25 by the number of facilities in the array; and 93.26 (4) the amount of this rate increase for the rate year 93.27 beginning July 1, 2002, is $1 plus an amount equal to $6.40 93.28 multiplied by the ratio of the facility's numerical rank divided 93.29 by the number of facilities in the array. 93.30 Sec. 28. Minnesota Statutes 2000, section 256B.431, is 93.31 amended by adding a subdivision to read: 93.32 Subd. 32. [ADDITIONAL INCREASES FOR LOW RATE 93.33 FACILITIES.] Before the calculation of the increases in 93.34 subdivision 31, the commissioner must provide for special 93.35 increases to facilities determined to be the lowest rate 93.36 facilities in the state. The commissioner shall place all 94.1 nursing facilities under section 256B.431 or 256B.434 into one 94.2 of the state development regions designated under section 94.3 462.385. Within each of the development regions, the 94.4 commissioner shall identify the median nursing facility rates by 94.5 case mix category. Nursing home rates that are below the median 94.6 must be adjusted to the greater of their current rates or 98 94.7 percent of the region median. Certified boarding care home 94.8 rates that are below the median must be adjusted to the greater 94.9 of their current rates or 90 percent of the region median. 94.10 Sec. 29. Minnesota Statutes 2000, section 256B.434, 94.11 subdivision 4, is amended to read: 94.12 Subd. 4. [ALTERNATE RATES FOR NURSING FACILITIES.] (a) For 94.13 nursing facilities which have their payment rates determined 94.14 under this section rather than section 256B.431, the 94.15 commissioner shall establish a rate under this subdivision. The 94.16 nursing facility must enter into a written contract with the 94.17 commissioner. 94.18 (b) A nursing facility's case mix payment rate for the 94.19 first rate year of a facility's contract under this section is 94.20 the payment rate the facility would have received under section 94.21 256B.431. 94.22 (c) A nursing facility's case mix payment rates for the 94.23 second and subsequent years of a facility's contract under this 94.24 section are the previous rate year's contract payment rates plus 94.25 an inflation adjustment. The index for the inflation adjustment 94.26 must be based on the change in the Consumer Price Index-All 94.27 Items (United States City average) (CPI-U) forecasted by Data 94.28 Resources, Inc., as forecasted in the fourth quarter of the 94.29 calendar year preceding the rate year. The inflation adjustment 94.30 must be based on the 12-month period from the midpoint of the 94.31 previous rate year to the midpoint of the rate year for which 94.32 the rate is being determined. For the rate years beginning on 94.33 July 1, 1999,andJuly 1, 2000, July 1, 2001, and July 1, 2002, 94.34 this paragraph shall apply only to the property-related payment 94.35 rate. In determining the amount of the property-related payment 94.36 rate adjustment under this paragraph, the commissioner shall 95.1 determine the proportion of the facility's rates that are 95.2 property-related based on the facility's most recent cost report. 95.3 (d) The commissioner shall develop additional 95.4 incentive-based payments of up to five percent above the 95.5 standard contract rate for achieving outcomes specified in each 95.6 contract. The specified facility-specific outcomes must be 95.7 measurable and approved by the commissioner. The commissioner 95.8 may establish, for each contract, various levels of achievement 95.9 within an outcome. After the outcomes have been specified the 95.10 commissioner shall assign various levels of payment associated 95.11 with achieving the outcome. Any incentive-based payment cancels 95.12 if there is a termination of the contract. In establishing the 95.13 specified outcomes and related criteria the commissioner shall 95.14 consider the following state policy objectives: 95.15 (1) improved cost effectiveness and quality of life as 95.16 measured by improved clinical outcomes; 95.17 (2) successful diversion or discharge to community 95.18 alternatives; 95.19 (3) decreased acute care costs; 95.20 (4) improved consumer satisfaction; 95.21 (5) the achievement of quality; or 95.22 (6) any additional outcomes proposed by a nursing facility 95.23 that the commissioner finds desirable. 95.24 Sec. 30. Minnesota Statutes 2000, section 256B.434, 95.25 subdivision 10, is amended to read: 95.26 Subd. 10. [EXEMPTIONS.] (a) To the extent permitted by 95.27 federal law, (1) a facility that has entered into a contract 95.28 under this section is not required to file a cost report, as 95.29 defined in Minnesota Rules, part 9549.0020, subpart 13, for any 95.30 year after the base year that is the basis for the calculation 95.31 of the contract payment rate for the first rate year of the 95.32 alternative payment demonstration project contract; and (2) a 95.33 facility under contract is not subject to audits of historical 95.34 costs or revenues, or paybacks or retroactive adjustments based 95.35 on these costs or revenues, except audits, paybacks, or 95.36 adjustments relating to the cost report that is the basis for 96.1 calculation of the first rate year under the contract. 96.2 (b)A facility that is under contract with the commissioner96.3under this section is not subject to the moratorium on licensure96.4or certification of new nursing home beds in section 144A.071,96.5unless the project results in a net increase in bed capacity or96.6involves relocation of beds from one site to another. Contract96.7payment rates must not be adjusted to reflect any additional96.8costs that a nursing facility incurs as a result of a96.9construction project undertaken under this paragraph. In96.10addition, as a condition of entering into a contract under this96.11section, a nursing facility must agree that any future medical96.12assistance payments for nursing facility services will not96.13reflect any additional costs attributable to the sale of a96.14nursing facility under this section and to construction96.15undertaken under this paragraph that otherwise would not be96.16authorized under the moratorium in section 144A.073. Nothing in96.17this section prevents a nursing facility participating in the96.18alternative payment demonstration project under this section96.19from seeking approval of an exception to the moratorium through96.20the process established in section 144A.073, and if approved the96.21facility's rates shall be adjusted to reflect the cost of the96.22project. Nothing in this section prevents a nursing facility96.23participating in the alternative payment demonstration project96.24from seeking legislative approval of an exception to the96.25moratorium under section 144A.071, and, if enacted, the96.26facility's rates shall be adjusted to reflect the cost of the96.27project.96.28(c)Notwithstanding section 256B.48, subdivision 6, 96.29 paragraphs (c), (d), and (e), and pursuant to any terms and 96.30 conditions contained in the facility's contract, a nursing 96.31 facility that is under contract with the commissioner under this 96.32 section is in compliance with section 256B.48, subdivision 6, 96.33 paragraph (b), if the facility is Medicare certified. 96.34(d)(c) Notwithstanding paragraph (a), if by April 1, 1996, 96.35 the health care financing administration has not approved a 96.36 required waiver, or the health care financing administration 97.1 otherwise requires cost reports to be filed prior to the 97.2 waiver's approval, the commissioner shall require a cost report 97.3 for the rate year. 97.4(e)(d) A facility that is under contract with the 97.5 commissioner under this section shall be allowed to change 97.6 therapy arrangements from an unrelated vendor to a related 97.7 vendor during the term of the contract. The commissioner may 97.8 develop reasonable requirements designed to prevent an increase 97.9 in therapy utilization for residents enrolled in the medical 97.10 assistance program. 97.11 Sec. 31. [256B.4351] [CONSTRUCTION PROJECTS FOR 97.12 ALTERNATIVE PAYMENT SYSTEM NURSING FACILITIES.] 97.13 (a) Beginning July 1, 2001, facilities reimbursed under 97.14 section 256B.434 shall receive reimbursement for projects 97.15 completed on or after July 1, 2001, as provided in this section. 97.16 (b) Facilities reimbursed under section 256B.434 that 97.17 complete a project as defined in section 256B.431, subdivision 97.18 17, paragraph (e), shall receive an add-on to the total payment 97.19 rate as defined in Minnesota Rules, part 9549.0070, subpart 1. 97.20 (c) The department of human services shall use the 97.21 facility's most recently submitted cost report, project cost 97.22 information, and rate setting processes used for projects 97.23 defined in section 256B.431, subdivision 17, paragraph (e), to 97.24 calculate the rate add-on. 97.25 (d) For the rate year beginning July 1, 2001, the 97.26 replacement-cost-new per bed limit must be $59,570 per licensed 97.27 bed in multiple bedrooms and $89,354 per licensed bed in a 97.28 single bedroom. The replacement-cost-new per bed limits must be 97.29 adjusted annually as specified in Minnesota Rules, part 97.30 9549.0060, subpart 4, item A, subitem (1), except that the index 97.31 that must be used is the Bureau of the Census: Composite 97.32 Fixed-Weighted Price Index as published in the C30 Report, Value 97.33 of New Construction Put in Place plus ten percent. 97.34 Sec. 32. [256B.4352] [PRIVATE ROOMS.] 97.35 Subdivision 1. [FEDERAL WAIVER.] The commissioner of human 97.36 services shall apply for any necessary waiver of federal 98.1 Medicaid regulations or change in state plan to allow the state 98.2 to cover the payment for a private or single bed room for 98.3 medical assistance recipients, regardless of the medical 98.4 necessity status of the recipient. 98.5 Subd. 2. [PRIVATE ROOM RATE.] Effective July 1, 2001, a 98.6 private room payment rate of 130 percent of the established 98.7 total payment rate for a resident must be allowed if the 98.8 resident is a medical assistance recipient, subject to any 98.9 limits determined under subdivision 1. Nursing facilities are 98.10 prohibited from discharging residents in order to provide single 98.11 bed rooms. Single bed rooms established through layaway under 98.12 section 144A.071 shall not receive rate adjustments under 98.13 section 256B.431, subdivision 30. Single bed rooms established 98.14 through planned partial closure shall not receive rate 98.15 adjustments under section 256B.437, subdivision 3, paragraph (b). 98.16 Sec. 33. [256B.437] [NURSING FACILITY VOLUNTARY CLOSURES 98.17 AND PLANNING AND DEVELOPMENT OF COMMUNITY-BASED ALTERNATIVES.] 98.18 Subdivision 1. [DEFINITIONS.] (a) The definitions in this 98.19 subdivision apply to subdivisions 2 to 9. 98.20 (b) "Closure" means the cessation of operations of a 98.21 nursing facility and delicensure and decertification of all beds 98.22 within the facility. 98.23 (c) "Commencement of closure" means the date on which the 98.24 commissioner of health is notified of a planned closure 98.25 according to section 144A.16 as part of an approved closure plan. 98.26 (d) "Completion of closure" means the date on which the 98.27 final resident of the nursing facility or facilities designated 98.28 for closure in an approved closure plan is discharged from the 98.29 facility or facilities. 98.30 (e) "Closure plan" means a plan to close one or more 98.31 nursing facilities and reallocate the resulting savings to 98.32 provide special rate adjustments at other facilities. 98.33 (f) "Partial closure" means the delicensure and 98.34 decertification of a portion of the beds within the facility. 98.35 (g) "Planned closure rate adjustment" means an increase in 98.36 a nursing facility's operating rates under this section. 99.1 Subd. 2. [REGIONAL LONG-TERM CARE PLANNING AND 99.2 DEVELOPMENT.] (a) The commissioner of human services shall 99.3 establish a process to adjust the capacity and distribution of 99.4 long-term care services to equalize the supply and demand for 99.5 different types of services. The process must include community 99.6 and regional planning, expansion or establishment of needed 99.7 services, and voluntary nursing facility closures. 99.8 (b) The commissioner shall issue a request for proposals to 99.9 contract with regional long-term care planning groups. Each 99.10 group must: 99.11 (1) consist of county health and social services agencies, 99.12 consumers, housing agencies, a representative of nursing 99.13 facilities, a representative of home and community-based 99.14 services providers, and area agencies on aging in the geographic 99.15 area; and 99.16 (2) serve an area that has at least 2,000 people who are 85 99.17 years of age or older. 99.18 In awarding contracts, the commissioner shall give preference to 99.19 groups that represent an entire area agency on aging region 99.20 where there is not already a planning and development group 99.21 established under section 256B.0917. An area not included in a 99.22 proposal must be included in a group convened by the area agency 99.23 on aging of that planning and service area through a contract 99.24 negotiated by the commissioner. 99.25 (c) Each regional long-term care planning group shall: 99.26 (1) conduct a detailed assessment of the region's long-term 99.27 care services system. This assessment must be completed within 99.28 90 days of the contract award and must evaluate the adequacy of 99.29 nursing facility beds and the impact of potential nursing 99.30 facility closures. The commissioner of health and the 99.31 commissioner of human services, as appropriate, shall provide 99.32 data to the group on nursing facility bed distribution, 99.33 housing-with-service options, the closure of nursing facilities 99.34 in the planning area that occur outside of the planned closure 99.35 process, the approval of planned closures in the planning area, 99.36 the addition of new community long-term care services in the 100.1 area, the closure of existing community long-term care services 100.2 in the area, and other available data; 100.3 (2) plan options for increasing community capacity to 100.4 provide more home and community-based services to reduce 100.5 reliance on nursing facility services; 100.6 (3) respond to a notice from a nursing facility of its 100.7 intent to propose voluntary bed closures under this section. 100.8 This response must consist of reviewing, assessing, and 100.9 providing recommendations to the commissioner of human services, 100.10 the interagency long-term care planning committee, and the 100.11 nursing facility about the impact of a nursing facility closure; 100.12 and 100.13 (4) develop community services alternatives to ensure that 100.14 sufficient community-based services are available to meet demand. 100.15 Subd. 3. [REQUEST FOR APPLICATIONS FOR PLANNED CLOSURE OF 100.16 NURSING FACILITIES.] (a) By July 15, 2001, the commissioner of 100.17 human services shall publish a request for applications for 100.18 closure or partial closure of nursing facilities. The request 100.19 for applications must specify: 100.20 (1) the criteria that will be used by the interagency 100.21 long-term care planning committee established under section 100.22 144A.31 and the commissioner to approve or reject applications; 100.23 (2) a requirement for the submission of a letter of intent 100.24 before the submission of an application; 100.25 (3) the information that must accompany an application; 100.26 (4) a schedule for letters of intent, applications, and 100.27 consideration of applications for a minimum of four review 100.28 processes to be conducted before June 30, 2003; and 100.29 (5) that applications may combine planned closure rate 100.30 adjustments with moratorium exception funding, in which case a 100.31 single application may serve both purposes. 100.32 Between October 1, 2001, and June 30, 2003, the commissioner may 100.33 approve planned closures of up to 4,000 nursing facility beds, 100.34 with no more than 2,000 approved for closure prior to July 1, 100.35 2002. 100.36 (b) A facility or facilities reimbursed under section 101.1 256B.431, 256B.434, or 256B.435 with a closure plan approved by 101.2 the commissioner under subdivision 6 may assign a planned 101.3 closure rate adjustment to another facility that is not 101.4 closing. The planned closure rate adjustment must be calculated 101.5 under subdivision 7. A planned closure rate adjustment under 101.6 this section is effective on the first day of the month 101.7 following completion of closure of all facilities designated for 101.8 closure in the application and becomes part of the nursing 101.9 facility's total operating payment rate. 101.10 Applicants may use the planned closure rate adjustment to 101.11 allow for a property payment for a new nursing facility or an 101.12 addition to an existing nursing facility. Applications approved 101.13 under this paragraph are exempt from other requirements for 101.14 moratorium exceptions under section 144A.073, subdivisions 2 and 101.15 3. 101.16 (c) To be considered for approval, an application must 101.17 include: 101.18 (1) a description of the proposed closure plan, which must 101.19 include identification of the facility or facilities to receive 101.20 a planned closure rate adjustment and the amount and timing of a 101.21 planned closure rate adjustment proposed for each facility; 101.22 (2) the proposed timetable for any proposed closure, 101.23 including the proposed dates for announcement to residents, 101.24 commencement of closure, and completion of closure; 101.25 (3) the proposed relocation plan for current residents of 101.26 any facility designated for closure. The proposed relocation 101.27 plan must be designed to comply with all applicable state and 101.28 federal statutes and regulations, including, but not limited to, 101.29 section 144A.16 and Minnesota Rules, parts 4655.6810 to 101.30 4655.6830, 4658.1600 to 4658.1690, and 9546.0010 to 9546.0060; 101.31 (4) a description of the relationship between the nursing 101.32 facility that is proposed for closure and the nursing facility 101.33 or facilities proposed to receive the planned closure rate 101.34 adjustment. If these facilities are not under common ownership, 101.35 copies of any contracts, purchase agreements, or other documents 101.36 establishing a relationship or proposed relationship must be 102.1 provided; 102.2 (5) documentation, in a format approved by the 102.3 commissioner, that all the nursing facilities receiving a 102.4 planned closure rate adjustment under the plan have accepted 102.5 joint and several liability for recovery of overpayments under 102.6 section 256B.0641, subdivision 2, for the facilities designated 102.7 for closure under the plan; and 102.8 (6) a detailed plan developed by the facility submitting 102.9 the application and by: 102.10 (i) a regional long-term care planning group established 102.11 under subdivision 2; 102.12 (ii) a seniors' agenda for independent living (SAIL) 102.13 project under section 256B.0917; or 102.14 (iii) if a grantee under item (i) or (ii) has not been 102.15 established, a group similar to the group described in 102.16 subdivision 2 that is coordinated by the area agency on aging 102.17 and is engaged in regional planning. 102.18 The plan must address how services will be established or 102.19 expanded in the community to meet the needs of people who 102.20 require long-term care or demonstrate that adequate services are 102.21 already available in the community. 102.22 (d) The application must address the criteria listed in 102.23 subdivision 4. 102.24 Subd. 4. [CRITERIA FOR REVIEW OF APPLICATION.] In 102.25 reviewing and approving closure proposals, the commissioner of 102.26 human services shall consider, but not be limited to, the 102.27 following criteria: 102.28 (1) improved quality of care and quality of life for 102.29 consumers; 102.30 (2) closure of a nursing facility that has a poor physical 102.31 plant; 102.32 (3) the existence of excess nursing facility beds, measured 102.33 in terms of beds per thousand persons aged 85 or older. The 102.34 excess must be measured in reference to: 102.35 (i) the county in which the facility is located; 102.36 (ii) the county and all contiguous counties; 103.1 (iii) the region in which the facility is located; or 103.2 (iv) the facility's service area. 103.3 The facility shall indicate in its proposal the area it believes 103.4 is appropriate for this measurement. A facility in a county 103.5 that is in the lowest quartile of counties with reference to 103.6 beds per thousand persons aged 85 or older is not in an area of 103.7 excess capacity; 103.8 (4) low-occupancy rates, provided that the unoccupied beds 103.9 are not the result of a personnel shortage. In analyzing 103.10 occupancy rates, the commissioner shall examine waiting lists in 103.11 the applicant facility and at facilities in the surrounding 103.12 area, as determined under clause (3); 103.13 (5) evidence of a community planning process to determine 103.14 what services are needed and ensure that needed services are 103.15 established; 103.16 (6) innovative use of reinvestment funds; 103.17 (7) innovative use planned for the closed facility's 103.18 physical plant; 103.19 (8) evidence that the proposal serves the interests of the 103.20 state; and 103.21 (9) evidence of other factors that affect the viability of 103.22 the facility, including excessive nursing pool costs. 103.23 Subd. 5. [CERTIFICATION.] Upon receipt of an application 103.24 for planned closure, the commissioner of human services shall 103.25 provide a copy of the application to the commissioner of 103.26 health. The commissioner of health shall certify to the 103.27 commissioner of human services within 30 days whether the 103.28 application, if implemented, will satisfy the requirements of 103.29 section 144A.16 and Minnesota Rules, parts 4655.6810 to 103.30 4655.6830 and 4658.1600 to 4658.1690. The commissioner of human 103.31 services shall reject all applications for which the 103.32 commissioner of health does not make the certification required 103.33 under this subdivision. 103.34 Subd. 6. [REVIEW AND APPROVAL OF PROPOSALS.] (a) The 103.35 interagency long-term care planning committee may recommend that 103.36 the commissioner of human services grant approval, within the 104.1 limits established in subdivision 3, paragraph (a), to 104.2 applications that satisfy the requirements of this section. The 104.3 interagency committee may appoint an advisory review panel 104.4 composed of representatives of counties, SAIL projects, 104.5 consumers, and providers to review proposals and provide 104.6 comments and recommendations to the committee. The 104.7 commissioners of human services and health shall provide staff 104.8 and technical assistance to the committee for the review and 104.9 analysis of proposals. The commissioners of human services and 104.10 health shall jointly approve or disapprove an application within 104.11 30 days after receiving the committee's recommendations. 104.12 (b) Approval of a planned closure expires 18 months after 104.13 approval by the commissioner of human services, unless 104.14 commencement of closure has begun. 104.15 (c) The commissioner of human services may change any 104.16 provision of the application to which all parties agree. 104.17 Subd. 7. [PLANNED CLOSURE RATE ADJUSTMENT.] The 104.18 commissioner of human services shall calculate the amount of the 104.19 planned closure rate adjustment available under subdivision 3, 104.20 paragraph (b), according to clauses (1) to (4): 104.21 (1) the amount available is the net reduction of nursing 104.22 facility beds multiplied by $2,080; 104.23 (2) the total number of beds in the nursing facility 104.24 receiving the planned closure rate adjustment must be 104.25 identified; 104.26 (3) capacity days are determined by multiplying the number 104.27 determined under clause (2) by 365; and 104.28 (4) the planned closure rate adjustment is the amount 104.29 available in clause (1), divided by capacity days determined 104.30 under clause (3). 104.31 Subd. 8. [OTHER RATE ADJUSTMENTS.] Facilities subject to 104.32 this section remain eligible for any applicable rate adjustments 104.33 provided under section 256B.431, 256B.434, or any other section. 104.34 Subd. 9. [COUNTY COSTS.] The commissioner of human 104.35 services may allocate up to $400 per nursing facility bed that 104.36 is closing, within the limits of the appropriation specified for 105.1 this purpose, to be used for relocation costs incurred by 105.2 counties for planned closures under this section or resident 105.3 relocation under section 144A.16. To be eligible for this 105.4 allocation, a county in which a nursing facility closes must 105.5 provide to the commissioner a detailed statement in a form 105.6 provided by the commissioner of additional costs, not to exceed 105.7 $400 per bed closed, that are directly incurred related to the 105.8 county's required role in the relocation process. 105.9 Sec. 34. Minnesota Statutes 2000, section 256B.48, 105.10 subdivision 1, is amended to read: 105.11 Subdivision 1. [PROHIBITED PRACTICES.] A nursing facility 105.12 is not eligible to receive medical assistance payments unless it 105.13 refrains from all of the following: 105.14 (a) Charging private paying residents rates for similar 105.15 services which exceed those which are approved by the state 105.16 agency for medical assistance recipients as determined by the 105.17 prospective desk audit rate, exceptunder the following105.18circumstances: thethat a nursing facility may(1) charge105.19private paying residents a higher rate for a private room, and105.20(2)charge for special services which are not included in the 105.21 daily rate if medical assistance residents are charged 105.22 separately at the same rate for the same services in addition to 105.23 the daily rate paid by the commissioner. Services covered by 105.24 the payment rate must be the same regardless of payment source. 105.25 Special services, if offered, must be available to all residents 105.26 in all areas of the nursing facility and charged separately at 105.27 the same rate. Residents are free to select or decline special 105.28 services. Special services must not include services which must 105.29 be provided by the nursing facility in order to comply with 105.30 licensure or certification standards and that if not provided 105.31 would result in a deficiency or violation by the nursing 105.32 facility. Services beyond those required to comply with 105.33 licensure or certification standards must not be charged 105.34 separately as a special service if they were included in the 105.35 payment rate for the previous reporting year. A nursing 105.36 facility that charges a private paying resident a rate in 106.1 violation of this clause is subject to an action by the state of 106.2 Minnesota or any of its subdivisions or agencies for civil 106.3 damages. A private paying resident or the resident's legal 106.4 representative has a cause of action for civil damages against a 106.5 nursing facility that charges the resident rates in violation of 106.6 this clause. The damages awarded shall include three times the 106.7 payments that result from the violation, together with costs and 106.8 disbursements, including reasonable attorneys' fees or their 106.9 equivalent. A private paying resident or the resident's legal 106.10 representative, the state, subdivision or agency, or a nursing 106.11 facility may request a hearing to determine the allowed rate or 106.12 rates at issue in the cause of action. Within 15 calendar days 106.13 after receiving a request for such a hearing, the commissioner 106.14 shall request assignment of an administrative law judge under 106.15 sections 14.48 to 14.56 to conduct the hearing as soon as 106.16 possible or according to agreement by the parties. The 106.17 administrative law judge shall issue a report within 15 calendar 106.18 days following the close of the hearing. The prohibition set 106.19 forth in this clause shall not apply to facilities licensed as 106.20 boarding care facilities which are not certified as skilled or 106.21 intermediate care facilities level I or II for reimbursement 106.22 through medical assistance. 106.23 (b)(1) Charging, soliciting, accepting, or receiving from 106.24 an applicant for admission to the facility, or from anyone 106.25 acting in behalf of the applicant, as a condition of admission, 106.26 expediting the admission, or as a requirement for the 106.27 individual's continued stay, any fee, deposit, gift, money, 106.28 donation, or other consideration not otherwise required as 106.29 payment under the state plan; 106.30 (2) requiring an individual, or anyone acting in behalf of 106.31 the individual, to loan any money to the nursing facility; 106.32 (3) requiring an individual, or anyone acting in behalf of 106.33 the individual, to promise to leave all or part of the 106.34 individual's estate to the facility; or 106.35 (4) requiring a third-party guarantee of payment to the 106.36 facility as a condition of admission, expedited admission, or 107.1 continued stay in the facility. 107.2 Nothing in this paragraph would prohibit discharge for 107.3 nonpayment of services in accordance with state and federal 107.4 regulations. 107.5 (c) Requiring any resident of the nursing facility to 107.6 utilize a vendor of health care services chosen by the nursing 107.7 facility. A nursing facility may require a resident to use 107.8 pharmacies that utilize unit dose packing systems approved by 107.9 the Minnesota board of pharmacy, and may require a resident to 107.10 use pharmacies that are able to meet the federal regulations for 107.11 safe and timely administration of medications such as systems 107.12 with specific number of doses, prompt delivery of medications, 107.13 or access to medications on a 24-hour basis. Notwithstanding 107.14 the provisions of this paragraph, nursing facilities shall not 107.15 restrict a resident's choice of pharmacy because the pharmacy 107.16 utilizes a specific system of unit dose drug packing. 107.17 (d) Providing differential treatment on the basis of status 107.18 with regard to public assistance. 107.19 (e) Discriminating in admissions, services offered, or room 107.20 assignment on the basis of status with regard to public 107.21 assistance or refusal to purchase special services. Admissions 107.22 discrimination shall include, but is not limited to: 107.23 (1) basing admissions decisions upon assurance by the 107.24 applicant to the nursing facility, or the applicant's guardian 107.25 or conservator, that the applicant is neither eligible for nor 107.26 will seek public assistance for payment of nursing facility care 107.27 costs; and 107.28 (2) engaging in preferential selection from waiting lists 107.29 based on an applicant's ability to pay privately or an 107.30 applicant's refusal to pay for a special service. 107.31 The collection and use by a nursing facility of financial 107.32 information of any applicant pursuant to a preadmission 107.33 screening program established by law shall not raise an 107.34 inference that the nursing facility is utilizing that 107.35 information for any purpose prohibited by this paragraph. 107.36 (f) Requiring any vendor of medical care as defined by 108.1 section 256B.02, subdivision 7, who is reimbursed by medical 108.2 assistance under a separate fee schedule, to pay any amount 108.3 based on utilization or service levels or any portion of the 108.4 vendor's fee to the nursing facility except as payment for 108.5 renting or leasing space or equipment or purchasing support 108.6 services from the nursing facility as limited by section 108.7 256B.433. All agreements must be disclosed to the commissioner 108.8 upon request of the commissioner. Nursing facilities and 108.9 vendors of ancillary services that are found to be in violation 108.10 of this provision shall each be subject to an action by the 108.11 state of Minnesota or any of its subdivisions or agencies for 108.12 treble civil damages on the portion of the fee in excess of that 108.13 allowed by this provision and section 256B.433. Damages awarded 108.14 must include three times the excess payments together with costs 108.15 and disbursements including reasonable attorney's fees or their 108.16 equivalent. 108.17 (g) Refusing, for more than 24 hours, to accept a resident 108.18 returning to the same bed or a bed certified for the same level 108.19 of care, in accordance with a physician's order authorizing 108.20 transfer, after receiving inpatient hospital services. 108.21 For a period not to exceed 180 days, the commissioner may 108.22 continue to make medical assistance payments to a nursing 108.23 facility or boarding care home which is in violation of this 108.24 section if extreme hardship to the residents would result. In 108.25 these cases the commissioner shall issue an order requiring the 108.26 nursing facility to correct the violation. The nursing facility 108.27 shall have 20 days from its receipt of the order to correct the 108.28 violation. If the violation is not corrected within the 20-day 108.29 period the commissioner may reduce the payment rate to the 108.30 nursing facility by up to 20 percent. The amount of the payment 108.31 rate reduction shall be related to the severity of the violation 108.32 and shall remain in effect until the violation is corrected. 108.33 The nursing facility or boarding care home may appeal the 108.34 commissioner's action pursuant to the provisions of chapter 14 108.35 pertaining to contested cases. An appeal shall be considered 108.36 timely if written notice of appeal is received by the 109.1 commissioner within 20 days of notice of the commissioner's 109.2 proposed action. 109.3 In the event that the commissioner determines that a 109.4 nursing facility is not eligible for reimbursement for a 109.5 resident who is eligible for medical assistance, the 109.6 commissioner may authorize the nursing facility to receive 109.7 reimbursement on a temporary basis until the resident can be 109.8 relocated to a participating nursing facility. 109.9 Certified beds in facilities which do not allow medical 109.10 assistance intake on July 1, 1984, or after shall be deemed to 109.11 be decertified for purposes of section 144A.071 only. 109.12 Sec. 35. Minnesota Statutes 2000, section 256B.501, is 109.13 amended by adding a subdivision to read: 109.14 Subd. 14. [ICF/MR RATE INCREASES BEGINNING JULY 1, 2001, 109.15 AND JULY 1, 2002.] (a) For the rate periods beginning July 1, 109.16 2001, and July 1, 2002, the commissioner shall make available to 109.17 each facility reimbursed under this section, section 256B.5011, 109.18 and Laws 1993, First Special Session chapter 1, article 4, 109.19 section 11, an adjustment to the total operating payment rate of 109.20 3.5 percent. 109.21 (b) For each facility, the commissioner shall make 109.22 available an adjustment using the percentage specified in 109.23 paragraph (a) multiplied by the total payment rate, excluding 109.24 the property-related payment rate in effect on the preceding 109.25 June 30. The total operating payment rate shall include the 109.26 adjustment provided in subdivision 12. 109.27 (c) Notwithstanding paragraph (a), for the rate increase 109.28 effective July 1, 2001, the adjustment applied to the increase 109.29 provided under section 256B.501, subdivision 12, shall be 6.125 109.30 percent. 109.31 (d) Any facility whose payment rates are governed by 109.32 closure agreements, receivership agreements, or Minnesota Rules, 109.33 part 9553.0075, is not eligible for an adjustment otherwise 109.34 granted under this subdivision. 109.35 Sec. 36. Laws 1999, chapter 245, article 3, section 45, as 109.36 amended by Laws 2000, chapter 312, section 3, is amended to read: 110.1 Sec. 45. [STATE LICENSURE CONFLICTS WITH FEDERAL 110.2 REGULATIONS.] 110.3 (a) Notwithstanding the provisions of Minnesota Rules, part 110.4 4658.0520, an incontinent resident must be checked according to 110.5 a specific time interval written in the resident's care plan. 110.6 The resident's attending physician must authorize in writing any 110.7 interval longer than two hours unless the resident, if 110.8 competent, or a family member or legally appointed conservator, 110.9 guardian, or health care agent of a resident who is not 110.10 competent, agrees in writing to waive physician involvement in 110.11 determining this interval. 110.12 (b) This section expires July 1,20012003. 110.13 Sec. 37. [PROVIDER RATE INCREASES.] 110.14 (a) The commissioner shall increase reimbursement rates by 110.15 3.5 percent each year of the biennium for the providers listed 110.16 in paragraph (b). The increases shall be effective for services 110.17 rendered on or after July 1 of each year. 110.18 (b) The rate increases described in this section shall be 110.19 provided to home and community-based waivered services for 110.20 persons with mental retardation or related conditions under 110.21 Minnesota Statutes, section 256B.501; home and community-based 110.22 waivered services for the elderly under Minnesota Statutes, 110.23 section 256B.0915; waivered services under community 110.24 alternatives for disabled individuals under Minnesota Statutes, 110.25 section 256B.49; community alternative care waivered services 110.26 under Minnesota Statutes, section 256B.49; traumatic brain 110.27 injury waivered services under Minnesota Statutes, section 110.28 256B.49; nursing services and home health services under 110.29 Minnesota Statutes, section 256B.0625, subdivision 6a; personal 110.30 care services and nursing supervision of personal care services 110.31 under Minnesota Statutes, section 256B.0625, subdivision 19a; 110.32 private-duty nursing services under Minnesota Statutes, section 110.33 256B.0625, subdivision 7; day training and habilitation services 110.34 for adults with mental retardation or related conditions under 110.35 Minnesota Statutes, sections 252.40 to 252.46; alternative care 110.36 services under Minnesota Statutes, section 256B.0913; adult 111.1 residential program grants under Minnesota Rules, parts 111.2 9535.2000 to 9535.3000; adult and family community support 111.3 grants under Minnesota Rules, parts 9535.1700 to 9535.1760; the 111.4 group residential housing supplementary service rate under 111.5 Minnesota Statutes, section 256I.05, subdivision 1a; 111.6 semi-independent living services under Minnesota Statutes, 111.7 section 252.275, including SILS funding under county social 111.8 services grants formerly funded under Minnesota Statutes, 111.9 chapter 256I; community support services for deaf and 111.10 hard-of-hearing adults with mental illness who use or wish to 111.11 use sign language as their primary means of communication; and 111.12 living skills training programs for persons with intractable 111.13 epilepsy who need assistance in the transition to independent 111.14 living. 111.15 Sec. 38. [DEVELOPMENT OF NEW NURSING FACILITY 111.16 REIMBURSEMENT SYSTEM.] 111.17 (a) The commissioner of human services shall develop and 111.18 report to the legislature by January 15, 2003, a system to 111.19 replace the current nursing facility reimbursement system 111.20 established under Minnesota Statutes, sections 256B.431, 111.21 256B.434, and 256B.435. 111.22 (b) The system must be developed in consultation with the 111.23 long-term care task force and with representatives of consumers, 111.24 providers, and labor unions. Within the limits of available 111.25 appropriations, the commissioner may employ consultants to 111.26 assist with this project. 111.27 (c) The new reimbursement system must: 111.28 (1) provide incentives to enhance quality of life and 111.29 quality of care; 111.30 (2) recognize cost differences in the care of different 111.31 types of populations, including subacute care and dementia care; 111.32 (3) establish rates that are sufficient without being 111.33 excessive; 111.34 (4) be affordable for the state and for private-pay 111.35 residents; 111.36 (5) be sensitive to changing conditions in the long-term 112.1 care environment; 112.2 (6) avoid creating access problems related to insufficient 112.3 funding; 112.4 (7) allow providers maximum flexibility in their business 112.5 operations; 112.6 (8) recognize the need for capital investment to improve 112.7 physical plants; and 112.8 (9) provide incentives for the development and use of 112.9 private rooms. 112.10 (d) Notwithstanding Minnesota Statutes, section 256B.435, 112.11 the commissioner must not implement a performance-based 112.12 contracting system for nursing facilities prior to July 1, 2003. 112.13 The commissioner shall continue to reimburse nursing facilities 112.14 under Minnesota Statutes, section 256B.431 or 256B.434, until 112.15 otherwise directed by law. 112.16 (e) The commissioner of human services, in consultation 112.17 with the commissioner of health, shall conduct or contract for a 112.18 time study to determine staff time being spent on various case 112.19 mix categories; recommend adjustments to the case mix weights 112.20 based on the time study data; and determine whether current 112.21 staffing standards are adequate for providing quality care based 112.22 on professional best practice and consumer experience. If the 112.23 commissioner determines the current standards are inadequate, 112.24 the commissioner shall determine an appropriate staffing 112.25 standard for the various case mix categories and the financial 112.26 implications of phasing into this standard over the next four 112.27 years. 112.28 Sec. 39. [REPORT ON STANDARDS FOR SUBACUTE CARE FACILITY 112.29 LICENSURE.] 112.30 By January 15, 2003, the commissioner of health shall 112.31 submit a report to the legislature on implementation of a 112.32 licensure program for subacute care. This report must include: 112.33 (1) definitions of subacute care and applicability of the 112.34 proposed licensure program to various types of licensed 112.35 facilities; 112.36 (2) an analysis of whether specific standards for subacute 113.1 levels of care need to be developed and the potential for 113.2 increased costs for existing providers of subacute care; 113.3 (3) recommendations on the applicability of the nursing 113.4 home moratorium law to the licensure of subacute care facilities 113.5 or programs; 113.6 (4) identification of federal regulations guiding the 113.7 provision of subacute care and whether further state standards 113.8 are needed; and 113.9 (5) identification of current and potential reimbursement 113.10 for subacute care under Medicare, Medicaid, or managed care 113.11 programs. 113.12 Sec. 40. [REGULATORY FLEXIBILITY.] 113.13 (a) By July 1, 2001, the commissioners of health and human 113.14 services shall: 113.15 (1) develop a summary of federal nursing facility and 113.16 community long-term care regulations that hamper state 113.17 flexibility and place burdens on the goal of achieving 113.18 high-quality care and optimum outcomes for consumers of 113.19 services; and 113.20 (2) share this summary with the legislature, other states, 113.21 national groups that advocate for state interests with Congress, 113.22 and the Minnesota congressional delegation. 113.23 (b) The commissioners shall conduct ongoing follow-up with 113.24 the entities to which this summary is provided and with the 113.25 health care financing administration to achieve maximum 113.26 regulatory flexibility, including the possibility of pilot 113.27 projects to demonstrate regulatory flexibility on less than a 113.28 statewide basis. 113.29 Sec. 41. [REPORT.] 113.30 By January 15, 2003, the commissioner of health and the 113.31 commissioner of human services shall report to the senate health 113.32 and family security committee and the house health and human 113.33 services policy committee on the number of closures that have 113.34 taken place under Minnesota Statutes, section 256B.437, and any 113.35 other nursing facility closures that may have taken place, 113.36 alternatives to nursing facility care that have been developed, 114.1 any problems with access to long-term care services that have 114.2 resulted, and any recommendations for continuation of the 114.3 regional long-term care planning process and the closure process 114.4 after June 30, 2003. 114.5 Sec. 42. [NURSING ASSISTANT; HOME HEALTH AIDE CURRICULUM.] 114.6 By January 1, 2003, the commissioner of health, in 114.7 consultation with long-term care consumers, advocates, unions, 114.8 and trade associations, shall present to the chairs of the 114.9 legislative committees dealing with health care policy 114.10 recommendations for updating the nursing assistant and home 114.11 health aide curriculum (1998 edition) to help students learn 114.12 front-line survival skills that support job motivation and 114.13 satisfaction. These skills include, but are not limited to, 114.14 working with challenging behaviors, communication skills, stress 114.15 management including the impact of personal life stress in the 114.16 work setting, building relationships with families, cultural 114.17 competencies, and working with death and dying. 114.18 Sec. 43. [REPORT ON WAGE AND BENEFIT INCREASES.] 114.19 The commissioner of human services shall report to the 114.20 chairs of the house and senate committees with jurisdiction over 114.21 health and human services policy and finance by February 1, 114.22 2002, on the wage and benefit increases provided at each 114.23 long-term care facility and long-term care provider as a result 114.24 of reimbursement increases provided by the 2001 legislature. 114.25 Sec. 44. [EVALUATION OF REPORTING REQUIREMENTS.] 114.26 The commissioners of human services and health, in 114.27 consultation with interested parties, shall evaluate long-term 114.28 care provider reporting requirements, balancing the need for 114.29 public accountability with the need to reduce unnecessary 114.30 paperwork, and shall eliminate unnecessary reporting 114.31 requirements, seeking any necessary changes in federal and state 114.32 law. The commissioner shall present a progress report by 114.33 February 1, 2002, to the chairs of the house and senate 114.34 committees with jurisdiction over health and human services 114.35 policy and finance. 114.36 Sec. 45. [APPROPRIATIONS.] 115.1 (a) The following amounts are appropriated from the general 115.2 fund to the commissioner of human services for the biennium 115.3 beginning July 1, 2001, for the purposes indicated: 115.4 (1) $....... for the following purposes related to the 115.5 nursing facility planned closure process: 115.6 (i) $....... for incentive payments to nursing facilities; 115.7 (ii) $....... for state and county administrative costs; 115.8 and 115.9 (iii) $....... for transition planning grants to nursing 115.10 facilities; 115.11 (2) $....... to develop and disseminate quality measures in 115.12 nursing facilities and other long-term care settings; 115.13 (3) $....... to develop a new nursing facility 115.14 reimbursement system; and 115.15 (4) $....... to implement the transition grant program. 115.16 (b) $....... is appropriated from the general fund to the 115.17 commissioner of health for the biennium beginning July 1, 2001, 115.18 for the purposes indicated: 115.19 (1) $....... to develop different regulatory standards for 115.20 the licensure of subacute care facilities; and 115.21 (2) $....... for implementation of an alternative survey 115.22 schedule. 115.23 ARTICLE 3 115.24 WORK FORCE 115.25 Section 1. Minnesota Statutes 2000, section 116L.11, 115.26 subdivision 4, is amended to read: 115.27 Subd. 4. [QUALIFYING CONSORTIUM.] "Qualifying consortium" 115.28 means an entity thatmay includeincludes a public or private 115.29 institution of higher education, work force center, county,and 115.30 oneor moreeligibleemployers, but must include a public or115.31private institution of higher education and one or more eligible115.32employersemployer. 115.33 Sec. 2. Minnesota Statutes 2000, section 116L.12, 115.34 subdivision 4, is amended to read: 115.35 Subd. 4. [GRANTS.] Within the limits of available 115.36 appropriations, the board shall make grants not to exceed 116.1 $400,000 each to qualifying consortia to operate local, 116.2 regional, or statewide training and retention programs. Grants 116.3 may be made from TANF funds, general fund appropriations, and 116.4 any other funding sources available to the board, provided the 116.5 requirements of those funding sources are satisfied. Grant 116.6 awards must establish specific, measurable outcomes and 116.7 timelines for achieving those outcomes. 116.8 Sec. 3. Minnesota Statutes 2000, section 116L.12, 116.9 subdivision 5, is amended to read: 116.10 Subd. 5. [LOCAL MATCH REQUIREMENTS.] A consortium must 116.11provide at least a 50 percent match from local resources for116.12money appropriated under this section. The local match116.13requirement must be satisfied on an overall program basis but116.14need not be satisfied for each particular client. The local116.15match requirement may be reduced for consortia that include a116.16relatively large number of small employers whose financial116.17contribution has been reduced in accordance with section 116L.15.116.18In-kind services and expenditures under section 116L.13,116.19subdivision 2, may be used to meet this local match116.20requirement. The grant application must specify the financial116.21contribution from each member of the consortiumsatisfy the 116.22 match requirements established in section 116L.02, paragraph (a). 116.23 Sec. 4. Minnesota Statutes 2000, section 116L.13, 116.24 subdivision 1, is amended to read: 116.25 Subdivision 1. [MARKETING AND RECRUITMENT.] A qualifying 116.26 consortium must implement a marketing and outreach strategy to 116.27 recruit into the health care and human services fields persons 116.28 from one or more of the potential employee target groups. 116.29 Recruitment strategies must include: 116.30 (1) a screening process to evaluate whether potential 116.31 employees may be disqualified as the result of a required 116.32 background check or are otherwise unlikely to succeed in the 116.33 position for which they are being recruited; and 116.34 (2) a process for modifying course work to meet the 116.35 training needs of non-English-speaking persons, when appropriate. 116.36 Sec. 5. [116L.146] [EXPEDITED GRANT PROCESS.] 117.1 (a) The board may authorize grants not to exceed $50,000 117.2 each through an expedited grant approval process to: 117.3 (1) eligible employers to provide training programs for up 117.4 to 50 workers; or 117.5 (2) a public or private institution of higher education to: 117.6 (i) provide predevelopment or curriculum development for 117.7 training programs prior to submission for program funding under 117.8 section 116L.12; 117.9 (ii) convert an existing curriculum for distance learning 117.10 through interactive television or other communication methods; 117.11 or 117.12 (iii) enable a training program to be offered when it would 117.13 otherwise be canceled due to an enrollment shortfall of one or 117.14 two students when the program is offered in a health-related 117.15 field with a documented worker shortage and is part of a 117.16 training program not exceeding two years in length. 117.17 (b) The board shall develop application procedures and 117.18 evaluation policies for grants made under this section. 117.19 Sec. 6. Minnesota Statutes 2000, section 144.1464, is 117.20 amended to read: 117.21 144.1464 [SUMMER HEALTH CARE INTERNS.] 117.22 Subdivision 1. [SUMMER INTERNSHIPS.] The commissioner of 117.23 health, through a contract with a nonprofit organization as 117.24 required by subdivision 4, shall award grants to hospitalsand, 117.25 clinics, nursing facilities, and home care providers to 117.26 establish a secondary and post-secondary summer health care 117.27 intern program. The purpose of the program is to expose 117.28 interested secondary and post-secondary pupils to various 117.29 careers within the health care profession. 117.30 Subd. 2. [CRITERIA.] (a) The commissioner, through the 117.31 organization under contract, shall award grants to 117.32 hospitalsand, clinics, nursing facilities, and home care 117.33 providers that agree to: 117.34 (1) provide secondary and post-secondary summer health care 117.35 interns with formal exposure to the health care profession; 117.36 (2) provide an orientation for the secondary and 118.1 post-secondary summer health care interns; 118.2 (3) pay one-half the costs of employing the secondary and 118.3 post-secondary summer health care intern, based on an overall118.4hourly wage that is at least the minimum wage but does not118.5exceed $6 an hour; 118.6 (4) interview and hire secondary and post-secondary pupils 118.7 for a minimum of six weeks and a maximum of 12 weeks; and 118.8 (5) employ at least one secondary student for each 118.9 post-secondary student employed, to the extent that there are 118.10 sufficient qualifying secondary student applicants. 118.11 (b) In order to be eligible to be hired as a secondary 118.12 summer health intern by a hospitalor, clinic, nursing facility, 118.13 or home care provider, a pupil must: 118.14 (1) intend to complete high school graduation requirements 118.15 and be between the junior and senior year of high school; and 118.16 (2) be from a school district in proximity to the facility;118.17and118.18(3) provide the facility with a letter of recommendation118.19from a health occupations or science educator. 118.20 (c) In order to be eligible to be hired as a post-secondary 118.21 summer health care intern by a hospital or clinic, a pupil must: 118.22 (1) intend to complete a health care training program or a 118.23 two-year or four-year degree program and be planning on 118.24 enrolling in or be enrolled in that training program or degree 118.25 program; and 118.26 (2) be enrolled in a Minnesota educational institution or 118.27 be a resident of the state of Minnesota; priority must be given 118.28 to applicants from a school district or an educational 118.29 institution in proximity to the facility; and118.30(3) provide the facility with a letter of recommendation118.31from a health occupations or science educator. 118.32 (d) Hospitalsand, clinics, nursing facilities, and home 118.33 care providers awarded grants may employ pupils as secondary and 118.34 post-secondary summer health care interns beginning on or after 118.35 June 15, 1993, if they agree to pay the intern, during the 118.36 period before disbursement of state grant money, with money 119.1 designated as the facility's 50 percent contribution towards 119.2 internship costs. 119.3 Subd. 3. [GRANTS.] The commissioner, through the 119.4 organization under contract, shall award separate grants to 119.5 hospitalsand, clinics, nursing facilities, and home care 119.6 providers meeting the requirements of subdivision 2. The grants 119.7 must be used to pay one-half of the costs of employing secondary 119.8 and post-secondary pupils in a hospitalor, clinic, nursing 119.9 facility, or home care setting during the course of the 119.10 program. No more than 50 percent of the participants may be 119.11 post-secondary students, unless the program does not receive 119.12 enough qualified secondary applicants per fiscal year. No more 119.13 than five pupils may be selected from any secondary or 119.14 post-secondary institution to participate in the program and no 119.15 more than one-half of the number of pupils selected may be from 119.16 the seven-county metropolitan area. 119.17 Subd. 4. [CONTRACT.] The commissioner shall contract with 119.18 a statewide, nonprofit organization representing facilities at 119.19 which secondary and post-secondary summer health care interns 119.20 will serve, to administer the grant program established by this 119.21 section. Grant funds that are not used in one fiscal year may 119.22 be carried over to the next fiscal year. The organization 119.23 awarded the grant shall provide the commissioner with any 119.24 information needed by the commissioner to evaluate the program, 119.25 in the form and at the times specified by the commissioner. 119.26 Sec. 7. Minnesota Statutes 2000, section 144.1496, 119.27 subdivision 3, is amended to read: 119.28 Subd. 3. [LOAN FORGIVENESS.] The commissioner may accept 119.29 up toten170 applicants a year. Applicants are responsible for 119.30 securing their own loans. For each year of nursing education, 119.31 for up to two years, applicants accepted into the loan 119.32 forgiveness program may designate an agreed amount, not to 119.33 exceed $3,000, as a qualified loan. For each year that a 119.34 participant practices nursing in a nursing home or intermediate 119.35 care facility for persons with mental retardation or related 119.36 conditions, up to a maximum of two years, the commissioner shall 120.1 annually repay an amount equal to one year of qualified loans. 120.2 Participants who move from one nursing home or intermediate care 120.3 facility for persons with mental retardation or related 120.4 conditions to another remain eligible for loan repayment. 120.5 Sec. 8. [144.1499] [PROMOTION OF HEALTH CARE AND LONG-TERM 120.6 CARE CAREERS.] 120.7 The commissioner of health, in consultation with an 120.8 organization representing health care employers, long-term care 120.9 employers, and educational institutions, may make grants to 120.10 qualifying consortia as defined in section 116L.11, subdivision 120.11 4, for intergenerational programs to encourage middle and high 120.12 school students to work and volunteer in health care and 120.13 long-term care settings. To qualify for a grant under this 120.14 section, a consortium shall: 120.15 (1) develop a health and long-term care careers curriculum 120.16 that provides career exploration and training in national skill 120.17 standards for health care and long-term care and that is 120.18 consistent with Minnesota graduation standards and other related 120.19 requirements; 120.20 (2) offer programs for high school students that provide 120.21 training in health and long-term care careers with credits that 120.22 articulate into post-secondary programs; and 120.23 (3) provide technical support to the participating health 120.24 care and long-term care employer to enable the use of the 120.25 employer's facilities and programs for K-12 health and long-term 120.26 care careers education. 120.27 Sec. 9. [144.15] [LOAN FORGIVENESS PROGRAM FOR LICENSED 120.28 PROFESSIONAL STAFF.] 120.29 Subdivision 1. [COORDINATION OF EXISTING PROGRAMS.] (a) 120.30 The commissioner of health shall coordinate all loan 120.31 forgiveness, grant, tuition waiver programs, and training 120.32 programs available for licensed and unlicensed health care 120.33 workers who work or pledge to work in long-term health care 120.34 settings. 120.35 (b) Loan forgiveness, grant, tuition waiver programs, and 120.36 training programs include, but are not limited to: 121.1 (1) national health services corps state loan repayment 121.2 program; 121.3 (2) state rural health network reform initiative; 121.4 (3) nursing grant program; 121.5 (4) rural physicians loan forgiveness loan program; 121.6 (5) rural midlevel practitioner loan forgiveness program; 121.7 (6) nurses in nursing homes or ICFs/MRs program; 121.8 (7) rural clinic sites for nurse practitioner education; 121.9 (8) health care and human services worker training and 121.10 retention program; 121.11 (9) health care and human services tuition waiver program; 121.12 (10) worker development fund; and 121.13 (11) tuition payback program established under subdivision 121.14 2. 121.15 (c) The department of health shall also serve as a 121.16 clearinghouse on available programs through the dissemination of 121.17 information to interested individuals and through the 121.18 development and performance of public education activities and 121.19 outreach. 121.20 Subd. 2. [ESTABLISHMENT OF TUITION PAYBACK PROGRAM.] The 121.21 commissioner of health shall establish a health care worker 121.22 tuition payback program, with grants made available to health 121.23 care facilities for the purpose of: (1) reimbursing employees' 121.24 cost of tuition for education needed to perform their current 121.25 job functions; (2) reimbursing employees' cost of tuition to 121.26 further their career development in the long-term care field; or 121.27 (3) payment for past tuition debts in exchange for pledges to 121.28 work within the facility for a specified period of time. 121.29 Sec. 10. Minnesota Statutes 2000, section 144A.62, 121.30 subdivision 1, is amended to read: 121.31 Subdivision 1. [ASSISTANCE WITH EATING AND DRINKING.] (a) 121.32 Upon federal approval, a nursing home may employ resident 121.33 attendants to assist with the activities authorized under 121.34 subdivision 2. The resident attendantwill notshall be counted 121.35 in the minimum staffing requirements under section 144A.04, 121.36 subdivision 7. 122.1 (b) The commissioner shall submit byMayJuly 15,2000122.2 2001, a new request for a federal waiver necessary to implement 122.3 this section. 122.4 Sec. 11. Minnesota Statutes 2000, section 144A.62, 122.5 subdivision 2, is amended to read: 122.6 Subd. 2. [DEFINITION.] (a) "Resident attendant" means an 122.7 individual who assists residentsin a nursing homewiththeone 122.8 or more of the following activitiesof eating and drinking: 122.9 (1) eating and drinking; and 122.10 (2) transporting. 122.11 (b) A resident attendant does not include an individual who: 122.12 (1) is a licensed health professional or a registered 122.13 dietitian; 122.14 (2) volunteers without monetary compensation; or 122.15 (3) is a registered nursing assistant. 122.16 Sec. 12. Minnesota Statutes 2000, section 144A.62, 122.17 subdivision 3, is amended to read: 122.18 Subd. 3. [REQUIREMENTS.] (a) A nursing home may not use on 122.19 a full-time or other paid basis any individual as a resident 122.20 attendant in the nursing home unless the individual: 122.21 (1) has completed a training and competency evaluation 122.22 program encompassing thetasksactivities in subdivision 2 that 122.23 the individual provides; 122.24 (2) is competent to providefeeding and hydration services122.25 those activities; and 122.26 (3) is under the supervision of the director of nursing. 122.27 (b) A nursing home may not use a current employee as a 122.28 resident attendant unless the employee satisfies the 122.29 requirements of paragraph (a) and volunteers to be used in that 122.30 capacity. 122.31 Sec. 13. Minnesota Statutes 2000, section 144A.62, 122.32 subdivision 4, is amended to read: 122.33 Subd. 4. [EVALUATION.] The training and competency 122.34 evaluation program may be facility based. It must include, at a 122.35 minimum, the training and competency standards foreating and122.36drinking assistancethe specific activities the attendant will 123.1 be conducting contained in the nursing assistant training 123.2 curriculum. 123.3 Sec. 14. [APPROPRIATIONS.] 123.4 Subdivision 1. [SUMMER HEALTH CARE INTERN 123.5 PROGRAM.] $....... is appropriated from the health care access 123.6 fund to the commissioner of health for the biennium ending June 123.7 30, 2003, to expand eligibility for the summer health care 123.8 intern program and to increase the number of internships funded. 123.9 Subd. 2. [NURSE LOAN FORGIVENESS PROGRAM.] $....... is 123.10 appropriated from the health care access fund to the 123.11 commissioner of health for the biennium ending June 30, 2003, to 123.12 expand the nurse loan forgiveness program. 123.13 Subd. 3. [MINNESOTA JOB SKILLS.] $....... is appropriated 123.14 from the general fund to the Minnesota job skills partnership 123.15 board for the biennium ending June 30, 2003, to fund the health 123.16 care and human services worker training program. 123.17 Sec. 15. [REPEALER.] 123.18 Minnesota Statutes 2000, sections 116L.10; and 116L.12, 123.19 subdivisions 2 and 7, are repealed. 123.20 ARTICLE 4 123.21 REGULATION OF SUPPLEMENTAL 123.22 NURSING SERVICES AGENCIES 123.23 Section 1. Minnesota Statutes 2000, section 144.057, is 123.24 amended to read: 123.25 144.057 [BACKGROUND STUDIES ON LICENSEES AND SUPPLEMENTAL 123.26 NURSING SERVICES AGENCY PERSONNEL.] 123.27 Subdivision 1. [BACKGROUND STUDIES REQUIRED.] The 123.28 commissioner of health shall contract with the commissioner of 123.29 human services to conduct background studies of: 123.30 (1) individuals providing services which have direct 123.31 contact, as defined under section 245A.04, subdivision 3, with 123.32 patients and residents in hospitals, boarding care homes, 123.33 outpatient surgical centers licensed under sections 144.50 to 123.34 144.58; nursing homes and home care agencies licensed under 123.35 chapter 144A; residential care homes licensed under chapter 123.36 144B, and board and lodging establishments that are registered 124.1 to provide supportive or health supervision services under 124.2 section 157.17;and124.3 (2) beginning July 1, 1999, all other employees in nursing 124.4 homes licensed under chapter 144A, and boarding care homes 124.5 licensed under sections 144.50 to 144.58. A disqualification of 124.6 an individual in this section shall disqualify the individual 124.7 from positions allowing direct contact or access to patients or 124.8 residents receiving services; 124.9 (3) individuals employed by a supplemental nursing services 124.10 agency, as defined under section 144A.70, who are providing 124.11 services in health care facilities; and 124.12 (4) controlling persons of a supplemental nursing services 124.13 agency, as defined under section 144A.70. 124.14 If a facility or program is licensed by the department of 124.15 human services and subject to the background study provisions of 124.16 chapter 245A and is also licensed by the department of health, 124.17 the department of human services is solely responsible for the 124.18 background studies of individuals in the jointly licensed 124.19 programs. 124.20 Subd. 2. [RESPONSIBILITIES OF DEPARTMENT OF HUMAN 124.21 SERVICES.] The department of human services shall conduct the 124.22 background studies required by subdivision 1 in compliance with 124.23 the provisions of chapter 245A and Minnesota Rules, parts 124.24 9543.3000 to 9543.3090. For the purpose of this section, the 124.25 term "residential program" shall include all facilities 124.26 described in subdivision 1. The department of human services 124.27 shall provide necessary forms and instructions, shall conduct 124.28 the necessary background studies of individuals, and shall 124.29 provide notification of the results of the studies to the 124.30 facilities, supplemental nursing services agencies, individuals, 124.31 and the commissioner of health. Individuals shall be 124.32 disqualified under the provisions of chapter 245A and Minnesota 124.33 Rules, parts 9543.3000 to 9543.3090. If an individual is 124.34 disqualified, the department of human services shall notify the 124.35 facility, the supplemental nursing services agency, and the 124.36 individual and shall inform the individual of the right to 125.1 request a reconsideration of the disqualification by submitting 125.2 the request to the department of health. 125.3 Subd. 3. [RECONSIDERATIONS.] The commissioner of health 125.4 shall review and decide reconsideration requests, including the 125.5 granting of variances, in accordance with the procedures and 125.6 criteria contained in chapter 245A and Minnesota Rules, parts 125.7 9543.3000 to 9543.3090. The commissioner's decision shall be 125.8 provided to the individual and to the department of human 125.9 services. The commissioner's decision to grant or deny a 125.10 reconsideration of disqualification is the final administrative 125.11 agency action. 125.12 Subd. 4. [RESPONSIBILITIES OF FACILITIES AND AGENCIES.] 125.13 Facilities and agencies described in subdivision 1 shall be 125.14 responsible for cooperating with the departments in implementing 125.15 the provisions of this section. The responsibilities imposed on 125.16 applicants and licensees under chapter 245A and Minnesota Rules, 125.17 parts 9543.3000 to 9543.3090, shall apply to these 125.18 facilities and supplemental nursing services agencies. The 125.19 provision of section 245A.04, subdivision 3, paragraph (e), 125.20 shall apply to applicants, licensees, registrants, or an 125.21 individual's refusal to cooperate with the completion of the 125.22 background studies. Supplemental nursing services agencies 125.23 subject to the registration requirements in section 144A.71 must 125.24 maintain records verifying compliance with the background study 125.25 requirements under this section. 125.26 Sec. 2. [144A.70] [REGISTRATION OF SUPPLEMENTAL NURSING 125.27 SERVICES AGENCIES; DEFINITIONS.] 125.28 Subdivision 1. [SCOPE.] As used in sections 144A.70 to 125.29 144A.74, the terms defined in this section have the meanings 125.30 given them. 125.31 Subd. 2. [COMMISSIONER.] "Commissioner" means the 125.32 commissioner of health. 125.33 Subd. 3. [CONTROLLING PERSON.] "Controlling person" means 125.34 a business entity, officer, program administrator, or director 125.35 whose responsibilities include the direction of the management 125.36 or policies of a supplemental nursing services agency. 126.1 Controlling person also means an individual who, directly or 126.2 indirectly, beneficially owns an interest in a corporation, 126.3 partnership, or other business association that is a controlling 126.4 person. 126.5 Subd. 4. [HEALTH CARE FACILITY.] "Health care facility" 126.6 means a hospital, boarding care home, or outpatient surgical 126.7 center licensed under sections 144.50 to 144.58, a nursing home 126.8 or home care agency licensed under this chapter, a residential 126.9 care home, or a board and lodging establishment that is 126.10 registered to provide supportive or health supervision services 126.11 under section 157.17. 126.12 Subd. 5. [PERSON.] "Person" includes an individual, firm, 126.13 corporation, partnership, or association. 126.14 Subd. 6. [SUPPLEMENTAL NURSING SERVICES 126.15 AGENCY.] "Supplemental nursing services agency" means a person, 126.16 firm, corporation, partnership, or association engaged for hire 126.17 in the business of providing or procuring temporary employment 126.18 in health care facilities for nurses, nursing assistants, nurse 126.19 aides, and orderlies. Supplemental nursing services agency does 126.20 not include an individual who only engages in providing the 126.21 individual's services on a temporary basis to health care 126.22 facilities. Supplemental nursing services agency also does not 126.23 include any nursing services agency that is limited to providing 126.24 temporary nursing personnel solely to one or more health care 126.25 facilities owned or operated by the same person, firm, 126.26 corporation, or partnership. 126.27 Sec. 3. [144A.71] [SUPPLEMENTAL NURSING SERVICES AGENCY 126.28 REGISTRATION.] 126.29 Subdivision 1. [DUTY TO REGISTER.] A person who operates a 126.30 supplemental nursing services agency shall register the agency 126.31 with the commissioner. Each separate location of the business 126.32 of a supplemental nursing services agency shall register the 126.33 agency with the commissioner. Each separate location of the 126.34 business of a supplemental nursing services agency shall have a 126.35 separate registration. 126.36 Subd. 2. [APPLICATION INFORMATION AND FEE.] The 127.1 commissioner shall establish forms and procedures for processing 127.2 each supplemental nursing services agency registration 127.3 application. An application for a supplemental nursing services 127.4 agency registration must include at least the following: 127.5 (1) the names and addresses of the owner or owners of the 127.6 supplemental nursing services agency; 127.7 (2) if the owner is a corporation, copies of its articles 127.8 of incorporation and current bylaws, together with the names and 127.9 addresses of its officers and directors; 127.10 (3) any other relevant information that the commissioner 127.11 determines is necessary to properly evaluate an application for 127.12 registration; and 127.13 (4) the annual registration fee for a supplemental nursing 127.14 services agency, which is $........ 127.15 Subd. 3. [REGISTRATION NOT TRANSFERABLE.] A registration 127.16 issued by the commissioner according to this section is 127.17 effective for a period of one year from the date of its issuance 127.18 unless the registration is revoked or suspended under section 127.19 144A.72, subdivision 2, or unless the supplemental nursing 127.20 services agency is sold or ownership or management is 127.21 transferred. When a supplemental nursing services agency is 127.22 sold or ownership or management is transferred, the registration 127.23 of the agency must be voided and the new owner or operator may 127.24 apply for a new registration. 127.25 Sec. 4. [144A.72] [REGISTRATION REQUIREMENTS.] 127.26 The commissioner shall require that, as a condition of 127.27 registration: 127.28 (1) the supplemental nursing services agency shall document 127.29 that each temporary employee provided to health care facilities 127.30 currently meets the minimum licensing, training, and continuing 127.31 education standards for the position in which the employee will 127.32 be working; 127.33 (2) the supplemental nursing services agency shall comply 127.34 with all pertinent requirements relating to the health and other 127.35 qualifications of personnel employed in health care facilities; 127.36 (3) the supplemental nursing services agency must not 128.1 restrict in any manner the employment opportunities of its 128.2 employees; 128.3 (4) the supplemental nursing services agency, when 128.4 supplying temporary employees to a health care facility, and 128.5 when requested by the facility to do so, shall agree that at 128.6 least 30 percent of the total personnel hours supplied are 128.7 during night, holiday, or weekend shifts; 128.8 (5) the supplemental nursing services agency shall carry 128.9 medical malpractice insurance to insure against the loss, 128.10 damage, or expense incident to a claim arising out of the death 128.11 or injury of any person as the result of negligence or 128.12 malpractice in the provision of health care services by the 128.13 supplemental nursing services agency or by any employee of the 128.14 agency; and 128.15 (6) the supplemental nursing services agency must not, in 128.16 any contract with any employee or health care facility, require 128.17 the payment of liquidated damages, employment fees, or other 128.18 compensation should the employee be hired as a permanent 128.19 employee of a health care facility. 128.20 Sec. 5. [144A.73] [COMPLAINT SYSTEM.] 128.21 The commissioner shall establish a system for reporting 128.22 complaints against a supplemental nursing services agency or its 128.23 employees. Complaints may be made by any member of the public. 128.24 Written complaints must be forwarded to the employer of each 128.25 person against whom a complaint is made. The employer shall 128.26 promptly report to the commissioner any corrective action taken. 128.27 Sec. 6. [144A.74] [MAXIMUM CHARGES.] 128.28 A supplemental nursing services agency must not bill or 128.29 receive payments from a nursing home licensed under this chapter 128.30 at a rate higher than 150 percent of the weighted average wage 128.31 rate for the applicable employee classification for the 128.32 geographic group to which the nursing home is assigned under 128.33 chapter 256B. The weighted average wage rates must be 128.34 determined by the commissioner of human services and reported to 128.35 the commissioner of health on an annual basis. Facilities shall 128.36 provide information necessary to determine weighted average wage 129.1 rates to the commissioner of human services in a format 129.2 requested by the commissioner. The maximum rate must include 129.3 all charges for administrative fees, contract fees, or other 129.4 special charges in addition to the hourly rates for the 129.5 temporary nursing pool personnel supplied to a nursing home. 129.6 Sec. 7. Minnesota Statutes 2000, section 245A.04, 129.7 subdivision 3, is amended to read: 129.8 Subd. 3. [BACKGROUND STUDY OF THE APPLICANT; DEFINITIONS.] 129.9 (a) Before the commissioner issues a license, the commissioner 129.10 shall conduct a study of the individuals specified in paragraph 129.11(c)(d), clauses (1) to (5), according to rules of the 129.12 commissioner. 129.13 Beginning January 1, 1997, the commissioner shall also 129.14 conduct a study of employees providing direct contact services 129.15 for nonlicensed personal care provider organizations described 129.16 in paragraph(c)(d), clause (5). 129.17 The commissioner shall recover the cost of these background 129.18 studies through a fee of no more than $12 per study charged to 129.19 the personal care provider organization. 129.20 Beginning August 1, 1997, the commissioner shall conduct 129.21 all background studies required under this chapter for adult 129.22 foster care providers who are licensed by the commissioner of 129.23 human services and registered under chapter 144D. The 129.24 commissioner shall conduct these background studies in 129.25 accordance with this chapter. The commissioner shall initiate a 129.26 pilot project to conduct up to 5,000 background studies under 129.27 this chapter in programs with joint licensure as home and 129.28 community-based services and adult foster care for people with 129.29 developmental disabilities when the license holder does not 129.30 reside in the foster care residence. 129.31 (b) Beginning July 1, 1998, the commissioner shall conduct 129.32 a background study on individuals specified in 129.33 paragraph(c)(d), clauses (1) to (5), who perform direct 129.34 contact services in a nursing home or a home care agency 129.35 licensed under chapter 144A or a boarding care home licensed 129.36 under sections 144.50 to 144.58, when the subject of the study 130.1 resides outside Minnesota; the study must be at least as 130.2 comprehensive as that of a Minnesota resident and include a 130.3 search of information from the criminal justice data 130.4 communications network in the state where the subject of the 130.5 study resides. 130.6 (c) Beginning August 1, 2001, the commissioner shall 130.7 conduct all background studies required under this chapter and 130.8 initiated by supplemental nursing services agencies registered 130.9 under chapter 144A. Studies for the agencies must be initiated 130.10 annually by each agency. The commissioner shall conduct the 130.11 background studies according to this chapter. The commissioner 130.12 shall recover the cost of the background studies through a fee 130.13 of no more than $....... per study, charged to the supplemental 130.14 nursing services agency. 130.15 (d) The applicant, license holder,theregistrant, bureau 130.16 of criminal apprehension,thecommissioner of health, and county 130.17 agencies, after written notice to the individual who is the 130.18 subject of the study, shall help with the study by giving the 130.19 commissioner criminal conviction data and reports about the 130.20 maltreatment of adults substantiated under section 626.557 and 130.21 the maltreatment of minors in licensed programs substantiated 130.22 under section 626.556. The individuals to be studied shall 130.23 include: 130.24 (1) the applicant; 130.25 (2) persons over the age of 13 living in the household 130.26 where the licensed program will be provided; 130.27 (3) current employees or contractors of the applicant who 130.28 will have direct contact with persons served by the facility, 130.29 agency, or program; 130.30 (4) volunteers or student volunteers who have direct 130.31 contact with persons served by the program to provide program 130.32 services, if the contact is not directly supervised by the 130.33 individuals listed in clause (1) or (3); and 130.34 (5) any person who, as an individual or as a member of an 130.35 organization, exclusively offers, provides, or arranges for 130.36 personal care assistant services under the medical assistance 131.1 program as authorized under sections 256B.04, subdivision 16, 131.2 and 256B.0625, subdivision 19a. 131.3 The juvenile courts shall also help with the study by 131.4 giving the commissioner existing juvenile court records on 131.5 individuals described in clause (2) relating to delinquency 131.6 proceedings held within either the five years immediately 131.7 preceding the application or the five years immediately 131.8 preceding the individual's 18th birthday, whichever time period 131.9 is longer. The commissioner shall destroy juvenile records 131.10 obtained pursuant to this subdivision when the subject of the 131.11 records reaches age 23. 131.12 For purposes of this section and Minnesota Rules, part 131.13 9543.3070, a finding that a delinquency petition is proven in 131.14 juvenile court shall be considered a conviction in state 131.15 district court. 131.16 For purposes of this subdivision, "direct contact" means 131.17 providing face-to-face care, training, supervision, counseling, 131.18 consultation, or medication assistance to persons served by a 131.19 program. For purposes of this subdivision, "directly supervised" 131.20 means an individual listed in clause (1), (3), or (5) is within 131.21 sight or hearing of a volunteer to the extent that the 131.22 individual listed in clause (1), (3), or (5) is capable at all 131.23 times of intervening to protect the health and safety of the 131.24 persons served by the program who have direct contact with the 131.25 volunteer. 131.26 A study of an individual in clauses (1) to (5) shall be 131.27 conducted at least upon application for initial license or 131.28 registration and reapplication for a license or registration. 131.29 The commissioner is not required to conduct a study of an 131.30 individual at the time of reapplication for a license or if the 131.31 individual has been continuously affiliated with a foster care 131.32 provider licensed by the commissioner of human services and 131.33 registered under chapter 144D, other than a family day care or 131.34 foster care license, if: (i) a study of the individual was 131.35 conducted either at the time of initial licensure or when the 131.36 individual became affiliated with the license holder; (ii) the 132.1 individual has been continuously affiliated with the license 132.2 holder since the last study was conducted; and (iii) the 132.3 procedure described in paragraph(d)(e) has been implemented 132.4 and was in effect continuously since the last study was 132.5 conducted. For the purposes of this section, a physician 132.6 licensed under chapter 147 is considered to be continuously 132.7 affiliated upon the license holder's receipt from the 132.8 commissioner of health or human services of the physician's 132.9 background study results. For individuals who are required to 132.10 have background studies under clauses (1) to (5) and who have 132.11 been continuously affiliated with a foster care provider that is 132.12 licensed in more than one county, criminal conviction data may 132.13 be shared among those counties in which the foster care programs 132.14 are licensed. A county agency's receipt of criminal conviction 132.15 data from another county agency shall meet the criminal data 132.16 background study requirements of this section. 132.17 The commissioner may also conduct studies on individuals 132.18 specified in clauses (3) and (4) when the studies are initiated 132.19 by: 132.20 (i) personnel pool agencies; 132.21 (ii) temporary personnel agencies; 132.22 (iii) educational programs that train persons by providing 132.23 direct contact services in licensed programs; and 132.24 (iv) professional services agencies that are not licensed 132.25 and which contract with licensed programs to provide direct 132.26 contact services or individuals who provide direct contact 132.27 services. 132.28 Studies on individuals in items (i) to (iv) must be 132.29 initiated annually by these agencies, programs, and 132.30 individuals. Except for personal care provider 132.31 organizations and supplemental nursing services agencies, no 132.32 applicant, license holder, or individual who is the subject of 132.33 the study shall pay any fees required to conduct the study. 132.34 (1) At the option of the licensed facility, rather than 132.35 initiating another background study on an individual required to 132.36 be studied who has indicated to the licensed facility that a 133.1 background study by the commissioner was previously completed, 133.2 the facility may make a request to the commissioner for 133.3 documentation of the individual's background study status, 133.4 provided that: 133.5 (i) the facility makes this request using a form provided 133.6 by the commissioner; 133.7 (ii) in making the request the facility informs the 133.8 commissioner that either: 133.9 (A) the individual has been continuously affiliated with a 133.10 licensed facility since the individual's previous background 133.11 study was completed, or since October 1, 1995, whichever is 133.12 shorter; or 133.13 (B) the individual is affiliated only with a personnel pool 133.14 agency, a temporary personnel agency, an educational program 133.15 that trains persons by providing direct contact services in 133.16 licensed programs, or a professional services agency that is not 133.17 licensed and which contracts with licensed programs to provide 133.18 direct contact services or individuals who provide direct 133.19 contact services; and 133.20 (iii) the facility provides notices to the individual as 133.21 required in paragraphs (a) to(d)(e), and that the facility is 133.22 requesting written notification of the individual's background 133.23 study status from the commissioner. 133.24 (2) The commissioner shall respond to each request under 133.25 paragraph (1) with a written or electronic notice to the 133.26 facility and the study subject. If the commissioner determines 133.27 that a background study is necessary, the study shall be 133.28 completed without further request from a licensed agency or 133.29 notifications to the study subject. 133.30 (3) When a background study is being initiated by a 133.31 licensed facility or a foster care provider that is also 133.32 registered under chapter 144D, a study subject affiliated with 133.33 multiple licensed facilities may attach to the background study 133.34 form a cover letter indicating the additional facilities' names, 133.35 addresses, and background study identification numbers. When 133.36 the commissioner receives such notices, each facility identified 134.1 by the background study subject shall be notified of the study 134.2 results. The background study notice sent to the subsequent 134.3 agencies shall satisfy those facilities' responsibilities for 134.4 initiating a background study on that individual. 134.5(d)(e) If an individual who is affiliated with a program 134.6 or facility regulated by the department of human services or 134.7 department of health or who is affiliated with a nonlicensed 134.8 personal care provider organization, is convicted of a crime 134.9 constituting a disqualification under subdivision 3d, the 134.10 probation officer or corrections agent shall notify the 134.11 commissioner of the conviction. The commissioner, in 134.12 consultation with the commissioner of corrections, shall develop 134.13 forms and information necessary to implement this paragraph and 134.14 shall provide the forms and information to the commissioner of 134.15 corrections for distribution to local probation officers and 134.16 corrections agents. The commissioner shall inform individuals 134.17 subject to a background study that criminal convictions for 134.18 disqualifying crimes will be reported to the commissioner by the 134.19 corrections system. A probation officer, corrections agent, or 134.20 corrections agency is not civilly or criminally liable for 134.21 disclosing or failing to disclose the information required by 134.22 this paragraph. Upon receipt of disqualifying information, the 134.23 commissioner shall provide the notifications required in 134.24 subdivision 3a, as appropriate to agencies on record as having 134.25 initiated a background study or making a request for 134.26 documentation of the background study status of the individual. 134.27 This paragraph does not apply to family day care and child 134.28 foster care programs. 134.29(e)(f) The individual who is the subject of the study must 134.30 provide the applicant or license holder with sufficient 134.31 information to ensure an accurate study including the 134.32 individual's first, middle, and last name; home address, city, 134.33 county, and state of residence for the past five years; zip 134.34 code; sex; date of birth; and driver's license number. The 134.35 applicant or license holder shall provide this information about 134.36 an individual in paragraph(c)(d), clauses (1) to (5), on forms 135.1 prescribed by the commissioner. By January 1, 2000, for 135.2 background studies conducted by the department of human 135.3 services, the commissioner shall implement a system for the 135.4 electronic transmission of: (1) background study information to 135.5 the commissioner; and (2) background study results to the 135.6 license holder. The commissioner may request additional 135.7 information of the individual, which shall be optional for the 135.8 individual to provide, such as the individual's social security 135.9 number or race. 135.10(f)(g) Except for child foster care, adult foster care, 135.11 and family day care homes, a study must include information 135.12 related to names of substantiated perpetrators of maltreatment 135.13 of vulnerable adults that has been received by the commissioner 135.14 as required under section 626.557, subdivision 9c, paragraph 135.15 (i), and the commissioner's records relating to the maltreatment 135.16 of minors in licensed programs, information from juvenile courts 135.17 as required in paragraph(c)(d) for persons listed in paragraph 135.18(c)(d), clause (2), and information from the bureau of criminal 135.19 apprehension. For child foster care, adult foster care, and 135.20 family day care homes, the study must include information from 135.21 the county agency's record of substantiated maltreatment of 135.22 adults, and the maltreatment of minors, information from 135.23 juvenile courts as required in paragraph(c)(d) for persons 135.24 listed in paragraph(c)(d), clause (2), and information from 135.25 the bureau of criminal apprehension. The commissioner may also 135.26 review arrest and investigative information from the bureau of 135.27 criminal apprehension, the commissioner of health, a county 135.28 attorney, county sheriff, county agency, local chief of police, 135.29 other states, the courts, or the Federal Bureau of Investigation 135.30 if the commissioner has reasonable cause to believe the 135.31 information is pertinent to the disqualification of an 135.32 individual listed in paragraph(c)(d), clauses (1) to (5). The 135.33 commissioner is not required to conduct more than one review of 135.34 a subject's records from the Federal Bureau of Investigation if 135.35 a review of the subject's criminal history with the Federal 135.36 Bureau of Investigation has already been completed by the 136.1 commissioner and there has been no break in the subject's 136.2 affiliation with the license holder who initiated the background 136.3 studies. 136.4 When the commissioner has reasonable cause to believe that 136.5 further pertinent information may exist on the subject, the 136.6 subject shall provide a set of classifiable fingerprints 136.7 obtained from an authorized law enforcement agency. For 136.8 purposes of requiring fingerprints, the commissioner shall be 136.9 considered to have reasonable cause under, but not limited to, 136.10 the following circumstances: 136.11 (1) information from the bureau of criminal apprehension 136.12 indicates that the subject is a multistate offender; 136.13 (2) information from the bureau of criminal apprehension 136.14 indicates that multistate offender status is undetermined; or 136.15 (3) the commissioner has received a report from the subject 136.16 or a third party indicating that the subject has a criminal 136.17 history in a jurisdiction other than Minnesota. 136.18(g)(h) An applicant'sor, license holder's, or 136.19 registrant's failure or refusal to cooperate with the 136.20 commissioner is reasonable cause to disqualify a subject, deny a 136.21 license application or immediately suspend, suspend, or revoke a 136.22 license or registration. Failure or refusal of an individual to 136.23 cooperate with the study is just cause for denying or 136.24 terminating employment of the individual if the individual's 136.25 failure or refusal to cooperate could cause the applicant's 136.26 application to be denied or the license holder's license to be 136.27 immediately suspended, suspended, or revoked. 136.28(h)(i) The commissioner shall not consider an application 136.29 to be complete until all of the information required to be 136.30 provided under this subdivision has been received. 136.31(i)(j) No person in paragraph(c)(d), clause (1), (2), 136.32 (3), (4), or (5), who is disqualified as a result of this 136.33 section may be retained by the agency in a position involving 136.34 direct contact with persons served by the program. 136.35(j)(k) Termination of persons in paragraph(c)(d), clause 136.36 (1), (2), (3), (4), or (5), made in good faith reliance on a 137.1 notice of disqualification provided by the commissioner shall 137.2 not subject the applicant or license holder to civil liability. 137.3(k)(l) The commissioner may establish records to fulfill 137.4 the requirements of this section. 137.5(l)(m) The commissioner may not disqualify an individual 137.6 subject to a study under this section because that person has, 137.7 or has had, a mental illness as defined in section 245.462, 137.8 subdivision 20. 137.9(m)(n) An individual subject to disqualification under 137.10 this subdivision has the applicable rights in subdivision 3a, 137.11 3b, or 3c. 137.12(n)(o) For the purposes of background studies completed by 137.13 tribal organizations performing licensing activities otherwise 137.14 required of the commissioner under this chapter, after obtaining 137.15 consent from the background study subject, tribal licensing 137.16 agencies shall have access to criminal history data in the same 137.17 manner as county licensing agencies and private licensing 137.18 agencies under this chapter. 137.19 Sec. 8. Minnesota Statutes 2000, section 245A.04, 137.20 subdivision 3a, is amended to read: 137.21 Subd. 3a. [NOTIFICATION TO SUBJECT AND LICENSE HOLDER OF 137.22 STUDY RESULTS; DETERMINATION OF RISK OF HARM.] (a) The 137.23 commissioner shall notify the applicantor, license holder, or 137.24 registrant and the individual who is the subject of the study, 137.25 in writing or by electronic transmission, of the results of the 137.26 study. When the study is completed, a notice that the study was 137.27 undertaken and completed shall be maintained in the personnel 137.28 files of the program. For studies on individuals pertaining to 137.29 a license to provide family day care or group family day care, 137.30 foster care for children in the provider's own home, or foster 137.31 care or day care services for adults in the provider's own home, 137.32 the commissioner is not required to provide a separate notice of 137.33 the background study results to the individual who is the 137.34 subject of the study unless the study results in a 137.35 disqualification of the individual. 137.36 The commissioner shall notify the individual studied if the 138.1 information in the study indicates the individual is 138.2 disqualified from direct contact with persons served by the 138.3 program. The commissioner shall disclose the information 138.4 causing disqualification and instructions on how to request a 138.5 reconsideration of the disqualification to the individual 138.6 studied. An applicant or license holder who is not the subject 138.7 of the study shall be informed that the commissioner has found 138.8 information that disqualifies the subject from direct contact 138.9 with persons served by the program. However, only the 138.10 individual studied must be informed of the information contained 138.11 in the subject's background study unless the only basis for the 138.12 disqualification is failure to cooperate, the Data Practices Act 138.13 provides for release of the information, or the individual 138.14 studied authorizes the release of the information. 138.15 (b) If the commissioner determines that the individual 138.16 studied has a disqualifying characteristic, the commissioner 138.17 shall review the information immediately available and make a 138.18 determination as to the subject's immediate risk of harm to 138.19 persons served by the program where the individual studied will 138.20 have direct contact. The commissioner shall consider all 138.21 relevant information available, including the following factors 138.22 in determining the immediate risk of harm: the recency of the 138.23 disqualifying characteristic; the recency of discharge from 138.24 probation for the crimes; the number of disqualifying 138.25 characteristics; the intrusiveness or violence of the 138.26 disqualifying characteristic; the vulnerability of the victim 138.27 involved in the disqualifying characteristic; and the similarity 138.28 of the victim to the persons served by the program where the 138.29 individual studied will have direct contact. The commissioner 138.30 may determine that the evaluation of the information immediately 138.31 available gives the commissioner reason to believe one of the 138.32 following: 138.33 (1) The individual poses an imminent risk of harm to 138.34 persons served by the program where the individual studied will 138.35 have direct contact. If the commissioner determines that an 138.36 individual studied poses an imminent risk of harm to persons 139.1 served by the program where the individual studied will have 139.2 direct contact, the individual and the license holder must be 139.3 sent a notice of disqualification. The commissioner shall order 139.4 the license holder to immediately remove the individual studied 139.5 from direct contact. The notice to the individual studied must 139.6 include an explanation of the basis of this determination. 139.7 (2) The individual poses a risk of harm requiring 139.8 continuous supervision while providing direct contact services 139.9 during the period in which the subject may request a 139.10 reconsideration. If the commissioner determines that an 139.11 individual studied poses a risk of harm that requires continuous 139.12 supervision, the individual and the license holder must be sent 139.13 a notice of disqualification. The commissioner shall order the 139.14 license holder to immediately remove the individual studied from 139.15 direct contact services or assure that the individual studied is 139.16 within sight or hearing of another staff person when providing 139.17 direct contact services during the period in which the 139.18 individual may request a reconsideration of the 139.19 disqualification. If the individual studied does not submit a 139.20 timely request for reconsideration, or the individual submits a 139.21 timely request for reconsideration, but the disqualification is 139.22 not set aside for that license holder, the license holder will 139.23 be notified of the disqualification and ordered to immediately 139.24 remove the individual from any position allowing direct contact 139.25 with persons receiving services from the license holder. 139.26 (3) The individual does not pose an imminent risk of harm 139.27 or a risk of harm requiring continuous supervision while 139.28 providing direct contact services during the period in which the 139.29 subject may request a reconsideration. If the commissioner 139.30 determines that an individual studied does not pose a risk of 139.31 harm that requires continuous supervision, only the individual 139.32 must be sent a notice of disqualification. The license holder 139.33 must be sent a notice that more time is needed to complete the 139.34 individual's background study. If the individual studied 139.35 submits a timely request for reconsideration, and if the 139.36 disqualification is set aside for that license holder, the 140.1 license holder will receive the same notification received by 140.2 license holders in cases where the individual studied has no 140.3 disqualifying characteristic. If the individual studied does 140.4 not submit a timely request for reconsideration, or the 140.5 individual submits a timely request for reconsideration, but the 140.6 disqualification is not set aside for that license holder, the 140.7 license holder will be notified of the disqualification and 140.8 ordered to immediately remove the individual from any position 140.9 allowing direct contact with persons receiving services from the 140.10 license holder. 140.11 (c) County licensing agencies performing duties under this 140.12 subdivision may develop an alternative system for determining 140.13 the subject's immediate risk of harm to persons served by the 140.14 program, providing the notices under paragraph (b), and 140.15 documenting the action taken by the county licensing agency. 140.16 Each county licensing agency's implementation of the alternative 140.17 system is subject to approval by the commissioner. 140.18 Notwithstanding this alternative system, county licensing 140.19 agencies shall complete the requirements of paragraph (a). 140.20 Sec. 9. Minnesota Statutes 2000, section 245A.04, 140.21 subdivision 3b, is amended to read: 140.22 Subd. 3b. [RECONSIDERATION OF DISQUALIFICATION.] (a) The 140.23 individual who is the subject of the disqualification may 140.24 request a reconsideration of the disqualification. 140.25 The individual must submit the request for reconsideration 140.26 to the commissioner in writing. A request for reconsideration 140.27 for an individual who has been sent a notice of disqualification 140.28 under subdivision 3a, paragraph (b), clause (1) or (2), must be 140.29 submitted within 30 calendar days of the disqualified 140.30 individual's receipt of the notice of disqualification. A 140.31 request for reconsideration for an individual who has been sent 140.32 a notice of disqualification under subdivision 3a, paragraph 140.33 (b), clause (3), must be submitted within 15 calendar days of 140.34 the disqualified individual's receipt of the notice of 140.35 disqualification. Removal of a disqualified individual from 140.36 direct contact shall be ordered if the individual does not 141.1 request reconsideration within the prescribed time, and for an 141.2 individual who submits a timely request for reconsideration, if 141.3 the disqualification is not set aside. The individual must 141.4 present information showing that: 141.5 (1) the information the commissioner relied upon is 141.6 incorrect or inaccurate. If the basis of a reconsideration 141.7 request is that a maltreatment determination or disposition 141.8 under section 626.556 or 626.557 is incorrect, and the 141.9 commissioner has issued a final order in an appeal of that 141.10 determination or disposition under section 256.045, the 141.11 commissioner's order is conclusive on the issue of maltreatment; 141.12 or 141.13 (2) the subject of the study does not pose a risk of harm 141.14 to any person served by the applicantor, license holder, or 141.15 registrant. 141.16 (b) The commissioner may set aside the disqualification 141.17 under this section if the commissioner finds that the 141.18 information the commissioner relied upon is incorrect or the 141.19 individual does not pose a risk of harm to any person served by 141.20 the applicantor, license holder, or registrant. In determining 141.21 that an individual does not pose a risk of harm, the 141.22 commissioner shall consider the consequences of the event or 141.23 events that lead to disqualification, whether there is more than 141.24 one disqualifying event, the vulnerability of the victim at the 141.25 time of the event, the time elapsed without a repeat of the same 141.26 or similar event, documentation of successful completion by the 141.27 individual studied of training or rehabilitation pertinent to 141.28 the event, and any other information relevant to 141.29 reconsideration. In reviewing a disqualification under this 141.30 section, the commissioner shall give preeminent weight to the 141.31 safety of each person to be served by the license holderor, 141.32 applicant, or registrant over the interests of the license 141.33 holderor, applicant, or registrant. 141.34 (c) Unless the information the commissioner relied on in 141.35 disqualifying an individual is incorrect, the commissioner may 141.36 not set aside the disqualification of an individual in 142.1 connection with a license to provide family day care for 142.2 children, foster care for children in the provider's own home, 142.3 or foster care or day care services for adults in the provider's 142.4 own home if: 142.5 (1) less than ten years have passed since the discharge of 142.6 the sentence imposed for the offense; and the individual has 142.7 been convicted of a violation of any offense listed in sections 142.8 609.20 (manslaughter in the first degree), 609.205 (manslaughter 142.9 in the second degree), criminal vehicular homicide under 609.21 142.10 (criminal vehicular homicide and injury), 609.215 (aiding 142.11 suicide or aiding attempted suicide), felony violations under 142.12 609.221 to 609.2231 (assault in the first, second, third, or 142.13 fourth degree), 609.713 (terroristic threats), 609.235 (use of 142.14 drugs to injure or to facilitate crime), 609.24 (simple 142.15 robbery), 609.245 (aggravated robbery), 609.25 (kidnapping), 142.16 609.255 (false imprisonment), 609.561 or 609.562 (arson in the 142.17 first or second degree), 609.71 (riot), burglary in the first or 142.18 second degree under 609.582 (burglary), 609.66 (dangerous 142.19 weapon), 609.665 (spring guns), 609.67 (machine guns and 142.20 short-barreled shotguns), 609.749 (harassment; stalking), 142.21 152.021 or 152.022 (controlled substance crime in the first or 142.22 second degree), 152.023, subdivision 1, clause (3) or (4), or 142.23 subdivision 2, clause (4) (controlled substance crime in the 142.24 third degree), 152.024, subdivision 1, clause (2), (3), or (4) 142.25 (controlled substance crime in the fourth degree), 609.224, 142.26 subdivision 2, paragraph (c) (fifth-degree assault by a 142.27 caregiver against a vulnerable adult), 609.228 (great bodily 142.28 harm caused by distribution of drugs), 609.23 (mistreatment of 142.29 persons confined), 609.231 (mistreatment of residents or 142.30 patients), 609.2325 (criminal abuse of a vulnerable adult), 142.31 609.233 (criminal neglect of a vulnerable adult), 609.2335 142.32 (financial exploitation of a vulnerable adult), 609.234 (failure 142.33 to report), 609.265 (abduction), 609.2664 to 609.2665 142.34 (manslaughter of an unborn child in the first or second degree), 142.35 609.267 to 609.2672 (assault of an unborn child in the first, 142.36 second, or third degree), 609.268 (injury or death of an unborn 143.1 child in the commission of a crime), 617.293 (disseminating or 143.2 displaying harmful material to minors), a gross misdemeanor 143.3 offense under 609.324, subdivision 1 (other prohibited acts), a 143.4 gross misdemeanor offense under 609.378 (neglect or endangerment 143.5 of a child), a gross misdemeanor offense under 609.377 143.6 (malicious punishment of a child), 609.72, subdivision 3 143.7 (disorderly conduct against a vulnerable adult); or an attempt 143.8 or conspiracy to commit any of these offenses, as each of these 143.9 offenses is defined in Minnesota Statutes; or an offense in any 143.10 other state, the elements of which are substantially similar to 143.11 the elements of any of the foregoing offenses; 143.12 (2) regardless of how much time has passed since the 143.13 discharge of the sentence imposed for the offense, the 143.14 individual was convicted of a violation of any offense listed in 143.15 sections 609.185 to 609.195 (murder in the first, second, or 143.16 third degree), 609.2661 to 609.2663 (murder of an unborn child 143.17 in the first, second, or third degree), a felony offense under 143.18 609.377 (malicious punishment of a child), a felony offense 143.19 under 609.324, subdivision 1 (other prohibited acts), a felony 143.20 offense under 609.378 (neglect or endangerment of a child), 143.21 609.322 (solicitation, inducement, and promotion of 143.22 prostitution), 609.342 to 609.345 (criminal sexual conduct in 143.23 the first, second, third, or fourth degree), 609.352 143.24 (solicitation of children to engage in sexual conduct), 617.246 143.25 (use of minors in a sexual performance), 617.247 (possession of 143.26 pictorial representations of a minor), 609.365 (incest), a 143.27 felony offense under sections 609.2242 and 609.2243 (domestic 143.28 assault), a felony offense of spousal abuse, a felony offense of 143.29 child abuse or neglect, a felony offense of a crime against 143.30 children, or an attempt or conspiracy to commit any of these 143.31 offenses as defined in Minnesota Statutes, or an offense in any 143.32 other state, the elements of which are substantially similar to 143.33 any of the foregoing offenses; 143.34 (3) within the seven years preceding the study, the 143.35 individual committed an act that constitutes maltreatment of a 143.36 child under section 626.556, subdivision 10e, and that resulted 144.1 in substantial bodily harm as defined in section 609.02, 144.2 subdivision 7a, or substantial mental or emotional harm as 144.3 supported by competent psychological or psychiatric evidence; or 144.4 (4) within the seven years preceding the study, the 144.5 individual was determined under section 626.557 to be the 144.6 perpetrator of a substantiated incident of maltreatment of a 144.7 vulnerable adult that resulted in substantial bodily harm as 144.8 defined in section 609.02, subdivision 7a, or substantial mental 144.9 or emotional harm as supported by competent psychological or 144.10 psychiatric evidence. 144.11 In the case of any ground for disqualification under 144.12 clauses (1) to (4), if the act was committed by an individual 144.13 other than the applicantor, license holder, or registrant 144.14 residing in the applicant'sor, license holder's, or 144.15 registrant's home, the applicantor, license holder, or 144.16 registrant may seek reconsideration when the individual who 144.17 committed the act no longer resides in the home. 144.18 The disqualification periods provided under clauses (1), 144.19 (3), and (4) are the minimum applicable disqualification 144.20 periods. The commissioner may determine that an individual 144.21 should continue to be disqualified from licensure or 144.22 registration because the license holderor, registrant, or 144.23 applicant poses a risk of harm to a person served by that 144.24 individual after the minimum disqualification period has passed. 144.25 (d) The commissioner shall respond in writing or by 144.26 electronic transmission to all reconsideration requests for 144.27 which the basis for the request is that the information relied 144.28 upon by the commissioner to disqualify is incorrect or 144.29 inaccurate within 30 working days of receipt of a request and 144.30 all relevant information. If the basis for the request is that 144.31 the individual does not pose a risk of harm, the commissioner 144.32 shall respond to the request within 15 working days after 144.33 receiving the request for reconsideration and all relevant 144.34 information. If the disqualification is set aside, the 144.35 commissioner shall notify the applicant or license holder in 144.36 writing or by electronic transmission of the decision. 145.1 (e) Except as provided in subdivision 3c, the 145.2 commissioner's decision to disqualify an individual, including 145.3 the decision to grant or deny a rescission or set aside a 145.4 disqualification under this section, is the final administrative 145.5 agency action and shall not be subject to further review in a 145.6 contested case under chapter 14 involving a negative licensing 145.7 appeal taken in response to the disqualification or involving an 145.8 accuracy and completeness appeal under section 13.04. 145.9 Sec. 10. Minnesota Statutes 2000, section 245A.04, 145.10 subdivision 3d, is amended to read: 145.11 Subd. 3d. [DISQUALIFICATION.] (a) Except as provided in 145.12 paragraph (b), when a background study completed under 145.13 subdivision 3 shows any of the following: a conviction of one 145.14 or more crimes listed in clauses (1) to (4); the individual has 145.15 admitted to or a preponderance of the evidence indicates the 145.16 individual has committed an act or acts that meet the definition 145.17 of any of the crimes listed in clauses (1) to (4); or an 145.18 administrative determination listed under clause (4), the 145.19 individual shall be disqualified from any position allowing 145.20 direct contact with persons receiving services from the license 145.21 holder or registrant: 145.22 (1) regardless of how much time has passed since the 145.23 discharge of the sentence imposed for the offense, and unless 145.24 otherwise specified, regardless of the level of the conviction, 145.25 the individual was convicted of any of the following offenses: 145.26 sections 609.185 (murder in the first degree); 609.19 (murder in 145.27 the second degree); 609.195 (murder in the third degree); 145.28 609.2661 (murder of an unborn child in the first degree); 145.29 609.2662 (murder of an unborn child in the second degree); 145.30 609.2663 (murder of an unborn child in the third degree); 145.31 609.322 (solicitation, inducement, and promotion of 145.32 prostitution); 609.342 (criminal sexual conduct in the first 145.33 degree); 609.343 (criminal sexual conduct in the second degree); 145.34 609.344 (criminal sexual conduct in the third degree); 609.345 145.35 (criminal sexual conduct in the fourth degree); 609.352 145.36 (solicitation of children to engage in sexual conduct); 609.365 146.1 (incest); felony offense under 609.377 (malicious punishment of 146.2 a child); a felony offense under 609.378 (neglect or 146.3 endangerment of a child); a felony offense under 609.324, 146.4 subdivision 1 (other prohibited acts); 617.246 (use of minors in 146.5 sexual performance prohibited); 617.247 (possession of pictorial 146.6 representations of minors); a felony offense under sections 146.7 609.2242 and 609.2243 (domestic assault), a felony offense of 146.8 spousal abuse, a felony offense of child abuse or neglect, a 146.9 felony offense of a crime against children; or attempt or 146.10 conspiracy to commit any of these offenses as defined in 146.11 Minnesota Statutes, or an offense in any other state or country, 146.12 where the elements are substantially similar to any of the 146.13 offenses listed in this clause; 146.14 (2) if less than 15 years have passed since the discharge 146.15 of the sentence imposed for the offense; and the individual has 146.16 received a felony conviction for a violation of any of these 146.17 offenses: sections 609.20 (manslaughter in the first degree); 146.18 609.205 (manslaughter in the second degree); 609.21 (criminal 146.19 vehicular homicide and injury); 609.215 (suicide); 609.221 to 146.20 609.2231 (assault in the first, second, third, or fourth 146.21 degree); repeat offenses under 609.224 (assault in the fifth 146.22 degree); repeat offenses under 609.3451 (criminal sexual conduct 146.23 in the fifth degree); 609.713 (terroristic threats); 609.235 146.24 (use of drugs to injure or facilitate crime); 609.24 (simple 146.25 robbery); 609.245 (aggravated robbery); 609.25 (kidnapping); 146.26 609.255 (false imprisonment); 609.561 (arson in the first 146.27 degree); 609.562 (arson in the second degree); 609.563 (arson in 146.28 the third degree); repeat offenses under 617.23 (indecent 146.29 exposure; penalties); repeat offenses under 617.241 (obscene 146.30 materials and performances; distribution and exhibition 146.31 prohibited; penalty); 609.71 (riot); 609.66 (dangerous weapons); 146.32 609.67 (machine guns and short-barreled shotguns); 609.749 146.33 (harassment; stalking; penalties); 609.228 (great bodily harm 146.34 caused by distribution of drugs); 609.2325 (criminal abuse of a 146.35 vulnerable adult); 609.2664 (manslaughter of an unborn child in 146.36 the first degree); 609.2665 (manslaughter of an unborn child in 147.1 the second degree); 609.267 (assault of an unborn child in the 147.2 first degree); 609.2671 (assault of an unborn child in the 147.3 second degree); 609.268 (injury or death of an unborn child in 147.4 the commission of a crime); 609.52 (theft); 609.2335 (financial 147.5 exploitation of a vulnerable adult); 609.521 (possession of 147.6 shoplifting gear); 609.582 (burglary); 609.625 (aggravated 147.7 forgery); 609.63 (forgery); 609.631 (check forgery; offering a 147.8 forged check); 609.635 (obtaining signature by false pretense); 147.9 609.27 (coercion); 609.275 (attempt to coerce); 609.687 147.10 (adulteration); 260C.301 (grounds for termination of parental 147.11 rights); and chapter 152 (drugs; controlled substance). An 147.12 attempt or conspiracy to commit any of these offenses, as each 147.13 of these offenses is defined in Minnesota Statutes; or an 147.14 offense in any other state or country, the elements of which are 147.15 substantially similar to the elements of the offenses in this 147.16 clause. If the individual studied is convicted of one of the 147.17 felonies listed in this clause, but the sentence is a gross 147.18 misdemeanor or misdemeanor disposition, the lookback period for 147.19 the conviction is the period applicable to the disposition, that 147.20 is the period for gross misdemeanors or misdemeanors; 147.21 (3) if less than ten years have passed since the discharge 147.22 of the sentence imposed for the offense; and the individual has 147.23 received a gross misdemeanor conviction for a violation of any 147.24 of the following offenses: sections 609.224 (assault in the 147.25 fifth degree); 609.2242 and 609.2243 (domestic assault); 147.26 violation of an order for protection under 518B.01, subdivision 147.27 14; 609.3451 (criminal sexual conduct in the fifth degree); 147.28 repeat offenses under 609.746 (interference with privacy); 147.29 repeat offenses under 617.23 (indecent exposure); 617.241 147.30 (obscene materials and performances); 617.243 (indecent 147.31 literature, distribution); 617.293 (harmful materials; 147.32 dissemination and display to minors prohibited); 609.71 (riot); 147.33 609.66 (dangerous weapons); 609.749 (harassment; stalking; 147.34 penalties); 609.224, subdivision 2, paragraph (c) (assault in 147.35 the fifth degree by a caregiver against a vulnerable adult); 147.36 609.23 (mistreatment of persons confined); 609.231 (mistreatment 148.1 of residents or patients); 609.2325 (criminal abuse of a 148.2 vulnerable adult); 609.233 (criminal neglect of a vulnerable 148.3 adult); 609.2335 (financial exploitation of a vulnerable adult); 148.4 609.234 (failure to report maltreatment of a vulnerable adult); 148.5 609.72, subdivision 3 (disorderly conduct against a vulnerable 148.6 adult); 609.265 (abduction); 609.378 (neglect or endangerment of 148.7 a child); 609.377 (malicious punishment of a child); 609.324, 148.8 subdivision 1a (other prohibited acts; minor engaged in 148.9 prostitution); 609.33 (disorderly house); 609.52 (theft); 148.10 609.582 (burglary); 609.631 (check forgery; offering a forged 148.11 check); 609.275 (attempt to coerce); or an attempt or conspiracy 148.12 to commit any of these offenses, as each of these offenses is 148.13 defined in Minnesota Statutes; or an offense in any other state 148.14 or country, the elements of which are substantially similar to 148.15 the elements of any of the offenses listed in this clause. If 148.16 the defendant is convicted of one of the gross misdemeanors 148.17 listed in this clause, but the sentence is a misdemeanor 148.18 disposition, the lookback period for the conviction is the 148.19 period applicable to misdemeanors; or 148.20 (4) if less than seven years have passed since the 148.21 discharge of the sentence imposed for the offense; and the 148.22 individual has received a misdemeanor conviction for a violation 148.23 of any of the following offenses: sections 609.224 (assault in 148.24 the fifth degree); 609.2242 (domestic assault); violation of an 148.25 order for protection under 518B.01 (Domestic Abuse Act); 148.26 violation of an order for protection under 609.3232 (protective 148.27 order authorized; procedures; penalties); 609.746 (interference 148.28 with privacy); 609.79 (obscene or harassing phone calls); 148.29 609.795 (letter, telegram, or package; opening; harassment); 148.30 617.23 (indecent exposure; penalties); 609.2672 (assault of an 148.31 unborn child in the third degree); 617.293 (harmful materials; 148.32 dissemination and display to minors prohibited); 609.66 148.33 (dangerous weapons); 609.665 (spring guns); 609.2335 (financial 148.34 exploitation of a vulnerable adult); 609.234 (failure to report 148.35 maltreatment of a vulnerable adult); 609.52 (theft); 609.27 148.36 (coercion); or an attempt or conspiracy to commit any of these 149.1 offenses, as each of these offenses is defined in Minnesota 149.2 Statutes; or an offense in any other state or country, the 149.3 elements of which are substantially similar to the elements of 149.4 any of the offenses listed in this clause; failure to make 149.5 required reports under section 626.556, subdivision 3, or 149.6 626.557, subdivision 3, for incidents in which: (i) the final 149.7 disposition under section 626.556 or 626.557 was substantiated 149.8 maltreatment, and (ii) the maltreatment was recurring or 149.9 serious; or substantiated serious or recurring maltreatment of a 149.10 minor under section 626.556 or of a vulnerable adult under 149.11 section 626.557 for which there is a preponderance of evidence 149.12 that the maltreatment occurred, and that the subject was 149.13 responsible for the maltreatment. 149.14 For the purposes of this section, "serious maltreatment" 149.15 means sexual abuse; maltreatment resulting in death; or 149.16 maltreatment resulting in serious injury which reasonably 149.17 requires the care of a physician whether or not the care of a 149.18 physician was sought; or abuse resulting in serious injury. For 149.19 purposes of this section, "abuse resulting in serious injury" 149.20 means: bruises, bites, skin laceration or tissue damage; 149.21 fractures; dislocations; evidence of internal injuries; head 149.22 injuries with loss of consciousness; extensive second-degree or 149.23 third-degree burns and other burns for which complications are 149.24 present; extensive second-degree or third-degree frostbite, and 149.25 others for which complications are present; irreversible 149.26 mobility or avulsion of teeth; injuries to the eyeball; 149.27 ingestion of foreign substances and objects that are harmful; 149.28 near drowning; and heat exhaustion or sunstroke. For purposes 149.29 of this section, "care of a physician" is treatment received or 149.30 ordered by a physician, but does not include diagnostic testing, 149.31 assessment, or observation. For the purposes of this section, 149.32 "recurring maltreatment" means more than one incident of 149.33 maltreatment for which there is a preponderance of evidence that 149.34 the maltreatment occurred, and that the subject was responsible 149.35 for the maltreatment. 149.36 (b) If the subject of a background study is licensed by a 150.1 health-related licensing board, the board shall make the 150.2 determination regarding a disqualification under this 150.3 subdivision based on a finding of substantiated maltreatment 150.4 under section 626.556 or 626.557. The commissioner shall notify 150.5 the health-related licensing board if a background study shows 150.6 that a licensee would be disqualified because of substantiated 150.7 maltreatment and the board shall make a determination under 150.8 section 214.104. 150.9 Sec. 11. [REPORT ON SUPPLEMENTAL NURSING SERVICES AGENCY 150.10 USE.] 150.11 Beginning July 1, 2001, through June 30, 2003, the 150.12 commissioner of human services shall require nursing facilities 150.13 and other providers of long-term care services to report 150.14 semiannually on the use of supplemental nursing services, in the 150.15 form and manner specified by the commissioner. The information 150.16 reported must include, but is not limited to: 150.17 (1) number of hours worked by supplemental nursing services 150.18 personnel, by job classification, for each month; 150.19 (2) payments to supplemental nursing services agencies, on 150.20 a per hour worked basis, by job classification, for each month; 150.21 and 150.22 (3) percentage of total monthly work hours provided by 150.23 supplemental nursing services agency personnel, by job 150.24 classification, for each shift and for weekdays and weekends. 150.25 Sec. 12. [APPROPRIATION.] 150.26 $....... is appropriated from the general fund to the 150.27 commissioner of health for the biennium beginning July 1, 2001, 150.28 to regulate supplemental nursing services agencies. 150.29 ARTICLE 5 150.30 LONG-TERM CARE INSURANCE 150.31 Section 1. Minnesota Statutes 2000, section 62A.48, 150.32 subdivision 4, is amended to read: 150.33 Subd. 4. [LOSS RATIO.] The anticipated loss ratio for 150.34 long-term care policies must not be less than 65 percent for 150.35 policies issued on a group basis or 60 percent for policies 150.36 issued on an individual or mass-market basis. This subdivision 151.1 does not apply to policies issued on or after January 1, 2002, 151.2 that comply with sections 62S.021 and 62S.081. 151.3 [EFFECTIVE DATE.] This section is effective the day 151.4 following final enactment. 151.5 Sec. 2. Minnesota Statutes 2000, section 62A.48, is 151.6 amended by adding a subdivision to read: 151.7 Subd. 10. [REGULATION OF PREMIUMS AND PREMIUM 151.8 INCREASES.] Policies issued under sections 62A.46 to 62A.56 on 151.9 or after January 1, 2002, must comply with sections 62S.021, 151.10 62S.081, 62S.265, and 62S.266 to the same extent as policies 151.11 issued under chapter 62S. 151.12 [EFFECTIVE DATE.] This section is effective the day 151.13 following final enactment. 151.14 Sec. 3. Minnesota Statutes 2000, section 62A.48, is 151.15 amended by adding a subdivision to read: 151.16 Subd. 11. [NONFORFEITURE BENEFITS.] Policies issued under 151.17 sections 62A.46 to 62A.56 on or after January 1, 2002, must 151.18 comply with section 62S.02, subdivision 2, to the same extent as 151.19 policies issued under chapter 62S. 151.20 [EFFECTIVE DATE.] This section is effective the day 151.21 following final enactment. 151.22 Sec. 4. Minnesota Statutes 2000, section 62S.01, is 151.23 amended by adding a subdivision to read: 151.24 Subd. 13a. [EXCEPTIONAL INCREASE.] (a) "Exceptional 151.25 increase" means only those increases filed by an insurer as 151.26 exceptional for which the commissioner determines the need for 151.27 the premium rate increase is justified due to changes in laws or 151.28 rules applicable to long-term care coverage in this state, or 151.29 due to increased and unexpected utilization that affects the 151.30 majority of insurers of similar products. 151.31 (b) Except as provided in section 62S.265, exceptional 151.32 increases are subject to the same requirements as other premium 151.33 rate schedule increases. The commissioner may request a review 151.34 by an independent actuary or a professional actuarial body of 151.35 the basis for a request that an increase be considered an 151.36 exceptional increase. The commissioner, in determining that the 152.1 necessary basis for an exceptional increase exists, shall also 152.2 determine any potential offsets to higher claims costs. 152.3 [EFFECTIVE DATE.] This section is effective the day 152.4 following final enactment. 152.5 Sec. 5. Minnesota Statutes 2000, section 62S.01, is 152.6 amended by adding a subdivision to read: 152.7 Subd. 17a. [INCIDENTAL.] "Incidental," as used in section 152.8 62S.265, subdivision 10, means that the value of the long-term 152.9 care benefits provided is less than ten percent of the total 152.10 value of the benefits provided over the life of the policy. 152.11 These values shall be measured as of the date of issue. 152.12 [EFFECTIVE DATE.] This section is effective the day 152.13 following final enactment. 152.14 Sec. 6. Minnesota Statutes 2000, section 62S.01, is 152.15 amended by adding a subdivision to read: 152.16 Subd. 23a. [QUALIFIED ACTUARY.] "Qualified actuary" means 152.17 a member in good standing of the American Academy of Actuaries. 152.18 [EFFECTIVE DATE.] This section is effective the day 152.19 following final enactment. 152.20 Sec. 7. Minnesota Statutes 2000, section 62S.01, is 152.21 amended by adding a subdivision to read: 152.22 Subd. 25a. [SIMILAR POLICY FORMS.] "Similar policy forms" 152.23 means all of the long-term care insurance policies and 152.24 certificates issued by an insurer in the same long-term care 152.25 benefit classification as the policy form being considered. 152.26 Certificates of groups that meet the definition in section 152.27 62S.01, subdivision 15, clause (1), are not considered similar 152.28 to certificates or policies otherwise issued as long-term care 152.29 insurance, but are similar to other comparable certificates with 152.30 the same long-term care benefit classifications. For purposes 152.31 of determining similar policy forms, long-term care benefit 152.32 classifications are defined as follows: institutional long-term 152.33 care benefits only, noninstitutional long-term care benefits 152.34 only, or comprehensive long-term care benefits. 152.35 [EFFECTIVE DATE.] This section is effective the day 152.36 following final enactment. 153.1 Sec. 8. [62S.021] [LONG-TERM CARE INSURANCE; INITIAL 153.2 FILING.] 153.3 Subdivision 1. [APPLICABILITY.] This section applies to 153.4 any long-term care policy issued in this state on or after 153.5 January 1, 2002, under this chapter or sections 62A.46 to 62A.56. 153.6 Subd. 2. [REQUIRED SUBMISSION TO COMMISSIONER.] An insurer 153.7 shall provide the following information to the commissioner 30 153.8 days prior to making a long-term care insurance form available 153.9 for sale: 153.10 (1) a copy of the disclosure documents required in section 153.11 62S.081; and 153.12 (2) an actuarial certification consisting of at least the 153.13 following: 153.14 (i) a statement that the initial premium rate schedule is 153.15 sufficient to cover anticipated costs under moderately adverse 153.16 experience and that the premium rate schedule is reasonably 153.17 expected to be sustainable over the life of the form with no 153.18 future premium increases anticipated; 153.19 (ii) a statement that the policy design and coverage 153.20 provided have been reviewed and taken into consideration; 153.21 (iii) a statement that the underwriting and claims 153.22 adjudication processes have been reviewed and taken into 153.23 consideration; and 153.24 (iv) a complete description of the basis for contract 153.25 reserves that are anticipated to be held under the form, to 153.26 include: 153.27 (A) sufficient detail or sample calculations provided so as 153.28 to have a complete depiction of the reserve amounts to be held; 153.29 (B) a statement that the assumptions used for reserves 153.30 contain reasonable margins for adverse experience; 153.31 (C) a statement that the net valuation premium for renewal 153.32 years does not increase, except for attained-age rating where 153.33 permitted; 153.34 (D) a statement that the difference between the gross 153.35 premium and the net valuation premium for renewal years is 153.36 sufficient to cover expected renewal expenses, or if such a 154.1 statement cannot be made, a complete description of the 154.2 situations where this does not occur. An aggregate distribution 154.3 of anticipated issues may be used as long as the underlying 154.4 gross premiums maintain a reasonably consistent relationship. 154.5 If the gross premiums for certain age groups appear to be 154.6 inconsistent with this requirement, the commissioner may request 154.7 a demonstration under item (i) based on a standard age 154.8 distribution; and 154.9 (E) either a statement that the premium rate schedule is 154.10 not less than the premium rate schedule for existing similar 154.11 policy forms also available from the insurer except for 154.12 reasonable differences attributable to benefits, or a comparison 154.13 of the premium schedules for similar policy forms that are 154.14 currently available from the insurer with an explanation of the 154.15 differences. 154.16 Subd. 3. [ACTUARIAL DEMONSTRATION.] The commissioner may 154.17 request an actuarial demonstration that benefits are reasonable 154.18 in relation to premiums. The actuarial demonstration shall 154.19 include either premium and claim experience on similar policy 154.20 forms, adjusted for any premium or benefit differences, relevant 154.21 and credible data from other studies, or both. If the 154.22 commissioner asks for additional information under this 154.23 subdivision, the 30-day time limit in subdivision 2 does not 154.24 include the time during which the insurer is preparing the 154.25 requested information. 154.26 [EFFECTIVE DATE.] This section is effective the day 154.27 following final enactment. 154.28 Sec. 9. [62S.081] [REQUIRED DISCLOSURE OF RATING PRACTICES 154.29 TO CONSUMERS.] 154.30 Subdivision 1. [APPLICATION.] This section shall apply as 154.31 follows: 154.32 (a) Except as provided in paragraph (b), this section 154.33 applies to any long-term care policy or certificate issued in 154.34 this state on or after January 1, 2002. 154.35 (b) For certificates issued on or after the effective date 154.36 of this section under a policy of group long-term care insurance 155.1 as defined in section 62S.01, subdivision 15, that was in force 155.2 on the effective date of this section, this section applies on 155.3 the policy anniversary following June 30, 2002. 155.4 Subd. 2. [REQUIRED DISCLOSURES.] Other than policies for 155.5 which no applicable premium rate or rate schedule increases can 155.6 be made, insurers shall provide all of the information listed in 155.7 this subdivision to the applicant at the time of application or 155.8 enrollment, unless the method of application does not allow for 155.9 delivery at that time; in this case, an insurer shall provide 155.10 all of the information listed in this subdivision to the 155.11 applicant no later than at the time of delivery of the policy or 155.12 certificate: 155.13 (1) a statement that the policy may be subject to rate 155.14 increases in the future; 155.15 (2) an explanation of potential future premium rate 155.16 revisions and the policyholder's or certificate holder's option 155.17 in the event of a premium rate revision; 155.18 (3) the premium rate or rate schedules applicable to the 155.19 applicant that will be in effect until a request is made for an 155.20 increase; 155.21 (4) a general explanation for applying premium rate or rate 155.22 schedule adjustments that must include: 155.23 (i) a description of when premium rate or rate schedule 155.24 adjustments will be effective, for example the next anniversary 155.25 date or the next billing date; and 155.26 (ii) the right to a revised premium rate or rate schedule 155.27 as provided in clause (3) if the premium rate or rate schedule 155.28 is changed; and 155.29 (5)(i) information regarding each premium rate increase on 155.30 this policy form or similar policy forms over the past ten years 155.31 for this state or any other state that, at a minimum, identifies: 155.32 (A) the policy forms for which premium rates have been 155.33 increased; 155.34 (B) the calendar years when the form was available for 155.35 purchase; and 155.36 (C) the amount or percent of each increase. The percentage 156.1 may be expressed as a percentage of the premium rate prior to 156.2 the increase and may also be expressed as minimum and maximum 156.3 percentages if the rate increase is variable by rating 156.4 characteristics; 156.5 (ii) the insurer may, in a fair manner, provide additional 156.6 explanatory information related to the rate increases; 156.7 (iii) an insurer has the right to exclude from the 156.8 disclosure premium rate increases that apply only to blocks of 156.9 business acquired from other nonaffiliated insurers or the 156.10 long-term care policies acquired from other nonaffiliated 156.11 insurers when those increases occurred prior to the acquisition; 156.12 (iv) if an acquiring insurer files for a rate increase on a 156.13 long-term care policy form acquired from nonaffiliated insurers 156.14 or a block of policy forms acquired from nonaffiliated insurers 156.15 on or before the later of the effective date of this section, or 156.16 the end of a 24-month period following the acquisition of the 156.17 block of policies, the acquiring insurer may exclude that rate 156.18 increase from the disclosure. However, the nonaffiliated 156.19 selling company must include the disclosure of that rate 156.20 increase according to item (i); and 156.21 (v) if the acquiring insurer in item (iv) files for a 156.22 subsequent rate increase, even within the 24-month period, on 156.23 the same policy form acquired from nonaffiliated insurers or 156.24 block of policy forms acquired from nonaffiliated insurers 156.25 referenced in item (iv), the acquiring insurer shall make all 156.26 disclosures required by this subdivision, including disclosure 156.27 of the earlier rate increase referenced in item (iv). 156.28 Subd. 3. [ACKNOWLEDGMENT.] An applicant shall sign an 156.29 acknowledgment at the time of application, unless the method of 156.30 application does not allow for signature at that time, that the 156.31 insurer made the disclosure required under subdivision 2. If, 156.32 due to the method of application, the applicant cannot sign an 156.33 acknowledgment at the time of application, the applicant shall 156.34 sign no later than at the time of delivery of the policy or 156.35 certificate. 156.36 Subd. 4. [FORMS.] An insurer shall use the forms in 157.1 Appendices B and F of the Long-term Care Insurance Model 157.2 Regulation adopted by the National Association of Insurance 157.3 Commissioners to comply with the requirements of subdivisions 1 157.4 and 2. 157.5 Subd. 5. [NOTICE OF INCREASE.] An insurer shall provide 157.6 notice of an upcoming premium rate schedule increase, after the 157.7 increase has been approved by the commissioner, to all 157.8 policyholders or certificate holders, if applicable, at least 45 157.9 days prior to the implementation of the premium rate schedule 157.10 increase by the insurer. The notice shall include the 157.11 information required by subdivision 2 when the rate increase is 157.12 implemented. 157.13 [EFFECTIVE DATE.] This section is effective the day 157.14 following final enactment. 157.15 Sec. 10. Minnesota Statutes 2000, section 62S.26, is 157.16 amended to read: 157.17 62S.26 [LOSS RATIO.] 157.18 (a) The minimum loss ratio must be at least 60 percent, 157.19 calculated in a manner which provides for adequate reserving of 157.20 the long-term care insurance risk. In evaluating the expected 157.21 loss ratio, the commissioner shall give consideration to all 157.22 relevant factors, including: 157.23 (1) statistical credibility of incurred claims experience 157.24 and earned premiums; 157.25 (2) the period for which rates are computed to provide 157.26 coverage; 157.27 (3) experienced and projected trends; 157.28 (4) concentration of experience within early policy 157.29 duration; 157.30 (5) expected claim fluctuation; 157.31 (6) experience refunds, adjustments, or dividends; 157.32 (7) renewability features; 157.33 (8) all appropriate expense factors; 157.34 (9) interest; 157.35 (10) experimental nature of the coverage; 157.36 (11) policy reserves; 158.1 (12) mix of business by risk classification; and 158.2 (13) product features such as long elimination periods, 158.3 high deductibles, and high maximum limits. 158.4 (b) This section does not apply to policies or certificates 158.5 that are subject to sections 62S.021, 62S.081, and 62S.265, and 158.6 that comply with those sections. 158.7 [EFFECTIVE DATE.] This section is effective the day 158.8 following final enactment. 158.9 Sec. 11. [62S.265] [PREMIUM RATE SCHEDULE INCREASES.] 158.10 Subdivision 1. [APPLICABILITY.] (a) Except as provided in 158.11 paragraph (b), this section applies to any long-term care policy 158.12 or certificate issued in this state on or after January 1, 2002, 158.13 under this chapter or sections 62A.46 to 62A.56. 158.14 (b) For certificates issued on or after the effective date 158.15 of this section under a group long-term care insurance policy as 158.16 defined in section 62S.01, subdivision 15, that was in force on 158.17 the effective date of this section, this section applies on the 158.18 policy anniversary following June 30, 2002. 158.19 Subd. 2. [NOTICE.] An insurer shall file a requested 158.20 premium rate schedule increase, including an exceptional 158.21 increase, to the commissioner for prior approval at least 60 158.22 days prior to the notice to the policyholders and shall include: 158.23 (1) all information required by section 62S.081; 158.24 (2) certification by a qualified actuary that: 158.25 (i) if the requested premium rate schedule increase is 158.26 implemented and the underlying assumptions, which reflect 158.27 moderately adverse conditions, are realized, no further premium 158.28 rate schedule increases are anticipated; and 158.29 (ii) the premium rate filing complies with this section; 158.30 (3) an actuarial memorandum justifying the rate schedule 158.31 change request that includes: 158.32 (i) lifetime projections of earned premiums and incurred 158.33 claims based on the filed premium rate schedule increase and the 158.34 method and assumptions used in determining the projected values, 158.35 including reflection of any assumptions that deviate from those 158.36 used for pricing other forms currently available for sale; 159.1 (A) annual values for the five years preceding and the 159.2 three years following the valuation date shall be provided 159.3 separately; 159.4 (B) the projections must include the development of the 159.5 lifetime loss ratio, unless the rate increase is an exceptional 159.6 increase; 159.7 (C) the projections must demonstrate compliance with 159.8 subdivision 3; and 159.9 (D) for exceptional increases, the projected experience 159.10 must be limited to the increases in claims expenses attributable 159.11 to the approved reasons for the exceptional increase and, if the 159.12 commissioner determines that offsets to higher claim costs may 159.13 exist, the insurer shall use appropriate net projected 159.14 experience; 159.15 (ii) disclosure of how reserves have been incorporated in 159.16 this rate increase whenever the rate increase will trigger 159.17 contingent benefit upon lapse; 159.18 (iii) disclosure of the analysis performed to determine why 159.19 a rate adjustment is necessary, which pricing assumptions were 159.20 not realized and why, and what other actions taken by the 159.21 company have been relied upon by the actuary; 159.22 (iv) a statement that policy design, underwriting, and 159.23 claims adjudication practices have been taken into 159.24 consideration; and 159.25 (v) if it is necessary to maintain consistent premium rates 159.26 for new certificates and certificates receiving a rate increase, 159.27 the insurer shall file composite rates reflecting projections of 159.28 new certificates; 159.29 (4) a statement that renewal premium rate schedules are not 159.30 greater than new business premium rate schedules except for 159.31 differences attributable to benefits, unless sufficient 159.32 justification is provided to the commissioner; and 159.33 (5) sufficient information for review and approval of the 159.34 premium rate schedule increase by the commissioner. 159.35 Subd. 3. [REQUIREMENTS PERTAINING TO RATE INCREASES.] All 159.36 premium rate schedule increases must be determined according to 160.1 the following requirements: 160.2 (1) exceptional increases shall provide that 70 percent of 160.3 the present value of projected additional premiums from the 160.4 exceptional increase will be returned to policyholders in 160.5 benefits; 160.6 (2) premium rate schedule increases must be calculated so 160.7 that the sum of the accumulated value of incurred claims, 160.8 without the inclusion of active life reserves, and the present 160.9 value of future projected incurred claims, without the inclusion 160.10 of active life reserves, will not be less than the sum of the 160.11 following: 160.12 (i) the accumulated value of the initial earned premium 160.13 times 58 percent; 160.14 (ii) 85 percent of the accumulated value of prior premium 160.15 rate schedule increases on an earned basis; 160.16 (iii) the present value of future projected initial earned 160.17 premiums times 58 percent; and 160.18 (iv) 85 percent of the present value of future projected 160.19 premiums not in item (iii) on an earned basis; 160.20 (3) if a policy form has both exceptional and other 160.21 increases, the values in clause (2), items (ii) and (iv), must 160.22 also include 70 percent for exceptional rate increase amounts; 160.23 and 160.24 (4) all present and accumulated values used to determine 160.25 rate increases must use the maximum valuation interest rate for 160.26 contract reserves permitted for valuation of whole life 160.27 insurance policies issued in this state on the same date. The 160.28 actuary shall disclose as part of the actuarial memorandum the 160.29 use of any appropriate averages. 160.30 Subd. 4. [PROJECTIONS.] For each rate increase that is 160.31 implemented, the insurer shall file for approval by the 160.32 commissioner updated projections, as defined in subdivision 2, 160.33 clause (3), item (i), annually for the next three years and 160.34 include a comparison of actual results to projected values. The 160.35 commissioner may extend the period to greater than three years 160.36 if actual results are not consistent with projected values from 161.1 prior projections. For group insurance policies that meet the 161.2 conditions in subdivision 11, the projections required by this 161.3 subdivision must be provided to the policyholder in lieu of 161.4 filing with the commissioner. 161.5 Subd. 5. [LIFETIME PROJECTIONS.] If any premium rate in 161.6 the revised premium rate schedule is greater than 200 percent of 161.7 the comparable rate in the initial premium schedule, lifetime 161.8 projections, as defined in subdivision 2, clause (3), item (i), 161.9 must be filed for approval by the commissioner every five years 161.10 following the end of the required period in subdivision 4. For 161.11 group insurance policies that meet the conditions in subdivision 161.12 11, the projections required by this subdivision must be 161.13 provided to the policyholder in lieu of filing with the 161.14 commissioner. 161.15 Subd. 6. [EFFECT OF ACTUAL EXPERIENCE.] (a) If the 161.16 commissioner has determined that the actual experience following 161.17 a rate increase does not adequately match the projected 161.18 experience and that the current projections under moderately 161.19 adverse conditions demonstrate that incurred claims will not 161.20 exceed proportions of premiums specified in subdivision 3, the 161.21 commissioner may require the insurer to implement any of the 161.22 following: 161.23 (1) premium rate schedule adjustments; or 161.24 (2) other measures to reduce the difference between the 161.25 projected and actual experience. 161.26 (b) In determining whether the actual experience adequately 161.27 matches the projected experience, consideration should be given 161.28 to subdivision 2, clause (3), item (v), if applicable. 161.29 Subd. 7. [CONTINGENT BENEFIT UPON LAPSE.] If the majority 161.30 of the policies or certificates to which the increase is 161.31 applicable are eligible for the contingent benefit upon lapse, 161.32 the insurer shall file: 161.33 (1) a plan, subject to commissioner approval, for improved 161.34 administration or claims processing designed to eliminate the 161.35 potential for further deterioration of the policy form requiring 161.36 further premium rate schedule increases, or both, or a 162.1 demonstration that appropriate administration and claims 162.2 processing have been implemented or are in effect; otherwise, 162.3 the commissioner may impose the condition in subdivision 8, 162.4 paragraph (b); and 162.5 (2) the original anticipated lifetime loss ratio, and the 162.6 premium rate schedule increase that would have been calculated 162.7 according to subdivision 3 had the greater of the original 162.8 anticipated lifetime loss ratio or 58 percent been used in the 162.9 calculations described in subdivision 3, clause (2), items (i) 162.10 and (iii). 162.11 Subd. 8. [PROJECTED LAPSE RATES.] (a) For a rate increase 162.12 filing that meets the following criteria, the commissioner shall 162.13 review, for all policies included in the filing, the projected 162.14 lapse rates and past lapse rates during the 12 months following 162.15 each increase to determine if significant adverse lapsation has 162.16 occurred or is anticipated: 162.17 (1) the rate increase is not the first rate increase 162.18 requested for the specific policy form or forms; 162.19 (2) the rate increase is not an exceptional increase; and 162.20 (3) the majority of the policies or certificates to which 162.21 the increase is applicable are eligible for the contingent 162.22 benefit upon lapse. 162.23 (b) If significant adverse lapsation has occurred, is 162.24 anticipated in the filing, or is evidenced in the actual results 162.25 as presented in the updated projections provided by the insurer 162.26 following the requested rate increase, the commissioner may 162.27 determine that a rate spiral exists. Following the 162.28 determination that a rate spiral exists, the commissioner may 162.29 require the insurer to offer, without underwriting, to all 162.30 in-force insureds subject to the rate increase, the option to 162.31 replace existing coverage with one or more reasonably comparable 162.32 products being offered by the insurer or its affiliates. The 162.33 offer must: 162.34 (1) be subject to the approval of the commissioner; 162.35 (2) be based upon actuarially sound principles, but not be 162.36 based upon attained age; and 163.1 (3) provide that maximum benefits under any new policy 163.2 accepted by an insured shall be reduced by comparable benefits 163.3 already paid under the existing policy. 163.4 (c) The insurer shall maintain the experience of all the 163.5 replacement insureds separate from the experience of insureds 163.6 originally issued the policy forms. In the event of a request 163.7 for a rate increase on the policy form, the rate increase must 163.8 be limited to the lesser of the maximum rate increase determined 163.9 based on the combined experience and the maximum rate increase 163.10 determined based only upon the experience of the insureds 163.11 originally issued the form plus ten percent. 163.12 Subd. 9. [PERSISTENT PRACTICE OF INADEQUATE INITIAL 163.13 RATES.] If the commissioner determines that the insurer has 163.14 exhibited a persistent practice of filing inadequate initial 163.15 premium rates for long-term care insurance, the commissioner 163.16 may, in addition to the provisions of subdivision 8, prohibit 163.17 the insurer from either of the following: 163.18 (1) filing and marketing comparable coverage for a period 163.19 of up to five years; or 163.20 (2) offering all other similar coverages and limiting 163.21 marketing of new applications to the products subject to recent 163.22 premium rate schedule increases. 163.23 Subd. 10. [INCIDENTAL LONG-TERM CARE 163.24 BENEFITS.] Subdivisions 1 to 9 do not apply to policies for 163.25 which the long-term care benefits provided by the policy are 163.26 incidental, as defined in section 62S.01, subdivision 17a, if 163.27 the policy complies with all of the following provisions: 163.28 (1) the interest credited internally to determine cash 163.29 value accumulations, including long-term care, if any, are 163.30 guaranteed not to be less than the minimum guaranteed interest 163.31 rate for cash value accumulations without long-term care set 163.32 forth in the policy; 163.33 (2) the portion of the policy that provides insurance 163.34 benefits other than long-term care coverage meets the 163.35 nonforfeiture requirements as applicable in any of the following: 163.36 (i) for life insurance, section 61A.25; 164.1 (ii) for individual deferred annuities, section 61A.245; 164.2 and 164.3 (iii) for variable annuities, section 61A.21; 164.4 (3) the policy meets the disclosure requirements of 164.5 sections 62S.10 and 62S.11 if the policy is governed by chapter 164.6 62S and of section 62A.50 if the policy is governed by sections 164.7 62A.46 to 62A.56; 164.8 (4) the portion of the policy that provides insurance 164.9 benefits other than long-term care coverage meets the 164.10 requirements as applicable in the following: 164.11 (i) policy illustrations to the extent required by state 164.12 law applicable to life insurance; 164.13 (ii) disclosure requirements in state law applicable to 164.14 annuities; and 164.15 (iii) disclosure requirements applicable to variable 164.16 annuities; and 164.17 (5) an actuarial memorandum is filed with the commissioner 164.18 that includes: 164.19 (i) a description of the basis on which the long-term care 164.20 rates were determined; 164.21 (ii) a description of the basis for the reserves; 164.22 (iii) a summary of the type of policy, benefits, 164.23 renewability, general marketing method, and limits on ages of 164.24 issuance; 164.25 (iv) a description and a table of each actuarial assumption 164.26 used. For expenses, an insurer must include percent of premium 164.27 dollars per policy and dollars per unit of benefits, if any; 164.28 (v) a description and a table of the anticipated policy 164.29 reserves and additional reserves to be held in each future year 164.30 for active lives; 164.31 (vi) the estimated average annual premium per policy and 164.32 the average issue age; 164.33 (vii) a statement as to whether underwriting is performed 164.34 at the time of application. The statement shall indicate 164.35 whether underwriting is used and, if used, the statement shall 164.36 include a description of the type or types of underwriting used, 165.1 such as medical underwriting or functional assessment 165.2 underwriting. Concerning a group policy, the statement shall 165.3 indicate whether the enrollee or any dependent will be 165.4 underwritten and when underwriting occurs; and 165.5 (viii) a description of the effect of the long-term care 165.6 policy provision on the required premiums, nonforfeiture values, 165.7 and reserves on the underlying insurance policy, both for active 165.8 lives and those in long-term care claim status. 165.9 Subd. 11. [LARGE GROUP POLICIES.] Subdivisions 6 and 9 do 165.10 not apply to group long-term care insurance policies as defined 165.11 in section 62S.01, subdivision 15, where: 165.12 (1) the policies insure 250 or more persons, and the 165.13 policyholder has 5,000 or more eligible employees of a single 165.14 employer; or 165.15 (2) the policyholder, and not the certificate holders, pays 165.16 a material portion of the premium, which is not less than 20 165.17 percent of the total premium for the group in the calendar year 165.18 prior to the year in which a rate increase is filed. 165.19 [EFFECTIVE DATE.] This section is effective the day 165.20 following final enactment. 165.21 Sec. 12. [62S.266] [NONFORFEITURE BENEFIT REQUIREMENT.] 165.22 Subdivision 1. [APPLICABILITY.] This section does not 165.23 apply to life insurance policies or riders containing 165.24 accelerated long-term care benefits. 165.25 Subd. 2. [REQUIREMENT.] An insurer must offer each 165.26 prospective policyholder a nonforfeiture benefit in compliance 165.27 with the following requirements: 165.28 (1) a policy or certificate offered with nonforfeiture 165.29 benefits must have coverage elements, eligibility, benefit 165.30 triggers, and benefit length that are the same as coverage to be 165.31 issued without nonforfeiture benefits. The nonforfeiture 165.32 benefit included in the offer must be the benefit described in 165.33 subdivision 5; and 165.34 (2) the offer must be in writing if the nonforfeiture 165.35 benefit is not otherwise described in the outline of coverage or 165.36 other materials given to the prospective policyholder. 166.1 Subd. 3. [EFFECT OF REJECTION OF OFFER.] If the offer 166.2 required to be made under subdivision 2 is rejected, the insurer 166.3 shall provide the contingent benefit upon lapse described in 166.4 this section. 166.5 Subd. 4. [CONTINGENT BENEFIT UPON LAPSE.] (a) After 166.6 rejection of the offer required under subdivision 2, for 166.7 individual and group policies without nonforfeiture benefits 166.8 issued after the effective date of this section, the insurer 166.9 shall provide a contingent benefit upon lapse. 166.10 (b) If a group policyholder elects to make the 166.11 nonforfeiture benefit an option to the certificate holder, a 166.12 certificate shall provide either the nonforfeiture benefit or 166.13 the contingent benefit upon lapse. 166.14 (c) The contingent benefit on lapse shall be triggered 166.15 every time an insurer increases the premium rates to a level 166.16 which results in a cumulative increase of the annual premium 166.17 equal to or exceeding the percentage of the insured's initial 166.18 annual premium based on the insured's issue age, and the policy 166.19 or certificate lapses within 120 days of the due date of the 166.20 premium increase. Unless otherwise required, policyholders 166.21 shall be notified at least 30 days prior to the due date of the 166.22 premium reflecting the rate increase. 166.23 Triggers for a Substantial Premium Increase 166.24 Percent Increase 166.25 Issue Age Over Initial Premium 166.26 29 and Under 200 166.27 30-34 190 166.28 35-39 170 166.29 40-44 150 166.30 45-49 130 166.31 50-54 110 166.32 55-59 90 166.33 60 70 166.34 61 66 166.35 62 62 166.36 63 58 167.1 64 54 167.2 65 50 167.3 66 48 167.4 67 46 167.5 68 44 167.6 69 42 167.7 70 40 167.8 71 38 167.9 72 36 167.10 73 34 167.11 74 32 167.12 75 30 167.13 76 28 167.14 77 26 167.15 78 24 167.16 79 22 167.17 80 20 167.18 81 19 167.19 82 18 167.20 83 17 167.21 84 16 167.22 85 15 167.23 86 14 167.24 87 13 167.25 88 12 167.26 89 11 167.27 90 and over 10 167.28 (d) On or before the effective date of a substantial 167.29 premium increase as defined in paragraph (c), the insurer shall: 167.30 (1) offer to reduce policy benefits provided by the current 167.31 coverage without the requirement of additional underwriting so 167.32 that required premium payments are not increased; 167.33 (2) offer to convert the coverage to a paid-up status with 167.34 a shortened benefit period according to the terms of subdivision 167.35 5. This option may be elected at any time during the 120-day 167.36 period referenced in paragraph (c); and 168.1 (3) notify the policyholder or certificate holder that a 168.2 default or lapse at any time during the 120-day period 168.3 referenced in paragraph (c) shall be deemed to be the election 168.4 of the offer to convert in clause (2). 168.5 Subd. 5. [NONFORFEITURE BENEFITS; REQUIREMENTS.] (a) 168.6 Benefits continued as nonforfeiture benefits, including 168.7 contingent benefits upon lapse, must be as described in this 168.8 subdivision. 168.9 (b) For purposes of this subdivision, "attained age rating" 168.10 is defined as a schedule of premiums starting from the issue 168.11 date which increases with age at least one percent per year 168.12 prior to age 50, and at least three percent per year beyond age 168.13 50. 168.14 (c) For purposes of this subdivision, the nonforfeiture 168.15 benefit shall be of a shortened benefit period providing 168.16 paid-up, long-term care insurance coverage after lapse. The 168.17 same benefits, amounts, and frequency in effect at the time of 168.18 lapse, but not increased thereafter, will be payable for a 168.19 qualifying claim, but the lifetime maximum dollars or days of 168.20 benefits shall be determined as specified in paragraph (d). 168.21 (d) The standard nonforfeiture credit will be equal to 100 168.22 percent of the sum of all premiums paid, including the premiums 168.23 paid prior to any changes in benefits. The insurer may offer 168.24 additional shortened benefit period options, as long as the 168.25 benefits for each duration equal or exceed the standard 168.26 nonforfeiture credit for that duration. However, the minimum 168.27 nonforfeiture credit must not be less than 30 times the daily 168.28 nursing home benefit at the time of lapse. In either event, the 168.29 calculation of the nonforfeiture credit is subject to the 168.30 limitation of this subdivision. 168.31 (e) The nonforfeiture benefit must begin not later than the 168.32 end of the third year following the policy or certificate issue 168.33 date. The contingent benefit upon lapse must be effective 168.34 during the first three years as well as thereafter. 168.35 (f) Notwithstanding paragraph (e), for a policy or 168.36 certificate with attained age rating, the nonforfeiture benefit 169.1 must begin on the earlier of: 169.2 (1) the end of the tenth year following the policy or 169.3 certificate issue date; or 169.4 (2) the end of the second year following the date the 169.5 policy or certificate is no longer subject to attained age 169.6 rating. 169.7 (g) Nonforfeiture credits may be used for all care and 169.8 services qualifying for benefits under the terms of the policy 169.9 or certificate, up to the limits specified in the policy or 169.10 certificate. 169.11 Subd. 6. [BENEFIT LIMIT.] All benefits paid by the insurer 169.12 while the policy or certificate is in premium-paying status and 169.13 in the paid-up status will not exceed the maximum benefits which 169.14 would be payable if the policy or certificate had remained in 169.15 premium-paying status. 169.16 Subd. 7. [MINIMUM BENEFITS; INDIVIDUAL AND GROUP 169.17 POLICIES.] There shall be no difference in the minimum 169.18 nonforfeiture benefits as required under this section for group 169.19 and individual policies. 169.20 Subd. 8. [APPLICATION; EFFECTIVE DATES.] This section 169.21 becomes effective January 1, 2002, and applies as follows: 169.22 (a) Except as provided in paragraph (b), this section 169.23 applies to any long-term care policy issued in this state on or 169.24 after the effective date of this section. 169.25 (b) For certificates issued on or after the effective date 169.26 of this section, under a group long-term care insurance policy 169.27 that was in force on the effective date of this section, the 169.28 provisions of this section do not apply. 169.29 Subd. 9. [EFFECT ON LOSS RATIO.] Premiums charged for a 169.30 policy or certificate containing nonforfeiture benefits or a 169.31 contingent benefit on lapse are subject to the loss ratio 169.32 requirements of section 62A.48, subdivision 4, or 62S.26, 169.33 treating the policy as a whole, except for policies or 169.34 certificates that are subject to sections 62S.021, 62S.081, and 169.35 62S.265 and that comply with those sections. 169.36 Subd. 10. [PURCHASED BLOCKS OF BUSINESS.] To determine 170.1 whether contingent nonforfeiture upon lapse provisions are 170.2 triggered under subdivision 4, paragraph (c), a replacing 170.3 insurer that purchased or otherwise assumed a block or blocks of 170.4 long-term care insurance policies from another insurer shall 170.5 calculate the percentage increase based on the initial annual 170.6 premium paid by the insured when the policy was first purchased 170.7 from the original insurer. 170.8 Subd. 11. [LEVEL PREMIUM CONTRACTS.] A nonforfeiture 170.9 benefit for qualified long-term care insurance contracts that 170.10 are level premium contracts shall be offered that meets the 170.11 following requirements: 170.12 (1) the nonforfeiture provision shall be appropriately 170.13 captioned; 170.14 (2) the nonforfeiture provision shall provide a benefit 170.15 available in the event of a default in the payment of any 170.16 premiums and shall state that the amount of the benefit may be 170.17 adjusted subsequent to being initially granted only as necessary 170.18 to reflect changes in claims, persistency, and interest as 170.19 reflected in changes in rates for premium paying contracts 170.20 approved by the commissioner for the same contract form; and 170.21 (3) the nonforfeiture provision shall provide at least one 170.22 of the following: 170.23 (i) reduced paid-up insurance; 170.24 (ii) extended term insurance; 170.25 (iii) shortened benefit period; or 170.26 (iv) other similar offerings approved by the commissioner. 170.27 [EFFECTIVE DATE.] This section is effective the day 170.28 following final enactment. 170.29 Sec. 13. Minnesota Statutes 2000, section 256.975, is 170.30 amended by adding a subdivision to read: 170.31 Subd. 8. [PROMOTION OF LONG-TERM CARE INSURANCE.] The 170.32 Minnesota board on aging, either directly or through contract, 170.33 shall promote the provision of employer-sponsored, long-term 170.34 care insurance. The board shall encourage private and public 170.35 sector employers to make long-term care insurance available to 170.36 employees, provide interested employers with information on the 171.1 long-term care insurance product offered to state employees, and 171.2 provide technical assistance to employers in designing long-term 171.3 care insurance products and contacting health plan companies 171.4 offering long-term care insurance products. 171.5 Sec. 14. [256B.0571] [LONG-TERM CARE PARTNERSHIP.] 171.6 Subdivision 1. [DEFINITIONS.] For purposes of this 171.7 section, the following terms have the meanings given them. 171.8 (a) "Home care service" means care described in section 171.9 144A.43. 171.10 (b) "Long-term care insurance" means a policy described in 171.11 section 62S.01. 171.12 (c) "Medical assistance" means the program of medical 171.13 assistance established under section 256B.01. 171.14 (d) "Nursing home" means nursing home as described in 171.15 section 144A.01. 171.16 (e) "Partnership policy" means a long-term care insurance 171.17 policy that meets the requirements under chapter 62S. 171.18 (f) "Partnership program" means the Minnesota partnership 171.19 for long-term care program established under this section. 171.20 Subd. 2. [PARTNERSHIP PROGRAM.] (a) Subject to federal 171.21 waiver approval, the commissioner of human services, along with 171.22 the commissioner of commerce, shall establish the Minnesota 171.23 partnership for long-term care program to provide for the 171.24 financing of long-term care through a combination of private 171.25 insurance and medical assistance. 171.26 (b) An individual who meets the requirements in paragraph 171.27 (c) is eligible to participate in the partnership program. 171.28 (c) The individual must: 171.29 (1) be a Minnesota resident; 171.30 (2) purchase a partnership policy that is delivered, issued 171.31 for delivery, or renewed on or after the effective date of this 171.32 section, and maintains the partnership policy in effect 171.33 throughout the period of participation in the partnership 171.34 program; and 171.35 (3) exhaust the minimum benefits under the partnership 171.36 policy as described in this section. Benefits received under a 172.1 long-term care insurance policy before the effective date of 172.2 this section do not count toward the exhaustion of benefits 172.3 required in this subdivision. 172.4 Subd. 3. [MEDICAL ASSISTANCE ELIGIBILITY.] (a) Upon 172.5 application of an individual who meets the requirements 172.6 described in subdivision 2, the commissioner of human services 172.7 shall determine the individual's eligibility for medical 172.8 assistance according to paragraphs (b) and (c). 172.9 (b) After disregarding financial assets exempted under 172.10 medical assistance eligibility requirements, the department 172.11 shall disregard an additional amount of financial assets equal 172.12 to the dollar amount of coverage under the partnership policy. 172.13 (c) The department shall consider the individual's income 172.14 according to medical assistance eligibility requirements. 172.15 Subd. 4. [FEDERAL APPROVAL.] (a) The commissioner of human 172.16 services shall seek appropriate amendments to the medical 172.17 assistance state plan and shall apply for any necessary waiver 172.18 of medical assistance requirements by the federal Health Care 172.19 Financing Administration to implement the partnership program. 172.20 The state shall not implement the partnership program unless the 172.21 provisions in paragraphs (b) and (c) apply. 172.22 (b) The commissioner shall seek any necessary federal 172.23 waiver of medical assistance requirements. 172.24 (c) Individuals who receive medical assistance under this 172.25 section are exempt from estate recovery requirements under 172.26 section 1917, title XIX of the federal Social Security Act, 172.27 United States Code, title 42, section 1396p. 172.28 Subd. 5. [APPROVED POLICIES.] (a) A partnership policy 172.29 must meet all of the requirements in paragraphs (b) to (h). 172.30 (b) Minimum coverage shall be for a period of not less than 172.31 three years and for a dollar amount equal to 36 months of 172.32 nursing home care at the minimum daily benefit rate determined 172.33 and adjusted under paragraph (c). The policy shall provide for 172.34 home health care benefits to be substituted for nursing home 172.35 care benefits on the basis of two home health care days for one 172.36 nursing home care day. 173.1 (c) Minimum daily benefits shall be $130 for nursing home 173.2 care or $65 for home care. These minimum daily benefit amounts 173.3 shall be adjusted by the department on October 1 of each year, 173.4 based on the health care index used under medical assistance for 173.5 nursing home rate setting. Adjusted minimum daily benefit 173.6 amounts shall be rounded to the nearest whole dollar. 173.7 (d) A third party designated by the insured shall be 173.8 entitled to receive notice if the policy is about to lapse for 173.9 nonpayment of premium, and an additional 30-day grace period for 173.10 payment of premium shall be granted following notification to 173.11 that person. 173.12 (e) The policy must cover all of the following services: 173.13 (1) nursing home stay; 173.14 (2) home care service; 173.15 (3) care management; and 173.16 (4) up to 14 days of nursing care in a hospital while the 173.17 individual is waiting for long-term care placement. 173.18 (f) Payment for service under paragraph (e), clause (4), 173.19 must not exceed the daily benefit amount for nursing home care. 173.20 (g) A partnership policy must offer both options in 173.21 paragraph (h) for an adjusted premium. 173.22 (h) The options are: 173.23 (1) an elimination period of not more than 100 days; and 173.24 (2) nonforfeiture benefits for applicants between the ages 173.25 of 18 and 75. 173.26 Sec. 15. [APPROPRIATION.] 173.27 Subdivision 1. [BOARD ON AGING.] $....... is appropriated 173.28 from the general fund to the commissioner of human services for 173.29 the biennium ending June 30, 2003, for the board on aging to 173.30 promote employer-sponsored long-term care insurance as required 173.31 under section 13. 173.32 Subd. 2. [LONG-TERM CARE PARTNERSHIP PROGRAM.] $....... is 173.33 appropriated from the general fund to the commissioner of human 173.34 services for the biennium ending June 30, 2003, for federal 173.35 waiver development and application under section 14.