5th Engrossment - 83rd Legislature (2003 - 2004) Posted on 12/15/2009 12:00am
1.1 A bill for an act 1.2 relating to operation of state government; making 1.3 changes to encourage consumer-driven health plans; 1.4 encouraging efficiency in providing health care; 1.5 requiring disease management initiatives; implementing 1.6 health care cost containment, cost-shifting 1.7 provisions, and reduction of government mandates; 1.8 implementing health plan competition and reform 1.9 provisions; changing health maintenance organization 1.10 regulatory authority; changing provisions related to 1.11 child care, economic supports, health care, long-term 1.12 care, continuing care, civil commitment, and program 1.13 integrity and administration; making health and human 1.14 services forecast adjustments and reductions; 1.15 appropriating money; amending Minnesota Statutes 2002, 1.16 sections 16A.10, by adding a subdivision; 43A.23, by 1.17 adding a subdivision; 62A.02, subdivision 2; 62A.28; 1.18 62A.30, subdivision 2, by adding a subdivision; 1.19 62D.02, subdivision 4, by adding a subdivision; 1.20 62D.03, subdivision 1; 62D.04, subdivision 1; 62D.05, 1.21 subdivision 1; 72A.20, by adding a subdivision; 1.22 119B.13, by adding a subdivision; 144.148, by adding a 1.23 subdivision; 144A.10, subdivision 1a, by adding a 1.24 subdivision; 144D.025; 147.03, subdivision 1; 253B.02, 1.25 by adding subdivisions; 253B.03, by adding a 1.26 subdivision; 253B.185, by adding a subdivision; 1.27 256.01, by adding subdivisions; 256.9365, subdivision 1.28 1; 256.955, subdivisions 2b, 4, 6; 256B.02, 1.29 subdivision 12; 256B.04, subdivision 14, by adding a 1.30 subdivision; 256B.056, subdivision 5, by adding 1.31 subdivisions; 256B.0916, subdivision 2; 256B.431, by 1.32 adding subdivisions; 256B.49, by adding a subdivision; 1.33 256D.045; 256D.051, subdivisions 1a, 3a, 6c; 256I.04, 1.34 subdivision 2a; 256L.01, subdivision 5; 256L.03, 1.35 subdivision 5, by adding a subdivision; 256L.04, 1.36 subdivision 2, by adding subdivisions; 256L.05, 1.37 subdivision 3; 549.02, by adding a subdivision; 1.38 549.04; Minnesota Statutes 2003 Supplement, sections 1.39 62E.08, subdivision 1; 62E.091; 62J.26, by adding a 1.40 subdivision; 119B.09, subdivision 9; 119B.13, 1.41 subdivision 1; 144.7063, subdivision 3; 144A.071, 1.42 subdivision 4c; 245A.10, subdivision 4; 246B.04, as 1.43 amended; 252.27, subdivision 2a; 256.019, subdivision 1.44 1; 256.046, subdivision 1; 256.955, subdivisions 2a, 1.45 3; 256B.056, subdivision 3c; 256B.057, subdivision 9; 1.46 256B.0595, subdivision 2; 256B.06, subdivision 4; 2.1 256B.0625, subdivision 9; 256B.0631, subdivision 2; 2.2 256B.19, subdivision 1; 256B.434, subdivision 4; 2.3 256B.69, subdivision 2; 256D.03, subdivisions 3, 4; 2.4 256D.44, subdivision 5; 256J.24, subdivision 6; 2.5 256J.37, subdivision 3a; 256J.53, subdivision 1; 2.6 256L.03, subdivision 1; 256L.035; 256L.07, 2.7 subdivisions 1, 3; 295.50, subdivision 9b; 295.53, 2.8 subdivision 1; Laws 2003, First Special Session 2.9 chapter 14, article 9, section 34; Laws 2003, First 2.10 Special Session chapter 14, article 13C, section 1; 2.11 Laws 2003, First Special Session chapter 14, article 2.12 13C, section 2, subdivisions 1, 3, 6, 7, 9, 11; Laws 2.13 2003, First Special Session chapter 14, article 13C, 2.14 section 10, subdivisions 1, 2; proposing coding for 2.15 new law in Minnesota Statutes, chapters 62J; 62L; 62Q; 2.16 144; 144A; 145; 151; 253B; 256B; repealing Minnesota 2.17 Statutes 2002, sections 62A.309; 62J.17, subdivisions 2.18 1, 3, 4a, 5a, 6a, 7, 8; 256.955, subdivisions 1, 2, 2.19 2b, 4, 5, 6, 7, 9; 256L.04, subdivision 11; Minnesota 2.20 Statutes 2003 Supplement, sections 62J.17, subdivision 2.21 2; 256.955, subdivisions 2a, 3, 4a; 256B.431, 2.22 subdivision 36. 2.23 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 2.24 ARTICLE 1 2.25 HEALTH CARE COST CONTAINMENT; CONSUMER EMPOWERMENT 2.26 Section 1. Minnesota Statutes 2002, section 43A.23, is 2.27 amended by adding a subdivision to read: 2.28 Subd. 4. [HEALTH SAVINGS ACCOUNTS.] During collective 2.29 bargaining negotiations with the exclusive representatives of 2.30 state employees, the commissioner must propose that state 2.31 employee health coverage include at least one plan of hospital 2.32 and medical benefits that combines a high deductible health plan 2.33 with a health savings account, so as to qualify the health 2.34 savings account under section 223 of the Internal Revenue Code, 2.35 as amended. 2.36 Sec. 2. [62J.81] [DISCLOSURE OF PAYMENTS FOR HEALTH CARE 2.37 SERVICES.] 2.38 Subdivision 1. [REQUIRED DISCLOSURE OF PAYMENT RANGE.] A 2.39 health care provider, as defined in section 62J.03, subdivision 2.40 8, shall, at the request of a consumer, provide that consumer 2.41 with the beginning and end of the range of payments received by 2.42 the provider from health plan companies for a specific service 2.43 or services that the consumer may reasonably expect to receive 2.44 from the provider, based upon the consumer's medical condition. 2.45 The beginning of the range of payments received by a provider is 2.46 the lowest amount the provider is paid by a health plan company 3.1 for a specific service and the end of the range is the highest 3.2 amount the provider is paid by a health plan company for the 3.3 service, based upon the provider agreements in force at the time 3.4 of the request. A provider is not required to identify the 3.5 names of health plan companies. 3.6 Subd. 2. [APPLICABILITY.] For purposes of this section, 3.7 "consumer" does not include a medical assistance, MinnesotaCare, 3.8 or general assistance medical care enrollee, for services 3.9 covered under those programs, and a health care provider shall 3.10 not include in the range, payments from the medical assistance, 3.11 MinnesotaCare, and general assistance medical care programs. 3.12 Sec. 3. [151.214] [PAYMENT DISCLOSURE.] 3.13 Subdivision 1. [EXPLANATION OF PHARMACY BENEFITS.] A 3.14 pharmacist licensed under this chapter must provide to a 3.15 patient, for each prescription dispensed where part or all of 3.16 the cost of the prescription is being paid or reimbursed by an 3.17 employer-sponsored plan or health plan company, or its 3.18 contracted pharmacy benefit manager, the patient's co-payment 3.19 amount and the usual and customary price of the prescription or 3.20 the amount the pharmacy will be paid for the prescription drug 3.21 by the patient's employer-sponsored plan or health plan company, 3.22 or its contracted pharmacy benefit manager. 3.23 Subd. 2. [NO PROHIBITION ON DISCLOSURE.] No contracting 3.24 agreement between an employer-sponsored health plan or health 3.25 plan company, or its contracted pharmacy benefit manager, and a 3.26 resident or nonresident pharmacy registered under this chapter, 3.27 may prohibit the pharmacy from disclosing to patients 3.28 information a pharmacy is required or given the option to 3.29 provide under subdivision 1. 3.30 ARTICLE 2 3.31 HEALTH CARE COST CONTAINMENT; BEST PRACTICES 3.32 Section 1. [62J.43] [BEST PRACTICES AND QUALITY 3.33 IMPROVEMENT.] 3.34 (a) To improve quality and reduce health care costs, state 3.35 agencies shall encourage the adoption of best practice 3.36 guidelines and participation in best practices measurement 4.1 activities by physicians, other health care providers, 4.2 universities and colleges, health care purchasers, and health 4.3 plan companies. The commissioner of health shall facilitate 4.4 access to best practice guidelines and quality of care 4.5 measurement information for providers, purchasers, and consumers 4.6 by: 4.7 (1) identifying and promoting local, community-based, 4.8 physician-designed best practices care across the Minnesota 4.9 health care system; 4.10 (2) disseminating information on adherence to best 4.11 practices care by physicians and other health care providers in 4.12 Minnesota; and 4.13 (3) educating consumers and purchasers on how to 4.14 effectively use this information in choosing their health care 4.15 providers and making purchasing decisions. 4.16 (b) The commissioner of health shall collaborate with a 4.17 nonprofit Minnesota quality improvement organization 4.18 specializing in best practices and quality of care measurements 4.19 to provide best practices criteria. 4.20 (c) The initial best practices and quality of care 4.21 measurement criteria developed shall address diabetes and 4.22 congestive heart failure. 4.23 (d) The commissioners of human services and employee 4.24 relations may use the best practices guidelines to assist them 4.25 in developing contracting strategies that are appropriate for 4.26 the populations they serve. The commissioners shall report to 4.27 the legislature by January 1, 2006, on agency use of best 4.28 practices guidelines. 4.29 (e) This section does not apply if the best practices 4.30 guidelines authorizes or recommends denial of treatment, food, 4.31 or fluids necessary to sustain life on the basis of the 4.32 patient's age or expected length of life or the patient's 4.33 present or predicted disability, degree of medical dependency, 4.34 or quality of life. 4.35 Sec. 2. Minnesota Statutes 2003 Supplement, section 4.36 144.7063, subdivision 3, is amended to read: 5.1 Subd. 3. [FACILITY.] "Facility" means a hospital licensed 5.2 under sections 144.50 to 144.58 or an outpatient surgical center 5.3 licensed under Minnesota Rules, chapter 4675. 5.4 Sec. 3. [256B.075] [DISEASE MANAGEMENT PROGRAMS.] 5.5 Subdivision 1. [GENERAL.] The commissioner shall implement 5.6 disease management initiatives that seek to improve patient care 5.7 and health outcomes and reduce health care costs by managing the 5.8 care provided to recipients with chronic conditions. 5.9 Subd. 2. [FEE-FOR-SERVICE.] (a) The commissioner shall 5.10 develop and implement a disease management program for medical 5.11 assistance and general assistance medical care recipients who 5.12 are not enrolled in the prepaid medical assistance or prepaid 5.13 general assistance medical care programs and who are receiving 5.14 services on a fee-for-service basis. The commissioner may 5.15 contract with an outside organization to provide these services. 5.16 (b) The commissioner shall seek any federal approval 5.17 necessary to implement this section and to obtain federal 5.18 matching funds. 5.19 Subd. 3. [PREPAID MANAGED CARE PROGRAMS.] For the prepaid 5.20 medical assistance, prepaid general assistance medical care, and 5.21 MinnesotaCare programs, the commissioner shall ensure that 5.22 contracting health plans implement disease management programs 5.23 that are appropriate for Minnesota health care program 5.24 recipients and have been designed by the health plan to improve 5.25 patient care and health outcomes and reduce health care costs by 5.26 managing the care provided to recipients with chronic conditions. 5.27 Subd. 4. [HEMOPHILIA.] The commissioner shall develop a 5.28 disease management initiative for Minnesota health care program 5.29 recipients who have been diagnosed with hemophilia. In 5.30 developing the program, the commissioner shall explore the 5.31 feasibility of contracting with a section 340B provider to 5.32 provide disease management services or coordination of care in 5.33 order to maximize the discounted prescription drug prices of the 5.34 federal 340B program offered through section 340B of the federal 5.35 Public Health Services Act, United States Code, title 42, 5.36 section 256b (1999). 6.1 ARTICLE 3 6.2 HEALTH CARE COST CONTAINMENT; COST-SHIFTING 6.3 Section 1. Minnesota Statutes 2002, section 16A.10, is 6.4 amended by adding a subdivision to read: 6.5 Subd. 4. [LIMIT ON STATE HEALTH CARE PROGRAM 6.6 EXPANSION.] No budget proposal shall include any provision that 6.7 requests new or increased funding for an expansion of 6.8 eligibility or covered services for a state health care program, 6.9 unless state health care program reimbursement rates for major 6.10 service categories, at the time the expansion is to take effect, 6.11 will be sufficient to cover estimated provider costs for each 6.12 major service category. For purposes of this section, "state 6.13 health care program" means the medical assistance, 6.14 MinnesotaCare, and general assistance medical care programs. 6.15 Sec. 2. [STUDY OF COST-SHIFTING.] 6.16 (a) The commissioner of health shall evaluate the extent to 6.17 which state health care program reimbursement rates result in 6.18 health care provider cost-shifting to private sector payers and 6.19 individuals paying for services out-of-pocket. In conducting 6.20 the evaluation, the commissioner shall: 6.21 (1) examine the extent to which average state health care 6.22 program reimbursement rates for major categories of services 6.23 vary from average private sector reimbursement rates; 6.24 (2) examine the extent to which average state health care 6.25 program reimbursement rates for major categories of services 6.26 cover average provider costs; 6.27 (3) estimate the amount by which average state health care 6.28 program reimbursement rates for major categories of services 6.29 would need to be increased to match average private sector 6.30 reimbursement rates and to cover average provider costs; and 6.31 (4) present recommendations to the legislature on methods 6.32 of increasing average state health care program reimbursement 6.33 rates for major categories of services, over a six-year period, 6.34 to the average private sector reimbursement rate and to a level 6.35 that covers average provider costs. 6.36 (b) The commissioner shall present results and 7.1 recommendations to the legislature by December 15, 2004. The 7.2 commissioner may contract with an actuarial consulting firm to 7.3 implement this section. Payment and reimbursement data 7.4 collected by the commissioner in the course of implementing this 7.5 section shall be classified as not public data under Minnesota 7.6 Statutes, chapter 13, except that data shall be classified as 7.7 public data not on individuals if the information collected was 7.8 already accessible to the public under the policies of the 7.9 private sector entity providing the data. For purposes of this 7.10 section, "state health care program" means the medical 7.11 assistance, MinnesotaCare, and general assistance medical care 7.12 programs. 7.13 ARTICLE 4 7.14 HEALTH CARE COST CONTAINMENT; REDUCING GOVERNMENT MANDATES 7.15 Section 1. Minnesota Statutes 2003 Supplement, section 7.16 62J.26, is amended by adding a subdivision to read: 7.17 Subd. 6. [MANDATED BENEFITS MORATORIUM.] (a) No new 7.18 mandated health benefit proposal, as defined in subdivision 1, 7.19 shall be enacted. 7.20 (b) This subdivision expires January 1, 2007. 7.21 Sec. 2. [62L.056] [SMALL EMPLOYER ALTERNATIVE BENEFIT 7.22 PLANS.] 7.23 (a) Notwithstanding any provision of this chapter, chapter 7.24 363A, or any other law to the contrary, the commissioner of 7.25 commerce shall by January 1, 2005, permit health carriers to 7.26 offer alternative health benefit plans to small employers if the 7.27 following requirements are satisfied: 7.28 (1) the health carrier is assessed less than ten percent of 7.29 the total amount assessed by the Minnesota Comprehensive Health 7.30 Association; 7.31 (2) the health plans must be offered in compliance with 7.32 this chapter, except as otherwise permitted in this section; 7.33 (3) the health plans to be offered must be designed to 7.34 enable employers and covered persons to better manage costs and 7.35 coverage options through the use of co-pays, deductibles, and 7.36 other cost-sharing arrangements; 8.1 (4) the health plans must be issued and administered in 8.2 compliance with sections 62E.141; 62L.03, subdivision 6; and 8.3 62L.12, subdivisions 3 and 4, relating to prohibitions against 8.4 enrolling in the Minnesota Comprehensive Health Association 8.5 persons eligible for employer group coverage; 8.6 (5) loss-ratio requirements do not apply to health plans 8.7 issued under this section; 8.8 (6) the health plans may alter or eliminate coverages that 8.9 would otherwise be required by law, except for maternity 8.10 coverage as required under federal law; 8.11 (7) each health plan must be approved by the commissioner 8.12 of commerce; and 8.13 (8) the commissioner may limit the types and numbers of 8.14 health plan forms permitted under this section, but must permit, 8.15 as one option, a health plan form in which a health carrier may 8.16 exclude or alter coverage of any or all benefits otherwise 8.17 mandated by state law, except for maternity coverage as required 8.18 under federal law. 8.19 (b) The definitions in section 62L.02 apply to this section 8.20 as modified by this section. 8.21 (c) An employer may provide health plans permitted under 8.22 this section to its employees, the employees' dependents, and 8.23 other persons eligible for coverage under the employer's plan, 8.24 notwithstanding chapter 363A or any other law to the contrary. 8.25 Sec. 3. [REPEALER; BONE MARROW TRANSPLANT MANDATE.] 8.26 Minnesota Statutes 2002, section 62A.309, is repealed. 8.27 ARTICLE 5 8.28 HEALTH CARE COST CONTAINMENT; 8.29 HEALTH PLAN COMPETITION AND REFORM 8.30 Section 1. Minnesota Statutes 2002, section 62A.02, 8.31 subdivision 2, is amended to read: 8.32 Subd. 2. [APPROVAL.] (a) The health plan form shall not be 8.33 issued, nor shall any application, rider, endorsement, or rate 8.34 be used in connection with it, until the expiration of 60 days 8.35 after it has been filed unless the commissioner approves it 8.36 before that time. 9.1 (b) Notwithstanding paragraph (a), a health plan form or a 9.2 rate, filed with respect to a policy of accident and sickness 9.3 insurance as defined in section 62A.01 by an insurer licensed 9.4 under chapter 60A, may be used on or after the date of filing 9.5 with the commissioner. Health plan forms and rates that are not 9.6 approved or disapproved within the 60-day time period are deemed 9.7 approved. This paragraph does not apply to Medicare-related 9.8 coverage as defined in section 62A.31, subdivision 3, paragraph 9.9 (q). 9.10 Sec. 2. Minnesota Statutes 2002, section 62A.28, is 9.11 amended to read: 9.12 62A.28 [COVERAGE FOR SCALP HAIR PROSTHESES.] 9.13 Subdivision 1. [SCOPE OF COVERAGE.] This section applies 9.14 to all policies of accident and health insurance, health 9.15 maintenance contracts regulated under chapter 62D, health 9.16 benefit certificates offered through a fraternal benefit society 9.17 regulated under chapter 64B, and group subscriber contracts 9.18 offered by nonprofit health service plan corporations regulated 9.19 under chapter 62C. This section does not apply to policies 9.20 designed primarily to provide coverage payable on a per diem, 9.21 fixed indemnity or nonexpense incurred basis, or policies that 9.22 provide only accident coverage. 9.23 Subd. 2. [REQUIRED COVERAGE.] Every policy, plan, 9.24 certificate, or contract referred to in subdivision 1 issued or 9.25 renewed after August 1, 1987, must provide coverage for scalp 9.26 hair prostheses worn for hair loss suffered as a result of 9.27 alopecia areata. 9.28 The coverage required by this section is subject to
a9.29 policy'sthe co-payment requirement, coinsurance, deductible, 9.30 and other enrollee cost sharing requirements that apply to 9.31 similar types of items under the policy, plan, certificate, or 9.32 contract, and is limited to a maximum of $350 in any benefit 9.33 year , exclusive of any deductible. 9.34 Sec. 3. Minnesota Statutes 2002, section 62A.30, 9.35 subdivision 2, is amended to read: 9.36 Subd. 2. [REQUIRED COVERAGE.] Every policy, plan, 10.1 certificate, or contract referred to in subdivision 1 issued or10.2 renewed after August 1, 1988,that provides coverage to a 10.3 Minnesota resident must provide coverage for routine screening 10.4 procedures for cancer, including mammograms, surveillance tests 10.5 for ovarian cancer for women who are at risk for ovarian cancer 10.6 as defined in subdivision 3, and pap smears, when ordered or 10.7 provided by a physician in accordance with the standard practice 10.8 of medicine. 10.9 Sec. 4. Minnesota Statutes 2002, section 62A.30, is 10.10 amended by adding a subdivision to read: 10.11 Subd. 3. [OVARIAN CANCER SURVEILLANCE TESTS.] For purposes 10.12 of subdivision 2: 10.13 (a) "At risk for ovarian cancer" means: 10.14 (1) having a family history: 10.15 (i) with one or more first or second-degree relatives with 10.16 ovarian cancer; 10.17 (ii) of clusters of women relatives with breast cancer; or 10.18 (iii) of nonpolyposis colorectal cancer; or 10.19 (2) testing positive for BRCA1 or BRCA2 mutations. 10.20 (b) "Surveillance tests for ovarian cancer" means annual 10.21 screening using: 10.22 (1) CA-125 serum tumor marker testing; 10.23 (2) transvaginal ultrasound; 10.24 (3) pelvic examination; or 10.25 (4) other proven ovarian cancer screening tests currently 10.26 being evaluated by the federal Food and Drug Administration or 10.27 by the National Cancer Institute. 10.28 Sec. 5. Minnesota Statutes 2002, section 62D.02, 10.29 subdivision 4, is amended to read: 10.30 Subd. 4. [HEALTH MAINTENANCE ORGANIZATION.] (a) "Health 10.31 maintenance organization" means a nonprofit corporation10.32 organized under chapter 317A, orperson, including a local 10.33 governmental unit as defined in subdivision 11, controlled and 10.34 operated as provided in sections 62D.01 to 62D.30, which 10.35 provides, either directly or through arrangements with providers 10.36 or other persons, comprehensive health maintenance services, or 11.1 arranges for the provision of these services, to enrollees on 11.2 the basis of a fixed prepaid sum without regard to the frequency 11.3 or extent of services furnished to any particular enrollee. 11.4 Sec. 6. Minnesota Statutes 2002, section 62D.02, is 11.5 amended by adding a subdivision to read: 11.6 Subd. 17. [PERSON.] "Person" means a natural or artificial 11.7 person, including, but not limited to, individuals, 11.8 partnerships, limited liability companies, associations, trusts, 11.9 corporations, other business entities, or governmental entities. 11.10 Sec. 7. Minnesota Statutes 2002, section 62D.03, 11.11 subdivision 1, is amended to read: 11.12 Subdivision 1. [CERTIFICATE OF AUTHORITY REQUIRED.] 11.13 Notwithstanding any law of this state to the contrary, any 11.14 nonprofit corporation organized to do so or a local governmental11.15 unitperson may apply to the commissioner of health for a 11.16 certificate of authority to establish and operate a health 11.17 maintenance organization in compliance with sections 62D.01 to 11.18 62D.30. No person shall establish or operate a health 11.19 maintenance organization in this state, nor sell or offer to 11.20 sell, or solicit offers to purchase or receive advance or 11.21 periodic consideration in conjunction with a health maintenance 11.22 organization or health maintenance contract unless the 11.23 organization has a certificate of authority under sections 11.24 62D.01 to 62D.30. An out-of-state corporation may qualify under 11.25 this chapter, subject to obtaining a certificate of authority to 11.26 do business in this state, as an out-of-state corporation under 11.27 chapter 303 and compliance with this chapter and other 11.28 applicable state laws. 11.29 Sec. 8. Minnesota Statutes 2002, section 62D.04, 11.30 subdivision 1, is amended to read: 11.31 Subdivision 1. [APPLICATION REVIEW.] Upon receipt of an 11.32 application for a certificate of authority, the commissioner of 11.33 health shall determine whether the applicant for a certificate 11.34 of authority has: 11.35 (a) demonstrated the willingness and potential ability to 11.36 assure that health care services will be provided in such a 12.1 manner as to enhance and assure both the availability and 12.2 accessibility of adequate personnel and facilities; 12.3 (b) arrangements for an ongoing evaluation of the quality 12.4 of health care; 12.5 (c) a procedure to develop, compile, evaluate, and report 12.6 statistics relating to the cost of its operations, the pattern 12.7 of utilization of its services, the quality, availability and 12.8 accessibility of its services, and such other matters as may be 12.9 reasonably required by regulation of the commissioner of health; 12.10 (d) reasonable provisions for emergency and out of area 12.11 health care services; 12.12 (e) demonstrated that it is financially responsible and may 12.13 reasonably be expected to meet its obligations to enrollees and 12.14 prospective enrollees. In making this determination, the 12.15 commissioner of health shall require the amounts of net worth 12.16 and working capital required in section 62D.042, the deposit 12.17 required in section 62D.041, and in addition shall consider: 12.18 (1) the financial soundness of its arrangements for health 12.19 care services and the proposed schedule of charges used in 12.20 connection therewith; 12.21 (2) arrangements which will guarantee for a reasonable 12.22 period of time the continued availability or payment of the cost 12.23 of health care services in the event of discontinuance of the 12.24 health maintenance organization; and 12.25 (3) agreements with providers for the provision of health 12.26 care services; 12.27 (f) demonstrated that it will assume full financial risk on 12.28 a prospective basis for the provision of comprehensive health 12.29 maintenance services, including hospital care; provided, 12.30 however, that the requirement in this paragraph shall not 12.31 prohibit the following: 12.32 (1) a health maintenance organization from obtaining 12.33 insurance or making other arrangements (i) for the cost of 12.34 providing to any enrollee comprehensive health maintenance 12.35 services, the aggregate value of which exceeds $5,000 in any 12.36 year, (ii) for the cost of providing comprehensive health care 13.1 services to its members on a nonelective emergency basis, or 13.2 while they are outside the area served by the organization, or 13.3 (iii) for not more than 95 percent of the amount by which the 13.4 health maintenance organization's costs for any of its fiscal 13.5 years exceed 105 percent of its income for such fiscal years; 13.6 and 13.7 (2) a health maintenance organization from having a 13.8 provision in a group health maintenance contract allowing an 13.9 adjustment of premiums paid based upon the actual health 13.10 services utilization of the enrollees covered under the 13.11 contract, except that at no time during the life of the contract 13.12 shall the contract holder fully self-insure the financial risk 13.13 of health care services delivered under the contract. Risk 13.14 sharing arrangements shall be subject to the requirements of 13.15 sections 62D.01 to 62D.30; 13.16 (g) demonstrated that it has made provisions for and 13.17 adopted a conflict of interest policy applicable to all members 13.18 of the board of directors and the principal officers of the 13.19 health maintenance organization. The conflict of interest 13.20 policy shall include the procedures described in section 13.21 317A.255, subdivisions 1 and 2, or a substantially similar 13.22 provision contained in the laws under which the health 13.23 maintenance organization is incorporated or otherwise 13.24 organized. However, the commissioner is not precluded from 13.25 finding that a particular transaction is an unreasonable expense 13.26 as described in section 62D.19 even if the directors follow the 13.27 required procedures; and 13.28 (h) otherwise met the requirements of sections 62D.01 to 13.29 62D.30. 13.30 Sec. 9. Minnesota Statutes 2002, section 62D.05, 13.31 subdivision 1, is amended to read: 13.32 Subdivision 1. [AUTHORITY GRANTED.] Any nonprofit13.33 corporation or local governmental unitperson may, upon 13.34 obtaining a certificate of authority as required in sections 13.35 62D.01 to 62D.30, operate as a health maintenance organization. 13.36 Sec. 10. Minnesota Statutes 2003 Supplement, section 14.1 62E.08, subdivision 1, is amended to read: 14.2 Subdivision 1. [ESTABLISHMENT.] The association shall 14.3 establish the following maximum premiums to be charged for 14.4 membership in the comprehensive health insurance plan: 14.5 (a) the premium for the number one qualified plan shall 14.6 range from a minimum of 101115 percent to a maximum of 125135 14.7 percent of the weighted average of rates charged by those 14.8 insurers and health maintenance organizations with individuals 14.9 enrolled in: 14.10 (1) $1,000 annual deductible individual plans of insurance 14.11 in force in Minnesota; 14.12 (2) individual health maintenance organization contracts of 14.13 coverage with a $1,000 annual deductible which are in force in 14.14 Minnesota; and 14.15 (3) other plans of coverage similar to plans offered by the 14.16 association based on generally accepted actuarial principles; 14.17 (b) the premium for the number two qualified plan shall 14.18 range from a minimum of 101115 percent to a maximum of 125135 14.19 percent of the weighted average of rates charged by those 14.20 insurers and health maintenance organizations with individuals 14.21 enrolled in: 14.22 (1) $500 annual deductible individual plans of insurance in 14.23 force in Minnesota; 14.24 (2) individual health maintenance organization contracts of 14.25 coverage with a $500 annual deductible which are in force in 14.26 Minnesota; and 14.27 (3) other plans of coverage similar to plans offered by the 14.28 association based on generally accepted actuarial principles; 14.29 (c) the premiums for the plans with a $2,000, $5,000, or 14.30 $10,000 annual deductible shall range from a minimum of 101115 14.31 percent to a maximum of 125135 percent of the weighted average 14.32 of rates charged by those insurers and health maintenance 14.33 organizations with individuals enrolled in: 14.34 (1) $2,000, $5,000, or $10,000 annual deductible individual 14.35 plans, respectively, in force in Minnesota; and 14.36 (2) individual health maintenance organization contracts of 15.1 coverage with a $2,000, $5,000, or $10,000 annual deductible, 15.2 respectively, which are in force in Minnesota; or 15.3 (3) other plans of coverage similar to plans offered by the 15.4 association based on generally accepted actuarial principles; 15.5 (d) the premium for each type of Medicare supplement plan 15.6 required to be offered by the association pursuant to section 15.7 62E.12 shall range from a minimum of 101115 percent to a 15.8 maximum of 125135 percent of the weighted average of rates 15.9 charged by those insurers and health maintenance organizations 15.10 with individuals enrolled in: 15.11 (1) Medicare supplement plans in force in Minnesota; 15.12 (2) health maintenance organization Medicare supplement 15.13 contracts of coverage which are in force in Minnesota; and 15.14 (3) other plans of coverage similar to plans offered by the 15.15 association based on generally accepted actuarial principles; 15.16 and 15.17 (e) the charge for health maintenance organization coverage 15.18 shall be based on generally accepted actuarial principles. 15.19 The list of insurers and health maintenance organizations 15.20 whose rates are used to establish the premium for coverage 15.21 offered by the association pursuant to paragraphs (a) to (d) 15.22 shall be established by the commissioner on the basis of 15.23 information which shall be provided to the association by all 15.24 insurers and health maintenance organizations annually at the 15.25 commissioner's request. This information shall include the 15.26 number of individuals covered by each type of plan or contract 15.27 specified in paragraphs (a) to (d) that is sold, issued, and 15.28 renewed by the insurers and health maintenance organizations, 15.29 including those plans or contracts available only on a renewal 15.30 basis. The information shall also include the rates charged for 15.31 each type of plan or contract. 15.32 In establishing premiums pursuant to this section, the 15.33 association shall utilize generally accepted actuarial 15.34 principles, provided that the association shall not discriminate 15.35 in charging premiums based upon sex. In order to compute a 15.36 weighted average for each type of plan or contract specified 16.1 under paragraphs (a) to (d), the association shall, using the 16.2 information collected pursuant to this subdivision, list 16.3 insurers and health maintenance organizations in rank order of 16.4 the total number of individuals covered by each insurer or 16.5 health maintenance organization. The association shall then 16.6 compute a weighted average of the rates charged for coverage by 16.7 all the insurers and health maintenance organizations by: 16.8 (1) multiplying the numbers of individuals covered by each 16.9 insurer or health maintenance organization by the rates charged 16.10 for coverage; 16.11 (2) separately summing both the number of individuals 16.12 covered by all the insurers and health maintenance organizations 16.13 and all the products computed under clause (1); and 16.14 (3) dividing the total of the products computed under 16.15 clause (1) by the total number of individuals covered. 16.16 The association may elect to use a sample of information 16.17 from the insurers and health maintenance organizations for 16.18 purposes of computing a weighted average. In no case, however, 16.19 may a sample used by the association to compute a weighted 16.20 average include information from fewer than the two insurers or 16.21 health maintenance organizations highest in rank order. 16.22 Sec. 11. Minnesota Statutes 2003 Supplement, section 16.23 62E.091, is amended to read: 16.24 62E.091 [APPROVAL OF STATE PLAN PREMIUMS.] 16.25 The association shall submit to the commissioner any 16.26 premiums it proposes to become effective for coverage under the 16.27 comprehensive health insurance plan, pursuant to section 62E.08, 16.28 subdivision 3. No later than 45 days before the effective date 16.29 for premiums specified in section 62E.08, subdivision 3, the 16.30 commissioner shall approve, modify, or reject the proposed 16.31 premiums on the basis of the following criteria: 16.32 (a) whether the association has complied with the 16.33 provisions of section 62E.11, subdivision 11; 16.34 (b) whether the association has submitted the proposed 16.35 premiums in a manner which provides sufficient time for 16.36 individuals covered under the comprehensive insurance plan to 17.1 receive notice of any premium increase no less than 30 days 17.2 prior to the effective date of the increase; 17.3 (c) the degree to which the association's computations and 17.4 conclusions are consistent with section 62E.08; 17.5 (d) the degree to which any sample used to compute a 17.6 weighted average by the association pursuant to section 62E.08 17.7 reasonably reflects circumstances existing in the private 17.8 marketplace for individual coverage; 17.9 (e) the degree to which a weighted average computed 17.10 pursuant to section 62E.08 that uses information pertaining to 17.11 individual coverage available only on a renewal basis reflects 17.12 the circumstances existing in the private marketplace for 17.13 individual coverage; 17.14 (f) a comparison of the proposed increases with increases 17.15 in the cost of medical care and increases experienced in the 17.16 private marketplace for individual coverage; 17.17 (g) the financial consequences to enrollees of the proposed 17.18 increase; 17.19 (h) the actuarially projected effect of the proposed 17.20 increase upon both total enrollment in, and the nature of the 17.21 risks assumed by, the comprehensive health insurance plan; 17.22 (i) the relative solvency of the contributing members; and 17.23 (j) other factors deemed relevant by the commissioner. 17.24 In no case, however, may the commissioner approve premiums 17.25 for those plans of coverage described in section 62E.08, 17.26 subdivision 1, paragraphs (a) to (d), that are lower than 10117.27 115 percent or greater than 125135 percent of the weighted 17.28 averages computed by the association pursuant to section 17.29 62E.08. The commissioner shall support a decision to approve, 17.30 modify, or reject any premium proposed by the association with 17.31 written findings and conclusions addressing each criterion 17.32 specified in this section. If the commissioner does not 17.33 approve, modify, or reject the premiums proposed by the 17.34 association sooner than 45 days before the effective date for 17.35 premiums specified in section 62E.08, subdivision 3, the 17.36 premiums proposed by the association under this section become 18.1 effective. 18.2 Sec. 12. [62Q.37] [AUDITS CONDUCTED BY NATIONALLY 18.3 RECOGNIZED INDEPENDENT ORGANIZATION.] 18.4 Subdivision 1. [APPLICABILITY.] This section applies only 18.5 to (i) a nonprofit health service plan corporation operating 18.6 under chapter 62C; (ii) a health maintenance organization 18.7 operating under chapter 62D; (iii) a community integrated 18.8 service network operating under chapter 62N; and (iv) managed 18.9 care organizations operating under chapter 256B, 256D, or 256L. 18.10 Subd. 2. [DEFINITIONS.] For purposes of this section, the 18.11 following terms have the meanings given them. 18.12 (a) "Commissioner" means the commissioner of health for 18.13 purposes of regulating health maintenance organizations and 18.14 community integrated service networks, the commissioner of 18.15 commerce for purposes of regulating nonprofit health service 18.16 plan corporations, or the commissioner of human services for the 18.17 purpose of contracting with managed care organizations serving 18.18 persons enrolled in programs under chapter 256B, 256D, or 256L. 18.19 (b) "Health plan company" means (i) a nonprofit health 18.20 service plan corporation operating under chapter 62C; (ii) a 18.21 health maintenance organization operating under chapter 62D; 18.22 (iii) a community integrated service network operating under 18.23 chapter 62N; or (iv) a managed care organization operating under 18.24 chapter 256B, 256D, or 256L. 18.25 (c) "Nationally recognized independent organization" means 18.26 (i) an organization that sets specific national standards 18.27 governing health care quality assurance processes, utilization 18.28 review, provider credentialing, marketing, and other topics 18.29 covered by this chapter and other chapters and audits and 18.30 provides accreditation to those health plan companies that meet 18.31 those standards. The American Accreditation Health Care 18.32 Commission (URAC), the National Committee for Quality Assurance 18.33 (NCQA), and the Joint Commission on Accreditation of Healthcare 18.34 Organizations (JCAHO) are, at a minimum, defined as nationally 18.35 recognized independent organizations; and (ii) the Centers for 18.36 Medicare and Medicaid Services for purposes of reviews or audits 19.1 conducted of health plan companies under Part C of Title XVIII 19.2 of the Social Security Act or under section 1876 of the Social 19.3 Security Act. 19.4 (d) "Performance standard" means those standards relating 19.5 to quality management and improvement, access and availability 19.6 of service, utilization review, provider selection, provider 19.7 credentialing, marketing, member rights and responsibilities, 19.8 complaints, appeals, grievance systems, enrollee information and 19.9 materials, enrollment and disenrollment, subcontractual 19.10 relationships and delegation, confidentiality, continuity and 19.11 coordination of care, assurance of adequate capacity and 19.12 services, coverage and authorization of services, practice 19.13 guidelines, health information systems, and financial solvency. 19.14 Subd. 3. [AUDITS.] (a) The commissioner may conduct 19.15 routine audits and investigations as prescribed under the 19.16 commissioner's respective state authorizing statutes. If a 19.17 nationally recognized independent organization has conducted an 19.18 audit of the health plan company using audit procedures that are 19.19 comparable to or more stringent than the commissioner's audit 19.20 procedures: 19.21 (1) the commissioner may accept the independent audit and 19.22 require no further audit if the results of the independent audit 19.23 show that the performance standard being audited meets or 19.24 exceeds state standards; 19.25 (2) the commissioner may accept the independent audit and 19.26 limit further auditing if the results of the independent audit 19.27 show that the performance standard being audited partially meets 19.28 state standards; 19.29 (3) the health plan company must demonstrate to the 19.30 commissioner that the nationally recognized independent 19.31 organization that conducted the audit is qualified and that the 19.32 results of the audit demonstrate that the particular performance 19.33 standard partially or fully meets state standards; and 19.34 (4) if the commissioner has partially or fully accepted an 19.35 independent audit of the performance standard, the commissioner 19.36 may use the finding of a deficiency with regard to statutes or 20.1 rules by an independent audit as the basis for a targeted audit 20.2 or enforcement action. 20.3 (b) If a health plan company has formally delegated 20.4 activities that are required under either state law or contract 20.5 to another organization that has undergone an audit by a 20.6 nationally recognized independent organization, that health plan 20.7 company may use the nationally recognized accrediting body's 20.8 determination on its own behalf under this section. 20.9 Subd. 4. [DISCLOSURE OF NATIONAL STANDARDS AND 20.10 REPORTS.] The health plan company shall: 20.11 (1) request that the nationally recognized independent 20.12 organization provide to the commissioner a copy of the current 20.13 nationally recognized independent organization's standards upon 20.14 which the acceptable accreditation status has been granted; and 20.15 (2) provide the commissioner a copy of the most current 20.16 final audit report issued by the nationally recognized 20.17 independent organization. 20.18 Subd. 5. [ACCREDITATION NOT REQUIRED.] Nothing in this 20.19 section requires a health plan company to seek an acceptable 20.20 accreditation status from a nationally recognized independent 20.21 organization. 20.22 Subd. 6. [CONTINUED AUTHORITY.] Nothing in this section 20.23 precludes the commissioner from conducting audits and 20.24 investigations or requesting data as granted under the 20.25 commissioner's respective state authorizing statutes. 20.26 Subd. 7. [HUMAN SERVICES.] The commissioner of human 20.27 services shall implement this section in a manner that is 20.28 consistent with applicable federal laws and regulations. 20.29 Subd. 8. [CONFIDENTIALITY.] Any documents provided to the 20.30 commissioner related to the audit report that may be accepted 20.31 under this section are private data on individuals pursuant to 20.32 chapter 13 and may only be released as permitted under section 20.33 60A.03, subdivision 9. 20.34 Sec. 13. Minnesota Statutes 2002, section 72A.20, is 20.35 amended by adding a subdivision to read: 20.36 Subd. 37. [ELECTRONIC TRANSMISSION OF REQUIRED 21.1 INFORMATION.] A health carrier, as defined in section 62A.011, 21.2 subdivision 2, is not in violation of this chapter for 21.3 electronically transmitting or electronically making available 21.4 information otherwise required to be delivered in writing under 21.5 chapters 62A to 62Q and 72A to an enrollee as defined in section 21.6 62Q.01, subdivision 2a, and with the requirements of those 21.7 chapters if the following conditions are met: 21.8 (1) the health carrier informs the enrollee that electronic 21.9 transmission or access is available and, at the discretion of 21.10 the health carrier, the enrollee is given one of the following 21.11 options: 21.12 (i) electronic transmission or access will occur only if 21.13 the enrollee affirmatively requests to the health carrier that 21.14 the required information be electronically transmitted or 21.15 available and a record of that request is retained by the health 21.16 carrier; or 21.17 (ii) electronic transmission or access will automatically 21.18 occur if the enrollee has not opted out of that manner of 21.19 transmission by request to the health carrier and requested that 21.20 the information be provided in writing. If the enrollee opts 21.21 out of electronic transmission, a record of that request must be 21.22 retained by the health carrier; 21.23 (2) the enrollee is allowed to withdraw the request at any 21.24 time; 21.25 (3) if the information transmitted electronically contains 21.26 individually identifiable data, it must be transmitted to a 21.27 secured mailbox. If the information made available 21.28 electronically contains individually identifiable data, it must 21.29 be made available at a password-protected secured Web site; 21.30 (4) the enrollee is provided a customer service number on 21.31 the enrollee's member card that may be called to request a 21.32 written copy of the document; and 21.33 (5) the electronic transmission or electronic availability 21.34 meets all other requirements of this chapter including, but not 21.35 limited to, size of the typeface and any required time frames 21.36 for distribution. 22.1 Sec. 14. [CHANGE OF HEALTH MAINTENANCE ORGANIZATION 22.2 REGULATORY AUTHORITY.] 22.3 (a) Effective July 1, 2005, regulatory authority for health 22.4 maintenance organizations under Minnesota Statutes, chapter 62D; 22.5 community health clinics with respect to health care services 22.6 prepaid option plans offered under Minnesota Statutes, section 22.7 62Q.22; community integrated service networks, as defined in 22.8 Minnesota Statutes, section 62N.02, subdivision 4a; health care 22.9 cooperatives operating under Minnesota Statutes, chapter 62R; 22.10 health care purchasing alliances and accountable provider 22.11 networks operating under Minnesota Statutes, chapter 62T; and 22.12 county-based purchasing programs operating under Minnesota 22.13 Statutes, section 256B.692, subdivision 2, is transferred from 22.14 the commissioner of health to the commissioner of commerce. 22.15 (b) Minnesota Statutes, section 15.039, applies to this 22.16 transfer of authority. 22.17 (c) The revisor of statutes shall make changes to conform 22.18 to paragraph (a) by changing references to the commissioner of 22.19 health, Department of Health, and similar references, to the 22.20 commissioner of commerce, Department of Commerce, or similar 22.21 references, and by changing references to both commissioners or 22.22 both departments or "the appropriate commissioner" or similar 22.23 term to the commissioner or Department of Commerce, as 22.24 appropriate in Minnesota Statutes, sections 62A.021, subdivision 22.25 1, paragraph (h); 62D.02, subdivision 3; 62D.12, subdivision 1; 22.26 62D.15, subdivision 1; 62D.24, by also changing the existing 22.27 reference to "commissioner of commerce" to read "commissioner of 22.28 health"; 62E.05, subdivision 2; 62E.11, subdivision 13; 62J.041, 22.29 subdivision 4; 62J.701; 62J.74, subdivisions 1 and 2; 62L.02, 22.30 subdivision 8; 62L.05, subdivision 12; 62L.08, subdivisions 10 22.31 and 11; 62L.09, subdivision 3; 62L.10, subdivision 4; 62L.11, 22.32 subdivision 2; 62M.11; 62M.16; 62N.02, subdivision 4; 62N.26; 22.33 62Q.01, subdivision 2; 62Q.106; 62Q.22, subdivisions 2, 6, and 22.34 7; 62Q.33, subdivision 2, by specifying that the commissioner 22.35 referenced in the last sentence is the commissioner of health; 22.36 62Q.49, subdivision 2; 62Q.51, subdivision 3; 62Q.525, 23.1 subdivision 3; 62Q.69, subdivisions 2 and 3; 62Q.71; 62Q.72; 23.2 62Q.73, subdivisions 3, 4, 5, and 6; 62R.04, subdivision 5; 23.3 62R.06, subdivision 1; 62T.01; 256B.692, subdivisions 2 and 7. 23.4 The revisor of statutes shall, in preparing Minnesota Statutes 23.5 2004, make all conforming changes in Minnesota Statutes, chapter 23.6 62D, and other chapters. 23.7 ARTICLE 6 23.8 HEALTH CARE COST CONTAINMENT; ADMINISTRATIVE SIMPLIFICATION 23.9 Section 1. Minnesota Statutes 2002, section 147.03, 23.10 subdivision 1, is amended to read: 23.11 Subdivision 1. [ENDORSEMENT; RECIPROCITY.] (a) The board 23.12 may issue a license to practice medicine to any person who 23.13 satisfies the requirements in paragraphs (b) to (f). 23.14 (b) The applicant shall satisfy all the requirements 23.15 established in section 147.02, subdivision 1, paragraphs (a), 23.16 (b), (d), (e), and (f). 23.17 (c) The applicant shall: 23.18 (1) have passed an examination prepared and graded by the 23.19 Federation of State Medical Boards, the National Board of 23.20 Medical Examiners, or the United States Medical Licensing 23.21 Examination program in accordance with section 147.02, 23.22 subdivision 1, paragraph (c), clause (2); the National Board of 23.23 Osteopathic Examiners; or the Medical Council of Canada; and 23.24 (2) have a current license from the equivalent licensing 23.25 agency in another state or Canada and, if the examination in 23.26 clause (1) was passed more than ten years ago, either: 23.27 (i) pass the Special Purpose Examination of the Federation 23.28 of State Medical Boards with a score of 75 or better within 23.29 three attempts; or 23.30 (ii) have a current certification by a specialty board of 23.31 the American Board of Medical Specialties, of the American 23.32 Osteopathic Association Bureau of Professional Education, or of 23.33 the Royal College of Physicians and Surgeons of Canada. 23.34 (d) The applicant shall pay a fee established by the board 23.35 by rule. The fee may not be refunded. 23.36 (e) The applicant must not be under license suspension or 24.1 revocation by the licensing board of the state or jurisdiction 24.2 in which the conduct that caused the suspension or revocation 24.3 occurred. 24.4 (f) The applicant must not have engaged in conduct 24.5 warranting disciplinary action against a licensee, or have been 24.6 subject to disciplinary action other than as specified in 24.7 paragraph (e). If an applicant does not satisfy the 24.8 requirements stated in this paragraph, the board may issue a 24.9 license only on the applicant's showing that the public will be 24.10 protected through issuance of a license with conditions or 24.11 limitations the board considers appropriate. 24.12 (g) Upon the request of an applicant, the board may conduct 24.13 the final interview of the applicant by teleconference. 24.14 Sec. 2. Minnesota Statutes 2002, section 256B.04, is 24.15 amended by adding a subdivision to read: 24.16 Subd. 20. [INFORMATION WEB SITE FOR INTERPRETER SERVICES.] 24.17 The commissioner shall establish an information Web site to 24.18 assist health care providers in obtaining oral language 24.19 interpreter services when these services are needed to enable a 24.20 patient to obtain a health care service from a provider. The 24.21 commissioner must collect and maintain contact and rate 24.22 information for providers of oral language interpreter services 24.23 and must make this information available to all health care 24.24 providers, whether or not the provider is enrolled in a state 24.25 health care program. The Web site list is not an endorsement by 24.26 the commissioner of any particular interpreter. 24.27 Sec. 3. [COST OF HEALTH CARE REPORTING.] 24.28 The commissioners of human services, health, and commerce 24.29 shall meet with representatives of health plan companies as 24.30 defined in Minnesota Statutes, section 62Q.01, subdivision 4, 24.31 and hospitals to evaluate reporting requirements for these 24.32 regulated entities and develop recommendations for reducing 24.33 required reports. The commissioner must meet with the specified 24.34 representatives prior to August 30, 2004, and must submit a 24.35 consolidated report to the legislature by January 15, 2005. The 24.36 report must: 25.1 (1) identify the name and scope of each required report; 25.2 (2) evaluate the need for and use of each report, including 25.3 the value of the report to consumers; 25.4 (3) evaluate the extent to which the report is used to 25.5 reduce costs and increase quality of care; 25.6 (4) identify reports that are no longer required; and 25.7 (5) specify any statutory changes necessary to eliminate 25.8 required reports. 25.9 Sec. 4. [REPEALER.] 25.10 Minnesota Statutes 2002, section 62J.17, subdivisions 1, 3, 25.11 4a, 5a, 6a, 7, and 8; and Minnesota Statutes 2003 Supplement, 25.12 section 62J.17, subdivision 2, are repealed effective the day 25.13 following final enactment. 25.14 ARTICLE 7 25.15 CHILD CARE 25.16 Section 1. Minnesota Statutes 2003 Supplement, section 25.17 119B.09, subdivision 9, is amended to read: 25.18 Subd. 9. [LICENSED AND LEGAL NONLICENSED FAMILY CHILD CARE 25.19 PROVIDERS; ASSISTANCE.] Licensed and legal nonlicensed family 25.20 child care providers are not eligible to receive child care 25.21 assistance subsidies under this chapter for their own children 25.22 or children in their custodyfamily during the hours they are 25.23 providing child care or being paid to provide child care. Child 25.24 care providers are eligible to receive child care assistance 25.25 subsidies for their own children when they are engaged in other 25.26 work activities that meet the requirements of this chapter and 25.27 for which child care assistance can be paid. The hours for 25.28 which the child care provider receives a child care subsidy for 25.29 their own children must not overlap with the hours the provider 25.30 provides child care services. 25.31 Sec. 2. Minnesota Statutes 2003 Supplement, section 25.32 119B.13, subdivision 1, is amended to read: 25.33 Subdivision 1. [SUBSIDY RESTRICTIONS.] (a) The maximum 25.34 rate paid for child care assistance under the child care fund 25.35 may not exceed the 75th percentile rate for like-care 25.36 arrangements in the county as surveyed by the commissioner. 26.1 (b) A rate which includes a provider bonus paid under26.2 subdivision 2 ora special needs rate paid under subdivision 3 26.3 may be in excess of the maximum rate allowed under this 26.4 subdivision. 26.5 (c) The department shall monitor the effect of this 26.6 paragraph on provider rates. The county shall pay the 26.7 provider's full charges for every child in care up to the 26.8 maximum established. The commissioner shall determine the 26.9 maximum rate for each type of care on an hourly, full-day, and 26.10 weekly basis, including special needs and handicapped care. Not26.11 less than once every two years, the commissioner shall evaluate26.12 market practices for payment of absences and shall establish26.13 policies for payment of absent days that reflect current market26.14 practice.26.15 (d) When the provider charge is greater than the maximum 26.16 provider rate allowed, the parent is responsible for payment of 26.17 the difference in the rates in addition to any family co-payment 26.18 fee. 26.19 Sec. 3. Minnesota Statutes 2002, section 119B.13, is 26.20 amended by adding a subdivision to read: 26.21 Subd. 7. [ABSENT DAYS.] Child care providers may not be 26.22 reimbursed for more than 25 absent days per child in a 12-month 26.23 period, or for more than ten consecutive absent days, unless the 26.24 child has a documented medical condition that causes more 26.25 frequent absences. Documentation of medical conditions must be 26.26 on the forms and submitted according to the timelines 26.27 established by the commissioner. 26.28 [EFFECTIVE DATE.] This section is effective July 1, 2004. 26.29 Sec. 4. Minnesota Statutes 2003 Supplement, section 26.30 245A.10, subdivision 4, is amended to read: 26.31 Subd. 4. [ANNUAL LICENSE OR CERTIFICATION FEE FOR PROGRAMS 26.32 WITH LICENSED CAPACITY.] (a) Child care centers and programs 26.33 with a licensed capacity shall pay an annual nonrefundable 26.34 license or certification fee based on the following schedule: 26.35 Licensed Capacity Child Care Other 26.36 Center Program 27.1 License Fee License Fee 27.2 1 to 24 persons $300$225 $400 27.3 25 to 49 persons $450$340 $600 27.4 50 to 74 persons $600$450 $800 27.5 75 to 99 persons $750$565 $1,000 27.6 100 to 124 persons $900$675 $1,200 27.7 125 to 149 persons $1,200$900 $1,400 27.8 150 to 174 persons $1,400$1,050 $1,600 27.9 175 to 199 persons $1,600$1,200 $1,800 27.10 200 to 224 persons $1,800$1,350 $2,000 27.11 225 or more persons $2,000$1,500 $2,500 27.12 (b) A day training and habilitation program serving persons 27.13 with developmental disabilities or related conditions shall be 27.14 assessed a license fee based on the schedule in paragraph (a) 27.15 unless the license holder serves more than 50 percent of the 27.16 same persons at two or more locations in the community. When a 27.17 day training and habilitation program serves more than 50 27.18 percent of the same persons in two or more locations in a 27.19 community, the day training and habilitation program shall pay a 27.20 license fee based on the licensed capacity of the largest 27.21 facility and the other facility or facilities shall be charged a 27.22 license fee based on a licensed capacity of a residential 27.23 program serving one to 24 persons. 27.24 Sec. 5. Laws 2003, First Special Session chapter 14, 27.25 article 9, section 34, is amended to read: 27.26 Sec. 34. [DIRECTION TO COMMISSIONER; PROVIDER RATES.] 27.27 (a) The provider rates determined under Minnesota Statutes, 27.28 section 119B.13, for fiscal year 2003 and implemented on July 1, 27.29 2002, are to be continued in effect through June 30, 20052007. 27.30 Beginning on July 1, 2005, counties shall not reduce any child 27.31 care center's reimbursement rate below the rate implemented on 27.32 July 1, 2003. 27.33 (b) The commissioner of human services is directed to 27.34 evaluate the costs of child care in Minnesota, to examine the 27.35 differences in the cost of child care in rural and metropolitan 27.36 areas, and to make recommendations to the legislature for 28.1 containing future cost increases in the child care program under 28.2 Minnesota Statutes, chapter 119B, in a manner that complies with 28.3 federal child care and development block grant requirements for 28.4 promoting parental choice and permits the department to track 28.5 the effect of rate changes on child care assistance program 28.6 costs, the availability of different types of care throughout 28.7 the state, the length of waiting lists, and the care options 28.8 available to program participants. The commissioner shall also 28.9 examine the allocation formula under Minnesota Statutes, section 28.10 119B.03, and make recommendations to the legislature in order to 28.11 create a more equitable formula. The commissioner shall 28.12 consider the impact any recommendations might have on work 28.13 incentives for low and middle income families and possible 28.14 changes to MFIP child care, basic sliding fee child care, and 28.15 the dependent care tax credit. The commissioner shall make 28.16 recommendations to the legislature by January 15, 2005. 28.17 The commissioner shall also study the relationship between 28.18 child care assistance subsidies and tax credits or tax 28.19 incentives related to child care expenses, and include this 28.20 information in the January 15, 2005, report to the legislature 28.21 under this section. 28.22 Sec. 6. [TEMPORARY INELIGIBILITY OF MILITARY PERSONNEL.] 28.23 Counties must reserve a family's position under the child 28.24 care assistance fund if a family has been receiving child care 28.25 assistance but is temporarily ineligible for assistance due to 28.26 increased income from active military service. Activated 28.27 military personnel may be temporarily ineligible until 28.28 deactivated. A county must reserve a military family's position 28.29 on the basic sliding fee waiting list under the child care 28.30 assistance fund if a family is approved to receive child care 28.31 assistance and reaches the top of the waiting list but is 28.32 temporarily ineligible for assistance. 28.33 ARTICLE 8 28.34 ECONOMIC SUPPORTS 28.35 Section 1. Minnesota Statutes 2002, section 256D.051, 28.36 subdivision 1a, is amended to read: 29.1 Subd. 1a. [NOTICES AND SANCTIONS.] (a) At the time the 29.2 county agency notifies the household that it is eligible for 29.3 food stamps, the county agency must inform all mandatory 29.4 employment and training services participants as identified in 29.5 subdivision 1 in the household that they must comply with all 29.6 food stamp employment and training program requirements each 29.7 month, including the requirement to attend an initial 29.8 orientation to the food stamp employment and training program 29.9 and that food stamp eligibility will end unless the participants 29.10 comply with the requirements specified in the notice. 29.11 (b) A participant who fails without good cause to comply 29.12 with food stamp employment and training program requirements of 29.13 this section, including attendance at orientation, will lose 29.14 food stamp eligibility for the following periods: 29.15 (1) for the first occurrence, for one month or until the 29.16 person complies with the requirements not previously complied 29.17 with, whichever is longer; 29.18 (2) for the second occurrence, for three months or until 29.19 the person complies with the requirements not previously 29.20 complied with, whichever is longer; or 29.21 (3) for the third and any subsequent occurrence, for six 29.22 months or until the person complies with the requirements not 29.23 previously complied with, whichever is longer. 29.24 If the participant is not the food stamp head of household, 29.25 the person shall be considered an ineligible household member 29.26 for food stamp purposes. If the participant is the food stamp 29.27 head of household, the entire household is ineligible for food 29.28 stamps as provided in Code of Federal Regulations, title 7, 29.29 section 273.7(g). "Good cause" means circumstances beyond the 29.30 control of the participant, such as illness or injury, illness 29.31 or injury of another household member requiring the 29.32 participant's presence, a household emergency, or the inability 29.33 to obtain child care for children between the ages of six and 12 29.34 or to obtain transportation needed in order for the participant 29.35 to meet the food stamp employment and training program 29.36 participation requirements. 30.1 (c) The county agency shall mail or hand deliver a notice 30.2 to the participant not later than five days after determining 30.3 that the participant has failed without good cause to comply 30.4 with food stamp employment and training program requirements 30.5 which specifies the requirements that were not complied with, 30.6 the factual basis for the determination of noncompliance, and 30.7 the right to reinstate eligibility upon a showing of good cause 30.8 for failure to meet the requirements. The notice must ask the 30.9 reason for the noncompliance and identify the participant's 30.10 appeal rights. The notice must request that the participant 30.11 inform the county agency if the participant believes that good 30.12 cause existed for the failure to comply and must state that the 30.13 county agency intends to terminate eligibility for food stamp 30.14 benefits due to failure to comply with food stamp employment and 30.15 training program requirements. 30.16 (d) If the county agency determines that the participant 30.17 did not comply during the month with all food stamp employment 30.18 and training program requirements that were in effect, and if 30.19 the county agency determines that good cause was not present, 30.20 the county must provide a ten-day notice of termination of food 30.21 stamp benefits. The amount of food stamps that are withheld 30.22 from the household and determination of the impact of the 30.23 sanction on other household members is governed by Code of 30.24 Federal Regulations, title 7, section 273.7. 30.25 (e) A participant in the diversionary work program with 30.26 children under age six may be required to participate in 30.27 employment services under this section, but is not subject to 30.28 sanction. 30.29 (f) The participant may appeal the termination of food 30.30 stamp benefits under the provisions of section 256.045. 30.31 Sec. 2. Minnesota Statutes 2002, section 256D.051, 30.32 subdivision 3a, is amended to read: 30.33 Subd. 3a. [PERSONS REQUIRED TO REGISTER FOR AND 30.34 PARTICIPATE IN THE FOOD STAMP EMPLOYMENT AND TRAINING PROGRAM.] 30.35 (a) To the extent required under Code of Federal Regulations, 30.36 title 7, section 273.7(a), each applicant for and recipient of 31.1 food stamps is required to register for work as a condition of 31.2 eligibility for food stamp benefits. Applicants and recipients 31.3 are registered by signing an application or annual reapplication 31.4 for food stamps, and must be informed that they are registering 31.5 for work by signing the form. 31.6 (b) The commissioner shall determine, within federal 31.7 requirements, persons required to participate in the food stamp 31.8 employment and training (FSET) program. 31.9 (c) The following food stamp recipients are exempt from 31.10 mandatory participation in food stamp employment and training 31.11 services: 31.12 (1) recipients of benefits under the Minnesota family 31.13 investment program, Minnesota supplemental aid program, or the 31.14 general assistance program; 31.15 (2) a child; 31.16 (3) a recipient over age 5549; 31.17 (4) a recipient who has a mental or physical illness, 31.18 injury, or incapacity which is expected to continue for at least 31.19 30 days and which impairs the recipient's ability to obtain or 31.20 retain employment as evidenced by professional certification or 31.21 the receipt of temporary or permanent disability benefits issued 31.22 by a private or government source; 31.23 (5) a parent or other household member responsible for the 31.24 care of either a dependent child in the household who is under 31.25 age six, unless the parent or other household member is a 31.26 participant in the diversionary work program, or a person in the 31.27 household who is professionally certified as having a physical 31.28 or mental illness, injury, or incapacity. Only one parent or 31.29 other household member may claim exemption under this provision; 31.30 (6) a recipient receiving unemployment compensation or who 31.31 has applied for unemployment compensation and has been required 31.32 to register for work with the Department of Economic Security as 31.33 part of the unemployment compensation application process; 31.34 (7) a recipient participating each week in a drug addiction 31.35 or alcohol abuse treatment and rehabilitation program, provided 31.36 the operators of the treatment and rehabilitation program, in 32.1 consultation with the county agency, recommend that the 32.2 recipient not participate in the food stamp employment and 32.3 training program; 32.4 (8) a recipient employed or self-employed for 30 or more 32.5 hours per week at employment paying at least minimum wage, or 32.6 who earns wages from employment equal to or exceeding 30 hours 32.7 multiplied by the federal minimum wage; or32.8 (9) a student enrolled at least half time in any school, 32.9 training program, or institution of higher education. When 32.10 determining if a student meets this criteria, the school's, 32.11 program's or institution's criteria for being enrolled half time 32.12 shall be used; and 32.13 (10) a participant in the diversionary work program who 32.14 meets the requirements in section 256J.95, subdivision 11, 32.15 paragraph (d). 32.16 Sec. 3. Minnesota Statutes 2002, section 256D.051, 32.17 subdivision 6c, is amended to read: 32.18 Subd. 6c. [PROGRAM FUNDING.] Within the limits of 32.19 available resources, the commissioner shall reimburse the actual 32.20 costs of county agencies and their employment and training 32.21 service providers for the provision of food stamp employment and 32.22 training services, including participant support services, 32.23 direct program services, and program administrative activities. 32.24 The cost of services for each county's food stamp employment and 32.25 training program shall not exceed an average of $400 per32.26 participantthe annual allocated amount. No more than 15 32.27 percent of program funds may be used for administrative 32.28 activities. The county agency may expend county funds in excess 32.29 of the limits of this subdivision without state reimbursement. 32.30 Program funds shall be allocated based on the county's 32.31 average number of food stamp cases as compared to the statewide 32.32 total number of such cases. The average number of cases shall 32.33 be based on counts of cases as of March 31, June 30, September 32.34 30, and December 31 of the previous calendar year. The 32.35 commissioner may reallocate unexpended money appropriated under 32.36 this section to those county agencies that demonstrate a need 33.1 for additional funds. 33.2 Sec. 4. Minnesota Statutes 2003 Supplement, section 33.3 256J.24, subdivision 6, is amended to read: 33.4 Subd. 6. [FAMILY CAP.] (a) MFIP assistance units shall not 33.5 receive an increase in the cash portion of the transitional 33.6 standard as a result of the birth of a child, unless one of the 33.7 conditions under paragraph (b) is met. The child shall be 33.8 considered a member of the assistance unit according to 33.9 subdivisions 1 to 3, but shall be excluded in determining family 33.10 size for purposes of determining the amount of the cash portion 33.11 of the transitional standard under subdivision 5. The child 33.12 shall be included in determining family size for purposes of 33.13 determining the food portion of the transitional standard. The 33.14 transitional standard under this subdivision shall be the total 33.15 of the cash and food portions as specified in this paragraph. 33.16 The family wage level under this subdivision shall be based on 33.17 the family size used to determine the food portion of the 33.18 transitional standard. 33.19 (b) A child shall be included in determining family size 33.20 for purposes of determining the amount of the cash portion of 33.21 the MFIP transitional standard when at least one of the 33.22 following conditions is met: 33.23 (1) for families receiving MFIP assistance on July 1, 2003, 33.24 the child is born to the adult parent before May 1, 2004; 33.25 (2) for families who apply for the diversionary work 33.26 program under section 256J.95 or MFIP assistance on or after 33.27 July 1, 2003, the child is born to the adult parent within ten 33.28 months of the date the family is eligible for assistance; 33.29 (3) the child was conceived as a result of a sexual assault 33.30 or incest, provided that the incident has been reported to a law 33.31 enforcement agency; 33.32 (4) the child's mother is a minor caregiver as defined in 33.33 section 256J.08, subdivision 59, and the child, or multiple 33.34 children, are the mother's first birth; or 33.35 (5) any child previously excluded in determining family 33.36 size under paragraph (a) shall be included if the adult parent 34.1 or parents have not received benefits from the diversionary work 34.2 program under section 256J.95 or MFIP assistance in the previous 34.3 ten months. An adult parent or parents who reapply and have 34.4 received benefits from the diversionary work program or MFIP 34.5 assistance in the past ten months shall be under the ten-month 34.6 grace period of their previous application under clause (2). 34.7 (c) Income and resources of a child excluded under this 34.8 subdivision, except income of the child support received or34.9 distributed on behalf of this childequal to the change in cash 34.10 standard due to the family cap, must be considered using the 34.11 same policies as for other children when determining the grant 34.12 amount of the assistance unit. 34.13 (d) The caregiver must assign support and cooperate with 34.14 the child support enforcement agency to establish paternity and 34.15 collect child support on behalf of the excluded child. Failure 34.16 to cooperate results in the sanction specified in section 34.17 256J.46, subdivisions 2 and 2a. Current support paid on behalf 34.18 of the excluded child shall be distributed according to section 34.19 256.741, subdivision 15. 34.20 (e) County agencies must inform applicants of the 34.21 provisions under this subdivision at the time of each 34.22 application and at recertification. 34.23 (f) Children excluded under this provision shall be deemed 34.24 MFIP recipients for purposes of child care under chapter 119B. 34.25 Sec. 5. Minnesota Statutes 2003 Supplement, section 34.26 256J.37, subdivision 3a, is amended to read: 34.27 Subd. 3a. [RENTAL SUBSIDIES; UNEARNED INCOME.] (a) 34.28 Effective July 1, 2003,The county agency shall count $50$200 34.29 of the value of public and assisted rental subsidies provided 34.30 through the Department of Housing and Urban Development (HUD) as 34.31 unearned income to the cash portion of the MFIP grant. The full 34.32 amount of the subsidy must be counted as unearned income when 34.33 the subsidy is less than $50$200. The income from this subsidy 34.34 shall be budgeted according to section 256J.34. 34.35 (b) The provisions of this subdivision shall not apply to 34.36 an MFIP assistance unit which includes a participant who is: 35.1 (1) age 60 or older; 35.2 (2) a caregiver who is suffering from an illness, injury, 35.3 or incapacity that has been certified by a qualified 35.4 professional when the illness, injury, or incapacity is expected 35.5 to continue for more than 30 days and prevents the person from 35.6 obtaining or retaining employment; or 35.7 (3) a caregiver whose presence in the home is required due 35.8 to the illness or incapacity of another member in the assistance 35.9 unit, a relative in the household, or a foster child in the 35.10 household when the illness or incapacity and the need for the 35.11 participant's presence in the home has been certified by a 35.12 qualified professional and is expected to continue for more than 35.13 30 days. 35.14 (c) The provisions of this subdivision shall not apply to 35.15 an MFIP assistance unit where the parentalcaregiver is an SSI 35.16 recipient. 35.17 (d) Prior to implementing this provision, the commissioner 35.18 must identify the MFIP participants subject to this provision 35.19 and provide written notice to these participants at least 30 35.20 days before the first grant reduction. The notice must inform 35.21 the participant of the basis for the potential grant reduction, 35.22 the exceptions to the provision, if any, and inform the 35.23 participant of the steps necessary to claim an exception. A 35.24 person who is found not to meet one of the exceptions to the 35.25 provision must be notified and informed of the right to a fair 35.26 hearing under section 256J.40. The notice must also inform the 35.27 participant that the participant may be eligible for a rent 35.28 reduction resulting from a reduction in the MFIP grant and 35.29 encourage the participant to contact the local housing authority. 35.30 Sec. 6. Minnesota Statutes 2003 Supplement, section 35.31 256J.53, subdivision 1, is amended to read: 35.32 Subdivision 1. [LENGTH OF PROGRAM.] In order for a 35.33 postsecondary education or training program to be an approved 35.34 work activity as defined in section 256J.49, subdivision 13, 35.35 clause (6), it must be a program lasting 2412 months or less, 35.36 and the participant must meet the requirements of subdivisions 36.1 2, 3, and 5. 36.2 ARTICLE 9 36.3 HEALTH CARE 36.4 Section 1. Minnesota Statutes 2003 Supplement, section 36.5 256.955, subdivision 2a, is amended to read: 36.6 Subd. 2a. [ELIGIBILITY.] An individual satisfying the 36.7 following requirements and the requirements described in 36.8 subdivision 2, paragraph (d), is eligible for the prescription 36.9 drug program who: 36.10 (1) is at least 65 years of age or older; and36.11 (2) is eligible as a qualified Medicare beneficiary 36.12 according to section 256B.057, subdivision 3 or 3a, or is 36.13 eligible under section 256B.057, subdivision 3 or 3a, and is 36.14 also eligible for medical assistance or general assistance 36.15 medical care with a spenddown as defined in section 256B.056, 36.16 subdivision 5; and 36.17 (3) applies for the Medicare drug discount card, if 36.18 eligible. 36.19 [EFFECTIVE DATE.] Clause (3) is effective July 1, 2004, or 36.20 when enrollment for the Medicare drug discount card is 36.21 available, whichever is later. 36.22 Sec. 2. Minnesota Statutes 2002, section 256.955, 36.23 subdivision 2b, is amended to read: 36.24 Subd. 2b. [ELIGIBILITY.] Effective July 1, 2002, an 36.25 individual satisfying the following requirements and the 36.26 requirements described in subdivision 2, paragraph (d), is 36.27 eligible for the prescription drug program: 36.28 (1) is under 65 years of age; and36.29 (2) is eligible as a qualified Medicare beneficiary 36.30 according to section 256B.057, subdivision 3 or 3a or is 36.31 eligible under section 256B.057, subdivision 3 or 3a and is also 36.32 eligible for medical assistance or general assistance medical 36.33 care with a spenddown as defined in section 256B.056, 36.34 subdivision 5; and 36.35 (3) applies for the Medicare drug discount card, if 36.36 eligible. 37.1 [EFFECTIVE DATE.] Clause (3) is effective July 1, 2004, or 37.2 when enrollment for the Medicare drug discount card is 37.3 available, whichever is later. 37.4 Sec. 3. Minnesota Statutes 2003 Supplement, section 37.5 256.955, subdivision 3, is amended to read: 37.6 Subd. 3. [PRESCRIPTION DRUG COVERAGE.] Coverage under the 37.7 program shall be limited to those prescription drugs that: 37.8 (1) are covered under the medical assistance program as 37.9 described in section 256B.0625, subdivision 13; 37.10 (2) are provided by manufacturers that have fully executed 37.11 seniorprescription drug program rebate agreements with the 37.12 commissioner and comply with such agreements; and37.13 (3) for a specific enrollee, are not covered under an 37.14 assistance program offered by a pharmaceutical manufacturer, as 37.15 determined by the board on aging under section 256.975, 37.16 subdivision 9, except that this shall not apply to qualified 37.17 individuals under this section who are also eligible for medical 37.18 assistance with a spenddown as described in subdivisions 2a, 37.19 clause (2), and 2b, clause (2) .; and 37.20 (4) for a specific enrollee, are not covered under a 37.21 Medicare drug discount card plan subsidy unless: 37.22 (i) the prescription drug is not included in the Medicare 37.23 discount card plan formulary, but is covered under the 37.24 prescription drug program; 37.25 (ii) the cost of a prescription drug is more than the 37.26 remaining Medicare drug discount card subsidy; or 37.27 (iii) a prescribed over-the-counter medication is not 37.28 included in the Medicare drug discount card plan formulary, but 37.29 is covered under the prescription drug program. 37.30 Sec. 4. Minnesota Statutes 2002, section 256.955, 37.31 subdivision 4, is amended to read: 37.32 Subd. 4. [APPLICATION PROCEDURES AND COORDINATION WITH 37.33 MEDICAL ASSISTANCE AND MEDICARE DRUG DISCOUNT CARD.] 37.34 Applications and information on the program must be made 37.35 available at county social service agencies, health care 37.36 provider offices, and agencies and organizations serving senior 38.1 citizens and persons with disabilities. Individuals shall 38.2 submit applications and any information specified by the 38.3 commissioner as being necessary to verify eligibility directly 38.4 to the county social service agencies: 38.5 (1) beginning January 1, 1999, the county social service 38.6 agency shall determine medical assistance spenddown eligibility 38.7 of individuals who qualify for the prescription drug program; 38.8 and 38.9 (2) program payments will be used to reduce the spenddown 38.10 obligations of individuals who are determined to be eligible for 38.11 medical assistance with a spenddown as defined in section 38.12 256B.056, subdivision 5. 38.13 Qualified individuals who are eligible for medical assistance 38.14 with a spenddown shall be financially responsible for the 38.15 deductible amount up to the satisfaction of the spenddown. No 38.16 deductible applies once the spenddown has been met. Payments to 38.17 providers for prescription drugs for persons eligible under this 38.18 subdivision shall be reduced by the deductible. 38.19 County social service agencies shall determine an 38.20 applicant's eligibility for the program within 30 days from the 38.21 date the application is received. Eligibility begins the month 38.22 after approval. 38.23 Enrollees who are also enrolled in the Medicare drug 38.24 discount card plan must obtain prescription drugs at a pharmacy 38.25 enrolled as a provider for both the Medicare drug discount plan 38.26 and the prescription drug program. 38.27 Sec. 5. Minnesota Statutes 2002, section 256.955, 38.28 subdivision 6, is amended to read: 38.29 Subd. 6. [PHARMACY REIMBURSEMENT.] The commissioner shall 38.30 reimburse participating pharmacies for drug and dispensing costs 38.31 at the medical assistance reimbursement level, minus the 38.32 deductible required under subdivision 7. The commissioner shall 38.33 not reimburse enrolled pharmacies until the Medicare drug 38.34 discount card subsidy has been exhausted, unless the exceptions 38.35 in subdivision 3, clause (3), are met. 38.36 Sec. 6. Minnesota Statutes 2003 Supplement, section 39.1 256B.056, subdivision 3c, is amended to read: 39.2 Subd. 3c. [ASSET LIMITATIONS FOR FAMILIES AND CHILDREN.] A 39.3 household of two or more persons must not own more than $20,000 39.4 in total net assets, and a household of one person must not own 39.5 more than $10,000 in total net assets. In addition to these 39.6 maximum amounts, an eligible individual or family may accrue 39.7 interest on these amounts, but they must be reduced to the 39.8 maximum at the time of an eligibility redetermination. The 39.9 value of assets that are not considered in determining 39.10 eligibility for medical assistance for families and children is 39.11 the value of those assets excluded under the AFDC state plan as 39.12 of July 16, 1996, as required by the Personal Responsibility and 39.13 Work Opportunity Reconciliation Act of 1996 (PRWORA), Public Law 39.14 104-193, with the following exceptions: 39.15 (1) household goods and personal effects are not 39.16 considered; 39.17 (2) capital and operating assets of a trade or business up 39.18 to $200,000 are not considered; 39.19 (3) one motor vehicle is excluded for each person of legal 39.20 driving age who is employed or seeking employment; 39.21 (4) one burial plot and all other burial expenses equal to39.22 the supplemental security income program asset limit are not39.23 considered for each individualassets designated as burial 39.24 expenses are excluded to the same extent excluded by the 39.25 supplemental security income program. Burial expenses funded by 39.26 annuity contracts or life insurance policies must irrevocably 39.27 designate the individual's estate as the contingent beneficiary 39.28 to the extent proceeds are not used for payment of selected 39.29 burial expenses; 39.30 (5) court-ordered settlements up to $10,000 are not 39.31 considered; 39.32 (6) individual retirement accounts and funds are not 39.33 considered; and 39.34 (7) assets owned by children are not considered. 39.35 Sec. 7. Minnesota Statutes 2003 Supplement, section 39.36 256B.057, subdivision 9, is amended to read: 40.1 Subd. 9. [EMPLOYED PERSONS WITH DISABILITIES.] (a) Medical 40.2 assistance may be paid for a person who is employed and who: 40.3 (1) meets the definition of disabled under the supplemental 40.4 security income program; 40.5 (2) is at least 16 but less than 65 years of age; 40.6 (3) meets the asset limits in paragraph (b); and 40.7 (4) effective November 1, 2003, pays a premium and other 40.8 obligations under paragraph (d). 40.9 Any spousal income or assets shall be disregarded for purposes 40.10 of eligibility and premium determinations. 40.11 After the month of enrollment, a person enrolled in medical 40.12 assistance under this subdivision who: 40.13 (1) is temporarily unable to work and without receipt of 40.14 earned income due to a medical condition, as verified by a 40.15 physician, may retain eligibility for up to four calendar 40.16 months; or 40.17 (2) effective January 1, 2004, loses employment for reasons 40.18 not attributable to the enrollee, may retain eligibility for up 40.19 to four consecutive months after the month of job loss. To 40.20 receive a four-month extension, enrollees must verify the 40.21 medical condition or provide notification of job loss. All 40.22 other eligibility requirements must be met and the enrollee must 40.23 pay all calculated premium costs for continued eligibility. 40.24 (b) For purposes of determining eligibility under this 40.25 subdivision, a person's assets must not exceed $20,000, 40.26 excluding: 40.27 (1) all assets excluded under section 256B.056; 40.28 (2) retirement accounts, including individual accounts, 40.29 401(k) plans, 403(b) plans, Keogh plans, and pension plans; and 40.30 (3) medical expense accounts set up through the person's 40.31 employer. 40.32 (c)(1) Effective January 1, 2004, for purposes of 40.33 eligibility, there will be a $65 earned income disregard. To be 40.34 eligible, a person applying for medical assistance under this 40.35 subdivision must have earned income above the disregard level. 40.36 (2) Effective January 1, 2004, to be considered earned 41.1 income, Medicare, Social Security, and applicable state and 41.2 federal income taxes must be withheld. To be eligible, a person 41.3 must document earned income tax withholding. 41.4 (d)(1) A person whose earned and unearned income is equal 41.5 to or greater than 100 percent of federal poverty guidelines for 41.6 the applicable family size must pay a premium to be eligible for 41.7 medical assistance under this subdivision. The premium shall be 41.8 based on the person's gross earned and unearned income and the 41.9 applicable family size using a sliding fee scale established by 41.10 the commissioner, which begins at one percent of income at 100 41.11 percent of the federal poverty guidelines and increases to 7.5 41.12 percent of income for those with incomes at or above 300 percent 41.13 of the federal poverty guidelines. Annual adjustments in the 41.14 premium schedule based upon changes in the federal poverty 41.15 guidelines shall be effective for premiums due in July of each 41.16 year. 41.17 (2) Effective January 1, 2004, all enrollees must pay a 41.18 premium to be eligible for medical assistance under this 41.19 subdivision. An enrollee shall pay the greater of a $35 premium 41.20 or the premium calculated in clause (1). 41.21 (3) Effective November 1, 2003, all enrollees who receive 41.22 unearned income must pay one-half of one percent of unearned 41.23 income in addition to the premium amount. 41.24 (4) Effective November 1, 2003, for enrollees whose income 41.25 does not exceed 200 percent of the federal poverty guidelines 41.26 and who are also enrolled in Medicare, the commissioner must 41.27 reimburse the enrollee for Medicare Part B premiums under 41.28 section 256B.0625, subdivision 15, paragraph (a). 41.29 (5) Increases in benefits under Title II of the Social 41.30 Security Act shall not be counted as income for purposes of this 41.31 subdivision until July 1 of each year. 41.32 (e) A person's eligibility and premium shall be determined 41.33 by the local county agency. Premiums must be paid to the 41.34 commissioner. All premiums are dedicated to the commissioner. 41.35 (f) Any required premium shall be determined at application 41.36 and redetermined at the enrollee's six-month income review or 42.1 when a change in income or household size is reported. 42.2 Enrollees must report any change in income or household size 42.3 within ten days of when the change occurs. A decreased premium 42.4 resulting from a reported change in income or household size 42.5 shall be effective the first day of the next available billing 42.6 month after the change is reported. Except for changes 42.7 occurring from annual cost-of-living increases, a change 42.8 resulting in an increased premium shall not affect the premium 42.9 amount until the next six-month review. 42.10 (g) Premium payment is due upon notification from the 42.11 commissioner of the premium amount required. Premiums may be 42.12 paid in installments at the discretion of the commissioner. 42.13 (h) Nonpayment of the premium shall result in denial or 42.14 termination of medical assistance unless the person demonstrates 42.15 good cause for nonpayment. Good cause exists if the 42.16 requirements specified in Minnesota Rules, part 9506.0040, 42.17 subpart 7, items B to D, are met. Except when an installment 42.18 agreement is accepted by the commissioner, all persons 42.19 disenrolled for nonpayment of a premium must pay any past due 42.20 premiums as well as current premiums due prior to being 42.21 reenrolled. Nonpayment shall include payment with a returned, 42.22 refused, or dishonored instrument. The commissioner may require 42.23 a guaranteed form of payment as the only means to replace a 42.24 returned, refused, or dishonored instrument. 42.25 [EFFECTIVE DATE.] This section is effective July 1, 2004. 42.26 Sec. 8. Minnesota Statutes 2003 Supplement, section 42.27 256B.06, subdivision 4, is amended to read: 42.28 Subd. 4. [CITIZENSHIP REQUIREMENTS.] (a) Eligibility for 42.29 medical assistance is limited to citizens of the United States, 42.30 qualified noncitizens as defined in this subdivision, and other 42.31 persons residing lawfully in the United States. 42.32 (b) "Qualified noncitizen" means a person who meets one of 42.33 the following immigration criteria: 42.34 (1) admitted for lawful permanent residence according to 42.35 United States Code, title 8; 42.36 (2) admitted to the United States as a refugee according to 43.1 United States Code, title 8, section 1157; 43.2 (3) granted asylum according to United States Code, title 43.3 8, section 1158; 43.4 (4) granted withholding of deportation according to United 43.5 States Code, title 8, section 1253(h); 43.6 (5) paroled for a period of at least one year according to 43.7 United States Code, title 8, section 1182(d)(5); 43.8 (6) granted conditional entrant status according to United 43.9 States Code, title 8, section 1153(a)(7); 43.10 (7) determined to be a battered noncitizen by the United 43.11 States Attorney General according to the Illegal Immigration 43.12 Reform and Immigrant Responsibility Act of 1996, title V of the 43.13 Omnibus Consolidated Appropriations Bill, Public Law 104-200; 43.14 (8) is a child of a noncitizen determined to be a battered 43.15 noncitizen by the United States Attorney General according to 43.16 the Illegal Immigration Reform and Immigrant Responsibility Act 43.17 of 1996, title V, of the Omnibus Consolidated Appropriations 43.18 Bill, Public Law 104-200; or 43.19 (9) determined to be a Cuban or Haitian entrant as defined 43.20 in section 501(e) of Public Law 96-422, the Refugee Education 43.21 Assistance Act of 1980. 43.22 (c) All qualified noncitizens who were residing in the 43.23 United States before August 22, 1996, who otherwise meet the 43.24 eligibility requirements of this chapter, are eligible for 43.25 medical assistance with federal financial participation. 43.26 (d) All qualified noncitizens who entered the United States 43.27 on or after August 22, 1996, and who otherwise meet the 43.28 eligibility requirements of this chapter, are eligible for 43.29 medical assistance with federal financial participation through 43.30 November 30, 1996. 43.31 Beginning December 1, 1996, qualified noncitizens who 43.32 entered the United States on or after August 22, 1996, and who 43.33 otherwise meet the eligibility requirements of this chapter are 43.34 eligible for medical assistance with federal participation for 43.35 five years if they meet one of the following criteria: 43.36 (i) refugees admitted to the United States according to 44.1 United States Code, title 8, section 1157; 44.2 (ii) persons granted asylum according to United States 44.3 Code, title 8, section 1158; 44.4 (iii) persons granted withholding of deportation according 44.5 to United States Code, title 8, section 1253(h); 44.6 (iv) veterans of the United States armed forces with an 44.7 honorable discharge for a reason other than noncitizen status, 44.8 their spouses and unmarried minor dependent children; or 44.9 (v) persons on active duty in the United States armed 44.10 forces, other than for training, their spouses and unmarried 44.11 minor dependent children. 44.12 Beginning December 1, 1996, qualified noncitizens who do 44.13 not meet one of the criteria in items (i) to (v) are eligible 44.14 for medical assistance without federal financial participation 44.15 as described in paragraph (j). 44.16 (e) Noncitizens who are not qualified noncitizens as 44.17 defined in paragraph (b), who are lawfully residing in the 44.18 United States and who otherwise meet the eligibility 44.19 requirements of this chapter, are eligible for medical 44.20 assistance under clauses (1) to (3). These individuals must 44.21 cooperate with the Immigration and Naturalization Service to 44.22 pursue any applicable immigration status, including citizenship, 44.23 that would qualify them for medical assistance with federal 44.24 financial participation. 44.25 (1) Persons who were medical assistance recipients on 44.26 August 22, 1996, are eligible for medical assistance with 44.27 federal financial participation through December 31, 1996. 44.28 (2) Beginning January 1, 1997, persons described in clause 44.29 (1) are eligible for medical assistance without federal 44.30 financial participation as described in paragraph (j). 44.31 (3) Beginning December 1, 1996, persons residing in the 44.32 United States prior to August 22, 1996, who were not receiving 44.33 medical assistance and persons who arrived on or after August 44.34 22, 1996, are eligible for medical assistance without federal 44.35 financial participation as described in paragraph (j). 44.36 (f) Nonimmigrants who otherwise meet the eligibility 45.1 requirements of this chapter are eligible for the benefits as 45.2 provided in paragraphs (g) to (i). For purposes of this 45.3 subdivision, a "nonimmigrant" is a person in one of the classes 45.4 listed in United States Code, title 8, section 1101(a)(15). 45.5 (g) Payment shall also be made for care and services that 45.6 are furnished to noncitizens, regardless of immigration status, 45.7 who otherwise meet the eligibility requirements of this chapter, 45.8 if such care and services are necessary for the treatment of an 45.9 emergency medical condition, except for organ transplants and 45.10 related care and services and routine prenatal care. 45.11 (h) For purposes of this subdivision, the term "emergency 45.12 medical condition" means a medical condition that meets the 45.13 requirements of United States Code, title 42, section 1396b(v). 45.14 (i) Pregnant noncitizens who are undocumented or, 45.15 nonimmigrants, or eligible for medical assistance as described 45.16 in paragraph (j), and who are not covered by a group health plan 45.17 or health insurance coverage according to Code of Federal 45.18 Regulations, title 42, section 457.310, and who otherwise meet 45.19 the eligibility requirements of this chapter, are eligible for 45.20 medical assistance payment without federal financial45.21 participation for care and servicesthrough the period of 45.22 pregnancy, andincluding labor and delivery, to the extent 45.23 federal funds are available under Title XXI of the Social 45.24 Security Act, and the state children's health insurance program, 45.25 followed by 60 days postpartum , except for labor and45.26 deliverywithout federal financial participation. 45.27 (j) Qualified noncitizens as described in paragraph (d), 45.28 and all other noncitizens lawfully residing in the United States 45.29 as described in paragraph (e), who are ineligible for medical 45.30 assistance with federal financial participation and who 45.31 otherwise meet the eligibility requirements of chapter 256B and 45.32 of this paragraph, are eligible for medical assistance without 45.33 federal financial participation. Qualified noncitizens as 45.34 described in paragraph (d) are only eligible for medical 45.35 assistance without federal financial participation for five 45.36 years from their date of entry into the United States. 46.1 (k) Beginning October 1, 2003, persons who are receiving 46.2 care and rehabilitation services from a nonprofit center 46.3 established to serve victims of torture and are otherwise 46.4 ineligible for medical assistance under this chapter or general 46.5 assistance medical care under section 256D.03 are eligible for 46.6 medical assistance without federal financial participation. 46.7 These individuals are eligible only for the period during which 46.8 they are receiving services from the center. Individuals 46.9 eligible under this paragraph shall not be required to 46.10 participate in prepaid medical assistance. 46.11 Sec. 9. Minnesota Statutes 2003 Supplement, section 46.12 256B.0625, subdivision 9, is amended to read: 46.13 Subd. 9. [DENTAL SERVICES.] (a)Medical assistance covers 46.14 dental services. Dental services include, with prior 46.15 authorization, fixed bridges that are cost-effective for persons 46.16 who cannot use removable dentures because of their medical 46.17 condition. 46.18 (b) Coverage of dental services for adults age 21 and over46.19 who are not pregnant is subject to a $500 annual benefit limit46.20 and covered services are limited to:46.21 (1) diagnostic and preventative services;46.22 (2) basic restorative services; and46.23 (3) emergency services.46.24 Emergency services, dentures, and extractions related to46.25 dentures are not included in the $500 annual benefit limit.46.26 [EFFECTIVE DATE.] This section is effective January 1, 2005. 46.27 Sec. 10. Minnesota Statutes 2003 Supplement, section 46.28 256B.0631, subdivision 2, is amended to read: 46.29 Subd. 2. [EXCEPTIONS.] Co-payments shall be subject to the 46.30 following exceptions: 46.31 (1) children under the age of 21; 46.32 (2) pregnant women for services that relate to the 46.33 pregnancy or any other medical condition that may complicate the 46.34 pregnancy; 46.35 (3) recipients expected to reside for at least 30 days in a 46.36 hospital, nursing home, orintermediate care facility for the 47.1 mentally retarded, or group residential housing facility under 47.2 chapter 256I, and whose only available income is a personal 47.3 needs allowance under section 256B.35 or 256B.36 and whose 47.4 exemption from co-payments is approved by the centers for 47.5 Medicare and Medicaid services; 47.6 (4) recipients receiving hospice care; 47.7 (5) 100 percent federally funded services provided by an 47.8 Indian health service; 47.9 (6) emergency services; 47.10 (7) family planning services; 47.11 (8) services that are paid by Medicare, resulting in the 47.12 medical assistance program paying for the coinsurance and 47.13 deductible; and 47.14 (9) co-payments that exceed one per day per provider for 47.15 nonpreventive visits, eyeglasses, and nonemergency visits to a 47.16 hospital-based emergency room. 47.17 [EFFECTIVE DATE.] This section is effective 90 days after 47.18 federal approval or January 1, 2005, whichever is later. 47.19 Sec. 11. Minnesota Statutes 2003 Supplement, section 47.20 256B.69, subdivision 2, is amended to read: 47.21 Subd. 2. [DEFINITIONS.] For the purposes of this section, 47.22 the following terms have the meanings given. 47.23 (a) "Commissioner" means the commissioner of human services. 47.24 For the remainder of this section, the commissioner's 47.25 responsibilities for methods and policies for implementing the 47.26 project will be proposed by the project advisory committees and 47.27 approved by the commissioner. 47.28 (b) "Demonstration provider" means a health maintenance 47.29 organization, community integrated service network, or 47.30 accountable provider network authorized and operating under 47.31 chapter 62D, 62N, or 62T that participates in the demonstration 47.32 project according to criteria, standards, methods, and other 47.33 requirements established for the project and approved by the 47.34 commissioner. For purposes of this section, a county board, or 47.35 group of county boards operating under a joint powers agreement, 47.36 is considered a demonstration provider if the county or group of 48.1 county boards meets the requirements of section 256B.692. 48.2 Notwithstanding the above, Itasca County may continue to 48.3 participate as a demonstration provider until July 1, 2004. 48.4 (c) "Eligible individuals" means those persons eligible for 48.5 medical assistance benefits as defined in sections 256B.055, 48.6 256B.056, and 256B.06. 48.7 (d) "Limitation of choice" means suspending freedom of 48.8 choice while allowing eligible individuals to choose among the 48.9 demonstration providers. 48.10 (e) This paragraph supersedes paragraph (c) as long as the 48.11 Minnesota health care reform waiver remains in effect. When the 48.12 waiver expires, this paragraph expires and the commissioner of 48.13 human services shall publish a notice in the State Register and 48.14 notify the revisor of statutes. "Eligible individuals" means 48.15 those persons eligible for medical assistance benefits as 48.16 defined in sections 256B.055, 256B.056, and 256B.06. An 48.17 individual enrolled under section 256B.055, subdivision 7, who 48.18 becomes ineligible for the program because of failure to submit 48.19 income reports or recertification forms in a timely manner, 48.20 shall remain enrolled in the prepaid health plan and shall 48.21 remain eligible to receive medical assistance coverage through 48.22 the last day of the month following the month in which the 48.23 enrollee became ineligible for the medical assistance program. 48.24 [EFFECTIVE DATE.] This section is effective July 1, 2004, 48.25 or upon federal approval, whichever is later. 48.26 Sec. 12. Minnesota Statutes 2003 Supplement, section 48.27 256D.03, subdivision 3, is amended to read: 48.28 Subd. 3. [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.] 48.29 (a) General assistance medical care may be paid for any person 48.30 who is not eligible for emergency medical assistance, or medical 48.31 assistance under chapter 256B, including eligibility for medical 48.32 assistance based on a spenddown of excess income according to 48.33 section 256B.056, subdivision 5, or MinnesotaCare as defined in 48.34 paragraph (b), except as provided in paragraph (c), and: 48.35 (1) who is receiving assistance under section 256D.05, 48.36 except for families with children who are eligible under 49.1 Minnesota family investment program (MFIP), or who is having a 49.2 payment made on the person's behalf under sections 256I.01 to 49.3 256I.06; or 49.4 (2) who is a resident of Minnesota; and 49.5 (i) who has gross countable income not in excess of 75 49.6 percent of the federal poverty guidelines for the family size, 49.7 using a six-month budget period and whose equity in assets is 49.8 not in excess of $1,000 per assistance unit. Exempt assets, the 49.9 reduction of excess assets, and the waiver of excess assets must 49.10 conform to the medical assistance program in section 256B.056, 49.11 subdivision 3, with the following exception: the maximum amount 49.12 of undistributed funds in a trust that could be distributed to 49.13 or on behalf of the beneficiary by the trustee, assuming the 49.14 full exercise of the trustee's discretion under the terms of the 49.15 trust, must be applied toward the asset maximum; or 49.16 (ii) who has gross countable income above 75 percent of the49.17 federal poverty guidelines butor assets in excess of the limits 49.18 in item (i), but whose income is not in excess of 175150 49.19 percent of the federal poverty guidelines for the family size, 49.20 using a six-month budget period, and whose equity in assets is 49.21 not in excess of the limits in section 256B.056, subdivision 3c, 49.22 and who applies during an inpatient hospitalization. 49.23 (b) General assistance medical care may not be paid for 49.24 applicants or recipients who meet all eligibility requirements 49.25 of MinnesotaCare as defined in sections 256L.01 to 256L.16, and 49.26 are adults with dependent children under 21 whose gross family 49.27 income is equal to or less than 275 percent of the federal 49.28 poverty guidelines. 49.29 (c) For applications received on or after October 1, 2003, 49.30 eligibility may begin no earlier than the date of application. 49.31 For individuals eligible under paragraph (a), clause (2), item 49.32 (i), a redetermination of eligibility must occur every 12 49.33 months. Individuals are eligible under paragraph (a), clause 49.34 (2), item (ii), only during inpatient hospitalization but may 49.35 reapply if there is a subsequent period of inpatient 49.36 hospitalization. Beginning January 1, 2000, Minnesota health 50.1 care program applications completed by recipients and applicants 50.2 who are persons described in paragraph (b), may be returned to 50.3 the county agency to be forwarded to the Department of Human 50.4 Services or sent directly to the Department of Human Services 50.5 for enrollment in MinnesotaCare. If all other eligibility 50.6 requirements of this subdivision are met, eligibility for 50.7 general assistance medical care shall be available in any month 50.8 during which a MinnesotaCare eligibility determination and 50.9 enrollment are pending. Upon notification of eligibility for 50.10 MinnesotaCare, notice of termination for eligibility for general 50.11 assistance medical care shall be sent to an applicant or 50.12 recipient. If all other eligibility requirements of this 50.13 subdivision are met, eligibility for general assistance medical 50.14 care shall be available until enrollment in MinnesotaCare 50.15 subject to the provisions of paragraph (e). 50.16 (d) The date of an initial Minnesota health care program 50.17 application necessary to begin a determination of eligibility 50.18 shall be the date the applicant has provided a name, address, 50.19 and Social Security number, signed and dated, to the county 50.20 agency or the Department of Human Services. If the applicant is 50.21 unable to provide a name, address, Social Security number, and 50.22 signature when health care is delivered due to a medical 50.23 condition or disability, a health care provider may act on an 50.24 applicant's behalf to establish the date of an initial Minnesota 50.25 health care program application by providing the county agency 50.26 or Department of Human Services with provider identification and 50.27 a temporary unique identifier for the applicant. The applicant 50.28 must complete the remainder of the application and provide 50.29 necessary verification before eligibility can be determined. 50.30 The county agency must assist the applicant in obtaining 50.31 verification if necessary. 50.32 (e) County agencies are authorized to use all automated 50.33 databases containing information regarding recipients' or 50.34 applicants' income in order to determine eligibility for general 50.35 assistance medical care or MinnesotaCare. Such use shall be 50.36 considered sufficient in order to determine eligibility and 51.1 premium payments by the county agency. 51.2 (f) General assistance medical care is not available for a 51.3 person in a correctional facility unless the person is detained 51.4 by law for less than one year in a county correctional or 51.5 detention facility as a person accused or convicted of a crime, 51.6 or admitted as an inpatient to a hospital on a criminal hold 51.7 order, and the person is a recipient of general assistance 51.8 medical care at the time the person is detained by law or 51.9 admitted on a criminal hold order and as long as the person 51.10 continues to meet other eligibility requirements of this 51.11 subdivision. 51.12 (g) General assistance medical care is not available for 51.13 applicants or recipients who do not cooperate with the county 51.14 agency to meet the requirements of medical assistance. 51.15 (h) In determining the amount of assets of an individual 51.16 eligible under paragraph (a), clause (2), item (i), there shall 51.17 be included any asset or interest in an asset, including an 51.18 asset excluded under paragraph (a), that was given away, sold, 51.19 or disposed of for less than fair market value within the 60 51.20 months preceding application for general assistance medical care 51.21 or during the period of eligibility. Any transfer described in 51.22 this paragraph shall be presumed to have been for the purpose of 51.23 establishing eligibility for general assistance medical care, 51.24 unless the individual furnishes convincing evidence to establish 51.25 that the transaction was exclusively for another purpose. For 51.26 purposes of this paragraph, the value of the asset or interest 51.27 shall be the fair market value at the time it was given away, 51.28 sold, or disposed of, less the amount of compensation received. 51.29 For any uncompensated transfer, the number of months of 51.30 ineligibility, including partial months, shall be calculated by 51.31 dividing the uncompensated transfer amount by the average 51.32 monthly per person payment made by the medical assistance 51.33 program to skilled nursing facilities for the previous calendar 51.34 year. The individual shall remain ineligible until this fixed 51.35 period has expired. The period of ineligibility may exceed 30 51.36 months, and a reapplication for benefits after 30 months from 52.1 the date of the transfer shall not result in eligibility unless 52.2 and until the period of ineligibility has expired. The period 52.3 of ineligibility begins in the month the transfer was reported 52.4 to the county agency, or if the transfer was not reported, the 52.5 month in which the county agency discovered the transfer, 52.6 whichever comes first. For applicants, the period of 52.7 ineligibility begins on the date of the first approved 52.8 application. 52.9 (i) When determining eligibility for any state benefits 52.10 under this subdivision, the income and resources of all 52.11 noncitizens shall be deemed to include their sponsor's income 52.12 and resources as defined in the Personal Responsibility and Work 52.13 Opportunity Reconciliation Act of 1996, title IV, Public Law 52.14 104-193, sections 421 and 422, and subsequently set out in 52.15 federal rules. 52.16 (j) Undocumented noncitizens and nonimmigrants are 52.17 ineligible for general assistance medical care, except that an 52.18 individual eligible under paragraph (a), clause (4), remains 52.19 eligible through September 30, 2003, and an undocumented 52.20 noncitizen or nonimmigrant who is diagnosed with active or 52.21 latent tuberculosis and meets all other eligibility requirements 52.22 of this section is eligible for the duration of the need for 52.23 tuberculosis treatment. For purposes of this subdivision, a 52.24 nonimmigrant is an individual in one or more of the classes 52.25 listed in United States Code, title 8, section 1101(a)(15), and 52.26 an undocumented noncitizen is an individual who resides in the 52.27 United States without the approval or acquiescence of the 52.28 Immigration and Naturalization Service. 52.29 (k) Notwithstanding any other provision of law, a 52.30 noncitizen who is ineligible for medical assistance due to the 52.31 deeming of a sponsor's income and resources, is ineligible for 52.32 general assistance medical care. 52.33 (l) Effective July 1, 2003, general assistance medical care 52.34 emergency services end. 52.35 [EFFECTIVE DATE.] This section is effective July 1, 2004, 52.36 except that the change in the income limit for hospital-only 53.1 coverage in paragraph (a), clause (2), item (ii) is effective 53.2 July 1, 2005. 53.3 Sec. 13. Minnesota Statutes 2003 Supplement, section 53.4 256D.03, subdivision 4, is amended to read: 53.5 Subd. 4. [GENERAL ASSISTANCE MEDICAL CARE; SERVICES.] 53.6 (a)(i) For a person who is eligible under subdivision 3, 53.7 paragraph (a), clause (2), item (i), general assistance medical 53.8 care covers, except as provided in paragraph (c): 53.9 (1) inpatient hospital services; 53.10 (2) outpatient hospital services; 53.11 (3) services provided by Medicare certified rehabilitation 53.12 agencies; 53.13 (4) prescription drugs and other products recommended 53.14 through the process established in section 256B.0625, 53.15 subdivision 13; 53.16 (5) equipment necessary to administer insulin and 53.17 diagnostic supplies and equipment for diabetics to monitor blood 53.18 sugar level; 53.19 (6) eyeglasses and eye examinations provided by a physician 53.20 or optometrist; 53.21 (7) hearing aids; 53.22 (8) prosthetic devices; 53.23 (9) laboratory and X-ray services; 53.24 (10) physician's services; 53.25 (11) medical transportation except special transportation; 53.26 (12) chiropractic services as covered under the medical 53.27 assistance program; 53.28 (13) podiatric services; 53.29 (14) dental services and dentures, subject to the53.30 limitations specified in section 256B.0625, subdivision 9as 53.31 covered under the medical assistance program; 53.32 (15) outpatient services provided by a mental health center 53.33 or clinic that is under contract with the county board and is 53.34 established under section 245.62; 53.35 (16) day treatment services for mental illness provided 53.36 under contract with the county board; 54.1 (17) prescribed medications for persons who have been 54.2 diagnosed as mentally ill as necessary to prevent more 54.3 restrictive institutionalization; 54.4 (18) psychological services, medical supplies and 54.5 equipment, and Medicare premiums, coinsurance and deductible 54.6 payments; 54.7 (19) medical equipment not specifically listed in this 54.8 paragraph when the use of the equipment will prevent the need 54.9 for costlier services that are reimbursable under this 54.10 subdivision; 54.11 (20) services performed by a certified pediatric nurse 54.12 practitioner, a certified family nurse practitioner, a certified 54.13 adult nurse practitioner, a certified obstetric/gynecological 54.14 nurse practitioner, a certified neonatal nurse practitioner, or 54.15 a certified geriatric nurse practitioner in independent 54.16 practice, if (1) the service is otherwise covered under this 54.17 chapter as a physician service, (2) the service provided on an 54.18 inpatient basis is not included as part of the cost for 54.19 inpatient services included in the operating payment rate, and 54.20 (3) the service is within the scope of practice of the nurse 54.21 practitioner's license as a registered nurse, as defined in 54.22 section 148.171; 54.23 (21) services of a certified public health nurse or a 54.24 registered nurse practicing in a public health nursing clinic 54.25 that is a department of, or that operates under the direct 54.26 authority of, a unit of government, if the service is within the 54.27 scope of practice of the public health nurse's license as a 54.28 registered nurse, as defined in section 148.171; and 54.29 (22) telemedicine consultations, to the extent they are 54.30 covered under section 256B.0625, subdivision 3b. 54.31 (ii) Effective October 1, 2003, for a person who is 54.32 eligible under subdivision 3, paragraph (a), clause (2), item 54.33 (ii), general assistance medical care coverage is limited to 54.34 inpatient hospital services, including physician services 54.35 provided during the inpatient hospital stay. A $1,000 54.36 deductible is required for each inpatient hospitalization. 55.1 (b) Gender reassignment surgery and related services are 55.2 not covered services under this subdivision unless the 55.3 individual began receiving gender reassignment services prior to 55.4 July 1, 1995. 55.5 (c) In order to contain costs, the commissioner of human 55.6 services shall select vendors of medical care who can provide 55.7 the most economical care consistent with high medical standards 55.8 and shall where possible contract with organizations on a 55.9 prepaid capitation basis to provide these services. The 55.10 commissioner shall consider proposals by counties and vendors 55.11 for prepaid health plans, competitive bidding programs, block 55.12 grants, or other vendor payment mechanisms designed to provide 55.13 services in an economical manner or to control utilization, with 55.14 safeguards to ensure that necessary services are provided. 55.15 Before implementing prepaid programs in counties with a county 55.16 operated or affiliated public teaching hospital or a hospital or 55.17 clinic operated by the University of Minnesota, the commissioner 55.18 shall consider the risks the prepaid program creates for the 55.19 hospital and allow the county or hospital the opportunity to 55.20 participate in the program in a manner that reflects the risk of 55.21 adverse selection and the nature of the patients served by the 55.22 hospital, provided the terms of participation in the program are 55.23 competitive with the terms of other participants considering the 55.24 nature of the population served. Payment for services provided 55.25 pursuant to this subdivision shall be as provided to medical 55.26 assistance vendors of these services under sections 256B.02, 55.27 subdivision 8, and 256B.0625. For payments made during fiscal 55.28 year 1990 and later years, the commissioner shall consult with 55.29 an independent actuary in establishing prepayment rates, but 55.30 shall retain final control over the rate methodology. 55.31 (d) Recipients eligible under subdivision 3, paragraph (a), 55.32 clause (2), item (i), shall pay the following co-payments for 55.33 services provided on or after October 1, 2003: 55.34 (1) $3 per nonpreventive visit. For purposes of this 55.35 subdivision, a visit means an episode of service which is 55.36 required because of a recipient's symptoms, diagnosis, or 56.1 established illness, and which is delivered in an ambulatory 56.2 setting by a physician or physician ancillary, chiropractor, 56.3 podiatrist, nurse midwife, advanced practice nurse, audiologist, 56.4 optician, or optometrist; 56.5 (2) $25 for eyeglasses; 56.6 (3) $25 for nonemergency visits to a hospital-based 56.7 emergency room; and 56.8 (4) $3 per brand-name drug prescription and $1 per generic 56.9 drug prescription, subject to a $20 per month maximum for 56.10 prescription drug co-payments. No co-payments shall apply to 56.11 antipsychotic drugs when used for the treatment of mental 56.12 illness ; and56.13 (5) 50 percent coinsurance on basic restorative dental56.14 services. 56.15 (e) Recipients of general assistance medical care are 56.16 responsible for all co-payments in this subdivision, except that 56.17 this requirement does not apply to recipients receiving group 56.18 residential housing payments under chapter 256I whose available 56.19 income is limited to a personal needs allowance under section 56.20 256B.35. The general assistance medical care reimbursement to 56.21 the provider shall be reduced by the amount of the co-payment, 56.22 except that reimbursement for prescription drugs shall not be 56.23 reduced once a recipient has reached the $20 per month maximum 56.24 for prescription drug co-payments. The provider collects the 56.25 co-payment from the recipient. Providers may not deny services 56.26 to recipients who are unable to pay the co-payment, except as 56.27 provided in paragraph (f). 56.28 (f) If it is the routine business practice of a provider to 56.29 refuse service to an individual with uncollected debt, the 56.30 provider may include uncollected co-payments under this 56.31 section. A provider must give advance notice to a recipient 56.32 with uncollected debt before services can be denied. 56.33 (g) Any county may, from its own resources, provide medical 56.34 payments for which state payments are not made. 56.35 (h) Chemical dependency services that are reimbursed under 56.36 chapter 254B must not be reimbursed under general assistance 57.1 medical care. 57.2 (i) The maximum payment for new vendors enrolled in the 57.3 general assistance medical care program after the base year 57.4 shall be determined from the average usual and customary charge 57.5 of the same vendor type enrolled in the base year. 57.6 (j) The conditions of payment for services under this 57.7 subdivision are the same as the conditions specified in rules 57.8 adopted under chapter 256B governing the medical assistance 57.9 program, unless otherwise provided by statute or rule. 57.10 (k) Inpatient and outpatient payments shall be reduced by 57.11 five percent, effective July 1, 2003. This reduction is in 57.12 addition to the five percent reduction effective July 1, 2003, 57.13 and incorporated by reference in paragraph (i). 57.14 (l) Payments for all other health services except 57.15 inpatient, outpatient, and pharmacy services shall be reduced by 57.16 five percent, effective July 1, 2003. 57.17 (m) Payments to managed care plans shall be reduced by five 57.18 percent for services provided on or after October 1, 2003. 57.19 (n) A hospital receiving a reduced payment as a result of 57.20 this section may apply the unpaid balance toward satisfaction of 57.21 the hospital's bad debts. 57.22 [EFFECTIVE DATE.] This section is effective January 1, 2005. 57.23 Sec. 14. Minnesota Statutes 2002, section 256L.01, 57.24 subdivision 5, is amended to read: 57.25 Subd. 5. [INCOME.] (a) "Income" has the meaning given for 57.26 earned and unearned income for families and children in the 57.27 medical assistance program, according to the state's aid to 57.28 families with dependent children plan in effect as of July 16, 57.29 1996. The definition does not include medical assistance income 57.30 methodologies and deeming requirements. The earned income of 57.31 full-time and part-time students under age 19 is not counted as 57.32 income. Public assistance payments and supplemental security 57.33 income are not excluded income. 57.34 (b) For purposes of this subdivision, and unless otherwise 57.35 specified in this section, the commissioner shall use reasonable 57.36 methods to calculate gross earned and unearned income including, 58.1 but not limited to, projecting income based on income received 58.2 within the last 30 days, the last 90 days, or the last 12 months. 58.3 [EFFECTIVE DATE.] This section is effective July 1, 2004. 58.4 Sec. 15. Minnesota Statutes 2003 Supplement, section 58.5 256L.03, subdivision 1, is amended to read: 58.6 Subdivision 1. [COVERED HEALTH SERVICES.] For individuals 58.7 under section 256L.04, subdivision 7, with income no greater 58.8 than 75 percent of the federal poverty guidelines or for 58.9 families with children under section 256L.04, subdivision 1, all 58.10 subdivisions of this section apply. "Covered health services" 58.11 means the health services reimbursed under chapter 256B, with 58.12 the exception of inpatient hospital services, special education 58.13 services, private duty nursing services, adult dental care 58.14 services other than servicesexcept as covered under section58.15 256B.0625,subdivision 9, paragraph (b), orthodontic services58.16 3b, nonemergency medical transportation services, personal care 58.17 assistant and case management services, nursing home or 58.18 intermediate care facilities services, inpatient mental health 58.19 services, and chemical dependency services. Outpatient mental 58.20 health services covered under the MinnesotaCare program are 58.21 limited to diagnostic assessments, psychological testing, 58.22 explanation of findings, medication management by a physician, 58.23 day treatment, partial hospitalization, and individual, family, 58.24 and group psychotherapy. 58.25 No public funds shall be used for coverage of abortion 58.26 under MinnesotaCare except where the life of the female would be 58.27 endangered or substantial and irreversible impairment of a major 58.28 bodily function would result if the fetus were carried to term; 58.29 or where the pregnancy is the result of rape or incest. 58.30 Covered health services shall be expanded as provided in 58.31 this section. 58.32 [EFFECTIVE DATE.] This section is effective January 1, 2005. 58.33 Sec. 16. Minnesota Statutes 2002, section 256L.03, is 58.34 amended by adding a subdivision to read: 58.35 Subd. 3b. [DENTAL SERVICES EFFECTIVE JANUARY 1, 2005.] (a) 58.36 Effective January 1, 2005, the provisions in paragraphs (b) to 59.1 (c) apply. 59.2 (b) For parents, grandparents, foster parents, relative 59.3 caretakers, and legal guardians eligible under section 256L.04, 59.4 subdivision 1, with incomes not exceeding 75 percent of the 59.5 federal poverty guidelines, dental services are covered as 59.6 provided under section 256B.0625, subdivision 9, except that no 59.7 coverage is provided for orthodontic services. 59.8 (c) For pregnant women and children under age 21, dental 59.9 services are covered as provided under section 256B.0625, 59.10 subdivision 9. 59.11 Sec. 17. Minnesota Statutes 2002, section 256L.03, 59.12 subdivision 5, is amended to read: 59.13 Subd. 5. [CO-PAYMENTS AND COINSURANCE.] (a) Except as 59.14 provided in paragraphs (b) and (c), the MinnesotaCare benefit 59.15 plan shall include the following co-payments and coinsurance 59.16 requirements for all enrollees: 59.17 (1) ten percent of the paid charges for inpatient hospital 59.18 services for adult enrollees, subject to an annual inpatient 59.19 out-of-pocket maximum of $1,000 per individual and $3,000 per 59.20 family; 59.21 (2) $3 per prescription for adult enrollees; 59.22 (3) $25 for eyeglasses for adult enrollees; and59.23 (4) $3 per nonpreventive visit. For purposes of this 59.24 subdivision, a visit means an episode of service which is 59.25 required because of an enrollee's symptoms, diagnosis, or 59.26 established illness, and which is delivered in an ambulatory 59.27 setting by a physician or physician ancillary, chiropractor, 59.28 podiatrist, advanced practice nurse, audiologist, optician, or 59.29 optometrist; 59.30 (5) $6 for nonemergency visits to a hospital-based 59.31 emergency room; and 59.32 (6) 50 percent of the fee-for-service rate for adult dental 59.33 care services other than preventive care services for persons 59.34 eligible under section 256L.04, subdivisions 1 to 7, with income 59.35 equal to or less than 175 percent of the federal poverty 59.36 guidelines. 60.1 (b) Paragraph (a), clause (1), does not apply to parents 60.2 and relative caretakers of children under the age of 21 in 60.3 households with family income equal to or less than 175 percent 60.4 of the federal poverty guidelines. Paragraph (a), clause (1), 60.5 does not apply to parents and relative caretakers of children 60.6 under the age of 21 in households with family income greater 60.7 than 175 percent of the federal poverty guidelines for inpatient 60.8 hospital admissions occurring on or after January 1, 2001. 60.9 (c) Paragraph (a), clauses (1) to (4)(6), do not apply to 60.10 pregnant women and children under the age of 21. 60.11 (d) Adult enrollees with family gross income that exceeds 60.12 175 percent of the federal poverty guidelines and who are not 60.13 pregnant shall be financially responsible for the coinsurance 60.14 amount, if applicable, and amounts which exceed the $10,000 60.15 inpatient hospital benefit limit. 60.16 (e) When a MinnesotaCare enrollee becomes a member of a 60.17 prepaid health plan, or changes from one prepaid health plan to 60.18 another during a calendar year, any charges submitted towards 60.19 the $10,000 annual inpatient benefit limit, and any 60.20 out-of-pocket expenses incurred by the enrollee for inpatient 60.21 services, that were submitted or incurred prior to enrollment, 60.22 or prior to the change in health plans, shall be disregarded. 60.23 (f) Paragraph (a), clauses (4) and (5), are limited to one 60.24 co-payment per day per provider. 60.25 [EFFECTIVE DATE.] This section is effective January 1, 2005. 60.26 Sec. 18. Minnesota Statutes 2003 Supplement, section 60.27 256L.035, is amended to read: 60.28 256L.035 [LIMITED BENEFITS COVERAGE FOR CERTAIN SINGLE 60.29 ADULTS AND HOUSEHOLDS WITHOUT CHILDREN.] 60.30 (a) "Covered health services" for individuals under section 60.31 256L.04, subdivision 7, with income above 75 percent, but not 60.32 exceeding 175 percent, of the federal poverty guideline means: 60.33 (1) inpatient hospitalization benefits with a ten percent 60.34 co-payment up to $1,000 and subject to an annual limitation of 60.35 $10,000; 60.36 (2) physician services provided during an inpatient stay; 61.1 and 61.2 (3) physician services not provided during an inpatient 61.3 stay ,; outpatient hospital services ,; chiropractic services 61.4 ,; lab and diagnostic services ,; vision services excluding the 61.5 dispensing, fitting, and adjustment of eyeglasses or contacts 61.6 and eye examinations to determine refractive state; and 61.7 prescription drugs ,; and supplies and equipment for diabetic 61.8 testing and insulin administration, subject to an aggregate cap 61.9 of $2,000 per calendar year and the following co-payments: 61.10 (i) $50 co-pay per emergency room visit; 61.11 (ii) $3 co-pay per prescription drug; and 61.12 (iii) $5 co-pay per nonpreventive physician and optometrist 61.13 visit. 61.14 For purposes of this subdivision, "a visit" means an 61.15 episode of service which is required because of a recipient's 61.16 symptoms, diagnosis, or established illness, and which is 61.17 delivered in an ambulatory setting by a physician or, physician 61.18 ancillary, or optometrist. 61.19 Enrollees are responsible for all co-payments in this 61.20 subdivision, except that this requirement does not apply to 61.21 enrollees receiving group residential housing payments under 61.22 chapter 256I whose available income is limited to a personal 61.23 needs allowance under section 256B.35. 61.24 (b) The November 2006 MinnesotaCare forecast for the 61.25 biennium beginning July 1, 2007, shall assume an adjustment in 61.26 the aggregate cap on the services identified in paragraph (a), 61.27 clause (3), in $1,000 increments up to a maximum of $10,000, but 61.28 not less than $2,000, to the extent that the balance in the 61.29 health care access fund is sufficient in each year of the 61.30 biennium to pay for this benefit level. The aggregate cap shall 61.31 be adjusted according to the forecast. 61.32 (c) Reimbursement to the providers shall be reduced by the 61.33 amount of the co-payment, except that reimbursement for 61.34 prescription drugs shall not be reduced once a recipient has 61.35 reached the $20 per month maximum for prescription drug 61.36 co-payments. The provider collects the co-payment from the 62.1 recipient. Providers may not deny services to recipients who 62.2 are unable to pay the co-payment, except as provided in 62.3 paragraph (d). 62.4 (d) If it is the routine business practice of a provider to 62.5 refuse service to an individual with uncollected debt, the 62.6 provider may include uncollected co-payments under this 62.7 section. A provider must give advance notice to a recipient 62.8 with uncollected debt before services can be denied. 62.9 [EFFECTIVE DATE.] This section is effective January 1, 2005. 62.10 Sec. 19. Minnesota Statutes 2002, section 256L.05, 62.11 subdivision 3, is amended to read: 62.12 Subd. 3. [EFFECTIVE DATE OF COVERAGE.] (a) The effective 62.13 date of coverage is the first day of the month following the 62.14 month in which eligibility is approved and the first premium 62.15 payment has been received. As provided in section 256B.057, 62.16 coverage for newborns is automatic from the date of birth and 62.17 must be coordinated with other health coverage. The effective 62.18 date of coverage for eligible newly adoptive children added to a 62.19 family receiving covered health services is the date of entry62.20 into the family. Themonth of placement or the month placement 62.21 is reported, whichever is later. The effective date of coverage 62.22 for other new recipientsmembers added to the family receiving62.23 covered health servicesis the first day of the month following 62.24 the month in which eligibility is approved or at renewal,62.25 whichever the family receiving covered health services62.26 prefersthe change is reported. All eligibility criteria must 62.27 be met by the family at the time the new family member is 62.28 added. The income of the new family member is included with the 62.29 family's gross income and the adjusted premium begins in the 62.30 month the new family member is added. 62.31 (b) The initial premium must be received by the last 62.32 working day of the month for coverage to begin the first day of 62.33 the following month. 62.34 (c) Benefits are not available until the day following 62.35 discharge if an enrollee is hospitalized on the first day of 62.36 coverage. 63.1 (d) Notwithstanding any other law to the contrary, benefits 63.2 under sections 256L.01 to 256L.18 are secondary to a plan of 63.3 insurance or benefit program under which an eligible person may 63.4 have coverage and the commissioner shall use cost avoidance 63.5 techniques to ensure coordination of any other health coverage 63.6 for eligible persons. The commissioner shall identify eligible 63.7 persons who may have coverage or benefits under other plans of 63.8 insurance or who become eligible for medical assistance. 63.9 Sec. 20. Minnesota Statutes 2003 Supplement, section 63.10 256L.07, subdivision 1, is amended to read: 63.11 Subdivision 1. [GENERAL REQUIREMENTS.] (a) Children 63.12 enrolled in the original children's health plan as of September 63.13 30, 1992, children who enrolled in the MinnesotaCare program 63.14 after September 30, 1992, pursuant to Laws 1992, chapter 549, 63.15 article 4, section 17, and children who have family gross 63.16 incomes that are equal to or less than 150 percent of the 63.17 federal poverty guidelines are eligible without meeting the 63.18 requirements of subdivision 2 and the four-month requirement in 63.19 subdivision 3, as long as they maintain continuous coverage in 63.20 the MinnesotaCare program or medical assistance. Children who 63.21 apply for MinnesotaCare on or after the implementation date of 63.22 the employer-subsidized health coverage program as described in 63.23 Laws 1998, chapter 407, article 5, section 45, who have family 63.24 gross incomes that are equal to or less than 150 percent of the 63.25 federal poverty guidelines, must meet the requirements of 63.26 subdivision 2 to be eligible for MinnesotaCare. 63.27 (b) Families enrolled in MinnesotaCare under section 63.28 256L.04, subdivision 1, whose income increases above 275 percent 63.29 of the federal poverty guidelines, are no longer eligible for 63.30 the program and shall be disenrolled by the commissioner. 63.31 Individuals enrolled in MinnesotaCare under section 256L.04, 63.32 subdivision 7, whose income increases above 175 percent of the 63.33 federal poverty guidelines are no longer eligible for the 63.34 program and shall be disenrolled by the commissioner. For63.35 persons disenrolled under this subdivision, MinnesotaCare63.36 coverage terminates the last day of the calendar month following64.1 the month in which the commissioner determines that the income64.2 of a family or individual exceeds program income limits.64.3 (c)(1) Notwithstanding paragraph (b), families enrolled in 64.4 MinnesotaCare under section 256L.04, subdivision 1, may remain 64.5 enrolled in MinnesotaCare if ten percent of their annual income 64.6 is less than the annual premium for a policy with a $500 64.7 deductible available through the Minnesota Comprehensive Health 64.8 Association. Families who are no longer eligible for 64.9 MinnesotaCare under this subdivision shall be given an 18-month 64.10 notice period from the date that ineligibility is determined 64.11 before disenrollment. This clause expires February 1, 2004. 64.12 (2) Effective February 1, 2004, notwithstanding paragraph 64.13 (b), children may remain enrolled in MinnesotaCare if ten 64.14 percent of their annual family income is less than the annual 64.15 premium for a policy with a $500 deductible available through 64.16 the Minnesota Comprehensive Health Association. Children who 64.17 are no longer eligible for MinnesotaCare under this clause shall 64.18 be given a 12-month notice period from the date that 64.19 ineligibility is determined before disenrollment. The premium 64.20 for children remaining eligible under this clause shall be the 64.21 maximum premium determined under section 256L.15, subdivision 2, 64.22 paragraph (b). 64.23 (d) Effective July 1, 2003, notwithstanding paragraphs (b) 64.24 and (c), parents are no longer eligible for MinnesotaCare if 64.25 gross household income exceeds $50,000. 64.26 Sec. 21. Minnesota Statutes 2003 Supplement, section 64.27 256L.07, subdivision 3, is amended to read: 64.28 Subd. 3. [OTHER HEALTH COVERAGE.] (a) Families and 64.29 individuals enrolled in the MinnesotaCare program must have no 64.30 health coverage while enrolled or for at least four months prior 64.31 to application and renewal. Children enrolled in the original 64.32 children's health plan and children in families with income 64.33 equal to or less than 150 percent of the federal poverty 64.34 guidelines, who have other health insurance, are eligible if the 64.35 coverage: 64.36 (1) lacks two or more of the following: 65.1 (i) basic hospital insurance; 65.2 (ii) medical-surgical insurance; 65.3 (iii) prescription drug coverage; 65.4 (iv) dental coverage; or 65.5 (v) vision coverage; 65.6 (2) requires a deductible of $100 or more per person per 65.7 year; or 65.8 (3) lacks coverage because the child has exceeded the 65.9 maximum coverage for a particular diagnosis or the policy 65.10 excludes a particular diagnosis. 65.11 The commissioner may change this eligibility criterion for 65.12 sliding scale premiums in order to remain within the limits of 65.13 available appropriations. The requirement of no health coverage 65.14 does not apply to newborns. 65.15 (b) Medical assistance, general assistance medical care, 65.16 and the Civilian Health and Medical Program of the Uniformed 65.17 Service, CHAMPUS, or other coverage provided under United States 65.18 Code, title 10, subtitle A, part II, chapter 55, are not 65.19 considered insurance or health coverage for purposes of the 65.20 four-month requirement described in this subdivision. 65.21 (c) For purposes of this subdivision, Medicare Part A or B 65.22 coverage under title XVIII of the Social Security Act, United 65.23 States Code, title 42, sections 1395c to 1395w-4, is considered 65.24 health coverage. An applicant or enrollee may not refusewho is 65.25 entitled to Medicare but has failed to apply or refused Medicare 65.26 coverage to establish eligibilityis not eligible for 65.27 MinnesotaCare. 65.28 (d) Applicants who were recipients of medical assistance or 65.29 general assistance medical care within one month of application 65.30 must meet the provisions of this subdivision and subdivision 2. 65.31 (e) Effective October 1, 2003, applicants who were65.32 recipients of medical assistance and hadCost-effective health 65.33 insurance whichthat was paid for by medical assistance are65.34 exempt fromis not considered health coverage for purposes of 65.35 the four-month requirement under this section, except if the 65.36 insurance continued after medical assistance no longer 66.1 considered it cost-effective or after medical assistance closed. 66.2 Sec. 22. [FEDERAL APPROVAL.] 66.3 The commissioner of human services shall request federal 66.4 approval to exempt from co-payments medical assistance 66.5 recipients with personal needs allowances by July 1, 2004, and 66.6 provide copies of the request to the chairs of the house Health 66.7 and Human Services Finance Committee and senate Health, Human 66.8 Services and Corrections Budget Division. If federal approval 66.9 to exempt all recipients with a personal needs allowance is not 66.10 obtained, the commissioner shall seek federal approval to exempt 66.11 from co-payments all those who can qualify for an exemption 66.12 through a state plan amendment or a waiver request. 66.13 Sec. 23. [REPEALER.] 66.14 Subdivision 1. [PRESCRIPTION DRUG PROGRAM.] Minnesota 66.15 Statutes 2002, section 256.955, subdivisions 1, 2, 2b, 4, 5, 6, 66.16 7, and 9; and Minnesota Statutes 2003 Supplement, section 66.17 256.955, subdivisions 2a, 3, and 4a, are repealed effective 66.18 January 1, 2006. 66.19 Subd. 2. [MINNESOTACARE OUTREACH GRANTS.] Minnesota 66.20 Statutes 2002, section 256L.04, subdivision 11, is repealed 66.21 effective July 1, 2004. 66.22 ARTICLE 10 66.23 LONG-TERM CARE 66.24 Section 1. Minnesota Statutes 2003 Supplement, section 66.25 144A.071, subdivision 4c, is amended to read: 66.26 Subd. 4c. [EXCEPTIONS FOR REPLACEMENT BEDS AFTER JUNE 30, 66.27 2003.] (a) The commissioner of health, in coordination with the 66.28 commissioner of human services, may approve the renovation, 66.29 replacement, upgrading, or relocation of a nursing home or 66.30 boarding care home, under the following conditions: 66.31 (1) to license and certify an 80-bed city-owned facility in 66.32 Nicollet County to be constructed on the site of a new 66.33 city-owned hospital to replace an existing 85-bed facility 66.34 attached to a hospital that is also being replaced. The 66.35 threshold allowed for this project under section 144A.073 shall 66.36 be the maximum amount available to pay the additional medical 67.1 assistance costs of the new facility; and67.2 (2) to license and certify 29 beds to be added to an 67.3 existing 69-bed facility in St. Louis County, provided that the 67.4 29 beds must be transferred from active or layaway status at an 67.5 existing facility in St. Louis County that had 235 beds on April 67.6 1, 2003. 67.7 The licensed capacity at the 235-bed facility must be reduced to 67.8 206 beds, but the payment rate at that facility shall not be 67.9 adjusted as a result of this transfer. The operating payment 67.10 rate of the facility adding beds after completion of this 67.11 project shall be the same as it was on the day prior to the day 67.12 the beds are licensed and certified. This project shall not 67.13 proceed unless it is approved and financed under the provisions 67.14 of section 144A.073; and 67.15 (3) to license and certify a new 60-bed facility in Austin, 67.16 provided that: 67.17 (i) 45 of the new beds are transferred from a 45-bed 67.18 facility in Austin under common ownership that is closed, and 15 67.19 of the new beds are transferred from a 182-bed facility in 67.20 Albert Lea under common ownership; 67.21 (ii) the commissioner of human services is authorized by 67.22 the 2004 legislature to negotiate budget-neutral planned nursing 67.23 facility closures; and 67.24 (iii) money is available from planned closures of 67.25 facilities under common ownership to make implementation of this 67.26 clause budget-neutral to the state. 67.27 The bed capacity of the Albert Lea facility shall be 67.28 reduced to 167 beds following the transfer. Of the 60 beds at 67.29 the new facility, 20 beds shall be used for a special care unit 67.30 for persons with Alzheimer's disease or related dementias. 67.31 (b) Projects approved under this subdivision shall be 67.32 treated in a manner equivalent to projects approved under 67.33 subdivision 4a. 67.34 Sec. 2. Minnesota Statutes 2002, section 144A.10, 67.35 subdivision 1a, is amended to read: 67.36 Subd. 1a. [TRAINING AND EDUCATION FOR NURSING FACILITY 68.1 PROVIDERS.] The commissioner of health must establish and 68.2 implement a prescribed process and program for providing 68.3 training and education to providers licensed by the Department 68.4 of Health, either by itself orin conjunction with the industry 68.5 trade associations, before using any new regulatory guideline, 68.6 regulation, interpretation, program letter or memorandum, or any 68.7 other materials used in surveyor training to survey licensed 68.8 providers. The process should include, but is not limited to, 68.9 the following key components: 68.10 (1) facilitate the implementation of immediate revisions to 68.11 any course curriculum for nursing assistants which reflect any 68.12 new standard of care practice that has been adopted or 68.13 referenced by the Health Department concerning the issue in 68.14 question; 68.15 (2) conduct training of long-term care providers and health 68.16 department survey inspectors eitherjointly or during the same68.17 time frameon the department's new expectations; and 68.18 (3) within available resourcesthe commissioner shall 68.19 cooperate in the development of clinical standards, work with68.20 vendors of supplies and services regarding hazards, and identify68.21 research of interest to the long-term care communityconsult 68.22 with experts in the field to develop or make available training 68.23 resources on current standards of practice and the use of 68.24 technology. 68.25 Sec. 3. Minnesota Statutes 2002, section 144A.10, is 68.26 amended by adding a subdivision to read: 68.27 Subd. 17. [AGENCY QUALITY IMPROVEMENT PROGRAM; ANNUAL 68.28 REPORT ON SURVEY PROCESS.] (a) The commissioner shall establish 68.29 a quality improvement program for the nursing facility survey 68.30 and complaint processes. The commissioner must regularly 68.31 consult with consumers, consumer advocates, and representatives 68.32 of the nursing home industry and representatives of nursing home 68.33 employees in implementing the program. The commissioner, 68.34 through the quality improvement program, shall submit to the 68.35 legislature an annual survey and certification quality 68.36 improvement report, beginning December 15, 2004, and each 69.1 December 15 thereafter. 69.2 (b) The report must include, but is not limited to, an 69.3 analysis of: 69.4 (1) the number, scope, and severity of citations by region 69.5 within the state; 69.6 (2) cross-referencing of citations by region within the 69.7 state and between states within the Centers for Medicare and 69.8 Medicaid Services region in which Minnesota is located; 69.9 (3) the number and outcomes of independent dispute 69.10 resolutions; 69.11 (4) the number and outcomes of appeals; 69.12 (5) compliance with timelines for survey revisits and 69.13 complaint investigations; 69.14 (6) techniques of surveyors in investigations, 69.15 communication, and documentation to identify and support 69.16 citations; 69.17 (7) compliance with timelines for providing facilities with 69.18 completed statements of deficiencies; and 69.19 (8) other survey statistics relevant to improving the 69.20 survey process. 69.21 (c) The report must also identify and explain 69.22 inconsistencies and patterns across regions of the state, 69.23 include analyses and recommendations for quality improvement 69.24 areas identified by the commissioner, consumers, consumer 69.25 advocates, and representatives of the nursing home industry and 69.26 nursing home employees, and provide action plans to address 69.27 problems that are identified. 69.28 Sec. 4. [144A.101] [PROCEDURES FOR FEDERALLY REQUIRED 69.29 SURVEY PROCESS.] 69.30 Subdivision 1. [APPLICABILITY.] This section applies to 69.31 survey certification and enforcement activities by the 69.32 commissioner related to regular, expanded, or extended surveys 69.33 under Code of Federal Regulations, title 42, part 488. 69.34 Subd. 2. [STATEMENT OF DEFICIENCIES.] The commissioner 69.35 shall provide nursing facilities with draft statements of 69.36 deficiencies at the time of the survey exit process and shall 70.1 provide facilities with completed statements of deficiencies 70.2 within 15 working days of the exit process. 70.3 Subd. 3. [SURVEYOR NOTES.] The commissioner, upon the 70.4 request of a nursing facility, shall provide the facility with 70.5 copies of formal surveyor notes taken during the survey, with 70.6 the exception of the resident, family, and staff interviews, at 70.7 the time the completed statement of deficiency is provided to 70.8 the facility. The survey notes shall be redacted to protect the 70.9 confidentiality of individuals providing information to the 70.10 surveyors. A facility requesting formal surveyor notes must 70.11 agree to pay the commissioner for the cost of copying and 70.12 redacting. 70.13 Subd. 4. [POSTING OF STATEMENTS OF DEFICIENCIES.] The 70.14 commissioner, when posting statements of a nursing facility's 70.15 deficiencies on the agency Web site, must include in the posting 70.16 the facility's response to the citations. The Web site must 70.17 also include the dates upon which deficiencies are corrected and 70.18 the date upon which a facility is considered to be in compliance 70.19 with survey requirements. If deficiencies are under dispute, 70.20 the commissioner must note this on the Web site using a method 70.21 that clearly identifies for consumers which citations are under 70.22 dispute. 70.23 Subd. 5. [SURVEY REVISITS.] The commissioner shall conduct 70.24 survey revisits within 15 calendar days of the date by which 70.25 corrections will be completed, as specified by the provider in 70.26 its plan of correction, in cases where category 2 or category 3 70.27 remedies are in place. The commissioner may conduct survey 70.28 revisits by telephone or written communications for facilities 70.29 at which the highest scope and severity score for a violation 70.30 was level E or lower. 70.31 Subd. 6. [FAMILY COUNCILS.] Nursing facility family 70.32 councils shall be interviewed as part of the survey process and 70.33 invited to participate in the exit conference. 70.34 Sec. 5. Minnesota Statutes 2002, section 256.01, is 70.35 amended by adding a subdivision to read: 70.36 Subd. 21. [INTERAGENCY AGREEMENT WITH DEPARTMENT OF 71.1 HEALTH.] The commissioner of human services shall amend the 71.2 interagency agreement with the commissioner of health to certify 71.3 nursing facilities for participation in the medical assistance 71.4 program, to require the commissioner of health, as a condition 71.5 of the agreement, to comply beginning July 1, 2005, with action 71.6 plans included in the annual survey and certification quality 71.7 improvement report required under section 144A.10, subdivision 71.8 17. 71.9 Sec. 6. Minnesota Statutes 2002, section 256B.431, is 71.10 amended by adding a subdivision to read: 71.11 Subd. 40. [DESIGNATION OF AREAS TO RECEIVE METROPOLITAN 71.12 RATES.] (a) For rate years beginning on or after July 1, 2004, 71.13 and subject to paragraph (b), nursing facilities located in 71.14 areas designated as metropolitan areas by the federal Office of 71.15 Management and Budget using census bureau data shall be 71.16 considered metro, in order to: 71.17 (1) determine rate increases under this section, section 71.18 256B.434, or any other section; and 71.19 (2) establish nursing facility reimbursement rates for the 71.20 new nursing facility reimbursement system developed under Laws 71.21 2001, First Special Session chapter 9, article 5, section 35, as 71.22 amended by Laws 2002, chapter 220, article 14, section 19. 71.23 (b) Paragraph (a) applies only if designation as a metro 71.24 facility results in a level of reimbursement that is higher than 71.25 the level the facility would have received without application 71.26 of that paragraph. 71.27 [EFFECTIVE DATE.] This section is effective July 1, 2004. 71.28 Sec. 7. Minnesota Statutes 2002, section 256B.431, is 71.29 amended by adding a subdivision to read: 71.30 Subd. 41. [PROFESSIONAL LIABILITY COSTS.] (a) The 71.31 commissioner shall make available to eligible nursing facilities 71.32 reimbursed under this section whose rates are not determined 71.33 under Minnesota Rules, part 9549.0057, and to eligible nursing 71.34 facilities reimbursed under section 256B.434, an adjustment to 71.35 the nursing facility's operating cost per diems for the rate 71.36 year beginning July 1, 2004, to assist facilities in paying 72.1 increased professional liability insurance premiums where the 72.2 increase, on a per bed basis, is greater than five percent. The 72.3 per diem adjustment shall be computed by the commissioner using 72.4 the information described in paragraph (b) and the method 72.5 described in paragraph (c). This adjustment is onetime and must 72.6 not be included in a facility's base when calculating operating 72.7 cost per diems for rate years beginning on or after July 1, 2005. 72.8 (b) A facility is eligible for an adjustment if the 72.9 facility experienced a rate of increase in premiums for 72.10 professional liability insurance of more than five percent 72.11 between calendar years 2002 and 2003, and provides to the 72.12 commissioner, in the form and manner specified by the 72.13 commissioner, information on the amount of premiums paid for 72.14 professional liability insurance for calendar years 2002 and 72.15 2003. The information must be delivered to the commissioner by 72.16 October 1, 2004, or postmarked by September 30, 2004. 72.17 Facilities that do not meet this deadline are ineligible for the 72.18 rate adjustment. 72.19 (c) The commissioner shall review the information timely 72.20 submitted under paragraph (b) to determine each facility's 72.21 allowable increased costs. For purposes of this requirement, 72.22 "allowable increased costs" is the dollar amount of the portion 72.23 of the percentage increase in a facility's professional 72.24 liability insurance between calendar years 2002 and 2003 that 72.25 exceeds five percent, on a per bed basis. Subject to the 72.26 limitation in paragraph (d), the commissioner shall compute a 72.27 facility's rate adjustment by dividing the allowable increased 72.28 costs for that facility by actual resident days from the most 72.29 recent reporting year. 72.30 (d) If the rate increases are projected to increase the 72.31 state share of medical assistance costs by $1,550,000 or less, 72.32 the rate adjustments shall be implemented. If the rate 72.33 increases are projected to increase the state share of medical 72.34 assistance costs by more than $1,550,000, the commissioner shall 72.35 proportionally decrease each facility's rate adjustment to 72.36 levels that project to spending no more than $1,550,000. 73.1 Sec. 8. Minnesota Statutes 2003 Supplement, section 73.2 256B.434, subdivision 4, is amended to read: 73.3 Subd. 4. [ALTERNATE RATES FOR NURSING FACILITIES.] (a) For 73.4 nursing facilities which have their payment rates determined 73.5 under this section rather than section 256B.431, the 73.6 commissioner shall establish a rate under this subdivision. The 73.7 nursing facility must enter into a written contract with the 73.8 commissioner. 73.9 (b) A nursing facility's case mix payment rate for the 73.10 first rate year of a facility's contract under this section is 73.11 the payment rate the facility would have received under section 73.12 256B.431. 73.13 (c) A nursing facility's case mix payment rates for the 73.14 second and subsequent years of a facility's contract under this 73.15 section are the previous rate year's contract payment rates plus 73.16 an inflation adjustment and, for facilities reimbursed under 73.17 this section or section 256B.431, an adjustment to include the 73.18 cost of any increase in Health Department licensing fees for the 73.19 facility taking effect on or after July 1, 2001. The index for 73.20 the inflation adjustment must be based on the change in the 73.21 Consumer Price Index-All Items (United States City average) 73.22 (CPI-U) forecasted by the commissioner of finance's national 73.23 economic consultant, as forecasted in the fourth quarter of the 73.24 calendar year preceding the rate year. The inflation adjustment 73.25 must be based on the 12-month period from the midpoint of the 73.26 previous rate year to the midpoint of the rate year for which 73.27 the rate is being determined. For the rate years beginning on 73.28 July 1, 1999, July 1, 2000, July 1, 2001, July 1, 2002, July 1, 73.29 2003, andJuly 1, 2004, July 1, 2005, and July 1, 2006, this 73.30 paragraph shall apply only to the property-related payment rate, 73.31 except that adjustments to include the cost of any increase in 73.32 Health Department licensing fees taking effect on or after July 73.33 1, 2001, shall be provided. In determining the amount of the 73.34 property-related payment rate adjustment under this paragraph, 73.35 the commissioner shall determine the proportion of the 73.36 facility's rates that are property-related based on the 74.1 facility's most recent cost report. 74.2 (d) The commissioner shall develop additional 74.3 incentive-based payments of up to five percent above the 74.4 standard contract rate for achieving outcomes specified in each 74.5 contract. The specified facility-specific outcomes must be 74.6 measurable and approved by the commissioner. The commissioner 74.7 may establish, for each contract, various levels of achievement 74.8 within an outcome. After the outcomes have been specified the 74.9 commissioner shall assign various levels of payment associated 74.10 with achieving the outcome. Any incentive-based payment cancels 74.11 if there is a termination of the contract. In establishing the 74.12 specified outcomes and related criteria the commissioner shall 74.13 consider the following state policy objectives: 74.14 (1) improved cost effectiveness and quality of life as 74.15 measured by improved clinical outcomes; 74.16 (2) successful diversion or discharge to community 74.17 alternatives; 74.18 (3) decreased acute care costs; 74.19 (4) improved consumer satisfaction; 74.20 (5) the achievement of quality; or 74.21 (6) any additional outcomes proposed by a nursing facility 74.22 that the commissioner finds desirable. 74.23 Sec. 9. [GRANTS TO MEDICARE CERTIFIED HOME CARE AGENCIES.] 74.24 Subdivision 1. [GRANT AVAILABILITY.] The commissioner of 74.25 human services shall make available to eligible Medicare 74.26 certified home care agencies reimbursed under Minnesota 74.27 Statutes, chapter 256B, grants to assist agencies in paying 74.28 professional liability insurance premiums greater than five 74.29 percent from the previous year. These grants are onetime and 74.30 shall not be included in an agency's payment rate. 74.31 Subd. 2. [ELIGIBILITY FOR GRANTS.] An agency is eligible 74.32 for a grant if the agency experienced a rate increase in 74.33 premiums for professional liability insurance of more than five 74.34 percent between calendar years 2002 and 2003, and provides to 74.35 the commissioner, in the form and manner specified by the 74.36 commissioner, information on the amount of premiums paid for 75.1 professional liability insurance for calendar years 2002 and 75.2 2003, and any increases in the number of client visits and the 75.3 number of employees for that time period. The information must 75.4 be delivered to the commissioner by October 1, 2004, or 75.5 postmarked by September 30, 2004. Agencies that do not meet this 75.6 deadline are ineligible for a grant. 75.7 Subd. 3. [GRANT BASED ON ALLOWABLE INCREASED COSTS.] The 75.8 commissioner shall review the information timely submitted to 75.9 determine each agency's allowable increased costs, and subject 75.10 to the limitations in subdivision 4, shall provide a grant to 75.11 the agency equal to the agency's allowable increased costs. For 75.12 purposes of this requirement, "allowable increased costs" is the 75.13 dollar amount of the portion of the percentage increase in an 75.14 agency's professional liability insurance premiums between 75.15 calendar years 2002 and 2003 that exceeds five percent, minus 75.16 any dollar amount due to an increase in the number of client 75.17 visits or the number of employees. 75.18 Subd. 4. [STATE SHARE; FEDERAL MATCH.] If the grants 75.19 provided to agencies are projected to increase state spending by 75.20 more than $150,000, the commissioner shall proportionally 75.21 decrease agency grant amounts to levels that limit state 75.22 spending to $150,000. If the commissioner is able to obtain a 75.23 federal match of medical assistance for this purpose, the 75.24 federal match shall be added to the state allocation, and used 75.25 to provide grants under this section. 75.26 Sec. 10. [NURSING FACILITY SCHOLARSHIP PROGRAM.] 75.27 For the rate year beginning July 1, 2004, the amount 75.28 determined under Minnesota Statutes, section 256B.431, 75.29 subdivision 36, shall be removed from each nursing facility's 75.30 rate. 75.31 Sec. 11. [PROGRESS REPORT.] 75.32 The commissioner of health shall include in the December 75.33 15, 2004, quality improvement report required under section 3 a 75.34 progress report and implementation plan for the following 75.35 legislatively directed activities: 75.36 (1) an analysis of the frequency of defensive documentation 76.1 and a plan, developed in consultation with the nursing home 76.2 industry, consumers, unions representing nursing home employees, 76.3 and advocates, to minimize defensive documentation; 76.4 (2) the nursing home providers workgroup established under 76.5 Laws 2003, First Special Session chapter 14, article 13C, 76.6 section 3; and 76.7 (3) progress in implementing the independent informal 76.8 dispute resolution process required under Minnesota Statutes, 76.9 section 144A.10, subdivision 16. 76.10 Sec. 12. [RESUBMITTAL OF REQUESTS FOR FEDERAL WAIVERS AND 76.11 APPROVALS.] 76.12 (a) The commissioner of health shall seek federal waivers, 76.13 approvals, and law changes necessary to implement the 76.14 alternative nursing home survey process established under 76.15 Minnesota Statutes, section 144A.37. 76.16 (b) The commissioner of health shall seek changes in the 76.17 federal policy that mandates the imposition of federal sanctions 76.18 without providing an opportunity for a nursing facility to 76.19 correct deficiencies, solely as the result of previous 76.20 deficiencies issued to the nursing facility. 76.21 Sec. 13. [REPEALER; NURSING FACILITY SCHOLARSHIPS.] 76.22 Minnesota Statutes 2003 Supplement, section 256B.431, 76.23 subdivision 36, is repealed effective July 1, 2004. 76.24 ARTICLE 11 76.25 CONTINUING CARE 76.26 Section 1. Minnesota Statutes 2003 Supplement, section 76.27 252.27, subdivision 2a, is amended to read: 76.28 Subd. 2a. [CONTRIBUTION AMOUNT.] (a) The natural or 76.29 adoptive parents of a minor child, including a child determined 76.30 eligible for medical assistance without consideration of 76.31 parental income, must contribute monthly to the cost of 76.32 services, unless the child is married or has been married, 76.33 parental rights have been terminated, or the child's adoption is 76.34 subsidized according to section 259.67 or through title IV-E of 76.35 the Social Security Act. 76.36 (b) For households with adjusted gross income equal to or 77.1 greater than 100 percent of federal poverty guidelines, the 77.2 parental contribution shall be computed by applying the 77.3 following schedule of rates to the adjusted gross income of the 77.4 natural or adoptive parents: 77.5 (1) if the adjusted gross income is equal to or greater 77.6 than 100 percent of federal poverty guidelines and less than 175 77.7 percent of federal poverty guidelines, the parental contribution 77.8 is $4 per month; 77.9 (2) if the adjusted gross income is equal to or greater 77.10 than 175 percent of federal poverty guidelines and less than or 77.11 equal to 375545 percent of federal poverty guidelines, the 77.12 parental contribution shall be determined using a sliding fee 77.13 scale established by the commissioner of human services which 77.14 begins at one percent of adjusted gross income at 175 percent of 77.15 federal poverty guidelines and increases to 7.5 percent of 77.16 adjusted gross income for those with adjusted gross income up to 77.17 375545 percent of federal poverty guidelines; 77.18 (3) if the adjusted gross income is greater than 375545 77.19 percent of federal poverty guidelines and less than 675 percent 77.20 of federal poverty guidelines, the parental contribution shall 77.21 be 7.5 percent of adjusted gross income; 77.22 (4) if the adjusted gross income is equal to or greater 77.23 than 675 percent of federal poverty guidelines and less than 975 77.24 percent of federal poverty guidelines, the parental contribution 77.25 shall be determined using a sliding fee scale established by the 77.26 commissioner of human services which begins at 7.5 percent of 77.27 adjusted gross income at 675 percent of federal poverty 77.28 guidelines and increases to ten percent of adjusted gross income 77.29 for those with adjusted gross income up to 975 percent of 77.30 federal poverty guidelines; and 77.31 (5) if the adjusted gross income is equal to or greater 77.32 than 975 percent of federal poverty guidelines, the parental 77.33 contribution shall be 12.5 percent of adjusted gross income. 77.34 If the child lives with the parent, the annual adjusted 77.35 gross income is reduced by $2,400 prior to calculating the 77.36 parental contribution. If the child resides in an institution 78.1 specified in section 256B.35, the parent is responsible for the 78.2 personal needs allowance specified under that section in 78.3 addition to the parental contribution determined under this 78.4 section. The parental contribution is reduced by any amount 78.5 required to be paid directly to the child pursuant to a court 78.6 order, but only if actually paid. 78.7 (c) The household size to be used in determining the amount 78.8 of contribution under paragraph (b) includes natural and 78.9 adoptive parents and their dependents under age 21, including 78.10 the child receiving services. Adjustments in the contribution 78.11 amount due to annual changes in the federal poverty guidelines 78.12 shall be implemented on the first day of July following 78.13 publication of the changes. 78.14 (d) For purposes of paragraph (b), "income" means the 78.15 adjusted gross income of the natural or adoptive parents 78.16 determined according to the previous year's federal tax form, 78.17 except, effective retroactive to July 1, 2003, taxable capital 78.18 gains to the extent the funds have been used to purchase a home 78.19 shall not be counted as income. 78.20 (e) The contribution shall be explained in writing to the 78.21 parents at the time eligibility for services is being 78.22 determined. The contribution shall be made on a monthly basis 78.23 effective with the first month in which the child receives 78.24 services. Annually upon redetermination or at termination of 78.25 eligibility, if the contribution exceeded the cost of services 78.26 provided, the local agency or the state shall reimburse that 78.27 excess amount to the parents, either by direct reimbursement if 78.28 the parent is no longer required to pay a contribution, or by a 78.29 reduction in or waiver of parental fees until the excess amount 78.30 is exhausted. 78.31 (f) The monthly contribution amount must be reviewed at 78.32 least every 12 months; when there is a change in household size; 78.33 and when there is a loss of or gain in income from one month to 78.34 another in excess of ten percent. The local agency shall mail a 78.35 written notice 30 days in advance of the effective date of a 78.36 change in the contribution amount. A decrease in the 79.1 contribution amount is effective in the month that the parent 79.2 verifies a reduction in income or change in household size. 79.3 (g) Parents of a minor child who do not live with each 79.4 other shall each pay the contribution required under paragraph 79.5 (a). An amount equal to the annual court-ordered child support 79.6 payment actually paid on behalf of the child receiving services 79.7 shall be deducted from the adjusted gross income of the parent 79.8 making the payment prior to calculating the parental 79.9 contribution under paragraph (b). 79.10 (h) The contribution under paragraph (b) shall be increased 79.11 by an additional five percent if the local agency determines 79.12 that insurance coverage is available but not obtained for the 79.13 child. For purposes of this section, "available" means the 79.14 insurance is a benefit of employment for a family member at an 79.15 annual cost of no more than five percent of the family's annual 79.16 income. For purposes of this section, "insurance" means health 79.17 and accident insurance coverage, enrollment in a nonprofit 79.18 health service plan, health maintenance organization, 79.19 self-insured plan, or preferred provider organization. 79.20 Parents who have more than one child receiving services 79.21 shall not be required to pay more than the amount for the child 79.22 with the highest expenditures. There shall be no resource 79.23 contribution from the parents. The parent shall not be required 79.24 to pay a contribution in excess of the cost of the services 79.25 provided to the child, not counting payments made to school 79.26 districts for education-related services. Notice of an increase 79.27 in fee payment must be given at least 30 days before the 79.28 increased fee is due. 79.29 (i) The contribution under paragraph (b) shall be reduced 79.30 by $300 per fiscal year if, in the 12 months prior to July 1: 79.31 (1) the parent applied for insurance for the child; 79.32 (2) the insurer denied insurance; 79.33 (3) the parents submitted a complaint or appeal, in writing 79.34 to the insurer, submitted a complaint or appeal, in writing, to 79.35 the commissioner of health or the commissioner of commerce, or 79.36 litigated the complaint or appeal; and 80.1 (4) as a result of the dispute, the insurer reversed its 80.2 decision and granted insurance. 80.3 For purposes of this section, "insurance" has the meaning 80.4 given in paragraph (h). 80.5 A parent who has requested a reduction in the contribution 80.6 amount under this paragraph shall submit proof in the form and 80.7 manner prescribed by the commissioner or county agency, 80.8 including, but not limited to, the insurer's denial of 80.9 insurance, the written letter or complaint of the parents, court 80.10 documents, and the written response of the insurer approving 80.11 insurance. The determinations of the commissioner or county 80.12 agency under this paragraph are not rules subject to chapter 14. 80.13 Sec. 2. Minnesota Statutes 2002, section 256.9365, 80.14 subdivision 1, is amended to read: 80.15 Subdivision 1. [PROGRAM ESTABLISHED.] The commissioner of 80.16 human services shall establish a program to pay private health 80.17 plan premiums for persons who have contracted human 80.18 immunodeficiency virus (HIV) to enable them to continue coverage 80.19 under a group or individual health plan. If a person is 80.20 determined to be eligible under subdivision 2, the commissioner 80.21 shall pay the portion of the group plan premium for which the 80.22 individual is responsible, if the individual is responsible for 80.23 at least 50 percent of the cost of the premium, or pay the 80.24 individual plan premium. The commissioner shall not pay for 80.25 that portion of a premium that is attributable to other family 80.26 members or dependents. The commissioner shall establish 80.27 cost-sharing provisions for individuals participating in this 80.28 program that are consistent with provisions in section 256B.057, 80.29 subdivision 9, for employed persons with disabilities. 80.30 [EFFECTIVE DATE.] This section is effective July 1, 2004. 80.31 Sec. 3. Minnesota Statutes 2002, section 256B.0916, 80.32 subdivision 2, is amended to read: 80.33 Subd. 2. [DISTRIBUTION OF FUNDS; PARTNERSHIPS.] (a) 80.34 Beginning with fiscal year 2000, the commissioner shall 80.35 distribute all funding available for home and community-based 80.36 waiver services for persons with mental retardation or related 81.1 conditions to individual counties or to groups of counties that 81.2 form partnerships to jointly plan, administer, and authorize 81.3 funding for eligible individuals. The commissioner shall 81.4 encourage counties to form partnerships that have a sufficient 81.5 number of recipients and funding to adequately manage the risk 81.6 and maximize use of available resources. 81.7 (b) Counties must submit a request for funds and a plan for 81.8 administering the program as required by the commissioner. The 81.9 plan must identify the number of clients to be served, their 81.10 ages, and their priority listing based on: 81.11 (1) requirements in Minnesota Rules, part 9525.1880; 81.12 (2) unstable living situations due to the age or incapacity 81.13 of the primary caregiver; 81.14 (3) the need for services to avoid out-of-home placement of 81.15 children; and81.16 (4) the need to serve persons affected by private sector 81.17 ICF/MR closures; and 81.18 (5) the need to serve persons whose consumer support grant 81.19 exception amount was eliminated in 2004. 81.20 The plan must also identify changes made to improve services to 81.21 eligible persons and to improve program management. 81.22 (c) In allocating resources to counties, priority must be 81.23 given to groups of counties that form partnerships to jointly 81.24 plan, administer, and authorize funding for eligible individuals 81.25 and to counties determined by the commissioner to have 81.26 sufficient waiver capacity to maximize resource use. 81.27 (d) Within 30 days after receiving the county request for 81.28 funds and plans, the commissioner shall provide a written 81.29 response to the plan that includes the level of resources 81.30 available to serve additional persons. 81.31 (e) Counties are eligible to receive medical assistance 81.32 administrative reimbursement for administrative costs under 81.33 criteria established by the commissioner. 81.34 Sec. 4. Minnesota Statutes 2003 Supplement, section 81.35 256B.19, subdivision 1, is amended to read: 81.36 Subdivision 1. [DIVISION OF COST.] The state and county 82.1 share of medical assistance costs not paid by federal funds 82.2 shall be as follows: 82.3 (1) beginning January 1, 1992, 50 percent state funds and 82.4 50 percent county funds for the cost of placement of severely 82.5 emotionally disturbed children in regional treatment centers; 82.6 (2) beginning January 1, 2003, 80 percent state funds and 82.7 20 percent county funds for the costs of nursing facility 82.8 placements of persons with disabilities under the age of 65 that 82.9 have exceeded 90 days. This clause shall be subject to chapter 82.10 256G and shall not apply to placements in facilities not 82.11 certified to participate in medical assistance; and 82.12 (3) beginning July 1, 2004, 80 percent state funds and 2082.13 percent county funds for the costs of placements that have82.14 exceeded 90 days in intermediate care facilities for persons82.15 with mental retardation or a related condition that have seven82.16 or more beds. This provision includes pass-through payments82.17 made under section 256B.5015; and82.18 (4)beginning July 1, 2004, when state funds are used to 82.19 pay for a nursing facility placement due to the facility's 82.20 status as an institution for mental diseases (IMD), the county 82.21 shall pay 20 percent of the nonfederal share of costs that have 82.22 exceeded 90 days. This clause is subject to chapter 256G. 82.23 For counties that participate in a Medicaid demonstration 82.24 project under sections 256B.69 and 256B.71, the division of the 82.25 nonfederal share of medical assistance expenses for payments 82.26 made to prepaid health plans or for payments made to health 82.27 maintenance organizations in the form of prepaid capitation 82.28 payments, this division of medical assistance expenses shall be 82.29 95 percent by the state and five percent by the county of 82.30 financial responsibility. 82.31 In counties where prepaid health plans are under contract 82.32 to the commissioner to provide services to medical assistance 82.33 recipients, the cost of court ordered treatment ordered without 82.34 consulting the prepaid health plan that does not include 82.35 diagnostic evaluation, recommendation, and referral for 82.36 treatment by the prepaid health plan is the responsibility of 83.1 the county of financial responsibility. 83.2 [EFFECTIVE DATE.] This section is effective the day 83.3 following final enactment. 83.4 Sec. 5. Minnesota Statutes 2002, section 256B.49, is 83.5 amended by adding a subdivision to read: 83.6 Subd. 21. [REPORT.] The commissioner shall expand on the 83.7 annual report required under section 256B.0916, subdivision 7, 83.8 to include information on the county of residence and financial 83.9 responsibility, age, and major diagnoses for persons eligible 83.10 for the home and community-based waivers authorized under 83.11 subdivision 11 who are: 83.12 (1) receiving those services; 83.13 (2) screened and waiting for waiver services; and 83.14 (3) residing in nursing facilities and are under age 65. 83.15 Sec. 6. [ICF/MR PLAN.] 83.16 The commissioner of human services shall consult with 83.17 ICF/MR providers, advocates, counties, and consumer families to 83.18 develop recommendations and legislation concerning the future 83.19 services provided to people now served in ICFs/MR. The 83.20 recommendations shall be reported to the house and senate 83.21 committees with jurisdiction over health and human services 83.22 policy and finance issues by December 15, 2004. In preparing 83.23 the recommendations, the commissioner shall consider: 83.24 (1) consumer choice of services; 83.25 (2) consumers' service needs, including, but not limited 83.26 to, active treatment; 83.27 (3) the total cost of providing services in ICFs/MR and 83.28 alternative delivery systems; 83.29 (4) whether it is the policy of the state to maintain an 83.30 ICF/MR system and, if so, the recommendations shall define the 83.31 ICF/MR payment system to ensure adequate resources to meet 83.32 changing consumer needs, provide crisis and respite services, 83.33 and ensure stability when occupancy changes; and 83.34 (5) if alternative services are recommended to support 83.35 people now receiving services in an ICF/MR, the recommendations 83.36 shall ensure adequate financial resources are available to meet 84.1 the needs of ICF/MR recipients. 84.2 [EFFECTIVE DATE.] This section is effective the day 84.3 following final enactment. 84.4 Sec. 7. [CONSUMER DIRECTED COMMUNITY SUPPORT; INDEPENDENT 84.5 EVALUATION AND STAKEHOLDER PARTICIPATION.] 84.6 The commissioner shall consult with a group of interested 84.7 stakeholders including representatives of persons affected, 84.8 families, guardians, advocacy groups, counties, and providers in 84.9 conducting an independent evaluation of the new consumer 84.10 directed community support option under the home and 84.11 community-based waiver programs required by the federal Center 84.12 for Medicare and Medicaid Services. The independent evaluation 84.13 shall include, but not be limited to, an examination of whether 84.14 any current consumer directed option participants will have 84.15 their funding reduced so significantly that their health, 84.16 safety, and welfare at home will be jeopardized and whether 84.17 replacement services will cost more or be of lower quality than 84.18 their current consumer directed services. The preliminary 84.19 findings of the independent evaluation shall be provided to the 84.20 house and senate committees with jurisdiction over human 84.21 services policy and finance by February 15, 2005. 84.22 ARTICLE 12 84.23 DHS PROGRAM INTEGRITY AND ADMINISTRATION 84.24 Section 1. Minnesota Statutes 2002, section 256.01, is 84.25 amended by adding a subdivision to read: 84.26 Subd. 2a. [AUTHORIZATION FOR TEST SITES FOR HEALTH CARE 84.27 PROGRAMS.] In coordination with the development and 84.28 implementation of HealthMatch, an automated eligibility system 84.29 for medical assistance, general assistance medical care, and 84.30 MinnesotaCare, the commissioner, in cooperation with county 84.31 agencies, is authorized to test and compare a variety of 84.32 administrative models to demonstrate and evaluate outcomes of 84.33 integrating health care program business processes and points of 84.34 access. The models will be evaluated for ease of enrollment for 84.35 health care program applicants and recipients and administrative 84.36 efficiencies. Test sites will combine the administration of all 85.1 three programs and will include both local county and 85.2 centralized statewide customer assistance. The duration of each 85.3 approved test site shall be no more than one year. Based on the 85.4 evaluation, the commissioner shall recommend the most efficient 85.5 and effective administrative model for statewide implementation. 85.6 Sec. 2. Minnesota Statutes 2003 Supplement, section 85.7 256.019, subdivision 1, is amended to read: 85.8 Subdivision 1. [RETENTION RATES.] When an assistance 85.9 recovery amount is collected and posted by a county agency under 85.10 the provisions governing public assistance programs including 85.11 general assistance medical care, general assistance, and 85.12 Minnesota supplemental aid, the county may keep one-half of the 85.13 recovery made by the county agency using any method other than 85.14 recoupment. For medical assistance, if the recovery is made by 85.15 a county agency using any method other than recoupment, the 85.16 county may keep one-half of the nonfederal share of the 85.17 recovery. County agencies may retain 25 percent of a 85.18 MinnesotaCare assistance recovery collection when the recovery 85.19 is collected and posted by the county. 85.20 This does not apply to recoveries from medical providers or 85.21 to recoveries begun by the Department of Human Services' 85.22 Surveillance and Utilization Review Division, State Hospital 85.23 Collections Unit, and the Benefit Recoveries Division or, by the 85.24 attorney general's office, or child support collections. In the 85.25 food stamp or food support program, the nonfederal share of 85.26 recoveries in the federal tax offset program only will be 85.27 divided equally between the state agency and the involved county 85.28 agency. 85.29 Sec. 3. Minnesota Statutes 2003 Supplement, section 85.30 256.046, subdivision 1, is amended to read: 85.31 Subdivision 1. [HEARING AUTHORITY.] A local agency must 85.32 initiate an administrative fraud disqualification hearing for 85.33 individuals, including child care providers caring for children 85.34 receiving child care assistance, accused of wrongfully obtaining 85.35 assistance or intentional program violations, in lieu of a 85.36 criminal action when it has not been pursued, in the aid to 86.1 families with dependent children program formerly codified in 86.2 sections 256.72 to 256.87, MFIP, child care assistance programs, 86.3 general assistance, family general assistance program formerly 86.4 codified in section 256D.05, subdivision 1, clause (15), 86.5 Minnesota supplemental aid, food stamp programs, general 86.6 assistance medical care, MinnesotaCare for adults without 86.7 children, and upon federal approval, all categories of medical 86.8 assistance and remaining categories of MinnesotaCare except for 86.9 children through age 18. The Department of Human Services, in 86.10 lieu of a local agency, may initiate an administrative fraud 86.11 disqualification hearing for individuals accused of wrongfully 86.12 obtaining assistance or intentional program violations, in lieu 86.13 of a criminal action when a criminal action has not been pursued 86.14 in the MinnesotaCare program for adults without children, and 86.15 upon federal approval, all remaining categories of 86.16 MinnesotaCare, except for children through age 18. The hearing 86.17 is subject to the requirements of section 256.045 and the 86.18 requirements in Code of Federal Regulations, title 7, section 86.19 273.16, for the food stamp program and title 45, section 86.20 235.112, as of September 30, 1995, for the cash grant, medical 86.21 care programs, and child care assistance under chapter 119B. 86.22 Sec. 4. Minnesota Statutes 2002, section 256B.02, 86.23 subdivision 12, is amended to read: 86.24 Subd. 12. "Third-party payer" means a person, entity, or 86.25 agency or government program that has a probable obligation to 86.26 pay all or part of the costs of a medical assistance recipient's 86.27 health services. Third-party payer includes an entity under 86.28 contract with the recipient to cover all or part of the 86.29 recipient's medical costs. 86.30 Sec. 5. Minnesota Statutes 2002, section 256B.04, 86.31 subdivision 14, is amended to read: 86.32 Subd. 14. [COMPETITIVE BIDDING.] When determined to be 86.33 effective, economical, and feasible, the commissioner may 86.34 utilize volume purchase through competitive bidding and 86.35 negotiation under the provisions of chapter 16C, to provide 86.36 items under the medical assistance program including but not 87.1 limited to the following: 87.2 (1) eyeglasses; 87.3 (2) oxygen. The commissioner shall provide for oxygen 87.4 needed in an emergency situation on a short-term basis, until 87.5 the vendor can obtain the necessary supply from the contract 87.6 dealer; 87.7 (3) hearing aids and supplies; and 87.8 (4) durable medical equipment, including but not limited to: 87.9 (a) hospital beds; 87.10 (b) commodes; 87.11 (c) glide-about chairs; 87.12 (d) patient lift apparatus; 87.13 (e) wheelchairs and accessories; 87.14 (f) oxygen administration equipment; 87.15 (g) respiratory therapy equipment; 87.16 (h) electronic diagnostic, therapeutic and life support 87.17 systems; 87.18 (5) special transportation services; and 87.19 (6) drugs. 87.20 Rate changes under chapters 256B, 256D, and 256L, do not 87.21 effect contract payments under this subdivision unless 87.22 specifically identified. 87.23 Sec. 6. Minnesota Statutes 2002, section 256B.056, 87.24 subdivision 5, is amended to read: 87.25 Subd. 5. [EXCESS INCOME.] (a) A person who has excess 87.26 income is eligible for medical assistance if the person has 87.27 expenses for medical care that are more than the amount of the 87.28 person's excess income, computed by deducting incurred medical 87.29 expenses from the excess income to reduce the excess to the 87.30 income standard specified in subdivision 5c. If a person is 87.31 ineligible for payment of long-term care services due to an 87.32 uncompensated transfer under section 256B.0595, only the current 87.33 month's long-term care expenses that are greater than the 87.34 average medical assistance rate for nursing facility services in 87.35 the state, along with other incurred medical expenses, may be 87.36 deducted from excess income. The person shall elect to have the 88.1 medical expenses deducted at the beginning of a one-month budget 88.2 period or at the beginning of a six-month budget period. 88.3 (b) The commissioner shall allow persons eligible for 88.4 assistance on a one-month spenddown basis under this subdivision 88.5 to elect to pay the monthly spenddown amount in advance of the 88.6 month of eligibility to the state agency in order to maintain 88.7 eligibility on a continuous basis. If the recipient does not 88.8 pay the spenddown amount on or before the 20thlast business day 88.9 of the month, the recipient is ineligible for this option for 88.10 the following month. The local agency shall code the Medicaid 88.11 Management Information System (MMIS) to indicate that the 88.12 recipient has elected this option. The state agency shall 88.13 convey recipient eligibility information relative to the 88.14 collection of the spenddown to providers through the Electronic 88.15 Verification System (EVS). A recipient electing advance payment 88.16 must pay the state agency the monthly spenddown amount on or88.17 before noon on the 20thlast business day of the month in order 88.18 to be eligible for this option in the following month. 88.19 [EFFECTIVE DATE.] The amendment to paragraph (b) is 88.20 effective upon implementation of HealthMatch. 88.21 Sec. 7. Minnesota Statutes 2002, section 256B.056, is 88.22 amended by adding a subdivision to read: 88.23 Subd. 8a. [NOTICE.] The state agency must be given notice 88.24 of monetary claims against a person, entity, or corporation that 88.25 may be liable to pay all or part of all of the cost of medical 88.26 care when the state agency has paid or becomes liable for the 88.27 cost of that care. Notice must be given as follows: 88.28 (a) An applicant for medical assistance shall notify the 88.29 state or local agency of any possible claims when the applicant 88.30 submits the application. A recipient of medical assistance 88.31 shall notify the state or local agency of any possible claims 88.32 when those claims arise. 88.33 (b) A person providing medical care services to a recipient 88.34 of medical assistance shall notify the state agency when the 88.35 person has reason to believe that a third party may be liable 88.36 for payment of the cost of medical care. 89.1 (c) A party to a claim that may be assigned to the state 89.2 agency under this section shall notify the state agency of its 89.3 potential assignment claim in writing at each of the following 89.4 stages of a claim: 89.5 (1) when a claim is filed; 89.6 (2) when an action is commenced; and 89.7 (3) when a claim is concluded by payment, award, judgment, 89.8 settlement, or otherwise. 89.9 Every party involved in any stage of a claim under this 89.10 subdivision is required to provide notice to the state agency at 89.11 that stage of the claim. However, when one of the parties to 89.12 the claim provides notice at that stage, every other party to 89.13 the claim is deemed to have provided the required notice for 89.14 that stage of the claim. If the required notice under this 89.15 paragraph is not provided to the state agency, all parties to 89.16 the claim are deemed to have failed to provide the required 89.17 notice. A party to the claim includes the injured person or the 89.18 person's legal representative, the plaintiff, the defendants, or 89.19 persons alleged to be responsible for compensating the injured 89.20 person or plaintiff, and any other party to the cause of action 89.21 or claim, regardless of whether the party knows the state agency 89.22 has a potential or actual assignment claim. 89.23 Sec. 8. Minnesota Statutes 2002, section 256B.056, is 89.24 amended by adding a subdivision to read: 89.25 Subd. 8b. [JOINDER OF STATE IN ACTIONS AGAINST THIRD 89.26 PARTIES.] Any medical assistance recipient or the recipient's 89.27 legal representative asserting a claim against a third party 89.28 potentially liable for all or part of the recipient's medical 89.29 costs shall join the state agency as a party to the claim. 89.30 Sec. 9. Minnesota Statutes 2002, section 256B.056, is 89.31 amended by adding a subdivision to read: 89.32 Subd. 8c. [SETTLEMENT.] Pursuant to United States Code, 89.33 title 42, section 1396k(b), no judgment, award, or settlement of 89.34 any action or claim by or on behalf of a medical assistance 89.35 recipient to recover damages from a third party potentially 89.36 liable for all or part of the recipient's medical costs shall be 90.1 acceded to or satisfied by the recipient or the recipient's 90.2 legal representative or approved by the court without granting 90.3 the state agency first recovery from the liable third party to 90.4 the full extent of its medical expenditures, minus pro rata 90.5 costs and attorney fees, regardless of whether the recipient has 90.6 been fully compensated. 90.7 Sec. 10. Minnesota Statutes 2003 Supplement, section 90.8 256B.0595, subdivision 2, is amended to read: 90.9 Subd. 2. [PERIOD OF INELIGIBILITY.] (a) For any 90.10 uncompensated transfer occurring on or before August 10, 1993, 90.11 the number of months of ineligibility for long-term care 90.12 services shall be the lesser of 30 months, or the uncompensated 90.13 transfer amount divided by the average medical assistance rate 90.14 for nursing facility services in the state in effect on the date 90.15 of application. The amount used to calculate the average 90.16 medical assistance payment rate shall be adjusted each July 1 to 90.17 reflect payment rates for the previous calendar year. The 90.18 period of ineligibility begins with the month in which the 90.19 assets were transferred. If the transfer was not reported to 90.20 the local agency at the time of application, and the applicant 90.21 received long-term care services during what would have been the 90.22 period of ineligibility if the transfer had been reported, a 90.23 cause of action exists against the transferee for the cost of 90.24 long-term care services provided during the period of 90.25 ineligibility, or for the uncompensated amount of the transfer, 90.26 whichever is less. The action may be brought by the state or 90.27 the local agency responsible for providing medical assistance 90.28 under chapter 256G. The uncompensated transfer amount is the 90.29 fair market value of the asset at the time it was given away, 90.30 sold, or disposed of, less the amount of compensation received. 90.31 (b) For uncompensated transfers made after August 10, 1993, 90.32 the number of months of ineligibility for long-term care 90.33 services shall be the total uncompensated value of the resources 90.34 transferred divided by the average medical assistance rate for 90.35 nursing facility services in the state in effect on the date of 90.36 application. The amount used to calculate the average medical 91.1 assistance payment rate shall be adjusted each July 1 to reflect 91.2 payment rates for the previous calendar year. The period of 91.3 ineligibility begins with the first day of the month after the 91.4 month in which the assets were transferred except that if one or 91.5 more uncompensated transfers are made during a period of 91.6 ineligibility, the total assets transferred during the 91.7 ineligibility period shall be combined and a penalty period 91.8 calculated to begin on the first day of the month after the 91.9 month in which the first uncompensated transfer was made. If 91.10 the transfer was reported to the local agency after the date 91.11 advance notice of a period of ineligibility that affects the 91.12 next month could be provided to the recipient and the recipient 91.13 received medical assistance services, or the transfer was not 91.14 reported to the local agency ,and the applicant or recipient 91.15 received medical assistance services during what would have been 91.16 the period of ineligibility if the transfer had been reported, a 91.17 cause of action exists against the transferee for the cost of 91.18 medical assistance services provided during the period of 91.19 ineligibility, or for the uncompensated amount of the transfer, 91.20 whichever is less. The action may be brought by the state or 91.21 the local agency responsible for providing medical assistance 91.22 under chapter 256G. The uncompensated transfer amount is the 91.23 fair market value of the asset at the time it was given away, 91.24 sold, or disposed of, less the amount of compensation received. 91.25 Effective for transfers made on or after March 1, 1996, 91.26 involving persons who apply for medical assistance on or after 91.27 April 13, 1996, no cause of action exists for a transfer unless: 91.28 (1) the transferee knew or should have known that the 91.29 transfer was being made by a person who was a resident of a 91.30 long-term care facility or was receiving that level of care in 91.31 the community at the time of the transfer; 91.32 (2) the transferee knew or should have known that the 91.33 transfer was being made to assist the person to qualify for or 91.34 retain medical assistance eligibility; or 91.35 (3) the transferee actively solicited the transfer with 91.36 intent to assist the person to qualify for or retain eligibility 92.1 for medical assistance. 92.2 (c) If a calculation of a penalty period results in a 92.3 partial month, payments for long-term care services shall be 92.4 reduced in an amount equal to the fraction, except that in 92.5 calculating the value of uncompensated transfers, if the total 92.6 value of all uncompensated transfers made in a month not 92.7 included in an existing penalty period does not exceed $200, 92.8 then such transfers shall be disregarded for each month prior to 92.9 the month of application for or during receipt of medical 92.10 assistance. 92.11 [EFFECTIVE DATE.] This section is effective for transfers 92.12 occurring on or after July 1, 2004. 92.13 Sec. 11. Minnesota Statutes 2003 Supplement, section 92.14 256D.03, subdivision 3, is amended to read: 92.15 Subd. 3. [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.] 92.16 (a) General assistance medical care may be paid for any person 92.17 who is not eligible for medical assistance under chapter 256B, 92.18 including eligibility for medical assistance based on a 92.19 spenddown of excess income according to section 256B.056, 92.20 subdivision 5, or MinnesotaCare as defined in paragraph (b), 92.21 except as provided in paragraph (c), and: 92.22 (1) who is receiving assistance under section 256D.05, 92.23 except for families with children who are eligible under 92.24 Minnesota family investment program (MFIP), or who is having a 92.25 payment made on the person's behalf under sections 256I.01 to 92.26 256I.06; or 92.27 (2) who is a resident of Minnesota; and 92.28 (i) who has gross countable income not in excess of 75 92.29 percent of the federal poverty guidelines for the family size, 92.30 using a six-month budget period and whose equity in assets is 92.31 not in excess of $1,000 per assistance unit. Exempt assets, the 92.32 reduction of excess assets, and the waiver of excess assets must 92.33 conform to the medical assistance program in section 256B.056, 92.34 subdivision 3, with the following exception: the maximum amount 92.35 of undistributed funds in a trust that could be distributed to 92.36 or on behalf of the beneficiary by the trustee, assuming the 93.1 full exercise of the trustee's discretion under the terms of the 93.2 trust, must be applied toward the asset maximum; or 93.3 (ii) who has gross countable income above 75 percent of the 93.4 federal poverty guidelines but not in excess of 175 percent of 93.5 the federal poverty guidelines for the family size, using a 93.6 six-month budget period, whose equity in assets is not in excess 93.7 of the limits in section 256B.056, subdivision 3c, and who 93.8 applies during an inpatient hospitalization. 93.9 (b) General assistance medical care may not be paid for 93.10 applicants or recipients who meet all eligibility requirements 93.11 of MinnesotaCare as defined in sections 256L.01 to 256L.16, and 93.12 are adults with dependent children under 21 whose gross family 93.13 income is equal to or less than 275 percent of the federal 93.14 poverty guidelines. 93.15 (c) For applications received on or after October 1, 2003, 93.16 eligibility may begin no earlier than the date of application. 93.17 For individuals eligible under paragraph (a), clause (2), item 93.18 (i), a redetermination of eligibility must occur every 12 93.19 months. Individuals are eligible under paragraph (a), clause 93.20 (2), item (ii), only during inpatient hospitalization but may 93.21 reapply if there is a subsequent period of inpatient 93.22 hospitalization. Beginning January 1, 2000, Minnesota health 93.23 care program applications completed by recipients and applicants 93.24 who are persons described in paragraph (b), may be returned to 93.25 the county agency to be forwarded to the Department of Human 93.26 Services or sent directly to the Department of Human Services 93.27 for enrollment in MinnesotaCare. If all other eligibility 93.28 requirements of this subdivision are met, eligibility for 93.29 general assistance medical care shall be available in any month 93.30 during which a MinnesotaCare eligibility determination and 93.31 enrollment are pending. Upon notification of eligibility for 93.32 MinnesotaCare, notice of termination for eligibility for general 93.33 assistance medical care shall be sent to an applicant or 93.34 recipient. If all other eligibility requirements of this 93.35 subdivision are met, eligibility for general assistance medical 93.36 care shall be available until enrollment in MinnesotaCare 94.1 subject to the provisions of paragraph (e). 94.2 (d) The date of an initial Minnesota health care program 94.3 application necessary to begin a determination of eligibility 94.4 shall be the date the applicant has provided a name, address, 94.5 and Social Security number, signed and dated, to the county 94.6 agency or the Department of Human Services. If the applicant is 94.7 unable to provide a name, address, Social Security number, and 94.8 signature when health care is delivered due to a medical 94.9 condition or disability, a health care provider may act on an 94.10 applicant's behalf to establish the date of an initial Minnesota 94.11 health care program application by providing the county agency 94.12 or Department of Human Services with provider identification and 94.13 a temporary unique identifier for the applicant. The applicant 94.14 must complete the remainder of the application and provide 94.15 necessary verification before eligibility can be determined. 94.16 The county agency must assist the applicant in obtaining 94.17 verification if necessary. 94.18 (e) County agencies are authorized to use all automated 94.19 databases containing information regarding recipients' or 94.20 applicants' income in order to determine eligibility for general 94.21 assistance medical care or MinnesotaCare. Such use shall be 94.22 considered sufficient in order to determine eligibility and 94.23 premium payments by the county agency. 94.24 (f) General assistance medical care is not available for a 94.25 person in a correctional facility unless the person is detained 94.26 by law for less than one year in a county correctional or 94.27 detention facility as a person accused or convicted of a crime, 94.28 or admitted as an inpatient to a hospital on a criminal hold 94.29 order, and the person is a recipient of general assistance 94.30 medical care at the time the person is detained by law or 94.31 admitted on a criminal hold order and as long as the person 94.32 continues to meet other eligibility requirements of this 94.33 subdivision. 94.34 (g) General assistance medical care is not available for 94.35 applicants or recipients who do not cooperate with the county 94.36 agency to meet the requirements of medical assistance. 95.1 (h) In determining the amount of assets of an individual 95.2 eligible under paragraph (a), clause (2), item (i), there shall 95.3 be included any asset or interest in an asset, including an 95.4 asset excluded under paragraph (a), that was given away, sold, 95.5 or disposed of for less than fair market value within the 60 95.6 months preceding application for general assistance medical care 95.7 or during the period of eligibility. Any transfer described in 95.8 this paragraph shall be presumed to have been for the purpose of 95.9 establishing eligibility for general assistance medical care, 95.10 unless the individual furnishes convincing evidence to establish 95.11 that the transaction was exclusively for another purpose. For 95.12 purposes of this paragraph, the value of the asset or interest 95.13 shall be the fair market value at the time it was given away, 95.14 sold, or disposed of, less the amount of compensation received. 95.15 For any uncompensated transfer, the number of months of 95.16 ineligibility, including partial months, shall be calculated by 95.17 dividing the uncompensated transfer amount by the average 95.18 monthly per person payment made by the medical assistance 95.19 program to skilled nursing facilities for the previous calendar 95.20 year. The individual shall remain ineligible until this fixed 95.21 period has expired. The period of ineligibility may exceed 30 95.22 months, and a reapplication for benefits after 30 months from 95.23 the date of the transfer shall not result in eligibility unless 95.24 and until the period of ineligibility has expired. The period 95.25 of ineligibility begins in the month the transfer was reported 95.26 to the county agency, or if the transfer was not reported, the 95.27 month in which the county agency discovered the transfer, 95.28 whichever comes first. For applicants, the period of 95.29 ineligibility begins on the date of the first approved 95.30 application. 95.31 (i) When determining eligibility for any state benefits 95.32 under this subdivision, the income and resources of all 95.33 noncitizens shall be deemed to include their sponsor's income 95.34 and resources as defined in the Personal Responsibility and Work 95.35 Opportunity Reconciliation Act of 1996, title IV, Public Law 95.36 104-193, sections 421 and 422, and subsequently set out in 96.1 federal rules. 96.2 (j) Undocumented noncitizens and nonimmigrants are 96.3 ineligible for general assistance medical care, except an 96.4 individual eligible under paragraph (a), clause (4), remains 96.5 eligible through September 30, 2003. For purposes of this 96.6 subdivision, a nonimmigrant is an individual in one or more of 96.7 the classes listed in United States Code, title 8, section 96.8 1101(a)(15), and an undocumented noncitizen is an individual who 96.9 resides in the United States without the approval or 96.10 acquiescence of the Immigration and Naturalization Service. 96.11 (k) Notwithstanding any other provision of law, a 96.12 noncitizen who is ineligible for medical assistance due to the 96.13 deeming of a sponsor's income and resources, is ineligible for 96.14 general assistance medical care. 96.15 (l) Effective July 1, 2003, general assistance medical care 96.16 emergency services end. 96.17 Sec. 12. Minnesota Statutes 2002, section 256D.045, is 96.18 amended to read: 96.19 256D.045 [SOCIAL SECURITY NUMBER REQUIRED.] 96.20 To be eligible for general assistance under sections 96.21 256D.01 to 256D.21, an individual must provide the individual's 96.22 Social Security number to the county agency or submit proof that 96.23 an application has been made. An individual who refuses to 96.24 provide a Social Security number because of a well-established 96.25 religious objection as described in Code of Federal Regulations, 96.26 title 42, section 435.910, may be eligible for general 96.27 assistance medical care under section 256D.03. The provisions 96.28 of this section do not apply to the determination of eligibility 96.29 for emergency general assistance under section 256D.06, 96.30 subdivision 2. This provision applies to eligible children 96.31 under the age of 18 effective July 1, 1997. 96.32 Sec. 13. Minnesota Statutes 2002, section 256L.04, is 96.33 amended by adding a subdivision to read: 96.34 Subd. 1a. [SOCIAL SECURITY NUMBER REQUIRED.] (a) 96.35 Individuals and families applying for MinnesotaCare coverage 96.36 must provide a Social Security number. 97.1 (b) The commissioner shall not deny eligibility to an 97.2 otherwise eligible applicant who has applied for a Social 97.3 Security number and is awaiting issuance of that Social Security 97.4 number. 97.5 (c) Newborns enrolled under section 256L.05, subdivision 3, 97.6 are exempt from the requirements of this subdivision. 97.7 (d) Individuals who refuse to provide a Social Security 97.8 number because of well-established religious objections are 97.9 exempt from this subdivision. The term "well-established 97.10 religious objections" has the meaning given in Code of Federal 97.11 Regulations, title 42, section 435.910. 97.12 Sec. 14. Minnesota Statutes 2002, section 256L.04, 97.13 subdivision 2, is amended to read: 97.14 Subd. 2. [COOPERATION IN ESTABLISHING THIRD-PARTY 97.15 LIABILITY, PATERNITY, AND OTHER MEDICAL SUPPORT.] (a) To be 97.16 eligible for MinnesotaCare, individuals and families must 97.17 cooperate with the state agency to identify potentially liable 97.18 third-party payers and assist the state in obtaining third-party 97.19 payments. "Cooperation" includes, but is not limited to, 97.20 complying with the notice and settlement requirements in section 97.21 256B.056, subdivisions 8a and 8c, identifying any third party 97.22 who may be liable for care and services provided under 97.23 MinnesotaCare to the enrollee, providing relevant information to 97.24 assist the state in pursuing a potentially liable third party, 97.25 and completing forms necessary to recover third-party payments. 97.26 (b) A parent, guardian, relative caretaker, or child 97.27 enrolled in the MinnesotaCare program must cooperate with the 97.28 Department of Human Services and the local agency in 97.29 establishing the paternity of an enrolled child and in obtaining 97.30 medical care support and payments for the child and any other 97.31 person for whom the person can legally assign rights, in 97.32 accordance with applicable laws and rules governing the medical 97.33 assistance program. A child shall not be ineligible for or 97.34 disenrolled from the MinnesotaCare program solely because the 97.35 child's parent, relative caretaker, or guardian fails to 97.36 cooperate in establishing paternity or obtaining medical support. 98.1 Sec. 15. Minnesota Statutes 2002, section 256L.04, is 98.2 amended by adding a subdivision to read: 98.3 Subd. 2a. [APPLICATIONS FOR OTHER BENEFITS.] To be 98.4 eligible for MinnesotaCare, individuals and families must take 98.5 all necessary steps to obtain other benefits as described in 98.6 Code of Federal Regulations, title 42, section 435.608. 98.7 Applicants and enrollees must apply for other benefits within 30 98.8 days. 98.9 Sec. 16. Minnesota Statutes 2002, section 549.02, is 98.10 amended by adding a subdivision to read: 98.11 Subd. 3. [LIMITATION.] Notwithstanding subdivisions 1 and 98.12 2, where the state agency is joined as a party according to 98.13 section 256B.056, subdivision 8b, or brings an independent 98.14 action to enforce the agency's rights under section 256B.056, 98.15 the state agency shall not be liable for costs to any prevailing 98.16 defendant. 98.17 Sec. 17. Minnesota Statutes 2002, section 549.04, is 98.18 amended to read: 98.19 549.04 [DISBURSEMENTS; TAXATION AND ALLOWANCE.] 98.20 Subdivision 1. [GENERALLY.] In every action in a district 98.21 court, the prevailing party, including any public employee who 98.22 prevails in an action for wrongfully denied or withheld 98.23 employment benefits or rights, shall be allowed reasonable 98.24 disbursements paid or incurred, including fees and mileage paid 98.25 for service of process by the sheriff or by a private person. 98.26 Subd. 2. [LIMITATION.] Notwithstanding subdivision 1, 98.27 where the state agency is joined as a party according to section 98.28 256B.056, subdivision 8b, or brings an independent action to 98.29 enforce its rights under section 256B.056, the state agency 98.30 shall not be liable for disbursements to any prevailing 98.31 defendant. 98.32 Sec. 18. [CONTINUATION OF LIFE ESTATES AND JOINT TENANCY 98.33 INTERESTS IN REAL ESTATE.] 98.34 Subdivision 1. [EXEMPTION FOR CERTAIN NURSING FACILITY 98.35 RESIDENTS.] The provisions of Minnesota Statutes, section 98.36 256B.15, subdivisions 1, 1d, 1f, 1g, 1h, 1i, and 1j, and section 99.1 514.981, subdivision 6, related to the continuation of a 99.2 recipient's life estate or joint tenancy interests in real 99.3 estate property after the recipient's death for the purpose of 99.4 recovering medical assistance, do not apply to life estates and 99.5 joint tenancy interests of recipients who were permanent 99.6 residents of a nursing facility on August 1, 2003, and who had 99.7 established a life estate or joint tenancy interest in real 99.8 estate prior to August 1, 2003. 99.9 Subd. 2. [TEMPORARY PROHIBITION ON RECOVERY.] The 99.10 commissioner of human services is prohibited from making medical 99.11 assistance recoveries related to the continuation of a 99.12 recipient's life estate or joint tenancy interests in real 99.13 estate after the recipient's death for decedents who die between 99.14 August 1, 2003, and July 31, 2005, and who had established a 99.15 life estate or joint tenancy interest in real estate prior to 99.16 August 1, 2003. 99.17 Subd. 3. [REFUND OF AMOUNTS RECOVERED.] The commissioner 99.18 of human services and any county agency which has collected any 99.19 sum attributable to a life estate or joint tenancy interest in 99.20 real estate which was continued for recipients described in 99.21 subdivisions 1 or 2, shall promptly refund the amount collected 99.22 to the person or persons who paid the amount collected, in 99.23 proportion to each person's contribution to the amount. 99.24 Subd. 4. [LIEN NOTICES.] Lien notices of record against 99.25 life estate or joint tenancy interests described in subdivisions 99.26 1 and 2 shall have no effect beyond the death of the recipient 99.27 unless continued after that time by the terms of the instrument 99.28 creating the interest, shall be disregarded by examiners of 99.29 title, and shall not be carried forward to subsequent 99.30 certificates of title. 99.31 Subd. 5. [IMMUNITY.] The commissioner of human services, 99.32 county agencies, and elected officials and their employees are 99.33 immune from all liability for actions taken pursuant to Laws 99.34 2003, First Special Session chapter 14, article 12, sections 40 99.35 to 52 and 90, as those laws existed at the time the action was 99.36 taken, and this section. 100.1 Subd. 6. [DEFINITIONS.] (a) For purposes of this section, 100.2 the following definitions apply. 100.3 (b) A life estate or joint tenancy interest is established 100.4 upon the recording or filing of the instrument creating the 100.5 interest in the office of the county recorder or registrar of 100.6 titles for the county where the real estate interest it 100.7 describes is located. The date upon which the interest is 100.8 established is the earliest of: (1) the date the instrument 100.9 creating the interest is filed or recorded in the office of the 100.10 county recorder or registrar of titles where the real estate 100.11 interest it describes is located; (2) the date on which the 100.12 judicial order or decree creating the interest was issued by the 100.13 court; or (3) the date upon which the interest devolves under 100.14 Minnesota Statutes, section 524.3-101. The recipient, any other 100.15 owner of an interest in the property, or any other person with 100.16 personal knowledge of the facts may record an affidavit 100.17 describing the property, the recipient's interest in the 100.18 property, and the date the decedent died for purposes of this 100.19 section. 100.20 (c) A recipient is a permanent resident of a nursing 100.21 facility if the recipient had resided in the nursing facility 100.22 for 30 days or longer and could not be reasonably expected to be 100.23 discharged and return home. 100.24 [EFFECTIVE DATE.] This section is effective retroactive to 100.25 August 1, 2003. 100.26 ARTICLE 13 100.27 MISCELLANEOUS 100.28 Section 1. Minnesota Statutes 2002, section 144.148, is 100.29 amended by adding a subdivision to read: 100.30 Subd. 9. [STATUS OF PREVIOUS AWARDS.] The commissioner 100.31 must regard grants or loans awarded to eligible rural hospitals 100.32 before August 1, 1999, as grants subject to the conditions of 100.33 this section and not subject to repayment as loans under 100.34 Minnesota Statutes 1998, section 144.148. 100.35 Sec. 2. [144.552] [PUBLIC INTEREST REVIEW.] 100.36 (a) A hospital seeking to increase its number of licensed 101.1 beds or an organization seeking to obtain a hospital license 101.2 must submit a plan to the commissioner of health. The plan must 101.3 include information that includes an explanation of how the 101.4 expansion will meet the public's interest. When submitting a 101.5 plan to the commissioner, an applicant shall pay the 101.6 commissioner for the commissioner's cost of reviewing the plan, 101.7 as determined by the commissioner and notwithstanding section 101.8 16A.1283. Money received by the commissioner under this section 101.9 is appropriated to the commissioner for the purpose of 101.10 administering this section. 101.11 (b) Plans submitted under this section shall include 101.12 detailed information necessary for the commissioner to review 101.13 the plan and reach a finding. The commissioner may request 101.14 additional information from the hospital submitting a plan under 101.15 this section and from others affected by the plan that the 101.16 commissioner deems necessary to review the plan and make a 101.17 finding. 101.18 (c) The commissioner shall review the plan and, within 90 101.19 days, but no more than six months if extenuating circumstances 101.20 apply, issue a finding on whether the plan is in the public 101.21 interest. In making the recommendation, the commissioner shall 101.22 consider issues including but not limited to: 101.23 (1) whether the new hospital or hospital beds are needed to 101.24 provide timely access to care or access to new or improved 101.25 services; 101.26 (2) the financial impact of the new hospital or hospital 101.27 beds on existing acute-care hospitals that have emergency 101.28 departments in the region; 101.29 (3) how the new hospital or hospital beds will affect the 101.30 ability of existing hospitals in the region to maintain existing 101.31 staff; 101.32 (4) the extent to which the new hospital or hospital beds 101.33 will provide services to nonpaying or low-income patients 101.34 relative to the level of services provided to these groups by 101.35 existing hospitals in the region; and 101.36 (5) the views of affected parties. 102.1 (d) Upon making a recommendation under paragraph (c), the 102.2 commissioner shall provide a copy of the recommendation to the 102.3 chairs of the house and senate committees having jurisdiction 102.4 over health and human services policy and finance. 102.5 Sec. 3. Minnesota Statutes 2002, section 144D.025, is 102.6 amended to read: 102.7 144D.025 [OPTIONAL REGISTRATION.] 102.8 An establishment that meets all the requirements of this 102.9 chapter except that fewer than 80 percent of the adult residents 102.10 are age 55 or older, or a supportive housing establishment 102.11 developed and funded in whole or in part with funds provided 102.12 specifically as part of the plan to end long-term homelessness 102.13 required under Laws 2003, chapter 128, article 15, section 9, 102.14 may ,at its option, register as a housing with services 102.15 establishment. 102.16 Sec. 4. [145.417] [FAMILY PLANNING GRANT FUNDS NOT USED TO 102.17 SUBSIDIZE ABORTION SERVICES.] 102.18 Subdivision 1. [DEFINITIONS.] (a) For purposes of this 102.19 section, the following definitions apply. 102.20 (b) "Abortion" means the use or prescription of any 102.21 instrument, medicine, drug, or any other substance or device to 102.22 intentionally terminate the pregnancy of a female known to be 102.23 pregnant, with an intention other than to prevent the death of 102.24 the female, increase the probability of a live birth, preserve 102.25 the life or health of the child after live birth, or remove a 102.26 dead fetus. 102.27 (c) "Family planning grant funds" means funds distributed 102.28 through the maternal and child health block grant program under 102.29 sections 145.881 to 145.889, the family planning special 102.30 projects grant program under section 145.925, the program to 102.31 eliminate health disparities under section 145.928, or any other 102.32 state grant program whose funds are or may be used to fund 102.33 family planning services. 102.34 (d) "Family planning services" means preconception services 102.35 that limit or enhance fertility, including methods of 102.36 contraception, the management of infertility, preconception 103.1 counseling, education, and general reproductive health care. 103.2 (e) "Nondirective counseling" means providing patients with: 103.3 (1) a list of health care providers and social service 103.4 providers that provide prenatal care, childbirth care, infant 103.5 care, foster care, adoption services, alternatives to abortion, 103.6 or abortion services; and 103.7 (2) nondirective, nonmarketing information regarding such 103.8 providers. 103.9 (f) "Public advocacy" means engaging in one or more of the 103.10 following: 103.11 (1) regularly engaging in efforts to encourage the passage 103.12 or defeat of legislation pertaining to the continued or expanded 103.13 availability of abortion; 103.14 (2) publicly endorsing or recommending the election or 103.15 defeat of a candidate for public office based on the candidate's 103.16 position on the legality of abortion; or 103.17 (3) engaging in civil litigation against a unit of 103.18 government as a plaintiff seeking to enjoin or otherwise 103.19 prohibit enforcement of a statute, ordinance, rule, or 103.20 regulation pertaining to abortion. 103.21 Subd. 2. [USES OF FAMILY PLANNING GRANT FUNDS.] No family 103.22 planning grant funds may be: 103.23 (1) expended to directly or indirectly subsidize abortion 103.24 services or administrative expenses; or 103.25 (2) paid or granted to an organization or an affiliate of 103.26 an organization that provides abortion services, unless the 103.27 affiliate is independent as provided in subdivision 4. 103.28 Subd. 3. [ORGANIZATIONS RECEIVING FAMILY PLANNING GRANT 103.29 FUNDS.] An organization that receives family planning grant 103.30 funds: 103.31 (1) may provide nondirective counseling relating to 103.32 pregnancy, but may not directly refer patients who seek abortion 103.33 services to any organization that provides abortion services, 103.34 including an independent affiliate of the organization receiving 103.35 family planning grant funds. For purposes of this clause, an 103.36 affiliate is independent if it satisfies the criteria in 104.1 subdivision 4, paragraph (a); 104.2 (2) may not display or distribute marketing materials about 104.3 abortion services to patients; 104.4 (3) may not engage in public advocacy promoting the 104.5 legality or accessibility of abortion; and 104.6 (4) must be separately incorporated from any affiliated 104.7 organization that provides abortion services. 104.8 Subd. 4. [INDEPENDENT AFFILIATES THAT PROVIDE ABORTION 104.9 SERVICES.] (a) To ensure that the state does not lend its 104.10 imprimatur to abortion services and to ensure that an 104.11 organization that provides abortion services does not receive a 104.12 direct or indirect economic or marketing benefit from family 104.13 planning grant funds, an organization that receives family 104.14 planning grant funds may not be affiliated with an organization 104.15 that provides abortion services unless the organizations are 104.16 independent from each other. To be independent, the 104.17 organizations may not share any of the following: 104.18 (1) the same or a similar name; 104.19 (2) medical facilities or nonmedical facilities, including, 104.20 but not limited to, business offices, treatment rooms, 104.21 consultation rooms, examination rooms, and waiting rooms; 104.22 (3) expenses; 104.23 (4) employee wages or salaries; or 104.24 (5) equipment or supplies, including, but not limited to, 104.25 computers, telephone systems, telecommunications equipment, and 104.26 office supplies. 104.27 (b) An organization that receives family planning grant 104.28 funds and that is affiliated with an organization that provides 104.29 abortion services must maintain financial records that 104.30 demonstrate strict compliance with this subdivision and that 104.31 demonstrate that its independent affiliate that provides 104.32 abortion services receives no direct or indirect economic or 104.33 marketing benefit from the family planning grant funds. 104.34 Subd. 5. [INDEPENDENT AUDIT.] When an organization applies 104.35 for family planning grant funds, the organization must submit 104.36 with the grant application a copy of the organization's most 105.1 recent independent audit to ensure the organization is in 105.2 compliance with this section. The independent audit must have 105.3 been conducted no more than two years before the organization 105.4 submits its grant application. 105.5 Subd. 6. [ORGANIZATIONS RECEIVING TITLE X FUNDS.] Nothing 105.6 in this section requires an organization that receives federal 105.7 funds under Title X of the Public Health Service Act to refrain 105.8 from performing any service that is required to be provided as a 105.9 condition of receiving Title X funds, as specified by the 105.10 provisions of Title X or the Title X program guidelines for 105.11 project grants for family planning services published by the 105.12 United States Department of Health and Human Services. 105.13 Subd. 7. [SEVERABILITY.] If any one or more provision, 105.14 word, phrase, clause, sentence, or subdivision of this section, 105.15 or the application to any person or circumstance, is found to be 105.16 unconstitutional, it is declared to be severable and the balance 105.17 of this section shall remain effective notwithstanding such 105.18 unconstitutionality. The legislature hereby declares that it 105.19 would have passed this section, and each provision, word, 105.20 phrase, clause, sentence, or subdivision of it, regardless of 105.21 the fact that any one or more provision, word, phrase, clause, 105.22 sentence, or subdivision be declared unconstitutional. 105.23 Sec. 5. Minnesota Statutes 2003 Supplement, section 105.24 246B.04, as amended by Laws 2004, chapter 134, section 2, is 105.25 amended to read: 105.26 246B.04 [RULES; EVALUATION.] 105.27 Subdivision 1. [PROGRAM RULES AND EVALUATION.] The 105.28 commissioner of human services shall adopt rules to govern the 105.29 operation, maintenance, and licensure of secure treatment 105.30 facilities operated by the Minnesota sex offender program or at 105.31 any other facility operated by the commissioner, for a person 105.32 committed as a sexual psychopathic personality or a sexually 105.33 dangerous person. The commissioner shall establish an 105.34 evaluation process to measure outcomes and behavioral changes as 105.35 a result of treatment compared with incarceration without 105.36 treatment, to determine the value, if any, of treatment in 106.1 protecting the public. 106.2 Subd. 2. [BAN ON OBSCENE MATERIAL OR PORNOGRAPHIC WORK.] 106.3 The commissioner shall prohibit persons civilly committed as 106.4 sexual psychopathic personalities or sexually dangerous persons 106.5 under sectionsMinnesota Statutes 1978, section 246.43 and 106.6 section 253B.185 from having or receiving material that is 106.7 obscene as defined under section 617.241, subdivision 1, 106.8 material that depicts sexual conduct as defined under section 106.9 617.241, subdivision 1, or pornographic work as defined under 106.10 section 617.246, subdivision 1, while receiving services in any 106.11 secure treatment facilities operated by the Minnesota sex 106.12 offender program or any other facilities operated by the 106.13 commissioner. 106.14 Sec. 6. Minnesota Statutes 2002, section 253B.02, is 106.15 amended by adding a subdivision to read: 106.16 Subd. 24. [ADMINISTRATIVE RESTRICTION.] "Administrative 106.17 restriction" means any measure utilized by the commissioner to 106.18 maintain safety and security, protect possible evidence, and 106.19 prevent the continuation of suspected criminal acts. 106.20 Administrative restriction does not mean protective isolation as 106.21 defined by Minnesota Rules, part 9515.3090, subpart 4. 106.22 Administrative restriction may include increased monitoring, 106.23 program limitations, loss of privileges, restricted access to 106.24 and use of possessions, and separation of a patient from the 106.25 normal living environment, as determined by the commissioner or 106.26 the commissioner's designee. Administrative restriction applies 106.27 only to patients in a secure treatment facility as defined in 106.28 subdivision 18a who: 106.29 (1) are suspected of criminal acts; 106.30 (2) are the subject of a criminal investigation; 106.31 (3) are awaiting sentencing following a conviction of a 106.32 crime; or 106.33 (4) are awaiting transfer to a correctional facility. 106.34 The commissioner shall establish policies and procedures 106.35 according to section 246.014, paragraph (d), regarding the use 106.36 of administrative restriction. The policies and procedures 107.1 shall identify the implementation and termination of 107.2 administrative restrictions. Use of administrative restriction 107.3 and the reason associated with the use shall be documented in 107.4 the patient's medical record. 107.5 Sec. 7. Minnesota Statutes 2002, section 253B.02, is 107.6 amended by adding a subdivision to read: 107.7 Subd. 25. [SAFETY.] "Safety" means protection of persons 107.8 or property from potential danger, risk, injury, harm, or damage. 107.9 Sec. 8. Minnesota Statutes 2002, section 253B.02, is 107.10 amended by adding a subdivision to read: 107.11 Subd. 26. [SECURITY.] "Security" means the measures 107.12 necessary to achieve the management and accountability of 107.13 patients of the facility, staff, and visitors, as well as 107.14 property of the facility. 107.15 Sec. 9. Minnesota Statutes 2002, section 253B.03, is 107.16 amended by adding a subdivision to read: 107.17 Subd. 1a. [ADMINISTRATIVE RESTRICTION.] (a) A patient has 107.18 the right to be free from unnecessary or excessive 107.19 administrative restriction; therefore, administrative 107.20 restriction shall not be used for the convenience of staff, for 107.21 retaliation for filing complaints, or as a substitute for 107.22 program treatment. Administrative restriction may not involve 107.23 any further deprivation of privileges than is necessary. 107.24 (b) Administrative restriction may include separate and 107.25 secure housing. 107.26 (c) Patients under administrative restriction shall not be 107.27 limited in access to their attorney. 107.28 Sec. 10. [253B.184] [LEGISLATIVE FINDINGS AND PURPOSE.] 107.29 (a) The Patients' and Residents' Bill of Rights in section 107.30 144.651 and the Patients' Bill of Rights in section 253B.03, 107.31 create statutory protections for persons in health care 107.32 facilities who generally have physical or mental conditions that 107.33 make it difficult or impossible for them to protect themselves 107.34 or who are particularly vulnerable to exploitation. Sexual 107.35 psychopathic personalities and sexually dangerous persons 107.36 civilly committed to the Minnesota sex offender program, 108.1 however, are a significantly and clearly different population 108.2 from other patients and residents protected by sections 144.651 108.3 and 253B.03 in several respects: 108.4 (1) civilly committed sex offenders have documented 108.5 histories of harmful sexual conduct, have been proven to be 108.6 highly likely to commit harmful sexual conduct and, as a result, 108.7 are dangerous to others if not committed to a secure treatment 108.8 facility. This predatory nature distinguishes them from other 108.9 voluntary or involuntary patients in health care facilities, 108.10 including patients committed as mentally ill and dangerous; 108.11 (2) most sex offenders are civilly committed directly from 108.12 prison, often after lengthy sentences, and tend to be far more 108.13 criminally sophisticated than patients or residents of health 108.14 care facilities who have not been institutionalized with 108.15 criminals for a long period of time; 108.16 (3) while all civilly committed sex offenders have 108.17 diagnosed mental or personality disorders that provide the 108.18 constitutional basis for civil commitment, they generally are 108.19 not psychotic and their disorders do not make them vulnerable to 108.20 abuse or exploitation by others. For this reason, civilly 108.21 committed sex offenders are not defined categorically as 108.22 vulnerable adults under the Minnesota Vulnerable Adult Act. 108.23 This difference distinguishes them from those committed as 108.24 mentally ill, mentally retarded, chemically dependent, or 108.25 mentally ill and dangerous; and 108.26 (4) more than ten years of operation of the current sex 108.27 offender program and decades of experience in the predecessor 108.28 programs (BEAD 1972-1975 and ITPSA 1975-1993) has demonstrated 108.29 that civilly committed sex offenders misuse and distort the 108.30 protections afforded by sections 144.651 and 253B.03 far more 108.31 than other patients, including those committed as mentally ill 108.32 and dangerous. Sex offenders have taken advantage of the rights 108.33 given them by the bills of rights to breach the security of the 108.34 treatment facility, communicate inappropriately with sexually 108.35 vulnerable children and others outside of the facility, commit a 108.36 variety of property-related crimes, engage in 109.1 counter-therapeutic conduct, and mount frivolous litigation 109.2 against the state and state employees. Other patients and 109.3 residents have not exhibited these behaviors to the extent that 109.4 committed sex offenders have. 109.5 (b) The legislature finds that, in order to further the 109.6 purposes of civil commitment of sex offenders, individuals in 109.7 the sex offender program require special consideration related 109.8 to patients' rights. The commissioner of human services is 109.9 authorized to limit the statutory rights under the patients' and 109.10 residents' bills of rights under sections 144.651 and 253B.03 of 109.11 individuals committed to the sex offender program in order to 109.12 ensure the safety and security of the treatment facility, staff, 109.13 other patients, and the public, and to maintain a safe 109.14 environment in which treatment can be best provided. These 109.15 limitations are not intended to make civil commitment punitive 109.16 or as punishment for past behavior, but are necessary to further 109.17 the legitimate purposes of the patients' commitment, protection 109.18 of the public, and treatment of the patients' disorders. 109.19 Furthermore, it is necessary to make explicit that any rights 109.20 conferred by sections 144.651 and 253B.03 do not confer a 109.21 private cause of action upon civilly committed sex offenders but 109.22 are instead enforceable by the Department of Health that 109.23 licenses the sex offender program. 109.24 Sec. 11. Minnesota Statutes 2002, section 253B.185, is 109.25 amended by adding a subdivision to read: 109.26 Subd. 7. [RIGHTS OF PATIENTS COMMITTED UNDER THIS 109.27 SECTION.] (a) The commissioner or the commissioner's designee 109.28 may limit the statutory rights described in paragraph (b) for 109.29 patients committed to the Minnesota sex offender program under 109.30 this section or with the commissioner's consent under section 109.31 246B.02. These statutory rights may be limited as necessary to 109.32 maintain a therapeutic environment and the security of the 109.33 facility, to prevent crime, or to protect the safety and 109.34 well-being of patients, staff, and the public. Limitations of 109.35 statutory rights may be applied facility-wide, or to parts of 109.36 the facility, or to individual patients, and are in addition to 110.1 any other limitations on rights permitted by sections 144.651, 110.2 253B.03, or any other law. 110.3 (b) The head of a secure treatment facility may limit the 110.4 statutory rights of patients and residents created by sections 110.5 144.651, subdivision 19 (personal privacy); 144.651, subdivision 110.6 21 (private communications); 144.651, subdivision 22 (retain and 110.7 use of personal property); 144.651, subdivision 25 (manage 110.8 personal financial affairs); 144.651, subdivision 26 (meet with 110.9 visitors and participate in groups); 253B.03, subdivision 2 110.10 (correspond with others); and 253B.03, subdivision 3 (receive 110.11 visitors and make telephone calls). Other statutory rights 110.12 enumerated by sections 144.651 and 253B.03 may be limited as 110.13 provided in those sections. 110.14 (c) Notwithstanding any other law, a patient committed to a 110.15 secure treatment facility under this section may not maintain a 110.16 civil cause of action to enforce section 144.651 or 253B.03. 110.17 [EFFECTIVE DATE.] This section is effective the day 110.18 following final enactment. 110.19 Sec. 12. Minnesota Statutes 2002, section 256.01, is 110.20 amended by adding a subdivision to read: 110.21 Subd. 14a. [SINGLE BENEFIT DEMONSTRATION.] The 110.22 commissioner may conduct a demonstration program under a federal 110.23 Title IV-E waiver to demonstrate the impact of a single benefit 110.24 level on the rate of permanency for children in long-term foster 110.25 care through transfer of permanent legal custody or adoption. 110.26 The commissioner of human services is authorized to waive 110.27 enforcement of related statutory program requirements, rules, 110.28 and standards in one or more counties for the purpose of this 110.29 demonstration. The demonstration must comply with the 110.30 requirements of the secretary of health and human services under 110.31 federal waiver and be cost neutral to the state. 110.32 The commissioner may measure cost neutrality to the state 110.33 by the same mechanism approved by the secretary of health and 110.34 human services to measure federal cost neutrality. The 110.35 commissioner is authorized to accept and administer county funds 110.36 and to transfer state and federal funds among the affected 111.1 programs as necessary for the conduct of the demonstration. 111.2 Sec. 13. Minnesota Statutes 2003 Supplement, section 111.3 256D.44, subdivision 5, is amended to read: 111.4 Subd. 5. [SPECIAL NEEDS.] In addition to the state 111.5 standards of assistance established in subdivisions 1 to 4, 111.6 payments are allowed for the following special needs of 111.7 recipients of Minnesota supplemental aid who are not residents 111.8 of a nursing home, a regional treatment center, or a group 111.9 residential housing facility. 111.10 (a) The county agency shall pay a monthly allowance for 111.11 medically prescribed diets if the cost of those additional 111.12 dietary needs cannot be met through some other maintenance 111.13 benefit. The need for special diets or dietary items must be 111.14 prescribed by a licensed physician. Costs for special diets 111.15 shall be determined as percentages of the allotment for a 111.16 one-person household under the thrifty food plan as defined by 111.17 the United States Department of Agriculture. The types of diets 111.18 and the percentages of the thrifty food plan that are covered 111.19 are as follows: 111.20 (1) high protein diet, at least 80 grams daily, 25 percent 111.21 of thrifty food plan; 111.22 (2) controlled protein diet, 40 to 60 grams and requires 111.23 special products, 100 percent of thrifty food plan; 111.24 (3) controlled protein diet, less than 40 grams and 111.25 requires special products, 125 percent of thrifty food plan; 111.26 (4) low cholesterol diet, 25 percent of thrifty food plan; 111.27 (5) high residue diet, 20 percent of thrifty food plan; 111.28 (6) pregnancy and lactation diet, 35 percent of thrifty 111.29 food plan; 111.30 (7) gluten-free diet, 25 percent of thrifty food plan; 111.31 (8) lactose-free diet, 25 percent of thrifty food plan; 111.32 (9) antidumping diet, 15 percent of thrifty food plan; 111.33 (10) hypoglycemic diet, 15 percent of thrifty food plan; or 111.34 (11) ketogenic diet, 25 percent of thrifty food plan. 111.35 (b) Payment for nonrecurring special needs must be allowed 111.36 for necessary home repairs or necessary repairs or replacement 112.1 of household furniture and appliances using the payment standard 112.2 of the AFDC program in effect on July 16, 1996, for these 112.3 expenses, as long as other funding sources are not available. 112.4 (c) A fee for guardian or conservator service is allowed at 112.5 a reasonable rate negotiated by the county or approved by the 112.6 court. This rate shall not exceed five percent of the 112.7 assistance unit's gross monthly income up to a maximum of $100 112.8 per month. If the guardian or conservator is a member of the 112.9 county agency staff, no fee is allowed. 112.10 (d) The county agency shall continue to pay a monthly 112.11 allowance of $68 for restaurant meals for a person who was 112.12 receiving a restaurant meal allowance on June 1, 1990, and who 112.13 eats two or more meals in a restaurant daily. The allowance 112.14 must continue until the person has not received Minnesota 112.15 supplemental aid for one full calendar month or until the 112.16 person's living arrangement changes and the person no longer 112.17 meets the criteria for the restaurant meal allowance, whichever 112.18 occurs first. 112.19 (e) A fee of ten percent of the recipient's gross income or 112.20 $25, whichever is less, is allowed for representative payee 112.21 services provided by an agency that meets the requirements under 112.22 SSI regulations to charge a fee for representative payee 112.23 services. This special need is available to all recipients of 112.24 Minnesota supplemental aid regardless of their living 112.25 arrangement. 112.26 (f) Notwithstanding the language in this subdivision, an 112.27 amount equal to the maximum allotment authorized by the federal 112.28 Food Stamp Program for a single individual which is in effect on 112.29 the first day of January of the previous year will be added to 112.30 the standards of assistance established in subdivisions 1 to 4 112.31 for individuals under the age of 65 who are relocating from an 112.32 institution or a Department of Human Services Rule 36 facility, 112.33 and who are shelter needy. An eligible individual who receives 112.34 this benefit prior to age 65 may continue to receive the benefit 112.35 after the age of 65. 112.36 "Shelter needy" means that the assistance unit incurs 113.1 monthly shelter costs that exceed 40 percent of the assistance 113.2 unit's gross income before the application of this special needs 113.3 standard. "Gross income" for the purposes of this section is 113.4 the applicant's or recipient's income as defined in section 113.5 256D.35, subdivision 10, or the standard specified in 113.6 subdivision 3, whichever is greater. A recipient of a federal 113.7 or state housing subsidy, that limits shelter costs to a 113.8 percentage of gross income, shall not be considered shelter 113.9 needy for purposes of this paragraph. 113.10 Sec. 14. Minnesota Statutes 2002, section 256I.04, 113.11 subdivision 2a, is amended to read: 113.12 Subd. 2a. [LICENSE REQUIRED.] A county agency may not 113.13 enter into an agreement with an establishment to provide group 113.14 residential housing unless: 113.15 (1) the establishment is licensed by the Department of 113.16 Health as a hotel and restaurant; a board and lodging 113.17 establishment; a residential care home; a boarding care home 113.18 before March 1, 1985; or a supervised living facility, and the 113.19 service provider for residents of the facility is licensed under 113.20 chapter 245A. However, an establishment licensed by the 113.21 Department of Health to provide lodging need not also be 113.22 licensed to provide board if meals are being supplied to 113.23 residents under a contract with a food vendor who is licensed by 113.24 the Department of Health; 113.25 (2) the residence is licensed by the commissioner of human 113.26 services under Minnesota Rules, parts 9555.5050 to 9555.6265, or 113.27 certified by a county human services agency prior to July 1, 113.28 1992, using the standards under Minnesota Rules, parts 9555.5050 113.29 to 9555.6265; or 113.30 (3) the establishment is registered under chapter 144D and 113.31 provides three meals a day, except thator is an establishment 113.32 voluntarily registered under section 144D.025 as a supportive 113.33 housing establishment. An establishment voluntarily registered 113.34 under section 144D.025, other than a supportive housing 113.35 establishment under this subdivision, is not eligible for an113.36 agreementto provide group residential housing. 114.1 The requirements under clauses (1), (2), and (3)this 114.2 subdivision do not apply to establishments exempt from state 114.3 licensure because they are located on Indian reservations and 114.4 subject to tribal health and safety requirements. 114.5 Sec. 15. Minnesota Statutes 2003 Supplement, section 114.6 295.50, subdivision 9b, is amended to read: 114.7 Subd. 9b. [PATIENT SERVICES.] (a) "Patient services" means 114.8 inpatient and outpatient services and other goods and services 114.9 provided by hospitals, surgical centers, or health care 114.10 providers. They include the following health care goods and 114.11 services provided to a patient or consumer: 114.12 (1) bed and board; 114.13 (2) nursing services and other related services; 114.14 (3) use of hospitals, surgical centers, or health care 114.15 provider facilities; 114.16 (4) medical social services; 114.17 (5) drugs, biologicals, supplies, appliances, and 114.18 equipment; 114.19 (6) other diagnostic or therapeutic items or services; 114.20 (7) medical or surgical services; 114.21 (8) items and services furnished to ambulatory patients not 114.22 requiring emergency care; and 114.23 (9) emergency services ; and114.24 (10) covered services listed in section 256B.0625 and in114.25 Minnesota Rules, parts 9505.0170 to 9505.0475. 114.26 (b) "Patient services" does not include: 114.27 (1) services provided to nursing homes licensed under 114.28 chapter 144A; 114.29 (2) examinations for purposes of utilization reviews, 114.30 insurance claims or eligibility, litigation, and employment, 114.31 including reviews of medical records for those purposes; 114.32 (3) services provided to and by community residential 114.33 mental health facilities licensed under Minnesota Rules, parts 114.34 9520.0500 to 9520.0690, and to and by children's residential 114.35 treatment programs licensed under Minnesota Rules, parts 114.36 9545.0905 to 9545.1125, or its successor; 115.1 (4) services provided to and by community support programs 115.2 and family community support programs approved under Minnesota 115.3 Rules, parts 9535.1700 to 9535.1760 or certified as mental 115.4 health rehabilitative services under chapter 256B; 115.5 (5) services provided to and by community mental health 115.6 centers as defined in section 245.62, subdivision 2; 115.7 (6) services provided to and by assisted living programs 115.8 and congregate housing programs; and115.9 (7) hospice care services .; 115.10 (8) home and community-based waivered services under 115.11 sections 256B.0915, 256B.49, 256B.491, and 256B.501; 115.12 (9) targeted case management services under sections 115.13 256B.0621; 256B.0625, subdivisions 20, 20a, 33, and 44; and 115.14 256B.094; and 115.15 (10) services provided to the following: supervised living 115.16 facilities for persons with mental retardation or related 115.17 conditions licensed under Minnesota Rules, parts 4665.0100 to 115.18 4665.9900; housing with services establishments required to be 115.19 registered under chapter 144D; board and lodging establishments 115.20 providing only custodial services that are licensed under 115.21 chapter 157 and registered under section 157.17 to provide 115.22 supportive services or health supervision services; adult foster 115.23 homes as defined in Minnesota Rules, part 9555.5105; day 115.24 training and habilitation services for adults with mental 115.25 retardation and related conditions as defined in section 252.41, 115.26 subdivision 3; boarding care homes as defined in Minnesota 115.27 Rules, part 4655.0100; adult day care centers as defined in 115.28 Minnesota Rules, part 9555.9600; and home health agencies as 115.29 defined in Minnesota Rules, part 9505.0175, subpart 15. 115.30 [EFFECTIVE DATE.] This section is effective retroactively 115.31 from January 1, 2004. 115.32 Sec. 16. Minnesota Statutes 2003 Supplement, section 115.33 295.53, subdivision 1, is amended to read: 115.34 Subdivision 1. [EXEMPTIONS.] (a) The following payments 115.35 are excluded from the gross revenues subject to the hospital, 115.36 surgical center, or health care provider taxes under sections 116.1 295.50 to 295.59: 116.2 (1) payments received for services provided under the 116.3 Medicare program, including payments received from the 116.4 government, and organizations governed by sections 1833 and 1876 116.5 of title XVIII of the federal Social Security Act, United States 116.6 Code, title 42, section 1395, and enrollee deductibles, 116.7 coinsurance, and co-payments, whether paid by the Medicare 116.8 enrollee or by a Medicare supplemental coverage as defined in 116.9 section 62A.011, subdivision 3, clause (10), or by Medicaid 116.10 payments under title XIX of the federal Social Security Act. 116.11 Payments for services not covered by Medicare are taxable; 116.12 (2) payments received for home health care services; 116.13 (3) payments received from hospitals or surgical centers 116.14 for goods and services on which liability for tax is imposed 116.15 under section 295.52 or the source of funds for the payment is 116.16 exempt under clause (1), (7), (10), or (14); 116.17 (4) payments received from health care providers for goods 116.18 and services on which liability for tax is imposed under this 116.19 chapter or the source of funds for the payment is exempt under 116.20 clause (1), (7), (10), or (14); 116.21 (5) amounts paid for legend drugs, other than nutritional 116.22 products, to a wholesale drug distributor who is subject to tax 116.23 under section 295.52, subdivision 3, reduced by reimbursements 116.24 received for legend drugs otherwise exempt under this chapter; 116.25 (6) payments received by a health care provider or the 116.26 wholly owned subsidiary of a health care provider for care 116.27 provided outside Minnesota; 116.28 (7) payments received from the chemical dependency fund 116.29 under chapter 254B; 116.30 (8) payments received in the nature of charitable donations 116.31 that are not designated for providing patient services to a 116.32 specific individual or group; 116.33 (9) payments received for providing patient services 116.34 incurred through a formal program of health care research 116.35 conducted in conformity with federal regulations governing 116.36 research on human subjects. Payments received from patients or 117.1 from other persons paying on behalf of the patients are subject 117.2 to tax; 117.3 (10) payments received from any governmental agency for 117.4 services benefiting the public, not including payments made by 117.5 the government in its capacity as an employer or insurer or 117.6 payments made by the government for services provided under 117.7 medical assistance,general assistance medical care, orthe 117.8 MinnesotaCare program, or the medical assistance program 117.9 governed by title XIX of the federal Social Security Act, United 117.10 States Code, title 42, sections 1396 to 1396v; 117.11 (11) government payments received by a regional treatment117.12 centerthe commissioner of human services for state-operated 117.13 services; 117.14 (12) payments received by a health care provider for 117.15 hearing aids and related equipment or prescription eyewear 117.16 delivered outside of Minnesota; 117.17 (13) payments received by an educational institution from 117.18 student tuition, student activity fees, health care service 117.19 fees, government appropriations, donations, or grants, and for 117.20 services identified in and provided under an individualized 117.21 education plan as defined in section 256B.0625 or Code of 117.22 Federal Regulations, chapter 34, section 300340(a). Fee for 117.23 service payments and payments for extended coverage are taxable; 117.24 and 117.25 (14) payments received under the federal Employees Health 117.26 Benefits Act, United States Code, title 5, section 8909(f), as 117.27 amended by the Omnibus Reconciliation Act of 1990. 117.28 (b) Payments received by wholesale drug distributors for 117.29 legend drugs sold directly to veterinarians or veterinary bulk 117.30 purchasing organizations are excluded from the gross revenues 117.31 subject to the wholesale drug distributor tax under sections 117.32 295.50 to 295.59. 117.33 [EFFECTIVE DATE.] This section is effective retroactively 117.34 from January 1, 2004. 117.35 ARTICLE 14 117.36 HEALTH AND HUMAN SERVICES FORECAST ADJUSTMENTS 118.1 Section 1. Laws 2003, First Special Session chapter 14, 118.2 article 13C, section 1, is amended to read: 118.3 Section 1. [HEALTH AND HUMAN SERVICES APPROPRIATIONSFORECAST 118.4 ADJUSTMENTS.] 118.5 The sums shown in the columns marked "APPROPRIATIONS" are 118.6 appropriated from the general fund, or any other fund named, to 118.7 the agencies and for the purposes specified in the sections of 118.8 this article, to be available for the fiscal years indicated for 118.9 each purpose. The figures "2004" and "2005" where used in this 118.10 article, mean that the appropriation or appropriations listed 118.11 under them are available for the fiscal year ending June 30, 118.12 2004, or June 30, 2005, respectively. Where a dollar amount 118.13 appears in parentheses, it means a reduction of an appropriation. 118.14 SUMMARY BY FUND 118.15 BIENNIAL 118.16 2004 2005 TOTAL 118.17 General $3,765,212,000 $3,727,319,000 $7,492,531,000118.18 $3,500,860,000 $3,746,520,000 $7,247,380,000 118.19 State Government 118.20 Special Revenue 45,337,000 45,104,000 90,441,000 118.21 Health Care 118.22 Access 294,090,000 308,525,000 602,615,000118.23 280,060,000 308,609,000 588,669,000 118.24 Federal TANF 261,552,000 270,364,000 531,916,000118.25 276,425,000 276,363,000 552,788,000 118.26 Lottery Prize 118.27 Fund 1,556,000 1,556,000 3,112,000 118.28 Special Revenue 3,340,000 3,340,000 6,680,000 118.29 TOTAL $4,371,087,000 $4,356,208,000 $8,727,295,000118.30 $4,107,578,000 $4,381,492,000 $8,489,070,000 118.31 APPROPRIATIONS 118.32 Available for the Year 118.33 Ending June 30 118.34 2004 2005 118.35 Sec. 2. Laws 2003, First Special Session chapter 14, 118.36 article 13C, section 2, subdivision 1, is amended to read: 118.37 Subdivision 1. Total 118.38 Appropriation $4,111,558,000 $4,110,496,000118.39 $3,848,049,000 $4,135,780,000 118.40 Summary by Fund 119.1 General 3,566,163,000 3,541,854,000119.2 3,301,811,000 3,561,055,000 119.3 State Government 119.4 Special Revenue 534,000 534,000 119.5 Health Care 119.6 Access 287,753,000 302,188,000119.7 273,723,000 302,272,000 119.8 Federal TANF 255,552,000 264,364,000119.9 270,425,000 270,363,000 119.10 Lottery Cash 119.11 Flow 1,556,000 1,556,000 119.12 [FEDERAL CONTINGENCY APPROPRIATION.] 119.13 (a) Any additionalFederal Medicaid 119.14 funds made available under title IV of 119.15 the federal Jobs and Growth Tax Relief 119.16 Reconciliation Act of 2003 are 119.17 appropriated to the commissioner of 119.18 human services for use in the state's 119.19 medical assistance and MinnesotaCare 119.20 programs. The commissioners of human 119.21 services and finance shall report to 119.22 the legislative advisory committee on 119.23 the additional federal Medicaid 119.24 matching funds that will be available 119.25 to the state. 119.26 (b) Contingent uponBecause of the 119.27 availability of these funds, the 119.28 following policies shall become 119.29 effective and necessary funds are119.30 appropriated for those purposes: 119.31 (1) medical assistance and 119.32 MinnesotaCare eligibility and local 119.33 financial participation changes 119.34 provided for in this act may be 119.35 implemented prior to September 2, 2003, 119.36 or may be delayed as necessary to 119.37 maximize the use of federal funds 119.38 received under title IV of the Jobs and 119.39 Growth Tax Relief Reconciliation Act of 119.40 2003; 119.41 (2) the aggregate cap on the services 119.42 identified in Minnesota Statutes, 119.43 section 256L.035, paragraph (a), clause 119.44 (3), shall be increased from $2,000 to 119.45 $5,000. This increase shall expire at 119.46 the end of fiscal year 2007. Funds may 119.47 be transferred from the general fund to 119.48 the health care access fund as 119.49 necessary to implement this provision; 119.50 and 119.51 (3) the following payment shifts shall 119.52 not be implemented: 119.53 (i) MFIP payment shift found in 119.54 subdivision 11; 119.55 (ii) the county payment shift found in 119.56 subdivision 1; and 120.1 (iii) the delay in medical assistance 120.2 and general assistance medical care 120.3 fee-for-service payments found in 120.4 subdivision 6. 120.5 (c) Notwithstanding section 14, 120.6 paragraphs (a) and (b) shall expire 120.7 June 30, 2007. 120.8 [RECEIPTS FOR SYSTEMS PROJECTS.] 120.9 Appropriations and federal receipts for 120.10 information system projects for MAXIS, 120.11 PRISM, MMIS, and SSIS must be deposited 120.12 in the state system account authorized 120.13 in Minnesota Statutes, section 120.14 256.014. Money appropriated for 120.15 computer projects approved by the 120.16 Minnesota office of technology, funded 120.17 by the legislature, and approved by the 120.18 commissioner of finance may be 120.19 transferred from one project to another 120.20 and from development to operations as 120.21 the commissioner of human services 120.22 considers necessary. Any unexpended 120.23 balance in the appropriation for these 120.24 projects does not cancel but is 120.25 available for ongoing development and 120.26 operations. 120.27 [GIFTS.] Notwithstanding Minnesota 120.28 Statutes, chapter 7, the commissioner 120.29 may accept on behalf of the state 120.30 additional funding from sources other 120.31 than state funds for the purpose of 120.32 financing the cost of assistance 120.33 program grants or nongrant 120.34 administration. All additional funding 120.35 is appropriated to the commissioner for 120.36 use as designated by the grantor of 120.37 funding. 120.38 [SYSTEMS CONTINUITY.] In the event of 120.39 disruption of technical systems or 120.40 computer operations, the commissioner 120.41 may use available grant appropriations 120.42 to ensure continuity of payments for 120.43 maintaining the health, safety, and 120.44 well-being of clients served by 120.45 programs administered by the department 120.46 of human services. Grant funds must be 120.47 used in a manner consistent with the 120.48 original intent of the appropriation. 120.49 [NONFEDERAL SHARE TRANSFERS.] The 120.50 nonfederal share of activities for 120.51 which federal administrative 120.52 reimbursement is appropriated to the 120.53 commissioner may be transferred to the 120.54 special revenue fund. 120.55 [TANF FUNDS APPROPRIATED TO OTHER 120.56 ENTITIES.] Any expenditures from the 120.57 TANF block grant shall be expended in 120.58 accordance with the requirements and 120.59 limitations of part A of title IV of 120.60 the Social Security Act, as amended, 120.61 and any other applicable federal 120.62 requirement or limitation. Prior to 120.63 any expenditure of these funds, the 120.64 commissioner shall assure that funds 120.65 are expended in compliance with the 121.1 requirements and limitations of federal 121.2 law and that any reporting requirements 121.3 of federal law are met. It shall be 121.4 the responsibility of any entity to 121.5 which these funds are appropriated to 121.6 implement a memorandum of understanding 121.7 with the commissioner that provides the 121.8 necessary assurance of compliance prior 121.9 to any expenditure of funds. The 121.10 commissioner shall receipt TANF funds 121.11 appropriated to other state agencies 121.12 and coordinate all related interagency 121.13 accounting transactions necessary to 121.14 implement these appropriations. 121.15 Unexpended TANF funds appropriated to 121.16 any state, local, or nonprofit entity 121.17 cancel at the end of the state fiscal 121.18 year unless appropriating language 121.19 permits otherwise. 121.20 [TANF FUNDS TRANSFERRED TO OTHER 121.21 FEDERAL GRANTS.] The commissioner must 121.22 authorize transfers from TANF to other 121.23 federal block grants so that funds are 121.24 available to meet the annual 121.25 expenditure needs as appropriated. 121.26 Transfers may be authorized prior to 121.27 the expenditure year with the agreement 121.28 of the receiving entity. Transferred 121.29 funds must be expended in the year for 121.30 which the funds were appropriated 121.31 unless appropriation language permits 121.32 otherwise. In accelerating transfer 121.33 authorizations, the commissioner must 121.34 aim to preserve the future potential 121.35 transfer capacity from TANF to other 121.36 block grants. 121.37 [TANF MAINTENANCE OF EFFORT.] (a) In 121.38 order to meet the basic maintenance of 121.39 effort (MOE) requirements of the TANF 121.40 block grant specified under Code of 121.41 Federal Regulations, title 45, section 121.42 263.1, the commissioner may only report 121.43 nonfederal money expended for allowable 121.44 activities listed in the following 121.45 clauses as TANF/MOE expenditures: 121.46 (1) MFIP cash, diversionary work 121.47 program, and food assistance benefits 121.48 under Minnesota Statutes, chapter 256J; 121.49 (2) the child care assistance programs 121.50 under Minnesota Statutes, sections 121.51 119B.03 and 119B.05, and county child 121.52 care administrative costs under 121.53 Minnesota Statutes, section 119B.15; 121.54 (3) state and county MFIP 121.55 administrative costs under Minnesota 121.56 Statutes, chapters 256J and 256K; 121.57 (4) state, county, and tribal MFIP 121.58 employment services under Minnesota 121.59 Statutes, chapters 256J and 256K; 121.60 (5) expenditures made on behalf of 121.61 noncitizen MFIP recipients who qualify 121.62 for the medical assistance without 121.63 federal financial participation program 121.64 under Minnesota Statutes, section 122.1 256B.06, subdivision 4, paragraphs (d), 122.2 (e), and (j); and 122.3 (6) qualifying working family credit 122.4 expenditures under Minnesota Statutes, 122.5 section 290.0671. 122.6 (b) The commissioner shall ensure that 122.7 sufficient qualified nonfederal 122.8 expenditures are made each year to meet 122.9 the state's TANF/MOE requirements. For 122.10 the activities listed in paragraph (a), 122.11 clauses (2) to (6), the commissioner 122.12 may only report expenditures that are 122.13 excluded from the definition of 122.14 assistance under Code of Federal 122.15 Regulations, title 45, section 260.31. 122.16 (c) By August 31 of each year, the 122.17 commissioner shall make a preliminary 122.18 calculation to determine the likelihood 122.19 that the state will meet its annual 122.20 federal work participation requirement 122.21 under Code of Federal Regulations, 122.22 title 45, sections 261.21 and 261.23, 122.23 after adjustment for any caseload 122.24 reduction credit under Code of Federal 122.25 Regulations, title 45, section 261.41. 122.26 If the commissioner determines that the 122.27 state will meet its federal work 122.28 participation rate for the federal 122.29 fiscal year ending that September, the 122.30 commissioner may reduce the expenditure 122.31 under paragraph (a), clause (1), to the 122.32 extent allowed under Code of Federal 122.33 Regulations, title 45, section 122.34 263.1(a)(2). 122.35 (d) For fiscal years beginning with 122.36 state fiscal year 2003, the 122.37 commissioner shall assure that the 122.38 maintenance of effort used by the 122.39 commissioner of finance for the 122.40 February and November forecasts 122.41 required under Minnesota Statutes, 122.42 section 16A.103, contains expenditures 122.43 under paragraph (a), clause (1), equal 122.44 to at least 25 percent of the total 122.45 required under Code of Federal 122.46 Regulations, title 45, section 263.1. 122.47 (e) If nonfederal expenditures for the 122.48 programs and purposes listed in 122.49 paragraph (a) are insufficient to meet 122.50 the state's TANF/MOE requirements, the 122.51 commissioner shall recommend additional 122.52 allowable sources of nonfederal 122.53 expenditures to the legislature, if the 122.54 legislature is or will be in session to 122.55 take action to specify additional 122.56 sources of nonfederal expenditures for 122.57 TANF/MOE before a federal penalty is 122.58 imposed. The commissioner shall 122.59 otherwise provide notice to the 122.60 legislative commission on planning and 122.61 fiscal policy under paragraph (g). 122.62 (f) If the commissioner uses authority 122.63 granted under section 11, or similar 122.64 authority granted by a subsequent 122.65 legislature, to meet the state's 123.1 TANF/MOE requirement in a reporting 123.2 period, the commissioner shall inform 123.3 the chairs of the appropriate 123.4 legislative committees about all 123.5 transfers made under that authority for 123.6 this purpose. 123.7 (g) If the commissioner determines that 123.8 nonfederal expenditures under paragraph 123.9 (a) are insufficient to meet TANF/MOE 123.10 expenditure requirements, and if the 123.11 legislature is not or will not be in 123.12 session to take timely action to avoid 123.13 a federal penalty, the commissioner may 123.14 report nonfederal expenditures from 123.15 other allowable sources as TANF/MOE 123.16 expenditures after the requirements of 123.17 this paragraph are met. The 123.18 commissioner may report nonfederal 123.19 expenditures in addition to those 123.20 specified under paragraph (a) as 123.21 nonfederal TANF/MOE expenditures, but 123.22 only ten days after the commissioner of 123.23 finance has first submitted the 123.24 commissioner's recommendations for 123.25 additional allowable sources of 123.26 nonfederal TANF/MOE expenditures to the 123.27 members of the legislative commission 123.28 on planning and fiscal policy for their 123.29 review. 123.30 (h) The commissioner of finance shall 123.31 not incorporate any changes in federal 123.32 TANF expenditures or nonfederal 123.33 expenditures for TANF/MOE that may 123.34 result from reporting additional 123.35 allowable sources of nonfederal 123.36 TANF/MOE expenditures under the interim 123.37 procedures in paragraph (g) into the 123.38 February or November forecasts required 123.39 under Minnesota Statutes, section 123.40 16A.103, unless the commissioner of 123.41 finance has approved the additional 123.42 sources of expenditures under paragraph 123.43 (g). 123.44 (i) Minnesota Statutes, section 123.45 256.011, subdivision 3, which requires 123.46 that federal grants or aids secured or 123.47 obtained under that subdivision be used 123.48 to reduce any direct appropriations 123.49 provided by law, do not apply if the 123.50 grants or aids are federal TANF funds. 123.51 (j) Notwithstanding section 14, 123.52 paragraph (a), clauses (1) to (6), and 123.53 paragraphs (b) to (j) expire June 30, 123.54 2007. 123.55 [WORKING FAMILY CREDIT EXPENDITURES AS 123.56 TANF MOE.] The commissioner may claim 123.57 as TANF maintenance of effort up to the 123.58 following amounts of working family 123.59 credit expenditures for the following 123.60 fiscal years: 123.61 (1) fiscal year 2004, $7,013,000; 123.62 (2) fiscal year 2005, $25,133,000; 123.63 (3) fiscal year 2006, $6,942,000; and 124.1 (4) fiscal year 2007, $6,707,000. 124.2 [FISCAL YEAR 2003 APPROPRIATIONS 124.3 CARRYFORWARD.] Effective the day 124.4 following final enactment, 124.5 notwithstanding Minnesota Statutes, 124.6 section 16A.28, or any other law to the 124.7 contrary, state agencies and 124.8 constitutional offices may carry 124.9 forward unexpended and unencumbered 124.10 nongrant operating balances from fiscal 124.11 year 2003 general fund appropriations 124.12 into fiscal year 2004 to offset general 124.13 budget reductions. 124.14 [TRANSFER OF GRANT BALANCES.] Effective 124.15 the day following final enactment, the 124.16 commissioner of human services, with 124.17 the approval of the commissioner of 124.18 finance and after notification of the 124.19 chair of the senate health, human 124.20 services and corrections budget 124.21 division and the chair of the house of 124.22 representatives health and human 124.23 services finance committee, may 124.24 transfer unencumbered appropriation 124.25 balances for the biennium ending June 124.26 30, 2003, in fiscal year 2003 among the 124.27 MFIP, MFIP child care assistance under 124.28 Minnesota Statutes, section 119B.05, 124.29 general assistance, general assistance 124.30 medical care, medical assistance, 124.31 Minnesota supplemental aid, and group 124.32 residential housing programs, and the 124.33 entitlement portion of the chemical 124.34 dependency consolidated treatment fund, 124.35 and between fiscal years of the 124.36 biennium. 124.37 [TANF APPROPRIATION CANCELLATION.] 124.38 Notwithstanding the provisions of Laws 124.39 2000, chapter 488, article 1, section 124.40 16, any prior appropriations of TANF 124.41 funds to the department of trade and 124.42 economic development or to the job 124.43 skills partnership board or any 124.44 transfers of TANF funds from another 124.45 agency to the department of trade and 124.46 economic development or to the job 124.47 skills partnership board are not 124.48 available until expended, and if 124.49 unobligated as of June 30, 2003, these 124.50 appropriations or transfers shall 124.51 cancel to the TANF fund. 124.52 [SHIFT COUNTY PAYMENT.] The 124.53 commissioner shall make up to 100 124.54 percent of the calendar year 2005 124.55 payments to counties for developmental 124.56 disabilities semi-independent living 124.57 services grants, developmental 124.58 disabilities family support grants, and 124.59 adult mental health grants from fiscal 124.60 year 2006 appropriations. This is a 124.61 onetime payment shift. Calendar year 124.62 2006 and future payments for these 124.63 grants are not affected by this shift. 124.64 This provision expires June 30, 2006. 124.65 [CAPITATION RATE INCREASE.] Of the 124.66 health care access fund appropriations 125.1 to the University of Minnesota in the 125.2 higher education omnibus appropriation 125.3 bill, $2,157,000 in fiscal year 2004 125.4 and $2,157,000 in fiscal year 2005 are 125.5 to be used to increase the capitation 125.6 payments under Minnesota Statutes, 125.7 section 256B.69. Notwithstanding the 125.8 provisions of section 14, this 125.9 provision shall not expire. 125.10 Sec. 3. Laws 2003, First Special Session chapter 14, 125.11 article 13C, section 2, subdivision 3, is amended to read: 125.12 Subd. 3. Revenue and Pass-Through 125.13 Federal TANF 55,855,000 53,315,000125.14 56,643,000 57,275,000 125.15 [TANF TRANSFER TO SOCIAL SERVICES BLOCK 125.16 GRANT.] $3,137,000 in fiscal year 2005 125.17 is appropriated to the commissioner for 125.18 the purposes of providing services for 125.19 families with children whose incomes 125.20 are at or below 200 percent of the 125.21 federal poverty guidelines. The 125.22 commissioner shall authorize a 125.23 sufficient transfer of funds from the 125.24 state's federal TANF block grant to the 125.25 state's federal social services block 125.26 grant to meet this appropriation. The 125.27 funds shall be distributed to counties 125.28 for the children and community services 125.29 grant according to the formula for the 125.30 state appropriations in Minnesota 125.31 Statutes, chapter 256M. 125.32 [TANF FUNDS FOR FISCAL YEAR 2006 AND 125.33 FISCAL YEAR 2007 REFINANCING.] 125.34 $12,692,000$6,692,000 in fiscal year 125.35 2006 and $9,192,000$3,192,000 in 125.36 fiscal year 2007 in TANF funds are 125.37 available to the commissioner to 125.38 replace general funds in the amount 125.39 of $12,692,000$6,692,000 in fiscal 125.40 year 2006 and $9,192,000$3,192,000 in 125.41 fiscal year 2007 in expenditures that 125.42 may be counted toward TANF maintenance 125.43 of effort requirements or as an 125.44 allowable TANF expenditure. 125.45 [ADJUSTMENTS IN TANF TRANSFER TO CHILD 125.46 CARE AND DEVELOPMENT FUND.] Transfers 125.47 of TANF to the child care development 125.48 fund for the purposes of MFIP child 125.49 care assistance shall be reduced by 125.50 $116,000 in fiscal year 2004 and shall 125.51 be increased by $1,976,000 in fiscal 125.52 year 2005. 125.53 Sec. 4. Laws 2003, First Special Session chapter 14, 125.54 article 13C, section 2, subdivision 6, is amended to read: 125.55 Subd. 6. Basic Health Care Grants 125.56 Summary by Fund 125.57 General 1,499,941,000 1,533,016,000126.1 1,290,454,000 1,475,996,000 126.2 Health Care Access 268,151,000 282,605,000126.3 254,121,000 282,689,000 126.4 [UPDATING FEDERAL POVERTY GUIDELINES.] 126.5 Annual updates to the federal poverty 126.6 guidelines are effective each July 1, 126.7 following publication by the United 126.8 States Department of Health and Human 126.9 Services for health care programs under 126.10 Minnesota Statutes, chapters 256, 256B, 126.11 256D, and 256L. 126.12 The amounts that may be spent from this 126.13 appropriation for each purpose are as 126.14 follows: 126.15 (a) MinnesotaCare Grants 126.16 Health Care Access 267,401,000 281,855,000126.17 253,371,000 281,939,000 126.18 [MINNESOTACARE FEDERAL RECEIPTS.] 126.19 Receipts received as a result of 126.20 federal participation pertaining to 126.21 administrative costs of the Minnesota 126.22 health care reform waiver shall be 126.23 deposited as nondedicated revenue in 126.24 the health care access fund. Receipts 126.25 received as a result of federal 126.26 participation pertaining to grants 126.27 shall be deposited in the federal fund 126.28 and shall offset health care access 126.29 funds for payments to providers. 126.30 [MINNESOTACARE FUNDING.] The 126.31 commissioner may expend money 126.32 appropriated from the health care 126.33 access fund for MinnesotaCare in either 126.34 fiscal year of the biennium. 126.35 (b) MA Basic Health Care Grants - 126.36 Families and Children 126.37 General 568,254,000 582,161,000126.38 427,769,000 489,545,000 126.39 [SERVICES TO PREGNANT WOMEN.] The 126.40 commissioner shall use available 126.41 federal money for the State-Children's 126.42 Health Insurance Program for medical 126.43 assistance services provided to 126.44 pregnant women who are not otherwise 126.45 eligible for federal financial 126.46 participation beginning in fiscal year 126.47 2003. This federal money shall be 126.48 deposited in the federal fund and shall 126.49 offset general funds for payments to 126.50 providers. Notwithstanding section 14, 126.51 this paragraph shall not expire. 126.52 [MANAGED CARE RATE INCREASE.] (a) 126.53 Effective January 1, 2004, the 126.54 commissioner of human services shall 126.55 increase the total payments to managed 126.56 care plans under Minnesota Statutes, 126.57 section 256B.69, by an amount equal to 127.1 the cost increases to the managed care 127.2 plans from by the elimination of: (1) 127.3 the exemption from the taxes imposed 127.4 under Minnesota Statutes, section 127.5 297I.05, subdivision 5, for premiums 127.6 paid by the state for medical 127.7 assistance, general assistance medical 127.8 care, and the MinnesotaCare program; 127.9 and (2) the exemption of gross revenues 127.10 subject to the taxes imposed under 127.11 Minnesota Statutes, sections 295.50 to 127.12 295.57, for payments paid by the state 127.13 for services provided under medical 127.14 assistance, general assistance medical 127.15 care, and the MinnesotaCare program. 127.16 Any increase based on clause (2) must 127.17 be reflected in provider rates paid by 127.18 the managed care plan unless the 127.19 managed care plan is a staff model 127.20 health plan company. 127.21 (b) The commissioner of human services 127.22 shall increase by two percent the 127.23 fee-for-service payments under medical 127.24 assistance, general assistance medical 127.25 care, and the MinnesotaCare program for 127.26 services subject to the hospital, 127.27 surgical center, or health care 127.28 provider taxes under Minnesota 127.29 Statutes, sections 295.50 to 295.57, 127.30 effective for services rendered on or 127.31 after January 1, 2004. 127.32 (c) The commissioner of finance shall 127.33 transfer from the health care access 127.34 fund to the general fund the following 127.35 amounts in the fiscal years indicated: 127.36 2004, $16,587,000; 2005, $46,322,000; 127.37 2006, $49,413,000; and 2007, 127.38 $52,659,000. 127.39 (d) For fiscal years after 2007, the 127.40 commissioner of finance shall transfer 127.41 from the health care access fund to the 127.42 general fund an amount equal to the 127.43 revenue collected by the commissioner 127.44 of revenue on the following: 127.45 (1) gross revenues received by 127.46 hospitals, surgical centers, and health 127.47 care providers as payments for services 127.48 provided under medical assistance, 127.49 general assistance medical care, and 127.50 the MinnesotaCare program, including 127.51 payments received directly from the 127.52 state or from a prepaid plan, under 127.53 Minnesota Statutes, sections 295.50 to 127.54 295.57; and 127.55 (2) premiums paid by the state under 127.56 medical assistance, general assistance 127.57 medical care, and the MinnesotaCare 127.58 program under Minnesota Statutes, 127.59 section 297I.05, subdivision 5. 127.60 The commissioner of finance shall 127.61 monitor and adjust if necessary the 127.62 amount transferred each fiscal year 127.63 from the health care access fund to the 127.64 general fund to ensure that the amount 127.65 transferred equals the tax revenue 128.1 collected for the items described in 128.2 clauses (1) and (2) for that fiscal 128.3 year. 128.4 (e) Notwithstanding section 14, these 128.5 provisions shall not expire. 128.6 (c) MA Basic Health Care Grants - Elderly 128.7 and Disabled 128.8 General 695,421,000 741,605,000128.9 610,518,000 743,858,000 128.10 [DELAY MEDICAL ASSISTANCE 128.11 FEE-FOR-SERVICE - ACUTE CARE.] The 128.12 following payments in fiscal year 2005 128.13 from the Medicaid Management 128.14 Information System that would otherwise 128.15 have been made to providers for medical 128.16 assistance and general assistance 128.17 medical care services shall be delayed 128.18 and included in the first payment in 128.19 fiscal year 2006: 128.20 (1) for hospitals, the last two 128.21 payments; and 128.22 (2) for nonhospital providers, the last 128.23 payment. 128.24 This payment delay shall not include 128.25 payments to skilled nursing facilities, 128.26 intermediate care facilities for mental 128.27 retardation, prepaid health plans, home 128.28 health agencies, personal care nursing 128.29 providers, and providers of only waiver 128.30 services. The provisions of Minnesota 128.31 Statutes, section 16A.124, shall not 128.32 apply to these delayed payments. 128.33 Notwithstanding section 14, this 128.34 provision shall not expire. 128.35 [DEAF AND HARD-OF-HEARING SERVICES.] 128.36 If, after making reasonable efforts, 128.37 the service provider for mental health 128.38 services to persons who are deaf or 128.39 hearing impaired is not able to earn 128.40 $227,000 through participation in 128.41 medical assistance intensive 128.42 rehabilitation services in fiscal year 128.43 2005, the commissioner shall transfer 128.44 $227,000 minus medical assistance 128.45 earnings achieved by the grantee to 128.46 deaf and hard-of-hearing grants to 128.47 enable the provider to continue 128.48 providing services to eligible persons. 128.49 (d) General Assistance Medical Care 128.50 Grants 128.51 General 223,960,000 196,617,000128.52 239,861,000 229,960,000 128.53 (e) Health Care Grants - Other 128.54 Assistance 128.55 General 3,067,000 3,407,000 128.56 Health Care Access 750,000 750,000 129.1 [MINNESOTA PRESCRIPTION DRUG DEDICATED 129.2 FUND.] Of the general fund 129.3 appropriation, $284,000 in fiscal year 129.4 2005 is appropriated to the 129.5 commissioner for the prescription drug 129.6 dedicated fund established under the 129.7 prescription drug discount program. 129.8 [DENTAL ACCESS GRANTS CARRYOVER 129.9 AUTHORITY.] Any unspent portion of the 129.10 appropriation from the health care 129.11 access fund in fiscal years 2002 and 129.12 2003 for dental access grants under 129.13 Minnesota Statutes, section 256B.53, 129.14 shall not cancel but shall be allowed 129.15 to carry forward to be spent in the 129.16 biennium beginning July 1, 2003, for 129.17 these purposes. 129.18 [STOP-LOSS FUND ACCOUNT.] The 129.19 appropriation to the purchasing 129.20 alliance stop-loss fund account 129.21 established under Minnesota Statutes, 129.22 section 256.956, subdivision 2, for 129.23 fiscal years 2004 and 2005 shall only 129.24 be available for claim reimbursements 129.25 for qualifying enrollees who are 129.26 members of purchasing alliances that 129.27 meet the requirements described under 129.28 Minnesota Statutes, section 256.956, 129.29 subdivision 1, paragraph (f), clauses 129.30 (1), (2), and (3). 129.31 (f) Prescription Drug Program 129.32 General 9,239,000 9,226,000 129.33 [PRESCRIPTION DRUG ASSISTANCE PROGRAM.] 129.34 Of the general fund appropriation, 129.35 $702,000 in fiscal year 2004 and 129.36 $887,000 in fiscal year 2005 are for 129.37 the commissioner to establish and 129.38 administer the prescription drug 129.39 assistance program through the 129.40 Minnesota board on aging. 129.41 [REBATE REVENUE RECAPTURE.] Any funds 129.42 received by the state from a drug 129.43 manufacturer due to errors in the 129.44 pharmaceutical pricing used by the 129.45 manufacturer in determining the 129.46 prescription drug rebate are 129.47 appropriated to the commissioner to 129.48 augment funding of the prescription 129.49 drug program established in Minnesota 129.50 Statutes, section 256.955. 129.51 Sec. 5. Laws 2003, First Special Session chapter 14, 129.52 article 13C, section 2, subdivision 7, is amended to read: 129.53 Subd. 7. Health Care Management 129.54 Summary by Fund 129.55 General 24,845,00026,199,000 129.56 24,834,000 129.57 Health Care Access 14,522,000 14,533,000 130.1 The amounts that may be spent from this 130.2 appropriation for each purpose are as 130.3 follows: 130.4 (a) Health Care Policy Administration 130.5 General 5,523,000 7,223,000 130.6 Health Care Access 1,066,000 1,200,000 130.7 [PAYMENT CODE STUDY.] Of this 130.8 appropriation, $345,000 each year is 130.9 for a study to determine the 130.10 appropriateness of eliminating 130.11 reimbursement for certain payment codes 130.12 under medical assistance, general 130.13 assistance medical care, or 130.14 MinnesotaCare. As part of the study, 130.15 the commissioner shall also examine 130.16 covered services under the Minnesota 130.17 health care programs and make 130.18 recommendations on possible 130.19 modification of the services covered 130.20 under the program. The commissioner 130.21 shall report to the legislature by 130.22 January 15, 2005, with an analysis of 130.23 the feasibility of this approach, a 130.24 list of codes, if any, to be eliminated 130.25 from the payment system, and estimates 130.26 of savings to be obtained from this 130.27 approach. 130.28 [TRANSFERS FROM HEALTH CARE ACCESS 130.29 FUND.] (a) Notwithstanding Minnesota 130.30 Statutes, section 295.581, to the 130.31 extent available resources in the 130.32 health care access fund exceed 130.33 expenditures in that fund during fiscal 130.34 years 2005 to 2007, the excess annual 130.35 funds shall be transferred from the 130.36 health care access fund to the general 130.37 fund on June 30 of fiscal years 2005, 130.38 2006, and 2007. These transfers shall 130.39 not be reduced to accommodate 130.40 MinnesotaCare expansions. The 130.41 estimated amounts to be transferred are: 130.42 (1) in fiscal year 2005, $192,442,000; 130.43 (2) in fiscal year 2006, $52,943,000; 130.44 and 130.45 (3) in fiscal year 2007, $59,105,000. 130.46 These estimates shall be updated with 130.47 each forecast, but in no case shall the 130.48 transfers exceed the amounts listed in 130.49 clauses (1) to (3). 130.50 (b) The commissioner shall limit 130.51 transfers under paragraph (a) in order 130.52 to avoid implementation of Minnesota 130.53 Statutes, section 256L.02, subdivision 130.54 3, paragraph (b). 130.55 (c) For fiscal years 2004 to 2007, 130.56 MinnesotaCare shall be a forecasted 130.57 program and, if necessary, the 130.58 commissioner shall reduce transfers 130.59 under paragraph (a) to meet forecasted 130.60 expenditures. 131.1 (d) The department of human services in 131.2 recommending its 2007-2008 budget shall 131.3 consider the repayment of the amount 131.4 transferred in fiscal years 2006 and 131.5 2007 from the health care access fund 131.6 to the general fund to the health care 131.7 access fund. 131.8 (e) Notwithstanding section 14, this 131.9 section is in effect until June 30, 131.10 2007. 131.11 [MINNESOTACARE OUTREACH REIMBURSEMENT.] 131.12 Federal administrative reimbursement 131.13 resulting from MinnesotaCare outreach 131.14 is appropriated to the commissioner for 131.15 this activity. 131.16 [MINNESOTA SENIOR HEALTH OPTIONS 131.17 REIMBURSEMENT.] Federal administrative 131.18 reimbursement resulting from the 131.19 Minnesota senior health options project 131.20 is appropriated to the commissioner for 131.21 this activity. 131.22 [UTILIZATION REVIEW.] Federal 131.23 administrative reimbursement resulting 131.24 from prior authorization and inpatient 131.25 admission certification by a 131.26 professional review organization shall 131.27 be dedicated to the commissioner for 131.28 these purposes. A portion of these 131.29 funds must be used for activities to 131.30 decrease unnecessary pharmaceutical 131.31 costs in medical assistance. 131.32 (b) Health Care Operations 131.33 General 19,322,00018,976,000 131.34 19,311,000 131.35 Health Care Access 13,456,000 13,333,000 131.36 [PREPAID MEDICAL PROGRAMS.] For all 131.37 counties in which the PMAP program has 131.38 been operating for 12 or more months, 131.39 state funding for the nonfederal share 131.40 of prepaid medical assistance program 131.41 administration costs for county managed 131.42 care advocacy and enrollment operations 131.43 is eliminated. State funding will 131.44 continue for these activities for 131.45 counties and tribes establishing new 131.46 PMAP programs for a maximum of 16 131.47 months (four months prior to beginning 131.48 PMAP enrollment and through the first 131.49 12 months of their PMAP program 131.50 operation). Those counties operating 131.51 PMAP programs for less than 12 months 131.52 can continue to receive state funding 131.53 for advocacy and enrollment activities 131.54 through their first year of operation. 131.55 Sec. 6. Laws 2003, First Special Session chapter 14, 131.56 article 13C, section 2, subdivision 9, is amended to read: 131.57 Subd. 9. Continuing Care Grants 131.58 Summary by Fund 132.1 General 1,504,933,000 1,490,958,000132.2 1,448,029,000 1,567,392,000 132.3 Lottery Prize Fund 1,408,000 1,408,000 132.4 The amounts that may be spent from this 132.5 appropriation for each purpose are as 132.6 follows: 132.7 (a) Community Social Services 132.8 General 496,000 371,000 132.9 (b) Aging and Adult Service Grant 132.10 General 12,998,000 13,951,000 132.11 [LONG-TERM CARE PROGRAM REDUCTIONS.] 132.12 For the biennium ending June 30, 2005, 132.13 state funding for the following state 132.14 long-term care programs is reduced by 132.15 15 percent from the level of state 132.16 funding provided on June 30, 2003: 132.17 SAIL project grants under Minnesota 132.18 Statutes, section 256B.0917; senior 132.19 nutrition programs under Minnesota 132.20 Statutes, section 256.9752; foster 132.21 grandparents program under Minnesota 132.22 Statutes, section 256.976; retired 132.23 senior volunteer program under 132.24 Minnesota Statutes, section 256.9753; 132.25 and the senior companion program under 132.26 Minnesota Statutes, section 256.977. 132.27 (c) Deaf and Hard-of-hearing 132.28 Service Grants 132.29 General 1,719,000 1,490,000 132.30 (d) Mental Health Grants 132.31 General 53,479,000 34,690,000132.32 46,551,000 132.33 Lottery Prize Fund 1,408,000 1,408,000 132.34 [RESTRUCTURING OF ADULT MENTAL HEALTH 132.35 SERVICES.] The commissioner may make 132.36 transfers that do not increase the 132.37 state share of costs to effectively 132.38 implement the restructuring of adult 132.39 mental health services. 132.40 [COMPULSIVE GAMBLING.] Of the 132.41 appropriation from the lottery prize 132.42 fund, $250,000 each year is for the 132.43 following purposes: 132.44 (1) $100,000 each year is for a grant 132.45 to the Southeast Asian Problem Gambling 132.46 Consortium. The consortium must 132.47 provide statewide compulsive gambling 132.48 prevention and treatment services for 132.49 Lao, Hmong, Vietnamese, and Cambodian 132.50 families, adults, and adolescents. The 132.51 appropriation in this clause shall not 132.52 become part of base level funding for 132.53 the biennium beginning July 1, 2005. 132.54 Any unencumbered balance of the 133.1 appropriation in the first year does 133.2 not cancel but is available for the 133.3 second year; and 133.4 (2) $150,000 each year is for a grant 133.5 to a compulsive gambling council 133.6 located in St. Louis county. The 133.7 gambling council must provide a 133.8 statewide compulsive gambling 133.9 prevention and education project for 133.10 adolescents. Any unencumbered balance 133.11 of the appropriation in the first year 133.12 of the biennium does not cancel but is 133.13 available for the second year. 133.14 (e) Community Support Grants 133.15 12,523,000 9,093,000133.16 12,024,000 133.17 [CENTERS FOR INDEPENDENT LIVING STUDY.] 133.18 The commissioner of human services, in 133.19 consultation with the commissioner of 133.20 economic security, the centers for 133.21 independent living, and consumer 133.22 representatives, shall study the 133.23 financing of the centers for 133.24 independent living authorized under 133.25 Minnesota Statutes, section 268A.11, 133.26 and make recommendations on options to 133.27 maximize federal financial 133.28 participation. Study components shall 133.29 include: 133.30 (1) the demographics of individuals 133.31 served by the centers for independent 133.32 living; 133.33 (2) the range of services the centers 133.34 for independent living provide to these 133.35 individuals; 133.36 (3) other publicly funded services 133.37 received by individuals supported by 133.38 the centers; and 133.39 (4) strategies for maximizing federal 133.40 financial participation for eligible 133.41 activities carried out by centers for 133.42 independent living. 133.43 The commissioner shall report with 133.44 fiscal and programmatic recommendations 133.45 to the chairs of the appropriate house 133.46 of representatives and senate finance 133.47 and policy committees by January 15, 133.48 2004. 133.49 (f) Medical Assistance Long-Term 133.50 Care Waivers and Home Care Grants 133.51 General 659,211,000 718,665,000133.52 624,631,000 748,189,000 133.53 [RATE AND ALLOCATION DECREASES FOR 133.54 CONTINUING CARE PROGRAMS.] 133.55 Notwithstanding any law or rule to the 133.56 contrary, the commissioner of human 133.57 services shall decrease reimbursement 134.1 rates or reduce allocations to assure 134.2 the necessary reductions in state 134.3 spending for the providers or programs 134.4 listed in paragraphs (a) to (d). The 134.5 decreases are effective for services 134.6 rendered on or after July 1, 2003. 134.7 (a) Effective July 1, 2003, the 134.8 commissioner shall reduce payment rates 134.9 for services and individual or service 134.10 limits by one percent. The rate 134.11 decreases described in this section 134.12 must be applied to: 134.13 (1) home and community-based waivered 134.14 services for the elderly under 134.15 Minnesota Statutes, section 256B.0915; 134.16 (2) day training and habilitation 134.17 services for adults with mental 134.18 retardation or related conditions under 134.19 Minnesota Statutes, sections 252.40 to 134.20 252.46; 134.21 (3) the group residential housing 134.22 supplementary service rate under 134.23 Minnesota Statutes, section 256I.05, 134.24 subdivision 1a; 134.25 (4) chemical dependency residential and 134.26 nonresidential service rates under 134.27 Minnesota Statutes, section 245B.03; 134.28 (5) consumer support grants under 134.29 Minnesota Statutes, section 256.476; 134.30 and 134.31 (6) home and community-based services 134.32 for alternative care services under 134.33 Minnesota Statutes, section 256B.0913. 134.34 (b) The commissioner shall reduce 134.35 allocations made available to county 134.36 agencies for home and community-based 134.37 waivered services to assure a 134.38 one-percent reduction in state spending 134.39 for services rendered on or after July 134.40 1, 2003. The commissioner shall apply 134.41 the allocation decreases described in 134.42 this section to: 134.43 (1) persons with mental retardation or 134.44 related conditions under Minnesota 134.45 Statutes, section 256B.501; 134.46 (2) waivered services under community 134.47 alternatives for disabled individuals 134.48 under Minnesota Statutes, section 134.49 256B.49; 134.50 (3) community alternative care waivered 134.51 services under Minnesota Statutes, 134.52 section 256B.49; and 134.53 (4) traumatic brain injury waivered 134.54 services under Minnesota Statutes, 134.55 section 256B.49. 134.56 County agencies will be responsible for 134.57 100 percent of any spending in excess 134.58 of the allocation made by the 135.1 commissioner. Nothing in this section 135.2 shall be construed as reducing the 135.3 county's responsibility to offer and 135.4 make available feasible home and 135.5 community-based options to eligible 135.6 waiver recipients within the resources 135.7 allocated to them for that purpose. 135.8 (c) The commissioner shall reduce deaf 135.9 and hard-of-hearing grants by one 135.10 percent on July 1, 2003. 135.11 (d) Effective July 1, 2003, the 135.12 commissioner shall reduce payment rates 135.13 for each facility reimbursed under 135.14 Minnesota Statutes, section 256B.5012, 135.15 by decreasing the total operating 135.16 payment rate for intermediate care 135.17 facilities for the mentally retarded by 135.18 one percent. For each facility, the 135.19 commissioner shall multiply the 135.20 adjustment by the total payment rate, 135.21 excluding the property-related payment 135.22 rate, in effect on June 30, 2003. A 135.23 facility whose payment rates are 135.24 governed by closure agreements, 135.25 receivership agreements, or Minnesota 135.26 Rules, part 9553.0075, is not subject 135.27 to an adjustment otherwise taken under 135.28 this subdivision. 135.29 Notwithstanding section 14, these 135.30 adjustments shall not expire. 135.31 [REDUCE GROWTH IN MR/RC WAIVER.] The 135.32 commissioner shall reduce the growth in 135.33 the MR/RC waiver by not allocating the 135.34 300 additional diversion allocations 135.35 that are included in the February 2003 135.36 forecast for the fiscal years that 135.37 begin on July 1, 2003, and July 1, 2004. 135.38 [MANAGE THE GROWTH IN THE TBI WAIVER.] 135.39 During the fiscal years beginning on 135.40 July 1, 2003, and July 1, 2004, the 135.41 commissioner shall allocate money for 135.42 home and community-based programs 135.43 covered under Minnesota Statutes, 135.44 section 256B.49, to assure a reduction 135.45 in state spending that is equivalent to 135.46 limiting the caseload growth of the TBI 135.47 waiver to 150 in each year of the 135.48 biennium. Priorities for the 135.49 allocation of funds shall be for 135.50 individuals anticipated to be 135.51 discharged from institutional settings 135.52 or who are at imminent risk of a 135.53 placement in an institutional setting. 135.54 [TARGETED CASE MANAGEMENT FOR HOME CARE 135.55 RECIPIENTS.] Implementation of the 135.56 targeted case management benefit for 135.57 home care recipients, according to 135.58 Minnesota Statutes, section 256B.0621, 135.59 subdivisions 2, 3, 5, 6, 7, 9, and 10, 135.60 will be delayed until July 1, 2005. 135.61 [COMMON SERVICE MENU.] Implementation 135.62 of the common service menu option 135.63 within the home and community-based 135.64 waivers, according to Minnesota 136.1 Statutes, section 256B.49, subdivision 136.2 16, will be delayed until July 1, 2005. 136.3 [LIMITATION ON COMMUNITY ALTERNATIVES 136.4 FOR DISABLED INDIVIDUALS CASELOAD 136.5 GROWTH.] For the biennium ending June 136.6 30, 2005, the commissioner shall limit 136.7 the allocations made available in the 136.8 community alternatives for disabled 136.9 individuals waiver program in order not 136.10 to exceed average caseload growth of 95 136.11 per month from June 2003 program 136.12 levels, plus any additional 136.13 legislatively authorized program 136.14 growth. The commissioner shall 136.15 allocate available resources to achieve 136.16 the following outcomes: 136.17 (1) the establishment of feasible and 136.18 viable alternatives for persons in 136.19 institutional or hospital settings to 136.20 relocate to home and community-based 136.21 settings; 136.22 (2) the availability of timely 136.23 assistance to persons at imminent risk 136.24 of institutional or hospital placement 136.25 or whose health and safety is at 136.26 immediate risk; and 136.27 (3) the maximum provision of essential 136.28 community supports to eligible persons 136.29 in need of and waiting for home and 136.30 community-based service alternatives. 136.31 The commissioner may reallocate 136.32 resources from one county or region to 136.33 another if available funding in that 136.34 county or region is not likely to be 136.35 spent and the reallocation is necessary 136.36 to achieve the outcomes specified in 136.37 this paragraph. 136.38 (g) Medical Assistance Long-term 136.39 Care Facilities Grants 136.40 General 543,999,000 514,483,000136.41 513,763,000 536,321,000 136.42 (h) Alternative Care Grants 136.43 General 75,206,000 66,351,000 136.44 [ALTERNATIVE CARE TRANSFER.] Any money 136.45 allocated to the alternative care 136.46 program that is not spent for the 136.47 purposes indicated does not cancel but 136.48 shall be transferred to the medical 136.49 assistance account. 136.50 [ALTERNATIVE CARE APPROPRIATION.] The 136.51 commissioner may expend the money 136.52 appropriated for the alternative care 136.53 program for that purpose in either year 136.54 of the biennium. 136.55 [ALTERNATIVE CARE IMPLEMENTATION OF 136.56 CHANGES TO FEES AND ELIGIBILITY.] 136.57 Changes to Minnesota Statutes, section 136.58 256B.0913, subdivision 4, paragraph 136.59 (d), and subdivision 12, are effective 137.1 July 1, 2003, for all persons found 137.2 eligible for the alternative care 137.3 program on or after July 1, 2003. All 137.4 recipients of alternative care funding 137.5 as of June 30, 2003, shall be subject 137.6 to Minnesota Statutes, section 137.7 256B.0913, subdivision 4, paragraph 137.8 (d), and subdivision 12, on the annual 137.9 reassessment and review of their 137.10 eligibility after July 1, 2003, but no 137.11 later than January 1, 2004. 137.12 (i) Group Residential Housing Grants 137.13 General 94,996,000 80,472,000137.14 94,547,000 81,055,000 137.15 [GROUP RESIDENTIAL HOUSING COSTS 137.16 REFINANCED.] (1) Effective July 1, 137.17 2004, the commissioner shall increase 137.18 the home and community-based service 137.19 rates and county allocations provided 137.20 to programs for persons with 137.21 disabilities established under section 137.22 1915(c) of the Social Security Act to 137.23 the extent that these programs will be 137.24 paying for the costs above the rate 137.25 established in Minnesota Statutes, 137.26 section 256I.05, subdivision 1. 137.27 (2) For persons in receipt of services 137.28 under Minnesota Statutes, section 137.29 256B.0915, who reside in licensed adult 137.30 foster care beds for which a 137.31 supplemental room and board payment was 137.32 being made under Minnesota Statutes, 137.33 section 256I.05, subdivision 1, 137.34 counties may request an exception to 137.35 the individual caps specified in 137.36 Minnesota Statutes, section 256B.0915, 137.37 subdivision 3, paragraph (b), not to 137.38 exceed the difference between the 137.39 individual cap and the client's monthly 137.40 service expenditures plus the amount of 137.41 the supplemental room and board rate. 137.42 The county must submit a request to 137.43 exceed the individual cap to the 137.44 commissioner for approval. 137.45 (j) Chemical Dependency 137.46 Entitlement Grants 137.47 General 49,251,000 50,337,000137.48 57,612,000 60,034,000 137.49 (k) Chemical Dependency Nonentitlement 137.50 Grants 137.51 General 1,055,000 1,055,000 137.52 Sec. 7. Laws 2003, First Special Session chapter 14, 137.53 article 13C, section 2, subdivision 11, is amended to read: 137.54 Subd. 11. Economic Support Grants 137.55 Summary by Fund 137.56 General 122,647,000 117,198,000138.1 124,697,000 116,985,000 138.2 Federal TANF 199,009,000 207,224,000138.3 212,844,000 209,264,000 138.4 The amounts that may be spent from this 138.5 appropriation for each purpose are as 138.6 follows: 138.7 (a) Minnesota Family Investment Program 138.8 General 59,922,000 39,375,000138.9 53,818,000 43,942,000 138.10 Federal TANF 106,535,000 110,543,000138.11 114,370,000 106,583,000 138.12 (b) Work Grants 138.13 General 666,000 14,678,000138.14 8,666,000 8,678,000 138.15 Federal TANF 92,474,000 96,681,000138.16 98,474,000 102,681,000 138.17 [MFIP SUPPORT SERVICES COUNTY AND 138.18 TRIBAL ALLOCATION.] When determining 138.19 the funds available for the 138.20 consolidated MFIP support services 138.21 grant in the 18-month period ending 138.22 December 31, 2004, the commissioner 138.23 shall apportion the funds appropriated 138.24 for fiscal year 2005 in such manner as 138.25 necessary to provide $14,000,000 more 138.26 to counties and tribes for the period 138.27 ending December 31, 2004, than would 138.28 have been available had the funds been 138.29 evenly divided within the fiscal year 138.30 between the period before December 31, 138.31 2004, and the period after December 31, 138.32 2004. 138.33 For allocations for the calendar years 138.34 starting January 1, 2005, the 138.35 commissioner shall apportion the funds 138.36 appropriated for each fiscal year in 138.37 such manner as necessary to provide 138.38 $14,000,000 more to counties and tribes 138.39 for the period ending December 31 of 138.40 that year than would have been 138.41 available had the funds been evenly 138.42 divided within the fiscal year between 138.43 the period before December 31 and the 138.44 period after December 31. 138.45 (c) Economic Support Grants - Other 138.46 Assistance 138.47 General 3,358,000 3,463,000 138.48 [SUPPORTIVE HOUSING.] Of the general 138.49 fund appropriation, $500,000 each year 138.50 is to provide services to families who 138.51 are participating in the supportive 138.52 housing and managed care pilot project 138.53 under Minnesota Statutes, section 139.1 256K.25. This appropriation shall not 139.2 become part of base level funding for 139.3 the biennium beginning July 1, 2007. 139.4 (d) Child Support Enforcement Grants 139.5 General 3,571,000 3,503,000 139.6 (e) General Assistance Grants 139.7 General 24,901,000 24,732,000139.8 26,329,000 26,909,000 139.9 [GENERAL ASSISTANCE STANDARD.] The 139.10 commissioner shall set the monthly 139.11 standard of assistance for general 139.12 assistance units consisting of an adult 139.13 recipient who is childless and 139.14 unmarried or living apart from parents 139.15 or a legal guardian at $203. The 139.16 commissioner may reduce this amount 139.17 according to Laws 1997, chapter 85, 139.18 article 3, section 54. 139.19 [EMERGENCY GENERAL ASSISTANCE.] The 139.20 amount appropriated for emergency 139.21 general assistance funds is limited to 139.22 no more than $7,889,812 in each fiscal 139.23 year of 2004 and 2005. Funds to 139.24 counties shall be allocated by the 139.25 commissioner using the allocation 139.26 method specified in Minnesota Statutes, 139.27 section 256D.06. 139.28 (f) Minnesota Supplemental Aid Grants 139.29 General 30,229,000 31,447,000139.30 28,955,000 30,490,000 139.31 [EMERGENCY MINNESOTA SUPPLEMENTAL AID 139.32 FUNDS.] The amount appropriated for 139.33 emergency Minnesota supplemental aid 139.34 funds is limited to no more than 139.35 $1,138,707 in fiscal year 2004 and 139.36 $1,017,000 in fiscal year 2005. Funds 139.37 to counties shall be allocated by the 139.38 commissioner using the allocation 139.39 method specified in Minnesota Statutes, 139.40 section 256D.46. 139.41 Sec. 8. Laws 2003, First Special Session chapter 14, 139.42 article 13C, section 10, subdivision 1, is amended to read: 139.43 Subdivision 1. Total 139.44 Appropriation $ 107,829,000 $ 92,649,000139.45 $ 106,221,000 $ 97,564,000 139.46 Summary by Fund 139.47 General 104,489,000 89,309,000139.48 102,881,000 94,224,000 139.49 State Special 139.50 Revenue 3,340,000 3,340,000 139.51 Sec. 9. Laws 2003, First Special Session chapter 14, 140.1 article 13C, section 10, subdivision 2, is amended to read: 140.2 Subd. 2. Child Care 140.3 [BASIC SLIDING FEE CHILD CARE.] Of this 140.4 appropriation, $27,628,000 in fiscal 140.5 year 2004 and $18,771,000 in fiscal 140.6 year 2005 are for child care assistance 140.7 according to Minnesota Statutes, 140.8 section 119B.03. These appropriations 140.9 are available to be spent either year. 140.10 The fiscal years 2006 and 2007 general 140.11 fund base for basic sliding fee child 140.12 care is $30,312,000 each year. 140.13 [MFIP CHILD CARE.] Of this 140.14 appropriation, $69,543,000$67,935,000 140.15 in fiscal year 2004 140.16 and $63,720,000$68,635,000 in fiscal 140.17 year 2005 are for MFIP child care. 140.18 [CHILD CARE PROGRAM INTEGRITY.] Of this 140.19 appropriation, $425,000 in fiscal year 140.20 2004, and $376,000 in fiscal year 2005 140.21 are for the administrative costs of 140.22 program integrity and fraud prevention 140.23 for child care assistance under 140.24 Minnesota Statutes, chapter 119B. 140.25 [CHILD CARE DEVELOPMENT.] Of this 140.26 appropriation, $1,115,000 in fiscal 140.27 year 2004, and $1,164,000 in fiscal 140.28 year 2005 are for child care 140.29 development grants according to 140.30 Minnesota Statutes, section 119B.21. 140.31 Sec. 10. [EFFECTIVE DATE.] 140.32 Sections 1 to 9 are effective the day following final 140.33 enactment, unless a different effective date is specified. 140.34 ARTICLE 15 140.35 APPROPRIATIONS 140.36 Section 1. [HEALTH AND HUMAN SERVICES APPROPRIATIONS.] 140.37 The sums shown in the columns marked "APPROPRIATIONS" are 140.38 added to or, if shown in parentheses, are subtracted from the 140.39 appropriations in Laws 2003, First Special Session chapter 14, 140.40 article 13C, or other law, and are appropriated from the general 140.41 fund, or any other fund named, to the agencies and for the 140.42 purposes specified in the sections of this article, to be 140.43 available for the fiscal years indicated for each purpose. The 140.44 figures "2004" and "2005" where used in this article, mean that 140.45 the appropriation or appropriations listed under them are 140.46 available for the fiscal year ending June 30, 2004, or June 30, 140.47 2005, respectively. 140.48 SUMMARY BY FUND 141.1 2004 2005 TOTAL 141.2 General $137,726,000 $(117,763,000) $ 19,963,000 141.3 Health Care 141.4 Access 41,994,000 (46,406,000) (4,412,000) 141.5 Federal TANF -0- -0- -0- 141.6 Lottery Prize Fund -0- 75,000 75,000 141.7 Other Funds -0- 188,000 141.8 TOTAL $178,918,000 $(247,992,000) $(69,149,000) 141.9 APPROPRIATIONS 141.10 Available for the Year 141.11 Ending June 30 141.12 2004 2005 141.13 Sec. 2. COMMISSIONER OF 141.14 HUMAN SERVICES 141.15 Subdivision 1. Total 141.16 Appropriation $ 179,720,000 $(163,256,000) 141.17 Summary by Fund 141.18 General 137,726,000 (117,081,000) 141.19 Health Care 141.20 Access 41,994,000 (46,400,000) 141.21 Federal TANF -0- -0- 141.22 Lottery Prize Fund -0- 75,000 141.23 Other Funds -0- 150,000 141.24 Subd. 2. Agency Management 141.25 Summary by Fund 141.26 General -0- (2,300,000) 141.27 The amounts that may be spent from the 141.28 appropriation for each purpose are as 141.29 follows: 141.30 (a) Financial Operations 141.31 General -0- (2,300,000) 141.32 (b) Legal and Regulatory Operations 141.33 (c) Management Operations 141.34 (d) Information Technology 141.35 Subd. 3. Revenue and Pass-Through 141.36 Federal TANF -0- 10,579,000 141.37 [TANF REFINANCING.] In addition to the 141.38 amount of TANF funds available for use 141.39 with the Minnesota working family tax 141.40 credit program under current law 141.41 appropriations, there is further 141.42 appropriated the following amounts: 141.43 FY 2005 ..... $10,579,000 142.1 FY 2006 ..... $15,028,000 142.2 FY 2007 ..... $15,254,000 142.3 [ADJUSTMENTS IN WORKING FAMILY CREDIT 142.4 EXPENDITURES COUNTED AS TANF MOE.] In 142.5 addition to the amounts identified in 142.6 Laws 2003, First Special Session 142.7 chapter 14, article 13C, section 2, the 142.8 commissioner may claim up to the 142.9 following amounts of Working Family 142.10 Credit expenditures for the following 142.11 fiscal years: 142.12 FY 2006 ..... $27,656,000 142.13 FY 2007 ..... $17,883,000 142.14 Subd. 4. Children's Services Grants 142.15 [PRIVATIZED ADOPTION GRANT.] For the 142.16 biennium ending June 30, 2005, federal 142.17 reimbursement for privatized adoption 142.18 grant and foster care recruitment grant 142.19 expenditures is appropriated to the 142.20 commissioner for adoption grants and 142.21 foster care and adoption administrative 142.22 purposes. 142.23 [ADJUSTMENTS IN TANF TRANSFERS TO CHILD 142.24 CARE DEVELOPMENT FUND.] Transfers of 142.25 TANF to the federal Child Care 142.26 Development Fund for child care 142.27 assistance shall be reduced by these 142.28 amounts in fiscal year 2005: 142.29 Basic sliding fee child care $170,000 142.30 MFIP child care $925,000 142.31 Subd. 5. Children's Services Management 142.32 Subd. 6. Basic Health Care Grants 142.33 Summary by Fund 142.34 General 133,114,000 (138,463,000) 142.35 Health Care Access 41,994,000 (46,700,000) 142.36 The amounts that may be spent from this 142.37 appropriation for each purpose are as 142.38 follows: 142.39 (a) MinnesotaCare Grants 142.40 Health Care Access 41,994,000 (46,700,000) 142.41 [HEALTH CARE ACCESS FUND TRANSFER.] 142.42 Notwithstanding Laws 2003, First 142.43 Special Session chapter 14, article 142.44 13C, section 2, subdivision 7, the 142.45 commissioner of finance shall transfer 142.46 $71,027,000 from the health care access 142.47 fund to the general fund on July 1, 142.48 2004. This transfer is in addition to 142.49 all other transfers from the health 142.50 care access fund to the general fund. 142.51 (b) MA Basic Health Care 142.52 Grants - Families and Children 143.1 General 76,265,000 (80,589,000) 143.2 [CAPITATION PAYMENTS.] Capitation 143.3 payments and performance withhold 143.4 payments under Minnesota Statutes, 143.5 chapters 256B, 256D, and 256L, for the 143.6 months of June 2004 and July 2004 shall 143.7 be made prior to June 30, 2004. This 143.8 rider is effective the day following 143.9 final enactment. 143.10 [HEALTH CARE GRANTS FORECAST.] The 143.11 commissioner of finance, as part of the 143.12 November 2004 forecast, shall determine 143.13 the extent to which projected state 143.14 spending for the portion of medical 143.15 assistance that serves MFIP and 143.16 Families basic health care grants for 143.17 the FY 2006-2007 biennium exceeds the 143.18 level of spending projected for those 143.19 programs in the FY 2004-2005 biennium. 143.20 If the level of state spending 143.21 projected for the FY 2006-2007 biennium 143.22 exceeds the level of state spending for 143.23 those programs in the FY 2004-2005 143.24 biennium by more than $100,000,000, the 143.25 commissioner of human services must 143.26 prepare a plan to reduce expenditures 143.27 for the portion of medical assistance 143.28 that serves MFIP and Families basic 143.29 health care grants for the FY 2006-2007 143.30 biennium by an amount so that 143.31 expenditures in those programs do not 143.32 exceed the expenditures for those 143.33 programs in the FY 2004-2005 biennium 143.34 by more than $100,000,000. The 143.35 reductions in the plan presented by the 143.36 commissioner of human services shall 143.37 not reduce medical assistance 143.38 reimbursement rates to providers. The 143.39 commissioner must present this plan to 143.40 the chairs of the House Health and 143.41 Human Services Finance Committee and 143.42 the Senate Finance Health, Human 143.43 Services and Corrections Budget 143.44 Division by December 15, 2004. 143.45 (c) MA Basic Health Care 143.46 Grants - Elderly and Disabled 143.47 General 29,171,000 (30,981,000) 143.48 (d) General Assistance 143.49 Medical Care Grants 143.50 General 28,028,000 (26,863,000) 143.51 (e) Health Care Grants - 143.52 Other Assistance 143.53 General -0- 290,000 143.54 Health Care Access -0- (750,000) 143.55 (f) Prescription Drug Program 143.56 General -0- -0- 143.57 [PRESCRIPTION DRUG PROGRAM.] The 143.58 commissioner may expend the money 144.1 appropriated for the prescription drug 144.2 program in either year of the 144.3 biennium. Unexpended funds do not 144.4 cancel and are available to the 144.5 commissioner for fiscal year 2006 144.6 prescription drug program expenditures. 144.7 Subd. 7. Health Care Management 144.8 Summary by Fund 144.9 General -0- 2,085,000 144.10 Health Care Access -0- 300,000 144.11 Other Funds -0- 150,000 144.12 The amounts that may be spent from this 144.13 appropriation for each purpose are as 144.14 follows: 144.15 (a) Health Care Policy 144.16 Administration 144.17 General -0- 1,965,000 144.18 Health Care Access -0- 300,000 144.19 Other Funds -0- 150,000 144.20 (b) Health Care 144.21 Operations 144.22 General -0- 120,000 144.23 Subd. 8. State-Operated Services 144.24 Summary by Fund 144.25 General 4,262,000 5,520,000 144.26 [TEMPORARY CONFINEMENT COST OF CARE.] 144.27 The cost of care shall be ten percent 144.28 as specified in Minnesota Statutes, 144.29 section 246.54, subdivision 2, for any 144.30 individual for whom a county obtained 144.31 an order from a court authorizing 144.32 temporary confinement, as defined in 144.33 Minnesota Statutes, section 253B.045, 144.34 between January 1, 2004, and June 30, 144.35 2004, to the Minnesota sex offender 144.36 program as defined in Minnesota 144.37 Statutes, section 253B.02, subdivision 144.38 18a, not 100 percent as required under 144.39 Minnesota Statutes, section 253B.045, 144.40 subdivision 3. 144.41 Subd. 9. Continuing Care Grants 144.42 Summary by Fund 144.43 General -0- 15,639,000 144.44 Lottery Prize Fund -0- 75,000 144.45 The amounts that may be spent from this 144.46 appropriation for each purpose are as 144.47 follows: 144.48 (a) Community Social Services 145.1 (b) Aging Adult Service Grant 145.2 General -0- 1,000 145.3 (c) Deaf and Hard-of-Hearing 145.4 Service Grants 145.5 General -0- 4,000 145.6 (d) Mental Health Grants 145.7 Lottery Prize Fund -0- 75,000 145.8 $75,000 in fiscal year 2005 is 145.9 appropriated from the lottery prize 145.10 fund to the commissioner of human 145.11 services for a grant to the Northstar 145.12 Problem Gambling Alliance, located in 145.13 Arlington, Minnesota. The Northstar 145.14 Problem Gambling Alliance must provide 145.15 services to increase public awareness 145.16 of problem gambling, education and 145.17 training for individuals and 145.18 organizations providing services to 145.19 problem gamblers and their families, 145.20 and research relating to problem 145.21 gambling. This appropriation is 145.22 contingent on the demonstration of an 145.23 equal amount in nonstate matching funds 145.24 to the commissioner of finance but may 145.25 be disbursed in two payments of $37,500 145.26 upon receipt of a commitment for an 145.27 equal amount of matching nonstate funds. 145.28 (e) Community Support Grants 145.29 General -0- 111,000 145.30 (f) Medical Assistance 145.31 Long-Term Waivers and Home 145.32 Care Grants 145.33 General -0- 2,222,000 145.34 [MANAGE THE GROWTH IN THE TBI WAIVER.] 145.35 The commissioner shall allocate funding 145.36 for home and community-based services 145.37 covered under Minnesota Statutes, 145.38 section 256B.49, so that new TBI waiver 145.39 caseload growth is limited to 300 each 145.40 year of the biennium ending June 30, 145.41 2007. State fiscal year 2005 caseload 145.42 levels, as determined in the February 145.43 2004 forecast, will serve as the base 145.44 against which these limits will be 145.45 established. Priority for new 145.46 allocations shall be given to 145.47 individuals seeking to be discharged 145.48 from institutional settings or who are 145.49 at imminent risk of placement in an 145.50 institutional setting. Notwithstanding 145.51 any provision to the contrary, this 145.52 paragraph remains in effect for the 145.53 biennium ending June 30, 2007. 145.54 [MANAGE THE GROWTH IN THE COMMUNITY 145.55 ALTERNATIVES FOR DISABLED INDIVIDUALS 145.56 WAIVER.] The commissioner shall 145.57 allocate funding for home and 145.58 community-based services covered under 145.59 Minnesota Statutes, section 256B.49, so 146.1 that new CADI caseload growth is 146.2 limited to an average of 160 per month 146.3 in each year of the biennium ending 146.4 June 30, 2007. State fiscal year 2005 146.5 caseload levels, as determined in the 146.6 February 2004 forecast, will serve as 146.7 the base against which these limits 146.8 will be established. Priority for new 146.9 allocations shall be given to 146.10 individuals seeking to be discharged 146.11 from institutional settings or who are 146.12 at imminent risk of a placement in an 146.13 institutional setting. Notwithstanding 146.14 any provision to the contrary, this 146.15 paragraph remains in effect for the 146.16 biennium ending June 30, 2007. 146.17 (g) Medical Assistance 146.18 Long-term Care Facilities Grants 146.19 General -0- 12,821,000 146.20 [NURSING FACILITY SCHOLARSHIP PROGRAM.] 146.21 From the effective date of this act 146.22 through June 30, 2005, nursing 146.23 facilities shall receive as a per diem 146.24 adjustment to their total payment 146.25 rates, the per diem amount determined 146.26 in Minnesota Statutes 2003 Supplement, 146.27 section 256B.431, subdivision 36, 146.28 paragraph (b), minus $0.25. If this 146.29 amount is less than zero, then the 146.30 facility shall receive no rate 146.31 adjustment. 146.32 For the rate year beginning July 1, 146.33 2005, the amount determined under 146.34 Minnesota Statutes 2003 Supplement, 146.35 section 256B.431, subdivision 36, 146.36 paragraph (b), shall be removed from 146.37 each nursing facility's rate. 146.38 [RATE AND ALLOCATION INCREASES FOR 146.39 CONTINUING CARE PROGRAMS.] 146.40 Notwithstanding any law or rule to the 146.41 contrary, including Laws 2003, First 146.42 Special Session chapter 14, article 146.43 13C, section 2, subdivision 9, the 146.44 commissioner of human services shall 146.45 increase reimbursement rates or 146.46 increase allocations to assure the 146.47 necessary increases in state spending 146.48 for the providers or programs listed in 146.49 clauses (1) to (4). The increases are 146.50 added to base-level funding and are 146.51 effective for services rendered on or 146.52 after July 1, 2004. 146.53 (1) Effective July 1, 2004, the 146.54 commissioner shall increase payment 146.55 rates for services and individual or 146.56 service limits by up to one-half 146.57 percent. The rate increases described 146.58 in this section must be applied to: 146.59 (i) home and community-based waivered 146.60 services for the elderly under 146.61 Minnesota Statutes, section 256B.0915; 146.62 (ii) day training and habilitation 146.63 services for adults with mental 147.1 retardation or related conditions under 147.2 Minnesota Statutes, sections 252.40 to 147.3 252.46; 147.4 (iii) the group residential housing 147.5 supplementary service rate under 147.6 Minnesota Statutes, section 256I.05, 147.7 subdivision 1a; 147.8 (iv) chemical dependency residential 147.9 and nonresidential service rates under 147.10 Minnesota Statutes, section 245B.03; 147.11 (v) consumer support grants under 147.12 Minnesota Statutes, section 256.476; 147.13 and 147.14 (vi) home and community-based services 147.15 for alternative care services under 147.16 Minnesota Statutes, section 256B.0913. 147.17 (2) The commissioner shall increase 147.18 allocations made available to county 147.19 agencies for home and community-based 147.20 waivered services to assure up to a 147.21 one-half percent increase in state 147.22 spending for services rendered on or 147.23 after July 1, 2004. The commissioner 147.24 shall apply the allocation increases 147.25 described in this section to: 147.26 (i) persons with mental retardation or 147.27 related conditions under Minnesota 147.28 Statutes, section 256B.501; 147.29 (ii) waivered services under community 147.30 alternatives for disabled individuals 147.31 under Minnesota Statutes, section 147.32 256B.49; 147.33 (iii) community alternative care 147.34 waivered services under Minnesota 147.35 Statutes, section 256B.49; and 147.36 (iv) traumatic brain injury waivered 147.37 services under Minnesota Statutes, 147.38 section 256B.49. 147.39 County agencies will be responsible for 147.40 100 percent of any spending in excess 147.41 of the allocation made by the 147.42 commissioner. Nothing in this section 147.43 shall be construed as changing the 147.44 county's responsibility to offer and 147.45 make available feasible home and 147.46 community-based options to eligible 147.47 waiver recipients within the resources 147.48 allocated to them for that purpose. 147.49 (3) The commissioner shall increase 147.50 deaf and hard-of-hearing grants by up 147.51 to one-half percent on July 1, 2004. 147.52 (4) Effective July 1, 2004, the 147.53 commissioner shall increase payment 147.54 rates for each facility reimbursed 147.55 under Minnesota Statutes, section 147.56 256B.5012, by increasing the total 147.57 operating payment rate for intermediate 147.58 care facilities for the mentally 147.59 retarded by up to one-half percent. 148.1 For each facility, the commissioner 148.2 shall multiply the adjustment by the 148.3 total payment rate, excluding the 148.4 property-related payment rate, in 148.5 effect on June 30, 2004. A facility 148.6 whose payment rates are governed by 148.7 closure agreements, receivership 148.8 agreements, or Minnesota Rules, part 148.9 9553.0075, is not subject to an 148.10 adjustment otherwise taken under this 148.11 subdivision. 148.12 Notwithstanding any contrary provision, 148.13 these adjustments shall not expire. 148.14 (h) Alternative Care Grants 148.15 General -0- 252,000 148.16 (i) Group Residential 148.17 Housing Grants 148.18 General -0- (25,000) 148.19 (j) Chemical Dependency 148.20 Entitlement Grants 148.21 General -0- 253,000 148.22 (k) Chemical Dependency 148.23 Nonentitlement Grants 148.24 Subd. 10. Continuing Care Management 148.25 Subd. 11. Economic Support Grants 148.26 Summary by Fund 148.27 General -0- 118,000 148.28 Federal TANF -0- (10,579,000) 148.29 The amounts that may be spent from this 148.30 appropriation for each purpose are as 148.31 follows: 148.32 (a) Minnesota Family 148.33 Investment Program 148.34 Federal TANF -0- (10,579,000) 148.35 (b) Work Grants 148.36 [FOOD STAMPS EMPLOYMENT AND TRAINING 148.37 FUNDS.] Notwithstanding Minnesota 148.38 Statutes, section 256D.051, subdivision 148.39 6d, for fiscal years 2005, 2006, and 148.40 2007 only, Federal food stamps 148.41 employment and training funds received 148.42 as reimbursement of Minnesota family 148.43 investment program consolidated fund 148.44 grant expenditures must be deposited in 148.45 the general fund. Consistent with the 148.46 receipt of these federal funds, the 148.47 commissioner may adjust the level of 148.48 working family credit expenditures 148.49 claimed as TANF maintenance of effort. 148.50 (c) Economic Support Grants - 148.51 Other Assistance 148.52 [MEC
2IMPLEMENTATION.] The commissioner 149.1 may make up to five percent of a 149.2 county's subsequent calendar year basic 149.3 sliding fee child care assistance 149.4 allocation available to the county in 149.5 the current calendar year to offset the 149.6 cash flow effect of MEC
2implementation. 149.7 This adjustment shall not be considered 149.8 when calculating future allocation 149.9 amounts under Minnesota Statutes, 149.10 section 119B.03. 149.11 [BASIC SLIDING FEE CHILD CARE.] The 149.12 fiscal year 2006 and 2007 general fund 149.13 base for basic sliding fee child care 149.14 is reduced by $11,045,000. 149.15 (d) Child Support Enforcement Grants 149.16 (e) General Assistance Grants 149.17 (f) Minnesota Supplemental Aid Grants 149.18 General -0- 118,000 149.19 Sec. 3. COMMISSIONER OF HEALTH 149.20 Subdivision 1. Total 149.21 Appropriation -0- (560,000) 149.22 Summary by Fund 149.23 General Fund -0- (592,000) 149.24 Health Care Access Fund -0- (6,000) 149.25 Miscellaneous Special Revenue Fund -0- 38,000 149.26 Subd. 2. Health Quality and Access 149.27 Health Care Access Fund -0- 83,000 149.28 Of the Health Care Access Fund 149.29 appropriation, $48,000 is for the 149.30 evaluation of health care providers 149.31 cost-shifting. This is a onetime 149.32 appropriation. 149.33 Subd. 3. Management and 149.34 Support Services -0- (692,000) 149.35 Health Care Access Fund -0- (89,000) 149.36 Miscellaneous Special Revenue Fund -0- 38,000 149.37 Subd. 4. Health Protection 149.38 General Fund -0- 100,000 149.39 [TRANSFER OF LEAD ABATEMENT.] The lead 149.40 abatement program is transferred from 149.41 the Department of Education to the 149.42 Department of Health. The program 149.43 shall be administered according to 149.44 Minnesota Statutes, section 119A.46. 149.45 Sec. 4. BOARD OF CHIROPRACTIC EXAMINERS 149.46 In fiscal year 2004, $200,000 in state 149.47 government special revenue funds is 149.48 transferred from Laws 2003, First 149.49 Special Session chapter 1, article 1, 149.50 section 28, to the Board of 150.1 Chiropractic Examiners to pay for 150.2 contested case activity. These funds 150.3 are available until June 30, 2005. 150.4 Sec. 5. VETERANS HOMES BOARD 150.5 General Fund -0- (90,000) 150.6 Sec. 6. [SUNSET OF UNCODIFIED LANGUAGE.] 150.7 All uncodified language contained in this article expires 150.8 on June 30, 2005, unless a different expiration date is explicit. 150.9 Sec. 7. [EFFECTIVE DATE.] 150.10 The provisions in this article are effective July 1, 2004, 150.11 unless a different effective date is specified.