HF 1760

2nd Engrossment - 86th Legislature (2009 - 2010) Posted on 02/09/2010 01:54am

A bill for an act
relating to human services; changing provisions for long-term care, adverse
health care events, suicide prevention, doula services, developmental disabilities,
mental health commitment, alternative care services, self-directed options,
nursing facilities, ICF/MR facilities, and data management; requiring a safe
patient handling plan; establishing a health department work group and an
Alzheimer's disease work group; amending Minnesota Statutes 2008, sections
43A.318, subdivision 2; 62Q.525, subdivision 2; 144.7065, subdivisions 8, 10;
145.56, subdivisions 1, 2; 148.995, subdivisions 2, 4; 182.6551; 182.6552,
by adding a subdivision; 252.27, subdivision 1a; 252.282, subdivisions 3, 5;
253B.095, subdivision 1; 256B.0657, subdivision 5; 256B.0913, subdivisions
4, 5a, 12; 256B.0915, subdivision 2; 256B.431, subdivision 10; 256B.433,
subdivision 1; 256B.441, subdivisions 5, 11; 256B.5011, subdivision 2;
256B.5012, subdivisions 6, 7; 256B.5013, subdivisions 1, 6; 256B.69,
subdivision 9b; 403.03; 626.557, subdivision 12b; proposing coding for new law
in Minnesota Statutes, chapter 182; repealing Minnesota Statutes 2008, section
256B.5013, subdivisions 2, 3, 5.

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

Section 1.

Minnesota Statutes 2008, section 43A.318, subdivision 2, is amended to
read:

Subd. 2.

Program creation; general provisions.

(a) The commissioner may
administer a program to make long-term care coverage available to eligible persons. The
commissioner may determine the program's funding arrangements, request bids from
qualified vendors, and negotiate and enter into contracts with qualified vendors. Contracts
are not subject to the requirements of section 16C.16 or 16C.19. Contracts must be for a
uniform term of at least one year, but may be made automatically renewable from term
to term in the absence of notice of termination by either party. The program may not be
self-insured until the commissioner has completed an actuarial study of the program and
reported the results of the study to the legislature and self-insurance has been specifically
authorized by law.

(b) The program may provide coverage for home, community, and institutional
long-term care and any other benefits as determined by the commissioner. Coverage is
optional. The enrolled eligible person must pay the full cost of the coverage.

(c) The commissioner shall promote activities that attempt to raise awareness of
the need for long-term care insurance among residents of the state and encourage the
increased prevalence of long-term care coverage. These activities must include the sharing
of knowledge gained in the development of the program.

(d) The commissioner may employ and contract with persons and other entities to
perform the duties under this section and may determine their duties and compensation
consistent with this chapter.

(e) The benefits provided under this section are not terms and conditions of
employment as defined under section 179A.03, subdivision 19, and are not subject to
collective bargaining.

(f) The commissioner shall establish underwriting criteria for entry of all eligible
persons into the program. Eligible persons who would be immediately eligible for benefits
may not enroll.

(g) Eligible persons who meet underwriting criteria may enroll in the program upon
hiring and at other times established by the commissioner.

(h) An eligible person enrolled in the program may continue to participate in the
program even if an event, such as termination of employment, changes the person's
employment status.

(i) Participating public employee pension plans and public employers may provide
automatic pension or payroll deduction for payment of long-term care insurance premiums
to qualified vendors contracted with under this section.

(j) The premium charged to program enrollees must include an administrative fee to
cover all program expenses incurred in addition to the cost of coverage. All fees collected
are appropriated to the commissioner for the purpose of administrating the program.

new text begin (k) Public employees of local units of government including but not limited to
townships, municipalities, cities, and counties may buy into the long-term care insurance
under this section.
new text end

Sec. 2.

Minnesota Statutes 2008, section 62Q.525, subdivision 2, is amended to read:

Subd. 2.

Definitions.

(a) For purposes of this section, the terms defined in this
subdivision have the meanings given them.

(b) "Medical literature" means articles from major peer reviewed medical journals
that have recognized the drug or combination of drugs' safety and effectiveness for
treatment of the indication for which it has been prescribed. Each article shall meet the
uniform requirements for manuscripts submitted to biomedical journals established by
the International Committee of Medical Journal Editors or be published in a journal
specified by the United States Secretary of Health and Human Services pursuant to United
States Code, title 42, section 1395x, paragraph (t), clause (2), item (B), as amended, as
acceptable peer review medical literature. Each article must use generally acceptable
scientific standards and must not use case reports to satisfy this criterion.

(c) "Off-label use of drugs" means when drugs are prescribed for treatments other
than those stated in the labeling approved by the federal Food and Drug Administration.

(d) "Standard reference compendia" means new text begin any of the following new text end :

deleted text begin (1) the United States Pharmacopeia Drug Information; or
deleted text end

deleted text begin (2) deleted text end new text begin (1) new text end the American Hospital Formulary Service Drug Information deleted text begin . deleted text end new text begin ;
new text end

new text begin (2) the National Comprehensive Cancer Network's Drugs and Biologics
Compendium;
new text end

new text begin (3) Thomson Micromedex's DrugDex;
new text end

new text begin (4) Elsevier Gold Standard's Clinical Pharmacology; or
new text end

new text begin (5) other authoritative compendia as identified from time to time by the United
States Department of Health and Human Services.
new text end

Sec. 3.

Minnesota Statutes 2008, section 144.7065, subdivision 8, is amended to read:

Subd. 8.

Root cause analysis; corrective action plan.

Following the occurrence of
an adverse health care event, the facility must conduct a root cause analysis of the event.
new text begin In conducting the root cause analysis, if evidence determines staffing is a factor, then the
facility will review the impact of staffing levels on the event. new text end Following the analysis, the
facility must: (1) implement a corrective action plan to implement the findings of the
analysis or (2) report to the commissioner any reasons for not taking corrective action. If
the root cause analysis and the implementation of a corrective action plan are complete at
the time an event must be reported, the findings of the analysis and the corrective action
plan must be included in the report of the event. The findings of the root cause analysis
and a copy of the corrective action plan must otherwise be filed with the commissioner
within 60 days of the event.

Sec. 4.

Minnesota Statutes 2008, section 144.7065, subdivision 10, is amended to read:

Subd. 10.

Relation to other law; data classification.

(a) Adverse health events
described in subdivisions 2 to 6 do not constitute "maltreatment," "neglect," or "a physical
injury that is not reasonably explained" under section 626.556 or 626.557 and are excluded
from the reporting requirements of sections 626.556 and 626.557, provided the facility
makes a determination within 24 hours of the discovery of the event that this section is
applicable and the facility files the reports required under this section in a timely fashion.

(b) A facility that has determined that an event described in subdivisions 2 to 6
has occurred must inform persons who are mandated reporters under section 626.556,
subdivision 3, or 626.5572, subdivision 16, of that determination. A mandated reporter
otherwise required to report under section 626.556, subdivision 3, or 626.557, subdivision
3, paragraph (e), is relieved of the duty to report an event that the facility determines under
paragraph (a) to be reportable under subdivisions 2 to 6.

(c) The protections and immunities applicable to voluntary reports under sections
626.556 and 626.557 are not affected by this section.

(d) Notwithstanding section 626.556, 626.557, or any other provision of Minnesota
statute or rule to the contrary, neither a lead agency under section 626.556, subdivision 3c,
or 626.5572, subdivision 13, the commissioner of health, nor the director of the Office of
Health Facility Complaints is required to conduct an investigation of or obtain or create
investigative data or reports regarding an event described in subdivisions 2 to 6. If the
facility satisfies the requirements described in paragraph (a), the review or investigation
shall be conducted and data or reports shall be obtained or created only under sections
144.706 to 144.7069, except as permitted or required under sections 144.50 to 144.564,
or as necessary to carry out the state's certification responsibility under the provisions of
sections 1864 and 1867 of the Social Security Act. new text begin If a licensed health care provider
reports an event to the facility required to be reported under subdivisions 2 to 6, in a
timely manner, the provider's licensing board is not required to conduct an investigation of
or obtain or create investigative data or reports regarding the individual reporting of the
events described in subdivisions 2 to 6.
new text end

(e) Data contained in the following records are nonpublic and, to the extent they
contain data on individuals, confidential data on individuals, as defined in section 13.02:

(1) reports provided to the commissioner under sections 147.155, 147A.155,
148.267, 151.301, and 153.255;

(2) event reports, findings of root cause analyses, and corrective action plans filed by
a facility under this section; and

(3) records created or obtained by the commissioner in reviewing or investigating
the reports, findings, and plans described in clause (2).

For purposes of the nonpublic data classification contained in this paragraph, the
reporting facility shall be deemed the subject of the data.

Sec. 5.

Minnesota Statutes 2008, section 145.56, subdivision 1, is amended to read:

Subdivision 1.

Suicide prevention plan.

The commissioner of health shall refine,
coordinate, and implement the state's suicide prevention plan using an evidence-based,
public health approach new text begin for a life span plan new text end focused on new text begin awareness and new text end prevention, in
collaboration with the commissioner of human services; the commissioner of public
safety; the commissioner of education; new text begin the chancellor of Minnesota State Colleges and
Universities; the president of the University of Minnesota; new text end and appropriate agencies,
organizations, and institutions in the community.

Sec. 6.

Minnesota Statutes 2008, section 145.56, subdivision 2, is amended to read:

Subd. 2.

Community-based programs.

To the extent funds are appropriated for the
purposes of this subdivision, the commissioner shall establish a grant program to fund:

(1) community-based programs to provide education, outreach, and advocacy
services to populations who may be at risk for suicide;

(2) community-based programs that educate community helpers and gatekeepers,
such as family members, spiritual leaders, coaches, and business owners, employers, and
coworkers on how to prevent suicide by encouraging help-seeking behaviors;

(3) community-based programs that educate populations at risk for suicide and
community helpers and gatekeepers that must include information on the symptoms
of depression and other psychiatric illnesses, the warning signs of suicide, skills for
preventing suicides, and making or seeking effective referrals to intervention and
community resources; and

(4) community-based programs to provide evidence-based suicide prevention and
intervention education to school staff, parents, and students in grades kindergarten through
12 new text begin , and for students attending Minnesota colleges and universities new text end .

Sec. 7.

Minnesota Statutes 2008, section 148.995, subdivision 2, is amended to read:

Subd. 2.

Certified doula.

"Certified doula" means an individual who has received
a certification to perform doula services from the International Childbirth Education
Association, the Doulas of North America (DONA), the Association of Labor Assistants
and Childbirth Educators (ALACE), Birthworks, Childbirth and Postpartum Professional
Association (CAPPA), deleted text begin or deleted text end Childbirth International new text begin , or International Center for Traditional
Childbearing new text end .

Sec. 8.

Minnesota Statutes 2008, section 148.995, subdivision 4, is amended to read:

Subd. 4.

Doula services.

"Doula services" means new text begin continuous new text end emotional and
physical support deleted text begin during pregnancy, labor, birth, and postpartum deleted text end new text begin throughout labor and
birth, and intermittently during the prenatal and postpartum periods new text end .

Sec. 9.

Minnesota Statutes 2008, section 182.6551, is amended to read:

182.6551 CITATION; SAFE PATIENT HANDLING ACT.

Sections 182.6551 to deleted text begin 182.6553 deleted text end new text begin 182.6554 new text end may be cited as the "Safe Patient Handling
Act."

Sec. 10.

Minnesota Statutes 2008, section 182.6552, is amended by adding a
subdivision to read:

new text begin Subd. 5. new text end

new text begin Clinical settings that move patients. new text end

new text begin "Clinical settings that move
patients" means physician, dental, and other outpatient care facilities, except for outpatient
surgical settings, where service requires movement of patients from point to point as part
of the scope of service.
new text end

Sec. 11.

new text begin [182.6554] SAFE PATIENT HANDLING IN CLINICAL SETTINGS.
new text end

new text begin Subdivision 1. new text end

new text begin Safe patient handling plan required. new text end

new text begin (a) By July 1, 2010, every
clinical setting that moves patients in the state shall develop a written safe patient handling
plan to achieve by January 1, 2012, the goal of ensuring the safe handling of patients by
minimizing manual lifting of patients by direct patient care workers and by utilizing
safe patient handling equipment.
new text end

new text begin (b) The plan shall address:
new text end

new text begin (1) assessment of risks with regard to patient handling that considers the patient
population and environment of care;
new text end

new text begin (2) the acquisition of an adequate supply of appropriate safe patient handling
equipment;
new text end

new text begin (3) initial and ongoing training of direct patient care workers on the use of this
equipment;
new text end

new text begin (4) procedures to ensure that physical plant modifications and major construction
projects are consistent with plan goals; and
new text end

new text begin (5) periodic evaluations of the safe patient handling plan. A health care organization
with more than one covered clinical setting that moves patients may establish a plan at
each clinical setting or establish one plan to serve this function for all the clinical settings.
new text end

new text begin Subd. 2. new text end

new text begin Facilities with existing programs. new text end

new text begin A clinical setting that moves patients
that has already adopted a safe patient handling plan that satisfies the requirements of
subdivision 1, or a clinical setting that moves patients that is covered by a safe patient
handling plan that is covered under and consistent with section 182.6553, is considered
to be in compliance with the requirements of this section.
new text end

new text begin Subd. 3. new text end

new text begin Training materials. new text end

new text begin The commissioner shall make training materials on
implementation of this section available at no cost to all clinical settings that move patients
as part of the training and education duties of the commissioner under section 182.673.
new text end

new text begin Subd. 4. new text end

new text begin Enforcement. new text end

new text begin This section shall be enforced by the commissioner under
section 182.661. An initial violation of this section shall not be assessed a penalty. A
subsequent violation of this section is subject to the penalties provided under section
182.666.
new text end

new text begin Subd. 5. new text end

new text begin Restriction; civil liability. new text end

new text begin The safe patient handling plan required under
this section is not a standard of care for purposes of civil liability. A court may not
consider a breach of the safe patient handling plan as a breach of duty, a breach of the
standard of care, or as negligence in a civil action.
new text end

Sec. 12.

Minnesota Statutes 2008, section 252.27, subdivision 1a, is amended to read:

Subd. 1a.

Definitions.

A "related condition" is a condition new text begin (1) new text end that is found to be
closely related to developmental disability, including, but not limited to, cerebral palsy,
epilepsy, autism, new text begin fetal alcohol spectrum disorder, new text end and Prader-Willi syndrome new text begin , new text end and new text begin (2) new text end that
meets all of the following criteria:

deleted text begin (1) deleted text end new text begin (i) new text end is severe and chronic;

deleted text begin (2) deleted text end new text begin (ii) new text end results in impairment of general intellectual functioning or adaptive behavior
similar to that of persons with developmental disabilities;

deleted text begin (3) deleted text end new text begin (iii) new text end requires treatment or services similar to those required for persons with
developmental disabilities;

deleted text begin (4) deleted text end new text begin (iv) new text end is manifested before the person reaches 22 years of age;

deleted text begin (5) deleted text end new text begin (v) new text end is likely to continue indefinitely;

deleted text begin (6) deleted text end new text begin (vi) new text end results in substantial functional limitations in three or more of the following
areas of major life activity: deleted text begin (i) deleted text end new text begin (A) new text end self-care, deleted text begin (ii) deleted text end new text begin (B) new text end understanding and use of language,
deleted text begin (iii) deleted text end new text begin (C) new text end learning, deleted text begin (iv) deleted text end new text begin (D) new text end mobility, deleted text begin (v) deleted text end new text begin (E) new text end self-direction, deleted text begin (vi) deleted text end new text begin (F) new text end capacity for independent
living; and

deleted text begin (7) deleted text end new text begin (vii) new text end is not attributable to mental illness as defined in section 245.462, subdivision
20, or an emotional disturbance as defined in section 245.4871, subdivision 15.

For purposes of deleted text begin clause (7) deleted text end new text begin item (vii) new text end , notwithstanding section 245.462, subdivision 20,
or 245.4871, subdivision 15, "mental illness" does not include autism or other pervasive
developmental disorders.

Sec. 13.

Minnesota Statutes 2008, section 252.282, subdivision 3, is amended to read:

Subd. 3.

Recommendations.

(a) Upon completion of the local system needs
planning assessment, the host county shall make recommendations by May 15, 2000, and
by July 1 every two years thereafter beginning in 2001. If no change is recommended, a
copy of the assessment along with corresponding documentation shall be provided to the
commissioner by July 1 prior to the contract year.

deleted text begin (b) Except as provided in section 252.292, subdivision 4, recommendations
regarding closures, relocations, or downsizings that include a rate increase shall be
submitted to the statewide advisory committee for review, along with the assessment, plan,
and corresponding documentation that supports the payment rate adjustment request.
deleted text end

deleted text begin (c) deleted text end new text begin (b) new text end Recommendations for closures, relocations, and downsizings that do not
include a rate increase and for modification of existing services for which a change in the
framework of service delivery is necessary shall be provided to the commissioner by July
1 prior to the contract year or at least 90 days prior to the anticipated change, along with
the assessment and corresponding documentation.

Sec. 14.

Minnesota Statutes 2008, section 252.282, subdivision 5, is amended to read:

Subd. 5.

Responsibilities of commissioner.

(a) In collaboration with counties and
providers, the commissioner shall ensure that services recognize the preferences and needs
of persons with developmental disabilities and related conditions through a recurring
systemic review and assessment of ICF/MR facilities within the state.

deleted text begin (b) The commissioner shall publish a notice in the State Register no less than
biannually to announce the opportunity for counties or providers to submit requests for
payment rate adjustments associated with plans for downsizing, relocation, and closure of
ICF/MR facilities.
deleted text end

deleted text begin (c) The commissioner shall designate funding parameters to counties and to the
statewide advisory committee for the overall implementation of system needs within the
fiscal resources allocated by the legislature.
deleted text end

deleted text begin (d) deleted text end new text begin (b) new text end The commissioner shall contract with ICF/MR providers. Contracts shall
be for two-year periods.

Sec. 15.

Minnesota Statutes 2008, section 253B.095, subdivision 1, is amended to read:

Subdivision 1.

Court release.

(a) After the hearing and before a commitment order
has been issued, the court may release a proposed patient to the custody of an individual or
agency upon conditions that guarantee the care and treatment of the patient.

(b) A person against whom a criminal proceeding is pending may not be released.

(c) A continuance for dismissal, with or without findings, may be granted for up to
90 days.

(d) When the court stays an order for commitment for more than 14 days beyond the
date of the initially scheduled hearing, the court shall issue an order that must include:

(1) a written plan for services to which the proposed patient has agreed;

(2) a finding that the proposed treatment is available and accessible to the patient
and that public or private financial resources are available to pay for the proposed
treatment; deleted text begin and
deleted text end

(3) conditions the patient must meet to avoid revocation of the stayed commitment
order and imposition of the commitment order new text begin ; and
new text end

new text begin (4) a condition that the patient is prohibited from giving consent to participate in a
psychiatric clinical drug trial while the court order is in effect new text end .

new text begin (e) If a stay of commitment is continued as provided in subdivision 3, the court may
allow the patient to give consent to participate in a specific psychiatric clinical drug trial if
the treating psychiatrist submits an affidavit that the patient may benefit from participating
in the trial because treatment options offered have been ineffective. The treating
psychiatrist must not be the psychiatrist conducting the psychiatric clinical drug trial.
new text end

deleted text begin (e) deleted text end new text begin (f) new text end A person receiving treatment under this section has all rights under this
chapter.

Sec. 16.

Minnesota Statutes 2008, section 256B.0657, subdivision 5, is amended to
read:

Subd. 5.

Self-directed supports option plan requirements.

(a) The plan for the
self-directed supports option must meet the following requirements:

(1) the plan must be completed using a person-centered process that:

(i) builds upon the recipient's capacity to engage in activities that promote
community life;

(ii) respects the recipient's preferences, choices, and abilities;

(iii) involves families, friends, and professionals in the planning or delivery of
services or supports as desired or required by the recipient; and

(iv) addresses the need for personal care assistant services identified in the recipient's
self-directed supports option assessment;

(2) the plan shall be developed by the recipient or by the guardian of an adult
recipient or by a parent or guardian of a minor child, deleted text begin with the assistance of an enrolled
medical assistance home care targeted case manager deleted text end new text begin and may be assisted by a new text end provider
who meets the requirements established for using a person-centered planning process and
shall be reviewed at least annually upon reassessment or when there is a significant change
in the recipient's condition; and

(3) the plan must include the total budget amount available divided into monthly
amounts that cover the number of months of personal care assistant services authorization
included in the budget. The amount used each month may vary, but additional funds shall
not be provided above the annual personal care assistant services authorized amount
unless a change in condition is documented.

(b) The commissioner shall:

(1) establish the format and criteria for the plan as well as the requirements for
providers who assist with plan development;

(2) review the assessment and plan and, within 30 days after receiving the
assessment and plan, make a decision on approval of the plan;

(3) notify the recipient, parent, or guardian of approval or denial of the plan and
provide notice of the right to appeal under section 256.045; and

(4) provide a copy of the plan to the fiscal support entity selected by the recipient.

Sec. 17.

Minnesota Statutes 2008, section 256B.0913, subdivision 4, is amended to
read:

Subd. 4.

Eligibility for funding for services for nonmedical assistance recipients.

(a) Funding for services under the alternative care program is available to persons who
meet the following criteria:

(1) the person has been determined by a community assessment under section
256B.0911 to be a person who would require the level of care provided in a nursing
facility, but for the provision of services under the alternative care program;

(2) the person is age 65 or older;

(3) the person would be eligible for medical assistance within 135 days of admission
to a nursing facility;

(4) the person is not ineligible for the payment of long-term care services by the
medical assistance program due to an asset transfer penalty under section 256B.0595 or
equity interest in the home exceeding $500,000 as stated in section 256B.056;

(5) the person needs long-term care services that are not funded through other
state or federal funding new text begin , or other health insurance or other third-party insurance such as
long-term care insurance new text end ;

(6) the monthly cost of the alternative care services funded by the program for
this person does not exceed 75 percent of the monthly limit described under section
256B.0915, subdivision 3a. This monthly limit does not prohibit the alternative care
client from payment for additional services, but in no case may the cost of additional
services purchased under this section exceed the difference between the client's monthly
service limit defined under section 256B.0915, subdivision 3, and the alternative care
program monthly service limit defined in this paragraph. If care-related supplies and
equipment or environmental modifications and adaptations are or will be purchased for
an alternative care services recipient, the costs may be prorated on a monthly basis for
up to 12 consecutive months beginning with the month of purchase. If the monthly cost
of a recipient's other alternative care services exceeds the monthly limit established in
this paragraph, the annual cost of the alternative care services shall be determined. In this
event, the annual cost of alternative care services shall not exceed 12 times the monthly
limit described in this paragraph; and

(7) the person is making timely payments of the assessed monthly fee.

A person is ineligible if payment of the fee is over 60 days past due, unless the person
agrees to:

(i) the appointment of a representative payee;

(ii) automatic payment from a financial account;

(iii) the establishment of greater family involvement in the financial management of
payments; or

(iv) another method acceptable to the lead agency to ensure prompt fee payments.

The lead agency may extend the client's eligibility as necessary while making
arrangements to facilitate payment of past-due amounts and future premium payments.
Following disenrollment due to nonpayment of a monthly fee, eligibility shall not be
reinstated for a period of 30 days.

(b) Alternative care funding under this subdivision is not available for a person
who is a medical assistance recipient or who would be eligible for medical assistance
without a spenddown or waiver obligation. A person whose initial application for medical
assistance and the elderly waiver program is being processed may be served under the
alternative care program for a period up to 60 days. If the individual is found to be eligible
for medical assistance, medical assistance must be billed for services payable under the
federally approved elderly waiver plan and delivered from the date the individual was
found eligible for the federally approved elderly waiver plan. Notwithstanding this
provision, alternative care funds may not be used to pay for any service the cost of which:
(i) is payable by medical assistance; (ii) is used by a recipient to meet a waiver obligation;
or (iii) is used to pay a medical assistance income spenddown for a person who is eligible
to participate in the federally approved elderly waiver program under the special income
standard provision.

(c) Alternative care funding is not available for a person who resides in a licensed
nursing home, certified boarding care home, hospital, or intermediate care facility, except
for case management services which are provided in support of the discharge planning
process for a nursing home resident or certified boarding care home resident to assist with
a relocation process to a community-based setting.

(d) Alternative care funding is not available for a person whose income is greater
than the maintenance needs allowance under section 256B.0915, subdivision 1d, but equal
to or less than 120 percent of the federal poverty guideline effective July 1 in the fiscal
year for which alternative care eligibility is determined, who would be eligible for the
elderly waiver with a waiver obligation.

Sec. 18.

Minnesota Statutes 2008, section 256B.0913, subdivision 5a, is amended to
read:

Subd. 5a.

Services; service definitions; service standards.

(a) Unless specified in
statute, the services, service definitions, and standards for alternative care services shall
be the same as the services, service definitions, and standards specified in the federally
approved elderly waiver plan, except alternative care does not cover transitional support
services, assisted living services, adult foster care services, and residential care and
benefits defined under section 256B.0625 that meet primary and acute health care needs.

(b) The lead agency must ensure that the funds are not used to supplant or
supplement services available through other public assistance or services programs,
including supplementation of client co-pays, deductibles, premiums, or other cost-sharing
arrangements for health-related benefits and services or entitlement programs and
services that are available to the person, but in which they have elected not to enroll.
new text begin The lead agency must ensure that the benefit department recovery system in the Medicaid
Management Information System (MMIS) has the necessary information on any other
health insurance or third-party insurance policy to which the client may have access. new text end For a
provider of supplies and equipment when the monthly cost of the supplies and equipment
is less than $250, persons or agencies must be employed by or under a contract with the
lead agency or the public health nursing agency of the local board of health in order to
receive funding under the alternative care program. Supplies and equipment may be
purchased from a vendor not certified to participate in the Medicaid program if the cost for
the item is less than that of a Medicaid vendor.

(c) Personal care services must meet the service standards defined in the federally
approved elderly waiver plan, except that a lead agency may contract with a client's
relative who meets the relative hardship waiver requirements or a relative who meets the
criteria and is also the responsible party under an individual service plan that ensures the
client's health and safety and supervision of the personal care services by a qualified
professional as defined in section 256B.0625, subdivision 19c. Relative hardship is
established by the lead agency when the client's care causes a relative caregiver to do any
of the following: resign from a paying job, reduce work hours resulting in lost wages,
obtain a leave of absence resulting in lost wages, incur substantial client-related expenses,
provide services to address authorized, unstaffed direct care time, or meet special needs of
the client unmet in the formal service plan.

Sec. 19.

Minnesota Statutes 2008, section 256B.0913, subdivision 12, is amended to
read:

Subd. 12.

Client fees.

(a) A fee is required for all alternative care eligible clients
to help pay for the cost of participating in the program. The amount of the fee for the
alternative care client shall be determined as follows:

(1) when the alternative care client's income less recurring and predictable medical
expenses is less than 100 percent of the federal poverty guideline effective on July 1 of
the state fiscal year in which the fee is being computed, and total assets are less than
$10,000, the fee is zero;

(2) when the alternative care client's income less recurring and predictable medical
expenses is equal to or greater than 100 percent but less than 150 percent of the federal
poverty guideline effective on July 1 of the state fiscal year in which the fee is being
computed, and total assets are less than $10,000, the fee is five percent of the cost of
alternative care services;

(3) when the alternative care client's income less recurring and predictable medical
expenses is equal to or greater than 150 percent but less than 200 percent of the federal
poverty guidelines effective on July 1 of the state fiscal year in which the fee is being
computed and assets are less than $10,000, the fee is 15 percent of the cost of alternative
care services;

(4) when the alternative care client's income less recurring and predictable medical
expenses is equal to or greater than 200 percent of the federal poverty guidelines effective
on July 1 of the state fiscal year in which the fee is being computed and assets are less than
$10,000, the fee is 30 percent of the cost of alternative care services; and

(5) when the alternative care client's assets are equal to or greater than $10,000, the
fee is 30 percent of the cost of alternative care services.

For married persons, total assets are defined as the total marital assets less the
estimated community spouse asset allowance, under section 256B.059, if applicable. For
married persons, total income is defined as the client's income less the monthly spousal
allotment, under section 256B.058.

All alternative care services shall be included in the estimated costs for the purpose
of determining the fee.

Fees are due and payable each month alternative care services are received unless the
actual cost of the services is less than the fee, in which case the fee is the lesser amount.

(b) The fee shall be waived by the commissioner when:

(1) a person is residing in a nursing facility;

(2) a married couple is requesting an asset assessment under the spousal
impoverishment provisions;

(3) a person is found eligible for alternative care, but is not yet receiving alternative
care services including case management services; or

(4) a person has chosen to participate in a consumer-directed service plan for which
the cost is no greater than the total cost of the person's alternative care service plan less
the monthly fee amount that would otherwise be assessed.

(c) The commissioner will bill and collect the fee from the client. Money collected
must be deposited in the general fund and is appropriated to the commissioner for the
alternative care program. The client must supply the lead agency with the client's Social
Security number at the time of application. The lead agency shall supply the commissioner
with the client's Social Security number and other information the commissioner requires
to collect the fee from the client. The commissioner shall collect unpaid fees using the
Revenue Recapture Act in chapter 270A and other methods available to the commissioner.
The commissioner may require lead agencies to inform clients of the collection procedures
that may be used by the state if a fee is not paid. deleted text begin This paragraph does not apply to
alternative care pilot projects authorized in Laws 1993, First Special Session chapter 1,
article 5, section 133, if a county operating under the pilot project reports the following
dollar amounts to the commissioner quarterly:
deleted text end

deleted text begin (1) total fees billed to clients;
deleted text end

deleted text begin (2) total collections of fees billed; and
deleted text end

deleted text begin (3) balance of fees owed by clients.
deleted text end

deleted text begin If a lead agency does not adhere to these reporting requirements, the commissioner may
terminate the billing, collecting, and remitting portions of the pilot project and require the
lead agency involved to operate under the procedures set forth in this paragraph.
deleted text end

Sec. 20.

Minnesota Statutes 2008, section 256B.0915, subdivision 2, is amended to
read:

Subd. 2.

Spousal impoverishment policies.

The commissioner shall apply:

deleted text begin (1) deleted text end the spousal impoverishment criteria as authorized under United States Code, title
42, section 1396r-5, and as implemented in sections 256B.0575, 256B.058, and 256B.059 deleted text begin ; deleted text end new text begin ,
except that individuals with income at or below the special income standard according
to Code of Federal Regulations, title 42, section 435.236, receive the maintenance needs
amount in subdivision 1d.
new text end

deleted text begin (2) the personal needs allowance permitted in section 256B.0575; and
deleted text end

deleted text begin (3) an amount equivalent to the group residential housing rate as set by section
256I.03, subdivision 5, and according to the approved federal waiver and medical
assistance state plan.
deleted text end

Sec. 21.

Minnesota Statutes 2008, section 256B.431, subdivision 10, is amended to
read:

Subd. 10.

Property rate adjustments and construction projects.

A nursing
deleted text begin facility's deleted text end new text begin facility completing a construction project that is eligible for a rate adjustment
under section 256B.434, subdivision 4f, and that was not approved through the moratorium
exception process in section 144A.073 must new text end request deleted text begin for deleted text end new text begin from the commissioner new text end a
property-related payment rate adjustment deleted text begin and the related supporting documentation of
project construction cost information must be submitted to the commissioner deleted text end new text begin . If the
request is made new text end within 60 days after the construction project's completion date deleted text begin to be
considered eligible for a property-related payment rate adjustment deleted text end new text begin the effective date of
the rate adjustment is the first of the month following the completion date. If the request
is made more than 60 days after the completion date, the rate adjustment is effective on
the first of the month following the request new text end . The commissioner shall provide a rate notice
reflecting the allowable costs within 60 days after receiving all the necessary information
to compute the rate adjustment. No sooner than the effective date of the rate adjustment
for the deleted text begin building deleted text end new text begin construction new text end project, a nursing facility may adjust its rates by the amount
anticipated to be allowed. Any amounts collected from private pay residents in excess of
the allowable rate must be repaid to private pay residents with interest at the rate used by
the commissioner of revenue for the late payment of taxes and in effect on the date the
rate increase is effective. Construction projects with completion dates within one year
of the completion date associated with the property rate adjustment request and phased
projects with project completion dates within three years of the last phase of the phased
project must be aggregated for purposes of the minimum thresholds in subdivisions 16
and 17, and the maximum threshold in section 144A.071, subdivision 2. "Construction
project" and "project construction costs" have the meanings given them in Minnesota
Statutes, section 144A.071, subdivision 1a.

Sec. 22.

Minnesota Statutes 2008, section 256B.433, subdivision 1, is amended to read:

Subdivision 1.

Setting payment; monitoring use of therapy services.

The
commissioner shall deleted text begin promulgate deleted text end new text begin adopt new text end rules deleted text begin pursuant to deleted text end new text begin under new text end the Administrative
Procedure Act to set the amount and method of payment for ancillary materials and
services provided to recipients residing in nursing facilities. Payment for materials and
services may be made to either deleted text begin the nursing facility in the operating cost per diem, to deleted text end the
vendor of ancillary services pursuant to Minnesota Rules, parts 9505.0170 to 9505.0475 new text begin , new text end
or to a nursing facility pursuant to Minnesota Rules, parts 9505.0170 to 9505.0475.
Payment for the same or similar service to a recipient shall not be made to both the nursing
facility and the vendor. The commissioner shall ensure the avoidance of double payments
through audits and adjustments to the nursing facility's annual cost report as required by
section 256B.47, and that charges and arrangements for ancillary materials and services
are cost-effective and as would be incurred by a prudent and cost-conscious buyer.
Therapy services provided to a recipient must be medically necessary and appropriate
to the medical condition of the recipient. If the vendor, nursing facility, or ordering
physician cannot provide adequate medical necessity justification, as determined by the
commissioner, the commissioner may recover or disallow the payment for the services
and may require prior authorization for therapy services as a condition of payment or
may impose administrative sanctions to limit the vendor, nursing facility, or ordering
physician's participation in the medical assistance program. If the provider number of a
nursing facility is used to bill services provided by a vendor of therapy services that is
not related to the nursing facility by ownership, control, affiliation, or employment status,
no withholding of payment shall be imposed against the nursing facility for services not
medically necessary except for funds due the unrelated vendor of therapy services as
provided in subdivision 3, paragraph (c). For the purpose of this subdivision, no monetary
recovery may be imposed against the nursing facility for funds paid to the unrelated
vendor of therapy services as provided in subdivision 3, paragraph (c), for services not
medically necessary. For purposes of this section and section 256B.47, therapy includes
physical therapy, occupational therapy, speech therapy, audiology, and mental health
services that are covered services according to Minnesota Rules, parts 9505.0170 to
9505.0475 deleted text begin , and that could be reimbursed separately from the nursing facility per diem deleted text end .
new text begin For purposes of this subdivision, "ancillary services" include transportation defined as
a covered service in section 256B.0625, subdivision 17. new text end

Sec. 23.

Minnesota Statutes 2008, section 256B.441, subdivision 5, is amended to read:

Subd. 5.

Administrative costs.

"Administrative costs" means the direct costs for
administering the overall activities of the nursing home. These costs include salaries and
wages of the administrator, assistant administrator, business office employees, security
guards, and associated fringe benefits and payroll taxes, fees, contracts, or purchases
related to business office functions, licenses, and permits except as provided in the external
fixed costs category, employee recognition, travel including meals and lodging, new text begin all new text end training new text begin
except as specified in subdivision 11 new text end , voice and data communication or transmission,
office supplies, liability insurance and other forms of insurance not designated to other
areas, personnel recruitment, legal services, accounting services, management or business
consultants, data processing, information technology, Web site, central or home office
costs, business meetings and seminars, postage, fees for professional organizations,
subscriptions, security services, advertising, board of director's fees, working capital
interest expense, and bad debts and bad debt collection fees.

Sec. 24.

Minnesota Statutes 2008, section 256B.441, subdivision 11, is amended to
read:

Subd. 11.

Direct care costs.

"Direct care costs" means costs for the wages of
nursing administration, deleted text begin staff education, deleted text end direct care registered nurses, licensed practical
nurses, certified nursing assistants, trained medication aides, new text begin employees conducting
training in resident care topics new text end and associated fringe benefits and payroll taxes; services
from a supplemental nursing services agency; supplies that are stocked at nursing stations
or on the floor and distributed or used individually, including, but not limited to: alcohol,
applicators, cotton balls, incontinence pads, disposable ice bags, dressings, bandages,
water pitchers, tongue depressors, disposable gloves, enemas, enema equipment, soap,
medication cups, diapers, plastic waste bags, sanitary products, thermometers, hypodermic
needles and syringes, clinical reagents or similar diagnostic agents, drugs that are not paid
on a separate fee schedule by the medical assistance program or any other payer, and
technology related to the provision of nursing care to residents, such as electronic charting
systems new text begin ; costs of materials used for resident care training, and training courses outside of
the facility attended by direct care staff on resident care topics new text end .

Sec. 25.

Minnesota Statutes 2008, section 256B.5011, subdivision 2, is amended to
read:

Subd. 2.

Contract provisions.

(a) The service contract with each intermediate
care facility must include provisions for:

(1) modifying payments when significant changes occur in the needs of the
consumers;

deleted text begin (2) the establishment and use of a quality improvement plan. Using criteria and
options for performance measures developed by the commissioner, each intermediate care
facility must identify a minimum of one performance measure on which to focus its efforts
for quality improvement during the contract period;
deleted text end

deleted text begin (3) deleted text end new text begin (2) new text end appropriate and necessary statistical information required by the
commissioner;

deleted text begin (4) deleted text end new text begin (3) new text end annual aggregate facility financial information; and

deleted text begin (5) deleted text end new text begin (4) new text end additional requirements for intermediate care facilities not meeting the
standards set forth in the service contract.

(b) The commissioner of human services and the commissioner of health, in
consultation with representatives from counties, advocacy organizations, and the provider
community, shall review the consolidated standards under chapter 245B and the supervised
living facility rule under Minnesota Rules, chapter 4665, to determine what provisions
in Minnesota Rules, chapter 4665, may be waived by the commissioner of health for
intermediate care facilities in order to enable facilities to implement the performance
measures in their contract and provide quality services to residents without a duplication
of or increase in regulatory requirements.

Sec. 26.

Minnesota Statutes 2008, section 256B.5012, subdivision 6, is amended to
read:

Subd. 6.

ICF/MR rate increases October 1, 2005, and October 1, 2006.

(a) For
the rate periods beginning October 1, 2005, and October 1, 2006, the commissioner shall
make available to each facility reimbursed under this section an adjustment to the total
operating payment rate of 2.2553 percent.

(b) 75 percent of the money resulting from the rate adjustment under paragraph (a)
must be used to increase wages and benefits and pay associated costs for employees,
except for administrative and central office employees. 75 percent of the money received
by a facility as a result of the rate adjustment provided in paragraph (a) must be used only
for wage, benefit, and staff increases implemented on or after the effective date of the rate
increase each year, and must not be used for increases implemented prior to that date. The
wage adjustment eligible employees may receive may vary based on merit, seniority, or
other factors determined by the provider.

(c) For each facility, the commissioner shall make available an adjustment, based
on occupied beds, using the percentage specified in paragraph (a) multiplied by the total
payment rate, including variable rate but excluding the property-related payment rate, in
effect on the preceding day. The total payment rate shall include the adjustment provided
in section 256B.501, subdivision 12.

(d) A facility whose payment rates are governed by closure agreements deleted text begin , deleted text end new text begin or
new text end receivership agreements deleted text begin , or Minnesota Rules, part 9553.0075, deleted text end is not eligible for an
adjustment otherwise granted under this subdivision.

(e) A facility may apply for the portion of the payment rate adjustment provided
under paragraph (a) for employee wages and benefits and associated costs. The application
must be made to the commissioner and contain a plan by which the facility will distribute
the funds according to paragraph (b). For facilities in which the employees are represented
by an exclusive bargaining representative, an agreement negotiated and agreed to by the
employer and the exclusive bargaining representative constitutes the plan. A negotiated
agreement may constitute the plan only if the agreement is finalized after the date of
enactment of all rate increases for the rate year. The commissioner shall review the plan to
ensure that the payment rate adjustment per diem is used as provided in this subdivision.
To be eligible, a facility must submit its plan by March 31, 2006, and December 31,
2006, respectively. If a facility's plan is effective for its employees after the first day of
the applicable rate period that the funds are available, the payment rate adjustment per
diem is effective the same date as its plan.

(f) A copy of the approved distribution plan must be made available to all employees
by giving each employee a copy or by posting it in an area of the facility to which all
employees have access. If an employee does not receive the wage and benefit adjustment
described in the facility's approved plan and is unable to resolve the problem with the
facility's management or through the employee's union representative, the employee
may contact the commissioner at an address or telephone number provided by the
commissioner and included in the approved plan.

Sec. 27.

Minnesota Statutes 2008, section 256B.5012, subdivision 7, is amended to
read:

Subd. 7.

ICF/MR rate increases effective October 1, 2007, and October 1, 2008.

(a) For the rate year beginning October 1, 2007, the commissioner shall make available to
each facility reimbursed under this section operating payment rate adjustments equal to
2.0 percent of the operating payment rates in effect on September 30, 2007. For the rate
year beginning October 1, 2008, the commissioner shall make available to each facility
reimbursed under this section operating payment rate adjustments equal to 2.0 percent
of the operating payment rates in effect on September 30, 2008. For each facility, the
commissioner shall make available an adjustment, based on occupied beds, using the
percentage specified in this paragraph multiplied by the total payment rate, including the
variable rate but excluding the property-related payment rate, in effect on the preceding
day. The total payment rate shall include the adjustment provided in section 256B.501,
subdivision 12. A facility whose payment rates are governed by closure agreements deleted text begin , deleted text end
new text begin or new text end receivership agreements deleted text begin , or Minnesota Rules, part 9553.0075, deleted text end is not eligible for an
adjustment otherwise granted under this subdivision.

(b) Seventy-five percent of the money resulting from the rate adjustments under
paragraph (a) must be used for increases in compensation-related costs for employees
directly employed by the facility on or after the effective date of the rate adjustments,
except:

(1) the administrator;

(2) persons employed in the central office of a corporation that has an ownership
interest in the facility or exercises control over the facility; and

(3) persons paid by the facility under a management contract.

(c) Two-thirds of the money available under paragraph (b) must be used for wage
increases for all employees directly employed by the facility on or after the effective
date of the rate adjustments, except those listed in paragraph (b), clauses (1) to (3). The
wage adjustment that employees receive under this paragraph must be paid as an equal
hourly percentage wage increase for all eligible employees. All wage increases under this
paragraph must be effective on the same date. Only costs associated with the portion of
the equal hourly percentage wage increase that goes to all employees shall qualify under
this paragraph. Costs associated with wage increases in excess of the amount of the equal
hourly percentage wage increase provided to all employees shall be allowed only for
meeting the requirements in paragraph (b). This paragraph shall not apply to employees
covered by a collective bargaining agreement.

(d) The commissioner shall allow as compensation-related costs all costs for:

(1) wages and salaries;

(2) FICA taxes, Medicare taxes, state and federal unemployment taxes, and workers'
compensation;

(3) the employer's share of health and dental insurance, life insurance, disability
insurance, long-term care insurance, uniform allowance, and pensions; and

(4) other benefits provided, subject to the approval of the commissioner.

(e) The portion of the rate adjustments under paragraph (a) that is not subject to the
requirements in paragraphs (b) and (c) shall be provided to facilities effective October
1 of each year.

(f) Facilities may apply for the portion of the rate adjustments under paragraph
(a) that is subject to the requirements in paragraphs (b) and (c). The application
must be submitted to the commissioner within six months of the effective date of the
rate adjustments, and the facility must provide additional information required by
the commissioner within nine months of the effective date of the rate adjustments.
The commissioner must respond to all applications within three weeks of receipt.
The commissioner may waive the deadlines in this paragraph under extraordinary
circumstances, to be determined at the sole discretion of the commissioner. The
application must contain:

(1) an estimate of the amounts of money that must be used as specified in paragraphs
(b) and (c);

(2) a detailed distribution plan specifying the allowable compensation-related and
wage increases the facility will implement to use the funds available in clause (1);

(3) a description of how the facility will notify eligible employees of the contents of
the approved application, which must provide for giving each eligible employee a copy of
the approved application, excluding the information required in clause (1), or posting a
copy of the approved application, excluding the information required in clause (1), for
a period of at least six weeks in an area of the facility to which all eligible employees
have access; and

(4) instructions for employees who believe they have not received the
compensation-related or wage increases specified in clause (2), as approved by the
commissioner, and which must include a mailing address, e-mail address, and the
telephone number that may be used by the employee to contact the commissioner or the
commissioner's representative.

(g) The commissioner shall ensure that cost increases in distribution plans under
paragraph (f), clause (2), that may be included in approved applications, comply with
requirements in clauses (1) to (4):

(1) costs to be incurred during the applicable rate year resulting from wage and
salary increases effective after October 1, 2006, and prior to the first day of the facility's
payroll period that includes October 1 of each year shall be allowed if they were not used
in the prior year's application and they meet the requirements of paragraphs (b) and (c);

(2) a portion of the costs resulting from tenure-related wage or salary increases
may be considered to be allowable wage increases, according to formulas that the
commissioner shall provide, where employee retention is above the average statewide
rate of retention of direct care employees;

(3) the annualized amount of increases in costs for the employer's share of health
and dental insurance, life insurance, disability insurance, and workers' compensation shall
be allowable compensation-related increases if they are effective on or after April 1 of
the year in which the rate adjustments are effective and prior to April 1 of the following
year; and

(4) for facilities in which employees are represented by an exclusive bargaining
representative, the commissioner shall approve the application only upon receipt of a letter
of acceptance of the distribution plan, as regards members of the bargaining unit, signed
by the exclusive bargaining agent and dated after May 25, 2007. Upon receipt of the letter
of acceptance, the commissioner shall deem all requirements of this section as having
been met in regard to the members of the bargaining unit.

(h) The commissioner shall review applications received under paragraph (f) and
shall provide the portion of the rate adjustments under paragraphs (b) and (c) if the
requirements of this subdivision have been met. The rate adjustments shall be effective
October 1 of each year. Notwithstanding paragraph (a), if the approved application
distributes less money than is available, the amount of the rate adjustment shall be reduced
so that the amount of money made available is equal to the amount to be distributed.

Sec. 28.

Minnesota Statutes 2008, section 256B.5013, subdivision 1, is amended to
read:

Subdivision 1.

Variable rate adjustments.

(a) For rate years beginning on or after
October 1, 2000, when there is a documented increase in the needs of a current ICF/MR
recipient, the county of financial responsibility may recommend a variable rate to enable
the facility to meet the individual's increased needs. Variable rate adjustments made under
this subdivision replace payments for persons with special needs under section 256B.501,
subdivision 8, and payments for persons with special needs for crisis intervention services
under section 256B.501, subdivision 8a. Effective July 1, 2003, facilities with a base rate
above the 50th percentile of the statewide average reimbursement rate for a Class A
facility or Class B facility, whichever matches the facility licensure, are not eligible for a
variable rate adjustment. Variable rate adjustments may not exceed a 12-month period,
except when approved for purposes established in paragraph (b), clause (1). Variable rate
adjustments approved solely on the basis of changes on a developmental disabilities
screening document will end June 30, 2002.

(b) A variable rate may be recommended by the county of financial responsibility
for increased needs in the following situations:

(1) a need for resources due to an individual's full or partial retirement from
participation in a day training and habilitation service when the individual: (i) has reached
the age of 65 or has a change in health condition that makes it difficult for the person
to participate in day training and habilitation services over an extended period of time
because it is medically contraindicated; and (ii) has expressed a desire for change through
the developmental disability screening process under section 256B.092;

(2) a need for additional resources for intensive short-term programming which is
necessary prior to an individual's discharge to a less restrictive, more integrated setting;

(3) a demonstrated medical need that significantly impacts the type or amount of
services needed by the individual; or

(4) a demonstrated behavioral need that significantly impacts the type or amount of
services needed by the individual.

(c) The county of financial responsibility must justify the purpose, the projected
length of time, and the additional funding needed for the facility to meet the needs of
the individual.

(d) The facility shall provide deleted text begin a quarterly deleted text end new text begin an annual new text end report to the county case manager
on the use of the variable rate funds and the status of the individual on whose behalf the
funds were approved. The county case manager will forward the facility's report with a
recommendation to the commissioner to approve or disapprove a continuation of the
variable rate.

(e) Funds made available through the variable rate process that are not used by
the facility to meet the needs of the individual for whom they were approved shall be
returned to the state.

Sec. 29.

Minnesota Statutes 2008, section 256B.5013, subdivision 6, is amended to
read:

Subd. 6.

Commissioner's responsibilities.

The commissioner shall:

(1) make a determination to approve, deny, or modify a request for a variable rate
adjustment within 30 days of the receipt of the completed application;

(2) notify the ICF/MR facility and county case manager of the duration and
conditions of variable rate adjustment approvals; new text begin and
new text end

(3) modify MMIS II service agreements to reimburse ICF/MR facilities for approved
variable rates deleted text begin ; deleted text end new text begin .
new text end

deleted text begin (4) provide notification of legislatively appropriated funding for facility closures,
downsizings, and relocations;
deleted text end

deleted text begin (5) assess the fiscal impacts of the proposals for closures, downsizings, and
relocations forwarded for consideration through the state advisory committee; and
deleted text end

deleted text begin (6) review the payment rate process on a biannual basis and make recommendations
to the legislature for necessary adjustments to the review and approval process.
deleted text end

Sec. 30.

Minnesota Statutes 2008, section 256B.69, subdivision 9b, is amended to read:

Subd. 9b.

Reporting provider payment rates.

(a) According to guidelines
developed by the commissioner, in consultation with new text begin health care providers, new text end managed care
plans new text begin , new text end and county-based purchasing plans, each managed care plan and county-based
purchasing plan must new text begin annually new text end provide to the commissioner deleted text begin , at the commissioner's request,
detailed or aggregate deleted text end information on reimbursement rates paid by the managed care plan
under this section or the county-based purchasing plan under section 256B.692 to provider
types and vendors for administrative services under contract with the plan.

new text begin (b) Each managed care plan and county-based purchasing plan must annually
provide to the commissioner, in the form and manner specified by the commissioner:
new text end

new text begin (1) aggregate provider payment data, categorized by subspecialty and primary care;
new text end

new text begin (2) evidence that increases in payments made to the plan under this section are
passed through to health care providers, including information on the proportion of the
increases paid to providers, categorized by subspecialty and primary care; and
new text end

new text begin (3) specific information on the methodology used to establish provider
reimbursement rates paid by the managed health care plan and county-based purchasing
plan.
new text end

new text begin Data provided to the commissioner under this subdivision must allow the
commissioner to conduct the analyses required under paragraph (d).
new text end

deleted text begin (b) Data provided to the commissioner under this subdivision are nonpublic data as
defined in section deleted text end deleted text begin .
deleted text end

new text begin (c) The commissioner shall analyze data provided under this subdivision by
procedure code, provider type, provider size, and geographic location of the provider. The
commissioner shall also array aggregate provider reimbursement rates across all plans by
subspecialty and primary care category. The commissioner shall report this information to
the legislature annually, beginning December 15, 2010, and each December 15 thereafter.
The commissioner shall also make this information available on the agency's Web site to
managed care and county-based purchasing plans, health care providers, and the public.
new text end

Sec. 31.

Minnesota Statutes 2008, section 403.03, is amended to read:

403.03 911 SERVICES TO BE PROVIDED.

Services available through a 911 system deleted text begin shall deleted text end new text begin must new text end include police, firefighting,
and emergency medical and ambulance services. Other emergency and civil defense
services may be incorporated into the 911 system at the discretion of the public agency
operating the public safety answering point. new text begin The 911 system may include a referral to
mental health crisis teams, where available.
new text end

Sec. 32.

Minnesota Statutes 2008, section 626.557, subdivision 12b, is amended to
read:

Subd. 12b.

Data management.

(a) In performing any of the duties of this section as
a lead agency, the county social service agency shall maintain appropriate records. Data
collected by the county social service agency under this section are welfare data under
section 13.46. Notwithstanding section 13.46, subdivision 1, paragraph (a), data under this
paragraph that are inactive investigative data on an individual who is a vendor of services
are private data on individuals, as defined in section 13.02. The identity of the reporter
may only be disclosed as provided in paragraph (c).

Data maintained by the common entry point are confidential data on individuals or
protected nonpublic data as defined in section 13.02. Notwithstanding section 138.163,
the common entry point shall deleted text begin destroy data deleted text end new text begin maintain data for new text end three calendar years after date
of receipt new text begin and then destroy the data unless otherwise directed by federal requirements new text end .

(b) The commissioners of health and human services shall prepare an investigation
memorandum for each report alleging maltreatment investigated under this section.
County social service agencies must maintain private data on individuals but are not
required to prepare an investigation memorandum. During an investigation by the
commissioner of health or the commissioner of human services, data collected under this
section are confidential data on individuals or protected nonpublic data as defined in
section 13.02. Upon completion of the investigation, the data are classified as provided in
clauses (1) to (3) and paragraph (c).

(1) The investigation memorandum must contain the following data, which are
public:

(i) the name of the facility investigated;

(ii) a statement of the nature of the alleged maltreatment;

(iii) pertinent information obtained from medical or other records reviewed;

(iv) the identity of the investigator;

(v) a summary of the investigation's findings;

(vi) statement of whether the report was found to be substantiated, inconclusive,
false, or that no determination will be made;

(vii) a statement of any action taken by the facility;

(viii) a statement of any action taken by the lead agency; and

(ix) when a lead agency's determination has substantiated maltreatment, a statement
of whether an individual, individuals, or a facility were responsible for the substantiated
maltreatment, if known.

The investigation memorandum must be written in a manner which protects the
identity of the reporter and of the vulnerable adult and may not contain the names or, to
the extent possible, data on individuals or private data listed in clause (2).

(2) Data on individuals collected and maintained in the investigation memorandum
are private data, including:

(i) the name of the vulnerable adult;

(ii) the identity of the individual alleged to be the perpetrator;

(iii) the identity of the individual substantiated as the perpetrator; and

(iv) the identity of all individuals interviewed as part of the investigation.

(3) Other data on individuals maintained as part of an investigation under this section
are private data on individuals upon completion of the investigation.

(c) The subject of the report may compel disclosure of the name of the reporter only
with the consent of the reporter or upon a written finding by a court that the report was
false and there is evidence that the report was made in bad faith. This subdivision does
not alter disclosure responsibilities or obligations under the Rules of Criminal Procedure,
except that where the identity of the reporter is relevant to a criminal prosecution, the
district court shall do an in-camera review prior to determining whether to order disclosure
of the identity of the reporter.

(d) Notwithstanding section 138.163, data maintained under this section by the
commissioners of health and human services must be deleted text begin destroyed deleted text end new text begin maintained new text end under the
following schedule new text begin and then destroyed unless otherwise directed by federal requirements new text end :

(1) data from reports determined to be false, deleted text begin two deleted text end new text begin maintained for three new text end years after the
finding was made;

(2) data from reports determined to be inconclusive, new text begin maintained for new text end four years after
the finding was made;

(3) data from reports determined to be substantiated, new text begin maintained for new text end seven years
after the finding was made; and

(4) data from reports which were not investigated by a lead agency and for which
there is no final disposition, deleted text begin two deleted text end new text begin maintained for three new text end years from the date of the report.

(e) The commissioners of health and human services shall each annually report to
the legislature and the governor on the number and type of reports of alleged maltreatment
involving licensed facilities reported under this section, the number of those requiring
investigation under this section, and the resolution of those investigations. The report
shall identify:

(1) whether and where backlogs of cases result in a failure to conform with statutory
time frames;

(2) where adequate coverage requires additional appropriations and staffing; and

(3) any other trends that affect the safety of vulnerable adults.

(f) Each lead agency must have a record retention policy.

(g) Lead agencies, prosecuting authorities, and law enforcement agencies may
exchange not public data, as defined in section 13.02, if the agency or authority requesting
the data determines that the data are pertinent and necessary to the requesting agency in
initiating, furthering, or completing an investigation under this section. Data collected
under this section must be made available to prosecuting authorities and law enforcement
officials, local county agencies, and licensing agencies investigating the alleged
maltreatment under this section. The lead agency shall exchange not public data with the
vulnerable adult maltreatment review panel established in section 256.021 if the data are
pertinent and necessary for a review requested under that section. Upon completion of the
review, not public data received by the review panel must be returned to the lead agency.

(h) Each lead agency shall keep records of the length of time it takes to complete its
investigations.

(i) A lead agency may notify other affected parties and their authorized representative
if the agency has reason to believe maltreatment has occurred and determines the
information will safeguard the well-being of the affected parties or dispel widespread
rumor or unrest in the affected facility.

(j) Under any notification provision of this section, where federal law specifically
prohibits the disclosure of patient identifying information, a lead agency may not provide
any notice unless the vulnerable adult has consented to disclosure in a manner which
conforms to federal requirements.

Sec. 33. new text begin HEALTH DEPARTMENT WORKGROUP; HOSPITAL ASSOCIATION
COMMITTEES.
new text end

new text begin (a) The commissioner of health shall consult with representatives from the
Minnesota Nurses Association, Minnesota Hospital Association, and other shareholders
to further define staffing levels for purposes of Minnesota Statutes, section 144.7065,
subdivision 8, and to develop questions related to staffing for inclusion in the root cause
analysis tool required under that subdivision.
new text end

new text begin (b) The Minnesota Nurses Association and the Minnesota Hospital Association shall
develop a memorandum of understanding that outlines ways to include representatives
from the Minnesota Nurses Association and the Minnesota Hospital Association work
groups and committees dealing with adverse health care events and corrective action plans
under Minnesota Statutes, section 144.7065.
new text end

Sec. 34. new text begin ALZHEIMER'S DISEASE WORKING GROUP.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment; members. new text end

new text begin The commissioner of health, in
collaboration with the Minnesota Board on Aging, must convene an Alzheimer's disease
working group that consists of no more than 15 members including, but not limited to:
new text end

new text begin (a) at least one caregiver of a person who has been diagnosed with Alzheimer's
disease;
new text end

new text begin (b) at least one person who has been diagnosed with Alzheimer's disease;
new text end

new text begin (c) a representative of the nursing facility industry;
new text end

new text begin (d) a representative of the assisted living industry;
new text end

new text begin (e) a representative of the adult day services industry;
new text end

new text begin (f) a representative of the medical care provider community;
new text end

new text begin (g) an Alzheimer's researcher;
new text end

new text begin (h) a representative of the Alzheimer's Association;
new text end

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

new text begin (j) the commissioner of health or a designee;
new text end

new text begin (k) the ombudsman for long-term care or a designee;
new text end

new text begin (l) the commissioner of public safety or a designee; and
new text end

new text begin (m) at least two members named by the governor.
new text end

new text begin Subd. 2. new text end

new text begin Duties; recommendations. new text end

new text begin The Alzheimer's disease working group must
examine the array of needs of individuals diagnosed with Alzheimer's disease, services
available to meet these needs, and the capacity of the state and current providers to meet
these and future needs. The working group shall consider and make recommendations
on the following issues:
new text end

new text begin (a) trends in the state's Alzheimer's population and service needs including, but
not limited to:
new text end

new text begin (1) the state's role in long-term care, family caregiver support, and assistance to
persons with early-stage and early-onset of Alzheimer's disease;
new text end

new text begin (2) state policy regarding persons with Alzheimer's disease and dementia; and
new text end

new text begin (3) establishment of a surveillance system for the purpose of having proper estimates
of the number of persons in the state with Alzheimer's disease, and the changing
population with dementia;
new text end

new text begin (b) existing resources, services, and capacity including, but not limited to:
new text end

new text begin (1) type, cost, and availability of dementia services;
new text end

new text begin (2) dementia-specific training requirements for long-term care staff;
new text end

new text begin (3) quality care measures for residential care facilities;
new text end

new text begin (4) capacity of public safety and law enforcement officers to respond to persons with
Alzheimer's disease or dementia;
new text end

new text begin (5) availability of home and community-based resources for persons with
Alzheimer's disease, including respite care;
new text end

new text begin (6) number and availability of long-term care dementia units;
new text end

new text begin (7) adequacy and appropriateness of geriatric psychiatric units for persons with
behavior disorders associated with Alzheimer's and related dementia;
new text end

new text begin (8) assisted living residential options for persons with dementia; and
new text end

new text begin (9) state support of Alzheimer's research through Minnesota universities and other
resources;
new text end

new text begin (c) needed policies or responses including, but not limited to, the provision of
coordinated services and supports to persons and families living with Alzheimer's and
related disorders, the capacity to meet these needs, and strategies to address identified
gaps in services.
new text end

new text begin Subd. 3. new text end

new text begin Meetings. new text end

new text begin At least four working group meetings must be public meetings,
and to the extent practicable, technological means, such as Web casts, should be used to
reach the greatest number of people throughout the state.
new text end

new text begin Subd. 4. new text end

new text begin Report. new text end

new text begin The commissioner of health must submit a report and
recommendations to the governor and chairs and ranking minority members of the
legislative committees with jurisdiction over health care no later than January 15, 2011.
new text end

new text begin Subd. 5. new text end

new text begin Private funding. new text end

new text begin To the extent available, the commissioner of health may
utilize funding provided by private foundations and other private funding sources to
complete the duties of the Alzheimer's disease working group.
new text end

new text begin Subd. 6. new text end

new text begin Sunset. new text end

new text begin The Alzheimer's disease working group sunsets upon delivery of
the required report to the governor and legislative committees.
new text end

Sec. 35. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2008, section 256B.5013, subdivisions 2, 3, and 5, new text end new text begin are repealed.
new text end