Minnesota Legislature
HF 1832
3rd Engrossment - 82nd Legislature (2001 - 2002) Posted on 12/15/2009 12:00am
KEY: stricken = removed, old language.
underscored = added, new language.
Bill Text Versions
| Engrossments | ||
|---|---|---|
| Introduction | Posted on 03/15/2001 | |
| 1st Engrossment | Posted on 03/28/2001 | |
| 2nd Engrossment | Posted on 04/27/2001 | |
| 3rd Engrossment | Posted on 05/01/2001 |
Current Version - 3rd Engrossment
1.1 A bill for an act 1.2 relating to human services; modifying provisions 1.3 relating to health department; health care; continuing 1.4 care and home care; consumer information and 1.5 assistance and community-based care; long-term care 1.6 reform and reimbursement; work force; regulation of 1.7 supplemental nursing services agencies; long-term 1.8 insurance; mental health and civil commitment; 1.9 assistance programs; licensing; appropriating money; 1.10 amending Minnesota Statutes 2000, sections 13.46, 1.11 subdivision 4; 62A.48, subdivision 4, by adding 1.12 subdivisions; 62S.01, by adding subdivisions; 62S.26; 1.13 103I.101, subdivision 6; 103I.112; 103I.208, 1.14 subdivisions 1, 2; 103I.235, subdivision 1; 103I.525, 1.15 subdivisions 2, 6, 8, 9; 103I.531, subdivisions 2, 6, 1.16 8, 9; 103I.535, subdivisions 2, 6, 8, 9; 103I.541, 1.17 subdivisions 2b, 4, 5; 103I.545; 121A.15, subdivision 1.18 6; 135A.14, by adding a subdivision; 144.057; 1.19 144.1202, subdivision 4; 144.122; 144.1222, by adding 1.20 a subdivision; 144.1464; 144.148, subdivision 2; 1.21 144.226, subdivision 4; 144.98, subdivision 3; 1.22 144A.071, subdivisions 1, 1a, 2, 4a; 144A.073, 1.23 subdivisions 2, 4; 144A.44, subdivision 1; 144A.62, 1.24 subdivisions 1, 2, 3, 4; 145.881, subdivision 2; 1.25 145.882, subdivision 7, by adding a subdivision; 1.26 145.885, subdivision 2; 145.924; 145.925, subdivisions 1.27 1, 1a; 145A.15, subdivision 1, by adding a 1.28 subdivision; 145A.16, subdivision 1, by adding a 1.29 subdivision; 148.212; 148B.21, subdivision 6a; 1.30 148B.22, subdivision 3; 157.16, subdivision 3; 157.22; 1.31 214.104; 245.462, subdivisions 8, 18, by adding a 1.32 subdivision; 245.4871, subdivisions 10, 27; 245.4876, 1.33 subdivision 1, by adding a subdivision; 245.4885, 1.34 subdivision 1; 245.4886, subdivision 1; 245.99, 1.35 subdivision 4; 245A.03, subdivision 2b; 245A.04, 1.36 subdivisions 3, 3a, 3b, 3c, 3d; 245A.05; 245A.06; 1.37 245A.07; 245A.08; 245A.13, subdivisions 7, 8; 245A.14, 1.38 by adding a subdivision; 245A.16, subdivision 1; 1.39 245B.08, subdivision 3; 246.57, by adding a 1.40 subdivision; 252.275, subdivision 4b; 252A.02, 1.41 subdivisions 12, 13, by adding a subdivision; 1.42 252A.111, subdivision 6; 252A.16, subdivision 1; 1.43 252A.19, subdivision 2; 252A.20, subdivision 1; 1.44 254B.02, subdivision 3; 254B.03, subdivision 1; 1.45 254B.04, subdivision 1; 254B.09, by adding a 1.46 subdivision; 256.01, subdivisions 2, 18, by adding a 2.1 subdivision; 256.045, subdivisions 3, 3b, 4; 256.476, 2.2 subdivisions 1, 2, 3, 4, 5, 8; 256.482, subdivision 8; 2.3 256.955, subdivision 2b; 256.9657, subdivision 2; 2.4 256.969, subdivisions 2b, 3a, by adding a subdivision; 2.5 256.973, by adding a subdivision; 256.975, by adding 2.6 subdivisions; 256B.04, by adding a subdivision; 2.7 256B.055, subdivision 3a; 256B.056, subdivisions 1a, 2.8 3, 4, 5; 256B.057, subdivision 9, by adding a 2.9 subdivision; 256B.0625, subdivisions 3b, 7, 13, 13a, 2.10 17, 17a, 18a, 19a, 19c, 20, 30, 34, by adding 2.11 subdivisions; 256B.0627, subdivisions 1, 2, 4, 5, 7, 2.12 8, 10, 11, by adding subdivisions; 256B.0635, 2.13 subdivisions 1, 2; 256B.0911, subdivisions 1, 3, 5, 6, 2.14 7, by adding subdivisions; 256B.0913, subdivisions 1, 2.15 2, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14; 256B.0915, 2.16 subdivisions 1d, 3, 5; 256B.0916, subdivisions 1, 7, 2.17 9, by adding a subdivision; 256B.0917, subdivision 7; 2.18 256B.092, subdivisions 2a, 5; 256B.093, subdivision 3; 2.19 256B.095; 256B.0951, subdivisions 1, 3, 4, 5, 7, by 2.20 adding subdivisions; 256B.0952, subdivisions 1, 4; 2.21 256B.431, subdivision 17, by adding subdivisions; 2.22 256B.434, subdivisions 4, 10, by adding subdivisions; 2.23 256B.49, by adding subdivisions; 256B.501, by adding a 2.24 subdivision; 256B.69, subdivisions 4, 5, 5b, 23, by 2.25 adding a subdivision; 256B.75; 256B.76; 256D.03, 2.26 subdivisions 3, 4; 256D.053, subdivision 1; 256D.35, 2.27 by adding subdivisions; 256D.44, subdivision 5; 2.28 256I.05, subdivision 1e; 256J.09, subdivisions 1, 2, 2.29 3, by adding subdivisions; 256J.15, by adding a 2.30 subdivision; 256J.24, subdivision 10; 256J.26, 2.31 subdivision 1; 256J.31, subdivisions 4, 12; 256J.32, 2.32 subdivision 7a; 256J.42, by adding a subdivision; 2.33 256J.45, subdivision 1; 256J.46, subdivisions 1, 2a, 2.34 by adding a subdivision; 256J.50, subdivisions 1, 7; 2.35 256J.56; 256J.57, subdivision 2; 256J.62, subdivision 2.36 9; 256J.625, subdivisions 1, 2, 4; 256J.751; 256K.03, 2.37 subdivision 1; 256K.07; 256K.25, subdivisions 1, 3, 4, 2.38 5, 6; 256L.06, subdivision 3; 256L.12, subdivision 9, 2.39 by adding a subdivision; 256L.16; 268.0122, 2.40 subdivision 2; 626.556, subdivisions 3, 3c, 10b, 10i; 2.41 626.557, subdivisions 3, 9d; 626.5572, subdivision 17; 2.42 Laws 1995, chapter 178, article 2, section 36; Laws 2.43 1995, chapter 207, article 3, section 21, as amended; 2.44 Laws 1997, chapter 203, article 9, section 21, as 2.45 amended; Laws 1999, chapter 152, sections 1, 4; Laws 2.46 1999, chapter 245, article 3, section 45, as amended; 2.47 Laws 1999, chapter 245, article 4, section 110; 2.48 proposing coding for new law in Minnesota Statutes, 2.49 chapters 62S; 144; 144A; 145; 145A; 246; 256; 256B; 2.50 256I; 256J; 299A; repealing Minnesota Statutes 2000, 2.51 sections 144.0721, subdivision 1; 144.148, subdivision 2.52 8; 145.882, subdivisions 3, 4; 145.9245; 145.927; 2.53 252A.111, subdivision 3; 256.476, subdivision 7; 2.54 256B.037, subdivision 5; 256B.0635, subdivision 3; 2.55 256B.0911, subdivisions 2, 2a, 4, 8, 9; 256B.0912; 2.56 256B.0913, subdivisions 3, 15a, 15b, 15c, 16; 2.57 256B.0915, subdivisions 3a, 3b, 3c; 256B.0951, 2.58 subdivision 6; 256B.434, subdivision 5; 256B.49, 2.59 subdivisions 1, 2, 3, 4, 5, 6, 7, 8, 9, 10; 256E.06, 2.60 subdivision 2b; 256J.42, subdivision 4; 256J.44; 2.61 256J.46, subdivision 1a; Laws 1995, chapter 178, 2.62 article 2, section 48, subdivision 6; Minnesota Rules, 2.63 parts 9505.2390; 9505.2395; 9505.2396; 9505.2400; 2.64 9505.2405; 9505.2410; 9505.2413; 9505.2415; 9505.2420; 2.65 9505.2425; 9505.2426; 9505.2430; 9505.2435; 9505.2440; 2.66 9505.2445; 9505.2450; 9505.2455; 9505.2458; 9505.2460; 2.67 9505.2465; 9505.2470; 9505.2473; 9505.2475; 9505.2480; 2.68 9505.2485; 9505.2486; 9505.2490; 9505.2495; 9505.2496; 2.69 9505.2500; 9505.3010; 9505.3015; 9505.3020; 9505.3025; 2.70 9505.3030; 9505.3035; 9505.3040; 9505.3065; 9505.3085; 2.71 9505.3135; 9505.3500; 9505.3510; 9505.3520; 9505.3530; 3.1 9505.3535; 9505.3540; 9505.3545; 9505.3550; 9505.3560; 3.2 9505.3570; 9505.3575; 9505.3580; 9505.3585; 9505.3600; 3.3 9505.3610; 9505.3620; 9505.3622; 9505.3624; 9505.3626; 3.4 9505.3630; 9505.3635; 9505.3640; 9505.3645; 9505.3650; 3.5 9505.3660; 9505.3670. 3.6 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 3.7 ARTICLE 1 3.8 HEALTH DEPARTMENT 3.9 Section 1. Minnesota Statutes 2000, section 103I.101, 3.10 subdivision 6, is amended to read: 3.11 Subd. 6. [FEES FOR VARIANCES.] The commissioner shall 3.12 charge a nonrefundable application fee of$120$150 to cover the 3.13 administrative cost of processing a request for a variance or 3.14 modification of rules adopted by the commissioner under this 3.15 chapter. 3.16 Sec. 2. Minnesota Statutes 2000, section 103I.112, is 3.17 amended to read: 3.18 103I.112 [FEE EXEMPTIONS FOR STATE AND LOCAL GOVERNMENT.] 3.19 (a) The commissioner of health may not charge fees required 3.20 under this chapter to a federal agency, state agency, or a local 3.21 unit of government or to a subcontractor performing work for the 3.22 state agency or local unit of government. 3.23 (b) "Local unit of government" means a statutory or home 3.24 rule charter city, town, county, or soil and water conservation 3.25 district, watershed district, an organization formed for the 3.26 joint exercise of powers under section 471.59, a board of health 3.27 or community health board, or other special purpose district or 3.28 authority with local jurisdiction in water and related land 3.29 resources management. 3.30 Sec. 3. Minnesota Statutes 2000, section 103I.208, 3.31 subdivision 1, is amended to read: 3.32 Subdivision 1. [WELL NOTIFICATION FEE.] The well 3.33 notification fee to be paid by a property owner is: 3.34 (1) for a new well,$120$150, which includes the state 3.35 core function fee; 3.36 (2) for a well sealing,$20$30 for each well, which 3.37 includes the state core function fee, except that for monitoring 3.38 wells constructed on a single property, having depths within a 4.1 25 foot range, and sealed within 48 hours of start of 4.2 construction, a single fee of$20$30; and 4.3 (3) for construction of a dewatering well,$120$150, which 4.4 includes the state core function fee, for each well except a 4.5 dewatering project comprising five or more wells shall be 4.6 assessed a single fee of$600$750 for the wells recorded on the 4.7 notification. 4.8 Sec. 4. Minnesota Statutes 2000, section 103I.208, 4.9 subdivision 2, is amended to read: 4.10 Subd. 2. [PERMIT FEE.] The permit fee to be paid by a 4.11 property owner is: 4.12 (1) for a well that is not in use under a maintenance 4.13 permit,$100$125 annually; 4.14 (2) for construction of a monitoring well,$120$150, which 4.15 includes the state core function fee; 4.16 (3) for a monitoring well that is unsealed under a 4.17 maintenance permit,$100$125 annually; 4.18 (4) for monitoring wells used as a leak detection device at 4.19 a single motor fuel retail outlet, a single petroleum bulk 4.20 storage site excluding tank farms, or a single agricultural 4.21 chemical facility site, the construction permit fee 4.22 is$120$150, which includes the state core function fee, per 4.23 site regardless of the number of wells constructed on the site, 4.24 and the annual fee for a maintenance permit for unsealed 4.25 monitoring wells is$100$125 per site regardless of the number 4.26 of monitoring wells located on site; 4.27 (5) for a groundwater thermal exchange device, in addition 4.28 to the notification fee for wells,$120$150, which includes the 4.29 state core function fee; 4.30 (6) for a vertical heat exchanger,$120$150; 4.31 (7) for a dewatering well that is unsealed under a 4.32 maintenance permit,$100$125 annually for each well, except a 4.33 dewatering project comprising more than five wells shall be 4.34 issued a single permit for$500$625 annually for wells recorded 4.35 on the permit; and 4.36 (8) for excavating holes for the purpose of installing 5.1 elevator shafts,$120$150 for each hole. 5.2 Sec. 5. Minnesota Statutes 2000, section 103I.235, 5.3 subdivision 1, is amended to read: 5.4 Subdivision 1. [DISCLOSURE OF WELLS TO BUYER.] (a) Before 5.5 signing an agreement to sell or transfer real property, the 5.6 seller must disclose in writing to the buyer information about 5.7 the status and location of all known wells on the property, by 5.8 delivering to the buyer either a statement by the seller that 5.9 the seller does not know of any wells on the property, or a 5.10 disclosure statement indicating the legal description and 5.11 county, and a map drawn from available information showing the 5.12 location of each well to the extent practicable. In the 5.13 disclosure statement, the seller must indicate, for each well, 5.14 whether the well is in use, not in use, or sealed. 5.15 (b) At the time of closing of the sale, the disclosure 5.16 statement information, name and mailing address of the buyer, 5.17 and the quartile, section, township, and range in which each 5.18 well is located must be provided on a well disclosure 5.19 certificate signed by the seller or a person authorized to act 5.20 on behalf of the seller. 5.21 (c) A well disclosure certificate need not be provided if 5.22 the seller does not know of any wells on the property and the 5.23 deed or other instrument of conveyance contains the statement: 5.24 "The Seller certifies that the Seller does not know of any wells 5.25 on the described real property." 5.26 (d) If a deed is given pursuant to a contract for deed, the 5.27 well disclosure certificate required by this subdivision shall 5.28 be signed by the buyer or a person authorized to act on behalf 5.29 of the buyer. If the buyer knows of no wells on the property, a 5.30 well disclosure certificate is not required if the following 5.31 statement appears on the deed followed by the signature of the 5.32 grantee or, if there is more than one grantee, the signature of 5.33 at least one of the grantees: "The Grantee certifies that the 5.34 Grantee does not know of any wells on the described real 5.35 property." The statement and signature of the grantee may be on 5.36 the front or back of the deed or on an attached sheet and an 6.1 acknowledgment of the statement by the grantee is not required 6.2 for the deed to be recordable. 6.3 (e) This subdivision does not apply to the sale, exchange, 6.4 or transfer of real property: 6.5 (1) that consists solely of a sale or transfer of severed 6.6 mineral interests; or 6.7 (2) that consists of an individual condominium unit as 6.8 described in chapters 515 and 515B. 6.9 (f) For an area owned in common under chapter 515 or 515B 6.10 the association or other responsible person must report to the 6.11 commissioner by July 1, 1992, the location and status of all 6.12 wells in the common area. The association or other responsible 6.13 person must notify the commissioner within 30 days of any change 6.14 in the reported status of wells. 6.15 (g) For real property sold by the state under section 6.16 92.67, the lessee at the time of the sale is responsible for 6.17 compliance with this subdivision. 6.18 (h) If the seller fails to provide a required well 6.19 disclosure certificate, the buyer, or a person authorized to act 6.20 on behalf of the buyer, may sign a well disclosure certificate 6.21 based on the information provided on the disclosure statement 6.22 required by this section or based on other available information. 6.23 (i) A county recorder or registrar of titles may not record 6.24 a deed or other instrument of conveyance dated after October 31, 6.25 1990, for which a certificate of value is required under section 6.26 272.115, or any deed or other instrument of conveyance dated 6.27 after October 31, 1990, from a governmental body exempt from the 6.28 payment of state deed tax, unless the deed or other instrument 6.29 of conveyance contains the statement made in accordance with 6.30 paragraph (c) or (d) or is accompanied by the well disclosure 6.31 certificate containing all the information required by paragraph 6.32 (b) or (d). The county recorder or registrar of titles must not 6.33 accept a certificate unless it contains all the required 6.34 information. The county recorder or registrar of titles shall 6.35 note on each deed or other instrument of conveyance accompanied 6.36 by a well disclosure certificate that the well disclosure 7.1 certificate was received. The notation must include the 7.2 statement "No wells on property" if the disclosure certificate 7.3 states there are no wells on the property. The well disclosure 7.4 certificate shall not be filed or recorded in the records 7.5 maintained by the county recorder or registrar of titles. After 7.6 noting "No wells on property" on the deed or other instrument of 7.7 conveyance, the county recorder or registrar of titles shall 7.8 destroy or return to the buyer the well disclosure certificate. 7.9 The county recorder or registrar of titles shall collect from 7.10 the buyer or the person seeking to record a deed or other 7.11 instrument of conveyance, a fee of$20$30 for receipt of a 7.12 completed well disclosure certificate. By the tenth day of each 7.13 month, the county recorder or registrar of titles shall transmit 7.14 the well disclosure certificates to the commissioner of health. 7.15 By the tenth day after the end of each calendar quarter, the 7.16 county recorder or registrar of titles shall transmit to the 7.17 commissioner of health$17.50$27.50 of the fee for each well 7.18 disclosure certificate received during the quarter. The 7.19 commissioner shall maintain the well disclosure certificate for 7.20 at least six years. The commissioner may store the certificate 7.21 as an electronic image. A copy of that image shall be as valid 7.22 as the original. 7.23 (j) No new well disclosure certificate is required under 7.24 this subdivision if the buyer or seller, or a person authorized 7.25 to act on behalf of the buyer or seller, certifies on the deed 7.26 or other instrument of conveyance that the status and number of 7.27 wells on the property have not changed since the last previously 7.28 filed well disclosure certificate. The following statement, if 7.29 followed by the signature of the person making the statement, is 7.30 sufficient to comply with the certification requirement of this 7.31 paragraph: "I am familiar with the property described in this 7.32 instrument and I certify that the status and number of wells on 7.33 the described real property have not changed since the last 7.34 previously filed well disclosure certificate." The 7.35 certification and signature may be on the front or back of the 7.36 deed or on an attached sheet and an acknowledgment of the 8.1 statement is not required for the deed or other instrument of 8.2 conveyance to be recordable. 8.3 (k) The commissioner in consultation with county recorders 8.4 shall prescribe the form for a well disclosure certificate and 8.5 provide well disclosure certificate forms to county recorders 8.6 and registrars of titles and other interested persons. 8.7 (l) Failure to comply with a requirement of this 8.8 subdivision does not impair: 8.9 (1) the validity of a deed or other instrument of 8.10 conveyance as between the parties to the deed or instrument or 8.11 as to any other person who otherwise would be bound by the deed 8.12 or instrument; or 8.13 (2) the record, as notice, of any deed or other instrument 8.14 of conveyance accepted for filing or recording contrary to the 8.15 provisions of this subdivision. 8.16 Sec. 6. Minnesota Statutes 2000, section 103I.525, 8.17 subdivision 2, is amended to read: 8.18 Subd. 2. [APPLICATION FEE.] The application fee for a well 8.19 contractor's license is$50$75. The commissioner may not act 8.20 on an application until the application fee is paid. 8.21 Sec. 7. Minnesota Statutes 2000, section 103I.525, 8.22 subdivision 6, is amended to read: 8.23 Subd. 6. [LICENSE FEE.] The fee for a well contractor's 8.24 license is $250, except the fee for an individual well 8.25 contractor's license is$50$75. 8.26 Sec. 8. Minnesota Statutes 2000, section 103I.525, 8.27 subdivision 8, is amended to read: 8.28 Subd. 8. [RENEWAL.] (a) A licensee must file an 8.29 application and a renewal application fee to renew the license 8.30 by the date stated in the license. 8.31 (b) The renewal application feeshall be set by the8.32commissioner under section 16A.1285for a well contractor's 8.33 license is $250. 8.34 (c) The renewal application must include information that 8.35 the applicant has met continuing education requirements 8.36 established by the commissioner by rule. 9.1 (d) At the time of the renewal, the commissioner must have 9.2 on file all properly completed well reports, well sealing 9.3 reports, reports of excavations to construct elevator shafts, 9.4 well permits, and well notifications for work conducted by the 9.5 licensee since the last license renewal. 9.6 Sec. 9. Minnesota Statutes 2000, section 103I.525, 9.7 subdivision 9, is amended to read: 9.8 Subd. 9. [INCOMPLETE OR LATE RENEWAL.] If a licensee fails 9.9 to submit all information required for renewal in subdivision 8 9.10 or submits the application and information after the required 9.11 renewal date: 9.12 (1) the licensee must includean additionala late feeset9.13by the commissionerof $75; and 9.14 (2) the licensee may not conduct activities authorized by 9.15 the well contractor's license until the renewal application, 9.16 renewal application fee, late fee, and all other information 9.17 required in subdivision 8 are submitted. 9.18 Sec. 10. Minnesota Statutes 2000, section 103I.531, 9.19 subdivision 2, is amended to read: 9.20 Subd. 2. [APPLICATION FEE.] The application fee for a 9.21 limited well/boring contractor's license is$50$75. The 9.22 commissioner may not act on an application until the application 9.23 fee is paid. 9.24 Sec. 11. Minnesota Statutes 2000, section 103I.531, 9.25 subdivision 6, is amended to read: 9.26 Subd. 6. [LICENSE FEE.] The fee for a limited well/boring 9.27 contractor's license is$50$75. 9.28 Sec. 12. Minnesota Statutes 2000, section 103I.531, 9.29 subdivision 8, is amended to read: 9.30 Subd. 8. [RENEWAL.] (a) A person must file an application 9.31 and a renewal application fee to renew the limited well/boring 9.32 contractor's license by the date stated in the license. 9.33 (b) The renewal application feeshall be set by the9.34commissioner under section 16A.1285for a limited well/boring 9.35 contractor's license is $75. 9.36 (c) The renewal application must include information that 10.1 the applicant has met continuing education requirements 10.2 established by the commissioner by rule. 10.3 (d) At the time of the renewal, the commissioner must have 10.4 on file all properly completed well sealing reports, well 10.5 permits, vertical heat exchanger permits, and well notifications 10.6 for work conducted by the licensee since the last license 10.7 renewal. 10.8 Sec. 13. Minnesota Statutes 2000, section 103I.531, 10.9 subdivision 9, is amended to read: 10.10 Subd. 9. [INCOMPLETE OR LATE RENEWAL.] If a licensee fails 10.11 to submit all information required for renewal in subdivision 8 10.12 or submits the application and information after the required 10.13 renewal date: 10.14 (1) the licensee must includean additionala late feeset10.15by the commissionerof $75; and 10.16 (2) the licensee may not conduct activities authorized by 10.17 the limited well/boring contractor's license until the renewal 10.18 application, renewal application fee, and late fee, and all 10.19 other information required in subdivision 8 are submitted. 10.20 Sec. 14. Minnesota Statutes 2000, section 103I.535, 10.21 subdivision 2, is amended to read: 10.22 Subd. 2. [APPLICATION FEE.] The application fee for an 10.23 elevator shaft contractor's license is$50$75. The 10.24 commissioner may not act on an application until the application 10.25 fee is paid. 10.26 Sec. 15. Minnesota Statutes 2000, section 103I.535, 10.27 subdivision 6, is amended to read: 10.28 Subd. 6. [LICENSE FEE.] The fee for an elevator shaft 10.29 contractor's license is$50$75. 10.30 Sec. 16. Minnesota Statutes 2000, section 103I.535, 10.31 subdivision 8, is amended to read: 10.32 Subd. 8. [RENEWAL.] (a) A person must file an application 10.33 and a renewal application fee to renew the license by the date 10.34 stated in the license. 10.35 (b) The renewal application feeshall be set by the10.36commissioner under section 16A.1285for an elevator shaft 11.1 contractor's license is $75. 11.2 (c) The renewal application must include information that 11.3 the applicant has met continuing education requirements 11.4 established by the commissioner by rule. 11.5 (d) At the time of renewal, the commissioner must have on 11.6 file all reports and permits for elevator shaft work conducted 11.7 by the licensee since the last license renewal. 11.8 Sec. 17. Minnesota Statutes 2000, section 103I.535, 11.9 subdivision 9, is amended to read: 11.10 Subd. 9. [INCOMPLETE OR LATE RENEWAL.] If a licensee fails 11.11 to submit all information required for renewal in subdivision 8 11.12 or submits the application and information after the required 11.13 renewal date: 11.14 (1) the licensee must includean additionala late feeset11.15by the commissionerof $75; and 11.16 (2) the licensee may not conduct activities authorized by 11.17 the elevator shaft contractor's license until the renewal 11.18 application, renewal application fee, and late fee, and all 11.19 other information required in subdivision 8 are submitted. 11.20 Sec. 18. Minnesota Statutes 2000, section 103I.541, 11.21 subdivision 2b, is amended to read: 11.22 Subd. 2b. [APPLICATION FEE.] The application fee for a 11.23 monitoring well contractor registration is$50$75. The 11.24 commissioner may not act on an application until the application 11.25 fee is paid. 11.26 Sec. 19. Minnesota Statutes 2000, section 103I.541, 11.27 subdivision 4, is amended to read: 11.28 Subd. 4. [RENEWAL.] (a) A person must file an application 11.29 and a renewal application fee to renew the registration by the 11.30 date stated in the registration. 11.31 (b) The renewal application feeshall be set by the11.32commissioner under section 16A.1285for a monitoring well 11.33 contractor's registration is $75. 11.34 (c) The renewal application must include information that 11.35 the applicant has met continuing education requirements 11.36 established by the commissioner by rule. 12.1 (d) At the time of the renewal, the commissioner must have 12.2 on file all well reports, well sealing reports, well permits, 12.3 and notifications for work conducted by the registered person 12.4 since the last registration renewal. 12.5 Sec. 20. Minnesota Statutes 2000, section 103I.541, 12.6 subdivision 5, is amended to read: 12.7 Subd. 5. [INCOMPLETE OR LATE RENEWAL.] If a registered 12.8 person submits a renewal application after the required renewal 12.9 date: 12.10 (1) the registered person must includean additionala late 12.11 feeset by the commissionerof $75; and 12.12 (2) the registered person may not conduct activities 12.13 authorized by the monitoring well contractor's registration 12.14 until the renewal application, renewal application fee, late 12.15 fee, and all other information required in subdivision 4 are 12.16 submitted. 12.17 Sec. 21. Minnesota Statutes 2000, section 103I.545, is 12.18 amended to read: 12.19 103I.545 [REGISTRATION OF DRILLING MACHINES REQUIRED.] 12.20 Subdivision 1. [DRILLING MACHINE.] (a) A person may not 12.21 use a drilling machine such as a cable tool, rotary tool, hollow 12.22 rod tool, or auger for a drilling activity requiring a license 12.23 or registration under this chapter unless the drilling machine 12.24 is registered with the commissioner. 12.25 (b) A person must apply for the registration on forms 12.26 prescribed by the commissioner and submit a$50$75 registration 12.27 fee. 12.28 (c) A registration is valid for one year. 12.29 Subd. 2. [PUMP HOIST.] (a) A person may not use a machine 12.30 such as a pump hoist for an activity requiring a license or 12.31 registration under this chapter to repair wells or borings, seal 12.32 wells or borings, or install pumps unless the machine is 12.33 registered with the commissioner. 12.34 (b) A person must apply for the registration on forms 12.35 prescribed by the commissioner and submit a$50$75 registration 12.36 fee. 13.1 (c) A registration is valid for one year. 13.2 [EFFECTIVE DATE.] This section is effective July 1, 2002. 13.3 Sec. 22. Minnesota Statutes 2000, section 121A.15, 13.4 subdivision 6, is amended to read: 13.5 Subd. 6. [SUSPENSION OF IMMUNIZATION REQUIREMENT; 13.6 MODIFICATION TO SCHEDULE.] (a) The commissioner of health, on 13.7 finding that an immunization required pursuant to this section 13.8 is not necessary to protect the public's health, may suspend for 13.9 one year the requirement that children receive that immunization. 13.10 (b) During portions of the year in which the legislature is 13.11 not meeting in regular or special session, the commissioner of 13.12 health may modify the immunization requirements of this section. 13.13 A modification made under this paragraph must be part of the 13.14 current immunization recommendations of each of the following 13.15 organizations: the United States Public Health Service's 13.16 Advisory Committee on Immunization Practices, the American 13.17 Academy of Family Physicians, and the American Academy of 13.18 Pediatrics. The commissioner shall modify the immunization 13.19 requirements through rulemaking using the expedited process in 13.20 section 14.389. A rule adopted under this paragraph shall be in 13.21 effect until the adjournment of the next regular legislative 13.22 session held after the rule is adopted. The commissioner shall 13.23 report to the legislature on any rules adopted under this 13.24 paragraph during the previous calendar year. Such reports are 13.25 due by January 15 of the year following the calendar year in 13.26 which the rule is adopted, except that if a rule is adopted in 13.27 January, a report on that rule is due by February 15 of that 13.28 year. 13.29 Sec. 23. Minnesota Statutes 2000, section 135A.14, is 13.30 amended by adding a subdivision to read: 13.31 Subd. 7. [MODIFICATIONS TO SCHEDULE.] During portions of 13.32 the year in which the legislature is not meeting in regular or 13.33 special session, the commissioner of health may modify the 13.34 immunization requirements of this section. A modification made 13.35 under this subdivision must be part of the current immunization 13.36 recommendations of each of the following organizations: the 14.1 United States Public Health Service's Advisory Committee on 14.2 Immunization Practices, the American Academy of Family 14.3 Physicians, and the American Academy of Pediatrics. The 14.4 commissioner shall modify the immunization requirements through 14.5 rulemaking using the expedited process in section 14.389. A 14.6 rule adopted under this subdivision shall be in effect until the 14.7 adjournment of the next regular legislative session held after 14.8 the rule is adopted. The commissioner shall report to the 14.9 legislature on any rules adopted under this subdivision during 14.10 the previous calendar year. Such reports are due by January 15 14.11 of the year following the calendar year in which the rule is 14.12 adopted, except that if a rule is adopted in January, a report 14.13 on that rule is due by February 15 of that year. 14.14 Sec. 24. Minnesota Statutes 2000, section 144.1202, 14.15 subdivision 4, is amended to read: 14.16 Subd. 4. [AGREEMENT; CONDITIONS OF IMPLEMENTATION.] (a) An 14.17 agreement entered into before August 2,20022003, must remain 14.18 in effect until terminated under the Atomic Energy Act of 1954, 14.19 United States Code, title 42, section 2021, paragraph (j). The 14.20 governor may not enter into an initial agreement with the 14.21 Nuclear Regulatory Commission after August 1,20022003. If an 14.22 agreement is not entered into by August 1,20022003, any rules 14.23 adopted under this section are repealed effective August 1,200214.24 2003. 14.25 (b) An agreement authorized under subdivision 1 must be 14.26 approved by law before it may be implemented. 14.27 Sec. 25. [144.1205] [RADIOACTIVE MATERIAL; SOURCE AND 14.28 SPECIAL NUCLEAR MATERIAL; FEES; INSPECTION.] 14.29 Subdivision 1. [APPLICATION AND LICENSE RENEWAL FEE.] When 14.30 a license is required for radioactive material or source or 14.31 special nuclear material by a rule adopted under section 14.32 144.1202, subdivision 2, an application fee according to 14.33 subdivision 4 must be paid upon initial application for a 14.34 license. The licensee must renew the license 60 days before the 14.35 expiration date of the license by paying a license renewal fee 14.36 equal to the application fee under subdivision 4. The 15.1 expiration date of a license is the date set by the United 15.2 States Nuclear Regulatory Commission before transfer of the 15.3 licensing program under section 144.1202 and thereafter as 15.4 specified by rule of the commissioner of health. 15.5 Subd. 2. [ANNUAL FEE.] A licensee must pay an annual fee 15.6 at least 60 days before the anniversary date of the issuance of 15.7 the license. The annual fee is an amount equal to 80 percent of 15.8 the application fee under subdivision 4, rounded to the nearest 15.9 whole dollar. 15.10 Subd. 3. [FEE CATEGORIES; INCORPORATION OF FEDERAL 15.11 LICENSING CATEGORIES.] (a) Fee categories under this section are 15.12 equivalent to the licensing categories used by the United States 15.13 Nuclear Regulatory Commission under Code of Federal Regulations, 15.14 title 10, parts 30 to 36, 39, 40, 70, 71, and 150, except as 15.15 provided in paragraph (b). 15.16 (b) The category of "Academic, small" is the type of 15.17 license required for the use of radioactive materials in a 15.18 teaching institution. Radioactive materials are limited to ten 15.19 radionuclides not to exceed a total activity amount of one curie. 15.20 Subd. 4. [APPLICATION FEE.] A licensee must pay an 15.21 application fee as follows: 15.22 Radioactive material, Application U.S. Nuclear Regulatory 15.23 source and fee Commission licensing 15.24 special material category as reference 15.26 Type A broadscope $20,000 Medical institution type A 15.27 Type B broadscope $15,000 Research and development 15.28 type B 15.29 Type C broadscope $10,000 Academic type C 15.30 Medical use $4,000 Medical 15.31 Medical institution 15.32 Medical private practice 15.33 Mobile nuclear 15.34 medical laboratory $4,000 Mobile medical laboratory 15.35 Medical special use 15.36 sealed sources $6,000 Teletherapy 16.1 High dose rate remote 16.2 afterloaders 16.3 Stereotactic 16.4 radiosurgery devices 16.5 In vitro testing $2,300 In vitro testing 16.6 laboratories 16.7 Measuring gauge, 16.8 sealed sources $2,000 Fixed gauges 16.9 Portable gauges 16.10 Analytical instruments 16.11 Measuring systems - other 16.12 Gas chromatographs $1,200 Gas chromatographs 16.13 Manufacturing and 16.14 distribution $14,700 Manufacturing and 16.15 distribution - other 16.16 Distribution only $8,800 Distribution of 16.17 radioactive material 16.18 for commercial use only 16.19 Other services $1,500 Other services 16.20 Nuclear medicine 16.21 pharmacy $4,100 Nuclear pharmacy 16.22 Waste disposal $9,400 Waste disposal service 16.23 prepackage 16.24 Waste disposal service 16.25 processing/repackage 16.26 Waste storage only $7,000 To receive and store 16.27 radioactive material waste 16.28 Industrial 16.29 radiography $8,400 Industrial radiography 16.30 fixed location 16.31 Industrial radiography 16.32 portable/temporary sites 16.33 Irradiator - 16.34 self-shielded $4,100 Irradiators self-shielded 16.35 less than 10,000 curies 16.36 Irradiator - 17.1 less than 10,000 Ci $7,500 Irradiators less than 17.2 10,000 curies 17.3 Irradiator - 17.4 more than 10,000 Ci $11,500 Irradiators greater than 17.5 10,000 curies 17.6 Research and 17.7 development, 17.8 no distribution $4,100 Research and development 17.9 Radioactive material 17.10 possession only $1,000 By-product possession only 17.11 Source material $1,000 Source material shielding 17.12 Special nuclear 17.13 material, less than 17.14 200 grams $1,000 Special nuclear material 17.15 plutonium-neutron sources 17.16 less than 200 grams 17.17 Pacemaker 17.18 manufacturing $1,000 Pacemaker by-product 17.19 and/or special nuclear 17.20 material - medical 17.21 institution 17.22 General license 17.23 distribution $2,100 General license 17.24 distribution 17.25 General license 17.26 distribution, exempt $1,500 General license 17.27 distribution - 17.28 certain exempt items 17.29 Academic, small $1,000 Possession limit of ten 17.30 radionuclides, not to 17.31 exceed a total of one curie 17.32 of activity 17.33 Veterinary $2,000 Veterinary use 17.34 Well logging $5,000 Well logging 17.35 Subd. 5. [PENALTY FOR LATE PAYMENT.] An annual fee or a 17.36 license renewal fee submitted to the commissioner after the due 18.1 date specified by rule must be accompanied by an additional 18.2 amount equal to 25 percent of the fee due. 18.3 Subd. 6. [INSPECTIONS.] The commissioner of health shall 18.4 make periodic safety inspections of the radioactive material and 18.5 source and special nuclear material of a licensee. The 18.6 commissioner shall prescribe the frequency of safety inspections 18.7 by rule. 18.8 Subd. 7. [RECOVERY OF REINSPECTION COST.] If the 18.9 commissioner finds serious violations of public health standards 18.10 during an inspection under subdivision 6, the licensee must pay 18.11 all costs associated with subsequent reinspection of the 18.12 source. The costs shall be the actual costs incurred by the 18.13 commissioner and include, but are not limited to, labor, 18.14 transportation, per diem, materials, legal fees, testing, and 18.15 monitoring costs. 18.16 Subd. 8. [RECIPROCITY FEE.] A licensee submitting an 18.17 application for reciprocal recognition of a materials license 18.18 issued by another agreement state or the United States Nuclear 18.19 Regulatory Commission for a period of 180 days or less during a 18.20 calendar year must pay one-half of the application fee specified 18.21 under subdivision 4. For a period of 181 days or more, the 18.22 licensee must pay the entire application fee under subdivision 4. 18.23 Subd. 9. [FEES FOR LICENSE AMENDMENTS.] A licensee must 18.24 pay a fee to amend a license as follows: 18.25 (1) to amend a license requiring no license review 18.26 including, but not limited to, facility name change or removal 18.27 of a previously authorized user, no fee; 18.28 (2) to amend a license requiring review including, but not 18.29 limited to, addition of isotopes, procedure changes, new 18.30 authorized users, or a new radiation safety officer, $200; and 18.31 (3) to amend a license requiring review and a site visit 18.32 including, but not limited to, facility move or addition of 18.33 processes, $400. 18.34 [EFFECTIVE DATE.] This section is effective July 1, 2002. 18.35 Sec. 26. Minnesota Statutes 2000, section 144.122, is 18.36 amended to read: 19.1 144.122 [LICENSE, PERMIT, AND SURVEY FEES.] 19.2 (a) The state commissioner of health, by rule, may 19.3 prescribe reasonable procedures and fees for filing with the 19.4 commissioner as prescribed by statute and for the issuance of 19.5 original and renewal permits, licenses, registrations, and 19.6 certifications issued under authority of the commissioner. The 19.7 expiration dates of the various licenses, permits, 19.8 registrations, and certifications as prescribed by the rules 19.9 shall be plainly marked thereon. Fees may include application 19.10 and examination fees and a penalty fee for renewal applications 19.11 submitted after the expiration date of the previously issued 19.12 permit, license, registration, and certification. The 19.13 commissioner may also prescribe, by rule, reduced fees for 19.14 permits, licenses, registrations, and certifications when the 19.15 application therefor is submitted during the last three months 19.16 of the permit, license, registration, or certification period. 19.17 Fees proposed to be prescribed in the rules shall be first 19.18 approved by the department of finance. All fees proposed to be 19.19 prescribed in rules shall be reasonable. The fees shall be in 19.20 an amount so that the total fees collected by the commissioner 19.21 will, where practical, approximate the cost to the commissioner 19.22 in administering the program. All fees collected shall be 19.23 deposited in the state treasury and credited to the state 19.24 government special revenue fund unless otherwise specifically 19.25 appropriated by law for specific purposes. 19.26 (b) The commissioner may charge a fee for voluntary 19.27 certification of medical laboratories and environmental 19.28 laboratories, and for environmental and medical laboratory 19.29 services provided by the department, without complying with 19.30 paragraph (a) or chapter 14. Fees charged for environment and 19.31 medical laboratory services provided by the department must be 19.32 approximately equal to the costs of providing the services. 19.33 (c) The commissioner may develop a schedule of fees for 19.34 diagnostic evaluations conducted at clinics held by the services 19.35 for children with handicaps program. All receipts generated by 19.36 the program are annually appropriated to the commissioner for 20.1 use in the maternal and child health program. 20.2 (d) The commissioner, for fiscal years 1996 and beyond,20.3 shall set license fees for hospitals and nursing homes that are 20.4 not boarding care homes at the following levels: 20.5 Joint Commission on Accreditation of Healthcare 20.6 Organizations (JCAHO hospitals)$1,01720.7 $7,055 20.8 Non-JCAHO hospitals$762 plus $34 per bed20.9 $4,680 plus $234 per bed 20.10 Nursing home$78 plus $19 per bed20.11 $183 plus $91 per bed 20.12For fiscal years 1996 and beyond,The commissioner shall 20.13 set license fees for outpatient surgical centers, boarding care 20.14 homes, and supervised living facilities at the following levels: 20.15 Outpatient surgical centers$51720.16 $1,512 20.17 Boarding care homes$78 plus $19 per bed20.18 $183 plus $91 per bed 20.19 Supervised living facilities$78 plus $19 per bed20.20 $183 plus $91 per bed. 20.21 (e) Unless prohibited by federal law, the commissioner of 20.22 health shall charge applicants the following fees to cover the 20.23 cost of any initial certification surveys required to determine 20.24 a provider's eligibility to participate in the Medicare or 20.25 Medicaid program: 20.26 Prospective payment surveys for $ 900 20.27 hospitals 20.29 Swing bed surveys for nursing homes $1,200 20.31 Psychiatric hospitals $1,400 20.33 Rural health facilities $1,100 20.35 Portable X-ray providers $ 500 20.37 Home health agencies $1,800 20.39 Outpatient therapy agencies $ 800 20.41 End stage renal dialysis providers $2,100 20.43 Independent therapists $ 800 20.45 Comprehensive rehabilitation $1,200 20.46 outpatient facilities 21.2 Hospice providers $1,700 21.4 Ambulatory surgical providers $1,800 21.6 Hospitals $4,200 21.8 Other provider categories or Actual surveyor costs: 21.9 additional resurveys required average surveyor cost x 21.10 to complete initial certification number of hours for the 21.11 survey process. 21.12 These fees shall be submitted at the time of the 21.13 application for federal certification and shall not be 21.14 refunded. All fees collected after the date that the imposition 21.15 of fees is not prohibited by federal law shall be deposited in 21.16 the state treasury and credited to the state government special 21.17 revenue fund. 21.18 Sec. 27. Minnesota Statutes 2000, section 144.148, 21.19 subdivision 2, is amended to read: 21.20 Subd. 2. [PROGRAM.] (a) The commissioner of health shall 21.21 award rural hospital capital improvement grants to eligible 21.22 rural hospitals. Except as provided in paragraph (b), A grant 21.23 shall not exceed $300,000 per hospital. Prior to the receipt of 21.24 any grant, the hospital must certify to the commissioner that at 21.25 least one-quarter of the grant amount, which may include in-kind 21.26 services, is available for the same purposes from nonstate 21.27 resources. 21.28 (b) A grant shall not exceed $1,500,000 per eligible rural 21.29 hospital that also satisfies the following criteria: 21.30 (1) is the only hospital in a county; 21.31 (2) has 25 or fewer licensed hospital beds with a net 21.32 hospital operating margin not greater than an average of two 21.33 percent over the three fiscal years prior to application; 21.34 (3) is located in a medically underserved community (MUC) 21.35 or a health professional shortage area (HPSA); 21.36 (4) is located near a migrant worker employment site and 21.37 regularly treats significant numbers of migrant workers and 21.38 their families; and 21.39 (5) has not previously received a grant under this section 21.40 prior to July 1, 1999. 21.41 Sec. 28. Minnesota Statutes 2000, section 144.226, 22.1 subdivision 4, is amended to read: 22.2 Subd. 4. [VITAL RECORDS SURCHARGE.] In addition to any fee 22.3 prescribed under subdivision 1, there is a nonrefundable 22.4 surcharge of$3$2 for each certified and noncertified birth or 22.5 death record, and for a certification that the record cannot be 22.6 found. The local or state registrar shall forward this amount 22.7 to the state treasurer to be deposited into the state government 22.8 special revenue fund. This surcharge shall not be charged under 22.9 those circumstances in which no fee for a birth or death record 22.10 is permitted under subdivision 1, paragraph (a).This surcharge22.11requirement expires June 30, 2002.22.12 Sec. 29. [144.585] [HOSPITAL CHARITY CARE AID.] 22.13 Subdivision 1. [PURPOSE.] The purpose of charity care aid 22.14 is to help offset excess charity care burdens at Minnesota acute 22.15 care, short-term hospitals. 22.16 Subd. 2. [DEFINITIONS.] (a) For purposes of this section, 22.17 the terms in this subdivision have the meanings given to them. 22.18 (b) "Charity care" is the dollar amount of charity care 22.19 adjustments as determined under subdivision 3. 22.20 (c) "Cost-to-charge ratio" means a hospital's total 22.21 operating expenses over the sum of gross patient revenue and 22.22 other operating revenue, as reported to the commissioner of 22.23 health under rules adopted under sections 144.695 to 144.703. 22.24 The commissioner shall use the most recently available data to 22.25 calculate the cost-to-charge ratio. 22.26 Subd. 3. [CHARITY CARE REPORTING.] (a) For a hospital to 22.27 report amounts as charity care adjustments, the hospital: 22.28 (1) must generate and record a charge; 22.29 (2) have a policy on the provision of charity care and must 22.30 communicate the policy to the public; 22.31 (3) have made a reasonable effort to identify a third party 22.32 payer, encourage the patient to enroll in public programs, and 22.33 should, to the extent possible, aid the patient in the 22.34 enrollment process; and 22.35 (4) ensure that the patient meets the charity care criteria 22.36 of this subdivision, which must be consistent with statewide 23.1 income standards set out in paragraph (c). 23.2 (b) In determining whether to classify care as charity 23.3 care, the hospital must consider the following: 23.4 (1) charity care may include services which the provider is 23.5 obligated to render independently of the ability to collect; 23.6 (2) charity care may include care provided to low-income 23.7 patients who meet the charity care income standards under 23.8 paragraph (c) and have partial coverage, but are unable to pay 23.9 the remainder of their medical bills. This does not apply to 23.10 that portion of the bill which has been determined to be the 23.11 patient's responsibility after a partial charity care 23.12 classification; 23.13 (3) charity care may include care provided to low-income 23.14 patients who may qualify for a public health insurance program 23.15 and meet the statewide eligibility criteria for charity care, 23.16 but who do not complete the application process for public 23.17 insurance despite the facility's best efforts; 23.18 (4) charity care may include care to individuals whose 23.19 eligibility for charity care was determined through third party 23.20 services employed by the hospital for information gathering 23.21 purposes only; 23.22 (5) charity care may not include contractual allowances, 23.23 which is the difference between gross charges and payments 23.24 received under contractual arrangements with insurance companies 23.25 and payers; 23.26 (6) charity care may not include bad debt; 23.27 (7) charity care may not include what may be perceived as 23.28 underpayments for operating public programs; 23.29 (8) charity care may not include cases which are paid 23.30 through a charitable contribution through a third party or 23.31 facility-related foundation; 23.32 (9) charity care may not include unreimbursed costs of 23.33 basic or clinical research and of professional education and 23.34 training; 23.35 (10) charity care may not include professional courtesy 23.36 discounts; 24.1 (11) charity care may not include community service or 24.2 outreach activities; and 24.3 (12) charity care may not include services for patients 24.4 against whom collection actions where taken which result in a 24.5 credit report. 24.6 (c) The hospital must use the income standards in this 24.7 paragraph for determining charity care eligibility for reporting 24.8 purposes. The hospital does not need to make a patient asset 24.9 determination in order to apply charity care income standards. 24.10 (1) Care to a patient with a family income at or below 150 24.11 percent of the Federal Poverty Guideline (FPG) may be reported 24.12 as full charity care or free care. 24.13 (2) The hospital's share of discounted charges for care to 24.14 a patient with family income below 275 percent of the FPG 24.15 qualifies for classification as charity care. The following 24.16 sliding fee schedules apply: 24.17 income as charges paid corresponding 24.18 % of FPG by patient charity care 24.19 151-200% 20% 80% 24.20 201-225% 40% 60% 24.21 226-250% 60% 40% 24.22 251-275% 80% 20% 24.23 (3) Care to a patient is considered medical hardship when 24.24 qualified medical expenses, as defined for the purposes of 24.25 federal income tax deductibility, exceeds 30 percent of family 24.26 income. Qualified medical expenses may be counted as charity 24.27 care in the amount that exceeds 30 percent of family income. 24.28 This clause applies even if the patient's family income exceeds 24.29 the charity care income standards in clauses (1) and (2). 24.30 Subd. 4. [APPLICATION.] To be eligible for funds under 24.31 this section, hospitals must submit an application to the 24.32 commissioner of health by the deadline established by the 24.33 commissioner. Applications must meet the criteria as 24.34 established by the commissioner, but must contain: 24.35 (1) the dollar amount of charity care in the previous year, 24.36 as defined in subdivision 3, paragraphs (b) and (c); 25.1 (2) a list with the most common diagnoses for which charity 25.2 care is provided; and 25.3 (3) descriptive aggregate statistics of the characteristics 25.4 of patients who receive charity care. 25.5 Subd. 5. [ALLOCATION OF FUNDS.] A hospital's share of the 25.6 available charity care aid is equal to that hospital's share of 25.7 charity care relative to the total charity care provided by 25.8 applicants. 25.9 Sec. 30. Minnesota Statutes 2000, section 144.98, 25.10 subdivision 3, is amended to read: 25.11 Subd. 3. [FEES.] (a) An application for certification 25.12 under subdivision 1 must be accompanied by the biennial fee 25.13 specified in this subdivision. The fees are for: 25.14 (1) nonrefundable base certification fee,$500$1,200; and 25.15 (2) test category certification fees: 25.16 Test Category Certification Fee 25.17 Clean water program bacteriology$200$600 25.18 Safe drinking water program bacteriology $600 25.19 Clean water program inorganic chemistry,25.20fewer than four constituents$100$600 25.21 Safe drinking water program inorganic chemistry,25.22four or more constituents$300$600 25.23 Clean water program chemistry metals,25.24fewer than four constituents$200$800 25.25 Safe drinking water program chemistry metals,25.26four or more constituents$500$800 25.27 Resource conservation and recovery program 25.28 chemistry metals $800 25.29 Clean water program volatile organic compounds$600$1,200 25.30 Safe drinking water program 25.31 volatile organic compounds $1,200 25.32 Resource conservation and recovery program 25.33 volatile organic compounds $1,200 25.34 Underground storage tank program 25.35 volatile organic compounds $1,200 25.36 Clean water program other organic compounds$600$1,200 26.1 Safe drinking water program other organic compounds $1,200 26.2 Resource conservation and recovery program 26.3 other organic compounds $1,200 26.4 (b) The total biennial certification fee is the base fee 26.5 plus the applicable test category fees.The biennial26.6certification fee for a contract laboratory is 1.5 times the26.7total certification fee.26.8 (c) Laboratories located outside of this state that require 26.9 an on-site survey will be assessed an additional$1,200$2,500 26.10 fee. 26.11 (d) Fees must be set so that the total fees support the 26.12 laboratory certification program. Direct costs of the 26.13 certification service include program administration, 26.14 inspections, the agency's general support costs, and attorney 26.15 general costs attributable to the fee function. 26.16 (e) A change fee shall be assessed if a laboratory requests 26.17 additional analytes or methods at any time other than when 26.18 applying for or renewing its certification. The change fee is 26.19 equal to the test category certification fee for the analyte. 26.20 (f) A variance fee shall be assessed if a laboratory 26.21 requests and is granted a variance from a rule adopted under 26.22 this section. The variance fee is $500 per variance. 26.23 (g) Refunds or credits shall not be made for analytes or 26.24 methods requested but not approved. 26.25 (h) Certification of a laboratory shall not be awarded 26.26 until all fees are paid. 26.27 Sec. 31. Minnesota Statutes 2000, section 144A.44, 26.28 subdivision 1, is amended to read: 26.29 Subdivision 1. [STATEMENT OF RIGHTS.] A person who 26.30 receives home care services has these rights: 26.31 (1) the right to receive written information about rights 26.32 in advance of receiving care or during the initial evaluation 26.33 visit before the initiation of treatment, including what to do 26.34 if rights are violated; 26.35 (2) the right to receive care and services according to a 26.36 suitable and up-to-date plan, and subject to accepted medical or 27.1 nursing standards, to take an active part in creating and 27.2 changing the plan and evaluating care and services; 27.3 (3) the right to be told in advance of receiving care about 27.4 the services that will be provided, the disciplines that will 27.5 furnish care, the frequency of visits proposed to be furnished, 27.6 other choices that are available, and the consequences of these 27.7 choices including the consequences of refusing these services; 27.8 (4) the right to be told in advance of any change in the 27.9 plan of care and to take an active part in any change; 27.10 (5) the right to refuse services or treatment; 27.11 (6) the right to know, in advance, any limits to the 27.12 services available from a provider, and the provider's grounds 27.13 for a termination of services; 27.14 (7) the right to know in advance of receiving care whether 27.15 the services are covered by health insurance, medical 27.16 assistance, or other health programs, the charges for services 27.17 that will not be covered by Medicare, and the charges that the 27.18 individual may have to pay; 27.19 (8) the right to know what the charges are for services, no 27.20 matter who will be paying the bill; 27.21 (9) the right to know that there may be other services 27.22 available in the community, including other home care services 27.23 and providers, and to know where to go for information about 27.24 these services; 27.25 (10) the right to choose freely among available providers 27.26 and to change providers after services have begun, within the 27.27 limits of health insurance, medical assistance, or other health 27.28 programs; 27.29 (11) the right to have personal, financial, and medical 27.30 information kept private, and to be advised of the provider's 27.31 policies and procedures regarding disclosure of such 27.32 information; 27.33 (12) the right to be allowed access to records and written 27.34 information from records in accordance with section 144.335; 27.35 (13) the right to be served by people who are properly 27.36 trained and competent to perform their duties; 28.1 (14) the right to be treated with courtesy and respect, and 28.2 to have the patient's property treated with respect; 28.3 (15) the right to be free from physical and verbal abuse; 28.4 (16) the right to reasonable, advance notice of changes in 28.5 services or charges, including at least ten days' advance notice 28.6 of the termination of a service by a provider, except in cases 28.7 where: 28.8 (i) the recipient of services engages in conduct that 28.9 alters the conditions of employment as specified in the 28.10 employment contract between the home care provider and the 28.11 individual providing home care services, or creates an abusive 28.12 or unsafe work environment for the individual providing home 28.13 care services; or 28.14 (ii) an emergency for the informal caregiver or a 28.15 significant change in the recipient's condition has resulted in 28.16 service needs that exceed the current service provider agreement 28.17 and that cannot be safely met by the home care provider; 28.18 (17) the right to a coordinated transfer when there will be 28.19 a change in the provider of services; 28.20 (18) the right to voice grievances regarding treatment or 28.21 care that is, or fails to be, furnished, or regarding the lack 28.22 of courtesy or respect to the patient or the patient's property; 28.23 (19) the right to know how to contact an individual 28.24 associated with the provider who is responsible for handling 28.25 problems and to have the provider investigate and attempt to 28.26 resolve the grievance or complaint; 28.27 (20) the right to know the name and address of the state or 28.28 county agency to contact for additional information or 28.29 assistance; and 28.30 (21) the right to assert these rights personally, or have 28.31 them asserted by the patient's family or guardian when the 28.32 patient has been judged incompetent, without retaliation. 28.33 Sec. 32. [145.4241] [DEFINITIONS.] 28.34 Subdivision 1. [APPLICABILITY.] As used in sections 28.35 145.4241 to 145.4246, the following terms have the meaning given 28.36 them. 29.1 Subd. 2. [ABORTION.] "Abortion" means the use or 29.2 prescription of any instrument, medicine, drug, or any other 29.3 substance or device to intentionally terminate the pregnancy of 29.4 a female known to be pregnant, with an intention other than to 29.5 increase the probability of a live birth, to preserve the life 29.6 or health of the child after live birth, or to remove a dead 29.7 fetus. 29.8 Subd. 3. [ATTEMPT TO PERFORM AN ABORTION.] "Attempt to 29.9 perform an abortion" means an act, or an omission of a 29.10 statutorily required act, that, under the circumstances as the 29.11 actor believes them to be, constitutes a substantial step in a 29.12 course of conduct planned to culminate in the performance of an 29.13 abortion in Minnesota in violation of sections 145.4241 to 29.14 145.4246. 29.15 Subd. 4. [MEDICAL EMERGENCY.] "Medical emergency" means 29.16 any condition that, on the basis of the physician's good faith 29.17 clinical judgment, complicates the medical condition of a 29.18 pregnant female to the extent that: 29.19 (1) an immediate abortion of her pregnancy is necessary to 29.20 avert her death; or 29.21 (2) a 24-hour delay in performing an abortion creates a 29.22 serious risk of substantial and irreversible impairment of a 29.23 major bodily function. 29.24 Subd. 5. [PHYSICIAN.] "Physician" means a person licensed 29.25 under chapter 147. 29.26 Subd. 6. [PROBABLE GESTATIONAL AGE OF THE UNBORN 29.27 CHILD.] "Probable gestational age of the unborn child" means 29.28 what will, in the judgment of the physician, with reasonable 29.29 probability, be the gestational age of the unborn child at the 29.30 time the abortion is planned to be performed. 29.31 Sec. 33. [145.4242] [INFORMED CONSENT.] 29.32 No abortion shall be performed in this state except with 29.33 the voluntary and informed consent of the female upon whom the 29.34 abortion is to be performed. Except in the case of a medical 29.35 emergency, consent to an abortion is voluntary and informed only 29.36 if: 30.1 (1) the female is told the following, by telephone or in 30.2 person, by the physician who is to perform the abortion or by a 30.3 referring physician, at least 24 hours before the abortion: 30.4 (i) the name of the physician who will perform the 30.5 abortion; 30.6 (ii) the particular medical risks associated with the 30.7 particular abortion procedure to be employed including, when 30.8 medically accurate, the risks of infection, hemorrhage, breast 30.9 cancer, danger to subsequent pregnancies, and infertility; 30.10 (iii) the probable gestational age of the unborn child at 30.11 the time the abortion is to be performed; and 30.12 (iv) the medical risks associated with carrying her child 30.13 to term. 30.14 The information required by this clause may be provided by 30.15 telephone without conducting a physical examination or tests of 30.16 the patient, in which case the information required to be 30.17 provided may be based on facts supplied the physician by the 30.18 female and whatever other relevant information is reasonably 30.19 available to the physician. It may not be provided by a tape 30.20 recording, but must be provided during a consultation in which 30.21 the physician is able to ask questions of the female and the 30.22 female is able to ask questions of the physician. If a physical 30.23 examination, tests, or the availability of other information to 30.24 the physician subsequently indicate, in the medical judgment of 30.25 the physician, a revision of the information previously supplied 30.26 to the patient, that revised information may be communicated to 30.27 the patient at any time prior to the performance of the 30.28 abortion. Nothing in this section may be construed to preclude 30.29 provision of required information in a language understood by 30.30 the patient through a translator; 30.31 (2) the female is informed, by telephone or in person, by 30.32 the physician who is to perform the abortion, by a referring 30.33 physician, or by an agent of either physician at least 24 hours 30.34 before the abortion: 30.35 (i) that medical assistance benefits may be available for 30.36 prenatal care, childbirth, and neonatal care; 31.1 (ii) that the father is liable to assist in the support of 31.2 her child, even in instances when the father has offered to pay 31.3 for the abortion; and 31.4 (iii) that she has the right to review the printed 31.5 materials described in section 145.4243. The physician or the 31.6 physician's agent shall orally inform the female that the 31.7 materials have been provided by the state of Minnesota and that 31.8 they describe the unborn child and list agencies that offer 31.9 alternatives to abortion. If the female chooses to view the 31.10 materials, they shall either be given to her at least 24 hours 31.11 before the abortion or mailed to her at least 72 hours before 31.12 the abortion by certified mail, restricted delivery to 31.13 addressee, which means the postal employee can only deliver the 31.14 mail to the addressee. 31.15 The information required by this clause may be provided by 31.16 a tape recording if provision is made to record or otherwise 31.17 register specifically whether the female does or does not choose 31.18 to review the printed materials; 31.19 (3) the female certifies in writing, prior to the abortion, 31.20 that the information described in this section has been 31.21 furnished her, and that she has been informed of her opportunity 31.22 to review the information referred to in clause (2); and 31.23 (4) prior to the performance of the abortion, the physician 31.24 who is to perform the abortion or the physician's agent receives 31.25 a copy of the written certification prescribed by clause (3). 31.26 Sec. 34. [145.4243] [PRINTED INFORMATION.] 31.27 (a) Within 90 days after the effective date of sections 31.28 145.4241 to 145.4246, the department of health shall cause to be 31.29 published, in English and in each language that is the primary 31.30 language of two percent or more of the state's population, the 31.31 following printed materials in such a way as to ensure that the 31.32 information is easily comprehensible: 31.33 (1) geographically indexed materials designed to inform the 31.34 female of public and private agencies and services available to 31.35 assist a female through pregnancy, upon childbirth, and while 31.36 the child is dependent, including adoption agencies, which shall 32.1 include a comprehensive list of the agencies available, a 32.2 description of the services they offer, and a description of the 32.3 manner, including telephone numbers, in which they might be 32.4 contacted or, at the option of the department of health, printed 32.5 materials including a toll-free, 24-hours-a-day telephone number 32.6 that may be called to obtain, orally, such a list and 32.7 description of agencies in the locality of the caller and of the 32.8 services they offer; and 32.9 (2) materials designed to inform the female of the probable 32.10 anatomical and physiological characteristics of the unborn child 32.11 at two-week gestational increments from the time when a female 32.12 can be known to be pregnant to full term, including any relevant 32.13 information on the possibility of the unborn child's survival 32.14 and pictures or drawings representing the development of unborn 32.15 children at two-week gestational increments, provided that any 32.16 such pictures or drawings must contain the dimensions of the 32.17 fetus and must be realistic and appropriate for the stage of 32.18 pregnancy depicted. The materials shall be objective, 32.19 nonjudgmental, and designed to convey only accurate scientific 32.20 information about the unborn child at the various gestational 32.21 ages. The material shall also contain objective information 32.22 describing the methods of abortion procedures commonly employed, 32.23 the medical risks commonly associated with each procedure, the 32.24 possible detrimental psychological effects of abortion, the 32.25 medical risks commonly associated with each procedure, and the 32.26 medical risks commonly associated with carrying a child to term. 32.27 (b) The materials referred to in this section must be 32.28 printed in a typeface large enough to be clearly legible. The 32.29 materials required under this section must be available at no 32.30 cost from the department of health upon request and in 32.31 appropriate number to any person, facility, or hospital. 32.32 Sec. 35. [145.4244] [PROCEDURE IN CASE OF MEDICAL 32.33 EMERGENCY.] 32.34 When a medical emergency compels the performance of an 32.35 abortion, the physician shall inform the female, prior to the 32.36 abortion if possible, of the medical indications supporting the 33.1 physician's judgment that an abortion is necessary to avert her 33.2 death or that a 24-hour delay in conformance with section 33.3 145.4242 creates a serious risk of substantial and irreversible 33.4 impairment of a major bodily function. 33.5 Sec. 36. [145.4245] [REMEDIES.] 33.6 Subdivision 1. [CIVIL REMEDIES.] Any person upon whom an 33.7 abortion has been performed or the parent of a minor upon whom 33.8 an abortion has been performed may maintain an action against 33.9 the person who performed the abortion in knowing or reckless 33.10 violation of sections 145.4241 to 145.4246 for actual and 33.11 punitive damages. Any person upon whom an abortion has been 33.12 attempted without complying with sections 145.4241 to 145.4246 33.13 may maintain an action against the person who attempted to 33.14 perform the abortion in knowing or reckless violation of 33.15 sections 145.4241 to 145.4246 for actual and punitive damages. 33.16 Subd. 2. [ATTORNEY FEES.] If judgment is rendered in favor 33.17 of the plaintiff in any action described in this section, the 33.18 court shall also render judgment for a reasonable attorney's fee 33.19 in favor of the plaintiff against the defendant. If judgment is 33.20 rendered in favor of the defendant and the court finds that the 33.21 plaintiff's suit was frivolous and brought in bad faith, the 33.22 court shall also render judgment for a reasonable attorney's fee 33.23 in favor of the defendant against the plaintiff. 33.24 Subd. 3. [PROTECTION OF PRIVACY IN COURT PROCEEDINGS.] In 33.25 every civil action brought under sections 145.4241 to 145.4246, 33.26 the court shall rule whether the anonymity of any female upon 33.27 whom an abortion has been performed or attempted shall be 33.28 preserved from public disclosure if she does not give her 33.29 consent to such disclosure. The court, upon motion or sua 33.30 sponte, shall make such a ruling and, upon determining that her 33.31 anonymity should be preserved, shall issue orders to the 33.32 parties, witnesses, and counsel and shall direct the sealing of 33.33 the record and exclusion of individuals from courtrooms or 33.34 hearing rooms to the extent necessary to safeguard her identity 33.35 from public disclosure. Each order must be accompanied by 33.36 specific written findings explaining why the anonymity of the 34.1 female should be preserved from public disclosure, why the order 34.2 is essential to that end, how the order is narrowly tailored to 34.3 serve that interest, and why no reasonable, less restrictive 34.4 alternative exists. In the absence of written consent of the 34.5 female upon whom an abortion has been performed or attempted, 34.6 anyone, other than a public official, who brings an action under 34.7 subdivision 1, shall do so under a pseudonym. This section may 34.8 not be construed to conceal the identity of the plaintiff or of 34.9 witnesses from the defendant. 34.10 Sec. 37. [145.4246] [SEVERABILITY.] 34.11 If any one or more provision, section, subsection, 34.12 sentence, clause, phrase, or word of sections 145.4241 to 34.13 145.4246 or the application thereof to any person or 34.14 circumstance is found to be unconstitutional, the same is hereby 34.15 declared to be severable and the balance of sections 145.4241 to 34.16 145.4246 shall remain effective notwithstanding such 34.17 unconstitutionality. The legislature hereby declares that it 34.18 would have passed sections 145.4241 to 145.4246, and each 34.19 provision, section, subsection, sentence, clause, phrase, or 34.20 word thereof, irrespective of the fact that any one or more 34.21 provision, section, subsection, sentence, clause, phrase, or 34.22 word be declared unconstitutional. 34.23 Sec. 38. Minnesota Statutes 2000, section 145.881, 34.24 subdivision 2, is amended to read: 34.25 Subd. 2. [DUTIES.] The advisory task force shall meet on a 34.26 regular basis to perform the following duties: 34.27 (a) review and report on the health care needs of mothers 34.28 and children throughout the state of Minnesota; 34.29 (b) review and report on the type, frequency and impact of 34.30 maternal and child health care services provided to mothers and 34.31 children under existing maternal and child health care programs, 34.32 including programs administered by the commissioner of health; 34.33 (c) establish, review, and report to the commissioner a 34.34 list of program guidelines and criteria which the advisory task 34.35 force considers essential to providing an effective maternal and 34.36 child health care program to low income populations and high 35.1 risk persons and fulfilling the purposes defined in section 35.2 145.88; 35.3 (d) review staff recommendations of the department of 35.4 health regarding maternal and child health grant awards before 35.5 the awards are made; 35.6 (e) make recommendations to the commissioner for the use of 35.7 other federal and state funds available to meet maternal and 35.8 child health needs; 35.9 (f) make recommendations to the commissioner of health on 35.10 priorities for funding the following maternal and child health 35.11 services: (1) prenatal, delivery and postpartum care, (2) 35.12 comprehensive health care for children, especially from birth 35.13 through five years of age, (3) adolescent health services, (4) 35.14 family planning services, (5) preventive dental care, (6) 35.15 special services for chronically ill and handicapped children 35.16 and (7) any other services which promote the health of mothers 35.17 and children;and35.18 (g) make recommendations to the commissioner of health on 35.19 the process to distribute, award and administer the maternal and 35.20 child health block grant funds; and 35.21 (h) review the measures that are used to define the 35.22 variables of the funding distribution formula in section 35.23 145.882, subdivision 4a, every two years and make 35.24 recommendations to the commissioner of health for changes based 35.25 upon principles established by the advisory task force for this 35.26 purpose. 35.27 Sec. 39. Minnesota Statutes 2000, section 145.882, is 35.28 amended by adding a subdivision to read: 35.29 Subd. 4a. [ALLOCATION TO COMMUNITY HEALTH BOARDS.] (a) 35.30 Federal maternal and child health block grant money remaining 35.31 after distributions made under subdivision 2 and money 35.32 appropriated for allocation to community health boards must be 35.33 allocated according to paragraphs (b) to (d) to community health 35.34 boards as defined in section 145A.02, subdivision 5. 35.35 (b) All community health boards must receive 95 percent of 35.36 the funding awarded to them for the 1998-1999 funding cycle. If 36.1 the amount of state and federal funding available is less than 36.2 95 percent of the amount awarded to community health boards for 36.3 the 1998-1999 funding cycle, the available funding must be 36.4 apportioned to reflect a proportional decrease for each 36.5 recipient. 36.6 (c) The federal and state funding remaining after 36.7 distributions made under paragraph (b) must be allocated to each 36.8 community health board based on the following three variables: 36.9 (1) 25 percent based on the maternal and child population 36.10 in the area served by the community health board; 36.11 (2) 50 percent based on the following factors, as 36.12 determined by averaging the data available for the three most 36.13 recent years: 36.14 (i) the proportion of infants in the area served by the 36.15 community health board whose weight at birth was less than 2,500 36.16 grams; 36.17 (ii) the proportion of mothers in the area served by the 36.18 community health board who received inadequate or no prenatal 36.19 care; 36.20 (iii) the proportion of births in the area served by the 36.21 community health board to women under age 19; and 36.22 (iv) the proportion of births in the area served by the 36.23 community health board to American Indian women and women of 36.24 color; and 36.25 (3) 25 percent based on the income of the maternal and 36.26 child population in the area served by the community health 36.27 board. 36.28 (d) Each variable must be expressed as a city or county 36.29 score consisting of the city or county frequency of each 36.30 variable in relation to the statewide frequency of the 36.31 variable. A total score for each city or county jurisdiction 36.32 must be computed by totaling the scores of the three variables. 36.33 Each community health board must be allocated an amount equal to 36.34 the total score obtained for the city, county, or counties in 36.35 its area multiplied by the amount of money available. 36.36 Sec. 40. Minnesota Statutes 2000, section 145.882, 37.1 subdivision 7, is amended to read: 37.2 Subd. 7. [USE OF BLOCK GRANT MONEY.](a)Maternal and 37.3 child health block grant money allocated to a community health 37.4 board or community health services area under this section must 37.5 be used for qualified programs for high risk and low-income 37.6 individuals. Block grant money must be used for programs that: 37.7 (1) specifically address the highest risk populations, 37.8 particularly low-income and minority groups with a high rate of 37.9 infant mortality and children with low birth weight, by 37.10 providing services,includingexcluding prepregnancy family 37.11 planning services, calculated to produce measurable decreases in 37.12 infant mortality rates, instances of children with low birth 37.13 weight, and medical complications associated with pregnancy and 37.14 childbirth, including infant mortality, low birth rates, and 37.15 medical complications arising from chemical abuse by a mother 37.16 during pregnancy; 37.17 (2) specifically target pregnant women whose age, medical 37.18 condition, maternal history, or chemical abuse substantially 37.19 increases the likelihood of complications associated with 37.20 pregnancy and childbirth or the birth of a child with an 37.21 illness, disability, or special medical needs; 37.22 (3) specifically address the health needs of young children 37.23 who have or are likely to have a chronic disease or disability 37.24 or special medical needs, including physical, neurological, 37.25 emotional, and developmental problems that arise from chemical 37.26 abuse by a mother during pregnancy; 37.27 (4) providefamily planning andpreventive medical care, 37.28 excluding prepregnancy family planning services, for 37.29 specifically identified target populations, such as minority and 37.30 low-income teenagers, in a manner calculated todecrease the37.31occurrence of inappropriate pregnancy andminimize the risk of 37.32 complications associated with pregnancy and childbirth; or 37.33 (5) specifically address the frequency and severity of 37.34 childhood injuries and other child and adolescent health 37.35 problems in high-risk target populations by providing services, 37.36 excluding prepregnancy family planning services, calculated to 38.1 produce measurable decreases in mortality and 38.2 morbidity.However, money may be used for this purpose only if38.3the community health board's application includes program38.4components for the purposes in clauses (1) to (4) in the38.5proposed geographic service area and the total expenditure for38.6injury-related programs under this clause does not exceed ten38.7percent of the total allocation under subdivision 3.38.8(b) Maternal and child health block grant money may be used38.9for purposes other than the purposes listed in this subdivision38.10only under the following conditions:38.11(1) the community health board or community health services38.12area can demonstrate that existing programs fully address the38.13needs of the highest risk target populations described in this38.14subdivision; or38.15(2) the money is used to continue projects that received38.16funding before creation of the maternal and child health block38.17grant in 1981.38.18(c) Projects that received funding before creation of the38.19maternal and child health block grant in 1981, must be allocated38.20at least the amount of maternal and child health special project38.21grant funds received in 1989, unless (1) the local board of38.22health provides equivalent alternative funding for the project38.23from another source; or (2) the local board of health38.24demonstrates that the need for the specific services provided by38.25the project has significantly decreased as a result of changes38.26in the demographic characteristics of the population, or other38.27factors that have a major impact on the demand for services. If38.28the amount of federal funding to the state for the maternal and38.29child health block grant is decreased, these projects must38.30receive a proportional decrease as required in subdivision 1.38.31Increases in allocation amounts to local boards of health under38.32subdivision 4 may be used to increase funding levels for these38.33projects.38.34 Sec. 41. Minnesota Statutes 2000, section 145.885, 38.35 subdivision 2, is amended to read: 38.36 Subd. 2. [ADDITIONAL REQUIREMENTS FOR COMMUNITY BOARDS OF 39.1 HEALTH.] Applications by community health boards as defined in 39.2 section 145A.02, subdivision 5, under section 145.882, 39.3 subdivision34a, must also contain a summary of the process 39.4 used to develop the local program, including evidence that the 39.5 community health board notified local public and private 39.6 providers of the availability of funding through the community 39.7 health board for maternal and child health services; a list of 39.8 all public and private agency requests for grants submitted to 39.9 the community health board indicating which requests were 39.10 included in the grant application; and an explanation of how 39.11 priorities were established for selecting the requests to be 39.12 included in the grant application. The community health board 39.13 shall include, with the grant application, a written statement 39.14 of the criteria to be applied to public and private agency 39.15 requests for funding. 39.16 Sec. 42. Minnesota Statutes 2000, section 145.924, is 39.17 amended to read: 39.18 145.924 [AIDS PREVENTION GRANTS.] 39.19 Subdivision 1. [GRANT AWARDS.] (a) The commissioner may 39.20 award grants to boards of health as defined in section 145A.02, 39.21 subdivision 2, state agencies, state councils, or nonprofit 39.22 corporations to provide evaluation and counseling services to 39.23 populations at risk for acquiring human immunodeficiency virus 39.24 infection, including, but not limited to, minorities, 39.25 adolescents, intravenous drug users, and homosexual men. 39.26 (b) The commissioner may award grants to agencies 39.27 experienced in providing services to communities of color, for 39.28 the design of innovative outreach and education programs for 39.29 targeted groups within the community who may be at risk of 39.30 acquiring the human immunodeficiency virus infection, including 39.31 intravenous drug users and their partners, adolescents, gay and 39.32 bisexual individuals and women. Grants shall be awarded on a 39.33 request for proposal basis and shall include funds for 39.34 administrative costs. Priority for grants shall be given to 39.35 agencies or organizations that have experience in providing 39.36 service to the particular community which the grantee proposes 40.1 to serve; that have policymakers representative of the targeted 40.2 population; that have experience in dealing with issues relating 40.3 to HIV/AIDS; and that have the capacity to deal effectively with 40.4 persons of differing sexual orientations. For purposes of this 40.5 paragraph, the "communities of color" are: the American-Indian 40.6 community; the Hispanic community; the African-American 40.7 community; and the Asian-Pacific community. 40.8 (c) All state grants awarded under thissectionsubdivision 40.9 for programs targeted to adolescents shall include the promotion 40.10 of abstinence from sexual activity and drug use. 40.11 Subd. 2. [OUTCOMES.] The commissioner, in consultation 40.12 with boards of health, agencies, councils, and nonprofit 40.13 organizations involved in human immunodeficiency virus infection 40.14 prevention efforts shall establish measurable outcomes to 40.15 determine the effectiveness of the grants provided under this 40.16 section in reducing the number of people who acquire human 40.17 immunodeficiency virus, the rates of infection, and average 40.18 numbers of sexual partners for populations served by grants 40.19 funded under this section. 40.20 Subd. 3. [EVALUATION.] (a) Using the outcomes established 40.21 according to subdivision 2, the commissioner shall conduct a 40.22 biennial evaluation of activities funded under this section. 40.23 The evaluation must include: 40.24 (1) the effect of these activities on the number of people 40.25 who acquire human immunodeficiency virus and the rates of 40.26 infection; 40.27 (2) the effect of these activities on average numbers of 40.28 sexual partners for populations served by grants funded under 40.29 this section; and 40.30 (3) a longitudinal tracking of outcomes for targeted 40.31 populations who are served under subdivision 1, paragraphs (a) 40.32 and (b). 40.33 (b) Grant recipients shall cooperate with the commissioner 40.34 in the evaluation and shall provide the commissioner with the 40.35 information needed to conduct the evaluation. Beginning January 40.36 15, 2003, the results of each evaluation must be submitted to 41.1 the chairs of the policy and finance committees in the house and 41.2 senate with jurisdiction over health and human services. 41.3 Sec. 43. Minnesota Statutes 2000, section 145.925, 41.4 subdivision 1, is amended to read: 41.5 Subdivision 1. [ELIGIBLE ORGANIZATIONS; PURPOSE.] The 41.6 commissioner of health may make special grants to cities, 41.7 counties, tribal governments, or groups of citiesor, counties, 41.8or nonprofit corporationsor tribal governments to provide 41.9 prepregnancy family planning services.targeted to low-income 41.10 and minority populations. A city, county, tribal government, or 41.11 group of cities, counties, or tribal governments that receives a 41.12 grant is responsible for ensuring that the grant funds are used 41.13 for services targeted to low-income and minority populations, 41.14 and must establish a goal for reducing specific pregnancy rates 41.15 in the service area. In determining populations to serve and 41.16 services to provide, a city, county, tribal government, or group 41.17 of cities, counties, or tribal governments must consider the 41.18 spacing of pregnancies in low-income and minority populations in 41.19 the service area, teen birth rates in the service area, and the 41.20 needs of populations of color in the service area. A city, 41.21 county, tribal government, or group of cities, counties, or 41.22 tribal governments may contract for the provision of 41.23 prepregnancy family planning services using grant funds provided 41.24 under this section only if the contract is specifically 41.25 authorized by the governing body of the city, county, or tribal 41.26 government that is contracting for the services. 41.27 Any organization or an affiliate of an organization which 41.28 provides abortions, promotes abortions, or directly refers for 41.29 abortions, shall be ineligible to receive funds under this 41.30 subdivision. 41.31 Sec. 44. Minnesota Statutes 2000, section 145.925, 41.32 subdivision 1a, is amended to read: 41.33 Subd. 1a. [FAMILY PLANNING SERVICES; DEFINED.] "Family 41.34 planning services" means counseling by trained personnel 41.35 regarding family planning; distribution of information relating 41.36 to family planning, referral to licensed physicians or local 42.1 health agencies for consultation, examination, medical 42.2 treatment, genetic counseling, and prescriptions for the purpose 42.3 of family planning; and the distribution of family planning 42.4 products, such as charts, thermometers, drugs, medical 42.5 preparations, and contraceptive devices. Family planning 42.6 services do not include services that, directly or indirectly, 42.7 encourage, counsel, refer, or provide abortions or abortion 42.8 referrals. For purposes of sections 145A.01 to 145A.14, family 42.9 planning shall mean voluntary action by individuals to prevent 42.10 or aid conception but does not includethe performance, or make42.11referrals for encouragement of voluntary termination of42.12pregnancyservices that, directly or indirectly, encourage, 42.13 counsel, refer, or provide abortions or abortion referrals. 42.14 Sec. 45. [145.9257] [TEEN PREGNANCY PREVENTION.] 42.15 Subdivision 1. [GOAL.] It is the goal of the state to 42.16 reduce teen pregnancy rates by 24 percent by 2006. To do so, 42.17 the commissioner of health shall establish a grant program to 42.18 reduce the rates of unintended teen pregnancies in the state. 42.19 If this goal of reducing teen pregnancy rates by 24 percent is 42.20 not met by December 31, 2006, this section expires June 30, 42.21 2007. No funds awarded under this section may be used for 42.22 medical services or family planning services or for services 42.23 that, directly or indirectly, encourage, counsel, refer, or 42.24 provide abortions or abortion referrals. 42.25 Any organization or an affiliate of an organization which 42.26 provides abortions, promotes abortions, or directly refers for 42.27 abortions, shall be ineligible to receive funds under this 42.28 section. 42.29 Subd. 2. [STATE-COMMUNITY PARTNERSHIPS; PLAN.] The 42.30 commissioner, in consultation with the commissioner of children, 42.31 families, and learning; the commissioner of human services; the 42.32 maternal and child health advisory task force under section 42.33 145.881; the Indian affairs council under section 3.922; the 42.34 council on affairs of Chicano/Latino people under section 42.35 3.9223; the council on Black Minnesotans under section 3.9225; 42.36 the council on Asian-Pacific Minnesotans under section 3.9226; 43.1 community health boards as defined in section 145A.02; tribal 43.2 governments; nonprofit community organizations; and others 43.3 interested in teen pregnancy prevention, shall develop and 43.4 implement a comprehensive, coordinated plan to reduce the number 43.5 of teen pregnancies. 43.6 Subd. 3. [MEASURABLE OUTCOMES.] The commissioner, in 43.7 consultation with the commissioners and community partners 43.8 listed in subdivision 2, shall establish measurable outcomes to 43.9 achieve the goal specified in subdivision 1 and to determine the 43.10 effectiveness of the grants provided under this section in 43.11 reducing teen pregnancies. The development of measurable 43.12 outcomes must be completed before any funds are distributed 43.13 under this section. 43.14 Subd. 4. [STATEWIDE ASSESSMENT.] The commissioner shall 43.15 use and enhance current statewide assessments of teen pregnancy 43.16 risk behaviors and attitudes among youth to establish a baseline 43.17 to measure the statewide effect of teen pregnancy prevention 43.18 activities. To the extent feasible, the commissioner shall 43.19 conduct the assessment so that the results may be compared to 43.20 national data. 43.21 Subd. 5. [PROCESS.] The commissioner, in consultation with 43.22 the commissioners and community partners listed in subdivision 43.23 2, shall develop the criteria and procedures used to allocate 43.24 grants under this section. In developing the criteria, the 43.25 commissioner shall establish an administrative cost limit for 43.26 grant recipients. At the time a grant is awarded, the 43.27 commissioner shall provide a grant recipient with information on 43.28 the outcomes established according to subdivision 3. 43.29 Subd. 6. [TEEN PREGNANCY PREVENTION DISPARITY GRANTS.] (a) 43.30 The commissioner shall award competitive grants to eligible 43.31 applicants for projects to reduce disparities in unintended teen 43.32 pregnancy rates for American Indians and populations of color, 43.33 as compared with unintended teen pregnancy rates for whites. 43.34 (b) No funds awarded under this subdivision may be used for 43.35 medical services or family planning services or for services 43.36 that, directly or indirectly, encourage, counsel, refer, or 44.1 provide abortions or abortion referrals. 44.2 Any organization or an affiliate of an organization which 44.3 provides abortions, promotes abortions, or directly refers for 44.4 abortions, shall be ineligible to receive funds under this 44.5 subdivision. 44.6 (c) Eligible applicants may include, but are not limited 44.7 to, nonprofit organizations, school districts, faith-based 44.8 organizations, community health boards, and tribal governments. 44.9 Applicants must submit proposals to the commissioner. A 44.10 proposal must specify the strategies to be implemented and must 44.11 take into account the need for a coordinated, statewide teen 44.12 pregnancy prevention effort. Strategies may include youth 44.13 development programs, after-school enrichment programs, youth 44.14 mentoring programs, academic support programs, and abstinence 44.15 until marriage education programs. 44.16 (d) The commissioner shall give priority to applicants who 44.17 demonstrate that their proposed project: 44.18 (1) emphasizes abstinence until marriage; 44.19 (2) is research-based or based on proven, effective 44.20 strategies; 44.21 (3) is designed to coordinate with related youth risk 44.22 behavior reduction activities; 44.23 (4) involves youth and parents in the project's development 44.24 and implementation; 44.25 (5) reflects racially and ethnically appropriate 44.26 approaches; and 44.27 (6) will be implemented through or with persons or 44.28 community-based organizations that reflect the race or ethnicity 44.29 of the population to be reached. 44.30 Subd. 7. [HIGH-RISK COMMUNITY TEEN PREGNANCY PREVENTION 44.31 GRANTS.] (a) The commissioner shall award grants to communities 44.32 that have significant risk factors for teen pregnancies, that 44.33 currently have in place youth development programs, and that are 44.34 interested in expanding existing efforts to prevent teen 44.35 pregnancies. 44.36 (b) No funds awarded under this subdivision may be used for 45.1 medical services or family planning services or for services 45.2 that, directly or indirectly, encourage, counsel, refer, or 45.3 provide abortions or abortion referrals. 45.4 Any organization or an affiliate of an organization which 45.5 provides abortions, promotes abortions, or directly refers for 45.6 abortions, shall be ineligible to receive funds under this 45.7 subdivision. 45.8 (c) To be eligible for a grant under this subdivision, an 45.9 applicant must be a tribal government or a community health 45.10 board as defined in section 145A.02. Applicants must submit 45.11 proposals to the commissioner. A proposal must specify the 45.12 strategies to be implemented. Strategies may include, but are 45.13 not limited to, youth development programs, youth mentoring 45.14 programs, academic support programs, and abstinence until 45.15 marriage education programs. Applicants must demonstrate that a 45.16 proposed project: 45.17 (1) emphasizes abstinence until marriage; 45.18 (2) is research-based or based on proven, effective 45.19 strategies; 45.20 (3) is designed to coordinate with related youth risk 45.21 behavior reduction activities; 45.22 (4) involves youth and parents in the project's development 45.23 and implementation; 45.24 (5) reflects racially and ethnically appropriate 45.25 approaches; and 45.26 (6) will be implemented through or with persons or 45.27 community-based organizations that reflect the race or ethnicity 45.28 of the population to be reached. 45.29 (d) Grants may be awarded to up to 15 community health 45.30 boards and three tribal governments based on areas having the 45.31 highest risk factors for teen pregnancies. The commissioner 45.32 shall award grants based on the following risk factors: 45.33 (1) the proportion of teens in the applicant's service area 45.34 who are sexually active; 45.35 (2) the proportion of births to teens in the applicant's 45.36 service area; and 46.1 (3) the proportion of births to teens who are American 46.2 Indian or of a population of color in the applicant's service 46.3 area. 46.4 Subd. 8. [ADOLESCENT PARENT GRANTS.] The commissioner 46.5 shall transfer funds to the commissioner of children, families, 46.6 and learning to increase the number of adolescent parent grants 46.7 currently provided by the commissioner of children, families, 46.8 and learning under section 124D.33. 46.9 Subd. 9. [COORDINATION.] The commissioner shall coordinate 46.10 the projects and initiatives funded under this section with 46.11 other efforts at the local, state, and national levels to avoid 46.12 duplication and promote complementary efforts. 46.13 Subd. 10. [EVALUATION.] Using the outcomes established 46.14 according to subdivision 3, the commissioner shall conduct a 46.15 biennial evaluation of the impact of each teen pregnancy 46.16 prevention initiative in this section. Grant recipients and the 46.17 commissioner of children, families, and learning shall cooperate 46.18 with the commissioner in the evaluation and shall provide the 46.19 commissioner with the information needed to conduct the 46.20 evaluation. 46.21 Subd. 11. [REPORT.] By January 15, 2002, and January 15 of 46.22 each even-numbered year thereafter, the commissioner shall 46.23 submit a report to the legislature on the projects funded under 46.24 this section and the results of the biennial evaluation. 46.25 Sec. 46. [145.9268] [COMMUNITY CLINIC GRANTS.] 46.26 Subdivision 1. [DEFINITION.] For purposes of this section, 46.27 "eligible community clinic" means: 46.28 (1) a clinic that provides services under conditions as 46.29 defined in Minnesota Rules, part 9505.0255 or 9505.0380, and 46.30 utilizes a sliding fee scale to determine eligibility for 46.31 charity care; 46.32 (2) an Indian tribal government or Indian health service 46.33 unit; or 46.34 (3) a consortium of clinics comprised of entities under 46.35 clause (1) or (2). 46.36 Subd. 2. [GRANTS AUTHORIZED.] The commissioner of health 47.1 shall award grants to eligible community clinics to improve the 47.2 ongoing viability of Minnesota's clinic-based safety net 47.3 providers. Grants shall be awarded to support the capacity of 47.4 eligible community clinics to serve low-income populations, 47.5 reduce current or future uncompensated care burdens, or provide 47.6 for improved care delivery infrastructure. 47.7 Subd. 3. [ALLOCATION OF GRANTS.] (a) To receive a grant 47.8 under this section, an eligible community clinic must submit an 47.9 application to the commissioner of health by the deadline 47.10 established by the commissioner. A grant may be awarded upon 47.11 the signing of a grant contract. 47.12 (b) An application must be on a form and contain 47.13 information as specified by the commissioner but at a minimum 47.14 must contain: 47.15 (1) a description of the project for which grant funds will 47.16 be used; 47.17 (2) a description of the problem the proposed project will 47.18 address; and 47.19 (3) a description of achievable objectives, a workplan, and 47.20 a timeline for project completion. 47.21 (c) The commissioner shall review each application to 47.22 determine whether the application is complete and whether the 47.23 applicant and the project are eligible for a grant. In 47.24 evaluating applications according to paragraph (e), the 47.25 commissioner shall establish criteria including, but not limited 47.26 to: the priority level of the project; the applicant's 47.27 thoroughness and clarity in describing the problem; a 47.28 description of the applicant's proposed project; the manner in 47.29 which the applicant will demonstrate the effectiveness of the 47.30 project; and evidence of efficiencies and effectiveness gained 47.31 through collaborative efforts. The commissioner may also take 47.32 into account other relevant factors, including, but not limited 47.33 to, the percentage for which uninsured patients represent the 47.34 applicant's patient base. During application review, the 47.35 commissioner may request additional information about a proposed 47.36 project, including information on project cost. Failure to 48.1 provide the information requested disqualifies an applicant. 48.2 (d) A grant awarded to an eligible community clinic may not 48.3 exceed $300,000 per eligible community clinic. For an applicant 48.4 applying as a consortium of clinics, a grant may not exceed 48.5 $300,000 per clinic included in the consortium. The 48.6 commissioner has discretion over the number of grants awarded. 48.7 (e) In determining which eligible community clinics will 48.8 receive grants under this section, the commissioner shall give 48.9 preference to those grant applications that show evidence of 48.10 collaboration with other eligible community clinics, hospitals, 48.11 health care providers, or community organizations. In addition, 48.12 the commissioner shall give priority, in declining order, to 48.13 grant applications for projects that: 48.14 (1) establish, update, or improve information, data 48.15 collection, or billing systems; 48.16 (2) procure, modernize, remodel, or replace equipment used 48.17 an the delivery of direct patient care at a clinic; 48.18 (3) provide improvements for care delivery, such as 48.19 increased translation and interpretation services; 48.20 (4) provide a direct offset to expenses incurred for 48.21 charity care services; or 48.22 (5) other projects determined by the commissioner to 48.23 improve the ability of applicants to provide care to the 48.24 vulnerable populations they serve. 48.25 Subd. 4. [EVALUATION.] The commissioner of health shall 48.26 evaluate the overall effectiveness of the grant program. The 48.27 commissioner shall collect progress reports to evaluate the 48.28 grant program from the eligible community clinics receiving 48.29 grants. 48.30 Sec. 47. [145.928] [ELIMINATING HEALTH DISPARITIES.] 48.31 Subdivision 1. [GOAL; ESTABLISHMENT.] It is the goal of 48.32 the state, by 2010, to decrease by 50 percent the disparities in 48.33 infant mortality rates and adult and child immunization rates 48.34 for American Indians and populations of color, as compared with 48.35 rates for whites. To do so and to achieve other measurable 48.36 outcomes, the commissioner of health shall establish a program 49.1 to close the gap in the health status of American Indians and 49.2 populations of color as compared with whites in the following 49.3 priority areas: infant mortality, breast and cervical cancer 49.4 screening, HIV/AIDS and sexually transmitted infections, adult 49.5 and child immunizations, cardiovascular disease, diabetes, and 49.6 accidental injuries and violence. If this goal of reducing 49.7 disparities in infant mortality rates and adult and child 49.8 immunization rates is not met by December 31, 2010, this section 49.9 expires June 30, 2011. 49.10 Subd. 2. [STATE-COMMUNITY PARTNERSHIPS; PLAN.] The 49.11 commissioner, in partnership with culturally-based community 49.12 organizations; the Indian affairs council under section 3.922; 49.13 the council on affairs of Chicano/Latino people under section 49.14 3.9223; the council on Black Minnesotans under section 3.9225; 49.15 the council on Asian-Pacific Minnesotans under section 3.9226; 49.16 community health boards as defined in section 145A.02; and 49.17 tribal governments, shall develop and implement a comprehensive, 49.18 coordinated plan to reduce health disparities in the health 49.19 disparity priority areas identified in subdivision 1. 49.20 Subd. 3. [MEASURABLE OUTCOMES.] The commissioner, in 49.21 consultation with the community partners listed in subdivision 49.22 2, shall establish measurable outcomes to achieve the goal 49.23 specified in subdivision 1 and to determine the effectiveness of 49.24 the grants and other activities funded under this section in 49.25 reducing health disparities in the priority areas identified in 49.26 subdivision 1. The development of measurable outcomes must be 49.27 completed before any funds are distributed under this section. 49.28 Subd. 4. [STATEWIDE ASSESSMENT.] The commissioner shall 49.29 enhance current data tools to ensure a statewide assessment of 49.30 the risk behaviors associated with the health disparity priority 49.31 areas identified in subdivision 1. The statewide assessment 49.32 must be used to establish a baseline to measure the effect of 49.33 activities funded under this section. To the extent feasible, 49.34 the commissioner shall conduct the assessment so that the 49.35 results may be compared to national data. 49.36 Subd. 5. [TECHNICAL ASSISTANCE.] The commissioner shall 50.1 provide the necessary expertise to grant applicants to ensure 50.2 that submitted proposals are likely to be successful in reducing 50.3 the health disparities identified in subdivision 1. The 50.4 commissioner shall provide grant recipients with guidance and 50.5 training on best or most promising strategies to use to reduce 50.6 the health disparities identified in subdivision 1. The 50.7 commissioner shall also assist grant recipients in the 50.8 development of materials and procedures to evaluate local 50.9 community activities. 50.10 Subd. 6. [PROCESS.] (a) The commissioner, in consultation 50.11 with the community partners listed in subdivision 2, shall 50.12 develop the criteria and procedures used to allocate grants 50.13 under this section. In developing the criteria, the 50.14 commissioner shall establish an administrative cost limit for 50.15 grant recipients. At the time a grant is awarded, the 50.16 commissioner must provide a grant recipient with information on 50.17 the outcomes established according to subdivision 3. 50.18 (b) A grant recipient must coordinate its activities to 50.19 reduce health disparities with other entities receiving funds 50.20 under this section that are in the grant recipient's service 50.21 area. 50.22 Subd. 7. [COMMUNITY GRANT PROGRAM; IMMUNIZATION RATES AND 50.23 INFANT MORTALITY RATES.] (a) The commissioner shall award grants 50.24 to eligible applicants for local or regional projects and 50.25 initiatives directed at reducing health disparities in one or 50.26 both of the following priority areas: 50.27 (1) decreasing racial and ethnic disparities in infant 50.28 mortality rates; or 50.29 (2) increasing adult and child immunization rates in 50.30 nonwhite racial and ethnic populations. 50.31 (b) The commissioner may award up to 20 percent of the 50.32 funds available as planning grants. Planning grants must be 50.33 used to address such areas as community assessment, coordination 50.34 activities, and development of community supported strategies. 50.35 (c) Eligible applicants may include, but are not limited 50.36 to, faith-based organizations, social service organizations, 51.1 community nonprofit organizations, community health boards, 51.2 tribal governments, and community clinics. Applicants must 51.3 submit proposals to the commissioner. A proposal must specify 51.4 the strategies to be implemented to address one or both of the 51.5 priority areas listed in paragraph (a) and must be targeted to 51.6 achieve the outcomes established according to subdivision 3. 51.7 (d) The commissioner shall give priority to applicants who 51.8 demonstrate that their proposed project or initiative: 51.9 (1) is supported by the community the applicant will serve; 51.10 (2) is research-based or based on promising strategies; 51.11 (3) is designed to complement other related community 51.12 activities; 51.13 (4) utilizes strategies that positively impact both 51.14 priority areas; 51.15 (5) reflects racially and ethnically appropriate 51.16 approaches; and 51.17 (6) will be implemented through or with community-based 51.18 organizations that reflect the race or ethnicity of the 51.19 population to be reached. 51.20 Subd. 8. [COMMUNITY GRANT PROGRAM; OTHER HEALTH 51.21 DISPARITIES.] (a) The commissioner shall award grants to 51.22 eligible applicants for local or regional projects and 51.23 initiatives directed at reducing health disparities in one or 51.24 more of the following priority areas: 51.25 (1) decreasing racial and ethnic disparities in morbidity 51.26 and mortality rates from breast and cervical cancer; 51.27 (2) decreasing racial and ethnic disparities in morbidity 51.28 and mortality rates from HIV/AIDS and sexually transmitted 51.29 infections; 51.30 (3) decreasing racial and ethnic disparities in morbidity 51.31 and mortality rates from cardiovascular disease; 51.32 (4) decreasing racial and ethnic disparities in morbidity 51.33 and mortality rates from diabetes; or 51.34 (5) decreasing racial and ethnic disparities in morbidity 51.35 and mortality rates from accidental injuries or violence. 51.36 (b) The commissioner may award up to 20 percent of the 52.1 funds available as planning grants. Planning grants must be 52.2 used to address such areas as community assessment, determining 52.3 community priority areas, coordination activities, and 52.4 development of community supported strategies. 52.5 (c) Eligible applicants may include, but are not limited 52.6 to, faith-based organizations, social service organizations, 52.7 community nonprofit organizations, community health boards, 52.8 tribal governments, and community clinics. Applicants shall 52.9 submit proposals to the commissioner. A proposal must specify 52.10 the strategies to be implemented to address one or more of the 52.11 priority areas listed in paragraph (a) and must be targeted to 52.12 achieve the outcomes established according to subdivision 3. 52.13 (d) The commissioner shall give priority to applicants who 52.14 demonstrate that their proposed project or initiative: 52.15 (1) is supported by the community the applicant will serve; 52.16 (2) is research-based or based on promising strategies; 52.17 (3) is designed to complement other related community 52.18 activities; 52.19 (4) utilizes strategies that positively impact more than 52.20 one priority area; 52.21 (5) reflects racially and ethnically appropriate 52.22 approaches; and 52.23 (6) will be implemented through or with community-based 52.24 organizations that reflect the race or ethnicity of the 52.25 population to be reached. 52.26 Subd. 9. [REFUGEE AND IMMIGRANT HEALTH.] (a) The 52.27 commissioner shall distribute funds to community health boards 52.28 for health screening and follow-up services for tuberculosis for 52.29 refugees. Funds shall be distributed based on the following 52.30 formula: 52.31 (1) $1,500 per refugee with pulmonary tuberculosis in the 52.32 community health board's service area; 52.33 (2) $500 per refugee with extrapulmonary tuberculosis in 52.34 the community health board's service area; 52.35 (3) $500 per month of directly observed therapy provided by 52.36 the community health board for each uninsured refugee with 53.1 pulmonary or extrapulmonary tuberculosis; and 53.2 (4) $50 per refugee in the community health board's service 53.3 area. 53.4 (b) Payments must be made at the end of each state fiscal 53.5 year. The amount paid per tuberculosis case, per month of 53.6 directly observed therapy, and per refugee must be 53.7 proportionately increased or decreased to fit the actual amount 53.8 appropriated for that fiscal year. 53.9 Subd. 10. [COORDINATION.] The commissioner shall 53.10 coordinate the projects and initiatives funded under this 53.11 section with other efforts at the local, state, or national 53.12 level to avoid duplication and promote complementary efforts. 53.13 Subd. 11. [EVALUATION.] Using the outcomes established 53.14 according to subdivision 3, the commissioner shall conduct a 53.15 biennial evaluation of the community grant programs under 53.16 subdivisions 7 and 8. Grant recipients shall cooperate with the 53.17 commissioner in the evaluation and shall provide the 53.18 commissioner with the information needed to conduct the 53.19 evaluation. 53.20 Subd. 12. [REPORT.] By January 15, 2002, and January 15 of 53.21 each even-numbered year thereafter, the commissioner shall 53.22 submit a report to the legislature on the local community 53.23 projects and community health board activities funded under this 53.24 section. The report must include information on grant 53.25 recipients, activities conducted using grant funds, and 53.26 evaluation data and outcome measures if available. 53.27 Sec. 48. Minnesota Statutes 2000, section 145A.15, 53.28 subdivision 1, is amended to read: 53.29 Subdivision 1. [ESTABLISHMENT.] (a) The commissioner of 53.30 health shall expand the current grant program to fund additional 53.31 projects designed to prevent child abuse and neglect and reduce 53.32 juvenile delinquency by promoting positive parenting, resiliency 53.33 in children, and a healthy beginning for children by providing 53.34 early intervention services for families in need. Grant dollars 53.35 shall be available to train paraprofessionals to provide in-home 53.36 intervention services and to allow public health nurses to do 54.1 case management of services. The grant program shall provide 54.2 early intervention services for families in need and will 54.3 include: 54.4 (1) expansion of current public health nurse and family 54.5 aide home visiting programs and public health home visiting 54.6 projects which prevent child abuse and neglect, prevent juvenile 54.7 delinquency, and build resiliency in children; 54.8 (2) early intervention to promote a healthy and nurturing 54.9 beginning; 54.10 (3) distribution of educational and public information 54.11 programs and materials in hospital maternity divisions, 54.12 well-baby clinics, obstetrical clinics, and community clinics; 54.13 and 54.14 (4) training of home visitors in skills necessary for 54.15 comprehensive home visiting which promotes a healthy and 54.16 nurturing beginning for the child. 54.17 (b) No new grants shall be awarded under this section after 54.18 June 30, 2001. Grant contracts awarded and in effect under this 54.19 section as of July 1, 2001, shall continue until their 54.20 expiration date. 54.21 Sec. 49. Minnesota Statutes 2000, section 145A.15, is 54.22 amended by adding a subdivision to read: 54.23 Subd. 5. [EXPIRATION.] This section expires June 30, 2003. 54.24 Sec. 50. Minnesota Statutes 2000, section 145A.16, 54.25 subdivision 1, is amended to read: 54.26 Subdivision 1. [ESTABLISHMENT.] The commissioner shall 54.27 establish a grant program to fund universally offered home 54.28 visiting programs designed to serve all live births in 54.29 designated geographic areas. The commissioner shall designate 54.30 the geographic area to be served by each program. At least one 54.31 program must provide home visiting services to families within 54.32 the seven-county metropolitan area, and at least one program 54.33 must provide home visiting services to families outside the 54.34 metropolitan area. The purpose of the program is to strengthen 54.35 families and to promote positive parenting and healthy child 54.36 development. No new grants shall be awarded under this section 55.1 after June 30, 2001. Competitive grant contracts awarded and in 55.2 effect under this section as of July 1, 2001, shall expire 55.3 December 31, 2003. 55.4 Sec. 51. Minnesota Statutes 2000, section 145A.16, is 55.5 amended by adding a subdivision to read: 55.6 Subd. 10. [EXPIRATION.] This section expires December 31, 55.7 2003. 55.8 Sec. 52. [145A.17] [FAMILY HOME VISITING PROGRAMS.] 55.9 Subdivision 1. [ESTABLISHMENT; GOALS.] The commissioner 55.10 shall establish a program to fund family home visiting programs 55.11 designed to foster a healthy beginning for children in families 55.12 at or below 200 percent of the federal poverty guidelines, 55.13 prevent child abuse and neglect, reduce juvenile delinquency, 55.14 promote positive parenting and resiliency in children, and 55.15 promote family health and economic self-sufficiency. A program 55.16 funded under this section must serve families at or below 200 55.17 percent of the federal poverty guidelines, and other families 55.18 determined to be at risk for child abuse, neglect, or juvenile 55.19 delinquency. Programs must give priority for services to 55.20 families considered to be in need of services, including but not 55.21 limited to families with: 55.22 (1) adolescent parents; 55.23 (2) a history of alcohol or other drug abuse; 55.24 (3) a history of child abuse, domestic abuse, or other 55.25 types of violence; 55.26 (4) a history of domestic abuse, rape, or other forms of 55.27 victimization; 55.28 (5) reduced cognitive functioning; 55.29 (6) a lack of knowledge of child growth and development 55.30 stages; 55.31 (7) low resiliency to adversities and environmental 55.32 stresses; or 55.33 (8) insufficient financial resources to meet family needs. 55.34 Subd. 2. [ALLOCATION OF FUNDS.] The commissioner shall 55.35 distribute funds available under this section to community 55.36 health boards, as defined in section 145A.02, and to tribal 56.1 governments. Funds shall be distributed to community health 56.2 boards as follows: (1) each community health board shall 56.3 receive an allocation of $25,000 per year; and (2) remaining 56.4 funds available to community health boards shall be distributed 56.5 according to the formula in section 256J.625, subdivision 3. 56.6 The commissioner, in consultation with tribal governments, shall 56.7 establish a formula for distributing funds to tribal governments. 56.8 Subd. 3. [REQUIREMENTS FOR PROGRAMS; PROCESS.] (a) Before 56.9 a community health board or tribal government may receive an 56.10 allocation under subdivision 2, a community health board or 56.11 tribal government must submit a proposal to the commissioner 56.12 that includes identification, based on a community assessment, 56.13 of the populations at or below 200 percent of the federal 56.14 poverty guidelines that will be served and the other populations 56.15 that will be served. Each program that receives funds must: 56.16 (1) use either a broad community-based or selective 56.17 community-based strategy to provide preventive and early 56.18 intervention home visiting services; 56.19 (2) offer a home visit by a trained home visitor. If a 56.20 home visit is accepted, the first home visit must occur 56.21 prenatally or as soon after birth as possible and must include a 56.22 public health nursing assessment by a public health nurse; 56.23 (3) offer, at a minimum, information on infant care, child 56.24 growth and development, positive parenting, preventing diseases, 56.25 preventing exposure to environmental hazards, and support 56.26 services available in the community; 56.27 (4) provide information on and referrals to health care 56.28 services, if needed, including information on health care 56.29 coverage for which the child or family may be eligible; and 56.30 provide information on preventive services, developmental 56.31 assessments, and the availability of public assistance programs 56.32 as appropriate; 56.33 (5) recruit home visitors who will represent, to the extent 56.34 possible, the races, cultures, and languages spoken by families 56.35 that may be served; 56.36 (6) train and supervise home visitors in accordance with 57.1 the requirements established under subdivision 4; 57.2 (7) maximize resources and minimize duplication by 57.3 coordinating activities with local social and human services 57.4 organizations, education organizations, and other appropriate 57.5 governmental entities and community-based organizations and 57.6 agencies; and 57.7 (8) utilize appropriate racial and ethnic approaches to 57.8 providing home visiting services. 57.9 (b) Funds available under this section shall not be used 57.10 for medical services. The commissioner shall establish an 57.11 administrative cost limit for recipients of funds. The outcome 57.12 measures established under subdivision 6 must be specified to 57.13 recipients of funds at the time the funds are distributed. 57.14 Subd. 4. [TRAINING.] The commissioner shall establish 57.15 training requirements for home visitors and minimum requirements 57.16 for supervision by a public health nurse. The requirements for 57.17 nurses must be consistent with chapter 148. Training must 57.18 include child development, positive parenting techniques, and 57.19 diverse cultural practices in child rearing and family systems. 57.20 Subd. 5. [TECHNICAL ASSISTANCE.] The commissioner shall 57.21 provide administrative and technical assistance to each program, 57.22 including assistance in data collection and other activities 57.23 related to conducting short- and long-term evaluations of the 57.24 programs as required under subdivision 7. The commissioner may 57.25 request research and evaluation support from the University of 57.26 Minnesota. 57.27 Subd. 6. [OUTCOME MEASURES.] The commissioner shall 57.28 establish outcomes to determine the impact of family home 57.29 visiting programs funded under this section on the following 57.30 areas: 57.31 (1) appropriate utilization of preventive health care; 57.32 (2) rates of substantiated child abuse and neglect; 57.33 (3) rates of unintentional child injuries; and 57.34 (4) any additional qualitative goals and quantitative 57.35 measures established by the commissioner. 57.36 Subd. 7. [EVALUATION.] Using the qualitative goals and 58.1 quantitative outcome measures established under subdivisions 1 58.2 and 6, the commissioner shall conduct ongoing evaluations of the 58.3 programs funded under this section. Community health boards and 58.4 tribal governments shall cooperate with the commissioner in the 58.5 evaluations and shall provide the commissioner with the 58.6 information necessary to conduct the evaluations. As part of 58.7 the ongoing evaluations, the commissioner shall rate the impact 58.8 of the programs on the outcome measures listed in subdivision 6, 58.9 and shall periodically determine whether home visiting programs 58.10 are the best way to achieve the qualitative goals established in 58.11 subdivision 1 and by the commissioner. If the commissioner 58.12 determines that home visiting programs are not the best way to 58.13 achieve these goals, the commissioner shall provide the 58.14 legislature with alternative methods for achieving them. 58.15 Subd. 8. [REPORT.] By January 15, 2002, and January 15 of 58.16 each even-numbered year thereafter, the commissioner shall 58.17 submit a report to the legislature on the family home visiting 58.18 programs funded under this section and on the results of the 58.19 evaluations conducted under subdivision 7. 58.20 Subd. 9. [NO SUPPLANTING OF EXISTING FUNDS.] Funding 58.21 available under this section may be used only to supplement, not 58.22 to replace, nonstate funds being used for home visiting services 58.23 as of July 1, 2001. 58.24 Sec. 53. Minnesota Statutes 2000, section 157.16, 58.25 subdivision 3, is amended to read: 58.26 Subd. 3. [ESTABLISHMENT FEES; DEFINITIONS.] (a) The 58.27 following fees are required for food and beverage service 58.28 establishments, hotels, motels, lodging establishments, and 58.29 resorts licensed under this chapter. Food and beverage service 58.30 establishments must pay the highest applicable fee under 58.31 paragraph (e), clause (1), (2), (3), or (4), and establishments 58.32 serving alcohol must pay the highest applicable fee under 58.33 paragraph (e), clause (6) or (7). The license fee for new 58.34 operators previously licensed under this chapter for the same 58.35 calendar year is one-half of the appropriate annual license fee, 58.36 plus any penalty that may be required. The license fee for 59.1 operators opening on or after October 1 is one-half of the 59.2 appropriate annual license fee, plus any penalty that may be 59.3 required. The fees in paragraphs (b), (c), and (d) effective 59.4 until June 30, 2001, shall be phased up as specified in section 59.5 55 to the fee amounts effective beginning July 1, 2004. 59.6 Notwithstanding section 16A.1285, in fiscal years 2002, 2003, 59.7 and 2004, the commissioner shall regulate food and beverage 59.8 service establishments, hotels, motels, lodging establishments, 59.9 and resorts with the fees collected for that purpose. 59.10 (b) All food and beverage service establishments, except 59.11 special event food stands, and all hotels, motels, lodging 59.12 establishments, and resorts shall pay an annual base fee of $100 59.13 until June 30, 2001. Effective July 1, 2004, the annual base 59.14 fee shall be $145. 59.15 (c) A special event food stand shall pay a flat fee of $30 59.16 annually until June 30, 2001. Effective July 1, 2004, the 59.17 annual flat fee shall be $35. "Special event food stand" means 59.18 a fee category where food is prepared or served in conjunction 59.19 with celebrations, county fairs, or special events from a 59.20 special event food stand as defined in section 157.15. 59.21 (d) In addition to the base fee in paragraph (b), each food 59.22 and beverage service establishment, other than a special event 59.23 food stand, and each hotel, motel, lodging establishment, and 59.24 resort shall pay an additional annual fee for each fee category 59.25 as specified in this paragraph: 59.26 (1) Limited food menu selection, $30 until June 30, 2001. 59.27 Effective July 1, 2004, the annual fee shall be $40. "Limited 59.28 food menu selection" means a fee category that provides one or 59.29 more of the following: 59.30 (i) prepackaged food that receives heat treatment and is 59.31 served in the package; 59.32 (ii) frozen pizza that is heated and served; 59.33 (iii) a continental breakfast such as rolls, coffee, juice, 59.34 milk, and cold cereal; 59.35 (iv) soft drinks, coffee, or nonalcoholic beverages; or 59.36 (v) cleaning for eating, drinking, or cooking utensils, 60.1 when the only food served is prepared off site. 60.2 (2) Small establishment, including boarding establishments, 60.3 $55 until June 30, 2001. Effective July 1, 2004, the annual fee 60.4 shall be $75. "Small establishment" means a fee category that 60.5 has no salad bar and meets one or more of the following: 60.6 (i) possesses food service equipment that consists of no 60.7 more than a deep fat fryer, a grill, two hot holding containers, 60.8 and one or more microwave ovens; 60.9 (ii) serves dipped ice cream or soft serve frozen desserts; 60.10 (iii) serves breakfast in an owner-occupied bed and 60.11 breakfast establishment; 60.12 (iv) is a boarding establishment; or 60.13 (v) meets the equipment criteria in clause (3), item (i) or 60.14 (ii), and has a maximum patron seating capacity of not more than 60.15 50. 60.16 (3) Medium establishment, $150 until June 30, 2001. 60.17 Effective July 1, 2004, the annual fee shall be $210. "Medium 60.18 establishment" means a fee category that meets one or more of 60.19 the following: 60.20 (i) possesses food service equipment that includes a range, 60.21 oven, steam table, salad bar, or salad preparation area; 60.22 (ii) possesses food service equipment that includes more 60.23 than one deep fat fryer, one grill, or two hot holding 60.24 containers; or 60.25 (iii) is an establishment where food is prepared at one 60.26 location and served at one or more separate locations. 60.27 Establishments meeting criteria in clause (2), item (v), 60.28 are not included in this fee category. 60.29 (4) Large establishment, $250 until June 30, 2001. 60.30 Effective July 1, 2004, the annual fee shall be $350. "Large 60.31 establishment" means either: 60.32 (i) a fee category that (A) meets the criteria in clause 60.33 (3), items (i) or (ii), for a medium establishment, (B) seats 60.34 more than 175 people, and (C) offers the full menu selection an 60.35 average of five or more days a week during the weeks of 60.36 operation; or 61.1 (ii) a fee category that (A) meets the criteria in clause 61.2 (3), item (iii), for a medium establishment, and (B) prepares 61.3 and serves 500 or more meals per day. 61.4 (5) Other food and beverage service, including food carts, 61.5 mobile food units, seasonal temporary food stands, and seasonal 61.6 permanent food stands, $30 until June 30, 2001. Effective July 61.7 1, 2004, the annual fee shall be $40. 61.8 (6) Beer or wine table service, $30 until June 30, 2001. 61.9 Effective July 1, 2004, the annual fee shall be $40. "Beer or 61.10 wine table service" means a fee category where the only 61.11 alcoholic beverage service is beer or wine, served to customers 61.12 seated at tables. 61.13 (7) Alcoholic beverage service, other than beer or wine 61.14 table service, $75 until June 30, 2001. Effective July 1, 2004, 61.15 the annual fee shall be $105. 61.16 "Alcohol beverage service, other than beer or wine table 61.17 service" means a fee category where alcoholic mixed drinks are 61.18 served or where beer or wine are served from a bar. 61.19 (8) Until June 30, 2001, lodging per sleeping accommodation 61.20 unit, $4, including hotels, motels, lodging establishments, and 61.21 resorts, up to a maximum of $400. Effective July 1, 2004, 61.22 lodging per sleeping accommodation unit, $6, including hotels, 61.23 motels, lodging establishments, and resorts, up to a maximum of 61.24 $600. "Lodging per sleeping accommodation unit" means a fee 61.25 category including the number of guest rooms, cottages, or other 61.26 rental units of a hotel, motel, lodging establishment, or 61.27 resort; or the number of beds in a dormitory. 61.28 (9) First public swimming pool, $100 until June 30, 2001; 61.29 each additional public swimming pool, $50 until June 30, 2001. 61.30 Effective July 1, 2004, first public swimming pool, $140; each 61.31 additional public swimming pool, $80. "Public swimming pool" 61.32 means a fee category that has the meaning given in Minnesota 61.33 Rules, part 4717.0250, subpart 8. 61.34 (10) First spa, $50 until June 30, 2001; each additional 61.35 spa, $25 until June 30, 2001. Effective July 1, 2004, first 61.36 spa, $80; each additional spa, $40. "Spa pool" means a fee 62.1 category that has the meaning given in Minnesota Rules, part 62.2 4717.0250, subpart 9. 62.3 (11) Private sewer or water, $30 until June 30, 2001. 62.4 Effective July 1, 2004, private sewer or water, $40. 62.5 "Individual private water" means a fee category with a water 62.6 supply other than a community public water supply as defined in 62.7 Minnesota Rules, chapter 4720. "Individual private sewer" means 62.8 a fee category with an individual sewage treatment system which 62.9 uses subsurface treatment and disposal. 62.10 (e)A fee is not required for a food and beverage service62.11establishment operated by a school as defined in sections62.12120A.05, subdivisions 9, 11, 13, and 17 and 120A.22.62.13(f)A fee of $150 for review of the construction plans must 62.14 accompany the initial license application for food and beverage 62.15 service establishments, hotels, motels, lodging establishments, 62.16 or resorts. 62.17(g)(f) When existing food and beverage service 62.18 establishments, hotels, motels, lodging establishments, or 62.19 resorts are extensively remodeled, a fee of $150 must be 62.20 submitted with the remodeling plans. 62.21(h)(g) Seasonal temporary food stands and special event 62.22 food stands are not required to submit construction or 62.23 remodeling plans for review. 62.24 Sec. 54. Minnesota Statutes 2000, section 157.22, is 62.25 amended to read: 62.26 157.22 [EXEMPTIONS.] 62.27 This chapter shall not be construed to apply to: 62.28 (1) interstate carriers under the supervision of the United 62.29 States Department of Health and Human Services; 62.30 (2) any building constructed and primarily used for 62.31 religious worship; 62.32 (3) any building owned, operated, and used by a college or 62.33 university in accordance with health regulations promulgated by 62.34 the college or university under chapter 14; 62.35 (4) any person, firm, or corporation whose principal mode 62.36 of business is licensed under sections 28A.04 and 28A.05, is 63.1 exempt at that premises from licensure as a food or beverage 63.2 establishment; provided that the holding of any license pursuant 63.3 to sections 28A.04 and 28A.05 shall not exempt any person, firm, 63.4 or corporation from the applicable provisions of this chapter or 63.5 the rules of the state commissioner of health relating to food 63.6 and beverage service establishments; 63.7 (5) family day care homes and group family day care homes 63.8 governed by sections 245A.01 to 245A.16; 63.9 (6) nonprofit senior citizen centers for the sale of 63.10 home-baked goods;and63.11 (7) food not prepared at an establishment and brought in by 63.12 individuals attending a potluck event for consumption at the 63.13 potluck event. An organization sponsoring a potluck event under 63.14 this clause may advertise the potluck event to the public 63.15 through any means. Individuals who are not members of an 63.16 organization sponsoring a potluck event under this clause may 63.17 attend the potluck event and consume the food at the event. 63.18 Licensed food establishments cannot be sponsors of potluck 63.19 events. Potluck event food shall not be brought into a licensed 63.20 food establishment kitchen; and 63.21 (8) a home school in which a child is provided instruction 63.22 at home. 63.23 Sec. 55. [ESTABLISHMENT FEES DURING TRANSITION PERIOD.] 63.24 For fiscal years 2002, 2003, and 2004, the following fees 63.25 shall apply to food and beverage service establishments, hotels, 63.26 motels, lodging establishments, and resorts for which fees are 63.27 established under Minnesota Statutes, section 157.16, 63.28 subdivision 3, paragraphs (b), (c), and (d): 63.29 Fiscal Year Fiscal Year Fiscal Year 63.30 Fee Category 2002 2003 2004 63.31 Annual base fee, all $111.25 $122.50 $133.75 63.32 food and beverage 63.33 service establishments 63.34 except special event 63.35 food stands and all 63.36 hotels, motels, lodging 64.1 establishments, and 64.2 resorts 64.3 Special event food $ 31.25 $ 32.50 $ 33.75 64.4 stand 64.5 Establishment with $ 32.50 $ 35.00 $ 37.50 64.6 limited food menu 64.7 selection 64.8 Small establishment $ 60.00 $ 65.00 $ 70.00 64.9 Medium establishment $165.00 $180.00 $195.00 64.10 Large establishment $275.00 $300.00 $325.00 64.11 Other food and $ 32.50 $ 35.00 $ 37.50 64.12 beverage service 64.13 Beer or wine table $ 32.50 $ 35.00 $ 37.50 64.14 service 64.15 Alcoholic beverage $ 82.50 $ 90.00 $ 97.50 64.16 service other than 64.17 beer or wine table 64.18 service 64.19 Lodging per sleeping $4.50 per $5.00 per $5.50 per 64.20 accommodation unit, unit, $450 unit, $500 unit, $550 64.21 up to a specified maximum maximum maximum 64.22 maximum 64.23 First public $110.00 $120.00 $130.00 64.24 swimming pool 64.25 Each additional $ 57.50 $ 65.00 $ 72.50 64.26 public swimming pool 64.27 First spa $ 57.50 $ 65.00 $ 72.50 64.28 Each additional spa $ 28.75 $ 32.50 $ 36.25 64.29 Private sewer or $ 32.50 $ 35.00 $ 37.50 64.30 water 64.31 Sec. 56. [REPEALER.] 64.32 (a) Minnesota Statutes 2000, sections 145.882, subdivisions 64.33 3 and 4; and 145.927, are repealed. 64.34 (b) Minnesota Statutes 2000, section 144.148, subdivision 64.35 8, is repealed. 64.36 [EFFECTIVE DATE.] Paragraph (b) of this section is 65.1 effective the day following final enactment. 65.2 ARTICLE 2 65.3 HEALTH CARE 65.4 Section 1. Minnesota Statutes 2000, section 256.01, 65.5 subdivision 2, is amended to read: 65.6 Subd. 2. [SPECIFIC POWERS.] Subject to the provisions of 65.7 section 241.021, subdivision 2, the commissioner of human 65.8 services shall: 65.9 (1) Administer and supervise all forms of public assistance 65.10 provided for by state law and other welfare activities or 65.11 services as are vested in the commissioner. Administration and 65.12 supervision of human services activities or services includes, 65.13 but is not limited to, assuring timely and accurate distribution 65.14 of benefits, completeness of service, and quality program 65.15 management. In addition to administering and supervising human 65.16 services activities vested by law in the department, the 65.17 commissioner shall have the authority to: 65.18 (a) require county agency participation in training and 65.19 technical assistance programs to promote compliance with 65.20 statutes, rules, federal laws, regulations, and policies 65.21 governing human services; 65.22 (b) monitor, on an ongoing basis, the performance of county 65.23 agencies in the operation and administration of human services, 65.24 enforce compliance with statutes, rules, federal laws, 65.25 regulations, and policies governing welfare services and promote 65.26 excellence of administration and program operation; 65.27 (c) develop a quality control program or other monitoring 65.28 program to review county performance and accuracy of benefit 65.29 determinations; 65.30 (d) require county agencies to make an adjustment to the 65.31 public assistance benefits issued to any individual consistent 65.32 with federal law and regulation and state law and rule and to 65.33 issue or recover benefits as appropriate; 65.34 (e) delay or deny payment of all or part of the state and 65.35 federal share of benefits and administrative reimbursement 65.36 according to the procedures set forth in section 256.017; 66.1 (f) make contracts with and grants to public and private 66.2 agencies and organizations, both profit and nonprofit, and 66.3 individuals, using appropriated funds; and 66.4 (g) enter into contractual agreements with federally 66.5 recognized Indian tribes with a reservation in Minnesota to the 66.6 extent necessary for the tribe to operate a federally approved 66.7 family assistance program or any other program under the 66.8 supervision of the commissioner. The commissioner shall consult 66.9 with the affected county or counties in the contractual 66.10 agreement negotiations, if the county or counties wish to be 66.11 included, in order to avoid the duplication of county and tribal 66.12 assistance program services. The commissioner may establish 66.13 necessary accounts for the purposes of receiving and disbursing 66.14 funds as necessary for the operation of the programs. 66.15 (2) Inform county agencies, on a timely basis, of changes 66.16 in statute, rule, federal law, regulation, and policy necessary 66.17 to county agency administration of the programs. 66.18 (3) Administer and supervise all child welfare activities; 66.19 promote the enforcement of laws protecting handicapped, 66.20 dependent, neglected and delinquent children, and children born 66.21 to mothers who were not married to the children's fathers at the 66.22 times of the conception nor at the births of the children; 66.23 license and supervise child-caring and child-placing agencies 66.24 and institutions; supervise the care of children in boarding and 66.25 foster homes or in private institutions; and generally perform 66.26 all functions relating to the field of child welfare now vested 66.27 in the state board of control. 66.28 (4) Administer and supervise all noninstitutional service 66.29 to handicapped persons, including those who are visually 66.30 impaired, hearing impaired, or physically impaired or otherwise 66.31 handicapped. The commissioner may provide and contract for the 66.32 care and treatment of qualified indigent children in facilities 66.33 other than those located and available at state hospitals when 66.34 it is not feasible to provide the service in state hospitals. 66.35 (5) Assist and actively cooperate with other departments, 66.36 agencies and institutions, local, state, and federal, by 67.1 performing services in conformity with the purposes of Laws 67.2 1939, chapter 431. 67.3 (6) Act as the agent of and cooperate with the federal 67.4 government in matters of mutual concern relative to and in 67.5 conformity with the provisions of Laws 1939, chapter 431, 67.6 including the administration of any federal funds granted to the 67.7 state to aid in the performance of any functions of the 67.8 commissioner as specified in Laws 1939, chapter 431, and 67.9 including the promulgation of rules making uniformly available 67.10 medical care benefits to all recipients of public assistance, at 67.11 such times as the federal government increases its participation 67.12 in assistance expenditures for medical care to recipients of 67.13 public assistance, the cost thereof to be borne in the same 67.14 proportion as are grants of aid to said recipients. 67.15 (7) Establish and maintain any administrative units 67.16 reasonably necessary for the performance of administrative 67.17 functions common to all divisions of the department. 67.18 (8) Act as designated guardian of both the estate and the 67.19 person of all the wards of the state of Minnesota, whether by 67.20 operation of law or by an order of court, without any further 67.21 act or proceeding whatever, except as to persons committed as 67.22 mentally retarded. For children under the guardianship of the 67.23 commissioner whose interests would be best served by adoptive 67.24 placement, the commissioner may contract with a licensed 67.25 child-placing agency to provide adoption services. A contract 67.26 with a licensed child-placing agency must be designed to 67.27 supplement existing county efforts and may not replace existing 67.28 county programs, unless the replacement is agreed to by the 67.29 county board and the appropriate exclusive bargaining 67.30 representative or the commissioner has evidence that child 67.31 placements of the county continue to be substantially below that 67.32 of other counties. Funds encumbered and obligated under an 67.33 agreement for a specific child shall remain available until the 67.34 terms of the agreement are fulfilled or the agreement is 67.35 terminated. 67.36 (9) Act as coordinating referral and informational center 68.1 on requests for service for newly arrived immigrants coming to 68.2 Minnesota. 68.3 (10) The specific enumeration of powers and duties as 68.4 hereinabove set forth shall in no way be construed to be a 68.5 limitation upon the general transfer of powers herein contained. 68.6 (11) Establish county, regional, or statewide schedules of 68.7 maximum fees and charges which may be paid by county agencies 68.8 for medical, dental, surgical, hospital, nursing and nursing 68.9 home care and medicine and medical supplies under all programs 68.10 of medical care provided by the state and for congregate living 68.11 care under the income maintenance programs. 68.12 (12) Have the authority to conduct and administer 68.13 experimental projects to test methods and procedures of 68.14 administering assistance and services to recipients or potential 68.15 recipients of public welfare. To carry out such experimental 68.16 projects, it is further provided that the commissioner of human 68.17 services is authorized to waive the enforcement of existing 68.18 specific statutory program requirements, rules, and standards in 68.19 one or more counties. The order establishing the waiver shall 68.20 provide alternative methods and procedures of administration, 68.21 shall not be in conflict with the basic purposes, coverage, or 68.22 benefits provided by law, and in no event shall the duration of 68.23 a project exceed four years. It is further provided that no 68.24 order establishing an experimental project as authorized by the 68.25 provisions of this section shall become effective until the 68.26 following conditions have been met: 68.27 (a) The secretary of health and human services of the 68.28 United States has agreed, for the same project, to waive state 68.29 plan requirements relative to statewide uniformity. 68.30 (b) A comprehensive plan, including estimated project 68.31 costs, shall be approved by the legislative advisory commission 68.32 and filed with the commissioner of administration. 68.33 (13) According to federal requirements, establish 68.34 procedures to be followed by local welfare boards in creating 68.35 citizen advisory committees, including procedures for selection 68.36 of committee members. 69.1 (14) Allocate federal fiscal disallowances or sanctions 69.2 which are based on quality control error rates for the aid to 69.3 families with dependent children program formerly codified in 69.4 sections 256.72 to 256.87, medical assistance, or food stamp 69.5 program in the following manner: 69.6 (a) One-half of the total amount of the disallowance shall 69.7 be borne by the county boards responsible for administering the 69.8 programs. For the medical assistance and the AFDC program 69.9 formerly codified in sections 256.72 to 256.87, disallowances 69.10 shall be shared by each county board in the same proportion as 69.11 that county's expenditures for the sanctioned program are to the 69.12 total of all counties' expenditures for the AFDC program 69.13 formerly codified in sections 256.72 to 256.87, and medical 69.14 assistance programs. For the food stamp program, sanctions 69.15 shall be shared by each county board, with 50 percent of the 69.16 sanction being distributed to each county in the same proportion 69.17 as that county's administrative costs for food stamps are to the 69.18 total of all food stamp administrative costs for all counties, 69.19 and 50 percent of the sanctions being distributed to each county 69.20 in the same proportion as that county's value of food stamp 69.21 benefits issued are to the total of all benefits issued for all 69.22 counties. Each county shall pay its share of the disallowance 69.23 to the state of Minnesota. When a county fails to pay the 69.24 amount due hereunder, the commissioner may deduct the amount 69.25 from reimbursement otherwise due the county, or the attorney 69.26 general, upon the request of the commissioner, may institute 69.27 civil action to recover the amount due. 69.28 (b) Notwithstanding the provisions of paragraph (a), if the 69.29 disallowance results from knowing noncompliance by one or more 69.30 counties with a specific program instruction, and that knowing 69.31 noncompliance is a matter of official county board record, the 69.32 commissioner may require payment or recover from the county or 69.33 counties, in the manner prescribed in paragraph (a), an amount 69.34 equal to the portion of the total disallowance which resulted 69.35 from the noncompliance, and may distribute the balance of the 69.36 disallowance according to paragraph (a). 70.1 (15) Develop and implement special projects that maximize 70.2 reimbursements and result in the recovery of money to the 70.3 state. For the purpose of recovering state money, the 70.4 commissioner may enter into contracts with third parties. Any 70.5 recoveries that result from projects or contracts entered into 70.6 under this paragraph shall be deposited in the state treasury 70.7 and credited to a special account until the balance in the 70.8 account reaches $1,000,000. When the balance in the account 70.9 exceeds $1,000,000, the excess shall be transferred and credited 70.10 to the general fund. All money in the account is appropriated 70.11 to the commissioner for the purposes of this paragraph. 70.12 (16) Have the authority to make direct payments to 70.13 facilities providing shelter to women and their children 70.14 according to section 256D.05, subdivision 3. Upon the written 70.15 request of a shelter facility that has been denied payments 70.16 under section 256D.05, subdivision 3, the commissioner shall 70.17 review all relevant evidence and make a determination within 30 70.18 days of the request for review regarding issuance of direct 70.19 payments to the shelter facility. Failure to act within 30 days 70.20 shall be considered a determination not to issue direct payments. 70.21 (17) Have the authority to establish and enforce the 70.22 following county reporting requirements: 70.23 (a) The commissioner shall establish fiscal and statistical 70.24 reporting requirements necessary to account for the expenditure 70.25 of funds allocated to counties for human services programs. 70.26 When establishing financial and statistical reporting 70.27 requirements, the commissioner shall evaluate all reports, in 70.28 consultation with the counties, to determine if the reports can 70.29 be simplified or the number of reports can be reduced. 70.30 (b) The county board shall submit monthly or quarterly 70.31 reports to the department as required by the commissioner. 70.32 Monthly reports are due no later than 15 working days after the 70.33 end of the month. Quarterly reports are due no later than 30 70.34 calendar days after the end of the quarter, unless the 70.35 commissioner determines that the deadline must be shortened to 70.36 20 calendar days to avoid jeopardizing compliance with federal 71.1 deadlines or risking a loss of federal funding. Only reports 71.2 that are complete, legible, and in the required format shall be 71.3 accepted by the commissioner. 71.4 (c) If the required reports are not received by the 71.5 deadlines established in clause (b), the commissioner may delay 71.6 payments and withhold funds from the county board until the next 71.7 reporting period. When the report is needed to account for the 71.8 use of federal funds and the late report results in a reduction 71.9 in federal funding, the commissioner shall withhold from the 71.10 county boards with late reports an amount equal to the reduction 71.11 in federal funding until full federal funding is received. 71.12 (d) A county board that submits reports that are late, 71.13 illegible, incomplete, or not in the required format for two out 71.14 of three consecutive reporting periods is considered 71.15 noncompliant. When a county board is found to be noncompliant, 71.16 the commissioner shall notify the county board of the reason the 71.17 county board is considered noncompliant and request that the 71.18 county board develop a corrective action plan stating how the 71.19 county board plans to correct the problem. The corrective 71.20 action plan must be submitted to the commissioner within 45 days 71.21 after the date the county board received notice of noncompliance. 71.22 (e) The final deadline for fiscal reports or amendments to 71.23 fiscal reports is one year after the date the report was 71.24 originally due. If the commissioner does not receive a report 71.25 by the final deadline, the county board forfeits the funding 71.26 associated with the report for that reporting period and the 71.27 county board must repay any funds associated with the report 71.28 received for that reporting period. 71.29 (f) The commissioner may not delay payments, withhold 71.30 funds, or require repayment under paragraph (c) or (e) if the 71.31 county demonstrates that the commissioner failed to provide 71.32 appropriate forms, guidelines, and technical assistance to 71.33 enable the county to comply with the requirements. If the 71.34 county board disagrees with an action taken by the commissioner 71.35 under paragraph (c) or (e), the county board may appeal the 71.36 action according to sections 14.57 to 14.69. 72.1 (g) Counties subject to withholding of funds under 72.2 paragraph (c) or forfeiture or repayment of funds under 72.3 paragraph (e) shall not reduce or withhold benefits or services 72.4 to clients to cover costs incurred due to actions taken by the 72.5 commissioner under paragraph (c) or (e). 72.6 (18) Allocate federal fiscal disallowances or sanctions for 72.7 audit exceptions when federal fiscal disallowances or sanctions 72.8 are based on a statewide random sample for the foster care 72.9 program under title IV-E of the Social Security Act, United 72.10 States Code, title 42, in direct proportion to each county's 72.11 title IV-E foster care maintenance claim for that period. 72.12 (19) Be responsible for ensuring the detection, prevention, 72.13 investigation, and resolution of fraudulent activities or 72.14 behavior by applicants, recipients, and other participants in 72.15 the human services programs administered by the department. 72.16 (20) Require county agencies to identify overpayments, 72.17 establish claims, and utilize all available and cost-beneficial 72.18 methodologies to collect and recover these overpayments in the 72.19 human services programs administered by the department. 72.20 (21) Have the authority to administer a drug rebate program 72.21 for drugs purchased pursuant to the prescription drug program 72.22 established under section 256.955 after the beneficiary's 72.23 satisfaction of any deductible established in the program. The 72.24 commissioner shall require a rebate agreement from all 72.25 manufacturers of covered drugs as defined in section 256B.0625, 72.26 subdivision 13. Rebate agreements for prescription drugs 72.27 delivered on or after July 1, 2002, must include rebates for 72.28 individuals covered under the prescription drug program who are 72.29 under 65 years of age. For each drug, the amount of the rebate 72.30 shall be equal to the basic rebate as defined for purposes of 72.31 the federal rebate program in United States Code, title 42, 72.32 section 1396r-8(c)(1). This basic rebate shall be applied to 72.33 single-source and multiple-source drugs. The manufacturers must 72.34 provide full payment within 30 days of receipt of the state 72.35 invoice for the rebate within the terms and conditions used for 72.36 the federal rebate program established pursuant to section 1927 73.1 of title XIX of the Social Security Act. The manufacturers must 73.2 provide the commissioner with any information necessary to 73.3 verify the rebate determined per drug. The rebate program shall 73.4 utilize the terms and conditions used for the federal rebate 73.5 program established pursuant to section 1927 of title XIX of the 73.6 Social Security Act. 73.7 (22) Have the authority to administer the federal drug 73.8 rebate program for drugs purchased under the medical assistance 73.9 program as allowed by section 1927 of title XIX of the Social 73.10 Security Act and according to the terms and conditions of 73.11 section 1927. Rebates shall be collected for all drugs that 73.12 have been dispensed or administered in an outpatient setting and 73.13 that are from manufacturers who have signed a rebate agreement 73.14 with the United States Department of Health and Human Services. 73.15(22)(23) Operate the department's communication systems 73.16 account established in Laws 1993, First Special Session chapter 73.17 1, article 1, section 2, subdivision 2, to manage shared 73.18 communication costs necessary for the operation of the programs 73.19 the commissioner supervises. A communications account may also 73.20 be established for each regional treatment center which operates 73.21 communications systems. Each account must be used to manage 73.22 shared communication costs necessary for the operations of the 73.23 programs the commissioner supervises. The commissioner may 73.24 distribute the costs of operating and maintaining communication 73.25 systems to participants in a manner that reflects actual usage. 73.26 Costs may include acquisition, licensing, insurance, 73.27 maintenance, repair, staff time and other costs as determined by 73.28 the commissioner. Nonprofit organizations and state, county, 73.29 and local government agencies involved in the operation of 73.30 programs the commissioner supervises may participate in the use 73.31 of the department's communications technology and share in the 73.32 cost of operation. The commissioner may accept on behalf of the 73.33 state any gift, bequest, devise or personal property of any 73.34 kind, or money tendered to the state for any lawful purpose 73.35 pertaining to the communication activities of the department. 73.36 Any money received for this purpose must be deposited in the 74.1 department's communication systems accounts. Money collected by 74.2 the commissioner for the use of communication systems must be 74.3 deposited in the state communication systems account and is 74.4 appropriated to the commissioner for purposes of this section. 74.5(23)(24) Receive any federal matching money that is made 74.6 available through the medical assistance program for the 74.7 consumer satisfaction survey. Any federal money received for 74.8 the survey is appropriated to the commissioner for this 74.9 purpose. The commissioner may expend the federal money received 74.10 for the consumer satisfaction survey in either year of the 74.11 biennium. 74.12(24)(25) Incorporate cost reimbursement claims from First 74.13 Call Minnesota into the federal cost reimbursement claiming 74.14 processes of the department according to federal law, rule, and 74.15 regulations. Any reimbursement received is appropriated to the 74.16 commissioner and shall be disbursed to First Call Minnesota 74.17 according to normal department payment schedules. 74.18(25)(26) Develop recommended standards for foster care 74.19 homes that address the components of specialized therapeutic 74.20 services to be provided by foster care homes with those services. 74.21 Sec. 2. Minnesota Statutes 2000, section 256.955, 74.22 subdivision 2b, is amended to read: 74.23 Subd. 2b. [ELIGIBILITY.] Effective July 1, 2002, an 74.24 individual satisfying the following requirements and the 74.25 requirements described in subdivision 2, paragraph (d), is 74.26 eligible for the prescription drug program: 74.27 (1) is under 65 years of age; and 74.28 (2) is eligible as a qualified Medicare beneficiary 74.29 according to section 256B.057, subdivision 3 or 3a, or is 74.30 eligible under section 256B.057, subdivision 3 or 3a, and is 74.31 also eligible for medical assistance or general assistance 74.32 medical care with a spenddown as defined in section 256B.056, 74.33 subdivision 5. 74.34 Sec. 3. [256.956] [PURCHASING ALLIANCE STOP-LOSS FUND.] 74.35 Subdivision 1. [DEFINITIONS.] For purposes of this 74.36 section, the following definitions apply: 75.1 (a) "Commissioner" means the commissioner of human services. 75.2 (b) "Health plan" means a policy, contract, or certificate 75.3 issued by a health plan company to a qualifying purchasing 75.4 alliance. Any health plan issued to the members of a qualifying 75.5 purchasing alliance must meet the requirements of chapter 62L. 75.6 (c) "Health plan company" means: 75.7 (1) a health carrier as defined under section 62A.011, 75.8 subdivision 2; 75.9 (2) a community integrated service network operating under 75.10 chapter 62N; or 75.11 (3) an accountable provider network operating under chapter 75.12 62T. 75.13 (d) "Qualifying employer" means an employer who: 75.14 (1) is a member of a qualifying purchasing alliance; 75.15 (2) has at least one employee but no more than ten 75.16 employees or is a sole proprietor or farmer; 75.17 (3) did not offer employer-subsidized health care coverage 75.18 to its employees for at least 12 months prior to joining the 75.19 purchasing alliance; and 75.20 (4) is offering health coverage through the purchasing 75.21 alliance to all employees who work at least 20 hours per week 75.22 unless the employee is eligible for Medicare. 75.23 For purposes of this subdivision, "employer-subsidized health 75.24 coverage" means health coverage for which the employer pays at 75.25 least 50 percent of the cost of coverage for the employee. 75.26 (e) "Qualifying enrollee" means an employee of a qualifying 75.27 employer or the employee's dependent covered by a health plan. 75.28 (f) "Qualifying purchasing alliance" means a purchasing 75.29 alliance as defined in section 62T.01, subdivision 2, that: 75.30 (1) meets the requirements of chapter 62T; 75.31 (2) services a geographic area located in outstate 75.32 Minnesota, excluding the city of Duluth; and 75.33 (3) is organized and operating before May 1, 2001. 75.34 The criteria used by the qualifying purchasing alliance for 75.35 membership must be approved by the commissioner of health. A 75.36 qualifying purchasing alliance may begin enrolling qualifying 76.1 employers after July 1, 2001, with enrollment ending by December 76.2 31, 2003. 76.3 Subd. 2. [CREATION OF ACCOUNT.] A purchasing alliance 76.4 stop-loss fund account is established in the general fund. The 76.5 commissioner shall use the money to establish a stop-loss fund 76.6 from which a health plan company may receive reimbursement for 76.7 claims paid for qualifying enrollees. The account consists of 76.8 money appropriated by the legislature. Money from the account 76.9 must be used for the stop-loss fund. 76.10 Subd. 3. [REIMBURSEMENT.] (a) A health plan company may 76.11 receive reimbursement from the fund for 90 percent of the 76.12 portion of the claim that exceeds $30,000 but not of the portion 76.13 that exceeds $100,000 in a calendar year for a qualifying 76.14 enrollee. 76.15 (b) Claims shall be reported and funds shall be distributed 76.16 on a calendar-year basis. Claims shall be eligible for 76.17 reimbursement only for the calendar year in which the claims 76.18 were paid. 76.19 (c) Once claims paid on behalf of a qualifying enrollee 76.20 reach $100,000 in a given calendar year, no further claims may 76.21 be submitted for reimbursement on behalf of that enrollee in 76.22 that calendar year. 76.23 Subd. 4. [REQUEST PROCESS.] (a) Each health plan company 76.24 must submit a request for reimbursement from the fund on a form 76.25 prescribed by the commissioner. Requests for payment must be 76.26 submitted no later than April 1 following the end of the 76.27 calendar year for which the reimbursement request is being made, 76.28 beginning April 1, 2002. 76.29 (b) The commissioner may require a health plan company to 76.30 submit claims data as needed in connection with the 76.31 reimbursement request. 76.32 Subd. 5. [DISTRIBUTION.] (a) The commissioner shall 76.33 calculate the total claims reimbursement amount for all 76.34 qualifying health plan companies for the calendar year for which 76.35 claims are being reported and shall distribute the stop-loss 76.36 funds on an annual basis. 77.1 (b) In the event that the total amount requested for 77.2 reimbursement by the health plan companies for a calendar year 77.3 exceeds the funds available for distribution for claims paid by 77.4 all health plan companies during the same calendar year, the 77.5 commissioner shall provide for the pro rata distribution of the 77.6 available funds. Each health plan company shall be eligible to 77.7 receive only a proportionate amount of the available funds as 77.8 the health plan company's total eligible claims paid compares to 77.9 the total eligible claims paid by all health plan companies. 77.10 (c) In the event that funds available for distribution for 77.11 claims paid by all health plan companies during a calendar year 77.12 exceed the total amount requested for reimbursement by all 77.13 health plan companies during the same calendar year, any excess 77.14 funds shall be reallocated for distribution in the next calendar 77.15 year. 77.16 Subd. 6. [DATA.] Upon the request of the commissioner, 77.17 each health plan company shall furnish such data as the 77.18 commissioner deems necessary to administer the fund. The 77.19 commissioner may require that such data be submitted on a per 77.20 enrollee, aggregate, or categorical basis. Any data submitted 77.21 under this section shall be classified as private data or 77.22 nonpublic data as defined in section 13.02. 77.23 Subd. 7. [DELEGATION.] The commissioner may delegate any 77.24 or all of the commissioner's administrative duties to another 77.25 state agency or to a private contractor. 77.26 Subd. 8. [REPORT.] The commissioner of commerce, in 77.27 consultation with the office of rural health and the qualifying 77.28 purchasing alliances, shall evaluate the extent to which the 77.29 purchasing alliance stop-loss fund increases the availability of 77.30 employer-subsidized health care coverage for residents residing 77.31 in the geographic areas served by the qualifying purchasing 77.32 alliances. A preliminary report must be submitted to the 77.33 legislature by February 15, 2003, and a final report must be 77.34 submitted by February 15, 2004. 77.35 Subd. 9. [SUNSET.] This section shall expire January 1, 77.36 2005. 78.1 Sec. 4. [256.958] [RETIRED DENTIST PROGRAM.] 78.2 Subdivision 1. [PROGRAM.] The commissioner of human 78.3 services shall establish a program to reimburse a retired 78.4 dentist for the dentist's license fee and for the cost of 78.5 malpractice insurance in exchange for the dentist providing 100 78.6 hours of dental services on a volunteer basis within a 12-month 78.7 period at a community dental clinic or a dental training clinic 78.8 located at a Minnesota state college or university. 78.9 Subd. 2. [DOCUMENTATION.] Upon completion of the required 78.10 hours, the retired dentist shall submit to the commissioner the 78.11 following: 78.12 (1) documentation of service provided; 78.13 (2) the cost of malpractice insurance for the 12-month 78.14 period; and 78.15 (3) the cost of the license. 78.16 Subd. 3. [REIMBURSEMENT.] Upon receipt of the information 78.17 described in subdivision 2, the commissioner shall provide 78.18 reimbursement to the retired dentist for the cost of malpractice 78.19 insurance for the previous 12-month period and the cost of the 78.20 license. 78.21 Sec. 5. Minnesota Statutes 2000, section 256.9657, 78.22 subdivision 2, is amended to read: 78.23 Subd. 2. [HOSPITAL SURCHARGE.] (a) Effective October 1, 78.24 1992, each Minnesota hospital except facilities of the federal 78.25 Indian Health Service and regional treatment centers shall pay 78.26 to the medical assistance account a surcharge equal to 1.4 78.27 percent of net patient revenues excluding net Medicare revenues 78.28 reported by that provider to the health care cost information 78.29 system according to the schedule in subdivision 4. 78.30 (b) Effective July 1, 1994, the surcharge under paragraph 78.31 (a) is increased to 1.56 percent. 78.32 (c) Notwithstanding the Medicare cost finding and allowable 78.33 cost principles, the hospital surcharge is not an allowable cost 78.34 for purposes of rate setting under sections 256.9685 to 256.9695. 78.35 Sec. 6. Minnesota Statutes 2000, section 256.969, 78.36 subdivision 2b, is amended to read: 79.1 Subd. 2b. [OPERATING PAYMENT RATES.] In determining 79.2 operating payment rates for admissions occurring on or after the 79.3 rate year beginning January 1, 1991, and every two years after, 79.4 or more frequently as determined by the commissioner, the 79.5 commissioner shall obtain operating data from an updated base 79.6 year and, within the limits of available appropriations, 79.7 establish operating payment rates per admission for each 79.8 hospital based on the cost-finding methods and allowable costs 79.9 of the Medicare program in effect during the base year. Rates 79.10 under the general assistance medical care, medical assistance, 79.11 and MinnesotaCare programs shall not be rebased to more current 79.12 data on January 1, 1997. The base year operating payment rate 79.13 per admission is standardized by the case mix index and adjusted 79.14 by the hospital cost index, relative values, and 79.15 disproportionate population adjustment. The cost and charge 79.16 data used to establish operating rates shall only reflect 79.17 inpatient services covered by medical assistance and shall not 79.18 include property cost information and costs recognized in 79.19 outlier payments. 79.20 Sec. 7. Minnesota Statutes 2000, section 256.969, is 79.21 amended by adding a subdivision to read: 79.22 Subd. 26. [GREATER MINNESOTA PAYMENT ADJUSTMENT AFTER JUNE 79.23 30, 2001.] (a) For admissions occurring after June 30, 2001, the 79.24 commissioner shall pay all medical assistance inpatient 79.25 fee-for-service admissions for the diagnosis-related groups 79.26 specified in paragraph (b) at hospitals located outside of the 79.27 seven-county metropolitan area at the higher of: 79.28 (1) the hospital's current payment rate for the diagnostic 79.29 category to which the diagnosis-related group belongs, exclusive 79.30 of disproportionate population adjustments received under 79.31 subdivision 9 and hospital payment adjustments received under 79.32 subdivision 23; or 79.33 (2) the rate in clause (1) plus a proportion of the 79.34 difference between the current average payment rate for that 79.35 diagnostic category for hospitals located within the 79.36 seven-county metropolitan area, exclusive of disproportionate 80.1 population adjustments received under subdivision 9 and hospital 80.2 payment adjustments received under subdivision 23, and the 80.3 current rate in clause (1). This proportion shall be 12.5 80.4 percent for the fiscal year beginning July 1, 2001, and shall 80.5 increase by 12.5 percentage points for each of the next seven 80.6 fiscal years, such that the proportion is 100 percent for the 80.7 fiscal year beginning July 1, 2008. 80.8 (b) The reimbursement increases provided in paragraph (a) 80.9 apply to the following diagnosis-related groups as they fall 80.10 within the diagnostic categories: 80.11 (1) 370 C-section with complicating diagnosis; 80.12 (2) 371 C-section without complicating diagnosis; 80.13 (3) 372 vaginal delivery with complicating diagnosis; 80.14 (4) 373 vaginal delivery without complicating diagnosis; 80.15 (5) 386 extreme immaturity, weight greater than 1,500 80.16 grams; 80.17 (6) 388 full-term neonates with other problems; 80.18 (7) 390 prematurity without major problems; 80.19 (8) 391 normal newborn case; 80.20 (9) 385 neonate, died or transferred to another health care 80.21 facility; 80.22 (10) 425 acute adjustment reaction and psychosocial 80.23 dysfunctioning; 80.24 (11) 430 psychosis; 80.25 (12) 431 childhood mental disorders; and 80.26 (13) 164-167 appendectomy. 80.27 Sec. 8. Minnesota Statutes 2000, section 256B.04, is 80.28 amended by adding a subdivision to read: 80.29 Subd. 1b. [CONTRACT FOR SERVICES FOR AMERICAN INDIAN 80.30 CHILDREN.] Notwithstanding subdivision 1, the commissioner may 80.31 contract with federally recognized Indian tribes with a 80.32 reservation in Minnesota for the provision of early and periodic 80.33 screening, diagnosis, and treatment administrative services for 80.34 American Indian children, according to Code of Federal 80.35 Regulations, title 42, section 441, subpart B, and Minnesota 80.36 Rules, part 9505.1693 et seq., when the tribe chooses to provide 81.1 such services. For purposes of this subdivision, "American 81.2 Indian" has the meaning given to persons to whom services will 81.3 be provided for in Code of Federal Regulations, title 42, 81.4 section 36.12. Notwithstanding Minnesota Rules, part 9505.1748, 81.5 subpart 1, the commissioner, the local agency, and the tribe may 81.6 contract with any entity for the provision of early and periodic 81.7 screening, diagnosis, and treatment administrative services. 81.8 [EFFECTIVE DATE.] This section is effective the day 81.9 following final enactment. 81.10 Sec. 9. Minnesota Statutes 2000, section 256B.055, 81.11 subdivision 3a, is amended to read: 81.12 Subd. 3a. [MFIP-S FAMILIES;FAMILIES ELIGIBLE UNDER PRIOR 81.13 AFDC RULES.] (a)Beginning January 1, 1998, or on the date that81.14MFIP-S is implemented in counties, medical assistance may be81.15paid for a person receiving public assistance under the MFIP-S81.16program.Beginning July 1, 2002, medical assistance may be paid 81.17 for a person who would have been eligible, but for excess income 81.18 or assets, under the state's AFDC plan in effect as of July 16, 81.19 1996, with the base AFDC standard increased by three percent 81.20 effective July 1, 2000. 81.21 (b) BeginningJanuary 1, 1998,July 1, 2002, medical 81.22 assistance may be paid for a person who would have been eligible 81.23 for public assistance under the income andresourceassets 81.24 standards, or who would have been eligible but for excess income81.25or assets,under the state's AFDC plan in effect as of July 16, 81.26 1996,as required by the Personal Responsibility and Work81.27Opportunity Reconciliation Act of 1996 (PRWORA), Public Law81.28Number 104-193with the base AFDC rate increased by three 81.29 percent effective July 1, 2000. 81.30 [EFFECTIVE DATE.] This section is effective July 1, 2002. 81.31 Sec. 10. Minnesota Statutes 2000, section 256B.056, 81.32 subdivision 1a, is amended to read: 81.33 Subd. 1a. [INCOME AND ASSETS GENERALLY.] Unless 81.34 specifically required by state law or rule or federal law or 81.35 regulation, the methodologies used in counting income and assets 81.36 to determine eligibility for medical assistance for persons 82.1 whose eligibility category is based on blindness, disability, or 82.2 age of 65 or more years, the methodologies for the supplemental 82.3 security income program shall be used. Effective upon federal 82.4 approval, for children eligible under section 256B.055, 82.5 subdivision 12, or for home and community-based waiver services 82.6 whose eligibility for medical assistance is determined without 82.7 regard to parental income, child support payments, including any 82.8 payments made by an obligor in satisfaction of or in addition to 82.9 a temporary or permanent order for child support, social 82.10 security payments, and other benefits for basic needs are not 82.11 counted as income. For families and children, which includes 82.12 all other eligibility categories, the methodologies under the 82.13 state's AFDC plan in effect as of July 16, 1996, as required by 82.14 the Personal Responsibility and Work Opportunity Reconciliation 82.15 Act of 1996 (PRWORA), Public Law Number 104-193, shall be used. 82.16 Effective upon federal approval, in-kind contributions to, and 82.17 payments made on behalf of, a recipient, by an obligor, in 82.18 satisfaction of or in addition to a temporary or permanent order 82.19 for child support or maintenance, shall be considered income to 82.20 the recipient. For these purposes, a "methodology" does not 82.21 include an asset or income standard, or accounting method, or 82.22 method of determining effective dates. 82.23 Sec. 11. Minnesota Statutes 2000, section 256B.056, 82.24 subdivision 3, is amended to read: 82.25 Subd. 3. [ASSET LIMITATIONS.] To be eligible for medical 82.26 assistance, a person must not individually own more than $3,000 82.27 in assets, or if a member of a household with two family 82.28 members, husband and wife, or parent and child, the household 82.29 must not own more than $6,000 in assets, plus $200 for each 82.30 additional legal dependent. In addition to these maximum 82.31 amounts, an eligible individual or family may accrue interest on 82.32 these amounts, but they must be reduced to the maximum at the 82.33 time of an eligibility redetermination. The accumulation of the 82.34 clothing and personal needs allowance according to section 82.35 256B.35 must also be reduced to the maximum at the time of the 82.36 eligibility redetermination. The value of assets that are not 83.1 considered in determining eligibility for medical assistance is 83.2 the value of those assets excluded under the AFDC state plan as 83.3 of July 16, 1996, as required by the Personal Responsibility and 83.4 Work Opportunity Reconciliation Act of 1996 (PRWORA), Public Law 83.5 Number 104-193, for families and children, and the supplemental 83.6 security income program for aged, blind, and disabled persons, 83.7 with the following exceptions: 83.8 (a) Household goods and personal effects are not considered. 83.9 (b) Capital and operating assets of a trade or business 83.10 that the local agency determines are necessary to the person's 83.11 ability to earn an income are not considered. 83.12 (c) Motor vehicles are excluded to the same extent excluded 83.13 by the supplemental security income program. 83.14 (d) Assets designated as burial expenses are excluded to 83.15 the same extent excluded by the supplemental security income 83.16 program. 83.17 (e) Effective upon federal approval, for a person who no 83.18 longer qualifies as an employed person with a disability due to 83.19 loss of earnings, assets allowed while eligible for medical 83.20 assistance under section 256B.057, subdivision 9, are not 83.21 considered for 12 months, beginning with the first month of 83.22 ineligibility as an employed person with a disability, to the 83.23 extent that the person's total assets remain within the allowed 83.24 limits of section 256B.057, subdivision 9, paragraph (b). 83.25 Sec. 12. Minnesota Statutes 2000, section 256B.056, 83.26 subdivision 4, is amended to read: 83.27 Subd. 4. [INCOME.] (a) To be eligible for medical 83.28 assistance, a person eligible under section 256B.055, 83.29subdivisionsubdivisions 7, 7a, and 12,not receiving83.30supplemental security income program payments, andmay have 83.31 income up to the following specified percentages of the federal 83.32 poverty guidelines for the family size effective on April 1 of 83.33 each year: 83.34 (1) 80 percent, effective July 1, 2002; 83.35 (2) 90 percent, effective July 1, 2003; 83.36 (3) 100 percent, effective July 1, 2004. 84.1 Increases in benefits under title II of the Social Security Act 84.2 shall not be counted as income for purposes of this subdivision 84.3 until the first day of the second full month following 84.4 publication of the change in the federal poverty guidelines. 84.5 (b) To be eligible for medical assistance, families and 84.6 children may have an income up to 133-1/3 percent of the AFDC 84.7 income standard in effect under the July 16, 1996, AFDC state 84.8 plan. Effective July 1, 2000, the base AFDC standard in effect 84.9 on July 16, 1996, shall be increased by three percent. Effective 84.10 January 1, 2000, and each successive January, recipients of 84.11 supplemental security income may have an income up to the 84.12 supplemental security income standard in effect on that date. 84.13 (c) Effective July 1, 2002, to be eligible for medical 84.14 assistance, families and children may have an income up to 100 84.15 percent of the federal poverty guidelines for the family size 84.16 effective on April 1 of each year. 84.17 (d) In computing income to determine eligibility of persons 84.18 under paragraphs (a) to (c) who are not residents of long-term 84.19 care facilities, the commissioner shall disregard increases in 84.20 income as required by Public Law Numbers 94-566, section 503; 84.21 99-272; and 99-509. Veterans aid and attendance benefits and 84.22 Veterans Administration unusual medical expense payments are 84.23 considered income to the recipient. 84.24 Sec. 13. Minnesota Statutes 2000, section 256B.056, 84.25 subdivision 5, is amended to read: 84.26 Subd. 5. [EXCESS INCOME.] A person who has excess income 84.27 is eligible for medical assistance if the person has expenses 84.28 for medical care that are more than the amount of the person's 84.29 excess income, computed by deducting incurred medical expenses 84.30 from the excess income to reduce the excess to the income 84.31 standard specified in subdivision 4, except that if federal 84.32 authorization to use the standard in subdivision 4 is not 84.33 obtained, the medically needy standard for purposes of a 84.34 spenddown shall be 133 and 1/3 percent of the AFDC income 84.35 standard in effect under the July 16, 1996, AFDC state plan, 84.36 increased by three percent. The person shall elect to have the 85.1 medical expenses deducted at the beginning of a one-month budget 85.2 period or at the beginning of a six-month budget period. The 85.3 commissioner shall allow persons eligible for assistance on a 85.4 one-month spenddown basis under this subdivision to elect to pay 85.5 the monthly spenddown amount in advance of the month of 85.6 eligibility to the state agency in order to maintain eligibility 85.7 on a continuous basis. If the recipient does not pay the 85.8 spenddown amount on or before the 20th of the month, the 85.9 recipient is ineligible for this option for the following 85.10 month. The local agency shall code the Medicaid Management 85.11 Information System (MMIS) to indicate that the recipient has 85.12 elected this option. The state agency shall convey recipient 85.13 eligibility information relative to the collection of the 85.14 spenddown to providers through the Electronic Verification 85.15 System (EVS). A recipient electing advance payment must pay the 85.16 state agency the monthly spenddown amount on or before the 20th 85.17 of the month in order to be eligible for this option in the 85.18 following month. 85.19 Sec. 14. Minnesota Statutes 2000, section 256B.057, 85.20 subdivision 9, is amended to read: 85.21 Subd. 9. [EMPLOYED PERSONS WITH DISABILITIES.] (a) Medical 85.22 assistance may be paid for a person who is employed and who: 85.23 (1) meets the definition of disabled under the supplemental 85.24 security income program; 85.25 (2) is at least 16 but less than 65 years of age; 85.26 (3) meets the asset limits in paragraph (b); and 85.27 (4) pays a premium, if required, under paragraph (c). 85.28 Any spousal income or assets shall be disregarded for purposes 85.29 of eligibility and premium determinations. 85.30 (b) For purposes of determining eligibility under this 85.31 subdivision, a person's assets must not exceed $20,000, 85.32 excluding: 85.33 (1) all assets excluded under section 256B.056; 85.34 (2) retirement accounts, including individual accounts, 85.35 401(k) plans, 403(b) plans, Keogh plans, and pension plans; and 85.36 (3) medical expense accounts set up through the person's 86.1 employer. 86.2 (c) A person whose earned and unearned income is equal to 86.3 or greater than200100 percent of federal poverty guidelines 86.4 for the applicable family size must pay a premium to be eligible 86.5 for medical assistance under this subdivision. The premium 86.6 shall beequal to ten percent ofbased on the person's gross 86.7 earned and unearned incomeabove 200 percent of federal poverty86.8guidelines forand the applicable family sizeup to the cost of86.9coverage, using a sliding fee scale established by the 86.10 commissioner which begins at one percent of income at 100 86.11 percent of the federal poverty guidelines and gradually 86.12 increases to 7.5 percent of income for those with incomes at or 86.13 above 300 percent of the federal poverty guidelines. 86.14 (d) A person's eligibility and premium shall be determined 86.15 by the local county agency. Premiums must be paid to the 86.16 commissioner. All premiums are dedicated to the commissioner. 86.17 (e) Any required premium shall be determined at application 86.18 and redetermined annually at recertification or when a change in 86.19 income or family size occurs. 86.20 (f) Premium payment is due upon notification from the 86.21 commissioner of the premium amount required. Premiums may be 86.22 paid in installments at the discretion of the commissioner. 86.23 (g) Nonpayment of the premium shall result in denial or 86.24 termination of medical assistance unless the person demonstrates 86.25 good cause for nonpayment. Good cause exists if the 86.26 requirements specified in Minnesota Rules, part 9506.0040, 86.27 subpart 7, items B to D, are met. Nonpayment shall include 86.28 payment with a returned, refused, or dishonored instrument. The 86.29 commissioner may require a guaranteed form of payment as the 86.30 only means to replace a returned, refused, or dishonored 86.31 instrument. 86.32 [EFFECTIVE DATE.] This section is effective September 1, 86.33 2001. 86.34 Sec. 15. Minnesota Statutes 2000, section 256B.057, is 86.35 amended by adding a subdivision to read: 86.36 Subd. 10. [CERTAIN PERSONS NEEDING TREATMENT FOR BREAST OR 87.1 CERVICAL CANCER.] (a) Medical assistance may be paid for a 87.2 person who: 87.3 (1) has been screened for breast or cervical cancer by the 87.4 Minnesota breast and cervical cancer control program, and 87.5 program funds have been used to pay for the person's screening; 87.6 (2) according to the person's treating health professional, 87.7 needs treatment, including diagnostic services necessary to 87.8 determine the extent and proper course of treatment, for breast 87.9 or cervical cancer, including precancerous conditions and early 87.10 stage cancer; 87.11 (3) meets the income eligibility guidelines for the 87.12 Minnesota breast and cervical cancer control program; 87.13 (4) is under age 65; 87.14 (5) is not otherwise eligible for medical assistance under 87.15 United States Code, title 42, section 1396(a)(10)(A)(i); and 87.16 (6) is not otherwise covered under creditable coverage, as 87.17 defined under United States Code, title 42, section 300gg(c). 87.18 (b) Medical assistance provided for an eligible person 87.19 under this subdivision shall be limited to services provided 87.20 during the period that the person receives treatment for breast 87.21 or cervical cancer. 87.22 (c) A person meeting the criteria in paragraph (a) is 87.23 eligible for medical assistance without meeting the eligibility 87.24 criteria relating to income and assets in section 256B.056, 87.25 subdivisions 1a to 5b. 87.26 Sec. 16. Minnesota Statutes 2000, section 256B.0625, 87.27 subdivision 3b, is amended to read: 87.28 Subd. 3b. [TELEMEDICINE CONSULTATIONS.](a)Medical 87.29 assistance covers telemedicine consultations. Telemedicine 87.30 consultations must be made via two-way, interactive video or 87.31 store-and-forward technology. Store-and-forward technology 87.32 includes telemedicine consultations that do not occur in real 87.33 time via synchronous transmissions, and that do not require a 87.34 face-to-face encounter with the patient for all or any part of 87.35 any such telemedicine consultation. The patient record must 87.36 include a written opinion from the consulting physician 88.1 providing the telemedicine consultation. A communication 88.2 between two physicians that consists solely of a telephone 88.3 conversation is not a telemedicine consultation. Coverage is 88.4 limited to three telemedicine consultations per recipient per 88.5 calendar week. Telemedicine consultations shall be paid at the 88.6 full allowable rate. 88.7(b) This subdivision expires July 1, 2001.88.8 Sec. 17. Minnesota Statutes 2000, section 256B.0625, is 88.9 amended by adding a subdivision to read: 88.10 Subd. 5a. [INTENSIVE EARLY INTERVENTION BEHAVIOR THERAPY 88.11 SERVICES FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS.] (a) 88.12 [COVERAGE.] Medical assistance covers home-based intensive early 88.13 intervention behavior therapy for children with autism spectrum 88.14 disorders. Children with autism spectrum disorder, and their 88.15 custodial parents or foster parents, may access other covered 88.16 services to treat autism spectrum disorder, and are not required 88.17 to receive intensive early intervention behavior therapy 88.18 services under this subdivision. Intensive early intervention 88.19 behavior therapy does not include coverage for services to treat 88.20 developmental disorders of language, early onset psychosis, 88.21 Rett's disorder, selective mutism, social anxiety disorder, 88.22 stereotypic movement disorder, dementia, obsessive compulsive 88.23 disorder, schizoid personality disorder, avoidant personality 88.24 disorder, or reactive attachment disorder. If a child with 88.25 autism spectrum disorder is diagnosed to have one or more of 88.26 these conditions, intensive early intervention behavior therapy 88.27 includes coverage only for services necessary to treat the 88.28 autism spectrum disorder. 88.29 (b) [PURPOSE OF INTENSIVE EARLY INTERVENTION BEHAVIOR 88.30 THERAPY SERVICES (IEIBTS).] The purpose of IEIBTS is to improve 88.31 the child's behavioral functioning, to prevent development of 88.32 challenging behaviors, to eliminate autistic behaviors, to 88.33 reduce the risk of out-of-home placement, and to establish 88.34 independent typical functioning in language and social 88.35 behavior. The procedures used to accomplish these goals are 88.36 based upon research in applied behavior analysis. 89.1 (c) [ELIGIBLE CHILDREN.] A child is eligible to initiate 89.2 IEIBTS if, the child meets the additional eligibility criteria 89.3 in paragraph (d) and in a diagnostic assessment by a mental 89.4 health professional who is not under the employ of the service 89.5 provider, the child: 89.6 (1) is found to have an autism spectrum disorder; 89.7 (2) has a current IQ of either untestable, or at least 30; 89.8 (3) if nonverbal, initiated behavior therapy by 42 months 89.9 of age; 89.10 (4) if verbal, initiated behavior therapy by 48 months of 89.11 age; or 89.12 (5) if having an IQ of at least 50, initiated behavior 89.13 therapy by 84 months of age. 89.14 To continue in IEIBTS, at least one of the child's custodial 89.15 parents or foster parents must participate in an average of at 89.16 least five hours of documented behavior therapy per week for six 89.17 months, and consistently implement behavior therapy 89.18 recommendations 24 hours a day. To continue after six-month 89.19 individualized treatment plan (ITP) reviews, the child must show 89.20 documented progress toward mastery of six-month benchmark 89.21 behavior objectives. The maximum number of months during which 89.22 services may be billed is 54. If significant progress towards 89.23 treatment goals has not been achieved after 24 months of 89.24 treatment, treatment must be discontinued. 89.25 (d) [ADDITIONAL ELIGIBLITY CRITERIA.] A child is eligible 89.26 to initiate IEIBTS if: 89.27 (1) in medical and diagnostic assessments by medical and 89.28 mental health professionals, it is determined that the child 89.29 does not have severe or profound mental retardation; 89.30 (2) an accurate assessment of the child's hearing has been 89.31 performed, including audiometry if the brain stem auditory 89.32 evokes response; 89.33 (3) a blood lead test has been performed prior to 89.34 initiation of treatment; and 89.35 (4) an EEG or neurologic evaluation is done, prior to 89.36 initiation of treatment, if the child has a history of staring 90.1 spells or developmental regression. 90.2 (e) [COVERED SERVICES.] The focus of IEIBTS must be to 90.3 treat the principal diagnostic features of the autism spectrum 90.4 disorder. All IEIBTS must be delivered by a team of 90.5 practitioners under the consistent supervision of a single 90.6 clinical supervisor. A mental health professional must develop 90.7 the ITP for IEIBTS. The ITP must include six-month benchmark 90.8 behavior objectives. All behavior therapy must be based upon 90.9 research in applied behavior analysis, with an emphasis upon 90.10 positive reinforcement of carefully task-analyzed skills for 90.11 optimum rates of progress. All behavior therapy must be 90.12 consistently applied and generalized throughout the 24-hour day 90.13 and seven-day week by all of the child's regular care 90.14 providers. When placing the child in school activities, a 90.15 majority of the peers must have no mental health diagnosis, and 90.16 the child must have sufficient social skills to succeed with 80 90.17 percent of the school activities. Reactive consequences, such 90.18 as redirection, correction, positive practice, or time-out, must 90.19 be used only when necessary to improve the child's success when 90.20 proactive procedures alone have not been effective. IEIBTS must 90.21 be delivered by a team of behavior therapy practitioners who are 90.22 employed under the direction of the same agency. The team may 90.23 deliver up to 200 billable hours per year of direct clinical 90.24 supervisor services, up to 750 billable hours per year of senior 90.25 behavior therapist services, and up to 1,800 billable hours per 90.26 year of direct behavior therapist services. A one-hour clinical 90.27 review meeting for the child, parents, and staff must be 90.28 scheduled 50 weeks a year, at which behavior therapy is reviewed 90.29 and planned. At least one-quarter of the annual clinical 90.30 supervisor billable hours shall consist of on-site clinical 90.31 meeting time. At least one-half of the annual senior behavior 90.32 therapist billable hours shall consist of direct services to the 90.33 child or parents. All of the behavioral therapist billable 90.34 hours shall consist of direct on-site services to the child or 90.35 parents. None of the senior behavior therapist billable hours 90.36 or behavior therapist billable hours shall consist of clinical 91.1 meeting time. If there is any regression of the autistic 91.2 spectrum disorder after 12 months of therapy, a neurologic 91.3 consultation must be performed. 91.4 (f) [PROVIDER QUALIFICATIONS.] The provider agency must be 91.5 capable of delivering consistent applied behavior analysis 91.6 (ABA)-based behavior therapy in the home. The site director of 91.7 the agency must be a mental health professional certified as a 91.8 behavior analyst by the Association for Behavior Analysis. Each 91.9 clinical supervisor must be certified as a behavior analyst by 91.10 the Association for Behavior Analysis. 91.11 (g) [SUPERVISION REQUIREMENTS.] (1) Each behavior therapist 91.12 practitioner must be continuously supervised while in the home 91.13 until the practitioner has mastered competencies for independent 91.14 practice. Each behavior therapist must have mastered three 91.15 credits of academic content and practice in an ABA sequence at 91.16 an accredited university. A college degree or minimum hours of 91.17 experience are not required. Each behavior therapist must 91.18 continue training through weekly direct observation by the 91.19 senior behavior therapist, through demonstrated performance in 91.20 clinical meetings with the clinical supervisor, and annual 91.21 training in ABA. 91.22 (2) Each senior behavior therapist practitioner must have 91.23 mastered the senior behavior therapy competencies, completed one 91.24 year of practice as a behavior therapist, and six months of 91.25 co-therapy training with another senior behavior therapist or 91.26 have an equivalent amount of experience in ABA. Each senior 91.27 behavior therapist must have mastered 12 credits of academic 91.28 content and practice in an ABA sequence at an accredited 91.29 university. Each senior behavior therapist must continue 91.30 training through demonstrated performance in clinical meetings 91.31 with the clinical supervisor, and annual training in ABA. 91.32 (3) Each clinical supervisor practitioner must have 91.33 mastered the clinical supervisor and family consultation 91.34 competencies, completed two years of practice as a senior 91.35 behavior therapist and one year of co-therapy training with 91.36 another clinical supervisor, or equivalent experience in ABA. 92.1 Each clinical supervisor must continue training through annual 92.2 training in ABA. 92.3 (h) [PLACE OF SERVICE.] IEIBTS are provided primarily in 92.4 the child's home and community. Services may be provided in the 92.5 child's natural school or preschool classroom, home of a 92.6 relative, natural recreational setting, or day care. 92.7 (i) [PRIOR AUTHORIZATION REQUIREMENTS.] Prior authorization 92.8 shall be required for services provided after 200 hours of 92.9 clinical supervisor, 750 hours of senior behavior therapist, or 92.10 1,800 hours of behavior therapist services per year. 92.11 (j) [PAYMENT RATES.] The following payment rates apply: 92.12 (1) for an IEIBTS clinical supervisor practitioner under 92.13 supervision of a mental health professional, the lower of the 92.14 submitted charge or $137 per hour unit; 92.15 (2) for an IEIBTS senior behavior therapist practitioner 92.16 under supervision of a mental health professional, the lower of 92.17 the submitted charge or $56 per hour unit; or 92.18 (3) for an IEIBTS behavior therapist practitioner under 92.19 supervision of a mental health professional, the lower of the 92.20 submitted charge or $19 per hour unit. 92.21 An IEIBTS practitioner may receive payment for travel time which 92.22 exceeds 50 minutes one-way. The maximum payment allowed will be 92.23 $0.51 per minute for up to a maximum of 300 hours per year. 92.24 For any week during which the above charges are made to 92.25 medical assistance, payments for the following services are 92.26 excluded: supervising mental health professional hours and 92.27 personal care attendant, home-based mental health, 92.28 family-community support, or mental health behavioral aide hours. 92.29 (k) [REPORT.] The commissioner shall collect evidence of 92.30 the effectiveness of intensive early intervention behavior 92.31 therapy services and present a report to the legislature by July 92.32 1, 2006. 92.33 [EFFECTIVE DATE.] This section is effective January 1, 2002. 92.34 Sec. 18. Minnesota Statutes 2000, section 256B.0625, 92.35 subdivision 13, is amended to read: 92.36 Subd. 13. [DRUGS.] (a) Medical assistance covers drugs, 93.1 except for fertility drugs when specifically used to enhance 93.2 fertility, if prescribed by a licensed practitioner and 93.3 dispensed by a licensed pharmacist, by a physician enrolled in 93.4 the medical assistance program as a dispensing physician, or by 93.5 a physician or a nurse practitioner employed by or under 93.6 contract with a community health board as defined in section 93.7 145A.02, subdivision 5, for the purposes of communicable disease 93.8 control. The commissioner, after receiving recommendations from 93.9 professional medical associations and professional pharmacist 93.10 associations, shall designate a formulary committee to advise 93.11 the commissioner on the names of drugs for which payment is 93.12 made, recommend a system for reimbursing providers on a set fee 93.13 or charge basis rather than the present system, and develop 93.14 methods encouraging use of generic drugs when they are less 93.15 expensive and equally effective as trademark drugs. The 93.16 formulary committee shall consist of nine members, four of whom 93.17 shall be physicians who are not employed by the department of 93.18 human services, and a majority of whose practice is for persons 93.19 paying privately or through health insurance, three of whom 93.20 shall be pharmacists who are not employed by the department of 93.21 human services, and a majority of whose practice is for persons 93.22 paying privately or through health insurance, a consumer 93.23 representative, and a nursing home representative. Committee 93.24 members shall serve three-year terms and shall serve without 93.25 compensation. Members may be reappointed once. 93.26 (b) The commissioner shall establish a drug formulary. Its 93.27 establishment and publication shall not be subject to the 93.28 requirements of the Administrative Procedure Act, but the 93.29 formulary committee shall review and comment on the formulary 93.30 contents. The formulary committee shall review and recommend 93.31 drugs which require prior authorization. The formulary 93.32 committee may recommend drugs for prior authorization directly 93.33 to the commissioner, as long as opportunity for public input is 93.34 provided. Prior authorization may be requested by the 93.35 commissioner based on medical and clinical criteria before 93.36 certain drugs are eligible for payment. Before a drug may be 94.1 considered for prior authorization at the request of the 94.2 commissioner: 94.3 (1) the drug formulary committee must develop criteria to 94.4 be used for identifying drugs; the development of these criteria 94.5 is not subject to the requirements of chapter 14, but the 94.6 formulary committee shall provide opportunity for public input 94.7 in developing criteria; 94.8 (2) the drug formulary committee must hold a public forum 94.9 and receive public comment for an additional 15 days; and 94.10 (3) the commissioner must provide information to the 94.11 formulary committee on the impact that placing the drug on prior 94.12 authorization will have on the quality of patient care and 94.13 information regarding whether the drug is subject to clinical 94.14 abuse or misuse. Prior authorization may be required by the 94.15 commissioner before certain formulary drugs are eligible for 94.16 payment. The formulary shall not include: 94.17 (i) drugs or products for which there is no federal 94.18 funding; 94.19 (ii) over-the-counter drugs, except for antacids, 94.20 acetaminophen, family planning products, aspirin, insulin, 94.21 products for the treatment of lice, vitamins for adults with 94.22 documented vitamin deficiencies, vitamins for children under the 94.23 age of seven and pregnant or nursing women, and any other 94.24 over-the-counter drug identified by the commissioner, in 94.25 consultation with the drug formulary committee, as necessary, 94.26 appropriate, and cost-effective for the treatment of certain 94.27 specified chronic diseases, conditions or disorders, and this 94.28 determination shall not be subject to the requirements of 94.29 chapter 14; 94.30 (iii) anorectics, except that medically necessary 94.31 anorectics shall be covered for a recipient previously diagnosed 94.32 as having pickwickian syndrome and currently diagnosed as having 94.33 diabetes and being morbidly obese; 94.34 (iv) drugs for which medical value has not been 94.35 established; and 94.36 (v) drugs from manufacturers who have not signed a rebate 95.1 agreement with the Department of Health and Human Services 95.2 pursuant to section 1927 of title XIX of the Social Security Act. 95.3 The commissioner shall publish conditions for prohibiting 95.4 payment for specific drugs after considering the formulary 95.5 committee's recommendations. An honorarium of $100 per meeting 95.6 and reimbursement for mileage shall be paid to each committee 95.7 member in attendance. 95.8 (c) The basis for determining the amount of payment shall 95.9 be the lower of the actual acquisition costs of the drugs plus a 95.10 fixed dispensing fee; the maximum allowable cost set by the 95.11 federal government or by the commissioner plus the fixed 95.12 dispensing fee; or the usual and customary price charged to the 95.13 public. The pharmacy dispensing fee shall be $3.65, except that 95.14 the dispensing fee for intravenous solutions which must be 95.15 compounded by the pharmacist shall be $8 per bag, $14 per bag 95.16 for cancer chemotherapy products, and $30 per bag for total 95.17 parenteral nutritional products dispensed in one liter 95.18 quantities, or $44 per bag for total parenteral nutritional 95.19 products dispensed in quantities greater than one liter. Actual 95.20 acquisition cost includes quantity and other special discounts 95.21 except time and cash discounts. The actual acquisition cost of 95.22 a drug shall be estimated by the commissioner, at average 95.23 wholesale price minus nine percent, except that where a drug has 95.24 had its wholesale price reduced as a result of the actions of 95.25 the National Association of Medicaid Fraud Control Units, the 95.26 estimated actual acquisition cost shall be the reduced average 95.27 wholesale price, without the nine percent deduction. The 95.28 maximum allowable cost of a multisource drug may be set by the 95.29 commissioner and it shall be comparable to, but no higher than, 95.30 the maximum amount paid by other third-party payors in this 95.31 state who have maximum allowable cost programs. The 95.32 commissioner shall set maximum allowable costs for multisource 95.33 drugs that are not on the federal upper limit list as described 95.34 in United States Code, title 42, chapter 7, section 1396r-8(e), 95.35 the Social Security Act, and Code of Federal Regulations, title 95.36 42, part 447, section 447.332. Establishment of the amount of 96.1 payment for drugs shall not be subject to the requirements of 96.2 the Administrative Procedure Act. An additional dispensing fee 96.3 of $.30 may be added to the dispensing fee paid to pharmacists 96.4 for legend drug prescriptions dispensed to residents of 96.5 long-term care facilities when a unit dose blister card system, 96.6 approved by the department, is used. Under this type of 96.7 dispensing system, the pharmacist must dispense a 30-day supply 96.8 of drug. The National Drug Code (NDC) from the drug container 96.9 used to fill the blister card must be identified on the claim to 96.10 the department. The unit dose blister card containing the drug 96.11 must meet the packaging standards set forth in Minnesota Rules, 96.12 part 6800.2700, that govern the return of unused drugs to the 96.13 pharmacy for reuse. The pharmacy provider will be required to 96.14 credit the department for the actual acquisition cost of all 96.15 unused drugs that are eligible for reuse. Over-the-counter 96.16 medications must be dispensed in the manufacturer's unopened 96.17 package. The commissioner may permit the drug clozapine to be 96.18 dispensed in a quantity that is less than a 30-day supply. 96.19 Whenever a generically equivalent product is available, payment 96.20 shall be on the basis of the actual acquisition cost of the 96.21 generic drug, unless the prescriber specifically indicates 96.22 "dispense as written - brand necessary" on the prescription as 96.23 required by section 151.21, subdivision 2. 96.24 (d) For purposes of this subdivision, "multisource drugs" 96.25 means covered outpatient drugs, excluding innovator multisource 96.26 drugs for which there are two or more drug products, which: 96.27 (1) are related as therapeutically equivalent under the 96.28 Food and Drug Administration's most recent publication of 96.29 "Approved Drug Products with Therapeutic Equivalence 96.30 Evaluations"; 96.31 (2) are pharmaceutically equivalent and bioequivalent as 96.32 determined by the Food and Drug Administration; and 96.33 (3) are sold or marketed in Minnesota. 96.34 "Innovator multisource drug" means a multisource drug that was 96.35 originally marketed under an original new drug application 96.36 approved by the Food and Drug Administration. 97.1 (e) The basis for determining the amount of payment for 97.2 drugs administered in an outpatient setting shall be the lower 97.3 of the usual and customary cost submitted by the provider; the 97.4 average wholesale price minus five percent; or the maximum 97.5 allowable cost set by the federal government under United States 97.6 Code, title 42, chapter 7, section 1396r-8(e) and Code of 97.7 Federal Regulations, title 42, section 447.332, or by the 97.8 commissioner under paragraph (c). 97.9 Sec. 19. Minnesota Statutes 2000, section 256B.0625, 97.10 subdivision 13a, is amended to read: 97.11 Subd. 13a. [DRUG UTILIZATION REVIEW BOARD.] A nine-member 97.12 drug utilization review board is established. The board is 97.13 comprised of at least three but no more than four licensed 97.14 physicians actively engaged in the practice of medicine in 97.15 Minnesota; at least three licensed pharmacists actively engaged 97.16 in the practice of pharmacy in Minnesota; and one consumer 97.17 representative; the remainder to be made up of health care 97.18 professionals who are licensed in their field and have 97.19 recognized knowledge in the clinically appropriate prescribing, 97.20 dispensing, and monitoring of covered outpatient drugs. The 97.21 board shall be staffed by an employee of the department who 97.22 shall serve as an ex officio nonvoting member of the board. The 97.23 members of the board shall be appointed by the commissioner and 97.24 shall serve three-year terms. The members shall be selected 97.25 from lists submitted by professional associations. The 97.26 commissioner shall appoint the initial members of the board for 97.27 terms expiring as follows: three members for terms expiring 97.28 June 30, 1996; three members for terms expiring June 30, 1997; 97.29 and three members for terms expiring June 30, 1998. Members may 97.30 be reappointed once. The board shall annually elect a chair 97.31 from among the members. 97.32 The commissioner shall, with the advice of the board: 97.33 (1) implement a medical assistance retrospective and 97.34 prospective drug utilization review program as required by 97.35 United States Code, title 42, section 1396r-8(g)(3); 97.36 (2) develop and implement the predetermined criteria and 98.1 practice parameters for appropriate prescribing to be used in 98.2 retrospective and prospective drug utilization review; 98.3 (3) develop, select, implement, and assess interventions 98.4 for physicians, pharmacists, and patients that are educational 98.5 and not punitive in nature; 98.6 (4) establish a grievance and appeals process for 98.7 physicians and pharmacists under this section; 98.8 (5) publish and disseminate educational information to 98.9 physicians and pharmacists regarding the board and the review 98.10 program; 98.11 (6) adopt and implement procedures designed to ensure the 98.12 confidentiality of any information collected, stored, retrieved, 98.13 assessed, or analyzed by the board, staff to the board, or 98.14 contractors to the review program that identifies individual 98.15 physicians, pharmacists, or recipients; 98.16 (7) establish and implement an ongoing process to (i) 98.17 receive public comment regarding drug utilization review 98.18 criteria and standards, and (ii) consider the comments along 98.19 with other scientific and clinical information in order to 98.20 revise criteria and standards on a timely basis; and 98.21 (8) adopt any rules necessary to carry out this section. 98.22 The board may establish advisory committees. The 98.23 commissioner may contract with appropriate organizations to 98.24 assist the board in carrying out the board's duties. The 98.25 commissioner may enter into contracts for services to develop 98.26 and implement a retrospective and prospective review program. 98.27 The board shall report to the commissioner annually on the 98.28 date the Drug Utilization Review Annual Report is due to the 98.29 Health Care Financing Administration. This report is to cover 98.30 the preceding federal fiscal year. The commissioner shall make 98.31 the report available to the public upon request. The report 98.32 must include information on the activities of the board and the 98.33 program; the effectiveness of implemented interventions; 98.34 administrative costs; and any fiscal impact resulting from the 98.35 program. An honorarium of$50$100 per meeting and 98.36 reimbursement for mileage shall be paid to each board member in 99.1 attendance. 99.2 Sec. 20. Minnesota Statutes 2000, section 256B.0625, 99.3 subdivision 17, is amended to read: 99.4 Subd. 17. [TRANSPORTATION COSTS.] (a) Medical assistance 99.5 covers transportation costs incurred solely for obtaining 99.6 emergency medical care or transportation costs incurred by 99.7 nonambulatory persons in obtaining emergency or nonemergency 99.8 medical care when paid directly to an ambulance company, common 99.9 carrier, or other recognized providers of transportation 99.10 services. For the purpose of this subdivision, a person who is 99.11 incapable of transport by taxicab or bus shall be considered to 99.12 be nonambulatory. 99.13 (b) Medical assistance covers special transportation, as 99.14 defined in Minnesota Rules, part 9505.0315, subpart 1, item F, 99.15 if the provider receives and maintains a current physician's 99.16 order by the recipient's attending physician certifying that the 99.17 recipient has a physical or mental impairment that would 99.18 prohibit the recipient from safely accessing and using a bus, 99.19 taxi, other commercial transportation, or private automobile. 99.20 Special transportation includes driver-assisted service to 99.21 eligible individuals. Driver-assisted service includes 99.22 passenger pickup at and return to the individual's residence or 99.23 place of business, assistance with admittance of the individual 99.24 to the medical facility, and assistance in passenger securement 99.25 or in securing of wheelchairs or stretchers in the vehicle. The 99.26 commissioner shall establish maximum medical assistance 99.27 reimbursement rates for special transportation services for 99.28 persons who need a wheelchairliftaccessible van or 99.29 stretcher-equipped vehicle and for those who do not need a 99.30 wheelchairliftaccessible van or stretcher-equipped vehicle. 99.31 The average of these two rates per trip must not exceed $15 for 99.32 the base rate and$1.20$1.50 per mile. Special transportation 99.33 provided tononambulatoryambulatory persons who do not need a 99.34 wheelchair lift van or stretcher-equipped vehicle, may be 99.35 reimbursed at a lower rate than special transportation provided 99.36 to persons who need a wheelchair lift van or stretcher-equipped 100.1 vehicle. 100.2 Sec. 21. Minnesota Statutes 2000, section 256B.0625, 100.3 subdivision 17a, is amended to read: 100.4 Subd. 17a. [PAYMENT FOR AMBULANCE SERVICES.] Effective for 100.5 services rendered on or after July 1,19992001, medical 100.6 assistance payments for ambulance services shall beincreased by100.7five percentpaid at the greater of: (1) the medical assistance 100.8 reimbursement rate in effect on June 30, 2000; or (2) the 100.9 current Medicare reimbursement rate for ambulance services. 100.10 Sec. 22. Minnesota Statutes 2000, section 256B.0625, 100.11 subdivision 18a, is amended to read: 100.12 Subd. 18a. [PAYMENT FOR MEALS AND LODGINGACCESS TO 100.13 MEDICAL SERVICES.] (a) Medical assistance reimbursement for 100.14 meals for persons traveling to receive medical care may not 100.15 exceed $5.50 for breakfast, $6.50 for lunch, or $8 for dinner. 100.16 (b) Medical assistance reimbursement for lodging for 100.17 persons traveling to receive medical care may not exceed $50 per 100.18 day unless prior authorized by the local agency. 100.19 (c) Medical assistance direct mileage reimbursement to the 100.20 eligible person or the eligible person's driver may not exceed 100.21 20 cents per mile. 100.22 (d) Medical assistance covers oral language interpreter 100.23 services when provided by an enrolled health care provider 100.24 during the course of providing a direct, person-to-person 100.25 covered health care service to an enrolled recipient with 100.26 limited English proficiency. 100.27 Sec. 23. Minnesota Statutes 2000, section 256B.0625, 100.28 subdivision 30, is amended to read: 100.29 Subd. 30. [OTHER CLINIC SERVICES.] (a) Medical assistance 100.30 covers rural health clinic services, federally qualified health 100.31 center services, nonprofit community health clinic services, 100.32 public health clinic services, and the services of a clinic 100.33 meeting the criteria established in rule by the commissioner. 100.34 Rural health clinic services and federally qualified health 100.35 center services mean services defined in United States Code, 100.36 title 42, section 1396d(a)(2)(B) and (C). Payment for rural 101.1 health clinic and federally qualified health center services 101.2 shall be made according to applicable federal law and regulation. 101.3 (b) A federally qualified health center that is beginning 101.4 initial operation shall submit an estimate of budgeted costs and 101.5 visits for the initial reporting period in the form and detail 101.6 required by the commissioner. A federally qualified health 101.7 center that is already in operation shall submit an initial 101.8 report using actual costs and visits for the initial reporting 101.9 period. Within 90 days of the end of its reporting period, a 101.10 federally qualified health center shall submit, in the form and 101.11 detail required by the commissioner, a report of its operations, 101.12 including allowable costs actually incurred for the period and 101.13 the actual number of visits for services furnished during the 101.14 period, and other information required by the commissioner. 101.15 Federally qualified health centers that file Medicare cost 101.16 reports shall provide the commissioner with a copy of the most 101.17 recent Medicare cost report filed with the Medicare program 101.18 intermediary for the reporting year which support the costs 101.19 claimed on their cost report to the state. 101.20 (c) In order to continue cost-based payment under the 101.21 medical assistance program according to paragraphs (a) and (b), 101.22 a federally qualified health center or rural health clinic must 101.23 apply for designation as an essential community provider within 101.24 six months of final adoption of rules by the department of 101.25 health according to section 62Q.19, subdivision 7. For those 101.26 federally qualified health centers and rural health clinics that 101.27 have applied for essential community provider status within the 101.28 six-month time prescribed, medical assistance payments will 101.29 continue to be made according to paragraphs (a) and (b) for the 101.30 first three years after application. For federally qualified 101.31 health centers and rural health clinics that either do not apply 101.32 within the time specified above or who have had essential 101.33 community provider status for three years, medical assistance 101.34 payments for health services provided by these entities shall be 101.35 according to the same rates and conditions applicable to the 101.36 same service provided by health care providers that are not 102.1 federally qualified health centers or rural health clinics. 102.2 (d) Effective July 1, 1999, the provisions of paragraph (c) 102.3 requiring a federally qualified health center or a rural health 102.4 clinic to make application for an essential community provider 102.5 designation in order to have cost-based payments made according 102.6 to paragraphs (a) and (b) no longer apply. 102.7 (e) Effective January 1, 2000, payments made according to 102.8 paragraphs (a) and (b) shall be limited to the cost phase-out 102.9 schedule of the Balanced Budget Act of 1997. 102.10 (f) Effective January 1, 2001, each federally qualified 102.11 health center and rural health clinic may elect to be paid 102.12 either under the prospective payment system established in 102.13 United States Code, title 42, section 1396a, paragraph (a) or 102.14 under an alternative payment methodology consistent with the 102.15 requirements of United States Code, title 42, section 1392a, 102.16 paragraph (a) and approved by the health care financing 102.17 administration. The alternative payment methodology shall be 102.18 100 percent of cost as determined according to Medicare cost 102.19 principles. 102.20 Sec. 24. Minnesota Statutes 2000, section 256B.0625, 102.21 subdivision 34, is amended to read: 102.22 Subd. 34. [INDIAN HEALTH SERVICES FACILITIES.] Medical 102.23 assistance payments and MinnesotaCare payments to facilities of 102.24 the Indian health service and facilities operated by a tribe or 102.25 tribal organization under funding authorized by United States 102.26 Code, title 25, sections 450f to 450n, or title III of the 102.27 Indian Self-Determination and Education Assistance Act, Public 102.28 Law Number 93-638, for enrollees who are eligible for federal 102.29 financial participation, shall be at the option of the facility 102.30 in accordance with the rate published by the United States 102.31 Assistant Secretary for Health under the authority of United 102.32 States Code, title 42, sections 248(a) and 249(b). General 102.33 assistance medical care payments to facilities of the Indian 102.34 health services and facilities operated by a tribe or tribal 102.35 organization for the provision of outpatient medical care 102.36 services billed after June 30, 1990, must be in accordance with 103.1 the general assistance medical care rates paid for the same 103.2 services when provided in a facility other than a facility of 103.3 the Indian health service or a facility operated by a tribe or 103.4 tribal organization. MinnesotaCare payments for enrollees who 103.5 are not eligible for federal financial participation at 103.6 facilities of the Indian Health Service and facilities operated 103.7 by a tribe or tribal organization for the provision of 103.8 outpatient medical services must be in accordance with the 103.9 medical assistance rates paid for the same services when 103.10 provided in a facility other than a facility of the Indian 103.11 Health Service or a facility operated by a tribe or tribal 103.12 organization. 103.13 [EFFECTIVE DATE.] This section is effective the day 103.14 following final enactment. 103.15 Sec. 25. Minnesota Statutes 2000, section 256B.0635, 103.16 subdivision 1, is amended to read: 103.17 Subdivision 1. [INCREASED EMPLOYMENT.]Beginning January103.181, 1998(a) Until June 30, 2002, medical assistance may be paid 103.19 for persons who received MFIP-S or medical assistance for 103.20 families and children in at least three of six months preceding 103.21 the month in which the person became ineligible for MFIP-S or 103.22 medical assistance, if the ineligibility was due to an increase 103.23 in hours of employment or employment income or due to the loss 103.24 of an earned income disregard. In addition, to receive 103.25 continued assistance under this section, persons who received 103.26 medical assistance for families and children but did not receive 103.27 MFIP-S must have had income less than or equal to the assistance 103.28 standard for their family size under the state's AFDC plan in 103.29 effect as of July 16, 1996,as required by the Personal103.30Responsibility and Work Opportunity Reconciliation Act of 1996103.31(PRWORA), Public Law Number 104-193,increased by three percent 103.32 effective July 1, 2000, at the time medical assistance 103.33 eligibility began. A person who is eligible for extended 103.34 medical assistance is entitled to six months of assistance 103.35 without reapplication, unless the assistance unit ceases to 103.36 include a dependent child. For a person under 21 years of age, 104.1 medical assistance may not be discontinued within the six-month 104.2 period of extended eligibility until it has been determined that 104.3 the person is not otherwise eligible for medical assistance. 104.4 Medical assistance may be continued for an additional six months 104.5 if the person meets all requirements for the additional six 104.6 months, according to title XIX of the Social Security Act, as 104.7 amended by section 303 of the Family Support Act of 1988, Public 104.8 Law Number 100-485. 104.9 (b) Beginning July 1, 2002, medical assistance for families 104.10 and children may be paid for persons who were eligible under 104.11 section 256B.055, subdivision 3a, paragraph (b), in at least 104.12 three of six months preceding the month in which the person 104.13 became ineligible under that section if the ineligibility was 104.14 due to an increase in hours of employment or employment income 104.15 or due to the loss of an earned income disregard. A person who 104.16 is eligible for extended medical assistance is entitled to six 104.17 months of assistance without reapplication, unless the 104.18 assistance unit ceases to include a dependent child, except 104.19 medical assistance may not be discontinued for that dependent 104.20 child under 21 years of age within the six-month period of 104.21 extended eligibility until it has been determined that the 104.22 person is not otherwise eligible for medical assistance. 104.23 Medical assistance may be continued for an additional six months 104.24 if the person meets all requirements for the additional six 104.25 months, according to title XIX of the Social Security Act, as 104.26 amended by section 303 of the Family Support Act of 1988, Public 104.27 Law Number 100-485. 104.28 [EFFECTIVE DATE.] This section is effective July 1, 2001. 104.29 Sec. 26. Minnesota Statutes 2000, section 256B.0635, 104.30 subdivision 2, is amended to read: 104.31 Subd. 2. [INCREASED CHILD OR SPOUSAL SUPPORT.]Beginning104.32January 1, 1998(a) Until June 30, 2002, medical assistance may 104.33 be paid for persons who received MFIP-S or medical assistance 104.34 for families and children in at least three of the six months 104.35 preceding the month in which the person became ineligible for 104.36 MFIP-S or medical assistance, if the ineligibility was the 105.1 result of the collection of child or spousal support under part 105.2 D of title IV of the Social Security Act. In addition, to 105.3 receive continued assistance under this section, persons who 105.4 received medical assistance for families and children but did 105.5 not receive MFIP-S must have had income less than or equal to 105.6 the assistance standard for their family size under the state's 105.7 AFDC plan in effect as of July 16, 1996,as required by the105.8Personal Responsibility and Work Opportunity Reconciliation Act105.9of 1996 (PRWORA), Public Law Number 104-193increased by three 105.10 percent effective July 1, 2000, at the time medical assistance 105.11 eligibility began. A person who is eligible for extended 105.12 medical assistance under this subdivision is entitled to four 105.13 months of assistance without reapplication, unless the 105.14 assistance unit ceases to include a dependent child. For a105.15person under 21 years of age, except medical assistance may not 105.16 be discontinued for that dependent child under 21 years of age 105.17 within the four-month period of extended eligibility until it 105.18 has been determined that the person is not otherwise eligible 105.19 for medical assistance. 105.20 (b) Beginning July 1, 2002, medical assistance for families 105.21 and children may be paid for persons who were eligible under 105.22 section 256B.055, subdivision 3a, paragraph (b), in at least 105.23 three of the six months preceding the month in which the person 105.24 became ineligible under that section if the ineligibility was 105.25 the result of the collection of child or spousal support under 105.26 part D of title IV of the Social Security Act. A person who is 105.27 eligible for extended medical assistance under this subdivision 105.28 is entitled to four months of assistance without reapplication, 105.29 unless the assistance unit ceases to include a dependent child, 105.30 except medical assistance may not be discontinued for that 105.31 dependent child under 21 years of age within the four-month 105.32 period of extended eligibility until it has been determined that 105.33 the person is not otherwise eligible for medical assistance. 105.34 [EFFECTIVE DATE.] This section is effective July 1, 2001. 105.35 Sec. 27. [256B.0637] [PRESUMPTIVE ELIGIBILITY FOR CERTAIN 105.36 PERSONS NEEDING TREATMENT FOR BREAST OR CERVICAL CANCER.] 106.1 Medical assistance is available during a presumptive 106.2 eligibility period for persons who meet the criteria in section 106.3 256B.057, subdivision 10. For purposes of this section, the 106.4 presumptive eligibility period begins on the date on which an 106.5 entity designated by the commissioner determines, based on 106.6 preliminary information, that the person meets the criteria in 106.7 section 256B.057, subdivision 10. The presumptive eligibility 106.8 period ends on the day on which a determination is made as to 106.9 the person's eligibility, except that if an application is not 106.10 submitted by the last day of the month following the month 106.11 during which the determination based on preliminary information 106.12 is made, the presumptive eligibility period ends on that last 106.13 day of the month. 106.14 Sec. 28. [256B.195] [HEALTH CARE SAFETY NET PRESERVATION.] 106.15 Subdivision 1. [INTERGOVERNMENTAL TRANSFERS AND RELATED 106.16 PAYMENTS.] (a) This section is contingent on federal approval of 106.17 the intergovernmental transfers and payments to safety net 106.18 hospitals authorized under this section. 106.19 (b) In addition to the percentage contribution paid by a 106.20 county under section 256B.19, subdivision 1, the governmental 106.21 units designated in this subdivision shall be responsible for an 106.22 additional portion of the nonfederal share of medical assistance 106.23 costs attributable to them. For purposes of this section, 106.24 "designated governmental unit" means Hennepin county, Ramsey 106.25 county, or the University of Minnesota. For purposes of this 106.26 section, "nonstate, government hospital" means Hennepin County 106.27 Medical Center, the successor or assignee to St. Paul-Ramsey 106.28 Medical Center as described in section 383A.91, or Fairview 106.29 University Medical Center. 106.30 (c) Effective July 1, 2001, the governmental units 106.31 designated in paragraph (a) shall in total transfer $2,833,333 106.32 on a monthly basis to the state Medicaid agency. The 106.33 commissioner shall allocate this assessment between the 106.34 governmental units based on the proportion of the Medicare upper 106.35 payment limit for each nonstate, government hospital located 106.36 within the governmental unit to the total Medicare upper payment 107.1 limit of all participating hospitals in paragraph (b). 107.2 (d) The commissioner shall distribute the proceeds of this 107.3 intergovernmental transfer, including the federal Medicaid 107.4 match, as follows: 107.5 (1) Proceeds may be no less than the amount of the 107.6 intergovernmental transfer in paragraph (c) multiplied by 1.75. 107.7 (2) The remaining proceeds provide funding for hospital 107.8 charity care aid under section 144.585. The commissioner of 107.9 human services shall work with the commissioner of health to 107.10 assure that hospital charity care aid payments are administered 107.11 in a manner that generates Medicaid matching funds. 107.12 (e) The successor or assignee to St. Paul-Ramsey Medical 107.13 Center shall transfer on a monthly basis to Ramsey county an 107.14 amount equal to the county assessment under paragraph (c). 107.15 Subd. 2. [DETERMINATION OF INTERGOVERNMENTAL TRANSFER 107.16 AMOUNTS.] Medicaid rate changes, including those required to 107.17 obtain federal financial participation under section 62J.692, 107.18 subdivision 8, enacted prior to the effective date of this 107.19 legislation, shall precede the determination of 107.20 intergovernmental transfer amounts determined in this section. 107.21 Participation in the intergovernmental transfer program shall 107.22 not result in the offset of any nonstate, government hospital's 107.23 receipt of Medicaid payment increases. 107.24 Subd. 3. [STATE PLAN AMENDMENTS.] The commissioner shall 107.25 amend the state Medicaid plan as necessary to implement this 107.26 section. 107.27 Subd. 4. [PROPORTIONATE ADJUSTMENTS.] (a) The commissioner 107.28 shall adjust the intergovernmental transfers under subdivision 107.29 1, paragraph (c), and the payments under subdivision 1, 107.30 paragraph (d), upon the approval of the designated governmental 107.31 unit named in subdivision 1, paragraph (b), based on the 107.32 commissioner's determination of Medicare upper payment limits, 107.33 hospital-specific federal limitations on disproportionate share 107.34 payments or to maximize additional federal reimbursements. 107.35 (b) In the event that: (i) federal approval is not 107.36 received for the total intergovernmental transfer amount 108.1 specified in subdivision 1, paragraph (d), or, (ii) federal 108.2 rules regarding the establishment of the 150 percent Medicare 108.3 upper payment limit, section 1102 of the Social Security Act, 108.4 United States Code, title 42, section 1302, enacted on March 13, 108.5 2001, are rescinded or, (iii) the federal 150 percent Medicare 108.6 upper payment limit is reduced to 100 percent, the amount of the 108.7 intergovernmental transfers and Medicaid payments to the 108.8 nonstate, government hospitals named in subdivision 1, paragraph 108.9 (b), shall be adjusted for each hospital based on the proportion 108.10 of each hospital's Medicaid inpatient hospital days to the total 108.11 Medicaid inpatient hospital days provided by all participating 108.12 hospitals. 108.13 [EFFECTIVE DATE.] This section is effective July 1, 2001. 108.14 Sec. 29. Minnesota Statutes 2000, section 256B.69, 108.15 subdivision 4, is amended to read: 108.16 Subd. 4. [LIMITATION OF CHOICE.] The commissioner shall 108.17 develop criteria to determine when limitation of choice may be 108.18 implemented in the experimental counties. The criteria shall 108.19 ensure that all eligible individuals in the county have 108.20 continuing access to the full range of medical assistance 108.21 services as specified in subdivision 6. The commissioner shall 108.22 exempt the following persons from participation in the project, 108.23 in addition to those who do not meet the criteria for limitation 108.24 of choice: 108.25 (1) persons eligible for medical assistance according to 108.26 section 256B.055, subdivision 1; 108.27 (2) persons eligible for medical assistance due to 108.28 blindness or disability as determined by the social security 108.29 administration or the state medical review team, unless: 108.30 (i) they are 65 years of age or older,; or 108.31 (ii) they reside in Itasca county or they reside in a 108.32 county in which the commissioner conducts a pilot project under 108.33 a waiver granted pursuant to section 1115 of the Social Security 108.34 Act; 108.35 (3) recipients who currently have private coverage through 108.36 a health maintenance organization; 109.1 (4) recipients who are eligible for medical assistance by 109.2 spending down excess income for medical expenses other than the 109.3 nursing facility per diem expense; 109.4 (5) recipients who receive benefits under the Refugee 109.5 Assistance Program, established under United States Code, title 109.6 8, section 1522(e); 109.7 (6) children who are both determined to be severely 109.8 emotionally disturbed and receiving case management services 109.9 according to section 256B.0625, subdivision 20;and109.10 (7) adults who are both determined to be seriously and 109.11 persistently mentally ill and received case management services 109.12 according to section 256B.0625, subdivision 20; and 109.13 (8) persons eligible for medical assistance according to 109.14 section 256B.057, subdivision 10. 109.15 Children under age 21 who are in foster placement may enroll in 109.16 the project on an elective basis. Individuals excluded under 109.17 clauses (6) and (7) may choose to enroll on an elective basis. 109.18 The commissioner may allow persons with a one-month spenddown 109.19 who are otherwise eligible to enroll to voluntarily enroll or 109.20 remain enrolled, if they elect to prepay their monthly spenddown 109.21 to the state.Beginning on or after July 1, 1997,The 109.22 commissioner may require those individuals to enroll in the 109.23 prepaid medical assistance program who otherwise would have been 109.24 excluded under clauses (1)and, (3), and (8), and under 109.25 Minnesota Rules, part 9500.1452, subpart 2, items H, K, and L. 109.26 Before limitation of choice is implemented, eligible individuals 109.27 shall be notified and after notification, shall be allowed to 109.28 choose only among demonstration providers. The commissioner may 109.29 assign an individual with private coverage through a health 109.30 maintenance organization, to the same health maintenance 109.31 organization for medical assistance coverage, if the health 109.32 maintenance organization is under contract for medical 109.33 assistance in the individual's county of residence. After 109.34 initially choosing a provider, the recipient is allowed to 109.35 change that choice only at specified times as allowed by the 109.36 commissioner. If a demonstration provider ends participation in 110.1 the project for any reason, a recipient enrolled with that 110.2 provider must select a new provider but may change providers 110.3 without cause once more within the first 60 days after 110.4 enrollment with the second provider. 110.5 Sec. 30. Minnesota Statutes 2000, section 256B.69, 110.6 subdivision 5, is amended to read: 110.7 Subd. 5. [PROSPECTIVE PER CAPITA PAYMENT.] The 110.8 commissioner shall establish the method and amount of payments 110.9 for services. The commissioner shall annually contract with 110.10 demonstration providers to provide services consistent with 110.11 these established methods and amounts for payment. Payment 110.12 rates established by the commissioner must be within the limits 110.13 of available appropriations. 110.14 If allowed by the commissioner, a demonstration provider 110.15 may contract with an insurer, health care provider, nonprofit 110.16 health service plan corporation, or the commissioner, to provide 110.17 insurance or similar protection against the cost of care 110.18 provided by the demonstration provider or to provide coverage 110.19 against the risks incurred by demonstration providers under this 110.20 section. The recipients enrolled with a demonstration provider 110.21 are a permissible group under group insurance laws and chapter 110.22 62C, the Nonprofit Health Service Plan Corporations Act. Under 110.23 this type of contract, the insurer or corporation may make 110.24 benefit payments to a demonstration provider for services 110.25 rendered or to be rendered to a recipient. Any insurer or 110.26 nonprofit health service plan corporation licensed to do 110.27 business in this state is authorized to provide this insurance 110.28 or similar protection. 110.29 Payments to providers participating in the project are 110.30 exempt from the requirements of sections 256.966 and 256B.03, 110.31 subdivision 2. The commissioner shall complete development of 110.32 capitation rates for payments before delivery of services under 110.33 this section is begun. For payments made during calendar year 110.34 1990 and later years, the commissioner shall contract with an 110.35 independent actuary to establish prepayment rates. 110.36 By January 15, 1996, the commissioner shall report to the 111.1 legislature on the methodology used to allocate to participating 111.2 counties available administrative reimbursement for advocacy and 111.3 enrollment costs. The report shall reflect the commissioner's 111.4 judgment as to the adequacy of the funds made available and of 111.5 the methodology for equitable distribution of the funds. The 111.6 commissioner must involve participating counties in the 111.7 development of the report. 111.8 Sec. 31. Minnesota Statutes 2000, section 256B.69, 111.9 subdivision 5b, is amended to read: 111.10 Subd. 5b. [PROSPECTIVE REIMBURSEMENT RATES.] (a) For 111.11 prepaid medical assistance and general assistance medical care 111.12 program contract rates set by the commissioner under subdivision 111.13 5 and effective on or after January 1, 1998, capitation rates 111.14 for nonmetropolitan counties shall on a weighted average be no 111.15 less than 88 percent of the capitation rates for metropolitan 111.16 counties, excluding Hennepin county. The commissioner shall 111.17 make a pro rata adjustment in capitation rates paid to counties 111.18 other than nonmetropolitan counties in order to make this 111.19 provision budget neutral. 111.20 (b) For prepaid medical assistance program contract rates 111.21 set by the commissioner under subdivision 5 and effective on or 111.22 after January 1,20012002, capitation rates for nonmetropolitan 111.23 counties shall, on a weighted average, be no less than8995 111.24 percent of the capitation rates for metropolitan counties, 111.25 excluding Hennepin county. The commissioner shall make a pro 111.26 rata adjustment in capitation rates paid to Hennepin county in 111.27 order to make the portion of the increase between 89 and 95 111.28 percent budget neutral. 111.29 (c) This subdivision shall not affect the nongeographically 111.30 based risk adjusted rates established under section 62Q.03, 111.31 subdivision 5a, paragraph (f). 111.32 (d) The commissioner shall require prepaid health plans to 111.33 use all revenue received from the increase in capitation rates 111.34 for nonmetropolitan counties from 89 to no less than 95 percent 111.35 of the capitation rate for metropolitan counties, excluding 111.36 Hennepin county, to increase reimbursement rates, effective 112.1 January 1, 2002, for providers under contract with the prepaid 112.2 health plan to serve enrollees from nonmetropolitan counties. 112.3 Sec. 32. Minnesota Statutes 2000, section 256B.69, is 112.4 amended by adding a subdivision to read: 112.5 Subd. 6c. [DENTAL SERVICES DEMONSTRATION PROJECT.] The 112.6 commissioner shall establish a dental services demonstration 112.7 project in Crow Wing, Todd, Morrison, Wadena, and Cass counties 112.8 for provision of dental services to medical assistance, general 112.9 assistance medical care, and MinnesotaCare recipients. The 112.10 commissioner may contract on a prospective per capita payment 112.11 basis for these dental services with an organization licensed 112.12 under chapter 62C, 62D, or 62N in accordance with section 112.13 256B.037 or may establish and administer a fee-for-service 112.14 system for the reimbursement of dental services. 112.15 [EFFECTIVE DATE.] This section is effective January 1, 2002. 112.16 Sec. 33. Minnesota Statutes 2000, section 256B.75, is 112.17 amended to read: 112.18 256B.75 [HOSPITAL OUTPATIENT REIMBURSEMENT.] 112.19 (a) For outpatient hospital facility fee payments for 112.20 services rendered on or after October 1, 1992, the commissioner 112.21 of human services shall pay the lower of (1) submitted charge, 112.22 or (2) 32 percent above the rate in effect on June 30, 1992, 112.23 except for those services for which there is a federal maximum 112.24 allowable payment. Effective for services rendered on or after 112.25 January 1, 2000, payment rates for nonsurgical outpatient 112.26 hospital facility fees and emergency room facility fees shall be 112.27 increased by eight percent over the rates in effect on December 112.28 31, 1999, except for those services for which there is a federal 112.29 maximum allowable payment. Services for which there is a 112.30 federal maximum allowable payment shall be paid at the lower of 112.31 (1) submitted charge, or (2) the federal maximum allowable 112.32 payment. Total aggregate payment for outpatient hospital 112.33 facility fee services shall not exceed the Medicare upper 112.34 limit. If it is determined that a provision of this section 112.35 conflicts with existing or future requirements of the United 112.36 States government with respect to federal financial 113.1 participation in medical assistance, the federal requirements 113.2 prevail. The commissioner may, in the aggregate, prospectively 113.3 reduce payment rates to avoid reduced federal financial 113.4 participation resulting from rates that are in excess of the 113.5 Medicare upper limitations. 113.6 (b) Notwithstanding paragraph (a), payment for outpatient, 113.7 emergency, and ambulatory surgery hospital facility fee services 113.8 for critical access hospitals designated under section 144.1483, 113.9 clause (11), shall be paid on a cost-based payment system that 113.10 is based on the cost-finding methods and allowable costs of the 113.11 Medicare program. 113.12 (c) Effective for services provided on or after July 1, 113.13 2002, rates that are based on the Medicare outpatient 113.14 prospective payment system shall be replaced by a budget neutral 113.15 prospective payment system that is derived using medical 113.16 assistance data. The department shall provide a proposal to the 113.17 2002 legislature to define and implement this provision. 113.18 Sec. 34. Minnesota Statutes 2000, section 256B.76, is 113.19 amended to read: 113.20 256B.76 [PHYSICIAN AND DENTAL REIMBURSEMENT.] 113.21 (a) Effective for services rendered on or after October 1, 113.22 1992, the commissioner shall make payments for physician 113.23 services as follows: 113.24 (1) payment for level one Health Care Finance 113.25 Administration's common procedural coding system (HCPCS) codes 113.26 titled "office and other outpatient services," "preventive 113.27 medicine new and established patient," "delivery, antepartum, 113.28 and postpartum care," "critical care,"Caesareancesarean 113.29 delivery and pharmacologic management provided to psychiatric 113.30 patients, and HCPCS level three codes for enhanced services for 113.31 prenatal high risk, shall be paid at the lower of (i) submitted 113.32 charges, or (ii) 25 percent above the rate in effect on June 30, 113.33 1992. If the rate on any procedure code within these categories 113.34 is different than the rate that would have been paid under the 113.35 methodology in section 256B.74, subdivision 2, then the larger 113.36 rate shall be paid; 114.1 (2) payments for all other services shall be paid at the 114.2 lower of (i) submitted charges, or (ii) 15.4 percent above the 114.3 rate in effect on June 30, 1992; 114.4 (3) all physician rates shall be converted from the 50th 114.5 percentile of 1982 to the 50th percentile of 1989, less the 114.6 percent in aggregate necessary to equal the above increases 114.7 except that payment rates for home health agency services shall 114.8 be the rates in effect on September 30, 1992; 114.9 (4) effective for services rendered on or after January 1, 114.10 2000, payment rates for physician and professional services 114.11 shall be increased by three percent over the rates in effect on 114.12 December 31, 1999, except for home health agency and family 114.13 planning agency services; and 114.14 (5) the increases in clause (4) shall be implemented 114.15 January 1, 2000, for managed care. 114.16 (b) Effective for services rendered on or after October 1, 114.17 1992, the commissioner shall make payments for dental services 114.18 as follows: 114.19 (1) dental services shall be paid at the lower of (i) 114.20 submitted charges, or (ii) 25 percent above the rate in effect 114.21 on June 30, 1992; 114.22 (2) dental rates shall be converted from the 50th 114.23 percentile of 1982 to the 50th percentile of 1989, less the 114.24 percent in aggregate necessary to equal the above increases; 114.25 (3) effective for services rendered on or after January 1, 114.26 2000, payment rates for dental services shall be increased by 114.27 three percent over the rates in effect on December 31, 1999; 114.28 (4) the commissioner shall award grants to community 114.29 clinics or other nonprofit community organizations, political 114.30 subdivisions, professional associations, or other organizations 114.31 that demonstrate the ability to provide dental services 114.32 effectively to public program recipients. Grants may be used to 114.33 fund the costs related to coordinating access for recipients, 114.34 developing and implementing patient care criteria, upgrading or 114.35 establishing new facilities, acquiring furnishings or equipment, 114.36 recruiting new providers, or other development costs that will 115.1 improve access to dental care in a region. In awarding grants, 115.2 the commissioner shall give priority to applicants that plan to 115.3 serve areas of the state in which the number of dental providers 115.4 is not currently sufficient to meet the needs of recipients of 115.5 public programs or uninsured individuals. The commissioner 115.6 shall consider the following in awarding the grants: (i) 115.7 potential to successfully increase access to an underserved 115.8 population; (ii) the ability to raise matching funds; (iii) the 115.9 long-term viability of the project to improve access beyond the 115.10 period of initial funding; (iv) the efficiency in the use of the 115.11 funding; and (v) the experience of the proposers in providing 115.12 services to the target population. 115.13 The commissioner shall monitor the grants and may terminate 115.14 a grant if the grantee does not increase dental access for 115.15 public program recipients. The commissioner shall consider 115.16 grants for the following: 115.17 (i) implementation of new programs or continued expansion 115.18 of current access programs that have demonstrated success in 115.19 providing dental services in underserved areas; 115.20 (ii) a pilot program for utilizing hygienists outside of a 115.21 traditional dental office to provide dental hygiene services; 115.22 and 115.23 (iii) a program that organizes a network of volunteer 115.24 dentists, establishes a system to refer eligible individuals to 115.25 volunteer dentists, and through that network provides donated 115.26 dental care services to public program recipients or uninsured 115.27 individuals. 115.28 (5) beginning October 1, 1999, the payment for tooth 115.29 sealants and fluoride treatments shall be the lower of (i) 115.30 submitted charge, or (ii) 80 percent of median 1997 charges;and115.31 (6) the increases listed in clauses (3) and (5) shall be 115.32 implemented January 1, 2000, for managed care; and 115.33 (7) effective for services provided on or after October 1, 115.34 2001, payment for diagnostic examinations and dental x-rays 115.35 provided to children under age 21 shall be the lower of (i) the 115.36 submitted charge, or (ii) 85 percent of median 1999 charges. 116.1 (c) Effective for dental services rendered on or after July 116.2 1, 2001, the commissioner may increase reimbursements to 116.3 dentists and dental clinics deemed by the commissioner to be 116.4 critical access dental providers. Reimbursement to a critical 116.5 access dental provider may be increased by not more than 50 116.6 percent above the reimbursement rate that would otherwise be 116.7 paid to the provider. Payments to health plan companies shall 116.8 be adjusted to reflect increased reimbursements to critical 116.9 access dental providers as approved by the commissioner. In 116.10 determining which dentists and dental clinics shall be deemed 116.11 critical access dental providers, the commissioner shall review: 116.12 (1) the utilization rate in the service area in which the 116.13 dentist or dental clinic operates for dental services to 116.14 patients covered by medical assistance, general assistance 116.15 medical care, or MinnesotaCare as their primary source of 116.16 coverage; 116.17 (2) the level of services provided by the dentist or dental 116.18 clinic to patients covered by medical assistance, general 116.19 assistance medical care, or MinnesotaCare as their primary 116.20 source of coverage; and 116.21 (3) whether the level of services provided by the dentist 116.22 or dental clinic is critical to maintaining adequate levels of 116.23 patient access within the service area. 116.24 In the absence of a critical access dental provider in a service 116.25 area, the commissioner may designate a dentist or dental clinic 116.26 as a critical access dental provider if the dentist or dental 116.27 clinic is willing to provide care to patients covered by medical 116.28 assistance, general assistance medical care, or MinnesotaCare at 116.29 a level which significantly increases access to dental care in 116.30 the service area. 116.31 (d) An entity that operates both a Medicare certified 116.32 comprehensive outpatient rehabilitation facility and a facility 116.33 which was certified prior to January 1, 1993, that is licensed 116.34 under Minnesota Rules, parts 9570.2000 to 9570.3600, and for 116.35 whom at least 33 percent of the clients receiving rehabilitation 116.36 services in the most recent calendar year are medical assistance 117.1 recipients, shall be reimbursed by the commissioner for 117.2 rehabilitation services at rates that are 38 percent greater 117.3 than the maximum reimbursement rate allowed under paragraph (a), 117.4 clause (2), when those services are (1) provided within the 117.5 comprehensive outpatient rehabilitation facility and (2) 117.6 provided to residents of nursing facilities owned by the entity. 117.7 [EFFECTIVE DATE.] This section is effective the day 117.8 following final enactment. 117.9 Sec. 35. [256B.78] [MEDICAL ASSISTANCE DEMONSTRATION 117.10 PROJECT FOR FAMILY PLANNING SERVICES.] 117.11 (a) The commissioner of human services shall establish a 117.12 medical assistance demonstration project to determine whether 117.13 improved access to coverage of prepregnancy family planning 117.14 services reduces medical assistance and MFIP costs. 117.15 (b) This section is effective upon federal approval of the 117.16 demonstration project. 117.17 Sec. 36. Minnesota Statutes 2000, section 256D.03, 117.18 subdivision 3, is amended to read: 117.19 Subd. 3. [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.] 117.20 (a) General assistance medical care may be paid for any person 117.21 who is not eligible for medical assistance under chapter 256B, 117.22 including eligibility for medical assistance based on a 117.23 spenddown of excess income according to section 256B.056, 117.24 subdivision 5, or MinnesotaCare as defined in paragraph (b), 117.25 except as provided in paragraph (c); and: 117.26 (1) who is receiving assistance under section 256D.05, 117.27 except for families with children who are eligible under 117.28 Minnesota family investment program-statewide (MFIP-S), who is 117.29 having a payment made on the person's behalf under sections 117.30 256I.01 to 256I.06, or who resides in group residential housing 117.31 as defined in chapter 256I and can meet a spenddown using the 117.32 cost of remedial services received through group residential 117.33 housing; or 117.34 (2)(i) who is a resident of Minnesota; and whose equity in 117.35 assets is not in excess of $1,000 per assistance unit. Exempt 117.36 assets, the reduction of excess assets, and the waiver of excess 118.1 assets must conform to the medical assistance program in chapter 118.2 256B, with the following exception: the maximum amount of 118.3 undistributed funds in a trust that could be distributed to or 118.4 on behalf of the beneficiary by the trustee, assuming the full 118.5 exercise of the trustee's discretion under the terms of the 118.6 trust, must be applied toward the asset maximum; and 118.7 (ii) who has countable incomenot in excess of the118.8assistance standards established in section 256B.056,118.9subdivision 4that does not exceed 133 and 1/3 percent of the 118.10 AFDC income standard in effect under the July 16, 1996, AFDC 118.11 state plan, increased by three percent, or whose excess income 118.12 is spent down according to section 256B.056, subdivision 5, 118.13 using a six-month budget period. The method for calculating 118.14 earned income disregards and deductions for a person who resides 118.15 with a dependent child under age 21 shall follow section 118.16 256B.056, subdivision 1a. However, if a disregard of $30 and 118.17 one-third of the remainder has been applied to the wage earner's 118.18 income, the disregard shall not be applied again until the wage 118.19 earner's income has not been considered in an eligibility 118.20 determination for general assistance, general assistance medical 118.21 care, medical assistance, or MFIP-S for 12 consecutive months. 118.22 The earned income and work expense deductions for a person who 118.23 does not reside with a dependent child under age 21 shall be the 118.24 same as the method used to determine eligibility for a person 118.25 under section 256D.06, subdivision 1, except the disregard of 118.26 the first $50 of earned income is not allowed; 118.27 (3) who would be eligible for medical assistance except 118.28 that the person resides in a facility that is determined by the 118.29 commissioner or the federal Health Care Financing Administration 118.30 to be an institution for mental diseases; or 118.31 (4) who is ineligible for medical assistance under chapter 118.32 256B or general assistance medical care under any other 118.33 provision of this section, and is receiving care and 118.34 rehabilitation services from a nonprofit center established to 118.35 serve victims of torture. These individuals are eligible for 118.36 general assistance medical care only for the period during which 119.1 they are receiving services from the center. During this period 119.2 of eligibility, individuals eligible under this clause shall not 119.3 be required to participate in prepaid general assistance medical 119.4 care. 119.5 (b) Beginning January 1, 2000, applicants or recipients who 119.6 meet all eligibility requirements of MinnesotaCare as defined in 119.7 sections 256L.01 to 256L.16, and are: 119.8 (i) adults with dependent children under 21 whose gross 119.9 family income is equal to or less than 275 percent of the 119.10 federal poverty guidelines; or 119.11 (ii) adults without children with earned income and whose 119.12 family gross income is between 75 percent of the federal poverty 119.13 guidelines and the amount set by section 256L.04, subdivision 7, 119.14 shall be terminated from general assistance medical care upon 119.15 enrollment in MinnesotaCare. 119.16 (c) For services rendered on or after July 1, 1997, 119.17 eligibility is limited to one month prior to application if the 119.18 person is determined eligible in the prior month. A 119.19 redetermination of eligibility must occur every 12 months. 119.20 Beginning January 1, 2000, Minnesota health care program 119.21 applications completed by recipients and applicants who are 119.22 persons described in paragraph (b), may be returned to the 119.23 county agency to be forwarded to the department of human 119.24 services or sent directly to the department of human services 119.25 for enrollment in MinnesotaCare. If all other eligibility 119.26 requirements of this subdivision are met, eligibility for 119.27 general assistance medical care shall be available in any month 119.28 during which a MinnesotaCare eligibility determination and 119.29 enrollment are pending. Upon notification of eligibility for 119.30 MinnesotaCare, notice of termination for eligibility for general 119.31 assistance medical care shall be sent to an applicant or 119.32 recipient. If all other eligibility requirements of this 119.33 subdivision are met, eligibility for general assistance medical 119.34 care shall be available until enrollment in MinnesotaCare 119.35 subject to the provisions of paragraph (e). 119.36 (d) The date of an initial Minnesota health care program 120.1 application necessary to begin a determination of eligibility 120.2 shall be the date the applicant has provided a name, address, 120.3 and social security number, signed and dated, to the county 120.4 agency or the department of human services. If the applicant is 120.5 unable to provide an initial application when health care is 120.6 delivered due to a medical condition or disability, a health 120.7 care provider may act on the person's behalf to complete the 120.8 initial application. The applicant must complete the remainder 120.9 of the application and provide necessary verification before 120.10 eligibility can be determined. The county agency must assist 120.11 the applicant in obtaining verification if necessary. On the 120.12 basis of information provided on the completed application, an 120.13 applicant who meets the following criteria shall be determined 120.14 eligible beginning in the month of application: 120.15 (1) has gross income less than 90 percent of the applicable 120.16 income standard; 120.17 (2) has liquid assets that total within $300 of the asset 120.18 standard; 120.19 (3) does not reside in a long-term care facility; and 120.20 (4) meets all other eligibility requirements. 120.21 The applicant must provide all required verifications within 30 120.22 days' notice of the eligibility determination or eligibility 120.23 shall be terminated. 120.24 (e) County agencies are authorized to use all automated 120.25 databases containing information regarding recipients' or 120.26 applicants' income in order to determine eligibility for general 120.27 assistance medical care or MinnesotaCare. Such use shall be 120.28 considered sufficient in order to determine eligibility and 120.29 premium payments by the county agency. 120.30 (f) General assistance medical care is not available for a 120.31 person in a correctional facility unless the person is detained 120.32 by law for less than one year in a county correctional or 120.33 detention facility as a person accused or convicted of a crime, 120.34 or admitted as an inpatient to a hospital on a criminal hold 120.35 order, and the person is a recipient of general assistance 120.36 medical care at the time the person is detained by law or 121.1 admitted on a criminal hold order and as long as the person 121.2 continues to meet other eligibility requirements of this 121.3 subdivision. 121.4 (g) General assistance medical care is not available for 121.5 applicants or recipients who do not cooperate with the county 121.6 agency to meet the requirements of medical assistance. General 121.7 assistance medical care is limited to payment of emergency 121.8 services only for applicants or recipients as described in 121.9 paragraph (b), whose MinnesotaCare coverage is denied or 121.10 terminated for nonpayment of premiums as required by sections 121.11 256L.06 and 256L.07. 121.12 (h) In determining the amount of assets of an individual, 121.13 there shall be included any asset or interest in an asset, 121.14 including an asset excluded under paragraph (a), that was given 121.15 away, sold, or disposed of for less than fair market value 121.16 within the 60 months preceding application for general 121.17 assistance medical care or during the period of eligibility. 121.18 Any transfer described in this paragraph shall be presumed to 121.19 have been for the purpose of establishing eligibility for 121.20 general assistance medical care, unless the individual furnishes 121.21 convincing evidence to establish that the transaction was 121.22 exclusively for another purpose. For purposes of this 121.23 paragraph, the value of the asset or interest shall be the fair 121.24 market value at the time it was given away, sold, or disposed 121.25 of, less the amount of compensation received. For any 121.26 uncompensated transfer, the number of months of ineligibility, 121.27 including partial months, shall be calculated by dividing the 121.28 uncompensated transfer amount by the average monthly per person 121.29 payment made by the medical assistance program to skilled 121.30 nursing facilities for the previous calendar year. The 121.31 individual shall remain ineligible until this fixed period has 121.32 expired. The period of ineligibility may exceed 30 months, and 121.33 a reapplication for benefits after 30 months from the date of 121.34 the transfer shall not result in eligibility unless and until 121.35 the period of ineligibility has expired. The period of 121.36 ineligibility begins in the month the transfer was reported to 122.1 the county agency, or if the transfer was not reported, the 122.2 month in which the county agency discovered the transfer, 122.3 whichever comes first. For applicants, the period of 122.4 ineligibility begins on the date of the first approved 122.5 application. 122.6 (i) When determining eligibility for any state benefits 122.7 under this subdivision, the income and resources of all 122.8 noncitizens shall be deemed to include their sponsor's income 122.9 and resources as defined in the Personal Responsibility and Work 122.10 Opportunity Reconciliation Act of 1996, title IV, Public Law 122.11 Number 104-193, sections 421 and 422, and subsequently set out 122.12 in federal rules. 122.13 (j)(1) An undocumented noncitizen or a nonimmigrant is 122.14 ineligible for general assistance medical care other than 122.15 emergency services. For purposes of this subdivision, a 122.16 nonimmigrant is an individual in one or more of the classes 122.17 listed in United States Code, title 8, section 1101(a)(15), and 122.18 an undocumented noncitizen is an individual who resides in the 122.19 United States without the approval or acquiescence of the 122.20 Immigration and Naturalization Service. 122.21 (2) This paragraph does not apply to a child under age 18, 122.22 to a Cuban or Haitian entrant as defined in Public Law Number 122.23 96-422, section 501(e)(1) or (2)(a), or to a noncitizen who is 122.24 aged, blind, or disabled as defined in Code of Federal 122.25 Regulations, title 42, sections 435.520, 435.530, 435.531, 122.26 435.540, and 435.541, or effective October 1, 1998, to an 122.27 individual eligible for general assistance medical care under 122.28 paragraph (a), clause (4), who cooperates with the Immigration 122.29 and Naturalization Service to pursue any applicable immigration 122.30 status, including citizenship, that would qualify the individual 122.31 for medical assistance with federal financial participation. 122.32 (k) For purposes of paragraphs (g) and (j), "emergency 122.33 services" has the meaning given in Code of Federal Regulations, 122.34 title 42, section 440.255(b)(1), except that it also means 122.35 services rendered because of suspected or actual pesticide 122.36 poisoning. 123.1 (l) Notwithstanding any other provision of law, a 123.2 noncitizen who is ineligible for medical assistance due to the 123.3 deeming of a sponsor's income and resources, is ineligible for 123.4 general assistance medical care. 123.5 Sec. 37. Minnesota Statutes 2000, section 256D.03, 123.6 subdivision 4, is amended to read: 123.7 Subd. 4. [GENERAL ASSISTANCE MEDICAL CARE; SERVICES.] (a) 123.8 For a person who is eligible under subdivision 3, paragraph (a), 123.9 clause (3), general assistance medical care covers, except as 123.10 provided in paragraph (c): 123.11 (1) inpatient hospital services; 123.12 (2) outpatient hospital services; 123.13 (3) services provided by Medicare certified rehabilitation 123.14 agencies; 123.15 (4) prescription drugs and other products recommended 123.16 through the process established in section 256B.0625, 123.17 subdivision 13; 123.18 (5) equipment necessary to administer insulin and 123.19 diagnostic supplies and equipment for diabetics to monitor blood 123.20 sugar level; 123.21 (6) eyeglasses and eye examinations provided by a physician 123.22 or optometrist; 123.23 (7) hearing aids; 123.24 (8) prosthetic devices; 123.25 (9) laboratory and X-ray services; 123.26 (10) physician's services; 123.27 (11) medical transportation; 123.28 (12) chiropractic services as covered under the medical 123.29 assistance program; 123.30 (13) podiatric services; 123.31 (14) dental services; 123.32 (15) outpatient services provided by a mental health center 123.33 or clinic that is under contract with the county board and is 123.34 established under section 245.62; 123.35 (16) day treatment services for mental illness provided 123.36 under contract with the county board; 124.1 (17) prescribed medications for persons who have been 124.2 diagnosed as mentally ill as necessary to prevent more 124.3 restrictive institutionalization; 124.4 (18) psychological services, medical supplies and 124.5 equipment, and Medicare premiums, coinsurance and deductible 124.6 payments; 124.7 (19) medical equipment not specifically listed in this 124.8 paragraph when the use of the equipment will prevent the need 124.9 for costlier services that are reimbursable under this 124.10 subdivision; 124.11 (20) services performed by a certified pediatric nurse 124.12 practitioner, a certified family nurse practitioner, a certified 124.13 adult nurse practitioner, a certified obstetric/gynecological 124.14 nurse practitioner, a certified neonatal nurse practitioner, or 124.15 a certified geriatric nurse practitioner in independent 124.16 practice, if (1) the service is otherwise covered under this 124.17 chapter as a physician service, (2) the service provided on an 124.18 inpatient basis is not included as part of the cost for 124.19 inpatient services included in the operating payment rate, and 124.20 (3) the service is within the scope of practice of the nurse 124.21 practitioner's license as a registered nurse, as defined in 124.22 section 148.171; 124.23 (21) services of a certified public health nurse or a 124.24 registered nurse practicing in a public health nursing clinic 124.25 that is a department of, or that operates under the direct 124.26 authority of, a unit of government, if the service is within the 124.27 scope of practice of the public health nurse's license as a 124.28 registered nurse, as defined in section 148.171; and 124.29 (22) telemedicine consultations, to the extent they are 124.30 covered under section 256B.0625, subdivision 3b. 124.31 (b) Except as provided in paragraph (c), for a recipient 124.32 who is eligible under subdivision 3, paragraph (a), clause (1) 124.33 or (2), general assistance medical care covers the services 124.34 listed in paragraph (a) with the exception of special 124.35 transportation services. 124.36 (c) Gender reassignment surgery and related services are 125.1 not covered services under this subdivision unless the 125.2 individual began receiving gender reassignment services prior to 125.3 July 1, 1995. 125.4 (d) In order to contain costs, the commissioner of human 125.5 services shall select vendors of medical care who can provide 125.6 the most economical care consistent with high medical standards 125.7 and shall where possible contract with organizations on a 125.8 prepaid capitation basis to provide these services. The 125.9 commissioner shall consider proposals by counties and vendors 125.10 for prepaid health plans, competitive bidding programs, block 125.11 grants, or other vendor payment mechanisms designed to provide 125.12 services in an economical manner or to control utilization, with 125.13 safeguards to ensure that necessary services are provided. 125.14 Before implementing prepaid programs in counties with a county 125.15 operated or affiliated public teaching hospital or a hospital or 125.16 clinic operated by the University of Minnesota, the commissioner 125.17 shall consider the risks the prepaid program creates for the 125.18 hospital and allow the county or hospital the opportunity to 125.19 participate in the program in a manner that reflects the risk of 125.20 adverse selection and the nature of the patients served by the 125.21 hospital, provided the terms of participation in the program are 125.22 competitive with the terms of other participants considering the 125.23 nature of the population served. Payment for services provided 125.24 pursuant to this subdivision shall be as provided to medical 125.25 assistance vendors of these services under sections 256B.02, 125.26 subdivision 8, and 256B.0625. For payments made during fiscal 125.27 year 1990 and later years, the commissioner shall consult with 125.28 an independent actuary in establishing prepayment rates, but 125.29 shall retain final control over the rate methodology. Payment 125.30 rates established by the commissioner must be within the limits 125.31 of available appropriations. Notwithstanding the provisions of 125.32 subdivision 3, an individual who becomes ineligible for general 125.33 assistance medical care because of failure to submit income 125.34 reports or recertification forms in a timely manner, shall 125.35 remain enrolled in the prepaid health plan and shall remain 125.36 eligible for general assistance medical care coverage through 126.1 the last day of the month in which the enrollee became 126.2 ineligible for general assistance medical care. 126.3 (e) There shall be no copayment required of any recipient 126.4 of benefits for any services provided under this subdivision. A 126.5 hospital receiving a reduced payment as a result of this section 126.6 may apply the unpaid balance toward satisfaction of the 126.7 hospital's bad debts. 126.8 (f) Any county may, from its own resources, provide medical 126.9 payments for which state payments are not made. 126.10 (g) Chemical dependency services that are reimbursed under 126.11 chapter 254B must not be reimbursed under general assistance 126.12 medical care. 126.13 (h) The maximum payment for new vendors enrolled in the 126.14 general assistance medical care program after the base year 126.15 shall be determined from the average usual and customary charge 126.16 of the same vendor type enrolled in the base year. 126.17 (i) The conditions of payment for services under this 126.18 subdivision are the same as the conditions specified in rules 126.19 adopted under chapter 256B governing the medical assistance 126.20 program, unless otherwise provided by statute or rule. 126.21 Sec. 38. Minnesota Statutes 2000, section 256J.31, 126.22 subdivision 12, is amended to read: 126.23 Subd. 12. [RIGHT TO DISCONTINUE CASH ASSISTANCE.] A 126.24 participant who is not in vendor payment status may discontinue 126.25 receipt of the cash assistance portion of the MFIP assistance 126.26 grant and retain eligibility for child care assistance under 126.27 section 119B.05and for medical assistance under sections126.28256B.055, subdivision 3a, and 256B.0635. For the months a 126.29 participant chooses to discontinue the receipt of the cash 126.30 portion of the MFIP grant, the assistance unit accrues months of 126.31 eligibility to be applied toward eligibility for child care 126.32 under section 119B.05and for medical assistance under sections126.33256B.055, subdivision 3a, and 256B.0635. 126.34 [EFFECTIVE DATE.] This section is effective July 1, 2002. 126.35 Sec. 39. Minnesota Statutes 2000, section 256K.03, 126.36 subdivision 1, is amended to read: 127.1 Subdivision 1. [NOTIFICATION OF PROGRAM.] Except for the 127.2 provisions in this section, the provisions for the MFIP 127.3 application process shall be followed. Within two days after 127.4 receipt of a completed combined application form, the county 127.5 agency must refer to the provider the applicant who meets the 127.6 conditions under section 256K.02, and notify the applicant in 127.7 writing of the program including the following provisions: 127.8 (1) notification that, as part of the application process, 127.9 applicants are required to attend orientation, to be followed 127.10 immediately by a job search; 127.11 (2) the program provider, the date, time, and location of 127.12 the scheduled program orientation; 127.13 (3) the procedures for qualifying for and receiving 127.14 benefits under the program; 127.15 (4) the immediate availability of supportive services, 127.16 including, but not limited to, child care, transportation, 127.17medical assistance,and other work-related aid; and 127.18 (5) the rights, responsibilities, and obligations of 127.19 participants in the program, including, but not limited to, the 127.20 grounds for exemptions and deferrals, the consequences for 127.21 refusing or failing to participate fully, and the appeal process. 127.22 [EFFECTIVE DATE.] This section is effective July 1, 2002. 127.23 Sec. 40. Minnesota Statutes 2000, section 256K.07, is 127.24 amended to read: 127.25 256K.07 [ELIGIBILITY FOR FOOD STAMPS, MEDICAL ASSISTANCE,127.26 AND CHILD CARE.] 127.27 The participant shall be treated as an MFIP recipient for 127.28 food stamps, medical assistance,and child care eligibility 127.29 purposes. The participant who leaves the program as a result of 127.30 increased earnings from employment shall be eligible for 127.31transitional medical assistance andchild care without regard to 127.32 MFIP receipt in three of the six months preceding ineligibility. 127.33 [EFFECTIVE DATE.] This section is effective July 1, 2002. 127.34 Sec. 41. Minnesota Statutes 2000, section 256L.06, 127.35 subdivision 3, is amended to read: 127.36 Subd. 3. [ADMINISTRATION AND COMMISSIONER'S DUTIES.] (a) 128.1 Premiums are dedicated to the commissioner for MinnesotaCare. 128.2 (b) The commissioner shall develop and implement procedures 128.3 to: (1) require enrollees to report changes in income; (2) 128.4 adjust sliding scale premium payments, based upon changes in 128.5 enrollee income; and (3) disenroll enrollees from MinnesotaCare 128.6 for failure to pay required premiums. Failure to pay includes 128.7 payment with a dishonored check, a returned automatic bank 128.8 withdrawal, or a refused credit card or debit card payment. The 128.9 commissioner may demand a guaranteed form of payment, including 128.10 a cashier's check or a money order, as the only means to replace 128.11 a dishonored, returned, or refused payment. 128.12 (c) Premiums are calculated on a calendar month basis and 128.13 may be paid on a monthly, quarterly, or annual basis, with the 128.14 first payment due upon notice from the commissioner of the 128.15 premium amount required. The commissioner shall inform 128.16 applicants and enrollees of these premium payment options. 128.17 Premium payment is required before enrollment is complete and to 128.18 maintain eligibility in MinnesotaCare. 128.19 (d) Nonpayment of the premium will result in disenrollment 128.20 from the planwithin one calendar month after the due date128.21 effective for the calendar month for which the premium was due. 128.22 Persons disenrolled for nonpayment or who voluntarily terminate 128.23 coverage from the program may not reenroll until four calendar 128.24 months have elapsed. Persons disenrolled for nonpayment who pay 128.25 all past due premiums as well as current premiums due, including 128.26 premiums due for the period of disenrollment, within 20 days of 128.27 disenrollment, shall be reenrolled retroactively to the first 128.28 day of disenrollment. Persons disenrolled for nonpayment or who 128.29 voluntarily terminate coverage from the program may not reenroll 128.30 for four calendar months unless the person demonstrates good 128.31 cause for nonpayment. Good cause does not exist if a person 128.32 chooses to pay other family expenses instead of the premium. 128.33 The commissioner shall define good cause in rule. 128.34 [EFFECTIVE DATE.] This section is effective July 1, 2002. 128.35 Sec. 42. Minnesota Statutes 2000, section 256L.12, 128.36 subdivision 9, is amended to read: 129.1 Subd. 9. [RATE SETTING.] Rates will be prospective, per 129.2 capita, where possible. The commissioner may allow health plans 129.3 to arrange for inpatient hospital services on a risk or nonrisk 129.4 basis. The commissioner shall consult with an independent 129.5 actuary to determine appropriate rates. Rates established by 129.6 the commissioner must be within the limits of available 129.7 appropriations. 129.8 Sec. 43. Minnesota Statutes 2000, section 256L.12, is 129.9 amended by adding a subdivision to read: 129.10 Subd. 11. [COVERAGE AT INDIAN HEALTH SERVICE 129.11 FACILITIES.] For American Indian enrollees of MinnesotaCare, 129.12 MinnesotaCare shall cover health care services provided at 129.13 Indian Health Service facilities and facilities operated by a 129.14 tribe or tribal organization under funding authorized by United 129.15 States Code, title 25, sections 450f to 450n, or title III of 129.16 the Indian Self-Determination and Education Act, Public Law 129.17 Number 93-638, if those services would otherwise be covered 129.18 under section 256L.03. Payments for services provided under 129.19 this subdivision shall be made on a fee-for-service basis, and 129.20 may, at the option of the tribe or organization, be made at the 129.21 rates authorized under sections 256.969, subdivision 16, and 129.22 256B.0625, subdivision 34, for those MinnesotaCare enrollees 129.23 eligible for coverage at medical assistance rates. For purposes 129.24 of this subdivision, "American Indian" has the meaning given to 129.25 persons to whom services will be provided for in the Code of 129.26 Federal Regulations, title 42, section 36.12. 129.27 Sec. 44. Minnesota Statutes 2000, section 256L.16, is 129.28 amended to read: 129.29 256L.16 [PAYMENT RATES; SERVICES FOR FAMILIES AND CHILDREN 129.30 UNDER THE MINNESOTACARE HEALTH CARE REFORM WAIVER.] 129.31 Section 256L.11, subdivision 2, shall not apply to services 129.32 provided tochildrenfamilies with children who are eligibleto129.33receive expanded servicesaccording to section256L.03,129.34subdivision 1a256L.04, subdivision 1, paragraph (a). 129.35 Sec. 45. Laws 1995, chapter 178, article 2, section 36, is 129.36 amended to read: 130.1 Sec. 36. [EMPOWERMENT ZONES; ADMINISTRATIVE SIMPLIFICATION 130.2 OF WELFARE LAWS.] 130.3 (a) The commissioner of human services shall make 130.4 recommendations to effectuate the changes in federal laws and 130.5 regulations, state laws and rules, and the state plan to improve 130.6 the administrative efficiency of the aid to families with 130.7 dependent children, general assistance, work readiness, family 130.8 general assistance, medical assistance, general assistance 130.9 medical care, and food stamp programs. At a minimum, the 130.10 following administrative standards and procedures must be 130.11 changed. 130.12 The commissioner shall: 130.13 (1) require income or eligibility reviews no more 130.14 frequently than annually for cases in which income is normally 130.15 invariant, as in aid to families with dependent children cases 130.16 where the only source of household income is Supplemental Social 130.17 Security Income; 130.18 (2) permit households to report income annually when the 130.19 source of income is excluded, such as a minor's earnings; 130.20 (3)require income or eligibility reviews no more130.21frequently than annually for extended medical assistance cases;130.22(4)require income or eligibility reviews no more 130.23 frequently than annually for a medical assistance postpartum 130.24 client, where the client previously had eligibility under a 130.25 different basis prior to pregnancy or if other household members 130.26 have eligibility with the same income/basis that applies to the 130.27 client; 130.28(5)(4) permit all income or eligibility reviews for foster 130.29 care medical assistance cases to use the short application form; 130.30 and 130.31(6)(5) make dependent care expenses declaratory for 130.32 medical assistance; and130.33(7) permit households to only report gifts worth $100 or130.34more per month. 130.35 (b) The county's administrative savings resulting from 130.36 these changes may be allocated to fund any lawful purpose. 131.1 (c) The recommendations must be provided in a report to the 131.2 chairs of the appropriate legislative committees by August 1, 131.3 1995. The recommendations must include a list of the 131.4 administrative standards and procedures that require approval by 131.5 the federal government before implementation, and also which 131.6 administrative simplification standards and procedures may be 131.7 implemented by a county prior to receiving a federal waiver. 131.8 (d) The commissioner shall seek the necessary waivers from 131.9 the federal government as soon as possible to implement the 131.10 administrative simplification standards and procedures. 131.11 Sec. 46. Laws 1999, chapter 245, article 4, section 110, 131.12 is amended to read: 131.13 Sec. 110. [PROGRAMS FOR SENIOR CITIZENS.] 131.14 The commissioner of human services shall study the 131.15 eligibility criteria of and benefits provided to persons age 65 131.16 and over through the array of cash assistance and health care 131.17 programs administered by the department, and the extent to which 131.18 these programs can be combined, simplified, or coordinated to 131.19 reduce administrative costs and improve access. The 131.20 commissioner shall also study potential barriers to enrollment 131.21 for low-income seniors who would otherwise deplete resources 131.22 necessary to maintain independent community living. At a 131.23 minimum, the study must include an evaluation of asset 131.24 requirements and enrollment sites. The commissioner shall 131.25 report study findings and recommendations to the legislature by 131.26JuneSeptember 30, 2001. 131.27 Sec. 47. [NOTICE OF NEW PREMIUM SCHEDULE.] 131.28 The commissioner of human services shall provide medical 131.29 assistance enrollees subject to premiums as employed persons 131.30 with disabilities with prior notice of the new premium schedule 131.31 established under the section 13 amendment to section 256B.057, 131.32 subdivision 9, paragraph (c). This notice must be provided at 131.33 least two months before the month in which the first premium 131.34 payment under the new schedule is due. 131.35 Sec. 48. [MEDICATION THERAPY MANAGEMENT PILOT PROGRAM.] 131.36 Subdivision 1. [ESTABLISHMENT.] The commissioner of human 132.1 services, in consultation with the advisory committee 132.2 established under subdivision 2, shall implement, beginning July 132.3 1, 2001, a two-year medication therapy management pilot program 132.4 for medical assistance enrollees. Medication therapy management 132.5 must be provided by teams of physicians and pharmacists working 132.6 in collaborative practice, as defined in Minnesota Statutes, 132.7 section 151.01, subdivision 27, clause (5), to help patients use 132.8 medications safely and effectively. The commissioner may enroll 132.9 individual pharmacists who participate in the pilot program as 132.10 medical assistance providers and shall seek to ensure that 132.11 participating pharmacists represent all geographic regions of 132.12 the state. 132.13 Subd. 2. [ADVISORY COMMITTEE.] The commissioner shall 132.14 establish a ten-member medication therapy management advisory 132.15 committee, to advise the commissioner in the implementation and 132.16 administration of the program and the development of eligibility 132.17 criteria for enrollees and providers and requirements for 132.18 collaborative practice agreements. The committee shall be 132.19 comprised of: two licensed physicians; two licensed 132.20 pharmacists; two consumer representatives; three members with 132.21 expertise in the area of medication therapy management, who may 132.22 be licensed physicians or licensed pharmacists; and a 132.23 representative of the commissioner, who shall serve as an 132.24 ex-officio nonvoting member. In appointing members who are not 132.25 consumer representatives, the commissioner shall consider 132.26 recommendations of associations representing pharmacy and 132.27 medical practitioners. The committee is governed by section 132.28 15.059, except that committee members do not receive 132.29 compensation or reimbursement for expenses. 132.30 Subd. 3. [EVALUATION.] The commissioner shall evaluate the 132.31 cost-effectiveness of the pilot program and its effect on 132.32 patient outcomes and quality of care, and shall report to the 132.33 legislature by December 15, 2003. The commissioner may contract 132.34 with a vendor to conduct the evaluation. 132.35 Sec. 49. [REGULATORY SIMPLIFICATION FOR STATE HEALTH CARE 132.36 PROGRAM PROVIDERS.] 133.1 The commissioner of human services, in consultation with 133.2 providers participating in state health care programs, shall 133.3 identify nonfinancial barriers to increased provider enrollment 133.4 and provider retention in state health care programs, and shall 133.5 implement procedures to address these barriers. Areas to be 133.6 examined by the commissioner shall include, but are not limited 133.7 to, regulatory complexity and inconsistencies between state 133.8 health care programs, provider requirements, provision of 133.9 technical assistance to providers, responsiveness to provider 133.10 inquiries and complaints, claims processing turnaround times, 133.11 and policies for rejecting provider claims. The commissioner 133.12 shall report to the legislature by February 15, 2002, on any 133.13 changes to the administration of state health care programs that 133.14 will be implemented as a result of the study, and present 133.15 recommendations for any necessary changes in state law. 133.16 Sec. 50. [REPEALER.] 133.17 (a) Minnesota Statutes 2000, section 256B.037, subdivision 133.18 5, is repealed effective January 1, 2002. 133.19 (b) Minnesota Statutes 2000, section 256B.0635, subdivision 133.20 3, is repealed effective July 1, 2002. 133.21 ARTICLE 3 133.22 CONTINUING CARE AND HOME CARE 133.23 Section 1. Minnesota Statutes 2000, section 245A.13, 133.24 subdivision 7, is amended to read: 133.25 Subd. 7. [RATE RECOMMENDATION.] The commissioner of human 133.26 services may review rates of a residential program participating 133.27 in the medical assistance program which is in receivership and 133.28 that has needs or deficiencies documented by the department of 133.29 health or the department of human services. If the commissioner 133.30 of human services determines that a review of the rate 133.31 established undersection 256B.501sections 256B.5012 and 133.32 256B.5013 is needed, the commissioner shall: 133.33 (1) review the order or determination that cites the 133.34 deficiencies or needs; and 133.35 (2) determine the need for additional staff, additional 133.36 annual hours by type of employee, and additional consultants, 134.1 services, supplies, equipment, repairs, or capital assets 134.2 necessary to satisfy the needs or deficiencies. 134.3 Sec. 2. Minnesota Statutes 2000, section 245A.13, 134.4 subdivision 8, is amended to read: 134.5 Subd. 8. [ADJUSTMENT TO THE RATE.] Upon review of rates 134.6 under subdivision 7, the commissioner may adjust the residential 134.7 program's payment rate. The commissioner shall review the 134.8 circumstances, together with the residentialprogram cost report134.9 program's most recent income and expense report, to determine 134.10 whether or not the deficiencies or needs can be corrected or met 134.11 by reallocating residential program staff, costs, revenues, 134.12 or any other resources includinganyinvestments, efficiency134.13incentives, or allowances. If the commissioner determines that 134.14 any deficiency cannot be corrected or the need cannot be met 134.15 with the payment rate currently being paid, the commissioner 134.16 shall determine the payment rate adjustment by dividing the 134.17 additional annual costs established during the commissioner's 134.18 review by the residential program's actual resident days from 134.19 the most recentdesk-audited costincome and expense report or 134.20 the estimated resident days in the projected receivership 134.21 period. The payment rate adjustmentmust meet the conditions in134.22Minnesota Rules, parts 9553.0010 to 9553.0080, andremains in 134.23 effect during the period of the receivership or until another 134.24 date set by the commissioner. Upon the subsequent sale, 134.25 closure, or transfer of the residential program, the 134.26 commissioner may recover amounts that were paid as payment rate 134.27 adjustments under this subdivision. This recovery shall be 134.28 determined through a review of actual costs and resident days in 134.29 the receivership period. The costs the commissioner finds to be 134.30 allowable shall be divided by the actual resident days for the 134.31 receivership period. This rate shall be compared to the rate 134.32 paid throughout the receivership period, with the difference, 134.33 multiplied by resident days, being the amount to be repaid to 134.34 the commissioner. Allowable costs shall be determined by the 134.35 commissioner as those ordinary, necessary, and related to 134.36 resident care by prudent and cost-conscious management. The 135.1 buyer or transferee shall repay this amount to the commissioner 135.2 within 60 days after the commissioner notifies the buyer or 135.3 transferee of the obligation to repay. This provision does not 135.4 limit the liability of the seller to the commissioner pursuant 135.5 to section 256B.0641. 135.6 Sec. 3. Minnesota Statutes 2000, section 252.275, 135.7 subdivision 4b, is amended to read: 135.8 Subd. 4b. [GUARANTEED FLOOR.] Each countywith an original135.9allocation for the preceding year that is equal to or less than135.10the guaranteed floor minimum index shall have a guaranteed floor135.11equal to its original allocation for the preceding year. Each135.12county with an original allocation for the preceding year that135.13is greater than the guaranteed floor minimum indexshall have a 135.14 guaranteed floor equal to the lesser of clause (1) or (2): 135.15 (1) the county's original allocation for the preceding 135.16 year; or 135.17 (2) 70 percent of the county's reported expenditures 135.18 eligible for reimbursement during the 12 months ending on June 135.19 30 of the preceding calendar year. 135.20For calendar year 1993, the guaranteed floor minimum index135.21shall be $20,000. For each subsequent year, the index shall be135.22adjusted by the projected change in the average value in the135.23United States Department of Labor Bureau of Labor Statistics135.24consumer price index (all urban) for that year.135.25 Notwithstanding this subdivision, no county shall be 135.26 allocated a guaranteed floor of less than $1,000. 135.27 When the amount of funds available for allocation is less 135.28 than the amount available in the previous year, each county's 135.29 previous year allocation shall be reduced in proportion to the 135.30 reduction in the statewide funding, to establish each county's 135.31 guaranteed floor. 135.32 Sec. 4. Minnesota Statutes 2000, section 254B.02, 135.33 subdivision 3, is amended to read: 135.34 Subd. 3. [RESERVE ACCOUNT.] The commissioner shall 135.35 allocate money from the reserve account to counties that, during 135.36 the current fiscal year, have met or exceeded the base level of 136.1 expenditures for eligible chemical dependency services from 136.2 local money. The commissioner shall establish the base level 136.3 for fiscal year 1988 as the amount of local money used for 136.4 eligible services in calendar year 1986. In later years, the 136.5 base level must be increased in the same proportion as state 136.6 appropriations to implement Laws 1986, chapter 394, sections 8 136.7 to 20, are increased. The base level must be decreased if the 136.8 fund balance from which allocations are made under section 136.9 254B.02, subdivision 1, is decreased in later years. The local 136.10 match rate for the reserve account is the same rate as applied 136.11 to the initial allocation. Reserve account payments must not be 136.12 included when calculating the county adjustments made according 136.13 to subdivision 2. For counties providing medical assistance or 136.14 general assistance medical care through managed care plans on 136.15 January 1, 1996, the base year is fiscal year 1995. For 136.16 counties beginning provision of managed care after January 1, 136.17 1996, the base year is the most recent fiscal year before 136.18 enrollment in managed care begins. For counties providing 136.19 managed care, the base level will be increased or decreased in 136.20 proportion to changes in the fund balance from which allocations 136.21 are made under subdivision 2, but will be additionally increased 136.22 or decreased in proportion to the change in county adjusted 136.23 population made in subdivision 1, paragraphs (b) and 136.24 (c). Effective July 1, 2001, funds deposited in the reserve 136.25 account in excess of those needed to meet obligations for 136.26 services provided during the biennium under this section and 136.27 sections 254B.06 and 254B.09 shall cancel to the general fund. 136.28 Sec. 5. Minnesota Statutes 2000, section 254B.03, 136.29 subdivision 1, is amended to read: 136.30 Subdivision 1. [LOCAL AGENCY DUTIES.] (a) Every local 136.31 agency shall provide chemical dependency services to persons 136.32 residing within its jurisdiction who meet criteria established 136.33 by the commissioner for placement in a chemical dependency 136.34 residential or nonresidential treatment service. Chemical 136.35 dependency money must be administered by the local agencies 136.36 according to law and rules adopted by the commissioner under 137.1 sections 14.001 to 14.69. 137.2 (b) In order to contain costs, the county board shall, with 137.3 the approval of the commissioner of human services, select 137.4 eligible vendors of chemical dependency services who can provide 137.5 economical and appropriate treatment. Unless the local agency 137.6 is a social services department directly administered by a 137.7 county or human services board, the local agency shall not be an 137.8 eligible vendor under section 254B.05. The commissioner may 137.9 approve proposals from county boards to provide services in an 137.10 economical manner or to control utilization, with safeguards to 137.11 ensure that necessary services are provided. If a county 137.12 implements a demonstration or experimental medical services 137.13 funding plan, the commissioner shall transfer the money as 137.14 appropriate. If a county selects a vendor located in another 137.15 state, the county shall ensure that the vendor is in compliance 137.16 with the rules governing licensure of programs located in the 137.17 state. 137.18 (c) The calendar year19982002 rate for vendors may not 137.19 increase more thanthreetwo percent above the rate approved in 137.20 effect on January 1,19972001. The calendar year19992003 137.21 rate for vendors may not increase more thanthreetwo percent 137.22 above the rate in effect on January 1,19982002. The calendar 137.23 years 2004 and 2005 rates may not exceed the rate in effect on 137.24 January 1, 2003. 137.25 (d) A culturally specific vendor that provides assessments 137.26 under a variance under Minnesota Rules, part 9530.6610, shall be 137.27 allowed to provide assessment services to persons not covered by 137.28 the variance. 137.29 Sec. 6. Minnesota Statutes 2000, section 254B.04, 137.30 subdivision 1, is amended to read: 137.31 Subdivision 1. [ELIGIBILITY.] (a) Persons eligible for 137.32 benefits under Code of Federal Regulations, title 25, part 20, 137.33 persons eligible for medical assistance benefits under sections 137.34 256B.055, 256B.056, and 256B.057, subdivisions 1, 2, 5, and 6, 137.35 or who meet the income standards of section 256B.056, 137.36 subdivision 4, and persons eligible for general assistance 138.1 medical care under section 256D.03, subdivision 3, are entitled 138.2 to chemical dependency fund services. State money appropriated 138.3 for this paragraph must be placed in a separate account 138.4 established for this purpose. 138.5 Persons with dependent children who are determined to be in 138.6 need of chemical dependency treatment pursuant to an assessment 138.7 under section 626.556, subdivision 10, or a case plan under 138.8 section 260C.201, subdivision 6, or 260C.212, shall be assisted 138.9 by the local agency to access needed treatment services. 138.10 Treatment services must be appropriate for the individual or 138.11 family, which may include long-term care treatment or treatment 138.12 in a facility that allows the dependent children to stay in the 138.13 treatment facility. The county shall pay for out-of-home 138.14 placement costs, if applicable. 138.15 (b) A person not entitled to services under paragraph (a), 138.16 but with family income that is less than the 1997 federal 138.17 poverty guidelines equivalent of 60 percent of the state median 138.18 income for a family of like size and composition, shall be 138.19 eligible to receive chemical dependency fund services within the 138.20 limit of fundsavailable after persons entitled to services138.21under paragraph (a) have been servedappropriated for this group 138.22 for the fiscal year. If notified by the state agency of limited 138.23 funds, a county must give preferential treatment to persons with 138.24 dependent children who are in need of chemical dependency 138.25 treatment pursuant to an assessment under section 626.556, 138.26 subdivision 10, or a case plan under section 260C.201, 138.27 subdivision 6, or 260C.212. A county may spend money from its 138.28 own sources to serve persons under this paragraph. State money 138.29 appropriated for this paragraph must be placed in a separate 138.30 account established for this purpose. 138.31 (c) Persons whose income is between the 1997 federal 138.32 poverty guidelines equivalent of 60 percent and 115 percent of 138.33 the state median income shall be eligible for chemical 138.34 dependency services on a sliding fee basis, within the limit of 138.35 fundsavailable, after persons entitled to services under138.36paragraph (a) and persons eligible for services under paragraph139.1(b) have been servedappropriated for this group for the fiscal 139.2 year. Persons eligible under this paragraph must contribute to 139.3 the cost of services according to the sliding fee scale 139.4 established under subdivision 3. A county may spend money from 139.5 its own sources to provide services to persons under this 139.6 paragraph. State money appropriated for this paragraph must be 139.7 placed in a separate account established for this purpose. 139.8 Sec. 7. Minnesota Statutes 2000, section 254B.09, is 139.9 amended by adding a subdivision to read: 139.10 Subd. 8. [PAYMENTS TO IMPROVE SERVICES TO AMERICAN 139.11 INDIANS.] The commissioner may set rates for chemical dependency 139.12 services according to the American Indian Health Improvement 139.13 Act, Public Law Number 94-437, for eligible vendors. These 139.14 rates shall supersede rates set in county purchase of service 139.15 agreements when payments are made on behalf of clients eligible 139.16 according to Public Law Number 94-437. 139.17 Sec. 8. Minnesota Statutes 2000, section 256.01, is 139.18 amended by adding a subdivision to read: 139.19 Subd. 19. [GRANTS FOR CASE MANAGEMENT SERVICES TO PERSONS 139.20 WITH HIV OR AIDS.] The commissioner may award grants to eligible 139.21 vendors for the development, implementation, and evaluation of 139.22 case management services for individuals infected with the human 139.23 immunodeficiency virus. HIV/AIDs case management services will 139.24 be provided to increase access to cost effective health care 139.25 services, to reduce the risk of HIV transmission, to ensure that 139.26 basic client needs are met, and to increase client access to 139.27 needed community supports or services. 139.28 Sec. 9. Minnesota Statutes 2000, section 256.476, 139.29 subdivision 1, is amended to read: 139.30 Subdivision 1. [PURPOSE AND GOALS.] The commissioner of 139.31 human services shall establish a consumer support grant 139.32 programto assistfor individuals with functional limitations 139.33 and their familiesin purchasing and securing supports which the139.34individuals need to live as independently and productively in139.35the community as possiblewho wish to purchase and secure their 139.36 own supports. The commissioner and local agencies shall jointly 140.1 develop an implementation plan which must include a way to 140.2 resolve the issues related to county liability. The program 140.3 shall: 140.4 (1) make support grants available to individuals or 140.5 families as an effective alternative to existing programs and 140.6 services, such as the developmental disability family support 140.7 program,the alternative care program,personal care attendant 140.8 services, home health aide services, and private duty nursing 140.9facilityservices; 140.10 (2) provide consumers more control, flexibility, and 140.11 responsibility overthe needed supportstheir services and 140.12 supports; 140.13 (3) promote local program management and decision making; 140.14 and 140.15 (4) encourage the use of informal and typical community 140.16 supports. 140.17 Sec. 10. Minnesota Statutes 2000, section 256.476, 140.18 subdivision 2, is amended to read: 140.19 Subd. 2. [DEFINITIONS.] For purposes of this section, the 140.20 following terms have the meanings given them: 140.21 (a) "County board" means the county board of commissioners 140.22 for the county of financial responsibility as defined in section 140.23 256G.02, subdivision 4, or its designated representative. When 140.24 a human services board has been established under sections 140.25 402.01 to 402.10, it shall be considered the county board for 140.26 the purposes of this section. 140.27 (b) "Family" means the person's birth parents, adoptive 140.28 parents or stepparents, siblings or stepsiblings, children or 140.29 stepchildren, grandparents, grandchildren, niece, nephew, aunt, 140.30 uncle, or spouse. For the purposes of this section, a family 140.31 member is at least 18 years of age. 140.32 (c) "Functional limitations" means the long-term inability 140.33 to perform an activity or task in one or more areas of major 140.34 life activity, including self-care, understanding and use of 140.35 language, learning, mobility, self-direction, and capacity for 140.36 independent living. For the purpose of this section, the 141.1 inability to perform an activity or task results from a mental, 141.2 emotional, psychological, sensory, or physical disability, 141.3 condition, or illness. 141.4 (d) "Informed choice" means a voluntary decision made by 141.5 the person or the person's legal representative, after becoming 141.6 familiarized with the alternatives to: 141.7 (1) select a preferred alternative from a number of 141.8 feasible alternatives; 141.9 (2) select an alternative which may be developed in the 141.10 future; and 141.11 (3) refuse any or all alternatives. 141.12 (e) "Local agency" means the local agency authorized by the 141.13 county board to carry out the provisions of this section. 141.14 (f) "Person" or "persons" means a person or persons meeting 141.15 the eligibility criteria in subdivision 3. 141.16 (g) "Authorized representative" means an individual 141.17 designated by the person or their legal representative to act on 141.18 their behalf. This individual may be a family member, guardian, 141.19 representative payee, or other individual designated by the 141.20 person or their legal representative, if any, to assist in 141.21 purchasing and arranging for supports. For the purposes of this 141.22 section, an authorized representative is at least 18 years of 141.23 age. 141.24 (h) "Screening" means the screening of a person's service 141.25 needs under sections 256B.0911 and 256B.092. 141.26 (i) "Supports" means services, care, aids,home141.27 environmental modifications, or assistance purchased by the 141.28 person or the person's family. Examples of supports include 141.29 respite care, assistance with daily living, andadaptive aids141.30 assistive technology. For the purpose of this section, 141.31 notwithstanding the provisions of section 144A.43, supports 141.32 purchased under the consumer support program are not considered 141.33 home care services. 141.34 (j) "Program of origination" means the program the 141.35 individual transferred from when approved for the consumer 141.36 support grant program. 142.1 Sec. 11. Minnesota Statutes 2000, section 256.476, 142.2 subdivision 3, is amended to read: 142.3 Subd. 3. [ELIGIBILITY TO APPLY FOR GRANTS.] (a) A person 142.4 is eligible to apply for a consumer support grant if the person 142.5 meets all of the following criteria: 142.6 (1) the person is eligible for and has been approved to 142.7 receive services under medical assistance as determined under 142.8 sections 256B.055 and 256B.056or the person is eligible for and142.9has been approved to receive services under alternative care142.10services as determined under section 256B.0913or the person has 142.11 been approved to receive a grant under the developmental 142.12 disability family support program under section 252.32; 142.13 (2) the person is able to direct and purchase the person's 142.14 own care and supports, or the person has a family member, legal 142.15 representative, or other authorized representative who can 142.16 purchase and arrange supports on the person's behalf; 142.17 (3) the person has functional limitations, requires ongoing 142.18 supports to live in the community, and is at risk of or would 142.19 continue institutionalization without such supports; and 142.20 (4) the person will live in a home. For the purpose of 142.21 this section, "home" means the person's own home or home of a 142.22 person's family member. These homes are natural home settings 142.23 and are not licensed by the department of health or human 142.24 services. 142.25 (b) Persons may not concurrently receive a consumer support 142.26 grant if they are: 142.27 (1) receiving home and community-based services under 142.28 United States Code, title 42, section 1396h(c); personal care 142.29 attendant and home health aide services under section 256B.0625; 142.30 a developmental disability family support grant; or alternative 142.31 care services under section 256B.0913; or 142.32 (2) residing in an institutional or congregate care setting. 142.33 (c) A person or person's family receiving a consumer 142.34 support grant shall not be charged a fee or premium by a local 142.35 agency for participating in the program. 142.36 (d) The commissioner may limit the participation ofnursing143.1facility residents, residents of intermediate care facilities143.2for persons with mental retardation, and therecipients of 143.3 services from federal waiver programs in the consumer support 143.4 grant program if the participation of these individuals will 143.5 result in an increase in the cost to the state. 143.6 (e) The commissioner shall establish a budgeted 143.7 appropriation each fiscal year for the consumer support grant 143.8 program. The number of individuals participating in the program 143.9 will be adjusted so the total amount allocated to counties does 143.10 not exceed the amount of the budgeted appropriation. The 143.11 budgeted appropriation will be adjusted annually to accommodate 143.12 changes in demand for the consumer support grants. 143.13 Sec. 12. Minnesota Statutes 2000, section 256.476, 143.14 subdivision 4, is amended to read: 143.15 Subd. 4. [SUPPORT GRANTS; CRITERIA AND LIMITATIONS.] (a) A 143.16 county board may choose to participate in the consumer support 143.17 grant program. If a county board chooses to participate in the 143.18 program, the local agency shall establish written procedures and 143.19 criteria to determine the amount and use of support grants. 143.20 These procedures must include, at least, the availability of 143.21 respite care, assistance with daily living, and adaptive aids. 143.22 The local agency may establish monthly or annual maximum amounts 143.23 for grants and procedures where exceptional resources may be 143.24 required to meet the health and safety needs of the person on a 143.25 time-limited basis, however, the total amount awarded to each 143.26 individual may not exceed the limits established in subdivision 143.27 5, paragraph (f). 143.28 (b) Support grants to a person or a person's family will be 143.29 provided through a monthly subsidy payment and be in the form of 143.30 cash, voucher, or direct county payment to vendor. Support 143.31 grant amounts must be determined by the local agency. Each 143.32 service and item purchased with a support grant must meet all of 143.33 the following criteria: 143.34 (1) it must be over and above the normal cost of caring for 143.35 the person if the person did not have functional limitations; 143.36 (2) it must be directly attributable to the person's 144.1 functional limitations; 144.2 (3) it must enable the person or the person's family to 144.3 delay or prevent out-of-home placement of the person; and 144.4 (4) it must be consistent with the needs identified in the 144.5 service plan, when applicable. 144.6 (c) Items and services purchased with support grants must 144.7 be those for which there are no other public or private funds 144.8 available to the person or the person's family. Fees assessed 144.9 to the person or the person's family for health and human 144.10 services are not reimbursable through the grant. 144.11 (d) In approving or denying applications, the local agency 144.12 shall consider the following factors: 144.13 (1) the extent and areas of the person's functional 144.14 limitations; 144.15 (2) the degree of need in the home environment for 144.16 additional support; and 144.17 (3) the potential effectiveness of the grant to maintain 144.18 and support the person in the family environment or the person's 144.19 own home. 144.20 (e) At the time of application to the program or screening 144.21 for other services, the person or the person's family shall be 144.22 provided sufficient information to ensure an informed choice of 144.23 alternatives by the person, the person's legal representative, 144.24 if any, or the person's family. The application shall be made 144.25 to the local agency and shall specify the needs of the person 144.26 and family, the form and amount of grant requested, the items 144.27 and services to be reimbursed, and evidence of eligibility for 144.28 medical assistanceor alternative care program. 144.29 (f) Upon approval of an application by the local agency and 144.30 agreement on a support plan for the person or person's family, 144.31 the local agency shall make grants to the person or the person's 144.32 family. The grant shall be in an amount for the direct costs of 144.33 the services or supports outlined in the service agreement. 144.34 (g) Reimbursable costs shall not include costs for 144.35 resources already available, such as special education classes, 144.36 day training and habilitation, case management, other services 145.1 to which the person is entitled, medical costs covered by 145.2 insurance or other health programs, or other resources usually 145.3 available at no cost to the person or the person's family. 145.4 (h) The state of Minnesota, the county boards participating 145.5 in the consumer support grant program, or the agencies acting on 145.6 behalf of the county boards in the implementation and 145.7 administration of the consumer support grant program shall not 145.8 be liable for damages, injuries, or liabilities sustained 145.9 through the purchase of support by the individual, the 145.10 individual's family, or the authorized representative under this 145.11 section with funds received through the consumer support grant 145.12 program. Liabilities include but are not limited to: workers' 145.13 compensation liability, the Federal Insurance Contributions Act 145.14 (FICA), or the Federal Unemployment Tax Act (FUTA). For 145.15 purposes of this section, participating county boards and 145.16 agencies acting on behalf of county boards are exempt from the 145.17 provisions of section 268.04. 145.18 Sec. 13. Minnesota Statutes 2000, section 256.476, 145.19 subdivision 5, is amended to read: 145.20 Subd. 5. [REIMBURSEMENT, ALLOCATIONS, AND REPORTING.] (a) 145.21 For the purpose of transferring persons to the consumer support 145.22 grant program from specific programs or services, such as the 145.23 developmental disability family support program andalternative145.24care program,personal careattendantassistant services, home 145.25 health aide services, ornursing facilityprivate duty nursing 145.26 services, the amount of funds transferred by the commissioner 145.27 between the developmental disability family support program 145.28 account,the alternative care account,the medical assistance 145.29 account, or the consumer support grant account shall be based on 145.30 each county's participation in transferring persons to the 145.31 consumer support grant program from those programs and services. 145.32 (b) At the beginning of each fiscal year, county 145.33 allocations for consumer support grants shall be based on: 145.34 (1) the number of persons to whom the county board expects 145.35 to provide consumer supports grants; 145.36 (2) their eligibility for current program and services; 146.1 (3) the amount of nonfederal dollars expended on those 146.2 individuals for those programs and services or, in situations 146.3 where an individual is unable to obtain the support needed from 146.4 the program of origination due to the unavailability of service 146.5 providers at the time or the location where the supports are 146.6 needed, the allocation will be based on the county's best 146.7 estimate of the nonfederal dollars that would have been expended 146.8 if the services had been available; and 146.9 (4) projected dates when persons will start receiving 146.10 grants. County allocations shall be adjusted periodically by 146.11 the commissioner based on the actual transfer of persons or 146.12 service openings, and the nonfederal dollars associated with 146.13 those persons or service openings, to the consumer support grant 146.14 program. 146.15 (c) The amount of funds transferred by the commissioner 146.16 fromthe alternative care account andthe medical assistance 146.17 account for an individual may be changed if it is determined by 146.18 the county or its agent that the individual's need for support 146.19 has changed. 146.20 (d) The authority to utilize funds transferred to the 146.21 consumer support grant account for the purposes of implementing 146.22 and administering the consumer support grant program will not be 146.23 limited or constrained by the spending authority provided to the 146.24 program of origination. 146.25 (e) The commissionershallmay use up to five percent of 146.26 each county's allocation, as adjusted, for payments to that 146.27 county for administrative expenses, to be paid as a 146.28 proportionate addition to reported direct service expenditures. 146.29 (f) Except as provided in this paragraph, the county 146.30 allocation for each individual or individual's family cannot 146.31 exceed 80 percent of the total nonfederal dollars expended on 146.32 the individual by the program of origination except for the 146.33 developmental disabilities family support grant program which 146.34 can be approved up to 100 percent of the nonfederal dollars and 146.35 in situations as described in paragraph (b), clause (3). In 146.36 situations where exceptional need exists or the individual's 147.1 need for support increases, up to 100 percent of the nonfederal 147.2 dollars expended by the consumer's program of origination may be 147.3 allocated to the county. Allocations that exceed 80 percent of 147.4 the nonfederal dollars expended on the individual by the program 147.5 of origination must be approved by the commissioner. The 147.6 remainder of the amount expended on the individual by the 147.7 program of origination will be used in the following 147.8 proportions: half will be made available to the consumer 147.9 support grant program and participating counties for consumer 147.10 training, resource development, and other costs, and half will 147.11 be returned to the state general fund. 147.12 (g) The commissioner may recover, suspend, or withhold 147.13 payments if the county board, local agency, or grantee does not 147.14 comply with the requirements of this section. 147.15 (h) Grant funds unexpended by consumers shall return to the 147.16 state once a year. The annual return of unexpended grant funds 147.17 shall occur in the quarter following the end of the state fiscal 147.18 year. 147.19 Sec. 14. Minnesota Statutes 2000, section 256.476, 147.20 subdivision 8, is amended to read: 147.21 Subd. 8. [COMMISSIONER RESPONSIBILITIES.] The commissioner 147.22 shall: 147.23 (1) transfer and allocate funds pursuant to this section; 147.24 (2) determine allocations based on projected and actual 147.25 local agency use; 147.26 (3) monitor and oversee overall program spending; 147.27 (4) evaluate the effectiveness of the program; 147.28 (5) provide training and technical assistance for local 147.29 agencies and consumers to help identify potential applicants to 147.30 the program; and 147.31 (6) develop guidelines for local agency program 147.32 administration and consumer information; and. 147.33(7) apply for a federal waiver or take any other action147.34necessary to maximize federal funding for the program by147.35September 1, 1999.147.36 Sec. 15. Minnesota Statutes 2000, section 256B.0625, 148.1 subdivision 7, is amended to read: 148.2 Subd. 7. [PRIVATE DUTY NURSING.] Medical assistance covers 148.3 private duty nursing services in a recipient's home. Recipients 148.4 who are authorized to receive private duty nursing services in 148.5 their home may use approved hours outside of the home during 148.6 hours when normal life activities take them outside of their 148.7 homeand when, without the provision of private duty nursing,148.8their health and safety would be jeopardized. To use private 148.9 duty nursing services at school, the recipient or responsible 148.10 party must provide written authorization in the care plan 148.11 identifying the chosen provider and the daily amount of services 148.12 to be used at school. Medical assistance does not cover private 148.13 duty nursing services for residents of a hospital, nursing 148.14 facility, intermediate care facility, or a health care facility 148.15 licensed by the commissioner of health, except as authorized in 148.16 section 256B.64 for ventilator-dependent recipients in hospitals 148.17 or unless a resident who is otherwise eligible is on leave from 148.18 the facility and the facility either pays for the private duty 148.19 nursing services or forgoes the facility per diem for the leave 148.20 days that private duty nursing services are used. Total hours 148.21 of service and payment allowed for services outside the home 148.22 cannot exceed that which is otherwise allowed in an in-home 148.23 setting according to section 256B.0627. All private duty 148.24 nursing services must be provided according to the limits 148.25 established under section 256B.0627. Private duty nursing 148.26 services may not be reimbursed if the nurse is thespouse of the148.27recipient or the parent orfoster care provider of a recipient 148.28 who is under age 18, or the recipient's legal guardian. 148.29 Sec. 16. Minnesota Statutes 2000, section 256B.0625, 148.30 subdivision 19a, is amended to read: 148.31 Subd. 19a. [PERSONAL CARE ASSISTANT SERVICES.] Medical 148.32 assistance covers personal care assistant services in a 148.33 recipient's home. To qualify for personal care assistant 148.34 services, recipients or responsible parties must be able to 148.35 identify the recipient's needs, direct and evaluate task 148.36 accomplishment, and provide for health and safety. Approved 149.1 hours may be used outside the home when normal life activities 149.2 take them outside the homeand when, without the provision of149.3personal care, their health and safety would be jeopardized. To 149.4 use personal care assistant services at school, the recipient or 149.5 responsible party must provide written authorization in the care 149.6 plan identifying the chosen provider and the daily amount of 149.7 services to be used at school. Total hours for services, 149.8 whether actually performed inside or outside the recipient's 149.9 home, cannot exceed that which is otherwise allowed for personal 149.10 care assistant services in an in-home setting according to 149.11 section 256B.0627. Medical assistance does not cover personal 149.12 care assistant services for residents of a hospital, nursing 149.13 facility, intermediate care facility, health care facility 149.14 licensed by the commissioner of health, or unless a resident who 149.15 is otherwise eligible is on leave from the facility and the 149.16 facility either pays for the personal care assistant services or 149.17 forgoes the facility per diem for the leave days that personal 149.18 care assistant services are used. All personal care services 149.19 must be provided according to section 256B.0627. Personal 149.20 care assistant services may not be reimbursed if the personal 149.21 care assistant is the spouse or legal guardian of the recipient 149.22 or the parent of a recipient under age 18, or the responsible 149.23 party or the foster care provider of a recipient who cannot 149.24 direct the recipient's own care unless, in the case of a foster 149.25 care provider, a county or state case manager visits the 149.26 recipient as needed, but not less than every six months, to 149.27 monitor the health and safety of the recipient and to ensure the 149.28 goals of the care plan are met. Parents of adult recipients, 149.29 adult children of the recipient or adult siblings of the 149.30 recipient may be reimbursed for personal care assistant services 149.31if they are not the recipient's legal guardian and, if they are 149.32 granted a waiver under section 256B.0627.Until July 1, 2001,149.33andNotwithstanding the provisions of section 256B.0627, 149.34 subdivision 4, paragraph (b), clause (4), the noncorporate legal 149.35 guardian or conservator of an adult, who is not the responsible 149.36 party and not the personal care provider organization, may be 150.1 granted a hardship waiver under section 256B.0627, to be 150.2 reimbursed to provide personal care assistant services to the 150.3 recipient, and shall not be considered to have a service 150.4 provider interest for purposes of participation on the screening 150.5 team under section 256B.092, subdivision 7. 150.6 Sec. 17. Minnesota Statutes 2000, section 256B.0625, 150.7 subdivision 19c, is amended to read: 150.8 Subd. 19c. [PERSONAL CARE.] Medical assistance covers 150.9 personal care assistant services provided by an individual who 150.10 is qualified to provide the services according to subdivision 150.11 19a and section 256B.0627, where the services are prescribed by 150.12 a physician in accordance with a plan of treatment and are 150.13 supervised by the recipientunder the fiscal agent option150.14according to section 256B.0627, subdivision 10,or a qualified 150.15 professional. "Qualified professional" means a mental health 150.16 professional as defined in section 245.462, subdivision 18, or 150.17 245.4871, subdivision 27; or a registered nurse as defined in 150.18 sections 148.171 to 148.285. As part of the assessment, the 150.19 county public health nurse willconsult withassist the 150.20 recipient or responsible partyandto identify the most 150.21 appropriate person to provide supervision of the personal care 150.22 assistant. The qualified professional shall perform the duties 150.23 described in Minnesota Rules, part 9505.0335, subpart 4. 150.24 Sec. 18. Minnesota Statutes 2000, section 256B.0625, 150.25 subdivision 20, is amended to read: 150.26 Subd. 20. [MENTAL HEALTH CASE MANAGEMENT.] (a) To the 150.27 extent authorized by rule of the state agency, medical 150.28 assistance covers case management services to persons with 150.29 serious and persistent mental illness and children with severe 150.30 emotional disturbance. Services provided under this section 150.31 must meet the relevant standards in sections 245.461 to 150.32 245.4888, the Comprehensive Adult and Children's Mental Health 150.33 Acts, Minnesota Rules, parts 9520.0900 to 9520.0926, and 150.34 9505.0322, excluding subpart 10. 150.35 (b) Entities meeting program standards set out in rules 150.36 governing family community support services as defined in 151.1 section 245.4871, subdivision 17, are eligible for medical 151.2 assistance reimbursement for case management services for 151.3 children with severe emotional disturbance when these services 151.4 meet the program standards in Minnesota Rules, parts 9520.0900 151.5 to 9520.0926 and 9505.0322, excluding subparts 6 and 10. 151.6 (c) Medical assistance and MinnesotaCare payment for mental 151.7 health case management shall be made on a monthly basis. In 151.8 order to receive payment for an eligible child, the provider 151.9 must document at least a face-to-face contact with the child, 151.10 the child's parents, or the child's legal representative. To 151.11 receive payment for an eligible adult, the provider must 151.12 document: 151.13 (1) at least a face-to-face contact with the adult or the 151.14 adult's legal representative; or 151.15 (2) at least a telephone contact with the adult or the 151.16 adult's legal representative and document a face-to-face contact 151.17 with the adult or the adult's legal representative within the 151.18 preceding two months. 151.19 (d) Payment for mental health case management provided by 151.20 county or state staff shall be based on the monthly rate 151.21 methodology under section 256B.094, subdivision 6, paragraph 151.22 (b), with separate rates calculated for child welfare and mental 151.23 health, and within mental health, separate rates for children 151.24 and adults. 151.25 (e) Payment for mental health case management provided by 151.26 county-contracted vendors shall be based on a monthly rate 151.27 negotiated by the host county. The negotiated rate must not 151.28 exceed the rate charged by the vendor for the same service to 151.29 other payers. If the service is provided by a team of 151.30 contracted vendors, the county may negotiate a team rate with a 151.31 vendor who is a member of the team. The team shall determine 151.32 how to distribute the rate among its members. No reimbursement 151.33 received by contracted vendors shall be returned to the county, 151.34 except to reimburse the county for advance funding provided by 151.35 the county to the vendor. 151.36 (f) If the service is provided by a team which includes 152.1 contracted vendors and county or state staff, the costs for 152.2 county or state staff participation in the team shall be 152.3 included in the rate for county-provided services. In this 152.4 case, the contracted vendor and the county may each receive 152.5 separate payment for services provided by each entity in the 152.6 same month. In order to prevent duplication of services, the 152.7 county must document, in the recipient's file, the need for team 152.8 case management and a description of the roles of the team 152.9 members. 152.10 (g) The commissioner shall calculate the nonfederal share 152.11 of actual medical assistance and general assistance medical care 152.12 payments for each county, based on the higher of calendar year 152.13 1995 or 1996, by service date, project that amount forward to 152.14 1999, and transfer one-half of the result from medical 152.15 assistance and general assistance medical care to each county's 152.16 mental health grants under sections 245.4886 and 256E.12 for 152.17 calendar year 1999. The annualized minimum amount added to each 152.18 county's mental health grant shall be $3,000 per year for 152.19 children and $5,000 per year for adults. The commissioner may 152.20 reduce the statewide growth factor in order to fund these 152.21 minimums. The annualized total amount transferred shall become 152.22 part of the base for future mental health grants for each county. 152.23 (h) Any net increase in revenue to the county as a result 152.24 of the change in this section must be used to provide expanded 152.25 mental health services as defined in sections 245.461 to 152.26 245.4888, the Comprehensive Adult and Children's Mental Health 152.27 Acts, excluding inpatient and residential treatment. For 152.28 adults, increased revenue may also be used for services and 152.29 consumer supports which are part of adult mental health projects 152.30 approved under Laws 1997, chapter 203, article 7, section 25. 152.31 For children, increased revenue may also be used for respite 152.32 care and nonresidential individualized rehabilitation services 152.33 as defined in section 245.492, subdivisions 17 and 23. 152.34 "Increased revenue" has the meaning given in Minnesota Rules, 152.35 part 9520.0903, subpart 3. 152.36 (i) Notwithstanding section 256B.19, subdivision 1, the 153.1 nonfederal share of costs for mental health case management 153.2 shall be provided by the recipient's county of responsibility, 153.3 as defined in sections 256G.01 to 256G.12, from sources other 153.4 than federal funds or funds used to match other federal funds. 153.5 (j) The commissioner may suspend, reduce, or terminate the 153.6 reimbursement to a provider that does not meet the reporting or 153.7 other requirements of this section. The county of 153.8 responsibility, as defined in sections 256G.01 to 256G.12, is 153.9 responsible for any federal disallowances. The county may share 153.10 this responsibility with its contracted vendors. 153.11 (k) The commissioner shall set aside a portion of the 153.12 federal funds earned under this section to repay the special 153.13 revenue maximization account under section 256.01, subdivision 153.14 2, clause (15). The repayment is limited to: 153.15 (1) the costs of developing and implementing this section; 153.16 and 153.17 (2) programming the information systems. 153.18 (l) Notwithstanding section 256.025, subdivision 2, 153.19 payments to counties for case management expenditures under this 153.20 section shall only be made from federal earnings from services 153.21 provided under this section. Payments to contracted vendors 153.22 shall include both the federal earnings and the county share. 153.23 (m) Notwithstanding section 256B.041, county payments for 153.24 the cost of mental health case management services provided by 153.25 county or state staff shall not be made to the state treasurer. 153.26 For the purposes of mental health case management services 153.27 provided by county or state staff under this section, the 153.28 centralized disbursement of payments to counties under section 153.29 256B.041 consists only of federal earnings from services 153.30 provided under this section. 153.31 (n) Case management services under this subdivision do not 153.32 include therapy, treatment, legal, or outreach services. 153.33 (o) If the recipient is a resident of a nursing facility, 153.34 intermediate care facility, or hospital, and the recipient's 153.35 institutional care is paid by medical assistance, payment for 153.36 case management services under this subdivision is limited to 154.1 the last30180 days of the recipient's residency in that 154.2 facility and may not exceed more thantwosix months in a 154.3 calendar year. 154.4 (p) Payment for case management services under this 154.5 subdivision shall not duplicate payments made under other 154.6 program authorities for the same purpose. 154.7 (q) By July 1, 2000, the commissioner shall evaluate the 154.8 effectiveness of the changes required by this section, including 154.9 changes in number of persons receiving mental health case 154.10 management, changes in hours of service per person, and changes 154.11 in caseload size. 154.12 (r) For each calendar year beginning with the calendar year 154.13 2001, the annualized amount of state funds for each county 154.14 determined under paragraph (g) shall be adjusted by the county's 154.15 percentage change in the average number of clients per month who 154.16 received case management under this section during the fiscal 154.17 year that ended six months prior to the calendar year in 154.18 question, in comparison to the prior fiscal year. 154.19 (s) For counties receiving the minimum allocation of $3,000 154.20 or $5,000 described in paragraph (g), the adjustment in 154.21 paragraph (r) shall be determined so that the county receives 154.22 the higher of the following amounts: 154.23 (1) a continuation of the minimum allocation in paragraph 154.24 (g); or 154.25 (2) an amount based on that county's average number of 154.26 clients per month who received case management under this 154.27 section during the fiscal year that ended six months prior to 154.28 the calendar year in question, in comparison to the prior fiscal 154.29 year, times the average statewide grant per person per month for 154.30 counties not receiving the minimum allocation. 154.31 (t) The adjustments in paragraphs (r) and (s) shall be 154.32 calculated separately for children and adults. 154.33 Sec. 19. Minnesota Statutes 2000, section 256B.0625, is 154.34 amended by adding a subdivision to read: 154.35 Subd. 43. [TARGETED CASE MANAGEMENT.] For purposes of 154.36 subdivisions 43a to 43h, the following terms have the meanings 155.1 given them: 155.2 (1) "Home care service recipients" means those individuals 155.3 receiving the following services under section 256B.0627: 155.4 skilled nursing visits, home health aide visits, private duty 155.5 nursing, personal care assistants, or therapies provided through 155.6 a home health agency. 155.7 (2) "Home care targeted case management" means the 155.8 provision of targeted case management services for the purpose 155.9 of assisting home care service recipients to gain access to 155.10 needed services and supports so that they may remain in the 155.11 community. 155.12 (3) "Institutions" means hospitals, consistent with Code of 155.13 Federal Regulations, title 42, section 440.10; regional 155.14 treatment center inpatient services, consistent with section 155.15 245.474; nursing facilities; and intermediate care facilities 155.16 for persons with mental retardation. 155.17 (4) "Relocation targeted case management" means the 155.18 provision of targeted case management services for the purpose 155.19 of assisting recipients to gain access to needed services and 155.20 supports if they choose to move from an institution to the 155.21 community. Relocation targeted case management may be provided 155.22 during the last 180 consecutive days of an eligible recipient's 155.23 institutional stay. 155.24 (5) "Targeted case management" means case management 155.25 services provided to help recipients gain access to needed 155.26 medical, social, educational, and other services and supports. 155.27 Sec. 20. Minnesota Statutes 2000, section 256B.0625, is 155.28 amended by adding a subdivision to read: 155.29 Subd. 43a. [ELIGIBILITY.] The following persons are 155.30 eligible for relocation targeted case management or home care 155.31 targeted case management: 155.32 (1) medical assistance eligible persons residing in 155.33 institutions who choose to move into the community are eligible 155.34 for relocation targeted case management services; and 155.35 (2) medical assistance eligible persons receiving home care 155.36 services, who are not eligible for any other medical assistance 156.1 reimbursable case management service, are eligible for home care 156.2 targeted case management services beginning January 1, 2003. 156.3 Sec. 21. Minnesota Statutes 2000, section 256B.0625, is 156.4 amended by adding a subdivision to read: 156.5 Subd. 43b. [RELOCATION TARGETED CASE MANAGEMENT PROVIDER 156.6 QUALIFICATIONS.] The following qualifications and certification 156.7 standards must be met by providers of relocation targeted case 156.8 management: 156.9 (a) The commissioner must certify each provider of 156.10 relocation targeted case management before enrollment. The 156.11 certification process shall examine the provider's ability to 156.12 meet the requirements in this subdivision and other federal and 156.13 state requirements of this service. A certified relocation 156.14 targeted case management provider may subcontract with another 156.15 provider to deliver relocation targeted case management 156.16 services. Subcontracted providers must demonstrate the ability 156.17 to provide the services outlined in subdivision 43d. 156.18 (b) A relocation targeted case management provider is an 156.19 enrolled medical assistance provider who is determined by the 156.20 commissioner to have all of the following characteristics: 156.21 (1) the legal authority to provide public welfare under 156.22 sections 393.01, subdivision 7; and 393.07, or a federally 156.23 recognized Indian tribe; 156.24 (2) the demonstrated capacity and experience to provide the 156.25 components of case management to coordinate and link community 156.26 resources needed by the eligible population; 156.27 (3) the administrative capacity and experience to serve the 156.28 target population for whom it will provide services and ensure 156.29 quality of services under state and federal requirements; 156.30 (4) the legal authority to provide complete investigative 156.31 and protective services under section 626.556, subdivision 10, 156.32 and child welfare and foster care services under section 393.07, 156.33 subdivisions 1 and 2, or a federally recognized Indian tribe; 156.34 (5) a financial management system that provides accurate 156.35 documentation of services and costs under state and federal 156.36 requirements; and 157.1 (6) the capacity to document and maintain individual case 157.2 records under state and federal requirements. 157.3 A provider of targeted case management under subdivision 20 may 157.4 be deemed a certified provider of relocation targeted case 157.5 management. 157.6 Sec. 22. Minnesota Statutes 2000, section 256B.0625, is 157.7 amended by adding a subdivision to read: 157.8 Subd. 43c. [HOME CARE TARGETED CASE MANAGEMENT PROVIDER 157.9 QUALIFICATIONS.] The following qualifications and certification 157.10 standards must be met by providers of home care targeted case 157.11 management. 157.12 (a) The commissioner must certify each provider of home 157.13 care targeted case management before enrollment. The 157.14 certification process shall examine the provider's ability to 157.15 meet the requirements in this subdivision and other state and 157.16 federal requirements of this service. 157.17 (b) A home care targeted case management provider is an 157.18 enrolled medical assistance provider who has a minimum of a 157.19 bachelor's degree or a license in a health or human services 157.20 field, and is determined by the commissioner to have all of the 157.21 following characteristics: 157.22 (1) the demonstrated capacity and experience to provide the 157.23 components of case management to coordinate and link community 157.24 resources needed by the eligible population; 157.25 (2) the administrative capacity and experience to serve the 157.26 target population for whom it will provide services and ensure 157.27 quality of services under state and federal requirements; 157.28 (3) a financial management system that provides accurate 157.29 documentation of services and costs under state and federal 157.30 requirements; 157.31 (4) the capacity to document and maintain individual case 157.32 records under state and federal requirements; and 157.33 (5) the capacity to coordinate with county administrative 157.34 functions. 157.35 Sec. 23. Minnesota Statutes 2000, section 256B.0625, is 157.36 amended by adding a subdivision to read: 158.1 Subd. 43d. [ELIGIBLE SERVICES.] Services eligible for 158.2 medical assistance reimbursement as targeted case management 158.3 include: 158.4 (1) assessment of the recipient's need for targeted case 158.5 management services; 158.6 (2) development, completion, and regular review of a 158.7 written individual service plan, which is based upon the 158.8 assessment of the recipient's needs and choices, and which will 158.9 ensure access to medical, social, educational, and other related 158.10 services and supports; 158.11 (3) routine contact or communication with the recipient, 158.12 recipient's family, primary caregiver, legal representative, 158.13 substitute care provider, service providers, or other relevant 158.14 persons identified as necessary to the development or 158.15 implementation of the goals of the individual service plan; 158.16 (4) coordinating referrals for, and the provision of, case 158.17 management services for the recipient with appropriate service 158.18 providers, consistent with section 1902(a)(23) of the Social 158.19 Security Act; 158.20 (5) coordinating and monitoring the overall service 158.21 delivery to ensure quality of services, appropriateness, and 158.22 continued need; 158.23 (6) completing and maintaining necessary documentation that 158.24 supports and verifies the activities in this subdivision; 158.25 (7) traveling to conduct a visit with the recipient or 158.26 other relevant person necessary to develop or implement the 158.27 goals of the individual service plan; and 158.28 (8) coordinating with the institution discharge planner in 158.29 the 180-day period before the recipient's discharge. 158.30 Sec. 24. Minnesota Statutes 2000, section 256B.0625, is 158.31 amended by adding a subdivision to read: 158.32 Subd. 43e. [TIME LINES.] The following time lines must be 158.33 met for assigning a case manager: 158.34 (1) for relocation targeted case management, an eligible 158.35 recipient must be assigned a case manager who visits the person 158.36 within 20 working days of requesting a case manager from their 159.1 county of financial responsibility as determined under chapter 159.2 256G. If a county agency does not provide case management 159.3 services as required, the recipient may, after written notice to 159.4 the county agency, obtain targeted relocation case management 159.5 services from a home care targeted case management provider, as 159.6 defined in subdivision 43c; and 159.7 (2) for home care targeted case management, an eligible 159.8 recipient must be assigned a case manager within 20 working days 159.9 of requesting a case manager from a home care targeted case 159.10 management provider, as defined in subdivision 43c. 159.11 Sec. 25. Minnesota Statutes 2000, section 256B.0625, is 159.12 amended by adding a subdivision to read: 159.13 Subd. 43f. [EVALUATION.] The commissioner shall evaluate 159.14 the delivery of targeted case management, including, but not 159.15 limited to, access to case management services, consumer 159.16 satisfaction with case management services, and quality of case 159.17 management services. 159.18 Sec. 26. Minnesota Statutes 2000, section 256B.0625, is 159.19 amended by adding a subdivision to read: 159.20 Subd. 43g. [CONTACT DOCUMENTATION.] The case manager must 159.21 document each face-to-face and telephone contact with the 159.22 recipient and others involved in the recipient's individual 159.23 service plan. 159.24 Sec. 27. Minnesota Statutes 2000, section 256B.0625, is 159.25 amended by adding a subdivision to read: 159.26 Subd. 43h. [PAYMENT RATES.] The commissioner shall set 159.27 payment rates for targeted case management under this 159.28 subdivision. Case managers may bill according to the following 159.29 criteria: 159.30 (1) for relocation targeted case management, case managers 159.31 may bill for direct case management activities, including 159.32 face-to-face and telephone contacts, in the 180 days preceding 159.33 an eligible recipient's discharge from an institution; 159.34 (2) for home care targeted case management, case managers 159.35 may bill for direct case management activities, including 159.36 face-to-face and telephone contacts; and 160.1 (3) billings for targeted case management services under 160.2 this subdivision shall not duplicate payments made under other 160.3 program authorities for the same purpose. 160.4 Sec. 28. Minnesota Statutes 2000, section 256B.0627, 160.5 subdivision 1, is amended to read: 160.6 Subdivision 1. [DEFINITION.] (a) "Activities of daily 160.7 living" includes eating, toileting, grooming, dressing, bathing, 160.8 transferring, mobility, and positioning. 160.9 (b) "Assessment" means a review and evaluation of a 160.10 recipient's need for home care services conducted in person. 160.11 Assessments for private duty nursing shall be conducted by a 160.12 registered private duty nurse. Assessments for home health 160.13 agency services shall be conducted by a home health agency 160.14 nurse. Assessments for personal care assistant services shall 160.15 be conducted by the county public health nurse or a certified 160.16 public health nurse under contract with the county. A 160.17 face-to-face assessment must include: documentation of health 160.18 status, determination of need, evaluation of service 160.19 effectiveness, identification of appropriate services, service 160.20 plan development or modification, coordination of services, 160.21 referrals and follow-up to appropriate payers and community 160.22 resources, completion of required reports, recommendation of 160.23 service authorization, and consumer education. Once the need 160.24 for personal care assistant services is determined under this 160.25 section, the county public health nurse or certified public 160.26 health nurse under contract with the county is responsible for 160.27 communicating this recommendation to the commissioner and the 160.28 recipient. A face-to-face assessment for personal 160.29 care assistant services is conducted on those recipients who 160.30 have never had a county public health nurse assessment. A 160.31 face-to-face assessment must occur at least annually or when 160.32 there is a significant change in the recipient's condition or 160.33 when there is a change in the need for personal care assistant 160.34 services. A service update may substitute for the annual 160.35 face-to-face assessment when there is not a significant change 160.36 in recipient condition or a change in the need for personal care 161.1 assistant service. A service update or review for temporary 161.2 increase includes a review of initial baseline data, evaluation 161.3 of service effectiveness, redetermination of service need, 161.4 modification of service plan and appropriate referrals, update 161.5 of initial forms, obtaining service authorization, and on going 161.6 consumer education. Assessments for medical assistance home 161.7 care services for mental retardation or related conditions and 161.8 alternative care services for developmentally disabled home and 161.9 community-based waivered recipients may be conducted by the 161.10 county public health nurse to ensure coordination and avoid 161.11 duplication. Assessments must be completed on forms provided by 161.12 the commissioner within 30 days of a request for home care 161.13 services by a recipient or responsible party. 161.14(b)(c) "Care plan" means a written description of personal 161.15 care assistant services developed by the qualified 161.16 professional or the recipient's physician with the recipient or 161.17 responsible party to be used by the personal care assistant with 161.18 a copy provided to the recipient or responsible party. 161.19 (d) "Complex and regular private duty nursing care" means, 161.20 effective July 1, 2001: 161.21 (1) complex care is private duty nursing provided to 161.22 recipients who are ventilator dependent or for whom a physician 161.23 has certified that were it not for private duty nursing the 161.24 recipient would meet the criteria for inpatient hospital 161.25 intensive care unit (ICU) level of care; and 161.26 (2) regular care is private duty nursing provided to all 161.27 other recipients. 161.28 (e) "Health-related functions" means functions that can be 161.29 delegated or assigned by a licensed health care professional 161.30 under state law to be performed by a personal care attendant. 161.31(c)(f) "Home care services" means a health service, 161.32 determined by the commissioner as medically necessary, that is 161.33 ordered by a physician and documented in a service plan that is 161.34 reviewed by the physician at least once every6260 days for the 161.35 provision of home health services, or private duty nursing, or 161.36 at least once every 365 days for personal care. Home care 162.1 services are provided to the recipient at the recipient's 162.2 residence that is a place other than a hospital or long-term 162.3 care facility or as specified in section 256B.0625. 162.4 (g) "Instrumental activities of daily living" includes meal 162.5 planning and preparation, managing finances, shopping for food, 162.6 clothing, and other essential items, performing essential 162.7 household chores, communication by telephone and other media, 162.8 and getting around and participating in the community. 162.9(d)(h) "Medically necessary" has the meaning given in 162.10 Minnesota Rules, parts 9505.0170 to 9505.0475. 162.11(e)(i) "Personal care assistant" means a person who: 162.12 (1) is at least 18 years old, except for persons 16 to 18 162.13 years of age who participated in a related school-based job 162.14 training program or have completed a certified home health aide 162.15 competency evaluation; 162.16 (2) is able to effectively communicate with the recipient 162.17 and personal care provider organization; 162.18 (3) effective July 1, 1996, has completed one of the 162.19 training requirements as specified in Minnesota Rules, part 162.20 9505.0335, subpart 3, items A to D; 162.21 (4) has the ability to, and provides covered personal care 162.22 assistant services according to the recipient's care plan, 162.23 responds appropriately to recipient needs, and reports changes 162.24 in the recipient's condition to the supervising qualified 162.25 professional or physician; 162.26 (5) is not a consumer of personal care assistant services; 162.27 and 162.28 (6) is subject to criminal background checks and procedures 162.29 specified in section 245A.04. 162.30(f)(j) "Personal care provider organization" means an 162.31 organization enrolled to provide personal care assistant 162.32 services under the medical assistance program that complies with 162.33 the following: (1) owners who have a five percent interest or 162.34 more, and managerial officials are subject to a background study 162.35 as provided in section 245A.04. This applies to currently 162.36 enrolled personal care provider organizations and those agencies 163.1 seeking enrollment as a personal care provider organization. An 163.2 organization will be barred from enrollment if an owner or 163.3 managerial official of the organization has been convicted of a 163.4 crime specified in section 245A.04, or a comparable crime in 163.5 another jurisdiction, unless the owner or managerial official 163.6 meets the reconsideration criteria specified in section 245A.04; 163.7 (2) the organization must maintain a surety bond and liability 163.8 insurance throughout the duration of enrollment and provides 163.9 proof thereof. The insurer must notify the department of human 163.10 services of the cancellation or lapse of policy; and (3) the 163.11 organization must maintain documentation of services as 163.12 specified in Minnesota Rules, part 9505.2175, subpart 7, as well 163.13 as evidence of compliance with personal care assistant training 163.14 requirements. 163.15(g)(k) "Responsible party" means an individual residing 163.16 with a recipient of personal care assistant services who is 163.17 capable of providing the supportive care necessary to assist the 163.18 recipient to live in the community, is at least 18 years old, 163.19 and is not a personal care assistant. Responsible parties who 163.20 are parents of minors or guardians of minors or incapacitated 163.21 persons may delegate the responsibility to another adult during 163.22 a temporary absence of at least 24 hours but not more than six 163.23 months. The person delegated as a responsible party must be 163.24 able to meet the definition of responsible party, except that 163.25 the delegated responsible party is required to reside with the 163.26 recipient only while serving as the responsible party. Foster 163.27 care license holders may be designated the responsible party for 163.28 residents of the foster care home if case management is provided 163.29 as required in section 256B.0625, subdivision 19a. For persons 163.30 who, as of April 1, 1992, are sharing personal care assistant 163.31 services in order to obtain the availability of 24-hour 163.32 coverage, an employee of the personal care provider organization 163.33 may be designated as the responsible party if case management is 163.34 provided as required in section 256B.0625, subdivision 19a. 163.35(h)(l) "Service plan" means a written description of the 163.36 services needed based on the assessment developed by the nurse 164.1 who conducts the assessment together with the recipient or 164.2 responsible party. The service plan shall include a description 164.3 of the covered home care services, frequency and duration of 164.4 services, and expected outcomes and goals. The recipient and 164.5 the provider chosen by the recipient or responsible party must 164.6 be given a copy of the completed service plan within 30 calendar 164.7 days of the request for home care services by the recipient or 164.8 responsible party. 164.9(i)(m) "Skilled nurse visits" are provided in a 164.10 recipient's residence under a plan of care or service plan that 164.11 specifies a level of care which the nurse is qualified to 164.12 provide. These services are: 164.13 (1) nursing services according to the written plan of care 164.14 or service plan and accepted standards of medical and nursing 164.15 practice in accordance with chapter 148; 164.16 (2) services which due to the recipient's medical condition 164.17 may only be safely and effectively provided by a registered 164.18 nurse or a licensed practical nurse; 164.19 (3) assessments performed only by a registered nurse; and 164.20 (4) teaching and training the recipient, the recipient's 164.21 family, or other caregivers requiring the skills of a registered 164.22 nurse or licensed practical nurse. 164.23 (n) "Telehomecare" means the use of telecommunications 164.24 technology by a home health care professional to deliver home 164.25 health care services, within the professional's scope of 164.26 practice, to a patient located at a site other than the site 164.27 where the practitioner is located. 164.28 Sec. 29. Minnesota Statutes 2000, section 256B.0627, 164.29 subdivision 2, is amended to read: 164.30 Subd. 2. [SERVICES COVERED.] Home care services covered 164.31 under this section include: 164.32 (1) nursing services under section 256B.0625, subdivision 164.33 6a; 164.34 (2) private duty nursing services under section 256B.0625, 164.35 subdivision 7; 164.36 (3) home healthaideservices under section 256B.0625, 165.1 subdivision 6a; 165.2 (4) personal care assistant services under section 165.3 256B.0625, subdivision 19a; 165.4 (5) supervision of personal care assistant services 165.5 provided by a qualified professional under section 256B.0625, 165.6 subdivision 19a; 165.7 (6)consultingqualified professional of personal care 165.8 assistant services under the fiscalagentintermediary option as 165.9 specified in subdivision 10; 165.10 (7) face-to-face assessments by county public health nurses 165.11 for services under section 256B.0625, subdivision 19a; and 165.12 (8) service updates and review of temporary increases for 165.13 personal care assistant services by the county public health 165.14 nurse for services under section 256B.0625, subdivision 19a. 165.15 Sec. 30. Minnesota Statutes 2000, section 256B.0627, 165.16 subdivision 4, is amended to read: 165.17 Subd. 4. [PERSONAL CARE ASSISTANT SERVICES.] (a) The 165.18 personal care assistant services that are eligible for payment 165.19 arethe following:services and supports furnished to an 165.20 individual, as needed, to assist in accomplishing activities of 165.21 daily living; instrumental activities of daily living; 165.22 health-related functions through hands-on assistance, 165.23 supervision, and cuing; and redirection and intervention for 165.24 behavior including observation and monitoring. 165.25 (b) Payment for services will be made within the limits 165.26 approved using the prior authorized process established in 165.27 subdivision 5. 165.28 (c) The amount and type of services authorized shall be 165.29 based on an assessment of the recipient's needs in these areas: 165.30 (1) bowel and bladder care; 165.31 (2) skin care to maintain the health of the skin; 165.32 (3) repetitive maintenance range of motion, muscle 165.33 strengthening exercises, and other tasks specific to maintaining 165.34 a recipient's optimal level of function; 165.35 (4) respiratory assistance; 165.36 (5) transfers and ambulation; 166.1 (6) bathing, grooming, and hairwashing necessary for 166.2 personal hygiene; 166.3 (7) turning and positioning; 166.4 (8) assistance with furnishing medication that is 166.5 self-administered; 166.6 (9) application and maintenance of prosthetics and 166.7 orthotics; 166.8 (10) cleaning medical equipment; 166.9 (11) dressing or undressing; 166.10 (12) assistance with eating and meal preparation and 166.11 necessary grocery shopping; 166.12 (13) accompanying a recipient to obtain medical diagnosis 166.13 or treatment; 166.14 (14) assisting, monitoring, or prompting the recipient to 166.15 complete the services in clauses (1) to (13); 166.16 (15) redirection, monitoring, and observation that are 166.17 medically necessary and an integral part of completing the 166.18 personal care assistant services described in clauses (1) to 166.19 (14); 166.20 (16) redirection and intervention for behavior, including 166.21 observation and monitoring; 166.22 (17) interventions for seizure disorders, including 166.23 monitoring and observation if the recipient has had a seizure 166.24 that requires intervention within the past three months; 166.25 (18) tracheostomy suctioning using a clean procedure if the 166.26 procedure is properly delegated by a registered nurse. Before 166.27 this procedure can be delegated to a personal care assistant, a 166.28 registered nurse must determine that the tracheostomy suctioning 166.29 can be accomplished utilizing a clean rather than a sterile 166.30 procedure and must ensure that the personal care assistant has 166.31 been taught the proper procedure; and 166.32 (19) incidental household services that are an integral 166.33 part of a personal care service described in clauses (1) to (18). 166.34 For purposes of this subdivision, monitoring and observation 166.35 means watching for outward visible signs that are likely to 166.36 occur and for which there is a covered personal care service or 167.1 an appropriate personal care intervention. For purposes of this 167.2 subdivision, a clean procedure refers to a procedure that 167.3 reduces the numbers of microorganisms or prevents or reduces the 167.4 transmission of microorganisms from one person or place to 167.5 another. A clean procedure may be used beginning 14 days after 167.6 insertion. 167.7(b)(d) The personal care assistant services that are not 167.8 eligible for payment are the following: 167.9 (1) services not ordered by the physician; 167.10 (2) assessments by personal care assistant provider 167.11 organizations or by independently enrolled registered nurses; 167.12 (3) services that are not in the service plan; 167.13 (4) services provided by the recipient's spouse, legal 167.14 guardian for an adult or child recipient, or parent of a 167.15 recipient under age 18; 167.16 (5) services provided by a foster care provider of a 167.17 recipient who cannot direct the recipient's own care, unless 167.18 monitored by a county or state case manager under section 167.19 256B.0625, subdivision 19a; 167.20 (6) services provided by the residential or program license 167.21 holder in a residence for more than four persons; 167.22 (7) services that are the responsibility of a residential 167.23 or program license holder under the terms of a service agreement 167.24 and administrative rules; 167.25 (8) sterile procedures; 167.26 (9) injections of fluids into veins, muscles, or skin; 167.27 (10) services provided by parents of adult recipients, 167.28 adult children, or siblings of the recipient, unless these 167.29 relatives meet one of the following hardship criteria and the 167.30 commissioner waives this requirement: 167.31 (i) the relative resigns from a part-time or full-time job 167.32 to provide personal care for the recipient; 167.33 (ii) the relative goes from a full-time to a part-time job 167.34 with less compensation to provide personal care for the 167.35 recipient; 167.36 (iii) the relative takes a leave of absence without pay to 168.1 provide personal care for the recipient; 168.2 (iv) the relative incurs substantial expenses by providing 168.3 personal care for the recipient; or 168.4 (v) because of labor conditions, special language needs, or 168.5 intermittent hours of care needed, the relative is needed in 168.6 order to provide an adequate number of qualified personal care 168.7 assistants to meet the medical needs of the recipient; 168.8 (11) homemaker services that are not an integral part of a 168.9 personal care assistant services; 168.10 (12) home maintenance, or chore services; 168.11 (13) services not specified under paragraph (a); and 168.12 (14) services not authorized by the commissioner or the 168.13 commissioner's designee. 168.14 (e) The recipient or responsible party may choose to 168.15 supervise the personal care assistant or to have a qualified 168.16 professional, as defined in section 256B.0625, subdivision 19c, 168.17 provide the supervision. As required under section 256B.0625, 168.18 subdivision 19c, the county public health nurse, as a part of 168.19 the assessment, will assist the recipient or responsible party 168.20 to identify the most appropriate person to provide supervision 168.21 of the personal care assistant. Health-related delegated tasks 168.22 performed by the personal care assistant will be under the 168.23 supervision of a qualified professional or the direction of the 168.24 recipient's physician. If the recipient has a qualified 168.25 professional, Minnesota Rules, part 9505.0335, subpart 4, 168.26 applies. 168.27 Sec. 31. Minnesota Statutes 2000, section 256B.0627, 168.28 subdivision 5, is amended to read: 168.29 Subd. 5. [LIMITATION ON PAYMENTS.] Medical assistance 168.30 payments for home care services shall be limited according to 168.31 this subdivision. 168.32 (a) [LIMITS ON SERVICES WITHOUT PRIOR AUTHORIZATION.] A 168.33 recipient may receive the following home care services during a 168.34 calendar year: 168.35 (1) up to two face-to-face assessments to determine a 168.36 recipient's need for personal care assistant services; 169.1 (2) one service update done to determine a recipient's need 169.2 for personal care assistant services; and 169.3 (3) up tofivenine skilled nurse visits. 169.4 (b) [PRIOR AUTHORIZATION; EXCEPTIONS.] All home care 169.5 services above the limits in paragraph (a) must receive the 169.6 commissioner's prior authorization, except when: 169.7 (1) the home care services were required to treat an 169.8 emergency medical condition that if not immediately treated 169.9 could cause a recipient serious physical or mental disability, 169.10 continuation of severe pain, or death. The provider must 169.11 request retroactive authorization no later than five working 169.12 days after giving the initial service. The provider must be 169.13 able to substantiate the emergency by documentation such as 169.14 reports, notes, and admission or discharge histories; 169.15 (2) the home care services were provided on or after the 169.16 date on which the recipient's eligibility began, but before the 169.17 date on which the recipient was notified that the case was 169.18 opened. Authorization will be considered if the request is 169.19 submitted by the provider within 20 working days of the date the 169.20 recipient was notified that the case was opened; 169.21 (3) a third-party payor for home care services has denied 169.22 or adjusted a payment. Authorization requests must be submitted 169.23 by the provider within 20 working days of the notice of denial 169.24 or adjustment. A copy of the notice must be included with the 169.25 request; 169.26 (4) the commissioner has determined that a county or state 169.27 human services agency has made an error; or 169.28 (5) the professional nurse determines an immediate need for 169.29 up to 40 skilled nursing or home health aide visits per calendar 169.30 year and submits a request for authorization within 20 working 169.31 days of the initial service date, and medical assistance is 169.32 determined to be the appropriate payer. 169.33 (c) [RETROACTIVE AUTHORIZATION.] A request for retroactive 169.34 authorization will be evaluated according to the same criteria 169.35 applied to prior authorization requests. 169.36 (d) [ASSESSMENT AND SERVICE PLAN.] Assessments under 170.1 section 256B.0627, subdivision 1, paragraph (a), shall be 170.2 conducted initially, and at least annually thereafter, in person 170.3 with the recipient and result in a completed service plan using 170.4 forms specified by the commissioner. Within 30 days of 170.5 recipient or responsible party request for home care services, 170.6 the assessment, the service plan, and other information 170.7 necessary to determine medical necessity such as diagnostic or 170.8 testing information, social or medical histories, and hospital 170.9 or facility discharge summaries shall be submitted to the 170.10 commissioner. For personal care assistant services: 170.11 (1) The amount and type of service authorized based upon 170.12 the assessment and service plan will follow the recipient if the 170.13 recipient chooses to change providers. 170.14 (2) If the recipient's medical need changes, the 170.15 recipient's provider may assess the need for a change in service 170.16 authorization and request the change from the county public 170.17 health nurse. Within 30 days of the request, the public health 170.18 nurse will determine whether to request the change in services 170.19 based upon the provider assessment, or conduct a home visit to 170.20 assess the need and determine whether the change is appropriate. 170.21 (3) To continue to receive personal care assistant services 170.22 after the first year, the recipient or the responsible party, in 170.23 conjunction with the public health nurse, may complete a service 170.24 update on forms developed by the commissioner according to 170.25 criteria and procedures in subdivision 1. 170.26 (e) [PRIOR AUTHORIZATION.] The commissioner, or the 170.27 commissioner's designee, shall review the assessment, service 170.28 update, request for temporary services, service plan, and any 170.29 additional information that is submitted. The commissioner 170.30 shall, within 30 days after receiving a complete request, 170.31 assessment, and service plan, authorize home care services as 170.32 follows: 170.33 (1) [HOME HEALTH SERVICES.] All home health services 170.34 provided by alicensed nurse or ahome health aide must be prior 170.35 authorized by the commissioner or the commissioner's designee. 170.36 Prior authorization must be based on medical necessity and 171.1 cost-effectiveness when compared with other care options. When 171.2 home health services are used in combination with personal care 171.3 and private duty nursing, the cost of all home care services 171.4 shall be considered for cost-effectiveness. The commissioner 171.5 shall limitnurse andhome health aide visits to no more than 171.6 one visit each per day. The commissioner, or the commissioner's 171.7 designee, may authorize up to two skilled nurse visits per day. 171.8 (2) [PERSONAL CARE ASSISTANT SERVICES.] (i) All personal 171.9 care assistant services and supervision by a qualified 171.10 professional, if requested by the recipient, must be prior 171.11 authorized by the commissioner or the commissioner's designee 171.12 except for the assessments established in paragraph (a). The 171.13 amount of personal care assistant services authorized must be 171.14 based on the recipient's home care rating. A child may not be 171.15 found to be dependent in an activity of daily living if because 171.16 of the child's age an adult would either perform the activity 171.17 for the child or assist the child with the activity and the 171.18 amount of assistance needed is similar to the assistance 171.19 appropriate for a typical child of the same age. Based on 171.20 medical necessity, the commissioner may authorize: 171.21 (A) up to two times the average number of direct care hours 171.22 provided in nursing facilities for the recipient's comparable 171.23 case mix level; or 171.24 (B) up to three times the average number of direct care 171.25 hours provided in nursing facilities for recipients who have 171.26 complex medical needs or are dependent in at least seven 171.27 activities of daily living and need physical assistance with 171.28 eating or have a neurological diagnosis; or 171.29 (C) up to 60 percent of the average reimbursement rate, as 171.30 of July 1, 1991, for care provided in a regional treatment 171.31 center for recipients who have Level I behavior, plus any 171.32 inflation adjustment as provided by the legislature for personal 171.33 care service; or 171.34 (D) up to the amount the commissioner would pay, as of July 171.35 1, 1991, plus any inflation adjustment provided for home care 171.36 services, for care provided in a regional treatment center for 172.1 recipients referred to the commissioner by a regional treatment 172.2 center preadmission evaluation team. For purposes of this 172.3 clause, home care services means all services provided in the 172.4 home or community that would be included in the payment to a 172.5 regional treatment center; or 172.6 (E) up to the amount medical assistance would reimburse for 172.7 facility care for recipients referred to the commissioner by a 172.8 preadmission screening team established under section 256B.0911 172.9 or 256B.092; and 172.10 (F) a reasonable amount of time for the provision of 172.11 supervision by a qualified professional of personal 172.12 care assistant services, if a qualified professional is 172.13 requested by the recipient or responsible party. 172.14 (ii) The number of direct care hours shall be determined 172.15 according to the annual cost report submitted to the department 172.16 by nursing facilities. The average number of direct care hours, 172.17 as established by May 1, 1992, shall be calculated and 172.18 incorporated into the home care limits on July 1, 1992. These 172.19 limits shall be calculated to the nearest quarter hour. 172.20 (iii) The home care rating shall be determined by the 172.21 commissioner or the commissioner's designee based on information 172.22 submitted to the commissioner by the county public health nurse 172.23 on forms specified by the commissioner. The home care rating 172.24 shall be a combination of current assessment tools developed 172.25 under sections 256B.0911 and 256B.501 with an addition for 172.26 seizure activity that will assess the frequency and severity of 172.27 seizure activity and with adjustments, additions, and 172.28 clarifications that are necessary to reflect the needs and 172.29 conditions of recipients who need home care including children 172.30 and adults under 65 years of age. The commissioner shall 172.31 establish these forms and protocols under this section and shall 172.32 use an advisory group, including representatives of recipients, 172.33 providers, and counties, for consultation in establishing and 172.34 revising the forms and protocols. 172.35 (iv) A recipient shall qualify as having complex medical 172.36 needs if the care required is difficult to perform and because 173.1 of recipient's medical condition requires more time than 173.2 community-based standards allow or requires more skill than 173.3 would ordinarily be required and the recipient needs or has one 173.4 or more of the following: 173.5 (A) daily tube feedings; 173.6 (B) daily parenteral therapy; 173.7 (C) wound or decubiti care; 173.8 (D) postural drainage, percussion, nebulizer treatments, 173.9 suctioning, tracheotomy care, oxygen, mechanical ventilation; 173.10 (E) catheterization; 173.11 (F) ostomy care; 173.12 (G) quadriplegia; or 173.13 (H) other comparable medical conditions or treatments the 173.14 commissioner determines would otherwise require institutional 173.15 care. 173.16 (v) A recipient shall qualify as having Level I behavior if 173.17 there is reasonable supporting evidence that the recipient 173.18 exhibits, or that without supervision, observation, or 173.19 redirection would exhibit, one or more of the following 173.20 behaviors that cause, or have the potential to cause: 173.21 (A) injury to the recipient's own body; 173.22 (B) physical injury to other people; or 173.23 (C) destruction of property. 173.24 (vi) Time authorized for personal care relating to Level I 173.25 behavior in subclause (v), items (A) to (C), shall be based on 173.26 the predictability, frequency, and amount of intervention 173.27 required. 173.28 (vii) A recipient shall qualify as having Level II behavior 173.29 if the recipient exhibits on a daily basis one or more of the 173.30 following behaviors that interfere with the completion of 173.31 personal care assistant services under subdivision 4, paragraph 173.32 (a): 173.33 (A) unusual or repetitive habits; 173.34 (B) withdrawn behavior; or 173.35 (C) offensive behavior. 173.36 (viii) A recipient with a home care rating of Level II 174.1 behavior in subclause (vii), items (A) to (C), shall be rated as 174.2 comparable to a recipient with complex medical needs under 174.3 subclause (iv). If a recipient has both complex medical needs 174.4 and Level II behavior, the home care rating shall be the next 174.5 complex category up to the maximum rating under subclause (i), 174.6 item (B). 174.7 (3) [PRIVATE DUTY NURSING SERVICES.] All private duty 174.8 nursing services shall be prior authorized by the commissioner 174.9 or the commissioner's designee. Prior authorization for private 174.10 duty nursing services shall be based on medical necessity and 174.11 cost-effectiveness when compared with alternative care options. 174.12 The commissioner may authorize medically necessary private duty 174.13 nursing services in quarter-hour units when: 174.14 (i) the recipient requires more individual and continuous 174.15 care than can be provided during a nurse visit; or 174.16 (ii) the cares are outside of the scope of services that 174.17 can be provided by a home health aide or personal care assistant. 174.18 The commissioner may authorize: 174.19 (A) up to two times the average amount of direct care hours 174.20 provided in nursing facilities statewide for case mix 174.21 classification "K" as established by the annual cost report 174.22 submitted to the department by nursing facilities in May 1992; 174.23 (B) private duty nursing in combination with other home 174.24 care services up to the total cost allowed under clause (2); 174.25 (C) up to 16 hours per day if the recipient requires more 174.26 nursing than the maximum number of direct care hours as 174.27 established in item (A) and the recipient meets the hospital 174.28 admission criteria established under Minnesota Rules, parts 174.299505.05009505.0501 to 9505.0540. 174.30 The commissioner may authorize up to 16 hours per day of 174.31 medically necessary private duty nursing services or up to 24 174.32 hours per day of medically necessary private duty nursing 174.33 services until such time as the commissioner is able to make a 174.34 determination of eligibility for recipients who are 174.35 cooperatively applying for home care services under the 174.36 community alternative care program developed under section 175.1 256B.49, or until it is determined by the appropriate regulatory 175.2 agency that a health benefit plan is or is not required to pay 175.3 for appropriate medically necessary health care services. 175.4 Recipients or their representatives must cooperatively assist 175.5 the commissioner in obtaining this determination. Recipients 175.6 who are eligible for the community alternative care program may 175.7 not receive more hours of nursing under this section than would 175.8 otherwise be authorized under section 256B.49. 175.9 Beginning July 1, 2001, private duty nursing services shall 175.10 be authorized for complex and regular care according to 175.11 subdivision 1. 175.12 (4) [VENTILATOR-DEPENDENT RECIPIENTS.] If the recipient is 175.13 ventilator-dependent, the monthly medical assistance 175.14 authorization for home care services shall not exceed what the 175.15 commissioner would pay for care at the highest cost hospital 175.16 designated as a long-term hospital under the Medicare program. 175.17 For purposes of this clause, home care services means all 175.18 services provided in the home that would be included in the 175.19 payment for care at the long-term hospital. 175.20 "Ventilator-dependent" means an individual who receives 175.21 mechanical ventilation for life support at least six hours per 175.22 day and is expected to be or has been dependent for at least 30 175.23 consecutive days. 175.24 (f) [PRIOR AUTHORIZATION; TIME LIMITS.] The commissioner 175.25 or the commissioner's designee shall determine the time period 175.26 for which a prior authorization shall be effective. If the 175.27 recipient continues to require home care services beyond the 175.28 duration of the prior authorization, the home care provider must 175.29 request a new prior authorization. Under no circumstances, 175.30 other than the exceptions in paragraph (b), shall a prior 175.31 authorization be valid prior to the date the commissioner 175.32 receives the request or for more than 12 months. A recipient 175.33 who appeals a reduction in previously authorized home care 175.34 services may continue previously authorized services, other than 175.35 temporary services under paragraph (h), pending an appeal under 175.36 section 256.045. The commissioner must provide a detailed 176.1 explanation of why the authorized services are reduced in amount 176.2 from those requested by the home care provider. 176.3 (g) [APPROVAL OF HOME CARE SERVICES.] The commissioner or 176.4 the commissioner's designee shall determine the medical 176.5 necessity of home care services, the level of caregiver 176.6 according to subdivision 2, and the institutional comparison 176.7 according to this subdivision, the cost-effectiveness of 176.8 services, and the amount, scope, and duration of home care 176.9 services reimbursable by medical assistance, based on the 176.10 assessment, primary payer coverage determination information as 176.11 required, the service plan, the recipient's age, the cost of 176.12 services, the recipient's medical condition, and diagnosis or 176.13 disability. The commissioner may publish additional criteria 176.14 for determining medical necessity according to section 256B.04. 176.15 (h) [PRIOR AUTHORIZATION REQUESTS; TEMPORARY SERVICES.] 176.16 The agency nurse, the independently enrolled private duty nurse, 176.17 or county public health nurse may request a temporary 176.18 authorization for home care services by telephone. The 176.19 commissioner may approve a temporary level of home care services 176.20 based on the assessment, and service or care plan information, 176.21 and primary payer coverage determination information as required. 176.22 Authorization for a temporary level of home care services 176.23 including nurse supervision is limited to the time specified by 176.24 the commissioner, but shall not exceed 45 days, unless extended 176.25 because the county public health nurse has not completed the 176.26 required assessment and service plan, or the commissioner's 176.27 determination has not been made. The level of services 176.28 authorized under this provision shall have no bearing on a 176.29 future prior authorization. 176.30 (i) [PRIOR AUTHORIZATION REQUIRED IN FOSTER CARE SETTING.] 176.31 Home care services provided in an adult or child foster care 176.32 setting must receive prior authorization by the department 176.33 according to the limits established in paragraph (a). 176.34 The commissioner may not authorize: 176.35 (1) home care services that are the responsibility of the 176.36 foster care provider under the terms of the foster care 177.1 placement agreement and administrative rules; 177.2 (2) personal care assistant services when the foster care 177.3 license holder is also the personal care provider or personal 177.4 care assistant unless the recipient can direct the recipient's 177.5 own care, or case management is provided as required in section 177.6 256B.0625, subdivision 19a; 177.7 (3) personal care assistant services when the responsible 177.8 party is an employee of, or under contract with, or has any 177.9 direct or indirect financial relationship with the personal care 177.10 provider or personal care assistant, unless case management is 177.11 provided as required in section 256B.0625, subdivision 19a; or 177.12 (4) personal care assistant and private duty nursing 177.13 services when the number of foster care residents is greater 177.14 than four unless the county responsible for the recipient's 177.15 foster placement made the placement prior to April 1, 1992, 177.16 requests that personal care assistant and private duty nursing 177.17 services be provided, and case management is provided as 177.18 required in section 256B.0625, subdivision 19a. 177.19 Sec. 32. Minnesota Statutes 2000, section 256B.0627, 177.20 subdivision 7, is amended to read: 177.21 Subd. 7. [NONCOVERED HOME CARE SERVICES.] The following 177.22 home care services are not eligible for payment under medical 177.23 assistance: 177.24 (1) skilled nurse visits for the sole purpose of 177.25 supervision of the home health aide; 177.26 (2) a skilled nursing visit: 177.27 (i) only for the purpose of monitoring medication 177.28 compliance with an established medication program for a 177.29 recipient; or 177.30 (ii) to administer or assist with medication 177.31 administration, including injections, prefilling syringes for 177.32 injections, or oral medication set-up of an adult recipient, 177.33 when as determined and documented by the registered nurse, the 177.34 need can be met by an available pharmacy or the recipient is 177.35 physically and mentally able to self-administer or prefill a 177.36 medication; 178.1 (3) home care services to a recipient who is eligible for 178.2 covered servicesincluding hospice, if elected by the recipient,178.3 under the Medicare program or any other insurance held by the 178.4 recipient; 178.5 (4) services to other members of the recipient's household; 178.6 (5) a visit made by a skilled nurse solely to train other 178.7 home health agency workers; 178.8 (6) any home care service included in the daily rate of the 178.9 community-based residential facility where the recipient is 178.10 residing; 178.11 (7) nursing and rehabilitation therapy services that are 178.12 reasonably accessible to a recipient outside the recipient's 178.13 place of residence, excluding the assessment, counseling and 178.14 education, and personal assistant care; 178.15 (8) any home health agency service, excluding personal care 178.16 assistant services and private duty nursing services, which are 178.17 performed in a place other than the recipient's residence; and 178.18 (9) Medicare evaluation or administrative nursing visits on 178.19 dual-eligible recipients that do not qualify for Medicare visit 178.20 billing. 178.21 Sec. 33. Minnesota Statutes 2000, section 256B.0627, 178.22 subdivision 8, is amended to read: 178.23 Subd. 8. [SHARED PERSONAL CARE ASSISTANT SERVICES.] (a) 178.24 Medical assistance payments for shared personal care assistance 178.25 services shall be limited according to this subdivision. 178.26 (b) Recipients of personal care assistant services may 178.27 share staff and the commissioner shall provide a rate system for 178.28 shared personal care assistant services. For two persons 178.29 sharing services, the rate paid to a provider shall not exceed 178.30 1-1/2 times the rate paid for serving a single individual, and 178.31 for three persons sharing services, the rate paid to a provider 178.32 shall not exceed twice the rate paid for serving a single 178.33 individual. These rates apply only to situations in which all 178.34 recipients were present and received shared services on the date 178.35 for which the service is billed. No more than three persons may 178.36 receive shared services from a personal care assistant in a 179.1 single setting. 179.2 (c) Shared service is the provision of personal 179.3 care assistant services by a personal care assistant to two or 179.4 three recipients at the same time and in the same setting. For 179.5 the purposes of this subdivision, "setting" means: 179.6 (1) the home or foster care home of one of the individual 179.7 recipients; or 179.8 (2) a child care program in which all recipients served by 179.9 one personal care assistant are participating, which is licensed 179.10 under chapter 245A or operated by a local school district or 179.11 private school; or 179.12 (3) outside the home or foster care home of one of the 179.13 recipients when normal life activities take the recipients 179.14 outside the home. 179.15 The provisions of this subdivision do not apply when a 179.16 personal care assistant is caring for multiple recipients in 179.17 more than one setting. 179.18 (d) The recipient or the recipient's responsible party, in 179.19 conjunction with the county public health nurse, shall determine: 179.20 (1) whether shared personal care assistant services is an 179.21 appropriate option based on the individual needs and preferences 179.22 of the recipient; and 179.23 (2) the amount of shared services allocated as part of the 179.24 overall authorization of personal care assistant services. 179.25 The recipient or the responsible party, in conjunction with 179.26 the supervising qualified professional, if a qualified 179.27 professional is requested by any one of the recipients or 179.28 responsible parties, shall arrange the setting and grouping of 179.29 shared services based on the individual needs and preferences of 179.30 the recipients. Decisions on the selection of recipients to 179.31 share services must be based on the ages of the recipients, 179.32 compatibility, and coordination of their care needs. 179.33 (e) The following items must be considered by the recipient 179.34 or the responsible party and the supervising qualified 179.35 professional, if a qualified professional has been requested by 179.36 any one of the recipients or responsible parties, and documented 180.1 in the recipient's health service record: 180.2 (1) the additional qualifications needed by the personal 180.3 care assistant to provide care to several recipients in the same 180.4 setting; 180.5 (2) the additional training and supervision needed by the 180.6 personal care assistant to ensure that the needs of the 180.7 recipient are met appropriately and safely. The provider must 180.8 provide on-site supervision by a qualified professional within 180.9 the first 14 days of shared services, and monthly thereafter, if 180.10 supervision by a qualified provider has been requested by any 180.11 one of the recipients or responsible parties; 180.12 (3) the setting in which the shared services will be 180.13 provided; 180.14 (4) the ongoing monitoring and evaluation of the 180.15 effectiveness and appropriateness of the service and process 180.16 used to make changes in service or setting; and 180.17 (5) a contingency plan which accounts for absence of the 180.18 recipient in a shared services setting due to illness or other 180.19 circumstances and staffing contingencies. 180.20 (f) The provider must offer the recipient or the 180.21 responsible party the option of shared or one-on-one personal 180.22 care assistant services. The recipient or the responsible party 180.23 can withdraw from participating in a shared services arrangement 180.24 at any time. 180.25 (g) In addition to documentation requirements under 180.26 Minnesota Rules, part 9505.2175, a personal care provider must 180.27 meet documentation requirements for shared personal care 180.28 assistant services and must document the following in the health 180.29 service record for each individual recipient sharing services: 180.30 (1) permission by the recipient or the recipient's 180.31 responsible party, if any, for the maximum number of shared 180.32 services hours per week chosen by the recipient; 180.33 (2) permission by the recipient or the recipient's 180.34 responsible party, if any, for personal care assistant services 180.35 provided outside the recipient's residence; 180.36 (3) permission by the recipient or the recipient's 181.1 responsible party, if any, for others to receive shared services 181.2 in the recipient's residence; 181.3 (4) revocation by the recipient or the recipient's 181.4 responsible party, if any, of the shared service authorization, 181.5 or the shared service to be provided to others in the 181.6 recipient's residence, or the shared service to be provided 181.7 outside the recipient's residence; 181.8 (5) supervision of the shared personal care assistant 181.9 services by the qualified professional, if a qualified 181.10 professional is requested by one of the recipients or 181.11 responsible parties, including the date, time of day, number of 181.12 hours spent supervising the provision of shared services, 181.13 whether the supervision was face-to-face or another method of 181.14 supervision, changes in the recipient's condition, shared 181.15 services scheduling issues and recommendations; 181.16 (6) documentation by the qualified professional, if a 181.17 qualified professional is requested by one of the recipients or 181.18 responsible parties, of telephone calls or other discussions 181.19 with the personal care assistant regarding services being 181.20 provided to the recipient who has requested the supervision; and 181.21 (7) daily documentation of the shared services provided by 181.22 each identified personal care assistant including: 181.23 (i) the names of each recipient receiving shared services 181.24 together; 181.25 (ii) the setting for the shared services, including the 181.26 starting and ending times that the recipient received shared 181.27 services; and 181.28 (iii) notes by the personal care assistant regarding 181.29 changes in the recipient's condition, problems that may arise 181.30 from the sharing of services, scheduling issues, care issues, 181.31 and other notes as required by the qualified professional, if a 181.32 qualified professional is requested by one of the recipients or 181.33 responsible parties. 181.34 (h) Unless otherwise provided in this subdivision, all 181.35 other statutory and regulatory provisions relating to personal 181.36 care assistant services apply to shared services. 182.1 (i) In the event that supervision by a qualified 182.2 professional has been requested by one or more recipients, but 182.3 not by all of the recipients, the supervision duties of the 182.4 qualified professional shall be limited to only those recipients 182.5 who have requested the supervision. 182.6 Nothing in this subdivision shall be construed to reduce 182.7 the total number of hours authorized for an individual recipient. 182.8 Sec. 34. Minnesota Statutes 2000, section 256B.0627, 182.9 subdivision 10, is amended to read: 182.10 Subd. 10. [FISCALAGENTINTERMEDIARY OPTION AVAILABLE FOR 182.11 PERSONAL CARE ASSISTANT SERVICES.] (a)"Fiscal agent option" is182.12an option that allows the recipient to:182.13(1) use a fiscal agent instead of a personal care provider182.14organization;182.15(2) supervise the personal care assistant; and182.16(3) use a consulting professional.182.17 The commissioner may allow a recipient of personal care 182.18 assistant services to use a fiscalagentintermediary to assist 182.19 the recipient in paying and accounting for medically necessary 182.20 covered personal care assistant services authorized in 182.21 subdivision 4 and within the payment parameters of subdivision 182.22 5. Unless otherwise provided in this subdivision, all other 182.23 statutory and regulatory provisions relating to personal care 182.24 assistant services apply to a recipient using the fiscalagent182.25 intermediary option. 182.26 (b) The recipient or responsible party shall: 182.27 (1)hire, and terminate the personal care assistant and182.28consulting professional, with the fiscal agentrecruit, hire, 182.29 and terminate a qualified professional, if a qualified 182.30 professional is requested by the recipient or responsible party; 182.31 (2)recruit the personal care assistant and consulting182.32professional and orient and train the personal care assistant in182.33areas that do not require professional delegation as determined182.34by the county public health nurseverify and document the 182.35 credentials of the qualified professional, if a qualified 182.36 professional is requested by the recipient or responsible party; 183.1 (3)supervise and evaluate the personal care assistant in183.2areas that do not require professional delegation as determined183.3in the assessment;183.4(4) cooperate with a consultingdevelop a service plan 183.5 based on physician orders and public health nurse assessment 183.6 with the assistance of a qualified professionaland implement183.7recommendations pertaining to the health and safety of the183.8recipient, if a qualified professional is requested by the 183.9 recipient or responsible party, that addresses the health and 183.10 safety of the recipient; 183.11(5) hire a qualified professional to train and supervise183.12the performance of delegated tasks done by(4) recruit, hire, 183.13 and terminate the personal care assistant; 183.14(6) monitor services and verify in writing the hours worked183.15by the personal care assistant and the consulting(5) orient and 183.16 train the personal care assistant with assistance as needed from 183.17 the qualified professional; 183.18(7) develop and revise a care plan with assistance from a183.19consulting(6) supervise and evaluate the personal care 183.20 assistant with assistance as needed from the recipient's 183.21 physician or the qualified professional; 183.22(8) verify and document the credentials of the consulting183.23 (7) monitor and verify in writing and report to the fiscal 183.24 intermediary the number of hours worked by the personal care 183.25 assistant and the qualified professional; and 183.26(9)(8) enter into a written agreement, as specified in 183.27 paragraph (f). 183.28 (c) The duties of the fiscalagentintermediary shall be to: 183.29 (1) bill the medical assistance program for personal care 183.30 assistant andconsultingqualified professional services; 183.31 (2) request and secure background checks on personal care 183.32 assistants andconsultingqualified professionals according to 183.33 section 245A.04; 183.34 (3) pay the personal care assistant andconsulting183.35 qualified professional based on actual hours of services 183.36 provided; 184.1 (4) withhold and pay all applicable federal and state 184.2 taxes; 184.3 (5) verify anddocumentkeep records of hours worked by the 184.4 personal care assistant andconsultingqualified professional; 184.5 (6) make the arrangements and pay unemployment insurance, 184.6 taxes, workers' compensation, liability insurance, and other 184.7 benefits, if any; 184.8 (7) enroll in the medical assistance program as a fiscal 184.9agentintermediary; and 184.10 (8) enter into a written agreement as specified in 184.11 paragraph (f) before services are provided. 184.12 (d) The fiscalagentintermediary: 184.13 (1) may not be related to the recipient,consulting184.14 qualified professional, or the personal care assistant; 184.15 (2) must ensure arm's length transactions with the 184.16 recipient and personal care assistant; and 184.17 (3) shall be considered a joint employer of the personal 184.18 care assistant andconsultingqualified professional to the 184.19 extent specified in this section. 184.20 The fiscalagentintermediary or owners of the entity that 184.21 provides fiscalagentintermediary services under this 184.22 subdivision must pass a criminal background check as required in 184.23 section 256B.0627, subdivision 1, paragraph (e). 184.24 (e) If the recipient or responsible party requests a 184.25 qualified professional, theconsultingqualified professional 184.26 providing assistance to the recipient shall meet the 184.27 qualifications specified in section 256B.0625, subdivision 19c. 184.28 Theconsultingqualified professional shall assist the recipient 184.29 in developing and revising a plan to meet the 184.30 recipient'sassessedneeds,and supervise the performance of184.31delegated tasks, as determined by the public health nurseas 184.32 assessed by the public health nurse. In performing this 184.33 function, theconsultingqualified professional must visit the 184.34 recipient in the recipient's home at least once annually. 184.35 Theconsultingqualified professional must reportto the local184.36county public health nurse concerns relating to the health and185.1safety of the recipient, andany suspected abuse, neglect, or 185.2 financial exploitation of the recipient to the appropriate 185.3 authorities. 185.4 (f) The fiscalagentintermediary, recipient or responsible 185.5 party, personal care assistant, andconsultingqualified 185.6 professional shall enter into a written agreement before 185.7 services are started. The agreement shall include: 185.8 (1) the duties of the recipient, qualified professional, 185.9 personal care assistant, and fiscal agent based on paragraphs 185.10 (a) to (e); 185.11 (2) the salary and benefits for the personal care assistant 185.12 andthose providing professional consultationthe qualified 185.13 professional; 185.14 (3) the administrative fee of the fiscalagentintermediary 185.15 and services paid for with that fee, including background check 185.16 fees; 185.17 (4) procedures to respond to billing or payment complaints; 185.18 and 185.19 (5) procedures for hiring and terminating the personal care 185.20 assistant andthose providing professional consultationthe 185.21 qualified professional. 185.22 (g) The rates paid for personal care assistant services, 185.23 qualified professionalassistanceservices, and fiscalagency185.24 intermediary services under this subdivision shall be the same 185.25 rates paid for personal care assistant services and qualified 185.26 professional services under subdivision 2 respectively. Except 185.27 for the administrative fee of the fiscalagentintermediary 185.28 specified in paragraph (f), the remainder of the rates paid to 185.29 the fiscalagentintermediary must be used to pay for the salary 185.30 and benefits for the personal care assistant orthose providing185.31professional consultationthe qualified professional. 185.32 (h) As part of the assessment defined in subdivision 1, the 185.33 following conditions must be met to use or continue use of a 185.34 fiscalagentintermediary: 185.35 (1) the recipient must be able to direct the recipient's 185.36 own care, or the responsible party for the recipient must be 186.1 readily available to direct the care of the personal care 186.2 assistant; 186.3 (2) the recipient or responsible party must be 186.4 knowledgeable of the health care needs of the recipient and be 186.5 able to effectively communicate those needs; 186.6 (3) a face-to-face assessment must be conducted by the 186.7 local county public health nurse at least annually, or when 186.8 there is a significant change in the recipient's condition or 186.9 change in the need for personal care assistant services. The186.10county public health nurse shall determine the services that186.11require professional delegation, if any, and the amount and186.12frequency of related supervision; 186.13 (4) the recipient cannot select the shared services option 186.14 as specified in subdivision 8; and 186.15 (5) parties must be in compliance with the written 186.16 agreement specified in paragraph (f). 186.17 (i) The commissioner shall deny, revoke, or suspend the 186.18 authorization to use the fiscalagentintermediary option if: 186.19 (1) it has been determined by theconsultingqualified 186.20 professional or local county public health nurse that the use of 186.21 this option jeopardizes the recipient's health and safety; 186.22 (2) the parties have failed to comply with the written 186.23 agreement specified in paragraph (f); or 186.24 (3) the use of the option has led to abusive or fraudulent 186.25 billing for personal care assistant services. 186.26 The recipient or responsible party may appeal the 186.27 commissioner's action according to section 256.045. The denial, 186.28 revocation, or suspension to use the fiscalagentintermediary 186.29 option shall not affect the recipient's authorized level of 186.30 personal care assistant services as determined in subdivision 5. 186.31 Sec. 35. Minnesota Statutes 2000, section 256B.0627, 186.32 subdivision 11, is amended to read: 186.33 Subd. 11. [SHARED PRIVATE DUTY NURSING CARE OPTION.] (a) 186.34 Medical assistance payments for shared private duty nursing 186.35 services by a private duty nurse shall be limited according to 186.36 this subdivision. For the purposes of this section, "private 187.1 duty nursing agency" means an agency licensed under chapter 144A 187.2 to provide private duty nursing services. 187.3 (b) Recipients of private duty nursing services may share 187.4 nursing staff and the commissioner shall provide a rate 187.5 methodology for shared private duty nursing. For two persons 187.6 sharing nursing care, the rate paid to a provider shall not 187.7 exceed 1.5 times thenonwaiveredregular private duty nursing 187.8 rates paid for serving a single individualwho is not ventilator187.9dependent,by a registered nurse or licensed practical nurse. 187.10 These rates apply only to situations in which both recipients 187.11 are present and receive shared private duty nursing care on the 187.12 date for which the service is billed. No more than two persons 187.13 may receive shared private duty nursing services from a private 187.14 duty nurse in a single setting. 187.15 (c) Shared private duty nursing care is the provision of 187.16 nursing services by a private duty nurse to two recipients at 187.17 the same time and in the same setting. For the purposes of this 187.18 subdivision, "setting" means: 187.19 (1) the home or foster care home of one of the individual 187.20 recipients; or 187.21 (2) a child care program licensed under chapter 245A or 187.22 operated by a local school district or private school; or 187.23 (3) an adult day care service licensed under chapter 245A; 187.24 or 187.25 (4) outside the home or foster care home of one of the 187.26 recipients when normal life activities take the recipients 187.27 outside the home. 187.28 This subdivision does not apply when a private duty nurse 187.29 is caring for multiple recipients in more than one setting. 187.30 (d) The recipient or the recipient's legal representative, 187.31 and the recipient's physician, in conjunction with the home 187.32 health care agency, shall determine: 187.33 (1) whether shared private duty nursing care is an 187.34 appropriate option based on the individual needs and preferences 187.35 of the recipient; and 187.36 (2) the amount of shared private duty nursing services 188.1 authorized as part of the overall authorization of nursing 188.2 services. 188.3 (e) The recipient or the recipient's legal representative, 188.4 in conjunction with the private duty nursing agency, shall 188.5 approve the setting, grouping, and arrangement of shared private 188.6 duty nursing care based on the individual needs and preferences 188.7 of the recipients. Decisions on the selection of recipients to 188.8 share services must be based on the ages of the recipients, 188.9 compatibility, and coordination of their care needs. 188.10 (f) The following items must be considered by the recipient 188.11 or the recipient's legal representative and the private duty 188.12 nursing agency, and documented in the recipient's health service 188.13 record: 188.14 (1) the additional training needed by the private duty 188.15 nurse to provide care to two recipients in the same setting and 188.16 to ensure that the needs of the recipients are met appropriately 188.17 and safely; 188.18 (2) the setting in which the shared private duty nursing 188.19 care will be provided; 188.20 (3) the ongoing monitoring and evaluation of the 188.21 effectiveness and appropriateness of the service and process 188.22 used to make changes in service or setting; 188.23 (4) a contingency plan which accounts for absence of the 188.24 recipient in a shared private duty nursing setting due to 188.25 illness or other circumstances; 188.26 (5) staffing backup contingencies in the event of employee 188.27 illness or absence; and 188.28 (6) arrangements for additional assistance to respond to 188.29 urgent or emergency care needs of the recipients. 188.30 (g) The provider must offer the recipient or responsible 188.31 party the option of shared or one-on-one private duty nursing 188.32 services. The recipient or responsible party can withdraw from 188.33 participating in a shared service arrangement at any time. 188.34 (h) The private duty nursing agency must document the 188.35 following in the health service record for each individual 188.36 recipient sharing private duty nursing care: 189.1 (1) permission by the recipient or the recipient's legal 189.2 representative for the maximum number of shared nursing care 189.3 hours per week chosen by the recipient; 189.4 (2) permission by the recipient or the recipient's legal 189.5 representative for shared private duty nursing services provided 189.6 outside the recipient's residence; 189.7 (3) permission by the recipient or the recipient's legal 189.8 representative for others to receive shared private duty nursing 189.9 services in the recipient's residence; 189.10 (4) revocation by the recipient or the recipient's legal 189.11 representative of the shared private duty nursing care 189.12 authorization, or the shared care to be provided to others in 189.13 the recipient's residence, or the shared private duty nursing 189.14 services to be provided outside the recipient's residence; and 189.15 (5) daily documentation of the shared private duty nursing 189.16 services provided by each identified private duty nurse, 189.17 including: 189.18 (i) the names of each recipient receiving shared private 189.19 duty nursing services together; 189.20 (ii) the setting for the shared services, including the 189.21 starting and ending times that the recipient received shared 189.22 private duty nursing care; and 189.23 (iii) notes by the private duty nurse regarding changes in 189.24 the recipient's condition, problems that may arise from the 189.25 sharing of private duty nursing services, and scheduling and 189.26 care issues. 189.27 (i) Unless otherwise provided in this subdivision, all 189.28 other statutory and regulatory provisions relating to private 189.29 duty nursing services apply to shared private duty nursing 189.30 services. 189.31 Nothing in this subdivision shall be construed to reduce 189.32 the total number of private duty nursing hours authorized for an 189.33 individual recipient under subdivision 5. 189.34 Sec. 36. Minnesota Statutes 2000, section 256B.0627, is 189.35 amended by adding a subdivision to read: 189.36 Subd. 13. [CONSUMER-DIRECTED HOME CARE DEMONSTRATION 190.1 PROJECT.] (a) Upon the receipt of federal waiver authority, the 190.2 commissioner shall implement a consumer-directed home care 190.3 demonstration project. The consumer-directed home care 190.4 demonstration project must demonstrate and evaluate the outcomes 190.5 of a consumer-directed service delivery alternative to improve 190.6 access, increase consumer control and accountability over 190.7 available resources, and enable the use of supports that are 190.8 more individualized and cost-effective for eligible medical 190.9 assistance recipients receiving certain medical assistance home 190.10 care services. The consumer-directed home care demonstration 190.11 project will be administered locally by county agencies, tribal 190.12 governments, or administrative entities under contract with the 190.13 state in regions where counties choose not to provide this 190.14 service. 190.15 (b) Grant awards for persons who have been receiving 190.16 medical assistance covered personal care, home health aide, or 190.17 private duty nursing services for a period of 12 consecutive 190.18 months or more prior to enrollment in the consumer-directed home 190.19 care demonstration project will be established on a case-by-case 190.20 basis using historical service expenditure data. An average 190.21 monthly expenditure for each continuing enrollee will be 190.22 calculated based on historical expenditures made on behalf of 190.23 the enrollee for personal care, home health aide, or private 190.24 duty nursing services during the 12 month period directly prior 190.25 to enrollment in the project. The grant award will equal 90 190.26 percent of the average monthly expenditure. 190.27 (c) Grant awards for project enrollees who have been 190.28 receiving medical assistance covered personal care, home health 190.29 aide, or private duty nursing services for a period of less than 190.30 12 consecutive months prior to project enrollment will be 190.31 calculated on a case-by-case basis using the service 190.32 authorization in place at the time of enrollment. The total 190.33 number of units of personal care, home health aide, or private 190.34 duty nursing services the enrollee has been authorized to 190.35 receive will be converted to the total cost of the authorized 190.36 services in a given month using the statewide average service 191.1 payment rates. To determine an estimated monthly expenditure, 191.2 the total authorized monthly personal care, home health aide or 191.3 private duty nursing service costs will be reduced by a 191.4 percentage rate equivalent to the difference between the 191.5 statewide average service authorization and the statewide 191.6 average utilization rate for each of the services by medical 191.7 assistance eligibles during the most recent fiscal year for 191.8 which 12 months of data is available. The grant award will 191.9 equal 90 percent of the estimated monthly expenditure. 191.10 (d) The state of Minnesota, county agencies, tribal 191.11 governments, or administrative entities under contract with the 191.12 state that participate in the implementation and administration 191.13 of the consumer-directed home care demonstration project, shall 191.14 not be liable for damages, injuries, or liabilities sustained 191.15 through the purchase of support by the individual, the 191.16 individual's family, or the authorized representative under this 191.17 section with funds received through the consumer-directed home 191.18 care demonstration project. Liabilities include but are not 191.19 limited to: workers' compensation liability, the Federal 191.20 Insurance Contributions Act (FICA), or the Federal Unemployment 191.21 Tax Act (FUTA). 191.22 Sec. 37. Minnesota Statutes 2000, section 256B.0627, is 191.23 amended by adding a subdivision to read: 191.24 Subd. 14. [TELEHOMECARE; SKILLED NURSE VISITS.] Medical 191.25 assistance covers skilled nurse visits according to section 191.26 256B.0625, subdivision 6a, provided via telehomecare, for 191.27 services which do not require hands-on care between the home 191.28 care nurse and recipient. The provision of telehomecare must be 191.29 made via live, two-way interactive audiovisual technology and 191.30 may be augmented by utilizing store-and-forward technologies. 191.31 Store-and-forward technology includes telehomecare services that 191.32 do not occur in real time via synchronous transmissions, and 191.33 that do not require a face-to-face encounter with the recipient 191.34 for all or any part of any such telehomecare visit. A 191.35 communication between the home care nurse and recipient that 191.36 consists solely of a telephone conversation, facsimile, 192.1 electronic mail, or a consultation between two health care 192.2 practitioners, is not to be considered a telehomecare visit. 192.3 Multiple daily skilled nurse visits provided via telehomecare 192.4 are allowed. Coverage of telehomecare is limited to two visits 192.5 per day. All skilled nurse visits provided via telehomecare 192.6 must be prior authorized by the commissioner or the 192.7 commissioner's designee and will be covered at the same 192.8 allowable rate as skilled nurse visits provided in-person. 192.9 Sec. 38. Minnesota Statutes 2000, section 256B.0627, is 192.10 amended by adding a subdivision to read: 192.11 Subd. 15. [THERAPIES THROUGH HOME HEALTH AGENCIES.] (a) 192.12 [PHYSICAL THERAPY.] Medical assistance covers physical therapy 192.13 and related services, including specialized maintenance 192.14 therapy. Services provided by a physical therapy assistant 192.15 shall be reimbursed at the same rate as services performed by a 192.16 physical therapist when the services of the physical therapy 192.17 assistant are provided under the direction of a physical 192.18 therapist who is on the premises. Services provided by a 192.19 physical therapy assistant that are provided under the direction 192.20 of a physical therapist who is not on the premises shall be 192.21 reimbursed at 65 percent of the physical therapist rate. 192.22 Direction of the physical therapy assistant must be provided by 192.23 the physical therapist as described in Minnesota Rules, part 192.24 9505.0390, subpart 1, item B. The physical therapist and 192.25 physical therapist assistant may not both bill for services 192.26 provided to a recipient on the same day. 192.27 (b) [OCCUPATIONAL THERAPY.] Medical assistance covers 192.28 occupational therapy and related services, including specialized 192.29 maintenance therapy. Services provided by an occupational 192.30 therapy assistant shall be reimbursed at the same rate as 192.31 services performed by an occupational therapist when the 192.32 services of the occupational therapy assistant are provided 192.33 under the direction of the occupational therapist who is on the 192.34 premises. Services provided by an occupational therapy 192.35 assistant under the direction of an occupational therapist who 192.36 is not on the premises shall be reimbursed at 65 percent of the 193.1 occupational therapist rate. Direction of the occupational 193.2 therapy assistant must be provided by the occupational therapist 193.3 as described in Minnesota Rules, part 9505.0390, subpart 1, item 193.4 B. The occupational therapist and occupational therapist 193.5 assistant may not both bill for services provided to a recipient 193.6 on the same day. 193.7 Sec. 39. Minnesota Statutes 2000, section 256B.0627, is 193.8 amended by adding a subdivision to read: 193.9 Subd. 16. [HARDSHIP CRITERIA; PRIVATE DUTY NURSING.] (a) 193.10 Payment is allowed for extraordinary services that require 193.11 specialized nursing skills and are provided by parents of minor 193.12 children, spouses, and legal guardians who are providing private 193.13 duty nursing care under the following conditions: 193.14 (1) the provision of these services is not legally required 193.15 of the parents, spouses, or legal guardians; 193.16 (2) the services are necessary to prevent hospitalization 193.17 of the recipient; and 193.18 (3) the recipient is eligible for state plan home care or a 193.19 home and community-based waiver and one of the following 193.20 hardship criteria are met: 193.21 (i) the parent, spouse, or legal guardian resigns from a 193.22 part-time or full-time job to provide nursing care for the 193.23 recipient; or 193.24 (ii) the parent, spouse, or legal guardian goes from a 193.25 full-time to a part-time job with less compensation to provide 193.26 nursing care for the recipient; or 193.27 (iii) the parent, spouse, or legal guardian takes a leave 193.28 of absence without pay to provide nursing care for the 193.29 recipient; or 193.30 (iv) because of labor conditions, special language needs, 193.31 or intermittent hours of care needed, the parent, spouse, or 193.32 legal guardian is needed in order to provide adequate private 193.33 duty nursing services to meet the medical needs of the recipient. 193.34 (b) Private duty nursing may be provided by a parent, 193.35 spouse, or legal guardian who is a nurse licensed in Minnesota. 193.36 Private duty nursing services provided by a parent, spouse, or 194.1 legal guardian cannot be used in lieu of nursing services 194.2 covered and available under liable third-party payers, including 194.3 Medicare. The private duty nursing provided by a parent, 194.4 spouse, or legal guardian must be included in the service plan. 194.5 Authorized skilled nursing services provided by the parent, 194.6 spouse, or legal guardian may not exceed 50 percent of the total 194.7 approved nursing hours, or eight hours per day, whichever is 194.8 less, up to a maximum of 40 hours per week. Nothing in this 194.9 subdivision precludes the parent's, spouse's, or legal 194.10 guardian's obligation of assuming the nonreimbursed family 194.11 responsibilities of emergency backup caregiver and primary 194.12 caregiver. 194.13 (c) A parent or a spouse may not be paid to provide private 194.14 duty nursing care if the parent or spouse fails to pass a 194.15 criminal background check according to section 245A.04, or if it 194.16 has been determined by the home health agency, the case manager, 194.17 or the physician that the private duty nursing care provided by 194.18 the parent, spouse, or legal guardian is unsafe. 194.19 Sec. 40. Minnesota Statutes 2000, section 256B.0627, is 194.20 amended by adding a subdivision to read: 194.21 Subd. 17. [QUALITY ASSURANCE PLAN FOR PERSONAL CARE 194.22 ASSISTANT SERVICES.] The commissioner shall establish a quality 194.23 assurance plan for personal care assistant services that 194.24 includes: 194.25 (1) performance-based provider agreements; 194.26 (2) meaningful consumer input, which may include consumer 194.27 surveys, that measure the extent to which participants receive 194.28 the services and supports described in the individual plan and 194.29 participant satisfaction with such services and supports; 194.30 (3) ongoing monitoring of the health and well-being of 194.31 consumers; and 194.32 (4) an ongoing public process for development, 194.33 implementation, and review of the quality assurance plan. 194.34 Sec. 41. Minnesota Statutes 2000, section 256B.0911, is 194.35 amended by adding a subdivision to read: 194.36 Subd. 4a. [PREADMISSION SCREENING OF INDIVIDUALS UNDER 65 195.1 YEARS OF AGE.] (a) It is the policy of the state of Minnesota to 195.2 ensure that individuals with disabilities or chronic illness are 195.3 served in the most integrated setting appropriate to their needs 195.4 and have the necessary information to make informed choices 195.5 about home and community-based service options. 195.6 (b) Individuals under 65 years of age who are admitted to a 195.7 nursing facility from a hospital must be screened prior to 195.8 admission as outlined in subdivision 4. 195.9 (c) Individuals under 65 years of age who are admitted to 195.10 nursing facilities with only a telephone screening must receive 195.11 a face-to-face assessment from the long-term care consultation 195.12 team member of the county in which the facility is located or 195.13 from the recipient's county case manager within 20 working days 195.14 of admission. 195.15 (d) At the face-to-face assessment, the long-term care 195.16 consultation team member or county case manager must perform the 195.17 activities required under subdivision 3. 195.18 (e) For individuals under 21 years of age, the screening or 195.19 assessment which recommends nursing facility admission must be 195.20 approved by the commissioner before the individual is admitted 195.21 to the nursing facility. 195.22 (f) In the event that an individual under 65 years of age 195.23 is admitted to a nursing facility on an emergency basis, the 195.24 county must be notified of the admission on the next working 195.25 day, and a face-to-face assessment as described in paragraph (c) 195.26 must be conducted within 20 working days of admission. 195.27 (g) At the face-to-face assessment, the long-term care 195.28 consultation team member or the case manager must present 195.29 information about home and community-based options so the 195.30 individual can make informed choices. If the individual chooses 195.31 home and community-based services, the long-term care 195.32 consultation team member or case manager must complete a written 195.33 relocation plan within 20 working days of the visit. The plan 195.34 shall describe the services needed to move out of the facility 195.35 and a time line for the move which is designed to ensure a 195.36 smooth transition to the individual's home and community. 196.1 (h) An individual under 65 years of age residing in a 196.2 nursing facility shall receive a face-to-face assessment at 196.3 least every 12 months to review the person's service choices and 196.4 available alternatives unless the individual indicates, in 196.5 writing, that annual visits are not desired. In this case, the 196.6 individual must receive a face-to-face assessment at least once 196.7 every 36 months for the same purposes. 196.8 (i) Notwithstanding the provisions of subdivision 6, the 196.9 commissioner may pay county agencies directly for face-to-face 196.10 assessments for individuals who are eligible for medical 196.11 assistance, under 65 years of age, and being considered for 196.12 placement or residing in a nursing facility. 196.13 Sec. 42. Minnesota Statutes 2000, section 256B.0916, 196.14 subdivision 1, is amended to read: 196.15 Subdivision 1. [REDUCTION OF WAITING LIST.] (a) The 196.16 legislature recognizes that as of January 1, 1999, 3,300 persons 196.17 with mental retardation or related conditions have been screened 196.18 and determined eligible for the home and community-based waiver 196.19 services program for persons with mental retardation or related 196.20 conditions. Many wait for several years before receiving 196.21 service. 196.22 (b) The waiting list for this program shall be reduced or 196.23 eliminated by June 30, 2003. In order to reduce the number of 196.24 eligible persons waiting for identified services provided 196.25 through the home and community-based waiver for persons with 196.26 mental retardation or related conditions, during the period from 196.27 July 1, 1999, to June 30, 2003, funding shall be increased to 196.28 add 100 additional eligible persons each year beyond the 196.29 February 1999 medical assistance forecast. 196.30 (c) The commissioner shall allocate resources in such a 196.31 manner as to use all resources budgeted during a biennium for 196.32 the home and community-based waiver for persons with mental 196.33 retardation or related conditions according to the priorities 196.34 listed in subdivision 2, paragraph (b), and then to serve other 196.35 persons on the waiting list. Resources allocated for a fiscal 196.36 year to serve persons affected by public and private sector 197.1 ICF/MR closures, but not expected to be expended for that 197.2 purpose, must be reallocated within that fiscal year to serve 197.3 other persons on the waiting list, and the number of waiver 197.4 diversion slots shall be adjusted accordingly. 197.5 (d) For fiscal year 2001, at least one-half of the increase 197.6 in funding over the previous year provided in the February 1999 197.7 medical assistance forecast for the home and community-based 197.8 waiver for persons with mental retardation and related 197.9 conditions, including changes made by the 1999 legislature, must 197.10 be used to serve persons who are not affected by public and 197.11 private sector ICF/MR closures. 197.12 (e) The commissioner of finance shall not reduce the 197.13 expenditure forecast for a biennium for which appropriations 197.14 have been made, if at the time of the forecast there is a 197.15 waiting list for waiver services for persons with mental 197.16 retardation or related conditions who need services within the 197.17 next 30 months. Funds that would have resulted from a projected 197.18 reduction in expenditures must be used by the commissioner of 197.19 human services to serve persons with developmental disabilities 197.20 through the home and community-based waiver for persons with 197.21 mental retardation or related conditions. 197.22 Sec. 43. Minnesota Statutes 2000, section 256B.0916, is 197.23 amended by adding a subdivision to read: 197.24 Subd. 6a. [STATEWIDE AVAILABILITY OF CONSUMER-DIRECTED 197.25 COMMUNITY SUPPORT SERVICES.] (a) The commissioner shall submit 197.26 to the federal Health Care Financing Administration by August 1, 197.27 2001, an amendment to the home and community-based waiver for 197.28 persons with mental retardation or related conditions to make 197.29 consumer-directed community support services available in every 197.30 county of the state by January 1, 2002. 197.31 (b) If a county declines to meet the requirements for 197.32 provision of consumer-directed community supports, the 197.33 commissioner shall contract with another county, a group of 197.34 counties, or a private agency to plan for and administer 197.35 consumer-directed community supports in that county. 197.36 (c) The state of Minnesota, county agencies, tribal 198.1 governments, or administrative entities under contract to 198.2 participate in the implementation and administration of the home 198.3 and community-based waiver for persons with mental retardation 198.4 or a related condition, shall not be liable for damages, 198.5 injuries, or liabilities sustained through the purchase of 198.6 support by the individual, the individual's family, or the 198.7 authorized representative with funds received through the 198.8 consumer-directed community support service under this section. 198.9 Liabilities include but are not limited to: workers' 198.10 compensation liability, the Federal Insurance Contributions Act 198.11 (FICA), or the Federal Unemployment Tax Act (FUTA). 198.12 Sec. 44. Minnesota Statutes 2000, section 256B.0916, 198.13 subdivision 7, is amended to read: 198.14 Subd. 7. [ANNUAL REPORT BY COMMISSIONER.] Beginning 198.15October 1, 1999, and each October 1November 1, 2001, and each 198.16 November 1 thereafter, the commissioner shall issue an annual 198.17 report on county and state use of available resources for the 198.18 home and community-based waiver for persons with mental 198.19 retardation or related conditions. For each county or county 198.20 partnership, the report shall include: 198.21 (1) the amount of funds allocated but not used; 198.22 (2) the county specific allowed reserve amount approved and 198.23 used; 198.24 (3) the number, ages, and living situations of individuals 198.25 screened and waiting for services; 198.26 (4) the urgency of need for services to begin within one, 198.27 two, or more than two years for each individual; 198.28 (5) the services needed; 198.29 (6) the number of additional persons served by approval of 198.30 increased capacity within existing allocations; 198.31 (7) results of action by the commissioner to streamline 198.32 administrative requirements and improve county resource 198.33 management; and 198.34 (8) additional action that would decrease the number of 198.35 those eligible and waiting for waivered services. 198.36 The commissioner shall specify intended outcomes for the program 199.1 and the degree to which these specified outcomes are attained. 199.2 Sec. 45. Minnesota Statutes 2000, section 256B.0916, 199.3 subdivision 9, is amended to read: 199.4 Subd. 9. [LEGAL REPRESENTATIVE PARTICIPATION EXCEPTION.] 199.5 The commissioner, in cooperation with representatives of 199.6 counties, service providers, service recipients, family members, 199.7 legal representatives and advocates, shall develop criteria to 199.8 allow legal representatives to be reimbursed for providing 199.9 specific support services to meet the person's needs when a plan 199.10 which assures health and safety has been agreed upon and carried 199.11 out by the legal representative, the person, and the county. 199.12 Legal representatives providing support underconsumer-directed199.13community support services pursuant to section 256B.092,199.14subdivision 4,the home and community-based waiver for persons 199.15 with mental retardation or related conditions or the consumer 199.16 support grant program pursuant to section256B.092, subdivision199.177256.476, shall not be considered to have a direct or indirect 199.18 service provider interest under section 256B.092, subdivision 7, 199.19 if a health and safety plan which meets the criteria established 199.20 has been agreed upon and implemented. ByOctober 1, 1999August 199.21 1, 2001, the commissioner shall submit, for federal approval, 199.22 amendments to allow legal representatives to provide support and 199.23 receive reimbursement under theconsumer-directed community199.24support services section of thehome and community-based waiver 199.25 plan. 199.26 Sec. 46. Minnesota Statutes 2000, section 256B.092, 199.27 subdivision 2a, is amended to read: 199.28 Subd. 2a. [MEDICAL ASSISTANCE FOR CASE MANAGEMENT 199.29 ACTIVITIES UNDER THE STATE PLAN MEDICAID OPTION.] (a) Upon 199.30 receipt of federal approval, the commissioner shall make 199.31 payments toapproved vendorscounties, private individuals, and 199.32 agencies enrolled as providers of case management services 199.33 participating in the medical assistance program to reimburse 199.34 costs for providing case management service activities to 199.35 medical assistance eligible persons with mental retardation or a 199.36 related condition, in accordance with the state Medicaid plan, 200.1 the home and community-based waiver for persons with mental 200.2 retardation and related conditions plan, and federal 200.3 requirementsand limitations. 200.4 (b) The commissioner shall ensure that each eligible person 200.5 is given a choice of county and private agency case management 200.6 service providers. Case management service providers are 200.7 prohibited from providing any other service to the person 200.8 receiving case management services. 200.9 Sec. 47. Minnesota Statutes 2000, section 256B.092, 200.10 subdivision 5, is amended to read: 200.11 Subd. 5. [FEDERAL WAIVERS.] (a) The commissioner shall 200.12 apply for any federal waivers necessary to secure, to the extent 200.13 allowed by law, federal financial participation under United 200.14 States Code, title 42, sections 1396 et seq., as amended, for 200.15 the provision of services to persons who, in the absence of the 200.16 services, would need the level of care provided in a regional 200.17 treatment center or a community intermediate care facility for 200.18 persons with mental retardation or related conditions. The 200.19 commissioner may seek amendments to the waivers or apply for 200.20 additional waivers under United States Code, title 42, sections 200.21 1396 et seq., as amended, to contain costs. The commissioner 200.22 shall ensure that payment for the cost of providing home and 200.23 community-based alternative services under the federal waiver 200.24 plan shall not exceed the cost of intermediate care services 200.25 including day training and habilitation services that would have 200.26 been provided without the waivered services. 200.27 (b) The commissioner, in administering home and 200.28 community-based waivers for persons with mental retardation and 200.29 related conditions, shall ensure that day services for eligible 200.30 persons are not provided by the person's residential service 200.31 provider, unless the person or the person's legal representative 200.32 is offered a choice of providers and agrees in writing to 200.33 provision of day services by the residential service provider. 200.34 The individual service plan for individuals who choose to have 200.35 their residential service provider provide their day services 200.36 must describe how health, safety, and protection needs will be 201.1 met by frequent and regular contact with persons other than the 201.2 residential service provider. 201.3 Sec. 48. Minnesota Statutes 2000, section 256B.093, 201.4 subdivision 3, is amended to read: 201.5 Subd. 3. [TRAUMATIC BRAIN INJURY PROGRAM DUTIES.] The 201.6 department shall fund administrative case management under this 201.7 subdivision using medical assistance administrative funds. The 201.8 traumatic brain injury program duties include: 201.9 (1) recommending to the commissioner in consultation with 201.10 the medical review agent according to Minnesota Rules, parts 201.11 9505.0500 to 9505.0540, the approval or denial of medical 201.12 assistance funds to pay for out-of-state placements for 201.13 traumatic brain injury services and in-state traumatic brain 201.14 injury services provided by designated Medicare long-term care 201.15 hospitals; 201.16 (2) coordinating the traumatic brain injury home and 201.17 community-based waiver; 201.18 (3)approving traumatic brain injury waiver eligibility or201.19care plans or both;201.20(4)providing ongoing technical assistance and consultation 201.21 to county and facility case managers to facilitate care plan 201.22 development for appropriate, accessible, and cost-effective 201.23 medical assistance services; 201.24(5)(4) providing technical assistance to promote statewide 201.25 development of appropriate, accessible, and cost-effective 201.26 medical assistance services and related policy; 201.27(6)(5) providing training and outreach to facilitate 201.28 access to appropriate home and community-based services to 201.29 prevent institutionalization; 201.30(7)(6) facilitating appropriate admissions, continued stay 201.31 review, discharges, and utilization review for neurobehavioral 201.32 hospitals and other specialized institutions; 201.33(8)(7) providing technical assistance on the use of prior 201.34 authorization of home care services and coordination of these 201.35 services with other medical assistance services; 201.36(9)(8) developing a system for identification of nursing 202.1 facility and hospital residents with traumatic brain injury to 202.2 assist in long-term planning for medical assistance services. 202.3 Factors will include, but are not limited to, number of 202.4 individuals served, length of stay, services received, and 202.5 barriers to community placement; and 202.6(10)(9) providing information, referral, and case 202.7 consultation to access medical assistance services for 202.8 recipients without a county or facility case manager. Direct 202.9 access to this assistance may be limited due to the structure of 202.10 the program. 202.11 Sec. 49. Minnesota Statutes 2000, section 256B.095, is 202.12 amended to read: 202.13 256B.095 [THREE-YEARQUALITY ASSURANCEPILOTPROJECT 202.14 ESTABLISHED.] 202.15 Effective July 1, 1998, an alternative quality assurance 202.16 licensing systempilotproject for programs for persons with 202.17 developmental disabilities is established in Dodge, Fillmore, 202.18 Freeborn, Goodhue, Houston, Mower, Olmsted, Rice, Steele, 202.19 Wabasha, and Winona counties for the purpose of improving the 202.20 quality of services provided to persons with developmental 202.21 disabilities. A county, at its option, may choose to have all 202.22 programs for persons with developmental disabilities located 202.23 within the county licensed under chapter 245A using standards 202.24 determined under the alternative quality assurance licensing 202.25 systempilotproject or may continue regulation of these 202.26 programs under the licensing system operated by the 202.27 commissioner. Thepilotproject expires on June 30,20012005. 202.28 Sec. 50. Minnesota Statutes 2000, section 256B.0951, 202.29 subdivision 1, is amended to read: 202.30 Subdivision 1. [MEMBERSHIP.] The region 10 quality 202.31 assurance commission is established. The commission consists of 202.32 at least 14 but not more than 21 members as follows: at least 202.33 three but not more than five members representing advocacy 202.34 organizations; at least three but not more than five members 202.35 representing consumers, families, and their legal 202.36 representatives; at least three but not more than five members 203.1 representing service providers; at least three but not more than 203.2 five members representing counties; and the commissioner of 203.3 human services or the commissioner's designee. Initial 203.4 membership of the commission shall be recruited and approved by 203.5 the region 10 stakeholders group. Prior to approving the 203.6 commission's membership, the stakeholders group shall provide to 203.7 the commissioner a list of the membership in the stakeholders 203.8 group, as of February 1, 1997, a brief summary of meetings held 203.9 by the group since July 1, 1996, and copies of any materials 203.10 prepared by the group for public distribution. The first 203.11 commission shall establish membership guidelines for the 203.12 transition and recruitment of membership for the commission's 203.13 ongoing existence. Members of the commission who do not receive 203.14 a salary or wages from an employer for time spent on commission 203.15 duties may receive a per diem payment when performing commission 203.16 duties and functions. All members may be reimbursed for 203.17 expenses related to commission activities. Notwithstanding the 203.18 provisions of section 15.059, subdivision 5, the commission 203.19 expires on June 30,20012005. 203.20 Sec. 51. Minnesota Statutes 2000, section 256B.0951, 203.21 subdivision 3, is amended to read: 203.22 Subd. 3. [COMMISSION DUTIES.] (a) By October 1, 1997, the 203.23 commission, in cooperation with the commissioners of human 203.24 services and health, shall do the following: (1) approve an 203.25 alternative quality assurance licensing system based on the 203.26 evaluation of outcomes; (2) approve measurable outcomes in the 203.27 areas of health and safety, consumer evaluation, education and 203.28 training, providers, and systems that shall be evaluated during 203.29 the alternative licensing process; and (3) establish variable 203.30 licensure periods not to exceed three years based on outcomes 203.31 achieved. For purposes of this subdivision, "outcome" means the 203.32 behavior, action, or status of a person that can be observed or 203.33 measured and can be reliably and validly determined. 203.34 (b) By January 15, 1998, the commission shall approve, in 203.35 cooperation with the commissioner of human services, a training 203.36 program for members of the quality assurance teams established 204.1 under section 256B.0952, subdivision 4. 204.2 (c) The commission and the commissioner shall establish an 204.3 ongoing review process for the alternative quality assurance 204.4 licensing system. The review shall take into account the 204.5 comprehensive nature of the alternative system, which is 204.6 designed to evaluate the broad spectrum of licensed and 204.7 unlicensed entities that provide services to clients, as 204.8 compared to the current licensing system. 204.9 (d) The commission shall contract with an independent 204.10 entity to conduct a financial review of the alternative quality 204.11 assurancepilotproject. The review shall take into account the 204.12 comprehensive nature of the alternative system, which is 204.13 designed to evaluate the broad spectrum of licensed and 204.14 unlicensed entities that provide services to clients, as 204.15 compared to the current licensing system. The review shall 204.16 include an evaluation of possible budgetary savings within the 204.17 department of human services as a result of implementation of 204.18 the alternative quality assurancepilotproject. If a federal 204.19 waiver is approved under subdivision 7, the financial review 204.20 shall also evaluate possible savings within the department of 204.21 health. This review must be completed by December 15, 2000. 204.22 (e) The commission shall submit a report to the legislature 204.23 by January 15, 2001, on the results of the review process for 204.24 the alternative quality assurancepilotproject, a summary of 204.25 the results of the independent financial review, and a 204.26 recommendation on whether thepilotproject should be extended 204.27 beyond June 30, 2001. 204.28 (f) The commissioner, in consultation with the commission, 204.29 shall examine the feasibility of expanding the project to other 204.30 populations or geographic areas and identify barriers to 204.31 expansion. The commissioner shall report findings and 204.32 recommendations to the legislature by December 15, 2004. 204.33 Sec. 52. Minnesota Statutes 2000, section 256B.0951, 204.34 subdivision 4, is amended to read: 204.35 Subd. 4. [COMMISSION'S AUTHORITY TO RECOMMEND VARIANCES OF 204.36 LICENSING STANDARDS.] The commission may recommend to the 205.1 commissioners of human services and health variances from the 205.2 standards governing licensure of programs for persons with 205.3 developmental disabilities in order to improve the quality of 205.4 services by implementing an alternative developmental 205.5 disabilities licensing system if the commission determines that 205.6 the alternative licensing system does not adversely affect the 205.7 health or safety of persons being served by the licensed program 205.8 nor compromise the qualifications of staff to provide services. 205.9 Sec. 53. Minnesota Statutes 2000, section 256B.0951, 205.10 subdivision 5, is amended to read: 205.11 Subd. 5. [VARIANCE OF CERTAIN STANDARDS PROHIBITED.] The 205.12 safety standards, rights, or procedural protections under 205.13 sections 245.825; 245.91 to 245.97; 245A.04, subdivisions 3, 3a, 205.14 3b, and 3c; 245A.09, subdivision 2, paragraph (c), clauses (2) 205.15 and (5); 245A.12; 245A.13; 252.41, subdivision 9; 256B.092, 205.16 subdivisions 1b, clause (7), and 10; 626.556; 626.557, and 205.17 procedures for the monitoring of psychotropic medications shall 205.18 not be varied under the alternative licensing systempilot205.19 project. The commission may make recommendations to the 205.20 commissioners of human services and health or to the legislature 205.21 regarding alternatives to or modifications of the rules and 205.22 procedures referenced in this subdivision. 205.23 Sec. 54. Minnesota Statutes 2000, section 256B.0951, 205.24 subdivision 7, is amended to read: 205.25 Subd. 7. [WAIVER OF RULES.] The commissioner of health may 205.26 exempt residents of intermediate care facilities for persons 205.27 with mental retardation (ICFs/MR) who participate in the 205.28 three-year quality assurance pilot project established in 205.29 section 256B.095 from the requirements of Minnesota Rules, 205.30 chapter 4665, upon approval by the federal government of a 205.31 waiver of federal certification requirements for ICFs/MR.The205.32commissioners of health and human services shall apply for any205.33necessary waivers as soon as practicable and shall submit the205.34concept paper to the federal government by June 1, 1998.205.35 Sec. 55. Minnesota Statutes 2000, section 256B.0951, is 205.36 amended by adding a subdivision to read: 206.1 Subd. 8. [FEDERAL WAIVER.] The commissioner of human 206.2 services shall seek federal authority to waive provisions of 206.3 intermediate care facilities for persons with mental retardation 206.4 (ICFs/MR) regulations to enable the demonstration and evaluation 206.5 of the alternative quality assurance system for ICFs/MR under 206.6 the project. The commissioner of human services shall apply for 206.7 any necessary waivers as soon as practicable. 206.8 Sec. 56. Minnesota Statutes 2000, section 256B.0951, is 206.9 amended by adding a subdivision to read: 206.10 Subd. 9. [EVALUATION.] The commission, in consultation 206.11 with the commissioner of human services, shall conduct an 206.12 evaluation of the alternative quality assurance system, and 206.13 present a report to the commissioner by June 30, 2004. 206.14 Sec. 57. Minnesota Statutes 2000, section 256B.0952, 206.15 subdivision 1, is amended to read: 206.16 Subdivision 1. [NOTIFICATION.]By January 15, 1998, each206.17affected county shall notify the commission and the206.18commissioners of human services and health as to whether it206.19chooses to implement on July 1, 1998, the alternative licensing206.20system for the pilot project. A county that does not implement206.21the alternative licensing system on July 1, 1998, may give206.22notice to the commission and the commissioners by January 15,206.231999, or January 15, 2000, that it will implement the206.24alternative licensing system on the following July 1. A county206.25that implements the alternative licensing system commits to206.26participate until June 30, 2001.For each year of the project, 206.27 region 10 counties shall give notice to the commission and 206.28 commissioners of human services and health by March 15 of intent 206.29 to join the quality assurance alternative licensing system, 206.30 effective July 1 of that year. A county choosing to participate 206.31 in the alternative licensing system commits to participate until 206.32 June 30, 2005. Counties participating in the quality assurance 206.33 alternative licensing system as of January 1, 2001, shall notify 206.34 the commission and the commissioners of human services and 206.35 health by March 15, 2001, of intent to continue participation. 206.36 Counties that elect to continue participation must participate 207.1 in the alternative licensing system until June 30, 2005. 207.2 Sec. 58. Minnesota Statutes 2000, section 256B.0952, 207.3 subdivision 4, is amended to read: 207.4 Subd. 4. [APPOINTMENT OF QUALITY ASSURANCE MANAGER.] (a) A 207.5 county or group of counties that chooses to participate in the 207.6 alternative licensing system shall designate a quality assurance 207.7 manager and shall establish quality assurance teams in 207.8 accordance with subdivision 5. The manager shall recruit, 207.9 train, and assign duties to the quality assurance team members. 207.10 In assigning team members to conduct the quality assurance 207.11 process at a facility, program, or service, the manager shall 207.12 take into account the size of the service provider, the number 207.13 of services to be reviewed, the skills necessary for team 207.14 members to complete the process, and other relevant factors. 207.15 The manager shall ensure that no team member has a financial, 207.16 personal, or family relationship with the facility, program, or 207.17 service being reviewed or with any clients of the facility, 207.18 program, or service. 207.19 (b) Quality assurance teams shall report the findings of 207.20 their quality assurance reviews to the quality assurance manager. 207.21 The quality assurance manager shall provide the report from the 207.22 quality assurance team to the county and, upon request, to the 207.23 commissioners of human services and health, and shall provide a 207.24 summary of the report to the quality assurance review council. 207.25 Sec. 59. Minnesota Statutes 2000, section 256B.49, is 207.26 amended by adding a subdivision to read: 207.27 Subd. 11. [AUTHORITY.] (a) The commissioner is authorized 207.28 to apply for home and community-based service waivers, as 207.29 authorized under section 1915(c) of the Social Security Act to 207.30 serve persons under the age of 65 who are determined to require 207.31 the level of care provided in a nursing home and persons who 207.32 require the level of care provided in a hospital. The 207.33 commissioner shall apply for the home and community-based 207.34 waivers in order to: (i) promote the support of persons with 207.35 disabilities in the most integrated settings; (ii) expand the 207.36 availability of services for persons who are eligible for 208.1 medical assistance; (iii) promote cost-effective options to 208.2 institutional care; and (iv) obtain federal financial 208.3 participation. 208.4 (b) The provision of waivered services to medical 208.5 assistance recipients with disabilities shall comply with the 208.6 requirements outlined in the federally approved applications for 208.7 home and community-based services and subsequent amendments, 208.8 including provision of services according to a service plan 208.9 designed to meet the needs of the individual. For purposes of 208.10 this section, the approved home and community-based application 208.11 is considered the necessary federal requirement. 208.12 (c) The commissioner shall provide interested persons 208.13 serving on agency advisory committees and task forces, and 208.14 others upon request, with notice of, and an opportunity to 208.15 comment on, any changes or amendments to the federally approved 208.16 applications for home and community-based waivers, prior to 208.17 their submission to the federal health care financing 208.18 administration. 208.19 (d) The commissioner shall seek approval, as authorized 208.20 under section 1915(c) of the Social Security Act, to allow 208.21 medical assistance eligibility under this section for children 208.22 under age 21 without deeming of parental income or assets. 208.23 (e) The commissioner shall seek approval, as authorized 208.24 under section 1915(c) of the Social Act, to allow medical 208.25 assistance eligibility under this section for individuals under 208.26 age 65 without deeming the spouse's income or assets. 208.27 Sec. 60. Minnesota Statutes 2000, section 256B.49, is 208.28 amended by adding a subdivision to read: 208.29 Subd. 12. [INFORMED CHOICE.] Persons who are determined 208.30 likely to require the level of care provided in a nursing 208.31 facility or hospital shall be informed of the home and 208.32 community-based support alternatives to the provision of 208.33 inpatient hospital services or nursing facility services. Each 208.34 person must be given the choice of either institutional or home 208.35 and community-based services, using the provisions described in 208.36 section 256B.77, subdivision 2, paragraph (p). 209.1 Sec. 61. Minnesota Statutes 2000, section 256B.49, is 209.2 amended by adding a subdivision to read: 209.3 Subd. 13. [CASE MANAGEMENT.] (a) Each recipient of a home 209.4 and community-based waiver shall be provided case management 209.5 services by qualified vendors as described in the federally 209.6 approved waiver application. The case management service 209.7 activities provided will include: 209.8 (1) assessing the needs of the individual within 20 working 209.9 days of a recipient's request; 209.10 (2) developing the written individual service plan within 209.11 ten working days after the assessment is completed; 209.12 (3) informing the recipient or the recipient's legal 209.13 guardian or conservator of service options; 209.14 (4) assisting the recipient in the identification of 209.15 potential service providers; 209.16 (5) assisting the recipient to access services; 209.17 (6) coordinating, evaluating, and monitoring of the 209.18 services identified in the service plan; 209.19 (7) completing the annual reviews of the service plan; and 209.20 (8) informing the recipient or legal representative of the 209.21 right to have assessments completed and service plans developed 209.22 within specified time periods, and to appeal county action or 209.23 inaction under section 256.045, subdivision 3. 209.24 (b) The case manager may delegate certain aspects of the 209.25 case management service activities to another individual 209.26 provided there is oversight by the case manager. The case 209.27 manager may not delegate those aspects which require 209.28 professional judgment including assessments, reassessments, and 209.29 care plan development. 209.30 Sec. 62. Minnesota Statutes 2000, section 256B.49, is 209.31 amended by adding a subdivision to read: 209.32 Subd. 14. [ASSESSMENT AND REASSESSMENT.] (a) Assessments 209.33 of each recipient's strengths, informal support systems, and 209.34 need for services shall be completed within 20 working days of 209.35 the recipient's request. Reassessment of each recipient's 209.36 strengths, support systems, and need for services shall be 210.1 conducted at least every 12 months and at other times when there 210.2 has been a significant change in the recipient's functioning. 210.3 (b) Persons with mental retardation or a related condition 210.4 who apply for services under the nursing facility level waiver 210.5 programs shall be screened for the appropriate level of care 210.6 according to section 256B.092. 210.7 (c) Recipients who are found eligible for home and 210.8 community-based services under this section before their 65th 210.9 birthday may remain eligible for these services after their 65th 210.10 birthday if they continue to meet all other eligibility factors. 210.11 Sec. 63. Minnesota Statutes 2000, section 256B.49, is 210.12 amended by adding a subdivision to read: 210.13 Subd. 15. [INDIVIDUALIZED SERVICE PLAN.] Each recipient of 210.14 home and community-based waivered services shall be provided a 210.15 copy of the written service plan which: 210.16 (1) is developed and signed by the recipient within ten 210.17 working days of the completion of the assessment; 210.18 (2) meets the assessed needs of the recipient; 210.19 (3) reasonably ensures the health and safety of the 210.20 recipient; 210.21 (4) promotes independence; 210.22 (5) allows for services to be provided in the most 210.23 integrated settings; and 210.24 (6) provides for an informed choice, as defined in section 210.25 256B.77, subdivision 2, paragraph (p), of service and support 210.26 providers. 210.27 Sec. 64. Minnesota Statutes 2000, section 256B.49, is 210.28 amended by adding a subdivision to read: 210.29 Subd. 16. [SERVICES AND SUPPORTS.] (a) Services and 210.30 supports included in the home and community-based waivers for 210.31 persons with disabilities shall meet the requirements set out in 210.32 United States Code, title 42, section 1396n. The services and 210.33 supports, which are offered as alternatives to institutional 210.34 care, shall promote consumer choice, community inclusion, 210.35 self-sufficiency, and self-determination. 210.36 (b) Beginning January 1, 2003, the commissioner shall 211.1 simplify and improve access to home and community-based waivered 211.2 services, to the extent possible, through the establishment of a 211.3 common service menu that is available to eligible recipients 211.4 regardless of age, disability type, or waiver program. 211.5 (c) Consumer directed community support services shall be 211.6 offered as an option to all persons eligible for services under 211.7 section 256B.49, subdivision 11, by January 1, 2002. 211.8 (d) Services and supports shall be arranged and provided 211.9 consistent with individualized written plans of care for 211.10 eligible waiver recipients. 211.11 (e) The state of Minnesota and county agencies that 211.12 administer home and community-based waivered services for 211.13 persons with disabilities, shall not be liable for damages, 211.14 injuries, or liabilities sustained through the purchase of 211.15 supports by the individual, the individual's family, or the 211.16 authorized representative with funds received through the 211.17 consumer-directed community support service under this section. 211.18 Liabilities include but are not limited to: workers' 211.19 compensation liability, the Federal Insurance Contributions Act 211.20 (FICA), or the Federal Unemployment Tax Act (FUTA). 211.21 Sec. 65. Minnesota Statutes 2000, section 256B.49, is 211.22 amended by adding a subdivision to read: 211.23 Subd. 17. [COST OF SERVICES AND SUPPORTS.] (a) The 211.24 commissioner shall ensure that the average per capita 211.25 expenditures estimated in any fiscal year for home and 211.26 community-based waiver recipients does not exceed the average 211.27 per capita expenditures that would have been made to provide 211.28 institutional services for recipients in the absence of the 211.29 waiver. 211.30 (b) The commissioner shall implement on January 1, 2002, 211.31 one or more aggregate, need-based methods for allocating to 211.32 local agencies the home and community-based waivered service 211.33 resources available to support recipients with disabilities in 211.34 need of the level of care provided in a nursing facility or a 211.35 hospital. The commissioner shall allocate resources to single 211.36 counties and county partnerships in a manner that reflects 212.1 consideration of: 212.2 (1) an incentive-based payment process for achieving 212.3 outcomes; 212.4 (2) the need for a state-level risk pool; 212.5 (3) the need for retention of management responsibility at 212.6 the state agency level; and 212.7 (4) a phase-in strategy as appropriate. 212.8 (c) Until the allocation methods described in paragraph (b) 212.9 are implemented, the annual allowable reimbursement level of 212.10 home and community-based waiver services shall be the greater of: 212.11 (1) the statewide average payment amount which the 212.12 recipient is assigned under the waiver reimbursement system in 212.13 place on June 30, 2001, modified by the percentage of any 212.14 provider rate increase appropriated for home and community-based 212.15 services; or 212.16 (2) an amount approved by the commissioner based on the 212.17 recipient's extraordinary needs that cannot be met within the 212.18 current allowable reimbursement level. The increased 212.19 reimbursement level must be necessary to allow the recipient to 212.20 be discharged from an institution or to prevent imminent 212.21 placement in an institution. The additional reimbursement may 212.22 be used to secure environmental modifications; assistive 212.23 technology and equipment; and increased costs for supervision, 212.24 training, and support services necessary to address the 212.25 recipient's extraordinary needs. The commissioner may approve 212.26 an increased reimbursement level for up to one year of the 212.27 recipient's relocation from an institution or up to six months 212.28 of a determination that a current waiver recipient is at 212.29 imminent risk of being placed in an institution. 212.30 (d) Beginning July 1, 2001, medically necessary private 212.31 duty nursing services will be authorized under this section as 212.32 complex and regular care according to section 256B.0627. 212.33 Sec. 66. Minnesota Statutes 2000, section 256B.49, is 212.34 amended by adding a subdivision to read: 212.35 Subd. 18. [PAYMENTS.] The commissioner shall reimburse 212.36 approved vendors from the medical assistance account for the 213.1 costs of providing home and community-based services to eligible 213.2 recipients using the invoice processing procedures of the 213.3 Medicaid management information system (MMIS). Recipients will 213.4 be screened and authorized for services according to the 213.5 federally approved waiver application and its subsequent 213.6 amendments. 213.7 Sec. 67. Minnesota Statutes 2000, section 256B.49, is 213.8 amended by adding a subdivision to read: 213.9 Subd. 19. [HEALTH AND WELFARE.] The commissioner of human 213.10 services shall take the necessary safeguards to protect the 213.11 health and welfare of individuals provided services under the 213.12 waiver. 213.13 Sec. 68. Minnesota Statutes 2000, section 256B.49, is 213.14 amended by adding a subdivision to read: 213.15 Subd. 20. [TRAUMATIC BRAIN INJURY AND RELATED CONDITIONS.] 213.16 The commissioner shall seek to amend the traumatic brain injury 213.17 waiver to include, as eligible persons, individuals with an 213.18 acquired or degenerative disease diagnosis where cognitive 213.19 impairment is present, such as multiple sclerosis. 213.20 Sec. 69. Minnesota Statutes 2000, section 256B.69, 213.21 subdivision 23, is amended to read: 213.22 Subd. 23. [ALTERNATIVE INTEGRATED LONG-TERM CARE SERVICES; 213.23 ELDERLY AND DISABLED PERSONS.] (a) The commissioner may 213.24 implement demonstration projects to create alternative 213.25 integrated delivery systems for acute and long-term care 213.26 services to elderly persons and persons with disabilities as 213.27 defined in section 256B.77, subdivision 7a, that provide 213.28 increased coordination, improve access to quality services, and 213.29 mitigate future cost increases. The commissioner may seek 213.30 federal authority to combine Medicare and Medicaid capitation 213.31 payments for the purpose of such demonstrations. Medicare funds 213.32 and services shall be administered according to the terms and 213.33 conditions of the federal waiver and demonstration provisions. 213.34 For the purpose of administering medical assistance funds, 213.35 demonstrations under this subdivision are subject to 213.36 subdivisions 1 to 22. The provisions of Minnesota Rules, parts 214.1 9500.1450 to 9500.1464, apply to these demonstrations, with the 214.2 exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457, 214.3 subpart 1, items B and C, which do not apply to persons 214.4 enrolling in demonstrations under this section. An initial open 214.5 enrollment period may be provided. Persons who disenroll from 214.6 demonstrations under this subdivision remain subject to 214.7 Minnesota Rules, parts 9500.1450 to 9500.1464. When a person is 214.8 enrolled in a health plan under these demonstrations and the 214.9 health plan's participation is subsequently terminated for any 214.10 reason, the person shall be provided an opportunity to select a 214.11 new health plan and shall have the right to change health plans 214.12 within the first 60 days of enrollment in the second health 214.13 plan. Persons required to participate in health plans under 214.14 this section who fail to make a choice of health plan shall not 214.15 be randomly assigned to health plans under these demonstrations. 214.16 Notwithstanding section 256L.12, subdivision 5, and Minnesota 214.17 Rules, part 9505.5220, subpart 1, item A, if adopted, for the 214.18 purpose of demonstrations under this subdivision, the 214.19 commissioner may contract with managed care organizations, 214.20 including counties, to serve only elderly persons eligible for 214.21 medical assistance, elderly and disabled persons, or disabled 214.22 persons only. For persons with primary diagnoses of mental 214.23 retardation or a related condition, serious and persistent 214.24 mental illness, or serious emotional disturbance, the 214.25 commissioner must ensure that the county authority has approved 214.26 the demonstration and contracting design. Enrollment in these 214.27 projects for persons with disabilities shall be voluntaryuntil214.28July 1, 2001. The commissioner shall not implement any 214.29 demonstration project under this subdivision for persons with 214.30 primary diagnoses of mental retardation or a related condition, 214.31 serious and persistent mental illness, or serious emotional 214.32 disturbance, without approval of the county board of the county 214.33 in which the demonstration is being implemented. 214.34 Before implementation of a demonstration project for 214.35 disabled persons, the commissioner must provide information to 214.36 appropriate committees of the house of representatives and 215.1 senate and must involve representatives of affected disability 215.2 groups in the design of the demonstration projects. 215.3 (b) A nursing facility reimbursed under the alternative 215.4 reimbursement methodology in section 256B.434 may, in 215.5 collaboration with a hospital, clinic, or other health care 215.6 entity provide services under paragraph (a). The commissioner 215.7 shall amend the state plan and seek any federal waivers 215.8 necessary to implement this paragraph. 215.9 Sec. 70. Minnesota Statutes 2000, section 256D.35, is 215.10 amended by adding a subdivision to read: 215.11 Subd. 11a. [INSTITUTION.] "Institution" means: a 215.12 hospital, consistent with Code of Federal Regulations, title 42, 215.13 section 440.10; regional treatment center inpatient services; a 215.14 nursing facility; and an intermediate care facility for persons 215.15 with mental retardation. 215.16 Sec. 71. Minnesota Statutes 2000, section 256D.35, is 215.17 amended by adding a subdivision to read: 215.18 Subd. 18a. [SHELTER COSTS.] "Shelter costs" means: rent, 215.19 manufactured home lot rentals; monthly principal, interest, 215.20 insurance premiums, and property taxes due for mortgages or 215.21 contract for deed costs; costs for utilities, including heating, 215.22 cooling, electricity, water, and sewerage; garbage collection 215.23 fees; and the basic service fee for one telephone. 215.24 Sec. 72. Minnesota Statutes 2000, section 256D.44, 215.25 subdivision 5, is amended to read: 215.26 Subd. 5. [SPECIAL NEEDS.] In addition to the state 215.27 standards of assistance established in subdivisions 1 to 4, 215.28 payments are allowed for the following special needs of 215.29 recipients of Minnesota supplemental aid who are not residents 215.30 of a nursing home, a regional treatment center, or a group 215.31 residential housing facility. 215.32 (a) The county agency shall pay a monthly allowance for 215.33 medically prescribed diets payable under the Minnesota family 215.34 investment program if the cost of those additional dietary needs 215.35 cannot be met through some other maintenance benefit. 215.36 (b) Payment for nonrecurring special needs must be allowed 216.1 for necessary home repairs or necessary repairs or replacement 216.2 of household furniture and appliances using the payment standard 216.3 of the AFDC program in effect on July 16, 1996, for these 216.4 expenses, as long as other funding sources are not available. 216.5 (c) A fee for guardian or conservator service is allowed at 216.6 a reasonable rate negotiated by the county or approved by the 216.7 court. This rate shall not exceed five percent of the 216.8 assistance unit's gross monthly income up to a maximum of $100 216.9 per month. If the guardian or conservator is a member of the 216.10 county agency staff, no fee is allowed. 216.11 (d) The county agency shall continue to pay a monthly 216.12 allowance of $68 for restaurant meals for a person who was 216.13 receiving a restaurant meal allowance on June 1, 1990, and who 216.14 eats two or more meals in a restaurant daily. The allowance 216.15 must continue until the person has not received Minnesota 216.16 supplemental aid for one full calendar month or until the 216.17 person's living arrangement changes and the person no longer 216.18 meets the criteria for the restaurant meal allowance, whichever 216.19 occurs first. 216.20 (e) A fee of ten percent of the recipient's gross income or 216.21 $25, whichever is less, is allowed for representative payee 216.22 services provided by an agency that meets the requirements under 216.23 SSI regulations to charge a fee for representative payee 216.24 services. This special need is available to all recipients of 216.25 Minnesota supplemental aid regardless of their living 216.26 arrangement. 216.27 (f) Notwithstanding the language in this subdivision, an 216.28 amount equal to the maximum allotment authorized by the federal 216.29 Food Stamp Program for a single individual which is in effect on 216.30 the first day of January of the previous year will be added to 216.31 the standards of assistance established in subdivisions 1 to 4 216.32 for individuals under the age of 65 who are relocating from an 216.33 institution and who are shelter needy. An eligible individual 216.34 who receives this benefit prior to age 65 may continue to 216.35 receive the benefit after the age of 65. 216.36 "Shelter needy" means that the assistance unit incurs 217.1 monthly shelter costs that exceed 40 percent of the assistance 217.2 unit's gross income before the application of this special needs 217.3 standard. "Gross income" for the purposes of this section is 217.4 the applicant's or recipient's income as defined in section 217.5 256D.35, subdivision 10, or the standard specified in 217.6 subdivision 3, whichever is greater. A recipient of a federal 217.7 or state housing subsidy, that limits shelter costs to a 217.8 percentage of gross income, shall not be considered shelter 217.9 needy for purposes of this paragraph. 217.10 Sec. 73. Minnesota Statutes 2000, section 256I.05, 217.11 subdivision 1e, is amended to read: 217.12 Subd. 1e. [SUPPLEMENTARY RATE FOR CERTAIN FACILITIES.] 217.13 Notwithstanding the provisions of subdivisions 1a and 1c, 217.14 beginning July 1,19992001, a county agency shall negotiate a 217.15 supplementary rate in addition to the rate specified in 217.16 subdivision 1, equal to25125 percent of the amount specified 217.17 in subdivision 1a, including any legislatively authorized 217.18 inflationary adjustments, for a group residential housing 217.19 provider that: 217.20 (1) is located in Hennepin county and has had a group 217.21 residential housing contract with the county since June 1996; 217.22 (2) operates in three separate locations a56-bed71-bed 217.23 facility,aand two 40-bedfacility, and a 30-bed facility217.24 facilities; and 217.25 (3) serves a chemically dependent clientele, providing 24 217.26 hours per day supervision and limiting a resident's maximum 217.27 length of stay to 13 months out of a consecutive 24-month period. 217.28 Sec. 74. [256I.07] [RESPITE CARE PILOT PROJECT FOR FAMILY 217.29 ADULT FOSTER CARE PROVIDERS.] 217.30 Subdivision 1. [PROGRAM ESTABLISHED.] The state recognizes 217.31 the importance of developing and maintaining quality family 217.32 foster care resources. In order to accomplish that goal, the 217.33 commissioner shall establish a two-year respite care pilot 217.34 project for family adult foster care providers in three 217.35 counties. This pilot project is intended to provide support to 217.36 caregivers of adult foster care residents. The commissioner 218.1 shall establish a pilot project to accomplish the provisions in 218.2 subdivisions 2 to 4. 218.3 Subd. 2. [ELIGIBILITY.] A family adult foster care home 218.4 provider as defined under section 144D.01, subdivision 7, who 218.5 has been licensed for six months is eligible for 30 days of 218.6 respite care per calendar year. In cases of emergency, a county 218.7 social services agency may waive the six-month licensing 218.8 requirement. In order to be eligible to receive respite payment 218.9 from group residential housing and alternative care, a provider 218.10 must take time off away from their foster care residents. 218.11 Subd. 3. [PAYMENT STRUCTURE.] (a) The payment for respite 218.12 care for an adult foster care resident eligible for only group 218.13 residential housing shall be based on the current monthly group 218.14 residential housing base room and board rate and the current 218.15 maximum monthly group residential housing difficulty of care 218.16 rate. 218.17 (b) The payment for respite care for an adult foster care 218.18 resident eligible for alternative care funds shall be based on 218.19 the resident's alternative care foster care rate. 218.20 (c) The payment for respite care for an adult foster care 218.21 resident eligible for Medicaid home and community-based services 218.22 waiver funds shall be based on the group residential housing 218.23 base room and board rate. 218.24 (d) The total amount available to pay for respite care for 218.25 a family adult foster care provider shall be based on the number 218.26 of residents currently served in the foster care home and the 218.27 source of funding used to pay for each resident's foster care. 218.28 Respite care must be paid for on a per diem basis and for a full 218.29 day. 218.30 Subd. 4. [PRIVATE PAY RESIDENTS.] Payment for respite care 218.31 for private pay foster care residents must be arranged between 218.32 the provider and the resident or the resident's family. 218.33 Sec. 75. Laws 1999, chapter 152, section 1, is amended to 218.34 read: 218.35 Section 1. [TASK FORCE.] 218.36 A day training and habilitation task force is established. 219.1 Task force membership shall consist of representatives of the 219.2 commissioner of human services, counties, service consumers, and 219.3 vendors of day training and habilitation as defined in Minnesota 219.4 Statutes, section 252.41, subdivision 9, including at least one 219.5 representative from each association representing day training 219.6 and habilitation vendors. Appointments to the task force shall 219.7 be made by the commissioner of human services and technical 219.8 assistance shall be provided by the department of human services. 219.9 Sec. 76. Laws 1999, chapter 152, section 4, is amended to 219.10 read: 219.11 Sec. 4. [REPORT.] 219.12 The task force shall present a report recommending a new 219.13 payment rate structure to the legislature by January 15, 2000, 219.14 and shall make recommendations to the commissioner of human 219.15 services regarding the implementation of the pilot project for 219.16 the individualized payment rate structure, so the pilot project 219.17 can be implemented by July 1, 2002, as required in section 3. 219.18 The task force expires onMarch 15, 2000December 30, 2003. 219.19 Sec. 77. [DAY TRAINING AND HABILITATION PAYMENT STRUCTURE 219.20 PILOT PROJECT.] 219.21 Subdivision 1. [INDIVIDUALIZED PAYMENT RATE 219.22 STRUCTURE.] Notwithstanding Minnesota Statutes, sections 219.23 252.451, subdivision 5; and 252.46; and Minnesota Rules, part 219.24 9525.1290, subpart 1, items A and B, the commissioner of human 219.25 services shall initiate a pilot project and phase-in for the 219.26 individualized payment rate structure described in this section 219.27 and section 74. The pilot project shall include actual 219.28 transfers of funds, not simulated transfers. The pilot project 219.29 may include all or some of the vendors in up to eight counties, 219.30 with no more than two counties from the seven-county 219.31 Minneapolis-St. Paul metropolitan area. Following initiation of 219.32 the pilot project, the commissioner shall phase in 219.33 implementation of the individualized payment rate structure to 219.34 the remaining counties and vendors according to the 219.35 implementation plan developed by the task force. The pilot and 219.36 phase-in shall not extend over more than 18 months and shall be 220.1 completed by December 31, 2003. 220.2 Subd. 2. [SUNSET.] The pilot project shall sunset upon 220.3 implementation of a new statewide rate structure according to 220.4 the implementation plan developed by the task force described in 220.5 subdivision 3, in its report to the legislature on December 1, 220.6 2001. The rates of vendors participating in the pilot project 220.7 must be modified to be consistent with the new statewide rate 220.8 structure, as implemented. 220.9 Subd. 3. [TASK FORCE RESPONSIBILITIES.] The day training 220.10 and habilitation task force established under Laws 1999, chapter 220.11 152, section 4, shall evaluate the pilot project authorized 220.12 under subdivision 1, and by December 1, 2001, shall report to 220.13 the legislature with an implementation plan, which shall address 220.14 how and when the pilot project individualized payment rate 220.15 structure will be implemented statewide, shall ensure that 220.16 vendors that wish to maintain their current per diem rate may do 220.17 so within the new payment system, and shall identify criteria 220.18 that would halt statewide implementation if vendors or clients 220.19 were adversely affected by the new payment rate structure, and 220.20 with recommendations for any amendments that should be made 220.21 before statewide implementation. These recommendations shall be 220.22 made in a report to the chairs of the house health and human 220.23 services policy and finance committees and the senate health and 220.24 family security committee and finance division. 220.25 Subd. 4. [RATE SETTING.] (a) The rate structure under this 220.26 section is intended to allow a county to authorize an individual 220.27 rate for each client in the vendor's program based on the needs 220.28 and expected outcomes of the individual client. Rates shall be 220.29 based on an authorized package of services for each individual 220.30 over a typical time frame. Rates may be established across 220.31 multiple sites run by a single vendor. 220.32 (b) With county concurrence, a vendor shall establish up to 220.33 four levels of service, A through D, based on the intensity of 220.34 services provided to an individual client of day training and 220.35 habilitation services. Service level A shall be the highest 220.36 intensity of services, marked primarily, but not exclusively, by 221.1 a one-to-one client-to-staff ratio. Service level D shall be 221.2 the lowest intensity of services. The county shall document the 221.3 vendor's description of the type and amount of services 221.4 associated with each service level. 221.5 (c) For each vendor, a county board shall establish a 221.6 dollar value for one hour of service at each of the service 221.7 levels defined in paragraph (b). In establishing these values 221.8 for existing vendors transitioning from the payment rate 221.9 structure under Minnesota Statutes, section 252.46, subdivision 221.10 1, the county board shall follow the formula and guidelines 221.11 developed by the day training and habilitation task force under 221.12 paragraph (e). 221.13 (d) A vendor may elect to maintain a single transportation 221.14 rate or may elect to establish up to five types of 221.15 transportation services: public transportation, public special 221.16 transportation, nonambulatory transportation, out-of-service 221.17 area transportation, and ambulatory transportation. For vendors 221.18 that elect to establish multiple transportation services, the 221.19 county board shall establish a dollar value for a round trip on 221.20 each type of transportation service offered through the vendor. 221.21 With vendor concurrence, the county may also establish a uniform 221.22 one-way trip value for some or all of the transportation service 221.23 types. 221.24 (e) The county board shall ensure that the vendor 221.25 translates the vendor's existing program and transportation 221.26 rates to the rates and values in the pilot project by using the 221.27 conversion calculations for services and transportation approved 221.28 by the day training and habilitation task force established 221.29 under Laws 1999, chapter 152, and included in the task force's 221.30 recommendations to the legislature. The conversion calculation 221.31 may be amended by the task force with the approval of the 221.32 commissioner and any amendments shall become effective upon 221.33 notification to the pilot project counties from the 221.34 commissioner. The calculation shall take the total 221.35 reimbursement dollars available to the vendor and divide by the 221.36 units of service expected at each service level and of each 222.1 transportation type. In determining the total reimbursement 222.2 dollars available to a vendor, the vendor shall multiply the 222.3 vendor's current per diem rate for both services and 222.4 transportation, including any new rate increases, by the 222.5 vendor's actual utilization for the year prior to implementation 222.6 of the pilot project. Vendors shall be allowed to allocate 222.7 available reimbursement dollars between service and 222.8 transportation before the vendor's service level and 222.9 transportation values are calculated. After translating its 222.10 existing service and transportation rates to the service level 222.11 and transportation values under the pilot, the vendor shall 222.12 project its expected reimbursement income using the expected 222.13 service and transportation packages for its existing clients, 222.14 based on current service authorizations. If the projected 222.15 reimbursement income is less than the vendor would have received 222.16 under the payment structure of Minnesota Statutes, section 222.17 252.46, the vendor and the county, with the approval of the 222.18 commissioner, shall adjust the vendor's service level and 222.19 transportation values to eliminate the shortfall. The 222.20 commissioner shall report all adjustments to the day training 222.21 and habilitation task force for consideration of possible 222.22 modifications to the pilot project individualized payment rate 222.23 structure. 222.24 Subd. 5. [INDIVIDUAL RATE AUTHORIZATION.] (a) As part of 222.25 its annual authorization of services for each client under 222.26 Minnesota Statutes, section 252.44, paragraph (a), clause (1), 222.27 and Minnesota Rules, part 9525.0016, subpart 12, the county 222.28 shall authorize and document a service package and a 222.29 transportation package as follows: 222.30 (1) the service package shall include the amount and type 222.31 of services at each applicable service level to be provided to 222.32 the client over a package period. An individual client may 222.33 receive services at multiple service levels over the course of 222.34 the package period. The service package rate shall be the sum 222.35 of the amount of services at each level over the package period, 222.36 multiplied by the dollar value for each service level; 223.1 (2) the transportation package shall include the amount and 223.2 type of transportation services to be provided to the client 223.3 over the package period. The transportation package rate shall 223.4 be the sum of the amount of transportation services, multiplied 223.5 by the dollar value associated with the type of transportation 223.6 service authorized for the client; 223.7 (3) the package period shall be established by the county, 223.8 and may be one week, two weeks, or one month; and 223.9 (4) the individual rate authorization may be reviewed and 223.10 modified by the county at any time and must be reviewed and 223.11 reauthorized by the county at least annually. 223.12 (b) For vendors with rates established under this section, 223.13 a service day under Minnesota Statutes, sections 245B.06 and 223.14 252.44, includes any day in which a client receives any 223.15 reimbursable service from a vendor or attends employment 223.16 arranged by the vendor. 223.17 Subd. 6. [BILLING FOR SERVICES.] The vendor shall bill 223.18 for, and shall be reimbursed for, the service package rate and 223.19 transportation package rate for the package period as authorized 223.20 by the county for each client in the vendor's program. The 223.21 length of the package period shall not affect the timing or 223.22 frequency of vendors' submissions of claims for payment under 223.23 the Medicaid Management Information System II (MMIS) or its 223.24 successors. 223.25 Subd. 7. [NOTIFICATION OF CHANGE IN CLIENT NEEDS.] The 223.26 vendor shall notify an individual client's case manager if the 223.27 vendor has knowledge of a material change in the client's needs 223.28 that may indicate a need for a change in service authorization. 223.29 Factors that would require such notice include, but are not 223.30 limited to, significant changes in medical status, residential 223.31 placement, attendance patterns, behavioral needs, or skill 223.32 functioning. The vendor shall notify the case manager as soon 223.33 as possible but no later than 30 calendar days after becoming 223.34 aware of the change in needs. The service authorization for the 223.35 client shall not change until the county authorizes a new 223.36 service and transportation package for the client in accordance 224.1 with the provisions in Minnesota Statutes, section 256B.092. 224.2 Sec. 78. [COUNTY BOARD RESPONSIBILITIES.] 224.3 For each vendor with rates established under section 73, 224.4 the county board shall document the vendor's description of the 224.5 type and amount of services associated with each service level, 224.6 the vendor's service level values, the vendor's transportation 224.7 values, and the package period that will be used to determine 224.8 the rate for each individual client. The county shall establish 224.9 a package period of one week, two weeks, or one month. 224.10 Sec. 79. [STUDY OF DAY TRAINING AND HABILITATION VENDOR 224.11 RATES.] 224.12 The commissioner shall identify the vendors with the lowest 224.13 rates or underfunded programs in the state and make 224.14 recommendations to reconcile the discrepancies prior to the 224.15 implementation of the individualized payment rate structure 224.16 described in sections 73 and 74. 224.17 Sec. 80. [FEDERAL APPROVAL.] 224.18 The commissioner shall seek any amendments to the state 224.19 Medicaid plan and any waivers necessary to permit implementation 224.20 of section 74 within the timelines specified. 224.21 Sec. 81. [SEMI-INDEPENDENT LIVING SERVICES (SILS) STUDY.] 224.22 The commissioner of human services, in consultation with 224.23 county representatives and other interested persons, shall 224.24 develop recommendations revising the funding methodology for 224.25 SILS as defined in Minnesota Statutes, section 252.275, 224.26 subdivisions 3, 4, 4a, 4b, and 4c, and report by January 15, 224.27 2002, to the chair of the house of representatives health and 224.28 human services finance committee and the chairs of the senate 224.29 health, human services, and corrections budget division. 224.30 Sec. 82. [WAIVER REQUEST REGARDING SPOUSAL INCOME.] 224.31 By September 1, 2001, the commissioner of human services 224.32 shall seek federal approval to allow recipients of home and 224.33 community-based waivers authorized under Minnesota Statutes, 224.34 section 256B.49, to choose either a waiver of deeming of spousal 224.35 income or the spousal impoverishment protections authorized 224.36 under United States Code, title 42, section 1396r-5, with the 225.1 addition of the group residential housing rate set according to 225.2 Minnesota Statutes, section 256I.03, subdivision 5, to the 225.3 personal needs allowance authorized by Minnesota Statutes, 225.4 section 256B.0575. 225.5 Sec. 83. [PROGRAM OPTIONS FOR CERTAIN PERSONS WITH 225.6 DEVELOPMENTAL DISABILITIES.] 225.7 (a) The commissioner of human services shall ensure that 225.8 services continue to be available to persons with developmental 225.9 disabilities who were covered by social services supplemental 225.10 grants prior to July 1, 2001. Services shall be provided in 225.11 priority order as follows: 225.12 (1) to the extent possible, the commissioner shall 225.13 establish for these persons targeted slots under the home and 225.14 community-based waivered services program for persons with 225.15 mental retardation or related conditions; 225.16 (2) persons accommodated under clause (1) shall, if 225.17 eligible, receive room and board services through group 225.18 residential housing under Minnesota Statutes, chapter 256I; and 225.19 (3) any remaining persons shall continue to receive 225.20 services through community social services supplemental grants 225.21 to the affected counties. 225.22 (b) This section applies only to individuals receiving 225.23 services under social services supplemental grants as of June 225.24 30, 2001. 225.25 Sec. 84. [FEDERAL APPROVAL.] 225.26 The commissioner of human services, by September 1, 2001, 225.27 shall request any federal approval and plan amendments necessary 225.28 to implement the choice of case manager provision in section 225.29 256B.092, subdivision 2a, paragraph (b). 225.30 Sec. 85. [FEDERAL WAIVER REQUESTS.] 225.31 The commissioner of human services shall submit to the 225.32 federal Health Care Financing Administration by September 1, 225.33 2001, a request for a home and community-based services waiver 225.34 for day services, including: community inclusion, supported 225.35 employment, and day training and habilitation services defined 225.36 in Minnesota Statutes, section 252.41, subdivision 3, clause 226.1 (1), for persons eligible for the waiver under Minnesota 226.2 Statutes, section 256B.092. 226.3 Sec. 86. [REPEALER.] 226.4 (a) Minnesota Statutes 2000, sections 256B.0951, 226.5 subdivision 6; and 256E.06, subdivision 2b, are repealed. 226.6 (b) Minnesota Statutes 2000, sections 145.9245; 256.476, 226.7 subdivision 7; 256B.0912; 256B.0915, subdivisions 3a, 3b, and 226.8 3c; and 256B.49, subdivisions 1, 2, 3, 4, 5, 6, 7, 8, 9, and 10, 226.9 are repealed. 226.10 (c) Laws 1995, chapter 178, article 2, section 48, 226.11 subdivision 6, is repealed. 226.12 (d) Minnesota Rules, parts 9505.2455; 9505.2458; 9505.2460; 226.13 9505.2465; 9505.2470; 9505.2473; 9505.2475; 9505.2480; 226.14 9505.2485; 9505.2486; 9505.2490; 9505.2495; 9505.2496; 226.15 9505.2500; 9505.3010; 9505.3015; 9505.3020; 9505.3025; 226.16 9505.3030; 9505.3035; 9505.3040; 9505.3065; 9505.3085; 226.17 9505.3135; 9505.3500; 9505.3510; 9505.3520; 9505.3530; 226.18 9505.3535; 9505.3540; 9505.3545; 9505.3550; 9505.3560; 226.19 9505.3570; 9505.3575; 9505.3580; 9505.3585; 9505.3600; 226.20 9505.3610; 9505.3620; 9505.3622; 9505.3624; 9505.3626; 226.21 9505.3630; 9505.3635; 9505.3640; 9505.3645; 9505.3650; 226.22 9505.3660; and 9505.3670, are repealed. 226.23 ARTICLE 4 226.24 CONSUMER INFORMATION AND ASSISTANCE 226.25 AND COMMUNITY-BASED CARE 226.26 Section 1. [144A.35] [EXPANSION OF BED DISTRIBUTION STUDY 226.27 AND CREATION OF CRITICAL ACCESS SITES.] 226.28 Subdivision 1. [OLDER ADULT SERVICES DISTRIBUTION 226.29 STUDY.] The commissioner of health, in coordination with the 226.30 commissioner of human services, shall monitor and analyze the 226.31 distribution of older adult services, including, but not limited 226.32 to, nursing home beds, senior housing, housing with services 226.33 units, and home and community-based services in the different 226.34 geographic areas of the state. The study shall include an 226.35 analysis of the impact of amendments to the nursing home 226.36 moratorium law which would allow for transfers of nursing home 227.1 beds within the state. The commissioner of health shall submit 227.2 to the legislature, beginning January 15, 2002, and each January 227.3 15 thereafter, an assessment of the distribution of long-term 227.4 health care services by geographic area, with particular 227.5 attention to service deficits or problems, the designation of 227.6 critical access service sites, and corrective action plans. 227.7 Subd. 2. [CRITICAL ACCESS SERVICE SITE.] "Critical access 227.8 service site" shall include nursing homes, senior housing, 227.9 housing with services, and home and community-based services 227.10 that are certified by the state as necessary providers of health 227.11 care services to a specific geographic area. For purposes of 227.12 this requirement, a "necessary provider of health care services" 227.13 is a provider that is: 227.14 (1) located more than 20 miles, defined as official mileage 227.15 as reported by the Minnesota department of transportation, from 227.16 the next nearest long-term health care provider; 227.17 (2) the sole long-term health care provider in the county; 227.18 or 227.19 (3) a long-term health care provider located in a medically 227.20 underserved area or health professional shortage area. 227.21 Subd. 3. [IDENTIFICATION OF CRITICAL ACCESS SERVICE 227.22 SITES.] Based on the results of the analysis completed in 227.23 subdivision 1, the commissioners of health and human services 227.24 shall identify and designate long-term health care providers as 227.25 critical access service sites. 227.26 Subd. 4. [CRITICAL ACCESS SERVICE SITES.] The commissioner 227.27 of health, in consultation with the commissioner of human 227.28 services, shall: 227.29 (1) develop and implement specific waivers to regulations 227.30 governing health care personnel scope of duties, physical plant 227.31 requirements, and location of community-based services, to 227.32 address critical access service site older adult service needs; 227.33 (2) identify payment barriers to the continued operation of 227.34 older adult services in critical access service sites, and 227.35 provide recommendations on changes to reimbursement rates to 227.36 facilitate the continued operation of these services. 228.1 Sec. 2. Minnesota Statutes 2000, section 256.973, is 228.2 amended by adding a subdivision to read: 228.3 Subd. 6. [GRANTS FOR HOME-SHARING PROGRAMS.] Grants 228.4 awarded for home-sharing programs under this section shall be 228.5 awarded through a request for proposals process every two years 228.6 according to criteria developed by the commissioner. In 228.7 awarding grants, the commissioner shall not give priority to an 228.8 applicant solely because the applicant has previously received a 228.9 grant under this section. Nothing under this subdivision shall 228.10 prohibit the commissioner from evaluating the performance of a 228.11 home-sharing program receiving a grant under this section and 228.12 allocating funds based on the evaluation. 228.13 Sec. 3. Minnesota Statutes 2000, section 256.975, is 228.14 amended by adding a subdivision to read: 228.15 Subd. 7. [CONSUMER INFORMATION AND ASSISTANCE; SENIOR 228.16 LINKAGE.] (a) The Minnesota board on aging shall operate a 228.17 statewide information and assistance service to aid older 228.18 Minnesotans and their families in making informed choices about 228.19 long-term care options and health care benefits. Language 228.20 services to persons with limited English language skills may be 228.21 made available. The service, known as Senior LinkAge Line, must 228.22 be available during business hours through a statewide toll-free 228.23 number and must also be available through the Internet. 228.24 (b) The service must assist older adults, caregivers, and 228.25 providers in accessing information about choices in long-term 228.26 care services that are purchased through private providers or 228.27 available through public options. The service must: 228.28 (1) develop a comprehensive database that includes detailed 228.29 listings in both consumer- and provider-oriented formats; 228.30 (2) make the database accessible on the Internet and 228.31 through other telecommunication and media-related tools; 228.32 (3) link callers to interactive long-term care screening 228.33 tools and make these tools available through the Internet by 228.34 integrating the tools with the database; 228.35 (4) develop community education materials with a focus on 228.36 planning for long-term care and evaluating independent living, 229.1 housing, and service options; 229.2 (5) conduct an outreach campaign to assist older adults and 229.3 their caregivers in finding information on the Internet and 229.4 through other means of communication; 229.5 (6) implement a messaging system for overflow callers and 229.6 respond to these callers by the next business day; 229.7 (7) link callers with county human services and other 229.8 providers to receive more in-depth assistance and consultation 229.9 related to long-term care options; and 229.10 (8) link callers with quality profiles for nursing 229.11 facilities and other providers developed by the commissioner of 229.12 health. 229.13 (c) The Minnesota board on aging shall conduct an 229.14 evaluation of the effectiveness of the statewide information and 229.15 assistance, and submit this evaluation to the legislature by 229.16 December 1, 2002. The evaluation must include an analysis of 229.17 funding adequacy, gaps in service delivery, continuity in 229.18 information between the service and identified linkages, and 229.19 potential use of private funding to enhance the service. 229.20 Sec. 4. [256.9754] [COMMUNITY SERVICES DEVELOPMENT GRANTS 229.21 PROGRAM.] 229.22 Subdivision 1. [DEFINITIONS.] For purposes of this 229.23 section, the following terms have the meanings given. 229.24 (a) "Community" means a town, township, city, or targeted 229.25 neighborhood within a city, or a consortium of towns, townships, 229.26 cities, or targeted neighborhoods within cities. 229.27 (b) "Older adult services" means any services available 229.28 under the elderly waiver program or alternative care grant 229.29 programs; nursing facility services; transportation services; 229.30 respite services; and other community-based services identified 229.31 as necessary either to maintain lifestyle choices for older 229.32 Minnesotans, or to promote independence. 229.33 (c) "Older adult" refers to individuals 65 years of age and 229.34 older. 229.35 Subd. 2. [CREATION.] The community services development 229.36 grants program is created under the administration of the 230.1 commissioner of human services. 230.2 Subd. 3. [PROVISION OF GRANTS.] The commissioner shall 230.3 make grants available to communities, providers of older adult 230.4 services identified in subdivision 1, or to a consortium of 230.5 providers of older adult services, to establish older adult 230.6 services. Grants may be provided for capital and other costs 230.7 including, but not limited to, start-up and training costs, 230.8 equipment, and supplies related to older adult services or other 230.9 residential or service alternatives to nursing facility care. 230.10 Grants may also be made to renovate current buildings, provide 230.11 transportation services, fund programs that would allow older 230.12 adults or disabled individuals to stay in their own homes by 230.13 sharing a home, fund programs that coordinate and manage formal 230.14 and informal services to older adults in their homes to enable 230.15 them to live as independently as possible in their own homes as 230.16 an alternative to nursing home care, or expand state-funded 230.17 programs in the area. 230.18 Subd. 4. [ELIGIBILITY.] Grants may be awarded only to 230.19 communities and providers or to a consortium of providers that 230.20 have a local match of 50 percent of the costs for the project in 230.21 the form of donations, local tax dollars, in-kind donations, 230.22 fundraising, or other local matches. 230.23 Subd. 5. [GRANT PREFERENCE.] The commissioner of human 230.24 services may award grants to the extent grant funds are 230.25 available and to the extent applications are approved by the 230.26 commissioner. Denial of approval of an application in one year 230.27 does not preclude submission of an application in a subsequent 230.28 year. The maximum grant amount is limited to $750,000. 230.29 Sec. 5. Minnesota Statutes 2000, section 256B.0911, 230.30 subdivision 1, is amended to read: 230.31 Subdivision 1. [PURPOSE AND GOAL.] (a) The purpose ofthe230.32preadmission screening programlong-term care consultation 230.33 services is to assist persons with long-term or chronic care 230.34 needs in making long-term care decisions and selecting options 230.35 that meet their needs and reflect their preferences. The 230.36 availability of, and access to, information and other types of 231.1 assistance is also intended to prevent or delay certified 231.2 nursing facility placementsby assessing applicants and231.3residents and offering cost-effective alternatives appropriate231.4for the person's needsand to provide transition assistance 231.5 after admission. Further, the goal ofthe programthese 231.6 services is to contain costs associated with unnecessary 231.7 certified nursing facility admissions. The commissioners of 231.8 human services and health shall seek to maximize use of 231.9 available federal and state funds and establish the broadest 231.10 program possible within the funding available. 231.11 (b) These services must be coordinated with services 231.12 provided under sections 256.975, subdivision 7, and 256.9772, 231.13 and with services provided by other public and private agencies 231.14 in the community to offer a variety of cost-effective 231.15 alternatives to persons with disabilities and elderly persons. 231.16 The county agency providing long-term care consultation services 231.17 shall encourage the use of volunteers from families, religious 231.18 organizations, social clubs, and similar civic and service 231.19 organizations to provide community-based services. 231.20 Sec. 6. Minnesota Statutes 2000, section 256B.0911, is 231.21 amended by adding a subdivision to read: 231.22 Subd. 1a. [DEFINITIONS.] For purposes of this section, the 231.23 following definitions apply: 231.24 (a) "Long-term care consultation services" means: 231.25 (1) providing information and education to the general 231.26 public regarding availability of the services authorized under 231.27 this section; 231.28 (2) an intake process that provides access to the services 231.29 described in this section; 231.30 (3) assessment of the health, psychological, and social 231.31 needs of referred individuals; 231.32 (4) assistance in identifying services needed to maintain 231.33 an individual in the least restrictive environment; 231.34 (5) providing recommendations on cost-effective community 231.35 services that are available to the individual; 231.36 (6) development of an individual's community support plan; 232.1 (7) providing information regarding eligibility for 232.2 Minnesota health care programs; 232.3 (8) preadmission screening to determine the need for a 232.4 nursing facility level of care; 232.5 (9) preliminary determination of Minnesota health care 232.6 programs eligibility for individuals who need a nursing facility 232.7 level of care, with appropriate referrals for final 232.8 determination; 232.9 (10) providing recommendations for nursing facility 232.10 placement when there are no cost-effective community services 232.11 available; and 232.12 (11) assistance to transition people back to community 232.13 settings after facility admission. 232.14 (b) "Minnesota health care programs" means the medical 232.15 assistance program under chapter 256B, the alternative care 232.16 program under section 256B.0913, and the prescription drug 232.17 program under section 256.955. 232.18 Sec. 7. Minnesota Statutes 2000, section 256B.0911, 232.19 subdivision 3, is amended to read: 232.20 Subd. 3. [PERSONS RESPONSIBLE FOR CONDUCTING THE232.21PREADMISSION SCREENINGLONG-TERM CARE CONSULTATION TEAM.] (a) A 232.22local screeninglong-term care consultation team shall be 232.23 established by the county board of commissioners. Each local 232.24screeningconsultation team shall consist ofscreeners who are a232.25 at least one social worker andaat least one public health 232.26 nurse from their respective county agencies. The board may 232.27 designate public health or social services as the lead agency 232.28 for long-term care consultation services. If a county does not 232.29 have a public health nurse available, it may request approval 232.30 from the commissioner to assign a county registered nurse with 232.31 at least one year experience in home care to participate on the 232.32 team.The screening team members must confer regarding the most232.33appropriate care for each individual screened.Two or more 232.34 counties may collaborate to establish a joint localscreening232.35 consultation team or teams. 232.36 (b)In assessing a person's needs, screeners shall have a233.1physician available for consultation and shall consider the233.2assessment of the individual's attending physician, if any. The233.3individual's physician shall be included if the physician233.4chooses to participate. Other personnel may be included on the233.5team as deemed appropriate by the county agencies.The team is 233.6 responsible for providing long-term care consultation services 233.7 to all persons located in the county who request the services, 233.8 regardless of eligibility for Minnesota health care programs. 233.9 Sec. 8. Minnesota Statutes 2000, section 256B.0911, is 233.10 amended by adding a subdivision to read: 233.11 Subd. 3a. [ASSESSMENT AND SUPPORT PLANNING.] (a) Persons 233.12 requesting assessment, services planning, or other assistance 233.13 intended to support community-based living must be visited by a 233.14 long-term care consultation team within ten working days after 233.15 the date on which an assessment was requested or recommended. 233.16 Assessments must be conducted according to paragraphs (b) to (g). 233.17 (b) The county may utilize a team of either the social 233.18 worker or public health nurse, or both, to conduct the 233.19 assessment in a face-to-face interview. The consultation team 233.20 members must confer regarding the most appropriate care for each 233.21 individual screened or assessed. 233.22 (c) The long-term care consultation team must assess the 233.23 health and social needs of the person, using an assessment form 233.24 provided by the commissioner of human services. 233.25 (d) The team must conduct the assessment in a face-to-face 233.26 interview with the person being assessed and the person's legal 233.27 representative, if applicable. 233.28 (e) The team must provide the person, or the person's legal 233.29 representative, with written recommendations for facility- or 233.30 community-based services. The team must document that the most 233.31 cost-effective alternatives available were offered to the 233.32 individual. For purposes of this requirement, "cost-effective 233.33 alternatives" means community services and living arrangements 233.34 that cost the same as or less than nursing facility care. 233.35 (f) If the person chooses to use community-based services, 233.36 the team must provide the person or the person's legal 234.1 representative with a written community support plan, regardless 234.2 of whether the individual is eligible for Minnesota health care 234.3 programs. The person may request assistance in developing a 234.4 community support plan without participating in a complete 234.5 assessment. 234.6 (g) The team must give the person receiving assessment or 234.7 support planning, or the person's legal representative, 234.8 materials supplied by the commissioner of human services 234.9 containing the following information: 234.10 (1) the purpose of preadmission screening and assessment; 234.11 (2) information about Minnesota health care programs; 234.12 (3) the person's freedom to accept or reject the 234.13 recommendations of the team; 234.14 (4) the person's right to confidentiality under the 234.15 Minnesota Government Data Practices Act, chapter 13; and 234.16 (5) the person's right to appeal the decision regarding the 234.17 need for nursing facility level of care or the county's final 234.18 decisions regarding public programs eligibility according to 234.19 section 256.045, subdivision 3. 234.20 Sec. 9. Minnesota Statutes 2000, section 256B.0911, is 234.21 amended by adding a subdivision to read: 234.22 Subd. 3b. [TRANSITION ASSISTANCE.] (a) A long-term care 234.23 consultation team shall provide assistance to persons residing 234.24 in a nursing facility, hospital, regional treatment center, or 234.25 intermediate care facility for persons with mental retardation 234.26 who request or are referred for such assistance. Transition 234.27 assistance must include assessment, community support plan 234.28 development, referrals to Minnesota health care programs, and 234.29 referrals to programs that provide assistance with housing. 234.30 (b) The county shall develop transition processes with 234.31 institutional social workers and discharge planners to ensure 234.32 that: 234.33 (1) persons admitted to facilities receive information 234.34 about transition assistance that is available; 234.35 (2) the assessment is completed for persons within ten 234.36 working days of the date of request or recommendation for 235.1 assessment; and 235.2 (3) there is a plan for transition and follow-up for the 235.3 individual's return to the community. The plan must require 235.4 notification of other local agencies when a person who may 235.5 require assistance is screened by one county for admission to a 235.6 facility located in another county. 235.7 (c) If a person who is eligible for a Minnesota health care 235.8 program is admitted to a nursing facility, the nursing facility 235.9 must include a consultation team member or the case manager in 235.10 the discharge planning process. 235.11 Sec. 10. Minnesota Statutes 2000, section 256B.0911, is 235.12 amended by adding a subdivision to read: 235.13 Subd. 4a. [PREADMISSION SCREENING ACTIVITIES RELATED TO 235.14 NURSING FACILITY ADMISSIONS.] (a) All applicants to Medicaid 235.15 certified nursing facilities, including certified boarding care 235.16 facilities, must be screened prior to admission regardless of 235.17 income, assets, or funding sources for nursing facility care, 235.18 except as described in subdivision 4b. The purpose of the 235.19 screening is to determine the need for nursing facility level of 235.20 care as described in paragraph (d) and to complete activities 235.21 required under federal law related to mental illness and mental 235.22 retardation as outlined in paragraph (b). 235.23 (b) A person who has a diagnosis or possible diagnosis of 235.24 mental illness, mental retardation, or a related condition must 235.25 receive a preadmission screening before admission regardless of 235.26 the exemptions outlined in subdivision 4b, paragraph (b), to 235.27 identify the need for further evaluation and specialized 235.28 services, unless the admission prior to screening is authorized 235.29 by the local mental health authority or the local developmental 235.30 disabilities case manager, or unless authorized by the county 235.31 agency according to Public Law Number 100-508. 235.32 The following criteria apply to the preadmission screening: 235.33 (1) the county must use forms and criteria developed by the 235.34 commissioner of human services to identify persons who require 235.35 referral for further evaluation and determination of the need 235.36 for specialized services; and 236.1 (2) the evaluation and determination of the need for 236.2 specialized services must be done by: 236.3 (i) a qualified independent mental health professional, for 236.4 persons with a primary or secondary diagnosis of a serious 236.5 mental illness; or 236.6 (ii) a qualified mental retardation professional, for 236.7 persons with a primary or secondary diagnosis of mental 236.8 retardation or related conditions. For purposes of this 236.9 requirement, a qualified mental retardation professional must 236.10 meet the standards for a qualified mental retardation 236.11 professional under Code of Federal Regulations, title 42, 236.12 section 483.430. 236.13 (c) The local county mental health authority or the state 236.14 mental retardation authority under Public Laws Numbers 100-203 236.15 and 101-508 may prohibit admission to a nursing facility if the 236.16 individual does not meet the nursing facility level of care 236.17 criteria or needs specialized services as defined in Public Laws 236.18 Numbers 100-203 and 101-508. For purposes of this section, 236.19 "specialized services" for a person with mental retardation or a 236.20 related condition means active treatment as that term is defined 236.21 under Code of Federal Regulations, title 42, section 483.440, 236.22 paragraph (a), clause (1). 236.23 (d) The determination of the need for nursing facility 236.24 level of care must be made according to criteria developed by 236.25 the commissioner of human services. In assessing a person's 236.26 needs, consultation team members shall have a physician 236.27 available for consultation and shall consider the assessment of 236.28 the individual's attending physician, if any. The individual's 236.29 physician must be included if the physician chooses to 236.30 participate. Other personnel may be included on the team as 236.31 deemed appropriate by the county. 236.32 Sec. 11. Minnesota Statutes 2000, section 256B.0911, is 236.33 amended by adding a subdivision to read: 236.34 Subd. 4b. [EXEMPTIONS AND EMERGENCY ADMISSIONS.] (a) 236.35 Exemptions from the federal screening requirements outlined in 236.36 subdivision 4a, paragraphs (b) and (c), are limited to: 237.1 (1) a person who, having entered an acute care facility 237.2 from a certified nursing facility, is returning to a certified 237.3 nursing facility; and 237.4 (2) a person transferring from one certified nursing 237.5 facility in Minnesota to another certified nursing facility in 237.6 Minnesota. 237.7 (b) Persons who are exempt from preadmission screening for 237.8 purposes of level of care determination include: 237.9 (1) persons described in paragraph (a); 237.10 (2) an individual who has a contractual right to have 237.11 nursing facility care paid for indefinitely by the veterans' 237.12 administration; 237.13 (3) an individual enrolled in a demonstration project under 237.14 section 256B.69, subdivision 8, at the time of application to a 237.15 nursing facility; 237.16 (4) an individual currently being served under the 237.17 alternative care program or under a home and community-based 237.18 services waiver authorized under section 1915(c) of the federal 237.19 Social Security Act; and 237.20 (5) individuals admitted to a certified nursing facility 237.21 for a short-term stay, which is expected to be 14 days or less 237.22 in duration based upon a physician's certification, and who have 237.23 been assessed and approved for nursing facility admission within 237.24 the previous six months. This exemption applies only if the 237.25 consultation team member determines at the time of the initial 237.26 assessment of the six-month period that it is appropriate to use 237.27 the nursing facility for short-term stays and that there is an 237.28 adequate plan of care for return to the home or community-based 237.29 setting. If a stay exceeds 14 days, the individual must be 237.30 referred no later than the first county working day following 237.31 the 14th resident day for a screening, which must be completed 237.32 within five working days of the referral. The payment 237.33 limitations in subdivision 7 apply to an individual found at 237.34 screening to not meet the level of care criteria for admission 237.35 to a certified nursing facility. 237.36 (c) Persons admitted to a Medicaid-certified nursing 238.1 facility from the community on an emergency basis as described 238.2 in paragraph (d) or from an acute care facility on a nonworking 238.3 day must be screened the first working day after admission. 238.4 (d) Emergency admission to a nursing facility prior to 238.5 screening is permitted when all of the following conditions are 238.6 met: 238.7 (1) a person is admitted from the community to a certified 238.8 nursing or certified boarding care facility during county 238.9 nonworking hours; 238.10 (2) a physician has determined that delaying admission 238.11 until preadmission screening is completed would adversely affect 238.12 the person's health and safety; 238.13 (3) there is a recent precipitating event that precludes 238.14 the client from living safely in the community, such as 238.15 sustaining an injury, sudden onset of acute illness, or a 238.16 caregiver's inability to continue to provide care; 238.17 (4) the attending physician has authorized the emergency 238.18 placement and has documented the reason that the emergency 238.19 placement is recommended; and 238.20 (5) the county is contacted on the first working day 238.21 following the emergency admission. 238.22 Transfer of a patient from an acute care hospital to a nursing 238.23 facility is not considered an emergency except for a person who 238.24 has received hospital services in the following situations: 238.25 hospital admission for observation, care in an emergency room 238.26 without hospital admission, or following hospital 24-hour bed 238.27 care. 238.28 Sec. 12. Minnesota Statutes 2000, section 256B.0911, is 238.29 amended by adding a subdivision to read: 238.30 Subd. 4c. [SCREENING REQUIREMENTS.] (a) A person may be 238.31 screened for nursing facility admission by telephone or in a 238.32 face-to-face screening interview. Consultation team members 238.33 shall identify each individual's needs using the following 238.34 categories: 238.35 (1) the person needs no face-to-face screening interview to 238.36 determine the need for nursing facility level of care based on 239.1 information obtained from other health care professionals; 239.2 (2) the person needs an immediate face-to-face screening 239.3 interview to determine the need for nursing facility level of 239.4 care and complete activities required under subdivision 4a; or 239.5 (3) the person may be exempt from screening requirements as 239.6 outlined in subdivision 4b, but will need transitional 239.7 assistance after admission or in-person follow-along after a 239.8 return home. 239.9 (b) Persons admitted on a nonemergency basis to a 239.10 Medicaid-certified nursing facility must be screened prior to 239.11 admission. 239.12 (c) The long-term care consultation team shall recommend a 239.13 case mix classification for persons admitted to a certified 239.14 nursing facility when sufficient information is received to make 239.15 that classification. The nursing facility is authorized to 239.16 conduct all case mix assessments for persons who have been 239.17 screened prior to admission for whom the county did not 239.18 recommend a case mix classification. The nursing facility is 239.19 authorized to conduct all case mix assessments for persons 239.20 admitted to the facility prior to a preadmission screening. The 239.21 county retains the responsibility of distributing appropriate 239.22 case mix forms to the nursing facility. 239.23 (d) The county screening or intake activity must include 239.24 processes to identify persons who may require transition 239.25 assistance as described in subdivision 3b. 239.26 Sec. 13. Minnesota Statutes 2000, section 256B.0911, 239.27 subdivision 5, is amended to read: 239.28 Subd. 5. [SIMPLIFICATION OF FORMSADMINISTRATIVE 239.29 ACTIVITY.] The commissioner shall minimize the number of forms 239.30 required in thepreadmission screening processprovision of 239.31 long-term care consultation services and shall limit the 239.32 screening document to items necessary forcarecommunity support 239.33 plan approval, reimbursement, program planning, evaluation, and 239.34 policy development. 239.35 Sec. 14. Minnesota Statutes 2000, section 256B.0911, 239.36 subdivision 6, is amended to read: 240.1 Subd. 6. [PAYMENT FORPREADMISSION SCREENINGLONG-TERM 240.2 CARE CONSULTATION SERVICES.] (a) The totalscreeningpayment for 240.3 each county must be paid monthly by certified nursing facilities 240.4 in the county. The monthly amount to be paid by each nursing 240.5 facility for each fiscal year must be determined by dividing the 240.6 county's annual allocation forscreeningslong-term care 240.7 consultation services by 12 to determine the monthly payment and 240.8 allocating the monthly payment to each nursing facility based on 240.9 the number of licensed beds in the nursing facility. Payments 240.10 to counties in which there is no certified nursing facility must 240.11 be made by increasing the payment rate of the two facilities 240.12 located nearest to the county seat. 240.13 (b) The commissioner shall include the total annual payment 240.14for screeningdetermined under paragraph (a) for each nursing 240.15 facility according to section 256B.431, subdivision 2b, 240.16 paragraph (g), 256B.434, or 256B.435. 240.17 (c) Payments forscreening activitieslong-term care 240.18 consultation services are available to the county or counties to 240.19 cover staff salaries and expenses to provide thescreening240.20functionservices described in subdivision 1a. Thelead agency240.21 county shall employ, or contract with other agencies to employ, 240.22 within the limits of available funding, sufficient personnel 240.23 toconduct the preadmission screening activityprovide long-term 240.24 care consultation services while meeting the state's long-term 240.25 care outcomes and objectives as defined in section 256B.0917, 240.26 subdivision 1. Thelocal agencycounty shall be accountable for 240.27 meeting local objectives as approved by the commissioner in the 240.28 CSSA biennial plan. 240.29 (d) Notwithstanding section 256B.0641, overpayments 240.30 attributable to payment of the screening costs under the medical 240.31 assistance program may not be recovered from a facility. 240.32 (e) The commissioner of human services shall amend the 240.33 Minnesota medical assistance plan to include reimbursement for 240.34 the localscreeningconsultation teams. 240.35 (f) The county may bill, as case management services, 240.36 assessments, support planning, and follow-along provided to 241.1 persons determined to be eligible for case management under 241.2 Minnesota health care programs. No individual or family member 241.3 shall be charged for an initial assessment or initial support 241.4 plan development provided under subdivision 3a or 3b. 241.5 Sec. 15. Minnesota Statutes 2000, section 256B.0911, 241.6 subdivision 7, is amended to read: 241.7 Subd. 7. [REIMBURSEMENT FOR CERTIFIED NURSING FACILITIES.] 241.8 (a) Medical assistance reimbursement for nursing facilities 241.9 shall be authorized for a medical assistance recipient only if a 241.10 preadmission screening has been conducted prior to admission or 241.11 thelocalcountyagencyhas authorized an exemption. Medical 241.12 assistance reimbursement for nursing facilities shall not be 241.13 provided for any recipient who the local screener has determined 241.14 does not meet the level of care criteria for nursing facility 241.15 placement or, if indicated, has not had a level IIPASARROBRA 241.16 evaluation as required under the federal Omnibus Reconciliation 241.17 Act of 1987 completed unless an admission for a recipient with 241.18 mental illness is approved by the local mental health authority 241.19 or an admission for a recipient with mental retardation or 241.20 related condition is approved by the state mental retardation 241.21 authority. 241.22 (b) The nursing facility must not bill a person who is not 241.23 a medical assistance recipient for resident days that preceded 241.24 the date of completion of screening activities as required under 241.25 subdivisions 4a, 4b, and 4c. The nursing facility must include 241.26 unreimbursed resident days in the nursing facility resident day 241.27 totals reported to the commissioner. 241.28 (c) The commissioner shall make a request to the health 241.29 care financing administration for a waiver allowing screening 241.30 team approval of Medicaid payments for certified nursing 241.31 facility care. An individual has a choice and makes the final 241.32 decision between nursing facility placement and community 241.33 placement after the screening team's recommendation, except as 241.34 provided inparagraphs (b) and (c)subdivision 4a, paragraph (c). 241.35(c) The local county mental health authority or the state241.36mental retardation authority under Public Law Numbers 100-203242.1and 101-508 may prohibit admission to a nursing facility, if the242.2individual does not meet the nursing facility level of care242.3criteria or needs specialized services as defined in Public Law242.4Numbers 100-203 and 101-508. For purposes of this section,242.5"specialized services" for a person with mental retardation or a242.6related condition means "active treatment" as that term is242.7defined in Code of Federal Regulations, title 42, section242.8483.440(a)(1).242.9(e) Appeals from the screening team's recommendation or the242.10county agency's final decision shall be made according to242.11section 256.045, subdivision 3.242.12 Sec. 16. Minnesota Statutes 2000, section 256B.0913, 242.13 subdivision 1, is amended to read: 242.14 Subdivision 1. [PURPOSE AND GOALS.] The purpose of the 242.15 alternative care program is to provide funding foror access to242.16 home and community-based services forfrailelderly persons, in 242.17 order to limit nursing facility placements. The program is 242.18 designed to supportfrailelderly persons in their desire to 242.19 remain in the community as independently and as long as possible 242.20 and to support informal caregivers in their efforts to provide 242.21 care forfrailelderly people. Further, the goals of the 242.22 program are: 242.23 (1) to contain medical assistance expenditures byproviding242.24 funding care in the communityat a cost the same or less than242.25nursing facility costs; and 242.26 (2) to maintain the moratorium on new construction of 242.27 nursing home beds. 242.28 Sec. 17. Minnesota Statutes 2000, section 256B.0913, 242.29 subdivision 2, is amended to read: 242.30 Subd. 2. [ELIGIBILITY FOR SERVICES.] Alternative care 242.31 services are available toall frail olderMinnesotans. This242.32includes:242.33(1) persons who are receiving medical assistance and served242.34under the medical assistance program or the Medicaid waiver242.35program;242.36(2) personsage 65 or older who are not eligible for 243.1 medical assistance without a spenddown or waiver obligation but 243.2 who would be eligible for medical assistance within 180 days of 243.3 admission to a nursing facility andserved undersubject to 243.4 subdivisions 4 to 13; and243.5(3) persons who are paying for their services out-of-pocket. 243.6 Sec. 18. Minnesota Statutes 2000, section 256B.0913, 243.7 subdivision 4, is amended to read: 243.8 Subd. 4. [ELIGIBILITY FOR FUNDING FOR SERVICES FOR 243.9 NONMEDICAL ASSISTANCE RECIPIENTS.] (a) Funding for services 243.10 under the alternative care program is available to persons who 243.11 meet the following criteria: 243.12 (1) the person has beenscreened by the county screening243.13team or, if previously screened and served under the alternative243.14care program, assessed by the local county social worker or243.15public health nursedetermined by a community assessment under 243.16 section 256B.0911, to be a person who would require the level of 243.17 care provided in a nursing facility, but for the provision of 243.18 services under the alternative care program; 243.19 (2) the person is age 65 or older; 243.20 (3) the person would befinanciallyeligible for medical 243.21 assistance within 180 days of admission to a nursing facility; 243.22 (4) the personmeets the asset transfer requirements ofis 243.23 not ineligible for the medical assistance program due to an 243.24 asset transfer penalty; 243.25 (5)the screening team would recommend nursing facility243.26admission or continued stay for the person if alternative care243.27services were not available;243.28(6)the person needs services that are notavailable at243.29that time in the countyfunded through othercounty,state,or 243.30 federal fundingsources; and 243.31(7)(6) the monthly cost of the alternative care services 243.32 funded by the program for this person does not exceed 75 percent 243.33 of the statewideaverage monthly medical assistance payment for243.34nursing facility care at the individual's case mix243.35classificationweighted average monthly nursing facility rate of 243.36 the case mix resident class to which the individual alternative 244.1 care client would be assigned under Minnesota Rules, parts 244.2 9549.0050 to 9549.0059, less the recipient's maintenance needs 244.3 allowance as described in section 256B.0915, subdivision 1d, 244.4 paragraph (a), until the first day of the state fiscal year in 244.5 which the resident assessment system, under section 256B.437, 244.6 for nursing home rate determination is implemented. Effective 244.7 on the first day of the state fiscal year in which a resident 244.8 assessment system, under section 256B.437, for nursing home rate 244.9 determination is implemented and the first day of each 244.10 subsequent state fiscal year, the monthly cost of alternative 244.11 care services for this person shall not exceed the alternative 244.12 care monthly cap for the case mix resident class to which the 244.13 alternative care client would be assigned under Minnesota Rules, 244.14 parts 9549.0050 to 9549.0059, which was in effect on the last 244.15 day of the previous state fiscal year, and adjusted by the 244.16 greater of any legislatively adopted home and community-based 244.17 services cost-of-living percentage increase or any legislatively 244.18 adopted statewide percent rate increase for nursing facilities. 244.19 This monthly limit does not prohibit the alternative care client 244.20 from payment for additional services, but in no case may the 244.21 cost of additional services purchased under this section exceed 244.22 the difference between the client's monthly service limit 244.23 defined under section 256B.0915, subdivision 3, and the 244.24 alternative care program monthly service limit defined in this 244.25 paragraph. If medical supplies and equipment oradaptations244.26 environmental modifications are or will be purchased for an 244.27 alternative care services recipient, the costs may be prorated 244.28 on a monthly basisthroughout the year in which they are244.29purchasedfor up to 12 consecutive months beginning with the 244.30 month of purchase. If the monthly cost of a recipient's other 244.31 alternative care services exceeds the monthly limit established 244.32 in this paragraph, the annual cost of the alternative care 244.33 services shall be determined. In this event, the annual cost of 244.34 alternative care services shall not exceed 12 times the monthly 244.35 limitcalculateddescribed in this paragraph. 244.36 (b)Individuals who meet the criteria in paragraph (a) and245.1who have been approved for alternative care funding are called245.2180-day eligible clients.245.3(c) The statewide average payment for nursing facility care245.4is the statewide average monthly nursing facility rate in effect245.5on July 1 of the fiscal year in which the cost is incurred, less245.6the statewide average monthly income of nursing facility245.7residents who are age 65 or older and who are medical assistance245.8recipients in the month of March of the previous fiscal year.245.9This monthly limit does not prohibit the 180-day eligible client245.10from paying for additional services needed or desired.245.11(d) In determining the total costs of alternative care245.12services for one month, the costs of all services funded by the245.13alternative care program, including supplies and equipment, must245.14be included.245.15(e)Alternative care funding under this subdivision is not 245.16 available for a person who is a medical assistance recipient or 245.17 who would be eligible for medical assistance without a 245.18 spenddown, unless authorized by the commissioneror waiver 245.19 obligation. A person whose initial application for medical 245.20 assistance is being processed may be served under the 245.21 alternative care program for a period up to 60 days. If the 245.22 individual is found to be eligible for medical assistance,the245.23county must billmedical assistance must be billed for services 245.24 payable under the federally approved elderly waiver plan and 245.25 delivered from the date the individual was found eligible 245.26 forservices reimbursable underthe federally approved elderly 245.27 waiverprogramplan. Notwithstanding this provision, upon 245.28 federal approval, alternative care funds may not be used to pay 245.29 for any service the cost of which is payable by medical 245.30 assistance or which is used by a recipient to meet a medical 245.31 assistance income spenddown or waiver obligation. 245.32(f)(c) Alternative care funding is not available for a 245.33 person who resides in a licensed nursing homeor, certified 245.34 boarding care home, hospital, or intermediate care facility, 245.35 except for case management services which arebeingprovided in 245.36 support of the discharge planning process to a nursing home 246.1 resident or certified boarding care home resident who is 246.2 ineligible for case management funded by medical assistance. 246.3 Sec. 19. Minnesota Statutes 2000, section 256B.0913, 246.4 subdivision 5, is amended to read: 246.5 Subd. 5. [SERVICES COVERED UNDER ALTERNATIVE CARE.] (a) 246.6 Alternative care funding may be used for payment of costs of: 246.7 (1) adult foster care; 246.8 (2) adult day care; 246.9 (3) home health aide; 246.10 (4) homemaker services; 246.11 (5) personal care; 246.12 (6) case management; 246.13 (7) respite care; 246.14 (8) assisted living; 246.15 (9) residential care services; 246.16 (10) care-related supplies and equipment; 246.17 (11) meals delivered to the home; 246.18 (12) transportation; 246.19 (13) skilled nursing; 246.20 (14) chore services; 246.21 (15) companion services; 246.22 (16) nutrition services; 246.23 (17) training for direct informal caregivers; 246.24 (18) telemedicine devices to monitor recipients in their 246.25 own homes as an alternative to hospital care, nursing home care, 246.26 or home visits;and246.27 (19) other servicesincludingwhich includes discretionary 246.28 funds and direct cash payments to clients,approved by the246.29county agencyfollowing approval by the commissioner, subject to 246.30 the provisions of paragraph(m)(j). Total annual payments for " 246.31 other services" for all clients within a county may not exceed 246.32 either ten percent of that county's annual alternative care 246.33 program base allocation or $5,000, whichever is greater. In no 246.34 case shall this amount exceed the county's total annual 246.35 alternative care program base allocation; and 246.36 (20) environmental modifications. 247.1 (b) The county agency must ensure that the funds are not 247.2 usedonly to supplement and notto supplant services available 247.3 through other public assistance or services programs. 247.4 (c) Unless specified in statute, the service definitions 247.5 and standards for alternative care services shall be the same as 247.6 the service definitions and standardsdefinedspecified in the 247.7 federally approved elderly waiver plan. Except for the county 247.8 agencies' approval of direct cash payments to clients as 247.9 described in paragraph (j) or for a provider of supplies and 247.10 equipment when the monthly cost of the supplies and equipment is 247.11 less than $250, persons or agencies must be employed by or under 247.12 a contract with the county agency or the public health nursing 247.13 agency of the local board of health in order to receive funding 247.14 under the alternative care program. Supplies and equipment may 247.15 be purchased from a non-Medicaid certified vendor if the cost 247.16 for the item is less than that of a Medicaid vendor. 247.17 (d) The adult foster care rate shall be considered a 247.18 difficulty of care payment and shall not include room and 247.19 board. The adult foster caredailyrate shall be negotiated 247.20 between the county agency and the foster care provider.The247.21rate established under this section shall not exceed 75 percent247.22of the state average monthly nursing home payment for the case247.23mix classification to which the individual receiving foster care247.24is assigned, and it must allow for other alternative care247.25services to be authorized by the case manager.The alternative 247.26 care payment for the foster care service in combination with the 247.27 payment for other alternative care services, including case 247.28 management, must not exceed the limit specified in subdivision 247.29 4, paragraph (a), clause (6). 247.30 (e) Personal care servicesmay be provided by a personal247.31care provider organization.must meet the service standards 247.32 defined in the federally approved elderly waiver plan, except 247.33 that a county agency may contract with a client's relativeof247.34the clientwho meets the relative hardship waiver requirement as 247.35 defined in section 256B.0627, subdivision 4, paragraph (b), 247.36 clause (10), to provide personal care services, but must ensure248.1nursingif the county agency ensures supervision of this service 248.2 by a registered nurse or mental health practitioner.Covered248.3personal care services defined in section 256B.0627, subdivision248.44, must meet applicable standards in Minnesota Rules, part248.59505.0335.248.6 (f)A county may use alternative care funds to purchase248.7medical supplies and equipment without prior approval from the248.8commissioner when: (1) there is no other funding source; (2)248.9the supplies and equipment are specified in the individual's248.10care plan as medically necessary to enable the individual to248.11remain in the community according to the criteria in Minnesota248.12Rules, part 9505.0210, item A; and (3) the supplies and248.13equipment represent an effective and appropriate use of248.14alternative care funds. A county may use alternative care funds248.15to purchase supplies and equipment from a non-Medicaid certified248.16vendor if the cost for the items is less than that of a Medicaid248.17vendor. A county is not required to contract with a provider of248.18supplies and equipment if the monthly cost of the supplies and248.19equipment is less than $250.248.20(g)For purposes of this section, residential care services 248.21 are services which are provided to individuals living in 248.22 residential care homes. Residential care homes are currently 248.23 licensed as board and lodging establishments and are registered 248.24 with the department of health as providing special 248.25 services under section 157.17 and are not subject to 248.26 registration under chapter 144D. Residential care services are 248.27 defined as "supportive services" and "health-related services." 248.28 "Supportive services" means the provision of up to 24-hour 248.29 supervision and oversight. Supportive services includes: (1) 248.30 transportation, when provided by the residential carecenter248.31 home only; (2) socialization, when socialization is part of the 248.32 plan of care, has specific goals and outcomes established, and 248.33 is not diversional or recreational in nature; (3) assisting 248.34 clients in setting up meetings and appointments; (4) assisting 248.35 clients in setting up medical and social services; (5) providing 248.36 assistance with personal laundry, such as carrying the client's 249.1 laundry to the laundry room. Assistance with personal laundry 249.2 does not include any laundry, such as bed linen, that is 249.3 included in the room and board rate. "Health-related services" 249.4 are limited to minimal assistance with dressing, grooming, and 249.5 bathing and providing reminders to residents to take medications 249.6 that are self-administered or providing storage for medications, 249.7 if requested. Individuals receiving residential care services 249.8 cannot receive homemaking services funded under this section. 249.9(h)(g) For the purposes of this section, "assisted living" 249.10 refers to supportive services provided by a single vendor to 249.11 clients who reside in the same apartment building of three or 249.12 more units which are not subject to registration under chapter 249.13 144D and are licensed by the department of health as a class A 249.14 home care provider or a class E home care provider. Assisted 249.15 living services are defined as up to 24-hour supervision, and 249.16 oversight, supportive services as defined in clause (1), 249.17 individualized home care aide tasks as defined in clause (2), 249.18 and individualized home management tasks as defined in clause 249.19 (3) provided to residents of a residential center living in 249.20 their units or apartments with a full kitchen and bathroom. A 249.21 full kitchen includes a stove, oven, refrigerator, food 249.22 preparation counter space, and a kitchen utensil storage 249.23 compartment. Assisted living services must be provided by the 249.24 management of the residential center or by providers under 249.25 contract with the management or with the county. 249.26 (1) Supportive services include: 249.27 (i) socialization, when socialization is part of the plan 249.28 of care, has specific goals and outcomes established, and is not 249.29 diversional or recreational in nature; 249.30 (ii) assisting clients in setting up meetings and 249.31 appointments; and 249.32 (iii) providing transportation, when provided by the 249.33 residential center only. 249.34Individuals receiving assisted living services will not249.35receive both assisted living services and homemaking services.249.36Individualized means services are chosen and designed250.1specifically for each resident's needs, rather than provided or250.2offered to all residents regardless of their illnesses,250.3disabilities, or physical conditions.250.4 (2) Home care aide tasks means: 250.5 (i) preparing modified diets, such as diabetic or low 250.6 sodium diets; 250.7 (ii) reminding residents to take regularly scheduled 250.8 medications or to perform exercises; 250.9 (iii) household chores in the presence of technically 250.10 sophisticated medical equipment or episodes of acute illness or 250.11 infectious disease; 250.12 (iv) household chores when the resident's care requires the 250.13 prevention of exposure to infectious disease or containment of 250.14 infectious disease; and 250.15 (v) assisting with dressing, oral hygiene, hair care, 250.16 grooming, and bathing, if the resident is ambulatory, and if the 250.17 resident has no serious acute illness or infectious disease. 250.18 Oral hygiene means care of teeth, gums, and oral prosthetic 250.19 devices. 250.20 (3) Home management tasks means: 250.21 (i) housekeeping; 250.22 (ii) laundry; 250.23 (iii) preparation of regular snacks and meals; and 250.24 (iv) shopping. 250.25 Individuals receiving assisted living services shall not 250.26 receive both assisted living services and homemaking services. 250.27 Individualized means services are chosen and designed 250.28 specifically for each resident's needs, rather than provided or 250.29 offered to all residents regardless of their illnesses, 250.30 disabilities, or physical conditions. Assisted living services 250.31 as defined in this section shall not be authorized in boarding 250.32 and lodging establishments licensed according to sections 250.33 157.011 and 157.15 to 157.22. 250.34(i)(h) For establishments registered under chapter 144D, 250.35 assisted living services under this section means either the 250.36 services describedand licensedin paragraph (g) and delivered 251.1 by a class E home care provider licensed by the department of 251.2 health or the services described under section 144A.4605 and 251.3 delivered by an assisted living home care provider or a class A 251.4 home care provider licensed by the commissioner of health. 251.5(j) For the purposes of this section, reimbursement(i) 251.6 Payment for assisted living services and residential care 251.7 services shall be a monthly rate negotiated and authorized by 251.8 the county agency based on an individualized service plan for 251.9 each resident and may not cover direct rent or food costs.The251.10rate251.11 (1) The individualized monthly negotiated payment for 251.12 assisted living services as described in paragraph (g) or (h), 251.13 and residential care services as described in paragraph (f), 251.14 shall not exceed the nonfederal share in effect on July 1 of the 251.15 state fiscal year for which the rate limit is being calculated 251.16 of the greater of either the statewide or any of the geographic 251.17 groups' weighted average monthlymedical assistancenursing 251.18 facility payment rate of the case mix resident class to which 251.19 the180-dayalternative care eligible client would be assigned 251.20 under Minnesota Rules, parts 9549.0050 to 9549.0059,unless the251.21 less the maintenance needs allowance as described in subdivision 251.22 1d, paragraph (a), until the first day of the state fiscal year 251.23 in which a resident assessment system, under section 256B.437, 251.24 of nursing home rate determination is implemented. Effective on 251.25 the first day of the state fiscal year in which a resident 251.26 assessment system, under section 256B.437, of nursing home rate 251.27 determination is implemented and the first day of each 251.28 subsequent state fiscal year, the individualized monthly 251.29 negotiated payment for the services described in this clause 251.30 shall not exceed the limit described in this clause which was in 251.31 effect on the last day of the previous state fiscal year and 251.32 which has been adjusted by the greater of any legislatively 251.33 adopted home and community-based services cost-of-living 251.34 percentage increase or any legislatively adopted statewide 251.35 percent rate increase for nursing facilities. 251.36 (2) The individualized monthly negotiated payment for 252.1 assisted living servicesare provided by a home caredescribed 252.2 under section 144A.4605 and delivered by a provider licensed by 252.3 the department of health as a class A home care provider or an 252.4 assisted living home care provider andareprovided in a 252.5 building that is registered as a housing with services 252.6 establishment under chapter 144D and that provides 24-hour 252.7 supervision in combination with the payment for other 252.8 alternative care services, including case management, must not 252.9 exceed the limit specified in subdivision 4, paragraph (a), 252.10 clause (6). 252.11(k) For purposes of this section, companion services are252.12defined as nonmedical care, supervision and oversight, provided252.13to a functionally impaired adult. Companions may assist the252.14individual with such tasks as meal preparation, laundry and252.15shopping, but do not perform these activities as discrete252.16services. The provision of companion services does not entail252.17hands-on medical care. Providers may also perform light252.18housekeeping tasks which are incidental to the care and252.19supervision of the recipient. This service must be approved by252.20the case manager as part of the care plan. Companion services252.21must be provided by individuals or organizations who are under252.22contract with the local agency to provide the service. Any252.23person related to the waiver recipient by blood, marriage or252.24adoption cannot be reimbursed under this service. Persons252.25providing companion services will be monitored by the case252.26manager.252.27(l) For purposes of this section, training for direct252.28informal caregivers is defined as a classroom or home course of252.29instruction which may include: transfer and lifting skills,252.30nutrition, personal and physical cares, home safety in a home252.31environment, stress reduction and management, behavioral252.32management, long-term care decision making, care coordination252.33and family dynamics. The training is provided to an informal252.34unpaid caregiver of a 180-day eligible client which enables the252.35caregiver to deliver care in a home setting with high levels of252.36quality. The training must be approved by the case manager as253.1part of the individual care plan. Individuals, agencies, and253.2educational facilities which provide caregiver training and253.3education will be monitored by the case manager.253.4(m)(j) A county agency may make payment from their 253.5 alternative care program allocation for "other services" 253.6provided to an alternative care program recipient if those253.7services prevent, shorten, or delay institutionalization. These253.8services maywhich include use of "discretionary funds" for 253.9 services that are not otherwise defined in this section and 253.10 direct cash payments to therecipientclient for the purpose of 253.11 purchasing therecipient'sservices. The following provisions 253.12 apply to payments under this paragraph: 253.13 (1) a cash payment to a client under this provision cannot 253.14 exceed 80 percent of the monthly payment limit for that client 253.15 as specified in subdivision 4, paragraph (a), clause(7)(6); 253.16 (2) a county may not approve any cash payment for a client 253.17 who meets either of the following: 253.18 (i) has been assessed as having a dependency in 253.19 orientation, unless the client has an authorized 253.20 representativeunder section 256.476, subdivision 2, paragraph253.21(g), or for a client who. An "authorized representative" means 253.22 an individual who is at least 18 years of age and is designated 253.23 by the person or the person's legal representative to act on the 253.24 person's behalf. This individual may be a family member, 253.25 guardian, representative payee, or other individual designated 253.26 by the person or the person's legal representative, if any, to 253.27 assist in purchasing and arranging for supports; or 253.28 (ii) is concurrently receiving adult foster care, 253.29 residential care, or assisted living services; 253.30 (3)any service approved under this section must be a253.31service which meets the purpose and goals of the program as253.32listed in subdivision 1;253.33(4) cash payments must also meet the criteria of and are253.34governed by the procedures and liability protection established253.35in section 256.476, subdivision 4, paragraphs (b) through (h),253.36and recipients of cash grants must meet the requirements in254.1section 256.476, subdivision 10; andcash payments to a person 254.2 or a person's family will be provided through a monthly payment 254.3 and be in the form of cash, voucher, or direct county payment to 254.4 vendor. Fees or premiums assessed to the person for eligibility 254.5 for health and human services are not reimbursable through this 254.6 service option. Services and goods purchased through cash 254.7 payments must be identified in the person's individualized care 254.8 plan and must meet all of the following criteria: 254.9 (i) they must be over and above the normal cost of caring 254.10 for the person if the person did not have functional 254.11 limitations; 254.12 (ii) they must be directly attributable to the person's 254.13 functional limitations; 254.14 (iii) they must have the potential to be effective at 254.15 meeting the goals of the program; 254.16 (iv) they must be consistent with the needs identified in 254.17 the individualized service plan. The service plan shall specify 254.18 the needs of the person and family, the form and amount of 254.19 payment, the items and services to be reimbursed, and the 254.20 arrangements for management of the individual grant; and 254.21 (v) the person, the person's family, or the legal 254.22 representative shall be provided sufficient information to 254.23 ensure an informed choice of alternatives. The local agency 254.24 shall document this information in the person's care plan, 254.25 including the type and level of expenditures to be reimbursed; 254.26 (4) the county, lead agency under contract, or tribal 254.27 government under contract to administer the alternative care 254.28 program shall not be liable for damages, injuries, or 254.29 liabilities sustained through the purchase of direct supports or 254.30 goods by the person, the person's family, or the authorized 254.31 representative with funds received through the cash payments 254.32 under this section. Liabilities include, but are not limited 254.33 to, workers' compensation, the Federal Insurance Contributions 254.34 Act (FICA), or the Federal Unemployment Tax Act (FUTA); 254.35 (5) persons receiving grants under this section shall have 254.36 the following responsibilities: 255.1 (i) spend the grant money in a manner consistent with their 255.2 individualized service plan with the local agency; 255.3 (ii) notify the local agency of any necessary changes in 255.4 the grant-expenditures; 255.5 (iii) arrange and pay for supports; and 255.6 (iv) inform the local agency of areas where they have 255.7 experienced difficulty securing or maintaining supports; and 255.8(5)(6) the county shall report client outcomes, services, 255.9 and costs under this paragraph in a manner prescribed by the 255.10 commissioner. 255.11 (k) Upon implementation of direct cash payments to clients 255.12 under this section, any person determined eligible for the 255.13 alternative care program who chooses a cash payment approved by 255.14 the county agency shall receive the cash payment under this 255.15 section and not under section 256.476 unless the person was 255.16 receiving a consumer support grant under section 256.476 before 255.17 implementation of direct cash payments under this section. 255.18 Sec. 20. Minnesota Statutes 2000, section 256B.0913, 255.19 subdivision 6, is amended to read: 255.20 Subd. 6. [ALTERNATIVE CARE PROGRAM ADMINISTRATION.] The 255.21 alternative care program is administered by the county agency. 255.22 This agency is the lead agency responsible for the local 255.23 administration of the alternative care program as described in 255.24 this section. However, it may contract with the public health 255.25 nursing service to be the lead agency. The commissioner may 255.26 contract with federally recognized Indian tribes with a 255.27 reservation in Minnesota to serve as the lead agency responsible 255.28 for the local administration of the alternative care program as 255.29 described in the contract. 255.30 Sec. 21. Minnesota Statutes 2000, section 256B.0913, 255.31 subdivision 7, is amended to read: 255.32 Subd. 7. [CASE MANAGEMENT.] Providers of case management 255.33 services for persons receiving services funded by the 255.34 alternative care program must meet the qualification 255.35 requirements and standards specified in section 256B.0915, 255.36 subdivision 1b. The case manager mustensure the health and256.1safety of the individual client andnot approve alternative care 256.2 funding for a client in any setting in which the case manager 256.3 cannot reasonably ensure the client's health and safety. The 256.4 case manager is responsible for the cost-effectiveness of the 256.5 alternative care individual care plan and must not approve any 256.6 care plan in which the cost of services funded by alternative 256.7 care and client contributions exceeds the limit specified in 256.8 section 256B.0915, subdivision 3, paragraph (b). The county may 256.9 allow a case manager employed by the county to delegate certain 256.10 aspects of the case management activity to another individual 256.11 employed by the county provided there is oversight of the 256.12 individual by the case manager. The case manager may not 256.13 delegate those aspects which require professional judgment 256.14 including assessments, reassessments, and care plan development. 256.15 Sec. 22. Minnesota Statutes 2000, section 256B.0913, 256.16 subdivision 8, is amended to read: 256.17 Subd. 8. [REQUIREMENTS FOR INDIVIDUAL CARE PLAN.] (a) The 256.18 case manager shall implement the plan of care for each180-day256.19eligiblealternative care client and ensure that a client's 256.20 service needs and eligibility are reassessed at least every 12 256.21 months. The plan shall include any services prescribed by the 256.22 individual's attending physician as necessary to allow the 256.23 individual to remain in a community setting. In developing the 256.24 individual's care plan, the case manager should include the use 256.25 of volunteers from families and neighbors, religious 256.26 organizations, social clubs, and civic and service organizations 256.27 to support the formal home care services. The county shall be 256.28 held harmless for damages or injuries sustained through the use 256.29 of volunteers under this subdivision including workers' 256.30 compensation liability.The lead agency shall provide256.31documentation to the commissioner verifying that the256.32individual's alternative care is not available at that time256.33through any other public assistance or service program.The 256.34 lead agency shall provide documentation in each individual's 256.35 plan of care and, if requested, to the commissioner that the 256.36 most cost-effective alternatives available have been offered to 257.1 the individual and that the individual was free to choose among 257.2 available qualified providers, both public and private. The 257.3 case manager must give the individual a ten-day written notice 257.4 of any decrease in or termination of alternative care services. 257.5 (b) If the county administering alternative care services 257.6 is different than the county of financial responsibility, the 257.7 care plan may be implemented without the approval of the county 257.8 of financial responsibility. 257.9 Sec. 23. Minnesota Statutes 2000, section 256B.0913, 257.10 subdivision 9, is amended to read: 257.11 Subd. 9. [CONTRACTING PROVISIONS FOR PROVIDERS.]The lead257.12agency shall document to the commissioner that the agency made257.13reasonable efforts to inform potential providers of the257.14anticipated need for services under the alternative care program257.15or waiver programs under sections 256B.0915 and 256B.49,257.16including a minimum of 14 days' written advance notice of the257.17opportunity to be selected as a service provider and an annual257.18public meeting with providers to explain and review the criteria257.19for selection. The lead agency shall also document to the257.20commissioner that the agency allowed potential providers an257.21opportunity to be selected to contract with the county agency.257.22Funds reimbursed to counties under this subdivisionAlternative 257.23 care funds paid to service providers are subject to audit by the 257.24 commissioner for fiscal and utilization control. 257.25 The lead agency must select providers for contracts or 257.26 agreements using the following criteria and other criteria 257.27 established by the county: 257.28 (1) the need for the particular services offered by the 257.29 provider; 257.30 (2) the population to be served, including the number of 257.31 clients, the length of time services will be provided, and the 257.32 medical condition of clients; 257.33 (3) the geographic area to be served; 257.34 (4) quality assurance methods, including appropriate 257.35 licensure, certification, or standards, and supervision of 257.36 employees when needed; 258.1 (5) rates for each service and unit of service exclusive of 258.2 county administrative costs; 258.3 (6) evaluation of services previously delivered by the 258.4 provider; and 258.5 (7) contract or agreement conditions, including billing 258.6 requirements, cancellation, and indemnification. 258.7 The county must evaluate its own agency services under the 258.8 criteria established for other providers.The county shall258.9provide a written statement of the reasons for not selecting258.10providers.258.11 Sec. 24. Minnesota Statutes 2000, section 256B.0913, 258.12 subdivision 10, is amended to read: 258.13 Subd. 10. [ALLOCATION FORMULA.] (a) The alternative care 258.14 appropriation for fiscal years 1992 and beyond shall cover 258.15 only180-dayalternative care eligible clients. Prior to July 1 258.16 of each year, the commissioner shall allocate to county agencies 258.17 the state funds available for alternative care for persons 258.18 eligible under subdivision 2. 258.19 (b)Prior to July 1 of each year, the commissioner shall258.20allocate to county agencies the state funds available for258.21alternative care for persons eligible under subdivision 2. The258.22allocation for fiscal year 1992 shall be calculated using a base258.23that is adjusted to exclude the medical assistance share of258.24alternative care expenditures. The adjusted base is calculated258.25by multiplying each county's allocation for fiscal year 1991 by258.26the percentage of county alternative care expenditures for258.27180-day eligible clients. The percentage is determined based on258.28expenditures for services rendered in fiscal year 1989 or258.29calendar year 1989, whichever is greater.The adjusted base for 258.30 each county is the county's current fiscal year base allocation 258.31 plus any targeted funds approved during the current fiscal 258.32 year. Calculations for paragraphs (c) and (d) are to be made as 258.33 follows: for each county, the determination of alternative care 258.34 program expenditures shall be based on payments for services 258.35 rendered from April 1 through March 31 in the base year, to the 258.36 extent that claims have been submitted and paid by June 1 of 259.1 that year. 259.2 (c) If thecountyalternative care program expendituresfor259.3180-day eligible clientsas defined in paragraph (b) are 95 259.4 percent or more ofitsthe county's adjusted base allocation, 259.5 the allocation for the next fiscal year is 100 percent of the 259.6 adjusted base, plus inflation to the extent that inflation is 259.7 included in the state budget. 259.8 (d) If thecountyalternative care program expendituresfor259.9180-day eligible clientsas defined in paragraph (b) are less 259.10 than 95 percent ofitsthe county's adjusted base allocation, 259.11 the allocation for the next fiscal year is the adjusted base 259.12 allocation less the amount of unspent funds below the 95 percent 259.13 level. 259.14 (e)For fiscal year 1992 only, a county may receive an259.15increased allocation if annualized service costs for the month259.16of May 1991 for 180-day eligible clients are greater than the259.17allocation otherwise determined. A county may apply for this259.18increase by reporting projected expenditures for May to the259.19commissioner by June 1, 1991. The amount of the allocation may259.20exceed the amount calculated in paragraph (b). The projected259.21expenditures for May must be based on actual 180-day eligible259.22client caseload and the individual cost of clients' care plans.259.23If a county does not report its expenditures for May, the amount259.24in paragraph (c) or (d) shall be used.259.25(f) Calculations for paragraphs (c) and (d) are to be made259.26as follows: for each county, the determination of expenditures259.27shall be based on payments for services rendered from April 1259.28through March 31 in the base year, to the extent that claims259.29have been submitted by June 1 of that year. Calculations for259.30paragraphs (c) and (d) must also include the funds transferred259.31to the consumer support grant program for clients who have259.32transferred to that program from April 1 through March 31 in the259.33base year.259.34(g) For the biennium ending June 30, 2001, the allocation259.35of state funds to county agencies shall be calculated as259.36described in paragraphs (c) and (d).If the annual legislative 260.1 appropriation for the alternative care program is inadequate to 260.2 fund the combined county allocations forfiscal year 2000 or260.32001a biennium, the commissioner shall distribute to each 260.4 county the entire annual appropriation as that county's 260.5 percentage of the computed base as calculated inparagraph260.6(f)paragraphs (c) and (d). 260.7 Sec. 25. Minnesota Statutes 2000, section 256B.0913, 260.8 subdivision 11, is amended to read: 260.9 Subd. 11. [TARGETED FUNDING.] (a) The purpose of targeted 260.10 funding is to make additional money available to counties with 260.11 the greatest need. Targeted funds are not intended to be 260.12 distributed equitably among all counties, but rather, allocated 260.13 to those with long-term care strategies that meet state goals. 260.14 (b) The funds available for targeted funding shall be the 260.15 total appropriation for each fiscal year minus county 260.16 allocations determined under subdivision 10 as adjusted for any 260.17 inflation increases provided in appropriations for the biennium. 260.18 (c) The commissioner shall allocate targeted funds to 260.19 counties that demonstrate to the satisfaction of the 260.20 commissioner that they have developed feasible plans to increase 260.21 alternative care spending. In making targeted funding 260.22 allocations, the commissioner shall use the following priorities: 260.23 (1) counties that received a lower allocation in fiscal 260.24 year 1991 than in fiscal year 1990. Counties remain in this 260.25 priority until they have been restored to their fiscal year 1990 260.26 level plus inflation; 260.27 (2) counties that sustain a base allocation reduction for 260.28 failure to spend 95 percent of the allocation if they 260.29 demonstrate that the base reduction should be restored; 260.30 (3) counties that propose projects to divert community 260.31 residents from nursing home placement or convert nursing home 260.32 residents to community living; and 260.33 (4) counties that can otherwise justify program growth by 260.34 demonstrating the existence of waiting lists, demographically 260.35 justified needs, or other unmet needs. 260.36 (d) Counties that would receive targeted funds according to 261.1 paragraph (c) must demonstrate to the commissioner's 261.2 satisfaction that the funds would be appropriately spent by 261.3 showing how the funds would be used to further the state's 261.4 alternative care goals as described in subdivision 1, and that 261.5 the county has the administrative and service delivery 261.6 capability to use them. 261.7 (e) The commissioner shall request applicationsby June 1261.8each year, for county agencies to applyfor targeted funds by 261.9 November 1 of each year. The counties selected for targeted 261.10 funds shall be notified of the amount of their additional 261.11 fundingby August 1 of each year. Targeted funds allocated to a 261.12 county agency in one year shall be treated as part of the 261.13 county's base allocation for that year in determining 261.14 allocations for subsequent years. No reallocations between 261.15 counties shall be made. 261.16(f) The allocation for each year after fiscal year 1992261.17shall be determined using the previous fiscal year's allocation,261.18including any targeted funds, as the base and then applying the261.19criteria under subdivision 10, paragraphs (c), (d), and (f), to261.20the current year's expenditures.261.21 Sec. 26. Minnesota Statutes 2000, section 256B.0913, 261.22 subdivision 12, is amended to read: 261.23 Subd. 12. [CLIENT PREMIUMS.] (a) A premium is required for 261.24 all180-dayalternative care eligible clients to help pay for 261.25 the cost of participating in the program. The amount of the 261.26 premium for the alternative care client shall be determined as 261.27 follows: 261.28 (1) when the alternative care client's income less 261.29 recurring and predictable medical expenses is greater than the 261.30medical assistance income standardrecipient's maintenance needs 261.31 allowance as defined in section 256B.0915, subdivision 1d, 261.32 paragraph (a), but less than 150 percent of the federal poverty 261.33 guideline effective on July 1 of the state fiscal year in which 261.34 the premium is being computed, and total assets are less than 261.35 $10,000, the fee is zero; 261.36 (2) when the alternative care client's income less 262.1 recurring and predictable medical expenses is greater than 150 262.2 percent of the federal poverty guideline effective on July 1 of 262.3 the state fiscal year in which the premium is being computed, 262.4 and total assets are less than $10,000, the fee is 25 percent of 262.5 the cost of alternative care services or the difference between 262.6 150 percent of the federal poverty guideline effective on July 1 262.7 of the state fiscal year in which the premium is being computed 262.8 and the client's income less recurring and predictable medical 262.9 expenses, whichever is less; and 262.10 (3) when the alternative care client's total assets are 262.11 greater than $10,000, the fee is 25 percent of the cost of 262.12 alternative care services. 262.13 For married persons, total assets are defined as the total 262.14 marital assets less the estimated community spouse asset 262.15 allowance, under section 256B.059, if applicable. For married 262.16 persons, total income is defined as the client's income less the 262.17 monthly spousal allotment, under section 256B.058. 262.18 All alternative care services except case management shall 262.19 be included in the estimated costs for the purpose of 262.20 determining 25 percent of the costs. 262.21 The monthly premium shall be calculated based on the cost 262.22 of the first full month of alternative care services and shall 262.23 continue unaltered until the next reassessment is completed or 262.24 at the end of 12 months, whichever comes first. Premiums are 262.25 due and payable each month alternative care services are 262.26 received unless the actual cost of the services is less than the 262.27 premium. 262.28 (b) The fee shall be waived by the commissioner when: 262.29 (1) a person who is residing in a nursing facility is 262.30 receiving case management only; 262.31 (2) a person is applying for medical assistance; 262.32 (3) a married couple is requesting an asset assessment 262.33 under the spousal impoverishment provisions; 262.34 (4)a person is a medical assistance recipient, but has262.35been approved for alternative care-funded assisted living262.36services;263.1(5)a person is found eligible for alternative care, but is 263.2 not yet receiving alternative care services; or 263.3(6)(5) a person's fee under paragraph (a) is less than $25. 263.4 (c) The county agency must record in the state's receivable 263.5 system the client's assessed premium amount or the reason the 263.6 premium has been waived. The commissioner will bill and collect 263.7 the premium from the clientand forward the amounts collected to263.8the commissioner in the manner and at the times prescribed by263.9the commissioner. Money collected must be deposited in the 263.10 general fund and is appropriated to the commissioner for the 263.11 alternative care program. The client must supply the county 263.12 with the client's social security number at the time of 263.13 application.If a client fails or refuses to pay the premium263.14due,The county shall supply the commissioner with the client's 263.15 social security number and other information the commissioner 263.16 requires to collect the premium from the client. The 263.17 commissioner shall collect unpaid premiums using the Revenue 263.18 Recapture Act in chapter 270A and other methods available to the 263.19 commissioner. The commissioner may require counties to inform 263.20 clients of the collection procedures that may be used by the 263.21 state if a premium is not paid. 263.22 (d) The commissioner shall begin to adopt emergency or 263.23 permanent rules governing client premiums within 30 days after 263.24 July 1, 1991, including criteria for determining when services 263.25 to a client must be terminated due to failure to pay a premium. 263.26 Sec. 27. Minnesota Statutes 2000, section 256B.0913, 263.27 subdivision 13, is amended to read: 263.28 Subd. 13. [COUNTY BIENNIAL PLAN.] The county biennial plan 263.29 forthe preadmission screening programlong-term care 263.30 consultation under section 256B.0911, the alternative care 263.31 program under this section, and waivers for the elderly under 263.32 section 256B.0915,and waivers for the disabled under section263.33256B.49,shall be incorporated into the biennial Community 263.34 Social Services Act plan and shall meet the regulations and 263.35 timelines of that plan.This county biennial plan shall include:263.36(1) information on the administration of the preadmission264.1screening program;264.2(2) information on the administration of the home and264.3community-based services waivers for the elderly under section264.4256B.0915, and for the disabled under section 256B.49; and264.5(3) information on the administration of the alternative264.6care program.264.7 Sec. 28. Minnesota Statutes 2000, section 256B.0913, 264.8 subdivision 14, is amended to read: 264.9 Subd. 14. [REIMBURSEMENTPAYMENT AND RATE ADJUSTMENTS.] (a) 264.10ReimbursementPayment forexpenditures for theprovided 264.11 alternative care services as approved by the client's case 264.12 manager shall be through the invoice processing procedures of 264.13 the department's Medicaid Management Information System (MMIS). 264.14 To receivereimbursementpayment, the county or vendor must 264.15 submit invoices within 12 months following the date of service. 264.16 The county agency and its vendors under contract shall not be 264.17 reimbursed for services which exceed the county allocation. 264.18 (b)If a county collects less than 50 percent of the client264.19premiums due under subdivision 12, the commissioner may withhold264.20up to three percent of the county's final alternative care264.21program allocation determined under subdivisions 10 and 11.264.22(c)The county shall negotiate individual rates with 264.23 vendors and maybe reimbursedauthorize service payment for 264.24 actual costs up tothe greater ofthe county's current approved 264.25 rateor 60 percent of the maximum rate in fiscal year 1994 and264.2665 percent of the maximum rate in fiscal year 1995 for each264.27alternative care service. Notwithstanding any other rule or 264.28 statutory provision to the contrary, the commissioner shall not 264.29 be authorized to increase rates by an annual inflation factor, 264.30 unless so authorized by the legislature. 264.31(d)(c)On July 1, 1993, the commissioner shall increase264.32the maximum rate for home delivered meals to $4.50 per meal.To 264.33 improve access to community services and eliminate payment 264.34 disparities between the alternative care program and the elderly 264.35 waiver program, the commissioner shall establish statewide 264.36 maximum service rate limits and eliminate county-specific 265.1 service rate limits. 265.2 (1) Effective July 1, 2001, for service rate limits, except 265.3 those in subdivision 5, paragraphs (d) and (j), the rate limit 265.4 for each service shall be the greater of the alternative care 265.5 statewide maximum rate or the elderly waiver statewide maximum 265.6 rate. 265.7 (2) Counties may negotiate individual service rates with 265.8 vendors for actual costs up to the statewide maximum service 265.9 rate limit. 265.10 Sec. 29. Minnesota Statutes 2000, section 256B.0915, 265.11 subdivision 1d, is amended to read: 265.12 Subd. 1d. [POSTELIGIBILITY TREATMENT OF INCOME AND 265.13 RESOURCES FOR ELDERLY WAIVER.](a)Notwithstanding the 265.14 provisions of section 256B.056, the commissioner shall make the 265.15 following amendment to the medical assistance elderly waiver 265.16 program effective July 1, 1999, or upon federal approval, 265.17 whichever is later. 265.18 A recipient's maintenance needs will be an amount equal to 265.19 the Minnesota supplemental aid equivalent rate as defined in 265.20 section 256I.03, subdivision 5, plus the medical assistance 265.21 personal needs allowance as defined in section 256B.35, 265.22 subdivision 1, paragraph (a), when applying posteligibility 265.23 treatment of income rules to the gross income of elderly waiver 265.24 recipients, except for individuals whose income is in excess of 265.25 the special income standard according to Code of Federal 265.26 Regulations, title 42, section 435.236. Recipient maintenance 265.27 needs shall be adjusted under this provision each July 1. 265.28(b) The commissioner of human services shall secure265.29approval of additional elderly waiver slots sufficient to serve265.30persons who will qualify under the revised income standard265.31described in paragraph (a) before implementing section265.32256B.0913, subdivision 16.265.33(c) In implementing this subdivision, the commissioner265.34shall consider allowing persons who would otherwise be eligible265.35for the alternative care program but would qualify for the265.36elderly waiver with a spenddown to remain on the alternative266.1care program.266.2 Sec. 30. Minnesota Statutes 2000, section 256B.0915, 266.3 subdivision 3, is amended to read: 266.4 Subd. 3. [LIMITS OF CASES, RATES,REIMBURSEMENTPAYMENTS, 266.5 AND FORECASTING.] (a) The number of medical assistance waiver 266.6 recipients that a county may serve must be allocated according 266.7 to the number of medical assistance waiver cases open on July 1 266.8 of each fiscal year. Additional recipients may be served with 266.9 the approval of the commissioner. 266.10 (b) The monthly limit for the cost of waivered services to 266.11 an individual elderly waiver client shall be thestatewide266.12average paymentweighted average monthly nursing facility rate 266.13 of the case mix resident class to which the elderly waiver 266.14 client would be assigned underthe medical assistance case mix266.15reimbursement system.Minnesota Rules, parts 9549.0050 to 266.16 9549.0059, less the recipient's maintenance needs allowance as 266.17 described in subdivision 1d, paragraph (a), until the first day 266.18 of the state fiscal year in which the resident assessment system 266.19 as described in section 256B.437 for nursing home rate 266.20 determination is implemented. Effective on the first day of the 266.21 state fiscal year in which the resident assessment system as 266.22 described in section 256B.437 for nursing home rate 266.23 determination is implemented and the first day of each 266.24 subsequent state fiscal year, the monthly limit for the cost of 266.25 waivered services to an individual elderly waiver client shall 266.26 be the rate of the case mix resident class to which the waiver 266.27 client would be assigned under Minnesota Rules, parts 9549.0050 266.28 to 9549.0059, in effect on the last day of the previous state 266.29 fiscal year, adjusted by the greater of any legislatively 266.30 adopted home and community-based services cost-of-living 266.31 percentage increase or any legislatively adopted statewide 266.32 percent rate increase for nursing facilities. 266.33 (c) If extended medical supplies and equipment or 266.34adaptationsenvironmental modifications are or will be purchased 266.35 for an elderly waiverservices recipientclient, the costs may 266.36 be proratedon a monthly basis throughout the year in which they267.1are purchasedfor up to 12 consecutive months beginning with the 267.2 month of purchase. If the monthly cost of a recipient'sother267.3 waivered services exceeds the monthly limit established inthis267.4 paragraph (b), the annual cost oftheall waivered services 267.5 shall be determined. In this event, the annual cost of all 267.6 waivered services shall not exceed 12 times the monthly 267.7 limitcalculated in this paragraph. The statewide average267.8payment rate is calculated by determining the statewide average267.9monthly nursing home rate, effective July 1 of the fiscal year267.10in which the cost is incurred, less the statewide average267.11monthly income of nursing home residents who are age 65 or267.12older, and who are medical assistance recipients in the month of267.13March of the previous state fiscal year. The annual cost267.14divided by 12 of elderly or disabled waivered servicesof 267.15 waivered services as described in paragraph (b). 267.16 (d) For a person who is a nursing facility resident at the 267.17 time of requesting a determination of eligibility for elderlyor267.18disabledwaivered servicesshall be the greater of the monthly267.19payment for: (i), a monthly conversion limit for the cost of 267.20 elderly waivered services may be requested. The monthly 267.21 conversion limit for the cost of elderly waiver services shall 267.22 be the resident class assigned under Minnesota Rules, parts 267.23 9549.0050 to 9549.0059, for that resident in the nursing 267.24 facility where the resident currently resides; or (ii) the267.25statewide average payment of the case mix resident class to267.26which the resident would be assigned under the medical267.27assistance case mix reimbursement system, provided thatuntil 267.28 July 1 of the state fiscal year in which the resident assessment 267.29 system as described in section 256B.437 for nursing home rate 267.30 determination is implemented. Effective on July 1 of the state 267.31 fiscal year in which the resident assessment system as described 267.32 in section 256B.437 for nursing home rate determination is 267.33 implemented, the monthly conversion limit for the cost of 267.34 elderly waiver services shall be the per diem nursing facility 267.35 rate as determined by the resident assessment system as 267.36 described in section 256B.437 for that resident in the nursing 268.1 facility where the resident currently resides multiplied by 365 268.2 and divided by 12, less the recipient's maintenance needs 268.3 allowance as described in subdivision 1d. The limit under this 268.4 clause only applies to persons discharged from a nursing 268.5 facility after a minimum 30-day stay and found eligible for 268.6 waivered services on or after July 1, 1997. The following costs 268.7 must be included in determining the total monthly costs for the 268.8 waiver client: 268.9 (1) cost of all waivered services, including extended 268.10 medical supplies and equipment and environmental modifications; 268.11 and 268.12 (2) cost of skilled nursing, home health aide, and personal 268.13 care services reimbursable by medical assistance. 268.14(c)(e) Medical assistance funding for skilled nursing 268.15 services, private duty nursing, home health aide, and personal 268.16 care services for waiver recipients must be approved by the case 268.17 manager and included in the individual care plan. 268.18(d) For both the elderly waiver and the nursing facility268.19disabled waiver, a county may purchase extended supplies and268.20equipment without prior approval from the commissioner when268.21there is no other funding source and the supplies and equipment268.22are specified in the individual's care plan as medically268.23necessary to enable the individual to remain in the community268.24according to the criteria in Minnesota Rules, part 9505.0210,268.25items A and B.(f) A county is not required to contract with a 268.26 provider of supplies and equipment if the monthly cost of the 268.27 supplies and equipment is less than $250. 268.28(e)(g) The adult foster caredailyratefor the elderly268.29and disabled waiversshall be considered a difficulty of care 268.30 payment and shall not include room and board. The adult foster 268.31 care service rate shall be negotiated between the county agency 268.32 and the foster care provider.The rate established under this268.33section shall not exceed the state average monthly nursing home268.34payment for the case mix classification to which the individual268.35receiving foster care is assigned; the rate must allow for other268.36waiver and medical assistance home care services to be269.1authorized by the case manager.The elderly waiver payment for 269.2 the foster care service in combination with the payment for all 269.3 other elderly waiver services, including case management, must 269.4 not exceed the limit specified in paragraph (b). 269.5(f) The assisted living and residential care service rates269.6for elderly and community alternatives for disabled individuals269.7(CADI) waivers shall be made to the vendor as a monthly rate269.8negotiated with the county agency based on an individualized269.9service plan for each resident. The rate shall not exceed the269.10nonfederal share of the greater of either the statewide or any269.11of the geographic groups' weighted average monthly medical269.12assistance nursing facility payment rate of the case mix269.13resident class to which the elderly or disabled client would be269.14assigned under Minnesota Rules, parts 9549.0050 to 9549.0059,269.15unless the services are provided by a home care provider269.16licensed by the department of health and are provided in a269.17building that is registered as a housing with services269.18establishment under chapter 144D and that provides 24-hour269.19supervision. For alternative care assisted living projects269.20established under Laws 1988, chapter 689, article 2, section269.21256, monthly rates may not exceed 65 percent of the greater of269.22either the statewide or any of the geographic groups' weighted269.23average monthly medical assistance nursing facility payment rate269.24for the case mix resident class to which the elderly or disabled269.25client would be assigned under Minnesota Rules, parts 9549.0050269.26to 9549.0059. The rate may not cover direct rent or food costs.269.27 (h) Payment for assisted living service shall be a monthly 269.28 rate negotiated and authorized by the county agency based on an 269.29 individualized service plan for each resident and may not cover 269.30 direct rent or food costs. 269.31 (1) The individualized monthly negotiated payment for 269.32 assisted living services as described in section 256B.0913, 269.33 subdivision 5, paragraph (g) or (h), and residential care 269.34 services as described in section 256B.0913, subdivision 5, 269.35 paragraph (f), shall not exceed the nonfederal share, in effect 269.36 on July 1 of the state fiscal year for which the rate limit is 270.1 being calculated, of the greater of either the statewide or any 270.2 of the geographic groups' weighted average monthly nursing 270.3 facility rate of the case mix resident class to which the 270.4 elderly waiver eligible client would be assigned under Minnesota 270.5 Rules, parts 9549.0050 to 9549.0059, less the maintenance needs 270.6 allowance as described in subdivision 1d, paragraph (a), until 270.7 the July 1 of the state fiscal year in which the resident 270.8 assessment system as described in section 256B.437 for nursing 270.9 home rate determination is implemented. Effective on July 1 of 270.10 the state fiscal year in which the resident assessment system as 270.11 described in section 256B.437 for nursing home rate 270.12 determination is implemented and July 1 of each subsequent state 270.13 fiscal year, the individualized monthly negotiated payment for 270.14 the services described in this clause shall not exceed the limit 270.15 described in this clause which was in effect on June 30 of the 270.16 previous state fiscal year and which has been adjusted by the 270.17 greater of any legislatively adopted home and community-based 270.18 services cost-of-living percentage increase or any legislatively 270.19 adopted statewide percent rate increase for nursing facilities. 270.20 (2) The individualized monthly negotiated payment for 270.21 assisted living services described in section 144A.4605 and 270.22 delivered by a provider licensed by the department of health as 270.23 a class A home care provider or an assisted living home care 270.24 provider and provided in a building that is registered as a 270.25 housing with services establishment under chapter 144D and that 270.26 provides 24-hour supervision in combination with the payment for 270.27 other elderly waiver services, including case management, must 270.28 not exceed the limit specified in paragraph (b). 270.29(g)(i) The county shall negotiate individual service rates 270.30 with vendors and maybe reimbursedauthorize payment for actual 270.31 costs up to thegreater of thecounty's current approved rateor270.3260 percent of the maximum rate in fiscal year 1994 and 65270.33percent of the maximum rate in fiscal year 1995 for each service270.34within each program. Persons or agencies must be employed by or 270.35 under a contract with the county agency or the public health 270.36 nursing agency of the local board of health in order to receive 271.1 funding under the elderly waiver program, except as a provider 271.2 of supplies and equipment when the monthly cost of the supplies 271.3 and equipment is less than $250. 271.4(h) On July 1, 1993, the commissioner shall increase the271.5maximum rate for home-delivered meals to $4.50 per meal.271.6(i)(j) Reimbursement for the medical assistance recipients 271.7 under the approved waiver shall be made from the medical 271.8 assistance account through the invoice processing procedures of 271.9 the department's Medicaid Management Information System (MMIS), 271.10 only with the approval of the client's case manager. The budget 271.11 for the state share of the Medicaid expenditures shall be 271.12 forecasted with the medical assistance budget, and shall be 271.13 consistent with the approved waiver. 271.14 (k) To improve access to community services and eliminate 271.15 payment disparities between the alternative care program and the 271.16 elderly waiver, the commissioner shall establish statewide 271.17 maximum service rate limits and eliminate county-specific 271.18 service rate limits. 271.19 (1) Effective July 1, 2001, for service rate limits, except 271.20 those described or defined in paragraphs (g) and (h), the rate 271.21 limit for each service shall be the greater of the alternative 271.22 care statewide maximum rate or the elderly waiver statewide 271.23 maximum rate. 271.24 (2) Counties may negotiate individual service rates with 271.25 vendors for actual costs up to the statewide maximum service 271.26 rate limit. 271.27(j)(l) Beginning July 1, 1991, the state shall reimburse 271.28 counties according to the payment schedule in section 256.025 271.29 for the county share of costs incurred under this subdivision on 271.30 or after January 1, 1991, for individuals who are receiving 271.31 medical assistance. 271.32(k) For the community alternatives for disabled individuals271.33waiver, and nursing facility disabled waivers, county may use271.34waiver funds for the cost of minor adaptations to a client's271.35residence or vehicle without prior approval from the271.36commissioner if there is no other source of funding and the272.1adaptation:272.2(1) is necessary to avoid institutionalization;272.3(2) has no utility apart from the needs of the client; and272.4(3) meets the criteria in Minnesota Rules, part 9505.0210,272.5items A and B.272.6For purposes of this subdivision, "residence" means the client's272.7own home, the client's family residence, or a family foster272.8home. For purposes of this subdivision, "vehicle" means the272.9client's vehicle, the client's family vehicle, or the client's272.10family foster home vehicle.272.11(l) The commissioner shall establish a maximum rate unit272.12for baths provided by an adult day care provider that are not272.13included in the provider's contractual daily or hourly rate.272.14This maximum rate must equal the home health aide extended rate272.15and shall be paid for baths provided to clients served under the272.16elderly and disabled waivers.272.17 Sec. 31. Minnesota Statutes 2000, section 256B.0915, 272.18 subdivision 5, is amended to read: 272.19 Subd. 5. [REASSESSMENTS FOR WAIVER CLIENTS.] A 272.20 reassessment of a client served under the elderlyor disabled272.21 waiver must be conducted at least every 12 months and at other 272.22 times when the case manager determines that there has been 272.23 significant change in the client's functioning. This may 272.24 include instances where the client is discharged from the 272.25 hospital. 272.26 Sec. 32. Minnesota Statutes 2000, section 256B.0917, 272.27 subdivision 7, is amended to read: 272.28 Subd. 7. [CONTRACT.] (a) The commissioner of human 272.29 services shall execute a contract with Living at Home/Block 272.30 Nurse Program, Inc. (LAH/BN, Inc.). The contract shall require 272.31 LAH/BN, Inc. to: 272.32 (1) develop criteria for and award grants to establish 272.33 community-based organizations that will implement 272.34 living-at-home/block nurse programs throughout the state; 272.35 (2) award grants to enablecurrentliving-at-home/block 272.36 nurse programs to continue to implement the combined 273.1 living-at-home/block nurse program model; 273.2 (3) serve as a state technical assistance center to assist 273.3 and coordinate the living-at-home/block nurse programs 273.4 established; and 273.5 (4) manage contracts with individual living-at-home/block 273.6 nurse programs. 273.7 (b) The contract shall be effective July 1, 1997, and 273.8 section 16B.17 shall not apply. 273.9 Sec. 33. [256B.0918] [DEVELOPMENT AND PURPOSE OF MEDICAL 273.10 ASSISTANCE PILOT PROJECT ON SENIOR SERVICES.] 273.11 Subdivision 1. [DEVELOPMENT AND PURPOSE.] The commissioner 273.12 of human services shall develop a medical assistance pilot 273.13 project on senior services to determine how converting the 273.14 delivery of housing, supportive services, and health care for 273.15 seniors into a flexible voucher program will impact public 273.16 expenditures for older adult service care and provide an 273.17 alternative way to purchase services based on consumer choice. 273.18 Subd. 2. [FEDERAL WAIVER AUTHORITY.] The commissioner 273.19 shall apply for any necessary federal waivers or approvals to 273.20 implement this pilot project. The commissioner shall submit the 273.21 waiver request no later than April 15, 2002. 273.22 Subd. 3. [REPORT.] The commissioner shall report to the 273.23 legislature by January 15, 2003, on approval of waivers 273.24 requested. Upon federal approval, the commissioner shall seek 273.25 legislative authorization to implement the pilot project. Once 273.26 the pilot project is implemented, participating communities and 273.27 the commissioner of human services shall collaborate to prepare 273.28 and issue an annual report each December 1 to the appropriate 273.29 committee chairs in the senate and house on: (1) the use of 273.30 state resources, including other funds leveraged for this 273.31 initiative; (2) the status of individuals being served in the 273.32 pilot project; and (3) the cost-effectiveness of the pilot 273.33 project. The commissioner shall provide data that may be needed 273.34 to evaluate the pilot project to communities that request the 273.35 data. 273.36 Subd. 4. [SUNSET.] This section sunsets June 30, 2008. 274.1 Sec. 34. [SERVICE ACCESS STUDY.] 274.2 By February 15, 2002, the commissioner of human services 274.3 shall submit to the legislature recommendations for creating 274.4 coordinated service access at the county agency level for both 274.5 publicly subsidized and nonsubsidized long-term care services 274.6 and housing options. The report must: 274.7 (1) include a plan to coordinate public funding streams to 274.8 allow low-income, privately paying consumers to purchase 274.9 services through a sliding fee scale; and 274.10 (2) evaluate the feasibility of statewide implementation, 274.11 based upon an evaluation of public cost, consumer preferences 274.12 and satisfaction, and other relevant factors. 274.13 Sec. 35. [RESPITE CARE.] 274.14 The Minnesota board on aging shall report to the 274.15 legislature by February 1, 2002, on the provision of in-home and 274.16 out-of-home respite care services on a sliding scale basis under 274.17 the federal Older Americans Act. 274.18 Sec. 36. [REPEALER.] 274.19 Minnesota Statutes 2000, sections 256B.0911, subdivisions 274.20 2, 2a, 4, 8, and 9; and 256B.0913, subdivisions 3, 15a, 15b, 274.21 15c, and 16; Minnesota Rules, parts 9505.2390; 9505.2395; 274.22 9505.2396; 9505.2400; 9505.2405; 9505.2410; 9505.2413; 274.23 9505.2415; 9505.2420; 9505.2425; 9505.2426; 9505.2430; 274.24 9505.2435; 9505.2440; 9505.2445; 9505.2450; 9505.2455; 274.25 9505.2458; 9505.2460; 9505.2465; 9505.2470; 9505.2473; 274.26 9505.2475; 9505.2480; 9505.2485; 9505.2486; 9505.2490; 274.27 9505.2495; 9505.2496; and 9505.2500, are repealed. 274.28 ARTICLE 5 274.29 LONG-TERM CARE REFORM AND REIMBURSEMENT 274.30 Section 1. [144.0724] [RESIDENT REIMBURSEMENT 274.31 CLASSIFICATION.] 274.32 Subdivision 1. [RESIDENT REIMBURSEMENT 274.33 CLASSIFICATIONS.] The commissioner of health shall establish 274.34 resident reimbursement classifications based upon the 274.35 assessments of residents of nursing homes and boarding care 274.36 homes conducted under this section and according to section 275.1 256B.437. The reimbursement classifications established under 275.2 this section shall be implemented after June 30, 2002, but no 275.3 later than January 1, 2003. 275.4 Subd. 2. [DEFINITIONS.] For purposes of this section, the 275.5 following terms have the meanings given. 275.6 (a) [ASSESSMENT REFERENCE DATE.] "Assessment reference 275.7 date" means the last day of the minimum data set observation 275.8 period. The date sets the designated endpoint of the common 275.9 observation period, and all minimum data set items refer back in 275.10 time from that point. 275.11 (b) [CASE MIX INDEX.] "Case mix index" means the weighting 275.12 factors assigned to the RUG-III classifications. 275.13 (c) [INDEX MAXIMIZATION.] "Index maximization" means 275.14 classifying a resident who could be assigned to more than one 275.15 category, to the category with the highest case mix index. 275.16 (d) [MINIMUM DATA SET.] "Minimum data set" means the 275.17 assessment instrument specified by the Health Care Financing 275.18 Administration and designated by the Minnesota department of 275.19 health. 275.20 (e) [REPRESENTATIVE.] "Representative" means a person who 275.21 is the resident's guardian or conservator, the person authorized 275.22 to pay the nursing home expenses of the resident, a 275.23 representative of the nursing home ombudsman's office whose 275.24 assistance has been requested, or any other individual 275.25 designated by the resident. 275.26 (f) [RESOURCE UTILIZATION GROUPS OR RUG.] "Resource 275.27 utilization groups" or "RUG" means the system for grouping a 275.28 nursing facility's residents according to their clinical and 275.29 functional status identified in data supplied by the facility's 275.30 minimum data set. 275.31 Subd. 3. [RESIDENT REIMBURSEMENT CLASSIFICATIONS.] (a) 275.32 Resident reimbursement classifications shall be based on the 275.33 minimum data set, version 2.0 assessment instrument, or its 275.34 successor version mandated by the Health Care Financing 275.35 Administration that nursing facilities are required to complete 275.36 for all residents. The commissioner of health shall establish 276.1 resident classes according to the 34 group, resource utilization 276.2 groups, version III or RUG-III model. Resident classes must be 276.3 established based on the individual items on the minimum data 276.4 set and must be completed according to the facility manual for 276.5 case mix classification issued by the Minnesota department of 276.6 health. The facility manual for case mix classification shall 276.7 be drafted by the Minnesota department of health and presented 276.8 to the chairs of health and human services legislative 276.9 committees by December 31, 2001. 276.10 (b) Each resident must be classified based on the 276.11 information from the minimum data set according to general 276.12 domains in clauses (1) to (7): 276.13 (1) extensive services where a resident requires 276.14 intravenous feeding or medications, suctioning, tracheostomy 276.15 care, or is on a ventilator or respirator; 276.16 (2) rehabilitation where a resident requires physical, 276.17 occupational, or speech therapy; 276.18 (3) special care where a resident has cerebral palsy; 276.19 quadriplegia; multiple sclerosis; pressure ulcers; fever with 276.20 vomiting, weight loss, or dehydration; tube feeding and aphasia; 276.21 or is receiving radiation therapy; 276.22 (4) clinically complex status where a resident has burns, 276.23 coma, septicemia, pneumonia, internal bleeding, chemotherapy, 276.24 wounds, kidney failure, urinary tract infections, oxygen, or 276.25 transfusions; 276.26 (5) impaired cognition where a resident has poor cognitive 276.27 performance; 276.28 (6) behavior problems where a resident exhibits wandering, 276.29 has hallucinations, or is physically or verbally abusive toward 276.30 others, unless the resident's other condition would place the 276.31 resident in other categories; and 276.32 (7) reduced physical functioning where a resident has no 276.33 special clinical conditions. 276.34 (c) The commissioner of health shall establish resident 276.35 classification according to a 34 group model based on the 276.36 information on the minimum data set and within the general 277.1 domains listed in paragraph (b), clauses (1) to (7). Detailed 277.2 descriptions of each resource utilization group shall be defined 277.3 in the facility manual for case mix classification issued by the 277.4 Minnesota department of health. The 34 groups are described as 277.5 follows: 277.6 (1) SE3: requires four or five extensive services; 277.7 (2) SE2: requires two or three extensive services; 277.8 (3) SE1: requires one extensive service; 277.9 (4) RAD: requires rehabilitation services and is dependent 277.10 in activity of daily living (ADL) at a count of 17 or 18; 277.11 (5) RAC: requires rehabilitation services and ADL count is 277.12 14 to 16; 277.13 (6) RAB: requires rehabilitation services and ADL count is 277.14 ten to 13; 277.15 (7) RAA: requires rehabilitation services and ADL count is 277.16 four to nine; 277.17 (8) SSC: requires special care and ADL count is 17 or 18; 277.18 (9) SSB: requires special care and ADL count is 15 or 16; 277.19 (10) SSA: requires special care and ADL count is seven to 277.20 14; 277.21 (11) CC2: clinically complex with depression and ADL count 277.22 is 17 or 18; 277.23 (12) CC1: clinically complex with no depression and ADL 277.24 count is 17 or 18; 277.25 (13) CB2: clinically complex with depression and ADL count 277.26 is 12 to 16; 277.27 (14) CB1: clinically complex with no depression and ADL 277.28 count is 12 to 16; 277.29 (15) CA2: clinically complex with depression and ADL count 277.30 is four to 11; 277.31 (16) CA1: clinically complex with no depression and ADL 277.32 count is four to 11; 277.33 (17) IB2: impaired cognition with nursing rehabilitation 277.34 and ADL count is six to ten; 277.35 (18) IB1: impaired cognition with no nursing 277.36 rehabilitation and ADL count is six to ten; 278.1 (19) IA2: impaired cognition with nursing rehabilitation 278.2 and ADL count is four or five; 278.3 (20) IA1: impaired cognition with no nursing 278.4 rehabilitation and ADL count is four or five; 278.5 (21) BB2: behavior problems with nursing rehabilitation 278.6 and ADL count is six to ten; 278.7 (22) BB1: behavior problems with no nursing rehabilitation 278.8 and ADL count is six to ten; 278.9 (23) BA2: behavior problems with nursing rehabilitation 278.10 and ADL count is four to five; 278.11 (24) BA1: behavior problems with no nursing rehabilitation 278.12 and ADL count is four to five; 278.13 (25) PE2: reduced physical functioning with nursing 278.14 rehabilitation and ADL count is 16 to 18; 278.15 (26) PE1: reduced physical functioning with no nursing 278.16 rehabilitation and ADL count is 16 to 18; 278.17 (27) PD2: reduced physical functioning with nursing 278.18 rehabilitation and ADL count is 11 to 15; 278.19 (28) PD1: reduced physical functioning with no nursing 278.20 rehabilitation and ADL count is 11 to 15; 278.21 (29) PC2: reduced physical functioning with nursing 278.22 rehabilitation and ADL count is nine or ten; 278.23 (30) PC1: reduced physical functioning with no nursing 278.24 rehabilitation and ADL count is nine or ten; 278.25 (31) PB2: reduced physical functioning with nursing 278.26 rehabilitation and ADL count is six to eight; 278.27 (32) PB1: reduced physical functioning with no nursing 278.28 rehabilitation and ADL count is six to eight; 278.29 (33) PA2: reduced physical functioning with nursing 278.30 rehabilitation and ADL count is four or five; and 278.31 (34) PA1: reduced physical functioning with no nursing 278.32 rehabilitation and ADL count is four or five. 278.33 Subd. 4. [RESIDENT ASSESSMENT SCHEDULE.] (a) A facility 278.34 must conduct and electronically submit to the commissioner of 278.35 health case mix assessments that conform with the assessment 278.36 schedule defined by the Code of Federal Regulations, title 42, 279.1 section 483.20, and published by the United States Department of 279.2 Health and Human Services, Health Care Financing Administration, 279.3 in the Long Term Care Assessment Instrument User's Manual, 279.4 version 2.0, October 1995, and subsequent clarifications made in 279.5 the Long-Term Care Assessment Instrument Questions and Answers, 279.6 version 2.0, August 1996. The commissioner of health may 279.7 substitute successor manuals or question and answer documents 279.8 published by the United States Department of Health and Human 279.9 Services, Health Care Financing Administration, to replace or 279.10 supplement the current version of the manual or document. 279.11 (b) The assessments used to determine a case mix 279.12 classification for reimbursement include the following: 279.13 (1) a new admission assessment must be completed by day 14 279.14 following admission; 279.15 (2) an annual assessment must be completed within 366 days 279.16 of the last comprehensive assessment; 279.17 (3) a significant change assessment must be completed 279.18 within 14 days of the identification of a significant change; 279.19 and 279.20 (4) the second quarterly assessment following either a new 279.21 admission assessment, an annual assessment, or a significant 279.22 change assessment. Each quarterly assessment must be completed 279.23 within 92 days of the previous assessment. 279.24 Subd. 5. [SHORT STAYS.] (a) A facility must submit to the 279.25 commissioner of health an initial admission assessment for all 279.26 residents who stay in the facility less than 14 days. 279.27 (b) Notwithstanding the admission assessment requirements 279.28 of paragraph (a), a facility may elect to accept a default rate 279.29 with a case mix index of 1.0 for all facility residents who stay 279.30 less than 14 days in lieu of submitting an initial assessment. 279.31 Facilities may make this election to be effective on the day of 279.32 implementation of the revised case mix system. 279.33 (c) After implementation of the revised case mix system, 279.34 nursing facilities must elect one of the options described in 279.35 paragraphs (a) and (b) on the annual report to the commissioner 279.36 of human services filed for each report year ending September 280.1 30. The election shall be effective on the following July 1. 280.2 (d) For residents who are admitted or readmitted and leave 280.3 the facility on a frequent basis and for whom readmission is 280.4 expected, the resident may be discharged on an extended leave 280.5 status. This status does not require reassessment each time the 280.6 resident returns to the facility unless a significant change in 280.7 the resident's status has occurred since the last assessment. 280.8 The case mix classification for these residents is determined by 280.9 the facility election made in paragraphs (a) and (b). 280.10 Subd. 6. [PENALTIES FOR LATE OR NONSUBMISSION.] A facility 280.11 that fails to complete or submit an assessment for a RUG-III 280.12 classification within seven days of the time requirements in 280.13 subdivisions 4 and 5 is subject to a reduced rate for that 280.14 resident. The reduced rate shall be the lowest rate for that 280.15 facility. The reduced rate is effective on the day of admission 280.16 for new admission assessments or on the day that the assessment 280.17 was due for all other assessments and continues in effect until 280.18 the first day of the month following the date of submission of 280.19 the resident's assessment. 280.20 Subd. 7. [NOTICE OF RESIDENT REIMBURSEMENT 280.21 CLASSIFICATION.] (a) A facility must elect between the options 280.22 in clauses (1) and (2) to provide notice to a resident of the 280.23 resident's case mix classification. 280.24 (1) The commissioner of health shall provide to a nursing 280.25 facility a notice for each resident of the reimbursement 280.26 classification established under subdivision 1. The notice must 280.27 inform the resident of the classification that was assigned, the 280.28 opportunity to review the documentation supporting the 280.29 classification, the opportunity to obtain clarification from the 280.30 commissioner, and the opportunity to request a reconsideration 280.31 of the classification. The commissioner must send notice of 280.32 resident classification by first class mail. A nursing facility 280.33 is responsible for the distribution of the notice to each 280.34 resident, to the person responsible for the payment of the 280.35 resident's nursing home expenses, or to another person 280.36 designated by the resident. This notice must be distributed 281.1 within three working days after the facility's receipt of the 281.2 notice from the commissioner of health. 281.3 (2) A facility may choose to provide a classification 281.4 notice, as prescribed by the commissioner of health, to a 281.5 resident upon receipt of the confirmation of the case mix 281.6 classification calculated by a facility or a corrected case mix 281.7 classification as indicated on the final validation report from 281.8 the commissioner. A nursing facility is responsible for the 281.9 distribution of the notice to each resident, to the person 281.10 responsible for the payment of the resident's nursing home 281.11 expenses, or to another person designated by the resident. This 281.12 notice must be distributed within three working days after the 281.13 facility's receipt of the validation report from the 281.14 commissioner. If a facility elects this option, the 281.15 commissioner of health shall provide the facility with a list of 281.16 residents and their case mix classifications as determined by 281.17 the commissioner. A nursing facility may make this election to 281.18 be effective on the day of implementation of the revised case 281.19 mix system. 281.20 (3) After implementation of the revised case mix system, a 281.21 nursing facility shall elect a notice of resident reimbursement 281.22 classification procedure as described in clause (1) or (2) on 281.23 the annual report to the commissioner of human services filed 281.24 for each report year ending September 30. The election will be 281.25 effective the following July 1. 281.26 (b) If a facility submits a correction to an assessment 281.27 conducted under subdivision 3 that results in a change in case 281.28 mix classification, the facility shall give written notice to 281.29 the resident or the resident's representative about the item 281.30 that was corrected and the reason for the correction. The 281.31 notice of corrected assessment may be provided at the same time 281.32 that the resident or resident's representative is provided the 281.33 resident's corrected notice of classification. 281.34 Subd. 8. [REQUEST FOR RECONSIDERATION OF RESIDENT 281.35 CLASSIFICATIONS.] (a) The resident, or resident's 281.36 representative, or the nursing facility or boarding care home 282.1 may request that the commissioner of health reconsider the 282.2 assigned reimbursement classification. The request for 282.3 reconsideration must be submitted in writing to the commissioner 282.4 within 30 days of the day the resident or the resident's 282.5 representative receives the resident classification notice. The 282.6 request for reconsideration must include the name of the 282.7 resident, the name and address of the facility in which the 282.8 resident resides, the reasons for the reconsideration, the 282.9 requested classification changes, and documentation supporting 282.10 the requested classification. The documentation accompanying 282.11 the reconsideration request is limited to documentation which 282.12 establishes that the needs of the resident at the time of the 282.13 assessment justify a classification which is different than the 282.14 classification established by the commissioner of health. 282.15 (b) Upon request, the nursing facility must give the 282.16 resident or the resident's representative a copy of the 282.17 assessment form and the other documentation that was given to 282.18 the commissioner of health to support the assessment findings. 282.19 The nursing facility shall also provide access to and a copy of 282.20 other information from the resident's record that has been 282.21 requested by or on behalf of the resident to support a 282.22 resident's reconsideration request. A copy of any requested 282.23 material must be provided within three working days of receipt 282.24 of a written request for the information. If a facility fails 282.25 to provide the material within this time, it is subject to the 282.26 issuance of a correction order and penalty assessment under 282.27 sections 144.653 and 144A.10. Notwithstanding those sections, 282.28 any correction order issued under this subdivision must require 282.29 that the nursing facility immediately comply with the request 282.30 for information and that as of the date of the issuance of the 282.31 correction order, the facility shall forfeit to the state a $100 282.32 fine for the first day of noncompliance, and an increase in the 282.33 $100 fine by $50 increments for each day the noncompliance 282.34 continues. 282.35 (c) In addition to the information required under 282.36 paragraphs (a) and (b), a reconsideration request from a nursing 283.1 facility must contain the following information: (i) the date 283.2 the reimbursement classification notices were received by the 283.3 facility; (ii) the date the classification notices were 283.4 distributed to the resident or the resident's representative; 283.5 and (iii) a copy of a notice sent to the resident or to the 283.6 resident's representative. This notice must inform the resident 283.7 or the resident's representative that a reconsideration of the 283.8 resident's classification is being requested, the reason for the 283.9 request, that the resident's rate will change if the request is 283.10 approved by the commissioner, the extent of the change, that 283.11 copies of the facility's request and supporting documentation 283.12 are available for review, and that the resident also has the 283.13 right to request a reconsideration. If the facility fails to 283.14 provide the required information with the reconsideration 283.15 request, the request must be denied, and the facility may not 283.16 make further reconsideration requests on that specific 283.17 reimbursement classification. 283.18 (d) Reconsideration by the commissioner must be made by 283.19 individuals not involved in reviewing the assessment, audit, or 283.20 reconsideration that established the disputed classification. 283.21 The reconsideration must be based upon the initial assessment 283.22 and upon the information provided to the commissioner under 283.23 paragraphs (a) and (b). If necessary for evaluating the 283.24 reconsideration request, the commissioner may conduct on-site 283.25 reviews. Within 15 working days of receiving the request for 283.26 reconsideration, the commissioner shall affirm or modify the 283.27 original resident classification. The original classification 283.28 must be modified if the commissioner determines that the 283.29 assessment resulting in the classification did not accurately 283.30 reflect the needs or assessment characteristics of the resident 283.31 at the time of the assessment. The resident and the nursing 283.32 facility or boarding care home shall be notified within five 283.33 working days after the decision is made. A decision by the 283.34 commissioner under this subdivision is the final administrative 283.35 decision of the agency for the party requesting reconsideration. 283.36 (e) The resident classification established by the 284.1 commissioner shall be the classification that applies to the 284.2 resident while the request for reconsideration is pending. 284.3 (f) The commissioner may request additional documentation 284.4 regarding a reconsideration necessary to make an accurate 284.5 reconsideration determination. 284.6 Subd. 9. [AUDIT AUTHORITY.] (a) The commissioner shall 284.7 audit the accuracy of resident assessments performed under 284.8 section 256B.437 through desk audits, on-site review of 284.9 residents and their records, and interviews with staff and 284.10 families. The commissioner shall reclassify a resident if the 284.11 commissioner determines that the resident was incorrectly 284.12 classified. 284.13 (b) The commissioner is authorized to conduct on-site 284.14 audits on an unannounced basis. 284.15 (c) A facility must grant the commissioner access to 284.16 examine the medical records relating to the resident assessments 284.17 selected for audit under this subdivision. The commissioner may 284.18 also observe and speak to facility staff and residents. 284.19 (d) The commissioner shall consider documentation under the 284.20 time frames for coding items on the minimum data set as set out 284.21 in the Resident Assessment Instrument Manual published by the 284.22 Health Care Financing Administration. 284.23 (e) The commissioner shall develop an audit selection 284.24 procedure that includes the following factors: 284.25 (1) The commissioner may target facilities that demonstrate 284.26 an atypical pattern of scoring minimum data set items, 284.27 nonsubmission of assessments, late submission of assessments, or 284.28 a previous history of audit changes of greater than 35 percent. 284.29 The commissioner shall select at least 20 percent of the most 284.30 current assessments submitted to the state for audit. Audits of 284.31 assessments selected in the targeted facilities must focus on 284.32 the factors leading to the audit. If the number of targeted 284.33 assessments selected does not meet the threshold of 20 percent 284.34 of the facility residents, then a stratified sample of the 284.35 remainder of assessments shall be drawn to meet the quota. If 284.36 the total change exceeds 35 percent, the commissioner may 285.1 conduct an expanded audit up to 100 percent of the remaining 285.2 current assessments. 285.3 (2) Facilities that are not a part of the targeted group 285.4 shall be placed in a general pool from which facilities will be 285.5 selected on a random basis for audit. Every facility shall be 285.6 audited annually. If a facility has two successive audits in 285.7 which the percentage of change is five percent or less and the 285.8 facility has not been the subject of a targeted audit in the 285.9 past 36 months, the facility may be audited biannually. A 285.10 stratified sample of 15 percent of the most current assessments 285.11 shall be selected for audit. If more than 20 percent of the 285.12 RUGS-III classifications after the audit are changed, the audit 285.13 shall be expanded to a second 15 percent sample. If the total 285.14 change between the first and second samples exceed 35 percent, 285.15 the commissioner may expand the audit to all of the remaining 285.16 assessments. 285.17 (3) If a facility qualifies for an expanded audit, the 285.18 commissioner may audit the facility again within six months. If 285.19 a facility has two expanded audits within a 24-month period, 285.20 that facility will be audited at least every six months for the 285.21 next 18 months. 285.22 (4) The commissioner may conduct special audits if the 285.23 commissioner determines that circumstances exist that could 285.24 alter or affect the validity of case mix classifications of 285.25 residents. These circumstances include, but are not limited to, 285.26 the following: 285.27 (i) frequent changes in the administration or management of 285.28 the facility; 285.29 (ii) an unusually high percentage of residents in a 285.30 specific case mix classification; 285.31 (iii) a high frequency in the number of reconsideration 285.32 requests received from a facility; 285.33 (iv) frequent adjustments of case mix classifications as 285.34 the result of reconsiderations or audits; 285.35 (v) a criminal indictment alleging provider fraud; or 285.36 (vi) other similar factors that relate to a facility's 286.1 ability to conduct accurate assessments. 286.2 (f) Within 15 working days of completing the audit process, 286.3 the commissioner shall mail the written results of the audit to 286.4 the facility, along with a written notice for each resident 286.5 affected to be forwarded by the facility. The notice must 286.6 contain the resident's classification and a statement informing 286.7 the resident, the resident's authorized representative, and the 286.8 facility of their right to review the commissioner's documents 286.9 supporting the classification and to request a reconsideration 286.10 of the classification. This notice must also include the 286.11 address and telephone number of the area nursing home ombudsman. 286.12 Subd. 10. [TRANSITION.] After implementation of this 286.13 section, reconsiderations requested for classifications made 286.14 under section 144.0722, subdivision 1, shall be determined under 286.15 section 144.0722, subdivision 3. 286.16 Sec. 2. Minnesota Statutes 2000, section 144A.071, 286.17 subdivision 1, is amended to read: 286.18 Subdivision 1. [FINDINGS.] The legislature declares that a 286.19 moratorium on the licensure and medical assistance certification 286.20 of new nursing home beds and construction projects that 286.21 exceed$750,000$1,000,000 is necessary to control nursing home 286.22 expenditure growth and enable the state to meet the needs of its 286.23 elderly by providing high quality services in the most 286.24 appropriate manner along a continuum of care. 286.25 Sec. 3. Minnesota Statutes 2000, section 144A.071, 286.26 subdivision 1a, is amended to read: 286.27 Subd. 1a. [DEFINITIONS.] For purposes of sections 144A.071 286.28 to 144A.073, the following terms have the meanings given them: 286.29 (a) "attached fixtures" has the meaning given in Minnesota 286.30 Rules, part 9549.0020, subpart 6. 286.31 (b) "buildings" has the meaning given in Minnesota Rules, 286.32 part 9549.0020, subpart 7. 286.33 (c) "capital assets" has the meaning given in section 286.34 256B.421, subdivision 16. 286.35 (d) "commenced construction" means that all of the 286.36 following conditions were met: the final working drawings and 287.1 specifications were approved by the commissioner of health; the 287.2 construction contracts were let; a timely construction schedule 287.3 was developed, stipulating dates for beginning, achieving 287.4 various stages, and completing construction; and all zoning and 287.5 building permits were applied for. 287.6 (e) "completion date" means the date on which a certificate 287.7 of occupancy is issued for a construction project, or if a 287.8 certificate of occupancy is not required, the date on which the 287.9 construction project is available for facility use. 287.10 (f) "construction" means any erection, building, 287.11 alteration, reconstruction, modernization, or improvement 287.12 necessary to comply with the nursing home licensure rules. 287.13 (g) "construction project" means: 287.14 (1) a capital asset addition to, or replacement of a 287.15 nursing home or certified boarding care home that results in new 287.16 space or the remodeling of or renovations to existing facility 287.17 space; 287.18 (2) the remodeling or renovation of existing facility space 287.19 the use of which is modified as a result of the project 287.20 described in clause (1). This existing space and the project 287.21 described in clause (1) must be used for the functions as 287.22 designated on the construction plans on completion of the 287.23 project described in clause (1) for a period of not less than 24 287.24 months; or 287.25 (3) capital asset additions or replacements that are 287.26 completed within 12 months before or after the completion date 287.27 of the project described in clause (1). 287.28 (h) "new licensed" or "new certified beds" means: 287.29 (1) newly constructed beds in a facility or the 287.30 construction of a new facility that would increase the total 287.31 number of licensed nursing home beds or certified boarding care 287.32 or nursing home beds in the state; or 287.33 (2) newly licensed nursing home beds or newly certified 287.34 boarding care or nursing home beds that result from remodeling 287.35 of the facility that involves relocation of beds but does not 287.36 result in an increase in the total number of beds, except when 288.1 the project involves the upgrade of boarding care beds to 288.2 nursing home beds, as defined in section 144A.073, subdivision 288.3 1. "Remodeling" includes any of the type of conversion, 288.4 renovation, replacement, or upgrading projects as defined in 288.5 section 144A.073, subdivision 1. 288.6 (i) "project construction costs" means the cost of the 288.7 facility capital asset additions, replacements, renovations, or 288.8 remodeling projects, construction site preparation costs, and 288.9 related soft costs. Project construction costsalsoinclude the 288.10 cost of any remodeling or renovation of existing facility space 288.11 which is modified as a result of the construction 288.12 project. Project construction costs also includes the cost of 288.13 new technology implemented as part of the construction project. 288.14 (j) "technology" means information systems or devices that 288.15 make documentation, charting, and staff time more efficient or 288.16 encourage and allow for care through alternative settings 288.17 including, but not limited to, touch screens, monitors, 288.18 hand-helds, swipe cards, motion detectors, pagers, telemedicine, 288.19 medication dispensers, and equipment to monitor vital signs and 288.20 self-injections, and to observe skin and other conditions. 288.21 Sec. 4. Minnesota Statutes 2000, section 144A.071, 288.22 subdivision 2, is amended to read: 288.23 Subd. 2. [MORATORIUM.] The commissioner of health, in 288.24 coordination with the commissioner of human services, shall deny 288.25 each request for new licensed or certified nursing home or 288.26 certified boarding care beds except as provided in subdivision 3 288.27 or 4a, or section 144A.073. "Certified bed" means a nursing 288.28 home bed or a boarding care bed certified by the commissioner of 288.29 health for the purposes of the medical assistance program, under 288.30 United States Code, title 42, sections 1396 et seq. 288.31 The commissioner of human services, in coordination with 288.32 the commissioner of health, shall deny any request to issue a 288.33 license under section 252.28 and chapter 245A to a nursing home 288.34 or boarding care home, if that license would result in an 288.35 increase in the medical assistance reimbursement amount. 288.36 In addition, the commissioner of health must not approve 289.1 any construction project whose cost exceeds$750,000$1,000,000 289.2 unless: 289.3 (a) any construction costs exceeding$750,000$1,000,000 289.4 are not added to the facility's appraised value and are not 289.5 included in the facility's payment rate for reimbursement under 289.6 the medical assistance program; or 289.7 (b) the project: 289.8 (1) has been approved through the process described in 289.9 section 144A.073; 289.10 (2) meets an exception in subdivision 3 or 4a; 289.11 (3) is necessary to correct violations of state or federal 289.12 law issued by the commissioner of health; 289.13 (4) is necessary to repair or replace a portion of the 289.14 facility that was damaged by fire, lightning, groundshifts, or 289.15 other such hazards, including environmental hazards, provided 289.16 that the provisions of subdivision 4a, clause (a), are met; 289.17 (5) as of May 1, 1992, the facility has submitted to the 289.18 commissioner of health written documentation evidencing that the 289.19 facility meets the "commenced construction" definition as 289.20 specified in subdivision 1a, clause (d), or that substantial 289.21 steps have been taken prior to April 1, 1992, relating to the 289.22 construction project. "Substantial steps" require that the 289.23 facility has made arrangements with outside parties relating to 289.24 the construction project and include the hiring of an architect 289.25 or construction firm, submission of preliminary plans to the 289.26 department of health or documentation from a financial 289.27 institution that financing arrangements for the construction 289.28 project have been made; or 289.29 (6) is being proposed by a licensed nursing facility that 289.30 is not certified to participate in the medical assistance 289.31 program and will not result in new licensed or certified beds. 289.32 Prior to the final plan approval of any construction 289.33 project, the commissioner of health shall be provided with an 289.34 itemized cost estimate for the project construction costs. If a 289.35 construction project is anticipated to be completed in phases, 289.36 the total estimated cost of all phases of the project shall be 290.1 submitted to the commissioner and shall be considered as one 290.2 construction project. Once the construction project is 290.3 completed and prior to the final clearance by the commissioner, 290.4 the total project construction costs for the construction 290.5 project shall be submitted to the commissioner. If the final 290.6 project construction cost exceeds the dollar threshold in this 290.7 subdivision, the commissioner of human services shall not 290.8 recognize any of the project construction costs or the related 290.9 financing costs in excess of this threshold in establishing the 290.10 facility's property-related payment rate. 290.11 The dollar thresholds for construction projects are as 290.12 follows: for construction projects other than those authorized 290.13 in clauses (1) to (6), the dollar threshold 290.14 is$750,000$1,000,000. For projects authorized after July 1, 290.15 1993, under clause (1), the dollar threshold is the cost 290.16 estimate submitted with a proposal for an exception under 290.17 section 144A.073, plus inflation as calculated according to 290.18 section 256B.431, subdivision 3f, paragraph (a). For projects 290.19 authorized under clauses (2) to (4), the dollar threshold is the 290.20 itemized estimate project construction costs submitted to the 290.21 commissioner of health at the time of final plan approval, plus 290.22 inflation as calculated according to section 256B.431, 290.23 subdivision 3f, paragraph (a). 290.24 The commissioner of health shall adopt rules to implement 290.25 this section or to amend the emergency rules for granting 290.26 exceptions to the moratorium on nursing homes under section 290.27 144A.073. 290.28 Sec. 5. Minnesota Statutes 2000, section 144A.071, 290.29 subdivision 4a, is amended to read: 290.30 Subd. 4a. [EXCEPTIONS FOR REPLACEMENT BEDS.] It is in the 290.31 best interest of the state to ensure that nursing homes and 290.32 boarding care homes continue to meet the physical plant 290.33 licensing and certification requirements by permitting certain 290.34 construction projects. Facilities should be maintained in 290.35 condition to satisfy the physical and emotional needs of 290.36 residents while allowing the state to maintain control over 291.1 nursing home expenditure growth. 291.2 The commissioner of health in coordination with the 291.3 commissioner of human services, may approve the renovation, 291.4 replacement, upgrading, or relocation of a nursing home or 291.5 boarding care home, under the following conditions: 291.6 (a) to license or certify beds in a new facility 291.7 constructed to replace a facility or to make repairs in an 291.8 existing facility that was destroyed or damaged after June 30, 291.9 1987, by fire, lightning, or other hazard provided: 291.10 (i) destruction was not caused by the intentional act of or 291.11 at the direction of a controlling person of the facility; 291.12 (ii) at the time the facility was destroyed or damaged the 291.13 controlling persons of the facility maintained insurance 291.14 coverage for the type of hazard that occurred in an amount that 291.15 a reasonable person would conclude was adequate; 291.16 (iii) the net proceeds from an insurance settlement for the 291.17 damages caused by the hazard are applied to the cost of the new 291.18 facility or repairs; 291.19 (iv) the new facility is constructed on the same site as 291.20 the destroyed facility or on another site subject to the 291.21 restrictions in section 144A.073, subdivision 5; 291.22 (v) the number of licensed and certified beds in the new 291.23 facility does not exceed the number of licensed and certified 291.24 beds in the destroyed facility; and 291.25 (vi) the commissioner determines that the replacement beds 291.26 are needed to prevent an inadequate supply of beds. 291.27 Project construction costs incurred for repairs authorized under 291.28 this clause shall not be considered in the dollar threshold 291.29 amount defined in subdivision 2; 291.30 (b) to license or certify beds that are moved from one 291.31 location to another within a nursing home facility, provided the 291.32 total costs of remodeling performed in conjunction with the 291.33 relocation of beds does not exceed$750,000$1,000,000; 291.34 (c) to license or certify beds in a project recommended for 291.35 approval under section 144A.073; 291.36 (d) to license or certify beds that are moved from an 292.1 existing state nursing home to a different state facility, 292.2 provided there is no net increase in the number of state nursing 292.3 home beds; 292.4 (e) to certify and license as nursing home beds boarding 292.5 care beds in a certified boarding care facility if the beds meet 292.6 the standards for nursing home licensure, or in a facility that 292.7 was granted an exception to the moratorium under section 292.8 144A.073, and if the cost of any remodeling of the facility does 292.9 not exceed$750,000$1,000,000. If boarding care beds are 292.10 licensed as nursing home beds, the number of boarding care beds 292.11 in the facility must not increase beyond the number remaining at 292.12 the time of the upgrade in licensure. The provisions contained 292.13 in section 144A.073 regarding the upgrading of the facilities do 292.14 not apply to facilities that satisfy these requirements; 292.15 (f) to license and certify up to 40 beds transferred from 292.16 an existing facility owned and operated by the Amherst H. Wilder 292.17 Foundation in the city of St. Paul to a new unit at the same 292.18 location as the existing facility that will serve persons with 292.19 Alzheimer's disease and other related disorders. The transfer 292.20 of beds may occur gradually or in stages, provided the total 292.21 number of beds transferred does not exceed 40. At the time of 292.22 licensure and certification of a bed or beds in the new unit, 292.23 the commissioner of health shall delicense and decertify the 292.24 same number of beds in the existing facility. As a condition of 292.25 receiving a license or certification under this clause, the 292.26 facility must make a written commitment to the commissioner of 292.27 human services that it will not seek to receive an increase in 292.28 its property-related payment rate as a result of the transfers 292.29 allowed under this paragraph; 292.30 (g) to license and certify nursing home beds to replace 292.31 currently licensed and certified boarding care beds which may be 292.32 located either in a remodeled or renovated boarding care or 292.33 nursing home facility or in a remodeled, renovated, newly 292.34 constructed, or replacement nursing home facility within the 292.35 identifiable complex of health care facilities in which the 292.36 currently licensed boarding care beds are presently located, 293.1 provided that the number of boarding care beds in the facility 293.2 or complex are decreased by the number to be licensed as nursing 293.3 home beds and further provided that, if the total costs of new 293.4 construction, replacement, remodeling, or renovation exceed ten 293.5 percent of the appraised value of the facility or $200,000, 293.6 whichever is less, the facility makes a written commitment to 293.7 the commissioner of human services that it will not seek to 293.8 receive an increase in its property-related payment rate by 293.9 reason of the new construction, replacement, remodeling, or 293.10 renovation. The provisions contained in section 144A.073 293.11 regarding the upgrading of facilities do not apply to facilities 293.12 that satisfy these requirements; 293.13 (h) to license as a nursing home and certify as a nursing 293.14 facility a facility that is licensed as a boarding care facility 293.15 but not certified under the medical assistance program, but only 293.16 if the commissioner of human services certifies to the 293.17 commissioner of health that licensing the facility as a nursing 293.18 home and certifying the facility as a nursing facility will 293.19 result in a net annual savings to the state general fund of 293.20 $200,000 or more; 293.21 (i) to certify, after September 30, 1992, and prior to July 293.22 1, 1993, existing nursing home beds in a facility that was 293.23 licensed and in operation prior to January 1, 1992; 293.24 (j) to license and certify new nursing home beds to replace 293.25 beds in a facility acquired by the Minneapolis community 293.26 development agency as part of redevelopment activities in a city 293.27 of the first class, provided the new facility is located within 293.28 three miles of the site of the old facility. Operating and 293.29 property costs for the new facility must be determined and 293.30 allowed under section 256B.431 or 256B.434; 293.31 (k) to license and certify up to 20 new nursing home beds 293.32 in a community-operated hospital and attached convalescent and 293.33 nursing care facility with 40 beds on April 21, 1991, that 293.34 suspended operation of the hospital in April 1986. The 293.35 commissioner of human services shall provide the facility with 293.36 the same per diem property-related payment rate for each 294.1 additional licensed and certified bed as it will receive for its 294.2 existing 40 beds; 294.3 (l) to license or certify beds in renovation, replacement, 294.4 or upgrading projects as defined in section 144A.073, 294.5 subdivision 1, so long as the cumulative total costs of the 294.6 facility's remodeling projects do not 294.7 exceed$750,000$1,000,000; 294.8 (m) to license and certify beds that are moved from one 294.9 location to another for the purposes of converting up to five 294.10 four-bed wards to single or double occupancy rooms in a nursing 294.11 home that, as of January 1, 1993, was county-owned and had a 294.12 licensed capacity of 115 beds; 294.13 (n) to allow a facility that on April 16, 1993, was a 294.14 106-bed licensed and certified nursing facility located in 294.15 Minneapolis to layaway all of its licensed and certified nursing 294.16 home beds. These beds may be relicensed and recertified in a 294.17 newly-constructed teaching nursing home facility affiliated with 294.18 a teaching hospital upon approval by the legislature. The 294.19 proposal must be developed in consultation with the interagency 294.20 committee on long-term care planning. The beds on layaway 294.21 status shall have the same status as voluntarily delicensed and 294.22 decertified beds, except that beds on layaway status remain 294.23 subject to the surcharge in section 256.9657. This layaway 294.24 provision expires July 1, 1998; 294.25 (o) to allow a project which will be completed in 294.26 conjunction with an approved moratorium exception project for a 294.27 nursing home in southern Cass county and which is directly 294.28 related to that portion of the facility that must be repaired, 294.29 renovated, or replaced, to correct an emergency plumbing problem 294.30 for which a state correction order has been issued and which 294.31 must be corrected by August 31, 1993; 294.32 (p) to allow a facility that on April 16, 1993, was a 294.33 368-bed licensed and certified nursing facility located in 294.34 Minneapolis to layaway, upon 30 days prior written notice to the 294.35 commissioner, up to 30 of the facility's licensed and certified 294.36 beds by converting three-bed wards to single or double 295.1 occupancy. Beds on layaway status shall have the same status as 295.2 voluntarily delicensed and decertified beds except that beds on 295.3 layaway status remain subject to the surcharge in section 295.4 256.9657, remain subject to the license application and renewal 295.5 fees under section 144A.07 and shall be subject to a $100 per 295.6 bed reactivation fee. In addition, at any time within three 295.7 years of the effective date of the layaway, the beds on layaway 295.8 status may be: 295.9 (1) relicensed and recertified upon relocation and 295.10 reactivation of some or all of the beds to an existing licensed 295.11 and certified facility or facilities located in Pine River, 295.12 Brainerd, or International Falls; provided that the total 295.13 project construction costs related to the relocation of beds 295.14 from layaway status for any facility receiving relocated beds 295.15 may not exceed the dollar threshold provided in subdivision 2 295.16 unless the construction project has been approved through the 295.17 moratorium exception process under section 144A.073; 295.18 (2) relicensed and recertified, upon reactivation of some 295.19 or all of the beds within the facility which placed the beds in 295.20 layaway status, if the commissioner has determined a need for 295.21 the reactivation of the beds on layaway status. 295.22 The property-related payment rate of a facility placing 295.23 beds on layaway status must be adjusted by the incremental 295.24 change in its rental per diem after recalculating the rental per 295.25 diem as provided in section 256B.431, subdivision 3a, paragraph 295.26 (c). The property-related payment rate for a facility 295.27 relicensing and recertifying beds from layaway status must be 295.28 adjusted by the incremental change in its rental per diem after 295.29 recalculating its rental per diem using the number of beds after 295.30 the relicensing to establish the facility's capacity day 295.31 divisor, which shall be effective the first day of the month 295.32 following the month in which the relicensing and recertification 295.33 became effective. Any beds remaining on layaway status more 295.34 than three years after the date the layaway status became 295.35 effective must be removed from layaway status and immediately 295.36 delicensed and decertified; 296.1 (q) to license and certify beds in a renovation and 296.2 remodeling project to convert 12 four-bed wards into 24 two-bed 296.3 rooms, expand space, and add improvements in a nursing home 296.4 that, as of January 1, 1994, met the following conditions: the 296.5 nursing home was located in Ramsey county; had a licensed 296.6 capacity of 154 beds; and had been ranked among the top 15 296.7 applicants by the 1993 moratorium exceptions advisory review 296.8 panel. The total project construction cost estimate for this 296.9 project must not exceed the cost estimate submitted in 296.10 connection with the 1993 moratorium exception process; 296.11 (r) to license and certify up to 117 beds that are 296.12 relocated from a licensed and certified 138-bed nursing facility 296.13 located in St. Paul to a hospital with 130 licensed hospital 296.14 beds located in South St. Paul, provided that the nursing 296.15 facility and hospital are owned by the same or a related 296.16 organization and that prior to the date the relocation is 296.17 completed the hospital ceases operation of its inpatient 296.18 hospital services at that hospital. After relocation, the 296.19 nursing facility's status under section 256B.431, subdivision 296.20 2j, shall be the same as it was prior to relocation. The 296.21 nursing facility's property-related payment rate resulting from 296.22 the project authorized in this paragraph shall become effective 296.23 no earlier than April 1, 1996. For purposes of calculating the 296.24 incremental change in the facility's rental per diem resulting 296.25 from this project, the allowable appraised value of the nursing 296.26 facility portion of the existing health care facility physical 296.27 plant prior to the renovation and relocation may not exceed 296.28 $2,490,000; 296.29 (s) to license and certify two beds in a facility to 296.30 replace beds that were voluntarily delicensed and decertified on 296.31 June 28, 1991; 296.32 (t) to allow 16 licensed and certified beds located on July 296.33 1, 1994, in a 142-bed nursing home and 21-bed boarding care home 296.34 facility in Minneapolis, notwithstanding the licensure and 296.35 certification after July 1, 1995, of the Minneapolis facility as 296.36 a 147-bed nursing home facility after completion of a 297.1 construction project approved in 1993 under section 144A.073, to 297.2 be laid away upon 30 days' prior written notice to the 297.3 commissioner. Beds on layaway status shall have the same status 297.4 as voluntarily delicensed or decertified beds except that they 297.5 shall remain subject to the surcharge in section 256.9657. The 297.6 16 beds on layaway status may be relicensed as nursing home beds 297.7 and recertified at any time within five years of the effective 297.8 date of the layaway upon relocation of some or all of the beds 297.9 to a licensed and certified facility located in Watertown, 297.10 provided that the total project construction costs related to 297.11 the relocation of beds from layaway status for the Watertown 297.12 facility may not exceed the dollar threshold provided in 297.13 subdivision 2 unless the construction project has been approved 297.14 through the moratorium exception process under section 144A.073. 297.15 The property-related payment rate of the facility placing 297.16 beds on layaway status must be adjusted by the incremental 297.17 change in its rental per diem after recalculating the rental per 297.18 diem as provided in section 256B.431, subdivision 3a, paragraph 297.19 (c). The property-related payment rate for the facility 297.20 relicensing and recertifying beds from layaway status must be 297.21 adjusted by the incremental change in its rental per diem after 297.22 recalculating its rental per diem using the number of beds after 297.23 the relicensing to establish the facility's capacity day 297.24 divisor, which shall be effective the first day of the month 297.25 following the month in which the relicensing and recertification 297.26 became effective. Any beds remaining on layaway status more 297.27 than five years after the date the layaway status became 297.28 effective must be removed from layaway status and immediately 297.29 delicensed and decertified; 297.30 (u) to license and certify beds that are moved within an 297.31 existing area of a facility or to a newly constructed addition 297.32 which is built for the purpose of eliminating three- and 297.33 four-bed rooms and adding space for dining, lounge areas, 297.34 bathing rooms, and ancillary service areas in a nursing home 297.35 that, as of January 1, 1995, was located in Fridley and had a 297.36 licensed capacity of 129 beds; 298.1 (v) to relocate 36 beds in Crow Wing county and four beds 298.2 from Hennepin county to a 160-bed facility in Crow Wing county, 298.3 provided all the affected beds are under common ownership; 298.4 (w) to license and certify a total replacement project of 298.5 up to 49 beds located in Norman county that are relocated from a 298.6 nursing home destroyed by flood and whose residents were 298.7 relocated to other nursing homes. The operating cost payment 298.8 rates for the new nursing facility shall be determined based on 298.9 the interim and settle-up payment provisions of Minnesota Rules, 298.10 part 9549.0057, and the reimbursement provisions of section 298.11 256B.431, except that subdivision 26, paragraphs (a) and (b), 298.12 shall not apply until the second rate year after the settle-up 298.13 cost report is filed. Property-related reimbursement rates 298.14 shall be determined under section 256B.431, taking into account 298.15 any federal or state flood-related loans or grants provided to 298.16 the facility; 298.17 (x) to license and certify a total replacement project of 298.18 up to 129 beds located in Polk county that are relocated from a 298.19 nursing home destroyed by flood and whose residents were 298.20 relocated to other nursing homes. The operating cost payment 298.21 rates for the new nursing facility shall be determined based on 298.22 the interim and settle-up payment provisions of Minnesota Rules, 298.23 part 9549.0057, and the reimbursement provisions of section 298.24 256B.431, except that subdivision 26, paragraphs (a) and (b), 298.25 shall not apply until the second rate year after the settle-up 298.26 cost report is filed. Property-related reimbursement rates 298.27 shall be determined under section 256B.431, taking into account 298.28 any federal or state flood-related loans or grants provided to 298.29 the facility; 298.30 (y) to license and certify beds in a renovation and 298.31 remodeling project to convert 13 three-bed wards into 13 two-bed 298.32 rooms and 13 single-bed rooms, expand space, and add 298.33 improvements in a nursing home that, as of January 1, 1994, met 298.34 the following conditions: the nursing home was located in 298.35 Ramsey county, was not owned by a hospital corporation, had a 298.36 licensed capacity of 64 beds, and had been ranked among the top 299.1 15 applicants by the 1993 moratorium exceptions advisory review 299.2 panel. The total project construction cost estimate for this 299.3 project must not exceed the cost estimate submitted in 299.4 connection with the 1993 moratorium exception process; 299.5 (z) to license and certify up to 150 nursing home beds to 299.6 replace an existing 285 bed nursing facility located in St. 299.7 Paul. The replacement project shall include both the renovation 299.8 of existing buildings and the construction of new facilities at 299.9 the existing site. The reduction in the licensed capacity of 299.10 the existing facility shall occur during the construction 299.11 project as beds are taken out of service due to the construction 299.12 process. Prior to the start of the construction process, the 299.13 facility shall provide written information to the commissioner 299.14 of health describing the process for bed reduction, plans for 299.15 the relocation of residents, and the estimated construction 299.16 schedule. The relocation of residents shall be in accordance 299.17 with the provisions of law and rule; 299.18 (aa) to allow the commissioner of human services to license 299.19 an additional 36 beds to provide residential services for the 299.20 physically handicapped under Minnesota Rules, parts 9570.2000 to 299.21 9570.3400, in a 198-bed nursing home located in Red Wing, 299.22 provided that the total number of licensed and certified beds at 299.23 the facility does not increase; 299.24 (bb) to license and certify a new facility in St. Louis 299.25 county with 44 beds constructed to replace an existing facility 299.26 in St. Louis county with 31 beds, which has resident rooms on 299.27 two separate floors and an antiquated elevator that creates 299.28 safety concerns for residents and prevents nonambulatory 299.29 residents from residing on the second floor. The project shall 299.30 include the elimination of three- and four-bed rooms; 299.31 (cc) to license and certify four beds in a 16-bed certified 299.32 boarding care home in Minneapolis to replace beds that were 299.33 voluntarily delicensed and decertified on or before March 31, 299.34 1992. The licensure and certification is conditional upon the 299.35 facility periodically assessing and adjusting its resident mix 299.36 and other factors which may contribute to a potential 300.1 institution for mental disease declaration. The commissioner of 300.2 human services shall retain the authority to audit the facility 300.3 at any time and shall require the facility to comply with any 300.4 requirements necessary to prevent an institution for mental 300.5 disease declaration, including delicensure and decertification 300.6 of beds, if necessary;or300.7 (dd) to license and certify 72 beds in an existing facility 300.8 in Mille Lacs county with 80 beds as part of a renovation 300.9 project. The renovation must include construction of an 300.10 addition to accommodate ten residents with beginning and 300.11 midstage dementia in a self-contained living unit; creation of 300.12 three resident households where dining, activities, and support 300.13 spaces are located near resident living quarters; designation of 300.14 four beds for rehabilitation in a self-contained area; 300.15 designation of 30 private rooms; and other improvements.; 300.16 (ee) to license and certify beds in a facility that has 300.17 undergone replacement or remodeling as part of a planned closure 300.18 under section 256B.437; 300.19 (ff) to license and certify a total replacement project of 300.20 up to 124 beds located in Wilkin county that are in need of 300.21 relocation from a nursing home substantially destroyed by 300.22 flood. The operating cost payment rates for the new nursing 300.23 facility shall be determined based on the interim and settle-up 300.24 payment provisions of Minnesota Rules, part 9549.0057, and the 300.25 reimbursement provisions of section 256B.431, except that 300.26 section 256B.431, subdivision 26, paragraphs (a) and (b), shall 300.27 not apply until the second rate year after the settle-up cost 300.28 report is filed. Property-related reimbursement rates shall be 300.29 determined under section 256B.431, taking into account any 300.30 federal or state flood-related loans or grants provided to the 300.31 facility; 300.32 (gg) to allow the commissioner of human services to license 300.33 an additional nine beds to provide residential services for the 300.34 physically handicapped under Minnesota Rules, parts 9570.2000 to 300.35 9570.3400, in a 215-bed nursing home located in Duluth, provided 300.36 that the total number of licensed and certified beds at the 301.1 facility does not increase; 301.2 (hh) to license and certify up to 120 new nursing facility 301.3 beds to replace beds in a facility in Anoka county, which was 301.4 licensed for 98 beds as of July 1, 2000, provided the new 301.5 facility is located within four miles of the existing facility 301.6 and is in Anoka county. Operating and property rates shall be 301.7 determined and allowed under section 256B.431 and Minnesota 301.8 Rules, parts 9549.0010 to 9549.0080, or section 256B.434 or 301.9 256B.435. The provisions of section 256B.431, subdivision 26, 301.10 paragraphs (a) and (b), do not apply until the second rate year 301.11 following settle-up; or 301.12 (ii) to transfer up to 98 beds of a 129-licensed bed 301.13 facility located in Anoka county that, as of March 25, 2001, is 301.14 in the active process of closing, to a 122-licensed bed 301.15 nonprofit nursing facility located in the city of Columbia 301.16 Heights or its affiliate. The transfer is effective when the 301.17 receiving facility notifies the commissioner in writing of the 301.18 number of beds accepted. The commissioner shall place all 301.19 transferred beds on layaway status held in the name of the 301.20 receiving facility. The layaway adjustment provisions of 301.21 section 256B.431, subdivision 30, do not apply to this layaway. 301.22 The receiving facility may only remove the beds from layaway for 301.23 recertification and relicensure at the receiving facility's 301.24 current site, or at a newly constructed facility located in 301.25 Anoka county. The receiving facility must receive statutory 301.26 authorization before removing these beds from layaway. 301.27 Sec. 6. Minnesota Statutes 2000, section 144A.073, 301.28 subdivision 2, is amended to read: 301.29 Subd. 2. [REQUEST FOR PROPOSALS.] At the authorization by 301.30 the legislature of additional medical assistance expenditures 301.31 for exceptions to the moratorium on nursing homes, the 301.32 interagency committee shall publish in the State Register a 301.33 request for proposals for nursing home projects to be licensed 301.34 or certified under section 144A.071, subdivision 4a, clause 301.35 (c). The public notice of this funding and the request for 301.36 proposals must specify how the approval criteria will be 302.1 prioritized by the advisory review panel, the interagency 302.2 long-term care planning committee, and the commissioner. The 302.3 notice must describe the information that must accompany a 302.4 request and state that proposals must be submitted to the 302.5 interagency committee within 90 days of the date of 302.6 publication. The notice must include the amount of the 302.7 legislative appropriation available for the additional costs to 302.8 the medical assistance program of projects approved under this 302.9 section. If no money is appropriated for a year, the 302.10 interagency committee shall publish a notice to that effect, and 302.11 no proposals shall be requested. If money is appropriated, the 302.12 interagency committee shall initiate the application and review 302.13 process described in this section at least twice each biennium 302.14 and up to four times each biennium, according to dates 302.15 established by rule. Authorized funds shall be allocated 302.16 proportionally to the number of processes. Funds not encumbered 302.17 by an earlier process within a biennium shall carry forward to 302.18 subsequent iterations of the process. Authorization for 302.19 expenditures does not carry forward into the following 302.20 biennium. To be considered for approval, a proposal must 302.21 include the following information: 302.22 (1) whether the request is for renovation, replacement, 302.23 upgrading, conversion, or relocation; 302.24 (2) a description of the problem the project is designed to 302.25 address; 302.26 (3) a description of the proposed project; 302.27 (4) an analysis of projected costs of the nursing facility 302.28 proposal, which are not required to exceed the cost threshold 302.29 referred to in section 144A.071, subdivision 1, to be considered 302.30 under this section, including initial construction and 302.31 remodeling costs; site preparation costs; technology costs; 302.32 financing costs, including the current estimated long-term 302.33 financing costs of the proposal, which consists of estimates of 302.34 the amount and sources of money, reserves if required under the 302.35 proposed funding mechanism, annual payments schedule, interest 302.36 rates, length of term, closing costs and fees, insurance costs, 303.1 and any completed marketing study or underwriting review; and 303.2 estimated operating costs during the first two years after 303.3 completion of the project; 303.4 (5) for proposals involving replacement of all or part of a 303.5 facility, the proposed location of the replacement facility and 303.6 an estimate of the cost of addressing the problem through 303.7 renovation; 303.8 (6) for proposals involving renovation, an estimate of the 303.9 cost of addressing the problem through replacement; 303.10 (7) the proposed timetable for commencing construction and 303.11 completing the project; 303.12 (8) a statement of any licensure or certification issues, 303.13 such as certification survey deficiencies; 303.14 (9) the proposed relocation plan for current residents if 303.15 beds are to be closed so that the department of human services 303.16 can estimate the total costs of a proposal; and 303.17 (10) other information required by permanent rule of the 303.18 commissioner of health in accordance with subdivisions 4 and 8. 303.19 Sec. 7. Minnesota Statutes 2000, section 144A.073, 303.20 subdivision 4, is amended to read: 303.21 Subd. 4. [CRITERIA FOR REVIEW.] The following criteria 303.22 shall be used in a consistent manner to compare, evaluate, and 303.23 rank all proposals submitted. Except for the criteria specified 303.24 in clause (3), the application of criteria listed under this 303.25 subdivision shall not reflect any distinction based on the 303.26 geographic location of the proposed project: 303.27 (1) the extent to which the proposal furthers state 303.28 long-term care goals,including the goals stated in section303.29144A.31, andincluding the goal of enhancing the availability 303.30 and use of alternative care services and the goal of reducing 303.31 the number of long-term care resident rooms with more than two 303.32 beds; 303.33 (2) the proposal's long-term effects on state costs 303.34 including the cost estimate of the project according to section 303.35 144A.071, subdivision 5a; 303.36 (3) the extent to which the proposal promotes equitable 304.1 access to long-term care services in nursing homes through 304.2 redistribution of the nursing home bed supply, as measured by 304.3 the number of beds relative to the population 85 or older, 304.4 projected to the year 2000 by the state demographer, and 304.5 according to items (i) to (iv): 304.6 (i) reduce beds in counties where the supply is high, 304.7 relative to the statewide mean, and increase beds in counties 304.8 where the supply is low, relative to the statewide mean; 304.9 (ii) adjust the bed supply so as to create the greatest 304.10 benefits in improving the distribution of beds; 304.11 (iii) adjust the existing bed supply in counties so that 304.12 the bed supply in a county moves toward the statewide mean; and 304.13 (iv) adjust the existing bed supply so that the 304.14 distribution of beds as projected for the year 2020 would be 304.15 consistent with projected need, based on the methodology 304.16 outlined in the interagency long-term care committee's1993304.17 nursing home bed distribution study; 304.18 (4) the extent to which the project improves conditions 304.19 that affect the health or safety of residents, such as narrow 304.20 corridors, narrow door frames, unenclosed fire exits, and wood 304.21 frame construction, and similar provisions contained in fire and 304.22 life safety codes and licensure and certification rules; 304.23 (5) the extent to which the project improves conditions 304.24 that affect the comfort or quality of life of residents in a 304.25 facility or the ability of the facility to provide efficient 304.26 care, such as a relatively high number of residents in a room; 304.27 inadequate lighting or ventilation; poor access to bathing or 304.28 toilet facilities; a lack of available ancillary space for 304.29 dining rooms, day rooms, or rooms used for other activities; 304.30 problems relating to heating, cooling, or energy efficiency; 304.31 inefficient location of nursing stations; narrow corridors; or 304.32 other provisions contained in the licensure and certification 304.33 rules; 304.34 (6) the extent to which the applicant demonstrates the 304.35 delivery of quality care, as defined in state and federal 304.36 statutes and rules, to residents as evidenced by the two most 305.1 recent state agency certification surveys and the applicants' 305.2 response to those surveys; 305.3 (7) the extent to which the project removes the need for 305.4 waivers or variances previously granted by either the licensing 305.5 agency, certifying agency, fire marshal, or local government 305.6 entity;and305.7 (8) the extent to which the project increases the number of 305.8 private or single bed rooms; and 305.9 (9) other factors that may be developed in permanent rule 305.10 by the commissioner of health that evaluate and assess how the 305.11 proposed project will further promote or protect the health, 305.12 safety, comfort, treatment, or well-being of the facility's 305.13 residents. 305.14 Sec. 8. [144A.185] [DEFINITIONS.] 305.15 Subdivision 1. [APPLICABILITY.] For purposes of sections 305.16 144A.185 to 144A.1887, the terms defined in this section have 305.17 the meanings given them. 305.18 Subd. 2. [CLOSURE.] "Closure" means the cessation of 305.19 operations of a nursing home and the delicensure or 305.20 decertification of all beds within the facility. 305.21 Subd. 3. [CURTAILMENT, REDUCTION, OR CHANGE IN 305.22 OPERATIONS.] "Curtailment, reduction, or change in operations" 305.23 means any change in operations or services that would result in 305.24 or encourage the relocation of residents. 305.25 Subd. 4. [FACILITY.] "Facility" means a licensed nursing 305.26 home or a certified boarding care home licensed according to 305.27 sections 144.50 to 144.56. 305.28 Subd. 5. [LICENSEE.] "Licensee" means the owner of the 305.29 facility or the owner's designee or the commissioner of health 305.30 for a facility in receivership. 305.31 Subd. 6. [LOCAL AGENCY.] "Local agency" means a county or 305.32 a multicounty social service agency authorized under section 305.33 393.01 as the agency responsible for providing social services 305.34 for the county in which the facility is located. 305.35 Subd. 7. [PLAN.] "Plan" means a process developed under 305.36 section 144A.186 for the closure or curtailment, reduction, or 306.1 change in operations of a facility and for the subsequent 306.2 relocation of residents. 306.3 Subd. 8. [RELOCATION.] "Relocation" means the discharge of 306.4 a resident and movement of the resident to another facility or 306.5 living arrangement as a result of a closure or curtailment, 306.6 reduction, or change in operations of a facility. 306.7 Sec. 9. [144A.1855] [INITIAL NOTICE.] 306.8 Subdivision 1. [NOTIFICATION; PARTIES.] A licensee shall 306.9 notify the following parties in writing when there is an intent 306.10 to close or curtail, reduce, or change operations which would 306.11 result in or encourage the relocation of residents: 306.12 (1) the commissioner of health; 306.13 (2) the commissioner of human services; 306.14 (3) the local agency; 306.15 (4) the office of the ombudsman for older Minnesotans; and 306.16 (5) the office of the ombudsman for mental health and 306.17 mental retardation. 306.18 Subd. 2. [NOTICE REQUIREMENTS.] The written notice shall 306.19 include the names, telephone numbers, fax numbers, and e-mail 306.20 addresses of the persons in the facility who are responsible for 306.21 coordinating the facility's efforts in the planning process and 306.22 the number of residents potentially affected by the closure or 306.23 curtailment, reduction, or change in operations. 306.24 Sec. 10. [144A.186] [PLANNING PROCESS.] 306.25 Subdivision 1. [LOCAL AGENCY REQUIREMENTS.] (a) A local 306.26 agency, within five working days of receiving an initial notice 306.27 from a licensee according to section 144A.1855, shall provide 306.28 all parties identified in section 144A.1855, subdivision 1, with 306.29 the names, telephone numbers, fax numbers, and e-mail addresses 306.30 of those persons who are responsible for coordinating local 306.31 agency efforts in the planning process. 306.32 (b) Within ten working days of receipt of the notice under 306.33 paragraph (a), the local agency and licensee shall meet to 306.34 develop the relocation plan under subdivision 2. The local 306.35 agency shall inform the departments of health and human 306.36 services, the office of the ombudsman for older Minnesotans, and 307.1 the office of the ombudsman for mental health and mental 307.2 retardation of the date, time, and location of the meeting so 307.3 that their representatives may attend. The relocation plan must 307.4 be completed within 45 days, but may be completed earlier 307.5 according to a schedule agreed to by all parties. 307.6 Subd. 2. [RELOCATION PLAN.] (a) The plan shall: 307.7 (1) identify the expected date of closure or curtailment, 307.8 reduction, or change in operations; 307.9 (2) outline the process for public notification of the 307.10 closure or curtailment, reduction, or change in operations; 307.11 (3) outline the process to ensure 60-day advance written 307.12 notice to residents, family members, and designated 307.13 representatives of residents; 307.14 (4) present an aggregate description of the resident 307.15 population remaining to be relocated and the population's needs; 307.16 (5) outline the individual resident assessment process to 307.17 be used; 307.18 (6) identify an inventory of available relocation options, 307.19 including home and community-based services; 307.20 (7) identify a timeline for submission of the list required 307.21 under section 144A.1865, subdivision 3; and 307.22 (8) identify a schedule for each element of the plan. 307.23 (b) All parties to the plan shall refrain from any public 307.24 notification of the intent to close or curtail, reduce, or 307.25 change operations until a relocation plan has been established. 307.26 Sec. 11. [144A.1865] [REQUIREMENTS OF LICENSEE.] 307.27 Subdivision 1. [RELOCATION.] The licensee shall provide 307.28 for the safe, orderly, and appropriate relocation of residents. 307.29 The licensee and facility staff shall cooperate with 307.30 representatives from the local agency, the departments of health 307.31 and human services, the office of the ombudsman for older 307.32 Minnesotans, and the office of the ombudsman for mental health 307.33 and mental retardation in planning for and implementing the 307.34 relocation of residents. 307.35 Subd. 2. [INTERDISCIPLINARY TEAM.] The licensee shall 307.36 establish an interdisciplinary team responsible for coordinating 308.1 and implementing the plan under section 144A.186, subdivision 308.2 2. The interdisciplinary team shall include representatives 308.3 from the local agency, the office of the ombudsman for older 308.4 Minnesotans, facility staff who provide direct care services to 308.5 the residents, and the facility administration. 308.6 Subd. 3. [RESIDENT LISTS.] The licensee shall provide a 308.7 list to the local agency that includes the following information 308.8 on each resident to be relocated: 308.9 (1) name; 308.10 (2) date of birth; 308.11 (3) social security number; 308.12 (4) medical assistance ID number; 308.13 (5) all diagnoses; and 308.14 (6) name of and contact information for the resident's 308.15 family or other designated representative. 308.16 Subd. 4. [CONSULTATION WITH LOCAL AGENCY.] The licensee 308.17 shall consult with the local agency on the availability and 308.18 development of resources and in the resident relocation process. 308.19 [EFFECTIVE DATE.] This section is effective the day 308.20 following final enactment. 308.21 Sec. 12. [144A.187] [RESIDENT AND PHYSICIAN NOTICE.] 308.22 Subdivision 1. [RESIDENT NOTICE REQUIRED.] (a) At least 60 308.23 days before the proposed date of closure or curtailment, 308.24 reduction, or change in operations as agreed to in the plan 308.25 under section 144A.186, the licensee shall send a written notice 308.26 of closure or curtailment, reduction, or change in operations to 308.27 each resident being relocated, the resident's family member or 308.28 designated representative, and the resident's attending 308.29 physician. 308.30 (b) The notice must include: 308.31 (1) the date of the proposed closure or curtailment, 308.32 reduction, or change in operations; 308.33 (2) the name, address, telephone number, fax number, and 308.34 e-mail address of the individuals in the facility responsible 308.35 for providing assistance and information; 308.36 (3) a notice of upcoming meetings for residents, families 309.1 and designated representatives, and resident and family councils 309.2 to discuss the relocation of residents; 309.3 (4) the name, address, and telephone number of the local 309.4 agency contact person; 309.5 (5) the name, address, and telephone number of the office 309.6 of the ombudsman for older Minnesotans and the office of the 309.7 ombudsman for mental health and mental retardation; and 309.8 (6) a notice of resident rights during discharge and 309.9 relocation. 309.10 (c) The notice to residents must comply with all applicable 309.11 state and federal requirements for notice of transfer or 309.12 discharge of nursing home residents. 309.13 Subd. 2. [MEDICAL INFORMATION REQUEST.] The licensee shall 309.14 request the attending physician to furnish the licensee with, or 309.15 arrange for the release of, any medical information needed to 309.16 update a resident's medical records and to prepare transfer 309.17 forms and discharge summaries. 309.18 Sec. 13. [144A.1875] [RELOCATION OF RESIDENTS.] 309.19 Subdivision 1. [PREPARATION; PLACEMENT INFORMATION.] A 309.20 licensee shall provide sufficient preparation to residents to 309.21 ensure safe, orderly, and appropriate discharge and relocation. 309.22 The facility is responsible for assisting residents in finding 309.23 placement within the resident's desired geographic location 309.24 using the Senior LinkAge database of the department of human 309.25 services. By January 1, 2002, Senior LinkAge line shall make 309.26 available via a Web site the name, address, and telephone and 309.27 fax numbers of each facility with available beds, the 309.28 certification level of the available beds, the types of services 309.29 available, and the number of beds that are available as updated 309.30 daily by the licensee. The Web site shall include the 309.31 information required by section 256.975, subdivision 7, 309.32 paragraph (b), clause (1), and home and community-based services 309.33 and other options for individuals with special needs. The 309.34 licensee must provide residents, their families or designated 309.35 representatives, the office of the ombudsman for older 309.36 Minnesotans, the office of the ombudsman for mental health and 310.1 mental retardation, and the local agency with the toll-free 310.2 number and Web site address for the Senior LinkAge line. 310.3 Subd. 2. [RESIDENT AND FAMILY MEETINGS.] After preparing 310.4 the plan according to section 144A.186, the licensee shall 310.5 conduct meetings with residents, families and designated 310.6 representatives, and resident and family councils to notify them 310.7 of the process for resident relocation. Representatives from 310.8 the local agency, the office of the ombudsman for older 310.9 Minnesotans, the office of the ombudsman for mental health and 310.10 mental retardation, the departments of health and human services 310.11 shall receive advance notice of these meetings. 310.12 Subd. 3. [PERSONAL PROPERTY.] (a) The licensee shall 310.13 update the inventory of residents' personal possessions and 310.14 provide a copy of the final inventory to each resident and the 310.15 resident's family or designated representative prior to the 310.16 relocation of the resident. The licensee is responsible for the 310.17 timely transfer of a resident's possessions for all relocations 310.18 within the state and within a 50-mile radius of the facility for 310.19 relocations outside the state. 310.20 (b) The licensee shall complete a final accounting of 310.21 personal funds held in trust by the licensee and provide a copy 310.22 of the accounting to each resident and the resident's family or 310.23 designated representative. The licensee is responsible for the 310.24 timely transfer of all personal funds held in trust by the 310.25 licensee. 310.26 Subd. 4. [SITE VISITS.] The licensee is responsible for 310.27 assisting residents desiring to make site visits to facilities 310.28 or other placements to which the resident may be relocated, 310.29 unless it is medically inadvisable, as documented by the 310.30 attending physician in the resident's care record. The licensee 310.31 shall provide, or make arrangements for, transportation for site 310.32 visits to facilities or other placements within a 50-mile radius. 310.33 Subd. 5. [FINAL NOTICE OF RELOCATION.] (a) Before 310.34 relocating a resident, the licensee shall provide a final 310.35 written notice to the resident, the resident's family or 310.36 designated representative, and the resident's attending 311.1 physician. 311.2 (b) The final written notice shall: 311.3 (1) be provided seven days before the relocation of a 311.4 resident, unless the resident agrees to waive the resident's 311.5 right to advance notice; and 311.6 (2) identify the date of the anticipated relocation and the 311.7 location to which the resident is being relocated. 311.8 Subd. 6. [ADMINISTRATIVE DUTIES.] (a) All administrative 311.9 duties of the licensee under subdivisions 1, 2, 4, and 5 must be 311.10 completed before relocation of a resident. 311.11 (b) The licensee is responsible for providing the receiving 311.12 facility or other health, housing, or care entity with a 311.13 complete and accurate resident record, including information on 311.14 family members, designated representatives, guardians, social 311.15 service caseworkers, and other contact information. The record 311.16 must also include all information necessary to provide 311.17 appropriate medical care and social services, including, but not 311.18 limited to, information on preadmission screening, Level I and 311.19 Level II screening, minimum data set and all other assessments, 311.20 resident diagnosis, behavior, and medication. 311.21 (c) For residents with special care needs, the licensee 311.22 shall consult with the receiving facility or other placement 311.23 entity and provide staff training or other preparation as needed 311.24 to assist in providing for the special needs. 311.25 (d) The licensee shall assist residents with the transfer 311.26 or reconnection of telephone service. The licensee shall bear 311.27 all costs associated with reestablishing telephone service. 311.28 Subd. 7. [TRANSPORTATION; CONTINUITY OF CARE.] The 311.29 licensee shall make arrangements or provide for the 311.30 transportation of residents to the new facility or placement 311.31 within the state or within a 50-mile radius for relocations 311.32 outside the state. The licensee shall provide a staff person to 311.33 accompany the resident during transportation, upon request of 311.34 the resident, the resident's family, or designated 311.35 representative. The discharge and relocation of residents must 311.36 comply with all applicable state and federal requirements and 312.1 must be conducted in a safe, orderly, and appropriate manner. 312.2 The licensee must ensure that there is no disruption in 312.3 providing meals, medications, or treatments of a resident during 312.4 the relocation process. 312.5 Sec. 14. [144A.1885] [RELOCATION REPORTS.] 312.6 (a) Beginning the week following development of the initial 312.7 relocation plan under section 144A.186, the licensee shall 312.8 submit weekly status reports to the commissioners of health and 312.9 human services, or their designees, and to the local agency. 312.10 (b) The first status report must identify the relocation 312.11 plan developed under section 144A.186, the interdisciplinary 312.12 team members, and the number of residents to be relocated. 312.13 (c) Subsequent status reports must note any modifications 312.14 to the relocation plan, any change of interdisciplinary team 312.15 members or number of residents relocated, the placement 312.16 destination to which residents have been relocated, and the 312.17 number of residents remaining to be relocated. Subsequent 312.18 status reports must also identify issues or problems encountered 312.19 during the relocation process and the resolution of these issues. 312.20 Sec. 15. [144A.1886] [REQUIREMENTS OF LOCAL AGENCY.] 312.21 Subdivision 1. [MEETING; REPRESENTATION.] (a) The local 312.22 agency with the licensee shall convene a meeting to develop a 312.23 plan according to section 144A.186, subdivision 1, paragraph (b). 312.24 (b) The local agency shall designate a representative to 312.25 the interdisciplinary team established by the licensee 312.26 responsible for coordinating the relocation efforts. 312.27 Subd. 2. [RESOURCE.] (a) The local agency shall serve as a 312.28 resource in the relocation process. 312.29 (b) Concurrent with the notice sent to residents from the 312.30 licensee according to section 144A.187, subdivision 1, the local 312.31 agency shall provide written notice to residents, family 312.32 members, and designated representatives describing: 312.33 (1) the local agency's role in the relocation process and 312.34 in the follow-up to relocation; 312.35 (2) a local agency contact name, address, and telephone 312.36 number; and 313.1 (3) the name, address, and telephone number of the office 313.2 of the ombudsman for older Minnesotans and the office of the 313.3 ombudsman for mental health and mental retardation. 313.4 (c) The local agency is responsible for the safe and 313.5 orderly relocation of residents in cases where an emergent need 313.6 arises or when the licensee has abrogated the licensee's 313.7 responsibilities under the relocation plan. 313.8 Subd. 3. [COORDINATION; OVERSIGHT.] (a) The local agency 313.9 shall meet with appropriate facility staff to coordinate any 313.10 assistance. Coordination shall include participating in group 313.11 meetings with residents, family members, and designated 313.12 representatives to explain the transfer or relocation process. 313.13 (b) The local agency shall monitor compliance with all 313.14 components of the relocation plan. When the licensee is not in 313.15 compliance, the local agency shall notify the commissioners of 313.16 health and human services. 313.17 (c) Except as requested by the resident, family member, or 313.18 designated representative and within the parameters of the 313.19 Vulnerable Adults Act, the local agency may halt a relocation 313.20 that it deems inappropriate or dangerous to the health or safety 313.21 of a resident. 313.22 Subd. 4. [FOLLOW-UP REVIEW.] (a) A member of the local 313.23 agency staff shall visit residents relocated within 100 miles of 313.24 the county within 30 days after a relocation. Local agency 313.25 staff shall interview the resident and family member or 313.26 designated representative or shall observe the resident on-site, 313.27 or both, and review and discuss pertinent medical or social 313.28 records with appropriate facility staff to assess the adjustment 313.29 of the resident to the new placement, recommend services or 313.30 methods to meet any special needs of the resident, and identify 313.31 residents at risk. 313.32 (b) The local agency may conduct subsequent follow-up 313.33 visits in cases where the adjustment of the resident to the new 313.34 placement is in question. 313.35 (c) Within 60 days of the completion of the follow-up 313.36 visits, the local agency shall submit a written summary of the 314.1 follow-up work to the commissioners of health and human 314.2 services, in a manner approved by the commissioners. 314.3 (d) The local agency shall submit a report of any issues 314.4 that may require further review or monitoring to the 314.5 commissioner of health. 314.6 Sec. 16. [144A.1887] [FUNDING.] 314.7 (a) Within 60 days of a nursing home ceasing operations, 314.8 the commissioner of human services shall reimburse nursing homes 314.9 that are reimbursed under sections 256B.431, 256B.434, and 314.10 256B.435 for operating costs incurred by the nursing home during 314.11 the closure process. The amount to be reimbursed to the nursing 314.12 home shall be determined by applying paragraphs (b) to (f). 314.13 (b) The facility shall provide the commissioner of human 314.14 services with the nursing home's operating costs for the time 314.15 period of 30 days prior to the notice specified under section 314.16 144A.16, to 30 days after the nursing home's closure. 314.17 (c) The nursing home shall provide the commissioner of 314.18 human services with the number of medical assistance, Medicare, 314.19 private pay, and other resident days for the period referenced 314.20 in paragraph (b) by the 11 case mix categories. 314.21 (d) The commissioner of human services shall calculate a 314.22 nursing home closure rate by dividing the facility operating 314.23 costs in paragraph (b) by the total resident days in paragraph 314.24 (c). 314.25 (e) The total closure costs attributable to medical 314.26 assistance shall be determined by multiplying the nursing home 314.27 closure rate in paragraph (d) by the medical assistance days 314.28 provided by the nursing facility in paragraph (c). 314.29 (f) The amount to be reimbursed to the nursing home is 314.30 equal to the total closure costs in paragraph (e) minus the sum 314.31 of the nursing facility's 11 operating rates times their 314.32 respective number of medical assistance days by case mix as 314.33 referenced in paragraph (c). 314.34 Sec. 17. [144A.36] [TRANSITION PLANNING GRANTS.] 314.35 Subdivision 1. [DEFINITIONS.] "Eligible nursing home" 314.36 means any nursing home licensed under sections 144A.01 to 315.1 144A.16 and certified by the appropriate authority under United 315.2 States Code, title 42, sections 1396-1396p, to participate as a 315.3 vendor in the medical assistance program established under 315.4 chapter 256B. 315.5 Subd. 2. [GRANTS AUTHORIZED.] (a) The commissioner shall 315.6 establish a program of transition planning grants to assist 315.7 eligible nursing homes in implementing the provisions in 315.8 paragraphs (b) and (c). 315.9 (b) Transition planning grants may be used by nursing homes 315.10 to develop strategic plans which identify the appropriate 315.11 institutional and noninstitutional settings necessary to meet 315.12 the older adult service needs of the community. 315.13 (c) At a minimum, a strategic plan must consist of: 315.14 (1) a needs assessment to determine what older adult 315.15 services are needed and desired by the community; 315.16 (2) an assessment of the appropriate settings in which to 315.17 provide needed older adult services; 315.18 (3) an assessment identifying currently available services 315.19 and their settings in the community; and 315.20 (4) a transition plan to achieve the needed outcome 315.21 identified by the assessment. 315.22 Subd. 3. [ALLOCATION OF GRANTS.] (a) Eligible nursing 315.23 homes must apply to the commissioner no later than September 1 315.24 of each fiscal year for grants awarded in that fiscal year. A 315.25 grant shall be awarded upon signing of a grant contract. 315.26 (b) The commissioner must make a final decision on the 315.27 funding of each application within 60 days of the deadline for 315.28 receiving applications. 315.29 Subd. 4. [EVALUATION.] The commissioner shall evaluate the 315.30 overall effectiveness of the grant program. The commissioner 315.31 may collect, from the nursing homes receiving grants, the 315.32 information necessary to evaluate the grant program. 315.33 Information related to the financial condition of individual 315.34 nursing homes shall be classified as nonpublic data. 315.35 Sec. 18. [144A.37] [ALTERNATIVE NURSING HOME SURVEY 315.36 PROCESS.] 316.1 Subdivision 1. [ALTERNATIVE NURSING HOME SURVEY 316.2 SCHEDULES.] (a) The commissioner of health shall implement 316.3 alternative procedures for the nursing home survey process as 316.4 authorized under this section. 316.5 (b) These alternative survey process procedures seek to: 316.6 (1) use department resources more effectively and efficiently to 316.7 target problem areas; (2) use other existing or new mechanisms 316.8 to provide objective assessments of quality and to measure 316.9 quality improvement; (3) provide for frequent collaborative 316.10 interaction of facility staff and surveyors rather than a 316.11 punitive approach; and (4) reward a nursing home that has 316.12 performed very well by extending intervals between full surveys. 316.13 (c) The commissioner shall pursue changes in federal law 316.14 necessary to accomplish this process and shall apply for any 316.15 necessary federal waivers or approval. If a federal waiver is 316.16 approved, the commissioner shall promptly submit, to the house 316.17 and senate committees with jurisdiction over health and human 316.18 services policy and finance, fiscal estimates for implementing 316.19 the alternative survey process waiver. The commissioner shall 316.20 also pursue any necessary federal law changes during the 107th 316.21 Congress. 316.22 (d) The alternative nursing home survey schedule and 316.23 related educational activities shall not be implemented until 316.24 funding is appropriated by the legislature. 316.25 Subd. 2. [SURVEY INTERVALS.] The commissioner of health 316.26 must extend the time period between standard surveys up to 30 316.27 months based on the criteria established in subdivision 4. In 316.28 using the alternative survey schedule, the requirement for the 316.29 statewide average to not exceed 12 months does not apply. 316.30 Subd. 3. [COMPLIANCE HISTORY.] The commissioner shall 316.31 develop a process for identifying the survey cycles for skilled 316.32 nursing facilities based upon the compliance history of the 316.33 facility. This process can use a range of months for survey 316.34 intervals. At a minimum, the process must be based on 316.35 information from the last two survey cycles and shall take into 316.36 consideration any deficiencies issued as the result of a survey 317.1 or a complaint investigation during the interval. A skilled 317.2 nursing facility with a finding of substandard quality of care 317.3 or a finding of immediate jeopardy is not entitled to a survey 317.4 interval greater than 12 months. The commissioner shall alter 317.5 the survey cycle for a specific skilled nursing facility based 317.6 on findings identified through the completion of a survey, a 317.7 monitoring visit, or a complaint investigation. The 317.8 commissioner must also take into consideration information other 317.9 than the facility's compliance history. 317.10 Subd. 4. [CRITERIA FOR SURVEY INTERVAL 317.11 CLASSIFICATION.] (a) The commissioner shall provide public 317.12 notice of the classification process and shall identify the 317.13 selected survey cycles for each skilled nursing facility. The 317.14 classification system must be based on an analysis of the 317.15 findings made during the past two standard survey intervals, but 317.16 it only takes one survey or complaint finding to modify the 317.17 interval. 317.18 (b) The commissioner shall also take into consideration 317.19 information obtained from residents and family members in each 317.20 skilled nursing facility and from other sources such as 317.21 employees and ombudsmen in determining the appropriate survey 317.22 intervals for facilities. 317.23 Subd. 5. [REQUIRED MONITORING.] (a) The commissioner shall 317.24 conduct at least one monitoring visit on an annual basis for 317.25 every skilled nursing facility which has been selected for a 317.26 survey cycle greater than 12 months. The commissioner shall 317.27 develop protocols for the monitoring visits which shall be less 317.28 extensive than the requirements for a standard survey. The 317.29 commissioner shall use the criteria in paragraph (b) to 317.30 determine whether additional monitoring visits to a facility 317.31 will be required. 317.32 (b) The criteria shall include, but not be limited to, the 317.33 following: 317.34 (1) changes in ownership, administration of the facility, 317.35 or direction of the facility's nursing service; 317.36 (2) changes in the facility's quality indicators which 318.1 might evidence a decline in the facility's quality of care; 318.2 (3) reductions in staffing or an increase in the 318.3 utilization of temporary nursing personnel; and 318.4 (4) complaint information or other information that 318.5 identifies potential concerns for the quality of the care and 318.6 services provided in the skilled nursing facility. 318.7 Subd. 6. [SURVEY REQUIREMENTS FOR FACILITIES NOT APPROVED 318.8 FOR EXTENDED SURVEY INTERVALS.] The commissioner shall establish 318.9 a process for surveying and monitoring of facilities which 318.10 require a survey interval of less than 15 months. This 318.11 information shall identify the steps that the commissioner must 318.12 take to monitor the facility in addition to the standard survey. 318.13 Subd. 7. [IMPACT ON SURVEY AGENCY'S BUDGET.] The 318.14 implementation of an alternative survey process for the state 318.15 must not result in any reduction of funding that would have been 318.16 provided to the state survey agency for survey and enforcement 318.17 activity based upon the completion of full standard surveys for 318.18 each skilled nursing facility in the state. 318.19 Subd. 8. [EDUCATIONAL ACTIVITIES.] The commissioner shall 318.20 expand the state survey agency's ability to conduct training and 318.21 educational efforts for skilled nursing facilities, residents 318.22 and family members, residents and family councils, long-term 318.23 care ombudsman programs, and the general public. 318.24 Subd. 9. [EVALUATION.] The commissioner shall develop a 318.25 process for the evaluation of the effectiveness of an 318.26 alternative survey process conducted under this section. 318.27 [EFFECTIVE DATE.] This section is effective the day 318.28 following final enactment. 318.29 Sec. 19. [144A.38] [INNOVATIONS IN QUALITY DEMONSTRATION 318.30 GRANTS.] 318.31 Subdivision 1. [PROGRAM ESTABLISHED.] The commissioner of 318.32 health and the commissioner of human services shall establish a 318.33 long-term care grant program that demonstrates best practices 318.34 and innovation for long-term care service delivery and housing. 318.35 The grants must fund demonstrations that create new means and 318.36 models for serving the elderly or demonstrate creativity in 319.1 service provision through the scope of their program or service. 319.2 Subd. 2. [ELIGIBILITY.] Grants may only be made to those 319.3 who provide direct service or housing to the elderly within the 319.4 state. Grants may only be made for projects that show 319.5 innovations and measurable improvement in resident care, quality 319.6 of life, use of technology, or customer satisfaction. 319.7 Subd. 3. [AWARDING OF GRANTS.] (a) Applications for grants 319.8 must be made to the commissioners on forms prescribed by the 319.9 commissioners. 319.10 (b) The commissioners shall review applications and award 319.11 grants based on the following criteria: 319.12 (1) improvement in direct care to residents; 319.13 (2) increase in efficiency through the use of technology; 319.14 (3) increase in quality of care through the use of 319.15 technology; 319.16 (4) increase in the access and delivery of service; 319.17 (5) enhancement of nursing staff training; 319.18 (6) the effectiveness of the project as a demonstration; 319.19 and 319.20 (7) the immediate transferability of the project to scale. 319.21 (c) In reviewing applications and awarding grants, the 319.22 commissioners shall consult with long-term care providers, 319.23 consumers of long-term care, long-term care researchers, and 319.24 staff of other state agencies. 319.25 (d) Grants for eligible projects may not exceed $100,000. 319.26 Sec. 20. [144A.39] [LONG-TERM CARE QUALITY PROFILES.] 319.27 Subdivision l. [DEVELOPMENT AND IMPLEMENTATION OF QUALITY 319.28 PROFILES.] (a) The commissioner of health and the commissioner 319.29 of human services shall develop and implement a quality profile 319.30 system for nursing facilities and, beginning not later than July 319.31 1, 2003, other providers of long-term care services, except when 319.32 the quality profile system would duplicate requirements under 319.33 sections 256B.5011 and 256B.5013. The system must be developed 319.34 and implemented to the extent possible without the collection of 319.35 new data. To the extent possible, the system must incorporate 319.36 or be coordinated with information on quality maintained by area 320.1 agencies on aging, long-term care trade associations, and other 320.2 entities. The system must be designed to provide information on 320.3 quality: 320.4 (1) to consumers and their families to facilitate informed 320.5 choices of service providers; 320.6 (2) to providers to enable them to measure the results of 320.7 their quality improvement efforts and compare quality 320.8 achievements with other service providers; and 320.9 (3) to public and private purchasers of long-term care 320.10 services to enable them to purchase high-quality care. 320.11 (b) The system must be developed in consultation with the 320.12 long-term care task force, area agencies on aging, and 320.13 representatives of consumers, providers, and labor unions. 320.14 Within the limits of available appropriations, the commissioners 320.15 may employ consultants to assist with this project. 320.16 Subd. 2. [QUALITY MEASUREMENT TOOLS.] The commissioners 320.17 shall identify and apply existing quality measurement tools to: 320.18 (1) emphasize quality of care and its relationship to 320.19 quality of life; and 320.20 (2) address the needs of various users of long-term care 320.21 services, including, but not limited to, short-stay residents, 320.22 persons with behavioral problems, persons with dementia, and 320.23 persons who are members of minority groups. 320.24 The tools must be identified and applied, to the extent 320.25 possible, without requiring providers to supply information 320.26 beyond current state and federal requirements. 320.27 Subd. 3. [CONSUMER SURVEYS.] Following identification of 320.28 the quality measurement tool, the commissioners shall conduct 320.29 surveys of long-term care service consumers to develop quality 320.30 profiles of providers. To the extent possible, surveys must be 320.31 conducted face-to-face by state employees or contractors. At 320.32 the discretion of the commissioners, surveys may be conducted by 320.33 telephone or by provider staff. Surveys must be conducted 320.34 periodically to update quality profiles of individual service 320.35 providers. 320.36 Subd. 4. [DISSEMINATION OF QUALITY PROFILES.] By July 1, 321.1 2002, the commissioners shall implement a system to disseminate 321.2 the quality profiles developed from consumer surveys using the 321.3 quality measurement tool. Profiles must be disseminated to the 321.4 Senior LinkAge line and to consumers, providers, and purchasers 321.5 of long-term care services through all feasible printed and 321.6 electronic outlets. The commissioners shall conduct a public 321.7 awareness campaign to inform potential users regarding profile 321.8 contents and potential uses. 321.9 Sec. 21. Minnesota Statutes 2000, section 256B.431, 321.10 subdivision 17, is amended to read: 321.11 Subd. 17. [SPECIAL PROVISIONS FOR MORATORIUM EXCEPTIONS.] 321.12 (a) Notwithstanding Minnesota Rules, part 9549.0060, subpart 3, 321.13 for rate periods beginning on October 1, 1992, and for rate 321.14 years beginning after June 30, 1993, a nursing facility that (1) 321.15 has completed a construction project approved under section 321.16 144A.071, subdivision 4a, clause (m); (2) has completed a 321.17 construction project approved under section 144A.071, 321.18 subdivision 4a, and effective after June 30, 1995; or (3) has 321.19 completed a renovation, replacement, or upgrading project 321.20 approved under the moratorium exception process in section 321.21 144A.073 shall be reimbursed for costs directly identified to 321.22 that project as provided in subdivision 16 and this subdivision. 321.23 (b) Notwithstanding Minnesota Rules, part 9549.0060, 321.24 subparts 5, item A, subitems (1) and (3), and 7, item D, 321.25 allowable interest expense on debt shall include: 321.26 (1) interest expense on debt related to the cost of 321.27 purchasing or replacing depreciable equipment, excluding 321.28 vehicles, not to exceed six percent of the total historical cost 321.29 of the project; and 321.30 (2) interest expense on debt related to financing or 321.31 refinancing costs, including costs related to points, loan 321.32 origination fees, financing charges, legal fees, and title 321.33 searches; and issuance costs including bond discounts, bond 321.34 counsel, underwriter's counsel, corporate counsel, printing, and 321.35 financial forecasts. Allowable debt related to items in this 321.36 clause shall not exceed seven percent of the total historical 322.1 cost of the project. To the extent these costs are financed, 322.2 the straight-line amortization of the costs in this clause is 322.3 not an allowable cost; and 322.4 (3) interest on debt incurred for the establishment of a 322.5 debt reserve fund, net of the interest earned on the debt 322.6 reserve fund. 322.7 (c) Debt incurred for costs under paragraph (b) is not 322.8 subject to Minnesota Rules, part 9549.0060, subpart 5, item A, 322.9 subitem (5) or (6). 322.10 (d) The incremental increase in a nursing facility's rental 322.11 rate, determined under Minnesota Rules, parts 9549.0010 to 322.12 9549.0080, and this section, resulting from the acquisition of 322.13 allowable capital assets, and allowable debt and interest 322.14 expense under this subdivision shall be added to its 322.15 property-related payment rate and shall be effective on the 322.16 first day of the month following the month in which the 322.17 moratorium project was completed. 322.18 (e) Notwithstanding subdivision 3f, paragraph (a), for rate 322.19 periods beginning on October 1, 1992, and for rate years 322.20 beginning after June 30, 1993, the replacement-costs-new per bed 322.21 limit to be used in Minnesota Rules, part 9549.0060, subpart 4, 322.22 item B, for a nursing facility that has completed a renovation, 322.23 replacement, or upgrading project that has been approved under 322.24 the moratorium exception process in section 144A.073, or that 322.25 has completed an addition to or replacement of buildings, 322.26 attached fixtures, or land improvements for which the total 322.27 historical cost exceeds the lesser of $150,000 or ten percent of 322.28 the most recent appraised value, must be $47,500 per licensed 322.29 bed in multiple-bed rooms and $71,250 per licensed bed in a 322.30 single-bed room. These amounts must be adjusted annually as 322.31 specified in subdivision 3f, paragraph (a), beginning January 1, 322.32 1993. 322.33 (f) For purposes of this paragraph, a total replacement 322.34 means the complete replacement of the nursing facility's 322.35 physical plant through the construction of a new physical plant, 322.36 the transfer of the nursing facility's license from one physical 323.1 plant location to another, or a new building addition to 323.2 relocate beds from three- and four-bed wards. For total 323.3 replacement projects completed on or after July 1, 1992, the 323.4 commissioner shall compute the incremental change in the nursing 323.5 facility's rental per diem, for rate years beginning on or after 323.6 July 1, 1995, by replacing its appraised value, including the 323.7 historical capital asset costs, and the capital debt and 323.8 interest costs with the new nursing facility's allowable capital 323.9 asset costs and the related allowable capital debt and interest 323.10 costs. If the new nursing facility has decreased its licensed 323.11 capacity, the aggregate investment per bed limit in subdivision 323.12 3a, paragraph (c), shall apply. If the new nursing facility has 323.13 retained a portion of the original physical plant for nursing 323.14 facility usage, then a portion of the appraised value prior to 323.15 the replacement must be retained and included in the calculation 323.16 of the incremental change in the nursing facility's rental per 323.17 diem. For purposes of this part, the original nursing facility 323.18 means the nursing facility prior to the total replacement 323.19 project. The portion of the appraised value to be retained 323.20 shall be calculated according to clauses (1) to (3): 323.21 (1) The numerator of the allocation ratio shall be the 323.22 square footage of the area in the original physical plant which 323.23 is being retained for nursing facility usage. 323.24 (2) The denominator of the allocation ratio shall be the 323.25 total square footage of the original nursing facility physical 323.26 plant. 323.27 (3) Each component of the nursing facility's allowable 323.28 appraised value prior to the total replacement project shall be 323.29 multiplied by the allocation ratio developed by dividing clause 323.30 (1) by clause (2). 323.31 In the case of either type of total replacement as 323.32 authorized under section 144A.071 or 144A.073, the provisions of 323.33 this subdivision shall also apply. For purposes of the 323.34 moratorium exception authorized under section 144A.071, 323.35 subdivision 4a, paragraph (s), if the total replacement involves 323.36 the renovation and use of an existing health care facility 324.1 physical plant, the new allowable capital asset costs and 324.2 related debt and interest costs shall include first the 324.3 allowable capital asset costs and related debt and interest 324.4 costs of the renovation, to which shall be added the allowable 324.5 capital asset costs of the existing physical plant prior to the 324.6 renovation, and if reported by the facility, the related 324.7 allowable capital debt and interest costs. 324.8 (g) Notwithstanding Minnesota Rules, part 9549.0060, 324.9 subpart 11, item C, subitem (2), for a total replacement, as 324.10 defined in paragraph (f), authorized under section 144A.071 or 324.11 144A.073 after July 1, 1999, or any building project that is a 324.12 relocation, renovation, upgrading, or conversionauthorized324.13under section 144A.073,completed on or after July 1, 2001, the 324.14 replacement-costs-new per bed limit shall be $74,280 per 324.15 licensed bed in multiple-bed rooms, $92,850 per licensed bed in 324.16 semiprivate rooms with a fixed partition separating the resident 324.17 beds, and $111,420 per licensed bed in single rooms. Minnesota 324.18 Rules, part 9549.0060, subpart 11, item C, subitem (2), does not 324.19 apply. These amounts must be adjusted annually as specified in 324.20 subdivision 3f, paragraph (a), beginning January 1, 2000. 324.21 (h) For a total replacement, as defined in paragraph (f), 324.22 authorized under section 144A.073 for a 96-bed nursing home in 324.23 Carlton county, the replacement-costs-new per bed limit shall be 324.24 $74,280 per licensed bed in multiple-bed rooms, $92,850 per 324.25 licensed bed in semiprivate rooms with a fixed partition 324.26 separating the resident's beds, and $111,420 per licensed bed in 324.27 a single room. Minnesota Rules, part 9549.0060, subpart 11, 324.28 item C, subitem (2), does not apply. The resulting maximum 324.29 allowable replacement-costs-new multiplied by 1.25 shall 324.30 constitute the project's dollar threshold for purposes of 324.31 application of the limit set forth in section 144A.071, 324.32 subdivision 2. The commissioner of health may waive the 324.33 requirements of section 144A.073, subdivision 3b, paragraph (b), 324.34 clause (2), on the condition that the other requirements of that 324.35 paragraph are met. 324.36 (i) For a renovation authorized under section 144A.073 for 325.1 a 65-bed nursing home in St. Louis county, the incremental 325.2 increase in rental rate for purposes of paragraph (d) shall be 325.3 $8.16, and the total replacement cost, allowable appraised 325.4 value, allowable debt, and allowable interest shall be increased 325.5 according to the incremental increase. 325.6 (j) For a total replacement, as defined in paragraph (f), 325.7 authorized under section 144A.073 involving a new building 325.8 addition that relocates beds from three-bed wards for an 80-bed 325.9 nursing home in Redwood county, the replacement-costs-new per 325.10 bed limit shall be $74,280 per licensed bed for multiple-bed 325.11 rooms; $92,850 per licensed bed for semiprivate rooms with a 325.12 fixed partition separating the beds; and $111,420 per licensed 325.13 bed for single rooms. These amounts shall be adjusted annually, 325.14 beginning January 1, 2001. Minnesota Rules, part 9549.0060, 325.15 subpart 11, item C, subitem (2), does not apply. The resulting 325.16 maximum allowable replacement-costs-new multiplied by 1.25 shall 325.17 constitute the project's dollar threshold for purposes of 325.18 application of the limit set forth in section 144A.071, 325.19 subdivision 2. The commissioner of health may waive the 325.20 requirements of section 144A.073, subdivision 3b, paragraph (b), 325.21 clause (2), on the condition that the other requirements of that 325.22 paragraph are met. 325.23 Sec. 22. Minnesota Statutes 2000, section 256B.431, is 325.24 amended by adding a subdivision to read: 325.25 Subd. 31. [PAYMENT DURING FIRST 90 DAYS.] (a) For rate 325.26 years beginning on or after July 1, 2001, the total payment rate 325.27 for a facility reimbursed under this section, section 256B.434, 325.28 or any other section for the first 90 days after admission shall 325.29 be: 325.30 (1) for the first 30 paid days, the rate shall be 120 325.31 percent of the facility's medical assistance rate for each case 325.32 mix class; and 325.33 (2) for the next 60 days after the first 30 paid days, the 325.34 rate shall be 110 percent of the facility's medical assistance 325.35 rate for each case mix class. 325.36 (b) Beginning with the 91st paid day after admission, the 326.1 payment rate shall be the rate otherwise determined under this 326.2 section, section 256B.434, or any other section. 326.3 (c) This subdivision applies to admissions occurring on or 326.4 after July 1, 2001. 326.5 Sec. 23. Minnesota Statutes 2000, section 256B.431, is 326.6 amended by adding a subdivision to read: 326.7 Subd. 32. [NURSING FACILITY RATE INCREASES BEGINNING JULY 326.8 1, 2001, AND JULY 1, 2002.] For the rate years beginning July 1, 326.9 2001, and July 1, 2002, the commissioner shall make available to 326.10 each nursing facility reimbursed under this section or section 326.11 256B.434 an adjustment equal to 3.0 percent of the total 326.12 operating payment rate. The operating payment rates in effect 326.13 on June 30, 2001, and June 30, 2002, respectively, shall include 326.14 the adjustment in subdivision 2i, paragraph (c). 326.15 Sec. 24. Minnesota Statutes 2000, section 256B.431, is 326.16 amended by adding a subdivision to read: 326.17 Subd. 33. [ADDITIONAL INCREASES FOR LOW RATE METROPOLITAN 326.18 AREA FACILITIES.] After the calculation of the increase for the 326.19 rate year beginning July 1, 2001, in subdivision 31, the 326.20 commissioner must provide for special increases to facilities 326.21 determined to be the lowest rate facilities in state development 326.22 region 11, as defined in section 462.385. Within this region, 326.23 the commissioner shall identify the median nursing facility rate 326.24 by case mix category for all nursing facilities under section 326.25 256B.431 or 256B.434. Nursing home rates that are below the 326.26 median for case mix class A must be adjusted to the set of case 326.27 mix rates for the facility at the median for case mix class A. 326.28 Sec. 25. Minnesota Statutes 2000, section 256B.431, is 326.29 amended by adding a subdivision to read: 326.30 Subd. 34. [RATE FLOOR FOR FACILITIES LOCATED OUTSIDE THE 326.31 METROPOLITAN AREA.] (a) For the rate year beginning July 1, 326.32 2001, the commissioner shall adjust operating costs per diem for 326.33 nursing facilities located outside of state development region 326.34 11, as defined in section 462.385, reimbursed under this section 326.35 and sections 256B.434 and 256B.435, as provided in this 326.36 subdivision. 327.1 (b) For each nursing facility, the commissioner shall 327.2 compare the operating costs per diem listed in this paragraph to 327.3 the operating costs per diem the facility would otherwise 327.4 receive for the July 1, 2001, rate year after provision of any 327.5 other rate increases required by this chapter. 327.6 Case mix classification Operating costs per diem 327.7 A $ 67.02 327.8 B $ 73.00 327.9 C $ 79.77 327.10 D $ 85.94 327.11 E $ 92.32 327.12 F $ 92.72 327.13 G $ 98.13 327.14 H $108.40 327.15 I $112.03 327.16 J $117.67 327.17 K $129.55 327.18 (c) If a facility's total reimbursement for operating 327.19 costs, using the case mix classification operating costs per 327.20 diem listed in paragraph (b), is greater than the total 327.21 reimbursement for operating costs the facility would otherwise 327.22 receive, the commissioner shall calculate operating costs per 327.23 diem for that facility for the rate year beginning July 1, 2001, 327.24 using the case mix classification operating costs per diem 327.25 listed in paragraph (b). 327.26 (d) If a facility's total reimbursement for operating 327.27 costs, using the case mix classification costs per diem listed 327.28 in paragraph (b), is less than the total reimbursement for 327.29 operating costs the facility would otherwise receive, the 327.30 commissioner shall reimburse that facility for the rate year 327.31 beginning July 1, 2001, as provided in this section, section 327.32 256B.434, or 256B.435, whichever is applicable, and shall not 327.33 calculate operating costs per diem for that facility using the 327.34 case mix classification operating costs per diem listed in 327.35 paragraph (b). 327.36 Sec. 26. Minnesota Statutes 2000, section 256B.431, is 328.1 amended by adding a subdivision to read: 328.2 Subd. 35. [EXCLUSION OF RAW FOOD COST ADJUSTMENT.] For 328.3 rate years beginning on or after July 1, 2001, in calculating a 328.4 nursing facility's operating cost per diem for the purposes of 328.5 constructing an array of nursing facility payment rates to be 328.6 used to determine future rate increases under this section, 328.7 section 256B.434, or any other section, the commissioner shall 328.8 exclude adjustments for raw food costs under subdivision 2b, 328.9 paragraph (h), that are related to providing special diets based 328.10 on religious beliefs. 328.11 Sec. 27. Minnesota Statutes 2000, section 256B.434, 328.12 subdivision 4, is amended to read: 328.13 Subd. 4. [ALTERNATE RATES FOR NURSING FACILITIES.] (a) For 328.14 nursing facilities which have their payment rates determined 328.15 under this section rather than section 256B.431, the 328.16 commissioner shall establish a rate under this subdivision. The 328.17 nursing facility must enter into a written contract with the 328.18 commissioner. 328.19 (b) A nursing facility's case mix payment rate for the 328.20 first rate year of a facility's contract under this section is 328.21 the payment rate the facility would have received under section 328.22 256B.431. 328.23 (c) A nursing facility's case mix payment rates for the 328.24 second and subsequent years of a facility's contract under this 328.25 section are the previous rate year's contract payment rates plus 328.26 an inflation adjustment and an adjustment to include the cost of 328.27 any increase in health department licensing fees for the 328.28 facility taking effect on or after July 1, 2001. The index for 328.29 the inflation adjustment must be based on the change in the 328.30 Consumer Price Index-All Items (United States City average) 328.31 (CPI-U) forecasted by Data Resources, Inc., as forecasted in the 328.32 fourth quarter of the calendar year preceding the rate year. 328.33 The inflation adjustment must be based on the 12-month period 328.34 from the midpoint of the previous rate year to the midpoint of 328.35 the rate year for which the rate is being determined. For the 328.36 rate years beginning on July 1, 1999,andJuly 1, 2000, July 1, 329.1 2001, and July 1, 2002, this paragraph shall apply only to the 329.2 property-related payment rate, except that adjustments to 329.3 include the cost of any increase in health department licensing 329.4 fees taking effect on or after July 1, 2001, shall be provided. 329.5 In determining the amount of the property-related payment rate 329.6 adjustment under this paragraph, the commissioner shall 329.7 determine the proportion of the facility's rates that are 329.8 property-related based on the facility's most recent cost report. 329.9 (d) The commissioner shall develop additional 329.10 incentive-based payments of up to five percent above the 329.11 standard contract rate for achieving outcomes specified in each 329.12 contract. The specified facility-specific outcomes must be 329.13 measurable and approved by the commissioner. The commissioner 329.14 may establish, for each contract, various levels of achievement 329.15 within an outcome. After the outcomes have been specified the 329.16 commissioner shall assign various levels of payment associated 329.17 with achieving the outcome. Any incentive-based payment cancels 329.18 if there is a termination of the contract. In establishing the 329.19 specified outcomes and related criteria the commissioner shall 329.20 consider the following state policy objectives: 329.21 (1) improved cost effectiveness and quality of life as 329.22 measured by improved clinical outcomes; 329.23 (2) successful diversion or discharge to community 329.24 alternatives; 329.25 (3) decreased acute care costs; 329.26 (4) improved consumer satisfaction; 329.27 (5) the achievement of quality; or 329.28 (6) any additional outcomes proposed by a nursing facility 329.29 that the commissioner finds desirable. 329.30 Sec. 28. Minnesota Statutes 2000, section 256B.434, is 329.31 amended by adding a subdivision to read: 329.32 Subd. 4c. [FACILITY RATE INCREASES EFFECTIVE JANUARY 1, 329.33 2002.] For the rate period beginning January 1, 2002, and for 329.34 the rate year beginning July 1, 2002, a nursing facility in 329.35 Morrison county licensed for 83 beds shall receive an increase 329.36 of $2.54 in each case mix payment rate to offset property tax 330.1 payments due as a result of the facility's conversion from 330.2 nonprofit to for-profit status. The increases under this 330.3 subdivision shall be added following the determination under 330.4 this chapter of the payment rate for the rate year beginning 330.5 July 1, 2001, and shall be included in the facility's total 330.6 payment rates for the purposes of determining future rates under 330.7 this section or any other section. 330.8 Sec. 29. Minnesota Statutes 2000, section 256B.434, is 330.9 amended by adding a subdivision to read: 330.10 Subd. 4d. [FACILITY RATE INCREASES EFFECTIVE JULY 1, 330.11 2001.] For the rate year beginning July 1, 2001, a nursing 330.12 facility in Hennepin county licensed for 302 beds shall receive 330.13 an increase of 29 cents in each case mix payment rate to correct 330.14 an error in the cost-reporting system that occurred prior to the 330.15 date that the facility entered the alternative payment 330.16 demonstration project. The increases under this subdivision 330.17 shall be added following the determination under this chapter of 330.18 the payment rate for the rate year beginning July 1, 2001, and 330.19 shall be included in the facility's total payment rates for the 330.20 purposes of determining future rates under this section or any 330.21 other section. 330.22 Sec. 30. Minnesota Statutes 2000, section 256B.434, is 330.23 amended by adding a subdivision to read: 330.24 Subd. 4e. [RATE INCREASE EFFECTIVE JULY 1, 2001.] A 330.25 nursing facility in Anoka county licensed for 98 beds as of July 330.26 1, 2000, shall receive an increase of $10 in each case mix rate 330.27 for the rate year beginning July 1, 2001. This increase shall 330.28 be included in the facility's total payment rate for purposes of 330.29 determining future rates under this section or any other section 330.30 through June 30, 2004. 330.31 Sec. 31. Minnesota Statutes 2000, section 256B.434, 330.32 subdivision 10, is amended to read: 330.33 Subd. 10. [EXEMPTIONS.] (a) To the extent permitted by 330.34 federal law, (1) a facility that has entered into a contract 330.35 under this section is not required to file a cost report, as 330.36 defined in Minnesota Rules, part 9549.0020, subpart 13, for any 331.1 year after the base year that is the basis for the calculation 331.2 of the contract payment rate for the first rate year of the 331.3 alternative payment demonstration project contract; and (2) a 331.4 facility under contract is not subject to audits of historical 331.5 costs or revenues, or paybacks or retroactive adjustments based 331.6 on these costs or revenues, except audits, paybacks, or 331.7 adjustments relating to the cost report that is the basis for 331.8 calculation of the first rate year under the contract. 331.9 (b)A facility that is under contract with the commissioner331.10under this section is not subject to the moratorium on licensure331.11or certification of new nursing home beds in section 144A.071,331.12unless the project results in a net increase in bed capacity or331.13involves relocation of beds from one site to another. Contract331.14payment rates must not be adjusted to reflect any additional331.15costs that a nursing facility incurs as a result of a331.16construction project undertaken under this paragraph. In331.17addition, as a condition of entering into a contract under this331.18section, a nursing facility must agree that any future medical331.19assistance payments for nursing facility services will not331.20reflect any additional costs attributable to the sale of a331.21nursing facility under this section and to construction331.22undertaken under this paragraph that otherwise would not be331.23authorized under the moratorium in section 144A.073. Nothing in331.24this section prevents a nursing facility participating in the331.25alternative payment demonstration project under this section331.26from seeking approval of an exception to the moratorium through331.27the process established in section 144A.073, and if approved the331.28facility's rates shall be adjusted to reflect the cost of the331.29project. Nothing in this section prevents a nursing facility331.30participating in the alternative payment demonstration project331.31from seeking legislative approval of an exception to the331.32moratorium under section 144A.071, and, if enacted, the331.33facility's rates shall be adjusted to reflect the cost of the331.34project.331.35(c)Notwithstanding section 256B.48, subdivision 6, 331.36 paragraphs (c), (d), and (e), and pursuant to any terms and 332.1 conditions contained in the facility's contract, a nursing 332.2 facility that is under contract with the commissioner under this 332.3 section is in compliance with section 256B.48, subdivision 6, 332.4 paragraph (b), if the facility is Medicare certified. 332.5(d)(c) Notwithstanding paragraph (a), if by April 1, 1996, 332.6 the health care financing administration has not approved a 332.7 required waiver, or the health care financing administration 332.8 otherwise requires cost reports to be filed prior to the 332.9 waiver's approval, the commissioner shall require a cost report 332.10 for the rate year. 332.11(e)(d) A facility that is under contract with the 332.12 commissioner under this section shall be allowed to change 332.13 therapy arrangements from an unrelated vendor to a related 332.14 vendor during the term of the contract. The commissioner may 332.15 develop reasonable requirements designed to prevent an increase 332.16 in therapy utilization for residents enrolled in the medical 332.17 assistance program. 332.18 Sec. 32. [256B.437] [IMPLEMENTATION OF A CASE MIX SYSTEM 332.19 FOR NURSING FACILITIES BASED ON THE MINIMUM DATA SET.] 332.20 Subdivision 1. [SCOPE.] This section establishes the 332.21 method and criteria used to determine resident reimbursement 332.22 classifications based upon the assessments of residents of 332.23 nursing homes and boarding care homes whose payment rates are 332.24 established under section 256B.431, 256B.434, or 256B.435. 332.25 Resident reimbursement classifications shall be established 332.26 according to the 34 group, resource utilization groups, version 332.27 III or RUG-III model as described in section 144.0724. 332.28 Reimbursement classifications established under this section 332.29 shall be implemented after June 30, 2002, but no later than 332.30 January 1, 2003. 332.31 Subd. 2. [DEFINITIONS.] For purposes of this section, the 332.32 following terms have the meanings given. 332.33 (a) [ASSESSMENT REFERENCE DATE.] "Assessment reference 332.34 date" has the meaning given in section 144.0724, subdivision 2, 332.35 paragraph (a). 332.36 (b) [CASE MIX INDEX.] "Case mix index" has the meaning 333.1 given in section 144.0724, subdivision 2, paragraph (b). 333.2 (c) [INDEX MAXIMIZATION.] "Index maximization" has the 333.3 meaning given in section 144.0724, subdivision 2, paragraph (c). 333.4 (d) [MINIMUM DATA SET.] "Minimum data set" has the meaning 333.5 given in section 144.0724, subdivision 2, paragraph (d). 333.6 (e) [REPRESENTATIVE.] "Representative" has the meaning 333.7 given in section 144.0724, subdivision 2, paragraph (e). 333.8 (f) [RESOURCE UTILIZATION GROUPS OR RUG.] "Resource 333.9 utilization groups" or "RUG" has the meaning given in section 333.10 144.0724, subdivision 2, paragraph (f). 333.11 Subd. 3. [CASE MIX INDICES.] (a) The commissioner of human 333.12 services shall assign a case mix index to each resident class 333.13 based on the Health Care Financing Administration's staff time 333.14 measurement study and adjusted for Minnesota-specific wage 333.15 indices. The case mix indices assigned to each resident class 333.16 shall be published in the Minnesota State Register at least 120 333.17 days prior to the implementation of the 34 group, RUG-III 333.18 resident classification system. 333.19 (b) An index maximization approach shall be used to 333.20 classify residents. 333.21 (c) After implementation of the revised case mix system, 333.22 the commissioner of human services may annually rebase case mix 333.23 indices and base rates using more current data on average wage 333.24 rates and staff time measurement studies. This rebasing shall 333.25 be calculated under subdivision 7, paragraph (b). The 333.26 commissioner shall publish in the Minnesota State Register 333.27 adjusted case mix indices at least 45 days prior to the 333.28 effective date of the adjusted case mix indices. 333.29 Subd. 4. [RESIDENT ASSESSMENT SCHEDULE.] (a) Nursing 333.30 facilities shall conduct and submit case mix assessments 333.31 according to the schedule established by the commissioner of 333.32 health under section 144.0724, subdivisions 4 and 5. 333.33 (b) The resident reimbursement classifications established 333.34 under section 144.0724, subdivision 3, shall be effective the 333.35 day of admission for new admission assessments. The effective 333.36 date for significant change assessments shall be the assessment 334.1 reference date. The effective date for annual and second 334.2 quarterly assessments shall be the first day of the month 334.3 following assessment reference date. 334.4 Subd. 5. [NOTICE OF RESIDENT REIMBURSEMENT 334.5 CLASSIFICATION.] Nursing facilities shall provide notice to a 334.6 resident of the resident's case mix classification according to 334.7 procedures established by the commissioner of health under 334.8 section 144.0724, subdivision 7. 334.9 Subd. 6. [RECONSIDERATION OF RESIDENT CLASSIFICATION.] Any 334.10 request for reconsideration of a resident classification must be 334.11 made under section 144.0724, subdivision 8. 334.12 Subd. 7. [RATE DETERMINATION UPON TRANSITION TO RUG-III 334.13 PAYMENT RATES.] (a) The commissioner of human services shall 334.14 determine payment rates at the time of transition to the RUG 334.15 based payment model in a facility-specific, budget-neutral 334.16 manner. The case mix indices as defined in subdivision 3 shall 334.17 be used to allocate the case mix adjusted component of total 334.18 payment across all case mix groups. To transition from the 334.19 current calculation methodology to the RUG based methodology, 334.20 the commissioner of health shall report to the commissioner of 334.21 human services the resident days classified according to the 334.22 categories defined in subdivision 3 for the 12-month reporting 334.23 period ending September 30, 2001, for each nursing facility. 334.24 The commissioner of human services shall use this data to 334.25 compute the standardized days for the reporting period under the 334.26 RUG system. 334.27 (b) The commissioner of human services shall determine the 334.28 case mix adjusted component of the rate as follows: 334.29 (1) determine the case mix portion of the 11 case mix rates 334.30 in effect on June 30, 2002, or the 34 case mix rates in effect 334.31 on or after June 30, 2003; 334.32 (2) multiply each amount in clause (1) by the number of 334.33 resident days assigned to each group for the reporting period 334.34 ending September 30, 2001, or the most recent year for which 334.35 data is available; 334.36 (3) compute the sum of the amounts in clause (2); 335.1 (4) determine the total RUG standardized days for the 335.2 reporting period ending September 30, 2001, or the most recent 335.3 year for which data is available using new indices calculated 335.4 under subdivision 3, paragraph (c); 335.5 (5) divide the amount in clause (3) by the amount in clause 335.6 (4) which shall be the average case mix adjusted component of 335.7 the rate under the RUG method; and 335.8 (6) multiply this average rate by the case mix weight in 335.9 subdivision 3 for each RUG group. 335.10 (c) The noncase mix component will be allocated to each RUG 335.11 group as a constant amount to determine the transition payment 335.12 rate. Any other rate adjustments that are effective on or after 335.13 July 1, 2002, shall be applied to the transition rates 335.14 determined under this section. 335.15 Sec. 33. [256B.4371] [NURSING FACILITY VOLUNTARY CLOSURES 335.16 AND PLANNING AND DEVELOPMENT OF COMMUNITY-BASED ALTERNATIVES.] 335.17 Subdivision 1. [DEFINITIONS.] (a) The definitions in this 335.18 subdivision apply to subdivisions 2 to 9. 335.19 (b) "Closure" means the cessation of operations of a 335.20 nursing facility and delicensure and decertification of all beds 335.21 within the facility. 335.22 (c) "Commencement of closure" means the date on which 335.23 residents and designated representatives are notified of a 335.24 planned closure according to sections 144A.185 to 144A.1887 as 335.25 part of an approved closure plan. 335.26 (d) "Completion of closure" means the date on which the 335.27 final resident of the nursing facility or nursing facilities 335.28 designated for closure in an approved closure plan is discharged 335.29 from the facility or facilities. 335.30 (e) "Closure plan" means a plan to close a nursing facility 335.31 and reallocate the resulting savings to provide planned closure 335.32 rate adjustments at other facilities. 335.33 (f) "Partial closure" means the delicensure and 335.34 decertification of a portion of the beds within the facility. 335.35 (g) "Planned closure rate adjustment" means an increase in 335.36 a nursing facility's operating rates resulting from a partial 336.1 planned closure of a facility or a planned closure of another 336.2 facility. 336.3 Subd. 2. [PLANNING AND DEVELOPMENT OF COMMUNITY BASED 336.4 SERVICES.] 336.5 (a) The commissioner of human services shall establish a 336.6 process to adjust the capacity and distribution of long-term 336.7 care services to equalize the supply and demand for different 336.8 types of services. This process must include community 336.9 planning, expansion or establishment of needed services, and 336.10 analysis of voluntary nursing facility closures. 336.11 (b) The purpose of this process is to support the planning 336.12 and development of community-based services. This process must 336.13 support early intervention, advocacy, and consumer protection 336.14 while providing resources and incentives for expanded county 336.15 planning and for nursing facilities to transition to meet 336.16 community needs. 336.17 (c) The process shall support and facilitate expansion of 336.18 community-based services under the county-administered 336.19 alternative care program under section 256B.0913 and waivers for 336.20 elderly under section 256B.0915, including the development of 336.21 supportive services such as housing and transportation. The 336.22 process shall utilize community assessments and planning 336.23 developed for the community health services plan and plan update 336.24 and for the community social services act plan. 336.25 (d) The addendum to the biennial plan shall be submitted 336.26 annually, beginning in 2001, and shall include recommendations 336.27 for development of community-based services. Both planning and 336.28 implementation shall be implemented within the amount of funding 336.29 made available to the county board for these purposes. 336.30 (e) The commissioner of health and the commissioner of 336.31 human services, as appropriate, shall provide available data 336.32 necessary for the county, including but not limited to data on 336.33 nursing facility bed distribution, housing with services 336.34 options, the closure of nursing facilities that occur outside of 336.35 the planned closure process, and approval of planned closures in 336.36 the county and contiguous counties. 337.1 (f) The plan, within the funding allocated, shall: 337.2 (1) identify the need for services based on demographic 337.3 data, service availability, caseload information, and provider 337.4 information; 337.5 (2) involve providers, consumers, cities, townships, 337.6 businesses, and area agencies on aging in the planning process; 337.7 (3) address the availability of alternative care and 337.8 elderly waiver services for eligible recipients; 337.9 (4) address the development of other supportive services, 337.10 such as transit, housing, and workforce and economic 337.11 development; and 337.12 (5) estimate the cost and timelines for development. 337.13 (g) The biennial plan addendum shall be coordinated with 337.14 the county mental health plan for inclusion in the community 337.15 health services plan and included as an addendum to the 337.16 community social services plan. 337.17 (h) The county board having financial responsibility for 337.18 persons present in another county shall cooperate with that 337.19 county for planning and development of services. 337.20 (i) The county board shall cooperate in planning and 337.21 development of community based services with other counties, as 337.22 necessary, and coordinate planning for long-term care services 337.23 that involve more than one county, within the funding allocated 337.24 for these purposes. 337.25 (j) The commissioners of health and human services, in 337.26 cooperation with county boards, shall report to the legislature 337.27 by February 1 of each year, beginning February 1, 2002, 337.28 regarding the development of community based services, 337.29 transition or closure of nursing facilities, and consumer 337.30 outcomes achieved, as documented by each county and reported to 337.31 the commissioner by December 31 of each year. 337.32 (k) The process established by the commissioner of human 337.33 services shall ensure: 337.34 (1) that counties consider multicounty service areas in 337.35 developing services that may impact delivery efficiencies; and 337.36 (2) review and comment by the area agencies on aging, 338.1 regional development commissions, where they exist, and other 338.2 planning agencies of the biennial plan addendum. 338.3 Subd. 3. [REQUEST FOR APPLICATIONS FOR PLANNED CLOSURE OF 338.4 NURSING FACILITIES.] (a) By July 15, 2001, the commissioner of 338.5 human services shall implement and announce a program for 338.6 closure or partial closure of nursing facilities. Names and 338.7 identifying information provided in response to the announcement 338.8 shall remain private unless approved, according to the timelines 338.9 established in the plan. The announcement must specify: 338.10 (1) the criteria that will be used by the interagency 338.11 long-term care planning committee established under section 338.12 144A.31 and the commissioner to approve or reject applications; 338.13 (2) a requirement for the submission of a letter of intent 338.14 before the submission of an application; 338.15 (3) the information that must accompany an application; 338.16 (4) a schedule for letters of intent, applications, and 338.17 consideration of applications for a minimum of four review 338.18 processes to be conducted before June 30, 2003; and 338.19 (5) that applications may combine planned closure rate 338.20 adjustments with moratorium exception funding, in which case a 338.21 single application may serve both purposes. 338.22 Between October 1, 2001, and June 30, 2003, the commissioner 338.23 shall approve planned closures of at least 5,140 nursing 338.24 facility beds, with no more than 2,070 approved for closure 338.25 prior to July 1, 2002, less the number of licensed beds in 338.26 facilities that close during the same time period without 338.27 approved closure plans or have notified the commissioner of 338.28 health of their intent to close without an approved closure plan. 338.29 (b) A facility or facilities reimbursed under section 338.30 256B.431, 256B.434, or 256B.435 with a closure plan approved by 338.31 the commissioner under subdivision 6 may assign a planned 338.32 closure rate adjustment to another facility that is not closing 338.33 or facilities that are not closing, or in the case of a partial 338.34 closure, to the facility undertaking the partial closure. A 338.35 facility may also elect to have a planned closure rate 338.36 adjustment shared equally by the five nursing facilities with 339.1 the lowest total operating payment rates in the state 339.2 development region, designated under section 462.385, in which 339.3 the facility receiving the planned closure rate adjustment is 339.4 located. The planned closure rate adjustment must be calculated 339.5 under subdivision 7. A planned closure rate adjustment under 339.6 this section is effective on the first day of the month 339.7 following completion of closure of all facilities designated for 339.8 closure in the application and becomes part of the nursing 339.9 facility's total operating payment rate. 339.10 Applicants may use the planned closure rate adjustment to 339.11 allow for a property payment for a new nursing facility or an 339.12 addition to an existing nursing facility. Applications approved 339.13 under this paragraph are exempt from other requirements for 339.14 moratorium exceptions under section 144A.073, subdivisions 2 and 339.15 3. 339.16 Facilities without a closure plan, or whose closure plan is 339.17 not approved by the commissioner, are not eligible for a planned 339.18 closure rate adjustment under subdivision 7. However, the 339.19 commissioner shall calculate the amount the facility would have 339.20 received under subdivision 7 and shall use this amount to 339.21 provide equal rate adjustments to the five nursing facilities 339.22 with the lowest total operating payment rates in the state 339.23 development region, designated under section 462.385, in which 339.24 the facility is located. 339.25 (c) To be considered for approval, an application must 339.26 include: 339.27 (1) a description of the proposed closure plan, which must 339.28 include identification of the facility or facilities to receive 339.29 a planned closure rate adjustment and the amount and timing of a 339.30 planned closure rate adjustment proposed for each facility; 339.31 (2) the proposed timetable for any proposed closure, 339.32 including the proposed dates for announcement to residents, 339.33 commencement of closure, and completion of closure; 339.34 (3) the proposed relocation plan for current residents of 339.35 any facility designated for closure. The proposed relocation 339.36 plan must be designed to comply with all applicable state and 340.1 federal statutes and regulations, including, but not limited to, 340.2 section 144A.16 and Minnesota Rules, parts 4655.6810 to 340.3 4655.6830, 4658.1600 to 4658.1690, and 9546.0010 to 9546.0060; 340.4 (4) a description of the relationship between the nursing 340.5 facility that is proposed for closure and the nursing facility 340.6 or facilities proposed to receive the planned closure rate 340.7 adjustment. If these facilities are not under common ownership, 340.8 copies of any contracts, purchase agreements, or other documents 340.9 establishing a relationship or proposed relationship must be 340.10 provided; 340.11 (5) documentation, in a format approved by the 340.12 commissioner, that all the nursing facilities receiving a 340.13 planned closure rate adjustment under the plan have accepted 340.14 joint and several liability for recovery of overpayments under 340.15 section 256B.0641, subdivision 2, for the facilities designated 340.16 for closure under the plan; and 340.17 (6) an explanation of how the application coordinates with 340.18 planning efforts under subdivision 2. 340.19 (d) The application must address the criteria listed in 340.20 subdivision 4. 340.21 Subd. 4. [CRITERIA FOR REVIEW OF APPLICATION.] In 340.22 reviewing and approving closure proposals, the commissioner 340.23 shall consider, but not be limited to, the following criteria: 340.24 (1) improved quality of care and quality of life for 340.25 consumers; 340.26 (2) closure of a nursing facility that has a poor physical 340.27 plant; 340.28 (3) the existence of excess nursing facility beds, measured 340.29 in terms of beds per thousand persons aged 85 or older. The 340.30 excess must be measured in reference to: 340.31 (i) the county in which the facility is located; 340.32 (ii) the county and all contiguous counties; 340.33 (iii) the region in which the facility is located; or 340.34 (iv) the facility's service area. 340.35 The facility shall indicate in its proposal the area it believes 340.36 is appropriate for this measurement. A facility in a county 341.1 that is in the lowest quartile of counties with reference to 341.2 beds per thousand persons aged 85 or older is not in an area of 341.3 excess capacity; 341.4 (4) low-occupancy rates, provided that the unoccupied beds 341.5 are not the result of a personnel shortage. In analyzing 341.6 occupancy rates, the commissioner shall examine waiting lists in 341.7 the applicant facility and at facilities in the surrounding 341.8 area, as determined under clause (3); 341.9 (5) evidence of a community planning process to determine 341.10 what services are needed and ensure that needed services are 341.11 established; 341.12 (6) innovative use of reinvestment funds; 341.13 (7) innovative use planned for the closed facility's 341.14 physical plant; 341.15 (8) evidence that the proposal serves the interests of the 341.16 state; and 341.17 (9) evidence of other factors that affect the viability of 341.18 the facility, including excessive nursing pool costs. 341.19 Subd. 5. [REVIEW AND APPROVAL OF PROPOSALS.] (a) The 341.20 interagency long-term care planning committee may recommend that 341.21 the commissioner of human services grant approval, within the 341.22 limits established in subdivision 3, paragraph (a), to 341.23 applications that satisfy the requirements of this section. The 341.24 interagency committee may appoint an advisory review panel 341.25 composed of representatives of counties, SAIL projects, 341.26 consumers, and providers to review proposals and provide 341.27 comments and recommendations to the committee. The 341.28 commissioners of human services and health shall provide staff 341.29 and technical assistance to the committee for the review and 341.30 analysis of proposals. The commissioners of human services and 341.31 health shall jointly approve or disapprove an application within 341.32 30 days after receiving the committee's recommendations. 341.33 (b) Approval of a planned closure expires 18 months after 341.34 approval by the commissioner of human services, unless 341.35 commencement of closure has begun. 341.36 (c) The commissioner of human services may change any 342.1 provision of the application to which all parties agree. 342.2 Subd. 6. [PLANNED CLOSURE RATE ADJUSTMENT.] The 342.3 commissioner of human services shall calculate the amount of the 342.4 planned closure rate adjustment available under subdivision 3, 342.5 paragraph (b), according to clauses (1) to (4): 342.6 (1) the amount available is the net reduction of nursing 342.7 facility beds multiplied by $2,080; 342.8 (2) the total number of beds in the nursing facility 342.9 receiving the planned closure rate adjustment must be 342.10 identified; 342.11 (3) capacity days are determined by multiplying the number 342.12 determined under clause (2) by 365; and 342.13 (4) the planned closure rate adjustment is the amount 342.14 available in clause (1), divided by capacity days determined 342.15 under clause (3). 342.16 Subd. 7. [OTHER RATE ADJUSTMENTS.] Facilities receiving 342.17 planned closure rate adjustments remain eligible for any 342.18 applicable rate adjustments provided under section 256B.431, 342.19 256B.434, or any other section. 342.20 Subd. 8. [COUNTY COSTS.] The commissioner of human 342.21 services shall allocate up to $500 per nursing facility bed that 342.22 is closing, within the limits of the appropriation specified for 342.23 this purpose, to be used for relocation costs incurred by 342.24 counties for planned closures under this section or resident 342.25 relocation under sections 144A.185 to 144A.1887. To be eligible 342.26 for this allocation, a county in which a nursing facility closes 342.27 must provide to the commissioner a detailed statement in a form 342.28 provided by the commissioner of additional costs, not to exceed 342.29 $500 per bed closed, that are directly incurred related to the 342.30 county's required role in the relocation process. 342.31 Sec. 34. Minnesota Statutes 2000, section 256B.501, is 342.32 amended by adding a subdivision to read: 342.33 Subd. 14. [ICF/MR RATE INCREASES BEGINNING JULY 1, 2001, 342.34 AND JULY 1, 2002.] (a) For the rate periods beginning July 1, 342.35 2001, and July 1, 2002, the commissioner shall make available to 342.36 each facility reimbursed under this section, section 256B.5011, 343.1 and Laws 1993, First Special Session chapter 1, article 4, 343.2 section 11, an adjustment to the total operating payment rate of 343.3 3.0 percent. 343.4 (b) For each facility, the commissioner shall determine the 343.5 payment rate adjustment using the percentage specified in 343.6 paragraph (a) multiplied by the total operating payment rate in 343.7 effect on the last day of the prior rate year, and dividing the 343.8 resulting amount by the facility's actual resident days. The 343.9 total operating payment rate shall include the adjustment 343.10 provided in subdivision 12. 343.11 (c) Any facility whose payment rates are governed by 343.12 closure agreements, receivership agreements, or Minnesota Rules, 343.13 part 9553.0075, is not eligible for an adjustment otherwise 343.14 granted under this subdivision. 343.15 Sec. 35. Minnesota Statutes 2000, section 256B.76, is 343.16 amended to read: 343.17 256B.76 [PHYSICIAN AND DENTAL REIMBURSEMENT.] 343.18 (a) Effective for services rendered on or after October 1, 343.19 1992, the commissioner shall make payments for physician 343.20 services as follows: 343.21 (1) payment for level one Health Care Finance 343.22 Administration's common procedural coding system (HCPCS) codes 343.23 titled "office and other outpatient services," "preventive 343.24 medicine new and established patient," "delivery, antepartum, 343.25 and postpartum care," "critical care,"Caesareancesarean 343.26 delivery and pharmacologic management provided to psychiatric 343.27 patients, and HCPCS level three codes for enhanced services for 343.28 prenatal high risk, shall be paid at the lower of (i) submitted 343.29 charges, or (ii) 25 percent above the rate in effect on June 30, 343.30 1992. If the rate on any procedure code within these categories 343.31 is different than the rate that would have been paid under the 343.32 methodology in section 256B.74, subdivision 2, then the larger 343.33 rate shall be paid; 343.34 (2) payments for all other services shall be paid at the 343.35 lower of (i) submitted charges, or (ii) 15.4 percent above the 343.36 rate in effect on June 30, 1992; 344.1 (3) all physician rates shall be converted from the 50th 344.2 percentile of 1982 to the 50th percentile of 1989, less the 344.3 percent in aggregate necessary to equal the above increases 344.4 except that payment rates for home health agency services shall 344.5 be the rates in effect on September 30, 1992; 344.6 (4) effective for services rendered on or after January 1, 344.7 2000, payment rates for physician and professional services 344.8 shall be increased by three percent over the rates in effect on 344.9 December 31, 1999, except for home health agency and family 344.10 planning agency services; and 344.11 (5) the increases in clause (4) shall be implemented 344.12 January 1, 2000, for managed care. 344.13 (b) Effective for services rendered on or after October 1, 344.14 1992, the commissioner shall make payments for dental services 344.15 as follows: 344.16 (1) dental services shall be paid at the lower of (i) 344.17 submitted charges, or (ii) 25 percent above the rate in effect 344.18 on June 30, 1992; 344.19 (2) dental rates shall be converted from the 50th 344.20 percentile of 1982 to the 50th percentile of 1989, less the 344.21 percent in aggregate necessary to equal the above increases; 344.22 (3) effective for services rendered on or after January 1, 344.23 2000, payment rates for dental services shall be increased by 344.24 three percent over the rates in effect on December 31, 1999; 344.25 (4) the commissioner shall award grants to community 344.26 clinics or other nonprofit community organizations, political 344.27 subdivisions, professional associations, or other organizations 344.28 that demonstrate the ability to provide dental services 344.29 effectively to public program recipients. Grants may be used to 344.30 fund the costs related to coordinating access for recipients, 344.31 developing and implementing patient care criteria, upgrading or 344.32 establishing new facilities, acquiring furnishings or equipment, 344.33 recruiting new providers, or other development costs that will 344.34 improve access to dental care in a region. In awarding grants, 344.35 the commissioner shall give priority to applicants that plan to 344.36 serve areas of the state in which the number of dental providers 345.1 is not currently sufficient to meet the needs of recipients of 345.2 public programs or uninsured individuals. The commissioner 345.3 shall consider the following in awarding the grants: (i) 345.4 potential to successfully increase access to an underserved 345.5 population; (ii) the ability to raise matching funds; (iii) the 345.6 long-term viability of the project to improve access beyond the 345.7 period of initial funding; (iv) the efficiency in the use of the 345.8 funding; and (v) the experience of the proposers in providing 345.9 services to the target population. 345.10 The commissioner shall monitor the grants and may terminate 345.11 a grant if the grantee does not increase dental access for 345.12 public program recipients. The commissioner shall consider 345.13 grants for the following: 345.14 (i) implementation of new programs or continued expansion 345.15 of current access programs that have demonstrated success in 345.16 providing dental services in underserved areas; 345.17 (ii) a pilot program for utilizing hygienists outside of a 345.18 traditional dental office to provide dental hygiene services; 345.19 and 345.20 (iii) a program that organizes a network of volunteer 345.21 dentists, establishes a system to refer eligible individuals to 345.22 volunteer dentists, and through that network provides donated 345.23 dental care services to public program recipients or uninsured 345.24 individuals. 345.25 (5) beginning October 1, 1999, the payment for tooth 345.26 sealants and fluoride treatments shall be the lower of (i) 345.27 submitted charge, or (ii) 80 percent of median 1997 charges; and 345.28 (6) the increases listed in clauses (3) and (5) shall be 345.29 implemented January 1, 2000, for managed care. 345.30 (c) An entity that operates both a Medicare certified 345.31 comprehensive outpatient rehabilitation facility and a facility 345.32 which was certified prior to January 1, 1993, that is licensed 345.33 under Minnesota Rules, parts 9570.2000 to 9570.3600, and for 345.34 whom at least 33 percent of the clients receiving rehabilitation 345.35 services and mental health services in the most recent calendar 345.36 year are medical assistance recipients, shall be reimbursed by 346.1 the commissioner for rehabilitation services and mental health 346.2 services at rates that are 38 percent greater than the maximum 346.3 reimbursement rate allowed under paragraph (a), clause (2), when 346.4 those services are (1) provided within the comprehensive 346.5 outpatient rehabilitation facility and (2) provided to residents 346.6 of nursing facilities owned by the entity. 346.7 Sec. 36. Laws 1995, chapter 207, article 3, section 21, as 346.8 amended by Laws 1999, chapter 245, article 3, section 43, is 346.9 amended to read: 346.10 Sec. 21. [FACILITY CERTIFICATION.] 346.11 (a) Notwithstanding Minnesota Statutes, section 252.291, 346.12 subdivisions 1 and 2, the commissioner of health shall inspect 346.13 to certify a large community-based facility currently licensed 346.14 under Minnesota Rules, parts 9525.0215 to 9525.0355, for more 346.15 than 16 beds and located in Northfield. The facility may be 346.16 certified for up to 44 beds. The commissioner of health must 346.17 inspect to certify the facility as soon as possible after the 346.18 effective date of this section. The commissioner of human 346.19 services shall work with the facility and affected counties to 346.20 relocate any current residents of the facility who do not meet 346.21 the admission criteria for an ICF/MR. Until January 1, 1999, in 346.22 order to fund the ICF/MR services and relocations of current 346.23 residents authorized, the commissioner of human services may 346.24 transfer on a quarterly basis to the medical assistance account 346.25 from each affected county's community social service allocation, 346.26 an amount equal to the state share of medical assistance 346.27 reimbursement for the residential and day habilitation services 346.28 funded by medical assistance and provided to clients for whom 346.29 the county is financially responsible. 346.30 (b) After January 1, 1999, the commissioner of human 346.31 services shall fund the services under the state medical 346.32 assistance program and may transfer on a quarterly basis to the 346.33 medical assistance account from each affected county's community 346.34 social service allocation, an amount equal to one-half of the 346.35 state share of medical assistance reimbursement for the 346.36 residential and day habilitation services funded by medical 347.1 assistance and provided to clients for whom the county is 347.2 financially responsible. 347.3 (c) Effective July 1, 2001, the commissioner of human 347.4 services shall fund the entire state share of medical assistance 347.5 reimbursement for the residential and day habilitation services 347.6 funded by medical assistance and provided to clients for whom 347.7 counties are financially responsible from the medical assistance 347.8 account, and shall not make any transfer from the community 347.9 social service allocations of affected counties. 347.10 (d) For nonresidents of Minnesota seeking admission to the 347.11 facility, Rice county shall be notified in order to assure that 347.12 appropriate funding is guaranteed from their state or country of 347.13 residence. 347.14 Sec. 37. Laws 1999, chapter 245, article 3, section 45, as 347.15 amended by Laws 2000, chapter 312, section 3, is amended to read: 347.16 Sec. 45. [STATE LICENSURE CONFLICTS WITH FEDERAL 347.17 REGULATIONS.] 347.18 (a) Notwithstanding the provisions of Minnesota Rules, part 347.19 4658.0520, an incontinent resident must be checked according to 347.20 a specific time interval written in the resident's care plan. 347.21 The resident's attending physician must authorize in writing any 347.22 interval longer than two hours unless the resident, if 347.23 competent, or a family member or legally appointed conservator, 347.24 guardian, or health care agent of a resident who is not 347.25 competent, agrees in writing to waive physician involvement in 347.26 determining this interval. 347.27 (b) This section expires July 1,20012003. 347.28 Sec. 38. [DEVELOPMENT OF NEW NURSING FACILITY 347.29 REIMBURSEMENT SYSTEM.] 347.30 (a) The commissioner of human services shall develop and 347.31 report to the legislature by January 15, 2003, a system to 347.32 replace the current nursing facility reimbursement system 347.33 established under Minnesota Statutes, sections 256B.431, 347.34 256B.434, and 256B.435. 347.35 (b) The system must be developed in consultation with the 347.36 long-term care task force and with representatives of consumers, 348.1 providers, and labor unions. Within the limits of available 348.2 appropriations, the commissioner may employ consultants to 348.3 assist with this project. 348.4 (c) The new reimbursement system must: 348.5 (1) provide incentives to enhance quality of life and 348.6 quality of care; 348.7 (2) recognize cost differences in the care of different 348.8 types of populations, including subacute care and dementia care; 348.9 (3) establish rates that are sufficient without being 348.10 excessive; 348.11 (4) be affordable for the state and for private-pay 348.12 residents; 348.13 (5) be sensitive to changing conditions in the long-term 348.14 care environment; 348.15 (6) avoid creating access problems related to insufficient 348.16 funding; 348.17 (7) allow providers maximum flexibility in their business 348.18 operations; 348.19 (8) recognize the need for capital investment to improve 348.20 physical plants; and 348.21 (9) provide incentives for the development and use of 348.22 private rooms. 348.23 (d) Notwithstanding Minnesota Statutes, section 256B.435, 348.24 the commissioner must not implement a performance-based 348.25 contracting system for nursing facilities prior to July 1, 2003. 348.26 The commissioner shall continue to reimburse nursing facilities 348.27 under Minnesota Statutes, section 256B.431 or 256B.434, until 348.28 otherwise directed by law. 348.29 (e) The commissioner of human services, in consultation 348.30 with the commissioner of health, shall conduct or contract for a 348.31 time study to determine staff time being spent on various case 348.32 mix categories; recommend adjustments to the case mix weights 348.33 based on the time study data; and determine whether current 348.34 staffing standards are adequate for providing quality care based 348.35 on professional best practice and consumer experience. If the 348.36 commissioner determines the current standards are inadequate, 349.1 the commissioner shall determine an appropriate staffing 349.2 standard for the various case mix categories and the financial 349.3 implications of phasing into this standard over the next four 349.4 years. 349.5 Sec. 39. [REPORT ON STANDARDS FOR SUBACUTE CARE FACILITY 349.6 LICENSURE.] 349.7 By January 15, 2003, the commissioner of health shall 349.8 submit a report to the legislature on implementation of a 349.9 licensure program for subacute care. This report must include: 349.10 (1) definitions of subacute care and applicability of the 349.11 proposed licensure program to various types of licensed 349.12 facilities; 349.13 (2) an analysis of whether specific standards for subacute 349.14 levels of care need to be developed and the potential for 349.15 increased costs for existing providers of subacute care; 349.16 (3) recommendations on the applicability of the nursing 349.17 home moratorium law to the licensure of subacute care facilities 349.18 or programs; 349.19 (4) identification of federal regulations guiding the 349.20 provision of subacute care and whether further state standards 349.21 are needed; and 349.22 (5) identification of current and potential reimbursement 349.23 for subacute care under Medicare, Medicaid, or managed care 349.24 programs. 349.25 Sec. 40. [REGULATORY FLEXIBILITY.] 349.26 (a) By July 1, 2001, the commissioners of health and human 349.27 services shall: 349.28 (1) develop a summary of federal nursing facility and 349.29 community long-term care regulations that hamper state 349.30 flexibility and place burdens on the goal of achieving 349.31 high-quality care and optimum outcomes for consumers of 349.32 services; and 349.33 (2) share this summary with the legislature, other states, 349.34 national groups that advocate for state interests with Congress, 349.35 and the Minnesota congressional delegation. 349.36 (b) The commissioners shall conduct ongoing follow-up with 350.1 the entities to which this summary is provided and with the 350.2 health care financing administration to achieve maximum 350.3 regulatory flexibility, including the possibility of pilot 350.4 projects to demonstrate regulatory flexibility on less than a 350.5 statewide basis. 350.6 Sec. 41. [REPORT.] 350.7 By January 15, 2003, the commissioner of health and the 350.8 commissioner of human services shall report to the senate health 350.9 and family security committee and the house health and human 350.10 services policy committee on the number of closures that have 350.11 taken place under Minnesota Statutes, section 256B.437, and any 350.12 other nursing facility closures that may have taken place, 350.13 alternatives to nursing facility care that have been developed, 350.14 any problems with access to long-term care services that have 350.15 resulted, and any recommendations for continuation of the 350.16 regional long-term care planning process and the closure process 350.17 after June 30, 2003. 350.18 Sec. 42. [NURSING ASSISTANT; HOME HEALTH AIDE CURRICULUM.] 350.19 By January 1, 2003, the commissioner of health, in 350.20 consultation with long-term care consumers, advocates, unions, 350.21 and trade associations, shall present to the chairs of the 350.22 legislative committees dealing with health care policy 350.23 recommendations for updating the nursing assistant and home 350.24 health aide curriculum (1998 edition) to help students learn 350.25 front-line survival skills that support job motivation and 350.26 satisfaction. These skills include, but are not limited to, 350.27 working with challenging behaviors, communication skills, stress 350.28 management including the impact of personal life stress in the 350.29 work setting, building relationships with families, cultural 350.30 competencies, and working with death and dying. 350.31 Sec. 43. [EVALUATION OF REPORTING REQUIREMENTS.] 350.32 The commissioners of human services and health, in 350.33 consultation with interested parties, shall evaluate long-term 350.34 care provider reporting requirements, balancing the need for 350.35 public accountability with the need to reduce unnecessary 350.36 paperwork, and shall eliminate unnecessary reporting 351.1 requirements, seeking any necessary changes in federal and state 351.2 law. The commissioners shall present a progress report by 351.3 February 1, 2002, to the chairs of the house and senate 351.4 committees with jurisdiction over health and human services 351.5 policy and finance. 351.6 Sec. 44. [NURSING FACILITY MULTIPLE SCLEROSIS PILOT 351.7 PROJECT.] 351.8 (a) For the period from July 1, 2001, to June 30, 2003, the 351.9 commissioner of human services shall establish and implement a 351.10 pilot project to contract with nursing facilities eligible to 351.11 receive medical assistance payments that, at the time of 351.12 enrollment in the pilot project, serve ten or more persons with 351.13 a diagnosis of multiple sclerosis. The commissioner shall 351.14 negotiate a payment rate with eligible facilities to provide 351.15 services to persons with multiple sclerosis that must not exceed 351.16 150 percent of the person's case mix classification payment rate 351.17 for that facility. The commissioner may contract with up to six 351.18 nursing facilities. 351.19 (b) Facilities may enroll in the pilot project between July 351.20 1, 2001, and December 31, 2001. 351.21 (c) The commissioner shall evaluate the additional payments 351.22 made under the pilot project to determine if the adjustment 351.23 enables participating facilities to adequately meet the needs 351.24 for individual care and specialized programming, including 351.25 programs to meet psychosocial, physiological, and case 351.26 management needs, without incurring financial losses. The 351.27 commissioner of human services, in consultation with the 351.28 commissioner of health, shall report to the legislature by 351.29 January 15, 2003, on the results of the project and with a 351.30 recommendation on whether the project should be made permanent. 351.31 (d) The negotiated adjustment shall not affect the payment 351.32 rate charged to private paying residents under the provisions of 351.33 Minnesota Statutes, section 256B.48, subdivision 1. 351.34 Sec. 45. [MINIMUM STAFFING STANDARDS REPORT.] 351.35 By January 15, 2002, the commissioner of health and the 351.36 commissioner of human services shall report to the legislature 352.1 on whether they should translate the minimum nurse staffing 352.2 requirement in Minnesota Statutes, section 144A.04, subdivision 352.3 7, paragraph (a), upon the transition to the RUG-III 352.4 classification system, or whether they should establish 352.5 different time-based standards, and how to accomplish either. 352.6 Sec. 46. [REPEALER.] 352.7 Minnesota Statutes 2000, sections 144.0721, subdivision 1, 352.8 and 256B.434, subdivision 5, are repealed. 352.9 ARTICLE 6 352.10 WORK FORCE 352.11 Section 1. Minnesota Statutes 2000, section 144.1464, is 352.12 amended to read: 352.13 144.1464 [SUMMER HEALTH CARE INTERNS.] 352.14 Subdivision 1. [SUMMER INTERNSHIPS.] The commissioner of 352.15 health, through a contract with a nonprofit organization as 352.16 required by subdivision 4, shall award grants to hospitalsand, 352.17 clinics, nursing facilities, and home care providers to 352.18 establish a secondary and post-secondary summer health care 352.19 intern program. The purpose of the program is to expose 352.20 interested secondary and post-secondary pupils to various 352.21 careers within the health care profession. 352.22 Subd. 2. [CRITERIA.] (a) The commissioner, through the 352.23 organization under contract, shall award grants to 352.24 hospitalsand, clinics, nursing facilities, and home care 352.25 providers that agree to: 352.26 (1) provide secondary and post-secondary summer health care 352.27 interns with formal exposure to the health care profession; 352.28 (2) provide an orientation for the secondary and 352.29 post-secondary summer health care interns; 352.30 (3) pay one-half the costs of employing the secondary and 352.31 post-secondary summer health care intern, based on an overall352.32hourly wage that is at least the minimum wage but does not352.33exceed $6 an hour; 352.34 (4) interview and hire secondary and post-secondary pupils 352.35 for a minimum of six weeks and a maximum of 12 weeks; and 352.36 (5) employ at least one secondary student for each 353.1 post-secondary student employed, to the extent that there are 353.2 sufficient qualifying secondary student applicants. 353.3 (b) In order to be eligible to be hired as a secondary 353.4 summer health intern by a hospitalor, clinic, nursing facility, 353.5 or home care provider, a pupil must: 353.6 (1) intend to complete high school graduation requirements 353.7 and be between the junior and senior year of high school; and 353.8 (2) be from a school district in proximity to the facility;353.9and353.10(3) provide the facility with a letter of recommendation353.11from a health occupations or science educator. 353.12 (c) In order to be eligible to be hired as a post-secondary 353.13 summer health care intern by a hospital or clinic, a pupil must: 353.14 (1) intend to complete a health care training program or a 353.15 two-year or four-year degree program and be planning on 353.16 enrolling in or be enrolled in that training program or degree 353.17 program; and 353.18 (2) be enrolled in a Minnesota educational institution or 353.19 be a resident of the state of Minnesota; priority must be given 353.20 to applicants from a school district or an educational 353.21 institution in proximity to the facility; and353.22(3) provide the facility with a letter of recommendation353.23from a health occupations or science educator. 353.24 (d) Hospitalsand, clinics, nursing facilities, and home 353.25 care providers awarded grants may employ pupils as secondary and 353.26 post-secondary summer health care interns beginning on or after 353.27 June 15, 1993, if they agree to pay the intern, during the 353.28 period before disbursement of state grant money, with money 353.29 designated as the facility's 50 percent contribution towards 353.30 internship costs. 353.31 Subd. 3. [GRANTS.] The commissioner, through the 353.32 organization under contract, shall award separate grants to 353.33 hospitalsand, clinics, nursing facilities, and home care 353.34 providers meeting the requirements of subdivision 2. The grants 353.35 must be used to pay one-half of the costs of employing secondary 353.36 and post-secondary pupils in a hospitalor, clinic, nursing 354.1 facility, or home care setting during the course of the 354.2 program. No more than 50 percent of the participants may be 354.3 post-secondary students, unless the program does not receive 354.4 enough qualified secondary applicants per fiscal year. No more 354.5 than five pupils may be selected from any secondary or 354.6 post-secondary institution to participate in the program and no 354.7 more than one-half of the number of pupils selected may be from 354.8 the seven-county metropolitan area. 354.9 Subd. 4. [CONTRACT.] The commissioner shall contract with 354.10 a statewide, nonprofit organization representing facilities at 354.11 which secondary and post-secondary summer health care interns 354.12 will serve, to administer the grant program established by this 354.13 section. Grant funds that are not used in one fiscal year may 354.14 be carried over to the next fiscal year. The organization 354.15 awarded the grant shall provide the commissioner with any 354.16 information needed by the commissioner to evaluate the program, 354.17 in the form and at the times specified by the commissioner. 354.18 Sec. 2. [144.1499] [PROMOTION OF HEALTH CARE AND LONG-TERM 354.19 CARE CAREERS.] 354.20 The commissioner of health, in consultation with an 354.21 organization representing health care employers, long-term care 354.22 employers, and educational institutions, may make grants to 354.23 qualifying consortia as defined in section 116L.11, subdivision 354.24 4, for intergenerational programs to encourage middle and high 354.25 school students to work and volunteer in health care and 354.26 long-term care settings. To qualify for a grant under this 354.27 section, a consortium shall: 354.28 (1) develop a health and long-term care careers curriculum 354.29 that provides career exploration and training in national skill 354.30 standards for health care and long-term care and that is 354.31 consistent with Minnesota graduation standards and other related 354.32 requirements; 354.33 (2) offer programs for high school students that provide 354.34 training in health and long-term care careers with credits that 354.35 articulate into post-secondary programs; and 354.36 (3) provide technical support to the participating health 355.1 care and long-term care employer to enable the use of the 355.2 employer's facilities and programs for K-12 health and long-term 355.3 care careers education. 355.4 Sec. 3. Minnesota Statutes 2000, section 144A.62, 355.5 subdivision 1, is amended to read: 355.6 Subdivision 1. [ASSISTANCE WITH EATING AND DRINKING.] (a) 355.7 Upon federal approval, a nursing home may employ resident 355.8 attendants to assist with the activities authorized under 355.9 subdivision 2. The resident attendantwill notshall be counted 355.10 in the minimum staffing requirements under section 144A.04, 355.11 subdivision 7. 355.12 (b) The commissioner shall submit byMayJuly 15,2000355.13 2001, a new request for a federal waiver necessary to implement 355.14 this section. 355.15 Sec. 4. Minnesota Statutes 2000, section 144A.62, 355.16 subdivision 2, is amended to read: 355.17 Subd. 2. [DEFINITION.] (a) "Resident attendant" means an 355.18 individual who assists residentsin a nursing homewiththeone 355.19 or more of the following activitiesof eating and drinking: 355.20 (1) eating and drinking; and 355.21 (2) transporting. 355.22 (b) A resident attendant does not include an individual who: 355.23 (1) is a licensed health professional or a registered 355.24 dietitian; 355.25 (2) volunteers without monetary compensation; or 355.26 (3) is a registered nursing assistant. 355.27 Sec. 5. Minnesota Statutes 2000, section 144A.62, 355.28 subdivision 3, is amended to read: 355.29 Subd. 3. [REQUIREMENTS.] (a) A nursing home may not use on 355.30 a full-time or other paid basis any individual as a resident 355.31 attendant in the nursing home unless the individual: 355.32 (1) has completed a training and competency evaluation 355.33 program encompassing thetasksactivities in subdivision 2 that 355.34 the individual provides; 355.35 (2) is competent to providefeeding and hydration services355.36 those activities; and 356.1 (3) is under the supervision of the director of nursing. 356.2 (b) A nursing home may not use a current employee as a 356.3 resident attendant unless the employee satisfies the 356.4 requirements of paragraph (a) and volunteers to be used in that 356.5 capacity. 356.6 Sec. 6. Minnesota Statutes 2000, section 144A.62, 356.7 subdivision 4, is amended to read: 356.8 Subd. 4. [EVALUATION.] The training and competency 356.9 evaluation program may be facility based. It must include, at a 356.10 minimum, the training and competency standards foreating and356.11drinking assistancethe specific activities the attendant will 356.12 be conducting contained in the nursing assistant training 356.13 curriculum. 356.14 Sec. 7. Minnesota Statutes 2000, section 148.212, is 356.15 amended to read: 356.16 148.212 [TEMPORARY PERMIT.] 356.17 Upon receipt of the applicable licensure or reregistration 356.18 fee and permit fee, and in accordance with rules of the board, 356.19 the board may issue a nonrenewable temporary permit to practice 356.20 professional or practical nursing to an applicant for licensure 356.21 or reregistration who is not the subject of a pending 356.22 investigation or disciplinary action, nor disqualified for any 356.23 other reason, under the following circumstances: 356.24 (a) The applicant for licensure by examination under 356.25 section 148.211, subdivision 1, has graduated from an approved 356.26 nursing program within the 60 days preceding board receipt of an 356.27 affidavit of graduation or transcript and has been authorized by 356.28 the board to write the licensure examination for the first time 356.29 in the United States. The permit holder must practice 356.30 professional or practical nursing under the direct supervision 356.31 of a registered nurse. The permit is valid from the date of 356.32 issue until the date the board takes action on the application 356.33 or for 60 days whichever occurs first. 356.34 (b) The applicant for licensure by endorsement under 356.35 section 148.211, subdivision 2, is currently licensed to 356.36 practice professional or practical nursing in another state, 357.1 territory, or Canadian province. The permit is valid from 357.2 submission of a proper request until the date of board action on 357.3 the application. 357.4 (c) The applicant for licensure by endorsement under 357.5 section 148.211, subdivision 2, or for reregistration under 357.6 section 148.231, subdivision 5, is currently registered in a 357.7 formal, structured refresher course or its equivalent for nurses 357.8 that includes clinical practice. 357.9 (d) The applicant for licensure by examination under 357.10 section 148.211, subdivision 1, as a registered nurse has been 357.11 issued a commission on graduates of foreign nurse schools 357.12 certificate, has completed all requirements for licensure except 357.13 the licensing examination, and has been authorized by the board 357.14 to write the licensure examination for the first time in the 357.15 United States. The permit holder must practice professional 357.16 nursing under the direct supervision of a registered nurse. The 357.17 permit is valid from the date of issue until the date the board 357.18 takes action on the application or for 60 days, whichever occurs 357.19 first. 357.20 ARTICLE 7 357.21 REGULATION OF SUPPLEMENTAL 357.22 NURSING SERVICES AGENCIES 357.23 Section 1. [144A.70] [REGISTRATION OF SUPPLEMENTAL NURSING 357.24 SERVICES AGENCIES; DEFINITIONS.] 357.25 Subdivision 1. [SCOPE.] As used in sections 144A.70 to 357.26 144A.74, the terms defined in this section have the meanings 357.27 given them. 357.28 Subd. 2. [COMMISSIONER.] "Commissioner" means the 357.29 commissioner of health. 357.30 Subd. 3. [CONTROLLING PERSON.] "Controlling person" means 357.31 a business entity, officer, program administrator, or director 357.32 whose responsibilities include the direction of the management 357.33 or policies of a supplemental nursing services agency. 357.34 Controlling person also means an individual who, directly or 357.35 indirectly, beneficially owns an interest in a corporation, 357.36 partnership, or other business association that is a controlling 358.1 person. 358.2 Subd. 4. [HEALTH CARE FACILITY.] "Health care facility" 358.3 means a hospital, boarding care home, or outpatient surgical 358.4 center licensed under sections 144.50 to 144.58, a nursing home 358.5 or home care agency licensed under this chapter, a residential 358.6 care home, or a board and lodging establishment that is 358.7 registered to provide supportive or health supervision services 358.8 under section 157.17. 358.9 Subd. 5. [PERSON.] "Person" includes an individual, firm, 358.10 corporation, partnership, or association. 358.11 Subd. 6. [SUPPLEMENTAL NURSING SERVICES 358.12 AGENCY.] "Supplemental nursing services agency" means a person, 358.13 firm, corporation, partnership, or association engaged for hire 358.14 in the business of providing or procuring temporary employment 358.15 in health care facilities for nurses, nursing assistants, nurse 358.16 aides, and orderlies. Supplemental nursing services agency does 358.17 not include an individual who only engages in providing the 358.18 individual's services on a temporary basis to health care 358.19 facilities. Supplemental nursing services agency also does not 358.20 include any nursing services agency that is limited to providing 358.21 temporary nursing personnel solely to one or more health care 358.22 facilities owned or operated by the same person, firm, 358.23 corporation, or partnership. 358.24 Sec. 2. [144A.71] [SUPPLEMENTAL NURSING SERVICES AGENCY 358.25 REGISTRATION.] 358.26 Subdivision 1. [DUTY TO REGISTER.] A person who operates a 358.27 supplemental nursing services agency shall register the agency 358.28 with the commissioner. Each separate location of the business 358.29 of a supplemental nursing services agency shall register the 358.30 agency with the commissioner. Each separate location of the 358.31 business of a supplemental nursing services agency shall have a 358.32 separate registration. 358.33 Subd. 2. [APPLICATION INFORMATION AND FEE.] The 358.34 commissioner shall establish forms and procedures for processing 358.35 each supplemental nursing services agency registration 358.36 application. An application for a supplemental nursing services 359.1 agency registration must include at least the following: 359.2 (1) the names and addresses of the owner or owners of the 359.3 supplemental nursing services agency; 359.4 (2) if the owner is a corporation, copies of its articles 359.5 of incorporation and current bylaws, together with the names and 359.6 addresses of its officers and directors; 359.7 (3) any other relevant information that the commissioner 359.8 determines is necessary to properly evaluate an application for 359.9 registration; and 359.10 (4) the annual registration fee for a supplemental nursing 359.11 services agency, which is $891. 359.12 Subd. 3. [REGISTRATION NOT TRANSFERABLE.] A registration 359.13 issued by the commissioner according to this section is 359.14 effective for a period of one year from the date of its issuance 359.15 unless the registration is revoked or suspended under section 359.16 144A.72, subdivision 2, or unless the supplemental nursing 359.17 services agency is sold or ownership or management is 359.18 transferred. When a supplemental nursing services agency is 359.19 sold or ownership or management is transferred, the registration 359.20 of the agency must be voided and the new owner or operator may 359.21 apply for a new registration. 359.22 Sec. 3. [144A.72] [REGISTRATION REQUIREMENTS.] 359.23 The commissioner shall require that, as a condition of 359.24 registration: 359.25 (1) the supplemental nursing services agency shall document 359.26 that each temporary employee provided to health care facilities 359.27 currently meets the minimum licensing, training, and continuing 359.28 education standards for the position in which the employee will 359.29 be working; 359.30 (2) the supplemental nursing services agency shall comply 359.31 with all pertinent requirements relating to the health and other 359.32 qualifications of personnel employed in health care facilities; 359.33 (3) the supplemental nursing services agency must not 359.34 restrict in any manner the employment opportunities of its 359.35 employees; 359.36 (4) the supplemental nursing services agency, when 360.1 supplying temporary employees to a health care facility, and 360.2 when requested by the facility to do so, shall agree that at 360.3 least 30 percent of the total personnel hours supplied are 360.4 during night, holiday, or weekend shifts; 360.5 (5) the supplemental nursing services agency shall carry 360.6 medical malpractice insurance to insure against the loss, 360.7 damage, or expense incident to a claim arising out of the death 360.8 or injury of any person as the result of negligence or 360.9 malpractice in the provision of health care services by the 360.10 supplemental nursing services agency or by any employee of the 360.11 agency; and 360.12 (6) the supplemental nursing services agency must not, in 360.13 any contract with any employee or health care facility, require 360.14 the payment of liquidated damages, employment fees, or other 360.15 compensation should the employee be hired as a permanent 360.16 employee of a health care facility. 360.17 Sec. 4. [144A.73] [COMPLAINT SYSTEM.] 360.18 The commissioner shall establish a system for reporting 360.19 complaints against a supplemental nursing services agency or its 360.20 employees. Complaints may be made by any member of the public. 360.21 Written complaints must be forwarded to the employer of each 360.22 person against whom a complaint is made. The employer shall 360.23 promptly report to the commissioner any corrective action taken. 360.24 Sec. 5. [144A.74] [MAXIMUM CHARGES.] 360.25 A supplemental nursing services agency must not bill or 360.26 receive payments from a nursing home licensed under this chapter 360.27 at a rate higher than 150 percent of the weighted average wage 360.28 rate for the applicable employee classification for the 360.29 geographic group to which the nursing home is assigned under 360.30 chapter 256B. The weighted average wage rates must be 360.31 determined by the commissioner of human services and reported to 360.32 the commissioner of health on an annual basis. Facilities shall 360.33 provide information necessary to determine weighted average wage 360.34 rates to the commissioner of human services in a format 360.35 requested by the commissioner. The maximum rate must include 360.36 all charges for administrative fees, contract fees, or other 361.1 special charges in addition to the hourly rates for the 361.2 temporary nursing pool personnel supplied to a nursing home. 361.3 Sec. 6. Minnesota Statutes 2000, section 245A.04, 361.4 subdivision 3, is amended to read: 361.5 Subd. 3. [BACKGROUND STUDY OF THE APPLICANT; DEFINITIONS.] 361.6 (a) Before the commissioner issues a license, the commissioner 361.7 shall conduct a study of the individuals specified in paragraph 361.8(c)(d), clauses (1) to (5), according to rules of the 361.9 commissioner. 361.10 Beginning January 1, 1997, the commissioner shall also 361.11 conduct a study of employees providing direct contact services 361.12 for nonlicensed personal care provider organizations described 361.13 in paragraph(c)(d), clause (5). 361.14 The commissioner shall recover the cost of these background 361.15 studies through a fee of no more than $12 per study charged to 361.16 the personal care provider organization. The fees collected 361.17 under this paragraph are appropriated to the commissioner for 361.18 the purpose of conducting background studies. 361.19 Beginning August 1, 1997, the commissioner shall conduct 361.20 all background studies required under this chapter for adult 361.21 foster care providers who are licensed by the commissioner of 361.22 human services and registered under chapter 144D. The 361.23 commissioner shall conduct these background studies in 361.24 accordance with this chapter. The commissioner shall initiate a 361.25 pilot project to conduct up to 5,000 background studies under 361.26 this chapter in programs with joint licensure as home and 361.27 community-based services and adult foster care for people with 361.28 developmental disabilities when the license holder does not 361.29 reside in the foster care residence. 361.30 (b) Beginning July 1, 1998, the commissioner shall conduct 361.31 a background study on individuals specified in 361.32 paragraph(c)(d), clauses (1) to (5), who perform direct 361.33 contact services in a nursing home or a home care agency 361.34 licensed under chapter 144A or a boarding care home licensed 361.35 under sections 144.50 to 144.58, when the subject of the study 361.36 resides outside Minnesota; the study must be at least as 362.1 comprehensive as that of a Minnesota resident and include a 362.2 search of information from the criminal justice data 362.3 communications network in the state where the subject of the 362.4 study resides. 362.5 (c) Beginning August 1, 2001, the commissioner shall 362.6 conduct all background studies required under this chapter and 362.7 initiated by supplemental nursing services agencies registered 362.8 under chapter 144A. Studies for the agencies must be initiated 362.9 annually by each agency. The commissioner shall conduct the 362.10 background studies according to this chapter. The commissioner 362.11 shall recover the cost of the background studies through a fee 362.12 of no more than $8 per study, charged to the supplemental 362.13 nursing services agency. The fees collected under this 362.14 paragraph are appropriated to the commissioner for the purpose 362.15 of conducting background studies. 362.16 (d) The applicant, license holder,theregistrant, bureau 362.17 of criminal apprehension,thecommissioner of health, and county 362.18 agencies, after written notice to the individual who is the 362.19 subject of the study, shall help with the study by giving the 362.20 commissioner criminal conviction data and reports about the 362.21 maltreatment of adults substantiated under section 626.557 and 362.22 the maltreatment of minors in licensed programs substantiated 362.23 under section 626.556. The individuals to be studied shall 362.24 include: 362.25 (1) the applicant; 362.26 (2) persons over the age of 13 living in the household 362.27 where the licensed program will be provided; 362.28 (3) current employees or contractors of the applicant who 362.29 will have direct contact with persons served by the facility, 362.30 agency, or program; 362.31 (4) volunteers or student volunteers who have direct 362.32 contact with persons served by the program to provide program 362.33 services, if the contact is not directly supervised by the 362.34 individuals listed in clause (1) or (3); and 362.35 (5) any person who, as an individual or as a member of an 362.36 organization, exclusively offers, provides, or arranges for 363.1 personal care assistant services under the medical assistance 363.2 program as authorized under sections 256B.04, subdivision 16, 363.3 and 256B.0625, subdivision 19a. 363.4 The juvenile courts shall also help with the study by 363.5 giving the commissioner existing juvenile court records on 363.6 individuals described in clause (2) relating to delinquency 363.7 proceedings held within either the five years immediately 363.8 preceding the application or the five years immediately 363.9 preceding the individual's 18th birthday, whichever time period 363.10 is longer. The commissioner shall destroy juvenile records 363.11 obtained pursuant to this subdivision when the subject of the 363.12 records reaches age 23. 363.13 For purposes of this section and Minnesota Rules, part 363.14 9543.3070, a finding that a delinquency petition is proven in 363.15 juvenile court shall be considered a conviction in state 363.16 district court. 363.17 For purposes of this subdivision, "direct contact" means 363.18 providing face-to-face care, training, supervision, counseling, 363.19 consultation, or medication assistance to persons served by a 363.20 program. For purposes of this subdivision, "directly supervised" 363.21 means an individual listed in clause (1), (3), or (5) is within 363.22 sight or hearing of a volunteer to the extent that the 363.23 individual listed in clause (1), (3), or (5) is capable at all 363.24 times of intervening to protect the health and safety of the 363.25 persons served by the program who have direct contact with the 363.26 volunteer. 363.27 A study of an individual in clauses (1) to (5) shall be 363.28 conducted at least upon application for initial license or 363.29 registration and reapplication for a license or registration. 363.30 The commissioner is not required to conduct a study of an 363.31 individual at the time of reapplication for a license or if the 363.32 individual has been continuously affiliated with a foster care 363.33 provider licensed by the commissioner of human services and 363.34 registered under chapter 144D, other than a family day care or 363.35 foster care license, if: (i) a study of the individual was 363.36 conducted either at the time of initial licensure or when the 364.1 individual became affiliated with the license holder; (ii) the 364.2 individual has been continuously affiliated with the license 364.3 holder since the last study was conducted; and (iii) the 364.4 procedure described in paragraph(d)(e) has been implemented 364.5 and was in effect continuously since the last study was 364.6 conducted. For the purposes of this section, a physician 364.7 licensed under chapter 147 is considered to be continuously 364.8 affiliated upon the license holder's receipt from the 364.9 commissioner of health or human services of the physician's 364.10 background study results. For individuals who are required to 364.11 have background studies under clauses (1) to (5) and who have 364.12 been continuously affiliated with a foster care provider that is 364.13 licensed in more than one county, criminal conviction data may 364.14 be shared among those counties in which the foster care programs 364.15 are licensed. A county agency's receipt of criminal conviction 364.16 data from another county agency shall meet the criminal data 364.17 background study requirements of this section. 364.18 The commissioner may also conduct studies on individuals 364.19 specified in clauses (3) and (4) when the studies are initiated 364.20 by: 364.21 (i) personnel pool agencies; 364.22 (ii) temporary personnel agencies; 364.23 (iii) educational programs that train persons by providing 364.24 direct contact services in licensed programs; and 364.25 (iv) professional services agencies that are not licensed 364.26 and which contract with licensed programs to provide direct 364.27 contact services or individuals who provide direct contact 364.28 services. 364.29 Studies on individuals in items (i) to (iv) must be 364.30 initiated annually by these agencies, programs, and 364.31 individuals. Except for personal care provider 364.32 organizations and supplemental nursing services agencies, no 364.33 applicant, license holder, or individual who is the subject of 364.34 the study shall pay any fees required to conduct the study. 364.35 (1) At the option of the licensed facility, rather than 364.36 initiating another background study on an individual required to 365.1 be studied who has indicated to the licensed facility that a 365.2 background study by the commissioner was previously completed, 365.3 the facility may make a request to the commissioner for 365.4 documentation of the individual's background study status, 365.5 provided that: 365.6 (i) the facility makes this request using a form provided 365.7 by the commissioner; 365.8 (ii) in making the request the facility informs the 365.9 commissioner that either: 365.10 (A) the individual has been continuously affiliated with a 365.11 licensed facility since the individual's previous background 365.12 study was completed, or since October 1, 1995, whichever is 365.13 shorter; or 365.14 (B) the individual is affiliated only with a personnel pool 365.15 agency, a temporary personnel agency, an educational program 365.16 that trains persons by providing direct contact services in 365.17 licensed programs, or a professional services agency that is not 365.18 licensed and which contracts with licensed programs to provide 365.19 direct contact services or individuals who provide direct 365.20 contact services; and 365.21 (iii) the facility provides notices to the individual as 365.22 required in paragraphs (a) to(d)(e), and that the facility is 365.23 requesting written notification of the individual's background 365.24 study status from the commissioner. 365.25 (2) The commissioner shall respond to each request under 365.26 paragraph (1) with a written or electronic notice to the 365.27 facility and the study subject. If the commissioner determines 365.28 that a background study is necessary, the study shall be 365.29 completed without further request from a licensed agency or 365.30 notifications to the study subject. 365.31 (3) When a background study is being initiated by a 365.32 licensed facility or a foster care provider that is also 365.33 registered under chapter 144D, a study subject affiliated with 365.34 multiple licensed facilities may attach to the background study 365.35 form a cover letter indicating the additional facilities' names, 365.36 addresses, and background study identification numbers. When 366.1 the commissioner receives such notices, each facility identified 366.2 by the background study subject shall be notified of the study 366.3 results. The background study notice sent to the subsequent 366.4 agencies shall satisfy those facilities' responsibilities for 366.5 initiating a background study on that individual. 366.6(d)(e) If an individual who is affiliated with a program 366.7 or facility regulated by the department of human services or 366.8 department of health or who is affiliated with a nonlicensed 366.9 personal care provider organization, is convicted of a crime 366.10 constituting a disqualification under subdivision 3d, the 366.11 probation officer or corrections agent shall notify the 366.12 commissioner of the conviction. The commissioner, in 366.13 consultation with the commissioner of corrections, shall develop 366.14 forms and information necessary to implement this paragraph and 366.15 shall provide the forms and information to the commissioner of 366.16 corrections for distribution to local probation officers and 366.17 corrections agents. The commissioner shall inform individuals 366.18 subject to a background study that criminal convictions for 366.19 disqualifying crimes will be reported to the commissioner by the 366.20 corrections system. A probation officer, corrections agent, or 366.21 corrections agency is not civilly or criminally liable for 366.22 disclosing or failing to disclose the information required by 366.23 this paragraph. Upon receipt of disqualifying information, the 366.24 commissioner shall provide the notifications required in 366.25 subdivision 3a, as appropriate to agencies on record as having 366.26 initiated a background study or making a request for 366.27 documentation of the background study status of the individual. 366.28 This paragraph does not apply to family day care and child 366.29 foster care programs. 366.30(e)(f) The individual who is the subject of the study must 366.31 provide the applicant or license holder with sufficient 366.32 information to ensure an accurate study including the 366.33 individual's first, middle, and last name; home address, city, 366.34 county, and state of residence for the past five years; zip 366.35 code; sex; date of birth; and driver's license number. The 366.36 applicant or license holder shall provide this information about 367.1 an individual in paragraph(c)(d), clauses (1) to (5), on forms 367.2 prescribed by the commissioner. By January 1, 2000, for 367.3 background studies conducted by the department of human 367.4 services, the commissioner shall implement a system for the 367.5 electronic transmission of: (1) background study information to 367.6 the commissioner; and (2) background study results to the 367.7 license holder. The commissioner may request additional 367.8 information of the individual, which shall be optional for the 367.9 individual to provide, such as the individual's social security 367.10 number or race. 367.11(f)(g) Except for child foster care, adult foster care, 367.12 and family day care homes, a study must include information 367.13 related to names of substantiated perpetrators of maltreatment 367.14 of vulnerable adults that has been received by the commissioner 367.15 as required under section 626.557, subdivision 9c, paragraph 367.16 (i), and the commissioner's records relating to the maltreatment 367.17 of minors in licensed programs, information from juvenile courts 367.18 as required in paragraph(c)(d) for persons listed in paragraph 367.19(c)(d), clause (2), and information from the bureau of criminal 367.20 apprehension. For child foster care, adult foster care, and 367.21 family day care homes, the study must include information from 367.22 the county agency's record of substantiated maltreatment of 367.23 adults, and the maltreatment of minors, information from 367.24 juvenile courts as required in paragraph(c)(d) for persons 367.25 listed in paragraph(c)(d), clause (2), and information from 367.26 the bureau of criminal apprehension. The commissioner may also 367.27 review arrest and investigative information from the bureau of 367.28 criminal apprehension, the commissioner of health, a county 367.29 attorney, county sheriff, county agency, local chief of police, 367.30 other states, the courts, or the Federal Bureau of Investigation 367.31 if the commissioner has reasonable cause to believe the 367.32 information is pertinent to the disqualification of an 367.33 individual listed in paragraph(c)(d), clauses (1) to (5). The 367.34 commissioner is not required to conduct more than one review of 367.35 a subject's records from the Federal Bureau of Investigation if 367.36 a review of the subject's criminal history with the Federal 368.1 Bureau of Investigation has already been completed by the 368.2 commissioner and there has been no break in the subject's 368.3 affiliation with the license holder who initiated the background 368.4 studies. 368.5 When the commissioner has reasonable cause to believe that 368.6 further pertinent information may exist on the subject, the 368.7 subject shall provide a set of classifiable fingerprints 368.8 obtained from an authorized law enforcement agency. For 368.9 purposes of requiring fingerprints, the commissioner shall be 368.10 considered to have reasonable cause under, but not limited to, 368.11 the following circumstances: 368.12 (1) information from the bureau of criminal apprehension 368.13 indicates that the subject is a multistate offender; 368.14 (2) information from the bureau of criminal apprehension 368.15 indicates that multistate offender status is undetermined; or 368.16 (3) the commissioner has received a report from the subject 368.17 or a third party indicating that the subject has a criminal 368.18 history in a jurisdiction other than Minnesota. 368.19(g)(h) An applicant'sor, license holder's, or 368.20 registrant's failure or refusal to cooperate with the 368.21 commissioner is reasonable cause to disqualify a subject, deny a 368.22 license application or immediately suspend, suspend, or revoke a 368.23 license or registration. Failure or refusal of an individual to 368.24 cooperate with the study is just cause for denying or 368.25 terminating employment of the individual if the individual's 368.26 failure or refusal to cooperate could cause the applicant's 368.27 application to be denied or the license holder's license to be 368.28 immediately suspended, suspended, or revoked. 368.29(h)(i) The commissioner shall not consider an application 368.30 to be complete until all of the information required to be 368.31 provided under this subdivision has been received. 368.32(i)(j) No person in paragraph(c)(d), clause (1), (2), 368.33 (3), (4), or (5), who is disqualified as a result of this 368.34 section may be retained by the agency in a position involving 368.35 direct contact with persons served by the program. 368.36(j)(k) Termination of persons in paragraph(c)(d), clause 369.1 (1), (2), (3), (4), or (5), made in good faith reliance on a 369.2 notice of disqualification provided by the commissioner shall 369.3 not subject the applicant or license holder to civil liability. 369.4(k)(l) The commissioner may establish records to fulfill 369.5 the requirements of this section. 369.6(l)(m) The commissioner may not disqualify an individual 369.7 subject to a study under this section because that person has, 369.8 or has had, a mental illness as defined in section 245.462, 369.9 subdivision 20. 369.10(m)(n) An individual subject to disqualification under 369.11 this subdivision has the applicable rights in subdivision 3a, 369.12 3b, or 3c. 369.13(n)(o) For the purposes of background studies completed by 369.14 tribal organizations performing licensing activities otherwise 369.15 required of the commissioner under this chapter, after obtaining 369.16 consent from the background study subject, tribal licensing 369.17 agencies shall have access to criminal history data in the same 369.18 manner as county licensing agencies and private licensing 369.19 agencies under this chapter. 369.20 Sec. 7. [REPORT ON SUPPLEMENTAL NURSING SERVICES AGENCY 369.21 USE.] 369.22 Beginning July 1, 2001, through June 30, 2003, the 369.23 commissioner of human services shall require nursing facilities 369.24 and other providers of long-term care services to report 369.25 semiannually on the use of supplemental nursing services, in the 369.26 form and manner specified by the commissioner. The information 369.27 reported must include, but is not limited to: 369.28 (1) number of hours worked by supplemental nursing services 369.29 personnel, by job classification, for each month; 369.30 (2) payments to supplemental nursing services agencies, on 369.31 a per hour worked basis, by job classification, for each month; 369.32 and 369.33 (3) percentage of total monthly work hours provided by 369.34 supplemental nursing services agency personnel, by job 369.35 classification, for each shift and for weekdays and weekends. 369.36 ARTICLE 8 370.1 LONG-TERM CARE INSURANCE 370.2 Section 1. Minnesota Statutes 2000, section 62A.48, 370.3 subdivision 4, is amended to read: 370.4 Subd. 4. [LOSS RATIO.] The anticipated loss ratio for 370.5 long-term care policies must not be less than 65 percent for 370.6 policies issued on a group basis or 60 percent for policies 370.7 issued on an individual or mass-market basis. This subdivision 370.8 does not apply to policies issued on or after January 1, 2002, 370.9 that comply with sections 62S.021 and 62S.081. 370.10 [EFFECTIVE DATE.] This section is effective the day 370.11 following final enactment. 370.12 Sec. 2. Minnesota Statutes 2000, section 62A.48, is 370.13 amended by adding a subdivision to read: 370.14 Subd. 10. [REGULATION OF PREMIUMS AND PREMIUM 370.15 INCREASES.] Policies issued under sections 62A.46 to 62A.56 on 370.16 or after January 1, 2002, must comply with sections 62S.021, 370.17 62S.081, 62S.265, and 62S.266 to the same extent as policies 370.18 issued under chapter 62S. 370.19 [EFFECTIVE DATE.] This section is effective the day 370.20 following final enactment. 370.21 Sec. 3. Minnesota Statutes 2000, section 62A.48, is 370.22 amended by adding a subdivision to read: 370.23 Subd. 11. [NONFORFEITURE BENEFITS.] Policies issued under 370.24 sections 62A.46 to 62A.56 on or after January 1, 2002, must 370.25 comply with section 62S.02, subdivision 2, to the same extent as 370.26 policies issued under chapter 62S. 370.27 [EFFECTIVE DATE.] This section is effective the day 370.28 following final enactment. 370.29 Sec. 4. Minnesota Statutes 2000, section 62S.01, is 370.30 amended by adding a subdivision to read: 370.31 Subd. 13a. [EXCEPTIONAL INCREASE.] (a) "Exceptional 370.32 increase" means only those premium rate increases filed by an 370.33 insurer as exceptional for which the commissioner determines 370.34 that the need for the premium rate increase is justified due to 370.35 changes in laws or rules applicable to long-term care coverage 370.36 in this state, or due to increased and unexpected utilization 371.1 that affects the majority of insurers of similar products. 371.2 (b) Except as provided in section 62S.265, exceptional 371.3 increases are subject to the same requirements as other premium 371.4 rate schedule increases. The commissioner may request a review 371.5 by an independent actuary or a professional actuarial body of 371.6 the basis for a request that an increase be considered an 371.7 exceptional increase. The commissioner, in determining that the 371.8 necessary basis for an exceptional increase exists, shall also 371.9 determine any potential offsets to higher claims costs. 371.10 [EFFECTIVE DATE.] This section is effective the day 371.11 following final enactment. 371.12 Sec. 5. Minnesota Statutes 2000, section 62S.01, is 371.13 amended by adding a subdivision to read: 371.14 Subd. 17a. [INCIDENTAL.] "Incidental," as used in section 371.15 62S.265, subdivision 10, means that the value of the long-term 371.16 care benefits provided is less than ten percent of the total 371.17 value of the benefits provided over the life of the policy. 371.18 These values must be measured as of the date of issue. 371.19 [EFFECTIVE DATE.] This section is effective the day 371.20 following final enactment. 371.21 Sec. 6. Minnesota Statutes 2000, section 62S.01, is 371.22 amended by adding a subdivision to read: 371.23 Subd. 23a. [QUALIFIED ACTUARY.] "Qualified actuary" means 371.24 a member in good standing of the American Academy of Actuaries. 371.25 [EFFECTIVE DATE.] This section is effective the day 371.26 following final enactment. 371.27 Sec. 7. Minnesota Statutes 2000, section 62S.01, is 371.28 amended by adding a subdivision to read: 371.29 Subd. 25a. [SIMILAR POLICY FORMS.] "Similar policy forms" 371.30 means all of the long-term care insurance policies and 371.31 certificates issued by an insurer in the same long-term care 371.32 benefit classification as the policy form being considered. 371.33 Certificates of groups that meet the definition in section 371.34 62S.01, subdivision 15, clause (1), are not considered similar 371.35 to certificates or policies otherwise issued as long-term care 371.36 insurance, but are similar to other comparable certificates with 372.1 the same long-term care benefit classifications. For purposes 372.2 of determining similar policy forms, long-term care benefit 372.3 classifications are defined as follows: institutional long-term 372.4 care benefits only, noninstitutional long-term care benefits 372.5 only, or comprehensive long-term care benefits. 372.6 [EFFECTIVE DATE.] This section is effective the day 372.7 following final enactment. 372.8 Sec. 8. [62S.021] [LONG-TERM CARE INSURANCE; INITIAL 372.9 FILING.] 372.10 Subdivision 1. [APPLICABILITY.] This section applies to 372.11 any long-term care policy issued in this state on or after 372.12 January 1, 2002, under this chapter or sections 62A.46 to 62A.56. 372.13 Subd. 2. [REQUIRED SUBMISSION TO COMMISSIONER.] An insurer 372.14 shall provide the following information to the commissioner 30 372.15 days prior to making a long-term care insurance form available 372.16 for sale: 372.17 (1) a copy of the disclosure documents required in section 372.18 62S.081; and 372.19 (2) an actuarial certification consisting of at least the 372.20 following: 372.21 (i) a statement that the initial premium rate schedule is 372.22 sufficient to cover anticipated costs under moderately adverse 372.23 experience and that the premium rate schedule is reasonably 372.24 expected to be sustainable over the life of the form with no 372.25 future premium increases anticipated; 372.26 (ii) a statement that the policy design and coverage 372.27 provided have been reviewed and taken into consideration; 372.28 (iii) a statement that the underwriting and claims 372.29 adjudication processes have been reviewed and taken into 372.30 consideration; and 372.31 (iv) a complete description of the basis for contract 372.32 reserves that are anticipated to be held under the form, to 372.33 include: 372.34 (A) sufficient detail or sample calculations provided so as 372.35 to have a complete depiction of the reserve amounts to be held; 372.36 (B) a statement that the assumptions used for reserves 373.1 contain reasonable margins for adverse experience; 373.2 (C) a statement that the net valuation premium for renewal 373.3 years does not increase, except for attained-age rating where 373.4 permitted; 373.5 (D) a statement that the difference between the gross 373.6 premium and the net valuation premium for renewal years is 373.7 sufficient to cover expected renewal expenses, or if such a 373.8 statement cannot be made, a complete description of the 373.9 situations in which this does not occur. An aggregate 373.10 distribution of anticipated issues may be used as long as the 373.11 underlying gross premiums maintain a reasonably consistent 373.12 relationship. If the gross premiums for certain age groups 373.13 appear to be inconsistent with this requirement, the 373.14 commissioner may request a demonstration under item (i) based on 373.15 a standard age distribution; and 373.16 (E) either a statement that the premium rate schedule is 373.17 not less than the premium rate schedule for existing similar 373.18 policy forms also available from the insurer except for 373.19 reasonable differences attributable to benefits, or a comparison 373.20 of the premium schedules for similar policy forms that are 373.21 currently available from the insurer with an explanation of the 373.22 differences. 373.23 Subd. 3. [ACTUARIAL DEMONSTRATION.] The commissioner may 373.24 request an actuarial demonstration that benefits are reasonable 373.25 in relation to premiums. The actuarial demonstration must 373.26 include either premium and claim experience on similar policy 373.27 forms, adjusted for any premium or benefit differences, relevant 373.28 and credible data from other studies, or both. If the 373.29 commissioner asks for additional information under this 373.30 subdivision, the 30-day time limit in subdivision 2 does not 373.31 include the time during which the insurer is preparing the 373.32 requested information. 373.33 [EFFECTIVE DATE.] This section is effective the day 373.34 following final enactment. 373.35 Sec. 9. [62S.081] [REQUIRED DISCLOSURE OF RATING PRACTICES 373.36 TO CONSUMERS.] 374.1 Subdivision 1. [APPLICATION.] This section applies as 374.2 follows: 374.3 (a) Except as provided in paragraph (b), this section 374.4 applies to any long-term care policy or certificate issued in 374.5 this state on or after January 1, 2002. 374.6 (b) For certificates issued on or after the effective date 374.7 of this section under a policy of group long-term care insurance 374.8 as defined in section 62S.01, subdivision 15, that was in force 374.9 on the effective date of this section, this section applies on 374.10 the policy anniversary following June 30, 2002. 374.11 Subd. 2. [REQUIRED DISCLOSURES.] Other than policies for 374.12 which no applicable premium rate or rate schedule increases can 374.13 be made, insurers shall provide all of the information listed in 374.14 this subdivision to the applicant at the time of application or 374.15 enrollment, unless the method of application does not allow for 374.16 delivery at that time; in this case, an insurer shall provide 374.17 all of the information listed in this subdivision to the 374.18 applicant no later than at the time of delivery of the policy or 374.19 certificate: 374.20 (1) a statement that the policy may be subject to rate 374.21 increases in the future; 374.22 (2) an explanation of potential future premium rate 374.23 revisions and the policyholder's or certificate holder's option 374.24 in the event of a premium rate revision; 374.25 (3) the premium rate or rate schedules applicable to the 374.26 applicant that will be in effect until a request is made for an 374.27 increase; 374.28 (4) a general explanation of applying premium rate or rate 374.29 schedule adjustments that must include: 374.30 (i) a description of when premium rate or rate schedule 374.31 adjustments will be effective, for example the next anniversary 374.32 date or the next billing date; and 374.33 (ii) the right to a revised premium rate or rate schedule 374.34 as provided in clause (3) if the premium rate or rate schedule 374.35 is changed; and 374.36 (5)(i) information regarding each premium rate increase on 375.1 this policy form or similar policy forms over the past ten years 375.2 for this state or any other state that, at a minimum, identifies: 375.3 (A) the policy forms for which premium rates have been 375.4 increased; 375.5 (B) the calendar years when the form was available for 375.6 purchase; and 375.7 (C) the amount or percent of each increase. The percentage 375.8 may be expressed as a percentage of the premium rate prior to 375.9 the increase and may also be expressed as minimum and maximum 375.10 percentages if the rate increase is variable by rating 375.11 characteristics; 375.12 (ii) the insurer may, in a fair manner, provide additional 375.13 explanatory information related to the rate increases; 375.14 (iii) an insurer has the right to exclude from the 375.15 disclosure premium rate increases that apply only to blocks of 375.16 business acquired from other nonaffiliated insurers or the 375.17 long-term care policies acquired from other nonaffiliated 375.18 insurers when those increases occurred prior to the acquisition; 375.19 (iv) if an acquiring insurer files for a rate increase on a 375.20 long-term care policy form acquired from nonaffiliated insurers 375.21 or a block of policy forms acquired from nonaffiliated insurers 375.22 on or before the later of the effective date of this section, or 375.23 the end of a 24-month period following the acquisition of the 375.24 block of policies, the acquiring insurer may exclude that rate 375.25 increase from the disclosure. However, the nonaffiliated 375.26 selling company must include the disclosure of that rate 375.27 increase according to item (i); and 375.28 (v) if the acquiring insurer in item (iv) files for a 375.29 subsequent rate increase, even within the 24-month period, on 375.30 the same policy form acquired from nonaffiliated insurers or 375.31 block of policy forms acquired from nonaffiliated insurers 375.32 referenced in item (iv), the acquiring insurer shall make all 375.33 disclosures required by this subdivision, including disclosure 375.34 of the earlier rate increase referenced in item (iv). 375.35 Subd. 3. [ACKNOWLEDGMENT.] An applicant shall sign an 375.36 acknowledgment at the time of application, unless the method of 376.1 application does not allow for signature at that time, that the 376.2 insurer made the disclosure required under subdivision 2. If, 376.3 due to the method of application, the applicant cannot sign an 376.4 acknowledgment at the time of application, the applicant shall 376.5 sign no later than at the time of delivery of the policy or 376.6 certificate. 376.7 Subd. 4. [FORMS.] An insurer shall use the forms in 376.8 Appendices B and F of the Long-term Care Insurance Model 376.9 Regulation adopted by the National Association of Insurance 376.10 Commissioners to comply with the requirements of subdivisions 1 376.11 and 2. 376.12 Subd. 5. [NOTICE OF INCREASE.] An insurer shall provide 376.13 notice of an upcoming premium rate schedule increase, after the 376.14 increase has been approved by the commissioner, to all 376.15 policyholders or certificate holders, if applicable, at least 45 376.16 days prior to the implementation of the premium rate schedule 376.17 increase by the insurer. The notice must include the 376.18 information required by subdivision 2 when the rate increase is 376.19 implemented. 376.20 [EFFECTIVE DATE.] This section is effective the day 376.21 following final enactment. 376.22 Sec. 10. Minnesota Statutes 2000, section 62S.26, is 376.23 amended to read: 376.24 62S.26 [LOSS RATIO.] 376.25 (a) The minimum loss ratio must be at least 60 percent, 376.26 calculated in a manner which provides for adequate reserving of 376.27 the long-term care insurance risk. In evaluating the expected 376.28 loss ratio, the commissioner shall give consideration to all 376.29 relevant factors, including: 376.30 (1) statistical credibility of incurred claims experience 376.31 and earned premiums; 376.32 (2) the period for which rates are computed to provide 376.33 coverage; 376.34 (3) experienced and projected trends; 376.35 (4) concentration of experience within early policy 376.36 duration; 377.1 (5) expected claim fluctuation; 377.2 (6) experience refunds, adjustments, or dividends; 377.3 (7) renewability features; 377.4 (8) all appropriate expense factors; 377.5 (9) interest; 377.6 (10) experimental nature of the coverage; 377.7 (11) policy reserves; 377.8 (12) mix of business by risk classification; and 377.9 (13) product features such as long elimination periods, 377.10 high deductibles, and high maximum limits. 377.11 (b) This section does not apply to policies or certificates 377.12 that are subject to sections 62S.021, 62S.081, and 62S.265, and 377.13 that comply with those sections. 377.14 [EFFECTIVE DATE.] This section is effective the day 377.15 following final enactment. 377.16 Sec. 11. [62S.265] [PREMIUM RATE SCHEDULE INCREASES.] 377.17 Subdivision 1. [APPLICABILITY.] (a) Except as provided in 377.18 paragraph (b), this section applies to any long-term care policy 377.19 or certificate issued in this state on or after January 1, 2002, 377.20 under this chapter or sections 62A.46 to 62A.56. 377.21 (b) For certificates issued on or after the effective date 377.22 of this section under a group long-term care insurance policy as 377.23 defined in section 62S.01, subdivision 15, issued under this 377.24 chapter, that was in force on the effective date of this 377.25 section, this section applies on the policy anniversary 377.26 following June 30, 2002. 377.27 Subd. 2. [NOTICE.] An insurer shall file a requested 377.28 premium rate schedule increase, including an exceptional 377.29 increase, to the commissioner for prior approval at least 60 377.30 days prior to the notice to the policyholders and shall include: 377.31 (1) all information required by section 62S.081; 377.32 (2) certification by a qualified actuary that: 377.33 (i) if the requested premium rate schedule increase is 377.34 implemented and the underlying assumptions, which reflect 377.35 moderately adverse conditions, are realized, no further premium 377.36 rate schedule increases are anticipated; and 378.1 (ii) the premium rate filing complies with this section; 378.2 (3) an actuarial memorandum justifying the rate schedule 378.3 change request that includes: 378.4 (i) lifetime projections of earned premiums and incurred 378.5 claims based on the filed premium rate schedule increase and the 378.6 method and assumptions used in determining the projected values, 378.7 including reflection of any assumptions that deviate from those 378.8 used for pricing other forms currently available for sale; 378.9 (A) annual values for the five years preceding and the 378.10 three years following the valuation date must be provided 378.11 separately; 378.12 (B) the projections must include the development of the 378.13 lifetime loss ratio, unless the rate increase is an exceptional 378.14 increase; 378.15 (C) the projections must demonstrate compliance with 378.16 subdivision 3; and 378.17 (D) for exceptional increases, the projected experience 378.18 must be limited to the increases in claims expenses attributable 378.19 to the approved reasons for the exceptional increase and, if the 378.20 commissioner determines that offsets to higher claim costs may 378.21 exist, the insurer shall use appropriate net projected 378.22 experience; 378.23 (ii) disclosure of how reserves have been incorporated in 378.24 this rate increase whenever the rate increase will trigger 378.25 contingent benefit upon lapse; 378.26 (iii) disclosure of the analysis performed to determine why 378.27 a rate adjustment is necessary, which pricing assumptions were 378.28 not realized and why, and what other actions taken by the 378.29 company have been relied upon by the actuary; 378.30 (iv) a statement that policy design, underwriting, and 378.31 claims adjudication practices have been taken into 378.32 consideration; and 378.33 (v) if it is necessary to maintain consistent premium rates 378.34 for new certificates and certificates receiving a rate increase, 378.35 the insurer shall file composite rates reflecting projections of 378.36 new certificates; 379.1 (4) a statement that renewal premium rate schedules are not 379.2 greater than new business premium rate schedules except for 379.3 differences attributable to benefits, unless sufficient 379.4 justification is provided to the commissioner; and 379.5 (5) sufficient information for review and approval of the 379.6 premium rate schedule increase by the commissioner. 379.7 Subd. 3. [REQUIREMENTS PERTAINING TO RATE INCREASES.] All 379.8 premium rate schedule increases must be determined according to 379.9 the following requirements: 379.10 (1) exceptional increases must provide that 70 percent of 379.11 the present value of projected additional premiums from the 379.12 exceptional increase will be returned to policyholders in 379.13 benefits; 379.14 (2) premium rate schedule increases must be calculated so 379.15 that the sum of the accumulated value of incurred claims, 379.16 without the inclusion of active life reserves, and the present 379.17 value of future projected incurred claims, without the inclusion 379.18 of active life reserves, will not be less than the sum of the 379.19 following: 379.20 (i) the accumulated value of the initial earned premium 379.21 times 58 percent; 379.22 (ii) 85 percent of the accumulated value of prior premium 379.23 rate schedule increases on an earned basis; 379.24 (iii) the present value of future projected initial earned 379.25 premiums times 58 percent; and 379.26 (iv) 85 percent of the present value of future projected 379.27 premiums not in item (iii) on an earned basis; 379.28 (3) if a policy form has both exceptional and other 379.29 increases, the values in clause (2), items (ii) and (iv), must 379.30 also include 70 percent for exceptional rate increase amounts; 379.31 and 379.32 (4) all present and accumulated values used to determine 379.33 rate increases must use the maximum valuation interest rate for 379.34 contract reserves permitted for valuation of whole life 379.35 insurance policies issued in this state on the same date. The 379.36 actuary shall disclose as part of the actuarial memorandum the 380.1 use of any appropriate averages. 380.2 Subd. 4. [PROJECTIONS.] For each rate increase that is 380.3 implemented, the insurer shall file for approval by the 380.4 commissioner updated projections, as described in subdivision 2, 380.5 clause (3), item (i), annually for the next three years and 380.6 include a comparison of actual results to projected values. The 380.7 commissioner may extend the period to greater than three years 380.8 if actual results are not consistent with projected values from 380.9 prior projections. For group insurance policies that meet the 380.10 conditions in subdivision 11, the projections required by this 380.11 subdivision must be provided to the policyholder in lieu of 380.12 filing with the commissioner. 380.13 Subd. 5. [LIFETIME PROJECTIONS.] If any premium rate in 380.14 the revised premium rate schedule is greater than 200 percent of 380.15 the comparable rate in the initial premium schedule, lifetime 380.16 projections, as described in subdivision 2, clause (3), item 380.17 (i), must be filed for approval by the commissioner every five 380.18 years following the end of the required period in subdivision 380.19 4. For group insurance policies that meet the conditions in 380.20 subdivision 11, the projections required by this subdivision 380.21 must be provided to the policyholder in lieu of filing with the 380.22 commissioner. 380.23 Subd. 6. [EFFECT OF ACTUAL EXPERIENCE.] (a) If the 380.24 commissioner has determined that the actual experience following 380.25 a rate increase does not adequately match the projected 380.26 experience and that the current projections under moderately 380.27 adverse conditions demonstrate that incurred claims will not 380.28 exceed proportions of premiums specified in subdivision 3, the 380.29 commissioner may require the insurer to implement any of the 380.30 following: 380.31 (1) premium rate schedule adjustments; or 380.32 (2) other measures to reduce the difference between the 380.33 projected and actual experience. 380.34 (b) In determining whether the actual experience adequately 380.35 matches the projected experience, consideration must be given to 380.36 subdivision 2, clause (3), item (v), if applicable. 381.1 Subd. 7. [CONTINGENT BENEFIT UPON LAPSE.] If the majority 381.2 of the policies or certificates to which the increase is 381.3 applicable are eligible for the contingent benefit upon lapse, 381.4 the insurer shall file: 381.5 (1) a plan, subject to commissioner approval, for improved 381.6 administration or claims processing designed to eliminate the 381.7 potential for further deterioration of the policy form requiring 381.8 further premium rate schedule increases, or both, or a 381.9 demonstration that appropriate administration and claims 381.10 processing have been implemented or are in effect; otherwise, 381.11 the commissioner may impose the condition in subdivision 8, 381.12 paragraph (b); and 381.13 (2) the original anticipated lifetime loss ratio, and the 381.14 premium rate schedule increase that would have been calculated 381.15 according to subdivision 3 had the greater of the original 381.16 anticipated lifetime loss ratio or 58 percent been used in the 381.17 calculations described in subdivision 3, clause (2), items (i) 381.18 and (iii). 381.19 Subd. 8. [PROJECTED LAPSE RATES.] (a) For a rate increase 381.20 filing that meets the following criteria, the commissioner shall 381.21 review, for all policies included in the filing, the projected 381.22 lapse rates and past lapse rates during the 12 months following 381.23 each increase to determine if significant adverse lapsation has 381.24 occurred or is anticipated: 381.25 (1) the rate increase is not the first rate increase 381.26 requested for the specific policy form or forms; 381.27 (2) the rate increase is not an exceptional increase; and 381.28 (3) the majority of the policies or certificates to which 381.29 the increase is applicable are eligible for the contingent 381.30 benefit upon lapse. 381.31 (b) If significant adverse lapsation has occurred, is 381.32 anticipated in the filing, or is evidenced in the actual results 381.33 as presented in the updated projections provided by the insurer 381.34 following the requested rate increase, the commissioner may 381.35 determine that a rate spiral exists. Following the 381.36 determination that a rate spiral exists, the commissioner may 382.1 require the insurer to offer, without underwriting, to all 382.2 in-force insureds subject to the rate increase, the option to 382.3 replace existing coverage with one or more reasonably comparable 382.4 products being offered by the insurer or its affiliates. The 382.5 offer must: 382.6 (1) be subject to the approval of the commissioner; 382.7 (2) be based upon actuarially sound principles, but not be 382.8 based upon attained age; and 382.9 (3) provide that maximum benefits under any new policy 382.10 accepted by an insured will be reduced by comparable benefits 382.11 already paid under the existing policy. 382.12 (c) The insurer shall maintain the experience of all the 382.13 replacement insureds separate from the experience of insureds 382.14 originally issued the policy forms. In the event of a request 382.15 for a rate increase on the policy form, the rate increase must 382.16 be limited to the lesser of the maximum rate increase determined 382.17 based on the combined experience and the maximum rate increase 382.18 determined based only upon the experience of the insureds 382.19 originally issued the form plus ten percent. 382.20 Subd. 9. [PERSISTENT PRACTICE OF INADEQUATE INITIAL 382.21 RATES.] If the commissioner determines that the insurer has 382.22 exhibited a persistent practice of filing inadequate initial 382.23 premium rates for long-term care insurance, the commissioner 382.24 may, in addition to the provisions of subdivision 8, take either 382.25 of the following actions: 382.26 (1) prohibit the insurer from filing and marketing 382.27 comparable coverage for a period of up to five years; or 382.28 (2) prohibit the insurer from offering all other similar 382.29 coverages and limit the insurer's marketing of new applications 382.30 for the products that are subject to recent premium rate 382.31 schedule increases. 382.32 Subd. 10. [INCIDENTAL LONG-TERM CARE 382.33 BENEFITS.] Subdivisions 1 to 9 do not apply to policies for 382.34 which the long-term care benefits provided by the policy are 382.35 incidental, as defined in section 62S.01, subdivision 17a, if 382.36 the policy complies with all of the following provisions: 383.1 (1) the interest credited internally to determine cash 383.2 value accumulations, including long-term care, if any, are 383.3 guaranteed not to be less than the minimum guaranteed interest 383.4 rate for cash value accumulations without long-term care set 383.5 forth in the policy; 383.6 (2) the portion of the policy that provides insurance 383.7 benefits other than long-term care coverage meets the 383.8 nonforfeiture requirements as applicable in any of the following: 383.9 (i) for life insurance, section 61A.25; 383.10 (ii) for individual deferred annuities, section 61A.245; 383.11 and 383.12 (iii) for variable annuities, section 61A.21; 383.13 (3) the policy meets the disclosure requirements of 383.14 sections 62S.10 and 62S.11 if the policy is governed by chapter 383.15 62S and of section 62A.50 if the policy is governed by sections 383.16 62A.46 to 62A.56; 383.17 (4) the portion of the policy that provides insurance 383.18 benefits other than long-term care coverage meets the 383.19 requirements as applicable in the following: 383.20 (i) policy illustrations to the extent required by state 383.21 law applicable to life insurance; 383.22 (ii) disclosure requirements in state law applicable to 383.23 annuities; and 383.24 (iii) disclosure requirements applicable to variable 383.25 annuities; and 383.26 (5) an actuarial memorandum is filed with the commissioner 383.27 that includes: 383.28 (i) a description of the basis on which the long-term care 383.29 rates were determined; 383.30 (ii) a description of the basis for the reserves; 383.31 (iii) a summary of the type of policy, benefits, 383.32 renewability, general marketing method, and limits on ages of 383.33 issuance; 383.34 (iv) a description and a table of each actuarial assumption 383.35 used. For expenses, an insurer must include percent of premium 383.36 dollars per policy and dollars per unit of benefits, if any; 384.1 (v) a description and a table of the anticipated policy 384.2 reserves and additional reserves to be held in each future year 384.3 for active lives; 384.4 (vi) the estimated average annual premium per policy and 384.5 the average issue age; 384.6 (vii) a statement as to whether underwriting is performed 384.7 at the time of application. The statement must indicate whether 384.8 underwriting is used and, if used, the statement must include a 384.9 description of the type or types of underwriting used, such as 384.10 medical underwriting or functional assessment underwriting. 384.11 Concerning a group policy, the statement must indicate whether 384.12 the enrollee or any dependent will be underwritten and when 384.13 underwriting occurs; and 384.14 (viii) a description of the effect of the long-term care 384.15 policy provision on the required premiums, nonforfeiture values, 384.16 and reserves on the underlying insurance policy, both for active 384.17 lives and those in long-term care claim status. 384.18 Subd. 11. [LARGE GROUP POLICIES.] Subdivisions 6 and 9 do 384.19 not apply to group long-term care insurance policies as defined 384.20 in section 62S.01, subdivision 15, where: 384.21 (1) the policies insure 250 or more persons, and the 384.22 policyholder has 5,000 or more eligible employees of a single 384.23 employer; or 384.24 (2) the policyholder, and not the certificate holders, pays 384.25 a material portion of the premium, which is not less than 20 384.26 percent of the total premium for the group in the calendar year 384.27 prior to the year in which a rate increase is filed. 384.28 [EFFECTIVE DATE.] This section is effective the day 384.29 following final enactment. 384.30 Sec. 12. [62S.266] [NONFORFEITURE BENEFIT REQUIREMENT.] 384.31 Subdivision 1. [APPLICABILITY.] This section does not 384.32 apply to life insurance policies or riders containing 384.33 accelerated long-term care benefits. 384.34 Subd. 2. [REQUIREMENT.] An insurer must offer each 384.35 prospective policyholder a nonforfeiture benefit in compliance 384.36 with the following requirements: 385.1 (1) a policy or certificate offered with nonforfeiture 385.2 benefits must have coverage elements, eligibility, benefit 385.3 triggers, and benefit length that are the same as coverage to be 385.4 issued without nonforfeiture benefits. The nonforfeiture 385.5 benefit included in the offer must be the benefit described in 385.6 subdivision 5; and 385.7 (2) the offer must be in writing if the nonforfeiture 385.8 benefit is not otherwise described in the outline of coverage or 385.9 other materials given to the prospective policyholder. 385.10 Subd. 3. [EFFECT OF REJECTION OF OFFER.] If the offer 385.11 required to be made under subdivision 2 is rejected, the insurer 385.12 shall provide the contingent benefit upon lapse described in 385.13 this section. 385.14 Subd. 4. [CONTINGENT BENEFIT UPON LAPSE.] (a) After 385.15 rejection of the offer required under subdivision 2, for 385.16 individual and group policies without nonforfeiture benefits 385.17 issued after the effective date of this section, the insurer 385.18 shall provide a contingent benefit upon lapse. 385.19 (b) If a group policyholder elects to make the 385.20 nonforfeiture benefit an option to the certificate holder, a 385.21 certificate shall provide either the nonforfeiture benefit or 385.22 the contingent benefit upon lapse. 385.23 (c) The contingent benefit on lapse must be triggered every 385.24 time an insurer increases the premium rates to a level which 385.25 results in a cumulative increase of the annual premium equal to 385.26 or exceeding the percentage of the insured's initial annual 385.27 premium based on the insured's issue age provided in this 385.28 paragraph, and the policy or certificate lapses within 120 days 385.29 of the due date of the premium increase. Unless otherwise 385.30 required, policyholders shall be notified at least 30 days prior 385.31 to the due date of the premium reflecting the rate increase. 385.32 Triggers for a Substantial Premium Increase 385.33 Percent Increase 385.34 Issue Age Over Initial Premium 385.35 29 and Under 200 385.36 30-34 190 386.1 35-39 170 386.2 40-44 150 386.3 45-49 130 386.4 50-54 110 386.5 55-59 90 386.6 60 70 386.7 61 66 386.8 62 62 386.9 63 58 386.10 64 54 386.11 65 50 386.12 66 48 386.13 67 46 386.14 68 44 386.15 69 42 386.16 70 40 386.17 71 38 386.18 72 36 386.19 73 34 386.20 74 32 386.21 75 30 386.22 76 28 386.23 77 26 386.24 78 24 386.25 79 22 386.26 80 20 386.27 81 19 386.28 82 18 386.29 83 17 386.30 84 16 386.31 85 15 386.32 86 14 386.33 87 13 386.34 88 12 386.35 89 11 386.36 90 and over 10 387.1 (d) On or before the effective date of a substantial 387.2 premium increase as defined in paragraph (c), the insurer shall: 387.3 (1) offer to reduce policy benefits provided by the current 387.4 coverage without the requirement of additional underwriting so 387.5 that required premium payments are not increased; 387.6 (2) offer to convert the coverage to a paid-up status with 387.7 a shortened benefit period according to the terms of subdivision 387.8 5. This option may be elected at any time during the 120-day 387.9 period referenced in paragraph (c); and 387.10 (3) notify the policyholder or certificate holder that a 387.11 default or lapse at any time during the 120-day period 387.12 referenced in paragraph (c) is deemed to be the election of the 387.13 offer to convert in clause (2). 387.14 Subd. 5. [NONFORFEITURE BENEFITS; REQUIREMENTS.] (a) 387.15 Benefits continued as nonforfeiture benefits, including 387.16 contingent benefits upon lapse, must be as described in this 387.17 subdivision. 387.18 (b) For purposes of this subdivision, "attained age rating" 387.19 is defined as a schedule of premiums starting from the issue 387.20 date which increases with age at least one percent per year 387.21 prior to age 50, and at least three percent per year beyond age 387.22 50. 387.23 (c) For purposes of this subdivision, the nonforfeiture 387.24 benefit must be of a shortened benefit period providing paid-up, 387.25 long-term care insurance coverage after lapse. The same 387.26 benefits, amounts, and frequency in effect at the time of lapse, 387.27 but not increased thereafter, will be payable for a qualifying 387.28 claim, but the lifetime maximum dollars or days of benefits must 387.29 be determined as specified in paragraph (d). 387.30 (d) The standard nonforfeiture credit is equal to 100 387.31 percent of the sum of all premiums paid, including the premiums 387.32 paid prior to any changes in benefits. The insurer may offer 387.33 additional shortened benefit period options, so long as the 387.34 benefits for each duration equal or exceed the standard 387.35 nonforfeiture credit for that duration. However, the minimum 387.36 nonforfeiture credit must not be less than 30 times the daily 388.1 nursing home benefit at the time of lapse. In either event, the 388.2 calculation of the nonforfeiture credit is subject to the 388.3 limitation of this subdivision. 388.4 (e) The nonforfeiture benefit must begin not later than the 388.5 end of the third year following the policy or certificate issue 388.6 date. The contingent benefit upon lapse must be effective 388.7 during the first three years as well as thereafter. 388.8 (f) Notwithstanding paragraph (e), for a policy or 388.9 certificate with attained age rating, the nonforfeiture benefit 388.10 must begin on the earlier of: 388.11 (1) the end of the tenth year following the policy or 388.12 certificate issue date; or 388.13 (2) the end of the second year following the date the 388.14 policy or certificate is no longer subject to attained age 388.15 rating. 388.16 (g) Nonforfeiture credits may be used for all care and 388.17 services qualifying for benefits under the terms of the policy 388.18 or certificate, up to the limits specified in the policy or 388.19 certificate. 388.20 Subd. 6. [BENEFIT LIMIT.] All benefits paid by the insurer 388.21 while the policy or certificate is in premium-paying status and 388.22 in the paid-up status will not exceed the maximum benefits which 388.23 would be payable if the policy or certificate had remained in 388.24 premium-paying status. 388.25 Subd. 7. [MINIMUM BENEFITS; INDIVIDUAL AND GROUP 388.26 POLICIES.] There must be no difference in the minimum 388.27 nonforfeiture benefits as required under this section for group 388.28 and individual policies. 388.29 Subd. 8. [APPLICATION; EFFECTIVE DATES.] This section 388.30 becomes effective January 1, 2002, and applies as follows: 388.31 (a) Except as provided in paragraph (b), this section 388.32 applies to any long-term care policy issued in this state on or 388.33 after the effective date of this section. 388.34 (b) For certificates issued on or after the effective date 388.35 of this section, under a group long-term care insurance policy 388.36 that was in force on the effective date of this section, the 389.1 provisions of this section do not apply. 389.2 Subd. 9. [EFFECT ON LOSS RATIO.] Premiums charged for a 389.3 policy or certificate containing nonforfeiture benefits or a 389.4 contingent benefit on lapse are subject to the loss ratio 389.5 requirements of section 62A.48, subdivision 4, or 62S.26, 389.6 treating the policy as a whole, except for policies or 389.7 certificates that are subject to sections 62S.021, 62S.081, and 389.8 62S.265 and that comply with those sections. 389.9 Subd. 10. [PURCHASED BLOCKS OF BUSINESS.] To determine 389.10 whether contingent nonforfeiture upon lapse provisions are 389.11 triggered under subdivision 4, paragraph (c), a replacing 389.12 insurer that purchased or otherwise assumed a block or blocks of 389.13 long-term care insurance policies from another insurer shall 389.14 calculate the percentage increase based on the initial annual 389.15 premium paid by the insured when the policy was first purchased 389.16 from the original insurer. 389.17 Subd. 11. [LEVEL PREMIUM CONTRACTS.] A nonforfeiture 389.18 benefit for qualified long-term care insurance contracts that 389.19 are level premium contracts must be offered that meets the 389.20 following requirements: 389.21 (1) the nonforfeiture provision must be appropriately 389.22 captioned; 389.23 (2) the nonforfeiture provision must provide a benefit 389.24 available in the event of a default in the payment of any 389.25 premiums and must state that the amount of the benefit may be 389.26 adjusted subsequent to being initially granted only as necessary 389.27 to reflect changes in claims, persistency, and interest as 389.28 reflected in changes in rates for premium paying contracts 389.29 approved by the commissioner for the same contract form; and 389.30 (3) the nonforfeiture provision must provide at least one 389.31 of the following: 389.32 (i) reduced paid-up insurance; 389.33 (ii) extended term insurance; 389.34 (iii) shortened benefit period; or 389.35 (iv) other similar offerings approved by the commissioner. 389.36 [EFFECTIVE DATE.] This section is effective the day 390.1 following final enactment. 390.2 Sec. 13. Minnesota Statutes 2000, section 256.975, is 390.3 amended by adding a subdivision to read: 390.4 Subd. 8. [PROMOTION OF LONG-TERM CARE INSURANCE.] The 390.5 Minnesota board on aging, either directly or through contract, 390.6 shall promote the provision of employer-sponsored, long-term 390.7 care insurance. The board shall encourage private and public 390.8 sector employers to make long-term care insurance available to 390.9 employees, provide interested employers with information on the 390.10 long-term care insurance product offered to state employees, and 390.11 provide technical assistance to employers in designing long-term 390.12 care insurance products and contacting companies offering 390.13 long-term care insurance products. 390.14 Sec. 14. [256B.0571] [LONG-TERM CARE PARTNERSHIP.] 390.15 Subdivision 1. [DEFINITIONS.] For purposes of this 390.16 section, the following terms have the meanings given them. 390.17 (a) "Home care service" means care described in section 390.18 144A.43. 390.19 (b) "Long-term care insurance" means a policy described in 390.20 section 62S.01. 390.21 (c) "Medical assistance" means the program of medical 390.22 assistance established under section 256B.01. 390.23 (d) "Nursing home" means nursing home as described in 390.24 section 144A.01. 390.25 (e) "Partnership policy" means a long-term care insurance 390.26 policy that meets the requirements under chapter 62S. 390.27 (f) "Partnership program" means the Minnesota partnership 390.28 for long-term care program established under this section. 390.29 Subd. 2. [PARTNERSHIP PROGRAM.] (a) Subject to federal 390.30 waiver approval, the commissioner of human services, along with 390.31 the commissioner of commerce, shall establish the Minnesota 390.32 partnership for long-term care program to provide for the 390.33 financing of long-term care through a combination of private 390.34 insurance and medical assistance. 390.35 (b) An individual who meets the requirements in paragraph 390.36 (c) is eligible to participate in the partnership program. 391.1 (c) The individual must: 391.2 (1) be a Minnesota resident; 391.3 (2) purchase a partnership policy that is delivered, issued 391.4 for delivery, or renewed on or after the effective date of this 391.5 section, and maintains the partnership policy in effect 391.6 throughout the period of participation in the partnership 391.7 program; and 391.8 (3) exhaust the minimum benefits under the partnership 391.9 policy as described in this section. Benefits received under a 391.10 long-term care insurance policy before the effective date of 391.11 this section do not count toward the exhaustion of benefits 391.12 required in this subdivision. 391.13 Subd. 3. [MEDICAL ASSISTANCE ELIGIBILITY.] (a) Upon 391.14 application of an individual who meets the requirements 391.15 described in subdivision 2, the commissioner of human services 391.16 shall determine the individual's eligibility for medical 391.17 assistance according to paragraphs (b) and (c). 391.18 (b) After disregarding financial assets exempted under 391.19 medical assistance eligibility requirements, the department 391.20 shall disregard an additional amount of financial assets equal 391.21 to the dollar amount of coverage under the partnership policy. 391.22 (c) The department shall consider the individual's income 391.23 according to medical assistance eligibility requirements. 391.24 Subd. 4. [FEDERAL APPROVAL.] (a) The commissioner of human 391.25 services shall seek appropriate amendments to the medical 391.26 assistance state plan and shall apply for any necessary waiver 391.27 of medical assistance requirements by the federal Health Care 391.28 Financing Administration to implement the partnership program. 391.29 The state shall not implement the partnership program unless the 391.30 provisions in paragraphs (b) and (c) apply. 391.31 (b) The commissioner shall seek any necessary federal 391.32 waiver of medical assistance requirements. 391.33 (c) Individuals who receive medical assistance under this 391.34 section are exempt from estate recovery requirements under 391.35 section 1917, title XIX of the federal Social Security Act, 391.36 United States Code, title 42, section 1396p. 392.1 Subd. 5. [APPROVED POLICIES.] (a) A partnership policy 392.2 must meet all of the requirements in paragraphs (b) to (h). 392.3 (b) Minimum coverage shall be for a period of not less than 392.4 three years and for a dollar amount equal to 36 months of 392.5 nursing home care at the minimum daily benefit rate determined 392.6 and adjusted under paragraph (c). The policy shall provide for 392.7 home health care benefits to be substituted for nursing home 392.8 care benefits on the basis of two home health care days for one 392.9 nursing home care day. 392.10 (c) Minimum daily benefits shall be $130 for nursing home 392.11 care or $65 for home care. These minimum daily benefit amounts 392.12 shall be adjusted by the department on October 1 of each year, 392.13 based on the health care index used under medical assistance for 392.14 nursing home rate setting. Adjusted minimum daily benefit 392.15 amounts shall be rounded to the nearest whole dollar. 392.16 (d) The insured shall be entitled to designate a third 392.17 party to receive notice if the policy is about to lapse for 392.18 nonpayment of premium, and an additional 30-day grace period for 392.19 payment of premium shall be granted following notification to 392.20 that person. 392.21 (e) The policy must cover all of the following services: 392.22 (1) nursing home stay; 392.23 (2) home care service; 392.24 (3) care management; and 392.25 (4) up to 14 days of nursing care in a hospital while the 392.26 individual is waiting for long-term care placement. 392.27 (f) Payment for service under paragraph (e), clause (4), 392.28 must not exceed the daily benefit amount for nursing home care. 392.29 (g) A partnership policy must offer both options in 392.30 paragraph (h) for an adjusted premium. 392.31 (h) The options are: 392.32 (1) an elimination period of not more than 100 days; and 392.33 (2) nonforfeiture benefits for applicants between the ages 392.34 of 18 and 75. 392.35 ARTICLE 9 392.36 MENTAL HEALTH AND CIVIL COMMITMENT 393.1 Section 1. [145.56] [SUICIDE PREVENTION.] 393.2 Subdivision 1. [PUBLIC HEALTH GOAL; SUICIDE PREVENTION 393.3 PLAN.] The commissioner of health shall make suicide prevention 393.4 an important public health goal of the state and shall conduct 393.5 suicide prevention activities to accomplish that goal using an 393.6 evidence-based, public health approach focused on prevention. 393.7 The commissioner shall refine, coordinate, and implement the 393.8 state's suicide prevention plan, in collaboration with assigned 393.9 staff from the department of human services; the department of 393.10 public safety; the department of children, families, and 393.11 learning; and appropriate agencies, organizations, and 393.12 institutions in the community. 393.13 Subd. 2. [COMMUNITY-BASED PROGRAMS.] (a) The commissioner 393.14 shall establish a grant program consistent with the policy goals 393.15 of this section to fund: 393.16 (1) community-based programs to provide education, 393.17 outreach, and advocacy services to populations who may be at 393.18 risk for suicide; 393.19 (2) community-based programs that educate natural community 393.20 helpers and gatekeepers, such as family members, spiritual 393.21 leaders, coaches, and business owners, employers, and coworkers, 393.22 on how to prevent suicide by encouraging help-seeking behaviors; 393.23 and 393.24 (3) community-based programs to provide evidence-based 393.25 suicide prevention and intervention education to school staff, 393.26 parents, and students in kindergarten through grade 12. 393.27 (b) Education to populations at risk for suicide and to 393.28 community helpers and gatekeepers must include information on 393.29 the symptoms of depression and other psychiatric illnesses, the 393.30 warning signs of suicide, skills for preventing suicides, and 393.31 making or seeking effective referrals to intervention and 393.32 community resources. 393.33 Subd. 3. [WORKPLACE AND PROFESSIONAL EDUCATION.] (a) The 393.34 commissioner shall promote the use of employee assistance and 393.35 workplace programs to support employees with depression and 393.36 other psychiatric illnesses and substance abuse disorders, and 394.1 refer them to services. In promoting these programs, the 394.2 commissioner shall collaborate with employer and professional 394.3 associations, unions, and safety councils. 394.4 (b) The commissioner shall provide training and technical 394.5 assistance to local public health and other community-based 394.6 professionals to provide for integrated implementation of best 394.7 practices for preventing suicides. 394.8 Subd. 4. [COLLECTING AND REPORTING SUICIDE DATA.] The 394.9 commissioner shall coordinate with federal, regional, local, and 394.10 other state agencies to collect, analyze, and annually issue a 394.11 public report on Minnesota-specific data on suicide and suicidal 394.12 behaviors. 394.13 Subd. 5. [PERIODIC EVALUATIONS; BIENNIAL REPORTS.] The 394.14 commissioner shall conduct periodic evaluations of the impact of 394.15 and outcomes from implementation of the state's suicide 394.16 prevention plan and each of the activities specified in this 394.17 section. By July 1, 2002, and July 1 of each even-numbered year 394.18 thereafter, the commissioner shall report the results of these 394.19 evaluations to the chairs of the policy and finance committees 394.20 in the house and senate with jurisdiction over health and human 394.21 services issues. 394.22 Sec. 2. Minnesota Statutes 2000, section 245.462, 394.23 subdivision 8, is amended to read: 394.24 Subd. 8. [DAY TREATMENT SERVICES.] "Day treatment," "day 394.25 treatment services," or "day treatment program" means a 394.26 structured program of treatment and care provided to an adult in 394.27 or by: (1) a hospital accredited by the joint commission on 394.28 accreditation of health organizations and licensed under 394.29 sections 144.50 to 144.55; (2) a community mental health center 394.30 under section 245.62; or (3) an entity that is under contract 394.31 with the county board to operate a program that meets the 394.32 requirements of section 245.4712, subdivision 2, and Minnesota 394.33 Rules, parts 9505.0170 to 9505.0475. Day treatment consists of 394.34 group psychotherapy and other intensive therapeutic services 394.35 that are provided at least one day a week by a multidisciplinary 394.36 staff under the clinical supervision of a mental health 395.1 professional. Day treatment may include education and 395.2 consultation provided to families and other individuals as part 395.3 of the treatment process. The services are aimed at stabilizing 395.4 the adult's mental health status, providing mental health 395.5 services, and developing and improving the adult's independent 395.6 living and socialization skills. The goal of day treatment is 395.7 to reduce or relieve mental illness and to enable the adult to 395.8 live in the community. Day treatment services are not a part of 395.9 inpatient or residential treatment services. Day treatment 395.10 services are distinguished from day care by their structured 395.11 therapeutic program of psychotherapy services. The commissioner 395.12 may limit medical assistance reimbursement for day treatment to 395.13 15 hours per week per person instead of the three hours per day 395.14 per person specified in Minnesota Rules, part 9505.0323, subpart 395.15 15. 395.16 Sec. 3. Minnesota Statutes 2000, section 245.462, 395.17 subdivision 18, is amended to read: 395.18 Subd. 18. [MENTAL HEALTH PROFESSIONAL.] "Mental health 395.19 professional" means a person providing clinical services in the 395.20 treatment of mental illness who is qualified in at least one of 395.21 the following ways: 395.22 (1) in psychiatric nursing: a registered nurse who is 395.23 licensed under sections 148.171 to 148.285, and who is certified 395.24 as a clinical specialist in adult psychiatric and mental health 395.25 nursing by a national nurse certification organization or who 395.26 has a master's degree in nursing or one of the behavioral 395.27 sciences or related fields from an accredited college or 395.28 university or its equivalent, with at least 4,000 hours of 395.29 post-master's supervised experience in the delivery of clinical 395.30 services in the treatment of mental illness; 395.31 (2) in clinical social work: a person licensed as an 395.32 independent clinical social worker under section 148B.21, 395.33 subdivision 6, or a person with a master's degree in social work 395.34 from an accredited college or university, with at least 4,000 395.35 hours of post-master's supervised experience in the delivery of 395.36 clinical services in the treatment of mental illness; 396.1 (3) in psychology:a psychologistan individual licensed 396.2 by the board of psychology under sections 148.88 to 148.98 who 396.3 has stated to the board of psychology competencies in the 396.4 diagnosis and treatment of mental illness; 396.5 (4) in psychiatry: a physician licensed under chapter 147 396.6 and certified by the American board of psychiatry and neurology 396.7 or eligible for board certification in psychiatry; 396.8 (5) in marriage and family therapy: the mental health 396.9 professional must be a marriage and family therapist licensed 396.10 under sections 148B.29 to 148B.39 with at least two years of 396.11 post-master's supervised experience in the delivery of clinical 396.12 services in the treatment of mental illness; or 396.13 (6) in allied fields: a person with a master's degree from 396.14 an accredited college or university in one of the behavioral 396.15 sciences or related fields, with at least 4,000 hours of 396.16 post-master's supervised experience in the delivery of clinical 396.17 services in the treatment of mental illness. 396.18 Sec. 4. Minnesota Statutes 2000, section 245.462, is 396.19 amended by adding a subdivision to read: 396.20 Subd. 25a. [SIGNIFICANT IMPAIRMENT IN FUNCTIONING.] 396.21 "Significant impairment in functioning" means a condition, 396.22 including significant suicidal ideation or thoughts of harming 396.23 self or others, which harmfully affects, recurrently or 396.24 consistently, a person's activities of daily living in 396.25 employment, housing, family, and social relationships, or 396.26 education. 396.27 Sec. 5. Minnesota Statutes 2000, section 245.4871, 396.28 subdivision 10, is amended to read: 396.29 Subd. 10. [DAY TREATMENT SERVICES.] "Day treatment," "day 396.30 treatment services," or "day treatment program" means a 396.31 structured program of treatment and care provided to a child in: 396.32 (1) an outpatient hospital accredited by the joint 396.33 commission on accreditation of health organizations and licensed 396.34 under sections 144.50 to 144.55; 396.35 (2) a community mental health center under section 245.62; 396.36 (3) an entity that is under contract with the county board 397.1 to operate a program that meets the requirements of section 397.2 245.4884, subdivision 2, and Minnesota Rules, parts 9505.0170 to 397.3 9505.0475; or 397.4 (4) an entity that operates a program that meets the 397.5 requirements of section 245.4884, subdivision 2, and Minnesota 397.6 Rules, parts 9505.0170 to 9505.0475, that is under contract with 397.7 an entity that is under contract with a county board. 397.8 Day treatment consists of group psychotherapy and other 397.9 intensive therapeutic services that are provided for a minimum 397.10 three-hour time block by a multidisciplinary staff under the 397.11 clinical supervision of a mental health professional. Day 397.12 treatment may include education and consultation provided to 397.13 families and other individuals as an extension of the treatment 397.14 process. The services are aimed at stabilizing the child's 397.15 mental health status, and developing and improving the child's 397.16 daily independent living and socialization skills. Day 397.17 treatment services are distinguished from day care by their 397.18 structured therapeutic program of psychotherapy services. Day 397.19 treatment services are not a part of inpatient hospital or 397.20 residential treatment services. Day treatment services for a 397.21 child are an integrated set of education, therapy, and family 397.22 interventions. 397.23 A day treatment service must be available to a child at 397.24 least five days a week throughout the year and must be 397.25 coordinated with, integrated with, or part of an education 397.26 program offered by the child's school. 397.27 Sec. 6. Minnesota Statutes 2000, section 245.4871, 397.28 subdivision 27, is amended to read: 397.29 Subd. 27. [MENTAL HEALTH PROFESSIONAL.] "Mental health 397.30 professional" means a person providing clinical services in the 397.31 diagnosis and treatment of children's emotional disorders. A 397.32 mental health professional must have training and experience in 397.33 working with children consistent with the age group to which the 397.34 mental health professional is assigned. A mental health 397.35 professional must be qualified in at least one of the following 397.36 ways: 398.1 (1) in psychiatric nursing, the mental health professional 398.2 must be a registered nurse who is licensed under sections 398.3 148.171 to 148.285 and who is certified as a clinical specialist 398.4 in child and adolescent psychiatric or mental health nursing by 398.5 a national nurse certification organization or who has a 398.6 master's degree in nursing or one of the behavioral sciences or 398.7 related fields from an accredited college or university or its 398.8 equivalent, with at least 4,000 hours of post-master's 398.9 supervised experience in the delivery of clinical services in 398.10 the treatment of mental illness; 398.11 (2) in clinical social work, the mental health professional 398.12 must be a person licensed as an independent clinical social 398.13 worker under section 148B.21, subdivision 6, or a person with a 398.14 master's degree in social work from an accredited college or 398.15 university, with at least 4,000 hours of post-master's 398.16 supervised experience in the delivery of clinical services in 398.17 the treatment of mental disorders; 398.18 (3) in psychology, the mental health professional must bea398.19psychologistan individual licensed by the board of psychology 398.20 under sections 148.88 to 148.98 who has stated to the board of 398.21 psychology competencies in the diagnosis and treatment of mental 398.22 disorders; 398.23 (4) in psychiatry, the mental health professional must be a 398.24 physician licensed under chapter 147 and certified by the 398.25 American board of psychiatry and neurology or eligible for board 398.26 certification in psychiatry; 398.27 (5) in marriage and family therapy, the mental health 398.28 professional must be a marriage and family therapist licensed 398.29 under sections 148B.29 to 148B.39 with at least two years of 398.30 post-master's supervised experience in the delivery of clinical 398.31 services in the treatment of mental disorders or emotional 398.32 disturbances; or 398.33 (6) in allied fields, the mental health professional must 398.34 be a person with a master's degree from an accredited college or 398.35 university in one of the behavioral sciences or related fields, 398.36 with at least 4,000 hours of post-master's supervised experience 399.1 in the delivery of clinical services in the treatment of 399.2 emotional disturbances. 399.3 Sec. 7. Minnesota Statutes 2000, section 245.4876, 399.4 subdivision 1, is amended to read: 399.5 Subdivision 1. [CRITERIA.] Children's mental health 399.6 services required by sections 245.487 to 245.4888 must be: 399.7 (1) based, when feasible, on research findings; 399.8 (2) based on individual clinical, cultural, and ethnic 399.9 needs, and other special needs of the children being served; 399.10 (3) delivered in a manner that improves family functioning 399.11 when clinically appropriate; 399.12 (4) provided in the most appropriate, least restrictive 399.13 setting that meets the requirements in subdivision 1a, and that 399.14 is available to the county board to meet the child's treatment 399.15 needs; 399.16 (5) accessible to all age groups of children; 399.17 (6) appropriate to the developmental age of the child being 399.18 served; 399.19 (7) delivered in a manner that provides accountability to 399.20 the child for the quality of service delivered and continuity of 399.21 services to the child during the years the child needs services 399.22 from the local system of care; 399.23 (8) provided by qualified individuals as required in 399.24 sections 245.487 to 245.4888; 399.25 (9) coordinated with children's mental health services 399.26 offered by other providers; 399.27 (10) provided under conditions that protect the rights and 399.28 dignity of the individuals being served; and 399.29 (11) provided in a manner and setting most likely to 399.30 facilitate progress toward treatment goals. 399.31 Sec. 8. Minnesota Statutes 2000, section 245.4876, is 399.32 amended by adding a subdivision to read: 399.33 Subd. 1a. [APPROPRIATE SETTING TO RECEIVE SERVICES.] A 399.34 child must be provided with mental health services in the least 399.35 restrictive setting that is appropriate to the needs and current 399.36 condition of the individual child. For a child to receive 400.1 mental health services in a residential treatment or acute care 400.2 hospital inpatient setting, the family may not be required to 400.3 demonstrate that services were first provided in a less 400.4 restrictive setting and that the child failed to make progress 400.5 toward or meet treatment goals in the less restrictive setting. 400.6 Sec. 9. Minnesota Statutes 2000, section 245.4885, 400.7 subdivision 1, is amended to read: 400.8 Subdivision 1. [SCREENING REQUIRED.] The county board 400.9 shall, prior to admission, except in the case of emergency 400.10 admission, screen all children referred for treatment of severe 400.11 emotional disturbance to a residential treatment facility or 400.12 informally admitted to a regional treatment center if public 400.13 funds are used to pay for the services. The county board shall 400.14 also screen all children admitted to an acute care hospital for 400.15 treatment of severe emotional disturbance if public funds other 400.16 than reimbursement under chapters 256B and 256D are used to pay 400.17 for the services. If a child is admitted to a residential 400.18 treatment facility or acute care hospital for emergency 400.19 treatment or held for emergen